ANZCTR search results

Difficult or failed intubation is a major and life threatening complication that may occur during induction of general anaesthesia. Thorough preoperative airway assessment is an important component of establishing a safe plan to secure patients’ airways perioperatively. Ultrasound technology is rapidly evolving and becoming more accessible as costs decrease and devices become both more portable and user-friendlier. The use of the ultrasound in airway assessment has been described as early as the 1980s, and recently there has been increasing interest in the use of this technology among anaesthetists worldwide. Ultrasound used in conjunction with clinical airway assessment has multiple advantages and there is a rapidly growing body of evidence supporting its use. Ultrasound can be used to view the majority of the upper airway structures, including the mouth, tongue, oropharynx, hypopharynx, hyoid bone, larynx, vocal cords, cartilages, trachea and oesophagus. In this prospective observational study we will assess the upper airway of patients presenting for surgery requiring endotracheal intubation in a tertiary hospital for potential difficult airway. This will be done both clinically and using an M- Turbo SonoSite ultrasound machine. We will measure the hyomental distance in neutral and the hyperextended position and will assess the anterior neck thickness at the level of the hyoid and thyrohoid membrane. Pre operative results and perioperative airway management including any difficulties with intubation will be documented and compared accordingly. The objectives of this study are to determine the utility of the use of the ultrasound to predict a difficult intubation, and examine the association, if any, between ultrasound measurements and difficult airway clinical screening tests.

Overweight and obesity are major global public health issues identified to contribute to disease burden by increasing the risk of diabetes and cardiovascular disease and their associated complications. Over half the adult female Australian population are classified as being overweight or obese with women of reproductive age having one of the highest rates of weight gain in Australia. At Westmead Hospital in 2014/15, 42.7% of the 5600 women who gave birth there were overweight or obese, approximately 50% had excessive gestational weight gain (GWG) and over 400 developed gestational diabetes. There are a number of well documented adverse outcomes associated with excessive weight gain and overweight and obesity during pregnancy and these risks increase with increasing BMI. Furthermore, growing evidence indicates the fetus of an overweight mother on an unhealthy diet is ‘programmed’ via epigenetics to lifelong obesity and ill-health. Interventions to prevent childhood obesity must begin during pregnancy. Women who are able to keep their gestational weight gain to within the recommended limits, whether obese or of normal weight, show significantly reduced rates of foetal and maternal complications. Due to the frequency of contact of health professions during the antenatal period, it is an ideal time to take the opportunity to intervene and make changes that mothers perceive will optimise the outcome for themselves and their offspring. A recent Cochrane review (2015), indicated that intense diet and exercise can reduce the risk of excessive GWG, with some studies reporting 5kg lower GWG, and a significant reduction in macrosomia, which has obvious implications for neonatal adiposity. Furthermore, it has been shown that the use of SMS text messaging are effective in promoting weight loss and appropriate GWG. We hypothesize that an early and intense dietary and lifestyle intervention, i.e. utilising frequent patient contact via mobile phone technology and face-to-face support, will reduce GWG, GDM, post-partum weight retention and infant adiposity, compared to standard antenatal care.

First episode psychosis (FEP) may lead to devastating, chronic illness. For many individuals with FEP, a progressive worsening of symptoms, decline in cognition, and associated reduction in quality of life is often observed. There is evidence to suggest that this illness progression can be diminished, and perhaps even averted, if appropriate treatments are given at the early stages of illness. N-acetyl cysteine (NAC) is a supplement form of an amino acid antioxidant found naturally in foods such as meat, fish and green leafy vegetables. NAC is currently used for treating some respiratory conditions and paracetamol overdose. NAC boosts the body’s antioxidant defences. There is evidence that the antioxidant defences are impaired in people who suffer from psychotic disorders. Antipsychotic medication is currently the best treatment for FEP; however, sometimes these medications are not effective at treating all of the symptoms of psychosis such as negative and cognitive symptoms. Several studies have shown a significant benefit for NAC in schizophrenia and bipolar disorder when it has been used in addition to antipsychotics; however, its benefits have not yet been determined for individuals with FEP. In this project we will test if NAC administered to young people who have experienced FEP can help to reduce some of the symptoms they experience. We will also investigate whether NAC can help to prevent this early psychotic experience from developing into a chronic disorder. Young people between the ages of 15 - 25 years admitted to the Early Psychosis Prevention and Intervention Centre for treatment of first episode of psychosis (N=162) will be randomised to 2000 mg daily NAC or placebo for 26 weeks, with a further 26-week non-treatment follow-up period, as an addition to treatment as usual (TAU). The primary outcome is reduction in global symptom severity. A range of symptomatic, functioning, quality of life, neuropsychological, neuroimaging and blood biomarkers of inflammation, oxidative and nitrostative stress measures will be included as secondary outcomes. Through this study, we will not only determine the clinical efficacy of NAC as an adjunct treatment for FEP, but potentially unlock some of the neurobiological mechanisms underpinning psychotic disorders.

Insulin initiation and/or titration for type 2 diabetes (T2DM) is a resource intensive process requiring a referral to a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). To address the challenges in IDA, we have developed an innovative mobile health (mhealth) based model of care to support the patients and clinicians in diabetes specialist outreach and telehealth clinics (REMODEL-IDA: REthinking MOdel of Diabetes care utilising EheaLth – Insulin Dose Adjustment). Advances in mhealth have enabled to redesign traditional models of healthcare delivery. This model aims to improve glycaemic management, improve healthcare service delivery efficiency and improve the patients’ experience. A two-arm pilot randomised controlled trial will be conducted for 3 months with 44 participants, randomised at a 1:1 ratio to receive either the mhealth-based model of care (intervention) or routine care (control), in diabetes specialist outreach and telehealth clinics. The intervention arm will exchange glycaemic management information via a Mobile-based Disease Management System (MDMS) developed for T2DM outpatients. They will receive advice for insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their glycaemic management. The routine care arm will be followed up via telephone calls. The primary outcome is change in HbA1c, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required by health care providers in both arms will be collected. This study will guide the conduct of a large-scale implementation study.

Delirium is an acute neurocognitive disorder that is characterised by a fluctuating level of consciousness with impaired attention and cognition. Delirium has been estimated to occur in approximately 30% of adults admitted the intensive care. Delirium is associated with poor outcomes which include longer stay in intensive care unit, longer stay in hospital by 10 days and experience a prolonged duration of mechanical ventilation. The longer-term outcomes include long-term cognitive impairment, dependency in activities of daily living and 2-3 times higher mortality rates. The restlessness and agitation experienced by patients leads to increasing workload of ICU nurses who need to stay continually by the bedside to ensure the patients safety, thereby requiring one-to-one nursing care. This increases the financial burden of delirium on the Intensive Care unit as well as the hospital. This study will evaluate the impact of a nursing-led delirium-prevention protocol (‘the intervention’) that is aimed at reducing the incidence, severity, and duration of delirium among adults admitted to ICU. The Delirium Prevention Nursing Protocol targets the risk factors for delirium which includes visual and hearing impairment, to prevent or treat sensory deprivation and ultimately the loss of orientation; sleep deprivation, cognitive impairment to (re)orientate patients with regard to time, place and person to prevent or minimize decline; and immobility, to improve patients’ functional mobility in the ICU and to stimulate patients’ cognition.

The study aims to establish whether the amino acid, glycine, is absorbed from the stomach in patients who are critically ill. It also aims to assess the effect of glycine supplementation on the structure and function of muscle. It is proposed that glycine will be absorbed from the stomach and cause an increase in glycine concentration in the blood. It is also thought that administering glycine to critically ill patients will have a protective effect on muscle, prevent muscle wasting and preserve physical function.

This pragmatic, open-label randomised partial cross-over trial aims to evaluate if adding a nicotine maintenance intervention (a nicotine vaporiser, 3 months of refill fluid at no cost and additional refill fluid at cost until final follow-up at 24 months) to standard quit support intervention (a 3 month course of cessation pharmacotherapy at no cost, self-help materials and active referral to Quitline) improves quit rates for people with priority medical conditions and whether offering both interventions concurrently (Condition A: both interventions used started at the same time) is more effective and cost-effective than offering the interventions sequentially (Condition B: only standard quit support offered at baseline and nicotine maintenance intervention only offered to those who are not abstinent at 6 months). Hypotheses: Condition A will have a higher rate of 3 months continuous abstinence compared to Condition B at 6 months (H1) and 12 months (H2) and lower relapse rates at 6, 12 and 24 months (H3). Condition A will be more cost-effective than Condition B at 6 months (H4) and 12 months (H5). Outcomes/significance: Smoking is a leading cause of preventable death for people with priority medical conditions due to their high smoking prevalence, greater vulnerability to tobacco-related disease and low quit rates with current cessation therapies. Our study will provide evidence on the effectiveness, safety and cost-effectiveness of offering nicotine maintenance in addition to standard cessation treatment to people living with comorbidities.

The purpose of this study is to determine whether a new psychological intervention for cancer-related anxiety is feasible and acceptable. Who is it for? You may be eligible for this study if you are attending the Kinghorn Cancer Centre, are aged over 18, have been diagnosed with a metastatic, recurrent or progressive cancer, and have clinically significant anxiety. Study details All participants will need to take part in 9 sessions, lasting 60-90 minutes of behaviour therapy with clinical psychologist. These 9 sessions will be weekly and will involve cognitive behaviour therapy, metacognitive therapy and acceptance and commitment therapy. This therapy program takes into account the specific concerns of patients with cancer, such as dealing with ongoing uncertainty and worries about the future. Participants will also be required to complete questionnaires at the beginning of the study, after each therapy session and 2 months after therapy has finished. It is hoped that this research will help determine whether this type of therapy is effective in reducing anxiety for participants and whether the content of the sessions is deemed by the participants to be essential and effective

A three-arm randomised controlled trial will be conducted to examine the effectiveness of each of the two intervention programs for improving older drivers’ safety, relative to receiving no intervention. The interventions will involve either on-road skills training, (two tailored driving lessons with a qualified instructor) or a home-based computerised cognitive training (training of speed of processing and cognitive-motor reaction time) for 1-2 hours per week over the 12 week intervention period. Driver safety will be assessed in on-road driving tests conducted pre- and post-intervention, and with off-road lab-based and paper and pencil measures of driver safety, driving self-efficacy, and cognitive functioning, also collected pre- and post-intervention. Diary data collected monthly for twelve months following baseline assessment will provide a self-report, secondary measure of driving incidents.

The primary purpose of this study is to set up a registry of patients with recurrent and advanced colorectal cancer to evaluate patterns in the presentation, treatment and outcomes of the disease. It is for patients over the age of 18. Researchers will collect information relating to the presentation and characteristics of each participant's disease and information on treatments received and response to treatment by reviewing medical records. It is hoped that the findings from the registry will enhance our understanding of how treatments received and the timings of these treatments affect disease outcomes, and how these relate to the presentation and characteristics of colorectal cancers.