ANZCTR search results

This investigation involves the collection of data via postal questionnaires from patients with low back pain who have been placed on a waiting list for surgical opinion. The questionnaires aim to identify those at risk of developing chronic back pain and will be evaluated for their usefulness in this patient group. Additionally, this study will ask the question of whether screening itself reduces pain and disability. This investigation will lay the critical platform for an investigation of treatment aimed at reducing risk.

The rationale for using antipsychotics for behavioural management in Huntington Disease is weak, and antipsychotics are potentially harmful. REAP-HD intends to change clinical practice in residential care facilities (RCFs) so that antipsychotics are used as second line, time-limited therapy subject to regular review. REAP-HD will implement two different strategies, and compare their efficacy in helping health care professionals reduce antipsychotic use.

Sporadic Inclusion body myositis is the most common acquired muscle disorder in patients over the age of 50. The cause of IBM is not known and there is no effective therapy. IBM is a slowly progressive disorder with increasing weakness and muscle atrophy involving particularly the thighs, long finger flexors and bulbar muscles resulting in progressive loss of mobility, loss of hand function and impaired swallowing. It progresses to disability over 5-10 years with wheel chair dependence, loss of hand function, impaired nutrition due to inability to swallow, increasing debility and susceptibility to aspiration. Theories for IBM pathogensesis can be divided into primary inflammatory hypotheses and primary degenerative hypotheses. Treating IBM with immunosuppression is not effective and steroids may accelerate the disorder possibly by stimulating catabolic pathways. Degenerative hypotheses can be grouped into several catagories, myofiber injury by beta-amyloid, myofiber injury due to other accumulated molecules, a myonuclear disorder, a disorder of protein degradation and a disorder of mitochondria. The most consistent finding in IBM is an abnormality of protein degradation with accumulation of degradation products in autophagic vacuoles. There is also a deficit in Proteosome 26-ubiquitin protein degradation. The proteosome-ubiquitin and autophagy pathways are activated in the presence of energy depletion and starvation to provide an alternate source of energy to fuel the citric acid cycle and maintain energy homeostasis. It is not certain as to whether there is an acceleration of protein breakdown or a defect of disposal of breakdown products or both in IBM. The crucial protein and organelle disposal pathway of autophagy is critically overloaded and this is probably the most important mechanism for myofibre damage. It is probable that this overloading is the result of catabolic pathway acceleration and this may result from a deficit in energy metabolism leading to activation of the catabolic cascade. Progressive muscle atrophy and increasing weakness indicate the predominance of protein catabolic over anabolic activities in IBM. It is hypothesised that repairing energy deficits and increasing anabolic activity will be beneficial in IBM and will in turn inhibit and “switch off” the harmful autophagic process. Trihepatanoin (TGC7) is a triglyceride containing three C7 fatty acid chains. After cleavage in the gut, heptanoate is absorbed through the gut and can be metabolised in most tissues. As a medium chain fatty acid, uptake into mitochondria is via diffusion and independent from the shuttle system, thereby providing fast energy. Each heptanoate provides both substrate (acyl CoA) and intermediates (oxaloacetate; via carboxylation of propionyl-CoA) for the CAC in muscle and brain. Therefore, TGC7 has the ability to refuel the CAC, increase ATP production and reverse the catabolic cascade. It is hypothesised that administering Triheptanoin, up to 30% of daily caloric requirement, by fuelling the CAC to enhance anabolic pathways and inhibit catabolism will have a significant benefit in the treatment of IBM to maintain and improve muscle strength and swallowing.

TNT is a pilot randomised control trial to determine the effect that access to and use of tablet technology within the first month following inpatient stroke rehabilitation has on stroke survivor quality of life. The primary aims of our pilot study TNT are to: 1. Determine the effect that access to and use of tablet use has on stroke survivor:quality of life, mood, cognition, communication, self efficacy and activity participation. 2. Estimate the frequency and nature of tablet use when stroke survivors are given training and access to tablet technology within the inpatient rehabilitation and community setting. We hypothesise that stroke survivors who use an iPad during the first month following discharge from rehabilitation will experience a better quality of life than those survivors who do not use this technology. Furthermore, we predict there will be a trend towards better mood, cognition, communication, self efficacy and higher levels of activity participation in survivors whom have access to iPads. Data from this pilot RCT study will be used to inform the design of future trials to determine the functional efficacy of tablet use during stroke rehabilitation.

The aim of this project is to reduce the deaths caused by Heart Failure in Tasmania. This will be achieved through implementation of a screening program for cardiac dysfunction and the use of protective therapy that will limit the development of heart failure. We plan to show the benefit of testing by recruitment of "at risk" subjects from the community and randomising them to a screening program based on echocardiography. Patients with abnormalities will be entered into a program of cardio-protective therapy, supervised by their general practitioner. Endpoints: 6-minute walk at a minimum of 24 months and comparison of the rate of heart failure among groups.

This study will investigate the molecular mechanisms by which a fruit and vegetable supplement modulates systemic inflammation. Based on previous studies utilising fruit and vegetable supplements and our own fruit and vegetable withdrawal study, we hypothesise that the extract will modify systemic inflammatory pathways, including NF-kappaB, AMPK, MAPK, PPARalpha/gamma and TLR2/4, among others. In addition, various proteins associated with inflammation, lipid metabolism and insulin resistance will be improved. Determining whether the supplement is an effective treatment for reducing systemic inflammation in obesity and identifying the mechanisms involved may assist in reducing the risk of chronic diseases, including CVD and diabetes. This is critically important for reducing the burden of disease in this subgroup of the population for whom weight management/ weight loss has not been achievable.

This study will assess the quality of life of women from a surgical oncology practice in North Sydney, Australia, who have undergone mastectomy for breast cancer, have chosen to have immediate breast reconstruction (IBR) and have also required post-mastectomy radiotherapy (PMRT). The purpose of this research is to provide evidence about the oncological safety and levels of patient satisfaction in this group of women. Study details All participants in this study will be asked to complete five surveys, six months after their final breast reconstruction operation, about their satisfaction with the aesthetic outcomes of their surgery, and its affect on their psychological wellbeing and quality of life. These patient-reported outcomes will be assessed alongside measures of their clinical outcomes, including any post-operative or post-radiotherapy complications, taken from their patient record. A subset of these women will also have a clinical examination and photos taken at six months following their final reconstruction procedure.

Neuraxial anaesthesia (spinal, epidural or combined spinal-epidural anaesthesia) is the gold standard technique for elective lower segment Caesarean section (LSCS) surgery. The traditional and accepted method of performing this anaesthetic procedure involves palpation of the patient’s spinous processes and iliac crests to identify the midline and intervertebral space to appropriately insert the needle and deliver the anaesthetic. The needle is then inserted through the skin, subcutaneous fat and ligaments until the epidural and spinal space is reached. Difficulties can be encountered during this procedure due to the misidentification of the appropriate level of insertion and midline of the spine and needle contact with vertebrae, nerves and blood vessels. Ultrasound images can help identify structures beneath the skin including bone, ligament anf muscle. This study aims to: * determine the accuracy of palpation-based identification of intervertebral level and midline of the spine compared with ultrasound, * assess the efficacy of ultrasound-assisted versus palpation-assisted neuraxial anaesthesia and identify the obstetric population, and * identify the obstetric population at higher risk of difficult neuraxial insertion. Full-term pregnant (>37 weeks gestation, adult patients undergoing elective LSCS surgery who are deemed appropriate to receive a neuraxial anaesthesia will be invited to participate in the study. Patients recruited to the study will be randomised to either the palpation-assisted (control) or ultrasound-assisted (intervention) group. Prior to the performance of a combined spinal-epidural anaesthetic, an anaesthetist will identify and mark the midline and “best” lumbar intervertebral space by palpating the patients hip bones and spine. An investigator will then perform an ultrasound of the patient’s lumbar spine to identify and mark the midline “best” intervertebral space. In the control group, the palpation-identified mark will be used as the needle insertion point. In the intervention group, the ultrasound-identified mark will be used as the needle insertion point. The combined spinal-epidural anaesthetic will be performed using the same standard technique in both groups.

An estimated 4 million Australians have a hearing loss. People with hearing loss are reluctant to seek or accept help for their hearing and listening problems. The literature shows that this reluctance is driven by a fear of stigmatisation and serves as a major barrier to the effective delivery of services which have been designed to reduce the health and social impacts of hearing loss. A population group at risk are farmers with two out of three affected by hearing loss. Permanent hearing damage can be caused by prolonged exposure to noise or immediately by sudden, extremely loud or explosive noises. There are many different and unique sources of noise on farms. This project tests the hypothesis that participating in early intervention hearing services focussed towards farming families will contribute to (a) significant reduction in the impact of hearing loss on farmers and (b) educate and empower farmers on their capacity to reduce their noise exposure.

This research study seeks to look at the best ways of supporting women who have completed breast cancer treatment within the last 12 months to make lifestyle changes (increasing physical activity, improving eating habits, and achieving and maintaining a healthy weight) to promote longer-term health and well-being. Who is it for? You may be eligible to join this study if you are a female aged between 18-75 years who has completed primary treatment with curative intent for stage I-III breast cancer (unilateral or bilateral) within the past 12 months. Study details All participants in this study will receive 6 months of telephone counselling from the NSW Get Healthy Service (GHS), which is a telephone counselling program for physical activity, healthy eating and weight loss. We are interested in whether this program is acceptable and beneficial for breast cancer survivors. In order to determine this, participants will be asked to complete a number of assessments and questionnaires on completion of the program to evaluate feasibility and acceptability of the project, changes in body weight, dietary intake, physical activity levels, quality of life, fatigue, depression, body image and menopausal symptoms.