The Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (MeTeOR2)
BackgroundThe meniscus is a c-shaped knee cartilage structure which distributes force between joint surfaces. Meniscal tears can occur, and often the torn parts are removed with keyhole surgery called arthroscopic partial meniscectomy. In Australia approximately 37,000 meniscectomies were performed between 2020-21, 10% were in young adults (< 30 years). Some people have considerable and persistent pain and impaired function after meniscectomy, and how to best treat this is unknown. Meniscal Allograft Transplant (MAT) is a treatment option where a donor meniscus is implanted into the knee. However, there is a lack of evidence whether this procedure is superior to physiotherapy.AimTo see if MAT surgery or Personalised Knee Therapy (PKT) is the most clinically and or cost-effective treatment, for people with knee pain and/or functional loss after a meniscectomy.Research MethodologyMETEOR2 is a two-armed multi-centred pragmatic, international, randomised controlled trial to assess the cost-effectiven
Strengthening clinical trials to provide high-quality evidence on health interventions and to improve research quality and coordination
Policy & Practice Report
Optimal Post Tpa-IV Monitoring in Ischaemic Stroke (OPTIMIST)
Aim: To establish that less-intense monitoring is at least as good as standard monitoring for patients who receive thrombolysis treatment for acute ischaemic stroke To establish that less-intense monitoring of patients is safe To establish that less-intense monitoring is cost-effective and allows more focussed nursing care.
Methodology:
An investigator-initiated and conducted, regionally coordinated, international, pragmatic, multicentre, prospective, stepped wedge, cluster randomised, blinded outcome assessed, clinical trial undertaken through a global network of investigators. The stepped wedge cluster (3 clusters, with 4 phases) will be undertaken at 120 hospitals, each recruiting average of 15 patient over a 4 month period per phase.
Fiji’s 3rd Round of the WHO STEPwise approach to non-communicable disease (NCD) risk factor surveillance
Background
The Fiji Ministry of Health & Medical Services (MHMS) will be conducting its third round of the STEPS Survey in 2024. The George Institute has been engaged to provide the MHMS with technical assistance in the implementation, data analysis and reporting of the survey, as part of Australia’s support to strengthening Fiji’s health sector. The consultancy will be led by Dr Bindu Patel and supported by a team of multidisciplinary experts: Professor Rohina Joshi (UNSW), Dr Anna Campain, Professor Jaime Miranda (USYD), Professor Laurent Billot and Sana Shan.
Why the STEPS Survey?
Fiji is experiencing an alarming rising trend in deaths from non-communicable diseases (NCDs), particularly heart disease and diabetes, before the age of 70.1 According to World Health Organization data from 2017, Fiji is ranked 39 out of 183 countries in the world in fatalities from heart disease.2 The three leading causes of heart disease in Fiji are raised blood pressure, high blood sugar and
Evaluating the impact, investment case and scale-up of ‘Health Promoting Schools’ in Fiji
BackgroundIn 2016, Health Promoting Schools (HPS) under the Fiji School Health Policy was launched as a joint program by the Ministry of Health and Medical Services and the Ministry of Education of Fiji. This is a ‘whole of school’ approach to improving health and wellbeing of Fiji’s children and youth by incorporating into the school curriculum resources to improve awareness and competency in promoting healthy behaviours. It has three key areas of focus: 1) diet and physical activity; 2) water, sanitation, and hygiene (WASH); and 3) mental health and wellbeing. In this initial phase of implementation, with support from the World Health Organization (WHO) and the Korean International Cooperation Agency (KOICA), HPS was delivered in 285 primary (ages 6-14 years, grades 1-8) and secondary schools (ages 14-18 years, grades 9-12).There has been limited evaluation of the HPS program with important issues as yet answered: how the HPS program is being used across the participating schools, whether the program
Ethical Considerations in Setting Health Research Priorities: A Philippine Case Study
Background
Research priority-setting (RPS) processes in the Philippines have applied a combination of principles and RPS frameworks such as the James Lind Alliance framework, Philippine National Health Research System Guidelines for Health Research Prioritization, bottom-up with top-down inputs approach, multi-criteria decision analysis, nominal group technique, and consensus-building. In a 2023 case study, the gaps identified highlight the need for ethical considerations and equity in RPS in the Philippine setting. Strengthening ethical considerations in health research is necessary to prevent perpetuation of inequities in global and national health systems
Aim
This project aims to:
Analyse ethical and equity considerations in health RPS exercises conducted by the Alliance for Improving Health Outcomes (AIHO) in the Philippines.
Develop recommendations for better integration of ethics and equity in future RPS activities by AIHO and in the Philippines.
Research
Fludrocortisone in ICU patients with aneurysmal subarachnoid haemorrhage (FLASH trial)
BackgroundAneurysmal subarachnoid haemorrhage (aSAH) is a severe and life-threatening form of stroke that affects approximately 2,000 Australians each year, with a mortality rate of around 30%. Survivors often experience long-term disability and reduced quality of life, contributing to the loss of 25,000 disability-adjusted life years annually. Despite advances in stroke care, no new treatments have emerged in the past 15 years to improve outcomes for these patients. Our research group, recognising this gap, formed a collaboration in 2017 to address the urgent need for improved clinical interventions in aSAH. Through a multicentre, binational study, we revealed that the case fatality rate of 29.2% has remained stagnant over the last decade, with patients requiring ICU admission facing a higher mortality rate and prolonged hospital stays compared to other neurological conditions.Further research into the long-term outcomes of aSAH patients identified significant functional impairment six months after their ICU
PReVENT-NEURO: PRophylaxis against VENTilator-associated infections in NEUROlogically injured ICU patients
Background
Ventilator-associated infections (VAI) represent a significant health burden among ICU patients, particularly those suffering from acute brain injuries. Conditions such as traumatic brain injury, subarachnoid haemorrhage, stroke, and status epilepticus often lead to reduced consciousness and impaired airway reflexes, which increase the risk of aspiration and subsequent lower respiratory tract infections, including pneumonia. These infections can exacerbate brain injury by causing hypoxia and increased intracranial pressure, both of which are linked to higher mortality rates and poor clinical outcomes. Globally, ventilator-associated pneumonia (VAP) is reported to affect between 9% and 27% of intubated patients, with particularly high mortality rates among those with neurological injuries.
In this vulnerable patient group, preventing infections is critical to reducing mortality and long-term disability. However, the use of prophylactic antibiotics remains contentious due to concerns
DAYARA: Developing and testing An intervention to promote psYchological wellbeing Among Scheduled TRibe communities in Andhra Pradesh
Background:
More than 104 million (approximately 8%) of India’s population belongs to Scheduled Tribe (ST) communities. About 35% of STs live below the poverty line and compared to other social groups, have poorer health and social indicators. Many live in remote areas or forest areas and have poor physical access to health facilities. ST communities have also been disproportionately affected by displacement and forced migration due to development projects. Although ST communities are exposed to a combination of social, economic and environmental factors that may affect their mental health and wellbeing, there is limited data related to mental health needs of tribal communities in India, with few mental health interventions involving tribal communities and limited evidence of appropriate mental health promotion interventions. Mental health promotion (MHP) is based on broader principles of health promotion in which the focus is not on disease or pathology but on promoting overall health and ps
INTErGenerational intervention to Reduce fraIlTY trial (INTEGRITY)
BackgroundIt is a huge achievement that we are living longer than before but sometimes older age also comes with poorer health. Frailty, defined as having an increased vulnerability, and dementia or cognitive decline are more common at older ages and often result in heightened care requirements and transition to aged care. Approximately 12-24 percent of older adults are identified as frail, while an additional 40 percent are categorized as 'prefrail' or mildly frail, and around 10% of adults over 65 have a diagnosis of dementia.But what if we could reduce the risk of becoming frail and help to protect our brain health and thinking or cognitive skills? We know that having greater physical activity, social engagement and using our brains in cognitive activities are linked to lowering the risk of developing frailty and cognitive decline. Increasing these aspects of our day to day life may help us. A fun way to do this can be through intergenerational practice.Intergenerational practice unites different generatio
8quity: Embedding Equity in our Research Processes
Background
Global health research reflects and can either perpetuate or challenge the complex power hierarchies and inequities that characterise our health systems and the societies in which they are situated. The imperative to embed equity in health research aligns with broader efforts globally to promote equitable partnerships among researchers, and between researchers and the communities potentially impacted by their research, or with whom knowledge is co-produced.
Aim
Our primary aim is to increase the capacity of public health researchers all over the globe to enhance equity integration across their research, regardless of their design, size or location. We want to improve conceptual understandings, know how and skills in application of ethical and equity-related principles, and contribute towards growing a culture of ethical praxis in global public health research.
Research Methodology
Case Study
We will develop case studies of research projects at The George
Factors influencing lung cancer outcomes in culturally and linguistically diverse (CALD) populations
Background
Lung cancer remains the leading cause of cancer-related mortality globally and in Australia, with 8,691 deaths recorded nationally in 2023. People from culturally and linguistically diverse (CALD) backgrounds experience disproportionately poorer outcomes, yet the reasons behind these disparities are not fully understood. Given that nearly one-third of Australia's population is born overseas, and a significant proportion come from CALD backgrounds, understanding and addressing these inequities is crucial.
CALD patients often face barriers such as language difficulties, cultural insensitivity, stigma, and limited health literacy, which can hinder access to timely diagnosis and treatment. About one-third of lung cancer patients in NSW present through emergency departments, often due to delays in care or lack of continuity. Bulk-billing practices, while more accessible, can be time-constrained and less conducive to preventive care discussions, particularly for patients requiring longer