ANZCTR search results

This retrospective observational study will be conducted by the Department of anaesthesia. Total hip arthroplasty (THA) can result in a significant surgical stress, which in turn can trigger a hypercoagulable state. These patients are at significant risk for the development of thromboembolic complications. Despite venous thromboembolism (VTE) chemoprophylaxis being administered to all patients who undergo THA at Austin Health, VTE remains a common cause of preventable death and a well recognised complication after total THA. Despite combining extended VTE chemoprophylaxis with early mobilization, compression stockings and intermittent pneumatic compression devices, many patients at Austin Health who undergo THA remain at high risk for VTE because of advanced age, extensive surgical procedures, and greater medical comorbidities. Furthermore, a large multicenter study showed that most VTE’s occur due to prophylaxis failure rather than failure to provide prophylaxis. Although several agents have been shown to reduce the risk of thromboembolic disease, there is no clear preference for thromboembolic chemoprophylaxis for patients undergoing elective total hip arthroplasty. Thromboelastography (TEG) measures whole blood coagulation and fibrinolysis providing a global view of the interaction between all components of clot formation, retraction and lysis. TEG is one of the most sensitive methods currently available for the assessment of a perioperative hypercoagulable state with numerous reports in surgical patients demonstrating an association between TEG measured variables, anaesthetic techniques, and postoperative thrombotic events. Studies have demonstrated that major joint arthroplasty is associated with activation of coagulation (hypercoagulable state) as measured by TEG, however there have been few comparisons of the effects of general and regional anaesthesia techniques on coagulation. Therefore, we propose to perform a retrospective audit of patients who underwent THA at Austin Health, who received a TEG as part of routine care. The primary aims of this retrospective review are to determine if VTE chemoprophylaxis with low molecular weight heparin prevents hypercoagulability after THA (as assessed by TEG) and if general or spinal anaesthesia had similar effects on perioperative coagulability as measured by TEG. Notably, there will be NO CLINICAL or patient contact at any point. All data collected has already been collected as part of routine clinical care according to standard anaesthesia and surgical processes. No new data will be collected.

The project aims to investigate the longitudinal trajectory of ventilation-perfusion mismatch measured using the Lockwood method in preterm infants less than 32 weeks of age at the end of first week, first month and 36 weeks postmenstrual age. This will be novel non-invasive data which may help to identify those infants at risk of developing bronchopulmonary dysplasia.

We aim to utilise a novel method for non-invasively estimating the ventilation-perfusion mismatch, a measure of the severity of lung disease of preterm babies with respiratory distress syndrome. The Lockwood algorithm uses routinely measure oxygen saturation levels paired with the amount of oxygen needed in order to calculate how much the oxygen dissociation curve has been "shifted" to provide a measure of the right-left shunt. This study aims to use measures of oxygen levels before and after surfactant treatment and the corresponding ventilation-perfusion levels in order to gauge response of the infant's lungs to surfactant treatment. The hypothesis is that the Lockwood measure will provide robust measure of ventilation-perfusion status in preterm infants with respiratory distress,

Vagal nerve stimulation is a noninvasive tool to improve mental health. vagal nerve stimulation uses a device that is attached either to the ear or held at the neck that emits a very low electrical pulse, which stimulates the nerve. Participants use this in the clinic for up to 30 minutes to improve physical and mental health.The study aims to compare a four week trial using VNS to treatment as usual using traditional biofeedback. The hypothesis is that vagal stimulation has a similar outcome to treatment as usual but requires less active participation by the patient

Exercise training is recommended for people with interstitial lung disease (ILD), to improve their exercise capacity, symptoms and quality of life. However, our group recently found that people who have ILD that is related to their underlying connective tissue disease showed less improvement in physical function and fatigue compared to other types of ILD. People with connective tissue disease often experience muscle and joint pain and weakness and this may make the standard gym-based approach difficult and painful. Water-based exercise uses warm water to relieve pain and the water's buoyancy reduces the impact on joints. It has been shown to be effective in people with other chronic lung conditions such as chronic obstructive pulmonary disease and in patients with rheumatoid arthritis. No previous studies have examined the benefits of water-based exercise in people with CTD-ILD. This study will establish whether water-based exercise is viable and beneficial in CTD-ILD and whether it can improve their breathing symptoms and physical function.

The purpose of this study is to evaluate the safety and clinical effectiveness of the Intralink medical device when treating low back pain due to Degenerative Disc Disease in adults. Degenerative disc disease in the lower back refers to a syndrome in which a compromised or damaged disc causes low back pain with or without pain radiating to the leg. Intralink is an injectable soluble polymeric material that is considered as a medical device. Intralink covalently bonds with the collagen in the spinal disc tissue to structurally strengthen the degraded disc and stabilize the spinal joint. These tissue strengthening and joint stabilizing effects, if they occur to the extent intended, may reduce the amount of back pain that the study participant experiences. Intralink contains a substance called Genipin that forms a mesh of load-sharing polymers that bond to the collagen matrix in load supporting tissues. Genipin is made from purified plant sources (Gardenia fruit) and is dissolved in a special buffer liquid prior to being injected into the spinal disc using image-guided injection techniques. A special dye called a contrast agent that is not part of Intralink is also added to Intralink before it is injected so that what is being injected can be seen by the physician doing the injection. There are two primary hypotheses being tested in this study. The first hypothesis involves the safety of the device and its image-guided delivery to the study participant. It is hypothesized that Intralink can be safely applied to degenerated intervertebral discs as evidenced by a clinically acceptable prevalence of Serious Adverse Events reported at 1 month post-procedure. The second primary hypothesis involves the clinical effectiveness of the device. It is hypothesized that the clinical success rate at 3 months after the Intralink implantation procedure will be greater than or equal to 50%. Clinical success is defined as successful injection delivery of Intralink to the targeted disc without the occurrence of serious adverse events with a significant reduction of pain and disability using standard assessment metrics. Objective imaging data will also be used to validate reduction of pain post-treatment. A maximum of 50 participants will be enrolled in this clinical study at 2-5 clinical centers. Safety and clinical effectiveness assessments will be carried out through 12 months post-implantation procedure.

An Open-label Study of Probiotic and Hen’s Egg or Cow’s Milk Oral Immunotherapy. This study is looking at the tolerability of the RUSH (rapid updosing schedule) and build up schedules.

Hormones released from the intestines help minimise the rise in blood glucose after meals. The role of one of these hormones, glucose-dependent insulinotropic polypeptide (GIP), has not been fully understood for lack of suitable tools to investigate its actions in humans. People with type 2 diabetes (T2DM) appear to be unresponsive to GIP, but recent evidence suggests this can be reversed when blood glucose is well controlled. We have now developed a tool – the GIP receptor antagonist, GIP(3-30)NH2 – which is suitable for use in humans, to examine the physiological actions of GIP. We will use this compound to understand how the contribution of GIP to blood glucose control improves in patients who achieve excellent blood glucose control (i.e. HbA1c within the therapeutic target of 7%).

The number of children who are overweight or obese continues to grow in Australia. These children risk getting heart disease and diabetes in their teens or as adults. The main ways for preventing these health problems in children are by modifying diet and exercise. Most individuals working in the healthcare system are for this reason focussed on increasing children’s physical activity levels. While physical activity and fitness are related, they are distinct, wherein physical activity focuses on increasing steps and movement while an increase in fitness also includes a purposeful improvement in the number of steps and movements taken. This program is specifically interested in learning about the importance of improving fitness, not just increasing activity, for preventing heart disease and diabetes in children who are overweight or obese.

The CHEER 3 Trial is a treatment strategy aimed at providing hope for patients who are otherwise very likely to die. In patients who suffer cardiac arrest, a range of interventions such as CPR, defibrillation and injection of drugs are provided at the scene by paramedics to attempt to restart the heart. If paramedics are unsuccessful, there is very little hope of recovery and the patient is usually declared deceased at scene. Transport to hospital with CPR may be attempted but previous research indicates this is usually unsuccessful due to the time taken to arrive at hospital for further treatments. This trial will evaluate an alternative approach involving doctors from The Alfred Hospital being transported to the scene and placing the patient on a heart-lung machine called ECMO. Once stabilised on ECMO, the patient will then be taken to the Alfred Hospital for further investigations and treatment.