tbuckley/cabot-search huggingface dataset:
Reducing error, improving safety
Authors: V. Barley
Journal: BMJ (2000)

Editor—It was brave to devote a whole issue to medical error1—how to recognise, how to investigate, how to analyse, and how to change systems to improve patient safety.1 However, we regret that the edition was dominated by American studies, ignoring the British contribution of confidential inquiries and analyses of closed claims, which have significantly improved safety in some well defined areas of medical practice.

In the United States the insurance industry provided the impetus for the study of adverse events,2 and in Australia the government funded a similar study3 because it was considering “no fault” compensation.3 In the United Kingdom, for 25 years the Department of Health has financed all successful claims against NHS hospitals and their staff. As a result the need to take a British study beyond the pilot phase may not be supported.4

Be that as it may, an important issue was not addressed in the BMJ. Behind each adverse event there is a patient, a doctor, and a doctor-patient relationship. A patient must be told when things have gone wrong. Every effort must be made to minimise the after effects, including financial compensation where necessary. Most patients wish to know in detail what happened and what is being done to reduce the possibility of a recurrence. And members of healthcare teams need mechanisms to come to terms with their fallibility. It is to be hoped that clinical governance will make a difference.

Meanwhile a change in the ethos of medical practice is required, and it is to this end that Action for Victims of Medical Accidents has set up a group for doctors. Action for Victims of Medical Accidents is often regarded as dealing solely with compensation and litigation, but its raison d'etre has always been to improve patient care.

In February this year the doctors' group met informally to discuss how best to translate into practice the General Medical Council's requirements of “good medical practice when things go wrong.”5 We are determined to take our discussion forward and would welcome input from others who see the need to change the defensive and exclusive culture of British medicine. Doctors who would like to be involved should contact Dr Anne Savage, who is acting as secretary to the group.
Studies of the control of plasma aldosterone concentration in normal man
Authors: Robert G. Dluhy, Lloyd Axelrod, Richard H. Underwood, Gordon H. Williams
Journal: Journal of Clinical Investigation (1972)

The responses of plasma aldosterone, cortisol, and corticosterone to an infusion of 75 mEq of potassium chloride over 120 min were studied in 10 normal subjects. Five subjects were fed a 10 mEq and five a 200 mEq sodium diet, while all subjects ingested 40 mEq and 200 mEq potassium sequentially. Two potassium infusions were performed in each subject when in balance on a fixed sodium intake and low and then high potassium diets. Regardless of dietary intake, increases of serum potassium of 0.5-1.5 mEq/liter above preinfusion levels were usually associated with significant increments in plasma aldosterone concentration. Our data agree with previous evidence that the potassium ion stimulates the adrenal cortex directly to secrete aldosterone. Peripheral renin activity did not increase after the potassium infusion. Plasma cortisol and corticosterone levels generally followed the expected diurnal decline during the infusion, implying that ACTH secretion did not increase. The plasma aldosterone response to incremental changes in serum potassium was linear on each of the four diets. The slopes of these linear relationships increased significantly when the potassium intake was increased from 40 to 200 mEq. No increase in slope occurred on either potassium intake when dietary sodium was restricted from 200 to 10 mEq. Thus, identical increases in serum potassium were associated with greater increments in plasma aldosterone above preinfusion levels on either sodium intake when the 200 mEq potassium diet was compared with the 40 mEq potassium intake.
Abstract 2933: Left Ventricular Structure And Functions In Hemodialysis Patients Treated By Strict Volume Control
Authors: Meral Kayikcioglu, Oner Ozdogan, Mehmet Ozkahya, Soner Duman, Huseyin Toz, Gulay Asci, Levent H Can, Ercan Ok
Journal: Circulation (2007)

Left ventricular hypertrophy (LVH) is reported to be as high as 70 – 80% in hemodialysis (HD) patients from the centers, where blood pressure can be controlled only in 50% of cases despite use of antihypertensive medications up to 90% of the patients. We evaluated LV structure and functions by echocardiography in HD patients treated by strict volume control strategy with rare usage (&lt;10%) of antihypertensive medications, in order to clarify whether volume control could prevent progression of cardiac abnormalities in HD. METHODS: All 704 patients, who were on our HD centre for at least 6 months, underwent echocardiography on a nondialysis day. Cardiac dimensions were measured and type of LVH was described according to relative wall thickness (RWT). Systolic function was judged by ejection fraction (EF); diastolic function was assessed from both mitral inflow PW Doppler and Tissue Doppler imaging (TDI). RESULTS: Echocardiographic images were available for evaluation in 621 patients. Mean HD duration was 55±46 months, interdialytic weight gain 2.31±0.94 kg, systolic blood pressure (SBP) 125±16 mmHg, diastolic blood pressure (DBP) 75±9 mmHg. Only 7% of patients were receiving antihypertensive agents. LVH (LVMI ≥ 150gr/m in men, ≥120 g/m in women) was present in 42% of patients. LVH was of the concentric type (RWT≥45) in almost all cases (96%). The LVMI was correlated with age (r: 0.15, p: 0.001), diabetes (r:0.097, p:0.001), SBP (r:0.23, p:0.001), DBP (r:0.17, p:0.01), and interdialytic weight gain (r: 0.14, p:0.001). No correlation was found between LVMI and duration of HD. Mean EF was 66±10%. Systolic dysfunction (EF &lt;45%) was present in only 9%. Diastolic dysfunction (by TDI) was observed in 62% of the patients. CONCLUSION: This is the largest echocardiographic study on HD patients. In patients under volume control strategy for hypertension, LVH was present in 42% and of the concentric type. No correlation is seen between LVH and duration of dialysis. These data suggest that development and progression of left ventricular abnormalities are not inevitable when strict volume control policy is applied.
DSM-IV field trials for oppositional defiant disorder and conduct disorder in children and adolescents
Authors: B B Lahey, B Applegate, R A Barkley, B Garfinkel, K McBurnett, L Kerdyk, L Greenhill, G W Hynd, P J Frick, J Newcorn
Journal: American Journal of Psychiatry (1994)

The purpose of the field trials for oppositional defiant disorder and conduct disorder was to select valid diagnostic thresholds for these disorders and to compare the psychometric properties of DSM-IV criteria for oppositional defiant disorder and conduct disorder with previous DSM diagnostic formulations.Structured diagnostic interviews, standardized clinician's validation diagnoses, and multiple measures of impairment were obtained for 440 clinic-referred children and adolescents aged 4-17 years.A diagnostic threshold of four symptoms of oppositional defiant disorder optimized identification of impaired children, improved agreement somewhat with the clinician's validation diagnosis, and had somewhat better test-retest agreement than DSM-III-R. In the case of conduct disorder, the optimal time window for ascertainment of symptoms was clarified. A diagnostic threshold of three symptoms of conduct disorder maximized accurate identification of impaired children and agreement with the clinician's validation diagnosis and resulted in slightly better test-retest agreement than DSM-III-R. Compared with the DSM-III-R definition, the DSM-IV definition of oppositional defiant disorder was somewhat more prevalent, but the prevalence of conduct disorder was essentially unchanged.DSM-IV definitions of oppositional defiant disorder and conduct disorder are somewhat better than DSM-III-R definitions in terms of internal consistency and test-retest agreement, and the validity of the DSM-IV definition of oppositional defiant disorder is slightly better than that of DSM-III-R.
Rheumatoid arthritis and bronchiectasis: A multicentre study assessing pulmonary disease severity using the bronchiectasis severity index (BSI)
Authors: Anthony De Soyza, John Davison, Melissa McDonnell, Elizabeth Perry, Stefano Aliberti, Pieter Goeminne, James Chalmers, Adam Hill
Journal: European Respiratory Journal (2014)

Introduction Our recent data from Newcastle, UK suggested non CF Bronchiectasis (BR) clinical severity was worse in coexistent RA (BR&RA) as compared to BR alone.  Aim To utilise the multi-domain BR severity index (BSI) comparing 1103 patients with BR alone vs. 81 with both BR&RA across 4 external validation centres.  Methods BSI was calculated from Milan (2BR&RA vs. 103 BR), Leuven (25 vs.228), Edinburgh (44vs. 564) and Dundee (10 vs.208) cohorts.  Results Heterogeneity analysis suggested individual cohorts could not be pooled hence we conducted a MH random effects meta-analysis. Data in Table 1 shown as: Odds Ratio and Mean differences (95% CI). The BSI was not significantly worse in BR&RA vs. BR alone but was worse in a sub-analysis of the UK cohorts- mean difference 1.60 (p  Conclusion In a large international cohort, BSI scores were not significantly different comparing BR&RA vs. BR alone. They were however significantly worse in the UK centres. This may reflect the sample sizes, differences in healthcare systems, referral patterns and clinical caseloads. The data suggest worse disease severity in the UK. Further data sets are needed to explore the links between BR&RA and potentially higher pulmonary disease severity.
A study to analyse the clinical profile and outcome of hospitalised patients with H1N1 and the factors influencing the outcome
Authors: Thomas James Ponneduthamkuzhy, B.R. Sandeep, P.V. Santhosh Kumar, Chetambath Ravindran
Journal: European Respiratory Journal (2011)

This was an observational study conducted in Institute of chest diseases, Calicut medical college,India between August 2009 and August 2010. All patients whose throat swabs were positive for H1N1 by Real time PCR and belonged to category C (severe disease)according to the clssafication by Ministry of health and family welfare were included in the study.  Out of the 110 confirmed cases, 38 (35%) were males and 72 (65%)were females.Of the 72 female patients 42 were pregnant and majority, (83%)were in the third trimester.Most of the patients were in the age group 20-30yrs (59%). Total no. of deaths were 10 (9%). Pregnancy was not associated with increased mortality (4.8%and 11.8%, P value.215). Initiation of Oseltamivir within 48 hours was associated with significant reduction in mortality (1.3% and 29%, P value  Presence of associated co morbidities were not associated with any increase in mortality rate (16.7% and 6.3%, P value.09)
Suicide and mental disorders: a case-control study of young men
Authors: A D Lesage, R Boyer, F Grunberg, C Vanier, R Morissette, C Ménard-Buteau, M Loyer
Journal: American Journal of Psychiatry (1994)

By means of the psychological autopsy method and a case-control design, the authors examined the association of specific mental disorders and comorbidity with suicide among young men.Seventy-five men aged 18-35 years whose deaths were adjudicated as completed suicides by coroners of greater Montreal and Quebec City were matched to 75 living young men for age, neighborhood, marital status, and occupation. For each subject in both groups a key respondent best acquainted with the subject was interviewed by clinicians using standardized schedules. Information from the coroner and medical records was also collected. Two experienced psychiatrists, blind to outcome, established best-estimate DSM-III-R diagnoses.Six-month prevalence rates for all axis I diagnoses for the suicide and comparison groups were 88.0% and 37.3%, respectively; major depression was present in 38.7% and 5.3%, alcohol dependence in 24.0% and 5.3%, psychoactive substance dependence in 22.7% and 2.7%. Borderline personality disorder was identified in 28.0% and 4.0%, respectively. Of the suicide subjects, 28.0% had at least two of the following disorders: major depression, borderline personality disorder, and alcohol or drug dependence; the rate was 0.0% among the comparison subjects.In young men, completed suicide is linked to specific mental disorders, namely, major depression, borderline personality disorder, and substance abuse. Comorbidity involving any of these disorders is frequently associated with completed suicide.
Biological priority and psychological supremacy: a new integrative paradigm derived from process theory
Authors: H C Sabelli, L Carlson-Sabelli
Journal: American Journal of Psychiatry (1989)

Process theory is a comprehensive theory of physical and psychological processes that can serve to integrate biological, social, and psychodynamic psychiatry. Process theory uses concepts derived from mathematical dynamics and Heraclitus's process philosophy. It provides three novel and clinically applicable concepts: 1) biological priority and psychological supremacy (as contrasted to theories of biological or psychological primacy), 2) union of opposites (as contrasted to psychoanalytic and dialectic conflicts and to systems homeostasis), and 3) creative bifurcations (as contrasted to determinism and developmental theories).
Interleukin-22 downregulates filaggrin expression and affects expression of profilaggrin processing enzymes
Authors: D. Gutowska-Owsiak, A.L. Schaupp, M. Salimi, S. Taylor, G.S. Ogg
Journal: British Journal of Dermatology (2011)

The identification of filaggrin mutations has contributed towards our understanding of hereditary factors associated with epidermal dysfunction observed in individuals with atopic eczema (AE). However, factors that predispose to acquired filaggrin modulation are not well understood. Interleukin (IL)-22 is upregulated in lesional AE tissue, but its effects on filaggrin expression and genes associated with epidermal function have not yet been comprehensively addressed.To investigate the effects of IL-22 on expression of filaggrin and genes encoding proteins relevant to epidermal function.Microarray analysis was performed on IL-22-stimulated HaCaT keratinocytes. Filaggrin protein level was assessed by an intracellular enzyme-linked immunosorbent assay (ELISA) and Western blot in HaCaT cells and the findings were validated in primary keratinocytes.Exposure to IL-22 cytokine resulted in a downregulation of profilaggrin mRNA expression in HaCaT keratinocytes. The expression of genes involved in enzymatic processing of profilaggrin as well as the generation of natural moisturizing factor was also altered. Furthermore, there was an upregulation of many transcripts encoding proteins of the S100 family. Profilaggrin/filaggrin downregulation was detected by intracellular ELISA and Western blot in HaCaT cells. The relevance to the primary setting was confirmed in primary keratinocytes by Western blot.IL-22 downregulates profilaggrin/filaggrin expression in keratinocytes at both mRNA and protein levels and affects genes relevant to epidermal function. This novel pathway may have relevance to the pathogenesis and treatment of atopic and other skin disease.
Essential Role of the Thymus to Reconstitute Naive (CD45RA+) T-Helper Cells After Human Allogeneic Bone Marrow Transplantation
Authors: Andreas Heitger, Nikolaus Neu, Hannelore Kern, Eva-Renate Panzer-Grümayer, Hildegard Greinix, David Nachbaur, Dietger Niederwieser, Franz Martin Fink
Journal: Blood (1997)
Mitochondrial Potassium Channels as Pharmacological Target for Cardioprotective Drugs
Authors: L. Testai, S. Rapposelli, A. Martelli, M.C. Breschi, V. Calderone
Journal: Medicinal Research Reviews (2014)

Abstract Brief periods of ischemia are known to confer to the myocardium an increased resistance to the injury due to a later and more prolonged ischemic episode. This phenomenon, known as ischemic preconditioning (IPreC), is ensured by different biological mechanisms. Although an exhaustive comprehension of them has not been reached yet, it is widely accepted that mitochondria are pivotally involved in controlling cell life and death, and thus in IPreC. Among the several signaling pathways involved, as triggers and/or end effectors, in the mitochondrial mechanisms of cardioprotection, an important role is played by the activation of potassium channels located in the mitochondrial inner membrane (mitoK) of cardiomyocytes. Presently, different types of mitoK channels have been recognized in the heart, such as ATP‐sensitive (mitoK ATP ) and calcium‐activated (mitoBK Ca and mitoSK Ca ) potassium channels. Consistently, drugs modulating mitoK, on one hand, have been employed as useful experimental tools for early basic studies on IPreC. On the other hand, activators of mitoK are promising and innovative therapeutic agents for limiting the myocardial injury due to ischemic episodes. In this review, we report the experimental evidence supporting the role of mitoK in signaling pathways in the mechanisms of cardioprotection and an overview on the most important molecules acting as modulators of these channels, with their profiles of selectivity. Some innovative pharmaceutical strategies for mitochondriotropic drugs have been also reported. Finally, an appendix describing the main experimental approaches usually employed to study mitoK in isolated mitochondria or in intact cells has been added.
Outbreak of diarrhea related to Clostridium perfringens in a correctional facility: an epidemiologic investigation
Authors: O. Keita-Perse, C. Pradier, S. Tempesta, N. Oran, F. Girard-Pipau, M.R. Popoff, E. Vautor, M.J. Vezolles, P. Dellamonica
Journal: Clinical Microbiology and Infection (1999)
Sputum inflammatory cells and allergen-induced airway responses in allergic asthmatic subjects
Authors: H. Imaoka, G. M. Gauvreau, R. M. Watson, T. Strinich, G. L. Obminksi, K. Howie, K. J. Killian, P. M. O’Byrne
Journal: Allergy (2011)

To cite this article: Imaoka H, Gauvreau GM, Watson RM, Strinich T, Obminksi GL, Howie K, Killian KJ, O'Byrne PM. Sputum inflammatory cells and allergen-induced airway responses in allergic asthmatic subjects. Allergy 2011; 66: 1075–1080. Background: Allergen inhalation causes early and late bronchoconstrictor responses, airway hyperresponsiveness and airway inflammation in allergic asthmatics. The role of airway inflammatory cells in causing allergen-induced bronchoconstriction and airway hyperresponsiveness is controversial. The objective of this study was to examine the relationships between allergen-induced increases in airway inflammatory cells, early and late bronchoconstrictor responses and methacholine airway hyperresponsiveness. Methods: Allergen inhalation challenge was conducted in 50 allergic asthmatics. Changes in the forced expired volume in 1 s (FEV1%) were followed for 7 h, induced sputum was obtained at 7 and 24 h, and the provocative concentration of methacholine causing a 20% fall in FEV1 (MCh PC20) was measured at 24 h. Results: There was a significant negative correlation between the baseline methacholine PC20 and baseline sputum eosinophils (r = −0.512, P = 0.0001). Allergen-induced changes in methacholine PC20 were also significantly negatively correlated to allergen-induced change in sputum eosinophils at 24 h (r = −0.434, P = 0.002), but not to changes in any other inflammatory cells. There were no significant correlations between sputum eosinophils or other inflammatory cells and the allergen-induced early or late asthmatic responses. Conclusion: Allergen-induced increases in airway eosinophils in asthmatic dual responders may contribute to allergen-induced changes in methacholine PC20, but not the late asthmatic responses.
Abstract P294: Urinary Sodium and Potassium Excretion and Progression of Chronic Kidney Disease
Authors: Jiang He, Katherine T Mills, Lawrence J Appel, Wei Yang, Jing Chen, Sylvia E Rosas, Anna Porter, Gail Makos, Matthew R Weir, L L Hamm, John Kusek
Journal: Circulation (2014)

Introduction: Chronic kidney disease is a major risk factor for end-stage renal disease, cardiovascular disease, and premature death. There are scarce data on the effects of dietary sodium and potassium intake on the development and progression of chronic kidney disease. Hypothesis: We investigated the prospective association of urinary sodium and potassium excretion with the risk of chronic kidney disease progression and all-cause mortality among patients with chronic kidney disease. Methods: The Chronic Renal Insufficiency Cohort study is a prospective, longitudinal cohort study among 3,939 patients with chronic kidney disease from 7 clinical centers in the US. Dietary sodium and potassium intake are accessed by averaging three 24-hour urinary measures and calibrating to sex-specific mean 24-hour urinary creatinine excretion. Estimated-glomerular filtration rate was obtained annually. Chronic kidney disease progression was defined as a composite end point of incident end-stage renal disease or halving of estimated-glomerular filtration rate from baseline. Results: A total of 905 events of chronic kidney disease progression and 540 deaths from all-causes were identified during follow-up. Overall, a 100-mmol/24 hours higher adjusted sodium excretion was associated with an increased hazard ratio of 1.28 (95% confidence interval 1.17, 1.41; p&lt;0.0001) for chronic kidney disease progression, 1.35 (1.21, 1.50; p&lt;0.0001) for all-cause mortality, and 1.30 (1.21, 1.41; p&lt;0.0001) for the composite outcome. Similar, a 50-mmol/24 hours higher adjusted potassium excretion was associated with increased hazard ratio of 1.56 (1.36, 1.78; p&lt;0.0001) for chronic kidney disease progression, 1.36 (1.15, 1.62; p=0.0004) for all-cause mortality, and 1.51 (1.35, 1.69; p&lt;0.0001) for the composite outcome after adjustment for important covariables, including baseline kidney function, diuretics, and other antihypertensive medication use. Conclusions: High dietary sodium and potassium intake are associated with increased risk of chronic kidney disease progression and all-cause mortality in patients with chronic kidney disease. These results suggest that a moderate reduction in dietary sodium and potassium intake might slow the progression of chronic kidney disease and reduce all-cause mortality in patients with chronic kidney disease.