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Although most patients with cirrhosis complicated by ascites initially respond to salt restriction and diuretics, as their liver disease progresses many lose diuretic responsiveness and develop refractory ascites, a condition for which there is no established drug treatment. Terlipressin is a synthetic analogue of vasopressin that causes splanchnic vasoconstriction, consequently improving renal blood flow and kidney function, and thus may ameliorate many of the pathophysiological changes that result in ascites formation. Its short half-life and bolus dose administration have previously precluded its long term use to treat ascites or other complications of cirrhosis. We performed a 4 week prospective trial of outpatient continuous terlipressin infusion in 5 patients with refractory ascites to examine its safety, practicality and efficacy in reducing ascites formation.

Measurement of actual cerebral blood flow during surgery is difficult due to the invasive or unpractical nature of the measurement tools needed. In contrast, cerebral oximetry is the continuous non-invasive measurement of cerebral oxygenation (amount of oxygen in the blood) and perfusion (the delivery of blood to the tissues of the brain). This allows anaesthetists to make critical decisions to maximise oxygen delivery and improve patient outcomes. Cerebral oximetry has been studied for more than 30 years and been commercially available for more than 2 decades. Numerous studies demonstrate that increases in blood carbon dioxide (PaCO2) increase blood flow to the brain. Carbon dioxide is a normal waste product of body metabolism, and is eliminated via the lungs. However, there are no physiological studies to date comparing the effects of normal blood carbon dioxide (normocapnia - defined as PaCO2 levels between 35-40 mmHg) and mildly elevated carbon dioxide levels (mild hypercapnia - defined as PaCO2 levels between 45-55 mmHg) on cerebral oximetry in patients undergoing major surgery. The primary aim of this study is to evaluate the effects of changes in PaCO2 on cerebral oximetry in patients undergoing major surgery. Secondary aims include the evaluation of the effects of normocapnia and mild hypercapnia on acid base blood variables, serum potassium levels, and postoperative delirium. A total of 40 subjects will be included at the Austin Hospital

Dietary restriction (dieting) is the most popular method for weight loss and is commonly the first strategy prescribed for weight loss in treating obesity. However, dietary interventions are often ineffective because energy restriction triggers the so-called “famine reaction”, a survival mechanism used by the body in order to conserve energy in times of starvation. The famine reaction involves a series of metabolic and behavioural adaptations including compensatory changes in metabolic rate, appetite and neuroendocrine hormones as well as a loss in metabolically active lean tissue in order to reduce energy requirements. Little is known about the underlying mechanisms involved in the famine reaction or whether different dietary restriction interventions can alter this response leading to more efficient and sustained weight loss. Our research group has found that a novel intermittent diet approach results in greater weight loss, reduced levels of stress hormone cortisol in blood and attenuation of the famine reaction. It is well known that dieting is psychologically stressful, and there are strong connections between stress and weight control through elevations of cortisol. Cortisol promotes central adiposity (obesity) and muscle loss and may lead to reductions in metabolic rate. Cortisol also stimulates appetite and cravings for sweet and fatty foods. For these reasons cortisol likely plays a major role in causing diet failure and resistance to weight loss. Therefore, one aspect of our study is to better understand the relationship between stress and weight loss. In order to investigate these, we firstly need to establish laboratory methods at Bond University and optimal conditions for measuring cortisol in lean healthy and obese humans. These studies will then enable us to apply these skills and perform larger weight loss interventions. The information gained for these studies will provide a greater understanding on the underlying mechanisms involved in the famine reaction and why individuals with obesity struggle to achieve weight loss goals; thereby, leading to new therapeutic strategies to target obesity.

The primary purpose of this trial is to evaluate the efficacy of an exercise and balance training intervention in patients with chemotherapy-induced peripheral neuropathy (CIPN) on functional, neurophysiological, and quality of life outcomes. Who is it for? Cancer survivors at least 3 months-post treatment, aged 18 or over, and with grade 2 or 3 CIPN. Study details All participants in this study will first complete an 8 week wait period to assess the rate of adaptive improvements occurring 'naturally' (e.g. without an exercise intervention). Participants will then complete an 8 week exercise program involving a combination of supervised and unsupervised exercise sessions, totaling three 45-60 minutes sessions per week. Sessions will include a combination of cardiovascular training, strength training and balance training. Participants will be asked to complete a number of assessments and questionnaires at enrolment, after the 8 week wait period and again after the 8 week exercise program. Assessments will include physical function tests, nerve testing, and quality of life questionnaires. This pilot study is being conducted to provide insight regarding the efficacy of exercise and balance training for the treatment of CIPN.

The primary purpose of this study is to evaluate the efficacy of alternative dressing and securement devices in preventing device failure and infection in peripherally inserted central catheters (PICCs) in cancer patients. You may be eligible to participate in this trial if you are a cancer patient of any age, with a haematological malignancy or solid tumour, and are having a PICC inserted as part of your therapy (which is expected to remain in place for at least 24 hours). All participants enrolled in this trial will be randomly allocated (by chance) to receive one of four PICC dressing/securement device combinations. These combinations are the standard securement device with a simple polyurethane dressing; the standard securement device with a simple polyurethane dressing and a chlorhexidine impregnated disc; an integrated securement device and simple polyurethane dressing combined into a single device; or an integrated securement device and chlorhexidine impregnated disc. The allocated dressing will be re-applied every 7 days or more frequently if required, until 8 weeks or until the time of device removal if removal is required earlier. Participants will be asked to rate the acceptability of the device and dressing, and the device will be observed closely to examine side effects, device failures and infections. It is hoped that the findings of this trial will provide information on which PICC securement devices and dressings are most effective in preventing PICC failure and infection in cancer patients.

Background: A smoking ban was implemented across all prisons in Queensland, Australia, in May 2014, with the aim of improving the health of prisoners and prison staff. However, post-release relapse to smoking among prisoners is common. The WISE study, conducted in the US by Clarke and colleagues (2013), is the only study that has rigorously evaluated an intervention aiming to assist individuals in remaining abstinent from smoking following release from a smoke-free prison. This intervention resulted in significantly higher abstinence rates for the intervention group compared to the control group three months post-release (11.5% and 2.4% respectively). Methods: This paper describes the design and rationale of a randomised controlled trial that aims to replicate an adapted version of the WISE intervention in Queensland prisons, with the goal of extending smoking abstinence among a population of incarcerated men due to be released from smoke-free prisons. Prisoners in the intervention group will receive four weekly sessions of a brief intervention involving group sessions of motivational interviewing and cognitive behavioural therapy, initiated in the four weeks prior to release. The control group will receive a pamphlet and brief verbal intervention at the time of baseline assessment. Assessment of post-release smoking status will be conducted by parole officers at weekly parole meetings for a maximum of three months post-release, allowing for smoking rates among the intervention and control groups to be compared. Discussion: Effective interventions that result in long-term smoking cessation are needed so as to reduce existing health disparities in this vulnerable group of Australians.

Quinoa (Chenopodium quinoa) seed is catalogued as a pseudocereal due to the similarity with the cereal family but with a different nutrient composition. Quinoa is a crop related to beetroot and spinach, grown primarily for its edible seeds. Cultivated in the Andean region between Bolivia and Peru, recent interest in this plant has been due to the nutritional value of the seeds in comparison to other cereals. Comparative to other cereals, quinoa is high in protein and rich in antioxidants (Vega-Galvez et al., 2010; Gorinstein et al., 2007). The quinoa seeds are highly nutritious and contain 60% starch and 15% protein. In addition, quinoa is a rich source of anti-oxidants including flavonoids, phenolic acids and squalene. Research has shown a potential role for quinoa in reducing oxidative stress which is increased in response to a high sugar diet (Pasko et al., 2010), and has also been reported to reduce adiposity in response to a high fat diet (Foucault et al., 2012). We have recently shown quinoa, contributing to 25% of the diet, to significantly increase adiponectin levels in C57BL/6 mouse models of obesity. Several studies have shown the benefits of increased circulating adiponectin particularly in the prevention of cardiovascular diseases, some cases of type 2 diabetes and the Metabolic Syndrome (Hotta et al., 2000; Spranger et al., 2003; Matsuzawa et al., 2004). Whilst body composition did not significantly change, a number of markers of health including lipid profiles were improved. The current study aims to assess the effect of quinoa seeds in varying quantities on adiponectin levels, blood lipid profiles and physical activity and body composition in overweight and obese humans. We hypothesise that inclusion of quinoa in the human diet will increase adiponectin levels and improve blood lipid profile in overweight and obese humans Participants receive either 25, 50, or 100 grams of quinoa per day for 12 weeks and results compared to a control group (0 grams quinoa/day).

Induction of labour is a common obstetric intervention that 1 in 4 women will experience. The ultimate goal of induction of labour is to achieve a vaginal birth, however in almost 40% of first time mothers it fails. The outcome of a failed induction, a caesarean delivery is associated with vast range of adverse effects, both short and long term for the mother and her baby. In this application we propose that a simple and inexpensive intervention will increase the success of induction of labour. Lessons from successful spontaneous births tell us that labour occurs more frequently, and is shorter with less intervention when it occurs at night. The driver of this is thought to be the endogenous hormone, melatonin. Melatonin is synthesised by the placenta. Healthy pregnant women have higher concentrations of melatonin compared to non-pregnant women. Melatonin levels also increase with gestation, peaking during labour and then falling rapidly after delivery. The biological reason for an altered melatonin cycle in pregnancy is unclear. However, the myometrium of the pregnant uterus expresses melatonin receptors and these receptors have been shown to be up-regulated in labouring compared to non-labouring women. Intriguingly, both melatonin and oxytocin activate the same signalling pathway that results in uterine contractions. Specifically, melatonin treatment of myometrium increases it’s sensitivity, enhances oxytocin-induced contractions and improves myometrium cell communication and synchronization. Taken together this suggests an important role of melatonin in the onset and progress of labour. We therefore hypothesise that supplementing women undergoing induction of labour with melatonin will improve the success rate of induction of labour. We will undertake a double-blinded randomised controlled trial of melatonin supplementation to improve the success of induction of labour in healthy first time mothers.

In a crossover study, we aim to determine whether a Mediterranean diet with adequate dairy foods, consumed over 8 weeks, will improve measures of blood pressure, cardiometablic health, wellbeing and cognitive performance, more than a low fat diet in an high risk population of men and women with for cardiovascular disease (CVD). We believe that volunteers consuming a Mediterranean diet enriched with dairy foods (MedDairy diet), to meet the nutrient reference values for calcium in Australia, will have greater improvements in blood pressure than a low fat diet, based on Heart Foundation recommendations. Low fat diets are recommended for treatment of many chronic diseases such as type 2 diabetes mellitus, heart health and secondary prevention of stroke etc. together with regular physical activity. We know that the MedDiet, rich in bioactive foods and nutrients, has significant effects on longevity as well as reduced total death and death from CVD. Furthermore, given the independent reported health benefits of dairy foods on CVD risk factors including blood pressure, blood lipids etc. a diet combing both a Mediterranean diet and dairy foods (MedDairy diet) may in fact improve indices of cardiovascular health more than a low fat diet.

This study is a pilot observational study, conducting a cross-sectional survey on patient attitudes and satisfaction with medical consultations whilst a medical scribe is present during an Emergency Medicine consultation. It will use a convenience sample of all patients attending Cabrini ED between the dates of April 2016 to September 2016 (the period of time there is a study being undertaken on the economics of using medical scribes at Cabrini Emergency Department). It will commence once ethics approval is obtained from Cabrini HREC. It will use a survey developed specifically for the purpose. Items will relate to patient satisfaction with the consultation and patient satisfaction with various components of the consultation. It will also include a net promoter score for the Emergency Department. It will compare consultations with scribes to consultations without scribes during the same time period using the same group of physicians and the same investigation site. Medical scribes are an emerging role in health. Their numbers are rapidly expanding. Research to date has focused on the economics of their use. There is a need for health administrators and emergency doctors to understand their potential impact on the patient during consultations and this exploratory work should assist with directing future work and guiding administrators and doctors on whether and how to utilise scribes in the future.