Many men with low-risk, localised prostate cancers can safely choose active surveillance or ‘watchful waiting’ instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at Dana-Farber Cancer Institute and Massachusetts General Hospital.
They say that their statistical models showed that ‘observation is a reasonable and, in some situations, cost-saving alternative to initial treatment’ for the estimated 70 percent of men whose cancer is classified as low-risk at diagnosis.
The researchers, led by Julia Hayes, MD, a medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber, said their findings support observation – active surveillance and watchful waiting – as a reasonable and underused option for men with low-risk disease.
‘About 70 percent of men in this country have low-risk prostate cancer, and it
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The Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study showed CRT, a standard of care in heart failure patients with a wide QRS, is not beneficial in patients with heart failure and a narrow QRS complex, below 130 milliseconds (msec).
The results reaffirm current guidelines excluding patients with a narrow QRS for CRT, and expand the body of evidence that simple electrocardiographic determination of QRS duration remains the most important predictor of the clinical benefits of CRT, rather than measures of mechanical dyssynchrony by echocardiography. Based on the results of EchoCRT, the identification of patients who will obtain the benefit of CRT can be done most easily by a 12 lead-ECG.
‘Results from previous smaller trials had suggested a potential for CRT in heart failure patients with narrow QRS. EchoCRT now provides evidence from a definite outcome trial that patients with symptomatic heart failure with QRS width less than 130msec do not benefit from CRT,’ said co-lead investigator Frank Ruschitzka, MD, from the University Hospital in Zurich, Switzerland.
‘The EchoCRT trial evaluated an important question for daily clinical practice. The results will help to guide physicians
Researchers from the University of Liverpool and University of the West of England, (UWE Bristol), have built a device that can read odours in urine to help diagnose patients with early signs of bladder cancer.
There are currently no reliable biomarkers to screen patients for bladder cancer in the same way that there are for breast and cervical cancers. Previous research has suggested that a particular odour in the urine could be detected by dogs trained to recognise the scent, indicating that methods of diagnoses could be based on the smell of certain gases.
The team have now built a device, called ODOREADER that contains a sensor which responds to chemicals in gas emitted from urine. The device, constructed in the laboratories at UWE Bristol
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A combined technique of liposuction and tummy tuck
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Nausea is one of the most debilitating symptoms of migraine and affects 80 percent of migraine suffers in the United States. Leading headache physician, Dr. Zoltan Medgyessy of the Berolina Clinic in Lohne, Germany demonstrated in a trial that pressure to the P6 antiemetic point on the inner wrist with an acupressure wristband is an effective and quick therapy for relieving nausea of migraine sufferers.
Migraine can be a disabling neurological disorder. It affects 36 million Americans, according to the American Migraine Foundation, and is considered by the World Health Organization as the 19th leading cause of all years lived with disability for both males and females.
Dr. Medgyessy’s acupressure study with the Department of Headache / Department of Psychosomatic at the Berolina Clinic included 41 patients who experienced an average of 33.1 migraine days during the previous three months with an average nausea intensity of 6.2 out of 10. Patients were given Sea-Band acupressure wristbands instead of antiemetic drugs during a migraine attack and 83 percent of patients noticed reduction of nausea. Reported nausea after therapy was rated a 2.9 out of 10 and relief was reported after an average of 28 minutes. Nearly all participants (98 percent) said they would use Sea-Band again for migraine nausea.
‘Acupressure wristbands are drug-free and that is an important advantage in using this therapy for migraine nausea as they have no risks for interaction with migraine drugs or the side effects commonly experienced with antiemetics, such as dizziness or tiredness,’ commented Dr. Medgyessy. ‘There are still many unknowns about migraine, making findings such as these an important stride toward improving the quality of life for those who suffer from the condition. I’m grateful that the International Headache Congress has given me a platform to share the results of my team’s study and look forward to discussing it with my colleagues.’
EurekAlert
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A novel drug may help increase the effectiveness of radiation therapy for the most deadly form of brain cancer, report scientists at Virginia Commonwealth University Massey Cancer Center. In mouse models of human glioblastoma multiforme (GBM), the new drug helped significantly extend survival when used in combination with radiation therapy.
The study provides the first pre-clinical evidence demonstrating that an ATM kinase inhibitor radiosensitizes gliomas. Gliomas are brain tumours that originate from glial cells, which provide support for nerve cells and help regulate the internal environment of the brain. ATM, or ataxia telangiectasia mutated, is an enzyme that helps repair DNA damage. The scientists used an experimental drug, KU-60019, to block the activation of ATM, which led to the enhanced destruction of the gliomas due to their reduced ability to repair the DNA damage caused by the radiation treatment. The new approach was particularly effective against gliomas that have a mutation in the p53 tumour suppressor gene, which accounts for approximately 30 percent of all glioma cases.
‘Sadly, the average life expectancy of patients diagnosed with glioblastoma is just 12 to 15 months,’ says the study
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A new study suggests that CPAP (continuos positive air passage) therapy reduces nightmares in veterans with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). Results show that the mean number of nightmares per week fell significantly with CPAP use, and reduced nightmare frequency aft er starting CPAP was best predicted by CPAP compliance.
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A brain imaging research team led by Simon Fraser University neuroscientist Dr. Ryan D
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Wake Forest Baptist Medical Center doctors have found that using stress cardiac magnetic resonance (CMR) imaging in an Emergency Department observation unit to care for patients with acute chest pain is a win-win – for the patient and the institution.
In a small, single-centre clinical trial, Chadwick Miller, M.D., M.S., and colleagues found that evaluating older, more complex patients in the observation unit with stress cardiac MRI, as opposed to usual inpatient care, reduced hospital readmissions, coronary revascularisation procedures and the need for additional cardiac testing.
The observation unit is an area of the Emergency Department designed for short stays – longer than a typical ED visit, said Miller, but shorter than a hospital admission. Cardiac MRI is a type of heart testing that uses magnetic forces to capture pictures of the heart.
‘We were looking at the optimum way to evaluate people with chest pain and focusing on those patients who are generally older, have many risk factors for coronary disease or may have had prior health problems, basically the intermediate to higher risk population,’ Miller said. ‘At most hospitals in the United States, after evaluation in the emergency department, these patients are admitted to the hospital to complete their care.’
Miller, who serves as director of clinical research and executive vice-chair of Emergency Medicine at Wake Forest Baptist, said the study built on previous research findings that more complex patients managed in an observation unit with stress CMR testing experienced a reduction in care costs of about $2,100 per patient per year. For the new study, the researchers wanted to specifically look at three care events: coronary revascularization, hospital readmissions and additional heart testing.
The researchers recruited 105 patients from Wake Forest Baptist’s Emergency Department, randomizing them to receive care either in the Observation Unit with CMR or in the hospital. The patients were followed for 90 days, after which the researchers found significant reductions in coronary revascularization procedures, fewer hospital readmissions and fewer recurrent cardiac testing episodes or the need for additional testing.
‘What’s exciting about this is not only can we reduce events that are important to patients, but we can reduce costs as well,’ Miller said. ‘What we think is happening is that the cardiac MRI is more accurately selecting patients who will benefit the most from having invasive procedures done. It’s a win-win.’
Wake Forest Baptist Medical Center
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