Browsing by Author "Robinson, T."

Now showing 1 - 4 of 4

Cluster-randomized, crossover trial of head positioning in acute stroke
(Massachusetts Medical Society, 2017) Anderson, C.S.; Arima, H.; Lavados, P.; Billot, L.; Hackett, M.L.; Olavarría, V.V; Muñoz Venturelli, P.; Brunser, A.; Peng, B.; Cui, L.; Song, L.; Rogers, K.; Middleton, S.; Lim, J.Y.; Forshaw, D.; Lightbody, C.E.; Woodward, M.; Pontes-Neto, O.; de Silva, H.A.; Lin, R.T.; Lee, T.H.; Pandian, J.D.; Mead, G.E.; Robinson, T.; Watkins, C.; Headpost Investigators and Coordinators
BACKGROUND: The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODS: In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours. The primary outcome was degree of disability at 90 days, as assessed with the use of the modified Rankin scale (scores range from 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death). RESULTS: The median interval between the onset of stroke symptoms and the initiation of the assigned position was 14 hours (interquartile range, 5 to 35). Patients in the lying-flat group were less likely than patients in the sitting-up group to maintain the position for 24 hours (87% vs. 95%, P<0.001). In a proportional-odds model, there was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the lying-flat group and patients in the sitting-up group (unadjusted odds ratio for a difference in the distribution of scores on the modified Rankin scale in the lying-flat group, 1.01; 95% confidence interval, 0.92 to 1.10; P=0.84). Mortality within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among the patients in the sitting-up group (P=0.83). There were no significant between-group differences in the rates of serious adverse events, including pneumonia. CONCLUSIONS: Disability outcomes after acute stroke did not differ significantly between patients assigned to a lying-flat position for 24 hours and patients assigned to a sitting-up position with the head elevated to at least 30 degrees for 24 hours. (Funded by the National Health and Medical Research Council of Australia; HeadPoST ClinicalTrials.gov number, NCT02162017 .).
Productive Efficiency of Culture-based Fisheries Production in Village Irrigation Systems of Sri Lanka
(Reviewing International Encounters 2018,The Research Center for Social Sciences (RCSS), University of Kelaniya, Sri Lanka, 2018) Kularatne, M.G.; Wilson, C.; Robinson, T.; Pascoe, S.
Over half of growing global aquaculture production being produced in freshwater ponds and tanks. Asia is the highest global consumer and epicenter of fresh water aquaculture production. Unique Inputs of fresh water fish production in Sri Lanka are multiple use of man-made Common property water bodies fixed in capacity, centralised fish breeding, group labour and collective agreements, natural organic feedings. The development of culture-based fisheries (CBFs) based on stocking fish fingerlings in village irrigation systems (VISs) has grown in popularity over the last three decades. CBF production has been given a high priority in Sri Lanka given fish are a cheap source of animal protein for rural low-income communities. Despite the growing popularity of CBFs associated with VISs, there is little knowledge about factors that influence productivity levels. Therefore, this is the first attempt to investigate on factors influence of technical efficiency of CBF production in Sri Lanka. Primary data from 325 fish farming groups in two districts (Kurunegala and Anuradhapura) are used to estimate a stochastic translog production frontier for CBF production. Analysis of these data indicates that technical efficiency in these irrigation systems is substantially lower than in other aquaculture production systems in a number of other Asian countries, suggesting that production can be increased substantially using existing technology. Removing subsidies, improving consultation with extension officials, and improving water user rights are found to be key means for improving efficiency. In particular, productivity could potentially be improved through the introduction of a transferable community quota system for water rights use
Regional variation in acute stroke care organisation
(Elsevier, 2016) Muñoz Venturelli, P.; Robinson, T.; Lavados, P.M.; Olavarría, V.V.; Arima, H.; Billot, L.; Hackett, M.L.; Lim, J.Y.; Middleton, S.; Pontes-Neto, O.; Peng, B.; Cui, L.; Song, L.; Mead, G.; Watkins, C.; Lin, R.T.; Lee, T.H.; Pandian, J.; de Silva, H.A.; Anderson, C.S.; HeadPoST Investigators
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS: 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
Triple therapy prevention of recurrent intracerebral disease events trial: rationale, design and progress
(Blackwell Publishing, 2022) Anderson, C.S.; Rodgers, A.; de Silva, H.A.; Martins, S.O.; Klijn, C.J.; Senanayake, B.; Freed, R.; Billot, L.; Arima, H.; Thang, N.H.; Zaidi, W.A.W.; Kherkheulidze, T.; Wahab, K.; Fisher, U.; Lee, T.H.; Chen, C.; Pontes-Neto, O.; Robinson, T.; Wang, J.; Naismith, S.; Song, L.; Schreuder, F.H.; Lindley, R.I.; Woodward, M.; MacMahon, S.; Salman, R.A.; Chow, C.K.; Chalmers, J.
Background: Patients who suffer intracerebral hemorrhage (ICH) are at very high risk of recurrent ICH and other serious cardiovascular events. A single-pill combination (SPC) of blood pressure (BP) lowering drugs offers a potentially powerful but simple strategy to optimize secondary prevention. Objectives: The Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial (TRIDENT) aims to determine the effects of a novel SPC "Triple Pill," three generic antihypertensive drugs with demonstrated efficacy and complementary mechanisms of action at half standard dose (telmisartan 20 mg, amlodipine 2.5 mg, and indapamide 1.25 mg), with placebo for the prevention of recurrent stroke, cardiovascular events, and cognitive impairment after ICH. Design: An international, double-blind, placebo-controlled, randomized trial in adults with ICH and mild-moderate hypertension (systolic BP: 130-160 mmHg), who are not taking any Triple Pill component drug at greater than half-dose. A total of 1500 randomized patients provide 90% power to detect a hazard ratio of 0.5, over an average follow-up of 3 years, according to a total primary event rate (any stroke) of 12% in the control arm and other assumptions. Secondary outcomes include recurrent ICH, cardiovascular events, and safety. Results: Recruitment started 28 September 2017. Up to 31 October 2021, 821 patients were randomized at 54 active sites in 10 countries. Triple Pill adherence after 30 months is 86%. The required sample size should be achieved by 2024.