ANZCTR search results

There is currently no evidence indicating that it is possible to prevent falls in community dwelling older people with dementia despite this group having a disproportionately higher rate of falls and fractures and poorer outcomes post event. However, there is evidence that a dementia specific approach to care, in which interventions are based on the individuals’ preserved abilities and in which the caregiver is provided with the skills to work effectively with the person with dementia, can be effective in improving daily function for the person with dementia and sense of competence for the carer. The purpose is to investigate whether a home-based exercise program and home hazard reduction program can: 1) reduce the risk of falls in older people with cognitive impairment or dementia, and 2) improve the quality of life of the person with cognitive impairment or dementia and their carer(s).

The purpose of this study is to evaluate whether the proposed algorithm-based approach to the global management (triage, screening, diagnosis and treatment) of Functional Gastrointestinal Disorders is feasible, acceptable, safe and effective.

This project aims to evaluate the effectiveness of a brain stimulation technique referred to as transcranial magnetic stimulation (TMS) in treating obsessive compulsive disorder (OCD). Thirty OCD patients will allocated to either the control or experimental condition and receive TMS once daily for three weeks (Monday to Friday). Patients will then be followed up at two times points; after one week and four weeks post-treatment. The treatment protocol will consist of identifying and stimulating three brain regions which have been shown to be involved in OCD. Each region will be stimulated for 10 minutes using TMS parameters developed within well-established safety guidelines. We will measure the primary and secondary symptoms that patients experience and also measure their ability to perform computerised and pen and paper tasks. It is hypothesised that patients who undergo active treatment will experience a reduction in their OCD symptoms when compared to patients in the control condition.

Our primary aim is to evaluate the effectiveness of a multi-component, multi-setting intervention for promoting physical activity among disadvantaged pre-school-aged children. We hypothesise that at mid-intervention (6 months) and post-intervention (18 months), children in early childhood services allocated to the intervention group will participate in 45 min/day of physical activity more than children in services allocated to the control group. Our secondary aims are (1) to examine the relative effects of the intervention on MVPA, sedentary time, behavioural self-regulation, adiposity, bone mineral density, and motor skills, and (2) to explore the potential mediating and moderating variables, cost-effectiveness and implications for public policy decision making.

This project is part of a research program examining the role that certain cognitions and behaviours play in mediating symptom reduction of internet-delivered cognitive behavioural therapy for depression and anxiety.

Financial incentives and external audit plus feedback are designed to motivate General Practitioners (GP) to change their clinical behaviour with the intention of improving the quality of care. Financial incentives are widely used at a significant cost to the Australian Government. Audit plus feedback is a key component of the RACGP Quality Improvement and Continuing Professional Development Program. To date, there is little empirical evidence about the impact of removing financial incentives and/or audit plus feedback on professional performance once they are in place. ACCEPt-able is a randomised trial that aims to investigate whether the removal of financial incentives and or audit plus feedback impacts on GP’s chlamydia testing performance. It will follow on from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a trial of the impact of a multifaceted intervention including incentive payments and quarterly audit plus feedback on GPs’ chlamydia testing rates. This trial will be conducted over 36 months involving 60 general practices (approx. 600 GPs) in QLD, NSW, VIC and SA. We have the unique opportunity to re-randomise GPs who participated in ACCEPt, to investigate whether chlamydia testing rates are sustained when incentive payments and/or feedback are removed.

Nowadays, many patients are surfing the internet for health information. However. patients surfing the internet without guidance may result in their requesting inappropriate care or complex treatments. Recently, it was found that, nearly half of Australian heath care professionals (not including dentists) are not recommending online health websites to their patients. This was due to lack of time and knowledge of reliable sources. Therefore, it is argued in this research that, guiding patients through patient centered open educational resources (based on website content analysis) will enhance the process of a shared clinical decision making and improve the healthcare outcome (oral and general health related quality of life). This research will contribute to patient education theory and fill the gap in knowledge regarding the applicability of using DOER in dental patient education. Moreover, this research will improve the clinical practice through enhancing the engagement of patients in the process of a shared clinical decision making leading to effective healthcare outcomes.

Occlusion of the lower limb arteries due to atherosclerosis (peripheral artery disease; PAD) affects ~10% of older adults and is associated with impaired quality of life, disability and a high mortality rate. Low physical activity levels are associated with PAD and predict worse outcomes. Exercise programs improve outcomes for PAD patients but on leaving such programs patients return to previous low activity levels. Previous research has identified that the major impediments to physical activity behaviour change in PAD patients are dysfunctional illness beliefs and low perceived efficacy of physical activity to improve PAD related outcomes. Previous research has also shown that brief behavioural counselling by a psychologist in patients' homes to redress these activity barriers can improve physical activity and other PAD outcomes for up to two years. More work is needed to evaluate behavioural counselling delivered by other health professionals and in other settings. The primary aim of the current study is to assess the efficacy of a brief behaviour counselling intervention delivered by allied health workers in health facilities to improve physical activity in patients with PAD over 4 months and then maintain this improvement at 12 and 24 months. We hypothesize that among patients with PAD, a brief behaviour counselling intervention will increase physical activity by ~50% compared to patients undertaking standard medical care (controls) evidenced by mean daily step counts of 5000+/-3400 for those patients receiving the intervention compared to 3300+/-2200 for those randomised to the control group at 4 months follow-up. We also hypothesise this improvement will be maintained at 12 and 24 months. Secondary aims of this study include examining the effect of the brief behaviour counselling intervention on participants’ functional capacity, psychological profile, revascularisation rate, resource use; and to perform an economic evaluation of the brief behaviour counselling intervention compared to usual care.

Plan EARLY is a randomised trial to assess the impact of Advance Care Planning (ACP) intervention on documentation of ACP, symptom management, healthcare utilisation and concordance with participant wishes in adults with an advanced, progressive life-threatening illness who present to the Emergency Department and who do not require referral for specialist palliative care. The trial will also seek to recruit the participant’s carers if available. Failure to recruit the carer will not result in the patient’s exclusion from the trial. Participants are randomised to one of two treatment groups: advance care planning (ACP) for patients plus Symptom Management and Support (SMS) for their healthcare providers, or Usual Care. The ACP plus SMS intervention involves: up to 4 face to face visits with a project nurse at the participant’s place of residence to discuss and complete ACP; completion of questionnaires at 9 weekly intervals; in-service style education to ED staff, RACF staff and GPs; individualised education to GPs regarding symptom management; written information regarding ACP, Plan EARLY and referral to specialist palliative care; and follow-up telephone calls to GP and family members at 6 week intervals. Usual care is the standard clinical care provided by the patient’s regular treating team. As health conditions are expected to vary among participants in the control group, the usual care may differ between participants. Participants randomised to the control group will complete questionnaires regarding their care and symptoms at 9 week intervals over a 6 month period. Furthermore, the SMS education component will be offered to healthcare providers of patients randomised to the intervention group only. However, it is expected that there may be some contamination of the control group with regard to SMS education as inevitably some healthcare providers will care for patients in opposite treatment groups. Participants in the SMS education component will not be asked to withhold the skills they may have acquired from patients randomised to the control group. Project staff will collect health care utilisation data from hospital records for participants in both the intervention and control groups. During the course of the study referral to specialist palliative care will be offered if care needs, such as symptom burden greater than 3/10 on SAS or distress requiring multidisciplinary specialist care, are identified. Finally, health care providers who participate in the SMS education component will be asked to complete an evaluation of the training received.

Postoperative nausea and vomiting (PONV) are common unwanted complications for patients following anaesthesia/cardiac surgery, affecting at least 1:3 patients, despite pharmacologic treatment. Patients have a strong preference for avoiding PONV: satisfaction with anaesthetic care and subsequent quality of health care is strongly related to experiences of PONV. Acupressure is one alternative approach thought to prevent nausea and vomiting through an alteration in endorphins and serotonin levels and is an intervention endorsed by the World Health Organisation (WHO). This two-group, parallel, superiority, randomised controlled trial (RCT) will test the efficacy of PC6 acupoint stimulation versus placebo for reducing PONV in cardiac surgery patients.