tbuckley/cabot-search huggingface dataset:
North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina
Journal: BMJ (1996)

The aim of this guideline is to provide recommendations to aid primary health care professionals in their management of patients with chronic stable angina due to coronary artery disease (not aortic stenosis or hypertrophic obstructive cardiomyopathy). It does not deal with unstable angina or myocardial infarction. It is a summary version of the full guideline,1 to which reference should be made for clarification or further information. The development group assumes that health care professionals will use general medical knowledge and clinical judgment in applying the general principles and specific recommendations in this document to the management of individual patients. Recommendations may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the practitioner in the light of available resources and circumstances presented by individual patients. Throughout this guideline categories of evidence (cited as I, II, and III) and the strength of recommendations (A, B, or C) are as described in the paper in the previous issue (23 March, p 760). Aspects covered by this guideline are investigation, risk factor identification and management, drug treatment, and referral. All recommendations are for primary health care professionals and apply to adult patients attending general practice with angina. Comment—Assessment will be based on a clinical history and relevant examination. This guideline requires that the following should be known: precipitants of anginal attacks; smoking history; occupation; amount of exercise taken; drug history; weight; blood pressure. Comment—The group thought that a chronological age limit for investigation or referral was not appropriate. Functional status was thought to be more appropriate. ### Precipitating factors RECOMMENDATION ### Investigation of angina RECOMMENDATION Patients being investigated for angina should have the following investigations:
A novel recurrent EP300–ZNF384 gene fusion in B-cell precursor acute lymphoblastic leukemia
Authors: Y Gocho, N Kiyokawa, H Ichikawa, K Nakabayashi, T Osumi, T Ishibashi, H Ueno, K Terada, K Oboki, H Sakamoto, Y Shioda, M Imai, Y Noguchi, Y Arakawa, Y Kojima, D Toyama, K Hata, T Yoshida, K Matsumoto, M Kato, T Fukushima, K Koh, A Manabe, A Ohara
Journal: Leukemia (2015)
New guidelines for urgent referral of patients with cancer
Authors: N. Summerton
Journal: BMJ (2000)

Editor—Any new policy initiative such as the Department of Health's new guidelines for urgent referral of patients with cancer is inevitably accompanied by the views of both iconoclasts and opportunists. Sikora has clearly expressed his view, but I believe he is wrong.1

As a general practitioner I am in a different position from Sikora. Patients do not arrive at my surgery with diagnoses and neatly typed referral letters; they arrive with often vague and undifferentiated problems. My task is to identify which patients with, for example, persistent cough warrant an urgent referral or radiography. Tertiary care specialists may often approach lymphadenopathy with biopsy; in general practice we need to adopt a watchful waiting approach.

Sikora may be correct in stating that there is no evidence that delay in diagnosis is a large problem in the United Kingdom. However, a lack of evidence is surely an opportunity for further research.

The guidelines are merely an attempt to identify evidence for the diagnosis of cancer that is applicable to primary care populations which have a low prevalence of cancer.2 As a member of the working group I accept the criticism that in many areas the evidence is inconclusive and consensus approaches have necessarily been adopted. However, a strong element of primary care has been and continues to be incorporated in the final output. Above all, the process of developing guidelines for referring patients with cancer must be seen as dynamic and evolutionary. It is an opportunity for us in primary care to encourage researchers and policy makers to focus on the clinical questions that matter most to us and not necessarily on populist or pharmaceutical priorities.

Correct and targeted referral should reduce patients' anxiety by ensuring that the right patients reach the appropriate specialist rapidly. When patients cannot be cured they and their general practitioner will have time to sort out benefits and develop a plan of shared care with the oncologist or palliative care specialists. It also allows patients to get their life in order. Aside from effects on mortality, I believe that many patients will be given the opportunity to end life in a more dignified fashion as a consequence of more rapid and appropriate referral by their general practitioner.
Emphysematous Cystitis and Renal Stones in Cystic Fibrosis
Authors: Daya Upadhyay, Manu Jain
Journal: JAMA (2004)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
The Problem of Pseudo-Syphilis
Authors: John H Stokes
Journal: Annals of Internal Medicine (1929)

Article1 May 1929The Problem of Pseudo-SyphilisJOHN H STOKES, M.D.JOHN H STOKES, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-2-11-1139 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptWe are but lately come from the day when the first duty of a syphilologist was to emphasize the importance of a high degree of chronic suspicious alertness towards the omnipresence and the difficulties of recognition of syphilis. In many situations, and in certain groups and communities, that day is certainly not passed. There can be no doubt that emphasis on this aspect of the problem of diagnosis has been and still is well placed. But it is to the credit both of the revived teaching of syphilology and of the conscious effort of the practicing physician to keep abreast...References(1) MITCHELL JH: Menace of the slightly positive Wassermann reaction, J. A. M. A. 87:1351-1355, Oct. 23, '26. CrossrefGoogle Scholar(2) SHEPLARLYONSMACNEAL AEMAWJ: Serologic discord in latent and treated syphilis; report of cases, Arch. Dermat. & Syph. 18:742-754, Nov. '28. CrossrefGoogle Scholar(3) STOKES JH: True non-specific positive blood Wassermanns, Modern Clinical Syphilology, W. B. Saunders Co., Phila., 1926, iFg. 52, p. 85. Google Scholar(4) The biologic false positive blood Wassermann in subacute bacterial endocarditis, Ibid, Fig. 695, p. 865. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pa.*Read before the Academy of Medicine and affiliated societies, Rochester, N. Y., January 2, 1929. From the Department of Dermatology and Syphilology, School of Medicine, University of Pennsylvania. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1929Volume 2, Issue 11Page: 1139-1154KeywordsDermatologySyphilis ePublished: 1 December 2008 Issue Published: 1 May 1929 PDF downloadLoading ...
A patient who changed my practice: Footsteps and faces
Authors: M. White
Journal: BMJ (1999)

It is said that a bird's eye view changes the perspective even of familiar things, but it was a bed's eye view that changed mine. Completely bed bound, unable to use a commode, I had a peculiar perspective on people passing through the ward. Their comings and goings became a series of footsteps and faces and, if I was lucky, smiles and voices.

I heard footsteps, quick yet purposeful, and a figure came into view. The face looked towards the floor, avoiding eye contact, but I could make out a frown across his forehead. Bustling along, appearing hassled and giving out signals which say, “I'm busy, don't bother me.” It's a junior doctor, wearing a white coat with pockets bulging. I don't recognise him. “He's not part of my team,” I thought, …
Benefits of pulmonary rehabilitation and predictor of changes in exercise capacity for idiopathic pulmonary fibrosis
Authors: Takuya Mishima, Tomoya Ogawa, Fumiko Watanabe, Jun Hirasawa, Furukawa Takurou, Yuko Tanaka, Kazuya Shingai, Yusuke Nagae, Hiroyuki Taniguchi, Yasuhiro Kondoh, Tomoki Kimura, Kensuke Kataoka, Toshiaki Matsuda, Toshiki Yokoyama, Shinichi Arizono
Journal: European Respiratory Journal (2014)

Background and Aim of Study

Previous studies reported the benefits of pulmonary rehabilitation (PR) for idiopathic pulmonary fibrosis (IPF). However, predictor of changes in exercise capacity following PR for IPF are limited. The aim of this study was to examine the effects of PR and predictor of changes in exercise capacity for IPF.

Methods

Outpatients with IPF completed a 10-weeks of PR at Tosei General Hospital from January 1999 to December 2013 were studied. PR program was consisted of high intensity exercise training (60 to 80%peak work rate on a cycle ergometer), resistance training and inspiratory muscle training with intensity of 30% of the patient's MIP. Pulmonary function (%FVC, %DLCO), dyspnea (BDI), quadriceps force, respiratory muscle strength (MEP and MIP), exercise capacity (6MWD), health status (SGRQ) were measured at baseline and after PR.

Results

Twenty nine patients with IPF (22 males, 69±6years ; %FVC;68±16%, %DLCO ; 47±13%) were included in the study. Following PR, quadriceps force (84.6±28.3 to 92.9±31.4Nm, p<0.01), MEP (132.3±50.2 to 142.7±52.3cmH2O, p<0.01), MIP (101.7±34.5 to 114.6±36.5cmH2O, p<0.01), 6MWD (485.7±72.7 to 498.7±80.5m, p<0.05) were significantly improved. The improvement in 6MWD was associated significantly with %FVC ( ρ=0.373, p=0.0485) and %DLCO ( ρ=0.389, p=0.0396) at baseline.

Conclusion

PR in IPF patients improved quadriceps force, respiratory muscle strength, and exercise capacity. %FVC and %DLCO at baseline were significant predictor of changes in exercise capacity following PR. These results suggest that PR should be performed early for patients with IPF.
Lesson of the week: Morphine induced allodynia in a child with brain tumour What is allodynia?
Authors: S. Heger, C. Maier, K. Otter, U. Helwig, M. Suttorp, A. Berger
Journal: BMJ (1999)

Morphine is the drug of choice for patients with severe acute or chronic pain, especially those with intractable pain associated with malignant diseases.The drug is metabolised by the liver into morphine-3-glucuronide and morphine-6-glucuronide.The glucuronides are mainly eliminated via bile and urine. 1 Morphine-6glucuronide binds to opiate receptors and can be detected in the cerebral fluid after systemic administration; its analgesic effect is 40 times as potent as that of morphine itself. 2 In contrast, morphine-3-glucuronide, which represents the major plasma and urinary metabolite of morphine, antagonises the effect of morphine and morphine-6-glucuronide. 3 According to the World Health Organisation's recommendations for treatment of cancer pain, the morphine dose should be adapted to the individual patient.Therefore, if patients complain of an insufficient analgesic response to standard morphine dosage, they should receive higher doses, which may exceed hundreds of milligrams of morphine hourly. 4In a few adults treated with higher dosages for prolonged periods of time, morphine induced hyperalgesia or allodynia develops. 5 6 Allodynia has been provoked in Sprague-Dawley rats.These animals are unable to metabolise morphine to morphine-6-glucuronide, and thus morphine-3glucuronide is the major morphine metabolite.A noticeable inverse relation was observed between the mean degree of analgesia and ratio of plasma morphine-3-glucuronide to morphine. 7Consequently, a raised morphine-3-glucuronide to morphine-6glucuronide ratio seems to be responsible for the phenomenon of hyperalgesia and allodynia.][10] Children metabolise morphine differently from adults, and the morphine-3glucuronide to morphine ratio, in particular, is dependent on age.][8] Allodynia and hyperalgesia induced by high amounts of morphine have already been described in adult patients. 11However, to our knowledge, morphine induced hyperalgesia has not been reported in children so far. 5In addition, in many previous articles concerning adult patients with hyperalgesia, the morphine and metabolite plasma concentrations were not measured.
Claude Lenfant, MD
Authors: Claude Lenfant
Journal: JAMA (2003)

He has seen six National Institutes of Health (NIH) directors come and go, but at the end of this month, Claude Lenfant, MD, director of the National Heart, Lung, and Blood Institute (NHLBI), will be absent from his office at 5 AM on a weekday for the first time since 1982.
Medicine’s Continuous Improvement Imperative
Authors: Robert S. Huckman, Ananth Raman
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
A Hepatitis Virus Complicating Studies With Mouse Leukemia
Authors: Robert A. Manaker, Chester V. Piczak, Alice A. Miller, Mearl F. Stanton
Journal: JNCI Journal of the National Cancer Institute (1961)

Hepatitis was frequently observed in strain BALB/c mice during the course of studies with the Moloney murine leukemia virus. A virus isolated from mice with hepatic disease was propagated and quantitatively assayed by methods in vitro. The properties of this agent, designated MHV-A59, were detailed, and a relationship to one member of the established mouse “hepatoencephalitis” group of viruses was ascertained.
Binding of hepatitis B virus to its cellular receptor alters the expression profile of genes of bile acid metabolism
Authors: Nicola Oehler, Tassilo Volz, Oliver D. Bhadra, Janine Kah, Lena Allweiss, Katja Giersch, Jeanette Bierwolf, Kristoffer Riecken, Jörg M. Pollok, Ansgar W. Lohse, Boris Fehse, Joerg Petersen, Stephan Urban, Marc Lütgehetmann, Joerg Heeren, Maura Dandri
Journal: Hepatology (2014)

Chronic hepatitis B virus (HBV) infection has been associated with alterations in lipid metabolism. Moreover, the Na+-taurocholate cotransporting polypeptide (NTCP), responsible for bile acid (BA) uptake into hepatocytes, was identified as the functional cellular receptor mediating HBV entry. The aim of the study was to determine whether HBV alters the liver metabolic profile by employing HBV-infected and uninfected human liver chimeric mice. Humanized urokinase plasminogen activator/severe combined immunodeficiency mice were used to establish chronic HBV infection. Gene expression profiles were determined by real-time polymerase chain reaction using primers specifically recognizing transcripts of either human or murine origin. Liver biopsy samples obtained from HBV-chronic individuals were used to validate changes determined in mice. Besides modest changes in lipid metabolism, HBV-infected mice displayed a significant enhancement of human cholesterol 7α-hydroxylase (human [h] CYP7A1 ; median 12-fold induction; P &lt; 0.0001), the rate-limiting enzyme promoting the conversion of cholesterol to BAs, and of genes involved in transcriptional regulation, biosynthesis, and uptake of cholesterol (human sterol-regulatory element-binding protein 2, human 3-hydroxy-3-methylglutaryl-coenzyme A reductase, and human low-density lipoprotein receptor), compared to uninfected controls. Significant h CYP7A1 induction and reduction of human small heterodimer partner, the corepressor of hCYP7A1 transcription, was also confirmed in liver biopsies from HBV-infected patients. Notably, administration of Myrcludex-B, an entry inhibitor derived from the pre-S1 domain of the HBV envelope, provoked a comparable murine CYP7A1 induction in uninfected mice, thus designating the pre-S1 domain as the viral component triggering such metabolic alterations. Conclusion : Binding of HBV to NTCP limits its function, thus promoting compensatory BA synthesis and cholesterol provision. The intimate link determined between HBV and liver metabolism underlines the importance to exploit further metabolic pathways, as well as possible NTCP-related viral-drug interactions. (Hepatology 2014;60:1483–1493)
Abstract 13223: Structural Equation Modeling Demonstrates only an Indirect Effect of Obesity on Carotid Intima-Media thickness in Adolescents and Young Adults
Authors: Zhiqian Gao, Philip R Khoury, Connie E McCoy, Amy S Shah, Thomas R Kimball, Lawrence M Dolan, Elaine M Urbina
Journal: Circulation (2014)

Introduction: Increased carotid intima-media thickness (cIMT) is associated with cardiovascular (CV) events in adults. Thicker cIMT is found in youth with elevated CV risk factors including obesity although biologically plausible reasons for a direct effect are not clear. We hypothesized that obesity affects cIMT only indirectly through other CV risk factors and this could be demonstrated with use of structural equation modeling (SEM). Methods: Ultrasound of the right and left common, bulb and internal carotid arteries was performed in 784 adolescent and young adults (10-24 years old, 65% female, 41% Caucasian, 32% T2DM). Demographics, anthropometrics and fasting laboratory data were collected. Traditional multiple regression analyses (MRA) were performed to assess independent determinants of cIMT. Analyses were then repeated with SEM. Results: MRA models explained 11%-22% of variation of common, bulb and internal cIMT. Obesity, age, sex and SBP z-score were significant determinants of all cIMT segments. Race, presence of T2DM, HbA1c and non-HDL contributed for some segments. In SEM, latent variable “cIMT” was used to represent the 3 segments of cIMT. Latent variable “BP” was extracted from SBP and DBP z-score. Latent variable “BGC” (blood glucose control) was extracted from fasting glucose and HbA1c. The final SEM explained a larger amount of the variance of cIMT (43%). The largest direct effect on cIMT was age followed by BP, blood glucose control and non-HDL. BMI, another central risk factor in the pathway towards atherosclerosis, only had a significant indirect effect through blood glucose control, BP &amp; non-HDL. CRP had a small indirect effect through blood glucose control. We conclude that traditional CV risk factors have important direct effects on cIMT in adolescents and young adults but adiposity exerts its influence only through other CV risk factors. SEM may be a useful tool in modeling complex biological pathways.
Chronotropic response during exercise in schistosomiasis associated PAH as compared to idiopathic PAH
Authors: Luciana Morinaga, André Albuquerque, Carlos Jardim, Caio Fernandes, Ana Paula Breda, Susana Hoette, Rogerio Souza
Journal: European Respiratory Journal (2013)

Chronotropic impairment is associated with decreased survival in Idiopathic Pulmonary Arterial Hypertension (IPAH) patients. However, little is known if this could be one of the factors that influence the different clinical course seen in schistosomiasis associated PAH (Sch-PAH).  Objetive: To compare the performance and heart rate (HR) response of Sch-PAH and IPAH patients during maximal cardiopulmonary exercise (CPET).  Method: Retrospective analysis of 23 CPETs (15 IPAH, 7 Sch-PAH). Gas exchange, ventilatory and chronotropic parameters were analyzed during rest, anaerobic threshold (AT) and peak. HR, VO2 and VO2/HR were analyzed as absolute and as a proportion of maximum predicted values (HR%pred, VO2%pred, VO2/HR%pred) at each point. HR recovery (HRR) was the difference between peak HR and HR on the first minute after exercise interruption.  Results: IPAH patients tended to be younger (37.6 ± 10.7 vs 47.8 ± 12.5 yrs, p=0.053), with higher proportion of female patients and similar hemodynamics and VO2%pred. IPAH had higher VO2/HR%pred during rest (0.37 ± 0.12 vs 0.23 ± 0.12, p=0.04), with no differences found at AT or peak exercise. Both groups had similar HR, HR%pred and VE/VCO2 at each point. HRR was also similar between groups (16.9 ± 8.2 vs 14.8 ± 12.6bpm, for IPAH and Sch-PAH respectively, p=0.72).  Conclusion: No differences were found in HR response between IPAH and Sch-PAH. Although VO2/HR was higher for resting iPAH, this difference was not found during exercise. Our results suggest that chronotropic impairment may not be the mechanism explaining the survival difference seen in IPAH and Sch-PAH.
Contribution of the sT elevation/T-wave normalization in q-wave leads during routine, pre-discharge treadmill exercise test to patient management and risk stratification after acute myocardial infarction
Authors: George Hahalis, Christos Stathopoulos, Dimitrios Apostolopoulos, Pavlos Vasilakos, Dimitrios Alexopoulos, Antonis S Manolis
Journal: Journal of the American College of Cardiology (2002)