Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Time to reflect: the value of longitudinal interviews in exploring coping strategies of patients with advanced cancer and their carers

Background Qualitative longitudinal methods, used successfully for research in chronic conditions, can potentially unpick the dynamics of coping with advanced cancer as both a skillset and process. Studies in palliative care commonly suffer from high attrition and raise challenges when exploiting the richness and utility of longitudinal data. Aims To develop longitudinal methodology by learning from a successful study exploring how and when patients with advanced cancer and their informal carers develop coping strategies. Methods 54 participants (n=27 patients, n=27 nominated carers) were recruited to a qualitative longitudinal serial interview study. Using a core topic guide and a semi-narrative, conversational format, two interviews with each participant (n=86 interviews) were scheduled 4–12 weeks apart to encompass a range of everyday challenges and life events. A multidimensional approach combined thematic coding and framework analysis to compare patients, carers, dyads and interview points. Results Researcher sensitivity, responsiveness and planning of second interviews resulted in low attrition between interviews (7.5%). Interviews were welcomed by participants and their timing was central to understanding how and when participants' developed coping strategies. Participants could reflect in ways which opened up the ‘black box’ of lived experience and researchers' were able to develop more relevant follow-up questions. This assisted participants to articulate how, why and when they had (or had not) developed particular coping strategies. Conclusions Supporting the development of coping strategies which benefit patients and carers is both imperative and time critical in palliative care. This study shows that longitudinal qualitative research is valuable when exploring the complex ‘everyday realities’ of lived experience which are fundamental to quality of life but often develop, unremarked, over time. By integrating opportunities for participant reflection and focusing on ‘change over time’ this study was able to explore deeper patient-centred insights on which to develop robust evidence-based practice

Cancer and seeking normality: a longitudinal, qualitative study to explore how patients with advanced cancer and their carers cope and maintain psychological wellbeing

Background: many people live with the stresses and uncertainty of advanced cancer, affecting quality of life, physical and mental health. Current professional responses pathologise the experience, largely ignoring patients' and carers' own, often successful, coping strategies. By exploring how people with advanced (stage 3/4) cancer and their carers use coping strategies to recover or maintain psychological well being and ‘normality' this innovative study examines lived experience to better understand how professionals can provide proactive support.Method: patients (n=26) and their nominated carers (n=28) were recruited to a qualitative longitudinal interview study, purposively selected by gender and disease group: palliative care, breast, prostate, colorectal and lung. Two interviews, 4-12 weeks apart, were scheduled to recognise potential points of change and examined a range of ‘everyday' challenges. Themes were generated from dual independent coding and confirmed through discussion with patients, carers and health professionals.Results: individuals employ a variety of coping strategies to achieve individualised perceptions of the ‘good days' which are fundamental to psychological wellbeing and achieving a new ‘normality'. These include self-indulgence, socialising and gaining support from others. Patients and carers often use the same or similar strategies but in different contexts, at different time-points and for different purposes. Participants attach great value to information from peers and highlight how this is substantively different from interactions with professionals.Conclusion: exploring the experiences of patient and carer dyads longitudinally enables better understanding not only of strategies used, but also how they are deployed and change over time. The results indicate that better access to ‘everyday' information from peers is likely to stimulate development of coping strategies independently of professional input.There is a need to develop initiatives which actively engage with patient and carer perspectives, and focus away from purely professional response