ANZCTR search results

Up to 20% of patients over 50yr presenting for elective surgery may have episodes of obstructed breathing e.g. snoring, which is likely to worsen and become a significant risk after surgery. Use of a recorder to continuously monitor breathing for the 12 hours immediately after surgery may help us to identify the most useful risk factors to look for during the assessment of patients at the clinic prior to surgery.

This project aims to determine if combined cognitive behaviour therapy (CBT) and antidepressant medication (fluoxetine) treatment of school refusing children (11-16.5 years) improves their response to treatment and longer term outcome, compared to CBT only group. In order to determine that this predicted improvement in outcome is due to the active effects of medication rather than expectancy effects associated with taking a pill, a third group comprising CBT + placebo treatment will be included.

Epilepsy is a chronic condition with complex effects on a person’s social, vocational, and psychological function. Physicians are increasingly recognizing that there is more to managing epilepsy than seizure control alone. Side effects of Anti epileptic drugs (drugs used to treat epilepsy), psychiatric and cognitive problems associated with epilepsy are increasingly recognised. Cognition can be loosely explained as an individual’s mental ability to process information and accounts for virtues such as memory, worldly knowledge and problem solving to name a few. It is becoming increasingly recognized that these problems could adversely influence the quality of life of patients, even in those whose seizures are well controlled. The psychiatric and cognitive problems could be due to illness itself or could be due to the side effects of antiepileptic medications. By effectively managing these problems we could maximise the quality of life (QOL) and over all well-being of patients suffering with epilepsy. Only six antiepileptic drugs were available prior to 1990. In the last decade several new anti epileptic drugs have become available increasing our therapeutic options. There has been great deal of research into formulating better anti epileptic drugs, primarily spurred by the fact that the available anti epileptic drugs did not provide adequate control or patients’ were experiencing side effects from drugs. Older Anti epileptic drugs have many undesired side effects. As a group, they have been shown to adversely influence body’s ability to process bodily hormones and drugs. This leads to unwanted side effects such as sexual dysfunction, bone thinning (Osteoporosis), and failure of oral contraceptives to name a few. Side effects such as drowsiness, lethargy and psychiatric and cognitive problems are also more common with older anti epileptic drugs. The newer drugs as a group overall have been shown to have less side effects and are better tolerated. The efficacy of newer drugs is comparable if not superior to older drugs but with less side effects. It is a well-known fact that approximately two thirds of patients would become seizure free with the first or second drug given to them. In recent studies, these treatment responsive patients responded to low doses of essentially all the anti epileptic drugs studied, both old and new. Because these patients will remain on the initial or second therapy for several years, and because they will respond to most drugs, the burden is on the treating physician to select the anti epileptic drug that is most tolerable, has the lowest potential for harm, and has the least likelihood of negatively impacting quality of life.Despite their potential benefits, use of newer anti epileptic drugs thus far is largely limited to refractory cases and to tertiary centres. The newer drugs such as Levetiracetam (Keppra), have the potential to improve quality of life in subjects with epilepsy. The rationale of this project is to compare the tolerability, side effect profile and quality of life outcomes in treatment with levetiracetam versus the “older AEDs” - carbamazepine and valproate; the two drugs most commonly used as first line treatment. We hypothesize that levetiracetam’s efficacy and favourable side effect profile will enhance QOL and will improve health outcomes. We intend to test our hypothesis by prospective assessments of seizure control, cognitive and psychiatric effects and QOL. Cognitive assessments are done through a computerized battery of tests called IntegNeuro. We will also, as part of this study, perform a pilot study of to assess the utility of ocular motility (eye movement) testing as a practical method of assessing anti epileptic drug effects on cognitive performance. It is being increasingly recognized that subtle abnormalities of eye movements are seen in cognitive dysfunction. We intend to perform computerized eye movement testing in a subgroup of 20 patients randomized to each drug, and assess its use as an index of cognitive dysfunction that could be associated with anti epileptic drug use. Psychiatric and QOL assessments are done through well-validated questionnaires. The study population will be patients with epilepsy who have failed treatment with first anti epileptic drug. Failure is defined as lack of efficacy in controlling seizures or need to stop the drug because of side effects. Previous studies of Levetiracetam have been performed in either medically refractory patients who have taken multiple anti epileptic drugs or newly treated patients, whose clinical course is not yet clear. If positive the results of this study will provide evidence for the earlier use of newer anti epileptic drugs, in particular levetiracetam, especially in early stages of epilepsy and help improve the health outcomes of patients with epilepsy.

The study will compare the effectiveness of cognitive behaviour therapy (CBT) and a non-directive psychotherapy matched for therapist input in delaying or preventing transition to psychosis among young people at high risk for psychosis. It is expected that patients assigned to CBT will: (1) show lower rates of transition to psychosis during the 12-month follow-up period; (2) survive longer without becoming psychotic even if they do make a transition during the 12-month follow-up period; (3) show better outcomes at 6 and 12 months in terms of psychotic and non-psychotic symptoms, quality of life and social functioning, whether or not they become psychotic.

Ethics application submitted and responses to comments are being drafted presently.

The recently released NHMRC-endorsed evidence-based clinical practice guideline for acute low-back pain management provides an opportunity to assess the effects of a tailored implementation strategy for use in general medical practice. This trial will assess the effectiveness of the implementation strategy both at the general practitioner and patient level and also assess the cost effectiveness of the strategy. Successful implementation of these guidelines will reduce the morbidity and cost of acute low-back pain. The trial will contribute to our knowledge about implementation strategies attempting to change clinical practice behaviour.

This study aims to identify whether visual cues assist elderly hospital inpatients to understand imaginary falls scenarios and other questions about falls and falls prevention strategies.

A majority of patients with asthma has nasal inflammation but it is not always diagnosed and treated. Nasal inflammation cause sleep disturbances that can be improved by treatment with nasal steroid spray. It has not been studied before if treatment with nasal steroids can improve sleep in patients with asthma. We will investigate 30 patients with asthma to see if their "quality of sleep" and "quality of life" can be improved by treament with nasal steroid spray compared to placebo.

This study will compare the effectiveness of two different ways of treating leg ulcers that are infected or slow to heal. The treatments being compared are cadexomer iodine (Iodosorb® product range), and a silver impregnated dressing (Acticoat® product range). It is hypothesised that one of these treatments will lead to quicker healing and reduced cost compared to the other commonly used dressing.