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Including the previously mentioned North London study discount neurontin 800mg with visa, a total of six randomized controlled trials and one nonrandomized trial of chest radi- ograph lung cancer screening have been performed discount neurontin 100 mg with amex. In all of these studies discount neurontin 800mg mastercard, the control group underwent some form of screening buy generic neurontin 800mg, though less fre- quently than the intervention arm. The Kaiser Foundation trial, though not specifically performed for lung cancer, randomized over 10,000 partici- pants ages 35 to 54 into an intervention group that was encouraged to par- ticipate in a multiphasic health checkup, including chest x-ray, and a control group that was not. The Erfurt, Germany, study was a nonrandomized trial with 41,000 males in the intervention group, who underwent biannual chest x-rays and 102,000 males in the control group, who had chest x-rays every 18 months. Under the auspices of the National Cancer Institute (NCI), three sepa- rate screening trials were performed in the U. Two of these studies, the Johns Hopkins study (32) and the Memorial Sloan- Kettering (33) study, enrolled over 10,000 males each into an intervention group that received annual chest x-rays and sputum cytology every 4 months, and a control group that received only an annual chest x-ray. While there was a slight benefit to sputum cytology at the prevalence screen, all-cause mortality was the same in both groups (34–36). The results led to the conclusion that sputum cytology does not significantly improve the yield of chest x-ray screening. At the initial screen, all participants received a chest x-ray and sputum analysis. After 19 prevalence cases were excluded, 6345 were randomized to either semiannual chest x-rays and sputum analysis for 3 years or a chest x-ray and sputum analysis at the end of the 3-year period. Both groups then received annual chest x-rays at 1-year intervals from years 4 through 6. The first reported results were promising, with 48% diagnosed at stage I or II and 27% undergoing curative resections in the intervention arm (37). At follow-up, however, despite the fact that the lung cancer in the screened group was of earlier stage, almost three times as likely to be resectable, and had a better 5-year survival from time of diagnosis, there were more lung cancer deaths in the intervention arm, all-cause mortality was greater in 62 J. Silvestri the intervention arm, and smoking-related deaths were greater in the inter- ventional arm (38). The Mayo Lung Project randomized 10,933 participants into an inter- vention arm of chest x-ray and sputum cytology every 4 months and a control arm of "usual care" for 6 years (40). Ninety-one prevalence cancers were detected with over 50% postsurgical stage I or II and 5-year survival of 40%. Prevalence cases tended to be of a more well-differentiated histol- ogy (41) and complete resection could be performed in twice as many screening participants compared to a previous cohort of over 1700 patients. By the end of the trial, 206 lung cancers had been detected in the screen- ing arm and 160 in the control arm. With follow-up out to 20 years, no benefit could be detected in the screened group (44). Over 73% of subjects received a chest radiograph in the last 2 years of the study, and 30% of the cancers in the control group were discovered on chest radiographs per- formed for reasons other than suspicion of lung cancer (43). The majority of these ostensibly "screen" cancers in the control group were resectable. Overdiagnosis bias is one of the proposed reasons for the excess cancers in the screen group, although this hypothesis, particularly as it applies to lung cancer, remains controversial (45–47). It has also been suggested that the Mayo Lung Project was underpowered and thus had only a 20% chance of showing a mortality benefit should it have existed (48). Although it was also suggested that there was heterogeneity between the groups that affected mortality (49), reappraisal of the populations in the study showed no difference in age at entry, cigarette smoking history, exposure to non- tobacco lung carcinogens, and comorbid pulmonary diseases (50). Regard- less of the controversy, it is important to realize that to date, lung cancer screening with chest radiographs has not been shown to reduce lung cancer mortality. There is one ongoing larger randomized control trial of lung cancer screening with chest radiograph as part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (51). The literature review revealed a total of nine trials of nonrandomized screening, three in Japan, three in Europe, and three in the United States, enrolling a total of 20,116 individuals for prevalence screens (52–60). Several of these studies have reported annual incidence data, and thus far 25,406 incidence screens have been reported (55,57,61–63) (Table 4.

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Kurt 69 HOW TO PRESENT AT MEETINGS Vonnegut boasts that he gave such bad lectures when a lecturer at New York University that he fell asleep during his own lectures discount neurontin 600 mg line. I remember giving a lecture in Manchester on creativity in science where the entire audience was almost unconscious and I suddenly thought: "This is rubbish purchase 600 mg neurontin with amex, utter rubbish" neurontin 100mg generic. Summary • Good presentations resemble each other but bad ones come in many forms • Lack of preparation neurontin 600 mg low cost, preparing for the wrong audience, making the talk too long or short and ignoring the topic all contribute to a bad presentation • Visual aids of poor quality, which are too numerous or with too much information, can be a hindrance • Mumbling, reading from a script and lack of eye contact are all signs of a boring presentation • A bad presentation rarely produces any questions 70 10 How to chair a session ROGER HORTON Chairing a session at a scientific meeting is like so many things in life – do a good job and no one will notice you or remember your name, but do a bad job and you will be blamed for everything, including the incoherent speaker who left his slides at home. The role and responsibilities of the chairman will be coloured by the type of meeting. Often you begin to learn the trade at a small, one-day learned society meeting, by chairing a short session of free communications, delivered by junior colleagues. The venue is probably familiar, the audience small, the atmosphere supportive, and the speakers petrified! A natural progression is to the larger, national conference, spread over several days with parallel sessions, and with a more intense and sometimes adversarial atmosphere. In attempting to offer advice, I have selected what many would consider the "worst case scenario". You have agreed to chair a half-day symposium, comprising six speakers, in an area with which you are familiar, but not an expert. The venue is a conference centre, also using several local hotels, in a city not known to you. International reputations, including yours, may be built and lost in such situations. In dealing with this (unlikely) set of circumstances I will set out the principles and timing which the reader can adapt to less demanding situations. As a starting point, search by name one of the bibliographic databases, such as Medline or Pubmed. Print off a list of publications, identify those related to the subject of the meeting, obtain off-prints of the papers, and read them. This should help you establish the standing of the speakers, how long they have worked in this particular field, areas of controversy, and recent advances. Two months before the meeting By now the meeting abstracts will be printed and the organisers may well have sent you, as chairman, copies of the abstracts of the speakers in your session. If not, request them, together with mail, telephone and e-mail contacts for the speakers. Send contact details and copies of abstracts to all speakers and encourage them to make contact with each other, even to exchange slides (one advantage of PowerPoint is the ability to send slides around the world as e-mail attachments – some people argue it’s the only advantage). The purpose of all this electronic interchange is to ensure a coherent programme and prevent each speaker giving essentially the same introduction. With more and more speakers using computer-generated slides, it is important to find out from the organisers: • what formats are being supported (PC, Mac)? It is worth encouraging the speakers to bring their laptops, complete with software packages and presentations; if things do go wrong, they can always do another down-load of the images. At this stage you need to ensure that all participants are absolutely clear about the venue and date of the symposium and, 72 HOW TO CHAIR A SESSION above all, the duration of their contribution (for example, 25 minutes allowed to speak and 10 minutes for questions). You also need to establish any special requirements such as dual projection or video and to relay this information to the meeting secretariat. If circumstances allow, I try to organise a social event for the speakers on the day before the session. This may be just meeting for coffee in the conference centre or going out for a meal. This is particularly valued by junior speakers who can be overawed by speaking on the same programme as "superstars". The local organisers will usually suggest appropriate venues and may even make bookings.

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