tbuckley/cabot-search huggingface dataset:
Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial * Commentary: Bootstrapping simplifies appreciation of statistical inferences
Authors: I. B C K.-d. Bos
Journal: BMJ (2003)

<h3>Abstract</h3> <b>Objective:</b> To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. <b>Design:</b> Economic evaluation alongside a randomised controlled trial. <b>Setting:</b> Primary care. <b>Participants:</b> 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs). <b>Main outcome measures:</b> Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques. <b>Results:</b> The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (€447; £273; $402) were around one third of the costs of physiotherapy (€1297) and general practitioner care (€1379). These differences were significant: P&lt;0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care. <b>Conclusions:</b> Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner. <h3>What is already known on this topic</h3> The cost of treating neck pain is considerable Many conservative interventions are available, such as prescription drugs, yet their cost effectiveness has not been evaluated No randomised trials of conservative treatment for neck pain have so far included an economic evaluation <h3>What this study adds</h3> Manual therapy is more effective and less costly than physiotherapy or care by a general practitioner for treating neck pain Patients undergoing manual therapy recovered more quickly than those undergoing the other interventions
Urokinase Exerts Antimetastatic Effects by Dissociating Clusters of Circulating Tumor Cells
Authors: Jin Woo Choi, Jun Ki Kim, Yun Jung Yang, Pilhan Kim, Kwon-Ha Yoon, Seok Hyun Yun
Journal: Cancer Research (2015)

Abstract Clusters of circulating tumor cells (CTC) exhibit more robust metastatic properties than single CTC. Thus, understanding the distinct behaviors of CTC clusters and how CTC clustering is regulated may offer new insights into how to limit metastasis. In this study, we utilized an in vivo confocal system to observe the clustering behavior of CTC in real time, finding that the number of clusters increased proportionally with the growth of the primary tumor. Our experiments also indicated that the flow rate of the CTC clusters in blood vessels was relatively slower than single CTC due to increased vessel wall adhesion. Depending on disease stage, 5% to 10% of total CTC in circulation were in clusters, with this proportion increasing to &amp;gt;24% within lung metastases examined. Notably, in the 4T1 mouse model of breast cancer metastasis, we found that injecting host animals with urokinase-type plasminogen activator, a clinical thrombolytic agent, was effective at preventing the assembly of CTC clusters and prolonging overall host survival by approximately 20% relative to control animals. Our results suggest a tractable approach to limit metastasis by suppressing the formation or stability of CTC clusters circulating in the blood of cancer patients. Cancer Res; 75(21); 4474–82. ©2015 AACR.
Age of menarche and risk of asthma: Systematic review and meta-analysis
Authors: Sofie Lieberoth, Vibeke Backer, Simon Francis Thomsen
Journal: European Respiratory Journal (2012)

Aim: To conduct a systematic review and meta-analysis of the relationship between the age at menarche and risk of asthma.

Methods: A prespecified literature search strategy was used to identify all articles directly concerning the relationship between asthma and age at menarche. We were interested in studies with asthma defined as self reported asthma, diagnosed asthma or asthma symptoms and in studies defining early menarche as menarche before the age of 12 years of age or younger. Further, we were interested in controlled trials, prospective and retrospective cohort studies, case-control-studies and cross-sectional studies with or without modelling.

Results: Our searches identified 34 articles of which 8 matched the inclusion criteria (two cross-sectional studies, three case-control studies, two retrospective studies, and one prospective study) with a total of 18124 patients. All articles were consistent in their results, showing a clear positive relationship between asthma and age at menarche. Estimates from the selected studies showed that the risk of asthma was increased between 1.13 and 2.34 times in girls with early menarche.

Conclusions : Early age at menarche is associated with increased risk of asthma. Hormonal, immunological, genetic, and environmental factors may act in a developmental context to explain this relationship.
Trends in co-morbidity in oxygen-dependent COPD
Authors: Magnus Ekström, Claes Jogreus, Kerstin Ström
Journal: European Respiratory Journal (2011)

In recent decades, mortality from non-respiratory diseases has increased in patients on long-term oxygen therapy (LTOT) for COPD (Ekstrom, M.P. et al. AJRCCM. Epub 2011 Jan 7). This study tests the hypothesis that co-morbidity has increased over time in oxygen-dependent COPD.   Material and methods:  Patients starting LTOT for COPD between 1 January 1992 and 31 December 2008 in the national Swedish Oxygen Register were included. All registered diagnoses within five years prior to initiating LTOT were collected retrospectively from the Swedish Hospital Discharge Register, which include about 99% of all public hospitalizations in Sweden. Odds ratios (ORs) for diagnosis entities per calendar year were estimated using logistic regression adjusted for age, sex, P a O 2  breathing air, FEV 1  and smoking history.   Results:  6147 patients (55% women) with a mean age 71.6 ± [SD] 8.4 years were included in the analysis. Adjusted odds ratios per calendar year (OR; 95% confidence interval; P-value) increased for anaemia (1.07; 1.04-1.10; P   Conclusion:  Co-morbidity has increased over time, which could contribute to the increased mortality from non-respiratory diseases in oxygen-dependent COPD.
Are junior doctors struggling to gain non-invasive ventilation (NIV) experience?
Authors: M.J. Naveed, Alexandros Mathioudakis, T. Bongers
Journal: European Respiratory Journal (2013)

Background: National Institute for Health and Clinical Excellence (NICE) guidance suggests that there should be local arrangements for prompt assessment and delivery of NIV by appropriately trained staff in hospital.  Objectives: We wanted to investigate the current knowledge and competence amongst doctors of various grades expected to come across an NIV patient in our hospital.  Methods: An anonymous questionnaire-based survey was handed out to doctors of various grades between October and November 2012. The questionnaire was designed to primarily test knowledge, experience, contraindications and some of the common problems surrounding NIV use.  Results: The response rate was 82.9% (58/70). 7(12%) doctors received no teaching/training about NIV. 19(32%) rated their NIV training as poor. 34(59%) doctors who had used NIV stated that they had low confidence when using it and knew what IPAP and EPAP stands for. 23(40%) doctors were able to change the appropriate settings to correct hypercapnia or hypoxia. 53% of the doctors recognised contraindications for NIV. 11 doctors felt confident in setting up NIV on a patient. Senior doctors were more confident and scored better in the contra-indications and basic settings (p  Conclusion: This study has highlighted that junior doctors have poor knowledge, lack of training and low confidence in using NIV. Currently, improvements need to be made in delivering the training to achieve competency in administering and managing a patient on NIV, especially outside of normal working hours. However, these could be easily remedied with simple education. We propose that training sessions are organized for trainees by integrating NIV scenario into simulation training days.
Guidelines for the management of vitiligo: the European Dermatology Forum consensus
Authors: A. Taieb, A. Alomar, M. Böhm, M.L. Dell’Anna, A. De Pase, V. Eleftheriadou, K. Ezzedine, Y. Gauthier, D.J. Gawkrodger, T. Jouary, G. Leone, S. Moretti, L. Nieuweboer-Krobotova, M.J. Olsson, D. Parsad, T. Passeron, A. Tanew, W. van der Veen, N. van Geel, M. Whitton, A. Wolkerstorfer, M. Picardo
Journal: British Journal of Dermatology (2012)

The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence-based and expert-based recommendations (S1 level).
The spectrum of paediatric dermatology.
Authors: G. H. FINDLAY, H. F. VISMER, T SOPHIANOS
Journal: British Journal of Dermatology (1974)

Almost 10,000 paediatric dermatological cases seen as out‐patients were classified according to diagnosis, sex and age. Diagnostic frequencies, relationships between diagnostic categories, biological significance of high and low frequencies and disturbances of sex ratios are noted. The application of this knowledge to medical education is outlined.
Detection of Alcohol-Induced Fatty Liver by Computerized Tomography
Authors: S L Allaway, C D Ritchie, D Robinson, T Seear, R Reznek, I Kelsey Fry, G R Thompson
Journal: Journal of the Royal Society of Medicine (1988)

Computerized tomographic (CT) scanning of the liver was undertaken in 17 occasional and 19 heavy drinkers undergoing health screening. The median attenuation value of the liver (CT number) in occasional drinkers with normal liver function tests was 54.4 compared with 25.9 in the heavy drinkers (P less than 0.001). Fourteen of the heavy drinkers had a CT number below the lowest value observed in occasional drinkers with normal liver function, indicating reduced liver density due to fatty change. Serum gamma-glutamyl transpeptidase was normal in 36% of these individuals. A rise in CT number was observed in 4 out of 5 heavy drinkers who underwent a second scan after decreasing their alcohol consumption. These findings suggest that CT scanning provides a noninvasive and convenient method of screening for a fatty liver, which occurred to a variable degree in over 70% of the men who admitted to regularly taking 8 or more alcoholic drinks per day.
Doctors and computers.
Authors: Mike Dent
Journal: BMJ (1968)

The twin concerns of the thesis are (a) to develop a labour process analysis that is able to account for professional work and (b) in so doing to explain the reasons for hospital doctors various responses to the introduction of computer systems into medical work.

This thesis constitutes a study of hospital doctors (clinicians) use of information technology in their clinic work. The first part reviews the literature and general developments in medical computing in relation to a theoretical analysis of the organisation and control of the clinic/medical labour process. The second part consists of an ethnographic study of the introduction of computer-based medical information systems into three hospitals; two being case studies of renal units and associated clinics and the third a study of an outpatients' department at a small acute hospital. The computer systems involved either replaced or supplemented the traditional form of the medical records and for this reason it was possible to focus on the role of these organisational records in the maintenance and reproduction of dominance and subordination within the labour process of clinic/medical work.
Guidance for the regulatory status of allergen extracts in clinical trials
Authors: Zuzana Diamant, Maurits van Maaren, Roy Gerth van Wijk, Jacobus R.B.J. Brouwers, Herman Pieterse
Journal: European Respiratory Journal (2015)

Following the introduction of the guidelines on clinical development and regulation of marketing authorisation for allergen extracts [1], there is an ongoing discussion on their regulatory status ( i.e. authorised or unauthorised (off label)) when applied in interventional or observational clinical trials [2]. Since in most European Union (EU) countries, many allergen extracts either do not have a marketing authorisation or are not authorised for the intended application within a study protocol, it is often unclear which documents are needed for submission to an Independent Ethics Committee (IEC) and the Competent Authority. Allergen extracts for NIMP use without EU marketing authorisation can be used if adequate justification is provided <http://ow.ly/Q8LdZ>
Measuring the Incremental Cost of Clinical Cancer Research
Authors: Dana P. Goldman, Michael L. Schoenbaum, Arnold L. Potosky, Jane C. Weeks, Sandra H. Berry, Jose J. Escarce, Beverly A. Weidmer, Meredith L. Kilgore, Nikhil Wagle, John L. Adams, Robert A. Figlin, Joy H. Lewis, Joel Cohen, Richard Kaplan, Mary McCabe
Journal: Journal of Clinical Oncology (2001)

PURPOSE: To summarize evidence on the costs of treating patients in clinical trials and to describe the Cost of Cancer Treatment Study, an ongoing effort to produce generalizable estimates of the incremental costs of government-sponsored cancer trials. METHODS: A retrospective study of costs will be conducted with 1,500 cancer patients recruited from a randomly selected sample of institutions in the United States. Patients accrued to either phase II or phase III National Cancer Institute–sponsored clinical trials during a 15-month period will be asked to participate in a study of their health care utilization (n = 750). Costs will be measured approximately 1 year after their trial enrollment from a combination of billing records, medical records, and an in-person survey questionnaire. Similar data will be collected for a comparable group of cancer patients not in trials (n = 750) to provide an estimate of the incremental cost. RESULTS: Evidence suggests insurers limit access to trials because of cost concerns. Public and private efforts are underway to change these policies, but their permanent status is unclear. Previous studies found that treatment costs in clinical trials are similar to costs of standard therapy. However, it is difficult to generalize from these studies because of the unique practice settings, insufficient sample sizes, and the exclusion of potentially important costs. CONCLUSION: Denials of coverage for treatment in a clinical trial limit patient access to trials and could impede clinical research. Preliminary estimates suggest changes to these policies would not be expensive, but these results are not generalizable. The Cost of Cancer Treatment Study is an ongoing effort to provide generalizable estimates of the incremental treatment cost of phase II and phase III cancer trials. The results should be of great interest to insurers and the research community as they consider permanent ways to finance cancer trials.
Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects
Authors: R.P. Dodiuk-Gad, E. Cohen-Barak, M. Khayat, H. Milo, L. Amariglio-Diskin, N. Danial-Faran, M. Sah, M. Ziv, A. Shani-Adir, B. Amichai, A. Zlotogorski, Z. Borochowitz, D. Rozenman, S. Shalev
Journal: British Journal of Dermatology (2015)

Darier disease (DD) is a rare genodermatosis caused by heterozygous mutations in the ATP2A2 gene. It has been associated with neuropsychiatric manifestations.To investigate the genetic basis of Israeli patients with DD, and its association with the neuropsychiatric phenotype.A cohort of 32 families comprising 74 affected individuals and 13 unaffected family members was recruited from the Haemek Dermatology Department and other dermatology clinics in Israel. The individuals were evaluated by detailed questionnaires, physical examination and genetic analysis. The main outcome measures were genetic mutations, psychiatric profile and their association.Twenty-three mutations in ATP2A2 were scattered over the entire gene, 14 of them novel. Two families shared the same mutation. Twenty-one patients (28%) had a history of psychiatric disorders, most of them mood disorders. Another seven patients (9%) were highly suspected of having a psychiatric disorder; 21 (28%) reported suicidal thoughts and five (7%) had attempted suicide. The psychiatric phenotype demonstrated inter- and intrafamilial variability, and was not associated with disease severity, family history of psychiatric disease or mutation location.The cohort demonstrated genetic heterogeneity with no mutation cluster along the gene, and a high prevalence of psychiatric disorders. Although no clear genotype-phenotype correlation was found, the results point to a major effect of genetic background on psychiatric phenotype, together with other modifiers.
Predictive value of microsatellite instability for benefit from adjuvant fluorouracil chemotherapy in colorectal cancer
Authors: B Iacopetta, T Watanabe
Journal: Gut (2006)

We read with interest the study by Jover and colleagues ( Gut 2006; 55 :848–55) on the predictive value of the DNA mismatch repair (MMR) or microsatellite instability (MSI) phenotype for response of colorectal cancer patients to 5-fluorouracil (5-FU) chemotherapy. We are concerned however about the conclusion reached by the authors and the accompanying commentary ( Gut 2006; 55 :759–61) that MSI status should be considered in decisions on the use of 5-FU. While the clinical utility of MSI status for screening of hereditary non-polyposis colorectal cancer (HNPCC) is unquestioned, we are of the opinion that currently available data cannot justify exclusion of patients with MSI tumours from receiving 5-FU treatment.

The authors state that “5-FU based chemotherapy may not be useful in stage II and III MMR deficient colorectal cancer and a revision …
Dose-dependent differential effects of thrombin in allergic bronchial asthma
Authors: Masahiro Onishi, Atsushi Tomaru, Kentaro Fujiwara, Masahito Urawa, Takehiro Takagi, Tetsu Kobayashi, Hiroyasu Kobayashi, Yasushi Miyake, Masaaki Toda, Corina D'Alessandro-Gabazza, Esteban Gabazza, Osamu Taguchi
Journal: European Respiratory Journal (2013)

Apart from its role in the coagulation system, thrombin plays an important role in the inflammatory response through its protease-activated receptor (PAR)-1, but its role in the immune response is unclear. This study evaluated the modulatory role in allergic bronchial asthma. Bronchial asthma was induced in mice by sensitization and challenge with ovalbumin. Mice with low but sustained coagulation activation had reduced allergic inflammation and allergic asthma was inhibited by low doses but worsened by high doses of thrombin. Allergic asthma was worsened by antithrombin, argatroban, hirudin and anti-thrombomodulin antibody. Mice with an increased concentration of an inhibitor of both thrombin and activated protein C had worsened disease. Heterozygous PAR-1 mice had less allergic inflammation but PAR-1 agonist worsened it. Allergic bronchial inflammation was worsened in mice that received adoptive transfer of PAR-1 agonist-treated Th2 cells compared to controls. Low concentrations of thrombin suppressed but high-dose of it enhanced maturation and secretion of cytokines in dendritic cells. The effects of thrombin on allergic asthma are dose-dependent with detrimental effects at high-dose being mediated by PAR-1 while low doses were protective via thrombomodulin. These data demonstrate that thrombin modulates the outcome in allergic bronchial asthma.
Lung Cancer Screening
Authors: Annette McWilliams, John Mayo, Sharyn MacDonald, Jean C. leRiche, Branko Palcic, Eva Szabo, Stephen Lam
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

Thoracic computed tomography (CT) is a sensitive method for detecting early lung cancer but has a high false-positive rate and is not sensitive for detecting central preinvasive and microinvasive cancer. Our hypothesis was that automated quantitative image cytometry (AQC) of sputum cells as the first screening method may improve detection rate by identifying individuals at highest risk for lung cancer. A total of 561 volunteer current or former smokers 50 years of age or older, with a smoking history of more than or equal to 30 pack/years, were studied. Among these, 423 were found to have sputum atypia defined as five cells or more with abnormal DNA content using AQC. Noncalcified pulmonary nodules were found in 46% (259/561). Of the 14 detected cancers, 13 were detected in subjects with sputum atypia—nine by CT and four carcinoma in situ/microinvasive cancers by autofluorescence bronchoscopy. One cancer was detected by CT alone. AQC of sputum cells improved the detection rate of lung cancer from 1.8 to 3.1%. CT scan alone would have missed 29% of the cancers. This screening paradigm shift has the additional potential of reducing the number of initial CT scans by at least 25% with further savings in follow-up investigations and treatment.
Recurrent Rhoa Mutations In Peripheral T-Cell Lymphoma
Authors: Teresa Palomero, Lucile Couronne, Hossein Khiabanian, Mi-Yeon Kim, Alberto Ambesi, Zachary Carpenter, Francesco Abate, Maddalena Allegretta, Izidore S Lossos, Concha Nicolas, Milagros Balbin, Christian Bastard, Govind Bhagat, Miguel Angel A. Piris, Elias Campo, Olivier A. Bernard, Raul Rabadan, Adolfo A. Ferrando
Journal: Blood (2013)