Caringbah

Researchers are evaluating treatments for community-acquired pneumonia CAP, especially in patients admitted to intensive care units ICUs. This trial also adapts to study treatments for respiratory pandemics like COVID-19. The goal is to determine which treatment strategies improve outcomes for patients with severe pneumonia, using a flexible, ongoing approach that can test multiple therapies simultaneously and update as new information becomes available. Participants receive different treatment strategies based on random assignment to study groups. Treatments include various antibiotics, steroids, antivirals, immune modulators, anticoagulation methods, and ventilation strategies. Some treatment options have been closed to recruitment, reflecting the trials adaptive nature. The trial includes several domains targeting specific infections such as influenza and COVID-19, with dosing and duration guided by clinical practice and local guidelines. During the study, participants are monitored closely with assessments including survival up to 90 days, days alive without organ support in ICU, ICU and hospital length of stay, ventilator-free days, organ failure-free days, and quality of life up to 6 months. Researchers collect detailed data on patient outcomes, organ support needs, and hospital discharge status. The study runs until February 2028, with ongoing evaluation to improve pneumonia treatment strategies in ICU settings and during respiratory pandemics.

Researchers are investigating the best treatment approaches for infections in artificial hip and knee joints. This study compares different surgical methods, antibiotic choices, and durations of antibiotic treatment to determine which combinations lead to the best outcomes and cure rates at 12 months. The trial focuses on adults with infected artificial joints and aims to address the significant health and economic impacts of prosthetic joint infections. Participants may receive one of several surgical strategies cleaning the infected joint without removing the implant DAIR, or revision surgery where the infected implant is replaced either in a single operation or two stages. Antibiotic treatments are also compared, with some participants receiving standard antibiotics alone and others receiving additional rifampicin. The study further explores different lengths of antibiotic courses after revision surgery, including shorter and longer durations and extended prophylaxis after two-stage revisions. During the study, participants consent to have their medical and treatment information collected in a central database and registry. Researchers will assess health status, infection cure, joint function, quality of life, and antibiotic use at 100 days and 12 months after starting the study. Outcomes like reinfection, survival, and revision surgeries will be monitored up to two years. This study does not require extra tests or treatments beyond routine care and follows participants closely to evaluate treatment success and safety.

Researchers are investigating long-term outcomes in survivors of out-of-hospital cardiac arrest, focusing on how different targets for sedation, temperature, and blood pressure management affect brain protection and recovery. This study is part of a larger international, multi-center randomized trial called STEPCARE. The study also explores the impact of caregiving on those caring for cardiac arrest survivors. Participants in the STEPCARE trial are randomly assigned to various combinations of sedation levels deep or minimal, temperature management using a feedback-controlled device or fever control without a device, and blood pressure targets high MAP above 85 mmHg or low MAP above 65 mmHg. These interventions are applied during the initial treatment period. The extended follow-up substudy enrolls survivors from selected sites who consent, following them and their nominated caregivers at 6 and 12 months after cardiac arrest. During the follow-up, researchers assess cognitive function of survivors using the Montreal Cognitive Assessment MoCA and measure caregiver burden with the Zarit Burden Interview ZBI at 6 months. The study includes questionnaires and evaluations to understand recovery and caregiving challenges. Participants are monitored over a total of 12 months, with data collected at both 6 and 12 months to evaluate long-term effects of the initial treatments and caregiving experiences.