admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

https://cyberleninka.org/article/n/148766.pdf

Cytochrome P450 enzymes in drug metabolism: Regulation of gene expression, enzyme activities, and impact of genetic variation

Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

/pdf/an-official-american-thoracic-society-european-respiratory-5fbz6s326i.pdf

An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

Aim Meta-analyses have been used to evaluate associations between polymorphisms and colorectal cancer risk, but the quality of individual studies used to inform them may vary substantially. Our aim was to apply well-established quality-control criteria to individual association studies and then compare the results of meta-analyses that included or excluded studies that did not meet these criteria.



Method  We used meta-analyses of studies reporting a relationship between polymorphisms and colorectal cancer published between 1996 and 2008. Polymorphism–cancer associations were derived in separate meta-analyses including only those meeting the quality-control criteria.



Results  Relative ORs varied substantially between the open and restricted group meta-analyses for all variants except MTHFR 677 CT. However, the associations were modest and the direction of relative risk did not change after applying criteria. Publication bias was detected for all associations, except the restricted set of studies for GSTP1 GG.



Conclusion  We observed variation in calculated relative risk and changes in tests for publication bias that were dependent on the inclusion criteria used for association studies of polymorphisms and colorectal cancer. Standardizing study inclusion criteria may reduce the variation in findings for meta-analyses of gene-association studies of common diseases such as colorectal cancer.

/pdf/a-comparison-of-approaches-for-association-studies-of-3lopkid7pi.pdf

A comparison of approaches for association studies of polymorphisms and colorectal cancer risk.

Objective: To measure agreement between women’s self-administered risk factor questionnaire and their providers’ evaluation of their medical eligibility for hormonal contraceptive use. Methods: This was an anonymous cross-sectional study. Participants were women 15–45 years old who completed a 20-item selfadministered questionnaire. Women were recruited from six public health family planning clinics in the Seattle Metropolitan area. A matching medical evaluation questionnaire was completed concurrently by each participant’s health care provider. Using provider evaluation as the bgold standardQ against which we compared self-reported medical history, we calculated participant–provider agreement with point estimates and 95% confidence interval (CI). Results: Of 399 participant and provider pairs, participant–provider agreement was obtained for 392 participant pairs. The majority of the participants (90.3%) were 15–30 years old and 77.7% had used a hormonal contraceptive method for more than 1 year. The estimated proportion of the overall agreement was 96% (95% CI, 0.92–0.98). Women were more likely to report severe headaches (12.4% vs. 3.3%), possible pregnancy (7.3% vs. 3.5%) and smoking (6.2% vs. 2.1%) than providers, but less likely to report smoking more than 15 cigarettes per day (2.6% vs. 9.2%) and irregular menses (6.5% vs. 9.9%). Conclusion: Overall, a high proportion of the women in this study completed our medical history questionnaire in concordance with their health care providers’ same-day medical evaluation. Agreement on critical medical eligibility criteria such as hypertension was well above 90%. For criteria on which there was disagreement, women were more likely to identify contraindications than were their providers.

Original research article Agreement between women's and providers' assessment of hormonal contraceptive risk factors

BACKGROUND: With the introduction of atypical neuroleptic medications into the marketplace, the use of conventional neuroleptics has fallen, attendant with the perception of a more favorable side-effect profile for the atypical neuroleptics. OBJECTIVE: The purpose of this study was to determine the risk of tardive dyskinesia (TD) associated with atypical and conventional neuroleptics. METHODS: Subjects were adult users of the Veterans Administration Puget Sound Health Care System (VA-PSHCS) who received ≥1 prescription for neuroleptic medications during the study period. Electronic medical and pharmacy records were used to obtain neuroleptic drug exposure, exclusionary diagnosis, diagnosis for TD, and select demographic data. Medical records were reviewed to collect demographic data not available electronically. Controls were randomly selected from a cohort of neuroleptic users without TD. The case-defining event was the diagnosis of TD. RESULTS: There were 42 cases and 160 controls for the final analysis. The only demographic difference found was a higher proportion of Caucasians (90%) in the TD group compared to the control group (76%). There was no significant difference in the risk of TD for patients on conventional neuroleptics compared to the atypical neuroleptic users (OR=1.29; 95% CI=0.71-2.34). After adjusting for age, gender, race, schizophrenia, schizoaffective disorder, depression, and anti-Parkinson drugs, there was still no significant difference in risk of TD between cases and controls (OR=1.02; 95% CI=0.465-2.232). CONCLUSION: This study did not find a statistically significant difference in the risk of TD for users of conventional neuroleptics versus users of atypical neuroleptics.

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Neuroleptic drug exposure and incidence of tardive dyskinesia: a records-based case-control study.

BACKGROUND: The choice between surgical versus non-surgical treatment options is a fundamental decision for men with local stage prostate cancer because of differences in risks of genitourinary side effects among available treatments. OBJECTIVES: We assessed whether preexisting genitourinary symptoms at the time of diagnosis influenced men's preferences for surgery versus other management options. METHODS: We recruited 593 patients with newly diagnosed local stage prostate cancer prior to initiating treatment from an integrated health care system, an academic urology center, and community urology clinics. Using logistic regression we compared whether men had a preference for non-surgical options or only preferred surgery. RESULTS: Nearly 60% indicated they were considering non-surgical options. Age and clinical characteristics but not preexisting genitourinary symptoms influenced the decision between preferences for surgical or non-surgical options. A total of 62% of men reported side effects as a main factor in their treatment decision. Men with more aggressive tumor types were less likely to consider side effects, however, men who reported poor ability to have an erection were more likely to consider side effects (p<0.001). CONCLUSION: Sexual dysfunction at time of diagnosis, but not other genitourinary symptoms, is associated with men considering treatment-related side effects when considering surgery versus other options. Men who are not experiencing sexual dysfunction at diagnosis may discount the risks of side effects in the decision making process.

/pdf/association-of-pre-existing-symptoms-with-treatment-1b97wvlmjs.pdf

David K. Blough

Papers

A comparison of approaches for association studies of polymorphisms and colorectal cancer risk.

Original research article Agreement between women's and providers' assessment of hormonal contraceptive risk factors

Neuroleptic drug exposure and incidence of tardive dyskinesia: a records-based case-control study.

Association of Pre-Existing Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients

A pilot study demonstrating effective virtual reality analgesia in the elderly