Long Term Follow-up Of Randomised Controlled Trials For Laparoscopic Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$712,100.00
Summary
17% of Australians use medication for gastro-oesophageal reflux, with many requiring tablets life long. In >15% this is not adequate. The alternative is surgery which is the only curative treatment for reflux and hiatus hernia. It achieves a good outcome in 90%, although some develop further reflux or side effects. To reduce problems procedures have been modified. In a series of trials we are evaluating long term outcomes for modifications, to determine the best surgical treatment for reflux.
Pre-hospital Antifibrinolytics For Traumatic Coagulopathy And Haemorrhage (The PATCH Study)
Funder
National Health and Medical Research Council
Funding Amount
$1,668,152.00
Summary
About 2500 Australians die annually from severe injuries. Bleeding is exacerbated by early-onset clotting defects, which are associated with high mortality. The antifibrinolytic agent tranexamic acid has been shown to reduce mortality due to bleeding when given in hospital in less developed trauma systems, but its usefulness as a pre-emptive strike at the scene of injury in developed systems is unknown. Building on our prehospital clinical trials expertise, we will conduct a trial to assess its ....About 2500 Australians die annually from severe injuries. Bleeding is exacerbated by early-onset clotting defects, which are associated with high mortality. The antifibrinolytic agent tranexamic acid has been shown to reduce mortality due to bleeding when given in hospital in less developed trauma systems, but its usefulness as a pre-emptive strike at the scene of injury in developed systems is unknown. Building on our prehospital clinical trials expertise, we will conduct a trial to assess its effect on 6-month death and disability.Read moreRead less
A La CaRT: Australasian Phase III Randomised Trial Comparing Laparoscopic-assisted Versus Open Resection For Rectal Cancer
Funder
National Health and Medical Research Council
Funding Amount
$974,440.00
Summary
The current major treatment for rectal cancer is surgical removal of the cancer. This type of surgery requires a large cut through the abdomen for removal of the cancer. There is a newer, less invasive procedure known as laparoscopic resection enabling the same surgery by using a scope inserted in the abdomen along with a smaller incision to allow removal of the tumour. This study is being conducted to determine whether the newer procedure is as safe and effective as the current procedure.
POSNOC (Positive Sentinel Node – A Randomised Trial Of Adjuvant Therapy Alone Versus Adjuvant Therapy Plus Clearance Or Axillary Radiotherapy)
Funder
National Health and Medical Research Council
Funding Amount
$1,223,428.00
Summary
POSNOC (POsitive Sentinel NOde – adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy) will address the key unresolved challenge in breast cancer surgery. A controversial US trial, ACOSOG Z0011, indicates that many breast cancer patients with limited disease in the sentinel node can safely avoid further nodal surgery. This would be a major advance, but there is widespread doubt that the results are broadly applicable. POSNOC will clarify this key issue.
Perioperative Beta-blockade To Prevent Cardiac Morbidity In High-risk Patients Undergoing Surgery (The POISE Study)
Funder
National Health and Medical Research Council
Funding Amount
$189,625.00
Summary
Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a subst ....Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a substantial group of patients are therefore at risk of an adverse outcome following surgery. Despite the magnitude of this problem, however, few studies have established treatments to decrease the risk of complications and death following surgery. Beta-blockers are a group of drugs which have been used for decades in the treatment of heart disease and high blood pressure. Beta-blockers are known to improve the way the heart copes with the stress of surgery. They decrease the heart rate, make the heart more efficient at using energy and reduce the likelihood of imbalance between oxygen supply and demand. Some previous studies showed that beta-blockers may reduce the risk of heart attack and death for up to 2 years after surgery. However, other studies have shown no effect of beta-blockers on outcome. These previous studies have involved small numbers of patients who may not represent the broader population having surgery. We therefore propose to undertake a large trial to definitively answer the question about whether beta-blockers improve the outcome after non-cardiac surgery in patients with, or at risk of, heart disease. Even if the effect of beta-blockers is relatively modest, because such large numbers of patients with heart disease have surgery, the overall effect on the rate of complications and death in the population could be very significant. The results of this study could have major implications for the success of, and cost of, surgery worldwide.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