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Demographic trends resulting in increased longevity and an increasingly aged population, combined with the current economic climate, indicate that there will be rising demand placed on already stretched health resources. This is accentuated by the rural location of the Mackay Health Service District (MHSD) which leads to a disproportionate amount of patient and clinician time being spent on travel, as compared to metropolitan services. Within Mackay Base Hospital there are pressures on bed availability (average 96.5% bed occupancy), necessitating innovative early discharge / admission prevention strategies. In addition, patients may be admitted unnecessarily because; they are nearing their emergency department (ED) wait limit target; there are limited and variable Allied Health (AH) services available for ED referrals; or existing ED staff do not have a detailed awareness of community services available to address these patients’ rehabilitation needs. Compounding this, anecdote suggests that there are inefficiencies within existing AH service delivery models; that tasks are duplicated by health professionals, that patients are frustrated by repeating information to AH staff involved in their care, that Allied Health Assistants (AHAs) are under utilised and that services are often fragmented. Increasing pressures on services, staff shortages and lone working, common in regional areas, has led to clinicians informally skill sharing, albeit in an ad-hoc and unstructured fashion, often without the requisite training and competence to enable them to be effective, or to recognise when they are out of their depth. There is inherent risk in this practice, unless a rigorous process has been followed to identify and risk analyse tasks for their appropriateness to share across professional boundaries or delegate. There is subjective information indicating that many tasks are undertaken by qualified practitioners that could be delegated to AHAs, and that there are tasks that can’t be delegated but don’t require highly specialist knowledge and skills to perform, for example routine assessments / interventions. In these instances, it is intuitively sensible to identify which tasks could be delegated / shared across professional boundaries, to use the skill set of the multi-disciplinary team (MDT) more effectively. The Calderdale Competency Framework is a systematic approach to identifying tasks carried out in teams, deciding which can be shared across professional boundaries, or delegated, and assessing competence. Following implementation of the Calderdale Framework, AH practitioners share professional skills across AH disciplines and increase delegation of tasks to AHAs, reducing the number of professionals involved in a patient’s care and minimising duplication of interviews, assessments, interventions, documentation and travel. The Calderdale Competency Framework has numerous potential benefits for the patients, clinicians and organisations, including: Patients are able to form a rapport with 1 individual who can meet most needs, reducing the number of visitors to their home or bedside - more rounded, holistic knowledge of the patient Access to a wider range if interventions for patients living in rural / remote areas Reduced repetition of personal details, condition history and assessments - reduced travel costs and duplication of tasks / roles Closer MDT working - Multi skilled staff - effective team built around the patient Increased awareness and respect of one another’s roles - more issues are identified and addressed - awareness of when staff need to seek the involvement of their colleagues Each discipline’s areas of expertise are identified - guides focus of resources Safe skill sharing / transferable skills Multi skilled workforce using the full scope of practice and delegating appropriately Increased job satisfaction – clarified roles and responsibilities - reduction in staff absence Less ‘hand offs’ - No need for patient handover Improved service productivity / patient flow Management of increased demands Although this framework has been applied in many settings in the UK, it has not been used previously in Australia and the clinical effectiveness of this model of care (MoC) has never been evaluated. In Queensland Health, this model of care is known as shared competencies and delegation practice (SCDP). The proposed study aims to examine the clinical and cost effectiveness in SCDP in relation to its current implementation in the Mackay Health Service District. All AH tasks carried out within the Emergency Department (ED) in the Mackay Health Services District will be identified and, using a risk management decision tool, tasks will be categorised into those that should be delegated to support staff, those that could be professionally skill shared and those which should remain uni-disciplinary. Competencies will be written / sourced and multi-disciplinary team (MDT) staff will teach each other skills, which have historically been considered their role. An Occupational Therapist and a Physiotherapist will then operate Shared Competencies and Delegation Practice within the ED setting. MDT staff will be fully engaged at all stages of the process to ensure sign up. The model is likely to enable patients, triaged to ED categories 2/3/4 (n=27,156 July 2010 - February 2011), to be assessed by AH staff quickly and admission avoided or length of stay reduced, as MDT assessments would have already been completed and discharge planning initiated. The nursing and medical input to patients will not be affected by this study. Aim(s) of project/study This study aims to determine the clinical and cost effectiveness in implementing a SCDP MoC with older people presenting to the ED. Research questions Is Shared Competencies and Delegation Practice (SCDP) clinically effective in enhancing patients’ functional independence, in an Emergency Department (ED) setting, as compared to usual care? Is SCPD cost effective? A prospective Randomised Controlled Trial design will be used with blinding of participants, outcome assessors and statistical analysts. Data will be collected at baseline, on discharge from Allied Health intervention and at 4 months post randomisation. The Cost Utility Study will be carried out from a societal perspective with both direct and indirect costs identified. The primary measure of benefit will be quality of life as measured by the Euroqol. Clients who attend the ED between the hours of 8am – 6pm Monday to Saturday, meet the study inclusion criteria and provide written informed consent to participate will be randomised to the intervention or control groups. The intervention group will receive AH input from clinicians trained in Shared Competencies and Delegation Practice whilst in ED, with follow-up on the ward or in the community if required. The AH clinicians based in the ED will be an occupational therapists and physiotherapists, by clinical background, but will be additionally trained in occupational therapy / physiotherapy / speech pathology / dietetics / podiatry and social work competencies. Thus, clinicians will be able to complete a more a rounded assessment and target intervention to meet the client’s complex needs. Intervention will aim to maximise functional independence, prevent admission and minimise the number of AH clinicians involved in a client’s care. An intervention protocol will be developed to ensure consistency in this approach. The control group will receive standard care, which comprises of clients being referred to individual disciplines, as the need is identified by the Community: Hospital Interface Programme (CHIP) nurses in the ED. Individual disciplines will then intervene with the clients using existing uni-disciplinary approaches and refer on to other services as indicated. Standard care will be documented via an audit prior to trial commencement to ensure that it can be clearly defined at the outset.

The aim is to assess the feasibility and efficacy of an evidence-based internet anxiety and depression prevention program for year 9-10 of high school. Currently, evidence-based programs do exist, but are largely not implemented in schools due to implementation (e.g., limited resources and teacher training) and dissemination failure. The aim of developing CRUfAD Schools: Alcohol Module is to overcome such concerns by developing a online intervention which would have the advantage of providing complete, consistent and flexible delivery on every occasion, without demanding excess teacher’s time, resources and training. CRUfAD Schools: Overcoming Anxiety and Combating Depression would also have the potential advantage of being an interactive program which would allow high-risk populations, who often do not seek help, to seek help with relative anonymity and confidentiality.

The project will aim to test a single-session parenting group for parents of children with problem eating. It is anticipated that the group will improve child feeding, the strategies parent use at mealtimes, and how parents think and feel about mealtimes. The study will also seek to identify which types of feeding problems respond best to this intervention.

This study seeks to determine if the use of a simple questionnaire can enhance the detection of carer distress in the Palliative care carer population.

This study will assess the effect and overall survival outcomes of radiotherapy following mastectomy in women with breast cancer. Who is it for? You may be eligible to join this study if you are a female with confirmed unilateral breast cancer with 'intermediate risk' of loco-regional recurrence following mastectomy. Trial details Participants in this trial will be randomly (by chance) allocated to one of two groups. Participants in one group will undergo radiotherapy 5 days a week for 3-5 weeks commencing 12 weeks after mastectomy or 6 weeks after adjuvant chemotherapy. Participants in the other group will receive standard of care and observation only. Participants are followed up twice in the first year, and then annually for 10 years in order to asses the study endpoints.

Atrial fibrillation (AF) is the most common heart arrhythmia affecting at least 240,000 Australians. Prevalence rises with age from approximately 1% of the whole population to 5% in those over 65 years. People with AF are up to seven times more likely to have a stroke than the general population, and AF related strokes are also likely to be more severe. In addition, one in every six strokes is AF related. Stroke is highly preventable in AF with the use of appropriate thromboprophylaxis. Therefore early identification and appropriate evidence based management of AF could lead to subsequent stroke prevention, significant reduction in the overall stroke burden and substantial savings to the health system. Our hypothesis is that a simple community pharmacy based screening program may be effective in detecting those with undiagnosed AF. The specific aims are to: 1. To identify the number of newly identified AF in people aged 65 years and over in a pharmacy setting. 2. Determine the feasibility of screening for AF using a pulse check and handheld singlelead electrocardiography (ECG) device in people aged 65 years and over. 3. Inform refinement of the intervention through the use of process measures with view to establishing a larger crosssectional study. 4. To increase the skills and knowledge of pharmacists regarding atrial fibrillation screening and management. We propose a crosssectional study offered in 10 community pharmacies in the districts surrounding the Concord Hospital. People aged 65 and over, attending community pharmacies will be invited to volunteer for the screening. The screening will consist of a pulse check, brief medical history including pharmacotherapy and screen of AF symptoms and an assessment with a handheld singlelead ECG device. The pharmacist will communicate the provisional diagnosis to the participants treating general practitioner (GP). For those participants suspected of having AF, the research team will contact the both the participant and their GP. We will invite the GP to refer their patient to Concord Hospital cardiology clinic for definitive diagnosis and standard cardiology care as appropriate. The primary outcome measure will be the number of newly identified atrial fibrillation in a community cohort aged 65 years and over. A process evaluation will also be undertaken to better appreciate factors that might influence sustainability beyond the trial setting.

People with bipolar disorder (BD) experience recurrent, extreme highs and lows in mood, which can severely affect their health, career and relationships. BD can often be effectively treated with long-term mood stabilizer (MS) medications. Unfortunately though, MS medications can cause birth defects and complications if taken during pregnancy. If women with BD stop taking MS medications during pregnancy however, they run a very high risk of relapse, and unstable maternal mental health during pregnancy is associated with poor outcomes for both mother and child. In this study, we aim to determine if a natural dietary supplement (omega-3 fatty acids), which is safe for both mother and baby, has the potential to offer women with bipolar disorder an effective alternative to MS medication during pregnancy. Long-chain omega-3 fatty acids (LC-omega-3 FA) comprise a family of essential nutrients which have a variety of vital actions in the body. In particular, LC-omega-3 FA have important effects on brain development and function. Recent studies indicate that LC-omega-3 FA supplementation can affect mood, particularly to reduce depression. In this project, we will undertake a clinical trial to evaluate the efficacy of LC-omega-3 FA supplementation to reduce the occurrence of mood episodes in bipolar women who discontinue their use of MS medication during pregnancy.

Do you worry a lot about the possibility of cancer recurrence? Does this worry affect your life? Almost all cancer survivors worry from time to time about the possibility of their cancer returning. For some people these fears are frequent, very distressing and make it hard to enjoy life. If you suffer from frequent or severe worry about the possibility of your cancer coming back, and it is getting in the way of how you wish to lead your life, you may be interested to join a research study comparing two different psychological treatments to help people to better manage fear of cancer recurrence. Hospitals around Australia are conducting the study together with a team of researchers from the Psycho-Oncology Co-operative Research Group at the University of Sydney, led by Prof Phyllis Butow. Am I eligible to be involved in this study? We are seeking people over the age of 18 years who: 1) Have been diagnosed with stage 0-III breast cancer, stage I-IIIA colorectal cancer, or stage IA-IIB melanoma; 2) Have completed hospital-based treatments (surgery, chemotherapy, or radiotherapy) more than 2 months and less than 5 years ago; 3) Have no medical evidence of active cancer; 4) Can speak and read English well; 5) Experience a high level of worry about their cancer coming back What does this study involve? If you decide to participate in the study, you will receive a psychological treatment focused on either the more physical (tension) aspects or the more mental (worry) aspects of fear of cancer recurrence. Which treatment you get, will be decided randomly (by chance). Both treatments will be provided free of charge and will involve attending five individual sessions with a psychologist or psychiatrist, each lasting 60-90 minutes, over a period of 10 weeks (one session per fortnight). You will also be asked to practice some of the techniques you learn during the sessions at home. In addition to attending treatment sessions, you will be asked to complete a questionnaire to evaluate how well your treatment is working at four time-points: 1) before treatment; 2) immediately after you complete treatment; 3) 3 months after you complete treatment; and 4) 6 months after you complete treatment. You may also be invited to participate in a 30-minute phone interview about your experience and satisfaction with the treatment you received. Where do I find more information? If you are interested in being involved or to find out if you are eligible please contact the research co-ordinator (Stephanie Tesson) at the University of Sydney by phoning 02 9351 4518 or emailing conquer.fear@psych.usyd.edu.au This study has been approved by the Human Research Ethics Committee South Eastern Sydney Local Health District (SESLHD)

Single-centre, randomised-controlled trial with a comparison of two protective ventilation techniques in order to determine the effect on the incidence of acute lung injury/ischaemia-reperfusion injury. Primary aims: 1. To determine the incidence and severity of acute lung injury post lung transplantation. 2. To determine the incidence of inflammatory markers in serum and bronchoalveolar lavage samples during anf after lung transplantation 3. To analyse the association between inflammatory markers and acute lung injury 4. To determine whether there is a decrease in the level of inflammation and incidence of acute lung injury associated with pressure-controlled, high positive end-expiratory pressure and alveolar recruitment Secondary aims: 1. To determine whether further protective ventilation techniques should be incorporated into lung transplantation anaesthesia. Hypothesis: Pressure-controlled ventilation and high positive end-expiratory pressure with the addition of alveolar recruitment will be more beneficial in minimising acute lung injury than low tidal volume protective ventilation alone in lung transplantation after allograft insertion.

We aim to investigate the effect of the drug hyaluronidase on the efficacy of ultrasound-guided fascia iliaca compartment block (FICB). Hyauluronidase is a naturally occurring enzyme that it available as a drug. It possesses spreading properties and it is used as a pharmaceutical agent to facilitate the dispersion of drugs and other substances. It has been proven to be effective in enhancing ocular regional anaesthesia but it has not been adequately studied in peripheral regional blockade. FICB is a safe and effective method of lumbar plexus regional anaesthesia. The goal of FICB is to provide femoral nerve, lateral cutaneous nerve of the thigh and obturator nerve block. While the femoral nerve and lateral cutaneous nerve of the thigh are reliably blocked by FICB the overall success rate of the block is limited by obturator nerve anaesthesia which is successful in only ~44% of ultrasound guided FICB - presumably due to the distance the local anaesthetic must traverse from its site of infiltration to reach this nerve. We hypothesise that adding hyaluronidase to a plain 0.5% ropivacine local anaesthetic solution will increase the success of FICB - chiefly the proportion of patients achieving obturator nerve anaesthesia (weakness of thigh adduction). We will also study effects on the speed of onset and blood levels of co-administered local anaesthetic. An improvement in the success of FICB should improve post-operative pain after knee replacement. If proven, there may also be other peripheral nerve block procedures that may benefit from the addition of hyaluronidase.