Rowan Harwood

Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]

Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care.The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottinghams Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting.SitesGeneral practices across Nottinghamshire and Derbyshire.Day hospitals:Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust)Sherwood Day Service (Nottingham City Hospital Trust)Leengate Day Hospital (Queens Medical Centre Nottingham University Hospital NHS Trust)

Stroke care : a practical manual

1. Is it a stroke? 2. What to do in the first few days 3. The first two weeks 4. Subarachnoid haemorrhage 5. Neuroimaging in stroke 6. Making difficult decisions 7. Terminal care 8. Rehabilitation 9. Discharge 10. Preventing strokes and other vascular events 11. Outcomes and prognosis 12. Longer-term problems and their management Appendices

Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke

BackgroundDysphagia occurs in up to 50% of patients admitted to hospital with acute strokes with up to 27% remaining by seven days. Up to 8% continue to have swallowing problems six months after their stroke with 1.7% still requiring enteral feeding. Nasogastric tubes (NGT) are the most commonly used method for providing enteral nutrition in early stroke, however they are easily and frequently removed leading to inadequate nutrition, early PEG (Percutaneous Endoscopic Gastrostomy) insertion or abandoning of feeding attempts. Looped nasogastric tube feeding may improve the delivery of nutrition to such patients.MethodsThree centre, two arm randomised controlled trial, with 50 participants in each arm comparing loop (the intervention) versus conventional nasogastric tube feeding. The primary outcome measure is proportion of intended feed delivered in the first 2 weeks. The study is designed to show a mean increase of feed delivery of 16% in the intervention group as compared with the control group, with 90% power at a 5% significance level. Secondary outcomes are treatment failures, mean volume of feed received, adverse events, cost-effectiveness, number of chest x-rays, number of nasogastric tubes and tolerability.Trial RegistrationISRCTN Number: ISRCTN61174381

The first 2 weeks

Welcome and check-in 2 to 4 pm Orientation 44.30 Dinner 5 pm 9 8 – 10 am IDs & Campus Tour 10– 11:30 am Dr. Kommalapati, STI Overview, Ms. Glover and Staff, Rules/ Expectations 1pm – 2pm Ms. Glover, Team Building –Brain Teasers 2pm – 4:30 Pre-Test 10 8:30 -10:00 AM Intro to Transportation Eng.& Transportation Jeopardy Dr. Hunter, URI 10:15 – 11:45AM Activity: “How Fast Are You? Dr. Hunter, URI 1:30 – 3:00 “How Long Should the Yellow Light Last?” Sign the Way Activity , Dr. Hunter, URI 11 8:30 –11:45AM Transportation Safety Issues— Red Light Running & Speeding Introducing Traffic Programming Logic Dr. Hunter 1:30 – 4:45 Signalized Intersection Data Capture and Reduction Dr. Hunter 12 8:30 – 11:45 Does the Signal Timing Meet Your Approval? Dr. Hunter 1:30 – 3:00 Introduction to Bridges & Bridge Building, Dr. Hunter 3:15 – 4:45 Airports/ Airplanes Dr. Hunter 13