Evaluation Of An Instrument For Management Of Behavioural And Psychological Symptoms Of Dementia.
Funder
National Health and Medical Research Council
Funding Amount
$598,468.00
Summary
Behavioural and Psychological Symptoms of Dementia (BPSD) distress the patient and others. The behaviours, and not the underlying causes, are often treated with antipsychotics, despite side effects and low efficacy. An assessment instrument for care staff to determine and address causes of BPSD will be implemented. We predict training will reduce inappropriate prescribing and other reasons for distress. Where medication is required, detailed information will assist more targeted prescribing.
Improving Outcomes Of Preschool Language Delay In The Community: Randomised Trial
Funder
National Health and Medical Research Council
Funding Amount
$927,327.00
Summary
7-15% of preschool children have language delay, so are vulnerable to poor lifelong academic, social and economic outcomes. Small trials suggest that intervention helps. This randomized trial aims to find out the population costs and benefits of optimized intervention for 4 year olds following systematic identification of language delay. Because we have studied the 1500 participants since infancy, the trial could also shed light on why some children respond better than others to treatment.
The Diamond Cohort Study - Long Term Outcomes Of Depressive Symptoms In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$567,538.00
Summary
The diamond study follows what happens to almost 800 people with depressive symptoms whom attend general practice for care over 5 years of their life. This study will map the severity of depressive symptoms, life circumstances, use of health care services and treatments and allow us to understand factors associated with relapse and recovery from depression in order to improve care. This will assist us to develop models of care that better suit the needs of people experiencing depressive symptoms ....The diamond study follows what happens to almost 800 people with depressive symptoms whom attend general practice for care over 5 years of their life. This study will map the severity of depressive symptoms, life circumstances, use of health care services and treatments and allow us to understand factors associated with relapse and recovery from depression in order to improve care. This will assist us to develop models of care that better suit the needs of people experiencing depressive symptoms.Read moreRead less
Population Outcomes And Cost-effectiveness Of Universal Newborn Hearing Vs Risk Factor Screening At Age 5 Years.
Funder
National Health and Medical Research Council
Funding Amount
$540,423.00
Summary
Universal newborn hearing screening (UNHS) is being widely implemented because it is thought to greatly improve outcomes for children with congenital deafness. However, it is also very costly. Between 2003-5, all New South Wales babies were offered UNHS, while Victorian babies were offered a risk-factor screening and referral program. This two-year 'natural experiment' paves the way for a unique population effectiveness and cost-effectiveness study of UNHS as the children reach 5 years of age.
Randomised Double-blind Placebo-controlled Trial Of Aspirin In Primary Prevention Of CVD Events Or Dementia In The Aged.
Funder
National Health and Medical Research Council
Funding Amount
$3,532,500.00
Summary
The single most important risk factor for cardiovascular disease is age. All men aged 75 years have a 10-15% risk of having a stroke or heart attack in the next 5 years. Low dose aspirin has been shown to prevent further strokes and heart attacks in people who have already had one. It has been also shown to protect people who have not had a heart attack or stroke but who are at increased risk. Given that the elderly are at increased risk why do we need to do a trial in this particular group? The ....The single most important risk factor for cardiovascular disease is age. All men aged 75 years have a 10-15% risk of having a stroke or heart attack in the next 5 years. Low dose aspirin has been shown to prevent further strokes and heart attacks in people who have already had one. It has been also shown to protect people who have not had a heart attack or stroke but who are at increased risk. Given that the elderly are at increased risk why do we need to do a trial in this particular group? The reason is that relatively few elderly patients were included in the previous prevention trials. Also while the elderly may have the most to gain from treatment, they also have the most to lose because they are more likely to suffer from side-effects. Aspirin prevents heart attacks by stopping clots forming in blood vessels. This also means that people taking it have an increased tendency to bleed. Thus though it may prevent strokes due to clots it may also increase the risk of strokes caused by bleeding. Bleeding from the gut is another major problem as aspirin tends to erode the lining of the stomach. Minor bleeding from the gut can also lower blood oxygen carrying capacity which may exacerbate other diseases associated with ageing, e.g. heart failure. Dementia may be caused by repeated clots in small or large vessels. Dementia is a particular problem in the elderly affecting 10% of 85 year olds. It is a major cause of loss of quality of life and a significant cost to the community. Aspirin may reduce the progression of such a disease leading to a maintained quality of life (QOL) for individuals and their families. As our age increases our years of life remaining decreases. This is self-evident. Thus the potential to add years to life reduces and the potential of diseases to adversely affect quality of life becomes more important. Thus it may be more important to prevent a nonfatal stroke that leads to institutionalisation than a fatal stroke. Hence QOL will be assessed.Read moreRead less
Testing A Tailored, Evidence-based Education Intervention To Enhance Outcomes For Patients Commencing Chemotherapy
Funder
National Health and Medical Research Council
Funding Amount
$311,250.00
Summary
This project tests an innovative education program aimed at reducing the physical and psychosocial burden experienced during a course of cancer chemotherapy. The aim of the study is to reduce the burden and distress associated with cancer chemotherapy. Cancer chemotherapy is associated with physical (nausea, fatigue, hair loss, infection) and psychosocial (fear, anxiety, worry about family) effects that cause significant distress. Patients experience a highly level of pre-treatment anxiety and f ....This project tests an innovative education program aimed at reducing the physical and psychosocial burden experienced during a course of cancer chemotherapy. The aim of the study is to reduce the burden and distress associated with cancer chemotherapy. Cancer chemotherapy is associated with physical (nausea, fatigue, hair loss, infection) and psychosocial (fear, anxiety, worry about family) effects that cause significant distress. Patients experience a highly level of pre-treatment anxiety and for many this distress lasts across the course of treatment. Over the past decade there has been a dramatic shift in chemotherapy delivery to the outpatient setting. This means that patients are now responsibile for monitoring their own health at home and may need to use self-care strategies to deal with the many adverse effects of treatment. Pre-treatment education has usually focused on providing information about the facts of treatment, i.e. likelihood of nausea, rather than preparing the patient for the experience of treatment or helping them to manage the self-care demands associated with receiving treatment in the outpatient setting. The innovative education program tested here is the first of its type to draw on high level research evidence about preparing patients for potentially threatening medical procedures, tailoring this education to the individual situation of the patient and coaching the patient to implement evidence-based self-care behaviours and to use stress reduction techniques across the course of treatment.Read moreRead less
LIM KINASE 1 (LIMK1) AND METASTASIS, THE SEARCH FOR LIMK1 INHIBITORS
Funder
National Health and Medical Research Council
Funding Amount
$461,250.00
Summary
Disseminated cancer, unlike the localized disease, can rarely be cured by drug therapy. We have found that LIM kinase (LIMK1), a protein that was discovered in our laboratory, plays an important role in controlling the ability of tumour cells to spread, a process called metastasis. Thus, this protein becomes an important target for the development of new drug therapies to prevent the spread of cancer. Importantly, we have demonstrated that (1) inhibiting LIMK1 blocks the formation of metastatic ....Disseminated cancer, unlike the localized disease, can rarely be cured by drug therapy. We have found that LIM kinase (LIMK1), a protein that was discovered in our laboratory, plays an important role in controlling the ability of tumour cells to spread, a process called metastasis. Thus, this protein becomes an important target for the development of new drug therapies to prevent the spread of cancer. Importantly, we have demonstrated that (1) inhibiting LIMK1 blocks the formation of metastatic tumours in mice, and (2) introduction of this protein into tumour cells makes them more invasive. In addition, we find that the level of LIMK1 is much higher in human tumour cell lines that have the propensity to easily form tumours in mice. Also, measuring the level of this protein in cancer cells that spread to other organs shows that it is at significantly elevated levels when compared to normal tissue. The goals of this research are to: (1) understand whether the ability of LIMK1 to regulate tumour spreading and invasiveness correlates with its ability to control metastasis; (2) examine in human tumour samples whether the levels of LIMK1 correlate with the development of metastatic tumours; and (3) search for drugs that can inhibit the activity of this protein. The results from this research will be highly significant because LIMK1 levels are likely to be an important marker for which tumours will become metastatic. It is possible that, at the time of tumour diagnosis, LIMK1 measurements will enable the clinician to predict whether an individual tumour will become metastatic. Secondly, this protein is a novel drug development target. Drugs that inhibit this protein may block the ability of tumours to invade and metastasise.Read moreRead less
Supply, Demand And The Distribution Of Health Services In Australia
Funder
National Health and Medical Research Council
Funding Amount
$308,038.00
Summary
The distribution of medical services and its impact on access and equity is widely recognised as a key concern of the Australian community. Access and equity are key indicators to the public of the performance of a health system. These concerns have led to the adoption of major policy goals under Medicare relating to equitable access to medical services for the population as a whole. Furthermore, both the community and policy makers have expressed high levels of concern over the distribution of ....The distribution of medical services and its impact on access and equity is widely recognised as a key concern of the Australian community. Access and equity are key indicators to the public of the performance of a health system. These concerns have led to the adoption of major policy goals under Medicare relating to equitable access to medical services for the population as a whole. Furthermore, both the community and policy makers have expressed high levels of concern over the distribution of medical services between sub-markets and sub-populations, in particular, in the distribution of medical services between urban and rural-remote areas. This project, for the first time, comprehensively examines the performance of Medicare in terms of access to medical services over time. Australian data sets, largely untapped by economic modelling, will be used for analysis of the relationships between the distribution of, access to, and demand and fees for Australian medical services and their impact upon mortality over time. The study will result in the first comprehensive Australian description of access and supply of different medical services by social group and by geographic location over time. Furthermore it will provide evidence on the key determinants of distribution and changes in the distribution of medical services and estimates the likely effects of policy instruments designed to address the distribution of, and access to, medical services.Read moreRead less
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
A Study Of The Molecular Epidemiology And Virulence Determinants Of Enterovirus 71 Strains From The Asia-Pacific Region
Funder
National Health and Medical Research Council
Funding Amount
$286,325.00
Summary
In this study, we aim to understand the reasons for the emergence of epidemics of severe neurological disease due to enterovirus 71 (EV71) in young children of the Asia-Pacific region since 1997, and to develop strategies for disease prevention. EV71 is a human enterovirus closely related to the polioviruses. Most infections with EV71 are trivial, however, they may occasionally result in severe disease, including brainstem encephalitis with a high mortality and acute flaccid paralysis similar to ....In this study, we aim to understand the reasons for the emergence of epidemics of severe neurological disease due to enterovirus 71 (EV71) in young children of the Asia-Pacific region since 1997, and to develop strategies for disease prevention. EV71 is a human enterovirus closely related to the polioviruses. Most infections with EV71 are trivial, however, they may occasionally result in severe disease, including brainstem encephalitis with a high mortality and acute flaccid paralysis similar to poliomyelitis. There has been a large increase in EV71 epidemic activity throughout the Asia-Pacific region since 1997, including a large epidemic in Perth, Western Australia in 1999. These epidemics have resulted in many deaths and cases of severe neurological disability. In view of the severity of EV71 neurological disease and the lack of effective treatments, our research effort needs to focus on prevention through public health surveillance and vaccine development. The major aims of our study are two-fold: 1. To study the origin and evolution of EV71 in the Asia-Pacific region using molecular techniques and to use this information to implement surveillance in Australia and Southeast Asia. It is anticipated that improved surveillance will provide early warning of impending epidemics. 2. To understand the molecular basis of virulence of EV71, with emphasis on the ability of virus to cause severe disease of the central nervous system. This study will have two goals: a. To identify the human cellular receptor of EV71. The ultimate goal of this research will be the development of a small animal model of EV71 encephalitis by constructing a transgenic mouse expressing the human cellular receptor for EV71. b. To construct an infectious cDNA clone of EV71 and to develop genetically defined attenuated strains by mutagenesis of the infectious clone. Mutant strains of EV71 will be tested for replication and virulence in newborn mice and in human neuroblastoma cells.Read moreRead less