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Peri-operative enhanced recovery hip fracture of patients with dementia

 

   

September 2017 Mid-Month Recruitment Update

 

After a poor month for recruitment in August, we are off to a slow start for this month as well, with just 7 patients in September.  This leaves our overall recruitment total at 176 patients.

 

On a more positive note, a big congratulations is due for the team in Bradford, who are now off the mark with their first patient! Well done to Jane, Lubena and Tizzy!!

 

An updated PERFECTED 40-Patient Dash can be found be found at the top of the page. 

August 2017 Recruitment Update

 

After a slow month for recruitment, I am sorry to announce that we have recruited just 12 patients in August. This leaves our overall recruitment total at 169 patients.

 

This marks our second lowest month for recruitment since the trial first opened in November 2016.

 

I appreciate that August is typically a difficult month for recruitment due to annual leave. However, we must really push on from here and look to improve our recruitment rate considerably over the coming months if we are to reach our revised recruitment target of 300 patients.

 

On a more positive note, a big well done is due for the teams at the NNUH/NSFT, who managed to recruit 3 patients in August, making them the top-recruiting site for the second month in a row! Congratulations to Celia, Denise and the rest of the NNUH and NSFT Teams for another solid month of recruitment and for now moving up into joint fourth place overall!

 

A monthly breakdown of recruitment can be found below and an updated PERFECTED 40-Patient Dash at the top of the page:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April 2017

16

85

May 2017

29

114

June 2017

24

138

July 2017

19

157

August 2017

12

169

July 2017 Recruitment Update

 

Following a sluggish start to the month with only 4 patients in the first 2 weeks, we managed to pull out all the stops and get patients into the trial before August arrived. We have now recruited a total of 157 patients; having consented 19 patients in July. This is an achievement for the summer months considering annual leave/holidays.

 

We will need to work hard through August to achieve the same again and hit an average of 23/24 patient per month with our new 300 patient target by the end of January 2018. We look forward to having an additional site shortly open, Bradford, to help us reach our recruitment goal so welcome team!

 

Please see a monthly breakdown of recruitment below:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April 2017

16

85

May 2017

29

114

June 2017

24

138

July 2017

19

157

 

From a site perspective, many congratulations to NNUH for recruiting 5 patients within the final weeks of the month, making them the top recruiting site!

 

Many thanks to those teams in PRUH, Leicester and Derby for recruiting 3 patients each this month.

 

However, a special mention must also go out to the teams in Fife and NNUH, they have now hit their 10  patient markers! J This means all sites have now achieved this goal.

 

Please find the updated “PERFECTED 40-Patient Dash!” attached at the top of the page. 

PERFECTED Recruitment Window has been extended

 

Following what has been a great upturn in recruitment over the past two-months, we are incredibly pleased to inform you that our request to extend the recruitment window has been accepted.

 

This will see the current trial timelines extended by 5-months. As such, please see the revised Trial Timelines below:

 

  • End of Recruitment:               31st January 2018
  • End of Patient Follow-Up:     31st July 2018

 

Thank you to everyone involved with the trial for all of your continued hard work and support, without which this successful extension request would not have been possible.

 

Based on our current rate of recruitment, we have now set a revised recruitment target of 300 patients. In order to achieve this target, we will need to ensure we maintain an average monthly recruitment rate of 23-24 patients.

 

Over the past months we have aptly demonstrated that we can consistently recruit to this level and are now really hitting in terms of recruiting to this study. Below, is a graph illustrating our projected recruitment.

 

End of June 2017 Recruitment Update

 

Following another solid month for recruitment, we have now recruited a total of 138 patients; having consented 24 patients in June!

 

After a slightly sluggish start to recruitment this month, to break the 20-patient mark for the second consecutive month and record our second highest monthly total to date, marks a significant achievement.

 

Please see a monthly breakdown of recruitment below:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April 2017

16

85

May 2017

29

114

June 2017

24

138

 

From a site perspective, Ipswich managed to recruit 5 patients, making them the top recruiting site for June! Congratulations to Stephanie, Steph, Sue & the rest of the team! This was very closely followed by the team in Edinburgh, who recruited 4 patients this month.

 

However, a special mention must also go out to the teams in Pinderfields and PRUH, both of whom managed to recruit 3 patients this month and have now hit their respective 10 and 20-patient markers! J

 

Please find the updated “PERFECTED 40-Patient Dash!” at the top of the page. 

Recruitment Update 1 June 2017

Following a fantastic month for recruitment we have now recruited a total of 114 patients; having consented 29 patients in May!

 

After an understandably slow month for recruitment in April due to the Easter break, this marks a tremendous achievement and makes May our highest recruiting month to date- beating the previous best of 23 patients in February by some margin! J

 

Please see a monthly breakdown of recruitment below:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April 2017

16

85

May 2017

29

114

 

From a site perspective, every site managed to recruit at least 2 patients in May, which is great to see.

 

A special mention must also go out to the top-recruiting teams. Firstly, the team in Pinderfields managed to recruit 4 patients, which to put this into perspective, actually doubled their previous overall total! Congratulations to Kate, Rosie, Tracey, Bev and Dr Holt!

 

However, the team at the Princess Royal in Kent actually managed to pip this month, after recruiting a staggering 5 patients in May! This is particularly impressive as it was in fact also Joanne’s first month on the trial! Congratulations to Joanne for making such a great start to your time on the study and to Nyma, Steve Jackson and Aza for all of your continued support.

 

Please find the updated “PERFECTED 40-Patient Dash!” attached at the top of the page.

 

 

Recruitment Update 12 May 2017

 

We have currently recruited a total of 92 patients; having consented 7 patients in May.

 

There are quite a few teams approaching the 10-patient marker!

 

Please see a monthly breakdown of recruitment below:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April 2017

16

85

May 2017

7

92

 

From a site perspective, most sites have recruited at least one patient this month so far! It is crucial we recruit well through to the end of May to try and top February as the best recruiting month.

 

Congratulations to Leicester for maintaining the lead on 17 participants, they are fast approaching the 20-patient marker. J

 

Please find the updated “PERFECTED 40-Patient Dash!” at the top of the page. 

Recruitment Update 28 April 2017

 

We have currently recruited a total of 85 patients; having consented 16 patients in April.

 

Please see a monthly breakdown of recruitment below:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

April

16

85

 

From a site perspective, a huge congratulations and well done is due for the team in Leicester, who are now topping the recruitment chart after managing to recruit a trial high 6 participants in April! This is a tremendous achievement, Sharon and Nicolette!

 

However, the team in Derby have also had a very respectable month for recruitment, in which they have hit their first 10-patient marker, having recruited 3 patients in April. Congratulations Rebecca and James!

 

Please find the updated “PERFECTED 40-Patient Dash!” at the top of this page. 

Recruitment Update 20 April 2017

 

We have currently recruited a total of 80 patients; after consenting a further 11 patients in April so far.

 

From a site perspective, the recruitment race is starting to hot up, with the teams in Ipswich, PRUH and Leicester currently all tied at the top on 13 patients. This is the first time that Leicester have found themselves in the top-spot, after recruiting a further 3 patients already this month- well done and please keep up the great work, Sharon! J

 

Please find the updated “PERFECTED 40-Patient Dash!” attached and at the top of this page.

Recruitment Update March 31 2017

We have now recruited a total of 69 patients across all 10 sites, after consenting 20 patients in March.

 

This shows a consistent improvement in comparison to the first three-months that the trial was open.

 

We are now at the half-way point in the recruitment window and we will continue to push-on from here.

 

Below is a monthly breakdown of recruitment:

 

Month

Number of Patients Recruited

Cumulative Total of Patients Recruited

November 2016

1

1

December 2016

12

13

January 2017

13

26

February 2017

23

49

March 2017

20

69

 

From a site perspective, congratulations are in order for the team in Leicester, who have managed to recruit 3 patients this month and reach their first 10-patient marker! Well done to Sharon and Nicki!

 

The teams in Fife and Denmark-Hill have also performed very well in March, recruiting 3-patients each. However, the team in Edinburgh are the top-recruiting site this month with 4!! This is a tremendous achievement, so well done and thank you Alastair, Pip and the rest of the team at the Edinburgh CRF.  

 

Please see above the “PERFECTED 40-Patient Dash!” 

Recruitment Update 17 March 2017

We have currently recruited a total of 62 patients across all 10 sites, putting us at 13 patients so far in March.

We are working hard to better the 23 patients that we managed to recruit in February.

From a site perspective, Ipswich have continued to recruit consistently well and have now pulled level with PRUH on 12 patients! However, the teams in Denmark-Hill,  Fife, Leicester and Derby have also done really well to maintain a one patient/week recruitment rate. 

Study Awards and Team Updates

Further to last week’s recruitment update, I just wanted to share two notable site achievements, as well as inform everyone of some important changes to the team here in Norwich.

Firstly, a big well done is also due for the team in Denmark-Hill, who after a delayed opening have since proved to be “the fastest out of the blocks” by recruiting 2 patients within their first two weeks of opening! This is a great achievement, so thank you to Monica and Dan for hitting the ground running so well! 

Firstly, a big congratulations is due to the team in Ipswich for hitting their first 10-patient marker! Well done to Sue, Steph and the rest of the team for reaching this important first recruitment milestone. The team have made terrific progress on the study and have actually managed to recruit 9 patients since the turn of the year, placing them spot-on the projected recruitment target of 1 patient/week. 

Well done to both teams and we hope you enjoyed your little token of congratulations for these achievements! J

Recruitment Update 3 March 2017

We are very happy to share that we have now recruited a total of 50 patients across our 10 open sites!

This follows a terrific period of recruitment, in which we managed to recruit a further 24 patients (23 in February- our highest monthly total to date by some margin). 

A special mention is due for the teams in Ipswich, Leicester and Derby- all of whom managed to recruit 4 or more patients during February; which put them in-line with our projected recruitment target of 1 patient per week. 

In addition to this, the team at Denmark-Hill have also done terrifically well to hit the ground running this month, after managing to recruit 2 patients within their first 2-weeks of opening! 

Hopefully, now that we have all 10 sites open and recruiting, we will be able to maintain and build upon this momentum moving forward over the coming months. 

 

Recruitment Update 17 FEB 2017

We are very pleased to announce that we have now recruited a total of 37 patients across our 10 open sites. 

This follows a great two weeks of recruitment. With 11 patients so far in February, we are already close to matching last month’s highest total of 13 patients. If we can reach 20 patients for February, it would be a great achievement and represent a significant improvement in recruitment since the trial opened. 

The team at the PRUH Orpington are still topping the recruitment chart, with a total of 11 patients now. Well done again to Aza and Karen and we hope you enjoyed your little token of congratulations for reaching that first 10-patient mark! 

Meanwhile, the team in Ipswich have managed to keep the gap to just 3 patients- with the team in Leicester doing tremendously well to recruit 3 more patients in just two weeks! 

A big well done is also due to the team in Fife, who have now recruited their first patient to the study. 

Please find the updated “PERFECTED 40-Patient Dash!” at the top of this page. 

Recruitment Update - 9th January 2017

We have now recruited a total of 29 patients across our 9 open sites.

The team at the PRUH Orpington are still topping the recruitment chart, with a total of 10 patients now. Congratulations again to Aza and Karen for hitting that first 10-patient marker! This is a fantastic achievement and leaves the stie well on schedule to hit its 40-patient target.

However, the teams in Ipswich have recruited tremendously well in January and have now closed the gap to just 3 patients!

Furthermore, I’m also pleased to share that our site in Denmark-Hill is on course to be opened early this week, so we look forward to having them open and recruiting shortly.

Please find the updated “PERFECTED 40-Patient Dash!” above. Hopefully we will be able to hit the 30-patient mark across all sites by the end of January!

Newsletter - Latest Edition

Click on the link below to download the latest edition of the PERFECTED Newsletter:

Download Latest PERFECTED Newsletter

For previous editions of the PERFECTED Newsletter select the "News Archive" tab, above (hover over the "News" tab to see this).

Biomarkers Study- ASCRIBED

Professor Chris Fox was successful in the bid for a supplementary International trial to study the hypothesis that greater inflammation after hip fracture is linked with worse acute brain injury and increased acceleration of cognitive decline.

The study- known as ASCRIBED, will be a world leading portfolio study which will provide an extremely rare opportunity to assess the role of acute systemic and brain inflammation in progression of dementia/delirium and will be important in helping to find new treatments.

ASCRIBED will be linked to the PERFECTED WP3 study. Subject to Ethical approval, recruitment is scheduled to begin in February or March 2017.

PERFECTED Work Package 3 - Pilot Study of Enhanced Recovery Pathway - Update!

This work package is about piloting the Enhanced Recovery Pathway in a cluster randomised controlled trial which compares the use of the Enhanced Recovery Pathway versus Usual Care. It will also involve interviews and focus groups of key stakeholders. The aim is to ascertain how feasible the procedures are and to gather information which would inform a definitive trial.

The trial is taking place in 10 sites across England and Scotland, with 5 sites in each of the intervention (Enhanced Recovery Pathway) and control (Usual Care) arms.

Following a 3-month lead in period for the active sites, during which time they were responsible for implementing and reporting their adherence to the Enhanced Recovery Pathway Intervention, the trial went live on the 01st of November 2016.

There are currently 8 sites open for recruitment: York Hospital, Ipswich Hospital, Edinburgh Royal Infirmary, Victoria Hospital Kirkcaldy, The Princess Royal University Hospital, Leicester Royal Infirmary, the Royal Derby Hospital and Pinderfields General Hospital.

A Site Initiation Visit for the Norfolk and Norwich University Hospital (NNUH) / Norfolk and Suffolk Foundation Trust (NSFT) has already been completed and a final Site Initiation Visit for our Denmark-Hill is site planned for January, so we are looking forward to having these remaining two sites activated and recruiting shortly.

From a recruitment perspective, we can also announce that we have recruited our first 2 patients into the trial - both courtesy of the team at the PRUH in Orpington. A massive “congratulations and well done” to Aza and Karen for reaching this fantastic milestone!

We will continue to keep you updated with how recruitment is progressing on the trial, as each site has a 40-patient recruitment target to meet before the 31st of August 2017.

Dr Chris Fox presenting at Age Anaesthesia Association

Dr Chris Fox Chief Investigator for PERFECTED will be giving a presentation about the study at the Age Anaesthesia Assocaition's scientific meeting on Thursday 14th May in Machester.

For further information please click on the following link:

http://www.ageanaesthesia.com/meetings/

 


Hazel Blears MP meets the PERFECTED team

On 20th January 2015 four members of the PERFECTED team met with Hazel Blears MP and Labour’s Norwich North parliamentary candidate Jessica Asato.   Hazel Blears who is Co-Chair of the All-Party Parliamentary Group on Dementia (APPG) was interested to hear about the progress of the project and the future direction it will take. The meeting was held at the recently re-opened Silver Road Community Centre in Norwich.

 

 


Dementia Friendly Norfolk

Age UK Norfolk have announced that they have been awarded £49,216 in the People's Millions competition to help further develop a dementia friendly Norfolk. 

Age UK have extended "a big thank you to everyone who voted, every vote was truly essential! Many thanks also to those who helped to spread the word. Not only did this massively boost the number of votes we received - which was vital to our success – but it also raised awareness of dementia and dementia friendly communities."

 

If you would like to find out more about Age UK Norfolk’s Dementia Support Services and Dementia Friendly Community work, please visit:

http://www.ageuk.org.uk/norfolk/dementia-support--services/

 


Perfected Knowledge Exchange Event

UEA Press Release

Dementia expert calls for innovation to improve NHS dementia services 

A leading dementia expert from the University of East Anglia will say NHS services to dementia patients face major pressure, but can be radically improved by implementing innovations, with huge benefits to people with dementia, their families and healthcare professionals.

Speaking alongside Rt Hon Norman Lamb MP and Chief Executive of the Alzheimer’s Society Jeremy Hughes today, Dr Chris Fox will discuss how current innovations in dementia care have the potential to revolutionise service redesigns across the healthcare system.

Dr Fox said: “The NHS is under increasing severe funding constraints and the forecast reduction in resources is an enormous challenge. Better standards of care can and must be implemented across the NHS.

“NHS Service redesign can save money and improve quality but much depends on how care is co-ordinated and the way services are implemented in a local setting.”

Dr Fox will present initial data from the NIHR-funded five-year ‘PERFECTED’ programme (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia), the first dementia-specific study to combine the most feasible and effective elements of best care with a formal system for putting them into practice.

“Despite one quarter of acute NHS hospital beds being occupied by people with dementia, there is little research on how best to look after these people in hospital. They are exceptionally vulnerable and at high risk of serious complications.”

“Our research is looking at people with dementia admitted with hip fractures, but it will have impact across the board. Inconsistent standards, poor physical and mental health management and overuse of sedatives have been highlighted in national reports. While these reports provide recommendations for improving care, for example preventing delirium in people who have broken hips – which is known to delay recovery – not enough is yet known about how modification in hospital care can prevent delirium in people with dementia.”

Speaking ahead of the event, Norman Lamb MP said: “In the coming decades our health and care system will face increasing pressure as a result of our ageing population and the increasing numbers of people who are living with complex long-term health conditions.

“It is essential that we transform our health and care system to join up care around the needs of individual patients, helping them maintain their quality of life and independence for as long as possible.

“In particular, dementia is going to be perhaps the greatest health challenge in the years ahead, with the numbers suffering from the disease expected to reach 1 million by 2025. Nationally, we are investing not just in research into treatments for the condition, with the aim of developing a cure or disease-altering therapy by 2025, but also into ways to improve care.

“It is incredibly important that organisations like the UEA continue to carry out pioneering research into improving dementia care, protecting patients’ quality of life and helping the NHS meet the challenges of the future.”

The PERFECTED programme will develop and pilot evidence based interventions to improve the hospital care of physical and mental health problems in people with dementia, leading to the creation of an Enhanced Recovery Pathway (ERP). The development of implementation principles will be central and include the consideration of patients, families and staff.

Dr Fox said: “We will create a set of guidelines for care and rehabilitation of people with dementia alongside training materials for staff. These may have massive benefits to people with dementia, their families and healthcare professionals – not only in the UK but around the world. We are creating a better system of care that can feature in any hospital in any country with our international collaborators.”

“This approach challenges the way care is currently delivered, creating a proactive rather than reactive approach and can be available to every patient, delivered by every nurse and by every clinical team. This could revolutionise care across the board.”

Invited guests at the “Innovative and integrated care for people with dementia in acute settings?” event include clinicians, service user representatives, managers and commissioners with expertise in dementia.

Head of Policy and Public Affairs at the Alzheimer’s Society, George McNamara, said: “Too often we hear of people with dementia who are struggling without support because of our fragmented care system. We know that people who aren’t supported are more likely to end up needing crisis care. Hip fractures are one of the most common reasons a person with dementia is admitted to hospital, and they often stay there much longer than those without dementia.

“Research into how we improve the lives of people with dementia today is a vital part of the fight against dementia and is more than just a stopgap until we find a cure. We’re really pleased to be a partner in this important piece of work in order to make a difference to the lives of the 850,000 people who’ll be living with dementia by next year.”

PERFECTED is funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme and aims to improve hospital care for patients with dementia who break their hip.

The study is hosted by the Norfolk and Norwich University Hospitals NHS Foundation Trust, where initial research is taking place. A further 10 hospitals will also be involved after three years. After the programme has ended, it is hoped that the guidelines will be rolled out under a four-year trial across the NHS.

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Peri-operative enhanced recovery hip fracture of patients with dementia