ANZCTR search results

The Birth Course: Evidence based childbirth education program to reduce rates of caesarean section in first time mothers. Maternal and child health are priority public health areas listed by the World Health Organisation (WHO). Successive reviews of maternity services for more than four decades, both in Australia and internationally, have called for a decrease in medical interventions, particularly caesarean section (CS), due to it associated morbidity and mortality. It is well established in the literature that medical interventions in labour significantly increase the risk of caesarean section (CS). In 2014, only 56% of women experienced a normal vaginal birth, with more than half receiving an epidural, and more than a third giving birth by caesarean section. However, there is a major practice gap in how to address the rising rates of intervention in childbirth, and strategies to provide effective and cost-effective methods to support women and reduce medical interventions are required. The Birth Course is a complementary medicine (CM) package of antenatal care combining education about normal physiology and pain dynamics in labour, with five different evidence-based CM techniques for the management of pain in normal labour and birth. The Birth Course education program is an intervention which introduces the concepts of: Physiology and hormones of birth, the Fear-Pain-Tension cycle, working with pain, the relaxation response, and uses the five techniques of: upright positions/yoga and movement for birth, acupressure techniques, guided visualisation, breathing techniques and massage. We hypothesise that this study will provide an effective antenatal education program to reduce rates of medical intervention in labour and birth, and provide women with non-pharmacological pain management options.

This multicentre pilot pragmatic open label randomized controlled Trial (RCT) compares early metabolic resuscitation treatment with Hydrocortisone, Vitamin C, and Thiamine in comparison to standard care defined as no treatment with Hydrocortisone, Vitamin C, and Thiamine. We hypothesize that in children presenting with sepsis and septic shock early intravenous administration of Vitamin C (30mg/kg iv q6h), Thiamine (4mg/kg q12h) and Hydrocortisone (1mg/kg q6h) delivered early during resuscitation is feasible. We hypothesize that these interventions will lead to a more rapid resolution of shock, reduced duration of organ dysfunction, leading to reduced intensive care resource utilisation. The study can provide the urgently needed evidence on currently used sepsis resuscitation bundles.

In view of the potential harm related to high volume fluid administration in septic shock, fluid-sparing algorithms using early intravenous inotropes to treat shock have been proposed as an alternative strategy. This multicentre pilot pragmatic open label randomized controlled Trial (RCT) compares early inotropes started after 20ml/kg fluid resuscitation with standard care defined as providing up to 40-60ml/kg fluid resuscitation prior to initiation of inotropes as per the American College of Critical Care Medicine recommendations. We hypothesize that in children presenting with sepsis and septic shock, a fluid-sparing algorithm using early inotropes delivered early during resuscitation is feasible and will lead to a more rapid resolution of shock and reduced duration of organ dysfunction.

A fatigue management guideline and new mental fatigue tools for use in therapy were developed to allow clients to regain control over their energy choices. These tools aim to promote relaxation and rests but also address other strategies for mental fatigue, such as reducing multitasking, distractions, and decision making. This project aims to evaluate the effectiveness of these new clinical tools at reducing post stroke mental fatigue, and to review their usefulness for participants and rehabilitation staff. We hypothesise that: i. Patients who engage in active treatment will show significant reduction in mental fatigue compared with standard care. ii. Patients who engage in active treatment will have significantly greater self-efficacy for daily living, and quality of life outcomes compared with patients receiving standard care. iii. Patients who engage in active treatment (including education and use of the matrix and routine tools) will perceive it to be beneficial. iiii. Therapists who use the fatigue management guideline will perceive it to be useful in enhancing their management of mental fatigue in clinical practice.

The current research aims to replicate findings of improved attention following training in meditation or action video games among healthy adults with limited prior video game or meditation experience. A further aim is to examine how this affects neural mechanisms that are important for attention, as indexed by attention related ERP components and spectral measures of EEG activity. Improvements are expected where the experimental measures are related to the executive control of attention.

Elevated progesterone on the day of hCG administration has been associated with significantly lower pregnancy rates when a fresh embryo transfer occurs. Although evidence is available to support this notion, numerous contradictory studies also exist . Presently, many clinics practice minimal stimulation and/or “minimal intervention” cycles, where patients are managed externally, and therefore patient’s progesterone levels at the time of hCG are not monitored. In 2014 Nayak et al demonstrated that elevated progesterone on the day of oocyte retrieval is associated with significantly lower implantaton and ongoing pregnancy rates. Implantation and pregnancy rates were significantly higher when the progesterone level was less than 12 ng/mL on the day of oocyte retrieval. Furthermore, miscarriage rates were higher when the P level was greater than or equal to 12 ng/mL, although this did not reach statistical significance. Premature progesterone elevation is believed to negatively impact endometrial receptivity however, premature progesterone rise has also been shown to have no effect on oocyte/embryo quality. Peripheral progesterone in the late follicular phase is likely to influence endometrial maturation. Endometrial samples exposed to low and high concentrations progesterone on the day of HCG administration had significantly different gene expression. These observations could explain the impairment of endometrial receptivity in the presence of elevated progesterone. Some reports discuss measures to prevent a premature progesterone rise, however once the progesterone rise has occurred then the optimal solution is to vitrify all embryos and transfer in a natural cycle. This method is supported by the fact that embryos obtained from cycles with an elevated progesterone and transferred into endometrium unaffected by elevated progesterone do not result in impaired pregnancy rates in either frozen-thawed or donor/recipients. Therefore, by evaluating progesterone levels at a time more proximal to embryo transfer, when patients must be in attendance with fertility staff, premature progesterone elevation could be identified so patient treatment could be modified to improve the chances of a successful pregnancy. Primary Objective: To determine the impact of serum progesterone concentration on the day of OPU on the probability of ongoing pregnancy in women undergoing IVF/ICSI. Secondary Objectives: To determine a progesterone cut-off value at oocyte retrieval that has the best capacity to discriminate between cycles that do and those that do not result in an ongoing pregnancy.

Addressing memory problems after stroke is a research priority due to significant unmet needs reported by survivors of stroke. Memory rehabilitation, including group programs based on teaching people strategies to compensate for their memory problems (such as using diaries or calendars), has been shown to produce significant short-term improvements in memory after a stroke. However, difficulties establishing new strategies into everyday routines can mean that effects are inconsistently maintained over time. In this project, we seek to evaluate the following two eHealth maintenance intervention programs that are designed to sustain the improvements in everyday memory made following six weeks of group-based memory skills training: 1) Booster sessions delivered via telehealth (videoconferencing), and 2) SMS or email reminders prompting use of memory strategies taught. As well as evaluating whether these eHealth interventions are effective in maintaining the use of strategies that enhance memory function, we are seeking to assess whether these interventions are appropriate, practical, and potentially cost-effective. In order to evaluate whether these intervention strategies are effective in helping people maintain their benefits, we will compare the results that we find from the two treatment options against results from having no maintenance support (which is the current practice). Identifying effective strategies for maintaining the benefits of memory rehabilitation could help reduce the long-term impact of these problems after a stroke. These benefits could include increased independence and employment opportunities, as well as better quality of life for those recovering from a stroke and their families.

We aim to investigate whether two different kinds of values clarification tasks are able to improve measures of wellbeing in healthy adults. The idea for this project came from research showing that interventions which ask people to identify/connect with and work toward their values tend to result in people feeling immediately happier, have improved longer-term physical health (e.g., several months down the track), and being more engaged in the activities that are important to them. In particular, we sought to weigh the relative benefits of (1) a straight-forward values identification task in which participants are asked to map specific achievable activities onto chosen their values, with (2) a creative writing task requiring people to write about their future when imagining that everything has turned out as well as they could have wished (called the best possible selves [BPS] procedure). To ensure we can draw sound conclusions from our research, we will also be comparing these two interventions with a no-intervention control condition, where people will be asked simply to write about the ordinary details of a day in the past week. It is hypothesised that both values clarification exercises will result in greater wellbeing scores than the control condition, where wellbeing will be assessed via a number of self-report questionnaires which participants will be asked to complete prior to and following the experiment. Furthermore, although values work is at present part of many larger therapy packages that have been shown to be effective in improving peoples’ mood and reducing low mood, different values clarification procedures have not yet been compared with one another. As such, to the extent that one intervention is more effective than the other, this will provide novel information on the relative benefit of different values clarification procedures in terms of boosting wellbeing.

While schools are increasingly expected to support the mental health of students, classroom teachers have reported feeling that they lack the skills and confidence in knowing how to best recognise and respond to students’ mental health issues. The role of Year Advisor has additional requirements to support students’ mental health, namely by existing as the main point of contact for parents, students, other school staff, and health professionals when managing student mental illness. Our research team also conducted a systematic review which found that few teacher training programs in adolescent mental had been formally evaluated for effectiveness. In addition, there was no evidence that existing training programs increased the rate of teachers’ helping behaviour towards students. Based on these findings, our research team was awarded the funds to develop an evidence-based mental health training program specifically for secondary school Year Advisors. An advisory group of Year Advisors was established to help develop the program including content selection and delivery mode. A review of the features of existing programs indicated that teacher training programs tend to use a didactic workshop style of delivery. While this format achieved short-term improvements in teachers’ knowledge and attitudes towards student mental health, it is unclear whether these improvements were long-term. Research in professional development and adult learning suggest that training programs which feature elements of online, collaborative, and skill-based learning are preferred by users and can lead to behaviour change. Collaboration with the Year Advisor advisory group indicated that ideally, training programs should focus on practical skills and collaborative learning with peers. Taken together, this indicated a need for an evidence-based, innovative skills-based training program aimed at improving Year Advisors’ knowledge, attitudes, confidence, and helping behaviours in responding to students’ mental health needs. We are now ready to test the training program for acceptability, feasibility, and preliminary effectiveness.

Aging slows down our mental abilities. However, some older adults may experience greater decline in their mental abilities than their peers. The study investigates how much age affects older people’s ability to pay attention and remember things. Attention is a core mental ability needed for other mental work and daily functioning. Most studies to date have shown problems with memory in older adults. Few studies have looked at whether a decline in attention affects other mental abilities in older adults. Attention training is not a common therapy for older adults with difficulties in attention and memory. There is also limited information on the effect of such training on older adults. Understanding the usefulness of attention training in older people may help in deciding whether it should be used as a regular form of therapy. 67 older adults aged between 60 and 80 years took part in this study. 63 of the 67 participants were healthy older adults residing in the community and the rest 4 had a diagnosis of Mild Cognitive Impairment (MCI) given by the Memory Clinic, Toowoomba Hospital and/or referred by geriatricians in their private practice. The healthy older adults group were further assigned to two groups. 34 participants received the Attention Training program and 29 participants received the Relaxation training program. Each group of participants received the weekly group training in smaller groups of maximum 8 participants at a time. Interested control group participants were offered the Attention Training program (same training for 10 weeks - 2 hours weekly) after they received their Relaxation Training and have had a minimum wash out period of 2 weeks in between the 2 trainings. The 4 participants with MCI received only the Attention Training program (10 sessions for 2 hours weekly). Pre-post evaluation of data will be completed.