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
Smoking Cessation And Bone Health: Observational And Intervention Studies In Twins And A Quitline Population
Funder
National Health and Medical Research Council
Funding Amount
$639,050.00
Summary
Osteoporosis is a major health problem that causes bones to break (fracture) easily. Many bones are susceptible, with hip fractures being the worst outcome of osteoporosis. They cause pain, disability, require major health interventions (surgery and rehabilitation), lead to death in about 20% of cases, and the overall care of hip fracture patients is very expensive. Osteoporosis is treated to reduce the risk of fractures. The prevention and treatment of osteoporosis should include avoidance of f ....Osteoporosis is a major health problem that causes bones to break (fracture) easily. Many bones are susceptible, with hip fractures being the worst outcome of osteoporosis. They cause pain, disability, require major health interventions (surgery and rehabilitation), lead to death in about 20% of cases, and the overall care of hip fracture patients is very expensive. Osteoporosis is treated to reduce the risk of fractures. The prevention and treatment of osteoporosis should include avoidance of factors known to bring on or worsen the condition. Smokers are known to have an increased risk of osteoporosis and fractures. However, it is not known how smoking brings on osteoporosis. Importantly, neither is it clear whether quitting smoking leads to improved bone health (and a reduced risk of fractures). These are important questions for the community in general and for smokers with osteoporosis in particular. We will endeavour to answer these questions by studying twins who do and do not smoke and by observing what happens to measures of bone health (bone mineral density and other factors) in people attempting to quit smoking. New information gained from these studies may lead to better ways of avoiding or treating the damage that smoking does to bone. We may also become able to predict the benefit to bone when people quit smoking.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
Short-term Effects Of Overfeeding On Metabolic Risk In Humans
Funder
National Health and Medical Research Council
Funding Amount
$417,196.00
Summary
The prevalence of obesity is rapidly increasing in Australia and other parts of the world. Obesity is closely associated with insulin resistance and plays a role in the development of type 2 diabetes. However, the effects of short-term periods of over nutrition in humans remain unclear. In the proposed study, we will investigate the effects of short-term weight gain by high fat feeding in lean subjects, in subjects who are overweight and in subjects who are genetically more likely to develop dia ....The prevalence of obesity is rapidly increasing in Australia and other parts of the world. Obesity is closely associated with insulin resistance and plays a role in the development of type 2 diabetes. However, the effects of short-term periods of over nutrition in humans remain unclear. In the proposed study, we will investigate the effects of short-term weight gain by high fat feeding in lean subjects, in subjects who are overweight and in subjects who are genetically more likely to develop diabetes (due to strong family history). The aims are to distinguish physiological and endocrine characteristics of individuals who store more fat in response to overfeeding. We will identify differences between these individuals and whether they have defects in upregulating machinery involved in fat oxidation and energy production in skeletal muscle that may help them adapt during to energy excess. We will look for changes in type 2 diabetes risk and we will have the potential to identify defects in factors that are involved in this response. We will also re-examine indivudals again after calorie restriction and weight loss. We also plan to confirm the role of the candidate genes involved in fat oxidation that have been identifieid in human studies by in vivo gene transfer technology in rodents. This study will determine whether overweight and lean subjects behave similarly when faced with an overfeeding challenge. We expect that individuals with a genetic predisposition for T2DM will become more IR, due to metabolic inflexibility and a decreased ability to upregulate machinery involved in fatty acid oxidation and mitochondrial function. By characterising the physiological and endocrine responses to overfeeding, we will establish quantifiable markers allowing us to distinguish those at risk and identify new targets for pharmacological or lifestyle intervention.Read moreRead less
Mechanisms Of Repair And Adaptation In The Gastric Mucosa: Roles Of COX-2 And Growth Factors
Funder
National Health and Medical Research Council
Funding Amount
$391,650.00
Summary
The stomach lining is continually threatened by its own acid and by hazards such as bacteria and ingested drugs. The drugs called COX inhibitors, which include aspirin, are widely used for treating arthritis and other inflammatory diseases and for preventing heart attacks and strokes. Despite their value in these conditions, COX inhibitors are responsible for about 5-10,000 hospital admissions annually in Australia due to complications from the side effect of stomach ulcers. A recent advance has ....The stomach lining is continually threatened by its own acid and by hazards such as bacteria and ingested drugs. The drugs called COX inhibitors, which include aspirin, are widely used for treating arthritis and other inflammatory diseases and for preventing heart attacks and strokes. Despite their value in these conditions, COX inhibitors are responsible for about 5-10,000 hospital admissions annually in Australia due to complications from the side effect of stomach ulcers. A recent advance has been the development of a sub-class called COX-2 inhibitors. In a very short time, one of these has become among the most prescribed drugs in Australia. The advantage of the COX-2 inhibitors is that they produce many less stomach ulcers. However, they have only been tested in patients who have not had a recent history of ulcer. Our preliminary experiments, together with some related information from two overseas groups, suggests that COX-2 is useful in the stomach, and is markedly increased around a healing ulcer. Our data suggest that blocking it delays the healing of experimental ulcers. This project aims to understand the roles of COX-2 in the stomach, and to clarify the effects of inhibiting it when the stomach is damaged or threatened. The project will also look for links between COX-2's functions and another protective process we have discovered called 'adaptation'. When anti-inflammatory drugs are given regularly to rats or humans under certain conditions, the stomach develops resistance after a few days so that the damage caused by each subsequent dose is markedly reduced. We have uncovered a number of mechanisms responsible for this during a current NH and MRC grant, and plan to explore some of the leads this work has given. The SIGNIFICANCE of the project is its potential to lead to safer use of anti-inflammatory drugs or eventually to new agents, and its potential to give new knowledge about how the lining of organs such as the stomach protects itself.Read moreRead less
Does Loss Of Melanocortin Glucose Sensing Contribute To Obesity Induced Diabetes?
Funder
National Health and Medical Research Council
Funding Amount
$617,531.00
Summary
Diabetes is a failure to properly regulate blood glucose levels. Escalating rates of diabetes are a major health problem. Melanocortin neurons in the brain detect blood sugar levels and usually regulate glucose production and utilization, but in obese animals they do not. We have developed a possible therapeutic, which appears to reverse the glucose insensitivity, and rapidly reduces blood glucose in diabetic mice. This project will determine how melanocortins act to regulate glucose levels