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Www.bmj
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24

Screening tests for tuberculosis before starting biological therapy

Before starting treatment, exclude active tuberculosis by asking about symptoms (such as cough, fever, weight loss, and night sweats) and possible exposure to or history of tuberculosis, and with a chest radiograph  
bmj.com
almost 5 years ago
Www.bmj
1
24

Screening tests for tuberculosis before starting biological therapy

Before starting treatment, exclude active tuberculosis by asking about symptoms (such as cough, fever, weight loss, and night sweats) and possible exposure to or history of tuberculosis, and with a chest radiograph  
bmj.com
almost 5 years ago
Static.www.bmj
1
2

People’s willingness to accept overdetection in cancer screening: population survey

Objectives To describe the level of overdetection people would find acceptable in screening for breast, prostate, and bowel cancer and whether acceptability is influenced by the magnitude of the benefit from screening and the cancer specific harms from overdetection.  
bmj.com
almost 5 years ago
Www.bmj
1
9

Screening and treatment for hepatitis C: a balanced perspective

Koretz and colleagues proposed a randomised trial of hepatitis C (HCV) screening on the basis of a selective literature review.1 We offer a contrasting view based on four key points:  
bmj.com
almost 5 years ago
9
0
2

Should breast cancer screening be reviewed?

What do you think about the controversy over breast cancer screening? Today the BBC have reported regarding the concerns about the potential damage that false positives results have on women screened for breast cancer in the UK. According to this article, despite 1,400 lives being saved through screening in England alone, the concern is regarding the false positives found and potentially avoidable trauma this causes. It stated that for every 2,000 women screened in a 10-year period: one life would be saved, 10 healthy women would have unnecessary treatment and at least 200 women would face psychological distress for many months because of false positive results. Do you think that breast cancer screening should be reviewed given these concerns? References found at: http://www.bmj.com/content/343/bmj.d6843 http://www.bbc.co.uk/news/health-15444879  
Gareth Lewis
about 8 years ago
7
0
18

What is the onset age of Mild Cognitive Impairment (MCI)?

The symptoms of Alzheimer's disease can occur at even the age of 40. I would like to know what is the estimated onset age of its preclinical stage. What is the earliest age when the presence of Mild Cognitive Impairment can be detected in a patient (e.g. by a screening test)? Unfortunately, I couldn't find any data regarding this, please, if possible, refer to literature when answering my question. Thank you.  
Zoltan Gyorgy Kovacs
about 7 years ago
6
0
21

Can someone help me with a question on epilepsy treatment?

Understanding the neurophysiology is important in treating epilepsy. In practice, how far often is it properly evaluated and how often is it simply treated by the drugs alone without any proper evaluation? Is the EEG a specific tool in epilepsy screening?  
sampath kumar
over 6 years ago
Foo20151013 2023 3p9kow?1444773972
29
1699

A medical mystery for Mother's Day...

I'd like to tell you a curious story. Jane was a 52 year old woman in need of a kidney transplant. Thankfully she had three loving sons who were all very happy to give her one of theirs. So Jane's doctors performed tests to find out which of the three boys would be the best match, but the results surprised everyone. In the words of Jeremy Kyle, the DNA test showed that Jane was not the mother of two of the boys... Hang on, said Jane, child birth is not something you easily forget. They're definitely mine. And she was right. It turns out Jane was a chimera. Chimerism is the existence of two genetically different cell lines in one organism. This can arise for a number of reasons- it can be iatrogenic, like when someone has an organ transplant, or it can be naturally occurring. In Jane's case, it began in her mum's womb, with two eggs that had been fertilised by different sperm creating two embryos. Ordinarily, they would develop into two non-identical twins. However in Jane's case the two balls of cells fused early in development creating one person with both cell lines. Thus when doctors did the first tissue typing tests on Jane, just by chance they had only sampled the 'yellow' cell line which was responsible for one of her sons. When they went back again they found the 'pink' cell line which had given rise to the other two boys. This particular type of human chimerism is thought to be pretty rare- there are only 30 case reports in the literature. (Though remarkably both House and CSI's Gil Grissom have encountered cases.) What happens far more frequently is fetal microchimerism- which occurs in pregnant women when cells cross the placenta from baby to mum. This is awesome because we used to think the placenta was this barrier which prevented any cells crossing over. Now we've found both cells and free floating DNA cross the placenta, and that the cells can hang around for decades after the baby was born. Why? As is often the case in medicine we're not sure but one theory is that the fetal cells might have healing properties for mum. In pregnant mice who've had a heart attack, fetal cells can travel to the mum's heart where the develop into new heart muscle to repair the damage. Whilst we're still in the early stages of understanding why this happens, we already have a practical application. In the United States today, a pregnant woman can have a blood test which isn't looking for abnormalities in her DNA but in that of her fetus. The DNA test isn't conclusive enough to be used to diagnose genetic conditions, but it is a good screening test for certain trisomies including Down's syndrome. Now, we started with a curious tale, so lets close with a curious fact, and one that's appropriate for Mother's Day: This exchange of cells across the placenta is a two way process. So you may well have some of your mum's cells rushing through your veins right now. In my case they're probably the ones that tell me to put on sensible shoes and put that boy down... (FYI: This is a story I originally posted on my own blog)  
Dr Catherine Carver
almost 7 years ago
%3fr=0
7
572

Dementia: A reflection from an Egyptian Perspective

Through different periods of the Egyptian history from Pharaonic, Greco-Roman, Coptic, Islamic and Modern Era; Egyptians tend to respect, appreciate and care for elderly. There is also a rich Eastern Christian tradition in respecting and taking care of old people that has continued since the first centuries of Christianity. Churches used to develop retirement homes served by monastic personnel and nurses. Egyptian culture traditionally linked some aspects of mental illnesses to sin, possession of evil, separation from the divine and it is usually associated with stigmatisation for all family members. However, forgetfulness with ageing was normalised. Until now, it seems that the difference between normal ageing and dementia is blurred for some people. Recently, the term 'Alzheimer' became popular, and some people use it as synonymous to forgetfulness. El-Islam, stated that some people erroneously pronounce it as 'Zeheimer' removing the 'Al' assuming it is the Arabic equivalent to the English 'the'. In 2010, a film was produced with the title 'Zeheimer' confirming the mispronunciation. Elderly face many health challenges which affect their quality of life. Dementia is one of these challenges as it is considered to be one of the disorders which attack elderly and affect their memory, mental abilities, independence, decision making and most cognitive functions. Therefore, the focus on dementia has increased around the world due to the rapid spread of the syndrome and the economical and psychosocial burden it cause for patients, families and communities. (Grossber and Kamat 2011, Alzheimer’s Association 2009, Woods et al. 2009). In recent years, the proportion of older people is increasing due to the improvement in health care and scientific development. The demographic transition with ageing of the population is a global phenomenon which may demand international, national, regional and local action. In Egypt the ageing population at the age of 65 and older are less than 5% of the Egyptian population (The World FactBook, 2012), yet, the World Health Organization (WHO) asserts that a demographic shift is going to happen as most of the rapid ageing population will transfer to the low and middle income countries in the near future (WHO, 2012). Egyptian statistics assert this shift. The Information Decision Support Center published the first comprehensive study of the elderly in Egypt in 2008. According to the report, in 1986, 5 percent of Egyptians were age 60 and older. In 2015, they will make up to 11 percent of the population and in 2050; over a fifth. Caring of older persons constitutes an increasing segment of the Egyptian labor market. However, nation wide statistics about number of dementia sufferers in Egypt may be unavailable but the previous demographic transition is expected to be accompanied by an increase in dementia patients in Egypt and will affect priorities of health care needs as well. The Egyptian society may need adequate preparation with regards to health insurance, accommodation and care homes for the upcoming ageing population (El-Katatney, 2009). Although the number of care home increased from 29 in 1986 to be around 140 home in 2009; it cannot serve more than 4000 elderly from a total of 5 million. Not every elderly will need a care home but the total numbers of homes around Egypt are serving less than 1% of the elderly population. These facts created a new situation of needs for care homes besides the older people who are requiring non-hospital health care facility for assisted living. The Egyptian traditions used to be strongly associated with the culture of extended family and caring for elderly as a family responsibility. Yet, in recent years changes of the economic conditions and factors as internal and external immigration may have affected negatively on elderly care within family boundaries. There is still the stigma of sending elderly to care homes. Some perceive it as a sign of intolerance of siblings towards their elderly parents but it is generally more accepted nowadays. Therefore, the need for care homes become a demand at this time in Egypt as a replacement of the traditional extended family when many older people nowadays either do not have the choice or the facilities to continue living with their families (El-Katatney 2009). Many families among the Egyptian society seem to have turned from holding back from the idea of transferring to a care home to gradual acceptance since elderly care homes are becoming more accepted than the past and constitutes a new concept of elderly care. Currently, many are thinking to run away from a lonely empty home in search of human company or respite care but numbers of geriatric homes are extremely lower than required and much more are still needed (Abdennour, 2010). Thus, it seems that more care homes may be needed in Egypt. Dementia patients are usually over 65, this is one of the factors that put them at high risk of exposure to different physical conditions related to frailty, old age, and altered cognitive functions. Additionally, around 50% of people with dementia suffers from other comorbidities which affect their health and increases hospital admissions (National Audit Office 2007). Therefore, it is expected that the possibility of doctors and nurses needing to provide care for dementia patients in various care settings is increasing (RCN 2010). Considering previous facts, we have an urgent need in Egypt to start awareness about normal and upnormal ageing and what is the meaning of dementia. Moreover, change of health policies and development of health services is required to be developed to match community needs. Another challenge is the very low number of psychiatric doctors and facilities since the current state of mental health can summarised as; one psychiatrist for every 67000 citizens and one psychiatric hospital bed for every 7000 citizens (Okasha, 2001). Finally the need to develop gerontologically informed assessment tools for dementia screening to be applied particularly in general hospitals (Armstrong and Mitchell 2008) would be very helpful for detecting dementia patients and develop better communication and planning of care for elderly. References: El Katateny, E. 2009. Same old, same old: In 2050, a fifth of Egyptians will be age 60 and older. How will the country accommodate its aging population?. Online available at: http://etharelkatatney.wordpress.com/category/egypt-today/page/3/ Fakhr-El Islam, M. 2008. Arab culture and mental health care. Transcultural Psychiatry, vol. 45, pp. 671-682 Ageing and care of the elderly. Conference of European churches. 2007. [online] available at: http://csc.ceceurope.org/fileadmin/filer/csc/Ethics_Biotechnology/AgeingandCareElderly.pdf World Health Organization. 2012 a. Ageing and life course: ageing Publications. [Online] available at : http://www.who.int/ageing/publications/en/ World Health Organization. 2012 b. Ageing and life course: interesting facts about ageing. [Online] available at: http://www.who.int/ageing/about/facts/en/index.html World Health Organization 2012 c. Dementia a public health priority. [online] available at: http://whqlibdoc.who.int/publications/2012/9789241564458_eng.pdf World Health Organization. 2012 d. Why focus on ageing and health, now?. Department of Health. 2009. Living well with dementia: a national dementia strategy. [Online] available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058 Andrawes, G., O’Brien, L. and Wilkes, L. 2007. Mental illness and Egyptian families. International Journal of Mental Health Nursing, vol.16, pp. 178-187 National Audit Office. 2007. Improving service and support for people with dementia. London. [online[ Available at: http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx Armstrong, J and Mitchell, E. 2008. Comprehensive nursing assessment in the care of older people. Nursing Older People, vol. 20, No. 1, pp. 36-40. Okasha, A. 2001. Egyptian contribution to the concept of mental health. Eastern Mediterranean Health Journal,Vol. 7, no. 3, pp. 377-380. Woods, R., Bruce, E., Edwards, R., Hounsome, B., Keady, J., Moniz-Cook, E., Orrell, M. and Tussell, I. 2009. Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol. Trials Journal: open access, Vol. 10, [online] available at: http://www.trialsjournal.com/content/10/1/64 Grossberg, G. and Kamat, S. 2011. Alzheimer’s: the latest assessment and treatment strategies. Jones and Bartlett, publisher: The United States of America. Alzheimer’s Association. 2009. 2009 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, Volume 5, Issue 3. [online] Available at: http://www.alz.org/news_and_events_2009_facts_figures.asp Royal College of Nursing. 2010. Improving quality of care for people with dementia in general hospitals. London. National Audit Office. 2007. Improving service and support for people with dementia. London. [online[ Available at: http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx Authors: Miss Amira El Baqary, Nursing Clinical instructor, The British University in Egypt 10009457@qmu.ac.uk Dr Emad Sidhom, MBBCh, ABPsych-Specialist in Old Age Psychiatry-Behman Hospital e.sidhom@behman.com  
Amira El Baqary
almost 6 years ago
Www.bmj
2
11

Breath technology identifies changes that lead to stomach cancer | The BMJ

Potential non-invasive screening tool for stomach cancer on the cards!  
bmj.com
over 4 years ago
Www.bmj
0
5

New breath technology identifies changes that lead to stomach cancer

Nanoarray analysis, a technology that senses tiny changes in volatile organic compounds in exhaled breath, could be a useful non-invasive screening tool for stomach cancer, research in the journal Gut has concluded.1  
feeds.bmj.com
over 4 years ago
Static.www.bmj
0
17

Opioids for low back pain

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.  
feeds.bmj.com
over 4 years ago
Preview
0
8

Colorectal cancer screening for older adults

In recent years evidence that the incidence of and mortality from colorectal cancer can be substantially reduced by screening has been accumulating. Strong evidence from randomised trials is available for both fecal occult blood testing1 2 3 and screening with flexible sigmoidoscopy.4 5 6 7 8 Observational epidemiological studies suggest an even larger benefit associated with screening colonoscopy.8 9 10 11 Screening for colorectal cancer is now widely recommended by expert committees and is being introduced in a rapidly increasing number of countries.  
feeds.bmj.com
over 4 years ago
Static.www.bmj
0
14

Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials

Eligibility criteria Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
6

New breath technology identifies changes that lead to stomach cancer

Nanoarray analysis, a technology that senses tiny changes in volatile organic compounds in exhaled breath, could be a useful non-invasive screening tool for stomach cancer, research in the journal Gut has concluded.1  
feeds.bmj.com
over 4 years ago
Www.bmj
0
11

Colorectal cancer screening for older adults

In recent years evidence that the incidence of and mortality from colorectal cancer can be substantially reduced by screening has been accumulating. Strong evidence from randomised trials is available for both fecal occult blood testing1 2 3 and screening with flexible sigmoidoscopy.4 5 6 7 8 Observational epidemiological studies suggest an even larger benefit associated with screening colonoscopy.8 9 10 11 Screening for colorectal cancer is now widely recommended by expert committees and is being introduced in a rapidly increasing number of countries.  
feeds.bmj.com
over 4 years ago
Static.www.bmj
0
10

Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials

Eligibility criteria Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
4

New breath technology identifies changes that lead to stomach cancer

Nanoarray analysis, a technology that senses tiny changes in volatile organic compounds in exhaled breath, could be a useful non-invasive screening tool for stomach cancer, research in the journal Gut has concluded.1  
feeds.bmj.com
over 4 years ago
Preview
0
4

Improved screening methods likely following new insights into Barrett's esophagus, cancer evolution

A new appreciation of how cancer cells evolve could help scientists design better screening methods to catch cancer before it advances.  
medicalnewstoday.com
over 4 years ago
Preview
0
3

Conversations more effective than observing physical behavior - new airport security screening method

Airport security agents using a new conversation-based screening method caught mock airline passengers with deceptive cover stories more than 20 times as often as agents who used the traditional...  
medicalnewstoday.com
over 4 years ago