tbuckley/cabot-search huggingface dataset:
P29 Impact Of Respiratory Virtual Clinics In Primary Care On Responsible Respiratory Prescribing And Inhaled Corticosteroid Withdrawal In Patients With Copd: A Feasibility Study
Authors: G. d'Ancona, I. Patel, A. Saleem, F. Royle, A. Hodgkinson, V. Burgess, C. McKenzie, J. Moxham, T. Sethi
Journal: Thorax (2014)

<h3>Introduction</h3> There is considerable variation in accuracy of diagnosis and long-term management of COPD in the UK. High rates of inhaled corticosteroid (ICS) prescribing have been reported, raising concerns about their over use, with less focus on high value interventions like stop smoking support/pulmonary rehabilitation. ICS are indicated in severe COPD patients (FEV<sub>1</sub> &lt;50% predicted) with frequent exacerbations (&gt;2 per year). Primary care data from SE London showed that 38% of COPD patients were over treated with high dose ICS, resulting in 12 additional cases of pneumonia, and costs &gt;£500,000, annually. There is limited guidance on methods and feasibility of withdrawing ICS in these patients. <h3>Methods</h3> A responsible respiratory prescribing group including CCG medicines management, respiratory pharmacist and integrated respiratory team agreed COPD prescribing guidance across primary/ secondary care. GPs were supported with COPD review templates, written step down protocols and educational events. Virtual clinics with an integrated respiratory consultant/GP respiratory lead were offered to support ICS withdrawal in primary care. <h3>Results</h3> 45/48 (94%) of CCG practices took part. Data from 372 patients on COPD registers reviewed over 25 virtual clinics is presented. 321 (86%) patients had confirmed COPD (including 33 with COPD and asthma), 34 had asthma, 15 needed more spirometry and 2 had another diagnosis. 279/321 (87%) patients had a recommendation made: 64 (23%) referred for PR, 53 (19%) for spirometry, and 45 (16%) for smoking cessation. Changes to drug therapies were also recommended: 42 (15%) patients had a LAMA recommended, 16 (5%) a LABA, and while 117/321 COPD patients (37%) required no change to ICS therapy, a graduated step down/stop was suggested for 198 (63%). The outcomes associated with this are in Table 1. Overall, from Q4 13/14 prescribing data, there was a 4% decrease in high dose ICS (as proportion of total ICS use) resulting in a saving of £50,000. <h3>Conclusion</h3> Integrated working through respiratory virtual clinics offers hugescope to improve high value care for COPD patients. Overuse of ICS in COPD is common and GP-led withdrawal of high dose ICS where appropriate is feasible, acceptable and well tolerated by patients.
Extracorporeal photopheresis: Lighting the way to immunomodulation
Authors: Aleksandar M. Babic
Journal: American Journal of Hematology (2008)

Abstract Photopheresis, initially established as an effective treatment of cutaneous T‐cell lymphoma, has in recent years also been used to treat chronic graft vs. host disease, heart transplant rejection, and several other conditions requiring immunosuppression. Despite reported beneficial results of this procedure in treatment of various conditions, randomized controlled clinical trials are lacking for the majority of suggested indications. Furthermore, the mechanisms of action of this procedure are still unclear. Deeper understanding of the molecular basis of photopheresis‐based immunomodulation will allow better selection of patients to be treated and will facilitate development of novel, minimally toxic immunomodulatory treatments. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.
THE TREATMENT OF PERFORATED "PEPTIC" ULCERS
Authors: HUGH H. TROUT
Journal: JAMA (1935)

This paper deals only with the acute perforations that demand immediate operation. It does not concern those cases of perforation of marginal ulcers causing gastrocolic fistulas, chronic abscesses posterior to the stomach, intermittent leakage with blockage to which attention was called by Lund 1 in 1905, or even the forme fruste types of perforated ulcers recently described by Singer. 2   The deductions reached are largely based on personal experience in the treatment of forty-one such cases. This experience has been greatly influenced, however, by numerous visits to other hospitals, conversation with other surgeons, and a careful review of the literature. Of course it is generally conceded, even by the most radical adherents of the nonsurgically inclined of medical men, that surgery offers the best hope of recovery. Therefore this discussion will be confined to surgical intervention in this condition, as considered under the following three headings:  1. Drainage after closure
BILATERAL NEPHRECTOMY FOR MALIGNANT HYPERTENSION
Authors: JohnF. Mahony, B.G. Storey, G.R. Gibson, G.R. Stokes, A.G.R. Sheil, J.H. Stewart, MargaretD. Bischel, DavidS. Gans, BenjaminH. Barbour
Journal: The Lancet (1972)
Recurrent Discharge of Fluid from the Uterus during Pregnancy
Authors: D. D. Brown
Journal: BMJ (1872)

to be the most frequent cause of death after chloroform" (American 7ozernal, 1871, p. 437), I can come to no other conclusion than that Mr. Lister's teaching is more than a serious mistake; that in practice it will be found a fatal error.Mr. Lister has also written as follows:-" When Mr. Clover virtually recommends medical men generally to follow him in abstain- ing from this practice (drawing out the tongue), he has given about as pernicious a piece of advice as can well be given with reference to the administration of chloroform." (
Parentmaking: A Practical Handbook for Teaching Parent Classes About Babies and Toddlers
Authors: Janice Hutchinson
Journal: JAMA (1986)

The physical, sexual, and emotional abuse committed by some parents on their children has brought attention not only to the abuse itself but also to the parenting. In the past few years, there has been slow recognition that parenting is a challenging event. As a pediatrician, I have come to recognize and acknowledge it as the hardest job there is. Unlike other long-term, complicated, difficult jobs, there is no training or official curriculum available on how to be a good parent. This is the uniqueness of parenting. This is also why there is a need for a book like<i>Parentmaking</i>. <i>Parentmaking</i>is a handbook for teaching parent classes about babies and toddlers. Fathers as well as mothers can become students. Nearly all references to caretaking activities address "parents," thus acknowledging the biologic existence of at least two potential primary caretakers. There is repeated support for and recognition of parental needs,
Measurements of Exocrine and Endocrine Functions of the Pancreas
Authors: Philip J. Snodgrass
Journal: JAMA (1962)

This book comprises the edited proceedings of a seminar held under the auspices of the Association of Clinical Scientists. As the editors indicate, it was intended to focus on problems of methodology, and also to encompass fundamental chemical considerations and clinical interpretations. In the opinion of the reviewer, the intention has been successful in the former but has failed in the latter. The first section, on the exocrine functions of the pancreas, offers admirable critiques of the various enzymatic methods available for measurement of amylase and lipase activities. The measurement of the trypsin inhibiting capacity of serum remains of doubtful usefulness, to judge by its empirical correlation with disease states of the pancreas. The references are among the most valuable dividends of the book. One discrepancy is the perpetuation of the idea that there is a specific collagenase in pancreatic juice, without considering the data of Lewis et al. (<i>J</i>
Reliability of the Roussel Uclaf Causality Assessment Method for assessing causality in drug-induced liver injury
Authors: James Rochon, Petr Protiva, Leonard B. Seeff, Robert J. Fontana, Suthat Liangpunsakul, Paul B. Watkins, Timothy Davern, John G. McHutchison
Journal: Hepatology (2008)

The Roussel Uclaf Causality Assessment Method (RUCAM) was developed to quantify the strength of association between a liver injury and the medication implicated as causing the injury. However, its reliability in a research setting has never been fully explored. The aim of this study was to determine test-retest and interrater reliabilities of RUCAM in retrospectively-identified cases of drug induced liver injury. The Drug-Induced Liver Injury Network is enrolling well-defined cases of hepatotoxicity caused by isoniazid, phenytoin, clavulanate/amoxicillin, or valproate occurring since 1994. Each case was adjudicated by three reviewers working independently; after an interval of at least 5 months, cases were readjudicated by the same reviewers. A total of 40 drug-induced liver injury cases were enrolled including individuals treated with isoniazid (nine), phenytoin (five), clavulanate/amoxicillin (15), and valproate (11). Mean ± standard deviation age at protocol-defined onset was 44.8 ± 19.5 years; patients were 68% female and 78% Caucasian. Cases were classified as hepatocellular (44%), mixed (28%), or cholestatic (28%). Test-retest differences ranged from −7 to +8 with complete agreement in only 26% of cases. On average, the maximum absolute difference among the three reviewers was 3.1 on the first adjudication and 2.7 on the second, although much of this variability could be attributed to differences between the enrolling investigator and the external reviewers. The test-retest reliability by the same assessors was 0.54 (upper 95% confidence limit = 0.77); the interrater reliability was 0.45 (upper 95% confidence limit = 0.58). Categorizing the RUCAM to a five-category scale improved these reliabilities but only marginally. Conclusion: The mediocre reliability of the RUCAM is problematic for future studies of drug-induced liver injury. Alternative methods, including modifying the RUCAM, developing drug-specific instruments, or causality assessment based on expert opinion, may be more appropriate. (HEPATOLOGY 2008.)
Response to Commentaries on “Patient Autonomy for the Management of Chronic Conditions: A Two-Component Re-Conceptualization”
Authors: Aanand D. Naik, Carmel B. Dyer, Mark E. Kunik, Laurence B. McCullough
Journal: The American Journal of Bioethics (2009)

The ethical concept of autonomy in modern bioethics has evolved with the healthcare system. The historical prominence of acute medical conditions and hospital-based medical care has strongly influe...
Occurrence of IgE antibodies against the 39-kDa allergen component of the mite Lepidoglyphus destructor in urban and rural subjects
Authors: M. van Hage‐Hamsten, E. Lagging, B. Härfast, S. G. O. Johansson
Journal: Allergy (1993)

Several species of storage mite have been shown to cause IgE‐mediated sensitization. Monoclonal antibodies (mabs) have been raised against the storage mite Lepidoglyphus destructor , and one mab (42B6) immunoprecipitated a band of 39 kDa of L. destructor . To search for the frequency of IgE antibodies in patient sera against this allergen component, we modified a radioimmunoassay (RIA), 42B6 being used as capturing antibody. Twenty of 43 sera from farmers who were RAST positive to L. destructor (46.5%) were scored as positive in this assay. There was a moderate degree of correlation between positive RAST results to L. destructor and the 39‐kDa allergen. Among 14 sera from Stockholm residents positive in RAST to both Dermatophagoides pteronyssinus and L. destructor , six detected the 39‐kDa allergen component. However, three sera from urban subjects lacking IgE antibodies against both mite species also had IgE antibodies against the 39‐kDa allergen. The present study demonstrates that the 39‐kDa allergen of L. destructor is an important allergen, and that rural as well as urban subjects can become sensitized.
Effect of Acetazolamide on Hypoxemia during Sleep at High Altitude
Authors: John R. Sutton, Charles S. Houston, Anthony L. Mansell, Murray D. McFadden, Peter M. Hackett, John R. A. Rigg, A. C. Peter Powles
Journal: New England Journal of Medicine (1979)

ACUTE exposure to high altitude results in respiratory alkalosis. With time (acclimatization) blood pH tends to return to normal levels1; return is hastened by acetazolamide, a carbonic anhydrase...
PLATELET REACTIVITY AND CLINICAL OUTCOMES AFTER CORONARY ARTERY IMPLANTATION OF DRUG-ELUTING STENTS IN SUBJECTS WITH PERIPHERAL ARTERIAL DISEASE: ANALYSIS FROM THE ADAPT-DES STUDY
Authors: Rajesh Gupta, Ajay Kirtane, Ke Xu, Bernhard Witzenbichler, Michael Rinaldi, Christopher Metzger, Giora Weisz, Thomas Stuckey, Bruce Brodie, Roxana Mehran, Gregg Stone
Journal: Journal of the American College of Cardiology (2014)
Dependence of myocardial blood flow and metabolism on cardiac innervation
Authors: A. J. DRAKE, J. STUBBS, M. I. M. NOBLE
Journal: Cardiovascular Research (1978)

Left ventricular blood flow was measured in dogs with radioactive microspheres at a fixed heart rate for each dog, achieved by right atrial pacing. Blood samples were taken from an artery and from the coronary sinus, into which a catheter had been introduced under fluoroscopic control. These were analysed for oxygen content, lactate, glucose, and free fatty acids. The coronary A-V differences for these variables were used together with the flow to calculate left ventricular oxygen consumption and left ventricular uptake of the three substances. Each dog was then subjected to cardiac denervation and after three weeks, to allow for endogenous catecholamines to be depleted, a second measurement of the left ventricular blood flow was made using microspheres with a different radioactive label, together with second measurements of coronary A-V differences for oxygen content, lactate, glucose, and free fatty acids. These measurements were made with the same heart rate, arterial pressure, and anaesthetic as in the first study in each dog. Left ventricular oxygen consumptions in the innervated control study were 109.6 ± 15.9 (1 SD) mm3 O2 · min−1·g−1, and after denervation were 141.8 ± 35.7 mm3 O2 ·min−1·g−l respectively. This increase in left ventricular oxygen consumption was accompanied by concomitant increases in lactate consumption from 277.4 ± 156.7 nmol·min−1·g−1 to 917 ± 213.3 nmol·min−1·g−1 respectively, but no consistent changes in glucose and free fatty acid uptake. External left ventricular work per cm3 of oxygen consumed fell from 4.38 ± 0.63 to 2.77 ± 0.92 J (P <0.05) and for each μmol of lactate consumed fell from 2.004 ± 0.949 to 0.433 ± 0.151 J (0.05>P>0.025). This implies that tonic release of noradrenaline from nerve terminals controls the conversion of substrate and oxygen into mechanical energy.
Climate Change, Health, and Vulnerability in Canadian Northern Aboriginal Communities
Authors: Christopher Furgal, Jacinthe Seguin
Journal: Environmental Health Perspectives (2006)

Canada has recognized that Aboriginal and northern communities in the country face unique challenges and that there is a need to expand the assessment of vulnerabilities to climate change to include these communities. Evidence suggests that Canada's North is already experiencing significant changes in its climate--changes that are having negative impacts on the lives of Aboriginal people living in these regions. Research on climate change and health impacts in northern Canada thus far has brought together Aboriginal community members, government representatives, and researchers and is charting new territory.In this article we review experiences from two projects that have taken a community-based dialogue approach to identifying and assessing the effects of and vulnerability to climate change and the impact on the health in two Inuit regions of the Canadian Arctic.The results of the two case projects that we present argue for a multi-stakeholder, participatory framework for assessment that supports the necessary analysis, understanding, and enhancement of capabilities of local areas to respond and adapt to the health impacts at the local level.
Personal Exposure of Faculty and Medical Students to Family Violence
Authors: Elizabeth A. deLahunta
Journal: JAMA (1996)

To determine the prevalence of exposure to personal family violence among medical students and full-time faculty at a major medical center.Self-reported, double-mailing, anonymous survey conducted in September 1995.Of 406 medical students and 917 full-time faculty surveyed, 787 (59%) responded, including 217 students and 559 faculty members who identified academic status and 292 women and 482 men who identified gender.Self-reported personal experience with partner abuse, child abuse, physical abuse, and sexual abuse.Response rates were higher for women (69%) than men (54%) (P<.001) and were higher for faculty (61%) than students (53%) (P=.01). Of the 787 respondents, 99 (12.6%; 95% confidence interval [CI], 10.9%-15.6%) reported physical abuse, sexual abuse, or both by a partner during their adult life, 118 (15.0%; 95% CI, 12.8%-17.8%) reported physical abuse, sexual abuse, or both as a child, and 188 (23.9%; 95% CI, 22.0-28.1%) reported physical abuse, sexual abuse, or both in their lifetime. Based on positive responses, a minimum of 17% of the female medical students and faculty and 3% of the male medical students and faculty have experienced physical abuse or sexual abuse by a partner in their adult life.Family violence is a pervasive problem that crosses into the personal experience of medical professionals. The conservative estimate of partner abuse for female medical students and faculty appears comparable with the general population national estimates. The acknowledgment by physicians that family violence is a potential risk for everyone, physicians and patients alike, is a step toward enhancing the identification of abuse and initiating interventions on behalf of survivors of family violence.
Complex Distribution of Avian Color Vision Systems Revealed by Sequencing the SWS1 Opsin from Total DNA
Authors: Anders Ödeen, Olle Håstad
Journal: Molecular Biology and Evolution (2003)

To gain insights into the evolution and ecology of visually acute animals such as birds, biologists often need to understand how these animals perceive colors. This poses a problem, since the human eye is of a different design than that of most other animals. The standard solution is to examine the spectral sensitivity properties of animal retinas through microspectophotometry—a procedure that is rather complicated and therefore only has allowed examinations of a limited number of species to date. We have developed a faster and simpler molecular method, which can be used to estimate the color sensitivities of a bird by sequencing a part of the gene coding for the ultraviolet or violet absorbing opsin in the avian retina. With our method, there is no need to sacrifice the animal, and it thereby facilitates large screenings, including rare and endangered species beyond the reach of microspectrophotometry. Color vision in birds may be categorized into two classes: one with a short-wavelength sensitivity biased toward violet (VS) and the other biased toward ultraviolet (UVS). Using our method on 45 species from 35 families, we demonstrate that the distribution of avian color vision is more complex than has previously been shown. Our data support VS as the ancestral state in birds and show that UVS has evolved independently at least four times. We found species with the UVS type of color vision in the orders Psittaciformes and Passeriformes, in agreement with previous findings. However, species within the families Corvidae and Tyrannidae did not share this character with other passeriforms. We also found UVS type species within the Laridae and Struthionidae families. Raptors (Accipitridae and Falconidae) are of the violet type, giving them a vision system different from their passeriform prey. Intriguing effects on the evolution of color signals can be expected from interactions between predators and prey. Such interactions may explain the presence of UVS in Laridae and Passeriformes.
Genetic “lnc”-age of noncoding RNAs to human disease
Authors: Andrew Troy, Norman E. Sharpless
Journal: Journal of Clinical Investigation (2012)

The list of functions of long noncoding RNAs (lncRNAs) in human tissues is rapidly growing. To further underscore their critical role in human health, two reports in this issue of JCI associate altered expression of novel lncRNAs with the heritable syndromes HELLP and brachydactyly type E.
1422 END OF TREATMENT RESPONSE AFTER PROTEASE INHIBITOR (PI)- BASED THERAPY FOR HEPATITIS C RECURRENCE AFTER LIVER TRANSPLANTATION: A MULTICENTRIC EUROPEAN EXPERIENCE
Authors: A. Coilly, J. Dumortier, D. Botta-Fridlund, M. Latournerie, V. Leroy, G.-P. Pageaux, E. Giostra, C. Moreno, B. Roche, P. Lebray, S. Radenne, A.-C. Saouli, Y. Calmus, L. Alric, M. Debette-Gratien, V. De Ledinghen, F. Durand, C. Duvoux, D. Samuel, J.-C. Duclos-Vallée
Journal: Journal of Hepatology (2013)
The 2013 Lung Allocation Controversy
Authors: Scott D. Halpern
Journal: Annals of Internal Medicine (2013)

LettersDecember 3, 2013The 2013 Lung Allocation ControversyScott D. Halpern, MD, PhDScott D. Halpern, MD, PhDFrom University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-11-201312030-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Mr. Harvey raises issue with my characterization of the judicial review process in the cases of Murnaghan and Acosta because of a specific rule commonly referred to as the OPTN “Final Rule” (or 42 CFR 121) (1) dictating that medical urgency be a basis for organ allocation. The relevant sections of this rule state that “transplant candidates shall be grouped by status categories ordered from most to least medically urgent” and that “criteria for status designations shall contain explicit thresholds for differentiating among patients and shall be expressed, to the extent possible, through objective and measurable medical criteria.” ...References1. Department of Health and Human Services. The Final Rule. 2 April 1998. Accessed at www.gaonet.gov/special.pubs/organ/appendd.pdf on 1 July 2013. Google Scholar2. Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, et al. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6:1212-27. [PMID: 16613597] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Pennsylvania, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1487. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTurning Wrong Into Right: The 2013 Lung Allocation Controversy Scott D. Halpern The 2013 Lung Allocation Controversy Stephen G. Harvey Metrics December 3, 2013Volume 159, Issue 11Page: 794-795KeywordsChildrenLung transplantationLungsTransplantation ePublished: 3 December 2013 Issue Published: December 3, 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Regional Intravenous Anesthesia
Authors: John P. Adams
Journal: JAMA (1965)

<h3>To the Editor:—</h3> I believe that your blanket statement in the last sentence, based on the limited bibliography referred to in the article, is invalid. We are continuing to use this form of anesthesia in selected cases and have found nothing, to date, which would indicate any of our earlier published assumptions are wrong (<i>J Bone Joint Surg [Amer]</i><b>46</b>:811-816, 1964). We are continuing to do research in this area to learn more about its physiological action as well as its clinical indications. Some of the problems presented although not all of them are discussed by Bell et al (<i>JAMA</i><b>186</b>: 544, 1963). The sun was shining on the sea, Shining with all his might! He did his very best to make The billows smooth and bright— And this was odd, because it was The middle of the night.