All current clinical practice guidelines for the management of acute low back pain (LBP) agree that acute LBP has an excellent prognosis with most cases recovering within 4-6 weeks. However, the information on prognosis is contradictory and in fact chronic low back pain could develop in as many as 56% of those with acute low back pain. There is also agreement among the guidelines that the rare cases of serious disease (eg cancer) can be detected with a routine clinical examination but no study h ....All current clinical practice guidelines for the management of acute low back pain (LBP) agree that acute LBP has an excellent prognosis with most cases recovering within 4-6 weeks. However, the information on prognosis is contradictory and in fact chronic low back pain could develop in as many as 56% of those with acute low back pain. There is also agreement among the guidelines that the rare cases of serious disease (eg cancer) can be detected with a routine clinical examination but no study has evaluated the accuracy of the complete clinical assessment, and there is only limited evidence on components of the clinical assessment. We will therefore investigate the 1 year prognosis of LBP and the accuracy of the clinical assessment for detecting serious disease in the back pain population. Our study will provide the first reliable estimates of prognosis of acute LBP and the accuracy of widely recommended clinical assessment procedures and thereby allow appropriate allocation of funds to this enormous problem.Read moreRead less
Using Healthcare Wisely: Reducing Inappropriate Use Of Tests And Treatments
Funder
National Health and Medical Research Council
Funding Amount
$9,578,895.00
Summary
Overdiagnosis and overtreatment as unintended consequences of modern healthcare due to expanded disease definitions labelling people with mild problems or at low risk of illness, diagnostic tests identifying inconsequential abnormalities and screening programs detecting disease that won’t progress. The result is much harm and unsustainable overuse. We will research the prevalence, causes and consequences of overdiagnosis and overtreatment, evaluate solutions and widely disseminate findings.
A Cluster Randomised Trial Of Early Intervention For Chronic Obstructive Pulmonary Disease By Practice Nurse-GP Teams
Funder
National Health and Medical Research Council
Funding Amount
$818,914.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a common problem for current or ex smokers but is often undiagnosed. Effective treatment is available so early diagnosis is important. In this study practice nurses will identify patients who are at risk of COPD and undertake case finding. Patients newly diagnosed with COPD will then be offered a novel management intervention involving the GP and practice nurse working in partnership.
CHEST Australia: Reducing Time To Consult In Primary Care With Symptoms Of Lung Cancer.
Funder
National Health and Medical Research Council
Funding Amount
$913,227.00
Summary
Lung cancer is the leading cause of cancer deaths in Australia and the second commonest cause of all deaths in men. Earlier, timely diagnosis could be a critical factor in improving lung cancer outcomes as many people present with late stage disease having had symptoms for a long time. This trial tests a novel nurse-led intervention in general practice aimed at promoting earlier consulting by people at higher risk of lung cancer when they develop chest symptoms.
BEST-Australia: A Phase II Study Of Non-Endoscopic Screening For Barretts Oesophagus In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$513,481.00
Summary
Barrett's oesophagus is common in people with heartburn and may progress to oesophageal cancer. Most cases of oesophageal cancer are diagnosed at a late stage when chances of survival are poor. Currently Barrett's is only diagnosed by endoscopy. We will test how effective and acceptable a non-endoscopic sponge capsule and novel laboratory test is at detecting Barrett's oesophagus early. This could potentially enable early detection of this pre-cancerous condition in general practice.
A Randomised Controlled Trial Of A Decision Aid For Prenatal Screening And Diagnosis
Funder
National Health and Medical Research Council
Funding Amount
$269,625.00
Summary
Prenatal screening is becoming increasingly available to pregnant women in many countries, including Australia, to test for Down syndrome and other chromosomal disorders as well as neural tube defects. Almost half the pregnant women in Victoria are now undergoing prenatal screening. Inherent in all screening tests is the possibility of false positive or false negative results. More than 5% of all women undergoing prenatal screening are likely to receive false positive results and must decide whe ....Prenatal screening is becoming increasingly available to pregnant women in many countries, including Australia, to test for Down syndrome and other chromosomal disorders as well as neural tube defects. Almost half the pregnant women in Victoria are now undergoing prenatal screening. Inherent in all screening tests is the possibility of false positive or false negative results. More than 5% of all women undergoing prenatal screening are likely to receive false positive results and must decide whether to put the pregnancy at risk of miscarriage, or a possible pregnancy termination, as a result of the necessary follow-up invasive diagnostic test. Many women do not realise they may have to face this decision. Others are not aware that their baby may be born with undiagnosed problems even if they have the screening test. One aspect of care that is likely to have a crucial influence on women's experience of screening is how much they are informed about a test prior to undergoing it. Most women visit a GP early in the first trimester of pregnancy. This visit provides an opportunity for information provision about prenatal screening. Decision aids have been developed as adjuncts to practitioners' counselling to prepare patients for decision-making. In this project we will be developing a decision aid for women considering their prenatal screening options. A randomised controlled trial will compare the efficacy of a general educational pamphlet to that of a tailored decision aid in preparing women for decision-making about prenatal screening. A total of 500 women who are less than 11 weeks pregnant and are attending one of 50 GPs will be included. Self-report questionnaires will be used to assess women immediately after use of the educational materials and then again at 24 weeks of pregnancy. The impact of the educational materials on informed choice, decisional conflict, anxiety, depression and uptake of prenatal screening tests will be compared.Read moreRead less