Body Composition Changes In Cardiac Cachexia: Pathophysiology, Quantification And Approaches To Therapy
Funder
National Health and Medical Research Council
Funding Amount
$120,000.00
Summary
Cachexia is weight loss and weakness caused by disease, or as a side effect of illness. Congestive heart failure is a common cardiovascular condition that is accompanied by high mortality (up to 50% over 2 years) and considerable suffering. People with congestive heart failure often develop cachexia. This project will explore the mechanisms responsible for the development of cachexia using an animal model of cardiac cachexia that the researchers have developed. It will be complemented by an exam ....Cachexia is weight loss and weakness caused by disease, or as a side effect of illness. Congestive heart failure is a common cardiovascular condition that is accompanied by high mortality (up to 50% over 2 years) and considerable suffering. People with congestive heart failure often develop cachexia. This project will explore the mechanisms responsible for the development of cachexia using an animal model of cardiac cachexia that the researchers have developed. It will be complemented by an examination of the effects of exercise on measures of cachexia in patients with congestive heart failure. The researchers believe that this study will supply valuable new information about the development of cachexia and lead to new therapies for this syndrome.Read moreRead less
Palliative Care For Aboriginal And Torres Strait Islander People With End-stage Renal Disease: An Action Research Initiati
Funder
National Health and Medical Research Council
Funding Amount
$295,554.00
Summary
There are significant gaps in current knowledge for providing culturally appropriate and effective palliative care for Aboriginal and Torres Strait Islander people with kidney failure. This project will consider these issues in partnership with the Kowanyama Community and the associated key Aboriginal and Torres Strait Islander and other agencies. Echoing the recommendations by the �National Indigenous Palliative Care Needs Study� this study will address the absence of a culturally appropriate m ....There are significant gaps in current knowledge for providing culturally appropriate and effective palliative care for Aboriginal and Torres Strait Islander people with kidney failure. This project will consider these issues in partnership with the Kowanyama Community and the associated key Aboriginal and Torres Strait Islander and other agencies. Echoing the recommendations by the �National Indigenous Palliative Care Needs Study� this study will address the absence of a culturally appropriate model of care pathway for Aboriginal and Torres Strait Islander people with advanced kidney failure to make effective informed choices for palliative care. Through the use of action research methodology this study will engage with Aboriginal and Torres Strait Islander people to consider these issues, taking into consideration their cultural, spiritual and social needs, those of their family, carers, healthcare personnel and the wider community. Subject to discussions and input from the Aboriginal and Torres Strait Islander people and other key stakeholders it is anticipated that the key areas of interest will focus on spirituality, quality of life, role of the family, carer and community, understandings and experience of kidney failure, treatment options, patient advocacy systems, the need for relocation, and the potential role of advanced care planning. Intervention strategies will also be conducted and evaluated. Subject to discussions and input from the Aboriginal and Torres Strait Islander participants and other key stakeholders it is anticipated that these will focus on a community based education program, development of a culturally appropriate quality of life questionnaire, development and piloting of a culturally appropriate mechanism for people to consider advanced care planning and development and piloting of a patient advocacy process for those from remote areas visiting metropolitan renal - palliative care health services.Read moreRead less
Detection And Management Of Depression In General Practice Patients With Chronic Manifestations Of Ischaemic Heart Disea
Funder
National Health and Medical Research Council
Funding Amount
$499,797.00
Summary
This research will investigate the impact of ischemic heart disease on the prevalence and severity of patients with depression. This will be done via a 12 month general practice based program of 1) systematic screening for depression 2) informing general practitioners of best-practice guidelines for management of depression in these patients, and 3) providing the treating general practitioner with patient-specific, psychiatric advice.
Oxygen To Relieve Dyspnoea In Non-hypoxaemic Patients With End-stage Heart Failure
Funder
National Health and Medical Research Council
Funding Amount
$445,658.00
Summary
Chronic heart failure is a cause of suffering and a major cause of death in the Australian community. Patients who have chronic heart failure suffer from a range of symptoms that severely impacts every aspect of their life. One of the most common and distressing symptoms is breathlessness. As people with heart failure near death, their breathlessness may worsen not only in terms of its frequency, but also in its intensity. This worsening of symptoms is a source of great distress, both to patient ....Chronic heart failure is a cause of suffering and a major cause of death in the Australian community. Patients who have chronic heart failure suffer from a range of symptoms that severely impacts every aspect of their life. One of the most common and distressing symptoms is breathlessness. As people with heart failure near death, their breathlessness may worsen not only in terms of its frequency, but also in its intensity. This worsening of symptoms is a source of great distress, both to patients as well as their carers and family. Breathlessness is also the most common cause of admission to hospital for patients. A key strategy for managing this distressing symptom in the home is the supply of oxygen. However, due to a lack of scientific evidence for the benefit of home oxygen for people with heart failure, who do not necessarily have low levels of oxygen, it is very difficult for clinicians to access this therapy for their patients. This study seeks to assess if a specific breathlessness action plan alone or if the addition of either oxygen or air can relieve this distressing symptom. The scientific evaluation of these strategies will assist in improving the palliative care of people with chronic heart failure.Read moreRead less
Which Heart Failure Intervention Is Most Cost-effective And Consumer Friendly In Reducing Hospital Care: The Which
Funder
National Health and Medical Research Council
Funding Amount
$921,640.00
Summary
Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. ....Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. We confirmed the results of pioneering Australian research that CHF-MPs dramatically improve health outcomes in CHF. CHF-MPs now form part of the recommended gold-standard management of CHF. However, we also have evidence that only a small proportion of patients are exposed to a CHF-MP in Australia. Residual issues such as consumer preference and the cost of applying these programs are hindering their wide-spread application. The WHICH? Study addresses this _road block� to implementing a potentially valuable health care service by tackling a number of critical issues: which form of CHF-MP (home or specialist clinic-based follow-up), will produce the best health outcomes, save the most money and meet the needs of consumers at the same time? To answer this question, we will undertake a randomised, head-to-head study of a home versus clinic-based CHF-MP, in 1000 recently hospitalised CHF patients recruited from SA, VIC, NSW and QLD. Patterns and of health care and consumer preferences and quality of life will then be compared for these two different forms of CHF-MP from a combined health economic, health policy and consumer perspective to determine the best form of CHF-MP to be applied. A _consensus� vision for applying an Australia-wide service will then be developed. The potential impact of the results of the study will then be modelled on the status of Australian CHF-MPs in the year 2010 and a blue-print for action devised.Read moreRead less
An Investigation Of Care Planning Decisions In Advanced Pulmonary And Cardiac Illness In The Bayside Health Care Region
Funder
National Health and Medical Research Council
Funding Amount
$47,726.00
Summary
There has been little Australian research to develop interventions that facilitate end of life decision making. This project will provide a framework for understanding the issues in the planning of end of life care for people with chronic and life limiting illness and the relationship of this planning to organizational policy. The care decisions in hospital records of people with advanced lung and heart disease will be reviewed and people with those diseases interviewed about the issues they exp ....There has been little Australian research to develop interventions that facilitate end of life decision making. This project will provide a framework for understanding the issues in the planning of end of life care for people with chronic and life limiting illness and the relationship of this planning to organizational policy. The care decisions in hospital records of people with advanced lung and heart disease will be reviewed and people with those diseases interviewed about the issues they experience in planning their future care. Professionals from a range of health organisations will be interviewed about their experiences of care planning for people with life limiting lung and heart disease. As a pilot, this project will be used to contribute to the development of a model for a coordinated multidisciplinary process that brings together the health care services in a region and contributes to the systematic, ongoing development of infrastructure to improve end of life care.Read moreRead less
Improving Care Of The Dying With Chronic Heart Failure
Funder
National Health and Medical Research Council
Funding Amount
$130,000.00
Summary
Chronic heart failure is increasing in prevalence and is primarily a condition of ageing. Although chronic heart failure has worse outcomes than many cancers, patients are often denied the benefits of palliative care with its emphasis on symptom management, spirituality, emotional health and focus on family issues. This project seeks to assess the state of knowledge in Australia related to palliative care in chronic heart failure. Guidelines and care maps appropriate to Australian conditions wil ....Chronic heart failure is increasing in prevalence and is primarily a condition of ageing. Although chronic heart failure has worse outcomes than many cancers, patients are often denied the benefits of palliative care with its emphasis on symptom management, spirituality, emotional health and focus on family issues. This project seeks to assess the state of knowledge in Australia related to palliative care in chronic heart failure. Guidelines and care maps appropriate to Australian conditions will be developed and their usefulness assessed in improving care of patients and their families.Read moreRead less
Investigation Of Neural Mechanisms Of 670 And 830nm Laser Acupuncture In Pain Relief, Using Rat
Funder
National Health and Medical Research Council
Funding Amount
$326,207.00
Summary
Background Chronic pain is common and costs $10 billion dollars per year in Australia. Drug therapies are widely used but serious side effects limit use. Patients actively seek non-drug treatments and laser acupuncture is one of the most commonly sought therapies for chronic pain, however, how it works is not well understood. Our previous work Researchers propose that laser acupuncture reduces pain by direct effects on nerves, altering how pain signals are transmitted to the brain. To investigat ....Background Chronic pain is common and costs $10 billion dollars per year in Australia. Drug therapies are widely used but serious side effects limit use. Patients actively seek non-drug treatments and laser acupuncture is one of the most commonly sought therapies for chronic pain, however, how it works is not well understood. Our previous work Researchers propose that laser acupuncture reduces pain by direct effects on nerves, altering how pain signals are transmitted to the brain. To investigate this we (CI A and CI B) previously undertook a study of infrared laser on nerve cell cultures. This followed on from a positive clinical study with the same laser wavelength in the treatment of neck pain, undertaken by CI B. We established that laser temporarily interrupts the nerve transport system, which is made up of a series of minute tubes, called microtubules. These act as a “monorail” system for transport of mitochondria, which provide energy for all nerve functions. We propose that temporary interruption of this system, called fast axonal transport, disrupts the conduction of pain signals along the nerve, resulting in pain relief. Important unanswered questions The mechanism by which 830nm laser acupuncture relieves pain clinically remains poorly understood. For its acceptance into mainstream clinical practice it is important to determine the effect of laser on the peripheral nerves and in particular the pain carrying fibres. We know from an earlier study that a single exposure causes significant but reversible changes in pain fibres including axonal microtubule disruption, decrease in mitochondrial membrane potential and block of fast axonal flow. These events would result in conduction failure. The question is whether the repeated irradiations, comparable to those delivered clinically result in the same changes. This would provide a scientific basis for understanding the clinical effectiveness of laser acupuncture. We also do not know if 670nm laser acupuncture would act in the same way. There is evidence that this may be more effective so that this remains another important unanswered question. Further, there is no evidence regarding which wavelength would be cost and time effective as it is desirable to deliver lower dose. We need to determine the most effective dose and wavelength so that clinical trials could be carried out as was done for the trials by CIB (Chow and Barnsley, 2006).Read moreRead less