The importance of a respiratory therapist in the ALS clinic.

Although multidisciplinary amyotrophic lateral sclerosis (ALS) clinics are widely endorsed, there is limited evidence they improve outcome. We retrospectively assessed use of non-invasive ventilation in 37 ALS patients seen before and 40 patients seen after the addition of a respiratory therapist to our clinic. Patients undergoing respiratory therapy were more likely to try non-invasive ventilation (odds ratio 4.01; 95% confidence interval 1.42-11.35) and more likely to use it for at least four hours per night (odds ratio 9.5, 95% confidence interval 2.32-38.88). Median survival following non-invasive ventilation institution was 10 months for those using it four or more hours per night and five months for those who refused it or who used it for less than four hours per night (p<0.03). We conclude that adding a respiratory therapist to our multidisciplinary ALS clinic led to an increase in the percentage of patients willing to try BiNIV as well as to use it more than four hours per night, and confirm as in prior studies that such use leads to prolonged survival.

Shared predispositions of parkinsonism and cancer: a population-based pedigree-linked study.

OBJECTIVE To use a statewide population-based genealogic database to evaluate the relationship between Parkinson disease (PD) and cancer subtypes. DESIGN Using a computerized genealogy for the Utah pioneers and their descendants linked to a statewide cancer registry and statewide death certificates, we estimated relative risks for cancer in individuals with PD listed on their death certificate, and in their first-degree, second-degree, and third-degree relatives. SETTING Utah Cancer Registry. PARTICIPANTS Approximately 2.3 million individuals in the Utah genealogic resource, including death certificates of 2998 individuals with PD listed as a cause of death from 1904 to 2008 and information on 100 817 individuals with a cancer diagnosis in the Utah Cancer Registry. RESULTS Melanoma and prostate cancer were the only cancers observed in significant excess among PD cases; colorectal, lung, pancreas, and stomach cancers were observed in deficit. A significantly increased risk for prostate cancer was observed in the PD population as well as among their relatives. A reciprocal significantly increased risk for PD was also found in the 22 147 prostate cancer cases and their relatives. A significantly elevated risk for melanoma was found in the Utah PD population as well as in their relatives. A reciprocal significantly increased relative risk for PD was found in 7841 Utah melanoma cases and their relatives. CONCLUSIONS Our study identified a novel association between PD and prostate cancer, which extended to first-degree, second-degree, and third-degree relatives. We also confirmed the reported risk association for melanoma in patients with PD; we extended the finding to include a significantly increased risk in relatives. These results strongly support a genetic link. This conclusion is further strengthened by observation of the reciprocal relationship, an increased risk for PD in relatives of individuals with melanoma or prostate cancer.