Summaries of findings, descriptions of interventions, and information about adverse effects would make reviews more informative

BACKGROUND AND OBJECTIVE: To describe challenges when extracting and presenting relevant, consistent, and accessible information from systematic reviews. MATERIALS AND METHODS: We systematically selected comparisons and outcomes from 18 Cochrane reviews, evaluated the quality of evidence for each outcome using the GRADE system, and developed standardized patient information. We evaluated the information using patient, review author, researcher, and clinician feedback. RESULTS: Challenges included large numbers of comparisons and outcomes; missing information about treatments and adverse effects; and variations in how effect was measured and presented. By selecting comparisons and outcomes based on patient-relevance, quality, and nonredundancy, we halved the number of outcomes. We prepared information about treatments and adverse effects using other sources. We framed outcomes consistently and standardized the presentation of magnitude of effect. CONCLUSIONS: The incorporation of summary of findings tables in reviews could address these challenges. Problems could also be reduced if review groups agreed upon standard outcomes; excluded less relevant outcomes; incorporated more information about interventions and adverse effects; and implemented clearer guidelines for the presentation of results.     

Determination of a selection of anti‐epileptic drugs and two active metabolites in whole blood by reversed phase UPLC‐MS/MS and some examples of application of the method in forensic toxicology cases

Quantitative determination of anti‐epileptic drug concentrations is of great importance in forensic toxicology cases. Although the drugs are not usually abused, they are important post‐mortem cases where the question of both lack of compliance and accidental or deliberate poisoning might be raised. In addition these drugs can be relevant for driving under the influence cases. A reversed phase ultra‐performance liquid chromatography‐tandem mass spectrometry method has been developed for the quantitative analysis of the anti‐epileptic compounds carbamazepine, carbamazepine‐10,11‐epoxide, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, 10‐OH‐carbazepine, phenobarbital, phenytoin, pregabalin, and topiramate in whole blood, using 0.1 mL sample volume with methaqualone as internal standard. Sample preparation was a simple protein precipitation with acetonitrile and methanol. The diluted supernatant was directly injected into the chromatographic system. Separation was performed on an Acquity UPLC® BEH Phenyl column with gradient elution and a mildly alkaline mobile phase. The mass spectrometric detection was performed in positive ion mode, except for phenobarbital, and multiple reaction monitoring was used for drug quantification. The limits of quantification for the different anti‐epileptic drugs varied from 0.064 to 1.26 mg/L in blood, within‐day and day‐to‐day relative standard deviations from 2.2 to 14.7% except for phenobarbital. Between‐day variation for phenobarbital was 20.4% at the concentration level of 3.5 mg/L. The biases for all compounds were within ±17.5%. The recoveries ranged between 85 and 120%. The corrected matrix effects were 88–106% and 84–110% in ante‐mortem and post‐mortem whole blood samples, respectively. Copyright © 2014 John Wiley & Sons, Ltd.