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IntroductionObstructive sleep apnoea (OSA) is characterised by a loss of neuromuscular tone of the upper airway dilator muscles while asleep. This study investigated the effectiveness of transcutaneous electrical stimulation in patients with OSA.Patients and methodsThis was a randomised, sham-controlled crossover trial using transcutaneous electrical stimulation of the upper airway dilator muscles in patients with confirmed OSA. Patients were randomly assigned to one night of sham stimulation and one night of active treatment. The primary outcome was the 4% oxygen desaturation index, responders were defined as patients with a reduction >25% in the oxygen desaturation index when compared with sham stimulation and/or with an index <5/hour in the active treatment night.ResultsIn 36 patients (age mean 50.8 (SD 11.2) years, male/female 30/6, body mass index median 29.6 (IQR 26.9–34.9) kg/m2, Epworth Sleepiness Scale 10.5 (4.6) points, oxygen desaturation index median 25.7 (16.0–49.1)/hour, apnoea-hypopnoea index median 28.1 (19.0–57.0)/hour) the primary outcome measure improved when comparing sham stimulation (median 26.9 (17.5–39.5)/hour) with active treatment (median 19.5 (11.6–40.0)/hour; p=0.026), a modest reduction of the mean by 4.1 (95% CI −0.6 to 8.9)/hour. Secondary outcome parameters of patients' perception indicated that stimulation was well tolerated. Responders (47.2%) were predominantly from the mild-to-moderate OSA category. In this subgroup, the oxygen desaturation index was reduced by 10.0 (95% CI 3.9 to 16.0)/hour (p<0.001) and the apnoea-hypopnoea index was reduced by 9.1 (95% CI 2.0 to 16.2)/hour (p=0.004).ConclusionTranscutaneous electrical stimulation of the pharyngeal dilators during a single night in patients with OSA improves upper airway obstruction and is well tolerated.Trial registration numberNCT01661712.

ObjectivesTo facilitate South Asian (SA) families and health‐care professionals (HCPs) participation in a prioritization exercise to co‐produce child health research and public awareness agendas.DesignA three‐stage process was adopted involving the following: (i) systematic literature review, (ii) HCP scoping survey and (iii) focus groups of SA adolescents and families. A Punjabi‐ and Urdu‐speaking community facilitator moderated focus groups. A British Sign Language interpreter assisted in the hard of hearing group. Concordant and discordant themes between HCPs and SAs were identified.SettingNational survey of HCPs. Leicestershire for SA families.ParticipantsA total of 27 HCPs and 35 SAs. SAs varied by descent, age (16‐74), UK stay length (3‐57 years) religion and disability.ResultsRanked by submission frequency in the survey, HCPs prioritized (i) public awareness on obesity, mental health, health‐care access, vitamin D and routine health checks and (ii) research on nutrition, diabetes, health education and parenting methods.DiscussionSouth Asians prioritized research into the effectiveness of alternative medicines, a theme not identified by HCPs. Both HCPs and SAs prioritized increased research or public awareness on mental health illness, blood and organ donation, obesity and diet. Whilst HCPs identified diabetes, vitamin D and rickets together with parenting methods were important priorities requiring increased public awareness, and these views were not shared by SAs.ConclusionsMinority groups are not always included in priority setting exercises due to concerns about language and perceived difficulty with accessing communities. Through this co‐production exercise, we showed that it is possible and essential.

BackgroundMulago National Referral Hospital has the largest maternity unit in sub-Saharan Africa. It is situated in Uganda, where the maternal mortality ratio is 310 per 100,000 live births. In 2010 a ‘Traffic Light System’ was set up to rapidly triage the vast number of patients who present to the hospital every day.The aim of this study was to evaluate the effectiveness of the obstetric department’s triage system at Mulago Hospital with regard to time spent in admissions and to identify urgent cases and factors adversely affecting the system.MethodsA prospective audit of the obstetric admissions department was carried out at the Mulago Hospital. Data were obtained from tagged patient journeys using two data collection tools and compiled using Microsoft Excel. StatsDirect was used to compose graphs to illustrate the results.ResultsInformal triage was occurring 46 % of the time at the first checkpoint in a woman’s journey, but the ‘Traffic Light System’ was not being used and many of the patient’s vital signs were not being recorded.ConclusionsIt is hypothesised that the ‘Traffic Light System’ is not being used due to its focus on examination finding and diagnosis, implying that it is not suitable for an early stage in the patient’s journey. Replacing it with a simple algorithm to categorise women into the urgency with which they need to be seen could rectify this.