This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

We attribute this low incidence to the use of an automated jet ventilator with airway pressure monitoring and control, and the alteration of ventilator parameters by an experienced anaesthetist.

Experienced anaesthetists required a longer time for intubation in a standard manikin using a McGrath compared with other laryngoscopes, but a shorter time for intubation in a difficult manikin using an APA with DAB, and with fewer glottic advances, compared with other laryngoscopes.

y The SNAP-2: EPICCS collaborators are listed in Supplementary material. AbstractBackground: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital-and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals

Hypnotizability may play a moderating role in the internalization of body image ideals and may also mediate suggested distortion of body image self‐representations, especially in restrained eaters. A modified version of the Creative Imagination Scale (CIS) incorporating a body expansion and a body reduction item, was used to examine the relationship between hypnotizability, dietary restraint and body image manipulation in restrained and non‐restrained eaters. Dietary restraint was measured in 40 female undergraduate participants using the Three‐Factor Eating Questionnaire and the Revised Restraint Scale. The results suggest that hypnotizability, as measured by the CIS, correlates significantly with both measures of dietary restraint. In addition, restrained eaters demonstrated generally elevated susceptibility to body image modification compared with unrestrained eaters, though both restrained and non‐restrained eaters appeared to be more susceptible to imagining body size expansion than reduction. These results are discussed in relation to social influences on eating and dietary disorders. Copyright © 1998 British Society of Experimental and Clinical Hypnosis

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Editor-We read with interest the article on transtracheal jet ventilation (TTJV) in patients with severe airway compromise by Ross-Anderson and colleagues. 1 We agree with the authors regarding the enormous value of the pause pressure protection offered by automated jet ventilators in the elective setting. Protection from barotrauma is just as important in the emergency obstructed airway. The Ventrain (Dolphys Medical, Eindhoven, The Netherlands) is a new device which offers an alternative approach to the prevention of major pressure-related complications. It was first presented at the Difficult Airway Society meeting in Liverpool in 2008 and is now commercially available from Inspiration Healthcare. It is a single-use TTJV device marketed for use in emergency complete airway obstruction scenarios. It consists of a handheld device with tubing to connect one end to an oxygen supply and the other to a narrow bore transtracheal catheter. It allows not only inspiration but also active expiration by generating suction using the Venturi effect, thus reducing the risk of barotrauma caused by inadequate exhalation. 2 We would be interested in the thoughts of the authors about the place of this device in emergency and elective airway management.

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