tbuckley/cabot-search huggingface dataset:
Placebo-blinded study of morphine sulfate sustained-release tablets and immediate-release morphine sulfate solution in outpatients with chronic pain due to advanced cancer.
Authors: J W Finn, T D Walsh, N MacDonald, E Bruera, L U Krebs, K V Shepard
Journal: Journal of Clinical Oncology (1993)

PURPOSE This study was conducted to compare the relative analgesic efficacy and safety of an every-4-hour immediate-release oral morphine (IRM) solution with that of an every-12-hour sustained-release oral morphine (SRM) formulation. PATIENTS AND METHODS This was a double-blind, placebo-blinded, crossover study in 34 adult male and female outpatients with pain due to advanced cancer. Baseline data were collected on day 1. On days 2 and 3, randomly assigned patients received either placebo plus IRM (Roxanol; Roxane Laboratories, Inc, Columbus, OH; 20 mg/mL) at 2, 6, and 10 am, and 2, 6, and 10 pm, or alternatively SRM (Oramorph SR; Roxane Laboratories, Inc; 30 mg) at 10 AM and 10 PM. Patients were then crossed over to the alternate treatment for days 4 through 6. Pain relief was measured using a conventional 100-mm visual analog scale (VAS) and by recording the incidence of breakthrough pain. Information on side effects was obtained from VAS scores for sedation, nausea, anxiety, and depression; by directly questioning the patient as to mental confusion, bowel movements, and laxative use; and from Karnofsky performance status scores. VAS data were analyzed using a linear statistical model. Breakthrough pain data were analyzed using analysis of variance (ANOVA). RESULTS There were no statistically significant differences between IRM and SRM treatments with respect to VAS pain scores, side effect scores, or incidence of breakthrough pain data. Karnofsky performance scores remained stable for all patients throughout the study. CONCLUSION It was concluded that every-12-hour administration of SRM and every-4-hour administration of IRM provide similar analgesic effectiveness and side effect profiles in the treatment of chronic pain in cancer patients.
Influence of Traumatic Grief on Suicidal Ideation Among Young Adults
Authors: Holly G. Prigerson, Jeffrey Bridge, Paul K. Maciejewski, Laurel C. Beery, Robert A. Rosenheck, Selby C. Jacobs, Andrew J. Bierhals, David J. Kupfer, David A. Brent
Journal: American Journal of Psychiatry (1999)

The purpose of this study was to examine the influence of traumatic grief on suicidal ideation.The Beck-Kovacs Scale for Suicidal Ideation was administered to 76 young adult friends of suicide victims.Traumatic grief was associated with a 5.08 times greater likelihood of suicidal ideation, after control for depression. Comorbid traumatic grief and depression were not associated with a greater likelihood of suicidal ideation.Syndromal traumatic grief heightens vulnerability to suicidal ideation.
Can we change the activity behaviour of COPD patients using a telemedicine feedback intervention
Authors: Monique Tabak, Miriam Vollenbroek-Hutten, Paul van der Valk, Job van der Palen, Hermie Hermens
Journal: European Respiratory Journal (2011)

Background:  Better insight in activity behaviour of COPD patients is needed to enable a tailoring of treatment. Our objective was 1) to measure the daily activity pattern of COPD patients and 2) to investigate whether this pattern can be altered by a telemedicine intervention in which feedback is provided on the activity level during the day.   Methods:  Thirty-seven COPD patients (66.3 yrs; FEV 1 %: 46.5%) and 21 healthy controls (55.4 yrs) were monitored for four days in their own environment to establish a baseline activity pattern, using accelerometry, in counts per minute (cpm). Of these, 9 patients participated in the feedback intervention. Patients had to deploy the same activity pattern as displayed on a PDA, for three weeks. Patients received text messages every hour with advice about their activity.   Results:  COPD patients (n=37) are less active than controls (1189±320 vs 829±219 cpm, p=0.003). The COPD activity pattern shows a clear dip in the afternoon. In the intervention group (n=9), activity levels slightly increase during the feedback period (baseline: 870±175, week 1: 898±207, week 2: 883±229, week 3: 922±213 cpm). The dip in activity pattern is strongly modified (figure 1).   Conclusions:  COPD patients show lower activity levels compared to controls and a less distributed pattern. First experiences with a telemedicine feedback intervention show that activity levels can be increased and the pattern can be changed.
Length of Life in the Ancient World: A Controlled Study
Authors: J D Montagu
Journal: Journal of the Royal Society of Medicine (1994)

The length of life for a population of ancient Greek and Roman men with quoted dates of birth and death has been compared statistically with three sample populations from different periods. It was found that the ancients who were born before 100 bc lived as long as the moderns who died before 1950; they lived significantly shorter lives than those who have died in the present half century.
Influence of posture on mechanical parameters derived from respiratory impedance
Authors: AM Lorino, G Atlan, H Lorino, D Zanditenas, A Harf
Journal: European Respiratory Journal (1992)

The influence of posture on respiratory mechanics was investigated in 10 healthy volunteers, using the forced pseudorandom noise technique. Subjects were studied in four randomly selected positions: sitting; sitting with the head turned sideways; supine; and prone with the head turned sideways. Respiratory compliance (Crs), inertance (Irs) and resistance estimated at 4 Hz (R4), were calculated by fitting respiratory impedance by a 4 parameter model with a frequency dependent resistance. When subjects changed from sitting to lying, whilst maintaining the head in the same position in relation to the body, Irs increased and Crs decreased, probably due to gravitational effects. R4 was significantly higher in the supine position than in either of the sitting or the prone positions. These results demonstrate that changes in lung volume cannot completely explain the influence of posture on respiratory resistance, and indicate upper airway geometry as a determinant factor of respiratory resistance.
As-needed formoterol (F) in asthma: An analysis of the East-Asian subgroup of the RELIEF study
Authors: S.G. Huang, Q.J. Cheng, M.R. Sears
Journal: European Respiratory Journal (2014)

RATIONALE: As-needed adjustments in budesonide/F reduce future exacerbation risk in Asian patients (pts) vs a fixed-dose combination + salbutamol (S).1 However, as safety data for as-needed F vs S in this population are limited, this was further explored in a subanalysis of Asian pts from the RELIEF study (SD-037-0699).2

METHODS: Pts aged ≥6 yrs with asthma who were using/able to use β2-agonist reliever medication were randomised to 6 months' open-label as-needed F (4.5µg/dose; Turbuhaler®) or S (200µg/dose; pMDI/DPI). Safety and efficacy were assessed by number of asthma-related (AR)/non-AR serious adverse events (SAEs) and discontinuations due to AEs (DAEs) and time to first exacerbation, respectively.

RESULTS: The analysis included 2834 East-Asian pts (mean age 35 [5–85] yrs; men 51%; n=1418 on F, n=1416 on S) with comparable baseline data. Similar numbers of pts on F experienced a SAE and/or a DAE (4.6 vs 5.5%, odds ratio [OR] .84, p=.32), AR-SAE (2.9 vs 3.7%, OR .79, p=.28) or death (.1 vs .3%, OR .50, p=.42) vs S. Risk of any exacerbation was 14% lower on F vs S (Fig.) with 18% and 20% decreases in severe exacerbations (p=.037) and need for increase in medication (p<.005), respectively.

![Figure][1] 



CONCLUSIONS: As-needed F reduced the risk/rate of exacerbations vs S and displayed a similar safety profile to S in Asian asthma pts.

FUNDING: AstraZeneca

REFERENCES: 1. Vogelmeier. CDI 2012;32:439–49 2. Pauwels. ERJ 2003;22:787–94.

 [1]: pending:yes
Etoposide (VP-16-213) in malignant brain tumors: a phase II study.
Authors: U Tirelli, M D'Incalci, R Canetta, S Tumolo, G Franchin, A Veronesi, E Galligioni, M G Trovò, C Rossi, E Grigoletto
Journal: Journal of Clinical Oncology (1984)

Twenty-two consecutive patients with recurrent malignant brain tumors after radiation therapy and systemic combination chemotherapy with BCNU and vincristine, four of whom were not evaluable due to early death, were treated with etoposide (VP-16-213) (50-100 mg/m2 for five days every three weeks). Response, defined as improvement in both clinical examination and computed tomography scan in absence of glucocorticoids dosage increase, was observed in three (17%) of 18 evaluable patients, lasting greater than 21, seven, and two months, respectively. Six additional patients had stable disease for greater than 10, seven, four, four, three, and two months: all of them had improvement of clinical symptoms but no variation in their scans. Overall median survival from the start of VP-16-213 was 4.5 months (range, 1-23 + months), whereas patients with response or stable disease had a median survival of eight months. Overall, treatment was well tolerated. In 10 patients concomitant plasma and cerebrospinal fluid samples were evaluated with a high-performance liquid chromatographic method for drug assay. The concentration of VP-16-213 in cerebrospinal fluid was less than 1% that found in plasma, even in the two patients with response. The activity of etoposide in patients with malignant, lomustine-vincristine-resistant brain tumors suggests an interesting potential use for this drug.
Abstract 1128: Depressive Symptoms After Cardiac Surgery: The Disappearing Act
Authors: Lynn V Doering, Rebecca Cross, Belinda Chen, Teresa L Diaz, Adey M Nyamathi, Michael Irwin
Journal: Circulation (2009)

In patients after cardiac surgery (CS) depressive symptoms have been reported to be common and severe. This study’s aim was to assess current prevalence and severity of depressive symptoms and determine the rate of clinical depression after CS.   Methods:  We studied 559 CS patients (67±10 years, 30% female, 29% valve surgery/71% bypass, 80% on statins, 12% on antidepressants[ATD]). Inclusions were: Mini-Mental Status Exam > 24 and no other major psychiatric disorders by Structured Clinical Interview for DSM [SCID]. At hospital discharge (T1) and 4 – 6 weeks later (T2), patients completed the Beck Depression Inventory (BDI). If either T1 or T2 BDI was > 10 (showing clinical symptoms) and patients had H/O depression, a SCID was conducted by a trained researcher to determine clinical depression. The BDI-cognitive/affective subscale (BDI-CA) was calculated to remove somatic symptoms; a cutoff of > 3 was used to indicate clinical symptoms.   Results:  At T1, mean BDI and BDI-CA scores were 7.2±5.0 and 2.7±1.06, respectively. At T2 (n=318), they were 7±5.0 and 2.3±1.0, respectively. The 75 th  percentiles for BDI-CA scores were 4 and 2.5, respectively (Figure). Of 115 patients who agreed to a SCID, 51 (9.1% of all patients) had clinical depression. Compared to patients without CA symptoms, those with BDI-CA scores > 3 tended to have lower statin use (71.9% vs. 81.7%, p=.09) but higher ATD use (11.8% vs. 4.9%, p=.07).   Conclusions:  The prevalence and severity of depressive symptoms and clinical depression after CS are lower now than reported previously. To explain the reduction in depression after CS, examination of changes in postop management, including the use of statins and ATDs, is warranted.
Poor quality of health services at primary care level is the leading cause of uncontrolled asthma in India
Authors: J.K. Samaria, Moosa Hussain, Pavan Yadav Mv, Anup P.K. Ahmed, Manoj Meena, Paresh Kulkarni, Archisman Mahapatra, Saket Sharma
Journal: European Respiratory Journal (2011)

Background:  Due to inadequate health resources in India the peripheral health services are provided by unqualified practitioners who are unaware of management protocols. This study attempts to assess the practices at primary care level   Method:  200 patients of Asthma were diagnosed and selected for the study. Data was collected by interview at a tertiary care center and by auditing the prescriptions of the practitioners   Observation:  Of the 200 patients in the study 70.2% were previously diagnosed as asthma of which only 3.38% had undergone spirometry. 16.7% of the subjects were being treated by unqualified practitioners, while 38% and 44% by GPs (medical graduate) and physician (PG degree) respectively. 93% patients treated by the unqualified practitioners were uncontrolled or partially controlled. Among those treated by unqualified practitioners 64.3% were being inappropriately prescribed oral bronchodilators and oral steroids. Subjects treated by physicians received appropriate treatment with 81.1% and 67.6% receiving inhaled beta2 agonist and inhaled steroids respectively. GPs prescribed inappropriate treatment in a higher proportion (63%) and prescribed medications like oral steroids (34.4%), oral beta2 agonists (34.4%) and thoephylline (38.8%). Only 15.5% of the subjects were being monitored by PEFR   Conclusion:  Asthmatics in India are being inadequately diagnosed, treated and monitored. Major reason is the poor understanding of practitioners especially with the guidelines –GINA especially in the case of unqualified practitioners and GPs. There is need to educate the practitioners particularly those at the periphery about the guidelines for asthma management.
Effect of rifampin on the pharmacokinetics of SU11248 in healthy volunteers
Authors: C. Bello, B. Houk, L. Sherman, S. Misbah, N. Sarapa, J. Smeraglia, X. Haung
Journal: Journal of Clinical Oncology (2005)

3078 Background: SU11248 is a novel oral multitargeted tyrosine kinase inhibitor with antiangiogenic and antitumor activity that specifically inhibits platelet derived growth factor receptor (PDGFR), vascular endothelial growth factor receptor (VEGFR), and stem-cell factor receptor (c-kit). SU11248 is metabolized by CYP3A4 to an equipotent metabolite SU12662, which is further metabolized by CYP34A. SU11248 exposure could consequently decrease if it is co-administered with drugs that induce CYP3A4. Methods: This was an open-label two-way crossover drug-interaction study in healthy male subjects to assess the pharmacokinetics (PK) of SU11248 with and without rifampin (RMP), a potent CYP3A4 inducer. The study also compared the PK of SU11248 in Caucasian and Asian males with and without CYP3A4 induction by RMP. Thirteen Caucasian and 13 Japanese subjects were initially randomized to either Treatment A (1 x 50 mg SU11248, PO) or Treatment B (RMP 600 mg/day PO for 17 days, combined with 50 mg SU11248, PO on day 8 only) with a 2-week washout between treatments. Results: CYP3A4 induction with RMP caused a 4-fold reduction in SU11248 plasma exposure (AUClast and AUC0-∞) and a 2.5-fold reduction in SU11248 plasma Cmaxcompared with SU11248 alone in both ethnic groups. A 1.4-fold increase in SU12662 AUC was observed after CYP3A4 induction with RMP. SU11248 and SU12662 PK results after treatment either with SU11248 alone or with SU11248 plus RMP were similar in Caucasian and Japanese subjects. Conclusions: The reduction in systemic exposure of SU11248 when co-administered with RMP indicates that concomitant treatment with potent CYP3A4 inducers should be avoided when SU11248 is used in patients with cancer. The similarity of SU11248 PK in Caucasian and Japanese subjects supports a common starting dose and schedule of SU11248 in these populations. No significant financial relationships to disclose.
The role of dynamic magnetic resonance imaging in the evaluation of pulmonary nodules and masses
Authors: Fatih Alper, Adile Tuba Polat Kurt, Yener Aydin, Mesut Ozgokce, Metin Akgun
Journal: European Respiratory Journal (2012)

Objective  :  The aim of our study was to determine whether dynamic magnetic resonance imaging (MRI) with use of kinetic and morphological parameters reveals significant differences between malignant and benign pulmonary lesions, and thus to evaluate the utility of dynamic MRI in the management of pulmonary nodules.   Materials and Methods  :  Thirty one patients (4 women and 27 men) underwent 1.5 T MRI, and 10 consecutive dynamic series were performed every 30 seconds by using 3D fast low-angle shot (FLASH) sequences. Percentage increase in signal intensity (%SI) of lesions was determined for each time point. Time-enhancement curves of the lesions were drawn and classified into four types (Type A, B, C, D). Early peak (EP) value and maximum peak (MP) value of the curves were calculated and compared with the patients9 diagnosis. In addition of the comparison of the parameters between the groups, Receiver Operating Characteristics analysis was used to assess sensitivity, specificity, positive predictive value, negative predictive value of EP and MP parameters.   Results:  Most of the malignant nodules showed stronger enhancement with higher EP and MP values. There were significant differences between benign and malignant lesions. Sensitivity, specificity, positive predictive value and negative predictive value were 75%, 93%, 92% and 78% for EP and 93%, 86%, 88% and 93% for MP, respectively.   Conclusion:  A combination of kinetic and morphological evaluation in dynamic MRI provided accurate differentiation between benign and malign pulmonary lesions. It was a useful and noninvasive method of evaluating pulmonary nodules.   Key Words:  Pulmonary nodules, dynamic MRI, kinetic parameters.
Structural pulmonary abnormalities on HRCT are early features of ACPA- positive rheumatoid arthritis
Authors: Reza Karimi, Gudrun Reynisdottir, Helga Olsen, Vijay Joshua, Aase Haj Hensvold, Anders Harju, Marianne Engström, Johan Grunewald, Sven Nyren, Anders Eklund, Lars Klareskog, Anca Irinel Catarina, Magnus Sköld
Journal: European Respiratory Journal (2013)

Background  The epidemiologic association between exposure to smoking and ACPA (anti citrullinated proteins antibodies)-positive rheumatoid arthritis (RA) suggests that the immunologic process in RA might start in the lungs. To test this we investigated structural changes in the lungs in a cohort of RA patients with early disease.  Material and methods  A total number of 105 patients with early, untreated RA, median diseases onset 6 months, and 43 healthy non-RA individuals were performed inspiratory and expiratory scans by high resolution computer tomography (HRCT). Bronchoscopy and bronchoalveolar lavage were performed in 21 out of 105 RA patients. Presence of ACPA and total levels of IgG were detected in serum and BAL fluide by anti-CCP2 ELISA and radial immunodiffusion assays with rate nephelometry respectively.  Results  51% (54/105) of the RA patients and only 28% (12/43) of the controls had any lung structural abnormalities (fibrosis, ground glass opacities, bronchioectasis, Nodules larger than 5 mm, emphysema) identifiable on HRCT (p  Conclusion  Presence of ACPA associates with early pulmonary changes on HRCT. Smoking may promote citrullination in the lungs leading to generation of ACPA immunity.
Review: Cannabinoids may improve symptoms for some indications but increase adverse events
Authors: Robert M. Arnold
Journal: Annals of Internal Medicine (2015)

ACP Journal Club15 September 2015Review: Cannabinoids may improve symptoms for some indications but increase adverse eventsRobert M. Arnold, MDRobert M. Arnold, MDUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA (R.M.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2015-163-6-004 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationWhiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456-73. https://pubmed.ncbi.nlm.nih.gov/26103030Clinical Impact RatingsGIM/FP/GP: Neurology: Oncology: References1. Romero-Sandoval, EA. Cannabinoid pharmacology and clinical promise. Eighth Annual Dartmouth Symposium on Substance Use. Medical marijuana: Compassionate care or oxymoron. 11 May 11 2012. Dartmouth College, Hanover, New Hampshire. www.dartmouth.edu/~dcare/pdfs/romero-sandoval_cannabinoids.pdf (accessed 25 June 15). Google Scholar2. Elliot S. Medical marijuana patients number 750,000 in California. May 2011. www.tokeofthetown.com/2011/05/medical_marijuana_patients_number_750000_in_califo.php (accessed 22 Jun 15). Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Pittsburgh, Pittsburgh, Pennsylvania, USA (R.M.A.)This article was published at Annals.org on 1 September 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 September 2015Volume 163, Issue 6Page: JC4KeywordsAdverse eventsCannabinoidsChemotherapyDatabasesGrading of Recommendations Assessment Development and EvaluationMarijuanaMultiple sclerosisNauseaSystematic reviewsVomiting ePublished: 15 September 2015 Issue Published: 15 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effects of Tai Chi Qigong exercise training on asthma control
Authors: Sumalee Kiatboonsri, Potjanee Korrungruang, Pornpimon Learsanantrakul
Journal: European Respiratory Journal (2012)

Though exercise training increased exercise capacity in asthma, its effect on asthma control has not been well described. This study aims at exploring the impact of Tai Chi Qigong(TCQ) exercise training on asthma control.   Methods:   This prospective, case-control study recruited adult asthmatics with pre-bronchodilator FEV 1  of ≤75% predicted. In addition to the self-monitored peak-expiratory flow rate(PEFR) and Asthma Control Questionnaires(ACQ), patients in TCQ and control groups were assessed at 0, 4 and 10 weeks. These included 6-minute walking distances(6MWD), pre and post-6MW spirometries and dyspnea indices(Borg), transitional dyspnea indices(TDI), Saint George Respiratory Questionnaires(SGRQ) and maximum inspiratory pressure(MIP). TCQ exercise trainings were provided to the TCQ group during week 4-10.   Results:   There were 29 and 8 patients in TCQ and control groups respectively. After TCQ training, the TCQ group demonstrated significant improvements in asthma control, i.e. ACQ (1.38±0.83  vs  1.05±0.81,  p=  0.011 ) and PEFR variability(%) (18.10±12.87  vs  12.8±11.39,  p  =0.007 ); 6MWD(meters) (461.66±44.83  vs  478.28±57.25,  p=  0.0378 ); MIP(-cmH 2 O) (81.07±27.62  vs  91.1±24.71,  p   ); Borg changes after 6MW (2.97±1.57  vs  2.03±1.15,  p=  0.0297 ) and TDI (10.45±2.26  vs  14.24±4.06,  p ). Neither of these parameters improved with time in the control group. SGRQ improved in the TCQ group (25.02±15.11  vs  21.13±15.48,  p=0.05 ), but deteriorated in the control group (16.32±11.81  vs  24.91±17.03).   Conclusions:   TCQ exercise training improved asthma control. This finding and the associated improvements in exercise capacity, muscle strength and dyspnea signified that TCQ training could be considered an effective, adjunctive asthma-therapy.