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Q&A Session on Maintenance Therapy for Advanced NSCLC: When, What, Why, & What’s Left After Post-Maintenance Relapse? (audio)

<p><span style="font-family: arial, sans, sans-serif; font-size: 13px; white-space: pre-wrap;">Dr. Mark Socinski, medical oncologist and leader of the Thoracic Oncology Program at Univ. of North Carolina, answers questions about what treatments to recommend after first line therapy for advanced NSCLC and when they should be pursued.</span></p>  
Howard (Jack) West, MD
almost 9 years ago
12
1
16

Q&A Session on Maintenance Therapy for Advanced NSCLC: When, What, Why, & What’s Left After Post-Maintenance Relapse? (video)

<p><span style="font-family: arial, sans, sans-serif; font-size: 13px; white-space: pre-wrap;">Dr. Mark Socinski, medical oncologist and leader of the Thoracic Oncology Program at Univ. of North Carolina, answers questions about what treatments to recommend after first line therapy for advanced NSCLC and when they should be pursued.</span></p>  
Howard (Jack) West, MD
almost 9 years ago
13
2
24

Maintenance Therapy for Advanced NSCLC: When, What, Why, & What’s Left After Post-Maintenance Relapse? (audio)

<p><span style="font-family: arial, sans, sans-serif; font-size: 13px; white-space: pre-wrap;">Dr. Mark Socinski, medical oncologist and leader of the Thoracic Oncology Program at Univ. of North Carolina, summarizes the evidence and presents a current approach to managing treatment of advanced NSCLC after first line therapy.</span></p>  
Howard (Jack) West, MD
almost 9 years ago
0
1
11

Maintenance Therapy for Advanced NSCLC: When, What, Why, & What’s Left After Post-Maintenance Relapse? (video)

<p><span style="font-family: arial, sans, sans-serif; font-size: 13px; white-space: pre-wrap;">Dr. Mark Socinski, medical oncologist and leader of the Thoracic Oncology Program at Univ. of North Carolina, summarizes the evidence and presents a current approach to managing treatment of advanced NSCLC after first line therapy.</span></p>  
Howard (Jack) West, MD
almost 9 years ago
5
1
52

SABCS 2008 | Case04

ResearchToPractice.com/SABCS_2008 – Second Opinion: Proceedings and Interviews from a 2-Part CME Satellite Symposia Held at the 31st Annual San Antonio Breast Cancer Symposium. Case: 65-year-old woman with rapidly progressive, symptomatic bone and lung metastases after recurrence during her fifth year of an adjuvant aromatase inhibitor for ER/PR-positive, HER2-negative BC. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
8
1
22

SABCS 2008 | Case07

ResearchToPractice.com/SABCS_2008 – Second Opinion: Proceedings and Interviews from a 2-Part CME Satellite Symposia Held at the 31st Annual San Antonio Breast Cancer Symposium. Case: 76-year-old woman with a 0.8-cm, ER/PR-positive, HER2-negative, moderately differentiated IDC with two positive nodes and an Oncotype DX® Recurrence Score® of 13. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
1
1
25

SABCS Spin-Off | 06 - Tripathy

Outside a protocol setting, the combination of lapatinib and capecitabine provides the best potential risk/benefit profile for women with ER-negative, PR-negative, HER2-positive, node-positive disease with cancer recurrence after AC->TH.  
Dr Neil Love
almost 9 years ago
10
1
9

MTPH1 2009 | Case 7 presented by Gracy Joshua, MD

ResearchToPractice.com/MTPH109 – Case 7 from the practice of Gracy Joshua, MD presented to Drs Gregory and Orlowski, moderated by Neil Love, MD. A 59-year-old man with MM treated with induction thalidomide/dexamethasone > ASCT > maintenance thalidomide received bortezomib/dexamethasone at relapse. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
1
1
11

PCU Think Tank 1 | 06 - Treatment for Patients with PSA-Only Relapse

Treatment for Patients with PSA-Only Relapse  
Dr Neil Love
almost 9 years ago
9
1
15

VPB2_2010 | Case01

ResearchToPractice.com/VPB210 – A 65-yo woman presents with a 2.1-cm, poorly differentiated, strongly ER+, PR-, HER2- BC with micrometastasis in the sentinel node and an Oncotype DX Recurrence Score of 36. Interview conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
9
1
15

VPB2 2009 | Case 3

ResearchToPractice.com/VPB209 - Case 3: A 72-year-old woman with cancer recurrence nine years after diagnosis of a 1-cm, poorly differentiated, node-positive, ER-positive, PR-negative, HER2-negative IDC. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
12
1
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VPB2 2009 | Case 6

ResearchToPractice.com/VPB209 - Case 6: A 51-year-old postmenopausal woman with a 1.3-cm, Grade II, node-negative, ER-positive, PR-positive, HER2-negative IDC and an Oncotype DX® Recurrence Score® of 21 (intermediate risk). Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
0
1
10

VPB2 2009 | Case 8

ResearchToPractice.com/VPB209 - Case 8: A 74-year-old woman with a cutaneous chest wall recurrence of metastatic ER-negative, PR-negative, HER2-positive inflammatory BC. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
3
1
16

VPB2 2009 | Case 11

ResearchToPractice.com/VPB209 - Case 11: A 47-year-old woman with extensive, high-grade, multifocal ductal carcinoma in situ (DCIS), a 3-mm focus of ER-positive, PR-negative, HER2-positive IDC and an Oncotype DX Recurrence Score of 34 (high risk). Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
almost 9 years ago
Preview
1
26

Eating Disorders

Anorexia Nervosa This is a psychological disorder, in which there is a relentless pursuit of thinness. Anorexia is significant as it has a very high mortality rate: 1/3 of patients make a complete recovery 1/3 make only partial recovery and have many relapses  
almostadoctor.com - free medical student revision notes
over 5 years ago
Www.bmj
1
74

Management and prevention of exacerbations of COPD

Patients with chronic obstructive pulmonary disease (COPD) are prone to acute respiratory exacerbations, which can develop suddenly or subacutely over the course of several days. Exacerbations have a detrimental effect on patients’ health status and increase the burden on the healthcare system. Initial treatment is unsuccessful in 24-27% of patients, who have a relapse or a second exacerbation within 30 days of the initial event. No obvious benefit has been seen in recent clinical trials of anti-tumour necrosis factor therapy, anti-leukotriene therapy, intensive chest physiotherapy, or early inpatient pulmonary rehabilitation for treatment of exacerbations. By contrast, clinical trials of prevention rather than acute treatment have shown promising results. Long acting β agonist (LABA) or long acting anti-muscarinic (LAMA) bronchodilators and inhaled corticosteroid-LABA combinations prevent exacerbations in patients at risk, with relative risk reductions averaging 14-27% for each of these drugs relative to placebo. Triple therapy with inhaled corticosteroid-LABA plus LAMA may provide additional benefit, although study results to date are heterogeneous and more studies are needed. Pneumonia is an important complication of treatment with inhaled corticosteroid-LABA products, and the risk of pneumonia seems to be doubled in patients with COPD who use fluticasone. The addition of azithromycin to usual COPD therapy prevents exacerbations, although it may prolong the Q-T interval and increase the risk of death from cardiovascular disease in patients prone to arrhythmia. New potential drugs—including mitogen activated protein kinase inhibitors, phosphodiesterase 3 inhibitors, and monoclonal antibodies to the interleukin 1 receptor—offer additional hope for treatments that may prevent exacerbations in the future.  
bmj.com
almost 5 years ago
Preview
1
28

Renal cell carcinoma

The treatment of renal cell carcinoma (RCC) has changed greatly over the past 15 years. Progress in the surgical management of the primary tumor and increased understanding of the molecular biology and genomics of the disease have led to the development of new therapeutic agents. The management of the primary tumor has changed owing to the realization that clean margins around the primary lesion are sufficient to prevent local recurrence, as well as the development of more sophisticated tools and techniques that increase the safety of partial nephrectomy. The management of advanced disease has altered even more dramatically as a result of new agents that target the tumor vasculature or that attenuate the activation of intracellular oncogenic pathways. This review summarizes data from prospective randomized phase III studies on the surgical management and systemic treatment of RCC, and provides an up to date summary of the histology, genomics, staging, and prognosis of RCC. It describes the management of the primary tumor and offers an overview of systemic agents that form the mainstay of treatment for advanced disease. The review concludes with an introduction to the exciting new class of immunomodulatory agents that are currently in clinical trials and may form the basis of a new therapeutic approach for patients with advanced RCC.  
bmj.com
almost 5 years ago
Foo20151013 2023 1ecatpw?1444774000
9
17232

My transition from medical student to patient

I started medical school in 2007 wanting to 'making people better'. I stopped medical school in 2010 facing the reality of not being able to get better myself, being ill and later to be diagnosed with several long term health conditions. This post is about my transition from being a medical student, to the other side - being a patient. There are many things I wish I knew about long-term health conditions and patients when I was a medical student. I hope that through this post, current medical students can become aware of some of theses things and put them into practice as doctors themselves. I went to medical school because I wanted to help people and make them better. I admired doctors up on their pedestals for their knowledge and skills and expertise to 'fix things'. The hardest thing for me was accepting that doctors can't always make people better - they couldn't make me better. Holding doctors so highly meant it was very difficult for me to accept their limitations when it came to incurable long-term conditions and then to accept that as a patient I had capacity myself to help my conditions and situation. Having studied medicine at a very academic university, I had a very strict perception of knowledge. Knowledge was hard and fast medical facts that were taught in a formal setting. I worked all day and night learning the anatomical names for all the muscles in the eye, the cranial nerves and citric acid cycle, not to mention the pharmacology in second year. Being immersed in that academic scientific environment, I correlated expertise with PhDs and papers. It was a real challenge to realise that knowledge doesn't always have to be acquired through a formal educational but that it can be acquired through experience. Importantly, knowledge acquired through experience is equally valid! This means the knowledge my clinicians have developed through studying and working is as valid as my knowledge of my conditions, symptoms and triggers, developed through experiencing it day in day out. I used to feel cross about 'expert patients' - I have spent all these hours in a library learning the biochemistry and pharmacology and 'Joe Bloggs' walks in and knows it all! That wasn't the right attitude, and wasn't fair on patients. As an expert patient myself now, I have come to understood that we are experts through different means, and in different fields. My clinicians remain experts in the biological aspects on disease, but that's not the full picture. I am an expert in the psychological and social impact of my conditions. All aspects need to be taken into account if I am going to have holistic integrated care - the biopsychosocial model in practice - and that's where shared-decision making comes in. The other concept which is has been shattered since making the transition from medical student to patient is that of routine. In my first rotation, orthopaedics and rheumatology, I lost track within the first week of how many outpatient appointments I sat in on. I didn't really think anything of them - they are just another 15 minute slot of time filled with learning in a very busy day. As a patient, my perspective couldn't be more different. I have one appointment with my consultant a year, and spend weeks planning and preparing, then a month recovering emotionally. Earlier this year I wrote a whole post just about this - The Anatomy of an Appointment. Appointments are routine for you - they are not for us! The concept of routine applies to symptoms too. After my first relapse, I had an emergency appointment with my consultant, and presented with very blurred vision and almost total loss of movement in my hands. That very fact I had requested an urgent appointment suggest how worried I was. My consultants response in the appointment was "there is nothing alarming about your symptoms". I fully appreciate that my symptoms may not have meant I was going to drop dead there and then, and that in comparison to his patients in ICU, I was not as serious. But loosing vision and all use of ones hands at the age of 23 (or any age for that matter) is alarming in my books! I guess he was trying to reassure me, but it didn't come across like that! I have a Chiari malformation (in addition to Postural Orthostatic Tachycardia Syndrome and Elhers-Danlos Syndrome) and have been referred to a neurosurgeon to discuss the possibility of neurosurgery. It is stating the obvious to say that for a neurosurgeon, brain surgery is routine - it's their job! For me, the prospect of even being referred to a neurosurgeon was terrifying, before I even got to the stage of discussing the operation. It is not a routine experience at all! At the moment, surgery is not needed (phew!) but the initial experience of this contact with neurosurgeons illustrates the concept of routines and how much our perspectives differ. As someone with three quite rare and complex conditions, I am invariable met in A&E with comments like "you are so interesting!". I remember sitting in the hospital cafeteria at lunch as a student and literally feasting on the 'fascinating' cases we had seen on upstairs on the wards that morning. "oh you must go and see that really interesting patient with X, Y and Z!" I am so thankful that you all find medicine so interesting - you need that passion and fascination to help you with the ongoing learning and drive to be a doctor. I found it fascinating too! But I no longer find neurology that interesting - it is too close to home. Nothing is "interesting" if you live with it day in day out. No matter what funky things my autonomic nervous may be doing, there is nothing interesting or fascinating about temporary paralysis, headaches and the day to day grind of my symptoms. This post was inspired by NHS Change Day (13th March 2013) - as a patient, I wanted to share these few things with medical students, what I wish I knew when I was where you are now, to help the next generation of doctors become the very best doctors they can. I wish you all the very best for the rest of your studies, and thank you very much for reading! Anya de Iongh www.thepatientpatient2011.blogspot.co.uk @anyadei  
Anya de Iongh
over 6 years ago
Foo20151013 2023 4ktnps?1444774050
4
187

Poo transplants

When is it medically advisable to eat some one else's poo? When you need a poo transplant. Poo transplants could be the solution to one of the biggest problems facing the NHS today- the bacterial infection Clostridium difficile. C.diff, as it's known to its friends, infects about 18,000 people in England and Wales every year and is involved in the deaths of about 2000 people. C.diff typically arises due to imbalances in the normal gut bacteria. The gut is like a city, a city with about 100 trillion bacterial residents happily munching away on a banquet of bowel contents. The average person has about 1000 different types of bacteria in their gut, and about 3% of healthy adults have C.diff in that mix. The C.diff doesn't cause them any problems because its numbers are kept in check by the other gut bacteria. However treatment with broad spectrum antibiotics such as clindamycin, cephalosporins, ciprofloxacin and co-amoxiclav, can disrupt this happy community- killing off vast swathes of bacteria but crucially not the C.diff. Given free rein the C.diff multiplies rapidly and produces toxins which damage the gut. In some people this causes mild diarrhoea and abdominal pain, in others it can lead to torrential diarrhoea, perforation of the colon and death. Traditional treatment includes stopping any broad spectrum antibiotics and possibly prescribing antibiotics which target the C.diff such as metronidazole or vancomycin. However with antibiotic use comes the risk of resistance. Moreover our current approach isn't entirely effective and about 22% of patients treated suffer a recurrence. This can result in a cycle of illness and hospital admission which is costly to the patient and the hospital. So it's time to start thinking outside of the box. Cue the poo transplant. The thinking goes like this- if the cause of the problem is disruption to the normal community of gut bacteria, why not just pop those bacteria back in to crowd out the C.diff? Simples. Practically, the first step is to identify a donor, usually a close relative of the patient, and screen them for a range of infectious diseases and parasites. It's also advisable to make sure they haven't recently consumed anything the intended recipient is allergic to, before asking them to make their "donation". You then pop it in a household blender and blitz it down, adding saline or milk to achieve a slurry consistency. Next you need to strain your concoction to remove large materials- one medic in the UK uses coffee filters. Top tip. Then you're ready to administer it- about 25ml from above (e.g. via nasogastric tube), or 250ml from below. Now, its important to note that poo transplants are still an experimental treatment. To date only small case studies have been carried out, but with 200 total reported cases, an average cure rate of 96% and no serious adverse events reported to date, it's worth carrying out a large trial to assess it thoroughly. Poo transplants- arguably the ideal treatment for a cash strapped NHS. It's cheap, plentiful and it seems to work. Now to convince people to consume someone else's poo... Bottoms up! FYI: This was first posted on my own blog. Image Courtesy of Marcus007 at de.wikipedia [Public domain], from Wikimedia Commons  
Dr Catherine Carver
over 6 years ago
Foo20151013 2023 38zku8?1444774057
1
2543

The BioPsychoSocial Model of Disease comes to life

The biopsychosocial model of disease existed in my notes... an excuse to get out the colouring crayons and draw a diagram, but ultimately another collection of facts that needed to be digested then regurgitated in the summer exams, something to be fitted in around learning about the important stuff - the science. But the biopsychosocial model has come alive for me recently, now I realise what an impact the later two components, psychological and social, can have on patients. As a former medical student and now full time patient, the model really means something to me now. In the 1977 paper in Science, George Engel introduced the biopsychosocial model: "The dominant model of disease today is biomedical, and it leaves no room within it's framework for the social, psychological and behavioural dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching and a design for action in the real world of health care." Following some conversations on Twitter recently and from my own experience at medical school and now as a patient, I wanted to explore my thoughts on this model. Twitter, in the wonderful way it does, recently introduced me to the Disabled Medic blog, which among many other great posts, has also explored the biopsychosocial model, and I would recommend a read. The biopsychosocial model shows the influence that emotions and social circumstances have on physical health, which is important. But while conversations about the model focus on the way it can be used by healthcare professionals (very important!), it needs emphasising that the model can provide a framework for patients to look at/after themselves. The model highlights the psychological and social causes of disease, but more optimistically, it can show that there are a range of treatments for disease, from the medical to the social and psychological. A diagnosis of a long-term health conditions is often simultaneous with loss of control. There are limitations to the success of medications, treatments and surgeries. And in receiving these, we are relatively passive as patients, no matter how engaged we are. The biopsychosocial model looks at our biological, psychological and social needs, and how these factors influence our overall health. Establishing that these factors affect our health is only the first step. As patients, when psychological and social factors are brought in to the equation, it becomes clear that we ourselves have some power to help ourselves. By framing our health in this more holistic way, as patients we are not as powerless as suggested by the medical model. Through self-management we can make positive changes to our own psychological and social situations, which can in turn benefit our physical biological health. To return to the traditional ground of the model - healthcare professionals.... One strength of the model is that it places psychology side beside its (generally considered) more superior counter-part, biology. I hope that by seeing the biopsychosocial model in action, physicians can appreciate the detrimental psychological impact of a diagnosis, and the assumption of "it is all in the mind" can fall by the way side. By integrating all three elements, the model shows that neither is independent of the others, so it can't be all in the mind, because other factors, biological or social, will be involved to some degree. For me personally, the biopsychosocial model makes me look at what a 'life' is. One of the attractions of medicine is saving lives. Without getting too deeply into philosophy or ethics, I just want to explore for a second what saving a life really means for me, as a patient. I still believe that A&E staff heroically save lives. But I have come to realise that a life is more than a swiggly line on a heart rate monitor. My counsellor has been just as heroic in saving my life, through addressing my emotions. My life is now something I can live, rather than endure. With saving lives being a key (and honourable) motivation among medical staff, it is important that we can allow them to save lives as often as possible, and in many different ways. It may not always be through emergency treatment in resuscitation, but if we embrace the biopsychosical model, they can save lives in many more ways. When there is a limit to the effectiveness of the biological approaches to an ill person, and they can't be returned to the land of the healthy, medical science becomes unstuck. Within the biopsychosocial model, the issue of doctors not being able to do anything is slightly less. As I mentioned in my post about making the transition from medical student to patient, I went to medical school because I wanted to make people better. But I was only being taught one way to make people better - drugs and surgery. If we really embraces the biopsychosocial model, doctors could make a difference, even if their standard tools of drugs aren't available because they could turn to psychological and social support. This isn't to say that all clinicians have to be counsellors or social workers - far from it. But an awareness and appreciation of their contribution to the management of a patient is important, as well as an understanding of the basic principles and skills such as motivational interviewing. In 2013, I don't think I can talk about social in this context without mentioning social media. It was not was Engel originally meant in 1977, but social media has become a vital social tool for patients to manage their health. Ignoring anxieties and postural problems associated with sitting at a screen seeing everyone else's photo-shopped lives, it is undeniable that social media is a big and good resource that can empower patients to take responsibility and manage their own health. To see the best examples in action, take a look at Michael Seres and his blog, Being a Patient Isn't Easy to see a whole new meaning to the social in biopsychosocial! I am still very grateful for the biological expertise of my medical team. Don't get me wrong - it's a good place to start and I wouldn't be here writing this post today if it wasn't for the biological support. But with chronic illness, when you are past the dramatic relapses, the biological isn't enough.... The biology has allowed me to live, but its the psychological and social support I have received that has allowed me to live. Anya de Iongh @anyadei www.thepatientpatient2011.blogspot.co.uk  
Anya de Iongh
over 6 years ago