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The Anterior Cervical Discectomy and Fusion (ACDF) is one of the most common operations utilised in treating cervical degenerative disc disease. This involves removal of an intervertebral disc and cartilage with surrounding bone removal to release compressed spinal nerves. Once the disc has been removed, an implant known as an ‘inter-body cage’ is introduced into the disc space to restore disc height with restoration of physiological alignment and create an environment to achieve bony fusion. Overall, this procedure aims to improve neck pain and nerve pain via neural decompression and improved stabilisation. One of the inherent problems with introducing an implant that is more resistant to compressive forces (i.e. an increased bulk modulus) when compared to vertebral bodies is subsidence. Subsidence involves the ‘sinking’ of an implant postoperatively into vertebral bodies over time. Radiologically, this is the distance measured between two vertebral bodies at the segment of interest. This can result in narrowing if the neural exit foramen and development of pathological alignment leading to recurrence of symptoms. Furthermore, adjacent levels are subjected to abnormal biomechanical stresses, ultimately leading to development of further issues. Early subsidence can also lead to increased mobility in the segment and lead to failure in fusion. Currently, there lacks consensus on the definition of subsidence, with reported parameters of radiological subsidence varying amongst publications, thus making comparison between studies difficult. Generally, it is accepted that subsidence has occurred when there is an absolute loss of 2-4mm in interbody height, or a 10% reduction in interbody height, when compared to cervical x-rays performed immediately postoperatively. Subsequent to the introduction of the ACDF utilising a standalone cage, the operation has been augmented by the addition of a metal, anterior cervical plate. By bridging the anterior aspect of a fused segment, this was shown to supplement the cage leading to increased fusion rates and better stability. However, some of the disadvantages associated with use of a plate included post-operative dislodgement, soft-tissue injury and dysphagia. Currently, there is no consensus over whether anterior cervical plating offers any added benefit, hence the need for this trial.

In older adults, insufficient protein intake facilitates muscle loss by limiting muscle anabolism. Furthermore, older people may experience ‘anabolic resistance’, increasing the threshold of protein required to stimulate postprandial protein anabolism (>25-30g). Importantly, providing that sufficient protein is ingested, ageing does not impair the capacity for muscle protein synthesis. Therefore, protein-rich supplements are commonly used to manage undernutrition in older people. In younger adults, protein is known to be the most satiating macronutrient - high-protein diets are often advocated to promote weight loss. Therefore, the satiating effects of increased protein ingestion could counteract the positive effects of increased protein ingestion on lean mass in older people. Interestingly, our studies have previously shown that suppression of energy intake after intraduodenal and oral whey protein loads is less in older compared to young people, despite slower gastric emptying and increased plasma CCK and GIP concentrations in the older subjects, factors which are associated with suppression of energy intake in young people. Timing of protein supplements (i.e. 3, 2, 1 hour(s) or just before a meal) did not affect energy intake at a subsequent meal. These studies suggest that older people have impaired appetite and energy intake regulation. The lack of suppression caused an increase in overall energy and protein intake, which supports the use of ‘pure’ protein supplements in undernourished older people. The aim of the study is to characterise in healthy younger and older individuals, the effect of oral protein ingestion 30 min before breakfast, lunch and dinner on energy intake, appetite, blood glucose and plasma gut hormone concentrations (e.g. insulin, glucagon, ghrelin, CCK, GIP, GLP-1 and PYY). We hypothesise that the acute suppression of appetite and energy intake by oral whey protein is less in healthy older than younger people. To investigate this, a total of 15 healthy older men aged 65-85 years with a body mass index (BMI) of 20-30 kg/m2 and 15 healthy younger men aged 18-35 years with a BMI of 20-30 kg/m2 will be recruited. Each subject will be studied on 3 occasions. On each occasion, they will receive, in randomized fashion, a drink of flavoured water (control; ~2 kcal) or a drinks of 30 g whey protein (120 kcal) 30 min before a breakfast (~9am, t = 30). Energy intake will be assessed at breakfast (t=30), lunch (t=270) and dinner (t=510). Blood samples will be taken, antral area will be measured and visual analog scales will completed at regular time intervals. Subjects will be allowed 30 min for all meals to freely consume food until they are comfortably full.

This project will be a 10 week strength training intervention in trained distance runners. The aim of this study is to investigate the effect a strength and conditioning program has on the mediators of running performance, in particular, running mechanics and muscle-tendon properties in distance runners. Methods will include collecting strength and stiffness measures using dynamometry and ultrasonography, an incremental treadmill running test to determine running economy and maximal aerobic capacity, and 3-dimensional motion analyses and musculoskeletal modeling of running and strength exercises. We anticipate this project will improve exercise prescription practices in distance runners. In addition, we expect this project to provide a greater understanding of the mechanisms underpinning improvements in run performance following a strength and conditioning intervention.

Premature infants usually need extra oxygen after birth because their lungs are not fully developed. However, their bodies do not yet have the ability to balance the stress that receiving that oxygen can cause. Oxygen is necessary for life, but both too much or too little can damage eyes, lungs, brain and other important organs of newborn babies. This study will compare outcomes of 1470 preterm infants up to 28/6 weeks gestation who have had respiratory care in the delivery room with (A) Initial FiO2 0.6 versus (B) Initial FiO2 0.3, followed by common SpO2 targeting until admission to NICU. FiO2, SpO2, and heart rate are recorded each minute from delivery of the child’s body for 10 minutes, then every 5 minutes until admission to NICU. Routine assessments are collected at baseline, 36 weeks, discharge and at 2 years corrected for gestation. Additionally a parent-completed developmental questionnaire is also collected at 2 years corrected for gestation.

The aim of the study is to assess the tolerability and efficacy of a herbal powder preparation for gastrointestinal disturbances. Gastrointestinal problems in the upper and lower gastrointestinal tract can manifest as frequent reflux or irritable bowel symptoms. The Nutrition Care Gut Relief Formula contains a mixture of herbs and nutrients which have been shown to be beneficial for the gastrointestinal system. In this interventional pre-post single-arm dose-response study of 16 weeks duration we aim to investigate the tolerability and the effectiveness of the Nutrition Care Gut Relief Formula on gastrointestinal disturbances in Australian adults.

The misuse of opioids is a major public health issue, and one aspect of concern is the prescribing of opioids after surgery creating new users. Alfred Health's Analgesic Stewardship Committee identified clinician education as a key priority to improve opioid and analgesic prescribing across the organisation. This study will evaluate the impact of a one-off pharmacist-led face-to-face analgesic education session on rates of opioid prescribing at discharge from surgical units. Eight of sixteen surgical units will be randomised to receive the education intervention, with the other eight serving as a control group; all opioid-naive patients discharged from all surgical units in the three months before and three months after the intervention will be included for analysis. Discharge summaries and prescriptions will be reviewed to determine opioid prescribing at discharge. We hypothesise that the intervention will demonstrate a modest reduction in the prescribing of regular opioids to opioid-naive patients on discharge from surgical units.

The aim of this study is to evaluate the effect of ActiPhen,™ a kiwi fruit powder extract, on gastrointestinal tract function (including bowel movements, abdominal pain, intestinal permeability) in healthy adults over 6 weeks. It is hypothesised ActiPhen™ will enhance gastrointestinal tract function (including bowel movements, abdominal pain, intestinal permeability) and increase quality of life compared to placebo.

Informed consent is an not only an essential part of preparing a patient for surgery, but also a legal requirement. Surgeons typically explain the condition, procedure, risks and benefits and expected recovery of the intended treatment. This didactic method of information delivery can often miss out important components, and patients may not retain much knowledge from these discussions. Audio-video presentations have already been shown to be a promising medium to aid patient understanding and increase satisfaction during the consent process. This project will investigate the role of video media in providing a better informed consent process for patients undergoing emergency appendicectomy, as compared with standard face-­to-­face verbal consent between doctor and patient. Patients who require this operation will be invited to participate in the study. When enrolled, participants will be randomised to receive either the intervention (video media) or standard method of consent first. A short knowledge test and consumer satisfaction questionnaire will be completed, and then the process repeated for the opposite consent method. At the conclusion, the participant's preference between video media or standard face-to-face consent will be recorded.

This study is proposed to run alongside the approved Riluzole in Spinal Cord Injury Study (RISCIS) at Prince of Wales and Royal North Shore Hospitals. RISCIS is a randomized, prospective trial in acute cervical spinal cord injury. The outcome data that will be collected for this study will be good quality and detailed. Running RISCIS represents a unique opportunity to also collect ancillary observational data on possible predictors of general outcomes in acute spinal cord injury as well as the type and frequency of complications. This data will allow the investigators to generate reliable and accurate information on quality of care of acute spinal cord injury at both participating hospitals. This can be compared with international bench-marks and also allow comparison between the Spinal Units at the two hospitals. As a result, it is hoped that care can be optimized at each site in light of the new information and also that standardization of care across both Spinal Units can be established according to best practice guidelines. This study will be purely observational and will not require additional investigations or clinical assessments than used in standard clinical care.

This is a Phase 1 trial to be conducted in a single center in Australia to evaluate the safety and tolerability of CBL-514 Injection on convexity or fullness of abdominal subcutaneous fat.