ANZCTR search results

Atrial fibrillation (AF) is a global epidemic associated with significant morbidity and mortality and growing health care burden. Hospitalisations due to AF are the most common cause for cardiovascular hospitalisation in Australia, many of which are preventable. Redesigning care delivery could result in fewer unnecessary hospitalisations and complications related to this condition, such as stroke, the most devastating yet often preventable complication of AF. Whilst effective medications can be used to reduce the risk of stroke, these are frequently under or overused, resulting in suboptimal care delivery. The use of protocols in the emergency department (ED) to guide clinicians in the acute management of AF has resulted in a marked reduction of hospitalisations related to AF in other countries, yet has never been tested in an Australian setting. This study seeks to evaluate an innovative model of care for the acute management of AF, combining an emergency department protocol with early outpatient follow up in a nurse led rapid access AF clinic. This will ensure standardised and guideline adherent care delivery to reduce the risk of preventable hospitalisations and complications in the AF population. We believe that this model of care will help to reduce unnecessary hospital admissions for AF, in addition to reducing complications associated with the condition and empowering individuals to learn how to self manage their AF.

The RIVASTIM trials aim to identify strategies to improve immunological responses to a 3rd booster dose of the mRNA Pfizer Comirnaty COVID-19 vaccine in a cohort of kidney transplant patients who have failed to achieve an adequate immune response to a standard two-dose COVID-19 vaccine course. Kidney transplant patients are a highly vulnerable group of immunosuppressed patients who suffer from disproportionately high COVID-19-related morbidity and mortality. The dietary fibre supplement inulin shows promise in enhancing immune responses to vaccination. In this study kidney transplant patients will be randomised to either take inulin supplements or placebo. Four weeks after randomisation, participants will receive a 3rd COVID-19 vaccine dose, and immunological responses will be assessed 4-6 weeks later.

This project will investigate how biceps femoris long head muscle and aponeurosis morphology are influenced after undertaking either a chronic concentric- or eccentric-only resistance training intervention in healthy, recreationally active males. A secondary aim is to determine the impact of these contraction mode specific interventions on biceps femoris long head muscle architecture, diffusion parameters, knee flexor strength, three-dimensional (3D) biomechanics and the musculotendinous demands experienced during running. We hypothesise this muscle-aponeurotic adaptation will be the major driving factor that influences the intrinsic tissue demands during gait (such as musculotendinous strain or fibre strain) instead of due to changes in joint kinematics or kinetics.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain an ongoing and preventable cause of heart disease affecting Aboriginal Australians and/or Torres Strait Islander people (hereafter referred to as Indigenous Australians). The diagnosis of ARF is based on the presence of signs or symptoms rather than a definitive investigation. This can lead to instances where the diagnosis is uncertain and diagnostic categories of possible, probable and definite are used. Failure to diagnose ARF accurately is of particular concern given secondary antibiotic prophylaxis is important in the prevention of further ARF as well as progression to RHD-related valvular heart disease. This multi-site research will use cardiac MRI in Alice Springs, Darwin, and Cairns to identify and quantify cardiac inflammation in patients with confirmed or suspected ARF. A score of extent of inflammation will be developed to aid in the diagnosis of ARF, such that more confidence can be placed in the accuracy of diagnosis and therefore the need for ongoing secondary antibiotic prophylaxis. This score will be compared to that of healthy controls and participants with non-ARF inflammatory conditions such as pneumonia. ARF cohort participants will be followed-up at two years to determine if they have subsequently developed RHD (per echocardiogram result). This is to determine whether baseline CMR predicts the future development of RHD (or whether this is dependent on number of antibiotic doses received).

Many people with dementia eventually move into residential care. Making this decision and coping with admission processes can be stressful and distressing. However, carers report that formal supports to help families cope during this time are lacking. This pilot randomised controlled trial aims to test whether it is feasible to provide a telehealth counselling support program and printed informational support following Aged Care Assessment Team approval for long-term care and whether different methods of information and support may help family members or friends of people with dementia cope with any issues surrounding the move into residential care. The Residential Care Transition Module (RCTM) consists of six telephone or video-link counselling sessions delivered to family carers over 12 weeks by a trained psychologist or counsellor. It includes education about dementia and residential care facilities, dementia-specific grief counselling, stress reduction techniques, and referral to support networks. The control group will receive a check-in call and a printed information pack about residential aged care, coping with placement, managing feelings, working in partnership with residential care staff, and details of support services by Dementia Australia. The pilot study will test whether delivery of the counselling and / or printed information is beneficial in reducing family carer stress, anxiety, depression, guilt, and grief, and improving social support during the course of placement. This may help carers to better cope and adjust once their relative has been admitted into residential care.

There are 445,000 stroke survivors in Australia and every year there are ~28,000 new strokes. Almost a third of ischemic strokes (the major stroke type), are related to Atrial Fibrillation (AF), an abnormal heart rhythm leading to blood clots in the heart which travel to the brain. 10% of these strokes are due to unknown AF only detected at the time of stroke. Ischemic strokes are potentially preventable by systematic population screening for AF in a setting where preventive treatment can be given. This could significantly reduce stroke burden and cost to society. One in four adults aged over 40 will develop AF in their lifetime. Prevalence and incidence of AF rise sharply with age (over 10% aged greater than and equal to 70 have AF). AF numbers are predicted to double in Australia between 2014 and 2034, even after adjustment for population ageing. It is an important health problem associated with a 5-fold increase in stroke, which is often disabling or fatal. AF is also associated with an increased risk of death, with growing evidence of an association with cognitive decline/dementia which may be reduced by oral anticoagulation, now standard therapy for AF. While AF may give rise to palpitations or other symptoms, often there are no symptoms in older people who are at the highest risk of stroke. Approximately 10% of ischemic strokes occur in people with newly diagnosed asymptomatic AF, which is unlikely to be identified without screening, thus a major opportunity for stroke prevention. The rationale underpinning a strategy of screening is to make an early diagnosis of asymptomatic and under-treated AF, so oral anticoagulants (showing a 64% stroke reduction by preventing cardio-embolism) can be started to prevent AF-related stroke. It is not known whether the screening strategy will be better than usual practice, This is the rational underpinning the the SAFER-AUS study which is a randomised controlled trial with stroke endpoint, where participants randomised to intervention (AF screening) or control (usual practice). We aim to recruit a total of 780 participants from a mixture of urban and rural settings across 3 states, with each practice having a minimum of 500 active registered patients aged greater than or equal to 70 years. The SAFER-AUS trial to screen for unknown AF is a research partnership between Australia and the University of Cambridge.

Use of a Smart phone application to encourage self-management with remote monitoring in patients admitted or referred to an East Metropolitan Heath Service hospital in Western Australia [Armadale Health Service (AHS), Royal Perth Hospital (RPH) or SJOG Midland Public and Private Hospital (SJOGMPPH)] with heart failure of chronic obstructive pulmonary disease: 1. The primary aim is to determine impact on quality of life. 2. Secondary aims include a. impact on symptom assessment scores b. change in average hospital length of stay in the 1 month, 3 months and 6 months following the intervention c. patient satisfaction with using the application Hypothesis The use of a Smart phone application to improve self-management with remote monitoring will significantly improve the domains of physical and emotional health, and positively impact symptom assessment and reduce average length of stay.

This study aims to investigate the safety and tolerability of Hydroxychloroquine in combination with Carfilzomib and Dexamethasone for multiple myeloma. Who is it for? You may be eligible for this study if you are a patient aged over 18 years who has a diagnosis of relapsed or refractory multiple myeloma patients with a partial response or less after 2 cycles of Carfilzomib treatment. Study details Participants will undergo 2 cycles of once-weekly Carfilzomib and Dexamethasone as per the standard of care. If participants are deemed to have a partial response or less by clinician assessment, Hydroxycholoroquine treatment will be initiated for the next 10 cycles alongside continuing Carfilzomib and Dexamethasone. Data on adverse events, toxicities and dose limiting toxicities as well as disease response will be collected. It is hoped that data from this study will help to inform the role of Hydroxychloroquine in treating multiple myeloma.

First responders, corrective service, and other frontline workers perform some of the most important roles in our society. As a result, first responders are at disparate risk of exposure to traumatic and/or stressful events, demanding workloads, and irregular hours – all known risk factors for mental ill health. Indeed, previous studies report high rates of post-traumatic stress disorder (PTSD), depression, and distress amongst first responders. Widespread reluctance to seek treatment for such mental health issues is especially prevalent in first responders. Mental health screening attempts to detect individuals at risk of, or suffering, a mental health condition to direct them to resources/treatment. Early detection of mental ill health is associated with less intensive treatments and improved recovery. This, in tandem with the fact that mental illness is currently a leading cause of sickness absence and work incapacity in many developed countries, has meant that screening of employee mental health is increasingly applied in workplaces. While increasingly common, workplace mental health screening has received criticisms including the cost and resources required, and employee concerns regarding confidentiality and consequences of disclosure leading to biased reporting. Nonetheless, workplace mental health screening is occurring in real-world first responder workplaces.

Australia’s 287 emergency departments (EDs) see more than 8 million patients a year. Failure to assess, treat comprehensively and escalate appropriately can be catastrophic. Emergency nurses are the first clinicians with whom patients have contact, so patient safety is contingent on their accurate assessment, interpretation of clinical data, intervention and escalation. Particularly as across Australia in 2017-18, only 64% of urgent patients were seen by medical officers within 30mins of ED arrival and were solely in the care of emergency nurses during this time. Patient assessment and management by Australia’s 29,000+ emergency nurses is hospital dependent and inconsistent resulting in avoidable patient deterioration, poor pain management, poor nursing documentation, human suffering and patient dissatisfaction with emergency care. We propose a solution - HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment). HIRAID is the only validated framework designed to teach emergency nurses how to systematically assess and manage emergency patients. We have successfully piloted HIRAID across rural, regional EDs for usability. In the simulated environment HIRAID improved nurse assessment and communication. We now need a multi-centre RCT to generate the ultimate evidence for embedding of HIRAID into policy and practice. Over 5 years, our team of Australia’s leading emergency clinician, nurse and health economic researchers will use an effectiveness-implementation hybrid design including a step–wedge cluster RCT across 31 NSW and Qld hospitals. We hypothesise that when HIRAID is implemented there will be a 20% reduction in inpatient deterioration events related to emergency nursing care and an increase in patient/carers who report their ED experience as very good. Our partners have been engaged with this proposal since inception and represent several of the key agencies that deliver or support emergency care in Australia.