Evaluation Of Multidisciplinary Care Plans For Patients With Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$83,500.00
Summary
Care planning for patients with chronic illnesses and complex needs is a major part of the Commonwealth Enhanced Primary Care package. This initiative, announced in late 1999, provides access to Medicare Benefits Schedule (MBS) items to remunerate general practitioners, involved in developing multidisciplinary care plans in cooperation with other health care providers. An issue of importance, and the one that this project investigates, is whether disease specific care is addressed in care plans ....Care planning for patients with chronic illnesses and complex needs is a major part of the Commonwealth Enhanced Primary Care package. This initiative, announced in late 1999, provides access to Medicare Benefits Schedule (MBS) items to remunerate general practitioners, involved in developing multidisciplinary care plans in cooperation with other health care providers. An issue of importance, and the one that this project investigates, is whether disease specific care is addressed in care plans and whether the care planning process is associated with improved provision and outcomes of care for a specific chronic illness. The chronic illness that has been chosen for this research project is diabetes because of its prevalence in the community, importance in general practice and because there are accepted standards of process and outcomes of care against which diabetes care contained in EPC care plans can be bench marked. Diabetes is estimated to affect 7.5% of the adult Australian population with more than 85% of those affected having type 2 or mature onset diabetes. Increasingly care of type 2 diabetes is provided in primary care under share care arrangements with specialist diabetes services and in a multidisciplinary team approach involving the patient and their carer as well as relevant health professionals. A recent review has shown that there is a lack of evidence on whether multidisciplinary care is associated with improved process and outcomes of diabetes care. The project will involve 50 general practitioners and 200 of their patients with diabetes in South West Sydney. The design of the project involves audit of the care plans to examine the extent and quality of the diabetes care contained in comparison to accepted benchmarks. The project will also audit the patients' medical records for the year of care before and after the care plan. This care will be compared to published guidelines for process of care and goals for outcomes.Read moreRead less
A Cluster Randomised Controlled Trial Of Nurse And General Practitioner Partnership For Care Of COPD
Funder
National Health and Medical Research Council
Funding Amount
$449,377.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD w ....Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD were published in 2003 but these need to be implemented in the community. General practice is well placed to have a key role in early intervention and evidence based management of COPD. There is evidence that specialised nurses working in collaboration with GPs can improve the care the chronic illnesses including COPD. Care Plans with input from health professionals from a range of disciplines have been recommended for COPD but there are barriers to implementing these in general practice. This project brings together nurse assistance and care planning in a model of care designed to deliver best practice management of COPD in the community. The aim of this research is to evaluate the impact of anurse and GP partnership for care of COPD. We will examine the effect on quality of care and health outcomes at 6 and 12 months follow up. Our hypothesis is that the use of a nurse to work as a team with the patient and GP to develop and implement a care plan based on clinical practice guidelines will improve the quality of care received and have a beneficial effect on the patients' respiratory and overall health. This research will be of major significance for improving COPD care in the community and will have far reaching implications for both policy and practice. It will also define a new role for nurses and GPs working in partnership.Read moreRead less
Genetic Analysis Of Cell Death Pathways, Drug Resistance And Oncogenic Co-operativity In IL-3 Dependent Cell Lines
Funder
National Health and Medical Research Council
Funding Amount
$445,270.00
Summary
The ultimate fate of most of our cells is to die by committing suicide, because they are no longer required, are no longer functioning, or are potentially harmful. This normal physiological process is termed apoptosis . Inappropriate apoptosis can contribute to cell loss following heart attacks, stroke or neurodegenerative diseases, such as Alzheimer s or Parkinson s disease. Conversely, when cell death fails to occur, abnormal cells can accumulate and lead to cancer. In addition, because drugs ....The ultimate fate of most of our cells is to die by committing suicide, because they are no longer required, are no longer functioning, or are potentially harmful. This normal physiological process is termed apoptosis . Inappropriate apoptosis can contribute to cell loss following heart attacks, stroke or neurodegenerative diseases, such as Alzheimer s or Parkinson s disease. Conversely, when cell death fails to occur, abnormal cells can accumulate and lead to cancer. In addition, because drugs that are used to treat cancer may exert their effect by inducing apoptosis, a failure of this suicide response may cause resistance to chemotherapy. The genes of the apoptosis pathway function either to promote or inhibit cell death. We have found that some genes in the apoptosis pathway allow apoptosis to proceed rapidly, but do not decide the fate of the cell. Other genes are required for a cell to commit to die. If these genes are mutated then apoptosis does not occur and a functional cell may survive. The distinction between cells that decide fate and those that do not is crucial because it is only the genes that decide cell fate that can act as cancer genes, and are valid targets for therapy. We use a model in which apoptosis is caused by removal of a growth factor, using cell lines derived from mice that lack particular genes in the cell death pathway. These cells proliferate normally in the presence of growth factor, and allow us to determine the role of the genes when growth factor is withdrawn. Because these cells are sensitive to chemotherapeutic drugs, we can also determine the contribution these genes make to cancer drug sensitivity. Using this system, we have discovered that Puma, a gene known to be required for apoptosis in response to radiation, is also a critical activator of apoptosis following growth factor withdrawal. We will determine the manner in which Puma is regulated by growth factors, as well as identify and characterise other key components.Read moreRead less
The Regulation Of 14-3-3 Protein Function By Post-translational Modification
Funder
National Health and Medical Research Council
Funding Amount
$212,036.00
Summary
The cells of our body have control mechanisms that prevent them from growing abnormally. However, when cells become cancerous they escape the normal checks and controls and are able to survive, divide and grow uncontrollably. In the last decade the molecular basis of several of the control mechanisms involved in preventing cancerous growth have been uncovered. However, our understanding is far from complete and recent research reports suggest that we have thus far overlooked a whole level of reg ....The cells of our body have control mechanisms that prevent them from growing abnormally. However, when cells become cancerous they escape the normal checks and controls and are able to survive, divide and grow uncontrollably. In the last decade the molecular basis of several of the control mechanisms involved in preventing cancerous growth have been uncovered. However, our understanding is far from complete and recent research reports suggest that we have thus far overlooked a whole level of regulation of cell growth control. Signals that instruct a normal cell to divide are propogated by pathways of interacting molecules within the cell. These pathways are regulated by switch mechanisms that either modify the interacting molecules, thereby inactivating their activity or by controlling when and where the molecules are allowed to interact. This spatial and temporal control mechanism is mediated by a family of specialised molecules, called 14-3-3 proteins. Recent research indicates that the function of these 14-3-3 proteins is also tightly controlled, although as yet we don't understand how. This research proposal attempts to discover the molecular mechanism of regulation of 14-3-3 function. An understanding of this process may provide new molecular targets for the development of therapeutics against cancer.Read moreRead less