ANZCTR search results

RESEARCH AIMS AND HYPOTHESIS The insertion of radial artery catheters for continuous measurement of blood pressure, as well as easy and regular sampling of blood, is a ubiquitous technique in critical care settings such as the intensive care unit and operating theatre. The radial artery is the preferred site of access due to its anatomic consistency and accessibility, relative ease of cannulation compared with other sites and the low complication rate. In 1990 the number of arterial catheters placed perioperatively was estimated to be 8 million in the United States and 2.5 million in Europe – and this number will only grow as the complexity of patients increases. Despite the ease with which some arterial lines are placed, there are numerous cases in which the operator struggles to obtain appropriate and timely access or causes complications such as bleeding, hematoma formation, psuedoaneurysm, infection, nerve damage, distal limb ischemia, temporary arterial spasm and occlusion, digital embolization / ischemia and patient discomfort. There is currently limited research into arterial line placement at the radial artery using ultrasound in the adult perioperative patient population. This study will evaluate the application of ultrasound guidance to radial artery cannulation in comparison with the traditional palpation technique in the adult cardiothoracic surgical population. The hypothesis of this study is that there will be a difference between the two techniques in time to successful cannulation, number of attempts before successful placement, number of cannulae used, and number of puncture sites per patient. The hypothesis is that this difference will favour ultrasound guidance. In addition, there has never been a cost-analysis performed on the use of ultrasound guidance for radial arterial line placement in comparison to the traditional technique in any population, and this will also be carried out.

Preterm babies take time to reach their full quota of oral feeds so often require prolonged intravenous nutrition. Peripheral venous cannulas have a short life span and may result in damage to the skin’s integrity, as well as having a short life span. Long lines or peripherally inserted central catheters(PICC) have a significantly longer life span as the tip is positioned in a large vein.However PICC line insertions are not without complications. The tip of the catheter may reach deep inside the cardiac chambers or fall short of the caval veins and end in entirely unexpected locations. Extravasation of fluid from the catheters in each of these positions has led to serious, and occasionally lethal, complications. These can be avoided if the catheter tip can be precisely localised. The narrow calibre silastic line cannot always be seen on plain radiography but can be visualised with use of a small amount of radio-opaquae contrast. However the contrast available contains Iodine which may cause transient hypothyroidism in newborns. Concerns regarding this have resulted in some units including ours restricting use of contrast when determining line position. The data supporting this decision are very limited and it is unclear as to the role of iodine containing contrast in the development of hypothyroidism. The few studies that have assessed the relationship are either cohort studies, before-and-after study or case series, none being a randomized control trial. The results of these studies are contrasting without any clear answer as to whether perceived benefits of withholding contrast outweigh the risks of developing hypothyroidism. To confuse things further, asymptomatic hypothyroidism is not uncommon in the preterm population. The aim of our study is to compare thyroid function tests in preterm neonates after exposure to IV contrast with controls, to ascertain the impact of a small iodine exposure on the thyroid gland in relation to gestational age. The study will be a randomized control trial for babies less than 30 weeks old requiring insertion of a PICC line. Study infants will be randomised to use of contrast(0.3ml Iopamidol containing iodine 300mg/ml)to assess line position(previous Unit practice) or no contrast. Blood and urine tests will be performed to assess any impact on the thyroid gland of contrast use. Repeat thyroid function tests(TFT) for both case and control will be taken as baseline then 7 and 14days after insertion of the line. Further TFT will be taken if day 7 or 14 results are abnormal.

Project aim: to compare the changes in upper limb volume between a low speed aquatic exercise protocol and a conventional aquatic exercise protocol in women with secondary lymphoedema. We anticipate that slow aquatic exercise (Ai Chi) will have a greater reduction in arm volume than fast aquatic exercise.

The study proposes to investigate whether a drug with specific effects which damp excessive nerve mediated activity can prevent the long term occurence of pain after chest surgery.

This study aims to evaluate whether treatment with Temozolomide, Irinotecan, and O6BG (O6-Benzylguanine) is tolerable, feasible, and effective for children with recurrent or resistant neuroblastoma (within the confines of a Phase 1 study). Who is it for? You or your child may be eligible to join this study if you/they are aged between 1-16 years and have had a diagnosis of neuroblastoma and it has recurred or is resistant to treatment. Patients need to have exhausted standard curative options of therapy, and must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study. Study details All participants in this study will undergo chemotherapy treatment with the drugs Temozolomide and Irinotecan, in conjunction with a new investigative agent known as O6BG (O6-Benzylguanine), followed by Peg-GCSF treatment. This is a dose escalation study design, which means that earlier patients will start on lower doses and this will determine the dose that later patients receive. The O6BG (120 mg/m2/day) is given first by intravenous infusion over one hour, followed by oral temozolomide (dependent on dose escalation stage of the study - 40/55/75 or 100 mg/m2/day) and after half an hour, the irinotecan (50 mg/m2/day) is given intravenously for one hour. This treatment is repeated for four more days (i.e. over a total of 5 days). On day 6, the patient is given Peg-GCSF (100 mcg/Kg). Each treatment cycle lasts a minimum of 21 days. Treatment will continue every 21 days until the doctor believes there is no more benefit for the patient. Participants will be regularly monitored to evaluate toxicity (weekly), feasibility of treatment and disease response (every 2 months) until the end of treatment and then every 3 months after treatment until the one year anniversary of the patient starting treatment; at which point patients will be monitored annually therafter up to 5 years.

The Australian Grace Risk Intervention Study (AGRIS) aims to enhance evidence based decision making and outcome delivery of Australian Acute Coronary Syndrome (ACS) patient care. Hospitals will be randomised to either implementation of objective risk stratification using the validated GRACE Risk score based decision support tool or to standard care. It is envisaged that the GRACE Risk tool together with recommendations for evidenced based care will improve the use of evidence based investigations and therapies and therefore enhance secondary prevention in hospital.

We will examine the effect of innovative programs for changing the way parents and teachers view manageable risk-taking for children with disabilities and increasing the level of responsibility that children take for their own actions. The program will have two arms: (1) risk reframing workshops to help parents and teachers distinguish manageable from unhealthy risk and recognise the benefits of manageable risktaking (e.g., becoming more responsible, vigilant) and (2) introducing materials with no obvious play value to the school playground to provide opportunities for adults and children to practice promoting and engaging in manageable risk-taking in the context of social, creative and active play.

The goal of this randomised controlled trial is to examine the effects of iron deficiency and compare its correction with either IV ferric carboxymaltose or iron sucrose on intact fibroblast growth factor 23 (FGF23)concentrations in individuals with end stage kidney disease undergoing chronic haemodialysis therapy.

This study aims to evaluate the influence of whole body 18F-FDG PET/CT and brain MRI on management of stage III melanoma patients with satellite or in-transit metastases as a first recurrence or at time of diagnosis. Who is it for? You may be eligible to join this study if you are aged 18 years or above and have satellite or in-transit cutaneous melanoma metastases as a first recurrence or at time of diagnosis, in absence of clinical evidence of nodal and/or distant metastasis. Study details All participants in this study will undergo staging total body 18F-Fluorodeoxyglucose Positron Emission Tomography and Magnetic Resonance Imaging of the brain at time of diagnosis of any first in transit or satellite metastasis to routinely screen for any distant metastasis. A positron emission tomography (PET) scan is a non-invasive procedure that uses a small and safe amount of a radioactive substance to detect disease in your body. A computed tomography (CT or CAT) scan is also a non-invasive procedure and uses x-rays. Combined in a PET/CT scan this creates three-dimensional pictures of your body. A small amount of a radioactive material needs to be injected into a vein in your arm. The total duration of the procedure is usually 2 hours, the imaging itself usually 30-60 minutes. MRI (Magnetic Resonance Imaging) is a non-invasive procedure that uses a magnet and radiofrequency energy to produce detailed images of your body. An injection of contrast agent into a vein in the arm is required. The MRI examination usually lasts 30-45 minutes. MRI is not suitable for some participants with pacemakers or other metal implants. If the first scans do not show any suspective lesions and, after six months, there are no visible signs of distant spread of melanoma, both scans will be repeated once. We will determine the percentage of patients with change of disease management arising from these additional scans. Participants will be followed up at 6 months to determine the diagnostic accuracy of the scans and whether their disease stage has changed.

The aim of this pilot research is a simple test of probiotics to improve dysbiosis as a hypothesised casual factor in resistant depression and orotic acid as a treatment in conjunction wit SSRI medication. The signal group design is to establish signals for these approaches to provide preliminary efficacy data.