Southport

Researchers are evaluating whether adding duroplasty, a surgical procedure that expands the dura (the tough membrane around the spinal cord), to standard spinal surgery improves muscle strength and outcomes after severe traumatic spinal cord injury in the neck. This condition often causes permanent disabilities like paralysis and loss of bladder and bowel control, and currently, no treatments have proven to improve recovery. The study focuses on adults with severe cervical spinal cord injury who need surgery within 72 hours of injury. Participants will be randomly assigned to receive either standard spinal surgery, which includes laminectomy (removal of part of the vertebra), or spinal surgery plus duroplasty. The duroplasty involves opening the dura and stitching a patch to relieve pressure on the swollen cord. A subgroup of patients will also take part in a smaller mechanistic study using probes at the injury site to monitor pressure, blood flow, metabolism, and inflammation. The study will recruit 222 adults over 4 years from major trauma centers in the UK. During the study, patients will be assessed at baseline, 3, 6, and 12 months after surgery for muscle strength, hand function, walking ability, bladder and bowel control, quality of life, complications, and survival. Some patients will have additional monitoring at the injury site. The main outcome measured is the change in motor function at 6 months compared to baseline. Participants will be followed for one year to evaluate recovery and safety.

Chronic obstructive pulmonary disease (COPD) is a common lung condition affecting about 10% of adults worldwide, with a prevalence of 4.5% in those aged 40 years and older in the UK. Exacerbations, or sudden worsening episodes often triggered by infections, can lead to hospital admissions and carry risks of increased illness and death. This trial focuses on the high-risk 90-day period after hospital discharge, during which patients have a 43% chance of readmission and 12% risk of mortality. The study aims to test whether a supported rescue pack management plan can reduce readmissions by 20%. This is a Phase 3, open-label, multicenter randomized controlled trial involving 1400 patients across 30 NHS trusts.