ANZCTR search results

The purpose of this project is to explore whether a clinician-guided treatment program can help to reduce PTSD symptoms in a population of adults (aged 18-75), when administered over the internet. A secondary purpose is to determine how acceptable people find this form of treatment. The study will inform how services can best improve future treatment programs for adults with PTSD.

Breast cancer is most common cancer in women. Aproximately 75% of patients diagosed will have hormone receptor positive breast cancer. Tamoxifen has long been considered the gold standard for adjuvant therapy for postmenopausal women with endocrine sensitive early breast cancer. Aromatase inhibitors (AIs) are commonly used and are in fact superior in improving disease free survival. As a result, it is expected that in coming years the use of AIs in the current setting will increase dramatically. However, trials of AIs for breast cancer treatment have indicated that more than 40% of women taking AIs experience joint pain and stiffness which doesn't respond to conventional pain medication and may cause discontinuation of AI treatment. Acupuncture is one such alternative technique currentlyused for treating a variety of conditions including musculoskeletal pain. The analgesic mechanism of acupuncture is uncertain but it is speculated that analgesia may be mediated by release of opiod peptides and serotonin.

Cardiovascular disease is the leading cause of mortality in type 1 diabetes (T1D). Prevention of vascular complications of diabetes requires strategies that begin early in the disease process. Risk factors in childhood track into adulthood and correlate with early markers of atherosclerosis such as vascular endothelial and smooth muscle function. We have shown that children and adolescents with type 1 diabetes have detectable endothelial and smooth muscle dysfunction that relate to body mass index (BMI). A significant number of youth with T1D are also overweight with insulin resistance. Metformin reduces insulin requirements and weight gain in type 1 diabetes. In type 2 diabetes Metformin substantially reduces risk of cardiovascular events and improves endothelial function. However there are no studies of cardiovascular outcomes or their earlier cardiovascular markers in type 1 diabetes despite the increasing prevalence of overweight status in this population and the fact that this is a major modifiable risk factor for cardiovascular disease. Determining the effect of Metformin on vascular function in overweight youth with type 1 diabetes in a double blind randomized placebo controlled parallel trial will provide additional strategies to intervene in early in the process of atherosclerosis.

Heart Failure (HF) is a leading cause of heart disease and mortality in developed countries. It is the leading reason for hospital admission among patients over 65 years and the most costly cardiovascular disorder in Western countries. A first hospital admission for HF has been shown to confer a worse prognosis than a first admission for bowel or breast cancer. The burden of HF is expected to increase in Australia due to the ageing population and improved survival from acute cardiac events. New cardiac imaging tools, such as cardiac MRI and novel applications of echocardiography (ultrasound of the heart), now permit an insight into some of the fundamental processes that underlie why some individuals don’t respond to conventional HF treatment. In particular, our research will focus on the scarring within the heart muscle, and the loss of coordination of the heart as it pumps, in perpetuating the vicious HF cycle. Furthermore, we will explore the role of a simple blood test, to measure markers of scarring from the heart, in predicting patient outcomes in the setting of a new diagnosis of HF. An understanding of these elements in the pathogenesis of cardiomyopathy will help clarify the mechanistic cascade of HF, and may thus lead to novel therapies to interrupt such an adverse process. This research may thus change the way cardiomyopathy is viewed and treated.

Chronic Lung Disease (Bronchopulmonary dyplasia) is a common and serious complication in extremely preterm infants below 28 weeks. In 2008 in Western Australia, over 120 infants were born at less than 28 weeks. 28% of the survivors developed Chronic lung disease. With it’s immunomodulatory effects, Pentoxifylline is emerging as a promising treatment for conditions such as sepsis, NEC and Chronic Lung disease. Whilst trials are encouraging for Pentoxifylline’s effect on Chronic lung disease; well organized, properly blinded trials have not been published. This trial aims to address this and discover whether nebulized pentoxifylline might help prevent bronchopulmonary dysplasia in extremely preterm infants.

This study is designed to evaluate a new method for monitoring the effects of sedatives on the brain's electrical activity. The method involves a sophisticated, physiologically motivated, algorithm for the analysis of the scalp recorded electroencephalogram.

Good control of diabetes is essential to reduce the risk of developing diabetes-associated complications such as blindness, amputations or kidney failure. Intensive management of diabetes ensures better control and this is pursued in our population by multiple daily injections, or use of an insulin pump (~30% of population). Insulin pumps better mimic natural insulin delivery, being infused on a constant basis at varying adjustable rates throughout the day. Extra insulin is bolused for meals, or if blood glucose recordings are above target range. Good control on a pump is directly related to the number of blood glucose readings tested so insulin can be titrated to requirement. These glucose readings are optimally used when inputted into the pump, a step which must be done manually by the user. This is suboptimal in our population relative to international data, recently established as a mean of 3.1 readings per day versus 4.8 per day in other centres. A novel blood glucose meter has been developed which automatically inputs the measurement into the pump via bluetooth shortly after it is taken. This device is TGA approved for use in the paediatric population and widely used in Europe. We wish to examine whether or not it significantly increases the number of blood glucose measurements in a patient’s pump and if this has an overall effect on diabetes control, as measured by HbA1c. We aim to randomise 50 users to either using their own regular insulin pump, or the new integrated pump system for the first six months. After the first six months, participants will 'crossover' i.e. people using their own pump will then have the opportunity to use the new pump for six months and those who had the new pump would revert back to using their own pump. We intend to examine the effects of the different pumps, if any, on the number of blood glucose tests recorded and on overall metabolic control.

Studies have shown that different conditions in which the POP-Q examination was performed and, variations in examination techniques eg. patient position, use of vaginal specula, retractors or tractors used, the type of straining used to develop the prolapse maximally, fullness of bladder and rectum, can affect the reproducibility of the measurements. Recent evidence suggests that intra-operative examination of prolapse under anaesthesia could be significantly different from pre-operative examination even if POP-Q system is used. Many pelvic surgeons use the moment directly before the start of the surgery, when the patient is already under anaesthesia to perform a final examination using traction and plan the exact operation. We propose that using the same examination technique ie. traction on the cervix, pre-operatively and intra-operatively under anaesthesia will increase the reproducibility of the POP-Q measurements obtained pre-operatively for uterine prolapse. The aims of the study are 2 fold. 1. To determine whether or not using traction on the cervix with an instrument pre-operatively to determine the severity of uterine prolapse reduces the difference between pre-operative and intra-operative POP-Q measurements of Point C 2. To determine the patient’s acceptability of using a traction instrument to assess uterine descent without anaesthetic

Staying Fit has been designed as an Internet-based adolescent weight management program for overweight or mildly obese Australian young people. Goals of the program include: targeting weight loss, promoting weight maintenance, decreasing weight and shape concerns, healthy eating and increasing physical activity. We propose to conduct a project, commencing in July, 2011, in metropolitan Melbourne, involving approximately 570 young people aged 12-17 years. We will be recruiting voluntary participants from the community via advertisements in local media, posters in youth friendly services and through school nurses and general practitioners. Parent consent will be sought using an active consent process; young people will not be able to participate without a signed consent form from their parent or guardian. Participation for the young person is completely voluntary and they will also be required to provide written consent. Half of the participants will be randomly assigned to the intervention group, and will participate in the program with access to all modules. The other participants will be randomly assigned to the control group, and will receive a list of health websites and handouts on healthy food choices and physical activity recommendations. There are 12 sessions in the program and it takes approximately 1-2 hours to work through each session. Sessions are released at the rate of one each week. Online interactive monitoring of key behaviours (e.g., food and physical activity logs) and an online discussion group are used to encourage participation. Data will be collected at the start of the program, at 3 months, 6 months and 12 months. Data from the project will be collected and analysed by the Centre for Adolescent Health (CAH) at the Royal Children’s Hospital.