tbuckley/cabot-search huggingface dataset:
Trabecular Bone Score in Patients With Chronic Glucocorticoid Therapy–Induced Osteoporosis Treated With Alendronate or Teriparatide
Authors: Kenneth G. Saag, Donato Agnusdei, Didier Hans, Lynn A. Kohlmeier, Kelly D. Krohn, Edward S. Leib, Edmund J. MacLaughlin, Jahangir Alam, Christine Simonelli, Kathleen A. Taylor, Robert Marcus
Journal: Arthritis & Rheumatology (2016)

Objective To determine the effect of alendronate (ALN) and teriparatide on trabecular bone score (TBS) in patients with glucocorticoid‐induced osteoporosis. Methods Patients with chronic glucocorticoid therapy–induced osteoporosis (median 7.5 mg/day prednisone equivalent for ≥90 days) were randomized to receive oral ALN 10 mg/day (n = 214) or subcutaneous teriparatide 20 μg/day (n = 214) for 36 months; 118 patients in the ALN group and 123 patients in the teriparatide group completed treatment. Dual x‐ray absorptiometry (DXA) results for 53 patients receiving ALN and 56 patients receiving teriparatide who had DXA scans with adequate resolution to perform TBS analysis and completed 36 months of therapy were blindly analyzed for TBS at baseline and 3, 6, 12, 18, 24, and 36 months. Results In teriparatide‐treated patients, TBS was significantly increased at 18 months compared to baseline, and by 36 months had increased 3.7% ( P &lt; 0.05). In ALN‐treated patients, there was not a significant change in TBS compared to baseline at any time point. Changes in lumbar spine bone mineral density (BMD) measured by DXA in the subgroup with TBS data were similar to BMD results in the overall study population. At 36 months, increases in lumbar spine BMD were 5.5% and 10.3% in patients treated with ALN and teriparatide, respectively. Conclusion In patients with glucocorticoid‐induced osteoporosis, both ALN and teriparatide increased lumbar spine BMD. However, trabecular bone score significantly increased with teriparatide but did not significantly change with ALN. The pathogenesis of glucocorticoid‐induced osteoporosis is predominantly reduced bone formation. TBS may represent a sensitive measure to discriminate treatment effects of an anabolic versus an antiresorptive drug in glucocorticoid‐induced osteoporosis.
TCTAP A-097 Impact of Strain Analysis in Ergonovine Stress Echocardiography Undertaken During Ergonovine Coronary Angiography for Diagnosis Vasospastic Angina
Authors: Sang Jin Ha, Won-Kyung Lee, Yeo-Jeong Song, Woo Dae Bang, Sang-Yong Yoo, Sangsig Cheong
Journal: Journal of the American College of Cardiology (2016)
Association of Osteoarthritis With Increased Risk of Cardiovascular Diseases in the Elderly: Findings From the Progetto Veneto Anziano Study Cohort
Authors: Nicola Veronese, Caterina Trevisan, Marina De Rui, Francesco Bolzetta, Stefania Maggi, Sabina Zambon, Estella Musacchio, Leonardo Sartori, Egle Perissinotto, Gaetano Crepaldi, Enzo Manzato, Giuseppe Sergi
Journal: Arthritis & Rheumatology (2015)

Objective The possible relevance of osteoarthritis (OA) as a cardiovascular disease (CVD) risk factor is still debated. The aim of this study was to investigate the association between OA and the onset of CVD in older individuals. Methods Among a sample of 3,099 elderly subjects, 2,158 were identified as having no CVD at baseline and were followed up for a mean ± SD 4.4 ± 1.2 years. OA was defined using a standardized algorithm that investigated disease history, medical documentation (including radiographic reports), symptoms, and physical examination of the joints. Incident CVD was defined as the onset of coronary artery disease, heart failure, stroke/transient ischemic attack, peripheral artery disease, and CVD‐related hospitalization or mortality. Results At baseline, 1,336 (61.9%) of the 2,158 study participants had OA. Participants with OA had more potential CVD risk factors, including obesity, hypertension, high levels of low‐density lipoprotein, greater severity of inflammation, and worse renal function, than did those without OA. During the follow‐up, 47.8% of the subjects with OA developed a new CVD event, compared to 41.3% of those without OA. Using an adjusted Cox regression analysis, the presence of OA significantly increased the risk of CVD (hazard ratio 1.22, 95% confidence interval 1.02–1.49; P = 0.04). The association between OA and CVD was stronger when the hip or knee was affected, and also was stronger in women than in men and when ≥2 joints were involved. Considering single CVD outcomes, the presence of OA significantly increased the risk of new coronary artery disease, heart failure, and hospitalization for CVD. Conclusion OA may be a significant predictor of the onset of CVD in elderly individuals, particularly in women with OA and when OA affects the lower limbs or ≥2 joints are involved.
Does Abdominal Aortic Aneurysm Screening Save Lives?
Authors: Frank A. Lederle
Journal: JAMA Surgery (2016)

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Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States
Authors: Cora L. Bernard, Margaret L. Brandeau, Keith Humphreys, Eran Bendavid, Mark Holodniy, Christopher Weyant, Douglas K. Owens, Jeremy D. Goldhaber-Fiebert
Journal: Annals of Internal Medicine (2016)

The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear.To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID.Empirically calibrated dynamic compartmental model.Published literature and expert opinion.Adult U.S. PWID.20 years and lifetime.PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage.Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years.Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence.Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited.PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained.National Institute on Drug Abuse.
Soundings: In committee
Authors: George Dunea
Journal: BMJ (2004)

Americans love committees more than any other people in the world. As an instrument of participatory democracy with opportunities for debate, discussion, dissension, and compromise, committees pervade all aspects of American life, from 5 year olds assigned to committees in kindergarten to the two houses of Congress passing widely disparate bills and then meeting in a joint conference committee to iron out differences.

Committees enable executives to receive input, obstruct, procrastinate, or fill in a boring day with nothing else to do. For some doctors committees provide relief from seeing an interminable succession of patients in the clinic. Hospitals have medical committees on quality, drug use, drug formulary, blood banking, intensive care, or tracheostomies, all reporting to the executive medical staff committee. Social clubs have committees for art, literature, sports, finance, and housekeeping. High-rise condominium buildings have committees for beautification, canopy and building facade, finance, employee protocol, infrastructure, and security.

You can often tell people's real personalities from how they behave in committees—that is, if you cannot watch them play football. Some people are effective in committee, others less so. A BMJ obituary once said about the deceased that “in committee he was not too effective.”

In universities the promotion committee is all-important for achieving rank and tenure. It has strict criteria for promotion at every level, to be deviated from only for political reasons. Some universities have separate tracks for professors of medicine (great research), professors of clinical medicine (not quite so great), and clinical professors (merely come to teach). Committees pay lip service to clinical excellence and teaching but really care only about publications and grants. The documentation required at higher ranks can be enormous. Applications weighing less than 100 g are unlikely to succeed.

Most candidates for promotion will have published on different subjects, but this is not always so. I remember one candidate, an infectious disease specialist, who had written much, but only about one fungal disease. Whereupon an aging professor who had slumbered through most of the discussion suddenly came to life and interjected, “But does he know how to treat the clap?”
AERO-B03: A randomized phase II trial of dose-dense docetaxel in node-positive breast cancer
Authors: P.-P. Piedbois, D. Serin, F. Priou, P. Laplaige, S. Greget, E. Angellier, E. Teissier, J. F. Berdah, M. Fabbro, B. Valenza
Journal: Journal of Clinical Oncology (2005)

647 Background: Administration of taxanes every 2 weeks (q2w), or “dose dense therapy”, is one of the most promising chemotherapy regimens in node positive (N+) breast cancer. AERO-B03 is a randomized phase II trial designed to assess the feasibility of docetaxel dose dense regimens in this setting. Methods: From December 2003 to September 2004, 100 patients (pts) with N+ breast cancer were randomized to receive 6 TEC (docetaxel 75 mg/m2, epirubicin 75 mg/m2 and cyclophosphamide 500 mg/m2 q3w) (control), 4 EC (epirubicin 100 mg/m2 and cyclophosphamide 600 mg/m2 q2w) followed by 4 T (docetaxel 100 mg/m2 q2w) (dose dense A) or 4 T followed by 4 EC (dose dense B). Pegfilgrastim was administered on day 2 of each cycle. Primary endpoint was grade 4 (G4) toxicity. Any of the 3 arms would be rejected from further study if G4 ≥ 50%. Data were reviewed by an independent safety monitoring committee. Results: Preliminary results are based on the first 61 pts (21 pts in control, 21 pts in dose dense A, and 19 in dose dense B). Pt characteristics were well balanced between the 3 arms: median age 55 [31–74], pT1 51%, pT2 46%, pT3 3%, pN1 80%, pN2 18%, pN3 2%, conservative surgery in 74%. No toxic deaths were reported. One pt who refused chemotherapy (dose dense A), and another without follow-up (dose dense B) were excluded. Treatment was discontinued for personal reasons in 1 pt in each arm, and for toxicity in 1 pt in dose dense A, and 2 in dose dense B. Mean dose intensities (mg/m2/w) were 24, 43 and 43 for docetaxel, 24, 47 and 47 for epirubicin, and 163, 279, and 278 for cyclophosphamide in control, dose dense A and dose dense B respectively. G4 toxicity (% pts) was reported in 33, 35, and 22 (control, dose dense A, dose dense B respectively). G3–4 toxicity rates were 52, 70, and 78, consisting mainly of neutropenia (38, 35, 33), cutaneous toxicity (0, 20, 28), hand foot syndrome (0, 25, 33), neurotoxicity (0, 15, 6), and nausea (0, 15, 6). Febrile neutropenia was infrequent (14%, 5% and 0% of pts). Conclusions: Toxicity of docetaxel dose dense arms is consistent with our initial expectations. Based on the study design, both dose dense regimens seem suitable for a future phase III trial. Final results will be presented during the meeting. Trial supported by Sanofi-Aventis and Amgen. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration sanofi-aventis sanofi-aventis sanofi-aventis
Staff shortages are putting UK breast cancer screening “at risk,” survey finds
Authors: Anne Gulland
Journal: BMJ (2016)

The Royal College of Radiologists has warned of a “looming crisis” in breast cancer screening in the United Kingdom after a workforce survey showed that more than a 10th of consultant breast radiologist posts were unfilled.

The survey, which covers 65% of breast cancer screening units and 30% of radiology departments in the UK, showed that 13% of consultant breast radiologist posts across the UK were empty, double the figure in 2010.1 Though the figure relates only to units that responded, it mirrors the national picture, said the college.

The region with the lowest fill rate was the south east of England, where …
Medicine and multimedia: Where There Is No Doctor: A Village Health Care Handbook for Africa
Authors: Haroon Saloojee
Journal: BMJ (1998)

David Werner, Carol Thuman, Jane Maxwell


Macmillan Education, £7.25, pp 446 




ISBN 0 333 51652 4

———————

Rating: ★★★★

Chances are that if you visited a remote district hospital in a developing country you would find a well thumbed copy of Where There Is No Doctor in its library. The book is intended primarily for village health workers, but generations of doctors and medical missionaries who have worked in underresourced communities globally will vouch for its value in providing concise reliable information.

This book is an all time medical favourite. It has been translated into over 50 languages since its initial publication in Spanish more than two decades ago, and it is still listed among the top 200 bestsellers by a popular internet bookstore. It has also found favour among writers of travel guides (as the ideal medical guide for today’s global traveller), experts in military survival, parents, and teachers.

Much of the book’s attraction lies in the simple illustrations that complement the clear, concise text. It has the easy to read appeal of a comic book. Although the emphasis is on the prevention, diagnosis, and management of illnesses found in poorer communities, the authors’ commonsense approach makes it equally useful to a villager as to any sophisticated city dweller with no medical background.

The book’s scope extends beyond just dealing with diseases to issues such as home cures, popular beliefs, healing without modern medicines (including the “right and wrong” use of them), and community development such as advice on how to build pit latrines.

Werner believes that people can and should take the lead in their own health care. However, he has an idealistic view of the community health worker and adopts a preaching tone when advocating values such as “work for the joy of it.” My experience is that these workers may be more materialistic and less compassionate today.

The book does have deficiencies. In the era of evidence based medicine, can the use of a soap enema for constipation still be acceptable? And who would recommend salt for heat cramps? A major revision is due—this was last done in 1993—to encompass newer knowledge. More space should be given to HIV and AIDS, particularly to issues relating to preventing transmission from mother to child. As a paediatrician, I would also like to see the WHO guidelines on acute respiratory infections incorporated into the text. Greater emphasis on the role of vitamin A and other micronutrients, and modifications to the recommendations about antibiotics, could only enhance its established status.
A systems <scp>BIOlogy</scp> Study to <scp>TAilored</scp> Treatment in Chronic Heart Failure: rationale, design, and baseline characteristics of <scp>BIOSTAT‐CHF</scp>
Authors: Adriaan A. Voors, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Pim van der Harst, Hans L. Hillege, Chim C. Lang, Jozine M. ter Maaten, Leong Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Faiz Zannad, Aeilko H. Zwinderman, Marco Metra
Journal: European Journal of Heart Failure (2016)
Anthraquinones As Pharmacological Tools and Drugs
Authors: Enas M. Malik, Christa E. Müller
Journal: Medicinal Research Reviews (2016)

Abstract Anthraquinones (9,10‐dioxoanthracenes) constitute an important class of natural and synthetic compounds with a wide range of applications. Besides their utilization as colorants, anthraquinone derivatives have been used since centuries for medical applications, for example, as laxatives and antimicrobial and antiinflammatory agents. Current therapeutic indications include constipation, arthritis, multiple sclerosis, and cancer. Moreover, biologically active anthraquinones derived from Reactive Blue 2 have been utilized as valuable tool compounds for biochemical and pharmacological studies. They may serve as lead structures for the development of future drugs. However, the presence of the quinone moiety in the structure of anthraquinones raises safety concerns, and anthraquinone laxatives have therefore been under critical reassessment. This review article provides an overview of the chemistry, biology, and toxicology of anthraquinones focusing on their application as drugs.
Case 3-1979
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely
Journal: New England Journal of Medicine (1979)

Presentation of Case A 27-year-old man was admitted to the hospital because of circulatory collapse. He was well until 12 days earlier, when he became obstipated. Three days later abdominal pain de...
The Net Chance of a Longer Survival as a Patient-Oriented Measure of Treatment Benefit in Randomized Clinical Trials
Authors: Julien Péron, Pascal Roy, Brice Ozenne, Laurent Roche, Marc Buyse
Journal: JAMA Oncology (2016)

Time to events, or survival end points, are common end points in randomized clinical trials. They are usually analyzed under the assumption of proportional hazards, and the treatment effect is reported as a hazard ratio, which is neither an intuitive measure nor a meaningful one if the assumption of proportional hazards is not met.To demonstrate that a different measure of treatment effect, called the net chance of a longer survival, is a meaningful measure of treatment effect in clinical trials whether or not the assumption of proportional hazards is met.In this simulation study, the net chance of a longer survival by at least m months, where m months is considered clinically worthwhile and relevant to the patient, was calculated as the probability that a random patient in the treatment group has a longer survival by at least m months than does a random patient in the control group minus the probability of the opposite situation. The net chance of a longer survival is equal to zero if treatment does not differ from control and ranges from -100% if all patients in the control group fare better than all patients in the treatment group up to 100% in the opposite situation. We simulated data sets for realistic trials under various scenarios of proportional and nonproportional survival hazards and plotted the Kaplan-Meier survival curves as well as the net chance of a longer survival as a function of m. Data analysis was performed from August 14 to 18, 2015.The net chance of a longer survival calculated for values of m ranging from 0 to 40 months.When hazards are proportional, the net chance of a longer survival approaches zero as m increases. The net chance of a longer survival (Δ) was 13% (95% CI, 6.5%-19.4%; P < .001) when any survival difference was considered clinically relevant (m = 0 months). When survival differences larger than 20 months were considered relevant (m = 20), the net chance of a longer survival was very close to zero (Δ[20] = 0.5%; 95% CI, -0.1% to 1.1%; P = .09). In contrast, when treatment effects are delayed or when some patients are cured by treatment, the net chance of a longer survival benefit remains high and tends to the cure rate. For crossing hazards, the Δ was negative (Δ = -6.9%; 95% CI, -14.0% to -0.5%; P = .047). However when large survival differences were considered (m = 20), the Δ(m) was positive (Δ[20] = 8.9%; 95% CI, 6.7%-11.1%; P < .001).The net chance of a longer survival is useful whether or not the assumption of proportional hazards is met in the analysis of survival end points and may be helpful as a measure of treatment benefit that has direct relevance to patients and health care professionals.
Soundings: Good advice?
Authors: Liam Farrell
Journal: BMJ (2002)

To paraphrase La Rochefoucauld, “There is something in the misfortune of other doctors that is not entirely unpleasant.” Just as with a tip for the horses, the responsibility for advice lies not with the donor but with the recipient; words are cheap, and ultimately it's your choice whether to act on them or not.

On my first night as casualty officer, as green as the water meadows of Alt-na-Brocaidh after the farmers have thoughtfully dumped fertiliser upriver, a young man was brought in unconscious. In those days I was quite thorough (I've matured since), so—among other things (such as pressing knuckles on his sternum to check he wasn't faking)—I ordered a drug screen.

I then received a call from the lab technician who explained politely that it was not lab policy to perform drug screens on unconscious patients without certain other indications. They had a protocol, she said. I can't remember what these indications were, but in those days protocols were new fangled and sounded quite impressive.

In those days, also, I was easily persuadable (I've matured since), which is usually a virtue and especially so in Northern Ireland, so I accepted this explanation. But when I described what had happened over coffee to the medical reg who'd been working there for donkey's years, he bristled with rage.

“I'm sick of those bastards,” he said, spitting at a passing porter, “What do lab techs know about patient care? That guy is your patient, you are the doctor, you are on the front line, you make the decisions; you are responsible, if something goes wrong it won't be the lab tech who gets the blame. The buck stops with you, and if you think you need a drug screen, damn well order it.” He stopped short of waving the Stars and Stripes and shouting, “You da man, you're bad,” but it was pretty rousing stuff.

Once again easily persuaded (sometimes this is not such a virtue), I rang back the lab tech and damn well ordered the drug screen done stat with no arguments and no messing, right? I was the doctor, he was my patient etc.

A few minutes later, the casualty sister came in and, portentously discreet, whispered deafeningly and rather moistly in my ear that the professor of chemical pathology wanted to speak to me at once.

“F***,” said the reg, making the traditional medical handwashing gesture, “you're in big trouble now.”