Putting the spotlight on case reports

Many doctors feel that individual patients’ stories are overlooked in today’s push towards evidence-based medicine. Cases Network is an open access online publisher which enables individual patient experiences to be recorded and shared by any doctor.

Richard Smith, former editor of the British Medical Journal, said of Cases Network’s goal: “Case reports are at the heart of medicine. They are how all doctors learn and every patient, no matter how ‘ordinary’ his or her problem, has something to teach us. We want to revitalise the excitement of case reports and encourage all doctors to write and read case reports. It’s one way to recover some of the lost humanity of medicine.”

● To access Cases Network, visit http://casenetwork.com

● To access Cases Journal, visit http://casesjournal.com

● To access the Journal of Medical Case Reports, visit http://jmedicalcasereports.com

An easy route to must-read content

The rise of online publishing has given academics a completely new platform for publishing their findings, which has been beneficial in some respects, but has also contributed greatly to doctors’ and scientists’ sense of information overload. This can be avoided with human community- driven filtering enabling Internet users to get straight to the best online content. Faculty of 1000 has added a new level to this model with the launch of F1000 Reports – www.f1000medicine.com/reports.

The expert-driven article evaluation services, Faculty of 1000 Medicine, is launching a journal to complement their award-winning service. The new journal, called F1000 Medicine Reports, is unlike existing scientific journals as most of its content has already been filtered for importance by Faculty of 1000’s community of over 5,000 of the world’s top scientists and clinicians.

F1000 Medicine Reports select and highlight the most significant and interesting articles recently evaluated on Faculty of 1000, as well as identify emerging trends within the large F1000 database of articles. In this way, F1000 Reports spot the tips of some new scientific icebergs before they become apparent elsewhere. With so much new literature for scientists and clinicians to read, F1000 Reports are easy routes to the must-read content.

● Visit: www.f1000medicine.com/reports

US FDA launches SAFEKIDS initiative

The US FDA will, with five partners, study the effects of anaesthetics and sedatives on the neurocognitive development of infants and young children.

The Safety of Key Inhaled and Intravenous Drugs in Pediatrics (SAFEKIDS) Initiative is a multi-year project designed to address major gaps in scientific information about the safe use of anaesthetics and sedatives received by millions of children each year.

“The long-term benefits of these studies will inform riskbenefit decisions that both anaesthesiologists and parents must make when considering the choice of anaesthesia in paediatric patients,” said FDA Acting Commissioner Frank M Torti, MD, MPH.

Research by the FDA’s National Center for Toxicological Research using juvenile animal models shows that exposure to some anaesthetics and sedatives is associated with memory and learning deficits and other neurodegenerative changes in the central nervous system. Insufficient human data exists to either support or refute the possibility that similar effects could occur in children. The SAFEKIDS Initiative will develop this data.

The FDA expects the first results from the SAFEKIDS Initiative will be available within two years.

GSK breaks mould, opens access to drugs for poor

Pharmaceutical giant GlaxoSmithKline (GSK) can be congratulated for breaking industry ranks and taking a major step toward helping poor people in developing countries to get better access to medicines, says international aid agency Oxfam.

“Big Pharma seems to be realising slowly that poor people in developing countries face huge and different barriers to good health, and so to break into these big new emerging markets the industry must change its existing ‘strong patents, high cost’ way of doing business,” Rohit Malpani, an Oxfam spokesperson, said.

GSK said it would cut the price of all its medicine to the world’s 52 poorest countries. “This is the first time a company has acknowledged that access to medicines is relevant to its entire portfolio of medicines, and not just for HIV and AIDS, TB and malaria,” said Malpani. “This alone won’t get the job done. Companies should reduce prices for poor people in middle-income countries too and show flexibility on intellectual property to stimulate generic competition – especially from low-cost manufacturers such as those in India – which is necessary for sustainable price reductions in poor countries.”

GSK said it would introduce a patent pool where small molecules and processes would be donated to encourage innovation for neglected diseases. “This is a big step. Patents must not be a barrier to innovation into neglected diseases. However, GSK has specifically excluded HIV and AIDS medicines from this patent pool. Although companies have reduced the prices of such medicines, new first and second line anti-retroviral medicines are often 5 to 10 times more expensive than older, off-patent first line medicines,” Malpani said.

GSK will invest 20% of the profits it gets in least-developed countries into health infrastructure in those countries. “GSK is right to identify health infrastructure as a big challenge in poor countries. GSK could reinforce good or bad practices, depending on how it spends this money. We hope GSK will strengthen the public healthcare system in poor countries and not invest into private sector delivery that sits outside of the healthcare system,” Malpani said.

HIV rates increase in older people

The number of older people with HIV may be increasing worldwide, but doctors seldom consider screening them for HIV, thus delaying diagnosis, according to an article in the World Health Organisation’s March Bulletin.

These individuals are also less likely to practise safe sex and the older the individual, the faster the progression from HIV infection to AIDS.

The article noted that in the United States, the proportion of HIV-positive individuals aged 50 years or older climbed from 20% in 2003 to 25% in 2006, while preliminary findings of data from countries in the developing world reveal a surprisingly high proportion of infected individuals in this age group.

While life-prolonging antiretroviral therapy may be contributing to the number of older individuals with HIV, scientists also suspect many are becoming infected at an advanced age.

Erectile-dysfunction drugs have been extending the sex life of many older individuals and may also be extending the HIV epidemic into older age groups.

WHO called for more research into the impact of these drugs on the HIV epidemic, as they were becoming more widely available in the Developing World.

Global policy report says many cancers preventable

Over 40% of colon and breast cancer cases in some countries are preventable through healthy patterns of diet, physical activity and weight maintenance, according to estimates in a report that has set out recommendations for policies and actions to prevent cancer.

The report, Policy and Action for Cancer Prevention, published by the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR), has estimated about 43% of colon cancer cases and 42% of breast cancer cases in the UK could be prevented in this way.

The overall message of the report is that all sections of society from governments to households should make public health and cancer prevention in particular, a higher priority. It includes estimates on the proportion of cancer cases that could be prevented through diet, physical activity and weight that demonstrate how important the issue is.

The estimates for the US are that 45% of colon cancer cases and 38% of breast cancer cases are preventable by these means. The report has also estimated the preventability of cancer in China and Brazil, which represent low and middle-income countries, respectively.

The overall estimate is about a third of the most common cancers in high-income countries and a quarter in lowerincome countries could be prevented. These figures do not include smoking, which alone accounts for about a third of cancers.

Professor Sir Michael Marmot, Chair of the Panel, said: “This report shows by making relatively straightforward changes, we could significantly reduce the number of cancer cases around the world.”

● The report can be downloaded at www.dietandcancerreport.org

ReNeuron gains approval for stem cell trial for stroke

Britain-based ReNeuron Group has received approval from the UK Medicines and Healthcare Products Regulatory Agency (MHRA) to commence a firstin- man clinical trial using stem cells for the treatment of patients who have been left disabled by an ischaemic stroke, the most common form of the condition. Stroke is the third largest cause of death and the single largest cause of adult disability in the Developed World.

In this ground-breaking Phase I trial using expanded neural stem cells, stroke patients will be treated with ReNeuron’s ReN001 stem cell therapy at the Institute of Neurological Sciences, Southern General Hospital, Greater Glasgow and Clyde NHS Board. The Principal Investigator for the trial is Dr Keith Muir, Senior Lecturer in Neurology at the University of Glasgow. MHRA approval for the trial has been given subject to provision of data both from an ongoing pre-clinical study and from the long term followup of trial participants.

The trial is designed primarily to test the safety profile of ReN001 in ischaemic stroke patients at a range of cell doses, but a number of efficacy measures will also be evaluated over the course of the trial. The ReN001 cells will be administered by direct injection into the affected region of the brain in a straightforward surgical procedure. Importantly, the nature of the procedure and the characteristics of the ReN001 cells mean that the patients will not require immunosuppression following treatment, thus eliminating the safety risks typically associated with immunosuppression regimens. Patients in the trial will be monitored for one year, with longer term followup procedures in place thereafter.  


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