Interaction with time since injury stratified by Glasgow Coma Scale (GCS). The graph shows how th... more Interaction with time since injury stratified by Glasgow Coma Scale (GCS). The graph shows how the treatment effect varies with time to treatment stratified by GCS. (PDF 6 kb)
Letter of favourable ethical opinion from the Observational/Interventions Research Ethics Committ... more Letter of favourable ethical opinion from the Observational/Interventions Research Ethics Committee at the London School of Hygiene and Tropical Medicine. (PDF 267Â kb)
Letter of favourable ethical opinion from the Medical Research and Ethics Committee and Health Re... more Letter of favourable ethical opinion from the Medical Research and Ethics Committee and Health Research Authority. (PDF 106Â kb)
Confirmation of funding for the CRASH-3 trial from the London School of Hygiene and Tropical Medi... more Confirmation of funding for the CRASH-3 trial from the London School of Hygiene and Tropical Medicine. (PDF 264Â kb)
Confirmation of funding for the CRASH-3 trial from the National Institute for Health Research. (P... more Confirmation of funding for the CRASH-3 trial from the National Institute for Health Research. (PDF 82Â kb)
SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 122Â kb)
Background The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduc... more Background The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduce deaths from intracranial bleeding after traumatic brain injury (TBI). To explore the mechanism of action of TXA in TBI, we examined the timing of its effect on death. Methods The CRASH-3 trial randomised 9202 patients within 3 h of injury with a GCS score ≤ 12 or intracranial bleeding on CT scan and no significant extracranial bleeding to receive TXA or placebo. We conducted an exploratory analysis of the effects of TXA on all-cause mortality within 24 h of injury and within 28 days, excluding patients with a GCS score of 3 or bilateral unreactive pupils, stratified by severity and country income. We pool data from the CRASH-2 and CRASH-3 trials in a one-step fixed effects individual patient data meta-analysis. Results There were 7637 patients for analysis after excluding patients with a GCS score of 3 or bilateral unreactive pupils. Of 1112 deaths, 23.3% were within 24 h of injury (ea...
NICE recommends that when adults present in primary care with depression, they should be asked ab... more NICE recommends that when adults present in primary care with depression, they should be asked about previous periods of overactivity or disinhibited behaviour. If this behaviour lasted for four or more days referral for a specialist mental health assessment should be considered. Although depressive episodes are not necessary for a diagnosis of bipolar disorder, they are common and dominate the lifetime pattern of the condition: 50% of the time is spent in a euthymic (well) state, 38% in a depressed and 12% in a manic state. If there have only been depressive symptoms, it is not possible to exclude bipolar disorder. A diagnosis of bipolar disorder is supported by diagnostic criteria and usually confirmed by a psychiatrist. If the GP suspects mania or severe depression, or if patients are a danger to themselves or others, an urgent referral should be made for a specialist mental health assessment. If a manic episode has been present during the history the diagnosis is bipolar I disor...
We aimed to investigate whether moderate alcohol consumption has favourable, adverse or no associ... more We aimed to investigate whether moderate alcohol consumption has favourable, adverse or no association with brain structure and function. Weekly alcohol intake and cognitive performance were measured repeatedly during a 30-year period (1985 to 2015) in communitydwelling adults enrolled in the Whitehall II cohort based in the United Kingdom (the Whitehall II imaging sub-study). Multimodal Magnetic Resonance Imaging (MRI) was performed at endpoint (2012-5).
BackgroundEarly tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain ... more BackgroundEarly tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain injury (TBI). We used brain scans that were acquired as part of the routine clinical practice during the CRASH-3 trial (before unblinding) to examine the mechanism of action of TXA in TBI. Specifically, we explored the potential effects of TXA on intracranial haemorrhage and infarction.MethodsThis is a prospective substudy nested within the CRASH-3 trial, a randomised placebo-controlled trial of TXA (loading dose 1 g over 10 min, then 1 g infusion over 8 hours) in patients with isolated head injury. CRASH-3 trial patients were recruited between July 2012 and January 2019. Participants in the current substudy were a subset of trial patients enrolled at 10 hospitals in the UK and 4 in Malaysia, who had at least one CT head scan performed as part of the routine clinical practice within 28 days of randomisation. The primary outcome was the volume of intraparenchymal haemorrhage (ie, contusio...
Interaction with time since injury stratified by Glasgow Coma Scale (GCS). The graph shows how th... more Interaction with time since injury stratified by Glasgow Coma Scale (GCS). The graph shows how the treatment effect varies with time to treatment stratified by GCS. (PDF 6 kb)
Letter of favourable ethical opinion from the Observational/Interventions Research Ethics Committ... more Letter of favourable ethical opinion from the Observational/Interventions Research Ethics Committee at the London School of Hygiene and Tropical Medicine. (PDF 267Â kb)
Letter of favourable ethical opinion from the Medical Research and Ethics Committee and Health Re... more Letter of favourable ethical opinion from the Medical Research and Ethics Committee and Health Research Authority. (PDF 106Â kb)
Confirmation of funding for the CRASH-3 trial from the London School of Hygiene and Tropical Medi... more Confirmation of funding for the CRASH-3 trial from the London School of Hygiene and Tropical Medicine. (PDF 264Â kb)
Confirmation of funding for the CRASH-3 trial from the National Institute for Health Research. (P... more Confirmation of funding for the CRASH-3 trial from the National Institute for Health Research. (PDF 82Â kb)
SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 122Â kb)
Background The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduc... more Background The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduce deaths from intracranial bleeding after traumatic brain injury (TBI). To explore the mechanism of action of TXA in TBI, we examined the timing of its effect on death. Methods The CRASH-3 trial randomised 9202 patients within 3 h of injury with a GCS score ≤ 12 or intracranial bleeding on CT scan and no significant extracranial bleeding to receive TXA or placebo. We conducted an exploratory analysis of the effects of TXA on all-cause mortality within 24 h of injury and within 28 days, excluding patients with a GCS score of 3 or bilateral unreactive pupils, stratified by severity and country income. We pool data from the CRASH-2 and CRASH-3 trials in a one-step fixed effects individual patient data meta-analysis. Results There were 7637 patients for analysis after excluding patients with a GCS score of 3 or bilateral unreactive pupils. Of 1112 deaths, 23.3% were within 24 h of injury (ea...
NICE recommends that when adults present in primary care with depression, they should be asked ab... more NICE recommends that when adults present in primary care with depression, they should be asked about previous periods of overactivity or disinhibited behaviour. If this behaviour lasted for four or more days referral for a specialist mental health assessment should be considered. Although depressive episodes are not necessary for a diagnosis of bipolar disorder, they are common and dominate the lifetime pattern of the condition: 50% of the time is spent in a euthymic (well) state, 38% in a depressed and 12% in a manic state. If there have only been depressive symptoms, it is not possible to exclude bipolar disorder. A diagnosis of bipolar disorder is supported by diagnostic criteria and usually confirmed by a psychiatrist. If the GP suspects mania or severe depression, or if patients are a danger to themselves or others, an urgent referral should be made for a specialist mental health assessment. If a manic episode has been present during the history the diagnosis is bipolar I disor...
We aimed to investigate whether moderate alcohol consumption has favourable, adverse or no associ... more We aimed to investigate whether moderate alcohol consumption has favourable, adverse or no association with brain structure and function. Weekly alcohol intake and cognitive performance were measured repeatedly during a 30-year period (1985 to 2015) in communitydwelling adults enrolled in the Whitehall II cohort based in the United Kingdom (the Whitehall II imaging sub-study). Multimodal Magnetic Resonance Imaging (MRI) was performed at endpoint (2012-5).
BackgroundEarly tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain ... more BackgroundEarly tranexamic acid (TXA) treatment reduces head injury deaths after traumatic brain injury (TBI). We used brain scans that were acquired as part of the routine clinical practice during the CRASH-3 trial (before unblinding) to examine the mechanism of action of TXA in TBI. Specifically, we explored the potential effects of TXA on intracranial haemorrhage and infarction.MethodsThis is a prospective substudy nested within the CRASH-3 trial, a randomised placebo-controlled trial of TXA (loading dose 1 g over 10 min, then 1 g infusion over 8 hours) in patients with isolated head injury. CRASH-3 trial patients were recruited between July 2012 and January 2019. Participants in the current substudy were a subset of trial patients enrolled at 10 hospitals in the UK and 4 in Malaysia, who had at least one CT head scan performed as part of the routine clinical practice within 28 days of randomisation. The primary outcome was the volume of intraparenchymal haemorrhage (ie, contusio...
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