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Patients with liver cirrhosis are at risk of having varices (dilated vessels) in their oesophagus and stomach. These varices can bleed and bleeding is associated with serious complications. It is recommended that all patients have their oesophagus examined with an endoscopy (flexible telescope / camera) to detect these varices. Currently these endoscopies are performed in the Gastrointestinal Investigation Unit using sedation (medication to make you drowsy). The purpose of this study is to evaluate the feasibility of performing this procedure in the outpatient clinic, using a new endoscope. The newer scope is very thin, disposable and can be used in a consultation room. The thinness of the scope allows the examination to be performed without sedation, using only local anaesthesia with lignocaine gargle or spray. The scope has already been shown to be as effective in the detection of large varices as standard endoscopy; this study aims to assess the viability of its use in the outpatient setting.

The search for an effective treatment for COVID-19 is underway around the world. A trial of nebulised heparin is warranted. A recent (not yet published; still under journal review) pre-pandemic double-blind multi-centre randomised study of 256 mechanically ventilated patients with or at risk of developing the Acute Respiratory Distress Syndrome (ARDS) of which 47% had ARDS, led by our group, found important pre-specified secondary outcomes were significantly improved with nebulised heparin. There was no evidence of harm. COVID-19 is associated with the development of ARDS displaying the typical features of diffuse alveolar damage with extensive pulmonary coagulation activation resulting in fibrin deposition in the microvasculature and formation of hyaline membranes in the air sacs. The anticoagulant actions of nebulised heparin limit fibrin deposition. Serendipitously, unfractionated heparin also inactivates the SARS-CoV-2 virus and prevents its entry into mammalian cells. Nebulisation of heparin may therefore limit fibrin-mediated lung injury and inhibit pulmonary infection by SARS-CoV-2. For these reasons we believe a trial of nebulised heparin in patients with COVID-19 is warranted. Our hypothesis is that nebulised heparin will reduce the time to separation from invasive ventilation at Day 28. Nebulised heparin sodium 25,000 Units, will be administered 6-hourly with a vibrating mesh nebuliser while patients are receiving invasive mechanical ventilation up to Day 10. The dose and methodology of nebulisation were established in previous clinical trials by our group. The intervention is given in addition to standard care.

Many patients undergo emergency intubations, also called Rapid Sequence Intubations (RSI), where a breathing tube is placed into their windpipe to provide oxygen to their lungs, both in hospital and at the roadside. To place a breathing tube requires the muscles of the voice box to be paralysed. Which drug and dose is best for this paralysis has undergone much debate and many studies. Rocuronium manufacturers suggest 1mg/kg will suffice to paralyse patients for RSI and this has become current anaesthetic and emergency department standard practice. Studies reveal 1mg/kg Rocuronium paralysis at 60seconds to be ‘adequate’ rather than ‘excellent’ however, as judged by those doing the intubations. Mathematical calculations based on patient data revealed that a dose of 1.8 – 2.3 mg/kg Rocuronium may be needed to achieve ‘excellent’ intubating conditions at 60 seconds in at least 90-95% of people. This study will ask how quickly 2mg/kg Rocuronium works compared to 1mg/kg and if that is better for Rapid Sequence Intubations. The time taken for paralysis effect in muscles can be measured in seconds, and anaesthetists can rate the quality of intubating conditions at 60s. If Rocuronium 2mg/kg proves to be reasonably faster and more effective than 1mg/kg, then this information could change the dose of Rocuronium given not only at prehospital emergency intubations but also in any operating theatre or intensive care unit when speed of action matters.

Sepsis and other inflammatory syndromes commonly result in acute kidney Injury requiring renal replacement therapy (RRT) in intensive care and this is associated with high patient mortality. Failure of the RRT circuit leads to lack of treatment time, blood loss and increased costs (both financial and care giver time). The oXiris membrane is a recent development in haemofilter membrane technology that advances on the membrane currently in use. It is treated to allow increased adsorption of endotoxin (produced by bacteria and contributing to the sepsis process) and cytokines associated with septic shock and the membrane is heparin-bonded which may reduce the risk of circuit failure. The oXiris membrane is easily integrated with existing clinical care and this multicentre randomised controlled trial will identify if it has a physiological effect on the shock state or requirement of vasoactive support, as well as any impact on treatment adequacy (by increasing circuit life). Additionally, there is the prospect of new information about possible effects on the proteins and metabolites produced in septic shock during RRT, providing an opportunity for detection of future biomarkers or treatment targets.

This study aims to provide proof of concept support for prevalence of aspiration and association with more frequent severe acute exacerbations in chronic obstructive pulmonary disease.

Novel coronavirus infection, named COVID-19 by the WHO in early February has reached pandemic scale and now been diagnosed worldwide. Currently over 450k infections and 20k deaths have been reported, with these numbers increasing rapidly. While international vaccine research is being accelerated there are no treatments currently recognised for use in COVID-19. International experience to date has indicated the children are relatively spared from the severe disease seen in adults, with few children around the world requiring invasive ventilatory support. The mechanisms behind this different expression of disease severity is the subject of ongoing studies. While children do not experience severe disease, they are thought to acquire SARS-CoV2 infections and remain relatively well or completely asymptomatic. In addition, the symptoms expressed by many children are similar to other childhood viral infections such as Respiratory Syncytial Virus (RSV) or Influenza. This lack of defining symptoms makes testing criteria and criteria for self-isolation difficult to apply to the paediatric population. In addition, this lack of symptoms makes it more likely for children to remain at school or in the community and potentially spread the SARS CoV2 infection to others with whom they are in contact. This study aims to quantify the presence of infection in children presenting to a metropolitan children’s emergency department and admitted to a children’s inpatient ward. This information can be used by governments and health authorities to inform policy around social distancing, self-isolation and testing criteria in this population. This is a repeating point prevalence study, sampling children presenting to the emergency department (ED) or admitted as an inpatient to the hospital on pre-defined days. Sampling will occur on a weekly basis, preferably on the same day each week although this may be varied for operational reasons. Screening for the inpatient ward and ED may occur on separate days to limit strain on limited nursing resources during this period. Children who present or are admitted to hospital with known SARS-CoV2 infection will be included in the study, however repeat testing is not performed on these children. For children who are admitted to hospital who have previously tested negative for SARS-CoV2 infection, repeat testing will only be performed if more than 72 hours have elapsed since the last swab collection

We hypothesise that an advanced bipolar energy device, such as the LigaSure Retractable L-Hook, is superior to advanced ultrasonic energy device, such as the Harmonic Ace +7, and therefore may result in shorter operating times, a reduction in blood loss and a reduced need for an additional haemostatic devices. This randomised controlled trial aims to compare surgical outcomes at total laparoscopic hysterectomy using two Therapeutic Goods Association (TGA) approved vessel sealing/dividing devices; the LigaSure Retractable L-Hook (Medtronic™) vs Harmonic ACE+7 (Ethicon™). The primary outcome is total operative time in minutes to complete a hysterectomy as defined from commencement of initial skin incision to commencement of final skin closure.

Title: Type1Screen: Diabetes autoantibody screening to identify individuals at risk for type 1 diabetes Objectives: 1) To identify individuals who have diabetes autoantibodies 2) To support antibody-positive individuals through a national network of diabetes centres and to perform metabolic testing to determine their risk of developing type 1 diabetes

The purpose of this study was to discover better ways to care for the psychological wellbeing of mothers, particularly in supporting mothers to cope with difficult thoughts and feelings about their childbirth and early feeding experiences. Participation in the study involved the completion of an online survey asking questions about your own coping, childbirth, and feeding experiences. After completing this survey, participants had a 50/50 chance of being given immediate access to a brief information package intended to support their wellbeing. The package included information on self-compassion, a compassion exercise, a tip sheet, and SMS reminders. Participants were randomised (like the flip of a coin) to either receive this information package straight away or after an 8-week waiting period. This allowed us to identify whether or not the package was helpful to mothers who use it. We anticipated that those who received access to the online self-compassion intervention would report greater wellbeing in a number of areas at an 8-week follow-up period.

This study will examine the characteristics of lung cancer patients admitted to intensive care and their outcomes at 3 month post-intensive care discharge Who is it for? This is a retrospective study of adult patients 18 years or older with lung cancer who were admitted to the intensive care unit at the Sunshine Coast University Hospital with a critical illness Study details: It is intended to collect data on patient demographics (age, sex, smoking status, performance status etc.), malignancy characteristics (type of lung cancer, molecular profile, staging etc.), and patient outcomes (survival to ICU and hospital discharge, 30- and 90-day survival, anti-cancer treatment received within 90 days of ICU discharge, etc.). Patients admitted to the ICU between 01/01/2018 and 01/01/2020 will be screened for those with a diagnosis of lung cancer (pre-existing or diagnosed [suspected or confirmed] during ICU admission). These patient’s charts will then be reviewed by a Queensland Health employee to extract the relevant data. The data will then be analysed to look at relationships between patient and malignancy details and patient outcomes. This study hopes to clarify the role intensive care plays in the treatment of lung cancer patients and to help better identify those patients who will benefit from treatment in Australian intensive care units.