tbuckley/cabot-search huggingface dataset:
Computers in primary care: where next?
Authors: R D Turner, R V Jones, J E Streeter
Journal: BMJ (1980)

At present a typical microcomputer with keyboard, screen, two disks, and a printer costs just under £2500.This is probably the minimum that a general practitioner should expect to pay for a reliable system.A machine of this size could hold a certain amount of information about each patient, and a set of programs is available commercially for about £500.This would print out, for example, how many patients came with various diseases, how many of each type were seen by each partner over a given period, and how many were given a particular type of drug.At the other end of the scale, a share in a system such as that developed by the Exeter computer project would cost about £1 per patient per year for a four-doctor practice and less if 30 or so shared the same system.This allows the doctor to record virtually anything about his patients and retrieve it on a screen in his consulting room as well as analyse it statistically.All the informa- tion held by either system has to be typed in, and all computers require power supplies and maintenance quite apart from any development costs.It seems clear that any form of computerheld record will be more expensive than the paper envelopes used in most practices.The question we have tried to answer is, Should every doctor consider how he could move over to com- puter-held records, or is the computer likely to be more of a hindrance than a help to a family doctor who prides himself on the individual attention he pays to each patient ? Advantages of ordinary recordsOrdinary records have several advantages which so far have not been matched by any computer system.Firstly, paper is cheap, readily available, familiar, and reliable.It can be used anywhere at any tirme without special equipment.Secondly, it can be sent through the post and one record folder can hold letters, charts, diagrams, reports, consent forms, and photo- graphs without them having to be converted or typed out again in any way.Lastly, records of any length or complexity can be held without the need of outside expertise, finance, or advice.The disadvantage of paper so far as general practitioners are concerned (apart from legibility, which could be improved with a typewriter much more easily than with a computer) is that it is laborious to cross-index the information it holds.This is one area in which computers excel to such an extent that it may be worth solving all the problems of data entry and retrieval, expansibility, reliability, confidentiality, response time, and cost.A vision opensnmp in which a doctor could look back over his experience and find out what caused his patients to become ill, which did best on which treatment, or what part of his time was spent most effectively.It is this vision which has led to the up- surge of interest in computers in the medical profession.Cost may no longer be the insuperable barrier it was, and the goal may be in sight.
657 UDCA UP-REGULATES HUMAN PLACENTAL BCRP EXPRESSION: PRELIMINARY RESULTS
Authors: F. Azzaroli, M.E. Raspanti, F. Alessandrelli, V. Feletti, F. Buonfiglioli, P. Cecinato, M. Montagnani, A. Colecchia, D. Festi, E. Roda, G. Mazzella
Journal: Journal of Hepatology (2009)
Increased T-cell receptor Vβ2 chain expression in skin homing lymphocytes in psoriasis
Authors: S Davison, M Allen, A Harmer, R Vaughan, J N W N Barker
Journal: British Journal of Dermatology (1999)

Studies have shown over‐representation of certain T‐cell receptor (TCR) Vβ chains in lesional psoriatic skin, implying selection or expansion, possibly by bacterial superantigen. We investigated the pattern of TCR Vβ chain usage in peripheral blood lymphocytes (PBL) bearing the skin homing receptor cutaneous lymphocyte associated antigen (CLA) in psoriasis patients. Results showed increased expression of TCR Vβ2 in CLA‐positive PBL in psoriasis patients (n = 15) compared with normals (n = 10); P < 0.002. As Vβ2 is preferentially expressed by lymphocytes responding to certain bacterial superantigens, this study could possibly indicate a role for superantigens in the pathogenesis of psoriasis.
Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin.
Authors: P. J. Prichard, G. K. Kitchingman, R. P. Walt, T. K. Daneshmend, C. J. Hawkey
Journal: BMJ (1989)

OBJECTIVE--To investigate the suitability of treatment with low dose aspirin or warfarin, or both, as possible prophylaxis against cardiovascular disease by determining the effect on gastric mucosal bleeding. DESIGN--Randomised crossover trial. SETTING--Academic department of therapeutics. SUBJECTS--Twenty healthy male volunteers aged 19-22. INTERVENTIONS--On separate occasions and in randomised order all subjects received aspirin 75 mg, warfarin, or aspirin 75 mg combined with warfarin. Each treatment was given for 12 days or (when warfarin was used) for longer if necessary until the international normalised ratio of the prothrombin time was stable at 1.4-1.6. END POINT--Loss of blood over 10 minutes into gastric washings. MEASUREMENTS AND MAIN RESULTS--Bleeding over 10 minutes into gastric washings under baseline conditions and after five days, and at end of each regimen of treatment. Aspirin 75 mg increased bleeding from 0.60 (95% confidence interval 0.36 to 0.99) microliters/10 minutes to 1.26 (0.71 to 2.25) microliters/10 minutes at five days, with no evidence of either progressive change or adaptation thereafter. Warfarin had no effect on bleeding either alone or when combined with aspirin. CONCLUSIONS--Aspirin 75 mg causes gastric mucosal bleeding. Low dose warfarin neither induces gastric mucosal bleeding nor enhances that caused by aspirin.
Will Partisan Politics Determine the Nature and Quality of Health Care?
Authors: William G. Anlyan
Journal: New England Journal of Medicine (1972)

DEAR Mr. President and Mr. Nominee:The health care of the American people is too important to become entangled in partisan politics. Strong bipartisan support should be given to the programs and the resources needed to develop, over a period of time, the finest health-care system in the world. The time span to achieve an optimum system may extend beyond the dominance of any one party; therefore, a blueprint that can be supported by both parties is required. The essence of this communication, however, will focus on the job that needs to be done in the next four years.Whereas . . .
Hypermagnesaemia and hypophosphataemia after ingestion of magnesium sulphate.
Authors: P Garcia-Webb, C Bhagat, T Oh, G Hart, W Thompson
Journal: BMJ (1984)

obtained, and in particular B melaninogenicus was found in two.In a recent survey of complications after sinus infections in children, Brook et al also found pathogenic anaerobes in every instance and Bacteroides spp in five of the eight cases.4Penicillin is active against most anaerobes but some strains of B melaninogenicus and most strains of B fragilis are resistant.In addi- tion, both of these strains have the capability to produce penicillinase, thus protecting penicillin sensitive organisms.Bacteroides and anaerobic cocci have a greater tendency to induce septic thrombophlebitis than aerobes,5 and their presence is therefore likely to favour complications.This emphasises the role of early, detailed, and accurate bacteriological investigation in each case.Distinction of anaerobes from microaerophilic streptococci may be difficult and gas-liquid chromatography for volatile fatty acids is particularly relevant.We suggest that unless anaerobes can be specifically excluded all paranasal sinus infections failing to respond promptly or developing complications should be treated with metronidazole in addition to the normal therapeutic regimen.We thank Mr P D M Ellis, Mr D Moffat, and Mr D Hardy for permission to report these cases and Dr R E Warren
Government is "minded" to introduce plain packaging--after another consultation
Authors: Z. Kmietowicz
Journal: BMJ (2014)

The government has said it is to run another consultation on introducing standardised packaging for tobacco products in England, dashing hopes that a decision on the policy would immediately follow the publication of an independent review that backed the removal of all branding from packets of cigarettes and tobacco.1

Cyril Chantler, a former paediatrician and past chairman of University College London Partners, said that his review of the evidence led him to conclude that standardised packaging of tobacco products was likely to contribute a modest but important reduction in smoking, including reducing the number of children taking up smoking.

Launching his report on 3 April in London, Chantler said, “I hope I have not wasted my time, and I hope it [standardised packaging] happens and I hope it happens soon.”

The review follows another consultation held in 2012 that found that standardised packaging reduced the appeal of tobacco …
An essential view in coronary arteriography.
Authors: P H Nath, G Velasquez, W R Castaneda-Zuniga, C Zollikofer, A Formanek, K Amplatz
Journal: Circulation (1979)

A significant stenosis of the left main coronary artery is associated with a significant mortality and is one of the major indications for aortocoronary bypass surgery. The diagnosis of this lesion on clinical grounds is inconsistent and should be established by angiography. All routine projections during coronary arteriography cause foreshortening of the left main coronary artery. Well-collimated anteroposterior and shallow right and left anterior oblique views show the main segment best. These views also show the proximal segments of circumflex and anterior descending branches, and should be routinely used during every coronary arteriogram.
Sesamin, a sesame lignan, is a potent inducer of hepatic fatty acid oxidation in the rat
Authors: Lakshmikuttyamma Ashakumary, Isabelle Rouyer, Yoko Takahashi, Takashi Ide, Nobuhiro Fukuda, Toshifumi Aoyama, Takashi Hashimoto, Michinao Mizugaki, Michihiro Sugano
Journal: Metabolism (1999)
US vaccination schedule is safe and effective, says Institute of Medicine
Authors: B. Roehr
Journal: BMJ (2013)

The schedule of recommended childhood vaccinations prepared by the US Advisory Committee on Immunization Practices is safe and effective, concludes a review of the evidence conducted by a committee of the Institute of Medicine.1

The review was the first to focus on the overall schedule of vaccinations rather than on individual vaccines within the series. It was released at a 16 January teleconference.

Alfred …
Obama administration proposes fix for religious objections to contraceptive mandate
Authors: M. McCarthy
Journal: BMJ (2014)

The Obama administration has proposed a workaround designed to tackle opposition from employers who have a religious objection to providing health insurance coverage for contraception.

Under the Affordable Care Act contraceptive care is considered an essential preventive service for women, which health plans must cover at no cost to the patient. However, a number of religious groups that oppose some or all forms of contraceptive have objected to the mandate, arguing that it violates their right to religious freedom.

To try to accommodate those …
Solitary necrotic nodule of the liver
Authors: Sang Jae Noh, Sarangerel Jachin, Woo Sung Moon
Journal: Clinical and Molecular Hepatology (2012)

Hepatic solitary necrotic nodule (SNN) is an unusual, benign mass forming lesion, first described by Shepherd and Lee in 1983.1 Since then, some possible pathogenetic hypotheses have been suggested. However, its exact etiology is still not established and disease entity of hepatic SNN remains uncertain. Although most SNNs show benign clinical course, it is difficult to distinguish from other lesions, including hepatic tumors and cancer metastasis by clinically and radiologically. In this issue, we present a case of SNN in a 48-year-old woman and discuss the histologic findings.
Acute upper airway obstruction due to supraglottic dystonia.
Authors: A. C. Thompson, L. G. McClymont
Journal: BMJ (1988)

apart; forced expiratory volume in one second <1 5 1; and forced vital capacity <2 1).Two other patients had stable hypoxia shown on one occasion and a forced expiratory volume in one second of <1 5 1.A further two had only stable hypoxia documented on one occasion and no results from spirometry.Five patients were recommended concentrators without evidence of stable hypoxia: three had an arterial oxygen pressure >7 3 kPa and no values were documented in the two others.Six
The Patient Package Insert
Authors: James M. Moss
Journal: JAMA (1978)

<h3>To the Editor.—</h3> For the past 15 years the Food and Drug Administration has insisted that every therapeutic innovation proposed by pharmaceutical companies be proved safe and effective by prospective controlled clinical trials. The FDA commissioner apparently feels that there is no need for the proof of safety and efficacy when a therapeutic innovation is proposed by the government. The FDA is proceeding with its plans for compulsory patient package inserts (PPIs) in all prescription drugs, but there are no data as to the safety and effectiveness of this major therapeutic innovation. The article by Morris, Mazis, and Gordon, "A Survey of the Effects of Oral Contraceptive Patient Information" (238: 2504-2508, 1977), is a retrospective "happiness index" survey that does not meet the criteria of a controlled clinical trial. However, this will be the standard reference article because there is nothing better. It would not be difficult to conduct a
Elevations in alanine aminotransferase levels late in the course of antiviral therapy in hepatitis C virus RNA-negative patients are associated with virological relapse
Authors: Monica Basso, Edoardo G. Giannini, Francesco Torre, Sabrina Blanchi, Vincenzo Savarino, Antonino Picciotto
Journal: Hepatology (2008)

The incidence and clinical meaning of elevated alanine aminotransferase (ALT) in chronic hepatitis C patients who are hepatitis C virus (HCV)-RNA negative during pegylated interferon (PEG-IFN) and ribavirin therapy have not been completely characterized. In this study our aim was to assess the incidence, pattern, predictive factors, and clinical meaning of elevated ALT in a cohort of 173 chronic hepatitis C patients who obtained viral clearance during either PEG-IFNalpha2(a) or alpha2(b) and weight-based ribavirin therapy. Patients were defined sustained viral responders (SVRs) or relapser responders (RRs) on the basis of a serum HCV-RNA result at 24-week follow-up. SVR and RR were obtained in 141 (58%) and 32 patients (13%), respectively. Among the 173 study patients, 57 patients (33%) had undetectable serum HCV-RNA and elevated ALT in at least one evaluation (weeks 2, 4, 12, 24 in all genotypes, and week 48 in HCV genotype 1 and 4 alone), and this phenomenon was not differently distributed between SVRs and RRs. No pretreatment demographic (age, gender), clinical (ALT levels, histological grade and stage, body mass index) and viral (load, genotype) parameter was associated with this phenomenon. The incidence of elevated ALT levels was not associated with type of PEG-IFN and ribavirin dose. Elevated ALT levels showed a different longitudinal pattern, occurring more frequently between week 12 and the end of treatment in RR as compared to SVR patients (90% versus 9%, P = 0.000001).The occurrence of elevated ALT levels in HCV-RNA-negative patients during PEG-IFN and ribavirin therapy is a fairly frequent and unpredictable phenomenon. Although ALT elevation per se is not associated with a greater risk of relapse, its occurrence in the later phases of therapy is more common in relapsing patients.
A high-resolution integrated map of the breast cancer loss of heterozygosity region on human chromosome 16q22.1
Authors: Eirik Frengen, Philippe Rocca-Serra, Sergey Shaposhnikov, Laurence Taine, Jim Thorsen, Azza Abd El Monéim, Michel Longy, Hans Prydz, Françoise Dorion-Bonnet
Journal: Nature Genetics (2001)
Spontaneously oscillating K+ channel activity in transformed Madin-Darby canine kidney cells.
Authors: A Schwab, H J Westphale, L Wojnowski, S Wünsch, H Oberleithner
Journal: Journal of Clinical Investigation (1993)

Intracellular alkalinization is known to be associated with tumorigenic transformation. Besides phenotypical alterations alkali-transformed Madin-Darby canine kidney (MDCK) cells exhibit a spontaneously oscillating cell membrane potential (PD). Using single-channel patch clamp techniques, it was the aim of this study to identify the ion channel underlying the rhythmic hyperpolarizations of the PD. In the cell-attached patch configuration, we found that channel activity was oscillating. The frequency of channel oscillations is 1.1 +/- 0.1 min-1. At the peak of oscillatory channel activity, single-channel current was -2.7 +/- 0.05 pA, and in the resting state it was -1.95 +/- 0.05 pA. Given the single-channel conductance of 53 +/- 3 pS for inward (and of 27 +/- 5 pS for outward) current the difference of single-channel current amplitude corresponded to a hyperpolarization of approximately 14 mV. The channel is selective for K+ over Na+. Channel kinetics are characterized by one open and by three closed time constants. The channel is Ca2+ sensitive. Half maximal activation in the inside-out patch mode is achieved at a Ca2+ concentration of 10 mumol/liter. In addition, we also found a 13-pS K+ channel that shows no oscillatory activity in the cell-attached patch configuration and that was not Ca2+ sensitive. We conclude that the Ca(2+)-sensitive 53-pS K+ channel is underlying spontaneous oscillations of the PD. It has virtually identical biophysical properties as a Ca(2+)-sensitive K+ channel in nontransformed parent MDCK cells. Hence, alkali-induced transformation of MDCK cells did not affect the channel protein itself but its regulators thereby causing spontaneous fluctuations of the PD.
'Rocker-bottom thymus'. A new sign of pneumomediastinum in the neonate
Authors: M. S. Kogutt
Journal: JAMA (1981)

THE OCCURRENCE of pneumomediastinum and pneumothorax in the neonate is relatively common. Pneumomediastinum is secondary to alveolar rupture with dissection of air along the pulmonary interstitium into the mediastinum.<sup>1</sup>This condition usually causes little or no respiratory distress. The classic configuration of pneumomediastinum is caused by elevation of the thymic lobes by air loculated within the anterior mediastinum. Several descriptive terms, including the "angel-wing" or "spinnaker sail" thymus, are well known.<sup>2</sup>Mediastinal air may also enter the subpleural space causing the "extrapleural air sing."<sup>3</sup>This article describes a previously unreported configuration of the thymus in pneumomediastinum. This should not be confused with more serious abnormalities such as mediastinal masses, anomalous vessels, or other pathological structures. <h3>Report of Cases</h3><h3>Case 1.—</h3> A 2,200-g infant was born after a full-term gestation and delivery. The infant was referred to this hospital after experiencing mild respiratory distress, and a chest roentgenogram
Circadian fluctuations in thrombogenicity in patients undergoing primary angioplasty for acute myocardial infarction
Authors: H. Mehrdad Sadeghi, Cindy L. Grines, Gregg W. Stone, Harish R. Chandra, Srinivas Dukkipati, Judith A. Boura, Lorelei Grines, Bruce R. Brodie, David Cox, William W. O'Neill
Journal: Journal of the American College of Cardiology (2003)
Pyridoxine and Penicillamine
Authors: MOISE D. LEVY
Journal: Annals of Internal Medicine (1982)

Letters and Corrections1 January 1982Pyridoxine and PenicillamineMOISE D. LEVY, M.D.MOISE D. LEVY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-96-1-125_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: I read with interest the brief report on penicillamine-induced neuropathy in rheumatoid arthritis (1). This report emphasizes the need for a physician to become familiar with the pharmacology of a drug before putting it to clinical use. Even though pyridoxine was not used in many of the clinical trials withD-penicillamine and it has been established thatD-penicillamine does not frequently antagonize pyridoxyl-dependent enzyme systems, Goodman and Gilman (2) point out that "Nevertheless, dietary supplementation of pyridoxine is recommended even when d-penicillamine is used."...References1. POOLFEITKIRKPATRICK KHJ. Penicillamine-induced neuropathy in rheumatoid arthritis. Ann Intern Med. 1981;95:457-8. LinkGoogle Scholar2. GOODMANGILMAN LA, eds. The Pharmacological Basis of Therapeutics. 5th ed. New York: McMillan; 1975:919. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Olin E. Teague Veterans' Center Temple, TX 76501 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByBiochemistry of the Water Soluble Vitamins: A Lecture for First Year Pharmacy Students 1 January 1982Volume 96, Issue 1Page: 125-125KeywordsClinical pharmacologyClinical trialsDrugsEnzymesNeuropathyPharmacologyPyridoxineRheumatoid arthritis Issue Published: 1 January 1982 PDF DownloadLoading ...
Sleep-Disordered Breathing, Hypoxia, and Risk of Mild Cognitive Impairment and Dementia in Older Women
Authors: Kristine Yaffe, Alison M. Laffan, Stephanie Litwack Harrison, Susan Redline, Adam P. Spira, Kristine E. Ensrud, Sonia Ancoli-Israel, Katie L. Stone
Journal: JAMA (2011)

<h3>Context</h3>Sleep-disordered breathing (characterized by recurrent arousals from sleep and intermittent hypoxemia) is common among older adults. Cross-sectional studies have linked sleep-disordered breathing to poor cognition; however, it remains unclear whether sleep-disordered breathing precedes cognitive impairment in older adults.<h3>Objectives</h3>To determine the prospective relationship between sleep-disordered breathing and cognitive impairment and to investigate potential mechanisms of this association.<h3>Design, Setting, and Participants</h3>Prospective sleep and cognition study of 298 women without dementia (mean [SD] age: 82.3 [3.2] years) who had overnight polysomnography measured between January 2002 and April 2004 in a substudy of the Study of Osteoporotic Fractures. Sleep-disordered breathing was defined as an apnea-hypopnea index of 15 or more events per hour of sleep. Multivariate logistic regression was used to determine the independent association of sleep-disordered breathing with risk of mild cognitive impairment or dementia, adjusting for age, race, body mass index, education level, smoking status, presence of diabetes, presence of hypertension, medication use (antidepressants, benzodiazepines, or nonbenzodiazepine anxiolytics), and baseline cognitive scores. Measures of hypoxia, sleep fragmentation, and sleep duration were investigated as underlying mechanisms for this relationship.<h3>Main Outcome Measures</h3>Adjudicated cognitive status (normal, dementia, or mild cognitive impairment) based on data collected between November 2006 and September 2008.<h3>Results</h3>Compared with the 193 women without sleep-disordered breathing, the 105 women (35.2%) with sleep-disordered breathing were more likely to develop mild cognitive impairment or dementia (31.1% [n = 60] vs 44.8% [n = 47]; adjusted odds ratio [AOR], 1.85; 95% confidence interval [CI], 1.11-3.08). Elevated oxygen desaturation index (≥15 events/hour) and high percentage of sleep time (&gt;7%) in apnea or hypopnea (both measures of disordered breathing) were associated with risk of developing mild cognitive impairment or dementia (AOR, 1.71 [95% CI, 1.04-2.83] and AOR, 2.04 [95% CI, 1.10-3.78], respectively). Measures of sleep fragmentation (arousal index and wake after sleep onset) or sleep duration (total sleep time) were not associated with risk of cognitive impairment.<h3>Conclusion</h3>Among older women, those with sleep-disordered breathing compared with those without sleep-disordered breathing had an increased risk of developing cognitive impairment.