ANZCTR search results

Aims: We would like to describe what the normal bowel function is in severely unwell children who are managed in our intensive care unit. Our current management protocol is based on that from the Royal Children's Hospital, Brisbane, and we want to investigate the effectiveness, or not, of this protocol in our population. We hypothesise that it is normal for the gut to behave differently when unwell compared to in good health, and that management strategies may lead to over-treatment and potential longer hospital stay. This is previously unpublished in children's intensive care literature. Research design: This is a prospective, observational study involving no deviation from current treatment received in our unit. This is a pilot study, which may lead on to a larger multi-centre trial to be run by a larger research group, such as ANZICS CTG, which would investigate the effect of non-intervention in those with slower bowel function, rather than escalating intervention. Methods: We will approach all admissions to our unit to be enrolled in this study. Participation will involve no change to management, only completion of the study questionnaire by the researcher every day until hospital discharge. Results will then be analysed prior to publication.

Introduction: Children who are hospitalised for an extended time frame are often cared for in a ward environment that does not provide input to promote speech and language development. These children are at an increased risk for language delay. Other barriers to early communication development for children who are hospitalised for a long stay include limited opportunities to develop early language skills and learn to make sounds. Speech Pathology services at the Royal Children’s Hospital are provided in order of priority to the most urgent and severe cases first. This often means that the assessment and treatment of children with feeding and swallowing disorders are prioritised first, and there is little time left to provide early speech and language therapy for children who are hospitalised for a long stay. Early intervention is important to give children the best chance of developing speech and language skills. It is important for Speech Pathologists to use their time wisely when providing services to children on the wards, so a new model of providing language therapy has been developed. Group therapy and parent education sessions will be trialled to see how beneficial they are for parents and children. Aims: This project aims to compare the usefulness of individual speech-language therapy with group therapy for children who are hospitalised for an extended stay (longer than 5 weeks). Specifically the aims are: (a) To trial a new group speech-language therapy model for young children admitted to hospital for a long stay. This will be compared individual speech-language therapy. (b) To provide parents of children admitted to hospital for a long stay with strategies and support to encourage their child’s speech and language development. Methods: Two groups of participants will be invited to be involved in this study: approximately 34 infants who are admitted to the Royal Children’s Hospital for a long stay (5+ weeks) and referred to the Allied Health Infant Team or the Speech Pathology Department. After consent has been gained, both groups will be asked to complete an age appropriate communication screen (including assessments of early language skills, receptive and expressive language and early speech sound production). Parent’s interaction style with their child will be formally measured and parents will be asked to complete a survey about how confident they are in encouraging their child’s early speech and language development. After initial assessment, children on the general medical ward will be allocated to participate in group speech-language therapy. Children who are from other wards will be provided with individual speech-language therapy because they will be unable to freely mix with other patients due to infection control rules. Each group will receive 5 weeks of therapy 2 x a week. After the therapy, children’s speech and language will be assessed again, using the same tests as before. Parent’s interaction style with their child will be formally measured again and parents will be asked to complete a survey about how confident they are in encouraging their child’s early language development and how beneficial they found the therapy.

Many remote Aboriginal communities experience high rates of curable sexually transmitted infections, with chlamydia and gonorrhoea being of particular importance. Untreated infection can lead to pelvic inflammatory disease and, over longer time periods, infertility, as well as increasing the potential for further transmission to sexual partners. Early diagnosis and timely treatment of STIs are therefore important from both a clinical and public health perspective. In many remote communities there may be considerable time, sometimes a month or more, between testing for STIs and the provision of treatment, primarily as a result of the time taken to transport and process specimens for routine testing at central laboratories. Once results are available and communicated back to the health centre, there may be further delays resulting from difficulty locating and recalling patients with infection back to the clinic for treatment. Point-of-care (POC) tests are simple to use and are able to provide a diagnostic result using routinely collected specimens while a patient waits. For chlamydia and gonorrhoea this type of test could help reduce the time to treatment by providing test results in the clinic, soon after the sample is collected from the patient, ensuring that those with infection are treated promptly. Such tests could potentially result in great improvements in the management and control of these infections. Point-of-care tests for a variety of illnesses have been used widely in other countries, but have had limited use to date in Australia. This project, the first of its kind in Australia- will trial the addition of POC testing to standard diagnostic procedures in remote communities. Health services in SA,WA and QLD will be recruited to participate in the trial. During the study, each health service will clinically manage chlamydia and gonorrhoea using two different approaches for one year each. In the first year, half of the health services will be randomly assigned to manage these infections under current guidelines (standard practice phase), and the other half will supplement standard guidelines with POC testing (POC phase), such that treatment is offered at the time of diagnosis for those found to be positive by the POC test. In the second year, the health services will cross over to the opposite management approach. The overall aim of the TTANGO trial will be to see whether POC tests reduce the time to treatment, increase uptake of partner notifications and reduce the percentage of young people re-infected with chlamydia or gonorrhoea in remote communities in WA, SA and QLD. We will also examine the cost-effectiveness and cultural and operational acceptability of POC testing in remote health services.

To evaluate whether routine administration of proton pump inhibitor (intravenous pantoprazole) to mechanically-ventilated critically ill patients: (1) Reduces the incidence and severity of gastrointestinal bleeding; and (2) Increases the incidence of ventilator-associated pneumonia and/or Clostridium difficile infection

Aims: To identify whether the quality of recovery over time is affected by sevoflurane versus desflurane when used as the primary anaesthetic for knee arthroscopy surgery. Significance: Quality of recovery is an emerging field within anaesthesia of great importance. Although large outcome studies are very important in anaesthesia, there is a changing focus from “mortality and morbidity studies”, to quality of recovery. The reason is that the frequency of mortality is now very low with the result that few interventions will further reduce mortality. Very large numbers are required to demonstrate any improvements in surgery and anaesthesia when mortality is used as an outcome. However early data on the PQRS as well as clinical reports indicate that the quality of recovery is often poor in many patients, and yet these are not identified by the treating anaesthetist. There are implications for the individual patient, for the practice of anaesthesia, and for the community (such as safe return to work or to driving). Knee arthroscopy is often performed as an outpatient (day) procedure, and therefore may be perceived as “minor surgery”. However, for some patients the quality of recovery including cognitive decline may be more profound than would be expected from brief peripheral surgery. The role of the anaesthetic agent may have an important influence on this recovery. It is frequently assumed by anaesthetists that anaesthetics from the same class should produce similar effects when administered for a brief anaesthetic, but there are insufficient data to validate that assumption. This study will help anaesthetists to choose the anaesthetic that is best for their patients undergoing brief surgery. Hypothesis: The null hypothesis is that there is no difference in recovery in all domains measured using the PQRS, in patients undergoing knee arthroscopy under general anaesthesia with either sevoflurane or desflurane as the primary anaesthetic Methods: A parallel group, randomised trial with 1:1 allocation ratio will be conducted in adult patients undergoing arthroscopy, where the intervention is to receive sevoflurane or desflurane as the primary anaesthetic agent. Quality of recovery will be measured using the Post-operative Quality of Recovery Scale (PQRS), at baseline (preoperative), 15 and 40 minutes, one and three days, and three months following surgery. Patients who are unable to complete the PQRS due to language limitations, or who will receive regional anaesthesia will be excluded. Recovery is defined as “return to baseline values or better” for each of the survey questions and is dichotomised to recovered or not recovered. Recovery is grouped within domains (physiological, emotive, nociceptive, cognitive, and activities of daily living, with a sixth domain of self-assessment). The primary endpoint will be the incidence of recovery for all domains (not including self-assessment) on the third day after surgery. Based on a pilot study performed at the Epworth Hospital, we estimate the ability to detect a clinically important difference with 150 patients in each group. Guidelines for other aspects of patient care including co-induction agents, antiemetics, and post-operative analgesics will be issued to reduce variability between patients. Likely benefits: There are pharmacological differences between sevoflurane and desflurane that make them more or less attractive to the anesthetist. Desflurane, should provide for earlier and more complete recovery then sevoflurane, but sevoflurane is an easier drug to administer due to a lower incidence of airway irritability. There are very few data investigating quality of recovery with these two drugs beyond emergence and PACU care. This study will provide data into whether there are longer-term differences in the quality of recovery between these two drugs.

The study aims to assess whether two different anaesthetic techniques can affect the postoperative quality of recovery in patients undergoing total hip replacement surgery. The two techniques are considered as sedation or light general anaesthesia as they supplement a spinal anaesthetic - which is the primary anaesthetic technique for these patients. The quality of recovery is measured using a scale called the PQRS, which measures recovery in a number of different domains and compares recovery to the patients pre-surgery values.

AIM: The aim of this study is to determine the effect of NIV during exercise on DHI (Dynamic HyperInflation) in people with COPD (Chronic Obstructive Pulmonary Disease) compared to exercise without NIV (Noninvasive Ventilation). NIV with two different settings, standard and individualised, will be compared with no NIV. HYPOTHESIS: Non-invasive ventilation during exercise will reduce dynamic hyperinflation and increase exercise endurance time in people with COPD who dynamically hyperinflate during exercise compared to exercise without NIV. Individualised NIV will be more effective than standard NIV and no NIV in reducing DHI during exercise. POTENTIAL SIGNIFICANCE: Breathlessness is a major symptom for patients with severe COPD impacting adversely on physical performance and quality of life. The immediate effects of NIV during exercise include significant improvements in breathlessness and exercise endurance beyond those achieved with unassisted breathing in selected patients with severe COPD. These acute effects could significantly improve the efficacy of a pulmonary rehabilitation program by enabling people with COPD to exercise for longer or at a higher intensity.

The Stepping Stones Project aims to address the significant, unmet mental health needs of young people with disabilities and their families. This project will raise awareness of the importance of early intervention for emotional and behavioural problems in young people with disabilities and improve access to the evidence-based positive parenting intervention, Stepping Stones Triple P. As part of the study, parents and caregivers of children with a disability aged 2-12 will be able to access free Stepping Stones Triple P parenting programs. Professionals will be able to access free training in Stepping Stones Triple P. Stepping Stones Triple P programs will gradually become available across Queensland, Victoria and New South Wales. It is expected that participating in Stepping Stones Triple P parenting programs will lead to individual and population-wide reductions in child behavioural and emotional difficulties and parent stress, and improve access to evidence-based parenting programs in the community.

This is an observational study evaluating bleeding and clotting complications in patients undergoing liver surgery for cancer. Who is it for? You may be eligible to join this study if you are aged 18 years or above and are undergoing hepatic resection (i.e. surgical removal of all or a portion of the liver) for malignancy at Peter MacCallum Cancer Centre. Study details Changes to the blood clotting system following liver surgery have not been well characterised and information is conflicting. The traditional view is that as the liver makes important clotting factors surgery would reduce this production and make patients more likely to bleed. However, some recent work has suggested that actually liver resection patients are prone to blood clotting and the bigger the surgery the higher the risk. This study aims to use laboratory tests of coagulation to determine what actually occurs. Patients will be observed from the day of surgery until 1 year post surgery with review points at: Day 1, Day 3, Day 5 (if certain conditions met), week 2-3 (clinic review time), week 4-6 (clinic review time) and 1 year (clinic review time). Data collected from this study will help us to develop guidelines for management of blood clotting around the time of liver surgery. Additionally, the rate of bleeding and clotting complications will also be recorded.

Bispectral Index monitoring is commonly used intraoperatively to decrease the risk of awareness. Multiple drugs are known to affect the bispectral index and many have been studied in detail. Our aim is to determine the relationship between alcohol concentration and BIS. Awareness is an uncommon but potentially stressful complication of anaesthesia occurring in 0.1-0.2% of surgical patients.[1] The BIS monitor processes EEG activity with time-domain, frequency domain, and bispectral analysis producing a dimensionless number between 0 and 100 with 40-60 being appropriate for surgery.[2] Large trials have shown a decrease in the occurrence of awareness when using BIS in high-risk patients.[1, 3] Studies have demonstrated that BIS decreases in patients with head injuries [4, 5], those with cognitive impairment such as dementia [6] and with sedation [7]. There has been a single case report detailing a case of intracranial arterial alcohol embolization in which the BIS decreased to zero[8]. We hypothesise that BIS will decrease with alcohol consumption. The effect of multiple drugs such as nitrous oxide, ketamine and opioid on bispectral index has been studied in detail.[2] Alcohol, a commonly consumed drug has not. Miner et al published a paper using BIS to validate the use of Altered Mental Status Scale in intoxicated patients.[9] This study did not aim to determine a relationship between alcohol concentration and BIS and included patients who may have consumed other drugs. Thus, there were potentially many confounding factors that may have influenced the relationship between alcohol concentration and BIS. 1. Myles, P.S., et al., Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet, 2004. 363(9423): p. 1757-63. 2. Dahaba, A.A., Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg, 2005. 101(3): p. 765-73. 3. Ekman, A., et al., Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand, 2004. 48(1): p. 20-6. 4. Haug, E., et al., Bispectral electroencephalographic analysis of head-injured patients in the emergency department. Acad Emerg Med, 2004. 11(4): p. 349-52. 5. Ebtehaj, M., et al., Correlation between BIS and GCS in patients suffering from head injury. Ir J Med Sci, 2012. 181(1): p. 77-80. 6. Erdogan, M.A., et al., The effects of cognitive impairment on anaesthetic requirement in the elderly. Eur J Anaesthesiol, 2012. 29(7): p. 326-31. 7. Liu, J., H. Singh, and P.F. White, Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg, 1997. 84(1): p. 185-9. 8. Unnikrishnan, K.P., et al., Case report: alterations in bispectral index following absolute alcohol embolization in a patient with intracranial arteriovenous malformation. Can J Anaesth, 2007. 54(11): p. 908-11. 9. Miner, J.R., A. Gaetz, and M.H. Biros, The association of a decreased level of awareness and blood alcohol concentration with both agitation and sedation in intoxicated patients in the ED. Am J Emerg Med, 2007. 25(7): p. 743-8.