Prior Elicitation and Bayesian Analysis of the Steroids for Corneal Ulcers Trial

PURPOSE: To elicit expert opinion on the use of adjunctive corticosteroid therapy in bacterial corneal ulcers. To perform a Bayesian analysis of the Steroids for Corneal Ulcers Trial (SCUT), using expert opinion as a prior probability. METHODS: The SCUT was a placebo-controlled trial assessing visual outcomes in patients receiving topical corticosteroids or placebo as adjunctive therapy for bacterial keratitis. Questionnaires were conducted at scientific meetings in India and North America to gauge expert consensus on the perceived benefit of corticosteroids as adjunct treatment. Bayesian analysis, using the questionnaire data as a prior probability and the primary outcome of SCUT as a likelihood, was performed. For comparison, an additional Bayesian analysis was performed using the results of the SCUT pilot study as a prior distribution. RESULTS: Indian respondents believed there to be a 1.21 Snellen line improvement, and North American respondents believed there to be a 1.24 line improvement with corticosteroid therapy. The SCUT primary outcome found a non-significant 0.09 Snellen line benefit with corticosteroid treatment. The results of the Bayesian analysis estimated a slightly greater benefit than did the SCUT primary analysis (0.19 lines verses 0.09 lines). CONCLUSION: Indian and North American experts had similar expectations on the effectiveness of corticosteroids in bacterial corneal ulcers; that corticosteroids would markedly improve visual outcomes. Bayesian analysis produced results very similar to those produced by the SCUT primary analysis. The similarity in result is likely due to the large sample size of SCUT and helps validate the results of SCUT

Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit

Objectives. To report on both the use and dosage of propofol, as a new intravenous (IV) conscious sedative agent, for anxious children referred to a specialist paediatric dentistry service. Setting. Paediatric Dentistry Unit, Glasgow Dental Hospital and School. Sample. Thirty-four children, 25 females and 9 males, mean age 12 years 10 months, with a mean weight of 54·6 kg (range 30–110 kg). Methods. Report from 34 patients receiving intravenous sedation for the first time in respect of weight dose and amount of treatment completed. Results. Thirty-two children successfully accepted operative dental care on their first visit, they received a mean total dose of 146·25 mg of propofol (range 10 mg to 356 mg); in relation to body weight, the mean was 2·5 mg/kg (range 0·2–5·4 mg/kg). The treatment that they received included fissure sealants, amalgam and adhesive restorations, root canal therapy and single and multiple extractions. Their sedation and recovery were uneventful. Conclusions. Sub-anaesthetic doses of propofol used for IV conscious sedation infusion facilitated operative dental treatment in anxious children