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Patients having operations under general anaesthesia will be asleep for the duration of the procedure and their own breathing efforts will be reduced by the anaesthetic drugs. The anaesthetist will support the patients breathing and will place a breathing tube into his/her windpipe as soon as the patient have drifted off to sleep. Normally, the anaesthetist discontinues the administration of oxygen during this manoeuvre as it usually takes only a short time to insert the breathing tube. We believe that continuing the supply of oxygen through a small tube into the inside of the patients cheek at this stage will keep the body oxygen levels higher than they would be otherwise. This is especially important for patients who are overweight or pregnant and also in children as their oxygen reserves exhaust more quickly. Computer programs and our understanding of the biology of people have suggested this would be the case. However, we do not have proof of this at present.

Laparoscopy is increasingly replacing open surgery as the preferred treatment option in most patients across disciplines. Additionally as technological improvements have occurred, mini-laparoscopic instruments have been designed to further reduce surgical trauma and minimize invasiveness. There are several studies in the literature, which show that using mini-laparoscopic instruments does not increase complication rates and may reduce patient recovery. Typically a 10mm umbilical incision and endoscope is routine for a total laparoscopic hysterectomy. In 2011, St John of God Hospital began to use high definition 5mm endoscopes. At this stage Dr Salfinger began to complete his total laparoscopic hysterectomy with a 5mm umbilical incision and endoscope and anecdotally noted that patients were requesting discharge earlier. In 2012 Dr Salfinger and Acton audited 328 consecutive cases in a single-surgeon series of total laparoscopic hysterectomy, comparing use of 5mm and 10mm rigid laparoscopes examining for length of hospital stay (LOS), return to normal daily routine, complication rates and conversion to laparotomy in women aged between 29-92 years. Findings were a significant increase in the number of women being discharged from hospital on day 1 in the 5mm-scope group compared to the 10mm scope group. Both groups had similar blood loss and complication rates. Notably the 5mm-scope group also had a significantly shorter time to return to normal function (subjective, patient assessed outcome) with 8 days in comparison to 17 days for the 10mm scope group. Because of these findings we are encouraged to perform a randomized controlled trial examining the impact of umbilical incision, port size and endoscope size on total laparoscopic hysterectomy. This will be a randomized controlled trial with participants randomized to either the 10mm or 5mm incision and endoscope. Participants will be recruited from Dr Salfinger and Dr Tan’s patients. Data collected will include basic patient demographics, type of umbilical incision and endoscope used, operating time, complication rates, discharge time and post operative pain scores on day 1 and day 7. It is hoped that this data will be used by other surgeons and encourage them to trial 5mm umbilical incision and endoscope as well as other health centers, encouraging them to provide new technology for their surgeons and patients, aiming for shorter length of stay.

This is a Phase II study of cetuximab, carboplatin and radiotherapy (RT) in patients with Locally Advanced Head and Neck Carcinomas (LAHNC) who are unfit for cisplatin. The aim of this study is to show the feasibility and safety profile of the combination of cetuximab, carboplatin and RT in treatment of patients with LAHNC.

Background: Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions. Aim: This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. Methods/ Design: We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. Discussion: This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting.

The study will be undertaken within community mental health services across one local health district in New South Wales, Australia. A two group multiple baseline design will be utilised to assess the effectiveness of a 12 month intervention. The 12 month intervention will be implemented sequentially across the two groups, and involve clinical practice change strategies to increase clinician provision of three elements of care for clients (assessment, brief advice, referral) for four health risk behaviours (smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption and inadequate physical activity). Primary data collection will consist of repeated cross-sectional computer assisted telephone interviews (CATIs) undertaken with clients receiving care from the community mental health services. The interviews will measure client reported receipt of preventive care on a weekly basis for 36 months. Surveys will commence in both groups six months prior to the intervention implementation in the first group of services, and continue until six months post the intervention implementation in the second group of services. To supplement the client data, CATIs will be undertaken with community mental health clinicians pre and post the intervention periods, to measure clinician self-reported preventive care provision.

Study Aim The proposed research aims to measure whether functional splinting in addition to motor training leads to improved upper limb function in children with cerebral palsy and brain injury Background A functional splint is a device that is used to support a weak or ineffective joint or muscle, in order to improve a person's ability to use the limb which the splint is supporting. Splinting to facilitate hand function is a widely practiced intervention in the treatment of children with neurological conditions, although there is little evidence to support the effectiveness of this intervention. There is emerging evidence to support interventions that focus on active use of a limb to improve function. These repetitive, task-specific interventions aim to bring about changes at the neural level. The use of a functional splint may lead to an immediate improvement in function, however, as this in effect inhibits active use at the joint it is supporting, both the short-term and the long-term effect on function when using these splints is unknown. This study seeks to address the gap in literature regarding functional splinting efficacy, and make an important contribution to the evidence base in this field.

The trial will invite patients at the Alfred Hospital, Melbourne, Victoria presenting with acute decompensated heart failure to participate in a study of a dietary supplement (Beetroot extract - Dietary Nitrate) within 48 hours of their hospital admission. Heart failure is a condition where the heart fails to provide enough blood pumping power for the needs of normal body function. At times the condition may worsen significantly leading to fluid retention, low blood pressure, kidney failure and breathlessness, which usually each requires hospitalization. Currently there are limited treatment options available for these patients and there is a high risk of further hospitalization or death in subsequent months after the patient’s admission to hospital. In this study we propose to study the effects of dietary nitrate in th patients described above. There is a growing body of evidence that dietary nitrate in the form of concentrated beetroot supplementation has beneficial cardiovascular effects including lowering blood pressure and enhances exercise performance during sub-maximal exercise. Forty patients will be invited to participate in the trial. After obtaining informed consent, twenty patients will be randomly assigned to treatment with oral Dietary Nitrate (70ml concentrated beetroot juice, manufactured by James White UK) or nitrate depleted placebo once daily for five days. This is in addition to any other medication prescribed by their treating doctor. At enrolment the patients will be educated and counselled about the trial and the intervention medication. Various parameters will be monitored on a daily basis, including objective and subjective symptom review, observations, blood vessel function, weight, kidney function, and medication requirement. Blood samples will also be taken and stored for analysis. We will contact the patient by telephone after 30 days to ask about their health. The primary objective of the trial is to see whether the administration of dietary nitrate will improve blood vessel function and overall treatment outcomes.

Reduced balance and gait are debilitating impairments associated with PD. A home-based interactive stepping videogame has been shown to be an enjoyable and effective form of training in the general older population. The aim of this randomised controlled trial is to determine if a home-based, interactive, stepping videogame for people with PD is effective in improving balance and gait. Secondary aims are to determine the effect on muscle power, mobility, fear of falling and freezing of gait, and to provide data that will establish an effect size for fall rates to inform the design of future trials. The use of the online blog to enhance participation and engagement in the training, as well as gauge acceptability of the interactive stepping videogame program, will also be evaluated. Since poor balance is a major risk factor for falls in people with PD, the development of effective, sustainable and engaging exercise programs to improve balance is an urgent research priority.

This project will investigate the clinical accuracy of the Invisalign(TM) orthodontic aligner system (Align Technology, California, USA) by comparing computer-proposed tooth movements with actual clinical tooth movement, following an increase in the rate of tooth movement per set of aligners from the default 0.25mm per fortnight to 0.5mm per fortnight.

The study is to determine the efficacy of duct tape in treating verruca pedis compared to cryotherapy. Current literature consists of low-quality studies on the use of duct tape for treating verrucae revealing inconsistent results. Thus, this study will assess the efficacy of duct tape in comparison to cryotherapy according to the criteria of total resolution, dimensions, resolution of surrounding warts, pain, adverse effects, participant satisfaction and cost effectiveness.