ANZCTR search results

With a clinically suspected scaphoid fracture, initial x-rays are unreliable. Current local practice is immobilization in plaster for 10 days with repeat x-rays, in order to not miss fractures. In retrospect, up to 90% of patients do not need the plaster. Advanced imaging (early MRI and Day 4 Bone scans) are proven as an alternate best practice, but are expensive and difficult to access, and thus not often used. A research project at BHS has demonstrated that early CT scans are a reliable, accessible, cost effective alternative. Our aim is to confirm the use of early CT and to implement early CT scans into a “best practice” clinical pathway for suspected scaphoid fractures.

To assess the role and effectiveness of the family meeting in the spiritual care of palliative patients and their families. The study looks at spirituality and spiritual care in a very broad way. This includes such things as attitude to life, reviewing life, bringing closure to things that have happened, foregiveness of self and others, having hope, finding meaning and purpose in the things that have happened in your life. For some people it will also include religious practices and beliefs.

The primary objective of this project is to demonstrate that the provision of information about chemotherapy and management of chemotherapy side effects 1.is perceived by GPs to be useful and, 2.when compared to usual care, results in (a)improved knowledge; (b)enhanced confidence regarding the management of patients having chemotherapy and (c)higher satisfaction with shared care with Peter Mac

Provision and use of a question prompt list by patients during a consultation increases question asking, reduces anxiety and improves recall. Previous work on question prompt sheets has found that when patients ask more questions, they gain a better understanding of the topic and satisfied with their treatment decisions. Medical staff also tend to be more satisfied with the consent process when patient’s display a better understanding of the discussion. A Question Prompt List has been developed for patients to facilitate patient participation in clinical trial consent discussions. This project aims to examine patient attitudes to clinical trials and to investigate the effects of promoting question asking when people with cancer are asked to consider entering a randomised clinical trial. The question prompt list will be evaluated by comparing results for the control and intervention groups on understanding of clinical trial information, satisfaction with the consent process and decision-making about trial participation and achievement of their information and involvement preference. It is expected that those patients receiving the question prompt list will have a higher mean knowledge score in the informed consent questionnaire, have enhanced achievement of their information and involvement preference and be more satisfied with the informed consent and the decision making process.

The aim of this study is to evaluate the feasibility of a randomised controlled trial comparing two types of pre-discharge occupational therapy consultations for older adults: home-based versus hospital-based consultations. In particular the study will test the feasability of trial procedures consent rates, and the acceptability of both forms of consultation. Individuals who are aged over 65 years and living in the community prior to admission will be asked to participate. Study participants (n=10) will be randomly assigned to receive either a hospital-based or a home-based pre-discharge occupational therapy assessment and education. The home-based consultations are more time-consuming and costly than hospital-based consultations, however it is unknown if patient outcomes differ. Participants will be tested before and during the study using standardised outcome measures by a qualified occupational therapist who is blind to group allocation.

Chest physiotherapy (CPT) is a standard component of multidisciplinary care of preterm infants receiving artificial ventilation for respiratory failure. Despite this, there is limited evidence concerning its effectiveness. This study aims to quantify the effects of the physiotherapy techniques of percussion and vibration on respiratory function in the preterm infant. Data from the electrical impedance tomography (EIT) and the multiple breath washout (MBW) will be downloaded directly onto a computer. The data analyst will be blinded as to the intervention.

Preterm infants are moved throughout different positions while nursed in the neonatal nursery. The aim of this study is to determine the effects of 3 commonly used positions on lung function in those infants requiring ventilatory support. The positions to be used include prone (lying on the stomach), supine (lying on the back), and ¼ turn from prone (lying on stomach with one side up). By looking at the ventilation distribution during positioning, this study will give clinicians an idea of how to optimise ventilation non-invasively using positioning. Factors we are investigating that are important in making this decision are optimal lung aeration and oxygenation. This trial will use recently developed scientific technology including lung scanning (EIT) and a new form of breath washout (MBW using sulphur hexafluoride) to give us a better understanding of the effectiveness of positioning. Data on EIT and MBW will be downloaded directly onto a computer and the data analyst will be blinded to the positions.

Nasal hyper reactivity is characterised by a reflex mediated increased sensitivity to inhaled unspecific irritants such as cold air, perfumes and smoke. Patients with obstructive sleep apnoea syndrome (OSAS) are treated with a “continuous positive air way pressure” (CPAP) device that relies upon a good nasal patency during sleep. The present study aims at evaluating a new non-invasive device, the Rhinolux, to identify patients with an increased risk of having nasal hyper reactivity during CPAP treatment. The Rhinolux is an oximetry device that measures changes in nasal blood flow by light absorption in haemoglobin. The majority of the patients in this study will not have tested CPAP before eventhough they have been given a description of the treatment procedure. To control for the bias that having prongs in the nose could effect the nasal blood flow, all subjects will initially wear the prongs for 10 minutes before the CPAP pressure is applied. In this sence the study could be considered to be single blind because only the examiner will be fully aware at what time the CPAP pressure is turned on.

Metabolic syndrome (MetS) is a condition characterised by over-weight, poor blood sugar control and high blood pressure. The aim of this study is to investigate the effect of weight training on muscle mass and strength, blood sugar and cholesterol levels, body composition, functional capacity (energy for daily living), some important measures of cardiovascular health, and quality of life in people who live with metabolic syndrome. To enhance the scientific validity of the study, we will also make the same measurements in healthy people (normal weight). The main predicted outcome is that strength training will improve muscle function (eg the muscle may dispose of sugar more efficiently), strength and the ability to carry out daily activities. All of this should reduce your risk from future cardiovascular disease or diabetes, and improve your health and sense of well-being. Volunteer will be separated into two groups. One group (called the training group) will perform a resistance-training program and the other group (the control group) will continue their normal daily activities. The control group is essential for the study in order to determine if changes - provided they occur- in the training group are due to the resistance training itself. The separation into groups will be done randomly after initial testing.

Borderline Personality Disorder (BPD) is a disabling syndrome which is generally associated with a history of severe childhood trauma and/or neglect. The disorder is characterized by intense, distressing and changeable emotions, impulsive self-destructive behaviour and troubled relationships. Around three quarters of the people with this diagnosis engage in deliberate self-harm (such as cutting or burning themselves) and around eight to ten percent suicide. Treatment of the condition is difficult because of stormy relationships with treating staff and staff anxiety about clients’ suicidality and self-harm. Spectrum is a statewide public sector specialist service, which was established to support the treatment of clients with BPD. Since its inception eight years ago, Spectrum has provided consultation and training to staff, and residential treatment for a small number of clients. Spectrum has been examining ways of offering treatment for a larger number of clients. A difficulty has been the need to do this within Spectrum’s current level of resourcing and that of the Area Mental Health services. Group treatment is, in general a particularly cost effective approach, and has the added benefit of providing an opportunity for clients to expand their social networks. Our aim is to develop a group treatment approach for BPD that can eventually be delivered by area clinicians with Spectrum support. Recently a brief outpatient group treatment was trialed in America and found to be very successful in treating the symptoms of BPD. The groups aimed to teach clients ways of managing their troubling emotions in crises so as to reduce impulsive self-destructiveness. The approach used in that study has many similarities to Spectrum’s residential treatment, and to a group outpatient treatment piloted by Spectrum in 2005. The very positive findings of the American study have lent support to our decision to continue testing a similar outpatient group treatment. The project has two phases. In phase one a 12 week series of groups teaching Crisis Skills will be trialed. For some clients this 12 week group treatment (with ongoing individual treatment) will be enough. For those who require more group treatment, additional skills training will be offered in phase two. Phase two will consist of three further series of groups (each lasting 10 weeks), teaching Interpersonal Skills, Emotion Skills and Mindfulness Skills. Clients who enter phase two treatment will thus be provided with the opportunity for approximately a year of group treatment in total (including phases 1 and 2 and short breaks between modules of treatment). Sixty clients will be recruited into phase 1, via referrals from staff from AMHS staff in Eastern Health, Northwest Mental Health and the Werribee-Mercy Networks. All clients will need to have a support person who can assist them in practicing the skills: e.g. an AMHS or Community Health Centre clinician, GP, or private psychiatrist. These clinicians will receive information and support to assist them in their role.Clients will be invited to attend an information session and a screening interview with one of the Spectrum clinicians and a diagnostic interview with a research assistant. Informed consent will be obtained at the screening interview. Half the clients will be randomly allocated to start phase 1 groups immediately, and the remainder to start after three months. When all clients have been offered the phase 1 groups, phase 2 groups will be offered to all clients. In order to evaluate the treatment, and better understand how it works, clients who consent, will be asked to complete questionnaires before the first group of each series, mid-way through each group series, after the last group of each series, and at three month follow up. Phase 1 treatment will be evaluated by comparing the changes in the first 30 clients treated with the 30 clients on the waiting list, and by comparing test results, for all clients before and after phase 1 treatment. Outcomes from the combined phase 1 and phase 2 groups will also be evaluated, and the process of change examined.