tbuckley/cabot-search huggingface dataset:
The ethics of randomised controlled trials from the perspectives of patients, the public, and healthcare professionals
Authors: S. J L Edwards, R J Lilford, J Hewison
Journal: BMJ (1998)

Since the introduction of randomised controlled trials, professionals and lay people alike have worried over whether doing this sort of experiment in humans is ethical. It has been argued that participants may be called to sacrifice their own best interests for the benefit of future patients.1 The scientific rationale for conducting a trial rests in collective equipoise, which means that the medical community as a whole is genuinely uncertain over which treatment is best. The key point, however, is that future patients benefit at no cost to participants, provided that participants are in personal equipoise and give informed consent on this basis. In these circumstances, the trial arms are an equally good bet prospectively.2

### Summary points

To find out what patients, the general public, and healthcare professionals thought about trials, we undertook a review of the ethics of randomised controlled trials from these perspectives as part of a broader review relating to the ethics of designing and conducting clinical trials.1 We searched BIDS, Medline, and Psychlit (for strategy see the BMJ website). There were 61 studies on attitudes …
A CASE OF RETROGRADE PUBERTY, IMPOTENCE AND DIABETES INSIPIDUS, RELIEVED BY SUPRARENAL CORTEX
Authors: WILLIAM T. BELFIELD
Journal: JAMA (1910)

<h3>History.—</h3> In 1897, H., aged 27, married, developed (1) polyuria without sugar, 120 to 150 ounces daily; (2) retrograde puberty; i. e., atrophy of testes, disappearance of beard, pubic and axillary hair, the scalp hair remaining luxuriant. The condition, called diabetes insipidus by the physicians consulted, had existed for twelve years, when, in 1909, the patient was referred to me. <h3>Diagnosis.—</h3> The polyuria and retrograde puberty suggested an excess of pituitary secretion. As an<i>x</i>-ray picture of the pituitary region by Dr. Reichmann revealed nothing abnormal, the pituitary excess was assumed to be not absolute, but relative, possibly from deficient secretion by the adrenal cortex. <h3>Treatment.—</h3> After thyroid substance, and later adrenalin (which is derived from the adrenal medulla only), had proved futile, he was given daily four grains of suprarenal substance, containing cortex as well as medulla. <h3>Result.—</h3> Improvement was prompt and distinct; after four months of this medication
Papal policy, poverty, and AIDS
Authors: M. Jarmulowicz
Journal: BMJ (1990)

Theatre and ward costs incurred for patients having either hysterectomy or endomnetrial resection for menorrhagia Endometrial Hysterectomy resection Mean theatre time (h) 1-24 0-75 Mean length of stay (days) 10-6 1 Mean cost (£): Theatre time* 253.37 153.25 Central sterile supply department 19.06 11.20 Sutures 20.00 Dressing 0.30 Gloves 4.00 1.00 Glycine 6.93 Syringes 0.14 Double irrigation system 5.00 Suction tubing 0.70 Sterile water 1.20 1.20 Medical assistantt 11.92 Anaesthetic 12.07 9.47 Cost of operation 321.92 188.89Mean ward costs (£)t 1140.67 107.61Total cost (£) 1462.59296.50 *The costs of theatre time (£204.33/hour)are based on an ideal 90% use of scheduled theatre time and incorporate operating time plus the time for induction and reversal of anaesthesia.tCalculated at an hourly rate from the midpoint on the senior house officer pay scale multiplied by the mean theatre time taken to perform hysterectomy.tCalculated at £107.61 a day.
The demise of the public health system in England
Authors: F. Greaves, D. Noble
Journal: BMJ (2011)

The health select committee has serious reservations about the changes to the public health system in the health reforms.1 We suggest that the government reforms threaten the public health system at every level.

The Health Protection Agency faces losing independence as it moves into central government. Health promotion functions are transferring to local authorities but possibly without a specialist …
CNTF is a major protective factor in demyelinating CNS disease: A neurotrophic cytokine as modulator in neuroinflammation
Authors: Ralf A. Linker, Mathias Mäurer, Stefanie Gaupp, Rudolf Martini, Bettina Holtmann, Ralf Giess, Peter Rieckmann, Hans Lassmann, Klaus V. Toyka, Michael Sendtner, Ralf Gold
Journal: Nature Medicine (2002)
A Lesson From the Slaughterhouse
Authors: Victor S. Sloan
Journal: Annals of Internal Medicine (2012)

Letters21 February 2012A Lesson From the SlaughterhouseVictor S. Sloan, MDVictor S. Sloan, MDFrom Robert Wood Johnson Medical School, Flemington, NJ 08822.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-4-201202210-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read the observation from Pusl and colleagues (1) regarding exogenous thyrotoxicosis with interest. The great medical journalist Berton Roueche described a similar phenomenon in his long-running column in The New Yorker, “Annals of Medicine” (2). In 1985, investigators from the Centers for Disease Control and Prevention traced an epidemic of thyrotoxicosis in a South Dakota meatpacking plant. Neck trimmings from the plant were being sold as 90% lean ground beef. The link was proven by, after approval by the Human Subjects Committee, having 4 volunteers eat cooked samples of the meat. Blood samples were obtained before ...References1. Pusl T, Jaehnig H, Dorn R. Thyrotoxicosis: a lesson from the slaughterhouse [Letter]. Ann Intern Med. 2011;155:646. [PMID: 22041959] LinkGoogle Scholar2. Roueche B. Annals of Medicine: “A Lean Cuisine.” The New Yorker. 27 June 1988;70. Google Scholar3. Gibson S. The house that Dave built. U of T Magazine. Winter 2008. Accessed at www.magazine.utoronto.ca/cover-story/david-shore-house-creator-television-producers/ on 2 November 2011. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Robert Wood Johnson Medical School, Flemington, NJ 08822.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThyrotoxicosis: A Lesson From the Slaughterhouse Thomas Pusl , Hendrik Jaehnig , and Robert Dorn Metrics 21 February 2012Volume 156, Issue 4Page: 328KeywordsBloodConflicts of interestMeatThyroid hormones ePublished: 21 February 2012 Issue Published: 21 February 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
1400 DISCOVERY OF A DIRECT ASSOCIATION BETWEEN PRIMARY BILIARY CIRRHOSIS AND LOW BONE MASS: IDENTIFICATION OF TNFSF11/RANKL AS A RISK LOCUS FOR PATIENTS WITH PBC
Authors: G.M. Hirschfield, B.D. Juran, P. Invernizzi, E.J. Atkinson, Y. Li, G. Xie, R. Kosoy, M. Ransom, Y. Sun, I. Bianchi, E.M. Schlicht, A. Lleo, C. Coltescu, F. Bernuzzi, C. Lammert, R. Shigetta, L.L. Chan, T. Balschun, M. Marconi, D. Cusi, A.L. Mason, R.P. Myers, P. Milkiewicz, J.A. Odin, V.A. Luketic, B. Bacon, H. Bodenheimer, V. Liakina, C. Vincent, C. Levy, A. Franke, P.K. Gregerson, V. Annese, M.E. Gershwin, M. de Andrade, C.I. Amos, K.N. Lazaridis, M.F. Seldin, K.A. Siminovitch
Journal: Journal of Hepatology (2012)
Medical Typists' Course
Authors: Frances W. Edmondson
Journal: JAMA (1965)

To the Editor:—  Would you like to have a secretary who—  Thinks like a man, Acts like a lady, Looks like a model, But works like a dog?  This anonymous motto has been adopted by the Medical Typists' Course, a program designed to give physicians better-trained medical secretaries. The lengthy transitional period from general secretary to qualified medical secretary is unfair to both employer and employee. Let's do something about it!  This problem is with us for a very good reason: Who is training the medical secretary? Almost no one. People within the medical profession are too busy to lend a hand here; people outside the medical profession don't know how. The responsibility actually lies with business teachers, but very few want to attempt material for which they themselves had no training.  On May 15 an educational forum on Teaching the Medical Typists' Course will be held at the Medical
Airway cells from atopic asthmatic patients exposed to ozone display an enhanced innate immune gene profile
Authors: Michelle Hernandez, Willie June Brickey, Neil E. Alexis, Rebecca C. Fry, Julia E. Rager, Baiming Zhou, Jenny P.Y. Ting, Haibo Zhou, David B. Peden
Journal: Journal of Allergy and Clinical Immunology (2011)
RELATION OF RHEUMATIC-LIKE CARDIAC LESIONS OF THE MOUSE TO LOCALIZATION OF GROUP A STREPTOCOCCAL CELL WALLS
Authors: S. H. Ohanian, J. H. Schwab, W. J. Cromartie
Journal: The Journal of Experimental Medicine (1969)

Mice injected intraperitoneally with isolated cell wall fragments of Group A streptococci develop a carditis similar to that previously observed in mice injected with crude extracts of this organism. Neither the soluble cytoplasmic components of Group A streptococcal cells nor the nonfragmented cell walls produced carditis in this experimental model. Fluorescein and (125)I-labeled antibodies specific for Group A streptococcal cell wall antigens were used to demonstrate that, for 5 wk after injection, cell wall material is localized around the sites of active lesions in the heart. In addition, the cell wall antigen accumulates in the liver, spleen, mediastinal lymph nodes, and the adjacent loose connective tissue, where it persists for at least 10 wk.
Benzodiazepines in general practice: time for a decision
Authors: M. G B Scott, J. Hosee
Journal: BMJ (1985)

Chlorothiazide is excreted rapidly and completely in the urine following its intravenous administration to dogs. Renal clearance studies show that chlorothiazide is secreted by the renal tubules; the tubular secretory component can be inhibited by probenecid. In nephrectomized dogs, plasma levels of a single intravenous dose of chlorothiazide fall as a result of rapid elimination in the bile, as much as 41% of a dose being excreted in the bile in 4 hours. Some 30 to 60% of a single oral dose of chlorothiazide is excreted in the urine. No accumulation of drug could be demonstrated in erythrocytes or tissues following C<sup>14</sup>-labeled chlorothiazide.
Inherited Chondrodysplasia Punctata Due to a Deletion of the Terminal Short Arm of an X Chromosome
Authors: Cynthia J. R. Curry, R. Ellen Magenis, Michael Brown, Joseph T. Lanman, Joseph Tsai, Patricia O'Lague, Peter Goodfellow, T. Mohandas, E. Ann Bergner, Larry T. Shapiro
Journal: New England Journal of Medicine (1984)

We studied two families with an inherited deletion of the short arm of an X chromosome (Xp) in which affected male offspring have epiphyseal stippling in infancy (chondrodysplasia punctata), nasal hypoplasia, ichthyosis, and mental retardation. The presence of ichthyosis and the apparent pattern of X-linked recessive inheritance prompted investigation of the short arm of the X chromosome through studies of genetic markers and focused cytogenetic analysis. Biochemical studies suggested that there was a deletion of three genes previously mapped to the X-chromosome short arm, including the steroid sulfatase locus, the Xg locus, and the M1C2X locus. Prometaphase chromosomes demonstrated a deletion of Xp at p22.32 in the affected boys, in their obligate-carrier mothers, and in 11 of 25 women at risk as potential carriers. The women carrying the Xp deletion had normal gonadal function and fertility but were shorter than the noncarriers in their families (P<0.00001). These findings have implications for the genetic organization of this portion of the human X chromosome and demonstrate that small cytogenetic abnormalities may account for disorders with apparent mendelian patterns of inheritance. (N Engl J Med 1984; 311:1010–5.)
HIV and Physical Examination Skills-Reply
Authors: Douglas S. Paauw
Journal: JAMA (1996)

In Reply.  —Dr Buhl is correct that the data collection for the study in which he participated took place several years ago. Physicians participated in the standardized patient examination in fall 1992. We appreciate Buhl's recognition of the importance of testing physical diagnosis skills on a regular basis and are pleased that the study has prompted initiation of continuing medical education courses related to identifying findings associated with HIV infection.
Case Report--The Testing and Training of an International Fast Bowler--Dennis Lillee
Authors: F. S. Pyke, G. C. Crouch, K. H. Davis
Journal: British Journal of Sports Medicine (1975)

After sustaining stress fractures in the lumbar vertebrae during the early part of 1973, the Australian fast bowler, Dennis Lillee rested from first-class cricket during the 1973-74 season.He had done no intensive exercise for almost eighteen months when he commenced his comeback training programme.
Predictors of Mortality among HIV-infected Women in Kigali, Rwanda
Authors: Christina P. Lindan, Susan Allen, Antoine Serufilira, Alan R. Lifson, Philippe Van de Perre, Amy Chen-Rundle, Jean Batungwanayo, Francois Nsengumuremyi, Joseph Bogaerts, Stephen Hulley
Journal: Annals of Internal Medicine (1992)

▪ Objective: To better characterize the natural history of disease due to human immunodeficiency virus (HIV) infection in African women. ▪ Design: Prospective cohort study over a 2-year follow-up period. ▪ Participants: A total of 460 HIV-seropositive women and a comparison cohort of HIV-seronegative women recruited from prenatal and pediatric clinics in Kigali, Rwanda in 1988. ▪ Measurements: Clinical signs and symptoms of HIV disease, AIDS, and mortality. ▪ Main Results: Follow-up data at 2 years were available for 93% of women who were still alive. At enrollment, many seropositive women reported symptoms listed in the World Health Organization (WHO) clinical case definition of AIDS, but these were nonspecific and often improved over time. The 2-year mortality among HIV-infected women by Kaplan-Meier survival analysis was 7% (95% Cl, 5% to 10%) overall, and 21% (Cl, 8% to 34%) for the 40 women who fulfilled the WHO case definition of AIDS at entry. In comparison, the 2-year mortality in women not infected with HIV was only 0.3% (Cl, 0% to 7%). Independent baseline predictors of mortality in seropositive women by Cox proportional hazards modeling were, in order of descending risk factor prevalence: a body mass index of 21 kg/m2 or less (relative hazard, 2.3; Cl, 1.1 to 4.8), low income (relative hazard, 2.3; Cl, 1.1 to 4.5), an erythrocyte sedimentation rate exceeding 60 mm/h (relative hazard, 4.9; Cl, 2.2 to 10.9), chronic diarrhea (relative hazard, 2.6; Cl, 1.1 to 5.7), a history of herpes zoster (relative hazard 5.3; Cl, 2.5 to 11.4), and oral Candida (relative hazard, 7.3; Cl, 1.6 to 33.3). Human immunodeficiency virus disease was the cause of death in 38 of the 39 HIV-positive women who died, but only 25 met the WHO definition of AIDS before death. ▪ Conclusions: Human immunodeficiency virus disease now accounts for 90% of all deaths among childbearing urban Rwandan women. Many symptomatic seropositive patients may show some clinical improvement and should not be denied routine medical care. Easily diagnosed signs and symptoms and inexpensive laboratory tests can be used in Africa to identify those patients with a particularly good or bad prognosis.
TCT-712 Clinical Outcomes of Patients With Low Flow, Low Gradient Severe Aortic Stenosis According To Treatment Modality
Authors: Crochan J. O'Sullivan, Lars Englberger, Stefan Stortecky, Christoph Huber, Nicola Hosek, Ahmed Khattab, Lutz Buellesfeld, Thomas Pilgrim, Bernhard Meier, Peter Wenaweser, Stephan Windecker
Journal: Journal of the American College of Cardiology (2013)
High protein diet brings risk of kidney stones
Authors: S. Gottlieb
Journal: BMJ (2002)

Diets heavy on foods that are high in protein and low in carbohydrates can increase the risk of kidney stones and reduce the body's ability to absorb calcium after just six weeks.

These findings from a new study come at a time when an increasing number of Americans, seduced by anecdotal accounts of fast weight loss, are turning to low carbohydrate, high protein diets. Popularised by Dr Robert Atkins, these diets are having a revival after a recent cover story in the New …
Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study
Authors: K. de Jong, J.-W. Poley, J. van Hooft, M. Visser, M. Bruno, P. Fockens
Journal: Endoscopy (2011)

See also: Commentaire de travail de K. de Jong et al., pp. 585Endoscopy 2011; 43(07): 647-647DOI: 10.1055/s-0031-1291783
Landmark article May 23, 1942: Diffuse collagen disease. Acute disseminated lupus erythematosus and diffuse scleroderma. By Paul Klemperer, Abou D. Pollack and George Baehr
Authors: P. Klemperer
Journal: JAMA (1984)

The thesis of Morgagni that diseases reside in certain organs of the human body has dominated pathologic anatomy and clinical investigation for centuries. Every diagnostic endeavor was directed toward establishing the fundamental organ disease. No doubt, this working hypothesis has been the cornerstone on which rests the edifice of modern medicine. The great advance of medicine throughout the nineteenth century is essentially founded on the method of correlating observations made in the hospital ward with those at the postmortem table. This clinicopathologic concept was further advanced by the recognition of an interdependence and unity of certain organs to form organ or tissue systems. Diseases of the hemopoietic or of the reticuloendothelial system represent such an extension of the scope of organ pathology. Nevertheless, one cannot justly maintain that an essential site is established in every disease. A number of acute infections and intoxications do not produce characteristic or even significant
Abstract P3-06-04: Differences in survival among women with primary and secondary metastatic breast cancer
Authors: J Barinoff, M Schmidt, A Schneeweiss, A Hinke, W Schoenegg, S Henken, A Kutscheidt, J Pintoffl, C Jackisch
Journal: Cancer Research (2013)

Abstract Background Retrospective analyses have shown survival differences in patients with primary metastatic breast cancer (PMBC) in comparison to patients with secondary metastatic breast cancer (SMBC). A subgroup analysis of 2,708 patients with metastatic breast cancer from two prospective non-interventional studies (NIS) allows exploring this hypothesis. The Her2-positive-NIS investigated trastuzumab therapy for Her2 positive metastatic disease additional to predominantly first line chemotherapy. The second NIS observed bevacizumab therapy for predominantly Her2 negative disease additional to chemotherapy as first- line option. Methods Information on PMBC or SMBC was available in 2,401 patients diagnosed with metastatic breast cancer and treated with targeted therapy between 2000 and 2011. Previously endocrine therapy in palliative status was allowed. Progression free survival (PFS) was defined as the time from the start of antibody therapy to disease progression or death; overall survival (OS) was defined as the time from the start of targeted therapy with antibody to death of any cause; PFS and OS were estimated by Kaplan-Meier product limit method. Results 570 (24%) women had PMBC and 1831 (76%) had SMBC. Median follow-up was 23 months (range: 0.2 - 137). Median PFS in patients with PMBC and SMBC was 13.0 and 10.4 months, respectively (p = 0.0043); median OS for women with PMBC and SMBC was 33.5 and 28.5 months, respectively (p = 0.0023). 5 years after start of the study treatment 28% patients with primary and 23% with secondary metastatic disease were alive. Conclusion In a population of breast cancer patients treated with modern antibody therapies, woman with PMBC live significantly longer than those with SMBC. A possible explanation for this observation might be a negative selection process of patients suffering from secondary disease in spite of adequate primary treatment. Every fourth patients with metastatic breast cancer is a long survivor. The clinical-pathological characteristics and risk factors for this group are unclear. Prospective trials including translational investigations for these patient populations are needed. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-04.
Competition, Regulation, and Hospital Cost
Authors: D. N. Mendelson
Journal: JAMA (1989)

To the Editor. —  A recent article by Drs Robinson and Luft 1 shows that the increasein hospital costs per adjusted admission in Massachusetts from 1982 through 1986 was 16.3% lower than that observed in 43 control states. On the basis of these figures, they conclude that Massachusetts was one of the  state programs most successful in controlling hospital cost inflation. Unfortunately, this assertion is highly misleading on account of two aspects of their methodology.  First, the study looks only at the period during which cost containment was in effect; success in controlling cost inflation is defined as the difference between the rate of increase in costs in Massachusetts and the rise in the country as a whole during this period. However, to assess the impact of the legislation, it is also necessary to consider the rate of increase in costs observed before cost containment was imposed. The
Inhibition of nitric oxide synthesis in the forearm arterial bed of patients with advanced cirrhosis
Authors: Bernard Campillo, Pierre-Etienne Chabrier, Gabriel Pelle, Said Sediame, Guy Atlan, Paul Fouet, Serge Adnot
Journal: Hepatology (1995)

Increased vascular production of nitric oxide (NO) may contribute to the peripheral vasodilation and hyperdynamic state complicating advanced liver cirrhosis. In this study, we examined the effect on forearm blood flow of local brachial artery infusion of noradrenaline (NA) and NG-monomethyl-L-arginine (L-NMMA), an inhibitor of NO-synthase, in 10 alcoholic ascitic cirrhotic patients (patients with decompensated alcohol-induced liver disease: DALD group) and 10 patients with well-compensated alcohol-induced liver disease (CALD group). Forearm blood flow was measured by venous occlusion plethysmography. As compared with the CALD group, the DALD group had higher cardiac index and forearm blood flow as well as lower systemic blood pressure and vascular resistance. Infusions of NA and L-NMMA produced similar reduction in resting blood flow in the CALD group. However, in the DALD group, NA was significantly less effective than L-NMMA. The forearm vasoconstrictor response to NA was also significantly reduced in the DALD group when compared with the CALD group. In the DALD group, NA decreased forearm blood flow by 21.0 +/- 6.2% and increased vascular resistance by 37.2 +/- 12.3%, whereas respective changes in the CALD group were 41.8 +/- 6.2% (P < .01) and 77.8 +/- 9.9% (P < .02). In contrast, L-NMMA induced greater forearm vasoconstriction in the DALD group than in the CALD group. In decompensated patients, L-NMMA decreased forearm blood flow by 50.4 +/- 2.7% and increased vascular resistance by 115.9 +/- 14.4%, whereas changes in compensated patients were 38.2 +/- 4.9% (P < .05) and 77.4 +/- 16.2% (NS), respectively. These results are consistent with the hypothesis that increased vascular synthesis of NO contributes to the high dynamic state of patients with advanced cirrhosis.