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Respiratory depression is more likely to be detected during sedation when capnography is used. However, sedation-induced respiratory depression is commonly transient and does not always cause patient harm. Randomised controlled trials have produced conflicting results regarding whether capnography improves patient safety when used during sedation and there is considerable variation in the utilisation of capnography monitoring in clinical practice. This project seeks to optimise the implementation of this technology into clinical practice. AIMS 1. To identify subgroups of patients based on their physiological responses to sedation. 2. To characterise the identified subgroups by determining whether they are associated with particular demographic and clinical characteristics. 3. To examine variation in clinical interventions applied to support respiratory function between subgroups. 4. To determine if there are associations between the subgroups and intra-procedural ventilation status as well as post-procedural outcomes.

Emergency Department (ED) Overcrowding is associated with reduced performance in standard process and flow measures, and worse patient outcomes including mortality. Access block, the situation of patients experiencing prolonged delays in the ED whilst waiting for an inpatient bed, is a particular issue for which the solutions lie outside the ED. There have been several detailed reports on effective hospital-wide interventions in Australia, with demonstrated improvements in process and flow and some evidence of mortality benefit. However, all of the previous reports have been retrospective and thus may suffer from publication bias. The aim of this study is to prospectively document the effects of a multimodal hospital-wide intervention on ED process, flow, and outcomes. In late 2015 and early 2016, The Canberra Hospital is undertaking such an intervention. This study will examine the effects using retrospective controls, Primary outcomes will be the workload caused by excessive inpatients in ED (hours per week with more than 13 inpatients in ED) and ED flow as measured by the standard National Emergency Access Target (4 hours). Secondary outcomes will be standard hospital measures including length of stay, readmission rates, and mortality.

Aims: This study aims to develop the methodology for clinical point of care (POC) sampling to determine the level of exposure to organophosphates (OP’s) by western Victorian farmers. Significance: This methodology will test for cholinesterase activity and provide the basis for future research work by identifying the potential chemical exposure pathways of individuals most at risk in farming communities. Expected outcomes: The study will provide a methodology for cholinesterase activity measurement in farmers and the possible integration of POC sampling in farmer health checks. Importantly it will highlight pesticide contact as a risk for farmers, leading to further research to quantify pesticide exposure both on the farm and in the home of farming families.

Many patients admitted to the intensive care unit (ICU) for on-going clinical management receive mechanical ventilation. Mechanical ventilation is the process by which a patient’s breathing is supported by a machine (ventilator). While receiving mechanical ventilation the patient’s intensive care clinicians make clinical decisions about their patient’s breathing. Beginning in the second half of 2016, and based on emerging evidence, the ICU Consultant group has agreed to implement a practice change in their management of carbon dioxide levels in mechanically ventilated patients. This practice change is termed ‘permissive mild hypercapnia’ and involves clinicians’ targeting of arterial carbon dioxide tension values of 50-55 mmHg instead of the usual value of 35-45 mmHg. This change applies to all adult mechanically ventilated patients, except for those who required extracorporeal membrane oxygen (ECMO) therapy, those in whom death is deemed imminent and those in whom a higher CO2 level is contraindicated for other clinical reasons. We plan to systematically audit biochemical, physiological and patient-centred outcomes and compare such outcomes after the introduction of this practice change with outcomes in patients before the practice change. Importantly, the knowledge generated by this audit may inform future interventional studies aimed at further optimising disease-specific PaCO2strategies for the care of critically ill patients. This audit will take a similar path to the recent conservative oxygen therapy trial, where a practice change allowed slightly lower than usual oxygen levels to be targeted at Austin Hospital and a before and after audit was conducted and showed clear benefits in patient outcomes including an increase in earlier spontaneous ventilation.

The aim of the study is to examine whether young children with early childhood dental decay who are scheduled for treatment under general anaesthesia can be successfully managed in primary care settings by the use of a minimally invasive Atraumatic Restorative Treatment-based approach.

Shoulder impingement syndrome (SIS) represents the most common diagnosis for patients experiencing shoulder pain and is a prevalent condition in overhead athletes. Optimal performance of overhead sporting activities requires overheads athletes to have unrestricted, pain free arm range of motion (ROM). On examination, overhead throwers typically present with an increase in external rotation ROM accompanied by a concomitant decrease in internal rotation ROM. This asymmetrical ROM finding is well documented in the literature. It is postulated that posterior capsule tightness (PST) causes de-centering of the humeral head within the glenohumeral joint with compression of tissues in that joint space and consequent pain and restriction of movement. Clinically, a variety of techniques are implemented to address PST. These include stretching, joint mobilisations and strengthening exercises with varying degrees of success. Outcomes of treatment are commonly measured using pain, disability questionnaires or changes in ROM in order to determine the effectiveness of the treatment program. However, despite studies showing the effects of PST on acromio-humeral distance (AHD) and anterior translation of the humeral head, few studies have focussed on whether or not there is a normalisation of humeral head position, with resolution of PST and reduction in pain with movement following treatment. Therefore this research project will aim to investigate whether a modified sleeper stretch or cross body stretch is most effective at addressing PST, AHD and anterior humeral translation in overhead athletes using diagnostic ultrasound to measure the changes in the subacromial space and humeral head position.

The aim of this study is: To conduct a pilot randomised controlled trial to evaluate if wearing customised fit shoes increases physical activity among children and adolescents with Down syndrome. The research questions are: In children with Down syndrome: * Does improving shoe fit increase physical activity? * Does improving shoe fit improve foot specific disability, and walking patterns? * Are customised fit shoes acceptable? The study methods are: We will conduct a pilot randomised trial to compare customised fit shoes (intervention) to a waitlist (control) group for children with Down syndrome. Thirty participants with Down syndrome aged 5 to 17 years will be recruited, and randomly allocated to one of two groups. The intervention group (15 children) will receive two pairs of customised fit shoes (from Clarks Australia): one pair for school and one pair for ordinary wear. The control group (15 children) will continue wearing their existing shoes for 12 weeks (and will then receive two pairs of customised fit shoes). Participants will be assessed at the start of the study (baseline/week 0), then at 6, and 12 weeks. Four outcomes will be measured: (1) physical activity (using an activity monitor collected over 7 days) (main outcome), (2) computerised gait analysis, (3) foot-specific disability using a questionnaire called the Oxford Ankle Foot Questionnaire for Children, and (4) acceptability of the intervention (using an interview approach).

We aim to evaluate the hypothesis that an experience of delirium during mechanical ventilation in the ICU impacts negatively on patients’ cognitive and psychosocial outcomes. This is an observational, prospective study that is conducted in two Intensive Care Units in Australia: The Canberra Hospital in the Australian Capital Territory; and the Prince of Wales Hospital in Sydney, New South Wales. The study aims to recruit 162 patients who have been mechanically ventilated for more than 24 hours, and who meet the study’s inclusion/exclusion criteria. Outcome assessments will be recorded at ICU discharge, and at six and 12 months after ICU discharge. We aim to evaluate the hypothesis that an experience of delirium during mechanical ventilation in the ICU impacts negatively on patients’ cognitive and psychosocial outcomes.

This study aims to examinie the acute administration effects of curcumin, on a cohort already taking long-term curcumin. In an earlier study within another investigator team a report of a significant effect was observed one hour after administration of curcumin within sustained attention and working memory tasks of the intervention group as compared to placebo group. Given that the KARVIAH study design provides an opportunity to re-test this hypothesis, using a different formulation of curcumin, we would like to undertake the following as a sub-study with those participants who have completed their final assessment time-point within the curcumin study.

The primary purpose of this trial is to evaluate the efficacy and safety of FOLFIRINOX chemotherapy for the treatment of gastric or gastroesophageal junction cancer prior to surgery. Who is it for? You may be eligible to participate in this trial if you are aged 18 to 80 years and have been diagnosed with gastric adenocarcinoma or gastroesophageal junction adenocarcinoma for which you are scheduled to undergo radical gastrectomy. Study details The first ten participants enrolled in this trial will all receive FOLFIRINOX chemotherapy prior to surgery. If six of these participants are able to undergo surgery as planned, then all remaining participants enrolled in this trial will then be randomly allocated computer generated software to receive either FOLFIRINOX chemotherapy prior to surgery, or to receive standard care ECF chemotherapy prior to surgery. Participants in the FOLFIRINOX group will receive a 46 hours continuous infusion of chemotherapy once every 2 weeks for 12 weeks. Participants in the ECF group will receive a 46 hours continuous infusion of chemotherapy every 3 weeks for 12 weeks before surgery and 3 cycles after surgery which will be also be every 3 weeks for 12 weeks . It is anticipated that all participants will then undergo surgery within 3-6 weeks. Participants will be assessed for side effects and followed-up for up to five years to assess disease progression and survival. It is hoped that the findings of this trial will establish whether FOLFIRINOX chemotherapy may be a safe and effective alternative to ECF chemotherapy for the pre-surgical treatment of gastric or gastroesophageal junction cancer.