Developing Improved Management For Peripheral Artery Diseases
Funder
National Health and Medical Research Council
Funding Amount
$569,219.00
Summary
~1 million Australians have peripheral artery disease. The current application is for a Practitioner Fellowship to support my research aimed at improving care of artery disease. The aim of the work is to develop improved management approaches for patients with blocked and weakened arteries. This work is particularly important given the recognised management deficiencies for patients with artery disease and the relative little research being undertaken in this area.
Ankle Brachial Index Determination By Oscillometric Method IN General Practice (ABIDING)
Funder
National Health and Medical Research Council
Funding Amount
$128,935.00
Summary
People who have peripheral arterial disease (PAD) have blockages of the circulation to their legs. If you have PAD you have blood vessel disease throughout the body and are very likely to have a heart attack or experience a stroke. PAD can be diagnosed simply by comparing the blood pressure in the arms and legs. Until now this needed a special costly instrument. New blood pressure machines can do this without this instrument. We want to know how reliably this can be done by practice nurses.
The Effect Of Stress/strain And Fatigue Fracture Sites On Durability Of Modular Aortic Endografts And Arterial Walls
Funder
National Health and Medical Research Council
Funding Amount
$300,919.00
Summary
Aneurysmal disease is an age related phenomenon. The mean life expectancy of western populations has doubled in 100 years because of the reduction in deaths from preventable and treatable diseases, and prolongation of life with chronic and incurable diseases. The older community (>65 years) continues to be active and productive contrary to prior predictions. Aneurysmal disease has emerged as a result of the changing pattern of diseases in the community. As with many other diseases, prophylaxi ....Aneurysmal disease is an age related phenomenon. The mean life expectancy of western populations has doubled in 100 years because of the reduction in deaths from preventable and treatable diseases, and prolongation of life with chronic and incurable diseases. The older community (>65 years) continues to be active and productive contrary to prior predictions. Aneurysmal disease has emerged as a result of the changing pattern of diseases in the community. As with many other diseases, prophylaxis against aneurysmal disease is the most effective approach since 80% of those that rupture will result in death. Endoluminal grafting provides a much less invasive procedure and provides an attractive and elegant alternative to open surgery. The danger is that structural strengths will be compromised with failures due to lack of strength and inadequate device durability. The most practical endografts are those that are built up from modules but vulnerable sites affected by fatiguing and disruptive forces are being identified, in particular where a tube divides into two outflow channels – the bifurcation - and joins. To improve and protect the current device, and enable sound engineering for future devices, we need to know the nature, magnitude and location of these forces. The existing collaboration with medical specialist, Cook Aust., the Advanced Fluid Dynamics Laboratory (CSIRO, Melb.) and University of WA combines a multidisciplinary team working towards the design and durability of the next generation of endoluminal devices and percutaneous insertions. While Australia is at the forefront of development, its current place in the market can only be maintained by further product development. Optimising and improving endoluminal grafts will reduce the suffering of major surgery while prolonging a higher quality of life with a much less invasive procedure whose long-term effectiveness, and thereby acceptance is dependent upon reliable durability.Read moreRead less
Atherosclerosis: Molecular Mechanisms Of Suppression By CD4+CD25+ Regulatory T-cells
Funder
National Health and Medical Research Council
Funding Amount
$535,333.00
Summary
Atherosclerosis, or hardening of large arteries is the underlying cause of up to 50% of deaths in Western communities, primarily from heart attacks and strokes. Today it is considered a chronic inflammatory disease arising from the accumulation of fats such as cholesterol into the inner lining of blood vessels including those supply vital organs such as the heart and brain. This study focuses on understanding how to use the body's own anti-inflammatory cells suppress inflammation.
Atherosclerosis: Molecular Action And Suppression Of NKT Cell Subsets
Funder
National Health and Medical Research Council
Funding Amount
$458,815.00
Summary
Atherosclerosis, or hardening of large arteries, is the underlying cause of up to 50% of deaths in Western communities from heart attacks and strokes. Today it is considered a chronic inflammatory disease arising from the influx of fats such as cholesterol into the inner liming of arteries that provide blood supply to organs such as the heart and the brain. However, the exact role that inflammation plays in the development of this blood vessel disease is poorly understood. This study is directed ....Atherosclerosis, or hardening of large arteries, is the underlying cause of up to 50% of deaths in Western communities from heart attacks and strokes. Today it is considered a chronic inflammatory disease arising from the influx of fats such as cholesterol into the inner liming of arteries that provide blood supply to organs such as the heart and the brain. However, the exact role that inflammation plays in the development of this blood vessel disease is poorly understood. This study is directed towards understanding the role of a subset of while blood cells known as NKT cells in the inflammatory process. In particular we will examine whether the activity of NKT cells in promoting atherosclerosis can be controlled either by the administration of drugs that deprive them of molecules that stimulate their activity and-or by the injection of another population of white blood cells known as regulatory T cells that may to limit their activity. Our preclinical study of atherosclerosis in mice has potential for extension to the control of atherosclerosis in humans. Successful translation in this way can be expected to provide a significant health benefit.Read moreRead less
Randomised Trial Of Continuity Of Nursing Care In Vascular Surgery
Funder
National Health and Medical Research Council
Funding Amount
$190,648.00
Summary
Both overseas (Bruni, Hoosier-Paty and Hoffman 1996) and in Australia (Norman, Semmens, Laurence-Brown and Holman, under review), surgeons have become increasingly aware of the need to improve outcomes for patients undergoing arterial surgery for the lower limb. Unlike other areas of health care reform such as cardiac surgery or breast cancer, there is little confidence that the current links between acute facilities, community-based health services and general practice, work optimally together. ....Both overseas (Bruni, Hoosier-Paty and Hoffman 1996) and in Australia (Norman, Semmens, Laurence-Brown and Holman, under review), surgeons have become increasingly aware of the need to improve outcomes for patients undergoing arterial surgery for the lower limb. Unlike other areas of health care reform such as cardiac surgery or breast cancer, there is little confidence that the current links between acute facilities, community-based health services and general practice, work optimally together. Peripheral vascular disease is rarely studied. In NSW, there are about 4200 inpatient episodes for arterial surgery for ischaemia of the lower limb each year (AN-DRG 228 - 232), the majority involving older men. This study brings together a multi-disciplinary team of CIs comprising an academic nurse, two vascular surgeons and an expert in outcomes evaluation to conduct a randomised trial (n-586) of continuity of nursing care for patients admitted for arterial surgery of the lower limb. The intervention is comprised of a 'Patient Stay' Flowchart, continuing postoperative in-patient nursing assessment and staff consultation, Patient Education Discharge Booklet, Patient - Family Care Plan; proactive and reactive telephone follow-up and extensive GP liaison. Blinded outcome evaluation at six and twelve months will compare its differential effectiveness against usual care to which only the Patient Stay' Flowchart has been added. We will generate Level 2 evidence for the effectiveness of continuity of nursing care in improving outcomes for patients undergoing arterial surgery for ischaemia of the lower limb. To our knowledge, this would be the first Australian efficacy trial of its type.Read moreRead less
Fenofibrate In The Management Of AbdoMinal Aortic AnEurysm (FAME)
Funder
National Health and Medical Research Council
Funding Amount
$455,713.00
Summary
Approximately 5% of men and 1% of women aged over 60 years develop weakening of the main abdominal artery. Currently the management of artery weakening is focused on surgery with no effective medications available. In this study we will assess whether a drug which limits artery weakening in pre-clinical testing also shows evidence of inhibiting processes important in artery damage in patients. We believe this is a critical next step in the assessment of a promising new treatment.
Our studies are aimed at examining how blood flow and pressure is controlled in the various tissues of the body. In particular, we hope to improve our understanding of how blood flow is matched to local metabolic requirements and how a constancy of conditions can be maintained despite changes in overall blood pressure. This ability to control local blood flow occurs through the ability of very small arteries to rapidly adjust their diameters through vasoconstriction or vasodilatation. The vessel ....Our studies are aimed at examining how blood flow and pressure is controlled in the various tissues of the body. In particular, we hope to improve our understanding of how blood flow is matched to local metabolic requirements and how a constancy of conditions can be maintained despite changes in overall blood pressure. This ability to control local blood flow occurs through the ability of very small arteries to rapidly adjust their diameters through vasoconstriction or vasodilatation. The vessels can thus act as valves regulating the transfer of blood flow and pressure to smaller vessels downstream. One particular response that small arteries exhibit is the ability to constrict when pressure within the vessels increases. The increase in pressure appears to stretch the vessel wall which in turn initiates a series of mechanical and biochemical steps that ultimately lead to contraction of muscle cells within the vessel wall. By contracting, the vessels limit the increase in downstream flow and pressure that would be expected to occur. The vessels being studied are very small, typically less than 100 micron. They are studied under isolated and controlled conditions using microscope and computer-based imaging techniques. While this allows us to directly monitor changes in vessel diameter to various stimuli (e.g. a change in pressure) we have also had to miniaturize biochemical measurements so we can understand the chemistry which underlies these vasoconstrictor responses. Understanding of how these local blood regulatory mechanisms occur is not only relevant to our understanding of the normal situation but is also vital to understanding disease states. For example, this work is very relevant to common cardiovascular disorders such as hypertension. It is hoped that a detailed understanding of the biochemical pathways by which small arteries contract will allow the design and targeting of pharmaceutical approaches for treatment of vascular disease states.Read moreRead less
HMGB1, A Cytokine Linking Inflammation, Lipid Accumulation, And Platelet Activation In Atherosclerosis
Funder
National Health and Medical Research Council
Funding Amount
$519,715.00
Summary
Atherosclerosis, or hardening of large arteries is the underlying cause of up to 50% of deaths in Western communities, primarily from heart attacks and strokes. Today it is considered a chronic inflammatory disease arising from the accumulation of fats such as cholesterol into the inner lining of blood vessels including those supplying vital organs such as the heart and brain. This study focuses on understanding how a major inflammatory factor, HMGB1, influences this disease process.
Mechanisms, Biomarkers And New Therapies For Abdominal Aortic Aneurysm
Funder
National Health and Medical Research Council
Funding Amount
$551,370.00
Summary
Approximately 5% of men and 1% of women aged over 60 years develop artery weakening. The management of artery weakening is currently focused on radiological imaging and surgery. In this fellowship work will be performed to better understand the mechanisms involved in artery weakening, assess new ways of monitoring disease progression and evaluate new medical therapies. It is envisaged that the work will identify a number of new management stratergies for this common condition.