Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats ....Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats and to begin to extend this knowledge to humans. This work will generate new knowledge about a vital function. The insights obtained will inform and guide future strategies in aged care, intensive care and perioperative care.Read moreRead less
It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible t ....It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible to further cognitive decline after anaesthesia and surgery. In order to explore the relationship between preoperative cognitive function and postoperative cognitive decline we plan to measure cognition in patients scheduled for elective hip replacement surgery. This is done by asking patients to complete a standard battery of cognitive tests. We will be then able to identify those patients who already have mild cognitive impairment before surgery and by repeated testing after the operation will be able to demonstrate if preoperative cognitive status is a determinant of postoperative cognitive dysfunction. The primary aim of the research is to test whether cognitive impairment before surgery leads to cognitive deficit after surgery in patients over the age of 65 undergoing total hip replacement surgery. The study will also establish the prevalence of pre-operative mild cognitive impairment and the magnitude of postoperative cognitive dysfunction after surgery in this patient group. The study will explore the relationship between preoperative cognitive status and postoperative cognitive deficit , providing information about the incidence, natural history and risk factors of postoperative cognitive deficit. This work will enable further research to isolate specific causative factors and identify therapeutic and prophylactic strategies.Read moreRead less
PREOPERATIVE RISK FACTORS, ADVERSE OUTCOMES AND EFFECTS OF EPIDURAL AND SPINAL ANAESTHESIA
Funder
National Health and Medical Research Council
Funding Amount
$66,110.00
Summary
Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. P ....Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. Providing clear answers to both questions requires careful analysis of large amounts of data in which systematic and random errors have been minimised. Databases from well-designed and supervised clinical trials represent an invaluable resource in this regard because they have been compiled through the rigorous application of unambiguous definitions and protocols during the process of recording, coding and entering the information. By bringing together the resources and expertise of the MASTER Trial group and the Collaborative Overview of Randomised of Trials of Regional Anaesthesia (CORTRA), both of which are major international projects led from the Australasian region, we have a unique opportunity to provide exceptionally robust answers to some of the most challenging issues in anaesthesia. The combined study of two large international databases will provide a more precise quantitative analysis of the components of preoperative risk and their relationship to life threatening post operative complications, and the possible role of epidural and spinal anaesthesia in minimising risk by reducing the frequency of these complications.Read moreRead less
Clinical Feasibility Study Of Omega-3 PUFA Therapy For The Reduction Of Post-cardiac Surgery Atrial Arrhythmias
Funder
National Health and Medical Research Council
Funding Amount
$442,092.00
Summary
The aim of this study is to determine the molecular and clinical impact of omega-3 polyunsaturated fatty acids (PUFA) pre-treatment 2 weeks before cardiac surgery in 150 patients. The outcome of this proposal will indicate proof of molecular concepts, clinical feasibility and specific design elements of a future, large scale, placebo controlled, prospective randomised trial of oral therapy with omega-3 polyunsaturated fatty acids (PUFA). Recently, omega-3 PUFA via fish diet was reported to be li ....The aim of this study is to determine the molecular and clinical impact of omega-3 polyunsaturated fatty acids (PUFA) pre-treatment 2 weeks before cardiac surgery in 150 patients. The outcome of this proposal will indicate proof of molecular concepts, clinical feasibility and specific design elements of a future, large scale, placebo controlled, prospective randomised trial of oral therapy with omega-3 polyunsaturated fatty acids (PUFA). Recently, omega-3 PUFA via fish diet was reported to be linked to low incidence of AF. The main aim is to provide a cheap and safe preventative therapy against post-operative atrial fibrillation (AF), a key heart rhythm disorder that occurs in at least 1 in 4 patients after heart surgery and increases post-operative complications, limits recovery and increases hospital stay and cost. Biochemical study elements are important to gain valuable insight into the molecular mechanisms (directly in human heart) that underlie post-operative heart rhythm disorder and may delineate new more precise molecular targets for therapy. No previous clinical study has ever examined whether omega-3 PUFA therapy prevents post-operative heart rhythm disorder. Use of 3g-day omega-3 PUFA pre-treatment in the surgical setting has been shown to be safe in a number of small studies, including our own. Our preliminary data indicates that therapy increases heart and blood content of omega-3 PUFA ~2-fold, and reduces the incidence of AF. Post-operative AF is an expensive resource burden in all cardiothoracic surgery units of Australian hospitals and targets key health priorities. Due to the non-patentable nature of omega-3 PUFA, significant industry based support for clinical research is limited. A positive outcome would rapidly pave the way for widespread use in elective surgery. Reduced length of hospital stay, cost-savings, and the increase in productivity as healthy individuals return to their communities would nationally repay the investment many fold.Read moreRead less
ANTIPODES The Australian National Trial Investigating Post-Operative Deficit, Early Extubation And Survival
Funder
National Health and Medical Research Council
Funding Amount
$370,509.00
Summary
Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after t ....Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after the operation, have given strong indications that they may also cause less brain damage. We plan to test this aspect of modern anaesthesia, by comparing the results of tests for brain damage after anaesthesia that has been given by traditional methods and the recent method which allows patients to wake up quickly.Read moreRead less
Palliative Care In Aged Care Facilities For Residents With A Non-cancer Diagnosis
Funder
National Health and Medical Research Council
Funding Amount
$70,000.00
Summary
Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any ....Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any unmet needs can be addressed.Read moreRead less
The Impact Of Hospital-based Aged Care And Dementia Services On Outcomes For People With Dementia Admitted To Hospital-a
Funder
National Health and Medical Research Council
Funding Amount
$1,308,580.00
Summary
This research explores how hospital based aged care and dementia services influence outcomes for people with dementia who are admitted to hospital. Using detailed data for NSW public hospitals, it will provide information about the kinds of hospital based aged care and dementia services available to assist people with dementia, and how the level and mix of these services is associated with different patient outcomes, including lower rates of admission to hospital. There is considerable evidence ....This research explores how hospital based aged care and dementia services influence outcomes for people with dementia who are admitted to hospital. Using detailed data for NSW public hospitals, it will provide information about the kinds of hospital based aged care and dementia services available to assist people with dementia, and how the level and mix of these services is associated with different patient outcomes, including lower rates of admission to hospital. There is considerable evidence that there are many hazards for people with dementia when they are hospitalized. The project will result in recommendations about the types of services and their features which produce better outcomes for people with dementia. Every stage of the research will be guided and informed by an Expert Panel comprising representatives of dementia service consumers, aged care providers, health service planning staff and key researchers. The Panel will provide contextual information about the service environment and how it affects people with dementia. Details of the patient's complete hospital stay can be investigated by linking existing administrative datasets. Data about hospital services will be gathered through a census of NSW hospitals, supplemented with in-depth interviews with key stakeholders and small group expert discussions with experts in each Area Health Service. The research team will also visit selected hospital sites. Multilevel modelling techniques will test for statistical associations between hospital based dementia services and care outcomes including admission rates to hospital, total length of hospital stay, mortality, admission rates to hospital, and the level of patient dependency on entry to residential aged care. The model will include the influence of regional variations in the provision of community aged care packages and residential aged care and the availability of informal care. The project will include a focus on the outcomes for people with co-morbidities and for people from different culturally and linguistically diverse backgrounds.Read moreRead less
The Enhanced Advance Care Planning And Life Review Longitudinal Intervention (EARLI) Study: Increasing Proactive Care Planning In Australian Community Aged Care Settings
Funder
National Health and Medical Research Council
Funding Amount
$955,828.00
Summary
The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) project will proactively screen older adults at high-risk of health decline and provide assistance to discuss and document preferences for future care. The intervention is implemented in the community aged care setting, through partnerships with home care providers. Expected benefits include increased rates of advance care planning, higher quality documents and improved wellbeing among older adults and carers.