Clinical Trial Service Unit

About: Clinical Trial Service Unit is a based out in . It is known for research contribution in the topics: Population & Stroke. The organization has 428 authors who have published 1387 publications receiving 181920 citations.

Fluid Intake and Dietary Factors and the Risk of Incident Kidney Stones in UK Biobank: A Population-based Prospective Cohort Study.

Abstract: Background Fluid intake and diet are thought to influence kidney stone risk. However, prospective studies have been limited to small samples sizes and/or restricted measures. Objective To investigate whether fluid intake and dietary factors are associated with the risk of developing a first kidney stone. Design, setting, and participants Participants were selected from UK Biobank, a population-based prospective cohort study. Outcome measurements and statistical analysis Cox proportional hazards models were used to investigate the association between fluid intake and dietary factors and the risk of a first incident kidney stone, ascertained from hospital inpatient records. Results and limitations After exclusion, 439 072 participants were available for the analysis, of whom 2057 had hospital admission with an incident kidney stone over a mean of 6.1 yr of follow-up. For every additional drink (200 ml) consumed per day of total fluid, the risk of kidney stones declined by 13% (hazard ratio [HR] = 0.87, 95% confidence interval [CI] 0.85–0.89). Similar patterns of associations were observed for tea, coffee, and alcohol, although no association was observed for water intake. Fruit and fibre intake was also associated with a lower risk (HR per 100 g increase of fruits per day = 0.88, 95% CI 0.83–0.93, and HR per 10 g fibre per day = 0.82, 95% CI 0.77–0.87), whereas meat and salt intake was associated with a higher risk (HR per 50 g increase in meat per week = 1.17, 95% CI 1.05–1.29, and HR for always vs never/rarely added salt to food = 1.33, 95% CI 1.12–1.58). Vegetable, fish, and cheese intake was not associated with kidney stone risk. Conclusions The finding that high intake of total fluid, fruit, and fibre was associated with a lower risk of hospitalisation for a first kidney stone suggests that modifiable dietary factors could be targeted to prevent kidney stone development. Patient summary We found that higher intake of total fluid, specifically tea, coffee, and alcohol (but not water), and consumption of fruit and foods high in fibre are linked with a reduced likelihood of developing kidney stones.

Optimum dose of vitamin D for disease prevention in older people: BEST-D trial of vitamin D in primary care.

Abstract: Summary This trial compared the effects of daily treatment with vitamin D or placebo for 1 year on blood tests of vitamin D status. The results demonstrated that daily 4000 IU vitamin D3 is required to achieve blood levels associated with lowest disease risks, and this dose should be tested in future trials for fracture prevention.

Large-scale randomized evidence: large, simple trials and overviews of trials.

Abstract: Worldwide, hundreds of thousands of premature deaths a year could be avoided by seeking large-scale randomized evidence about various widely practicable treatments for the common causes of death, and by disseminating such evidence appropriately. Likewise, appropriately large-scale randomized evidence could vastly improve the management of many important, but non-fatal, medical problems. The chief techniques for obtaining large-scale randomized evidence are large, simple trials (or “mega-trials”) such as the ISIS [l-4] and GISSI [5,6] studies, and large systematic overviews of trials (or “meta-analyses”) such as those from the worldwide collaborative groups of trialists [7-91 or of meta-analysts [lo]. Over the past decade the introduction of these complementary techniques has already yielded a succession of striking and definite findings that have improved the treatment of millions of patients. But, what has been achieved so far is only a fraction of what could quite readily be achieved by the wholehearted pursuit of such research strategies. Inevitably, any review of the need for really large-scale randomized evidence has to discuss to some extent the general unreliability of nonrandomized evidence (whether this be called “historically controlled” evidence, “data-base analyses” or, more misleadingly, “outcomes research” or “effectiveness analysis”), and it has to discuss to some extent the general unreliabil-

British Heart Foundation surveys (1987 and 1989) of United Kingdom treatment policies for acute myocardial infarction.

Abstract: Consultant physicians and cardiologists were surveyed early in 1987 and 1989 to document the management policies for the treatment of acute myocardial infarction in United Kingdom hospitals and to assess the influence of major clinical trials on these policies. The response rate to both these surveys was high (84% (1178 physicians) in 1987 and 76% (982 physicians) in 1989). The percentage of physicians that reported using antiplatelet therapy "routinely" in acute myocardial infarction rose from 9% in 1987 to 84% in 1989 while those who reported using it "rarely or never" fell from 42% to 3%. Similarly, "routine" use of fibrinolytic therapy rose from 2% to 68%, and use "rarely or never" fell from 53% to 3%. This increase in the reported use of fibrinolytic therapy was accompanied by greater certainty about its efficacy and relative safety and by a general widening of the indications for its use. The use of other treatments in acute myocardial infarction (for example, the general use of anticoagulants, beta blockers, nitrates, calcium antagonists, or prophylactic antiarrhythmic agents) seemed to change little during this period, although the routine use of coronary angiography and oral anticoagulants after fibrinolytic therapy fell substantially between 1987 and 1989 (from 23% to 4%, and from 24% to 7% respectively). Fibrinolytic and antiplatelet therapy were accepted into the routine management of myocardial infarction during a relatively short period that coincided with the reporting of several positive controlled trial results. Clinical trials have rarely been seen to have had such a great impact on practice. In this case the rapid acceptance of the trial results may have been due to the consistency and reliability of the estimates of the size of the benefits (and risks) of therapy seen in these unusually large studies.