ANZCTR search results

Problem: Chronic rhinosinusitis remains a condition with an associated signficant burden through morbidity and social factors. Its primary management is medical. However, in cases that are recalcitrant to medical therapy, operative intervention has been proven to be beneficial. Surgery is conducted using specialised tools including high definition video equipment and surgical intruments specifically designed for use within the nose and paranasal sinuses. The specialised nature of these tools aids in the the performance of surgical procedures but the ease of operating is also affected by other peri-operative factors including optimising the condition of the lining of the nose (mucosa) and therefore minimising variables such as bleeding that can increase both operative time and complications. The use of pre-operative steroids given orally to the patient prior to an endoscopic sinus surgical procedure has been shown to be favourable. However, while the provision of post-operative antibiotics has been suggested to have beneficial effects, no such evidence has been presented for the use of pre-operative antibitiocs. In particular, there is one group of antibiotics called macrolides that has been found to have anti-inflammatory effects in concert with their usual anti-bacterial actions. These are widely prescribed as a short course prior to endoscopic sinus surgery procedures within our institution but as yet have no formal evidential basis to support their efficacy. Hypothesis and aims: Consequently, this study will aim to assess whether the use of a short course of the macrolide antibiotic, roxithromycin, is helpful is improving operative conditions as assessed through the degree of bleeding during the procedure. As secondary aims, the study will also evaluate: 1. any change in the flora of the nasal mucosa before and after the prescription of antibiotics 2. changes in patient symptoms as measured by the sinonasal outcome questionnaire (SNOT22) 3. differences in post-surgical outcomes including evidence of scarring

This study looks at the effect of a drug, called Glycopyrrolate, on noisy rattling breathing in palliative care patients at the end of life. Who is it for? You can join this study if you are an inpatient in a Palliative Care unit and are willing to discuss end of life care. Trial details Participants will be randomly divided into one of two groups. One group will receive a drug called Glycopyrrolate. This is administered via an injection followed by a continuous infusion (into the vein) for a duration of 24 hours . The other group will receive a placebo (sham) treatment also delivered in the same manner. The placebo has no expected treatment effect. Participants will not know which group they have been allocated to. This study aims to determine whether a larger scale trial of the drug, Glycopyrrolate, is feasible for the treatment of noisy rattling breathing at the end of life.

There are various suturing techniques used to repair wounds after skin surgery. This study was designed to assess the differences between two of these existing techniques, as well as a 'new' technique in terms of scarring.

This project is a randomised controlled trial evaluating the effects of "MobileMums": an intervention delivered predominantly by mobile telephone text messaging. The aim of this study is to determine the effects of the program on physical activity levels of women with young children, relative to a control group. We hypothesise that MobileMums will increase the amount of time women spend doing moderate-to-vigorous intensity physical activity each week.

Hypertrophic cardiomyopathy (HCM) is the most common cardiovascular genetic disorder and can cause significant morbidity and mortality, including the most serious complications of heart failure and sudden death. At present, there are no proven pharmacological therapies that either prevent or cause regression of clinical features. This is largely due to a lack of knowledge in our understanding of the molecular and functional consequences of the disease-causing gene mutations leading to the clinical disease. The proposed study will aim to test whether cardiac energetic compromise is a central pathophysiological mechanism in HCM. We will investigate potentially beneficial treatments based on our hypothesis of trialling the use of metformin in a HCM group. If the results from this ‘proof of concept study’ are confirmatory, it could pave the way for larger multi-centre randomised studies (with longer duration of treatment) with either metformin or facilitators of fatty acid oxidation such as ranolazine. If realised, these treatments could prevent the vicious cycle of cardiac hypertrophy and myocardial dysfunction seen in HCM, leading to improved morbidity and mortality. These investigations will establish early phenotype changes in HCM patients and provide insights into potential therapeutic interventions for a condition that currently has little therapeutic evidence base.

Based on our prior research we have found that a large number of people are missing out on best practice care and this is leading to many avoidable deaths, especially from heart attack and stroke. HealthTracker is an electronic system that provides tailored management advice to staff and patients to reduce the risks of heart attack and stroke. There is a large body of international evidence that has shown electronic decision support systems lead to better quality care. Despite this, development of these systems in Australia has been limited and HealthTracker is the first of its kind to be used in primary health care services. In the study, we will conduct: 1. Health service audits at the beginning and again at the end of 12 months. Anonymous data is collected on how well cardiovascular risk factors are measured and whether people at high risk of heart attack or stroke are being prescribed the recommended medicines. Comparisions will be made between the group who received the HealthTracker software and the group that did not. 2. Interviews with selected health staff and patients are being conducted to understand the usefulness and acceptability of HealthTracker. 3. Video or audio recording of some healthcare consultations between staff and patients will be conducted to better understand how HealthTracker is actually used in practice.

Experimental studies and previous clinical trials suggest an improvement in mortality and neurological function with hypothermia after cardiac arrest. However, the accrued evidence is inconclusive and associated with risks of systematic error, design error and random error. Elevated body temperature after cardiac arrest is associated with a worse outcome. Previous trials did not treat elevated body temperature in the control groups. The optimal target temperature for post-resuscitation care is not known. The primary purpose with the TTM-trial is to evaluate if there are differences in all-cause mortality, neurological function and adverse events between a target temperature management at 33 degrees Celsius and 36 degrees Celsius for 24 hours following return of spontaneous circulation after cardiac arrest.

The purpose of the study was to prospectively evaluate the utiilty of the two pateint education interventions to faciliate the medical aesthetic treaments decisions of subjects in the two educatoin groups

The prevalence of cancer detected at an early stage of the disease is rising, which means that more people require adjuvant cancer treatment and are surviving for longer periods of time. As a result, cancer specialists are faced with large numbers of patients who not only require treatment but also long term follow-up care. In Australia, radiation oncology clinics are heavily subscribed and patients’ appointments are subject to waiting lists. This situation would be improved if patients who have completed their treatment could be discharged to the care of their GP. It is anticipated that routine follow-up with a specialist will not be possible in the future and alternative safe and effective strategies for follow-up need to be developed. Prostate cancer is the most common cancer in Australian men. Although prostate cancer is life threatening, the majority of patients who present with early disease live beyond five years. While treatment increases survival rates, a myriad of associated physical side effects may have an impact on the patient’s quality of life. Common side effects of radiation therapy include: loss of sexual potency, erectile dysfunction, loss of libido, urinary tract symptoms, incontinence and proctitis. If prostate cancer is not treated early patients are also at risk of disease spread. Following radiation therapy patients therefore need to be monitored for both side effects and disease spread. The provision of follow-up care for prostate cancer is under-researched. GPs are well placed to take on the role of providing follow-up care for patients who have previously been treated in specialist clinics. However, previous studies report that GPs have varying knowledge of the use of radiation therapy and consequently have limited expertise in managing side effects and providing appropriate referral. Innovative educational resources therefore need to be developed to assist GPs in advising patients who have received radiation therapy. Hypothesis: The evidence based resources (GP educational program) will assist GPs in providing follow-up care to patients and increase patient enablement. If GPs are able to take on this role in the multidisciplinary team, other patients will be able to access radiation oncology sooner and radiation oncology will be able to provide rapid access to patients who require urgent treatment or care.

This study compares the safety and effectiveness of different types of chemotherapy to treat late stage acute myeloid leukaemia. Who is it for? You can join this study if you are aged 18 years or over and have been diagnosed with acute myeloid leukaemia, for which you have undergone two or three previously unsuccessful chemotherapy regimens. Trial details In this study, participants are randomly (by chance) divided into two groups. One group will receive chemotherapy with the drug, Elacytarabine. This will be administered intravenously (into the vein) continuously for 3 days every 3 weeks. The investigator wil decide how long it is beneficial for you to receive treatment.The other group will receive one of a number of other chemotherapy regimens used to treat leukaemia. The treatment administered will be selected by the treating doctor based on your condition. Participants will be regularly monitored in order to determine the safety and effectiveness of treatment.