tbuckley/cabot-search huggingface dataset:
Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs
Authors: M.L.A. Schuttelaar, K.M. Vermeulen, P.J. Coenraads
Journal: British Journal of Dermatology (2011)

In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction.To determine costs and cost-effectiveness of care provided by NPs vs. dermatologists and to compare our results with those in studies from other countries.We estimated the healthcare costs, family costs and the costs in other sectors alongside the RCT. All the costs were linked to quality of life [Infants' Dermatitis Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI)] and to patient satisfaction (Client Satisfaction Questionnaire-8) to determine the incremental cost-effectiveness ratio (ICER). We also examined all the reported studies on the costs of childhood eczema.The mean annual healthcare costs, family costs and costs in other sectors were €658, €302 and €21, respectively, in the NP group and €801, €608 and €0·93, respectively, in the dermatologist group. The ICER in the NP group compared with the dermatologist group indicated €925 and €751 savings per one point less improvement in IDQOL and CDLQI, respectively, and €251 savings per one point more satisfaction in the NP group at 12 months. The mean annual healthcare costs and family costs varied considerably in the six identified studies.Substituting NPs for dermatologists is both cost-saving and cost-effective. The treatment of choice is that provided by the NPs as it is similarly effective to treatment provided by a dermatologist with a higher parent satisfaction. International comparisons are difficult because the types of costs determined, the units and unit prices, and eczema severity all differ between studies.
Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey
Authors: Robert Peck, Janneth Mghamba, Fiona Vanobberghen, Bazil Kavishe, Vivian Rugarabamu, Liam Smeeth, Richard Hayes, Heiner Grosskurth, Saidi Kapiga
Journal: The Lancet Global Health (2014)

BackgroundHistorically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs.MethodsBetween November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources.FindingsOf adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV.InterpretationMost outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements.FundingUK Medical Research Council.
Rapamycin increases survival in ALS mice lacking mature lymphocytes
Authors: Kim A Staats, Sara Hernandez, Susann Schönefeldt, André Bento-Abreu, James Dooley, Philip Van Damme, Adrian Liston, Wim Robberecht, Ludo Van Den Bosch
Journal: Molecular Neurodegeneration (2013)

Abstract Background Amyotrophic Lateral Sclerosis (ALS) is a devastating progressive neurodegenerative disease. Disease pathophysiology is complex and not yet fully understood, but is proposed to include the accumulation of misfolded proteins, as aggregates are present in spinal cords from ALS patients and in ALS model organisms. Increasing autophagy is hypothesized to be protective in ALS as it removes these aggregates. Rapamycin is frequently used to increase autophagy, but is also a potent immune suppressor. To properly assess the role of rapamycin-induced autophagy, the immune suppressive role of rapamycin should be negated. Findings Autophagy is increased in the spinal cord of ALS mice. Dietary supplementation of rapamycin increases autophagy, but does not increase the survival of mutant SOD1 mice. To measure the effect of rapamycin in ALS independent of immunosuppression, we tested the effect of rapamycin in ALS mice deficient of mature lymphocytes. Our results show that rapamycin moderately increases the survival of these ALS mice deficient of mature lymphocytes. Conclusions Rapamycin could suppress protective immune responses while enhancing protective autophagy reactions during the ALS disease process. While these opposing effects can cancel each other out, the use of immunodeficient mice allows segregation of effects. Our results indicate that maximal therapeutic benefit may be achieved through the use of compounds that enhance autophagy without causing immune suppression.
William Ernest Bowden Elisabeth Jean McQueen Lloyd Peter Roberts David Robertson Smith John William Woolley
Authors: D. Bowden and Robert Bowden
Journal: BMJ (2001)

After the death of his practitioner father in 1934, he took over the vacant town centre practice.Experience in general practice pre-NHS gave him an invaluable advisory role post 1948.He was police surgeon and medical officer to the fire service, and was chair of the local medical committee for 20 years.His special interest was dermatology in which he held an appointment as clinical assistant.He was president of the Merseyside branch of the BMA, and was elected a fellow in 1972.Ernest found relaxation in the countryside and his garden.Predeceased by his wife, Mary, he leaves three children and six grandchildren.
Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections
Authors: George P Schmid, Anne Buvé, Peter Mugyenyi, Geoff P Garnett, Richard J Hayes, Brian G Williams, Jesus Garcia Calleja, Kevin M De Cock, James A Whitworth, Saidi H Kapiga, Peter D Ghys, Catherine Hankins, Basia Zaba, Robert Heimer, J Ties Boerma
Journal: The Lancet (2004)
Sunitinib-Induced Pseudoprogression After Whole-Brain Radiotherapy for Metastatic Renal Cell Carcinoma
Authors: Paul J. Kelly, Stephanie E. Weiss, David J. Sher, Antonio R. Perez-Atayde, Paola Dal Cin, Toni K. Choueiri
Journal: Journal of Clinical Oncology (2010)

A now 29-year-old female originally presented in 1995 at age 15, when flank pain prompted an evaluation that revealed a large retroperitoneal mass and a distinct right kidney mass.Pathology from resection was consistent with renal cell carcinoma (RCC) with a papillary growth pattern (Fig 1).The papillae had scant fibrovascular cores and were lined by clear cells with voluminous cytoplasm (Fig 1 inset).She developed metastatic disease in 1996, which has since been managed with metastasectomies and various clinical trials.In 2008, fluorescent in situ hybridization evaluation for the TFE3 rearrangement at Xp11 was positive, confirming the diagnosis of Xp11 translocation RCC (Fig 2).In June 2009, she presented with right foot weakness.Magnetic resonance imaging (MRI) of the brain revealed eight contrast-enhancing lesions with associated vasogenic edema consistent with brain metastases, the largest of which measured 17 mm in diameter and was located in the high convexity of the left parietal lobe.Dexamethasone (DEX) therapy was initiated and whole-brain radiotherapy was administered in 2.5-Gy fractions over the course of 3 weeks to a total dose of 37.5 Gy.The patient's right foot weakness gradually resolved and she successfully tapered DEX.On completion of radiotherapy, she was maintained on 2 mg twice daily dosage of DEX.Five days after completing whole-brain radiotherapy, sunitinib was commenced for progressive extracranial disease at a dose of 50 mg once daily as part of a standard 4 week-on, 2 week-off regimen.Owing to concern regarding CYP3A4 induction with DEX, the patient's corticosteroid was changed to prednisone, again in tapering doses over several weeks.During a 3-week period after starting sunitinib, the patient developed extreme fatigue, lethargy, nausea, and vomiting
Expression of Matrix Metalloproteinases and Their Inhibitors in Medulloblastomas and Their Prognostic Relevance
Authors: Özlem Özen, Bjarne Krebs, Bernhard Hemmerlein, Arnulf Pekrun, Hans Kretzschmar, Jochen Herms
Journal: Clinical Cancer Research (2004)

Abstract Purpose and Experimental Design: The cellular mechanisms leading to metastatic disease in medulloblastoma (MB), the most common malignant brain tumor in childhood, are mainly unknown. Recently, however, the involvement of matrix metalloproteinases (MMPs) has been suggested. We examined the expression and localization of four MMPs—MMP-2 and -9, membrane-type 1 and 2 MMP (MT1- and MT2-MMP)—and correlated the data with those for their main inhibitors, tissue inhibitors of metalloproteinases (TIMP-1, -2, and -3), in 83 classical and 18 desmoplastic MBs. Results: Independent of the histological subtype, MMP-2 expression was found in a small percentage of tumors, whereas MMP-9 and MT1- or MT2-MMP were expressed in &amp;gt;75% of tumor samples. The expression of TIMP-1, -2, and -3, on the other hand, was found to depend on the histological subtype: TIMP-3 was often found in classical MB, whereas TIMP-2 was often expressed in desmoplastic MB (P = 0.007–0.001). In addition, both TIMP-3 and -2 correlated significantly with the expression of all studied metalloproteinases except MMP-2. TIMP-1, detected only in classical MB in a low percentage, was the only TIMP that correlated with the expression of MMP-2. Kaplan-Meier estimation revealed significantly reduced long-term survival of patients with strong MMP expression in tumor samples. In multivariate logistic regression analysis, however, the prognosis was significantly determined only by clinical parameters. Conclusions: TIMP-3 and -2 expression is highly correlated with histological subtypes of MBs and strongly associated with the expression of certain MMPs. The expression of TIMPs and MMPs, however, does not determine prognosis independently of clinical parameters.
Surgery With or Without Preoperative Paclitaxel and Carboplatin in Early-Stage Non–Small-Cell Lung Cancer: Southwest Oncology Group Trial S9900, an Intergroup, Randomized, Phase III Trial
Authors: Katherine M.W. Pisters, Eric Vallières, John J. Crowley, Wilbur A. Franklin, Paul A. Bunn, Robert J. Ginsberg, Joe B. Putnam, Kari Chansky, David Gandara
Journal: Journal of Clinical Oncology (2010)

PURPOSE Patients with early-stage non-small-cell lung cancer (NSCLC) have a poor prognosis even after complete resection. Earlier studies of preoperative (induction) chemotherapy in resectable NSCLC demonstrated feasibility and encouraging survival data. This randomized phase III trial compared overall survival (OS) for preoperative paclitaxel and carboplatin followed by surgery with surgery alone in patients with early-stage NSCLC. PATIENTS AND METHODS Patients with clinical stage IB-IIIA NSCLC (excluding superior sulcus tumors and N2 disease) were eligible. Patients were randomly assigned to surgery alone or to three cycles of paclitaxel (225 mg/m(2)) and carboplatin (area under curve, 6) followed by surgical resection. The primary end point was OS; secondary end points were progression-free survival (PFS), chemotherapy response, and toxicity. RESULTS The trial closed early with 354 patients after reports of a survival benefit for postoperative chemotherapy in other studies. The median OS was 41 months in the surgery-only arm and 62 months in the preoperative chemotherapy arm (hazard ratio, 0.79; 95% CI, 0.60 to 1.06; P = .11.) The median PFS was 20 months for surgery alone and 33 months for preoperative chemotherapy (hazard ratio, 0.80; 95% CI, 0.61 to 1.04; P = .10.) Major response to chemotherapy was seen in 41% of patients; no unexpected toxicity was observed. CONCLUSION This trial closed prematurely after compelling evidence supporting postoperative chemotherapy emerged. Although OS and PFS were higher with preoperative chemotherapy, the differences did not reach statistical significance. At present, stronger evidence exists for postoperative chemotherapy in early-stage NSCLC.
Eribulin Mesylate for the Treatment of Patients with Refractory Metastatic Breast Cancer: Use of a “Physician's Choice” Control Arm in a Randomized Approval Trial
Authors: Martha Donoghue, Steven J. Lemery, Weishi Yuan, Kun He, Rajeshwari Sridhara, Stacy Shord, Hong Zhao, Anshu Marathe, Lori Kotch, Josephine Jee, Ying Wang, Liang Zhou, William M. Adams, Vaishali Jarral, Anne Pilaro, Richard Lostritto, Joseph E. Gootenberg, Patricia Keegan, Richard Pazdur
Journal: Clinical Cancer Research (2012)

This work describes the considerations that led to the approval by the U.S. Food and Drug Administration (FDA), on November 15, 2010, of eribulin mesylate (Halaven; Eisai, Inc.) for the treatment of patients with refractory metastatic breast cancer. The FDA review focused primarily on the results of a single randomized, open-label, multicenter trial of 762 patients with refractory locally advanced or metastatic breast cancer. The patients were randomized to receive eribulin or any single-agent treatment of the physician's choice, selected prior to randomization. The FDA's approval of eribulin mesylate was based on demonstration of a statistically significant prolongation of overall survival (OS) in patients who had been randomized to receive eribulin. The median OS was 13.1 months in the eribulin arm compared with 10.6 months in the control arm [HR 0.81 (95% CI, 0.66-0.99); P = 0.041]. Treatment with eribulin did not show a statistically significant treatment effect [HR 0.87 (95% CI, 0.71-1.05)] on progression-free survival as determined by independent review. This approval highlights the appropriate use of an innovative trial design and shows that improvement in OS is an achievable endpoint in the setting of advanced breast cancer. On the basis of the different conclusions arising from the OS and progression-free survival results, investigators should consider using OS as a primary endpoint in clinical trials for refractory breast cancer.
Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans
Authors: A.T. Iacono, T.E. Corcoran, B.P. Griffith, W.F. Grgurich, D.A. Smith, A. Zeevi, G.C. Smaldone, K.R. McCurry, B.A. Johnson, J.H. Dauber
Journal: European Respiratory Journal (2004)

The majority of patients who develop bronchiolitis obliterans, after lung transplantation, die within 2–3 yrs after onset since treatment with conventional immunosuppression is typically ineffective. A case/control study was conducted in lung transplant recipients with biopsy-documented bronchiolitis obliterans to determine whether aerosol cyclosporin use contributed to increased survival. The cases comprised 39 transplant recipients who received open-label aerosol cyclosporin treatment in addition to conventional immunosuppression. The controls were transplant recipients treated with conventional immunosuppression alone. There were 51 controls from the University of Pittsburgh Medical Center and 100 from a large multicentric database (Novartis Lung Transplant Database). Forced expiratory volume in one second expressed as a percentage of the predicted value was an independent predictor of survival in all patients with bronchiolitis obliterans. Cox proportional-hazards analysis revealed a survival advantage for aerosol cyclosporin cases compared to the Pittsburgh control group. A survival advantage was also seen when comparing study cases to multicentric controls. Aerosol cyclosporin, given with conventional immunosuppression to lung transplant recipients with bronchiolitis obliterans, provides a survival advantage over conventional therapy alone.
Prevalence of occult inflammatory bowel disease in ankylosing spondylitis.
Authors: P B Costello, J A Alea, A C Kennedy, R T McCluskey, F A Green
Journal: Annals of the Rheumatic Diseases (1980)

Fifty-five patients with ankylosing spondylitis and 16 control patients matched for sex and age were examined for evidence of occult inflammatory bowel disease. In all patients evaluation included history and physical examination, barium enema, sigmoidoscopy, and rectal biopsy. The results of this study suggest that there is no increased prevalence of occult inflammatory bowel disease in patients with ankylosing spondylitis.
Obesity Accelerates the Progression of Coronary Atherosclerosis in Young Men
Authors: Henry C. McGill, C. Alex McMahan, Edward E. Herderick, Arthur W. Zieske, Gray T. Malcom, Richard E. Tracy, Jack P. Strong
Journal: Circulation (2002)

Background — Obesity is a risk factor for adult coronary heart disease and is increasing in prevalence among youths as well as adults. Results regarding the association of obesity with atherosclerosis are conflicting, particularly when analyses account for other risk factors. Methods and Results — The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study collected arteries, blood, and other tissue from ≈3000 persons aged 15 to 34 years dying of external causes and autopsied in forensic laboratories. We measured gross atherosclerotic lesions in the right coronary artery (RCA), American Heart Association (AHA) lesion grade in the left anterior descending coronary artery (LAD), serum lipid concentrations, serum thiocyanate (for smoking), intimal thickness of renal arteries (for hypertension), glycohemoglobin (for hyperglycemia), and adiposity by body mass index (BMI) and thickness of the panniculus adiposus. BMI in young men was associated with both fatty streaks and raised lesions in the RCA and with AHA grade and stenosis in the LAD. The effect of obesity (BMI&gt;30 kg/m 2 ) on RCA raised lesions was greater in young men with a thick panniculus adiposus. Obesity was associated with non-HDL and HDL (inversely) cholesterol concentrations, smoking (inversely), hypertension, and glycohemoglobin concentration, and these variables accounted for ≈15% of the effect of obesity on coronary atherosclerosis in young men. BMI was not associated with coronary atherosclerosis in young women although there was trend among those with a thick panniculus adiposus. Conclusions — Obesity is associated with accelerated coronary atherosclerosis in adolescent and young adult men. These observations support the current emphasis on controlling obesity to prevent adult coronary heart disease.
Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis
Authors: C Hassan, A Repici, P Sharma, L Correale, A Zullo, M Bretthauer, C Senore, C Spada, Cristina Bellisario, P Bhandari, D K Rex
Journal: Gut (2015)

<h3>Objective</h3> To assess the efficacy and safety of endoscopic resection of large colorectal polyps. <h3>Design</h3> Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966–2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I<sup>2</sup> statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. <h3>Results</h3> 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I<sup>2</sup>=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I<sup>2</sup>=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). <h3>Conclusions</h3> Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
Ring around the Diagnosis
Authors: Maria-Fernanda Bonilla, Daniel R. Kaul, Sanjay Saint, Carlos M. Isada, Daniel J. Brotman
Journal: New England Journal of Medicine (2006)

A 71-year-old retired schoolteacher from rural Ohio presented to his local hospital with a two-week history of malaise, fever, anorexia, chills, and sweats. He had not had a cough or symptoms involving the upper respiratory, gastrointestinal, or urinary tract.