End of the scandal of free Medical Education

BMJ (Photo credit: Wikipedia)

A great article that you can read in the British Medical Journal today..........of course....if you pay first. So which is the scandal ? If you work hard, you could be a revisor of some papers in the BMJ......actually I was there for a couple of years......no credits for my resumee, no fees, and not avalaible to see the same articles I used to work on it.........no pay, but also not information for that. Happy for Fiona Heath, and many important people there. But.....are these people aware that medical information must be also free ? They don't write the papers, they have a lot of revisor for free, and there are no costs (or low costs ), for post an article in internet.......so....be serious. The only scandal here is the tittle and the BMJ itself. Free Medical Education from BMJ........ ?????

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Minimally invasive radical prostatectomy vs. retropubic radical prostatectomy

Jim C. Hu, MD, MPH; Xiangmei Gu, MS; Stuart R. Lipsitz, ScD; Michael J. Barry, MD; Anthony V. D’Amico, MD, PhD; Aaron C. Weinberg, MD; Nancy L. Keating, MD, MPH

JAMA. 2009;302(14):1557-1564. 
Full Text 
Context Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP).
Objective To determine the comparative effectiveness of MIRP vs RRP.
Design, Setting, and Patients Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899).
Main Outcome Measures We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control.
Results Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35).
Conclusion Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.

Author Affiliations: Division of Urologic Surgery (Drs Hu and Weinberg), Center for Surgery and Public Health (Drs Hu, Lipsitz, and Weinberg and Ms Gu), Department of Radiation Oncology (Dr D’Amico), and Division of General Internal Medicine (Dr Keating), Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute (Dr Hu), The Medical Practices Evaluation Center, Massachusetts General Hospital (Dr Barry), and Department of Health Care Policy, Harvard Medical School (Dr Keating), Boston. 

Comment in

• Minimally invasive vs open radical prostatectomy. [JAMA. 2010]
• Words of wisdom. Re: Comparative effectiveness of minimally invasive vs open radical prostatectomy. [Eur Urol. 2010]
• Words of wisdom. Re: Comparative effectiveness of minimally invasive vs open radical prostatectomy. [Eur Urol. 2010]
• Words of wisdom. Re: comparative effectiveness of minimally invasive versus open radical prostatectomy. [Eur Urol. 2010]

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The Lancet Oncology, Early Online Publication, 13 September 2011

doi:10.1016/S1470-2045(11)70223-6Cite or Link Using DOI

Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: a pooled analysis of 26 epidemiological studies

Dr Xavier Castellsagué MD a d , Mireia Díaz MSc a, Salvatore Vaccarella PhD b, Silvia de Sanjosé MD a d, Nubia Muñoz MDa, Rolando Herrero MD b, Silvia Franceschi MD b, Prof Chris J L M Meijer MD c, F Xavier Bosch MD a e

Summary

Background

Intrauterine device (IUD) use has been shown to reduce the risk of endometrial cancer, but little is known about its association with cervical cancer risk. We assessed whether IUD use affects cervical human papillomavirus (HPV) infection and the risk of developing cervical cancer.

Methods

We did a pooled analysis of individual data from two large studies by the International Agency for Research on Cancer and Institut Català d'Oncologia research programme on HPV and cervical cancer; one study included data from ten case—control studies of cervical cancer done in eight countries, and the other included data from 16 HPV prevalence surveys of women from the general population in 14 countries. 2205 women with cervical cancer and 2214 matched control women without cervical cancer were included from the case—control studies, and 15 272 healthy women from the HPV surveys. Information on IUD use was obtained by personal interview. HPV DNA was tested by PCR-based assays. Odds ratios and 95% CIs were estimated using multivariate unconditional logistic regression for the associations between IUD use, cervical HPV DNA, and cervical cancer.

Findings

After adjusting for relevant covariates, including cervical HPV DNA and number of previous Papanicolaou smears, a strong inverse association was found between ever use of IUDs and cervical cancer (odds ratio 0·55, 95% CI 0·42—0·70; p<0·0001). A protective association was noted for squamous-cell carcinoma (0·56, 0·43—0·72; p<0·0001), adenocarcinoma and adenosquamous carcinoma (0·46, 0·22—0·97; p=0·035), but not among HPV-positive women (0·68, 0·44—1·06; p=0·11). No association was found between IUD use and detection of cervical HPV DNA among women without cervical cancer.

Interpretation

Our data suggest that IUD use might act as a protective cofactor in cervical carcinogenesis. Cellular immunity triggered by the device might be one of several mechanisms that could explain our findings.

Funding

Instituto de Salud Carlos III; Agència de Gestió d'Ajuts Universitaris i Recerca; Marató TV3 Foundation; Bill & Melinda Gates Foundation; International Agency for Research on Cancer; European Community; Fondo de Investigaciones Sanitarias, Spain; Preventiefonds, Netherlands; Programa Interministerial de Investigación y Desarrollo, Spain; Conselho Nacional de Desenvolvimiento Cientifico e Tecnologico, Brazil; and Department of Reproductive Health & Research, WHO.

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