Recreational drug use has been common for many years, but a major recent change in epidemiology has been the increasing use of new recreational drugs, sometimes termed Novel Psychoactive Substances (NPS) or ‘legal highs.’
These substances are numerous and associated with significant acute toxicity including increasing hospital presentations and fatalities. The effects of chronic exposure are usually unknown. Currently there is no systematic national UK data collection system linking analytically confirmed use of NPS with acute toxicity. This causes a delay before clinicians, public health teams, law enforcement and policy makers can define and mitigate the harms associated with specific NPS. There are typically no published data available on the pharmacology and toxicity of these substances as they emerge into recreational use, leaving healthcare professionals without evidence to guide patient management in the event of toxicity.
This research will help to address this gap by collating information about the acute toxicity of NPS in the UK via four inter-related studies using (1) Anonymised aggregated data collected by the National Poisons Information Service (NPIS) (2) Anonymised aggregated data available on positive samples from participating NHS toxicology laboratories (3) Further laboratory analysis of linked-anonymised samples collected from patients with acute severe toxicity as part of usual clinical care and sent to participating NHS laboratories, where NPS use is suspected. (4) Collection and analysis of samples from consenting patients presenting to participating emergency departments with severe toxicity associated with suspected NPS use. Samples will be subjected to detailed toxicology analysis using state of the art methods, informed by the latest information on the NPS being encountered by clinicians in the UK.
The research will identify trends in enquiries and positive laboratory samples relating to NPS.
1. Ambulatory Device, Rocket Pleural vent insertion
2. Standard Treatment, Aspiration +/- chest drain
Primary Outcome Measures
To assess whether use of an ambulatory device (Rocket Pleural Vent) and treatment strategy reduces hospital stay. Total length of stay in hospital up to 30 days post randomisation. Up to 30 days post randomisation.
RAMPP trial - Randomised Controlled Trial: Pleural vent (rocket) V standard care in Primary Spontaneous Pnuemothorax
Patients commonly present to the Emergency Department with epistaxsis (nose bleed). Standard first aid measures such as applying pressure can often stem bleeding however in more severe cases of epistaxsis further treatment is required.
Novel Use of Tranexamic Acid to Reduce the Need for Nasal Packing