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A Phase II Trial Of Follow-up Of Men With Prostate Cancer In Primary Care.
Funder
National Health and Medical Research Council
Funding Amount
$584,465.00
Summary
This study aims to develop and test a novel model of shared care for the follow-up of men with prostate cancer. Men treated for prostate cancer experience distressing and ongoing side-effects of treatment and significant psychological issues. Current models of care fail to address adequately these issues. The new model is designed to improve the care received and therefore the quality of life of men after treatment for prostate cancer.
The Effect Of Glucosamine Sulphate On Structural Disease Progression In Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$1,250,214.00
Summary
Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommendi ....Osteoarthritis (OA) is a joint disease characterized by a progressive loss of cartilage and joint space resulting in increasing pain and difficulty performing usual daily activities. OA is the leading health problem amongst older Australians and a National Health Priority area. There is no known cure for OA and no intervention demonstrated to slow disease progression or delay time to joint replacement surgery. Currently patients are managed symptomatically with all clinical guidelines recommending paracetamol as 'the preferred long term oral analgesic'. This recommendation is based on the increased risk of serious gastrointestinal, cardiovascular and renal diseases with long-term NSAIDs use in older people. However, NSAIDs appear to provide better pain relief for patients with more than mild joint pain. Amongst patients with OA, there is much demand for the dietary supplement glucosamine sulphate. Product marketing has led to the belief that glucosamine is able to slow the rate of joint destruction and cartilage loss and help ease joint pain with, in contrast to NSAIDs, little risk of side effects. However, the few trials conducted to date have been inconclusive. If the marketing claims are unjustified, many older people are wasting limited financial resources and due to unrealistic expectations of the benefit of glucosamine, placing a lower priority on lifestyle changes of proven effectiveness, such as regular exercise and weight loss. A total of 900 patients with knee OA will be randomly allocated to glucosamine sulphate or matching placebo capsules for two years. The main outcomes will be the rate of joint space narrowing, use of NSAIDs and physical disability. If glucosamine results in slowing disease progression or in reducing NSAIDs consumption, the widespread use of this product would effectively decrease pain, disability and NSAIDs-related illnesses amongst the increasing number of people with OA.Read moreRead less
Exercise: An Examination Of Dose-response Relationships For Women Aged 65-74 Yr.
Funder
National Health and Medical Research Council
Funding Amount
$696,249.00
Summary
The increasing number of older women in Australia presents a significant challenge to our health system. Preventative and health promotion strategies must be developed for this important group of Australian's if chronic disease and disability are to be contained and the decline in functional capacity attenuated. One potential intervention strategy is regular exercise. However, if exercise is to have multi-systems benefits, the dose of the exercise must be known. We do not know the exercise presc ....The increasing number of older women in Australia presents a significant challenge to our health system. Preventative and health promotion strategies must be developed for this important group of Australian's if chronic disease and disability are to be contained and the decline in functional capacity attenuated. One potential intervention strategy is regular exercise. However, if exercise is to have multi-systems benefits, the dose of the exercise must be known. We do not know the exercise prescription that will maximize those health benefits required for this group of Australian's. We propose to resolve this situation via two related experiments involving women aged 65-74 yr. Experiment 1 will select moderate-intensity treadmill walking for 30 min-session with the weekly exercise frequency varied from 1 to 5 session-wk for 64 sessions. Experiment 2 will also select moderate-intensity treadmill walking with the total exercise time per week (120 min-wk) and the number of weeks of training (24 wk) fixed but varying the exercise duration per session (24 to 120 min-session) and the exercise frequency per week; 5 (x 24 min) to 1 (x 120 min) session-wk. Each subject will undergo lung function tests, body fat test, fitness tests and blood tests at selected time intervals throughout each experiment. A separate fitness test will be conducted on the subjects' leg muscle to help us understand what is happening directly in the muscle. We will also conduct a tilt test to help us understand how regular exercise might lessen the likelihood of 'falls' in older individuals. We expect to determine the optimum exercise prescription to improve health and minimize injury and misadventure. It is essential that GP's who have the main responsibility for prescribing exercise for their older patients, have access to knowledge on the optimum exercise prescription to maximize the beneficial changes in health and functional capacity in females aged 65-74 yr.Read moreRead less
This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professiona ....This study proposes to examine the quality of procedural medical care provided by rural doctors who are not specialists. The disciplines of Anaesthetics, Surgery and Obstetrics will be included. Most of these services in rural Australia are not provided by specialist medical practitioners, but rather by rural general practitioners who have obtained additional training, albeit shorter than that undertaken by specialist trainees, and who are supported by skilled nurses and other health professionals in relatively small rural hospitals. Patients and rural doctors often have little choice but to manage urgent cases locally and in some cases experienced and skilled local teams are able to offer a wider range of services, including a limited number of elective procedures. Despite underlying assumptions that the quality of the services cannot match that of specialist care in larger hospitals, there is no agreement on what constitutes quality of rural procedural care and little evidence that the quality is different. This issue is important as substantial government funds are spent on recruiting, training and retaining a qualified rural medical workforce, and yet fewer rural doctors are providing these services and fewer rural hospitals have the facilities to support those rural doctors still providing the services. Further, measuring the quality of care is a complex issue on which different stakeholders may have different views. This study proposes a multi-perspective approach to assessing the quality of care through a number of case studies provided by rural doctors.Read moreRead less
Systematic Medical Assessment, Referral And Treatment For Diabetes Care In China Using Lay Family Health Promoters - SMART Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$1,385,858.00
Summary
Type 2 Diabetes (T2DM) affects 113.9 million people in China. Prevalence has risen dramatically to over 10% and is expected to continue rising. Few Chinese with T2DM are achieving adequate management targets to prevent complications and the current health system infrastructure is struggling to meet these gaps in care. Our project will expand the family health promoter model to develop a scalable model for low cost, high quality diabetes care in urban and rural China.
Often when people are sick they cannot communicate their wishes regarding medical decisions. This research will explore, through surveys and interviews, how older general practice patients understand these decisions and how their understanding compares with that of their loved ones and their general practitioner. We aim to provide an insight into the meaning people give to these decisions thereby assisting those who wish to plan for their future medical care and their doctors.
Quality Improvement In Indigenous Primary Health Care: Leveraging Effective Ambulatory Practices (LEAP)
Funder
National Health and Medical Research Council
Funding Amount
$1,144,570.00
Summary
Although much is known about best practice in quality improvement in Indigenous Primary Health Care Services, getting this into practice remains challenging. The LEAP project works in partnership with health services to i) identify challenges faced when improving care; ii) design and trial interventions to address these challenges; and iii) evaluate how this process works in different settings.
Preventing Suicide: A psychological autopsy study of the last contact with a health professional before suicide. In Australia, 48% of all suicides in 2000 were by 35-64 year olds; an additional 13% were by 65 years and over. This study will examine the last clinical contact older suicide victims had with health professionals in order to determine whether this contact offers an opportunity for intervention. For the first time in Australia, GP's, health professionals, and the deceased's next-of-ki ....Preventing Suicide: A psychological autopsy study of the last contact with a health professional before suicide. In Australia, 48% of all suicides in 2000 were by 35-64 year olds; an additional 13% were by 65 years and over. This study will examine the last clinical contact older suicide victims had with health professionals in order to determine whether this contact offers an opportunity for intervention. For the first time in Australia, GP's, health professionals, and the deceased's next-of-kin will be interviewed to determine the context surrounding the deceased's death, and the abilities of health professionals to identify warning signs and to intervene prior to suicide. Given our ageing population, the outcomes will be significant in educating all health professionals to identify suicidal signs, and to prevent premature death in the elderly.Read moreRead less
QUality Improvement In Primary Care To Prevent Hospitalisations And Improve Effectiveness And Efficiency Of Care For People Living With Heart Disease (QUEL)
Funder
National Health and Medical Research Council
Funding Amount
$828,305.00
Summary
Heart disease accounts for a great number of deaths and admissions to hospital. We aim to improve ongoing prevention for people with heart disease by supporting general practices to use their data and provide more systematic care. We propose a randomised trial to determine whether a practice level strategy reduces cardiovascular events and hospitalisations and saves money. The research will directly inform government decision-making and policy regarding primary care incentive payment programs.