Archive for March 20th, 2009

Time for the Big Easy

March 20th, 2009 | No Comments | Source: Archives Int. Medicine, MedPageToday

thisgoeswhere?That Canadian study showing colonoscopy screening wasn’t as effective as first thought caused quite a dust up around the New Year, but consensus remains strong that the Big Easy is a life-saver and people need to get it done.

Yet only 60% of eligible patients report being up-to-date with the test and harried physicians often don’t have the time to discuss preventive services with their patients.

Which is why the results of a trial of a decidedly low-tech reminder system are so heartening.

timeforthebigeasyThomas Sequist and colleagues from the Brigham implemented a randomized trial of mailed reminders to patients and lo and behold, they actually improved colonoscopy utilization!

The scientists enrolled 21,860 patients between the ages 50-80 from 11 clinics during 2006-2007. All patients were overdue for the ‘scope.

Subjects either received nothing or a mailing that contained an educational pamphlet, a fecal occult blood testing pad, and instructions for scheduling a colonoscopy.

The scientists also sent electronic reminders to the patients’ primary care physicians.

Among patients who received the mailed reminders, 44% got it done. The number was 38% in the control group.

Reminders were increasingly effective as subjects got older, with the difference favoring the reminded group rising from 3.7% for ages 50 to 59 to 10.1% for ages 70 to 80.

The study is in the Archives of Internal Medicine.

if1worksdoes20workbetter?“Our findings underscore that informed patients can play an active role in completing effective preventive services,” the scientists concluded.

Interestingly, the electronic reminders to physicians didn’t boost colonoscopy rates, “in part because over one-third of patients had no visits with their primary care physician during the 15-month study period,” the scientists reported.

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Generalisimo Francisco Franco is Still Dead

March 20th, 2009 | No Comments | Source: NY Times

where'sthesandblaster?Thirty years after Chevy Chase kept telling the world what it already knew about the fate of Spain’s fascist dictator, the nation’s Socialist government wants to remove from public display hundreds of statues, monuments and emblems throughout the country that commemorate his rule.

In fact Prime Minister José Luis Rodríguez Zapatero’s government has passed a law mandating that they be expunged.

That doesn’t sit well with Sinforiano Bezanilla, a city employee who was 11 when Franco died, but who boned up on the man and liked what he read.

Franco saved Spain from communism and elevated the Catholic Church to an exalted status in daily life, he emphasizes. In today’s Spain abortion, divorce and gay marriage are all legal.

“A lot of people are afraid to express themselves,” Bezanilla wailed to the Wall Street Journal. “The left is attempting to rewrite our country’s history. They base it on a series of half-lies, half-truths and outright lies.” 

Never mind that Franco’s Nationalist thugs slaughtered tens of thousands of foes after prevailing in a civil war that itself cost 500,000 lives. Or that they sent tens of thousands more to forced labor camps while giving their children away to families who supported the regime.

theyshoudafriedWhen Franco died, Spain’s fledgling democracy didn’t put his generals on trial as Latin American nations did, nor did it organize Truth and Reconciliation Commissions like South Africa.

The passivity all but assured the bitter ideological divisions would fester for generations.

In fact Spain’s ambivalence can be heard every time Real Madrid takes the pitch.

Years ago, Spanish politicians decreed that a certain phrase in its national anthem that reminded many of the repressive dictator’s rule would be deleted: “Raise your arms, sons of the Spanish people.”

But the pols couldn’t decide on a suitable replacement, so nowadays Spaniards either roll their own lyrics or just hum along.

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Personalized Breast Cancer Treatment

March 20th, 2009 | No Comments | Source: BurrillReport, J. Clinical Oncology

A consortium of US scientists has reported that an easy-to-perform analysis of 50 genes can reliably sort breast cancer tissue samples by type and predict which therapies are most likely to work. 
  
reasonforhopePhilip Bernard, Joel Parker, Matthew Ellis and many others published the heartening findings in the Journal of Clinical Oncology.

“Unlike a widely used genomic test that applies only to lymph-node negative, estrogen-receptor positive breast cancer, this new genomic test is broadly applicable for all women diagnosed with breast cancer,” Ellis, a breast cancer expert from Washington University told BurrillReport.
 
To develop and validate the 50 gene test, the scientists reviewed more than 1,000 breast cancer tissue specimens. They were able to establish a genetic signature for each major form of breast cancer: luminal A, luminal B, basal-like and HER2-enriched.
 
Then, having accurately classified 133 consecutive tissue specimens using their tool, the scientists assessed how the different breast cancer phenotypes responded to chemotherapy.

The test turned out to be highly predictive of chemotherapy response, and superior to currently used tests like estrogen and progesterone receptor status and HER2 gene expression status.
 
For example, patients with luminal A cancers did not respond to chemotherapy, suggesting that they ought to forgo chemotherapy in lieu of hormone-based treatment.

nowweregettinsomewhereConversely, basal-like breast cancer, which carries an ominous prognosis, turned out to be “the most sensitive to chemotherapy. By identifying (the cancer types correctly) we can ensure they are treated adequately,” Ellis said.
 
The scientists are now studying how each breast cancer type responds to the 20 or so chemotherapeutic drugs on the market.

When it’s ready, the new genomic test will be marketed by University Genomics, which is owned by Washington University, the University of Utah and the University of North Carolina.

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