BACKGROUND\nOrganised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke, acute, rehabilitation, comprehensive), with a mobile stroke team or within a generic disability service (mixed rehabilitation ward).\n\n\nOBJECTIVES\nTo assess the effect of stroke unit care compared with alternative forms of care for patients following a stroke.\n\n\nSEARCH STRATEGY\nWe searched the Cochrane Stroke Group trials register (last searched April 2006), the reference lists of relevant articles, and contacted researchers in the field.\n\n\nSELECTION CRITERIA\nRandomised and prospective controlled clinical trials comparing organised inpatient stroke unit care with an alternative service.\n\n\nDATA COLLECTION AND ANALYSIS\nTwo review authors initially assessed eligibility and trial quality. Descriptive details and trial data were then checked with the co-ordinators of the original trials.\n\n\nMAIN RESULTS\nThirty-one trials, involving 6936 participants, compared stroke unit care with an alternative service; more organised care was consistently associated with improved outcomes. Twenty-six trials (5592 participants) compared stroke unit care with general wards. Stroke unit care showed reductions in the odds of death recorded at final (median one year) follow up (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.76 to 0.98; P = 0.02), the odds of death or institutionalised care (OR 0.82; 95% CI 0.73 to 0.92; P = 0.0006) and death or dependency (OR 0.82; 95% CI 0.73 to 0.92; P = 0.001). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to trials that used formal randomisation procedures with blinded outcome assessment. Outcomes were independent of patient age, sex or stroke severity, but appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in a longer hospital stay.\n\n\nAUTHORS' CONCLUSIONS\nStroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. No systematic increase was observed in the length of inpatient stay.

Organised inpatient (stroke unit) care for stroke

Clinical Trials: A Practical Approach

EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century.

Background
Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Atypical squamous changes occur in the transformation zone of the cervix with mild, moderate or severe changes described by their depth (CIN 1, 2 or 3). Cervical intraepithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the grade and extent of the disease.

Objectives
To assess the effectiveness and safety of alternative surgical treatments for CIN.

Search methods
We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (up to November 2012). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.

Selection criteria
Randomised controlled trials (RCTs) of alternative surgical treatments in women with cervical intraepithelial neoplasia.

Data collection and analysis
Two review authors independently abstracted data and assessed risks of bias. Risk ratios that compared residual disease after the follow-up examination and adverse events in women who received one of either laser ablation, laser conisation, large loop excision of the transformation zone (LLETZ), knife conisation or cryotherapy were pooled in random-effects model meta-analyses.

Main results
Twenty-nine trials were included. Seven surgical techniques were tested in various comparisons. No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although the trials did not provide data for every outcome measure. There were not enough data to assess the effect on morbidity when compared with laser ablation.

Authors' conclusions
The evidence suggests that there is no obvious superior surgical technique for treating cervical intraepithelial neoplasia in terms of treatment failures or operative morbidity.

/pdf/surgery-for-cervical-intraepithelial-neoplasia-ouc1rfg04e.pdf

Surgery for cervical intraepithelial neoplasia

Information giving and decision-making in patients with advanced cancer : A systematic review

a b s t r a c t TheGSTM1nullgenotypeisassociatedwithasmallincreasedlungcancerriskwhencomparedtocontrols withatleastonecopyoftheGSTM1gene.AstwocopiesoftheGSTM1genemightprovidemoreprotection than a single copy, we have determined GSTM1 copy number in a lung cancer case­control study. Cases with incident lung cancer were identified through a Bronchoscopy Unit and two separate hospital based control groups with non­malignant disease were selected with one from the same Bronchoscopy Unit and the other from a chest clinic at the same hospital. Subjects with at least one GSTM1 copy had a decreased lung cancer risk whatever the control group: the odds ratio (95% CI), after adjustment for age, gender and smoking duration, was 0.64 (0.41-0.98) and 0.54 (0.32-0.91) with bronchoscopy and chest clinic controls, respectively. Lung cancer risk varied with GSTM1 copy number with chest clinic controls only: the OR was 0.56 (0.32-0.97) for one copy of the GSTM1 gene and with two copies 0.43 (0.15-1.22), a trend that was significant ( p=0.02): with bronchoscopy controls the trend was not significant ( p=0.07). Results then confirm that the presence of GSTM1 provides protection against the risk of lung cancer. In addition there is equivocal evidence that this protection varies with the number of gene copies.

Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis

Objective: To determine the cost to the NHS and the impact on anxiety of a one stop clinic for assessing women with suspected breast cancer. Study design: Randomised controlled trial. Participants: Women aged 35 or over referred with a breast lump. Study setting: Teaching hospital, north west England. Interventions: Women were randomly allocated to attend a one stop clinic or a dedicated breast clinic. Outcome measures: Reduction in mean anxiety from baseline at 24 hours after the first visit and at 3 weeks and 3 months after diagnosis; mean cost per patient. Results: 670 women were randomised. Compared with women who attended the dedicated clinic, patients attending the one stop clinic were less anxious 24 hours after the visit (adjusted mean change in state anxiety −5.7 (95% confidence interval −8.4 to −3.0)) but not at 3 weeks or 3 months after diagnosis. The additional cost to the NHS of a one stop attendance was £32 per woman; this was largely explained by greater cytopathological and radiological staff costs. Conclusion: One stop clinics may not be justified in terms of a reduction in short term anxiety.

https://www.bmj.com/content/bmj/324/7336/507.full.pdf

Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trial

Does additional lubrication reduce condom failure

In a randomized controlled trial, the additional provision of information on videotape was no more effective than written information alone in reducing pre-treatment worry about radiotherapy. Images of surviving cancer patients, however, may provide further reassurance to patients once therapy is completed. © 2001 Cancer Research Campaign http://www.bjcancer.com

/pdf/randomized-controlled-trial-to-assess-the-effectiveness-of-a-3ou02bruz0.pdf

Randomized controlled trial to assess the effectiveness of a videotape about radiotherapy

BACKGROUND: There is overwhelming evidence of the effectiveness of specialist stroke rehabilitation, but more limited evidence of the effectiveness of organised stroke care during the acute phase of stroke. OBJECTIVE: To determine the impact on outcome of access to a mobile team during the acute phase of stroke among patients admitted to general wards. STUDY POPULATION: 308 patients admitted to one of two hospitals within 5 days of the onset of a clinically diagnosed stroke. STUDY DESIGN: Randomised controlled trial. STUDY GROUPS: Following admission, patients in the intervention arm were visited by members of a mobile stroke team who advised clinical staff on appropriate and timely investigation and management. They co-ordinated early input from therapy groups and identified those ready for transfer to the stroke rehabilitation unit. Patients in the control arm were not visited by the mobile stroke team. MAIN OUTCOME MEASURE: All-cause mortality measured at 6 weeks and 12 months. RESULTS: There was no statistically significant difference observed between study groups in mortality at 6 weeks (95% CI(adj) -7.4 to 7.4%) nor at 12 months ( 95% CI(adj) -4.1 to 15.9%). There were also no differences observed between study groups in morbidity outcomes or health-related quality of life measured at 12 months. CONCLUSION: The trial was terminated before the necessary sample size was collected but findings suggest that the mobile stroke team failed to confer significant long-term mortality benefit compared with general ward-based care alone.

/pdf/early-assessment-by-a-mobile-stroke-team-a-randomised-32shl2m3j1.pdf

Alan Gibbs

Papers

Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis

Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trial

Does additional lubrication reduce condom failure

Randomized controlled trial to assess the effectiveness of a videotape about radiotherapy

Early assessment by a mobile stroke team: a randomised controlled trial