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Hip fractures are a common presentation to hospital in the elderly associated with significant morbidity and mortality. To reduce hip fracture associated morbidity and mortality it has been recommended that patients receive frequent pain assessment, multimodal analgesia and adequate analgesia to allow mobilisation day one post-operatively. Part of a balanced multimodal analgesia plan includes performing a regional nerve block such as a femoral nerve block or a fascia iliac nerve block to reduce the requirement for opioid analgesia, potentially reduced rates of delirium, and facilitate early mobilization provided they do not cause motor weakness. The current standard in treatment for regional anaesthesia is a femoral nerve block, however studies have not shown a great clinical reduction in pain scores and there is associated quadriceps muscle weakness potentially delaying mobility after surgery. This had led to an interest in the development of a regional nerve block which produces a more significant reduction in pain without causing motor weakness. An anatomical study in 2018 explored the sensory innervation of the hip joint which has led to the development of the Pericapsular Nerve Group (PENG) block, first described in the literature in late 2018. The literature surrounding PENG blocks is so far limited to small case series and editorials, however the reported studies show potentially positive results of improved pain scores and potentially a reduction in quadriceps weakness. The aim of this feasibility study was to evaluate the impact of this new regional technique on pain scores, opioid use, and quadriceps strength compared to the femoral nerve block.

Identifying ways to support individuals with Alopecia Areata (AA) with mental health condition who have low levels of physical activity (PA) to overcome perceived barriers and enhance the perceived value of PA for preventing future relapse are crucial. There is an evidence-base for behavioural activation (BA) for depression, which focuses on supporting individuals to resume activities that have been avoided, but mental health practitioners have no specific training in promoting PA. We aim to evaluate an integrated PA together with Acceptance and Commitment Therapy (ACT), a self-help intervention to enhance mental health among individuals with AA. This study investigates, whether PA combined with ACT has a positive impact on study participants compared to stand-alone PA, ACT and control group, with regard to the self-reported secondary outcomes of: depression, anxiety, stress, and acceptance following treatment and at six-weeks follow up. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to individuals with AA, there is a need for further research to test its effectiveness through intervention, particularly with regards to combining ACT with PA to increase mental health status in individuals with AA. This intervention is a randomised control trial (RCT) to evaluate the effectiveness of PA and ACT for individuals with AA to improve mental health.

Obstructive sleep apnoea (OSA) increases the risk of atrial fibrillation in a dose-dependent manner. There is growing evidence to suggest that early diagnosis and aggressive management of OSA with continuous positive airway pressure (CPAP) can reduce the symptoms and improve the long-term outcomes associated with atrial fibrillation. However, diagnosis of sleep apnoea is difficult, requiring admission to hospital for intensive overnight monitoring (polysomnography). Furthermore, there is evidence to suggest that single assessment during just one night is insufficient to make an accurate diagnosis. New generation implantable cardiac devices offer new hope for detection of respiratory disturbance during sleep, allowing for continuous monitoring of respiratory disturbance from home over periods of weeks rather than hours. Medtronic, in conjunction with the Principle Investigator, have developed a variety of algorithms for the diagnosis of obstructive sleep apnoea using the implantable Medtronic LinQ device. Diagnosis is based on monitoring of ventilation by means of thoracic impedance changes between the device case and electrode tip. This study will assess the ability of these device-based algorithms to detect obstructive sleep apnoea through comparison with gold-standard polysomnography results. Patients with clinically indicated Medtronic LinQ Recorder implants will be recruited and will subsequently undergo overnight polysomnography. A Holter monitor capable of collecting electrograms directly from the Reveal LinQ device will be used during polysomnography. Medtronic algorithm data from the Reveal LinQ device will then be compared with polysomnography data to validate the use of the Medtronic algorithm to diagnose sleep apnoea.

The incidence of type 2 diabetes in the Aboriginal community is particularly high, about three times greater and up to five times in the age group of 35-44 years compared with Caucasians. The consequences of this are grave and studies have suggested there is a 17-year gap in life expectancy between Indigenous and Caucasians in Australia for which diabetes is a major contributor. An understanding of the inherent differences between Aboriginal and Caucasian groups in the pathogenesis of type 2 diabetes is of major clinical relevance if we are to take steps to bridge this gap and target lifestyle and pharmacological managements effectively. This study is designed to provide new information about the way the gastrointestinal tract (stomach and intestines) contributes to development of type 2 diabetes. It is well recognised that the presence of nutrients in the small intestine triggers the release of certain hormones from the gut. We are interested in studying two gut hormones in particular, GLP-1 and GIP (also referred to as the ‘incretin’ hormones). The incretin hormones have been found to play a critical role in maintaining blood sugar levels. Similarly, the rate at which food is emptied from the stomach to the small intestine (referred to as ‘gastric emptying’) is also crucial. The aim of the study is to determine if, following a standard meal, the gastric emptying or the response by the incretin hormones (GLP-1, GIP) is altered in the indigenous community compared with Caucasians. We will recruit both aboriginal and non-aboriginal participants in this study.

This study focuses on testing a new model of psychosocial care for older aged Australians affected by depression, alcohol misuse and related comorbidities. Eligible participants are allocated to one of two treatment conditions: 1. Breathing Space only 2. Breathing Space + SHADE online program Breathing Space is a private, purpose built online social network. SHADE- Is a 10-session evidence based program of web-based intervention for problematic alcohol use and depressed mood. Our study aims to answer the following specific research questions: 1) Does the Breathing Space social network improve depression, suicidality, and alcohol use in Australians aged 60 years and over? 2) Does adding the SHADE online intervention program to the Breathing Space social network significantly improve depression, suicidality, and alcohol use in Australians aged 60 years and over compared to Breathing Space alone? 3) Does the BreathingSpace social network improve social isolation in Australians aged 60 years and over? The study will integrate the BreathingSpace online peer community and the SHADE online treatment program with the aim of delivering targeted psychological intervention to reduce suicide risk factors in older Australians - depression, alcohol use and social isolation - and to provide evidence-based results on these interventions. The results of this study will also add to the developing evidence for the safety and efficacy of technology-based interventions to improve the health and wellbeing of Australians aged 60 years and over.

The developmental significance of sleep transition in early childhood. This project aims to advance understanding of sleep functioning as children transition from many naps, to one nap, then none. Through an intense, objective longitudinal study of sleep from age one to five years, the project seeks to examine the interplay of sleep, care environment and ongoing child development. The project is expected to deliver much needed evidence to address the controversy surrounding care practice in family and early childhood education and care contexts. The expected benefit for parents and educators is improved knowledge and confidence in supporting children’s sleep. The expected benefit for children is positive development, given the known impacts of sleep on ongoing learning, behaviour and health.

The purpose of the study is to establish if probiotics taken in pregnancy can reduce the incidence of gestational diabetes (GDM) in women who are at increased risk of GDM. The study hypothesis is the administration of probiotics to pregnant women at risk of gestational diabetes from 12 weeks of gestation reduces the incidence of GDM diagnosed at 26-28 weeks gestation. The study is a prospective, double-blinded randomized controlled trial. Women attending public hospital antenatal services who are at increased risk of developing GDM will be invited to participate. Participants will be randomly allocated to either the control group receiving a placebo or the intervention group receiving probiotics daily from booking in appointment (usually approx. 12 weeks gestation) until the Oral Glucose Tolerance Test (routinely done at 26-28 weeks gestation). Women. The primary outcome is incidence of GDM in the control and intervention groups..

The purpose of the study is to evaluate the feasibility of an evidence-based approach to improving physical activity (PA) and communication between cancer care clinicians (CCCs) and their patients. In addition, exploring a PA referral pathway from clinicians to exercise physiologists (EP). Who is it for? You may be eligible to participate in this study if you are 18 years or older and a Cancer care clinician-CCC (e.g., oncologists, oncology nurses, and general practitioners) working at St. George Hospital in Sydney. You are also eligible for this study if you are a Cancer patient/survivor of the participating CCCs. Study details If you are a cancer care clinician, you will be involved in undertaking a 1-2 minute conversation about Physical activity and the important role it plays as part of the patient’s cancer treatment. Clinicians will refer patients to a an exercise physiologist (EP) and indicate that the EP would contact the patient directly to further discuss PA/exercise options and the formal referral process. Both participants and clinicians will be involved in providing feedback on the acceptability of PA discussion and referral process. This feedback will happen via an optional semi structured telephone interview lasting approximately 30-40 minutes. This research will provide knowledge for clinicians concerning exercise as part of cancer care and assist with the refinement of a PA/exercise communication and referral pathway approach to be utilised as a subsequent part of usual cancer care practice. This research will also benefit cancer patients/survivors as it will provide education concerning the importance of exercise throughout the cancer trajectory, as well as provide knowledge about resources to assist with undertaking exercise specific to cancer care.

The Austin hospital is introducing a critical care outreach consultant to oversee the assessment and management of patients outside the ICU at the acute campus This commenced April 20th 2020, and has now received permanent funding. The schedule for this role has been developed by ICU staff and has been approved by the Medical Director of the Department of Intensive Care, Austin Hospital. Patients will not be randomised as part of this new role, which will be considered as routine care. The role has been introduced to: 1. Improve the timeliness of referral and admission from the emergency department (ED) 2. Oversee the assessment and review of patients seen by the Medical Emergency Team MET) and Intensive Care nurse consultants (ICNC) 3. Coordinate referrals to the ICU from all sources (internal and external) 4. Assist with the stabilization and admission of unplanned ICU admissions in some circumstances The deteriorating patient committee is expecting the outcomes of this role to be audited as part of the PDSA (plan – do – study – act) cycle. The purpose of this audit is to outline the nature of the data that will be collected as part of this audit.

A variety of different treatments have been found to have similar levels of effectiveness for chronic low back pain (CLBP). Addressing postural abnormalities in both the lower back and the feet in the subpopulation of CLBP cases that also suffer from an un-level back due to fall of the arch in the foot on one side (FSL-UFHP) may prove to be a more effective treatment combination. Through this trial we take the first step in investigating this possibility. Methods: One hundred and thirty-eight adults with CLBP and FSL-UFHP to be recruited in Melbourne Australia and Madrid and Seville Spain. Forty six participants at each site to be randomized to: a) multimodal chiropractic treatment including spinal manipulation, or b) multimodal chiropractic treatment together with custom-made foot orthoses. Chiropractic visits to comprise of 12 treatments over 4 weeks. Outcome measures to include recruitment, CLBP-related disability (RMQ) and perceived LBP (NRS-11). Combining multimodal chiropractic treatment with orthoses to correct a functional short leg due to a fallen foot arch may be a promising therapeutic strategy in this subpopulation of CLBP patients, hence deserving rigorous methods of scientific investigation.