tbuckley/cabot-search huggingface dataset:
Measuring outcomes in economic evaluations
Authors: S. Dixon, C. Green, D. J Torgerson
Journal: BMJ (1999)

Editor—The series of occasional notes on economics has undoubtedly helped clinicians to understand the key concepts and jargon used by economists. The note discussing the use of outcome measures in economic evaluation is, however, misleading.1

Firstly, condition specific outcome measures and generic quality of life scales should not, in general, be used in cost effectiveness analysis.2 The primary reason for this is that such scales do not have the requisite interval properties. The scores produced by the short form-36 questionnaire (SF-36), for example, are little more than transformed ordinal rankings.

Even if interval properties can be shown, the use of generic quality of life scales in cost effectiveness analysis is severely restricted by their production of a set of scores reflecting different domains of health. For example, if the SF-36 is used in an evaluation, it can produce conflicting cost effectiveness ratios with respect to its various dimension scores.2 It is best to restrict the set of outcome measures appropriate for cost effectiveness analysis to those measured in natural units.3 Following such an approach would limit the direct use of health scales to cost consequences analyses—that is, the presentation of cost and outcome data in a disaggregated format.4

Secondly, the paper restricts its commentary on cost utility analysis to the use of utility based quality of life scales as the measure of outcome. Use of such scales is increasing and will become the dominant form of utility measurement in clinical research. However, health state valuation techniques, such as the standard gamble and the time trade off,5 may be used to produce study specific utility values. Such techniques are also the basis for the values awarded by the utility scales.

Thirdly, the economics note should point out that the use of willingness to pay and conjoint analysis is developmental, and their use in cost benefit analysis (as opposed to simple investigation of the patient’s preferences) is extremely rare. It should also be noted that both of these approaches are valuation techniques, as opposed to outcome measures. As such, they can be used only if the effects or characteristics of the interventions have already been measured.

We recognise that this series of short articles must simplify important issues to remain concise. As it stands, however, this economics note is likely to mislead readers regarding good practice and commonly accepted practice.
Abstract P1-02-07: Contrast-enhanced ultrasound for evaluation of therapeutic efficacy of radiofrequency ablation for primary breast cancer
Authors: Toshikazu Ito, Jyunji Okayama, Kumiko Uji, Masaaki Izukura
Journal: Cancer Research (2015)

Abstract &amp;lt;Purpose&amp;gt; To evaluate therapeutic efficacy of percutaneous ultrasound (US) guided radiofrequency (RF) ablation therapy for primary breast cancer using contrast-enhanced US. &amp;lt;Methods and Materials&amp;gt; The study was approved by the institutional ethics committee, and written informed consent was obtained. Between January 2012 and April 2014, 25 patients with biopsy-confirmed T1 breast cancer underwent RF ablation therapy in one institution. We examined 25 patients with 25 T1 breast cancers by contrast-enhanced MRI/CT, and contrast-enhanced US before and after RF ablation therapy. US guided RF abltion was performed using a 17-gauge internally cooled electrode (Cool-TipTM, Valleylab, Boulder, CO, USA) under general anesthesia. After injection 0.015mL/kg body weight of Sonazoid®(perflubutane), contrast-enhanced US was performed at a low mechanical index (0.17-0.24). Therapeutic success was defined as a lack of contrast enhancement by contrast-enhanced MRI, US and non-viable cancer tissues by US guided vacuum assisted biopsy (VAB) or core needle biopsy (CNB). &amp;lt;Results&amp;gt; Contrast-enhanced US and MRI four weeks or more after RF ablation therapy showed ablation zones and adequate tumor necrosis in all 25 cancer lesions treated. Contrast-enhanced US made it possible to see that tumor vessels of treated lesions had disappeared after treatment. Contrast enhanced MRI showed a lack of stain with ring-like enhancement of ablation zone and non-viable tissues were seen by VAB and/or CNB in 25 ablation zones. &amp;lt;Conclusion&amp;gt; Contrast-enhanced US using Sonazoid® was useful modalities for evaluating the efficacy of RF ablation therapy in breast cancer lesions. Citation Format: Toshikazu Ito, Jyunji Okayama, Kumiko Uji, Masaaki Izukura. Contrast-enhanced ultrasound for evaluation of therapeutic efficacy of radiofrequency ablation for primary breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-07.
FDG PET but not RECIST agrees with histologic response of soft tissue sarcoma to neoadjuvant chemotherapy
Authors: S. M. Schuetze, J. F. Eary, K. A. Griffith, B. P. Rubin, D. S. Hawkins, C. B. Vernon, G. N. Mann, E. U. Conrad
Journal: Journal of Clinical Oncology (2005)

9005 Background: Criteria for tumor response that rely on changes in size may underestimate the true response rate in soft tissue sarcomas (STS). We report an interim analysis of a prospective study to compare STS response by RECIST and FDG PET after 2 and 4 cycles of doxorubicin and ifosfamide (A/I) with histologic response after 4 cycles of A/I. Methods: Patients with localized, high-grade STS received 4 cycles of neoadjuvant A/I, tumor resection, 2 cycles of adjuvant A/I and radiation. A MRI or CT scan and FDG PET scan of the STS were done at diagnosis, after 2 and 4 cycles of A/I. Histologic response was determined after the 4th cycle of A/I unless the sarcoma was progressive unequivocally after the 2nd cycle. Response was dichotomized into good vs poor, respectively, as follows: RECIST (complete or partial response vs stable or progressive disease), FDG PET (≥ vs < 40% decline in the tumor maximum standardized uptake value (SUV)) and histology (≤ vs > 10% residual viable tumor). McNemar’s test of dependent proportions was used to determine agreement between methods of response assessment. Results: STS was resected after 2 cycles of A/I in 8 patients because of disease progression and resected after 4 cycles of A/I in 33 patients. All 8 of the sarcomas resected after 2 cycles showed poor histologic response and an increase in the tumor SUV (n=5) or progression by RECIST (n=3). Among 11 patients with a good histologic response, 8 had a good PET response and 1 a response by RECIST. Among 30 patients with a poor histologic response, 20 had a poor PET response and 30 did not have a response by RECIST. Response assessment by FDG PET after the 2nd and 4th cycles was similar. RECIST response after the 2nd cycle of A/I and histologic response were not in agreement (P=0.002), whereas the FDG PET response after the 2nd cycle of A/I did not disagree with histologic response (P=0.092). Conclusions: RECIST is not indicative of histologic response in high-grade STS treated with A/I. Response by FDG PET after 2 cycles of A/I may provide evidence of drug activity. This study is ongoing and will evaluate relationships between FDG PET, RECIST and histologic responses and outcome. Supported by NIH/NCI CA 65537. No significant financial relationships to disclose.
Safety and Efficacy of Low Blood Pressures Among Patients With Diabetes
Authors: Josep Redon, Giuseppe Mancia, Peter Sleight, Helmut Schumacher, Peggy Gao, Janice Pogue, Robert Fagard, Paolo Verdecchia, Michael Weber, Michael Böhm, Bryan Williams, Khalid Yusoff, Koon Teo, Salim Yusuf
Journal: Journal of the American College of Cardiology (2011)
Reply to Villanacci et al.
Authors: Marietta Iacucci, Xianyong Gui, Subrata Ghosh
Journal: Endoscopy (2015)

We appreciate the comments of Villanacci et al. [1], as we believe that this discussion will be useful to the readers of Endoscopy. We completely agree that a detailed histological scoring system is designed for research purpose only, and it is particularly suitable for a study of mucosal healing because it is expected to reflect the minor residual histological changes. It is too complex for daily routine practice. Our study was designed to establish that even patients with a Mayo endoscopic subscore of 0 have subtle endoscopic and histological abnormalities, the significance of which remains to be established. A simple histological scoring scheme suitable for daily diagnostic work-up would likely miss many subtle histological abnormalities of both active and inactive disease.
Psychiatry's Part in Preventive Medicine
Authors: Arthur H. Ruggles
Journal: Annals of Internal Medicine (1929)

Article1 October 1929Psychiatry's Part in Preventive MedicineARTHUR H. RUGGLESARTHUR H. RUGGLESSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-3-4-366 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptUp to about fifteen years ago, psychiatry did very little that was actively preventive; its concern was largely with classification, the improvement in methods of treatment and the discussion of heredity vs. environment. With the advent of the Wasserman and the treatment of General Paresis with the arsenicals, and with the more general employment of lumbar puncture, Psychiatry learned that no case of syphilis could be considered permanently immune from neuro-syphilis unless repeated negative blood Wassermans were obtained following intensive intravenous therapy, and more especially unless it was determined over a period of at least two years following infection that... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Providence, Rhode Island*Read before the Boston meeting of the American College of Physicians, April 10, 1929. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 October 1929Volume 3, Issue 4Page: 366-370KeywordsBloodHeredityLumbar puncturePreventive medicineSyphilis ePublished: 1 December 2008 Issue Published: 1 October 1929 PDF downloadLoading ...
Abstract 12473: A Novel Selective EP4 Receptor Agonist Improves Intracellular Ca2+ Handling and Cardiomyocyte Function in Intact Failing Cardiomyocytes
Authors: Wakako Murakami, Shigeki Kobayashi, Takeki Myoren, Shigehiko Nishimura, Takayoshi Kato, Masakazu Fukuda, Makoto Ono, Hiroki Tateishi, Mamoru Mochizuki, Tetsuro Oda, Shinichi Okuda, Takeshi Yamamoto, Masafumi Yano
Journal: Circulation (2013)

Background: Prostaglandin E2 (PGE2) has four receptor subtypes, EP1-EP4. EP4 is reported to be a dominant receptor subtype expressed in cardiac tissue. However, the precise role of EP4 receptor in ...
Outcome and family study of the subtypes of schizophrenia in the west of Ireland
Authors: K S Kendler, M McGuire, A M Gruenberg, D Walsh
Journal: American Journal of Psychiatry (1994)

The authors sought to clarify differences in outcome and familial psychopathology among the classical subtypes of schizophrenia.In the epidemiologically based Roscommon Family Study, personal interviews were conducted with 88% of traceable living probands (N = 415) an average of 16 years after illness onset and with 86% of traceable living first-degree relatives (N = 1,753). Probands meeting the DSM-III-R criteria for schizophrenia were subtyped by DSM-III-R and ICD-9.By both diagnostic systems, age at onset differed significantly across subtypes, being earliest in the subjects with the hebephrenic and catatonic subtypes and latest in the paranoid subjects. The probands with the paranoid subtype had substantially better outcome, especially in occupational functioning and capacity for self-care. The DSM-III-R criteria for paranoid schizophrenia were considerably more successful than the ICD-9 criteria in selecting good-outcome cases. Neither the risk for schizophrenia nor the risk for schizophrenia spectrum disorders significantly differed in relatives as a function of the proband subtype. The subtypes of schizophrenia did not "breed true" within families.Paranoid schizophrenia, especially when narrowly defined, as in DSM-III-R, has a substantially better outcome than other subtypes. From a familial perspective, 1) paranoid schizophrenia is not a milder form of schizophrenia and 2) catatonic schizophrenia is probably closely related to typical schizophrenia. The subtypes of schizophrenia are not, from a familial perspective, etiologically distinct syndromes.
Improvement of endothelial function and insulin sensitivity with vitamin C in patients with coronary spastic angina
Authors: Osamu Hirashima, Hiroaki Kawano, Takeshi Motoyama, Nobutaka Hirai, Masamichi Ohgushi, Kiyotaka Kugiyama, Hisao Ogawa, Hirofumi Yasue
Journal: Journal of the American College of Cardiology (2000)
Abstract 1381: Novel Role of Extracellular SOD as a Positive Regulator for H2O2-dependent VEGF Signaling Linked to Angiogenesis in Endothelial Cells
Authors: Jin Oshikawa, Ha Won Kim, Nikolay A Patrushev, Ronald McKinney, Tohru Fukai, Masuko Ushio-Fukai
Journal: Circulation (2008)
Homicide and depression
Authors: Milton Rosenbaum, Binni Bennett
Journal: American Journal of Psychiatry (1986)

The relationship of depression to homicide has been overlooked in clinical psychiatry. The authors report on six homicidal depressed control compare them with nonhomicidal depressed control subjects. They also analyze data from 81 case summaries found elsewhere in the literature. Their preliminary data suggest that homicidal depressed patients are more likely to have a personality disorder, to have been physically abused as a child, to abuse alcohol or drugs, and to be suicidal than are nonhomicidal depressed patients. In homicidal patients, the event precipitating the depression is more likely to be sexual infidelity, either real or fantasized.
The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services
Authors: L R Landerman, B J Burns, M S Swartz, H R Wagner, L K George
Journal: American Journal of Psychiatry (1994)

This study investigated how insurance coverage for mental health services affects outpatient mental health service utilization among those with and among those without a DSM-III psychiatric diagnosis. The authors used a representative community sample to compare the regression effects of insurance coverage on utilization of mental health services among these subjects.Data are from the second wave of the Piedmont, North Carolina, site of the Epidemiologic Catchment Area project. These data contain DSM-III diagnostic measures derived from the National Institute of Mental Health Diagnostic Interview Schedule as well as measures of insurance coverage and utilization. Responses from 2,889 community residents were analyzed using both ordinary least squares and logistic regression.In both models, insurance coverage was strongly associated with care among those with as well as among those without a psychiatric disorder. The association between coverage and the probability of care was strongest among those with a disorder.The findings are not consistent with the claim that failing to provide insurance coverage will reduce discretionary but not necessary mental health care utilization. They provide evidence that failing to provide insurance coverage will reduce utilization as much or more among those with a psychiatric disorder as among those without. This result has important implications for health care reform.
Phase I trial of lestaurtinib for children with refractory neuroblastoma (NB): A New Approach to Neuroblastoma Therapy (NANT) Consortium study.
Authors: J. E. Minturn, J. Villablanca, G. A. Yanik, J. R. Park, S. G. Groshen, E. T. Hellriegel, D. Bensen-Kennedy, K. K. Matthay, G. M. Brodeur, J. M. Maris
Journal: Journal of Clinical Oncology (2010)

9532 Background: TrkB acts as an oncogenic kinase in a subset of human NB. Lestaurtinib, a multi-kinase inhibitor with potent activity against Trk kinases, has demonstrated anti-tumor activity in preclinical models of human NB. Methods: We performed a Phase I trial of Lestaurtinib in patients with recurrent or refractory high-risk neuroblastoma starting at 80% of the adult recommended Phase II dose. Subjects received lestaurtinib twice daily for five days on, two days off continuous dosing. Lestaurtinib dose was escalated using a 3+3 design. Pharmacokinetics and plasma phospho-TrkB inhibitory activity were evaluated in the first cycle defined as 28 days. Response data were obtained after the first and then every other cycle. Results: Forty-seven patients were enrolled, and 10 dose levels explored starting at 25 mg/m2/dose BID, with 42 patients evaluable for dose escalation and 47 patients evaluable for response. Asymptomatic and reversible gr 3-4 transaminase elevation was dose limiting in 4 patients. Pancreatitis (gr 2) was observed in 3 patients after prolonged treatment (≥5 cycles) at dose levels ≥5 and considered possibly related to drug. Symptoms resolved with discontinuation or dose reduction. Other toxicities were mild and reversible. Pharmacokinetic analyses indicate that drug is rapidly absorbed in children, however systemic exposure (Cmax and AUC on d1, Ctrough on d5 and d26) did not consistently increase with increasing dose, and inter-patient variability was large. Plasma inhibition of phospho-TrkB activity was observed 1 hour post-dosing at 85 mg/m2 with uniform inhibition at 120 mg/m2. There were two objective responses and 10 patients had prolonged stable disease at dose levels ≥5, (median: 12 cycles) before disease progression (pending review). A biologically effective and recommended phase II dose of 120 mg/m2/dose BID was established. Conclusions: Lestaurtinib was well tolerated in this heavily pre-treated patient group with refractory NB, and a dose level required to provide enough free drug to inhibit TrkB activity was established. Safety and signs of activity at the higher dose levels warrants further evaluation of this drug or other Trk-directed therapies in NB. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Cephalon Cephalon Cephalon
Environmental lead and children's intelligence
Authors: H. L Needleman
Journal: BMJ (1995)

Nearly half the sample favoured maintenance prescription of injectable opiates.The inevitable outcome of such practices is illicit selling on of drugs, with accidental overdoses and deaths.Indeed, much prescribed oral methadone ends up on the streets and already seems to play a part in accidental deaths.The emergence of "dual diagnosis" patients, with both mental disorder and substance misuse, highlights the importance of psychiatric input to drug services.Although the Health of the Nation recommends consultation with users and carers, it does not suggest that services should be designed solely to satisfy consumers' preference or convenience.'Planning of services should be based on good evidence and sound clinical practice.
New dawn for Botswana. Offering free HIV treatment -- and hope.
Authors: Stephenson J
Journal: JAMA (2004)

Although the prevalence of HIV/AIDS in Botswana is one of the highest in the world with infection estimates of about 37.4% of adults a public- private partnership for addressing the epidemic has brought  hope to the country. One critical component of the African Comprehensive HIV/AIDS Partnerships (a collaboration between Botswanas government the Bill & Melinda Gates Foundation and the Merck Foundation/Merck & Co Inc) is Masa (a Setswana word meaning new dawn) an ambitious program involving offering free antiretroviral drugs to all Botswana citizens who require treatment (http://www.achap.org/MASA.htm). Overseeing Masas efforts is Ernest Darkoh MD MPH an American-born son of Ghanian parents who grew up in Africa and later received his medical and public health degrees from Harvard University and an MBA from Oxford University. JAMA recently spoke with him about how the program is progressing. (excerpt)
Abstract 5526: Genetic Variation at <i>PCSK5</i> Influences HDL-C Levels
Authors: Iulia Iatan, Zari Dastani, Ron Do, Swneke D. Bailey, Isabelle Ruel, Larbi Krimbou, Annik Prat, Nabil G. Seidah, James C. Engert, Jacques Genest
Journal: Circulation (2008)

Low plasma HDL-C is a well-established risk factor for coronary artery disease. The role of endothelial lipase (EL) in HDL metabolism has been recently characterized. The proprotein convertase subtilisin/kexin 5 (PC5/6 or PCSK5) is known to inactivate both EL and lipoprotein lipase (LPL) ex vivo , enzymes critical in modulating plasma levels of HDL-C. In the present study, we investigated the role of human PCSK5 genetic variants on HDL-C; in addition, we characterized lipoprotein fractions in Pcsk5 +/− mice, compared with wild type. Sequencing of the PCSK5 gene was performed in 12 probands with low HDL-C (&lt;5 th percentile) and 7 novel non-coding genetic variants were found. We genotyped these SNPs along with 163 tag SNPs and 12 additional SNPs (n=182 total) selected from the HapMap Project, in 457 individuals with documented coronary artery disease. We identified 10 SNPs associated with HDL-C (p&lt;0.05), with the strongest result being rs11144782 (minor allele frequency: 0.164, p=0.002). In an analysis of HDL-C as a dichotomous trait, 3 of the 10 SNPs were also associated with low HDL-C at either the 5 th or the 10 th percentile (p&lt;0.05). The rare allele of rs111447782 decreased HDL by 0.076 mmol/L in a gene dosage-dependent fashion. We further investigated the effect of this SNP on other lipoprotein levels and identified an association with very low density lipoprotein (p=0.039), triglycerides (p=0.049) and total ApoB (p=0.022) levels. Furthermore, in conditional regression analysis, we identified 3 additional SNPs contributing to HDL-C (p&lt;0.05), all independent of the effect of rs11144782. In addition, we characterized serum from Pcsk5 KO mice. Serum from Pcsk5 +/− mice ( Pcsk5 −/− is embryonic lethal) showed reduction in HDL-C by gel permeation chromatography on HPLC and size redistribution of HDL species by 1D and 2D PAGGE. These results, and the rs11144782 SNP result presented above, are consistent with the concept that PCSK5 modulates HDL, likely upstream of EL and LPL. We conclude that variability at the PCSK5 gene locus influences HDL-C levels and consequently, atherosclerotic cardiovascular disease risk.