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Intensive care patients require many blood tests. Each blood test requires a small amount of blood loss and when added together this can lead to anaemia and the need for a blood transfusion. ICU blood tests are taken through a drip, and an amount of blood must be wasted each time, to clear the drip set and access the patient’s blood. This “discard volume” is important: too little and the blood tests may be inaccurate, too much and the patient loses even more blood unnecessarily. The ideal discard volume for most blood tests is unknown and so hospitals and health professionals take various amounts; it is highly likely that unnecessary blood loss occurs. In our study we plan to identify the minimum discard volume required to obtain accurate results for several of the most common blood tests performed in ICUs. The laboratory scientists (assessors) performing the outcomes measures will be blinded to intervention group of each blood sample.

This study is designed to assess the effectiveness of the Bispectral Index (BIS) monitor in helping nurses to decide if intensive care patient’s are receiving the right amount of sedation medication to keep them comfortable and asleep while they are connected to the ventilator. The BIS monitor is a non-invasive machine that measures electrical brain wave activity, and converts it into a number that indicates if patients are too awake or deeply unresponsive. The study will be conducted in the Intensive Care Unit at the Alfred Hospital. This study is designed as a prospective randomised control trial with parallel design. This means that participants’ will be randomly allocated into either one of two groups – an intervention or control group. Participant’s randomised to the intervention group will receive BIS monitoring. The control group will receive standard ICU sedation assessment and management. To determine if BIS monitoring is useful in ICU, information will be collected by auditing patient charts and determining the average amounts of sedation medication for each nursing shift. In addition, the years of critical care experience and critical care qualification will be recorded for each nurse managing patients recruited to the study.

This is a non-randomised, open-label treatment protocol for patients with advanced renal cell carcinoma, who received previous systemic therapy for advanced disease, and who do not have access to or are not eligible for other clinical trials with sorafenib (BAY 43-9006). Safety data and limited efficacy data will be collected.

The purpose of the protocol is to examine the effects of two levels of commonly used ambient humidity (70% and 80%) in the incubator on 1) body temperature control 2) fluid and electrolyte balance 3)bacterial colonisation and visibility as a result of water condensation in preterm infants born at 28 weeks gestation and less. This information will be used as a basis for a unit protocol for nursing preterm infants in humidity. We hypothesize that in the first two weeks of life after birth, there is no significant difference in body temperature stability when nursing preterm infants in either 70% or 80% incubator humidity.

Patients undergoing cardiac surgery for coronary artery bypass or valve repair/replacement are at risk of a number of complications. One of the most common complications is atrial fibrillation (AF), or abnormal contraction of the upper chamber of the heart, which occurs in about 30% to 55% of patients, depending on the type of surgery. While AF itself is not particularly dangerous, it does lead to increased length of stay in hospital, with associated costs, and also increases the risk of stroke. Patients suffering from post-surgical AF are generally prescribed additional medications, some of which can have unpleasant side effects. The purpose of this study is to determine whether fish oil given prior to surgery reduces the risk of developing AF after surgery. We also plan to investigate a number of mechanisms by which fish oil may exert its cardio-protective properties

To participate in a 14 day, self help programme consisting of a 99 page manual, 2 CD's and workbook with optional teaching if required. A confidential, in depth trial questionnaire to be answered by the participant in order to interpret and analyse the success or otherwise of the programme, taking into account individual criterion of each participant.

This trial examines whether a new dialysis membrane has potential advantages to the patients by way of determining whether the membrane results in less of an inflammatory state - reflected by both markers of inflammation and nutrition in the blood. It is a short term pilot study only, as a possible lead in to a longer more detailed study. The dialysis membranes will be supplied blinded in that all will look the same (but carry a code) such that the treating dialysis nurses and the patients will be unaware of which dialyser is in use at any given time.

Pulse oximeters are used in many areas of clinical medicine and a clear understanding of their performance is critical to appropriate and safe use. This study aims to evaluate the accuracy of a new pulse oximeter under a range of oxygen conditions compared with CO-ocimetry, which is the current reference method for this measurement.

The standard treatment regimen for uncomplicated ankle sprains comprises ‘RICE’ (Rest, Ice, Compression and Elevation). Assuming the patient is compliant then rest, compression and elevation can be applied with some consistency. Anecdotally, however, the application of ice to the affected area is more variable. This results from the availability of ice itself and the variability in which it is applied. Large ice blocks, chipped ice and ‘frozen peas’ could be expected to have differing levels of effectiveness. Furthermore, the areas of the affected part actually in contact with this ‘ice’ may vary considerably, depending upon the technique. Frozen gel packs have been used as an alternative to ice. However, these can be too cold and have been known to induce skin and subcutaneous tissue damage. They also lack ‘compliance’ when frozen and may be difficult to wrap around the injured area effectively. Recently, a polymer gel has been developed that has the properties of gentle and sustained extraction of heat from the environment (convection) and contacting surfaces (conduction). This gel can be modified to continue heat extraction until its own temperature reaches a pre-determined level of 6oC. This polymer gel can be fashioned into small or large plates that can be inserted into a variety of cloth garments for application to a range of body parts. It has been successfully employed in cooling vests to avoid heat stress and improve the performance of elite athletes. Does treatment with a gel polymer cooling regimen result in better function and reduced pain compared to traditional ice in the acute management of uncomplicated ankle sprains? This study will be a non-blinded randomised controlled trial comparing the use of standard ice with a cloth booty containing cooling gel polymer as an adjunct for treating sprained ankles. 135 patients will be randomised to one of three groups: episodic ankle cooling with ice, episodic cooling with gel polymer booty and continuous daytime cooling with the gel polymer booty. Each cooling regimen will last for at least 48 hours and all other treatments provided will be follow usual guidelines. Outcome measures of pain and ankle function will be sought at 5 and 15 days post-injury by telephone follow up. The findings of this study will inform best practice management of this common injury.

Lay Summary Project Title: Does habitual low dietary sodium intake augment the response to angiotensin receptor blockade and thiazide therapy in hypertensive patients with type 2 diabetes and elevated albumin excretion rate? Rationale: One of the complications of type 2 (adult) diabetes and high blood pressure (BP) is diabetic kidney disease. In this disorder, the kidneys leak protein (albumin) into the urine and in early stages this is known as microalbuminuria. In some patients this progressively worsens, leading to kidney failure. Some groups of blood pressure lowering medications also lower the blood pressure in the kidneys. This protects against kidney damage by slowing the progression of the protein leakage into the urine. The effectiveness of these groups of blood pressure tablets is reduced when the salt intake in the diet is high. Aims of this study: To determine if the effectiveness of the antihypertensive drug telmisartan, alone, and in combination with the drug hydrochlorothiazide, is increased by a low dietary salt (sodium chloride) intake, and if there is an additional beneficial effect on kidney function; In this study, participants with type 2 diabetes, high blood pressure and early diabetic kidney disease (microalbuminuria) will be recruited. Two groups will be compared - those who usually have a high salt intake in their diet versus those who usually have a low salt intake in their diet, as determined by previous urine sodium test results. All patients will take antihypertensive medication to control their blood pressure called verapamil, prazosin and methyldopa, these medications do not interfere with the test results. The participants will continue their usual diet and dietary salt intake throughout the study, however they will take salt and placebo capsules at various times during the study to look at the effects of additional salt intake on blood pressure and kidney function in patients with high versus those with low dietary sodium intake. Participants: The participants (n=32) includes men and non-pregnant women aged 20-80, with type 2 diabetes, high blood pressure, early diabetic kidney disease and a high or low dietary salt intake. Study Design and Procedures: Cross-over double blind study design. The study involves 12 scheduled visits over 28 weeks. The study consists of 3 phases: Two 8 week phases separated by a 6 week washout. Patients commence on verapamil ± prazosin ± methyldopa therapy and this is maintained throughout the 28 study period. The effect of telmisartan will be studied in each 8 week phase, and a thiazide will be added at week 4 to 8. The effect of salt or placebo will be examined in the last 2 weeks of each 4 week cycle. During the study, a total of approximately 210 ml (10 tablespoons) of blood will be collected. Potential side effects: There are potential side effects of blood pressure lowering medications however as all the patients have high blood pressure, they will be on blood pressure lowering medications. This study involves exposure to a very small amount of radiation during nuclear medicine MAG 3 tests to look at kidney function. This has been approved by the radiation research subcommittee. Provision of test results: Participants (and their general practitioner with their consent) will have access to all laboratory tests and when the final study report is produced by the investigator, this will be forwarded to study participants in lay terms.