tbuckley/cabot-search huggingface dataset:
Hospice or Hemlock? Searching for Heroic Compassion
Authors: Linda Farber Post
Journal: Annals of Internal Medicine (2003)

Medical Writings: Book Notes6 May 2003Hospice or Hemlock? Searching for Heroic CompassionLinda Farber Post, JD, BSN, MALinda Farber Post, JD, BSN, MADepartment of Epidemiology Social Medicine Montefiore Medical Center Bronx New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-9-200305060-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Putnam CE. 232 pages. Westport, CT: Greenwood Publishing; 2002. $44.95. ISBN 0897899210. Order phone 800-225-5800.Field of medicine: Medical ethics.Format: Hardcover book.Audience: All physicians, including those in training, who care for patients at or approaching the end of life. The book will have special relevance for those in palliative medicine, geriatrics, infectious disease, and oncology.Purpose: To identify and formulate questions about key issues related to end-of-life decision making, and to provide an accessible analytic framework for further discussion.Content: The book's premise is that, because decisions about death are possible, they have become mandatory; as a result, ... Author, Article, and Disclosure InformationAffiliations: Department of Epidemiology Social Medicine Montefiore Medical Center Bronx New York. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 6 May 2003Volume 138, Issue 9Page: 776KeywordsComputed axial tomographyDecision makingEnd of life careEpidemiologyGeriatricsInfectious diseasesMedical ethicsPatientsSoftware toolsSuicide ePublished: 6 May 2003 Issue Published: 6 May 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
P251 Junior doctors' interpretation of CXRs is more consistent than consultants in the context of possible pneumonia
Authors: B. Singh, J. Curtis, S. B. Gordon, P. J. Diggle, D. G. Wootton
Journal: Thorax (2011)

<h3>Introduction and Objectives</h3> BTS guidelines suggest the diagnostic test for pneumonia (in hospital) is a CXR. Since management should be commenced within 4 h of arrival the initial interpretation of the CXR is most often performed by junior doctors. Consultants review patients and their CXRs within 24 h of admission and a radiologist9s report is issued at a later time point but diagnosis dependent decisions—whether to admit, risk stratification and whether to give antibiotics—fall to junior doctors. We measured the inter-observer agreement within groups of doctors involved at key points in CAP diagnosis and management. <h3>Methods</h3> 24 admission CXRs from patients attending a large teaching hospital between February and April 2011 with a suspected diagnosis of CAP were collected on a radiology computer workstation. Eleven reporting radiologists, eight attending consultants and twenty-two junior doctors from a range of acute medical specialties were recruited. All 41 recruits independently interpreted the CXRs, answering "yes" or "no" for presence of pneumonic infiltrate. Agreement within groups was tested using the Fleiss-Cuzick extension of Cohen9s κ statistic (abbreviated here as κ). <h3>Results</h3> Agreement (κ scores) for each group of doctors are shown in Abstract P251 figure 1. Radiologists had moderate agreement (κ 0.52, CI 0.49 to 0.55), junior doctors had moderate agreement (κ 0.47, CI 0.45 to 0.48) and attending consultants fair agreement (κ 0.34, CI 0.30 to 0.38). <h3>Conclusions</h3> In the context of possible pneumonia, the CXR was not consistently reported by any group. Junior doctors were more consistent than attending consultants and radiologists were most consistent. A possible explanation for these differences is that junior doctors, by necessity, have developed similar ideas of what they will consider pneumonic where as consultants who less frequently make the initial diagnostic decision vary in their criteria for diagnosing pneumonia. This study does not present a "gold standard" interpretation and therefore does not address the issue of accuracy but it does raise questions about to what extent the CXR ever be regarded as a "reliable" diagnostic test.
Agriculture and health
Authors: A. Dorward, A. D. Dangour
Journal: BMJ (2012)

We live in a "triple F" crisis.Global and European financial problems dominate the press and the concerns of privileged people in privileged societies.But for the poor it is fuel and, for most of the poorest, food that present the greatest direct threats to their daily lives.Our ability to sustainably produce and ensure access to a diet of sufficient quantity and quality (in terms of vitamin and mineral content) is central to guaranteeing both food and nutrition security, and it is a major emphasis of current global development policy and planning. 1 In the linked systematic review (doi:10.1136/bmj.d8222),Masset and colleagues assess evidence from low income countries on the effects of interventions that aim to improve children's nutritional status by enhancing households' agricultural production and improving diets.
Translating Research to Practice
Authors: Russell E. Glasgow
Journal: Diabetes Care (2003)

Diabetes and its care have captured the attention of clinicians, managed care, regulatory agencies, and the media. Several successful trials over the past decade have brought the issue of translating evidence-based findings on diabetes care into practice to the forefront of health care discussions (1–3).

Despite these promising advances, it is well documented that there is a large gap between what is known about diabetes care and what is commonly practiced (4–6). Studies of the level of diabetes care provided in the real world, and especially in primary care practices where the vast majority of patients are seen, consistently show that performance levels fall short of what is recommended (4–7). Even relatively simple actions, such as ordering a blood sample for analysis or regularly checking HbA1c, are performed far less frequently than recommended (5,6). Adherence to behaviorally oriented aspects of good diabetes and preventive care are performed even less often (with the possible exception of smoking cessation advice) (4,7).

Diabetes Care has devoted a series of articles to the discussion of translation issues and different perspectives on this topic (8–10). This article contributes to the discussion by 1 ) discussing changes needed in the conduct of research studies if we are to reduce the gap between research and practice, and 2 ) identifying specific areas for future translation research. There have been two positive examples of the adoption of research-based innovations. First, there has been a paradigm shift in the approach to self-management education and behavior change, both within diabetes education and the broader behavioral science community. This shift has been from provider-centered “compliance” approaches to more patient-centered “empowerment” methods (11–13).

The second change that has become widely adopted, at least within leading …
Varieties of Healing. 1: Medical Pluralism in the United States
Authors: Ted J. Kaptchuk, David M. Eisenberg
Journal: Annals of Internal Medicine (2001)

Medicine has become interested in unconventional healing practices, ostensibly because of recent demographic research that reveals a thriving medical market of multiple options. This essay presents a historical overview of medical pluralism in the United States. Consistent evidence is examined suggesting that unconventional medicine has been a persistent presence in U.S. health care. Despite parallels with the past, the recent widespread interest in alternative medicine also represents a dramatic reconfiguration of medical pluralism—from historical antagonism to what might arguably be described as a topical acknowledgment of postmodern medical diversity. This recent shift may have less to do with acknowledging "new" survey data than with representing shifts in medicine's institutional authority in a consumer-driven health care environment. This essay is an introduction to a discussion of a taxonomy of contemporary U.S. medical pluralism, which also appears in this issue.
On Premature Rupture of the Membranes
Authors: J. Thorburn
Journal: BMJ (1872)

fals forward and droops, and the dorsal portion of the spine bends in a bow to accommodate these derangements.What follows will be seen in the following picture of one in the decline of life.i.The head is bent, the neck approaches more and more towards the sternum, and the return of venous blood from the brain is thus
Points From Letters: Content of General Practice
Authors: G. M. Langham-Hobart
Journal: BMJ (1963)

BHLmhave their ill effects minimized by quite simple tuition or mechanical devices (e.g., wing mirrors for those with restricted side-vision), we think that a more com- prehensive eye-test for drivers would be a major contribution to road safety.Such an eye-test can be given simply and quickly, and is therefore a practical pro- position even with the many millions of drivers we have in this country.By way of support for this argument I take the liberty of drawing attention to the W.H.O.Report No. 12, Road Traffic Accidents, by Dr. L. G. Norman, who deals with this matter on pages 74-5 and 92-3.May I conclude by saying that we are well aware of the objection that to insti- tute stiffer eye tests may lead to the ban- ning of many who at present hold a driving licence ?If people's vision is such that they are unsafe to drive, then surely the good of the many must take priority over the interest of the individual.How- ever, a stiffer standard need not in fact result in the withdrawal of many licences but merely in the revealing of those who need to receive full professional advice, treatment, and tuition.-! am.etc.,
Sex differences in the use of asthma drugs: cross sectional study
Authors: M. Sexton, M. D Althuis, N. Santanello, S. Hyndman, R. Williams, D. Schmeidler
Journal: BMJ (1998)

<b>Objectives:</b> To assess the use of asthma drugs by men and women with asthma and to identify sex specific predictors for the use of oral steroids. <b>Design:</b> Cross sectional study. <b>Setting:</b> Six general practicesin East Anglia. <b>Subjects:</b> 103 men and 134 women aged 20-54 with asthma. <b>Main outcome measures:</b> Self reported use of β agonists, inhaled steroids, and oral steroids. <b>Results:</b> No sex difference was found in use of β agonists or inhaled steroids. However a strong association existed between sex and oral steroid use. 40 (30%) women reported using oral steroids compared with nine (9%) men. Women were more than five times (odds ratio=5.5, 95% confidence interval 2.2 to 13.7) more likely to report use of oral steroids than men after asthma symptoms, age, visits to the general practitioner in previous six months, and time since diagnosis of asthma were controlled for. Women who had visited the general practitioner for asthma one or more times in the previous six months were four times (3.9, 1.6 to 9.5) as likely to report use of oral steroids. In addition, more frequent visits to the general practitioner for asthma were related in a dose-response manner to a greater likelihood of using oral steroids among women after asthma symptoms, age, and time since diagnosis were controlled for. This relation was not observed among men. <b>Conclusion:</b> Women used oral steroids more than men. The more frequent consultations with a doctor by women may result in more requests for oral steroids or doctors may preferentially prescribe oral steroids to women.
The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam
Authors: A. Meining, V. Semmler, A. Kassem, R. Sander, U. Frankenberger, M. Burzin, J. Reichenberger, M. Bajbouj, C. Prinz, R. Schmid
Journal: Endoscopy (2007)

See also: Commentaire de travail de A. Meining et al., pp. 345Endoscopy 2007; 39(04): 383-384DOI: 10.1055/s-0032-1306926
Molecular basis of Barrett's oesophagus and oesophageal adenocarcinoma
Authors: R C Fitzgerald
Journal: Gut (2006)

arrett's oesophagus is the eponym used to describe the change from the normal stratified, squamous epithelium of the lower oesophagus to a polarised, columnar-lined epithelium with intestinal-type differentiation. 1 This condition develops in the context of chronic gastro-oesophageal reflux disease (GORD) 2 and is associated with a 0.5-1% annual conversion rate to oesophageal adenocarcinoma. 3 4The overall 5-year survival rate in patients presenting with symptomatic adenocarcinoma is a dismal 13%. 5 An understanding of the molecular basis for the development and progression of Barrett's metaplasia is required to develop effective clinical management strategies.Before discussing the molecular changes at the level of the tissue, it is important to briefly consider the environmental and inherited genetic factors that contribute to an individual's susceptibility to these conditions. EFFECT OF ENVIRONMENTAL AND INHERITED FACTORS ON INDIVIDUAL SUSCEPTIBILITYThe role of environmental factors is evident from the short time period over which the incidence of Barrett's oesophagus 6 and oesophageal adenocarcinoma 7 has increased.Furthermore, the demonstration of a ''birth cohort effect'', with higher incidence rates in younger cohorts, 8 would support the idea that exposure to environmental factors in early life is an important determinant of risk.Identification of specific environmental exposures is difficult, but factors that increase gastro-oesophageal reflux, such as dietary components, increasing body mass index and eradication of Helicobacter pylori, may be relevant. 9Whether or not smoking and alcohol consumption are risk factors for Barrett's oesophagus is controversial; however, an association was found in a recent population study. 10In order for an individual to develop Barrett's oesophagus, and in some cases oesophageal adenocarcinoma, these environmental exposures probably need to interact with genetically determined characteristics that define personal susceptibility 11 (fig 1).As most cases are sporadic, occurring in the absence of a family history, these inherited genetic factors are likely to be normal variations or polymorphisms in multiple genes rather than single gene mutations.In Barrett's oesophagus, polymorphisms in genes involved in DNA repair, chemical detoxification and cytokine responses have been identified. 12-14However, to reliably detect the low to moderate risks expected to be associated with multiple genetic polymorphisms, large, population-based case collections are required, with comprehensive epidemiological, clinical and pathological data. 15In summary, Barrett's oesophagus occurs in the context of inherited genetic susceptibility loci and specific environmental exposures.The remainder of this review is concerned with the molecular changes in the oesophageal tissue in the development and progression of Barrett's oesophagus.
Advertisements for donepezil (Aricept) in the BMJ
Authors: S. Gray, N. Wagner
Journal: BMJ (1997)

Editor—I wish to express my anger and concern that advertising space on the wrapper around the clinical research edition of the BMJ (issues of 3 and 10 May) was sold to promote donepezil hydrochloride (Aricept). This is the first time that I have been aware of a promotion of this nature, and I find this form of advertising disturbing. While I appreciate that the BMJ generates necessary income from pharmaceutical companies and I can deal with advertisements within the journal, I find that to be faced by a paper strip on top of the BMJ that has to be forcefully removed before one can even read the contents page is irritating and intrusive. No doubt because of this, it is a successful marketing ploy and generates enormous amounts of income. As a general policy, however, I hope that the journal will reconsider accepting this type of advertisement, as I …
Acid aspiration results in ileal injury without altering ileal V(O2)-D(O2) relationships.
Authors: E D Crouser, M W Julian, S E Weisbrode, P M Dorinsky
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Systemic organ endothelial injury and V(O2)-D(O2) relationship alterations occur frequently in the setting of acute lung injury, and they are believed to play an important role in the pathogenesis of the multiple organ dysfunction syndrome (MODS). However, the relationship, if any, between systemic organ endothelial injury and V(O2)-D(O2) relationship alterations remains unknown. We hypothesized that microvascular endothelial injury and attendant interstitial edema would result in increased diffusion distances for oxygen and altered systemic organ V(O2)-D(O2) relationships. To test this hypothesis, we utilized the in situ autoperfused feline ileal preparation to evaluate ileal V(O2)-D(O2) relationships in control animals (n = 5) and in animals with HCl-induced acute lung and systemic organ injury (n = 5). As expected, ileal endothelial protein permeability (CL/CP) was increased in HCl-injured animals compared to control animals (0.187 +/- 0.024 versus 0.097 +/- 0.009; p < 0.01). However, contrary to our original hypothesis and despite marked morphologic and endothelial protein permeability alterations, ileal V(O2)-D(O2) relationships were not altered in the HCl-injured animals. Moreover, V(O2)-D(O2) relationships in the ileum remained unchanged even when ileal venous pressures were increased to 15 mm Hg. Taken together, these findings do not support an important role for oxygen diffusion limitation in the pathogenesis of altered systemic organ V(O2)-D(O2) relationships.
MYOCARDIAL INSUFFICIENCY-Reply
Authors: George R. Herrmann
Journal: JAMA (1949)

<h3>To the Editor:—</h3> Dr. Labecki is right. He read the paper more carefully than I or my associates read the proof. The statement on page 509 concerning the direct application of the Fick principle should read, "cardiac output per minute equals the total oxygen consumption divided by the arteriovenous oxygen difference times 100." The only way I can explain it is that I had "A.V." in my manuscript and my secretary interpreted the A.V. incorrectly as auricular-ventricular rather than as it should have been, arteriovenous. I should have caught the error in proofreading. The routine application of the Fick principle in measuring the cardiac output in man has been indirect. However, right heart catheterization permits the direct application in man. There is some preference for determination of the difference between oxygen content rather than carbon dioxide content in the arterial and venous blood samples. The arterial blood is taken from
Vascular Infarction in Small-Bowel Ulcers
Authors: Leon Morgenstern
Journal: JAMA (1965)

<h3>To the Editor:—</h3> The two papers on "Potassium-Induced Lesions of the Small Bowel" by Boley, Allen et al (<b>193</b>:997,1965) favor venous infarction as the important factor in the pathogenesis of these ulcerations. In our clinical material, which constitutes one of the largest groups of cases in the country, our pathologists have been unable to demonstrate significant vascular lesions. Noteworthy has been the complete absence of venous thrombotic changes in any of the 30 cases studied. Similarly, in our experimental material, we have not been able to substantiate the existence of primary vascular lesions, either arterial or venous, in conjunction with experimentally produced ulcers. We have recently studied the evolution of the experimental lesion under the operating microscope and have documented by cinematography the absence of change in both arteries and veins supplying the area undergoing damage by topically applied potassium compounds. We cannot, on the basis of studies similar
Adjuvant Chemotherapy for Non–Small-Cell Lung Cancer — The Smoke Clears
Authors: Katherine M.W. Pisters
Journal: New England Journal of Medicine (2005)

Lung cancer has been the most common cancer in the world since 1985 and is today the leading cause of cancer-related death. In 2002, there were 1.35 million new cases and 1.18 million related deaths worldwide.1 Non–small-cell lung cancer, the most common form, accounts for 80 to 85 percent of cases. Given the size of the problem, the benefit of adjuvant chemotherapy for non–small-cell lung cancer, reported by Winton et al. in this issue of the Journal, has tremendous implications.2 Complete surgical resection is the best hope for cure in patients with operable non–small-cell lung cancer, yet the five-year overall . . .
Medicinal chemistry and therapeutic potential of muscarinic M3 antagonists
Authors: Ilaria Peretto, Paola Petrillo, Bruno P. Imbimbo
Journal: Medicinal Research Reviews (2009)

Abstract Muscarinic acetylcholine receptors belong to the G‐protein‐coupled receptors family. Currently five different receptor subtypes have been identified and cloned. M3 receptor subtypes are coupled to G q family proteins and increase phosphatidyl inositol hydrolysis and calcium release from internal stores. They are widely distributed both in the central nervous system and in the periphery. At the central level, M3 receptor subtypes are involved in modulation of neurotransmitter release, temperature homeostasis, and food intake, while in the periphery they induce smooth muscle contraction, gland secretion, indirect relaxation of vascular smooth muscle, and miosis. The main therapeutic applications of M3 antagonists include overactive bladder (OAB), chronic obstructive pulmonary disease (COPD), and pain‐predominant irritable bowel syndrome (IBS). The introduction of selective M3 antagonists has not improved clinical efficacy compared with the old non‐selective antimuscarinics but has reduced the rate of adverse events mediated by the blockade of cardiac M2 receptors (tachycardia) and central M1 receptors (cognitive impairment). Improved tolerability has been obtained also with controlled release or with inhaled formulations. However, there is still a need for safer M3 antagonists for the treatment of COPD and better‐tolerated and more effective compounds for the therapy of OAB. New selective muscarinic M3 antagonists currently in early discovery and under development have been designed to address these issues. However, as M3 receptors are widely located in various tissues including salivary glands, gut smooth muscles, iris, and ciliary muscles, further clinical improvements may derive from the discovery and the development of new compounds with tissue rather than muscarinic receptor subtype selectivity. © 2009 Wiley Periodicals, Inc. Med Res Rev, 29, No. 6, 867–902, 2009
Short-term (1 month) results of the dose response IRIS feasibility study of a beta-particle emitting radioisotope stent
Authors: J.W. Moses, S.G. Ellis, S.R. Bailey, B.D. Raybuck, P.S. Teirstein, N.J. Weissman, J.J. Popma
Journal: Journal of the American College of Cardiology (1998)