WTAJ |
When traditional cancer therapy doesn't work
WTAJ Head and neck cancers are the sixth most common cancers worldwide, in large part due to the presence of the HPV virus. Now, researchers are testing an immunotherapy treatment they say is highly effective for patients with cancer that spreads or comes ... |
Hyponatremia due to excessive fluid intake (i.e. primary polydipsia (PP)) is common. It may culminate in profound hyponatremia—carrying considerable risk of morbidity. However, data on patients with PP leading to hyponatremia is lacking. Herein, we describe the characteristics of polydiptic patients hospitalised with profound hyponatremia, and assess one-year outcomes.
Substudy of the prospective observational Co-MED Study.
Patients with an episode of profound hyponatremia (≤125mmol/l) due to PP in the medical emergency were eligible and classified into psychogenic polydipsia (PsyP), dipsogenic polydipsia (DiP), and beer potomania (BP).
Symptoms, laboratory findings, and factors contributing to hyponatremia (comorbidities, medication, and liquid intake) were assessed. A one-year follow-up was performed to evaluate recurrence of hyponatremia, re-admission rate, and mortality.
23 patients were included (median age 56 years [IQR 50-65], 74% female), 7 had PsyP, 8 DiP, and 8 BP. Median serum sodium of all patients was 121mmol/l (IQR 114-123), median urine osmolality 167mmol/l (IQR 105-184), and median copeptin 3.6mmol/l (IQR 1.9-5.5). Psychiatric diagnosis, particularly dependency disorder (43%) and depression (35%), were highly prevalent. Factors provoking hyponatremia were found in all patients (e.g. acute water load, medication, stress).
During the follow-up period, 67% of patients were readmitted, 52% of these with re-hyponatremia, and 3 patients (38%) with BP died.
Patients with PP are more likely to be female, and have addictive and affective disorders. Given the high recurrence, re-hospitalisation, and mortality rate, careful monitoring and long-term follow-up including controls of serum sodium, education and behavioural therapy is needed.
This article is protected by copyright. All rights reserved.
Sickle cell disease (SCD) results in end organ damage and a shortened lifespan. Both the pathophysiology of the disease and the social determinants of health affect patient outcomes. Randomized controlled trials have been completed among this population and resulted in medical advances; however, the gestation of these advances and the lack of penetrance into clinical practice have limited advancements in clinical improvements for many people with SCD. We discuss the role of implementation science in SCD and highlight the need for this science to shorten the length of time to implement evidence-based care for more people with SCD.
Choline acetyltransferase-positive (ChAT+) neurons within the subventricular zone (SVZ) have been shown to promote neurogenesis after stroke in mice by secreting acetylcholine (ACh); however, the mechanisms remain unclear. Receptors known to bind ACh include the nicotinic ACh receptors (nAChRs), which are present in the SVZ and have been shown to be important for cell proliferation, differentiation, and survival. In this study, we investigated the neurogenic role of the alpha-7 nAChR (α7 nAChR) in a mouse model of middle cerebral artery occlusion (MCAO) by using α7 nAChR inhibitor methyllycaconitine. Mice subjected to MCAO exhibited elevated expression of cytomembrane and nuclear fibroblast growth factor receptor 1 (FGFR1), as well as increased expression of PI3K, pAkt, doublecortin (DCX), polysialylated - neuronal cell adhesion molecule (PSA-NCAM), and mammalian achaete-scute homolog 1 (Mash1). MCAO mice also had more glial fibrillary acidic protein (GFAP)/5-bromo-2′-deoxyuridine (BrdU)-positive cells and DCX-positive cells in the SVZ than did the sham-operated group. Methyllycaconitine treatment increased cytomembrane FGFR1 expression and GFAP/BrdU-positive cells, upregulated the levels of phosphoinositide 3-kinase (PI3K) and phospho-Akt (pAkt), decreased nuclear FGFR1 expression, decreased the number of DCX-positive cells, and reduced the levels of DCX, PSA-NCAM, and Mash1 in the SVZ of MCAO mice compared with levels in vehicle-treated MCAO mice. MCAO mice treated with α7 nAChR agonist PNU-282987 exhibited the opposite effects. Our data show that α7 nAChR may decrease the proliferation of neural stem cells and promote differentiation of existing neural stem cells after stroke. These results identify a new mechanism of SVZ ChAT+ neuron-induced neurogenesis.
The Review |
Newell native not stopped by thyroid cancer
The Review “The day I received my diagnosis, I felt like my whole life came crashing down around me,” she said. “You never think something like that would ever happen to you. After the doctor told me I had thyroid cancer, I couldn't listen to anything he said. I ... |
Four strains of rhizobia isolated from nodules of Vigna unguiculata (UFLA03-321T, UFLA03-320 and UFLA03-290) and Macroptilium atropurpureum (UFLA04-0212) in Brazilian soils were previously reported as a new group within the genus Bradyrhizobium. To determine their taxonomic position, these strains were characterized in this study using a polyphasic approach. The analysis of the 16S rRNA gene grouped the four strains with Bradyrhizobium pachyrhizi PAC48T. However, the concatenated sequence analysis of the two (recA and glnII) or three (atpD, gyrB and recA) housekeeping genes indicated that these strains represent a novel species of Bradyrhizobium, which is very closely related to B. pachyrhizi PAC48T and B. elkanii USDA 76T. Genomic relatedness analyses between the UFLA03-321T strain and B. elkanii USDA 76T and B. pachyrhizi PAC48T revealed an average nucleotide identity below 96% and values of estimated DNA–DNA hybridization below 70%, confirming that they represent genomically distinct species. Analysis of MALDI-TOF MS (Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry) profiles and phenotypic characteristics also allowed differentiation of the novel species from its two neighboring species. In phylogenetic analysis of nodC and nifH genes, UFLA03-321T exhibited maximum similarity with B. tropiciagri CNPSo 1112T. The data suggest that these four UFLA strains represent a novel species, for which the name Bradyrhizobium brasilense sp. nov. is proposed, with UFLA03-321T (=LMG 29353 =CBAS645) as type strain. G + C content in the DNA of UFLA03-321T is 63.9 mol %.
Los Angeles Times |
Val Kilmer admits having a 'healing of cancer'
Los Angeles Times Douglas "was probably trying to help me cause press probably asked where I was these days, and I did have a healing of cancer, but my tongue is still swollen altho healing all the time," the "Tombstone" actor said. "Because I don't sound my normal self ... and more » |
LGBTQ Nation |
HPV vaccine might lower risk of oral cancer for young men
LGBTQ Nation Tom Jackson, 65, of Houston, shows where he first noticed a tumor related to his HPV-related tonsil cancer, found in 2013. Jackson spoke from his home on Wednesday, May 17, 2017. He said doctors told him the cancer could haven taken away his voice. Vaccine Cuts HPV, Oral Cancer Risk in MenNewsmax all 18 news articles » |
Cat eye syndrome: A constitutional chromosome abnormality (one that is present at or before birth) with multiple malformations characterized by the combination of a cat-like slit of the iris of the eye (vertical coloboma) and no anal opening (anal atresia). Frequently there are also down slanting eye slits (palpebral fissures), tissue tags or pits just in front of the ears, heart malformations and kidney anomalies.
There is usually normal or near-normal development with the cat eye syndrome, unlike the situation with many other constitutional chromosome abnormalities, and intelligence may be normal or near-normal in cat eye syndrome.
The syndrome is due to the presence of an extra small chromosome that is smaller than chromosome 21, the smallest chromosome in humans. This extra abnormal chromosome is derived from chromosome 22. (In technical terms, this chromosome represents an inversion and duplication of chromosome band 22q11p.)
The name comes from the cat-like appearance of the iris of the eye.
Herein we describe the usefulness of a successful combination of dermoscopy and in vivo RCM for the early diagnosis of 3 AM in 2 OCA patients OCA is a group of rare autosomal recessive disorders of pigmentation. It consists in the absence or reduction of melanin in the skin, hair, and eyes due to a partial or total deficit in the activity of tyrosinase(TYR)1 or other related genes2,3. Those patients are at higher risk of non melanoma skin cancer, while still debated is their increased risk of melanoma, in particular amelanotic4. They usually lack in clinical and dermoscopic pattern, what makes them challenging to be diagnosed, especially at early stage.
This article is protected by copyright. All rights reserved.
dissecting cellulitis of the scalp (DCS) is a chronic inflammatory condition characterized by recurrent nodules, abscesses and sinus tract formation.1-3 It usually starts as a simple folliculitis with occlusion of follicular openings mainly on the scalp vertex or nape, generally followed by perifollicular pustules and painful firm or fluctuant nodules releasing a purulent discharge, either spontaneously or after a gentle pressure.
This article is protected by copyright. All rights reserved.
Psoriasis is known to be associated with inflammatory comorbidities. Coeliac disease (CD) is an immune-mediated enteropathy caused by permanent intolerance to dietary gliadin, which is present in wheat, barley, and rye.1 The disease occurs in predisposed individuals, and is characterized clinically by malabsorption and histologically by villous atrophy and crypt hyperplasia, which improves when the causal antigen is removed through a gluten-free diet.1 We investigated the relationship between psoriasis and CD in Denmark.
This article is protected by copyright. All rights reserved.
medisite.fr |
Ganglions dans le cou : un symptôme du cancer du larynx ?
medisite.fr Comme bon nombre de cancers, le cancer du larynx est très souvent associé au tabagisme. Il se manifeste d'abord par une toux, un mal de gorge et une voix rauque. Cette tumeur maligne entraîne également une augmentation du volume des ganglions ... and more » |
WFMZ Allentown |
Health Beat: Hunting head and neck cancer cells - WFMZ
WFMZ Allentown Head and neck cancers are the sixth most common cancers worldwide, in large part due to the presence of the HPV virus. Now, researchers are testing an ... and more » |
13WHAM-TV |
Unusual chamber helps Rochester woman beat stage 4 cancer
13WHAM-TV "When they did the surgery, they removed half of the tongue. They reconstructed it with muscle from my arm and they removed 41 lymph nodes on the right side of my neck," said Gauer, who was diagnosed with stage four oral squamous cell carcinoma. |
Phosphate depletion is one of the favorable ways to enhance the sewage water treatment with the algae, however, detailed information is essential with respect to internal phosphate concentration and physiology of the algae. The growth rate of the phosphate-starved Scenedesmus cells was reduced drastically after 48 h. Indicating cells entered in the stationary phase of the growth cycle. Fourier Transform Infrared analysis of phosphate-starved Scenedesmus cells showed the reduction in internal phosphate concentration and an increase in carbohydrate/phosphate and carbohydrate/lipid ratio. The phosphate-starved Scenedesmus cells, with an initial cell density of, 1 × 106 cells mL−1 shows 87% phosphate and 100 % nitrogen removal in 24 h. The normal Scenedesmus cells need approximately 48 h to trim down the nutrients from wastewater up to this extent. Other microalgae, Ankistrodesmus, growth pattern was not affected due to phosphate starvation. The cells of Ankistrodesmus was able to reduce 71% phosphate and 73% nitrogen within 24 h, with an initial cell density of, 1 × 106 cells mL−1.
Mangrove is a complex ecosystem that contains diverse microbial communities, including rare actinobacteria with great potential to produce bioactive compounds. To date, bioactive compounds extracted from mangrove rare actinobacteria have demonstrated diverse biological activities. The discovery of three novel rare actinobacteria by polyphasic approach, namely Microbacterium mangrovi MUSC 115T, Sinomonas humi MUSC 117T and Monashia flava MUSC 78T from mangrove soils at Tanjung Lumpur, Peninsular Malaysia have led to the screening on antibacterial, anticancer and neuroprotective activities. A total of ten different panels of bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) ATCC 43300, ATCC 70069, Pseudomonas aeruginosa NRBC 112582 and others were selected for antibacterial screening. Three different neuroprotective models (hypoxia, oxidative stress, dementia) were done using SHSY5Y neuronal cells while two human cancer cells lines, namely human colon cancer cell lines (HT-29) and human cervical carcinoma cell lines (Ca Ski) were utilized for anticancer activity. The result revealed that all extracts exhibited bacteriostatic effects on the bacteria tested. On the other hand, the neuroprotective studies demonstrated M. mangrovi MUSC 115T extract exhibited significant neuroprotective properties in oxidative stress and dementia model while the extract of strain M. flava MUSC 78T was able to protect the SHSY5Y neuronal cells in hypoxia model. Furthermore, the extracts of M. mangrovi MUSC 115T and M. flava MUSC 78T exhibited anticancer effect against Ca Ski cell line. The chemical analysis of the extracts through GC–MS revealed that the majority of the compounds present in all extracts are heterocyclic organic compound that could explain for the observed bioactivities. Therefore, the results obtained in this study suggested that rare actinobacteria discovered from mangrove environment could be potential sources of antibacterial, anticancer and neuroprotective agents.
Kung-Som is a popular traditional Thai fermented shrimp product. It is rich in glutamic acid, which is the major substrate for the biosynthesis of gamma-aminobutyric acid (GABA) by lactic acid bacteria (LAB). In the present study, LAB from Kung-Som were isolated, screened for GABA formation, and the two isolates that transform glutamic acid most efficiently into GABA were identified. Based on the API-CHL50 fermentation profile and a phylogenetic tree of 16S rDNA sequences, strain CS3 and CS5 were identified as Lactobacillus futsaii, which was for the first time shown to be a promising GABA producer. L. futsaii CS3 was the most efficient microorganism for the conversion of 25 mg/mL monosodium glutamate (MSG) to GABA, with a maximum yield of more than 99% conversion rate within 72 h. The open reading frame (ORF) of the glutamate decarboxylase (gad) gene was identified by PCR. It consists of 1410 bp encoding a polypeptide of 469 amino acids with a predicted molecular weight of 53.64 kDa and an isoelectric point (pI) of 5.56. Moreover, a good quality of the constructed model of L. futsaii CS3 was also estimated. Our results indicate that L. futsaii CS3 could be of interest for the production of GABA-enriched foods by fermentation and for other value-added products.
995 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:
These pubmed results were generated on 2017/05/27
PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
| Related Articles |
Public Open Spaces and Leisure-Time Walking in Brazilian Adults.
Int J Environ Res Public Health. 2017 May 23;14(6):
Authors: Florindo AA, Barrozo LV, Cabral-Miranda W, Rodrigues EQ, Turrell G, Goldbaum M, Cesar CLG, Giles-Corti B
Abstract
Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults' residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants' homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09-2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.
PMID: 28545242 [PubMed - in process]
 |
Related Articles |
Escalation of Commitment in the Surgical ICU.
Crit Care Med. 2017 Apr;45(4):e433-e436
Authors: Braxton CC, Robinson CN, Awad SS
Abstract
OBJECTIVES: Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU. We hypothesize that factors previously identified in business and organizational psychology literature including self-justification, accountability, sunk costs, and cognitive dissonance result in escalation of commitment behavior in the surgical ICU setting resulting in increased utilization of resources and cost.
DESIGN: A descriptive case study that illustrates common ICU narratives in which escalation of commitment can occur. In addition, we describe factors that are thought to contribute to escalation of commitment behaviors.
MAIN RESULTS: Escalation of commitment behavior was observed with self-justification, accountability, and cognitive dissonance accounting for the majority of the behavior. Unlike in business decisions, sunk costs was not as evident. In addition, modulating factors such as personality, individual experience, culture, and gender were identified as contributors to escalation of commitment.
CONCLUSIONS: Escalation of commitment occurs in the surgical ICU, resulting in significant expenditure of resources despite a predicted and often known poor outcome. Recognition of this phenomenon may lead to actions aimed at more rational decision making and may contribute to lowering healthcare costs. Investigation of objective measures that can help aid decision making in the surgical ICU is warranted.
PMID: 28291105 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Screening for distress using the distress thermometer and the University of Washington Quality of Life in post-treatment head and neck cancer survivors.
Eur Arch Otorhinolaryngol. 2017 May;274(5):2253-2260
Authors: Ghazali N, Roe B, Lowe D, Tandon S, Jones T, Brown J, Shaw R, Risk J, Rogers SN
Abstract
The primary aim was to determine the efficacy of the Distress Thermometer (DT) in screening for anxiety and mood problems against the University of Washington Quality of Life, version 4 (UWQOL). Secondary aims were to evaluate the association between demographic, clinical and health-related QOL variables with significant distress. Two hundred and sixty one disease-free HNC ambulatory patients attending routine follow-up clinics were prospectively recruited. Both DT and UWQOL were completed pre-consultation. Receiver operating characteristic (ROC) curve analyses of DT score for anxiety dysfunction yielded an area under the curve (AUC) of 0.877, with a sensitivity of 84% (43/51) and specificity of 76% (159/210) for a DT cut-off of ≥4; with a corresponding AUC of 0.825 for mood with sensitivity 78% (28/36) and specificity 71% (159/225). Treatment with radiotherapy and a longer consultation time were associated with significant distress (DT ≥4). Significant distress was also reported in two third of those reporting less than "Good" overall QOL. Distress levels were particularly associated with poor Social-Emotional function, more so than the association seen with poor physical function. DT is a reasonable screening tool for distress in the HNC population. The DT cut-off score ≥4 was effective in identifying those with significant distress. Significant distress is associated in survivors with poor health-related quality of life, those who received radiotherapy and patients who have longer consultation times in clinic.
PMID: 28168421 [PubMed - indexed for MEDLINE]
 |
Related Articles |
[Ethical dilemmas about disclosure of errors in medicine].
Rev Med Chil. 2016 Sep;144(9):1191-1198
Authors: Lavanderos S, Pedraza J, Russo N M, Salas SP
Abstract
Since the publication of the Institute of Medicines report To Err is Human: Building a Safer Health System awareness of the importance of medical errors has increased. These are a major cause of morbidity and mortality and recent studies suggest that they can be the third leading cause of death in the United States. Difficulties have been identified by health personnel to prevent, detect and disclose to patients the occurrence of a medical error, an also to report them to the appropriate authorities. Although human error cannot be eliminated, it is possible to design safety systems to mitigate their frequency and consequences. Our goal is to provide an update on the major concepts related to medical errors, a review of Chilean legislation on the subject, and a bioethical analysis on the principles involved, along with a management proposal. We propose mandatory reporting of errors to the health institution where they occur, to serve as a measure of personal and team learning, and to disclose the error to patients, depending on their own preferences.
PMID: 28060982 [PubMed - indexed for MEDLINE]
|
Related Articles |
[Conflicts of interest in nephrology].
Rev Med Chil. 2016 Aug;144(8):1053-1058
Authors: Salas SP, Vukusich A, Catoni MI, Valdivieso A, Roessler E
Abstract
Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation-ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.
PMID: 27905652 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of São Paulo, Brazil: cross-sectional study.
Sao Paulo Med J. 2016 Sep-Oct;134(5):375-384
Authors: Depintor JD, Bracher ES, Cabral DM, Eluf-Neto J
Abstract
CONTEXT AND OBJECTIVE:: Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it.
DESIGN AND SETTING:: Cross-sectional epidemiological study on a sample of the population of the city of São Paulo.
METHOD:: Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerström test for nicotine dependence and Brazilian economic classification criteria were used.
RESULTS:: A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain.
CONCLUSION:: The prevalence of chronic spinal pain in this segment of the population of São Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.
PMID: 27901240 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Longitudinal Pooled Deep Sequencing of the Plasmodium vivax K12 Kelch Gene in Cambodia Reveals a Lack of Selection by Artemisinin.
Am J Trop Med Hyg. 2016 Dec 07;95(6):1409-1412
Authors: Brazeau NF, Hathaway N, Parobek CM, Lin JT, Bailey JA, Lon C, Saunders DL, Juliano JJ
Abstract
The emergence of artemisinin resistance among Plasmodium falciparum in the Greater Mekong subregion threatens malaria control interventions and is associated with multiple unique mutations in K13 (PF3D7_1343700). The aim of this study was to survey Cambodian Plasmodium vivax for mutations in the K13 ortholog (K12, PVX_083080) that might similarly confer artemisinin resistance. Extracted DNA from Cambodian isolates collected between 2009 and 2012 was pooled by province and year and submitted for next-generation sequencing. Single-nucleotide polymorphisms (SNPs) were identified using a pile-up approach that detected minority SNPs. Among the 14 pools, we found six unique SNPs, including three nonsynonymous SNPs, across six codons in K12 However, none of the SNPs were orthologous to artemisinin resistance-conferring mutations in PF3D7_1343700, and nonsynonymous changes did not persist through time within populations. These results suggest a lack of selection in the P. vivax population in Cambodia due to artemisinin drug pressure.
PMID: 27799638 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials: a start in setting international standards.
Lancet Oncol. 2016 Nov;17(11):e510-e514
Authors: Bottomley A, Pe M, Sloan J, Basch E, Bonnetain F, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Dueck AC, Devlin N, Flechtner HH, Gotay C, Greimel E, Griebsch I, Groenvold M, Hamel JF, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Moinpour CM, Musoro J, O'Connor D, Oliver K, Piault-Louis E, Piccart M, Pimentel FL, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Taphoorn MJ, Velikova G, Coens C, Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) consortium
Abstract
Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures are analysed and interpreted make it difficult to compare results across trials, and hinders the application of research findings to inform publications, product labelling, clinical guidelines, and health policy. To address these problems, the Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative has been established. This consortium, directed by the European Organisation for Research and Treatment of Cancer (EORTC), was convened to provide recommendations on how to standardise the analysis of HRQOL and other patient-reported outcomes data in cancer randomised trials. This Personal View discusses the reasons why this project was initiated, the rationale for the planned work, and the expected benefits to cancer research, patient and provider decision making, care delivery, and policy making.
PMID: 27769798 [PubMed - indexed for MEDLINE]
  |
Related Articles |
Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study.
BMC Psychiatry. 2016 Oct 11;16(1):328
Authors: Mitchison D, Dawson L, Hand L, Mond J, Hay P
Abstract
BACKGROUND: Emerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers' perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms.
METHOD: 19 women from the community with a history of eating disorders (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed.
RESULTS: Thematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children.
CONCLUSIONS: Impairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential 'backdoor' approach to improving ED symptoms.
PMID: 27724943 [PubMed - indexed for MEDLINE]
|
Related Articles |
Opening the Door: The Experience of Chronic Critical Illness in a Long-Term Acute Care Hospital.
Crit Care Med. 2017 Apr;45(4):e357-e362
Authors: Lamas DJ, Owens RL, Nace RN, Massaro AF, Pertsch NJ, Gass J, Bernacki RE, Block SD
Abstract
OBJECTIVE: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates.
DESIGN: We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates. Conversations were recorded, transcribed, and analyzed.
SETTING: One long-term acute care hospital.
SUBJECTS: Chronically critically ill patients, defined by tracheotomy for prolonged mechanical ventilation, or surrogates.
INTERVENTION: Semi-structured conversation about quality of life, expectations, and planning for setbacks.
MEASUREMENTS AND MAIN RESULTS: A total of 50 subjects (30 patients and 20 surrogates) were enrolled. Thematic analyses demonstrated: 1) poor quality of life for patients; 2) surrogate stress and anxiety; 3) optimistic health expectations; 4) poor planning for medical setbacks; and 5) disruptive care transitions. Nearly 80% of patient and their surrogate decision makers identified going home as a goal; 38% were at home at 1 year.
CONCLUSIONS: Our study describes the experience of chronically critically ill patients and surrogates in an long-term acute care hospital and the feasibility of patient-focused research in this setting. Our findings indicate overly optimistic expectations about return home and unmet palliative care needs, suggesting the need for integration of palliative care within the long-term acute care hospital. Further research is also needed to more fully understand the challenges of this growing population of ICU survivors.
PMID: 27632675 [PubMed - indexed for MEDLINE]
|
Related Articles |
Long-Term Outcomes After ICU Admission Triage in Octogenarians.
Crit Care Med. 2017 Apr;45(4):e363-e371
Authors: Andersen FH, Flaatten H, Klepstad P, Follestad T, Strand K, Krüger AJ, Hahn M, Buskop C, Rime AK, Kvåle R
Abstract
OBJECTIVE: To describe ICU admission triage and outcomes in octogenarians.
DESIGN: Multicenter prospective observational study.
SETTING: Three nonuniversity hospitals and three university hospitals in Norway.
PATIENTS: Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered "too ill/old" were advanced age and low functional status. Risk factors for ICU refusal in patients considered "too well" were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age- and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores.
CONCLUSIONS: Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age- and sex-matched control population.
PMID: 27618269 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis.
PLoS Med. 2016 Aug;13(8):e1002067
Authors: Leung W, Kvizhinadze G, Nair N, Blakely T
Abstract
BACKGROUND: The anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone receptor (PR) status, which has previously been unexplored, to assist prioritisation.
METHODS AND FINDINGS: A cost-utility analysis was performed using a Markov macro-simulation model, with a lifetime horizon, comparing a 12-mo regimen of trastuzumab with chemotherapy alone using the latest (2014) effectiveness measures from landmark randomised trials. A New Zealand (NZ) health system perspective was adopted, employing high-quality national administrative data. Incremental quality-adjusted life-years for trastuzumab versus chemotherapy alone are two times higher (2.33 times for the age group 50-54 y; 95% CI 2.29-2.37) for the worst prognosis (ER-/PR-) subtype compared to the best prognosis (ER+/PR+) subtype, causing incremental cost-effectiveness ratios (ICERs) for the former to be less than half those of the latter for the age groups from 25-29 to 90-94 y (0.44 times for the age group 50-54 y; 95% CI 0.43-0.45). If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]-adjusted: US$30,300; €23,700; £21,200), our study suggests that trastuzumab (2011 PPP-adjusted US$45,400/€35,900/£21,900 for 1 y at formulary prices) may not be cost-effective for ER+ (which are 61% of all) node-positive HER2+ early breast cancer patients but cost-effective for ER-/PR- subtypes (37% of all cases) to age 69 y. Market entry of trastuzumab biosimilars will likely reduce the ICER to below this threshold for premenopausal ER+/PR- cancer but not for ER+/PR+ cancer. Sensitivity analysis using the best-case effectiveness measure for ER+ cancer had the same result. A key limitation was a lack of treatment-effect data by hormone receptor subtype. Heterogeneity was restricted to age and hormone receptor status; tumour size/grade heterogeneity could be explored in future work.
CONCLUSIONS: This study highlights how cost-effectiveness can vary greatly by heterogeneity in age and hormone receptor subtype. Resource allocation and licensing of subsidised therapies such as trastuzumab should consider demographic and clinical heterogeneity; there is currently a profound disconnect between how funding decisions are made (largely agnostic to heterogeneity) and the principles of personalised medicine.
PMID: 27504960 [PubMed - indexed for MEDLINE]
 |
Related Articles |
The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study.
Am J Obstet Gynecol. 2016 Oct;215(4):457.e1-457.e13
Authors: Doll KM, Barber EL, Bensen JT, Revilla MC, Snavely AC, Bennett AV, Reeve BB, Gehrig PA
Abstract
BACKGROUND: There are currently no assessments of the impact of surgical complications on health-related quality of life in gynecology and gynecologic oncology. This is despite complications being a central focus of surgical outcome measurement, and an increasing awareness of the need for patient-reported data when measuring surgical quality.
OBJECTIVE: We sought to measure the impact of surgical complications on health-related quality of life at 1 month postoperatively, in women undergoing gynecologic and gynecologic oncology procedures.
STUDY DESIGN: This is a prospective cohort study of women undergoing surgery by gynecologic oncologists at a tertiary care academic center from October 2013 through October 2014. Patients were enrolled preoperatively and interviewed at baseline and 1, 3, and 6 months postoperatively. Health-related quality of life measures included validated general and disease-specific instruments, measuring multiple aspects of health-related quality of life, including anxiety and depression. The medical record was abstracted for clinical data and surgical complications were graded using validated Clavien-Dindo criteria, and women grouped into those with and without postoperative complications. Bivariate statistics, analysis of covariance, responder analysis, and multivariate modeling was used to analyze the relationship of postoperative complications to change health-related quality of life from baseline to 1 month. Plots of mean scores and change over time were constructed.
RESULTS: Of 281 women enrolled, response rates were 80% (n = 231/281) at baseline, and from that cohort, 81% (n = 187/231), 74% (n = 170/231), and 75% (n = 174/231) at 1, 3, and 6 months, respectively. The primary analytic cohort comprised 185 women with completed baseline and 1-month interviews, and abstracted clinical data. Uterine (n = 84, 45%), ovarian (n = 23, 12%), cervical (n = 17, 9%), vulvar (n = 3, 2%), and other (n = 4, 2%) cancers were represented, along with 53 (30%) cases of benign disease. There were 42 (24%) racial/ethnic minority women. Minimally invasive (n = 115, 63%) and laparotomy (n = 60, 32%) procedures were performed. Postoperative complications occurred in 47 (26%) of patients who experienced grade 1 (n = 12), grade 2 (n = 29), and grade 3 (n = 6) complications. At 1 month, physical (20.6 vs 22.5, P = .04) and functional (15.4 vs 18.3, P = .02) well-being, global physical health (43.1 vs 46.3, P = .02), and work ability (3 vs 7.2, P = .001) were lower in postoperative complication vs non-postoperative complication women. Relative change, however, in most health-related quality of life domains from baseline to 1 month did not differ between postoperative complication and nonpostoperative complication groups. Postoperative complication patients did have increased odds of sustained or worsened anxiety at 1 month vs baseline (odds ratio, 2.5; 95% confidence interval, 1.2-5.0) compared to nonpostoperative complication patients.
CONCLUSION: Collectively, women who experienced postoperative complications after gynecologic and gynecologic oncology procedures did not appear to have differences in most health-related quality of life trends over time compared to those who did not. An exception was anxiety, where postoperative complications were associated with sustained or worsened levels of high anxiety after surgery.
PMID: 27131589 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Racial differences in dietary changes and quality of life after a colorectal cancer diagnosis: a follow-up of the Study of Outcomes in Colorectal Cancer Survivors cohort.
Am J Clin Nutr. 2016 Jun;103(6):1523-30
Authors: Lewis CM, Wolf WA, Xun P, Sandler RS, He K
Abstract
BACKGROUND: Substantial racial disparities exist in colorectal cancer (CRC) survival.
OBJECTIVE: This was an exploratory study to assess the racial differences in dietary changes in relation to quality of life (QoL), recurrence, and survival after a CRC diagnosis.
DESIGN: Four hundred fifty-three stage II CRC patients were enrolled in the cohort study through the North Carolina Central Cancer Registry. Self-reported diet, physical activity, treatment, comorbidities, demographic characteristics, and QoL were collected at diagnosis and 12 and 24 mo after diagnosis. QoL was assessed with the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and the Medical Outcomes 12-Item Short Form Health Survey (SF-12) inventories. An overall dietary index score was calculated. Generalized estimating equations and logistic regression models were used to explore potential associations. Statistical power for this study was ∼50%.
RESULTS: African Americans (n = 81) were more likely to increase intakes of reduced-fat milk, vegetables, and fruit and decrease intakes of regular cheese, red meat, fried food, fast food, and fat (P < 0.05) than were Caucasians (n = 184) 24 mo after diagnosis. The least-squares means ± SEs for changes in dietary index were 6.05 ± 0.40 and 4.07 ± 0.27 for African Americans and Caucasians, respectively (P < 0.001). African Americans exhibited higher scores on portions of the FACT-C (colorectal cancer subscale: β = 1.04; 95% CI: 0.26, 1.82) and the SF-12 (Physical Component Summary: β = 2.49; 95% CI: 0.51, 4.48). Those who improved their dietary quality over 24 mo had lower risk of recurrence and mortality combined (OR: 0.42; 95% CI: 0.25, 0.72).
CONCLUSIONS: African Americans made more healthful changes in diet and had a higher QoL than did Caucasians in this underpowered study that used self-reported dietary data. No racial differences in recurrence or survival were evident, although improvements in dietary quality did reveal survival benefits overall. More prospective research on racial disparities in health behavior changes after diagnosis is desperately needed.
PMID: 27099251 [PubMed - indexed for MEDLINE]
 |
Related Articles |
Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future.
Phys Ther. 2016 Jul;96(7):949-60
Authors: Furze JA, Tichenor CJ, Fisher BE, Jensen GM, Rapport MJ
Abstract
The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship postprofessional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a "critical period" in the educational process is emerging. The purposes of this perspective article are: (1) to analyze the state of residency and fellowship education within the profession, (2) to identify best practice elements from other health professions that are applicable to physical therapy residency and fellowship education, and (3) to propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs. Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. Although the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high-quality education with a common focus on delivering health care in the context of societal needs.
PMID: 26678444 [PubMed - indexed for MEDLINE]
|
Related Articles |
Vestibular Rehabilitation After Traumatic Brain Injury: Case Series.
Phys Ther. 2016 Jun;96(6):839-49
Authors: Kleffelgaard I, Soberg HL, Bruusgaard KA, Tamber AL, Langhammer B
Abstract
BACKGROUND AND PURPOSE: There has been an increasing focus on vestibular rehabilitation (VR) after traumatic brain injury (TBI) in recent years. However, detailed descriptions of the content of and patient responses to VR after TBI are limited. The purposes of this case series are (1) to describe a modified, group-based VR intervention and (2) to examine changes in self-reported and performance-based outcome measures.
CASE DESCRIPTION: Two women and 2 men (aged 24-45 years) with mild TBI, dizziness, and balance problems participated in an 8-week intervention consisting of group sessions with guidance, individually modified VR exercises, a home exercise program, and an exercise diary. Self-reported and performance-based outcome measures were applied to assess the impact of dizziness and balance problems on functions related to activity and participation.
OUTCOMES: The intervention caused no adverse effects. Three of the 4 patients reported reduced self-perceived disability because of dizziness, diminished frequency and severity of dizziness, improved health-related quality of life, reduced psychological distress, and improved performance-based balance. The change scores exceeded the minimal detectable change, indicating a clinically significant change or improvement in the direction of age-related norms. The fourth patient did not change or improve in most outcome measures.
DISCUSSION: A modified, group-based VR intervention was safe and appeared to be viable and beneficial when addressing dizziness and balance problems after TBI. However, concurrent physical and psychological symptoms, other neurological deficits, and musculoskeletal problems might influence the course of central nervous system compensation and recovery. The present case series may be useful for tailoring VR interventions to patients with TBI. Future randomized controlled trials are warranted to evaluate the short- and long-term effects of VR after TBI.
PMID: 26586860 [PubMed - indexed for MEDLINE]
|
Related Articles |
Therapeutic Exercise Training to Reduce Chronic Headache in Working Women: Design of a Randomized Controlled Trial.
Phys Ther. 2016 May;96(5):631-40
Authors: Rinne M, Garam S, Häkkinen A, Ylinen J, Kukkonen-Harjula K, Nikander R
Abstract
BACKGROUND: Cervicogenic headache and migraine are common causes of visits to physicians and physical therapists. Few randomized trials utilizing active physical therapy and progressive therapeutic exercise have been previously published. The existing evidence on active treatment methods supports a moderate effect on cervicogenic headache.
OBJECTIVE: The aim of this study is to investigate whether a progressive, group-based therapeutic exercise program decreases the intensity and frequency of chronic headache among women compared with a control group receiving a sham dose of transcutaneous electrical nerve stimulation (TENS) and stretching exercises.
DESIGN: A randomized controlled trial with 6-month intervention and follow-up was developed. The participants were randomly assigned to either a treatment group or a control group.
SETTING: The study is being conducted at 2 study centers.
PATIENTS: The participants are women aged 18 to 60 years with chronic cervicogenic headache or migraine.
INTERVENTION: The treatment group's exercise program consisted of 6 progressive therapeutic exercise modules, including proprioceptive low-load progressive craniocervical and cervical exercises and high-load exercises for the neck muscles. The participants in the control group received 6 individually performed sham TENS treatment sessions.
MEASUREMENTS: The primary outcome is the intensity of headache. The secondary outcomes are changes in frequency and duration of headache, neck muscle strength, neck and shoulder flexibility, impact of headache on daily life, neck disability, fear-avoidance beliefs, work ability, and quality of life. Between-group differences will be analyzed separately at 6, 12, and 24 months with generalized linear mixed models. In the case of count data (eg, frequency of headache), Poisson or negative binomial regression will be used.
LIMITATIONS: The therapists are not blinded.
CONCLUSIONS: The effects of specific therapeutic exercises on frequency, intensity, and duration of chronic headache and migraine will be reported.
PMID: 26472297 [PubMed - indexed for MEDLINE]
181 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:
These pubmed results were generated on 2017/05/27
PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
In this study, the occurrence and removal efficiencies of 31 antibiotics, including 11 sulfonamides (SAs), five fluoroquinolones (FQs), four macrolides (MLs), four tetracyclines (TCs), three chloramphenicols (CAPs), and four other antibiotics (Others), were investigated in 12 municipal wastewater treatment plants (WWTPs) in Dalian, China. A total of 29 antibiotics were detected in wastewater samples with the concentration ranging from 63.6 to 5404.6 ng/L. FQs and SAs were the most abundant antibiotic classes in most wastewater samples, accounting for 42.2 and 23.9% of total antibiotic concentrations, respectively, followed by TCs (16.0%) and MLs (14.8%). Sulfamethoxazole, erythromycin, clarithromycin, azithromycin, ofloxacin, and norfloxacin were the most frequently detected antibiotics; of these, the concentration of ofloxacin was the highest in most of influent (average concentration = 609.8 ng/L) and effluent (average concentration = 253.4 ng/L) samples. The removal efficiencies varied among WWTPs in the range of −189.9% (clarithromycin) to 100% (enoxacin, doxycycline, etc), and more than 50% of antibiotics could not be efficiently removed with the removal efficiency less than 65%. An environmental risk assessment was also performed in the WWTP effluents by calculating the risk quotient (RQ), and high RQ values (>1) indicated erythromycin and clarithromycin might cause the ecological risk on organisms in surrounding water near discharge point of WWTPs in this area, which warrants further attention.
This review describes the current role of diagnostic and interventional radiology in the management of solid organ trauma, particularly the role of non-operative endovascular interventions such as angioembolization (AE). We will also provide a brief highlight of interventions available for thoracic trauma.
There has been a paradigm shift over the past 2 decades in the management of solid organ injuries from surgical management to non-operative management, especially in cases of minor injuries. Many factors, including the advances in multidetector contrast enhanced CT (MD-CECT) imaging, demands of cost-effective healthcare, and innovation of minimally invasive interventions with lower complication rates than surgical laparotomy have all contributed to this shift. Interventional radiology now plays a crucial role in the management of solid organ trauma, focusing on less invasive endovascular therapies. In addition, the grading and triaging of patients with stable solid organ traumatic injuries has become more reliant on MD-CECT findings.
This review article highlights the common imaging findings, grading systems, and most current management guidelines for solid organ trauma with a brief highlight of thoracic trauma.
The purpose of this article is to review recent literature evaluating the role of dual-energy CT (DECT) in assessing focal and diffuse liver diseases.
Recent generation of DECT scanners and newer DECT technologies are equipped with advanced multi-material decomposition algorithms and have better spectral separation capabilities. These have the potential for improvement in quantitative assessment of deposition disorders. Advancements in image reconstructions have also demonstrated enhanced detection hypovascular and hypervascular liver lesions.
This article will provide an updated overview of a wide array of clinical applications of DECT in liver imaging with case illustrations.
In this paper, we report the mechanism of electrical transport properties of polyaniline coated Ti0.9Al0.1C prepared by chemical route. Samples are characterized by X-ray diffraction technique and morphology has been observed by field emission scanning electron microscope. Semiconducting behavior is obtained for the samples and this behavior has been analyzed by different existing models. Out of different models the Mott's variable range hopping is the most suitable for analyzing the dc conductivity at lower temperatures. Correlated barrier hopping type of charge transfer process is followed in alternating current conductivity. We observe a transformation from negative to positive dc and ac magnetoconductivity by incorporating Ti0.9Al0.1C in polyaniline. Dielectric properties and impedance analysis are described by Maxwell–Wagner capacitor model. We determine different parameters like localization length, hopping distance, density of states from the analysis of the experimental data. The theory regarding magnetic field dependent ac conductivity is insufficient. This result will be a significant hint for a new theoretical challenge.
| Related Articles |
Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review.
Drug Alcohol Depend. 2017 May 16;177:1-13
Authors: Park JY, Wu LT
Abstract
BACKGROUND: The use of marijuana for medical purposes is now legal in some U.S. states and other jurisdictions, such as Canada, and Israel. Despite the widespread legalization of medical marijuana globally, there is limited information on patterns and correlates of medical marijuana use (MMU). We conducted a literature review to assess prevalence, reasons, perceived effects, and correlates of MMU among adolescents and adults.
METHODS: We searched peer-reviewed articles in English between January 1996 and August 2016 from several databases (PubMed, Google Scholar, Embase, CINAHL, and PsycINFO) using different combinations of keywords.
RESULTS: A total of 25 articles met the inclusion criteria. In the U.S., national survey estimates of prescribed MMU was 1.1% among 12th graders and 17% among adults who reported past-year marijuana use. The reported prevalence of prescribed MMU ranged from <1.7% in Israeli cancer patients to 17.4% in American health care patients. The reported prevalence of self-medication with marijuana ranged from 15% in Canadian patients with chronic pain to 30% in British patients with multiple sclerosis. Pain was the most frequently endorsed reason for use. MMU appeared to provide symptom relief for a range of pain conditions, sleep disturbance, and anxiety symptoms, but it did not appear to provide sufficient relief of cluster headache symptoms. Non-medical marijuana use was a common factor associated with MMU across studies.
CONCLUSION: Either MMU or self-medication with marijuana was common, mainly due to pain management. Additional research is needed to evaluate temporal and causal associations of non-medical marijuana use with MMU.
PMID: 28549263 [PubMed - as supplied by publisher]
