The Role Of Afferent Input In The Development Of Focal Task Specific Dystonia
Funder
National Health and Medical Research Council
Funding Amount
$213,000.00
Summary
The term dystonia is used to describe a condition that is characterised by abnormal muscle activation patterns. This leads to impaired control of voluntary movements. Depending upon which part of the body is affected, dystonia may be classified as generalised (affecting two or more body segments), hemi (involving one side), segmental (involving adjacent body parts or a segment), or focal (affecting one part of the body). Many of the focal dystonias are also task specific and the aim of this prop ....The term dystonia is used to describe a condition that is characterised by abnormal muscle activation patterns. This leads to impaired control of voluntary movements. Depending upon which part of the body is affected, dystonia may be classified as generalised (affecting two or more body segments), hemi (involving one side), segmental (involving adjacent body parts or a segment), or focal (affecting one part of the body). Many of the focal dystonias are also task specific and the aim of this proposal is to investigate these task-specific focal dystonias. Task-specific focal dystonia is common in the community and causes considerable suffering and loss of productivity. For example, writer's cramp (a common form of task specific focal dystonia) is probably the commonest cause of writing difficulty in patients in whom this is the sole complaint. No treatment regimen has been shown to be effective in alleviating it's often debilitating symptoms. The aim of these studies is to further define the pathophysiological changes seen in task-specific dystonia and investigate the mechanisms responsible for their generation. Using the techniques of transcranial magnetic stimulation and peripheral nerve stimulation we will investigate the organisation of the motor cortex in this condition and examine the influence of afferent input on intrinsic cortical circuitry. We hypothesise that the motor regions of the brain are more sensitive to the particular repeated patterns of sensory information reaching the brain during repetitive movement and this results in abnormal alterations in organisation that may be responsible for the symptoms of dystonia. Additionally, we predict that it may be possible to reverse these organisational changes by applying novel patterns of nerve stimulationRead moreRead less
Nurses' Pain Management Decisions In The Post Surgery Context: A Naturalistic Study
Funder
National Health and Medical Research Council
Funding Amount
$56,368.00
Summary
In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and h ....In the hospital environment, doctors often prescribe medications for pain using an as required format on the drug order chart. Very often, this form of prescription occurs in the surgical wards of a hospital, where a patient may need a lot of pain relieving medication in the early period following the operation, and very little medication a few days following the operation. In the as required form of prescribing, the nurse caring for the patient has enormous flexibility in determining when and how much medication should be administered. Previous work has consistently shown that nurses do not administer adequate medication, which often results in poor pain control. Several nurse-related reasons have been proposed for poor pain management, including the fear of addiction, the fear of producing difficulties in breathing, and inadequate education about the medications administered. The focus of previous work has relied on examining small areas in isolation. Primarily, researchers have examined information on the drug order charts following patient discharge from hospital. They have also relied on analysing nurses' views on pain management relating to hypothetical patient situations. Overall, the research fails to address the multiple and interconnected factors faced by the nurse which could impact on pain management. Sources of these factors may be the patient, nurse, medication or environment. Examples of these factors include the presence or absence of the doctor, nurses' communication with doctors and other nurses about patient care, layout of the hospital ward, ward management structure, and methods used by the nurse to assess patient pain. By identifying the complex factors that impinge on decisions for managing pain, this study will provide opportunities to address the barriers that prevent adequate pain management. Nurses will then be in a position to change their practice in order to improve the management of patients' pain.Read moreRead less
Laser Acupuncture In Patients With Chronic Knee Pain: A Randomised Placebo-controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$701,120.00
Summary
Chronic knee pain is a common and disabling musculoskeletal condition that causes a loss of functional independence and results in significant health care costs. In the majority of patients the most common cause is osteoarthritis. Acupuncture is a form of non-surgical treatment commonly sought by patients and often recommended by GP's. The main outcomes from our project are to establish the role, clinical effectiveness and cost benefit of laser and needle acupuncture in knee pain patients.
Management Of Burn Injury: Fluid Dynamics And Antibiotic Pharmacokinetics
Funder
National Health and Medical Research Council
Funding Amount
$342,375.00
Summary
It is well known that major burns, as well as being relatively common injuries, are notoriously difficult to manage. Patients exhibit significant variability due to a combination of anatomic, physiologic, hormonal and immunologic alterations occurring both at the wound site and, more importantly, in other body compartments and vital organ systems. Skin burn injury results in the release of multiple inflammatory mediators in addition to significant fluid loss. The distribution of inflammatory med ....It is well known that major burns, as well as being relatively common injuries, are notoriously difficult to manage. Patients exhibit significant variability due to a combination of anatomic, physiologic, hormonal and immunologic alterations occurring both at the wound site and, more importantly, in other body compartments and vital organ systems. Skin burn injury results in the release of multiple inflammatory mediators in addition to significant fluid loss. The distribution of inflammatory mediators and wound bacteria to central organs can cause complex physiological changes that may lead to multiple organ failure, with serious infections occurring in around 50% of patients with serious burns. Antibiotic distribution kinetics, such as bioavailability, clearance, volume of distribution, elimination half-life and unbound fraction in plasma can be significantly altered in burn patients. Without detailed knowledge of changes and relationships between factors such as wound pH, tissue oxygenation, protein concentrations of fluid leaked from the local wound microvasculature, tissue binding, oedema and changes in burned and non-burned tissue induced by resuscitation therapies, the optimisation of both local and systemic infection contriol therapies can hardly be expected to advance. This project aims to determine how changes the physiology of burn patients, in particular in the burn wound environment, affect antibiotic penetration and distribution into tissues. We also believe that these changes will vary between patients and are aiming to determine whether certain parameters can be used to give an indication of the best antibiotic dosing regimens for individual patients.Read moreRead less