tbuckley/cabot-search huggingface dataset:
Impact of focussed education on accuracy of acute asthma severity assessment
Authors: Alison MacKenzie, Lorraine Bridges, Peter Kewin
Journal: European Respiratory Journal (2013)

Introduction  Safe management of acute asthma is based on an objective assessment of disease severity (BTS 2012). We previously identified poor severity assessment as a fundamental issue in acute asthma management (Tsim et al ERS 2012). We sought to improve this through focussed asthma education.  Methods  Education sessions with interactive cases were provided over 2 weeks. Invitation was extended to Emergency Medicine (EM) and Medical Trainees (MT), but was only accepted by MT. Subsequent asthma admissions were prospectively audited (Aug-Nov 2012).  Results  Of 34 admissions, accurate assessment was made by 27% junior staff (7/19), 29% middle grade (2/7) and 0% Consultant (0/1); 14% of EM (4/28) and 33% of MT admissions (2/6). Performance did not improve following education (Table 1), with poor PEFR monitoring (Table 2)  Conclusions  In isolation, focussed eduction cannot improve performance. A multi-modal approach, targeting broader clinician groups, with an integrated care pathway and multi-speciality clinical governance meetings may improve assessment and reduce potential adverse outcomes.
Knowledge of non invasive ventilation in the emergency department
Authors: Rachel Jones, Andrew Stanton, Mark Juniper
Journal: European Respiratory Journal (2014)

Introduction   Non Invasive Ventilation (NIV) is being used more widely outside intensive care units (ICU) where there may not be the experience or expertise to initiate and manage situations appropriately   Aims   To investigate doctors9 knowledge of NIV in an emergency department (ED) including indications for use, appropriate set up and ongoing care.   Methods   An anonymous online questionnaire was distributed to all doctors working in ED at a UK district general hospital in February 2014. Participants were asked to identify appropriate indications for NIV and then led through a scenario of managing a patient with COPD and decompensated ventilatory failure.   Results   41%(15/37) of doctors responded across all grades. Self-identified confidence in managing NIV improves with seniority (5.25 vs 3.3) and past job experience in ICU (4.5 vs 2.25). Doctors were unclear about indications for NIV outside ICU/HDU. Whilst the majority (93%) correctly identified COPD exacerbations as an indicator, doctors at all grades would also use NIV for: asthma (20%), significant hypoxia (13%) and pneumothorax (7%). A quarter (27%) would start NIV without initial medical therapy. Only 40% could identify safe initial ventilatory pressures. Suggesting a value for back up rate was more problematic with 53% unable to provide any value. Only 33% could correctly alter settings while 53% of ED doctors altered both IPAP and EPAP by equal amounts.   Conclusions   Knowledge of appropriate use of NIV is sub optimal across all grades in ED, and probably reflects the increasing use of a specialist intervention in the hands of non-specialists. There are a number of doctors whose use of NIV could compromise patient safety. Urgent education across all grades is needed.
Phase I trial of 13-cis-retinoic acid in children with neuroblastoma following bone marrow transplantation.
Authors: J G Villablanca, A A Khan, V I Avramis, R C Seeger, K K Matthay, N K Ramsay, C P Reynolds
Journal: Journal of Clinical Oncology (1995)

PURPOSE Treatment of neuroblastoma cell lines with 13-cis-retinoic acid (cis-RA) can cause sustained inhibition of proliferation. Since cis-RA has demonstrated clinical responses in neuroblastoma patients, it may be effective in preventing relapse after cytotoxic therapy. This phase I trial was designed to determine the maximal-tolerated dosage (MTD), toxicities, and pharmacokinetics of cis-RA administered on an intermittent schedule in children with neuroblastoma following bone marrow transplantation (BMT). PATIENTS AND METHODS Fifty-one assessable patients, 2 to 12 years of age, were treated with oral cis-RA administered in two equally divided doses daily for 2 weeks, followed by a 2-week rest period, for up to 12 courses. The dose was escalated from 100 to 200 mg/m2/d until dose-limiting toxicity (DLT) was observed. A single intrapatient dose escalation was permitted. RESULTS The MTD of cis-RA was 160 mg/m2/d. Dose-limiting toxicities in six of nine patients at 200 mg/m2/d included hypercalcemia (n = 3), rash (n = 2), and anemia/thrombocytopenia/emesis/rash (n = 1). All toxicities resolved after cis-RA was discontinued. Three complete responses were observed in marrow metastases. Serum levels of 7.4 +/- 3.0 mumol/L (peak) and 4.0 +/- 2.8 mumol/L (trough) at the MTD were maintained during 14 days of therapy. The DLT correlated with serum levels &gt; or = 10 mumol/L. CONCLUSION The MTD of cis-RA given on this intermittent schedule was 160 mg/m2/d. Serum levels known to be effective against neuroblastoma in vitro were achieved at this dose. The DLT included hypercalcemia, and may be predicted by serum cis-RA levels. Monitoring of serum calcium and cis-RA levels is indicated in future trials.
Mass Treatment With Bariatric Surgery for Type 2 Diabetes Mellitus—Reply
Authors: Anita P. Courcoulas, John M. Jakicic
Journal: JAMA Surgery (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Anastrozole Is Superior to Tamoxifen as First-Line Therapy for Advanced Breast Cancer in Postmenopausal Women: Results of a North American Multicenter Randomized Trial
Authors: J.M. Nabholtz, A. Buzdar, M. Pollak, W. Harwin, G. Burton, A. Mangalik, M. Steinberg, A. Webster, M. von Euler
Journal: Journal of Clinical Oncology (2000)

PURPOSE: The efficacy and tolerability of anastrozole (Arimidex; AstraZeneca, Wilmington, DE, and Macclesfield, United Kingdom) and tamoxifen were compared as first-line therapy for advanced breast cancer in 353 postmenopausal women. PATIENTS AND METHODS: The randomized, double-blind, multicenter study was designed to evaluate anastrozole 1 mg once daily relative to tamoxifen 20 mg once daily in patients with hormone receptor–positive tumors or tumors of unknown receptor status who were eligible for endocrine therapy. Primary end points were objective response (OR), defined as complete (CR) or partial (PR) response, time to progression (TTP), and tolerability. RESULTS: Anastrozole was as effective as tamoxifen in terms of OR (21% v 17% of patients, respectively), with clinical benefit (CR + PR + stabilization ≥ 24 weeks) observed in 59% of patients on anastrozole and 46% on tamoxifen (two-sided P = .0098, retrospective analysis). Anastrozole had a significant advantage over tamoxifen in terms of TTP (median TTP of 11.1 and 5.6 months for anastrozole and tamoxifen, respectively; two-sided P = .005). The tamoxifen:anastrozole hazards ratio was 1.44 (lower one-sided 95% confidence limit, 1.16). Both treatments were well tolerated. However, thromboembolic events and vaginal bleeding were reported in fewer patients who received anastrozole compared with those who received tamoxifen (4.1% v 8.2% [thromboembolic events] and 1.2% v 3.8% [vaginal bleeding], respectively). CONCLUSION: Anastrozole satisfied the predefined criteria for equivalence to tamoxifen. Furthermore, we observed both a significant increase in TTP and a lower incidence of thromboembolic events and vaginal bleeding with anastrozole. These findings indicate that anastrozole should be considered as first-line therapy for postmenopausal women with advanced breast cancer.
How farming exposure affects lung development in young adults
Authors: Anneli C.S. Bolund, Ioannis Basinas, Grethe Elholm, Martin R. Miller, Øyvind Omland, Vivi Schlünssen, Torben Sigsgaard
Journal: European Respiratory Journal (2013)

Exposure to organic dust in agricultural work has been associated with lower lung function. Longitudinal studies on lung function decline in agricultural workers are few. We studied 1,964 farming students and 407 controls in 1992/4, and 963 and 172 of these again in 2007/8. Spirometry, a health questionaire, smoking and occupational history were collected each time. Cumulative dust and endotoxin exposures were estimated from job-exposure matrices based on personal dust measurements. Lung function was expressed as z-scores using the LMS equations (Stanojevic S, et al. AJRCCM 2008; 177: 253-60). In 1135 subjects with longitudinal data and aged
Bromodomain-Containing Protein 4
Authors: Jolyane Meloche, François Potus, Mylène Vaillancourt, Alice Bourgeois, Ian Johnson, Laure Deschamps, Sophie Chabot, Grégoire Ruffenach, Sarah Henry, Sandra Breuils-Bonnet, Ève Tremblay, Valérie Nadeau, Caroline Lambert, Renée Paradis, Steeve Provencher, Sébastien Bonnet
Journal: Circulation Research (2015)

Rationale: Pulmonary arterial hypertension (PAH) is a vasculopathy characterized by enhanced pulmonary artery (PA) smooth muscle cell (PASMC) proliferation and suppressed apoptosis. Decreased expression of microRNA-204 has been associated to this phenotype. By a still elusive mechanism, microRNA-204 downregulation promotes the expression of oncogenes, including nuclear factor of activated T cells, B-cell lymphoma 2, and Survivin. In cancer, increased expression of the epigenetic reader bromodomain-containing protein 4 (BRD4) sustains cell survival and proliferation. Interestingly, BRD4 is a predicted target of microRNA-204 and has binding sites on the nuclear factor of activated T cells promoter region. Objective: To investigate the role of BRD4 in PAH pathogenesis. Methods and Results: BRD4 is upregulated in lungs, distal PAs, and PASMCs of patients with PAH compared with controls. With mechanistic in vitro experiments, we demonstrated that BRD4 expression in PAH is microRNA-204 dependent. We further studied the molecular downstream targets of BRD4 by inhibiting its activity in PAH–PASMCs using a clinically available inhibitor JQ1. JQ1 treatment in PAH–PASMCs increased p21 expression, thus triggering cell cycle arrest. Furthermore, BRD4 inhibition, by JQ1 or siBRD4, decreased the expression of 3 major oncogenes, which are overexpressed in PAH: nuclear factor of activated T cells, B-cell lymphoma 2, and Survivin. Blocking this oncogenic signature led to decreased PAH-PASMC proliferation and increased apoptosis in a BRD4-dependent manner. Indeed, pharmacological JQ1 or molecular (siRNA) inhibition of BRD4 reversed this pathological phenotype in addition to restoring mitochondrial membrane potential and to increasing cells spare respiratory capacity. Moreover, BRD4 inhibition in vivo reversed established PAH in the Sugen/hypoxia rat model. Conclusions: BRD4 plays a key role in the pathological phenotype in PAH, which could offer new therapeutic perspectives for patients with PAH.
An increased respiratory drive accounts for the severity of dyspnea in systemic sclerosis
Authors: Maarten Ninaber, Willem Hamersma, Anne Schouffoer, Annemie Schuerwegh, Jan Stolk
Journal: European Respiratory Journal (2013)

Introduction  Dyspnea in progressive systemic sclerosis (SSc) may originate from pulmonary hypertension or interstitial lung disease. Respiratory drive is a major determinant of dyspnea. Evaluation of the respiratory drive measured by mouth occlusion pressures and CO2 rebreathing may better relate to the magnitude of dyspnea than the severity of gas transfer or lung volume impairment.  Methods  In 73 SSc patients referred to a targeted outpatient health care program PFT as well as mouth occlusion pressures after 0.1 sec (P0.1) were measured while breathing room air at resting ventilation and during rebreathing of a gas mixture containing 7% CO2 and 93% O2. An abnormal V’E/P0.1 is defined as   Results  Mean P0.1 in patients with normal normal V’E/P0.1 (n=45) was 1.1 ± 0.04 and in patients with abnormal V’E/P0.1 (n=28) 1.6 ± 0.08 cmH20, p   Conclusion  In SSc with an abnormal V’E/P0.1, an increased respiratory drive to CO2 is present and accounts for the severity of dyspnea.
Assessment of satisfaction with inhalation devices in Greek patients
Authors: Nikolaos Grekas, Katerina Athanassiou, Katerina Papataxiarchou
Journal: European Respiratory Journal (2013)

INTRODUCTION   Patients’ satisfaction with their inhalation devices is usually decided by appropriate questionnaires. The Feeling of Satisfaction with Inhalers (FSI-10) questionnaire is specifically designed to assess patient opinion regarding the satisfaction and usability of the inhalers.   OBJECTIVES   A pooled analysis of the data derived from studies to measure patient satisfaction with the Greek version of the FSI-10 questionnaire is presented.   METHODS   The primary data from three non interventional, observational studies which were conducted in Greece over the last four years were combined. The database included 1.499 patients (866 men) with pulmonary disorders aged between 16 – 97 years, who completed in full the FSI-10. Statistical analysis was done by SPSS version 17.0.   RESULTS   909 patients suffered from asthma, 529 from COPD and 29 from both diseases. Four different dry powder inhalers (DPIs) were used. 470 of the participants used Diskus®, 465 Elpenhaler®, 458 Turbuhaler® and 106 Aerolizer®. Mean total scores were found to be 40.2, 43.6, 41.3 and 37.0 respectively. Although consistent and satisfactory results were obtained with all DPIs examined, certain statistically significant differences in the ratings were detected between the devices. Reliability of the measurements was assessed in terms of internal consistency. Cronbach’s alpha was found to be equal to 0.916. Reliability analysis was also separately performed by gender, disease or device. Satisfactory alpha values (> 0.9) were obtained in all cases.   CONCLUSIONS   Greek FSI-10 is a valid and reliable instrument for assessing the opinion of the patients with pulmonary disorders regarding their satisfaction with the inhalers. It is useful for device selection.
Adjuvant intraperitoneal chemotherapy with carbon-adsorbed mitomycin in patients with gastric cancer: results of a randomized multicenter trial of the Austrian Working Group for Surgical Oncology.
Authors: H R Rosen, G Jatzko, S Repse, S Potrc, H Neudorfer, P Sandbichler, J Zacherl, H Rabl, P Holzberger, P Lisborg, M Czeijka
Journal: Journal of Clinical Oncology (1998)

PURPOSE Previous studies have demonstrated a beneficial effect of intraperitoneally applied mitomycin bound to activated carbon particles (M-CH) in preventing intraabdominal recurrence following curative surgery for gastric cancer. The Austrian Working Group for Stomach Cancer, a subgroup of the Austrian Working Group for Surgical Oncology, initiated a multicentric phase III trial to evaluate the safety and efficacy of this treatment regimen. PATIENTS AND METHODS A total of 91 patients with a radically resected gastric cancer infiltrating the serosal surface were randomly assigned to receive either 50 mg mitomycin bound to a solution of 375 mg carbo adsorbens intraperitoneally before closure of the abdominal wound (n = 46) or served as a surgical control group (n = 45). Postoperative complications and recurrence-free and overall survival were evaluated to analyze the risks and benefits of this treatment. RESULTS After a median observation period of 597 days (range, 72 to 1,096), a significantly higher postoperative complication rate was observed in the M-CH group (35%) compared with the control group (16%) (P &lt; .02). In accordance with this finding, the postoperative (60 days) mortality rate was also significantly elevated in the M-CH group (11% v 2% in the control group). Since analysis of overall and recurrence-free survival failed to show any beneficial effect of M-CH therapy, the protocol committee decided to stop further recruitment of patients onto this study. CONCLUSION Adjuvant intraperitoneal therapy of gastric cancer by mitomycin bound to activated carbon particles is associated with an increased rate of postoperative complications. However, no benefit for prognosis following radical resection of locally advanced tumors was observed in this multicenter phase III trial.
Zinc Content of Pancreatic Tumors of Islet Cell Origin&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Tatsuo Tomita
Journal: JNCI Journal of the National Cancer Institute (1970)

The quantity of zinc in 5 islet cell tumors of the pancreas was measured by direct chemical analysis; histochemical correlation was attempted in 2. The zinc content of these tumors was within the expected range of normal pancreatic tissue except for 1 tumor which had an exceedingly high concentration of zinc. The pancreatic tissue immediately surrounding 2 islet cell tumors contained 25–50% of the normal concentration. Histochemical studies showed only weak staining of zinc in these 2 tumors. The tissue of the islet cell tumors contained greater concentrations of zinc than tissue from exocrine pancreatic tumors and atrophic pancreatic tissue from patients with advanced diabetes mellitus.
Nurse-patient collaboration; a grounded theory study in patients with chronic obstructive pulmonary disease on non-invasive ventilation
Authors: Dorthe Sørensen, Kirsten Frederiksen, Thorbjørn Grøfte, Kirsten Lomborg
Journal: European Respiratory Journal (2012)

Objectives: This paper provides a theoretical account of nurses' collaborations with patients' with chronic obstructive pulmonary disease during non-invasive ventilation treatment at the hospital.

Background: Despite strong evidence for the effect of non-invasive ventilation treatment, success remains a huge challenge. Nurse and patient collaboration may be vital for treatment tolerance and success. A better understanding of how nurses and patients collaborate during non-invasive ventilation may therefore contribute to improvement.

Design: A constant comparative classical grounded theory.

Method: The data comprised sessions of qualitative participant observation during the treatment of 21 patients with non-invasive ventilation, which included unstructured conversations with the nurses and semi-structured interviews with 11 patients after treatment completion. Data were collected at three Danish hospitals.

Results: Definition of the situation emerged as the core category in nurse-patient collaborations during non-invasive ventilation treatment. The main concern was resolved by activating of one or more of the following four complex adjusted modalities: (1) joint modality; (2) patient-initiated modality; (3) nurse-initiated modality; or (4) split modality. Modalities 1–3 were characterised by mutual definitions of the situation, whereas the fourth was characterised by divergent definitions of the situation.

Conclusions: This study offers a robust account of nurses' and patients' concerns about their definition of the situation and how they activate different complex adaptive modalities. We offer a theoretical basis for developing complex interventions.
Antitumor Activity of Purified Cell Walls From Corynebacterium parvum
Authors: V. Riveros-Moreno, R. Bomford, M. T. Scott
Journal: JNCI Journal of the National Cancer Institute (1978)

Journal Article Antitumor Activity of Purified Cell Walls From Corynebacterium parvum Get access V. Riveros-Moreno, V. Riveros-Moreno Search for other works by this author on: Oxford Academic PubMed Google Scholar R. Bomford, R. Bomford Search for other works by this author on: Oxford Academic PubMed Google Scholar M. T. Scott M. T. Scott Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 60, Issue 3, March 1978, Pages 653–658, https://doi.org/10.1093/jnci/60.3.653 Published: 01 March 1978 Article history Received: 08 June 1977 Accepted: 22 September 1977 Published: 01 March 1978
Physiologic Measures: Pulmonary Function Tests
Authors: Paul L. Enright, Michael D. Lebowitz, Donald W. Cockroft
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

When the effectiveness of asthma interventions are evaluated in the research setting, the physiologic manifestation of asthma—variable airways obstruction—is always objectively measured by some of the following pulmonary function tests: (1) Baseline spirometry gives a highly accurate "snapshot" of asthma severity and the degree of airways obstruction. The FEV1, derived from spirometry, is the most reproducible pulmonary function parameter and is linearly related to the severity of airways obstruction. There are no contraindications for the test, spirometers are widely available at reasonable cost, and methods and result interpretation are comprehensively standardized. (2) The post-bronchodilator FEV1 measures the best lung function that can be achieved by bronchodilator therapy on the day of the visit and therefore is a more stable measure in asthmatics than comparing visit-to-visit baseline FEV1. Although a positive acute response to bronchodilator helps to confirm the diagnosis of asthma, the degree of bronchodilator reversibility from visit-to-visit (change in reversibility) is not a useful index of asthma outcome. (3) Airway responsiveness (bronchial challenge) measures the degree to which an individual withstands nonspecific stimuli that trigger asthmatic attacks. The methacholine challenge test is safe and requires less than an hour, but it requires more technical skill than baseline spirometry and is contraindicated in some situations. (4) Ambulatory monitoring, using peak flow meters or hand-held spirometers, provides multiple measurements of the degree of obstruction for days to weeks in the patient's natural setting. PEF meters are very inexpensive and almost all asthmatics can use them, but PEF results are less reliable than the FEV1. The often asymptomatic obstruction of an asthmatic has both short-term (within a day and day-to-day) and longer-term variations that are triggered by naturally occurring stimuli. These changes are measured by PEF lability but not by spirometry during clinic visits. (5) Other pulmonary function tests, such as absolute lung volumes and airways resistance, may provide confirmatory data, but the instruments are large, expensive, and technically demanding. The results of all the above pulmonary function tests are significantly correlated with each other and with symptom scores and medication use in large groups of patients with widely varying degrees of asthma severity. Since a "gold standard" with which to measure asthma severity does not currently exist, all of these tests contribute an additional amount of unique information when measuring asthma outcome in a clinical trial.