Research Projects

Authors
(Jones, Smith)
(Jones B, Smith J)
(Jones Bob, Smith John)

Project description

Year

Australian Clinical Trials Registry (ACTR)

Simes J, Ghersi D Manager: Askie L

Australasians can now find out which clinical trials are taking place in all areas of health: new drugs, treatments, therapies, surgical procedures and medical devices. With the establishment of the Australian New Zealand Clinical Trials Register (ANZCTR), we now have a comprehensive, on-line register of clinical trials being conducted in Australia and New Zealand.

The National Health and Medical Research Council (NHMRC) and New Zealand Health Research Council, by funding the ACTR, is enabling Australian and New Zealand researchers to contribute to a worldwide initiative: to make public all clinical trials. The World Health Organization (WHO) has established a trials' registry portal, the International Clinical Trials Registry Platform (ICTRP) through which trials registers around the world can be accessed http://www.who.int/trialsearch The ANZCTR contributes data to this platform as one of the WHO's Primary Registries.

Prior registration is also now a condition of publishing trials research. The International Committee of Medical Journal Editors (ICMJE, including editors of the Medical Journal of Australia, Lancet, and New England Journal of Medicine and others) will not publish the results of any clinical trials not included on a recognised register at the trial's inception. Knowing about all existing clinical trials will assist patients and practitioners to make more informed choices about trial participation. It will assist researchers in identifying gaps in their own research and help prevent unnecessary duplication. The ANZCTR can be accessed at: http://www.anzctr.org.au


 

PARIS Collaboration: an individual patient data review of antiplatelets to prevent pre-eclampsia

Henderson-Smart D, Duley L, Stewart L, Askie L.

There is now good evidence that antiplatelet agents (principally low dose aspirin) prevent pre-eclampsia, a leading cause of morbidity and mortality for pregnant women and their babies. A Cochrane Review identified moderate, but clinically important, reductions in the relative risks of pre-eclampsia (19%), preterm birth (7%) and perinatal mortality (16%) in women allocated antiplatelets, rather than placebo or no antiplatelet. Uncertainty remains, however, about whether some women (in terms of risk) benefit more than others, what dose of aspirin is best and when in pregnancy treatment should ideally start. Rather than undertake new trials, the best way to answer these questions is to utilise existing individual patient data from women enrolled in each trial by undertaking a systematic review with meta-analysis based on.

The PARIS (Perinatal Antiplatelet Review of International Studies) Collaboration was formed to undertake the review. The objective was to confirm that antiplatelet agents, given during pregnancy, reduce the incidence of pre-eclampsia. The review found confirmed moderate, but statistically significant reductions, in adverse outcomes for both mother and their babies in women taking antiplatelets compared to placebo. However, there was no evidence that any particular group of 'at risk' women benefited more or less from antiplatelet therapy. This was the first individual patient data review in the perinatal field. Primary results were published in The Lancet in 2007.


 

Community preferences for organ donation and allocation in Australia

K Howard, A/Prof S Jan, Prof A Cass, Dr. J Rose, Dr. S Chadban, Prof R. Allen.

Community preferences for organ donation and allocation in Australia. ARC Discovery Grant.

$240,000

2009 - 2011


 

NeOProM Collaboration: a prospective, individual patient data meta-analysis assessing appropriate levels of oxygen stauration for extremely preterm infants


Askie L, Simes J, Tarnow-Mordi W, Kirby A, Darlow B, Finer N, Brocklehurst P, Schmidt B.

Despite oxygen being one of the most commonly used therapies in the care of small or sick newborns, uncertainty regarding the most appropriate levels of oxygenation for extremely preterm infants has existed for over 50 years. It remains unknown whether the anticipated short term benefits (such as reduced respiratory and ophthalmic morbidity) of targeting oxygen saturation levels generally "lower" from birth can be achieved without resulting in small, but important, increases in death and major disability rates for these vulnerable infants. The Neonatal Oxygenation Prospective Meta-analysis (NeOProM)

Collaboration has been formed to undertake a prospective individual patient data meta-analysis to answer this important clinical question. This approach is considered "gold standard" of systematic review methodology. It provides the same strengths as a single large-scale randomised trial, but provides greater pragmatic flexibility, especially regarding the different regulatory and recognition needs that arise when multiple funding sources are required. This will be the first prospective meta-analysis undertaken in neonatology. Several randomised trials of similar design are now being conducted worldwide. Together these trials plan to recruit approximately 5,200 infants which is a sufficient sample size to detect a difference in death and/or major disability of as little as 4%. A collaborative group was formed in 2003. The first participating trial commenced enrolment in 2005. Final results should be ready for presentation to, and discussion with, the NeOProM Advisory Group in 2012 with the main publication is expected soon thereafter.


 

Prevention of diabetes in women with past gestational diabetes mellitus (GDM): a pilot study

Cheung W, Smith B, McLean M, Bauman A.

Women who have GDM are a group who are at high risk for the development of frank diabetes. About one third of women in Australia who develop diabetes might have had an earlier GDM pregnancy. This study is investigating the efficacy of a physical activity and dietary intervention to bring about behaviour change and reduce the risk of future frank diabetes. The challenge is to develop a cost-effective program which is acceptable and effective for women who have had GDM.


 

The Time Use Validation Study

van der Ploeg H, Merom D, Bauman A, Bittman M.

The goal of this study is to determine the feasibility of time use data for physical activity surveillance purposes. The study determines the test-retest reliability of time use diaries and their criterion validity against the Actigraph accelerometer.


 

Serious and Continuing Illness Policy Practice Study (SCIPPS)

Leeder S, Colagiuri R, Gillespie J, Glasgow N, Jan S, Wells R.


 

Noncommunicable disease risk factors and socioeconomic inequalities - what are the links? A multi-country analysis of noncommunicable disease surveillance data

Bauman A, Phongsavan P, Schoeppe S.

This research project aimed to conduct comparable cross-country analyses to examine the relationships between noncommunicable risk factors and indices of social disadvantage and socio-economic status. The central research question is whether socio-economic distribution in risk factors within countries are similar across socio-economic groups between different countries cultures and economies, or whether they are different and in what way those differences are manifest. Although this question has been explored in developed countries to a large extent, cross-national data from developing countries are sparse. Participating countries include China, Malaysia, Fiji, Nauru and the Philippines.


 

Active commuting to school

van der Ploeg H, Merom D, Corpuz G, Tanner M, Bauman A

Physically active forms of transport are beneficial for human and environmental health. This study uses the Household Travel Surveys from the New South Wales Government Department of Transport to analyze trends and determinants of inactive and active commuting to school in the Sydney Greater Metropolitan Region.


 

Using pedometers to promote walking in the community-the Step by Step randomised controlled trial

Merom D, Rissel C, Phongsavan P, Smith B, Brown W, Bauman A.

This study is designed to evaluate the efficacy and feasibility of pedometers as a motivational aid to promote a physically active lifestyle among inactive adults living in the community. In the 'Step by Step' trial eligible adults (30-65 years old and inactive) were recruited via the NSW Population Health Survey and through advertisements. Participants were randomised to two intervention groups and a 'no-treatment' control group. The intervention materials were developed based on Social Cognitive Theory principles and were mailed to participants with no further contact or support. This study will assist in determining whether wide dissemination of pedometers is a worthwhile population-based strategy to promote physical activity on top of traditional print-based resources and will further explore its sustainability and applicability in other settings.


 

Initiative for Cardiovascular Health Research in the Developing Countries (IC-Health)

Leeder S

In 2003 and 2004, Stephen Leeder worked with colleagues Henry Greenberg and Susan Raymond at Columbia University at the Center for Global Health and Economic Development. Their work, entitled A Race against Time, was launched in April 2004 and received worldwide publicity. It concerned the prospects for less developed countries, both socially and economically, in the light of increasing rates of cardiovascular disease. With research funding from IC-Health, Stephen continues to work on the economic consequences of cardiovascular disease and the translation of these economic insights into effective preventive and control strategies through the recruitment of industry, labour and top order treasury and finance ministers from these nations.


 

Development and implementation of a model for a new community driven primary health care

Barclay L, Page S, Saberi V, et al

Multi Purpose Service (MPS) facility to serve rural and remote areas to include communities up to 12,000 in size.

2008 - ongoing


 

The Australian Health News Research Collaboration

Chapman S, Blood W, Pirkis J.

NHMRC Capacity Building Grant(571376). $1,897,375 2009-2013.


 

Personal and professional development (PPD) in medical education

Birden H, Wilson C, Farmer L, Usherwood T.

The aim of this project is to determine how PPD is conceptualised, understood, valued, and applied by rural clinicians who serve as clinical preceptors/supervisors for medical students through the NCMEC, and to develop a conceptual and practical approach to improved teaching of PPD. Components of the project include;

* A qualitative study to assess PPD attributes of current preceptors and determine how they developed

* A Best evidence in medical education (BEME) systematic review of the PPD literature

* A cohort study to track PPD evolution in medical students through their training and into their practice years

* A survey of PPD curricula across Australian med schools

* Development of a theoretical framework and curriculum model for PPD.

2008 - ongoing


 

Evaluating the impact of a park redesign on population physical acitivity levels and community social cohesion in socio-economically disadvantaged areas.

Phongsavan P. Merom, D.

This is a cohort before and after study to assess the impact of urban park redesign and expansion in a disadvantaged community on physical activity, obesity, social cohesion, sense of community and safety. Residents living within 0.5km radius of the intervention and comparison parks will be surveyed BEFORE work on the upgrade begin and six months AFTER the upgrade is completed.

This research represents a rare opportunity to carry out an evaluation of the impact of environmental manipulations on physical activity levels. The information will help us profile the type and quality of existing and upgraded facilities, if these new facilities are used and how they are used by the community. The findings will provide valuable information for local and state government policy makers and planners.


 

Pacific Physical Activity Guidelines for Adults: Framework for Accelerating the Communication of Physical Activity Guidelines.

Bauman A, Phongsavan P.

Currently, no formal physical activity guidelines exist in the Pacific countries to guide health care professionals in communicating messages about the frequency, duration, intensity and type of physical activity for health-enhancing benefits, with accuracy, balance and consistency. This is a WHO-auspiced initiative to develop and communicate the Pacific regional guidelines for physical activity promotion throughout the Pacific Island Ccountries (PICs). This project also provides a framework for evaluating the guidelines implementation and uptake in the PICs.


 

Getting Research into Practice: ensuring the use of Guidelines in clinical practice

Irving M, Craig J

Iron Guideline - baseline and post implementation results

In 2004, the first stage of an Iron implementation project was commenced. This involved performing a clinical audit of 6 renal centres for their practices and procedures regarding Iron levels for their patients and comparison of these results against the CARI Guidelines on iron and haemoglobin targets in use at that time. We found that there was considerable variability in achievement of iron and haemoglobin targets, with 30-68% falling within ferritin targets of 300-800µg/L; 65-73% within transferrin saturation (TSAT) targets of 20-50 % and 25-32% of patients in the haemoglobin targets of 110-120g/L, across the units. Barriers to implementation include lack of knowledge, lack of awareness or trust in the CARI Guideline, inability to implement the guideline, as well as inability to reach agreement within a unit to a uniform protocol. Factors that were associated with achievement of targets set by the CARI Guidelines included having a nurse-driven iron management protocol, use of an iron management decision aid, presence of fewer nephrologists per dialysis unit, and whether the unit's protocol aimed at actively keeping iron levels within target range ("proactive") or only reacting if out of range ("reactive"). More details about this project can be found in the published paper: Irving MJ, Craig JC, Gallagher M, McDonald S, et al, Implementing iron management clinical practice guidelines in patients with chronic kidney disease having dialysis. MJA 2006:185(6):310-314. In 2005, the second stage of this project was begun. Six renal units were monitored for their iron management and ferritin, haemoglobin, TSAT and epoetin use. Three of the 6 units actively made changes in their iron management practices to reflect the guidelines. Strategies to implement the CARI iron guideline differed in each unit. Each unit focussed on their management of in-centre haemodialysis patients. Wide variation of iron indices was observed across the units. Statistically significant improvements in median ferritin levels were seen across the study. Based on our observations, the variation in results between the 3 units are due to differences in the upper management support for the project, workplace culture and selection of opinion leaders to oversee the practice change. This study shows that with a senior, motivated, opinion leader implementation of a guideline can indeed be successful. Support from an external body such as CARI may assist units to change.

A paper outlining further results of this study is currently being written. Results from this project were presented at the ANZSN meeting in September 2007 and the 4th Guidelines International Network conference held in August 2007 in Toronto, Canada.


 

Transport - Systematic Review

Corcoran K, McNab J, Girgis S, Colagiuri R
This is a systematic review of published literature to: determine if transport is a barrier to health services accessibility for individuals with chronic disease (with a focus on chronic heart failure, chronic obstructive pulmonary disorder, diabetes mellitus); and, to identify the nature and effectiveness of interventions to overcome this barrier. This review is scheduled for completion within 2010.


 

Meta-analysis of utility estimates for kidney dialysis and transplantation

Morton RL, Howard K, Webster AC.

A meta-regression of published utilities for kidney dialysis and transplantation will be undertaken. The relative importance of study population and elicitation method will be assessed.


 

Cost-effectiveness of Tacrolimus immunosuppression in kidney transplantation

Morton RL, Howard K, Webster AC, Wong G, Craig JC.

This economic evaluation will assess the costs and health outcomes of Tacrolimus compared to Cyclosporin immunosuppression for recipients of a kidney transplant.


 

Men's Health Study

O'Connell D, Smith D, Gattellari M, Jurd E, Walker C, Ward J, Steginga S, Pinnock C, Sitas F, Slevin T.

This study will collect valuable information about the general health of men in NSW and their attitudes to, and experiences with, medical tests, such as those for cancer. By accurately describing men's health and healthcare experiences in the general community, we will be able to provide services that better serve all men in the community. The information collected will also assist in healthcare planning and delivery.

A population-based sample of 27,000 men aged 50-84 years will be selected from the NSW Electoral Roll. This large number of men is needed to ensure the collection of reliable information from a wide cross-section of the community. By means of telephone interviews, the men will be asked about their medical history and for their views about medical tests, such as those for cancer. Some men will be asked to take part in a second interview one year later to investigate any changes over time.

This study is funded by the National Health and Medical Research Council (NHMRC, and is being conducted by the Cancer Epidemiology Research Unit at The Cancer Council NSW.


 

Physical Activity in Culturally and Linguistically Diverse Communities

Hardy L, Okely T, Pearson P, McKeen K, Boyd A

This project was developed in response to data from the NSW Schools Physical Activity and Nutrition Survey (SPANS), 2004, which found that Middle-Eastern children had higher levels of overweight and obesity and small screen recreation and lower levels of cardiorespiratory endurance and fundamental movement skills. The project was a collaboration between the Child Obesity Research Centre (University of Wollongong), the NSW Department of Education and Community and the Physical Activity Nutrition Obesity Research Group (PANORG). The project aimed to evaluate the impact and process of the PALDC on selected physical activity-related variables among primary school students in Years 1, 3, and 5 over a one-year period and to document the role the PALDC played in increasing teachers’ understanding of the PDHPE curriculum and of the change process in schools. The project was extended into high schools and aimed to increase the time students spent in moderate-to-vigorous physical activity during school PE lessons.


 

NSW School Physical Activity and Nutrition Survey (SPANS)

Hardy LL, King L, Bauman A

SPANS is a vehicle to monitor weight and weight-related behaviours of NSW school children. SPANS is a representative cross-sectional survey conducted in schools, across government, non-government and independent sectors, and from urban and rural areas. NSW is the only Australian state to have systematic surveillance of school aged children since 1985. The survey information is used to guide policy, practice and interventions. SPANS is funded by NSW Health.


 

Long term economic impacts of disease on older workers to 2030: Costs to government and individuals and opportunities for intervention.

Schofield D, Passey M, Kelly S, Vos E, Percival R

This project will determine the impacts of chronic illness on individuals due to lost labour force participation through reduced income and savings and increased poverty rates and on government due to reduced taxation revenue and increased social security payments. The economic model, Health&WealthMOD2030 will capture trend changes in disease prevalence, population ageing, labour force participation rates, wages growth and superannuation.


 

Genetic and environmental risk factors for melanoma

Cust A, Armstrong B, Aitken J, Kefford R, Giles G, Schmid H, Hopper J, Jenkins M, Goumas C, Holland E, G Mann.

The aim of this research is to identify genetic and environmental causes of melanoma, and develop strategies to prevent new cases of melanoma and improve early detection of the disease. Analyses are being conducted using data from the Australian Melanoma Family Study (a case-control-family study), and international collaborations of melanoma researchers (GenoMEL and GEM). Melanoma is the third most common cancer in Australian men and women with an overall lifetime risk of 5.8%. Efforts aimed at early detection and prevention of melanoma are likely the best hope for reducing the burden of this disease. This research will focus primarily on melanoma in young people, for whom melanoma accounts for approximately 1 in 5 cancers diagnosed. The outcomes of this research will contribute to improved identification of individuals at high risk of melanoma so that they can take the right precautions to avoid developing melanoma, or to detect the cancer early.


 

Making a difference – Interventions for Aboriginal health improvement

Eades S, Bailey S, Banks E, Butow P, Cass A, D’Este C, Jan S, Kaldor J, Kippax S, Leask J, McIntyre P, Nutbeam D, Redman S, Sanson-Fisher R, Thompson S.

The program will build skills in the development and evaluation of intervention programs to improve Aboriginal health outcomes. It will focus on the health of Aboriginal people living in urban and regional centres and examine (i) child and adolescent health and (ii) chronic disease. The program is led by two indigenous people and will build capacity in six indigenous early career researchers and a further three from non-indigenous backgrounds in (i) the development of research partnerships with Aboriginal communities; (ii) the identification of potentially effective interventions (iii) the investigation of the impact of health interventions and (iv) the integration of research with policy.

NHMRC Capacity Building Grant: ($2.317m 2007- 11)


 

Diagnostic Test Evaluation of Tests used in Children with Suspected Kidney Disease

Craig J, Irwig L.
A number of studies are being done which evaluate the test performance and reproducibility of diagnostic tests used in children. These include studies of the inter-observer variability of radionuclide tests, and systematic reviews of radionuclide tests for kidney damage, and urinalysis for the diagnosis of urinary tract infection.


 

Educate, screen and treat – an implementation study of cervical cancer screening for rural women in Tamil Nadu, India

Isaacs R, Trevena L, Finkel M, Olver I.
This study uses peer education to promote a low-tech screening program in primary care health posts in Tamil Nadu. The micro-financing women’s self-help groups have been used to facilitate discussion about cervical cancer prevention.


 

Sunlight exposure for falls prevention

Sambrook P, Cameron I, March L, Cumming R

Vitamin D levels are related to risk of falling in older people and sunlight plays an essential role in vitamin D metabolism. This cluster randomised trial will be the first study ever to assess whether increased sunlight exposure can prevent falls. Recruitment of subjects commenced in 2006.


 

Systematic review of the association between occupational sitting and health

van Uffelen JGZ, Wong J, Chau JY, van der Ploeg HP, Riphagen I, Gilson N, Burton NW, Healy GN, Thorp AA, Clark BK, Gardiner PA, Dunstan D, Bauman A, Owen N, Brown WJ.
Occupational sitting may be associated with different health outcomes such diabetes, cardiovascular disease, cancer, obesity and mortality. This work systematically reviews the current evidence base to see whether there are associations between occupational sitting and health outcomes. This work is supported by funding from Health Promotion Queensland and a NHMRC Program Grant.


 

Promoting cycling infrastructure and physical activity

Rissel C, Merom D, Bauman A, Garrard J.

Funded by a NSW Health Promotion Demonstration Grant, this intervention research project seeks to increase the prevalence of cycling in Fairfield and Liverpool. A range of intervention strategies, including community engagement small group sessions, cycling skills courses, information and map resource development and social marketing will attempt to get more people cycling more often. Evaluation will involve a pre and post telephone survey of cycling behaviour and physical activity in the intervention area as well as a socio- demographically comparison area, as well as monitoring bike counters at designated locations.

2006-2009


 

DRIVE Study

R Ivers, R Norton, A Williamson, M Stevenson, M Woodward, M Eisenbruch and L Lam.
The DRIVE Study is an NHMRC funded longitudinal study examining risk factors for driver injury in 20000 young drivers.


 

Concord Health and Ageing in Men Project (CHAMP)

Cumming R, Handelsman D, Seibel M, Creasey H, Sambrook P, Waite L, Naganathan V, LeCouteur D.

CHAMP is one of the world's most comprehensive studies of the health of older men. Recruitment of 1705 men occurred in 2005 and 2006 and the first two year follow-up examinations have also been completed. Five year follow-up visits, which include a detailed dietary assessment, are currently underway. These men have a wide range of tests at the CHAMP clinic, including bone densitometry, neuropsych assessment and uroflowmetry. A wide range of blood tests are performed, including serum testosterone levels. DNA has been extracted. CHAMP is a real bench to bedside to population study that involves researchers from a wide range of disciplines. The study has produced 20 papers to date (2011)


 

Farmer's mental health service networks: A service collaboration model.

Kelly B, Fragar L, Fuller J, Hazell T, Stain H

This project builds on a pilot program funded through an ARHRF Grant-in-Aid that 1) established the beneficial outcomes from training workshops in rural communities across rural NSW focussed on addressing the mental health needs of farmers, and 2) enabled the successful pilot investigation of a tool to evaluate clinical service networks.

Services related to the mental health needs of people in farming are provided by a range of health professionals in a rural community: specialist mental health staff, general practitioners, counsellors in agencies such as state and national government agencies (eg Centrelink, Community Health Services), and non-government organisations (such as church based counselling organisations). However, many other agencies-such as those providing on-farm practical and emotional support, financial advice, and farm management assistance-are important for the wellbeing of these communities. Effective management of mental health problems in farmers, in particular the early identification of potentially serious issues, requires effective collaboration between all these groups. This study will evaluate the effectiveness of a service collaboration model in improving access to, effectiveness and timeliness of mental health care for farming communities.

  • It is hypothesised that compared with closely matched control communities, the establishment of the service collaboration model will be associated with:
  • increased confidence in recognition, response and referral for farmers with mental health problems in personnel in rural community agencies;
  • an increase in the perceived support and effective response from mental health services by personnel in rural community agencies;
  • increased confidence in health professionals in providing mental health care to farmers and working with rural community agencies;
  • increased communication and referral between health services and rural non-health sector through greater number of contacts for advice, referral and service planning focussing on mental health problems, as measured through social network analysis.

Australian Rotary Health Research Fund ($105,816): 2007-2008


 

Combining Test Information: The febrile child

Craig J, Irwig L, Macaskill P, Glasziou, Hanson.
The study will involve ascertaining primary diagnoses of a random sample of children presenting with fever to the Emergency Department by prospective follow up and microbiological confirmation. The test performances of the clinical signs and symptoms and laboratory tests routinely used to assess children with fever will be analysed, singly and in combination, against the reference standards for four common and important diagnoses - urinary tract infection, occult bacteraemia, pneumonia, and meningitis. We will investigate statistical methods to assess incremental gain when combining the results of two or more tests that take into account correlation in tests errors and missing test results for some individuals. The results of this study will be used in further work as outlined in informed decision-making.


 

Effectiveness of an early intervention trial to prevent childhood obesity Phase 2: Follow-up and cost-effectiveness analysis.

Wen LM, Baur LA, Rissel C, Flood V, Simpson JM, Hayes AJ, Hardy L.

The Healthy Beginnings trial aims to tackle the onset of childhood obesity by means of home visits by early childhood health nurses to first time mothers living in disadvantaged areas of Sydney. The intervention phase which has already taken place, is during the infants first two years of life. Phase 2 of the trial involves longer follow-up to age 5 years including a cost-effectiveness analysis of the intervention compared to normal care. Economic evaluation will be carried out from the perspective of the health care provider. The objectives are to establish cost-effectiveness using a number of outcomes at different ages: these include breastfeeding at 6 and 12 months, unit BMI reduction, and increases in the PedsQL quality of life scale at both 3.5 years and 5 years. Additionally a cost-utility analysis will examine incremental cost per QALY at 5 years.


 

Cochrane Renal Group

Atkins R, Becker, G, Bernardinis J, Chadban S, Craig J, Green S, Hodson E, Penna T, Roberts M, Webster A, Willis N

The responsibilities of the Review Group are to:
* Identify all trials concerning kidney diseases

* Assess the trials for relevance and quality

* Assemble and analyse the trial data

* Prepare structured reports for inclusion in the Cochrane Database of Systematic Reviews


 

Pilot study of Evaluation of Communication Strategies used between Health practitioners and Teams in the major Teaching Hospital Cipto Mangunkusumo, Jakarta.

Hunter C, Witjaksono J, Widiarni D

This proposal aims to observe and interact with clinicians and clinical teams in their everyday work practices to discover how they communicate about patients and patients' treatment and welfare while in their care. It is a qualitative study using 1) a survey questionnaire conducted face-to-face with a researcher and a clinician and 2) ethnographic observations of clinicians at work in their wards. The research will be conducted at the Cipto Mangunkusumo Hospital and is between the University of Sydney and the Faculty of Medicine, Universitas Indonesia (FKUI). The results will inform the Faculty of Medicine, UI of the kinds of interactions being undertaken by clinicians in a teaching public hospital and where necessary contain suggestions as to how these interactions between clinicians could be improved for the quality and safety of patients.
2009 - ongoing

Grant - International Program Development Fund (IPDF) University of Sydney


 

Identifying General practitioner knowledge and information needs about chronic viral hepatitis and liver cancer

Tipper S, Robotin M, George J, Levy M, Phung N


 

Defining Australian research priorities in Complementary Therapies using formal consensus building methods

Bensoussan A, Robotin M, Olver I, Clarke S, Leeder S, Spiegelmann A


 

Informed Decisions in Diagnosis for Clinicians: The febrile child

Craig J, Macaskill P, Irwig L, Hanson.
Once the combined accuracy of the clinical and laboratory tests used to evaluate febrile children to diagnose bacterial disease has been determined (Accuracy Theme), data on pre-test probabilities of the possible diagnoses and the likelihood ratios for each diagnostic test will be developed into computer-based diagnostic algorithms. Interactive software will be developed so that when individual patient clinical and laboratory data are entered into the Emergency-Department based computer terminals, the probability of each relevant diagnosis will be provided to the clinician. Children randomly chosen during the third year of the study will be randomly allocated to the conventional diagnostic decision-making process or our new computerised evidence-based process. The primary outcome will be the number of incorrect diagnoses made on the day of presentation (missed diagnoses and false positive diagnoses). Secondary outcome measures will be the time from presentation to reach a correct diagnosis, duration of symptoms until recovery, process of care measures (number of tests arranged, number of admission) and staff satisfaction.

We plan to determine whether giving explicit probabilities of disease in individual patients based on the best available local and published research information and given to the clinician in real time using interactive software, results in improved diagnostic accuracy and improved outcomes compared with the traditional diagnostic decision-making model.


 

Informed Decisions for Policymakers: Discrete Choice Modelling

Salkeld G and Butow P.
This study will further develop the application of choice-based decision techniques, such as discrete choice modelling, to inform public policy on community preferences for screening. The application of discrete choice modelling (DCM) to screening will be used to determine what factors of screening (such as the cost, harms, benefits and the process of screening itself) are important to consumers and by how much. This information will help policymakers design screening programs that best meet the needs of the community.


 

Study of cervical health

Sitas F, Ling B, O\'Connell D, Banks E, Campion M, Carter J, Dalrymple C, Frazer I, Rose B, Zuo Y, Ng R.

The researchers will look at whether certain factors put women at increased risk of developing cervical abnormalities including lifestyle factors, certain medications like oral contraceptives, hormone replacement therapy (HRT) and similar preparations, smoking, and infections with the human papilloma virus (HPV).

This study began in December 2005 and will run for several years.


 

Cancer in Indigenous people in NSW

Supramaniam R, O'Connell D, Sitas F

Cancer is rarely mentioned as a health priority for Indigenous people yet is it is the second biggest cause of death after ischemic heart disease in this community. Very little is known about cancer in Indigenous people in Australia and what is known relates to Indigenous people living in the remotest parts of the country, predominately the Northern Territory and Western Australia. New South Wales has the largest population of Indigenous people and the largest populations living in urban areas.

Our first study in this area will have several components, building on the descriptive epidemiological work we have done, using surveys of health professionals, medical services and Indigenous people with cancer.


 

The NSW Cancer, Lifestyle and the Evaluation of Risk (CLEAR) Study

Sitas F, Canfell K, Delgado, A, O'Connell D, Barton M, Ward R, Banks E, McCawley L.

The NSW Cancer, Lifestyle and the Evaluation of Risk (CLEAR) Study will provide the most comprehensive information to date on the lifestyle and genetic factors that influence cancer risk in the NSW population. This study aims to see which factors are important, and to see if they differ amongst various groups in our community.

The first stage of the study will involve 5,000 people who have been diagnosed with cancer for the first time, and 5,000 partners of people that have been diagnosed. The partners of people with cancer will form an important reference group for the assessment of the risk factors for cancer.

The NSW CLEAR study will investigate the effects of various factors, including physical activity, alcohol consumption, smoking, migration, ethnicity, reproductive history, occupation, screening behaviour and certain dietary patterns, on the risk of developing cancer.

In the first few years of the study, results for cancers of the colon and rectum, prostate, breast and lung, melanoma and non-Hodgkin lymphoma will be available. By the fifth year of the study, enough information will be available to assess the effects of the various genetic and lifestyle factors on the risk of developing hepatoma, thyroid, ovarian and pancreatic cancers.


 

Probiotic Prophylaxis of Spinal Cord Injury Urinary Tract-Infection Therapeutic Trial (ProSCIUTTU).

Lee BB, Simpson JM, Middleton JW, Goodall S.

Urinary tract infections (UTI) are very common in people with spinal cord injury. They are increasingly difficult and expensive to treat as the organisms that cause them become more antibiotic resistant. Non-antibiotic prevention is needed to prevent UTI without increasing resistance. We will conduct a randomised controlled trial to test the effectiveness of probiotic therapy in preventing UTI in people with spinal cord injury.


 

ACT On-line

Barratt A, Tattersall M, Askie L, Crossing S, Butow P, Currow D, McGeechan K.

This project is building and evaluating a website, Australian Cancer Trials On-line which will enable people affected by cancer to quickly and easily search for patients cancer clinical trials which are currently open and for which they may be eligible anywhere in Australia. The website will contain up-to-date information about currently open cancer clinical trials so that consumers can search for trials about specific cancer types, cancer stages and cancer treatments. Cancer consumers have been advocating for such a website for some years and this projects enjoys strong professional and consumer organization support. Use of the website will be evaluated in a cluster randomized in NSW and Victoria. The project is a collaboration between CeMPED, the Australian and New Zealand Clinical Trials Registry and Cancer Australia.


 

A Community Response to Avian Influenza – Bali and Lombok

Hunter C, Toribio J-A, Birden H, Booy R, Adiputra N, Muktasam A, Ambarawati A and Gerudug K.

An evaluation of the impact of education and awareness programs about highly pathogenic avian influenza (HPAI H5N1) or Avian influenza disseminated to populations in Sectors 3 and 4 (small breeders and backyard farms) of the poultry industry in Bali and Lombok by government and international organizations.


Project objectives include:
1. Document the HPAI education, control and surveillance activities implemented by human and animal health agencies in Bali and Lombok, especially since 2004

2. Evaluate the response to HPAI H5N1 outbreaks and to HPAI education, control and surveillance activities of members of sector 3 and 4 communities in Bali and Lombok.

3. Explore the social, cultural, economic and poultry management repercussions of HPAI for households in sectors 3 and 4 of the poultry industry in Bali and Lombok.

4. Determine the levels of implementation of HPAI education, control and surveillance activities across members of the district human health and animal health agencies in Bali and Lombok.

5. Investigate the relationships between the human health and animal health sectors at district and sub-district levels.

6. Provide up-to-date information to appropriate policy-makers at central, provincial and district levels of the research findings and their implications for future activities in Bali and Lombok.

2010 - ongoing


 

Managing Asthma in Pregnancy

Gibson, P, Clifton V, Giles W, Hensley, M, Taylor R, Murphy V, Woods A, McCaffery K.

NHMRC Project grant. $869,875. 2007-2009.


 

Increasing adherence with the use of Hip Protectors by older people in the community: RCT

Cameron I, Kurrle S, Quine S et al.
Over the last decade several projects relating to hip protectors and prevention of hip fracture have been conducted by these researchers, funded by NHMRC. This latest project is a RCT which examines the effectiveness of external hip protectors for the prevention of hip fractures in frail older people living in the community. The findings of this most recent project are currently (2010) being written up for publication


 

Multidisciplinary Ageing Initiatives

H Kendig, S Quine, M Fintorone-Singh.
Funded from a research and infrastructure block grant from the University of Sydney, this project involves the development of multidisciplinary grant proposals on a range of ageing issues.


 

Australian Study of Health and Relationships

Rissel C, Anthony Smith.
This is a substantial grant, initially awarded by the National Health and Medical Research Council grant to conduct a national sexual health survey, entitled the Australian Study of Health and Relationships. This study is now funded by the Commonwealth Department of Health and Aged Services and is being conducted in collaboration with all the major centres of sexual health research in Australia.


 

The attributes of kidney dialysis important to patients and carers

Morton RL, Howard K, Snelling P, Webster AC.

A qualitative study designed to uncover the characteristics of dialysis that are important to patients and carers. Three study populations will be interviewed: dialysis patients (including home and hospital haemodialysis and peritoneal dialysis), dialysis carers and patients with chronic kidney disease. A grounded theory approach will be used to analyse and code the data.


 

Patient INformation about Options for Treatment (PINOT). National audit of information provided to patients and carers regarding treatment options for Stage 5 chronic kidney disease (CKD)

Morton RL, Howard K, Snelling P, Webster AC.

A prospective study designed to describe the current Australian practice surrounding patient and carer education on treatment options for end stage kidney disease. All renal units will be invited to participate by completing a survey on new (incident) Stage 5 CKD patients between 1st July -30th September 2009.


 

Search strategies for economic evaluations in kidney dialysis and transplantation

Morton RL, Howard K, Webster AC.

Published economic evaluations are thinly spread through many journals. Studies described as cost effectiveness analyses or cost benefit analyses often do not fulfill the criteria of an economic evaluation (i.e. present both costs and health outcomes comparing alternatives). In the kidney dialysis and transplantation area we will identify the best search terms to elicit evaluations that meet a minimum quality standard, that would be useful for clinicians and policy makers to aid decision making. Defined search terms from Medline, EMBASE and Cochrane NHS EED databases will be compared to a hand search of the literature (gold standard) for the years 1995/96; 2000/01, and 2005/06, in the highest ranking journals from general medicine, nephrology and health economics. The sensitivity, specificity and precision (positive predictive value) of the search strategies in each database will be determined.


 

Developing Register for chronic hepatitis B surveillance in at risk groups in NSW

Robotin M, George J, Dore G, Batey R, Levy M, Tipper S, Hornell S


 

Evaluating the cost effectiveness of screening and surveillance strategies for chronic hepatitis B treatment vs. early detection of liver cancer

Robotin M, Kansil M, Clarke I, George J, Law M, Dore G, Howard K.

A model has been developed, and testing is to commence in August 07


 

General practitioner information needs re chronic HBV infection- developing a HBV and liver cancer monograph

Crooks L. Chapter submission: Robotin M,.

All chapters are completed, and are now being peer reviewed.


 

Developing a research tool for prioritising local pancreatic cancer research using Delphi process methodologies

Biankin A, Iverson D, Robotin M

Formative research completed, Delphi process commenced in August 07.


 

SmokeCheck

Hearn S, Wise M, Conigrave K, Carroll B, Massi L, Mitchell M, Daly S.

The NSW SmokeCheck Aboriginal and Torres Strait Islander Tobacco prevention project (SmokeCheck) is being implemented as an important component of the NSW Tobacco Action Plan 2005-2009. The focus of the project is to train Aboriginal Health Workers and other health professionals who work predominantly with Aboriginal communities around NSW in the delivery of evidence-based best practice brief intervention for smoking cessation. The long-term goal of the project is to reduce tobacco-related morbidity and mortality among Aboriginal people in NSW. The Project is funded and managed by the NSW Department of Health and the Cancer Institute (NSW) and administered through the School of Public Health at the University of Sydney.

A quasi-experimental evaluation design was used in Phase 1 to assess the impact of the program on the knowledge, attitudes, and practice of the Aboriginal Health Workers who undertake the training, and to assess the effectiveness of the organisational and professional support received by the Aboriginal Health Workers to carry out the quit smoking intervention with their clients. The SmokeCheck Phase 1 Final report is available on the SmokeCheck website. Phase 2 of the Project in 2009-2011 will broaden its focus to include workforce and organisational capacity-building activities which seek to improve the routine provision of brief intervention by Aboriginal Health workforce for their Indigenous health clients. Additional communication strategies will also be instigated to support the project. For further information on this project visit www.smokecheck.com.au


 

Measuring Individual Preferences for Preventive Goods: the Application of Conjoint Analysis to Colorectal Cancer Screening

Salkeld G, Ward J, Solomon M, Short L, Irwig L and Macaskill P.
Discrete choice modelling (DCM) is a technique relatively new to the evaluation of health care services in Australia. This NHMRC-funded project uses DCM in a survey of men and women aged 50-70 years and living in the Central Sydney Health Area to find out whether they would choose to be screened for colorectal cancer and, if so, what attributes of screening matter most to them. The study is also exploring the reliability of the DCM technique in a group of people who have not been screened for colorectal cancer.


 

Examination of the Costs of Different Diagnostic Strategies as Proposed in the NHS Guidelines for the Diagnosis of Symptomatic Women

Salkeld, G.
This project funded by the NHMRC National Breast Cancer Centre estimates 1) the costs of clinical management of women presenting with symptoms which may be breast cancer and 2) the costs of mammography, ultrasonography and fine needle aspiration biopsy in the context of clinical practice guidelines for the diagnosis of women presenting with symptoms which may be breast cancer.


 

Population health at the clinical interface: pregnancy and childbirth.

Roberts CL, Ford JB, Haines MM, Simpson JM, Ashton AW, Taylor LK, Morris JM, Ellwood DA.

The CRE objective is to support innovative research to improve the prediction, prevention and treatment of complications in pregnancy and childbirth.


 

The Second Australian Study of Health and Relationships

Smith A, Richters J, Rissel C, de Visser R, Simpson JM.

In the Second Australian Study of Health and Relationships, we will survey 20,000 Australians aged 16-69, in 2011-12 in order to understand and document the changes in Australian sexual behaviour over the past decade. It is essential that policy and practice in the arena of sexual and reproductive health be evidence-based and that the evidence base be as current as is practicable.


 

Understanding and improving communication and decision-making among radiotherapy patients with low literacy.

Smith SK, Dhillon H, Milross C, McCaffery K.

Patients with cancer are increasingly expected to process complex medical information and make decisions about their treatment and follow-up care. There is growing concern, however, that many patients do not have the literacy or numeracy skills to do this and experience greater difficulties understanding information and taking part in decision making. While there have been major advances to inform and involve patients with cancer in treatment decision making, there has been little research with patients who have lower education and literacy. This is an important group in the community who have limited health knowledge and experience poorer health outcomes. This study will focus on patients receiving radiotherapy to explore how patients with different literacy levels communicate with radiation oncologists and radiation therapists at different stages of their treatment trajectory, from initial treatment planning through to follow-up care. This study will aim to identify ways to improve patient understanding and involvement in consultations among patients with low literacy. Recruitment for this study commenced in June 2011.


 

Treatment of asymptomatic candidiasis in pregnant women for the prevention of preterm birth: a randomised trial.

Giles W, Roberts CL, Simpson JM, Kotsiou G, Bowen J, Hirst J.

Prevention of preterm birth remains one of the most important challenges in modern maternity care. While the connection between ascending infection and preterm birth is undisputed, research focussed on finding effective treatments has been disappointing. This is the first randomised controlled trial to assess whether treatment of asymptomatic vaginal candidiasis is effective in the prevention of spontaneous preterm birth. It is a pragmatic multicentre trial with a simple Candida testing protocol that can be easily incorporated into usual antenatal care, a simple treatment intervention which is readily available and widely accepted, and simple assessment of outcomes from validated, routinely-collected, computerised databases. These features will minimise the cost of the trial and maximise the ability for direct translation into clinical practice.


 

Optimising the residential and community aged care workforce: the evidence-based development of clinical leadership in middle managers in aged care

Jeon YH, Kendig HL, Simpson JM, Chenoweth LL.

Partner/Collaborating Organisations: Baptist Community Services (NSW and ACT) Strong, effective clinical leadership is critical in improving healthcare workforce retention and care quality, and reducing associated costs. Yet little evidence exists about the best ways to enable middle managers of aged care to develop clinical leadership skills, critical to the effective delivery of quality care. The study will conduct research essential to develop a clinical leadership qualities framework and a clinical leadership program for middle managers focused specifically on aged care. It will then establish the feasibility and the effectiveness of the program using a cluster randomised controlled design.


 

NHMRC Type 1 Diabetes Guidelines

Twigg S, Craig M, , Chow K-A, Gomez M, Phelan H
The Australasian Paediatric Endocrine Group (APEG) and the Australian Diabetes Society (ADS) have been commissioned by the NHMRC to develop a comprehensive guideline on type 1 diabetes across the age spectrum. Work on this project commenced in 2009 and will be completed by the end 2010.


 

ADS Diabetes & Research Project Plan

Twigg S, Kamp M, Hocking B, Stevenson V, Carter J, Neylon S, Abernethy P, Girgis S.
The primary purpose of this initial project is to provide information to health professionals (general practitioners and specialists) on how to assess the readiness of person with diabetes to undertake private and commercial driving (at the time license application or standard re-application) following a severe hypoglycemic event, as well as inform drivers in relation to what they should do when they drive, and the signs and symptoms of neurogenic hypoglycemia. The secondary purpose of the project is to provide input to the national standards for assessing fitness to drive and to be a train driver. The project commenced April 2010 and will be completed September 2010. The project is commissioned by the Australian Diabetes Society.


 

International Physical Activity Prevalence & Validation studies

Bauman A, Smith B, Bowles H, Merom D, van der Ploeg H, Chey T.

The Centre for Physical Activity and Health is acting as the data management centre for the International Physical Activity Prevalence and Validation studies, which is being carried out in 20 countries. Tasks here include investigating the prevalence of levels and types of physical activity undertaken in the countries taking part in the study; as well as determining reliability and validity of measuring physical activity internationally.


 

Systematic review of workplace interventions to reduce sitting

Chau JY, van der Ploeg HP, van Uffelen JG, Wong J, Riphagen I, Healy GN, Gilson ND, Dunstan DW, Bauman AE, Owen N, Brown WJ.
There is a growing body of literature suggesting that sitting at work may be adversely associated with various health outcomes. This systematic review examines whether workplace interventions are able to reduce sitting effectively. This work is supported by funding from Health Promotion Queensland and a NHMRC Program Grant.


 

Cancer Australia Primary Care Clinical Trials Collaborative PC4

J Emery, J Gunn, M Pirotta, L Trevena, A Barratt, K McCaffery, G Mitchell, S Kilbreath, L Monterosso, L Foreman, P Booth, D Weller, K Forster, M King.

This is the newest of Cancer Australia national clinical trials groups and focuses on Primary care cooperative cancer clinical trials group. Cancer Australia - $219,564.currently funded until 2012 for $500,000


 

Development of a set of core HPV messages to promote informed choice for both tests and vaccination for use in primary care and broader UK settings.

S. Wilkinson, S Wilson, P Sasieni, J Patnick, M Hendry, J Austoker, D Weller, T Marteau, K McCaffery, C Bankhead.

Cancer Research UK Project Grant(GBP 225,871; A$540,000). 2008-2011.


 

Surveillance of noncommunicable disease risk factors in Nauru

Phongsavan P, Smith B.

This is an international collaborative project between the World Health Organization, Nauru Ministry of Health and the Centre for Physical Activity and Health, School of Public Health to design and implement a nation-wide survey of non-communicable disease (heart disease, diabetes, stroke, obesity) risk factors in the Republic of Nauru. These surveys are a part of a global drive to instigate non-communicable disease risk factors surveillance in developing countries, including the Pacific Island Countries.


 

A trial of the Polypill compared to usual care among Aboriginal and Torres Strait Islander people at high CVS risk.

Cass A, Brown A, Rodgers A, Hayman N, Usherwood T, Peiris D. *through the George Institute*

Project Aims:

  • To assess whether a polypill- based strategy for Aboriginal and Torres Strait Islander people at high risk of a cardiovascular event will result in better adherence to indicated therapies, and thus lower blood pressure and cholesterol levels, compared with usual care.
  • To determine the cost-effectiveness of this strategy within Aboriginal Health Services.
  • To explore the underlying reasons why this strategy might or might not be more effective than standard care for the indigenous population.
  • To build capacity within Aboriginal Medical Services to undertake high-quality research.


 

National registration of health practitioners: a comparative study of the complaints and notification system under the national system and in NSW.

Chiarella EM, Walton MM, Bennett BJ, Carney TR, Kelly PJ,, Foster JP

This project will compare the NSW healthcare complaints system with that of the new Australian Health Practitioner Regulation Agency to provide insight into complaints handling and notification at a state and national level. It will determine best practice in government assessment and resolution methods and reveal complainant experiences.

Partner/Collaborating Organisations: Australian Health Practitioner Regulation Agency, Health Professional Councils Authority Administering Organisation


 

The PRESERVE Trial: Prevention of Serious Adverse Events following angiography.

Cass A, Gallagher M, Hillis G, Brieger D, Aylward P, Chew D *through the George Institute*

This project aims to provide high quality data on the effectiveness of widely used treatments for the prevention of acute kidney injury following intravenous contrast administered during angiographic procedures.


 

Formative research concerning health risks among women with past gestational diabetes mellitus (GDM)

van der Ploeg H, Cheung W, Smith B, Razee H, Blignault I, Bauman A, McLean M, McElduff A, Ross G.

Women who have gestational diabetes (GDM) are a group who are at high risk for the development of frank diabetes. About one third of women in Australia who develop diabetes might have had an earlier GDM pregnancy. This study is investigating the efficacy of a physical activity and dietary intervention to bring about behaviour change and reduce the risk of future frank diabetes. The challenge is to develop a cost-effective program which is acceptable and effective for women who have had GDM.


 

Developing Methods for the Evaluation of Screening Programs and Diagnostic Tests

L.Irwig.
Improving design and analysis of studies

  • The design and analysis of primary studies and meta-analyses to compare performance characteristics of two or more tests
  • The detection of and correction for publication bias in meta-analyses of test performance
  • Correcting for misclassification of the reference (gold) standard when assessing test performance.


 

Measuring patient preferences for treatment of colorectal cancer using discrete choice modeling

Salkeld G, Solomon M, Short L and Butow P.

The aims of this project are:

  • To determine which characteristics of colorectal cancer treatment patients regard as being important.
  • To quantify the kind of trade-offs patients make between these characteristics.
  • To explore how variations in levels of these characteristics influence their choice of treatment.
  • To recommend ways in which discrete choice modeling can be used to help patients make treatment choices.


The project has been conducted in three stages, they are 1) Focus groups; 2) A self administered questionnaire on CRC treatment and 3) discrete choice survey.


For stage 2, 215 CRC patients consented to be sent a self completed questionnaire. 175 questionnaires were completed and returned, giving a response rate of 80%. The data were analysed using factor analysis to discern the most important attributes to a patient of their surgical management for colorectal cancer. Four attributes were selected for the third and final stage of the study, a discrete choice survey. Those four attributes were: the surgeon having had specialised training in CRC, communication, health service delivery (type of hospital) and information on their treatment.


In stage 3, one hundred and three patients completed an initial discrete choice questionnaire as well as a repeat interview 2 weeks later (test retest reliability). Data analysis was completed at the end of 2002.


 

CARI Guidelines

Gallagher M, Campbell D, Irving M, Tong A, Lopez-Vargas P, Howell M, Naidoo V.

The CARI Guidelines is an evidence-based project that commenced in 1999. The two bodies assuming responsibility for the CARI Guidelines are the Council of the Australian and New Zealand Society of Nephrology (ANZSN) and the Board of Kidney Health Australia (KHA). The aim of the CARI Guidelines is to improve the health care and outcomes of paediatric and adult patients with kidney disease by helping clinicians and health care workers to adhere to evidence-based medical practice as often as possible. It is anticipated that the guidelines will serve as both a valuable educational resource and a means of enhancing the quality, appropriateness, consistency and cost-effectiveness of renal health care. The guidelines were initially developed for use in Australia, however they are now being used more widely in the region.


 

Evidence-based patient choice in surgery

Salkeld G.
Evidence based patient choice (EBPC) encapsulates two movements in western health care systems. The first is the role of evidence-based information. The second is the centrality of individual patient choices and values. In practice, EBPC may lead to greater involvement of the individual patient in deliberations about appropriate forms of clinical management. Economics recognizes that there will always be asymmetry of information between surgeon and patient due to the complexities of synthesizing probabilistic information on the outcomes of treatment. For this reason an agency relationship exists whereby the surgeon supplies information to a patient and it is the patient who decides treatment (or where the choice is made to transfer the responsibility of a treatment decision back to the surgeon). In its most paternalistic form, the surgeon gathers medical information from a patient and decides upon treatment without considering patient preferences. Evidence based patient choice represents a shift away from a paternalistic model to one that actively considers the values, wishes and desires of patients.

Evidence-based patient choice throws out a challenge; how do surgeons get behind patient values and translate this into actual treatment choices? A research program is being designed around issues relating to evidence-based patient choice in surgery.


 

Smoking and mental health: a literature review.

Authors: Ragg M, Ahmed T

Commissioned by The Cancer Council NSW.

Smoking is the leading cause of death for people with mental illness, yet it is often not considered important by people working in the field. This review was commissioned to establish a baseline for action by the Cancer Council, and to inform debate. It will contribute to the Cancer Council's social equity strategy of reducing smoking among disadvantaged populations.


 

Clinical Monitoring in Renal Transplant Recipients

Cross N, Craig J, O'Connell P.

Renal transplantation is the best treatment for patients with end-stage renal failure. Patients are monitored following transplantation in an effort to maintain health of the recipient and function of the graft, using clinical, laboratory and radiologic measurements. Variation in clinical or laboratory observations may occur for many reasons, some of which are not due to a change in clinical status. Scientific methods exist for the analysis of variation, and have been widely applied for monitoring purposes in non-medical settings such as manufacturing.

This project aims to assess application of such methods to the process of detecting clinical events in renal transplant recipients, with the aim of improving renal transplant outcomes.


 

Hip fracture multiple intervention RCT: HIPFIT

Fiatarone Singh M, Quine S, Singh N.

Physical, functional, psychological and quality of life outcomes for older people following hip fracture remain poor, relative to pre-fracture, for those surviving the first 12 months following fracture. Strategies to improve these outcomes are needed, and have potential not only to improve the factors listed above, but also to reduce hospital re-admissions and institutionalisation. This innovative project incorporates a randomised controlled trial design, with the control group receiving usual care. The intervention group will receive a multiple pronged, targeted intervention program, founded on current research evidence of effective strategies. The research team is multi-disciplinary and the project is funded on an NHMRC project grant. All data are now collected and analyses underway (2010)
.


 

A Qualitative Study to Improve the Quality of Life of Residents of Aged Care Facilities

Chin L, Quine S
This is a qualitative ethnographic study. The findings have major policy and costing implications for aged care providers. Two aged care facilities in Sydney participated. Detailed observations of the built environment (site, buildings, rooms, corridors, furniture and fittings etc) and usage by residents were conducted, followed by semi-structured interviews with residents to understand their usage and those aspects of aged care facilities which are important to them. On the basis of the findings recommendations to improve the quality of life of residents in existing facilities by changing the use of available spaces and furniture etc will be made. In addition, recommendations for the design of new aged care facilities will be proposed which permit and encourage social interaction between residents and are thereby likely to increase residents' quality of life. The analysis phase is close to completion (2010) and papers are planned for late 2010 and 2011.


 

A Qualitative study of a Community Kitchen in a Socio-economically Disadvantaged Neighbourhood

Furber S, Quine S
This is a qualitative ethnographic study designed to investigate the role a community kitchen plays in providing meals and the opportunities for social interaction and access to needed health and social services. It also explores the impact on the lives of kitchen clients who are given on the job training and the opportunity to work as volunteers in the Kitchen. Clients and staff were interviewed using semi-structured interviews. The study was partially funded by an Illawarra Health Services Research and Development grant. The research is ongoing. One paper has been submitted (2010) and others are in preparation.


 

A Qualitative Study of Australian Suicide Notes

Quine S, Duflou J, Carter G, Hobbs C.


The object of the study is to identify possible modifiable factors which could inform preventive suicide strategies and thereby reduce the incidence of future suicides. This is a descriptive qualitative study based on thematic content analysis of the suicide notes left by completed suicide cases. Demographic and autopsy data will also be used to examine the identified themes in relation to information about the suicide incident. (2010-2011).

This project is a sub-study of the NHMRC funded project: Case-control studies of suicide and attempted suicide in young adults in NSW.


 

Cross sectional survey to examine and assess the nature of the relationship between resilience and health behaviour among Indigenous and non-Indigenous adolescents attending school, and among Indigenous adolescents who are out of school.

Hearn S, Nutbeam D, Bauman A, Wise M.

The purpose of this study is to measure and better understand the concept of resilience among indigenous and non-indigenous students, and to examine the extent to which different measures of resilience predicts the likelihood of students engaging in a range of behaviours that either support, or potentially compromise their health status and education attainment.


 

Cancer and kidney disease

Wong G, Webster A

Several related research projects exploring the interaction of chronic kidney disease and cancer. Cohort studies of cancer incidence, risk, and survival using national registry data, linkage studies, and longitudinal cohort data, and including economic evaluation.


 

HPV testing Decision Aid for women with Minor Atypia on Pap smear (The IMAP Study)

McCaffery K, Irwig L, Howard K, Davey E, Barratt A, Salkeld G, Lewicka M, Weisberg E.

This study will compare the psychosocial outcomes of different management strategies for women with a mildly abnormal Pap smear: (a) usual care (repeat Pap smear), (b) HPV testing, a new management proposed for this group, and (c) the choice of either management using a decision aid to support women to make their preferred choice. The study will assess psychosocial and quality of life outcomes and will model the effectiveness of each management strategy.


 

Process tools for evidence-policy transfer in Indigenous-mainstream primary health care partnerships.

Fuller J, Passey M, Hermeston W.

The evidence-policy transfer in two programs related to different chronic conditions (mental health and diabetes) will be examined. The cases are (1) the RAISE Wellbeing Program (social and emotional wellbeing) operating out of the Pika Wiya Health Service in Pt Augusta, SA and (2) the Goorie Diabetes Complication and Assessment Clinic (DCAC) operating out of the Dharah Gibinj Aboriginal Medical Service in Casino, NSW.

Each case study involves links between an Aboriginal health service and mainstream private and public health care services that operate under a state system of area health governance. Comparative case analysis will be used to examine the development, sustainability and transferability of Indigenous and mainstream primary health care partnership programs into policy.

Action research using network analysis and role clarification will be used to engage the stakeholders, who will include service delivery staff and managers, area health specialists and directors, state health policy officers and community representatives. In both cases, networks will be bound to the information sharing, client servicing and resource links between local Aboriginal and mainstream health services, area health and the state health department. Within-case and cross-case analysis of qualitative and quantitative data will provide evidence about the use of network analysis and role clarification tools by the partner stakeholders to develop and sustain each partnership.

The case findings will then be considered against a relevant systematic literature review to inform policy. This analysis will illustrate how these tools helped to facilitate transfer of evidence about the partnerships into policy for wider application. The outcome will be tried process tools that can be used for evidence-policy transfer in Indigenous-mainstream primary health care partnerships.

Australian Primary Health Care Research Institute ($313,000): 2006-2008


 

Evaluation of cervical cytology accuracy according to different strategies of providing information to cytologists

Davey E, Macaskill P, Irwig L This study, in collaboration with a large pathology laboratory, examines how the accuracy of cervical cytology reading varies according to whether cytologists have no information on client details or previous cytology and histology results when they evaluate slides, read slides with these details available or read slides initially with no access to information and again after provision of such information. Cytology slides from over 600 women will be used amongst 9 cytologists, with all cytologists examining all slides blind to others' results and blind to histology. Histology will be used as a reference standard in all cases.


 

A Decision Aid in the management of patients with locally advanced rectal cancer

Butow P, Solomon M, Whelen T, Salkeld G, Tattersall M, Rhuby G, Young J.

This project is a collaboration between the Surgical Outcomes Research Centre in Australia and Dr Tim Whelen, in Canada, and is developing a decision aid for patients with locally advanced rectal cancer deciding whether or not to have adjuvant chemo/radiotherapy before or after their surgery. The aid will be on a computer screen used interactively in the surgical consultation, with patients provided with the same material in a booklet form to take home. The decision aid was piloted in 2003, and a randomized controlled trial in 2004.


 

Resolving patients’ complaints about hospitals: responsive regulation by health ombudsmen.

Walton M, Healy J, Braithwaite J

Responsive regulation theory assumes that soft regulation works in most cases. This project will test this hypothesis by analysing the regulatory strategies of health ombudsmen in two Australian states (New South Wales and Queensland), and the responses by hospitals to ombudsmen resolutions of patients’ complaints. It will examine whether undertakings by hospitals to improve the quality of their services are implemented, and whether softer regulatory strategies (informal procedures) are more likely to produce such changes than harder strategies (formal procedures). The study will make a significant contribution to regulatory theory and to promoting health system responsiveness and accountability to the public.


 

FEVER Project

Craig J, Deeks J, Codarini M, Chan S, Macaskill P.
In this project we plan to develop and test a new model to help clinicians make better informed diagnostic decisions. Currently clinicians are expected to make accurate and prompt diagnostic decisions without the support of the full range of information available to them. This is a complex task. Interpretation of a patient's test result should take into account the probability of the disease before the test, the patient's test result and the accuracy of the test. When multiple tests are done, and combined with a patient's history and physical examination, the complexity is substantially increased. In practice patient's results are compared to a normal range, ignoring the accuracy of the tests and probability of disease. This project is about developing and testing a system that incorporates all the test components and presents the information to the clinician as an explicit probability of disease. We will then determine whether this improves.


 

Virtual Colonoscopy Project

Howard K, Salkeld G.
In Australia, conventional colonoscopy is the diagnostic test of choice for the investigation of patients suspected of having colorectal disease. The number of colonoscopy procedures reimbursed through the nations universal health insurance scheme, Medicare, has risen exponentially over recent years. This rise has occurred in spite of a 20% reduction in the Medicare fee schedule in 2002. However, an alternative diagnostic test, a virtual colonoscopy, could potentially offer a cheaper and less invasive means of diagnosing colorectal disease. Virtual colonoscopy (VC) is a non-invasive procedure performed by a helical CT scan of the colon. In 2002, a National Bowel Cancer Screening Pilot Program has been established in Australia. If successful, these pilots will be a forerunner to a national mass colorectal cancer (CRC) screening program. Hence the Australian government is keen to explore whether resources should be allocated to virtual colonoscopy as a possible alternative to conventional colonoscopy in some patients. For this reason, a trial of the diagnostic accuracy of virtual colonoscopy and conventional colonoscopy is being conducted as part of the screening pilot of FOBTs (faecal occult blood tests). The trial will assess the diagnostic accuracy of the two procedures, the costs as well as patient preferences in a group of patients suspected of having colorectal disease. A discrete choice study of patient preferences for VC compared to conventional colonoscopy is being conducted to inform policy makers and clinicians about optimal service delivery for the investigation of patients suspected of having colorectal disease.


 

Applying Clinical Evidence: a randomized trial of consumers asking questions

Barratt A, Tattersall M, Trevena L, del Mar C, Carey-Hazell K, Butow P, McGeechan K.

The study is to evaluate the use of a set of consumer questions on patient doctor communication. The questions have been developed jointly by researchers and consumers and are advocated by consumer groups. In the study we will train and deploy Standardized Patients who will audiorecord their consultations. The audiorecordings will be analysed using a newly developed coding scheme. The study is taking place in both general practice and specialist practice (with oncologists).


 

Australian Screening Mammography Decision Aid Trial Online ( Mammography Decision Aid for women aged 40 years)

Mathieu E, Barratt A, Howard K, McGeechan K, Davey H, Houssami N.

This decision aid aims to help women around 40 years of age make an informed choice about whether to begin screening for breast cancer or wait until later (50 years). The decision aid is available on on-line at www.mammogram.med.usyd.edu.au. It has been evaluated in a randomized controlled trial conducted on-line and is now in publication process. The decision aid increased knowledge, and decreased the proportion of women who were undecided. The trial demonstrated the usefulness and feasibility of an on-line decision aid to help women make this decision.
These results are now published: Mathieu E, Barratt AL, McGeechan K, Davey HM, Howard K, Houssami N. Helping women make choices about mammography screening: an online randomised trial of a decision aid for 40 year old women. Patient education and counseling, 2010; doi:10.1016/j.pec.2010.01.


 

Discrete choice experiments for dialysis modality decision making

Morton RL, Howard K.

Discrete choice experiments (DCE's) are a methodology for taking account of preferences that can be applied in the health care setting. DCE's have been shown to be sensitive to health outcomes such as survival and quality of life, as well as non-health outcomes or process attributes such as distance to a health centre. In the end stage kidney disease population we will determine the health attributes, assign levels to the characteristics, design choice scenarios and conduct choice experiments. Regression techniques will be used to analyse the responses.


 

Managing Return-to-play Decisions Following Mild Traumatic Brain Injury - mTBI

Stevenson M, Hollis S, Taylor C, Finch C, McIntosh A, Shores A, Collins M

*through the George Institute*

The study will estimate the incidence of mild traumatic brain injury in Rugby players, assess the risk and protective factors for injury and recovery and, will develop recommendations on return-to-play following mTBI.


 

PRIVENT: Prevention of Recurrent urinary tract Infection in children with VEsicoureteric reflux and Normal renal tracts Trial

Study Coordinator: Alison Lowe. Gunasekera H, Craig J, Hodson E, Roy P, Hartley M, Taylor S.

PRIVENT is an NHMRC funded, multicentre double blind randomised controlled trial designed to determine whether long-term antibiotics prevents urinary tract infection in children. Antibiotics are given daily to the children over 1 year in which investigators, pharmacy staff and outcome assessors are all blind to the treatment allocation. It aims to enrol 780 children with urine infection and randomise them to receive antibiotic prophylaxis or placebo. 480 children have been enrolled to date.


 

Nephrotic Syndrome Research

Hodson E, Willis N, Fletcher J, Faniran S, Craig J

This is a series of systematic reviews of the treatment of childhood nephrotic syndrome for the Cochrane Renal Group. In addition the group had undertaken a prospective surveillance of the incidence of nephrotic syndrome in childhood through the The Australian Paediatric Surveillance Unit (APSU).


 

Study of Environment on Aboriginal Resilience and Child Health [SEARCH]

Craig J, Gunasekera H.

SEARCH is the result of a collaboration between a number of organisations, including the Coalition for Research to Improve Aboriginal Health (comprising the Aboriginal Health and Medical Research Council and the Sax Institute), NSW Department of Health, the University of Sydney and six Aboriginal Medical Services across New South Wales.

The SEARCH program aims: a) to describe and investigate the causes of health and illness in Aboriginal children with a focus on healthy environments and selected child health problems by; a cross sectional study of 800 families in urban and large regional centres, a prospective cohort study of the 800 families over 5 years, and a prospective cohort study of the 800 families over 20 years. b) to determine whether a community appointed health broker in (i) a randomised trial focussed on otitis media and (ii) a feasibility trial of housing improvement is an effective, sustainable agent for improving the environment and health of aboriginal children and their families.


 

ARDAC - Antecendants for Renal Disease in Aboriginal Children

Haysom L, Williams R, Lopez-Vargas P, Hodson E. Craig J, Roy P, Lyle D

We are undertaking a screening study of 1000 Aboriginal and 1000 non-Aboriginal primary school children in NSW: - to determine how commonly Aboriginal and non-Aboriginal primary school children have blood and protein in their urine. - to investigate whether these numbers vary between urban, rural and remote communities - to determine whether there are any associations between these kidney disease markers and the children\'s height, weight and blood pressure levels.


 

Use of evidence about diabetes by GPs

Entwistle, Barratt A, Trevena L.

This is a qualitative study about the use of evidence in practice- joint study between the University of Sydney and the University of Dundee.


 

Developing teachers in clinical skills and teamwork for critical care using contemporary methods – Timor Leste

Trevena L, Foster K, Bandaranayake D, Delaney A, Marshall A, Kuzmiak L, Riordan R.
This study has used videodata from three workshops to identify how local teachers adopt and use contemporary teaching methods and how participants learn clinical skills and teamwork through small group rotating stations and case scenarios in Timor Leste.


 

University of North Carolina - collaboration in the development of a decision aid for older people considering colonoscopy screening for colon cancer in the US

Lewis, Pignone, Trevena L

This project develops and evaluates a decision aid for people over the age of 75 years who are considering whether they should continue colonoscopy screening for bowel cancer in the US setting.


 

A randomized trial of a web-based toolkit for applying evidence in the general practice cervical cancer prevention visit

Chief Investigators: Trevena L, McCaffery K, Barratt A, Leask J, Brotherton J, Dobbins T, Dieng M, Raynes-Greenow C. Research Coordinator: Dieng M. This project is funded by the Cancer Council NSW and involves the development and evaluation of a website for young women who are considering a Pap smear. It provides evidence-based information about cervical cancer risk reduction include lifestyle factors, screening options and vaccination. It will include aA randomised trial tests the effect of providing this information on how informed the 400 women are and the effect on length of the consultation in general practice.


 

Determinants of overweight and obesity - energy balance and physical activity

Allman-Farinelli M, Bauman A.

We have found age period and birth cohort effects on rates of obesity and are examining likely etiological factors. Energy balance including leisure time physical activity and occupational activity expenditure are being studied using the data sets from the National Health Surveys.


 

Comparison of accuracy of liquid-based cervical cytology evaluated using the ThinPrep Imager (TPI) with conventional cytology evaluated manually

Davey E, Macaskill P, Irwig L, Chan SF, D'Assuncao J

The relative performance of manually-read LBC and conventional cytology (CC) has been evaluated in several studies, and substantial evidence suggests that LBC slides are faster to read than CC slides. However, the introduction of computer-assisted reading of LBC slides, such as with the TPI, may affect the accuracy of LBC relative to CC, may affect laboratory performance if timing alters, and may therefore change the cost-effectiveness of LBC relative to CC. This is important in countries such as Australia and NZ that have not already adopted LBC into screening programs. Our study, in collaboration with a large pathology laboratory, compares the accuracy of more than 50,000 pairs of TPI-read LBC slides with that of manually read CC slides, using re-reading of histology and Pap Test Register reports as the reference standard.

A substudy examines the time required to read TPI-processed LBC slides and CC slides amongst 41 cytolgists under normal laboratory conditions over 5-7 months, and analyses these times according to years of cytologists' experience.


 

Vitamin D following primary treatment of melanoma at high risk of recurrence. Placebo controlled randomised phase II study

Armstrong BK, Mason R, Saw R, Morton RL
This randomised controlled trial aims to assess the feasibility, the safety and the toxicity of an oral loading dose of Vitamin D (500,000IU) followed by an oral dose of 50,000 IU of Vitamin D for 2 years. The target population are patients aged 18-79 who have completed primary (surgical) treatment for cutaneous malignant melanoma and considered to be at high risk for recurrence: Stage IIb, IIc, IIIa (N1a) and IIIb (N1a, N2a). The primary end points are dose sufficiency, dose compliance and safety. The project commenced in 2009 and is expected to be completed in 2013.


 

B Positive project - optimising the diagnosis and treatment of chronic hepatitis B to prevent liver cancer

Robotin M, George J, Dore G, Batey R, Levy M, Tipper S.

This project aims to determine the acceptability and feasibility of early detection and intervention in chronic hepatitis B infection to reduce liver cancer risk in at risk communities in South Western Sydney. Study recruitment commenced in February 2009.


 

Blue Mountains Eye Study

Mitchell P, Smith W, Cumming R, Leeder SR, Wang JJ, Mann G.

The Blue Mountains Eye Study (BMES) was the first large population-based assessment of visual impairment and common eye diseases of a representative older Australian community sample. Baseline data collection took place in 1992-1994 with 3654 residents. Follow-up assessments have been conducted at 5 year (BMES2); 10 year (BMES3) and 15 year intervals (BMES4). From BMES2, the design of the study was extended to include detailed hearing assessment (BMHS) conducted by audiologists, giving a more comprehensive picture of sensory functioning in older Australians. As part of the BMEHS an NHMRC capacity building research grant has been awarded, allowing a postdoctoral researcher to focus on identifying the health policy implications of the data.

NHMRC Capacity Building Grant in Population Health Research. 2003 - 2009


 

An interactive decision aid for prioritising health-check activities

Trevena L, Barratt A, Del Mar, Dobbins T, McCaffery K, Dowie J, Torvaldsen S, Raynes-Greenow C, Dieng M.
This study involves the use of a web-based tool for multi-criteria decision analysis called 'My Health Check' which allows consumers and their practitioners to prioritise preventive health activities for their check-up. Multicriteria decision analysis allows for the combination of best evidence based on burden of disease data with individual patient preferences. A will involve a randomized controlled trial of a web-based tool for health check activities amongst healthy Australians presenting to the GP for a check-up amongst 1000 Australian adults aged 30-69 years will assess the effect of this personalised approach to preventive healthcare on the adoption of these activities. It is funded by NSW Cancer Council for three years


 

Healthy Beginnings - early intervention to prevent childhood obesity

Wen LM, Alperstein G, Bauer L, Rissel C.

Funded by the NHMRC, this family-based randomised controlled trial features a series of developmentally staged home visits by early childhood nurses to address risk factors associated with overweight and obesity. The protocol is available on-line in the BMC Public Health 2007, 7:76.

2006-2009


 

Exercise and falls prevention after stroke

Dean C, Rissel R, Sherrington C, Cumming R.

Funded by a NSW Health Promotion Demonstration Grant, this randomised controlled trial seeks to prevent falls and fall related injury among people with a stroke. Working with NSW Stroke Clubs, the intervention group will receive a lower limb physical activity program, and the control group another program.

2006-2009


 

Systematic review and synthesis of qualitative health research

Tong A,/b>

The synthesis of findings from multiple qualitative studies can provide a range and depth of meanings, experiences, and perspectives of participants across health-care contexts. The methods for synthesising qualitative research are in the early stages of development. Synthesis of qualitative research involves: searching for qualitative studies, appraising the reporting of qualitative research, and synthesising the findings of primary qualitative research.

Synthesis of qualitative research are being conducted on a range of topics including: health care professional perspectives on wait listing and organ allocation, children and adolescent perspectives across the trajectory of chronic kidney disease, carer experiences in caring for people with chronic kidney disease, attitudes, beliefs and behaviours relating to medicine taking, and the experiences of living donors.


 

OSPREY (Outcomes, Services and Policy for the Reproductive and Early Years): Building capacity for research to improve health services for mothers, babies and children.

Jorm LR, Roberts CL, Preen D, Simpson JM, Moorin RE, Haines MM, Bambrick HJ, Holman CDJ.

The OSPREY program will build human capacity, skills and methods to use linked health service data for research to inform improvements in health services for mothers, babies and children. It brings together experienced chief investigators from NSW and WA, and eminent national and international mentors. Through the program, nine team investigators will develop as independent researchers, substantially boosting Australia's capacity for health services research focused on a "Healthy start to life".


 

Air Quality & Respiratory Health Study

Cowie, C will be managing this study. Marks G, Cortes A, Ezz W.

The Air Quality & Respiratory Health Study (AQRHS) is being conducted to determine whether the effects of changes in air quality arising from traffic-related air pollution are associated with changes in respiratory health in people living around the Lane Cove Tunnel. A study cohort (2-75 yr olds) has been established in four locations around the Lane Cove area. These four locations are expected to experience varying changes in traffic related air pollution as a result of the road changes in the area. A study population of around 3,000 people has been recruited into a questionnaire survey of respiratory and irritant health. A sub-group of 360 people has also been recruited to a diary study where peak flow measurements and respiratory symptoms are being recorded twice daily. Each part of the study is being conducted both before and after opening of the tunnel, with pre-opening data being collected in 2006. The tunnel opened in March 2007. Various methodologies for assigning individual exposure to traffic related air pollution are also being explored in this study.

Collection for health outcome data for this project is being funded through the CRC for Asthma and Airways and the NSW Health Department, with the study being conducted through the Woolcock Institute of Medical Research.

Due to be completed in 2008.


 

Clinical Pathways in Acute Coronary Syndromes in China Study – CPACS

Patel A, Turnbull F, Lu X, Chen L.

*through the George Institute*

Collaboration:

  • The Chinese Society of Cardiology
  • Peking University Health Science Center

The overall objective of this project is to develop, implement and evaluate clinical pathways for the management of acute coronary syndromes (ACS) in tertiary and non-tertiary centers in China.


 

Incidence and risk factors for lymphoedema secondary to surgery for breast cancer: a prospective cohort study.

Kilbreath SL, Refshauge KM, Simpson JM, Ward L, Ung O, Beith J, French J, Koelmeyer L.

The aims of this project are to determine the incidence of lymphoedema and the factors that predict it, following surgical treatment for early stage breast cancer. We will conduct a longitudinal study, recruiting a consecutive cohort of 650 women after surgery, and following them for 3 years.


 

Understanding the impact of social, economic and geographic disadvantage on the health of Australians in mid - later life: what are the opportunities for prevention?

Bauman A, Redman S, Bailey S, Bambrick H, Banks E, Beard J, Broom D, Byles J, Clark J, Harris M, Jalaludin B, Jorm L, McMichael A, Nutbeam D, Rodgers B, Schofield D, Woodruff R, Woodward M.

Social, economic and environmental factors play a key role in the health of all Australians. As the Australian population ages, there is an urgent need to understand how people can remain healthy and independent for as long as possible. This research will examine the ways in which social, economic and environmental factors contribute to the health of Australians in mid to later life. It will help identify ways in which policy and preventive programs can contribute to improving health in mid to later life particularly among disadvantaged Australians. We will explore in detail social, economic and environmental factors in 100,000 people aged 45 and over; this will be the largest study of its kind ever undertaken in Australia. We will examine the relationship between these social, economic factors, and lifestyle factors such as smoking, physical activity, environmental and obesity. We will look at how these factors contribute to health and health service use. Because of the large numbers of people participating in the study, we will be able to investigate for the first time, the ways in which these factors affect each other and their importance in different subgroups in the population. This will enable us to identify where programs and policies should be directed to most rapidly improve the health of disadvantaged Australians.

NHMRC Program Grant: ($1.8m 2007-11)


 

Heart Outcomes Prevention Evaluation: SOLARIS Study of Lipid Modification and Blood Pressure Reduction in People at Average Risk - HOPE-3

Patel A, Groenestein P

*through the George Institute*

Collaboration:

  • The Population Health Research Institute, McMaster University, Canada
  • The Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne
  • The University of Sydney School of Rural Health, Dubbo

The HOPE-3 trial will evaluate the benefits of combined cholesterol and blood pressure lowering therapies in reducing cardiovascular risk in a wide group of people without vascular disease.


 

Blood Pressure Lowering Treatment Trialists Collaboration – BPLTTC

Turnbull F, Algert C, Neal B, MacMahon S, Perkovic V, Chalmers J, Woodward M.

*through the George Institute*

This study aims to provide reliable evidence about the effects of different classes of blood pressure lowering drugs on cardiovascular mortality and morbidity in a variety of patient groups.


 

Randomised trial of online family history tool and GP triage for colorectal cancer screening

Trevena L, Meisser B, Kirk J, Barlow-Stewart K, ,Dobbins T, Goodwin A. This cluster-randomised trial is funded by Cancer Australia and assesses the effect of online family history assessment and GP triage on risk-appropriate screening for colorectal cancer. It is funded for 3 years until 2012.


 

Electronic Decision Support Study

Patel A, Peiris D, Turnbull F, Groenestein P, Joshi R, Webster R

Collaboration: Western Clinical School: University of Sydney
*through the George Institute*
This study involves the preliminary assessment of a novel electronic decision support tool that integrates risk assessment with multiple Australian guidelines to provide individualized treatment recommendations for patients.

The Pfizer CVL research grant.


 

The Kanyini Vascular Collaboration

*through the George Institute*

Improving health outcomes for Aboriginal Australians with chronic disease through strategies to reduce systems barriers to necessary care


 

The Guidelines Adherence with the Polypill Study – GAP

Patel A, Groenestein P, Jan S, Neal B

  • Collaboration: Clinical Trials Research Unit, School of Population Health, University of Auckland
  • Department of Epidemiology and Preventative Medicine, Monash University, Victoria

*through the George Institute*
NHMRC project grant
This is an Australian trial evaluating whether a "polypill" will help patients who have to take multiple medicines to help prevent cardiovascular events.


 

RCT of Normal vs. Augmented Level of Renal Replacement Therapy in ICU - RENAL

*through the George Institute*

This study is looking at the effect of different doses of dialysis (renal replacement therapy) in patients with severe, acute kidney failure in the intensive care unit (ICU).


 

The Burden of Chronic Kidney Disease

*through the George Institute*

This study aims to establish the human and financial burden of chronic kidney disease in Australia and internationally and to explore the cost-effectiveness of screening and intervention to prevent progression of disease.

Funded by Kidney Health Australia


 

Study of Heart and Renal Protection- SHARP

*through the George Institute*

This Study aims to determine the effects of cholesterol lowering with a combination of simvastatin and ezetimibe on the risk of major vascular complications in patients with chronic kidney diseases.


 

Improving Indigenous Patient Access to Kidney Transplantation - IMPAKT

*through the George Institute*

IMPAKT comprises five component studies aimed at identifying Indigenous Australians' barriers to accessing renal transplantation, and proposing strategies to reduce disparities in Indigenous Australians' access to renal transplantation.


 

Retrospective Analysis of Trauma Transfers - RATTS study

Stevenson M, Taylor C, Fitzharris M, Middleton P, Sinclair G

*through the George Institute*

The study aims to identify rates of compliance to protocol 4 (the trauma by-pass protocol), estimate the time to definitive care in rural NSW and determine the impact of interventions implemented by the NSW Ambulance Service on adherence to protocol 4.


 

Internet based randomized trials

Barratt A, Mathieu E, McGeechan K, Tattersall M, Herbert R

Very little is known about the quality of data and results, generated by web-based (or on-line) trials. This is important as investigators look to the web to implement trials. Our study will address whether data quality and results are affected by on-line participation in trials. To do this we will run a web-based trial and assess its data quality and any biases.

NHMRC Grant, 2008-2010


 

Review and update of the Commonwealth guidelines for treatment of alcohol problems and supplementary booklets

Haber P, Lintzeris N, Proude E, Cooney A.

Funded by the Department of Health & Ageing. The aim of this project is to provide up-to-date evidence-based information to health professionals treating alcohol problems to guide management, treatment, education and professional development. The project will utilise various methodologies to ensure two core aims (1) updating the evidence and guidelines to reflect current evidence and the new NHMRC guidelines; and (2) ensuring that the dissemination materials are well-suited to the target audiences identified.


 

Pharmacokinetic and pharmacodynamic properties of intranasal, sublingual and intravenous buprenorphine in buprenorphine maintained patients.

Lintzeris N, Haber P, Murnion B, Savage S.

Funded by Reckitt Benckiser. The aim of the study is to investigate the feasibility of using a buprenorphine intranasal spray in buprenorphine maintained individuals for the management of opioid dependence. The study will compare the pharmacokinetic and pharmacodynamic profile of equivalent doses of intravenous and intranasal and sublingual buprenorphine products in buprenorphine patients. The primary research objective of the study is to characterise the pharmacodynamic (subjective, physiological and cognitive−performance) profile of the different routes of administration. Secondary objectives of the project are 1. To compare the pharmacokinetic profile (AUC, Cmax, Tmax) and the degree of individual variability for the intranasal route compared to sublingual and intravenous routes over a 24 hour dosing period. 2. To compare the patient acceptability and adverse events of each route of administration as a potential treatment modality in this group.


 

The effects of methadone, alone and in combination with alcohol and alprazolam, on simulated driving performance

Leung S, Lintzeris N, Haber P.

Funded by a competitive peer reviewed grant from the Mental Health and Drug and Alcohol Office, NSW Department of Health. The aim of this project is to gain direct experimental evidence of the effect of methadone and other commonly taken substances on driving performance using a state-of-the-art STISIM driving simulator. Using an open label within- and between-subjects crossover design, an Experimental group comprising of 12 stable methadone-maintained clients and a Control group comprising of 12 healthy non-methadone using volunteers matched by age, gender and education level will be recruited. Each subject will undergo a total of 4 x 5 hour test sessions. At each test session, participants will be administered (under double-blind conditions) their routine methadone dose (Experimental group only) and the study medication (placebo, 2mg alprazolam or 0.7g/kg alcohol), and will be asked to complete a simulated driving test.


 

Pharmacological investigation of alprazolam administration in buprenorphine and methadone maintained individuals

Lintzeris N, Nielsen S, McDonough M, Haber P, Leung S, Savage S.

Funded by Turning Point, VIC. Buprenophine (BPN) and methadone are used for treating heroin dependence. There are concerns regarding their safety when used with benodiazepines - present in >50% of all methadone/buprenorphine-related deaths. Whilst BPN is safe when taken sublingually, most BPN-related deaths occur in individuals injecting BPN and co-using benzodiazepines. This project examines the pharmacological effects of alprazolam (a benzodiazepine) administered to methadone and buprenorphine patients under laboratory conditions. Buprenorphine will be administered sublingually (therapeutic) and intravenously (abuse conditions), providing a better understanding of the risks associated with BPN abuse, and methadone/buprenorphine-benzodiazepine interactions; and enhancing safer prescribing in this high-risk group.


 

Genetic determinants of the response to pharmacotherapy for alcohol dependence

Morley K, Haber P, Seth D.

Funded by NSW Health. The aim of the proposed project is to build on pharmacotherapy research by adopting a novel approach to improving treatment success for alcohol dependence. Certain genetic mutations selectively alter brain function and may compromise the effectiveness of medications, in this case, acamprosate, naltrexone and baclofen. Genotyping for such mutations of biologically relevant genes may be an efficient way to identify patients who may not respond to medication. The proposed project will be the first to investigate genetic predictors of treatment response to all three pharmacotherapies from clinical trials run at Royal Prince Alfred Hospital and our overseas collaborators. The findings will allow targeting of treatment to those more likely to benefit and avoid exposure of others to unnecessary cost and risks of ineffective medication.


 

Novel treatments for young people with harmful alcohol use

Haber P, Teeson M, Baillie A, Leung S, Sannibale C, Schneiring C, Rapee C.

A trial of structured stepped-care intervention for psychiatric comorbidity. Funded by the Mental Health and Drug and Alcohol NSW Department of Health. The purpose of this study is to investigate the effectiveness of a novel, integrated, stepped-care treatment for harmful alcohol use and comorbid anxiety or depression in youths. Despite the high prevalence of these co-existing conditions, there are surprisingly few services available to young sufferers seeking help. The proposed \"stepped care\" model entails assessing the outcome of primary treatment and systematically offering a secondary treatment where indicated. This approach is consistent with good clinical care. It has the potential to provide a clearly structured, logical and economical treatment. Furthermore, through the implementation of a youth-focused therapy treatment it is hoped that adolescent/young adult sufferers will respond encouragingly and consequently maintain a positive treatment outcome.


 

Novel treatments for alcohol dependence

Haber P, Teesson M, Baillie A, Sannibale C, Morley K, Leung S, (project coordinator) Weltman M, Phung N, Thiagarajan S, (NDARC).

Funded by the Alcohol Rehabilitation and Education Foundation (AERF). A randomised trial of structured stepped-care intervention for psychiatric co-morbidity (3 yr study): Co-morbid depression and anxiety are a critical issue in the management of alcohol dependence due to the high prevalence, debilitating effects and challenges in treatment. This study seeks to generate and evaluate a novel, integrated treatment for comorbid anxiety or depressive disorder.


 

Prevalence of methamphetamine use amongst patients accessing Sydney South West Area Drug Health Services and Emergency Departments

Haber P, Becker K, Proude E, Lintzeris N.

The use of methamphetamine (ice) is reportedly growing in the Sydney area. Harms related to this substance can be psychological as well as physical in nature. The primary aim of the study is to investigate the current use of ice amongst patients attending the services described below, if they have any physical or psychological problems relating to its use, and whether they have sought any treatment for this drug. Patients aged 17 and over will be administered a short questionnaire by a health worker or researcher over a one-week period.


 

Adolescent experiences and perspectives following transplantation

Tong A, Howard K, Morton RL, Craig JC.
Organ transplantation has improved survival for adolescents with kidney disease, but little is known about its impact on quality of life from their perspective. The uncertainty of graft survival, lifestyle and family readjustment, and treatment side effects significantly impact on the physical and psychosocial outcomes in transplant recipients. This project aims to examine adolescents' experiences and perceptions of their quality of life, to elicit strategies from them on ways to improve their quality of life, and to evaluate the health status and health-related quality of life in adolescents who have received a kidney transplant. In-depth, face-to-face interviews will be conducted with approximately 25-30 adolescent kidney transplant recipients (aged 12 - 18 years). The participants will be asked about their experiences and perspectives of transplantation and how it has impacted their quality of life. They will also be asked to suggest ways to improve care and support delivered to adolescent transplant recipients. The interviews will general qualitative data that will be thematically analysed to identify and understand recurring (and uncommon) adolescent experiences, needs and perspectives. The adolescents' health related quality of life will be evaluated using standard questionnaires that measure factors including physical functioning, mental health, self-esteem, general health perceptions and role functioning. Utility based quality of life will be assessed using the HUI2 multi-attribute utility instrument and the time trade off (TTO) method.


 

Evaluation of Addiction Medicine OP Clinic linked to CL

Ramasamy P, Lintzeris N, Sutton Y, Haber P.

Evaluation of Outpatient Clinic in Addiction Medicine established in Liverpool Hospital to facilitate after-care in Consultation Liaison patients discharged from hospital. Evaluation consists of pre-post service evaluation of DHS referral uptake in CL patients from Liverpool Hospital, patient satisfaction surveys & key-informant interviews.


 

HBV vaccination rates and seroconverion following rapid immunation schedule in OTP patients at Liverpool Hospital

Ramasamy P, Lintzeris N, Sutton Y, Haber P.

Retrospective study of HBV vaccination rates of completion and seroconverison in a group of 143 methadone patients conducted in 1999. Data analysed and submitted for publication.


 

The establishment of a cohort of substance using pregnant women and their babies

Haber P, Stephens C, Burns L, (NDARC), Sinclair H, Conroy E.

Although the consequences of illicit drug use in pregnancy can be severe, in Australia there is no comprehensive research available about the socio-demographic characteristics or health needs of these women and children. In particular, no Australian study has yet described in detail the socio-demographic, obstetric, mental and physical health and antenatal care of this group of pregnant women. Neither is there any longer term information available about the health status of these women or of their children as they grow. The specific aims of this study are therefore to (1) conduct a pilot study measuring the maternal and neonatal characteristics of pregnant women seeking substance use treatment and, (2) to establish the most cost-effective methods of recruitment and follow-up of this cohort.


 

Attitudes and barriers to hepatitis C treatment uptake among methadone maintenance clients

Day C, (project coordinator), Rutter S, Pritchard-Jones J, Haber P.

The aim of this project is to examine attitudes and barriers to hepatitis C treatment among methadone maintenance treatment (MMT) clients. Clients attending three private and one public MMT clinic will be surveyed concerning their knowledge and attitudes to hepatitis C treatment. Referrals to both formal and informal assessment will be provided for those interested in treatment and treatment uptake and outcomes will be assessed.


 

Integrating treatment for PTSD and alcohol use problems

Sannibale C, Teesson M, Sitharthan T, Creamer M, Mills K, Bryant R, Haber P, Taylor K, (project coordinator).

This study tests the efficacy of treatment for posttraumatic stress disorder (PTSD) when delivered to participants with alcohol use problems. Two-hundred and sixty-four individuals, who meet criteria for current PTSD and are drinking at risky levels, will be screened for risky alcohol consumption and current PTSD, assessed, and randomly allocated to either 16 sessions of simultaneous treatment of alcohol use and PTSD or to 16 sessions of treatment for alcohol use problems alone supplemented by a control condition. Participants will be reassessed three and six months following treatment completion. The primary outcome measures will be alcohol consumption and PTSD symptoms.


 

A retrospective cohort of hepatitis C treatment outcomes in the opioid pharmacotherapy treatment setting

Day C, (project coordinator), Haber P, Dore G, Batey R.

The prevalence of HCV in the opioid replacement treatment (ORT) settings is around 70%, and currently <5% receive treatment, therefore a large number of people in these settings require HCV treatment assessment. There is currently very little known about the long term impact of HCV treatment for injecting drug users or those receiving ORT. The purpose of the study is to assess a group of ORT clients for HCV treatment and establish a longitudinal cohort of those who successfully commence on treatment. A retrospective/prospective cohort design will be employed using a network of tertiary care clinics and public and private methadone clinics undertaking HCV treatment assessment and monitoring.


 

Munch and Move: promoting health eating and physical activity in early childhood services

King, L, Hardy, L, Farrell L, Howlett S.

Munch and Move is an intervention research study investigating the effectiveness of an intervention to promote health eating and physical activity within early childhood settings.


 

Evaluation of the Good for Kids child obesity prevention program in Hunter New England Area Health Service

Hardy L, King L

The Prevention Research Centres are collaborating with NSW Health Department and Hunter New England Area Health Service on the evaluation of this large, multi-strategic community-based intervention, which is currently underway.


 

Evaluation and enhancement of treatment services to Aboriginal communities in an urban area.

Conigrave K, Becker K, Kelaher B, Simpson L, Long G, Wade V.

Trials of approaches to increase implementation of screening and early intervention for alcohol problems.Studies of approaches to increase access to the full range of treatments for alcohol problems for Aboriginal communities in urban and rural settings. Five-year NHMRC funded project to reduce smoking in remote Aboriginal communities


 

Clinical correlates of lymphoedema.

Kilbreath SL, Ward LC, Refshauge KM, Baldock C, Bailey DL, Giuffre B, Lee MJ, Schembri G, Beith J, Simpson JM.

The aim of this study is to identify the clinical correlates associated with the earliest anatomical and functional changes of intractable lymphoedema with a view to improving early detection of the condition. This will enable treatment to occur as early as possible to prevent permanent tissue damage, thereby improving provision of health care in ways that are important for cancer survivors. We will conduct a cross-sectional study in cancer survivors who have developed secondary lymphoedema. We will determine the relationship between anatomical and functional measures derived from 3T magnetic resonance imaging and lymphoscintigraphy with clinical measures of arm volume using perometry, interlimb impedance ratios from BIS and self-reported symptoms.


 

Paediatric Trauma Case Management Study: A randomised controlled trial

Lawrence Lam, Frank Ross, Fiona Fahy, SVS Soundappan, Daniel Cass

This study aims to evaluate the effectiveness of a case management approach using senior trauma nurses in providing trauma care services to children who have been moderately or severely injured and hospitalised. This is a randomised control trial with outcomes of improving clinical information gathering, service quality, and clinician-patient-parent communication and thus patients' satisfaction.

Funding body: Motor Accident Authority

Commenced in 2007, expected to finish in 2009.


 

Childhood mental health longitudinal study in China

Lawrence Lam, ZiWen Peng

This project aims to investigate the current mental health status of children residing in GuangZhou city in determining the extend of childhood mental well-being or mental problems within the population. A cohort of primary school children will be recruited and followed for 3 years longitudinally. The mental health of these children will be assessed clinically aiming to identify at risk individuals for early intervention.


 

Mental health of elite young athletes in China

Lawrence Lam, ZiWen Peng

This project aims to investigate the current mental health status of a special group of adolescent elite athletes in GuangZhou city in determining the extend of mental well-being or mental problems within the population.

Commenced and finished in 2008.


 

The use of evidence by policy makers in cancer screening programs.

Salkeld G, Flitcroft K.

This qualitative PhD project involves interviews with key informants about how policies concerning colorectal cancer screening have come to be made. More specifically, it considers the importance of research evidence in decision-making about colorectal cancer screening in Austraila, New Zealand and the UK. A systematic review of the use of evidence about the benefits, harms and net benefits in screening criteria has been conducted as part of this project.


 

Voluntary clinical teachers at the University of Sydney: barriers and motivating factors

Investigators Birden, H. Usherwood, T. Reid S.

This is a qualitative study to determine the motivators and barriers faced by clinicians through their efforts to provide voluntary teaching services to the Faculty of Medicine. A qualitative research method is appropriate for achieving an in-depth understanding of the experience of voluntary clinical teachers in the context of an ever changing medico-political, clinical and educational environment. Since the participation of voluntary clinical teachers is an essential component of the University of Sydney medical education program, this study will add knowledge relevant to the recruitment and retention of such clinicians.

Year to commence: 2008 Finish year: 2009


 

Chlamydia incidence and re-infection (CIRIS) study: a longitudinal study of young Australian Women

Investigators: Hudson Birden, Jane Hocking, Jane Walker, Christopher Fairley, Frank Bowden, Basil Donovan, John Kaldor, Jane Gunn, Marie Pirotta, Harindra Veerakathy, Lyle Gurrin, Suzanne Garland, Kathleen McNamee

Cohort study to determine: Prevalence of Chlamydia and Mycoplasma genitalium in young a Australian women. And how many young women with Chlamydia become re-infected (infected again) over a year.

Year to commence 2008 Finish year 2009


 

Using health economics to strengthen ties between evidence, policy and practice in chronic disease

Jan S, Clarke P, Howard K, Salkeld G, Chalmers JP, Leeder SR

There is a major shortage of researchers with health economics expertise in Australia. This grant will provide training and development for a team of health economists to research chronic diseases covering issues such as: What is the value for money from investment in different treatments? How do such diseases affect the economic circumstances of families? How do we ensure that strategies to address illness work in practice and can be sustained? How do these issues get put on the policy agenda?

NHMRC Capacity Building Grant. 2009 - 2013


 

Menzies Centre for Health Policy

Wells R, Leeder SR

The Menzies Centre for Health Policy was established in 2006 through a competitive grant from the Sir Robert Menzies Memorial Foundation. Since its inception the Menzies Foundation has committed more than $20 million to a number of program initiatives. The Menzies Centre for Health Policy is the most recent of these.

The Menzies Centre for Health Policy is a joint venture between The Australian National University and the University of Sydney. It aims to provide the Australian people with a better understanding of their health system and what it provides for them. The Centre encourages informed debate about how Australians can influence health policy to ensure that it is consistent with their values and priorities and is able to deliver safe, high quality health care that is sustainable in the long term.

Menzies Foundation grant. 2006-2010


 

Approved Sound Practice: Supporting sustainable careers in orchestral musicians through Occupational Health and Safety initiatives.

Dr. BJ Ackermann, Prof DT Kenny, A/Prof. TR Driscoll

The performing arts enrich Australia's life and build its image as an innovative and sophisticated nation. This impacts on the global perception of nations as much as do economic and other indicators. Classical orchestral and ensemble music are an important part of the performing arts and an essential component of Australian cultural life. It also makes a major contribution to the Australian economy. Australia has 8 major professional orchestras including 6 symphony state orchestras and 2 opera and ballet orchestras. The Orchestras of Australia association website1 lists 165 orchestras as members within Australia. There are 335,000 people involved in the music industry of whom 118,800 received an income from this work2; 88% of the adult population attend a cultural event or venue within a twelve month period (ABS 2005/6)3.

    Specifically, the AIMS of this project are to:
  • 1. Establish an effective and reliable prospective injury surveillance system for orchestras
  • 2. Establish a systematic assessment protocol to identify risk factors for pain/injury in musicians.
  • 3. Conduct a risk factor analysis that can identify potential targeted interventions for musician sub-groups.
  • 4. Assess and prioritise impact of risk factors in terms of injuries, days lost from work and insurance premiums (cost).

The data obtained form the injury surveillance project will enable inferences to be made on injury causality of identified risk factors. Data will be analysed to prioritise risk factors, and this will lead to further planning of intervention trials that aim to address these identified risk factors. By establishing baseline information we can clearly identify risks particular to instrumental groups and particular orchestras as well as professional orchestral musicians as an occupational group. In addition, the physical and psychological screening measurements will enable identification of characteristics that may make an individual more vulnerable to injury, allowing targeted prevention approaches.

An ARC Linkage Grant $734,042

2009-2013


 

Popping the Bubblewrap, Unleashing the Power of Play.

A Bundy; GA Naughton; PJ Tranter; SR Wyver; Prof LA Baur; WE Schiller; Prof. A Bauman.

ARC Discovery Grant $398,923

2009-2011


 

Occupational Moving and Sitting Research Study

Chau JY, van der Ploeg HP, King L, Kurko J, Dunn S, Bauman A.
This study aims to develop an accurate and reliable measure of occupational sitting. This research will help to improve the measurement and analysis of occupational sitting in epidemiological and intervention studies. This study is being conducted in collaboration with the Heart Foundation and City of Sydney.


 

Food and drink company sponsorship of children's sport: publicity or philanthropy?

Prof LA Baur; Prof. A Bauman; B Smith; K Chapman.

ARC Linkage $290,000

2009-2011


 

The use of Web 2.0 internet sites to undermine tobacco advertising bans and to mobilise tobacco control advocates

Chapman S, R Freeman R, Assunta Kolandai M.

NHMRC project grant #570869. $351,000

2009-2011


 

What is influential public health research?

Chapman SF, Hall WD, Redman S, Leeder SR, Gillespie JJ.

NHMRC project grant #570870. $433,500

2009-2010


 

Sex-related changes in asthmas during the transition through puberty in the CAPS birth cohort.

Marks GB, Toelle BG, Leeder SR, Cowell CT, Tovey ER, Almqvist CES.

Early adolescence is a critical period in the life of people with asthma. Some children "grow out" of their asthma and others acquire the disease for the first time. There are important sex differences in the pattern of change. We believe these changes are related to the passage through puberty. This study will examine changes in the features of asthma and allergy during this period and their relation to early life and current environmental exposures.

We will follow-up a high risk cohort for asthma that was recruited antenatally between 1997 and 2000. During their first five years of life, the children were participants in a randomised controlled trial of two interventions, house dust mite avoidance and modification of dietary fatty acids, to prevent the onset of asthma. The members of cohort were last assessed at age eight years. In the study proposed here, we will obtain data on growth in height at three monthly intervals and self-reported stages of puberty, including age at menarche (in girls) and the development of secondary sexual characteristics, at yearly intervals from age 11 years. At ages 11 ½ and 14 years, we will undertake detailed assessments of environmental exposures, pubertal stage (including sex-hormone levels) and respiratory and allergic outcomes. This cohort analysis will allow us to examine the relation among early and current environmental exposures, stages of puberty and sex-specific changes in the course of asthma during early-to-mid adolescence.

NHMRC project grant #570919. $783,875

2009-2013


 

Improving quality of life at the end of life. RCT of a doctor/nurse/patient intervention

Butow PN, Tattersall MHN, Clayton JM, Young JM, Davidson PM, Epstein RM.

NHMRC project grant #571346 $660,800

2009-2011


 

Nutrition and genome damage in children

Milne E, Fenech MF, Armstrong BK, de Klerk NH, Miller M.

NHMRC grant project #572623. $686,600

2009-2011


 

Infection, lifestyle and skin cancer.

NSW Cancer Council Sitas F, Armstrong BK, Banks E, Kricker A, Weber M, Pawlita M.

NHMRC project grant with the NSW Cancer Council $953,200

2009-2011


 

CHALLENGE: Colon Health And Life Long Exercise ChaNGE

Vardy J, Dhillon HM, van der Ploeg HP, Zalcberg JR, Courneya KS, Meyer RM. AI's Simes J, Bauman A, Karapetis C, Walpole E, Clarke S, Goldstein D.

NHMRC project grant #570907. $2,418,375

2009-2013


 

Australian Placental Transfusion Study (APTS)

Prof WO Tarnow-Mordi, A/Prof DA Osborn, Prof D Isaacs, Prof JP Newnham, A/Prof N Evans A/Prof K Simmer

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #571309 $2,696,700


 

Aspirin to prevent recurrent deep vein thrombosis or pulmonary embolism

Brighton T, Simes J, Eikelboom J, Gallus A, Agnelli G, Kakkar A.

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #570967. $1,916,600


 

Does palliative chemotherapy palliate?

Prof M Friedlander, A/Prof M King, Dr M Gainford, Prof At OzA (ANZGOG Study)

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #570893. $502,250


 

PORTEC-3

Prof M Quinn, Dr L Mileshkin, Dr P Khaw, Dr C Creutzberg, Prof M Friedlander, Dr M Gainford, (ANZGOG study)

*through the NHMRC Clinical Trials Centre*

NHMRC Project Grant #570894. $443,125


 

Guidelines for designing and appraising studies investigating the impactof a diagnostic test on patient management.

Lord SJ. Chen RYM,

*through the NHMRC Clinical Trials Centre*

NHMRC Project Grant #571044. $128,638


 

ACTIVE Dialysis: A Clinical Trial of InvesiVE Dialysis

Cass A, Perkovic V, Howard K, McDagar JW, Hawley C, Kerr PG.

*through the George Institute*

NHMRC Project Grant #571045. $1,248,175

People with kidney disease requiring dialysis have substantially reduced life expectancy and quality of life. Better treatments are therefore urgently required. ACTIVE Dialysis is a clinical trial that aims to assess whether increased duration of dialysis improves these critical outcomes for affected patients. A formal cost-effectiveness analysis will also be performed. The results of this study have the potential to improve the health and longevity of many thousands of Australians.

2009-2012


 

Erythropoiesis Stimulating Agents Trialists\' Collaboration

Cass A, Perkovic V, Huxley R, Baigent D, Levin A.

*through the George Institute*

NHMRC Project Grant # 571047. $104,750

Erythropoiesis Stimulating Agents are used to correct the anaemia associated with kidney disease, and cost Australia around $100m in 2004. The optimal target haemoglobin remains the subject of intense debate despite several large trials in the area. This project will use pooled data from these trials to provide a definitive analysis of the overall harms and benefits associated with different targets for the first time and will guide the use of these expensive drugs to maximise patient benefit.

2009-2011


 

Passive mechanical properties of muscle fascicles and tendons of people

A/Professor R Herbert

*through the George Institute*

NHMRC Project Grant # $179,398

Muscle contracture - abnormal stiffening of muscles - is common in many conditions, including stroke, spinal cord injury and multiple sclerosis. Contractures can be very disabling.The mechanisms of muscle contracture are poorly understood. This study will determine whether contractures of calf muscles in people with stroke, spinal cord injury and multiple sclerosis are due to changes in the mechanical properties of muscle fascicles or tendons.

2009-2010


 

Exercise self-management to improve long-term functioning & prevent falls after hip fracture

Sherrington C, Clemson L, Lord SR, Howard K, Moseley AM, Vogler CM

*through the George Institute*

NHMRC Project Grant #570886. $809,875

Up to 20,000 older Australians suffer hip fractures each year. Many people don't fully recover. We have designed a self-management training program which incorporates individualised exercise prescription. This novel program is designed for people who have completed usual treatment and rehabilitation for hip fracture. We will conduct a well-designed randomised controlled trial to test the effects of this program on disability, falls and hospital readmissions and to assess its cost-effectiveness.

2009-2012


 

A randomised controlled trial of a promising new treatment for chronic whiplash

Maher C, Latimer J. Sterling M, Jull MA, Connelly LB.

*through the George Institute*

NHMRC Project Grant #570884. $598,025

Following a whiplash injury about one third of people develop persisting pain and disability i.e. chronic whiplash. In a series of pilot trials we have developed a new physiotherapy treatment for chronic whiplash. Initial results are very promising. We now propose to definitively establish the effectiveness of this new treatment in a large clinical trial. At the same time we will evaluate the cost-effectiveness of the treatment.

2009-2011


 

The first placebo-controlled trial of paracetamol for back pain.

Latimer J, Maher C McLachlan AJ, Cooper CW, Hancock MJ.

*through the George Institute*

NHMRC Project Grant #570883. $602,625

Each year in Australia over $1Billion is spent on treatments for low back pain yet despite this expenditure symptoms persist in about 10% of patients. An important approach to solving this problem is to evaluate back pain treatments that are readily available, safe, cheap and effective. Our previous work suggests that regular paracetamol may be such a treatment. We propose to conduct the first ever placebo controlled trial of paracetamol for acute low back pain in a large clinical trial.

2009-2011


 

Buckle up safely

Ivers R, Bilston L, Stevenson M, Brown J, Simpson JM.

*through the George Institute*

NHMRC project Grant #570853. $703,200

Despite overwhelming evidence that child restraints dramatically reduce the risk of death and injury there are currently a large number of children globally who either do not use appropriate child restraints, or misuse them, contributing to the overwhelming burden of road traffic injury in children. This project, using rigorous methodology, will assess the efficacy of feasible, evidence based interventions aimed at increased use of appropriate restraints, and decreasing misuse.

2009-2011


 

Triggers for preeclampsia.

Ford JB, Roberts CL, A/Prof RD Herbert Prof JM Morris, Dr CH Raynes-Greenow, Mr CS Algert

*through the Kolling Institute*

NHMRC Project Grant #570903. $199,500

2009-2011


 

Pertussis vaccine for newborns

Prof P McIntyre, Prof T Nolan, Dr. N Wood, Dr. H Marshall, Dr. J Rowe *throught the National Centre for Immunisation Research and Surveillance*

NHMRC Project Grant #570756. $1,450,206

Over 80% of hospitalistions and all deaths from pertussis in children currently occur under the age of 4 months but the first vaccine dose is not given until 2 months and at least 2 doses are required for protection, with second dose at 4 months. This randomised controlled trial will test whether the addition of a monovalent acellular pertussis vaccine at birth to an accelerated schedule of diphtheria, tetanus and pertussis vaccination commencing at 6 instead of 8 weeks provides the antibodies required for protection against pertussis by 2 months of age. Amount Awarded: $1,450,206 + in kind contribution of monovalent vaccine and laboratory testing from Glaxo Smith Kline of > $750,000.


 

Supporting Mums to Quit: smoking intervention research for pregnant rural Aboriginal women

M Passey, R Sanson-Fischer, J Gale, B Holt, R Martin, C Leatherday

* through UDRH Northern Rivers*

Indigenous Tobacco Control Initiative, Australian Government Department of Health & Ageing

$620,000


 

Systematic Review - Effectiveness of strategies to improve linkage in primary mental health care

Fuller J, Perkins D, Kelly B, Fragar L.

Australian Primary Health Care Research Insitute

National policies advocate linkages (partnership) between specialist mental health, generalist primary health and other human services, however partnership as a form of service organisation can be problematic. Hence health service decision-makers need evidence based support in order to overcome the barriers to successful linkages in primary mental health care in Australia.

This systematic review and stakeholder consultation will synthesise the evidence into a decision making support framework around the following questions.

1. What are the drivers of and barriers to successful linkage between primary mental health care sub-sectors (including specialist mental health services, general practice, community health services and other government and non-government services involved in mental health care)?

2. What are the drivers of and barriers to appropriate integrated referral arrangements in primary mental health care in Australia?

3. Are the drivers of and barriers to successful linkage in primary mental health care services different for patients in different priority groups, such as low socio-economic status groups, Indigenous Australians, elderly people, people with cultural or linguistic disadvantages or people with high prevalence compared to low prevalence mental disorders?

4. Which of these drivers are the most cost effective? What strategies could be implemented to strengthen the most effective and cost effective drivers to enhance linkage and collaboration? What would be the benefits in terms of collaboration and what would be the costs of implementing such strategies?

Start date 1 Jan 2009, End date 30 Dec 2009

$275,000


 

Baseline study of knowledge and awareness of anti-doping in the sporting community

Orr R, Bauman A, Macniven R Despite the implementation of a standard Anti-doping Code by the World Anti-Doping Agency (WADA), doping in sport by the taking of banned performance enhancing drugs continues. Despite the willingness of some athletes to engage in doping behaviour, their knowledge and understanding of these substances is commonly lacking. The study will examine awareness and knowledge of anti-doping policy and testing procedures, investigate level of knowledge about prohibited substances, look at attitudes towards doping in sport, and investigate any links between knowledge and attitudes to doping in sport in high performance athletes and coaches. Australian Government of Health and Ageing through the Anti-Doping Research Program $167,200


 

BEACH (Bettering the Evaluation and Care of Health)

Britt H, Miller G.

The BEACH program is a continuous, national, cross-sectional study of general practice activity in Australia. Each year, approximately 1,000 randomly sampled recognised, practising GPs from across the country provide details about 100,000 clinical encounters with (unidentified) patients. BEACH is unique, being the only continuous randomised study of general practice activity in the world, and the only national program that provides direct linkage of management actions (e.g. prescriptions, referrals, investigations) to the problem under management.

BEACH is conducted by the Australian General Practice Statistics and Classification Centre (AGPSCC), a collaborating centre of the Family Medicine Research Centre (FMRC) at the University of Sydney and the Australian Institute of Health and Welfare (AIHW). The program's aims are to provide a reliable and valid data collection process for general practice that is responsive to the ever-changing needs of information users; to establish an ongoing database of GP-patient encounter information; and to assess patient risk factors and health states, and the relationship these factors have with health service delivery. The program commenced in 1998 and has attracted funding of more than $12 million to date from government instrumentalities and private industry.


 

Social research in chronic kidney disease, transplantation and organ donation

Tong, A

Patient-important outcomes in nephrology evaluation and research (PIONEER) Project

Aims
  • elicit outcomes that are important and relevant to patients on renal replacement therapy
  • develop a hierarchical categorisation of the outcomes that are important to patients
  • determine patients' preferences for how patient-important outcomes should be measured in research and incorporated into routine clinical care
The project involves 3 phases:
  • a combined focus group and nominal group technique to elicit outcomes that are relevant and important to patients,
  • a questionnaire to develop a hierarchical categorisation of outcomes that are important to patients
  • a patient consultation workshop to determine patients' preferences for how these outcomes can be measured and incorporated in research and clinical care.


 

Design and preparation of a pilot project to reduce maternal and neonatal mortality through demand side interventions in West Java Province, Indonesia

Heywood P.

There is an identified need in Indonesia to introduce demand side instruments that protect families against maternal and neonatal mortality resulting from a high proportion of in-home births. This project seeks to design a demand-side voucher system to encourage expectant mothers to deliver in health facilities. The project seeks to identify access barriers and develop social marketing tools which can be implemented in a later pilot project.

Funded by a Ford Foundation Grant. 2009 -2011


 

“Pacific Focus”: Understanding Health Policy Development and Capacity in the Pacific

Negin J.

Consultancy project conducted for the Australian International Health Institute, University of Melbourne.

In the arena of Global Health, health policy is one of the key areas in which many of the actors such as international agencies, donors, researchers, NGO's, national governments are involved. Much of the health policy emphasis globally has been on what health policy reforms countries should introduce. (Walt and Gilson 1994) The Pacific is no exception: debates have persisted regarding health sector reforms, financing options, and disease control priorities. What has received little analysis is how countries carry out reforms, how policy is developed and implemented, and who is involved in these processes. (ibid.) This project looks at the "how" of policy development by applying the lens of health policy analysis.

2009


 

Survey on Attitudes towards the Australian health system

Gillespie J.

The Menzies Centre for Health Policy and The Nous Group recently surveyed 1200 Australians to understand their attitudes towards the health system. The survey covered the following topics:

* Expectations, confidence and satisfaction with the system

* Health literacy and the ability to access care

* Cost-related access and private health insurance

* Privacy

* Commonwealth-State relations

The results of the survey will be progressively released from October 2008 through early 2009. Further information, latest results, along with media releases and articles can be found at the Menzies website

2008 - ongoing


 

Novel Retinal Architectural Vascular Signs and Risk of Cardiovascular Disease: The AusDiab Study

Wong T, Shaw J, Cheung N, Kawasaki R, McGeechan K, Lee M.
In this proposed study retinal architectural vascular parameters (fractal dimension, tortuosity, and branching angles and patterns) will be measured for the 2,000+ AusDiab study participants at baseline (1999-2000). We will then determine if these retinal parameters predict the 11-year incidence of CVD and 5-year incidence of diabetes, PAD and nephropathy
.
NHMRC project grant 590212