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CRCT Of A Multidisciplinary, Team Building Intervention To Manage Fever, Sugar And Swallowing (FeSS) In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$405,450.00
Summary
The latest acute stroke guidelines and recommendations from Ausralia's National Stroke Unit Program endorse a prompt and evidence-based treatment for fever, blood sugar and swallowing in acute stroke. This Clustered Randomised Control Trial (CRCT) will develop and rigorously evaluate a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. The intervention comprises: an evidence-based clinical treatme ....The latest acute stroke guidelines and recommendations from Ausralia's National Stroke Unit Program endorse a prompt and evidence-based treatment for fever, blood sugar and swallowing in acute stroke. This Clustered Randomised Control Trial (CRCT) will develop and rigorously evaluate a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. The intervention comprises: an evidence-based clinical treatment pathway (the FeSS Pathway) and facility-based support consisting of multidisciplinary, team building workshops, a standardised, interactive education program and engagement of local staff through support and feedback. Stroke Units allocated to the control group will receive only the FeSS Pathway with no facility-based support. Expected patient outcomes comprise decreased: disability on discharge, length of stay, 90-day disability, 90-day dependency, 90-day death and disability and higher 90-day health status for those patients allocated to receive care at intervention Stroke Units. Further, medical record audits will be undertaken to measure the integrity of the FeSS Pathway uptake. By conducting a CRCT, we will generate Level 2 evidence for the effectiveness of a standardised, multidisciplinary team-building intervention for the management of fever, blood sugar and swallowing in patients following acute stroke. Thus, this trial is highly significant both within Australia and internationally.Read moreRead less
A Randomised Controlled Trial Of Caseload Midwifery Care
Funder
National Health and Medical Research Council
Funding Amount
$761,311.00
Summary
There is concern about the rising levels of caesarean section in Australia and some evidence that women may benefit from caseload midwifery care. This randomised control trial will determine whether caseload midwifery care can reduce interventions and is as safe as usual hospital maternity care. A Cochrane systematic review of midwifery led care versus routine care was designed to answer these questions.This will be the first randomised controlled trial to contribute to this review
The Evidence-based Consumer: Making Informed Decisions About Menopause, Hormone Replacement And Complementary Therapies
Funder
National Health and Medical Research Council
Funding Amount
$97,750.00
Summary
This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based ....This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based on up-to-date medical evidence about conventional HRT along with evidence about complementary therapies such as wild yam cream and herbal medicines. The information will outline the risks and benefits of these and other therapies as well as the proper use of HRT to control symptoms and effects of menopause. Current knowledge about reduction in heart disease risk and prevention of osteoporosis with the use of HRT, and the current knowledge about risk of ovarian, breast and uterine cancer will also be included in the information kit or brochure(s). The sample of women living in the Southern metropolitan region of South Australia will be included in the trial. They will be asked to complete a questionnaire and then some of the women will be asked to study the information about menopause and HRT. All participants will be asked to complete further questionnaires 3 months and 12 months later. The results will show whether providing women with information about menopause, HRT and complementary therapy will result in: 1. the women being more informed and better equipped to make the right decisions about treatment of the symptoms and effects of menopause, and 2. a more appropriate use of hormone replacement and complementary therapies to meet the individual needs of the women.Read moreRead less
Changing Decision-making Behaviour In General Practice By Providing Access To Online Evidence.
Funder
National Health and Medical Research Council
Funding Amount
$206,375.00
Summary
The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online eviden ....The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online evidence retrieval systems as a component in any evidence-based strategy, through a rigorous and controlled approach to the study of clinical behaviour change. It will also provide a powerful test of the value of search filters as a specific technology in support of evidence retrieval. The focus on prescribing patterns in NHMRC priority areas as an outcome measure will also provide a significant data set reflecting current practice in primary care.Read moreRead less
Are Cardiac Conditions In Older Women Managed Appropriately?
Funder
National Health and Medical Research Council
Funding Amount
$289,492.00
Summary
Cardiac conditions, including heart attach, heart failure, angina and high blood pressure are very common among older Australians. They account for large proportions of deaths, morbidity and health care costs. For most of these conditions there are highly effective treatments, however there is evidence that these are not as well used as they should be. Also, for women, diagnosis may be delayed due to perceptions that heart disease is a problem mainly among men. The project is based on the Austra ....Cardiac conditions, including heart attach, heart failure, angina and high blood pressure are very common among older Australians. They account for large proportions of deaths, morbidity and health care costs. For most of these conditions there are highly effective treatments, however there is evidence that these are not as well used as they should be. Also, for women, diagnosis may be delayed due to perceptions that heart disease is a problem mainly among men. The project is based on the Australian Longitudinal Study on Women's Health which includes more than 10,000 women, over half living in rural and remote areas. Women with cardiac conditions will be surveyed about their medical care. This information, together with data they have provided over the last 6 years (and Medicare data if the women have given their consent), will be compared with best practice guidelines established by NHMRC and the Heart Foundation. In this way the project will examine the adequacy of medical care among older women in sufficient detail to make actionable recommendations to health authorities for where improvements are needed.Read moreRead less
A Clinical Trial Of Manipulative Therapy And/or NSAIDs For Significant Acute Low Back Pain
Funder
National Health and Medical Research Council
Funding Amount
$521,625.00
Summary
Acute low back pain is a disabling condition with many sufferers being unable to perform their family or work duties due to severe pain. Treatment of acute LBP is also costly, this condition being one of the most frequent problems managed by general practitioners. Guidelines about how to treat patients with acute low back pain have suggested that advice and paracetamol should be the first line of treatment. In patients with insufficient pain relief two of the most frequently used additional trea ....Acute low back pain is a disabling condition with many sufferers being unable to perform their family or work duties due to severe pain. Treatment of acute LBP is also costly, this condition being one of the most frequent problems managed by general practitioners. Guidelines about how to treat patients with acute low back pain have suggested that advice and paracetamol should be the first line of treatment. In patients with insufficient pain relief two of the most frequently used additional treatments are anti-inflammatory medication and manipulative physiotherapy. However, to date it is not known whether the addition of one or both of these treatments results in faster recovery for the patient. Our clinical trial will clarify whether the addition of (i) anti-inflammatory medication and-or (ii) manipulative physiotherapy, to advice and paracetamol given by the doctor results in a faster recovery for the patient with acute low back pain. This results of this study will make it possible for general practitioners to manage acute low back pain in an evidence-based way.Read moreRead less
Azithromycin Versus Placebo In The Treatment Of Asymptomatic Acute Otitis Media In Young Aboriginal Children : A RCT
Funder
National Health and Medical Research Council
Funding Amount
$1,357,460.00
Summary
Remote Aboriginal children have the highest rates of severe ear infection reported in the medical literature. At any time, large numbers of children have a bulging eardrum (acute otitis media) but most are completely asymptomatic. In our previous antibiotic study, acute otitis media (AOM) persisted in 50% of children after 1 week of treatment. In terms of clinical success, it didn't make any difference whether azithromycin or amoxicillin was used (although azithromycin seemed to be better at red ....Remote Aboriginal children have the highest rates of severe ear infection reported in the medical literature. At any time, large numbers of children have a bulging eardrum (acute otitis media) but most are completely asymptomatic. In our previous antibiotic study, acute otitis media (AOM) persisted in 50% of children after 1 week of treatment. In terms of clinical success, it didn't make any difference whether azithromycin or amoxicillin was used (although azithromycin seemed to be better at reducing the level of infection). Currently local clinicians are: i) uncertain whether antibiotics make any difference at all; and ii) reluctant to devote resources to case-finding without good evidence of substantial benefit. In this randomised controlled trial, we will determine the benefits of 2 doses of azithromycin given 1 week apart in children with asymptomatic acute otitis media will improve health outcomes. The results of the trial will become the best available evidence to guide the medical management of asymptomatic AOM in high-risk children. We anticipate that it will make an important contribution in the shift toward more effective prevention and management of otitis media in Australian Aboriginal children. It will also have implications for all disadvantaged populations where adverse outcomes are common and compliance with recommended treatment is poor.Read moreRead less
Reconceptualising Health Promotion: The Role Of Values, Ethics And Evidence In Obesity Intervention.
Funder
National Health and Medical Research Council
Funding Amount
$485,103.00
Summary
Obesity and overweight are public health priorities. Population-level programs, campaigns and regulations are required to prevent and reduce obesity. How should these interventions proceed? What is effective? What is ethical? How can we avoid doing harm? At present, we do not know. By studying current interventions in detail, and working with experts and practitioners in health promotion and ethics, this project will develop a new framework to guide overweight and obesity intervention in future.
Effectiveness Of Continuing Medical Eduation And Feedback In Altering Diabetes Outcomes At A Population Level. A RCT.
Funder
National Health and Medical Research Council
Funding Amount
$947,956.00
Summary
Changing clinical practice so that it is closer to best-evidence care is important to improving health outcomes. This research will test a multi-component intervention with GPs to improve popultaion outcomes for people with diabetes. Rural communities will be randomly allocated to the intervention and control groups, and groups will be compared on indicators of diabetes management at the population level.