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https://www.readbyqxmd.com/read/28731949/cancer-screening-in-the-elderly-a-review-of-breast-colorectal-lung-and-prostate-cancer-screening
#1
Ashwin A Kotwal, Mara A Schonberg
There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28731947/early-stage-cancer-in-older-adults-prostate-avoiding-overtreatment-and-undertreatment
#2
Vikram Narayan, Song Jiang, Christopher A Warlick
The diagnosis of prostate cancer in elderly men is likely to increase over the next several decades, owing to changing demographics and a rising population of men older than 65 years. Given the heterogeneity and well-documented challenges in screening, diagnosing, and managing indolent versus aggressive prostate cancer, the geriatric patient population is particularly vulnerable to prostate cancer treatment nuances. Clinicians must become familiar with geriatric assessment tools to better answer life-expectancy questions prior to counseling patients on treatment options...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28730923/an-epidemic-of-overdiagnosis-and-overtreatment-getting-to-the-heart-of-the-problem
#3
David Warriner, Aseem Malhotra, Andrew Apps
No abstract text is available yet for this article.
January 1, 2017: Journal of the Royal Society of Medicine
https://www.readbyqxmd.com/read/28725589/multi-parametric-magnetic-resonance-imaging-as-a-management-decision-tool
#4
REVIEW
David C Johnson, Robert E Reiter
The ability to image the prostate accurately and better characterize cancerous lesions makes multiparametric magnetic resonance imaging (mpMRI) an invaluable tool to improve management of localized prostate cancer (PCa). Improved risk stratification is warranted given the evidence of significant overtreatment of indolent PCa. mpMRI can more accurately rule out clinically significant PCa in men deciding between surveillance and definitive treatment to reduce overtreatment. mpMRI improves detection of clinically significant PCa, which helps minimize sampling error, a major limitation of the traditional diagnostic paradigm...
June 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28725586/role-of-prostate-magnetic-resonance-imaging-in-active-surveillance
#5
REVIEW
Xiaosong Meng, Andrew B Rosenkrantz, Samir S Taneja
Active surveillance (AS) has emerged as a beneficial strategy for management of low risk prostate cancer (PCa) and prevention of overtreatment of indolent disease. However, selection of patients for AS using traditional 12-core transrectal prostate biopsy is prone to sampling error and presents a challenge for accurate risk stratification. In fact, around a third of men are upgraded on repeat biopsy which disqualifies them as appropriate AS candidates. This uncertainty affects adoption of AS among patients and physicians, leading to current AS protocols involving repetitive prostate biopsies and unclear triggers for progression to definitive treatment...
June 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28725580/pre-biopsy-mri-as-an-adjunct-for-cancer-detection-in-men-with-elevated-psa-and-no-previous-biopsy
#6
REVIEW
Facundo Uriburu-Pizarro, Veeru Kasivisvanathan, Philippe Puech, Arnauld Villers
The role of magnetic resonance imaging (MRI) prior to biopsy in the diagnosis of prostate cancer in biopsy-naïve patients has been strengthened by recent developments such as the PIRADS V2 criteria, which cover acquisition, interpretation, and reporting for clinical practice and data collection for research. Important questions on the role of prostate MRI remain: can MRI be used as a triage test before first biopsy series? Can it be used to avoid the use of systematic biopsies (SB) and instead use only targeted biopsies (TB) to MRI-suspicious lesions? Studies to evaluate image guided TB compared to SB have started to accumulate...
June 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28725272/brazilian-guidelines-on-prevention-of-cardiovascular-disease-in-patients-with-diabetes-a-position-statement-from-the-brazilian-diabetes-society-sbd-the-brazilian-cardiology-society-sbc-and-the-brazilian-endocrinology-and-metabolism-society-sbem
#7
REVIEW
Marcello Casaccia Bertoluci, Rodrigo Oliveira Moreira, André Faludi, Maria Cristina Izar, Beatriz D Schaan, Cynthia Melissa Valerio, Marcelo Chiara Bertolami, Ana Paula Chacra, Marcus Vinicius Bolivar Malachias, Sérgio Vencio, José Francisco Kerr Saraiva, Roberto Betti, Luiz Turatti, Francisco Antonio Helfenstein Fonseca, Henrique Tria Bianco, Marta Sulzbach, Adriana Bertolami, João Eduardo Nunes Salles, Alexandre Hohl, Fábio Trujilho, Eduardo Gomes Lima, Marcio Hiroshi Miname, Maria Teresa Zanella, Rodrigo Lamounier, João Roberto Sá, Celso Amodeo, Antonio Carlos Pires, Raul D Santos
BACKGROUND: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk...
2017: Diabetology & Metabolic Syndrome
https://www.readbyqxmd.com/read/28723330/active-surveillance-for-low-risk-cancers-a-viable-solution-to-overtreatment
#8
Megan R Haymart, David C Miller, Sarah T Hawley
There is wide variation in the intensity of treatment for low-risk cancers, and many patients are at risk for overtreatment. Despite 5-year survival rates that approach 100% among patients with low-risk differentiated thyroid cancer, prostate cancer, and ductal carcinoma in situ (DCIS) of the..
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28715042/-diagnostic-significance-of-multiparametric-mri-combined-with-us-fusion-guided-biopsy-of-the-prostate-in-patients-with-increased-psa-levels-and-negative-standard-biopsy-results-to-detect-significant-prostate-cancer-correlation-with-the-gleason-score-korrelation
#9
Manuela Hoffmann, Manuela A Hoffmann, Helmut J Wieler, Frank M Jakobs, Kasra Taymoorian, Arnd Gerhards, Matthias Miederer, Mathias Schreckenberger
AIMS: To increase diagnostic precision and to reduce overtreatment of low-risk malignant disease, multiparametric MRI (mpMRI) combined with ultrasound (US) fusion guided biopsy of the prostate were performed. METHODS: In 99 male patients with increased PSA plasma levels and previous negative standard biopsy procedures, mpMRI was carried out followed by US fusion guided perineal biopsy. PI-RADS-Data (PS) of mpMRI and histopathological Gleason score (GS) were categorized and statistically compared...
July 17, 2017: Nuklearmedizin. Nuclear Medicine
https://www.readbyqxmd.com/read/28711318/procalcitonin-guided-decision-making-for-duration-of-antibiotic-therapy-in-neonates-with-suspected-early-onset-sepsis-a-multicentre-randomised-controlled-trial-neopins
#10
Martin Stocker, Wendy van Herk, Salhab El Helou, Sourabh Dutta, Matteo S Fontana, Frank A B A Schuerman, Rita K van den Tooren-de Groot, Jantien W Wieringa, Jan Janota, Laura H van der Meer-Kappelle, Rob Moonen, Sintha D Sie, Esther de Vries, Albertine E Donker, Urs Zimmerman, Luregn J Schlapbach, Amerik C de Mol, Angelique Hoffman-Haringsma, Madan Roy, Maren Tomaske, René F Kornelisse, Juliette van Gijsel, Eline G Visser, Sten P Willemsen, Annemarie M C van Rossum
BACKGROUND: Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS: We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals...
July 12, 2017: Lancet
https://www.readbyqxmd.com/read/28710200/thyrotoxicosis-in-patients-with-hypothyroidism-is-not-just-overtreatment
#11
Punith Kempegowda, Ananth U Nayak
A 62-year-old Caucasian woman presented with hypothyroid symptoms and biochemical thyrotoxic picture. Previously, she underwent right-sided subtotal thyroidectomy and left partial thyroid lobectomy for thyroid lumps, and treated with thyroxine replacement for hypothyroidism. Although there were no significant findings on clinical examination, investigations confirmed thyrotoxicosis with positive autoimmunity against thyroid glandâ€"all in line with a diagnosis of Graves’ hyperthyroidism. We would like to highlight atypical presentations of thyroid dysfunction and conversion of underactive to overactive thyroid status with this case...
July 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28700803/factors-associated-with-underestimation-of-invasive-cancer-in-patients-with-ductal-carcinoma-in-situ-precautions-for-active-surveillance
#12
Carlos Chavez de Paz Villanueva, Valentina Bonev, Maheswari Senthil, Naveenraj Solomon, Mark E Reeves, Carlos A Garberoglio, Jukes P Namm, Sharon S Lum
Importance: Recent recognition of the overdiagnosis and overtreatment of ductal carcinoma in situ (DCIS) detected by mammography has led to the development of clinical trials randomizing women with non-high-grade DCIS to active surveillance, defined as imaging surveillance with or without endocrine therapy, vs standard surgical care. Objective: To determine the factors associated with underestimation of invasive cancer in patients with a clinical diagnosis of non-high-grade DCIS that would preclude active surveillance...
July 12, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28699898/marcks-promotes-invasion-and-is-associated-with-biochemical-recurrence-in-prostate-cancer
#13
Emma Dorris, Amanda O'Neill, Karen Hanrahan, Ann Treacy, R William Watson
BACKGROUND: Overtreatment of low-grade prostate cancer is a recognised problem for clinicians and patients. However, under-treatment runs the risk of missing the opportunity for cure in those who could benefit. Identification of new biomarkers of disease progression, including metastases, is required to better stratify and appropriately treat these patients. The ability to predict if prostate cancer will recur is an important clinical question that would impact treatment options for patients...
June 30, 2017: Oncotarget
https://www.readbyqxmd.com/read/28698318/words-do-matter-a-systematic-review-on-how-different-terminology-for-the-same-condition-influences-management-preferences
#14
Brooke Nickel, Alexandra Barratt, Tessa Copp, Ray Moynihan, Kirsten McCaffery
OBJECTIVES: Changing terminology for low-risk, screen-detected conditions has now been recommended by several expert groups in order to prevent overdiagnosis and reduce the associated harms of overtreatment. However, the effect of terminology on patients' preferences for management is not well understood. This review aims to synthesise existing studies on terminology and its impact on management decision making. DESIGN: Systematic review. METHODS: Studies were included that compared two or more terminologies to describe the same condition and measured the effect on treatment or management preferences and/or choices...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28696454/a-cation-exchange-controlled-core-shell-mns-bi2s3-theranostic-platform-for-multimodal-imaging-guided-radiation-therapy-with-hyperthermia-boost
#15
Yuhao Li, Yun Sun, Tianye Cao, Qianqian Su, Zili Li, Mingxian Huang, Ruizhuo Ouyang, Haizhou Chang, Shuping Zhang, Yuqing Miao
Overtreatment as a crucial modern medicine issue needs to be urgently addressed. Theranostic agents supply a unique platform and integrate multiple diagnosis and therapies to deal with this issue. In this study, a core-shell MnS@Bi2S3 nanostructure was fabricated via two step reactions for tri-modal imaging guided thermo-radio synergistic therapy. The mass ratio between the core and shell of the constructed MnS@Bi2S3 can be precisely controlled via cation exchange reaction. After surface PEGylation, MnS@Bi2S3-PEG nanoparticles exhibited excellent aqueous medium dispersibility for bioapplications...
July 11, 2017: Nanoscale
https://www.readbyqxmd.com/read/28693482/the-development-and-feasibility-of-a-personal-health-optimization-system-for-people-with-bipolar-disorder
#16
Øystein Eiring, Kari Nytrøen, Simone Kienlin, Soudabeh Khodambashi, Magne Nylenna
BACKGROUND: People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies...
July 10, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28684060/top-10-myths-regarding-the-diagnosis-and-treatment-of-cellulitis
#17
Erin K McCreary, Melissa E Heim, Lucas T Schulz, Robert Hoffman, Jeffrey Pothof, Barry Fox
BACKGROUND: Cellulitis is commonly treated in the emergency department (ED). Patients who present with cellulitis incur significant health care costs and may be overtreated with antibiotics. The accurate diagnosis and treatment of cellulitis plays an important role in cost-effective, high-quality medical care, as well as appropriate antibiotic utilization. OBJECTIVE: We aim to describe common fallacies regarding cellulitis. We present 10 myths that result in misdiagnosis, overtreatment, or inappropriate empiric management of cellulitis...
July 3, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28683860/latent-hypothyroidism-in-adults
#18
Jeannine Schübel, Joachim Feldkamp, Antje Bergmann, Wolfgang Drossard, Karen Voigt
BACKGROUND: The prevalence of latent/subclinical hypothyroidism is between 3% and 10%, according to epidemiologic studies that have been carried out in the USA, the United Kingdom, and Denmark. As persons with latent hypo - thyroidism are often asymptomatic, the diagnosis is often made incidentally in routine laboratory testing. METHODS: This review is based on a selective search in PubMed for publications on the diagnosis and treatment of latent hypothyroidism...
June 23, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28683750/use-of-malaria-rapid-diagnostic-tests-by-community-health-workers-in-afghanistan-cluster-randomised-trial
#19
Toby Leslie, Mark Rowland, Amy Mikhail, Bonnie Cundill, Barbara Willey, Asif Alokozai, Ismail Mayan, Anwar Hasanzai, Sayed Habibullah Baktash, Nader Mohammed, Molly Wood, Habib-U-Rahman Rahimi, Baptiste Laurent, Cyril Buhler, Christopher J M Whitty
BACKGROUND: The World Health Organisation (WHO) recommends parasitological diagnosis of malaria before treatment, but use of malaria rapid diagnostic tests (mRDTs) by community health workers (CHWs) has not been fully tested within health services in south and central Asia. mRDTs could allow CHWs to diagnose malaria accurately, improving treatment of febrile illness. METHODS: A cluster randomised trial in community health services was undertaken in Afghanistan. The primary outcome was the proportion of suspected malaria cases correctly treated for polymerase chain reaction (PCR)-confirmed malaria and PCR negative cases receiving no antimalarial drugs measured at the level of the patient...
July 7, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28683242/targeted-levothyroxine-therapy-for-treatment-of-congenital-hypothyroidism
#20
Melissa J Schoelwer, Wanzhu Tu, Junyi Zhou, Erica A Eugster
OBJECTIVE: The purpose of this study was to determine if infants with congenital hypothyroidism (CH) whose initial dose of levothyroxine (LT4) is based on thyroid gland anatomy require fewer dose adjustments in the first six months of life than those who were started empirically on LT4. METHODS: Newborns with CH who had a thyroid ultrasound performed at diagnosis were eligible for this prospective, historical case-controlled study. The daily LT4 dose prescribed was based on results on the thyroid ultrasound as follows: 15 mcg/kg for athyreosis, 12 mcg/kg for a dysgenetic thyroid, and 10 mcg/kg for an anatomically normal gland...
July 6, 2017: Endocrine Practice
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