Outcomes Of The Arterial Switch Operation: A Multi-centre Study
Funder
National Health and Medical Research Council
Funding Amount
$86,733.00
Summary
The arterial switch operation is the surgery of choice for children born with transposition of the great arteries, a congenital heart defect where the main two vessels of the heart arise from wrong pumping chambers of the heart. There are very few studies looking at adults after this operation. We aim to study all patients who have had an arterial switch. The results of this study will further increase our knowledge of the long term consequences of having the arterial switch operation.
Superior Surgical Fixation Using A Novel Orthopaedic Expandable Fastener
Funder
National Health and Medical Research Council
Funding Amount
$414,076.00
Summary
Surgeons repair bone fractures using metal plates and screws. Sometimes the screws loosen and the surgery needs to be repeated. Expandable screws are stronger, but more difficult and sometimes impossible to remove. The research team will test a new type of screw that holds the bones together with greater strength (our current work shows 40% stronger) but can be removed easily if necessary. This grant will allow extensive mechanical testing in preparation for a first-in-human clinical trial.
Development And Clinical Evaluation Of A Depth Of Anaesthesia Monitor
Funder
National Health and Medical Research Council
Funding Amount
$424,785.00
Summary
Waking up during surgery (awareness under anaesthesia) is a frightening reality for some patients. Although uncommon (occurring in about 1 in 1000 operations), it remains one of the main concerns of patients before their surgery. Recent studies (including our own) have demonstrated that processed EEG monitoring using bispectral index (BIS) can markedly reduce the risk of awareness. Other EEG monitors are being developed, but each have weaknesses. As approximately two million Australians have a g ....Waking up during surgery (awareness under anaesthesia) is a frightening reality for some patients. Although uncommon (occurring in about 1 in 1000 operations), it remains one of the main concerns of patients before their surgery. Recent studies (including our own) have demonstrated that processed EEG monitoring using bispectral index (BIS) can markedly reduce the risk of awareness. Other EEG monitors are being developed, but each have weaknesses. As approximately two million Australians have a general anaesthetic each year, about 2000 will suffer an episode of awareness. More than 60 million people around the world have an anaesthetic, and so the problem is substantial. This suggests the potential benefits (health outcomes, commercial gains) are very great. In 2000 less than 5% of US hospitals used BIS monitoring; the current figure in the US is about 69% of the best-rated hospitals (US News and World Report) and 78% of teaching hospitals. A similar rapid growth is occurring in Australia and Europe. We are working with a successful Australian Company (Compumedics Ltd) to develop a better awareness monitor. We plan studies in groups of patients have surgery.Read moreRead less
Combined Randomised And Observational Study Of Type B Ankle Fracture Treatment
Funder
National Health and Medical Research Council
Funding Amount
$117,331.00
Summary
Ankle fractures are frequently seen in emergency departments, and isolated AO type B fibula fractures are the most common type of ankle fracture. Current treatment is equally divided between surgical, and non-surgical, as per surgeon preference. When managed surgically, these fractures consume considerable healthcare resources and expose patients to risks. This study will determine if surgery improves outcomes for patients with type B ankle fractures when compared with non-surgical management.
Obstructive sleep apnea (OSA) is one of the most common complications of obesity and is independently associated with a reduced quality of life and cardiovascular disease. This project aims to identify the underlying factors linking obesity with OSA by examining how weight loss surgery can improve these factors. These important findings will contribute greatly to our understanding of OSA pathophysiology and are necessary to find better treatments for obesity-associated OSA.
A Randomised Controlled Trial Comparing Intraoperative To Conventional Radiotherapy In Women With Early Beast Cancer.
Funder
National Health and Medical Research Council
Funding Amount
$874,046.00
Summary
With the advent of breast screening in Australia many women are diagnosed with small low risk cancers that can be treated with breast conserving therapy with good outcomes. Surgery and radiotherapy in this situation are used to minimise the risk of local recurrence. It is now being questioned whether we can tailor radiotherapy to suit individual patients rather than recommending the daily 6-7 weeks of standard external beam radiotherapy to all patients. This trial aims to answer this question as ....With the advent of breast screening in Australia many women are diagnosed with small low risk cancers that can be treated with breast conserving therapy with good outcomes. Surgery and radiotherapy in this situation are used to minimise the risk of local recurrence. It is now being questioned whether we can tailor radiotherapy to suit individual patients rather than recommending the daily 6-7 weeks of standard external beam radiotherapy to all patients. This trial aims to answer this question as a new device which can deliver radiotherapy intraoperatively in a single session has now been tested and proven safe to use in the breast. The main objective of this trial is to demonstrate that a single dose of radiotherapy delivered intraoperatively (IORT) gives an equivalent local control rate to standard external beam radiotherapy in women with early low risk breast cancer who are suitable for breast conserving therapy. Other objectives include comparing the two treatments with respect to; disease-free-overall survival, cosmetic outcome, patient satisfaction-preference, quality of life and cost benefit. If the study finds that IORT alone after breast conserving surgery is as effective in achieving local control as standard external beam radiotherapy, a major benefit to patients would be shorter treatment duration by avoiding the 6-7 weeks of standard radiotherapy. A reduction in the number of early breast cancer patients requiring access to standard radiotherapy would also benefit treatment centres and other cancer patients by reducing the waiting times for radiotherapy. Consumer groups have supported the concept from the beginning and there has been recent increase in level of support by originally unsupportive groups. Of great significance is this trial offers an opportunity to formally investigate the efficacy of delivering IORT in the safe confines of a clinical trial, before allowing it to become a standard treatment which is occurring in other countries.Read moreRead less
Improving Muscle Function After Injury: Novel Tissue Engineering Strategies For Exercise, Surgery And Sports Medicine
Funder
National Health and Medical Research Council
Funding Amount
$288,210.00
Summary
Muscles can be injured by excessive strains when playing sports, in road and workplace accidents, and during plastic and reconstructive surgery. Some surgeries require an unavoidable interruption to the muscle's normal blood supply (called 'ischaemia'). Subsequent return of the muscle's blood supply (reperfusion) is problematic in that a severe secondary muscle injury can ensue mediated by the influx of damaging free radicals when blood flow is restored. Tissue-engineering provides a novel thera ....Muscles can be injured by excessive strains when playing sports, in road and workplace accidents, and during plastic and reconstructive surgery. Some surgeries require an unavoidable interruption to the muscle's normal blood supply (called 'ischaemia'). Subsequent return of the muscle's blood supply (reperfusion) is problematic in that a severe secondary muscle injury can ensue mediated by the influx of damaging free radicals when blood flow is restored. Tissue-engineering provides a novel therapeutic approach to restore muscle structure and function to damaged muscles after injury or disease. Our recent research using controlled release of growth factors from biodegradable hydrogels has exciting application for muscle repairafter injury. We will utilize these cutting edge tissue engineering strategies to deliver to damaged muscles a hydrogel containing controlled delivery (slow release) microcapsules loaded with an anabolic agent (the beta-agonist, formoterol) and-or a growth factor (IL-15) designed to enhance functional muscle repair after three distinct but clinically relevant models of muscle injury: a) crush injury: A model for muscle injuries on the sports field, in the workplace, and those associated with road trauma; b) ischaemia-reperfusion injury: a model for muscle damage associated with surgical interventions, muscle transfers for functional restoration, and other injuries associated with plastic and reconstructive surgery; and c) contraction-induced injury: a model for strain injuries such as hamstring muscle tears that can occur on the sports field. After injury we will assess functional muscle repair using a comprehensive series of histological, biochemical, molecular, immunochistochemical, and physiological techniques. The research has broad application to exercise and clinical medicine; including sports, emergency and rehabilitation medicine, and plastic, reconstructive, and orthopaedic surgery.Read moreRead less
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$1,031,381.00
Summary
Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some co ....Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some continue to experience symptoms. Surgery is the only treatment which will cure reflux. It has a clear role in the treatment of patients with ongoing symptoms, those who don t want to take tablets, and patients with a large hiatus hernia in whom symptoms occur due to the relocation of the stomach from the abdomen into the chest. Approximately 5,000 Australians per year undergo surgery for reflux. The standard operation achieves a good outcome in approximately 90%, although some patients are troubled by side effects. To reduce the risk of this, the original procedure has been modified. However, the evidence supporting modifications has until recently been limited. The best way to compare different operations is in randomised trials. The majority of the largest and best trials addressing this area have been undertaken in Adelaide. We have already entered 504 patients into 5 randomised trials, 4 conducted entirely in Adelaide, and one across multiple sites with the cooperation of 15 Australasian surgeons. These trials have provided a more reliable evidence base for surgeons undertaking surgery for reflux. However, long term follow-up is required to ensure that conclusions drawn are valid at late follow-up. In addition we are establishing 2 new randomised trials, which will determine how best to perform surgery for reflux, and how best to repair a large hiatus hernia. These studies will be undertaken in collaboration with more than 25 other surgeons throughout Australia.Read moreRead less
Pancreatic Cancer is the fourth leading cause of cancer death in men and women in Western societies. Nothing, apart from surgery in a small proportion of individuals gives any hope. The identification of novel treatment strategies in the modern era necessitates a rational scientific approach, where an understanding of the molecular mechanisms involved in the evolution of cancer underpins the development of such strategies in an efficient manner. Retinoids are derivatives of Vitamin A, and have b ....Pancreatic Cancer is the fourth leading cause of cancer death in men and women in Western societies. Nothing, apart from surgery in a small proportion of individuals gives any hope. The identification of novel treatment strategies in the modern era necessitates a rational scientific approach, where an understanding of the molecular mechanisms involved in the evolution of cancer underpins the development of such strategies in an efficient manner. Retinoids are derivatives of Vitamin A, and have been used extremely successfully in the treatment of some leukaemias. Unfortunately, retinoids have not worked as well in other cancers. We have identified an important role for abnormal retinoid function in the evolution of pancreatic cancer, which may be responsible for the lack of effective response to retinoid treatment. This project focuses on identifying if these abnormalities in retinoid function can be reversed with adding specific pharmaceuticals so that retinoid based therapies will be effective in pancreatic cancer.Read moreRead less