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Shock is a medical emergency in which the organs and tissues of the body are not receiving adequate blood flow. Preventing low blood pressure (or hypotension) in such patients is an integral part of standard treatment, but it is unclear what degree of hypotension in relation to patients’ usual resting/basal blood pressure (basal-BP) should be treated. In our pilot study, we reported that in usual practice, the achieved-BP for shocked patients in intensive care unit (ICU) was generally lower and often unrelated to their basal-BP. It resulted in varying degree of untreated relative hypotension (BP-deficit) that was associated with an increased risk of acute kidney injury (AKI). The main purpose of this study is to test or confirm these findings in a broader clinical practice. Further, the novel data on both degree and duration of relative hypotension accepted in routine care in a broad multicentre setting would be crucial to design a major interventional trial. Our hypothesis for this study is that some degree of relative hypotension, quantified as mean perfusion pressure deficit (MPP-deficit), would be common in routine care for vasopressor-treated patients. In critically ill patients, who often have blunted autoregulation, a persisting MPP-deficit may fail to restore adequate renal perfusion that may result in worsening kidney function. We hypothesize that such MPP-deficit, a measure of untreated relative hypotension, in patients with shock during vasopressor therapy is associated with an increased risk of new-onset AKI. The association between study exposure variables and outcome measures will be adjusted for pre-specified covariates in a multivariate model.

In this parallel randomised controlled study in individuals with type 1 diabetes, we will compare two methods of adjusting the dose of insulin to match the nutrients in a meal. One method, known as carbohydrate counting, uses an algorithm (= formula) that matches the dose of insulin to the carbohydrate content of the meal. The second method uses a novel algorithm based on the food’s normal insulin response in healthy subjects (the Food Insulin Index or FII). Participants will be randomised to either the carbohydrate counting or FII intervention group and will receive education regarding the practical implementation of their corresponding algorithm. Glycosylated haemoglobin (HbA1c) and postprandial glycaemia and the occurrence of hypoglycaemia (recorded using a Continuous Glucose Monitoring System, CGMS) will be compared at baseline and after 3 months. We hypothesize that using the novel FII to adjust mealtime insulin dose will improve blood glucose control, compared with carbohydrate counting.

Cellulitis and erysipelas are common skin infections, and it is not known what the ideal duration of IV therapy is for treatment. This is a trial which commenced at Barwon Health in November 2012 expanded to multiple sites in Australia and New Zealand to study whether a short-course of IV therapy is not inferior to longer duration IV therapy. Over 300 participants are required for this trial, however a lack of funding led to only 80 being recruited. The trial was ceased in 2016. Patients who attend hospital emergency departments, or are admitted to hospital wards, or hospital in the home (HITH) programs with a diagnosis of cellulitis and are planned for IV therapy are reviewed to determine if they fulfill the criteria for inclusion in the trial. Those who meet the criteria and agree to participate are consented to participation in the trial, and are then randomly allocated to either IV therapy of 72 hours or more (as an inpatient or on hospital in the home) or 24 hours IV therapy, both followed by oral therapy for a maximum of 7-10 days. Antibiotics that are used are those ordinarily recommended for cellulitis and are not experimental. Each participant is involved for approximately one month, including 3 visits over the first 10 days and a follow-up phone contact at Day 30. In order to determine that short course IV therapy is safe and effective when compared to longer durations, we measure the following things to determine that cellulitis has resolved: 1) That fever has resolved at 48-72 hours 2) That skin abnormalities have not gotten worse at Days 7-10 3) That ongoing antibiotic therapy is not required after 10 days. We also measure; time taken for fever to resolve, pain as reported by the patient, photos of the affected leg over the first 10 days, and whether there are any side effects that patients experience while on this trial. At 30 days the patient is telephoned to check that their cellulitis has not recurred.

The study aim is to determine whether the availability of a simple blood test for colorectal cancer will improve participation in screening for colorectal cancer (CRC). Our hypothesis is that a blood test will improve participation in screening for CRC. Patients attending General Practices in Adelaide that are involved in the study, who are aged 50-74 years old and are at average risk for bowel cancer may be invited to participate in this study. Study details: Many people do not participate in stool (faecal) sample-based screening programs for early detection of colorectal cancer because of their dislike for the test. The purpose of this research is to determine if a blood test for colorectal cancer, if offered to people who have just declined a standard faecal occult blood (FOB)-based screening test, will be completed and result in a significant improvement in the overall program participation rate, relative to a program where only faecal occult blood test (FOBT) is offered. Participants in this study will be randomly (by chance) allocated to one of two programs – one where they are offered the blood test if they declined the FOBT provided through the study, and one where FOBT is offered twice. We will assess how many of these invitees completed a screening test and compere participation rates between groups.

The current study is investigating the effects of supplementation with a herbal complex called LZ Complex3 on sleep quality, daytime functioning, mood and brain function. The complex contains a combination of herbal ingredients that have individually been used to improve aspects such as sleep quality, mood, and calmness. The complex also contains dietary supplements that may provide nutritional support for sleep. However, there has not been any studies to date that has looked at the combination of these ingredients together and their effect on sleep quality.

Provision of allied health services over 7 days per week as opposed to 5 days per week for medical and surgical hospital inpatients is a practice inconsistently applied across health services in Australia. Presently, no evidence from randomised trials is available to guide service delivery for this population. These services have developed incrementally and in an ad hoc process at Monash, Western and Melbourne Health, in a similar experience to other health services around the state. It is possible that this is wasting resources that could be used for other purposes within these organisations. This study aims to examine whether removal and provision of weekend allied health services on general medical and surgical wards has an impact on length of stay on those wards, other indicators of quality and safety of service provision, and staff satisfaction. A novel research methodology will be applied using a stepped wedge cluster randomised controlled trial design to both incrementally remove existing services, then reintroduce services in a structured, stakeholder driven process (the 1st phase has been registered as a separate trial ID: ACTRN12613001231730). At Monash, Western and Melbourne Health, new, stakeholder driven weekend allied health services will be incrementally rolled out across 6 wards over a 7 month period. Outcomes will be collected predominantly through existing data collection processes, although additional data will be collected through staff group and key informant interviews, and random sampling of patients.

Twenty patients undergoing kidney transplant will be included in the study. Data regarding preoperative variables, intraoperative and postoperative variables are prospectively collected. A non-invasive device (called Sidestream Dark Field imaging), that allow for clinical observation of the microcirculation will be used. It is hand-held probe with a sterile extension for direct contact with renal parenchyma. kidney biopsies are performed to assess Immunohystochemical intensity of ET-1 and other markers. The tissue to be acquired in this study will be obtained from surgical specimens taken from consented participants having kidney transplant.

Women who misuse alcohol and other drugs have low rates of contraceptive use and higher rates of pregnancies (including unplanned pregnancies) compared to the general population. Once pregnant, these women and their babies experience higher rates of adverse health outcomes such as preterm birth, low birth weight and adverse developmental and social outcomes. Our research aims to explore whether women in drug and alcohol treatment who do not wish to conceive will have better rates of contraceptive use when contraceptive services are integrated into drug treatment clinics, compared to standard care where women are referred to primary health care services for their contraceptive needs. With this model we seek to increase use of all contraceptive methods but particularly methods that do not require daily adherence such as injections, implants and intrauterine devices that are reversible but extremely reliable. These methods are known collectively as the long acting reversible contraceptive (LARC) methods. A pilot integrated contraceptive medical service will be introduced within a drug and alcohol clinical setting. We propose to evaluate this pilot, to determine whether integrated care is feasible, and if it is more effective in increasing the use of contraceptive methods and reducing unplanned pregnancy than the standard of care.

Type 1 diabetes (T1D) incidence is rising globally at a rate of 3–5% per year with patients having increased susceptibility to macrovascular complications and diabetic retinopathy a major microvascular complication of diabetes. Cardiovascular disease is the major cause of disability and death, with diabetic retinopathy the leading cause of blindness and significant burden to the individual and society. Current treatments target elevated blood glucose, high blood lipids and blood pressure, however diabetic patients continue to have 2- to 4-fold greater risk of a heart attack (MI), hence the optimum treatment for minimising this complication during diabetes has not yet been established, and additional treatment strategies are urgently needed. Hormones of the renin-angiotensin-system (RAS) are key mediators of adverse complications in diabetes, with blockade of this system by medications known as angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are routinely used as therapy for diabetes; although there are mixed reports for their efficacy in diabetic retinopathy. We propose this variability is due to the action of aldosterone, another steroid hormone in the renin-angiotensin-aldosterone system (RAAS). Aldosterone exerts adverse actions via activation of mineralocorticoid receptors (MR), often referred to as “aldosterone receptors”. Our hypothesis is that adding a medication known as “aldosterone receptor” antagonist to standard treatment for T1D will delay or prevent progression of complications of diabetes. Although this medication is used treat patients with heart failure and MI, there are no clinical trials investigating this medication in T1D. The design is open label, 9 week duration, proof-of-concept study to assess the efficacy of the selective "aldosterone receptor" antagonist, eplerenone in T1D. Twenty patients with T1D will be recruited from the Diabetes clinic. They will have baseline measures within the first week and then receive eplerenone for 12 weeks in addition to standard treatment. The same measures are repeated in each patient at the end of the treatment period; hence the proof-of-concept is baseline versus treatment for each person. The patients will return 7 days after completing the study for routine clinical visit. A separate group of 20 age matched, healthy volunteers will be recruited for comparing the same measures to establish prognostic markers. Our specific objectives are: 1. Prevent and arrest the complications of diabetes on cardiac structure and function, including platelet activation and reactivity and endothelial dysfunction; 2. Prevent progression to diabetic retinopathy; 3. Improve metabolic control; 4. Provide prognostic and predictive biomarkers for clinical management.

Long-chain omega-3 polyunsaturated fatty acids (PUFAs) play an important role in a range of physiological processes in all living organisms. Supplementation with omega-3 PUFAs has been shown to have range of beneficial effects on both physical and mental health, while results of previous trials in child and adult populations suggest that omega-3 PUFAs may offer a safe and effective treatment for depression. However, conclusions from these trials have been limited by their relatively small sample sizes. This study aims to test the therapeutic effects of a 12-week randomised, placebo controlled trial of approximately 1.4 grams/day omega-3 fatty acids in 300 help-seeking 15 to 25 year olds presenting with moderate to severe major depressive disorder (MDD). The primary hypothesis is that young people with moderate-to-severe MDD will show greater improvement after 12 weeks of treatment with omega-3 PUFAs plus cognitive behavioural case management (CBCM) compared to treatment with placebo plus CBCM. The primary outcome measure is change in the Quick Inventory of Depression Symptomatology (QIDS-A17-C) score. The secondary hypotheses include the rate of remission (defined as patients not meeting the criteria for MDD at 12 weeks and 6 months) will be greater for young people treated with omega-3 PUFAs plus CBCM compared to treatment with placebo plus CBCM.