tbuckley/cabot-search huggingface dataset:
PTH-006 Current Performance Of Ercp In The Clearance Of Bile Duct Stones In Uk Centres - Working Towards Robust Key Performance Indicators: Abstract PTH-006 Table 1
Authors: CA Wadsworth, LK Dwyer, B Paranandi, N Philips, S Mahmood, B Krishnan, TL Taylor, E Seward, P Wilson, A Singhal, E Williams, D Westaby, GJ Webster, RP Sturgess
Journal: Gut (2014)

<h3>Introduction</h3> Choledocholithiasis is the commonest indication for endoscopic retrograde cholangiopancreatography (ERCP). ERCP carries substantial risk of complication when compared to other endoscopic modalities. The identification of key performance indicators (KPIs) in colonoscopy practice and implementation of related standards has driven quality assurance in the UK and elsewhere. The failure to establish similar contemporary, meaningful and measurable KPIs in ERCP has hampered the development of national standards. We aimed to quantify current performance in a potential new endoscopic KPI: the complete clearance of CBD stones at first ERCP. <h3>Methods</h3> Seven centres participated – four secondary and three tertiary HPB units. All patients undergoing first ERCP for confirmed or suspected choledocholithiasis over a twelve month period were included and data were analysed on an intention to treat basis. The primary endpoint was complete clearance of bile duct stones. Failure to clear stones was defined as i) persisting stones reported ii) placement of biliary endoprosthesis, even if considered precautionary. Secondary endpoints were CBD cannulation, successful biliary decompression and complications. Outcomes were analysed by unit and by consultant clinician performing the procedure. <h3>Results</h3> 1178 patients were included in the study. 20 consultant endoscopists carried out or supervised the procedures. Overall, deep biliary cannulation was achieved in 1074/1178 (91%, range for seven units 82–96%). Complete bile duct clearance at first ERCP was achieved in 861/1178 (73%, 65–81%). <h3>Conclusion</h3> We investigated the outcome of 1178 ERCP procedures, representing real-life practice in the UK. Duct clearance was possible at first ERCP in almost three quarters of patients. There were significant differences in performance between units and individual operators. The reasons for this are not fully elucidated. The primary endpoint of this study has strengths as a potential KPI. It is clearly defined, measurable on an intention to treat basis and is strongly focused on patient outcome. In addition, it quantifies performance in the commonest indication for ERCP, stone extraction, which is undertaken in all ERCP units. <h3>Disclosure of Interest</h3> None Declared.
Re: Francesco Porpiglia, Carlo Terrone, Julien Renard, Susanna Grande, Francesca Musso, Marco Cossu, Francesca Vacca and Roberto Mario Scarpa. Transcapsular Adenomectomy (Millin): A Comparative Study, Extraperitoneal Laparoscopy versus Open Surgery. Eur Urol 2006;49:120–6
Authors: N.O.K. Gibbon
Journal: European Urology (2007)
'I'll bet you a fiver it's not'
Authors: K. Patel
Journal: BMJ (2009)

Post-take ward rounds are not usually an opportunity to earn some much needed cash, so you can imagine my surprise when the consultant playfully offered me a cash reward to make a diagnosis on a patient with a rare condition.

Why did the consultant bet money against my diagnosis? Because the condition in question was vanishingly rare, and with odds of nearly a million to one he believed (not unreasonably) that his money would be safe. Why did …
THE DOCTOR IN THE PUBLIC SCHOOLS.
Authors: G. W. HIETT
Journal: JAMA (1900)

Shall we put a well-educated physician in each of the public schools? is a question; and if not why not? Let it be a physician who will make a thorough study of the pupils, classify them with reference to their physical and mental development and aptitude, both for study and play. Without bone and muscle and without a plentiful supply of wholesome blood, the brain and nervous system can not long remain intact and properly perform their respective functions. The daily expenditure of brain energy and nervous force must necessarily have its corresponding recuperation by sound sleep, proper food, and wholesome exercise in the open air. This applies to all classes and conditions of ages, and especially to school children. The excellence of the public school system everywhere is conceded. It is apparently almost perfect. The present system of education is broad, comprehensive, and fulfils the order of discipline in
Involvement of α -4 Integrins in Allergic Airway Responses and Mast Cell Degranulation <i>In Vivo</i>
Authors: MASAYUKI HOJO, KARIM MAGHNI, THOMAS B. ISSEKUTZ, JAMES G. MARTIN
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Antibodies against integrins have been shown to inhibit allergic airway responses. The purpose of this study was to test the hypothesis that the β1 integrin, very late antigen-4 (VLA-4), is involved in mast cell activation triggered by allergen exposure in sensitized animals. To do this we studied Brown Norway rats that were sensitized to ovalbumin (OA; 1 mg subcutaneously) using Bordetella pertussis as an adjuvant. Two weeks later rats were challenged with OA, pulmonary resistance (Rl) was determined, and the concentrations of histamine and tryptase in bronchoalveolar lavage fluid and N-acetyl-leukotriene (LT)E4 in bile were measured. Pretreatment with a monoclonal antibody against VLA-4 (TA-2) attenuated the early response after OA challenge (342.9 ± 24.4% baseline Rl versus 153.3 ± 19.4%; p < 0.01). There were significantly lower concentrations of histamine (67.11 ± 11.90 μ g/ml versus 26.69 ± 1.84; p < 0.01) and tryptase (0.143 ± 0.035 μ g/ml versus 0.053 ± 0.022 μ g/ml; p < 0.01) in TA-2-treated animals. The increases in the concentrations of biliary N-acetyl-LTE4 after OA challenge were also significantly lower in TA-2-treated animals. These data suggest that a selective anti-VLA-4 monoclonal antibody prevents early responses through inhibition of mast cell activation.
Morphology of the Jejunum in Children with Eczema due to Food Allergy
Authors: R. Mccalla, E. Savilahtl, M. Perkkiö, P. Kuitunen, A. Backman
Journal: Allergy (1980)

We report the results of a morphometric study of jejunal biopsy specimens from 18 children wth eczema due to food allergy. The measurements were compared with those for 13 age‐matched children without gastrointestinal or immunological diseases. The patients' ages ranged from 2 months to 4 years. In 14 the food responsible for the symptoms was cow's milk. During the challenge tests with suspected foods 10 children had skin symptoms only (group I) and eight had gastrointestinal symptoms in addition (group II). Both groups showed a significant decrease in the villus/crypt ratio, mostly due to an increase in crypt depth. The counts of lymphocytes and plasma cells in the lamina propria and of intraepithelial lymphocytes did not differ from those seen in the controls. Four patients had increased counts of jejunal eosinophils, but the mean count for the whole group was not significantly increased. Considering nine measurements only five of the patients had moderate changes in jejunal morphology.
Evaluation of Left Ventricular Function by Echocardiography
Authors: NICHOLAS J. FORTUIN, WILLIAM P. HOOD, ERNEST CRAIGE
Journal: Circulation (1972)

Ventricular minor-axis dimensions were measured by echocardiography at end-systole (S 8 ) and end-diastole (S D ) in five groups of patients: (I) normal; (II) mitral stenosis; (III) compensated volume overload; (IV) idiopathic hypertrophic subaortic stenosis; and (V) congestive heart failure. Cardiac pump function was evaluated by determination of left ventricular volumes and ejection fraction (EF) from the echographic dimensions using formulae previously reported. The mean velocity of circumferential fiber shortening (V CF ), a parameter of cardiac muscle performance previously obtained only by invasive methods, was determined from the echographic dimensions by the formula:[See Equation in PDF File]. The duration of minor-axis shortening (dt) was measured directly from the echocardiogram. Dimension and volume measurements in these groups of patients were similar to those reported in similar patients determined by angiographic methods. Measurement of the relative changes in echographic dimensions with systole (%ΔS), EF, and V CF allowed separation of patients with clinical heart failure (group V) from normal subjects (group I). Patients in group II had reduced values for these parameters compared to group I. Those in III did not differ significantly, and those in IV had increased values. In general, V CF , EF, and %ΔS showed similar trends, but individual patients sometimes differed. The findings reported here demonstrate the feasibility of evaluating ventricular function by a noninvasive method in a large group of ambulatory patients.
Pain and radiographic damage in osteoarthritis
Authors: T. Pincus, J. A Block
Journal: BMJ (2009)

Are correlated, but managing individual patients requires consideration of other factors 

A person who has severe knee pain and extensive radiographic evidence of osteoarthritis is thought to have an “obvious” explanation for the pain. Some people, however, may have severe radiographic damage (Kellgren-Lawrence grade 41) with no pain, or vice versa.2 Such discordances, which are also seen in rheumatoid arthritis,3 have been the subject of much interest for clinicians and researchers. Some researchers have suggested that little or no relation exists between the “illness” of joint pain and the “disease” of radiographic osteoarthritis.

In the linked study (doi:10.1136/bmj.b2844), Neogi and colleagues assess the association between knee pain and radiographic osteoarthritis in people whose knees were discordant for pain.4 The study design was a within person, knee matched case-control study that examined 696 people from the Multicenter Osteoarthritis Study (MOST) and 336 from Framingham. Odds ratios were 151 (95% confidence interval 43 …
George Washington and Variolation; Edward Jenner and Vaccination-Reply
Authors: Quinn H. Becker
Journal: JAMA (1986)

<h3>In Reply.—</h3> In response to the letter by Dr Rabasa on smallpox inoculation of the Continental Army, it should be made clear that General George Washington did, in fact, order the entire American army to be inoculated after recognizing the serious threat of smallpox to military operations. This recommendation was made by Dr John Morgan, physicianin-chief of the American army, who wrote a treatise in 1776 entitled "Recommendation of Inoculation According to Baron Dimsdale's Method."<sup>1</sup>The policy was implemented in 1777, by Dr William Shippen, Jr, who succeeded Morgan. Special inoculation hospitals were established to inoculate all recruits who had not experienced smallpox. Although cases of smallpox did still occur in the Army, the morbidity and mortality were considerably less than that experienced during the first two years of the war, and the vaccination program contributed significantly to the winning of independence by the colonies.<sup>2</sup> Dr Rabasa is
An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device
Authors: N. Sakurazawa, S. Kato, M. Miyashita, T. Kiyama, I. Fujita, N. Yamashita, Y. Saitou, T. Tajiri, E. Uchida
Journal: Endoscopy (2009)

In recent years, endoscopic submucosal dissection (ESD) has been applied for the treatment of gastric tumors, and the en-bloc resection rate of early gastric cancer has greatly improved. Herein, we introduce spring-assisted ESD, for quicker submucosal dissection.ESD was carried out in 32 patients (20 men, 12 women; mean age 72.6 years, range 53 - 88 years) for early gastric cancer, with tumors over 10 mm in diameter. The patients were divided retrospectively into two groups (spring-assisted ESD, n = 20; conventional ESD, n = 12). To comparatively evaluate the performance speed of ESD, the circumferential length and the area of the resected specimen were calculated by the approximation formula for ellipse. Then, the circumferential cutting speed, the submucosal dissection speed, and the total ESD speed were calculated as index scores. The scores for spring-assisted ESD and conventional ESD were compared.The mean (+/-SD) circumferential cutting speeds in spring-assisted ESD and conventional ESD were 0.53 +/- 0.27 and 0.60 +/- 0.30 cm/minute, respectively ( P = 0.51). The mean submucosal dissection speeds in spring-assisted ESD and conventional ESD were 0.67 +/- 0.41 and 0.32 +/- 0.24 cm (2)/minute, respectively ( P = 0.005). The mean total ESD speeds in spring-assisted ESD and conventional ESD were 0.25 +/- 0.10 and 0.17 +/- 0.07 cm (2)/minute, respectively ( P = 0.015). The mean total ESD times were 57 and 75 minutes in the spring and conventional group, respectively ( P = 0.30).Using the aforementioned indices, we evaluated the performance speed of ESD. Spring-assisted ESD may allow faster submucosal dissection.
Everyday Doctoring: A New Approach to the Logic and Reasoning of Neurology and Medicine
Authors: William E. Golden
Journal: JAMA (1987)

Reexamination of the medical school curriculum during the last two decades has underscored the need for students to be able to generate broad-based hypotheses in the initial approach to a patient. As such, medical educators now seek to direct the curriculum away from the memorization of detailed information and instead offer instruction that will equip the student to narrow diagnostic options and to seek more detailed information from a variety of informational sources. By acquiring history and physical skills that enable such hypothesis testing, new physicians can limit their dependence on technology and expedite a patient's diagnostic travels. <i>Everyday Doctoring</i>by Margulies is an unorthodox textbook offered by a small publisher. The author seeks to offer students a manual detailing techniques of a directed physical examination, particularly in the neurological sciences. The book makes use of extensive photographs, drawings, and innovative typographical techniques to simulate more of a conversational approach
Systemic complement activation, lung injury, and products of lipid peroxidation.
Authors: P A Ward, G O Till, J R Hatherill, T M Annesley, R G Kunkel
Journal: Journal of Clinical Investigation (1985)

Previously we have demonstrated that systemic activation of the complement system after intravenous injection of cobra venom factor (CVF) results in acute lung injury as reflected by increases in the vascular permeability of the lung as well as by morphologic evidence of damage to lung vascular endothelial cells. In using the vascular permeability of the lung as the reference, the current studies show a quantitative correlation between lung injury and the appearance in plasma of lipid peroxidation products (conjugated dienes) as well as increased concentrations of lactic dehydrogenase (LDH) and one of its isoenzymes (LDH-4). After injection of CVF, extracts of lungs also showed elevated levels of conjugated dienes, whereas no elevations were found in extracts of liver, kidney, and spleen. There was no evidence in CVF-injected rats of renal or hepatic injury as reflected by the lack of development of proteinuria and the failure to detect increased serum levels of liver-related enzymes. Other peroxidation products identified in plasma of CVF-injected rats involved hydroperoxides and fluorescent compounds with features of Schiff bases. Not surprisingly, malondialdehyde was not found to be a reliable plasma indicator of lipid peroxidation associated with oxygen radical-mediated lung vascular injury. In using a model of oxygen radical-independent lung injury induced by oleic acid, although large amounts of LDH and LDH-4 were found in the plasma, no increases in plasma levels of conjugated dienes were detected. In CVF-injected animals treated with interventions protective against lung injury (neutrophil depletion, catalase, hydroxyl radical scavengers, or iron chelators), there were striking reductions in the plasma levels of conjugated dienes, hydroperoxides, and fluorochromic products. Morphometric analysis of lung sections revealed that the protective interventions did not interfere with the accumulation of neutrophils in lung interstitial capillaries after systemic activation of complement. In vitro studies with phorbol-stimulated neutrophils failed to demonstrate appearance of conjugated dienes, suggesting that the dienes appearing in plasma of CVF-injected animals are not the result of autotoxic changes in neutrophils. The data presented in this paper suggest that acute lung injury mediated by oxygen radicals derived from phagocytic cells can be monitored by the appearance in plasma of products of lipid peroxidation.
Excision repair of DNA in some photodermatoses
Authors: M. ICHIHASHI, C.A. RAMSAY
Journal: British Journal of Dermatology (1976)

Excision repair of DNA was measured in a number of photosensitive subjects by estimating unscheduled DNA synthesis in cultured fibroblasts after ultraviolet radiation. The amount of unscheduled DNA synthesis and the action spectrum for this process were estimated in each subject and compared with seven normal subjects. Two subjects with polymorphic light eruption and three with actinic reticuloid exhibited normal levels of DNA repair and normal action spectra. In one subject with classical xeroderma pigmentosum no excision repair could be demonstrated whilst in another the amount of repair was lower than normal. The finding of normal DNA excision repair in polymorphic light eruption does not support an earlier claim that this repair process is abnormal in this common photodermatosis.
Somatization and medicalization
Authors: L. Dolin
Journal: JAMA (1996)

To the Editor.  —While Drs Barsky and Borus 1 make a number of pointed observations about somatizing patients, they ultimately succumb to the same process of medicalization they criticize. Their pejorative comments about somatization defined as the propensity to experience and report somatic symptoms that have no pathophysiological explanation are just another kind of labeling, no better than the diagnoses that patients seek to legitimize their suffering.  It's true that physicians are trained to think in terms of diagnoses and that reimbursement systems cannot function without diagnosis codes. 2 But we need to understand that patients, whatever label physicians pin on them, most of all want to feel better. It's time to stop basing treatment on labels (somatizer, lung cancer, tension headache) and start basing therapy on making connexions, ie, first understanding what the illness means to the patient. 3   The primary goal of clinicians should be to keep patients
INJURIES TO NERVES FROM SURGICAL TREATMENT OF DISEASES OF THE FACE AND NECK
Authors: W. WAYNE BABCOCK
Journal: JAMA (1925)

Pain, spasm, salivation, paralysis or even death occurs from irritation or injury to certain nerves during operations on the face and neck. The symptoms may follow compression, tension, torsion or division of nerves during operation; secondary edema or inflammation involving the nerve trunks; or pressure by new connective tissue or new growths. From the irritation of the facial nerve, convulsive tic occurs; from the irritation of the accessory nerve, torticollis, and from the irritation of the sympathetic in the neck, myosis, flushing and excessive perspiration of the face occur. Compression or division of the seventh nerve leads to facial paralysis; of the hypoglossal nerve, to limited movement and hemiatrophy of the tongue. Irritation of the trifacial nerve may be followed by severe neuralgic pains, or tic douloureux; of the lingual nerve, paresthesia of the tongue, and salivation; of the cervical branches, neuralgic pain and paresthesia of the neck, ear and
The Harvard fraud case: where does the problem lie?
Authors: Richard Knox
Journal: JAMA (1983)

A detailed account is presented of the John Darsee scientific fraud case at Harvard Medical School, which culminated in the harshest penalty the federal government has ever imposed on a researcher for falsifying data. The National Institutes of Health also took the unprecedented step of extending its findings and sanctions beyond the individual researcher to the scientists in charge of the laboratory where he worked. The Darsee case has occasioned widespread examination of the competitiveness of the research environment.
Models of morality
Authors: Molly J. Crockett
Journal: Trends in Cognitive Sciences (2013)

Moral dilemmas engender conflicts between two traditions: consequentialism, which evaluates actions based on their outcomes, and deontology, which evaluates actions themselves. These strikingly resemble two distinct decision-making architectures: a model-based system that selects actions based on inferences about their consequences; and a model-free system that selects actions based on their reinforcement history. Here, I consider how these systems, along with a Pavlovian system that responds reflexively to rewards and punishments, can illuminate puzzles in moral psychology.
Physician Health and Patient Care
Authors: E. Frank
Journal: JAMA (2004)

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Authors' reply to Boucher
Authors: E. Theodoratou, J. P. A. Ioannidis
Journal: BMJ (2014)

Boucher presents several arguments for substantial benefits from vitamin D supplementation,1 but this is not clearly shown in our review.2 

Given that we selected only one review per outcome for our analysis, the risk of overlap of original studies is minimal for any given outcome. Boucher’s comments on the importance of supplement doses …
Focal Pericarditis in a Huge Heart Demonstrated by Positron Emission Tomography/Computed Tomography
Authors: Kai-Hang Yiu, Yim-Lung Leung, Chung-Wah Siu, Man-Hong Jim, Wing-Hing Chow, Hung-Fat Tse
Journal: Clinical Nuclear Medicine (2009)

We report a case of focal pericarditis diagnosed using positron emission tomography/computed tomography (PET/CT). The patient received a course of a nonsteroidal anti-inflammatory drug and her symptoms and fever resolved accordingly.