Perampanel: An audit of clinical experience using the epilepsy electronic patient record.

Perampanel is a non-competitive antagonist of AMPA glutamate receptors on post synaptic neurons. The aim of this study was to conduct an audit of the experience of perampanel treatment in Ireland based on the interrogation of the national epilepsy electronic patient record (EPR). A retrospective audit was compiled which reviewed the progress of patients who had been treated across two regional epilepsy centres. The EPR was used to identify patients and collect information relevant to their perampanel therapy. Collected data was entered into a statistical package for social sciences for analysis using descriptive statistics. Seventy patients were identified for inclusion in this audit. Partial onset epilepsy was the predominant epilepsy syndrome treated with perampanel. Eight milligrams daily was the maximum dose achieved in 31.45% (n=22). Complex partial seizures demonstrated the best seizure response to perampanel, which was optimal at doses of 4mgs to 8mgs once daily. Treatment was discontinued primarily due to side effect profile (28.5%; n=20). The common side effects reported were behavioural alteration, sedation and dizziness. Abnormal thoughts were identified in 4.2% (n=3). Overall perampanel has been shown to be an effective adjunct. The EPR was demonstrated as an effective tool for audit and research.

First-year medical students' knowledge of, attitudes toward, and personal histories of family violence.

PURPOSE: To assess first-year students' knowledge of, attitudes toward, and personal histories of family violence. METHOD: An anonymous, self-administered, 70-item questionnaire was developed and distributed in the first six months of medical school to 390 first-year students at three New England medical schools in 1991-92. The students were tested on knowledge and asked questions about their personal histories. Attitude questions were scored on a five-point Likert scale. Attitude scales were developed by dividing questions into three content groups (education about family violence, the physician as advocate, acceptability of violent behaviors) and removing items for which inter-item coefficients with all other items were less than .20. Two-tailed t-tests were performed on continuous variables and chi-square tests on categorical variables. Ninety-five percent Cls were calculated for point estimates. RESULTS: In all, 370 students (95%) responded. Of these, 139 (38%) reported personal histories of abuse. The mean knowledge score was 11.3 (of 16 questions). One-third of the students answered more than 75% of these questions correctly; 12% answered less than half of the questions correctly. The women felt more strongly than the men about the need for violence education (p < .001). The students who reported histories of abuse more strongly favored education (p < .05) and advocacy roles (p < .001) for physicians. In addition, the students who had histories of family violence were more likely to report histories of suicidal thoughts (p < .0001). CONCLUSION: The students lacked knowledge but felt a need to learn more about family violence. Family violence curricula should be better integrated into medical education. These curricula should be sensitive to students' attitudes, given the reported high prevalence of personal histories of family violence among students.

Analysis of the mitogenic effect of fetuin preparations on arterial smooth muscle cells: the role of contaminant platelet-derived growth factor.

Fetuin, a major protein of fetal calf serum, partially purified by the method of Pedersen, stimulated growth of aortic smooth muscle cells. More highly purified fetuin preparations stimulated growth less than Pedersen fetuin, as previously described for other cell types, suggesting that this activity is due to a contaminant. Recently bovine alpha 2-macroglobulin or "Embryonin" has been proposed as the mitogenic component of crude fetuin preparations. We found that active fetuin preparations did contain alpha 2-macroglobulin that stimulated smooth muscle cell growth. However, alpha 2-macroglobulin purified directly from platelet-poor bovine plasma or fetuin purified from Pedersen fetuin by gel filtration lacked appreciable mitogenic effect on smooth muscle cells. Since alpha 2-macroglobulin can bind platelet-derived growth factor (PDGF), and since highly acidic fetuin might bind the very basic PDGF molecule non-specifically, we measured the PDGF content of various fetuin preparations and found a good correlation between the PDGF content and mitogenic activity. Gel filtration experiments demonstrated that in Pedersen fetuin PDGF occurred both free, and in association with alpha 2-macroglobulin. We conclude that the principal mitogenic component for smooth muscle cells in crude fetuin preparations is PDGF, since purified bovine alpha 2-macroglobulin or fetuin do not appreciably affect growth of these cells. These results help to resolve a long-standing controversy regarding the nutrition of cultured cells. In addition, we suggest that before alpha 2-macroglobulin or "Embryonin" is accepted as a bona fide growth factor for a given cell type, the role of contamination with PDGF should be assessed.