Reforming the cancer drug fund focus on drugs that might be shown to be cost effective

The Cancer Drug Fund was originally conceived as a temporary measure, until value based pricing for drugs was introduced, to give NHS cancer patients access to drugs not approved by NICE. Spending on these drugs rose from less than the £50m (€63m; $79m) budgeted for the first year in 2010-11 to well over £200m in 2013-14, and the budget for the scheme—now extended for a further two years—will reach £280m by 2016.1 The recent changes to the fund recognise the impossibility, within any sensible budget limit, of providing all the new cancer drugs that offer possible benefit to patients. More radical changes are needed to the working of the fund, given the failure to introduce value based pricing, so that it deals with the underlying problem of inadequate information on the effectiveness and cost effectiveness of new cancer drugs when used in the NHS

A Proton Magnetic Resonance Study of the Association of Lysozyme with Monosaccharide Inhibitors

It has been shown that the acetamido methyl protons of N-acetyl-d-glucosamine undergo a chemical shift to higher fields in their proton magnetic resonance spectrum when the inhibitor is bound to lysozyme. The observed chemical shift in the presence of the enzyme is different for the agr- and ß-anomeric forms of 2-acetamido-2-deoxy-d-glucopyranose indicating either a difference in the affinity of the anomeric forms for lysozyme or different magnetic environments for the methyl protons in their enzyme-bound state. That the agr- and ß-anomeric forms of GlcAc bind to lysozyme in a competitive fashion was indicated by observing the proton magnetic resonance spectra in the presence of 2-acetamido-d3-2-deoxy-agr-d-glucopyranose. The methyl glycosides, methyl-agr-GlcAc and methyl-ß-GlcAc, were also shown to bind competitively with both anomers of GlcAc. Quantitative analysis of the chemical shift data observed for the association of GlcAc with lysozyme was complicated by the mutarotation of GlcAc between its agr- and ß-anomeric forms. However, in the case of the methyl glucosides, where the conformation of each anomer is frozen, it was possible to analyze the chemical shift data in a straightforward manner, and the dissociation constant as well as the chemical shift of the acetamido methyl protons of the enzyme-inhibitor complex was determined for both anomers. The results indicate that the two anomers of methyl-GlcAc bind to lysozyme with slightly different affinities but that the acetamido methyl groups of both anomers experience identical magnetic environments in the enzyme-inhibitor complex

Sport concussion assessment tool—fifth edition normative reference values for professional rugby union players

Objective: To describe distributions and establish normative ranges for new or changed subcomponents of the Sports Concussion Assessment Tool (SCAT)-5. Design: Cross-sectional study. Setting and Participants: Professional Rugby Union players performing 2017 preseason baseline SCAT-5 testing. Independent Variables: Subcomponent tests newly introduced or changed in the SCAT-5. Main Measurements: The 10-word immediate and delayed recall tests and the rapid neurological screen. Results: Thousand two hundred three players were included in complete case analyses. The 10-word immediate recall test [median score 15, interquartile range (IQR) 15-22, range 3-30] showed an asymmetrical, bimodal distribution. The delayed recall test (median score 7, IQR 5-9, range 0-10) demonstrated a left skewed distribution. The diplopia and reading/following instruction tests of the neurological screen were performed normally by virtually all participants (98.5% and 99.6%, respectively). Normative classification ranges for each SCAT-5 subcomponents of interest were determined. Conclusions: The increased spread of scores, with improved midrange centering, suggests that the increase to 10-word list lengths should improve the performance of immediate and delayed recall tests. Normative ranges will provide a distribution against which postinjury SCAT-5 scores can be compared and interpreted

Molecular confirmation of Sarcocystis fayeri in a donkey

Sarcocystis fayeri is a canine protozoan parasite with an equine intermediate host. Historically classified as an incidental pathogen, recent literature has described the toxic effects of Sarcocystis fayeri in human food poisoning, and highlighted potential involvement in equine neuromuscular disease. Until now, horses were believed to be the exclusive intermediate host. This study reports the first molecular confirmation of S. fayeri in a donkey, and gives rise to the consideration of donkeys being a potential reservoir for the parasite. This finding is of particular importance in understanding the epidemiology of this disease

Disease activity and cognition in rheumatoid arthritis : an open label pilot study

Acknowledgements This work was supported in part by NIHR Newcastle Biomedical Research Centre. Funding for this study was provided by Abbott Laboratories. Abbott Laboratories were not involved in study design; in the collection, analysis and interpretation of data; or in the writing of the report.Peer reviewedPublisher PD

Rugby World Cup 2019 injury surveillance study

Background: Full contact team sports, such as rugby union, have high incidences of injury. Injury surveillance studies underpin player welfare programmes in rugby union.Objective: To determine the incidence, severity, nature and causes of injuries sustained during the Rugby World Cup 2019.Methods: A prospective, whole population study following the definitions and procedures recommended in the consensus statement for epidemiologic studies in rugby union. Output measures included players’ age (years), stature (cm), body mass (kg), playing position, and group-level incidence (injuries/1000 player-hours), severity (days-absence), injury burden (days absence/1000 player-hours), location (%), type (%) and inciting event (%) of injuries.Results: Overall incidences of injury were 79.4 match injuries/1000 player-match-hours (95% CI: 67.4 to 93.6) and 1.5 training injuries/1000 player-training-hours (95% CI: 1.0 to 2.3). The overall mean severity of injury was 28.9 (95% CI: 20.0 to 37.8) days absence during matches and 14.8 (95% CI: 4.1 to 25.5) days absence during training. The most common locations and types of match injuries were head/face (22.4%), posterior thigh (12.6%), ligament sprain (21.7%) and muscle strain (20.3%); the ankle (24.0%), posterior thigh (16.0%), muscle strain (44.0%) and ligament sprain (16.0%) were the most common locations and types of injuries during training. Tackling (28.7%), collisions (16.9%) and running (16.9%) were responsible for most match injuries and non-contact (36.0%) and contact (32.0%) rugby skills activities for training injuries.Conclusion: The incidence, severity, nature and inciting events associated with match and training injuries at Rugby World Cup 2019 were similar to those reported for Rugby World Cups 2007, 2011 and 2015. Keywords: Rugby World Cup, injury incidence, injury severity, injury burden, injury ris