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To determine objectively how inactive cystic fibrosis patients are during and after a hospital admission for an acute pulmonary exacerbation by assessing them using a highly accurate physical activity level monitor. The study also seeks to determine whether exercise tolerance and skeletal muscle strength are reduced during periods of hospitalisation for an acute exacerbation.

Periodontitis is a chronic inflammatory condition affecting 1 in 5 Australian adults. Current treatment involves intensive cleaning although treatment does not completely resolve the associated inflammation. The long chain omega-3 polyunsaturated fatty acids (omega-3) from fish oil help reduce inflammation in several chronic conditions. Regular consumption of food rich in omega-3 may benefit periodontal health. Studies suggest that omega-3 metabolites may serve as “stop signals” for preventing neutrophil-mediated tissue damage, a key component of periodontal disease. Studies in rodents show a positive, modulating effect of omega-3 on gingival inflammation, which can be mediated through reduced expression of pro-inflammatory cytokines. Other reports that are less positive have used limited treatment periods which may have been insufficient to induce substantial incorporation of omega-3 into cell membranes. The aim of this study is to see whether supplementation with different types of fish oil improves the efficacy of standard periodontal treatment (scaling and debridement) in patients with newly diagnosed, but not aggressive periodontitis. We will also investigate the involvement of anti-inflammatory mechanisms.

Use of an oral topically-active glucocorticoid with limited side effects will control the gastrointestinal inflammatory process of GVHD and minimize glucocorticoid exposure.

COPD is a common problem for current or ex smokers but is often undiagnosed or diagnosed late when the condition has deteriorated significantly. Effective treatment is available so early diagnosis is very important. In this study practice nurses will identify patients who are at risk of COPD and undertake case finding. Patients newly diagnosed with COPD who attend the “intervention practices” will be offered a management involving the GP and practice nurse working in partnership. The patients who attend the “control practices” will receive usual care from their GPs. We will then primarily examine the impact of the “intervention” or the “usual care” on patients' quality of life, health status and lung function and draw a comparison between the two groups in order to asses the effectiveness of the intervention.

In this study we aim to investigate the effects of preoperative warming and/or warmed irrigation fluid on temperature control, thermal comfort, and post-anaesthetic recovery time in patients undergoing elective arthroscopic shoulder surgery.

Breathlessness at rest or on minimal exertion (speaking, bathing, dressing) continues to be a major clinical problem for many people with advanced progressive illnesses such as cancer, end-stage cardiac failure or chronic obstructive pulmonary disease even when they are receiving the best treatment for that underlying disease. Although there are some interventions that may offer benefit (oxygen therapy (when oxygen levels in the blood are low), sustained release low dose morphine) for this refractory breathlessness, other therapeutic options need to be explored. Benzodiazepines are widely used as sedatives to help with sleep, to reduce anxiety and to decrease the risk of seizures in people who have, or are at risk of epilepsy. These medications are also widely used around the world to treat breathlessness, however there have been no adequately powered studies that have explored net symptomatic benefit (symptom relief, side effects, maintenance of any benefit) for refractory breathlessness. Each benzodiazepine has slightly different properties in the level of sedation, ability to reduce anxiety and duration of effect. Two key questions need to be answered in order to establish the place of benzodiazepines in the management of refractory background dyspnoea: is there a net symptomatic benefit from benzodiazepines and, if so, is that benefit maintained over time? The latter question is important given the rapid tolerance to benzodiazepines when used as sedatives. Given the ability to dose once daily, the well defined pharmacokinetic and pharmacodynamics (including in children) and the range of formulations/routes of administration available, clonazepam has been chosen for this study. The proposed dose is unlikely to cause significant sedation and is at the lower end of the dosing range for its major long term clinical use in epilepsy. Aim: The primary aim of this pilot study is to refine protocol design including recruitment and retention to the study, establish levels of symptomatic response and variance in that response for power calculations for a definitive trial, and establish whether that benefit is maintained at two weeks.

Very little information exists on the effectiveness of oral pain-relieving medication administered acutely to adult patients presenting to the Emergency Department (ED) with moderate pain. As a result, the most effective combination of pain-relievers for acute pain is unknown. Studies in children in the emergency setting have suggested that a number of pain reliever combinations may be equally as effective for the treatment of moderate pain. Similar studies have not been replicated in adults. Southern Health (SH) Emergency Medicine has an established guideline for the management of patients presenting to the Emergency Department with pain. The triage Nurse may administer one of a number of combinations of pain relieving medications provided certain clinical requirements are met. However, the guideline for pain relief when a patient has moderate pain (pain score >3 and <8), is not clear, suggesting the administration of a number of pain relief alternatives. These include; paracetamol with oxycodone and Ibuprofen, or alternatively Panadeine Forte-Registered Trademark (R) (paracetamol & codeine phosphate) with or without ibuprofen. It is not clear from past research whether or not one combination is superior. Additionally, the ease of nursing accessibility varies with oxycodone and Panadeine Forte(R) due to the different drug schedule of each pain reliever. Oxycodone is an S8 drug, requiring a higher degree of security and accountability to dispense. This has implications for nursing time to retrieve and give the drug to patients. Anecdotally, there is a perception by some emergency nursing staff that it may be easier or quicker to administer Panadeine Forte(R) compared to oxycodone. Some studies done in other settings suggest that oxycodone with paracetamol may be a more effective pain reliever for acute pain than Panadeine Forte(R), but data is conflicting and despite numerous systematic reviews of both pain relievers the differences may be small in patients with moderate pain. In the initial management of moderate pain at triage, the small benefit oxycodone+paracetamol confers over Panadeine Forte (R) may be offset by the added time it takes to deliver the former agent to the patient and the subsequent time of onset of pain relief. Our study intends to compare three widely accepted combinations of analgesics for treatment of moderate pain in adults who present to the ED following acute limb injury. Firstly, paracetamol 1g with ibuprofen 400mg will be compared to 2) Codeine Phosphate 60 mg with paracetamol 1g and ibuprofen 400mg and, 3) Oxycodone (Endone (R)) 10 mg with paracetamol 1g and ibuprofen 400mg. All of these drugs are currently included in some combination in the current Southern Health Emergency Medicine nurse-initiated pain guideline for management of moderate pain. The study will be carried out in all three Southern Health EDs. Subjects will be given one of three randomly assigned and unknown combinations of the drugs. Their pain scores will be determined at regular intervals for 90 minutes. There will be regular monitoring for side effects and for the need for additional painkillers. We aim to recruit 216 subjects. Equal relief of pain with all the regimens may improve delivery of pain relief in the ED by reducing the need to access S8 medications in moderate pain, thus reducing time to delivery of effective analgesia. If the oxycodone arm is found to provide superior analgesia the current guideline could be amended to simplify the currently recommended treatment options. Alternatively if it is found the arm without opioid analgesia is equivalent the routine use of codeine and oxycodone for moderate pain will be reviewed.

D-cycloserine (DCS) is an antibiotic that has been used for the treatment of Tuberculosis over the last 40 years. Research indicates that DCS affects receptors in the brain known as N-methyl-D-aspartate (NMDA) receptors which are located in a region of the brain called the Amygdala. When the NMDA receptors become active (as occurs during extinction) this leads to a reduction in fear levels. Research suggests that DCS enhances the activity of these receptors, and as a result, enhances therapy techniques such as exposure (Guastella, Lovibond, Dadds, Mitchell & Richardson, 2007). To date, few studies have investigated the effects of DCS as an adjunct to exposure therapy using human participants, and of these none have done so using imaginal exposure therapy. The research thus far has focused primarily on the effects of DCS with in-vivo exposure on individuals. Yet, the same underlying processes appear to contribute to the success of both imaginal and in-vivo exposure therapy, i.e. the activation of anxiety and the formation of new associations in the brain through confrontation of the feared stimulus or situation. If DCS works by strengthening the formation or accessibility of new, non-threat associations (Guastella, Richardson, Lovibond, Rapee, Gaston, Mitchell & Dadds 2008), then it should also enhance the effects of imaginal exposure. Therefore there is good theoretical reason to see whether DCS has the same exposure enhancing properties when used as an adjunct to imaginal exposure therapy. In terms of its application in clinical settings, imaginal exposure therapy has several advantages compared to in-vivo exposure techniques, offering greater practicality and flexibility, particularly with regards to situations that are not readily accessible. Research also suggests that individuals experience less aversion when exposed to fearful images than when they are in direct contact with the feared object or situation (Hunt, Bylsma, Brock, Fenton, Goldberg, Miller, Tran & Urgelles, 2006). This relatively novel area of research has the potential to revolutionise the practice of psychotherapy and possibly offer new treatment options to individuals with public speaking anxiety and possibly other anxiety disorders. Aims of the study - 1. To replicate previous research which shows that DCS enhances in-vivo exposure therapy for individuals with public speaking anxiety 2. To extend previous research by showing that DCS enhances imaginal exposure therapy for individuals with public speaking anxiety 3. To determine whether the ability to conjure up a vivid image and become absorbed in that image increases anxiety levels as measured by self-report and physiological changes, and in turn, leads to positive treatment outcome 4. To determine whether competency in public speaking improves as treatment progresses

The purpose is to investigate an enhanced psychotherapy for anorexia nervosa. Anorexia nervosa is a serious psychological illness that is associated with much distress and many difficulties for people living with the illness. Many people do not get better with current therapies. Dr Meyer and her colleagues in Loughborough (England) have developed an enhanced form of cognitive behaviour therapy (CBT), which is a psychotherapy or talking therapy for anorexia nervosa. CBT in anorexia nervosa treatment focuses on how people think about eating, weight and shape and what they do about them (e.g. diet to lose weight). The therapy we are testing in this study has been enhanced by focussing more on some features of anorexia nervosa that have been found to be prevent people getting better from anorexia nervosa.

This study will investigate the effects of a 12 week individualised exercise program on PTSD symptoms, physical parameters such as blood pressure, sleep patterns and medication useage. It is hypothesized that by adding this structured exercise program to usual care, patient outcomes will improve.