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Does neurofeedback enhance sleep?
Expand descriptionCurrent sleep research in patients with insomnia has indicated the non- pharmacological intervention of neurofeedback (the ability to self-regulate brainwave frequencies) has the capability to successfully enhance sleep parameters. The purpose of this study is to assess the effectiveness of an individualised neurofeedback protocol for optimising sleep in healthy individuals. With sleep believed to be one of the fundamental aspects of recovery and wellbeing, developing an effective non-pharmacological treatment for enhancing sleep has great potential to enhance recovery and everyday performances.
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Child Life Therapy in Paediatric Burns Management
Expand descriptionBurns are unfortunately a very common childhood injury. The Burns and Plastics Treatment Centre (BPTC) at the Children’s Hospital at Westmead is the only children’s Burns Unit servicing the children of New South Wales (NSW) and the Australian Capital Territory (ACT). We undertake approximately 3500 burns dressings in our BPTC per year. When a child presents to our BPTC they are given pain medicines and then taken into a treatment room to have their burns dressing done. These can be extremely painful and anxiety provoking, despite medication. We are very lucky that our service has access to a Child Life Therapist (formerly known as a Play Therapist). This therapist provides patient and family education prior to the procedure, distraction during the procedure from the dressing change occurring independently by nursing staff, and ongoing support after the procedure. Many studies have shown that Child Life Therapy or distraction therapy may be useful in reducing pain and anxiety in children. None however have shown its benefits for burnt children. We aim by undertaking this study, to prove that Child Life Therapy is beneficial by reducing pain and anxiety experienced by children during their dressing changes. To do this, we aim to recruit 100 new burns patients, attending our BPTC for the first time, to our study. Approximately half of these patients will have a Child Life Therapist during their dressing change, the other half will not. Patients will be greeted in the waiting room and explained the study. They will then be asked to participate. If they choose to participate, they will then be given their regular pain medications. Whilst the pain medications are taking time to work, the parent/carer will be asked to fill out a survey about what they expect the pain and anxiety will be. The child will then be taken into the treatment room with their parent/carer to have their dressing done. During the dressing a medical person will be in the room, watching the dressing and recording pain and anxiety scores in 5 minute intervals. After the dressing is over, the child if >5 years old, the parent/carer, and the nurse involved in the procedure, will all fill out questionnaires about how painful or anxiety provoking they thought the dressing was. These questionnaires will be age appropriate. This data will then be collected and analysed by our hospital biostatistician. We hope to find that Child Life Therapy is beneficial and support its further use for reducing pain and anxiety associated with childhood procedures.
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Evolution of surgery: kidney transplant by using key-hole surgical technique
Expand descriptionThe aim of this study is to apply the laparoscopic technique (key-hole surgery) to clinical human kidney transplant after successful pre-clinic experiment in the large animal pig model (RA/3/100/1040, UWA). In order to apply this laparoscopic technique safely to the human kidney transplant, The study has also being conducted on human cadaver body to define the ideal ports position. After successful application of laparoscopic technique in some cases of human kidney transplant, the randomised study will be considered in the near future to demonstrate the advantages of this new technique in clinical kidney transplant such as smaller incision, less pain, quicker recovery, shorter hospital stay, better cosmetics and equal graft function in comparison with routine open surgery.
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Randomised controlled trial (RCT) of home HIV testing to increase HIV testing frequency
Expand descriptionThis randomised controlled trial (RCT) aims to assess the effectiveness, acceptability and feasibility of home HIV testing among gay men in Australia. Approximately 350 high risk gay men (including 50 men who report their last HIV test was more than 24 months ago) will be recruited from clinics and community-based sites and randomised 1:1 to one of the two study arms: home HIV testing arm (intervention); or clinic HIV testing arm (control). At enrolment, all study procedures will be explained to the participants and they will be required to sign a written consent form which will cover all data collection activities of the trial. The OraQuick In-Home HIV Test will be used for home HIV testing in this study. It is a rapid self-administered over-the-counter (OTC) test which is used with an oral fluid specimen and provides a result 20 minutes after specimen collection. The test is developed by OraSure Technologies Inc., (Bethlehem, Pennsylvania, United States) and is approved for home use in the United States (US) by the Food and Drug Administration (FDA). It is not yet approved by the Therapeutic Goods Administration (TGA) of Australia, but can be imported to Australia for personal use and research purposes. This is a wait-list control RCT, with each participant followed-up for 24 months after enrolment. After initial 12 months, participants in the clinic HIV testing arm will switch to home HIV testing arm, so that all the participants will have access to home HIV testing in the last 12 months. At enrolment, men in the home testing arm will receive four OraQuick home tests with written and video instructions. Further home tests will be available on request, with a maximum of 12 kits per participant per year. Ongoing support via a 24 hour phone line will be available to men in the home HIV testing arm throughout the study. Men in both arms will have access to routine HIV testing and care at their preferred clinic. Demographic, sexual behaviour and HIV/STI testing information will be collected from participants through a self-administered questionnaire at enrolment. Every 3 months, brief information on HIV/STI tests and the results will be collected through an online self-administered questionnaire. In addition, HIV/STI test results will be collected from clinics attended by the participants during the study period. At 12 and 24 months, these questionnaires will include additional questions to collect information on acceptability of clinic and home HIV testing and confidence on the performance of home HIV test. At the end of study, selected participants will be invited to participate in in-depth interviews to obtain detailed information about their home test experience and influence on sexual behaviour.
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A randomised controlled trial comparing daily (400 international units) and single bolus dosing (50,000 international units) of vitamin D in healthy breastfed infants of vitamin D deficient mothers.
Expand descriptionTo assess the proportion of breastfed infants who are vitamin D sufficient (25 OH vit D > 50nmol/L) in the intervention group (bolus vitamin D dosing) versus the standard daily vitamin D dosing. This will be achieved by measurement of 25 OH vit D levels ; a marker of vitamin D status. This is an open label, single site - hospital based centre Primary: Proportion of subjects at 4 months of age with 25 OH vit D levels > 50nmol/L. Secondary: Total calcium as marker of safety, compliance, clinical markers of vitamin D deficiency Recruitment period: May – Feb 2014. Four month follow up period 1) 400 IU vitamin D daily 2) 50,000 IU at birth only (bolus) Sample size of 70 with 28 in each group + drop out rate. Term breastfed infants born to pregnant women who are found to be vitamin D deficient (25 OH vit D < 50nmol/L) at 35-37 weeks gestation
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Modulation of chronic pain perception with noninvasive central and peripheral nervous system stimulation.
Expand descriptionThe aims of the randomized controlled research project are to investigate the effects of five consecutive daily sessions (1 x 30 minute session/ treatment day) of both: 1) transcranial direct current stimulation (tDCS) and 2) transcutaneous electrical nerve stimulation (TENS) in improving pain intensity, physical functioning, mental health and quality of life in a chronic pain population awaiting pain clinic intervention. The study also aims to investigate whether prior treatment with consecutive daily sessions of both tDCS and TENS improves the outcomes of pain clinic intervention. Outcome measures and methods that will be used to achieve these aims will include: 1) asking subjects to complete self-reported questionnaires that include questions related to measures of pain, physical function, mental health and quality of life 2) measuring the subject's sensitivity to mechanical, electrical and thermal induced pain stimuli (i.e. the stimulus intensity will be increased until the subject can confidently perceive that the pain elicited by the stimulus ‘matches’ the level of intensity of their current pain problem) delivered to the subject's dominant hand using a pressure algometer, electric current stimulator and thermal stimulus respectively 3) collecting subject's saliva to assess induced changes to pain related biomarkers using immunohistochemical techniques.
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Evaluation of weekend allied health services on acute medical / surgical wards
Expand descriptionProvision 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 2nd phase is registered as a separate trial on ANZCTR). At Monash and Western Health, existing weekend allied health services will be incrementally removed across 6 wards over a 7 month period (5 wards over 6 months at Melbourne Health). 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.
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Investigation of a portable, non-invasive vibrator (the Respiratory Assist Device-RAD) to reduce breathlessness in people with Chronic Obstructive Pulmonary Disease (COPD).
Expand descriptionBreathlessness can stop people from being able to perform activities of daily living or exercise, and as such may have a negative impact on their quality of life. Past research has shown that applying mechanical vibration of 100 Hz to the chest wall decreases the sensation of breathlessness (dyspnoea) in both healthy subjects and in people with spinal cord injury, chronic obstructive airway disease and asthma. The devices used in previous research studies have not been portable nor have they been able to be used by people during activities of daily living. The Respiratory Aid Device (RAD) is a portable, battery operated, user friendly device which applies mechanical vibration (˜ 100 Hz) to the chest wall. Participants with stable COPD will be recruited from the pulmonary rehabilitation programme at Royal Prince Alfred Hospital via a flyer. All participants will be seen twice during their regular visits to the pulmonary rehabilitation programme. On the first occasion the level of exercise that causes moderate breathlessness will be established. On the second occasion, participants will perform two (2) 10 minute exercise bouts on a stationary cycle at an intensity based on 60% of the calculated peak work capacity (Hill et al 2008). The RAD will be attached to the chest wall during both exercise bouts, with the order of the placement randomised to either the active position or sham position. . The severity of the sensation of breathlessness will be recorded at one minute intervals throughout the exercise sessions using the Borg breathlessness scale. The RAD is a non-invasive, portable device consisting of two main components, a sensor and a vibrator. The respiration sensor is a 100K NTC thermister mounted on a plastic face mask such that the air flow through the face mask can effectively heat and cool the thermister in phase with respiration. The two vibrators consist of an off-the-shelf vibrator (normally used in mobile phones). When 3volts DC is applied to the vibrator it vibrates at 100Hz. The vibrators are taped to the chest wall. The system is powered by two 1.5V “AA” alkaline batteries.
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Anti-inflammatory treatment for dermatological disorders.
Expand descriptionA Phase I, randomised, double blind, placebo-controlled, study of the safety, tolerability, pharmacokinetics and clinical activity of AKP-11 administration to healthy volunteers and patients with mild to moderate psoriasis.
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The effect of a bout of resistance exercise on pressure pain sensitivity in knee osteoarthritis
Expand descriptionThis study investigates the analgesic effects of a bout resistance exercise on pressure pain thresholds and pressure pain tolerance in healthy participants and participants with knee osteoarthritis. The pain measures will be assessed at baseline and will be repeated following a bout of resistance exercise. Questionnaires concerning physical activity, pain, disability and injury will be completed by the participants.