ANZCTR search results

Study of Progressive Resistance and INterval Training in coronary HEART disease (SPRINT HEART) is a 12-week, single blind, randomised controlled trial with a control group crossover. Participants will be randomised to either high intensity aerobic interval training (HIIT), high intensity resistance training (PRT) or usual medical care (control). The key aims of this investigation are to directly compare high-intensity aerobic and resistance training in terms of relevant physiological adaptations, fitness, safety and feasibility in a cardiac rehabilitation cohort.

Vitamin C is an essential cofactor for multiple metabolic processes. Vitamin C levels are known to fall dramatically following the onset of acute inflammation from any cause. The resulting low levels of vitamin C are associated with worsening sickness and organ failure. Small studies suggest that replacing these levels may of benefit to critically ill patients.. This study is designed to study whether or not replacing Vitamin C will be of any benefit to very sick patients on life support in the intensive care unit. The study hypothesis is that replacement of vitamin C intravenously will result in an improvement in patient outcomes.

The nature of training and competition in the majority of popular sports dictates that debilitating injury is not uncommon when individuals engage in high musculoskeletal loading patterns and/or high impact collisions. A consequence of such injuries is that repair and remodelling of tissues and joints often requires significant periods of limb immobilisation. During immobilisation a reduction in the normal mechanical loading of skeletal muscle results in muscle wasting (atrophy). A challenge for individuals during periods of reduced physical activity (e.g. bed rest) or immobilisation is the management of body composition. The muscle unloading interaction with dietary intake has the capacity to modulate the effects of immobilisation on mechanisms regulating skeletal muscle mass. We (Areta et al. 2014) and others (Pasiakos et al. 2013) have shown that reduced total energy intake (30-40% below energy balance requirements) decreases muscle protein synthesis and results in a loss of fat mass but also muscle mass. However, higher protein intakes (>1.6 g/kg) during energy deficit may attenuate losses in lean mass (Pasiakos et al. 2013), despite an increased expression of genes associated with muscle protein breakdown (Carbone et al. 2013). How these dietary-muscle protein interactions change during periods of immobilisation is unknown. Decreased energy expenditure from cessation of physical activity with immobilisation necessitates restriction of energy intake to prevent undesirable gains in fat mass. However, whether implementing an energy deficit, despite higher protein intakes, exacerbates muscle wasting experienced during muscle unloading is unknown. Importantly, the effect of an energy deficit on the magnitude of muscle loss and the associated underlying molecular profile during immobilisation is currently unknown. The aim of this study is to determine changes in inducible gene/protein expression and skeletal muscle mass in the acute (3 d) and early (14 d) immobilisation period while under a moderate (30%) energy restriction with sufficient protein intake (1.4-1.5 g/kg). We will compare the effect of this energy deficit on muscle mass with immobilised participants in energy balance, a study previously completed in our laboratory. We hypothesize that 14 d of limb immobilisation with energy deficit will result in greater losses of total body fat, immobilised limb mass and gene expression for protein breakdown compared to immobilised limbs in energy balance.

There is growing research on using risk algorithms to identify individuals at increased risk for future mental ill-health and for prevention interventions. However, there is lack of research on the effects of communicating personal mental health risk profiles on psychological or behavioral outcomes. There is potential that personal risk profiles can cause short term distress but motivate people to modify behavior to reduce their risks. Our research team has developed a risk algorithm to predict the 12-month risk of psychological distress in working Australian adults (Fernandez et al, 2017). This study explores the impact of communicating different types of personal mental health risk profiles on psychological outcomes and engagement with a smartphone App. The aim of this study is to investigate the effect of communicating different personal mental health risk profile on psychological distress and engagement with a smartphone App (Mindtrack). The secondary aim of the study is to explore how level of risk affects the psychological outcomes and engagement. The study’s purpose is to answer three main research questions namely: (1) What is the impact of different methods of communicating personal mental health risk profile on psychological outcomes in the medium term? (2) What is the impact of different methods of communicating personal mental health risk profile on engagement with an App? (3) Is an individual’s current or achievable risk an effect modifier of these outcomes? In order to achieve these objectives, a randomized controlled non-inferiority design will compare the effects of communicating (1) their current personal risk profile or (2) achievable personal risk profile or (3) no personal risk profile on psychological outcomes and engagement in the Mindtrack App. The 3 main study hypotheses are: i) The participants provided with the current risk profile and the achievable risk profile do not have unacceptably worse levels of psychological distress (defined as the lower bounds of the 95% CI is less than 4.6 points difference on the K10 between groups) compared to participants who do not receive personal risk profile at the endpoint (4 weeks). ii) The participants provided with the current risk profile and achievable risk profile will have higher levels of psychological distress (defined as a significant difference in K10) compared to participants who do not receive personal risk profile at 1-week post-test. iii) The participants provided with the current risk profile and the achievable risk profile do not have significantly different levels of wellbeing (defined as a significant difference in SF-12) compared to participants who do not receive personal risk profile at the endpoint (4 weeks). Other hypotheses available on request.

This research aims to identify whether individuals currently living in a Queensland Health Community Care Unit (CCU) and who have a diagnosed psychiatric disability (Schizophrenia), maximize their recovery during rehabilitation for discharge and successful community living. Galletly et al. (2016) points out that social and economic costs for “individuals living with a diagnosis of schizophrenia is associated with a greater burden of long­term disability more so than any other mental disorder”. Individuals continue to face social exclusion, experience high levels of economic poverty, unemployment, homelessness and declining physical health (Sawyer & Savy 2014). The purpose of admission to a psychiatric rehabilitation service is to address not only psychological distress but improve recovery and social functioning outcomes. Social Cognition Interaction Training (SCIT) (Roberts, Penn & Combs (2016) is a group based psychotherapy targeting social cognition (SC) deficits which has been identified as a hallmark of schizophrenia. Green et al (2008) defines SC as the "mental operations that underlie social interactions". There are four core domains, emotional processing (perceiving and displaying emotions), theory of mind (ToM, the ability to represent the mental states of others), social perception (decoding and interpreting social cues in others)and attributional style (the way individuals explain the causes and or make sense, of social events or interactions)(Pinkham et al 2014). Trialing SCIT at CCU enhances the existing psychiatric rehabilitation program to provide the individual with opportunity to expand their recovery. SCIT targets visual and vocal perception of emotion in others, difficulties interpreting and inferring others ambiguity during conversation, identifies jumping to conclusions occurs from the attribution of subjective bias and learning to make better guesses by obtaining more information (Roberts & Penn (2009). The ability to construct representations of the relations between oneself and others, and to use those representations flexibly to guide social behaviors (Adolphs cited in Galletly et al. 2016) for improved social outcomes and functioning is the goal of researching SCIT. The aim of the research is to improve social cognition skills so individual's living with a SEMI may obtain greater “choice, getting and keeping of valued social roles” that provide meaningful and rewarding lived experiences. A trial of SCIT at CCU will identify if improvement in SC has been achieved with regards to skill development in social engagement and social functioning.

Contemporary Australian data suggest that pulmonary hypertension (PHT) is more common than previously reported and confers a poor prognosis, however this single-centre data needs confirmation in a large population study from many locations and diverse backgrounds. Identification of underlying cause and prognosis of PHT non-invasively using simple markers would have a major impact on the diagnosis and management of patients with PHT. PHT is often identified during echocardiography, performed for investigation of breathlessness. PHT is not a diagnosis in itself, but has a number of underlying causes that require additional investigation to delineate. Such causes include left heart diseases, various chronic respiratory illnesses, and chronic thromboembolic and pulmonary vascular diseases. Over 900,000 echocardiograms (echos) are performed in Australia each year, but to date there has been no systematic method for capturing data from these echos. The newly developed National Echo Database Australia (NEDA) is designed to obtain measurement and report data, but no images, from digital echo laboratory across Australia and transfer them to a secure database, matched against national mortality data. The NEDA database will be the largest echo database in the world. Identification of the population of patients with PHT is of great importance, both to target those who may benefit from disease-specific therapy, and to better understand all forms of PHT in Australia and New Zealand. Abnormalities identifiable using echocardiography may be very useful prognostic indicators, and may help separate various causes for PHT. This information could be used to both identify patients who may respond to treatment, and to identify them earlier, with the goal of decreasing both morbidity and mortality for this common condition.

The purpose of this study is to see if app-based mindfulness training can reduce stress and related problems for public sector employees. This three-arm parallel group RCT will assess the effects of self-guided use of the Smiling Mind Workplace App (App group) and the use of the App supported by four seminars (App+ group) on the primary outcome of perceived stress from pre- to post-intervention, when compared with a wait list control (WLC group). The relative efficacy of each active group will be assessed as a research question. Secondary outcomes include changes in mindfulness, mental health, psychosocial job quality, workplace safety and conflict incidents, productivity changes and health-related quality of life outcomes. Changes on these measures from pre- to post-intervention and then at 12-month follow-up will be investigated by group. Informant reports of observed mindfulness and citizenship behaviours will also be collected and the relationship between observer and self-reports of change will be explored. Participant reports of the perceived usefulness of program elements will be collected to inform acceptability and feasibility. User-data from the Smiling Mind servers will be used to assess adherence and to investigate effects by level(s) of engagement with the program. This study addresses the current lack of strong evidence for app-based mindfulness training for working adults. It will examine the Smiling Mind Workplace App for its efficacy for reducing stress and related mental health problems, and explore its influence on psychosocial, safety and conflict related stressors in the workplace. The study will contribute evidence regarding the importance of including teacher-led classes/seminars to support app-based learning, in terms of efficacy, and it will report economic considerations. It draws on multiple sources of data to cross-validate self-report changes, enable objective assessment of program adherence, and determine if app-based mindfulness training leads to noticeable changes in behaviour at work.

Tympanic membrane retraction can lead to increased technical difficulties for surgeons when conducting tympanoplastic procedures. Nitrous Oxide is a commonly used inhaled anaesthetic agent that has a solubility 35 times higher than Nitrogen. Its diffusion into the middle ear has been well reported and the effects on middle ear pressure and effusions have previously been investigated. Currently, at the discretion of the anesthetist and surgeon the use of Nitrous Oxide as part of anesthetic prior to surgery to the middle ear is conducted at our hospital. It has been noted that in patients with a retraction, normalization of the tympanic membrane can occur thereby allowing for ease of surgery. This study aims to assess the effect of Nitrous Oxide on retracted tympanic membranes, in a controlled manner to see if this practice should be implemented as a standard of care. It is hypothesized that the use of Nitrous Oxide at the time of induction on patients with tympanic membrane retraction will result in normalization of positioning of the membrane thereby allowing for ease of surgery. A multicenter randomized prospective control trial will be conducted at the Townsville Hospital and the Mater Health Service North Queensland. All patients undergoing middle ear surgery with a retracted tympanic membrane graded Sade 2 or higher will be assessed for suitability for participation. Patients will be randomized via random number generator into two groups of either 30% Oxygen and 70 % Nitrous Oxide vs 30% Oxygen and Air. At time of surgery following the insertion of airway device, the tympanic membrane will be visualized by the surgeon, its state recorded and tympanography will be performed. Single blinded to the Surgeon; who will leave the operating room to prepare for surgery, the maintenance gases will be commenced at 6L/min for 10 minutes. Following cessation, the surgeon will return and again visualize the tympanic membrane and repeat tympanography will be performed allowing for comparison. The operation will then commence. Following the surgery the surgeon will document his personal experience or ease of surgery using a standardized system. Postoperative nausea or vomiting will be documented as well as use of antiemetic’s. Patients will be followed up at 3 months as per our hospitals standard procedures and any complications will be noted.

The purpose of the research is to determine the feasibility of a school-based program called Making Maths a HIIT at School. This is an initiative focusing on High Intensity Interval training (HIIT) and mathematics. The program integrates mathematics and physical activity into the delivery of the school curriculum. Based on previous studies, increased participation in Physical Activity (PA) may improve cognitive functioning and academic achievement. Movement can actually aid learning and the integration of physical activity has the potential to enhance learning and student engagement in other curriculum areas.

This study will provide novel, translational data by evaluating the feasibility and efficacy of a structured, goal directed, exercise and physical activity intervention, coupled with nurse-led education, initiated within one month of implant, for patients receiving a primary prevention ICD. Across Australia, there are ~4000 new recipients of an implanted cardioverter defibrillator (ICD) annually. Recipients are commonly those with left ventricular (LV) dysfunction and/or inducible ventricular arrhythmia. Annual all-cause mortality in patients with prophylactic ICD implantation is approximately 5.0 to 8.5% . Additionally, ICD recipients report lower quality of life coupled with both anxiety and depressive symptoms, which may be exaggerated by higher prevalence of inactivity. The rationale for this study is therefore to combine nurse-led education with a physical activity intervention in new recipients of a primary prevention ICD. Both interventions are clinically effective in patients with heart failure or an ICD, yet have not been comprehensively assessed in a combined strategy.