The attenuation values for venous drainage on unenhanced cranial CT constitute a practical adjunct in the assessment of anemia. Given the number of individuals undergoing CT without blood work, this rapid assessment technique for anemia is a convenient means for narrowing possible diagnoses.
BackgroundTobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most popular pharmacological options for smoking cessation. The purpose of this study is to critically evaluate the extent of gastrointestinal adverse effects of varenicline when used at maintenance dose (1 mg twice a day) for smoking cessation.MethodsWe conducted a meta-analysis of randomised controlled trials published in PUBMED and EMBASE according to the PRISMA guidelines. Selected studies satisfied the following criteria: (i) duration of at least 6 weeks, (ii) titrated dose of varenicline for 7 days then a maintenance dose of 1 mg twice-per-day, (iii) randomized placebo-controlled design, (iv) extractable data on adverse event - nausea, constipation or flatulence. Data was synthesized into pooled odd ratios (OR) basing on random effects model. Quality of studies was also rated as per Cochrane risk-of-bias assessment. Number need to harm (NNH) was calculated for each adverse effect.Results98 potentially relevant studies were identified, 12 of which met the final inclusion criteria (n = 5114). All 12 studies reported adverse events on nausea, which led to an OR of 4.45 (95% CI = 3.79-5.23, p < 0.001; I2 = 0.06%, CI = 0%-58.34%) and a NNH of 5. Eight studies (n = 3539) contain data on constipation pooled into an OR of 2.45 (95% CI = 1.61-3.72, p < 0.001; I2 = 34.09%, CI = 0%-70.81%) with a NNH of 24. Finally, five studies (n = 2516) reported adverse events of flatulence, which pooled an OR of 1.74 (95% CI = 1.23-2.48, p = 0.002; I2 = 0%, CI = 0%- 79.2%) with a NNH of 35.ConclusionsUse of varenicline at maintenance dose of 1 mg twice a day for longer than 6 weeks is associated with adverse gastrointestinal effects. In realistic terms, for every 5 treated subjects, there will be an event of nausea, and for every 24 and 35 treated subjects, we will expect an event of constipation and flatulence respectively. Family physicians should counsel patients of such risks accordingly during their maintenance therapy with varenicline.
Introduction: The incidence of bladder cancer varies by gender. Whether differences exist between women and men in extent of disease, treatment, and outcome is not well-described. We evaluate gender differences in bladder cancer using a population-based cohort. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy or radical radiotherapy (RT) in Ontario between 1994 and 2008. We compare extent of disease at time of cystectomy, treatment, and outcomes between women and men. Results: In total, 5259 patients with bladder cancer were treated with cystectomy or radical RT; of these, 25% (n = 1296) were women. There was no gender difference in the proportion of patients treated with cystectomy (75% of women [974/1296] Among the 2944 patients with muscle-invasive urothelial carcinoma treated with cystectomy, use of neoadjuvant (5% vs. 4%, p = 0.419) and adjuvant chemotherapy (18% vs. 20%, p = 0.190) did not differ significantly between genders. Five-year cancer-specific survival and overall survival of the full cohort did not differ between women and men (38% vs. 39%, p = 0.522; 33% vs. 33%, p = 0.795).Conclusions: This population-based cohort did not demonstrate any substantial differences in extent of disease, treatment, or outcome between women and men treated with cystectomy or radical RT for bladder cancer.
PurposeThe relative distribution of research output across cancer sites is not well described. Here, we evaluate whether the volume of published research is proportional to the public health burden of individual cancers. We also explore whether research output is proportional to research funding. MethodsStatistics from the Canadian and American cancer societies were used to identify the top ten causes of cancer death in 2013. All journal articles and clinical trials published in 2013 by Canadian or U.S. authors for those cancers were identified. Total research funding in Canada by cancer site was obtained from the Canadian Cancer Research Alliance. Descriptive statistics and Pearson correlation coefficients were used to describe the relationship between research output, cancer mortality, and research funding. ResultsWe identified 19,361 publications and 2661 clinical trials. The proportion of publications and clinical trials was substantially lower than the proportion of deaths for lung (41% deaths, 15% publications, 16% clinical trials), colorectal (14%, 7%, 6%), pancreatic (10%, 7%, 5%), and gastroesophageal (7%, 5%, 3%) cancers. Conversely, research output was substantially greater than the proportion of deaths for breast cancer (10% deaths, 29% publications, 30% clinical trials) and prostate cancer (8%, 15%, 17%). We observed a stronger correlation between research output and funding (publications r = 0.894, p < 0.001; clinical trials r = 0.923, p < 0.001) than between research output and cancer mortality (r = 0.363, p = 0.303; r = 0.340, p = 0.337). ConclusionsResearch output is not well correlated with the public health burden of individual cancers, but is correlated with the relative level of research funding.
Introduction: The incidence of bladder cancer varies by gender. Whether differences exist between women and men in extent of disease, treatment, and outcome is not well-described. We evaluate gender differences in bladder cancer using a population-based cohort. Methods: Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy or radical radiotherapy (RT) in Ontario between 1994 and 2008. We compare extent of disease at time of cystectomy, treatment, and outcomes between women and men. Results: In total, 5259 patients with bladder cancer were treated with cystectomy or radical RT; of these, 25% (n = 1296) were women. There was no gender difference in the proportion of patients treated with cystectomy (75% of women [974/1296], 73% of men [2905/3963], p = 0.189). At the time of cystectomy, women were more likely to have muscle-invasive disease (86% [836/974] vs. 80% [2335/2905], p < 0.001), but less likely to have lymph nodes dissected (68% [664/974] vs. 76% [2210/2905], p < 0.001]. Among the 2944 patients with muscle-invasive urothelial carcinoma treated with cystectomy, use of neoadjuvant (5% vs. 4%, p = 0.419) and adjuvant chemotherapy (18% vs. 20%, p = 0.190) did not differ significantly between genders. Five-year cancer-specific survival and overall survival of the full cohort did not differ between women and men (38% vs. 39%, p = 0.522; 33% vs. 33%, p = 0.795). Conclusions: This population-based cohort did not demonstrate any substantial differences in extent of disease, treatment, or outcome between women and men treated with cystectomy or radical RT for bladder cancer.
Morning Report is an integral element of residency education, however, changes in training have limited its effectiveness. To improve the effectiveness and accessibility of Morning Report, we developed an innovative electronic teaching resource.
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