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This is an observational study of patients who have previously been diagnosed and treated for Microangiopathic Thrombocytopenia (MAT). The study will collect clinical and laboratory data to assess the disease characteristics, laboratory features, treatments, and clinical outcome.

Bronchiectasis is pathological condition with diverse aetiologies, characterised by and abnormal dilation of conducting airways due to repeated cycles of airway infection and inflammation ultimately resulting in airway and lung parenchyma destruction. This leads to an alteration of the ciliated epithelial lining and compromises mucus clearance. In the affected areas there is excess production of mucus, where the impaired clearance of secretions causes colonisation and infections. Airway clearance techniques are regarded as an integral component in the management of Bronchiectasis, as it clears blockages of conducting airway and improves pulmonary ventilation. Some patients with Bronchiectasis only have scant secretions and it is unclear if airway clearance assists them. A systemic review on patients with chronic obstructive pulmonary disease, has reported airway clearance techniques to be useful only in patients who produce greater than 25 ml (one tablespoon) of sputum per day. Mechanical forms of airway clearance such as Flutter (Scandipharm Inc, Birmingham, Alabama, USA) has shown to assist with secretion clearance. Flutter is a simple hand held pipe like device which produces oscillating positive pressure on exhalation, through repeated displacement of the steel ball within a cone. Oscillation frequency within 3-17 Hz range has been shown to facilitate mucociliary clearance. On patients with cystic fibrosis (CF), the flutter demonstrated a mean oscillation frequency of 11.3 Hz 5. This was close to this optimal frequency range to facilitate mucociliary clearance. This study also demonstrated the Flutter to have a peak expiratory flow rate (PEFR) / peak inspiratory flow rate (PIFR) ratio > 1.1, which is critical level required for annular flow of secretions towards the oropharynx. In addition flutter has shown to alter physical properties of mucus in patients with Bronchiectasis which further assist secretion clearance. Lung Flute (Medical Acoustics, LLC, Buffalo, NY USA) is new device which has shown to assist secretion clearance. It is relatively cheaper than the Flutter. The current literature on the efficacy of the lung Flute is limited. The lung flute is a hand held device shaped like a flute with a mouth piece and a reed inside it. When the user blows into the lung flute, it creates a specific low frequency sound. The manufactures claim that this sound generates 18-22Hz with an output of 110 to 115 dB using 2.5 cmH2O pressure. This sound wave, when generated at the mouth with mild exhalation, is thought to travel retrograde down the tracheobronchial tress and vibrates the tracheobronchial secretions. The manufactures claim that this sound vibrates the airways and thins the lung secretions, which facilitate mucocilary clearance. Lung flute has demonstrated to expectorate similar quantity of sputum as active cycle breathing technique in patients with Bronchiectasis. No study has been done to evaluate the effectiveness lung flute compared to the Flutter. Therefore, the aim of the current study was to evaluate if the lung flue was as effective as the flutter in secretion clearance. Method. Study design: After ethics approval participants were recruited from the Bronchiestasis clinic at CRGH and any person with bronchiectasis referred for physiotherapy from other respiratory specialists. During the study patients were seen as outpatients. Inclusion criteria: patients with productive non – cystic fibrosis (CF) bronchiectasis (diagnosed on high resolution computerised tomography) who would produce greater than 25ml of sputum per day. Exclusion criteria: current pneumothorax, untreated cor pulmonale, haemoptysis, patients with an exacerbation in the 4 weeks prior or during the study and if they were hospitalised during the study. Information sheet about the study would be given to the participant and informed consent would be obtained. Patients would attend two visits over a two week period standardised to the same time of day, with advice to withhold usual airway clearance 24 hours prior to attendance. At each session one of the following airway clearance techniques (flutter, lung flute) will be performed in random order determined by computer generated randomisation with concealed allocation. Patients would receive comprehensive standardised practical instructions in each airway clearance technique. Participants would be supervised throughout by an experienced senior respiratory physiotherapist to ensure each technique was performed in a standardised and optimal manner. Duration of treatment would be recorded. Baseline medications were not altered. Treatment techniques Both treatment techniques would be performed in sitting. Patients would be instructed to clear secretions without to swallow the sputum. Flutter The patient would be instructed to inhale deeply and hold his/her breath for 2-3 seconds. Then the patient would be instructed to place the mouthpiece of the device into the mouth and exhale into expiratory reserve volume (ie, slightly further than one would exhale during normal breath but not to residual volume). During expiration through the flutter, the patient would be instructed to tilt the flutter upwards and downwards by a few degrees to induce maximum oscillations within the chest wall. This would be repeated for 10 breaths, with the patient inhaling through the nose and exhaling through the flutter. Then the patients would be performing one or two mid to low volumes huffs combined with periods of breathing control (normal tidal breathing). If the patients felt that they had cleared the secretions to the oropharynx then they would be instructed to do a high volume huff or cough to clear the secretions. Then the cycle was repeated after clearing secretions or if there was no secretions to clear from the oropharynx, after the low volume huff. The duration of periods of breathing control was varied depending on patients, the time required for patients to regain their normal breathing pattern and fatigue. The patients would be allowed to cough as required. The end point of the technique would be defined as two cycles and dry sounding huff. If the defined end point was not achieved within 30 minutes, the session was judged complete. Lung Flute The patients would be instructed to inhale slowly slightly deeper than normal and then place the mouthpiece of the device into the mouth. Then hold the lung flute pointing down at an angle and blow gently into the lung flute as if trying to blow out a candle. As they blow into the lung flute they would hear the reel inside the horn making a fluttering noise as it moves. Instruct the patient to concentrate on making more noise by blowing harder and faster into the lung flute. After blowing into the lung Flute twice, patients would be instructed to remove the mouth piece and wait for five seconds, taking several normal breaths. Then repeat this whole cycle of 20 sets with two blows each, unless the patient feels lightheaded or fatigued. If the patient was unable to tolerate the number of sets, the technique would be modified to do fewer sets. At the end of the session patients would be instructed to wait for 5 minutes and then do a low to mid volume huff , and when the secretions are in the oropharynx to to do a high volume huff or cough to clear the secretions. The average session would for 5 -10 minutes. This would be the end point of this technique.

Colonoscopy patients are often "dry" or dehydrated as a result of the bowel preparation. This often results in a drop in blood pressure during the procedure. A study in 2006 showed that by giving patients 15ml/kg of fluid, it did not result in improvement of blood pressures, and it was postulated that the volume infused could have been insufficient. In our study, we plan to give 30ml/kg of fluid to colonoscopy patients before their procedure, as we hypothesise that 30ml/kg may be enough to prevent or reduce the drop in blood pressures. We aim to do this by using echocardiography (taking a picture of the heart) to titrate fluids so that patients will not be overloaded with fluids.

Low back pain is one of the most common health problems and affects 80 – 85% of people over their life time. Health costs due to back problems in Australia were estimated to be $4.79 million in 2012. Low back-related leg pain or sciatica is a common variation of low back pain and may require back surgery. Thirty percent of people report persistent pain after back surgery which is associated with disability, reduced quality of life, reduced work capacity and substantial health care costs. Whilst several risk factors have been identified (e.g. psychological factors such as catastrophising, unhelpful beliefs about pain and disability) for poor outcome after surgery, the role of pre-sensory pain sensitivity is unknown. Research suggests that certain people who demonstrate hypersensitivity to sensory stimuli such as hot/cold, touch and pressure, pin-prick and vibration may be more vulnerable to develop ongoing pain, however this has not yet been explored in people with back and leg pain. This study will investigate if pre-surgical responses to these stimuli may play a role in predicting persistent pain after back surgery. The findings may assist in developing pre-surgical screening methods and in using this outcome to target pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability.

The ultimate goal of burn wound management is to promote early healing as this has considerable influence on the long term quality and appearance of scarring. Negative pressure wound therapy (NPWT) is a device that is applied to a wound to ultimately help promote healing. It is widely used in both hospitals and the home on a wide range of wounds. A dressing is applied to the wound bed and covered with a transparent film dressing and attached to the therapy device using tubing and a canister. A number of studies have demonstrated improved graft take following split skin graft when NWPT was used compared to standard dressings. However, there is very little information regarding the use of NWPT as a primary treatment for burns with respect to wound progression and pain management. A small number of studies have demonstrated improvement in acute burn wounds with the application of NPWT in the first 48 - 72 hours following injury. In addition, clinically we have seen a reduction in pain with the use of NPWT. The aim of this pilot study is to determine the feasibility of the novel application of NPWT on acute burn wounds. The outcomes of interest being pain, burn wound progression and healing. All children presenting to the Royal Children's Hospital Department of Emergency Medicine with a partial thickness burn injury aged 3 - 15 years of age will be considered for the study. Treating surgical registrars of all children meeting the inclusion/exclusion criteria presenting to the Royal Children’s Hospital, Brisbane will determine eligibility for enrolment in the study. With the parent/caregivers permission an investigator aligned with the study will discuss the study with the parents/caregivers and seek informed consent. Once informed consent is obtained participants will be randomised to one of two treatment groups (standard dressings or standard dressings plus NPWT). Dressings (+/negative pressure depending on group allocation) will be changed at day three post burn injury. Following day three all children will be managed with standard dressings until full re epithelialisation or grafting. Negative pressure will not be reapplied from day three onwards. Outcome measures include burn wound progression measured using laser Doppler imaging on day 0 and day 3, wound healing and pain.

Pneumatic tourniquet has been used in hands and forearm surgery to reduce blood loss. When the tourniquet is used for a longer period under general anaesthesia, rapid heart rate and high blood pressure can be observed. This is often referred to as ‘tourniquet pain’. In awake patients, tourniquet pain is experienced as a vague, dull aching pain in the affected limb associated with an increased blood pressure. Intercostobrachial nerve supplies sensation to the skin of the armpit and inner side of the upper arm. The nerve lies just below the skin and can be easily blocked to help with upper arm tourniquet pain. The purpose of this study is to determine the efficacy of intercostobrachial nerve block which could reduce pain from tourniquet on the upper arm. Patients who suit the participation in the study will be randomised to either group (intercostobrachial nerve block with lignocaine or saline). The pain score will be assessed every 5 minutes after the touniquet is inflated.

The proposed proof of concept study aims to identify factors that influence successful use of the CommunicAid App within a residential aged care setting. Using a case series design the study aims to create five in-depth case profiles of CommunicAid App use, characterising individual client factors (e.g. communication profile, previous use of technology) and environmental factors (e.g. communication opportunities, available communication support, lighting and noise levels within the facility). Systematic analysis and interpretation of the individual case profiles will allow the critical factors to be identified that influence successful use of the App during everyday interactions. This will provide direction for the development of tailored training and communication support strategies to embed use of the App into routine care delivery.

The aim of the study is to assess how reducing adolescent sitting time affects adolescents’ energy levels, cardio-metabolic measures and their level of concentration. To accurately assess these outcomes, the study involves the use of the whole room calorimeter. The whole room calorimeter is a room around the size of an adolescent’s bedroom that measures the oxygen consumption and carbon dioxide production of the person inside. These measurements enable energy levels to be accurately measured. Research shows that adolescents spend more than 50% of their waking hours sitting. The total period of time they sit for per day is only slightly less than the total time the elderly (65 years and older) sit. Research involving adolescent sitting- time and health outcomes is limited. It has been reported that high levels of sitting are associated with lower levels of cardiorespiratory fitness, and higher levels of cholesterol, and body fat. Given the potential harmful effects of excessive sitting and that a large majority of an adolescent’s waking day is spent at school, it is important to understand how much more energy is expended if an adolescent sits for less total time during a typical school day. Currently adolescents spend approximately 240 minutes (4 hours) each day sitting during school time. This study plans to investigate a reduction in sitting time amongst adolescents during a typical day at school. It has the potential to improve the energy expenditure, which can impact health and developmental outcomes of adolescents. This study will provide the highest level of evidence available to move this research field forward, due to use of the University of Wollongong’s whole- room calorimeter, as it is the only one in Australia.

This is a Phase I trial to determine safety and tolerability of paclitaxel in combination with cisplatin and capecitabine in patients with advanced gastric cancer and peritoneal metastases. Who is it for? You may be eligible to join this study if you are aged 18 years or above, have been diagnosed with gastric cancer and peritoneal metastases, and have not had previous chemotherapy for metastatic gastric cancer. Study details All participants will be given the combined treatment of paclitaxel, given through an intraperitoneal catheter (a thin tube surgically inserted through the stomach cavity), cisplatin, given intravenously (through a tube inserted into the vein), and capecitabine, given orally. Different doses will be tested to determine the maximum tolerated dose for paclitaxel. Participants will be follow-up for up to 6 cycles, or 18 weeks, during treatment and then for a further two years post treatment in order to determine safety and tolerability of paclitaxel, response rate, survival and effect of treatment on quality of life.

The research question Does exposing patients to a website containing accurate, free and easily accessible information related to the operation to be performed as part of the consent process improve the informed consent attained? This will be measured by accessing 3 end points: comprehension satisfaction anxiety Hypothesis: The use of the Orthoanswer website, as an adjunct to standard consent procedures, significantly improves the satisfaction and comprehension of informed consent whilst decreasing anxiety levels concerning the operation.