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Chronic heart failure (CHF) is a costly and debilitating condition. The benefits of applying nurse led CHF management programs (CHF-MPs) has shown that they improve health outcomes in CHF, especially in prolonging survival & reducing hospital readmission. The aim of WHICH? is to determine whether clinic based or home based programs produce the best outcomes. A randomised study of 1000 patients is proposed. Patterns of health care and quality of life will then be compared. The perspective examined will be health, economic, health policy and consumer.

Whilst the long-term effects of chemotherapy and hormonal therapy with tamoxifen on sexual function and quality of life of women with breast cancer has been well documented, less is known about the impact of aromatase inhibitors (AIs) on a woman’s sexual functioning. Common sexual issues raised have included vaginal dryness, painful sexual intercourse (dyspareunia) and a reduction in libido. AIs have largely replaced tamoxifen as choice of hormonal treatment in post-menopausal women and as there will an increasing number of women on AIs, it is important to document the impact of AI use on sexual functioning. The result of this study will raise the awareness of the potential effects of AI use and sexual dysfunction for both the physician and patient.

The Practitioner Asthma Communication and Education (PACE) Australia study is a collaborative project of the University of Sydney, The Woolcock Institute of Medical Research, The Royal Children’s Hospital, Melbourne and the University of Michigan, funded by the Australian Government Department of Health and Ageing. The aim of the study was to assess the impact of an evidence–based paediatric asthma program for GPs on GP practice and family health outcomes. We recruited a total of 150 GPs and 221 patients from western and central Sydney. We performed a randomised controlled trial with intervention GPs randomly allocated to receive the PACE workshops. Comparison GPs did not receive the PACE workshops until the end of the study. The PACE workshops comprised two 3-hour interactive sessions led by asthma experts. These sessions focussed on best practice approaches to paediatric asthma management and communication strategies with parents. Outcome measures for both GPs and patients were determined at baseline and 12 months. Following the PACE Australia workshops: 1. GPs reported increased use of the recommended communication strategies with their patients; increased use of the Asthma Cycle of Care item numbers and more frequent provision of written asthma action plans. 2. Families of intervention GPs reported increased receipt of asthma action plans and spacer devices, as well as more appropriate medication use. The program resulted in significant improvements in the way in which GPs manage asthma consultations, particularly with regard to doctor-patient communication and adherence to asthma management guidelines with a resultant improvement in key patient outcomes. The PACE Australia workshops were highly rated by all participating GPs. Here’s what some GPs said: “Improved my communication with patients and my knowledge and use of asthma devices.” “I have been able to provide more useful education to the patients by using the models provided at the workshop.” “I have been more interactive with parents & child, involving child more in treatment planning.”

The purpose of this study is to evaluate whether the timing of breast cancer surgery during a woman’s menstrual cycle affects her ultimate outcome- the likelihood of recurrence of breast cancer or death from breast cancer. This study involves taking a small sample of blood from the woman close to her surgery to evaluate her menstrual phase on the basis of hormones in her blood. The woman will then go on to have whichever treatments for her breast cancer that she decides with her doctor. The woman will be observed for at least 5 years and information regarding her treatment and disease progression will be submitted.

Radiotherapy is an effective treatment for people with cancer that has spread to their bones and is causing problems. Sometimes, a second course of radiation is required. This international randomised trial will determine if it is better for a second course of radiation to be done as one large treatment, or as several smaller treatments.

Surgery is the standard treatment for melanoma that has spread to nearby lymph glands, but it sometimes recurs despite surgery. Radiotherapy given soon after surgery may redue the risk of the melanoma coming back, but mat also cause side effects. This national randomised trial will determine the benefits and side effects of adding radiotherpay after surgery.

While positive end expiratory pressure (PEEP) is always used during intermittent positive pressure ventilation (IPPV), there are no current recommendations about the use of PEEP or continuous positive airway pressure (CPAP) during neonatal resusciation. The Neopuff is a manual ventilation device which delivers PEEP or CPAP. The Laerdal bag is the commonest manual ventilation device in use worldwide and does not deliver PEEP. Our hypothesis is that the delivery of PEEP or CPAP to very premature infants at birth may lead to a more rapid improvement in lung volume and therefore oxygenation.

A key goal in our research is to develop an empirically validated, cost effective psycho-educational coping program to improve pyshcoloigcal and physical adjustment for women with breast cancer and their nominate support persons.

Patients with type 2 diabetes are at risk of developing cardiovascular disease. Lifestyle changes and an exercise program may reduce damage to the structure and function of blood vessels and improve heart function. In this trial, subjects with type 2 diabetes will be randomly assigned to one of two groups – “Usual care” (ie standard treatment of diabetes according to guidelines) or “Active intervention” (additional measures such as frequent follow-up, additional dietary advice and an exercise program, in addition to usual care). The efficacy of these interventions on cardiovascular structure and function, exercise capacity, attainment of target biochemistry and outcome will be assessed after 1 month, 1 year and 3 years

Not all of the heart muscle involved in a heart attack is irreversibly damaged. Although bypass operations may lead to improvement in the function of this tissue, the procedure is risky for very many patients who are elderly or sick from other conditions. A number of pieces of evidence suggest that this damaged but viable tissue can be improved by drugs that optimize the use of oxygen in the muscle cells. We will study patients with damaged heart muscle, using one particular agent (perhexilene) that is produced in Australia. We anticipate that therapy will improve regional and global function of the heart, prevent enlargement and improve exercise capacity, and that these changes will correspond to the effects of the drug on cardiac metabolism. This study is based on particular strengths in measurement of regional and global function and use of cardiac magnetic resonance to improve our understanding of the effect of the amount of scarring.