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    ABSTRACT: Cardiovascular disease (CVD) accounts for 30% of UK deaths. It is associated with modifiable lifestyle factors, including insufficient consumption of fruit and vegetables (F&V). Lay health trainers (LHTs) offer practical support to help people develop healthier behaviour and lifestyles. Our two-group pilot randomized controlled trial (RCT) investigated the effectiveness of LHTs at promoting a heart-healthy lifestyle among adults with at least one risk factor for CVD to inform a full-scale RCT. Eligible adults (aged 21-78 years), recruited from five practices serving deprived populations, were randomized to health information leaflets plus LHTs' support for 3 months (n = 76) versus health information leaflets alone (n = 38). We recruited 114 participants, with 60% completing 6 month follow-up. Both groups increased their self-reported F&V consumption and we found no evidence for LHTs' support having significant added impact. Most participants were relatively less deprived, as were the LHTs we were able to recruit and train. Our pilot demonstrated that an LHT's RCT whilst feasible faces considerable challenges. However, to justify growing investment in LHTs, any behaviour changes and sustained impact on those at greatest need should be demonstrated in an independently evaluated, robust, fully powered RCT.
    Full-text · Article · Nov 2013 · Journal of Public Health
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    ABSTRACT: Clinical encounters in daily practice can provide a fertile ground for identifying uncertainties that require further investigation. Addressing such uncertainties by undertaking a Cochrane review can be a rewarding educational process and result in important contributions to health care policy. This paper describes the experiences of a UK GP undertaking a Cochrane review whilst working in clinical practice. It outlines some of the practical issues when starting a review, the importance of effective mentorship and collaboration, the power of the modern medial media (BMJ, Wikipedia) and engaging with policy makers (WHO).
    No preview · Article · Nov 2013 · The European journal of general practice
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    ABSTRACT: Aims: To profile site of stroke/cerebrovascular accident, type and extent of field loss, treatment options, and outcome. Methods: Prospective multicentre cohort trial. Standardised referral and investigation protocol of visual parameters. Results: 915 patients were recruited with a mean age of 69 years (SD 14). 479 patients (52%) had visual field loss. 51 patients (10%) had no visual symptoms. Almost half of symptomatic patients (n = 226) complained only of visual field loss: almost half (n = 226) also had reading difficulty, blurred vision, diplopia, and perceptual difficulties. 31% (n = 151) had visual field loss as their only visual impairment: 69% (n = 328) had low vision, eye movement deficits, or visual perceptual difficulties. Occipital and parietal lobe strokes most commonly caused visual field loss. Treatment options included visual search training, visual awareness, typoscopes, substitutive prisms, low vision aids, refraction, and occlusive patches. At followup 15 patients (7.5%) had full recovery, 78 (39%) had improvement, and 104 (52%) had no recovery. Two patients (1%) had further decline of visual field. Patients with visual field loss had lower quality of life scores than stroke patients without visual impairment. Conclusions: Stroke survivors with visual field loss require assessment to accurately define type and extent of loss, diagnose coexistent visual impairments, and offer targeted treatment.
    Full-text · Article · Sep 2013
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