ANZCTR search results

This project will investigate the effect of restoration of transdermal Testosterone and Oestrogen on dry eye clinical indicators and biomarkers in post menopausal women. Association between these sex hormones levels and the measured parameters might be elucidated while suggesting for an option of dry eye treatment in this population.

The concept of non-technical skills training (NTST) arose in the aviation industry after observation that a number of avoidable incidents were caused by human error rather than mechanical failure. In medical training, clinical knowledge and skills are emphasised with little attention given to “human factors”. These encompass such aspects as leadership, team-working, communication and decision-making. Thus far, study in this area has been restricted to simulations. Our project aims to evaluate the impact of implementation of training in non-technical skills for our Medical Emergency Team (MET) service on team performance and patient outcomes. This will be a multi-partite quality improvement project run at the Lyell McEwin Hospital, a tertiary metropolitan hospital in Adelaide. We plan to perform a retrospective audit of existing MET service data to establish baseline data. Then a period of prospective study will occur before and after delivery of NTST to members of the MET service. Team attendances will be independently observed for demonstration of non-technical skills and patients will be tracked during their hospital admission. A pilot observation will also be conducted to validate the observational assessment tool and measure inter-rater reliability between the investigators. The primary outcomes will be 1) MET performance of non-technical skills as graded by a specifically developed qualitative assessment tool and 2) incidence of efferent limb failure as defined by a) requirement for a second MET attendance within 24 hours for the same calling criterion, b) unplanned admission to the Intensive Care Unit (ICU) within 24 hours of MET attendance, c) unexpected cardiac arrest and/or death within 24 hours of MET attendance. Secondary outcomes will include hospital and ICU length-of-stay, and vital status at hospital discharge. These will be used as a comparator between all periods of the project. NTST will be delivered to MET members by the investigators in collaboration with a group of active instructors from QANTAS and the Royal Australian Air Force Reserves. Oversight will be provided by the hospital Safety and Quality Unit. The baseline audit will include 2000 patients and the observational stage of the study is anticipated to enrol 600 patients, equally divided between the before- and after-NTST periods. We aim to demonstrate that training in non-technical skills improves MET service performance leading to a reduction in incidence of efferent limb failure. The anticipation is that this will then extrapolate to reductions in length-of-stay and mortality.

The null hypothesis is that a scored, formalized questionnaire reflecting a focused history and clinical examination for a patient presenting with heel pain will not reliably and reproducibly identify patients with a diagnosis of plantar fasciitis in a population of patients presenting with foot and ankle complaints.

This project will investigate the effectiveness of two different types of resistance training programs and the influence of stage of maturation on responsiveness in adolescent (14-18 year old) male rugby union players. There is no debate about that resistance training is a safe approach to health and fitness in adolescents, but there is debate about the particular pattern of resistance training that is used. Therefore this project will compare the effects of two different training patterns that are similar in training load to determine whether training pattern influences outcomes in this age group. As a result of participating in either of the two RT programs the participants will experience improvements in their strength, power, speed, and body composition assessment. It is hypothesized that there will be no difference in the magnitude of change between the two different RT programs.

This study will look at patients diagnosed with recurrent erosion syndrome which is a problem where people affected have repeated episodes of abrasions of the cornea (clear portion of the front of the eye). It will examine the incidence of episodes of erosions following treatment with Diamond Burr Superficial Keratectomy (DBSK). This study will use information from each patient’s medical chart and ask each participant to answer a very quick questionnaire via telephone interview. The results compiled will help decide whether this treatment should be offered to more patients in the future.

This study will evaluate whether maneuvres to re-inflate collapsed areas of lung during surgery for lung cancer help to improve post-operative oxygen levels. Who is it for? You may be eligible to join this study if you are 18 years or above and are scheduled to undergo surgical resection of your lung cancer with one lung ventilation. Trial details Participants in this trial will be randomly (by chance) allocated to one of two groups. Participants in one group will undergo what is called an alveolar recruitment manoeuvre once during and once following surgery. This involves a brief period of increased airway pressures with the aim of re-inflating collapsed lung units. Participants in the other group will undergo standard treatment with a protective one-lung ventilation strategy. Participants will not know to which group they have been assigned. Participants will be assessed peri-operatively to compare respiratory outcomes between these two manoeuvres.

Ventilator Associated Tracheobronchitis (VAT) and Ventilator Associated Pneumonia (VAP) are common complications of mechanical ventilation, that may result in prolonging ICU stays and can also be fatal for critically ill patients. The standard treatment is currently intravenous antibiotics. The emergence of multidrug resistant bacteria and Gram negative pathogens makes this approach increasingly less effective. In order to improve treatment options, aerosol antibiotics have been investigated. They generally result in a higher sputum concentration compared to intravenous delivery, with reduced systemic exposure. Studies of aerosolized antibiotics to treat or to prevent VAP indicate benefits such as lower rates of VAP at the end of treatment, reduced usage of systemic antibiotics, and earlier weaning of patients from the ventilator, leading to shorter stays in the ICU. Since VAP may be caused by Gram negative and/or positive bacteria, an adequate antibiotic regimen needs to cover both, and also have coverage for MRSA. This study therefore plan to investigate the combination of amikacin and fosfomycin.

Background There is debate about the effectiveness of written COPD action plans. A recent study by Bischoff et al (Thorax 2011) showed that adherence to a COPD action plan was associated with reduced time for exacerbation recovery. There are several barriers to adherence with a COPD action plan, such as: *The practicalities of the patient obtaining the relevant prescribed medications from the pharmacy at a time when the patient is unwell. *The indiscriminate us of relevant prescribed medication This study will test the effect of removing one of these barriers. For this pragmatic pilot study the COPD action plan, from the Australian Lung Foundation (ALF) will be utilised The Respiratory Chronic Care Program provides, regular planned home visits, offering continuing health support through education and assistance to patients, carers and their families. The program augments existing respiratory services by enhancing communicating and coordination of care between hospital, community and general partitioners. Primary Aim Is to provide a written action plan to COPD patients to assess whether dispensing antibiotic and prednisone leads to: *Better adherence with a written action plan *Better health outcomes Over 9 months compared with prescription “only” without dispensing these medications Secondary Aims *For the RCC team to gain an appreciation and understanding for research *Providing pragmatic data for future research and funding Reference: Effects of written action plan adherence on COPD exacerbation recovery. Bischoff E, Hamd D, Sedeno M et al. Thorax 2011;66:26-31

The American College of Sports Medicine has highlighted that there is insufficient evidence to recommend the utility of perceptually-regulated exercise as a primary method of exercise prescription. We have provided evidence that sedentary participant can use percpetually regulated exercise to increase fitness. This trial will: 1) test the efficacy of an 8 week perceptually-regulated program on aerobic fitness; 2) test the efficacy of an 8 week percpetually-regulated program on motivational processes. It is hypothesised that perceptually-reguated exercise at RPE 15 will lead to greater increases in aerobic fitness, compared to theRPE 13 and control, but that these will not be sustained over the 6 month follow-up period.

The aim of this investigation is to investigate three modes of supporting our outpatients to undertake the physical activity prescribed by their treating health professional (e.g. physiotherapist). This four group randomised study will investigate the merit of three modes of offering personalised support to patients (via the telephone, letters in the mail or email) in comparison to usual care. Potential participants will be identified by their clinical team who will also provide the research team with a list suitable activities they have prescribed for their patients based on their level of fitness and any health conditions they may have. These participants will then be randomised into one of four groups. The first group will only receive their routine care and no additional support (usual care control). The second group will receive support via the telephone. The third group will receive support via letters sent in the mail. The fourth group will receive letters sent via email. The interventions will last for a period of 12 weeks. They start off with intensive support, gradually reducing to less frequent support over the 12-week period. The support is provided by a suitably qualified health professional (e.g. Physiotherapist) as prescribed by the patients usual treating team. Data from this investigation will provide important information about the feasibility, costs and effectiveness of these interventions. This information will be used to inform future service delivery improvements and future research investigations.