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The aim of this study is to compare the effectiveness of an internet-based lifestyle modification (high protein diet) program, tailored for overweight/obese young women (age 18 to 35 years), against metformin or placebo treatments in achieving and maintaining weight loss. We also want to assess the effects of different methods of weight loss on reproductive function, metabolic health, and nutritional status. Information on psychological well-being and general health will also be collected.

We have developed a unique transfer technique which utilizes cells cultured on a therapeutic contact lens and propose that this may be a potentially novel treatment strategy for patients suffering severe corneal disease where corneal epithelial wound healing is not properly regulated, possibly as a consequence of stem cell damage, stem cell failure or stem cell depletion. Currently, patients are treated by grafting foreign or autologous stem cells that are cultured in the presence of animal products or by using techniques which involve growing ocular stem cells on amniotic membrane (foreign biological material) then transferring these cells along with the amniotic membrane to the damaged cornea. Our proposed system would be entirely autologous.

Many patients experience some degree of breathing difficulty after major surgery and breathing difficulties may be the basis for serious, but uncommon complications of anaesthesia and surgery. The use of sedatives and morphine-like drugs for the relief of pain, although very necessary, contributes to decreased breathing effort, pauses and obstruction. Patients with obstructive sleep apnoea (OSA) syndrome, associated with a history of snoring, observed pauses in breathing during sleep and daytime sleepiness, may be at especially high risk with anaesthesia. This syndrome is associated with obesity, and may be a partial cause for, many types of heart and lung disease. Specialized high-dependency postoperative care is advocated for these patients. We are interested in patients who do not have a definite diagnosis of OSA or severe symptoms, but who do have a high body mass index (BMI) and some abnormal airway features that imply increased risk of obstruction. Such patients may make up to 20% of patients presenting for elective surgery at the RMH. An initial respiratory monitoring study in progress, suggests that patients with these risk factors have increased breathing difficulties and reduced blood oxygen in the period after surgery. In the proposed study, patients who are considered to be at risk of breathing problems on the basis of questionnaires and examination prior to surgery, will be randomized to either standard opioid (morphine) pain relief for the first day after surgery or to a group where other pain relieving dugs (ketamine, parecoxib and tramadol) are used in an attempt to reduce opioid use while maintaining adequate pain relief. In both groups dugs will be used according to protocols approved by the Acute Pain Service at the Royal Melbourne Hospital.

The primary purpose of this study is to find out what dose of intravenous fluid maintains enough fluid volume in the body after a spinal anaesthetic. Particpiants in this study are randomly assigned to have a high dose of intravenous fluid or a low dose of intravenous fluid. We find out how much fluid is in the body by doing an ultrasound of the heart before the the intravenous fluid is given, after the intravenous fluid is given, after the spinal anaesthetic is given and at the end of the operation.

This study seeks to identify if community based individual falls prevention intervention improves outcomes in individuals who have received current hospital based intervention either from the Emergency Department or the out patient Falls Clinic. Improved outcomes are in areas of understanding falls can be prevented and measures they can take to reduce risks. This includes implementing changes in behaviour or environment. It also will determine if the extent of awareness and implementatin of reducing risk factors reduces the incidence of subsequent falls.

To investigate whether an advice and exercise program provided by a physiotherapist improves outcomes for patients with fractures of the wrist

Neuropathic pain is a debilitating form of chronic pain that arises from nerve damage. Current treatments for neuropathic pain can have undesirable side-effects and are limited in their effectiveness. ACV1 is a small synthetic drug designed from a component of the venom of an Australian marine cone snail, and is being developed as a treatment for neuropathic pain. The aim of this study is to investigate whether ACV1 provides pain relief to patients with diabetic peripheral neuropathy or post-herpetic neuralgia.

to study if tonsillectomy using the plasmaknife results in any difference in pain and recovery

Almost one third of patients with schizophrenia do not respond to commonly used antipsychotic medicines. For up to 60% of these patients, the novel antipsychotic medicine clozapine can be very effective and has been shown to reduce the high rate of suicide in these patients. While generally temporary and not life-threatening, a few side effects can be fatal. In particular, inflammation and reduced contraction (dysfunction) of the heart muscle have been documented with clozapine use (up to 8.5% of patients). The cause of the heart problems following clozapine use is not known, and there is a need to identify patients at greater risk of developing these side effects during treatment. The current study will observe about 40 adult patients each year with schizophrenia starting clozapine therapy through the Eastern Health Adult Mental Health Program. As is standard care for this group of patients, assessments of heart function will be performed prior to, and at regular intervals from 1 to 6 months, and each 6 months thereafter, for the duration of treatment. We hypothesise that this study will identify early subtle changes in heart function that precede overt dysfunction in patients taking clozapine. Such patients displaying early signs during can then be identified and managed appropriately.

In patients with Type 1 diabetes the body does not produce any insulin. Insulin is a hormone that the body (pancreas) produces. Insulin is essential for life; In a healthy body the pancreas produces insulin continuously all day to keep blood sugar in a healthy range to allow us to do all activities that do not require eating such as walking, talking, sleeping. In the event of eating the pancreas automatically produces an extra amount of Insulin on demand when food is consumed. Foods such as carbohydrates and starches are processed by the body into sugar in the bloodstream. The hormone Insulin stabilizes blood sugar to a healthy range so that there is not too much or too little sugar in the blood. In a diabetic maintaining this balance is difficult because the pancreas is not producing any insulin. As such external insulin must be administered. The results of a landmark study known as the Diabetes Control and Complications Trial (DCCT) demonstrated that strict blood sugar control reduced the development of complications in patients with Type I diabetes like strokes, kidney and eye disease. An ideal solution in these patients would be the replacement of insulin in a manner identical to that in the healthy state. At present the two main options for patients, both of which deliver insulin through injections, are multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) via a mechanical device usually referred to as a “pump.” CSII or the “pump” delivers insulin in a flexible and precisely controlled manner via a programmable pager sized device with an insulin reservoir. Insulin delivery rates can be varied according to the time of day, and reduced temporarily during periods of exercise. A patient-initiated dose of insulin can be delivered in a variety of profiles aimed to match the nature of the ingested meal. Recently a combination real-time Continuous (blood) Glucose Monitoring/ CSII “pump” device has become available (Paradigm? Real-time system / MMT 722, Medtronic, Minimed, Northridge CA) and is the first such pump commercially available worldwide. The ultimate aim in the management of patients with Type I diabetes is the attainment of stable blood glucose, as this strategy will prevent the development of complications. The above product is instrumental to this. However, preliminary data suggests that the employment of real-time system “pump” in the absence of a patient education program may not result in an improvement in glycaemic control. An algorithm informing and educating the patient on how to deal with the information provided by this new technology will be analysed as part of this study. In addition a blood test known as Hba1c will also be performed. This blood test measures on average a patient’s blood glucose control over a three month span. Quality of Life Questionnaires will also be used to assess whether diabetes has impacted of every day life and activities. Five sites across Melbourne have been selected to take part. The principle Investigators are at St Vincent’s Adults public Hospital. The other sites involved are: The Western General Hospital, Monash Medical Centre, The Royal Children’s Hospital and The Royal Melbourne Hospital.