tbuckley/cabot-search huggingface dataset:
Two cheers for NSAIDs.
Authors: J Urquhart
Journal: Gut (1986)

Leading articleTwo cheers for NSAIDsThe non-steroidal anti-inflammatory drugs (NSAIDs) have had a bad press in the past several years.Five new and two old NSAID products have been withdrawn.A spate of recent_publications 1-5 promote the inference, if they do not prove conclusively, 7 that NSAID use increases the risk of gastrointestinal ulceration, bleeding and perforation.This news has had a background obbligato of tsk's, implying that the pharmaceutical industry has spent so much to develop more than two dozen 'me-too' NSAIDs, different chemical species of NSAID that can scarcely be distinguished from one another in controlled clinical trials.To that bleakness, however, it may be useful to add several other perspectives, especially for readers whose specialised focus is on the diseases of the gut.First, and most obvious, is that these drugs offer undeniable benefits to patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and related conditions.This effectiveness is documented in many controlled clinical trials of various sizes, including a recent one with over 2000 patients.8Nevertheless, many arthritic patients are dissatisfied with available NSAID treatment, as evidenced by a great deal of switching from one product to another, and by the fact that there is usually a relative rush to try each new NSAID.On this latter point there hangs a tale, discussed further on.The controlled trials that can scarcely distinguish one NSAID from another aggregate data from dozens, or hundreds of patients who meet the trials' inclusion/exclusion criteria.As Guyatt, Sackett, and colleagues from
On Punctiform Ecchymoses in the Interior of the Body as a Proof of Death by Suffocation
Authors: F. Ogston
Journal: BMJ (1868)

THE BRITISH MEDICAL 7OURNAL.(Sept.24 i8I oe of rebellar disase.When hemiplegia exists, it is on the side opposite to the lesion.The c).exist eneof hemiplegia of one side, with paralysis of the third nere of the opposite side, Is indicative of lesion of the crus cerebri on the sidelon which the third nerve is paralysed.
Ecological studies: advantages and disadvantages
Authors: P. Sedgwick
Journal: BMJ (2014)

<h3>Background</h3> According to the good practice contract (CBUMPP), our University Hospital submits an annual self-evaluation to the Regional Health Authority (ARS) assessing the good practice of implantable medical devices (IMDs) prescriptions. <h3>Purpose</h3> To analyse the IMD indications according to CBUMPP requirements, namely to verify the conformity with national recommendations and justify off-label prescriptions. <h3>Materials and methods</h3> Each year in our hospital, an audit is performed to analyse all IMD prescriptions during a randomly selected week. Using various software, the hospital’s IT department establishes a database from patient and IMD records. This is matched against from the CBUMPP criteria. Pharmacists and surgeons consider the indications and look for evidence in the patient file if it does not conform. <h3>Results</h3> Over one week in 2013, the data collected from the entire hospital contained 746 lines containing IMDs. Our study focused on a sample of 485 IMD lines (65%) for 67 patients. The surgical branches represented were: Orthopaedics, Paediatrics (spine), Maxillofacial surgery (CMF), Otorhinolaryngology (ORL) and Ophthalmology. In many cases, multiple implants were often required for the same intervention (ranging from 1 to 32 implants in our study). 100% of the prescriptions complied with national recommendations. The main indications observed in Orthopaedics (41 patients) were prosthesis (141 IMDs), ligamentoplasty (27 IMDs), osteosynthesis (4 IMDs) and in Paediatrics (4 patients) were scoliosis (59 IMDs) and ligamentoplasty (2 IMDs). In CMF and ORL (22 patients), we analysed 252 IMDs. <h3>Conclusions</h3> In our sample, the good practice recommendations were followed. However, current national recommendations in these specialities are not very restrictive. Close collaboration between pharmacists and surgeons is essential to obtain complete data and evidence in order to evaluate the IMD conformity. No conflict of interest.
Germany sets up quality control institute for health care
Authors: Annette Tuffs
Journal: BMJ (2004)

Germany's federal joint committee of doctors, health insurance companies, and patients (the Gemeinsame Bundesausschuss) has announced the foundation of a new, independent Institute for Quality and Economic Efficiency in Health Care—Germany's equivalent of England's National Institute for Clinical Excellence.

The main task of the new institute, which has a staff of about 30, …
Aerospace medicine; the first 200 years
Authors: P. Gunby
Journal: JAMA (1986)

AMERICAN AEROSPACE MEDICINE went on record exactly 200 years ago, when a Massachusetts physician's account of his scientific observations during pioneering balloon flights was read before members of the Royal Society in Britain. Shortly thereafter, what has been called "the first book in the English language on aeronautics by an American" appeared under the title "A Narrative of the Two Aerial Voyages of Doctor Jeffries with Mons [sic] Blanchard; with Meteorological Observations and Remarks, by Doctor Jeffries, London, 1786." The author in both instances was John Jeffries, MD, who was born Feb 5, 1744, in Boston. He generally is credited with being "the first American to make a free flight in a balloon and the first balloonist to conduct scientific studies of the atmosphere" (<i>Aviat Space Environ Med</i>1984;55:993-999 and 1985;56:99-104). He did so during a Nov 30, 1784, flight from London to Kent and a Jan 7, 1785, crossing
Anterior and Posterior Pituitary Failure after Head Injury
Authors: K. P. Goldman, A. Jacobs
Journal: BMJ (1960)

Head injury has been reported as a cause of diabetes insipidus (Porter and Miller, 1948), and less commonly of anterior pituitary failure (Witter and Tascher, 1957).The case presented here is that of a girl in whom diabetes insipidus developed after a minor head injury.She died in hypopituitary coma six years later, and a post-mortem examination revealed unusual pathological features. Case ReportThe patient, born in 1936, had had no serious illnesses in childhood and was quite healthy until the age of 15, when she was knocked down by a car in a road accident.There was only momentary loss of consciousness, but she was admitted to hospital, where x-ray examination of the skull revealed no fracture.She was kept in hospital for 10 days and then discharged perfectly well, two scalp wounds having healed.The patient was next seen two years later complaining of polyuria, polydipsia, and loss of over a stone (6.4 kg.) in weight, and, although a poor witness, she said the symptoms dated from shortly after the time of the accident.There was no family history of any similar trouble.On examination she was seen to be a thin girl with a blood- pressure of 140/90 mm.Hg; no abnormal physical signs were detected.She was a dull, immature type of person, and at first it was thought her thirst might be due to hysteria.However, the diagnosis of diabetes insipidus was made when it was found that her urinary output measured up to 6.5 litres daily, while the speciflc gravity of the urine remained at 1004 after 24 hours' deprivation of water.Nicotine and intravenous hypertonic saline had no antidiuretic effect, but after an injection of " pitressin " the concentration of urine rose and the volume sharply diminished.The Wassermann reaction and Kahn test were negative and x-ray films of the skull and chest were normal.No other abnormalities were found.While in hospital the patient was uncooperative and refused to take pitressin by injection.She was discharged, taking two ampoules of pituitary snuff daily, which was sufficient to control her symptoms.She was next seen nine months later, aged 18, complaining of vomiting and amenorrhoea.Menstruation had previously been normal since it started at the age of 10.She was found to be pregnant, and in June, 1955, after a normal pregnancy and labour an infant girl was born; there was no post- partum haemorrhage.She was discharged home breast- feeding the baby and taking 3 ml. of pitressin tannate by daily injection.
THE NEURAMINIC ACID CONTENT OF CEREBROSPINAL FLUID AS AFFECTED BY NEUROLOGICAL DISEASES*
Authors: L. Lahut Uzman, Edgar A. Bering, Charles E. Morris
Journal: Journal of Clinical Investigation (1959)

Interest in the presence of neuraminic acid in human cerebrospinal fluid (CSF) and the varia- tions in its concentration is derived from the pos- sibility that these may reflect some aspect of cen- tral nervous metabolic activity.This, in turn, is based on the fact that neuraminic acid constitutes a part of the molecular structure of those water soluble glycolipids of brain that are generally re- ferred to as gangliosides (1).However, the ubiquitous nature of neuraminic acid in all tissue fluids and structures renders any inquiry based on analysis of CSF for neuraminic acid alone of doubtful significance.It need only be pointed out that neuraminic acid is found in many tissues either as part of the tissue gangliosides or else in mucoprotein-bound forms in such diverse struc- tures as submaxillary glands (2, 3), urinary mu- cins (4), human serum (5, 6), red cell stroma ( 1, 7, 8) and even the somatic glycolipid of Escherichia coli (9).Hence, in assessing the significance of changes in the neuraminic acid con- tent of CSF, the major problem resolves itself into excluding the neuraminic acid contributed by the serum to the CSF as well as that moiety de- rived from cellular elements (white and red cells) extrinsic to the central nervous system.The discovery by Bbhm, Dauber and Bau- meister (5, 10) that serum contains neuraminic acid (NA) in protein-bound form was followed by the demonstration by Uzman and Rosen ( 11 ) that the maximal concentration of NA occurred in the glyco-proteins of the a1-and a2-globulin group, with a preponderance in the latter.This was con- firmed by the studies of Baudouin, Lewin and Hillion (12), Jayle (13) and others.Since the total NA in serum is almost entirely in non- dialyzable form and is almost completely accounted
US physicians work fewer hours and see fewer patients than in 2008
Authors: E. Davies
Journal: BMJ (2012)

Physicians are working fewer hours, seeing fewer patients, and limiting access to their practices in light of substantial changes to the medical practice environment, according to research from the Physicians Foundation.

Between 2008 and 2012, the average number of hours physicians worked fell from 57 hours a week to 53, and doctors saw 16.6% fewer …
Left Ventricular Midwall Fibrosis as a Predictor of Mortality and Morbidity After Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy
Authors: Francisco Leyva, Robin J. Taylor, Paul W.X. Foley, Fraz Umar, Lawrence J. Mulligan, Kiran Patel, Berthold Stegemann, Tarek Haddad, Russell E.A. Smith, Sanjay K. Prasad
Journal: Journal of the American College of Cardiology (2012)
Recommendations for Medical Management of Adult Lead Exposure
Authors: Michael J. Kosnett, Richard P. Wedeen, Stephen J. Rothenberg, Karen L. Hipkins, Barbara L. Materna, Brian S. Schwartz, Howard Hu, Alan Woolf
Journal: Environmental Health Perspectives (2006)

Research conducted in recent years has increased public health concern about the toxicity of lead at low dose and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. In this article, which appears as part of a mini-monograph on adult lead exposure, we summarize a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations < 40 microg/dL. Based on this literature, and our collective experience in evaluating lead-exposed adults, we recommend that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if two successive blood lead concentrations measured over a 4-week interval are > or = 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to < 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.
Kenneth C Edelin
Authors: N. Stafford
Journal: BMJ (2014)

Doctor who performed the abortion at the centre of a major US court case



AP/PA

It started out as a routine elective abortion at Boston City Hospital. The patient was a 17 year old in her sixth month of pregnancy. The attending doctor was Kenneth Edelin, the first African-American to be named chief resident of obstetrics and gynaecology at the hospital. It was October 1973—nine months after the US Supreme Court had affirmed the legal right of women to have abortions in the landmark Roe v Wade case.

Edelin successfully performed the abortion. Six months later he was charged by Boston prosecutors with manslaughter in the death of the aborted fetus. Later, Edelin would say he had been the victim of a “witch hunt.”

The Supreme Court’s abortion ruling was not popular with Boston’s large Irish-Catholic community. Furthermore, Boston in the early 1970s was being rocked by racial unrest. Federal courts had ordered the city’s racially segregated schools to be desegregated. African-American students were bussed to white schools, and vice versa.

“In Boston, …
CRITICISM OF THE ANTITOXIN TREATMENT FROM A DIFFERENT STANDPOINT.
Authors: CARL STRUEH
Journal: JAMA (1896)

The enthusiasm for the antitoxin treatment has at the present time become so common that one can hardly dare to give a pessimistic opinion if he does not want to run the risk of being called heretic or unscientific. Still Iwould like to explain in a few words the standpoint which IIake as to the antitoxin treatment. The statistics show the undeniable fact that since the introduction of the seserum-therapy in diphtheria has decreased to about one-half of its former figure. Yet I think it wrong to ascribe this decrease in the mortality exclusively to the antitoxin treatment, but I take it for a very important causal factor that the serum-therapy, though absolutely not harmless, is less harmful than the drug treatment formerly used. The proof for this assertion is given us by those cases in which we apply antitoxin for mere prophylactic purposes in healthy persons. The less severe disturbances which the antitoxin causes in
Exercise Training Normalizes Sympathetic Outflow by Central Antioxidant Mechanisms in Rabbits With Pacing-Induced Chronic Heart Failure
Authors: Lie Gao, Wei Wang, Dongmei Liu, Irving H. Zucker
Journal: Circulation (2007)

In a recent study, we demonstrated that an increase in oxidative stress in the rostral ventrolateral medulla plays a critical role in the sympathoexcitation observed in chronic heart failure (CHF). Growing evidence indicates that exercise training evokes an antioxidative effect in CHF. In the present study, we therefore hypothesized that long-term exercise exerts its beneficial effect on autonomic activity in CHF via central antioxidative mechanisms.Experiments were performed on New Zealand White rabbits. All rabbits were instrumented to measure mean arterial pressure, heart rate, and renal sympathetic nerve activity and to test baroreflex sensitivity. Exercise training significantly decreased baseline renal sympathetic nerve activity (65.8+/-5.2% to 41.3+/-3.9% of Max [where "Max" is the maximum renal sympathetic nerve activity induced by a 50-mL puff of smoke directed to the external nares of the rabbit], P<0.05) and increased the maximal gain of the baroreflex curves for heart rate (2.2+/-0.2 to 4.6+/-0.7 bpm per mm Hg, P<0.01) and renal sympathetic nerve activity (1.9+/-0.2% to 4.5+/-0.4% of Max per mm Hg, P<0.01) in CHF rabbits. Exercise training increased expression of CuZn superoxide dismutase (0.3+/-0.1 to 1.5+/-0.3 [ratio of CuZn superoxide dismutase to tubulin], P<0.01) and decreased NAD(P)H oxidase subunit gp91(phox) protein expression (1.9+/-0.2 to 1.2+/-0.1 [ratio of gp91(phox) to tubulin], P<0.05) in the rostral ventrolateral medulla of CHF rabbits. Central overexpression of CuZn superoxide dismutase dose-dependently decreased baseline renal sympathetic nerve activity (control, 68.5+/-7.1% of Max; 10(10) particles of adenovirus, 53.2+/-4.4% of Max; and 10(11) particles of adenovirus, 33.7+/-3.5% of Max; P<0.05) in CHF rabbits.These results suggest that an upregulation in central antioxidative mechanisms and suppressed central prooxidant mechanisms may contribute to the exercise training-induced beneficial effects on autonomic activity in CHF.
Use of the Hospital in a Randomized Trial of Prepaid Care
Authors: Gordon Schiff
Journal: JAMA (1988)

To the Editor.—  The most important finding from the article entitled Use of the Hospital in a Randomized Trial of Prepaid Care1needs to be underscored, not buried or explained away. Health maintenance organizations (HMOs) reduced needed (nondiscretionary) medical admissions by the same amount as they reduced  admissions—a 56% reduction (from 34 vs 15 per 1000 person-years) in needed admissions compared with a 53% reduction (30 vs 14 per 1000 person-years) in admissions deemed less necessary.  Thus, the study fails to find evidence that the HMO mechanism achieves its reductions in medical hospitalizations by effectively discriminating between needed and unnecessary admissions. Rather than selectively excising wasteful admissions, the instrument is apparently more of a sledgehammer than a careful surgical knife.  For the surgical patients, there was a decrease in the rate of discretionary admissions, while the rate of more acute, nondiscretionary surgery did not decrease. The authors conclude that
Is ignorance bliss?
Authors: D. Baxby
Journal: BMJ (2001)

In the old days a chemist would dispense prescribed medicine in an anonymous container with the minimum of information—three times a day and no alcohol, or whatever. Now a pharmacist will probably provide tablets in the manufacturer's original package—complete with generic and company product names, with a comprehensive leaflet describing the indications, contraindications, advice on overdose, and an impressive list of potential side effects. In some instances relatively detailed information is provided on the drug's mode of action.

No doubt this is in keeping with the openness of the new NHS, and partly perhaps to meet health and safety requirements. Having worked in a medical school for 36 years I have some knowledge of my own subject and rather less of peripheral specialties. However, until recently I did not even know I had angiotensin-converting enzymes, let alone that they might need inhibiting. I find such product information leaflets interesting but also somewhat confusing and …
Joyce Fanny Elsom
Authors: E. Winterton
Journal: BMJ (2013)

Joyce Fanny Elsom (nee Grant) was born in London and educated at Henrietta Barnett School. From there she went to Girton College Cambridge in 1940, where she not only excelled academically, winning several prizes, but also won a half blue in netball. Between 1943 and 1946 she completed her clinical medical training at King’s College Hospital, where again her outstanding academic talents were recognised, and she was awarded a Rockefeller scholarship for further study in the United States. This prestigious award was declined, as Joyce had chosen to accept a somewhat different offer, and, after getting married in 1947, she moved to Staffordshire with her husband, Raymond, who became a …
LPCAT1 regulates surfactant phospholipid synthesis and is required for transitioning to air breathing in mice
Authors: James P. Bridges, Machiko Ikegami, Lauren L. Brilli, Xueni Chen, Robert J. Mason, John M. Shannon
Journal: Journal of Clinical Investigation (2010)

Respiratory distress syndrome (RDS), which is the leading cause of death in premature infants, is caused by surfactant deficiency. The most critical and abundant phospholipid in pulmonary surfactant is saturated phosphatidylcholine (SatPC), which is synthesized in alveolar type II cells de novo or by the deacylation-reacylation of existing phosphatidylcholine species. We recently cloned and partially characterized a mouse enzyme with characteristics of a lung lysophosphatidylcholine acyltransferase (LPCAT1) that we predicted would be involved in surfactant synthesis. Here, we describe our studies investigating whether LPCAT1 is required for pulmonary surfactant homeostasis. To address this issue, we generated mice bearing a hypomorphic allele of Lpcat1 (referred to herein as Lpcat1GT/GT mice) using a genetrap strategy. Newborn Lpcat1GT/GT mice showed varying perinatal mortality from respiratory failure, with affected animals demonstrating hallmarks of respiratory distress such as atelectasis and hyaline membranes. Lpcat1 mRNA levels were reduced in newborn Lpcat1GT/GT mice and directly correlated with SatPC content, LPCAT1 activity, and survival. Surfactant isolated from dead Lpcat1GT/GT mice failed to reduce minimum surface tension to wild-type levels. Collectively, these data demonstrate that full LPCAT1 activity is required to achieve the levels of SatPC essential for the transition to air breathing.
A murky portrait of human cruelty
Authors: Albert Bandura
Journal: Behavioral and Brain Sciences (2006)

In this commentary, I review diverse lines of research conducted at both the macrosocial and microbehavioral level that dispute the view that cruelty is inherently gratifying. Expressions of pain and suffering typically inhibit rather than reinforce cruel conduct in humans. With regard to functional value, cruelty has diverse personal and social effects, not just the alluring benefits attributed to it.