tbuckley/cabot-search huggingface dataset:
Book Review: Medical Appraisal, Selection and Revalidation: a Professional's Guide to Good Practice
Authors: Laurie Montgomery Irvine
Journal: Journal of the Royal Society of Medicine (2001)

Appraisal and revalidation will soon be part of everyday life for British doctors, but some remain unsure of what is involved, and feel threatened. Extraction of relevant facts from the numerous published sources (often jargon-ridden) can be difficult and time-consuming.

For Calman trainees there are three appraisals during each post, with a yearly in-training assessment. Failure can mean retaking the year or removal from the training programme. For those who have completed training, a revalidation folder is part of the yearly appraisal. At the end of the five-year cycle the completed folder is submitted to the revalidation group. Poor performance could lead to removal from the Medical Register.

Since appraisal and part of revalidation depend on an interview, Gatrell and White begin their book with interviewing skills—including not only the use of open, closed and probing questions but also non-verbal communication. There are useful tips here for both interviewer and interviewee. They then go on to appraisal of various grades of doctor, with a section on the folder and the structure of revalidation groups. Clearly, the collection of information required for these processes will be complex and time-consuming; questions of funding for data collection and who will be responsible have yet to be fully addressed. The final chapter deals with the selection process. The pros and cons of application by curriculum vitae or special forms are discussed, and there is a section on how to short-list without bias (with examples of a scoring profile); another deals with the sorts of interview panels needed for different grades of doctor and the uncomfortable task of feedback to unsuccessful candidates.

Although not all the flow diagrams are easy to follow (or even necessary), in general the book is clear and well set out. Each chapter concludes with a summary of key points and there are references for further reading. Doctors in all specialties, on whatever side of the interview table, will find this concise book a useful source of information.
The real obstacles to collaborative and affordable healthcare in the UK
Authors: B. T. Hart
Journal: BMJ (2015)

The King’s Fund article suggests we need to look across the Atlantic for future models of integrated care.1 Really? We’ve been here before.

Readers may remember Feachem and colleagues’ paper, published 13 years ago, which compared clinical outcomes between Kaiser Permanente and the NHS and suggested that we should ditch the NHS model for the …
Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results.
Authors: A M Gianni, S Siena, M Bregni, M Di Nicola, S Orefice, F Cusumano, B Salvadori, A Luini, M Greco, R Zucali, F Rilke, M Zambetti, P Valagussa, G Bonadonna
Journal: Journal of Clinical Oncology (1997)

To assess the efficacy, toxicity, and applicability of high-dose therapy administered as adjuvant initial treatment to women with breast cancer with extensive nodal involvement.Sixty-seven patients with stage II to III breast cancer involving > or = 10 axillary nodes received a novel high-dose sequential (HDS) regimen, including the high-dose administration of three non-cross-resistant drugs (cyclophosphamide, methotrexate, and melphalan) given within the shortest interval of time as possible with hematologic and nonhematologic toxicity.Sixty-three patients completed the program as planned, one patient died of acute toxicity, and three patients were switched to standard-dose adjuvant therapy. After a median follow-up duration of 48.5 months and a lead follow-up of 78 months, actuarial relapse-free survival for all 67 registered patients is 57% and overall survival is 70%, respectively. Comparison with a historical control group of 58 consecutive patients showed a significantly superior rate of freedom from relapse for the HDS-treated group (57% v 41%, respectively), in particular when two subgroups of patients, more homogeneous for their number of involved nodes, were compared (65% v 42%). Overall, treatment was of short duration (median, 70 days), required a median of 32 days of hospital stay, and was associated with only a few severe side effects (the most distressing being oral mucositis after melphalan therapy).HDS therapy emerges as an effective and applicable regimen, whose major toxicity was occasional. Final assessment of its value in a randomized, multicenter trial is presently underway.
Cholestanol and survival with simvastatin
Authors: E J Wallis, R Williamson, L E Ramsay, W W Yeo, P R Jackson, T. A Miettinen, H. Gylling, T. Strandberg, S. Sarna
Journal: BMJ (1998)

Protecting children from armed conflictChildren affected by war must not be stigmatised as permanently damagedEditor-Southall and Abbasi quote Unicef when they state that the psychological consequences of armed conflict on children are so great that they can rarely be repaired. 1Unicef indeed says that "time does not heal trauma," but there is no sound empirical basis for a generalisation that risks stigmatising whole populations of children affected by war as sick or permanently damaged.Even child survivors of Auschwitz did not turn out like this as a general rule, and there are no published studies of children from non-Western war zones to support such a conlusion.Unicef and other agencies need to review such claims and costly interventions based on them; the claims owe more to prevailing sociocultural assumptions in the West than anything else.Over the past 50 years psychological explanations for life events and the medicalisation of distress have grown hugely.Because many people believe, for example, that rape or other criminal violence, childhood abuse, or even persistent bullying at school is an experience that may have lifelong psychological effects it seems unthinkable that war and atrocity should not do this to almost everyone exposed to them.Constructions of "trauma" deployed in the health field are increasingly expansive and undiscriminating. 2 No one wants to play down what children may suffer, or that war may produce clear psychological dysfunction in some (a minority).But it is not to their mental worlds but to their social worlds that survivors direct their attention, and humanitarian agencies should follow suit.The literature of both anthropology and mental health (in the case of mental health, starting with a classic study by Freud and Burlingham 3 ) shows the positive impact of family and community in buffering the short and longer term effects of war.The concept of child trauma is currently fashionable.But it is the social, cultural, and economic rebuilding of worlds shattered by war (including valued institutions such as schools), allied to urgent issues of equity and justice, which will determine the future wellbeing of several million child survivors worldwide. 4For those for whom this does not happen war may indeed mean a life sentence, but this is not trauma.
Expression of eotaxins in nasal mucosa of allergic patients after intranasal provocation- preliminary study
Authors: Joanna Hermanowicz-Salamon, Magdalena Paplinska-Goryca, Patrycja Nejman-Gryz, Ryszarda Chazan, Hanna Grubek-Jaworska
Journal: European Respiratory Journal (2013)

[Background] Eosinophilic infiltration is present in the late phase of allergic reaction. Eotaxins are the strongest and most specific chemotactic agents attracting eosinophils. The nasal provocation test is a useful diagnostic method assessing the specific response to allergens.  [The aim] Was to assess the impact of a single nasal allergen challenge on levels of eotaxins expression in nasal mucosa of allergic rhinitis patients.  [Method] 9 patients with allergic rhinitis, mean age 31.2 y (39-26), 5 M. We measured the level of eotaxin expression and inflammatory cell count in nasal mucosa of patients without symptoms and 6 hours after allergic provocation. The symptoms were measured using pointed scale (0-14 points). Expression of eotaxins was measured using quantitative RT- PCR. Exfoliative cytology of nasal mucosa was estimated.  [Results] 8 provocations were clinically positive - median value 6 points. Expression of eotaxins is presented as a percentage of expression before provocation. We did not observe statistical differences between expression before and after allergen provocation. Expression of CCL26 was significantly lower in group of patients with strong allergic response.  [Conclusion] In patients with high allergic response expression of all eotaxins was decreased (significantly in CCL26 only) 6 hours after allergen challenges. We suggest that expression of eotaxins should be probably measured later.
Vulnerability of Jews to affective disorders
Authors: I Levav, R Kohn, J M Golding, M M Weissman
Journal: American Journal of Psychiatry (1997)

Psychiatric literature over the past 100 years suggests that Jews are at higher risk for affective disorders than numbers of other religious groups. To examine these claims, the authors analyzed data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study. In addition, the relationships among gender, alcoholism, and major depression were investigated. The period prevalence and lifetime rates of DSM-III major depression among Jews, Catholics, Protestants, individuals in other religious groups, and individuals with no religious affiliation were examined in the Los Angeles and New Haven, Conn., ECA data. Logistic regression with covariates for site, gender, marital status, and socioeconomic status was used to estimate odds ratios and 95% confidence intervals. The calculated rates, based on the combined data from ECA study waves 1 and 2 for the white population, were weighted according to the 1980 U.S. population census. Female-to-male rate ratios and rates of alcohol abuse/dependence were also obtained. While no differences were found among females, Jewish males had significantly higher rates of major depression than Catholics, Protestants, and all non-Jews combined. Jews had a 1:1 female-to-male ratio for major depression, in contrast to the other religious groups, which approached the universal 2:1 ratio. Rates of alcohol abuse/dependence were inversely related to rates of major depression. The results support only in part the earlier reports that Jews have higher rates of depression. The equal gender distribution of major depression among Jews may be associated with the lower rate of alcoholism among Jewish males.
Asthma phenotypes with rapid decline in lung function
Authors: Tadao Nagasaki, Hisako Matsumoto, Yoshihiro Kanemitsu, Kneji Izuhara, Yuji Tohda, Hideo Kita, Takahiko Horiguchi, Kazunobu Kuwabara, Keisuke Tomii, Kojiro Otsuka, Masaki Fujimura, Noriyuki Ohkura, Katsuyuki Tomita, Akihito Yokoyama, Hiroshi Ohnishi, Yasutaka Nakano, Tetsuya Oguma, Soichiro Hozawa, Guergana Petrova, Isao Ito, Tsuyoshi Oguma, Hideki Inoue, Tomoko Tajiri, Toshiyuki Iwata, Yumi Izuhara, Junya Ono, Shoichiro Ohta, Akio Niimi, Michiaki Mishima
Journal: European Respiratory Journal (2013)

Background  Clustering approach has been used to classify heterogeneous asthma population into distinct phenotypes. However, longitudinal aspects of the phenotypes have been unclear.   Objective  To determine associations between phenotypes and annual decline in forced expiratory volume in one second (ΔFEV 1 ) in asthmatic patients.   Methods  224 adult asthmatic patients (mean age 62.3 years) treated with inhaled corticosteroid (ICS) for at least 4 years were enrolled. We applied cluster analysis to determine asthma phenotypes using seven variables: serum IgE levels, gender, age of asthma onset, BMI, %FEV 1 , asthma control test (ACT), and blood eosinophil counts. ΔFEV 1 , from at least one year after the initiation of ICS therapy to the time of enrollment or later (mean 16.2 measurements over 8 years per person), were assessed. Differences in clinical indices including ΔFEV 1  and blood biomarkers at enrollment among clusters were analyzed.   Results  Four distinct phenotypes were determined. Cluster 1 (n = 25): late-onset, non-atopic, pauci-inflammatory (≤250 eosinophil/μL and ≤5000 neutrophil/μL), and preserved lung function. Cluster 2 (n = 105): early-onset, atopic, eosinophilic, and small decline in FEV 1 . Cluster 3 (n = 73): late-onset, eosinophilic, moderate decline in FEV 1 , and the highest serum periostin level among the four clusters. Cluster 4 (n = 21): mixed type (eosinophilic and neutrophilic) with the lowest FEV 1 , the greatest decline in FEV 1 , the lowest ACT score, and the highest serum IL-6 level among clusters. The proportions of patients with rapid FEV 1  decline, defined as 30 ml·yr -1  or greater decline, were over 30% in clusters 3 and 4.   Conclusions  We identified asthma phenotypes with rapid FEV 1  decline using a cluster analysis.
Tuberculosis lineage in a low prevalence area; epidemiology and clinical characteristics
Authors: Tom Hartley, Stephen Murphy, Sharon Stothard, Craig Blundred, Tricia Cresswell
Journal: European Respiratory Journal (2013)

Background . The UK health protection agency (HPA) recently introduced strain typing of  M. tuberculosis  isolates using mycobacterial interspersed repetitive unit analysis (MIRU) for routine TB surveillance. Aim of this study was to investigate molecular epidemiology of TB & clinical/epidemiological correlates in Sunderland UK an area of high social deprivation, homogeneous population (93% White British) and low TB prevalence.   Methods  TB cases (2011-2012) identified. Clinical, bacteriological & epidemiological data obtained. Strain typing of  M. tuberculosis  isolates by 24 loci MIRU analysis (HPA TB reference laboratory). MIRU24 profiles analyzed using online tools: MIRU-VNTR plus  and TBinsight (NIH).   Results  47 cases. Race: White-British 61.7%, South Asian 23%, African 8.5%, SE Asian 6.3%. Male 63.8 %, median age (range) 40 (2-86) y, all HIV negative. Extra-Pulmonary (EP) disease > in Asians: 90.5% v 54% (OR 8.1 1.56- 42.3).  M. tuberculosis  isolated in 81% all fully sensitive to first line drugs. MIRU24 profiles available in 32 cases. Lineages: Euro-American (EUA) 56.3% (White British 95%), Indo-Oceanic (IO)18.6 %, East African-Indian (EAI) 15.6%, Africanum 6.3% and East-Asian (EA) 6.3%. Disease phenotype related to lineage: EP disease IO 50%, EAI 30%, EUA 20% (P=0.014). EUA associated with pulmonary or invasive EP disease OR (adjusted for race 95% CI) 7.5 (1.7- 33.3). Two epidemiological clusters were confirmed and further unsuspected cluster identified by MIRU24 analysis.   Conclusion  Distribution of  M. tuberculosis  lineage in Sunderland is associated with race/ethnicity. Disease type is related to  M. tuberculosis  lineage. Strain clustering by MIRU24 analysis confirmed epidemiological clusters.
Response to Hron et al.
Authors: Peter V. Lovell, Morgan Wirthlin, Lucia Carbone, Wesley C. Warren, Claudio V. Mello
Journal: Genome biology (2015)

Hron et al. provide transcriptome evidence that three (1.1 %) of the 274 genes reported by Lovell et al. as missing in birds may actually be ‘hidden’ as a result of high GC content. Although this factor may explain some gene absences from genomic assemblies, we believe it is insufficient to account for the extensive syntenic losses described in Lovell et al. Please see related article: www.dx.doi.org/10.1186/s13059-015-0724-z
Randomised prospective study of intermittent versus continuous androgen suppression in advanced prostate cancer
Authors: K. Miller, U. Steiner, A. Lingnau, U. Keilholz, U. Witzsch, A. Haider, U. Wachter, C. Rüssel, J. Altwein
Journal: Journal of Clinical Oncology (2007)

5015 Background: Based on results of animal experiments intermittent androgen blockade was suggested to delay progression of advanced prostate cancer to the hormone refractory stage. We conducted a prospective randomized study to compare intermittent with continuous androgen suppression. Methods: This was a multi-centre, randomised, two-arm study comparing treatment with goserelin + bicalutamide (intermittent, group A) vs. goserelin + bicalutamide (continuous, group B). The primary endpoint was time to clinical and/or biochemical progression of the disease despite androgen suppression. Secondary enpoints were survival time, patient’s quality of life (QoL) and toxicity. Patients eligibility criteria were: histologically confirmed adenocarcinoma of the prostate in clinical stage T1–4N1–3M0 or T1–4N0–3M1 (D1 oder D2). After an induction phase of 24 weeks with MAB, 335 patients whose PSA decreased under 4 ng/ml or = 90% from baseline were randomized. Results: About two-thirds of the patients of both the intermittent and the continuous therapy arm (65% versus 66%, ITT population) experienced a clinical and/or biochemical disease progression due to any reason during this study. The median time to disease progression was longer for patients randomised to the intermittent therapy arm (16.6 months) compared with patients randomised to the continuous therapy arm (11.5 months). This difference however was not statistically significant (log rank test, p=0.1758). The median time to death from any cause was 51.4 month in the intermittent arm compared and 53.8 months in the continuous therapy arm (p = 0.658). There were no differences in the incidence of patients with AEs or SAEs or in any other safety parameter between patients treated intermittently and patients treated continuously. Patients’ self-assessment of their overall health and of their sexual activity appeared to be favourable in the intermittent compared with the continuous therapy arm. 88% of all patients treated intermittently experienced more than 50% of the number of treatment days as treatment-free days. Conclusions: Intermittent therapy in D1 and D2 prostate cancer patients appears to be safe and feasible. Off treatment periods are &gt; 40 % and attribute to patients quality of life. No significant financial relationships to disclose.
Infusional Paclitaxel and Weekly Vinorelbine Chemotherapy With Concurrent Filgrastim for Metastatic Breast Cancer: High Complete Response Rate in a Phase I-II Study of Doxorubicin-Treated Patients
Authors: Georgiana K. Ellis, Julie R. Gralow, H. Irving Pierce, Margaret A. Williams, R. B. Livingston
Journal: Journal of Clinical Oncology (1999)

PURPOSE: We investigated 96-hour paclitaxel infusion combined with weekly (days eight and 15) vinorelbine as salvage therapy for metastatic breast cancer in anthracycline-exposed patients. All patients received scheduled support with granulocyte colony-stimulating factor (G-CSF; filgrastim). Tumor response, toxicity, time to progression (TTP), and survival were assessed. PATIENTS AND METHODS: This single-center nonrandomized trial enrolled 32 patients. Anthracycline exposure and subsequent progression were common to all patients. Paclitaxel and vinorelbine were escalated over three dosing levels, stratified by liver function. RESULTS: Seven patients (22%) achieved a complete response and nine patients achieved a partial response for an overall response rate of 50%. The median TTP was 6.1 months, and median survival time was 14.1 months. Dose-limiting toxicity was neutropenia, with dose delay or reduction in seven of 32 patients. Febrile neutropenia requiring hospitalization was uncommon (three of 32 patients; 9%). There were no treatment-related deaths. Grade 3/4 thrombocytopenia occurred in two patients (6%), and 13 patients (41%) required RBC transfusions for anemia. Grade 3 nausea and vomiting was seen in one patient, who was found to be Addisonian. Despite potentially overlapping neurologic toxicities of the two agents, only two patients (6%) were removed from the study because of progressive peripheral neuropathy. CONCLUSION: Administration of 96-hour paclitaxel infusion and subsequent weekly vinorelbine with G-CSF support is well tolerated. The response rate, TTP, and survival data are encouraging for therapy given to anthracycline pretreated patients with metastatic breast cancer. If these results can be verified in multi-institution trials, this or a similar combination of drugs would merit investigation as first-line therapy in this patient population.
Abstract 4054: Determinants of Circulating Asymmetric Dimethylarginine, Monomethylarginine and L-Arginine: A Population-Based Study
Authors: Julio A Chirinos, Josefina Medina Lezama, Robert David, J. Alexander Bralley, Oscar L Morey Vargas, Humberto Zea Diaz, Juan F Bolanos, Zoila Valdivia Ascuna, Sheyla Paredes Diaz, Fernando F Corrales Medina, Carolina Cuba, Edgar Munoz Atahualpa, Julio Chirinos Pacheco
Journal: Circulation (2006)
Modeling Hypersomnolence in Sleep-disordered Breathing
Authors: NARESH M. PUNJABI, DANIEL J. O'HEARN, DAVID N. NEUBAUER, F. JAVIER NIETO, ALAN R. SCHWARTZ, PHILIP L. SMITH, KAREN BANDEEN-ROCHE
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

The etiology of excessive daytime sleepiness in patients with sleep-disordered breathing (SDB) is not well defined. In this study, we examined the relationships between several clinical and polysomnographic parameters and the degree of hypersomnolence in 741 patients with SDB (apnea–hypopnea index [AHI] ⩾ 10 events/h). The study sample was obese (body mass index [BMI]: 35.3 ± 8.5 kg/m2) and had evidence of moderate SDB (AHI: 47.6 ± 29.3 events/h). Hypersomnolence was quantified with the multiple sleep latency test (MSLT) and survival analysis was used to assess the risk factors for hypersomnolence. In a multivariate proportional hazards model, AHI and nocturnal hypoxemia were independent predictors of hypersomnolence (MSLT < 10 min). The adjusted relative risks (RR) of hypersomnolence were 1.00, 1.30, and 1.65 for patients with an AHI of 10 to 29.9, 30 to 59.9, and ⩾ 60 events/h, respectively. A positive association between hypersomnolence and oxyhemoglobin desaturation ( Δ SaO2 ) was observed with RR of 1.00, 1.18, 1.43, and 1.94 for a Δ SaO2 of ⩽ 5%, 5.1 to 10%, 10.1 to 15%, and > 15%, respectively. Sleep fragmentation, as assessed by the distribution of sleep stages, was also an independent predictor of hypersomnolence. Using stage 1 sleep as a reference, an increase in stage 2 and slow wave sleep (SWS) were protective from hypersomnolence. For a 10% increase in stage 2 or SWS the adjusted RR for hypersomnolence were 0.93 and 0.79, respectively. REM sleep showed no significant association with the degree of hypersomnolence. These results suggest that AHI, nocturnal hypoxemia, and sleep fragmentation are independent determinants of hypersomnolence in SDB.
Medicare payouts for improper claims drop by a third
Authors: James Ciment
Journal: BMJ (1999)

A report issued on 9 February by the inspector general at the US Department of Health and Human Services found a 38% drop in the amount paid out by the government in improper Medicare claims between 1997 and 1998.

According to the report, the department dispensed $12.6bn (£7.87bn) in mistaken or fraudulent claims last year (about seven cents for every dollar). The figures for 1997 and 1996 were $20.3bn and $23.2bn respectively.

The biggest drop, the report noted, …