All Clinical Trials in United Kingdom

This research project incorporates a series of studies to investigate the relationship between physical performance (e.g. tests of strength, balance and walking distance) and physical activity (activity measured in day to day life) in people with COPD and other chronic lung diseases. Read Less

Sepsis is an increasingly recognised burden to healthcare systems worldwide. Intravenous fluid therapy is a common first-line intervention recommended by international guidelines. Hyperoncotic preparations of human albumin solution are widely available, but their efficacy has yet to be proven. This randomised feasibility trial will test whether it is feasible to administer hyperoncotic albumin solutions as both fluid resuscitation and as a regular supplement in patients with early septic shock. Read Less

The NHS Long Term Plan for Cancer has set out the strategy to deliver personalised care to every patient treated for cancer (1) to improve experience and quality of life for patients. Personalised Follow-Up (PFU) focuses on the tailored needs of patients who have completed cancer treatment and PFU programmes have been established nationally for patients with breast and colorectal cancer. PFU for Head and Neck Cancer (HNC) services will be established nationally by 2024. Currently, there is a lack of evidence that measures prospectively the impact of PFU on patients and providers. In January 2022, Guys and St. Thomas' NHS Foundation Trust initiated PFU for patients with HNC. For the first 2 years following treatment, patients treated curatively are followed up according to institutional protocol. At 2 years following completion of treatment, patients who remain disease free, have no significant risk factors for recurrence and no severe treatment-related toxicity are referred to the programme and discharged from routine oncology FU. Patients are reviewed in a nurse-led HNC PFU clinic where they receive personalised survivorship, health promotion and education in identifying signs of disease recurrence with information on the pathway to re-present directly to the services at Guy's Cancer. This mixed methods research project will evaluate implementation factors of this new PFU programme whilst prospectively measuring its effectiveness. A hybrid type 2 implementation-effectiveness study design will be used to determine the value patients and health care providers (HCP). Semi-structured interviews and focus groups with patients and HCP will be undertaken to evaluate barriers and facilitators, safety, acceptability and user experience. Data will be collected over a 24 month period. All patients who are transferred to the PFU pathway will be eligible to participate, alongside HCP involved in delivering the service. Read Less

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and estimates suggest its prevalence is increasing. Despite the advances in AF ablation strategies, the outcome of ablation procedures in persistent AF is still unsatisfactory. In addition, many patients are not candidates for ablation due to advanced age, comorbidities and previous failed ablation procedures. It is well known that there is no mortality benefit from rhythm versus rate control strategy in AF, therefore the increased number of AV node ablation and pacemaker insertion for patients with symptomatic AF with uncontrolled heart rate. Following AV node ablation, it is understandable that these patients will be paced 100% of the time where the value of physiological pacing will be at its most. The current standard practice is to pace the right ventricle for this cohort of patients unless they have severe LV systolic dysfunction when a biventricular pacing might be recommended. Previous data showed that RV pacing only can lead to deterioration of LV function, worsening of heart failure symptoms and increased mortality. HIS bundle pacing is a novel technique of pacing through placing the pacemaker lead on the junction box between the top and bottom chamber of the heart. This will allow the utilisation of the normal/intrinsic HIS Purkinjie (eclectic cables) to stimulate the ventricles. This can offer a physiological pacing modality and reduce pacing induced cardiomyopathy specially in pacing dependent pacing. The Ablate and Pace HIS Study proposes that the new method of HIS pacing is safe, effective and superior to the existing method of RV pacing in patients with atrial fibrillation who demonstrate signs of heart failure. Read Less

Cognitive analytic therapy (CAT) is used within mental health services as a treatment for a range of mental health difficulties. Recent research has adapted CAT to be used as guided self-help for anxiety within Increasing Access to Psychological Therapies (IAPT). IAPT is a mental health service. Guided self help-CAT (CAT-GSH) is delivered by mental health professionals called Psychological Wellbeing Practitioners (PWPs). This current study aims to develop and pilot a CAT-GSH manual for depression for use in the same context and practitioners. Stage one uses past research and consultation meetings to help develop the treatment. Stage two will use different approaches to explore the acceptability and outcomes of the intervention. Read Less

Knowledge about abnormal organ development is important to understand pathology and to develop novel treatment approaches for individuals with congenital and acquired disease. Most of our current understanding is based on examination of tissues from the embryo and early fetus, collected from women undergoing termination of pregnancy in the first trimester (third) of pregnancy. There is very little known about normal and abnormal organ development from a developmental perspective during the crucial last two-thirds of pregnancy when much remodelling of fetal tissues occurs. We aim to collect tissue from a variety of developing fetal organs in the last two-thirds of pregnancy from women who decide to undergo a termination of pregnancy and who wish to undergo a clinical fetal postmortem (PM) examination. Read Less

The goal of this clinical trial is to see if several weeks of self-administered, home-based, treatment involving breathing hydroxy gas (a mixture of hydrogen and oxygen) for at least 2 hours a day for 3 weeks, will relieve symptoms in patients suffering from Long COVID. The main question it aims to answer is whether inhaling hydroxy gas might be a useful treatment option to help patients with long COVID cope better and recover quicker from this condition. Participants will wear a nasal canula (placed in their nostrils) to inhale a gas from a machine that they will be trained to use at home. In one 3-week period, the machine will deliver hydroxy gas (treatment) and in a separate 3-week period the machine will deliver normal air (placebo). The order of the treatment or placebo periods will be randomized and separated by a minimum of 3-weeks during which the participants will not use the machine ('washout' period). Neither the participant nor the investigators will know which 3-week period is the treatment and which is the placebo phase. Participants will visit the laboratory (or be tested at home) at the start and end of each 3-week period. Testing will involve measuring physical ability (handgrip strength, how far they can walk in 6 minutes, how many times they can stand up and sit down in a minute), breathing problems (how hard they can blow out, how breathless they feel), cognitive ability (how quickly they can mark out a trail based on numbers and letters), and state of mind (mood). The investigators hypothesize that compared to inhaling placebo, inhaling the hydroxy gas will produce greater improvement in physical ability, relieve breathing problems, and enhance cognitive ability and mood, thereby showing that it can relieve key symptoms of long COVID Read Less

The study is looking to see if a new drug (remimazolam) that is used to sedate and relax adults (aged 18-59 years) having dental treatment is better than the current drug in use (midozolam). Intravenous sedation is where a drug is injected into a patient's hand or arm. The drug stops them feeling worried, and helps them relax. After sedation, patients wait in a recovery area until they are safe to walk but the side effects of the drug can last until the next day. A new drug has been developed that has the same sedation effect and safety, but the recovery is much quicker. The investigators think that the side effects from the new drug will have worn off by the time patients are ready to leave the hospital. Patients who are coming to Guy's Hospital to have their wisdom tooth extracted under sedation will be asked if they want to be included in the research. Patients will be randomised to receive either remimazolam of standard of care midazolam. The sedation and dental treatment will be carried out in the normal way. The patients will be asked to do will be some questionnaires and some tests which are as follows: 1. Patients are asked to listen to some words and repeat them back. This tests how well they can remember new information 2. Reaction test - Patients are asked to rest their fingers on a keypad and move their fingers when lights come on above them. This tests how quick their reactions are. 3. Symbol test- Patients are asked to draw small shapes that are linked to numbers. This tests how well they can process information. 4. Standing test- Patients are asked to stand on a platform that measures how much they are swaying back and forth. This tests how stable they are to walk. By testing people before and after the sedation the investigators can see how they recovered and compare the two drugs. The research will take place during the day case visit and involve 2 x 30 mins research assessments (before sedation and post sedation). After the post-sedation tests, participants will be discharged, followed by a telephone review 3-10 days post procedure. Read Less

Pyruvate dehydrogenase (PDH) deficiency is one of the most common mitochondrial disorders. Patients with this genetic condition have difficulty utilising carbohydrates to produce energy and develop a combination of problems including seizures, poor balance, developmental delay, disability and have a reduced life expectancy. As for most mitochondrial disorders there is a lack of effective treatments. It is essential to understand the mechanisms underlying the disease in order to identify new treatments, and to understand the natural history of disease in order to prepare for clinical trials. To date, a natural history study of PDH deficiency has not been undertaken in the UK. The researchers aim to undertake the first natural history study of PDH deficiency in the UK, to describe the spectrum of symptoms, genetics, management and outcomes in both children and adult patients. Read Less

A small-scale study using interviews to explore patients', carers' and health care professionals' experience of pain relief strategies currently used in UK practice for dressing change in chronic wounds. Read Less

There are trillions of microorganisms living alongside us in our guts. Recent research has shown that this community, known as the gut microbiome, has a big influence on our health and wellbeing. Imbalances in the composition of the gut microbial community has been linked to several diseases including COVID, mental ill health, and diabetes. When the composition of the gut microbiome changes towards a less healthy one (called dysbiosis) this will, in turn, affect our health in a negative way. The composition of our gut microbiome remains fairly stable during adulthood, however, as we move into older age, there is a shift and its composition will change to a less healthy one; this is one of the reasons why older people can be more susceptible to diseases. Fortunately, there are several tools that we can use to improve our gut microbiome and one of them is exercise. Besides its well-known effects on our health, exercise has been shown to be able to improve the gut microbiome composition of younger people and those with certain metabolic diseases such as obesity. However, less is known about the effects of exercise on the gut microbiome of older adults. The aim of this study, therefore, is to assess the effects of a 12-week exercise intervention on the gut microbiome of physically inactive older adults. Hopefully, after this study, the investigators will have more information on whether exercise can be used as a tool to improve the gut microbiome of older adults therefore improving their overall health and quality of life. Read Less

The goal of this feasibility study is to learn whether a new approach to breathing tube removal within the Intensive Care Unit is safe and acceptable to participants who require a breathing tube for the management of severe breathing difficulties. The main questions it aims to answer are: * What is the recruitment rate to the study over 12 months? * Is the study design acceptable and safe to participants? Participants will receive high flow nasal oxygen before their breathing tube is removed. The investigators will compare this with standard practice of applying conventional, low-flow oxygen after the breathing tube removed to see if this effects the rate of repeat breathing tube insertion. The investigators hypothesise that they will recruit 30 participants to the study protocol (15 participants in each group) over 12 months and that our study protocol will be tolerable and acceptable to participants. Read Less