The Risks And Benefits Of Contemporary Total Hip Replacement
Funder
National Health and Medical Research Council
Funding Amount
$493,530.00
Summary
The number of hip replacements undertaken in Australia is steadily increasing. The most common complications of hip replacements are dislocation and loosening due to bone loss around the implant, requiring complex and expensive revision surgery. This study will investigate the incidence of dislocation and, using a new diagnostic imaging technique, the incidence and amount of bone loss around a relatively new prosthetic material, the outcomes of which are not known despite its increasing use.
The WA Safety And Quality Of Surgical Care Project: Improving The Safety, Quality And Provision Of Surgical Care.
Funder
National Health and Medical Research Council
Funding Amount
$583,500.00
Summary
The basis of this application is a three-year project which aims to improve the safety, quality and the provision of surgical care. This application constitutes the core of the WA Safety and Quality of Surgical Care Project (SQSCP), which was established in 1996 to evaluate the clinical epidemiology, health care utilisation, patient safety and health outcomes following admission to hospital for specific surgical and medical procedures in Western Australia (WA). The study will use data from the W ....The basis of this application is a three-year project which aims to improve the safety, quality and the provision of surgical care. This application constitutes the core of the WA Safety and Quality of Surgical Care Project (SQSCP), which was established in 1996 to evaluate the clinical epidemiology, health care utilisation, patient safety and health outcomes following admission to hospital for specific surgical and medical procedures in Western Australia (WA). The study will use data from the WA Data Linkage System, which brings together 15 million records from hospital morbidity, death, cancer, midwives notification and mental health databases. Surgical procedures have been selected for review based on national priorities and after consultation with the WA Branch of the Royal Australasian College of Surgeons (RACS) and other clinical Colleges. This application proposes to continue the core research activities of the SQSCP. A special focus will be on the use of minimally invasive surgical techniques including laparoscopic, endoscopic and endoluminal procedures, which have increased dramatically during the last decade. The study will also evaluate differences in the outcomes of surgical care in rural and metropolitan settings. The findings of the SQSCP will be comprehensively disseminated to surgeons, the RACS, hospital managers, health policy makers and consumers. The rationale of this project is that by providing high quality data on the epidemiology, utilisation and outcomes of surgical care, we will be able to increase the knowledge-base that will contribute to improvements in the safety, quality and provision of surgical care in Australia and internationally. The aims of the SQSCP are consistent with national health priorities and the recommendations of the Taskforce on Quality of Australian Health Care Study, the Australian Council for Safety and Quality in Health Care and the National Institute of Clinical Studies.Read moreRead less
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$1,031,381.00
Summary
Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some co ....Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some continue to experience symptoms. Surgery is the only treatment which will cure reflux. It has a clear role in the treatment of patients with ongoing symptoms, those who don t want to take tablets, and patients with a large hiatus hernia in whom symptoms occur due to the relocation of the stomach from the abdomen into the chest. Approximately 5,000 Australians per year undergo surgery for reflux. The standard operation achieves a good outcome in approximately 90%, although some patients are troubled by side effects. To reduce the risk of this, the original procedure has been modified. However, the evidence supporting modifications has until recently been limited. The best way to compare different operations is in randomised trials. The majority of the largest and best trials addressing this area have been undertaken in Adelaide. We have already entered 504 patients into 5 randomised trials, 4 conducted entirely in Adelaide, and one across multiple sites with the cooperation of 15 Australasian surgeons. These trials have provided a more reliable evidence base for surgeons undertaking surgery for reflux. However, long term follow-up is required to ensure that conclusions drawn are valid at late follow-up. In addition we are establishing 2 new randomised trials, which will determine how best to perform surgery for reflux, and how best to repair a large hiatus hernia. These studies will be undertaken in collaboration with more than 25 other surgeons throughout Australia.Read moreRead less
The WA Safety And Quality Of Surgical Care Project: Improving The Safety, Quality And Provision Of Surgical Care.
Funder
National Health and Medical Research Council
Funding Amount
$446,807.00
Summary
This study aims to improve the safety, quality and the provision of surgical care in WA by evaluating the patterns of underlying disease, health care utilisation, patient safety and health outcomes following admission to hospitals for surgical and medical procedures. The selected procedures are based on national priorities and and include the use of minimally invasive surgical techniques. Differences in the outcomes of surgical care in rural and metropolitan settings will also be evaluated.
The Quality Of Surgical Care Project: Quality Assurance, Clinical Audit And Outcomes Evaluation In Western Australia
Funder
National Health and Medical Research Council
Funding Amount
$346,018.00
Summary
The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA ....The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA. The QSCP is only possible because of the unique population-based record linkage available in this state and is consistent with priorities identified in the National Health Information Development Plan in the areas of record linkage and health outcomes, as well as with the monitoring of interventions recommended by the Taskforce on Quality in Australian Health Care. The surgical procedures reviewed are selected to include a broad range of surgical specialties on the basis of national priority, in consultation with the RACS and with input from the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S). This application proposes to continue the core program in promoting best practice in procedural care by reviewing selected procedures including the outcomes of laparoscopic and endoscopic procedures, and endoluminal stenting surgery due to their rapid proliferation during the 1990's. This second stage of the QSCP proposes the introduction of two new quality assurance themes. Firstly, to promote the clinical safety and post-implementation surveillance of new surgical interventions and other medical technology by establishing the WA Registry and Surgical Audit of New Surgical Interventions. Secondly, to comprehensively and independently audit all surgical mortality at a population level. A dissemination strategy will be established to 'complete the loop' in the evaluation and audit processes.Read moreRead less
Neural Circuits Producing Pelvic Vasodilation In Females
Funder
National Health and Medical Research Council
Funding Amount
$472,770.00
Summary
The reproductive organs and genitalia in males and females experience a large increase in blood flow during sexual and reproductive activity. This increased blood flow (vasodilation) is a key component of penile and clitoral erection, and enhances secretion from the lining of the internal reproductive organs. Vasodilation during sexual activity is produced by a special sets of nerves receiving signals from the genitalia and the brain. In fact, Viagra works by enhancing and prolonging the actions ....The reproductive organs and genitalia in males and females experience a large increase in blood flow during sexual and reproductive activity. This increased blood flow (vasodilation) is a key component of penile and clitoral erection, and enhances secretion from the lining of the internal reproductive organs. Vasodilation during sexual activity is produced by a special sets of nerves receiving signals from the genitalia and the brain. In fact, Viagra works by enhancing and prolonging the actions of these nerves. An important part of this neural pathway is a group of nerve cells in the spinal cord that connects the central nervous system with peripheral nerves in the reproductive organs - these are called preganglionic neurons. Recently we discovered that a major pathway from the spinal cord to the pelvic blood vessels in females leaves the spinal cord at a different level (lumbar) from that thought previously (sacral level). Currently there is no information on how these lumbar preganglionic nerves in females are connected to other nerve pathways that are active during sexual activity, and how they integrate signals from both the internal organs and the brain. We will use an array of modern cellular techniques together with direct observation of dilation in isolated uterine arteries to discover how these nerve cells are wired up in circuits in the spinal cord. This information is vital for us to understand the factors producing increased blood flow in normal sexual activity, and how these might be altered in inflammation or in conditions where there could be selective damage to one nerve pathway and not the other, such as after pelvic surgery, spinal cord damage at different levels, or stimulation of the spinal cord for treatment of chronic pain. Our study also will help understand referred pain and sensations of discomfort in abdominal and pelvic organs.Read moreRead less
Prospective Evaluation Of A Model To Predict Outcomes Following Endovascular Aortic Aneurysm Repair
Funder
National Health and Medical Research Council
Funding Amount
$1,098,901.00
Summary
Once present, abdominal aortic aneurysms tend to enlarge over time resulting in an increased risk of death if they rupture. Endovascular aneurysm repair may be used to fix the aneurysm but this procedure can result in complications over time. We developed a model that uses pre-operative information to predict the chance of an individual having poor results.This study aims to assess whether the model is a good predictor of outcomes and whether extra information will improve its accuracy.
Sentinel Node Biopsy Versus Axillary Clearance In Early Breast Cancer: The SNAC Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,257,525.00
Summary
Over 10,000 Australian women are diagnosed with breast cancer each year. Most need surgery to remove the cancer and determine if it has spread to glands in the armpit (axillary lymph nodes). Knowing whether the cancer has spread to the axillary lymph nodes helps determine prognosis and plan treatment. Surgical removal is the most reliable way to assess the axillary lymph nodes. This study compares two operations for assessing cancer spread to the lymph nodes in women with early breast cancer: 1) ....Over 10,000 Australian women are diagnosed with breast cancer each year. Most need surgery to remove the cancer and determine if it has spread to glands in the armpit (axillary lymph nodes). Knowing whether the cancer has spread to the axillary lymph nodes helps determine prognosis and plan treatment. Surgical removal is the most reliable way to assess the axillary lymph nodes. This study compares two operations for assessing cancer spread to the lymph nodes in women with early breast cancer: 1) axillary clearance and 2) sentinel node biopsy. Axillary clearance involves removal of most lymph nodes in the armpit. In sentinel node biopsy only a few lymph nodes most closely related to the breast cancer are removed. Axillary clearance is the current standard operation. However, it is associated with risks including infection, pain, stiffness, numbness and lymphoedema (arm swelling). Lymphoedema may occur in 5-50% of women treated for breast cancer and can cause major symptoms and disabilities. In many women the breast cancer has not spread to the lymph nodes, and axillary clearance is unnecessary. Recent studies suggest sentinel node biopsy may provide as much information as axillary clearance. Scans and dye are used to help locate the sentinel nodes. Minimising the amount of surgery to the armpit should reduce the side effects. However, the long term safety and effectiveness of removing only a few nodes is unknown. This trial will determine if sentinel node biopsy reduces lymphoedema and gives equivalent cure rates. If it does, then it should become standard practice. The study compliments comparable studies being done in US, UK and Europe by providing unique information about symptoms and quality of life from the women's perspective. One thousand Australian women will take part. The is study is being conducted by Australian breast surgeons under the auspices of the Royal Australasian College of Surgeons and the NHMRC Clinical Trials Centre.Read moreRead less
THE CONTROL OF TYPE 2 DIABETES THROUGH WEIGHT LOSS IN INDIGENOUS AUSTRALIANS: THE FEASIBILITY AND ACCEPTABILITY OF LAGB
Funder
National Health and Medical Research Council
Funding Amount
$600,854.00
Summary
Our recent clinical trial showed that 3 out of every 4 obese people with type 2 diabetes who undergo substantial weight loss have their diabetes go into remission. In this project we recognise in the Indigenous people specific cultural and socio-economic factors and family and community approach to health care and seek to test if the Lap-Band procedure is acceptable to them and if it is feasible to achieve substantial weight loss and control of diabetes as was seen in a European population.
Radiostereometric Analysis Of The Effect Of A Large Articulation On Prosthetic Wear And Migration After Hip Replacement
Funder
National Health and Medical Research Council
Funding Amount
$192,186.00
Summary
At total hip replacement, there has been a recent trend to use prostheses with a larger ball and liner in the socket. This may decrease the risk of post-operative dislocation, but may also increase the amount of wear, leading to bone loss and loosening of prostheses, which may then require replacement. This project will use a special type of x-ray to determine whether wear and movement of these new prostheses is clinically acceptable, so that they can be used with confidence in patients.