ANZCTR search results

We are undertaking research into the use of ultrasound to diagnose pneumonia in children. Currently, doctors may order a chest X-ray if they are concerned a child has pneumonia. Studies that have looked into this in children and adults suggest that ultrasound of the lungs may be as good as chest X-ray at identifying pneumonia and it has the added advantage of being at the patient’s bedside and not exposing the child to radiation. We aim to perform a lung ultrasound on children in the emergency department who have had a chest X-ray ordered by their treating doctor. We will then compare the results of the X-ray and the ultrasound to see whether the ultrasound has similar findings. Lastly, we will perform a follow-up phone interview 2-3 weeks after each child has been discharged from the emergency department to document if they improved, whether or not they needed antibiotics, or subsequently needed to consult another doctor. We hope our study will provide support to the growing idea that lung ultrasound may is useful for diagnosing pneumonia. In addition, we hope that we may begin to understand when it would be a good idea for the child to still have a chest X-ray and when the findings of a lung ultrasound are sufficient. This information may guide future research into using lung ultrasound to diagnose pneumonia.

Chronic lung diseases, including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), bronchiectasis and asthma, are characterised by breathlessness, reduced exercise tolerance and impaired quality of life. ‘Flareups’ of chronic lung disease are common in people with this condition and often lead to admission to hospital and decline in lung function, imposing considerable burden on patients and the healthcare system. Pulmonary rehabilitation is known to be effective at improving exercise tolerance and function, and helping to prevent ‘flareups’ particularly for people with COPD. However, it is often difficult for people to access these group exercise training programs due to issues surrounding transport and lack of access to programs, particularly in regional areas of Australia. Advances in internet technology and accessibility have made it possible for people to receive specialist medical care and rehabilitation therapy directly to their home. By using readily available equipment such as an exercise bike and iPad it is possible for people with chronic lung disease to undertake a supervised pulmonary rehabilitation program in their own home. However, whether this kind of training is as effective as hospital-based pulmonary rehabilitation is unknown. This project aims to determine whether pulmonary rehabilitation undertaken at home, using internet-based technology, is at least as effective as centre-based pulmonary rehabilitation in improving quality of life, breathlessness and exercise capacity in people with chronic lung disease. People who agree to take part in the study will be randomly allocated to undertake pulmonary rehabilitation at either a hospital-based group or in their home, with internet-based supervision. At the beginning and end of the 8 weeks of the intervention phase, and at 12months post completion of pulmonary rehabilitation, participants will undergo measurements of health status and exercise capacity. Hospital medical records and GP records will be reviewed to determine the frequency of acute chest infection and to identify hospital admissions and treatment of acute infections. This will be tracked for 12 months for all participants. It is hypothesized that: 1. Home-based telerehabilitation will provide clinically significant improvements in health-related quality of life, exercise capacity and symptoms which are equivalent to those seen in centre-based rehabilitation. 2. Telerehabilitation, delivered using our low cost model, will be more cost-effective from a societal perspective when compared to centre-based pulmonary rehabilitation for chronic respiratory disease.

Most colorectal surgery is now performed laparoscopically. Therefore most pain is deep inside the abdomen rather than the small incisions on the abdominal wall. This study would like to use a pain management technique that uses local anaesthetic infused via plastic catheters into the intraperitoneal space in the abdomen, close to the internal incisions. It is hoped that by doing this patients will need to use less opioid drugs and thereby avoid the side effects of these drugs and possibly recover more quickly from the surgical procedure with less pain. Currently there are many different pain management techniques used after surgery and include: -Intravenous pain medication with opioid drugs such as Morphine or Fentanyl. -Epidural (small plastic tube inserted near spinal cord where medication can be given) with a combination of local anaesthetic drugs +/- morphine-like drugs. -Local anaesthetic blocks via small plastic tubes placed between the abdominal muscles at the time of operation and allow for local anaesthetic to be given between these muscles. -Oral pain medication such as paracetamol and oxycodone. -A combination of any of the above techniques. These techniques can have side effects especially with the Morphine-like drugs that can be a problem in patients having surgery on the bowel and include: -Nausea and vomiting -Reduced bowel function (constipation or bowel temporarily stops working - ileus) -Drowsiness or sleepiness -Slowed respiratory rate and reduced cough -Reduced mobility leading to prolonged bedrest -Increased risk of blood clots due to immobility Because of these side effects the study is designed to see if the local anaesthetic infused intraperitoneally will result in improved pain relief, mobility, earlier return of gut function and less complications,

Over 40% of older people living in the community fall each year. In clinical practice, recent guidelines recommend that older people be regularly asked about falls and their circumstances. Ascertaining falls is also important to measure the success of any intervention. In research settings previous studies have found that asking about falls 3- or 12-monthly results in under reporting of falls compared with a daily calendar returned monthly with telephone or paper-based questionnaire follow-up to determine the circumstances of falls. This method of a daily falls calendar and monthly follow-up by questionnaire or telephone call has been well validated and is now considered to be the gold standard in falls ascertainment. However, this method is labour and cost intensive as every month there are postage costs, need to manually check that the calendar has been returned (previous studies have reported 30% need follow-up), telephoning to determine circumstances of falls and data or medical file entry by a research assistant or clinician. Therefore there is an important need to improve the way falls ascertainment is conducted. We aim to undertake the world first testing of a novel emailed electronic falls ascertainment tool (TASeFALL) that reminds participants to complete the electronic questionnaire, with responses automatically fed into a database or clinicians email.

This project aims to assess the effectiveness and feasibility of a program to increase physical activity in individuals with the most common inherited heart disease, Hypertrophic Cardiomyopathy (HCM). A sample of 22 patients will be recruited from the HCM and Genetic Heart Disease clinics at the Royal Prince Alfred Hospital. They will undertake a survey to establish baseline measurements of moderate-vigorous physical activity (MVPA, measured by IPAQ-Long), mental and physical health (SF-36v2), and self-efficacy and barriers to physical activity; and wear an accelerometer for 7 days. A motivational interview, including discussion of barriers and goal setting, will be conducted with a member of the research team. Participants will also be provided with a FitBit Charge device to self-monitor their physical activity. Over the following study period of 12 weeks, participants will receive phone calls (weeks 2, 4, 8 and 12) and weekly text messages from the research team to encourage them to meet their goals and to offer support that is personalised and consistent with Control Theory principles. At the completion of the intervention, participants will undergo the same evaluation as at baseline, and also provide process evaluation feedback regarding the intervention.

Research Plan This research will examine the benefits of HIIT on IR metabolic syndrome and polycystic ovarian syndrome women. A controlled trial was conducted in Armidale for 12 weeks. Metabolic syndrome women with or without PCOS aged between 18 to 70 years were recruited to the high intensity interval training group (HIIT G) or the control group (CG). The primary purpose of this study is to examine the benefits of HIIT on insulin resistance in men and women with metabolic syndrome. Research Hypothesis HIIT induces metabolic changes and improves IR, glucose homeostasis and lipid metabolism HIIT induced regulation of insulin will reduce androgen production HIIT enhances skeletal muscle oxidative capacity Aims To accomplish the primary purpose of this study the following assessments will be conducted:- 1. Evaluate the percentage of change in body composition parameters. 2. Assess the level of change in hormonal parameters. 3. Assess the level of change in blood glycaemic parameters 4. Evaluate the level of change in blood lipid profile 5. Evaluate the percentage of improvement in parameters of cardiovascular fitness, heart rate variability and telomere length. Research Plan This research will examine the benefits of HIIT on IR metabolic syndrome and polycystic ovarian syndrome women. A controlled trial was conducted in Armidale for 12 weeks. Metabolic syndrome women with or without PCOS aged between 18 to 70 years were recruited to the high intensity interval training group (HIIT G) or the control group (CG). Two information and screening sessions will be conducted for participants before the intervention. Information regarding HIIT, exercise testing procedures, blood tests and the intervention study will be discussed. Participants will be asked to complete a health questionnaire. Based on the information provided by the participant and the health questionnaire, decision will be made on eligibility for participation. During the screening session consent forms will be signed. HIIT G participants will undergo supervised high intensity exercise training on bicycle ergometers 3 times/week. A HIIT session will be a 5 min warm up, 3 sets of HIIT for 20 seconds (3×20), 2 minutes of low intensity exercise after each HIIT set, 5 min cool down period and stretching. Participants assigned to the control group will continue with their usual care and will not participate in supervised exercise sessions. Both intervention groups will be provided with an activity journal to record their daily physical activity. Pre training assessment for peak VO2 will be done using an incremental exercise test on an exercise bike. Heart rate will be monitored during each exercise session. Measurements for body composition, blood essays for glycaemic markers, hormones and lipids will be conducted at baseline, 6 weeks, 12 weeks and 6 week post intervention completion.

Osteoarthritis (OA) is a chronic disorder affecting the joints, most commonly involving the hands, knees and hips. In view of the strong association of OA with ageing, major concerns with the disease exist due to the continuous rise in the number of elderly. Pain is the most common symptom in addition to progressive difficulty or incapacity to perform daily activities. Among the different disease phenotypes, OA of the hands is a frequent condition, causing symptoms in up to 15% of the population worldwide. The subtype affecting the base of the thumb, in particular, is probably caused by mechanical factors overloading the joint in addition to genetic predisposition. Debilitating symptoms can occur in this subset of patients, including pain during daily activities such as writing and grasping, loss of hand function and joint stiffness. Due to modest effects, current non-surgical treatment frequently do not meet patients’ demand while surgery is only indicated in cases refractory to conservative therapy due to potential complications. For this reason, the need for novel studies addressing new conservative treatment strategies is emphasized by several reviews. Combination of therapies is often used in clinical practice but little evidence exists about its efficacy. Furthermore, the combination of non-pharmacological and pharmacological rehabilitation interventions has never been studied in the context of patients with thumb base OA. Therefore, the objective of this study is to investigate the effect of a combination of therapies compared to a control group receiving usual care. The new strategy will be delivered over a 6-week period and will consist of education about the disease and joint protection, exercises for the hand, splint for the base of the thumb and use of a topical NSAID. The control group will receive education and instructions on joint protection techniques alone.

The aim of this study is to determine the activity and safety of treating a site of disease with with a single fraction of SABR during immunotherapy with nivolumab in advanced NSCLC progressing after 1 or 2 lines of chemotherapy. Who is it for? Adults with advanced non-small-cell lung cancer (NSCLC) progressing after 1 or 2 lines of chemotherapy and with an asymptomatic metastasis suitable for SABR. Tumour blocks should be available to test for PD-L1 expression. Study details Participants will be randomly allocated in a ratio of 2:1 to either nivolumab 240mg every 2 weeks plus SABR (experimental) or nivolumab 240mg every 2 weeks alone (control). Nivolumab is continued until disease progression or prohibitive toxicity. Participants will be assessed regularly for treatment response and side effects during the treatment and follow up phase. Clinical assessments will be performed before each cycle of nivolumab (2 weekly) and CT scans at baseline, week 6, 12, 18, 24 then 12 weekly until progression. Anticancer treatments and survival will be reviewed every 12 weeks after progression. This will enable us to determine the activity and safety of each treatment option in patients with an asymptomatic metastasis.

Our aim is to design and pilot an innovative, translatable ­by design online parenting support package: Parenting Acceptance and Commitment Therapy (PACT) for families of young children with CP. We will pilot PACT in a randomised controlled trial recruiting 66 families of children with CP (2-6yo). We predict that PACT will be associated with improvements in the parent-child relationship, in child functioning, and in both parent and child  adjustment and quality of life. Outcomes will be assessed immediately post-intervention and at 6 months post-intervention (retention). 

The aim of the research is to evaluate the feasibility and preliminary efficacy of a 3-month healthy lifestyle program (HEYMAN) for young men (aged 18-25 years) delivered using ehealth and weekly face-to-face sessions. HEYMAN is developed based on previous formative research with young men Participants will be randomly allocated to the intervention (HEYMAN) or waiting list control group. After 3-months the waiting list control group will receive access to hEYMAN program tools. Participants in both groups will be asked to have a series of measures taken (e.g. weight, height) and complete online questionnaires at the start of the program (baseline) and post program (3-months). The researchers will also track intervention participants engagement with the program (e.g. session attendance, website use metrics), retention, acceptability and satisfaction with the program.