ItemPilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people STOPCUTS": study protocol"(BioMed Central, 2015-04-01) Powell, R. J.; Hayward, C. J.; Snelgrove, C. L.; Polverino, K.; Park, L.; Chauhan, R.; Evans, P. H.; Byford, R.; Charman, C.; Foy, C. J.; Kingsley, A.BACKGROUND: Skin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common and occur mostly in older adults and those taking medications that compromise skin integrity. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment to heal. Traumatic injuries are the second most common type of wounds after pressure ulcers in care homes and are the commonest reason for older adults to require the attention of a community nurse. Common causes of skin tear injuries are bumping into furniture and other obstacles, using mobility aids, transfer to/from wheelchairs, getting in and out of bed and falls. No effective preventative measures currently exist but knee-length, protective socks are now available that contain impact-resistant Kevlar fibres (of the type used in stab-proof vests) and cushioning layers underneath. METHODS/DESIGN: In this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury will be randomised with equal allocation to receive the intervention or usual care. They will be recruited from care homes and from the community via general practices and a research volunteer database. Pilot outcomes include recruitment, eligibility, attrition, ascertainment of injuries and completion of outcome measures. Acceptability of the intervention and of study participation will be explored using semi-structured interviews. The proposed primary outcome for the future definitive trial is skin tear-free days. Secondary outcomes are skin tear severity, health status, specific skin-tears quality of life, capability and fear of falling, measured at baseline and the end of the study and in the event of a skin tear. DISCUSSION: The results of this study will be used to inform the development and design of a future randomised controlled trial to assess the effectiveness and cost-effectiveness of a unique and innovative approach to skin tear prevention. Approval was granted by the NRES - Cornwall and Plymouth Research Ethics Committee (13/SW/013). Dissemination will include publication of quantitative and qualitative findings, and experience of public involvement in peer-reviewed journals. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN96565376. ItemUse of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy.(Wiley, 2015-01) Huddart, S; Peden, C J; Swart, M; McCormick, Bruce; Dickinson, M; Mohammed, M A; Quiney, NEmergency laparotomies in the U.K., U.S.A. and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence-based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal-directed fluid therapy and postoperative intensive care. ItemImproving inhaler technique(Mark Allen Group, 2015-01-02) Halpin, David M; Holmes, S.; Calvert, J.; McInerney, D.Correct inhaler technique is essential for patients to get benefits from their therapy. The South West Respiratory Network formulated a project to develop and deliver an inhaler technique training programme for clinicians ItemSouth West Respiratory Network inhaler training project(Mark Allen Group, 2015-03-02) Halpin, David M; Holmes, S.; Calvert, J.; McInerney, D.Correct inhaler technique is essential for patients to get benefits from their therapy. Evidence shows that up to 90% of patients do not take their inhaler properly. A number of factors are associated with an increased chance of poor inhaler technique. Health professionals have an important role in teaching patients the correct inhaler technique, but many clinicians themselves do not know how to use inhalers correctly. The South West Respiratory Network formulated a project to develop and deliver an inhaler technique training programme for clinicians. The first wave of training created 50 ‘ambassadors’, who will deliver training locally to other health professionals, thus spreading expertise. An online competency assessment tool will provide assurance of the level of competence in knowledge of inhalers gained through the training and additional practice. The project aims to increase the number of people who are able to use their inhaler correctly, resulting in better disease control and savings to the NHS. ItemThe Effect of Incidental Consolidation on Management and Outcomes in COPD Exacerbations: Data from the European COPD Audit.(PLoS One, 2015-07-27) Saleh, A.; López-Campos, J. L.; Hartl, S.; Pozo-Rodríguez, F.; Roberts, C. M.; Halpin, David MThere is controversy regarding the significance of radiological consolidation in the context of COPD exacerbation (eCOPD). While some studies into eCOPD exclude these cases, consolidation is a common feature of eCOPD admissions in real practice. This study aims to address the question of whether consolidation in eCOPD is a distinct clinical phenotype with implications for management decisions and outcomes.