Our overview shows that PPI therapy is associated with significant and potentially serious adverse events that should be discussed with patients. The effect sizes and risk factors provided should facilitate this discussion and promote shared decision making.
A significant number of prostate cancer patients use complementary alternative medicines (CAMs) as an adjunct to their conventional treatment. Examples of CAMs that are frequently used by prostate cancer patients include green tea extract, lycopene, and pomegranate fruit extract. In many cases there is little if any clinical study-based evidence to support the efficacy of CAMs in this setting, and, importantly, some CAMs can cause serious adverse effects when taken a high doses and/or have significant drug interactions. The latter is an important consideration in this patient group as most patients are older and take multiple medications in addition to their anti-cancer drugs. This review summaries prostate cancer patient clinical trial data that is available for CAMs which are commonly used by prostate cancer patients, and provides dose, dose form, adverse effect, and drug interaction data. Providing evidence-based guidance regarding CAMs to prostate cancer patients can potentially improve patient outcomes, including the avoidance of adverse effects and drug interactions which impact drug efficacy.
Objective To assess the ability of otolaryngology residents to rate the hypernasal resonance of patients with velopharyngeal dysfunction. We hypothesize that experience (postgraduate year [PGY] level) and training will result in improved ratings of speech samples. Study Design Prospective cohort study. Setting Otolaryngology training programs at 2 academic medical centers. Subjects and Methods Thirty otolaryngology residents (PGY 1-5) were enrolled in the study. All residents rated 30 speech samples at 2 separate times. Half the residents completed a training module between the rating exercises, with the other half serving as a control group. Percentage agreement with the expert rating of each speech sample and intrarater reliability were calculated for each resident. Analysis of covariance was used to model accuracy at session 2. Results The median percentage agreement at session 1 was 53.3% for all residents. At the second session, the median scores were 53.3% for the control group and 60% for the training group, but this difference was not statistically significant. Intrarater reliability was moderate for both groups. Residents were more accurate in their ratings of normal and severely hypernasal speech. There was no correlation between rating accuracy and PGY level. Score at session 1 positively correlated with score at session 2. Conclusion Perceptual training of otolaryngology residents has the potential to improve their ratings of hypernasal speech. Length of time in residency may not be best predictor of perceptual skill. Training modalities incorporating practice with hypernasal speech samples could improve rater skills and should be studied more extensively.
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