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The lymphatic transport system provides the way for extra-cellular fluid and other substances to be transported back to the venous system. This fluid is taken up by lymph capillaries, flows into lymph collectors, then to lymph nodes in various parts of the body. Each part of the body flows to its own nodes eg fluid from the left arm will flow to the axilla under the left arm. In Australia a major cause for disruption to the lymphatic system is surgery and radiation therapy. Breast cancer treatment commonly includes modified radical mastectomy surgery, radiation to the chest wall, and removal of lymph nodes. These treatments all contribute to disruptions in lymphatic system function. Secondary arm lymphoedema after treatment from breast cancer occurs in at least 20% of women although this figure is usually quoted as being higher. Research into the effects and benefits of different exercise modalities for women with secondary arm lymphoedema as a result of breast cancer treatment have shown that various types of exercise do not worsen lymphoedema - as long as the exercise is given in a supervised and controlled way, with adequate warm-up and cool-down. Women also report that attending a group exercise class helps keep them motivated to continue with their self-management regime. Recently, studies based on tai-chi and breathing and gentle exercises including breathing and relaxation, have led to slight decreases in the amount of fluid in the affected arm. Yoga has been reported to lower levels of anxiety and depression and improve quality of life and immune function in women. However to date there has been no investigation on the effectiveness of yoga in the treatment of lympoedema. This study will examine the effects of an eight week yoga intervention on lymphoedema in breast cancer survivors. A range of measures of degree of lympoedema, strength, range of motion and quality of life will be measured in women on commencement and after four and eight weeks of a yoga intervention and at four weeks after completion of the intervention. Results will be compared with a control group who receive usual care.

Whey proteins are normally found in milk. Supplementation appears to strengthen the immune system by promoting anti-bacterial activity. Lactoferrin is a protein isolated from whey proteins in milk with documented anti-bacterial, anti-fungal, anti-viral, and immune function strengthening effects. Studies have shown lactoferrin is an iron-binding protein that is present in body secretions such as tears, nasal exudates, saliva, and bronchial mucus. A high concentration is also found in breast milk to help the infant fight infection. Lactoferrin is also a major component of circulating white blood cells known as neutrophils and is released by these cells in infected areas. Further, lactoferrin has also been shown in laboratory experiments to bind to viral receptor sites and inhibit the growth of several viruses that include HIV, Herpes simplex 1 and 2, hepatitis C, and human cytomegalovirus. To date, there are no clinical trials that have specifically investigated the effect of lactoferrin to prevent or treat the common cold. However, because of its scientifically demonstrated antiviral, antibacterial, and anti-inflammatory properties, lactoferrin may be of benefit in alleviating the symptoms or complications of these viral infections and a clinical trial could introduce significant merit to clinical claims.

Participants will be randomly assigned to active treatment with oral cholecalciferol using a single (10 ml) dose of 50000 IU weekly for 8 weeks then 50000 IU monthly or identical placebo. Dosing will be under the supervision of dialysis nursing staff at the conclusion of dialysis sessions. Testing at baseline and 6 months will be performed as described above.

To determine whether or not acute ketamine administration produces schizophrenic-like changes in the way one's own body is represented mentally.

This is a study to determine whether a 3 month program of diet and exercise can reduce the risk of diabetes following kidney transplantation from a living kidney donor

Presently, there is no information to guide clinicians on how to dose a new antibiotic, doripenem, in critically ill patients receiving a form of dialysis called continuous venovenous haemodiafiltration. The aim of this study is to describe the how concentrations of Doripenem (a carbapenem antibiotic) in critically ill patients are affected by Continuous Venovenous Haemodiafiltration (CVVHDF). We will then analyse the changing concentrations and use this information to provide strong evidence on what dose of doripenem to use in these patients. We hypothesise that a dose of 500mg every eight hours by intravenous infusion will provide therapeutic doripenem concentrations. Our process will be to enroll 12 patients who clinically need both doripenem and CVVHDF. We will collect various blood samples and analyse the changing concentrations with computer software to enable description of what doses future patients will need.

Patients undergoing haematopietic blood stem cell transplant (HSCT) are primarily treated for haematological cancer. After treatment, these patients can experience a number of side effects affecting their quality of life for up to several years. Common problems observed amongst transplant survivors include weight loss, gastrointestinal symptoms (e.g. nausea, poor appetite, sore mouth and excessive diarrhoea), and fatigue. These symptoms can increase the risks of developing other issues such as poor nutritional status, poorer health status and reduced physical functioning. As a result of the combined factors, some people are unable to return to work or they are unable to perform their usual activities. One of the reasons for physical impairment may be the loss of muscle; and the cause of muscle loss may be the result of reduced physical activity and poor nutritional status. Despite report of these research findings, patients are not routinely followed up by allied health professionals to receive ongoing support. This study looks at the effects of a combined nutrition advice and individualised exercise program compared to standard care on quality of life, nutritional status and body composition in cancer patients after undergoing haematopoietic stem cell transplant. Who is it for – Eligible participants are adult cancer patient over the age of 18 and scheduled for autologous haematopoietic stem cell transplant at The Wesley Hospital. Trial details – Participants will be randomised to one of two groups, either (i) an individualised nutrition program from the hospital dietitian combined with an individualised exercise program from the hospital exercise physiologist, or (ii) usual care as provided as standard by the hospital attended. Participants in the combined group will be followed up by a hospital dietitian fortnightly for a 20-30 minute dietary counselling session to address specific nutritional need (i.e. food choices), and the exercise component will be variable but, in general, patients will undertake a home-based exercise program involving a minimum of 5x30 minutes exercise a week for 12 weeks, and the type and intensity of exercise will be dependent on what is manageable by each patient. There will be a 1 hour consultation with the exercise physiologist conducted face-to-face in the hospital prior to discharge, and subsequent follow up will be done fortnightly (20-30 minutes/session) over the phone after patients are discharged. Participants in the usual care group will receive treatment as usual, according to the recruiting hospital’s standards, and there will be no follow up by a hospital dietitian or exercise physiologist after discharge for this group. The aim of this study is to determine whether a combined nutrition advice and individualised exercise program may help in the quality of life, nutritional status, and body composition of cancer patients post-haematopoietic stem cell transplant compared to standard care.

This was a non-blinded, 2 phase, randomised dietary intervention trial investigating if the rate of weight loss is important in long-term weight maintenance; if physiological adaptations encouraging weight regain are different with different rates of weight loss; if these adaptations reverse with time and if psychological profile can help us choose if slow or rapid weight loss is best suited to a particular psychological profile. Participants were obese (BMI 30.0 - 45.0 kg/m2) and aged between 18 and 70 years. Following telephone and onsite screening 200 subjects commenced phase 1 of the trial (weight loss phase) and were randomised by strata to either a rapid or gradual weight loss program. During this phase appointments were at the same interval with similar quality of dietary education materials for all subjects. Projected weight-loss graphs were personalised to each participant and utilised at each visit to compare expected and actual weight-loss achieved at each time point. Both the rapid and gradual weight loss group had prescriptions for the same overall energy deficit (105,000 kcal or 430,500 kJ). The rapid weight loss group were asked to accumulate the deficit over 3 months while the gradual weight loss group had to accumulate the same deficit over 9 months. In both treatment groups, participants were instructed to undertake at least 30 minutes a day of mild to moderate intensity exercise (e.g. brisk walk). Participants attended fortnightly for individual consultations with the same qualified dietitian. During these visits, they had anthropometry measurements taken and were given dietary counselling based on their individual needs in order to remain on their projected curve and achieve their target weight of 15% weight loss. All participants who successfully achieved 15% weight loss in phase 1 were eligible to enter into phase 2 (weight maintenence phase) of the trial. During phase 2 participants followed a weight maintenance diet which was individualised for each participant and similar to the Australian Guidelines for Healthy Eating(Smith A 1998). Individual sessions were conducted with the study dietitian quarterly for the three years following phase I.

Microbial keratitis is a significant cause of ocular morbidity and visual loss, as well as a significant health cost to the community. Ultraviolet light is known to be microbicidal. We think it is likely that the proposed treatment will lead to quicker recovery from this serious eye infection and better visual outcomes.

ACE inhibitors are a widely prescribed class of medications in Australia with established benefits in reducing mortality in a range of cardiovascular, endocrine and renal conditions. They are generally well tolerated in many patients, although they are assoicated with a range of adverse effects. One of these adverse effects is angioedema, which usually presents as non-pitting oedema of the subcutaneous tissues, usually around the head and neck. Occassionally airway obstruction may occur. While there are some recognised risk factors for ACE inhibitor associated angioedema, it is not possible to prospectively identify patients at particular risk. Improved methods to identify patients at risk may be useful to improve drug safety. One small study has identified a genetic marker, the single-nucleotide polymorphism, C-2399A of the XPNPEP2 gene which encodes plasma aminopeptidase P, for increased risk of ACE inhibitor associated angioedema. This study attempts to confirm the previous study and investigate the frequency of this genetic variant in the Australian population. We aim to enroll 40 patients who have had an episode of ACE inhibitor associated angioedema, and compare the frequency of the genetic variant in these patients with 120 control patients who have been exposed to ACE inhibitor, but have not had angioedema. We will also compare the frequency in a population sample, from healthy people.