Clinical trials

As part of an admission to an Intensive Care Unit (ICU) many patients have breathing tube inserted into their windpipe, also referred to as intubation . This is done for a variety of reasons which can include the need for invasive breathing support and to place the patient into a medically induced coma to allow their body to rest and be treated for the underlying cause of their deterioration. One the patient has started to recover from their illness, the process of removing the breathing tube (extubation) and stopping the breathing machine begins. Optimising this process and ensuring successful removal of the breathing tube is extremely important to optimise outcomes. Therefore, identifying new methods to determine the likelihood for successful extubation is of clinical significance. There are several markers of extubation readiness that clinicians can use to support their decision making discussed in the literature. A novel method is the use of respiratory muscle activity monitoring via sensory electromyogram (sEMG). sEMG has previously been shown to be useful to measure the strength and activity of muscles. However, until recently measuring diaphragm activity has been a challenge due to noise from the chest movements, cardiac artefacts. Recent advancements in signal processing and growing interest in better diagnostic methods has led to an improvement in metrics. Using wavelet transforms and machine learning, new techniques have been developed to measure diaphragm muscle activity using sEMG. sEMG has been shown to be effective in detecting patient-ventilator asynchrony as well as respiratory strength in those not requiring mechanical ventilation. However, its use in assessing patients nearing readiness for extubation has not been explored. Therefore, the purpose of this feasibility trial is to explore the use of sEMG in patients undergoing trials of extubation. The results of this study will be used to design a multi-site trial.

The goal of this feasibility study is to learn about the ability to use a different form of oxygen therapy (known as high flow oxygen therapy) in patients who have a spinal cord injury in the upper back or neck. The main questions it aims to answer are: 1. Is it possible to recruit patients to the study 2. It is possible to follow the protocol in its current format 3. What is the impact on those receiving the intervention. Participants will be randomised to receive either standard care or high flow oxygen therapy for 10 days following inclusion.

At the moment, no-one is sure what the best way to treat heel pain is. The purpose of this research is to try out some study methods to prepare for a future clinical trial, that will assess how helpful combining different treatments are for people with heel pain (plantar fasciitis). At this stage, the aim is only to test the study processes and ask for feedback - that is why this is called a feasibility study. No experimental techniques or devices will be tested. All of the treatments in the study are routinely carried out in NHS clinics, but participants will be allocated to different combinations of treatments. Each participant will be asked to complete questionnaires and a diary for around six months in total. Some people will also be invited to take part in an interview or focus group discussion.

Waiting times for NHS services are of growing public interest. This is because accessing some services is getting more difficult, and we know that longer waits can result in negative impacts for those waiting. People in Wales waiting for care for their musculoskeletal problems are deemed to be cared for in good time if they get an appointment in less than 14 weeks. This target has been set by Welsh Government, for everyone who waits, no matter what condition they are waiting with and how that condition is affecting them. We know that impact of wait for people with MSK problems can vary, from complete recovery, to worsening of their pain and function. The impact experienced seems to be influenced by factors such as their age and their mental health statusz\\. This suggests that setting one target for all may not be the right thing to do. However, we don't yet know whether waiting over 14 weeks has a big effect on impact. We also don't know about the lived experience of those waiting, while they wait, despite knowing that learning this is vital to informing change. We plan to study the impact of waiting for these services by asking those waiting to complete a survey that measures the impact of their msk problem, at the start and end of their wait, and then understanding how the scores correlate with length of time waited. We will also ask some of these people to document their experience as they wait. We hope that this will provide an understanding of how effective the current target is at measuring access to these services, and whether we need to think differently. People will be able to complete this work in their own home.

The goal of this observational study is to learn more about phenotypic, genetic, biochemical, neurophysiological and radiological patterns in epilepsy. Participants will be asked to consent to use of clinical and paraclinical data (obtained during standard care) for research, and will be asked to donate blood samples at their routine clinic visits.