Reduction In Mean Number Research Articles

Impact of dronedarone treatment on healthcare resource utilization in patients with atrial fibrillation/flutter.

BackgroundThe ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in Patients with Atrial Fibrillation/Atrial Flutter) trial demonstrated a significant reduction (26%) in the rate of first cardiovascular (CV) hospitalization in dronedarone-treated patients with paroxysmal or persistent atrial fibrillation/flutter (AF/AFL). ATHENA was the first trial to demonstrate a CV outcomes benefit, specifically reduced CV hospitalizations, with an antiarrhythmic drug. The objective of this study was to assess the impact of dronedarone treatment on healthcare resource utilization among real-world patients with AF/AFL in United States clinical practice.MethodsThis retrospective cohort study used claims data from the MarketScan® databases (Truven Health, Durham, NC, USA) to identify patients with ≥2 concurrent de novo pharmacy claims for dronedarone (≥180 days’ total supply) between June 2009 and March 2011, and with an AF/AFL diagnosis and no heart failure-related hospitalization during the 12 months preceding the initial (index) dronedarone claim. Annualized inpatient and outpatient resource utilization were compared between the pre-index (baseline) and post-index (follow-up) periods.ResultsIn total, 5,656 AF/AFL patients were prescribed dronedarone for ≥6 months and were followed for mean (standard deviation) 11.9 (4.7) months. Reductions in mean numbers of annualized all-cause, CV- and AF-related hospitalizations (~40–45%), and emergency department visits (~30–45%) were realized. These benefits were offset by increases in office visits (~10–30%) and AF-related prescription claims (74%) after dronedarone initiation. The sub-cohort of patients switching to dronedarone from Prior Rhythm-Control therapy (n = 2,080) showed similar reductions in hospital and emergency department events.ConclusionsThis study suggests that dronedarone use in real-world practice, as in the ATHENA trial, results in substantial reductions in hospital admissions, both in first-line and second-line antiarrhythmic treatment settings.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0108-x) contains supplementary material, which is available to authorized users.

The success of our patient blood management program depended on an institution‐wide change in transfusion practices

Patient blood management (PBM) programs seek to optimize the utilization of blood components. Since our institution's program started, the annual number of red blood cell (RBC) units transfused has decreased by 27% overall. We collected data for 6 months in 2007 (pre-PBM) compared with the same months in 2011 (post-PBM) to determine which changes in practice decreased RBC utilization. Indications for transfusion of nonsurgical patients were collected from the electronic medical records, while surgical indications were assigned to the admitting physician's specialty. Pre-PBM, we transfused 19,888 RBC units for a mean of 0.96 units per patient discharged, compared with 14,472 post-PBM, for a mean of 0.55 units per discharge. This represents a 43% reduction in RBC units transfused per patient discharged. While transfusion episodes decreased only slightly from 9519 to 9261, the success can be explained by the overall reduction in mean number of units per transfusion from 2 to 1.5 (p < 0.0001). Pre-PBM, 22 and 48% of patients received 1 or 2 units of RBCs per transfusion episode, respectively, while in 2011, the percentages were 51 and 33%, respectively (p < 0.0001). The mean number of RBC units per transfusion decreased significantly for approximately 50% of the indications. Our success was achieved through hospital-wide physician buy-in toward a restrictive transfusion approach. We hope to encourage others to consider PBM for improved patient outcomes and blood conservation.

Mirabegron in overactive bladder: A review of efficacy, safety, and tolerability

Mirabegron, the first β3 -adrenoceptor agonist to enter clinical practice, has a different mechanism of action from antimuscarinic agents. This review presents data on the efficacy, safety, and tolerability of mirabegron in studies conducted to date. All clinical data on mirabegron that are currently in the public domain are included, including some in-press manuscripts. In Phase III clinical trials in patients with overactive bladder (OAB), mirabegron at daily doses of 25, 50, and 100 mg demonstrated significant efficacy in treating the symptoms of OAB, including micturition frequency, urgency incontinence, and urgency. Significant improvements in micturition frequency, urgency incontinence, and mean volume voided/micturition were seen as early as the first assessment (week 4) for mirabegron 50 and 100 mg, and were maintained throughout treatment. Responder analyses showed a significant improvement with mirabegron 50 and 100 mg in terms of dry rates, ≥50% reduction in mean number of incontinence episodes/24 hr, and the proportion of patients with ≤8 micturitions/24 hr at final visit. The benefit of mirabegron 50 and 100 mg was also evident in patients ≥65 years of age, and in both treatment-naïve patients and those who previously discontinued antimuscarinic therapy. These data therefore demonstrate a clinically meaningful benefit with mirabegron in the objective endpoints of OAB. Assessment of measures of health-related quality of life and treatment satisfaction showed that patients perceived treatment with mirabegron as meaningful. In OAB clinical trials of up to 12 months mirabegron appeared to be well tolerated. The most common adverse events (AEs) observed with mirabegron in clinical trials of up to 12 months were hypertension, nasopharyngitis, and urinary tract infection. The incidence of dry mouth was similar to placebo, and was between three and fivefold less than for tolterodine extended release 4 mg. Since dry mouth is the most bothersome AE associated with antimuscarinic drugs and often a reason for treatment discontinuation, mirabegron may be a valuable treatment option for these patients. In Phase III clinical trials, mirabegron at daily doses of 25, 50, and 100 mg demonstrated significant efficacy in treating symptoms of OAB and, at doses of 50 and 100 mg, demonstrated significant improvements versus placebo on key secondary endpoints, as early as the first assessment (week 4), and these were maintained throughout treatment. In OAB clinical trials of up to 12 months, mirabegron appeared to be well tolerated.

FRI0368 GOUT flare prevention with rilonacept in patients with TOPHI and/or polyarticular disease who initiate uric acid-lowering therapy

BackgroundPatients (pts) with visible tophi and/or polyarticular disease (T/PD) may be at greater risk of gout flares (GFs) when initiating uric acid-lowering therapy (ULT).ObjectivesTo determine the risk presented by T/PD...

PTH-049 Sub-Optimal Bowel Preparation in the Surveillance Population - what Does it Mean?

IntroductionModern colonoscopic surveillance follows clear evidence based guidelines, and clinical decisions appear straight forward. However, the guidelines do not define what should be done in cases with sub-optimal preparation.MethodsWe retrospectively...

Individualized Medication Assessment and Planning: Optimizing Medication Use in Older Adults in the Primary Care Setting

To test the feasibility and effectiveness of an individualized Medication Assessment and Planning (iMAP) program integrated within a primary care practice on the number and prevalence of medication-related problems (MRPs) and acute health services utilization, defined as combined hospitalizations and emergency department visits. Six-month, prospective, observational pilot study. Community-based primary care medical practice. Convenience sample of 64 patients aged 65years and older who were taking at least five medications. Each patient was enrolled in the iMAP program-a collaborative, multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6months as part of routine clinical care. MRPs were assessed and recommendations proposed using the previously published MRP classification tool; physician acceptance of recommendations served to validate the assessments. There was a significant reduction in mean number of MRPs/patient (4.2 at baseline vs 1.0 at 6mo, p<0.0001) when adjusted for number of medications, race, and pharmacist. The prevalence of MRPs at 6months compared with baseline was also significant (p<0.0008). Acute health services utilization was assessed by medical record abstraction. The 64 patients experienced a rate of 8.3 events/100 person-months (64 total events) during the 12-month prestudy period. During the 6-month study period, the same patients experienced 5.4 events/100 person-months (20 total events). Thus, we noted a reduction in acute health services utilization of 35%. Physicians were enthusiastically supportive of iMAP. iMAP has the potential to address a significant and timely issue affecting older adults and primary care practices: the burden of managing and continuously monitoring multiple medications in medically complex older adults. A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit.

Effect of post‐teneral diets on the performance of sterileAnastrepha ludensandAnastrepha obliquafruit flies

AbstractThe effect of post‐teneral diets on the mating performance, pheromone production and longevity of sterileAnastrepha ludensandAnastrepha obliquafruit flies (Diptera: Tephritidae) was investigated. Enriched pre‐release diets improved male mating performance. Wild and sterile males fed on mango and orange fruits achieved the greatest copulatory success, followed by those fed on a 3 : 1 sugar : yeast (SY) diet. Males fed only on a sugar diet achieved the lowest number of matings. The mean numbers of copulas achieved by wild males were significantly higher than those by sterile males fed on a sugar‐only diet, while there were no significant differences between wild males and sterile males fed on yeast diets. There was a trend of reduced mean number of copulas as the proportion of yeast was reduced in the diet, but differences were not significant. Pre‐release diets had a significant effect on pheromone production. Males fed on a 3 : 1 SY diet produced the greatest amount of the three main pheromone components inA. ludensmales and two major components inA. obliquamales, followed by males fed on fruits or pasteurized fruit juice. Males fed on a sugar only diet produced the lowest amounts. The longevity response to post‐teneral diets was complex. The most yeast‐rich diet and the poorest diet (sugar only) resulted in the lowest life expectancies. Flies fed on 24 : 1 SY diets showed the highest life expectancies for both males and females of the two species. Considering the tradeoffs between mating performance and longevity, the 24 : 1 SY diet would be recommended for programmes integrating the sterile insect technique, but the effects of these diets on field survival and dispersal still need to be investigated.

Gender difference in efficacy and dose response in Japanese patients with nocturia treated with four different doses of desmopressin orally disintegrating tablet in a randomized, placebo‐controlled trial

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Desmopressin orally disintegrating tablet (ODT) 60-240 μg has proved an effective and well-tolerated antidiuretic treatment in male and female patients with nocturia. The main adverse event is hyponatraemia. Recent studies suggest that female patients are more sensitive to desmopressin ODT, achieving the same efficacy at lower doses than male patients. The study demonstrates the efficacy of desmopressin ODT in male and female Japanese patients with nocturia. It provides further evidence that the optimum desmopressin dose for the treatment of nocturia is lower in females than in males. Tailoring the dose according to gender provides an improved therapeutic window with the benefits of a decreased risk of hyponatraemia without compromising efficacy. To establish the dose-response efficacy of desmopressin in a Japanese patient population for the treatment of nocturia. To explore gender differences in sensitivity to desmopressin in Japanese patients with nocturia. A phase II multicentre, randomized, placebo-controlled, double-blind, parallel-group, comparative clinical trial was conducted. Subjects aged 55-75 years, with a mean of ≥2 voids per night, were included and randomized to receive placebo or one of four doses of desmopressin orally disintegrating tablet (ODT): 10 μg, 25 μg, 50 μg or 100 μg. The dose-response relationship of pharmacodynamic variables measured after a single dose of desmopressin administered to water-loaded subjects (treatment period 1) was compared with the primary clinical endpoint of change from baseline in mean number of nocturnal voids, after 28 days of desmopressin treatment (treatment period 2). A total of 116 patients were treated in treatment period 1 of whom 113 qualified for treatment period 2, and 111 completed the study. In treatment period 1 a dose-response relationship was observed, both overall and in each gender group. Overall, the duration of antidiuretic action (DOA; time with urine osmolality >200 mOsm/kg) for the 25, 50 and 100 μg doses was 2 h (P = 0.010), 3.45 h (P < 0.001) and 5.74 h (P < 0.001), respectively; all statistically significant compared with placebo. Female patients were found to be more sensitive to desmopressin; DOA in female patients was longer than in male patients after desmopressin 25 and 50 μg. Extrapolation suggests that male patients require ∼58 μg to achieve similar DOA to females receiving 25 μg. A dose-response relationship was also seen in treatment period 2 for the group overall with a greater reduction in mean number of nocturnal voids from baseline to day 28 at higher doses, and with significant reductions in the 25- (P = 0.015) 50- (P < 0.001) and 100-μg (P = 0.001) dose groups compared with placebo. Similar dose-response relationships were also seen when the data were analysed by gender. Desmopressin ODT was well tolerated with no serious or severe adverse events. A dose-response relationship for desmopressin ODT was shown in a population of Japanese patients with nocturia. The study suggests that the optimum desmopressin dose for the treatment of nocturia is lower in females than in males, indicating a gender-specific therapeutic window with a decreased risk of hyponatraemia without compromising efficacy on reduction of nocturnal voids. Further dose-finding studies are planned to confirm the recommended dose for the treatment of nocturia in a Japanese patient population.

OC-065 Targeted inhibition of tissue factor and thrombin on CD31 expressing cells suppresses hepatic fibrosis in CCl4 treated mice

IntroductionRecent evidence suggests a role for the coagulation cascade in promoting liver fibrosis. However, the cellular basis for this relationship is unclear. In order to explore this relationship we employed...

390 TARGETED INHIBITION OF TISSUE FACTOR AND THROMBIN ON CD31 EXPRESSING CELLS SUPPRESSES HEPATIC FIBROSIS IN CCL4 TREATED MICE

Introduction Recent evidence suggests a role for the coagulation cascade in promoting liver fibrosis. However, the cellular basis for this relationship is unclear. In order to explore this relationship we employed two unique transgenic mice strains expressing membrane–tethered tissue factor pathway inhibitor (TFPI) or hirudin (anti-thrombin) fusion proteins driven by a CD31 promoter. These strains allow for the selective inhibition of tissue factor (TF) or thrombin on endothelial cells, monocytes and platelets expressing CD31. Aims To evaluate the impact of the targeted inhibition of tissue factor and thrombin on effector cells of liver fibrosis in murine hepatic fibrosis induced by CCl 4 . Methods Liver fibrosis was induced in CD31-TFPI, CD31-Hirudin and wild type control mice with 4 weeks carbon tetrachloride (CCl 4 ) administered by intraperitoneal injection. Animals were culled and livers extracted for histological and biochemical analysis. Fibrosis was scored using a four point semi-quantitative system and quantified by digital image analysis to determine percentage area of fibrosis. Immunohistochemistry to determine α-SMA expression, a marker of hepatic stellate cell activation was performed and the mean number of activated stellate cells was quantified per high power field. Results The percentage area of fibrosis was significantly less in CD31-TFPI (1.89%±0.26, p=0.001) and CD31-Hirudin mice (1.04%±0.16, p=0.00003) in comparison to control mice (3.66%±0.39). Semiquantitative fibrosis scoring showed a significant difference between the CD31-TFPI (median 2/4) and CD31-Hirudin (median 3/4) mice in comparison with control mice (median 3/4, p=0.009) but the difference between the two transgenic strains was not significant. Both transgenic strains demonstrated a significantly reduced mean number of α-SMA stellate cells per high power field in comparison to control mice (CD31-TFPI vs control, 7.4 vs 29.4, p=0.0002; CD31-hirudin vs control, 5.25 vs 29.4, p=0.0002). Conclusion CD31 targeted inhibition of TF and thrombin significantly reduces liver fibrosis and stellate cell activation in a murine CCl 4 model. The data supports the use of this novel murine model as a tool for investigating the cellular biology of the role of coagulation in liver fibrogenesis. It will also provide information for developing new treatments of human liver fibrosis. Competing interests None declared.

Reduction in Healthcare and Societal Resource Utilization Associated with Cladribine Tablets in Patients with Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis (MS) is a common, chronic, neurodegenerative condition associated with substantial healthcare and societal economic burden. Disease-modifying MS treatments have the potential to reduce health resource utilization (HRU), thereby reducing the attendant socioeconomic burden. This study aimed to compare health and societal resource use and productivity in patients with relapsing-remitting MS (RRMS) receiving cladribine tablets versus placebo over 96 weeks in the CLARITY study. The CLARITY study was a 96-week, randomized, double-blind, placebo-controlled study in patients with RRMS. HRU data, societal resource use and productivity data were collected at baseline and during scheduled patient visits, at 6-month intervals. The recall period for the HRU questionnaire was 3 months. The study was carried out at 155 sites across 32 countries worldwide. The intent-to-treat population comprised 1326 patients with RRMS randomized to cladribine 3.5 mg/kg (n = 433) or 5.25 mg/kg (n = 456) tablets or placebo (n = 437). Patient subgroups with high baseline disease activity were identified based on criteria of ≥2 relapses in the previous year (n = 392); ≥1 T1 gadolinium-enhancing (Gd+) lesion (n = 413); and ≥2 relapses in the previous year plus ≥1 T1 Gd+ lesion (n = 138). Cladribine tablets were administered in two (3.5 mg/kg group) or four (5.25 mg/kg group) short courses given at 4-week intervals at the start of a 48-week treatment period, followed by another two courses at the start of a subsequent 48-week re-treatment period. Interferon-β rescue therapy was permitted from week 24. Intravenous corticosteroids were available for the treatment of neurological relapses. HRU outcomes included mean number of hospital days and emergency room (ER), clinic and home visits during each study period. Societal resource use and productivity outcomes included mean number of hours and days of paid assistance, mean patient and carer work days missed, and self-reported productivity. The mean number of hospital days per patient over 96 weeks was lower in the cladribine tablets groups (3.5 mg/kg group: -3.19 days; 5.25 mg/kg group: -1.54 days [both p < 0.01]) versus placebo. Likewise the mean number of ER visits was lower in both cladribine tablet groups compared with placebo (3.5 mg/kg group: -0.09 visits; 5.25 mg/kg group: -0.11 visits [both p < 0.01]), and the mean number of clinic visits was also lower in both cladribine tablet groups (3.5 mg/kg group: -0.68 visits; 5.25 mg/kg group: -0.66 visits [both p = 0.01]). Furthermore, treatment with cladribine tablets was associated with reduced mean numbers of missed work days for patients (3.5 mg/kg group: -2.42 days [p < 0.01]; 5.25 mg/kg group: -0.60 days [p = 0.50]). Corticosteroid use was lower amongst patients in the cladribine tablet groups than in the placebo group. The reduction in hospital days following treatment with cladribine tablets was also observed in patients with high disease activity at study baseline. This study provides evidence that the efficacy of cladribine tablets observed during the CLARITY study was associated with a reduced consumption of healthcare resources and a decreased need for medical and societal support. ClinicalTrials.gov identifier: NCT00213135; EudraCT number: 2004-005148-28.

Phase III dose‐comparison study of glatiramer acetate for multiple sclerosis

To evaluate the safety, tolerability, and efficacy of glatiramer acetate (GA) 40 mg compared to a 20mg dose. Patients with multiple sclerosis (MS) with ≥ 1 documented relapse in 12 months prior to screening, or ≥ 2 documented relapses in 24 months prior to screening, and Expanded Disability Status Scale (EDSS) score 0 to 5.5 were enrolled. Patients were evaluated at screening, baseline, and at months 1, 2, 3, 6, 9, and 12. Primary endpoint was rate of confirmed relapses observed during 12-month study. Analysis was by intent-to-treat. A total of 1,155 patients randomized to GA 20 mg (n = 586) or 40 mg (n = 569). The groups were well-matched at baseline on demographic, clinical, and magnetic resonance imaging (MRI) characteristics. The primary endpoint was similar in both groups (relative risk [RR] = 1.07; 95% confidence interval [CI], 0.88-1.31; p = 0.486) with mean annualized relapse rates (ARRs) of 0.33 for the 20 mg group, 0.35 for the 40 mg group, and 0.27 for patients from both groups who completed the entire 1-year treatment. A total of 77% of patients remained relapse-free in both groups. Both groups showed a reduction in mean number of gadolinium-enhancing and new T2 lesions over time with trend for faster reduction in the first trimester with the 40 mg dose compared with 20 mg dose. Both doses were well-tolerated with a safety profile similar to that observed in previous studies of 20 mg GA. In relapsing-remitting MS patients, both the currently-approved GA 20 mg and 40 mg doses were safe and well-tolerated, with no gain in efficacy for the higher dose.

Rifaximin Improves Psychometric Performance and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy (The RIME Trial)

Cirrhotics with minimal hepatic encephalopathy (MHE) have a poor health-related quality of life (HRQOL). Treatment of MHE is still evolving. The aim of this double-blind randomized pilot study was to assess the efficacy of rifaximin in improving neuropsychometric (NP) test performance and HRQOL in patients with MHE. MHE was diagnosed if any two NP tests (number and figure connection tests, picture completion, digit symbol, and block design tests) were deranged beyond 2 s.d. of normal. HRQOL was assessed using the sickness impact profile (SIP) questionnaire. A total of 486 patients with cirrhosis were screened and 284 were found eligible. Out of these 115 (40.9%) had MHE, of which 21 refused consent and 94 were randomized to receive placebo (n=45) and rifaximin (n=49; 1200 mg/day) for 8 weeks. At the end of treatment, significantly more number of patients in rifaximin group showed reversal of MHE (75.5% (37/49) vs. 20% (9/45) in placebo group; P<0.0001). Rifaximin group also showed significant reduction in mean number of abnormal NP tests (baseline, 2.35 (95% confidence interval (CI), 2.17-2.53); 2 weeks, 1.29 (95% CI, 1.02-1.56), P=0.002; 8 weeks, 0.81 (95% CI, 0.61-1.02), P=0.000), compared with placebo group (baseline, 2.31 (95% CI, 2.03-2.59); 2 weeks, 2.03 (95% CI, 1.74-2.31); 8 weeks, 1.97 (95% CI, 1.69-2.25), P>0.05). The mean total SIP score also improved significantly in rifaximin group (baseline, 11.67 (95% CI, 10.31-13.03); 8 weeks, 6.45 (95% CI, 5.59-7.30); P=0.000) compared with placebo group (baseline, 9.86 (95% CI, 8.66-11.06); 8 weeks, 8.51 (95% CI, 7.35-9.67); P=0.82). Improvement in HRQOL correlated with improvement in NP tests. Rifaximin was well tolerated. Rifaximin significantly improves both cognitive functions and HRQOL in patients with MHE.

Relative oral health outcome trends between people inside and outside capital city areas of Australia

The aim of this study was to evaluate relative change over 17 years in clinical oral health outcomes inside and outside capital city areas of Australia. Using data from the National Oral Health Survey of Australia 1987-88 and the National Survey of Adult Oral Health 2004-06, relative trends in clinical oral health outcomes inside and outside capital city areas were measured by age and gender standardized changes in the percentage of edentate people and dentate adults with less than 21 teeth, in mean numbers of decayed, missing and filled teeth, and mean DMFT index. There were similar reductions inside and outside capital city areas in the percentage of edentate people (capital city 63.7%, outside capital city 60.7%) and dentate people with less than 21 teeth (52.5%, 50.1%), in the mean number of missing teeth (34.3%, 34.5%), filled teeth (0.0%, increase of 5.5%), and mean DMFT index (21.2%, 19.2%). The reduction in mean number of decayed teeth was greater in capital city areas (78.0%) than outside capital city areas (50.0%). Trends in four of the five clinical oral health outcomes demonstrated improvements in oral health that were of a similar magnitude inside and outside capital city areas of Australia.

BAS/BSCR52 Investigating the importance of heparan sulphate in determining endothelial progenitor cell function

The increased risk of cardiovascular disease with age may, in part, be due to a decline in the function of endothelial progenitor cells (EPCs). Cell surface heparan sulphate proteoglycans (HSPGs)...

Rifaximin Improves Cognitive Functions and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial (The RIME Trial)

Rifaximin Improves Cognitive Functions and Health-Related Quality of Life in Patients With Minimal Hepatic Encephalopathy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial (The RIME Trial)

Randomized comparison of long-term desmopressin and alarm treatment for bedwetting

To compare the efficacy of long-term primary nocturnal enuresis (PNE) treatment using desmopressin versus enuresis alarm. A 6-month randomized trial was performed with patients from 29 enuresis clinics: 251 patients ≥ 5 years in age with severe PNE (mean 5.5-5.6 wet nights/week) were randomized to desmopressin (0.2-0.4 mg daily) or alarm. Efficacy was assessed by percentage reduction in mean number of wet nights/week; patients achieving dryness, mean initial duration of sleep and compliance were evaluated. Efficacy analyses were performed using the intent-to-treat population (all patients) and excluding patients who withdrew; 12-month follow-up data were collected. Data could not be evaluated for the 32% of alarm patients and 7% of desmopressin patients who withdrew early. In intent-to-treat analyses, a similar proportion of patients across groups showed a ≥ 50% reduction in wet nights/week (desmopressin: 37.5%, alarm: 32.2%) and achieved dryness (desmopressin: 32%, alarm: 37%). Compliance was higher with desmopressin: 95-98% of patients took >75% of tablets; 50-78% used alarm >75% of nights. Initial sleep duration was 1.02 h longer at the end of treatment with desmopressin (95% CI: 0.045, 1.99). Desmopressin and alarm demonstrated comparable efficacy in the treatment of PNE. Withdrawal from the alarm group was high, indicating the importance of considering family motivation before selecting treatment, for optimal outcome.

Efficacy of Tree Trunk Coating Materials in the Control of the Apple Clearwing,Synanthedon myopaeformis

The efficacy of trunk treatment with three materials, cotton seed oil, lime and used motor oil, were evaluated for the control of apple clearwing, Synanthedon myopaeformis (Borkhausen) (Lepidoptera: Sesiidae) in an apple orchard during two successive years (2004 and 2005). The weekly total number of adult catches and exuviae was recorded each year. No treatments caused significant reductions in mean numbers of adults caught in bait traps or the exuviae protruding from the barks of tree trunks and thick branches in the first year of the study whereas all of them differed significantly from each other or from water-treated control in the second year (P < 0.05). A comparison of the mean numbers of adult catches and exuviae in both years revealed significant differences between the used motor oil and cotton seed oil treatments (P < 0.05). The lime treatments in both years significantly differed in terms of adult catches, but not exuviae (P<0.05). In the second year, compared with those in water-treated control plots, the mean number of adult catches and exuviae decreased by 81.3% and 88.3% in the used motor oil-treated plots, and by 70.8% and 83.3% in the cotton seed oil-treated plots, respectively. Although population reductions in the lime treatment were significant in the second year, the effect was at a much reduced level in comparison to the two oil treatments. The overall results suggest that used motor oil and cotton seed oil may have potential for the control of apple clearwing.

Topiramate intervention to prevent transformation of episodic migraine: The topiramate INTREPID study

The study sought to evaluate whether topiramate prevents development of chronic daily headache (CDH, ≥15 headache days per month) in adult subjects with high-frequency episodic migraine (HFEM, 9-14 migraine headache days/month). A secondary objective was to assess the efficacy of topiramate as preventive migraine treatment in this population. This was a multicenter, randomized, double-blind, placebo-controlled study comparing topiramate 100 mg/day and placebo for 26 weeks. The primary efficacy variable was new-onset CDH at month 6. Secondary efficacy measures included migraine and headache days. Adverse events (AEs) were evaluated. A total of 159 topiramate subjects and 171 placebo subjects were efficacy-evaluable. At month 6, 1.4% of topiramate subjects versus 2.3% of placebo subjects had CDH (p = .589). Compared with placebo, topiramate treatment was associated with statistically significant reductions in mean number of migraine days (6.6 vs. 5.3/28 days; p = .001) and headache days (6.6 vs 5.3/28 days; p = .001). Most commonly reported AEs in the topiramate versus placebo group included paresthesia (32.4% vs. 7.0%), fatigue (14.8% vs. 8.6%), dizziness (11.4% vs. 7.6%) and nausea (10.8% vs. 9.2%). Topiramate 100 mg/day did not prevent the development of CDH at six months in subjects with HFEM. Topiramate was effective in reducing headache days and migraine headache days and generally well tolerated.

Viscogonioplasty in narrow angle glaucoma: a randomized controlled trial

Purpose:To determine the effect of viscogonioplasty and cataract extraction on intraocular pressure in patients with narrow angle glaucoma.Methods:This was a double-masked randomized controlled trial involving 50 eyes (25 cases and 25 controls) from 38 consecutive patients. All patients underwent phacoemulsification with or without viscogonioplasty. The main outcome measures were intraocular pressure post-treatment and number of glaucoma medications post-treatment.Results:Cases had a greater reduction in intraocular pressure than controls, with a mean intraocular pressure (standard deviation) at 12 months of 13.7 (±2.89) mmHg compared with 16.2 (±3.55) mmHg in controls (P = 0.009). Cases had a greater reduction in mean number of antiglaucoma medications than controls at 12-month review, with 13 of 25 eyes (52%) of cases controlled without any antiglaucoma therapy versus 9 of 25 (36%) of the controls (P = 0.005).Conclusions:Viscogonioplasty combined with cataract extraction has a significantly greater effect than cataract extraction alone on lowering intraocular pressure in patients with poorly controlled narrow angle glaucoma and should therefore be considered as a treatment option for patients with this condition.