tbuckley/cabot-search huggingface dataset:
Cost effectiveness of the NHS breast screening programme: life table model
Authors: P. D. P. Pharoah, B. Sewell, D. Fitzsimmons, H. S. Bennett, N. Pashayan
Journal: BMJ (2013)

<b>Objective</b> To assess the overall cost effectiveness of the NHS breast screening programme, based on findings of the Independent UK Panel on Breast Cancer Screening and taking into account the uncertainty of associated estimates of benefits, harms, and costs. <b>Design</b> A life table model comparing data from two cohorts. <b>Setting</b> United Kingdom’s health service. <b>Participants and interventions</b> 364 500 women aged 50 years—the population of 50 year old women in England and Wales who would be eligible for screening—were followed up for 35 years without screening, compared with a similar cohort who had regular mammographic screening between ages 50 and 70 years and were then followed for another 15 years. <b>Main outcome measures</b> Between the cohorts, we compared the number of breast cancer diagnoses, number of deaths from breast cancer, number of deaths from other causes, person years of survival adjusted for health quality, and person years of survival with breast cancer. We also calculated the costs of treating primary and end stage breast cancer, and the costs of screening. Probabilistic sensitivity analysis explored the effect of uncertainty in key input parameters on the model outputs. <b>Results</b> Under the base case scenario (using input parameters derived from the Independent Panel Review), there were 1521 fewer deaths from breast cancer and 2722 overdiagnosed breast cancers. Discounting future costs and benefits at a rate of 3.5% resulted in an additional 6907 person years of survival in the screened cohort, at a cost of 40 946 additional years of survival after a diagnosis of breast cancer. Screening was associated with 2040 additional quality adjusted life years (QALYs) at an additional cost of £42.5m (€49.8m; $64.7m) in total or £20 800 per QALY gained. The gain in person time survival over 35 years was 9.2 days per person and 2.7 quality adjusted days per person screened. Probabilistic sensitivity analysis showed that this incremental cost effectiveness ratio varied widely across a range of plausible scenarios. Screening was cost effective at a threshold of £20 000 per QALY gained in 2260 (45%) scenarios, but in 588 (12%) scenarios, screening was associated with a reduction in QALYs. <b>Conclusion </b>The NHS breast screening programme is only moderately likely to be cost effective at a standard threshold. However, there is substantial uncertainty in the model parameter estimates, and further primary research will be needed for cost effectiveness studies to provide definitive data to inform policy.
Is systemic autoimmune disease a risk factor for terbinafine-induced erythema multiforme?
Authors: V. Goeteyn, J.M. Naeyaert, J. Lambert, L. Monbaliu, F. Vermander
Journal: British Journal of Dermatology (2000)

S ir, Terbinafine is a frequently used systemic antimycotic drug, with tinea unguium as its most frequent indication. Most side‐effects are related to the gastrointestinal system (nausea, diarrhoea, taste disorders and hepatitis). Various terbinafine‐induced cutaneous manifestations have been described, including erythema, urticaria, acute generalized exanthematous pustulosis, erythema annulare centrifugum, fixed drug eruption, psoriasis and erythema multiforme (EM). We report three patients who developed EM during treatment with terbinafine (Lamisil®, Novartis) 250 mg daily for onychomycosis. In each case there was a typical clinical presentation of EM with histological confirmation of the diagnosis. Remarkably, each of the three patients had a pre‐existing systemic autoimmune disease. The first patient was a 60‐year‐old man with systemic lupus erythematosus (LE) (anti‐DNA+, SSA+), who had acute cutaneous LE lesions and was being treated with prednisolone 15 mg daily and hydroxychloroquine 400 mg daily. Four weeks after starting terbinafine for onychomycosis, he developed a severe cutaneous eruption that was diagnosed as EM. Terbinafine was stopped and the dose of prednisolone was raised to 40 mg daily. The eruption faded rapidly.
Technetium-99m RBC Venography Revealing Bilateral Iliac Vein Obstruction
Authors: NEAL M. LISANN, CHRISTOPHER J. PALESTRO, RICHARD S. BENUA
Journal: Clinical Nuclear Medicine (1986)

Tc-99m RBC venography demonstrated bilateral iliac vein obstruction with subsequent collateral flow through the internal iliac veins into the internal and perimuscular rectal plexuses.
Website of the week: Eye sites
Authors: A. Ellis
Journal: BMJ (2002)

Fundoscopy is top of my list of clinical mysteries that I, as a medical student, shamefully confess to “faking” occasionally, along with hearing murmurs and feeling masses. My kind, dedicated mentor has taken time out to help me find the optic disc and, rather than face the embarrassment of not having a clue, I say “mm, yes” when he asks if I can see it.

This week's clinical review (p 1195) looks at recent research and the management of myopia. The internet allows bright, interactive teaching on many topics, and none is perhaps so “visual” in medicine as ophthalmology and optics. There are some excellent sites on the web that are easy to follow and have lots of pictures that you definitely can see.

Fascinatingly, www.macula.org/amd/index.html shows what patients with conditions such as macular degeneration see. There are retinal photos and beautiful pictures of cellular components of the eye. It's a good site to learn about macula degeneration as well as the eye and retina in general, but the site doesn't include diabetic retinopathy.

The Glaucoma Research Foundation (www.glaucoma.org) is primarily aimed at patients, but it is comprehensive and subdivides and explains the different types of glaucoma.

The Digital Journal of Ophthalmology, a web based peer reviewed journal, provides excellent information at www.djo.harvard.edu. Obviously it is up there at “ophthalmologist” standard, so may be over the heads of some.

Supposedly for students, www.medfak.uu.se/fysiologi/lectures/EyeOptics.html is a Swedish site with an incredibly complex tutorial on optics. The best bit is at the end, with the interactive eye where you can adjust about 15 parameters and see what happens to the eye and to vision. Patients can also benefit from interactive explanations; I liked www.allaboutvision.com/conditions/myopia.htm and www.stlukeseye.com (eye conditions section) because they were both colourfully illustrated and balanced simplicity with information.
Increased dosage of mammalian Sir2 in pancreatic β cells enhances glucose-stimulated insulin secretion in mice
Authors: Kathryn A. Moynihan, Andrew A. Grimm, Marie M. Plueger, Ernesto Bernal-Mizrachi, Eric Ford, Corentin Cras-Méneur, M. Alan Permutt, Shin-ichiro Imai
Journal: Cell Metabolism (2005)
Evidence against a role for endotoxin in the hyperdynamic circulation of rats with prehepatic portal hypertension
Authors: Chi-Jen Chu, Fa-Yauh Lee, Sun-Sang Wang, Full-Young Chang, Han-Chieh Lin, Rei-Hwa Lu, Shwu-Ling Wu, Che-Chang Chan, Chun-Ching Tai, I-Nien Lai, Shou-Dong Lee
Journal: Journal of Hepatology (1999)
630 SERUM BLYS/BAFF LEVELS IN ACUTE HEPATITIS C PREDICT CLINICAL OUTCOME
Authors: G. Tarantino, V. Di Marco, P.L. Almasio, F. Barbaria, A. Ciaccio, F. D'Antoni, R. Di Stefano, A. Iacò, A. Licata, S. Petta, A. Craxì
Journal: Journal of Hepatology (2008)
The History of the Full-Time Clinical Faculty System-Reply
Authors: W. Bruce Fye
Journal: JAMA (1991)

In Reply.  —As the title indicated, my article dealt with theoriginof the clinical full-time faculty system, rather than its introduction (in many different forms) into America's medical schools. The focus on The Johns Hopkins Medical School  not meant to imply that important adaptations of the plan did not emerge elsewhere. I am sure that Landau, as a journal editor, appreciates the pressures authors face in attempting to present in a brief essay a theme that could be the subject of a book-length monograph.  In 1952, historian Ilza Veith and Franklin McLean,1professor and former director of university clinics at the University of Chicago, explained that a clinical full-time plan  inaugurated at Chicago in 1917 that was based upon the original plan of Johns Hopkins,... [but] with the approach of the opening of the Clinics in 1927, it became apparent that the Johns Hopkins plan, resting
Expression of the 6C3 antigen on murine hematopoietic neoplasms. Association with expression of abl, ras, fes, src, erbB, and Cas NS-1 oncogenes but not with myc.
Authors: H C Morse, G F Tidmarsh, K L Holmes, T F Frederickson, J N Hartley, J H Pierce, W Y Langdon, M O Dailey, I L Weissman
Journal: The Journal of Experimental Medicine (1987)

The monoclonal antibody 6C3 was used to test a wide variety of murine hematopoietic neoplasms for cell surface expression of a 160 kD glycoprotein (gp160(6C3)) previously shown to be expressed by neoplastic pre-B and some B lymphocytes transformed by Abelson murine leukemia virus (A-MuLV). This antigen was expressed on many pre-B and B cell lymphomas, but not on A-MuLV-transformed fibroblasts, T cell lymphomas, or myelomonocytic leukemias, gp160(6C3) was expressed by most early B-lineage spontaneous tumors, and early B tumors induced by replication-defective MuLV-containing oncogenes the products of which are associated with the cytoplasmic aspect of the plasma membrane, i.e., fes, abl, H-ras, bas, src, erbB, and Cas NS-1. By comparison, none of the early B lineage lymphomas induced by the "nuclear" oncogene avian v-myc MuLV, or arising in mice transgenic for a murine c-myc gene, or later B cell lineage stages bearing translocations of the c-myc locus expressed this antigen.
Renin Release
Authors: FRANKLIN D. NASH, HOWARD H. ROSTORFER, MICHAEL D. BAILIE, RONALD L. WATHEN, EDWARD G. SCHNEIDER
Journal: Circulation Research (1968)

The relations between renin release and renal hemodynamics, renal sodium load, and sodium and water balance were studied during hyponatremia, hypernatremia, mercurial natriuresis, norepinephrine infusion, and reduction in renal perfusion pressure. Significant reciprocal relations were found between renin secretory activity and the renal arterial plasma sodium concentration, the filtered sodium load, and urinary sodium excretion; however, no significant, or even consistent, relations were found between renin release and any hemodynamic parameter or sodium or water balance. During bilateral stimulation of renin release, unilateral restoration of the filtered sodium load inhibited ipsilateral renin release, without demonstrable changes in hemodynamics, while renin release from the contralateral kidney continued unabated. However, this inhibition was not seen unless the filtered sodium load and urinary sodium excretion rose to control levels even though renal venous plasma sodium concentrations exceeded 170 mEq/liter. Thus, renin release can be dissociated from hemodynamics and sodium and water balance, but not from some function of the filtered sodium load. We propose that renin secretory activity is controlled by an intrarenal, but extravascular, sodium-sensitive mechanism and that the stimulus is a function of the sodium flux across the macula densa into the interstitium surrounding the contiguous juxtaglomerular cells.
Human Immunodeficiency Virus and the Outcome of Treatment for New and Recurrent Pulmonary Tuberculosis in African Patients
Authors: JILL MURRAY, PAMELA SONNENBERG, STUART C. SHEARER, PETER GODFREY-FAUSSETT
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

The purpose of this study was to evaluate the impact of human immunodeficiency virus (HIV) infection on treatment for tuberculosis (TB). The study population comprised 28,522 black Southern African gold miners. Patients with sputum culture-positive new or recurrent pulmonary TB diagnosed in 1995 were prospectively enrolled in the cohort. Directly observed therapy (DOT) was practiced and outcomes were assessed at 6 mo after treatment was begun. There were 376 cases of TB (incidence 1,318 per 100,000), of which 190 (50%) were HIV positive and 82 (22%) had recurrent TB. There was no association between HIV status and history of previous TB or drug resistance. Neither the treatment interruption rate (2%) nor the rate at which patients transferred out of the treatment program (1.6%) were associated with HIV status. Excluding deaths, cure rates were similar for HIV-positive and HIV-negative patients (89% versus 88%), but significantly lower in those with recurrent than in those with new TB (77% versus 92%). Mortality was 0.5% in HIV-negative patients versus 13.7% in HIV-positive patients, and in the latter group was associated with CD4(+) lymphocyte depletion. Autopsy examination showed that in HIV-positive patients, early mortality was due to TB whereas late deaths were most commonly due to cryptococcal pneumonia. The study showed that a well-run TB control program can result in acceptable cure rates even in a population with a very high incidence of TB and HIV infection. Particular vigilance is needed for concurrent infections, which may contribute significantly to mortality during treatment of TB in HIV-positive patients.
REFERENCE TO BERRY
Authors: Chauncey D. Leake
Journal: JAMA (1960)

To the Editor:—  You are running some beautiful sleepers, but some of them are a little confusing. You have a fine editorial on Theodoric on Surgery inThe Journal, May 14, page 176. This is a delightful editorial. Then you bring in on the last paragraph a reference to Berry. You have not said a thing about him in the whole editorial, and he all of a sudden pops up with sort of a bang. Is it your idea that we had better go back and see who Berry is? This is all right, but it may upset some of your readers.  Certainly you can be proud of the fine way in which the whole program ofThe Journalis rolling along. I am glad that the correspondence column is attracting interest. Keep happy and enjoy yourself.
Crohn's disease or Crohn's diseases?
Authors: I D R Arnott
Journal: Gut (2003)

Disease behaviour in Crohn’s disease is dynamic and not stable over time

In their landmark paper of 1932, Crohn, Ginzburg, and Oppenheimer1 described “a disease of the terminal ileum, affecting mainly young adults and characterised by a subacute or chronic necrotising and cicratrising inflammation. The ulceration of the mucosa is accompanied by a disproportionate connective tissue reaction . . . which frequently leads to stenosis of the lumen of the intestine, associated with the formation of multiple fistulas”. In the intervening years however, the term Crohn’s disease has been introduced, and now covers a heterogeneous range of clinical presentations, including the classical phenotype of regional ileitis. A number of attempts have been made to subclassify patients with Crohn’s disease into subgroups with similar stable phenotypic characteristics. These attempts have been catalysed first by attempts to individualise therapy, and most recently by progress in understanding the molecular genetics of Crohn’s disease, and the need to relate genotype to disease phenotype. Indeed, it is increasingly clear that assigning disease phenotype may be difficult, but critical in determining the successful outcome of genetic association and linkage studies. The experience of the Toronto group is particularly instructive in this respect, demonstrating that the erroneous assignation of phenotype may lead to a 40% loss of power in linkage studies.2

The Vienna classification of the working party of the World Congress of Gastroenterology proposed a subclassification of Crohn’s disease according to three overriding phenotypic characteristics, implicated in detailed studies of populations in Europe and North America—age, location of disease, and disease behaviour.3 It is the subclassification of disease behaviour into inflammatory (non-stricturing non-penetrating), stricturing …
Buccaling under the pressure: influence of secondary care establishments on the prescribing of glyceryl trinitrate buccal tablets in primary care
Authors: A J Pryce, H F Heatlie, S R Chapman
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To determine which characteristics were the best predictors of high rates of prescribing of glyceryl trinitrate buccal tablets. <b>Design</b>: Practice and patient characteristics from 197 practices were examined, and a multiple regression analysis was performed to examine which variables were important in predicting this prescribing. <b>Setting</b>: Former family health services authority (197 practices). <b>Main outcome measure</b>: Volume of prescribing of glyceryl trinitrate buccal tablets. <b>Results</b>: Four variables contributed significantly to a multiple regression model: the catchment area of the secondary care establishment; the number of partners in a practice; the level of practice deprivation; and whether the practice served an urban or a rural area. The model suggests that the most important variable was the catchment area of the secondary care establishment in which the practice was located. <b>Conclusion</b>: Although only the prescribing of short acting glyceryl trinitrate buccal tablets was studied, an impact of this size on primary care prescribing may have extensive implications for all drug expenditure in primary care. <h3>Key messages</h3> Using glyceryl trinitrate buccal tablets as an example, this study measured the “hospital effect” in different catchment areas in a family health services authority Catchment area was the single most important variable in predicting prescribing levels A statistical model comprising catchment area, urbanity, number of partners in a practice, and a deprivation score explained over 47% of the variation in the prescribing of glyceryl trinitrate buccal tablets
Development of delayed hypersensitivity to dinitrochlorobenzene in patients with Crohn's disease.
Authors: J V Jones, J Housley, P M Ashurst, C F Hawkins
Journal: Gut (1969)

<h3>Introduction</h3> Low back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions. <h3>Methods</h3> This is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors. <h3>Results</h3> It was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both). <h3>Conclusion</h3> There was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.
Nebulized and intravenous colistin in experimental pneumonia caused by Pseudomonas aeruginosa
Authors: Qin Lu, Cassio Girardi, Mao Zhang, Belaïd Bouhemad, Kamel Louchahi, Olivier Petitjean, Frédéric Wallet, Marie-Helene Becquemin, Gilles Le Naour, Charles-Hugo Marquette, Jean-Jacques Rouby
Journal: Intensive Care Medicine (2010)
Viability of chondroscopy as a means of cartilage assessment.
Authors: X Ayral, M Dougados
Journal: Annals of the Rheumatic Diseases (1995)

Chondroscopy of the knee.Grade 0 = normal articular cartilage (medialfemorotibial compartment); grade I = swelling, softening or both (blister of the lateralfemoral condyle); grade II = superficialfibrillations ('velvet like' appearance of the patella); grade III = deep fibrillations ('crab-meat like ' appearance of the patella); grade IV= deep ulceration (medialfemoral condyle); grade V= exposure of subchondral bone (medialfemoral condyle).tologist and an orthopaedic surgeon for, respectively, medical and chondroscopic management of the patient.Training sessions are necessary to become familiar with local anaesthesia, even for experienced arthroscopists, in order to obtain a painless procedure and useful videorecording.
Blood lead levels in pregnant women of high and low socioeconomic status in Mexico City.
Authors: P Farias, V H Borja-Aburto, C Rios, I Hertz-Picciotto, M Rojas-Lopez, R Chavez-Ayala
Journal: Environmental Health Perspectives (1996)

This study examined the determinants of blood lead (BPb) in 513 pregnant women in Mexico City: 311 from public hospital prenatal clinics, representing primarily women of low socioeconomic status (SES), and 202 from private hospitals, primarily women of high SES. Overall, BPb levels ranged from 1.38 to 29 micrograms/dl, with geometric means of 6.7 and 11.12 micrograms/dl for women from private and public hospitals, respectively. The crude geometric means difference obtained by t-test was 4.42 (p < 0.001). BPb was measured from January 1994 to August 1995 and showed higher levels during fall and winter and lower levels during spring and summer. The main BPb determinants were the use of lead-glazed ceramics in women from public hospitals and season of the year in women from private hospitals. Consumption of tortillas (corn bread rich in calcium) decreased BPb levels in the lower SES group, but the relationship was not statistically significant (p > 0.05). Consumption of milk products significantly (p < 0.05) reduced BPb levels in the higher SES group. In 112 women whose diets were deficient in calcium, taking calcium supplements lowered their blood lead levels about 7 micrograms/dl. A predictive model fitted to these data, using the strongest predictors plus gestational age, showed a difference of 14 micrograms/dl between the best and worst scenarios in women from public hospitals. Avoiding use of lead-glazed ceramics, consuming diets rich in calcium, and, if needed, taking calcium supplements, would be expected to result in substantial lowering of BPb, especially in pregnant women of low socioeconomic status.