tbuckley/cabot-search huggingface dataset:
The Importance of Considering Clinical Utility in the Construction of a Diagnostic Manual
Authors: Stephanie N. Mullins-Sweatt, Gregory J. Lengel, Hilary L. DeShong
Journal: Annual Review of Clinical Psychology (2015)

The development of major diagnostic manuals primarily has been guided by construct validity rather than clinical utility. The purpose of this article is to summarize recent research and theory examining the importance of clinical utility when constructing and evaluating a diagnostic manual. We suggest that construct validity is a necessary but not sufficient criterion for diagnostic constructs. This article discusses components of clinical utility and how these have applied to the current and forthcoming diagnostic manuals. Implications and suggestions for future research are provided.
Overt disseminated intravascular coagulation in severe sepsis associated with specific organ dysfunction and poor survival
Authors: Hou-Tai Chang, Kuei-Pin Chung, Jih-Shuin Cheng, Chong-Jen Yu
Journal: European Respiratory Journal (2012)

BACKGROUND 

In sepsis, abnormal coagulation cascade cause disseminated intravascular coagulation (DIC). Little is known about the clinical characteristics in overt DIC in severe sepsis.

OBJECTIVES 

To investigate the clinical features and dysfunction of different organ systems in overt DIC in severe sepsis

METHODS 

This prospective observational study was conducted in the medical intensive care unit in a tertiary medical center in Taiwan. Adult patients admitted for severe sepsis would be enrolled. Patients with cirrhosis or advanced malignancies would be excluded. Baseline patient profiles were obtained, including APACHE II and SOFA scores. Overt DIC was defined according to the scoring system from the International Society on Thrombosis and Haemostasis.

RESULTS 

From Oct 2009 to Dec 2011, 248 consecutive patients admitted for severe sepsis were screened for the eligibility, and a total of 100 patients were enrolled. The APACHE II and SOFA scores were 25.9±0.8 and 9.9±0.4, respectively. Only 8 patients (8%) had overt DIC. The 28-day mortality was higher in patients with overt DIC than in those without (62.5% vs. 20.7%, P =0.001). Patients with overt DIC had higher SOFA scores than those without (14.1±0.8 vs. 9.5±0.4, P =0.001). Higher hepatic ( P =0.003), cardiovascular ( P =0.031) and coagulation ( P <0.001) SOFA sub-scores were found in patients with overt DIC, while the respiration, central nervous system, and renal subscores were not significantly different compared to those without overt DIC.

CONCLUSIONS 

In our patients with severe sepsis, overt DIC is uncommon, and is associated with organ dysfunction mainly involving hepatic, cardiovascular, and coagulation systems.
Localized Childhood Hodgkin’s Disease: Response-Adapted Chemotherapy With Etoposide, Bleomycin, Vinblastine, and Prednisone Before Low-Dose Radiation Therapy—Results of the French Society of Pediatric Oncology Study MDH90
Authors: J. Landman-Parker, H. Pacquement, T. Leblanc, J.L. Habrand, M.J. Terrier-Lacombe, Y. Bertrand, Y. Perel, A. Robert, C. Coze, I. Thuret, J. Donadieu, G. Schaison, G. Leverger, J. Lemerle, O. Oberlin
Journal: Journal of Clinical Oncology (2000)

PURPOSE: The French Society of Pediatric Oncology MDH82 study demonstrated the effectiveness of 20 Gy irradiation of involved fields after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone/ABVD chemotherapy in children with localized Hodgkin’s disease (HD). The response to primary chemotherapy was the only predictor of survival. To reduce long-term treatment complications without compromising efficacy, the MDH90 study was based on a new chemotherapy regimen devoid of both alkylating agents and anthracycline, followed by 20 Gy of radiotherapy (RT) for good responders. PATIENTS AND METHODS: From January 1990 to July 1996, 202 children were enrolled from 30 institutions. Good responders to four cycles of vinblastine, bleomycin, etoposide (VP16), and prednisone (VBVP) were given 20 Gy of RT and no further therapy. Poor responders were given vincristine, procarbazine, prednisone, and doxorubicin. After a second evaluation, good responders were given 20 Gy of RT, and poor responders were given 40 Gy of RT. RESULTS: One hundred seventy-one patients (85%) were good responders to VBVP, 27 (15%) were poor responders, and four did not respond. With a median follow-up of 74 months (range, 25 to 117 months), the 5-year overall survival rate (mean ± SD) is 97.5% ± 2.1%, and the event-free survival rate (mean ± SD) is 91.1% ± 1.8%. Significant predictors of worse event-free survival in multivariate analysis were hemoglobin &lt; 10.5 g/L, “b” biologic class, and nodular sclerosis. CONCLUSION: These results suggest that most children with clinical stage I and II HD can be treated with chemotherapy devoid of alkylating agents and anthracycline, followed by low-dose RT.
An over the counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild to moderate atopic dermatitis: A randomized, controlled trial
Authors: Drew W Miller, Sarah B Koch, Brad A Yentzer, Adele R Clark, Jenna R O'Neill, Julie Fountain, Teresa M Weber, Alan B Fleischer
Journal: Journal of the American Academy of Dermatology (2011)
Influence of different spirometry interpretation algorithms (SIA) on decision making among primary care physicians
Authors: Anthony D'Urzo, Pieter Jugovic, Reuven Jhirad
Journal: European Respiratory Journal (2012)

Background: Typically, the only spirometric data required for clinical decision making are the Forced Expiratory Volume in one second (FEV1) and the Forced Vital Capacity (FVC). Limitations of SIA promoted for adoption in primary care have been described (Can Fam Physician October 2011 57: 1148-1152, 1153-1156).

Aims and Objectives: This study examines how different SIA may influence decision making among primary care physicians.

Method: Thirty seven primary care physicians were asked to interpret nine spirograms presented twice in random sequence using two different SIA (as stand alone aids) and touch pad technology (remote audience response devices) for anonymous data capture and recording.

Results: We observed important differences in the interpretation of the same spirograms using two different SIA. When the pre-bronchodilator FEV1/FVC ratio was greater than 0.70 one algorithm lead to a normal interpretation; the second SIA prompted a bronchodilator challenge revealing changes in FEV1 that were consistent with asthma. The reliance of changes in FEV1 after bronchodilator challenge to distinguish asthma from COPD in one SIA led to consideration of asthma despite the presence of data that was also consistent with COPD; the latter SIA did not include a logic string leading to a post-bronchodilator FEV1/FVC so a definitive consideration of COPD could not be made. The absence of a post-bronchodilator FEV1/FVC decision node in one algorithm prompted referral for evaluation of low FVC.

Conclusions: This pilot study suggests that different SIA may influence decision making and lead clinicians to interpret the same spirometry data differently.
Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa–pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation?
Authors: Richard J. Sylvester, Willem Oosterlinck, Sten Holmang, Matthew R. Sydes, Alison Birtle, Sigurdur Gudjonsson, Cosimo De Nunzio, Kikuo Okamura, Eero Kaasinen, Eduardo Solsona, Bedeir Ali-El-Dein, Can Ali Tatar, Brant A. Inman, James N’Dow, Jorg R. Oddens, Marek Babjuk
Journal: European Urology (2015)
The risk of default in TB patients in the Russian Federation
Authors: Sergey Sterlikov, Vadim Testov
Journal: European Respiratory Journal (2014)

The risk of default in MDR-TB and non MDR-TB cohorts for new cases and previously treated patients was estimated.   Methods.  A prospective cohort review of patients treated in 2010 included: 1). 3.760 MDR-TB cases including 995 new TB cases, 534 relapses and 2231 other retreatment cases (1.297-after treatment failure, 161-after default and 773 – from group “other”); 2). 10.458 non MDR-TB patient including 7717 new cases, 1149 relapses and 1592 other retreatment cases). Absolute (AR) and relative risk (RR) of default were calculated.   Results.  Treatment success and default rates comprised for: new MDR-TB cases – 60.7% and 15.4%; new non MDR-TB cases - 67.2% and 12.7%; MDR-TB relapses – 51.9% and 14.0%; non MDR-TB relapses – 54.0% and 12.4%; other MDR-TB retreatments – 39.2% and 21.4%; other non MDR-TB retreatments – 34.8% and 22.0% respectively. New MDR-TB cases demonstrated maximal RR of default due to increasing of treatment duration. There were not significant differences in the RR for MDR-TB and non MDR-TB patients with relapses and other retreatment cases. MDR-TB patients from group “treatment after default” demonstrated maximal AR of default and 30% of them resulted as defaulters.   Conclusion.  New MDR-TB patients have maximal RR of default but highest treatment success rate and they are focus group for default prevention tools.
Sternal osteomyelitis after cardiopulmonary resuscitation
Authors: R H Mallinson, C H Tremlett, B V Payne, J E Richards
Journal: Journal of the Royal Society of Medicine (1999)

A diabetic woman aged 71 had an asystolic cardiac arrest during insertion of an intrauterine caesium implant for treatment of adenocarcinoma of the uterus. After successful cardiopulmonary resuscitation with defibrillation, closed chest compression, pharmacological therapy and endotracheal intubation, she was transferred to the intensive care unit and a right internal jugular line and right radial arterial line were inserted for supportive therapy. She was ventilated for 24 hours and required intravenous dopamine for 48 hours to maintain renal function. Cardiac enzymes were not raised and no electrocardiographic changes were noted after her arrest. Her condition was stabilized sufficiently to allow transfer to the general ward and her diabetes remained well controlled with insulin. She was apyrexial and showed no signs of infection at the time of transfer. She recovered well and four days after her arrest the internal jugular catheter was removed. The skin around the line was noted to be red and inflamed at this time and a swab from this site was sent for microbiological culture; although this yielded a heavy growth of Staphylococcus aureus sensitive to erythromycin, flucloxacillin and vancomycin, no antibiotics were prescribed. After six more days in hospital, she was discharged home on a maintenance dose of insulin, captopril, frusemide and aspirin. Seven days after discharge she was readmitted with increasing confusion, immobility and shortness of breath. She had a bruise on the right side of the sternum. Her temperature was 39.4°C; blood pressure 110/60mmHg; pulse 120 beats per minute; white blood count 26.6 x 109/L. Sepsis was diagnosed; and, after blood had been taken for culture, she was started on thrice daily cefotaxime 1 g and metronidazole 500 mg. Despite full supportive therapy, she died within four hours of readmission. The blood cultures taken at the time of readmission grew S. aureus with the same antibiotic susceptibility profile as that isolated from inflamed skin around her right internal jugular line during her previous admission. Post-mortem examination revealed sternal osteomyelitis evolving from a fracture of the mid part of the body of the sternum. Pus from this infection had tracked into the subcutaneous tissues and into the left pleural space. Culture of this pus yielded S. aureus. The cause of death was judged to be staphylococcal septicaemia arising from osteomyelitis of the sternum following fracture.
Validity of optoelectronic plethysmography at rest and during submaximal exercise
Authors: Danielle Vieira, Mariana Hoffman, Danielle Gomes, Raquel Britto, Veronica Parreira
Journal: European Respiratory Journal (2014)

Background:  Optoelectronic plethysmography (OEP) has been used in different experimental protocols, including exercise. The investigation of the validity of OEP has been performed mainly during maximal exercise.  Aim and objectives:  To evaluate the validity of the OEP system at rest and during submaximal exercise in heatlhy subjects.  Method:  Twelve subjects (6 M / 6F; 24±1 yrs) with normal lung function completed the study protocol. Participants were assessed at rest and during a 12-minute submaximal exercise protocol on a cycle ergometer. IC maneuvers were performed at rest and during exercise and were simultaneously recorded by OEP system (IC OEP ) and by a spirometer (IC SP ). The percentage of discrepancy between measurements, linear regression analysis and Bland-Altman analysis were used to compare measurements. The study was approved by the Institution Ethics Committee.  Results:  It was considered 150 IC maneuvers for analysis. The percentage of discrepancy between the measurements were -9.6 (8.6%) at rest and -4.6 (5.5%) during exercise. Regression equation at rest was IC OEP = 1.16 x (IC  SPRIMOMETER ) - 0.15 (R 2  =0.90; p = 0.0002) and, during exercise, IC OEP = 1.01 x (IC  SPRIMOMETER ) + 0.10 (R 2  =0.96; p = 0.0008). Figure 1 presents the results for Bland-Altman analysis during exercise .    Conclusions:  The results of this study demonstrate that the OEP is a valid evaluation system of healthy individuals at rest and during exercise.
Detection of prostate cancer recurrence using an ultrasensitive nanoparticle-based PSA assay
Authors: J. Storhoff, T. Lubben, P. Lefebvre, T. Holzman
Journal: Journal of Clinical Oncology (2009)

e16146 Approximately 400,000 men are diagnosed each year with prostate cancer worldwide, and many of those patients undergo radical prostatectomy in an attempt to cure the disease. Although prostatectomy is effective for a majority of patients, approximately 15 to 40 % will experience prostate cancer recurrence within 5 years, and a majority of those patients will die from the disease (JAMA. 2008;299:2760-2769). Currently, prostate cancer recurrence is determined by monitoring prostate specific antigen (PSA) levels in patients following treatment, and those patients whose PSA levels rise above the clinical cutoff of 200 pg/mL PSA are defined as having recurrent prostate cancer. For those that do recur and have high PSA doubling times, early salvage radiotherapy confers a significant increase in prostate cancer specific survival (1). We have developed an ultrasensitive assay that measures PSA levels with a limit of detection of 0.5 pg/mL PSA with a CV of less than 20 % at 2 pg/mL. This assay utilizes functionalized gold nanoparticles to label PSA targets captured onto antibody coated glass substrates. The amount of PSA is quantified through silver enhancement of the functionalized gold. In this presentation, we describe the application of this technology in monitoring PSA levels in patients that are approximately 400 fold below the current clinical cutoff as a means of diagnosing prostate cancer recurrence at a much earlier timepoint than current assays. [Table: see text]
Importance of bone marrow cytogenetic evaluation before autologous bone marrow transplantation for Hodgkin's disease.
Authors: N J Chao, A P Nademanee, G D Long, G M Schmidt, T A Donlon, P Parker, M L Slovak, L S Nagasawa, K G Blume, S J Forman
Journal: Journal of Clinical Oncology (1991)

Alkylating agents used either with or without radiation therapy have been associated with the development of myelodysplastic syndrome (MDS) and acute nonlymphoblastic leukemia (ANLL) after treatment of both malignant and nonmalignant disorders. This report describes seven patients with recurrent Hodgkin's disease (HD) evaluated for bone marrow transplantation (BMT) who developed chromosomal abnormalities, and emphasizes the importance of bone marrow cytogenetic studies before bone marrow harvest. Three patients with histologically normal bone marrow underwent autologous BMT and subsequently developed an MDS or ANLL. Four patients had the clonal abnormality detected before bone marrow harvest and did not proceed to BMT.
Use of an electronic monitoring system to generate objective information on patients' adherence to taking treatments of a novel inhaled tobramycin solution
Authors: Dorota Sands, Ewa Sapiejka, Henryk Mazurek, Grzegorz Gaszczyk
Journal: European Respiratory Journal (2013)

Objective:  Patient adherence to inhaled medications is important to interpret study results. Self-reported diaries have a high potential for manipulation. To provide a reliable tool to assess patient adherence to treatment, a monitoring feature was developed and incorporated into a specific eFlow technology nebulizer. TIS I (VANTOBRA/Tolero) was compared in a randomised study in cystic fibrosis patients with TIS II (TOBI/PARI LC PLUS).   Methods:  The configuration’s key feature is an electronic chip card recording date, time and duration of each nebulization session and cause for termination. The nebulizer operates only by insertion of a valid chip card. Recorded data were processed using PARI’s Patient Monitoring Software. Adherence is calculated as the ratio of actual/planned inhalations and shown graphically per study day or cumulatively.   Results:  Data of 54/58 patients were analysed. Mean adherence was 99% for all evaluable patients, 98% in patients > 13 years and 99% in patients of 7-13 years of age. The adherence rate was comparable in all treatment cycles, independent whether the patient was randomized to receive TIS I as the first or second treatment cycle. As per patient diary, the compliance in the TIS II group was 99%. Mean time/inhalation was 4.4 min (TIS I) and 24.3 min (TIS II).   Conclusion:  The eFlow technology nebulizer with patient monitoring function provides objective adherence data. The monitoring feature offers the potential to distinguish whether an observed treatment failure is based on lack of drug efficacy or non-adherence to the prescribed treatment regimen.
Lung cancer in women: A seven years study in Eastern Algeria
Authors: Tarek Djenfi, Lilia Haouara, Abla Karrouche, Bahria Haddad, Abdelmadjid Djebbar
Journal: European Respiratory Journal (2013)

Background  The increase in lung cancer incidence in women is probably the most important epidemiological event in the recent years.  Aims  The aim of this study was to identify the particularities of lung cancer in women in eastern Algeria (Aures region) including age, risk factors, clinical symptoms, comorbidities, histological type, metastatic sites, staging and treatment modalities.  Patients and methods:  A retrospective and descriptive study from January 2006 to October 2012 including 237 patients admitted in the respiratory department of Batna, Algeria with a histological confirmed lung cancer.  Results:  The 33 women who have been the subject of our study had a mean age of 61 years vs 62 years for men with a sex-ratio of 6. Our study covers a period of more than seven years, during which the number of cases has oscillated between 2 and 9 cases (in 2009). Risk-factors such as active smoking, passive smoking, exposing jobs and hormonal factors were related. All women were non-smokers, 27% passive smokers, 3% taking chewing tobacco. The relative risk of developing lung cancer among non-smokers was 5 compared to male non-smokers. Clinical signs were dominated by hemoptysis and chest pain in about 60% of cases and cough was reported in 40% patients, unlike men in whom cough was frequently reported (84%), followed by pain and hemoptysis. The most common histological type was squamous cell carcinoma (48%) followed by adenocarcinoma (36%). The main metastatic site was the lung (15%). 72% of patients were classified IIIb or IV.  Conclusion  Lung cancer in women is different then men, smoking is not the most important risk factor.
Controversies in Management: Community care allows patients to reach their full potential
Authors: J Young
Journal: BMJ (1994)

Controversies in ManagementIs stroke better managed in the community?Community care allows patients to reach their full potential John Young Hospital based care currently dominates the manage- ment of stroke in Britain.This has been an insidious and unplanned process, and it is concerning that this acute care model may become regarded as the solution to stroke.I do not believe that hospital care should be This is the tenth in a series of articles examining some ofthe difficult decisio that arise in medicine
Pharmacy chain leaves US Chamber of Commerce over tobacco policy
Authors: Michael McCarthy
Journal: BMJ (2015)

The second largest pharmacy chain in the United States, CVS Health, announced on 7 July that it would leave the US Chamber of Commerce after revelations that the trade group and its foreign affiliates had been actively lobbying against anti-smoking laws abroad, particularly in developing nations.

“We were surprised to read recent press reports concerning the US Chamber of Commerce’s position on tobacco products outside the United States. CVS Health’s purpose is to help people on their path to better health, and we fundamentally believe tobacco use is in …
Abstract 14985: The Impact of the Rapid Use of Beta-Blockers on Ventricular Remodeling and Mortality in End-Stage Heart Failure (The FAST Study)
Authors: Domingos Savio B Melo, Antonio Carlos P Barretto, Aristea I Oliveira, Juliano N Cardoso, Fernando Savio A Melo, Marcelo Ochiai, Paulo c Morgado, Jose F Ramirez
Journal: Circulation (2011)

Introduction: The therapy with beta blockers (BB) is fundamental in the treatment of heart failure(HF). However, even though the data documents the benefits of BBs, the optimizing of the dosage of ...
Apoptotic cells trigger a membrane-initiated pathway to increase ABCA1
Authors: Aaron M. Fond, Chang Sup Lee, Ira G. Schulman, Robert S. Kiss, Kodi S. Ravichandran
Journal: Journal of Clinical Investigation (2015)

Macrophages clear millions of apoptotic cells daily and, during this process, take up large quantities of cholesterol. The membrane transporter ABCA1 is a key player in cholesterol efflux from macrophages and has been shown via human genetic studies to provide protection against cardiovascular disease. How the apoptotic cell clearance process is linked to macrophage ABCA1 expression is not known. Here, we identified a plasma membrane-initiated signaling pathway that drives a rapid upregulation of ABCA1 mRNA and protein. This pathway involves the phagocytic receptor brain-specific angiogenesis inhibitor 1 (BAI1), which recognizes phosphatidylserine on apoptotic cells, and the intracellular signaling intermediates engulfment cell motility 1 (ELMO1) and Rac1, as ABCA1 induction was attenuated in primary macrophages from mice lacking these molecules. Moreover, this apoptotic cell-initiated pathway functioned independently of the liver X receptor (LXR) sterol-sensing machinery that is known to regulate ABCA1 expression and cholesterol efflux. When placed on a high-fat diet, mice lacking BAI1 had increased numbers of apoptotic cells in their aortic roots, which correlated with altered lipid profiles. In contrast, macrophages from engineered mice with transgenic BAI1 overexpression showed greater ABCA1 induction in response to apoptotic cells compared with those from control animals. Collectively, these data identify a membrane-initiated pathway that is triggered by apoptotic cells to enhance ABCA1 within engulfing phagocytes and with functional consequences in vivo.