Using the Primary care Academic CollaboraTive to explore the characteristics and healthcare use of older housebound patients in England: protocol for a retrospective observational study and clinician survey (the CHiP study).

BACKGROUND: Older housebound people are an under-researched group for whom achieving good primary health care can be resource intensive. AIMS: To describe the characteristics and healthcare use of older (≥65 years) housebound people; explore clinician views on delivery of care to housebound people; and assess the feasibility of using a new network of healthcare professionals to deliver high quality research. DESIGN & SETTING: Retrospective observational study of electronic GP records and clinician survey in England. METHOD: Clinical members of a new UK research network called the Primary care Academic CollaboraTive (PACT) will collect the data. For part A, around 20 GP practices will be recruited and clinicians will identify 20 housebound and 20 non-housebound people, matched by age and gender (around 400 total in each group). Anonymised data will be collected on characteristics (age, gender, ethnicity, deprivation decile), long-term conditions, prescribed medicines, quality of healthcare (via Quality Outcomes Framework targets), and continuity of care. Reports with benchmarked practice-level data will be provided to practices to identify areas for quality improvement and to enhance engagement. For part B, 2-4 clinicians will be recruited from around 50 practices in England (around 150 clinicians) to complete a survey about delivery of healthcare for housebound people. For part C, data will be collected to assess the feasibility of using the PACT network to deliver primary care research. CONCLUSION: Older housebound people are a neglected group both in terms of research and clinical care. Understanding the characteristics and use of primary healthcare of housebound people will help identify how to improve their care.

47 W continuous-wave 1726 nm thulium fiber laser core-pumped by an erbium fiber laser.

The high-power, short-wavelength operation of a thulium-doped silica fiber laser at 1726 nm has been demonstrated in a core-pumped monolithic (all-fiber) resonator configuration, in-band pumped by a high-power erbium-only fiber laser operating at 1580 nm. The thulium fiber laser yielded 47 W in a single-spatial-mode output beam for 60-W absorbed pump power. The corresponding slope efficiency, with respect to an absorbed pump power of 80%, compares favorably with the theoretical maximum (Stokes) efficiency of 91.5%. The prospects for further scaling of single-mode power in this wavelength regime to >100 W are considered, as well as the potential applications for high-power lasers operating in this difficult-to-reach wavelength band.