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It is commonly believed that acute postoperative pain can lead to an impaired outcome by means of stress hormone provoked physiological changes (e.g. hyperglycaemia, altered immune response, increased myocardial oxygen consumption). However, it has not yet been investigated whether or not pain that is often measured by means of subjective pain scales (e.g. numeric rating scale, NRS) actually correlates with changes in the plasma level of stress hormones. Aim of this study is to investigate the relationship between the subjective NRS score (0-10; 0= no pain, 10 = worst pain) and the plasma levels of adrenaline and noradrenaline. Furthermore, the correlation between these parameters and other non-invasive measures of pain (heart rate [HR], blood pressure [BP], respiration rate [RR], heart rate variability [HRV]) will be investigated. For this purpose, 85 patients scheduled for non-emergency plastic surgery will be included in the trial. On arrival in the recovery room, 4 ml blood will be taken from a cannula sited during the anaesthetic into the cubital fossa to measure plasma levels of catecholamines. Simultaneously, HR, BP and RR will be recorded as part of the recovery room protocol and the patient will be asked to rate their pain on the NRS. In addition, data from the connected electrocardiogram will be downloaded onto a laptop PC to calculate parameters of HRV by means of the MEMCALC method: total power, low frequency, high frequency, the low: high frequency ratio and a non-linear approach, ultra-short entropy. These HRV parameters are purely mathematical calculations (hence “no touch” technique) and have previously shown correlations with the sympatho-vagal balance. At the time of discharge from the recovery unit, above mentioned procedure will be repeated. In between these 2 time points, the procedure may be repeated up to 3 times if a patient “moves” from one pain category into another (4 categories defined: no [NRS 0], mild [NRS 1-3], moderate [NRS 4-5] and severe [NRS 6-10] pain). To identify changes in pain perception, patients are frequently (approx. 5 minutely) asked to rate their pain on the NRS. This is a standard procedure in the Royal Perth Hospital recovery room. Hence, a minimum of 2 and a maximum of 5 blood samples (=20ml) may be taken of a subject. The study period ends with discharge of a patient from the recovery room.

Ophthalmic regional blocks are some of the most commonly used in Australia. yet most of them require blind insertions to the posterior of the eye. This study aims to study a new technique which injects under vision to the anterior of the eye. In theory this should be a simpler and safer technique. it's efficacy and safety will be the subject of this study.

Infants on ventilatory support in neonatal intensive care regularly require suction to clear their airways of secretions. This process entails the introduction of a catheter into the endotracheal tube through which the infant is ventilated to suction the secretions. There are two brief episodes of disconnection from the ventilator (to remove then reinsert the flow measurement device, or pneumotachograph) before and after the suctioning. Although this is a necessary process, some infants experience a reduction in oxygenation possibly due to lung collapse from this procedure. In the past we did not have any good monitoring tool to assess the changes occurring in lung volume during and after suction in ventilated newborn infants. Electrical impedance tomography (EIT) is a new non-invasive lung volume monitoring tool, which is well suited to this purpose. Our study group has shown that EIT measures ventilation distribution highly accurately and gives information on the level of lung inflation in preterm infants. The purpose of the study is to attempt to examine the effect of endotracheal suction on ventilation distribution and lung de-recruitment in preterm infants.

The main aim of the current study is to determine and compare the impact of laproscopic Roux-en-Y gastric bypass (RYGB) and laproscopic adjustable gastric banding (LAGB) on gastric emptying (GE), small intestinal (SI) transit, gut hormones, glycaemia, plasma insulin, haemodynamics, absorption, appetite, gastrointestinal (GI) symptoms, plasma lipids and body weight.

Purpose of the study is to determine the place, if any, of bifocal tissue scanning in diagnosis of skin cancers as compared to tissue biopsy. We hope to determine if a) there is a better and easier way of diagnosis of skin lesion other than biopsy and b) if there is a reliable method of determining the limits of spread of the skin lesion to reduce the need for repeated surgeries.

We have observed that patients with gastro-oesophageal reflux disease (GORD) have an increased incidence of upper and lower respiratory infections. In addition GORD is strongly associated with bronchial asthma. This study seeks to identify whether patients with GORD have impaired mechano or chemo laryngeal sensitivity which may reduced airway protective mechanisms and lead to an increased risk of pulmonary aspiration of gastric acid. This study therefore aims to determine the mechano and chemo senitivity of laryngeal protective mechanisms in patients with GORD and healthy controls

This study aims to evaluate the effectiveness of a brief psychosocial intervention in reducing depression and anxiety in patients with cancer. Who is it for? You can join this study if you are aged 18 years or more and have a diagnosis of cancer for which you are attending any of the participating clinical sites for treatment. Patients already receiving current specialised psychological treatments or taking antidepressant medication will not be eligible. Trial details Eligible patients who have mild to moderate depression/distress and/or risk factors for becoming depressed will undergo a maximum of 4 x 30 minute tailored psychosocial therapy sessions over a period of 4 weeks. The type of therapy will vary depending on the each patient's needs, examples of which include practical concerns (e.g. finances), family concerns (e.g. child care), emotional concerns (e.g. anxiety about chemotherapy) physical concerns (e.g. pain), and spiritual concerns (e.g. shame). The psychosocial therapy will be delivered by health professionals who have undergone special training. Patients with low distress or risk factors will receive a patient self-directed resource kit comprising materials demonstrated to be acceptable and effective for patients with cancer. Patients who have no distress and no risk factors for the development of depression will continue to receive usual medical treatment. Participants will complete questionnaires at baseline and 10 weeks to assess depression, anxiety, unmet needs, and quality of life.

Some patients with neck and arm pain have symptoms because nerves in the neck and arm have become overly sensitive to movement. There is some evidence that this type of neck and arm pain can be well managed with specific treatment to the nerves in the neck and arm (nerve mobilisation). However, the evidence is limited and we cannot predict which patients respond best to nerve mobilisation. The primary aim of this trial is to determine whether nerve mobilisation leads to clinically important improvements in pain and function for patients with nerve-related neck and arm pain. The secondary aim is to determine if a set of clinical findings can accurately predict which patients with nerve-related neck and arm pain will respond best to nerve mobilisation.

This study looks at the effectiveness and safety of the chemotherapy drug Bendamustine in treating advanced slow-growing non-Hodgkin's lymphoma or mantle cell lymphoma. Who is it for? You may be able to join this study if you have advanced indolent non-Hodgkin's lymphoma or mantle cell lymphoma. Trial details Participants will be randomly divided into two groups. One group will receive a combination of the drugs Bendamustine and Rituximab (BR). The other will receive standard treatment with either Rituximab, Cyclophosphamide, Vincristine, and Prednisone (R-CVP) or Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP). The study aims to compare the efficacy and safety of the combination of Bendamustine and Rituximab (BR) to the current standard treatments.

This study looks at how supervised exercise programs can help in rehabilitating people with a major loss of muscle or nerves following surgery for sarcoma. Who is it for? You can join this study if you are recovering from a major loss of muscles or nerves after surgery for sarcoma. Trial details Participants will take part in a 12 week supervised rehabilitation program with exercises, 3 times per week, for 1.5 hours. The opposite unaffected limb is not used in the exercise program, and is monitored for comparison. Five tools will be used to monitor the psychological and physiological wellbeing of patients. The ultimate goal is to restore function of the affected limb to 80% of the unaffected limb, The study aims to see how well exercise is tolerated, and how effective exercises are at increasing muscle strength and mobility, and also quality of life.