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Evaluation of the Implementation of a Delirium Education Intervention using Clinical Simulation in a Private Healthcare Setting
This study will be a clustered randomised control trial comparing a multi-modal delirium education intervention to traditional didactic education on translating delirium knowledge into clinical practice. The study will be conducted across three private hospital sites, with inpatient medical and surgical wards randomised into the intervention or control group. All participants will be invited to complete a survey at two time points, (i) immediately prior to the intervention and (ii) 6 weeks post intervention. The surveys consist of four questions asking the participants to rate their self- perceived confidence and competence on delirium assessment and knowledge using a 5-point Likert scale. The surveys also consist of a 20 questions delirium knowledge quiz. Six weeks post intervention participants will be observed in clinical practice undertaking a delirium assessment.
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Shared Medical Appointments for Type 2 Diabetes
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The impact of continuous terlipressin infusion on complications of end-stage liver disease
End-stage liver disease, known as cirrhosis, is a common condition in Western society, and is associated with poor prognosis. Cirrhosis can lead to many complications, including fluid retention, kidney impairment and increased risk of infection. Many patients with cirrhosis are malnourished and also develop muscle wasting. Terlipressin is a medication used in the management of severe bleeding and some forms of kidney impairment associated with liver disease, but little is known about its impact on other complications of liver disease such as muscle wasting, fluid retention or infection. Early data from our centre suggests that terlipressin can also improve nutrition in this population. This study will attempt to confirm that long-term terlipressin can improve nutrition and muscle mass in patients with end-stage liver disease as well as understanding the mechanisms by which this occurs. It will also look at whether it improves other complications such as ascites (fluid retention in the abdominal cavity), infection, hospital admissions and healthcare costs. Participants will undertake 2 study periods: an observation period and a treatment period, where they will receive a continuous infusion of terlipressin for 12 weeks which will be administered via the Hospital-in-the-Home program. They will undergo assessment of muscle strength and function using radiology scans and bedside tests, as well as monthly blood tests during both study periods. Hospital records will be accessed to identify causes of hospital admission and estimates of infection rates and to calculate direct healthcare costs. Quality of life will be assessed using validated questionnaires. In total, the participants will be involved in the study for a period of 6 months.
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Accelerating ventilator weaning in spinal cord injury with non-invasive Abdominal Stimulation
A spinal cord injury is a devastating event, with approximately 350 new cases in Australia every year. Each injury has a lifetime cost of >$5m. More than half of these injuries will be caused by an injury to the cervical (neck) area of the spinal cord, termed tetraplegia. While tetraplegia is commonly associated with paralysis of all four limbs, paralysis also affects the major respiratory muscles, namely the diaphragm, abdominal and intercostal muscles. This reduces respiratory function, with associated complications a leading cause of illness and death for people with tetraplegia. Poor respiratory function leads to approximately 40% of people with tetraplegia requiring mechanical ventilation in the early stage of injury. This increases the likelihood of illness and death, delays rehabilitation and hospital discharge and costs an additional $2,000 per patient per day. The application of electrical pulses to the abdominal muscles, called Abdominal Functional Electrical Stimulation (Abdominal FES) improves respiratory function in tetraplegia. We have shown that Abdominal FES is a feasible technique to assist ventilator weaning for this group. Despite these positive results, a lack of data from large trials has prevented Abdominal FES being adopted as a standard treatment. We propose an international randomised controlled trial to assess whether Abdominal FES reduces mechanical ventilation duration in people with tetraplegia. Such a reduction has the potential to improve the health and rehabilitation prospects of people with tetraplegia globally, and result in a significant cost saving for health care providers. The final outcome of this project will be the development of an Abdominal FES treatment program, facilitating the successful translation of this research into worldwide clinical practice.
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Does a single dose of steroid improve the time to resolution of cellulitis (skin infection) in adults when given with standard antibiotic treatment
The use of steroids in combination with antibiotics for cellulitis may reduce symptoms, such as swelling, warmth, pain and redness for patients and time to resolution of the infection. For the Emergency Department (ED) this may mean a reduction in admissions into hospital/observation unit, the use of secondary antibiotics, and re-presentation to the ED. The study is designed as a double-blind placebo-controlled study with the use of a single dose of 50mg prednisolone or a single dose of placebo alongside standard care of antibiotics on first presentation of cellulitis to the ED. Measurement of time to resolution of symptoms will be obtained by telephone follow up at day 3 and 7, also at day 14 if infection has not resolved. Electronic medical records will be checked at day 28 to see if the participant re-presented to ED. There is a suggestion from limited previous research that courses of steroids in cellulitis alongside standard care (antibiotics) have reduced hospital stays. This study will focus on patients discharged from ED with oral antibiotics. Primarily, comparisons will be made between the two groups (steroid vs placebo) to determine if there is a statistically significant difference in time to resolution and patient’s perceived symptoms. The secondary objective will be to compare rates of re-presentation to the ED
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A study examining the effects of empagliflozin (Jardiance®), a tablet for treatment of diabetes on autonomic nervous system and heart function in patients with type 2 diabetes.
The overall aims are to assess changes in cardiac function and sympathetic nervous system activity at rest and during exercise with empagliflozin in patients with type 2 diabetes without established heart disease. We hypothesised that: - 3 months treatment with empagliflozin will be associated with a measurable improvement in exercise capacity as reflected by peak oxygen consumption during maximal exercise (VO2peak) in addition to key physiological variables during exercise (heart rate reserve, blood pressure and ventilatory efficiency) in type 2 diabetes subjects without overt clinical heart failure. - Empagliflozin is associated with changes in sympathetic nervous system activity that may cause changes in cardiovascular function.
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Non-operative management of TFCC injury; a randomised, control trial investigating hand therapy, wrist splint and cortisone injection for triangular fibrocartilage complex injuries in the wrist
This study aims to determine the effectiveness and clinical outcomes of non-operative treatments offered to patients who have a triangular fibrocartilage complex (TFCC) injuries. Injury to the triangular fibrocartilage complex has been observed as a common cause of both short and long-term wrist pain, loss of wrist function and impact on quality of life. Currently, it is common practice for health care providers to initially recommend non-surgical or “conservative treatments” for patients. Treatments can include immobilising the wrist using a splint to relieve pain; injection of corticosteroid to reduce inflammation and provide pain relief; and hand therapy exercises to help manage pain and improve function. This study will investigate whether splint immobilisation, corticosteroid injection or a combination of the two, contribute to the efficacy of hand therapy, in relieving symptoms and improving function in patients with TFCC tears. Adults presenting with a MRI confirmed TFCC tear, between 6 weeks and 12 months from primary injury will be invited to participate in the research study. Participants will be randomly allocated to one of four groups: Group A: will receive hand therapy Group B: will receive a thermoplastic, volar wrist splint + hand therapy Group C: will receive a corticosteroid injection to the wrist + hand therapy Group D: will receive a wrist splint + corticosteroid injection + hand therapy. Participants will be asked to complete an electronic survey consisting questions specific to wrist pain and function. The survey will be completed in-person before treatment and at 6 weeks and 12 weeks after intervention commencement. The investigation will be conducted at the Brisbane Hand and Upper Limb Research Institute at the Brisbane Private Hospital.
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Caffeine and anaerobic exercise performance: an exploration of caffeine’s effects on performance in young men and the influence of genotype on the variation in responses
The aim of the study will be to investigate the effects of caffeine (3 mg/kg 60 min pre-exercise) on vertical jump performance, movement velocity in resistance exercise, muscular endurance, and power output. Additionally, the aim is to explore if the inter-individual variation in responses to caffeine ingestion influenced by variations in genotype. The study hypothesis is that individuals classified as AA genotype will experience greater improvements in exercise performance following caffeine ingestion than those with AC and CC genotypes.
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Evaluation of intra-venous mesenchymal stem cells for the treatment of small joint osteoarthritis
This is a proof of concept pilot study to evaluate the safety and tolerability of autologous adipose-derived mesenchymal stem cells (ADMSC) administered intravenously for the treatment of small joint osteoarthritis. A secondary objective will be to assess efficacy with pain and functional assessment over a 12month follow-up period.
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The effect of a cannabidiol (medicinal cannabis) toothpaste and mouthwash on gingivitis
The purpose of this trial is to assess whether combination toothpaste and mouthwash containing cannabidiol (CBD) can improve symptoms of Gingivitis compared to placebo. This is a double-blind, placebo-controlled, between-subject study design comprising of four visits in which gingivitis is assessed using the gum bleeding index (GBI; A screening visit, Baseline (Day 5), Day 10 and Day 35). Healthy participants will visit the dental clinic for initial assessment for suitability of inclusion in the study. If the participant is not excluded he/she will be assessed on the Gingivitis Bleeding Scale (GBI), instructed not to use dental hygiene (brushing teeth or using mouthwash) for 5 days and to return for their next visit (Baseline/Day 5). The participant will then be randomized to the trial and provided with treatment (CBD toothpaste/mouthwash or placebo toothpaste/mouthwash) which they will use for the next 30 days. On Days 10 (after 5 days of treatment) and Day 35 (after 30 days of treatment) they will return for another GBI assessment. The study duration is 35 days (from screening visit to 30-day follow-up visit). Treatment (brushing teeth and using mouthwash) will occur three times a day for 30 days in total.