ANZCTR search results

Disturbances of sleep occur frequently in the critically ill. Much less is known as to whether sleep disturbance is acute and resolves as patients recover, or is an issue that persists after hospital discharge and continues to adversely affect patients. Studies using patient subjective assessment suggest that sleep disturbances persist. However, only 28 patients in total (3 studies) have used objective measures (e.g. polysomnography) in ICU survivors to measure sleep, and in none of these three studies were measurements taken in ICU or hospital. This study will provide novel data as it will be the first comprehensive and objective longitudinal assessment of sleep disturbances in patients admitted to ICU. This inception cohort study will determine feasibility of objectively and subjectively measuring sleep, provide estimates of the proportion of long-stay ICU patients who have a new sleep disorder and evaluate whether sleep changes over time during critical illness and recovery.

This project is designed to determine if specific genetic sub-groups associated with metabolic disease risk benefit from a Mediterranean diet. This research may lead to personalised nutrition recommendations using genomic information to promote health. The aims of the proposed project are to: (i) Determine the influence of an 8-week Mediterranean dietary intervention on gut bacteria, levels of metabolites (involved in glucose, fat and protein metabolism) present in blood, and gene modifiers (whether genes are turned on or off) in blood. This will be compared to a person’s habitual diet (baseline results) and a general healthy eating diet following The Australian Guide to Healthy Eating (control diet). (ii) Determine the potential of key genetic variants related to metabolic disease (including the Fat Mass and Obesity-Associated (FTO) gene, Transcription Factor 7-Like 2 (TCF7L2) gene, and Apolipoprotein E (APOE) gene) to influence gut bacteria, blood metabolite and gene modifying outcomes in response to the dietary interventions. (iii) Determine whether differences between genetic variants exist for body composition, key hormones (ghrelin and insulin), glucose tolerance, and dietary intake (food frequency and nutrient composition) in response to the dietary interventions. It is hypothesized that variations in key genes associated with metabolic disease impacts on gut bacteria, blood metabolites and gene modifiers following an 8-week Mediterranean dietary intervention.

Acute adenoviral conjunctivitis is a highly contagious, widespread endemic disease associated with frequent outbreaks, significant patient discomfort, lost productivity, and in some cases permanent visual compromise from long-term immune mediated sequelae. OKG-0301 is a novel ophthalmic solution with a potent ribonuclease that has broad-spectrum antiviral properties relevant for the treatment of acute adenoviral conjunctivitis. This randomized, double masked, multi-center Phase 2 study is being conducted entirely within Australia and is designed to support the safety and efficacy of OKG-0301 for the treatment of acute adenoviral conjunctivitis. The study intends to show superiority of OKG-0301 Ophthalmic Solution compared to vehicle for the primary efficacy endpoint of mean change from baseline in viral titre in patients with acute adenoviral conjunctivitis. Secondary efficacy endpoints including adenoviral eradication, clinical cure of acute adenoviral conjunctivitis, subepithelial infiltrates, other clinical signs and symptoms, and rate of cross-over infection to the other eye will also be assessed. Safety will also be evaluated.

Although impaired cardiac function initiates the syndrome, subsequent skeletal muscle and vascular abnormalities are major determinant of functional capacity and quality of life in the heart failure (HF) syndrome. Exercise based rehabilitation is a cornerstone of HF therapy. Improvements in functional capacity resulting from exercise training predict prognosis, enhance quality of life, and reduces frailty and hospitalizations. An impediment to exercise rehabilitation for heart failure patients is the early physical deconditioning which is a trademark characteristic of this patient group which can limit classical aerobic and concentric strengthening exercise prescription. The current project aims to trial a new form of exercise, utilising eccentric muscular contractions, which have unique characteristics that allows for peripheral (muscular) gains at lower oxygen consumption and promisingly suggests enhanced functional benefits at lower cardiovascular risk.

This study aims to conduct a single-blind randomised controlled trial to evaluate health outcomes of the Virgin Pulse Global Challenge (VPGC) programme across several Australian organisations. A comparison of the VPGC programme with a control treatment in terms of physical activity, sleep, psychological well-being, cognition and overall health outcomes will be assessed. It is hypothesised that the VPGC will improve both physical and mental health of participants. The project will contribute to filling a gap in the literature (rigorous evaluation of the health benefits of programmes similar to the VPGC and the development of a heart age measure that quickly responds to behavioural change) while providing Virgin Pulse with tools, insights, models and recommendations for improving the Global Challenge programme.

Physician-performed focused cardiac ultrasound (FCU) is established in anaesthesia and critical practice and is increasingly taught in undergraduate medicine curricula. The most important barrier to adoption, reported by Conlin (Conlin et al., Anesth Analg 2017;125:1878–82) was lack of training opportunity, and identifies a strong need for a scalable teaching process that provides acceptable learning outcomes The traditional training model for FCU is a combination of didactic learning followed by proctored practical teaching of ultrasound image acquisition with FCU trainers (eg. iHeartScan, University of Melbourne), who are in short supply. Reliability on trainers restricts training to participants who can access the limited number of courses. Ultrasound simulators are increasingly adopted by medical institutions to teach FCU. We have developed an FCU course that reduces the requirement for trainers from one and a half days to only three hours (FCU TTE Course) using a cloud-based platform that provides eLearning of knowledge base and instruction to participants on their personal device on how to teach themselves image acquisition using an ultrasound simulator. We have demonstrated that the simulator course was more effective in teaching FCU image acquisition (Canty et al. J Crit Care 2019;49:38–44). This reduction in trainer time required to teach FCU increases the capacity for training FCU, however is still significantly restricted by the 3-hour proctored session. We have recently eliminated the requirement for trainers by replacing the 3-hour proctored learning session with an eLearning package and on-line automated assessment. The aim of this study is to determine whether the learning of image acquisition skills by medical students who complete the self-directed simulator course is non-inferior to students not exposed to the course, and to determine if the learning of cardiovascular clinical examination of patients with cardiac disease is improved. Justification and expected benefits There is increasing demand for FCU training and for this to begin in medical school. An entirely self-directed FCU teaching course that also course improves the learning of cardiovascular clinical examination would be a significant step to answering this demand.

Project summary - This project is a pilot study to examine whether the difference in psychosocial and physical measures are associated with gaze behaviour in individuals with OA and their younger healthier counterparts. The purpose of this research is to examine motor, cognitive and perceptual behaviours in individuals with OA; and, investigate whether the manifestation of these behaviours are associated with an increased risk of previous or future falls. Hypothesis - The hypothesis of this project is that individuals with osteoarthritis will demonstrate compromised gait patterns, adverse gaze behaviour and poorer walking automaticity (normally found in healthy adults). The adverse gait patterns, gaze behaviour and inability to complete dual tasks while walking is also hypothesized to be linked with greater falls prevalence.

The primary goal of the Return to Work study is to help supervisors to better support their injured or ill workers so that these workers can achieve sustainable return to work (RTW). Previous research has found that improved supervisor and employee relationships could assist in sustainable RTW. However, supervisors may be unsure about how to best support the employee, or they may get busy or overwhelmed. The study's main hypothesis is that addressing supervisors’ cognitive overload, decision fatigue and availability bias through behavioural interventions may improve worker-supervisor relationships and consequently improve sustainable return to work rates. This study will evaluate the effect of materials package for supervisors to assist them in supporting their injured or ill workers during their absence and through the various stages of the return to work process. The outcomes examined in this study include the RTW rate, supervisor confidence and behaviours in supporting their employees, employee's perceived level of support from their supervisor and perceived usefulness of intervention materials.

Case-based learning (CBL) is widely used in health professional education (Thistlewaite, 2015) about which they engage in problem solving, practical skills development, and independent study. Currently, ‘cases’ or ‘scenarios’ are typically presented in class, using a ‘pen and paper’ format, with learning assessed through written and oral exams, but whether this is the most engaging or effective approach to develop students’ theoretical or professional reasoning is unknown. In comparison, integrating Science and Practice (iSAP) is an online CBL framework that incorporates elements of learning through practice, collaboration and discussion by presenting students with multimedia case studies that simulate real-world practice issues reflective of their future roles as health professionals (Williams, Schliphake, Heinrich & Baird, 2017). This study to compare students’ learning outcomes, clinical reflection and reasoning skills, students’ experience with learning and costs associated with delivering iSAP and CBL/SBL. We aim to evaluate learning outcomes and clinical reflection and reasoning skills using standardised outcomes, academic assessments and surveys. We will use survey with open ended questions and focus groups to explore students’ experience. We hypothesise that students who complete iSAP will achieve equal or better learning outcomes compare to CBL/SBL.

Advancing age is synonymous with physiological changes that contribute to loss of muscle mass and weakness (sarcopenia), gut function, integrity and overall health. Dietary intake often reduces in the elderly, which is a result of reduced satiety, altered oral health (decreased saliva production, dental loss), sensory changes etc. These factors lead to altered structure, amounts and type of fibre reaching the large bowel and therefore contributes to changes in the composition and metabolic activity of the gut microbiota, resulting in a less diverse microbiome with fewer commensal bacteria and an unfavourable metabolic environment. Several in vitro and animal studies have demonstrated a relationship between the gut microbiome and muscle physiology or vice versa. Putative molecular pathways include amino acids (e.g. tryptophan and its metabolites), pro-inflammatory cytokines composition and function linked to microbiome and pathogen-associated molecular patterns (PAMPS) such as lipopolysaccharide, flagellins, peptidoglycan etc. Supporting unpublished preclinical evidence using germ free (GF) animal models has now identified a gut microbiome-skeletal muscle axis which regulates muscle growth The mice conventionalized with exercised young adult microbiota showed significantly increased muscle function. These findings are of paramount importance as it establishes microbial regulation of muscle mass and its functions, which may hold true in humans as well. These findings strongly support the possibility of microbial manipulation to enhance host muscle function. Several recent human clinical trials have found that exercise significantly impacts upon host microbiome structure and function. Aim: To conduct a pilot study to develop an integrated framework for elucidating a deeper understanding of the relationship between gut health, body composition and cognitive function in free-living sedentary and active elderly populations to optimise personalised lifestyle interventions in Singapore and Australia. Objectives: To establish a framework and commence the establishment of a reference baseline of functional microbiome and metabolic profiles among active and sedentary elderly in Singapore and Australia. To establish a framework and commence comparative phenotyping of the brain, liver, muscle and bone using advanced imaging technologies in active and sedentary elderly in Singapore and Australia. Hypotheses H0: Participants from the active group will not have significantly higher gut microbial diversity than participants from the sedentary group and this will not lead to systemic health benefits. H1: Participants from the active group will have significantly higher gut microbial diversity than participants from the sedentary group and this will lead to systemic health benefits.