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Following major surgery patients are at increased risk of developing blood clots in the veins of the lower limb and in some patients these may dislodge, travel to the lung as pulmonary emboli, resulting in breathing difficulties and rarely death. The situation is no different after caesarian section, where patients are at increased risk of blood clots, however the risk is not the same for all but influenced by factors such as previous history of blood clots, the need for emergency surgery, age and body weight. After your surgery we can minimize the risk of blood clots by mobilizing you as soon as possible, using below knee compression stockings, which prevent pooling of blood in calf veins and in certain patients by once daily injections under the skin of a blood thinning low molecular weight heparin drug (LMWH) called enoxaparin. For many years the dose of enoxaparin has been fixed and not adjusted for body weight, however there is evidence from studies in overweight non-pregnant patients that as body weight increases an increase in dose is required to maintain prevention. Pregnancy also alters the way these enoxaparin is handled by the body resulting in an increase in the dose required (at the end of pregnancy and immediately after delivery) to provide the same action as in the non-pregnant patient. Recently, the Royal College of Obstetrician and Gynaecologists (RCOG) in the United Kingdom have updated their guidelines for prevention of thrombosis after caesarian section and recommend that patients classified as intermediate risk or greater should be given LMWH with the dose determined by their actual body weight at 8 -16 weeks of gestation (usually referred to as the booking weight). We believe that you fall into the intermediate (or high) risk category and therefore would benefit from having LMWH preventative treatment. The dose given to you will be that recommended by the RCOG guideline and will be calculated based on your body weight at the time of registering for care at the Mercy Hospital for Women. For patients of less than 90 kg you will receive what for many years has been the standard dose of enoxaparin. For patients above 90 kg you will receive a dose greater than this fixed dose, which we believe is safe and is likely to result in better prevention of clots compared to the usual dose. We are asking that you consent to having three samples of blood (10 mls each) taken and analyzed for LMWH blood thinning activity (antiXa levels). The first and second samples will be taken immediately prior to & then four hours after your first preventative injection some 4-12 hours after completion of your caesarian section. A third sample will be taken four hours after your third or fourth dose given on the day prior to your discharge from hospital. An additional small plastic cannula will be inserted into a arm vein at the time of your caesarian section and the first blood sample taken at that time. A second sample, hopefully via the cannula, will be taken 3 – 5 hours after the injection of Enoxaparin some 4-12 hours after your caesarian delivery. The third sample will require a separate blood test to be taken. The study does not change the obstetric or anaesthetic management of your delivery. Breast feeding is considered safe whilst on enoxaparin. All blood thinners lead to a slightly increased risk of wound and uterine bleeding. We don't believe that the risk of bleeding is increased over that seen in non pregnant patients given enoxaparin to prevent blood clots following surgery.

This study aims to determine whether a tailored educational package can reduce psychological distress in women with breast cancer who are referred for radiotherapy. Who is it for? You may be eligible to join this study if you are a woman aged 18 years or more who has been diagnosed with breast cancer for which you are about to commence a course of radiation therapy that will be more than 4 weeks. Trial details Participants in this trial will be allocated to one of two groups. One group will receive the standard information provided in radiation oncology. The other group will undergo an innovative radiotherapy program, consisting of two one-on-one 20 minute educational sessions with their radiotherapist. During the consultations the radiation therapist will discuss the procedure that is about to occur, what will be expected of the patient, any immediate discomfort or pain they should anticipate, and any short or long term side effects that may result from the procedure. Participants will be assessed on four occasions before and after treatment to determine their psychological distress levels, specific concerns about radiotherapy, knowledge of radiotherapy, and preparedness for treatment.

Background Following admission to a nursing home, the feelings of depression and burden that family carers may experience do not necessarily diminish. Additionally, they may experience feelings of guilt and grief for the loss of a previously close relationship. At the same time, individuals with dementia may develop symptoms of depression and agitation (BPSD) that may be related to changes in family relationships, social interaction and stimulation. Until now, interventions to alleviate carer stress and BPSD have treated carers and relatives separately rather than focusing on maintaining or enhancing their relationships. One-to-one structured activities have been shown to reduce BPSD and also improve the caring experience, but barriers exist to the implementation of activities in aged care facilities, for example lack of resources. The current study will investigate the effect of individualised activities based on the Montessori methodology administered by family carers in residential care. Methods/ Design We will conduct a cluster-randomised trial to train family carers in conducting personalised one-to-one activities based on the Montessori methodology with their relatives. Montessori activities derive from the principles espoused by Maria Montessori and subsequent educational theorists to promote engagement in learning, namely task breakdown, guided repetition, progression in difficulty from simple to complex, and the careful matching of demands to levels of competence. Persons with dementia living in aged care facilities and frequently visiting family carers will be included in the study. Consented, willing participants will on facility level be randomly assigned to a treatment condition using the Montessori approach or a control waiting list condition. We hypothesise that family carers conducting Montessori-based activities will experience improvements in quality of visits and overall relationship with the resident as well as higher self-rated mastery, fewer depressive symptoms, and a better quality of life than carers in the waiting list condition. Discussion Training family carers to deliver personalised activities to their relatives in a residential setting may make visits more satisfying and improve the quality of life for carers and their relatives. These beneficial effects might also reduce nursing staff burden and thus impact positively on residential facilities.

The aim of the study is to examine if an early oral health promotion intervention using a brief motivational interviewing counseling session among parents of new-born children will affect the occurrence of early childhood dental decay. The hypothesis being tested is that the motivational interviewing intervention will reduce the occurrence of early childhood dental decay compared with standard "Lift the Lip" screening program.

Peripheral Arterial Disease (PAD) is a major public health problem in Australia. The incidence increases with age and an estimated 10-25% of men and women over the age of 55 years are affected. The ageing Australian population will see an increase in the prevalence of PAD and consequently the national annual health expenditure on cardiovascular disease is likely to increase, greatly exceeding the 5.4 billion dollars spent in 2000-01. PAD is preceded by endothelial dysfunction, show an increase in inflammatory markers and failing of the circulation in affected limbs. EPA and DHA have been demonstrated to exert anti-inflammatory effects within the blood vessel wall thus reducing the amount of potent inflammatory markers produced. They also exert anti-thrombotic effects thus increasing the flow of blood within vessels. Dietary supplementation with fish oil rich in n-3 PUFA has been shown to positively impact on vascular function in the setting of atherosclerosis. It is known that there is a heritable basis to PAD, however, little is known whether improvements in endothelial function can be achieved in asymptomatic children of those with established PAD using n-3 PUFA. Early detection and intervention using a non-invasive, readily available, affordable and acceptable supplement such as fish oil has the potential to improve clinical management and prevent or delay the onset of those at high risk of developing symptomatic PAD. The aim of this study is to implement a 12 week, moderate dose fish oil intervention (10ml/day containing ~1.5g EPA and ~1g DHA), that will result in clinically and statistically significant improvements in terms of: a) Endothelial function; b) Inflammation; c) Lipid status (Total cholesterol, LDL, HDL, TG); and d) Omega 3 Fatty Acid levels.

The purpose of this study is to improve the medication management and health related quality of life of a cohort of older Australians by applying a prescribing indicators tool to detect potential and actual drug related problems, and then attempting to correct them by writing to the patients general medical practitioner.

We hypothesise that Mupirocin nasal rinses are more efficacious compared to placebo in patients that are bothered by persistent S.aureus infection despite complete sinus surgery.

Cardiovascular disease is a common major complication in patients with Type 2 diabetes. People with Type 2 diabetes have abnormal blood fat levels which contribute to this risk of heart disease, particularly high triglycerides, low HDL (good) cholesterol and high small dense LDL (bad) cholesterol. Cholesterol lowering medications called ‘statins’ are widely used to treat this abnormal blood fat metabolism found in Type 2 diabetes. Cholesterol guidelines advise that the LDL-cholesterol be treated to a level of less than 2.5mmol/L. However, more than 30% of patients with Type 2 diabetes continue to have high triglycerides at levels greater than 1.7mmol/L even when their LDL-cholesterol is treated to less than 2.5mmol/L. These patients with high triglyceride levels remain at higher risk of cardiovascular disease despite the statin therapy. Vildagliptin is used to lower blood sugar in patients with Type 2 diabetes. It belongs to a class of medicines known as DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors) and is effective in lowering post-meal blood sugar levels. Current evidence suggests that vildagliptin lowers post-meal blood triglyceride levels in patients with Type 2 diabetes not taking statin therapy. It is not known whether vildagliptin improves artery function (a marker of risk of cardiovascular disease) in people with Type 2 diabetes. It is proposed that, for the group of patients with Type 2 diabetes and high blood triglyceride levels despite statin treatment, an improvement of artery function could occur concurrently with improvement of post-meal blood triglyceride levels with vildagliptin treatment. Thus, vildagliptin may help reduce the high risk of future cardiovascular disease in this group of patients. The aim of this study is to examine the effect of vildagliptin on post-meal blood fat levels and post-meal artery function in patients with type 2 diabetes and high blood triglyceride levels despite taking statins. Participating patients will already be receiving metformin to control blood sugar.

This project aims to explore, in a randomised trial, whether a novel training program based on the observation of hand action can influence the early development of hand reaching and grasping in healthy infants and infants with asymmetric brain injury. This study will compare Action Observation Training with standard Observation Training in a population of healthy term infants, as well as in a population of infants with asymmetric brain injury. It is predicted that: (1) Action Observation Training will improve the symmetry of bimanual hand function as measured on the Infant Hand Assesment at 18 weeks, compared to standard Observation Training; and (2) Action Observation Training will have a greater impact on the quantity and quality of reaching and grasping of the impaired hand as measured on the Reach and Grasp Assessment at 18 weeks, compared to standard Observation Training.