Searching a biomedical database from Bulgaria : the ABS database

The University of Sofia, Bulgaria, disseminates local biomedical literature (1994 to present) through a free online database, ABS. We systematically searched ABS to identify citations to controlled trials and find what proportion of these studies are to be found on MEDLINE. We searched using Bulgarian and English phrases; manually selected citations of controlled trials and sought these citations on MEDLINE. Using the two languages we found a total of 628 unique citations, of which 47 of which seem to be relevant controlled trials (precision 7.48%, 13% of ABS citations were found on MEDLINE). The trials in ABS commonly focused on evaluation of care for people with cardiovascular or urological problems

Searching a biomedical database from Bulgaria : the ABS database

The University of Sofia, Bulgaria, disseminates local biomedical literature (1994 to present) through a free online database, ABS. We systematically searched ABS to identify citations to controlled trials and find what proportion of these studies are to be found on MEDLINE. We searched using Bulgarian and English phrases; manually selected citations of controlled trials and sought these citations on MEDLINE. Using the two languages we found a total of 628 unique citations, of which 47 of which seem to be relevant controlled trials (precision 7.48%, 13% of ABS citations were found on MEDLINE). The trials in ABS commonly focused on evaluation of care for people with cardiovascular or urological problems

Effect of broodstock holding environment on egg quality in farmed brown trout (Salmo trutta)

Brown trout (Salmo trutta) broodstock from a single population were separated prior to spawning and exposed to two different holding environments: a ‘raceway system’ and a ‘tank system’. Eggs were stripped from females and 13 measures of egg quality were collected, analysed individually, combined by principle components analysis into an integrated egg quality score which was validated against egg survival. The multivariate egg quality score (PC1) differed for fish held in the tank and raceway systems. Egg survival, chorion breaking strength and chorion Se concentrations were higher in eggs produced by broodstock held in the tank system compared to those in the raceway system. In contrast, chorion concentrations of P and K were higher in eggs from fish held in the raceway system. The results suggest that brown trout broodstock reared in tank systems produced higher quality eggs compared to trout reared in raceways. Finally, this study also indicates that multivariate statistical analysis can be used to determine egg quality from multiple egg parameters

Determining trophic niche width: a novel approach using stable isotope analysis

1. Although conceptually robust, it has proven difficult to find practical measures of niche width that are simple to obtain, yet provide an adequate descriptor of the ecological position of the population examined. 2. Trophic niche has proven more tractable than other niche dimensions. However, indices used as a proxy for trophic niche width often suffer from the following difficulties. Such indices rarely lie along a single scale making comparisons between populations or species difficult; have difficulty in combining dietary prey diversity and evenness in an ecologically meaningful way; and fail to integrate diet over ecological time-scales thus usually only comprise single snapshots of niche width. 3. We propose an alternative novel method for the comparison of trophic niche width: the use of variance of tissue stable isotope ratios, especially those of nitrogen and carbon. 4. This approach is a potentially powerful method of measuring trophic niche width, particularly if combined with conventional approaches, because: it provides a single measure on a continuous axis that is common to all species; it integrates information on only assimilated prey over time; the integration period changes with choice of tissue sampled; and data production is theoretically fast and testing among populations simple. 5. Empirical studies are now required to test the benefits of using isotopic variance as a measure of niche width, and in doing so help refine this approach

Randomised trials relevant to mental health conducted in low and middle-income countries: protocol for a survey of studies published in 1991, 1995 and 2000 and assessment of their relevance

BACKGROUND A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations. Despite this, relatively little is known about the quality and content of clinical research undertaken in these countries, or the relevance of the interventions evaluated and specifically that of randomised trials. This project aims to survey the content, quality and accessibility of a sample of trials relevant to mental health conducted within low and middle-income countries; to compare these with studies conducted in high-income countries; and to assess their relevance for the needs of low and middle-income countries. METHODS An extensive search for all trials, or possible trials, published in 1991, 1995 and 2000 with participants in low and middle-income countries has already been conducted. Studies evaluating prevention or treatment of a mental health problem within these three years will be identified and further searches conducted to assess completeness of the initial search. Data on study quality and characteristics will be extracted from each report. Accessibility will be estimated based on whether each citation is available on MEDLINE. Trials relevant to schizophrenia will be compared with a random sample of schizophrenia trials from high-income countries in the same years. Topics covered by the trials will be compared with the estimated burden of disease. CONCLUSION Trials and systematic reviews of trials are the gold standard of evaluation of care and increasingly provide the basis for recommendations to clinicians, to providers of care and to policy makers. Results from this study will present the first assessment of the scope, quality and accessibility of mental health trials in low and middle-income countries

The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) prisons project pilot study: protocol for a randomised controlled trial comparing dihydrocodeine and buprenorphine for opiate detoxification

Background In the United Kingdom (UK), there is an extensive market for the class 'A' drug heroin. Many heroin users spend time in prison. People addicted to heroin often require prescribed medication when attempting to cease their drug use. The most commonly used detoxification agents in UK prisons are buprenorphine, dihydrocodeine and methadone. However, national guidelines do not state a detoxification drug of choice. Indeed, there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons. This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons. Methods/Design The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) Prisons Pilot Study will use randomised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification, given in the context of routine care, within HMP Leeds. Prisoners who are eligible and give informed consent will be entered into the trial. The primary outcome measure will be abstinence status at five days post detoxification, as determined by a urine test. Secondary outcomes during the detoxification and then at one, three and six months post detoxification will be recorded

Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro-Brazil: a prevalence study

The medical management of aggressive and violent behaviour is a critical situation for which there is little evidence. In order to prepare for a randomised trial, due to start in the psychiatric emergency rooms of Rio de Janeiro in 2001, a survey of current practice was necessary. A seven day survey of pharmacological management of aggressive people with psychosis in the emergency rooms of all four public psychiatric hospitals in Rio de Janeiro, Brazil. In one hospital data were not available. Of the 764 people with psychosis attending these ERs, 74 were given IM medication for rapid tranquillisation (9.7%, 2.1/week/100,000). A haloperidol-promethazine mix (with or without other drugs) was used for the majority of patients (83%). The haloperidol-promethazine mix, given intramuscularly for rapid tranquilization, is prevalent in Rio, where it is considered both safe and efficient. However, scientific evaluation of all pharmacological approaches to rapid tranquilization of psychotic people is inadequate or incomplete and a randomized trial of IM haloperidol-promethazine is overdue

Calcium channel blockers for antipsychotic-induced tardive dyskinesia (review)

BackgroundSchizophrenia and related disorders affect a sizable proportion of any population. Antipsychotic medications are the primary treatment for these disorders. Antipsychotic medications are associated with a variety of adverse effects including tardive dyskinesia. Dyskinesia is a disfiguring movement disorder of the orofacial region that can be tardive (having a slow or belated onset). Tardive dyskinesia is difficult to treat, despite experimentation with several treatments. Calcium channel blockers (diltiazem, nifedipine, nimodipine, verapamil, flunarizine) have been among these experimental treatments. ObjectivesTo determine the effects of calcium channel blocker drugs (diltiazem, nifedipine, nimodipine, verapamil) for treatment of neuroleptic‐induced tardive dyskinesia in people with schizophrenia, schizoaffective disorder or other chronic mental illnesses. Search methodsWe searched the Cochrane Schizophrenia Group Trials Register (July 2015 and April 2017), inspected references of all identified studies for further trials and contacted authors of trials for additional information. Selection criteriaWe selected randomised controlled trials comparing calcium channel blockers with placebo, no intervention or any other intervention for people with both tardive dyskinesia and schizophrenia or serious mental illness who remained on their antipsychotic medication. Data collection and analysisWe independently extracted data and estimated risk ratios of dichotomous data or mean differences (MD) of continuous data, with 95% confidence intervals (CI). We assumed that people who left the trials early had no improvement. We also created a 'Summary of findings' table using GRADE. Main resultsPrevious versions of this review included no trials. From the 2015 search, we identified three cross‐over trials that could be included. The 2017 search found no new studies relevant to this review. The included trials randomised 47 inpatients with chronic mental illnesses in the USA and China. Trials were published in the 1990s and were of short duration (six to 10 weeks). Overall, the risk of bias was unclear, mainly due to poor reporting; allocation concealment was not described, generation of the sequence was not explicit, studies were not clearly blinded, and attrition and outcome data were not fully reported. Findings were sparse, no study reported on the primary outcome 'no clinically important improvement in tardive dyskinesia symptoms,' but two small studies (37 participants) found no difference on the tardive dyskinesia symptoms scale Abnormal Involuntary Movement Scale (AIMS) scores between diltiazem or flunarizine and placebo after three to four weeks' treatment (MD ‐0.71, 95% CI ‐2.68 to 1.26, very low quality evidence). Only one study randomising 20 participants reported on adverse events, and reported that there were no adverse events with flunarizine or with placebo (very low quality evidence). One study with 18 participants reported no events of deterioration in mental state with diltiazem or with placebo (very low quality evidence). No studies reported on acceptability of treatment or on social confidence, social inclusion, social networks or personalised quality of life outcomes designated important to patients. Authors' conclusionsAvailable evidence from randomised controlled trials is extremely limited and very low quality, conclusions cannot be drawn. The effects of calcium channel blockers for antipsychotic‐induced tardive dyskinesia are unknown. Their use is experimental and should only be given in the context of well‐designed randomised trials

Rispridone for psychosis-induced aggression or agitation (rapid tranquilisation) (review)

BackgroundAggressive, agitated or violent behaviour due to psychosis constitutes an emergency psychiatric treatment where fast‐acting interventions are required. Risperidone is a widely accessible antipsychotic that can be used to manage psychosis‐induced aggression or agitation. ObjectivesTo examine whether oral risperidone alone is an effective treatment for psychosis‐induced aggression or agitation. Search methodsWe searched the Cochrane Schizophrenia Group's Study‐Based Register of Trials (up to April 2017); this register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records into the register. Selection criteriaRandomised controlled trials (RCTs) comparing rapid use of risperidone and other drugs, combinations of drugs or placebo for people exhibiting aggression or agitation (or both) thought to be due to psychosis. Data collection and analysisWe independently inspected all citations from searches, identified relevant abstracts, and independently extracted data from all included studies. For binary data we calculated risk ratio (RR) and for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CI) and used a fixed‐effect model. We assessed risk of bias for the included studies and used the GRADE approach to produce a ’Summary of findings’ tables. Main resultsThe review now contains data from nine trials (total n = 582) reporting on five comparisons. Due to risk of bias, small size of trials, indirectness of outcome measures and a paucity of investigated and reported 'pragmatic' outcomes, evidence was graded as very‐low quality. None of the included studies provided useable data on our primary outcome 'tranquillisation or asleep' by 30 minutes, repeated need for tranquillisation or any economic outcomes. Data were available for our other main outcomes of agitation or aggression, needing restraint, and incidence of adverse effects. Risperidone versus haloperidol (up to 24 hours follow‐up) For the outcome, specific behaviour ‐ agitation, no clear difference was found between risperidone and haloperidol in terms of efficacy, measured as at least 50% reduction in the Positive and Negative Syndrome Scale ‐ Psychotic Agitation Sub‐score (PANSS‐PAS) (RR 1.04, 95% CI 0.86 to 1.26; participants = 124; studies = 1; very low‐quality evidence) and no effect was observed for need to use restraints (RR 2.00, 95% CI 0.43 to 9.21; participants = 28; studies = 1; very low‐quality evidence). Incidence of adverse effects was similar between treatment groups (RR 0.94, 95% CI 0.54 to 1.66; participants = 124; studies = 1; very low‐quality evidence). Risperidone versus olanzapine One small trial (n = 29) reported useable data for the comparison risperidone versus olanzapine. No effect was observed for agitation measured as PANSS‐PAS endpoint score at two hours (MD 2.50, 95% CI ‐2.46 to 7.46; very low‐quality evidence); need to use restraints at four days (RR 1.43, 95% CI 0.39 to 5.28; very‐low quality evidence); specific movement disorders measured as Behavioural Activity Rating Scale (BARS) endpoint score at four days (MD 0.20, 95% CI ‐0.43 to 0.83; very low‐quality evidence). Risperidone versus quetiapine One trial reported (n = 40) useable data for the comparison risperidone versus quetiapine. Aggression was measured using the Modified Overt Aggression Scale (MOAS) endpoint score at two weeks. A clear difference, favouring quetiapine was observed (MD 1.80, 95% CI 0.20 to 3.40; very‐low quality evidence). No evidence of a difference between treatment groups could be observed for incidence of akathisia after 24 hours (RR 1.67, 95% CI 0.46 to 6.06; very low‐quality evidence). Two participants allocated to risperidone and one allocated to quetiapine experienced myocardial ischaemia during the trial. Risperidone versus risperidone + oxcarbazepine One trial (n = 68) measured agitation using the Positive and Negative Syndrome Scale ‐ Excited Component.(PANSS‐EC) endpoint score and found a clear difference, favouring the combination treatment at one week (MD 2.70, 95% CI 0.42 to 4.98; very low‐quality evidence), but no effect was observed for global state using Clinical Global Impression ‐ Improvement (CGI‐I) endpoint score at one week (MD ‐0.20, 95% CI ‐0.61 to 0.21; very‐low quality evidence). Incidence of extrapyramidal symptoms after 24 hours was similar between treatment groups (RR 1.59, 95% CI 0.49 to 5.14; very‐low quality evidence). Risperidone versus risperidone + valproic acid Two trials compared risperidone with a combination of risperidone plus valproic acid. No clear differences between the treatment groups were observed for aggression (MOAS endpoint score at three days: MD 1.07, 95% CI ‐0.20 to 2.34; participants = 54; studies = 1; very low‐quality evidence) or incidence of akathisia after 24 hours: RR 0.75, 95% CI 0.28 to 2.03; participants = 122; studies = 2; very low‐quality evidence). Authors' conclusionsOverall, results for the main outcomes show no real effect for risperidone. The only data available for use in this review are from nine under‐sampled trials and the evidence available is of very low quality. This casts uncertainty on the role of risperidone in rapid tranquillisation for people with psychosis‐induced aggression. High‐quality pragmatic RCTs are feasible and are needed before clear recommendations can be drawn on the use of risperidone for psychosis‐induced aggression or agitation

Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine

OBJECTIVE: To compare two widely used drug treatments for people with aggression or agitation due to mental illness. DESIGN: Pragmatic, randomised clinical trial. SETTING: Three psychiatric emergency rooms in Rio de Janeiro, Brazil. SUBJECTS: 301 aggressive or agitated people. INTERVENTIONS: Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine. MAIN OUTCOME MEASURES: Patients tranquil or sedated at 20 minutes. Secondary outcomes: patients tranquil or asleep by 40, 60, and 120 minutes; restrained or given extra drugs within 2 hours; severe adverse events; another episode of agitation or aggression; needing extra visits from doctor during first 24 hours; overall antipsychotic load in first 24 hours; and not discharged by two weeks