tbuckley/cabot-search huggingface dataset:
Saving your G --ass !!!
Authors: Phyllis Murphie, Helen Coles, Margaret Gall, Irene Hunter, Jane Gysin, Stuart Little
Journal: European Respiratory Journal (2012)

A national home oxygen service contract review is being undertaken in NHS Scotland with the implementation of a domiciliary oxygen service best practice/guidance Statement. The Respiratory nursing team in NHS Dumfries and Galloway have undertaken a regional review of all patients using any modality of home oxygen. Since March 2011 - 300 patient clinic reviews have been conducted regarding home oxygen use in the nurse led clinics.

Findings: Prescription of oxygen is often conducted without establishing that people meet the criteria for this. There is a perception that oxygen is a treatment for breathlessness without assessing for hypoxaemia. Inappropriate prescribing is arising both in primary and secondary care settings. The costs of inappropriate oxygen prescribing are significant.

Outcomes: 50 oxygen concentrators installed for those who met the criteria for LTOT resulting in a saving of £ 30,000 in previous oxygen cylinder prescribing costs. 30 patients identified who met the criteria for the more efficient Homefill oxygen system with predicted annual savings costs of £47,000. 20 patients were identified who would benefit from an oxygen conserving device adding further efficiency savings. Oxygen was withdrawn from 12 users who were not hypoxaemic with only two being problematic.

Conclusions: Better technology/equipment that meets service user's needs is becoming available regionally and nationally. National Guidance /best practice local adoption and implementation are central to better prescribing practices and service improvement. A successful educational, communication and implementation strategy are central to delivering this new service locally. Significant efficiency savings have already been identified in our organisation as a result of this review.
High Efficacy of Fractionated Stereotactic Radiotherapy of Large Base-of-Skull Meningiomas: Long-Term Results
Authors: Juergen Debus, Martina Wuendrich, Andrea Pirzkall, Angelika Hoess, Wolfgang Schlegel, Ivan Zuna, Rita Engenhart-Cabillic, Michael Wannenmacher
Journal: Journal of Clinical Oncology (2001)

PURPOSE: Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy. PATIENTS AND METHODS: One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (± 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter. RESULTS: The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred. CONCLUSION: The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.
Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study.
Authors: M Degiuli, M Sasako, A Ponti, T Soldati, F Danese, F Calvo
Journal: Journal of Clinical Oncology (1998)

PURPOSE To investigate whether pancreas preservation together with a strict quality-control system could ameliorate the outcome of D2 resections for gastric cancer in Western patients. PATIENTS AND METHODS Italian patients with potentially curable proven adenocarcinoma of the stomach were registered from nine general and/or university hospitals in the area of Turin, Northern Italy. The study was performed according to the guidelines of the Japanese Research Society for Gastric Cancer (JRSGC). A strict quality-control system was guaranteed by a supervising surgeon of the reference center, who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy. The standard procedure entailed removal of the level 1 and 2 lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. RESULTS Between May 1994 and December 1996, 191 eligible patients were entered onto the study. The mean number of lymph nodes removed was 39. The overall morbidity rate was 20.9%. Surgical complications were observed in 16.7% of patients. Reoperation was necessary in six patients and was always successful. The overall hospital mortality rate was 3.1%; it was higher after total gastrectomy (7.46%) than after distal gastrectomy (0.8%). The average length of hospital stay was 17 days. CONCLUSION Given that postoperative morbidity and mortality rates are favorably comparable with those reported after the Western standard gastrectomy, the more extensive Japanese procedure with pancreas preservation can be regarded as a safe radical treatment of gastric cancer for selected Western patients treated in experienced centers.
Imprecision in medical communication: study of a doctor talking to patients with serious illness
Authors: J R Skelton, J Murray, F D R Hobbs
Journal: Journal of the Royal Society of Medicine (1999)

Uncertainty is believed to be a central feature in illness experiences. Conversations between a consultant haematologist and 61 seriously ill patients were transcribed, entered on a database and scrutinized for patterns of language uncertainty by linguistic concordancing analysis. Transcripts were then discussed in detail with the haematologist, and techniques of protocol analysis were used to gain insight into his thought processes during consultations. The main findings were that the doctor used many more expressions of uncertainty than did patients: that evaluative terms were widely used to reassure rather than to worry patients; and that patients and doctor together used certain key terms ambiguously, in a manner which allowed the doctor to feel that facts were not misrepresented while perhaps permitting the patient to feel reassured.
Elevated serum c-erbB-2 antigen levels and decreased response to hormone therapy of breast cancer.
Authors: K Leitzel, Y Teramoto, K Konrad, V M Chinchilli, G Volas, H Grossberg, H Harvey, L Demers, A Lipton
Journal: Journal of Clinical Oncology (1995)

PURPOSE Decisions concerning the use of hormone therapy to treat metastatic breast cancer are made on the basis of the presence of estrogen receptor (ER). Despite the presence of ER, half of patients will not respond to hormone treatment. The purpose of this study was to determine the effect of overexpression of HER-2/neu on the response to hormone therapy. PATIENTS AND METHODS Sera from 300 metastatic breast cancer patients with ER-positive (ER+), ER status unknown, or ER-/progesterone receptor-positive (PR+) randomized to receive second-line hormone therapy with either megestrol acetate or fadrozole were evaluated. An enzyme immunoassay (EIA) specific for the extracellular domain of the c-erbB-2 (HER-2/neu) oncogene product was used to detect serum levels. RESULTS Fifty-eight patients (19.3%) had elevated serum c-erbB-2 protein levels, using a selected cut-point of 30 U/mL. The response rate (complete responses [CRs] plus partial responses [PRs] plus stable disease [S]) to endocrine therapy was 40.9% in 242 patients with low serum c-erbB-2 levels and only 20.7% in 58 patients with elevated serum c-erbB-2 levels (P = .004). The median duration of treatment response was longer in the group with low serum c-erbB-2 levels (15.5 months) compared with the group with elevated serum c-erbB-2 levels (11.6 months). Survival was also significantly shorter in patients with elevated serum c-erbB-2 levels (P &lt; .0001). CONCLUSION Patients with ER+/c-erbB-2+ metastatic breast cancer are less likely to respond to hormone treatment than ER+/c-erbB-2- patients. Their survival duration is also shorter.
Age-dependent changes in whole-lung septal thickness measured by 129Xe MRI: A comparison of healthy volunteers and subjects with IPF
Authors: Neil J. Stewart, General Leung, Graham Norquay, Helen Marshall, Juan Parra-Robles, Catherine Billings, Philip Murphy, Rolf F. Schulte, Jan Wolber, David G. Kiely, Moira K.B. Whyte, Jim M. Wild
Journal: European Respiratory Journal (2014)

Introduction: Techniques for studying lung function with hyperpolarised (HP) 129Xe are promising for quantification of whole-lung septal thickness, but are yet to be validated in older healthy subjects, or in patients with known fibrotic parenchyma.

Objective: To demonstrate the feasibility of non-invasive measurement of lung septal thickness with HP 129Xe MRI in healthy volunteers and subjects with IPF.

Methods: 129Xe spectroscopy was performed at 1.5T with 10 healthy volunteers (23-74 yrs) and 4 IPF patients. A chemical shift saturation recovery (CSSR) method was used to assess the dynamics of xenon uptake into parenchymal tissues and blood and to derive quantitative information about lung microstructure. Standard pulmonary function tests (PFTs) were conducted for comparison.

Results: A gradual increase in whole-lung septal thickness with volunteer age was measured by HP 129Xe CSSR. Statistically significant thickening of alveolar septa was observed in IPF subjects as compared to volunteers (p 70% predicted), whilst IPF subjects had variable FEV1 and FVC (40-100%) and poor DLCO (<45%).

![Figure][1] 



Conclusions: 129Xe CSSR is sensitive to small changes in lung microstructure with aging in healthy lungs that cannot be identified by PFTs. The technique shows potential for assessment of severity of fibrotic and interstitial lung disorders.

 [1]: pending:yes
Doxifluridine and leucovorin: an oral treatment combination in advanced colorectal cancer.
Authors: E Bajetta, M Colleoni, M Di Bartolomeo, R Buzzoni, F Bozzetti, R Doci, L Somma, F Cappuzzo, C G Stampino, A Guenzi
Journal: Journal of Clinical Oncology (1995)

PURPOSE This study was designed to test the activity and feasibility of an all-oral regimen of levo-leucovorin and doxifluridine (dFUR) in the treatment of advanced colorectal cancer and to establish whether the pharmacokinetics of dFUR and fluorouracil (FU) are affected by demographic and/or biologic parameters. MATERIALS AND METHODS One hundred eight patients with histologically proven colorectal cancer received orally administered levo-leucovorin 25 mg followed 2 hours later by dFUR 1,200 mg/m2 on days 1 to 5, with the cycle being repeated every 10 days. RESULTS Among 62 previously untreated patients, two complete responses (CRs) and 18 partial responses (PRs) were observed (overall response rate, 32%; 95% confidence interval, 21% to 45%). The median response duration was 4 months (range, 2 to 13) and the median survival time, 14 months. Among 46 pretreated patients, there were three CRs and three PRs (response rate, 13%; 95% confidence interval, 5% to 26%). In this group of patients, the median response duration was 4 months (range, 1 to 12) and the median survival time, 12 months. No toxic deaths were observed. The only World Health Organization (WHO) grade 3 to 4 side effect was diarrhea (32 patients). CONCLUSION This regimen is active in previously untreated colorectal cancer patients and combines good compliance with safety. Limited but definite efficacy was also detected in the patients previously treated with FU, which suggests incomplete cross-resistance between the two drugs. The pharmacokinetic results suggest that the conversion rate of dFUR to FU increases between days 1 and 5, but that FU levels remain low in comparison to those measured after classical FU therapy. Under the experimental conditions used in this study, the interpatient variability of pharmacokinetic parameters remains largely unexplained by the tested variables.
Fair shares in health care? Ethnic and socioeconomic influences on recording of preventive care in selected inner London general practices
Authors: J Atri, M Falshaw, A Livingstone, J Robson
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To describe the association of ethnic and socioeconomic status with recording of preventive care information by selected general practitioners. <b>Design</b>: Random selection of people aged 20-64 registered with 43 general practitioners. Ethnic and social characteristics of stratified samples were determined at interview in the subject9s home. Recording of preventive information was ascertained from general practitioners9 medical records. <b>Setting</b>: Inner London borough of Tower Hamlets. <b>Subjects</b>: 505 out of 739 people confirmed as resident at their home address (190 white, 86 black, 112 Bangladeshi, 105 Chinese or Vietnamese, 12 other). <b>Main outcome measures</b>: Socioeconomic characteristics, consultation with general practitioner, and recorded preventive activities for ethnic groups. <b>Results</b>: Minority ethnic groups were considerably more disadvantaged than white people and five times more likely to be overcrowded (31% v 6%), three times less likely to own their own home (11% v 37%), twice as likely to be in social classes IV and V (54% v 28%) and less likely to be employed (34% v 63%). There were no significant differences between white, black, Bangladeshi, and Chinese or Vietnamese subjects in recording of smoking, blood pressure, alcohol consumption, weight, and height in the general practitioners9 medical records. White women were more likely to have a record of mammography (46% v 20%; P=0.03) and of cervical smears than women in minority ethnic groups. <b>Conclusion</b>: Despite major socioeconomic inequity, equitable recording of preventive activity for the major causes of death for white, black and Bangladeshi populations is possible. Chinese and Vietnamese people had lower levels of recording and consultation. Mammography and, to a lesser extent, cervical cytology are inequitably recorded and require additional support at practice level. <h3>Key messages</h3> Key messages Despite these socioeconomic disparities, selected general practitioners equitably deliver preventive services for the major causes of premature death Recording of mammography and cervical cytology were important exceptions and these programmes require additional support at practice level
Role of endogenous cathepsin D-like and chymotrypsin-like proteolysis in human epidermal desquamation
Authors: None Horikoshi, None Igarashi, None Uchiwa, None Brysk, None Brysk
Journal: British Journal of Dermatology (1999)

Even though the skin surface is acidic (about pH 5), most in vitro studies on desquamation have been performed at alkaline pH. We demonstrate that the standard in vitro model system, which achieves squame shedding upon incubation of plantar stratum corneum for 1 day in an alkaline buffer that must include a chelating agent, can be extended to a more realistic model in which the incubation is for 4 days, at varying pHs from 5 to 8, without exogenous chelators. Desmoglein I from stratum corneum was degraded by the squames shed at pH 5 as well as at pH 8. Squame shedding was inhibited to varying extents by the addition of proteinase inhibitors, whose specificity suggested that the crucial enzymatic activity at pH 8 was a chymotrypsin-like serine proteinase, while a similar activity at pH 5 was accompanied by an aspartic proteinase activity of comparable strength. Four degradation peaks were observed when the insulin B chain was reacted with shed squames at pH 5. Two of these peptides were suppressed by the addition of phenylmethylsulphonyl fluoride, the other two by pepstatin A; chymostatin inhibited all four, but E-64 and leupeptin showed no effect. The implied specificity was confirmed by reacting the insulin (without squames) with the standard enzymes human liver cathepsin D and pancreatic chymotrypsin, reproducing the expected degradation products. These results suggest that epidermal desquamation at acidic pH requires two proteolytic activities, one of which is an analogue of chymotrypsin and the other of cathepsin D. Endogenous proteinases corresponding to these activities have been previously identified, namely the stratum corneum chymotryptic enzyme and the mature active form of cathepsin D.
Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelae
Authors: M. von Laffert, V. Stadie, J. Wohlrab, W.C. Marsch
Journal: British Journal of Dermatology (2010)

Hidradenitis suppurativa/acne inversa is a chronic, inflammatory, scarring disease in the terminal hair follicle and apocrine gland-bearing areas (skin folds). There is considerable histological evidence that perifolliculitis and follicular hyperkeratosis precede the rupture of the follicle. The timing of the epithelial hyperplasia at the infundibula of inflamed terminal follicles has not yet been clarified.To clarify the early histopathological life of lesions ('chronology') in hidradenitis suppurativa/acne inversa, focusing on the terminal follicle structure and its surrounding tissue (hyperkeratosis, hyperplasia of follicular epithelium, perifolliculitis and rupture).In total, 485 operative specimens obtained from 128 patients with diagnosed hidradenitis suppurativa/acne inversa (all surgically treated by wide excision) were examined histologically. Two to five histological preparations (total 485) per operation area (total 196) were prepared by multiple slicing.Hidradenitis suppurativa/acne inversa showed a heterogeneous histological pattern: hyperkeratosis of the terminal follicles (89%), hyperplasia of follicular epithelium (80%), pronounced perifolliculitis (68%) and follicle rupture (24%). Perifolliculitis, follicular hyperkeratosis and hyperplasia occurred prior to the rupture of the follicle. Other histological criteria were: subepidermal cellular inflammatory infiltrate (82%), epidermal psoriasiform hyperplasia (56%), pronounced acute dermal inflammation (28%), pronounced chronic dermal inflammation (49%), and involvement of apocrine glands (52%) and subcutis (31%).Infundibular hyperkeratosis, hyperplasia of the follicular epithelium and perifolliculitis are major histopathological characteristics of hidradenitis suppurativa/acne inversa. These apparently precede rupture of the follicle. In particular, hyperplasia of the follicular epithelium probably marks the beginning of sinus formation, which usually spreads horizontally. Psoriasiform hyperplasia of the interfollicular epidermis with subepidermal inflammatory infiltrate might be interpreted as an inflammation-driven process basically identical to that which is evident at the terminal follicle. However, it does not lead to harmful and progressive sequelae like those (rupture, sinus tracts) seen at the terminal follicles.
How often do respiratory specialists agree with the diagnosis of COPD made in general practice? An audit of referrals to a community based COPD centre (BreathingSpace) in the UK
Authors: Angela Green, Gurnam Basran, Gail South
Journal: European Respiratory Journal (2011)

The Rotherham BreathingSpace (BS) is a nurse-led community based centre for the delivery of specialist care for Chronic Obstructive Pulmonary Disease (COPD). Previous Rotherham general practice (GP) audits of COPD diagnosis and management showed some improvements in quality between 2007 and 2008 but highlighted the current UK Quality and Outcomes Framework used in general practice assessed only the quantity and not the quality of spirometry. The purpose of this audit was to assess the reliability of the diagnosis of COPD made in general practice when referred on to a specialist respiratory service (BS). A retrospective review of a random sample of COPD patient referral forms (N=398, 207 males and 191 females) sent to BS from general practice between May 2007 and Sept 2010 was undertaken. 213 (54%) of these referrals had spirometry measures included on the referral (mean FEV1% p = 54, FEV1/FVC= 0.59). Of the completed assessments (N=341) BS agreed with GP diagnosis of COPD in 277 (81%) of patients and disagreed with the COPD diagnosis in 64 (19%) of patients. The BS non COPD diagnoses were Asthma (N=30, 9%), Restrictive lung disease (N=20, 6%), non obstructive Emphysema (N=5, 2%), Bronchiectasis (N=2, 0.6%) and no respiratory disease (N=20, 6%). These findings suggest that 4 out of 5 COPD diagnoses made in general practice referred to our centre (BS) are reliable but there is still room for improvement. Further education and quality improvement is recommended in COPD diagnosis in line with national guidelines.
Pirfenidone Initiates a New Era in the Treatment of Idiopathic Pulmonary Fibrosis
Authors: Anna S. Selvaggio, Paul W. Noble
Journal: Annual Review of Medicine (2015)

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal disease that has long eluded therapy. Prognosis remains very poor, and currently lung transplantation offers the only hope of survival. Recently, great strides have been made in the development of pharmaceutical therapy to treat IPF. Pirfenidone, an oral antifibrotic agent, has been shown to slow progression of the disease and improve progression-free survival, offering new hope for patients suffering from IPF.
Use of Implantable Cardioverter-Defibrillators Among Medicare Patients
Authors: Daniel E. Forman, Mathew S. Maurer, Michael W. Rich
Journal: JAMA (2015)

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