tbuckley/cabot-search huggingface dataset:
Factors Associated with Do-Not-Resuscitate Orders: Patients' Preferences, Prognoses, and Physicians' Judgments
Authors: Rosemarie B. Hakim
Journal: Annals of Internal Medicine (1996)

Background: Medical treatment decisions should be based on the preferences of informed patients or their proxies and on the expected outcomes of treatment. Because seriously ill patients are at risk for cardiac arrest, examination of do-not-resuscitate (DNR) practices affecting them provides useful insights into the associations between various factors and medical decision making. Objective: To examine the association between patients' preferences for resuscitation (along with other patient and physician characteristics) and the frequency and timing of DNR orders. Design: Prospective cohort study. Setting: 5 teaching hospitals. Patients: 6802 seriously ill hospitalized patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) between 1989 and 1994. Measurements: Patients and their surrogates were interviewed about patients' cardiopulmonary resuscitation preferences, medical records were reviewed to determine disease severity, and a multivariable regression model was constructed to predict the time to the first DNR order. Results: The patients' preference for cardiopulmonary resuscitation was the most important predictor of the timing of DNR orders, but only 52% of patients who preferred not to be resuscitated actually had DNR orders written. The probability of surviving for 2 months was the next most important predictor of the timing of DNR orders. Although DNR orders were not linearly related to the probability of surviving for 2 months, they were written earlier and more frequently for patients with a 50% or lower probability of surviving for 2 months. Orders were written more quickly for patients older than 75 years of age, regardless of prognosis. After adjustment for these and other influential patient characteristics, the use and timing of DNR orders varied significantly among physician specialties and among hospitals. Conclusions: Patients' preferences and short-term prognoses are associated with the timing of DNR orders. However, the substantial variation seen among hospital sites and among physician specialties suggests that there is room for improvement. In this study, DNR orders were written earlier for patients older than 75 years of age, regardless of prognosis. This finding suggests that physicians may be using age in a way that is inconsistent with the reported association between age and survival. The process for making decisions about DNR orders needs to be improved if such orders are to routinely and accurately reflect patients' preferences and probable outcomes. *For a list of the SUPPORT investigators, see the Appendix.
Diagnosis of Deep Vein Thrombosis with 99mTc-streptokinase: A Clinical Comparison with Phlebography
Authors: V. Kempi, W. Van Der Linden, C. Von Scheele
Journal: BMJ (1974)

Nineteen patients with signs of deep vein thrombosis in the legs were investigated with a new technique using (9 9m)Tc-streptokinase. This compound is probably superior to iodine-labelled fibrinogen in detecting established thrombi. The ratio between the activity in the leg with suspected thrombosis and the other leg was calculated. The results were compared with those obtained with phlebography. A pathologically high activity ratio was found in 11 out of 13 patients in whom phlebography showed a thrombus, while the ratio was normal in the remaining six patients who showed no thrombus on phlebography. No negative correlation was found between the activity ratio and the titrated initial dose of streptokinase. The activity ratio as well as diagnosing the presence of a thrombus may also provide a guide for therapy.
Abstract 3308: Endothelin 3/endothelin receptor B signaling pathway blockade depletes radio-chemoresistant glioblastoma stem cells
Authors: Fei Ye, Kazunari Yamada, Yue Liu, Jinny Choe, Anna Dembo, Jonathan L. Tso, Timothy F. Cloughesy, Dörthe Schaue, William McBride, Linda M. Liau, Cho-Lea Tso
Journal: Cancer Research (2011)

Abstract Background: Patients with glioblastoma multiforme (GBM) despite being treated with gross total resection and post-operative temozolomide (TMZ) plus radiation therapy (RT), will almost always develop tumor recurrence. Hypothesis and objective: We hypothesize GBM stem cells (GSC) are responsible for post-treatment tumor recurrence and blockade of endothelin-3 (EDN3)/endothelin receptor B(EDNRB) signaling, a signaling pathway for neural crest development that hyperactivated in GSC, will enhance TMZ/RT treatment efficacy for GSC. Materials and Methods: Patient tumor-derived GSC were seeded at clonal density and subjected to radiochemotherapy at dose and schedule comparable to patient treatment. Treatment efficacy and synergy of EDNRB antagonist (BQ788) plus TMZ/RT were evaluated by the clonogenic efficiency, cell proliferation, and cell apoptosis of GSCs. Results: GSC are resistant to TMZ treatment alone (10μM), while treatment with BQ788 (75μM) alone can restrict cell migration, decrease clonogenic efficiency, and induce cell apoptosis. The RT displays the highest treatment efficacy on GSC when compared to TMZ or BQ788 alone and addition of TMZ to RT is slightly synergistic. Although only few small tumor spheres were detected when treated with RT or RT/TMZ, the survival clones regain proliferative activity and possess enhanced clonogenicity and anti-apoptotic ability when compared to untreated GSC. Treatment efficacy was greatly improved when GSC treated with BQ788 combined with RT/TMZ and no cells with self- renewal capacity were detected or recovered from the treatment. Conclusion: Subsets of GSC clones are resistance to standard RT/TMZ treatment and possess enhanced tumor sphere-forming capacity. Incorporate EDN3/EDNRB antagonist to a standard radiochemotherapy provide a significant treatment synergy in depletion of functional GSC and thus highlights a novel therapeutic strategy for the prevention of GSC-mediated tumor occurrence and recurrence. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3308. doi:10.1158/1538-7445.AM2011-3308
Inosine infusion in dogs with acute ischaemic left ventricular failure: favourable effects on myocardial performance and metabolism
Authors: O. A SMISETH
Journal: Cardiovascular Research (1983)

Haemodynamic and metabolic effects of inosine were examined during acute left ventricular (LV) failure in closed-chest anaesthetised dogs. Embolisation of the left main coronary artery with 50 microm plastic microspheres induced severe depression of LV function, and the dogs remained in stable failure throughout the experimental period as shown in the untreated control dogs (n = 4). Intravenous infusion of inosine 3.8 to 7.5 mg . min-1 . kg-1 caused an increase in maximum LVdP/dt from 290 +/- 32 (mean +/- SEM, n = 8) to 376 +/- 39 kPa . s-1 and a decrease in LV end-diastolic pressure from 3.6 +/- 0.2 to 2.5 +/- 0.1 kPa. Total peripheral resistance decreased from 10.2 +/- 1.0 to 7.4 +/- 0.7 kPa . litre-1 min, and cardiac output increased from 1.64 +/- 0.17 to 2.27 +/- 0.23 litre . min-1 during inosine infusion. Myocardial blood flow increased from 65 +/- 10 to 94 +/- 16 cm3 . min-1 . 100 g-1 with no change in myocardial oxygen consumption. Inosine markedly decreased arterial concentrations and myocardial uptake of FFA. Arterial concentrations of glucose were moderately decreased while myocardial uptake of glucose showed a non-significant increase. Inosine markedly increased myocardial uptake of lactate. These metabolic changes were associated with increased plasma concentrations of insulin. In conclusion, inosine improved myocardial performance and increased myocardial uptake of carbohydrates relative to FFA during acute ischaemic LV failure in dogs.
Treatment of Refractory Reticulum Cell Sarcoma With Low Doses of Vincristine Sulfate
Authors: William J. Yount, Harvey E. Finkel
Journal: JAMA (1966)

Small doses of vincristine sulfate produced dramatic improvement in patients with far-advanced reticulum cell sarcoma which previously had been resistant to other forms of therapy. The maximal initial dose was 25μg/kg body weight weekly; maintenance levels have been as low as 5μg/kg biweekly. This dosage schedule permitted prolonged courses of therapy and minimized toxicity, thus providing sustained antitumor effect. In one patient with disseminated reticulum cell sarcoma refractory to alkylating agents and irradiation, a 17-month course of therapy was tolerated without toxicity. Death, due to unrelated causes, occurred 29 months after initiation of vincristine; no tumor was found at autopsy. It is suggested that vincristine, given in small doses for weeks or months, is a systemic agent worthy of consideration for the primary therapy of generalized reticulum cell sarcoma.
HIV entry inhibitors and their potential in HIV therapy
Authors: Keduo Qian, Susan L. Morris‐Natschke, Kuo‐Hsiung Lee
Journal: Medicinal Research Reviews (2008)

Abstract This review discusses recent progress in the development of anti‐HIV agents targeting the viral entry process. The three main classes (attachment inhibitors, co‐receptor binding inhibitors, and fusion inhibitors) are further broken down by specific mechanism of action and structure. Many of these inhibitors are in advanced clinical trials, including the HIV maturation inhibitor bevirimat, from the authors' laboratories. In addition, the CCR5 inhibitor maraviroc has recently been FDA‐approved. Possible roles for these agents in anti‐HIV therapy, including treatment of virus resistant to current drugs, are also discussed. © 2008 Wiley Periodicals, Inc. Med Res Rev, 29, No. 2, 369–393, 2009
Whole-Genome Sequencing of Asian Lung Cancers: Second-Hand Smoke Unlikely to Be Responsible for Higher Incidence of Lung Cancer among Asian Never-Smokers
Authors: Vidhya G. Krishnan, Philip J. Ebert, Jason C. Ting, Elaine Lim, Swee-Seong Wong, Audrey S.M. Teo, Yong G. Yue, Hui-Hoon Chua, Xiwen Ma, Gary S.L. Loh, Yuhao Lin, Joanna H.J. Tan, Kun Yu, Shenli Zhang, Christoph Reinhard, Daniel S.W. Tan, Brock A. Peters, Stephen E. Lincoln, Dennis G. Ballinger, Jason M. Laramie, Geoffrey B. Nilsen, Thomas D. Barber, Patrick Tan, Axel M. Hillmer, Pauline C. Ng
Journal: Cancer Research (2014)

Asian nonsmoking populations have a higher incidence of lung cancer compared with their European counterparts. There is a long-standing hypothesis that the increase of lung cancer in Asian never-smokers is due to environmental factors such as second-hand smoke. We analyzed whole-genome sequencing of 30 Asian lung cancers. Unsupervised clustering of mutational signatures separated the patients into two categories of either all the never-smokers or all the smokers or ex-smokers. In addition, nearly one third of the ex-smokers and smokers classified with the never-smoker-like cluster. The somatic variant profiles of Asian lung cancers were similar to that of European origin with G.C>T.A being predominant in smokers. We found EGFR and TP53 to be the most frequently mutated genes with mutations in 50% and 27% of individuals, respectively. Among the 16 never-smokers, 69% had an EGFR mutation compared with 29% of 14 smokers/ex-smokers. Asian never-smokers had lung cancer signatures distinct from the smoker signature and their mutation profiles were similar to European never-smokers. The profiles of Asian and European smokers are also similar. Taken together, these results suggested that the same mutational mechanisms underlie the etiology for both ethnic groups. Thus, the high incidence of lung cancer in Asian never-smokers seems unlikely to be due to second-hand smoke or other carcinogens that cause oxidative DNA damage, implying that routine EGFR testing is warranted in the Asian population regardless of smoking status.
The Patient Safety Handbook
Authors: Onyebuchi A. Arah
Journal: Annals of Internal Medicine (2004)

Medical Writings: Book Notes4 May 2004The Patient Safety HandbookOnyebuchi A. Arah, MD, DScOnyebuchi A. Arah, MD, DScFrom Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-9-200405040-00034 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Youngberg BJ, Hatlie MJ, eds. Sudbury, MA: Jones and Bartlett; 2004. $99.95. ISBN 0763731471. Order phone 978-443-5000.Field of medicine: Clinical medicine, health care delivery and management, medical law, and ethics.Format: Hardcover book.Audience: Clinicians, other health care professionals, health care administrators, health care organizations, advocates, health care safety students, and policymakers.Purpose: To help health care organizations and providers become highly reliable, safe, and responsive entities for patient care.Content: The book's 49 chapters cover a wide range of patient safety issues, such as scope, context, risk management, investigation, root-cause analysis, response to adverse events, organizational strategies, role ... Author, Article, and Disclosure InformationAffiliations: From Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 4 May 2004Volume 140, Issue 9Page: 768KeywordsForecastingHealth careHealth care providersHealth care qualityHealth services researchMedical lawResearch quality assessmentRisk managementSafetySoftware tools ePublished: 4 May 2004 Issue Published: 4 May 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Raised serum activity of phospholipase A2 immunochemically related to group II enzyme in inflammatory bowel disease: its correlation with disease activity of Crohn's disease and ulcerative colitis.
Authors: T Minami, H Tojo, Y Shinomura, S Tarui, M Okamoto
Journal: Gut (1992)

Calcium dependent phospholipase A2 activity in the mixed micelles of 1-palmitoyl-2-oleoyl-phosphatidylglycerol and cholate was measured in sera of 39 patients with Crohn9s disease, 40 patients with ulcerative colitis, and 40 healthy controls. The phospholipase A2 activity was significantly raised in those sera of the patients with active Crohn9s disease and those with moderate and severe ulcerative colitis. The major phospholipase A2 activity derived from the sera was separated into two peaks by reverse phase high performance liquid chromatography. The phospholipase A2 active fractions were immunochemically characterised using specific antibody directed against human group II phospholipase A2 purified from rheumatoid synovial fluid. The results suggest that raised serum phospholipase A2 activity in patients with Crohn9s disease and ulcerative colitis was mainly attributed to the two forms of phospholipase A2 immunochemically related to group II enzyme. In patients with Crohn9s disease, serum phospholipase A2 activity decreased in parallel with clinical improvement, and correlated with serum C-reactive protein and erythrocyte sedimentation rate. The results suggest that serum phospholipase A2 activity may serve as an additional indicator of disease activity. Serum phospholipase A2 activity in patients with ulcerative colitis tends to increase in relation with endoscopic severity, and may be a more sensitive laboratory index than serum C-reactive protein and erythrocyte sedimentation rate to evaluate disease activity.
25 Years in Continuing Medical Education
Authors: Arthur M. Osteen
Journal: JAMA (1993)

THE AMERICAN Medical Association Physician's Recognition Award (AMA PRA) was established by the AMA House of Delegates in December 1968. As the time approaches to celebrate the PRA's 25th anniversary, we take stock of the award, how it has changed, and how it has not. It is also an opportunity to look briefly at other ways in which the AMA has been involved in continuing medical education (CME). These other involvements have perhaps been more important to CME than the PRA award itself.  The resolution establishing the award set out the following rationale and goals:   To provide recognition for the many thousands of physicians who regularly participate in CME.  To encourage all physicians to keep up-to-date and to improve their knowledge and judgment by CME.  To provide reassurance to the public that America's physicians are maintaining their competence by regular participation in CME.  To emphasize the AMA's position as a
When are randomised trials unnecessary? Picking signal from noise
Authors: Paul Glasziou, Iain Chalmers, Michael Rawlins, Peter McCulloch
Journal: BMJ (2007)

Although randomised trials are widely accepted as the ideal way of obtaining unbiased estimates of treatment effects, some treatments have dramatic effects that are highly unlikely to reflect inadequately controlled biases. We compiled a list of historical examples of such effects and identified the features of convincing inferences about treatment effects from sources other than randomised trials. A unifying principle is the size of the treatment effect (signal) relative to the expected prognosis (noise) of the condition. A treatment effect is inferred most confidently when the signal to noise ratio is large and its timing is rapid compared with the natural course of the condition. For the examples we considered in detail the rate ratio often exceeds 10 and thus is highly unlikely to reflect bias or factors other than a treatment effect. This model may help to reduce controversy about evidence for treatments whose effects are so dramatic that randomised trials are unnecessary.
Skeletal muscle molecular responses to resistance training and dietary supplementation in COPD
Authors: Despina Constantin, Manoj K Menon, Linzy Houchen-Wolloff, Michael D Morgan, Sally J Singh, Paul Greenhaff, Michael C Steiner
Journal: Thorax (2013)

<h3>Background</h3> Skeletal muscle dysfunction is a systemic feature of chronic obstructive pulmonary disease (COPD), contributing to morbidity and mortality. Physical training improves muscle mass and function in COPD, but the molecular regulation therein is poorly understood. <h3>Methods</h3> Candidate genes and proteins regulating muscle protein breakdown (ubiquitin proteasome pathway), muscle protein synthesis (phosphatidylinositol 3 kinase/Akt/mammalian target of rapamycin pathway), myogenesis (MyoD, myogenin and myostatin) and transcription (FOXO1, FOXO3 and RUNX1) were determined in quadriceps muscle samples taken at four time points over 8 weeks of knee extensor resistance training (RT) in patients with COPD and healthy controls (HCs). Patients with COPD were randomly allocated to receive protein/carbohydrate or placebo supplements during RT. <h3>Results</h3> 59 patients with COPD (mean (SD) age 68.0 (9.3) years, forced expiratory volume in 1 s (FEV<sub>1</sub>) 46.9 (17.8) % predicted) and 21 HCs (66.1 (4.8) years, 105.0 (21.6) % predicted) were enrolled. RT increased lean mass (∼5%) and strength (∼20%) in all groups. Absolute work done during RT was lower throughout in patients with COPD compared with HCs. RT resulted in increases (from basal) in catabolic, anabolic, myogenic and transcription factor protein expression at 24 h, 4 weeks and 8 weeks of exercise in HCs. This response was blunted in patients with COPD, except for myogenic signalling, which was similar. Nutritional supplementation did not augment functional or molecular responses to RT. <h3>Conclusions</h3> The potential for muscle rehabilitation in response to RT is preserved in COPD. Except for markers of myogenesis, molecular responses to RT are not tightly coupled to lean mass gains but reflect the lower work done during RT, suggesting some caution when identifying molecular targets for intervention. Increasing post-exercise protein and carbohydrate intake is not a prerequisite for a normal training response in COPD.
Influenza vaccine coverage rates and perceptions on vaccination in South Korea
Authors: Sae Yoon Kee, Jin Soo Lee, Hee Jin Cheong, Byung Chul Chun, Joon Young Song, Won Suk Choi, Yu Mi Jo, Yoo Bin Seo, Woo Joo Kim
Journal: Journal of Infection (2007)

This survey was performed to assess the level of influenza vaccine coverage, to understand the driving forces and barriers to vaccination and determine vaccination interventions for the following year in Korean population.A national sample of 1720 community dwelling adults of age 18 and older were surveyed by individual visits during April 2005. Demographics, state of influenza vaccination, reasons for vaccination or non-vaccination and perceptions on vaccinations were asked by questionnaire.Influenza vaccination coverage in general population and high risk group was 34.3% and 61.3%, respectively. Predictors for vaccination were > or =65 of age, performance of regular exercise, vaccination in the previous season, experience of influenza-like illness, belief that vaccine can prevent common cold and opinion that vaccine must be taken annually. The most common reason for vaccination for both whole population and high risk groups was to prevent both influenza and common cold, while the most common reason for non-vaccination was the thought that he/she was healthy enough not to be in need for vaccination. Having more information on influenza and vaccination as well as doctor's recommendation for vaccination appeared to be the most important modus operandi to encourage influenza vaccination among non-vaccinees.Doctor's recommendation was the most important factor in encouraging people to be vaccinated against influenza. Doctors should be geared up with precise information and actively encourage high risk population in order to increase vaccination coverage.
Cytotoxic Drugs for Systemic Lupus
Authors: R. D. Hill, G. W. Scott
Journal: BMJ (1964)

1587)-as an examiner-is concerned to defend the F.R.C.S. as a worthy hallmark for an otologist.I am concerned with what I as a teacher believe to be the far more important matter of the education available for the aspirants to that hallmark.I have suggested:(1) that the Royal Colleges should stan- dardize their requirements.(2) That they should provide far more systematic
On Closed-Chest Cardiac Resuscitation-Reply
Authors: Myron L. Weisfeldt
Journal: JAMA (1982)

In Reply.—  We appreciate Dr Warshauer's generally favorable remarks and share with him the desire to study the efficacy of various CPR methods. However, we do not share his pessimistic view of conventional CPR. It is beneficial and life-saving to many in cardiac arrest. Most impressive are the studies demonstrating efficacy of lay-administered CPR in man by Thompson et al. 1 Furthermore, a good amount of information concerning the complications of conventional CPR has been obtained by Nagel et al. 2   Whether new approaches that we and others have proposed for performing CPR have clinical use remains at question. With regard to abdominal binding, our article concluded: This study provides justification for further detailed clinical studies to evaluate the long-term beneficial and side-effects of this technique.  The major point of the study was to demonstrate that blood pressure (BP) rose consistently with abdominal binding during CPR in man. Some investigators