A Multicentre Randomised Clinical Trial Of Laser Treatment Plus Intravitreal Traimcilone For Diabetic Macular Oedema
Funder
National Health and Medical Research Council
Funding Amount
$529,500.00
Summary
A diagnosis of diabetes immediately confers a 25 fold increase in a person's risk of blindness. The macula is the vision centre of the retina, which is like the film in a camera. In people with diabetes, swelling of the macula (macular oedema) due to leakage of retinal blood vessels is the commonest cause of loss of vision. Laser treatment is proven to be helpful in reducing the risk of vision loss in eyes with diabetic macular oedema (DMO), but it does not work in 40% of cases. Injection of slo ....A diagnosis of diabetes immediately confers a 25 fold increase in a person's risk of blindness. The macula is the vision centre of the retina, which is like the film in a camera. In people with diabetes, swelling of the macula (macular oedema) due to leakage of retinal blood vessels is the commonest cause of loss of vision. Laser treatment is proven to be helpful in reducing the risk of vision loss in eyes with diabetic macular oedema (DMO), but it does not work in 40% of cases. Injection of slow release steroids is an emerging revolutionary treatment for DMO. We are the first in the world to perform a randomised clinical trial of triamcinolone injection into the eye with DMO that has failed laser treatment. A randomised clinical trial is when an equal number of eyes are randomly allocated to the treatment and placebo (no treatment) groups, so that none of the patients or the doctors knows whether each particular eye is receiving treatment or placebo. The preliminary results of our study in progress have proved that, at least in the short term, intravitreal triamcinolone (IVTA) leads to reduction of macular oedema and improved vision. We now propose a two year randomised clinical trial to test whether the combination of IVTA with laser treatment will result in a further improvement in vision in eyes with DMO. We are in a unique position to conduct such a study, having recently concluded the world's first randomised clinical trial of IVTA for wet age-related macular degeneration in 151 eyes. We have extensive experience of IVTA's significant but manageable adverse event profile. The Australian Retinal Collaboration is a group of academic retinal specialists who are committed to attaining the highest possible standards in clinical research in Australia for common blinding conditions of the retina. The results of the proposed study are likely to lead directly to a reduction of the risk of vision impairment and blindness in people with diabetes.Read moreRead less
An Open-label Extension Of A Randomised Clinical Trail Of Intravitreal Triamcinolone For Diabetic Macular Oedema
Funder
National Health and Medical Research Council
Funding Amount
$167,733.00
Summary
A 25 fold increase in the risk of going blind on diagnosis of diabetes is one of the most daunting threats that patients face. Most cases of vision impairment in diabetes are due to macular oedema that persists or recurs after laser treatment. There are now a number of uncontrolled, anecdotal reports that intravitreal triamcinolone (IVTA) is highly effective for the treatment of diabetic macular edema which is refractory to conventional laser treatment. We commenced the first placebo-controlled, ....A 25 fold increase in the risk of going blind on diagnosis of diabetes is one of the most daunting threats that patients face. Most cases of vision impairment in diabetes are due to macular oedema that persists or recurs after laser treatment. There are now a number of uncontrolled, anecdotal reports that intravitreal triamcinolone (IVTA) is highly effective for the treatment of diabetic macular edema which is refractory to conventional laser treatment. We commenced the first placebo-controlled, double masked clinical trial of intravitreal triamcinolone for refractory macular oedema in 2002. The 3 month results from this study provide the first scientific proof of principle that intravitreal triamcinolone reduces macular thickness and improves vision. The two year results will be available in March 2005, but confidential interim analysis of efficacy data in September 2004 suggested that the beneficial effect of triamcinolone treatment persisted. Thus it appears that treatment with intravitreal triamcinolone may be the most significant development for the prevention of blindness in people with diabetes since the introduction of laser treatment. It would also be a highly cost-effective intervention that could be administered by general ophthalmologists. The treatment cannot be recommended for routine use, however, until its long term efficacy and safety have been established. Since we already have a well studied group of patients who have received treatment for 2 years, we are in a unique position to extend the study in order to provide the long-term (5-year) safety and efficacy data that does not appear to be forthcoming from any other source. The results of this study will significantly improve knowledge of long-term outcomes of local high dose steroids for diabetic macular oedema, allowing the treatment to be used more rationally. Thus the study is very likely to directly reduce the risk of blindness in people with diabetes.Read moreRead less
A Randomised Control Trial Of Physiotherapy And Corticosteroid Injections Of Lateral Epicondylalgia In Primary Care.
Funder
National Health and Medical Research Council
Funding Amount
$193,775.00
Summary
Musculoskeletal conditions account for the third leading cause of health systems expenditure in Australia. Lateral epicondylalgia (tennis elbow) is such a condition and is often treated in primary care. Both the individual and community are affected by this condition: 7 per 1000 patients seeing their medical doctor have this condition. Most are not tennis related. On average 10-30% of sufferers take 12 weeks off work. The condition may last 6-48 months and it tends to become stubborn to treatmen ....Musculoskeletal conditions account for the third leading cause of health systems expenditure in Australia. Lateral epicondylalgia (tennis elbow) is such a condition and is often treated in primary care. Both the individual and community are affected by this condition: 7 per 1000 patients seeing their medical doctor have this condition. Most are not tennis related. On average 10-30% of sufferers take 12 weeks off work. The condition may last 6-48 months and it tends to become stubborn to treatment and recurs often. Two popular treatment options that are commonly prescribed for the management of lateral epicondylalgia are physiotherapy and corticosteroid injections. To date there is little evidence supporting physiotherapy, especially current best practice methods such as manual therapy and therapeutic exercise. The lack of evidence is largely due to a small number of studies of physiotherapy, most of which are of poor quality and of treatments that are currently deemed to be less than optimal. A larger number of studies of corticosteroid injections have shown that corticosteroid injections are beneficial in the short term (3-6 weeks), but not over 12 months where they are associated with greater recurrence rates. Manual therapy has been shown to have short term pain relieving effects and therapeutic exercise exerts long standing improvements in this condition. It is proposed that the addition of manual therapy to therapeutic exercise will have superior short- and long-term effects. This project will conduct a randomised clinical trial to evaluate this proposition and also the factors associated with success, failure or recurrence rates. A cost-benefit analysis will also be conducted to calculate the relative economic merits of the treatments. A tangible outcome of this project will be the development of clinical guidelines for the most effective method of treating lateral epicondylalgia in primary health care.Read moreRead less
Australian Aquaculture - Practical Solutions To The Triple Bottom Line - A National Workshop
Funder
Fisheries Research and Development Corporation
Funding Amount
$63,910.00
Summary
Federal and state legislation is increasingly demanding more stringent environmental controls on aquaculture activities and place the onus of proof for demonstrating environmental performance on the industry. In addition, regulation for and approval of aquaculture activities is increasingly directed through state EPAs. There is thus a regulatory imperative to defining the ESD sustainability indicators for the aquaculture industry.
Public perception of the industry as environmentally u ....Federal and state legislation is increasingly demanding more stringent environmental controls on aquaculture activities and place the onus of proof for demonstrating environmental performance on the industry. In addition, regulation for and approval of aquaculture activities is increasingly directed through state EPAs. There is thus a regulatory imperative to defining the ESD sustainability indicators for the aquaculture industry.
Public perception of the industry as environmentally unsustainable is often not substantiated by scientific fact, but can have a detrimental affect on aquaculture development through objections to individual aquaculture planning applications. A negative public perception can also enhance the influence of uninformed pressure groups on Government policy development. This is a constraint to future development of the whole industry.
To address these two issues, there is a clear need to identify the issues related to various aquaculture sectors and develop protocols and frameworks through which organisations can demonstrate their compliance with environmental objectives. What is required is a national framework and standards for assessing the environmental performance of aquaculture. Additionally, industry needs to be equipped with practical tools and solutions for dealing with these issues.
The Standing Committee on Fisheries and Aquaculture (SCFA) adopted an ESD framework for fisheries in 1998 and a FRDC/SCFA-funded project has undertaken a number of case studies using this framework. To date the focus of SCFA framework case studies has been on wild fisheries. This approach needs to be expanded to a broader range of stakeholders involved in aquaculture and fine-tuned to ensure it is appropriate for all aquaculture systems and sectors.
In addition, internationally benchmarked environmental management systems (such as ISO 14000) are options that should be explored to implement ESD frameworks and have already been developed for aquaculture sectors in other parts of the world (Gavine et al 1996, Boyd, 1999).
Advantages for the aquaculture industry in adopting the principles of ESD and documenting environmental performance include:
(1) Improved public perception of the industry; (2) Reduction in waste and improved efficiency at site level; (3) A competitive advantage in the market place if accreditation is used as a branding tool; and (4) Ability to effectively engage new Government policies (such as Tradeable Emissions Policies).
This workshop will be the first step in bringing together the stakeholders to identify issues and develop practical solutions that will allow the Australian aquaculture industry to continue to develop in a sustainable manner.
Boyd, C. 1999. The aquaculture industry must learn to deal effectively with environmental issues, beginning with recognising the role of the different players involved. World Aquaculture 30 (2):10. Gavine, F. M., Rennis, D. S. and Windmill, D. 1996. Implementing environmental management systems in the UK finfish aquaculture industry. J.C.I.W.E.M 10, October: 341-347. Objectives: 1. To identify practical solutions to ESD issues which will enable aquaculture organisations to develop in a sustainable and cost effective manner. 2. To develop an action plan that achieves a) standard auditing and reporting protocols for environmental performance of aquaculture operations within and ESD framework and b) adapts the existing SCFA ESD framework to incorporate the requirements of aquaculture operations. Read moreRead less
Assisting Commercial And Recreational Organisations Adapt To National Maritime Safety Standards
Funder
Fisheries Research and Development Corporation
Funding Amount
$79,460.00
Summary
The Marine Safety (Domestic Commercial Vessel) National Law Act 2012 defines general safety obligations on both the Owner and Master. The Owner has a general safety obligation to implement and maintain a safety management system that ensures that the vessel and the operations of the vessel are, so far as reasonably practicable, safe. The Master also has a general safety obligation aboard the vessel to, so far as reasonably practicable, implement and comply with the safety management system for t ....The Marine Safety (Domestic Commercial Vessel) National Law Act 2012 defines general safety obligations on both the Owner and Master. The Owner has a general safety obligation to implement and maintain a safety management system that ensures that the vessel and the operations of the vessel are, so far as reasonably practicable, safe. The Master also has a general safety obligation aboard the vessel to, so far as reasonably practicable, implement and comply with the safety management system for the vessel and the operations of the vessel. http://www.amsa.gov.au/domestic/vessels-operations-surveys/certificates-of-operation/
The Australian Maritime Safety Authority (AMSA) is rolling out a program of risk management and SMS workshops to help industry meet the National Standard for Commercial Vessels, Part E Operations. A number of other organisation are also delivering SMS training to meet Part E. FRDC recognises that some industry sectors face particular challenges in accessing these programs, possibly due to location, timing, English language proficiency, or sector specific operations. These specific needs may be beyond the scope of these other programs. This funding will complement those programs by addressing these challenges.
The Australian Government’s Policy for a More Competitive and Sustainable Fisheries Sector (2013) included a commitment to assist commercial and recreational organisations adapt to National Maritime Safety Standards. Funding is provided by the Fisheries Research and Development Corporation on behalf of the Australian Government to deliver on this commitment.
Objectives: 1. Manage funding to help industry meet the National Standard for Commercial Vessels, Part E Operations Read moreRead less
A Case Study Into The Development Of OH&S Processes In The Pinctada Maxima Pearling Industry To Benchmark Worlds Best Industry Diving Practice
Funder
Fisheries Research and Development Corporation
Funding Amount
$71,656.00
Summary
At various periods, the lack of detailed information on the development and application of the pearl industry dive protocols has resulted in criticism of the industry's occupation health and safety performance from Coroners, Unions, Government, Statutory Organisations and other parties.
The review of OH&S processes and finalisation of the drift dive research will present a cogent, defensive argument of the Industry's safe diving practices. This will place Industry in a better position ....At various periods, the lack of detailed information on the development and application of the pearl industry dive protocols has resulted in criticism of the industry's occupation health and safety performance from Coroners, Unions, Government, Statutory Organisations and other parties.
The review of OH&S processes and finalisation of the drift dive research will present a cogent, defensive argument of the Industry's safe diving practices. This will place Industry in a better position to negate the need for future legislative or Industrial Relations initiatives by responsible departments and bodies because they will be better informed regarding pearling industry occupational health & safety standards.
The diving systems and protocols developed by the pearling industry would be applicable to similar diving industries. Without a review and documentation of the process by which they were developed and the results, it could limit those industries ability to adopt and develop their own appropriate economic and efficient systems of safe diving.
This review will also constitute an element of the required documentation for Worksafe WA to consider, examine and gazette a Pearling Industry Code of Practice. This Review will also contribute to the consistency of OH&S across WA fisheries.
There is a crucial need for an objective, factual measure of the safety being achieved by the pearling industry. The drift dive database was the tool used for this measurment, however it has become dysfunctional and requires upgrading to supply this measure. (This component of the proposed review comes under the State IDU Programme 5 - 'Information Systems' and Strategy 5.2 - ' Maintain a database of relevant information, and access to similar databases.'
It will also be a benchmark document by which further studies and research on divers health can refer to and build from. Objectives: 1. Write a brief history of the pearling industry focusing on the reasons and 'drivers' for the development of the OH&S processes and programs within the industry. 2. Compile, from all previous reports to FRDC & Fisheries, the Final Research Report on the drift diving profile research and summarise in the review report the results and principles applied to establish their safety. This Final Report is for the FRDC project 'IMPROVED HARVESTING EFFICIENCY OF PEARL OYSTERS THROUGH MODIFICATION OF DIVE PROFILES' (94/098) 3. Document the development process and implimentation of the PPA Diving Code of Practice that was developed in conjuction with Fisheries WA and Worksafe WA. 4. Update the PPA drift dive database and draft a statistical report from the dive data base, which will have logged the total manhours of drift diving over the past 10 years and correlate the reduction in decompression illness (DCI) incidents to the adoption of the research results. 5. Collect and summarise the international presentation papers of pearling industry systems by Dr. R. Wong. Briefly describe the fishing industries worldwide that have adopted the principles that underpin the pearl diving system as conveyed by Dr. Wong at international hyperbaric medical conferences. 6. Document the work done by the PPA in support of hyperbaric medicine including the provision, training and support of the recompression chamber facilities in Broome. 7. In support of the above objectives, to collect all source documents regarding OH&S in the pearl diving industry since the inception of the PPA (1989). (Dive mortalities, Incidents, Coroners reports, CoP development, Chamber Purchase, International Conference papers etc.) Read moreRead less
Quality And Safety Assurance In Marine Finfish Products - A Pilot Study
Funder
Fisheries Research and Development Corporation
Funding Amount
$78,690.00
Summary
Objectives: 1. To identify key reservoir sites for L monocytogenes at processing plants and determine environmental and other factors which are likely to permit multiplication of these organisms on the fish and/or in the processing plant 2. To assess the efficiency of currently recommended hygiene and decontamination procedures 3. To determine prevalences of the parasite in fish of different ages and kept in different geographic sites 4. To correlate any observed variations ....Objectives: 1. To identify key reservoir sites for L monocytogenes at processing plants and determine environmental and other factors which are likely to permit multiplication of these organisms on the fish and/or in the processing plant 2. To assess the efficiency of currently recommended hygiene and decontamination procedures 3. To determine prevalences of the parasite in fish of different ages and kept in different geographic sites 4. To correlate any observed variations in prevalence with factors such as age of fish, presence of possible intermediate hosts in the environment, etc Read moreRead less
SeSAFE - Delivering Industry Safety Through Electronic Learning
Funder
Fisheries Research and Development Corporation
Funding Amount
$692,000.00
Summary
The fishing industry ranks amongst the highest risk industries in Australia for safety, yet there are considerable barriers to basic safety training, including:
• Cost – operators cannot afford it • Time – Courses are infrequent throughout the year. This does not meet the operational needs of the industry, where workers may be required at short notice. • Location – Courses are usually delivered in major cities. This makes access to the training difficult for many workers .... The fishing industry ranks amongst the highest risk industries in Australia for safety, yet there are considerable barriers to basic safety training, including:
• Cost – operators cannot afford it • Time – Courses are infrequent throughout the year. This does not meet the operational needs of the industry, where workers may be required at short notice. • Location – Courses are usually delivered in major cities. This makes access to the training difficult for many workers, including once they are at sea. • Context – Courses are usually delivered in a classroom setting with activities related to survival in emergency situations at sea. They do not address general workplace safety such as manual handling, electrical safety, fall protection, noise, fatigue, hazardous substances, personal protective equipment (PPE), etc. • Access – The internet is rarely available at sea, making access to safety training and information impossible for much of the time workers are fishing. • Demographic – workers in the fishing industry are largely represented by young, early school leavers with a high sense of adventure and risk appetite. Learning must be structured with this in mind to ensure the learner is engaged and the lessons are delivered effectively. • Culture - the information both subliminal as well as overt sent out about safety.
The electronic LMS, which is the fundamental base for this project, is to be designed to address all of the above barriers, and provide a structured, cheap, easily accessible and timely safety course, in a manner which is readily absorbed and understood by the crew member undertaking the course. The training modules are to be delivered online and offline, making them accessible anywhere at any time and can also be tailored to specific industry sectors, while retaining the core units, and aim to achieve best practice in all aspects of WHS.
RIRDC initiated a project (attached) due to significant knowledge deficiencies in the area of commercial fishing occupational health and safety data and of the existing circumstances of the industry. The gaps in knowledge have arisen due to previous difficulties in collating and interpreting data, which have resulted from disaggregation of State data, creating difficulties in data analysis at the national level; availability of state data; and the nature of the fishing industry which results in many participants not being included in official statistics or records.
The report found that there was a lack of awareness of occupational health and safety, or safety culture, and that it still fails to be effectively dealt with across all States of Australia. The OHS data identifies that the claims for fatal injuries in aquaculture and non fatal in marine (or wild capture) fisheries are both increasing. The most ‘at risk’ group in the industry are those between the ages of 20 to 24 years, with those aged 45 – 54 years being the next most at risk group, who will receive injuries from non powered hand tools to their upper bodies. Objectives: 1. Design and trial the electronic Learning Management System in the Northern Prawn Fishery, and up to three other Australian domestic fisheries. Monitor the uptake, utility, and determine feedback on ease of use and applicability from the trials, to help make necessary modifications before distribution to others. 2. Create linkages and pathways for the LMS to be taken up by industry associations and agencies to be used in championing the improvement in safety culture and training with on-ground fishers. 3. Based on the trials, facilitate further development of 'fishery specific' modules via assistance from the PI and technical input from consultants (365 Solutions) to improve efficiency of the program and direct relevance to specific fisheries/sectors and/or agencies. 4. Utilise information from existing in-progress and under development safety projects funded by FRDC to ensure that the LMS is designed to optimise adoption and uptake by industry. 5. Identify and, where feasible, implement mechanisms to integrate the LMS into the overall marine safety program aimed at changing the culture and behaviour towards safety of the fishing industry. Read moreRead less