Practical Tools For Robust Analysis Of Large Epidemiological Studies With Incomplete Data
Funder
National Health and Medical Research Council
Funding Amount
$358,492.00
Summary
Studies of the causes and consequences of health outcomes follow large cohorts of individuals for long time periods. A major challenge in analysing data from these studies is that information is often incomplete. Participants rarely complete all waves of data collection, or provide all requested information. Statistical research has led to increased use of a statistical method (multiple imputation) that recovers information from incomplete cases. This project will develop and improve this method
New Evidence To Guide Decisions About The Prevention And Treatment Of Common Cardiovascular Diseases.
Funder
National Health and Medical Research Council
Funding Amount
$7,309,675.00
Summary
The Program brings together clinicians, epidemiologists and statisticians in a unique endeavour designed to improve the prevention and treatment of heart attack and stroke. For the foreseeable future, these conditions will remain leading causes of death and disease in Australia and most other countries in the region. While there are many established treatment and prevention strategies for these conditions there remains great potential for further advances to be made, which might avert very large ....The Program brings together clinicians, epidemiologists and statisticians in a unique endeavour designed to improve the prevention and treatment of heart attack and stroke. For the foreseeable future, these conditions will remain leading causes of death and disease in Australia and most other countries in the region. While there are many established treatment and prevention strategies for these conditions there remains great potential for further advances to be made, which might avert very large numbers of premature deaths and serious disabling outcomes. This Program of research seeks to provide new information that will give patients, doctors and policy makers innovative options for the treatment and prevention of heart attack and stroke. The Program will incorporate two main elements: observational studies and randomised controlled trials. The observational studies will establish the precise importance of each of the main causes of cardiovascular diseases (such as diabetes, blood pressure, smoking and cholesterol) at different ages, in different ethnic groups and in different geographic regions. Furthermore, these studies will also define the relative importance of established and novel risk factors for cardiovascular disease, providing important new information about how resources for prevention should be directed. The large-scale trials will provide evidence about the effectiveness and safety of a range of new cardiovascular disease prevention and treatment strategies. The work will build on the team�s very successful approach of evaluating the effects of established interventions in high-risk groups for whom those particular treatments are not currently indicated.The Program will also include studies that address the critical issue of translating health research findings into practice _ in terms of health policy, clinical practice and consumer behaviour. A particular focus involves the application and evaluation of novel Internet technologies for promoting best practice. The methodologies used by the team will ensure that the evidence generated by the Program is as precise and reliable as possible, in order to provide a sound base to guide decisions about changes in health care policy and practice. The research findings will have direct relevance to the healthcare needs of millions of Australians within the next five years, and the impact of the work will be assured by the development of implementation and dissemination plans for each major component of the Program.Read moreRead less
Characterisation Of A New Localisation For Susceptibility To Inflammatory Bowel Disease On Chromosome 12
Funder
National Health and Medical Research Council
Funding Amount
$76,125.00
Summary
One of the greatest challenges facing contemporary gastroenterology is to understand the causes of the inflammatory bowel diseases in order to develop more effective therapies. Although there have been advances in treatment over the last few years, the causes of IBD are still not known. The existence of a genetic predisposition to IBD is now well established, and there is strong evidence that the disease is the result of the interaction of a number of different genes. To date, two genetic locali ....One of the greatest challenges facing contemporary gastroenterology is to understand the causes of the inflammatory bowel diseases in order to develop more effective therapies. Although there have been advances in treatment over the last few years, the causes of IBD are still not known. The existence of a genetic predisposition to IBD is now well established, and there is strong evidence that the disease is the result of the interaction of a number of different genes. To date, two genetic localisations (one on chromosome 16 and a second on chromosome 12) have been confirmed in multicentre studies. We have identified a novel localisation for disease susceptibility on chromosome 12 in the Australian population during the course of a genome scan on 73 multiplex inflammatory bowel disease families. (The importance of this localisation has been confirmed in English and American families.) This localisation is quite separate from that originally described and many genes separate the two localisations. We will refine the new localisation by fine scale mapping in the region of the localisation that we originally identified in pure Crohn's disease families. At this stage, the localisation appears not to be important in families suffering from ulcerative colitis or in families in which both CD and UC occurs (known as mixed families), though this finding will be tested. Using state of the art molecular genetics, we will then identify and characterise the gene involved. The significance of this project lies in the importance of this localisation to the understanding of underlying biochemistry and genetics of a complex disease in which multiple genes are segregating and interacting in, some as yet undefined manner.Read moreRead less
Strengthening The Evidence Foundation For Public Health Guidelines
Funder
National Health and Medical Research Council
Funding Amount
$987,647.00
Summary
Public health guidelines should be based on rigorous evidence. If underlying studies are not sound, guidelines will not be credible or implemented. Dietary guidelines have been criticized for being biased. Our group studies bias across the whole research process – from the questions asked to the final publication. This project will measure the influence of bias at all stages in nutrition research in order to improve the evaluation of this research and the evidence base for dietary guidance.
Measuring The Productive Efficiency Of Hospitals - A Comparison Of Parametric And Non-parametric Approaches
Funder
National Health and Medical Research Council
Funding Amount
$61,815.00
Summary
In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technic ....In the face of rising health service costs, an ageing population, and falling private health insurance rates, the efficient use of scarce health service resources has become a central theme in health system reform. Productive (or technical) efficiency is a key aspect of health system reform - that given health services are produced with the minimum feasible amount of resources. Despite the importance of technical efficiency there have been few published studies in Australia which measure technical efficiency in the health sector. This study will develop theoretical and empirical approaches to measuring technical efficiency in the production of hospital services using data from Victoria. Measures of hospital technical efficiency will be developed using two quantitative modelling approaches: stochastic frontier modelling and data envelopment analysis. Results will be used to investigate the impact of patient and hospital characteristics on efficiency, and to identify economies of scale and scope in the provision of hospital services. The robustness of results to changes in variables, the sample of hospitals studied, and model assumptions will be tested, and two techniques will be compared to assess their appropriateness in the health services context which has not previously been done. Criteria for assessing the approaches include the degree to which: assumptions affect the robustness of results; the techniques capture the salient features of health services production; and the techniques produce similar rankings and estimates of inefficiency. The methods used will represent a significant contribution to international knowledge of hospital efficiency measurement, and the relationships between hospital characteristics, casemix, and efficiency. The study wil provide improved measures of hospital efficiency in Victoria, and will inform debate on hospital funding policy.Read moreRead less
Generating Credible Evidence For Health Care Decision Making: Advancing Methods For Evidence Synthesis And Meta-analysis
Funder
National Health and Medical Research Council
Funding Amount
$360,476.00
Summary
Systematic reviews often underpin recommendations in guidelines and are therefore critical to the translation of research evidence into practice. However, weaknesses in the conduct of reviews can yield biased results, which may lead to patients receiving ineffective or harmful treatments. During my fellowship I will develop and evaluate novel methods to assess and adjust for bias in reviews, to improve the credibility of evidence needed to make well-informed choices about health care.
Confirming The Burden Of Disease Associated With Dementia Using New Empirically Driven Australian Based Disability Rati
Funder
National Health and Medical Research Council
Funding Amount
$138,084.00
Summary
The amount of burden the population experiences as a result of individual diseases influences health policy. The Australian Burden of Disease project quantifies the relative burden associated with each disease. New estimates are to be released this year will outline the magnitude of burden associated with dementia now and estimate that for the year 2023. Although the projections use the best data available, three improvements to the methodology would improve the accuracy of the dementia burden e ....The amount of burden the population experiences as a result of individual diseases influences health policy. The Australian Burden of Disease project quantifies the relative burden associated with each disease. New estimates are to be released this year will outline the magnitude of burden associated with dementia now and estimate that for the year 2023. Although the projections use the best data available, three improvements to the methodology would improve the accuracy of the dementia burden estimates. First, the dementia calculations currently use a “disability weight” metric derived from a Dutch study. This is problematic in that the weights do not reflect an Australian experience of dementia, nor do they reflect the preferences of people closely affected by the disease (e.g. carers). Second, the dementia estimates do not include cases of mild cognitive impairment (considered a precursor state of dementia). Hence the dementia estimates may not estimate the full impact of dementia in Australia. Finally, there is no evidence that the method used by the Burden of Disease study to account for the impact of disease comorbidity adequately deals with the comorbidity associated with dementia. Consequently, there is need to develop a new and comprehensive set of disability weights for dementia that are Australian-based, include all stages of dementia severity and account for comorbidity. The proposed project aims to develop a new set of empirically derived Australian-based disability weights for dementia. The project will entail three studies. The first study will generate empirically based case vignettes that describe a range of dementia case scenarios. These descriptions will then be used in rating exercises (Study 2) to develop new disability weights. The second study involves Australian health practitioners, carers and lay persons reading case vignettes and completing health valuation rating exercises to generate new disability weights for dementia. The third study uses the new disability weights to re-calculate the burden of disease estimates for dementia. The new estimates will be compared to those reported by the 2007 Australian Burden of Disease project. In knowing the accuracy of the estimates, policy makers can use the burden data for dementia with confidence when engaging in service planning for the future.Read moreRead less
The Role Of CD30 Overexpression In CD30-positive Non-Hodgkins Lymphomas
Funder
National Health and Medical Research Council
Funding Amount
$457,242.00
Summary
The CD30 molecule sits on the surface of normal blood cells, but in a type of cancer called Lymphoma, CD30 concentration is high. The level of expression of CD30 may determine if the cancer cell is killed by the normal defense mechanisms or is able to grow uncontrollably. We are studying the control elements of the CD30 gene to understand how control is lost when the cell becomes cancerous. This knowledge may lead to therapeutic strategies to control lymphoma.