Adult asthma: what community nurses should know (2018)

Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Feb 2018; vol. 32 (no. 1); p. 48-53

Abstract:
Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during I acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK — a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and provide patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. The key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGKr < 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration.

Link to full-text [NHS OpenAthens account required]

What’s in a name: friend or foe? Coping strategies used by stoma patients (2018)

Type of publication:
Journal article

Author(s):
*Powell, Julie

Citation:
British Journal of Nursing; Mar 2018; vol. 27 (no. 5) S22

Abstract:
The article examines how stoma patients chose to name their stoma and discusses how this can inform medical professionals' understanding of patient experiences. It provides examples of patients who named stoma after common first names or after television characters and explores the success of such coping strategies.

Link to full-text [NHS OpenAthens account required]

Optimising patient experience within the ACHD outreach network: A questionnaire based study (2018)

Type of publication:
Conference abstract

Author(s):
Ooues G.; Clift P.; Bowater S.; Arif S.; Hawkesford S.; Pope N.; Anthony J.; Gaffey T.; Thorne S.; Hudsmith L.; Epstein A.; Prasad N.; Adamson D.; Cummings M.; Spencer C.; Woodmansey P.; *Ingram T.; Morley-Davies A.; Roberts W.; Qureshi N.

Citation:
Heart; Feb 2018; vol. 104, Suppl 2, A12

Abstract:
Purpose The NHS England Congenital Heart Disease standards review is based on a network model to deliver high quality, safe and effective services as locally as possible. We developed a Patient Questionnaire across our Adult Congenital Heart Disease (ACHD) West Midlands network to measure patient experience, satisfaction and to improve services across the network. Methods Patient questionnaires were distributed to patients in all 8 Outreach and the Level 1 ACHD Centre (University Hospital Birmingham). Data was analysed including patients' replies on travel to outpatient clinic, satisfaction on location and timing of their appointment, review by ACHD Specialist Nurse and tests performed, information on their condition and leaflets provided and patients' demographics. Results 130 questionnaires were returned. The majority of patients (67%, n=87) travelled to their appointment with their own car, either alone (36%, n=46) or with a member of their family (44%, n=56). Most patients (93%, n=120) travelled less than one hour to hospital and less than 20 miles (86%, n=99). Patients attending Level 1 Centre appointments travelled a longer distance (mean 29.6+/-44 miles) compared to the Outreach Centres (mean 9.9+/-2.8 miles). Almost all patients found the appointment time and location convenient for them (91%, n=117% and 95%, n=121), and were given enough information regarding their condition (85%, n=98). Conclusion With the development of ACHD Network Outreach clinics to facilitate services and appointments closer to patients' homes, travel times are reduced and high patient satisfaction is maintained.

Link to full-text [NHS OpenAthens account required]

Feasibility of performing MRI prostate before prostate biopsy in a district general hospital in the UK (2017)

Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Anandakumar A.; *Umranikar S.; *Lynn N.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: Men with abnormal digital rectal examination or raised PSA usually undergo
transrectal ultrasound (TRUS) prostate biopsies. NICE guidelines do not recommend routine MRI prostate before prostate biopsy unless they have a previous negative prostate biopsy. However, all men with positive prostate biopsies will have MRI prostates. The recent publication of PROMIS (Prostate MR Imaging Study) trial suggests that MRI prostate can reduce unnecessary biopsies by a quarter and can improve detection of clinically significant cancer. In light of this, we would like to determine if performing MRI prostate before biopsy is likely to increase workload in our radiology department in a district general hospital in the UK. Materials and Methods: Patients who underwent TRUS prostate biopsy between 3 Dec 2015 to 28 April 2016 were identified. Their data were analysed retrospectively. 1 year follow-up was chosen to see how many patients would have had MRIs. Results: 173 patients were listed for prostate biopsies but only 158 patients had biopsies with an average age of 69.8 years old (range: 49-88 years old) and an average PSA of 48.1ug/l (range: 0.5-3283.1ug/l). 57 patients had a negative prostate biopsy during this period. 30/57 patients did not have a MRI at all; 12/57 patients had a MRI after biopsy; 1/57 patient had a MRI as an acute setting after biopsy to look for abscesses; and 14/57 patients had a MRI before biopsy. Conclusions: In our study, 30/158 (19.0%) did not have any MRI prostate in 1 year after their first prostate biopsy. However, it is possible that this group of patients will have a MRI prostate in the second year or later. If we were to perform a MRI prostate before TRUS prostate biopsy for all patients, it would increase 19.0% workload for our radiology department.

Current trends in cytoreductive nephrectomy in the era of targeted molecular therapy (2017)

Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Segaran S.; *Bell J.; *Nakada S.Y.; *Rane A.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: Several factors are considered when determining if a patient is a candidate for
cytoreductive nephrectomy (CN). Our aim was to study geographic trends and factors associated with the decision to consider CN. Materials and Methods: An investigator designed survey was created to assess the rate of CN being performed around the world and the factors considered when determining patient eligibility. This was distributed to attendees at the World Congress of Endourology 2016 in Cape Town in order to capture an international cohort of urologists. The survey included questions about physician demographics, the timing of CN, what patient factors were considered prior performing CN, and if they followed any guidelines when deciding on CN. Results: 158 urologists responded to our survey (Asia = 46, Europe = 35, Africa = 34, North America = 29, South America = 13 and Australia = 1). 78 (49.4%) urologists indicated that they follow guidelines for recommending CN. 107 (67.7%) of respondents stated they perform CN. 64 urologists perform CN prior to systemic therapy while 20 urologists perform CN after systemic treatment, and 22 urologists perform CN before or after systemic treatment. Performance status was the most considered factor while calcium level was the least considered factor when determining eligibility for CN. Conclusions: This cohort of urologists most commonly consider performance status, age and extent of metastatic disease when determining candidacy for CN; while the grade of the tumour and the calcium level were the least considered. We eagerly await the results of CARMENA and SURTIME trials.

A pilot experience in using a digital app to follow-up prostate cancer patients in Shropshire, UK (2017)

Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Loh A.; *Anandakumar A.; *Umranikar S.; *Elves A.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: It is not uncommon for patients with cancer to experience physical, mental and social distress, forming a significant burden that has a negative impact on their quality of life. We have piloted a digital app called VitruCare in our hospital in order to address these issues in patients with prostate cancer. More importantly, the app also serves as a communication tool between the hospital medical team and the patients. Materials and Methods: Patients with prostate cancer were invited to use VitruCare in our pilot study. 53 users were followed prospectively. Data on various domains such as "My Goals", "My Lifestyle", "My Priorities", "My Diaries", and "How Do I Feel Today" were analysed retrospectively. Results: The users of this application have a median age of 72.5 years old. 14% have nodal or bone metastasis, and median time since treatment is 48 months. 60% have completed the lifestyle questionnaire and "How Do I Feel Today" trackers. 20% of the users who completed the lifestyle questionnaire reported anxiety. 42% have used the diary function and 47% have used the secured messaging function. Usage of the lifestyle questionnaire, "How Do I Feel Today" trackers, secured messaging and diary functions does not appear to be age related. Patients who have been treated and further away from treatment in time are more likely to be used the app. Conclusions: The level of engagement in this pilot study reflects the willingness of patients to utilize this innovative app that has the potential to monitor the well-being of patients with prostate cancer out with the constraints of a fixed clinic appointment.

Real world efficacy of 12 weeks sofosbuvir, daclastivir with ribavirin among cirrhotic pre and post-transplant genotype 3 (2017)

Type of publication:
Conference abstract

Author(s):
Schmidt-Martin D.; Bufton S.; Haydon G.H.; Mutimer D.; Elsharkawy A.M.; Roberts M.; *Rye K.; Singhal S.; Eldred S.; Perry I.; Corbett C.; Unitt E.; Wood V.; Dillon H.

Citation:
Journal of Hepatology; 2017; vol. 66 (no. 1)

Abstract:
Background and Aims: Current EASL guidelines recommend combined Sofosbuvir and Daclatasvir with Ribavirin (SOF + DCV + RBV) for 24 weeks in compensated/decompensated cirrhosis for genotype 3 patients. We investigated response to 12weeks treatment in a large cohort of pre and post-transplant predominantly compensated cirrhotic genotype 3 patients. Methods: All patients who received a single dose and treated in 8 treatment centres within our hospital network included. SVR12 rates for all patients who started treatment are reported on an intention to treat (ITT) basis and we include a modified intention to treat (mITT) analysis excluding non virological failures. Results: 156 patients ((M:F) 109:47) mean age 51.5 were commenced on treatment. The overall SVR12 rate was 88.5% (138/156) (ITT) and 95.8% (138/144) (mITT). 2 patients stopped treatment without side effects. Five patients did not attend for confirmation of SVR12, three patients died on treatment (2 due to cardiac arrest, 1 due to sepsis) and a further patient died following completion of treatment prior to SVR12 (hepatocellular carcinoma). mITT SVR12 for patients with compensated and decompensated cirrhosis (Child Pugh B/C) were 96.7% (116/120) and 82% (23/28)respectively. 96.4% (80/83) of patients with previous exposure to interferon and ribavirin achieved SVR12. All patients with HIV co infection achieved SVR (n = 8). 89% of liver transplant patients achieved SVR. 18%(5/28) of the decompensated cohort (Child Pugh B/C) had died within 2 years of commencing treatment. Conclusions: SOF + DCV + RBV for 12 weeks achieved real world SVR12 rates comparable with 24 weeks treatment in cirrhotic genotype 3 patients or 12 weeks sofosbuvir/velpastasvir. This is the largest reported cohort of posttransplant genotype 3 patients with advanced fibrosis. Our data suggests 12 weeks treatment for all cirrhotic patients may be considered regardless of previous interferon and ribavirin exposure (Table presented).

Coronary heart disease mortality in treated Familial Hypercholesterolaemia: Update of the UK Simon Broome FH Register (2017)

Type of publication:
Conference abstract

Author(s):
Humphries S.E.; Cooper J.A.; Seed M.; *Capps N.; Durrington P.N.; Jones B.; McDowell I.F.W.; Soran H.; Neil

Citation:
Atherosclerosis Supplements; 2017; vol. 28, Pages 41-46

Abstract:
Background: Guidelines for the management of patients with Familial Hypercholesterolaemia (FH) recommend the use of high intensity statin therapy to reduce subsequent risk of Coronary Heart Disease (CHD). Here we compare changes in CHD mortality in patients with heterozygous (FH) pre 1992 before lipid-lowering therapy with statins was used routinely, and in the periods 1992-2008 and 2008 till the present. Methods: Analysis used 1903 Definite (DFH) and 1650 Possible (PFH) patients (51% women) aged 20-79 years, recruited from 21 lipid clinics in the United Kingdom and followed prospectively between 1980-1991 (6627 personyears) 1992-2008 (43117 person-years) and 2009-2016 (17317 person-years). The excess CHD standardised mortality ratio (SMR) compared to the population in England and Wales was calculated (with 95% Confidence intervals). Results: There were 252 deaths from CHD. Overall, treated DFH patients had a higher CHD SMR than PFH patients (post 1991 35% higher 2.40 (2.00-2.86) vs 1.78 (1.44-2.19) p = 0.03). In treated DFH patients with previous CHD the CHD SMR was significantly elevated at all time periods but in men fell from a 4.83-fold excess (2.32-8.89) pre-1992 to 4.66 (3.46-6.14) in 1992-2008 and 2.51 (1.01-5.17) post 2008, while in women these values were 7.23 (2.65-15.73), 4.42 (2.70-6.82) and 6.34 (2.06-14.81)). In treated DFH men with no previous CHD the CHD SMR fell over the three time periods, and was not significantly elevated post 2008 (0.89 (0.29-2.08), but in women the SMR remained significantly elevated (post 2008 3.65 (1.75-6.72)). Conclusions: The data confirm the major benefit in CHD mortality associated with statin treatment, but suggest that FH patients with pre-existing disease, and women with FH may not be being treated adequately.

Impact of PCSK9 inhibitors Alirocumab and Evolocumab on total & LDL cholesterol in clinical practice (2017)

Type of publication:
Conference abstract

Author(s):
*Capps N.

Citation:
Atherosclerosis Supplements; 2017; vol. 28, e13

Abstract:
Background: The PCSK9 inhibitors Alirocumab (Al) and Evolocumab (Ev) were recently recommended for use in the NHS on the basis of NICE TA393 and 394 respectively. Clinical trials of both drugs show rapid, significant and continued reductions in total (TC) and LDL cholesterol (LDLC), however confirmation of their efficacy in UK clinical practice is required. Methods: The first patients in the hospital lipid clinic treated with Al 75 mg (14) or Ev 140 mg (13), with pre and post initiation (after 2-3 injections) fasting bloods, were evaluated. All results are in mmol/L. Results: 19 patients had Familial Hypercholesterolaemia, 9 classed by NICE as high or very high risk. Of the remaining 8 patients 5 were HR and 3 VHR. Overall mean TC and LDLC fell from 7.83 to 5.04 and 5.8 to 3.0, ie by 36 and 48%. For Alirocumab 75 mg mean TC and LDLC fell from 8.21 to 5.71 and 6.20 to 3.48, ie by 30 and 44%; individual reductions were 10 to 45% for TC and 13 to 62% for LDLC. For Evolocumab 140 mg mean TC and LDLC fell from 7.41 to 4.32 and 5.33 to 2.44, reductions of 42 and 54%; individual reductions were 32 to 55% for TC and 45 to 69% for LDLC. LDLC fell below 2.0 in 6 patients (Al 1, Ev 5), the lowest to 1.4 mmol/L. Conclusions: The data confirm the rapid and significant reductions in TC and LDLC with Al and Ev in previously difficult to treat patients, however many still had LDLC higher than ideal. This cohort did not contain patients treated with 150 mg Al, or by both drugs, so a direct comparison is not reported.

The REstart or STop Antithrombotics Randomised Trial (RESTART) after stroke due to intracerebral haemorrhage: Study protocol for a randomised controlled trial (2018)

Type of publication:
Journal article

Author(s):
Al-Shahi Salman R.; Dennis M.S.; Innes K.; Drever J.; Dinsmore L.; Williams C.; Whiteley W.N.; Sandercock P.A.G.;  Sudlow C.L.M.; Murray G.D.; White P.M.; Newby D.E.; Sprigg N.; Werring D.J.; Dennis M.; Sudlow C.; Whiteley W.; Lerpiniere C.; McCormick K.; Perry J.; Parakramawansha R.; Hunter N.; Doubal F.; Paulton R.; O'Brien R.; Burgess S.; Mead G.; Taylor P.; MacLeod M.-J.; Maclennan B.; Clarke R.; Taylor V.; Klaasen K.; Crouch N.; Jagpal B.; Furnace J.; Irvine J.; Gow H.; Joyson A.; Nelson S.; Ross S.; Davies R.; Jose D.; Robinson N.; Codd L.; Dodd A.; Moroney H.; Weir P.; Little V.; Gott V.; Sangster G.; Owings P.; Cherian S.; Downham S.; Epstein D.; Webber A.; Qureshi S.; Nicholas P.; Krishnamurthy V.; Shukla A.; Jones I.; Ahmed A.; Cunningham M.; Zahoor T.; Johnson S.; Denniss C.; Albazzaz M.; Ramadan H.; Maguire S.; Patterson C.; Bellfield R.; Hairsine B.; Quinn O.; Hooley M.; Nair A.; Alam M.I.; Greig J.; Rana P.; Robinson M.; Sajid M.; Ball M.; Gascoyne R.; Ghaly G.; Raghunathan S.; Clarke J.; Wilkes G.; Law Z.; Appleton J.; Matias O.; Jackson B.; Keshvara R.; Whittamore K.; Jordan C.; Sheikh S.; Roffe J.; Gilzeane N.; Krishnan K.; Buck A.; Havard D.; Hedstrom A.; Shelton F.; Godfrey M.; Webster T.; Haider S.; Seagrave S.; Leason S.; Nallasivan A.; Chatterjee K.; Perkins C.; Mohd Nor A.; Persad N.; Eglinton C.; Brown C.; Weinling M.; Shah A.; Baker J.; Hyams B.; Kini M.; Fong R.; Chadha D.; Walstow D.; Proeschel H.; Sharpe S.; Horton S.; Jones S.; Byrne A.; McGhee C.; Smart A.; Copeland C.; Dutta D.; Bakawala R.; O'Connell S.; Hughes C.; Brown P.; Davis F.; Collins K.; Ward D.; Turfrey J.; Rudd T.; Marks K.; Kullane S.; Jonathan B.; Bhalla A.; Yip B.; Bell M.; MacInnes B.; Macliver L.; Esson D.; Yadava R.; Stafford S.; Reddan J.; Sangombe M.; Azhar K.; Jenkins C.; Price F.; Mercer L.; Vasileiadis E.; Mason C.; Aweid B.; Holden M.; Parry A.; Landers G.; Broughton D.; Chapman K.; Sigsworth A.; Tryambake D.; Young A.; Dixon L.; Bergin A.; Barber M.; Brodie F.; Anjum T.; Connor L.; Tucker S.; Thomas S.; Davies C.; Slade P.; Treadwell S.; Wani M.; Beaty T.; Krishnan M.; Dacey L.; Spencer J.; Quinn L.; Chenna S.; Storton S.; Jones T.; Jones H.T.; Hussain M.; Homan J.; Foster E.; Brotherton L.; Durman H.; Hunt N.; Foot J.; Whitcher A.; Pawley C.; Khan M.; Whiting R.; Harvey M.; Brown S.; Foote L.; Richard B.; Triscott C.; Edwards M.; Lawson H.; Wallace R.; Nott C.; Moseley S.; Buckle S.; Sarah P.; Whiteman J.; Fotherby K.; Butler D.; Willberry A.; Ahmad N.; Jennings-Preece K.; Baig F.; Morgan D.; Stevens A.; Metcalf K.; McDonald S.; Ravenhill G.; Anversha A.; Shinh N.; Perfitt R.; Greenwood R.; Saada J.; Waterfield K.; Sutton P.; Jagger J.; Wiltshire A.; Luder R.; Johnson V.V.; Bridger H.; Bhargava M.; Gallagher J.; Adesina T.; van Someren C.; Carpenter M.; Walker M.; Stanners A.; Ball J.; Jackson L.; Datta P.; Bateman G.; Fathima R.; Davey R.; Needle A.; Siddegowda P.; Ponnambath S.; Suttling A.; Harrington-Davies Y.; Butler R.; James M.C.; Valentine M.S.; Dobson T.; Howard P.; Tandy J.; Hyatt L.; Jarrett D.; Saulat A.; Sims D.; Willmot M.; Green C.; Jones R.; Cunningham J.; Maiden S.; Sutton C.; Hurley J.; Littleton E.; Shekhar R.; Crown R.; Ahmed I.; Fuller S.T.; Gilham E.; Andole S.; Gadapa N.; Dunne M.K.; Krommyda M.; Burssens E.; King S.; Goorah N.; Bell A.; Patel F.; Tomlinson B.; Duberley S.; Singh A.; Kelly C.; Walford J.; Harrington F.; Schofield C.; Lucas L.; Ellis S.; Bond K.; Mate A.; Adie K.; James A.; Maund B.; Courtauld G.; Mudd P.; Hemsley A.; Thorpe K.; Gupwell K.; Goff A.; Sword J.; Roughan C.; Strain D.; Cageao J.; Bowring A.; Keenan S.; James M.; Kingwell H.; Miller K.; Harkness K.; Doyle C.; Majis A.; Stocks K.; Maatouk A.; Barron L.; Dakin K.; Lindert R.; Kamara C.; Bayliss P.; Redgrave J.; Kibutu F.; Blank C.; Ali A.; Balitska O.; Birchall K.; Richards E.; Howe J.; Smyth N.; Giallombardo E.; Sykes L.; Wilson J.; Langhorne P.; McAlpine C.; Humphreys L.; Iqbal M.S.; Graham R.; Kerr G.; Wright F.; Kumar P.; Thomas P.; Culmsee C.; Huggett I.; Dunn M.L.; Barker J.; Manoj A.; Fitzsimmons P.; Lopez M.P.; Sharma N.; Cox P.; Fletcher G.; Wilkinson M.; Emsley H.; Raj S.; Doyle D.; Gregory B.; Punekar S.; Sultan S.; McLoughlin A.; Pasco K.; Balazikova M.O.; Nasim A.; Peixoto C.; Kane I.; Pitt- Ford A.; Hervey S.; Thompson P.; Latter M.L.; Barbon E.; Breeds J.; Rajkumar C.; Gainsborough N.; Gaylard J.; Choulerton J.; Shaw L.; Madigan B.; Howcroft D.; Lucas S.; Stone A.; Avis J.; Gbadamoshi L.; Button D.; Stephanie M.; Dow L.; Davis M.; Thompson T.; Hogg V.; Hays C.; Fawcett M.; Atkinson N.; Guy H.; Woodward S.; Parry-Jones A.; Marshall S.; Jarapa R.; Lee S.; Harrison L.; Johnes M.; Oloughlin V.; Wood E.; Perez J.; Naing Z.; Morell J.; Marsden T.; Ingham A.; Burger I.; Shaw K.M.; Hall A.; Punter M.; Weir N.; Evans S.; Walters A.; Gartrell M.I.; Smith M.F.; Cox M.C.; Smith C.N.S.; Egerton S.; Creeden R.; Marigold J.R.; Blades A.; Crawford P.; Battersby- Wood E.; Pressly V.; Allen C.; Howard G.; Muir K.; Kalladka D.; Smith W.; Day N.; Moreton F.; Cheripelli B.K.; Huang X.; Welch A.; El Tawil S.; Ramachandran S.; Crosbie C.; Elliot J.; Cluckie G.; Clarke B.; Dayal N.; Orefo C.; Adedoyin T.; Ghatala R.; Clarke N.; Jones V.; Blight A.; Lovelock C.; Chopra N.; Moynihan B.; Kennedy K.; Williams R.; Kerin M.L.; Jeyaraj M.N.; Choy L.; Watson F.; Trippier S.; O'Reill J.; Haque M.; Symonds S.; Maanoosi M.; Herman J.; Vassallo J.; Krishnamoorthy S.; Cochrane H.; Walter D.; O'Connell J.; Fox C.; Krishnamurthy R.; Osborne E.; Smith A.; Mokoena B.; Gulliver D.; Brew H.; Myint M.; Majmudar N.; Bunea G.; Sattar N.; *Srinivasan M.; *Mukherjee I.; *Motherwell N.; *Donaldson D.; *Campbell R.; *Hurford F.; Thavanesan K.; David O.; Tiwari D.; Hann G.; Longland B.; Bell J.; Rogers M.E.; Bagnall M.C.; Iqbal M.A.; Keltos M.; Jupp B.; Roberts J.; Cox C.; Ovington C.; Bhaskaran B.; Garfield-Smith J.; Buxton J.; Horan K.; Ayres G.; Bearne H.; Tomlin D.; Szabo S.; Kelly D.; Salih I.; Bhakri H.; Fitzell P.; Wilson D.; Wroath B.; Dynan K.; Power M.; Thompson S.; Ghosh S.; Henry M.; Gilmour D.; Barrie E.; Kenton A.; Nyabadza M.S.; Martin M.I.; Hunt B.; Hassan H.; Dallol B.; Muddegowda G.; Hiden M.J.; Maguire H.; Grocott J.; Finney K.; Barry A.; Roffe C.; Lyjko S.; Sanyal R.; Remegoso A.; Ferdinand P.; Butler A.; Abano N.; Causley M.C.; Denic H.; Carpio R.; Stevens S.; Moores A.; Varquez R.; Pai Y.; Bruce D.; Dima S.; Baliga V.; Naeem M.; Rogers G.; Brown E.; Hayman R.; Garside M.; Dhakal M.; Smith G.M.; Clayton S.; Orugun E.; Poultney U.; Glover R.; Crowther H.; Thornthwaite S.; Webb T.; Beranova E.; Walker S.; Cosier T.; Rudenko H.; Cowie L.; Verrion A.; Thomson A.; Gamble E.; Charles B.; Grue R.; Blane S.; Hague A.; Rashed K.; Vickers C.; Wood D.; Board J.; Buckley C.; Allison J.; Board S.; William-Yesson B.; Balian L.; Keeling E.; Kar A.; Halse O.; Nguyen V.; Harvey K.; Gardener L.; Mashate S.; Tilley V.; Wilding P.; Geraghty O.; Hazel B.; Harrison T.; Cuenoud L.; Auld G.; Erumere E.; Redjep O.; Grimwood G.; Howaniec L.; Hove D.; Salek-Haddadi A.; Saastamoinen K.; Argandona L.; Wiggam I.; Wallace A.; Cuddy S.; Tauro S.; Hunter A.; Kerr E.; Fulton A.; Putterill J.; Kakar P.; Jha R.; Gallifent R.; Pusalkar A.; Chan K.; Dangri P.; Crabtree K.; Beadle H.; Cook A.; Black T.; Cronin J.; Fennelly R.; Tribbeck M.; Clarke C.; Miriam S.; Anthony A.; Mead D.; Esisi B.; Bokhari M.; Cassidy T.; McClelland B.; Cooper M.; Wynter I.; Rajapakse A.; Nasar M.; Anwar I.; Ramshaw A.; Annamalai A.; Crawford S.; Nozedar T.; Skinner H.; Kumar B.; McArdle D.; Holmes C.; Dodd E.; Clarke S.; Caine S.; Baker P.; Murphy P.; Osborn M.; Guthrie L.B.; Steele A.; Devitt N.; Mangion D.; Fletcher J.; Hardwick A.; Constantin C.; Markova S.; Lawrence T.; Subramonian S.; Temple M.N.; Owusu-Agyei P.; Butterworth-Cowin N.; Werring D.; Hogan C.; brezitski M.; Elliott E.; Francia N.; Ashton A.; Hostettler I.; Oji N.; Banaras A.; Patel K.; Crook L.; Watchurst C.; Erande R.; Sekaran L.; Mohammed N.; Chauhan M.; Sethuraman S.; Simon R.; Bharaj K.; Tate M.; Justin F.; Phiri D.; Hewitt J.; Gray J.; Mardania R.; Procter M.S.; Elfandi K.; Khan U.; Ragab S.; Knops K.; Jinks E.; Dickson C.; Gleave L.; Leggett J.; Dube J.; Garcia T.; McIlmoyle J.; Anwar S.; Dhar S.; Jones K.; Jeffs C.; Dickinson C.; Howard J.; England T.; Donnelly R.; Maddula M.; Hassan A.; Veraque E.; Kambafwile M.; Makawa L.; Randall M.; Papavasileiou V.; Waugh D.; Ispoglou S.; Hayes A.; Ankolekar S.; Evans R.; Ni H.; Graham C.; Jose J.; Milligan J.; Rahman B.; Findlay P.; Macaden A.; Shread I.; Keegan B.; Blair C.; Kelly J.; Doherty M.; Dewar R.; White J.; Thomas K.; Cohen D.; David A.; Owoyele E.; Njoku K.; Poku P.; Sukdeo V.; Chandrakumar A.; Chamberlain A.; Abbdulsaheb M.; Guo F.; Oshodi M.A.; Licenik R.; Devine J.; Davies S.; Nisar N.; Niranchanan R.; Roganova T.; Mpelembue M.; Burgess L.; Bathula R.; Ngwako M.; Eveson D.; Mistri A.; Stephens C.; Musarrat K.; Lam M.Y.; Sattar S.; Khan S.; Moqsith M.; Manning L.; Patel C.; Schulz U.; Kennedy J.; Ford G.; Harston G.; Teal R.; Mathieson P.; Lenti G.; Reckless I.; Cullen C.; Stevenson S.; Harrison M.; Ewing J.; Shackcloth D.; Durairaj R.; Zoe M.; Ingram T.; Thant H.; Peters J.; Sutton V.; Ivatts S.; Amey I.; Clayton-Evans L.; Baird Y.; Sally M.; Newton S.; Guyler P.; Ng K.X.; Prabakaran R.O.; Ngo D.; Rashmi S.; Coward L.; Menon N.; Kelavkar S.; Kunhunny S.; Sinha D.; Siddiqui A.; Loganathan T.; Tysoe S.; Shah S.; Kalathil L.; Gautam N.; Meir J.; Bailey D.; Salehin M.; Miller R.; Kelly A.; Rayessa R.; Rodgers A.; Wilson L.; Naylor C.; Wilson S.; Clarkson E.; McCarron M.; McVerry F.; McKee S.J.; Cvoro V.; Ullah K.; Chapman N.; Couser M.; Mcauley S.; Pound S.; Nicolson A.; Imam J.; Wood L.; O'Brien E.; Hannon N.; Finlay S.; Hayhoe H.; Handley D.; Kelly S.; Mcgee J.; Mitchell J.; Amis E.; Sesay J.; Crisp S.; Francis J.

Citation:
Trials; Mar 2018; vol. 19 (no. 1)

Abstract:
Background: For adults surviving stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken an antithrombotic (i.e. anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before the ICH, it is unclear whether starting antiplatelet drugs results in an increase in the risk of recurrent ICH or a beneficial net reduction of all serious vascular events compared to avoiding antiplatelet drugs. Methods/design: The REstart or STop Antithrombotics Randomised Trial (RESTART) is an investigatorled, randomised, open, assessor-blind, parallel-group, randomised trial comparing starting versus avoiding antiplatelet drugs for adults surviving antithrombotic-associated ICH at 122 hospital sites in the United Kingdom. RESTART uses a central, web-based randomisation system using a minimisation algorithm, with 1:1 treatment allocation to which central research staff are masked. Central follow-up includes annual postal or telephone questionnaires to participants and their general (family) practitioners, with local provision of information about adverse events and outcome events. The primary outcome is recurrent symptomatic ICH. The secondary outcomes are: symptomatic haemorrhagic events; symptomatic vaso-occlusive events; symptomatic stroke of uncertain type; other fatal events; modified Rankin Scale score; adherence to antiplatelet drug(s). The magnetic resonance imaging (MRI) sub-study involves the conduct of brain MRI according to a standardised imaging protocol before randomisation to investigate heterogeneity of treatment effect according to the presence of brain microbleeds. Recruitment began on 22 May 2013. The target sample size is at least 720 participants in the main trial (at least 550 in the MRI sub-study). Discussion: Final results of RESTART will be analysed and disseminated in 2019.

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