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Health Care Priorities: The Community's Preferences For Using Community Preferences
Funder
National Health and Medical Research Council
Funding Amount
$52,355.00
Summary
Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use ....Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use of their preferences in informing health care priorities needs to be investigated. Four specific questions will be addressed in this study: (i) do members of the general public feel that, as individuals, they have a legitimate role to play in informing priority decisions in health care? if so why? if not, why not? (ii) does the nature-level-setting of the decisions for which priorities are to be set affect whether individual members of the public would wish to participate in the priority setting process? (e.g. different health services, medical procedures-treatments, diseases) (iii) whose preferences should be used if not the community's? (iv) faced ex post with the preferences of the community and the preferences (possibly different) of health service decision makers (i.e. Oexperts'), does this knowledge affect preferences for having community preferences count? A number of health authorities are currently looking for ways of engaging local communities in health care decision making. This study will indicate the appropriate levels at which community preferences are to be elicited and the type of decisions and settings in which they are most relevant.Read moreRead less
Randomised Double-blind Controlled Trial Of Oxygen Versus Air To Palliate Intractable End-of-life Dyspnoea When Pa02 >55
Funder
National Health and Medical Research Council
Funding Amount
$463,318.00
Summary
Shortness of breath at the end-of-life is one of the most feared symptoms. Unlike most other symptoms, it worsens as death approaches. Despite the fact that more than 50,000 Australian will die an expected death in the next year, of whom the majority will have breathlessness toward the end-of-life, we know little about how best to treat this symptom. Oxygen is frequently introduced but we have not identified whether it is more effective than medical air, and, if it is more effective, which patie ....Shortness of breath at the end-of-life is one of the most feared symptoms. Unlike most other symptoms, it worsens as death approaches. Despite the fact that more than 50,000 Australian will die an expected death in the next year, of whom the majority will have breathlessness toward the end-of-life, we know little about how best to treat this symptom. Oxygen is frequently introduced but we have not identified whether it is more effective than medical air, and, if it is more effective, which patients would most benefit from it. Because of this lack of evidence, oxygen is only funded in Australia in community settings for people who have severely low oxygen levels in their blood. Palliative oxygen is provided on a compassionate basis at times but this is on an ad hoc basis and does not ensure equitable access for people at the end of life who experience shortness of breath. This multi-centre study will compare oxygen and air, with neither the participant nor caring clinicians knowing which treatment they will receive. After careful explanation, volunteers who agree to participate will be asked to use the oxygen machine for at least 15 hours each day for 7 days and fill out a diary twice each day. Five centres across Australia are planning to enroll 240 participants in this study. Outcomes will include whether the sensation of breathlessness has improved, the overall quality of life while being treated, the ability to perform activities of daily living and any side effects experienced. This study is eagerly awaited by clinicians and health planners not only in Australia but in North America and Europe. This study will provide data in a long-standing international debate about the role of oxygen in people with relatively normal levels of oxygen in their blood who suffer from shortness of breath at the end-of-life.Read moreRead less
The Role Of Peroxisome Proliferator Activated Receptor Gamma In Sodium Transport In Human Proximal Tubule Cells
Funder
National Health and Medical Research Council
Funding Amount
$566,946.00
Summary
Renal failure accounts for a considerable component of the excess morbidity and mortality observed in patients with diabetes mellitus. In addition, the emotional, social and cost to the community of dialysis is enormous. PPARgamma is activated by drugs that have been recently introduced for the treatment of type 2 diabetes mellitus. The propensity for these drugs to cause fluid retention has emerged recently as the most common serious adverse drug reaction associated with these compounds. the de ....Renal failure accounts for a considerable component of the excess morbidity and mortality observed in patients with diabetes mellitus. In addition, the emotional, social and cost to the community of dialysis is enormous. PPARgamma is activated by drugs that have been recently introduced for the treatment of type 2 diabetes mellitus. The propensity for these drugs to cause fluid retention has emerged recently as the most common serious adverse drug reaction associated with these compounds. the definitive cause of fluid retention with the use of PPAR gamma agonists is not known. Studies reported in the last 12 - 18 months have suggested that a common pathway may be involved in the development of the fluid retention, the high blood pressure and the scarring that occurs in the kidney. This project will be the first to provide a comprehensive examination of the effect of PPARgamma induction on renal sodium absorption and fluid retention in the human proximal tubule cells and the potential molecular mechanisms underlying them. This will provide insight as to potential adjuvant treatments for patients with diabetes.Read moreRead less
An Investigation Into The Importance Of Potable Water As A Source Of Melioidosis In Northern Australia
Funder
National Health and Medical Research Council
Funding Amount
$362,036.00
Summary
Melioidosis is a potentially fatal infection that occurs throughout the Top End. Infection usually sets in after exposure to contaminated soil or surface water. A recent outbreak of melioidosis in which three of seven cases died was traced to the community's drinking water supply. Subsequent improvements to the community's drinking water treatment appear to have brought the outbreak under control. However, the ability of the bacteria responsible for this infection to survive within the body for ....Melioidosis is a potentially fatal infection that occurs throughout the Top End. Infection usually sets in after exposure to contaminated soil or surface water. A recent outbreak of melioidosis in which three of seven cases died was traced to the community's drinking water supply. Subsequent improvements to the community's drinking water treatment appear to have brought the outbreak under control. However, the ability of the bacteria responsible for this infection to survive within the body for many years before causing late onset infection means that further cases may be recorded in the affected community for years to come. This project aims to assess whether the drinking water supply to other rural communities presents a risk of melioidosis throughout the Top End. Drinking water supplies will be tested for the presence of the bacteria that cause melioidosis. Genetic fingerprinting will be used to compare each strain isolated from water specimens with strains obtained from infections previously diagnosed in hospitals throughout the Top End. This will involve the combined efforts of researchers in Western Australia, the Northern Territory and Queensland. Comparison of these results with standard measures of drinking water quality will enable the research team to work out whether any routinely performed tests can be used as a guide to melioidosis risk. The team will also examine whether any geographical features such as deep water supply or the type of vegetation present can be used to assess melioidosis risk. A clearer picture of melioidosis risk will make it easier to target the delivery of preventive methods such as chlorination or alternatives to specific water supplies. Preliminary studies in Western Australia suggest that primary prevention of melioidosis may be possible. We need to see how widely those findings apply. It is hoped that this work will lead to a significant reduction in the risk of contracting this disease throughout the endemic region.Read moreRead less
A Randomised, Double Blinded Intervention Study To Assess Health Effects Of Drinking Water From Rainwater Tanks
Funder
National Health and Medical Research Council
Funding Amount
$860,510.00
Summary
We are planning to perform a study in Adelaide to assess if drinking untreated rainwater causes a health risk. Eight years into a drought Australia's water sources are becoming increasingly depleted, so we need to reduce water consumption and consider using alternative sources of water. Increased use of rainwater is one of a number of solutions available. However, current recommendations state that rainwater can be safely used for purposes other than drinking, but because of potential contaminat ....We are planning to perform a study in Adelaide to assess if drinking untreated rainwater causes a health risk. Eight years into a drought Australia's water sources are becoming increasingly depleted, so we need to reduce water consumption and consider using alternative sources of water. Increased use of rainwater is one of a number of solutions available. However, current recommendations state that rainwater can be safely used for purposes other than drinking, but because of potential contamination and limited evidence regarding safety, drinking untreated rainwater is not approved by state health departments. The main outcome of this study will be to determine whether drinking untreated water from rainwater tanks poses a significant health risk. Additionally, we will determine if specific tank or maintenance characteristics can be identified that increase illness risk. The study design consists of following the health of 300 families who drink unboiled rainwater. Families will have a special tap installed that draws water through a water treatment unit (WTU). Half the families will have a working WTU and half will have a sham unit identical in appearance. The functional units sterilise water to remove any microorganisms present, while the sham filters have no effect. All participating families will keep a health diary for one year to record how often they suffer gastroenteritis. Neither the families nor the research workers will know which type of filter has been fitted. Water samples will be collected from selected households. At the end of a year the number of illnesses in the two groups will be compared. If those drinking rainwater from a sham filter suffer more often, then rainwater would be implicated as a source of gastroenteritis. This study will provide health authorities with a better understanding of the relationship between rainwater consumption and human health, and will provide data regarding safe uses of this alternative water source.Read moreRead less