Objective To determine the optimum duration of oral anticoagulant therapy after an episode of deep vein thrombosis or pulmonary embolism, or both. Design Multicentre, prospective, randomised study with follow-up for one year. Setting 46 hospitals in United Kingdom. Participants Patients aged ≥18 with deep vein thrombosis or pulmonary embolism, or both.

A particular pattern of circadian variation of cardiovascular and cerebrovascular diseases has been reported in the literature. The circadian periodicity of ischaemic stroke with peak onset in the morning hours may not be a random event and could depend on some underlying precipitating and associated cardiovascular risk factors. In a prospective observational study, we observed that ischaemic stroke onset was significantly higher in late morning hours between 6.00 and 12.00 hours. Ischaemic heart disease and hypertension were significantly associated with the occurrence of late morning ischaemic strokes. Further studies in the future are needed to understand the significance of this association and whether these risk factors are implicated in the pathogenesis of stroke.

Post-traumatic growth can develop soon after stroke. Deliberate rumination is a key factor in post-traumatic growth. Both active coping and denial coping were associated with post-traumatic growth demonstrating the psychological complexity of poststroke adjustment. Implications for rehabilitation Therapists can expect stroke survivors to show post-traumatic growth in the first months after stroke. Therapists should look to promote post-traumatic growth and positive adjustment through working with survivors to increase active coping (attempts to deal effectively with the impact of stroke) and rumination (cognitive processing of the impact of the stroke). Since denial coping was also associated with posttraumatic growth, stroke survivors who maintain overly optimistic views about the severity and impact of their stroke are likely to benefit from therapists continually facilitating capacity for growth and well-being.

Unforeseen difficulties in the translation of our paradigm to a clinical setting required some deviations from the preregistered protocol. We explicitly detail these changes, discuss the accompanied additional challenges that can arise in clinical neurofeedback studies, and formulate recommendations for how these can be addressed. Taken together, this work provides new insights about the feasibility of motor imagery-based graded fMRI-NF training in MCA stroke survivors and serves as a first example for comprehensive study preregistration of an (fMRI) neurofeedback experiment.

[4, 5]. The trait is inherited in an autosomal dominant fashion and a mutation of the receptor site shared by meal and enema, and CT of the thorax, abdomen and pelvis, bronchoscopy and brushings also failed to reveal any abnormality.warfarin and vitamin K is postulated, although the locus of the mutation is unknown. He was commenced on full-dose ( porcine mucosal) heparin for 10 days and the warfarin dose was increased to 15 mg daily untilMeasurement of the plasma warfarin concentration may be helpful in all these circumstances, since at steady state, his INR had risen to 4.0, when his plasma warfarin concentration was measured at 3.1 mg l −1 . the reference range is 0.8 to 2.4 mg l −1 [6]. The reference range for warfarin clearance (calculated by dividing the daily Patients vary markedly in their requirement for warfarin, warfarin dose by the steady-state plasma concentration) is but 95% of subjects need more than 1 and less than 2.5 to 8.7 l day −1

Aims We investigated the effects of repeated‐dose charcoal administered several hours after sodium valproate on the pharmacokinetics of a single dose of the drug in healthy volunteers. Methods The pharmacokinetics of sodium valproate were studied in seven healthy volunteers after administration of a syrup (300 mg) on two occasions, one of which was followed by administration of repeated doses of oral charcoal starting 4 h after the drug up to 32 h (total dose 80 g). Results Valproate was rapidly absorbed with maximum concentrations 1 h after administration. The area under the plasma concentration‐time curve to 48 h (AUC (0,48 h)) was 408 ± 114.5 (s.d.)mgl−1 h in the control phase and 398 ± 108.6 mgl−1 h after charcoal and the t1/2 elimination was 20 ± 6.8 h in the control phase, and 22 ± 9.2 h after charcoal (NS). Conclusions Repeated‐dose activated charcoal does not appear to enhance the rate of elimination of sodium valproate after therapeutic doses of the drug and any beneficial effect of charcoal in overdose may be to prevent absorption of valproate still present in the gut.

Background and rationaleReliable prediction of discharge destination in acute stroke informs discharge planning and can determine the expectations of patients and carers. There is no existing model that does this using routinely collected indices of pre-morbid disability and stroke severity. MethodsAge, gender, pre-morbid modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) were gathered prospectively on an acute stroke unit from 1,142 consecutive patients. A multiclass random forest classifier was used to train and validate a model to predict discharge destination. ResultsUsed alone, the mRS is the strongest predictor of discharge destination. The NIHSS is only predictive when combined with our other variables. The accuracy of the final model was 70.4% overall with a positive predictive value (PPV) and sensitivity of 0.88 and 0.78 for home as the destination, 0.68 and 0.88 for continued inpatient care, 0.7 and 0.53 for community hospital, and 0.5 and 0.18 for death, respectively. ConclusionPre-stroke disability rather than stroke severity is the strongest predictor of discharge destination, but in combination with other routinely collected data, both can be used as an adjunct by the multidisciplinary team to predict discharge destination in patients with acute stroke.

Repeated-dose activated charcoal does not appear to enhance the rate of elimination of sodium valproate after therapeutic doses of the drug and any beneficial effect of charcoal in overdose may be to prevent absorption of valproate still present in the gut.