ANZCTR search results

Surgical removal of the adrenal glands is in our unit performed by a posterior approach were the adrenal is accessed from the back with keyhole surgery. The retroperitoneum (space around the adrenal) is inflated with pressurized carbon dioxide (CO2) to create an operative space. Normally, we use a starting pressure of 25mmHg, which may be increased to 28 mmHg, at the surgeon’s discretion. Occasionally, CO2 retention with increasing levels of CO2 in blood can occur and the retroperitoneum needs to be deflated for the patients CO2 levels to recover. On the other hand, with too low pressure, bleeding may increase and visibility may become be impaired. In the early experiences of retroscopicadrenalectomy, centers reported that they used pressures of 12mmHg to 15mmHg with success. However, many authors claim to have less bleeding and better visibility using pressures over 20-24mmHg. Also, in the largest cohort of retroperitoneoscopic adrenalectomy published, a pressure between 20mmHg and 28mmHg was routinely used without any excess of adverse events. The implications of using different pressures have been reported in a few studies. The first one compared pressures at 15 mmHg and at 20mmHg in retroperitoneoscopic adrenalectomy and showed a statistical, but not clinical, significant difference in arterial pCO2 levels. Another study did not show any difference in arterial carbon dioxide pressure between patients undergoing open and retroperitoneoscopic adrenalectomy at 12 to 16mmHg. There are no studies examining the different physiological effects of pressures between 25-20mmHg in retroperitoneoscopic adrenalectomy, but nonetheless high pressures are routinely used in general practise with very few adverse events. The current study proposes to start with a pressure of 25 mmHg in group A and 20 mmHg in Group B as insufflation pressures during retroperitonescopic (keyhole) adrenalectomy. Routine clinical blood samples (arterial line blood gases) will be drawn every 30 minutes, and these samples are, together with selected clinical data, recorded for data analysis.

This project is a cross-sectional observational study examining the association between and among cognition, type and severity of brain injury and upper limb bimanual performance in a large sample of children (n=150), aged 6 to 12 years, with unilateral CP. The project will be conducted across 5 Australian sites specializing in the management of children with CP. The aim of this Project is to: (a) describe the association between and among cognition and upper limb bimanual performance in children with unilateral CP; (b) describe the association between and among cognition and upper limb bimanual performance and type and severity of brain injury in children with unilateral CP.

Chest pain is a common cause for presentations to hospital Emergency Departments (ED). The clinical investigation of undifferentiated chest pain must include the expeditious assessment for acute coronary syndrome. To date, there have been no large-scale clinical trials comparing coronary computed tomographic angiography (CTCA) based care to exercise treadmill electrocardiography (ExECG)-based care in possible acute coronary syndrome patients The CT Coronary Angiography Compared to Exercise ECG (CT-COMPARE) study was a prospective randomized trial that compared dual source CTCA with ExECG as part of the standard of care in low-intermediate risk possible ACS patients presenting to the ED. The primary endpoints were the diagnostic performance measures and the hospital-based costs of CTCA-based care as compared to ECG-based care

One of the major adaptations of muscle to endurance training is a slower utilization of carbohydrate stored in the muscle (muscle glycogen) and blood glucose and greater reliance on fat oxidation during low intensity exercise. . These adaptations are thought to play an important role in the large increase in the ability to perform prolonged strenuous exercise that occurs in response to endurance exercise training. However, the results of early studies demonstrate ‘carbohydrate dependence’ during prolonged endurance events (i.e. marathon running) lasting up to 3 hours, with little (<10%) contribution from fat to the total fuel requirements of exercise. Using a pharmacological agent Nicotinic acid(also known as Niacin or Vitamin B3) to block the breakdown and liberation of free fatty acids into the bloodstream(lipolysis) and impair rates of fat oxidation during exercise, we will test the hypothesis that carbohydrate is the predominant (>90% of total energy requirements) fuel for muscle oxidation during cycling time trials lasting from 60-120 min. Using a repeated measures design, we will test our hypothesis in 10 well-trained cyclists who, after a standardised diet/exercise control, will each perform six maximal, all-out cycling time-trials (over 60, 90 and 120 min duration), three under conditions where lipolysis and fat oxidation are ‘blocked’ and three under normal conditions (control). We hypothesise that there will be no differences in the time-trial performance for any duration, and that carbohydrate oxidation will be the major fuel for oxidative energy production.

A number of studies have been published which appear to show that performing an endometrial biopsy results in an increase in pregnancy and live birth rates. Most of the studies have been conducted in a focussed subgroup of women, such as those with recurrent implantation failure, and there is little data available on the utility of endometrial biopsy prior to frozen-thaw embryo transfer. To address these limitations, PIP-IVF is a pragmatic randomised trial recruiting all women undergoing autologous embryo transfer, and has been powered to allow detection of subgroup effects such women undergoing their first IVF cycle and women undergoing frozen-thaw transfers.

The primary aim of this research project is to examine changes in health outcomes following the introduction of a single or two cycling exercise sessions a week to kidney failure patients. We hypothesise that after 12 weeks of either once or twice weekly of cycling sessions per week, health outcomes are improved.

This study aims to evaluate whether Mental Health First Aid (MHFA) training, delivered in eLearning or Blended learning (eLearning plus face-to-face) modes, leads to improvements in mental health first aid knowledge, stigmatizing attitudes, confidence in supporting a person in the social network with a mental health problem, and self-reported supportive behaviours if someone in their social network develops a mental health problem. It will also evaluate the effects of the training on the participants’ personal help-seeking if they have a mental health problem and on their own mental health.

We are investigating the effect of Indacaterol on the effect on volatile organic compounds (VOCS) in COPD from exhaled air. VOCS would be initially sampled from healthy controls and COPD. The COPD patients would be randomised to treatment or placebo and VOCS measured. We would then determine whether there are specific VOCS in COPD that changes with treatment. Thsi would give us insights into biomarkers for this disease.

This study will explore the influence of modified night lighting installed in specific locations within hospital patient rooms and toilets, on how well patients sleep, how they move about at night and the effect of the lighting on other related aspects of the environment (such as the use of other forms of lighting at night). The modified lighting is being implemented as part of a larger study, a cluster randomised controlled trial across six RBWH wards, examining whether improved night lighting reduces the number of patient falls on these wards. By collecting this additional data directly from patients before and after the lighting is installed, the current observational study will allow us to compare whether there are differences at the patient-level between control and intervention environments.

BACKGROUND Falls among older hospital patients are a concerning and costly problem. While most falls occur during the day, nearly 40% happen outside normal hours; potentially while patients attempt to mobilise to and from the toilet in poorly lit environments. A practical solution for these problems is the installation of targeted low-intensity lighting around key room features without disrupting the dark sleep environment. Previous laboratory research has demonstrated improved postural stability and gait among older people with such lighting. Subsequent evaluations in aged care facilities have confirmed high levels of acceptance among staff and residents. In order to test the clinical acceptability of this solution the investigative team recently completed a multi-site user acceptance study (unpublished). Formal patient and staff feedback after ward demonstrations of the novel lighting confirmed both acceptability and the likelihood of sleep and safety improvements. User feedback has been incorporated into the final intervention design for the present trial. AIM We aim to test the effect of the night lighting intervention on ward level patient fall rates. METHODS The effect of our intervention on the primary outcome will be evaluated through a stepped-wedge cluster randomised controlled trial (RCT) across six inpatient wards at the Royal Brisbane and Women's Hospital over fourteen months. A stepped-wedge cluster RCT design describes a staggered roll-out of the intervention across participating wards such that the order of roll-out is randomly generated. Therefore, participating wards provide control data prior to implementation and intervention data after implementation.