David L Cohen

Post-stroke dysphagia: A review and design considerations for future trials

Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.

All in this together: the corporate capture of public health

The UK government is increasingly handing over its role of health policy maker to private corporations

Randomised, double-blind, placebo-controlled crossover study of single-dose guanfacine in unilateral neglect following stroke

Objective Unilateral neglect is a poststroke disorder that impacts negatively on functional outcome and lacks established, effective treatment. This multicomponent syndrome is characterised by a directional bias of attention away from contralesional space, together with impairments in several cognitive domains, including sustained attention and spatial working memory. This study aimed to test the effects of guanfacine, a noradrenergic alpha-2A agonist, on ameliorating aspects of neglect. Methods Thirteen right hemisphere stroke patients with leftward neglect were included in a randomised, double-blind, placebo-controlled proof-of-concept crossover study that examined the effects of a single dose of guanfacine. Patients were tested on a computerised, time-limited cancellation paradigm, as well as tasks that independently assessed sustained attention and spatial working memory. Results On guanfacine, there was a statistically significant improvement in the total number of targets found on the cancellation task when compared with placebo (mean improvement of 5, out of a possible 64). However, there was no evidence of a change in neglect patients’ directional attention bias. Furthermore, Bayesian statistical analysis revealed reliable evidence against any effects of guanfacine on search organisation and performance on our sustained attention and spatial working memory tasks. Conclusions Guanfacine improves search in neglect by boosting the number of targets found but had no effects on directional bias or search organisation, nor did it improve sustained attention or working memory on independent tasks. Further work is necessary to determine whether longer term treatment with guanfacine may be effective for some neglect patients and whether it affects functional outcome measures. Trial registration number NCT00955253.

Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage: observational study

BackgroundRecruitment to randomised prevention trials is challenging, not least for intracerebral haemorrhage (ICH) associated with antithrombotic drug use. We investigated reasons for not recruiting apparently eligible patients at hospital sites that keep screening logs in the ongoing REstart or STop Antithrombotics Randomised Trial (RESTART), which seeks to determine whether to start antiplatelet drugs after ICH.MethodBy the end of May 2015, 158 participants had been recruited at 108 active sites in RESTART. The trial coordinating centre invited all sites that kept screening logs to submit screening log data, followed by one reminder. We checked the integrity of data, focused on the completeness of data about potentially eligible patients and categorised the reasons they were not randomised.ResultsOf 108 active sites, 39 (36%) provided usable screening log data over a median of ten (interquartile range = 5–13) months of recruitment per site. During this time, sites screened 633 potentially eligible patients and randomised 53 (8%) of them. The main reasons why 580 patients were not randomised were: 43 (7%) patients started anticoagulation, 51 (9%) patients declined, 148 (26%) patients’ stroke physicians were not uncertain about using antiplatelet drugs, 162 (28%) patients were too unwell and 176 (30%) patients were not randomised due to other reasons.ConclusionRESTART recruited ~8% of eligible patients. If more physicians were uncertain about the therapeutic dilemma that RESTART is addressing, RESTART could have recruited up to four times as many participants. The trial coordinating centre continues to engage with physicians about their uncertainty.Trial registrationEU Clinical Trials, EudraCT 2012-003190-26. Registered on 3 July 2012.

Around 9% of patients with ischaemic stroke are suitable for thrombectomy.

As suggested by Apps and colleagues,1 we have already quantified the group of patients with stroke who are eligible for thrombectomy. After publication of the thrombectomy trials, we studied all admissions to our hyperacute stroke unit to see how many would be eligible for endovascular therapy if the trial criteria were applied. The criteria were …

OP76 Corporate funding of scientific research: a case study of Coca-Cola

Background Global corporations have come under sustained attack in recent years for their lack of transparency. In particular, concerns have been raised about their funding of research to support their advocacy campaigns, in some cases with concealment of the links between the funder and the researcher. Most attention has been focused on the tobacco industry, which has a long history of conducting research designed to create confusion and to reframe the agenda in ways that advance its interests. Similarly, the food industry has sought to reframe the debate on obesity as one driven primarily by too little physical activity rather than by high levels of intake of energy dense food. In this paper we report the findings of the case study of Coca-Cola. The Coca-Cola Corporation has been the subject of extensive criticism, in particular because of its support of academics at certain American universities who have been in the forefront of advancing the argument that the obesity epidemic should be tackled through greater physical activity rather than reductions in energy dense products. However, it has also claimed that it embraced transparency by publishing a list of researchers that it funds, although this was in response to widespread public criticism when it was realised that Coca-Cola had donated more than

Squeezing the best out of stroke care

4 million to the non-profit group “Global Energy Balance Network”, whose research framed obesity as determined by the lack of physical activity rather than by dietary habits. However, we challenge Coca-Cola’s commitment to transparency by demonstrating that its list of scientific experts that it collaborated with is selective and severely incomplete. Methods Using web scraping tools, we have collected information from the Web of Science Core Collection on every article published in a scientific journal that acknowledges the Coca-Cola Company or the Coca-Cola Foundation as a funding agency. From a total sample of 262 articles, involving approximately 2,100 authors, we impose further restrictions to the sampling procedure and end up with a total of 247 articles and 647 authors. Results 151 articles, published in roughly 100 different journals, and involving 468 authors, were funded by grants from the Coca-Cola Company or the Coca-Cola Foundation (its philanthropic arm), but were not listed on Coca-Cola’s press release of scientific experts it has funded since 2010. Discussion Many of these articles equate the obesity epidemic with lack of physical activity, which raises important questions about the role of industry funding in academic research.

Transport and clinical practice

New treatments and strict specifications about how care should be organised have dramatically advanced stroke medicine over the past 5 years. This progress is built upon an evidence-based national audit organised by the Royal College of Physicians and has led to the emergence of stroke medicine as a