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This study is investigating whether it is feasible to administer an exercise program prior to radical surgery for patients with bladder cancer. Who is it for? You may be eligible for this study if you are aged 18 or older, you have been diagnosed with bladder cancer, you will be undergoing radical open cystectomy and you have been invited to participate in the program by one of the investigating urologists who are based in Western Australia (Professor Hayne and Dr La Bianca). Participants who are not being treated in Western Australia will not be eligible for this study. Study details Participants who are invited to participate in this study will be prescribed an exercise program to be completed 2-3 times each week for a maximum of 4 weeks, dependent upon when their surgery has been scheduled, for cystectomy only and for those undergoing neo-adjuvant chemotherapy for approximately 12 weeks. Participants will undergo one-on-one training with an exercise physiologist for 2-3 one hour sessions each week, and will also be asked to complete another 20-30 minute exercise sessions (e.g. walking) on the other 2 days at home. The supervised sessions will involve two types of exercise, resistance training that may involve lifting weights or performing strength exercises, and aerobic training that may involve walking or jogging on a treadmill, cycling or rowing on a stationary machine. The exercise regime will finish prior to your scheduled surgery. You will be asked to complete a series of questionnaires before starting the exercise program, after completing the program, and 3 months after your surgery. It is hoped this research will demonstrate that a pre-surgical exercise program is safe and feasible to deliver to patients with bladder cancer, and that the exercise program may improve post-operative outcomes in these patients.

We will assess the effect of Photobiomodulation therapy (PBMt; ‘light therapy’) on nipple pain in breastfeeding women to contribute information for establishing optimal treatment settings. The study will be conducted at The Possums Clinic, Brisbane. Forty-six eligible participants with nipple pain will be recruited for this study and randomised into either intervention Group A (standard gestalt intervention plus light therapy) or Group B (standard gestalt intervention plus sham light therapy). In addition to the review of the gestalt therapy techniques at every appointment (thrice weekly for the duration of the study), light therapy will be administered three times per week and thrice weekly treatment will continue until the participant reports zero pain, or for 4 weeks, whichever occurs sooner. We expect that the use of light therapy will reduce nipple pain earlier than would be expected with standard gestalt therapy alone.

Fatigue and excessive daytime sleepiness are common complaints in individuals living with multiple sclerosis (MS). Fatigue and excessive daytime sleepiness are associated with the emergence and exacerbation of cognitive, motor and mood disturbances and over time lead to impaired rehabilitation outcomes, a decline in the capacity to perform daily activities and reduced quality of life. Treatment of fatigue and daytime somnolence in individuals with MS is therefore essential. Over the last three decades a large body of evidence has accumulated noting the positive effects of non-pharmaceutical strategies for treating sleep and circadian rhythm disturbances in individuals with sleep disorders. Among these, sleep hygiene and light therapy have been shown to be efficacious for sleep and circadian rhythm disruption. Despite this large body of evidence, a relatively small number of studies have evaluated the therapeutic utility of sleep hygiene and light therapy for the treatment of fatigue and daytime sleepiness in individuals with MS. Preliminary evidence suggests that these strategies are feasible and effective in treating fatigue and daytime sleepiness in individuals with traumatic brain injury and Parkinson’s disease. However, there is a fundamental need to replicate these findings in individuals with other neurological conditions, including MS, using larger randomised controlled trials. Furthermore, there is a need to evaluate the synergistic effects of both therapeutic approaches for these populations. The purpose of this study is to evaluate the feasibility and therapeutic effects of light therapy in combination with sleep hygiene, compared to sleep hygiene alone, in individuals with MS. It is hypothesised that both therapies will have positive effects on fatigue and daytime sleepiness, however, light therapy plus sleep hygiene will be more beneficial in reducing symptoms of fatigue and daytime sleepiness in individuals with MS than sleep hygiene alone.

Fixed airway narrowing is a common complication of long standing asthma. It occurs despite good treatment with puffers that are effective in controlling inflammation. It causes symptoms such as wheeze, cough, shortness of breath and there is no known treatment for asthma related fixed airway narrowing because the mechanisms and causes are poorly understood. It is more common in older patients who have had asthma for many years, in whom there are also greater symptoms. The underlying mechanism of airway and lung tissue remodelling are unknown but preliminary data support a crucial role for inflammatory cells, and in particular, neutrophils and macrophages. Neutrophils, as well as other inflammatory cells such as macrophages release proteolytic enzymes that mediate tissue remodelling and tissue destruction. This is supported by both CT and histological evidence of lung tissue remodelling that explains the loss of lung elastic recoil in longstanding asthma. Inflammation driven remodelling of peripheral airways and surrounding lung is therefore a likely mechanism causing FAO in older people with longstanding asthma. The aim of this research is to determine how neutrophils and macrophages affect the function of the smaller airways, and how they can cause airway and lung damage in older people with asthma. We will recruit people with asthma who are >40 years of age, are non-smokers and have no other significant lung or heart problems. Participants will undergo breathing tests, CT scanning and a bronchoscopy, using a small camera on the end of a flexible tube, to obtain samples from their lungs. The significance of this study will be the discovery of the mechanisms that underlies this major complication of asthma. It will assist in overcoming the major barrier halting progress to an effective treatment strategy for which the mechanisms are unknown.

It is unclear what constitutes standardised or routine head injury management whilst in the emergency department (ED). Further, ED head injury discharge processes, management and communication to patients, families and carers is often inconsistent or ad hoc. This inconsistent management of head injury both within the hospital environment and transition to home in the community may not optimise best patient outcomes. Further, how clinicians communicate the discharge plan and manage activities such as return to work/study and or resuming sporting activities needs to be explored further. In addition, patient compliance and adherence with discharge instructions is also critical for optimising the recovery trajectory, health outcomes and avoidable representations and yet little is known about patient compliance and adherence for this group. To date little is known of how concussion is managed in the community by both adults and parents whose child has experienced a head injury and is symptomatic of concussion. Therefore, this study seeks to better understand the characteristics of people that present with head injuries and symptoms of concussion to an ED and how on discharge concussion is managed in the community.

This study involves the evaluation of safeTALK workshops delivered to secondary school students in North-West Melbourne. As part of the questionnaires used to evaluate the training, students will also be screened for risk and referred to the school wellbeing team. It is hypothesised that completion of the safeTALK workshop will be associated with: increased intentions to intervene with a suicidal person; higher levels of suicide literacy; higher levels of perceived behavioural control regarding intervening with a suicidal person; reduced stigma towards suicide and suicidal behaviour, increased health-service use; increased help-seeking from informal sources; and, improved attitudes towards help-seeking. It is hypothesised that the screening will lead to the identification of students at risk of suicide-related behaviour who had not previously sought help. Finally, it hypothesised that the safeTALK program or screening will not be associated with iatrogenic effects.

Informed medical consent is how clinicians communicate important information to patients about procedures/treatments they are recommending. The process of communication is highly individualised, time consuming and at a pace that is usually set by the healthcare worker. It is therefore not surprising that patients report variable and inconsistent comprehension and understanding of clinicians’ explanations of procedures/treatments. The literature demonstrates that audiovisual consent, when used to supplement current methods, improves the patient experience, including higher satisfaction, better comprehension and less anxiety. We will, for the first time in the procedure of kidney biopsies, evaluate patient reported benefits of video-assisted electronic consent compared to a conventional consent process, that being a clinician consenting the patient.

Australian families with preschool/school children have been experiencing significant distress during the COVID-19 pandemic and it is estimated that 1,600,000 Australian families will experience financial hardship during the pandemic. The associated economic recession is resulting in widespread job losses and financial stress, adding further distress. An extra three quarters of a million children are now living in families experiencing employment stress with three suburbs from South West Sydney (SWS) in the top 10 communities impacted3 and marginalised families in rural communities have been further isolated as well. Parental mental health difficulties consequent to the pandemic will adversely impact children’s development and well-being. Specifically, families from priority populations such as from culturally and linguistically diverse (CALD) and rural/regional backgrounds are particularly at risk of poor health outcomes. This has been compounded by the closure of Child and Family Health Nurse (CFHN) services for in-person consultation which has substantially reduced access to resources for vulnerable families during the pandemic. The Watch Me Grow – Electronic (WMG-E) Platform is an innovative technology that will provide a unique opportunity to reach vulnerable families at their homes, critical during the current pandemic. WMG-E has been evaluated for child developmental monitoring and we now propose to expand this to screening and addressing parents’ mental health and unmet psychosocial needs (e.g. financial support, housing) - optimising the family’s wellbeing. We will use this "virtual care approach" to focus on a predominantly CALD community (Fairfield in SWSLHD) and a regional/rural area (Murrumbidgee LHD). We will utilise the opportunistic contact for routine CFHN checks to engage and empower parents (including those who would otherwise not engage with health services), normalise and de-stigmatise mental health and psychosocial screening, and provide urgent targeted interventions.

The number of Australians living with diabetes is increasing and so is the cost of healthcare for these people. Many people living with diabetes are managed by Australian diabetes centres. These centres are members of the National Association of Diabetes Centres (NADC) and include a mixture of primary, secondary and tertiary care facilities. The clinical management provided by these Centres is evaluated by the Australian National Diabetes Audit (ANDA), an annual benchmarking activity where de-identified patient data for a range of process and clinical outcomes is collected, collated and compared for all participating sites. A previous qualitative study sought opinions from clinical staff regarding the acceptability and utility of the audit feedback currently provided. This study has informed redevelopment of the feedback provided to participating sites and development of the cointerventions in this trial.. Providing these enhanced feedback and community of practice interventions in a cluster randomised trial will allow us to evaluate the utility and acceptability of the feedback and cointerventions provided, and also the effect on selected clinical outcomes. We hypothesise that delivery of redesigned audit feedback and educational and peer support resources to diabetes centres will improve the utility and acceptability of the Australian National Diabetes Audit (ANDA) feedback to participating diabetes centres. We also hypothesise that the interventions will lead to improved clinical outcomes including mean HbA1c. This project will contribute to the body of knowledge about how to bring about practice change in diabetes centres in Australia. The outcomes of the study have the potential to improve the health outcomes of the many people with diabetes managed by participating diabetes centres.

Preliminary evidence suggests that low-carbohydrate (LC) diets appear safe for use in type 1 diabetes (T1D) and may be effective for certain subgroups of this clinical population. However, the available body of research is limited and there is still a lack of consensus regarding the efficacy of LC diets for improving T1D management. Since there are a multiplicity of lifestyle factors impacting T1D management, and with consideration that all individuals have their own personal needs and preferences, an interventional study that uses participants as their own controls and investigates a patient-led dietary approach will be of important clinical relevance. Therefore, a within-patient interventional study investigating a LC diet with an adaptive carbohydrate prescription (25-75 g/day) will be undertaken in adults with T1D in an outpatient setting. The aim of this research is to assess the efficacy of a LC diet in adults with T1D. Our primary objective is to determine the effects of a LC diet (25-75 g/day) on clinical markers of T1D management including HbA1c, glycaemic variability, frequency of hypoglycaemia, total daily insulin, and quality of life. We expect that a LC diet will result in improved T1D management compared to habitual diets higher in carbohydrates.