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
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
The Evidence-based Consumer: Making Informed Decisions About Menopause, Hormone Replacement And Complementary Therapies
Funder
National Health and Medical Research Council
Funding Amount
$97,750.00
Summary
This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based ....This project aims to find out whether providing women with information about menopause, and therapies to treat the symptoms and effects of menopause will change their use of hormone replacement therapy (HRT) or complementary therapies. A menopause information kit or brochure(s) with information about the risks and benefits of therapies and treatments for the symptoms and effects of menopause, will be provided to a group of women between the ages of 40 and 64 years. The information will be based on up-to-date medical evidence about conventional HRT along with evidence about complementary therapies such as wild yam cream and herbal medicines. The information will outline the risks and benefits of these and other therapies as well as the proper use of HRT to control symptoms and effects of menopause. Current knowledge about reduction in heart disease risk and prevention of osteoporosis with the use of HRT, and the current knowledge about risk of ovarian, breast and uterine cancer will also be included in the information kit or brochure(s). The sample of women living in the Southern metropolitan region of South Australia will be included in the trial. They will be asked to complete a questionnaire and then some of the women will be asked to study the information about menopause and HRT. All participants will be asked to complete further questionnaires 3 months and 12 months later. The results will show whether providing women with information about menopause, HRT and complementary therapy will result in: 1. the women being more informed and better equipped to make the right decisions about treatment of the symptoms and effects of menopause, and 2. a more appropriate use of hormone replacement and complementary therapies to meet the individual needs of the women.Read moreRead less
A Clinical Trial Of Manipulative Therapy And/or NSAIDs For Significant Acute Low Back Pain
Funder
National Health and Medical Research Council
Funding Amount
$521,625.00
Summary
Acute low back pain is a disabling condition with many sufferers being unable to perform their family or work duties due to severe pain. Treatment of acute LBP is also costly, this condition being one of the most frequent problems managed by general practitioners. Guidelines about how to treat patients with acute low back pain have suggested that advice and paracetamol should be the first line of treatment. In patients with insufficient pain relief two of the most frequently used additional trea ....Acute low back pain is a disabling condition with many sufferers being unable to perform their family or work duties due to severe pain. Treatment of acute LBP is also costly, this condition being one of the most frequent problems managed by general practitioners. Guidelines about how to treat patients with acute low back pain have suggested that advice and paracetamol should be the first line of treatment. In patients with insufficient pain relief two of the most frequently used additional treatments are anti-inflammatory medication and manipulative physiotherapy. However, to date it is not known whether the addition of one or both of these treatments results in faster recovery for the patient. Our clinical trial will clarify whether the addition of (i) anti-inflammatory medication and-or (ii) manipulative physiotherapy, to advice and paracetamol given by the doctor results in a faster recovery for the patient with acute low back pain. This results of this study will make it possible for general practitioners to manage acute low back pain in an evidence-based way.Read moreRead less
A Randomised Controlled Trial Of Internet-based Therapy For Panic Disorder.
Funder
National Health and Medical Research Council
Funding Amount
$202,575.00
Summary
Approximately 9.7% of the adult population have an anxiety disorder with one of the more common, panic disorder, often with agoraphobia, afflicting 2.4% of the community. Around 8% of patients consulting a GP also have panic disorder (PD). A further 10% of the community experience spontaneous panic, but do not have full PD (termed non-clinical panic). People with PD frequently experience clinical depression, about 15% abuse alcohol and non-prescription drugs and PD is associated with an increase ....Approximately 9.7% of the adult population have an anxiety disorder with one of the more common, panic disorder, often with agoraphobia, afflicting 2.4% of the community. Around 8% of patients consulting a GP also have panic disorder (PD). A further 10% of the community experience spontaneous panic, but do not have full PD (termed non-clinical panic). People with PD frequently experience clinical depression, about 15% abuse alcohol and non-prescription drugs and PD is associated with an increased risk of suicide. Over time people with PD appear to have an increased risk of heart problems. They also have substantial financial burdens through multiple attendances at doctors' rooms and through restricted employment opportunities. Only just over one in four people with an anxiety disorder consults a health professional for their problems, with most going to their GP. It has been estimated that less than 10% of these people seek the services of a mental health specialist such as a clinical psychologist or psychiatrist. Therefore because of blocks to do with access, cost or embarrassment, many people with mental health problems do not seek face-to-face specialised mental health treatment. People in rural and regional Australia are particularly disadvantaged by limited access to these specialists. We have developed an internet-based treatment program on panic and anxiety for people in the community, and particularly in regional Australia. Early evaluation of this program has found it is more effective than other types of therapist-assisted self-help treatment. The aim of this research project is to compare it to best-practice face-to-face psychological and pharmacological treatment for PD. If the effectiveness of our internet-based treatment is comparable to best-practice face-to-face treatment, its availability will assist the many Australians who suffer from debilitating panic but who are unable to access specialised mental health assistance.Read moreRead less
Individual Nutrition Therapy And Exercise Regime: A Controlled Trial Of Injured, Vulnerable Elderly (INTERACTIVE Trial).
Funder
National Health and Medical Research Council
Funding Amount
$572,542.00
Summary
Hip fractures are a common and growing problem for older Australians. Unfortunately recovery is incomplete in most people. In this study two factors believed to be important for recovery will be investigated - exercise and nutrition. After a hip fracture the ability to walk is severely compromised, as are appetite and dietary intake. These factors are likely to contribute to the loss of muscle mass and strength frequently observed amongst this patient group. There is considerable evidence to sug ....Hip fractures are a common and growing problem for older Australians. Unfortunately recovery is incomplete in most people. In this study two factors believed to be important for recovery will be investigated - exercise and nutrition. After a hip fracture the ability to walk is severely compromised, as are appetite and dietary intake. These factors are likely to contribute to the loss of muscle mass and strength frequently observed amongst this patient group. There is considerable evidence to suggest that this loss has serious consequences in terms of ability to return to pre-injury levels of function, restriction in independence and ultimately transfer into a hostel or nursing home. Given these facts it makes sense that an exercise program incorporating strength and functional activities, and a nutrition program aimed at achieving nutritional requirements, will improve ability to walk, but there is no conclusive evidence that this is so. Only a small number of studies have tested whether an exercise program improves recovery after a hip fracture and these have mostly commenced weeks or months after the injury when it is likely that there has been irreversible decline in muscle mass and strength. In contrast, most of the nutrition studies commence soon after the injury but provide protein and calories insufficient to meet requirements, provide supplements that patients find difficult to drink or provide the supplements for only a short duration. This study will use the best quality research methods to test whether providing a 6-month individualised exercise and nutrition program to hip fracture patients soon after injury improves walking and other important health outcomes. Patients will be followed for 12 months to determine what difference the exercise and nutrition programs make. If they help then health services will have the evidence they need to recommend this type of program to the growing number of older Australians that suffer a hip fracture.Read moreRead less
Adolescent Depression: Evaluation Of A Preventive Intervention And Identification Of Risk Factors
Funder
National Health and Medical Research Council
Funding Amount
$307,313.00
Summary
This project will evaluate the long-term effectiveness of a school-based program to prevent depression among adolescents. It also aims to identify factors that predict the onset of depression in those who do not receive the intervention. The intervention focuses on the training of interpersonal problem solving skills and enhancement of optimistic thinking styles within a classroom-based curriculum. This project extends the current research program of the applicant. The intervention has already b ....This project will evaluate the long-term effectiveness of a school-based program to prevent depression among adolescents. It also aims to identify factors that predict the onset of depression in those who do not receive the intervention. The intervention focuses on the training of interpersonal problem solving skills and enhancement of optimistic thinking styles within a classroom-based curriculum. This project extends the current research program of the applicant. The intervention has already been developed and implemented with 1600 young people, with the support of local education authorities. The evaluation uses well-researched measures and includes a control group of adolescents who do not receive the intervention. Around 5% of adolescents experience clinical levels of depression and an even larger percentage show subclinical levels. Depression results in many debilitating consequences such as impaired school, work and social functioning and is also a risk factor in adolescent suicide. The prevention of mental health problems is a priority for Commonwealth and State governments and yet there is minimal research to demonstrate the effectiveness of preventive interventions, particularly in the area of depression. If the present study demonstrates a positive outcome, it will provide important guidelines as to preventive materials that should be included in the school curriculum. It is predicted that: a) the intervention will be associated with lower levels of depression over the 4 year follow-up, particularly for adolescents who are assessed as showing mild symptoms of depression, poor problem solving skills or pessimistic cognitive style prior to intervention b) risk factors for the development of depression in adolescents who do not receive the intervention will include initial mild symptoms of depression, poor problem solving skills and pessimistic attributional style.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.
Developing A Research Base For Intravenous Peripheral Catheter Resites. The DRIP Trial.
Funder
National Health and Medical Research Council
Funding Amount
$440,772.00
Summary
Most Australians will have an IV catheter (IV drip) in their hand or arm during a hospital stay. Catheter insertion is painful and costly. It is repeated during hospitalisation because it was thought catheters could only be used for 3-4 days without vein irritation or infection. Newer catheters and preliminary research suggest catheters can actually be used until no longer needed. This research will confirm whether this approach reduces pain and costs without increasing side effects.