STudy Of Risk Assessment To Reduce Complications In Patients Following Noncardiac SurgerY (STRATIFY)
Funder
National Health and Medical Research Council
Funding Amount
$436,000.00
Summary
Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduce ....Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduces longterm risk. However, in many patients undergoing major noncardiac surgery, this approach may be inappropriately aggressive, as these patients are often elderly, have other diseases that make heart operations more difficult and risky than usual, and in any case may have a reduced life expectancy from the disease necessitating the operation. As the most critical issue is to ensure that patients undergo their surgery uneventfully, an alternative is the use of intensive medical therapy to protect the heart. This multicentre study, based at Brisbane hospitals that perform large numbers of major operations, will follow up patients for complications, and outcome (including quality of life) will be assessed six months after the operation. We will address two important questions about the efficacy and cost of risk reduction strategies. First, in patients at higher levels of risk and with a positive stress test, could a combination of medical therapy designed to protect the heart be as effective as current approaches, which include the performance of bypass surgery or coronary balloon angioplasty? Second, in patients identified as being at some risk - but low risk - are drugs sufficiently effective to avoid the need for further testing to quantify risk? As the population continues to age, the numbers of at risk patients undergoing major surgery will increase, and answers to these questions will provide important information to guide their management.Read moreRead less
Deaths In Young People Involved In The Youth Justice System: Towards Evidence-based Prevention
Funder
National Health and Medical Research Council
Funding Amount
$620,705.00
Summary
Young offenders have complex health needs and are at dramatically increased risk of preventable death due to drug overdose, suicide and injury. In order to inform effective prevention, a more detailed understanding of mortality in these young people is required. This project will examine all deaths in young offenders in Queensland from 1993 to 2015, identify targets for prevention, and recommend policy reforms and interventions that are supported by evidence and are culturally appropriate.
Rapidly giving intravenous fluid to prevent or treat shock (fluid resuscitation) is one of the commonest treatments given to critically ill patients. Current guidelines recommend crystalloid solutions but it is unknown whether any particular crystalloid is better than others. This trial will determine whether the use of one of two crystalloid fluids, saline or PlasmaLyte, reduces the risk of organ injuries, such as kidney failure, and improves patients chances of surviving critically illness.
Assessing The Benefit Of Low Dose Aspirin In The Prevention Of Severe Sepsis.
Funder
National Health and Medical Research Council
Funding Amount
$391,880.00
Summary
Recent discoveries suggest that low doses of aspirin may save lives in patients with infection by limiting its severity. We will conduct a large-scale primary prevention study using daily low-dose aspirin to explore whether this widely used drug can safely prevent severe infection. This study is made possible by collaborative involvement in an existing Australian and USA funded study called ASPREE. Finding a treatment that helps prevent severe effects and outcomes of infection would be a major h ....Recent discoveries suggest that low doses of aspirin may save lives in patients with infection by limiting its severity. We will conduct a large-scale primary prevention study using daily low-dose aspirin to explore whether this widely used drug can safely prevent severe infection. This study is made possible by collaborative involvement in an existing Australian and USA funded study called ASPREE. Finding a treatment that helps prevent severe effects and outcomes of infection would be a major health advance.Read moreRead less
Macrophages are white blood cells that provide front line defence against infection by initiating inflammatory responses by ingesting or phagocytosing microbes and by releasing soluble messengers (cytokines) to recruit other immune cells. These defensive functions require extensive trafficking of proteins within the macrophages. Protein trafficking is orchestrated in part by a family of membrane fusion proteins called SNAREs. By defining the relevant SNAREs, we have recently discovered a much ac ....Macrophages are white blood cells that provide front line defence against infection by initiating inflammatory responses by ingesting or phagocytosing microbes and by releasing soluble messengers (cytokines) to recruit other immune cells. These defensive functions require extensive trafficking of proteins within the macrophages. Protein trafficking is orchestrated in part by a family of membrane fusion proteins called SNAREs. By defining the relevant SNAREs, we have recently discovered a much acclaimed and novel pathway that allows efficient, combined cytokine secretion and phagocytosis in macrophages. Our studies proposed here will now expand on this discovery by comparing the phagocytic process, in terms of SNARE-mediated membrane and cytokine trafficking, for a wide range of microbes, highlighting differences that could provide new avenues for drug development. Moreover, since our strategy of using SNAREs to investigate and map trafficking pathways has proven so successful, we will now launch a major large-scale initiative to study ALL SNARE-mediated trafficking pathways in macrophages using a discovery pipeline of assays, including live cell imaging, we have developed. This will provide valuable information on many SNAREs including those associated with disease, and will elucidate trafficking pathways governing all macrophage actions in immunity, including cytokine secretion and antigen presentation. All of these pathways are highly relevant to current drug targets being used clinically or studied in inflammatory disease and for the development of vaccines.Read moreRead less
Gene Expression Profiling In Critically Ill Patients With Septic Shock: The ADRENAL-GEPS Study
Funder
National Health and Medical Research Council
Funding Amount
$863,304.00
Summary
Sepsis refers to a whole body inflammation caused by severe infection. Approximately one in three adults admitted with septic shock die within 28 days and it is unclear whether treatment with anti-inflammatory drugs is beneficial in terms of patient survival. The aim of this study is to develop a clinical test based on gene activity that can be used to predict patient survival and also determine what the best treatment might be for individual patients.
The D-Health Trial: A Large-scale Population-based Trial Of Vitamin D Supplementation For Improving The Health Of Older Adults
Funder
National Health and Medical Research Council
Funding Amount
$2,591,860.00
Summary
The D-Health Trial is a randomised placebo-controlled trial of vitamin D supplementation for improving the health of older Australian adults. Over 21,000 people were recruited and randomised to monthly doses of vitamin D or placebo. This grant will enable completion of the planned 5 years of supplementation and long-term follow-up of mortality and cancer. The results of the trial will inform decisions about food fortification and/or supplementation with vitamin D.
Putting death in its place. The project aims to link 890,000 population records to place of residence from 1838 to 1930, to examine the relationships between where people live, mortality, life expectancy and health. Where people live impacts their life-course outcomes. Using novel matching techniques, the project expects to identify intergenerational changes and the spatial dynamics of inequality and social mobility. Expected outcomes include the creation of a public resource of linked data and ....Putting death in its place. The project aims to link 890,000 population records to place of residence from 1838 to 1930, to examine the relationships between where people live, mortality, life expectancy and health. Where people live impacts their life-course outcomes. Using novel matching techniques, the project expects to identify intergenerational changes and the spatial dynamics of inequality and social mobility. Expected outcomes include the creation of a public resource of linked data and a better understanding of long-run health and inequality. These should provide economic and social benefits by informing policy aimed at contemporary social and health challenges, enhancing our understanding of Australian history, and developing public resources.Read moreRead less