Changing Decision-making Behaviour In General Practice By Providing Access To Online Evidence.
Funder
National Health and Medical Research Council
Funding Amount
$206,375.00
Summary
The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online eviden ....The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online evidence retrieval systems as a component in any evidence-based strategy, through a rigorous and controlled approach to the study of clinical behaviour change. It will also provide a powerful test of the value of search filters as a specific technology in support of evidence retrieval. The focus on prescribing patterns in NHMRC priority areas as an outcome measure will also provide a significant data set reflecting current practice in primary care.Read moreRead less
Thousands of chemicals are used in Australian workplaces. For many of these chemicals it is not known if they are harmful to people who work with them. Unless we can measure how much of a chemical a worker has been exposed to, we cannot determine if the chemical is harmful. While we can test what chemicals a worker is currently exposed to, it is more difficult to estimate how much chemical exposure they have had in the past. This project aims to improve the ways we estimate past chemical exposur ....Thousands of chemicals are used in Australian workplaces. For many of these chemicals it is not known if they are harmful to people who work with them. Unless we can measure how much of a chemical a worker has been exposed to, we cannot determine if the chemical is harmful. While we can test what chemicals a worker is currently exposed to, it is more difficult to estimate how much chemical exposure they have had in the past. This project aims to improve the ways we estimate past chemical exposure. We will build on existing best-practice methods to improve occupational exposure assessment. New computer technology will be used to develop an intelligent evolving database that can be used when asking people about jobs they have had in the past. Experts can examine the answers to the questions to decide whether the worker was exposed to particular chemicals. New methods of processing information, called artificial neural networks, will be used to automate some of these decisions.Read moreRead less
Improved Patient Outcomes Through Dosage Individualisation Of The Newer Immunosuppressant Drugs
Funder
National Health and Medical Research Council
Funding Amount
$486,206.00
Summary
After organ transplantation, recipients need to take medicines continually to stop their immune system from rejecting their new organ. This treatment with immunosuppressant drugs is vital for long-term success of their graft. However, too many people are losing their transplant or are experiencing drug toxicity or infection due to poorly managed immunosuppression. The project aims to accurately define the best way to dose newer immunosuppressant drugs in Australian transplant populations.
Reliability Of An Online Geriatric Assessment Procedure
Funder
National Health and Medical Research Council
Funding Amount
$343,822.00
Summary
This study will examine the reliability, safety and cost of a novel new method of providing geriatrician assessment to older people in hospital. Nurses consult with the patient and enter their findings on a web-based software system that enables the geriatrician to review, report and make recommendations over the internet.
Evaluating The Safety Of Computer Decision Support Systems In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$300,389.00
Summary
Use of clinical software has many benefits. However it is also likely that clinical software will introduce new computer-generated errors that may harm patients. This project will evaluate the safety of software for prescribing in general practice. We will firstly examine mechanisms for errors generated by clinical software on its own, and then in the hands of typical users. The outcomes will have broad potential to guide the regulation, use and design of clinical software in general practice.
Pharmacokinetic And Pharmacodynamic Studies Of The Newer Immunosuppressants
Funder
National Health and Medical Research Council
Funding Amount
$406,650.00
Summary
After an organ transplant (such as a liver or kidney transplant), people need to take medicines continually to stop their immune systems from rejecting their new organ. This treatment with immunosuppressant drugs is vital for long-term success of the graft. These drugs are designed to prevent rejection in patients who have received organ transplants (e.g. kidney, liver) and are also being used to treat a variety of autoimmune diseases, including rheumatoid arthritis. However, too many people are ....After an organ transplant (such as a liver or kidney transplant), people need to take medicines continually to stop their immune systems from rejecting their new organ. This treatment with immunosuppressant drugs is vital for long-term success of the graft. These drugs are designed to prevent rejection in patients who have received organ transplants (e.g. kidney, liver) and are also being used to treat a variety of autoimmune diseases, including rheumatoid arthritis. However, too many people are losing transplanted organs, or not achieving remission from their autoimmune diseases, or are experiencing significant illness and sometimes death from over immunosuppression (infection or side effects) because these drugs are not being used in the best way. The quality and duration of life of increasing numbers of Australians is being affected by lack of understanding and application of some basic principles about dosing regimens for these drugs. The aim of this project is to accurately define the best way to dose these newer immunosuppressant drugs in Australian populations, before they become more widely used .Read moreRead less
Alternatives To Homologous Blood Transfusion - Development Of Evidence- Based Decision Aids.
Funder
National Health and Medical Research Council
Funding Amount
$213,697.00
Summary
Transfusion of donor blood is the traditional means of treating blood loss resulting from injury or during surgery. Donor blood is in short supply and in the past there have been episodes of contamination by viruses that have led to hepatitis and AIDS. Consequently there is much interest in a range of techniques designed to reduce the need for transfusion of donor blood. One of the most popular is transfusion of patients' own blood (autologous transfusion). Despite the popularity of some of thes ....Transfusion of donor blood is the traditional means of treating blood loss resulting from injury or during surgery. Donor blood is in short supply and in the past there have been episodes of contamination by viruses that have led to hepatitis and AIDS. Consequently there is much interest in a range of techniques designed to reduce the need for transfusion of donor blood. One of the most popular is transfusion of patients' own blood (autologous transfusion). Despite the popularity of some of these techniques their true value is not really proven. They may be capable of diminishing the need for a transfusion of donor blood, but the long-term effects of this are not clear. In addition the preparation of autologous blood is a burden for overworked blood banks, and autologous blood may itself be associated with its own problems. The main aims of this study are to carry out reviews of the best quality trials of the various alternatives to transfusion of donor blood and to carry out surveys to find out what patients and doctors think. In a third phase of the project we will use the information gathered in the first two phases to design decision aids. These are comprehensive structured summaries of the available evidence to enable patients and their physicians to collaborate in making informed decisions that are likely to lead to the best outcomes for patients. The products of the research will be a number of reviews of 'best evidence' that appear in the International Cochrane Library, available to health professionals around the world. In addition, the decision aids, if successful, will be made available in a form that can be used by all Australian patients who are facing surgery that is likely to require a blood transfusion.Read moreRead less
Development And Evaluation Of A Decision Aid For Women With A Breech-presenting Baby.
Funder
National Health and Medical Research Council
Funding Amount
$156,890.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby ( ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women with a breech presenting baby (bottom rather than head first) in late pregnancy. A decision aid for breech presentation is timely because recent results of an international trial have dramatically altered women's options in the management of breech presentation. The trial of vaginal breech birth versus planned caesarean section (CS) found overwhelming evidence of reduced infant death and disability for women with a planned CS. Planned CS is now considered best practice for delivery of a breech presentation at birth. However, another treatment option for women with a breech presentation is turning the breech to head first before birth (called external cephalic version, ECV). Each of these options (ECV or planned CS) has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The breech decision aid developed in this project will be based on the best and most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women to a treatment option that best suits them, taking ~20 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less
Cancer Trials Australia-OnLine: A Tool For Cancer Patients To Find Open Clinical Trials And Consider Trial Participation
Funder
National Health and Medical Research Council
Funding Amount
$525,604.00
Summary
We will develop and evaluate a website for consumers which will interface with the ACTR to provide up to date information on currently recruiting cancer trials. Aims are: a) to increase awareness of cancer trials, and facilitate discussion between doctors and patients about participation in a clinical trial, and b) to support cancer consumers to make an informed decision about enrolling in a trial. A randomized trial will assess the effectiveness of the site in achieving these aims.
A Randomised Controlled Trial Of A Decision Aid For The Management Of Pain In Labour And Childbirth
Funder
National Health and Medical Research Council
Funding Amount
$267,375.00
Summary
Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women regarding the management of pai ....Many studies have shown that women want to participate in clinical decisions about the treatments they receive during pregnancy and that involvement in decision making increases satisfaction with maternity care. Decision aids are interventions to help people make specific and deliberative decisions by providing information on the options and outcomes relevant to the person's health. This project aims to develop and evaluate the world's first decision aid for women regarding the management of pain in labour and childbirth. A decision aid for managing the pain of childbirth is both practical and timely because there is a strong evidence base on labour analgesia but a lack of evidence-based information for women. For example, brochures on epidural analgesia outline the advantages of epidurals such as complete amelioration of pain, but do not present any information on adverse obstetric outcomes such as the doubling of risk for an instrumental birth. Most women are willing to experience pain in childbirth but do not want pain to overwhelm them. The decision aid will include a range of available drug and non-drug options for pain relief in labour and childbirth. Each of the options has benefits and risks, and the relative importance of these benefits and risks varies for individual women, a scenario where a decision aid produces the greatest benefit. The pain management decision aid developed in this project will be based on the best most recently available evidence and outcomes. It will incorporate a workbook, audiotape-CD and worksheet that will guide (but not direct) women with their pain management options that best suit them, taking ~30 minutes to complete. The decision aid will be evaluated to assess the impact on women's satisfaction with decision making, knowledge, anxiety and pregnancy outcomes. If successful, the results could be applied to improve consumer information and participation in clinical decisions across a wide spectrum of pregnancy care issues.Read moreRead less