Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

BACKGROUND

Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption.

OBJECTIVES

To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment.

DESIGN

A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment.

SETTING

The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England.

PARTICIPANTS

Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual.

INTERVENTIONS

The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy.

MAIN OUTCOME MEASURES

Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data.

RESULTS

The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment.

CONCLUSIONS

The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN36257982.

FUNDING

This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.

A SEVENTEEN-YEAR SURVEY OF THE RINGWORM FLORA OF BIRMINGHAM

The nature of the ringworm flora of Birmingham over 17 years was investigated and tabulated by species, geographical distribution and concentration.

The rise and fall of such outbreaks as occurred has been charted.

The persistent preponderance of zoophilic species, in spite of the recent decline in over-all incidence, has been demonstrated.

THE THALASSAEMIA TRAIT IN AN ENGLISH FAMILY

Nine cases of the thalassaemia trait are described in an English family. The problem of distinguishing these cases from those of the common hypochromic anaemias by simple laboratory tests is discussed.Iron-resistant hypochromic anaemia in people of British ancestry may be caused by the thalassaemia trait. Such cases have been reported by Bywaters (1938), Israëls, Suderman, and Hoogstraten (1955), Israëls and Turner (1955), and Havard, Lehmann, and Bodley Scott (1958). Dacie (1960) mentions similar cases and Callender, Mallet, and Lehmann (1961) recently described the finding of 25 cases in three English families.

THE ROLE OF RADIOTHERAPY IN THE TREATMENT OF TUMOURS IN CHILDREN

Radiotherapy has an established place in the treatment of some tumours in children, both for cure and palliation. An evaluation of this form of treatment is made, based on experience with the children admitted to the Christie Hospital and Holt Radium Institute during the past 30 years.

SOME OBSERVATIONS ON THE USE OF THE QUCHTERLONY GEL DIFFUSION TECHNIQUE IN THE STUDY OF MYXOMATOSIS

1. Laboratory rabbits were infected with seventeen different preparations of myxoma virus (this probably represents thirteen strains of which four could be classified as fully virulent and the rest as attenuated, two being markedly so).

2. One hundred and twenty-four wild rabbit carcasses were obtained from a rabbit infestation in the throes of an outbreak of myxomatosis.

3. All the carcasses were examined for the presence or absence of myxoma antigens and antibodies by a modified Ouchterlony gel-diffusion precipition test.

4. As a result of (3), we have concluded that the gel test can provide confirmation of the presence or absence of myxomatosis. It is particularly useful in cases of doubt about the clinical diagnosis. The test can also give a reasonable indication of the number of recovered rabbits in a population and, more important still, it can give an indication of the recovery rate during an outbreak of disease. However, attempts to differentiate between fully virulent and attenuated strains of virus were unsuccessful.

VIRUSES IN ACUTE RESPIRATORY INFECTION IN A GENERAL COMMUNITY

The aetiology of acute respiratory infections between September 1962 and August 1963 was studied in two general practices in Cambridge. These practices were reasonably representative of the permanent community of Cambridge.

There were 592 spells of acute respiratory infection in the combined practices, representing an incidence of 11·4 spells per 100 persons. Children aged 0–4 had the highest rates (51·6 spells per 100 persons).

It was possible to establish a diagnosis in 62·5% of cases investigated. Influenza and parainfluenza infections featured prominently, being responsible between them for 46·6% of all respiratory infections investigated. From September 1962 to January 1963, parainfluenza viruses were prevalent, causing acute laryngo-tracheo-bronchitis in children (croup), and an influenza-like illness in adults. From February to April 1963, influenza A (Asian) was epidemic, a clinical diagnosis of influenza being frequently confirmed by laboratory studies at this time. There were nine cases of Eaton agent infection, seven of which had PAP, the other two being family contacts who later developed influenza-like illnesses.

Adenovirus (four cases), and RS virus (three cases) were not prevalent to any large extent in Cambridge during the survey.