ANZCTR search results

Research Question Can measurements of lactate clearance with a point of care lactate measuring device (StatStripAccutrend) assist in the management and early identification of patients at higher risk of deterioration in the emergency department? Rationale for Current Study In the emergency department, the undifferentiated patient presents a diagnostic and time management challenge. Lactate is used as a surrogate marker for global hypoperfusion in sepsis, trauma and patients with surgical abdomens, but there are also other areas of developing interest where lactate measurements could be used to assist in fast tracking decisions and risk stratifying patients to decide their disposition. Primary Objective 1. To measure serial lactate measurements in the ED within the first hour of presentation and at 3 hours of stay to monitor and predict deterioration in the department or the hospital in the first 72 hours? STUDY DESIGN This study is a prospective longitudinal study where data will be collected over a year. The data will be collected with written or and verbal consent, and fact sheet given to the participant about the study. Verbal and written consent will be obtained at the first reading and second readings taken to make sure that participants are happy to continue with the study. Patients can withdraw at any time in the study. Exclusion criteria of patients will include those that are <18 years old, severe hepatic failure, presentation of known seizure disorders and those triaged to other areas apart from the adult acute area or self discharged from the department before completion of treatment, if they don’t have a serial measurement of their lactate at 3 hours. The lactate measurements will be recorded at a time within one hour of presentation and the second reading at 3 hours of presentation electronically on their medical records. The data will then be extracted and de-identified for this research project and determined if the participant is to be excluded or included in the study. . This study to reach the sample size of 1000 participants would approximately go over the course of 6 months to a year.

Sleep is important for health, quality of life and general well being. Patients in rehabilitation often sleep poorly but the reasons for this are not well understood. It is important to better understand why patients sleep poorly in rehabilitation and how this can be managed. Through this study, it is hoped that a “clinical pathway” which consists of guides for clinicians will help clinicians understand and better address sleep problems. Patients will be divided into two groups randomly, with one group receiving care based on the “clinical pathway” and the other group receiving usual care without use of the “clinical pathway”. Sleep is starting to emerge as an important consideration in the overall management of rehabilitation patients however there is paucity of current literature relating to the efficacy of treatment of sleep disorders to guide treatment. For clinicians who actively manage sleep issues, most rely on evidence obtained in non-rehabilitation patients and commonly use hypnotic agents, Behavioural interventions and where appropriate devices such as continuous positive airway pressure (CPAP). Currently available clinical pathways for the treatment of sleep disorders focus predominantly on the management of obstructive sleep apnoea and do not extrapolate well to sleep disorders in a rehabilitation setting. This study aims to determine the feasibility and effectiveness of a sleep optimisation clinical pathway within the rehabilitation setting when compared to usual care on sleep quality, patient satisfaction with sleep, engagement with rehabilitation therapy, fatigue and length of inpatient rehabilitation stay through a randomized controlled trial with blinded patients and outcome assessors.