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Hyperphosphatemia (high phosphate concentration in the blood) is common in dialysis patients. Hyperphosphatemia can cause renal bone disease and is also associated with higher mortality. Most dialysis patients are prescribed phosphate binder drugs to bind phosphate in the gut and prevent its absorption. These include Calcium Carbonate (Caltrate (Registered Trademark) or Calsup (Registered Trademark)), Aluminium Hydroxide (Alu-Tab (Registered Trademark)), Lanthanum Carbonate (Fosrenol (Registered Trademark)) and Sevelamer (Renagel (Registered Trademark)). In theory some phosphate binder drugs need the stomach to be acidic to work effectively and bind phosphate. Haemodialysis patients are often prescribed gastric acid suppressant drugs to treat gastric ulcers and gastric reflux disease (heartburn). These drugs include Pantoprazole (Somac (Registered Trademark)), Omeprazole (Losec (Registered Trademark)) and Esomperazole (Nexium (Registered Trademark)). These acid suppressing drugs may reduce stomach acidity and therefore the effectiveness of phosphate binders. This potential drug interaction may worsen hyperphosphatemia The primary purpose of this study to evaluate the effectiveness of phosphate binders in managing hyperphosphataemia when they are co-administered with acid suppressive therapy in haemodialysis patients

The study investigated the effectiveness of a high calorie, high protein nutritional supplement in terms of changes in recovery rate as measured by abilities in activities of daily living (ADL), and nutritional status.

Background Proponents of minimally invasive knee replacements argue that retracting rather than everting the patella results in quicker postoperative recovery and improved function compared to the standard approach. We aimed to investigate this in a group of patients undergoing knee arthroplasty using a standard medial parapatellar approach. Methods In a prospective randomized double-blinded study sixty-six patients undergoing total knee arthroplasty through a standard medial parapatellar approach were assigned to either retraction or eversion of the patella. An independent observer assessed the Oxford knee score, the SF12 score, visual analog pain scores and range of motion data preoperatively, at three months and at one-year post surgery. Results Early (3 month) follow-up showed no difference in Oxford knee scores, SF12, visual analog pain scores or flexion. A statistically significant improvement in extension was found in the retraction group but this was not thought to be clinically significant. There was no difference in any outcomes at one year. There were two partial divisions of the patella tendon in the retraction group, but no patella related complications in the eversion group Conclusions Retracting rather than everting the patella during total knee arthroplasty results in no significant clinical benefit. There is an increased risk of damage to the patellar tendon, and reduced visualization of the lateral compartment.

Atomoxetine is an established treatment for ADHD. Despite its routine use, little is understood how it influences brain functioning. This study will test the effect of atomoxetine treatment on a range of brain functions relevant to ADHD.

At present, about 50% of homosexual men have HIV tests at least once per year. Increasing this proportion is predicted to reduce the rate of HIV transmission in the population, due to changes in sexual behaviour brought about by diagnosis. Rapid HIV tests are not currently approved or available for general use in Australia, but these may prove more accepatable because patients do not need to return for a second consultation for their result and a less invasive sample is required. This study is a randomised trial of the effect of making rapid HIV tests available to men having sex with men (MSM) on the frequency with which they have HIV tests. Consenting HIV-negative MSM requesting an HIV test at Melbourne Sexual Health Centre (MSHC) will be randomised in equal proportion to either onging access to a rapid test for 18 months or to standard laboratory-based serology (which requires them to return for their result in a week). This is not blinded; both groups are sent three-monthly reminders by e-mail and SMS, reminding them of their study allocation, and asking them to complete six-monthly questionnaires on sexual behaviour and whether they have had HIV tests elsewhere.

The hypothesis to be tested by this study is that the improved clearance of middle molecules (thought to be important uremic toxins) by the new FX 80 membrane would lead to less oxidative stress and inflammation when compared to dialysis using a standard hig-flux membrane.

This study will randomly allocate patients with PTSD to either (a)cognitive behaviour therapy, or (b) supportive counselling.

Appendicitis is the most common abdominal pathology in children. Laparoscopic appendicectomy is the standard treatment in most developed countries. Infection remains the most common post operative complication; with reported rates between 2.5–36% Currently at Monash Medical Centre we perform approximately 330 laparoscopic appendicectomies per 12 month period. Of these approximately one third will be perforated appendicitis with significant peritoneal pus. Our overall infection rate is 5%. The abscess formation rate for the perforated appendicitis group is higher, 11.3%. Compared to the best reported results in the literature, there is room for improvement. Peritoneal lavage is an intraoperative manoeuvre performed whereby following removal of contamination the peritoneal cavity is lavaged with saline and then suction applied to remove the saline solution. At appendicectomy not all surgeons will perform peritoneal lavage. Peritoneal irrigation has been advocated as a method to reduce post operative complications. The evidence for peritoneal lavage is largely historical and based on adult practice . It is proposed that lavage reduces intraperitoneal bacterial load, and furthermore that laparoscopy facilitates improved peritoneal lavage in peritonitis. However, the evidence is divided with some indicating that it may in fact increase the risk of post operative infections. Advocates of this argument proposed that lavage may spread contamination throughout the peritoneal cavity with an increased risk of abscess formation. Studies assessing lavage with antibiotic solutions have shown no difference in outcomes Currently throughout the world there is no consensus and both techniques are commonplace and accepted modes of practice. Within our department of Paediatric Surgery in Monash Medical Centre there are surgeons who advocate generous lavage and other surgeons who advocate no lavage. Currently our patients will receive lavage or not depending on which consultant is in charge of their care. To date there have been no prospective randomized clinical studies in children assessing the difference in outcome in laparoscopic appendicectomy following peritoneal lavage or no peritoneal lavage. Therefore, the aim of this study is to assess whether intraoperative peritoneal lavage in laparoscopic appendicectomy in children reduces post operative complications, with the eventual goal of minimizing post-operative infection rate. Our proposal is to carry out a prospective randomised clinical trial.

Early Childhood Caries (ECC) causes profound suffering, frequently requiring expensive treatment under a general anaesthetic. It is the strongest predictor of poor oral health in adulthood. Despite ECC being entirely preventable, marked ECC disparities exist between Maori and non-Maori children in New Zealand. If the burden of ECC and associated oral health inequalities experienced by Maori children is to be reduced, more needs to be done to ensure that appropriate preventive measures, together with support for maintaining optimal oral health, are provided to carers of such children in the early life stages. This will be an interventional study, with all the participants receiving the intervention benefits. Pregnant Maori women and their families will be included. The intervention will be implemented from birth and continue for the first three years of a participating child’s life. It will involve four components: dental care provided to the mother, application of a topical fluoride to the teeth of children, anticipatory guidance and motivational interviewing. Following a kaupapa Maori research framework and methodology, the intervention will be tailored at the individual- or whanau-level, with each carer or whanau progressing to the next level only when they are ready. Developing a culturally-appropriate ECC intervention that aims to improve child oral health, in full partnership with the Maori communities involved, will provide much needed evidence for policy makers to address the challenge of improved oral health and related outcomes for Maori children. The goal of this study is to determine whether implementation of a culturally-appropriate Early Childhood Caries (ECC) intervention utilising a kaupapa Maori methodology reduces dental disease burden and oral health inequalities among young Maori children living wthin the Waikato-Tainui tribal area. More specifically, the aim is: Aim: To determine whether implementation of a culturally-appropriate ECC intervention, that employs a tailored approach and draws on a range of kaupapa Maori relevant contexts including oral health knowledge, oral self-care, dental service utilisation, and oral health-related self-efficacy, reduces dental disease burden and oral health inequalities among young Maori children living within the Waikato-Tainui tribal area. Hypothesis: Exposure to a culturally-appropriate (kaupapa Maori) ECC intervention will reduce dental disease burden and oral health inequalities among young Maori children who reside within the Waikato-Tainui tribal area. It is anticipated that implementation of a culturally-appropriate ECC intervention that aims to improve levels of oral health among tamariki Maori will, in turn, lead to improved general health outcomes. This is through (1) Maramatanga – increased understanding of the processes that lead to dental diseases and in turn, other health conditions; (2) Te Taha Tinana – a greater appreciation of the role of prevention in reducing ECC; the dietary component of which may, in turn, have benefits for other preventable, dietary-related conditions such as obesity and diabetes; (3) Te Taha Whanau – improved knowledge of lifestyle habits that are not conducive to optimim oral health; (4) Te Ara Tika – increased understanding of how to access oral health care for the whanau.

The Glycemic Index is a system of ranking carbohydrate-containing foods according to their immediate effect on blood sugar levels. A pool of up to 20 participants will initially need to be formed and maintained (ie have up-to-date glycemic response data for the reference food) for this purpose. If required due to demand for testing, the pool of participants will be increased further. The test protocol itself is standardised, straightforward and well-defined. Briefly, a set number of participants (minimum of 10) consume the test or reference food (containing 50 g of available carbohydrate). Immediately before, and at designated intervals after food consumption, capillary blood (a few microlitres) is collected by fingerprick and its glucose content measured. Integrated areas under the glycemic response curves are then derived. To calculate the Glycemic Index of the test food, its Integrated Area Under Curve is indexed against that of the average Integrated Area Under Curve for the reference food (mean of three separate tests).