tbuckley/cabot-search huggingface dataset:
Changes in the Surgical Management of Early Breast Cancer in England
Authors: J Morris, G T Royle, I Taylor
Journal: Journal of the Royal Society of Medicine (1989)

A questionnaire survey of consultant surgeons in England indicates that there has been a considerable change in opinion over the past few years concerning the management of early breast cancer; only 39.1% would now perform mastectomy, whereas 64.4% would perform conservative surgery. The most common forms of management are simple mastectomy and axillary clearance (21.9%); wide excision, axillary clearance plus radiotherapy (20.1%); and wide excision plus radiotherapy alone (16.9%). The majority of the surgeons would offer patients a choice of surgery, but only 52% had access to a breast care nurse.
Extramedullary Sites of Involvement in Hematologic Malignancies
Authors: C. S. Chim, W. M. Wong, J. Nicholls, L. P. Chung, R. Liang
Journal: Journal of Clinical Oncology (2002)

Article Tools DIAGNOSIS IN ONCOLOGY Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.20.1.344 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11773190 Extramedullary Sites of Involvement in Hematologic Malignancies Case 3. Hemorrhagic Gastric Plasmacytoma as the Primary Presentation in Multiple Myeloma C. S. ChimxC. S. ChimSearch for articles by this author , W. M. WongxW. M. WongSearch for articles by this author , J. NichollsxJ. NichollsSearch for articles by this author , L. P. ChungxL. P. ChungSearch for articles by this author , R. LiangxR. LiangSearch for articles by this author Show More Queen Mary Hospital, University of Hong Kong, Hong Kong https://doi.org/10.1200/JCO.2002.20.1.344 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical Oncology
The periodontal disease–systemic health–infectious disease axis in developing countries
Authors: Cyril O. Enwonwu, Nathanael Salako
Journal: Periodontology 2000 (2012)

Abstract Oral health is relatively low priority in the health policy of many developing countries. These countries, particularly those in sub‐Saharan Africa, are still constrained by a wide range of infectious diseases such as HIV/AIDS, tuberculosis, measles and malaria, as well as by a heavy burden of intergenerational malnutrition. There is currently a disturbing trend in the rise of noncommunicable diseases in these countries. The noncommunicable diseases share many risk factors with periodontal diseases, the prevalence and severity of which are already markedly influenced by microbial infections. There are many fundamental gaps in our understanding of oral diseases, particularly in resource‐poor settings. Perhaps this is the time to integrate neglected oral diseases and the noncommunicable diseases into the relatively well‐funded global programs for the elimination of malaria, tuberculosis, AIDS and malnutrition.
Accuracy of the API Campy system, the Vitek 2 Neisseria–Haemophilus card and matrix-assisted laser desorption ionization time-of-flight mass spectrometry for the identification of Campylobacter and related organisms
Authors: D. Martiny, A. Dediste, L. Debruyne, L. Vlaes, N.B. Haddou, P. Vandamme, O. Vandenberg
Journal: Clinical Microbiology and Infection (2010)
Hepatic encephalopathy due to liver cirrhosis
Authors: Mark A Ellul, Santosh A Gholkar, Timothy J Cross
Journal: BMJ (2015)

#### The bottom line

Overt hepatic encephalopathy affects approximately 20% of patients with liver cirrhosis each year.1 It is a pathognomonic feature of liver failure and a common cause of admission to emergency departments. It affects the quality of life of both patient and relatives2 and signifies a poor prognostic indicator for patients with cirrhosis, with a survival of only 23% at three years from onset.3 Treatments aimed at interrupting the pathogenesis of hepatic encephalopathy are known to reduce frequency of hospital admissions and improve survival.4

Studies suggest that the prevalence of chronic liver disease in the United Kingdom is increasing, in part owing to the increasing prevalence of non-alcoholic fatty liver disease (NAFLD), alcohol related liver disease, and hepatitis C.5 6 Clinicians therefore need to be able to recognise signs and symptoms of hepatic encephalopathy in patients who might not have a diagnosis of chronic liver disease.

This review aims to highlight the importance of recognising hepatic encephalopathy in chronic liver failure and outlines a practical and evidence based approach to its management, based on the framework of recent guidelines from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD).4 Hepatic encephalopathy in acute liver failure is managed differently, and will not be addressed.

#### Sources and selection criteria

We searched …
Confusing communication by health organizations in the public debate on legal smoking ban in Switzerland
Authors: Rainer Kaelin, Pascal Diethelm
Journal: European Respiratory Journal (2011)

Background:  Signature of the FCTC and the parliamentary initiative of MP Gutzwiller MD in 2004 started the process to a smoking ban, but resulted 10/08 in the federal Alibi Law, meeting neither international nor WHO standards. Thus, the Swiss Lung League (SLL; federation of cantonal lung leagues) launched an initiative with the collection of 130 000 signatures by 05/10. Media reporting is poor: only 10% of articles in the period 11/09- 02/10 were positive on smoking bans; so pressure on MP9s is insufficient to improve legislation.   Aim:  To detect communication flaws contributing to poor media reporting.   Method:  Analysis of official positions by health organizations on passive smoking.   Results:  A. The FMH (Federation of Swiss physicians) declined (letter 03/09), but finally backed 01/10 the SLL-initiative. B. The president of the the Society of Internists (SSI), declined positioning on passive smoking at its assembly 2008, arguing the congress was9nt nonsmoking and sponsors should be consulted (letter 04/08). The SSI has not positioned itself yet (submission) on its support of the SLL initiative. C. By its launchig the SLL urged cantonal lung leagues to collect signatures. Some cantonal leagues did not (e.g.Zurich, Vaud). Despite initial desaprobation by the lung league Vaud (letter 12/08), the annual report 2009 of this league declared official support of the SLL initiative.   Conclusion:  Reports on smoking bans are likely to improve, if health organizations communicate in a coordinated way. This can be achieved by all health organizations, since toxicity of passive smoke and public health benefits of smoking ban in public places are based on sound scientific evidence.
Death risk factors in COPD patients in Italian general practices: The COMODHES study
Authors: Sara Maio, Sandra Baldacci, Marco Borbotti, Franca Martini, Patrizia Silvi, Giuseppe Sarno, Sonia Cerrai, AnnaPaola Pala, Giovanni Viegi
Journal: European Respiratory Journal (2013)

Background : Chronic obstructive pulmonary disease (COPD) represents an important and increasing burden worldwide and can be an important cause of premature death.   Aims : to evaluate the risk factors for a death event reported by general practitioners (GPs) in their COPD patients.   Methods : prospective observational study in different Italian areas. 139 GPs enrolled 1874 patients with COPD diagnosis. Questionnaires were used to collect data on COPD management, health status and risk factors at baseline and after 12 months.  Univariate analyses were used to assess the relationship between reported death events and demographic characteristics (age, sex), risk factors exposure, health services use and GPs education. Logistic regression analysis was used to confirm the relationships found through the univariate analyses.   Results : After 12 months 7.3% of patients died. Univariate analyses showed a significantly higher frequency of death in males, older age, subjects with a higher number of exacerbations, ex-smokers, subjects with higher use of health services (GPs visits, emergency room and hospital admissions) and higher COPD severity level; a lower frequency was shown in subjects that received a GPs education on smoking reduction.  The logistic regression analysis confirmed the associations between death and older age (OR 1.10), higher number of exacerbations (OR 1.12), male gender (OR 1.83), current smoking (OR 2.08), hospital admissions (OR 2.10) and very severe COPD (OR 3.63).   Conclusions : beside the known demographic characteristics, a very severe COPD requiring hospitalisation and current smoking habits are closely related to a reduced life expectancy.  Funded by the Italian Health Minister.
A dose-escalation study with the novel formulation of the oral pan-class I PI3K inhibitor BEZ235, solid dispersion system (SDS) sachet, in patients with advanced solid tumors.
Authors: J. D. Peyton, J. Rodon Ahnert, H. Burris, C. Britten, L. C. Chen, J. Tabernero, V. Duval, N. Rouyrre, A. P. Silva, C. Quadt, J. Baselga
Journal: Journal of Clinical Oncology (2011)

3066 Background: BEZ235 is a potent and highly specific oral dual mTOR/PI3K inhibitor. BEZ235 hard-gelatin capsule (Burris, ASCO 2010) and SDS capsule (Rodon, SABCS 2010) were reported previously. Here we present the dose escalation with the new BEZ235 formulation (BEZ235 SDS sachet). Methods: Phase I dose-escalation study of BEZ235 given orally once daily to adult patients with advanced solid tumors. A Bayesian logistic regression model with overdose control was used to guide dose escalation. Results: At the time of abstract submission, 25 patients have been treated with BEZ235 SDS sachet once daily at 4 dose levels: 800 mg (6); 1,000 mg (4), 1,400 mg (8), 1,600 mg (7). Tumor types enrolled included: colorectal (8), breast (4), NSCLC (3), renal (3) and sarcoma (3). 4/25 patients have been treated for >3 cycles, 10/25 patients progressed within the first three cycles of treatment and 8/25 are on treatment at time of abstract preparation. Maximum tolerated dose (MTD) for BEZ235 SDS sachet is 1,600 mg/d. Dose limiting toxicities (DLT) included: 2 cases of grade 3 fatigue/asthenia (at 1,400 mg) and 1 grade 3 thrombocytopenia (at 1,600 mg). Most common adverse events (AE) which are considered possibly treatment related included: nausea, diarrhea, vomiting and fatigue (G1-G3). At 1,600 mg, PK was evaluated in 7 patients. The absorption was slow with a tmax within 4 to 6 hours post-dose. The elimination half-life is ranging from 3.5 to 13.5 hours. At steady state, the median Cmax was 1,800 ng/mL (CV% = 38) and exposure was 22,375.5 ng.h/mL (CV% = 44). The accumulation ratio based on exposures between day 1 and steady state was estimated to be approximately 6 fold. Conclusions: BEZ235 SDS sachet was well tolerated with a favorable safety profile. Following the Bayesian model recommendation, the MTD for BEZ235 SDS sachet was determined as 1600 mg/d. Based on safety and pharmacology, this formulation is the chosen one for phase II clinical trials and it is being investigated in monotherapy in solid tumor patients with PI3K pathway alterations and in combination with trastuzumab for breast cancer.
Preventing ischaemic heart disease in one general practice: from one patient, through clinical audit, needs assessment, and commissioning into quality improvement Commentary: Clinical and economic perspectives have to be integrated when selecting priorities for intervention
Authors: M. Pringle, J. Jones
Journal: BMJ (1998)

Editorial by Fahey and pp 112511301134 Since the introduction of clinical audit 1 2 and the creation of medical audit advisory groups,3 general practice has begun to look beyond reactive care and, more recently, proactive care, towards the new doctrine of clinical effectiveness. 4 5 The white paper Health of the Nation 6 set a range of strategic goals, and fundholding and commissioning gave general practice the means to achieve these goals and more. These changes, together with the need to implement established research findings7and to use resources most effectively,8 put into place a new philosophical framework for the strategic delivery of primary care. If practices are to act within this framework they need some tools, and they need the skills touse them. Conventional clinical audit—looking at the care of cohorts of patients 1 2—is useful, but increasingly it is being linked to significant event auditing in which insights from the care of individual patients are integrated into quality assurance.9–12Health needs assessment13 can then be used to put the results of audits into context and to help a practice prioritise. These priorities (each evaluated against the prevailing evidence and guidelines14–16) form the basis of commissioning decisions which improve patient care. Although this sounds straightforward, few practices have adopted this approach systematically. Often clinical audits are not linked to health needs assessment or commissioning and commissioning is not linked to evidence of need or effectiveness. This article illustrates how one practice linked the elements in the new framework to improve its care for one group of patients—those at risk of ischaemic heart disease. #### Summary points
Fatal co-infection with pulmonary tuberculosis and herpes simplex virus 1 pneumonia under steroid treatment
Authors: C Charasse, JM Liegaux, Y Le Tulzo, C Camus, R Thomas, F Cartier, MP Ramee, P Andre
Journal: European Respiratory Journal (1992)

We report a case of adult respiratory distress syndrome in a 65 yr old man under inappropriate steroid therapy who developed both Herpes simplex virus 1 (HSV) and Mycobacterium tuberculosis pneumonia; we conclude from clinical and histological data that HSV 1 played a major role in the fatal outcome of this immunocompromised patient, in spite of acyclovir treatment.
Lung transplantation in Portugal: 2008-2010 results
Authors: Sofia Granadeiro, Alexandra Borba, Luisa Semedo, Miguel Araujo, Joao Cardoso, Fernando Martelo, Jose Fragata
Journal: European Respiratory Journal (2011)

Introduction: Lung transplant is the final therapeutic option for patients with end stage lung disease, to whom no other therapeutic is available.  Purpose: Evaluation of a lung transplant center results.  Material and methods: The authors reviewed the results of all patients to lung transplantation at the only center in Portugal, between 2008-2010 (after reorganization of the program). Demographic data, diagnosis at referral, time on waiting list and survival at first year were analyzed.  Results: Twenty five patients were submitted to a lung transplant (72% male), with a medium age of 43,3 years (range 17 to 63). Ten procedures were bilateral and 15 unilateral. Twelve patients had terminal lung fibrosis, five cystic fibrosis, three COPD, three bronchiectasis and two had silicosis. The average time on waiting list was 181 days and 20% of these patients were on mechanical ventilatory support (invasive or non-invasive) at the time of transplantation. Six patients died (5 in the first month after procedure). The 1 year survival rate was 78,4% (Kaplan-Meier curves).  Conclusion: After reorganization in 2008, the Portuguese Lung Transplantation program results are comparable to the results published by the International Society of Heart and Lung Transplantation.
Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013
Authors: Harlan M. Krumholz, Sudhakar V. Nuti, Nicholas S. Downing, Sharon-Lise T. Normand, Yun Wang
Journal: JAMA (2015)

<h3>Importance</h3> In a period of dynamic change in health care technology, delivery, and behaviors, tracking trends in health and health care can provide a perspective on what is being achieved. <h3>Objective</h3> To comprehensively describe national trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013. <h3>Design, Setting, and Participants</h3> Serial cross-sectional analysis of Medicare beneficiaries aged 65 years or older between 1999 and 2013 using Medicare denominator and inpatient files. <h3>Main Outcomes and Measures</h3> For all Medicare beneficiaries, trends in all-cause mortality; for fee-for-service beneficiaries, trends in all-cause hospitalization and hospitalization-associated outcomes and expenditures. Geographic variation, stratified by key demographic groups, and changes in the intensity of care for fee-for-service beneficiaries in the last 1, 3, and 6 months of life were also assessed. <h3>Results</h3> The sample consisted of 68 374 904 unique Medicare beneficiaries (fee-for-service and Medicare Advantage). All-cause mortality for all Medicare beneficiaries declined from 5.30% in 1999 to 4.45% in 2013 (difference, 0.85 percentage points; 95% CI, 0.83-0.87). Among fee-for-service beneficiaries (n = 60 056 069), the total number of hospitalizations per 100 000 person-years decreased from 35 274 to 26 930 (difference, 8344; 95% CI, 8315-8374). Mean inflation-adjusted inpatient expenditures per Medicare fee-for-service beneficiary declined from $3290 to $2801 (difference, $489; 95% CI, $487-$490). Among fee-for-service beneficiaries in the last 6 months of life, the number of hospitalizations decreased from 131.1 to 102.9 per 100 deaths (difference, 28.2; 95% CI, 27.9-28.4). The percentage of beneficiaries with 1 or more hospitalizations decreased from 70.5 to 56.8 per 100 deaths (difference, 13.7; 95% CI, 13.5-13.8), while the inflation-adjusted inpatient expenditure per death increased from $15 312 in 1999 to $17 423 in 2009 and then decreased to $13 388 in 2013. Findings were consistent across geographic and demographic groups. <h3>Conclusions and Relevance</h3> Among Medicare fee-for-service beneficiaries aged 65 years or older, all-cause mortality rates, hospitalization rates, and expenditures per beneficiary decreased from 1999 to 2013. In the last 6 months of life, total hospitalizations and inpatient expenditures decreased in recent years.
Levels of L-asparagine in CSF after intramuscular administration of asparaginase from Erwinia in children with acute lymphoblastic leukemia.
Authors: S P Dibenedetto, A Di Cataldo, R Ragusa, C Meli, L Lo Nigro
Journal: Journal of Clinical Oncology (1995)

PURPOSE As part of a study on the pharmacokinetics associated with the administration of asparaginase (ASNase) from Erwinia to the CNS, we determined the levels of asparagine in the CSF of children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Twenty children received eight standard doses of intramuscular ASNase (10,000 IU/m2) every 3 days as part of induction therapy. In the postremission phase of therapy, the children were randomized to receive either 20 courses of high-dose intramuscular ASNase (25,000 IU/m2) weekly (n = 8) or four courses of standard-dose intramuscular ASNase (10,000 IU/m2) every 3 days (n = 12). RESULTS All patients had detectable levels of L-asparagine in the CSF at the time of diagnosis. The levels of L-asparagine in CSF were undetectable in 15 of 20 (75%) and in seven of 19 (36.8%) children 3 and 5 days, respectively, after administration of standard-dose ASNase. After administration of high-dose ASNase, the levels of L-asparagine in the CSF were undetectable in five (62.5%) and two (25%) of eight children after 3 and 5 days, respectively. CONCLUSION In this study 60% to 70% and 25% to 35% of children had complete depletion of L-asparagine from the CSF after 3 and 5 days, respectively, after administration of both schedules of ASNase from Erwinia. In the remaining patients, administration of ASNase may have resulted in a suboptimal antileukemic effect at the CNS level.
Screening Pelvic Examinations in Adult Women
Authors: Risa B. Burns, Jennifer E. Potter, Hope A. Ricciotti, Eileen E. Reynolds
Journal: Annals of Internal Medicine (2015)

Pelvic examinations have historically been a part of regular preventive care. However, because women can now be screened for cervical cancer at intervals up to every 5 years, the question of whether women need to be seen annually for routine pelvic examinations has arisen. In July 2014, the American College of Physicians (ACP) issued a guideline presenting the available evidence on screening for pathologic conditions using pelvic examination in adult, asymptomatic women at average risk. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice had previously issued a committee opinion in August 2012 on the need for annual examinations and provided guidelines on important elements of this procedure, including when to examine asymptomatic women. ACOG reaffirmed its initial position after publication of the ACP guideline. The guidelines differ—the ACP guideline recommends against and the ACOG committee opinion recommends in favor of routine annual pelvic examination. This paper summarizes a discussion between an internist and a gynecologist on how they would balance these recommendations in general and what they would suggest for an individual patient.
The use of single-agent sorafenib in the treatment of patients with advanced hepatocellular carcinoma with underlying Child-Pugh B liver cirrhosis.
Authors: J. Chiu, Y. F. Tang, T. J. Yao, A. Wong, H. Wong, R. C. Leung, P. Chan, T. T. Cheung, R. T. P. Poon, S. T. Fan, C. C. Yau
Journal: Journal of Clinical Oncology (2011)

4083 Background: Previous sorafenib studies in advanced hepatocellular carcinoma (HCC) involved predominantly patients with Child-Pugh A liver cirrhosis, leaving the routine administration of sorafenib to patients with more advanced liver cirrhosis controversial. This study aimed to explore the tolerability and survival benefits in using sorafenib in Child-Pugh B patients. Methods: Advanced HCC patients treated with sorafenib at Queen Mary Hospital, Hong Kong were analyzed retrospectively. Patients were stratified into Child-Pugh A or Child-Pugh B liver cirrhosis. Toxicities were graded according to the NCI CTCAE version 3.0. Results: One hundred and sixty-six advanced HCC patient were included with 106 had underlying Child-Pugh A and 60 Child-Pugh B patients. The age, gender, hepatitis status, disease stages and baseline laboratory parameters between the two groups were similar. The most common treatment related non-haematological grade 3/4 adverse events were hand-foot-syndrome (13.9%), diarrhea (9.7%), rash (7.3%) and malaise (3.6%). Moreover, grade 3/4 neutropenia and thrombocytopenia occurred in 3.0% and 4.9% of the patients in the cohort, respectively. Notably, Child-Pugh A and B patients experienced similar incidence of all these adverse events. Nonetheless, Child-Pugh B patients had higher baseline bilirubin level, and experienced more grade 3 or 4 bilirubinemia during treatment compared with Child-Pugh A patients (33.9% vs. 19.0%, p<0.05). More importantly, Child-Pugh B patients also developed more gastrointestinal bleeding (15% vs. 5.6%, p=0.05) and hepatic encephalopathy (10% vs. 1.9%, p<0.05). Overall, progression free survival was similar among the Child-Pugh A (3.2 months) and B (3.0) patients. However, the overall survival was longer in Child-Pugh A than B patients (6.0 vs 3.9 months, p<0.01). Conclusions: Child-Pugh A and B patients tolerate sorafenib similarly and derive similar survival benefit from the treatment. Nevertheless, Child –Pugh B patients are more susceptible to develop cirrhotic complications during sorafenib treatment, especially hyperbilirubinemia, gastrointestinal bleeding and hepatic encephalopathy.