tbuckley/cabot-search huggingface dataset:
The sight test fee Little evidence to support conclusions
Authors: G R Kirkby
Journal: BMJ (1994)

and colleagues describe the effect of the introduction of the sight test fee on the number of referrals to Bristol Eye Hospital.'They use the numbers of referrals for 1984-8 to predict the expected numbers of referrals in 1989- 92.This use of their data would have been appropriate if the introduction of the fee on 1 April 1989 had been made without prior warning.The government's proposal for the sight test fee had, however, been made public on 25 November 1987.2This announcement (and subsequent con- firmations) would be expected to have had two effects.Firstly, the high figure for referrals in 1988 may partly simply be due to the increased general publicity about sight tests.Secondly, some people who would have had an eye test after 1 April 1989 may have decided to have one beforehand instead.These "early" sight tests would have increased the figure for referrals in 1988 and reduced that in 1989.The authors consider whether early referrals received in 1988 could account for a reduction in referrals from 1989 onwards.They reject this idea on the grounds that the number of referrals in 1988 was a mere 343 (5 6%) above that expected.Ifthese 343 are regarded as early referrals and are taken from the total for 1988 and added to the total for 1989, however, then the fall in referrals from 1988 to 1989 is not by 15-1% but by only 4-8%.Whether this transfer of numbers of referrals is valid is clearly arguable, but this manoeuvre illustrates that a more cautious analysis might have been appropriate in the study.In particular, it would have been preferable not to have used data for 1988 (the year before introduction of the fee) to predict the numbers of referrals afterwards.If the figure for 1988 is omitted from the analysis the actual numbers of referrals for 1989-92 all fall within the recalculated 95% confidence intervals for the predicted numbers.
Physiological Responses to Intermittent Methohexitone for Conservative Dentistry
Authors: C. C. Wise, J. S. Robinson, M. J. Heath, P. J. Tomlin
Journal: BMJ (1969)

Intermittent methohexitone for conservative dentistry has been shown to cause clinically undetectable respiratory obstruction, depression of the laryngeal reflex, and arterial hypoxaemia. Because of the pronounced decrease in total peripheral resistance, the blood pressure was maintained only by large increases in cardiac output. Furthermore, the output of the heart could not increase when challenged by hypoxia.
The Myocardial Depressant Effect of Beta-Receptor Blocking Agents
Authors: CHANG-SENG LIANG, WILLIAM B. HOOD
Journal: Circulation Research (1974)

dl -Propranolol, d -propranolol, and practolol were administered in increasing doses to conscious dogs before and after acute coronary artery occlusion. dl -Propranolol and practolol caused dose-dependent decreases in cardiac output, stroke volume, stroke work, and maximum rate of left ventricular pressure rise before and after coronary artery occlusion. These parameters were reduced 25-40% after the largest cumulative doses--1.43 mg/kg for dl -propranolol and 52 mg/kg for practolol--were administered. The degree of beta-receptor blockade increased in proportion to the logarithm of plasma drug concentration. After occlusion, both drugs produced identical decreases in cardiac output at equivalent degrees of beta-receptor blockade. Neither drug affected resting heart rate before infarction, and neither drug reduced the tachycardia induced by coronary artery occlusion; this tachycrotic response probably resulted from cardiac vagal withdrawal. Mean systemic arterial blood pressure and total peripheral vascular resistance increased following beta-receptor blockade before infarction, most likely because of increased peripheral vascular alpha-adrenergic activity. These two effects did not occur after coronary artery occlusion, probably because vascular alpha-adrenergic activity had already been stimulated. d -Propranolol produced none of these effects. We concluded that the cardiodepressant effect of beta-receptor blocking agents in the doses administered was caused by their inhibition of endogenous sympathetic tone to the heart rather than by their quinidinelike action.
Deep thinking in children: The case for knowledge change in analogical development
Authors: Dedre Gentner, Mary Jo Rattermann
Journal: Behavioral and Brain Sciences (1998)

Halford, Wilson &amp; Phillips argue that cognitive development is driven by increases in processing capacity. We suggest that changes in relational knowledge are as important or more so. We present evidence that 3-year-olds' analogical abilities are sharply improved by teaching them relational labels; over a 30-minute experimental session children gained approximately 2 years in effective performance. These results mandate caution interpreting age-related change as indicating maturational change, and call for a deeper consideration of the role of epistemological change in cognitive development.
Antiarrhythmic effects of solvents: II Effects of propylene glycol and benzyl alcohol on the effective refractory period of isolated rabbit atria
Authors: W. J. YASAKA, F. W. EICHBAUM, S. OGA
Journal: Cardiovascular Research (1979)

The effect of propylene glycol, benzyl alcohol, quinidine, and procainamide on the effective refractory period of isolated rabbit atria were compared. The lengthening of effective refractory period reached its maximum at approximately 10 min for solvents and 40 to 50 min for quinidine and procainamide. The slopes of the effective refractory period curves were similar for propylene glycol and benzyl alcohol. The slopes of the effective refractory period curves for quinidine and procainamide were similar, but they differed from those obtained with propylene glycol and benzyl alcohol. These differences suggest that propylene glycol and benzyl alcohol lengthen the effective refractory period by different mechanisms than that of quinidine and procainamide. The effective dose 50% required for lengthening the effective refractory period is 20-fold greater for quinidine than for procainamide with similar relative responsiveness. On the other hand, the solvents showed low affinity and low relative responsiveness, although the combination of propylene glycol and benzyl alcohol showed similar relative responsiveness to procainamide. Despite the fact that these solvents have a lower antiarrhythmic potency, their therapeutic index is 5- to 50-fold greater than quinidine and/or procainamide.
Learning to Detect, Categorize, and Identify Skin Lesions
Authors: Liam Rourke, Sarah Oberholtzer, Trish Chatterley, Alain Brassard
Journal: JAMA Dermatology (2015)

Educators use a variety of practices to train laypersons, medical students, residents, and primary care providers to diagnose skin lesions. Researchers have described these methods for decades, but there have been few attempts to catalog their scope or effectiveness.To determine the scope and effectiveness of educational practices to improve the detection, categorization, and identification of skin lesions.Literature indexed in MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, and BIOSIS Previews from inception until April 1, 2014, using terms cognate with skin disease, diagnosis, and education.Studies in which the educational objective was operationalized as the ability to detect, categorize, or identify skin lesions, and the intervention was evaluated through comparisons of participants' abilities before and after the intervention.Information about trainees, educational practices, educational outcomes, and study quality was extracted; it was synthesized through meta-analysis using a random effects model. Effect sizes were calculated by dividing the differences between preintervention and postintervention means by the pooled standard deviation (ie, standardized mean difference [SMD]). Heterogeneity was assessed using an I2 statistic.Pooled effect size across all studies and separate effect sizes for each of the educational practices.Thirty-seven studies reporting 47 outcomes from 7 educational practices met our inclusion criteria. The pooled effect of the practices on participants' abilities was large, with an SMD of 1.06 (95% CI, 0.81-1.31) indicating that posttest scores were approximately 1 SD above pretest scores. Effect sizes varied categorically between educational practices: the dermatology elective (SMD = 1.64; 95% CI, 1.17-2.11) and multicomponent interventions (SMD = 2.07; 95% CI, 0.71-3.44) had large effects; computer-based learning (SMD = 0.64; 95% CI, 0.36-0.92), lecture (SMD = 0.59; 95% CI, 0.28-0.90), pamphlet (SMD = 0.47; 95% CI, -0.11 to 1.05), and audit and feedback (SMD = 0.58; 95% CI, 0.10-1.07) had moderate effects; and moulage had a small effect (SMD = 0.15; 95% CI, -0.26 to 0.57).A number of approaches are used to improve participants' abilities to diagnose skin lesions; some are more effective than others. The most effective approaches engage participants in a number of coordinated activities for an extended period, providing learners with the breadth of knowledge and practice required to change the mechanisms underlying performance.
Collagen-stimulated human platelet aggregation is mediated by endogenous calcium-activated neutral protease.
Authors: T Toyo-oka, W S Shin, Y Okai, Y Dan, M Morita, M Iizuka, T Sugimoto
Journal: Circulation Research (1989)

To clarify the physiological role of calcium-activated neutral protease (CANP) in human platelets, we loaded the platelets with a Ca2+ -sensitive fluorescent dye, fura-2, and measured the degree of aggregation, cytosolic calcium ion concentration [( Ca2+]i), and proteolysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). At physiological concentration of Ca2+ (1 mM) in the incubation medium, [Ca2+]i was below 0.5 microM and platelet aggregation was not shown. Ionomycin (0.15 microM) or collagen (50 micrograms/ml), but not ADP (10 microM), sharply enhanced the [Ca2+]i to near 1 microM and caused the aggregation. A calcium entry blocker, verapamil, completely abolished both the [Ca2+]i rise and the aggregation. NCO-700, a membrane permeable inhibitor against cysteine proteases (including CANP), dose-dependently blocked the aggregation but did not change the [Ca2+]i transient. SDS-PAGE revealed that filamin, talin, and 70 kDa protein were specifically degraded when platelets were aggregated by ionomycin or collagen and that the proteolysis was not observed when the aggregation was blocked by verapamil or NCO-700. These data provided evidence that Ca2+ entry exceeding 0.5 microM is essential, but not sufficient per se, and that activation of cysteine protease, most likely CANP, is involved in the platelet aggregation by collagen or calcium ionophore.
Emergency centre aims to end age discrimination
Authors: A. Gulland
Journal: BMJ (2003)

The government's “tsar” for elderly people, Professor Ian Philp, has welcomed a new emergency medicine centre at Whipps Cross University Hospital in northeast London that aims to end age discrimination by treating elderly patients on the basis of clinical need.

Opening the £2.5m ($4.1m; €3.6m) centre last week with Sir George Alberti, the government's tsar for emergency medicine, Professor Philp said, “This care centre is definitely ahead of the game. Older people are the main users of services and we need to move away from services where they're at the margins to making sure mainstream …
Antiparkinsonian Agents and Depot Phenothiazine
Authors: CHING-PIAO CHIEN, ALBERTO DIMASCIO, JONATHAN O. COLE
Journal: American Journal of Psychiatry (1974)

To determine whether antiparkinsonian (AP) drugs should be regularly given prophylactically to all patients receiving depot antipsychotic drugs, the authors assigned 41 psychotic patients receiving fluphenazine enanthate to one of three groups. The first received only enough AP medication to control the occurrence of acute extrapyramidal symptoms (EPS), the second received AP medication for five days after each injection of depot fluphenazine, and the third received the AP agent daily. There were no significant differences among the three groups in the number and intensity of EPS, although some subjects in the first group displayed gross EPS that were controlled. The authors conclude that the routine prophylactic use of AP drugs is questionable but that further research is necessary.
Preliminary Results or a Phase II Clinical Trial Utilising Tru-Scint® AD™ in Primary and Metastatic Breast Cancer
Authors: A. J.B. McEwan, G. D. MacLean, L. Golberg, K. Golberg, G. R. Boniface, T. Sykcs, S. McQuarrle, G. Amyotte, A. Noujalm
Journal: Clinical Nuclear Medicine (1994)

McEwan, A. J.B.; MacLean, G. D.; Golberg, L.; Golberg, K.; Boniface, G. R.; Sykcs, T.; McQuarrle, S.; Amyotte, G.; Noujalm, A. Author Information
STRICTURE OF THE URETHRA IN WOMEN.Read in the Section of Obstetrics and Gynecology, at the Forty-first Annual Meeting of the American Medical Association, at Nashville, Tenn., May, 1890.
Authors: ELY VAN DE WARKER
Journal: JAMA (1890)

In this paper I limit the term stricture of the urethra to organic contractions in the lumen of the canal not caused by traumatism, incidental to her sex or the result of destructive or malignant disease. In a surgical sense, it is the same condition that we define by this term in the male. I find it necessary to thus limit the disease, because the affection is supposed to be rarely found in women, that all manner of causes have to be enumerated in order to explain its presence. In the two most recent and elaborate monographs upon the subject, that by Fissiaux and by Herman, all manner of accidental conditions are invoked to explain the condition. When the causes of urethral stricture in women are reduced to two, specific urethritis and traumatism principally (Fissiaux), it will be clear to any one who studies it independently and free from
Coronary vasomotor effects of serotonin in patients with angina. Relation to coronary stenosis morphology.
Authors: D Tousoulis, G Davies, E McFadden, J Clarke, J C Kaski, A Maseri
Journal: Circulation (1993)

BACKGROUND Previous experimental studies have shown that the effect of serotonin on a coronary stenosis depends on whether that stenosis is compliant or fixed. However, the relation between coronary stenosis morphology and the response to serotonin in patients with angina is not known. METHODS AND RESULTS Using computerized quantitative coronary angiography, we studied the effects of intracoronary infusion of serotonin on 38 coronary stenoses of different morphologies (concentric, eccentric, complicated) in 11 patients with stable angina and 4 with variant angina. In response to the maximum infused concentration of serotonin, 100% of complicated stenoses and 50% of concentric stenoses constricted by &gt; or = 20% (P &lt; .05). The magnitude of constriction was greater at eccentric stenoses (32.08 +/- 4.1%) than concentric stenoses (15.68 +/- 2.8%, P &lt; .05) and greater in complicated stenoses (57.69 +/- 7.6%, P &lt; .05) than eccentric stenoses. At complicated stenoses, the constriction was greater (0.85 +/- 0.16 mm, P &lt; .05) than at the adjacent reference segments (0.42 +/- 0.12 mm). It was similar to the reference segment for both concentric and eccentric stenoses. The constriction at the stenosis was greater for irregular (complicated) lesions than for smooth (concentric and eccentric) lesions in both patients with stable (51.8 +/- 7.3% versus 22.5 +/- 4.1%, P &lt; .001) and those with variant (77 +/- 17% versus 28.2 +/- 8.1%, P &lt; .05) angina. There was a weak correlation (r = .39) of magnitude of constriction with stenosis length but not with baseline stenosis severity (minimum diameter). CONCLUSIONS In these patients, the magnitude of the vasoconstrictor response to serotonin at the site of an atheromatous coronary plaque depends on the morphological characteristics of the plaque and is more closely related to irregular contour than stenosis severity or length. This relation suggests that variations in receptor type or density or in the smooth muscle cell response to stimulation may determine the response to locally released serotonin in patients with coronary disease.
Persistent Splenic Visualization on Technetium-99m DISIDA Hepatobiliary Studies
Authors: JESSE BALSEIRO, MELVIN J. FRATKIN, JERRY I. HIRSCH, HALCOTT T. HADEN
Journal: Clinical Nuclear Medicine (1990)

Tc-99m DISIDA is widely used for studying a variety of biliary conditions. It is generally recognized that the spleen is normally visualized on DISIDA imaging only during the blood pool phase. Upon review of our experience with DISIDA, visualization of the spleen was found more common than generally acknowledged. All DISIDA examinations performed at our two institutions were retrospectively reviewed; 95 studies were performed at Institution #1 and 150 studies at Institution #2. There were 138 men and 107 women. Quality control to confirm radiochemical purity included sephadex gel column chromatography. Of 245 patient studies, persistent splenic visualization was identified in one patient (1.0%) at Institution #1 and in 11 patients (7.3%) at Institution #2. There was no correlation between age, sex or final diagnosis and persistent visualization of the spleen. It is suggested that persistent splenic visualization may be caused by an elevated concentration of reduced hydrolized technetium (colloid) in DISIDA.
Bile Porphyrin Analysis in the Evaluation of Variegate Porphyria
Authors: George M. Logan, Mary K. Weimer, Mark Ellefson, Claus A. Pierach, Joseph R. Bloomer
Journal: New England Journal of Medicine (1991)

Variegate porphyria is a genetic disorder of porphyrin metabolism in which patients may have both neurologic dysfunction and photocutaneous lesions. Biochemical confirmation of the diagnosis can be difficult, particularly in patients without neurologic dysfunction at the time of testing. The demonstration of increased fecal excretion of porphyrin is frequently used for this purpose, but levels may be normal. Since elevated fecal porphyrin levels in variegate porphyria are presumably a consequence of increased biliary excretion, we evaluated whether analysis of porphyrins in bile distinguishes better between patients with variegate porphyria and controls.
Doctors face GMC over failure to spot overdose in Shipman patient
Authors: Owen Dyer
Journal: BMJ (2005)

The former heads of an intensive care unit that treated one of Harold Shipman's victims failed to raise the alarm over the morphine overdose that killed her, the General Medical Council heard last week.

Geraint Brown and Murtaza Husaini were joint directors of Tameside General Hospital's intensive care unit in February 1994, when a 47 year old patient, named only as Ms A, was admitted. She was in a persistent vegetative state after respiratory arrest brought on by a single massive dose of morphine, given by GP Harold Shipman, who is thought to have murdered more than 100 of his patients. Ms A …
Rheumatologists issue guidelines for preventing and treating corticosteroid-induced osteoporosis
Authors: A. A. Skolnick
Journal: JAMA (1997)

DESPITE ALL that is known about the bone-robbing effects of corticosteroids, many physicians still do not realize the importance of prescribing proper therapy to prevent osteoporosis in patients on long-term corticosteroid treatment. That is the finding of a study reported at the 1996 National Scientific Meeting of the American College of Rheumatology (ACR) in Orlando, Fla. The study found that the majority of physicians surveyed in 1995 underestimated the risk of osteoporosis from corticosteroid use in men and premenopausal women. Most also did not know about the efficacy of several leading therapies for preventing bone loss. To better educate physicians regarding the care of patients taking corticosteroids, the ACR released at the meeting its first guidelines for the medical management of steroid-induced osteoporosis. The guidelines describe the options the ACR recommends for women, men, and children who are taking corticosteroids (<i>Arthritis Rheum</i>. 1996;39: 1791-1801). Corticosteroids are widely used for treating
Polycythemia vera in a patient with acquired immunodeficiency syndrome
Authors: Hesham M. Taha, Barry H. Kaplan
Journal: American Journal of Hematology (1998)

The letter published in the November 1997 issue, regarding simultaneous occurrence of lupus anticoagulant (LA) and factor VIII inhibitors [1,2], is very interesting.We agree with Dr. D.A. Triplett that it is of critical importance to differentiate an LA from a factor VIII inhibitor.Strict observance of the criteria recommended by the SSC Subcommittee on Lupus Anticoagulant/Phospholipid-Dependent Antibodies [3] is essential for this purpose.More than one test, with different assay principles, is necessary to screen for an LA, mainly in patients with other simultaneous coagulation defects, such as a neutralizing inhibitor or a factor deficiency.In a recently published study of 170 consecutive hemophilia A patients, we found 36 hemophiliacs who fulfilled the criteria for the diagnosis of LA, 18 of them with a time-dependent effect.It is possible that subjects with a strong time-dependent effect may have both a factor VIII inhibitor and an LA (n ‫ס‬ 12) [4].LAs were diagnosed based mainly on diluted Russell viper venom time (dRVVT).The activated partial thromboplastin time (APTT) is affected by factor VIII inhibitors; however, the platelet neutralization procedure of the APTT showed similar results to those obtained for dRVVT, except in three patients with positive dRVVT, for whom the shortening of the PNP was not sufficient to be considered positive.In our study, the StaclotLA results agreed with those from dRVVT; 8/8 were positive on LAs and 3/3 were negative on factor VIII inhibitors.We believe that factor VIII inhibitors could be masked by LA and the misdiagnosis could delay the prescription of the appropriate therapy [5].The above evidence stresses the need to develop a specific test to identify factor VIII inhibitors without interference of LA, and vice versa.
The Early Diagnosis of Traumatic Bronchial Rupture
Authors: R. Maurice Hood
Journal: JAMA (1963)

<h3>To the Editor:</h3> —The Original Contribution titled, "Early Diagnosis of Traumatic Rupture of the Bronchus," which appeared in the Aug 25, 1962, issue ofThe Journal(<b>181</b>:682) shows in my opinion several errors in collection as well as in interpretation of data. Part of the difficulty comes from transposing one case into a major clinical experience. Dr. Burke's review of the literature is inaccurate in several regards. The author suggests that patients with major bronchial injury are frequently found to have lacerations of the great vessels and severe injuries to the head or other portions of the body. I refer to the article written by myself and Dr. Herbert Sloan, that appeared in the October, 1959, issue of<i>The Journal of Thoracic and Cardiovascular Surgery</i>. In reviewing a total of 98 cases, in 80 cases for which sufficient information was available it was apparent that in more than half