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Nathan Goodyear

Guidelines have done more harm than good. [Blood Purif. 2008] - PubMed result - 0 views

www.ncbi.nlm.nih.gov/...18182801

medical practice medicine guidelines standard of care

shared by Nathan Goodyear on 12 May 11 - No Cached
  • Guidelines certainly do not encourage clinicians to consider and treat each patient as an individual
  • This all but guarantees many guidelines are obsolete by the time they are published
  • unlikely to stimulate original research
  • ...2 more annotations...
  • reated by a process that is artificial, laborious and cumbersome
  • uidelines are produced with industry support and recommendations often have a major impact on sales of industry products
  • Nathan Goodyear on 12 May 11
     
    Medical guidelines likely do more harm than good
Nathan Goodyear

Frequency and level of evidence used in recommendations by the National Comprehensive C... - 0 views

www.bmj.com/bmj.k668

cancer cancer guidelines recommendations

shared by Nathan Goodyear on 14 Mar 18 - No Cached
  • Nathan Goodyear on 14 Mar 18
     
    Just the facts: US National Comprehensive Cancer Network (NCCN) recommendations often lack evidence, but financial ties of the NCCN members that create the guidelines do not. I think it is time to start calling out the lack of evdience of some of the so-called creators of evidence-based guidelines.
Nathan Goodyear

Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Stat... - 0 views

press.endocrine.org/...jc.2014-1413

hyperparathyroidism hormones

shared by Nathan Goodyear on 06 Dec 16 - No Cached
  • Nathan Goodyear on 06 Dec 16
     
    not that guidelines are the only route, but it is always useful to know them.  This is the latest guidelines on the management of Hyperparathyroidism.
Nathan Goodyear

Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guidel... - 0 views

press.endocrine.org/...jc.2014-2260

T Testosterone women therapy hormone hormones

shared by Nathan Goodyear on 07 Oct 14 - No Cached
  • Nathan Goodyear on 07 Oct 14
     
    data on androgen therapy in women is sparse at best.  The conclusion here is suspect: "evidence supports the short-term efficacy and safety of high physiological doses of T" for women with with hypoactive sexual desire, yet the same authors recommend against long-term therapy.  How do those 2 go together???  They don't.  Support with physiologic Testosterone when appropriate testing reveals low T and symptoms support the same.  This is a practice guideline that lacks evidence to strongly back it up because so little evidence exists.  Practice guidelines are for lazy physicians.
Nathan Goodyear

Guideline for Male Testosterone Therapy: A Clinician's Perspective -- Morgentaler 92 (2... - 0 views

jcem.endojournals.org/...416

male testosterone therapy

shared by Nathan Goodyear on 01 Mar 11 - No Cached
  • Guideline for Male Testosterone Therapy: A Clinician’s Perspective
  • Nathan Goodyear on 01 Mar 11
     
    Guideline for Male Testosterone Therapy: A Clinician's Perspective; minus the blood testing for testosterone evaluation, very good review article
Nathan Goodyear

Testosterone deficiency: Practical guidelines for diagnosis and treatment | BC Medical ... - 0 views

www.bcmj.org/...elines-diagnosis-and-treatment

low T low Testosterone hypogonadism men male hormone hormones

shared by Nathan Goodyear on 12 Aug 14 - No Cached
  • Nathan Goodyear on 12 Aug 14
     
    I am not a fan of guideline medicine, but this review of the literature on low T is worth while.
Nathan Goodyear

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Cl... - 0 views

jcem.endojournals.org/...2536.full

testosterone therapy deficiency low T androgen

shared by Nathan Goodyear on 31 Jan 12 - No Cached
  • Nathan Goodyear on 31 Jan 12
     
    androgen deficiency and guidelines for Testosterone therapy.  Nice review of statistics and symptoms.  Many symptoms of low T go unrecognized.
Nathan Goodyear

Use, misuse and abuse of androgens. The Endocrine... [Med J Aust. 2000] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...10776394

androgen androgens endocrine society australia guidelines testosterone therapy replacement BHRT HRT men

shared by Nathan Goodyear on 12 Feb 12 - No Cached
  • Nathan Goodyear on 12 Feb 12
     
    Endocrine society of australia guidelines for androgen therapy.
Nathan Goodyear

Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Cli... - 0 views

jcem.endojournals.org/...1911.abstract

vitamin vitamin d deficiency

shared by Nathan Goodyear on 10 Sep 11 - No Cached
  • Nathan Goodyear on 10 Sep 11
     
    the Endocrine Society clinical practice guideline to not screen for vitamin D deficiency, proves that this organization cannot be looked to for reliable analysis of scientific data
Nathan Goodyear

Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH... - 0 views

www.ncbi.nlm.nih.gov/...PMC6482353

cancer anemia

shared by Nathan Goodyear on 08 Jun 19 - No Cached
  • Nathan Goodyear on 08 Jun 19
     
    New "guidelines" for management of anemia in cancer.
Nathan Goodyear

Diagnostic Potential of Saliva: Current State and Future Applications - 0 views

www.clinchem.org/...675.full

saliva salivary hormone hormones evaluation testing analysis

shared by Nathan Goodyear on 30 May 12 - No Cached
  • Nathan Goodyear on 30 May 12
     
    saliva testing is the new "gold standard" for hormone evaluation.  No testing method is perfect and thus there are guidelines for salivary collections.  However, saliva is equal too or superior to blood for hormone evaluation.
Nathan Goodyear

The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline - 0 views

jcem.endojournals.org/...1526.long

cortisol saliva salivary hormone hormones test testing evaluation Cushing's syndrome practice guidelines

shared by Nathan Goodyear on 07 Feb 12 - No Cached
  • late night salivary cortiso
  • high diagnostic accuracy
  • Nathan Goodyear on 07 Feb 12
     
    salivary cortisol testing recommended as first-line test for Cushing's syndrome due to "high diagnostic accuracy".  So, I wonder why so many state medical boards and insurance companies have missed this one?
Nathan Goodyear

US lowers cutoff for lead poisoning in young kids | Fox News - 0 views

www.foxnews.com/...r-lead-poisoning-in-young-kids

lead toxicity poisoning children

shared by Nathan Goodyear on 16 May 12 - No Cached
  • Nathan Goodyear on 16 May 12
     
    new CDC guidelines lower lead toxicity levels in children.  CDC: " there is no safe level of blood lead in children".  If no level is safe in children, what about other age groups?
Nathan Goodyear

https://www.endocrine.org/~/media/endosociety/Files/Publications/Clinical%20Practice%20... - 0 views

www.endocrine.org/...-Practice-Guideline-NonCME.pdf

HGH GH human growth hormone growth hormone

shared by Nathan Goodyear on 04 Nov 14 - No Cached
  • Nathan Goodyear on 04 Nov 14
     
    Current recommendations on HGH origin, evaluation, and therapy.
Nathan Goodyear

Best practice in the treatment of nonmuscle invasive bladder cancer - 0 views

www.ncbi.nlm.nih.gov/...PMC3263923

bladder cancer bladder cancer

shared by Nathan Goodyear on 05 Jan 15 - No Cached
  • Nathan Goodyear on 05 Jan 15
     
    2 year old "best practice" guidelines for bladder cancer.
ajaykumarind091

Coleus Forskolii Manufacturers -commonly known as Indian Coleus - 0 views

www.starhiherbs.com/coleus-forshkolii-extract.html

shared by ajaykumarind091 on 16 Aug 14 - No Cached
  • ajaykumarind091 on 16 Aug 14
     
    Star Hi Herbs Pvt Ltd. With 10 years dynamic experience have developed Coleus Forskolii Manufacturers inconsistent quality products as per gmp and cgmp Guidelines. Our company is a product-development and marketing company. We are manufacturers of standardized herbal extracts of natural products, neutraceuticals, phytochemicals, oleoresins cosmetics etc.
Nathan Goodyear

Evolving landscape of human epidermal growth factor receptor 2-positive breast cancer t... - 0 views

www.sciencedirect.com/...S0960977617300103

HER-2 breast cancer cancer herceptin Perjeta

shared by Nathan Goodyear on 06 Aug 18 - No Cached
  • 15%–20%
  • key mediator of cell growth, differentiation, and survival
  • of higher histological grade and are more likely to invade axillary lymph nodes
  • ...15 more annotations...
  • shortened survival and an increased risk of disease recurrence and metastasis
  • Currently, four HER2-directed agents are approved for the treatment of patients with HER2+ breast cancer: trastuzumab, pertuzumab, lapatinib, and ado-trastuzumab emtansine (T-DM1)
  • biosimilars
  • trastuzumab may provide greater benefit when administered concurrently with chemotherapy rather than after, and this has become the standard approach
  • concurrent use of anthracyclines (ie, doxorubicin or epirubicin) and trastuzumab is not recommended because of an increased risk for cardiac toxicity
    • Nathan Goodyear
      Nathan Goodyear on 06 Aug 18
       
      avoid herceptin in conjuction with antracyclines i.e. doxorubicin
  • Sequential doxorubicin plus cyclophosphamide followed by concomitant paclitaxel or docetaxel and trastuzumab is recommended for most patients
    • Nathan Goodyear
      Nathan Goodyear on 06 Aug 18
       
      top recommended regimen combination
  • Guidelines also recommend trastuzumab in combination with paclitaxel, docetaxel and carboplatin, or docetaxel and cyclophosphamide, particularly for patients with increased risk for cardiac toxicity or those with small (≤1 cm), node-negative HER2+ tumors
    • Nathan Goodyear
      Nathan Goodyear on 06 Aug 18
       
      good alternative in patients with increased risk of cardiac toxicity.
  • guidelines recommend up to 1 year of adjuvant trastuzumab
  • Neoadjuvant chemotherapy with trastuzumab is associated with higher rates of pathologic complete response (pCR) than chemotherapy alone or in combination with lapatinib
  • the combination of trastuzumab, lapatinib, and chemotherapy is not recommended because it failed to demonstrate noninferiority versus trastuzumab and chemotherapy in the adjuvant setting
  • recommend the combination of trastuzumab, pertuzumab, and chemotherapy as neoadjuvant treatment for patients with locally advanced HER2+ breast cancer and for some patients (node-positive or tumor ≥2 cm) with early-stage disease
  • neoadjuvant chemotherapy in combination with pertuzumab and trastuzumab reduced the risk of progression or death by 31% and recurrence or death by 40% versus trastuzumab alone
  • Concurrent chemotherapy and HER2-directed therapy improves survival outcomes over chemotherapy alon
  • dual inhibition of HER2 with trastuzumab and pertuzumab in combination with paclitaxel reduced the risk of death or progression by approximately 40% compared with concurrent trastuzumab and paclitaxel
  • the combination of trastuzumab, pertuzumab, and taxane chemotherapy is the preferred first-line regimen
  • Nathan Goodyear on 06 Aug 18
     
    HER-2 + breast cancer = appx 15-20% of all breast cancers and is a marker of worse prognosis and an indication for targeted immunotherapy blockade.
Nathan Goodyear

https://www.austinozone.com/wp-content/uploads/Dr.-Renate-Viebahn-Guidelines-OSE-1212-p... - 0 views

www.austinozone.com/...delines-OSE-1212-published.pdf

ozone

shared by Nathan Goodyear on 31 Jul 18 - No Cached
  • Nathan Goodyear on 31 Jul 18
     
    ozone
Nathan Goodyear

Platelet Transfusion: A Clinical Practice Guideline From the AABB | Annals of Internal ... - 0 views

annals.org/...l-practice-guideline-from-aabb

platelets

shared by Nathan Goodyear on 10 Jan 19 - No Cached
  • Nathan Goodyear on 10 Jan 19
     
    Platelets and "recommended" indications for transfusion.
Nathan Goodyear

Late Disseminated Lyme Disease: Associated Pathology and Spirochete Persistence Post-Tr... - 0 views

ajp.amjpathol.org/...fulltext

Lyme Lyme disease borrelia burgdorferi

shared by Nathan Goodyear on 14 Dec 17 - No Cached
  • In this study, we have demonstrated microscopic pathology ranging from minimal to moderate in multiple different tissues previously reported to be involved with LD, including the nervous system (central and peripheral), heart, skeletal muscle, joint-associated tissues, and urinary bladder 12 to 13 months following tick-inoculation of rhesus macaques by Bb strain B31
  • Based on histomorphology, inflammation consisted predominantly of lymphocytes and plasma cells, with rare scattered histiocytes
  • in rare instances, morphologically intact spirochetes were observed in inflamed brain and heart tissue sections from doxycycline-treated animals
  • ...41 more annotations...
  • colocalization of the Bb 23S rRNA probe was not observed in any of the sections of experimental inoculated animals shown to harbor rare persistent spirochetes (Supplemental Figure S1). Previous in vitro work has shown large decreases in Bb rRNA levels when in a stationary phase of growth despite the majority of spirochetes remaining viable
  • The possibility that the spirochetes were intact but dead also exists, though this may be unlikely given the precedence for viable but non-cultivable B. burgdorferi post-treatment
  • The doxycycline dose utilized in this study (5mg/kg) was based on a previous pharmacokinetic analysis of oral doxycycline in rhesus macaques proven to be comparable to levels achieved in humans and was meant to mimic treatment of disseminated LD
  • In addition to the brain of two treated animals, rare morphologically intact spirochetes immunoreactive to OspA were observed in the heart of one treated animal
  • Although we did not measure the doxycycline levels in the cerebrospinal fluid, they have been found to be 12% to 15% of the amount measured in serum
  • We and others have demonstrated the development of a drug-tolerant persister population when B. burgdorferi are treated with antibiotics in vitro
  • The adoption of a dormant or slow-growing phenotype likely allows the spirochetes to survive and re-grow following removal of antibiotic
  • The basic premise that antibiotic tolerance may be an adaptation of the sophisticated stringent response required for the enzootic cycle by the spirochetes is described in a recent review as well
  • Although current IDSA guidelines recommend intravenous ceftriaxone (2g daily for 30 days) over oral doxycycline for treatment of neuroborreliosis, a randomized clinical trial failed to show any enhanced efficacy of I.V. penicillin G to oral doxycycline for treatment of Lyme neuroborreliosis (no treatment failures were reported in this study of 54 patients).
  • we can speculate that the minimal to moderate inflammation that was observed, especially within the CNS and PNS can, in part, explain the breadth of symptoms experienced by late stage Lyme disease patients, such as cognitive impairment and neuralgia.
  • Erythema migrans, the clinical hallmark of early localized Lyme disease, was observed in one of the rhesus macaques from this study.
  • In 2014, a trailblazing study in mice demonstrated a dramatic decline in B. burgdorferi DNA in the tissues for up to eight months after antibiotic treatment followed by the resurgence of B. burgdorferi growth 12 months after treatment
  • This study provides evidence that the slow-growing spirochetes which persist after treatment, but are not cultivable in standard growth media may remain viable.
  • The first well-documented indication of Lyme disease (LD) in the United States occurred in the early 1970s
  • Lyme, Connecticut.
  • Lyme disease is now known to be caused by multiple closely related genospecies classified within the Bb sensu lato complex, representing the most common tick-borne human disease in the Northern Hemisphere
  • approximately 30,000 physician-reported cases occur annually in the United States, the annual incidence has been estimated to be 10-fold higher by the Centers for Disease Control and Prevention.6
  • Current antibiotic therapy guidelines outlined by the Infectious Disease Society of America (IDSA) are successful in the treatment of LD for the majority of LD patients, especially when administered early in disease immediately following identification of erythema migrans (EM)
  • ‘post-treatment Lyme disease syndrome’ (PTLDS)
  • host-adapted spirochetes that persist in the tissues, probably in small numbers, inaccessible or impervious to antibiotic
  • inflammatory responses to residual antigens from dead organisms
  • residual tissue damage following pathogen clearance;
  • autoimmune responses, possibly elicited by antigenic mimicry
  • Experimental studies on immunocompetent mice, dogs, and rhesus macaques have provided evidence for the persistence of Bb spirochetes subsequent to antibiotic treatment in the form of residual spirochetes detected within tissue by IFA and PCR, and recovered by xenodiagnoses
  • Ten male rhesus macaques
  • half (five) of the NHP received antibiotic treatment, consisting of 5 mg/kg oral doxycycline twice per day.
  • Minimal and focal lymphoplasmacytic inflammation
  • inflammation was observed in the leptomeninges overlying a section of temporal cerebral cortex
  • Minimal localized lymphoplasmacytic choroiditis
  • Peripheral nerves contained minimal to moderate lymphoplasmacytic inflammation with a predilection for collagen-rich epineurium and perivascular spaces
  • Inflammation was observed in 56% (5/9) of the NHPs irrespective of treatment group
  • For all animals, inflammation was reserved to perineural tissue
  • The treatment lasted 28 days
  • Minimal to mild lymphoplasmacytic inflammation of either the myocardial interstitium (Figure 2Figure 2A), pericardium (Figure 2Figure 2B), or combination therein was observed in 60% of NHPs
  • A single morphologically intact spirochete, as indicated by positive red immunofluorescence (Figure 2Figure 2C), was observed in the myocardium of one treated animal
  • mild, multifocal lymphoplasmacytic inflammation was observed in one doxycycline-treated animal
  • three animals exhibited minimal to mild lymphoplasmacytic inflammation affecting joint-associated structures
  • 10% to -20% of human patients treated
  • Multiple randomized placebo-controlled studies which evaluated sustained antimicrobial therapy concluded that there is no benefit in alleviating patients’ symptoms and indicated that long-term antibiotic therapy may even be detrimental to patients due to potential associated complications (ie, catheter infection and/or clostridial colitis)
  • and the rapid clearance of dead spirochetes in a murine model
  • higher doses may be needed to combat neuroborreliosis
  • Nathan Goodyear on 14 Dec 17
     
    persistent borrelia burgdorferia were found in the brain (2) and the heart (1) up to 13 months post standard antibiotic treatment suggesting borrelia burdorferia, the cause of Lyme, can persist in a chronic, persistant state poste acute treatment.
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