tbuckley/cabot-search huggingface dataset:
GPs in England still reluctant to offer patients choice of provider, says report
Authors: C. Hicks
Journal: BMJ (2010)

Most patients want a choice of hospital provider, but only about half say they have been given that choice by their GPs, says a report published jointly by the King’s Fund, the Picker Institute, RAND Europe, and the Office of Health Economics. 

GPs’ perception that it is only younger, more educated patients who want choice is also misguided, says the report, which found that older people, those with no formal qualifications, and those from diverse ethnic backgrounds were more likely to think that choice was important. This could lead GPs to offer choice selectively, the report warns.

Its findings are …
Coeliac disease: is case finding the correct ethical and logistical approach?
Authors: D S Sanders
Journal: Gut (2003)

Caution with the use of cyclosporin in pregnancyWe read the article by Alstead and Nelson-Piercy with great interest. 1 We report a case (submitted for publication) of a woman with fulminant ulcerative colitis in the 29th week of pregnancy.Her disease was refractory to steroids, but she refused to have cyclosporin whilst pregnant.She therefore underwent an emergency Caesarean section and was given intravenous cyclosporin post-operatively.After 48 hours of treatment she developed severe hypertension with hypertensive encephalopathy and seizures.Although cyclosporin has been considered to be safe for both mother and foetus, we would like to highlight concerns that it is associated with potentially life threatening side effects.As a result, patients must be counselled thoroughly about the potential morbidity associated with this treatment and monitored closely.We agree with Dr Alstead in that cyclosporin should be used with extreme caution in pregnancy and the postnatal period.
Behavioral Methods in the Treatment of Hypertension
Authors: ALVIN P. SHAPIRO
Journal: Annals of Internal Medicine (1977)

Behavioral methods to lower blood pressure include biofeedback, relaxation, psychotherapy, suggestion and placebo, and environmental modification. Reported data for each method have been examined applying the clinical pharmacologic format used to study other therapeutic agents. Most studies have been Phase I type, small numbers of subjects in acute (short-term) treatment situations. Phase II studies, controlled trials with comparison with known effective agents, are sparse, and Phase III studies are not yet appropriate. These Phase I studies indicate blood pressure effects that are small, with minimal data about their duration and their relation to the use of pharmacologic agents. The methods are adjunctive and not alternative, while the compliance problem is similar to that with pharmacologic agents. The major differences between the methods are the ease with which they can be used. Widespread application of the nonpharmacologic methods cannot currently be recommended, but further basic and clinical research into mechanisms and outcomes is encouraged.
Protecting Privacy of Computerized Patient Information May Lie in the Cards
Authors: Andrew A. Skolnick
Journal: JAMA (1994)

NO MATTER which—if any—sort of national health care system reform is finally adopted by Congress, it is almost certain to bring about a great change in the way patient information is gathered, stored, and used for patient care, for medical and social research, and for physician and hospital reimbursement. The shift from paper to computerized recordkeeping, which is virtually mandated by health care system reform, promises not only greater efficiency and cost savings but increased concerns about the threat to patient privacy. Such concerns have not been lessened by reports of recent breaches of computer security that could have been disastrous for the patients involved. For example, the theft of three computers and floppy disks from Jackson Memorial Hospital in Miami, Fla, last November, suggests how harmful such breaches can be. Stored in the computers and on the disks were the names of more than 7000 patients who had received
Reasonableness and Randomization in Clinical Trials: Fundamental Law and Governmental Regulation
Authors: William J. Curran
Journal: New England Journal of Medicine (1979)

The basic law of this country, the common law, has dealt very little with the complex issues of human rights presented by randomization. The fundamental legal approach to this subject would start with an examination of the duty owed to the subjects in the study. If each of the potential subjects is a patient in need of treatment, the primary duty of the clinical group is to provide proper medical care. No research study could be allowed to compromise this primary obligation.In a hospital setting where both subjects and controls are sick patients, the clinical investigator may be tempted . . .
Herpes zoster in pregnancy.
Authors: W J McKinlay
Journal: BMJ (1980)

However, it seems relevant to refer now to the incidence of vomiting in paracetamol poison- ing.In total, we have records of 392 patients who ingested analgesic overdoses which included paracetamol; 120 took paracetamol alone, 44 took Distalgesic (dextropropoxyphene and paracetamol) alone, 157 took paracetamol combined with other drugs, and 71 took Distalgesic combined with other drugs.Among these patients only 46 (11-7 %) had vomited or were vomiting at the time of admission; and of the 63 who were treated with oral methionine, vomiting occurred in only 13.Further examination of these cases shows that all vomited before the treatment began but that this symptom did not persist during treatment.Obviously further analysis of these data is required, but it is already appaient that the difference in the incidence of vomiting with this type of poisoning as reported from Edinburgh (77 %)1 and London (16 %)2 cannot be explained simply by the fact that many of the latter data are collected indirectly through the Poisons Information Service inquiries.
Prevalence of Nonstenosing, Complicated Atherosclerotic Plaques in Cryptogenic Stroke
Authors: Tobias M. Freilinger, Andreas Schindler, Caroline Schmidt, Jochen Grimm, Clemens Cyran, Florian Schwarz, Fabian Bamberg, Jennifer Linn, Maximilian Reiser, Chun Yuan, Konstantin Nikolaou, Martin Dichgans, Tobias Saam
Journal: JACC. Cardiovascular imaging (2012)
Dietary Sodium and Blood Pressure
Authors: Ronald M. Krauss
Journal: JAMA (1996)

<h3>To the Editor.</h3> —Just as the meta-analysis that addressed the impact of dietary salt reduction on blood pressure was published in<i>JAMA</i>,<sup>1</sup>an updated analysis from the Intersalt study was published in the<i>BMJ</i>.<sup>2</sup>The investigators of this large, observational study indicate that their earlier estimates of the association of salt intake with both level of blood pressure and increase of blood pressure with age were underestimated because of incomplete statistical correction for regression dilution bias. They concluded that the results of the Intersalt study support population-based recommemdations for salt reduction for the prevention and control of adverse blood pressure levels. Several accompanying editorials and letters to the editor concur with this recommendation and are critical of the "vested interest" of the food industry for keeping the salt controversy alive. The media continue to publicize this apparent controversy. Any guideline for an upper limit of sodium intake is admittedly arbitrary and
225 A randomized placebo controlled trial of vitamin E in alcoholic hepatitis
Authors: E MEZEY, J POTTER, L RENNIETRANKERSLEY, J CABALLERIA, A PARES
Journal: Hepatology (2003)

Background/Aims: The effect of vitamin E administration on clinical and laboratory parameters of liver function and on markers of fibrogenesis was assessed in patients with mild to moderate alcoholic hepatitis in a double blind placebo controlled randomized trial. Methods: Twenty-five patients received 1000 I.U. of vitamin E per day, while 26 patients received placebo for 3 months. The patients were followed for 1 year after entry into the trial. Results: Vitamin E did not result in significant greater decreases in serum aminotransferases and serum bilirubin or in greater increases in serum albumin as compared with placebo. Prothrombin time did not change, while serum creatinine remained in the normal range. Monocyte nuclear nuclear factor-kB binding activity decreased in patients who remained abstinent, regardless of whether they received vitamin E. As regards markers of hepatic fibrogenesis, vitamin E treatment decreased serum hyaluronic acid ( P< 0.05) while serum aminoterminal peptide of type III procollagen did not change in either group. Four patients in the treatment group and five in the placebo group died during the 1-year study. Conclusions: Vitamin E treatment improves serum hyaluronic acid but has no beneficial effects on tests of liver function in patients with mild to moderate alcoholic hepatitis. q 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Interferon-α Treatment of Four Patients with the Churg-Strauss Syndrome
Authors: Efstratios Tatsis
Journal: Annals of Internal Medicine (1998)

Interferon-alpha is reported to have a beneficial effect on patients with the idiopathic hypereosinophilic syndrome.To study the effect of interferon-alpha on the Churg-Strauss syndrome.Case series.University hospital.Four patients with biopsy-proven Churg-Strauss syndrome.Interferon-alpha at dosages of 7.5 to 63 million U per week.Disease extent, disease activity, and blood eosinophil count in a treatment period ranging from 14 to 25 months.Interferon-alpha therapy led to remission of disease and a substantial reduction of the prednisolone requirement in two patients who had attained incomplete remission with cyclophosphamide or methotrexate. The third patient's condition stabilized, and the fourth patient maintained remission. During interferon-alpha therapy, the blood eosinophil count in all patients decreased in a dose-dependent manner and paralleled the extent of clinical disease and disease activity.Interferon-alpha may be an effective treatment for the Churg-Strauss syndrome. It seems to exert its effect primarily by producing a dose-dependent decrease in the blood eosinophil count.
Childhood asthma in adult life: a further study at 28 years of age.
Authors: W J Kelly, I Hudson, P D Phelan, M C Pain, A Olinsky
Journal: BMJ (1987)

A group of 323 subjects who had wheezed in childhood and 48 control subjects of the same age were studied prospectively from 7 to 28 years of age. A classification system based on wheezing frequency was found to correlate well with clinical and spirometric features of airway obstruction. The amount of wheezing in early adolescence seemed to be a guide for severity in later life with 73% of those with few symptoms at 14 continuing to have little or no asthma at 28 years. Similarly 68% of those with frequent wheezing at 14 still suffered from recurrent asthma at 28 years. Most subjects with frequent wheezing at 21 continued to have comparable asthma at 28 years. Of those with infrequent wheezing at 21, 44% had worsened at 28 years. Women fared better than men between 21 and 28 with 19% having worse symptoms compared with 28% of men. Treatment at all ages was generally inadequate. The number of smokers among those with asthma was of concern.
Stimulation of cyclic AMP synthesis by combined overexpression of the nucleoside diphosphate kinase NM23H2 and the alpha-subunit of Gs proteins
Authors: Feraydoon Niroomand, Hans-Joerg Hippe, Susanne Lutz, Katrin Knorr, Matthias Meyborg
Journal: Journal of the American College of Cardiology (2002)
The Electrokymograph: Studies in Recording Fidelity
Authors: HARRY F. ZINSSER, CALVIN F. KAY, J. MALVERN BENJAMIN
Journal: Circulation (1950)

Several electrokymographs were subjected to study of their recording fidelity. Distortions were found in respect to time and amplitude of recorded response. The recording defects were analyzed quantitatively, and the degree to which the various components of the electrokymograph contribute to these distortions was measured. The significance of these deviations in recording fidelity is discussed in reference to the application of the electrokymograph to the study of cardiovascular dynamics.
901-28 Lack of Correlation Between Relief of Chest Pain After Sublingual Nitroglycerin and Reversible Radionuclide Perfusion Defects or Presence of Significant Coronary Atherosclerosis on Coronary Angiography
Authors: Joseph P. Ornato, Robert L. Jesse, James L. Tatum, Christopher S. Nicholson, Mary Ann Peberdy, Charlotte S. Roberts
Journal: Journal of the American College of Cardiology (1995)
Australian doctors on strike.
Authors: P C Arnold
Journal: BMJ (1984)

far as the members of the medical profession themselves are concerned, there can be no doubt that the nature of their calling as doctors, surgeons and nurses imposes on them a moral duty never to strike or to engage in any action designed to reduce the level of service provided, no matter how deep or bitter their sense of grievance.,,1 Many within and without the profession would agree with Professor Macfarlane's claim. Yet nurses' strikes are almost beyond counting. Preliminary research shows that doctors have taken strike action in at least 17 Western countries, in many of which there have been more than one strike. Now Australia has had its first doctors' strike. An understanding of this event requires some knowledge of recent changes in health insurance arrangements. The system before February 1984 has been described recently.2 3 Australia has a comprehensive system of public (state owned) and private (charity or commercial) hospitals. The current dispute concerns the conditions under which consultants may treat private, fee paying patients in public hospitals. For decades consultants have offered thejr services free of charge in the public hospitals, treating the indigent and teaching medical and nursing students. In exchange these honoraries could admit private patients. The public hospitals also employed staff specialists, fully salaried but with the right to treat some private patients. Over the past 15 years Australia has experienced a variety of health insurance schemes. The costs of medical and hospital care have been shared?in varying proportions, at different times, in many schemes?between the federal government, the state governments, and the voluntary health insurance  (British United Provident Association type organisations*). Each change of government policy has resembled a game of musical chairs, with the major responsibility for costs being tossed around between the governments and the funds like the proverbial hot potato. In New South Wales, where specialists led the recent strike, the state government decided some years ago on a novel method of economising on staff specialists' salaries. It offered them the opportunity of treating more private patients in exchange for a substantial reduction in salary. As the patients' fees were met through the funds, which were in turn subsidised by the federal government, a clever New South Wales government was able to pass the buck. The specialists most affected were those in pathology, radiology, and nuclear medicine. Their work, as is usual in these specialties, consists of the interpretation of data obtained
SELECTION OF ANESTHETIC IN SURGERY.
Authors: JOHN A. WYETH
Journal: JAMA (1900)

I shall state my own views, based on a fairly large operative experience extending over a period of more than a quarter of a century, rather than read a paper fortified with the records of experiments, the statistics of accidents, or the peculiar views of others. I shall deal only with the two well-known anesthetics, chloroform and ether, and these without mixture. My early experience under my preceptor in northern Alabama, and at the University of Louisville in 1867-68-69, when I was a student there, was altogether in the use of chloroform. I do not think that in those three years I saw any other anesthetic employed. About the time of my graduation in Louisville, in 1869, I witnessed the death of a girl, about 16 years of age, to whom chloroform was being administered preliminary to a minor operation for the removal of a portion of a diseased tarsus.
The Association of Cyclosporine With the 1-Year Costs of Cadaver-Donor Kidney Transplants
Authors: Jonathan Showstack
Journal: JAMA (1990)

Cyclosporine is associated with lower hospitalization costs for transplantation of cadaver kidneys. Whether this cost-lowering effect persists after discharge was assessed for 203 patients who received cadaver kidneys at the University of California, San Francisco, between July 1982 and June 1986. During the transplantation hospitalization period, cyclosporine was associated with significantly better graft survival (88.7% vs 71.0%) and lower (standardized) costs ($37 174 vs $52 983). Following discharge, however, there were no significant differences in graft survival, total charges ($29 716 vs $34 434), the number of readmissions, the total number of days hospitalized, or physician charges, although cyclosporine was associated with higher drug costs ($3885 vs $373). The results suggest that the initial association of cyclosporine with lower costs diminished substantially over time. For grafts that survive beyond several months, there may be little additional cost-reducing benefits of cyclosporine. (<i>JAMA</i>. 1990;264:1818-1823)
Losartan Reduces the Costs Associated With Diabetic End-Stage Renal Disease
Authors: William H. Herman, Shahnaz Shahinfar, George W. Carides, Erik J. Dasbach, William C. Gerth, Charles M. Alexander, John R. Cook, William F. Keane, Barry M. Brenner
Journal: Diabetes Care (2003)

OBJECTIVE—To evaluate the within-trial effect of losartan and conventional antihypertensive therapy (CT) compared with placebo and CT on the economic cost associated with end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS—The Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan (RENAAL) study was a multinational double-blind randomized placebo-controlled clinical trial designed to evaluate the renal protective effects of losartan on a background of CT (excluding ACE inhibitors and angiotensin II receptor agonists [AIIAs]) in patients with type 2 diabetes and nephropathy. The primary composite end point was doubling of serum creatinine, ESRD, or death. Data on the duration of ESRD were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the days each patient experienced ESRD with the cost of ESRD over time. The cost of ESRD for individuals with diabetes was estimated using data from the U.S. Renal Data System. Total cost was estimated as the sum of the cost associated with ESRD and the cost of study therapy. RESULTS—We estimated that losartan and CT compared with placebo and CT reduced the number of days with ESRD by 33.6 per patient over 3.5 years (P = 0.004, 95% CI 10.9–56.3). This reduction in ESRD days resulted in a decrease in cost associated with ESRD of $5,144 per patient (P = 0.003, 95% CI $1,701 to $8,587). After accounting for the cost of losartan, the reduction in ESRD days resulted in a net savings of $3,522 per patient over 3.5 years (P = 0.041, $143 to $6,900). CONCLUSIONS—Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the incidence of ESRD, but also resulted in substantial cost savings.
Intensive Statin Therapy and the Risk of Hospitalization for Heart Failure After an Acute Coronary Syndrome in the PROVE IT–TIMI 22 Study
Authors: Benjamin M. Scirica, David A. Morrow, Christopher P. Cannon, Kausik K. Ray, Marc S. Sabatine, Petr Jarolim, Amy Shui, Carolyn H. McCabe, Eugene Braunwald
Journal: Journal of the American College of Cardiology (2006)
Evaluation of Toxicity in Long-Term Clinical Trials
Authors: Edward D. Freis
Journal: JAMA (1964)

ALL EFFECTIVE DRUGS are potentially toxic. The toxicity of a new agent is relative and must be evaluated in relation to the drug's effectiveness as well as to the severity of the disease being treated. If the disease is serious, an increased incidence of toxicity can be tolerated in a new drug if it is more effective than previously known agents. On the other hand, if the disease is minor then only minimal toxicity will be tolerated regard-less of how effective the drug may be. The three factors—toxicity, therapeutic effectiveness, and the severity of the disease—must be considered in relation to each other. <h3>Preliminary Procedures</h3> A sequence of routine steps should be taken before the submission of a large series of patients to a long-term trial of a new agent. The investigator must be supplied by the sponsor with the chemical structure and animal pharmacology of the drug. The acute
Surgery in patients with hemoglobin SC disease
Authors: Lynne Neumayr, Mabel Koshy, Charles Haberkern, Ann Noonan Earles, Rita Bellevue, Kathryn Hassell, Scott Miller, Dennis Black, Elliott Vichinsky
Journal: American Journal of Hematology (1998)

While surgery is commonly required for complications related to hemoglobin SC (HbSC) disease, little is known about the perioperative complications or the indications for preoperative transfusion in this group. We describe the patient characteristics, preoperative transfusion regimens, and outcome in 92 patients with HbSC and sickle-variants undergoing elective surgery. Thirty-eight percent of the patients were transfused preoperatively. Patients transfused were more likely to have been hospitalized in the year prior to the surgery and scheduled for abdominal procedures. Abdominal and ear, nose and throat procedures were the most common surgeries in our study. The overall complication rate was 18% and sickle cell-related complications occurred in 9% of patients. In patients undergoing intra-abdominal procedures, the incidence of sickle cell-related complications was significantly higher in those patients not transfused prior to their surgery (35 vs. 0%). There were two deaths. We recommend selective use of preoperative transfusion in patients with HbSC disease undergoing surgery. Transfusion appears to be beneficial in abdominal cases but is not necessary with minor procedures such as myringtomy.
To the Editors: The Asthma Control Questionnaire for children: still more questions than answers
Authors: L. van den Bemt, S. van Bragt, T. Schermer
Journal: European Respiratory Journal (2011)

The Asthma Control Questionnaire for children: still more questions than answersTo the Editors:Optimising control is the main goal in paediatric asthma management and reliable instruments that can help physicians to evaluate asthma control in an easy way are valuable.The article by JUNIPER et al.[1] provides some initial insights on the use of the Asthma Control Questionnaire (ACQ), an instrument that was originally developed for adult asthma, to assess asthma control in children.The process of developing and
Why the Piagetian A-not-B phenomenon is no error: A comparative perspective
Authors: Jack P. Hailman
Journal: Behavioral and Brain Sciences (2001)

A-not-B behavior in various mammals and birds suggests it has been selected for during evolution. One scenario is that displacement to B of one food item from a trove at A should not distract the forager. Piagetian stage V experiments may not test for object permanence, but rather for the more abstract notion that physical objects can be unique.