The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF): feasibility trial protocol

Background: Topical lidocaine patches, applied over rib fractures, have been suggested as a non-invasive method of local anaesthetic delivery to improve respiratory function, reduce opioid consumption and consequently reduce pulmonary complications. Older patients may gain most benefit from improved analgesic regimens yet lidocaine patches are untested as an early intervention in the Emergency Department (ED). The aim of this trial is to investigate uncertainties around trial design and conduct, to establish whether a definitive randomised trial of topical lidocaine patches in older patients with rib fractures is feasible. Methods: RELIEF is an open label, multicentre, parallel group, individually randomised, feasibility randomised controlled trial with economic scoping and nested qualitative study. Patients aged ≥ 65 years presenting to the ED with traumatic rib fracture(s) requiring admission will be randomised 1:1 to lidocaine patches (intervention), in addition to standard clinical management, or standard clinical management alone. Lidocaine patches will be applied immediately after diagnosis in ED and continued daily for 72 hours or until discharge. Feasibility outcomes will focus on recruitment, adherence and follow-up data with a total sample size of 100. Clinical outcomes, such as 30-day pulmonary complications, and resource use will be collected to understand feasibility of data collection. Qualitative interviews will explore details of the trial design, trial acceptability and recruitment processes. An evaluation of the feasibility of measuring health economics outcomes data will be completed. Discussion: Interventions to improve outcomes in elderly patients with rib fractures are urgently required. This feasibility trial will test a novel early intervention which has the potential of fulfilling this unmet need. The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF) feasibility trial will determine whether a definitive trial is feasible. ISRCTN Registration: ISRCTN14813929 (22/04/2021)

Palestinians in Israel Nationality and citizenship

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Characterising recovery from renal transplantation and live-related donation using cardiopulmonary exercise testing

Background: An association between end-stage renal failure and exercise intolerance exists. Whether live kidney donation impacts on exercise tolerance is unknown. Here recovery post renal transplant and donation using cardiopulmonary exercise testing is investigated. Methods: Renal donors (n = 28) and recipients (n = 24) undertook a cardiopulmonary exercise test, Duke activity score index and patient reported health score questionnaires pre-operatively and in the 7th and 14th week post-operatively. Anaerobic threshold, peak oxygen uptake and ventilatory equivalents were measured in relation to activity and reported health scores. Haemoglobin and renal function was recorded. Results: Recipients showed impaired cardiopulmonary function compared to donors with lower anaerobic threshold (10.5 vs. 14.4 ml/kg/min) and peak oxygen uptake (18.5 vs 23.0 ml/kg/min). Post-operatively the anaerobic threshold of recipients improved and normalised by the 14th week, whereas that in donors fell by ∼20% by the 7th (mean 11.4 ml/kg/min), recovering by the 14th (mean 15.6 ml/kg/min). Reported health but not activity scores showed similar changes. Conclusions: Recovery following renal transplantation and donation differ. Transplantation improves renal function resulting in an increase in anaerobic threshold and peak oxygen uptake which essentially normalise by the 14th week post-operatively. Donors suffer a 20% reduction in cardiopulmonary reserve post-operatively, which recovers by the 14th week, suggesting no associated chronic exercise intolerance.IMPLICATIONS FOR REHABILITATION Cardiopulmonary exercise testing is a real-time predictor of functional capacity and thus is used as a pre-operative tool to measure physiological fitness and predict outcomes. Renal failure is associated with exercise intolerance and transplantation is transformational in terms of quality of life, longevity and healthcare cost. Live–related renal donation is increasingly available but whether donation itself carries a long-term health burden has not been previously well established. This study suggests that renal donation is not associated with long-term cardiopulmonary compromise and patients who donate their kidneys recover their previous fitness within 14 weeks

Characterising recovery following abdominal aortic aneurysm repair using cardiopulmonary exercise testing and patient reported outcome measures

AbstractBackgroundMajor surgery is associated with a post-operative stress response, changes in cardiopulmonary reserve and increased metabolic demand. Here recovery after abdominal aortic aneurysm is investigated using cardiopulmonary exercise testing and patient reported health and activity questionnaires. MethodsPatients undergoing open (n=30) or endovascular (n=30) aortic repair undertook a cardiopulmonary exercise test, Duke activity score index and patient reported health score questionnaires pre-operatively and at 8 and 16 weeks post-operatively. Anaerobic threshold, peak oxygen uptake and ventilatory equivalents were measured and haemoglobin concentration and renal function was recorded.ResultsPost-operatively patients showed impaired cardiopulmonary function characterised by a fall in anaerobic threshold, peak oxygen uptake and oxygen pulse at 8 weeks which normalised by 16 weeks. Certain changes seemed to be associated with operative severity; the 8 week fall in peak oxygen uptake was greater following open versus endovascular repair (3.5 vs. 1.6 ml/kg/min) and AT showed a similar tendency (3.1 vs. 1.7 ml/kg/min) . Reported health and activity scores did not show similar changes.ConclusionsOpen or endovascular aortic repair is associated falls in anaerobic threshold, peak oxygen uptake and oxygen pulse at 8 weeks post-operative. The magnitude of the changes may be linked to operative severity and resolve by 16 weeks. Thus at 8 weeks post-operative there is a 15-20% reduction in these cardiopulmonary parameters normalising by 16 weeks. During this post-operative period patients are at higher risk and less able to cope with further metabolic demands such as a cardiac event, chemotherapy, infection, or further surgery