Adjunctive pregabalin for uncontrolled partial-onset seizures: findings from a prospective audit.

AIMS: Pregabalin (PGB) was licensed in Europe as an add-on antiepileptic drug (AED) for the treatment of partial-onset seizures in 2004. This audit assessed the response to adjunctive PGB in patients with uncontrolled seizures. METHODS: PGB was titrated in 135 patients [73 men; 62 women, aged 18-76 (median 44 years) until one of the following occurred: ≥ 6 months' seizure freedom, ≥ 50% or < 50% seizure reduction over 6 months; PGB withdrawal because of adverse effects, lack of efficacy or both. RESULTS: Of the 135 patients, 14 (10.4%) became seizure-free for ≥ 6 months (median PGB dose 300 mg/day; range 75-600 mg). A ≥ 50% seizure reduction occurred in 33 (24.4%) patients; 20 (14.8%) had < 50% reduction. PGB was withdrawn in 68 (50.4%) (40 adverse effects, seven lack of efficacy and 21 both). Commonest problems resulting in withdrawal were sedation (n = 18), weight gain (n = 14) and ataxia (n = 9). There was a positive correlation between increasing dose and weight gain (r = 0.42, P = 0.045). CONCLUSIONS: Add-on PGB benefited 50% of patients, but only 10% achieved 6 months' seizure freedom. Adverse effects, most commonly sedation, dose-related weight gain and ataxia, led to drug discontinuation by 45%. Prospective audits of novel AEDs are a useful adjunct to randomized, controlled trials in managing epilepsy.

A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2.

BACKGROUND: AMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. Our objective was to compare, contrast and establish both inter-rater reliability and usability of both tools as part of two overviews of systematic reviews. Strictly speaking, one tool assesses methodological quality (AMSTAR-2) and the other assesses risk of bias (ROBIS), but there is considerable overlap between the tools in terms of the signalling questions. METHODS: Three reviewers independently assessed 31 systematic reviews using both tools. The inter-rater reliability of all sub-sections using each instrument (AMSTAR-2 and ROBIS) was calculated using Gwet's agreement coefficient (AC1 for unweighted analysis and AC2 for weighted analysis). RESULTS: Thirty-one systematic reviews were included. For AMSTAR-2, the median agreement for all questions was 0.61. Eight of the 16 AMSTAR-2 questions had substantial agreement or higher (> 0.61). For ROBIS, the median agreement for all questions was also 0.61. Eleven of the 24 ROBIS questions had substantial agreement or higher. CONCLUSION: ROBIS is an effective tool for assessing risk of bias in systematic reviews and AMSTAR-2 is an effective tool at assessing quality. The median agreement between raters for both tools was identical (0.61). Reviews that included a meta-analysis were easier to rate with ROBIS; however, further developmental work could improve its use in reviews without a formal synthesis. AMSTAR-2 was more straightforward to use; however, more response options would be beneficial.

Systematic review of interventions for the prevention and treatment of postoperative urinary retention.

Background: Postoperative urinary retention (PO-UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO-UR that might be alternatives to urinary catheterization. Methods: Electronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO-UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random-effects meta-analysis. The overall quality of the body of evidence was rated using the GRADE approach. Results: Some 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO-UR. Based on GRADE, there was high-certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha-blockers (number needed to treat to prevent one case of PO-UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay. Conclusion: Promising interventions exist for PO-UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.

An integrating thermoluminescent Rn daughter personal dosimeter.

An integrating Rn daughter dosimeter using conventional Dy-doped CaSO4 thermoluminescent (TL) material has been developed for use as a personal monitor. The dosimeter was found to have a linear response over the range 0.5 WL-h to 25 WL-h and to be insensitive to the state of equilibrium of the Rn daughters. The use of the dosimeter to monitor both 222Rn and 220Rn daughters is described. The limiting sensitivity of the dosimeter, at a sampling rate of 1 L min-1, was determined to be 0.1 WL-h for 222Rn daughters and 0.5 WL-h for 220Rn daughters. The application of the thermoluminescent dosimeter (TLD) to occupational monitoring of 222Rn and 220Rn daughters is discussed.

A study of radiation parameters in an open-pit mine.

Radiation parameters associated with the open pit mining of a small (10,000 tonnes), but high grade (2%) uranium deposit at Nabarlek, N.T., have been investigated in detail. External radiation levels, radon emanation rates and radon daughter levels were measured systematically during the development of the mine, and are correlated with ore grade, properties of the host rock and atmospheric conditions. Significant radon daughter concentrations were observed only under stable atmospheric conditions, usually during the might and were invariably associated with thermal inversions. The mean cumulative exposure to radon daughters was estimated from the measured levels to be 0.065 Working Level Months for employees working in the pit for the entire four and a half months of mining. The mean cumulative external gamma ray exposure for the same employee group was measured using thermoluminescent dosimeters to be 2.3 mSv (230 mrem). For most other employees, however, exposures were much lower. Data on long lived radionuclides in dust and on particle size distribution are also presented.

Atmospheric dispersion of radon gas and its decay products under stable conditions in arid regions of Australia.

The radon and radon daughter concentration-in-air from natural background are assessed along with the micrometeorology and synoptic weather systems in an arid region of Australia. The radon daughter contribution to population dose is biased towards the frequency of nocturnal inversions. Classical atmospheric models are not applicable during stable atmospheric conditions in inland Australia. An atmospheric Box Model is used along with measured data from tethersonde profiles in predicting radon/radon daughter concentration-in-air. Predicted and measured concentrations are compared for spatial and temporal variations.