Assessment of impact of various screening and diagnostic measure on Rheumatic heart disease (RHD) burden in Australia
RHD is among the primary causes of cardiovascular death plus morbidity in many nations in the world in children and adolescents in disadvantaged populaces. Australia is among the countries globally impacted by rheumatic heart diseases and several screening and diagnosis methods have been advanced to manage the condition. The advent of echocardiographic screening offers the prospect of untimely illness, as well as intervention. In the last decades, several groups globally have carried out populace-based screening for rheumatic heart disease utilizing portable echocardiography, displaying its feasibility in diverse backgrounds (Steeret et al., 2009).
The study aims to assess the impact of various screenings and diagnostic measure on the rheumatic disease burden on Australia. The proposed study is planned to be carried out in the Northern Territory of Australia and Central Australia that will be carried out in public hospitals because the target population will be children aged between 5 and 17 years in schools in Australia. The study will start in November 1, 2018 and end in November 2, 2019. The data that will be collected from the study will be analysed through computing the relative of RHD amongst children in the study area that will represent the entire population in Australia. The study will use cross-sectional and cohort study to collect the needed data needed to evaluate the influence of different screening and diagnosis measure of RHD in Australia. The main implication of the study is anticipated to play a leading role in advancing screening and diagnostic measures for RHD among the Australians towards managing this condition in Australia and globally (Roberts et al., 2013).
RHD, the only long-standing result of acute rheumatic fever (ARF), is prevalent amongst middle-income, as well as low-income nations, as well as in some indigenous societies in developed societies, like Australia. It is estimated that at least 30 million persons are affected by RHD globally and causes more 345,000 deaths on a yearly basis. The majority of the patients in resource-restricted environments present with complex disease burden along with complications, as well as thus prediction at the moment of diagnosis are deprived. RHD for many decades has been the main object of public health screen where the World Health Organization (WHO) carries on recommending screening as constituent of RHD control in high incidence parts in the world. During the last decade, several groups globally have carried out populace-based diagnosis and screening for RHD utilizing convenient echocardiography confirming its feasibility in many backgrounds (Roberts et al., 2014).
According to Roberts, Maguire and Brown (2014), screening for RHD offers a prospect to accurately define the present illness burden and to identify children with illness not diagnosed who might profit from early medication. Many researches have demonstrated that heart auscultation is devoid of sensitivity along with specificity needed for screening the rheumatic heart disease plus must no longer be employed for screening purposes to diagnose RHD. Marijon, Tafflet and Jouven (2008) argue that echocardiography has demonstrated to be effective and highly sensitive screening instrument for RHD, increasing the likelihood that a populace-oriented screening program would identify cases earlier, as well as enhance disease outcomes via secondary antibiotic prophylaxis. In addition, the creation of proper screening guidelines need a consideration of the history of echocardiagraphic modifications in a given period of time and the way these modifications associated with the threat of advancing clinical obstacles. Thus, convenient echocardiography has become a more important instrument, as well as its significance was improved by the issuance of the World Heart Foundation (WHF) principles for the echocardiographic diagnosis of rheumatic heart disease in 2012 (Marijon, Tafflet & Jouven, 2008).
Saxena, Zuhlke and Wilson (2013) argues that the WHF principle for echocardiographic diagnosis of the disease has offered standardization, as well as enhanced specificity, as well as the efficacy of these principles in screening situation is currently extensively acknowledged by the cardiology society. In this regard, rheumatic heart disease is shifting nearer to satisfying the principles for an illness appropriate for screening. There is as well a “latent” phase, which may be noticed (by echocardiography utilizing WHF principles) plus though conjuncture remains regarding the account of WHF’s “borderline” group, there is a growing agreement that screen-sensed “explicit rheumatic heart disease” embodies real illness plus is a sign for regimen benzathine penicillin G(BPG) prophylaxis (Saxena, Zuhlke & Wilson, 2013). In many environments, people with the borderline rheumatic heart disease have not been put on prophylaxis. Hence, if a huge populace of the borderline faction certainly has true, dormant rheumatic heart disease, then the case for screen could be more convincing.
Conventionally, rheumatic heart disease was diagnosed by auscultation for a heart mutter in those with account of acute rheumatic fever. It was not until the last few years, the stethoscope tool was the only non-invasive diagnostic instrument accessible to health professionals in low-income nations, as well as in distant areas in which RHD and ARF are mainly widespread. Nonetheless, the discovery rates were much low. Thus, the echocardiography has confirmed to be more responsive in addition to explicit that auscultation. Rheumatic heart disease detected on echocardiography without a linked pathological heart hum is called subclinical RHD. With the development of portable tech, echocardiography may at the present be carried out at a comparatively economical, and to the isolated surroundings (Godown et al., 2015).
The primary goal of the research proposal will be to assess the impact of different screening and diagnostic measure on Rheumatic heart disease (RHD) burden in Australia towards recommending an appropriate screening and diagnostic tool to be used. The assessment is designed to provide a tool that will be used to screen and diagnose the Australians believed to be having RHD especially children in public schools in Australia. The primary objective of the research proposal is to carry out research to assess the impact of diverse screening along with a diagnostic measure on RHD burden amongst the Australians. Another objective of the research proposal is to provide recommendation on the appropriate screening and diagnostic tool that will be used to measure RHD among school-aged children schools in Australia (Zachariah & Samnaliev, 2015). The Health Ministry of Australia will fund the project from the start to the conclusion. The study may have some biases because of the population taking part in the study.
This part will examine the methodology that will be used to collect the data needed to establish the impact of various screening and diagnostic measure on rheumatic heart disease (RHD) burden in Australia. The study will be divided into the study design, research population, the size of the sample, data collection techniques, data analysis and ethical considerations.
The study will adopt cross-sectional and cohort study that will be appropriate for the study to collect the needed results to establish the health issue in question. The study will sample different schools in the Northern Territory of Australia and Central Australia that will represent the entire population. The design of the study is meant to ensure that the cohort study is the representative of the entire population. The children in the study will be evaluated prospectively for the advance of progressive valve anomalies, as well as retrospectively for the prevalence of ARF. In this study, the comparator will be sex, age, as well as ethnicity-equaled controls that have formerly had a standard screening echocardiogram (Yardley & Marks, 2003).
This study will recruit participants who are mainly a subset of kids that had an echocardiogram during the previous screening study. This population has historically been the target group for RHD screening and diagnosing. The participants live in 28 remote communities across northern, as well as central Australia. Utilizing a school-based strategy has feasible advantages of screening several children in a single location, and detection of younger participants has the highest impact on the outcome once preventative measures have been started. Thus, this population will be vital in the evaluation of influence of screening plus a diagnostic measure of RHD (Colquhoun, Kado, & Remenyi, 2014). The inclusion criterion is that children in the study will be between 5 and 17 years and they should identify as Aboriginal Australian and/or Torres Strait Islander and reside in distant sites. In addition, the children should be attending school because the study will target school. The exclusion criterion is that children that have had diagnosis of congenital valvular heart disease will not take part in the study.
All kids between 5 and 17 years (inclusive) will be eligible for the study, comprising children with identified record of rheumatic heart disease or congenital heart disease (CHD). Children will be recognized by the enrolment record schools taking part in the study. In consultation with school authorities and students, study information and consent forms will be distributed to all families of eligible children.
The sample size approximations for the study should be based on estimated rates of ARF founded on the yearly occurrence of ARF in persons with the identified rheumatic heart disease, along with the background yearly occurrence of ARF in children amid 5 and 17 years of age. The sample size will be calculated founded on the Northern Territory and Central Australia register approximations, which the point prevalence of RHD in those children aged between 5 and 17 years. 3500 children in the participating schools will be selected for the study to collect the needed data for the study (Zuhlke & Mayosi, 2013). The control group will be important for this study in ensuring valid and reliable data is collected. The control group will be crucial in this study because it will provide a basis for comparison and ensure that the analysis is done in an effective manner. The control group will comprise of 1700 children in selected schools with no history of ARF/RHD (Chambers & Skinner, 2003).
Questionnaires will be the most appropriate for the study towards the collection of the appropriate data needed. Well-organized questionnaire is cost-effective tool for collecting data because it has the advantage of providing the needed responses to the questions of the study. The interview will not be appropriate for this kind of study because the cohort is too large and it will be cumbersome to undertake interview sessions, which implies that questionnaires would be appropriate for the study (Presser, 2004). For this study, self-administered or self-completion will be selected as the primary tool because it is quick to manage and perhaps has a higher percentage of return rate when organized well. Given that the population under study are school children, questionnaire will be appropriate. The study will use semi-structured questionnaire that will use both open-ended and closed-ended questions to elicit response from the participants of the study (MacDonald, 2012).
The principal analysis would be founded on univariate analysis that comares the different cases plus matched controls. The analysis will comprise x2 analysis that will be used to compare the number of kids with an incident of RHD (stratified by distinct, probable, as well as latent in the follow-up process plus those who have shown development of a valve injury (Parnaby & Carapetis, 2010). In addition, more comprehensive analysis of the collected data from the questionnaire will be used through the use of logistic regression because of the nature of the study to establish the relationship regarding the impact of screening and diagnostic measures of RHD among children in the sample (Presser, 2004).
Studies that entail epidemiology are in most cases subjected to ethical issues since they are primarily touches human beings and there is normally the likelihood to harm the participants either mentally or physically. In the current study, there is the need to consider ethical issues because the population under study are mainly school children. Therefore, these children demand that ethics be observed to avoid legal implications afterward (Shamoo & Resnik, 2009).
Written consent for the population under study will be necessary to be obtained from the parents and guardians of the children before they are enrolled in the study. Furthermore, written consent will be sought from kids with 13 years and above following an explanation utilizing flip-charts, as well as culturally educational resource.
All the children that will be taking part in then study will be registered into the study enrolment log by study number, name, as well as the date of birth. Thus, the study enrolment log will be maintained exclusively by the study coordinator for the study areas where all paperwork with identifiable details will be stored in a separate and locked facility. Accordingly, all the data has been collected and analysed will be use only study number rather than the names of the participants. This will guarantee the confidentiality of the personal information of the participants (Roberts, Colquhoun, Steer, Remenyi & Carapetis, 2013).
When the child will be founded to have anomaly on the echocardiogram, the medical record along with RHD register will be accessed to verify whether this will be a novel finding. The two records will be checked occasionally all through the study period to make sure that children who had been referred for specialist review will complete a follow-up process.
Ethical clearance will be accrued by the pertinent committee that include: Central Australian Human Research Ethics Committee, and Western Australian Aboriginal Health Information and Ethics Committee.
The study entails a long cohort study that is the primary limitation, whereby 120 months is a long period. This period makes it hard to make a follow-up because of the different population dynamics that include migration and education. In addition, the long duration of the study will make the study to be more expensive. Another restraint of the research is the large number of participants that will make it hard to undertake data collection and to make analysis, which will increase the biasness of the study in the long-term (MacDonald, 2012).
The study will be beneficial to the healthcare providers and professionals in allowing them to develop an appropriate screening and diagnostic instrument to measure the RHD. In addition, the findings of the study will be helpful to the government, where they will use the information to develop policies that will promote the screening and diagnosis of RHD among the Australians. Policymakers will also benefit from the study because the findings will help them to update their policy documents on the current impact of screening and diagnostic measures for RHD burden (Carapetis et al., 2008).
For the proposed study, I will be responsible for the investigation and the final proposal will be submitted to the Ministry of Health of Australia for the appropriate funding and management of the actual research. The public schools will offer the necessary support in organizing students to take part in the study during data collection. Finally, the Central Australian Human Research Ethics Committee will be responsible for ethical review and monitoring of the project.
Conclusion
The main purpose of the research proposal is to undertake a study to assess the impact of diverse screening along with a diagnostic measure on RHD burden amongst the Australians.The study will be crucial towards the assessment of appropriate diagnostic and screening methods designed to reduce cases of RHD in Australia. The projected if funded adequately will a milestone in the healthcare sector that ensure that incidences of RHD and cardiovascular diseases are managed within the population.
References
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