Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial.

INTRODUCTION: There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers' health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers' health-related quality of life (HRQOL) after care recipients' hospital discharge. METHODS AND ANALYSIS: A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient's discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30-45 min telephone support sessions over 6 months. The primary outcome is caregivers' HRQOL measured using the Assessment of Quality of Life-eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements. ETHICS AND DISSEMINATION: Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ACTRN12620000060943.

Diagnostic confusion resolved by being upbeat.

The classical stroke presentation - captured by the public health campaign mnemonic FAST (face, arm, speech, time) - does not apply in a large number of stroke cases; yet establishing a prompt diagnosis is imperative for optimal management. Here, we describe a patient with acute bulbar weakness, numbness in all extremities and an apparently normal magnetic resonance imaging (MRI) of the brain upon admission for whom even the fundamental question of whether this reflected a central or peripheral nervous system process was unclear. The critical localizing sign was upbeat nystagmus that denotes a brainstem cause. MRI of the brain in the second week confirmed a diagnosis of medial medullary infarction.

Mild stroke symptoms as the initial presentation of a patient with underlying subacute bacterial endocarditis.

We describe a patient with sub-acute bacterial endocarditis, whose chief presenting feature was mild expressive dysphasia.

Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures.

BACKGROUND: 15-25% of general hospital admissions tend to involve patients that have had a short-term indwelling urinary catheter (IDC) inserted some time during their stay. There is little data on the specific incidence and complications of short-term urinary catheterization in elderly patients with neck of femur fractures. METHODS: Data was collected from the notes of 50 patients at Hemel Hempstead General Hospital with neck of femur fractures retrospectively from 31 August 2007. Specific information on patient demographics, premorbid status, record and reason for urethral catheterization, place of insertion, gentamicin cover pre- and post-removal of IDC, residual volumes, duration of catheter insertion, catheter clamping prior to removal of IDC, urinary tract infection with IDC, post-IDC removal newly incontinent/in retention were collated from patient notes. Patients with prior chronic catheterization were excluded from the study. RESULTS: 78% of the patients had an IDC insertion (95% confidence interval, 64-88.4%). Most of the catheters were inserted on the ward (75%) with the rest being inserted mostly in theatre and recovery. Only approximately one-third of the sample that had IDC inserted had residual volume documented in the notes. Of these patients, the majority had residual volume above 300 mL. The main reasons for IDC insertion were urinary retention (50%), incontinence (30.8%) and fluid monitoring (11.5%). Of the patients, 31.4% had documented urinary tract infection as a result of IDC insertion. CONCLUSION: This study revealed a higher incidence of short-term IDC insertion ( approximately 75%) in elderly patients with neck of femur fractures in comparison to general hospital admissions of 15-25%. There is a role for more effective documentation in patient notes on the reasons behind urinary IDC insertion and increased clinical vigilance in preventing unnecessary catheterizations.