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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

Testosterone and glucose metabolism in men: current concepts and controversies - 0 views

joe.endocrinology-journals.org/...R37.full

Low T Testosterone metabolic syndrome MetS Diabetes men male glucose hormone hormones g

shared by Nathan Goodyear on 04 Feb 14 - No Cached
  • Around 50% of ageing, obese men presenting to the diabetes clinic have lowered testosterone levels relative to reference ranges based on healthy young men
  • The absence of high-level evidence in this area is illustrated by the Endocrine Society testosterone therapy in men with androgen deficiency clinical practice guidelines (Bhasin et al. 2010), which are appropriate for, but not specific to men with metabolic disorders. All 32 recommendations made in these guidelines are based on either very low or low quality evidence.
  • A key concept relates to making a distinction between replacement and pharmacological testosterone therapy
  • ...59 more annotations...
  • The presence of symptoms was more closely linked to increasing age than to testosterone levels
  • Findings similar to type 2 diabetes were reported for men with the metabolic syndrome, which were associated with reductions in total testosterone of −2.2 nmol/l (95% CI −2.41 to 1.94) and in free testosterone
  • low testosterone is more predictive of the metabolic syndrome in lean men
  • Cross-sectional studies uniformly show that 30–50% of men with type 2 diabetes have lowered circulating testosterone levels, relative to references based on healthy young men
  • In a recent cross-sectional study of 240 middle-aged men (mean age 54 years) with either type 2 diabetes, type 1 diabetes or without diabetes (Ng Tang Fui et al. 2013b), increasing BMI and age were dominant drivers of low total and free testosterone respectively.
  • both diabetes and the metabolic syndrome are associated with a modest reduction in testosterone, in magnitude comparable with the effect of 10 years of ageing
  • In a cross-sectional study of 490 men with type 2 diabetes, there was a strong independent association of low testosterone with anaemia
  • In men, low testosterone is a marker of poor health, and may improve our ability to predict risk
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      probably the most important point made in this article
  • low testosterone identifies men with an adverse metabolic phenotype
  • Diabetic men with low testosterone are significantly more likely to be obese or insulin resistant
  • increased inflammation, evidenced by higher CRP levels
  • Bioavailable but not free testosterone was independently predictive of mortality
  • It remains possible that low testosterone is a consequence of insulin resistance, or simply a biomarker, co-existing because of in-common risk factors.
  • In prospective studies, reviewed in detail elsewhere (Grossmann et al. 2010) the inverse association of low testosterone with metabolic syndrome or diabetes is less consistent for free testosterone compared with total testosterone
  • In a study from the Framingham cohort, SHBG but not testosterone was prospectively and independently associated with incident metabolic syndrome
  • low SHBG (Ding et al. 2009) but not testosterone (Haring et al. 2013) with an increased risk of future diabetes
  • In cross-sectional studies of men with (Grossmann et al. 2008) and without (Bonnet et al. 2013) diabetes, SHBG but not testosterone was inversely associated with worse glycaemic control
  • SHBG may have biological actions beyond serving as a carrier protein for and regulator of circulating sex steroids
  • In men with diabetes, free testosterone, if measured by gold standard equilibrium dialysis (Dhindsa et al. 2004), is reduced
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      expensive, laborious process filled with variables
  • Low free testosterone remains inversely associated with insulin resistance, independent of SHBG (Grossmann et al. 2008). This suggests that the low testosterone–dysglycaemia association is not solely a consequence of low SHBG.
  • Experimental evidence reviewed below suggests that visceral adipose tissue is an important intermediate (rather than a confounder) in the inverse association of testosterone with insulin resistance and metabolic disorders.
  • testosterone promotes the commitment of pluripotent stem cells into the myogenic lineage and inhibits their differentiation into adipocytes
  • testosterone regulates the metabolic functions of mature adipocytes (Xu et al. 1991, Marin et al. 1995) and myocytes (Pitteloud et al. 2005) in ways that reduce insulin resistance.
  • Pre-clinical evidence (reviewed in Rao et al. (2013)) suggests that at the cellular level, testosterone may improve glucose metabolism by modulating the expression of the glucose-transported Glut4 and the insulin receptor, as well as by regulating key enzymes involved in glycolysis.
  • More recently testosterone has been shown to protect murine pancreatic β cells against glucotoxicity-induced apoptosis
  • Interestingly, a reciprocal feedback also appears to exist, given that not only chronic (Cameron et al. 1990, Allan 2013) but also, as shown more recently (Iranmanesh et al. 2012, Caronia et al. 2013), acute hyperglycaemia can lower testosterone levels.
  • There is also evidence that testosterone regulates insulin sensitivity directly and acutely
  • In men with prostate cancer commencing androgen deprivation therapy, both total as well as, although not in all studies (Smith 2004), visceral fat mass increases (Hamilton et al. 2011) within 3 months
  • More prolonged (>12 months) androgen deprivation therapy has been associated with increased risk of diabetes in several large observational registry studies
  • Testosterone has also been shown to reduce the concentration of pro-inflammatory cytokines in some, but not all studies, reviewed recently in Kelly & Jones (2013). It is not know whether this effect is independent of testosterone-induced changes in body composition.
  • the observations discussed in this section suggest that it is the decrease in testosterone that causes insulin resistance and diabetes. One important caveat remains: the strongest evidence that low testosterone is the cause rather than consequence of insulin resistance comes from men with prostate cancer (Grossmann & Zajac 2011a) or biochemical castration, and from mice lacking the androgen receptor.
  • Several large prospective studies have shown that weight gain or development of type 2 diabetes is major drivers of the age-related decline in testosterone levels
  • there is increasing evidence that healthy ageing by itself is generally not associated with marked reductions in testosterone
  • Circulating testosterone, on an average 30%, is lower in obese compared with lean men
  • increased visceral fat is an important component in the association of low testosterone and insulin resistance
  • The vast majority of men with metabolic disorders have functional gonadal axis suppression with modest reductions in testosterone levels
  • obesity is a dominant risk factor
  • men with Klinefelter syndrome have an increased risk of metabolic disorders. Interestingly, greater body fat mass is already present before puberty
  • Only 5% of men with type 2 diabetes have elevated LH levels
  • inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion from GNRH neurons situated in the preoptic area
  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • suppression of the diabesity-associated HPT axis is functional, and may hence be reversible
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Modifiable risk factors such as obesity and co-morbidities are more strongly associated with a decline in circulating testosterone levels than age alone
  • 55% of symptomatic androgen deficiency reverted to a normal testosterone or an asymptomatic state after 8-year follow-up, suggesting that androgen deficiency is not a stable state
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • Leptin treatment resolves hypogonadism in leptin-deficient men
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • change in BMI was associated with the change in testosterone (Corona et al. 2013a,b).
  • weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in men who improved their glycaemic control over time, testosterone levels increased. By contrast, in those men in whom glycaemic control worsened, testosterone decreased
  • testosterone levels should be measured after successful weight loss to identify men with an insufficient rise in their testosterone levels. Such men may have HPT axis pathology unrelated to their obesity, which will require appropriate evaluation and management.
  • Nathan Goodyear on 04 Feb 14
     
    Article discusses the expanding evidence of low T and Metabolic syndrome.
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.
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