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Each year, approximately 24,000 infants are born prematurely in Australia, with approximately 3,500 of these infants residing in regional and remote locations. Research has identified that infants born prematurely are more likely to experience developmental delay and disability compared to their term born peers. The evidence for early intervention to improve motor and cognitive outcomes for preterm infants prior to preschool age is growing, however more research is needed to understand the most effective dosage, timing and content of such therapy. Even less understood is the impact of early intervention for preterm infants on their participation. The aim of the new PreEMPT Physiotherapy Program is to enhance Standard Physiotherapy Care in the first four months post term corrected age via 3 key aspects: - Participation-focused: PreEMPT has been designed to put the focus on participation of the infant within the context of their family. Life situations important to the family will be identified by the family at the start of each PreEMPT session, and will be used as a starting point to drill down to the sensorimotor capabilities needed to participate in these identified life situations. - Enablement-model - PreEMPT focuses on an enablement model with parents/care-givers to facilitate goal-setting and take a solution-focused approach to supporting their infant’s development in the context of their unique family circumstances. - Mix service delivery model of face to face and telehealth: Telehealth has been used across a variety of adult and paediatric populations to support the health and rehabilitation of those who reside in regional and remote areas, however there are no current studies published that incorporate telehealth-based physiotherapy services for preterm infants. Telehealth will be used to provide more regular opportunities for checking development, for progressing intervention, and for supporting parent enablement in the first 4 months post term age. 20 infants will be recruited. Following consent and baseline assessment at term corrected age, infants will be randomised to either Standard Physiotherapy Care (SPC) (n=10) or PreEMPT Physiotherapy (n=10). Infants randomised to SPC will receive 3 physiotherapy sessions consisting of general information regarding physical develop as is the current practice at Toowoomba Hospital. Infants randomised to the PreEMPT arm will receive alternating face to face (total = 7) and telehealth (total=7) weekly from 2 -15 weeks corrected age. The primary aim is to evaluate the feasibility and efficacy in improving motor performance of infants at 4 months corrected age. Secondary aims include exploring the relationship between motor performance and participation, evaluating the effectiveness of PreEMPT on an infant’s General Movements, and on an infant’s language, motor, and cognitive development and finally to evaluate the impact of PreEMPT on parental mental well-being and satisfaction.

The aim of this research is to evaluate the feasibility (e.g. acceptability, usage and ability to recruit and retain) of a brief (single use) online nutrition intervention for young adult (17-35 years) university students, and to estimate its preliminary efficacy in changing eating behaviours compared with control. Participants will be randomly allocated to the intervention (EATS: Eating Advice To Students) or attention control (Thrive online alcohol intervention) group. Participants in both groups will be asked to complete online questionnaires prior to completing the intervention or control program (baseline) and 3 months later (follow-up). Participants in the intervention group will also be asked to complete an additional online survey to assess the acceptability of EATS. Participant’s usage of the EATS website will also be tracked.

Background: Sepsis is one of the leading causes of death in hospital patients. The early administration of broad spectrum antimicrobials improves survival in sepsis. However, the use of these antimicrobials must be balanced with their unintended consequences, such as the development of antimicrobial resistance and adverse effects. Many patients receive prolonged courses of inappropriate antimicrobials in suspected sepsis. The established antimicrobial stewardship (AMS) team currently do a post-­prescription review of restricted antimicrobials and positive blood cultures. They do not routinely review treatment in sepsis, however they may have a role to promote the optimal use of antimicrobials in this setting. Aim: To determine the impact of AMS intervention in patients with medical emergency team (MET) calls for suspected sepsis Hypothesis: AMS intervention will improve appropriateness of antimicrobial therapy in suspected sepsis Participants: Patients with MET calls for suspected sepsis Method: Randomised controlled trial Control: Standard care (antimicrobials managed by the home team) Intervention: Standard care PLUS AMS review 48 hours post MET call Outcomes: Appropriateness of antimicrobial therapy at 72 hours post MET call

This study will will address the gaps in the literature by exploring the underlying neural correlates of an acute dose of caffeine using both an attentional network task and a flanker Go/NoGo task. Specifically, caffeine is expected to improve the alerting and executive control networks of attention, but not the orienting network. For the attentional network task, it is hypothesised there will be a reduction in reaction time and an increase brain activity (N1 amplitude) following alerting (central) but not orienting (spatial) cues after caffeine ingestion in comparison to placebo. For the flanker go/nogo task, it is hypothesised that Reaction Time and brain activity (N2 amplitude) will be greater for incongruent relative to congruent trials, and that this flanker interference effect would be reduced from pre- to post-ingestion for caffeine relative to placebo.

The use of Mepolizumab has demonstrated success in the management of eosinophilic asthma. Anecdotal experience with mepolizumab in a well defined group of chronic rhinosinusitis patients with eosinophilic inflammation has been very positive. This study assesses the effect of mepolizumab in nasal polyp eosinophilia, in particular, aiming to demonstrate the effect of mepolizumab treatment of respiratory mucosal eosinophilic inflammation at the tissue level, in addition to the serum eosinophil level. This study aims to assess factors that may contribute to treatment success and failure including tissue histopathology, serum/blood biomarkers including blood eosinophils, assessment of recorded endoscopy and patient reported clinical improvement based on patient reported outcome measures. This study would provide evidence of the direct tissue response to mepolizumab, provide a relationship between tissue and serum levels and might provide prognostic information to responders to therapy.

This study is designed to test the hypothesis that MAP application to the skin using a small number of healthy adult subjects with a well characterised influenza vaccine antigen (A/Singapore/GP1908/2015) results in comparable safety / local skin reaction to conventional intramuscular vaccination. This study represents the first time that polymer MAPs with an active vaccine will be applied to humans. Therefore, this study will assess both systemic and the local reaction to application of the A/Sing MAP delivering a 15 mcg HA intramuscular-equivalent dose with the application of three MAPs, in comparison to uncoated MAPs, intramuscular injection with Afluria Quadrivalent (delivering 15 mcg A/Sing HA) and intramuscular injection with 15 mcg A/Sing HA (as a monovalent antigen). The local skin response will be monitored for up to 60 days. On-site clinic assessments will be performed up to 2 hours post application and at 1, 3, 7, 21 and 60 days (if required) post application. Phone calls will be made at Day 36 and Day 50

The incision for major hepatobiliary surgery is across the right upper quadrant of the abdomen extending up the midline. Due to its size and position this incision can be very painful and affect normal breathing and mobilization. Inadequate control of pain can lead to impairment of ventilatory capacity with subsequent respiratory complications. Regional anaesthesia is often employed to improve pain control. It also has the benefit of reducing the requirement for opioids and therefore reducing opioid side effects, such as nausea, constipation and itch. Transversus abdominis plane (TAP) catheters have been found to be non-inferior to epidural anaesthesia for abdominal surgery. Current standard of practice at our institution is to place a TAP catheter and infuse a slow continuous infusion of local anaesthetic via a volumetric pump at a fixed rate. However, it is not known whether the most effective method of delivering local anaesthetic is via continuous infusion or intermittent bolus. Intermittent bolus has the presumed benefit of volume effect and further spread and therefore may provide better analgesia. We plan to compare timed intermittent boluses of regional anaesthesia (TIBRA) to a slow continuous infusion of local anaesthetic in terms of analgesic efficacy and opioid requirement. From January ’18, all eligible patients undergoing major hepatobiliary surgery will be identified in surgical clinic and invited to participate. The study is anticipated to run for 12 months. Participants will be randomised into either continuous or intermittent bolus group. The participants will not know which group they have been randomised to. Each day they will be visited by a member of the research team and asked to score their level of pain on a numerical rating scale. The total dose of other painkillers required will be documented, and they will be asked about any side effects they may have from these medications.

The primary purpose of this study is to evaluate the pharmacokinetic and pharmacodynamic outcomes with standard beta lactam antibiotics given to patients with febrile neutropenia as a result of intensive chemotherapy. Who is it for? You may be eligible to join this study if you are aged 18 or over, and have been prescribed a course of intensive chemotherapy for acute leukaemia or high-grade lymphoma. Study details This is an observational study, so all participants will undergo the standard care prescribed to them by their treating physician. To assess outcomes, blood samples will be taken at baseline, two samples approximately 24 hours after commencement of antibiotics and at onset of fever, and one urine sample will also be taken 24 hours after onset of fever. Additional information including length of antibiotic use and hospital stay will also be noted. It is hoped that the findings of this trial will aid understanding of the distribution and levels of this class of antibiotics in the body, and their impact on outcomes in patients with febrile neutropenia as a result of intensive chemotherapy.

Ovarian cancer is the second most common gynaecological malignancy and the most common cause of gynaecological cancer death in Australia. The majority of women are diagnosed with advanced disease, where standard treatment includes surgery followed by six cycles of adjuvant platinum-based chemotherapy. The purpose of this research project is to test how safe and effective the combination treatment of durvalumab and tremelimumab in combination with standard chemotherapy is as a treatment for patients with ovarian, fallopian tube or peritoneal cancers. Who is it for? You may be eligible to join this study if you are a female aged 18 years or older with a confirmed diagnosis of stage III or IV high grade serous ovarian, fallopian tube, or peritoneal carcinoma, and a life expectancy of at least 12 weeks. Study details Participants in this study will be randomly allocated (by chance) to one of two groups. Participants in one group will receive [18 weeks/6 cycles] of treatment with Carboplatin, paclitaxel combined with durvalumab and tremelimumab (Du-T-NACT) administered intravenously (i.e. directly into the vein). This will then be followed by maintenance therapy with Durvalumab (every 4 weeks) and Tremelimumab (every 12 weeks) for 36 weeks or until disease progression, unacceptable toxicity, withdrawal of consent, or another discontinuation criterion is met. Durvalumab and tremelimumab are new drugs which are designed to increase the body’s immune response. Participants in the other group will receive [18 weeks/6 cycles] of chemotherapy with Carboplatin and paclitaxel only, followed by an observation period, which involves 4 weekly CA-125 assessments. Participants in both groups may also undergo interval debulking surgery after 3 cycles of treatment, if suitable. All participants will be monitored regularly for up to 12 months post treatment in order to assess clinical response and treatment safety. It is hoped that that durvalumab and tremelimumab will stimulate the immune cells to be able to prevent or slow down cancer growth. The study aims to recruit 75 patients (50 patients to receive adjuvant treatment and 25 to receive neoadjuvant treatment at a 2:1 ratio), across 10 Australian sites over a 2 year recruitment period.

All-polyethylene (AP) tibial components in patients aged greater than 60 years have stable tibial migration patterns and favorable survival rates when compared to identical metal-backed (MB) designs. Tibial component fixation in patients aged less than 60 years was measured with radiostereometric analysis (RSA) and compared to a previous cohort of AP and MB tibial components of identical design in patients aged greater than 60 years. Methods A prospective consecutive study examined tibial component migration in 21 patients aged less than 60 years undergoing a cemented total knee arthroplasty with an AP tibial component by RSA to 24 months. Results were compared to the authors previous series of 21 patients aged greater than 60 years that were randomized to either an AP or MB tibial component. The articulating geometry and stem design of the implants were identical as were the operative technique and post-operative regime Results At 2-years both age groups of patients implanted with an all-polyethylene component had stable migration patterns with no patient having greater than 0.2 degree rotation or 0.5mm maximum total point motion. Five of 11 metal-backed tibial components displayed continued migration between 1 and 2 years. Median internal/external rotation was greater with MB components; 0.15, 0.08, 0.28, AP < 60 years, AP > 60 years, and MB cohorts. Subsidence significantly greater for MB implants; median subsidence 0.17, 0.10, 0.25, AP < 60 years, AP > 60 years, and MB cohorts. Median maximum total point motion was greater for the MB cohort 0.34, 0.33, 0.61mm, AP < 60 years, AP > 60 years, and MB cohorts Conclusions Young patients implanted with an all-polyethylene tibial component had stable tibial migration patterns comparable to older patients with the same all-polyethylene implant. Regardless of age, all-polyethylene tibial components were at least as stable as metal-backed tibial components. The study will continue until 10-years.