tbuckley/cabot-search huggingface dataset:
Oregon's Low In-Hospital Death Rates: What Determines Where People Die and Satisfaction with Decisions on Place of Death?
Authors: Susan W. Tolle
Journal: Annals of Internal Medicine (1999)

Where Americans die is much more influenced by what part of the country they live in than by what their preferences are for location of death. Although most Americans report a preference for death at home, a majority still die in acute care hospitals. We describe the experiences of patients who died in Oregon (the state that currently has the lowest in-hospital death rate in the United States—31%) and the views of their families. We examine the factors influencing respect for dying patients' preferred location of death. Data from Oregon studies confirm that decisions to avoid hospital admission are far more common than discharge of the actively dying. Do-not-resuscitate orders were reported for 91% of nursing home residents in one study and living wills were reported for 67% of a random sample of adult Oregon decedents in a second study. In the second study, decisions not to start treatment were far more common than decisions to stop treatment (79% compared with 21%). Only 2.4% of families reported that "too little" treatment was given. Throughout the United States, use and availability of beds in acute care hospitals have been confirmed to be the principal determining factors in location of death. Within that constraint, however, the availability of other resources and services both facilitates the process of arranging for patients to die outside the hospital and improves satisfaction with the quality of terminal care.
Genetic predispositions for the immunological features of chronic active hepatitis
Authors: Albert J. Czaja, Herschel A. Carpenter, Paula J. Santrach, Breanndan S. Moore
Journal: Hepatology (1993)

To assess the frequency and genetic predispositions of concurrent immunological diseases and immunoserological markers in autoimmune hepatitis and chronic viral hepatitis, we assessed 185 patients prospectively, including 122 patients with autoimmune hepatitis and 63 patients with viral disease. Human leukocyte antigens were determined in all patients. Sixty patients (32%) had concurrent immunological diseases, and the majority of the diseases (68%) had known human leukocyte antigen associations. Although patients with autoimmune hepatitis had concurrent immunological diseases more commonly than those with viral disease (38% vs. 22%; p = 0.04), the nature of the diseases was similar in both groups, as were the frequencies of human leukocyte antigen-DR4 (42% vs. 39%; p = 0.7). The presence of human leukocyte antigen-DR4 was associated with the concurrence of immunological diseases in both autoimmune (62% vs. 33%; p = 0.01) and viral hepatitis (75% vs. 29%; p = 0.009). In autoimmune hepatitis, human leukocyte antigen-DR4 was also associated with the expression of smooth muscle antibodies and high-titer antinuclear antibodies. We conclude that concurrent immunological diseases and immunoserological markers are common in autoimmune and chronic viral hepatitis. Both conditions have a common genetic predisposition for concurrent immunological disease associated with human leukocyte antigen-DR4. The expression of smooth muscle antibodies and high-titer antinuclear antibodies is associated with human leukocyte antigen-DR4 in autoimmune hepatitis only, suggesting that this response is associated with triggering antigens and immune recognition systems that are different from those in viral disease. (HEPATOLOGY 1993;18:816-822).
Prolonged use of nitrazepam for epilepsy in children with tuberous sclerosis.
Authors: J Dennis, A Hunt
Journal: BMJ (1985)

A case note study of 90 children with tuberous sclerosis showed that 56 had taken nitrazepam for seizures for from one month to 13 years. In 38 children nitrazepam was withdrawn but only two had immediate major seizures. Given that sleepiness, deterioration in motor skills, or ataxia seems to be associated in some children with treatment with nitrazepam, doctors may wish to review their long term prescriptions of this drug in children with tuberous sclerosis.
McCOY NO LONGER WITH LOS ANGELES TIMES
Authors: E. Taggart
Journal: JAMA (1934)

To the Editor:—  An anonymous letter received today enclosed a clipping fromThe Journalpublished by the American Medical Association under date of Aug. 4, 1934, Vol. 103, No. 5, carrying an article headed A Dietary Quack Discusses Dysentery, in which it is stated that Dr. Frank McCoy of Los Angeles is associated with the Los Angeles Times as writer of a health column. I wish to correct this impression. Dr. Frank McCoy has not been with the Los Angeles Times since February 1932.
103 A GENOME-WIDE STUDY IDENTIFIES SUSCEPTIBILITY LOCI FOR HEPATITIS C VIRUS-INDUCED HEPATOCELLULAR CARCINOMA
Authors: N. Kato, V. Kumar, R. Muroyama, N. Kowatari, W. Li, M. Otsuka, R. Tateishi, H. Yoshida, M. Omata, K. Koike, Y. Nakamura, K. Matsuda
Journal: Journal of Hepatology (2011)
Utilization of Surveillance for Hepatocellular Carcinoma Among Hepatitis C Virus–Infected Veterans in the United States
Authors: Jessica A. Davila, Louise Henderson, Jennifer R. Kramer, Fasiha Kanwal, Peter A. Richardson, Zhigang Duan, Hashem B. El-Serag
Journal: Annals of Internal Medicine (2011)

This article has been corrected. The original version (PDF) is appended to this article as a supplement. Background: Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown. Objective: To examine the prevalence and determinants of HCC surveillance among HCV-infected patients with cirrhosis in Veterans Affairs (VA) health care facilities in the United States. Design: Retrospective cohort study of HCV-infected patients using data obtained from the national VA Hepatitis C Clinical Case Registry. Setting: 128 VA medical centers. Patients: HCV-infected patients with cirrhosis diagnosed between fiscal years 1998 and 2005. Measurements: Abdominal ultrasonography and measurement of α-fetoprotein for HCC surveillance were identified from administrative data by using a previously validated algorithm. Patients were categorized as having routine (tests done during at least 2 consecutive years in the 4 years after cirrhosis diagnosis), inconsistent (at least 1 test, but not routine), or no surveillance in the 4 years after cirrhosis diagnosis. Predictors of surveillance were identified by using hierarchical random-effects regression. Results: 126 670 patients with HCV were identified; 13 002 (10.1%) had cirrhosis. Approximately 42.0% of patients with cirrhosis received 1 or more HCC surveillance tests within the first year after the cirrhosis index date; however, a decline in receipt of surveillance was observed in the following 2 to 4 years. Among patients with cirrhosis and at least 2 years of follow-up, routine surveillance occurred in 12.0%, inconsistent surveillance in 58.5%, and no surveillance in 29.5%. Lower medical and psychological comorbid conditions, presence of varices, and the absence of decompensated liver disease were associated with a higher likelihood of receiving routine surveillance. Limitations: Hepatocellular carcinoma surveillance tests were indirectly identified from registry data. Physician recommendations could not be captured. Conclusion: Few HCV-infected veterans with cirrhosis received routine HCC surveillance. New strategies are needed to improve the implementation of HCC surveillance in clinical practice. Primary Funding Source: Houston Veterans Affairs Health Services Research and Development Center of Excellence and the National Cancer Institute.
Giving a voice to the unheard
Authors: Bryan Christie
Journal: BMJ (2007)

Seven years ago Abu Bakarr Kargbo had his hands hacked off by rebels during Sierra Leone's brutal civil war. Today he still lives with his wife and three children in an abandoned camp for amputees, hoping for a better future.⇓ 

A series of photographs about his life as an amputee has won this year's Luis Valtuena International Humanitarian Photography Award, …
Infection with E.B. virus.
Authors: J E Parker, R A Rockerbie
Journal: BMJ (1973)

SIR,-I was interested to read your leading article (26 May, p. 436) in which the different presentations of typhoid within developed temperate countries and undeveloped African countries was attributed to variations in in- fective, emotional, cultural, and religious backgrounds.Several years ago I had the opportunity of working in a mixed European and Asian conmunity during an outbreak of typhoid.Psychiatric symptoms occurred in no more than 10% of cases, and there was no apparent difference in the incidence of these symptoms between the two racial groups.
Meatal Colonization and Catheter-Associated Bacteriuria
Authors: Richard A. Garibaldi, John P. Burke, Michael R. Britt, William A. Miller, Charles B. Smith
Journal: New England Journal of Medicine (1980)

DESPITE widespread use of aseptic "closed" methods for drainage of urine, urinary-tract infections associated with catheters continue to account for more than 30 per cent of all hospital-acquired infections.1 2 3 Bacteria may gain entry into the catheterized bladder by either of two routes. They may migrate from the collection bag or the catheter-drainage tube junction within the catheter lumen, 1 , 2 , 4 or they may ascend in the periurethral mucous sheath outside the catheter.5 With "open" drainage methods, retrograde intraluminal spread is probably the more important pathway.6 In this report, we provide evidence that, with closed drainage, migration of bacteria extraluminally in the periurethral . . .
Pertussis and Pertussis Vaccines in Adults
Authors: Lorween A. Herwaldt
Journal: JAMA (1993)

Seventy-one years ago John Phillips observed that "pertussis in adults is often unrecognized, and this is accountable... for the spread of the disease.... The prevalent idea among the laity, and sometimes among physicians and nurses, that adults seldom contract whooping cough is responsible for lack of quarantine."<sup>1</sup>Despite numerous reports to the contrary,<sup>2-18</sup>physicians still embrace the myth that pertussis is a disease affecting only children. To illustrate this point, in a grand rounds presentation on pertussis I asked physicians who had seen adult patients with persistent cough to raise their hands. Not surprisingly, almost everyone had seen such a patient. When asked whether they had included pertussis in the differential diagnosis, only one physician among 200 raised his hand. The worldwide impact of pertussis remains enormous with approximately 60 million cases of pertussis and 600 000 pertussis-related deaths each year.<sup>19</sup>In the United States, 27826 cases
Demethylchlortetracycline and griseofulvin as examples of specific treatment for mycosis fungoides
Authors: WALTER B. SHELLEY
Journal: British Journal of Dermatology (1981)

Long‐term control of mycosis fungoides in the tumour stage was achieved in one patient by daily demethylchlortetracycline therapy. On two occasions widespread nodules and tumours completely involuted within I month of initiating this therapy. A second patient showed complete resolution of his plaque stage mycosis fungoides after the institution of oral griseofulvin therapy for a chronic fungus infection. The disease reappeared upon stopping the griseofulvin and involuted upon its resumption. The observations are interpreted as evidence that reduction or eradication of a persistent bacterial or fungal antigen may have a remarkable ameliorative effect in selected mycosis fungoides patients.
Intense immunosuppressive therapy followed by autologous peripheral blood selected progenitor cell reinfusion for severe autoimmune disease
Authors: Maurizio Musso, Ferdinando Porretto, Alessandra Crescimanno, Francesca Bond�, Vita Polizzi, Renato Scalone
Journal: American Journal of Hematology (2001)

Autologous stem cell transplantation (HSCT) has been shown to be effective in curing a large spectrum of autoimmune disorders. Case reports are being collected in the EBMT/EULAR Autoimmune Disease Stem Cell Project registry, which reports transplant-related mortality (TRM) of 6%. In order to reduce TRM and preserve the anti-autoimmune effect we evaluated a more immunoablative as opposed to myeloablative conditioning regimen for the autotransplant of severe immunomediated diseases. We enrolled patients affected by systemic lupus erythematosus (SLE: 3 patients), by autoimmune thrombocytopenic purpura (AITP: one patient), by thrombotic thrombocytopenic purpura (TTP: one patient), by pure red cell aplasia (PRCA: one patient), and by a severe cryoglobulinemia (one patient). All patients were mobilized with cyclophosphamide (Cy) 4 g/m2 + G-csf. Conditioning regimen consisted of Cy 50 mg/kg/day (days -6 and -5); anti-T-globulin (ATG) 10 mg/kg/day and 6-methylprednisolone (PDN) 1 g/day (days -4, -3, and -2). Immunomagnetically selected CD34+ cells were re-infused on day 0. In three patients neutrophil count fell below 0.5 x 10(9)/l, while a PLT count below 20 x 10(9)/l was registered in two patients. Extrahematological toxicity was very low. Four patients (2 SLE, 1 TTP, 1 cryoglobulinemia) are in complete corticosteroid-free remission with a median follow up of 335 days. The third SLE patient improved considerably; however, he still needs low-dose corticosteroid maintenance. The AITP and PRCA patients achieved a CR but soon relapsed; nevertheless, the procedure restored a steroid-sensitive status. The use of this immunoablative conditioning regimen in auto-HSCT transplant was shown to be effective in controlling disease progression and could be a valuable strategy in reducing TRM.
Childhood leukaemia masquerading as juvenile idiopathic arthritis
Authors: M J Murray, T Tang, C Ryder, D Mabin, J C Nicholson
Journal: BMJ (2004)

Children with leukaemia may first present with musculoskeletal symptoms mimicking juvenile idiopathic arthritis and often have normal haematological variables.1 The correct diagnosis may be delayed because evaluation focuses on the arthritis. Treatment with steroids may be started early, which may delay diagnosis further and reduce the subsequent response to chemotherapy.2 We report a case, initially diagnosed as juvenile idiopathic arthritis, in which acute lymphoblastic leukaemia became apparent six months after presentation and only after treatment with both steroids and methotrexate. This case emphasises the importance of early bone marrow examination if there are any atypical features of juvenile idiopathic arthritis and certainly before starting steroids or cytotoxic agents.

A previously fit 7 year old boy with no relevant family history presented with a one month history of upper chest and shoulder pain. He had malaise, lethargy, and poor appetite but no history of night sweats. He was pale with low grade pyrexia of 37.8°C. Examination showed reduced range of movements in his shoulder joints, restricted by pain. All other joints were normal. Plain radiographs of the shoulder joints were normal. Erythrocyte sedimentation rate was raised at 90 mm/hour. Full blood count was haemoglobin 11.8 g/dl, platelets 249×109/l, total white cell count 4.7×109/l, and neutrophil count 2.0×109/l. He was diagnosed as having musculoskeletal injury and was given ibuprofen.

Despite this he re-presented a month later after developing pain in his hip, knee, and ankle joints bilaterally associated with further malaise and lethargy. The pain was particularly prominent at night. He was systemically unwell but had no rash, lymphadenopathy, or hepatosplenomegaly. He had tenderness bilaterally over the anterior aspects of the tibia and his right knee was warm, tender, and swollen with an associated effusion. He was referred to the local paediatric team and …
Recurrent Thrombosis of Mesenteric Veins Complicating Cirrhosis of Liver
Authors: A. G. Chappell, G. Walters
Journal: BMJ (1961)

MEDICAL MEMORANDA BJUAIn four specimens of stool, no pus cells, red cells, ova, cysts, amoebae, or worms were seen.The white blood cells numbered 14,300/c.mm., with 20% eosinophils.The Casoni skin test for hydatid disease was positive on three occasions in Egypt.At Charing Cross Hospital a weakly positive reaction was obtained.Chest x-ray and barium-meal ex- amination, cholecystogram, and excretion urogram were normal, but barium-enema films showed depression of the hepatic flexure of the colon.At laparotomy there were two partially cystic masses in the right lobe of the liver, the larger being 7.5 cm. in diameter.Partial hepatectomy was performed, including both masses in the specimen.The rest of the liver appeared pale and firm, and the spleen was enlarged; no other abnormality was found in the abdomen.foci of.granulomatousreaction, tubercuod type.with.a necrotic core partially coagulatl.. y .....
Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study
Authors: P. A. Tiffin, J. Illing, A. S. Kasim, J. C. McLachlan
Journal: BMJ (2014)

<b>Objective</b> To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities. <b>Design</b> Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC). <b>Setting</b> Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system. <b>Participants</b> 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route. <b>Main outcome measure</b> Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK. <b>Results</b> International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates. <b>Conclusions</b> These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system.
Weight Gain and Serum Triglycerides in Normal Men
Authors: Margaret J. Albrink, J. Wister Meigs, Morris A. Granoff
Journal: New England Journal of Medicine (1962)

RECENT reports from this laboratory1 , 2 and elsewhere3 4 5 of high serum triglyceride concentrations in patients with coronary-artery disease have focused attention on the significance of serum triglycerides in normal middle-aged persons. A previously reported study revealed that a triglyceride concentration of 5.4 milliequiv. per liter best separated the normal population from the subjects with coronary-artery disease.1 Five per cent of normal young men in their twenties had serum triglycerides above this limit. Between the ages of forty and sixty-nine, 35 per cent exceeded this limit, and 82 per cent of patients with coronary-artery disease had triglycerides above 5.4 milliequiv. per liter. . . .
Carcinogenicity of 1,3-butadiene.
Authors: R L Melnick, C C Shackelford, J Huff
Journal: Environmental Health Perspectives (1993)

1,3-Butadiene, a high-production volume chemical used largely in the manufacture of synthetic rubber, is a multiple organ carcinogen in rats and mice. In inhalation studies conducted in mice by the National Toxicology Program, high rates of early lethal lymphomas occurring at exposure levels of 625 ppm or higher reduced the development and expression of later developing tumors at other sites. Use of survival-adjusted tumor rates to account for competing risk factors provided a clearer indication of the dose responses for 1,3-butadiene-induced neoplasms. An increase in lung tumors in female mice was observed at exposure concentrations as low as 6.25 ppm, the lowest concentration ever used in a long-term carcinogenicity study of this gas. Human exposures to 1,3-butadiene by workers employed at facilities that produce this chemical and at facilities that produce styrene-butadiene rubber have been measured at levels higher than those that cause cancer in animals. Furthermore, epidemiology studies have consistently revealed associations between occupational exposure to 1,3-butadiene and excess mortality due to lymphatic and hematopoietic cancers. In response to the carcinogenicity findings for 1,3-butadiene in animals and in humans, the Occupational Safety and Health Administration has proposed lowering the occupational exposure standard for this chemical from 1000 ppm to 2 ppm. Future work is needed to understand the mechanisms of tumor induction by 1,3-butadiene; however, the pursuit of this research should not delay the reduction of human exposure to this chemical.
Cardiovascular and infectious diseases in South Asia: the double whammy
Authors: Buddha Basnyat, Lalini Chandika Rajapaksa
Journal: BMJ (2004)

Innovation, political commitment, and new partnerships are needed 

The burden of disease in South Asia is changing. Unsafe water, poor sanitation, and unprotected sex are some of the familiar—and still important—risk factors for disease, while alcohol, tobacco, hypertension, and hypercholesterolaemia have lately become responsible for a major share. Two articles in this issue focus on the enormity and importance of both communicable and non-communicable diseases in the region.1 2 But what is the impact of this double burden and how might it be addressed?

In 2000, 44% of the burden of disease in this region—measured in disability adjusted life years (DALYs)—was attributed to non-communicable diseases; communicable diseases, maternal and perinatal conditions, and nutritional deficiencies accounted for 43%.3 Coronary deaths in India are expected to double over 20 years and reach 2 …
THE RESISTANCE OF NORMAL HUMAN ERYTHROCYTES TO HYPOTONIC SALINE SOLUTIONS
Authors: CHAUNCEY D. LEAKE
Journal: JAMA (1925)

This report is made for the purpose of calling attention to the extremely wide variations in the normal resistance of red blood cells to hypotonic saline solutions. These variations are more striking when the fragility of the erythrocytes is tested quantitatively, according to Simmel's technic. 1   Briefly, the method is as follows: The standard Simmel's fluid contains 8.2 gm. of sodium chlorid, 0.2 gm. of potassium chlorid, 0.2 gm. of magnesium chlorid, 0.2 gm. of calcium chlorid, 0.2 gm. of sodium acid phosphate and 0.05 gm. of sodium bicarbonate in 1 liter of water. This solution is isotonic with whole blood, is buffered to approximately the same degree as whole blood, has the same p H, and the salts are in approximately the same proportions as in whole blood. This standard fluid is diluted with water to 70, 60, 50 and 40 per cent., respectively. A red blood cell count