The Impact Of Evidence Based Guidelines And Standardisation Of Clinical Practice Upon Patient Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$32,003.00
Summary
Over the last decade there has been a significant move toward evidence based clinical care and clinical guidelines in medical care. Despite this movement there are numerous clinical situations where evidence for any treatment is scant and where large gaps between the evidence and current practice exist. My research seeks to explore the barriers that exist in the health system that impede the uptake of evidence into practice and methods to improve patient outcomes where the evidence is poor.
Development Of National Protocols For The Detection Of Influenza A H5N1
Funder
National Health and Medical Research Council
Funding Amount
$248,229.00
Summary
This project will develop a best practice approach to the diagnosis of influenza A H5N1 (Bird Flu) in Australian public health laboratories. Tests such as reverse transcription polymerase chain reaction (RT-PCR) are in use globally for influenza A H5N1 detection. Some proprietary rapid influenza A tests also claim to detect influenza A H5N1. However there is little information on systematic evaluation of these, largely because there have been relatively few human influenza A H5N1 cases and patie ....This project will develop a best practice approach to the diagnosis of influenza A H5N1 (Bird Flu) in Australian public health laboratories. Tests such as reverse transcription polymerase chain reaction (RT-PCR) are in use globally for influenza A H5N1 detection. Some proprietary rapid influenza A tests also claim to detect influenza A H5N1. However there is little information on systematic evaluation of these, largely because there have been relatively few human influenza A H5N1 cases and patient specimens. Australian laboratories need authoritative guidelines as to optimal influenza tests, target genes and reagents. Development of a simple, potentially automated type specific test for influenza A H5N1 antibody such as enzyme immunoassay (EIA) is also desirable, as widely used tests cannot distinguish between infection with H5 or other influenza types. Reference methods such as haemagglutination inhibition (HAI) are cumbersome. In this project mock specimens for virus and antibody detection will be created using viral cell culture and infected chicken derived influenza A H5N1. This will be undertaken in physical containment level 4 (PC4) facilities in Australia's designated human and animal PC4 laboratories. This material will be used for (i) specimen panels to compare the performance of candidate laboratory tests (ii) positive control material in all tests undertaken and (iii) quality assurance exercises to ensure high standards of testing. Using these panels the group will assess influenza H5N1 RT-PCR, tests for detection of influenza proteins including immunofluorescence, and rapid point of care influenza A detection tests available in Australia. An EIA method currently used to detect influenza antibodies from different animal species will be refined to develop a simple test for type specific detection influenza A H5N1 antibodies, and subsequently evaluated using animal sera. A standard method for HAI reference serology for use in public health laboratories will also be recommended, and the best approaches to high throughput automated RT-PCR, and performing RT-PCR in the field on portable instrumentation will be explored. Recommendations for standard protocols for influenza A H5N1 will be developed and will submitted for review and endorsement by Commonwealth ministerial advisory committees.Read moreRead less
Pushing And Pulling Evidence Into Practice: Implementing Best Practices In Upper Limb Movement Therapy After Acquired Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$178,157.00
Summary
Acquired Brain Injury (ABI) is the leading cause of disability in adults in Australia. After ABI, many people are unable to use their upper limb (UL) to perform important, everyday tasks. While there is research evidence which has shown that movement therapy targeted at the UL will improve the likelihood of being able to use the UL after rehabilitation, many therapists do not currently provide sufficient UL movement therapy to patients. This practice gap will be addressed in this project.
Methods For Evaluating The Therapeutic Impact Of Diagnostic Tests - Development Of Guidelines
Funder
National Health and Medical Research Council
Funding Amount
$132,325.00
Summary
New diagnostic tests are frequently adopted in clinical practice without any evidence that they improve patient outcomes. This project will produce the first guidelines about the role and optimal design of studies assessing the impact of a new test on therapeutic decisions for conclusions about its clinical value. This work will inform researchers and clinicians to improve evidence-based diagnostic practice and promote the more efficient use of limited health care resources.
Multicentre Evaluation Of A Clinical Pathway For Chronic Cough In Children- Can Its Use Improve Clinical Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$971,362.00
Summary
Chronic cough is a common presenting symptom to doctors. It is associated with significant morbidity and may be a symptom of a serious underlying problem. This is especially pertinent to Aboriginal children. In this study we will examine the utility and efficacy of an evidence based clinical pathway for the management of chronic cough in Aboriginal and non-Aboriginal children. This study will contribute to clinical policy and improve clinical outcomes and early diagnosis of respiratory illnesses
CRCT Of A Multidisciplinary, Team Building Intervention To Manage Fever, Sugar And Swallowing (FeSS) In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$405,450.00
Summary
The latest acute stroke guidelines and recommendations from Ausralia's National Stroke Unit Program endorse a prompt and evidence-based treatment for fever, blood sugar and swallowing in acute stroke. This Clustered Randomised Control Trial (CRCT) will develop and rigorously evaluate a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. The intervention comprises: an evidence-based clinical treatme ....The latest acute stroke guidelines and recommendations from Ausralia's National Stroke Unit Program endorse a prompt and evidence-based treatment for fever, blood sugar and swallowing in acute stroke. This Clustered Randomised Control Trial (CRCT) will develop and rigorously evaluate a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. The intervention comprises: an evidence-based clinical treatment pathway (the FeSS Pathway) and facility-based support consisting of multidisciplinary, team building workshops, a standardised, interactive education program and engagement of local staff through support and feedback. Stroke Units allocated to the control group will receive only the FeSS Pathway with no facility-based support. Expected patient outcomes comprise decreased: disability on discharge, length of stay, 90-day disability, 90-day dependency, 90-day death and disability and higher 90-day health status for those patients allocated to receive care at intervention Stroke Units. Further, medical record audits will be undertaken to measure the integrity of the FeSS Pathway uptake. By conducting a CRCT, we will generate Level 2 evidence for the effectiveness of a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. Thus, this trial is highly significant both within Australia and internationally.Read moreRead less
Health Care In The Round: Building Capacity For Integrated Decision-making For Improving Health Services.
Funder
National Health and Medical Research Council
Funding Amount
$2,156,378.00
Summary
Our title, ‘Healthcare in the round’, reflects two key perspectives on improving health services. First, we wish to ‘close the loop’ between the introduction of an innovation and measuring its uptake and impact. Second, we are seeking to explore how decisions about health services might be ‘rounded out’ if the ethical dimensions, economic implications and community’s views on what is being proposed were routinely considered in deciding what changes to make to existing patterns of care.