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The primary aim of the trial is to examine, using a randomised controlled trial, the effectiveness of an online healthy recovery intervention program (“Prevent 2nd Stroke”[P2S]) in improving health-related quality of life amongst stroke survivors at 6 months follow-up. Stroke survivors will be recruited from the The Australian Stroke Clinical Registry (AuSCR) or the Hunter Stroke Research Volunteer Register (HSRVR) databases which contain the contact information of individuals who have had a stoke or TIA (indexed stroke event). Individuals assigned to the intervention group will receive 12 weeks access to the P2S program which they are able to to use to help improve their health behaviours and health outcomes. P2S is an online health behaviour change program containing six modules: 1) Blood Pressure, 2) Smoking, 3) Alcohol, 4) Activity, 5) Nutrition, and 6) Feelings and Mood. The program is interactive and tailored to accommodate stroke-related symptoms. Goals and progress will be monitored and graphed and will be available to the user in a ‘My Progress’ section of the program. at 6 months follow-up, Health-related quality of life will be determined, as too will be: a) depression and anxiety levels; b) self-reported physical functioning and independent living; c) four health risk behaviours (smoking cessation, reduction in alcohol use, diet quality, and increase in moderate physical activity), and; d) hospital admission for recurrent stroke, myocardial infarction and all causes Cost-effectiveness of the intervention will also be determined at 6 months.

Background: The majority of extremely premature infants receive mechanical ventilation despite current strategies for prevention. They remain at high risk of mortality, bronchopulmonary dysplasia (BPD) and other morbidities, and developmental disabilities. In an era of high use of antenatal corticosteroids for lung maturation and postnatal nCPAP, the optimal respiratory support strategy for extremely premature infants is currently unclear. Substantial practice variation exists including prophylactic intubation and surfactant either with immediate extubation or brief mechanical ventilation (goal <1 hour) and extubation to nCPAP, or nCPAP and rescue surfactant using various techniques. Primary clinical hypothesis: To determine if early surfactant administration via a thin catheter to spontaneously breathing preterm infants on nCPAP will reduce need for mechanical ventilation without an increase in neonatal morbidity or mortality compared to prophylactic surfactant with brief mechanical ventilation. Study objectives In extremely premature infants, the pilot study aims to determine the following to inform a larger definitive trial: 1. The feasibility and tolerance of delivery room thin catheter instillation of surfactant. 2. Effectiveness of prophylactic thin catheter surfactant in preventing intubation and mechanical ventilation. 3. Optimal enrolment and randomisation procedures. Study design This is a pilot parallel open label randomised controlled pilot study trial to one of 2 strategies of respiratory support and surfactant delivery. Study population All infants born at 24 weeks and 0 days to 27 weeks and 6 days completed gestation. Study interventions Infants born at <28 weeks: all infants with parental consent will be enrolled at birth and randomised to either: 1. Intubation, surfactant and brief mechanical ventilation 2. Nasal continuous positive airway pressure (nCPAP) with thin catheter surfactant Primary outcome [pilot study] 1. Intubation and mechanical ventilation 2. Incidence of events requiring resuscitation during surfactant administration (events requiring IPPV and/or intubation) Secondary outcomes Secondary outcomes include all major neonatal morbidities during hospital admission and neurodevelopmental outcomes at 3 years of age. Power and Sample Size 62 infants (31 each group) will be required to detect a 30% absolute reduction in the rate of intubation and ventilation in the first week after birth from 90% in the prophylactic / rescue surfactant group to 60% in the nCPAP with thin catheter surfactant group with a power of 80% at the p=0.05 level. For a 20% absolute risk reduction with 80% power at the p=0.05 level, 124 infants (62 each group) are required.

This study aims to determine if acute ingestion of EMIQ, a dietary flavonoid, can improve blood vessel function and blood pressure stress response in human volunteers. We will investigate the biochemical mechanism of any beneficial effects via the measurement of plasma levels of nitrate, nitrite and biomarkers of vascular function and oxidative stress. We hypothesize that EMIQ will improve vascular function and moderate the BP response to stress.

Prostate artery embolisation (PAE) is an emerging, minimally invasive treatment for lower urinary tract symptoms caused by benign prostate enlargement. The first prospective trial of PAE in Australia was performed at The Wesley Hospital, and this project builds on those successful results. Whilst PAE was shown to be very effective at shrinking the prostate and relieving urinary tract symptoms during short-term follow-up, its impact on urodynamics, and the complex interplay between prostate obstruction and bladder function, is yet to be studied. This project aims to be the first study to comprehensively assess the impact of PAE on bladder function (urodynamics), as well as improvements in urinary symptoms and quality of life. The study will also compare the responses of patients with differing severity of prostate enlargement, and those with recurrent symptoms after a surgical resection. This information will be used to hopefully predict which patients are likely to best respond to a PAE, and can therefore be considered as an alternative to medical therapy or as an effective medium term precursor to more invasive surgical resection.

Prostate artery embolisation (PAE) is a minimally invasive technique that has proven effective in decreasing lower urinary tract symptoms (LUTS) in men with medically refractive benign prostatic hyperplasia (BPH). BPH, or an enlarging prostate, affects more than 50% of males older than 60 years. LUTS include multiple night-time urination, urgency, hesitancy initiating urination, weak or interrupted urinary stream and post-urination dribble. The primary goals of BPH therapy are to decrease LUTS, improve quality of life (QoL) and prevent disease progression. For men with mild-to-moderate symptoms, sequential step-up therapy starting with watchful waiting and escalating to single or multiple medical therapies and, in some cases surgery, constitutes common clinical practice. A common combined medical therapy is Duodart, a fixed-dose combination of 0.5 mg Dutasteride and 0.4 mg Tamsulosin, that is usually prescribed for men with more severe prostate enlargement. The benefits of combined therapy can be explained by the synergistic mechanisms of action of the component drugs. Tamsulosin, an a-blocker, relaxes the smooth muscle tissue in the prostate and bladder neck, allowing urine to flow more freely. Treatment with Tamsulosin provides improvement of LUTS but has no effect on prostate growth. Dutasteride, a 5-alpha reductase inhibitor, blocks the production of dihydrotestosterone, the metabolic driver of prostate growth. Thus Dutasteride treatment reduces prostate size and impedes disease progression related to prostatic overgrowth. Adverse side effects associated with these medication include retrograde ejaculation, urinary incontinence and impotence. Overall, medications are generally ineffective for long-term control of LUTS, and medical therapies are often abandoned because of poor tolerance and inefficacy. PAE is emerging as a viable alternative to medication and invasive surgery for patients with LUTS. PAE has already shown promise as a short to medium-term treatment in patients who are not willing, or not able to undergo surgery. Medium-term follow-up in patients who have undergone PAE demonstrates that: • Improved symptoms and increased quality of life persist for at least 5 years in a majority of patients, • PAE is more efficacious than medical therapy alone, • PAE causes fewer side-effects than surgical resection, • PAE can be repeated if required, and does not preclude future surgical options. To date, a direct comparison between PAE and medical therapy in a randomised controlled trial has not been performed. The study proposed here will extend knowledge in this area by investigating whether PAE is a suitable intervention in treatment-naive men who would otherwise be prescribed medications as a first-line treatment.

The purpose of this study is to test whether a video designed to trigger the Autonomous Sensory Meridian Response (ASMR) will have an effect on preoperative anxiety. Preoperative anxiety is a significant phenomenon that negatively impacts patients that are preparing to undergo a procedure. In this study, we showed preoperative patients an informational video that told them about the anesthetic procedure that they were going to undergo. This video was either one specially designed to trigger an ASMR, or a normal video with the same information. ASMR is an alternative approach to relaxation and is currently very popular. You-Tube channels dedicated to producing ASMR videos have large followings and achieves significant viewership. Despite its rising popularity in society, only a few studies have been conducted to scientifically evaluate the effects of ASMR. We measured preoperative anxiety using standardized questionnaires that have been proven to be effective in many other studies. The questionnaires that we chose are the Visual Analogue Scale (VAS), the State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). We compared the results from the patients that watched the ASMR video with the results from patients that watched a normal video. Our aim is to assess the effects of ASMR on preoperative anxiety and determine if it yielded any clinically significant effects.

The aim of this study is to evaluate the quantity and quality of tissue obtained through macroscopic on-site evaluation (MOSE) and the diagnostic ability of the procedure when compared with the conventional combined histologic-cytologic analysis. Who is it for? You may be eligible to join this study if you aged 18 years or over are referred for Endoscopic ultrasound (EUS) - guided tissue acquisition for intestinal or extra- intestinal solid lesions more than 2cm in the largest diameter. Study details Patients will be assigned on a 'chance' basis to receive standard care or an intervention. All participants will undergo endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) using a 19-gauge needle which is standard care when obtaining solid lesion specimens. Intervention group specimens will be subjected to the macroscopic on-site evaluation (MOSE) prior to being pathologically evaluated. We hypothesis that MOSE during EUS-FNA could improve the diagnostic yield of the procedure.

Paediatric patients are a vulnerable population who can deteriorate rapidly. Teaching medical and nursing staff across the state to recognise this in a learning environment that simulates this is crucial in maintaining their skills. Simulation and appropriate debriefing has been well-documented as an ideal tool to prepare for these real-life situations. It is currently unknown the impact that the introduction of a script will have on the quality of the debriefing, particularly by novice instructors. This proposal aims to improve the quality of the delivery of a paediatric resuscitation course that is delivered state-wide, including rural and remote centres, by introduction of pre-scripted debriefing. The ability to utilise an approved team with access to train clinicians each year will directly improve the care delivery at the bedside for children across the state. Furthermore, the findings may be applicable to how large scale simulation courses are taught and delivered.

Peanut allergy is the most common cause of severe food allergic reactions in children, and rates of peanut allergy appear to be rising. Some infants are at an increased risk of developing a peanut allergy due to the presence of eczema, other food allergies or a family history of allergy. For these high-risk infants, early introduction of peanut with regular consumption starting before 12 months of age significantly decreases the incidence of peanut allergy. However, parental apprehension to introduce peanut early leads to only 1 in 5 high risk infants starting peanut within the recommended window. Recent guidelines released by the Australasian Society of Clinical Immunology and Allergy suggest at risk infants should see their doctor for advice on introducing peanut, however uncertainty remains amongst health care professionals about how and where high risk infants should introduce peanut. The aim of the Promoting Introduction to Prevent Peanut Allergy (PIPPA) project is to develop a safe and efficient parent-led, clinician-supported model that promotes early introduction of peanut. This intervention study will examine the efficacy of a new model of care, where parents with high risk infants will introduce peanut in a supported environment. The primary outcome of the PIPPA project will be to compare the number of high risk infants consuming peanut before 12 months of age, between families who attend the PIPPA clinic (intervention group) and families who receive the current standard of care, and the proportion of infants who have an allergic reaction to first consumption of peanut in the PIPPA clinic. Secondary outcomes will examine whether there is any difference in the incidence of peanut allergy between the intervention and standard care group. The PIPPA project will provide evidence for the safety and efficacy of a new model of care to be implemented in a wide range of settings across Australia. The key components of the PIPPA project can be replicated in almost any healthcare environment, including primary care and rural/regional hospitals, ultimately reducing the incidence of peanut allergy in the community.

Snacks are important because they keep us going until the next meal. Sometimes though, we eat too many, or choose snacks that are unhealthy. Even though each snack is usually small, over time these snacks can add up. This can make us gain weight. Smart snacking means choosing nutritious, healthy snacks that give you energy until the next meal. While many of us want to change the way we snack, this can be very hard to do. Often we make plans but have trouble sticking to them over long periods of time. This study is testing a ‘smart snacking’ tool that will make sure that plans to snack healthily are high quality and easy to follow in the long term. To test the effect of this tool on snacking behaviour, we randomised participants to receive one of three planning tools: 1. Volitional help sheet (the online smart snacking planning tool) 2. Directions to create a detailed plan 3. Hints and tips to snack healthily