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‘Agents of Change’ is a new collaborative research project funded by the NHMRC Boosting Dementia Research Grants and NHMRC Cognitive Decline Partnership Centre. The project aims to improve the implementation of three key recommendations from the Clinical Practice Guidelines for Dementia in Australia: 1. ‘People living in the community should be offered occupational therapy (reflecting evidence based programs)’ 2. ‘People with dementia should be strongly encouraged to exercise’ 3. ‘Carers and family should have access to programs to support and optimise their ability to provide care for the person with dementia’ This will be achieved by establishing a national quality collaborative in which health professionals across Australia are trained and supported to develop and enact an implementation plan addressing one of the recommendations. Health professionals (e.g. general practitioners, nurses, social workers, occupational therapists, physiotherapists, psychologists) who regularly provide services to people with dementia, and who have some influence in their workplace to affect change will act as implementation clinicians. Implementation clinicians will be trained and supported to develop and then enact an implementation plan tailored to their recommendation of interest. They will participate in an online training course about quality improvement and translating research evidence into practice. In addition to the online training and tools, Implementation clinicians will be supported by a team of clinical, consumer and quality improvement experts to develop their unique implementation plan. They will have regular opportunities to have online communication with their collaborative. The primary outcome of this project is to measure the number of people living with dementia receiving the recommended level of care (consistent with the implementation plan). The feasibility of establishing national quality collaborative will also be explored. Interest and participation in the program will be assessed and feedback about the success of plans and barriers to implementation from clinicians and the people with dementia they are supporting will be gathered.

This study will evaluate the effectiveness of targeted screening of people at high-risk of melanoma using 3D full body imaging and genomic risk assessment. Who is it for? You may be eligible to join this study if you have been diagnosed with melanoma before the age of 40 years old. Study details Participants in this study are randomly allocated (by chance) to one of two groups. Participants in one group will receive standard care at the participants’ discretion which may involve regular skin checks from their own doctor. Participants in the other group will attend a screening program involving 6-monthly 3D full body imaging for 24 months and a once-off genetic testing for high-risk melanoma genes. We hypothesise our surveillance program using 3D whole body photography and genomic testing will be cost-effective, and will result in fewer excisions of benign lesions and earlier/smaller excision of malignant lesions than the control standard care group

Due to high susceptibility to infections, antibiotics are the most widely used drugs for newborns. Recent evidence suggests that antibiotics exposure in newborn period (first 4 weeks of life) predisposes to an imbalance in the gut, which may have long lasting consequences. Imbalances in the infants’ gut bacteria (microbiome) caused by antibiotics has been shown to alter the development of the neonate’s immune response. This altered immune development caused by a poorly balanced microbiome during this crucial phase of early life has been associated with the development of atopy, asthma, eczema, allergy, type 1 diabetes and inflammatory bowel disease. Mucosal immunity development in the gut has been shown to be aberrant as early as one month of age in children who go on to develop allergy symptoms in future. RESTORE is a clinical trial of a multi-strain probiotic for antibiotics exposed term newborn infants with aims to restore biodiversity and reduce dysbiosis (imbalance of bacteria) in the newborn gut in early months after birth. This is the first study of its kind to examine effects of probiotics on these high-risk infants’ gut biodiversity and mucosal immune development. Research Questions 1. Can the gut microbial diversity of infants exposed to postnatal antibiotics be restored earlier (within neonatal period after birth) by daily use of multi-strain probiotic supplementation? 2. Is this effect sustained at 3 months and 12 months? 3. Can probiotics in antibiotic exposed infants improve the production of salivary and secretory IgA to that seen in infants without antibiotics exposure? Methodology This randomised control trial will be conducted at Fiona Stanley Hospital. A total of 120 term neonates will be recruited, 80 of whom would have received antibiotics at birth for clinical reasons. Forty of the antibiotic exposed neonates will receive daily probiotics for 3 months and forty infants will receive a placebo. Forty infants without antibiotic exposure will serve as a reference group. Stool, saliva and blood will collected for microbiome and/or immunological tests at five time-points in the first 12 months of life. Predicted Benefits and Relevance: Neonatal infections, antibiotic use and allergy in later life are highly relevant health issues for infants, with gut microbiome as the potential denominator. In Australia, the economic cost of allergic diseases is estimated to be >$30 billion annually. Probiotics have been extensively used to restore microbiome balance in adults and hold potential to be useful for newborns for this indication. Although some promising data exists from animal studies, No human studies have yet determined whether probiotics are effective in rapidly restoring the balance of bacteria in term neonates’ gut following exposure to antibiotics. We are proposing a randomised control trial to determine if multi-strain probiotics can rapidly normalize the infants’ microbiome following neonatal antibiotic exposure during the crucial time of immune development and improve mucosal immunity. This study will provide insights for conducting larger multicentre trial to confirm clinical benefits; which will potentially change the practice to routinely supplement these high-risk babies with probiotics in the newborn period.

The aim of the project is to evaluate the risk of antibodies to blood donor proteins developing after blood transfusions from blood donors selected to be compatible with the recipient. Participants will be patients who are planned to undergo a kidney transplant with a live donor. Testing for antibodies to donor proteins will be done before and 6-8 weeks after the transfusion to look for the development of new antibodies. This will help researchers to find a way to give patients blood transfusions without the risk of them developing antibodies that could put later transplants at risk.

The Harmony in the Bush dementia study will implement innovative strategies of an individualised care model developed based on the principles of a well-established Progressively Lowered Stress Threshold (PLST) framework for non-pharmacological care of dementia. The PLST model recognises that behavioural and psychological symptoms of dementia, such as agitation, are experienced by people with dementia and increased stress is triggered by internal and external environmental factors. These factors will be identified during the assessment phase of this research intervention, and the investigators will work with the residential aged care staff to help them modify the daily routine and implement more flexible, personalised activities of daily living including sleep. Actigraphy watches will be fitted on the wrists of participating residents living with dementia to record the sleep patterns. Collectively, these information will be used in co-designing personalised care plans based on the PLST model seven principles .This research will also expand the PLST-based personalised care model intervention, by incorporating individualised preferred music/arts and movement programs to co-design a PLST plus music/arts and movement personalised care intervention. The investigators hypothesise that these co-designed PLST-based (without and with integrated individualised preferred music/arts activities) personalised care interventions will result in a low stress organisational environment and a positive workplace culture; thus leading to improved residents with dementia outcomes such as reduced agitation level, better quality sleep and overall wellbeing, reduced caregivers stress level, and a positive change in the workplace culture.

This study will evaluate the effectiveness of using activity monitors to assess pain and physical activity in patients with advanced cancer. Who is it for? To be eligible for the study participants are to be over the age of 18 years, diagnosed with advanced cancer, are experiencing pain, and are patients at Mater Misericordaie Ltd or St Vincent's Private Hospital, Brisbane. Study Details: Participants will receive an tri- accelerometer which will be similar in size/design to a watch. Participants are to wear the monitor for the duration of the study for a total of 6 days. It will record a number of activities during this time like sleep, steps taken, body position etc. Participants will be required to keep a diary at home, where they are to complete daily pain score assessments. Participants are to return to a scheduled clinic appointment on day 7 and return tri-accelerometer and diaries. Nil follow-up regarding the trial is required; participants will continue to see the doctor as per scheduled appointments. This research will help determine whether we may assess the effectiveness of pain management programs in an objective way. This in turn will allow us to determine which pain management methods are most effective.

Elective total shoulder arthroplasty (TSA) is a common and effective orthopaedic procedure for the treatment of osteoarthritis and rotator cuff injuries. Infection remains a common reason for surgical revision. A common bacteria causing these infection is Propionibacterium Acnes. The current method to reduce post op infections is to use skin preparations prior to surgery. This standard surgical prophylaxis does not seem to decrease the bacterial load. This may be a potential source of infection for susceptible patients having procedures with surgical implants. Benzyl Peroxide (BPO) and Benzyl Peroxide/Clindamycin (BPO/C) topical skin preparations have been shown to reduce the superficial skin colonization of P. acnes. This study aims to investigate the use of BPO and BPO/C as a topical skin preparation and to determine the effects it has in reducing positive cultures in patients undergoing TSA. Study Outcomes • Contamination and inoculation with P. Acnes will be determined via microbiological analysis. Positive cultures will be noted and compared statistically between groups. From this data efficacy between preparations can be determined. • Compliance with the various skin preparations will be completed at the 2 week follow-up via survey.

The purpose of the study is to see whether the antibiotic combination of 100mg doxycycline, 500mg azithromycin and 300mg rifabutin is a safe and effective treatment for coronary artery disease which has not responded to "standard" treatment. Coronary artery disease is the process of plaque build up within the walls of the arteries responsible for the supplying the heart with oxygen and nutrients. Plaque is usually made up of fatty deposits, minerals and various amounts of tissue and white cells which eventually narrows the artery, reducing blood flow to the heart. The resulting damage and build up of fat results in inflammation of the arterial wall and eventually the arteries narrow. The researchers involved in this study consider that a pathogen called Chlamydophila pneumonia, which can live inside cells, may cause this inflammation of the arterial wall. The purpose of this study is to see if treatment with this antibiotic combination in patients with CHD is safe and effective in reducing disease severity measured at coronary angiography and improving quality-of-life. Approximately 60 patients will be involved in this trial. The treatment period is 90 days, with a further 90 day follow-up period.

Background: Although Negative Pressure Wound Therapy (NPWT) has become widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has never been adequately investigated, with research in children particularly lacking. There is limited evidence, however, that NPWT might benefit paediatric burns patients, amongst whom scar formation, wound progression, and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression, and decreases pain more effectively than routine treatment alone. Methods: A total of 96 paediatric burns patients will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present with a thermal burn covering <5% of their total body surface area to the participating children’s hospital within 7 days of their injury. Facial and trivial burns will be excluded. Following a randomised controlled, parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™, secured with Hypafix™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants will undergo dressing changes every 3-5 days until the point of healing. The primary endpoint will be time to re-epithelialisation. Secondary outcomes include pain, pruritus, wound progression, cost effectiveness, ease of management, treatment satisfaction, and adverse events. A linear mixed model will be performed to determine the evolution across time and between groups in primary and secondary outcomes, with patients as random effect. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. Discussion: The study will be the first randomised controlled trial to explore the effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management.

Gluteal tendinopathy (GT) is a common, debilitating musculoskeletal condition, most often seen in middle aged females, and sedentary overweight people. The resultant lateral hip pain leads to reduction in physical activity and often poor sleep, which may impact on general health and well-being, as well as quality of life and employment status. It has been proposed that compressive loading is a factor that contributes to the development of insertional tendinopathy. Compressive loading of the gluteal tendons occurs between the iliotibial band (ITB) and the greater trochanter in positions of hip adduction. Daily postures, such as sitting with knees crossed, standing ‘hanging on one hip’ in adduction, and side-lying, may contribute to cumulative compression on the tendons. The impact of this can be imparted to the patient through education, which has been proposed as a key component of load management. Tendon loading can be controlled by postural changes, avoidance of aggravating activities, and regulation of physical activity volumes and intensities. Most literature suggests a multimodal program of education in addition to appropriate exercise prescription. A randomized controlled trial recently demonstrated that a multimodal load management program in the form of advice and practical strategies in addition to exercises in GT was superior in terms of pain reduction and perceived rating of improvement in the overall condition to corticosteroid injection or a wait and see approach in both the short and long term. To date, the impact of load management through education alone has not been investigated. Therefore, the primary aim of this study is to: 1.Investigate the efficacy of online education/information material on global rating of change in individuals with gluteal tendinopathy. The secondary aims of this study are to: 2. Evaluate the patients’ perceptions of the education brochure by assessing quantitative and qualitative questionnaires at 6 weeks. 3. Assess possible prognostic variables of pain and disability for gluteal tendinopathy at 12 months