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As a low risk, readily available treatment, PRP injections are becoming an increasingly popular therapeutic adjunct offered by musculoskeletal clinicians. However, there is a clear need to scientifically assess the merits of this treatment option for athletes with ankle syndesmosis injury in order to establish recommendations for evidence-based practice. We published a pilot study entitled- "Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury". Available at http://bmjopensem.bmj.com/content/1/1/e000033.full.pdf+html We found a reduction in return to play by 20.7 days for the intervention (PRP) group, when compared to an historical control treated with the same rehabilitation protocol. The study supports the viability of an RCT to fully evaluate this treatment. We have calculated that a minumum of 30 participants would be required to detect a significant difference between groups in return to play, but would define a clinically significant difference as a minimum of one week. We will conduct a prospective randomised controlled trial comparing single US-guided PRP injection to an active placebo prolotherapy. Assessors, investigators and participants will be blinded to their allocation and only the treating radiologist who will only interact with particpants to perform injections, will know allocations. Prospective participants from Rugby union clubs within the Sydney Rugby Union Championship will be invited to enrol. On clinical assessment, only those with a low probability for ASI will not be referred for MRI. After MRI, those meeting enrolment criteria and consenting to participate will be randomly allocated to PRP or active placebo groups, and given usual injury management in accordance with our previously published milestone based rehabilitation protocol (Samra et al 2015). A single injection by co-author JL will be provided within 14 days of injury. A central randomisation register will provide the allocation to JL only. The injection protocol will be identical between groups, except for lack of injection of the PRP in the active placebo group. 1-2mL of 2% lignocaine will be infiltrated to the skin and superficial tissues. Blood will be drawn and centrifuged at 3000RPM for 8 minutes. The PRP will be manually aspirated. 0.5-1mL of PRP will be injected with a 25 guage needle into the defect of the AITFL seen on ultrasound in the intervention group. The active placebo group will undergo the same process with the omission of injection of the PRP. Instead, a peppering technique of 5 passes into the AITFL will be performed. Participants will be given oral analgesia and post-injection care information and followup. No other injections of the ankle will be permitted during the rehabilitation of these athletes or within 1 week of return to play. Return to play will be recorded in days from injury onset to first competitive match (of any duration) played since injury

ABSTRACT Background: People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. Methods & Design This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education centres across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills – knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, health literacy; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program. Ethics and dissemination The study has ethical approval from the University of Sydney and 10 NSW Institutes of TAFE. Results will be published in peer reviewed journals, and reported to partner organisations.

Background: Continuous enteral feeding mode that is aimed at achieving daily caloric target is the standard practice in ICU. However, there is no strong evidence in favour of continuous enteral feeding over intermittent feeding. Continuous feeding infusions are interrupted for nearly 25% of the time and are often delivered at a reduced rate for reasons such as perceived gut intolerance or dysmotility and the need to withhold feeds for concurrent medical, surgical and diagnostic procedures. Consequently, patients in ICU are often underfed. Intermittent enteral feeding is more physiological. It mimics the natural ingestion-fasting cycle and preserves the natural cyclical secretion of gut hormones such as gastrin and motilin. These hormones are closely related to the cycle of meal ingestion and the period of fasting between two meals. It is plausible that continuous feeding interferes with ingestion-fasting cycle and interrupts the natural rhythm of hormonal secretion that is primarily responsible for gastrointestinal motility. Further, intermittent feeding mode is less affected by frequent interruptions, and therefore may also be more effective in achieving daily caloric target. Additionally, there is evidence for more efficient gastric emptying in the right lateral position (J Nucl Med. 1996). Delivering intermittent feeds while in right lateral position seems feasible, as regular posture turns are part of standard nursing care. However, such posture-aided intermittent feeding has not yet been investigated. Aim: To determine whether intermittent enteral feeding during the right lateral tilt position results in less gastrointestinal intolerance compared to standard care among mechanically ventilated patients. Methods: 120 eligible patients who are likely to require mechanical ventilation in ICU for at least 24 hours will be randomly allocated to either standard care arm or intermittent feeding arm. The feeding formulae and target feed volume and continuous infusion rate will be determined prior to randomization. Patients in the intermittent feeding arm will be fed at least three times a day with one third of daily target feed volume infused over one hour each time. Informed consent will be sought from the person responsible or the legal surrogate. Patients will be followed until ICU discharge or maximum 14 days whichever is earlier. Primary end-point: Incidence rate of gastrointestinal intolerance (vomiting, diarrhea or constipation). Secondary end-points: Days free of gastrointestinal intolerance (vomiting, diarrhea or constipation) until day 14, episodes of vomiting and diarrhea per patient, time to vomiting or diarrhea, mean diet volume ratio (diet received/ diet prescribed) expressed as percentage, ventilator-free days until day 14, and all-cause hospital mortality.

For patients that survive ICU there are considerable long-term burdens from being so unwell and the treatments administered in ICU. Because of the long-term health issues it has been proposed that patients who survive ICU should be able to access specialised services via so-called ‘follow-up clinics’. However, the health budget is relatively fixed and so an increase in provision of one health service means that another health service must be reduced. Follow-up clinics are expensive and currently there is no evidence that these follow-up clinics benefit patients. Accordingly, it is imperative that we establish whether these follow-up clinics are helpful or represent a waste of valuable resources. We will study a very specific group of patients, those with diabetes who have survived ICU. We are studying this group of patients as patients with diabetes make up a significant proportion of patients in ICU. It is also likely, but not yet known, that patients with pre-existing diabetes who survive ICU may be particularly vulnerable to poor health outcomes after ICU. The intervention we will study is a follow-up clinic run by physicians with expertise in ICU (intensivist) and diabetes (endocrinologist). Our study will provide preliminary information as to whether this type of ICU follow-up clinic is of benefit. If the preliminary data are promising we will undertake a much larger study so that we can precisely measure the effects of these clinics.

Little is known about how patients function in the community following discharge from rehabilitation. Despite the assumption that patients will continue to improve on their own, limited data suggests that they do not. We will assess the function of older adults living in the community within 12 months of being discharged from inpatient rehabilitation. Analysis will identify factors associated with ageing well in the community and factors that predict functional decline. This will provide important data to aid rehabilitation clinicians to tailor their care to optimise function and prevent functional decline.

The uptake and timeliness of the primary immunisation series in infancy is critical to preventing infectious diseases morbidity and mortality. There is a high burden of vaccine preventable diseases in Aboriginal and Torres Strait Islander children irrespective of geographic location, however limited attention has been paid to those living in urban and regional settings. The need to improve the timeliness of the primary series has been known for at least 10 years but there has been little change over that time. Recent data from a cohort of Aboriginal and Torres Strait Islander children in Caboolture, Queensland suggests approximately 44% of children have not completed the primary series by 7 months of age. Identifying simple, culturally appropriate and cost effective interventions to improve timeliness is therefore a priority. This trial aims to To evaluate the effectiveness of targeted, culturally appropriate short messaging service (SMS) and/or home visiting in improving the uptake and timeliness of the primary immunisation series in urban/regional Aboriginal and Torres Strait Islander children

This study has been designed to elucidate when is the optimal time to introduce weight management to newly diagnosed patients with OSA who are about to commence on standard care which is overnight CPAP. We have designed this trial to have a step wedge element so that each person will be exposed to the intervention over a 12 month period. To address aim 1) Primary outcome (weight) as measured during each month during the control and intervention periods of the stepped wedge design will be compared between periods. The main effect of the intervention will be examined using a multilevel, mixed effects, linear mixed model analysis approach. Fixed effects will be included in this model for “time” and “intervention”, while a random effect will be included for the effect of “participant”. To address aim 2) We will examine the association between lifestyle intervention commencement month and weight at 12 month follow-up (adjusted for baseline weight). This analysis will treat "lifestyle intervention commencement month" as a continuous variable and examine both a linear and quadratic relationship with the outcome. This design has certain advantages over standard randomized controlled trials which include enabling every participant to be exposed to the intervention and that the impact of time is assessed. This design consists of an initial period, where no one is exposed to the intervention. Eventually, at regular intervals (the “steps”) one cluster (one group) will be randomised to cross from the control to the intervention under evaluation.

Currently, Emergency Physicians in Australia perform a significant amount of clerical tasks in the provision of direct patient care. These clerical tasks may take up to 44% of the time dedicated to an individual patient and include the writing of notes, obtaining results, faxing and organising investigations, contacting other healthcare providers and billing. More broadly, the aging population and increasing use of the healthcare system in Australia, coupled with restrictions on the funding of healthcare is mounting pressure on emergency departments to make productivity gains and ensure their economic sustainability. Currently, physicians in the Cabrini Emergency department see 1.0 patients per hour on average however 2-3 patients per hour are seen with the assistance of medical scribes in other health systems (1,2). This gain in productivity forms an economic basis for the use of scribes in emergency departments, but the implementation of a scribe program can be a daunting experience to the physicians they work with. For a physician to work well with a scribe and improve their productivity they need to work differently, working in a team with their scribe, trusting the scribe’s work; letting go of administrative tasks and focusing on higher-level cognitive tasks for the majority of their time. This probably requires a good working relationship with their scribe and a positive experience of using a scribe. Physician experience with scribes is not yet broadly described, however Hess notes that 60% of their providers liked or really liked having a scribe whilst 9% would be happier if they weren’t allocated a scribe. Initial work at Cabrini describes marked differences in productivity gains between providers. There is no work published to date on the experiences of emergency physicians who like or don’t like having scribes and how this relates to the economics gains (or not), of the providers. Work is required to identify what a provider experiences when working with a scribe. What issues are anticipated before working with a scribe? Are these issues real issues as they work scribed shifts? Are there common themes of concerns about scribe utilisation? Can these barriers or concerns be described so that solutions can be considered? How do these concerns relate to productivity gains for each provider? This study aims to investigate the common concerns faced by physicians during the implementation of a scribe program and to compare these to the concerns held once the program is established. This study also aims to correlate the concerns regarding perceived productivity with actual productivity data. References 1. Arya R, Salovich DM, Ohman-Strickland P, Merlin MA. Impact of scribes on performance indicators in the emergency department. Acad. Emerg. Med. 2010; 17: 490–4. 2. ACEP use of scribes in the emergency department – an information paper. June 2011. [Cited 24 Jan 2016.] Available from URL: http://www.ACEP.org

Hypothesis: We hypothesize that the introduction of NIR service at our hospital is associated with a significant reduction in unfavorable neurological outcomes related to SV among patients with SAH. Our secondary hypothesis is that there is an association between clinical outcomes and the length of ICU stay prior to the surgical or endovascular management of SAH and that prior to suspected SV. Aims: Our primary aim is to compare differences in neurological outcomes, among patients who were admitted with SAH and were suspected to have SV, during a period of 30 months before-and-after the introduction of NIR service at a university-affiliated tertiary referral hospital. Primary objective: To assess and compare modified Rankin scores (mRS), at/or closest to 6 months after hospital discharge, among patients with SAH and suspected SV during a period of 30 months before and 30 months after the introduction of NIR service at our hospital. Secondary objectives: * To assess whether the ‘after’ phase was associated with lower incidence of SV, lower incidence of cerebral infarcts, shorter length of hospital admission, and lower mortality as compared to that during the ‘before’ phase. * To assess whether the time spent with unsecured aneurysm, or the time spent in non-critical care areas prior to the onset of SV have any relationship with mRS scores and mortality. Methods: This is a retrospective before-and-after study at a multidisciplinary academic ICU at John Hunter Hospital, Newcastle. The study will be conducted over a period of 12 months during which the required data will be collected retrospectively for the 1 Jul 2010 to 30 Dec 2012 period and then for the 1 Jan 2013 to 30 June 2015 period. All consecutive eligible patients admitted during the two periods will be enrolled in the study. Besides demographics, severity scores and clinical outcomes, the study will also collect data related to process-of-care during the two periods. Significance: The health and financial burden of long-term complications due to SV among patients with SAH are substantial. This observational study will inform the overall clinical outcomes for these patients in our practice. This may help us benchmark our clinical outcomes against those reported in international studies. This baseline data might also be useful to design an interventional trial investigating strategies to improve quality of care delivered to this patient group.

Research indicates a high prevalence of eating disorder symptomology in elite athletes in comparison to the non-athlete population (Smolak et al., 2000). Perfectionism is an a critical risk and maintaining factor in eating disorders (Egan et al., 2011) and compulsive exercise (Coen & Ogles, 1993). CBT guided self-help treatment has been found to treat effectively perfectionism (Egan et al., 2014). This trial will implement an online, guided self-help treatment for perfectionism in athletes to examine if it reduces Eating Disoder symptomology, compulsive exercise and burnout in athletes.