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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.

The aim of this study is to test the impact of messages about COVID-19 vaccine booster doses in adults vaccinated against COVID-19 on intention to receive a COVID-19 vaccine booster dose. We will recruit adults vaccinated against COVID-19. Participants will receive 1 of 4 information conditions or a control. The 4 information conditions will focus on: the personal health impacts of vaccinating; family and community health impacts of vaccinating; non-health benefits of vaccinating; and personal choice and control associated with vaccinating. The control will be text about eligibility for a COVID-19 vaccine booster dose. Analysis will compare the primary outcome measure (intention to receive a COVID-19 vaccine booster dose) between intervention groups and the control (4 comparisons) using an ANOVA test. Secondary analyses will compare secondary outcome measures (beliefs about COVID-19 vaccines) between intervention groups and the control using an ANOVA test.

Less than one third of people with type 1 diabetes (T1D) achieve glycaemic targets known to reduce the risk of long-term complications. Automated insulin delivery (AID; also known as closed loop or artificial pancreas) is a new therapy that improves outcomes for people with T1D. AID combines an insulin pump and continuous glucose monitor (a small sensor worn under the skin) with a maths program, which tells the pump how much insulin to give based on the glucose levels. Current AID systems still require users to manually give insulin at mealtimes. We are investigating an open-source AID system developed within the diabetes community, to see if it can safely treat diabetes without any manual input. A key barrier that may prevent AID systems from maintaining good glucose control around meal times is speed. This is because it takes several minutes for the glucose sensor to detect a rise in blood glucose, and then several minutes for the insulin to act once it is delivered. We are investigating an ultra-fast acting preparation of insulin, called Fiasp, to see if this is more effective than a "standard" insulin (NovoRapid) in managing mealtime glucose levels. We will recruit 20 participants into this trial. They will have already completed a six-month trial (CLOSE IT), in which they will have used an automated insulin delivery system without mealtime boluses, using insulin NovoRapid. We will change NovoRapid to Fiasp and look to see if this has any effect on glucose levels over the course of four weeks. During the trial we'll closely monitor every participant to ensure their safety, and issue a report if any issues emerge.

Less than one third of people with type 1 diabetes (T1D) achieve glycaemic targets known to reduce the risk of long-term complications. Automated insulin delivery (AID; also known as closed loop or artificial pancreas) is a new therapy that improves outcomes for people with T1D. AID combines an insulin pump and continuous glucose monitor (a small sensor worn under the skin) with a maths program, which tells the pump how much insulin to give based on the glucose levels. Current AID systems still require users to manually give insulin at mealtimes. In this trial we will investigate an open-source AID system developed within the diabetes community, to see if it can safely treat diabetes without any manual input. We will recruit 75 people with diabetes across Australia and New Zealand to one of two study sites: the Baker Institute in Melbourne and the University of Otago in Christchurch. The duration of the study is six months. During the first three months everyone will start on an insulin pump and continuous glucose monitor. Participants will need to manually give a bolus whenever they have a meal, but the system will automate all other aspects of insulin deliver. We'll gradually adjust the settings to achieve the best possible control. During the second three months participants will be randomly divided into two groups. The first group will stop giving manual insulin boluses with meals. The second group will continue to give manual insulin boluses with meals. At the end of the trial we'll compare the glucose recording between the two groups, to see if stopping manual boluses made any difference to diabetes control. During the trial we'll closely monitor every participant to ensure their safety, and issue a report if any issues emerge. We'll also collect data relating to the experiences of participants using the AID system, including standardised questionnaires and an interview with 15 participants.

The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) aims to enable older adults to effectively engage with Advance Care Planning (ACP), in the home care setting. Advance care planning is the process by which older adults, or people who are experiencing chronic disease, terminal illness (including cancer) and/or are at risk of dementia and similar conditions can provide instructions to their carer/s about their main preferences and goals for future care, should they reach a stage where they may not be able to make these decisions on a day-to-day basis. Who is it for? You may be eligible for this study if you are aged 65 years or older (50 years or older for Aboriginal or Torres Strait Islander people), you have had a previous aged care assessment team (ACAT) assessment, you are living in a private residence (own or rented dwelling, including retirement village or other co-operative housing, but NOT a residential aged care facility) and you are receiving home care services from one of the participating aged care provider study sites (Home Care Package Level 1-4, or commensurate self-funded service). Participants who meet these criteria and have been diagnosed with cancer will also be eligible. Study details Participants who choose to enrol in this study will be allocated to one of two groups. The first group will receive the EARLI program which involves meeting with a member of the research team every fortnight for up to 10 weeks. Each meeting is expected to last up to 1 hour and these participants will be guided through the ACP process and given an opportunity to discuss their goals and preferences with members of their aged care and primary care (GP or other specialist) teams. The second group will be given one 30 minute session which provides a brief introduction to ACP and directs participants to available resources. The allocation into the first or second group is randomised (like flipping a coin) - each aged care provider study site will be randomly allocated to recruit for the first or second group for a defined period of time, before swapping over. Each participant will be invited to participate in just one of the groups, with the allocation depending on which stage of the process the aged care organisation is in at the time the participant is recruited to the study. The overall duration of participation in this study will be 3 months from the date of enrolment. It is hoped that this study will determine whether this program is effective in helping older adults in the home care setting to be clearer about their values, preferences and plans for the future, while strengthening relationships and improving wellbeing.