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Insulin pump therapy is a potential long-term treatment options in patients with type 1 diabetes not achieving optimal glycemic control. Compared to standard care insulin pump therapy is expensive and requires high levels of medical and patient input, and its use in Australia is rapidly increasing. Despite this the potential long-term effects of insulin pump therapy in patients with type 1 diabetes in comparison with standard of care is poorly documented, with no studies published with more than 5 years of follow-up. The aim of this study is to review long term (5 to 16 years) follow-up clinic data relating to clinical outcomes (glycemic control, hypoglycaemia, weight, clinical service utilisation) between 2000 and 2016 of people commenced on insulin pump therapy compared to standard care which is people who have undergone formalised training in insulin dose adjustment (FlexIt Program) between 2000 and 2011.. We intend to provide “real life” long term data to examine the efficacy and costs of on insulin pump therapy compared to modern standard care.

The currently accepted paradigm holds that systemic autoimmunity and inflammation have a directly causal relationship with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and with the associated cardiovascular (CV) disease. However, the evidence supporting this paradigm is inconclusive and possibly contradicted but clinical studies. The T-BIRD study inverts the existing paradigm to explore the hypothesis that while autoimmunity sets the stage for the development of arthritis, it is the connective tissue biomechanical properties (stiffness) that: 1. Determine the risk of developing RA and PsA 2. Influence the severity of the RA and PsA and; 3. Determine the severity of the CV disease seen in association with RA and PsA . If this hypothesis is confirmed then a considerable part of the inheritance of RA and PsA (much of which remains unaccounted for) might be explained. There would also be important clinical implications as it would change the way clinicians undertake risk assessment and therapeutic decisions in managing inflammatory arthritis and its associated cardiovascular disease. This preliminary study will begin exploring this hypothesis by evaluating the relationship between articular biomechanical characteristics in the joints, skin and arteries and exploring the relationships between tissue biomechanical properties upon rheumatoid and psoriatic arthritis and vascular and cutaneous disease.

Obesity is one of the most significant health issues of our time. Regardless of pre-pregnancy BMI, the amount of weight gained during pregnancy [gestational weight gain (GWG)] has the potential to impact the health and wellbeing of the childbearing woman and her baby in the short, medium and long term. Women who gain excessive weight in pregnancy are more likely to retain weight in the short, medium and long term, progressing from normal weight to obese over their childbearing years. The Institute of Medicine (IOM) offers the most robust guidance, recommending specific GWG target ranges for women who are underweight, normal, overweight and obese according to defined Body Mass Index (BMI) categories. Only 36% of Australian women have optimal GWG. Interventions targeting GWG have focused on overweight and obese women, been resource intensive and have had limited success. Behavioural change interventions have also been criticised for increasing the socio-economic gradient of obesity. There is a critical need to reduce the burden of maternal obesity and excessive GWG with programs that are effective, accessible and scalable for delivery at a population level and to understand how socio-economic factors impact on GWG and uptake of interventions. This project addresses these two key issues by examining the efficacy of the “Eating4Two” Smartphone application in a population of pregnant women of all BMI categories. We hypothesise that use of the Eating4Two smartphone App will reduce rates of excessive gestational weight gain.

In Australia there are currently >425,000 people living with a stroke related disability and this number is only set to rise with the aging population and burgeoning epidemics of diabetes and obesity. In the chronic post-stroke period the only way to improve function and independence is through rehabilitation. Constraint-Induced Movement Therapy (CIMT) is the current best practice for upper-limb rehabilitation. Recent evidence suggests that CIMT's success may be due to one component, the transfer package which encourages patients to be more responsible for their own recovery. The package includes daily revision of a behavioural contract, Motor Activity Log (an index of how well the patient can complete everyday activities with their more-affected hand), daily activity diary, daily schedule (including home practice), and patient-centred goal setting and problem solving. Preliminary research also suggests that this package can be transferred to other intensive therapies with equal benefits. However, such intensive programs are rarely used in routine clinical practice due to lack of staff and resources. This study aims to investigate the use of the transfer package delivered via telehealth in current hospital outpatient rehabiltation programs. I hypothesise that patients receiving the transfer package will have greater improvements in function and will not require recurrent outpatient programs thus reducing costs and improving the capacity of the outpatient hospital system.

Stress incontinence (SUI) is defined as urinary leakage with activities that increase intra-abdominal pressure (e.g. cough, sneeze, laugh and exercise). SUI is a prevalent condition with high burden of suffering. Midurethral slings (MUS) have become the operation of choice for treatment of female stress urinary incontinence. MUS are synthetic tapes that are implanted transvaginally to support the urethra. The urethra is a tube that connects the bladder to the outside of the body and removes urine from the body. Midurethral slings can be deployed in a retropubic or transobturator fashion. A retropubic approach involves tunneling the sling from the suburethral region, in close contact to the bladder in the retropubic space (behind the pubic bone), to the lower abdominal wall. In contrast, the transobturator approach involves the passage of a sling through the obturator membrane which is further away from the bladder. This approach has been shown to have a reduced rate of intra-operative bladder perforation. Recent systematic reviews of retropubic or transobturator midurethral tapes suggest equivalent efficacy, at least in the medium term. Long term success rates of the retropubic approach are up to 91%. Both midurethral systems continue to have clinically significant complications such as bladder injuries, vagina mesh exposures, voiding difficulty, denovo (new onset) urgency and groin/thigh pain reported. Retropubic slings have more hematoma, bladder perforations, whereas transobturator slings have less over active bladder symptoms and less voiding difficulties. The minisling is a single incision sling system with small integrated self-fixating tips that anchor into the obturator internus muscle. This potentially avoids complications associated with trocar passage through retropubic or transobturator route. Randomised trials of minislings against transobturator slings have shown similar results, with the added advantage of less overactive bladder symptoms and voiding difficulties. The self-fixating tips of the minislings allow them to be placed under more tension, whilst retaining the advantages of the transobturator sling. There have been no studies comparing the efficacy of the retropubic sling with the minisling. Minislings may provide equivalent results as the retropubic sling with lower complication rates. We seek to examine if the minisling is as efficacious as the retropubic sling for women with urodynamic stress incontinence (USI) and compare their clinical outcomes.

The primary purpose of this trial is to evaluate whether early referral for palliative care can improve quality of life, cost effectiveness and quality of end of life care for adults who are newly diagnosed with advanced lung cancer. Who is it for? You may be eligible to enroll in this trial if you are aged 18 or over and have been diagnosed with advanced non-small cell lung cancer, extensive small cell lung cancer or advanced malignant pleural mesothelioma within the last 60 days. Study details All participants enrolled in this trial will be randomly allocated (by chance) to receive either standard care referral to palliative care at the discretion of the treating oncologist, or to receive early referral to palliative care within 7 days of enrolling in this trial. With the exception of the timing of the referral, the palliative care received by each group will be as per standard care, with information and care provided by the palliative care team as required for each participant. Participants will be asked to complete a number of questionnaires relating to quality of life and cancer symptoms at regular time points until their death. Carers will be asked to complete quality of life and death questionnaires and an interview at regular intervals up to six months following participant death. It is anticipated that the findings from this trial will provide information on whether early referral to palliative care following diagnosis of advanced lung cancer is beneficial for patient quality of life and end of life, and cost-effectiveness of care.

The purpose of the present study is to quantify, measure and investigate the effects of time-restricted feeding of a high-fat diet on circadian metabolomics, blood glucose, insulin, lipids and hormones with regulatory roles in satiety/appetite compared to unrestricted feeding of the same high-fat diet. We hypothesize that in the face of a high-fat diet (HFD), time-restricted feeding will ‘rescue’ the disruptions to circadian metabolomics observed with unrestricted intake of a HFD (previously demonstrated in animal models).

The primary purpose of this trial is to evaluate the effectiveness of Ex-Med Cancer, a community-based exercise medicine program designed to improve physical and psychosocial wellbeing in cancer survivors. Who is it for? You may be eligible to enroll in this trial if you are aged 18 or over and have completed cancer treatment (surgery, chemotherapy and/or radiotherapy) within the previous one year (Note: participants are eligible if they are currently receiving/scheduled to receive hormone therapy). Study details All participants enrolled in this trial will complete a 12 week group-based, supervised exercise program delivered 3 times per week in community fitness centres/gyms in Victoria. Participants will receive an individualised exercise plan developed by an up-skilled exercise physiologist. Exercise sessions will last approximately one hour and comprise of a combination of aerobic, strength and flexibility training. This trial will provide information on whether Ex-Med Cancer is an acceptable, efficacious and sustainable model of care that has the potential to be translated into cancer care.

Heart disease is a major cause of death and disability in Australia. We have already shown that diet has a key role to play in maintaining blood vessel health. A low magnesium diet is emerging as a risk factor for heart disease and is associated with an increased risk of fatal and nonfatal ischaemic heart disease. Few studies have examined the effect of Mg on endothelial function in healthy adults. The hypothesis is that an improvement blood vessel function measured by flow mediated dilatation after a high magnesium diet achieved using dietary supplements.

A prospective randomised controlled trial comparing skin closure of surgical incisions in children using either a wound dressing only, adhesive tape (SteriStrips) or adhesive glue (Dermabond). The choice of which of these techniques is used is usually dependent upon the surgeon’s preference and there is little evidence to show which of the three is better. This study will help to determine which of these three techniques, if any, is better and will help paediatric surgeons choose the best skin closure technique for their patients. Parents of children presenting for elective surgical procedures will be approached for enrolment. Participating children will then be randomised to have surgical incision skin closure with sutures and then either adhesive tape, adhesive glue or a simple wound dressing. Postoperatively, children will be followed up at 2 weeks via telephone survey where a parental satisfaction survey in terms of the wounds will be performed. Parents will also be asked questions related to: 1. Wound healing 2. The presence of any complications such as wound infection 3. Requirement to see a doctor regarding the wound postoperatively, 4. Time taken for each skin closure type to come off 5. Any parental concerns regarding the type of skin closure used. Parents will also be asked to fill out an online survey in which they will rate the cosmetic outcome of the wound. Parents unable to be reached via telephone will have a link emailed to their email address to complete the entire survey online. There will be a second followup at 6 weeks postoperatively where children will be reviewed by a paediatric surgeon in the Outpatients Clinic to assess the cosmetic outcome of the surgical wound and parents will be asked to complete a survey in hard-copy or on an iPad about the cosmetic outcome of the wound and overall parental satisfaction with the skin closure technique. Data collected will then be used to assess for differences between the three patient groups including blinded photographic assessment of the surgical wounds. This project will aim to look for differences between the three groups in terms of cosmetic outcome (as rated by the parents and a blinded paediatric surgeon assessor), differences in wound infection and wound breakdown rates and a comparison of parental satisfaction with the skin closure technique. It is hypothesised that, as all three wound closure techniques are used in clinical practice, it is likely that there will be minimal difference between the three groups. However these techniques have not been compared in a controlled trial.