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Aim: This paper describes the use of the single patient therapy plan (SPTP). The SPTP has been designed to assess the efficacy at an individual level of a commercially available cannabinoid product, cannabidiol, in reducing seizure frequency in paediatric patients with intractable epilepsy. Method(s): The SPTP is a randomised, double-blind, placebo-controlled N-of-1 trial designed to assess the efficacy of treatment in a neurology outpatient setting. The primary objective of the SPTP is to assess the efficacy of cannabidiol in reducing seizure frequency in each patient with intractable epilepsy, with change in seizure frequency being the primary outcome of interest. The analysis adopts a Bayesian approach, which provides results in the form of posterior probabilities that various levels of benefit (based on the primary outcome measure, seizure frequency) have been achieved under active treatment compared to placebo, accompanied by decision rules that provide thresholds for deciding whether treatment has been successful in the individual patient. The SPTP arrangement is most accurately considered part of clinical practice rather than research, since it is aimed at making clinical treatment decisions for individual patients and is not testing a hypothesis or collecting aggregate data. Therefore, Human Research Ethics Committee approval was considered not to be required, although it is recommended that hospital Clinical Ethics Committees provide ethical oversight. Conclusion(s): These SPTP resources are made available so that they may inform clinical practice in the treatment of severe epilepsy or adapted for use in other conditions.Copyright © 2020, Commonwealth of Australia. Journal of Paediatrics and Child Health © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Background: Melatonin is a potent oxygen scavenger and is capable of altering blood flow in various vascular beds. Aim(s): We aimed to determine the effect of melatonin on ovarian vascular indices during ovarian stimulation for in vitro fertilisation (IVF). Material(s) and Method(s): This is a pilot double-blind placebo-controlled randomised trial. Sixty-nine women (mean age 35.8 +/- 4.3 years) undergoing their first cycle of IVF were randomised to receive either placebo, 2, 4 or 8 mg of melatonin, twice a day. Each participant underwent a transvaginal ultrasound at days 6-10 assessing follicular number and size. The vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI) were measured. These indices were then correlated with embryological outcomes. Informed consent was obtained from participants. This trial was registered with the Australia New Zealand Clinical Trials Registry (ACTRN12613001317785). Result(s): The number of follicles did not differ between groups (P = 0.4). There were no differences in the VI (P = 0.4), FI (P = 0.1) or VFI (P = 0.3) in the right ovary or the FI (P = 0.3) or VFI (P = 0.3) in the left ovary between groups. When comparing placebo to any dose of melatonin, there were no differences in any measured parameter. While there was correlation between the number of follicles on ultrasound and all measured embryological outcomes, there was no correlation between ovarian vascular indices and these important clinical outcomes. Conclusion(s): Melatonin does not appear to change ovarian vascular indices during ovarian stimulation. In addition, such vascular indices cannot predict the number or quality of oocytes or embryos obtained in an IVF cycle. These findings require confirmation in future larger studies.Copyright © 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Aim: This paper describes the use of the single patient therapy plan (SPTP). The SPTP has been designed to assess the efficacy at an individual level of a commercially available cannabinoid product, cannabidiol, in reducing seizure frequency in paediatric patients with intractable epilepsy. Method(s): The SPTP is a randomised, double-blind, placebo-controlled N-of-1 trial designed to assess the efficacy of treatment in a neurology outpatient setting. The primary objective of the SPTP is to assess the efficacy of cannabidiol in reducing seizure frequency in each patient with intractable epilepsy, with change in seizure frequency being the primary outcome of interest. The analysis adopts a Bayesian approach, which provides results in the form of posterior probabilities that various levels of benefit (based on the primary outcome measure, seizure frequency) have been achieved under active treatment compared to placebo, accompanied by decision rules that provide thresholds for deciding whether treatment has been successful in the individual patient. The SPTP arrangement is most accurately considered part of clinical practice rather than research, since it is aimed at making clinical treatment decisions for individual patients and is not testing a hypothesis or collecting aggregate data. Therefore, Human Research Ethics Committee approval was considered not to be required, although it is recommended that hospital Clinical Ethics Committees provide ethical oversight. Conclusion(s): These SPTP resources are made available so that they may inform clinical practice in the treatment of severe epilepsy or adapted for use in other conditions.Copyright © 2020, Commonwealth of Australia. Journal of Paediatrics and Child Health © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Background: Melatonin is a potent oxygen scavenger and is capable of altering blood flow in various vascular beds. Aim(s): We aimed to determine the effect of melatonin on ovarian vascular indices during ovarian stimulation for in vitro fertilisation (IVF). Material(s) and Method(s): This is a pilot double-blind placebo-controlled randomised trial. Sixty-nine women (mean age 35.8 +/- 4.3 years) undergoing their first cycle of IVF were randomised to receive either placebo, 2, 4 or 8 mg of melatonin, twice a day. Each participant underwent a transvaginal ultrasound at days 6-10 assessing follicular number and size. The vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI) were measured. These indices were then correlated with embryological outcomes. Informed consent was obtained from participants. This trial was registered with the Australia New Zealand Clinical Trials Registry (ACTRN12613001317785). Result(s): The number of follicles did not differ between groups (P = 0.4). There were no differences in the VI (P = 0.4), FI (P = 0.1) or VFI (P = 0.3) in the right ovary or the FI (P = 0.3) or VFI (P = 0.3) in the left ovary between groups. When comparing placebo to any dose of melatonin, there were no differences in any measured parameter. While there was correlation between the number of follicles on ultrasound and all measured embryological outcomes, there was no correlation between ovarian vascular indices and these important clinical outcomes. Conclusion(s): Melatonin does not appear to change ovarian vascular indices during ovarian stimulation. In addition, such vascular indices cannot predict the number or quality of oocytes or embryos obtained in an IVF cycle. These findings require confirmation in future larger studies.Copyright © 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Aim The Fish oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial investigated whether 3 months of omega-3 polyunsaturated fatty acids, either alone or in combination with aspirin, will effectively reduce primary access failure of de novo arteriovenous fistulae. This report presents the baseline characteristics of all study participants, examines whether study protocol amendments successfully increased recruitment of a broader and more representative haemodialysis cohort, including patients already receiving aspirin, and contrasts Malaysian participants with those from Australia, New Zealand and the United Kingdom (UK). Method This international, randomized, double-blind, placebo-controlled trial included patients older than 19 years with stage 4 or 5 chronic kidney disease currently receiving, or planned within 12 months to receive haemodialysis. Results Participants (n = 568) were overweight (28.6 +/- 7.3 kg/m2), relatively young (54.8 +/- 14.3 years), and predominantly male (63%) with a high prevalence of diabetes mellitus (46%) but low rate of ischaemic heart disease (8%). Sixty one percent were planned for lower arm arteriovenous fistula creation. Malaysian participants (n = 156) were younger (51.8 +/- 13.6 years vs 57.1 +/- 14.2 years, P < 0.001) with a higher prevalence of diabetes mellitus (65% vs 43%, P < 0.001), but less ischaemic heart disease (5% vs 14%, P < 0.01) compared with the combined Australian, New Zealand and UK cohort (n = 228). Protocol modifications allowing for inclusion of patients receiving aspirin increased the prevalence of co-morbidities compared with the original cohort. Conclusions The FAVOURED study participants, while mostly similar to patients in contemporary national registry reports and comparable recent clinical trials, were on average younger and had less ischaemic heart disease. These differences were reduced as a consequence of including patients already receiving aspirin.Copyright © 2015 Asian Pacif

Objective: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Method(s): Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 x 500 mg paracetamol and 2 x 200 mg ibuprofen with 2 x 100 mg thiamine (non-opioid), 2 x 30 mg codeine (codeine) or 2 x 5 mg oxycodone tablets (oxycodone). Primary Outcome: difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Result(s): Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95% CI) between groups at 30 min were as follows: non-opioid versus codeine -2.6 (-8.8 to 3.6); non-opioid versus oxycodone -2.7 (-9.3 to 3.9); codeine versus oxycodone 0.1 (-6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were -13.5, -16.1 and -16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6% (64.7-87.5), 81.0% (67.2-89.0) and 73.6% (59.7-84.7) and adverse events by 3.3% (0.4-11.3), 1.6% (0.4-8.7) and 16.9% (8.4-29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: -23.2 and -18.7 mm for non-opioid; -30.7 and -33.3 mm for codeine; and -26.1 and -31.7 mm for oxycodone. Conclusion(s): At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.Copyright © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

Aim The Fish oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial investigated whether 3 months of omega-3 polyunsaturated fatty acids, either alone or in combination with aspirin, will effectively reduce primary access failure of de novo arteriovenous fistulae. This report presents the baseline characteristics of all study participants, examines whether study protocol amendments successfully increased recruitment of a broader and more representative haemodialysis cohort, including patients already receiving aspirin, and contrasts Malaysian participants with those from Australia, New Zealand and the United Kingdom (UK). Method This international, randomized, double-blind, placebo-controlled trial included patients older than 19 years with stage 4 or 5 chronic kidney disease currently receiving, or planned within 12 months to receive haemodialysis. Results Participants (n = 568) were overweight (28.6 +/- 7.3 kg/m2), relatively young (54.8 +/- 14.3 years), and predominantly male (63%) with a high prevalence of diabetes mellitus (46%) but low rate of ischaemic heart disease (8%). Sixty one percent were planned for lower arm arteriovenous fistula creation. Malaysian participants (n = 156) were younger (51.8 +/- 13.6 years vs 57.1 +/- 14.2 years, P < 0.001) with a higher prevalence of diabetes mellitus (65% vs 43%, P < 0.001), but less ischaemic heart disease (5% vs 14%, P < 0.01) compared with the combined Australian, New Zealand and UK cohort (n = 228). Protocol modifications allowing for inclusion of patients receiving aspirin increased the prevalence of co-morbidities compared with the original cohort. Conclusions The FAVOURED study participants, while mostly similar to patients in contemporary national registry reports and comparable recent clinical trials, were on average younger and had less ischaemic heart disease. These differences were reduced as a consequence of including patients already receiving aspirin.Copyright © 2015 Asian Pacif

Objective: The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus. Method(s): A prospective, double-blind, double dummy trial of adult patients requiring intravenous metoclopramide in the ED. Participants were randomised to receive either: metoclopramide 20mg as a bolus and normal saline infusion over 15min, or normal saline bolus and metoclopramide 20mg infused over 15min. Patients were assessed for DIA using the Prince Henry Akathisia Rating Scale before treatment was commenced and at 20, 40 and 60min post. Nausea was assessed with a visual analog scale. Result(s): Of 210 participants assessed for eligibility, 206 were randomised and 205 were included in the final analysis. Participant characteristics and indication for metoclopramide were well matched between the treatment groups. Overall, incidence of DIA was 26 out of 205 participants (12.68%, 95% confidence interval [CI] 8.09-17.3). DIA occurred in 11 out of 103 (10.68%, 95% CI 4.61-16.74%) in the bolus group, and in 15 out of 102 (14.71%, 95% CI 7.71-21.70%) in the infusion group (P = 0.67). Severe DIA occurred in six patients in each group. The mean age of patients experiencing DIA was 34 years (interquartile range 29-40) and 42 years (interquartile range 40-45) in those without akathisia (P = 0.04). Nausea reduction was equivalent in both groups. Conclusion(s): The incidence of DIA and reduction in nausea is unaffected by the rate of administration of intravenous metoclopramide 20mg. © 2013 The Authors. EMA © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Objective: The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus. Method(s): A prospective, double-blind, double dummy trial of adult patients requiring intravenous metoclopramide in the ED. Participants were randomised to receive either: metoclopramide 20mg as a bolus and normal saline infusion over 15min, or normal saline bolus and metoclopramide 20mg infused over 15min. Patients were assessed for DIA using the Prince Henry Akathisia Rating Scale before treatment was commenced and at 20, 40 and 60min post. Nausea was assessed with a visual analog scale. Result(s): Of 210 participants assessed for eligibility, 206 were randomised and 205 were included in the final analysis. Participant characteristics and indication for metoclopramide were well matched between the treatment groups. Overall, incidence of DIA was 26 out of 205 participants (12.68%, 95% confidence interval [CI] 8.09-17.3). DIA occurred in 11 out of 103 (10.68%, 95% CI 4.61-16.74%) in the bolus group, and in 15 out of 102 (14.71%, 95% CI 7.71-21.70%) in the infusion group (P = 0.67). Severe DIA occurred in six patients in each group. The mean age of patients experiencing DIA was 34 years (interquartile range 29-40) and 42 years (interquartile range 40-45) in those without akathisia (P = 0.04). Nausea reduction was equivalent in both groups. Conclusion(s): The incidence of DIA and reduction in nausea is unaffected by the rate of administration of intravenous metoclopramide 20mg. © 2013 The Authors. EMA © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness ofomega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Method(s): A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of >3.5mM to 10.0 mM using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Result(s): Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mM at baseline to 4.44mM (-11.6%) after dietary intervention and 3.37 mM (-32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mM to 5.02 mM (-6%) after dietary intervention and to 2.30 mM (-56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mM to 4.05 mM (-15.1%) after dietary intervention and to 4.08 mM (-14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (chi2=6.04, P=0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was-2.32 mM (95% CI-4.52,-0.12 mM). Conclusion(s): Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART. © CSIRO 2006.

Fifty-five patients were randomized in a double-blinded manner to large loop excision of the transformation zone (LLETZ) (29 patients) or radical cervical diathermy with fulgaration (RCDF) (26 patients) for treatment of cervical intraepithelial neoplasia (CIN). Patients completed a 2-month diary of symptoms and completed a 10-week postoperative questionnaire. White vaginal discharge lasted 7.3 (4.6) days (SD) for RCDF compared to 3.4 (1.6) days (SD) for LLETZ. There was no significant difference in any other symptoms on analysis This appears to be the first report clearly assessing the length and severity of postoperative symptoms following LLETZ or RCDF. There is no reason on length and severity of postoperative symptoms to choose 1 of these 2 treatment methods over the other.

Background: Animal studies have demonstrated an interaction within the striatum between the angiotensin and dopaminergic systems. In rats, the angiotensin converting enzyme (ACE) inhibitor, perindopril, crosses the blood brain barrier and increases striatal dopamine synthesis and release. In humans, angiotensin type 1 receptors have been found on dopaminergic neurons in the substantia nigra and striatum. In Parkinson's disease, there is a marked reduction of these receptors associated with the nigrostriatal dopaminergic neuron loss. Aim(s): We performed a double blind placebo controlled crossover pilot study in seven patients to investigate the effect of the ACE inhibitor, perindopril on the clinical features of moderately severe Parkinson's disease. Result(s): After a four week treatment period with perindopril, patients had a faster onset in their motor response to L-dopa and a reduction in 'on phase' peak dyskinesia, p=0.021 and p=0.014 respectively. Patients also reported more 'on' periods during their waking day in their movement diary, p=0.007. Perindopril was well tolerated without any significant postural hypotension or renal dysfunction. Conclusion(s): These results suggest that ACE inhibitors such as perindopril may have a place in the management of motor fluctuations and dyskinesia in Parkinson's disease and justify further study.

Objective: To assess whether electrocardiogram (ECG) interpretation accuracy improves with advancing years of emergency medicine training. Method(s): A prospective cross-sectional double-blinded study of emergency medicine trainees attending teaching sessions in ACEM accredited Victorian hospitals. Subjects completed a survey about level of training, rotations completed and ECG training. They were then asked for the 'main diagnosis' on 10 clinically significant ECG. Those in their fourth year of advanced training onwards, or in active preparation for fellowship examination (senior trainees) were compared with trainees in earlier years (other trainees). Result(s): There were 122 trainees surveyed in total. In the present study, 48/122 were senior trainees and 74/122 were other trainees. The overall accuracy of ECG interpretation was 67.5% (95% confidence interval [CI] 63.2-71.8%) for the senior trainees and 49.6% (95% CI 45.2-53.9%) for the others. Results for some of the individual ECG were: left bundle branch block: 81.3% (95% CI 69.9-92.6%) seniors and 58.1% (95% CI 46.6-69.7%) others; ventricular tachycardia: 43.8% (95% CI 29.3-58.2%) seniors and 37.8% (95% CI 26.5-49.2%) others; and ventricular fibrillation: 70.8% (95% CI 57.6-84.1%) seniors and 63.5% (95% CI 52.2-74.9%) others. Conclusion(s): There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training. © 2007 The Authors.

1. The aim of the present study was to determine whether anti-oxidant therapy with vitamin E and/or cholesterol-lowering therapy with simvastatin would augment resting forearm blood flow (FBF) and metabolic vasodilation in response to exercise and improve endothelial function in young patients with hypercholesterolaemia. 2. Endothelium-dependent and -independent, nitric oxide (NO)-mediated vasodilation have been shown to be impaired in young, otherwise healthy subjects with hypercholesterolaemia. Recent experimental and clinical studies suggest that vascular function may be improved with anti-oxidant or cholesterol-lowering therapy, although these treatments may be synergistic. 3. We compared FBF at rest, in response to isotonic exercise, the endothelium-dependent vasodilator acetylcholine (ACh), the endothelium-independent vasodilator sodium nitroprusside (SNP) and the NO synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) in 26 young, otherwise healthy volunteers (mean (+/-SD) age 29+/-7 years; 14 female, 12 male) with hypercholesterolaemia, before and after 6 months treatment with vitamin E, simvastatin and/or placebo. Treatment was randomized, double-blinded in a 2 x 2 factorial design. Forearm blood flow was measured using venous occlusion plethysmography. 4. Vitamin E therapy increased plasma alpha-tocopherol from 39.5+/-9.6 to 75.7+/-33.8 mumol/L (P < 0.001). Simvastatin reduced total cholesterol from 6.9+/-1.7 to 4.9+/-0.8 mmol/L and low-density lipoprotein (LDL) from 4.8+/-1.7 to 3.0+/-0.7 mmol/L (both P < 0.001), although total and LDL-cholesterol also decreased slightly in the placebo group. Vitamin E increased resting FBF from 2.1+/-0.3 to 2.4+/-0.3 mL/100mL per min (P= 0.04) and decreased resting forearm vascular resistance from 42.1+/-4.2 to 36.1+/-3.4 units (P = 0.01), but the reduction in resting FBF with L-NMMA was not affected. Vasodilation in response to isotonic exercise, ACh and SNP was similar before and after treatment in the placebo, vitamin

Background: Plasma homocysteine is elevated in patients with end-stage renal disease (ESRD) and is a risk factor for cardiovascular disease. Folic acid has been shown to partially reduce homocysteine levels in dialysis patients. It is not known whether vitamin B12 reduces homocysteine independent of folic acid in patients who are not vitamin B12 deficient. Aim(s): To determine whether 1 mg vitamin B12 lowers homocysteine in stable, chronic, haemodialysis patients independent of folic acid. Method(s): Twenty-eight haemodialysis patients were randomized to receive three doses of 1 mg vitamin B12 or 1 mL saline placebo in a double-blind fashion at 1-month intervals. Fasting plasma total homocysteine, folic acid, red-cell folate, vitamin B12 and haemoglobin levels were determined prior to each dose and 4 weeks after the final injection. The study was powered to detect a 30% reduction in homocysteine over the 3 months. Result(s): Both the two groups were well matched with respect to total homocysteine levels, folic acid, red-cell folate and vitamin B12 levels. Serum vitamin B12 levels were significantly higher in the treatment group compared to placebo (217.7 pmol/L; 95% confidence interval (CI) 103.0-332.5; P < 0.001) at the end of the trial but homocysteine levels were not significantly different (3.08 nmol/L; 95% CI -4.44-10.61; P = 0.406). Conclusion(s): The administration of intramuscular vitamin B12 over a 3-month period does not result in any reduction of plasma homocysteine levels in haemodialysis patients independent of folate status, however reductions of <30% cannot be excluded by the present study. High-dose folic acid remains the treatment of choice in reducing homocysteine, but whether this results in a reduction in cardiovascular events remains to be determined.

Background and objective: Hyperoxia has been shown to reduce resting ventilation, hyperinflation and dyspnoea in patients with severely hypoxaemic COPD. This study assessed the effects of hyperoxia on these resting measures in patients with COPD of varying disease severity and characterized those patients who responded. Method(s): Measurements of dyspnoea (Borg score), oxyhaemoglobin saturation (SpO2), inspiratory capacity (IC), minute ventilation, tidal volume, breathing and cardiac frequency were performed at rest in 51 patients with COPD while they breathed air and 44% oxygen, in a randomized double-blinded fashion. Result(s): Hyperoxia induced significant reductions in cardiac frequency and dyspnoea and a significant increase in SpO2. No significant change was noted in IC for the group overall, and there was substantial inter-subject variation in this measurement. No significant changes were found in ventilation, and there was no correlation between change in dyspnoea and change in IC. In patients with moderate to severe airflow obstruction (FEV1 < 70% predicted), a significant association was found between the degree of airflow obstruction and change in IC induced by hyperoxia. Conclusion(s): Hyperoxia improved dyspnoea but did not significantly alter resting pulmonary hyperinflation in a group of patients with COPD of varying severity. However, in a subset patients with moderate to severe airflow obstruction a relationship existed between the severity of airflow obstruction and volume response to hyperoxia.

One hundred and sixty nine men with early male pattern baldness (androgenic alopecia) were treated in a random, double-blind fashion with either 2% minoxidil solution or placebo vehicle for 24 weeks, one ml applied twice daily. After 24 weeks all patients received the active solution until week 48. After 24 weeks the minoxidil treated patients had increased their non-vellus hair counts significantly more than the placebo treated group; means were 37.6 and 8.8 hairs per reference area, 95% C.I. for difference = 10.85 to 60.75. The rate of non-vellus hair regrowth was also greater among minoxidil treated patients than placebo treated patients. Nine (12.5%) evaluable minoxidil treated patients compared with 2 (2.7%) evaluable placebo treated patients reported moderate or dense hair regrowth at week 24. Minimal regrowth was reported by 18 (25%) active group and 15 (20%) placebo group patients. The investigators considered that 3 (2%) of the minoxidil group and none of the placebo group had moderate hair regrowth and that none had dense regrowth. After 48 weeks treatment 28 (23%) patients considered that they had moderate hair regrowth and the investigators considered that 14 (12%) patients had moderate regrowth. None had dense growth. No serious adverse reactions or deaths were reported. Minoxidil solution appeared to be an efficacious and safe treatment for early androgenic alopecia.

Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness ofomega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Method(s): A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of >3.5mM to 10.0 mM using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Result(s): Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mM at baseline to 4.44mM (-11.6%) after dietary intervention and 3.37 mM (-32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mM to 5.02 mM (-6%) after dietary intervention and to 2.30 mM (-56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mM to 4.05 mM (-15.1%) after dietary intervention and to 4.08 mM (-14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (chi2=6.04, P=0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was-2.32 mM (95% CI-4.52,-0.12 mM). Conclusion(s): Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART. © CSIRO 2006.

Anecdotally, hysteroscopy and curettage under general anaesthesia causes crampy postoperative pain. A randomised, double-blind trial to investigate whether intrauterine lignocaine could decrease such pain was initiated by us. At an interim analysis, the results of the study found that almost half of all women studied so far (n = 53) were completely painfree from the moment they awoke with no difference between placebo and treatment groups. Of the remainder, most rated pain as either 'mild', or less. For most women, hysteroscopy, dilatation and curettage causes either none or very little pain postoperatively.

Fifty-five patients were randomized in a double-blinded manner to large loop excision of the transformation zone (LLETZ) (29 patients) or radical cervical diathermy with fulgaration (RCDF) (26 patients) for treatment of cervical intraepithelial neoplasia (CIN). Patients completed a 2-month diary of symptoms and completed a 10-week postoperative questionnaire. White vaginal discharge lasted 7.3 (4.6) days (SD) for RCDF compared to 3.4 (1.6) days (SD) for LLETZ. There was no significant difference in any other symptoms on analysis This appears to be the first report clearly assessing the length and severity of postoperative symptoms following LLETZ or RCDF. There is no reason on length and severity of postoperative symptoms to choose 1 of these 2 treatment methods over the other.

Background: Animal studies have demonstrated an interaction within the striatum between the angiotensin and dopaminergic systems. In rats, the angiotensin converting enzyme (ACE) inhibitor, perindopril, crosses the blood brain barrier and increases striatal dopamine synthesis and release. In humans, angiotensin type 1 receptors have been found on dopaminergic neurons in the substantia nigra and striatum. In Parkinson's disease, there is a marked reduction of these receptors associated with the nigrostriatal dopaminergic neuron loss. Aim(s): We performed a double blind placebo controlled crossover pilot study in seven patients to investigate the effect of the ACE inhibitor, perindopril on the clinical features of moderately severe Parkinson's disease. Result(s): After a four week treatment period with perindopril, patients had a faster onset in their motor response to L-dopa and a reduction in 'on phase' peak dyskinesia, p=0.021 and p=0.014 respectively. Patients also reported more 'on' periods during their waking day in their movement diary, p=0.007. Perindopril was well tolerated without any significant postural hypotension or renal dysfunction. Conclusion(s): These results suggest that ACE inhibitors such as perindopril may have a place in the management of motor fluctuations and dyskinesia in Parkinson's disease and justify further study.

Objective: To assess whether electrocardiogram (ECG) interpretation accuracy improves with advancing years of emergency medicine training. Method(s): A prospective cross-sectional double-blinded study of emergency medicine trainees attending teaching sessions in ACEM accredited Victorian hospitals. Subjects completed a survey about level of training, rotations completed and ECG training. They were then asked for the 'main diagnosis' on 10 clinically significant ECG. Those in their fourth year of advanced training onwards, or in active preparation for fellowship examination (senior trainees) were compared with trainees in earlier years (other trainees). Result(s): There were 122 trainees surveyed in total. In the present study, 48/122 were senior trainees and 74/122 were other trainees. The overall accuracy of ECG interpretation was 67.5% (95% confidence interval [CI] 63.2-71.8%) for the senior trainees and 49.6% (95% CI 45.2-53.9%) for the others. Results for some of the individual ECG were: left bundle branch block: 81.3% (95% CI 69.9-92.6%) seniors and 58.1% (95% CI 46.6-69.7%) others; ventricular tachycardia: 43.8% (95% CI 29.3-58.2%) seniors and 37.8% (95% CI 26.5-49.2%) others; and ventricular fibrillation: 70.8% (95% CI 57.6-84.1%) seniors and 63.5% (95% CI 52.2-74.9%) others. Conclusion(s): There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training. © 2007 The Authors.

1. The aim of the present study was to determine whether anti-oxidant therapy with vitamin E and/or cholesterol-lowering therapy with simvastatin would augment resting forearm blood flow (FBF) and metabolic vasodilation in response to exercise and improve endothelial function in young patients with hypercholesterolaemia. 2. Endothelium-dependent and -independent, nitric oxide (NO)-mediated vasodilation have been shown to be impaired in young, otherwise healthy subjects with hypercholesterolaemia. Recent experimental and clinical studies suggest that vascular function may be improved with anti-oxidant or cholesterol-lowering therapy, although these treatments may be synergistic. 3. We compared FBF at rest, in response to isotonic exercise, the endothelium-dependent vasodilator acetylcholine (ACh), the endothelium-independent vasodilator sodium nitroprusside (SNP) and the NO synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) in 26 young, otherwise healthy volunteers (mean (+/-SD) age 29+/-7 years; 14 female, 12 male) with hypercholesterolaemia, before and after 6 months treatment with vitamin E, simvastatin and/or placebo. Treatment was randomized, double-blinded in a 2 x 2 factorial design. Forearm blood flow was measured using venous occlusion plethysmography. 4. Vitamin E therapy increased plasma alpha-tocopherol from 39.5+/-9.6 to 75.7+/-33.8 mumol/L (P < 0.001). Simvastatin reduced total cholesterol from 6.9+/-1.7 to 4.9+/-0.8 mmol/L and low-density lipoprotein (LDL) from 4.8+/-1.7 to 3.0+/-0.7 mmol/L (both P < 0.001), although total and LDL-cholesterol also decreased slightly in the placebo group. Vitamin E increased resting FBF from 2.1+/-0.3 to 2.4+/-0.3 mL/100mL per min (P= 0.04) and decreased resting forearm vascular resistance from 42.1+/-4.2 to 36.1+/-3.4 units (P = 0.01), but the reduction in resting FBF with L-NMMA was not affected. Vasodilation in response to isotonic exercise, ACh and SNP was similar before and after treatment in the placebo, vitamin

Background: Plasma homocysteine is elevated in patients with end-stage renal disease (ESRD) and is a risk factor for cardiovascular disease. Folic acid has been shown to partially reduce homocysteine levels in dialysis patients. It is not known whether vitamin B12 reduces homocysteine independent of folic acid in patients who are not vitamin B12 deficient. Aim(s): To determine whether 1 mg vitamin B12 lowers homocysteine in stable, chronic, haemodialysis patients independent of folic acid. Method(s): Twenty-eight haemodialysis patients were randomized to receive three doses of 1 mg vitamin B12 or 1 mL saline placebo in a double-blind fashion at 1-month intervals. Fasting plasma total homocysteine, folic acid, red-cell folate, vitamin B12 and haemoglobin levels were determined prior to each dose and 4 weeks after the final injection. The study was powered to detect a 30% reduction in homocysteine over the 3 months. Result(s): Both the two groups were well matched with respect to total homocysteine levels, folic acid, red-cell folate and vitamin B12 levels. Serum vitamin B12 levels were significantly higher in the treatment group compared to placebo (217.7 pmol/L; 95% confidence interval (CI) 103.0-332.5; P < 0.001) at the end of the trial but homocysteine levels were not significantly different (3.08 nmol/L; 95% CI -4.44-10.61; P = 0.406). Conclusion(s): The administration of intramuscular vitamin B12 over a 3-month period does not result in any reduction of plasma homocysteine levels in haemodialysis patients independent of folate status, however reductions of <30% cannot be excluded by the present study. High-dose folic acid remains the treatment of choice in reducing homocysteine, but whether this results in a reduction in cardiovascular events remains to be determined.

Background and objective: Hyperoxia has been shown to reduce resting ventilation, hyperinflation and dyspnoea in patients with severely hypoxaemic COPD. This study assessed the effects of hyperoxia on these resting measures in patients with COPD of varying disease severity and characterized those patients who responded. Method(s): Measurements of dyspnoea (Borg score), oxyhaemoglobin saturation (SpO2), inspiratory capacity (IC), minute ventilation, tidal volume, breathing and cardiac frequency were performed at rest in 51 patients with COPD while they breathed air and 44% oxygen, in a randomized double-blinded fashion. Result(s): Hyperoxia induced significant reductions in cardiac frequency and dyspnoea and a significant increase in SpO2. No significant change was noted in IC for the group overall, and there was substantial inter-subject variation in this measurement. No significant changes were found in ventilation, and there was no correlation between change in dyspnoea and change in IC. In patients with moderate to severe airflow obstruction (FEV1 < 70% predicted), a significant association was found between the degree of airflow obstruction and change in IC induced by hyperoxia. Conclusion(s): Hyperoxia improved dyspnoea but did not significantly alter resting pulmonary hyperinflation in a group of patients with COPD of varying severity. However, in a subset patients with moderate to severe airflow obstruction a relationship existed between the severity of airflow obstruction and volume response to hyperoxia.

One hundred and sixty nine men with early male pattern baldness (androgenic alopecia) were treated in a random, double-blind fashion with either 2% minoxidil solution or placebo vehicle for 24 weeks, one ml applied twice daily. After 24 weeks all patients received the active solution until week 48. After 24 weeks the minoxidil treated patients had increased their non-vellus hair counts significantly more than the placebo treated group; means were 37.6 and 8.8 hairs per reference area, 95% C.I. for difference = 10.85 to 60.75. The rate of non-vellus hair regrowth was also greater among minoxidil treated patients than placebo treated patients. Nine (12.5%) evaluable minoxidil treated patients compared with 2 (2.7%) evaluable placebo treated patients reported moderate or dense hair regrowth at week 24. Minimal regrowth was reported by 18 (25%) active group and 15 (20%) placebo group patients. The investigators considered that 3 (2%) of the minoxidil group and none of the placebo group had moderate hair regrowth and that none had dense regrowth. After 48 weeks treatment 28 (23%) patients considered that they had moderate hair regrowth and the investigators considered that 14 (12%) patients had moderate regrowth. None had dense growth. No serious adverse reactions or deaths were reported. Minoxidil solution appeared to be an efficacious and safe treatment for early androgenic alopecia.