The SILKIE (Skin graftIng Low friKtIon Environment) study: a non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns.

OBJECTIVES: To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. DESIGN: Proof of concept before and after study with feasibility of delivering the intervention. SETTING: Three burns services within two UK hospital trusts. PARTICIPANTS: Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. INTERVENTION: Introduction of LF sheets and pillowcases during a 15-month period. OUTCOME MEASURES: For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. RESULTS: 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was £-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. CONCLUSIONS: LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified. TRIAL REGISTRATION NUMBER: ISRCTN82599687.

Barrett's Oesophagus Surveillance versus endoscopy at need Study (BOSS): protocol and analysis plan for a multicentre randomized controlled trial.

OBJECTIVES: The absolute annual risk of patients with Barrett's oesophagus (BO) developing oesophageal adenocarcinoma (OAC) is ≤ 0.5%. Screening BO patients for malignant progression using endoscopic surveillance is widely practised. To assess the efficacy and cost-effectiveness of this, we developed a protocol for a randomized controlled trial of surveillance versus 'at need' endoscopy. METHODS: In a multicentre trial, 3400 BO patients randomized to either 2-yearly endoscopic surveillance or 'at need' endoscopy will be followed up for 10 years. Urgent endoscopy will be offered to all patients who develop symptoms of dysphagia, unexplained weight loss > 7lb (3.2 kg), iron deficiency anaemia, recurrent vomiting, or worsening upper gastrointestinal symptoms. Participants must have endoscopically and histologically confirmed BO, with circumferential BO ≥ 1 cm or maximal tongue/island length ≥ 2 cm. Candidates with existing oesophageal high-grade dysplasia or cancer, or previous upper gastrointestinal cancer will be excluded. Primary outcome will be overall survival. Secondary outcomes will be cost effectiveness (cost per life year saved and quality adjusted life years); cancer-specific survival; time to OAC diagnosis and stage at diagnosis; morbidity and mortality related to any interventions; and frequency of endoscopy. CONCLUSIONS: This randomized trial will provide data to evaluate the efficacy and cost-effectiveness of screening BO patients for OAC.

The Watcombe Housing Study: the short term effect of improving housing conditions on the health of residents.

OBJECTIVE: To assess the short term health effects of improving housing. DESIGN: Randomised to waiting list. SETTING: 119 council owned houses in south Devon, UK. PARTICIPANTS: About 480 residents of these houses. INTERVENTION: Upgrading houses (including central heating, ventilation, rewiring, insulation, and re-roofing) in two phases a year apart. MAIN OUTCOME MEASURES: All residents completed an annual health questionnaire: SF36 and GHQ12 (adults). Residents reporting respiratory illness or arthritis were interviewed using condition-specific questionnaires, the former also completing peak flow and symptom diaries (children) or spirometry (adults). Data on health service use and time lost from school were collected. RESULTS: Interventions improved energy efficiency. For those living in intervention houses, non-asthma-related chest problems (Mann-Whitney test, p = 0.005) and the combined asthma symptom score for adults (Mann-Whitney test, z = 2.7, p = 0.007) diminished significantly compared with control houses. No difference between intervention and control houses was seen for SF36 or GHQ12. CONCLUSIONS: Rigorous study designs for the evaluation of complex public health and community based interventions are possible. Quantitatively measured health benefits are small, but as health benefits were measured over a short time scale, there may have been insufficient time for measurable improvements in general and disease-specific health to become apparent.

The use of carers' and users' expectations of services (CUES) in an epidemiological survey of need.

BACKGROUND AND METHOD: This study surveyed need in a group of psychiatric patients in Gloucester, using a new instrument, the CUES. Keyworkers gave out questionnaires to all patients with psychosis in contact with specialist services. A total of 148 forms were anonymously completed, with a response rate of 37% of the mental health services caseload. RESULTS: 53.5 to 83.2% of patients were satisfied and 61.5 to 89.6% expressed their experiences 'as good as' a normative statement across the 16 domains. There was mostly 'moderate' agreement between satisfaction and normative questions by Kappa correlations, although responses to normative questions tended to be about 10% higher. Extensive free text responses were subject to content analysis, demonstrating needs across a wide range of health, social and leisure areas, many of which were not directly linked to the adequacy or otherwise of psychiatric treatment. CONCLUSIONS: The results imply that the CUES may be of value at an individual level to aid in care planning, and also have some value in aggregated form to benchmark user experiences of services.

From research to practice: a local mental health services needs assessment.

BACKGROUND: Service planning based on aggregated needs assessment is rarely practised. There is a lack of research into how population-based needs assessment approaches can be translated into routine clinical settings. AIMS: This study aimed to ascertain the 2-month period prevalence of psychosis in Gloucester City, to investigate the level of need among those in contact with mental health services, and to identify the compromises which are involved in routine collection of data to inform services, compared with specifically funded research studies. Method People with ICD-10 diagnosis of functional psychosis were identified by searching General Practice and mental health service records in Gloucester City. The needs of the sub-sample in touch with mental health services were assessed using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). RESULTS: Four hundred and seventy-four cases were identified, including 403 in contact with mental health services. Staff CANSAS data were collected for 225 patients, with a mean rating of 7.0 met and 3.6 unmet needs per patient. Unmet need was higher in the non-Caucasian group. CONCLUSIONS: In this locality, patients with functional psychosis were largely in contact with mental health services, were in employment, were disproportionately looked after by a few City centre General Practitioners, and high levels were in supported accommodation. Higher levels of need were found than previously demonstrated. Systematic assessment of needs with research instruments to contribute to locality service planning is possible without a major research grant, but involves compromises on established research designs.

From local concern to randomized trial: the Watcombe Housing Project.

BACKGROUND: A randomized study of the effect on people's health of improving their housing is underway in Torbay. The link between poor health, particularly respiratory health, and poor housing conditions has been recognized for a long time, but there have been few intervention studies to demonstrate that improving housing can improve health. In 1994, South and West Devon Health Authority set up a community development project in a deprived area of Torbay, in response to the concerns of local primary health-care workers. A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms. The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years. The Health Authority, University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme. PARTICIPANTS AND METHODS: Of 119 houses eligible for the study, 50 were chosen at random and improved in the first year. The rest were improved the following year. Questionnaires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out. More detailed health surveys were completed by community nurses visiting residents in their homes. All adults were asked to complete SF-36 and GHQ 12 questionnaires, as well as disease-specific questionnaires if appropriate. PROGRESS: All houses in the study have now been improved, including insulation, double-glazing, re-roofing, heating, ventilation and electrical rewiring. Follow-up surveys are underway.