East Lancashire Hospitals NHS Trust is an NHS hospital trust in Lancashire, England. It was established on 1 September 2002, as the result of a locally controversial, cost saving merger of Blackburn Hyndburn & Ribble Valley (BHRV) NHS Trust and Burnley Health Care NHS Trust, first announced in September 1999.
Objectives To determine whether neurorehabilitation can be enhanced through regional implementation of group-based telerehabilitation, we implemented the NeuroRehabilitation OnLine (NROL) innovation regionally and evaluated scale-up from a systems perspective.Design Observational, exploratory service evaluation using a mixed-methods convergent parallel design.Setting Stroke and neurological rehabilitation services from four organisations across a regional healthcare system in the UK.Participants Therapy staff from community-based services and patients with a stroke or neurological condition receiving active community rehabilitation including NROL from April 2022 to March 2024.Intervention A regional multidisciplinary group-based neurological telerehabilitation innovation (NROL).Outcome measures Selected Proctor’s implementation outcomes, to establish system-level adoption, acceptability and sustainability of the regional NROL innovation.Results NROL was adopted by all intended organisations and continues as part of usual care with participation growing. It was acceptable to therapy staff and patients across the region, well-used, valued and supported increased therapy provision. For sustainability, staffing and travel efficiencies were identified through effective collaborative regional systems working. The importance of continued wide stakeholder engagement, robust evaluation and alignment was highlighted.Conclusions NROL was successfully embedded into real-world practice at a system level and enhanced neurorehabilitation. Looking forward, longer-term sustainment of this innovation will require a compelling business case and value proposition for decision-makers, addressing economic, equality and operational efficiency considerations.
Background Delivering recommended intensity of neurorehabilitation remains a challenge, with telerehabilitation offering one solution. NeuroRehabilitation OnLine (NROL) is a multidisciplinary, group-based telerehabilitation model embedded within one region in England, showing promise and alignment with healthcare strategic priorities. The importance of scaling successful evidence-informed practices is recognised, however careful adaptation is required to ensure contextual fit and sustainability. Objective To describe the adaptation of NROL for implementation in a new context. Methods The four-step ADAPT guidance was applied with previously identified implementation strategies to guide the adaptation of NROL from Region 1 to Region 2. Adaptation activities were co-produced. Contextual factors were detailed using the Consolidated Framework for Implementation Research and the Intervention Sustainability Assessment Tool. The adapted innovation was described using the TIDieR-Rehab checklist. Results NROL was successfully adapted for Region 2. Step 1 confirmed strategic fit but identified barriers including workforce, infrastructure and resource. Led by an adaptation team and supported by a learning collaborative, Step 2 responded to barriers, retaining core components while tailoring role configuration and materials. Step 3 demonstrated feasibility and acceptability through piloting and phased integration, and improved fit within service pathways. Step 4 focused on sustainment, supported by training, stakeholder engagement, and reporting. Conclusion This study offers key considerations for scale-up, providing an example of context-sensitive adaptation to a new region, demonstrating how frameworks and co-production can support the adaptation of telerehabilitation models. This example has potential wider use for researchers and implementers tasked with delivering impact, though highlights the effort and resource needed.
IntroductionRegional disparities in the incidence of colorectal cancer remain a concern within the United Kingdom, particularly in the North West of England, with 37% higher incidences than the national average. Given the growing burden of treatment-related side effects such as cognitive impairment, this study aims to investigate whether prehabilitation can improve brain health and cognitive function in patients with colorectal cancer receiving adjuvant and neoadjuvant chemotherapy.MethodsThis randomised control trial will recruit eighty-six patients with stage II and III colorectal cancer, who will receive adjuvant and neoadjuvant chemotherapy (fluorouracil, capecitabine, or oxaliplatin) and will be randomised between prehabilitation and standard care groups. The prehabilitation group will be provided an individualised, home-based exercise programme before and during chemotherapy, multivitamin supplementation, telephone check-ins, and activity devices. The standard care group will be provided with information about physical activity and nutrition at the start of the intervention. Habitual physical activity will be tracked in all patients. Assessments will be conducted at baseline, 72 hours before the first chemotherapy administration, and 72-96 hours after the final treatment. Outcome measures will include cardiopulmonary fitness, neurotrophic biomarkers, electroencephalographic activity, cognitive function tests, and a cognitive-related quality of life assessment.DiscussionThis study protocol is designed to test whether home-based prehabilitation can improve brain health and reduce chemotherapy-related cognitive impairments in patients with colorectal cancer. Insights from this work may support the development of more accessible and effective prehabilitation programmes to address treatment specific cognitive impairment.Trial registrationClinicalTrials.gov NCT07341217.
Background Acute pancreatitis is an inflammatory disorder of the pancreas with diverse etiologies, among which drug-induced pancreatitis (DIP) represents a rare but clinically important subset. Doxycycline, a widely used tetracycline antibiotic, has been infrequently implicated as a causative agent in isolated case reports, leaving the true incidence and risk factors unclear. Objective This prospective study aimed to evaluate the incidence, clinical characteristics, and biochemical profile of acute pancreatitis in patients receiving doxycycline therapy and to identify potential associations between patient characteristics, duration of therapy, and disease occurrence. Methods This 24-month prospective observational study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan. A total of 130 adult patients receiving doxycycline therapy were enrolled, of whom 124 completed follow-ups. Baseline pancreatic, hepatic, and renal enzyme profiles were assessed before therapy initiation, and patients were followed weekly for clinical symptoms and biochemical parameters. Acute pancreatitis was diagnosed according to the revised Atlanta criteria. Data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States). Quantitative variables were expressed as mean ± SD, and categorical variables as n (%). Associations were evaluated using chi-square and t-tests, with p < 0.05 considered statistically significant. Results Among 124 participants, seven patients (5.6%) developed acute pancreatitis confirmed by biochemical and radiological findings. The mean latency to onset was 8.1 ± 2.3 days. The mean duration of therapy was significantly longer in affected patients (12.3 ± 2.1 vs. 10.6 ± 3.1 days; p = 0.03), while no significant associations were observed with age, gender, or BMI. All affected patients presented with classical symptoms, elevated serum amylase (422 ± 118 U/L) and lipase (698 ± 210 U/L), and recovered completely with conservative management. No mortality occurred. Conclusion Doxycycline-induced acute pancreatitis, though uncommon, is a clinically relevant adverse event with favorable outcomes upon early detection and drug withdrawal. Prolonged therapy beyond 10 days may increase risk, underscoring the need for clinical vigilance and patient monitoring during treatment.
