ANZCTR search results

The study aims to evaluate the effectiveness of the TA intervention in young people who present to the ED for DSH or suicidal ideation with past DSH behaviour. The results of this project will be used to determine whether TA is effective in adherence to aftercare services and repeat presentations to the ED for DSH. The objectives are to: 1) To examine the effectiveness of the TA intervention on adherence to aftercare services at 6-months and 12-months post-presentation to the ED for DSH, including young people who present with suicidal ideation with a history of DSH. 2) To examine the effectiveness of the TA intervention on reducing rates of re-presentations to the ED for DSH or suicidal ideation at 6-months and 12-months post-presentation. 3) To identify key modifiable factors associated with access and availability of aftercare services for young people post presentation to ED for DSH or suicidal ideation with a history of DSH, in metropolitan and regional settings.

This is an 18 to 54-week open-label study to evaluate the efficacy of Full-Spectrum Medicinal Cannabis Plant Extract 0.08% THC (NTI164) on the severity of paediatric acute-onset neuropsychiatric syndrome (PANS) in children. The purpose of this study is to determine how effective NTI164 is in patients with PANS when treated for 18 to 54 weeks. Participants will commence treatment with a daily dose of 5mg/kg of NTI164. This will gradually increase over a four-week period until the maximum tolerated daily dose or 20mg/kg per day is achieved (Up-titration phase). Participants will continue to receive their respective maximum dose for eight (8) weeks (Treatment phase). Participants who wish to continue receiving their maximum tolerated dose beyond the 8-week Treatment phase may do so for up to fifty-four (54) weeks (Extension phase). At the end of the Treatment or Extension phase, participants will be gradually decreased by 5 mg/kg for a period of 4 weeks until the end of their participation (Down-titration phase). Efficacy will be measured and monitored by performing participant- and psychologist- led questionnaires specific to measuring changes in the emotions and behaviour of patients with PANS. Whole blood RNA sequencing will validate the immune dysfunction signature.

There is considerable evidence that harsh managerial styles influence workplace efficiency and worker wellbeing. In contrast, supportive managerial styles that are characterized by empathy and non-judgmental attitudes to workers are associated with more positive workplaces and productivity. This issue is particularly influential in organisations that are characterized by demanding work duties, where mental health issues are more prevalent and contribute to absenteeism. The goal of this research is to evaluate the extent to which training managers in NSW Police can result in more supportive behavior of managers, and promote better help seeking in officers with mental health problems. This project is being conducted in collaboration with NSW Police. Sergeants in 6 regional commands in NSW will be trained in how to (a) provide supportive managerial assistance to officers under their command, (b) identify officers who may experience mental health issues or be dissatisfied with their work environment, (c) engage in supportive discussions in a way that promotes a better sense of employee control and work satisfaction, and (d) offer them confidential referrals for assistance they may need with personal issues. These trainings will be conducted in face-to-face group sessions in the 6 commands (each one comprising 10-20 sergeants) in 1 x 2.5-hour session. The outcomes of the project will be compared with 6 matched commands in NSW (identified by NSW Police). The primary outcomes of the project will be sergeants' reports of frequency of referring an officer for mental health assistance. Secondary outcomes will be knowledge of appropriate strategies to provide to officers; this data will be obtained from sergeants when they complete a brief questionnaire that is emailed to them by NSW Police. The primary outcome timepoint will be 26 weeks after the program.

Every clinical guideline recommends that individuals with knee osteoarthritis (OA) undertake planned, structured, and repetitive physical exercise. Such programs are ideally provided by physiotherapists or exercise physiologists. However, referral for planned exercise programs for people with OA by their GP is low. This prevents many people with knee OA from having the opportunity to participate in a treatment that will improve their knee pain. This study will investigate the effectiveness of two strategies designed to improve access to exercise programs provided by physiotherapists or exercise physiologists. Strategy 1 is including an educational message that exercise is important in the report sent to the GP after the person with knee OA has undergone x-ray. Strategy 2 supplements the GP educational message with an infographic to the person with knee OA informing them about the benefits of exercise for pain and function. We will work with radiology clinics in NSW to compare the strategies with current practice (no information to people with OA or GPs). We expect both strategies will be more effective than current practice in increasing the number of people being referred and attending appointments with physiotherapists or exercise physiologists.

This is a longitudinal observation study which is evaluating the association of hospitalised community-acquired pneumonia with (i) myocardial fibrosis and with (ii) new-onset left ventricular dysfunction. An abundance of epidemiological data strongly associates pneumonia and subsequent new-onset heart failure, however the mechanism is unclear. Experimental animal data suggest that bacterial invasion of the myocardium with resulting cardiac fibrosis could be implicated. In a recent exploratory study of 20 adults with bacterial community-acquired pneumonia, highly-selected to ensure no prior history of any heart disease, we reported the highly novel finding of myocardial fibrosis and new-onset left ventricular dysfunction in 30% and 5% respectively (Rajwani et al, Bacterial pneumonia is associated with myocardial fibrosis and new-onset left ventricular dysfunction, JACC Advances 2022, in press). If this novel finding of a pathophysiological process in the myocardium is replicated in larger studies of pneumonia, this could herald a major paradigm shift in the post-discharge care of pneumonia. In this current larger study, adults free of prior heart disease who are hospitalised with community-acquired pneumonia (except those with positive viral nucleic acid amplification assay at admission) will be recruited. Myocardial function and composition will be assessed during convalescence post-discharge, as well as longer-term clinical outcomes for heart failure. Predictors of myocardial fibrosis will also be evaluated, in order to allow enrichment of future translational studies exploring preventative strategies.

Induced coma and breathing machines have become synonymous with intensive care units (ICU). Breathing machines are undoubtedly life-saving in many situations where a person can’t breathe for themselves. Despite it being one of the most potent life-sustaining technology available, it causes significant increases in hospital length of stay, an increased hospital cost burden and a leading cause of distress for patients and families in ICU. Non-invasive alternatives such as nasal high-flow oxygen delivery systems or pressurised face masks are usually used as first line treatment to prevent a breathing machine. Low oxygen levels can also be improved with the addition of nitric oxide gas. One study has demonstrated a trend toward decreased need for breathing machines for a portion of patients receiving nasal high-flow oxygen and nitric oxide gas, however this research remains sparse. Our study will examine the feasibility and clinical outcomes of comparing nasal high-flow oxygen alone over nasal high-flow oxygen with nitric oxide gas in preventing patients to require a breathing machine. Based on previous research and physiological rationale, we hypothesise the latter to be superior.

The primary objective of this study is to evaluate Shift, a novel smartphone application designed to support the mental health and wellbeing of Junior Medical Officers in a cohort of senior medical students. We anticipate that senior medical students experience reductions in depression and anxiety symptoms after using Shift because the app addresses familiar challenges, for example, through experiences in clinical placement programs. Shift will be the first app of its kind, in that it is specifically designed for emerging doctors who would like to learn about how to improve or maintain their mental health while entering the workforce in the demanding medical profession. The app uses therapeutic elements (cognitive-behavioural, mindfulness, and psycho-educational contents) designed to alleviate or prevent the worsening of mental health symptoms and encourage help-seeking behaviours.

High blood sugar levels are common in patients who are critically ill even if they do not have a history of diabetes. Glucagon-like-peptide-1 (GLP-1) is thought to be an alternative treatment to control high blood sugar levels in intensive care patients as it has the advantage of not causing low blood sugar levels. The purpose of this study is to compare glycaemic control between exogenous intravenous glucagon-like peptide-1 (GLP-1) and insulin for the management of stress-induced hyperglycaemia in critically ill patients. The study is a randomised, double-blind, double-dummy, parallel study comparing GLP-1 and insulin intravenous infusions over 48 hours in critically ill patients. It is hypothesised that there will be no difference in the time outside target glucose range (4.0 – 10.0 mmol/L) between exogenous intravenous GLP-1 and insulin infusions.

The proposed pilot trial will be the first of its kind in the world with an aim to assess the role of using an antimicrobial sealant in reducing the incidence of surgical site infection following elective caesarean section. We believe this study will assist in planning and implementation of methods to minimise post operative complications, maximise recovery after surgery, and increase patient satisfaction. By participating in the study you will be allocated randomly to either a treatment group or a control group on the day of your operation. Participants allocated in the treatment group will have an antimicrobial sealant and antibacterial skin preparation applied to their abdomen before the caesarean section begins. Participants in the control group will receive only antibacterial skin preparation (routine surgical care) prior to their caesarean section. Although at this point you will have an epidural/spinal anaesthetic, the application of the antimicrobial sealant is not painful. Following your procedure, we will care for you as we usually would following a caesarean section. We will record any evidence of surgical site infection whilst you are an inpatient. Once you are discharged from hospital, we will continue to check in with you on Day 7-10 and day 28-30 post operatively to assess for the development of infection. We will contact you through a videoconference call so we can both talk to you and review your wound visually. We will also ask you to take a picture of your caesarean wound at these video conference reviews which we will keep to assess for infection. There will be no identifying features on these photos, so you don’t need to worry about being identified from the photo. All photographs will be deleted following the mandatory period in which they are required to be stored. We will also assess your recovery activity using another visual scoring system, which will be provided to you on you discharge from hospital. We will use the collated information to determine whether using an antimicrobial sealant reduces the likelihood of developing a surgical site infection after a Caesarean section, compared to current standard practice. We will also look at the rate of readmission to hospital with infection following the operation, rate of skin irritation, rate of antibiotic prescription and overall recovery following the Caesarean section between the two groups

Background: Cerebral vasospasm is a relatively common complication following aneurysmal subarachnoid haemorrhage (aSAH), which is associated with significant morbidity and mortality. Current treatment options to treat cerebral vasospasm are limited. Intravenous milrinone infusion is a potentially promising treatment with a relatively low incidence of adverse effects however, has not been explored in a randomized controlled trial. Aim: This will be a pilot study to determine the safety and feasibility of intravenous milrinone infusion as a treatment for cerebral vasospasm following aSAH compared to current standard therapy. Hypothesis: Intravenous milrinone will be a feasible treatment option in the management of cerebral vasospasm following aSAH Methods: The proposed study is a pilot study trialling intravenous milrinone infusion in patients with radiographically confirmed cerebral vasospasm following aSAH. 20 patients will be allocated to receive IV milrinone alongside standard therapy. A control group of 20 patients will receive standard therapy alone. The primary outcome measured will include the dose and duration of milrinone infusion. Secondary outcomes will include the incidence of adverse events, the resolution of cerebral vasospasm on CT or digital-subtraction angiography (DSA) and the vasopressor requirement.