Will you lose more pounds at a bigger diet center?

NEW YORK (Reuters Health) - Weight loss loves company, hints new research.

For every additional 10 people signed up at a clinical center for a weight loss trial, the average person loses half a percent more weight, the study found.

Dr. Arne Astrup of the University of Copenhagen in Denmark and his colleagues delved into a database of 22 weight-loss centers across five countries, gathered in a previous large clinical trial.

Each center served between 4 and 85 men and women, and all of the more than 600 total participants were instructed to follow a nutritionally balanced diet of 800 to 1,000 calories a day. (Typical recommendations for non-dieters range from 1,600 to 2,400 calories per day, depending on gender, age, and level of activity.)

The average participant started the trial weighing 242 pounds, and lost 24 pounds (10 percent of their body weight) after 2 months on the low-calorie diet. Average weight loss among the centers ranged from 6 percent to 12 percent.

Taking into account age, initial body mass index (a measure of weight in relation to height) and sex, the researchers found that 10 more participants at a center translated into a modest half a percent climb in weight loss for the average person at that center. An average 200-pound woman, for example, would have dropped one extra pound over those 2 months.

The idea to investigate such a link came to the team of Danish and Belgian researchers after they noticed the relative performance of weight loss, or bariatric, surgeons. Those who have more experience, they write in the journal Obesity, tend to provide safer and more effective treatments.

Weight loss center size may reflect quality of care in a similar way, Astrup told Reuters Health by email. He noted that investigators, study coordinators and dieticians working at weight loss centers serving large numbers of participants would tend to be more experienced than those at smaller centers.While he notes that the study is "the first of its kind," Pedro Teixeira of the Technical University of Lisbon, in Portugal, is concerned that 2 months is too short to determine a diet's effectiveness.

Teixeira, who was not involved in the study, also suggests that other factors left unaccounted for could explain some of the differences seen across centers. In separate studies, he has identified a set of weight loss predictors, including self-motivation and realistic expectations.

The researchers, too, point to other possible explanations for their preliminary findings. A larger center may have a larger pool of subjects, for example, allowing them to recruit more highly motivated individuals than smaller centers.

Regardless, if an obese or overweight person seeking treatment is given the option, "larger centers with more patient flow are probably the best," advised Astrup. "Go for the big ones."

Source: Will you lose more pounds at a bigger diet center?

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Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 5

Future Research

Recommendations for further research:

• Primary evidence is needed, comparing the effectiveness of early versus delayed surgery, nonoperative versus operative interventions, and among the nonoperative treatment options. Future research examining the comparative effectiveness of open, mini-open, or arthroscopic approaches is also a priority, as arthroscopic procedures are more costly and technically difficult.


• All future studies should employ a comparison or control group and should ensure comparability of treatment groups, optimally through the use of randomization.


• Future research should seek to minimize bias by blinding outcome assessors, using validated and standardized outcome assessment instruments, and ensuring adequate allocation concealment (where applicable) and the appropriate handling and reporting of missing data.


• Studies examining the long-term effectiveness of treatments over the course of several years are needed; at the very least, studies should follow patients for a minimum of 12 months.


• To avoid numerous studies on disparate interventions, the interventions and comparisons chosen for study should be guided by consensus regarding the most promising and/or controversial interventions.


• To ensure consistency and comparability across future studies, consensus is needed on outcomes that are important to both clinicians and patients. Moreover, consensus on minimal clinically important differences is needed to guide study design and interpretation of results.


• To permit the appropriate interpretation of results, future research needs to be reported in a consistent and comprehensive manner.
  
  

Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears

Table of Contents

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

• Introduction


• Key Questions


• Methods


• Results


• Future Research


• Conclusions

        

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Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears Part 2

Key Questions

The following key questions (KQ) were investigated for a population of adult patients with partial- and full-thickness RC tears:

1. Does early surgical repair compared to late surgical repair (i.e., nonoperative intervention followed by surgery) lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
2. What is the comparative effectiveness of operative approaches (e.g., open surgery, mini-open surgery, and arthroscopy) and postoperative rehabilitation on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?

* Which operative approach should be used for different types of tears (e.g., partial-thickness or full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?

3. What is the comparative effectiveness of nonoperative interventions on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength? Nonoperative interventions include, but are not limited to, exercise, manual therapy, cortisone injections, acupuncture, and treatments and modalities typically delivered by physical therapists, osteopaths, and chiropractors.

* Which nonoperative treatment approach should be used for different types of tears (e.g., partial-thickness, full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?

4. Does operative repair compared with nonoperative treatment lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
5. What are the associated risks, adverse effects, and potential harms of nonoperative and operative therapies?
6. Which demographic (e.g., age, gender, ethnicity, comorbidities, workers’ compensation claims) and clinical (e.g., size/severity of tear, duration of injury, fatty infiltration of muscle) prognostic factors predict better outcomes following nonoperative and operative treatment?

* Which (if any) demographic and clinical factors account for potential differences in surgical outcomes between patients who undergo early versus delayed surgical treatment?

Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears

Table of Contents

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

• Introduction


• Key Questions


• Methods


• Results


• Future Research


• Conclusions

        

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Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

Introduction

The rotator cuff (RC) is comprised of four muscle-tendon units, which stabilize the humeral head within the shoulder joint and aid in powering the movement of the upper extremity.1 RC tears refer to a partial or full discontinuation of one or more of the muscles or tendons and may occur as a result of traumatic injury or degeneration over a period of years. The incidence of RC tears is related to increasing age; 54 percent of patients over the age of 60 years have a partial or complete RC tear compared with only 4 percent of adults under 40 years of age.2 Although not a life-threatening condition, RC tears may cause significant pain, weakness, and limitation of motion.1

Both nonoperative and operative treatments are used in an attempt to relieve pain and restore movement and function of the shoulder.3 The majority of patients first undergo 6 weeks to 3 months of nonoperative treatment, which may consist of any combination of pain management (medications and injections), rest from activity, passive and active exercise, and treatments with heat, cold or ultrasound. Failing nonoperative treatment, the cuff may be surgically repaired using an open, mini-open, or all-arthroscopic approach. A variety of postoperative rehabilitation programs are used to restore range of motion, muscle strength, and function following operative treatment.

Earlier operative treatment has been proposed to improve patient outcomes and result in an earlier return to work, and decreased costs;4,5 therefore, patients and clinicians face the difficult decision of when to forgo attempts at nonoperative treatment in favor of operative treatment. Moreover, the comparative effectiveness of the various nonoperative and operative treatment options for patients with RC tears remains uncertain.
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears

Table of Contents

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

• Introduction


• Key Questions


• Methods


• Results


• Future Research


• Conclusions

        

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New Targeted Therapy Effective in Treating Advanced Prostate Cancer

An experimental drug is showing promise for the treatment of men with an aggressive form of advanced prostate cancer. A new multicenter study has concluded that the targeted therapy MDV3100 is safe and effective for patients with castration-resistant prostate cancer (CRPC), known for its poor prognosis and limited treatment options. The research, led by investigators at Memorial Sloan-Kettering Cancer Center, appears early online and in an upcoming edition of The Lancet.

According to the findings of the Phase 1-2 study, MDV3100 not only shrank patients' tumors, but also reduced serum levels of the tumor marker prostate-specific antigen (PSA), stabilized disease that had spread to soft tissues and the bone, and reduced the number of circulating tumor cells in the blood.

"We were encouraged to see antitumor activity in men whose disease had spread to other parts of the body after either becoming resistant to previous hormone treatments or progressing following chemotherapy," said the study's lead author Howard Scher, MD, Chief of the Genitourinary Oncology Service at Memorial Sloan-Kettering. "These findings strengthen the drug's potential to change the outlook for a group of patients who currently have limited effective treatment options from which to choose."

According to the research, MDV3100 slows tumor growth and induces tumor cells to die in men with CRPC, or hormone-refractory disease, which depends on male hormones to grow, but is unresponsive or becomes resistant to standard therapies used to lower or block those hormones. MDV3100 works by blocking testosterone from binding to the androgen (male hormone) receptor, stopping the movement of the androgen receptor to the nucleus of prostate cancer cells, preventing the receptor from binding to DNA, and inducing cancer cell death, even when the expression of the androgen receptor is elevated.

"This study validates what our preclinical studies have suggested: that sustained androgen receptor signaling drives CRPC and that a substantial number of CRPC tumors that progress despite multiple hormone and chemotherapy treatments remain dependent on androgen receptor signaling for growth," said study co-author, Charles Sawyers, MD, Chair of Memorial Sloan-Kettering's Human Oncology and Pathogenesis Program and a Howard Hughes Medical Institute investigator.

The drug was co-invented by Dr. Sawyers and Michael Jung, PhD, Professor of Chemistry at the University of California, Los Angeles. Their research originally demonstrated that CRPC cells have increased expression of the androgen receptor and that elevated expression of this receptor may contribute to disease progression due to a developed resistance to hormone treatment. Their collaboration led to the discovery of a number of nonsteroidal, small molecule antiandrogen compounds, including MDV3100.

In the current study, 140 patients were treated with doses of MDV3100 ranging from 30 to 600 mg daily. PET imaging, bones scans, and blood tests were used to assess the antitumor effects of the drug, which were observed at all dosages. Investigators reported declines in PSA of at least 50 percent in more than half of the patients and tumor regressions in 22 percent of the patients. Overall, two-thirds of patients had partial remissions or stable disease in tumors that had spread to soft tissue or bone.

The findings also showed that the number of circulating tumor cells fell in 49 percent of patients, and 91 percent of patients who initiated therapy with favorable counts retained favorable counts during treatment. This is important because previous research shows that changes in circulating tumor cell counts after treatment were more predictive of survival than were changes in PSA, with favorable post-treatment counts associated with a 21-month median survival.

The drug was generally well tolerated, with nausea, constipation, diarrhea, and anorexia being the most common mild side effects reported. The most frequently reported Grade 3 side effect at higher doses was fatigue. The researchers determined that the maximum tolerated dose for sustained treatment was 240 mg daily.

Based on the positive results of the current study, a multinational randomized Phase 3 clinical trial has begun to examine MDV3100 versus a placebo for the treatment of men with advanced prostate cancer who were previously treated with chemotherapy. Information about patient eligibility and enrollment can be obtained by visiting www. affirmtrial .com or by calling the AFFIRM study's toll free hotline at 888-782-3256.

The research was supported by Medivation; the Prostate Cancer Foundation, the National Cancer Institute, the Howard Hughes Medical Institute, and the Department of Defense Prostate Cancer Research Program Clinical Consortium (which includes Memorial Sloan-Kettering, the Oregon Health and Science University Knight Cancer Institute, The University of Washington, the Dana-Farber Cancer Institute, and M. D. Anderson Cancer Center).         

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