ANZCTR search results

Chronic heart failure (CHF) is a major health burden in Australia, with an estimated 300,000 patients affected. Our goal is to optimise approaches aimed at enhancing exercise capacity in these patients, which will directly translate to improved prognosis and morbidity in advanced CHF. Our aims will be achieved by bringing together novel biomechanical and physiological approaches that have not previously been applied in the context of CHF in testing the following hypotheses: 1) The mechanical work capacity of skeletal muscle will be significantly lower in CHF patients, compared to age-matched controls. This will be linked to sub-optimal in vivo mechanical properties of the muscle. 2) Eccentric exercise training (EET) will significantly increase a) the mechanical work capacity of the skeletal muscle and b) exercise capacity in CHF, relative to the impact of conventional exercise training approaches. Significance: Exercise intolerance is a cardinal symptom of CHF and is associated with poor prognosis.The locus of physical limitations in CHF is typically in the periphery (skeletal muscle). However, traditional approaches to exercise rehabilitation in CHF have borrowed from ideas that work in healthy populations, in whom the limitations to performance differ from those relevant to CHF. Surprisingly, no studies have investigated the relevance of in vivo skeletal muscle mechanical characteristics in these patients. Consequently, no exercise interventions have been applied which are specifically designed to ameliorate skeletal muscle biomechanical limitations in CHF. We propose that eccentric training will significantly improve skeletal muscle mechanics and exercise capacity, compared to conventional exercise approaches. The findings from this study will help to optimise exercise prescription in CHF, directly benefiting CHF life expectancy and quality, and will encourage the widespread prescription of evidence-based exercise approaches for patients with CHF.

This study will evaluate the effect of a drug called regorafenib for treatment of advanced oesophago-gastric cancer. Who is it for? You may be eligible to join this study if you are aged 18 years or above and have been diagnosed with advanced (metastatic or locally recurrent) oesophago-gastric cancer which has not responded to treatment. Trial Details: Participants in this trial will be randomly (by chance) allocated to one of two groups. Participants will either take regorafenib (Group 1) or a placebo (sham) (Group 2) tablet oncer per day on days 1-21 of each 28 day cycle. Treatment will continue until disease progression or prohibitive adverse events. Participants will not know whether they are taking regorafenib or the placebo until after the trial is completed. Participants will be followed up every 2-4 weeks in order to evaluate how they are responding to treatment.

The purpose of the study is to help reduce the incidence of contrast induced nephropathy in patients who have impaired kidney function and required a purcutaneous coronary intervention procedure (e.g. stent) due to cardiovascular disease.

To test the hypothesis that acute stroke patients (both ischaemic and haemorrhagic) treated with IV minocycline within 24 hours of symptom onset have improved clinical outcomes compared with standard stroke care.

This study aims to determine if a new technique in treating prolapse will give a better long term result than the current standard treatment. The new technique aims to reduce the size of the opening in the pelvic floor and is done at the same time as the standard prolapse repair surgery.

This study aims to assess whether higher doses of steroids increase the risk of heart disease in pituitary patients. We hope that this study will increase the understanding of the effects of steroid replacement dose in patients with pituitary disorders. This information may influence what doses of steroid replacement are optimal for the long-term health of pituitary patients.

Calcium supplements increase bone density and are frequently prescribed to patients with osteoporosis. However, it is not certain whether they reduce the risk of fracture. A recent study from Auckland, New Zealand raised the possibility that calcium supplements might increase the risk of a heart attack (1). Therefore the medical community is reassessing the pros and cons of taking calcium supplements. After taking calcium tablets, the concentration of calcium in blood increases slightly for a few hours. The flow of calcium from blood into the muscle cells that line blood vessels causes them to contract. We hypothesize that the increase in blood calcium after taking calcium tablets makes the blood vessels contract and become stiffer, putting pressure on the heart. This study will assess the stiffness of blood vessels in 20 subjects before and after a single dose of calcium. We hope to determine whether arterial stiffening is a mechanism that could explain a relationship between calcium supplements and an increased risk of heart disease. Reference 1. Bolland MJ, Barber PA, Doughty RN et al. BMJ 2008; 336:262-266

Fasting of solids and fluids before general anaesthesia is essential to patient safety in order to reduce the risk of the pulmonary aspiration. The high acidity of stomach contents upon aspiration can cause significant damage to lung tissue. The estimated incidence of pulmonary aspiration is low, ranging between 1/2000 to 1/14000 with morbidity relating to aspiration even lower ranging between 1/4000 to 1/99000. Current fasting guidelines according to American Society of Anesthesiologists recommend a 2-hour fast for clear fluids before general anaesthesia. However, clear scientific evidence supporting this recommendation is lacking and the ideal fasting time and maximal permissible volume for water have yet to be determined. New evidence suggests that water up to 450mls can be safely consumed up to 90 minutes before induction of anaesthesia and that stomach volumes are lower in those who had consumed preoperative water than those who had a fast of 6 hours. Others have demonstrated that preoperative water consumption can also decrease patient thirst and anxiety without adverse effects. The proposed project aims to investigate the effect on stomach contents as measured by level of acidity and volume, following consumption of 200 ml of water up to 45 minutes before general anaesthesia. For this pilot study, approximately 90 elective adult patients scheduled for gastroscopy will be recruited. Patients will be randomly allocated into 2 groups. Both groups will be fasted for solids and clear fluids as per standard guidelines (6 hours for solids and 2 hours for clear fluid) but they will then be randomized to drink 200 ml (standard drinking cup) at 90-150 minutes or 45-60 minutes prior to their procedure respectively. Immediately post induction, gastric content is suctioned and emptied under direct vision via the gastroscope to assess for its volume and pH. This will strengthen the body of evidence that water consumption before general anesthesia up to 45 minutes before anaesthesia has minimal effect on gastric contents and may be potentially beneficial to patients.

To investigate the practice of removal of orthosis in patients with cervical trauma at time of clinical union in relation to patients perception of pain, their activity limitation and participation restriction measures

The main objective of this survey is to identify the capacity any pharmacy throughout South Australia has to be able to respond rapidly to the symptom control of palliative patients in the last few days or hours of life. This information will provide us with an objective overview as to how community pharmacies across South Australia currently are able to respond to palliative patients. It will also provide a basis to build approaches which support community pharmacy to respond to meet the needs of palliative care patient’s access to medicines. De-identified information will be used to: Guide the development of a priority medicines list for palliative patients across South Australia. This list will be chosen using three factors: clinical evidence, cost and medication accessibility. Where two or more medicines are clinically/cost equivalent we will need to identify which one has greater community accessibility. Provide feedback to the broader pharmacy community (Australian and overseas) in the form of a report published in a peer reviewed Journal; Flag factors that limit access to palliative medicines within the community to inform future quality improvement activities Create a baseline dataset from which to measure changes resulting from the implementation of quality improvement activities We would like to identify the general spread of responses of pharmacies across the state as well as differences between regions.