tbuckley/cabot-search huggingface dataset:
Responding to Legal Requests for Physician-Assisted Suicide
Authors: James A. Tulsky, Ralph Ciampa, Elliott J. Rosen
Journal: Annals of Internal Medicine (2000)

In 1998, 15 terminally ill Oregon residents ended their lives with overdoses of medications supplied legally by their physicians. Many more people consider this possibility. This paper examines the ways in which the physician's response to requests for assisted suicide may change in an era of legalization, articulates some of the resulting conceptual challenges, and provides practical advice to physicians facing such requests. In areas where it is legal, assisted dying becomes one of the many options that can be freely considered for terminally ill patients with extreme suffering. Some patients even view assisted death as a right that can be expected on demand. We consider the ethical implications of disclosing assisted dying to patients as an option of last resort and suggest that physicians working in environments where assisted dying is legal are obliged to do so. However, we conclude that physicians should not encourage patients to hasten death even when practicing in jurisdictions that allow assisted dying. Furthermore, without abandoning the model, we suggest that strict informed consent does not fully address patients' needs at this time. Physicians must also focus on patients' broader biopsychosocial concerns and help them identify solutions through empathic listening and emotional support. We provide a framework and vocabulary for physicians to use when responding to requests for assisted suicide. Physicians should clarify the request, explore and address the patient's concerns, achieve a shared understanding of the goals of treatment, search for less harmful alternatives, express to the patient what they are willing to do, discuss the relevant legal issues, and share their decision making with colleagues.
212. Delivery of Galactocerebrosidase Activity to the Peripheral Nervous System of Mice with Globoid Cell Leukodystrophy (Krabbe Disease) by Intramuscular Injection
Authors: Mohammad A. Rafi, Han Zhi Rao, Paola Luzi, Mark T. Curtis, David A. Wenger
Journal: Molecular Therapy (2006)

Globoid cell leukodystrophy (GLD) or Krabbe disease is a neurodegenerative disorder that affects both the central and peripheral nervous system (CNS and PNS). The deficiency of the lysosomal enzyme galactocerebrosidase (GALC) leads to the accumulation of psychosine, resulting in the death of oligodendrocytes and Schwann cells. Bone marrow transplantation (BMT) of the mouse models of GLD can prolong their lives up to one year compared to 40-50 days if untreated. Intracranial and intraventricular injections of adeno-associated virus (AAV) types 1 and 5 containing mouse GALC cDNA into affected mice results in widespread GALC expression in the brain, pathological improvement and modest extension of life span compared to untreated mice. Mice treated with either BMT or viral therapy still demonstrate mild twitching and premature death at least partially due to lack of correction of PNS pathology. In an attempt to improve the biochemical and pathological condition of the peripheral nerves in affected mice, AAV2/1-mGALC viral particles were injected into the gastrocnemius muscles of affected mice. Biochemical analysis of the different tissues from the treated mice demonstrated very high GALC activity in the injected muscle and significantly increased GALC activity in the contralateral muscles. This was confirmed by histochemical staining of GALC activity where a large number of myofibers and the sciatic nerve in the injected side were strongly positive. The sciatic nerve on the contralateral side was also positive for GALC activity. While the sciatic nerve of untreated affected mice was thickened due to edema, initial studies following intramuscular injection showed that the sciatic nerve was much thinner and similar to control mice. Sections from the spinal cord also demonstrated some GALC-positive motoneurons indicating retrograde transfer of AAV2/1-GALC from the intramusclar injections. Transgene expression in the injected muscle was still very strong three months after injection. Combining intramuscular injections with other therapeutic approaches that improve the CNS pathology may have additional advantages in the successful treatment of the animal models of GLD.
Will e-learning improve clinical judgment?
Authors: Daniel J Klass
Journal: BMJ (2004)

Not until doctors build collegial learning into practice 

At the turn of the 20th century, when “modern” medical education was just getting up and running, a clarion call of the reformers was to reduce the overload on students' minds. “Medical educators of the latter nineteenth century were the first physicians in history to feel the real shock of the information explosion.”1 But wait a minute, that's just what the problem seems to be today, and so it was in the 1980s as described in the famous report on “the general professional education of the physician,” and in the1960s when an earlier study of medical education in the United States was published.2 3 This complaint about overload by medical students and their teachers seems to be a constant one and may reflect a tendency to complain rather than the sudden emergence of an unbearable weight of knowledge that needs to be absorbed. The real problem is the matter of selection, and the tenacity of the complaint serves to remind teachers of our poor performance in the first and probably hardest role of the teacher—helping students to learn how to separate the wheat from the chaff.

The problem is even more difficult when the “student” is a practising doctor. At first glance, selection of material for practitioners should be …
TCTAP A-162 Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients who Received Non-chronic Total Occlusion Lesion Intervention
Authors: Byoung Geol Choi, Seung-Woon Rha, Se Yeon Choi, Yoonjee Park, Akkala Raghavender Goud, Hu Li, Sunki Lee, Ji Bak Kim, Sung Il Im, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
Journal: Journal of the American College of Cardiology (2014)
Abstract 467: Effects of <i>Monascus</i>-fermented rice extract on malignant cell associated neovascularization and intravasation by chicken embryo chorioallantoic membrane model
Authors: Bing-Ying Ho, Yao-Ming Wu, Ya-Wen Hsu, Li-Chuan Hsu, Yao-Haur Kuo, King-Jen Chang, Tzu-Ming Pan
Journal: Cancer Research (2010)

Abstract The traditional Chinese medicine, “Hong-Qu”, also call “red mold rice” in the United States and Europe, has been identified and used for the treatment of blood stasis, a disorder related to hyperlipidemia and atherosclerosis. In addition to its value in improving metabolism syndrome, extracts from Monascus fermented rice inhibited proliferation of various cancer cells in vitro and in vivo have demonstrated previously. The objective of the current study was to examine correlation of red mold rice ethanol extract (RMRE) on the process of angiogenesis, invasion and metastasis during tumor progression. In the current study, we examined the inhibitory effects of SW480 and SW620 human colorectal carcinoma cells by RMRE using in vitro MTT assay. RMRE significantly inhibited the proliferation of SW480 and SW620 cells in dose- and time-dependent manner. However, human umbilical vein endothelial cells (HUVECs) showed a minor reduction effect of cell viability up to 20 µg/mL of RMRE for 48 hours using crystal violet staining assay. The capillary-like network morphology was observed following 20 ng/mL VEGF or SW620 culture-conditional medium (CM) addition. Nevertheless, capillary-like tube formation have failed to show when RMRE participation. Moreover, SW620 cells could growth in Matrigel grafts and spontaneously intravasation from the upper to the lower of chick embryo chorioallantoic membrane (CAM) model, which detected human Alu genomic DNA by PCR amplification from the lower CAMs at RMRE-untreated group. The percentage of neovascularization was increased 75.3±11.6% by SW620 cells onplant with Matrigel grafts on the CAM model. However, addition of RMRE significantly reduced CAM neovascularization in dose-dependent effect. Finally, we have finding that RMRE effectively decreased activity of matrix metalloproteinase (MMP)-7 determined by RT-PCR, Western blotting, and casein zymography assays. In summary Monascus fermented products exerted a potent effect on tumor growth and activation, suggesting that it may useful serves as a supplementary agent in adjuvant cancer therapy. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 467.
Unfunded research? I am shocked, shocked!
Authors: M. Phillips
Journal: JAMA (1993)

To the Editor.  —Remember Claude Raines in Casablanca ? In his role as a policeman he exclaimed, I am shocked, shocked! to discover that there was gambling in a nightclub, while he stuffed a large wad of winnings in his pocket. Stein et al 1 appear to be shocked, shocked, to discover that some physicians actually perform medical research without financial support, while they acknowledge no funding for their own publication.  They hint at dark scandals, of procedures that presumably were performed for research purposes and not as part of routine patient care... part of the cost may have been passed on to study participants or their third-party payers, perhaps unknowingly. Presumably? May have been? Perhaps? If this is an expose of Researchgate, the authors should have presented some hard data to support their speculations.  The truth of the matter is that unfunded medical research has always been the rule rather than
All vascular surgeons are performing within expected limits, show individual outcome data
Authors: Z. Kmietowicz
Journal: BMJ (2013)

<h3>Abstract</h3> Polyploidy is an important generator of evolutionary novelty across diverse groups in the Tree of Life, including many crops. However, the impact of whole-genome duplication (WGD) depends on the mode of formation: doubling within a single lineage (autopolyploidy) versus doubling after hybridization between two different lineages (allopolyploidy). Researchers have historically treated these two scenarios as completely separate cases based on patterns of chromosome pairing, but these cases represent ideals on a continuum of chromosomal interactions among duplicated genomes. Understanding the history of polyploid species thus demands quantitative inferences of demographic history and rates of exchange between subgenomes. To meet this need, we developed diffusion models for genetic variation in polyploids with subgenomes that cannot be bioinformatically separated and with potentially variable inheritance patterns, implementing them in the dadi software. We validated our models using forward SLiM simulations and found that our inference approach is able to accurately infer evolutionary parameters (timing, bottleneck size) involved with the formation of auto- and allotetraploids, as well as exchange rates in segmental allotetraploids. We then applied our models to empirical data for allotetraploid shepherd’s purse (<i>Capsella bursa-pastoris</i>), finding evidence for allelic exchange between the subgenomes. Taken together, our model provides a foundation for demographic modeling in polyploids using diffusion equations, which will help increase our understanding of the impact of demography and selection in polyploid lineages.
O74 URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) IS A STRONG PREDICTOR OF SHORT-TERM OUTCOME IN PATIENTS WITH ACUTE DECOMPENSATION OF CIRRHOSIS. RELATIONSHIP WITH ACUTE-ON-CHRONIC LIVER FAILURE (ACLF)
Authors: X. Ariza, P. Angeli, R. Barreto, R. Jalan, M. Morales Ruiz, C. Elia, E. Sola, E. Garcia, F. Nevens, J. Trebicka, F. Saliba, J. Fernandez, W. Jimenez, M. Pavesi, A. Gerbes, R. Moreau, M. Bernardi, V. Arroyo, P. Ginès
Journal: Journal of Hepatology (2014)
Transvaginal Cholecystectomy
Authors: Stephanie G. Wood, Daniel Solomon, Lucian Panait, Robert L. Bell, Andrew J. Duffy, Kurt E. Roberts
Journal: JAMA Surgery (2013)

Transvaginal cholecystectomy (TVC) is the leading natural orifice transluminal endoscopic surgery to date and has the potential to offer improved cosmesis, less pain, and shorter recovery times for female patients.To investigate quality of life and female sexual function in our patients undergoing TVC.A prospective cohort study from August 14, 2009, to June 12, 2012, of TVCs performed at our institution to date.Tertiary academic referral center.The first 47 consecutive female patients (aged 18-65 years) who received a TVC by a single surgeon.A hybrid TVC was performed by a 5-mm umbilical trocar and a 12-mm transvaginal trocar with standard laparoscopic instruments.Quality-of-life index (36-Item Short Form Health Survey) and female sexual function (Female Sexual Function Index) scores.A total of 47 TVCs were performed, with a mean age of 39 years, mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 31, and mean operative time of 65 minutes. No difference was noted in overall female sexual function from preoperatively to 1 and 3 months postoperatively. When comparing quality of life preoperatively vs 1 and 3 months postoperatively, there were significant improvements in physical function (P = .02), energy and fatigue (P = .001), emotional well-being (P = .01), pain (P < .001), and general health (P = .03). No significant changes were noted in physical limitations (P = .18), emotional problems (P = .72), and social function (P = .12).In our experience to date, female sexual function is unchanged and quality of life either is unchanged or improves at 1 and 3 months following TVC. Undergoing TVC does not appear to negatively affect female sexual function or quality of life in the short term.
General Quality of Life in Youth With Type 1 Diabetes
Authors: Lori M.B. Laffel, Alexa Connell, Laura Vangsness, Ann Goebel-Fabbri, Abigail Mansfield, Barbara J. Anderson
Journal: Diabetes Care (2003)

OBJECTIVE—To evaluate self-report and parent proxy report of child/teen general quality of life in youth with type 1 diabetes, compare their responses with those of a general pediatric population, and identify relationships between diabetes management, diabetes-related family behavior, and diabetes-specific family conflict with quality of life in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS—Study participants included 100 children, 8–17 years of age (12.1 ± 2.3), with type 1 diabetes for 0.5–6 years (2.7 ± 1.6). Each child and a parent completed the Pediatric Quality of Life Inventory (PedsQL), completed the Diabetes Family Conflict Scale, and provided data on parent involvement in diabetes management. An independent measure of adherence to treatment assessed by the patient’s clinician and a measure of glycemic control (HbA1c) were also collected. RESULTS—PedsQL responses from youth with type 1 diabetes were stable over 1 year and similar to norms from a healthy standardization sample for all three scales of the PedsQL: total, physical, and psychosocial quality of life. After controlling for age, duration of diabetes, sex, HbA1c, and family involvement, child report of diabetes-specific family conflict (P &amp;lt; 0.01) was the only significant predictor of child report of quality of life (model R2 = 0.21, P &amp;lt; 0.02). CONCLUSIONS—Youth with type 1 diabetes report remarkably similar quality of life to a nondiabetic youth population. Greater endorsement of diabetes-specific family conflict predicted diminished quality of life for the child. As treatment programs focus on intensifying glycemic control in youth with type 1 diabetes, interventions should include efforts to reduce diabetes-specific family conflict in order to preserve the child’s overall quality of life.
Is SARS Just ARDS?
Authors: Gordon D. Rubenfeld
Journal: JAMA (2003)

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South Africa will not pay for antiretroviral therapy
Authors: P. Sidley
Journal: BMJ (2001)

South Africa's health minister has dashed any remaining hopes that her government will provide antiretroviral treatment for the estimated five million people who are infected with HIV.

Dr Manto Tshabalala-Msimang has told parliament again, and repeated in several group meetings, that her government cannot afford the drugs regardless of how low the price goes. She repeated the government's view that the infrastructure necessary to deliver the treatment is not uniformly available, and she expressed the government's continuing fears of “toxicity” and the development of resistance. The government is also afraid that patients taking the treatment will not fully comply with …
Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families
Authors: John J. You, James Downar, Robert A. Fowler, François Lamontagne, Irene W. Y. Ma, Dev Jayaraman, Jennifer Kryworuchko, Patricia H. Strachan, Roy Ilan, Aman P. Nijjar, John Neary, John Shik, Kevin Brazil, Amen Patel, Kim Wiebe, Martin Albert, Anita Palepu, Elysée Nouvet, Amanda Roze des Ordons, Nishan Sharma, Amane Abdul-Razzak, Xuran Jiang, Andrew Day, Daren K. Heyland
Journal: JAMA Internal Medicine (2015)

Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process.Multicenter survey of medical teaching units of nurses, internal medicine residents, and staff physicians from participating units at 13 university-based hospitals from 5 Canadian provinces.Importance of 21 barriers to goals of care discussions rated on a 7-point scale (1 = extremely unimportant; 7 = extremely important).Between September 2012 and March 2013, questionnaires were returned by 1256 of 1617 eligible clinicians, for an overall response rate of 77.7% (512 of 646 nurses [79.3%], 484 of 634 residents [76.3%], 260 of 337 staff physicians [77.2%]). The following family member-related and patient-related factors were consistently identified by all 3 clinician groups as the most important barriers to goals of care discussions: family members' or patients' difficulty accepting a poor prognosis (mean [SD] score, 5.8 [1.2] and 5.6 [1.3], respectively), family members' or patients' difficulty understanding the limitations and complications of life-sustaining treatments (5.8 [1.2] for both groups), disagreement among family members about goals of care (5.8 [1.2]), and patients' incapacity to make goals of care decisions (5.6 [1.2]). Clinicians perceived their own skills and system factors as less important barriers. Participants viewed it as acceptable for all clinician groups to engage in goals of care discussions-including a role for advance practice nurses, nurses, and social workers to initiate goals of care discussions and be a decision coach.Hospital-based clinicians perceive family member-related and patient-related factors as the most important barriers to goals of care discussions. All health care professionals were viewed as playing important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication and decision making about goals of care.
MPs vote to ban tobacco displays and cigarette vending machines
Authors: C. Dyer
Journal: BMJ (2009)

A ban on the display of tobacco products in shops and the sale of cigarettes from vending machines in the United Kingdom moved a step closer this week.

The House of Commons approved the move for England, Wales, and Northern Ireland. Scotland has its own separate bill to achieve the same reform.

Powers to introduce the bans are contained in the Health Bill, which had its final stages in the House of Commons this week. The bill will now go forward to the House of Lords, where the new clause allowing a ban on cigarette …
A Systematic Review and Canadian Consensus Recommendations on the Use of Biomarkers in the Treatment of Non-small Cell Lung Cancer
Authors: Peter M. Ellis, Normand Blais, Dennis Soulieres, Diana N. Ionescu, Meenakshi Kashyap, Geoff Liu, Barb Melosky, Tony Reiman, Phillippe Romeo, Frances A. Shepherd, Ming-Sound Tsao, Natasha B. Leighl
Journal: Journal of Thoracic Oncology (2011)
Achievements and Perspectives in Prostate Cancer Phase 3 Trials from Genitourinary Research Groups in Europe: Introducing the Prostate Cancer Consortium in Europe
Authors: Karim Fizazi, Per-Anders Abrahamsson, Goran Ahlgren, Joaquim Bellmunt, Daniel Castellano, Stephane Culine, Ronald de Wit, Silke Gillessen, Juergen E. Gschwend, Freddie Hamdy, Nicholas James, Raymond McDermott, Kurt Miller, Thomas Wiegel, Manfred Wirth, Bertrand Tombal
Journal: European Urology (2014)
Flattery will get you everywhere
Authors: Des Spence
Journal: BMJ (2012)

We are all vain, we all like the sound of our own voice, and we all believe our own foolish views. Flattery is petrol to the flames of our egos. Our vanity betrays us, making us uncritical, unquestioning, and overconfident. And flattery is big pharma’s instrument of manipulation. Money, praise, and attention are used to produce pharma’s so called independent medical experts. Likewise, honours, titles, gongs, and gifts are mere superficial seductions, leading to that scourge of academia: deference. Regrettably, the more doctors crave these trapping …