tbuckley/cabot-search huggingface dataset:
Oxygen prescription and oxygen therapy on the wards according to British Thoracic Society guidelines: Experience of an acute trust in the UK
Authors: Aiza Jamil, Bandipalyam Prathibha
Journal: European Respiratory Journal (2011)

Background:  Oxygen is one of the most commonly used drugs in a hospital setting. The British Thoracic Society (BTS) published guidelines in Oct 2008 to guide oxygen use in hospital settingS aimed at standardising practise in the prescription and delivery of oxygen therapy. An audit was carried out in 2010 in East Kent Hospitals University Trust (EKHUT) To assess current practise of prescription and monitoring of oxygen therapy and ompliance with standards set out in the BTS Guideline   Methodology:  All adult patients admitted to a medical or surgical ward and using oxygen or prescribed oxygen at the time of the audit were included. Data collection was carried out using the BTS audit tool on 6th Feb 2010. The patient9s drug chart, monitoring chart and medical notes were used to gather information about oxygen prescription and use. In total 740 patients were audited.   Results:  11% of patients in EKHUT were using oxygen at the time of the audit. This is comparable with national figures of 17.5%.Only 30% had formal prescription and the mode (continuous or PRN) of oxygen delivery was clearly documented and but 12% did not have any documentation about the mode. Rest of them had instruction about oxygen therapy in the medical notes but not on the chart. Majority of patients were within the target saturation range at their most recent observation round indicating that adherence to prescription target ranges was overall good.   Conclusion:  This audit has highlighted the need to raise awareness in all medical and nursing staff of BTS recommendations and educate health professionals to deliver oxygen in a more standardised and safe manner.
Involvement of the genitourinary system in multiple primary malignant neoplasms: a review.
Authors: P Ray, R Sharifi, V Ortolano, P Guinan
Journal: Journal of Clinical Oncology (1983)

A case is presented of a patient with separate primaries of the cervix, breast, bladder, and kidney. In a review of 352,073 cancer patients in the literature, the genitourinary system appears to be at a greater risk of this phenomenon. The entity of multiple primary malignant neoplasms is reviewed with an analysis of the involvement of the genitourinary system.
Erythropoiesis-Stimulating Agents in Oncology
Authors: John A. Glaspy
Journal: Journal of the National Comprehensive Cancer Network (2008)

Patients who have cancer, particularly those undergoing chemotherapy, frequently become anemic. Therapy with erythropoiesis-stimulating agents (ESAs) is associated with an increase in hemoglobin levels, a reduction in transfusion requirements, and, according to many clinical trialists and experienced clinicians, an improvement in functional status, productivity, and quality of life. Several randomized trials of ESAs in patients who have cancer have recently reported inferior outcomes in tumor progression or survival, raising appropriate concerns about the safety of ESAs in oncology. However, 3 important caveats to these reports exist. First, these clinical trials did not reflect the common use of ESAs in oncology practice (i.e., to treat, rather than prevent, anemia in patients undergoing chemotherapy). Second, the trials were seriously flawed and did not meet reasonable standards for cancer progression or survival trials. Third, during the same period, randomized trials were presented or published that showed no negative impact on tumor progression or survival; these trials have approximately the same shortcomings as trials that suggest a safety issue exists. The lack of definitive answers about the safety of ESAs for treating chemotherapy-related anemia has placed physicians, regulators, and most importantly patients in a difficult position that can only be addressed with additional data. This article reviews relevant preclinical and clinical available data to help improve understanding and guide decision making.
Does resistance training improve physical activity in patients with COPD
Authors: Linzy Houchen, Manoj Menon, Samantha Harrison, Carolyn Sandland, Michael Morgan, Michael Steiner, Sally Singh
Journal: European Respiratory Journal (2011)

Introduction: Quadriceps (quads) weakness is a functional problem for patients (pts) with COPD. Resistance training (RT) can increase quads strength. The translation of increased strength to physical activity (PA) is less clear.

Aim: To determine if RT in isolation (outside of pulmonary rehabilitation) can increase PA in pts with COPD.

Method: PA was measured before & after an 8week RT course. RT was 5×30 bilateral knee extensions; 3 times/week on an isokinetic dynamometer (Cybex: speed = 180°/sec). Pts were enrolled in a trial of protein supplementation (PS) during RT. PS did not augment the benefits of RT & PA results are therefore pooled.

20 pts [mean (SD) age 69.2 (9.4) yr, BMI 25.6 (4.4), FEV1 48.8 (14.3)%pred, 11 men] had PA measured using the DUKE Activity Status Index [DASI (range 0-58.2)] & ActiTrac accelerometer [IM Systems: mean acceleration/min, average activity for 7 days]. Isometric quads strength [Cybex: Newton metres (Nm)], thigh lean mass [DEXA: grams (g)] & cycle ergometry peak work (W) were also recorded.

Results: Mean values (SD) & change (95% CI) from baseline are shown in table 1. PA changes were not significant at 8 weeks.

View this table:

Table 1





Conclusion: Our findings suggest that increases in strength are not routinely translated into PA changes when RT is done in isolation. Our intervention did not include aerobic training/PA advice.
The Role of Radiation Therapy in the Treatment of Medullary Thyroid Cancer
Authors: Stephanie A. Terezakis, Nancy Y. Lee
Journal: Journal of the National Comprehensive Cancer Network (2010)

Medullary thyroid cancer (MTC) is a neuroendocrine tumor derived from parafollicular or C cells of the thyroid gland. Surgical resection is the mainstay of treatment for MTC. External-beam radiation treatment (EBRT) has traditionally played a limited role in the management of MTC. Despite aggressive surgery, patients at high risk for local recurrence may benefit from adjuvant EBRT. With improvements in radiation technique, adequate dose can be effectively delivered to the region at risk while minimizing dose to surrounding critical structures. Although the role of EBRT in the management of these tumors has thus far been poorly defined, EBRT should be considered as a treatment option for patients with locally advanced MTC to optimize locoregional control.
A randomized study comparing cisplatin or carboplatin with etoposide in patients with advanced non-small-cell lung cancer: European Organization for Research and Treatment of Cancer Protocol 07861.
Authors: J Klastersky, J P Sculier, H Lacroix, G Dabouis, G Bureau, P Libert, M Richez, P Ravez, G Vandermoten, J Thiriaux
Journal: Journal of Clinical Oncology (1990)

The European Organization for Research and Treatment of Cancer (EORTC) Lung Cancer Working Party conducted a randomized trial comparing cisplatin (CDDP; 120 mg/m2, day 1) and carboplatin (CBDCA; 325 mg/m2, day 1) in combination with etoposide (VP16; 100 mg/m2, days 1, 2, and 3) in advanced non-small-cell lung cancer (NSCLC). Two hundred twenty-eight patients were eligible for survival and 202 assessable for response. We obtained 27 of 100 objective responses (ORs; 27%) in the CDDP arm and 16 of 102 (16%) in the CBDCA arm (P = .07). There was no significant difference in survival. Toxicity, consisting mainly of myelosuppression and renal function impairment, was significantly increased in the patients receiving the CDDP treatment. We conclude that CDDP plus VP16 was more active but also more toxic than CBDCA plus VP16 in advanced NSCLC.
The particularities of new cases of tuberculosis at homeless people
Authors: Elena Artin, Aurelia Ustian
Journal: European Respiratory Journal (2013)

Background: Homeless people are a dangerous outbreak of unidentified tuberculosis, and it is a serious medical and social problem.  Aim: To study the incidence, clinical aspects and results of the treatment of new cases of tuberculosis at homeless people.  Materials and methods: There have been studied 102 clinical records of new cases of tuberculosis at homeless people in Chisinau.  Results: Correlation men/women is 3,5/1. From the whole patients, postmortem, the diagnosis was established at 34 persons. The rest 68 of patients were divided according to the age:21-40years-39,8%, 41-60 years-57,3%, over 60 years -2,9%; were distributed according to the marital status: married-14, 7%, unmarried-85, 3%. The number of chronic alcoholics was 43, chronic respiratory system diseases was registered at 45, and drug addiction at 2, HIV at 7. By passive pathway were detected 92.6%. The process expanded was at 72.1%. Sputum microscopy and culture was positive at 39,7 %. Mycobacterial sensibility was maintained at 61.8% patients. Resistance was divided in: poliresistance-14, 7%; monoresistance-11, 8%; MDR-7, 3%. Results of treatment: in 7,4% of treatment was successful, interruption of treatment was established in 63.2%, failure - in 2, 9%; death - in 26 ,5%.  Conclusion: In the city of Chisinau a large number of homeless with tuberculosis, forming the outbreaks dangerous, impossible for the control infection builds up. A lot of patients interrupts continuation phase of treatment, because they do not belong to any association of territorial administrative.
BMA calls for action over rise in consultant vacancies in Scotland
Authors: G. Iacobucci
Journal: BMJ (2015)

Vacancies for NHS consultant posts in Scotland increased by more than 25% in the past year, official figures have shown. BMA Scotland expressed alarm at the figures and warned the Scottish government that it faced a “major recruitment and retention problem” that could threaten services.

The figures, published by Information Services Division Scotland,1 showed that the number of vacant whole time …
Why students might find it difficult to recognise “cheating”
Authors: Kathleen Collins, Scott W Oliver
Journal: BMJ (2015)

We agree that “cheating” extends far beyond simple plagiarism in coursework or examinations but do not believe that its definition includes students simply benefitting from colleagues sharing their experiences.1

We are familiar with the phenomenon of students reproducing questions after leaving the examination hall.1 Anecdotally, we believe this is actively encouraged by some providers …
Improvement in the prognosis of breast cancer from 1965 to 1984.
Authors: M J Edwards, J W Gamel, E J Feuer
Journal: Journal of Clinical Oncology (1998)

PURPOSE The prognosis of breast cancer has improved over the past three decades. It is uncertain, however, whether this improvement results from an increase in the cure rate, extension of the life span of uncured patients, or some combination. METHODS From the Connecticut Tumor Registry, we obtained data on 25,091 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer who were diagnosed over the two decades between 1965 and 1984, with follow-up through 1993. The data for these patients were analyzed using a variety of parametric models to quantitate likelihood of cure and median survival time among uncured patients. These models incorporate the assumption that time to death from breast cancer follows a specific distribution. RESULTS For patients with node-negative disease, parametric analysis revealed no significant difference in cured-fraction or median survival time over the two decades studied. For patients with node-positive disease, however, a significant increase in median survival time (P &lt; .001) was found during the second decade (1970 to 1979). There was also a trend toward a higher cured-fraction over time, but this was not statistically significant. CONCLUSION This study confirms that patients with node-positive disease had an improved prognosis over the two decades studied. Parametric analysis suggests that this improvement reflects primarily an increase in the median survival time for uncured patients, although there is a trend toward an increase in the likelihood of cure.
Postexercise Electrocardiogram in Arteriosclerotic Heart Disease
Authors: George P. Robb
Journal: JAMA (1967)

An evaluation of the electrocardiographic exercise test in the diagnosis and prognosis of latent arteriosclerotic heart disease was made using improved methods of performance and interpretation. The evaluation was based on 2,224 male applicants for life insurance given the test. A long-term follow-up of these cases disclosed: Ischemic ST segment depression after exercise is pathognomonic of coronary insufficiency for all practical purposes. The amount of ischemic ST depression indicates the degree of the insufficiency and the prognosis. Ischemic response involving multiple leads has a worse prognosis than that involving one lead. In the vast majority of cases, a nonischemic response—ST junction depression, negative response, or T-wave change—excludes latent coronary insufficiency of significant degree. Preexercise T-wave abnormality due to coronary disease is distinguished by an ischemic response. In this study, the postexercise electrocardiogram gave more reliable evidence of latent or silent coronary disease than did the medical history. No adverse effect resulted from the test.
High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery
Authors: François Stéphan, Benoit Barrucand, Pascal Petit, Saida Rézaiguia-Delclaux, Anne Médard, Bertrand Delannoy, Bernard Cosserant, Guillaume Flicoteaux, Audrey Imbert, Catherine Pilorge, Laurence Bérard
Journal: JAMA (2015)

Noninvasive ventilation delivered as bilevel positive airway pressure (BiPAP) is often used to avoid reintubation and improve outcomes of patients with hypoxemia after cardiothoracic surgery. High-flow nasal oxygen therapy is increasingly used to improve oxygenation because of its ease of implementation, tolerance, and clinical effectiveness.To determine whether high-flow nasal oxygen therapy was not inferior to BiPAP for preventing or resolving acute respiratory failure after cardiothoracic surgery.Multicenter, randomized, noninferiority trial (BiPOP Study) conducted between June 15, 2011, and January 15, 2014, at 6 French intensive care units.A total of 830 patients who had undergone cardiothoracic surgery, of which coronary artery bypass, valvular repair, and pulmonary thromboendarterectomy were the most common, were included when they developed acute respiratory failure (failure of a spontaneous breathing trial or successful breathing trial but failed extubation) or were deemed at risk for respiratory failure after extubation due to preexisting risk factors.Patients were randomly assigned to receive high-flow nasal oxygen therapy delivered continuously through a nasal cannula (flow, 50 L/min; fraction of inspired oxygen [FiO2], 50%) (n = 414) or BiPAP delivered with a full-face mask for at least 4 hours per day (pressure support level, 8 cm H2O; positive end-expiratory pressure, 4 cm H2O; FiO2, 50%) (n = 416).The primary outcome was treatment failure, defined as reintubation, switch to the other study treatment, or premature treatment discontinuation (patient request or adverse effects, including gastric distention). Noninferiority of high-flow nasal oxygen therapy would be demonstrated if the lower boundary of the 95% CI were less than 9%. Secondary outcomes included mortality during intensive care unit stay, changes in respiratory variables, and respiratory complications.High-flow nasal oxygen therapy was not inferior to BiPAP: the treatment failed in 87 of 414 patients with high-flow nasal oxygen therapy (21.0%) and 91 of 416 patients with BiPAP (21.9%) (absolute difference, 0.9%; 95% CI, -4.9% to 6.6%; P = .003). No significant differences were found for intensive care unit mortality (23 patients with BiPAP [5.5%] and 28 with high-flow nasal oxygen therapy [6.8%]; P = .66) (absolute difference, 1.2% [95% CI, -2.3% to 4.8%]. Skin breakdown was significantly more common with BiPAP after 24 hours (10% vs 3%; 95% CI, 7.3%-13.4% vs 1.8%-5.6%; P < .001).Among cardiothoracic surgery patients with or at risk for respiratory failure, the use of high-flow nasal oxygen therapy compared with intermittent BiPAP did not result in a worse rate of treatment failure. The findings support the use of high-flow nasal oxygen therapy in similar patients.clinicaltrials.gov Identifier: NCT01458444.
Urticaria in Children
Authors: K. Kauppinen, K. Juntunen, H. Lanki
Journal: Allergy (1984)

A retrospective study supplemented with follow-up was carried out in 163 children, aged 6 months to 16 years, who were hospitalized because of acute, recurrent or chronic urticaria in 1976-1980. Etiologic agents were identified in 55% of cases. Physical factors were the commonest causes, especially in cases of chronic urticaria, while infections predominated in acute urticaria. 81% of the children participated in the follow-up study. Follow-up for a year or more revealed that 53% of the children had become symptom-free, 36% still had symptoms but less frequently and in 11% urticaria was unresolved. The results indicate that the etiologic factors in childhood urticaria are similar to those found in adults and that prognosis is favorable, particularly when the etiology is established.
Bubonic and pneumonic plague - Uganda, 2006.
Authors: A. Ogen-Odoi, E. K. Mbidde, J. Lutwama, J. Wamala, A. Mucunguzi, M. Mugagga, A. Kagirita, L. Lukwago, M. M. Musanza, A. Talisuna, J. Turyagaruki, J. Kirungi, O. Namusisi, R. Downing, J. Tappero, R. Enscore, M. Schriefer, S. Bearden, C. Sexton, E. Zielinski-Gutierrez, K. Griffith, P. Mead, M. Duffy
Journal: MMWR Morbidity and Mortality Weekly Report (2009)
Atlas of Gastrointestinal Pathology as Seen on Biopsy.
Authors: Ian M. P. Dawson
Journal: Annals of Internal Medicine (1984)

described in the 28 chapters of this volume and it will be found in use to be a reliable guide.Unquestionably the two volumes of the 7th edition here reviewed are well up to the standards set by their predecessors, and may stand up even better to highly specialised scrutiny.Topley and Wilson remains a necessity and one of the good things of life.
Phase III study (20050181) of panitumumab (pmab) with FOLFIRI versus FOLFIRI alone as second-line treatment (tx) in patients (pts) with metastatic colorectal cancer (mCRC): Pooled safety results
Authors: M. Peeters, G. Wilson, M. Ducreux, A. Cervantes, T. André, Y. Hotko, F. Lordick, S. Collins, M. Shing, T. J. Price
Journal: Journal of Clinical Oncology (2008)

4064 Background: Pmab is a fully human anti-EGFr monoclonal antibody (MAb) with activity as a single agent in refractory mCRC. Study 20050181 is the first global, phase III trial investigating an anti-EGFr MAb combined with FOLFIRI as 2nd-line tx for pts with mCRC. Methods: This is a randomized, multicenter, phase III study with pt eligibility criteria that include: histologically/cytologically- confirmed adenocarcinoma of the colon or rectum with metastatic disease; only 1 prior fluoropyrimidine-based chemotherapy regimen for mCRC; ECOG performance status (PS) 0 to 2. No prior EGFr staining is required for inclusion. Pts are randomized 1:1 to receive Pmab 6.0 mg/kg Q2W + FOLFIRI Q2W (Pmab+FOLFIRI) or FOLFIRI Q2W alone (FOLFIRI). Co-primary endpoints are progression-free survival and overall survival. Secondary endpoints include overall objective response rate, time to progression, duration of response, and safety. Study endpoints will be investigated by pts’ KRAS mutational status in both arms as a potential biomarker for pmab activity combined with FOLFIRI. The study includes multiple, planned safety interim analyses conducted by an independent Data Monitoring Committee (DMC); the latest safety interim analysis included 701 pts of approx. 1,100 planned target accrual. Results: 352 pts are in the Pmab+FOLFIRI arm and 349 pts are in the FOLFIRI arm. Of all pts, 431 (61%) are men, median age is 61 yrs (range, 29–85), ECOG PS 0: 47%, PS 1: 45%, PS 2: 7%. Of all pts, 99% received at least 1 cycle of study therapy, and 59 % have stopped study tx. Median follow-up time was 15 weeks. Adverse events of interest are shown (table). Conclusions: After the safety interim analysis of the first 701 pts conducted by the DMC, study 20050181 continues per protocol. Study 20050181 enrollment is anticipated to be completed in Q1 2008. Updated pooled safety data for approx. 1,100 pts will be presented. Adverse Events of Interest: Pooled Analysis of 701 pts Adverse Event, MedDRA terms Any Grade - n (%) by CTC AE v3.0 Grade 3/4 - n (%) by CTC AE v3.0 Skin and subcutaneous tissue SOC * 429 (61) 83 (12) Diarrhea 384 (55) 65 (9) Nausea 301 (43) 14 (2) Fatigue 197 (28) 29 (4) Neutropenia 192 (27) 103 (15) Hypomagnesemia 46 (7) 7 (1) Dehydration 24 (3) 14 (2) Infection 4 (1) 3 (<1) * SOC=system organ class. There was 1 investigator-reported adverse event of infusion reaction (grade 1). Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Amgen, Merck Serono, Roche Amgen, ImClone Systems Amgen, Baxter, Merck, Merck Lipha, Merck Serono, Pfizer, Roche, sanofi-aventis Amgen, Merck Serono, sanofi-aventis Merck UK
Alteplase is safe to use within existing treatment guidelines, says independent review
Authors: Ingrid Torjesen
Journal: BMJ (2015)

The thrombolytic drug alteplase is safe and effective for licensed use up to 4.5 hours after the onset of symptoms of acute ischaemic stroke in patients for whom it is licensed, an independent expert group set up by the UK Medicines and Healthcare Products Regulatory Agency has concluded.1

The group emphasised that the chances of a more favourable outcome for patients were greater the earlier the treatment was given.

However, some other doctors are concerned that the review has not seen all the evidence and that the safety of alteplase remains uncertain.

The MHRA’s review was announced in August 2014,2 after concerns about the drug were raised by Roger Shinton, a former consultant physician at Birmingham’s Heartlands Hospital, in a letter to the Lancet .3 He raised several concerns about the initial trial used to obtain marketing approval for alteplase4 and a later trial that was key to extending its window of use in Europe from three to four and a half hours after onset of symptoms of stroke.5 Other clinicians have also raised questions about its use beyond three hours.6

The expert group reviewed all available evidence on alteplase, which included extensive published literature, data from the holder of the marketing authorisation, submissions from individual clinicians, information from professional bodies, …