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Physical activity is an effective intervention for managing many chronic diseases. The majority of the general population are not sufficiently active to meet physical activity guidelines and physical inactivity is more prevalent in people living with chronic disease. People with chronic disease require guidance from healthcare professionals to make lifestyle changes to manage their condition and improve health outcomes, however, there is a lack of healthcare professionals and services available people living in regional and remote NSW. PhyzX 2U is a new mobile service that uses a combination of face to face consultation, mobile exercise tracking and a health coaching service via telehealth to provide exercise programs to people living with chronic disease in remote rural communities of NSW’s Central West. Objectives: To evaluate the delivery of the PhyzX2U service in its pilot phase. The specific aims are to determine the (i) feasibility, uptake and impact of the PhyzX 2U program in improving health and quality of life for people with chronic disease living in rural and remote communities; and (ii) acceptability of the PhyzX 2U program, including facilitators and barriers to implementation, from the perspectives of the providers and recipients. Study plan: An observational mixed methods study will be used. Health and goal outcomes from recipients of the PhyzX 2U program will be compared between program initiation and following completion of the 12-week program. Client adherence to the 12-week exercise intervention and PhyzX resources to run the program will also be determined. Semi-structured interviews will be conducted with a subsample of program recipients and program providers to determine the acceptability of the program, and to identify facilitators and barriers to program implementation. Data will be collected between September 2017 and 30 June 2018.

Research has found Dialectical Behaviour Therapy (DBT) to be an effective treatment model for adolescents who have a variety of mental health concerns and difficulties coping with their emotions. This study involves the use of an online DBT skills-only training program for the management of emotional dysregulation for young people aged 18-25 years. The study will recruit young people through headspace and allocate them to either a 4-week, an 8-week, or a TAU+ 4-week online skills training in DBT skills. The study will test the effectiveness of the online skills training program in improving participants’ emotional regulation and coping skills. Understanding the role such programs can play and has the potential to greatly benefit clinical practice and further inform prevention and intervention policies.

OVERALL AIM: This pilot study aims to determine the feasibility and acceptability of treatment of male partners of women with bacterial vaginosis (BV). OTHER AIMS: To examine the impact of dual partner treatment (male and female treatment) for BV on BV-associated bacteria on the male and female genitalia for 1 month after treatment. BACKGROUND AND SIGNIFICANCE: BV is the most common cause of abnormal vaginal discharge in women of reproductive age affecting between 12-30% of women, suggesting it may currently affect at least 1 million Australian women. It can be associated with important complications such as miscarriage, premature birth, low birth weight, pelvic infection, and increased risk of HIV and sexually transmitted infections. We have shown that BV recurrence (getting the infection back again) in women is common even after they take the recommended antibiotic treatment. A number of investigators have shown that BV-associated bacteria (BVAB) are present in male partners of women with BV on the penile skin and also at the end of the urethra (the tube you pee through), but male partner treatment is not currently recommended by current treatment guidelines. Studies of recurrent BV indicate that reinfection from sexual partners may be contributing to the high rates of recurrence but this requires more evaluation. Metronidazole and topical clindamycin are both antibiotics approved for use in Australia to treat BV in women. As BV has not previously been thought to affect men they have not been licensed for use to treat BV in men. Metronidazole is however a commonly used antibiotic in men and women and has been approved for use for many conditions affecting men and women, including gastroenteritis, abscesses, dental infections and types of pneumonia, to list a few. There is extensive experience in using it in men for these other conditions. Topical clindamycin cream has not been approved for use for any conditions in men; however men may get exposed to the cream if they are having sexual intercourse with their partner while she is using the cream to treat BV. Clindamycin cream and oral metronidazole are therefore considered is an experimental treatment for BV in men. This means that they are being tested to see if they are an effective treatment to get rid of BV-associated bacteria in men.

Title: Benefits of calculating and communicating to GPs a Drug Burden Index (DBI) in elderly patients discharged from the Emergency Department- a pilot study The purpose of the study is to investigate whether Emergency Department visits by older people who are taking one or more prescribed medications can be reduced by effectively communicating to primary care providers the burden of toxic and/or unnecessary medications being taken by their patients. We are investigating to see if some patients’ prescribed medications may no longer be necessary. We are also investigating whether some people’s combinations of prescribed medications might have side-effects that could make them more liable to experience adverse effects such as falls, dizziness and confusion. We aim to accomplish this by calculating a Drug Burden Index. The Drug Burden Index (DBI) calculation takes account of the total amounts of all the different types (‘classes’) of prescribed medicines a person is using. Two classes of prescribed medications (anticholinergics and sedatives) in particular are associated with adverse clinical outcomes. The calculated Drug Burden Index measures a person’s cumulative exposure to these medications and its potential impact on physical and cognitive function. The calculated Drug Burden Index and accompanying explanatory material will be appended to the discharge letter sent to all patients’ GPs after their Emergency Department visit. We encourage patients to discuss this matter with their GPs at the next opportunity. If the calculated Drug Burden Index indicates that a person might potentially be adversely affected by their prescribed medications, this is an opportunity for the GP to review and adjust medications where indicated. By collecting this and other information we hope to gain a better understanding of how many visits to Emergency Departments may be related to unnecessary or interacting prescribed medications, with the aim of ultimately reducing these preventable visits by encouraging GPs to review and adjust prescriptions. The study is to be conducted wholly at the Emergency Department of Royal North Shore Hospital and the expected duration of the study is 1 year.

Previous studies suggested dietary sugar consumption as one of the main factors of obesity, yet the findings on children were inconsistent. Notably, although the consumption of sugar-sweetened beverages (SSB) was found to be positively associated with body weight gain in children, the association between the consumption of free sugar, as defined by the World Health Organization (WHO), and weight gain on children remained inconclusive. Hence, the current analysis aimed to assess the effects of consuming free sugar on the BMI z-score of a group of Australian children and adolescents.

Diffuse idiopathic skeletal hyperostosis (DISH), is a skeletal disorder for which, apart from non-steroidal anti-inflammatory drugs and analgesics, there is no effective pharmacological treatment. The aim of this retrospective/prospective data audit is to determine the effect of tumour necrosis factor inhibitors in clinically active DISH patients. This will be achieved by the comparison of changes in pain and function in people with DISH that are treated with tumour necrosis factor inhibitor (TNFi) to similar people with DISH that are not treated with TNFi, with people with ankylosing spondylitis, over time.

This study is looking to see if group tummy time exercise classes can be an effective way to promote tummy time. It will also see if there are any positive health effects by infants who engage in tummy time. Approximately 40 mothers and their healthy infants who agree to attend a mother's group will be recruited from the Illawarra region of New South Wales. Participants will be recruited from their home visit with their child and family health nurse. Those who would like to be involved in the study will be randomly assigned to either an intervention (group tummy time exercise class) or a control group (usual care). The measurements to assess the effectiveness of the classes will be the amount of time spent in tummy time by the infants, the infant’s ability to move, their head shape, the amount of sleep and screen time they have and the accuracy of the parents to recall the amount of tummy time the baby has been given. A measurement device that the infant wears around their waist will be used to determine the amount of tummy time the infant receives. They will wear this device for at least 3, 24-hour periods over 1 week. The parents will also be asked to complete a questionnaire which will have questions about their education, where they live, how much knowledge they have about tummy time etc. The group tummy time exercise class will run for about 20 minutes, once per week, for 4 weeks. They will be run by a Physiotherapist. To provide encouragement to attend, build relationships and enhance the learning in the group exercise class, a closed Facebook or WhatsApp group will also be created so mothers can contact each other and share tips and strategies they have found helpful about tummy time during the week.

The aim of this study is to evaluate the validity, reliability and sensitivity of predicting VO2max from a perceptually-regulated exercise test (PRET) and to evaluate the efficacy of regulated exercise intensity during cardiac rehabilitation using perceived exertion. Specifically, the study will assess how perceptions of effort change over a 6-week exercise program and will quantify these changes in relation to physiological (i.e. heart rate and VO2) and performance (i.e. work rate) indicators of exercise intensity. Participants referred for cardiac rehabilitation, following myocardial infarction or cardiac surgery, will complete a symptom-limited exercise test to establish VO2max and 3 PRETs. Participants will then be randomised to a supervised exercise or wait-list control. Supervised exercise will consist of 6-weeks of exercise training for 1 hour 2x per week. Exercise intensity will be regulated at RPE 13 on Borg’s 6-20 RPE scale. Heart rate will be measures in each session and oxygen uptake objectively measured during the first and last week. Participants will then repeat the symptom-limited exercise test and 3 PRETs.

Hyperglycaemia in hospitalised patients is independently associated with increased morbidity and mortality in a wide range of patient groups, including post-operative outcomes. The association between hyperglycaemia and poor outcomes is strong in patients without diabetes, but a weaker predictor in patients with diabetes. This discrepancy is in part driven by the difficulty in distinguishing genuine stress hyperglycaemia from chronic high levels seen in diabetic patients. A high plasma glucose concentration in a hospitalised patient can occur because of chronic poor diabetes control and be “normal” for that patient, represent a transient physiologic response to an inter¬current illness (stress hyperglycaemia), or be a combination of the above. A metric for stress hyperglycaemia has been developed at Flinders Medical Centre - the Stress Hyperglycaemia Ratio is defined as glucose concentration divided by the Estimated Average Glucose concentration, which is calculated from HbA1c. This enables quantification of the relative change in hyperglycaemia eg a patient with a SHR of 1.4 has an glucose concentration 40% higher than their average glucose over the prior 3 months. Our previous work indicated that the relative change in glucose was a better indicator of stress hyperglycaemia and more strongly associated with adverse patient outcomes than glucose. This initial work needs to be confirmed in a further population of hospitalised patients. We also aim to study some specific subgroups of interest, namely infections (both at admission and those that develop during the admission), and events related to blood clots (heart attacks, stroke, deep vein thromboses, and pulmonary emboli). This will enable us to determine those patients who might benefit most from early management of elevated glucose levels due to stress hyperglycaemia.

Hybrid closed loop (HCL) systems for the treatment of type 1 diabetes are rapidly advancing, particularly with respect to the algorithms that are used to calculate the automated insulin delivery. Hybrid closed loop systems consists of an insulin pump, a continuous glucose monitor, and an algorithm that determines the rate of insulin delivery between meals. Meals are still required to be announced by the user, and an insulin bolus proportional to the carbohydrate ingested is delivered according to an individualised carbohydrate ratio. The first commercially available HCL system has been FDA approved and is available in the United States. However, ongoing enhancements are required to improve glycaemic outcomes and patient user experience. We will conduct a single-center pilot study, that is randomized, two arm parallel group in design in a hotel setting for 7 days, in subjects with type 1 diabetes on insulin pump therapy. Patients aged 13-25 years will be randomized in 2 groups to either use the 670G 3.0 system or the 670G 3.1+UmaxCB system. The objective is to assess function and usability of the two alternate algorithms in a highly supervised environment and provide an estimate of effect size and standard deviation in order to power future larger studies. During the study, we will challenge the performance of the two systems with different meal compositions and exercise.