Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient care

Misconceptions and ill-founded theories can arise in all areas of science. However, the apparent accessibility of many epidemiology findings and popular interest in the subject can lead to additional misunderstandings. The article below is the third in an occasional series of short editorials highlighting some current misinterpretations of epidemiological findings. Invited authors will be given wide scope in judging the prevalence of the misconception under discussion. We hope that this series will prove instructive to cancer researchers in other disciplines as well as to students of epidemiology. Adrian L Harris and Leo Kinle

Spontaneous recanalization of a completely occluded saphenous vein graft two months following acute myocardial infarction with persistent one year patency

Acute myocardial infarction resulting from saphenous vein graft occlusion occurs not infrequently in patients who have undergone coronary artery bypass graft surgery. In this case report, we present a novel case of spontaneous recanalization of a thrombotic graft occlusion in a patient who presented with a subacute myocardial infarction. The patient was treated medically with aspirin as the only anti-platelet agent. Interestingly, he presented 2 months later with new onset angina. Coronary angiography demonstrated complete resolution of thrombus but a severe focal stenosis in the distal anastomoses. Following drug eluting stent placement, a favorable clinical course has ensued and patency confirmed on follow up angiography at 1 year

A randomised controlled trial to evaluate and optimize the use of antiplatelet agents in the perioperative management in patients undergoing general and abdominal surgery- the APAP trial (ISRCTN45810007)

<p>Abstract</p> <p>Background</p> <p>Due to the increase of cardiovascular diseases acetylsalicylic acid (ASA) has become one of the most frequently prescribed drugs these days. Despite the rising number of patients with ASA medication presenting for elective general and abdominal surgery and the potentially increased risk of hemorrhage in these patients, there are no clear, evidence-based guidelines for the perioperative use of antiplatelet agents. The present randomised controlled trial was designed to evaluate the safety and optimize the use of ASA in the perioperative management of patients undergoing general and abdominal surgery.</p> <p>Methods/Design</p> <p>This is a two-arm, monocenter randomised controlled trial. Patients scheduled for elective surgical treatment (i.e. inguinal hernia repair, cholecystectomy and colorectal resections) with ASA as a permanent medication are randomised equally to perioperative continuation or discontinuation of ASA. Patients who are randomised in the discontinuation group stop the administration of ASA five days prior to surgical treatment and start intake of ASA on postoperative day 5. Fifty-two patients will be enrolled in this trial. The primary outcome is the incidence of postoperative bleeding and cardiovascular events at 30 days after surgery. In addition a set of general as well as surgical variables are analysed.</p> <p>Discussion</p> <p>This is a randomised controlled two-group parallel trial designed to assess the safety and optimize the use of ASA in the perioperative management of patients undergoing general and abdominal surgery. The results of this pilot study build the basis for a confirmative randomised controlled trial that may help to clarify the use and potential risk/benefits of perioperative ASA medication in patients undergoing elective surgery.</p> <p>Trial registration</p> <p>The trial is registered with Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN45810007">ISRCTN45810007</a>.</p

Coordinated ionospheric and magnetospheric observations from the ISIS 2 satellite by the ISIS 2 experimenters. Volume 1: Optical auroral images and related direct measurements

A representative set of data from ISIS 2 covering a range of operating modes and geophysical conditions is presented. The data show the typical values and range of ionospheric and magnetospheric characteristics, as viewed from 1400 km with the ISIS 2 instruments. The definition of each data set depends partly on geophysical parameters and partly on satellite operating mode. Preceding the data set is a description of the organizational parameters and a review of the objectives and general characteristics of the data set. The data are shown as a selection from 12 different data formats. Each data has a different selection of formats, but uniformity of a given format selection is preserved throughout each data set

Recent advances in cardiovascular medicines : thrombolytics

Thrombolytic therapy represents a major advance in reducing mortality following myocardial infarction. Pharmacists must be aware of the principles and problems of thrombolysis and the extant large studies conducted in hospitals and in the community. This article describes the various use and medicinal aspects of the various thrombolytic agents available on the market.peer-reviewe

A study of large, medium and small scale structures in the topside ionosphere

Alouette and ISIS data were studied for large, medium, and small scale structures in the ionosphere. Correlation was also sought with measurements by other satellites, such as the Atmosphere Explorer C and E and the Dynamic Explorer 2 satellites, of both neutrals and ionization, and with measurements by ground facilities, such as the incoherent scatter radars. Large scale coherent wavelike structures were found from ISIS 2 electron density contours from above the F peak to nearly the satellite altitude. Such structures were also found to correlate with the observation by AE-C below the F peak during a conjunction of the two satellites. Vertical wavefronts found in the upper F region suggest the dominance of diffusion along field lines as well. Also discovered were multiple, evenly spaced field-aligned ducts in the F region that, at low latitudes, extended to the other hemisphere and were in the form of field-aligned sheets in the east-west direction. Low latitude heating events were discovered that could serve as sources for waves in the ionosphere

The antiplatelet activity of Aspirin

The synthesis of aspirin in the late nineteenth century marked the development of what was to become the most widely used household analgesic in the twentieth century. However, with the increased understanding of the major role of platelets in vascular occlusion over the last ten years, the importance of aspirin as an antiplatelet drug and, consequently, its applications in reducing the risks of thrombotic vascular events, have received major attention.peer-reviewe

The Recent History of Platelets in Thrombosis and Other Disorders

The transcript of a Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2005. ©The Trustee of the Wellcome Trust, London, 2005. All volumes freely available following the links to publications and Wellcome Witnesses at www.ucl.ac.uk/histmed.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.Annotated and edited transcript of a Witness Seminar held on 25 November 2003. Introduction by Professor Tom Meade, London School of Hygiene and Tropical Medicine.The recent history of research on platelets and its applications in medicine started with the introduction of ex vivo methods for studying platelet behaviour. The Witness Seminar held on 25 November 2003, chaired by Professor Tom Meade, considered the detailed study of platelets starting with the recognition of their role in haemostasis, both in thrombotic and bleeding disorders . Professor Gustav Born described his research and the invention and development of the optical aggregometer that bears his name. Other topics included the biochemistry and function of platelets ; the platelet release reaction and the effect of aspirin on it ; the Nobel Prize-winning discovery by Sir John Vane of how aspirin inhibits the natural production of prostaglandins; and results of randomized controlled trials of aspirin and other thrombolytic drugs for the prevention of thrombotic conditions. An appendix includes a discussion of the streptokinase trials, 1986-96, from the unpublished Witness Seminar meeting on Thrombolysis held on 28 January 2003, chaired by Professor Brian Pentecost. Participants : Dr Y S [Mick] Bakhle, Sir Christopher Booth, Professor Donald Chambers, Professor John Dickinson, Professor Peter Elwood, Professor Rod Flower, Professor Alison Goodall, Professor John Hampton, Professor Michael Harrison, Professor Stan Heptinstall, Dr Peter Hunter, Dr Peter MacCallum, Dr Marty Mahaut-Smith, Professor Salvador Moncada, Professor Michael Oliver, Professor Clive Page, Professor Sir Stanley Peart, Professor Colin Prentice, Professor Peter Richardson, Dr Stewart Sage, and Dr Duncan Thomas; and from Thrombolysis, Dr Hewan Dewar, the late Sir Richard Doll, Professor John Hampton, Dr Arthur Hollman, Professor Desmond Julian, Dr Robin Norris, Professor Tom Quinn, Dr Roger Smith, and Professor Andrew Stevens. Reynolds L A, Tansey E M. (eds) (2005) The Recent history of platelets in thrombosis and other disorders, Wellcome Witnesses to Twentieth Century Medicine, vol. 23. London: The Wellcome Trust Centre for the History of Medicine at UCL.The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust,which is a registered charity, no. 210183

Targeting deprived areas within small areas in Scotland: population study

No abstract available