Rural Clinical/Health Project

Unit Code

00627

Department/Institution Offering Unit

Department of Rural Health
School of Rural Health
University of Melbourne
Graham Street (PO Box 6500)
Shepparton
Victoria 3630 Australia

tel: +61 3 5823 4500
fax: +61 3 5823 4555
web: www.ruralhealth.unimelb.edu.au/index.html

Unit Points

Research Points: 100

Coursework Points: 0

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Contacts

Unit Coordinator/s:

Assoc Prof Julie Pallant
Director of Research and Graduate Studies
School of Rural Health
The University of Melbourne
49 Graham St, Shepparton
Victoria 3630 Australia

tel: +61 3 582 34517
fax: +61 3 5823 4555
email: jpallant@unimelb.edu.au

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Overall Objectives

• To pursue research in clinical or health service areas of particular importance to regional and rural communities, including comparisons with metropolitan communities.
• To enhance the understanding of the determinants of health in non-metropolitan settings, including any rural-metropolitan health differentials.
• To understand the implications of cultural meanings and contexts on the health of rural and indigenous populations.
• To enhance the understanding of the utility, barriers, impacts and outcomes of the use of information and communication technologies to address the key rural issues of access, multidisciplinary teamwork and professional/personal isolation.

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Content

Coursework: Students will participate in research methods courses conducted by the School of Rural Health in Shepparton.

Research: Each student will work with one or more supervisors from the School of Rural Health to develop a research proposal and conduct systematic reviews and fieldwork, where appropriate. Some projects are based in Shepparton and some are based in Ballarat.

Sample Research Topics:

1. Sexual Health

The Centre of Excellence in Rural Sexual Health (CERSH) based at the School of Rural Health, Shepparton has an opportunity for a student to undertake their AMS project with a multidisciplinary team on one of the following projects.

• Audit of Chlamydia Screening.  CERSH will be conducting an audit of medical professionals at regional hospitals and in private practice to determine the rate of screening and assess adherence to national guidelines.  Supervisor: A/Prof Glyn Teale (Ob/Gyn)
• Use of services for sexual health by rural young people.  Young people in rural areas face a range of barriers to using health services for their sexual health needs, including distance, cost, confidentiality, overlapping relationships, appropriateness, embarrassment and communication limitations and other access issues.  This project will interview rural young people to identify the key barriers to their sexual health care and conduct focus groups with young people to gain their response to innovative strategies strategies that could provide access to appropriate sexual health care to young, rural Victorians. 

Funding is available by application to support a student in undertaking one of these projects for their AMS year.  For more information contact Lisa Bourke at the School of Rural Health on 5823 4519 or at bourke@unimelb.edu.au.

Project Supervisor: A/Prof Lisa Bourke (PhD)

2. Developing rural GPs' skills in managing depression

The significant impact of depression in rural Australia has been highlighted recently in the media. Much of the discussion about this issue has focused on the problem; less attention has been given to potential solutions. This project is about solutions. It seeks to understand the factors that limit rural GPs' capacity to effectively manage depression and assess a program that aims to develop GPs depression management skills.
Many patients prefer non-drug depression treatments. Problem solving therapy is an evidence based talking therapy for depression that is suitable for use by GPs. The limited number of other mental health professionals in rural areas means that GPs are often the key provider of depression therapy.
As part of a research team the student will investigate ways to promote GPs' problem solving therapy skills. The mental health learning needs of GPs not trained in Australia, a group who significantly contribute to the rural medical workforce, will be investigated by the student as well as the effectiveness of using simulated patients to develop these GPs' mental health skills. The student may also consider the application of this approach to other clinical skills.
The student will be based at the School of Rural Health , Ballarat.
Project supervisor: Dr David Pierce

3. What women living in rural communities know about osteoporosis and where they get their information

Little is known about care for osteoporosis among rural women in Australia. Although sunlight in Australia has always been presumed to be protective, increasing concern about skin cancer has led to decreasing sun exposure. Dairy products are not supplemented in Australia with vitamin D. As the population ages, osteoporosis and osteoporotic fractures are increasingly affecting both women and men. Although several small studies suggest that rates of fracture in similar geographic areas may be lower for rural women, possibly because of a more active lifestyle, a growing population at risk and increasingly problematic rural access to medical care may overwhelm this difference. Finally, simple interventions such as calcium and vitamin D supplementation have been shown to significantly reduce fracture risk in elderly women.
This project will examine what rural women know about osteoporosis and these simple, easily available preventive measures, and where rural women get their health information. The student will review the literature on rural inhabitants and osteoporosis including reported prevalence of osteoporosis and fracture incidence in rural Victoria. The student will design a survey with the supervisor and access rural women who might be willing to complete the survey. The resulting paper will attempt to describe what rural women know about osteoporosis in the context of their risk for osteoporosis, where they get their information about the disease, and whether or not and by what method they would prefer to learn about osteoporosis. The paper will discuss the perceived need for education and how to most effectively educate women in rural communities about osteoporosis prevention.
Project Supervisor: Professor Dawn DeWitt

4. Rural-urban health differentials

Rural-urban health differentials provide an understanding of key differences between rural and urban health. Differentials can be examined across a range of domains, including: (a) clinical domains, e.g., diabetes, asthma, hepatitis, community acquired pneumonia; (b) health services, e.g., diabetes education and outreach, Community Interlink, Emergency Department presentations and re-presentations; and/or (c) policy and systems areas, e.g., the City of Greater Shepparton public health plan.

5. eHealth

eHealth in metropolitan, regional and rural Victoria: Students are welcome to join a project team to examine the ethical and behavioural aspects as well as the impacts of the use of information and communication technologies on health care, health education and health. This broad project allows examination of particular areas, such as integrated health information systems, electronic decision support, online communities and information-enhanced care.

6. Rural Health Academic Network:

The School of Rural Health has established a research network across northern Victoria. Clinicians and other health professionals in rural centres across this region are developing a range of projects aimed to improve the quality, continuity and access to care from a regional approach. Students are welcome to work on these projects, either based in Shepparton or in one of the spokes that are part of the network

7. The intrapartum determinants of abnormal cord blood results in an Australian rural health service.

The aim of this study is to investigate associations between birthing variables and sub-optimal cord gas results. Retrospective cohort analysis will be used to abstract data from approximately 1500 case records of delivery and analysis of the resulting database. Ethics approval has been obtained previously for audit processes.

8. Community Acquired Pneumonia in a regional Australian setting: Outcomes of in-patient treatment

Community Acquired Pneumonia (CAP) is one of the most common reasons for admission to rural hospitals. There are substantial variations in the length of hospital stay for CAP in different hospitals in different regions and even within the same hospital. The optimal management of patients with CAP requires careful specialist medical assessment because of heterogeneity with respect to, the bacterial aetiology, which, in most cases, is unknown and the clinical severity.
This project evaluates two novel approaches to estimate pneumonia severity and identify pneumonia aetiology for patients at the time of presenting to hospital. The first is a computer based version of the PORT scoring system, a widely used to assist in quantifying the clinical severity and to stratify patients into five groups with mortality risks varying from as low as <1% to as high as 30%, has been developed. This has been developed by the Victorian Rural Physicians Network and is being used as the basis for an evidence based decision support tool. This computer based scoring system is in current to assess patients presenting to Ballarat hospital.
The second is an antigen detection test which can be applied to urine samples has been developed. This could be used to detect antigen of Step pneumoniae, which is the most common bacterial cause of CAP. The project provides a unique opportunity to evaluate the scoring system in conjunction with new tests for pneumonia aetiology. Outcomes of interest include time to clinical stability, which is the time taken to return to normal levels in systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, ability to eat and mental status.
The student will be attached to The Internal Medicine and Emergency Medicine Services of Ballarat Hospital.
Project Supervisor: Associate Professor James Hurley

9. Hepatitis C in a regional Australian setting: Prevalence, risks and outcomes of treatment.

Chronic infection with Hepatitis C is common with over 200 000 people in Australia living with HCV antibodies at the end of 2001. The prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and hepato-cellular carcinoma will more than triple in Australia by 2020.
Treatment outcomes for patients with Hepatitis C have improved since treatment first became available in the early 1990's. Currently available combination therapies may achieve Sustained Viral Response rates of over 80% in some treatment groups, thus minimising the risk of long term liver injury in these patients. Most of the published Australian literature regarding the treatment of hepatitis C reflects the tertiary hospital experience. The impact of treatment on the burden of hepatitis C disease in the rural Australian community is largely unknown.
The student will investigate the prevalence and treatment outcomes of Hepatitis C in the Grampians community. There is an active liver clinic at Ballarat Health Services to which the student will be attached. The student will also investigate clinical and laboratory data from other sources.
The Research will also involve a literature review to determine current expectations regarding Hepatitis C prevalence and treatment. This literature review will also examine currently available models of Hepatitis C treatment in the Australian context and a critical assessment of their applicability in a regional context. The case notes of all patients who have attended the Liver Clinic since inception will be available for retrospective review. This will allow a determination of demographic features, Hepatitis C risk factors and clinical outcomes including outcome of treatment. Local sero-prevalance will be determined from sources such as local pathology laboratories in Ballarat or The Victorian Infectious Diseases reference laboratory. Harm reduction practices will be surveyed in liaison with Ballarat Community Health Centre (eg Needle exchange program).
Project Supervisors: Dr Grant Phelps and Associate Professor James Hurley

10. How much of hospital acquired urinary tract infection is attributable to cross infection, an ecologic study of published studies

Hospital acquired urinary tract infection (HAUTI) is common among patients admitted to hospital and a common and potentially preventable cause of mortality. There are three types of risk factors for any hospital acquired infection; patient specific, intervention specific and center specific. The impact of center specific factors, such as "colonization pressure", on hospital acquired infection is poorly defined and the most difficult to study. These may be suspected if the observed frequency of infection and patterns of isolates deviate from that expected. An outbreak, which is a significantly increased rate of disease above the baseline expected prevalence in a given population, is an extreme example of a center specific factor. However, no simple method exists to estimate the importance of center specific factors relative to the patient and intervention specific factors in the usual non-outbreak setting. Heterogeneity in patient specific risk factors and diagnostic criteria confound direct comparisons between groups from different studies. Hence, the evaluation of center specific factors requires an ecological analysis.
This project will be largely literature based. The student will extract from the literature all studies of methods to prevent HAUTI. The first step will be to perform a meta-analysis to determine the extent of heterogeneity among the results of the studies. Then to compare the rates of HAUTI and types of isolates seen among the control groups across a broad range of prevention studies. From this, the impact of factors such as study design and diagnostic criteria for HAUTI on the study results will be evaluated. The objective of this analysis is to compare the rates of HAUTI and types of isolates seen among the control groups across a broad range of prevention studies in an attempt to account for some unusual observations among the control groups of the antibiotic based prevention studies.
The student will be attached to The Internal Medicine and Infection control Units of Ballarat Health Services. The student will acquire statistical and epidemiological skills. The project is a natural extension of a similar project that investigated the center specific risk factors for hospital acquired pneumonia which has recently been published by the supervisor.
Project Supervisor: Associate Professor James Hurley

11. Evaluating the use of alternative medicines among palliative care patients

General interest in complementary and alternative medicine (CAM) therapies has grown rapidly and is reported to be particularly widespread in relation to cancer treatment and palliative care. Because of some tension and unease in orthodox medicine over the response it needs to make to the 'threat' of CAM and the grass-roots demands of patients, there is often a lack of communication between patients and treating physicians, about which the physician may or may not be aware.
The researcher in this project will develop appropriate procedures for gathering and evaluating information from palliative care patients to determine:
- What alternative pharmaceuticals they use, eg Chinese, Indian, Homeopathic and Naturopathic medicines.
- Why and when palliative care patients use them.
- Source and cost of these alternative medicines.
- Benefits and/or potential hindrances to health.
The student will work as part of a team with palliative care and aged care services in and around Ballarat to plan and carry out this project.
Project Supervisor: Dr David Brumley

If you have a project of your own please contact the unit coordinator.

More detailed project information

If you have a project of your own please contact the unit coordinator.

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Assessment Breakdown

Research Component: 100 points
Written Research Report (8000- 10,000 words): 90%
Oral presentations (of research proposal and research findings: 10%

Coursework Component: 0 points
N/A

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Student Numbers

Number of places available:
12