ANZCTR search results

The primary aim of this pragmatic study was to explore the role of an intensive care diary in the ICU, particularly with reference to the logistics of recruitment, potential acceptance of diaries amongst our patient population and it’s impact on anxiety, stress and depression. The secondary aims of the study were to ascertain if there was an association between provision of an ICU diary and PTSD symptoms which could then provide baseline profile for future hypothesis testing on its impact Ethical approval for this study was obtained from the Royal Adelaide Hospital Human Research Ethics Committee HREC reference number: HREC/15/RAH/48 RAH Protocol No: 150216

The current study aims to explore the benefits of a brief reminiscence task on mood for older adults living in residential aged care. The reminiscence task involves remembering past positive memories and recalling past experiences where the participant had to solve a problem. Previous research with community samples suggests that thinking about these meaningful experiences leads to improved mood and feelings about the future and oneself. Research has not yet investigated if positive outcomes occur for older adults living in residential aged care.

Sulforaphane is a naturally occurring compound belonging to the isothiocyanate group. It can be obtained naturally through cruciferous vegetables with broccoli sprouts being one of the richest sources. Sulforaphane obtained through ingested broccoli sprouts are activated by myrosinase, a chemical that is released by chewing of the vegetable. Myrosinase is also present in the gut flora of individuals and mediates the conversion of pre­cursor compound to bioavailable Sulforaphane. Previous studies in humans has demonstrated the anti­oxidative, anti­inflammatory effects of Sulforaphane and its ability to protect against endothelial dysfunction and end organ damage. Therefore, we believe Sulforaphane may have a potential clinical utilitity in maternity care as a ‘low risk’ intervention for the treatment of pre-­eclampsia. The aim of the research project is to evaluate the pharmacokinetics (PK) of sulforaphane obtained through the ingestion of two different natural broccoli sprout supplements in a healthy cohort of subjects n=6. Participation involves the ingestion of each of the two different supplements with associated PK blood sampling at 8 pre-determined time points, one just prior to ingestion and then following at: 15, 30, 60, 90, 120, 240 and 480 minutes intervals. The study is an open-label, crossover design, with a two week ‘wash out’ period, between taking the first supplement and the second (different) supplement.

The use of diuretics in critically ill patients is widespread. Indications include the management of volume overload, maintenance of acid-base balance and potassium homeostasis. Commonly used diuretics include frusemide and acetazolamide. Despite the common use of these drugs there is no high quality evidence available comparing the effect of these drugs on the haemodynamic status and metabolic status of critically ill patients. We aim to evaluate the comparative effect of a standard dose of intravenous frusemide vs a standard dose of acetazolamide in critically ill patients. We plan to enrol a total of twenty-four patients in whom a decision has been made to administer a diuretic. These twenty-four patients will then be randomly assigned to receive a single dose of either frusemide of acetazolamide. To understand the effect of the diuretic administration, we will retrieve routinely recorded patient demographic data, haemodynamic data (such as blood pressure, heart rate, central venous pressure and cardiac output), data from the arterial blood gas samples (serum creatinine, sodium and potassium) as well as urine from the patient’s existing indwelling urinary catheter. The results of this study will provide insight into the effects of these two diuretics on electrolyte imbalances and the haemodynamic status of critically ill patients.

Low rates of psychosocial service use (e.g., helplines or support programs) are well documented, especially for rural men affected by cancer. Developing targeted information specifically for this group has previously been suggested as a way to provide information on psychosocial services, and address the barriers to using services. However, theory-based informational resources for rural men affected by cancer have not previously been objectively developed or tested. This trial aimed to develop targeted rural- and targeted rural male-psychosocial service information brochures. Specifically, the trial examined the effectiveness of such information in increasing how personally relevant the information is seen as, and attitudes to seeking help and intention to use services after reading one version of the brochure. Targeted versions of an existing Cancer Council SA brochure were developed based on psychological theory. Participants viewed one copy of the brochure in a randomised fashion (either the existing version, or the targeted rural- or rural male-version). Participants completed questionnaires before, immediately after, and approximately 24 hours after viewing a brochure. N = 114 rural men affected by cancer were recruited via supportive accommodation facilities, Ninety participants returned all questionnaires and were included in the final analyses. Results showed that attitudinal or behavioural measures between the three brochure groups were not significantly different. Participants reported that they primarily sourced service information from other people (friends, family, medical professionals, others). Notably, existing service use was high in the sample or participants, reflecting the recruitment methods, and therefore increasing awareness of services may have been particularly challenging. There was no evidence that targeting rurality or gender improved attitudes to service use in this trial. Further qualitative research to build understanding about the acceptability of various targeting techniques in this population would be useful, as would replicating this study in a sample not recruited via a Cancer Council SA service.

Falls among older adults cause serious challenges for the individual and health care systems, including bone fractures. Our recent systematic review and meta-analysis has shown that reactive step training (repeated exposure to balance perturbations) can reduce falls by approximately 50% (Okubo et al., 2016). However, the methods to generate perturbations (e.g. slips) in previous studies have been considerably heterogeneous and have limitations to training reactive balance control. We have developed a novel overground perturbation system which can generate both slips and trips in random locations. Since this system can provide unpredictable slips and trips, it is theoretically possible to train specifically reactive balance control (as opposed to proactive balance control or prediction). This randomized controlled trial will examine the effectiveness of the reactive step training using this perturbation system in older adults.

This project aims to improve the quality of care for older people with dementia when admitted to hospital by targeting delirium - a common condition in this population associated with serious adverse consequences. Experienced nurses at the Princess Alexandra Hospital will be provided with comprehensive education regarding the identification, prevention and management of delirium. They will subsequently pass this education onto other nurses on their wards. Expected project outcomes include improvements in nursing practices for patients with cognitive impairment (dementia and delirium).

Patients having sleep/CPAP/ventilation (SCV) studies for chronic respiratory failure often require arterial blood to be taken for measurement of blood oxygen, pH and carbon dioxide measurement - so called arterial blood gases (ABGs). These measurements are used to assist in 1. identifying inadequate breathing 2. determining need for assisted ventilation in patients with known or possible ventilatory disorders (eg chronic respiratory or neuromuscular disease or reduced ventilatory capacity associated with obesity ( “obesity hypoventilation syndrome”) . 3. providing information to assist in modification of ventilator settings in such patients. An arterial blood sample is somewhat more difficult to obtain and generally believed to be more painful than a venous sample (venous blood gases (VBGs)), but there is currently no evidence that VBGs can adequately replace the role of ABGs in this setting. The project will involve taking a venous blood sample for VBGs at the same time as the standard arterial blood sample (for ABGs) from patients already having SCV studies already including ABGs. The results from the arterial and venous samples will be compared. The study will involve an additional paired blood test for each ABG (estimated two per patient), during the same visit and should take minimal extra time (estimated 10 minutes total). At the end of the study we will compare the ABG and VBG measurements to see if we can use venous gases as a reliable alternative to ABGs in future. The data may also be used to see if we can use an equation to better approximate the arterial values from VBGs and if there is a consistent relationship between VBGs and transcutaneous measurements (across skin) of carbon dioxide, which are already being measured.

The emergence of bacteria or germs that have become resistant to most antibiotic treatments is an urgent public health problem. Often called “superbugs”, these germs have the ability to resist treatment with almost all antibiotics and can infect hospitalized as well as healthy people in the community. Superbugs transform previously easily treated minor infections into life-threatening conditions with very few treatment options. So far efforts to reduce superbug spread in our hospitals have failed to halt the global spread of these organisms. Nor are there new antibiotics in production to deal with this problem. New innovative approaches are needed to deal with this emerging threat. The faecal microbiota transplant, also called FMT, is a procedure where stool is collected from healthy donors and delivered to the gut of the recipient. This is done with the goal of the healthy bacteria from the donor replacing the harmful bacteria in the recipient. The FMT procedure is already proven safe and effective in treating patients with another type of bacterial gut infection called Clostridium difficile. FMT has also been shown in animal studies and human cases to eliminate gut carriage of certain superbugs called multi-resistant gram negative bacteria. The elimination of gut carriage would both prevent superbug infections developing in the individual and also prevent the spread of these organisms to other persons. In order to address this growing problem we have designed a study to test the effectiveness of FMT in people who have suffered from recurrent infections with a type of superbug. The goals of this study are to determine if FMT can result in clearance of superbug bacteria from the stool and to observe the effect of FMT on rates of recurrent infections in study participants. In collaboration with South Australian experts in this field the stool will be analysed to determine how FMT affects the range of germs in the gut and their ability to become resistant to antibiotics. If successful this study will represent a major scientific advance in our ability to prevent superbug infection and spread. It will open up new treatment possibilities for patients who suffer from superbug infections and benefit the community at large by giving us a new tool to stop the spread of superbugs to others.

The aim of this study is to investigate the impact of discharge education and the use of patient resources in patients that have had a heart attack or unstable angina when they return home. We will explore if patients actually follow the recommended activity guidelines and use of healthcare services such as cardiac rehabilitation, pharmacy, general practice, pathology and emergency department in the first 30 up to 90 days after discharge from hospital. Patients who live in areas with high and low levels of access to cardiac services will be compared with each other. Outcomes will be assessed with the use of Global Positioning Systems (GPS) and Geographic Information Systems (GIS). Participants who agree to participate will be educated on the use of a phone which they will be asked to carry for at least 30 days. Participants will receive weekly phone calls for the duration of the study during which the nurse will ask a series of questions about their experiences with the phone and will ask about the health service locations that have been visited.