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The primary purpose of this study was to determine the concentrations of the drug paracetamol in the plasma and cerebrospinal fluid after intravenous and oral administration to adult patients having surgery under spinal anaesthesia.

Labour is perhaps the most hazardous time in pregnancy for the fetus. Uterine contractions can contribute to more than a halving of blood flow to the uterus and placenta and this in turn may lead to fetal distress. In most pregnancies, the placental blood supply and function is adequate but it may not be sufficient to tolerate the extra demands of labour. Up to 63% of babies who become distressed and suffer oxygen deprivation in labour have no prior risk factors. Furthermore, events in labour account for as many as 20% of cases of cerebral palsy in term infants. Recent research demonstrates that the changes in blood flow to the fetus can be detected by ultrasound and that these changes are highly predictive of identifying fetuses at risk of becoming distressed in labour, as well as reliably excluding those that were not at risk. With this in mind, investigating ways to preserve and promote the blood supply and in turn, the oxygenation to the fetus has the potential to significantly change intrapartum care. Sildenafil is a vasodilator (opens blood vessels) and based on previous research may play a role in enhancing blood flow to the fetus. This clinical trial will investigate if having sildenafil in labour improves the blood flow to the fetus and reduces the need for emergency operative delivery (either caesarean section or operative vaginal birth) for fetal distress.

Background: Postoperative complications and delayed physical recovery are significant problems following emergency abdominal surgery. Physiotherapy aims to aid recovery and prevent complications in the acute phase after surgery and is commonplace in most first-world hospitals. Despite ubiquitous service provision, no well-designed, adequately-powered, parallel-group, randomised controlled trial has investigated the effect of physiotherapy on the incidence of respiratory complications, paralytic ileus, rate of physical recovery, ongoing need for formal sub-acute rehabilitation, hospital length of stay, health-related quality of life, and mortality following emergency abdominal surgery. We hypothesise that an enhanced physiotherapy care package of additional education, breathing exercises, and early rehabilitation prevents postoperative complications and improves physical recovery following emergency abdominal surgery compared to standard-care alone. Methods: The Incidence of Complications following Emergency Abdominal surgery: Get Exercising (ICEAGE) trial is a pragmatic, investigator-initiated, multicentre, patient and assessor-blinded, parallel-group, active-placebo controlled randomised trial, powered for superiority. ICEAGE will compare standard-care physiotherapy to an enhanced physiotherapy care package in 288 participants admitted for emergency abdominal surgery at three Australian hospitals. Participants will be randomised using concealed allocation to receive either standard-care physiotherapy (education, single session of coached breathing exercises, and daily early ambulation for 15-minutes), or an enhanced physiotherapy care package (education, twice daily coached breathing exercises for a minimum two days, and at least 30-minutes of daily supervised early rehabilitation for at least five postoperative days). The primary outcome is respiratory complications during the first seven postoperative hospital days assessed daily with standardised diagnostic criteria. Secondary outcomes include referral for sub-acute rehabilitation services, discharge destination, paralytic ileus, hospital length of stay and costs, intensive care unit utilisation, 90-day patient-reported complications and health-related quality of life and physical capacity, and mortality at 30-days and at one year following surgery. Discussion: The morbidity, mortality, and fiscal burdens following emergency abdominal surgery are some of the worst within surgery. Physiotherapy may be an effective, low-cost, low-harm intervention to improve outcomes and reduce hospital utilisation following this surgery type. ICEAGE will test the benefits of this commonly provided intervention within a methodologically robust, multicentre, double-blinded, active-placebo controlled randomised trial.

The aim of this study is to gather information about the effectiveness of a foam dressing to prevent the development of sacral pressure injuries (PI). Currently, preventative dressings are not used routinely. In this study,of adult patients who are at high risk of developing a PI, half of the sample of 126 patients will be randomly allocated to receive the sacral foam dressing and half will receive standard care i.e. no sacral dressing. The dressing will remain in place for the duration of each participant's hospital stay. It will be replaced routinely after 7 days, or before if needed. In all patients, the sacral skin will be inspected on a daily basis to observe for the presence of PI, for a maximum period of 4 weeks. The main outcome measure will be the occurrence of sacral PI. Dressing comfort will be evaluated from the patient's perspective, and its utility will be evaluated by nurses. A cost analysis will also be undertaken. It is anticipated that patients treated with the foam dressing will have a lower incidence of pressure injuries than those receiving standard care.

The Predictors of Post Concussive Syndrome Protocol that we are developing concerns a study on the derivation and validation of a clinical prediction rule for PCS in children aged 5 to 18 years, who present to the ED for concussion. In order to assist clinicians in identifying patients at high risk of PCS, who will benefit from a closer follow up and early referral to a dedicated concussion clinic, we set out to derive and validate a clinical prediction rule based on pre-injury and injury-related data to be used in the ED.

The aims of our study are to determine whether the use of algorithms with point of care testing to guide the use of factor concentrates can target bleeding more quickly and precisely and lead to a reduction in red cell transfusion rates compared to the use of allogeneic blood products. We will also examine its impact on other secondary outcomes, such as morbidity and mortality, bleeding and thrombotic complications.

kContact is a three-year study to develop and trial an enhanced model of managing and supporting contact between children in care and their birth parents. The aim is to reduce current and future distress related to contact, improve children's relationships with their parents.

It is routine practice at the Haemophilia Treatment Centre at The Alfred that patients who undergo dental extraction or low risk endoscopic procedures receive tranexamic acid (TXA) with or without factor concentrate replacement (depending on proceduralist determined bleeding risk). Despite clinical reports of no increased rate of bleeding utilising this strategy, the underlying biological mechanism has not been extensively explored. We aim to evaluate the impact of TXA on functional fibrionolysis by enrolling such patients and healthy controls into the proposed study. Enrolled patients will ingest one gram of oral tranexamic acid on the day of procedure and blood will be collected immediately before and 4 hours post ingestion. Plasma samples will be prepared and stored for evaluation of fibrinolysis utilising contemporary clot lysis assay. Correlation of the results will be made with clinical bleeding as reported by the proceduralist who are blinded to the results. Healthy volunteer subjects will also take a dose of one gram of tranexamic acid and have plasma samples collected at 2,4, and 8 hours post ingestion. Fibrinolysis will be measured using a light transmission based assay where thrombin and tissue plasminogen activator are added to the plasma. The expected effect of tranexamic acid is a delay in fibrinolysis in the control samples. In the patient samples, it is expected that clot formation will be impaired by the bleeding disorder but the tranexamic acid may similarly delay fibrinolysis when compared with controls.

The purpose of this study is to determine if immunonutrition prior to pelvic exenteration surgery for people with cancer decreases complications, length of hospital stay and immune markers after their surgery. Who is it for? You may be eligible to join this study if you are aged 18 years or above, and are scheduled to undergo pelvic exenteration surgery for cancer. Study details - Participants in this study will be randomly (by chance) allocated to one of two groups. Participants in one group will consume 3 immunonutrition supplements (known as Impact Advanced Recovery) each day for 5 days prior to their surgery. Participants in the other group will instead consume 3 nutrition supplements with equivalent protein and energy as the immunonutrition supplements (3 x Resource Protein) each day for 5 days prior to their operation. All participants will be monitored for up to 3 months post hospital discharge for any post-operative complications, such as infectious or non-infectious complications and immune markers.

In Australia ~75% of eye examinations are delivered by Optometrists. Optometrists have a legal and moral obligation to identify eye disease, manage suitable cases and refer others requiring medical or surgical intervention to ophthalmologists. With an aging population, the management of chronic eye disease is an increasing issue for the already stretched health system. The NHMRC glaucoma guidelines encourage development of shared-care models between primary health care providers and ophthalmologists. The guidelines also highlight the need for low-risk glaucoma patients to be monitored by primary eye care providers and not referred to Ophthalmology thereby minimizing the possibility that the health system is overloaded with false positive referrals. Until now, this new model of glaucoma management has been largely unexplored, especially with regards to assessing the effectiveness of the current optometric profession in clinical diagnosis, referral quality, appropriately utilization of new technologies and integrating with complementary facilities and services. The Centre for Eye Health (CFEH), a joint Guide Dogs NSW/ACT and UNSW initiative is leading the way in promoting a shared care model for eye-care in Australia. Ophthalmic practitioners refer patients to CFEH for visual assessment using the latest technology. Over 830 optometrists in NSW/ACT have registered with CFEH. It is proposed that this pool of participants be analysed with regards to current glaucoma practice characteristics, effectiveness in clinical diagnosis, referral quality, appropriate utilisation of new technologies and integration with complementary facilities and services. The research will inform current models of Glaucoma management and the evidence will have direct policy implications for the regulatory partners. Ultimately, more cohesive and patient-focused service delivery will lead to improved quality of life for patients and a reduced economic burden of eye disease nationally.