ANZCTR search results

The burden of stroke due to atrial fibrillation (AF; a common irregular heart rhythm) is high, especially in older persons in whom AF is most common. To prevent stroke in this high-risk population antithrombotic (anti-clotting) medicines must be used. Warfarin is currently the recommended therapy, however, it requires careful monitoring & management to avoid side-effects (eg bleeding), leading some clinicians to choose less effective therapies (aspirin) for their patients. This clinical trial will test the use of a novel computerised clinical tool (CARAT) to assist GPs in assessing their patients risk of stroke versus side-effects from treatment, and recommended treatment based on ‘risk assessment’.

The aim of this project is to understand whether specific FTO risk gene variants influence the skeletal muscle’s ability to utilise carbohydrates and fats at a genetic and tissue level following a 12 week high intensity intermittent exercise training intervention. Ten (10) healthy males with the FTO rs9939609 risk allele (A) and 10 healthy males with two FTO rs9939609 wild type alleles (TT) between the ages 20 - 50 will be recruited to participate in this study. Following a buccal swab and venous blood sampling to obtain a genetic and metabolic signature profile, participants will perform a low (40% VO2max-LO) and high-intensity (80% VO2max-HI) exercise bout for approximately 70 and 38 minutes, respectively. This second test will occur a minimum of 2 days following the commencement of the first exercise test (maximum of up to 1 week). Venous blood will be sampled prior to, immediately after, 15 minutes, and 3 hours following completion of the exercise. Urine samples will be collected prior to and 3 hours following the completion of the exercise. A 12 week exercise training intervention will then be employed. 36 training sessions will be conducted in total over the 12 week period. This intervention will involve participants cycling at 150% VO2max for 20 seconds with 40 seconds passive recovery per minute, and the frequency and duration of sessions will be incremented in 4 x 3 week blocks. Following this intervention the LO and HI exercise tests will be repeated (following the same procedures as indicated above).This project will provide important information on whether low or high intensity exercise is more effective to stimulating glucose and fat metabolism in skeletal muscle, and whether high intensity intermittent exercise training can influence the metabolic profile of those with FTO obesity risk variants. This project may also provide genetically susceptible individuals with an insight in to risk-reducing behaviours that can be effective in prevention of obesity.

Mitotane is the only systemic treatment available for advanced adrenocortical cancer and is toxic, with variable pharmacokinetics (variable drug metabolism between patients). This study aims to achieve ideal plasma levels of the drug quickly by adjustment of the dose based on plasma level, and maintain the plasma level within the ideal range by regular blood level monitoring and dose adjustment. We also aim to study factors that contribute to variability between patients in their metabolism of the drug, and confirm a relationship between drug level and anticancer effect. As a consequence of this study we aim to provide a high quality therapeutic drug monitoring service for clinicians and patients with this disease in Australia.

The use of general anaesthesia (GA) in infants and young children has generally been considered safe. Recent research from laboratory animal studies has raised concerns that exposure to anaesthetic medicines in early life could potentially be related to impaired memory, learning and behaviour. Cystic Fibrosis (CF) is an inherited condition that is usually diagnosed in the first few weeks of life through the newborn screening program. CF leads to serious chest infections and lung damage. To try and identify chest infections and treat them early before they have a chance to cause lung damage, children with CF may undergo many tests and treatments. The ACFBAL study was initiated to examine the use of BAL to direct therapy in young children with CF who are unable to expectorate sputum. This current study takes advantage of the previous randomisation to bronchoscopy directed therapy where children received bronchoscopy and BAL at baseline initially in the first six months of life, and subsequently with exacerbations requiring hospital admission or with Pseudomonas aeruginosa identified from oropharyngeal sampling.

The primary purpose of this study is to explore and describe the clinical decision making of Australian general practitioners involved in the management of blood pressure: how is BP being measured? How is BP being recorded? How is BP being interpreted by the GP and patient? How is BP being managed – lifestyle interventions, medication, as an isolated risk factor or in the context of absolute cardiovascular risk? We also want to explore the barriers and facilitators to the management of blood pressure in Australian general practice: What factors influence the clinical decision-making of the GP?

This study was designed to investigate if differences existed between acute energy consumption and perceived satiety in fatty acid (FA) hypersensitive and hyposenstive subjects following a high fat breakfast.

Abstract Introduction: Myalgia and headache are frequently observed conditions after electroconvulsive therapy (ECT). In this study, we aimed to compare the effects of succinylcholine and rocuronium-sugammadex on myalgia and headache after ECT. Material and Method: Forty five patients undergoing ECT were included in the study. Anesthesia induction was provided with propofol 1 mg/kg and succinylcholine 1 mg/kg in the Group S (n=24), and with propofol 1 mg/kg and rocuronium 0,3 mg/kg in the Group R (n=21). Electroshock was applied after obtaining full muscular relaxation. Sugammadex 4 mg/kg was administered to the group R after the motor seizure. The first three ECT sessions of all the patients were evaluated as regards the time of start of spontaneous respiration following the induction, time of opening the eyes in response to verbal stimuli, and VAS scores for myalgia and headache at hours 2, 6, 12 and 24 following the ECT. Results: There were no significant differences as regards demographic data and hemodynamic data upon comparison of the two groups. The times for the start of the spontaneous respiration and opening the eyes in response to verbal stimuli were found significantly shorter in all the three sessions in the Group R as compared to the Group S (p<0,002). MyalgiaVAS scores at hours 2, 6 and 12 and the headache VAS scores at hours 2 and 6 were significantly higher in the Group S as compared to the Group R (p<0,015). Conclusion: We concluded that the rate of myalgia and headache after ECT was significantly lower in group R than in group S and also the awakening time (spontaneous respiration and opening the eyes in response to verbal stimuli) in group R was significantly shorter than in group S. Key Words: Electroconvulsive therapy, succinylcholine, sugammadex, myalgia, headache

High blood pressure (BP) is the most common modifiable cause of death from cardiovascular disease (CVD). Lowering BP with medication improves patient outcomes, but even in populations with normal upper arm (brachial) BP there remains considerable residual risk for CVD. Our recent pilot work found that much of this risk may be due to persistently elevated central BP. However, there has never been a trial to determine the clinical value of targeted central BP lowering. This remains the most significant question to be answered before central BP can be considered for routine clinical use, and is the aim of this project. The proposed study will be a multi-centre, prospective, randomized, open-label, blinded endpoint (PROBE) trial over two years in 300 patients treated for hypertension who have controlled brachial BP but relatively high central BP. Randomisation to spironolactone (and lowering of central BP) is expected to significantly improve CVD risk, despite no significant change in clinic measured brachial BP.

Project aim: The aim of this project is to determine the effectiveness and tolerability of full-length shoe-stiffening inserts for the treatment of osteoarthritis of the big-toe joint of the foot. Rationale: Osteoarthritis of the big-toe joint is common and painful. Although full-length shoe-stiffening inserts are a recommended treatment for this condition, the evidence supporting their use is lacking.

Many depressed individuals fail to respond to available pharmacological and psychological therapies and there is a significant need to develop novel antidepressant treatment approaches. Traditionally, both research into and treatment approaches for depression have focused on the emotional disturbance associated with this illness. However, depression also disrupts cognitive processing. There is now considerable evidence indicating that the cognitive and emotional symptoms of depression interact with each other (e.g. causing an individual to remember more negative memories, or to pay more attention to negative thoughts and stimuli), and these interactions directly contribute to the length and severity of depressive episodes. Recently it has been suggested that targeting the cognitive symptoms of depression may also help to improve emotional dysfunction. One way that this could be achieved via cognitive control training (CCT). CCT simply involves a small number of thinking activities that an individual repeatedly practices to improve their ability to sustain and focus their attention and to self-direct their thought processes. The cognitive processes that CCT aims to enhance are largely subsumed by a frontal region of the brain called the dorsolateral prefrontal cortex. Research has shown that a mild form of brain stimulation called transcranial direct current stimulation (tDCS) administered to this brain region can enhance cognitive processing. As such, tDCS may be a useful means of augmenting the efficacy of CCT for depression.