ANZCTR search results

Background: Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. The purpose of the study is to examine the effects of the ACE service on RACF residents’ transfer to hospital using a controlled pre-post design. Methods: Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors. Results: Residents of the aged care facilities were old with an average age of 86 years. ED presentations were common. With transfers ranging from between 16 and 211 visits for every 100 beds in the RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR=1.17, p=0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 minutes (p=0.0575), and was 40% less likely to be admitted to hospital, .The latter was highly significant (p=0.0012). Transfers to ED and admission to hospital are common for residents of RACFs. A complex multi-strategy intervention led by nursing staff can successfully reduce hospital admissions for older people living in Residential Aged Care Facilities. By defining goals of care prior to transfer to the ED, clinicians have the opportunity to better deliver care that patients require. Integrated care requires accountability from multiple stakeholders.

Tne Breathe Easy Early study is a randomised control trial to assess the efficacy of early intervention with humidified high flow nasal cannula in the emergency department- Optimising outcomes in the Golden Hour of respiaratory failure. Many patients present to the emergency department frequently feeling breathless. The cause of the breathlessness is varied and can be caused by problems with the heart, lungs, cancer or infection. On presentation to the emergency department, standard treatment of the breathless patient involves the application of oxygen via a face mask in addition to drug therapy and investigations including chest xrays and blood tests. If breathlessness gets worse, the patient may need breathing support in the way of non invasive or invasive breathing support which requires intensive nursing and medical care. Despite the benefit of these therapies they come with inherent risks to the patient. A breathing support device that provides noninvasive humidified high flow via a nasal cannula is one method of breathing support that is currently utilised safely in the critical care units of adult and paediatric hospitals. The high flow delivery provides small amounts of pressure to reduce the effort exerted by the patient while breathing in and to help splint the airways open. This pressure is not present during simple oxygen therapy. Additionally, the humidification of the high flow therapy helps maintain normal airway and lung function, by not drying out the airways. If we treat patients early with high flow therapy rather than using the standard facemask, we may be able to relieve symptoms of shortness of breath sooner and avoiding the worsening of breathing difficulties. Research Design and Methods: Ipswich Hospital Emergency Department will be the pilot site for this randomised controlled trial of early intervention with humidified high flow nasal cannula (HHFNC) vs. standard practice in the breathless patient. Patients that present to the Ipswich Hospital ED with dyspnoea will be identified at the point of triage and flagged as potential participants in the study. Participants will be randomised to receive study arm (HHFNC) or standard practice. Outcomes: The Primary outcome will be the proportion of patients who experience relief of dyspnoea. The secondary outcomes will include Time to relief of dyspnoea Time requiring respiratory supplementation Health care cost reduction with early initiation of supportive respiratory support

The aim of this study is to compare three different treatments for decreasing the symptoms of insomnia. There are certain factors that may impact the effectiveness of treatments for insomnia. Therefore comparing these three treatments will help us develop a more effective way to treat insomnia. This study is the first well controlled comparison of these treatments. This study also investigates whether having a bed partner affects a person's sleep in any way.

Purpose: The primary purpose of this study is to develop an electronic castrate-resistant prostate cancer (CRPC) Australian database called ePAD. The data from this will then be used to evaluate the patterns of care for Australians with CRPC. Who is it for? Patients will be 'recruited' at participating sites; these sites will submit an ethics application to enable them to collect patient data from routine clinical practice. This is a non-interventional study and purely data collection at the approved site/hospital. Study details: All participants enrolled in this study will have data collected at baseline and ongoing clinic visits. Follow up data will continue to be collected after the completion of patient enrolment which is anticipated to run until September 2019. Data collected will include patient characteristics, details regarding local treatment and use of androgen deprivation therapy, details regarding diagnosis of castration-resistance, prescription of and effectiveness of each systemic therapy and survival. Additionally, factors that influence decision-making around systemic treatment selection and the rationale for change of treatments will be collected. Data will be collected from clinic visits or from medical records. It is hoped that the findings of this study will allow researchers to determine the patterns of care provided to CRPC patients, and potentially improve knowledge of which treatment options may be the most beneficial for individual patients with CRPC.

The purpose of this study is to determine the effectiveness of incorporating short sprints into current clinical practice guidelines for improving blood glucose management during exercise in individuals with Type 1 Diabetes. We hypothesize that incorporating shorts sprints into any sustained period of physical activity will reduce the incidence of exercise-mediated hypoglycaemia in individuals with Type 1 Diabetes in a free-living setting.

The primary objective was to determine the benefits of a pre-surgical exercise programme for rectal cancer patients scheduled for rectal resection. It was hypothesised that: i) between baseline and pre-surgery patients would demonstrate – higher physical functional performance, maintain higher levels of muscle strength and endurance, ii) during the weeks following surgery patients would demonstrate – reduced physical functional performance, reduced muscular strength and endurance iii) between baseline and post-surgery, patients would demonstrate – improved recovery with a higher physical functional performance, maintain higher muscular strength and endurance.

The primary purpose of this trial is to examine the detection rate of lesions using narrow band imaging (NBI bronchoscopy) with a computed tomography (CT) scan, in comparison to the standard white light bronchoscopy in head and neck cancer patients who completed treatment 3-5 years previously. Who is it for? You may be eligible to participate in this trial if you are aged 18 or over and have completed curative treatment for a head or neck cancer in the previous 3-5 years. Study details All participants will receive a bronchoscopy, CT scan of chest and spirometry . Bronchoscopy is a procedure done under a light sedative where we look at the bronchial tubes as well as the upper airway and voice box. In this we can use a normal "white" light as well as a "blue" light. The Blue light potentially helps to find the earliest changes in the upper airway and bronchial tubes. Where it looks abnormal we take a small sample, a biopsy. Any biopsied tissue will then be analysed in a laboratory to examine whether it contains abnormal/cancerous tissue. Researchers will compare the rate of lesion detection using both types of imaging.Also each patient will have a CT (CAT) scan of the chest in the Radiology (Xray) department to look for any supsicious areas there, as is usually done by ENT surgeons at this timepoint. We will use a computer to assist in the interpretation of the CT scan. All patients will have a simple breathing test (Spirometry) in the Lung function ldepartment which requires 2 or 3 deep breaths into a tube to record the lung capacity. This will give us information about the way lung capacity may be related to the risk of developing small additional cancers. It is hoped that the findings from this trial will provide information on whether NBI bronchoscopy may be beneficial in the detection of airway lesions in previous head and neck cancer patients, in whom these tumours are relatively common.

Social anxiety disorder (SAD) is a common and debilitating mental illness, with sufferers frequently experiencing chronic anxiety in anticipation of, and during and following exposure to, social situations. Currently, group cognitive therapy is efficiacious for SAD, but some 80% fail to achieve normative functioning. The current project will investigate the utility of a novel treatment approach for SAD, namely imagery-enhanced cognitive behavioural group therapy (IE-CBGT). In this approach, imagery-based techniques are used to enhance existing evidence-based techniques within a 12-session treatment package. In this trial participants will be randomised to one of two conditions: i) IE-CBGT, or ii) a ‘gold-standard’ treatment, verbally-based CBGT (VB-CBGT, which relies on identifying and challenging anxiety-provoking beliefs predominantly within the verbal cognitive mode). A minimum of ninety-six individuals with SAD will be recruited through established referral pathways to the Centre for Clinical Interventions (CCI) from general practitioners, psychiatrists and psychologists and randomised into one of the two treatment groups. Between 6-12 patients will be admitted per group. The objectives of the project are threefold: i) to compare outcomes of IE-CBGT and current gold-standard VB-CBGT for SAD, across cognitive, behavioural, psychophysiological and emotional measures (i.e., questionnaires, behavioural tasks and physiological monitoring), ii) to evaluate unique and common mechanisms of change across the two treatments to inform theory and future treatment innovations, and iii) to compare the cost-effectiveness of the treatments to ensure that IE-CBGT has broader cost benefits in a health sector with limited resources and increasing demand. A standard battery of self-report questionnaires will be administered at baseline, and prior to each treatment session in line with current practice at CCI. Additional self-report questionnaires will be administered following sessions 4 and 8 and after the final treatment session. A routine CCI (group) follow-up appointment will be made 1-month after treatment completion with the treating psychologist. An additional individual assessment appointment will be made 1-month after treatment completion so that a diagnostic interview and self-report questionnaires can be administered. Another follow-up appointment will be made 6 months after treatment, allowing for fine-grained assessment of mechanisms of change to be assessed. Psychophysiological responses will be recorded during a social stress task at baseline and upon completion of the treatment sessions (at the individual assessment 1-month follow-up).

The primary aim of this study is to determine whether short activity breaks incorporating upright simple resistance activities can improve blood vessel (endothelial) function compared to 5 hours of prolonged, uninterrupted sitting. Secondary outcome measures will also provide information on the potential signalling pathways (insulin and SNS-mediated vasoconstriction pathways) that are contributing to the decline in vascular function with prolonged sitting. For this, we propose to undertake a randomised crossover trial in twenty five inactive and injury-free overweight/obese adults aged between 35-75 years. This study will involve two acute experimental conditions (each of 6 hours duration), separated by a minimum 5-day washout period to account for any residual physiological effects of the intervention. Each participant will complete two conditions, involving (i)Uninterrupted Sitting - 5 hours of prolonged sitting; and (ii) Simple Resistance Exercises + Interrupted Sitting: 5 hours of sitting with 3 minutes of simple resistance activity breaks every 30 minutes. Standardised breakfast will be provided for the test. Lunch and dinner will also be provided following each condition. Vascular function will be directly measured using Flow Mediated Dilation (FMD). FMD is a widely-used non-invasive method to describe endothelial function and vasodilation of an artery following ischaemia. Venous blood samples will be collected every 30 minutes and blood markers of endothelial function will also be measured, including nitric oxide and endothelin-1 production. Changes in Sympathetic Nervous System (SNS) activity may help to explain any differences in FMD over the day and between conditions. SNS activity will be indirectly measured via catecholamine levels in the blood; and directly measured using microneurography, where a microelectrode will be inserted under the skin to sit on top of the peroneal nerve (behind the knee) and record electrical activity. The SNS also helps to mediate the baroreflex, which regulates acute blood pressure changes by controlling heart rate, contractility and peripheral artery resistance. Spontaneous baroreflex responses will be assessed using ECG and a beat-to-beat finger BP cuff. Plasma markers of cardiovascular health and inflammation will also be measured. At the conclusion of each condition, participants will be fitted with both a 24 hour ambulatory blood pressure monitor (ABPM) and a continuous glucose monitoring system (CGMS).

Patients with diagnosed hypogonadism will be studied at baseline and then after 2 weeks of testosterone replacement initiation at usual therapeutic doses (10 g Testogel). The study will involve measurements of urea metabolism, and whole body protein breakdown and oxidation, and how much of the amino acids are being recycled for new protein synthesis.