Barrett's esophagus (BE), a common condition, is the only known precursor to esophageal adenocarcinoma (EAC). There is uncertainty about the best way to manage BE as most people with BE never develop ...EAC and most patients diagnosed with EAC have no preceding diagnosis of BE. Moreover, there have been recent advances in knowledge and practice about the management of BE and early EAC. To aid clinical decision making in this rapidly moving field, Cancer Council Australia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE; and methods for managing BE and early EAC. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.
Cancer Council Australia's Cancer Guidelines Portal is progressing well and clinical practice guidelines can be accessed online at http://wiki.cancer.org.au/australia.
Cancer Council Australia's Clinical Guidelines Network is progressing well during its transition to publishing online clinical guidelines with its newly developed Cancer Guidelines Portal (wiki-based ...platform).
Abstract only
e17587
Background: The challenge for clinical practice guidelines is keeping them regularly updated with new evidence, and widely disseminated in a cost effective manner. This is ...difficult with printed guidelines and so Cancer Council Australia developed an internet based wiki platform for guidelines and assessed the impact of wiki lung cancer treatment guidelines 6 months after their development. Methods: The key steps in guideline development of identifying questions, literature searching, appraisal of papers, experts writing evidence-based recommendations and wide public consultation and dissemination were integrated in an access-protected wiki. Google web analytics was used to monitor usage. New papers are added and the writers continuously engaged in updating their questions. The evaluation spanned 6 months from May to November 2012. Results: The lung cancer guidelines had 67 clinical questions and 2076 articles were critically appraised. In the first month during public consultation there were 1055 visits to the site and 2955 visits in the following 5 months. The guidelines were accessed from a mobile device by 7% for consultation and 11% subsequently. During the consultation 80% of visits were from Australia, 6% New Zealand, 4% USA and 2% UK. In the consultation period 56% visits resulted from organic search traffic, 31% direct access and 13% referrals and subsequently 72% from searches, 19% direct and 11% referrals. The guideline partner Cancer Australia was the major source of referral (26% during consultation and 25% subsequently) as well as Cancer Council’s main website 9% during the consultation and 38% subsequently. Facebook was responsible for 6-8% of referrals highlighting the role of social media in promoting guidelines. The average highest visit duration by a country was 9.06 minutes in the consultation month (Australia) and 7.24 for Canada. Bounce rates vary widely from 20% (Germany) to above 70% (USA, UK, India). Conclusions: Both clinicians and the public will engage with wiki guidelines and they reach a wide international audience.
Abstract
B
arrett's esophagus (
BE
), a common condition, is the only known precursor to esophageal adenocarcinoma (
EAC
). There is uncertainty about the best way to manage
BE
as most people with
BE
...never develop
EAC
and most patients diagnosed with
EAC
have no preceding diagnosis of
BE
. Moreover, there have been recent advances in knowledge and practice about the management of
BE
and early
EAC
. To aid clinical decision making in this rapidly moving field,
C
ancer
C
ouncil
A
ustralia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of
BE
and early
EAC
; prevalence, incidence, natural history, and risk factors for
BE
; and methods for managing
BE
and early
EAC
. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.
Abstract Leukocyte 8-hydroxydeoxyguanosine (8OHdG) is an indicator of oxidative stress, impaired metabolism, and mitochondrial dysfunction, features that have been implicated in Huntington disease ...(HD). Increased levels of 8OHdG have been reported in the caudate, parietal cortex, and peripherally in the serum and leukocytes, in patients diagnosed with HD. However, little is known about levels in prodromal patients and changes that might occur as the disease progresses. To address these issues, 8OHdG was tracked over time for a subset of participants enrolled in the PREDICT-HD study. Participants were stratified into four groups based on proximity to HD diagnosis at study entry: Controls (gene-negative individuals), Low (low probability of near-future diagnosis), Medium , and High . Blood samples were analyzed using Liquid Chromatography Electrochemical Array, and for comparison purposes, a separate cross-sectional sample was analyzed using liquid chromatography coupled with multiple-reaction-monitoring mass spectrometry. Longitudinal data analysis showed that initial status (at study entry) and annual rate of change varied as a function of proximity group, adjusting for sex, education, age at study entry, and site effects. Overall levels were lowest for the Control group and highest for the High group, and the rate of increase varied in a similar manner. The finding that 8OHdG concentrations increased as a function of proximity to projected disease diagnosis and duration indicates support for the continued assessment of 8OHdG as a robust clinical HD biomarker.
Abstract Huntington disease (HD) is a fatal neurodegenerative disorder caused by an expanded CAG repeat. Its length can be used to estimate the time of clinical diagnosis, which is defined by overt ...motor symptoms. Non-motor symptoms begin before motor onset, and involve changes in hypothalamus-regulated functions such as sleep, emotion and metabolism. Therefore we hypothesized that hypothalamic changes occur already prior to the clinical diagnosis. We performed voxel-based morphometry and logistic regression analyses of cross-sectional MR images from 220 HD gene carriers and 75 controls in the Predict-HD study. We show that changes in the hypothalamic region are detectable before clinical diagnosis and that its grey matter contents alone are sufficient to distinguish HD gene carriers from control cases. In conclusion, our study shows, for the first time, that alterations in grey matter contents in the hypothalamic region occur at least a decade before clinical diagnosis in HD using MRI.
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