tbuckley/cabot-search huggingface dataset:
“It’s about the conversation”: A multidisciplinary intervention to support advance-care planning.
Authors: Finly Zachariah, Linda Klein, Nancy Clifton-Hawkins, Becky Andrews, Andrea McQueary, Gaby Dillard, Dawn Gross
Journal: Journal of Clinical Oncology (2014)

111 Background: A recent California Healthcare Foundation study found that 60% of Californians highly valued “making sure their families are not burdened by tough decisions about their care." However, less than 50% have communicated their end-of-life wishes to their surrogate decision maker. 82% say it is important to have end-of-life wishes in writing, but only 23% say they have done so. At City of Hope National Cancer Medical Center (COH) the advance directive (AD) completion rate is less than 15%. The Department of Supportive Care Medicine Sheri &amp; Les Biller Patient and Family Resource Center (BRC) is leading development of innovative strategies to foster Advance Care Planning (ACP) communication and documentation. Methods: A multi-specialty physician and interdisciplinary team assembled and designed a social media advertised 4-hour interactive event that was held in the BRC. Over 40 staff and volunteers facilitated individualized ACP conversations with the “Go Wish” cards, private consultations with social workers, showed novel COH ACP videos, provided multi-lingual ACP literature and advance directive documents available for completion with Notary support on-site. Results: Over 300 people attended, including patients, caregivers and COH staff. Forty-seven advance directives were completed (24 by patient/caregivers, 23 by COH staff). Twenty-nine Go Wish games were facilitated (2 in Spanish). Of the 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported that the event increased their comfort and likelihood of having conversations about ACP with others. Importantly, 38 of the 52 surveyed, did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). Conclusions: Advanced care planning is an all too often avoided conversation that results in increased distress of patients, families and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates and family can ensure their values are honored and met become possible.
Maintenance capecitabine and bevacizumab versus bevacizumab alone after initial first-line bevacizumab and docetaxel for patients with HER2-negative metastatic breast cancer (IMELDA): a randomised, open-label, phase 3 trial
Authors: Joseph Gligorov, Dinesh Doval, José Bines, Emilio Alba, Paulo Cortes, Jean-Yves Pierga, Vineet Gupta, Rômulo Costa, Stefanie Srock, Sabine de Ducla, Ulrich Freudensprung, Giorgio Mustacchi
Journal: The Lancet Oncology (2014)
Having some lifesaving skills must be better than having none
Authors: A. Wills
Journal: BMJ (1997)

Data are not now collected by ethnic group in South AfricaEditor-Claire Hilton notes that since April 1995 British hospitals have had to collect data on each patient's ethnic group. 1 In the United States this is standard practice.In the Morbidity and Mortality Weekly Report data on numerous variables relating to the health and ill health of black and white people are regularly given 2 -as also, on occasion, are data on Hispanics, American Indians, Inuits, and Pacific Islanders.In South Africa precisely the converse has occurred.Ethnic subdivisions have stopped appearing in reports from the Central Statistics Services, and thus mortalities are no longer given for the constituent populations (black, Asian, coloured (Eur-African-Malay), and white), only for the combined population.Additionally, in our big cities annual reports from public health departments provide only combined data on morbidity and mortality.Disadvantages are many.Recently, colleagues and I reviewed changes in the total death rate and the death rate from coronary heart disease in South African populations. 3 We found that, from 1978 to 1989, mortality from coronary heart disease fell by 56% in the white population and by 36% in each of the Indian and coloured populations.Because changes in mortality from this foremost "killer" are continuing we intended to update our information.But this is now precluded.Currently, desegregation does not apply to our national cancer registry.But if it did how, for example, could benefits from Papanicolaou smear tests be assessed?The incidences of cervical cancer in the black and coloured populations are among the highest in the world.The constituent populations of South Africa have a wider divergence in the occurrence of a variety of diseases than occurs in any other country: coronary heart disease, appendicitis, colon cancer, and hip fractures.Interethnic differences in the occurrence of disease, reactivity, and metabolism are well known elsewhere. 4 In South Africa the change to using combined data will make it harder to identify and quantify the target populations who are in most need of help, as well as severely stultifying research on the occurrence of disease and on combating it.Hilton is right, of course, that the level of treatment is affected by ethnic group.Recently, in the United States the effect of race and income on mortality and the use of services among beneficiaries of Medicare was investigated; both race and income were shown as having substantial prejudicial effects, that of race being much more pronounced than that of income. 5This is a matter of universal shame.
Anticoagulant Therapy in Superior Mediastinal Obstruction
Authors: H. F. Hope-Stone, J. J. Key
Journal: BMJ (1961)

autogeneous blood clot in the lung alveoli, and to a foreign irritant in the adjuvant site.Her blood lympho- cytes were not reduced in quantity.She had recently developed high-titre antistreptolysin-O serum antibodies, and her serum globulins were not below the normal level.She had rejected two skin homografts.All this argues that her general capacity for immune responses was not impaired.The normal placenta is not rejected as a homograft.On the whole, we conclude from the evidence here that this choriocarcinoma was also effectively non-antigenic.The simplest explanation is that its trophoblast was exhibiting the same mechanisms or properties of physio- logical non-antigenicity (whatever they may be) that exist in the normal placenta.SUMMARY A patient with placental choriocarcinoma was treated by immufnization with her husband's leucocytes, and subsequent homograft immunity against his skin was demonstrated.In spite of this, the tumour did not regress and the patient died.Examination of serum and of necropsy material indicated that the patient had normal immune responses, but no serological or histological evidence of an antitrophoblastic effect was found.Many specialists made their records, opinions, techniques.and materials freely available to us in connexion with this case.We are grateful to Dr. Thatcher and Professor Cox (clinical management), Dr. Hardy (biopsy reports), Dr.
Thrombocytopenia in Gaucher's Disease
Authors: DAVID GREEN
Journal: Annals of Internal Medicine (1971)

A 63-year-old man with Gaucher's disease presented with bleeding secondary to thrombocytopenia. Bone marrow examination showed many typical Gaucher cells and adequate numbers of megakaryocytes. A 51Cr platelet survival study indicated a markedly shortened half-disappearance time of 0.8 days and a major uptake of the 51Cr label by the spleen. After splenectomy the platelet count rose to normal levels, and a repeat survival study showed a normal half-disappearance time of 5.1 days. Electron-microscopic analysis of the spleen disclosed intact platelets within the Gaucher cells. These studies indicate that the spleen plays an important role in the pathogenesis of the thrombocytopenia by virtue of its large content of Gaucher cells.
Investigation of efficacy of Co-administration of heat killed listeria with modifiedpeanut protein for the treatment of peanut-induced hypersensitivity in a murine model
Authors: Jin-Hua Li, Kamal D Srivastava, James Huleatt, Kim Bottomly, Wesley Burks, Gary A Bannon, Xiu-Min Li, Hugh A Sampson
Journal: Journal of Allergy and Clinical Immunology (2002)
Lecturing by remote
Authors: Trisha Greenhalgh
Journal: BMJ (2007)

I recently suggested that conference organisers should stop using so-called “international experts” (defined as anyone who arrives on a business class flight with a PowerPoint presentation and is incapable of locating their hotel unaided) as the pull to get bums on seats locally.

Soon after that, an important-sounding gathering in California wanted me to speak, and was up for the creative use of new technology. The chair sent me a detailed brief, and I prepared my presentation, along …
Antibodies to gliadin detected by immunofluorescence and a micro-ELISA method: markers of active childhood and adult coeliac disease.
Authors: U Volta, M Lenzi, R Lazzari, F Cassani, A Collina, F B Bianchi, E Pisi
Journal: Gut (1985)

Antibodies to gliadin have been detected by immunofluorescence (IFL-AGA) and a micro-ELISA method (ELISA-AGA) in 45 out of 47 (96%) sera from patients with active childhood and adult coeliac disease. The two methods were more sensitive than R1-reticulin antibodies (R1-ARA) which were found only in 28 of the same patients (60%). R1-ARA were always negative in the 26 sera from patients with childhood coeliac disease and adult coeliac disease after gluten free diet, while IFL- and ELISA-AGA were respectively found in three (12%) and in four (15%) out of these patients. Moreover, while R1-ARA and IFL-AGA were strictly confined to coeliac disease. ELISA-AGA were occasionally found in patients with control diseases. These 'false positive' antibodies were all of IgG class and had low titres. In our experience IFL- and ELISA-AGA of IgA class were strictly confined to active childhood coeliac disease and adult coeliac disease. The detection of AGA is useful in monitoring the diet and in the follow up of coeliac disease. IFL- and ELISA-AGA, then, are to be preferred to R1-ARA for the screening of coeliac patients.
An initiation codon mutation (AUG----GUG) of the human alpha 1-globin gene. Structural characterization and evidence for a mild thalassemic phenotype.
Authors: P Moi, F E Cash, S A Liebhaber, A Cao, M Pirastu
Journal: Journal of Clinical Investigation (1987)

alpha-globin is encoded by two adjacent genes, alpha 1 and alpha 2. Recent evidence suggests that these genes are not equally expressed and that the alpha 2-globin gene encodes the majority of alpha-globin. This finding would predict that a thalassemic mutation of the alpha 2-globin gene would result in a more severe loss of alpha-chain synthesis than a similar mutation in the alpha 1-globin gene. In a previous study we described a nondeletion alpha-thalassemia defect in the alpha 2-globin gene resulting from an AUG----ACG initiation codon mutation. In the present study we describe a different initiation codon mutation, AUG----GUG, present in the alpha 1-globin gene. The alpha 1- and alpha 2-globin gene initiation codon mutations result in similarly lowered levels of encoded mRNA. Despite the similarity of these two mutations, the alpha 2 mutant results in a more severe loss of alpha-globin synthesis and a more severe clinical alpha-thalassemia phenotype than the corresponding alpha 1-globin gene mutation. This difference reflects the dominant role of alpha 2-globin gene in overall alpha-globin synthesis.
Habitual Physical Activity in Adult IDDM Patients: A study with portable motion meters
Authors: Ernst Chantelau, Rainer Wirth
Journal: Diabetes Care (1992)

The objective of this study was to assess the habitual physical activity of insulin-dependent diabetes mellitus (IDDM) patients on intensive insulin therapy. This case-control study consisted of 34 IDDM patients (14 on multiple injection therapy, 20 on continuous subcutaneous insulin infusion [CSII], and control subjects matched for sex, age, weight, height, body mass index, smoking behavior, and occupational status). Seven IDDM patients were studied before and after changing from multiple injection to CSII therapy. All patients were well controlled according to HbA1c. Portable motion meters were used to assess habitual physical activity during 7 consecutive days with appreciable reproducibility (coefficient of variation 1.24%) and agreement to standardized activity protocols (r = 0.96, P &amp;lt; 0.001). Habitual physical activity was similar in IDDM patients on injection treatment and in controls, respectively. CSII-treated patients exhibited on the average 17% less habitual physical activity than control subjects (P &amp;lt; 0.05). Changing from multiple injection therapy to CSII lowered habitual physical activity insignificantly in seven patients. There was no indication of decreasing physical exercise (e.g., sports) by CSII in this patient group. No correlations were found between habitual physical activity and HbA1c or body mass index, respectively. Habitual physical activity is similar in IDDM patients on multiple injection therapy and control subjects, but may decrease by CSII therapy.
Government's plans on public health are too vague, experts say
Authors: M. Limb
Journal: BMJ (2011)

Experts from the NHS and local government have voiced fresh concerns over legislation that will pave the way for a major shake up of public health in England.

They warned a House of Commons inquiry that the Health and Social Care Bill is vague about who will be responsible under the new system for funding and coordinating key services.

Frank Atherton, president of the Association of Directors of Public Health, called for greater clarity from government saying that uncertainty carried risks.

He said there was potential for fragmentation affecting services such as health protection and emergency planning, cancer, health in schools, and domestic violence.

He told the inquiry. “It’s hard to see how the pandemic response would be planned under the [new] system. One problem is that GP consortia won’t have the same responsibilities as primary …
Efficacy and safety outcomes of oral anticoagulants and antiplatelet drugs in the secondary prevention of venous thromboembolism: systematic review and network meta-analysis
Authors: L. A. Castellucci, C. Cameron, G. Le Gal, M. A. Rodger, D. Coyle, P. S. Wells, T. Clifford, E. Gandara, G. Wells, M. Carrier
Journal: BMJ (2013)

<b>Objective</b> To summarise and compare the efficacy and safety of various oral anticoagulants (dabigatran, rivaroxaban, apixaban, and vitamin K antagonists) and antiplatelet agents (acetylsalicylic acid) for the secondary prevention of venous thromboembolism. <b>Design</b> Systematic review and network meta-analysis. <b>Data sources</b> Literature search using Medline (1950 to present), Embase (1980 to present), and the Cochrane Register of Controlled Trials using the OVID interface. Publications from potentially relevant journals were also searched by hand. <b>Review methods</b> Randomised controlled trials of patients receiving anticoagulants, antiplatelet drugs, or placebo or observation for secondary prevention of venous thromboembolism. Selected outcomes were rates of recurrent venous thromboembolism and major bleeding. Two reviewers independently extracted data onto standardised forms. <b>Results</b> 12 articles met our inclusion criteria, with 11 999 patients evaluated for efficacy and 12 167 for safety. All treatments reduced the risk of recurrent venous thromboembolism. Compared with placebo or observation, vitamin K antagonists at a standard adjusted dose (target international normalised ratio 2.0-3.0) showed the highest risk difference (odds ratio 0.07; 95% credible interval 0.03 to 0.15) and acetylsalicylic acid showed the lowest risk difference (0.65; 0.39 to 1.03). Risk of major bleeding was higher with a standard adjusted dose of vitamin K antagonists (5.24; 1.78 to 18.25) than with placebo or observation. Fatal recurrent venous thromboembolism and fatal bleeding were rare. Detailed subgroup and individual patient level data were not available. <b>Conclusions</b> All oral anticoagulants and antiplatelet agents investigated in this analysis were associated with a reduced recurrence of venous thromboembolism compared with placebo or observation, although acetylsalicylic acid was associated with the lowest risk reduction. Vitamin K antagonists given at a standard adjusted dose was associated with the greatest risk reduction in recurrent venous thromboembolism, but also the greatest risk of major bleeding.
Positive End-Expiratory Pressure and Shunting across Foramen Ovale
Authors: Mark D. Siegel
Journal: Annals of Internal Medicine (1994)

Letters1 April 1994Positive End-Expiratory Pressure and Shunting across Foramen OvaleMark D. Siegel, MDMark D. Siegel, MDYale University School of Medicine; New Haven, CT 06520Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-7-199404010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The study by Cujec and colleagues [1], showing that positive end-expiratory pressure (PEEP) increased right-to-left shunting in patients with a patent foramen ovale, raises several questions. First, did the echocardiographers know whether the patients were receiving PEEP? The interpretation of contrast echocardiograms is potentially subjective [2], and a nonblinded study is open to bias. Second, did the patients with and without a patent foramen ovale have similar functional residual capacities? The ability of PEEP to improve oxygen delivery varies among patients and correlates well with lower initial functional residual capacity [3]; therefore, this variable should have been ...References1. Cujec B, Polasek P, Mayers I, Johnson D. Positive end-expiratory pressure increases the right-to-left shunt in mechanically ventilated patients with patent foramen ovale. Ann Intern Med. 1993; 119:887-94. Google Scholar2. Cross SJ, Thomson LF, Evans SA, Lee HS, Jennings KP. Inter- and intra-observer variability in detection of patent foramen ovale with contrast echocardiography. Eur Heart J. 1993; 14:388-90. Google Scholar3. Suter PM, Fairley HB, Isenberg MD. Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med. 1975; 292:284-9. Google Scholar4. West JB. Pulmonary Pathophysiology—The Essentials. 3d ed. Baltimore: Williams & Wilkins; 1987;30. Google Scholar5. Ravenscraft SA, Marinelli WA, Johnson T, Henke CA. Profound hypoxemia precipitated by positive-end-expiratory pressure: induction of an intracardiac shunt. Crit Care Med. 1992; 20:434-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of Medicine; New Haven, CT 06520 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1994Volume 120, Issue 7Page: 620KeywordsAcute respiratory distress syndromeAlveoliOxygenPositive end expiratory pressure Issue Published: 1 April 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Hepatoma Metastasizing to the Esophagus
Authors: David Sohn
Journal: JAMA (1965)

CARCINOMA metastasizing to the esophagus is rare. Gross and Freedman<sup>1</sup>cited a review of 1,000 autopsies performed on patients with cancer in which only 11 esophageal metastases were found. They added one case with primary site in the prostate and refer to three other cases, found in the literature, with distant primaries. Toreson<sup>2</sup>found 26 esophageal metastases in 599 consecutive autopsies of patients with cancer. Metastases from distant primary sites were infrequent, occurring in only two of the 11 cases in the series cited by Gross and Freedman, in their own case, and in the three cases they found in the literature, and in only seven of the 26 cases of Toreson. The majority of the cases of esophageal involvement by tumor were from adjacent organs such as stomach, larynx, trachea, or bronchus, presumably by direct extension. Additional reports of malignant neoplasms metastasizing to the esophagus were made
Role of nitric oxide in oxygen transport in rat liver sinusoids during endotoxemia
Authors: T Huang, T Nishida, W Kamike, H Kosaka, A Seiyama, Y Morimoto, S Tanaka, S Obunai, Y Takei, T Shiga, H Matsuda
Journal: Hepatology (1997)

To evaluate the role of nitric oxide (NO) in hepatic microcirculation and liver injury during endotoxemia, we studied O2 transport in the hepatic microcirculation of endotoxin-infused rats. Rats were continuously infused with Escherichia coli lipopolysaccharide (LPS) (0.8 mg/kg/h) for 7 hours. LPS increased the plasma levels of NO2- + NO3- and aspartate transaminase (AST), and decreased the bile flow rate and hepatic adenosine triphosphate (ATP) level. Hepatic microcirculation was evaluated by two methods: reflectance spectrophotometry showed a decrease in the oxygenation of hemoglobin (Hb) in the liver, and dual-spot microspectroscopy indicated that LPS administration decreased blood velocity, the oxygenation of Hb, and O2 release from sinusoids to hepatocytes. The observed decreases in the O2 transport parameters were prominent in pericentral sinusoids. All of these phenomena were further aggravated by the administration of N(w)-nitro-L-arginine methyl ester (L-NAME) (5 mg/kg/h) plus LPS, and by aminoguanidine (AMG) (5 mg/kg/h) plus LPS, and these could be reversed by the concomitant administration of L-arginine (L-Arg) (100 mg/kg/h). These results suggest that deterioration of hepatic oxygen transport and liver function induced by endotoxin can be ameliorated by NO.
The Pathology and Surgical Treatment of Tumors.
Authors: Nicholas Senn
Journal: JAMA (1895)

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