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C Warlow

Publications and source records attributed to C Warlow.

119 records · Page 7Linked to original sources
PubMedDate not supplied

Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial.

BACKGROUND: Undernutrition is common in hospital patients with stroke, can develop or worsen in hospital, and is associated with poor outcomes. We aimed to establish whether routine oral nutritional supplements improve outcome after stroke. METHODS: The FOOD trials are a family of three pragmatic, multicentre, randomised controlled trials. We measured the outcomes of stroke patients who could swallow and who were randomly allocated normal hospital diet or normal hospital diet plus oral nutritional supplements until hospital discharge. The primary outcome was death or poor outcome (modified Rankin scale [MRS] grade 3-5), 6 months after enrollment, measured unaware of treatment allocation. Analysis was by intention to treat. FINDINGS: Between Nov 1, 1996, and July 31, 2003, 4023 patients were enrolled by 125 hospitals in 15 countries. Only 314 (8%) patients were judged to be undernourished at baseline. Vital status and MRS at the end of the trial were known for 4012 and 4004 patients, respectively. Supplemented diet was associated with an absolute reduction in risk of death of 0.7% (95% CI -1.4 to 2.7) and an increased risk of death or poor outcome of 0.7% (-2.3 to 3.8). INTERPRETATION: We could not confirm the anticipated 4% absolute benefit for death or poor outcome from routine oral nutritional supplements for mainly well nourished stroke patients in hospital. Our results would be compatible with a 1% or 2% absolute benefit or harm from oral supplements. These results do not support a policy of routine oral supplementation after stroke.

Aged↗
PubMedDate not supplied

Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial.

BACKGROUND: Undernutrition is common in patients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months. METHODS: The FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat. FINDINGS: Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5.8% (95% CI -0.8 to 12.5, p=0.09) and a reduction in death or poor outcome of 1.2% (-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1.0% (-10.0 to 11.9, p=0.9) and an increased risk of death or poor outcome of 7.8% (0.0 to 15.5, p=0.05). INTERPRETATION: Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.

Activities of Daily Living↗
PubMedDate not supplied

Families of trials: the answers to all our questions?

Many of the important clinical decisions we make on a daily basis in stroke medicine are not supported by adequate evidence. This leads to variations in practice. If practice influences outcome, this must be regarded as unacceptable since it implies that many patients are receiving sub-optimal treatment. Where the advantages of certain treatment policies over others are only moderate, large randomised clinical trials provide the most reliable evidence of effectiveness. However, only a tiny proportion of patients with stroke are randomised in trials. Instead, the majority are exposed to treatments allocated haphazardly, rather than randomly, which serves only to delay the emergence of evidence concerning the relative merits of alternative treatment approaches. We suggest that we might increase the proportion of patients who contribute to advancing our knowledge by developing 'families' of trials. A 'family' would comprise a series of randomised trials into which patients with stroke may be enrolled either simultaneously or sequentially into one or more of the trials which would share common systems for randomisation and follow-up. Such a system would facilitate large, simple, randomised trials, reduce research costs, increase the generalisability of trial results and allow clinicians and patients to contribute to advancing our knowledge whenever they are uncertain about the best treatment. In this article, we discuss the advantages of this approach, some of the problems and their potential solutions.

Bias↗
PubMedDate not supplied

The natural history of lacunar infarction: the Oxfordshire Community Stroke Project.

In a consecutive series of 515 first-ever strokes in a community-based study of stroke that combined prompt clinical assessment by a study neurologist with a high rate of confirmed pathologic diagnosis, 108 cases (21%) had a lacunar syndrome. A computed tomography (CT) scan was performed in 104 (96%) of these cases. Only 3 cases had primary intracerebral hemorrhage, and another 3 had "inappropriate" areas of infarcts were seen in 34 of the remaining 98 (35%) CT scans. The crude annual incidence of lacunar infarction was 0.33/1,000. There was no excess risk among men. The case fatality rates were 1% at 1 month and 9.8% at 1 year. The rate of recurrent strokes was 11.8% in the first year. Among patients surviving 1 year, 66% were capable of independent existence.

Activities of Daily Living↗
PubMedDate not supplied

Remedial therapy and functional recovery in a total population of first-stroke patients.

A consecutive series of 155 patients with a first-ever stroke and who were registered with the Oxfordshire Community Stroke Project (OCSP) were followed up. Their receipt of remedial therapy was recorded and their functional recovery was measured using the Barthel index of activities of daily living. Only a minority of patients received remedial therapy during the first 6 months after stroke. Those who were admitted to hospital during the first month following their stroke, or who were severely dependent, were significantly more likely to receive remedial therapy than those who remained in the community or were less dependent. A comparison of functional recovery amongst a matched subsample of patients who received remedial therapy and those who did not showed that there was comparable recovery amongst patients who did not receive remedial therapy.

Activities of Daily Living↗
PubMedDate not supplied

Promoting awareness and practice of testicular self-examination.

AIM: To evaluate the efficacy of a health promotion initiative on men's knowledge of testicular cancer and self-examination rates. METHOD: A quasi-experimental, pre- and post-test questionnaire study of men at 14 workplace and leisure sites across two primary care trusts was undertaken: ten experimental sites received the intervention and four acted as a control. Men at all 14 sites were given a pre- and post-test questionnaire. RESULTS: Of the 835 pre-test and 835 post-test questionnaires distributed, 518 (62.0 per cent) and 356 (42.6 per cent) were respectively returned for evaluation. In the intervention group, the median total knowledge score increased from three points (interquartile range: 2,4) at baseline to four points (interquartile range: 2,4) at post-test. However, no statistically significant change was observed in the control group. Post-intervention, the percentage of test participants examining their testicles regularly increased from 58.4 per cent to 68.3 per cent, while levels among control peers did not significantly alter. CONCLUSION: This evaluation highlights the potential of using a low-cost initiative which targets innovative venues to improve men's knowledge of testicular cancer and rates of self-examination. Longer-term follow-up may be required to determine whether such increases are sustained.

Adolescent↗
PubMedDate not supplied

Carotid endarterectomy.

Explore the source record for details and available documents.

Carotid Artery Diseases↗