tbuckley/cabot-search huggingface dataset:
Self-Study from Web-Based and Printed Guideline Material
Authors: Douglas S. Bell, Gregg C. Fonarow, Carol M. Mangione
Journal: Annals of Internal Medicine (2001)

Letters20 March 2001Self-Study from Web-Based and Printed Guideline MaterialDouglas S. Bell, MD, PhD, Gregg C. Fonarow, MD, and Carol M. Mangione, MD, MSPHDouglas S. Bell, MD, PhDUniversity of California, Los Angeles; Los Angeles, CA 90095-1736 (Bell, Fonarow, Mangione)Search for more papers by this author, Gregg C. Fonarow, MDUniversity of California, Los Angeles; Los Angeles, CA 90095-1736 (Bell, Fonarow, Mangione)Search for more papers by this author, and Carol M. Mangione, MD, MSPHUniversity of California, Los Angeles; Los Angeles, CA 90095-1736 (Bell, Fonarow, Mangione)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-6-200103200-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Blank for highlighting the tension in medical education between teaching simplified rules for patient care and teaching the underlying primary evidence. We agree that the latter approach should support more robust decision making, but it also generally requires more time. Our intervention was intended to facilitate learning both guideline recommendations and the evidence that underlies them, but, as we noted, few of the participants pursued the evidence in depth. The participants may have shared an attitude that was found recently among British general practitioners—they do not have time to pursue critical appraisal of the primary ...References1. McColl A, Smith H, White P, Field J. General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316:361-5. [PMID: 0009487174] CrossrefMedlineGoogle Scholar2. Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes RB. Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills [Editorial]. BMJ. 2000;320:954-5. [PMID: 0010753130] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, Los Angeles; Los Angeles, CA 90095-1736 (Bell, Fonarow, Mangione) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSelf-Study from Web-Based and Printed Guideline Materials Douglas S. Bell , Gregg C. Fonarow , Ron D. Hays , and Carol M. Mangione Self-Study from Web-Based and Printed Guideline Material Robert D. Blank Metrics 20 March 2001Volume 134, Issue 6Page: 534-535KeywordsComputersDecision makingMedical educationPatientsQuality improvement ePublished: 20 March 2001 Issue Published: 20 March 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Treatment of Asymptomatic <i>Clostridium difficile</i> Carriers (Fecal Excretors) with Vancomycin or Metronidazole
Authors: Stuart Johnson, Scott R. Homann, Kristine M. Bettin, Judith N. Quick, Connie R. Clabots, Lance R. Peterson, Dale N. Gerding
Journal: Annals of Internal Medicine (1992)

▪Objective: To compare the efficacy of vancomycin and metronidazole for eradication of asymptomatic Clostridium difficile fecal excretion as a means of controlling nosocomial outbreaks of C. difficile diarrhea. ▪Design: Randomized, placebo-controlled, nonblinded trial. ▪Setting: Six hundred-bed regional referral Veterans Affairs Medical Center. ▪Patients: Thirty patients excreting C. difficilewithout diarrhea or abdominal symptoms. ▪Interventions: All patients were randomized to receive 10 days of oral vancomycin, 125 mg four times daily; metronidazole, 500 mg twice daily; or placebo, three times daily. ▪Measurements: Stool cultures were obtained during treatment and for 2 months after treatment. All C. difficile isolates were typed by restriction endonuclease analysis (REA). ▪Results: Clostridium difficile organisms were not detected during and immediately after treatment in 9 of 10 patients treated with vancomycin compared with 3 of 10 patients treated with metronidazole (P = 0.02) and 2 of 10 patients in the placebo group (P = 0.005). The fecal vancomycin concentration was 1406 ± 1164 µg/g feces, but metronidazole was not detectable in 9 of 10 patients. Eight of the nine evaluable patients who had negative stool cultures after treatment with vancomycin began to excrete C. difficile again 20 ± 8 days after completing treatment. Three of these patients received additional antibiotics before C. difficile excretion recurred, and five acquired new C. difficile REA strains. Four of six patients who received only vancomycin before C. difficile excretion recurred were culture-positiveat the end of the study compared with one of nine patients who received only placebo (P = 0.047). ▪Conclusions: Asymptomatic fecal excretion of C. difficile is transient in most patients, and treatment with metronidazole is not effective. Although treatment with vancomycin is temporarily effective, it is associated with a significantly higher rate of C. difficile carriage 2 months after treatment and is not recommended.
Drug target validation and identification of secondary drug target effects using DNA microarrays
Authors: Matthew J. Marton, Joseph L. DeRisi, Holly A. Bennett, Vishwanath R. Iyer, Michael R. Meyer, Christopher J. Roberts, Roland Stoughton, Julja Burchard, David Slade, Hongyue Dai, Douglas E. Bassett, Leland H. Hartwell, Patrick O. Brown, Stephen H. Friend
Journal: Nature Medicine (1998)
CD2-positive B-cell precursor acute lymphoblastic leukemia with an early switch to the monocytic lineage
Authors: L Slamova, J Starkova, E Fronkova, M Zaliova, L Reznickova, F W van Delft, E Vodickova, J Volejnikova, Z Zemanova, K Polgarova, G Cario, M Figueroa, T Kalina, K Fiser, J P Bourquin, B Bornhauser, M Dworzak, J Zuna, J Trka, J Stary, O Hrusak, E Mejstrikova
Journal: Leukemia (2013)
'Do Not Resuscitate' Orders
Authors: Barbara A. Elliott, Thomas W. Day
Journal: JAMA (1986)

<h3>To the Editor.—</h3> An order stating that a patient should not be resuscitated ("do not resuscitate," or DNR) means that in the event of cardiac or respiratory arrest, life-restoring efforts will be withheld. Confusion exists concerning inferences from such an order. A recent issue of<i>JAMA</i>contains a report regarding DNR orders<sup>1</sup>similar to an article published a year earlier.<sup>2</sup>Although the format of the investigation is similar, some of the results and many of the conclusions differ markedly. Some of the differences are disturbing. Youngner et al<sup>2</sup>emphasize that the "DNR order does not mean that patients will be medically or emotionally abandoned." By contrast, Zimmerman et al<sup>1</sup>feel that "avoiding treatment that would not positively affect the patient's condition" is ethically implied by the DNR order. Both cite findings from their studies supporting these radically different ethical interpretations of the DNR order. As stated by
STRESS PERFUSION/FUNCTION IMAOINO WITH TC-99M SESTAMIBI (MIBI) FOR THE DETECTION OF CORONARY VASCULOPATHY FOLLOWING CARDIAC TRANSPLANTATION
Authors: James L. Tatum, Hassan Ibrahim, Evelyne Goudreau, Diane Ponder, P. K. Mohanty
Journal: Clinical Nuclear Medicine (1994)

Tatum, James L. M.D.; Ibrahim, Hassan M.D.; Goudreau, Evelyne M.D.; Ponder, Diane C.N.M.T.; Mohanty, P. K. M.D. Author Information
Endoscopic Suprapapillary Blunt Dissection of the Distal Common Bile Duct in Cases of Difficult Cannulation: A Pilot Series
Authors: K. Hashiba, M. A. D’Assunção, S. Armellini, R. T. Hassegawa, C. A. Cappellanes, D. Moribe
Journal: Endoscopy (2004)

Background and Study Aims: There is no consensus about the optimal alternative procedure in cases of failed cannulation of the common bile duct (CBD). The alternatives are usually considered to be high-risk procedures. This study describes endoscopic dissection of the distal biliary tract (EDBT) as a new technique in cases of difficult cannulation of the CBD. Patients and Methods: Out of a total of 1057 patients in whom cannulation was attempted, deep cannulation failed in 49 patients, and 48 of those underwent EDBT. The procedure consists of cutting the mucosa, and the partial isolation of the distal part of the biliary tract using catheters, a needle-knife papillotome, and thin forceps. Access to the biliary tract was achieved with an endoscopic needle or forceps with or without electrocoagulation. Results: EDBT was successful in all cases. In 46 patients EDBT was followed by standard sphincterotomy. Four patients developed clinical pancreatitis and hyperamylasemia occurred in 11 cases. Perforation, uncontrolled bleeding, and other complications did not occur in this series. Conclusions: EDBT is feasible, safe and constitutes a potential alternative for cannulation of the CBD. The endoscopic visualization of the wall structure and duodenal layers during the maneuvers at the papilla probably accounts for the absence of major complications.
Genome‐wide analysis of gene expression in human intrahepatic cholangiocarcinoma†
Authors: Kazutaka Obama, Katsuaki Ura, Meihua Li, Toyomasa Katagiri, Tatsuhiko Tsunoda, Akinari Nomura, Seiji Satoh, Yusuke Nakamura, Yoichi Furukawa
Journal: Hepatology (2005)

Intrahepatic cholangiocarcinoma is a neoplasm arising in the liver, and its incidence is increasing in Japan as well as in Western countries. Prognosis of patients with this type of tumor remains unsatisfactory because no effective chemotherapeutic drugs are available, we have no sensitive tumor markers to detect this tumor in its early stage, and it is difficult to identify a high-risk group for the disease. To clarify the molecular mechanism of tumorigenesis and identify molecular targets for diagnosis and treatment, we analyzed global gene-expression profiles of 25 intrahepatic cholangiocarcinomas using tumor cell populations purified by laser microbeam microdissection and a cDNA microarray containing 27,648 genes. We identified 52 genes that were commonly upregulated and 421 that were downregulated in intrahepatic cholangiocarcinomas compared with noncancerous biliary epithelial cells. From the 52 upregulated genes, we selected P-cadherin and survivin for further investigation and corroborated enhanced expression of their products in cancer tissues by immunohistochemical staining. Furthermore, comparison between tumors with lymph node metastasis and those without metastasis identified 30 genes that were associated with lymph node involvement. In conclusion, these data should be helpful for a better understanding of the tumorigenesis of intrahepatic cholangiocarcinoma and should contribute to the development of diagnostic and therapeutic strategies for this type of tumor. Supplementary material for this article can be found on the HEPATOLOGY website (http://www.interscience.wiley.com/jpages/0270-9139/suppmat/index.html). (HEPATOLOGY 2005.)
374. Hepatitis Delta Virus-Mediated Amplification of Therapeutic RNAi
Authors: Dirk Haussecker, Menashe Elazar, Jeff S. Glenn, Mark A. Kay
Journal: Molecular Therapy (2006)

With RNAi-based therapeutics directed against genetic diseases or viral infections, sustained activity is typically desirable. siRNAs made of double-stranded RNAs do not persist and require frequent re-administration. Although gene transfer of vectors that express small hairpin RNAs (shRNAs) from host RNA polymerase II and III-promoters promotes comparatively prolonged knockdown, RNAi activity is commonly limited by epigenetic silencing of shRNA transcription and, in the case of episomal vectors, vector loss due to cell division.
Effects of Olanzapine, Quetiapine, and Risperidone on Neurocognitive Function in Early Psychosis: A Randomized, Double-Blind 52-Week Comparison
Authors: Richard S.E. Keefe, John A. Sweeney, Hongbin Gu, Robert M. Hamer, Diana O. Perkins, Joseph P. McEvoy, Jeffrey A. Lieberman
Journal: American Journal of Psychiatry (2007)

Objective: The authors sought to compare the effects of olanzapine, quetiapine, and risperidone on neurocognitive function in patients with early psychosis. Method: In a 52-week double-blind, multicenter study, 400 patients early in the course of psychotic illness (<5 years) were randomly assigned to treatment with olanzapine (2.5–20 mg/day), quetiapine (100–800 mg/day), or risperidone (0.5–4 mg/day). The mean modal daily dose was 11.7 mg (SD=5.3) for olanzapine, 506 mg (SD=215) for quetiapine, and 2.4 mg (SD=1.0) for risperidone. A total of 224 patients completed neurocognitive assessments at baseline and at 12 weeks, and 81 patients also completed them at 52 weeks. Neurocognitive composite scores were calculated from the neurocognitive battery used in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and from the Brief Assessment of Cognition in Schizophrenia. Results: At week 12, there was significant improvement in neurocognition for each treatment (p<0.01), but no significant overall difference between treatments. Composite z score improvements on the CATIE neurocognitive battery were 0.17 for olanzapine, 0.33 for quetiapine, and 0.32 for risperidone. Composite z score improvements on the Brief Assessment of Cognition in Schizophrenia were 0.19 for olanzapine, 0.34 for quetiapine, and 0.22 for risperidone. Statistically significant relationships between improvements in neurocognition and functional outcome were observed at weeks 12 and 52. Conclusions: Olanzapine, quetiapine, and risperidone all produced significant improvements in neurocognition in early-psychosis patients. Although cognitive improvements were modest, their clinical importance was suggested by relationships with improvements in functional outcome.
Disproportionate Distribution of <i>Burkholderia cepacia</i> Complex Species and Transmissibility Markers in Cystic Fibrosis
Authors: JOHN J. LiPUMA, THEODORE SPILKER, LISA H. GILL, PRESTON W. CAMPBELL, LIXIA LIU, ESHWAR MAHENTHIRALINGAM
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

Several distinct species (genomovars) comprise bacteria previously identified merely as Burkholderia cepacia. Understanding how these species, collectively referred to as the B. cepacia complex, differ in their epidemiology and pathogenic potential in cystic fibrosis (CF) is important in efforts to refine management strategies. B. cepacia isolates recovered from 606 CF patients receiving care at 132 treatment centers in 105 cities in the United States were assessed to determine species within the B. cepacia complex and examined for the presence of putative transmissibility markers (B. cepacia epidemic strain marker [BCESM] and cable pilin subunit gene [cblA]). Fifty percent of patients were infected with B. cepacia complex genomovar III, 38% with B. multivorans (formerly genomovar II), and 5% with B. vietnamiensis (formerly genomovar V); fewer than 5% of patients were infected with either genomovar I, B. stabilis (formerly genomovar IV), genomovar VI, or genomovar VII. BCESM was found in 46% of genomovar III isolates and not in any other species. Only one isolate, from a patient infected with the ET12 epidemic lineage, contained the complete cblA pilin subunit gene. Our data indicate a differential capacity for human infection among the phylogenetically closely related species of the B. cepacia complex. The low frequency of BCESM and cblA suggests that they are not sufficient markers of B. cepacia virulence or transmissibility.
Natural Ventilation for Prevention of Airborne Contagion: Authors' Reply
Authors: Adrian Roderick Escombe, David A. J Moore, Jon S Friedland, Carlton A Evans, Robert H Gilman
Journal: PLoS Medicine (2007)

We would like to thank the correspondents for their thoughtful contributions to this important public health topic [1]. As our abstract and article state, we measured natural and mechanical ventilation and then calculated the effects of these ventilation rates on estimated tuberculosis (TB) infection rates using a mathematical model of airborne infection. This appears to be the first published assessment of natural ventilation rates in health-care settings, and the novel conclusions of our article are that extremely high rates of dilutional ventilation can be achieved through natural ventilation at very little cost by simply opening windows and doors. Indeed, this natural ventilation was far in excess of even the best maintained mechanical ventilation systems used in health-care settings. Importantly, this natural ventilation greatly reduced the calculated risk of airborne infection.

Measuring TB transmission itself is difficult, as rates in staff are confounded by exposures outside the workplace, and mechanical air sampling techniques have had limited success. We have established a guinea pig air sampling facility to directly measure TB transmission in a hospital ward in Lima, Peru [2] and have used this model to evaluate the effects of upper room ultraviolet light and negative air ionization on TB transmission. We plan to use this facility to further study natural ventilation, and its effect on actual TB transmission.

The results of the current study cannot be generalized to regions too cold to tolerate enhanced natural ventilation and not every room may be as amenable to natural ventilation as the Peruvian rooms that we studied. However, the key conclusions are clear: high rates of natural ventilation were achieved even on days with little wind and even rooms without high ceilings and large windows were well ventilated, such that natural ventilation significantly exceeded mechanical ventilation.

It is therefore clear that natural ventilation has an important role to play in the fight against institutional TB transmission in resource-limited settings. Mechanical ventilation is expensive to install, requires costly ongoing maintenance, may be dangerous if poorly maintained (for example, delivering positive instead of negative pressure), and is clearly inappropriate for the great majority of resource-limited settings where the burden of TB is highest. TB infection control is an urgent priority, underscored by the emergence of extreme drug-resistant TB strains and the increasing congregation in potentially high-risk overcrowded settings of persons living with HIV through the roll-out of enhanced HIV care. When infectious TB patients share rooms with others, opening windows and doors to enhance natural ventilation is a simple, inexpensive, and effective strategy in the fight against nosocomial TB transmission.
P68 Conventional and interventional bronchoscopy trainee practice and challenges
Authors: H Al-Najjar, H Lockman
Journal: Thorax (2013)

<h3>Introduction</h3> Bronchoscopy, an integral skill for respiratory registrar training, has been challenged by changing work patterns. Exposure to interventional bronchoscopy has posed further challenges to trainees. <h3>Objective</h3> To assess if UK respiratory trainee bronchoscopy practice and skills are in keeping with guidelines and whether their curriculum is being adhered to. We also gauged trainee attitudes and exposure to interventional bronchoscopy. <h3>Methods</h3> A survey was designed by us to assess training opportunities, exposure, competency and practice in conventional bronchoscopy with a section dedicated to interventional bronchoscopy. This was piloted locally then expanded nationally with 15 deaneries participating. <h3>Results</h3> 144 replies represented 24% of potential survey recipients. 13% had bronchoscopy experience outside specialist training such as fellowships or overseas experience. 53% were scheduled to attend bronchoscopy lists at least weekly although 27% achieved this (mainly due to on-call commitments). Just 70% of trainees had performed &gt;200 bronchoscopies by their final training year. 97% kept a logbook, though only 62% recorded <i>‘hit-rates’</i>. More scope via nose than mouth (53% vs 14%) and from the front than behind (44% vs 15%). Most right-handed (68%) and left-handed (73%) trainees preferred handling the control-lever with their dominant hand, 58% were influenced by their first trainer. 98% used midazolam and 52% opioids for sedation with 8% routinely using no sedation. Trainees tend use midazolam rather than opioids first when using both (61% vs 24%). By the final year of training, not everyone was completely independent with common diagnostic procedures, e.g. only 30% were for transbronchial biopsy. Almost all were trained on-the-job (figure). 62% of trainees rated flexible bronchoscopy training <i>excellent</i> or <i>good</i>. Unfortunately most interventional bronchoscopy techniques weren’t experienced by the vast majority. Only TBNA (36%) and EBUS-TBNA (22%) were performed by significant numbers of trainees. 24% had a definite interest in interventional bronchoscopy and of those 54% rated training <i>poor</i> or <i>very poor</i>. <h3>Discussion</h3> The results have highlighted bronchoscopy training deficiencies and a substantial number of trainee’s desire for exposure to interventional bronchoscopy techniques. Using e-portfolio akin to that already used for endoscopy and creating separate training pathways for interventional bronchoscopy may help in remedying this.
William Alexander Gillespie
Authors: D. Speller
Journal: BMJ (2004)

Emeritus professor of clinical bacteriology University of Bristol (b Dublin 1912; q Trinity College Dublin 1936), d 13 August 2003.​2003.




Figure 1




During a long career William Gillespie energetically pursued his interests in the fundamentals and practicalities of infection control in hospitals. His most notable contribution was the establishment of the importance of closed urinary drainage after operative procedures and indwelling catheterisation, and of ancillary measures in support of this. Early in the occurrence of cross infection by multi-resistant strains of Staphylococcus aureus, he determined the need for multiple control measures, and he was influential in the introduction of central departments using reliable methods to provide sterile supplies. He had enthusiasms for the Italian language and literature, gardening, archaeology, and the history of medicine. He leaves a wife, Marjorie, and two children.
Lichenoid reactions of murine mucosa associated with amalgam
Authors: A. Dunsche, M.P. Frank, J. Luttges, Y. Acil, J. Brasch, E. Christophers, I.N.G. Springer
Journal: British Journal of Dermatology (2003)

Journal Article Lichenoid reactions of murine mucosa associated with amalgam Get access A. Dunsche, A. Dunsche Departments of Oral and Maxillofacial Surgery Search for other works by this author on: Oxford Academic Google Scholar M.P. Frank, M.P. Frank Conservative Dentistry and Periodontology Search for other works by this author on: Oxford Academic Google Scholar J. Lüttges, J. Lüttges Pathology and Search for other works by this author on: Oxford Academic Google Scholar Y. Açil, Y. Açil Departments of Oral and Maxillofacial Surgery Search for other works by this author on: Oxford Academic Google Scholar J. Brasch, J. Brasch Dermatology, University of Kiel, Arnold‐Heller‐Str. 16, D‐24105 Kiel, Germany Search for other works by this author on: Oxford Academic Google Scholar E. Christophers, E. Christophers Dermatology, University of Kiel, Arnold‐Heller‐Str. 16, D‐24105 Kiel, Germany Search for other works by this author on: Oxford Academic Google Scholar I.N.G. Springer I.N.G. Springer Departments of Oral and Maxillofacial Surgery Ingo N.G.Springer, MD, DMD. E‐mail: springer@mkg.uni‐kiel.de Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 148, Issue 4, 1 April 2003, Pages 741–748, https://doi.org/10.1046/j.1365-2133.2003.05229.x Published: 01 April 2003 Article history Accepted: 21 September 2002 Published: 01 April 2003
High Epstein–Barr virus-specific T-cell counts are associated with near-zero likelihood of acute myeloid leukemia relapse after hematopoietic cell transplantation
Authors: M Hoegh-Petersen, S Sy, A Ugarte-Torres, T S Williamson, M Eliasziw, A Mansoor, Y Liu, S Liu, P Podgorny, F Khan, P R Duggan, D A Stewart, J A Russell, J Storek
Journal: Leukemia (2011)