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Biomedical subjects

Peter Fisher

Publications and source records attributed to Peter Fisher.

At least 19 recordsLinked to original sources
PubMed2006

Reporting data on homeopathic treatments (RedHot): a supplement to CONSORT*.

When homeopathy is tested in clinical trials, understanding and appraisal are likely to be improved if published reports contain details of prescribing strategies and treatments. An international Delphi panel was convened to develop consensus guidelines for reporting homeopathic methods and treatments. The panel agreed 28 treatment- and provider-specific items that supplement the CONSORT (Consolidated Standards of Reporting Trials) Statement items 2, 3, 4 and 19. The authors recommend these for adoption by authors and journals when reporting trials of homeopathy.

Delphi Technique↗
PubMed2006

Prediction of breast cancer using volatile biomarkers in the breath.

We evaluated a breath test for volatile organic compounds (VOCs) as a predictor of breast cancer. Breath VOCs were assayed in 51 asymptomatic women with abnormal mammograms and biopsy-proven breast cancer, and 42 age-matched healthy women. A fuzzy logic model predicted breast cancer with accuracy superior to previously reported findings. Following random assignment to a training set (64) or a prediction set (29), a model was constructed in the training set employing five breath VOCs that predicted breast cancer in the prediction set with 93.8% sensitivity and 84.6% specificity. The same model predicted no breast cancer in 16/50 (32.0%) women with abnormal mammograms and no cancer on biopsy. A two-minute breath test could potentially provide a safe, accurate and painless screening test for breast cancer, but prospective validation studies are required.

Age Factors↗
PubMed2006

Changing reality.

Explore the source record for details and available documents.

Evidence-Based Medicine↗
PubMed2006

Evaluation of specific and non-specific effects in homeopathy: feasibility study for a randomised trial.

OBJECTIVE: To determine the feasibility, in terms of acceptability to patients, physicians and other staff; data return and statistical power of a study to elucidate the relative contributions of specific and non-specific effects in homeopathic treatment of dermatitis. DESIGN: Randomised, controlled 4-arm trial, 2 arms double-blind. SETTING: Outpatient clinic, Royal London Homoeopathic Hospital. PARTICIPANTS: Seventy-five adult patients with dermatitis. INTERVENTIONS: Patients were randomly allocated to: 'fast track' open verum homeopathy, 'fast track' double-blind verum homeopathy, 'fast track' double-blind placebo homeopathy or waiting list control. MAIN OUTCOME MEASURES: One hundred millimeter visual analogue scale of overall symptom severity; 10 point digital scores of sleep, itching, skin condition; weekly 5-point Likert scale of topical steroid use; Dermatology Life Quality Index at entry and completion. RESULTS: Recruitment was below target, but the study was acceptable to staff and feasible. Blinded patients were more likely to withdraw (P=0.021, chi2 test). After correction for baseline differences and multiple comparisons, no outcome measure showed statistically significant between group differences. Blindness appeared to have a negative effect, but this was confounded by differential withdrawal. CONCLUSIONS: A definitive trial of this design is unlikely to discriminate the relative contributions of the non-specific and specific effects to the outcome of homeopathic treatment of dermatitis, because of patient preference issues.

Adult↗
PubMed2005

Homeopathy and mainstream medicine: a dialogue of the deaf?

Various definitions of complementary and alternative medicine have been proposed. Homeopathy is unique among CAM therapies in originating in European Enlightenment thought. It is controversial and scientifically implausible yet popular, widespread and durable. The result has been a longstanding 'dialogue of the deaf', with little progress or genuine discussion. Clinical collaboration and serious and scientific discourse concerning homeopathy is possible and should be pursued. The alternative is not that homeopathy disappears but that it is absorbed into a dis-affected medical counter-culture with adverse consequences, particularly for patients. The Royal London Homoeopathic Hospital is developing clinical integration and scientific collaboration with a major academic medical centre in London.

Cooperative Behavior↗
PubMed2005

Comparing statistical and semantic approaches for identifying change from land cover datasets.

In this paper, we examine methods for integrating spatial data which apparently should be comparable because they are of the same data type or theme, but which are incompatible or discordant because the classes of that theme are different. For a variety of reasons including changes in methods, in understanding of the resource, and in policy initiatives in the commissioning of the survey, this problem is widespread in the results of natural resources surveys. We present two generic methods: one method is grounded in a statistical approach using discriminant analysis, and the other exploits the knowledge of experts. We use the context of land cover mapping of Great Britain to explore these approaches for integrating discordant data. We demonstrate that the expert-based approach gives very good levels of identification of locations with incompatible classifications at different times, and gives a much better rate of recognition of change. Some conclusions are made about the need to expand current metadata and data quality reporting to include descriptions of:- data conceptualisations, semantics and ontologies;- who decided and defined what the features of interest in a dataset are, and why. If the benefits of spatial data initiatives such as GRID, E-science and INSPIRE are to be fully realised then some method needs to be found to communicate that information most effectively to the potential user of the data.

Conservation of Natural Resources↗
PubMed2004

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial.

OBJECTIVE: To determine the effects of a policy of "use acupuncture" on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of "avoid acupuncture." DESIGN: Randomised, controlled trial. SETTING: General practices in England and Wales. PARTICIPANTS: 401 patients with chronic headache, predominantly migraine. Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care. MAIN OUTCOME MEASURES: Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months. RESULTS: Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2). CONCLUSIONS: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

Acupuncture Therapy↗
PubMed2004

'Designer' tumors in mice.

We have developed and tested successfully a general method based on Cre-mediated recombination that can be used for ubiquitous or tissue-specific expression of protein products, including tumor-inducing oncoproteins. Depending on the specificity of a chosen promoter driving cre expression, tumors develop by design in bitransgenic mouse progeny derived by crossing Cre-producing mice with partners carrying a dormant oncogenic transgene (targeted into the 3' noncoding region of the cytoplasmic beta-actin locus) that becomes functional after excision of a 'floxed' DNA segment. To provide proof-of-principle, we have used as models transgenes encoding the polyomavirus middle T antigen (PVMT) and the T antigens of the SV40 early region (SVER). Cre-dependent activation of widespread SVER expression resulted in hyperplasias or invasive tumors affecting particular visceral smooth muscles, whereas Cre-dependent, mammary gland-specific expression of PVMT-induced adenocarcinomas, according to plan. Unexpectedly, we also encountered spontaneous (Cre-independent) oncogene expression occurring as a rare event, which simulates the initiation of sporadic tumors and leads to PVMT-induced hemangiomas and mammary carcinomas or SVER-induced disseminated sarcomas, thus, revealing particular tissue susceptibilities to the actions of these oncoproteins.

Actins↗
PubMed2004

A mouse model of uterine leiomyosarcoma.

We are using an approach that is based on the cre/loxP recombination process and involves a binary system of Cre-producing and Cre-responding transgenic mice to achieve ubiquitous or tissue-specific expression of oncoproteins. To develop mouse models of tumorigenesis, Cre-producers are mated with responder animals carrying a dormant oncogene targeted into the 3' untranslated region of the locus encoding cytoplasmic beta-actin (actin cassette). Production of oncoprotein from a bicistronic message is accomplished in bitransgenic progeny by Cre-mediated excision of a segment flanked by loxP sites that is located upstream from the oncogenic sequence. Widespread Cre-dependent activation and expression of an actin-cassette transgene encoding the T antigens of the SV40 early region (SVER) commencing in embryos was compatible with normal development and did not impair viability. However, at approximately 3 months of age, all female animals developed massive uterine leiomyosarcomas, whereas practically all males exhibited enormously enlarged seminal vesicles because of pronounced hyperplasia of the smooth muscle layers. In addition, because of smooth muscle hyperproliferation, marked dilation of the gallbladder was observed in mice of both sexes. To begin exploring aberrant signaling events in the SVER-triggered tumorigenic pathways, we analyzed the expression profile of leiomyosarcomas by DNA microarray analysis.

Actins↗
PubMed2004

Modulation of notch signaling elicits signature tumors and inhibits hras1-induced oncogenesis in the mouse mammary epithelium.

Deregulation of Notch signaling, which normally affects a broad spectrum of cell fates, has been implicated in various neoplastic conditions. Here we describe a transgenic mouse model, which demonstrates that expression of a constitutively active form of the Notch1 receptor in the mammary epithelium induces the rapid development of pregnancy/lactation-dependent neoplasms that consistently exhibit a characteristic histopathological pattern. These signature tumors retain the ability to respond to apoptotic stimuli and regress on initiation of mammary gland involution, but eventually appear to progress in subsequent pregnancies to nonregressing malignant adenocarcinomas. Additionally, we present evidence indicating that cyclin D1 is an in vivo target of Notch signals in the mammary glands and demonstrate that we can effectively inhibit Hras1-driven, cyclin D1-dependent mammary oncogenesis by transgenic expression of the Notch antagonist Deltex.

Adenocarcinoma↗
PubMed2004

Effectiveness gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine.

BACKGROUND: An effectiveness gap (EG) is an area of clinical practice in which available treatments are not fully effective. EGs have not been previously researched. Complementary and alternative medicine (CAM) interventions, by definition, are not generally available through normal health care channels. Therefore, if effective, they have the potential to increase achieved community effectiveness. AIMS: A pilot study to determine whether EGs exist, and if so to provide initial data on their nature, frequency, and causes. To obtain preliminary data on whether CAM may offer effective interventions in these clinical areas. DESIGN: Semistructured telephone interviews; literature search. SETTING: Twenty-two (22) general practitioners (GPs) in London, U.K. METHOD: One hundred and fifty-two (152) doctors who had responded to an earlier survey on attitudes to CAM were approached. Respondents were asked to specify EGs and to give reasons why available treatment is unsatisfactory and to estimate the frequency and severity of clinical problems relating to EGs. Sampling was continued to redundancy. A bibliometric study examined the volume and type of published evidence on the effectiveness of CAM interventions in the identified clinical areas. RESULTS: There was good concordance among respondents on EGs encountered in general/family practice. Seventy-eight (78) clinical problems were cited. EGs are encountered quite frequently: 68 of 78 (85%) of EGs were encountered at least once per month. Musculoskeletal problems were cited by 20 of 22 (90%) of respondents as being affected by EGs. Depression, eczema, chronic pain, and irritable bowel syndrome were also frequently mentioned. Systematic reviews and meta-analyses conclude that there is evidence for the effectiveness of various CAM interventions in most of these areas. CONCLUSIONS: EGs, mapped against evidence, have the potential to inform service development and research policy. Further study should be undertaken: it should incorporate improved sampling and data collection methodology. Specifically, where effective CAM interventions exist but are not being applied, EGs form part of the "avoidable burden of illness" identified by early work on evidence-based medicine. Practice guidelines should incorporate CAM interventions where there is evidence. The CAM research agenda should focus on areas affected by EGs.

Attitude of Health Personnel↗