ANZCTR search results

Aim: To compare the intra-operative and post-operative outcome measures between three different patellar implant designs in patients undergoing total knee arthroplasty (TKA) surgery with regards to patellar bone coverage and tracking, patient-reported outcomes and post-operative radiological and scintigraphic analysis. Background: Controversy remains regarding whether the patella should be resurfaced in total knee arthroplasty. However, at present the scientific literature supports patellar resurfacing with regards to reduced re-operation risk and improved long term patient satisfaction. Two basic techniques present for resurfacing the patella; either onlay or inset. In the inset design, a round domed implant is reamed in the patella and fixed with a single central projection (peg). On the other hand, the onlay design has either round (symmetrical) or oval (asymmetrical) shaped patellae with three small peripheral pegs fixed on the cut surface of the patella. When using a round patellar implant, either onlay or inset, some surgeons perform a lateral facetectomy to avoid lateral compression syndrome and enhance patellar tracking. However, neither method has proved to be superior. A wide range of complications are associated with patellar resurfacing. These include patellar fracture, osteonecrosis related to devascularisation, patellar polyethylene (PE) wear, aseptic loosening, instability, dislocation, overstuffing and rupture of the extensor mechanism. Many of these can be catastrophic. One should always consider the peculiar blood supply to the patella during TKA and patellar resurfacing as iatrogenic disruption of supplying vessels has been identified as a major contributing factor in post-operative patellofemoral complications. The hypothesis of this study is that onlay oval design provides optimal bone coverage, better tracking, better patient reported outcome scores and carries the lowest risk of osteonecrosis in comparison with the other two designs. Trial Objectives: To prospectively compare intra-operative observed measures, patient-reported outcome measures and radiological results between inset, onlay round and onlay oval designs of patellar implants in patients undergoing total knee arthroplasty surgery. Specifically, we will compare patellar surface bone coverage, pain and functional scores together with patellar tracking and vascular status of the patella postoperatively.

The aim of this project is to show whether if there is a difference in the length of hospital stay and effect on health economics for patients who are using ‘patient controlled analgesics’ (PCA) compared to those patients who are on conventional oral or intravenous pain relief administered by nurse. The significance of this project is that, if there is a difference between the two groups, PCA and conventional pain relief group, this can help improve the cost of service to the patient. Reduced length of hospital stay means earlier discharge for the patients to their own environment for recovery and prevents nosocomial infections, this will also free up hospital bed for other patients and reduce the cost of administering PCA. The research question is whether there is a difference in the length of hospital stay for patients who are using PCA compared to conventional analgesics after orthognathic jaw surgery. Our hypothesis is that, those patients who are on PCA will have prolonged hospital stay compared to those who are on conventional oral or intravenous analgesics.

Energy distribution (i.e., timing of calories ingested) and sedentary behaviours are important factors for glucose metabolism. Most Australians currently consume the majority of their energy in the evening, with dinner and an evening snack contributing up to 45% of the total daily energy intake. The pattern of increased energy intake in the evenings has previously been associated with an increased risk of obesity while partitioning calories normally consumed from dinner to earlier in the day (i.e., breakfast) has been associated with better appetite control and lower blood glucose and blood insulin levels-two important risk factors for type 2 diabetes. In addition, the extent to which sedentary behaviours (particularly prolonged periods of uninterrupted sitting) may contribute to the negative effects back-ending current feeding patterns is not well understood. However, earlier consumption of energy (i.e. larger breakfasts) and may be more beneficial to glucose metabolism in the context of prolonged periods of sitting. Similarly, frequent active breaks in the form of simple resistance exercises may also improve glucose metabolism when performed during extended periods of sedentary behaviour. Consequently, the aim of the present study is to examine how manipulations to the distribution of energy throughout the day influences blood glucose and insulin metabolism, and appetite control, during periods of prolonged sitting compared to breaking-up sitting time with intermittent simple resistance exercise in overweight/obese men and women. It is hypothesised that a day of prolonged uninterrupted sitting may potentially accentuate the effects elicited by a high caloric end-of-day feeding pattern compared to prolonged sitting interrupted by simple resistance exercises in individuals with pre-diabetes and Type 2 diabetes.

This study aims to assess the efficacy of use of two different Niagara Thermo Cyclo Pad units, used twice daily for 20 minutes for four weeks on knee pain, stiffness and symptoms in knee osteoarthritis patients, using a randomised, placebo–controlled double–blind design over four weeks.

Help Out a Mate is a short (one hour) mental health literacy program that focuses on what mental health and mental illness is, specific disorders including depression and anxiety, how you could recognise these in a friend, and what to do if you do recognise it. The aim of the program is to decrease mental health risk and stigma and increase skills to help out a friend, both on and off the field.

The investigators are proposing a prospective, randomized study of 2x41 patients undergoing major abdominal surgery to compare ultrasound-guided TQL block catheters versus surgically placed PP catheters as an active control-group. We have been conservative in estimating the number of patients required, as there are no parallel active trials in the literature to draw from. However a single study using single shot TQl block in the lower abdominal surgery found 25 patients sufficient to get power of 0.8.The study will be conducted with pain score on cough as primary measurable endpoint and Analgesic use as secondary endpoint (cumulative and daily -PACU, day 1, day 2- Fentanyl use) and pain score differences over time as secondary endpoint -PAC, day 1, day 2 at rest.The investigators hypothesize that ultrasound-guided TQL block is superior to surgically guided Pre-Peritoneal block with respect to both end-points and either technique may be superior in discharge times or cost-efficacy. The primary objective of the study is to compare analgesia used and the pain scores with the ultrasound guided TQL vs. surgically placed PP catheter infusion techniques in abdominal surgery. Secondary aim is to assess the subjective quality of pain management (satisfaction score), discharge times and cost analysis of the two methods of delivery. Patients in the PP group will have PP catheters placed under direct vision by the surgeon at the end of the surgery. Initially the surgeon injects 20 ml ropivacaine 0.375% at each site; subcutaneous, sub-fascia and pre-peritoneal levels followed by catheter insertion. This catheter are connected to an elastomeric pump. In the TQL group post-surgery, with the patient in lateral position, under ultrasound guidance, an 18 gauge Tuohy needle will be used to reach the QL muscle posterior aspect. This is confirmed by injecting saline and followed by a bolus dose of 20 ml of ropivacaine 0.375%. Subsequently a catheter is inserted. The same technique is repeated on the other side. Both groups will receive multimodal analgesia with Paracetamol 1 gram QID (orally or IV) and a Fentanyl PCA device (bolus 10 to 40 mcg; lockout time 5 min). Both groups will be infused with 0.2% ropivacaine 5ml/hr on each side during 48 hours via elastomeric pump. Acute Pain Service (APS) personnel will independently assess the postoperative pain scores and analgesia used in recovery and on day one and two. Procedure related technical issues; duration of introduction of catheter insertions and complications related to it will be noted. Patient satisfaction will be assessed on day 2 and during a follow-up telephone call at one month. First flatus or bowels opening time and discharge time will also be tracked. Personnel and material costs will be used for a cost analysis.

The aim of the study is to explore the impact of military land transit on the physical performance of dismounted combatants. Participants will be required to complete a number of physical performance tests prior to and following a two hour exposure to simulated military land transit. Participants are required to complete the following battery of tests prior to and following the two hour exposure; drop jump, 20m sprint, reactive agility, arm-hand steadiness, isometric deadlift, and sit and reach test. Data collected in a previous study identified a number of tasks regularly performed by ADF infantry personnel following dismount that rely on aspects of an individuals physical abilities to successful complete. As such the battery of tests was design to assess the physical attributes that underpin each of the tasks. The two hour exposure will consist of one of four conditions; seated no harness, seated with harness, seated with harness and 1st class road conditions, seated with harness and cross country conditions. Data collected in the previously mentioned study indicated that the Bushmaster PMV is the most commonly used vehicle by ADF infantry personnel and as such accelerometer data collected from a Bushmaster PMV in transit was used to generate a military land transit simulation. In addition participants of the previous study indicated that the most common duration of land transit was two hours and whilst in transit they would regularly secure themselves into place using the built in seat harness. This data resulted in the design of the four two hour exposure groups. In addition to the physical performance tests, participants will have a number of electrodes positioned on their person to measure the muscle activity of the following muscles; glute medius, external obliques, and longissiums. It is postulated that the data collected will indicate if the two hour land transit exposure impacts the muscle activity providing insight into the mechanisms responsible for any changes in performance.

A major early component of neuropathic pain is infiltration of immune cells into the injured tissue that release inflammatory mediators. These mediators could either directly, or through the induction of neurotrophic factors, trigger increased alpha-1 adrenoceptor expression on neurons and other cells around the site of injury. In turn, activation of alpha-1 adrenoceptors on fibroblasts and keratinocytes may trigger further release of growth factors and inflammatory mediators. Thus, an upward spiral of alpha-1 adrenoceptor expression on these cells and on regenerating neurons could engender an adrenergic component of inflammation and pain. The aim of this project is to investigate this hypothesis in a large sample of patients with complex regional pain syndrome and in other forms of painful neuropathy. An adrenergic component of pain in the skin will be assessed in response to intradermal injection of the adrenergic agonists phenylephrine and clonidine. In addition, we will investigate the expression of alpha-1 adrenoceptors and inflammatory mediators in skin biopsies of hyperalgesic and control skin. This project may have significant treatment implications, as blocking up-regulation of the alpha-1 adrenoceptor could ultimately prove to be a useful therapeutic strategy for patients with an adrenergic component of pain.

The primary objectives of the study are 1) to determine self-reported adherence or non-adherence to prescribed cardiac medications in cardiac patient referred to a cardiac rehabilitation program and 2) to explore individual, behavioural and environmental factors that affect adherence to cardiac medications. The secondary objective is to conduct pilot-testing of the hypothesis that, compared to standard care alone, standard care plus a multifaceted intervention comprising motivational interviewing techniques and text message reminders will enhance cardiac medication adherence among cardiac patients referred to attend cardiac rehabilitation program. The study hypothesis is that motivational interviewing (MINT) counselling and text message reminders delivered in an outpatient setting in addition to standard care will enhance maintenance of medication adherence in cardiac patients compared to standard care alone.

BACKGROUND: Approximately one third of patients with Type 1 diabetes (T1D) have impaired awareness of hypoglycaemia and these have an associated threefold increase in the likelihood of a severe hypoglycaemic event. For the patient and the family, impaired hypoglycaemia awareness has profound consequences for their ability to function in society and for quality of life. The limitations associated with this morbidity place a significant burden and result in anxiety and other mental health problems. Impaired hypoglycaemia awareness (IAH) and counter-regulatory failure develop as a result of recurrent hypoglycaemia and avoidance of hypoglycaemia has been shown to correct defective responses. The clinical problem has been the difficulty of avoiding hypoglycaemic exposure. Hybrid closed loop system which is based on automated insulin delivery dependent on real time continuous glucose monitoring and minimal patient interaction is a tool which could potentially avoid hypoglycaemia and improve hypoglycaemia awareness in this subgroup of patients with IAH. It is hypothesised that the use of hybrid closed loop therapy can lead to recovery of the counter-regulatory hormones and restore awareness of hypoglycaemia in this patient cohort. AIM: This study will assess as to whether a hybrid closed loop system can improve hypoglycaemic awareness as assessed by epinephrine response in hyperinsulinemic hypoglycaemic clamp studies. METHOD: 38 participants (aged from 12 to 55 years old) with T1D and impaired hypoglycaemia awareness will undergo a parallel randomised controlled trial. After 2 weeks of baseline blinded CGM period, the subjects will undergo a hypoglycaemic clamp study to measure hormonal and symptomatic responses to a standardised hypoglycaemic stimulus in a hyperinsulinemic, hypoglycaemic clamp. They will then be randomised to either hybrid closed loop or standard CSII therapy for six weeks. After the six weeks study period, participants will undergo a second hyperinsulinemic hypoglycaemic clamp to determine the change in hormonal and symptomatic responses to hypoglycaemia. OUTCOMES: The primary outcome is the increase in epinephrine response to hypoglycaemia in the hypoglycaemic clamp study. Secondary outcomes include other counterregulatory hormonal responses to hypoglycaemia in the hypoglycaemic clamp study, glycaemic outcomes (CGM data, HbA1c) and psychosocial outcomes (including recovery of hypoglycaemia awareness score, fear of hypoglycaemia, treatment satisfaction).