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Background: caffeine is present in a variety of beverages and food and is widely consumed. In a previous study of patients recovering from an acute ischaemic stroke using transcranial Doppler ultrasound we demonstrated a fall in middle cerebral artery blood velocity of 12% following ingestion of 250 mg caffeine. The aim of this study was to investigate if this velocity change reXected a change in cerebral blood Xow. Methods: the study used a randomised, double blind, cross-over design. Nineteen patients recovering from an acute ischaemic stroke in the middle cerebral artery territory and 10 controls attended two sessions, having abstained from caffeine for 48 hours previously. At each session cerebral blood Xow was measured four times using xenon clearance, twice before the oral administration of 250 mg caffeine or matched placebo, and twice after. Similarly, three middle cerebral artery blood velocity readings using transcranial Doppler were made prior to administration and four after. Results: the caffeine resulted in a signiWcant fall in cerebral blood Xow and middle cerebral artery blood velocity compared to placebo. Conclusions: since caffeine is present in the diet of most patients recovering from an acute ischaemic stroke this effect may have adverse clinical consequences.

Objectives: to assess the functioning and well-being of older patients presenting with congestive heart failure (CHF) using established generic health status measures—the short form 36 health survey (SF-36) and Dartmouth COOP charts. Methods: patients aged 60 or older with CHF were asked if they would take part. They were requested to complete interviewer-administered questionnaires before angiotensin converting enzyme (ACE) inhibitor treatment and at follow-up 4 weeks later. The interviewer administered the SF-36, COOP charts, the oxygen cost diagram and also asked patients to assess their health state overall and, after treatment, to assess changes, if any, in overall health. Results: multi-dimensional health status measures indicate that patient's functioning and well-being is substantially compromised by CHF, especially in areas relating to physical functioning, and that treatment with ACE inhibitors has only limited effect in improving health-related quality of life. However, on simple single-item global assessments of health, patients report that their overall health-related quality of life is good and many report improvements in overall health status at foliow-up. Conclusions: ACE inhibitor treatment, whilst lengthening life, has a relatively limited impact on its quality. While multidimensional health status measures indicate CHF to be associated with poor health as measured by the SF-36 and COOP charts. However, when patients are asked simple single-item questions relating to their overall health state and the extent of change experienced after treatment, they report relatively good health and positive improvements as a consequence of therapy. Since elderly patients' expectations of improvement may be modest and their expectations of physical ability relatively limited, relatively small improvements, which may not appear large when reported in effect size statistics, may be important. Standardized questionnaires, and standardized statistical methods of assessing change, may not be appropriate for this patient group. A fuller understanding of their expectations and assessment of treatment outcomes is necessary.