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One of the most serious complications of general anaesthesia in pregnant women is hypoxic brain injury and fetal and/or maternal death related to difficulty oxygenating a pregnant woman. This is due to inability of the anaesthetist to intubate the trachea and ventilate a pregnant woman because of the changed anatomy and physiology of pregnant women leading to the known problem of the difficult obstetric airway. The latest obstetric airway management guidelines by the Obstetric Anaesthetists’ Association (OAA) & Difficult Airway Society (DAS) discuss the importance of pre-oxygenation in managing pregnant women undergoing general anaesthesia as it increases oxygen reserve in the lungs during apnoea. The guidelines recommend that the end-tidal oxygen fraction (FetO2) of equal to or greater than 90%, indicating effective lung denitrogentation, should be achieved prior to induction of anaesthesia. The current way anaesthetists pre-oxygenate pregnant women undergoing general anaesthesia is to use a tight fitting face mask to deliver 100% inspired oxygen. The new guideline also states an alternative method. The guidelines states that nasal oxygenation, to facilitate bulk flow of oxygen to the alveoli could be considered as part of 1. Pre-oxygenation - A pre-oxygenation method and 2. Apnoeic oxygenation - A technique to increase apnoeic time. The guideline suggests that the anaesthetist should consider attaching nasal cannulae with 5 l.min-1 oxygen flow before starting pre-oxygenation, to maintain bulk flow of oxygen (O2) during intubation attempts, or attach nasal oxygenation after pre-oxygenation during the apnoeic period. There is also mention of humidified high flow nasal oxygenation however no data exists in pregnant women as to its safety or efficacy or acceptability by pregnant women. It is possible that a new pre-oxygenation technique, using high flow humidified nasal oxygen, may have an application in pregnant women however before this new pre-oxygenation technique is considered, it should be equivalent (at least) to the current available technique in terms of safety and efficacy i.e. be able to obtain FetO2 of at least 90% after three minutes of pre-oxygenation. Currently there are no studies reporting FetO2 values in pregnant women with high-flow humidified nasal oxygen delivery systems and no studies reporting the use of nasal high flow oxygen to increase apnoea times therefore it is unclear whether humidified high flow nasal oxygenation, is safe and beneficial in pregnant women. In this prospective study we aim to recruit two groups of women. The first group of women will be those who will electively undertake high flow humidified nasal oxygenation in order to examine this technique in the setting of pre-oxygenation (Pre-oxygenation group). The second group of women will be those who are undergoing general anaesthesia for caesarean section and will have high flow humidified nasal oxygenation after induction of anaesthesia.

Obesity and diabetes have become global epidemics. It is known that adequate physical activity and a healthy diet are among the key factors in weight control and management of type 2 diabetes. However, participation in regular exercise could be a challenge to some individuals with various capacities. There have been reports in the literature that hypoxia interventions, alone or combined with exercise, may have beneficial effects on weight control and blood glucose homeostasis in individuals with obesity and hyperglycaemia. With advancement of technology, hypoxia chambers and breathing devices (hypoxicators) have become available to provide air with various levels of oxygen. Whether hypoxia can be validated as an alternative or complementary intervention for obesity and diabetes requires further research. The aim of this research is to conduct a preliminary investigation on the effect of four weeks intermittent exposure to mild hypoxia (with the target blood oxygen saturation level at approximately 90%) on blood glucose homeostasis and insulin sensitivity in individuals with impaired fasting blood glucose. The participants’ responses (including blood oxygen saturation level, heart rate, and blood pressure) during the intervention sessions will be closely monitored, and their blood glucose, insulin and HbA1c levels, and glucose tolerance will be assessed pre and post the intervention period to determine the effects.

Intradialytic hypotension (low blood pressure during dialysis) is a common problem in hemodialysis patients and can lead to poor outcomes. Pneumatic compression devices (PCD) are well established in the prevention of deep venous thrombosis and pulmonary embolism. It is thought that the use of PCDs during hemodialysis will increase venous return and improve hemodynamic stability. However, there is paucity in evidence regarding the use of PCDs during dialysis. We aim to investigate the effect of PCDs on intradialytic hypotension, compared with standard of care. The study is a two-period, eighteen-treatment, randomized crossover trial. We aim to recruit between 16 and 25 patients from hemodialysis unit at Frankston Hospital. Participants will be randomised into 2 groups, either to start with PCD or without PCD. Group A participants will have 3 weeks of dialysis with PCD, then one-week washout period of no intervention, followed by 3 weeks of dialysis without PCD. Group B participants will have 3 weeks of dialysis without PCD, followed by 3 weeks of dialysis with PCD. Standard of care during dialysis will remain the same during non-treatment period and washout period. Primary outcome measured is intradialytic hypotension. Secondary outcomes are intradialytic hypotension with nursing intervention and patient symptoms, intradialytic hypotension with symptoms, lowest blood pressure less than 100 mmHg, ability to achieve dry weight, postural hypotension at the end of dialysis and maximum fluid removal. Postural hypotension is defined as a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within three minutes of standing.

This study will evaluate the reproducibility of magnetic resonance imaging (MRI) setup of patients in the radiotherapy treatment position and assess how this impacts the image quality for radiotherapy planning and treatment delivery. Who is it for? You may be eligible to join this study if you are aged 18 years or above and have been diagnosed with prostate, head and neck, central nervous system, rectal, cervix or lung cancer. Study details: Patients would otherwise be undergoing an MRI scan in the radiotherapy department for their cancer treatment or other research purposes. Patients will undergo a planning MRI scan in the treatment position then the patient would then get off the MRI couch and be set-up for a second MRI scan with limited MRI sequences. The main purpose of this study is to determine the consistency of positioning and the impact of MRI distortion, landmark positions and contours between scans.

Misoprostol and Dinoprostone are both medications used to ripen a woman's cervix in preparation for labour. In a phase III trial by Wing et al misoprostol vaginal insert, when compared to dinoprostone vaginal insert, was thought to reduce the time from insert to vaginal delivery and decrease the number of women needing further intervention by oxytocin for induction of labour by 26% without an increase in the complications of caesarean section or neonatal morbidity. Misoprostol was found to increase the rate of tachysystole (too frequent uterine contractions) to 13% compared with 4% for dinoprostone. Wing et al used both primiparous women and multiparous women in their study. We hypothesize that by using misoprostol in primiparous women only we may still be able to achieve the significant reduction in need for other interventions for induction of labour but without the significant increase in rates of uterine tachysystole. Women admitted to the study will have either the misoprostol or dinoprostone inserted for cervical ripening and data collected on whether or not they then needed to have a cervical ripening balloon for further ripening, whether they needed oxytocin for induction of labour, whether they had too many contractions that required intervention to control, what their mode of delivery was, what the time interval between when the pessary was inserted and when they delivered and whether or not there were any neonatal complications.

This proposed research will examine the feasibility of the FRAIL Screen in general practice as a screening tool for frailty and determine the impact of a high- as compared to low-quality protein supplement in combination with a centre- and home-based exercise intervention on muscle strength, physical function parameter and quality of life in frail older people who live in the community. Aims: 1. To examine, the feasibility of recruiting 120 community-dwelling older people, aged 65 years and older who have screened frail (>1) using the FRAIL SCREEN tool to a 6 months intervention study involving nutrition and exercise; 2. To determine the effects, over a period of 6 months, of exercise in combination with either (i) high-quality whey protein supplements or (ii) lower-quality rice protein supplement, on the primary outcomes of gait speed, leg press and grip strength, and physical performance, and other secondary outcomes including frailty, muscle mass, nutritional intake, physical activity, and quality of life. Hypotheses: 1. It is feasible to recruit 120 community dwelling frail older people using the FRAIL SCREEN tool through the ACH referral system and multiple proposed referral strategies. 2. It is feasible for participants to participate in the proposed nutritional and exercise supplementation program for a period of 6 months. 3. The higher-quality whey protein supplement combined with a pragmatic exercise program will result in greater improvement of gait speed and grip strength, physical performance and quality of life, and the other secondary outcomes at 3 months and 6 months than a lower quality rice protein combined with pragmatic exercise program, in older people who are frail or at-risk of frailty as determined by the FRAIL Screen.

The proposed research plans to examine the application of an ointment (Rectogesic 0.2% GTN), a pharmaceutical agent approved for human use, on venous leg ulcers. GTN ointment works in part by releasing nitric oxide (NO) into the wound, which acts to improve blood flow to the area and has the capacity to kill unwanted bacteria in the wound. The product to date has not been used routinely for the treatment of venous leg ulcers. A previous study by the chief investigator demonstrated the enzyme (iNOS), which drives the production of NO, was elevated in patients with faster healing leg ulcers, suggesting that application of a topical GTN donor (the ointment) might accelerate this healing process. The trial will be double blinded with half of the recruited patients receiving a placebo and the other half receiving the GTN donor. Neither the patients nor the research nurse involved in treatment will know if the product is the placebo or the GTN donor. The trial will run only for 4 weeks for each patient so rates of healing will be determined by planimetry (ulcer tracing) as complete healing of the ulcer will most likely not be achieved in the time frame being examined. If a statistically significant difference exists between the two groups the treatment will deemed successful. It is hoped that a subsequent larger trial will be planned based on the findings from this study. Hypothesis: Participants receiving the Rectogesic (GTN donor) will have a statistically higher linear healing rate (LHR) compared to patients that receive only the placebo.

Pancreatic cancer is a devastating disease that is set to become the 2nd leading cause of cancer-related deaths worldwide by 2020. Over 80% of pancreatic cancer patients are diagnosed with unresectable locally advanced or metastatic disease. Through data collection and correlation with analyses of archival tumour specimens and blood collections, this trial aims to identify and validate novel diagnostic and monitoring methods; novel predictive and prognostic biomarkers and to use these to inform studies of novel therapeutic opportunities that will improve the management of pancreatic cancer. Who is it for? You may be eligible to join this study if you are aged 18 years or above, and have been diagnosed with pancreatic ductal adenocarcinoma (PDAC). Study details This protocol aims to enrol at least 500 consecutive eligible patients over 10 years. Enrolled patients will undergo collection of clinical data and archival tumour specimens. Where applicable, patients will also undergo collection of blood and/ or urine at several time points. Once a sufficient cohort has been enrolled, selected molecular analyses will be conducted on each specimen, thus, allowing for batching of specimens. Enrolled patients will undergo collection of clinical data and archival or fresh tumour specimens as part of routine clinical management, with all patients will be treated as per standard of care. When applicable, archival tissue samples from the primary pancreatic cancer, matched normal pancreas tissue and/or resected metastases will be obtained, upon enrolment. to study. Where possible, current biopsy specimens (fresh tissue) will be collected by either Victorian Cancer Biobank or local pathology laboratories at the time of standard of care procedures. Patients that consent to the “liquid biopsy” (blood and urine collection) sub-study will undergo collection of blood/plasma and urine at the beginning and during each systemic therapy. Blood (upto 60 ml) and urine (upto 60 ml) will be collected for research purposes on the following occasions: 1. Before and after surgical removal of pancreatic cancer (if applicable) 2. Before and after any chemotherapy regimen (if applicable) 3. Every 6 months while you are on active surveillance (if applicable) Follow up will occur until the end of active surveillance, death or 5 years post enrolment, whichever occurs first.

The research aims to provide evidence of efficacy of social support to young clients (13-25) who utilise the projects secure social network community site for peer-to-peer support supervised by a counsellor at Kids Help Line. This will validate that the best way to support and manage young peoples mental health issues is through extending solution focused one-on-one counselling practice to incorporate group counselling with peers, of the same age and problem, in a supportive, private and secure social network environment.

Providing individuals with physical activity advice and guidance can help to improve their physical activity behavior. This is especially the case when individuals are motivated to read the information and are able to understand it and consider it thoughtfully. There is some evidence that providing people with information that is matched to their cognitive processing style, known as need for cognition, increases motivation and ability to read the messages presented. Further, there is evidence that this in turn is associated with greater improvements in attitudes and behaviors. This has been shown in a health context before (e.g., mammogram utilization), but evidence in the physical activity field is lacking. Given that interventions matched to participant’s need for cognition are more resource intensive to develop than unmatched interventions (requiring at least double the intervention materials), research examining the impact of matching to need for cognition in the physical activity domain is needed before this technique is adopted en masse in this area. We aim to examine how stimuli optimized for central route (deep thinking) processing compared to peripheral route processing (use of simple cues) are processed by individuals with higher and lower need for cognition and the impact of this on the persuasiveness of the materials. This will be achieved in a mixed method laboratory-based study, with outcomes assessed using eye-trackers, combined with brief questionnaires and qualitative interview. We hypothesize that individuals who are shown materials that best match their cognitive processing style will show greater attention to the materials and less distraction when processing them (assessed by eye tracking devices) compared to individuals who are shown materials that do not match their cognitive processing style. Further, we anticipate that greater attention will be associated with more positive ratings of the intervention materials and greater motivation for physical activity participation (assessed via self-report; quantitative and qualitative methods). Overall, this study will provide valuable insights into how to develop physical activity messages and in doing so may help to inform the development of more effective physical activity interventions in the future.