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More formal economic evaluation would allow better use of the available data. All identified studies were conducted in unconscious patients. However, further research is needed to evaluate new ODM probes that may be tolerated by awake patients. Given the paucity of the existing economic evidence base, any further primary research should include an economic evaluation or should provide data suitable for use in an economic model.

BackgroundAllopurinol, a xanthine oxidase inhibitor, reduced progression of carotid-intima media thickness and lowered blood pressure in a small clinical trial in people with ischaemic stroke. Xanthine oxidase inhibition for improvement of long-term outcomes following ischaemic stroke and transient ischaemic attack (XILO-FIST) aims to assess the effect of allopurinol treatment on white matter hyperintensity progression and blood pressure after stroke. This paper describes the XILO-FIST protocol.MethodsXILO-FIST is a multicentre randomised double-blind, placebo-controlled, parallel group clinical trial funded by the British Heart Foundation and the Stroke Association. The trial has been adopted by the Scottish Stroke Research Network and the UK Clinical Research Network. The trial is registered in clinicaltrials.gov (registration number NCT02122718). XILO-FIST will randomise 464 participants, aged greater than 50 years, with ischaemic stroke within the past month, on a 1:1 basis, to two years treatment with allopurinol 300 mg twice daily or placebo. Participants will undergo brain magnetic resonance imaging, cognitive assessment, ambulatory blood pressure monitoring and blood sampling at baseline and after two years treatment. The primary outcome will be white matter hyperintensity progression, measured using the Rotterdam progression scale. Secondary outcomes will include change in white matter hyperintensity volume, mean day-time systolic blood pressure and measures of cognitive function. Up to 100 will undergo additional cardiac magnetic resonance imaging in a sub-study of left ventricular mass.DiscussionIf white matter hyperintensity progression is reduced, allopurinol could be an effective preventative treatment for patients with ischaemic stroke and clinical endpoint studies would be needed. If allopurinol reduces blood pressure after stroke, then it could be used to help patients reach blood pressure targets.

Purpose-The purpose of this paper is to provide a framework for analysing and modelling detailed workflow of image-guided interventions to facilitate simulation and the re-engineering process for the development of new procedures in multi-modal imaging environments. Design/methodology/approach-The methodology presented includes a literature review on workflow simulation in surgery, focussing on radiology environments, an assessment of simulation tools, a data gathering and management framework and research on methods for conceptual modelling of the processes. Findings-The literature review reveals that few authors attempted to analyse the phases within image-guided interventions, and those that did, only did so partially. The framework developed for this work intends to fill the gap found in the survey. It allows the maintenance and management of large amounts of data, one of the most critical factors when modelling detailed workflow. In addition, selecting the appropriate simulation software plays an important role, saving time in later stages of the project. Originality/value-The framework presented for endovascular interventions can be extended to other types of image-guided interventions. Moreover, modelling the workflow processes in a modular way facilitates the re-engineering process when integrating different imaging modalities during the same procedure.

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