Background: The calcipotriol/betamethasone dipropionate two-compound product is safe and effective in the short-term treatment of psoriasis. Objective: The primary objective was to investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks. The efficacy results are presented here. Methods: Six hundred and thirty-four patients were randomised double-blind to treatment (once daily, when required) with either: 52 weeks of two-compound product (two-compound group), 52 weeks of alternating 4-week periods of two-compound product and calcipotriol (alternating group), or 4 weeks of two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Results: There was a trend towards a difference between treatments from the overall treatment effect for the percentage of satisfactory responses for each patient during the study (p = 0.071). This appeared to be due to the comparison of the two-compound and calcipotriol groups (p = 0.025). Conclusion: There was a trend towards the efficacy of the two-compound product used for up to 52 weeks being better than that of 4 weeks of the two-compound product followed by 48 weeks of calcipotriol.

SummaryWe investigated the influence of either propofol or desflurane on the incidence of postoperative cognitive dysfunction in a randomised trial of 180 patients undergoing coronary artery bypass surgery. The primary outcome was incidence of postoperative cognitive dysfunction at 3 months, defined as ‡ 1 SD deterioration in two or more of 12 neurocognitive tests. Secondary outcomes included early postoperative cognitive dysfunction (between days three and seven), delirium on day one, morbidity and length of hospital stay. Early postoperative cognitive dysfunction was significantly higher with propofol compared with desflurane (56 ⁄ 84 (67.5%) vs 41 ⁄ 83 (49.4%), respectively, p = 0.018), but this effect was not seen at 3 months (10 ⁄ 87 (11.2%) vs 9 ⁄ 90 (10.0%), respectively. There was no difference in delirium (7 ⁄ 89 (7.9%) vs 12 ⁄ 91 (13.2%), respectively, length of hospital stay (median (IQR [range]) 7 (6-9 [4-15]) vs 6 (5-7 [5-16) days, respectively or other morbidities. Desflurane was associated with reduced early cognitive dysfunction. Postoperative cognitive dysfunction (POCD) is a common morbidity associated with coronary artery bypass surgery, ranging in frequency from 20% to 60% for between 6 weeks to 3 months after surgery [1][2][3]. It can be an enduring problem for patients, as the presence of POCD at 3 months after surgery has a high chance of persisting into the long term [3,4]. Much research has been devoted to investigating aspects of cardiopulmonary bypass that have been considered to be the most likely cause of POCD, with conflicting results. The focus on cardiopulmonary bypass, and consequent aortic manipulation required for aortic

This is the accepted version of the paper.This version of the publication may differ from the final published version. This study aimed to examine variability in cognitive performance in volunteers. Methods: One hundred forty-three volunteers completed the cognitive domain questions at baseline, after 15 min and 40 min, and on days 1 and 3. Delivery via face-to-face interview was conducted for the first three measurements, and then randomized for day 1 and 3 measurements (faceto-face only, telephone only, telephone then face-to-face, face-to-face then telephone). Permanent repository linkResults: All volunteers answered orientation correctly. Mean change scores for other tests were positive, indicating a modest learning effect. There were no significant differences between methods of delivery (all P > 0.05). Due to variability in volunteers' performances, the authors propose a new scoring system to introduce a tolerance factor in scoring cognitive recovery. The proposed revised change from baseline scores are: orientation 0 or higher, digits forward −2 or higher, digits back −1 or higher, word recall −3 or higher, and word generation −3 or higher. This resulted in approximately 95% volunteers classed as "recovered" for each test item, and recovery for the domains ranged from 82.6 to 89.1%. The initial feasibility study was reanalyzed and cognitive recovery increased at all assessment times. At 3 days, cognitive recovery was found to increase from 33.5 to 86.4%. Conclusion:The authors recommend adoption of the new method for scoring cognitive recovery in the Postoperative Quality of Recovery Scale. Telephone or face-to-face delivery was equivalent and either method can be reliably applied. What We Already Know about This Topic• The Postoperative Quality of Recovery Scale, published in AneSTheSiology in 2010, found lower than anticipated recovery in the cognitive domain.• one hundred forty-three volunteers completed the Postoperative Quality of Recovery Scale cognitive domain questions at baseline, 15 min, 40 min, and 1 and 3 days. Delivery was faceto-face for the first three measurements, and then randomized for day 1 and 3 measurements to combinations of face-toface and telephone interviews. What This Article Tells Us That Is New• The investigators propose a new scoring system that includes performance tolerance such that more than 80% of subjects are considered recovered in the cognitive domain at 3 days. • There were no important differences between methods of delivery; telephone administration of Postoperative Quality of Recovery Scale is, thus, valid.

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