ANZCTR search results

The aim of this study is to assess whether, following a spinal anaesthetic for caesarean, transient maternal hip and knee flexion in the left lateral tilt supine position can allow caesarean section to commence earlier than traditional positioning with lower limbs straight. If this technique safely speeds up the onset of "adequate" surgical block suitable for the caesarean operation, it can potentially reduce the rate of caesarean sections requiring general anaesthetics. It is well established that in pregnant women requiring caesarean section most of the anaesthesia related risks have higher rate under general anaesthesia in comparison to spinal anaesthesia.

The primary purpose of this pilot project is to demonstrate the feasibility of a randomised controlled trial (RCT) investigating whether older people undergoing rehabilitation who receive feedback on activity levels are more active than patients who do not receive feedback. One of the main reasons older people are admitted for rehabilitation is to improve their mobility. There is increasing evidence indicating that mobility is improved by increasing physical activity. However, studies have shown that physical activity levels are very low in people undergoing rehabilitation. One difficulty for therapists is that to date there has been no way of easily measuring or monitoring activity levels in patients. It is therefore difficult to know how active a person really is, and whether their activity levels are improving during their rehabilitation stay. There are now devices available that can provide accurate feedback about activity levels, even in people who have very low levels of mobility and activity. One device is the SenseWear armband, which is the size of a watch and can measure even small changes in activity. The SenseWear armband has an optional display unit, which provides the person and their therapists with real time feedback about their level of activity. Studies in community dwelling groups have shown that feedback about activity levels can be used to improve activity. However, older people undergoing rehabilitation are typically more frail and dependent on staff to assist them be active. Hence, it is not known whether providing feedback to older people undergoing rehabilitation will lead to increased activity levels. Forty older people admitted for inpatient rehabilitation will be randomly allocated to either receive feedback and develop activity goals based on their activity level (intervention group) or monitoring of activity without feedback (control group). All participants will wear a Sensewear device for up to 3 weeks while undertaking inpatient rehabilitation. The results of the pilot will be utilised to inform the design and need for a future RCT. If we find that feedback provided by Sensewear device can promote activity, we shall further investigate if ongoing use can maximise activity level and mobility outcomes and reduce length of stay during inpatient rehabilitation.

Cognitive impairment is one complication of T2DM that has gained considerable recognition in the last decade. Pooled estimates from prospective studies of people with T2DM reveal a 60% increase risk for future dementia. Over 3 million Australian suffer or are at risk of T2DM and this number is projected to rise markedly in the next 20 years; thus increasing the prevalence of diabetes-related impairments including accelerated cognitive decline and dementia later in life. A postulated underlying mechanism of T2DM-related cognitive decline is endothelial dysfunction in the cerebral microvasculature. Transcranial Doppler (TCD) ultrasound offers an economical and non-invasive assessment of the dependence of cognition on cerebral perfusion, by measuring increases of blood flow velocity in the middle cerebral arteries (MCA), resulting from downstream dilatation of cerebral arterioles, which can occur in response to acute hypercapnia or cognitive stimulation. Hypercapnia is a condition of abnormally elevated carbon dioxide (CO2) levels in the blood This technique is known as cerebral vasodilator responsiveness (CVR). There are currently no studies characterizing the CVR to hypercapnia in the posterior cerebral arteries in adults with T2DM. There is increasing evidence that certain bioactive nutrients can act on endothelial cells to enhance vasodilator function. It is also evident that consumption of these sources of vasoactive nutrients may lead to enhanced cognitive performance, yet it is only recently that the concept that nutrients can deliver cognitive benefits by improving cerebral circulation has been recognized. This study aims to determine the most efficacious dose of resveratrol to improve cerebral vasodilator responsiveness (CVR) to hypercapnia in the anterior circulation (MCA) in adults with T2DM. An acute randomised, double-blind, placebo-controlled, crossover dietary intervention will be undertaken at the Clinical Nutrition Research Centre (CNRC) at the University of Newcastle. Interested participants will be sent a Participant Information Statement and Consent Form. Upon returning the signed Consent Form, the study coordinator will send the Health and Lifestyle Questionnaire. This will determine the participant’s suitability before visiting the CNRC for a screening visit. 40 non-insulin-dependent type 2 diabetes mellitus adults aged 40-80 years old will be selected. Suitable participants will be required to attend the CNRC five times at weekly intervals. Subjects will be provided with each dose on one occasion; this dose will be consumed in the clinic. The study will also assess the dose-response effects of resveratrol supplementation on neuropsychological test performance.

This study is intended to investigate the efficacy of intensive cognitive behavioural therapy for social anxiety disorder. The effect of this intervention will be analysed, and participants will be questioned about the acceptability of the intensive treatment format. The results of this study will hopefully inform us of any benefit of intensive individual CBT for the treatment of social anxiety disorder.

The Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE) is an Australian observational registry that describes management and outcomes in patients with Acute Coronary Syndromes (ACS) and feeds back both performance and outcome measures to participating hospitals.

The aim is to conduct a cluster randomised controlled study in residential aged care facilities to investigate the effectiveness of a skin moisturising cleanser when used during regular bathing, and in addition to twice daily application of moisturising lotion, as compared to usual care

This study is an observational study examining the day to day variation in FOT measures in 20 asthma subjects, and examining the relationship between the variability seen and asthma severity and symptom control

This study aims to find out if muscle lengthening surgery or bone surgery is more successful for improving hip displacement in young children with cerebral palsy (CP) who have severe hip displacement. Hip displacement refers to the ‘ball’ (femoral head) of the hip joint moving out of the ‘socket’ (acetabulum) and is common amongst children with CP. Hip displacement can lead to changes in shape of the hip joint, degeneration of the joint, loss of function and eventual pain. In severe cases, or when untreated, displacement can lead to complete dislocation of the hip. Studies have demonstrated that the success of surgery to lengthen tight hip muscles (soft tissue release, or STR) has a limited effect. This surgery is most unsuccessful for children who are not able to walk independently. Up to 86% of these children go on to require further surgery or develop severe hip displacement. The surgical alternative to STR is invasive surgery to change the shape of the hip (varus derotation osteotomy, or VDRO). It has been thought that the earlier the age at which VDRO is done, the higher the chance that it will need to be repeated in the future. At present, efforts are made to delay this surgery in young children by using STR as a ‘temporising’ measure. Previous studies suggest that VDRO is likely to be more successful than STR in managing hip displacement, but it is less clear what the impacts are on factors such as burden of care, parent satisfaction and quality of life. This study will compare the effects of STR and VDRO surgery. To find out the effect of each surgery on hip displacement, the primary outcome measure will be Migration Percentage, a reliable measure of hip displacement that can be taken from a standard hip xray. Impact on factors such as comfort, burden of care and quality of life will be measured through a reliable parent-report questionnaire. All outcome measures will be assessed at baseline, 3 months after surgery (12 weeks) and then at 6, 12 and 24 months after surgery.

This prospective randomised trial will compare the diagnostic yield of capsule endoscopy (CE) findings between three patient groups undergoing CE to investigate obscure gastrointestinal bleeding (OGIB). A control group who will take no bowel preparation will be compared to two groups undergoing different bowel preparation regimens. CE is a standard test for the investigation of OGIB. A video capsule device is swallowed by the patient and passes through the gastrointestinal tract taking 2-6 images per second. The examination is then reviewed for abnormalities that may represent a source of bleeding. The study is specifically aimed at examining the small bowel mucosa although abnormalities can be picked up in other areas. The diagnostic utility of CE can be adversely impacted by small bowel residue obscuring mucosal views. Mucosal views in endoscopic examinations can be improved by pretest preparation regimens, such as bowel preparation in colonoscopy, or washing and suctioning during the procedure. The capsule device is unable to directly clean the mucosa hence prepration regimens are the only option to improve mucosal views by reducing the amount of residue present. Currently there is limited data to recommend routine use of bowel preparation regimens for capsule endoscopy. Our hypothesis is that bowel preparation taken prior to capsule ingestion will improve small bowel mucosal visualisation thereby improving the diagnostic utility of the test.

I hypothesise that, compared to a milk-based jelly preload sweetened with table sugar, similar preload sweetened with artificial sweetener sucralose reduces postprandial carbohydrate oxidation but does not affect energy expenditure. I further hypothesise that artificially-sweetened preload does not increase hunger sensations, subsequent food intake, and total daily energy intake. Diet products (sugar free) are widely used as a strategy to reduce energy intake by individuals who continuously monitor their body weight and by overweight individuals who are trying to lose weight. This practice is supported by findings from intervention studies that reported greater weight loss in adults and less weight gain in children when diet beverages were supplemented. However, some observational studies failed to observe the beneficial effects of artificial sweetener use on body weight, or have even reported positive association between body weight and artificial sweetener use. While it is possible that the relationship observed may be explained by reverse-causation (overweight individuals included more diet products to assist weight loss), there is evidence proposing a neurobiological explanation to heightened food intake induced by artificial sweeteners, which has been documented in animal studies. According to this hypothesis, increased appetite and food intake may be due to the infidelity between sweet taste signals (hinting the body of potential carbohydrate intake) and absence of carbohydrate after the ingestion of artificial sweeteners. While this hypothesis may be plausible, this effect has yet to be replicated in humans, where human studies have found no effect of diet beverages on food intake or hunger sensations. However, what remains unknown is whether artificial sweeteners promote appetite and food intake when they are added to foods in forms other than liquid and where sugar is the only energy source.