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Seizures in previously seizure-free patients with brain tumours who have undergone resection can be prevented with the use of antiepileptic agents. This review of current literature showed that phenytoin was ineffective in preventing seizures when all trials were considered (OR=0.939; 95% CI=0.609-1.448; P=0.775). However, studies found levetiracetam to be significantly effective with low reported seizure frequencies (ranging from 2.5% to 7.0%) compared to patients without levetiracetam reported as 20%, (P<0.05). One head-to-head study demonstrated significant reduction of seizures in the levetiracetam group (1.9%) when compared to the phenytoin group (13.8%), P=0.034. Even with the limited evidence that exists regarding levetiracetam, significantly fewer seizures have been reported in patients undergoing brain tumour resection. Levetiracetam use in patients undergoing brain tumour resection should be considered on a case-by-case basis in the absence of good quality evidence from future trials to guide practice. [ABSTRACT FROM AUTHOR]

Background: Breakthrough cancer pain (BTCP) is complex and severe, affecting quality of life and increasing hospitalisation. BTCP has a rapid onset that requires fast acting medication with minimal side effects. Aim: This article compares the effectiveness of intranasal fentanyl spray (INFS) and oral transmucosal fentanyl citrate (OTFC) and their alleviation of BTCP within 10 minutes of administration. Method: The article considers pharmacokinetic and bioavailability studies demonstrating the efficacy of the route of administration, time-based effects of pain relief as well as patient preference. Conclusion: The data collected indicates that INFS is more effective than OTFC for BTCP. [ABSTRACT FROM AUTHOR]

Objectives: To determine the clinical effectiveness of pressurised metered dose inhalers compared with other hand held inhaler devices for delivering short acting 2 agonists in stable asthma. Design: Systematic review of randomised controlled trials. Data sources: Cochrane Airways Group specialised trials database (which includes hand searching of 20 relevant journals), Medline, Embase, Cochrane controlled clinical trials register, pharmaceutical companies, and bibliographies of included trials. Trials: All trials in children or adults with stable asthma that compared the pressurised metered dose inhaler (with or without a spacer device) against any other hand held inhaler device containing the same 2 agonist. Results: 84 randomised controlled trials were included. No differences were found between the pressurised metered dose inhaler and any other hand held inhaler device for lung function, blood pressure, symptoms, bronchial hyperreactivity, systemic bioavailability, inhaled steroid requirement, serum potassium concentration, and use of additional relief bronchodilators. In adults, pulse rate was lower in those using the pressurised metered dose inhaler compared with those using Turbohaler (standardised mean difference 0.44, 95% confidence interval 0.05 to 0.84); patients preferred the pressurised metered dose inhaler to the Rotahaler (relative risk 0.53, 95% confidence interval 0.36 to 0.78); hydrofluoroalkane pressurised metered dose inhalers reduced the requirement for rescue short course oral steroids (relative risk 0.67, 0.49 to 0.91). Conclusions: No evidence was found to show that alternative inhaler devices are more effective than standard pressurised metered dose inhalers for delivering acting 2 agonist bronchodilators in asthma. Pressurised metered dose inhalers remain the most cost effective delivery devices. [ABSTRACT FROM AUTHOR]

The article reports that esomeprazole did not improve asthma symptoms in patients with poorly controlled asthma and asymptomatic gastroesophageal reflux. A study conducted in 19 clinical centers in the U.S. has conclusively shown that these widely prescribed medications for patients with poorly controlled asthma do not improve symptom scores, rescue-inhaler use, episodes of poor asthma control, night awakening, spirometry or quality of life

Background: There is lack of consensus from randomized controlled trials on the efficacy of antivirals in the management of herpes zoster. Therefore, a systematic review and meta-analysis was undertaken to provide better understanding of effectiveness of antivirals in management of herpes zoster., Methods: A total of 12 randomized controlled trials with 7,277 patients were included in the review. Trials compared one antiviral to another (aciclovir, valaciclovir, famciclovir or brivudin) for a minimum of 7 days in immunocompetent patients presenting with herpes zoster diagnosed within 72 h of symptom onset. Primary outcome was reduction in pain., Results: Compared with aciclovir, valaciclovir showed significant reduction in herpes-zoster-associated pain up to 112 days. The largest risk reduction in pain (36%) was seen at 21-30 days (relative risk [RR] 0.64, 95% CI 0.59, 0.70) with number needed to treat to benefit (NNT) of 3 (95% CI 2.7, 3.8). Famciclovir was also superior to aciclovir with a 46% reduction in risk of pain at 28-30 days (RR 0.54, 95% CI 0.48, 0.68) with NNT of 3 (95% CI 2, 5). Time to lesion healing and adverse effect profile was comparable., Conclusions: Evidence from quality trials have shown significant reduction in risk of pain with valaciclovir and famciclovir for management of herpes zoster including ophthalmicus. Valaciclovir or famciclovir should be preferred treatment options in patients with herpes zoster as they both provide significant reduction in risk of herpes-zoster-associated pain. Furthermore, the superior pharmacokinetics and more convenient dosing regimens with the use of valaciclovir and famciclovir clearly make them the preferred treatment option.

Aim: To determine self-reported use of New Zealand's Guidelines Group (NZGG) and BPAC resources by practice nurses (PNs) in the Greater Auckland area of New Zealand., Method: A postal survey of all PNs registered on the University of Auckland's Department of General Practice and Primary Health Care's database., Results: A total of 419 of 917 (46%) PNs working in 280 general practices returned completed questionnaires. The majority of PNs did not use either the NZGG (53%) or BPAC guidelines (57%) and 35% did not use any evidence resources. The main reason these resources were not used was lack of knowledge about them, one-third of PNs had never heard of NZGG guidelines and 42% had never heard of BPAC guidelines. Of those who knew of NZGG guidelines, 74% found them useful, (a 'fair amount' or 'very') and 94% found BPAC guidelines useful (a 'fair amount' or 'very'). When PNs knew of these resources, 74% used NZGG guidelines and 69% used BPAC guidelines for patient care., Conclusion: PNs who knew of New Zealand Guidelines and BPAC found them useful in patient management. Practice nurses are not routinely on the mailing list of these two organisations. Strategies to increase PN awareness of these publicly funded evidence-based resources may increase their use and thus contribute to the reduction in health inequalities between ethnic groups in New Zealand.

Purpose of Review: The role of theophylline in the management of chronic obstructive pulmonary disease remains controversial. This review was undertaken to determine the efficacy of theophylline in patients with stable disease., Recent Findings: Twenty-two good quality randomized controlled trials were included in this systematic review. The review showed that theophylline significantly improved forced expiratory volume in 1 s and forced vital capacity (weighted mean difference 0.10 L; 95% confidence interval 0.04-0.16 and weighted mean difference 0.21 L; 95% confidence interval 0.10-0.31, respectively). V also improved with theophylline (weighted mean difference 195.27 mL/min; 95% confidence interval 112.71-277.83), as did Pa and Pa (weighted mean difference 1.45 mmHg; 95% confidence interval 0.26-2.65 and weighted mean difference -1.09 mmHg; 95% confidence interval -1.83 to -0.35, respectively). Patients preferred theophylline over placebo (relative risk 2.27; 95% confidence interval 1.26-4.11). Theophylline increased the risk of nausea, however, compared with placebo (relative risk 7.67; 95% confidence interval 1.47-39.94)., Summary: This review has shown that oral theophylline plays an important role in the management of patients with stable chronic obstructive pulmonary disease by improving lung function, arterial blood gas tensions and ventilatory capacity. Patients also preferred treatment with theophylline when compared with placebo. The benefits of theophylline in stable chronic obstructive pulmonary disease, however, have to be weighed against the risk of adverse effects, particularly nausea.

Education about asthma and self-management of asthma are now key recommendations of asthma management guidelines. A Cochrane systematic review of 12 RCTs found that limited education programmes that offer information about asthma but not self-management skills did not reduce hospitalisation rates or visits to the doctor for asthma. The positive outcomes from limited asthma education were a reduction in symptoms. Asthma self-management education which consists of information, self-monitoring, regular medical review, and a written action plan is effective and leads to a reduction in hospitalisation and ER visits for asthma, unscheduled doctors visits, days lost from work, episodes of nocturnal asthma, indirect costs and an improvement in quality of life. The effects were large enough to be of both clinical and statistical significance. While a structured asthma self-management programme is effective in a hospital setting, attempts to deliver these programmes in primary care have met with varying success.

Objectives: To determine the effectiveness of non-invasive positive pressure ventilation (NPPV) in the management of respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease., Design: Systematic review of randomised controlled trials that compared NPPV and usual medical care with usual medical care alone in patients admitted to hospital with respiratory failure resulting from an exacerbation of chronic obstructive pulmonary disease and with PaCO2 >6 kPa., Results: The eight studies included in the review showed that, compared with usual care alone, NPPV as an adjunct to usual care was associated with a lower mortality (relative risk 0.41 (95% confidence interval 0.26 to 0.64)), a lower need for intubation (relative risk 0.42 (0.31 to 0.59)), lower likelihood of treatment failure (relative risk 0.51 (0.38 to 0.67)), and greater improvements at 1 hour in pH (weighted mean difference 0.03 (0.02 to 0.04)), PaCO2 (weighted mean difference -0.40 kPa (-0.78 to -0.03)), and respiratory rate (weighted mean difference -3.08 breaths per minute (-4.26 to -1.89)). NPPV resulted in fewer complications associated with treatment (relative risk 0.32 (0.18 to 0.56)) and shorter duration of stay in hospital (weighted mean difference -3.24 days (-4.42 to -2.06))., Conclusions: NPPV should be the first line intervention in addition to usual medical care to manage respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease in all suitable patients. NPPV should be tried early in the course of respiratory failure and before severe acidosis, to reduce mortality, avoid endotracheal intubation, and decrease treatment failure.