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Current measures of cognition utilised in rehabilitation are valuable diagnostically but often do not fully address the functional implications of cognitive deficits. One primary concern at discharge from hospital is predicting the ability of a patient to function independently or to estimate the degree of assistance required to do so. The focus of this study is on the use of the Kettle Test as a quick performance measure that is based on a complex everyday task and is designed to tap into basic and higher-level cognitive processes to predict cognitive function. The participant group would be recruited from patients participating in rehabilitation at the Sir Charles Gairdner Hospital (SCGH), Geriatric Evaluation and Management Unit (GEM). The study design is a Prospective Cohort Study. The Mini Mental Status Examination (MMSE) and Cognitive FIM Instrument are cognitive assessment tools currently used with inpatients on GEM. They are standardised tools involving a series of questions and paper based assessments. The Kettle Test is a new cognitive assessment tool, which utilises a functional task. We wish to assess the Kettle Tests accuracy in detecting cognitive impairment, when compared to traditionally used assessment tools. Also we will assess all tools capacity to predict a patient’s functional capacity. Functional capacity will be measured via the motor component of the Functional Independence Measure (mFIM). The study also includes questions from a Daily Living Self-Efficacy Scale to assess the level of individual’s belief in their functional abilities and confidence to return home. Participants or their caregivers would receive a phone call within their first week post discharge to review their functional status (via the mFIM), management at home, caregiver support, community service use and representation rates. The participants would receive an additional phone call at one month post discharge to review functional status (via the mFIM), management at home, caregiver support, community service use, representation rates, medical status and deaths. We will also collect data concerning age, gender, length of rehabilitation stay (LOS) and diagnoses. It is anticipated that the Kettle Test will accurately detect cognitive functional deficits in adults with suspected cognitive impairments, and that the Kettle test will give clear and specific information about the functional abilities and impairments of the patient once discharged to the home environment.

The serratus anterior is an important muscle that assists in the control of the shoulder blade and movement of the arm. We know that serratus anterior muscle activity is affected in painful shoulders, and is often targeted by physiotherapists for the treatment of shoulder pain. We are conducting this study to compare if Real-time ultrasound (RTUS) is more effective than manual facilitation in the rehabilitation of serratus anterior muscle. We expect that both interventions will improve activation of the serratus anterior, but that there will be better activation of the muscle with RTUS

The survival of an organism in the face of internal and external events requires a measured and appropriate stress response. It has been hypothesised that an abnormal stress response is linked to the likelihood of the development and severity of critical illness and multi-organ failure. The stress response is coordinated by the primitive brain structures of the diencephalon and brainstem in response to somatosensory inputs and comprises a broad range of neuro-hormonal and immune effects. We hypothesise that the use of sedating medications confuses the normal generation of a stress response. If this is confirmed, this may be a fundamental underlying cause for the abnormal haemodynamics, metabolic disturbances and organ dysfunction observed in critical illness. The large multi-centre randomised-controlled SPICE-III study offers the opportunity to study two similar groups of patients who may have differing levels of physiological stress as a result of an Early Goal-Directed Sedation (EGDS) strategy as compared to standard care. We aim to conduct a substudy to determine whether a strategy of EGDS and the resultant reduced sedation level results in a differing physiological stress response in critically unwell patients as measured by a panel of blood-borne markers. We hypothesise that the application of an early goal directed sedation protocol and the resultant reduced sedation level in the first 5 days of critical illness will result in a differing pattern of stress as measured by metabolic, sympathetic, hormonal and inflammatory responses. All-SPICE will be a prospective parallel-group multi-centre observational sub-study of the the SPICE-III study. The SPICE-III study is a prospective, un-blinded, randomised controlled trial of Early Goal-Directed Sedation compared with Standard care. The SPICE-III study will recruit patients who are intubated and ventilated in a participating ICU, are expected to remain intubated the day after enrolment and need immediate and ongoing sedation. Due to the immediate need to choose a sedative regimen for ongoing patient safety and comfort, it is proposed that study enrolment will occur using deferred consent. A total of 100 patients from approximately 4 ICUs will be enrolled in All-SPICE. Immediately following randomisation on day 1, patients will have blood samples taken, which will be repeated on days 2, 4 and 6. These samples will be assessed for various blood-borne markers which are considered to be potentially affected by the coordination of the stress response.

Traditionally, anaesthetists have always been verbally instructing patients how to position themselves for spinal or epidural anaesthesia. This project is based on our hypothesis that if we use images in addition to verbal instructions, the patients could understand easily what is expected of them and therefore they can position themselves appropriately and quickly. We believe this will increase the satisfaction of both anaesthetists and patients with the whole procedure. This project involves randomising patients into two groups, one group gets the standard verbal instructions and the other group gets to see images of the correct position as well. We note the time taken to do a successful procedure, the number of skin punctures made and the satisfaction scores of patients and anaesthetists. The two groups are compared and analysed if showing visual images is any beneficial as opposed to mere verbal instructions.

The overall aim of this project is to improve and preserve optimal visual function of residents in Australian residential aged care facilities (RACFs), in order to improve or optimise this critical sensory input in their already restricted environment. There is clear evidence that people living in RACFs have more vision issues which are not adequately managed, when compared to similarly aged people living in their own home. Vision issues include macular degeneration (the main cause of blindness and major vision loss in people over 50), glaucoma, diabetic retinopathy, untreated cataract, uncorrected refractive error and many other conditions. Eye testing of residents will be conducted to quantify the extent of vision issues in these facilities, and to test the practicality of onsite testing, or alternate means when necessary. After gaining a detailed knowledge base of the current landscape, legislative requirements and issues through consultation with an expert reference group, the project will identify the existing eye health practices in eight different RACFs from four different providers (Estia Health, Presbyterian Aged Care, BaptistCare, Allambie Heights Village) using a detailed audit. The facilities to be audited will have varying levels of additional services provided. The audit will focus on existing policies and procedures to determine: a) whether appropriate baseline records of a resident's vision are obtained; b) whether residents obtain regular ongoing eye tests, and if so, how; c) whether resident care (including treatment and rehabilitation) is modified as a result of vision issues; d) the extent of communication regarding eye health with the residents' healthcare providers (eg GP and relevant specialists) and family. Using input from the expert reference group, a draft 'minimum standard of care' model will be developed. A manual will then be produced to provide a practical/workable guide for use in RACFs. In addition, an audio-visual education tool will be developed for use by RACF management and staff, as well as an educational publication for families. The manual and video will then be tested within the RACFs prior to final production and distribution to all RACFs across Australia.

Borderline personality disorder (BPD) affects over 95,000 15-24 year-old Australians and is a leading cause disability and mortality in this age group. Up to half of patients with BPD experience distressing and disabling auditory verbal hallucinations (AVHs) but opinion about their veracity and their treatment is polarised. Second generation antipsychotic medications (SGAs) are prescribed frequently ‘off label’ for BPD, despite limited supporting evidence. Recent studies show that AVHs in BPD and schizophrenia are phenomenologically indistinguishable. However, no randomised controlled trial (RCT) has ever tested whether conventional pharmacotherapy for AVHs in schizophrenia is applicable to AVHs in BPD. This study is a 12-week, single-centre, RCT of aripiprazole versus placebo, with a 27-week follow-up period, for 15-25 year-olds with BPD and AVH. The primary outcome is AVH severity, measured using a standardised scale. Secondary outcomes include BPD severity, general psychopathology, functioning, experience of psychotic symptoms and changes in neurobiological mechanisms underlying AVHs that are associated with treatment. Currently, the NHMRC clinical practice guidelines for BPD recommend against the use of antipsychotic medications as first-line treatment for BPD, which places them in direct conflict with NHMRC clinical practice guidelines for psychotic disorders. This novel study will advance knowledge about treatment for BPD by providing information about the efficacy of antipsychotics in the treatment of AVHs when they co-occur with BPD. It will also extend knowledge about the phenomenology of AVHs, whether AVHs should be considered as part of the symptom profile of BPD and the neurobiological basis of this symptom.

‘Zap and Run’ is a ten minute one on one training workshop focused on developing and maintaining skills in use of a cardiac defibrillator for rhythm recognition, defibrillation, cardioversion and external pacing. It utilises the portable ALSi simulator. This project aims to evaluate the skills of participants while undertaking the workshop. Participants will be asked to rate their training experience and time to treat will be measured using the logging features of the simulator. This evaluation will be used to determine the skills gap and need for training. The workshop consists of testing the skills of participants using a simulated defibrillator over seven scenarios. The simulator logs the times and actions of the participant. The instructor then explains and corrects any errors and the scenario is run again if necessary to confirm learning before moving to the next scenario. At the beginning and end of the workshop the participant will fill out a workshop evaluation questionnaire.

This project aims to bring to proof of concept an evidence-based, flexibly delivered, information technology driven (interactive website) program of structured health promotion and risk reduction (the Women's Wellness Program), which aims to decrease menopausal symptoms and instill sustained and positive health behaviours in midlife women.

The primary purpose of this study is to evaluate the efficacy of cancer therapy which is matched specifically to the genetic profile of each individual's tumour in patients with metastatic melanoma. Who is it for? You may be eligible to participate in this study if you are aged 18 or over, and are newly diagnosed with stage IIIB, IIIC or IV melanoma. Study details: All participants in this study will first undergo standard testing to establish whether a certain type of genetic mutation (BRAF/NRAS mutation) is present in their tumour cells. This is carried out using an existing or fresh tumour tissue sample. All participants will then begin standard care therapy for the melanoma. In participants with tumours testing negative for BRAF/NRAS mutations in the initial test, and who show disease progression or who are unable to continue standard care therapy, further testing on their tumour tissue sample will be carried out. This will provide further information regarding the genetic profile of the tumour. Researchers will then match this genetic profile to a specific therapy which targets it. Researchers will measure disease progression and survival to evaluate the efficacy of the matched targeted treatment in comparison to standard care only. The matched targeted therapies which may be used will be continuously updated as other research provides more information on which drugs may target which genetic profiles. It is hoped that the findings of this study will provide valuable information regarding the efficacy of therapies which target the specific genetic profile of metastatic melanoma tumours, in comparison to the current standard care.

Visually impaired older people are increasing in number and have significant ongoing morbidity including risk of falls, but are neglected in regard to falls prevention programs. We aim to evaluate the effectiveness of the Lifestyle approach to reducing Falls through Exercise (LiFE) program to prevent falls and improve function in older people with vision impairment compared to usual care, delivered through specialist Orientation and Mobility Instructors. Secondary aims are to establish the cost-effectiveness of the LiFE program compared to usual care and to identify determinants of the success of the LiFE program and implementation issues in the vision impaired population. We will conduct a randomized controlled trial evaluating the LiFE program in older people with visual impairment in NSW and ACT in collaboration with Guide Dogs NSW/ACT, a leading community service organisation for people with vision impairment. A total of 588 participants will be recruited through Guide Dogs client database, and randomized to receive either the LiFE intervention or usual care (control group). Guide Dogs' Orientation and Mobility Instructors will receive training in delivering the LiFE program, which will be delivered to those in the intervention group. Social and demographic characteristics and visual and physical status and will be assessed at baseline, and physical status reassessed at 12 months to characterise the study cohort.. Falls will be self-reported on a monthly basis. Physical activity will be measured using actigraphy at baseline, 3 and 12 months. A sample of 30 participants in the intervention group will be interviewed after completing the program to determine how well the LiFE program concepts are integrated into daily activity. An economic evaluation will be modeled from a health service provider perspective, with data collected on costs to deliver the LiFE program, in-patient hospital admissions, emergency department presentations and other health and community service contact, The primary outcome measures will be the rate of falls over the 12 months following randomization and the Late Life Disability and Function Index.. The secondary outcomes will be falls requiring medical care and the rate of falls per steps taken.