tbuckley/cabot-search huggingface dataset:
Update in Mechanical Ventilation, Sedation, and Outcomes 2014
Authors: Ewan C. Goligher, Ghislaine Douflé, Eddy Fan
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Section:ChooseTop of pageAbstract <<Acute Respiratory Distres...Modes of Mechanical Venti...Long-Term OutcomesSedation and AnalgesiaOrganization of CareFuture DirectionsReferencesCITING ARTICLES
Cluster of hepatitis A cases among travellers returning from Egypt, Belgium, September through November 2008
Authors: E Robesyn, M I Micalessi, S Quoilin, M Naranjo, I Thomas
Journal: Eurosurveillance (2009)

From September to November 2008, 34 cases of hepatitis A imported from Egypt were reported to the German public health authorities. Investigations point to a continuing common source of infection, most likely linked to Nile river cruises. The patients affected had not been vaccinated, which emphasises the need for more effective travel advice before trips to hepatitis A endemic countries.
Usefulness of COPD assessment test (CAT™) for the management of COPD according to GOLD 2011
Authors: Takashi Motegi, Takeo Ishii, Kumiko Hattori, Yuuji Kusunoki, Ryuko Furutate, Kouichi Yamada, Akihiko Gemma, Kozui Kida
Journal: European Respiratory Journal (2012)

Background:  The GOLD report (2011) proposes a new strategy for the management of stable COPD—the use of the CAT score. Is a CAT score ≥10 a useful borderline value for disease severity in a Japanese cohort?   Purpose:  To determine the association between the CAT score of patients, and prior exacerbation frequency and usage of medical resources.   Method:  A total of 180 patients recruited from a secondary COPD clinic. The CAT score was examined under stable conditions at least four weeks after any exacerbations. We investigated the association between the CAT score and various clinical parameters, including pulmonary function tests, 6-minute walking distance (6MWD), the St George9s Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression score (HAD), a multidimensional assessment system (BODE index), exacerbation rate of the previous year, and the use of resources such as unscheduled visits and long-term oxygen therapy (LTOT).   Results:  The mean age was 71.9, and %FEV 1  was 59.3%. The CAT score was significantly associated with following parameters: %FEV 1  (ρ -0.42, p    Conclusions:  We concluded that a CAT score ≥10 can be considered a reasonable borderline value for exacerbation frequency and usage of medical resources in a Japanese cohort.
Obstructive lung disease in northern Sweden: respiratory symptoms assessed in a postal survey
Authors: B Lundback, L Nystrom, L Rosenhall, N Stjernberg
Journal: European Respiratory Journal (1991)

The prevalence of respiratory symptoms in 6,610 adults (3,372 men and 3,238 women); 35-36, 50-51 and 65-66 yrs of age, living in selected areas of Norrbotten, northern Sweden, were assessed in a postal survey. Response rates were identical in men and women, and at least one respiratory symptom was reported by 41% of each sex. Twenty two percent reported sputum production, and 14% reported wheezing. Despite differences in smoking habits and in the different age groups, the prevalence of symptoms did not differ between the sexes, or between urban and rural areas. Symptoms were as common in people living in the rural interior as in the industrialized coastal area. Present or past history of asthma was reported by 323 (5.9%) subjects, whilst 234 (4.1%) subjects stated that they had chronic bronchitis or emphysema. Less than half of the subjects who reported attacks of breathlessness together with wheezing stated that they had at any time had asthma. Whilst the exact prevalence of had asthma. Whilst the exact prevalence of at any time had asthma and chronic bronchitis cannot be assessed from this postal survey, its results indicate that the prevalence of asthma may be higher in northern Sweden than has been reported from the south of Sweden.
Modernising the NHS: A promising start, but fundamental reform is needed
Authors: A. C Enthoven
Journal: BMJ (2000)

This is the first of seven articles 

The NHS has just received its largest sustained increase in resources since the service was started in 1948. To ensure that the money is spent wisely, Britain's prime minister has set about producing a national plan for health, with the help of six action teams—on prevention and inequalities, partnership, performance and productivity, the professions and the wider NHS workforce, patient care (empowerment), and patient care (speed of access). The BMJ has asked six commentators to state what their priorities would be in each of these areas, and we will be publishing these articles over the next few weeks. This week, however, we start with a commentary from Alain Enthoven, professor of public and private management at the graduate business school, Stanford University. Enthoven's ideas were a driving force behind the creation of the internal market in the NHS in the 1990s; he recently revisited the subject in last year's Rock Carling lecture, and we invited him to give his impressions on the prime minister's current plans for the NHS.

The prime minister was right to promise more money for the NHS. I recently wrote: “The NHS is obviously very short of resources needed to achieve its objectives. One sees it in the buildings, the pay, the staff and equipment shortages, the very short times doctors spend with patients, and the headlines about crises.” 1

The prime minister was also right to say “that the NHS needs fundamental reform if it is to provide the standard of care that people deserve in the 21st century.” 2 Money alone will not get us there.

And the prime minister was right to call attention to the wide variations in performance in the NHS. Among his many examples: “Why is there a twofold difference in the cost …
Lymphoblastic lymphoma in adults.
Authors: D E Slater, R Mertelsmann, B Koziner, C Higgins, S McKenzie, P Schauer, T Gee, D Straus, S Kempin, Z Arlin
Journal: Journal of Clinical Oncology (1986)

Fifty-one patients with lymphoblastic lymphoma (LBL) treated with one of five successive intensive chemotherapy protocols for acute lymphoblastic leukemia (ALL) since 1971 were reviewed. The patients were divided into leukemic and nonleukemic groups, and their clinical and laboratory parameters compared. The projected 5-year survival rate for all patients treated with the L10/17 protocols was 45% for both leukemic and nonleukemic LBL. The response to treatment was compared with that of 111 patients with ALL and was nearly identical. Poor prognostic factors were age beyond 30, WBC greater than 50,000/microL, failure to achieve a complete response (CR), and a late CR during induction. Leukemia at presentation, T cell surface markers, and the presence of a mediastinal mass did not adversely affect survival. The use of intensive chemotherapy protocols has proven to be a significant advance in the treatment of LBL.
Tragedy of Shadows
Authors: Lawrence J. Hergott
Journal: Annals of Internal Medicine (2015)

Ad Libitum20 October 2015Tragedy of ShadowsLawrence J. Hergott, MDLawrence J. Hergott, MDFrom Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0868 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We'll neither know what shaped your choice,the thing or things that stopped you.I cannot know without your voice—your voice entombed chose not tosay, or even glance,at what it was that stilled the dance.Lawrence J. Hergott, MDCenter for Bioethics and Humanities, University of Colorado School of MedicineDenver, Colorado Author, Article, and Disclosure InformationAffiliations: From Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado.Current Author Address: Lawrence J. Hergott, MD; e-mail, [email protected]net. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 October 2015Volume 163, Issue 8Page: 644 ePublished: 20 October 2015 Issue Published: 20 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effects of Budesonide and Fluticasone on 24-Hour Plasma Cortisol
Authors: RICHARD DONNELLY, KENNETH M. WILLIAMS, A. BARRY BAKER, CARO-ANNE BADCOCK, RICHARD O. DAY, J. PAUL SEALE
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Comparison of the risk-benefit profiles of different inhaled glucocorticoids has been limited by inadequate information about the dose-response relationships for efficacy relative to side effects. Fluticasone propionate (FP) is twice as effective as budesonide (BUD), but the potency ratio of FP:BUD with respect to suppression of cortisol production is unknown. The effects of 5 d of treatment with BUD (800, 1,600, and 3,200 μ g/d via pMDI) and FP (750, 1,500, and 2,000 μ g/d via pMDI) on integrated area under the curve of 24-h plasma cortisol profiles (AUC24h) were compared in a randomized, placebo-controlled, seven-period crossover study in normal male volunteers (n = 28). Plasma cortisol concentrations were measured during the last 24 h of each treatment period. Each treatment (except BUD 800 μ g) produced significant dose-dependent reductions in AUC24h compared with placebo; e.g., percent reductions in AUC24h were 23, 41, and 69% for the three doses of BUD, and, correspondingly, 46, 85, and 93% for the three doses of FP. Model-derived measurements of dose potency ratios showed that FP was 2.9 times more potent than BUD in reducing AUC24h (95% CI, 2.5 to 3.5) and 3.1 times more potent in reducing 8:00 a.m. plasma cortisol (95% CI, 2.4 to 4.0). Thus, on a microgram-for-microgram notional dose basis, the systemic effects of a given dose of FP on AUC24h cortisol were equivalent to the effects of three times the dose of BUD.
Is mediastinoscopy necessary in patients with negative EBUS-TBNA – A challenge to the ESTS Guidelines for staging of lung cancer
Authors: Mark Krasnik, Peter Vilmann, Felix Herth
Journal: European Respiratory Journal (2011)

Objective:  Mediastinoscopy is the golden standard for mediastinal staging of lung cancer.The aim of the present study was to examine whether mediastinoscopy may be avoided if a standardized EBUS-TBNA procedure using the same criterias as required during mediastinoscopy with representative biopsies without malignant cells from lymph nodes in station 4R, 7 and 4L, is performed.   Methods:  Patients with known or suspected lung cancer underwent a standardized EBUS-TBNA procedure. All patients with EBUS-TBNA from station 4 R, 4L and 7 without cancer cells og a specific diagnose were further referred for a VATS/thoracotomy.   Results:  A total of 76 out of 95 consecutive patients, 48 males, 28 females were enrolled. Mean age 65 years (range 40-85). The mean sizes of the lymph nodes in all 3 stations were 9mm (range 2 - 35mm). The final primary diagnosis was cancer in 67 patients and benign diagnoses in 8 patients. In 4 patients mediastinal metastases were found by surgery (5%). One patient had a metastasis in station 4 R and 2 patients in station 5 and one patient in station 6. The NPV was 0.95 and with a specificity of 1  In total the false negative rate of EBUS-TBNA in mediastinal staging of lung cancer was 4 out of 67 (6%).   Conclusions:  The results of the present study seem to challenge mediastinoscopy as the gold standard. When EBUS-TBNA is performed under the same standardised conditions as described by the ESTS guidelines for mediastinoscopy with demonstration of lymphatic tissue from relevant lymph node stations, our study shows that very little, if anything, is gained by an additional mediastinoscopy and can be avoided.
Analytical decision model for the cost-effective management of solitary pulmonary nodules.
Authors: S S Gambhir, J E Shepherd, B D Shah, E Hart, C K Hoh, P E Valk, T Emi, M E Phelps
Journal: Journal of Clinical Oncology (1998)

Multiple strategies are currently being used to manage patients who present with indeterminate solitary pulmonary nodules (SPN). We have used decision-analysis models to assess the cost-effectiveness of various strategies for the diagnosis and management of SPN. Four decision strategies were compared: a wait and watch strategy, a surgery strategy, a computed tomography (CT)-based strategy, and a CT-plus-positron emission tomography (PET) strategy. An incremental cost-effectiveness ratio (ICER) was used to compare all strategies to the wait and watch strategy.A CT-plus-PET strategy was the most cost-effective over a large pretest likelihood (probability of having a malignant nodule), with a range of 0.12 to 0.69. Furthermore, within this likelihood range, the potential cost savings of using the CT-plus-PET strategy over the CT strategy ranged from $91 to $2,200 per patient. This translates to a yearly national savings of approximately $62.7 million.Decision-analysis modeling indicates the potential cost-effectiveness of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in the management of SPN. Furthermore, the decision trees developed can be used to model various features of the management of SPN, including modeling the cost-effectiveness of other newly emerging technologies.
NB87 induction protocol for stage 4 neuroblastoma in children over 1 year of age: a report from the French Society of Pediatric Oncology.
Authors: C Coze, O Hartmann, J Michon, D Frappaz, F Dusol, H Rubie, E Plouvier, G Leverger, P Bordigoni, C Béhar, D Beck, F Mechinaud, C Bergeron, D Plantaz, J Otten, J M Zucker, T Philip, J L Bernard
Journal: Journal of Clinical Oncology (1997)

PURPOSE NB87 was designed to test the efficacy of a short, non cross-resistant, induction protocol for unselected patients over 1 year of age with stage 4 neuroblastoma. A secondary objective was to compare in a randomized study the toxicity of two modalities of cisplatin administration. PATIENTS AND METHODS A total of 183 patients received two cycles of alternating sequences: cyclophosphamide 300 mg/m2/d on days 1 to 5, vincristine 1.5 mg/m2/d on days 1 and 5, and doxorubicin 60 mg/m2/d on day 5 (CADO); and cisplatin 40 mg/m2/d and etoposide 100 mg/m2/d on days 1 to 5 (CVP), followed by surgery of the primary tumor (126 patients). Ninety-one were randomized to receive cisplatin either as bolus (BO; n = 48) or continuous infusion (CI; n = 43). International Neuroblastoma Staging System (INSS) and Response Criteria (INRC) were used with emphasis on skeletal evaluation by meta-iodobenzylguanidine (MIBG). RESULTS Hematotoxicity was predominant, with a higher incidence of neutropenia (P = .01) for CADO and of thrombocytopenia for CVP (P &lt; .001). Severe infections, as well as nonhematologic toxicities, occurred more often after the first sequence. Gastrointestinal complications were predominant during both courses of CVP. The toxic death rate, including surgery, was 3%. Complete remissions (CRs) were less frequent on MIBG (45%) compared with marrow (66%) or other metastases (61%). Combining all metastatic sites resulted in a 39% CR rate. After surgery, the final CR rate was 42%. Nephrotoxicity was minimal in both arms (92% normal clearance for CI v 82% for BO). Hearing loss greater than 40 dB at 6,000 to 8,000 Hz was reported equally in both arms (n = 6 for CI v n = 5 for BO). CONCLUSION Intensified chemotherapy using CADO/CVP increases CR rates despite a shorter induction duration. However, the rate of MIBG normalization remains unsatisfactory and could be raised through the dose-intensive use of agents such as cyclophosphamide.
Observe or treat bronchial hyperreactivity in children
Authors: Nella Paramonova
Journal: European Respiratory Journal (2014)

After a respiratory viral infection a bronchial hyperreactivity may develop in some children. A wheezing-syndrome or a prolonged cough clinically manifests the bronchial hyppereactivity. The reason for this is the damage to the bronchial epithelium, the increased sensitivity of the receptors, which in turn, contributes to the cough reflex under the impact of exogenous and endogenous factors.

The object of study: 132 children 6-14 years old (7,2 ± 2,8), after an acute respiratory disease. All children carried out a comprehensive survey to clarify the reasons for the prolonged cough. During FVD research there were normal levels in 35 children (27%), 84 kids showed bronchial obstruction (64%), and 13 children had hidden bronchospasm (a positive test with a bronchodilator with normal FVD parameters) (10%). Coughing was provoked by physical exercises in 83 children (63 %), emotional stress in 11( 8%), and cold air in 17 kids(13%).

For the cupping of protracted cough and wheezing-syndrome 64 patients with impaired FVD (1st group) were appointed with the drug montelukast 5 mg, 20 (2nd group) - received antihistamines and bronchodilators. Reexamination was carried out in a month. The improvement of general condition of both groups of children was registered. However, in the 1st group paroxysmal cough remained only in 8% of the patients after treatment, whereas in the second - in 43.5 % (p < 0.001 ); dyspnea during physical exercises was revealed in 4% versus 24 % (p < 0.001). All children of the first group showed normalization of FVD while the second group had only 20%.

These results confirm the appropriateness of the inclusion of the drug montelukast 5 mg in the complex therapy of children with postviral bronchial hyperreactivity.
Treatment of Locally Advanced Prostate Cancer: Is Chemotherapy the Next Step?
Authors: William K. Oh, Philip W. Kantoff
Journal: Journal of Clinical Oncology (1999)

PURPOSE: Management of locally advanced prostate cancer remains controversial. Various single and combination modality approaches have been advocated, but an accepted standard of care remains undefined. The purpose of this review is to define the current knowledge in managing locally advanced prostate cancer and to propose new treatment approaches based on current knowledge. MATERIALS AND METHODS: A MEDLINE search to detect all relevant articles on the management of locally advanced prostate cancer was performed. A review of the staging, natural history, and prognosis of this disease was also performed. RESULTS: The lack of a clearly defined treatment approach to patients with locally advanced prostate cancer stems from multiple factors, including ambiguities in clinical staging, inadequate knowledge of the natural history of the cancer, and a dearth of comparative randomized trials evaluating efficacy of different therapies. Single modality treatment, including radical prostatectomy (RP) or external-beam radiotherapy alone, is associated with high rates of failure. The use of adjuvant hormonal ablation therapy in combination with external-beam radiotherapy has shown improvement in progression-free and overall survival, although similar improvements have not been clearly demonstrated for surgical patients treated with hormonal therapy. New advances in chemotherapy for hormone-refractory prostate cancer suggest that response rates may be as high as 50% or more, and current trials are evaluating the addition of chemotherapy to hormonal ablation in either surgery or radiation therapy in locally advanced prostate cancer. CONCLUSION: Optimal management of locally advanced prostate cancer remains undefined. Standard treatment options include RP, external-beam radiotherapy, or hormonal ablation therapy, alone or in combination. New approaches being tested include improved methods for delivering radiation or combining hormonal ablation with surgery or radiation. It is possible that other forms of systemic therapy, including chemotherapy, may become important components of multimodality treatment. Clinical trials designed to test this hypothesis are ongoing.
Self reports in research with non-English speakers
Authors: S. Hunt
Journal: BMJ (2003)

association with head trauma, although this is yet to be validated in other studies. 15 For football players the avoidance of exposure to brain injury is important, although currently there are few means by which this may be achieved.Most head to head contact is inadvertent, and coaching techniques and visual perception training may help in a few cases but are unlikely to eliminate this problem entirely.Soft shell helmets or head protectors currently do not have the biomechanical capability to prevent concussive trauma and hence cannot be recommended.
Drugs Are Not Enough: Some Principles of Psychopharmacology for General Medical Practice
Authors: W D ROSS
Journal: JAMA (1963)

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