tbuckley/cabot-search huggingface dataset:
Demonstration skills and knowledge for inhalers use are lacking among NCHD and nurses
Authors: Olga Mikulich, Lookman Abdul, Christina Mc Donnell, Paula Ryan, Brian Casserly, Aidan O'Brien
Journal: European Respiratory Journal (2013)

RATIONALE: Limited information is available on healthcare professionals knowledge of inhaled medications and devices for their administration(1).  METHODS: Prospective audit of Non-Consultant Hospital Doctors(NCHD) and nurses. 70 subjects (20 nurses,50 NCHD)completed questionnaires about the most commonly prescribed inhalers (Spiriva, Seretide, Symbicort, Beclasone, Ventolin) and underwent evaluation of their demonstration skills for: meter-dose inhaler(MDI), Easibreathe, Turbohaler,Diskus,Handihaler,Respimat.  RESULTS:Ventolin was the most familiar inhaler: 94% doctors(D) and 85% nurses(N) knew its generic name, 86% D and 60% N knew its drug class and 75% of both knew frequency of use. Only 12% of D (vs 55% N) knew its correct dosage.Least familiarity was shown for Symbicort generic name (22% D vs 10% N), its drug class (34% D vs 25% N) and frequency of usage (42% D vs 70% N).Nurses were more familiar with devices: 60% named correct device for Seretide, 50% for Ventolin and 40% remainder. For doctors: 24% Seretide, 18% Ventolin, 16% Beclasone ,14% Symbicort and 8% Spiriva. 80% doctors and 60% nurses demonstrated correct use of MDI. Demonstration skills were least successful for Respimat (16% D; 25% N).  CONCLUSION:  Inhalers knowledge among healthcare professionals is lacking. Doctors demonstrate better knowledge about inhalers generic names and drug class than nurses.Nurses’ knowledge is better for doses, frequency of use and devices.Education of healthcare professionals about inhaled respiratory medication is extremely important.  REFERENCE:1.Self T et al. Inadequate skill of healthcare professionals in using asthma inhalation devices.J Asthma. 2007 Oct;44(8):593-8.
Cancer survival is a poor indicator of quality of care
Authors: Claudina Michal-Teitelbaum
Journal: BMJ (2015)

The Nuffield Trust and Health Foundation compared the quality of care of health systems in similar Organisation for Economic Co-operation and Development countries.1 This comparison, based on quality indicators, is relayed by the media to put policy makers under pressure, with particular emphasis on poor cancer survival results.

However, if the ultimate aim is improving health outcomes …
A possible therapeutic agent for pulmonary fibrosis: Antibody against integrin α8β1
Authors: Norihisa Nishimichi, Keishi Kanno, Kazuhiro Sentani, Wataru Yasui, Yasuyuki Yokosaki
Journal: European Respiratory Journal (2013)

Integrins are transmembrane receptors that modulate multiple cellular behaviors. One member of this family, the integrin αvβ6, has been also shown to activate the pro-fibrotic growth factor, TGF-β, in the extracellular space, and to play an important role in pulmonary fibrosis. A monoclonal antibody targeting this integrin is currently in phase 2 clinical trials for treatment of pulmonary fibrosis. However, αvβ6 is restricted in its expression to epithelial cells, so inhibition of this integrin might not modulate the behavior of pathological fibroblasts that are not in contact with epithelial cells. For example, anti-αvβ6 blocking antibody did not attenuate liver fibrosis induced by CCl 4 . We have targeted the α8β1 integrin, that is expressed on activated fibroblasts and reported that anti-integrin α8β1, inhibited liver fibrosis induced by either CCL 4  or bile duct ligation (Nishimichi, N. et al. Am J Respir Crit Care Med 2012; 185: A1949). We now extend these findings to pulmonary fibrosis. In this study, we treated mice with intratracheal bleomycin and then with either. 10 mg/kg anti-α8β1 antibody or saline i.p. every 3 days from day 0 to day 21 after bleomycin instillation. On day 21, lung specimens from antibody-treated mice showed reduced fibrosis by H.E. and Masson’s trichrome staining compared to mice treated with saline control. α-SMA and collagen type I gene expression and hydroxyproline content were also lower in the antibody-treated mice than control mice. Antibody treatment also protected the mice from body weight loss. These results suggest that anti-integrin α8β1 antibody could be a new therapeutic agent for pulmonary fibrosis.
High-dose chemoradiotherapy and anti-B-cell monoclonal antibody-purged autologous bone marrow transplantation in mantle-cell lymphoma: no evidence for long-term remission.
Authors: A S Freedman, D Neuberg, J G Gribben, P Mauch, R J Soiffer, D C Fisher, K C Anderson, N Andersen, R Schlossman, M Kroon, J Ritz, J Aster, L M Nadler
Journal: Journal of Clinical Oncology (1998)

PURPOSE The role for high-dose therapy and autologous stem-cell transplantation in mantle-cell lymphoma (MCL) is unknown. We retrospectively analyzed patients with chemosensitive disease who underwent high-dose chemoradiotherapy and anti-B-cell monoclonal antibody-purged autologous bone marrow transplantation (ABMT) for MCL in first remission, as well as following relapse from conventional therapy. PATIENTS AND METHODS Between August 1985 and April 1996, 28 patients underwent ABMT using a uniform ablative regimen with cyclophosphamide and total-body irradiation (TBI) and a bone marrow-purging regimen. Re-review of original tissue demonstrated that all patients had morphologic, phenotypic, and genotypic characteristics of MCL. MCL was the original diagnosis in 21 patients, whereas seven patients had a prior diagnosis of diffuse small cleaved-cell lymphoma. RESULTS Twenty patients received multiple regimens before ABMT, while eight underwent ABMT in first complete remission (CR)/partial remission (PR) following CHOP induction. At bone marrow harvest, only 18% of patients were in CR and overt BM infiltration was present in 57%. Following cyclophosphamide/TBI, no treatment-related deaths were seen. Nineteen of 28 patients have relapsed at a median time of 21 months (range, 3 to 70). Of eight patients transplanted in first CR/PR, five have relapsed. Nine patients are in continuous CR with a median follow-up time of 24 months (range, 10 to 135). Disease-free survival (DFS) and overall survival (OS) are estimated to be 31% and 62% at 4 years, respectively. CONCLUSION ABMT using cyclophosphamide/TBI conditioning may at best be effective in only a small fraction of patients with relapsed MCL. The lack of plateau with a median follow-up time of 24 months suggests cure may not be achievable. The role of this therapy in patients in first remission requires more study using better induction therapy to enhance the CR rate before ABMT.
Outbreak of norovirus infection in a nursing home for the elderly in Malta, November-December 2008
Authors: A Grima, A Gatt, G Zahra, A Gambin
Journal: Eurosurveillance (2009)

In norovirus outbreak in a nursing home in Malta in November and December 2008, 44 people were affected. 35 of 91 residents and nine of 44 employees were symptomatic. The overall attack rate among residents was 38.5% [corrected]. The outbreak lasted 17 days and the symptoms were mild.
Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study
Authors: Lu Yang, Chan-Yan Huang, Zhi-Bin Zhou, Zhi-Shuang Wen, Guan-Rong Zhang, Ke-Xuan Liu, Wen-Qi Huang
Journal: International Journal of Surgery (2015)
IP-10 is an additional marker to evaluate the RD1-specific responses in HIV-infected subjects
Authors: Valentina Vanini, Teresa Chiacchio, Cristiana Gioia, Gilda Cuzzi, Nicoletta Orchi, Alessia Rianda, Lucia Alba, Maria Letizia Giancola, Aristide Conte, Elisa Petruccioli, Linda Petrone, Enrico Girardi, Delia Goletti
Journal: European Respiratory Journal (2011)

Background: The suboptimal sensitivity of IFN-γ-based assays, especially in immunocompromised individuals, emphasizes the need for alternative markers for diagnosing tuberculosis (TB). Objective of this study was to evaluate whether IP-10 can be a useful biomarker for evaluating a specific response to RD1 antigens associated to active TB in HIV-infected individuals. Control with QuantiFERON-TB Gold In tube (QFT-IT) was performed.

Methodology: 118 HIV-infected individuals were prospectively enrolled in Rome, 21 with active-TB and 98 without. Epidemiological characteristics were analyzed. IFN-γ and IP-10 response to QFT-IT was performed. Plasma was harvested at day-1 and soluble factors evaluated by ELISA.

Results: Significant differences between those with or without active TB were found for the CD4+ T cell counts (p=0.02), and IFN-γ and IP-10 response to QFT-IT (p=0.001 for both analysis). Differently no significant differences were found for the age and HIV-RNA. Based on the commercial cut-off of the QFT-IT and on a cut-off found by ROC analysis for the IP-10-based responses, the sensitivity for active TB of QFT-IT and the IP-10 to QFT-IT was 52% and 67% respectively (p=0.001; K: 0.545). The response to IP-10 was not influenced by the ability to respond to the mitogen. The specificity for active TB of QFT-IT and of the experimental test were 84% and 77% respectively (p=0.01; k:0.710). Among those without active TB a significant correlation between a positive score and Mtb exposure was found (p<0.001).

Conclusions: These data suggest that IP-10 is an additional marker to evaluate the RD1-specific responses in HIV-subjects confirming data previously obtained in high TB endemic countries.
Pharmacokinetic Study of Single Doses of Oral Fludarabine Phosphate in Patients With “Low-Grade” Non-Hodgkin's Lymphoma and B-Cell Chronic Lymphocytic Leukemia
Authors: James M. Foran, David Oscier, Jennifer Orchard, Stephen A. Johnson, Mary Tighe, Michael H. Cullen, Philippa G. de Takats, Christian Kraus, Marcus Klein, T. Andrew Lister
Journal: Journal of Clinical Oncology (1999)

PURPOSE: Fludarabine phosphate (F-AMP), a purine analog, requires daily intravenous administration. A pharmacokinetic study of an oral formulation (10 mg immediate-release tablet) was undertaken in patients with “low-grade” non-Hodgkin's lymphoma and B-cell chronic lymphocytic leukemia. PATIENTS AND METHODS: Oral F-AMP was incorporated into the “conventional” treatment schedule. Single oral trial doses of 50, 70, and 90 mg of F-AMP were given on the first day of three cycles of treatment; a comparative 50-mg intravenous trial dose was given on the first day of the fourth cycle. Intravenous F-AMP (25 mg/m 2 ) was given on days 2 to 5 at 4-week intervals. Pharmacokinetic samples taken after each trial dose were analyzed for plasma 2-fluoro-arabinofuranosyl-adenine (2F-ara-A) concentration (its main metabolite); area under the curve 0 to 24 hours (AUC(0-24h)) and maximum concentration (C max ) were calculated. Eighteen patients received all three oral trial doses, and bioavailability was determined in 15 patients who completed four courses of therapy. RESULTS: Oral administration of F-AMP resulted in a dose-dependent increase in C max and AUC(0-24h) of 2F-ara-A and achieved an AUC(0-24h) similar to intravenous administration, although at a lower C max . The linear increase in mean AUC(0-24h) by factors of 1.36 ± 0.22 (mean ± SD) and 1.72 ± 0.31 corresponded well with the increase in oral dose from 50 to 70 mg (factor of 1.4) and 90 mg (factor of 1.8), respectively. Bioavailability (approximately 55%, with low intraindividual variation) and time to C max were dose independent. CONCLUSION: Oral doses of F-AMP can achieve an AUC(0-24h) of 2F-ara-A similar to intravenous administration, with dose-independent bioavailability. The tablet will greatly enhance the use of F-AMP in a palliative setting.
Why Doctors Don't Use Computers: Some Empirical Findings
Authors: J G Anderson, S J Jay, H M Schweer, M M Anderson
Journal: Journal of the Royal Society of Medicine (1986)

The attitudes of 148 medical students, 141 residents, and 644 practising physicians towards computer applications in medicine were studied. The results indicate that physicians recognize the potential of computers to improve patient care, but are concerned about the possibility of increased governmental and hospital control, threats to privacy, and legal and ethical problems. In general, all three groups are uncertain as to the potential effects of computers on their traditional professional role and on the organization of practice. Practising physicians, however, express more concern about these potential effects of computers than do medical students and residents. While attitudes appear to be somewhat independent of prior computer experience, they significantly affect the extent to which physicians use a computer-based hospital information system. This may be a major reason for the slow introduction of clinical computer systems.
Initial reliability and validity of a new retrospective measure of child abuse and neglect
Authors: D P Bernstein, L Fink, L Handelsman, J Foote, M Lovejoy, K Wenzel, E Sapareto, J Ruggiero
Journal: American Journal of Psychiatry (1994)

This report presents initial findings on the reliability and validity of a new retrospective measure of child abuse and neglect, the Childhood Trauma Questionnaire.Two hundred eighty-six drug- or alcohol-dependent patients were given the Childhood Trauma Questionnaire as part of a larger test battery, and 40 of these patients were given the questionnaire again after an interval of 2 to 6 months. Sixty-eight of the patients were also given a structured interview for child abuse and neglect, the Childhood Trauma Interview, that was developed by the authors.Principal-components analysis of responses on the Childhood Trauma Questionnaire yielded four rotated orthogonal factors: physical and emotional abuse, emotional neglect, sexual abuse, and physical neglect. Cronbach's alpha for the factors ranged from 0.79 to 0.94, indicating high internal consistency. The Childhood Trauma Questionnaire also demonstrated good test-retest reliability over a 2- to 6-month interval (intraclass correlation = 0.88), as well as convergence with the Childhood Trauma Interview, indicating that patients' reports of child abuse and neglect based on the Childhood Trauma Questionnaire were highly stable, both over time and across type of instruments.These findings provide strong initial support for the reliability and validity of the Childhood Trauma Questionnaire.
Evidence and Controversies in the Use of Post-Mastectomy Radiation
Authors: Shaneli A. Fernando, Stephen B. Edge
Journal: Journal of the National Comprehensive Cancer Network (2007)

Radiation after mastectomy is recommended for women with positive nodes, larger tumors, or positive margins. In addition to its role in reducing the risk for locoregional recurrence, it has an additive effect to the survival benefit seen with adjuvant systemic therapy. This article reviews the role of post-mastectomy radiation (PMRT) based on the recommendations in the 2007 NCCN Breast Cancer Clinical Practice Guidelines in Oncology and addresses the risk factors for recurrence after mastectomy. The data supporting both improvement in locoregional failure and survival are reviewed in detail. This article also discusses controversial areas in PMRT, including regional nodal radiation in women with 1 to 3 positive lymph nodes, PMRT in node-negative women with large tumors, and inclusion of internal mammary nodes. The final section discusses radiation field design and potential complications.
Importance of cardiac biomarkers in the evaluation of acute pulmonary thromboembolism severity, mortality and complicated clinical course
Authors: Gulseren Sagcan, Orhan Arseven, Gulfer Okumus, Remisa Gelisgen, Hafize Uzun
Journal: European Respiratory Journal (2011)

Background: Severity of pulmonary thromboembolism (PTE) is related to the determination of early mortality risk rather than distribution and the load of trombus. To determine the risk evaluation biomarkers level have important roles than echocardiography, alternatively.

Aim: Investigation of the effectiveness of biomarkers in the determination of 3 months complicated clinical course (CCC) and mortality, and also acute PTE risk level.

Material and methods: Demographic characteristics, history, clinical findings, risk factors, additional diseases, hemodynamic symptoms of 47 patients (22M, 25F) with objectively documented diagnosis of PTE, were recorded. Before PTE treatment, serum and plasma samples were kept to measure the levels of D-Dimer, cTnT, Mb, NT-ProBNP, HAFBP and GDF-15. Patients were followed for 3 months for complication and mortality.

Results: NT-proBNP levels were similar in submassive and nonmassive groups but they were significantly higher in massive group when compared to other groups (p<0.05). GDF-15 levels were significantly higher in massive group when compared to nonmassive group (p=0.013). Mortality was present in 9 patients.When all the deaths caused are predicted by D-Dimer, HFABP, NT-proBNP and GDF. Deaths caused by PTE were only predicted by D-Dimer, HFABP and GDF-15 levels. NT-proBNP and GDF 15 valuables were predicted the complications (p< 0.05).

Conclusions: This biomarkers used in this study had no significant role in the differentiation of nonmassive and submassive groups. However, NT-proBNP and GDF-15 have been shown that these biomarkers would be beneficial for mortality and CCC, in prediction of 3 months.
Highly effective induction therapy for stage 4 neuroblastoma in children over 1 year of age.
Authors: B H Kushner, M P LaQuaglia, M A Bonilla, K Lindsley, N Rosenfield, S Yeh, J Eddy, W L Gerald, G Heller, N K Cheung
Journal: Journal of Clinical Oncology (1994)

PURPOSE To test the efficacy of a protocol for poor-risk neuroblastoma that builds on the following: (1) our favorable previously reported results with dose-intensive use of cyclophosphamide; (2) our retrospective analysis of neuroblastoma chemotherapy reports, which supported the value of high-dose cisplatin and etoposide (VP-16); and (3) the Goldie-Coldman hypothesis that rapid cytoreduction plus the use of non-cross-resistant chemotherapy combinations will decrease the risk of drug resistance. PATIENTS AND METHODS The N6 protocol included seven courses of high-dose chemotherapy plus surgical resection of bulk disease. Courses 1, 2, 4, and 6 consisted of 6-hour intravenous infusions of cyclophosphamide 70 mg/kg/d on days 1 and 2 (ie, 140 mg/kg per course), a 72-hour intravenous infusion of doxorubicin 75 mg/m2 and vincristine 0.1 mg/kg beginning day 1, and vincristine 1.5 mg/m2 intravenous bolus on day 9. Courses 3, 5, and 7 consisted of 2-hour intravenous infusions of VP-16 200 mg/m2/d on days 1 to 3 (ie, 600 mg/m2 per course), and 1-hour intravenous infusions of cisplatin 50 mg/m2/d on days 1 to 4 (ie, 200 mg/m2 per course). Courses were to start after neutrophil counts reached 500/microL and platelet counts reached 100,000/microL. Response was defined by international criteria. RESULTS Among 24 consecutive previously untreated patients diagnosed with stage 4 neuroblastoma at more than 1 year of age, 21 patients achieved a complete or very good partial remission; one patient had no evidence of disease except by iodine-131-metaiodobenzylguanidine (MIBG) scan, which was markedly improved; and one patient had resolution of extensive metastatic disease, but still had an incompletely resected primary tumor. The sole patient to have a poor response had clinical features at diagnosis that are atypical for neuroblastoma, namely, 8 years of age and an unknown primary tumor. Severe toxicities included myelosuppression, mucositis, and hearing deficits. CONCLUSION The N6 approach reliably achieves significant cytoreduction against stage 4 neuroblastoma. This may eventuate in an improved cure rate, since consolidative treatments using myeloablative therapy, immunotherapy, or biologic response modifiers such as cis-retinoic acid are most likely to be effective against minimal residual disease.
The Recognition of Depressive Disorder in Children
Authors: J B Pearce
Journal: Journal of the Royal Society of Medicine (1978)

A study of 547 children aged between 3 and 17 years, attending a child psychiatric clinic, showed that 23% were rated as having the symptom of morbid depression present. This group was compared with a control group from the same clinic without depression. The depressed children had a number of symptoms which were significantly associated with depression and formed a characteristic pattern of symptoms that could be defined as a specific depressive disorder.
Growth impairment in children with atopic eczema
Authors: F Kristmundsdottir, T J David
Journal: Journal of the Royal Society of Medicine (1987)

Growth was studied in 89 children with atopic eczema aged 1-16 years. Nine (10%) had a standing height below the 3rd centile. Both boys and girls had significantly reduced sitting height but normal subischial leg length, and both sexes had significantly delayed skeletal maturity scores. Impaired growth was particularly associated with widespread eczema, but also with the presence of asthma and the potency of topical corticosteroid. Six of the 15 patients with a corrected height centile below the 10th centile had been receiving potent (British National Formulary category I or II) topical corticosteroids. This study suggests that impaired linear growth is a feature of atopic eczema. While the causes of the growth impairment are unclear, there is a need for caution in the use of potent topical corticosteroids in children.
Risk factors of incomplete asthma control in asthmatic patients with allergic rhinitis
Authors: Kazuto Matsunaga, Asako Oka, Tadashi Kamei, Yukihiro Sakamoto, Yoshiaki Minakata
Journal: European Respiratory Journal (2013)

Background:  Allergic rhinitis is common in asthma and has a major impact on asthma control, but risk factors that contribute to poor asthma control have not been fully examined.  Objective:  To investigate the determinants of incomplete asthma control in patients with asthma and allergic rhinitis.  Methods:  A cross-sectional survey in 410 patients with asthma using Asthma Control Questionnaire (ACQ), spirometry, exhaled nitric oxide fraction (FENO), and questionnaires on rhinitis symptoms based on Allergic Rhinitis and its Impact on Asthma (ARIA) criteria.  Results:  A total of 260 patients (63.4%) had allergic rhinitis. Compared to the populations without rhinitis, asthma patients with allergic rhinitis showed more severe asthma symptoms (ACQ) and more airway inflammation (FENO)(all p  Conclusions:  The persistence and severity of rhinitis and the lower airway inflammation measured by FENO were associated with incomplete asthma control in asthmatic patients with allergic rhinitis, particularly if patients were not receiving nasal steroid therapy.