ANZCTR search results

There is a severe shortage of geriatricians and gerontic nurses across Australia. These specialists play a pivotal role in hospital geriatric consultation services which, among other clinical functions, make important triage decisions around access to geriatric assessment units, rehabilitation, community post-acute care, and residential care. In the face of inexorable workload growth, improving the efficiency of geriatric consultation without compromising integrity of the process, is a major challenge. This study explores the reliability, safety and cost-effectiveness of an “online” method of conducting geriatric assessment. The model under scrutiny has been developed by the Academic Unit in Geriatric Medicine and the Centre for Online Health at the University of Queensland. It comprises: - Standardised assessment (based on the interRAI Acute Care system) performed on location by a specifically trained gerontic nurse - Data entry on web-based software - An inbuilt clinical decision support system - A capacity for geriatricians to review and report cases “online” (who can be anywhere in the world) immediately on completion of the nurse assessment - A training strategy for all participating and affiliated practitioners - Electronic messaging systems to facilitate distribution of findings among clinicians. Preliminary research suggests the method to be attractive to clinicians, reliable, safe and highly efficient, while improving the quality of assessment and promoting the skills of gerontic nurse assessors. The study will examine: - The level of agreement between online and live geriatrician clinical assessments and recommendations, taking into account inter-rater reliability of live consultations. The cost of the “online” approach compared to conventional geriatric consultation (including a formal economic evaluation) Paired assessments (online and live) of 115 patients referred for geriatric consultation will be performed by separate geriatricians. To evaluate “natural” variation between geriatrician assessment, inter-rater reliability of (115 paired) live assessments will also be determined. Three pairs of geriatricians across 3 hospital sites will participate. The paired assessments will be randomly configured to remove potential biases. Combinations relate to format (live-live or live-online) and order of patient contact (the order of geriatrician consultation will be randomly allocated for live-live pairings). The assessment outcomes of interest include recommendations for rehabilitation and permanent long term care, as well as diagnoses of common geriatric syndromes. Agreement will be characterised by kappa statistics calculated to appraise the level of agreement of triage recommendations. New diagnoses not present in the medical record at the time of assessment will be recorded, to identify the risk and potential impact of these being overlooked in the online approach. Each procedure will be subject to a detailed costing analysis to support an economic evaluation. If demonstrated to be valid, safe and cost effective, the online assessment method may generate considerable cost savings and dramatically extend the availability of high quality specialist comprehensive geriatric assessment across Australia and the world.

This study investigates the use of metformin in Australian Aboriginal and Torres Strait Islander patients with type 2 diabetes. The aim of this study is to compare the pharmacokinetics of metformin in Australian Aboriginal and non-Aboriginal Australians patients. It involves obtaining a medical history of the patient and asking patients about their metformin formulation, dose, dosing times and their compliance to the medication.

The aim is to determine whether 4 fingerprick BGLs routinely performed at nominal times of 0700, 1200, 1700 (these three timeslots are just before meals) and 2100 hours accurately assess the efficacy and safety of basal bolus insulin in hospitalized patients.

People living in residential aged care facilities (RACF) are amongst the most vulnerable Australians. Their acute healthcare needs are great yet we do not know whether the current system of providing much of this care in hospitals meets their interests or those of the broader community. This trial will test a new model of caring for people in RACF, to determine whether it can reduce hospital utilisation and improve quality of life.

The current research aims to determine whether changing the treatment paradigm from a drug to a non-drug (i.e psychological) approach will result in improved outcomes for those with a unipolar non-melancholic depression. By altering the primary treatment approach, we hypothesise that more positive outcomes are likely to occur.

The primary purpose of the study is to investigate telmisartan as a novel therapy for patients with abdominal aortic aneurysms. We hypothesize that telmisartan will reduce AAA growth.

The trial aims to assess whether in women undergoing simple gynaecological laparoscopy, the Proseal (TM) airway device reduces post-operative pain and/or nausea and vomiting. We will also assess whether the device reduces sore throat or hoarse voice.

The purpose of this project is to explore whether a clinician-guided treatment program can help to reduce anxiety symptoms in a population of mature adults (aged 60-75), 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 mature adults with anxiety.

The purpose of this project is to explore the efficacy of a clinician-guided treatment program for symptoms of depression in older adults (aged 60-75), administered over the internet in a Ramdomised Controlled Trial. A secondary purpose is to determine the acceptability of the treatment protocol and materials to older adults with symptoms of depression. A tertiary purpose of this project is to explore the efficacy of a self-guided version of the program, with participants from the Waitlist Control Group.

Currently, patients who are suspected of having obstructive sleep apnea (OSA) need to be seen by a sleep specialist and undergo a full sleep study in a laboratory to confirm the diagnosis. A full sleep study involves monitoring of brain waves, eye and chin muscle movements to determine different stages of sleep, breathing patterns, oxygen levels, heart rate and leg movements. Waiting lists to see a specialist and have a laboratory sleep study can often be long, even up to 6-12 months in some centres. To address this problem, increasing numbers of simplified sleep recording devices designed to be used in the patients’ own home are being developed, and have a smaller number of channels recording only breathing patterns and/or oxygen levels overnight, without recording of brain waves to determine stages of sleep. It is currently unclear whether patients who undergo simplified sleep study recordings to test for OSA have treatment results (for example, in the degree of improvement in their symptoms) compared to patients who undergo full sleep studies. In this study, patients referred to a sleep specialist for investigation of possible OSA will be randomly assigned to one of three groups for diagnosis: (1) an overnight sleep study with full monitoring of brain waves, eye and chin muscle movements, breathing patterns, oxygen levels, heart rate and leg movements; (2) an overnight sleep study with monitoring of only breathing patterns, oxygen levels, and heart rate or (3) an overnight sleep study with monitoring of only oxygen levels. The aim of the study is see whether patients who receive treatment from a sleep specialist on the basis of a simplified sleep study recording will do as well (in terms of improvement in symptoms and ability to perform usual daily activities) as patients who have had a full sleep study after 3 months of follow-up.