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OBJECTIVE: This article reviews and compares the tolerability profiles of atypical antipsychotics in adults with schizophrenia or bipolar disorder in randomized controlled trials (RCTs). METHODS: A systematic search of the BIOSIS, Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and PsycINFO databases was conducted for English-language papers and abstracts that reported RCTs comparing > or =2 atypical antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone) in the treatment of adult patients with schizophrenia or bipolar disorder. The search was completed in December 2007. A panel of 4 psychiatrists with expertise in the treatment of schizophrenia, schizoaffective disorder, or bipolar disorder identified potentially relevant outcomes that would reflect patients' subjective perception of adverse effects during treatment with antipsychotic medications. These outcomes were daily activities, anxiety or depression, bodily anxiety or restlessness, dizziness or nausea, extrapyramidal symptoms (EPS), sexual dysfunction, stiffness or tremor, tiredness or weakness, and weight gain. Data on these outcomes were extracted from relevant studies, and mixed treatment comparisons were conducted using Bayesian Markov Chain Monte Carlo simulation. Summary effect estimates (odds ratios [ORs] and 95% credible intervals [95% CrIs]) were calculated and reported in comparison with risperidone. RESULTS: The search identified 2963 potentially relevant publications, of which 50 provided data on 48 RCTs comparing > or =2 atypical antipsychotics. Outcomes that were statistically significant compared with risperi-done at the 5% level were decreased bodily anxiety or restlessness with quetiapine (OR = 0.506; 95% CrI = 0.290, 0.789), decreased EPS with quetiapine (OR = 0.441; 95% CrI = 0.129, 0.910), increased weight gain with olanzapine (OR = 2.139; 95% CrI = 1.764, 2.626), and decreased weight gain with ziprasidone (OR = 0.466; 95% CrI = 0.317, 0.657). CONCLUSION: The atypical antipsychotics had mixed tolerability profiles in this mixed treatment comparison, with some agents having significantly greater tolerability than others depending on the outcome assessed. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials are the most effective way to differentiate between the effects of competing interventions. However, head-to-head studies are unlikely to have been conducted for all competing interventions.Aim: Evaluation of different methodologies used to indirectly compare interventions based on meta analyses of randomised controlled trials.Methods: Systematic review of Cochrane Database of Systematic Reviews, Cochrane Methodology Register, EMBASE and MEDLINE for reports including meta analyses that contained an indirect comparison. Searching was completed in July 2007. No restriction was placed on language or year of publication.Results: Sixty-two papers identified contained indirect comparisons of treatments. Five different methodologies were employed: comparing point estimates (1/62); comparing 95% confidence intervals (26/62); performing statistical tests on summary estimates (8/62); indirect comparison using a single common comparator (20/62); and mixed treatment comparison (MTC) (7/62). The only methodologies that provide an estimate of the difference between the interventions under consideration and a measure of the uncertainty around that estimate are indirect comparison using a single common comparator and MTC. The MTC might have advantages over other approaches because it is not reliant on a single common comparator and can incorporate the results of direct and indirect comparisons into the analysis. Indirect comparisons require an underlying assumption of consistency of evidence. Utilising any of the methodologies when this assumption is not true can produce misleading results.Conclusions: Use of either indirect comparison using a common comparator or MTC provides estimates for use in decision making, with the preferred methodology being dependent on the available data. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the effectiveness of budesonide/formoterol using fixed dosing (BUD/FORM) with inhaled corticosteroid (ICS) alone or alternative ICS and long-acting beta(2)-agonist (LABA) regimens for adults with moderate/severe asthma. METHODS: BIOSIS, CENTRAL, EMBASE and MEDLINE were searched for abstracts and papers. All searching was completed in July 2006. No restriction was placed on language. Meta-analysis of randomised controlled trials (RCTs) using a fixed effects model. RCTs were included if the comparator with BUD/FORM had an equivalent daily dose of ICS at the start of the trial. The primary outcome measure was, 'treatment failure', defined as: asthma-related serious adverse event, oral glucocorticosteroid treatment, A&E visit and/or admission to hospital, withdrawal due to a need for additional asthma therapy. RESULTS: Of the 330 papers identified in the literature search, 15 met the inclusion criteria. The following alternative treatments were found: ICS alone (BUD), BUD/FORM adjustable maintenance dose (BUD/FORM-AMD), and salmeterol/fluticasone in a single inhaler (SALM/FP). Meta-analysis of treatment failure demonstrated a 50% increase with BUD versus BUD/FORM (Relative Risk [RR] 1.50, 95% confidence interval [95% CI]: 1.12-2.02, p = 0.007; 2 RCTs); a trend in favour of a reduction with BUD/FORM-AMD versus BUD/FORM (RR 0.88, 95% CI: 0.77-1.02, p = 0.09; 11 RCTs); and no evidence of a difference with SALM/FP versus BUD/FORM (RR 0.99, 95% CI: 0.83-1.16, p = 0.86; 3 RCTs). Significant heterogeneity was not detected in the primary analyses. Secondary analyses demonstrated the following significant differences: hospitalisations/A&E visits (49% increased risk with SALM/FP vs. BUD/FORM, RR 1.49, 95% CI: 1.07-2.08, p = 0.02, and 28% reduced risk with BUD/FORM-AMD vs. BUD/FORM, RR 0.72, 95% CI: 0.52-0.99, p = 0.04); and use of oral steroids (51% increase in risk with BUD vs. BUD/FORM, RR 1.51, 95% CI: 1.10-2.09, p = 0.01, and 19% reduced risk with BUD/FORM-AMD vs. BUD/FORM, RR 0.81, 95% CI: 0.70-0.95, p = 0.01). CONCLUSIONS: Fixed-dose BUD/FORM is an effective treatment option for adult patients with moderate/severe asthma when compared to BUD and SALM/FP, with adjustable maintenance dosing demonstrating important advantages over fixed dosing in relation to exacerbation prevention and reduced treatment load. [ABSTRACT FROM AUTHOR]

This literature review substantiates that there is confusion regarding what constitutes excessive gastric residual volume in adult tube-fed patients. Only one research study regarding gastric residuals was located; it indicated that 200 ml for a nasogastric tube and 100 ml for a gastrostomy tube should cause concern. The implications of these findings for adult-health nurses are discussed. [ABSTRACT FROM AUTHOR]