High-dose intravenous pamidronate for metastatic bone pain.

The bisphosphonates are able to relieve pain from metastatic bone disease and, when given intravenously, may promote bone healing of lytic metastases. In this study, the aim was to assess the acute effects of a single 'high-dose' intravenous treatment with pamidronate on pain, mobility, analgesic consumption and quality of life (QOL). Thirty-four normocalcaemic patients with painful progressing bone metastases (22 from breast, five prostate and seven others) received a single intravenous infusion of 120 mg of pamidronate as palliative therapy. No other systemic therapy or drugs known to influence bone metabolism were administered during the study. Patients' subjective response to treatment was assessed weekly with a pain questionnaire recording a composite of pain intensity, mobility, performance status and analgesic consumption. In addition, patients completed the Rotterdam Symptom Check List (RSCL) for measurement of QOL and a mobility questionnaire. The mean reduction in the pain questionnaire score (recorded on at least two occasions) was 25% [standard error (s.e.) 3%, range 0-75%]. Twenty patients (59%) showed a > or = 20% improvement and were classified as responders. The median duration of symptomatic response was 12 (range 4-24 +) weeks. The responding patients showed a reduction in RSCL score (improvement in QOL) from 35% before treatment to 27% at 6 weeks, but no significant improvement was noted in non-responders. Twenty-one patients were retreated with pamidronate when their symptoms deteriorated again. Eight out of 15 responders showed a second reduction in pain score of > or = 20%, but this was not seen in any of the six non-responders. Five patients have remained well with no additional treatment for their disease other than repeat infusions of pamidronate every 3-6 months. Treatment was well tolerated. Eight (24%) experienced fever after the first treatment only, and four had asymptomatic, biochemical evidence of hypocalcaemia. The acute inhibition of osteoclastic bone resorption induced by a single high-dose treatment with pamidronate can provide useful palliation for patients with bone metastases. Responding patients may be retreated as symptoms dictate to good effect. We are currently running a phase III double-blind trial with high-dose pamidronate for progressive painful metastatic bone disease to exclude any placebo effect and observer bias

Pulmonary function in patients with trophoblastic disease treated with low-dose methotrexate

The Sheffield Trophoblastic Disease Centre treats about 25 patients with persistent trophoblastic disease each year. A total of 75% of patients are classified as low risk according to the Charing Cross Hospital prognostic scoring system and receive methotrexate (MTX) 50 mg, i.m., on days 1, 3, 5, 7 with folinic acid 7.5 mg orally 24 h after each methotrexate injection. There is a 7-day rest between treatment cycles. Remission is achieved in 85% of cases. Approximately 20% of patients experienced pleuritic chest pain and dyspnoea. We have evaluated prospectively lung function in 16 low-risk patients receiving methotrexate. All patients had pulmonary function tests [spirometry-forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), and transfer factor - TLCO, kCO] performed before and after completed treatment. A mean of 7.5 cycles of MTX were administered (range 4-11). There was a significant reduction in the mean TLCO (mean pre/post 8.15/7.38 mmol min-1 kPa-1, P = 0.01), but there were no other statistically significant changes. Three patients experienced respiratory symptoms and were found to have a 39%, 28%, and 11% reduction in TLCO from baseline, improving on follow up to pretreatment levels. Low-dose MTX is an effective therapy but may cause troublesome pulmonary toxicity

New times, new politics: history and memory during the final years of the CPGB

This article examines the relationship between collective memory, historical interpretation and political identity. It focuses on the dissolution of the Communist Party of Great Britain (CPGB) as constructed through collective narrative memory, and on Marxist interpretations of history. The divisions within the party and the wider Marxist community, stretching from 1956 until 1991, were often framed around questions of historical interpretation. The events of 1989–1991 created an historical and mnemonic crisis for CPGB members who struggled to reconcile their past identities with their present situation. Unlike the outward-facing revisionism of other political parties, this was an intensely personal affair. The solution for many was to emphasise the need to find new ways to progress socialist aims, without relying on a discredited grand narrative. In contrast, other Communist parties, such as the Communist Party of Britain, which had been established (or ‘re-established’) in 1988, fared rather better. By adhering to the international party line of renewal and continued struggle, the party was able to hold its narrative together, condemning the excesses of totalitarian regimes, while reaffirming the need for international class struggle

(Un)twisted: talking back to media representations of eating disorders

In 2014-15, there were several news reports about a rise in the diagnoses and treatment of eating disorders (EDs), as attributed to the use of image-driven social media. Such coverage can be situated within a long history of concern in which those diagnosed with an ED are constructed as ‘especially vulnerable’ to the power of media images – a subjectivity which is pathologised and devalued precisely through its association with femininity. The most incisive objections to EDs being presented as a response to the ‘weight’ of media representation have come from Abigail Bray (2005) in her work on how anorexia is constructed as a reading as well as an eating disorder. Indeed, there is a whole history of empirical work in Feminist Media Studies and Girlhood Studies which has challenged the pernicious construction of female subjectivity as ‘excessively’ invested in, and ‘damaged’ by, the consumption of mass mediated forms. Yet the media consumption practices of those with experience of an ED have not been subject to similar feminist re-evaluation – an omission which this research seeks to address. In exploring the results of 17 semi-structured interviews with people who have experience of an ED discussing their encounters with media representations of EDs (material that is often co-opted into debates about the ‘toxic’ nature of media culture in this regard), this article seeks to intervene in how such imagined media consumption practices are often defined. In seeking to speak back to historically pathologising constructions, the article seeks to explore the qualitative responses in the context of more ‘every day’ understandings of media engagement, thus working against the gendered othering which has persistently occurred

Signifying Trauma in the Post-9/11 Combat Film: The Hurt Locker and In the Valley of Elah

This is an accepted manuscript of an article published by Taylor and Francis in Journal of War and Culture Studies on 13/05/2019, available online: https://www.tandfonline.com/doi/full/10.1080/17526272.2019.1615706 The accepted version of the publication may differ from the final published version.This article addresses two Iraq War films, The Hurt Locker (Bigelow 2008) and In the Valley of Elah (Haggis 2007), through the lens of trauma theory. Uniquely, it engages with Slavoj Žižek’s account of the Real in its analysis of how victim/perpetrator trauma is signified in their respective narrative structures and visual style. The primary argument is that the pattern of traumatic memory is reflected in their narrative modes. At the same time, it claims that the unfolding narrative of In the Valley of Elah mimics certain forms of trauma treatment, operating in a therapeutic mode for its characters (as well as offering narrative resolution for spectators). Such analysis of trauma differs from other scholarly approaches to these films that have variously considered them from perspectives of: embodiment in the war film (Burgoyne 2012); the ethics of viewing traumatic suffering (Straw 2011); the de-politicisation of torture by the inclusion of posttraumatic stress disorder (PTSD) (Barker 2011); indifference to post-9/11 war films as an inability to respond to the trauma and loss that terrorism poses (Toffoletti and Grace 2010); trauma and the militarised body (Andreescu 2016); and the narration of trauma in Iraq War Films (Kopka 2018)

Second primary malignancies after treatment for malignant lymphoma

To determine the incidence and possible causes of second primary malignancies after treatment for Hodgkin's and Non-Hodgkin's lymphoma (HL and NHL). A cohort of 3764 consecutive patients diagnosed with HL or NHL between January 1970 and July 2001 was identified using the Sheffield Lymphoma Group database. A search was undertaken for all patients diagnosed with a subsequent primary malignancy. Two matched controls were identified for each case. Odds ratios were calculated to detect and quantify any risk factors in the cases compared to their matched controls. Mean follow-up for the cohort was 5.2 years. A total of 68 patients who developed second cancers at least 6 months after their primary diagnosis were identified, giving a crude incidence of 1.89% overall: 3.21% among the patients treated for HL, 1.32% in those treated for NHL. Most common were bronchial, breast, colorectal and haematological malignancies. High stage at diagnosis almost reached statistical significance in the analysis of just the NHL patients (odds ratio=3.48; P=0.068) after adjustment for other factors. Treatment modality was not statistically significant in any analysis. High stage at diagnosis of NHL may be a risk factor for developing a second primary cancer

Coping with a Crisis of Meaning: Televised Paranoia

Across all genres, television communicates a host of perceived dangers or risks to human survival as entertainment, responding and reproducing the victim and risk consciousness of the late twentieth and early twenty-first centuries. Terrorism has captured the imaginations of not only politicians but also producer/writers, and as a consequence of this, and the visual spectacle that war and terrorism provide, it has featured regularly and consistently in British and American television programming. This article presents the analysis of some British current affairs entertainment programming (film and documentary) broadcast by the BBC during the height of the misnamed ‘war on terror’. Through the analysis of these programmes, I will demonstrate a psycho-cultural approach to textual analysis informed by early object relations psychoanalysis. Being aware of the degree to which political elites have shaped what is known about the ‘war on terror’ allows us to apply knowledge of the political and historical context of these elites to understanding why the dominant ‘war on terror’ perspective is paranoid in character. I will offer an explanation of why a paranoid style predominates in terrorism related programming in my conclusion

Electives in undergraduate medical education: AMEE Guide No. 88

This Guide outlines the scope and potential roles an elective can contribute to undergraduate medical training and identifies ways to maximize learning opportunities, including within global health. The types of educational activity available for electives range from meeting individual educational need through to exploration of potential career pathways, with many factors influencing choice. Key areas of organization underpinning a successful elective before, during and after the placement include developing clarity of the intended educational outcomes as well as addressing practicalities such as travel and accommodation. Risk management including the implications for the participating schools as well as the student and their elective supervisors is crucial. This Guide would not be complete without some discussion around ethics and professional conduct during an elective, with consideration of the impact of elective placements, particularly in low-middle income countries

Communism and the Meaning of Social Memory: Towards a Critical-Interpretive Approach

This article was published in the journal, Integrative Psychological and Behavioral Science [© Springer Verlag] and the definitive version is available at: http://dx.doi.org/10.1007/s12124-012-9207-xUsing a case study of representations of communism in Romania, the paper offers a sketch of a critical-interpretive approach for exploring and engaging with the social memory of communism. When one considers the various contemporary appraisals, responses to and positions towards the communist period one identifies and one is obliged to deal with a series of personal and collective moral/political quandaries. In their attempt to bring about historical justice, political elites create a world that conforms more to their needs and desires than to the diversity of meanings of communism, experiences and dilemmas of lay people. This paper argues that one needs to study formal aspects of social memory as well as "lived", often conflicting, attitudinal and mnemonic stances and interpretive frameworks. One needs to strive to find the meaning of the social memory of communism in the sometimes contradictory, paradoxical attitudes and meanings that members of society communicate, endorse and debate. Many of the ethical quandaries and dilemmas of collective memory and recent history can be better understood by describing the discursive and sociocultural processes of meaning-making and meaning-interpretation carried out by members of a polity