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December 28, 2005

Annual Mammogram Is All That Needed

Annual Mammogram Is All That Needed
Annual mammograms and doctor visits are the best follow-up strategy for women who have been treated for early stage breast cancer, according to a new review of recent research.

The report suggests that more intensive lab tests like liver scans and molecular tumor markers do not improve the chances of detecting a recurrence of cancer or increase survival rates among former breast cancer patients.

The finding is at odds with the usual therapy for breast cancer patients, according to Dr. Roldano Fossati of the Mario Negri Institute in Italy and his colleagues.

Fossati says "intensive follow-up is quite common in clinical practice and represents a significant workload for radiotherapy, surgical and oncologic departments".

The review appears in the recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The new analysis is an update of a 20-year-old Cochrane report on the topic. The current review includes four randomized controlled trial studies of 3,055 patients that compare different types of breast cancer follow-up care.

After analyzing data from two of the studies, the scientists found no significant difference in terms of survival, detection of new cancers or quality of life between a group of women who got regular physical exams and annual mammograms and a group who underwent a more extensive battery of laboratory tests that included liver scans, molecular tumor markers, chest x-rays and blood and liver function tests.

Another study included in the review found that follow-up care by hospital-based specialists was not significantly different from that offered by general practitioners in terms of improvements in the patient's quality of life or speed in detecting new cancers. However, patients were more likely to be satisfied with care by their general practitioner.........

Emily      Permalink


December 28, 2005

How Clinical Trial Participants Perform?

How Clinical Trial Participants Perform?
People who participate in randomized controlled studies to test new therapies seem to fare no better or no worse than those who receive the same care outside of such studies, a new review of research has found.

The finding was published against a backdrop of debate about drug trials for popular pain-relievers and about whether trial results can be safely applied to an entire population. "These results challenge the assertion that the results of RCTs (randomized controlled trials) are not applicable to usual clinical practice," report the authors, who say this review is the most comprehensive of its kind conducted to date.

A randomized clinical trial is considered the "gold standard" of medical research because it is the best way to make sure that the only difference between the groups that are compared is the therapy they receive. Patients are assigned to each group randomly in order to increase the probability that differences between the groups can be attributed only to the therapy under study.

Critics, however, say the rigorous standards for inclusion in trials and the nature of those who conduct and participate in them mean that when a new drug or therapy is applied to a general population, the results might be different.

A recent article in the prestigious journal The Lancet suggested that clinical trials cannot be expected to be relevant to all patients with the same conditions for many reasons, such as selecting trial participants who are in better overall health, excluding people who have conditions in addition to the one being studied and the reality that in a general population patients will not always act according to doctors' instructions.

In the new study, scientists led by Gunn Elisabeth Vist of the Norwegian Health Services Research Centre, systematically identified and reviewed 55 studies involving a total of more than 31,000 patients who were treated in randomized clinical trials and more than 20,000 patients who were treated outside of them.........

Daniel      Permalink


December 28, 2005

Counseling Encourages Exercise

Counseling Encourages Exercise
Professional counseling and support can boost physical activity among adults, a new review finds, but scientists aren't sure what kind of professional advice work best to encourage exercise or whether counseling increases physical activity over the long run.

Counseling generally encourages exercise, according to Dr. Melvyn Hillsdon of University College London and his colleagues. However, the scientists found no evidence that counseling can help people reach a specific exercise goal.

"More research is needed to establish which methods of exercise promotion work best in the long term to encourage different types of people to be more physically active," Hillsdon says, noting that most of the studies included in the review lasted less than a year.

The review appears in the recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Hillsdon and his colleagues reviewed 17 studies that included 6,255 healthy adults age 16 and older. All of the studies were randomized controlled trials that compared different ways to encourage sedentary adults to become more physically active.

The studies measured the effects of interventions such as individual and group counseling, telephone calls, written motivational materials and supervised and unsupervised exercise.

Hillsdon and his colleagues say continuing professional support combined with self-directed exercise may provide the most consistent results, but they acknowledge the studies vary too widely to recommend any single approach.........

Janet      Permalink


December 27, 2005

Steroids Increase Death Risk

Steroids Increase Death Risk
The common use of anti-inflammatory steroids for traumatic head injuries like those from car crashes may actually increase the risk of death, according to a new review of studies about the therapy.

A prior review found there was not enough evidence to recommend that routine use of steroids be stopped. This newer analysis published by the British-based Cochrane Library draws heavily from a recent study of corticosteroid therapy for brain injury, including coma and concussion, that included 10,008 patients, more than all similar studies combined.

The large study found that patients treated with corticosteroids were 18 percent more likely to die from their brain injury than those who did not take the drugs. Among the patients who received steroid therapy, 21 percent ,or 1,052 of the 4,985 treated, died, compared to 18 percent who received a placebo.

"The significant increase in death with steroids found in this trial suggests that steroids should no longer be routinely used in people with traumatic head injury," says Dr. Phil Alderson, lead author of the Cochrane study.

The review appears in the recent issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Corticosteroids are anti-inflammatory hormones used to treat all kinds of inflammation, from joint injury to asthma. They differ from anabolic steroids, the sex hormones like androgen, which are typically used to increase muscle mass and improve athletic performance.

Corticosteroids are "widely used in medicine to treat inflammation," Alderson explains. "It is thought that some of the damage after a brain injury results from inflammation following the initial injury and that reducing inflammation might reduce this secondary injury".........

Daniel      Permalink


December 27, 2005

Depression And Heart Disease Death

Depression Andf Heart Disease Death
Depression can double the risk of death or repeat heart disease in heart attack patients, according to two reviews of more than 40 studies that examine the link between depression and heart disease. The reviews are published in the journal Psychosomatic Medicine.

In the first analysis of 22 studies, patients who were depressed after their heart attacks had a twofold increase in the risk of dying or suffering a new heart problem two years after their heart attack, according to Joost van Melle, M.D., and his colleagues of University Hospital Groningen in the Netherlands.

In the second analysis of 20 studies by J├╝rgen Barth, Ph.D., of University of Freiburg in Gera number of and his colleagues, the scientists concluded that depressed patients were twice as likely to die within two years after their first heart disease episode compared with non-depressed patients.

According to van Melle, post-heart attack depression is common, affecting nearly 20 percent of all heart attack patients.

The two research teams found that the relationship between depression and a higher risk of death and disease stayed consistent despite a variety of ways to measure depression.

The finding "may have important clinical implications for the identification of post-heart attack patients with poor prognosis, because questionnaires are easier, faster and cheaper than psychiatric interviews," van Melle says.

In their study, van Melle and his colleagues also noticed a stronger link between depression and higher risk of death in studies published before 1992.

"It may be possible that improvements in cardiac care for hospitalized and rehabilitating heart attack patients are responsible for this finding, but this would need further research," van Melle says.........

JoAnn      Permalink


December 27, 2005

Daily Weighing Helps People Lose Weight

Daily Weighing Helps People Lose Weight
People who are trying to either lose weight or avoid gaining do better by weighing themselves daily, according to a new study in the recent issue of Annals of Behavioral Medicine.

The research team evaluated self-weighing practices of more than 3,000 people participating in either a weight-loss or a weight-gain prevention program. The study's key finding: "Higher weighing frequency was associated with greater 24-month weight loss or less weight gain".

When people weigh themselves daily, "something is going on. It's independent of things such as diet and exercise, so it may be worth recommending," said lead researcher Jennifer Linde, an associate professor at the University of Minnesota. "If people see that their number has gone up they may realize it's time to do something. It's probably easier to make that small correction," Linde said, than to try to compensate after gaining a lot of weight.

The first study group consisted of 1,800 obese or overweight adults enrolled in a weight-loss program. Participants all had a body mass index (BMI) of at least 27. They were randomly divided into three groups: a telephone-based weight-loss intervention, a mail-based weight loss intervention or a usual-care control condition. The scientists weighed them every six months for two years.

"The average 12-month and 24-month weight losses of 1.3 and 2 BMI units respectively ..... were in the clinically significant range," reported the researchers.

The other group consisted of 1,226 overweight adults - BMI above 25 - enrolled in a weight-gain prevention program. They were randomly divided into either an educational weight-control intervention, the same educational intervention plus a reward for returning self-monitoring postcards or a minimal-contact control condition. The scientists weighed the participants at the study's outset and every year for three years.........

JoAnn      Permalink


December 27, 2005

Alcohol Over-consumption By Glass Shapes

Alcohol Over-consumption By Glass Shapes Koert van Ittersum
Your eyes can play tricks when it comes to pouring drinks. People - even professional bartenders - inadvertently pour 20 to 30 percent more alcohol into short, wide glasses than tall, slender ones of the same volume, according to a new research study published in the BMJ (British Medical Journal).

"People focus their attention on the height of the liquid they are pouring and insufficiently compensate for its width," explains Koert van Ittersum, an assistant professor of marketing at Georgia Tech College of Management.

Even educating people about this human perceptual tendency and encouraging them to be careful doesn't eliminate alcohol over-pouring, find van Ittersum and Brian Wansink, a professor of marketing, applied economics and nutrition science at Cornell University, in their study, "Reducing Alcohol Over-pouring and Underreporting".

They consider their findings relevant to policymakers and law-enforcement officials who want to increase public safety, groups wanting to promote responsible drinking and decrease alcohol abuse, and people in the hospitality industry who want to cut costs (via serving size) without decreasing customer satisfaction.

"If short tumblers lead people - even bartenders - to pour more alcohol than highball glasses, then there are two easy solutions," van Ittersum says. "Either use tall glasses or ones with alcohol-level marks etched on them as is done in some European countries".

The scientists conducted their study using 198 students of legal drinking age at the University of Illinois at Urbana-Champaign who poured mock mixed drinks into both tall and short glasses from liquor bottles filled with water or tea instead of alcohol. Study subjects also included eighty-two bartenders in Philadelphia who had an average of 6.3 years of bartending experience.........

Janet      Permalink


December 27, 2005

Lifestyle Changes Have Major Health Impact

Lifestyle Changes Have Major Health Impact
New Year's resolutions to lose weight, stop smoking and exercise are made by countless people every January. Unfortunately, these goals seldom seem attainable and good intentions often fall by the wayside after a few weeks. Is there really a way to keep your resolutions and transform your body and your health? .

The results of a two-year study involving the Department of Human Services (7,500 employees) of the State of Oklahoma conclude the answer is "yes". A lifestyle management program using step-by-step attainable goals was shown to successfully translate good intentions to live a healthier lifestyle into reality.

The study participants were enrolled in INTERVENTUSA, a scientifically-based lifestyle management program offered in the Atlanta area through the Emory Heart Center. Individualized programs to help participants implement and adhere to exercise, nutrition, weight management, stress management, and smoking cessation resolutions were implemented and administered via the telephone and the Internet.

Not only did a number of of the participants in the program, named OK Health, reach their goals but the health claim costs of the employees who completed one year of program participation were lowered by a staggering 31 percent, according to the Oklahoma Employees Benefits Council and Oklahoma Department of Human Services.

"In employees with abnormal risk factor values at the start of the study, one year of program participation resulted in impressive improvements in blood pressure and cholesterol levels, with increases in HDL ('good' cholesterol) and decreases in the 'bad' lipids (LDL cholesterol and triglycerides). In addition, on average, there was a weight loss of 11 pounds and a significant reduction of fasting blood glucose levels," says Neil F. Gordon, MD, PhD, clinical professor of medicine in the Emory University School of Medicine and INTERVENTUSA founder.........

Janet      Permalink


December 27, 2005

Phase III Clinical Trial on Pleural Mesothelioma

Phase III Clinical Trial on Pleural Mesothelioma
Emory Winship Cancer Institute will be one of two facilities in Georgia to conduct a phase III clinical trial of Vorinostat (oral suberoylanilide hydromaxic acid) in patients with advanced cancerous pleural mesothelioma. The purpose of the study is to test the safety and efficacy of Vorinostat as well as to compare the overall survival associated with therapy of the drug.

A rare but devastating disease, it is estimated that 2,000 to 3,000 new mesothelioma cases will be diagnosed each year in the United States. Mesothelioma is cancer of the cells found in the mesothelium, which is the protective lining covering most of the internal organs of the body. Pleural mesothelioma is the most common type of mesothelioma, and it is identified by the presence of malignant cells located in the tissue outside of the lungs and inside of the ribs.

Vorinostat is an experimental drug that is believed to work against cancer cells. When cells become malignant, chemical reactions inside the cancer cell allow those cells to multiply out of control. Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

The principal investigator on the Vorinostat clinical trial at Winship is Dong M. Shin, MD, Professor of Hematology/Oncology and Otolaryngology; Director of Clinical and Translational Cancer Prevention Programs; and Co-Director of the Lung and Aerodigestive Tract Malignancies Program at Emory Winship Cancer Institute. Dr. Shin joined Winship in 2003 after more than 15 years as a faculty member at M.D. Anderson Cancer Center in Houston and the University of Pittsburgh Cancer Institute.

"This is a very important study for this terrible disease," said Dr. Shin. "As a second line treatment, there are currently no options other than this clinical trial."........

Scott      Permalink


December 27, 2005

How To Make Cox-2 Inhibitors Safer

How To Make Cox-2 Inhibitors Safer
A recently identified path of inflammation once thought to be wholly independent of other inflammatory systems has now been linked to another major pathway. The findings by neuroresearchers at Johns Hopkins are likely to point researchers to novel drugs that significantly reduce the risks of taking COX-2 inhibitor pain relievers, the researchers report.

In a paper published in the Dec. 23 issue of Science, a Johns Hopkins team led by Solomon H. Snyder, M.D., said the iNOS (inducible nitric oxide synthase)-based inflammation pathway has now been found to cross-link with the more well-known COX-2 pathway that is the target of COX-2 inhibitor drugs such as Vioxx. Until now, these two major inflammatory mechanisms were assumed to be unrelated and independent of each other, the scientists say.

"The fundamental significance of this work is that it demonstrates a totally unsuspected connection between the two most important inflammatory systems in the body," says Snyder, professor and director of neuroscience in Johns Hopkins' Institute for Basic Biomedical Sciences. "The therapeutic significance is that drugs which block the binding of iNOS and COX-2 might represent novel anti-inflammatory agents or reduce the dosage needed and side effects of this family of drugs".

COX-2 is an enzyme that makes prostaglandins, molecules that cause inflammation and pain. iNOS is an enzyme that makes NO (nitric oxide), a molecule that acts as a signal for a variety of cellular functions throughout the body, including the triggering of inflammation, dilating of blood vessels and penile erection.

The site on the iNOS protein that binds to COX-2 is close to the active or business end of the iNOS, the scientists found. As a result, it should be possible to design drugs that do double duty by inhibiting iNOS while also blocking iNOS binding to COX-2. This would decrease the formation of both NO and prostaglandins, Snyder said.........

Mark      Permalink




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