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Neonatal seizures in a rural Kenyan District Hospital: aetiology, Incidence and outcome of hospitalization

BMC Medicine — Wed, 17 Mar 2010 00:00:00 +0100

Conclusion: There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available to the neonates. (Source: BMC Medicine)

Frequency and circumstances of placebo use in clinical practice - a systematic review of empirical studies

BMC Medicine — Tue, 23 Feb 2010 00:00:00 +0100

Conclusions: Although the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues. (Source: BMC Medicine)

Mitf-Mdel, a novel melanocyte/melanoma-specific isoform of microphthalmia-associated transcription factor-M, as a candidate biomarker for melanoma

BMC Medicine — Wed, 17 Feb 2010 00:00:00 +0100

Conclusion: MITF-Mdel, a novel melanocyte/melanoma-specific isoform of MITF-M, may serve as a potential candidate biomarker for diagnostic and follow-up purposes in melanoma. (Source: BMC Medicine)

Reduced levels of hydroxylated, polyunsaturated ultra long-chain fatty acids in the serum of colorectal cancer patients: implications for early screening and detection

BMC Medicine — Mon, 15 Feb 2010 00:00:00 +0100

Conclusions: A novel comprehensive metabolomics technology was used to identify a systemic metabolic dysregulation comprising previously unknown hydroxylated polyunsaturated ultra-long chain fatty acid metabolites in CRC patients. These metabolites are easily measurable in serum and a decrease in their concentration appears to be highly sensitive and specific for the presence of CRC, regardless of ethnic or geographic background. The measurement of these metabolites may represent an additional tool for the early detection and screening of CRC. (Source: BMC Medicine)

A functional polymorphism in the DNA methyltransferase 3A promoter modifies the susceptibility in gastric cancer but not in esophageal carcinoma

BMC Medicine — Wed, 03 Feb 2010 00:00:00 +0100

Conclusions: The DNMT3A -448A>G polymorphism is a novel functional SNP and contributes to its genetic susceptibility to GC. -448A>G can be used as a stratification marker to predict an individual's susceptibility to GC, especially in the subgroups of individuals at the age range [less than or equal to] 60 years. However, the relative distribution of -448A>G in EC can not be used as a prediction marker in order to evaluate an individual's susceptibility to EC. (Source: BMC Medicine)

Incidence, detection, and tumour stage of breast cancer in a cohort of Italian women with negative screening mammography report recommending early (short-interval) rescreen

BMC Medicine — Mon, 01 Feb 2010 00:00:00 +0100

Background: Although poorly described in the literature, the practice of early (short-interval) rescreen after a negative screening mammogram is controversial due to its financial and psychological burden and because it is of no proven benefit. Methods: The present study targeted an Italian 2-yearly screening programme (Emilia-Romagna Region, 1997-2002). An electronic dataset of 647,876 eligible negative mammography records from 376,257 women aged 50-69 years was record-linked with the regional breast cancer registry. The statistical analysis addressed the following research questions: (1) the prevalence of recommendation for early ( (Source: BMC Medicine)

The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial

BMC Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Conclusions: When added to the currently recommended first-line care of acute low back pain, a treatment programme based on the McKenzie method does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect. However, the McKenzie method seems to reduce health utilization although it does not reduce patient's risk of developing persistent symptoms.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12605000032651 (Source: BMC Medicine)

Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score

BMC Medicine — Thu, 21 Jan 2010 00:00:00 +0100

Conclusions: This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain. (Source: BMC Medicine)

Access to pain treatment as a human right

BMC Medicine — Wed, 20 Jan 2010 00:00:00 +0100

DiscussionSignificant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses.SummaryAccording to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps ...

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

BMC Medicine — Mon, 18 Jan 2010 00:00:00 +0100

Conclusions: Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI-even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies. (Source: BMC Medicine)

An evaluation of inflammatory gene polymorphisms in sibships discordant for premature coronary artery disease: the GRACE-IMMUNE study

BMC Medicine — Wed, 13 Jan 2010 00:00:00 +0100

Background: Inflammatory cytokines play a crucial role in coronary artery disease (CAD). We investigated the association between 48 coding and three non-coding single nucleotide polymorphisms (SNPs) from 35 inflammatory genes and the development of CAD, using a large discordant sibship collection (2699 individuals in 891 families). Methods: Family-based association tests (FBAT) and conditional logistic regression (CLR) were applied to single SNPs and haplotypes and, in CLR, traditional risk factors of CAD were adjusted for. Results: An association was observed between CAD and a common three-locus haplotype in the interleukin one (IL-1) cluster with P=0.006 in all CAD cases, P=0.01 in myocardial infarction (MI) cases and P=0.0002 in young onset CAD cases ( (Source: BMC Medicine)

The interleukin-1 cluster, dyslipidaemia and risk of myocardial infarction

BMC Medicine — Wed, 13 Jan 2010 00:00:00 +0100

Coronary heart disease (CHD) is among the most serious worldwide health problems. Recent genetic studies have robustly identified a number of polymorphic loci throughout the genome that are associated with disease risk but it is certain that more remain to be discovered. It is well established that inflammation plays a key role in the pathophysiology of CHD. Determining whether or not polymorphisms in genes involved in the inflammatory cascade affect the risk of CHD is of considerable interest with respect to understanding the direction of the causal arrow between increased expression of inflammatory genes and CHD. Establishing an association between the variation in inflammatory genes and CHD would provide conceptual support for the use of appropriately specific anti-inflammatory agents i...

Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system

BMC Medicine — Mon, 11 Jan 2010 00:00:00 +0100

Conclusion: Our extensive diagnostic and treatment data demonstrated that the strongest predictor of suicide-related behaviors for older patients newly treated with AED monotherapy was a previous diagnosis of affective disorder. Additional, research using a larger sample is needed to clearly determine the risk of suicide-related behaviors among less commonly used AEDs. (Source: BMC Medicine)

A randomized phase II study of carboplatin plus pegylated liposomal doxorubicin versus carboplatin plus paclitaxel in platinum sensitive ovarian cancer patients: a Hellenic Cooperative Oncology Group study

BMC Medicine — Thu, 07 Jan 2010 00:00:00 +0100

Background: Platinum-based combinations are the standard second-line treatment for platinum-sensitive ovarian cancer (OC). This randomized phase II study was undertaken in order to compare the combination of carboplatin and pegylated liposomal doxorubicin (LD) with carboplatin and paclitaxel (CP) in this setting. Methods: Patients with histologically confirmed recurrent OC, at the time of or more than 6 months after platinum-based chemotherapy, were randomized to six cycles of CP (carboplatin AUC5 + paclitaxel 175mg/m2, d1q21) or CLD (carboplatin AUC5 + pegylated LD 45mg/m2, d1q28). Results: A total of 189 eligible patients (CP 96, CLD 93), with a median age of 63 years, median Performance Status (PS) 0 and a median platinum free interval (PFI) of 16.5 months, entered the study. Discontinu...

IGF-I induced genes in stromal fibroblasts predict the clinical outcome of breast and lung cancer patients

BMC Medicine — Tue, 05 Jan 2010 00:00:00 +0100

Conclusion: Expression patterns of genes induced by IGF-I in primary breast and lung fibroblasts accurately predict outcomes in breast and lung cancer patients. Furthermore, these IGF-I induced gene signatures derived from stromal fibroblasts might be promising predictors for the response to IGF-I targeted therapies.See the related commentary by Werner and Bruchim: http://www.biomedcentral.com/1741-7015/8/2 (Source: BMC Medicine)

Basic and clinical significance of IGF-I-induced signatures in cancer

BMC Medicine — Tue, 05 Jan 2010 00:00:00 +0100

The insulin-like growth factor (IGF) system mediates growth, differentiation and developmental processes; it is also involved in various metabolic activities. Deregulation of IGF system expression and action is linked to diverse pathologies, ranging from growth deficits to cancer development. Targeting of the IGF axis emerged in recent years as a promising therapeutic approach in cancer and other medical conditions. Rational use of IGF-I-induced gene signatures may help to identify patients who might benefit from IGF axis-directed therapeutic modalities. In the accompanying research article in BMC Medicine, Rajski et al. show that IGF-I-induced gene expression in primary breast and lung fibroblasts accurately predict outcomes in breast and lung cancer patients.See the associated research p...

Calculating the potential for within-flight transmission of influenza A (H1N1)

BMC Medicine — Thu, 24 Dec 2009 00:00:00 +0100

Conclusions: Our results provide insights into the potential utility of air travel restrictions on controlling influenza pandemics in the winter of 2009/2010. They show travel by one infectious individual, rather than causing a single outbreak of H1N1, could cause several simultaneous outbreaks. These results imply that, during a pandemic, quarantining passengers who travel in Economy on long-haul flights could potentially be an important control strategy. Notably, our results show that quarantining passengers who travel First Class would be unlikely to be an effective control strategy. (Source: BMC Medicine)

Patient-centred tuberculosis treatment delivery under programmatic conditions in Tanzania: a cohort study

BMC Medicine — Mon, 21 Dec 2009 00:00:00 +0100

Conclusion: The PCT approach showed similar cure rates and better treatment success rates compared to daily health-facility DOT. The results indicate that there are no specific prerequisites for the supporter chosen by the patient. The programmatic setting of the study lends strong support for scaling-up of TB treatment observation outside the health facility. (Source: BMC Medicine)

Psychoeducation for depression, anxiety and psychological distress: a meta-analysis

BMC Medicine — Wed, 16 Dec 2009 00:00:00 +0100

Conclusions: Although it is commonly believed that psychoeducation interventions are ineffective, this meta-analysis revealed that brief passive psychoeducational interventions for depression and psychological distress can reduce symptoms. Brief passive psychoeducation interventions are easy to implement, can be applied immediately and are not expensive. They may offer a first-step intervention for those experiencing psychological distress or depression and might serve as an initial intervention in primary care or community models. The findings suggest that the quality of psychoeducation may be important. (Source: BMC Medicine)

A systems analysis of chemosensitivity of breast cancer cells to the polyamine analogue PG-11047

BMC Medicine — Mon, 14 Dec 2009 00:00:00 +0100

Conclusions: A 13-gene transcriptional marker set was developed as a predictor of response to PG-11047 that warrants clinical evaluation. Analyses of the pathways, networks and genes associated with response to PG-11047 suggest that response may be influenced by interferon signalling and differential inhibition of aspects of motility and epithelial to mesenchymal transition.See the related commentary by Benes and Settleman: http://www.biomedcentral.com/1741-7015/7/78 (Source: BMC Medicine)

Integrating complex genomic datasets and tumour cell sensitivity profiles to address a 'simple' question: which patients should get this drug?

BMC Medicine — Mon, 14 Dec 2009 00:00:00 +0100

It is becoming increasingly apparent that cancer drug therapies can only reach their full potential through appropriate patient selection. Matching drugs and cancer patients has proven to be a complex challenge, due in large part to the substantial molecular heterogeneity inherent to human cancers. This is not only a major hurdle to the improvement of the use of current treatments but also for the development of novel therapies and the ability to steer them to the relevant clinical indications. In this commentary we discuss recent studies from Kuo et al., published this month in BMC Medicine, in which they used a panel of cancer cell lines as a model for capturing patient heterogeneity at the genomic and proteomic level in order to identify potential biomarkers for predicting the clinical ...

Combination strategies for pandemic influenza response - a systematic review of mathematical modeling studies

BMC Medicine — Thu, 10 Dec 2009 00:00:00 +0100

Conclusions: Combination strategies increase the effectiveness of individual strategies. They include pharmaceutical (antiviral agents, antibiotics and vaccines) and non-pharmaceutical interventions (case isolation, quarantine, personal hygiene measures, social distancing and travel restriction). Local epidemiological and modeling studies are needed to validate efficacy and feasibility. (Source: BMC Medicine)

Malaria paediatric hospitalization between 1999 and 2008 across Kenya

BMC Medicine — Wed, 09 Dec 2009 00:00:00 +0100

Conclusion: A country-wide assessment of trends in malaria hospitalizations indicates that all is not equal, important variations exist in the temporal pattern of malaria admissions between sites and these differences require more detailed investigation to understand what is required to promote a clinical transition across Africa. (Source: BMC Medicine)

Post-exposure prophylaxis during pandemic outbreaks

BMC Medicine — Wed, 02 Dec 2009 00:00:00 +0100

Conclusions: Our findings suggest that, in the presence of transmissible drug resistance, strategies that prioritize the treatment of only ill individuals, rather than the prophylaxis of those suspected of being exposed, are most effective in reducing the morbidity and mortality of the pandemic. The impact of post-exposure prophylaxis depends critically on the treatment level and the transmissibility of resistant strains and, therefore, enhanced surveillance and clinical monitoring for resistant mutants constitutes a key component of any comprehensive plan for antiviral drug use during an influenza pandemic. (Source: BMC Medicine)

Can we improve outcomes in AF patients by early therapy?

BMC Medicine — Thu, 26 Nov 2009 00:00:00 +0100

Atrial fibrillation affects at least 1% of the population and causes marked society-wide morbidity and mortality. Current management of atrial fibrillation including antithrombotic therapy and management of concomitant conditions in all patients, rate control therapy in most patients, and rhythm control therapy in patients with severe atrial fibrillation-related symptoms can alleviate atrial fibrillation-related symptoms but can neither effectively prevent recurrent atrial fibrillation nor suppress atrial fibrillation-related complications. Hence, there is a need for better therapy of atrial fibrillation .The etiology of atrial fibrillation is complex. Most of the causes of atrial fibrillation which are known at present perpetuate themselves in vicious circles, and presence of the arrhythm...

Migraine pathogenesis and state of pharmacological treatment options

BMC Medicine — Mon, 16 Nov 2009 00:00:00 +0100

Migraine is a largely inherited disorder of the brain characterised by a complex but stereotypical dysfunction of sensory processing. The most obvious clinical symptom often is head pain, but non-headache symptoms such as photophobia, phonophobia and nausea are clearly part of the typical presentation. This review discusses current pathophysiological concepts of migraine and migraine aura, such as a possible brainstem dysfunction and cortical spreading depression. Acute and preventive migraine treatment approaches are briefly covered with a focus on shortcomings of the currently available treatment options. A number of different receptors such as calcitonin gene-related peptide (CGRP), TRPV1 and glutamate receptors are currently being targeted by potential novel migraine therapeutics. Pros...

Oral high dose ascorbic acid treatment for one year in young CMT1A patients: a randomised, double-blind, placebo-controlled phase II trial

BMC Medicine — Thu, 12 Nov 2009 00:00:00 +0100

Conclusions: Oral high dose ascorbic acid for one year did not improve myelination of the median nerve in young Charcot-Marie-Tooth type 1A patients. Treatment was relatively safe.Trial registration: Current Controlled Trials ISRCTN56968278, ClinicalTrials.gov NCT00271635. (Source: BMC Medicine)

Human papillomavirus testing with Pap triage for cervical cancer prevention in Canada: a cost-effectiveness analysis

BMC Medicine — Mon, 09 Nov 2009 00:00:00 +0100

Conclusions: A strategy of human papillomavirus testing beginning at age 25, with Pap triage for women with positive human papillomavirus results may be more effective at reducing cervical cancer at a lower cost than the current recommended strategy for screening in Canada. (Source: BMC Medicine)

Adherence to isoniazid prophylaxis among HIV-infected children: a randomized controlled trial comparing two dosing schedules

BMC Medicine — Tue, 03 Nov 2009 00:00:00 +0100

Conclusions: Adherence to isoniazid was excellent regardless of the dosing schedule used. Intermittent dosing of isoniazid prophylaxis can be considered as an alternative to daily dosing, without compromising adherence or efficacy.Trial registration - Clinical Trials NCT00330304 (Source: BMC Medicine)

Accumulation of neutral lipids in peripheral blood mononuclear cells as a distinctive trait of Alzheimer patients and asymptomatic subjects at risk of disease

BMC Medicine — Mon, 02 Nov 2009 00:00:00 +0100

Conclusions: We suggest that neutral lipid-peripheral blood mononuclear cells and plasma high density lipoprotein-cholesterol determinations might be of interest to outline a distinctive metabolic profile applying to both Alzheimer's disease patients and asymptomatic subjects at higher risk of disease. (Source: BMC Medicine)

Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

BMC Medicine — Wed, 28 Oct 2009 00:00:00 +0100

Conclusions: We found a decreasing ROM in children with CP from 2-14 years of age. This information is important for both the treatment and follow-up planning of the individual child as well as for the planning of health care programmes for all children with CP. (Source: BMC Medicine)

Genomic and epigenetic evidence for oxytocin receptor deficiency in autism

BMC Medicine — Wed, 21 Oct 2009 23:00:00 +0100

Conclusions: Together, these data provide further evidence for the role of OXTR and the oxytocin signaling pathway in the etiology of autism and, for the first time, implicate the epigenetic regulation of OXTR in the development of the disorder.See the related commentary by Gurrieri and Neri: http://www.biomedcentral.com/1741-7015/7/63 (Source: BMC Medicine)

Defective oxytocin function: a clue to understanding the cause of autism?

BMC Medicine — Wed, 21 Oct 2009 23:00:00 +0100

The autism spectrum disorders are a group of conditions with neurobehavioral impairment affecting approximately 0.6% of children. The clinical presentation is complex and the etiology is largely unknown, although a major role of genetic factors is widely accepted. A number of genetic studies led to the identification of genes and/or copy number variants whose alterations are associated with autism, but no specific factor has been found so far to be responsible for a substantial proportion of cases. Epigenetic modifications may also play a role, as demonstrated by the occurrence of autism in genetic conditions caused by mutations in imprinted genes or regions.The article by Gregory et al. published this month in BMC Medicine, reports on genomic and epigenetic alterations of OXTR, the gene e...

Suicidal ideation during treatment of depression with escitalopram and nortriptyline in Genome-Based Therapeutic Drugs for Depression (GENDEP): a clinical trial

BMC Medicine — Wed, 14 Oct 2009 23:00:00 +0100

Conclusions: Increases in suicidal ideation were associated with depression severity and decreased during antidepressant treatment. In men, treatment with escitalopram is associated with lower risk of suicidal ideation compared to nortriptyline. Clinicians should remain alert to suicidal ideation beyond the initial weeks of antidepressant treatment.Trial registration: EudraCT (No.2004-001723-38) and ISRCTN (No. 03693000). (Source: BMC Medicine)

Trends of the public health research output from India during 2001-2008

BMC Medicine — Tue, 13 Oct 2009 23:00:00 +0100

Background: An understanding of how public health research output from India is changing in relation to the disease burden and public health priorities is required in order to inform relevant research development. We therefore studied the trends in the public health research output from India during 2001-2008 that was readily available in the public domain. Methods: The scope and type of the published research from India in 2007 that was included in the PubMed database was assessed and compared with a previous similar assessment for 2002. Papers were classified based on the review of abstracts and original public health research papers were assessed in detail. Impact factors for the journals were used to compute quality-adjusted research output. The websites of governmental organizations, ...

An evaluation of exclusionary medical/psychiatric conditions in the definition of chronic fatigue syndrome

BMC Medicine — Sun, 11 Oct 2009 23:00:00 +0100

Conclusions: Medical and psychiatric illnesses associated with fatigue are common among the unwell. Those who fulfill CFS-like criteria need to be evaluated for potentially treatable conditions. Those with exclusionary conditions are equally impaired as those without exclusions.See the related commentary by Harvey and Wessely: http://www.biomedcentral.com/1741-7015/7/58 (Source: BMC Medicine)

Chronic fatigue syndrome: identifying zebras amongst the horses

BMC Medicine — Sun, 11 Oct 2009 23:00:00 +0100

There are currently no investigative tools or physical signs that can confirm or refute the presence of chronic fatigue syndrome (CFS). As a result, clinicians must decide how long to keep looking for alternative explanations for fatigue before settling on a diagnosis of CFS. Too little investigation risks serious or easily treatable causes of fatigue being overlooked, whilst too many increases the risk of iatrogenic harm and reduces the opportunity for early focused treatment. A paper by Jones et al published this month in BMC Medicine may help clinicians in deciding how to undertake such investigations. Their results suggest that if clinicians look for common psychiatric and medical conditions in those complaining of prolonged fatigue, the rate of detection will be higher than previously...

A vision of the future for BMC Medicine: serving science, medicine and authors

BMC Medicine — Tue, 06 Oct 2009 23:00:00 +0100

In June 2009, BMC Medicine received its first official impact factor of 3.28 from Thomson Reuters. In recognition of this landmark event, the BMC Medicine editorial team present and discuss the vision and aims of the journal. (Source: BMC Medicine)

Chemical and environmental vector control as a contribution to the elimination of visceral leishmaniasis on the Indian subcontinent: cluster randomized controlled trials in Bangladesh, India and Nepal

BMC Medicine — Sun, 04 Oct 2009 23:00:00 +0100

Conclusions: Sand fly control can contribute to the regional VL elimination programme; IRS should be strengthened in India and Nepal but in Bangladesh, where vector control has largely been abandoned during the last decades, the insecticide treatment of existing bed nets (coverage above 90% in VL endemic districts) could bring about an immediate reduction of vector populations; operational research to inform policy makers about the efficacious options for VL vector control and programme performance should be strengthened in the three countries. (Source: BMC Medicine)

Self-perceived psychological stress and ischemic stroke: a case-control study

BMC Medicine — Wed, 30 Sep 2009 23:00:00 +0100

Conclusions: In this case-control study, we found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype. Our results emphasize the need for further prospective studies addressing the potential role for psychological stress as a risk factor for ischemic stroke. In such studies ischemic stroke subtypes should be taken into consideration. (Source: BMC Medicine)

Who uses firearms as a means of suicide? A population study exploring firearm accessibility and method choice

BMC Medicine — Wed, 23 Sep 2009 23:00:00 +0100

This study, accessing all cases of suicide 1997-2004, explores factors which may impact on the choice of firearms as a suicide method, including current licence possession and previous history of legal access. Methods: Detailed information on all Queensland suicides (1997-2004) was obtained from the Queensland Suicide Register, with additional details of firearm licence history accessed from the Firearm Registry (Queensland Police Service). Cases were compared against licence history and method choice (firearms or other method). Odds ratios (OR) assessed the risk of firearms suicide and suicide by any method against licence history. A logistic regression was undertaken identifying factors significant in those most likely to use firearms in suicide. Results: The rate of suicide using firear...

The economics of treating stroke as an acute brain attack

BMC Medicine — Tue, 22 Sep 2009 23:00:00 +0100

Currently, treatments for ischemic stroke focus on restoring or improving perfusion to the ischemic area using thrombolytics. The increased hospitalization costs related to thrombolysis are offset by a decrease in rehabilitation costs, for a net cost savings to the healthcare system. However, early treatment is essential. The benefit of thrombolysis is time-dependent but only a very small proportion of patients, 2%, are presently being treated with tPA. In the United States, if the proportion of all ischemic stroke patients that receive tPA were increased to 4, 6, 8, 10, 15, or 20%, the realized cost saving would be approximately $ 15, 22, 30, 37, 55, and 74 million, respectively. Being so, efforts should be made to educate the public and paramedics regarding early stroke signs. Furthermor...

Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

BMC Medicine — Sun, 20 Sep 2009 23:00:00 +0100

Conclusion: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems. (Source: BMC Medicine)

Evaluation of a multiple ecological level child obesity prevention program: Switch what you Do, View, and Chew

BMC Medicine — Thu, 17 Sep 2009 23:00:00 +0100

Conclusions: The results indicate that the Switch program yielded small-to-modest treatment effects for promoting children's FV fruit and vegetable consumption and minimizing ST. The Switch program, which targets multiple behaviors through multiple channels, offers promise for use in youth obesity prevention. (Source: BMC Medicine)

Childhood emotional problems and self-perceptions predict weight gain in a longitudinal regression model

BMC Medicine — Thu, 10 Sep 2009 23:00:00 +0100

Conclusions: Emotional problems, low self-esteem and an external locus of control in childhood predict weight gain into adulthood. This has important clinical implications as it highlights a direction for early intervention strategies that may contribute to efforts to combat the current obesity epidemic. (Source: BMC Medicine)

Seasonal transmission potential and activity peaks of the new influenza A(H1N1): a Monte Carlo likelihood analysis based on human mobility

BMC Medicine — Wed, 09 Sep 2009 23:00:00 +0100

Conclusions: The analysis shows the potential for an early epidemic peak occurring in October/November in the Northern hemisphere, likely before large-scale vaccination campaigns could be carried out. The baseline results refer to a worst-case scenario in which additional mitigation policies are not considered. We suggest that the planning of additional mitigation policies such as systematic antiviral treatments might be the key to delay the activity peak in order to restore the effectiveness of the vaccination programs. (Source: BMC Medicine)

Safety and tolerability of the antimicrobial peptide human lactoferrin 1-11 (hLF1-11)

BMC Medicine — Mon, 07 Sep 2009 23:00:00 +0100

Conclusions: The new antimicrobial hLF1-11 is well tolerated in healthy volunteers with repeated daily doses up to 5 mg. The side-effect profile is very favourable for an antimicrobial, the only undesirable effect being a possible elevation of transaminases, which may be related to hLF1-11 although the current data do not allow conclusive interpretation of treatment relationship. A lower dose is recommended for the forthcoming multiple dosing studies in HSCT patients.Trial registration: ClinicalTrials.gov: nct00509938. (Source: BMC Medicine)

Modelling the progression of pandemic influenza A (H1N1) in Vietnam and the opportunities for reassortment with other influenza viruses

BMC Medicine — Wed, 02 Sep 2009 23:00:00 +0100

Conclusions: It is likely that, in the absence of effective interventions, the introduction of a novel H1N1 into a densely populated country such as Vietnam will result in a widespread epidemic. A large epidemic in a country with intense human-animal interaction and continued co-circulation of other seasonal and avian viruses would provide substantial opportunities for H1N1 to acquire new genes. (Source: BMC Medicine)

Phosphorylated ERK is a potential predictor of sensitivity to sorafenib when treating hepatocellular carcinoma: evidence from an in vitro study

BMC Medicine — Sun, 23 Aug 2009 23:00:00 +0100

Conclusions: In this in vitro study, pERK was confirmed to be a potential biomarker predictive of sensitivity to sorafenib in treating HCC. The RAF/MEK/ERK pathway may be involved in drug resistance to traditional chemotherapy in HCC. (Source: BMC Medicine)

Predicting the response to sorafenib in hepatocellular carcinoma: where is the evidence for phosphorylated extracellular signaling-regulated kinase (pERK)?

BMC Medicine — Sun, 23 Aug 2009 23:00:00 +0100

The approval of sorafenib and active development of many other molecularly targeted agents in hepatocellular carcinoma (HCC) have presented a challenge to understand the mechanism of action of sorafenib and identify predictive biomarkers to select patients more likely to benefit from sorafenib. The preclinical study by Zhang and celleagues published this month in BMC Medicine provides preliminary evidence that baseline phosphorylated extracellular signaling-regulated kinase (pERK) may be a relevant marker to reflect the level of constitutive activation of the RAF/mitogen-activated protein kinase kinase (MEK)/ERK signaling pathway and has the potential value in predicting response to sorafenib. The clinical data from the initial single arm phase II study and preliminary report from the rand...

Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review

BMC Medicine — Thu, 06 Aug 2009 23:00:00 +0100

Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations ar...

Hospital variation in transfusion and infection after cardiac surgery: a cohort study

BMC Medicine — Thu, 30 Jul 2009 23:00:00 +0100

Conclusions: Allogeneic blood transfusion was associated with an increased risk of infection at multiple sites, suggesting a system-wide immune response. Hospital variation in transfusion practices after coronary artery bypass grafting was considerable, indicating that quality efforts may be able to influence practice and improve outcomes. (Source: BMC Medicine)

Does blood transfusion harm cardiac surgery patients?

BMC Medicine — Thu, 30 Jul 2009 23:00:00 +0100

RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study

BMC Medicine — Sun, 26 Jul 2009 23:00:00 +0100

Background: Pneumonia is among the main causes of illness and death in children (Source: BMC Medicine)

Identification of pediatric septic shock subclasses based on genome-wide expression profiling

BMC Medicine — Tue, 21 Jul 2009 23:00:00 +0100

Conclusions: Genome-wide expression profiling can identify pediatric septic shock subclasses having clinically relevant phenotypes. (Source: BMC Medicine)

Effects of clinical pathways in the joint replacement: a meta-analysis

BMC Medicine — Tue, 30 Jun 2009 23:00:00 +0100

Conclusion: The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way, teams critically analyse the actual organisation of the process and the multidisciplinary team is highly involved in the re-organisation. Further studies should focus on the evaluation of pathways as complex interventions to help to understand which mechanisms within the clinical pathways can really improve the qu...

Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1)

BMC Medicine — Sun, 21 Jun 2009 23:00:00 +0100

Here we present a review of the literature of influenza modeling studies, and discuss how these models can provide insights into the future of the currently circulating novel strain of influenza A (H1N1), formerly known as swine flu. We discuss how the feasibility of controlling an epidemic critically depends on the value of the Basic Reproduction Number (R0). The R0 for novel influenza A (H1N1) has recently been estimated to be between 1.4 and 1.6. This value is below values of R0 estimated for the 1918-1919 pandemic strain (mean R0 ~ 2: range 1.4 to 2.8) and is comparable to R0 values estimated for seasonal strains of influenza (mean R0 1.3: range 0.9 to 2.1). By reviewing results from previous modeling studies we conclude it is likely that a pandemic of H1N1 could be contained, but a co...

Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study

BMC Medicine — Mon, 08 Jun 2009 04:00:00 +0100

Conclusion: Introducing one extra cleaner produced a measurable effect on the clinical environment, with apparent benefit to patients regarding meticillin-resistant S. aureus infection. Molecular epidemiological methods supported the possibility that patients acquired meticillin-resistant S. aureus from environmental sources. These findings suggest that additional research is warranted to further clarify the environmental, clinical and economic impact of enhanced hygienic cleaning as a component in the control of hospital-acquired infection. (Source: BMC Medicine)

Calculating the return on investment of mobile healthcare

BMC Medicine — Tue, 02 Jun 2009 04:00:00 +0100

Conclusions: By using published data that quantify the value of prevention practices and the value of preventing unnecessary use of emergency departments, an empirical method was developed to determine the value of a typical mobile health clinic. The Family Van, a mobile health clinic that has been serving the medically disenfranchised of Boston for 16 years, was evaluated accordingly and found to have return on investment of $36 for every $1 invested in the program. (Source: BMC Medicine)

Varicella vaccination in Europe - taking the practical approach

BMC Medicine — Thu, 28 May 2009 04:00:00 +0100

Varicella is a common viral disease affecting almost the entire birth cohort. Although usually self-limiting, some cases of varicella can be serious, with 2 to 6% of cases attending a general practice resulting in complications. The hospitalisation rate for varicella in Europe ranges from 1.3 to 4.5 per 100,000 population/year and up to 10.1% of hospitalised patients report permanent or possible permanent sequelae (for example, scarring or ataxia). However, in many countries the epidemiology of varicella remains largely unknown or incomplete.In countries where routine childhood vaccination against varicella has been implemented, it has had a positive effect on disease prevention and control. Furthermore, mathematical models indicate that this intervention strategy may provide economic bene...

Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis

BMC Medicine — Wed, 13 May 2009 04:00:00 +0100

Conclusion: Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis. (Source: BMC Medicine)

Preventing contrast-induced nephropathy: problems, challenges and future directions

BMC Medicine — Wed, 13 May 2009 04:00:00 +0100

Contrast-induced nephropathy is an injury to the kidney occurring as a result of exposure to intravascular contrast media. It results in both short- and long-term adverse events including mortality. Since treatment of the injury after it has occurred is ineffective, efforts to prevent the injury are the focus of investigators and clinicians alike. In this commentary, the pathogenesis and clinical relevance of contrast-induced nephropathy are reviewed. Prophylactic strategies are discussed with a focus on the use of meta-analysis of small single-center trials. (Source: BMC Medicine)

Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial

BMC Medicine — Tue, 05 May 2009 04:00:00 +0100

Conclusions: The expected beneficial effects of zinc supplementation for acute diarrhea were not observed. Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children. Trial registration The study was registered as an International Standard Randomized Controlled Trial (ISRCTN85071383). (Source: BMC Medicine)

Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study

BMC Medicine — Wed, 29 Apr 2009 04:00:00 +0100

Background: Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections. Methods: Cohorts of caesarean sections by indication (that is, planned repeat caesarean section, failure to progress, foetal distress) were selected from the period 1998 to 2004 (N = 50,806). Deliveries performed under general anaesthesia were compared with those performed under spinal or epidural, for the outcomes of neonatal intubation and 5-minute Apgar (Apgar5) (Source: BMC Medicine)

Immunogenicity and safety of concomitant administration of a measles, mumps and rubella vaccine (M-M-RvaxPro(R)) and a varicella vaccine (VARIVAX(R)) by intramuscular or subcutaneous routes at separate injection sites: a randomised clinical trial

BMC Medicine — Tue, 14 Apr 2009 04:00:00 +0100

Conclusions: The immunogenicities of M-M-RvaxPro and VARIVAX administered by the intramuscular route were comparable with those following subcutaneous administration, and the tolerability of the two vaccines was comparable regardless of administration route. Integration of both administration routes in the current European indications for the two vaccines will now allow physicians in Europe to choose their preferred administration route in routine clinical practice. Trial registration: ClinicalTrials.gov NCT00432523 (Source: BMC Medicine)

Different atrophy-hypertrophy transcription pathways in muscles affected by severe and mild spinal muscular atrophy

BMC Medicine — Tue, 07 Apr 2009 04:00:00 +0100

Conclusions: Our study suggests a different picture of atrophy pathways in each of the two forms of SMA. In particular, p38 may be the regulator of protein synthesis in SMA I. The SMA III profile appears as the result of the concurrent presence of atrophic and hypertrophic fibers. This more favorable condition might be due to the over-expression of MTOR that, given its role in the activation of protein synthesis, could lead to compensatory hypertrophy in SMA III muscle fibers. (Source: BMC Medicine)

Intradermal influenza vaccination of healthy adults using a new microinjection system: a 3-year randomised controlled safety and immunogenicity trial

BMC Medicine — Thu, 02 Apr 2009 04:00:00 +0100

Conclusions: An influenza vaccine with 9ug of haemagglutinin/strain given using an intradermal microinjection system showed comparable immunogenic and safety profiles to a licensed intramuscular vaccine, and presents a promising alternative to intramuscular vaccination for influenza for adults younger than 60 years. Trial registration: Clinicaltrials.gov NCT00703651. (Source: BMC Medicine)

Sex differences in rheumatoid arthritis: more than meets the eye...

BMC Medicine — Mon, 30 Mar 2009 04:00:00 +0100

Sex differences in the prevalence of autoimmune diseases such as rheumatoid arthritis (RA) are well described, but the literature is not as clear about sex differences in RA disease course and prognosis. A recent study from a very large cross-sectional international cohort demonstrated slightly worse levels of disease activity and function in female patients with RA, compared with men. These findings are discussed in the context of our evolving knowledge of sex differences in the expression of this prototypic autoimmune disease, both in terms of the actual disease activity level, the effects that the disease has on physical function, and our ability accurately to measure these aspects. (Source: BMC Medicine)

Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review

BMC Medicine — Tue, 24 Mar 2009 04:00:00 +0100

Conclusions: Measure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia. (Source: BMC Medicine)

Proteinuria as a predictor of complications of pre-eclampsia

BMC Medicine — Tue, 24 Mar 2009 04:00:00 +0100

Proteinuria is a defining criterion for the diagnosis of pre-eclampsia. The amount of protein lost per day has been thought by some to predict both maternal and fetal outcome. The systematic review of 16 primary papers including over 6700 patients by Thangaratinam and colleagues published this month in BMC Medicine suggests otherwise. This finding may influence our management of pre-eclampsia. (Source: BMC Medicine)

A compact VEGF signature associated with distant metastases and poor outcomes

BMC Medicine — Mon, 16 Mar 2009 04:00:00 +0100

Conclusions: These data identify a compact in vivo hypoxia signature that tends to be present in distant metastasis samples, and which portends a poor outcome in multiple tumor types. This signature suggests that the response to hypoxia includes the ability to promote new blood and lymphatic vessel formation, and that the dual targeting of multiple cell types and pathways will be needed to prevent metastatic spread. (Source: BMC Medicine)

Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents

BMC Medicine — Wed, 11 Mar 2009 04:00:00 +0100

Conclusions: The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required. (Source: BMC Medicine)

Recent developments in Alzheimer's disease therapeutics

BMC Medicine — Thu, 19 Feb 2009 05:00:00 +0100

Alzheimer's disease is a devastating neurological disorder that affects more than 37 million people worldwide. The economic burden of Alzheimer's disease is massive; in the United States alone, the estimated direct and indirect annual cost of patient care is at least $100 billion. Current FDA-approved drugs for Alzheimer's disease do not prevent or reverse the disease, and provide only modest symptomatic benefits. Driven by the clear unmet medical need and a growing understanding of the molecular pathophysiology of Alzheimer's disease, the number of agents in development has increased dramatically in recent years. Truly 'disease-modifying' therapies that target the underlying mechanisms of Alzheimer's disease have now reached late stages of human clinical trials. Primary targets include be...

Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study

BMC Medicine — Fri, 06 Feb 2009 05:00:00 +0100

Conclusions: During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause. (Source: BMC Medicine)

Trait-specific tracking and determinants of body composition: a 7-year follow-up study of pubertal growth in girls

BMC Medicine — Mon, 26 Jan 2009 05:00:00 +0100

Background: Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, puberty and adolescence is vital since it holds key information regarding current and future health. Our study aimed to determine how BM, LM and FM track from prepuberty to early adulthood in girls and what factors are associated with intra- and inter-individual variation in these three tissues. Methods: The study was a 7-year longitudinal cohort study. BM, LM and FM measured using dual-energy X-ray absorptiometry, self-reported dietary information, leisure time physical activity (LTPA) and other factors were assessed one to eight times in 396 girls aged 10 to 13 years (baseline), and in 255 mothers once. Results: The location of a girl's BM, LM and FM in the lower, middle or upper part of the s...

The relationship between trust in mass media and the healthcare system and individual health: evidence from the AsiaBarometer Survey

BMC Medicine — Thu, 22 Jan 2009 05:00:00 +0100

Conclusions: Vertical trust in mass media is associated with better health in Asian people. Since mass media is likely an important arena for public health, media trust should be enhanced to make people healthier. (Source: BMC Medicine)

BMC Medicine celebrates its 5th anniversary

BMC Medicine — Thu, 15 Jan 2009 05:00:00 +0100

In November 2008, BMC Medicine passed the landmark of its first 5 years of publishing. When we launched the journal with the aim of publishing high quality research of general interest and special importance, we had no idea what the future would bring. To mark the occasion of our 5th anniversary, we consider the achievements of the last 5 years and discuss our plans for the future. (Source: BMC Medicine)

Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: a network meta-analysis

BMC Medicine — Wed, 14 Jan 2009 05:00:00 +0100

Conclusions: We found no evidence that one single inhaled drug regimen is more effective than another in reducing exacerbations. Inhaled corticosteroids when added to long-acting beta-agonists reduce exacerbations only in patients with COPD with FEV1 (Source: BMC Medicine)

The Association of Posttraumatic Stress Disorder and Metabolic Syndrome: A Study of Increased Health Risk in Veterans

BMC Medicine — Fri, 09 Jan 2009 05:00:00 +0100

Conclusions: These findings provide preliminary evidence linking higher severity of PTSD with risk factors for diminished health and increased morbidity, as represented by metabolic syndrome. (Source: BMC Medicine)

Upregulation of CRABP1 in human neuroblastoma cells overproducing the Alzheimer-typical Abeta42 reduces their differentiation potential

BMC Medicine — Tue, 16 Dec 2008 05:00:00 +0100

Conclusions: We conclude that increasing the Abeta42/Abeta40 ratio up-regulates CRABP1, which in turn reduces the differentiation potential of the human neuroblastoma cell line SH-SY5Y, but increases cell proliferation. This work might contribute to the better understanding of AD neurogenesis, currently a controversial topic. (Source: BMC Medicine)

A controlled trial of the effectiveness of internet continuing medical education

BMC Medicine — Thu, 04 Dec 2008 05:00:00 +0100

Conclusions: Physicians who participated in selected internet CME activities were more likely to make evidence-based clinical choices than non-participants. Internet CME activities show promise in offering a searchable, credible, available on-demand, high-impact source of CME for physicians. (Source: BMC Medicine)

The cost-effectiveness of increasing alcohol taxes: a modelling study

BMC Medicine — Fri, 28 Nov 2008 05:00:00 +0100

Conclusions: Focusing on health care costs and health consequences for drinkers, an alcohol tax increase is a cost-effective policy instrument. (Source: BMC Medicine)

Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals

BMC Medicine — Wed, 26 Nov 2008 05:00:00 +0100

Conclusions: Our finding of negative coverage of herbal remedy trials is contrary to the positive trends in most published research based primarily on anecdotal accounts. Our results highlight how media coverage is not providing the public with the information necessary to make informed decisions about medical treatments. Most concerning is the lack of disclosure of trial funding and conflicts of interest that could influence the outcome or reporting of trial results. This lack of reporting may impact the medical research community who have the most to lose by way of public trust and respect. (Source: BMC Medicine)

Valvular regurgitation and surgery associated with fenfluramine use: an analysis of 5743 individuals

BMC Medicine — Thu, 06 Nov 2008 05:00:00 +0100

Background: Use of fenfluramines for weight loss has been associated with the development of characteristic plaques on cardiac valves causing regurgitation. However, previously published studies of exposure to fenfluramines have been limited by relatively small sample size, short duration of follow-up, and the lack of any estimate of the frequency of subsequent valvular surgery. Methods: We performed an observational study of 5743 users of fenfluramines examined by echocardiography between July 1997 and February 2004 in a single large cardiology clinic. Results: The prevalence of at least mild aortic regurgitation (AR) or moderate mitral regurgitation (MR) was 19.6% in women and 11.8% in men (p < 0.0001 for gender difference). Duration of use was strongly predictive of mild or greater AR (...

25 years of HIV-1 research: progress and perspectives

BMC Medicine — Fri, 31 Oct 2008 04:00:00 +0100

Twenty-five years after the discovery and isolation of HIV-1 by French and American scientists, much progress has been made in AIDS basic research, clinical treatment, and public health prevention measures. Here, we summarize, in brief, advances that have been achieved and provide some perspectives on future challenges. (Source: BMC Medicine)

Lack of association of two common polymorphisms on 9p21 with risk of coronary heart disease and myocardial infarction; results from a prospective cohort study

BMC Medicine — Thu, 16 Oct 2008 04:00:00 +0100

Conclusion: we were not able to show an association of the studied SNPs with risks of CHD and MI. This may be due to differences in genes involved in the occurrence of CHD in young and older people. (Source: BMC Medicine)

The problems of meta-analysis for antibiotic treatment of chronic obstructive pulmonary disease, a heterogeneous disease: a commentary on Puhan et al

BMC Medicine — Fri, 10 Oct 2008 04:00:00 +0100

Exacerbations are a major cause of morbidity and mortality in chronic obstructive pulmonary disease. Exacerbations can be of bacterial, viral or mixed etiology, with bacteria involved in 50% of exacerbations. Consequently, current management of exacerbations frequently involves the use of antibiotics. The paper by Puhan et al published this month in BMC Medicine examines the benefit of antibiotics in placebo-controlled trials in mild to moderate outpatient exacerbations. The authors use a meta-analytic approach and rightly conclude that more trials are needed in this area. However, the heterogeneity of chronic obstructive pulmonary disease patients and exacerbations and the limited end-points in past trials do not allow firm conclusions to be drawn about antibiotic use in outpatient exacer...

Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review

BMC Medicine — Fri, 10 Oct 2008 04:00:00 +0100

Conclusions: Placebo-controlled trials do not support the use of antibiotics in chronic obstructive pulmonary disease patients with mild to moderate exacerbations. Conducting head-to-head trials is, therefore, scientifically and ethically questionable. This underscores the requirement to perform or study systematic reviews of placebo-controlled trials before conducting head-to-head trials. (Source: BMC Medicine)

The problems of meta-analysis for antibiotic treatment of COPD, a heterogeneous disease: a commentary on Puhan et al.

BMC Medicine — Fri, 10 Oct 2008 04:00:00 +0100

Exacerbations are a major cause of morbidity and mortality in COPD. Exacerbations can be of bacterial, viral or mixed etiology, with bacteria involved in 50% of exacerbations. Consequently, current management of exacerbations frequently involves the use of antibiotics. The paper by Puhan et al , published this month in BMC Medicine examines the benefit of antibiotics in placebo controlled trials in mild to moderate outpatient exacerbations. The authors use a meta-analytic approach and rightly conclude that more trials are needed in this area. However, the heterogeneity of COPD patients and exacerbations and the limited end-points in past trials does not let firm conclusions to be drawn about antibiotic use in outpatient exacerbations based on this meta-analysis. Future trials need to take ...

Genomic variation in myeloma: design, content, and initial application of the Bank On A Cure SNP Panel to detect associations with progression-free survival

BMC Medicine — Mon, 08 Sep 2008 04:00:00 +0100

Conclusion: A targeted gene approach was undertaken to develop an SNP panel that can test for associations with clinical outcomes in myeloma. The initial analysis provided some predictive power, demonstrating that genetic variations in the myeloma patient population may influence PFS. (Source: BMC Medicine)

Genomic Variation in Myeloma: Design, content, and initial application of the Bank On A Cure SNP Panel to detect associations with progression free survival

BMC Medicine — Mon, 08 Sep 2008 04:00:00 +0100

Conclusions: A targeted gene approach was undertaken to develop an SNP panel that can test for associations with clinical outcomes in myeloma. The initial analysis provided some predictive power, demonstrating that genetic variations in the myeloma patient population may influence PFS. (Source: BMC Medicine)

Germline Polymorphisms as Modulators of Cancer Phenotypes

BMC Medicine — Mon, 08 Sep 2008 04:00:00 +0100

Identifying the complete repertoire of genes and genetic variants that regulate the pathogenesis and progression of human disease is a central goal of post-genomic biomedical research. In cancer, recent studies have shown that genome-wide association studies can be successfully used to identify germline polymorphisms associated with an individual's susceptibility to malignancy. In parallel to these reports, substantial work has also shown that patterns of somatic alterations in human tumors can be successfully employed to predict disease prognosis and treatment response. A paper by Van Ness et al. published this month in BMC Medicine reports the initial results of a multi-institutional consortium for multiple myeloma designed to evaluate the role of germline polymorphisms in influencing mu...

Association between umbilical cord glucocorticoids and blood pressure at age 3 years

BMC Medicine — Thu, 28 Aug 2008 04:00:00 +0100

Conclusions: A higher F/E ratio in umbilical venous cord blood, likely reflecting reduced placental 11beta-HSD2 activity, was associated with higher systolic blood pressure at age 3 years. Our data suggest that increased fetal exposure to active maternal glucocorticoids may program later systolic blood pressure. (Source: BMC Medicine)

Increased deposition of C3b on red cells with low CR1 and CD55 in a malaria-endemic region of western Kenya: implications for the development of severe anemia

BMC Medicine — Thu, 21 Aug 2008 04:00:00 +0100

Conclusions: Increasing malaria prevalence among children >6 to [less than or equal to]36 months of age in western Kenya, together with low red cell CR1 and CD55 levels, results in increased C3b deposition on red cells and low hemoglobin. The strong contribution of age to C3b deposition suggests that there are still additional unidentified age-related factors that increase the susceptibility of red cells to C3b deposition and destruction. (Source: BMC Medicine)

The pathophysiology of malarial anaemia: where have all the red cells gone?

BMC Medicine — Thu, 21 Aug 2008 04:00:00 +0100

Malarial anaemia is an enormous public health problem in endemic areas and occurs predominantly in children in the first 3 years of life. Anaemia is due to both a great increase in clearance of uninfected cells and a failure of an adequate bone marrow response. Odhiambo, Stoute and colleagues show how the age distribution of malarial anaemia and the haemolysis of red blood cells may be linked by an age-dependent increase in the capacity of red blood cells to inactivate complement components absorbed or deposited directly on to the surface of the red blood cell. In this commentary, we discuss what has been established about the role of complement deposition on the surface of red blood cells in the pathology of malarial anaemia, how genetic polymorphisms of the complement control proteins in...

Modelling neurofibromatosis type 1 tibial dysplasia and its treatment with lovastatin

BMC Medicine — Thu, 31 Jul 2008 04:00:00 +0100

Conclusion: Our data suggest the potential usefulness of lovastatin, a drug approved by the US Food and Drug Administration in 1987 for the treatment of hypercholesteraemia, in the treatment of Nf1-related fracture healing abnormalities. The experimental model presented here constitutes a valuable tool for the pre-clinical stage testing of candidate drugs, targeting Nf1-associated bone dysplasia. (Source: BMC Medicine)

Statins, bone, and neurofibromatosis type 1

BMC Medicine — Thu, 31 Jul 2008 04:00:00 +0100

Neurofibromatosis type 1 (NF1) is a dominantly inherited multi-system disorder. Major features include pigmentary abnormalities, benign tumors of the nerve sheath (neurofibromas), malignant tumors, learning disabilities, and skeletal dysplasia. The NF1 gene functions as a tumor suppressor, but haploinsuffiency probably accounts for some aspects of the non-tumor phenotype. The protein product, neurofibromin, is a Ras GTPase-activating protein, and various Ras pathway inhibitors are being tested in preclinical models and clinical trials for effectiveness in treating NF1 complications. The paper by Kolanczyk et al in this volume of BMC Medicine describes a preclinical mouse model for one of the most difficult NF1 lesions to treat, tibial dysplasia, and provides evidence that a existing drug w...

Connexin-43 upregulation in micrometastases and tumor vasculature and its role in tumor cell attachment to pulmonary endothelium

BMC Medicine — Tue, 22 Jul 2008 04:00:00 +0100

Conclusion: Connexin-43 facilitates metastatic 'homing' by increasing adhesion of cancer cells to the lung endothelial cells. The marked upregulation of connexin-43 in tumor cell-endothelial cell contact areas, whether in preexisting 'homing' vessels or in newly formed tumor vessels, suggests that connexin-43 can serve as a potential marker of micrometastases and tumor vasculature and that it may play a role in the early incorporation of endothelial cells into small tumors as seeds for vasculogenesis. (Source: BMC Medicine)

A panel of kallikrein markers can reduce unnecessary biopsy for prostate cancer: data from the European Randomized Study of Prostate Cancer Screening in Göteborg, Sweden

BMC Medicine — Tue, 08 Jul 2008 04:00:00 +0100

Conclusion: Multiple kallikrein forms measured in blood can predict the result of biopsy in previously unscreened men with elevated PSA. A multivariable model can determine which men should be advised to undergo biopsy and which might be advised to continue screening, but defer biopsy until there was stronger evidence of malignancy. (Source: BMC Medicine)

A panel of kallikrein markers can reduce unnecessary biopsy for prostate cancer: data from the European Randomized Study of Prostate Cancer Screening in Goteborg, Sweden

BMC Medicine — Tue, 08 Jul 2008 04:00:00 +0100

Conclusions: Multiple kallikrein forms measured in blood can predict the result of biopsy in previously unscreened men with elevated PSA. A multivariable model can determine which men should be advised to undergo biopsy and which might be advised to continue screening, but defer biopsy until there was stronger evidence of malignancy. (Source: BMC Medicine)

Assessment of strategies for switching patients from olanzapine to risperidone: a randomized, open-label, rater-blinded study

BMC Medicine — Mon, 30 Jun 2008 04:00:00 +0100

Conclusions: When switching patients from olanzapine to risperidone, a gradual reduction in the dose of olanzapine over 2 weeks was associated with higher rates of retention compared with abrupt or less gradual discontinuation. Switching via any strategy was associated with significant improvements in positive and anxiety symptoms and was generally well tolerated. Trial registration: ClinicalTrials.gov NCT00378183 (Source: BMC Medicine)

Comments on strategies for switching antipsychotics

BMC Medicine — Mon, 30 Jun 2008 04:00:00 +0100

Both the new generation of antipsychotics and the more traditional antipsychotic drugs produce an important and meaningful improvement in patients with schizophrenia, but most patients are neither cured nor free of symptoms. As a consequence, it is common to switch from one drug to another in the hope of obtaining a better response. All antipsychotic drugs produce some side effects, so switching can also be a tolerance issue. There are reports in the literature on the tactics of switching: abrupt discontinuation, cross tapering, starting a patient on a new drug while continuing with the old drug until the new drug has reached a steady state, or some variation on these tactics. In this issue, Ganguli et al. have carried out a randomized switching study, the data from which indicates the tac...

Tracking the spatial diffusion of influenza and norovirus using telehealth data: a spatio-temporal analysis of syndromic data

BMC Medicine — Thu, 26 Jun 2008 04:00:00 +0100

Conclusion: Spatiotemporal analyses of telehealth data, specifically fever calls, provided a timely and unique description of the evolution of a national influenza outbreak. In a similar way the tool may be useful for tracking norovirus, although the lack of consistent comparison data makes this more difficult to assess. In interpreting these results, care must be taken to consider other infectious and non-infectious causes of fever and vomiting. The scan statistic should be considered for spatial analyses of telehealth data elsewhere and will be used to initiate prospective geographical surveillance of influenza in England. (Source: BMC Medicine)

miR-124 and miR-137 inhibit proliferation of GBM cells and induce differentiation of brain tumor stem cells

BMC Medicine — Tue, 24 Jun 2008 04:00:00 +0100

In this study, we investigated the role of microRNAs in regulating the differentiation and proliferation of neural stem cells and glioblastoma-multiforme tumor cells. Methods: We used quantitative RT-PCR to assess microRNA expression in high-grade astrocytomas and adult mouse neural stem cells. To assess the function of candidate microRNAs in high-grade astrocytomas, we transfected miR mimics to cultured-mouse neural stem cells, -mouse oligodendroglioma-derived stem cells, -human glioblastoma multiforme-derived stem cells and -glioblastoma multiforme cell lines. Cellular differentiation was assessed by immunostaining, and cellular proliferation was determined using fluorescence-activated cell sorting. Results: Our studies revealed that expression levels of microRNA-124 and microRNA-137 w...

microRNAs: regulators of oncogenesis and stemness

BMC Medicine — Tue, 24 Jun 2008 04:00:00 +0100

MicroRNAs (miRNAs) are essential post-transcriptional regulators that determine cell identity and fate. Aberrant expression of miRNAs can lead to diseases, including cancer. Expression of many miRNAs in the de-differentiated brain tumor cancer stem cells resembles that of neural stem cells. In this issue of BMC Medicine, Silber et al provide evidence of the expression of such miRNAs and their potential to mediate differentiation in both stem cell populations. In this commentary, we discuss the known functions of miRNAs in cancer and stem cells, their therapeutic potential and how the findings of Silber et al provide insight into the role of miR-124/miR-137 dysregulation in glioblastomas. (Source: BMC Medicine)

Helping editors, peer reviewers, and authors improve the clarity, completeness, and transparency of reporting health research

BMC Medicine — Mon, 16 Jun 2008 04:00:00 +0100

Inadequate reporting is problematic for several reasons. If authors do not provide sufficient details concerning the conduct of their study, readers are left with an incomplete picture of what was done. As such, they are not able to judge the merits of the results and interpret them. The EQUATOR Network is a new initiative aimed at improving the clarity and transparency of reporting health research. (Source: BMC Medicine)

Measuring maternal mortality: an overview of opportunities and options for developing countries

BMC Medicine — Mon, 26 May 2008 04:00:00 +0100

Conclusions: Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act. (Source: BMC Medicine)

Collagen density promotes mammary tumor initiation and progression

BMC Medicine — Mon, 28 Apr 2008 04:00:00 +0100

Conclusions: This study provides the first data causally linking increased stromal collagen to mammary tumor formation and metastasis, and demonstrates that fundamental differences arise and persist in epithelial tumor cells that progressed within collagen-dense microenvironments. Furthermore, the imaging techniques and signature identified in this work may provide useful diagnostic tools to rapidly assess fresh tissue biopsies. (Source: BMC Medicine)

The Method for Assigning Priority Levels (MAPLe): a new decision support system for allocating home care resources

BMC Medicine — Wed, 26 Mar 2008 04:00:00 +0100

Conclusion: The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services. (Source: BMC Medicine)

Birth then and now

BMC Medicine — Tue, 18 Mar 2008 04:00:00 +0100

Halfway through the 20th century, views on pain in labour encompassed almost everything from women's self-blame to blaming nurses, midwives, doctors or partners for 'bad experiences'. Soon after that, giving birth came to be seen - in some settings and by some caregivers - as a 'natural' and thus benign event which women could 'master'. In their recent systematic review of women's expectations and experiences of pain relief in labour, Joanne Lally, Madeleine Murtagh, Sheila Mcphail, and Richard Thomson show that there is wide variation in women's expectations and knowledge about the first birth. This systematic review provides us with a strong basis for reflection and action. (Source: BMC Medicine)

More in hope than expectation: Women's experience and expectations of pain relief in labour: A review

BMC Medicine — Fri, 14 Mar 2008 04:00:00 +0100

Conclusions: Women may have ideal hopes of what they would like to happen with respect to pain relief, control and engagement in decision making, but expectations are often very different from experience. Antenatal educators need to ensure that pregnant women are appropriately prepared for what might actually happen to limit this expectation-experience gap and potentially support greater satisfaction with labour. (Source: BMC Medicine)

Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case-control study

BMC Medicine — Fri, 15 Feb 2008 05:00:00 +0100

Conclusions: A single PSA test taken at or before age 50 is a very strong predictor of advanced prostate cancer diagnosed up to 25 years later. This suggests the possibility of using an early PSA test to risk-stratify patients so that men at highest risk are the focus of the most intensive screening efforts. (Source: BMC Medicine)

Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1, Part 2 and PACES examinations

BMC Medicine — Thu, 14 Feb 2008 05:00:00 +0100

Conclusions Candidates from different UK medical schools perform differently in all three parts of the MRCP(UK) examination, the ordering being consistent across the parts of the exam, and the differences in Part 1 performance being consistent from 1989 to 2005. Although pre-admission qualifications explained some of the medical school variance, the remaining differences seem not to result from career preference or other selection biases, and were presumed to result from unmeasured differences in ability at entry to medical school, or to differences between medical schools in teaching focus, content, and approaches. Exploration of causal mechanisms would be enhanced by results from a national medical qualifying examination. (Source: BMC Medicine)

Physicians' experience with end-of-life decision-making: surey in 6 European countries and Australia

BMC Medicine — Tue, 12 Feb 2008 05:00:00 +0100

Conclusions: There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude. (Source: BMC Medicine)

Yellow fever control in Cameroon: where are we now and where are we going?

BMC Medicine — Fri, 08 Feb 2008 05:00:00 +0100

Conclusion: Amidst other competing health priorities, Cameroon has over the past four years successfully planned and implemented evidence-based strategies for preventing yellow fever outbreaks and for detecting and responding to the outbreaks when they occur. In order to sustain these initial successes, the country will have to attain and sustain high routine vaccination coverage in each successive birth cohort in every district. This would require fostering and sustaining high-level political commitment, improving the planning and monitoring of immunisation services at all levels, adequate community mobilisation, and efficient coordination of current and future immunisation partners. (Source: BMC Medicine)

Mortality after infection with methicillin resistant Staphylococcus aureus (MRSA) diagnosed in the community

BMC Medicine — Thu, 31 Jan 2008 05:00:00 +0100

Conclusions: MRSA infections diagnosed in the community are associated with significant mortality in the year after diagnosis. (Source: BMC Medicine)

Low birthweight and preterm birth in young people with special educational needs: a magnetic resonance imaging analysis

BMC Medicine — Wed, 30 Jan 2008 05:00:00 +0100

Conclusion: Although a two-fold increased prevalence of a history of low birthweight and preterm birth exists within the special educational needs population, other aetiological factors must be considered for the overwhelming majority of cases. Neuroanatomical findings within this sample include qualitative anomalies of brain structure and grey matter deficits within temporal lobe structures and the cerebellum that persist into adolescence. These findings suggest a neurodevelopmental mechanism for the cognitive difficulties associated with these obstetric risk factors. (Source: BMC Medicine)

Predicting long-term response to strong opioids in patients with low back pain: findings from a randomised, controlled trial of transdermal fentanyl and morphine

BMC Medicine — Fri, 21 Dec 2007 05:00:00 +0100

Conclusion: No clear pattern of baseline pain (type or severity) or patient characteristics emerged that could be used to predict responders before the start of opioid treatment. However, a one month trial period appears sufficient to determine response and tolerability in most cases. (Source: BMC Medicine)

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

BMC Medicine — Thu, 13 Dec 2007 05:00:00 +0100

Conclusion: In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone. Trial registration: Current Controlled Trials ISRCTN 41800323 (Source: BMC Medicine)

Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics

BMC Medicine — Tue, 11 Dec 2007 05:00:00 +0100

Conclusions: The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service delivery. (Source: BMC Medicine)

Clinical effectiveness of usual care with or without antidepressant medication for primary care patients with minor or mild-major depression: a randomized equivalence trial

BMC Medicine — Fri, 07 Dec 2007 05:00:00 +0100

Conclusion: UCandAD was as effective as UCnoAD over the first 6 weeks, but not at 13, 26, and 52 weeks. However, superiority of either treatment could not be demonstrated either. The question whether antidepressants add any clinical effect to usual care remains unresolved. We recommend future studies to look for subgroups of patients who may benefit from antidepressants. Trial registration: Dutch Trial Registry ISRCN03007807. (Source: BMC Medicine)

Validity of Electron Beam Computed Tomography for Coronary Artery Disease: A Systematic Review and Meta-analysis

BMC Medicine — Sun, 25 Nov 2007 05:00:00 +0100

Conclusions: Increasing EBCT scores indicate higher risk for CAD in both asymptomatic and symptomatic patients. In general, asymptomatic patients with EBCT scores in the High category can perhaps be considered for preventive medical therapy and risk factor modification. Symptomatic patients with EBCT scores in the Low category can perhaps, at least temporarily, avoid invasive coronary angiography. However, the non-uniform quality of studies and the lack of availability of individual-level data preclude the extension of our results to individual patients. (Source: BMC Medicine)

Predictability and epidemic pathways in global outbreaks of infectious diseases: the SARS case study

BMC Medicine — Wed, 21 Nov 2007 05:00:00 +0100

Conclusions: The presented computational approach shows that the integration of long-range mobility and demographic data provides epidemic models with a predictive power that can be consistently tested and theoretically motivated. This computational strategy can be therefore considered as a general tool in the analysis and forecast of the global spreading of emerging diseases and in the definition of containment policies aimed at reducing the effects of potentially catastrophic outbreaks. (Source: BMC Medicine)

Kisspeptin and GPR54 immunoreactivity in a cohort of 518 patients defines favourable prognosis and clear cell subtype in ovarian carcinoma

BMC Medicine — Thu, 15 Nov 2007 05:00:00 +0100

Background: Kisspeptins and their G-protein coupled receptor, GPR54 are required for GnRH release and have been associated with anti-metastatic tumour cell behaviour in model systems. The latter may suggest that their overexpression would be associated with a better prognosis in cancer. However, kisspeptin/GPR54 interactions (autocrine, paracrine, and/or endocrine) could also impact tumour behaviour in a negative manner. Here, for the first time, we associate the immunoreactivity of the kisspeptin/GPR54 ligand-receptor pair with favourable prognosis in a large cohort of ovarian carcinomas. Methods: Immunohistochemical analysis for kisspeptin and GPR54 was performed on a tissue microarray (TMA) consisting of 518 early stage ovarian carcinomas, all with linked clinical outcome data. The TMA...

A Meta-analysis of N-acetylcysteine in Contrast-induced Nephrotoxicity: Unsupervised Clustering to Resolve Heterogeneity

BMC Medicine — Wed, 14 Nov 2007 05:00:00 +0100

Conclusion: This meta-analysis does not support the efficacy of NAC to prevent CIN. (Source: BMC Medicine)

Contraception use and pregnancy among 15-24 year old South African women: a nationally representative cross-sectional survey

BMC Medicine — Sun, 28 Oct 2007 04:00:00 +0100

Conclusions: Specific emphasis must be placed on encouraging young women to use contraceptive methods that offer protection against pregnancy and STIs/HIV. Our consistent finding of a relationship between discussing condom use with partners and condom use indicates the importance of involvement of male partners in women's contraceptive decisions. (Source: BMC Medicine)

International ranking systems for universities and institutions: a critical appraisal

BMC Medicine — Thu, 25 Oct 2007 04:00:00 +0100

Conclusion: Naive lists of international institutional rankings that do not address these fundamental challenges with transparent methods are misleading and should be abandoned. We make some suggestions on how focused and standardized evaluations of excellence could be improved and placed in proper context. (Source: BMC Medicine)

The influence of gender on the effects of aspirin in preventing myocardial infarction

BMC Medicine — Thu, 18 Oct 2007 04:00:00 +0100

Conclusions: Gender accounts for a substantial proportion of the variability in the efficacy of aspirin in reducing MI rates across these trials, and supports the notion that women might be less responsive to aspirin than men. (Source: BMC Medicine)

A new therapy for highly effective tumor eradication using HVJ-E combined with chemotherapy

BMC Medicine — Fri, 21 Sep 2007 04:00:00 +0100

Conclusion: Combination therapy consisting of HVJ-E and chemotherapy completely eradicated the tumor, and generated anti-tumor immunity. The combination therapy may be a promising new strategy for cancer therapy. (Source: BMC Medicine)

Parasitological impact of two-year preventive chemotherapy on schistosomiasis and soil-transmitted helminthiasis in Uganda

BMC Medicine — Mon, 03 Sep 2007 04:00:00 +0100

Conclusions: Annual anthelminthic treatment delivered to schoolchildren and to adults at high risk in Uganda can significantly reduce the prevalence and intensity of infection for schistosomiasis and STH, and potentially also significantly reduce levels of environmental transmission of infection. (Source: BMC Medicine)

Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

BMC Medicine — Tue, 28 Aug 2007 04:00:00 +0100

Conclusions: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however low rates of formal psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases which is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area which requires further investigation in the UK. (Source: BMC Medicine)

Gestational diabetes as a risk factor for pancreatic cancer: A prospective cohort study

BMC Medicine — Thu, 16 Aug 2007 04:00:00 +0100

Conclusion: We conclude that gestational diabetes is strongly related to the risk of cancer of the pancreas in women in this population and can precede its diagnosis by many years. (Source: BMC Medicine)

Planning an integrated disease surveillance and response system: a matrix of skills and activities

BMC Medicine — Wed, 15 Aug 2007 04:00:00 +0100

Conclusions: The matrix for Integrated Disease Surveillance and Response (IDSR) in the African region made explicit the linkage between public health surveillance functions and participation across all levels of national health systems. The matrix framework is adaptable to requirements for new programs and strategies. This framework makes explicit the essential tasks and activities that are required for strengthening or expanding existing surveillance systems that will be able to adapt to current and emerging public health threats. (Source: BMC Medicine)

Methodological Issues in Detecting Gene-Gene Interactions in Breast Cancer Susceptibility: A Population-Based Study in Ontario

BMC Medicine — Tue, 07 Aug 2007 04:00:00 +0100

Conclusion: The strategy used here has the potential to identify complex biological relationships among breast cancer genes and processes. This will lead to the discovery of novel biological information, which will improve breast cancer risk management. (Source: BMC Medicine)

The effects of dictatorship on health: the case of Turkmenistan

BMC Medicine — Mon, 30 Jul 2007 04:00:00 +0100

Conclusions: The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis. (Source: BMC Medicine)

Simvastatin is associated with a reduced incidence of dementia and Parkinson's disease

BMC Medicine — Thu, 19 Jul 2007 04:00:00 +0100

Background: Statins are class of medications that reduce cholesterol by inhibiting HMG-CoA reductase. Whether statins can benefit subjects with dementia remains unclear because of conflicting results. Some of the confusion in the literature might arise from differences in efficacy among the statins. We have used a large database to compare the action of several different statins to investigate whether some statins might be differentially associated with a reduction in the incidence of dementia and Parkinson disease. Methods: We analyzed data from the decision support system of the US Veterans Affairs database, which contains diagnostic, medication and demographic information on 4.5 million subjects. The association of lovastatin, simvastatin and atorvastatin with dementia was examined with...

Migraine aura or TIA? A 5-year follow-up case-control study of women with transient CNS disorders in pregnancy.

BMC Medicine — Tue, 17 Jul 2007 04:00:00 +0100

Conclusion: The diagnosis of migraine aura was difficult because many experienced their first attack and headache tended to be absent or of non-migraineous type. The aura features were more complex with several aura symptoms and higher prevalence of sensory and dysphasic aura than usual. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the ICHD classification, seems to be useful for differentiating aura from other transient disorders. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. The 5-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events. (Source: BMC Medi...

Corticotrophin releasing factor 2 receptor agonist treatment significantly slows disease progression in mdx mice

BMC Medicine — Thu, 12 Jul 2007 04:00:00 +0100

Conclusions: Together these data demonstrate that CRF2R activation can prevent the progressive degeneration of diaphragm muscle associated with dystrophin gene mutation. (Source: BMC Medicine)

Association between cancer prevalence and use of thiazolidinediones (TZDs): results from the Vermont Diabetes Information System.

BMC Medicine — Thu, 21 Jun 2007 04:00:00 +0100

Conclusions: These data suggest an association between TZD use and cancer in patients with diabetes. Further studies are required to determine if this association is causal. (Source: BMC Medicine)

How far will we need to go to reach HIV-infected people in rural South Africa?

BMC Medicine — Tue, 19 Jun 2007 04:00:00 +0100

Conclusions: Our results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go before we will be able to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal. (Source: BMC Medicine)

Multidisciplinary team meetings and their impact on work-flow in Radiology and Pathology Departments

BMC Medicine — Wed, 13 Jun 2007 04:00:00 +0100

Conclusions: Difficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working. (Source: BMC Medicine)

Do citizens have minimum medical knowledge? - A survey

BMC Medicine — Thu, 31 May 2007 04:00:00 +0100

Conclusions: This sample of Swiss citizens did not know more than a third of the MMK. We found little difference within groups with medical experience (personal or professional), suggesting that there is a consistent and dramatic lack of knowledge in the general public about the typical signs and risk factors of relevant clinical conditions. (Source: BMC Medicine)

The effect of acetaminophen (four grams a day for three consecutive days) on hepatic tests in alcoholic patients - a multicenter randomized study

BMC Medicine — Wed, 30 May 2007 04:00:00 +0100

Conclusions: Alcoholic patients treated with the maximum recommended daily dose of acetaminophen for 3 consecutive days did not develop increases in serum transaminase or other measures of liver injury. Treatment of pain or fever for 3 days with acetaminophen appears safe in newly-abstinent alcoholic patients, such as those presenting for acute medical care. Trial registration number: Clintrials.org: [NCT00402571] (Source: BMC Medicine)

How to optimise the coverage rate of infant and adult immunisations in Europe

BMC Medicine — Tue, 29 May 2007 04:00:00 +0100

DiscussionAt a recent Summit of Independent European Vaccination Experts, we focused on the perception of vaccines and vaccination by the general public and health care professionals and discussed ways to improve vaccine uptake in Europe. Despite the substantial impact and importance of the media, health care professionals were identified as the main advocates for vaccination and the most important source of information about vaccines for the general public. Health care professionals should receive more support for their own education on vaccinology, have rapid access to up-to-date information on vaccines, and have easy ways to consult with experts regarding vaccination-related problems. Vaccine information systems should be set up to facilitate promotion of vaccination. SummaryEvery oppor...

A review of the methodological features of systematic reviews in maternal medicine

BMC Medicine — Thu, 24 May 2007 04:00:00 +0100

Conclusion: This study identifies areas that have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine. (Source: BMC Medicine)

Impact of long-term treatment of onchocerciasis with ivermectin in Ecuador: potential for elimination of infection.

BMC Medicine — Wed, 23 May 2007 04:00:00 +0100

Conclusions: The distribution of ivermectin in endemic communities in Ecuador may have eliminated ocular morbidity and significant progress has been made towards elimination of the infection. A strategy of more frequent treatments with ivermectin may be required in communities where the infection persists to achieve the objective of the elimination of the infection from Ecuador. The elimination of the infection from an endemic country in Latin America would be a major public health achievement and may stimulate the implementation of elimination strategies in other endemic countries. (Source: BMC Medicine)

Performance in the MRCP(UK) Examination 2003-4: Analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender

BMC Medicine — Thu, 03 May 2007 04:00:00 +0100

Conclusions: The cause of these differences is most likely to be multifactorial, but cannot be readily explained in terms of previous educational experience or differential performance on particular parts of the examination. Potential examiner prejudice, significant only in the cases where there were two non-white examiners and the candidate was non-white, might indicate different cultural interpretations of the judgements being made. (Source: BMC Medicine)

Promoting childbirth companions in South Africa: A randomised pilot study

BMC Medicine — Mon, 30 Apr 2007 04:00:00 +0100

Conclusion: The quality and humanity of care in these state hospitals needs to improve. Introducing childbirth companions was more difficult than we anticipated, particularly in under resourced health care systems with frequent staff changes. We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals. (Source: BMC Medicine)

Analysis of NAMCS data for Multiple Sclerosis, 1998-2004

BMC Medicine — Thu, 05 Apr 2007 04:00:00 +0100

Conclusions: Strategies that lead to improved use of IMAs in the management of MS in the outpatient setting are needed. (Source: BMC Medicine)

In vitro prediction of stop-codon supression by by intravenous gentamycin in patients with cystic fibrosis; a pilot study

BMC Medicine — Thu, 29 Mar 2007 04:00:00 +0100

Conclusion: Suppression of stop mutations in the CFTR gene with parenteral gentamycin can be predicted in vitro and is associated with clinical benefit and significant modification of the CFTR-mediated Cl- transport in nasal and sweat gland epithelium. Trial registration: ClinicalTrial NCT00376428 (Source: BMC Medicine)