ANZCTR search results

The aim of the study is to investigate the acute postprandial effects of prior resistance exercise on a low dairy calcium breakfast, and to gain an appreciation of its effects relative to the high dairy calcium breakfast. We therefore hypothesized that prior resistance exercise would obviate the poorer post-prandial fat oxidation and thermogenesis following low calcium to a level found after a high calcium meal.

The Alfred Hospital Trauma Service admits over 5000 patients per year with 1 in 5 deemed to have suffered major trauma (Trauma Registry, The Alfred, Trauma Audit 2010). Acute hospital care must be as efficient and effective as possible, given the high demand and the current pressure on inpatient beds. The doctors stabilise the patient medically and surgically as soon as possible, while the allied health team prepares the patient physically, psychologically and socially for timely discharge. For the trauma physiotherapists this involves treating patients in the emergency department, the intensive care unit and the ward. Despite dedicated clinical resources, trauma patient care may be impacted on by other acute care priorities and this can result in sub-optimal patient recovery and delayed discharge. A recent audit (2010) undertaken in the trauma service at The Alfred revealed only 33% of patients who could sit out of bed for meals, actually did so. We hypothesize that inadequate resources and low patient self confidence results in an unacceptable achievement of simple daily tasks after trauma. The optimal intensity / frequency of physiotherapy intervention for trauma patients in the acute care is unclear. Studies have shown early and intensive physiotherapy to be safe following stroke (Bernhardt et al 2008) and within the intensive care context (Schweickert et al 2008, Hopkins et al 2009). It also assists with functional independence and discharge destination gains following acquired brain injury (Turner-Stokes et al 2005), femoral fracture (Oldmeadow et al 2006, Pendleton et al 2007) and ankle fracture (Kimmel et al 2010). The goal of the physiotherapy intervention in the acute hospital is to prepare the patient physically for discharge to the community, commonly detailed as independence in transfers and ambulation (with or without a gait aid) and the ability to safely negotiate steps. These criteria are achieved through a regime of strengthening exercises and gait retraining. It seems reasonable to hypothesise that success may be enhanced by increasing the patients opportunity to practice these skills and may result in improved functional ability, a shorter hospital length of stay and more discharges directly home. Information regarding the optimal intensity / frequency of physiotherapy input will inform appropriate resource allocation to ensure maximum benefit for the patient, their families and the health care system.

This research project is aiming to determine the effects of Bacopa on cognitive function, cardiovascular function and stress. Bacopa is a herb found in wetlands and muddy shore lines that has been used in traditional Indian medicine as a treatment for epilepsy and asthma. Russo & Borrelli (2005) claim that it has been used for over 3000 years as a memory and intellect enhancer. There is also evidence to suggest that Bacopa is an antioxidant, playing an important role in reducing the oxidation of fats in the bloodstream. This study will investigate the cognitive, cardiovascular and stress effects of two doses of bacopa compared to placebo. Participants will be required to attend three testing sessions (and one practice session). Each session will see participants taking one of three interventions (administered in capsules); (1) Bacopa Monniera – 300mg (2 x 150mg capsules, 2 x placebo capsules) (2) Bacopa Monneria – 600mg (4 x 150mg capsules) (3) Placebo (4 x capsules) On the testing days participants will complete baseline testing (consisting of the cognitive battery, cardiovascular measures and stress testing) after which they will be administered their randomly assigned treatment. Two hours post dose participant will complete the testing again (cognitive battery, cardiovascular measures and stress testing). There will be a seven day washout period and the process will be repeated again. Over the course of the investigation, participants will complete all three treatments with treatment order being randomised and counterbalanced across participants. Russo, A. and F. Borrelli (2005). "Bacopa monniera, a reputed nootropic plant: an overview." Phytomedicine 12(4): 305-317

The project aims to assess the impact of an Integrated Point of Care Testing service (IPcOT) within the emergency department. Point of care testing (PoCT) involves the installation of a blood analyser within the emergency department that can process a selection of specific tests. The emergency department staff operates the machine, and a result is available in a few minutes. IPoCT involves integrating this machine with the hospital pathology service so that the results of testing performed on this machine are recorded within the SEALS database, and these results can be accessed through the patients electronic medical record. It would seem intuitive that having a IPoCT machine in the ED would have obvious benefits with rapid availability of blood tests allowing rapid decision making that would translate into shorter ED LOS. However, this does not take into account that a IPoCT machine must be operated by ED staff, rather than the lab staff, increasing the work load of ED staff and diverting them away from their usual duties. The IPoCT machine may be able to process a single sample in several minutes, however, in a busy ED where many patients require blood tests simultaneously it is likely that multiple staff will be competing to process blood samples on the one machine, leading to a back-log of tests so that turn-around times for IPoCT could be much longer than expected. The aim of this study is to determine the impact that the availability of point of care testing has on time to admission/discharge decision, and a secondary objective is to perform an economic evaluation (ie what is the cost per unit time saved in decision making time?).

The purpose of this study is to determine if nutrients that have been shown to improve blood flow and increase circulating insulin-like growth factor 1 concentrations in the blood can improve both blood flow in the ovary and elevate the concentration of insulin-like growth factor 1 in the follicular fluid surrounding the eggs. The ability to increase the concentration of IGF-1 in follicular fluid surrounding the eggs in the ovary in this way may provide an inexpensive and simple alternative to growth hormone treatment for improving egg quality in patients undergoing IVF treatment.

To determine whether a brief period of topical glucose application to the eye can transiently elevate the vitreous glucose concentration. This is a pilot study designed to provide motivation (or not) to proceed to further research. It would be inappropriate to proceed without a pilot study of this nature We aim to proceed to a human trial using topical glucose as a neurorecovery agent in glaucoma patients. However, before proceeding to this trial we need to establish that topical glucose can elevate the vitreous glucose concentration. This is a Phase I type study in the sense that glucose eye drops have not been previously used therapeutically and we are not assessing efficacy. But it differs from a classic Phase I study in the sense that we are not seeking to assess the dose at which the glucose becomes unacceptably toxic; however, we believe that a modified dose escalation strategy would provide the optimal safety and still provide the necessary vitreous concentration data for statistical analysis.

The introduction of induction transplant medications (i.e. given before transplantation) such as Thymoglobulin and Basiliximab has led to a major reduction in acute kidney rejection and enhanced early kidney transplant survival. Despite improvement in short-term outcomes, there has been minimal improvement in longer-term kidney transplant survival due to progressive scarring and damage of transplanted kidneys, partly attributed to the use of other transplant medications such as tacrolimus (a form of calcienurin-inhibitor). In addition, renal transplant recipients receiving marginal donor kidneys (poorer quality kidneys) have more damage/scarring and have reduced graft survival compared to standard donor kidneys. A population of circulating rare cells known as regulatory T cells, have been shown to be beneficial in kidney transplantation, possibly by reducing patients’ immune responses (therefore may reduce rejection risk) and prevent inflammation and scarring (which may improve long-term outcome of kidney transplants). Thymoglobulin and sirolimus (another type of transplant medication) have been shown independently to promote the development of regulatory T cells and may possibly prevent scarring in the transplanted kidney. However, the combination of thymoglobulin with sirolimus on transplant outcomes have not been evaluated. The aims of this study will be to compare recipients of donation after cardiac death donor kidneys receiving Thymoglobulin compared to basiliximab induction with low-dose tacrolimus, mycophenolic acid and steroids (other transplant medications) for at least months, changing to sirolimus in appropriate recipients up to 12 months post-transplant. The following outcomes will be assessed: proportion of circulating regulatory T cells, transplant kidney injury and scarring, metabolic and inflammatory outcomes as well as efficacy and tolerability between the two treatment groups.

Exercise therapy, in particular aerobic exercise, in the CKD population has been shown to decrease cardiovascular risk factors and subsequent CVD, however there has been little work comparing the effectiveness of different exercise prescriptions. Furthermore, patients with CKD endure significant muscle wasting which greatly impacts on their ability to complete day to day activities and their quality of life. The primary measure will be cardiorespiratory fitness, measured as maximal oxygen uptake using expired air gas analysis during an exercise stress test. Additionally, although previous studies in chronic disease populations have demonstrated exercise therapy to be effective in reducing muscle wastage, the intensity of the training required for maximum benefits is still equivocal. The effects of training intensity on muscle wasting will be assessed through whole body composition dual x-ray absorptiometry. As the mechanisms of the persistent loss of muscle mass observed in patients with CKD is poorly understood, this study also aims to investigate the effects of exercise training on pathways of muscle breakdown. To investigate the mechanisms, plasma samples will be collected and muscle biopsies will be performed before and after the training.

Implantation of the embryo remains a key rate limiting step for successful outcome in an IVF/ICSI cycle in women with subfertility. Several small and heterogeneous studies have suggested that injury to the endometrium (lining of the uterus) prior to an IVF/ICSI cycle improves the clinical pregnancy rate or live birth rate. The aim of this study is to determine whether a single endometrial biopsy prior to an IVF/ICSI cycle influences the live birth rate in women under 40 years of age who have failed to conceive a pregnancy despite having undergone at least 2 embryo transfers of reasonable quality embryos. The study will be a large, single blind, randomised controlled trial with the above aim, whilst trying to control for many of the confounders present in previous small studies.

A randomised controlled trial comparing Internet based cognitive behavioural therapy for major depressive disorder plus a cognitive bias modification intervention (OxIGen) vs. Internet based cognitive behavioural therapy for major depressive disorder vs. a waitlist control on symptoms of depression and negative interpretation bias.