ANZCTR search results

Patients admitted to ICU often suffer from muscle wasting and ICU acquired weakness associated with complications such as reduced mobilisation, respiratory weakness requiring prolonged ventilatory support, and prolonged ICU and hospital length of stay (LOS). There is renewed interest in provision of more protein, as this may increase muscle synthesis and thus improve functional recovery. While international recommendations encourage providing more protein, this is not yet supported by high quality evidence. Previous data from a randomised controlled trial conducted > 10 years ago, as well as survey data from our region, suggests that usual practice is to deliver much less than that recommended by international guidelines. Our group has planned a trial to answer the question whether greater protein doses can improve survival and patient recovery compared to current practice. However, to ensure the standard care arm constitutes true current practice, we need to first quantify how much protein patients in Australia and New Zealand actually receive. We plan to conduct an observational study evaluating current practice. One hundred and twenty patients will be included consecutively across 6 sites and protein delivery evaluated.

A safe and common surgical procedure; hip and knee arthroplasty (THA, TKA) is not immune to the occurrence of postoperative complications such as surgical site infection (SSI) or surgical wound dehiscence (SWD). While published rates of SSI following hip or knee arthroplasty are low, 1-2% in some cases, it is the resulting wound complication and its clinical management and the catastrophic impact to the patient’s wound healing and wellbeing and return to daily life that is of considerable concern. Complications such as surgical site infection and/or dehiscence following TKA and THA, often result in extended lengths of stay, readmission for further surgery, primary and community nursing visits, and are a costly burden to healthcare settings. To address the evidence gap for the early identification and prevention of postoperative wound complications in obese patients following hip or knee arthroplasty, a non randomized pragmatic trial is proposed which will utilize an advanced hydropolymer wound dressing coupled with smartphone technology for the early identification of complication and prevention. The advanced wound hydropolymer dressing is transparent and allows for complete visibility of the incision line. This allows the patient to send digital images of their incision line to the clinician who is able determine the healing progress of the participants surgical wound. The use of digital images of the wound sent to the clinician for assessment remotely and without removal of the dressing potentially removes the need for hospital readmission due the ability to diagnose a complication early and intervene. Furthermore, use of this patient engaged model empowers the patient in their wound healing. This study will determine the feasibility of such a model in the post discharge setting to assist in reducing the number of hospital readmission due to surgical wound breakdowns, often diagnosed and treated too late to prevent the escalation to a catastrophic wound breakdown.

Obesity and high blood sugars are common in patients who require hip or knee replacement and are associated with poor outcomes such as infection. The study seeks to clarify if 6 weeks of dietary change in the form of the CSIRO's Low Carb Diet book can improve weight and blood sugar management around the time of surgery. Blood sugar will be monitored by a small wearable device known as a continuous glucose monitor. The hypothesis of the study is that 6 weeks of dietary change will improve patients blood sugars around the time of joint replacement.

The purpose of this study is to test the safety and absorption of a new formulation of a drug called NOX66. Who is it for? You may be eligible for this study if you are aged 18 to 50, and in generally good health. Study details All participants will be administered two doses of the study drug with a week between doses. The study drug is administered as a suppository (inserted into the rectum). As part of the study, participants will provide blood, urine and stool samples; and wear a heart monitor on their chest. It is hoped this research will provide some baseline information about how this new formulation of NOX66 is metabolised by the body, and show the medication is safe in this form.

The purpose of this study is to identify the time point of peak serum potassium levels during the reperfusion phase of adult liver transplantation. We aim to assess the the changes in blood potassium levels from baseline values during reperfusion, and evaluate clinical factors that may be associated with the development of hyperkalaemia. Who is it for? The study will include adult patients undergoing liver resection surgery. This is a retrospective study to test the hypothesis that the addition of intrathecal morphine (ITM) results in reduced postoperative opioid use and enhanced postoperative analgesia in patients undergoing open liver resection using a standardized enhanced recovery after surgery (ERAS) protocol with multimodal analgesia. Study details The aim of this study is to quantify the cumulative oral morphine equivalent daily dose in milligrams (oMEDD) in the postoperative period and evaluate maximum pain scores at rest and on movement after surgery. In addition, we will highlight the importance of using intrathecal morphine in patients undergoing liver resection. It is hoped that this study will be hypothesis generating and provide valuable data for power calculations for future studies on evaluating the use of intrathecal morphine in patients undergoing liver resection surgery.

Implementation of practice-level quality improvement (QI) through primary care has excellent potential to improve patient outcomes, but knowledge is needed on how they are best implemented, scaled and what measurable outcomes they can achieve. QUEL will generate this specific evidence required to address these questions for patients living with CHD and through its structure and partnerships lead the way to translation of this evidence to health care. In the QUEL Study, we will test the implementation of a structured quality improvement program in primary care (where practices are supported to enhance efficiency and outcomes by better using their routinely collected data). Our overall aim is to boost the quality of CHD management delivered in primary care through the implementation of a practice-level quality improvement strategy and assess whether it reduces hospitalisations and health outcomes in a cost-effective way. The strategy is based on supporting primary practices to make better and more proactive use of their existing practice data. QUEL partners include government, primary health networks (PHNs), clinical groups and consumers and as a group they see this evidence generation as fundamental to informing service delivery.

There is no consensus as to which nasogastric fluid regime (continuous or intermittent-bolus fluids) should be prescribed for patients with bronchiolitis who cannot maintain oral hydration. We will perform a randomised controlled trial (RCT) in the future comparing intermittent bolus and continuous nasogastric fluids for patients with bronchiolitis that require nasogastric fluids, with the aim of determining which fluid regime leads to a quicker return to normal oral feeding. Prior to this, we will conduct a pilot RCT, in order to test and refine the study procedures prior to beginning the main trial and to identify the feasibility, power calculation and sample size for the main trial. This pilot study is the one currently being conducted, not the main RCT. The main RCT will occur in the future after the results of this current pilot study are analysed and reported.

Vaporised nicotine products (VNPs or electronic cigarettes) hold significant potential as both cessation aids and harm reduction support for people who smoke tobacco. It is important to determine the efficacy of novel strategies compared to current best practice treatment, Nicotine Replacement Therapy (NRT) and telephone Quitline. The aim of this world-first trial is to test the effectiveness of VNPs in conjunction with telephone Quitline at increasing smoking cessation amongst individuals receiving treatment at alcohol and other drug (AOD) residential withdrawal services compared to current best practice treatment (NRT and Quitline). Service users from six residential and inpatient withdrawal AOD services across three states (NSW, Victoria and Queensland) will be recruited and randomised. The intervention will be provided for 3-months post-discharge. Surveys will be conducted at 3 and 9-months post discharge and examine smoking cessation related variables.

This project, Talking about Aboriginal Gambling (TAG), will evaluate the effectiveness of a community-developed, co-designed online health promotion platform in reducing harm from gambling in NSW Aboriginal communities. The proposed evaluation methodology is a Randomised Control Trial (RCT) stepped-wedge design, as well as a mixed-methods process evaluation. This proposal presents a unique partnership between the NSW Aboriginal Safe Gambling Service, Australian National University (ANU) Centre for Gambling Research, Menzies School of Health Research (MSHR) and ThinkPlace. The design of the online health promotion platform was developed through a community co-design process with ThinkPlace, the NSW Aboriginal Safe Gambling Service and Aboriginal communities in NSW.

It is well established that with normal ageing come reductions in mobility, physical ability and associated functional performance. It has been identified that a mismatch between actual physical abilities and perceived physical ability are associated with increased falls risk and risk-taking behavior in older adults. This mismatch between physical and perceived abilities may be partly due to impairments in motor planning which commonly deteriorates with ageing. A simple way to measure the association between actual and perceived abilities is to compare the difference (error) in time or distance between actual and imagined (or perceived) performance. Motor imagery is the imagining of an action without its physical execution and can effectively improve motor skill and promote motor leaning as it activates areas of the brain that are normally activated during actual physical performance. Motor imagery has been shown to improve muscle strength and mobility, but it is not known whether motor imagery can influence the relationship between actual and perceived ability. The aim of this study is to identify whether four weeks of motor imagery training can improve physical abilities together with perception of motor abilities in older adults.