ANZCTR search results

Despite rapid advances in the field of technology to monitor blood glucose continuously and prevent hypoglycaemia in type 1 diabetes (T1DM), the majority of patients, particularly young children, fail to achieve recommended HbA1C target of 7.5%. Real-time continuous glucose monitoring (RT CGM) offers the opportunity to improve diabetes control by providing a continuous glucose reading every 5 minutes. The most recent generation of RT CGM systems are more accurate in the hypoglycaemic range and have an added feature which allows transmission of the glucose values via bluetooth to a mobile device and share it with caregivers or health care providers. Little is known of the psychosocial impact of these technological advances on the patients and their caregivers. This study aims to evaluate the impact of RT CGM with the added feature of remote monitoring on psychosocial factors such as fear of hypoglycaemia and quality of life measures in young children with type 1 diabetes mellitus (T1DM) and their parents.

Background: People do not engage in sufficient physical activity (PA), and therefore, do not confer health benefits and reduce risk of chronic diseases. Increasing PA levels reduces this risk and is also linked to better quality of life and reduced stress. Healthcare professionals frequently provide guidance on physical activity; however often do not meet the recommendations themselves. There is a need for large-scale coordinated efforts to promote PA at the population level and, in particular, in healthcare professionals who often experience stressful work patterns. Recent developments in technology have been used to promote PA through tailored interventions. The main objective of this study is to develop and test the feasibility, acceptability and efficacy of tailored interventions in healthcare professionals to increase their PA and quality of life, and to reduce work-related stress and absenteeism. The study will also compare the unique and interactive effects of three forms of the tailored intervention on study outcomes based on different techniques from behavioural theory. Methods/Design: Frontline hospital staff (N = 168) will be recruited from four hospitals in Perth, Western Australia via employer’s mailing list, leaflets and posters. Participants will be randomised to one of the four conditions: motivation, self-regulation, habit, and control. Participants in all conditions will be provided with access to a web-based platform that provides a library of short lay-language articles on promoting PA. All intervention groups will receive a tailored intervention administered via the web-based platform with supporting text messages. Theory-based personalised information will be delivered to participants based on their responses to surveys assessing theory-based cognitions (e.g., motivation, self-efficacy). The content of the tailored messages will adopt specific techniques based on behavioural theory. The primary outcome will be PA measured using activity monitors. Secondary outcomes include: self-reported quality of life, stress, anxiety, sleep, and absenteeism from employee records. All outcomes will be assessed pre- and post-intervention (at 3 months). Website engagement, retention and preferences related to each component of the intervention, and potential mediators and moderators of the intervention will be assessed. Discussion: This is the first study to deliver a tailored, technology-supported intervention aiming to increase PA in frontline healthcare professionals. In addition, the inclusion of different techniques based on behavioural theory in different arms of the trial will assist in providing an evidence base assessing the effectiveness of motivational, self-regulatory and habit-forming strategies in promoting PA. The online platform developed in this study has a potential to deliver efficient, scalable and personally-relevant intervention that can be translated to other occupational settings.

This research examines the utility of Let's Talk About Children intervention for its application in Australian mental health services. The objectives of the project are to determine the effectiveness of the Let's Talk program, an innovative, evidence-based program which involves training clinicians in talking to mental health clients about their children. The research will investigate the impact of Let's Talk on parenting confidence and family functioning along with aspects of recovery (e.g. self worth, relationships, independent living) and quality of life, as compared to a control group receiving standard treatment.

Background: The leading cause of death for Aboriginal Australians is cardiovascular disease, including stroke and heart attack. Atrial Fibrillation is a precursor to stroke. There are no published studies about the prevalence of Atrial Fibrillation for Aboriginal people. The purpose of the study is twofold: to estimate prevalence of Atrial Fibrillation in Australian Aboriginal people and evaluate the effectiveness of opportunistic screening, and assessment and treatment pathways for Aboriginal people with Atrial Fibrillation or other arrhythmias. Methods: This is a mixed methods study which will screen 1500 Australian Aboriginal people living in New South Wales, Northern Territory or Western Australia to estimate prevalence of Atrial Fibrillation. This data will be analysed statistically to estimate prevalence. In addition, the study will conduct semi-structured interviews with Aboriginal workers who conduct the screens to evaluate qualitatively the effectiveness of opportunistic screening using an iECG to facilitate timely assessment and treatment for Aboriginal people over 45 years. Discussion: The study aims to determine the feasibility of the portable iECG device to diagnose abnormal heart rhythm in Aboriginal people and facilitate access to further assessment and treatment; estimate the prevalence of AF in Aboriginal people in Australia; improve health literacy in Aboriginal people and health workers; and help prevent the effects of untreated AF in Aboriginal people; including ischemic stroke and prevent early deaths or impairment.

Lateral epicondylitis (LE) or "tennis elbow" is the most commonly diagnosed condition of the elbow and occurs mostly in patients whose activities require strong gripping or repetitive movements. 1 in 10 patients with LE who receive standard therapies like coricosteriod injections do not obtain relief from symptoms. In Australia, such patients with severe, chronic non responsive LE for over 6 months are referred for surgical treatment. OrthoATI (Trademark) is a class 3 biological autologous tenocyte implantation (ATI) product manufactured in Australia by Orthocell Ltd, that could potentially prevent or delay the need for surgery in LE patients who don't respond to standard therapies. OrthoATI (Trademark) is indicated for patients with symptoms of degenerative tendon injury who have failed conservative treatment methods. The current research project is a 1 year, single dose, single-centre, randomised, open label, parallel group, comparator controlled, non-inferiority study to assess the efficacy, safety and tolerability of OrthoATI (Trademark) in patients with severe, chronic, treatment resistant lateral epicondylitis compared to surgery.

Overweight individuals use exercise primarily as a means to reduce body weight. Given the continued rise in the prevalence of overweight and obesity (Hill et al., 2012; Ziauddeen et al., 2015), optimising the benefits of exercise for weight loss is crucial. In recognition of this, evidence-based recommendations for exercise prescription including frequency, intensity, mode, duration, pattern, and volume have been developed (Donnelly et al., 2009; Garber et al., 2011). Similarly, some countries have established guidelines for minimum physical activity levels required for weight maintenance and weight loss (Donnelly et al., 2009; insert OZ ref). However, there is no such recommendation for the optimal time-of-day at which exercise should be performed to maximise its impact on weight loss. Circadian rhythms regulate several physiological processes that influence appetite, sleep/wake cycles and exercise performance (Almoosawi et al., 2013; Drust et al., 2005; Froy, 2007; Thun et al., 2015; Winget et al., 1985; Youngstedt et al., 2002), therefore, it is possible that individuals will respond differently when exercise is performed in the morning, compared to the evening. However, the majority of available exercise-based weight loss research either does not control, or does not report, the time-of-day at which exercise has been prescribed. Therefore, the implications of exercise time-of-day for weight loss are unknown. The aim of this chapter is to present an overview of the available literature including observational and experimental studies in the area of exercise timing and its potential effects on body weight and composition. Additionally, some discussion surrounding the physiological responses to exercise and circadian rhythm of hormones will be presented to provide additional insight to understand the mechanisms behind the time-of-day effect on body weight and composition

Dental caries (tooth decay) in the early childhood, known as Early Childhood Caries (ECC) can be debilitating, significantly impacting on a child’s growth, nutrition, sleep, learning, appearance and quality of life. Children from refugee backgrounds face significant barriers in accessing timely care and therefore continue to experience significant disparities in oral health. The persisting barriers to seek and provide dental care inevitably leads to emergency hospitalisations and dental extractions. Topical fluoride varnish application, specifically 5% sodium fluoride varnish (NaF), has been recommended in the prevention and control of dental caries in children. This forms part of current best practice in caries prevention along with provision of oral hygiene and dietary advice. Silver diamine fluoride (SDF) is another topical fluoride modality that has shown to have greater efficacy than NaF and is non-invasive, easy to apply, and effective treatment modality to arrest dental caries in high-risk children. The aims of this project are to evaluate the: (i) effectiveness of SDF in arresting carious lesions in refugee children (ii) quality of life (QoL) changes in refugee children before and after SDF application Refugee children under the age of 12 years will undergo a dental examination through the RHS, as per current protocols. The option of fluoride treatment will be offered to the parents of children presenting with at least one carious lesion. Eligible children will then undergo simple sequential randomisation and SDF or NaF will be applied to the carious lesions at initial visit, 6 months and 12 months at RHS and final review will be conducted at OHCWA at 18 months. Follow-up QoL surveys, dental charting and intra-oral photographs will be taken to assess changes in the carious lesions. The expected outcome of this study is to develop the use of SDF as an adjunctive treatment modality for refugee children, thereby improving their quality of life and reducing the need for emergency dental treatment.

Background: Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate lowering therapy (ULT) is poor, with rates of less than 50% one year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. Aims: We aim to evaluate the effectiveness of use of a personal, self-management, ‘smartphone’ application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. Method: A prospective, cluster randomised controlled trial is conducted in primary care setting. GP practices are randomised to either intervention or control clusters with their patients allocated to the same cluster. The intervention group has access to the Healthy.me app tailored for the self-management of gout. The control group patients have access to the same app modified to remove all functions except the Gout Attack Diary. Outcome measures: Primary outcome is the proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes are proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a =30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed ‘drop-out’ rate 20%. Conclusion: The study is being conducted. Involvement of GPs is essential to the management of people with gout in the community and in the evaluation of usefulness of new technology in primary care.

This will be an observational study in CF patients with mild lung disease, examining the relationship between neurocognitive function and sleep parameters. Additional factors to be studied include hypoxemia, inflammatory markers, circadian rhythm and mood. CF participants will be tested at baseline, during and after lung exacerbation. Age and education matched non-CF controls will be invited to participate as well. Summary of tests to be performed at each visit: 1. Sleep study with high density EEG 2. Blood tests 3. Activity and oxygen monitoring with watches 4. Neurocognitive tests and Questionnaires.

The primary objective of the study is to investigate whether frailty increases the risk of major haemorrhage / clinically significant non-major bleed in older patients initiating an oral anticoagulant. The secondary objectives are to investigate whether frailty is a risk factor for cessation of oral anticoagulants, stroke / VTE and the association between pharmacological risk factors ability to predict the primary and secondary outcomes will be investigated in frail and non-frail participants.