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Background: A commonly reported problem with the conduct of multicentre randomised controlled trials (RCTs) is that recruitment is often slower or more difficult than expected, with many trials failing to reach their planned sample size within the timescale and funding originally envisaged. The aim of this study was to explore factors that may have been associated with good and poor recruitment in a cohort of multicentre trials funded by two public bodies: the UK Medical Research Council (MRC) and the Health Technology Assessment (HTA) Programme., Methods: The cohort of trials was identified from the administrative databases held by the two funding bodies. 114 trials that recruited participants between 1994 and 2002 met the inclusion criteria. The full scientific applications and subsequent trial reports submitted by the trial teams to the funders provided the principal data sources. Associations between trial characteristics and recruitment success were tested using the Chi-squared test, or Fisher's exact test where appropriate., Results: Less than a third (31%) of the trials achieved their original recruitment target and half (53%) were awarded an extension. The proportion achieving targets did not appear to improve over time. The overall start to recruitment was delayed in 47 (41%) trials and early recruitment problems were identified in 77 (63%) trials. The inter-relationship between trial features and recruitment success was complex. A variety of strategies were employed to try to increase recruitment, but their success could not be assessed., Conclusion: Recruitment problems are complex and challenging. Many of the trials in the cohort experienced recruitment difficulties. Trials often required extended recruitment periods (sometimes supported by additional funds). While this is of continuing concern, success in addressing the trial question may be more important than recruitment alone.

Background: A previously published cohort study of some 2670 employees of the North American sand industry, followed through 1994, provided strong evidence of a causal relationship between quartz exposure and death from both silicosis and lung cancer, after allowance for cigarette smoking and in the absence of known occupational carcinogens. Unexpectedly, a significant excess mortality from chronic non-malignant renal disease [observed 16; expected 7.6; standardized mortality ratio (SMR) 212] was also found, whereas deaths from renal cancer at this stage were close to expectation (observed 6; expected 5.2)., Objectives: Our primary aim was to discover whether death from chronic renal disease was related to the estimated intensity of crystalline silica exposure. A further aim was to determine whether or not our previous estimates of lung cancer and silicosis risk were confirmed by mortality in the cohort 6 years later., Methods: With help from the US National Death Index, surviving members of the cohort, with the exception of employees of a small plant in Canada, were traced through 2000. The cause of death was determined for all who had died, for comparison against National and State mortality rates. Nested case-referent analyses were then undertaken, as previously, of deaths from lung cancer and silicosis, plus end-stage renal disease and kidney cancer, in relation to quantitative re-estimates of quartz exposure., Results: The total number of deaths through 1994 was 990; there were 231 additional deaths during the period 1995-2000. The SMRs were significantly higher in the later than the earlier period, mainly due to a relative increase in heart disease and external causes. The updated odds ratios for lung cancer and silicosis were almost identical to those published previously, with lung cancer risk again related to average silica concentration and cumulative exposure, but not to length of employment. In contrast, risks of neither end-stage renal disease nor renal cancer were related to cumulative exposure, although now based on 19 cases (SMR 239), and 10 cases (SMR 202), respectively, in fact, opposite trends were apparent for both diseases. However, because of the small numbers there was only limited power to assess the statistical significance of these trends or of any separate relationship with the duration or intensity of exposure., Conclusions: Our findings support a causal relationship between lung cancer and quartz exposure after allowance for cigarette smoking, in the absence of other known carcinogens, but failed to find similar evidence to explain the excess mortality from either chronic renal disease or kidney cancer.

Objective: To evaluate the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in hemodialysis patients., Design: A cross-sectional observational study assessing the nutritional status of hemodialysis patients., Setting: Private tertiary Australian hospital., Subjects: Sixty patients, ages 63.9 +/- 16.2 years., Intervention: Scored PG-SGA questionnaire, comparison of PG-SGA score > or =9 with subjective global assessment (SGA), albumin, corrected arm muscle area, and triceps skinfold., Results: According to SGA, 80% of patients were well nourished and 20% of patients were malnourished. Patients classified as well nourished (SGA-A) attained a significantly lower median PG-SGA score compared with those rated as moderately malnourished or at risk of malnutrition (SGA-B). A PG-SGA score > or =9 had a sensitivity of 83% and a specificity of 92% at predicting SGA classification. There were significant correlations between the PG-SGA score and serum albumin, PG-SGA score, and percentage weight loss over the past 6 months. There was no association between PG-SGA score and body mass index or anthropometric measurements., Conclusion: The scored PG-SGA is an easy-to-use nutrition assessment tool that allows quick identification of malnutrition in hemodialysis patients.

Objective: To assess the efficacy of passive and active limb movement to improve visual scanning in patients with hemispatial neglect., Design: Before-after trial: behavioral analyses of a case series., Setting: Stroke rehabilitation unit in a tertiary care hospital., Participants: Nine individuals with right-hemisphere stroke (mean time poststroke, 19.5 mo) and left-sided neglect, as assessed by the Sunnybrook Bedside Neglect Battery., Intervention: Active left limb movement (button push; n=3) or passive left limb movement (n=8) with functional electric stimulation (FES) administered during visual scanning testing., Main Outcome Measures: Performance on visual scanning tests involving naming of letters and numbers., Results: Both active and passive movement significantly improved target detection on the left side, but not on the right side, on the visual scanning task. Positive results were seen in 2 of 3 active movement patients and 6 of 8 passive movement patients., Conclusions: Both active and FES-stimulated passive movements are potential techniques for the treatment of hemispatial neglect., (Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

The presence of abnormal palmar flexion creases (APFC) and dermatoglyphic ridge dissociation (RD) may constitute enduring evidence of a prenatal insult that occurred before the third trimester of intrauterine life. We examined these dermatoglyphic abnormalities in a twin study of psychotic disorders. RD and APFC were analyzed in a monozygotic (MZ) twin sample from the Maudsley Hospital in London (11 normal control pairs, 16 pairs concordant for psychosis, 9 pairs discordant for psychosis, 1 concordant triplet, and 1 triplet with one affected member). The risk of either RD or APFC was 44 percent in affected twins and 20 percent in nonaffected twins (odds ratio = 3.25, 95% confidence interval: 1.03-10.31; one-sided p = 0.023). In the group of MZ twins discordant for psychosis, discordance for RD or APFC always paralleled discordance for psychosis (one-sided p = 0.078), suggesting the operation of nongenetic factors. The results confirm previous work suggesting the possibility that nongenetic factors early in pregnancy contribute to the liability to develop psychosis in later life.