ANZCTR search results

Conduct problems are the most common reason children are referred for mental health treatment, and each child with conduct problems incurs a lifetime public service cost more than eight times greater than that for a healthy child. The presence of callous-unemotional (CU) traits (e.g., lack of empathy/guilt, uncaring attitudes) designates an important subgroup of children whose severe, stable, and aggressive conduct problems are developmental precursors to psychopathy and antisocial behaviour in adulthood. Consequently, CU traits were added as a specifier (called ‘with limited prosocial emotions’) to the diagnosis of conduct disorder in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders. Between 50-70% of Australian children with diagnosable conduct problems show clinically significant levels of CU traits ('CP+CU children’). Given that treatment for adult psychopathy does not significantly reduce crime and violence, early intervention with at-risk children is vital. However, the conduct problems of CP+CU children are resistant to many traditional evidence-based behavioural interventions that are effective for children without CU traits (‘CP only children’). The reason for this resistance to treatment appears to be that the conduct problems of children with CU traits arise from distinct factors from those typically targeted in traditional interventions. While the field has developed a better understanding of the unique deficits and needs of CP+CU children, interventions that comprehensively target them have not yet been systematically developed and tested. In order to improve the clinical outcomes of these particularly high risk (CP+CU) children, a major shift in clinical practice paradigms is needed. We propose testing the efficacy of a novel intervention to improve emotional and behavioural outcomes in young CP+CU children. Through pilot testing, an adaptation of Parent-Child Interaction Therapy (PCIT), a traditional evidence-based model of parent management training (PMT) intervention, has developed and refined. PCIT-CU, as it is known, addresses the distinct temperamental deficits of CP+CU children—reward dominance, and insensitivity to distress cues and punishment. PCIT-CU differs from standard PCIT in three key ways: it (a) trains parents to engage in warm, emotionally responsive parenting that improves conscience development among temperamentally fearless children, (b) systematically supplements punishment-based parenting strategies (i.e., time out) with reward-based techniques shown to improve treatment outcomes for reward-dominant CP+CU children, and (c) delivers emotional skill-building instruction to CP+CU children to target their distinct emotional deficits. Given the significant societal burden of this seriously impaired and treatment-resistant subpopulation of children, outcomes associated with the project have the potential to yield impactful and far-reaching clinical and public health benefits.

This research project aims to help improve detection methods for heart disease. The purpose of this research project is to investigate whether it is possible to prepare patients faster and whether it is possible to improve imaging of the heart for cardiac PET imaging. Usual practice is to have patients on a high fat, low carbohydrate diet from the evening beforehand and then to have them fasting for 4-6 hours immediately prior to the scan. The new method is called intravenous fat emulsion (trade name Intralipid), which should be able to be administered rapidly. This will be tested to see if it is an effective preparation for positron emission tomography using a sugar-based radionuclide as an alternative method of preparation.

Biliary complications are significant cause of graft failure and morbidity in Liver Transplantation. Cellular injury has been shown in the literature to contribute to the development of biliary complications. A growing body of evidence demonstrate that bile duct injury occurs early after organ retrieval. Bile salt toxicity is a vector of injury to bile ducts which may be preventable. Experimental animal studies on pigs have indicated that flush the bile duct with hydrophobic bile salts and preservation solution can induce injury to the biliary epithelium during cold ischaemia. In addition, there have been studies demonstrating the importance of adequate biliary flush out before cold storage in liver transplantation, however this would typically occur at the backtable procedure in the donor surgery, which may be up to 20minutes from cross clamping. Our hypothesis is that an intraoperative bile duct flush (IBF) before cross clamping, will decrease exposure of hydrophobic bile salts to bile duct and reduce bile salt toxicity. The reduced bile salt toxicity should decrease injury to the bile duct which has been associated with the development of biliary strictures and biliary complications and highlights the expected benefit of the intervention.

Type 1 diabetes affects 10 - 15 per cent of all people with diabetes. Based on the promising findings from our preliminary studies on the efficacy of Tai Chi for type 2 diabetes, the overall aim of the proposed project is to assess the effects of Tai Chi on type 1 diabetes. The proposed project is a two-group quasi randomized controlled trial. Participants with type 1 diabetes will be randomly allocated to the Tai Chi, or the usual medical care alone control group based on recruitment date. Metabolic/biochemical, physical, psychological, general health and well-being, and behavioral measures will be assessed at baseline, 3 and 6 months for intervention group and at baseline and 3 months for the control group. The main hypothesis of the project is that study participants with type 1 diabetes who receive the Tai Chi program will demonstrate improvements in indicators of glycaemic control, mental health and quality of life after 3 months of participation relative to participants who receive usual care alone over the same period.

A key defect in type 2 diabetes (T2D) is the impaired ability to respond to insulin and remove circulating glucose and store it in muscle. We have recently established that long-term and high dose vitamin C supplementation improves insulin sensitivity in muscle in people with T2D to a degree which is clinically significant. Therefore, this cheap and safe supplement is likely to be an effective adjunct therapy to complement current standard care and control excess blood glucose levels. Therefore, the aim of this project is to investigate whether antioxidant vitamin C supplementation results in a clinically significant improvement in glycaemic control in people with T2D. Forty males and females with T2D (aged 45-75 yrs) will be recruited and undergo placebo and vitamin C (0.5g twice daily) in a double-blind, randomized, cross-over manner. Outcome measures will be conducted at the beginning (baseline) and end of each 4 month treatment and involve a visit at each of these times to the Clinical Research Laboratory at Deakin University. There will be a 4 week washout between treatments, so total involvement will be 9 months. Participants will be asked to complete a 4-day food and physical activity diary the week prior to each laboratory visit. Participants will have their height, weight and blood pressure measured and a DXA scan to measure body composition. Participants will be fitted with an accelerometer to measure physical activity and a Continuous Glucose Monitoring (CGM) system to monitor interstitial blood glucose. The following morning they will visit the laboratory in a fasted state and have a blood sample taken and eat a healthy breakfast provided by us. The accelerometer and CGM will be worn at home by participants, and (blinded) measurements will occur over a continuous 48-hour period while participants eat pre-prepared healthy meals provided by us.

This study aims to demonstrate a more time intensive therapeutic intervention by experienced alcohol and drug nurse clinicians called Engagement Assisted Referral Therapy (EART) is significantly superior to the brief standard treatment, a Brief Information Pack (BIP) and matched time with BIP + Adjusted Time with a student nurse in general conversation (BIP + AT), in improving engagement with the external alcohol and drug rehabilitation agency of patient choice and outcomes for patients with comorbid substance use disorder and mental illness. after discharge from the Sir Charles gairdner Mental Health Unit

Aim: To investigate the short-term and long-term effects of brief alcohol abstention on behavioural and clinical measures of health and wellbeing among non-dependent drinkers using a randomised controlled trial design under real-world conditions. Hypotheses: Short-term change. We hypothesise that: a) Mean alcohol intake during abstinence pledge periods will be significantly lower compared to usual (baseline) alcohol intake. b) Compared to usual drinking, four consecutive weeks of abstinence will effect significant changes in adiposity, diet, sleep quantity/quality, activity level, mental and physical health, other substance use, behaviour towards others (BTO) and harms from others’ drinking (HFO), biomarkers for CVD (blood pressure, fats, inflammation) and liver function (enzymes). c) Compared to usual drinking and four consecutive weeks of abstinence, Eight weeks of consecutive of abstinence will effect significant changes in adiposity, diet, sleep quantity/quality, activity level, mental and physical health, other substance use, BTO, HFO, biomarkers for CVD and liver function. Long-term change. We hypothesise that: d) Mean alcohol intake one, three and six months after abstinence pledge periods will be significantly lower compared to baseline alcohol intake, and that these differences may be more pronounced among those with higher levels of alcohol consumption at baseline. e) There will be significant changes in adiposity, diet, sleep quantity/quality, activity level, mental and physical health, other substance use, behaviour towards others, harms from the drinking of others, biomarkers for cardiovascular disease and liver function, at three and six months follow-up compared to baseline.

Osteoarthritis (OA) is a degenerative joint disease affecting many middle-aged and older adults. As osteoarthritic symptoms typically involve joint pain and stiffness, individuals with OA of the knee are insufficiently physically active, have low levels of physical function and are at increased risk of other comorbidities, falls and reduced quality of life. While continuous moderate intensity cycling is often recommended for individuals with knee OA, little is known about the potential benefits and risks of high intensity interval training (HIIT) cycling for this population, even though this form of exercise is becoming more commonly utilised by a range of other chronic disease groups. This randomised controlled feasibility trial sought to gain some insight into the feasibility, safety and effectiveness of home-based HIIT compared to continuous cycling in middle-aged and older adults with knee OA. Methods: Middle-aged and older adults with knee OA were randomly allocated to either continuous (MICT) or HIIT home-based cycle training programs; with both programs requiring the performance of four cycling sessions (~25 minutes per session) each week. Participants were measured at baseline and post-intervention (8 weeks). Feasibility was assessed by withdrawal rate, adherence rate and number of adverse effects. Efficacy was assessed by the WOMAC, Lequesne index of severity for osteoarthritis of the knee, Timed Up-and-go (TUG) test; Sit-to-stand (STS), preferred gait speed and body composition.

This study aims to identify genetic differences and dermatological characteristics that pose greater risk for development of skin cancer. Who is it for? You may be eligible to join this study if you are aged 18 years or more and are either undergoing targeted therapies and/or immunotherapies at the Cancer Services (PA Hospital) for stage III or IV melanoma OR if you are considered to be at a high risk of melanoma. Study details: This is an observational prospective study (no additional treatment) on the natural history of naevi in advanced melanoma patients receiving treatment. This will include observations of molecular and genetic differences associated with changing naevi and melanoma risk. Patients will be followed up every 4 months for 1 year (4 visits in total) with 3D whole body photography and dermoscopy of all naevi larger than 3mm. The germline genotype is determined by collecting saliva together with baseline demographic data along with images. During follow up visits, naevi which show clinical and dermoscopic changes in pigmentation are sampled using a microbiopsy device. DNA and RNA can be isoalted from these samples for somatic genotyping. The same naevus can be sampled several times over the course of its growth and following visits. Additional shave biopsies (up to 3) will also be taken for comparative purposes. It is hoped that this study will lead to better understanding of genetic and phenotypic characteristics that lead to high risk of melanoma development and that may then assist in early diagnosis and preventative behaviours of skin cancer.

Purpose of the study: This study aims to explore how adults with no history of thyroid cancer would make decisions about treatments based on the terminology used to describe a hypothetical diagnosis of papillary thyroid cancer. Who is it for?: You may be eligible to join this study if you are aged 18 years or more, have no history of thyroid cancer. Study details: All participants in this study will be presented with three hypothetical scenarios that describe the diagnosis of papillary thyroid cancer using various terminology with and without the "cancer" term. The order in which these scenarios will be provided is random (by chance). Each hypothetical scenario and the treatment options presented to participants will be identical with the only difference being the terminology used. Following presentation with these scenarios participants will be assessed on treatment preferences and psycho-social outcomes. This research study will contribute to a new body of research aimed at understanding how different terminology for precancerous conditions or early stage cancer affect patient’s decision making about treatment.