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Health And Medical Research Council (health + and_medical_research_council)
Kinds of Health And Medical Research Council Selected AbstractsSix-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disordersDRUG AND ALCOHOL REVIEW, Issue 2 2002GARY K. HULSE Abstract The objective of this study was to evaluate the 6-month outcomes of a brief intervention to reduce alcohol consumption by psychiatric in-patients in the general hospital setting and following resolution of psychiatric morbidity. Patients from the psychiatric wards of three general hospitals were screened using the Alcohol Use Disorders Identification Test. Of 144 people approached who matched the study criteria, 120 (83%) people aged 18,64 years (mean 31.7) were recruited. Participants were randomized to either a brief motivational interview or an information package to reduce alcohol consumption. Alcohol consumption was assessed as total weekly consumption and categorized on Australian National Health and Medical Research Council (NH&MRC) criteria. We delivered 62 motivational interviews and 58 information packages. At the 6-month follow-up 83 (69%), participants were reassessed. Both groups had significantly reduced alcohol consumption. However, the motivation group had a significantly greater reduction in weekly consumption than the information group (F = 6.8, (1,65) p < 0.025) after controlling for age, sex, SCL-90-R GSI and alcohol dependence (and baseline alcohol consumption). A greater proportion of the motivation group compared to the information group also ,improved' in their classification on NH&MRC criteria (,2 = 7.3, df 1, p < 0.01). Brief interventions, especially motivational interviews, are effective in reducing alcohol use in persons with psychiatric disorders. They are effective across the mid-range of GSI severity scores for in-patients. Screening and brief interventions can and should be incorporated into the routine assessment and management in psychiatric units. [source] The validity of an Australian modification of the AUDIT questionnaireDRUG AND ALCOHOL REVIEW, Issue 2 2001LOUISA J. DEGENHARDT Abstract The Alcohol Use Disorders Identification Test (AUDIT) has been used widely and is reported to be superior to conventional questionnaires in detection of current hazardous and harmful alcohol use. We assessed the validity of an Australian modification of the AUDIT (the AusAUDIT), which has been employed widely in Australian and New Zealand early intervention programmes. We used a cross-sectional study of 370 subjects from the follow-up phase of a randomized controlled trial of early intervention to reduce hazardous alcohol consumption. Scores on the AusAUDIT were compared against 12-month ICD-10 diagnoses of harmful alcohol use and dependence, as determined by the Composite International Diagnostic Interview, and against self-report of alcohol consumption exceeding Australian National Health and Medical Research Council (NH&MRC) recommended limits. AusAUDIT had good internal consistency and discriminated significantly between persons meeting criteria for ICD-10 alcohol use disorders, and drinkers who did not. At currently recommended cut-off scores, AusAUDIT detected more than 85% of people meeting criteria for ICD-10 alcohol use disorders, or drinking over NH&MRC recommended limits, but its specificity was limited (29% in men, and 58% in women for drinking over NH&MRC limits). No subset of questions performed as well as the full AusAUDIT in detection of drinking problems, but the alcohol consumption items provided a reasonable screen for drinking over NH&MRC limits. We conclude that AusAUDIT is effective in detecting problematic drinking, but positive cases should be confirmed by clinical assessment. The findings illustrate the need for validation of questionnaire modifications, and the difficulty in increasing test sensitivity without reducing specificity. [source] Options in Prehospital analgesiaEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2002Meredith L Borland Abstract Background: Prehospital analgesia options for paramedics have been limited due to the difficulty in achieving safe and effective pain relief without compromising transportation to hospital. The present paper identifies the analgesia methods currently available in the prehospital setting so as to evaluate the various options and highlight areas for future research. Methods: A literature review of Medline and Embase databases from 1966 until the present was undertaken. Further hand searching of all the references identified in these papers was also performed. All current literature was analysed and categorized according to one of four levels of evidence using National Health and Medical Research Council of Australia guidelines (1999). Results: There is a paucity of randomized control trials relating to prehospital analgesia. All published literature was level III or IV prospective or retrospective studies. Drug options used included nitrous oxide/oxygen mixtures, intravenous/intramuscular nalbuphine, intravenous tramadol and intravenous pure opiate agonists. Conclusions: The evidence supporting analgesic options in the prehospital setting is limited. There are few published data in this area despite the inadequacy of pain relief being recognized as a weakness in prehospital care. Prehospital analgesia is an area worthy of innovative methods for the administration of safe and effective analgesics without significant impact on transport times. Such methods should be prospectively evaluated in well-constructed trials. [source] Use of fresh-frozen plasma at Royal Darwin Hospital: a retrospective auditINTERNAL MEDICINE JOURNAL, Issue 9 2008S. Moylan Abstract Background:, The aim of the study was to assess the appropriateness of use of fresh-frozen plasma (FFP) at Royal Darwin Hospital against the National Health and Medical Research Council and Australian and New Zealand Society for Blood Transfusion guidelines. Methods:, A retrospective review of blood product request forms, online pathology storage system data, pathology records and clinical notes between 1 January 2006 and 31 December 2006 was carried out. The appropriateness of requests was assessed against existing guidelines. The percentage of appropriate and inappropriate FFP transfusions was obtained. Results:, Six hundred and forty-eight of 950 units (68%) of FFP were used with an appropriate indication as per National Health and Medical Research Council/Australian and New Zealand Society for Blood Transfusion guidelines. Of the remaining units, 14% (137 units) was given without a clear indication and a decision of appropriateness could not be established for 17% (165 units) because of inadequate clinical or pathology information (e.g. coagulation results). Multiple issues around prescribing practice were identified. Conclusion:, There is significant use of FFP at Royal Darwin Hospital without clear clinical indication. The employment of a transfusion nurse to monitor use of FFP (and other blood products) and provide education is aimed at improving transfusion efficiency and patient safety. [source] Comprehensive measurement of maternal satisfaction: The modified Mason SurveyINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2002Maree Johnson RN A three-stage process was undertaken to identify and modify a tool that was capable of measuring the many aspects of maternal satisfaction relevant to Australian women. First, the scope of maternal satisfaction to be measured was defined by summarizing available literature and surveys purporting to measure maternal satisfaction (including surveys used in maternity services in New South Wales). The multidimensional nature of maternal satisfaction was confirmed, with 16 core aspects (common to the literature and local surveys) and nine additional unique aspects of maternal satisfaction being identified. Second, these core and additional aspects were used to examine the comprehensiveness of the Mason Survey, a survey recommended by the National Health and Medical Research Council of Australia for use in maternity services. Eighty-eight per cent of the core and additional aspects (22/25) were found to be present in the Mason Survey. Third, an expert panel further modified the Mason Survey by removing items not applicable to the Australian context. The modified Mason Survey is a comprehensive measure of maternal satisfaction suitable for Australian women and capable of providing valuable information on the quality of services and future planning for maternity services. [source] Pain assessment in older people with dementia: literature reviewJOURNAL OF ADVANCED NURSING, Issue 1 2009Linda McAuliffe Abstract Title.,Pain assessment in older people with dementia: literature review. Aim., This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers. Background., Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain. Data sources., Searches were conducted of CINAHL, Medline and other databases for the period 1993,2007 using the search terms pain, dementia, assess*, barrier* and obstacle*. Methods., Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute. Results., Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a ,no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools. Conclusion., More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia. [source] Case for postoperative surveillance following colorectal cancer resectionANZ JOURNAL OF SURGERY, Issue 1-2 2004Tim R. Worthington Over 4 years have elapsed since the first National Health and Medical Research Council (NHMRC) guidelines were published for the management of patients after potentially curative resection of colorectal cancer. New information has now been published indicating that more intensive follow up than was originally recommended might provide a survival benefit for patients. This new information should be considered when formulating new NHMRC guidelines. In particular, meta-analyses of published individual trials have suggested a survival advantage that was not evident in the individual studies. There have been significant developments in chemotherapy with new individual agents and use of agents in combination that have proved far more effective than previous protocols. The therapeutic effect of these developments is the downstaging of some patients with metastatic disease, which was previously unresectable, to undergo resection. Furthermore, there is now some evidence that palliation of patients with advanced disease is more effective if commenced before the development of symptoms and this needs to be considered in the assessment of the benefits of follow up. There have been limited studies of cost-effectiveness, but international analyses suggest that the costs associated with more intensive follow-up regimes are within the accepted cost parameters associated with the management of many other conditions. [source] Cutaneous invasive squamous cell carcinoma: 10-year experience and recommendations for follow upAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2009Corinne Yoong ABSTRACT Currently, the National Health and Medical Research Council do not have any recommendations about the frequency of follow up after treatment of primary cutaneous invasive squamous cell cancer (SCC), due to a lack of data. The present study aimed to establish appropriate follow-up times and to determine the long-term risk of subsequent non-melanoma skin cancers and melanoma. Patients who had a primary invasive cutaneous SCC excised during 1996 were retrospectively identified from the databases of a dermatologist in private practice in south-east Queensland. Data on size, site, depth, differentiation, perineural involvement, lymphovascular involvement of the index SCC were obtained. The patients were regularly followed up and lymph-node involvement, patient immunocompetence, and the presence of local recurrences and subsequent SCC, basal cell carcinomas and melanoma were recorded. Forty patients were identified, comprising 25 men and 15 women with a mean age of 65 years. The majority (60%) of primary incident SCC were in the low-risk category. The median follow-up time was 7.5 years. One in two developed a second SCC within 5 years, a significant number had a second SCC detected only in 5,10 year follow up, and 72.5% had a BCC within 5 years, and 82.5% at 10 years. One in eight had a subsequent melanoma detected. [source] Clinicians choices of restorative materials for childrenAUSTRALIAN DENTAL JOURNAL, Issue 4 2003LA Tran Abstract Background: Recently, there has been an expansion in the range of tooth-coloured restorative materials available. In 1999, the National Health and Medical Research Council recommended clinicians use alternatives to amalgam in children ,where appropriate'. Methods: A three-part 29-item questionnaire was developed, tested in a focus group, and distributed to members of the Australasian Academy of Paediatric Dentistry (AA; paediatric dentists and paediatric dentistry postgraduate students; n=55), and the Australian and New Zealand Society of Paediatric Dentistry, Victorian Branch (SPD; general dentists and dental therapists; n=50). Participant information, material choices, and six hypothetical clinical scenarios were addressed. Results: The overall response rate was 74 per cent. For both groups, the first ranked factor influencing choice of restorative material for vital primary teeth was child age, and caries experience for vital first permanent molars. For moderate-sized Class I and II restorations in primary molars, a tooth-coloured material was chosen by 92 and 84 per cent respondents respectively. For restoring two separate proximal lesions in a primary molar, 65 per cent chose a tooth-coloured material followed by a stainless steel crown (27 per cent; all AA members), then amalgam (8 per cent). The SPD respondents were significantly more likely to choose glass ionomer cement for Class I and II restorations and for restoring two proximal lesions (all p=0.000) in primary molars than AA respondents, who were more likely to choose composite resins/compomers or amalgam/stainless steel crowns for these restorations. Younger respondents (21,40 years) were significantly more likely to choose composite resins/compomers or amalgam/stainless steel crowns (p=0.048) than older respondents (41,65 years), who were likely to choose glass ionomer cement. Conclusions: For Class I and II restorations in primary molars, glass ionomer cement was the material chosen most frequently (SPD respondents); preference for amalgam or stainless steel crowns was low (both SPD and AA groups). The wide range of materials chosen for the hypothetical clinical scenarios suggests the need for guidelines on selection of restorative materials, and the need for longitudinal studies to follow actual clinical outcomes of the materials chosen. [source] Funding for rural health research from the Australian Research Council: A missed opportunity?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2009John McDonald Abstract Objective:,To determine the number of projects, and level of funding, for rural health research from the Australian Research Council (ARC). Design:,Analyses of ARC searchable datasets of completed, and new and ongoing projects from 2001 to 2008. Main outcome measures:,Number of rural health research projects as a proportion of total funding; level of funding for rural health research projects as a proportion of total funding. Results:,Only 46 of 6498 ARC completed projects were classified as rural health research projects. This represents 0.7% of the total number of projects, and 0.39% of the total funding allocated. Only 25 of 4659 ARC new and ongoing projects were classified as rural health research projects. This represents 0.54% of the total number of projects, and 0.27% of the total funding allocated. None of the 832 completed fellowships were classified as rural health. Only five (0.52%) of the 953 new and ongoing fellowships were classified as rural health. Conclusions:,The level of under-funding for rural health research could be partially addressed by directing applications towards the ARC, in addition to the National Health and Medical Research Council. With a few exceptions, rural health researchers are not yet competitive in the national funding arena. [source] Further survey of Australian ophthalmologist's diabetic retinopathy management: did practice adhere to National Health and Medical Research Council guidelines?CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2010Joshua Yuen MPH Abstract Background:, To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines. Methods:, Self-reported cross-sectional survey of patterns of practice. Questionnaires were sent to all Australian ophthalmologists, comprising questions regarding professional details, diabetic retinopathy screening attitudes/practices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression. Result:, 480 of the 751 (64%) eligible Australian ophthalmologists participated. The majority (80%, n = 376) reported they consistently reviewed patient's glycaemic control, but only 55% and 41% regularly reviewed blood pressure and serum cholesterol control, respectively. Ophthalmologists generally adhered to NHMRC-recommended screening intervals, although only 38% agreed with the guidelines relating to screening of pre-pubertal diabetic patients. Fluorescein angiogram was used more than recommended, especially for mild non-proliferative diabetic retinopathy where 45% of respondents used this investigation. Practice duration >15 years was associated with more regular fluorescein angiogram use (OR = 3.74; 95% CI: 2.53,5.53, P < 0.001). In the clinical scenarios where clinically significant macular oedema was concurrently present with cataract or proliferative diabetic retinopathy, >26% referred to retinal subspecialists for management; 85% of the remaining ophthalmologists performed macular laser first. Respondents with practice duration >15 years were 7.8 times (P = 0.001) more likely to perform cataract surgery first. Conclusion:, Diabetic retinopathy management guidelines were generally well followed by Australian ophthalmologists. However, areas of practice variation existed including frequent use of fluorescein angiogram. Significant proportion of practitioners referred diabetic patients to retinal subspecialists, who were more likely to adhere to guideline recommendations. Ophthalmologists with greater experience (>15 years) were more likely to employ practices differing from NHMRC recommendations. [source] Victorian orthoptists' performance in the photo evaluation of diabetic retinopathyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2007Zoran Georgievski BAppSc(Orth)Hons Abstract Purpose:, The aim of this study was to investigate the effectiveness of orthoptists in detecting various grades of diabetic retinopathy (DR) and retinal pathology not directly associated with diabetes and to identify factors associated with best performance. Methods:, Forty-five orthoptists completed a survey comprising questions regarding their workplace experiences, plus a photo evaluation task with 36 digital fundus images. Results:, We found that orthoptists' overall performance in detecting the presence of abnormality in a series of DR images was high, the mean sensitivity being 86% and specificity 91%. The sensitivity was lower for images with minimal non-proliferative DR, but higher for those with mild,moderate and severe grades of DR. No factors were predictive of performance on the screening task. Conclusions:, Orthoptists performed extremely well, meeting the guidelines for DR screening recommended by National Health and Medical Research Council. The results indicate that orthoptists could potentially be used in DR screening models in Australia. [source] | |||||||||||||||||||