Long-term,open-label,safety study of once-daily ropinirole extended/prolonged release in early and advanced Parkinson's disease

Long-term safety of once-daily ropinirole extended/prolonged release (ropinirole XL/PR) was evaluated in subjects with early and advanced Parkinson's disease (PD) in this study, 101468/248. Subjects (n = 419) who completed one of three prior studies evaluating ropinirole XL/PR for the treatment of PD were enrolled in this open-label, multicenter, extension study, and were to be followed for up to 73 months. Ropinirole XL/PR was titrated/continued, and adjusted as appropriate during the maintenance phase (maximum 24 mg/d). Levodopa (L-dopa) and other nondopamine agonist PD medications were permitted. Safety outcomes that were investigated included frequency of adverse events (AEs). Subjects’ preference regarding once daily versus three times daily study medication regimens was also investigated in a subset of the study population. The median duration of ropinirole XL/PR exposure was 1275 d. Most subjects (87%) reported at least one AE, with the most common (≥ 10%) AEs being, back pain (14%), hallucinations (13%), somnolence (11%) and peripheral edema (11%). Twenty-five percent of subjects discontinued the study prematurely due to an AE during the treatment period. Long-term treatment with ropinirole XL/PR was not associated with any new or unexpected safety concerns in patients with early and advanced PD, and a majority of subjects preferred the once-daily dosing regimen.     

Identity and stammering: negotiating hesitation,side‐stepping repetition,and sometimes avoiding deviation

Individuals who experience speech dysfluency are often stigmatised because their speech acts differ from the communicative norm. This article is located in and seeks to further the identity debates in exploring how individuals who are subject to the intermittent emergence of a stigmatised characteristic manage this randomised personal discrediting in their identity work. Through a series of focus groups and semi‐structured interviews participants grudgingly report their management approaches which include concealing, drafting in unwitting others, role‐playing and segregating self from their stammer. In describing how they manage their stammer they detail their use of the social space in a number of ways, including as a hiding place; a site for ‘it’ (the stammer); a gap in which to switch words; and a different area in which to perform. This study offers important insights, increasing our understanding of the often hidden negotiations of identity work and the sometime ingenious use of space in the management of a social stigma.     

Technical competence in surgeons

In this paper, we review the literature to date on technical competence in surgeons; how it can be defined, taught to trainees and assessed. We also examine how we can predict which candidates for surgical training will most likely develop technical competence. While technical competency is just one aspect of what makes a good surgeon, we have recognized a need to review the literature in this area and to combine this with broader definitions of competency. Our review found that several methods are available to objectively measure, assess and predict technical competence and should be used in surgical training.