A Randomised Control Trial Of A Group-Based Intervention For Substance Abuse In Psychosis.
Funder
National Health and Medical Research Council
Funding Amount
$345,250.00
Summary
The use of alcohol and illicit substances is common amongst people with psychotic illnesses, and is associated with a poor outcome in terms of severity of symptoms, treatment adherence, work-studies, family cohesion, aggression and quality of life. All this adds significantly to the cost of mental health services and society more broadly. The proposed study aims to refine, pilot, and rigorously evaluate a group-based intervention that targets substance use in such individuals at different stages ....The use of alcohol and illicit substances is common amongst people with psychotic illnesses, and is associated with a poor outcome in terms of severity of symptoms, treatment adherence, work-studies, family cohesion, aggression and quality of life. All this adds significantly to the cost of mental health services and society more broadly. The proposed study aims to refine, pilot, and rigorously evaluate a group-based intervention that targets substance use in such individuals at different stages of their illness, and within a number of different treatment settings. The intervention will be informed by an enhanced understanding of the motivations for substance use in people with psychotic illnesses The specific aims are to: Refine, implement and evaluate, using a controlled experimental design, a novel group-based intervention for reducing substance abuse comorbidity in people with psychotic disorders; Determine reasons for substance use by these individuals, to inform the intervention procedures; Pilot the intervention in a series of different treatment settings, including early episode and rehabilitation programs, and non-government organisations dealing with people with psychotic disorders, to ensure generalisability, adaptability, and acceptability; Augment case managers' knowledge and skills in dealing with comorbid drug and alcohol use Enhance detection, motivation to change, ongoing monitoring and relapse prevention of substance misuse in clients with psychotic disorders. It will also be possible, once the treatment intervention is finalised and evaluated, to expand its use to patients with non-psychotic mental illnesses.Read moreRead less
Randomised Control Trial Of Three Treatments For Adolescent Stutterers
Funder
National Health and Medical Research Council
Funding Amount
$376,320.00
Summary
Effective communication is an essential of everyday life, and stuttering impairs this function. Those who stutter may find effective communication impossible, and severe cases may be rendered almost mute. Clinically significant anxiety figures prominently in the disorder with almost half of those seeking treatment warranting a comorbid diagnosis of social phobia. The adolescent years are generally regarded as a difficult time of life, at which time the potential effects of disfigured speech can ....Effective communication is an essential of everyday life, and stuttering impairs this function. Those who stutter may find effective communication impossible, and severe cases may be rendered almost mute. Clinically significant anxiety figures prominently in the disorder with almost half of those seeking treatment warranting a comorbid diagnosis of social phobia. The adolescent years are generally regarded as a difficult time of life, at which time the potential effects of disfigured speech can be devastating. There has been much research and development of treatments for children and adults who stutter, proven effective treatments are available for those age groups. However, little is known about how to treat adolescents who stutter, and there has been little research and development to find the best treatment-s for this age group. The present proposal is for a randomised, controlled trial of three treatments that have been shown recently to have promise as treatment methods for this age group of patients. The trial will compare (1) a treatment that involves biofeedback muscle activity during speech, (2) a treatment that involves biofeedback of voice box activity during speech, and (3) a variant of a standard treatment that trains the speaker in a new speech pattern. The control group will receive no treatment. The trial extends for a period of 12 months after the subjects are randomly allocated to a treatment group or a control group. The subjects' speech will be assessed in a variety of situations in the clinic and during everyday life. The prime outcome measure will be percentage of syllables stuttered, and secondary measures will be the time required for treatment and how natural the patients sound after treatment. At the conclusion of the trial, the subjects in the control group will be given the treatment that was shown to be most effective.Read moreRead less
A Randomised Controlled Trial Of Normoglycaemia Versus Conventional Glycaemic Control In Intensive Care Unit Patients.
Funder
National Health and Medical Research Council
Funding Amount
$1,773,507.00
Summary
The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are u ....The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are unsure if the treatment would work in their patients because of differences in the types of patients found in intensive care units in Australia, and because of other treatment given to the patients in the Belgian study. In particular the doctors in the Belgian unit studied only patients who had had operations and gave large amounts of intravenous sugar to their patients. This is not normally done in Australian Intensive Care Units and the safety of giving high dose insulin to patients not receiving large amounts of intravenous sugar is not known. This is of particular interest as reducing blood glucose to abnormally low levels can cause serious side effects and even result in permanent brain damage. The Australian and New Zealand Intensive Care Society proposes to conduct a new study involving 4,000 patients from intensive care units in Australia and New Zealand and will study all patients regardless of whether or not they have had an operation. These patients will be randomly assigned to receive insulin to control blood sugar levels to normal or to slightly above normal levels as has been tradition in intensive care units around the world. Outcome and serious side effects will be closely monitored. The results will be available within three years of starting the study, and these are likely to influence the treatment of the majority of patients admitted to intensive care units both in Australia and worldwide.Read moreRead less
A Randomised Trial Assessing A Shade Development Intervention In Secondary Schools For Adolescent Skin Cancer Prevention
Funder
National Health and Medical Research Council
Funding Amount
$709,615.00
Summary
Skin cancer is a significant burden to health costs, and morbidity and mortality in Australia. Reduction of exposure to ultraviolet radiation (UVR) in sunlight, particularly during childhood and adolescence is an important strategy for preventing skin cancer in later life. Adolescents have been particularly resistant to skin cancer prevention messages. Despite a high knowledge of skin cancer, the majority of Australian adolescents report a reliance on sunscreen, a resistance to hat wearing, and ....Skin cancer is a significant burden to health costs, and morbidity and mortality in Australia. Reduction of exposure to ultraviolet radiation (UVR) in sunlight, particularly during childhood and adolescence is an important strategy for preventing skin cancer in later life. Adolescents have been particularly resistant to skin cancer prevention messages. Despite a high knowledge of skin cancer, the majority of Australian adolescents report a reliance on sunscreen, a resistance to hat wearing, and commonly experience sunburn, an important indicator of increased risk of skin cancer. Psycho-social interventions have shown limited influence on adolescents' sun protective behaviours to date. The current research proposal explores an alternative approach to psycho-social interventions for adolescents. The study will assess the effect of increasing available shade at secondary schools. In a randomised control trial study design, the change in the number of students using certain outdoor areas at intervention schools will be observed 'before' and 'after' the installation of built shade sail structures. Our main hypothesis states that the number of students using these newly shaded areas in intervention schools will increase compared with use of equivalent unshaded areas in control schools. Shade development is increasingly becoming an issue for secondary schools and given both the high cost of providing shade structures and adolescents' resistance to other forms of sun protection it is important to establish that adolescents will use this form of sun protection. This study will determine whether adolescents actively avoid or seek shade and so provide evidence for informing decisions about further investment in shade provision in schools.Read moreRead less
A Parent Education And Skills Training Early Intervention For Children With Autism
Funder
National Health and Medical Research Council
Funding Amount
$305,674.00
Summary
Autism is a severely handicapping disorder adversely affecting social interaction, communication, and behaviour, interests and activities. Over the past 9 years our team has conducted a follow-up study of a large group of 111 Australian children and adolescents with autism. The young people have continued to have very high levels of emotional and behavioural disturbance and generally do not improve. Parents of children with autism are under significant amounts of stress; reporting high levels of ....Autism is a severely handicapping disorder adversely affecting social interaction, communication, and behaviour, interests and activities. Over the past 9 years our team has conducted a follow-up study of a large group of 111 Australian children and adolescents with autism. The young people have continued to have very high levels of emotional and behavioural disturbance and generally do not improve. Parents of children with autism are under significant amounts of stress; reporting high levels of disturbed family functioning and mental health problems. Although there is no cure, children benefit most when early help is provided (under 5 years). There are several promising interventions based on intensive behaviour and educational management, for example requiring 40 hours per week of therapist contact over 2 years. Such programs are costly and impractical as widely available treatment options. Training parents to understand and manage their child also shows promise. This study will evaluate the effectiveness of a parent skills training and education treatment program compared to supportive therapy, and to generally available community services. The therapists will follow a treatment manual that will ensure a consistent and replicable approach. The progress of the children with autism and their families will be reassessed immediately after treatment, and at 1 and 2 years post-treatment in order to ascertain immediate and long-term effects of the treatment. If treatment proves to be of use, we will have established a defined, cost efficient, practical and effective model of early treatment that can be easily taught to professionals and widely disseminated throughout early childhood services.Read moreRead less
Optimising Outcomes For Chronic Obstructive Pulmonary Disease (COPD): Evaluation Of Walking Training.
Funder
National Health and Medical Research Council
Funding Amount
$440,161.00
Summary
This will be the first study to examine whether a short-term and long-term program of ground walking training is sufficient to improve and maintain exercise capacity and quality of life in people with COPD. If ground walking training is shown to be an effective intervention, this will translate into more widespread provision of exercise training to people with COPD, particularly those living in rural or remote communities.
Reducing Cancer Patients Psychosocial Needs. A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$452,025.00
Summary
With 345,000 cases of cancer diagnosed each year, cancer is one of the nation's health priority areas. Although significant improvements in the early detection and treatment of cancer have increased survival, these advancements may have added to the psychological, physical and resource burdens placed on patients by increasing the time between diagnosis and definitive outcome. Addressing the physical and psychological needs of cancer patients throughout the course of their illness has become an i ....With 345,000 cases of cancer diagnosed each year, cancer is one of the nation's health priority areas. Although significant improvements in the early detection and treatment of cancer have increased survival, these advancements may have added to the psychological, physical and resource burdens placed on patients by increasing the time between diagnosis and definitive outcome. Addressing the physical and psychological needs of cancer patients throughout the course of their illness has become an important component care. A potential mechanism for reducing the psychological morbidity associated with cancer is to intervene to reduce a patient's level of unmet needs. This proposal intends to test the cost-effectiveness of an innovative intervention to reduce the level of unmet needs among colorectal patients. The study involves recruiting patients diagnosed with colorectal cancer within the past 3 months through the cancer registry and assessing their level of unmet needs at four points-at entry into the study: 6-, 12- and 18- months post diagnosis. Experimental subjects will be assigned a specially trained volunteer worker attached to the cancer council to aid the patient in identifying resources to address their unmet needs. The volunteer will act as an information resource and emotional support person. The volunteer will access information about the patients unmet needs from study questionnaires, and work with patients to devise a plan for addressing their unmet needs. The study will determine whether the level of unmet needs among cancer patients can be reduced in this manner and whether this strategy also reduces psychological distress. The proposed research is unique as it could highlight mechanisms that could be utilised by all cancer councils in Australia. The intervention has the additional benefit of being able to reach all cancer patients in a particular state regardless of their geographic location or where they receive treatment.Read moreRead less
A Factorial Randomised Trial Of Intensive Blood Pressure Lowering And Glucose Control In Subjects With Type 2 Diabetes.
Funder
National Health and Medical Research Council
Funding Amount
$303,330.00
Summary
People with diabetes are well known to be at high risk of developing major health problems earlier in life than people without diabetes. In particular, people with diabetes are more likely to suffer from heart attacks, stroke, blindness, kidney failure and leg ulcers that may lead to amputation. Studies of diabetics have shown that if blood pressure levels or glucose levels are uncontrolled, the risk of complications is much higher. Careful management of these two risk factors is therefore now a ....People with diabetes are well known to be at high risk of developing major health problems earlier in life than people without diabetes. In particular, people with diabetes are more likely to suffer from heart attacks, stroke, blindness, kidney failure and leg ulcers that may lead to amputation. Studies of diabetics have shown that if blood pressure levels or glucose levels are uncontrolled, the risk of complications is much higher. Careful management of these two risk factors is therefore now a cornerstone of diabetic care and there are well-established guidelines for treatment. However, there is new evidence to suggest that tighter control of blood pressure and glucose levels than is currently recommended might result in even greater benefits. ADVANCE (Action in Diabetes and Vascular Disease) is a large new study that has been designed by Australian researchers based at the Institute for International Health in Sydney. The aim of ADVANCE is to see if treatment to control blood pressure and glucose levels more tightly than usual reduces the risk of complications among adult diabetics. The study will include 10,000 individuals recruited from about 20 countries worldwide that will be followed for an average of 4.5 years. The first participants will be enrolled in April 2001 and the study results should be available by the end of 2006. There are presently about 300 million people in the world with diabetes and this number is increasing rapidly. The results of ADVANCE will therefore influence the care of a very large number of people. If the findings of the study were positive, implementation of the new treatments could be expected to prevent many tens of thousands of premature heart attacks and strokes around the world each year.Read moreRead less
Plasma Exchange And Glucocorticoids In ANCA Associated Vasculitis: A Randomised Controlled Trial (PEXIVAS Australia)
Funder
National Health and Medical Research Council
Funding Amount
$635,243.00
Summary
Vasculitis is a life-threatening disease, and the current treatment for this condition is not satisfactory. This clinical trial aims to determine 1) if plasma exchange can lower mortality and the development of severe kidney failure due to this disease, and 2) if the use of lower doses of corticosteroids can lessen the infectious complications of treatment. This trial is part of a major international effort which will involve a total of 500 patients from Australia, UK, Europe, USA and NZ.
Enhancing Efficacy Of Cognitive Behavioural Treatment For Children With Anxiety Disorders: Treating Parent Anxiety.
Funder
National Health and Medical Research Council
Funding Amount
$377,961.00
Summary
Much attention is focused on childhood problems such as attention-deficit, depression and substance abuse. However, the most prevalent psychological problem experienced in childhood is anxiety. There is even some evidence to suggest that anxiety may lead to later problems such as depression or substance abuse. We know that anxiety disorders are a widespread problem in our youth. We also know that anxiety, if left untreated, will persist through the child's life and cause significant disruption t ....Much attention is focused on childhood problems such as attention-deficit, depression and substance abuse. However, the most prevalent psychological problem experienced in childhood is anxiety. There is even some evidence to suggest that anxiety may lead to later problems such as depression or substance abuse. We know that anxiety disorders are a widespread problem in our youth. We also know that anxiety, if left untreated, will persist through the child's life and cause significant disruption to their life. The good news is that there has been an increased interest in these disorders and as a result treatments that work have been developed. However, a recent review of the best psychological treatments for anxiety in children showed that on average studies are reporting remission rates of only 56.5%. Clearly we need to develop more effective treatments for anxious children. One possible approach to improve outcomes for children with anxiety is to provide additional treatment for the parents. We know that anxiety runs in families: anxious children are more likely than non-anxious children to have anxious parents. A number of theories have suggested that parental anxiety plays an important role in the development of anxiety in children: An anxious parent may model anxious behaviour, encourage avoidance of anxious situations and reinforce anxious behaviour in their child. The results of this study will determine whether it is possible to improve the efficacy of treatments for anxiety in children by addressing anxiety in their parents. If the data show no additional benefit of the modified treatment, therapists can be more efficient in their treatment of anxious children by ignoring the parent's own anxiety. However, if as expected the modified treatment proves to be more efficacious, then we will have identified an important strategy to increase the efficacy of intervention for this highly prevalent and debilitating childhood problem.Read moreRead less