ANZCTR search results

This study is examining brain tumour blood flow and drug uptake in patients with brain tumours originating from breast cancer. Who is it for? You may be eligible for this study if you are aged 18 or over and have a history of breast cancer, with radiologically diagnosed metastatic brain disease. Study details All participants will have an intravenous infusion containing a chemical tracer used in a PET scan. On the day of administration, plus an additional one or two occasions in the following week, participants will have a PET-MR scan. The study aims to use imaging to examine the uptake of the chemical tracer in brain metastases originating from breast cancer. It will provide new information about how treatment could be affected by unique blood flow patterns in the brain.

Advanced liver disease, or cirrhosis, is associated with increased morbidity and mortality and patients suffer frequent complications. Sarcopenia, defined as the the loss of muscle mass as well as muscle function, is among the commonest complications, with an estimated prevalence of up to 70%. Sarcopenia is independently associated with reduced survival, increased infection risk and higher rates of hospitalisation in this cohort. Despite this, little is known about how to increase muscle mass in this population. Branched chain amino acids (BCAAs) include three essential amino acids which are used as building blocks for protein and energy in muscle. In addition to being the primary energy source for skeletal muscle, they are also used to help clear toxins that build up in liver disease. Patients with cirrhosis have reduced levels of BCAAs, which is thought to be a major contributing factor that contributes to low muscle mass in these patients. Treating patients with oral BCAA supplements, in the form of a soluble powder, may improve quality of life and overall nutrition in patients with cirrhosis. However, the impact on muscle mass is unknown. Our study aims to investigate the effect of oral BCAA powdered supplements on sarcopenia in patients with cirrhosis. Our randomised trial will compare BCAAs to a control protein supplement to assess whether replacing dietary protein deficit as a whole or BCAAs specifically can influence outcomes. Our primary outcome will be an increase in muscle mass and strength in treated subjects. If we can improve sarcopenia, we anticipate we may also improve other outcomes. Therefore, our secondary outcomes of this study will be improved muscle function, hepatic encephalopathy, insulin resistance, rates of hospitalisation, health care costs, quality of life and overall mortality. Given the higher rates of infections seen in patients with sarcopenia, the second focus of our study will be on immune function through monitoring blood samples and infectious complications.

The aim of this research is to evaluate whether it is feasible to add a manual therapy technique, called Muscle Energy Technique, to a Pulmonary Rehabilitation program for people with COPD. Muscle Energy Technique is a gentle manual technique used by osteopaths, physiotherapists and massage therapists to improve joint motion and stretch the muscles. Muscle Energy Technique is commonly used in clinical practice in Australia and around the world. Recent studies have shown positive effects when Muscle Energy Technique are used with Pulmonary Rehabilitation. These benefits include improved ability to exercise. This research is important to help us understand what effects Muscle Energy Technique may have in people with COPD. Participants will be enrolled for a total of 12 weeks. Participation in the research will involve participants attending a Pulmonary Rehabilitation program twice per week for 8 weeks. In weeks 1, 2 and 3 and 5, 6 and 7 they will also receive a Muscle Energy Technique treatment before the Pulmonary Rehabilitation session once per week. These will be conducted in the physiotherapy department at Austin Health. In week 12 participants will receive a follow up phone call from the researcher. The follow up phone call in week 12 should take no longer than 10 minutes.

Older adults are increasingly having operations on their heart, which improves heart function however often leads to problems with learning and memory (cognitive impairment). These adults are already at high risk of dementia due to poor heart health, therefore this cognitive impairment after surgery puts them at even greater risk of late-life dementia. This project aims to decrease future dementia risk following heart surgery, in 120 patients 65 years and older, using cognitive training interventions. Learning and memory will be measured at the beginning of the study, so any changes can be assessed following surgery. The cognitive interventions will take place both before and after surgery in half of the patients. Cognitive impairment (such as delirium) will be monitored in hospital and learning and memory will be tested 4 and 6 and 12 months, and 1 and 3 years post-surgery. It is expected that patients who undertake cognitive training will demonstrate better learning and memory after surgery compared to patients who did not.

Acute chest pain is one of the commonest causes of presentation to Emergency Departments (EDs) locally (~7.5% of all attendances to Royal Perth Hospital ED in 2015), nationally and worldwide. The majority (>75%) of these individuals are at low risk of serious complications, with only a small proportion ultimately diagnosed with an acute coronary syndrome (ACS) or other major pathology. The consequences of misdiagnosis are, however, potentially catastrophic. Thus, considerable time and resources are expended to ensure the accurate triage of such patients. Recent data from Shah et al suggests that patients with very low levels of high sensitivity troponin (hs-cTn; a very sensitive and specific blood marker of cardiac injury) on arrival to ED (the majority of all those with presenting with chest pain) are at extremely low risk and could be safely and quickly discharged. They found that of all patients presenting with suspected acute coronary syndromes, 61% had a high sensitivity troponin I of <5 ng/L which had a negative predictive value of 99.6% (95% CI 99.3-99.8) for index myocardial infarction and subsequent myocardial infarction or cardiac death at 30 days. If their serum troponin measurement was taken more than 2 hours after the onset of symptoms then this increased the negative predictive value to 99.8% (95% CI 99.6-100%). Based on this research and current best practice, our group has developed a rapid assessment “single troponin” chest pain pathway that will be introduced at Royal Perth Hospital in early 2018. Using a pre/post cohort study design we will observe the efficacy and safety of this innovative pathway, which offers the most accelerated triage of patients with chest pain currently available, and compare it with the current National Heart Foundation of Australia / Cardiac Society of Australia and New Zealand Guidelines based “Suspected ACS Pathway” which represents current best practice. We hypothesise that using a combination of hs-cTnI levels, careful clinical assessment, objective risk scores and structured, evidence-based, early follow up and investigation will greatly reduce the length of stay for low risk patients without any increase in adverse outcomes. If this proves correct this novel pathway will result in considerable efficiencies and cost savings that can be easily replicated in other hospitals.

We previously recruited 506 adults (mean age 38.8 ± 11.8 years; 18% male) who completed a nutrition questionnaire. Included were individuals with different classes of obesity and past weight loss surgery (11%, n=55). The relationship between demographic characteristics, nutrition knowledge, and diet quality were explored. Those with obesity (BMI >30 kg.m-2) had lower levels of nutrition knowledge and those with a BMI >40 kg.m-2 had the lowest diet quality of the BMI groups studied. The lowest diet quality was reported for individuals with past weight loss surgery. Our findings provide evidence that individuals who have undergone weight loss surgery should be targeted for nutrition interventions aimed at assisting in the adoption of higher quality diets. This study aims to evaluate cooking skills and diet quality of individuals who previously had a Sleeve Gastrectomy (at least 12 months ago) using a cross-sectional questionnaire. In addition, to conducting an on-line intervention that encourages cooking from fresh and basic ingredients delivered via a Closed Facebook group. The intervention will consist of healthy cooking tips and recipes specially developed for individuals 12 months post Sleeve Gastrectomy, delivered over 10 weeks.

Background: Patients with type 2 diabetes mellitus area at a higher risk of developing heart failure and a significant number of patients with established heart failure are receiving treatment for type 2 diabetes mellitus. The EMPA-REG OUTCOME study concluded that the inclusion of empagliflozin in the treatment received by patients with a high risk for cardiovascular events reduced the rate of primary adverse cardiovascular outcomes and mortality. Aim: The aim of this study is to test the hypothesis that treatment with sodium-glucose co-transporter 2(SGLT-2) inhibitors will decrease the risk, progression and severity of heart failure and also if there is any benefit in the quality of life in these patients following the addition of a SGLT-2 inhibitor as part of standard medical care. Methods: Participants will be recruited from the diabetes clinics at Box Hill and Maroondah Hospitals. These patients will have been identified by their treating physicians as suitable for SGLT-2 inhibitors. The SGLT-2 inhibitors (dapaglifozin or ertuglifozin) will be started in the course of normal clinical practice and according to existing clinical guidelines. The SGLT-2 inhibitor will be added to additional therapy or substituted for additional therapy at the discretion of the treating physician. Baseline blood tests and a Living with Heart failure questionnaire will be completed by the patients. Treatment will be monitored and further changes to therapy, the addition of other agents or the discontinuation of other agents, including SGLT-2 inhibitors, will also be at the discretion of the treating physician. Audit information will be collected prospectively but no information will be collected that is not a normal part of clinical practice in patients with heart failure. Recruitment of the participants will be by the registrars/consultants from the diabetes clinics after a thorough discussion about the safety of SGLT2 inhibitors and with full consent by the patient.

This study is assessing the effects of a comprehensive geriatric assessment on health-related quality of life Who is it for? You may be eligible for this study if you are aged over 65 and have a new diagnosis of non-small cell lung cancer (NSCLC) Study details Participants will be randomised (by chance) into two groups. One group will receive the standard oncology care, including blood tests and questionnaire. The other group will recieve standard care as well as a Comprehensive Geriatric Assesment (CGA). CGA refers to the multi-disciplinary assessment of an older patients’ physical function, cognition, mood, other health problems, medication use and social situation, followed by the implementation of an individualised management plan aimed at improving any identified impairments or vulnerabilities. The assessments used and interventions prescribed are all frequently used in common medical, geriatric, practice and as such, are not expected to pose any significant risks or safety concerns. It is hoped this study will demonstrate the utility of the CGA model which may contribute to its implementation in standard practice.

Craniotomy is one of the common surgeries performed in the modern day and age with brain tumour being the seventh commonest diagnosed cancer in the world. There are multiple other surgical conditions being amenable to craniotomy: Resection of brain tumours and arteriovenous malformations, clipping of brain aneurysms and microvascular decompression for trigeminal neuralgia just to mention a few. Post-craniotomy pain is often under-treated and under-estimated. Both acute and chronic post craniotomy headaches have been found to be common and significant clinical phenomena. In cross-sectional studies of the immediate post-operative pain levels, post craniotomy pain incidence is at 60 percent, more common than generally assumed. Post-operative pain is a common factor in delayed mobilization, lengthened hospital stay, development of anxiety and depression as well as development of chronic pain. Opioids are still the mainstay of post-operative craniotomy pain management. However effective opioid analgesia administration for the purposes of pain relief can precipitate decreased respiration and hypercarbia. We plan to recruit a total of 136 patients in this parallel arm double- blind trial in order to test our hypothesis that patients receiving subcutaneous sumatriptan will have improved analgesia control and recovery scores post-operatively. We will follow up the patients at 30 days to assess these outcomes at the thirty day mark.

The research proposed will study the use of Point of Care Ultrasound (PoCUS) to differentiate the diagnosis of skin and soft tissue infections (SSTI). SSTI are a common emergency department (ED) presentation with a differential diagnosis of cellulitis or abscess and therefore differing treatment strategies. The use of ultrasound as a diagnostic tool to determine the subsequent treatment has emerged as an adjunct to emergency physician practice. Nurse Practitioners (NP) as an integral part of the Nepean ED team are expanding their Scope of Practice (SOP) to include the use of PoCUS. This research will look at the NP’s use of PoCUS in the ED to improve time to a diagnosis and the definitive management plan of patients with SSTI. The study will be undertaken using a pre and post intervention design with the intervention being Nurse Practitioners accreditation in the use of PoCUS.