ANZCTR search results

This trial aims to determine the prevalence of vestibular dysfunction in patients admitted to a specialist rehabilitation unit. Who is it for? Patients aged 18 or above, current inpatients of BIRU or GARU wards at Princess Alexandra Hospital, Queensland Study details All participants will complete the Vestibular Screening Test and then complete objective vestibular testing. All participants from the same ward will be tested consecutively on the same day. It is hoped that this study will demonstrate the prevalence of vestibular dysfunction within patients of the specialised wards. It is also hoped that the outcomes of this project may have implications for physiotherapists working in subacute rehabilitation units to include vestibular screening as part of their standardised initial physiotherapy assessment on admission. A timely and routine vestibular screening assessment could be a worthwhile adjunct to the standard physiotherapy assessment to guide early and appropriate intervention and achieve optimal rehab outcomes.

Only 15% of cardiac rehabilitation attendees are achieving the physical activity guidelines. In people with heart disease, insufficient physical activity is an independent risk factor for all-causes of death. Within cardiac rehabilitation, people with heart disease are encouraged to meet the physical activity guidelines. Yet clearly, an innovative and effective physical activity intervention is needed in these programs. Our preliminary work has found that regular physical activity measurement by health professionals alone can drive physical activity adherence in insufficiently active adults. However, the optimum frequency of measurement in cardiac rehabilitation is unknown. ‘Measure It!’ is a very brief intervention, taking clinicians less than 5 minutes to complete. It includes a self-report and objective measure of physical activity (wearable activity tracker steps) plus physical activity advice. We will test two frequencies of physical activity measurement (2 and 5 measurements in total) by cardiac rehabilitation clinicians over 24-weeks. This hybrid effectiveness-implementation trial will recruit 190 insufficiently active cardiac rehabilitation attendees from 5 cardiac rehabilitation programs in the Australian Capital Territory and New South Wales. Daily minutes of accelerometer moderate-to-vigorous physical activity is the primary effectiveness outcome. Implementation outcomes will include acceptability, appropriateness, adoption, costs and sustainability. We hypothesize that 5 physical activity measurements over 24-weeks will result in increased accelerometer daily minutes of moderate-to-vigorous physical activity in insufficiently active cardiac rehabilitation attendees with heart disease compared with 2 physical activity measurements. If ‘Measure It!’ is successful, we will be able to recommend ways to incorporate this very brief intervention into cardiac rehabilitation service delivery. It will be a time and cost-effective approach to targeting physical activity within and beyond cardiac rehabilitation programs. Results will potentially drive changes in current practice, directly informing the development and implementation of cardiac rehabilitation services, leading to improved health for a large number of Australians with heart disease.

Autologous haematopoietic stem cell transplantation (AHSCT) is a procedure that is typically used to give high doses of chemotherapy to patients with blood cancers, followed by stem cell infusion, so that a new blood and immune system can regrow. Stem cells are collected from the blood following stimulation with intravenous cyclophosphamide chemotherapy and granulocyte colony stimulating factor (GCSF) injections. Patients are then admitted into hospital to receive high doses of chemotherapy that intensely suppresses their immune system. Subsequently they have their stem cells transfused to re-grow a new immune system and provide protection from the toxic effects of the chemotherapy. It takes about 14 days for the new stem cells to grow and all patients are monitored carefully over the subsequent months and years to see if the immunosuppression controls their auto-immune disease. Over the last 15 years AHSCT become much safer, and evidence has accumulated suggesting a proportion of patients with severe autoimmune conditions will respond to AHSCT. Often these patients had prolonged remissions of their AID. In well selected patients there is a possibility to establish a prolonged period of disease remission.

Q fever is a highly infectious disease caused by the bacteria Coxiella burnetii. Currently there is an effective Q fever vaccine which is recommended for those considered to be in “occupational at risk” groups, such as abattoir workers, veterinarians and farmers. However, several recent studies have highlighted that the risk in the non-traditional “at risk” groups, such as children, metropolitan dwellers, is higher than previously thought. The only vaccine available in the world is Q-VAX®, which is, according to the Australian Immunisation Handbook, only recommended for people aged 15 years or over, and therefore children under 15 years old, who are at risk of contracting Q fever, because they live on farms, near abattoirs or are children of “at risk” workers cannot be vaccinated. This is a Phase IV, multi-centre, vaccine trial in which 1000 children, aged 10 to <15 years, and 100 adults (aged >=15 to <=30 years) will be recruited across NSW and Queensland. This clinical trial is designed to assess the safety, reactogenicity and immunogenicity of the licensed Q fever vaccine (Q-VAX®) in children aged 10 to < 15 years.

The widespread misuse of prescription opioids is a current ‘crisis’ that is already being faced in many countries, including the United States and Canada. Australia is rapidly following the same path as opioids are often prescribed to patients who present to EDs with pain. Australia now ranks eighth internationally on the number of daily doses of prescription opioids per million population (at approximately 40% the level of USA. A proportion of these would result from the prescribing of opioids by physicians in the emergency setting. The principle hypothesis of this study is that restricted prescription of Oxycodone in the Emergency Department will significantly reduce opioid prescription rates compared to current practice including educational programs

A postoperative pulmonary complication (PPC) is more than 15 times more common following upper abdominal surgery (UAS) than a cardiac complication. A PPC more than doubles the baseline cost of abdominal surgery.1,2 A single PPC costs the hospital approximately $AUD 45 000 to treat.1 John Hunter Hospital is a major centre in NSW for UAS such as open gastro-oesophageal cancer resections, performing 384 UAS procedures in 2019. Due to the pathophysiological impact that these higher risk procedures have, PPCs are more likely to occur when compared to lower abdominal and non-thoracic surgeries.2,3 Prospective collection of PPCs in a group of patients undergoing UAS at JHH (n=48) between November 2021 and June 2022 demonstrated a rate of PPCs of 25%. An Australian/New Zealand multicentre randomized control trial (RCT) and economic analysis evaluated the impact of a simple 30-minute preoperative Physiotherapy education intervention for those undergoing high risk abdominal surgery.3 (ACTRN12613000664741) This intervention involved education related to postoperative pulmonary complications, their causes and implications, and the importance of deep breathing, coughing and early mobility in their prevention. This intervention resulted in a reduction in the incidence of PPC by half and an absolute risk reduction of PPC of 15%. 3 It is unclear how this research translates into clinical practice, particularly when preoperative flow may differ between health services and also when many perioperative appointments are now conducted via telehealth. This research aims to evaluate the feasibility of the pragmatic delivery of a 20 minute 1:1 physiotherapy preoperative education session (Boden et al 3) for people undergoing UAS at JHH and the impact on PPCs . We hypothesise, that more than 90% of patients eligible for this study will be delivered the preoperative education, and that a reduction in PPCs, similar to that reported by Boden et al 3, will be observed. 1. Fleisher LA, Linde-Zwirble WT. Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures. Perioper Med (Lond). 2014;3:7. 2. Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. Lancet Respir Med. 2014;2(12):1007-1015. 3. Boden I, El-Ansary D, Zalucki N, et al. Physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity: a nested mixed-methods randomised-controlled study. Physiotherapy. 2018;104(2):194-

Pressure injuries (also known as pressure ulcers or bed sores) are wounds caused by pressure related damage to the skin and underlying tissues which typically occurs when patients are immobile or unwell. Pressure injuries cause pain and suffering, predispose the person to infection, may require lengthy hospital stay and can cause premature death. Pressure injuries affect up to 28% of residents of aged care facilities in Australia and cost an estimated AU$983 million per annum. The International Practice Guidelines for pressure injury prevention and management provide direction for the assessment, care and monitoring of people who have or who are at risk of pressure injuries. However, it is challenging to implement clinical practice guidelines in practice. This is particularly the case in residential aged care, where there may be variable skill mix among staff. Access to Wound Consultants may be a barrier in this setting and furthermore, direct access (in Home) to nurse consultant expertise may not feasible (e.g. during the global pandemic). Evidence-based pressure injury care is essential to prevent pressure injuries and ensure timely healing of existing pressure injuries. The Project seeks to implement and evaluate an innovative approach to care, specifically a remote expert nurse consultation model for pressure injury management. A pilot study asks whether something can be done, should the researchers proceed with it, and if so, how. We hypothesise that the study will answer these questions and will therefore inform the future conduct of a larger trial to evaluate the effectiveness of remote expert would nurse consultation for healing pressure injuries in residential aged care.

This study is a double-blind, randomised, placebo-controlled clinical trial seeking to investigate the efficacy and safety of Cannabidiol (CBD) oral oil versus placebo, for the management of abdominal pain in patients with irritable bowel syndrome (IBS). Given CBD’s noted anxiolytic, antidepressant, immunomodulatory, and anti-inflammatory activity, we believe that CBD will be a safe and potentially effective candidate for use in adults with IBS. Many gaps still exist in our knowledge on the efficacy and safety of cannabidiol in the clinical setting for the management of symptoms of IBS. However, with suboptimal therapeutic effects, and associated side-effects, of pharmaceutical drugs such as antidepressants, anticholinergics and opioids, this has led to this study being developed to explore CBD as a potential therapy for IBS. As such,this study will determine whether CBD may alleviate the broad list of symptoms which may present in IBS patients.

The proposed study will be the first to compare the effects of "typical" breakfast timing (Early at 7:00 am, Mid at 09:30 am and Delayed at 12:00 pm conditions) and 20 minutes of exercise after breakfast on postprandial hyperglycaemia in free-living adults with Type 2 Diabetes (T2D) using continuous glucose monitors (CGM) in a 6-week randomised crossover-controlled trial. The hypothesis of this study is that altering the time of breakfast will modify postprandial hyperglycaemia, and that twenty minutes of brisk walking after breakfast will attenuate (lower) postprandial hyperglycaemia.

This feasibility study is designed to investigate the potential effectiveness of a professional learning intervention to support educators in supporting children with maladaptive behaviours in the early childhood education context. Intervention impact will be evaluated in terms of (1) shifts in child behaviour (2) changes in teacher-child relationships, and (3) shifts in room-level practice. It is hypothesised that there will be improved self-regulation in the intervention group compared to those in the control group.