A Randomised Control Trial Of Non-specific Clinical Management Versus CBT In Chronic Anorexia Nervosa
Funder
National Health and Medical Research Council
Funding Amount
$555,843.00
Summary
Anorexia nervosa (AN) is a serious mental illness that usually starts in adolescence and often runs a chronic course. With an estimated prevalence rate between 0.5% and 3.7% of women, and up to 50% remaining chronically ill, the illness poses a disproportionate burden on health and social services. AN has inpatient costs alone that exceed that for schizophrenia. Chronic AN has the highest mortality rate of any mental illness. Chronic AN patients are known for their ambivalence about engaging in ....Anorexia nervosa (AN) is a serious mental illness that usually starts in adolescence and often runs a chronic course. With an estimated prevalence rate between 0.5% and 3.7% of women, and up to 50% remaining chronically ill, the illness poses a disproportionate burden on health and social services. AN has inpatient costs alone that exceed that for schizophrenia. Chronic AN has the highest mortality rate of any mental illness. Chronic AN patients are known for their ambivalence about engaging in treatment and poor motivation to change their eating disorder behaviours. They often fail to respond to traditional treatments and develop a history of negative treatment experiences and repeated treatment failures. A new approach is needed to reduce both the personal suffering and the burden of the illness on social and medical services. To date, there has been little scientific investigation into the development of specific treatment for those patients with chronic AN. This study will trial a recently manualised therapy - non-specific supportive clinical management - which initial evidence suggests may hold promise for chronic AN because it offers a more indirect, motivationally-matched approach. This treatment will be compared to the establishment therapy Cognitive Behavioural Therapy. Patients will be randomly allocated to one of the two treatment conditions and will receive 40 sessions over 12 months. They will be thoroughly assessed prior to during and after they have completed treatment and followed up for 6 months. This is the worlds first trial of a psychological treatment for chronic AN; it is hoped the study will establish an effective treatment for this debilitating and expensive illness. Further, as the project aims to explore the core, but often over-looked, feature of AN - poor motivation for recovery - it will also be in a position to shed light on the deep psychological processes that maintain this illness.Read moreRead less
Development Of A Health-related Quality Of Life Instrument For Children With Cerebral Palsy
Funder
National Health and Medical Research Council
Funding Amount
$114,000.00
Summary
This project aims to develop and test a measure of quality of life for children with cerebral palsy (CP). This is a new project of international significance that has been recommended as the highest research priority of the United Cerebral Palsy Association with the strong support of CP researchers and clinicians internationally. CP remains the most common cause of physical disability in childhood, with an incidence of 2-2.0-2.5 per 1,000 live births. Described as a 'non-progressive motor impair ....This project aims to develop and test a measure of quality of life for children with cerebral palsy (CP). This is a new project of international significance that has been recommended as the highest research priority of the United Cerebral Palsy Association with the strong support of CP researchers and clinicians internationally. CP remains the most common cause of physical disability in childhood, with an incidence of 2-2.0-2.5 per 1,000 live births. Described as a 'non-progressive motor impairment of central origin recognised in infancy or childhood', CP presents as a static lesion on the brain characterised by progressive muscoskeletal deformity. Its impact on children and families is profound, resulting in extensive and life-long burden of care for families, and significant limitations to children's development and wellbeing. The management of the neuromuscular sequelae and health problems is a considerable cost to the health system because children require frequent visits for medical management, surgical procedures and rehabilitation. Trials of CP management effectiveness are hampered by the absence of patient outcome measures. Whilst new treatment options aim to provide substantial improvements in impairment and functioning they have disadvantages. For example, spasticity management includes Botulinum toxin A and intrathecal baclofen, both may improve function but are costly and invasive; treatments for ambulation (multi-level orthopaedic surgery) offer improved gait and mobility but require extensive rehabilitation; treatments for severe eating difficulties and poor growth (gastrostomy) may improve survival but result in aggravation of gastro-oesophageal reflux; and surgery for intractable epilepsy may improve seizure disorder but result in functional deficits. Quality of life is now a mandatory component of clinical trial research; valid and reliable tools sensitive to detecting change are urgently required.Read moreRead less
This Study aims to answer the question: When is the best time for adults with kidney disease to start dialysis? This question is currently a subject of intense international debate. It has been suggested that patients who commence dialysis relatively early, when they still have a high level of remaining kidney function, have fewer complications, maintain a better level of function in the community and are less likely to die as a result of their kidney disease. However, this has not been determin ....This Study aims to answer the question: When is the best time for adults with kidney disease to start dialysis? This question is currently a subject of intense international debate. It has been suggested that patients who commence dialysis relatively early, when they still have a high level of remaining kidney function, have fewer complications, maintain a better level of function in the community and are less likely to die as a result of their kidney disease. However, this has not been determined in a rigorous scientific manner. In fact starting dialysis earlier may expose the person to the risks associated with the use of dialysis and may also impact on their quality of life. Many international kidney societies have formulated guidelines recommending that dialysis should be commenced early - when the remaining kidney function drops to a level of approximately 10-15% of normal kidney function. Recent practice in Australia and New Zealand has been to commence dialysis when the remaining kidney function is between 6 and 9% of normal. Hence, the adoption of these guidelines recommending an earlier dialysis start time will have a significant impact on health costs; therefore a net benefit to the patient and the community, needs to be demonstrated. To answer this important question, we have designed and instituted a multi-center trial, that was commenced in 2000. The trial has been scientifically designed (randomised controlled trial) to compare the effect of early start dialysis (remaining kidney function between 10-14%) versus late start dialysis (remaining kidney function between 5-7%) on survival, disease and dialysis complications and subsequent hospitalization. To date 748 of the required 800 patients have been entered into the trial and will be followed for a minimum of 3 years. We are confident the results of this trial will impact at a local, national and international level, delineating best practice management of dialysis in people with kidney failure.Read moreRead less
Establishing The Safety And Effectiveness Of A Diagnostic Therapeutic Trial For Asthma In Community Elderly
Funder
National Health and Medical Research Council
Funding Amount
$397,155.00
Summary
Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 5 ....Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 55 years. There are clear patient and system factors that contribute to under diagnosis. The patient factors are currently being addressed in a general practice patient pilot study. System issues make the diagnosis of asthma in general practice a difficult task. The study is important, as older people are more likely to access the general practitioner than a specialist for respiratory problems. Spirometry in general practice is not common and is of variable quality. The most common approach to diagnosis by the general practitioner is a diagnostic trial of medication to provide evidence of asthma. This can be broken down into four elements of: entry criteria to a therapeutic trial; choice of drug in a therapeutic trial; length of time for a therapeutic trial, and; assessment criteria in a therapeutic trial. No evidence-based guidelines are available to assist the general practitioner in each of these stages making the therapeutic trial a safety and effectiveness issue of major importance, especially in the older person. The purpose of the study proposed is to conduct a randomised controlled trial in a representative population sample of older people to determine the evidence-based components of a diagnostic therapeutic trial for the guidance of general practitioners. The study will also assess which diagnostic questions and medical tests provide greatest assistance to the general practitioner in diagnosing asthma in the older person.Read moreRead less
Certain Death In Uncertain Time: A Qualitative Study Of The Experience Of Advanced Ovarian Cancer.
Funder
National Health and Medical Research Council
Funding Amount
$221,755.00
Summary
Modern medicine aims to find effective treatments for life-threatening diseases. Cures are seldom found, however. More typically, rapidly fatal diseases gradually become less rapidly fatal. Consequently, there is a category of patients who are certain they will die from their disease or a related factor, but who are equally uncertain as to whether they have weeks or years left to live. It is difficult to discuss this predicament because we do not even have a name for it, let alone a useful termi ....Modern medicine aims to find effective treatments for life-threatening diseases. Cures are seldom found, however. More typically, rapidly fatal diseases gradually become less rapidly fatal. Consequently, there is a category of patients who are certain they will die from their disease or a related factor, but who are equally uncertain as to whether they have weeks or years left to live. It is difficult to discuss this predicament because we do not even have a name for it, let alone a useful terminology to describe it. The absence of discussion exacerbates patients' social isolation. Also, the quality of their remaining life, and the quality of the care they get, depends heavily on the quality of understanding and communication within the social systems that support them. A growing proportion of patients in developed countries fall into this category, including the 1200 Australian women who are diagnosed each year with advanced ovarian cancer. This study aims to increase our understanding of the experience of certain death in uncertain time by recruiting a group of 20 women with advanced ovarian cancer, and interviewing them every few months over three years. The study will explore all aspects of the experience of having advanced ovarian cancer, and generate a terminology for it - one that grows out of the women's own language. The study will inform the organisation and delivery of clinical care and services to women with ovarian cancer. It will also inform patient education programs, and help to tune medical education to the particular needs and perceptions of patients who are experiencing the certainty of death in uncertain time. Finally, the researchers will also explore the implications of the findings for medical ethics and health law, and for communication, information and decision-making in cancer medicine.Read moreRead less