Royal Brisbane Hospital Research Articles

Intergenerational effects of a maternal high fat diet on feto-placental development in a rabbit model

Intergenerational effects of a maternal high fat diet on feto-placental development in a rabbit model

Delay to diagnosis amongst patients with catecholaminergic polymorphic ventricular tachycardia

a Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia b Sydney Medical School, University of Sydney, Sydney, Australia c Royal Children's Hospital, Melbourne, Victoria, Australia d Genetic Health Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia e The Heart Centre for Children, The Children's Hospital, Westmead, Sydney, NSW, Australia f Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

MRI guided vacuum assisted biopsies – The RBWH experience

Background: Many breast lesions can usually be detected using mammography and ultrasound given the advancements made in these imaging modalities. However, few lesions can only be demonstrated by magnetic resonance imaging (MRI) and in such cases MRI-guided vacuum-assisted breast biopsy (VABB) becomes an essential diagnostic technique in obtaining specimens for pathological diagnosis. Method: We performed a retrospective study covering a period of 18 months to review the MRI VABB of suspicious breast lesions at the Royal Brisbane Hospital, the first public hospital in Queensland, Australia to offer this diagnostic procedure. We evaluated the MRI findings that led to biopsy and correlated the radiological BIRADS score with the pathological outcome. Patients and results: Of 11 women (median age 47years), MRI Guided vacuum assisted biopsies were successfully conducted in 10 women for suspicious breast lesions detected and visible only on MRI. Of the 10 cases, 1 revealed ductal carcinoma in situ (DCIS), 1 was reported as atypical lobular hyperplasia and the remaining 8 had benign histology on pathology. One case was cancelled as the patient opted to have short-term follow-up MR imaging instead of the biopsy. Conclusion: Our preliminary experience shows that MRI-guided vacuum assisted biopsy holds promise of being a fast and safe alternative to surgical biopsy for lesions detected and visible only on MRI.

Use of blue dye in sentinel lymph node biopsy: Time to reevaluate

Use of blue dye in sentinel lymph node biopsy: Time to reevaluate

Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair.

Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8% and 88.9% at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. • The association of calcification and thrombus volumes with EVAR outcome is unclear • Quantifiable methods for assessing calcification and thrombus were not used previously • This study used reproducible methods for assessing AAA calcification and thrombus volumes.

Carpe Diem: time to seize the opportunity for cancer prevention.

In his plea for increased resources to implement cancer prevention strategies, Graham Colditz, MD, states that half or more of cancers in the U.S. and other high-income countries are preventable with information already available. He describes the data-driven possibilites: screening, vaccination, exercise, smoking cessation, sun protection, safe sexual practices, and moderate to no alcohol intake, as well as approaches to implement these strategies and makes a compelling case for using resources for this purpose. Dr. Colditz is Associate Director of Prevention and Control in the Alvin J. Siteman Cancer Center, and Niess-Gain Professor in the Department of Surgery at the Washington University School of Medicine. He received his PhD in epidemiology from Harvard University, and his Internal Medicine Training at the Royal Brisbane Hospital in Australia. Dr. Colditz has an enormous volume of publications, with over 800 original research articles. He has worked to identify lifestyle and environmental factors that affect people's health, and to develop and teach cancer prevention strategies at the individual and community levels. His research also powers a website-www.yourdiseaserisk.wustl.edu-that helps people assess their risk of developing cancer, diabetes and other diseases as well as suggesting ways to lead longer, healthier lives. His work is inspirational in combining excellent scientific investigation with dedication to making results available and useful to non-scientists. Gini F. Fleming, MD, Cancer Education Committee Chair.

Patterns of Retreatment by Radiotherapy

AimsTo describe patterns of treatment for those who receive more than one episode of megavoltage radiotherapy (retreatment) by cancer type for better service planning and benchmarking. Materials and methodsInstitutional databases of all patients who received their first megavoltage radiotherapy for any type of cancer at the Liverpool and Macarthur Cancer Therapy Centres (LM), New South Wales, Australia, Royal Brisbane and Women's Hospital (RBWH), Queensland, Australia and Radiotherapeutic Institution Friesland (RIF), Leeuwarden, the Netherlands, over the period 1991–2009 were examined. Radiotherapy retreatment was defined as any radiotherapy episode, to any body site, after an initial episode of radiotherapy, for the same cancer diagnosis. The total retreatment rate was defined as the number of retreatment episodes of radiotherapy divided by the number of cases in the cohort. ResultsIn total, 62 270 patients (RBWH 38581, LM 9654, RIF 14035) received 77 762 episodes of radiotherapy, giving a total retreatment rate of 0.25; 52 351 patients (84%) received only one episode of treatment and 9919 (16%) received two or more episodes of treatment. Overall retreatment rates for LM, RBWH and RIF were 0.24, 0.25 and 0.26, respectively. For the five most common cancer types treated, the median time between treatment episodes was longest for breast cancer (11.3 months), then head and neck cancer (9.7 months), colorectal cancer (7.2 months), prostate cancer (4.4 months) and lung cancer (4.1 months). Ninety-one per cent of all fractions were delivered in the first episode of treatment. ConclusionsThe retreatment rate was very similar between the three facilities, suggesting agreement about the indications for retreatment.

Prevalence and outcomes of laser treatment of aggressive posterior retinopathy of prematurity

To describe outcomes in a cohort of extremely premature infants treated for aggressive posterior retinopathy of prematurity by diode laser panretinal photocoagulation. Retrospective study. Fifteen eyes in eight infants. A review was carried out on infants between 23 and 25.6 weeks gestational age admitted to The Royal Brisbane and Women's Hospital neonatal intensive care unit between 1992 and 2009. Success of treatment, visual and refractive outcomes. Five hundred fifty-four infants were admitted to neonatal intensive care unit, 373 survived till screening, and 304 had retinopathy of prematurity. Sixty-six infants required treatment, and eight of these had aggressive posterior retinopathy of prematurity (2.5% of all infants with retinopathy of prematurity). Mean gestational age was 24.2 weeks, mean birthweight was 634 g, and treatment occurred at mean 34.1 weeks post-menstrual age. The mean total number of burns per eye was 2967. Five of 15 treated eyes required retreatment. Two patients subsequently died of unrelated causes. Regression occurred in 9 of 11 remaining eyes; one eye progressed to stage 4b and another to stage 5 retinopathy of prematurity. Vitrectomy was performed in two eyes. Five eyes had 6/12 vision, one had 3/60, and three had no perception of light. Of the remaining two eyes, one had good fixation and the other had poor fixation. Despite good structural outcomes, visual outcomes for conventional laser treatment of aggressive posterior retinopathy of prematurity are poor.

Comparing Survival and Recurrence in Curative Stage I to III Colorectal Cancer in Transfused and Nontransfused Patients

Evidence of the association between blood transfusions and its impact on prognostic outcomes in patients who undergo curative resection of colorectal cancer remains controversial. The aim of this study was to determine whether receiving peri-operative blood transfusions during curative colorectal cancer resection affected overall survival, cancer-related survival, and cancer recurrence. This retrospective study was undertaken at The Royal Brisbane and Women's Hospital, Australia, between 1984 and 2004. The outcomes of 1370 patients undergoing curative colorectal cancer resection for TNM stage I to III were analyzed. Four hundred twenty three patients (30.9%) required transfusion and 947 patients (69.1%) did not. Peri-operative transfusion was associated with higher rates of cancer recurrence on multivariate analysis (P = 0.024, RR, 1.257, 95% CI, 1.03-1.53); however, it was not independently associated with poorer overall or cancer-related survival. Where the aim is curative resection, this study contributes to a body of evidence that blood transfusions may be associated with poorer outcomes.

Dysphagia and swallowing-related quality of life in Friedreich ataxia

Dysphagia in Friedreich ataxia (FRDA) and its impact on quality of life is not adequately understood. The objective of this study was to characterise dysphagia in FRDA and to determine the impact of swallowing dysfunction on activities, participation, and sense of well-being. Thirty-six individuals with a confirmed diagnosis of FRDA were assessed via a clinical bedside examination (CBE), the Royal Brisbane Hospital outcome measure for swallowing, an oral-motor examination and the Australian therapy outcome measures for speech and swallowing (AusTOMS). Data on swallowing function, diet modification and swallowing strategies were collated. Thirty-three (91.67%) participants exhibited clinical signs of dysphagia according to the CBE, and all participants received ratings indicating swallowing difficulties on at least one other measure. Dysphagia in FRDA is characterised by oral and pharyngeal stage impairment relating to incoordination, weakness and spasticity. A significant positive correlation was found between the severity of impairment, activity, participation and distress/well-being on the AusTOMS, suggesting that swallowing function decreases with overall reductions in quality of life. A significant correlation was found between activity on the AusTOMS and disease duration (r=-0.283, p=0.012). No significant correlations were found between dysphagia severity and GAA repeat length, age of onset or disease severity. Participants employing diet modification and swallowing strategies demonstrated higher dysphagia severity, activity limitations and participation restrictions. These data advocate a holistic approach to dysphagia management in FRDA. Early detection of swallowing impairment and consideration of the potential impact dysphagia has on quality of life should be key aspects in disease management.

In Reply

The University of Queensland, UQ Centre for Clinical Research and, Centre for Advanced Prenatal Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia Financial Disclosure The authors did not report any potential conflicts of interest.

Magnetic Resonance Imaging: An Accurate, Radiation-Free, Alternative to Computed Tomography for the Primary Imaging and Three-Dimensional Reconstruction of the Bony Orbit

To determine the extent to which the accuracy of magnetic resonance imaging (MRI) based virtual 3-dimensional (3D) models of the intact orbit can approach that of the gold standard, computed tomography (CT) based models. The goal was to determine whether MRI is a viable alternative to CT scans in patients with isolated orbital fractures and penetrating eye injuries, pediatric patients, and patients requiring multiple scans in whom radiation exposure is ideally limited. Patients who presented with unilateral orbital fractures to the Royal Brisbane and Women's Hospital from March 2011 to March 2012 were recruited to participate in this cross-sectional study. The primary predictor variable was the imaging technique (MRI vs CT). The outcome measurements were orbital volume (primary outcome) and geometric intraorbital surface deviations (secondary outcome) between the MRI- and CT-based 3D models. Eleven subjects (9 male) were enrolled. The patients' mean age was 30 years. On average, the MRI models underestimated the orbital volume of the CT models by 0.50 ± 0.19 cm(3). The average intraorbital surface deviation between the MRI and CT models was 0.34 ± 0.32 mm, with 78 ± 2.7% of the surface within a tolerance of ±0.5 mm. The volumetric differences of the MRI models are comparable to reported results from CT models. The intraorbital MRI surface deviations are smaller than the accepted tolerance for orbital surgical reconstructions. Therefore, the authors believe that MRI is an accurate radiation-free alternative to CT for the primary imaging and 3D reconstruction of the bony orbit.

Supporting families and carers during the inpatient admission

The Royal Brisbane and Women's Hospital Eating Disorder Unit is a Room: State wide public specialist service providing high quality support and intervention to adults requiring an inpatient admission to treat eating disorders. Family members and carers play a significant role in providing support for their loved one both in the community and during inpatient admissions. A gap in service delivery was noted in the provision of support to families and carers during the inpatient admission. The identification of a nominated family worker (provided by the Social Worker) was developed to ensure that families and carers were able to access support and assistance in a timely manner. In conjunction with this an information booklet was produced to be given to families on admission of their loved ones as a way of providing detailed, up to date information to better assist and improve the support family members received. The information booklet was developed in conjunction with consumers, a paid carer representative and other eating disorder professionals. This abstract was presented in the Care in Inpatient and Community Settings stream of the 2013 ANZAED Conference.

A cohesive multidisciplinary team approach to the management of patients with eating disorders

Eating disorders can be a life threatening illness not only due to the effects of starvation, but also the effects of impaired capacity. At Robina Hospital, patients admitted with a BMI < 14 are admitted to the Acute Medical Unit (AMU) for nutritional restoration and medical management before being transferred to a suitable mental health ward for ongoing treatment. The AMU at Robina has been managing patients with eating disorders, in particular Anorexia Nervosa for a number of years. The treatment plan implemented by the Acute Medical team is considered to be of a very high standard by the Eating Disorders Outreach Service (EDOS), a specialist consulting liaison service provided by the Royal Brisbane and Women's Hospital. The AMU prides itself on developing a cohesive multidisciplinary team approach, striving for best practice management by utilising protocols and guidelines developed by the EDOS service. This presentation will discuss the experiences of the Acute Medical Team in managing eating disorder patients. It will outline the team structure, current practices and guidelines used and identify areas of improvement recognised through lessons learned. The aim is to present information and experiences that may assist other acute inpatient medical settings in managing eating disorder patients discussing evidence based strategies developed to support and improve the management and physical health of patients with eating disorders. This abstract was presented in the Care in Inpatient and Community Settings stream of the 2013 ANZAED Conference.

Health-related quality of life of patients treated with primary chemoradiotherapy for oral cavity squamous cell carcinoma: a comparison with surgery

Our aim was to document the health-related quality of life (QoL) of patients with squamous cell carcinoma (SCC) of the oral cavity who were treated with chemoradiotherapy, and to compare it with that of patients treated with conventional surgery with or without adjuvant treatment. All patients who presented with SCC of the oral cavity treated with chemoradiotherapy alone at the Royal Brisbane & Women's Hospital between 2000 and 2011 and who were alive without disease were included. Health-related QoL was assessed by the University of Washington QoL questionnaire version 4, and the European Organisation for the Research and Treatment of Cancer (EORTC) QoL questionnaires C30 and HN35. The questionnaires were sent to all survivors. Those who responded to chemoradiotherapy were matched with patients who were treated by conventional surgery with or without adjuvant treatment by age, sex, subsite of tumour, and TNM stage. Sixteen patients completed the questionnaires (8 in each group). There was no significant difference between the 2 groups in any of the domains of any of the questionnaires. The overall outcome scores for both treatments in all 3 groups were reasonably high, which suggests that both treatments provided acceptable health-related QoL. The surgical group recorded higher scores than the chemoradiotherapy alone group in all domains of the UW-QoL except shoulder and anxiety. They recorded lower scores in all scales and items of EORTC HN35. There was no significant difference in health-related QoL between the 2 groups. Conventional surgery with or without adjuvant treatment recorded higher scores in most QoL domains including chewing, swallowing, saliva, and speech, issues most important to patients with SCC of the oral cavity.

Late Radiation-Associated Dysphagia (RAD) and Lower Cranial Neuropathy After Oropharyngeal Radiation Therapy: A Case–Control Dosimetric Comparison

Purpose/Objective(s): Many patients will require parenteral nutrition due to dysphagia during definitive radiation therapy for locally advanced head and neck cancer. However, the optimal timing of feeding tube (FT) insertion (prophylactic versus reactive) remains controversial. This study describes prospectively collected functional outcomes comparing prophylactic versus reactive FTs. Materials/Methods: Patients undergoing definitive radiation therapy for stage III and IV head and neck cancer between 2004 and 2009 prospectively underwent functional outcome assessment at baseline and 3, 6, 12, 24, and 36 months post-treatment. The use of FT and timing of insertion was at the discretion of the attending oncologist. Instruments included the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), the Performance Status Scale for Head and Neck Cancer Patients (PSSHN), and the Edmonton Symptom Assessment Scale. Multivariable analysis was conducted to determine the significance of FT status while controlling for potential confounding variables including age, gender, tumor stage, chemotherapy use, and primary site of disease. Results: A total of 178 patients were assessed with a median follow-up of 36.4 months. FTs were inserted prophylactically in 92 (51.7%), reactively in 23 (12.9%), and no tube in 63 (35.4%) patients. Compared to patients who received a prophylactic FT, those who had a reactive FT did not have a statistically significant difference in worse swallowing functional outcomes for PSS-HN subscales of eating in public (adjusted odds ratio [AOR] 1.65, p Z 0.42), understandability of speech (AOR 0.73, p Z 0.58), and normalcy of diet (AOR 1.39, pZ 0.66). Similarly, there were no differences in the RBHOMS levels for modified diet (AOR 1.00, pZ 0.99) and FT dependence (AOR 1.78, p Z 0.37). Patients who completed treatment without a FT had statistically significantly improved functional outcomes in PSS-HN and RBHOMS scores compared to both FT groups. Conclusions: Patients who received a reactive FT did not have a statistically significant difference in long-term functional outcomes compared to those with a prophylactically inserted FT. These findings warrant confirmation in a larger cohort of patients and should be considered when comparing the risks and benefits of different strategies for FT placement. Author Disclosure: H.C. Quon: None. C. Myers: None. A. Martens: None. J. Butler: None. R. Stimpson: None. D. Duerksen: None. H. CampbellEnns: None.

Feasibility of an Interdisciplinary Early Intervention for Patients with Low Levels of Responsiveness Following an Acquired Brain Injury

There is a scarcity of research investigating interdisciplinary early rehabilitation intervention models for people with low levels of responsiveness following acquired brain injury. This is particularly problematic for service models in acute hospital settings where early rehabilitation of such patients may be assigned a low priority in comparison to other competing demands. This pilot study investigated the feasibility of implementing an interdisciplinary early rehabilitation intervention in an acute neurosciences ward within existing staffing, and describes clinical changes among intervention participants. A prospective longitudinal study, with a matched historical control (individually matched by Glasgow Coma Scale) was undertaken. Prospective intervention participants (n= 13) received up to twice-weekly interdisciplinary intervention in addition to usual care. Matched historical controls (n= 13) received only usual care. Implementing an interdisciplinary early intervention proved feasible in this acute care setting. Significant improvement (alpha = .05) among the patients receiving the interdisciplinary intervention was observed across all clinical outcomes, including: Coma Recovery Scale-Revised, Glasgow Coma Scale, Mental Status Questionnaire, Royal Brisbane Hospital Outcome Measure for Swallowing, selected subtests of the Functional Independence Measure, Acquired Brain Injury Physiotherapy Assessment and the Clinical Outcomes Variable Scale. A future randomised clinical trial is warranted.

Hypoxaemia in the peripartum period in a woman with undiagnosed pulmonary arteriovenous malformations

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 53, Issue 6 p. 593-594 Case Report Hypoxaemia in the peripartum period in a woman with undiagnosed pulmonary arteriovenous malformations Anisha Parambi, Corresponding Author Anisha Parambi Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, AustraliaCorrespondence: Dr Anisha Parambi, Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Herston, QLD 4051, Brisbane, Australia. Email: [email protected]Search for more papers by this authorJenna S. Allen, Jenna S. Allen Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorAnders P. Faber-Swensson, Anders P. Faber-Swensson Department of Obstetrics and Gynaecology, Nambour Hospital, Nambour, Queensland, AustraliaSearch for more papers by this authorKarin Lust, Karin Lust Department of Internal Medicine & Aged Care and Womens & New Born Services, The Royal Brisbane & Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorLeonie Callaway, Leonie Callaway Department of Internal Medicine & Aged Care and Womens & New Born Services, The Royal Brisbane & Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this author Anisha Parambi, Corresponding Author Anisha Parambi Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, AustraliaCorrespondence: Dr Anisha Parambi, Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Herston, QLD 4051, Brisbane, Australia. Email: [email protected]Search for more papers by this authorJenna S. Allen, Jenna S. Allen Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorAnders P. Faber-Swensson, Anders P. Faber-Swensson Department of Obstetrics and Gynaecology, Nambour Hospital, Nambour, Queensland, AustraliaSearch for more papers by this authorKarin Lust, Karin Lust Department of Internal Medicine & Aged Care and Womens & New Born Services, The Royal Brisbane & Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorLeonie Callaway, Leonie Callaway Department of Internal Medicine & Aged Care and Womens & New Born Services, The Royal Brisbane & Women's Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 02 August 2013 https://doi.org/10.1111/ajo.12114Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume53, Issue6December 2013Pages 593-594 RelatedInformation

Educational support for specialist international medical graduates in anaesthesia

To measure specialist international medical graduates' (SIMGs) level of learning through participation in guided tutorials, face-to-face or through videoconferencing (VC), and the effect of tutorial attendance and quality of participation on success in specialist college examinations. Tutorials were conducted at the Royal Brisbane and Women's Hospital between 19 September 2007 and 23 August 2010, and delivered through VC to participants at other locations. Tutorials were recorded and transcribed, and speaker contributions were tagged and ranked using content analysis software. Summary examination results were obtained from the Australian and New Zealand College of Anaesthetists. Tutorial participation and attendance, and college examination pass and fail rates. Transcripts were obtained for 116 tutorials. The median participation percentage for those who subsequently failed the college examinations was 1% (interquartile range [IQR], 0%-1%), while for those who passed the exams it was 5% (IQR, 2%-8%; P < 0.001). There was also an association between attendance and exam success; the median (IQR) attendance of those who failed was 24% (IQR, 14%-39%), while for those who passed it was 59% (IQR, 39%-77%; P < 0.001). Use of VC technology was found to be a feasible method to assist SIMGs to become aware of the requirements of the exam and to prepare more effectively.

A pilot randomised trial of Medilixir cream shows some promising results, but control treatment may have been inappropriate

Aim To test the efficacy of Medilixir [cream] against the standard treatment of aqueous cream in the provision of relief from the symptoms of postburn itch. Design RCT with two parallel arms. Setting Professor Stuart Pegg Adult Burns Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia. Participants Fifty-two patients aged between 18 and 80 years, admitted directly to the burns centre between 10 March and 22 July 2008, were able to provide informed consent, and had shown no allergic reaction to a patch test with the study medication, were randomised. Patients admitted from intensive care or high dependency were excluded. Main results Effect estimates and confidence intervals were not reported for any of the outcomes; only group means/proportions and P-values from hypothesis testing were provided. More patients in the intervention group reported itch reduction compared to comparison treatment (91 vs. 82%, P=0.001). Itch recurrence after cream application occurred later in the intervention group compared to the control group (P<0.001). Use of antipruritic medication was significantly greater in the control group (P=0.023). There was no difference in sleep disturbance between groups (not quantified). On average, Medilixir took longer to apply than aqueous cream (157s for Medilixir vs. 139s for aqueous cream; mean difference 17s), but authors noted that the groups did not differ significantly (CI for mean difference and P-values were not reported).