ANZCTR search results

Aim: To test the efficacy of a strucured diet and lifestyle program for plasma cholesterol and weight reduction which can be used at point of care to reduce absolute cardiovascular risk and the need for lipid lowering drugs.

AIM: To determine patient and family preferences for immobilisation of undisplaced buckle (greenstick) type fractures of the forearm near to the wrist (distal forearm). BACKGROUND: In the group of children who sustain fractures (breaks) of the forearm near to the wrist, which are undisplaced the mode and length of immobilisation in plaster has been variable. It has been shown that adequate treatment is to immobilize the arm for a two week period, remove the plaster cast then reassess the fracture site for tenderness. The treatment is then either to mobilise if there is minimal tenderness or to re-plaster for a further 1-2 weeks if there is still significant pain. The method of immobilising these injuries has traditionally been in a full, encircling plaster cast, which requires splitting for removal. Another method that has gained popularity recently is the plaster slab (half cast), fashioned and moulded to one side of the child’s forearm and wrist and held in place with a crepe bandage. The functional outcome anecdotally appears to be the same with these two techniques, but the patient preference and comfort have never been investigated. HYPOTHESIS: That plaster slab treatment of buckle fractures of the distal forearm is at least as acceptable to patients as full plaster casting, and that return to function will not be delayed. PROJECT DESIGN: this is to be a prospective randomised study of two techniques of immobilisation of buckle fractures of the distal forearm in children. All children < 17 years of age, with an undisplaced fracture of the radius or ulna, presenting to the Emergency Department of the Royal Children’s Hospital will be enrolled into the study and randomised into either application of a full plaster cast or a plaster slab (half cast) Parents will be asked to keep a daily diary of analgesia use, child complaints or perceived problems with the plaster. Follow up will be in the Emergency Department by one of the two investigators at 2 weeks post injury. At this time a patient and parent satisfaction questionnaire will be completed, the plaster will be removed and the forearm fracture reassessed. If there is minimal or no tenderness the patient will be allowed to mobilise and return to normal function. If there is pain the plaster, or plaster slab, will be replaced and review in a further 2 weeks will occur. RELEVANCE: This research is relevant to current clinical management of patients with the described injuries as it will provide information as to the most acceptable immobilisation from the patients and families point of view. It will also establish the time taken for different immobilisation techniques to return the children to full function. These results should guide future treatment of these injuries, both in the hospital and in general practice clinics.

This project will provide for the first time a sound Australian-sourced evidence base for the effective management of this intractable problem amongst the more severely disabled elderly chronic pain sufferers. This research proposal addresses National Research Priorities of improving the mental and physical capacities (and self-reliance) of chronically-ill ageing Australians, by helping to minimise disability, improve self-reliance, workforce participation (where relevant) and quality of life in chronically-ill elderly Australians.

Stubbing of the finger-tip is a common injury in sports such as basketball, volleyball, cricket and football. This can result in a Mallet finger deformity, where the end joint of a finger cannot be actively straightened out. In most mallet finger cases seen at The Alfred, the skin remains intact, and the impairment results from a tear of the extensor tendon or an avulsion (a small fracture where the tendon attaches to the bone). Treatment commonly involves immobilising the end joint of the finger in a splint for six or more weeks so patient compliance is a major factor in the quality of the outcome achieved. This study aims to compare two different types of splintage (the commonly used thermoplastic thimble splint and the aluminium-foam “Mexican hat” splint which is in use in Britain) with a control splint (thermoplastic prefabricated “stack splint” with tape). Outcome measures will include patient compliance with the splint, degree of extensor lag, active movement of the joint, and any complications.

We aim to show if introducing a delay between instillation of local anaesthetic gel into the urethra and the performance of catheterisation produces less discomfort than immediate catheterisation. The assessor who administers the pain scale rating will be blinded to the assignment of the patient (delayed or immediate catheterisation). The participant and proceduralist will not be blinded to the assignment.

IV cannulation can be painful. Both EMLA and nitrous oxide can be used for analgesia, especially in children. We aimed to determine which is better for pain relief in children for this procedure

This study evaluates the use of parenting skills training with or without nutrition and activity education during parent-led family child weight management

Following the achievement of deep molecular response on tyrosine kinase inhibitors (TKIs) 54 around half of patients with chronic myeloid leukemia (CML) can discontinue TKI and remain in 55 treatment-free remission (TFR). The ALLG CML8 study commenced in July 2006 and enrolled 40 patients with undetectable BCR-ABL1 mRNA (approximately MR4.5 56 ). Molecular relapse was 57 defined as detectable BCR-ABL1 at any level on two consecutive tests or a single value >0.1%. 58 With a median follow-up of 8.6 years (range 5.7-11.2 years) 18 patients remain alive and in TFR 59 (45.0%; 95% confidence interval 31.9% - 63.4%). The latest relapse that occurred was at 27 60 months after stopping imatinib. No patient progressed to advanced phase CML. Twenty-two 61 patients met the criteria for imatinib re-treatment and all regained undetectable molecular 62 response. Twelve of these patients attempted TFR a second time after a median 5.9 years re63 treatment, and 5/12 patients had restarted TKI at last follow-up. Nine patients in long-term TFR 64 were additionally monitored by highly-sensitive BCR-ABL1 DNA PCR in a sufficient number of 65 samples to enable more precise quantification of residual leukemia. The level of BCR-ABL1 DNA decreased from a median of MR5.5 in the first year of TFR to MR6.2 66 in the latest 3 years of TFR. 67 Our results support the long-term safety and remarkable stability of response after imatinib 68 discontinuation in appropriately selected CML patients. Furthermore, serial high sensitivity testing 69 provides a new and unexpected finding: that the level of residual leukemia steadily declines in 70 patients in prolonged TFR

The purpose of this study is to examine the genotypes of ABCB1 (a type of gene found in your cells) in a larger group of patients to test whether the correlation (matching of genes with more side effects from drug treatment) seen in the previous small study are true. The primary (main) endpoint will be a correlation of ABCB1 genotype and imatinib dose after three months of therapy that will allow for dose adjustments based on toxicity (side effects). The larger patient numbers will also allow a haplotype (gene) analysis to be done. The importance of dose individualisation is illustrated by studies that show better outcomes for cancer patients who have post-treatment dose adjustments based on therapeutic drug monitoring or on toxicity. However, with these methods, the optimum dose for each patient is often not reached until after the majority of the treatment course has been given. A correlation between ABCB1 genotype and toxicity-adjusted dose has practical significance since a simple blood test could allow effective dose selection in individuals. Approximately 300 patients will be required.