tbuckley/cabot-search huggingface dataset:
Was Rodney Ledward a statistical outlier?:Authors' reply
Authors: Mike Harley, John Yates, Mohammed A Mohammed, Shakir Hussain, Abdullah Almasri
Journal: BMJ (2005)

The General Medical Council and the future of revalidation GMC member respondsEditor-Esmail and Kmietowicz give an inaccurate account of the General Medical Council's policy development on revalidation, ignoring an iterative process with interested parties since 1998 in an attempt to introduce the most fundamental change to medical regulation since its foundation in 1858. 1 2 The GMC clearly has had regard to the legitimate interests of three principal groups-government and the NHS, patients and the public, and the various tribes that make up the UK medical profession.Despite suggestions to the contrary, an initial exploratory meeting on revalidation convened by Sir Donald Irvine in June 1998 was held in the context of a high profile professional conduct case, but well before the Bristol inquiry report and absolutely nothing to do with Rodney Ledward or, indeed, Harold Shipman.It was recognised then that some doctors were not keeping fully up to date nor were they indulging in reflective practice.Irvine correctly proposed that there was a need to make registration with the GMC more meaningful to the public than a mere recognition that doctors had reached a certain standard of professional knowledge in their early 20s.Both articles promote the idea that the doctors' regulator should be filling the vacuum within the NHS created by its failing to fulfil its public responsibility to monitor doctors' clinical standards.Clinical governance is now, slowly, being developed and eventually will extend from systems and teams to individuals-but is it reasonable, as both authors postulate, that such monitoring should become the financial and moral responsibility of the GMC sitting in London and Manchester rather than local managers at the coalface?Although revalidation is a continuing process, it becomes summative only every five years.The NHS and its local systems must not be allowed to abrogate their responsibility for the safety of patients on a day to day basis.Nor should they demand that the GMC and its prime function of assuring fitness to practise and the meaning of the medical register be inappropriately promoted as the first line of defence for the maintenance of clinical quality and safety.
England's health regulator screens hospitals to identify which to inspect first
Authors: N. Hawkes
Journal: BMJ (2013)

England’s Care Quality Commission has published a list of 19 hospital trusts chosen for early inspection, on the basis of a new risk profiling tool. Nine of these are identified as posing the highest risk under the commission’s “intelligent monitoring system,” which uses data from 150 performance indicators, including feedback from patients, death rates, and staff surveys.1

The trusts to be inspected also include some already inspected by Bruce Keogh, the NHS’s medical director, on the basis of their high mortality scores,2 and some aspirant foundation trusts that the regulator of these trusts, Monitor, has asked the commission to take a closer look at. 

Eight mental health trusts and community health services will also be inspected, not because they are considered to be at high risk but to help the commission test and develop …
Relation between exposure to fluoride and bronchial responsiveness in aluminium potroom workers with work-related asthma-like symptoms.
Authors: V Soyseth, J Kongerud, J Ekstrand, J Boe
Journal: Thorax (1994)

BACKGROUND--The relation between plasma fluoride levels and bronchial responsiveness was investigated in a longitudinal study in aluminium potroom workers who reported work-related asthmatic symptoms. METHODS--From a cross-sectional respiratory survey, 26 men who reported work-related asthmatic symptoms on a validated questionnaire were selected for repeated measurements of bronchial responsiveness to methacholine. Regular analyses of plasma fluoride levels were performed. Exposure to fluoride and total particulates was assessed from routine surveillance of the workplace. Bronchial responsiveness was expressed as the dose-response slope of the line through the origin and last data point. RESULTS--A positive association was found between bronchial responsiveness and plasma fluoride levels, such that an increase in the plasma fluoride level of 10 ng/ml was associated with an increase in the dose-response slope by a factor of 1.11 (95% confidence interval 1.05 to 1.17). Plasma fluoride levels were associated with the total atmospheric fluoride concentration in mg/m3 (beta = 28.1), but not with total particulates in the environment. CONCLUSIONS--Bronchial responsiveness in aluminium potroom workers reporting work-related asthmatic symptoms appears to be related to plasma levels of fluoride. The underlying mechanism is, however, unknown.
FDG PET/CT Demonstration of Pancreatic Metastasis From Prostate Cancer
Authors: Bhushan Desai, Wafaa Elatre, David I. Quinn, Hossein Jadvar
Journal: Clinical Nuclear Medicine (2011)

We report the hybrid FDG PET/CT appearance of a biopsy-proven pancreatic metastasis from prostate cancer in a man with castrate-resistant metastatic disease. The common sites of metastases from prostate cancer are bone and locoregional lymph nodes. Pancreas is an atypical location of metastasis from prostate cancer. PET/CT in this case helped with the targeted pathologic confirmation to differentiate primary pancreatic tumor from an unusual metastasis from prostate cancer which in turn affected the clinical management.
1305 ASSOCIATION BETWEEN ADHERENCE TO THE MEDITERRANEAN DIET (MD) AND CLINICAL CHARACTERISTICS OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Authors: M. Kontogianni, A. Margariti, M. Georgoulis, N. Tileli, M. Deutsch, D. Tiniakos, E. Fragopoulou, R. Zaflropoulou, I. Manios, G. Papatheodoridis
Journal: Journal of Hepatology (2012)
Alteration of Bile Salt Metabolism by Dietary Fibre (Bran)
Authors: E. W. Pomare, K. W. Heaton
Journal: BMJ (1973)

Feeding dietary fibre in the form of bran induced changes in bile salt metabolism in five people with intact gall bladders. There was evidence of reduced dehydroxylation of bile salts; the proportion of deoxycholate conjugates in bile was reduced and the transfer of radioactivity from labelled taurocholate to deoxycholate was decreased. These findings, which were independent of changes in intestinal transit rate, imply that bran reduced the degradation of bile salts by colonic bacteria. This property of bran accords with recent theories that fibre-depleted diets favour the degradation of bile salts in the colon. These findings may be relevant to the aetiology of large bowel cancer.
A Pattern of Structural Change in Liver Autotransplantation
Authors: Bernard Sigel
Journal: JAMA (1961)

LIVER AUTOTRANSPLANTATION is the surgical removal of hepatic tissue from its natural site and relocation within the same subject. Further, as suggested by Dempster,<sup>1</sup>autotransplantation entails the transfer of tissue without significant interruption of its blood supply, thus assuring a maximal survival of cells. This definition distinguishes transplantation from implantation. Implantation is the transfer of free fragments of tissue without provision for a continuity of the vascular supply, resulting initially in varying degrees of necrosis. The lack of a clear distinction between auto-transplantation and autoimplantation and a scarcity of long-term observations of either method of liver tissue transfer has resulted in incomplete and sometimes confusing descriptions of the morphology of liver autotransplants. A study which would add such information would, therefore, be of importance, particularly in 2 respects: (1) to enhance the understanding of the general transplantation phenomenon by delineating what anatomical changes may be inherent to transplantation per
Assessment of clinical competence using objective structured examination.
Authors: R M Harden, M Stevenson, W W Downie, G M Wilson
Journal: BMJ (1975)

To avoid many of the disadvantages of the traditional clinical examination we have introduced the structured clinical examination. In this students rotate round a series of stations in the hospital ward. At one station they are asked to carry out a procedure, such as take a history, undertake one aspect of physical examination, or interpret laboratory investigations in the light of a patient9s problem, and at the next station they have to answer questions on the findings at the previous station and their interpretation. As they cannot go back to check on omissions multiple-choice questions have a minimal cueing effect. The students may be observed and scored at some stations by examiners using a check list. In the structured clinical examination the variables and complexity of the examination are more easily controlled, its aims can be more clearly defined, and more of the student9s knowledge can be tested. The examination is more objective and a marking strategy can be decided in advance. The examination results in improved feed-back to students and staff.
Coffee, Cocktails and Coronary Candidates
Authors: William B. Kannel
Journal: New England Journal of Medicine (1977)

The technologic revolution has provided a surfeit of rich foods at low muscle-energy cost and promoted indolence, sedentary living, obesity, the cigarette habit and extensive use of stimulating beverages. Of these factors only the cigarette habit, obesity and physical inactivity have been firmly incriminated as causes of excess cardiovascular mortality in prospective epidemiologic studies.For those wishing to avoid a heart attack, further depressing news came from the Boston Collaborative Study implying that coffee also damages the heart. And perhaps the final blow was the revelation that the daily social cocktail also caused myocardial damage.1 2 3 In this issue of the . . .
Influence of contraceptive pill and menstrual cycle on serum lipids and high-density lipoprotein cholesterol concentrations.
Authors: P N Demacker, R W Schade, A F Stalenhoef, P M Stuyt, A van't Laar
Journal: BMJ (1982)

The fluctuations of serum lipid and lipoprotein concentrations within one cycle were studied both in women using and not using oral contraceptives. High-density lipoprotein cholesterol decreased significantly from 1.47 mmol/l (57 mg/100 ml) to 1.30 mmol/l (50 mg/100 ml) during one contraceptive cycle in eight women and rose again to the initial value during the pill-free days. The mean concentration of total cholesterol also fell significantly as a result of the decrease of high-density lipoprotein cholesterol and of a not significant decrease of low-density lipoprotein cholesterol. The mean serum triglyceride concentration did not change significantly. The fluctuations in the concentration of serum lipids and lipoproteins in 10 women not using oral contraceptives were smaller than in the women using oral contraceptives and no significant changes in the concentrations were found during one cycle. Thus, high-density lipoprotein cholesterol concentration decreases during each contraceptive cycle. The time of blood sampling during the cycle is, therefore, of vital importance in interpreting the effect of oral contraceptives on high-density lipoprotein cholesterol. In women not using oral contraceptives blood can be sampled on random days during the cycle.
Management efficient NHS?
Authors: O. Furlong
Journal: BMJ (1984)

But does this mean that we should have a national grocery board and a series of general managers to control the grocery industry in each district ?This would be as relevant to the grocery industry as it is to the National Health Service.It is now too late to turn back, however, and we must continue to divert our energies and some of our best brains into devising a meaningful job description for general managers and in trying to devise ways of measuring their effectiveness.
Preventive health care in elderly people needs rethinking
Authors: Dee Mangin, Kieran Sweeney, Iona Heath
Journal: BMJ (2007)

<b>Dee Mangin, Kieran Sweeney, </b>and<b> Iona Heath</b> argue that, rather than prolonging life, preventive treatments in elderly people simply change the cause of death—the manner of our dying
Partial hepatectomy induces mobilization of a unique population of haematopoietic progenitor cells in human healthy liver donors
Authors: Ursula M. Gehling, Marc Willems, Maura Dandri, Jörg Petersen, Marc Berna, Michelle Thill, Tina Wulf, Lars Müller, Joerg M. Pollok, Kathleen Schlagner, Christiane Faltz, Dieter K. Hossfeld, Xavier Rogiers
Journal: Journal of Hepatology (2005)
An Animal Model of Autoimmune Emphysema
Authors: Laimute Taraseviciene-Stewart, Robertas Scerbavicius, Kang-Hyeon Choe, Melissa Moore, Andrew Sullivan, Mark R. Nicolls, Andrew P. Fontenot, Rubin M. Tuder, Norbert F. Voelkel
Journal: American Journal of Respiratory and Critical Care Medicine (2004)

Although cigarette smoking is implicated in the pathogenesis of emphysema, the precise mechanisms of chronic progressive alveolar septal destruction are not well understood. We show, in a novel animal model, that immunocompetent, but not athymic, nude rats injected intraperitoneally with xenogeneic endothelial cells (ECs) produce antibodies against ECs and develop emphysema. Immunization with ECs also leads to alveolar septal cell apoptosis and activation of matrix metalloproteases MMP-9 and MMP-2. Anti-EC antibodies cause EC apoptosis in vitro and emphysema in passively immunized mice. Moreover, immunization also causes accumulation of CD4+ T cells in the lung. Adoptive transfer of pathogenic, spleen-derived CD4+ cells into naive immunocompetent animal also results in emphysema. This study shows for the first time that humoral- and CD4+ cell-dependent mechanisms are sufficient to trigger the development of emphysema, suggesting that alveolar septal cell destruction might result from immune mechanisms.
Emotional responses in mother-infant musical interactions: A developmental perspective
Authors: Elena Longhi
Journal: Behavioral and Brain Sciences (2008)

Abstract With this commentary, I raise two issues relevant to the theoretical framework from a developmental perspective. First, the infants' emotional responses are induced by the music as well as by the multimodal information they perceive in interaction with their mothers, and these responses change with time. Second, contrary to what is suggested in the target article, musical expectancy is already experienced by young infants.
The extent of myocardial damage assessed by contrast‐enhanced MRI is a major determinant of N‐BNP concentration after myocardial infarction
Authors: Alexandre Cochet, Marianne Zeller, Yves Cottin, Clothilde Robert‐Valla, Alain Lalande, Isabelle L'Huilllier, Alexandre Comte, Paul M. Walker, Jean Desgres, Jean‐Eric Wolf, François Brunotte
Journal: European Journal of Heart Failure (2004)
The Effect of Isoniazid on BCG-Induced Toxicity in Patients with Superficial Bladder Cancer
Authors: M. Al Khalifa, P. Elfving, W. M&aring;nsson, S. Colleen, S. Hellsten, M. Duchek, G. Nyberg, P. Callaghan, C. Rademark, R. Eriksson, R. Olsson, G. Hagberg, C.E. Nelson
Journal: European Urology (2000)
TCT-37 Comparison of Sirolimus-eluting, Everolimus-eluting, Biodegradable Polymer stent, and Endothelial Progenitor Cell Capture stent in Patients with ST-elevation Myocardial Infarction
Authors: Hyun Woo Park, H.E.E.S.O.O.N. PARK, Se Hun Kang, Sang Soo Cheon, Min Su Kim, Byeong Joo Bae, Jae Hyung Roh, Mineok Chang, Sung-Han Yoon, Jung-Min Ahn, Jong-Young Lee, Soo-Jin Kang, Duk-Woo Park, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park
Journal: Journal of the American College of Cardiology (2014)
Contemplating a one child world
Authors: A J McMichael
Journal: BMJ (1995)

In this commentary, King et al. are cited for expressing the concern that fertility decline is too slow and ecological conditions are unprecedented in their deterioration. Today's situation is described by them as just a few countries having severely compromised their natural resources and the resultant inability to feed their populations. Malthusian threats are not just reruns of complaints, but very real, because food productivity options have reached their limits. Technological solutions to food scarcity issues are viewed by King et al. as not feasible. Consumerism is rising and so is the depletion of resources for producing consumer goods. The recommended solution is to reconceptualize public health within a long-term ecologically balanced framework. Confusion about environmental consequences is viewed as widespread and as fueled by vested interests opposed to changing religious authority, political power, institutional positions, ever expanding trade, and established priorities for health care. Taboos about a one-child policy are perpetuated as a means of relieving anxiety and preserving a short-term view. Taboos impede the acceptance of the need for action. Carrying capacity has become intertwined with the ability to purchase outside a country's borders sufficient food to feed national populations. Fertility control is an emotional issue. King et al. state the obvious by stating that individual rights cannot ignore ecological constraints. It is argued that extreme measures are necessary for rapid reduction of fertility both within the overpopulated South and the massively consuming North. The prevailing models of development reflect the excesses of the North and South. King et al. recommend action that is informed by a composite understanding of demographic, ecological, sociological, and economic conditions. Rwanda's civil war is the present day example of what the future may hold.
Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California
Authors: David A Wrone, Susan M Swetter, Barbara M Egbert, Bruce R Smoller, Paul A Khavari
Journal: Journal of the American Academy of Dermatology (1996)

We have noted a high frequency of aggressive-growth basal cell carcinomas (BCCS) in our patient population. Subtypes observed with increased frequency include morpheaform, infiltrative, and micronodular.Our purpose was to examine the frequency of histologic subtypes of all BCCs seen in the dermatology clinics in the Veterans Affairs Palo Alto Health Care System in an 18-month period.We reviewed 432 consecutive primary BCC biopsy specimens taken from 252 patients.Aggressive-growth BCC was observed in 20.7% of biopsy specimens, including 13.4% morpheaform, 5.7% infiltrative, and 1.6% micronodular subtypes. The mean age of the patient population was 70 years, with a standard deviation of 9.1 years.Our observed percentage of aggressive-growth BCC is substantially higher than in most other large studies. A high frequency of aggressive-growth BCC coupled with the increasing incidence of nonmelanoma skin cancer may have significant implications for future health care resource allocation.
ANTIBODY RESPONSE OF PATIENTS WITH POLIOMYELITIS TO VIRUS RECOVERED FROM THEIR OWN ALIMENTARY TRACT
Authors: Alex J. Steigman, Albert B. Sabin
Journal: The Journal of Experimental Medicine (1949)

Of 20 strains of virus recovered from 40 patients with poliomyelitis only 9 possessed a titer of 10(-3) or more, permitting significant quantitative neutralization tests in monkeys. Seven of the 9 high titer strains were derived from patients whose illness was ultimately paralytic, and tests with their undiluted sera indicated that the acute phase as well as the 3 month convalescent specimens neutralized maximum amounts of the patient's own virus. However when varying dilutions of the sera were tested against a single dose of virus, it was found that the antibody was present in lowest concentration early after onset and progressively increased in titer over a period of weeks during convalescence. The 2 remaining high titer strains were recovered from patients with a non-paralytic illness, and in both of these the acute phase sera were without significant amounts of antibody for their own virus. Antibody was demonstrable at 14, 28, and 92 days after onset in one of these patients, while the other had none at 1 month and only a minimal amount at 3 and 8 months. Tests with the Lansing virus on the same sera, clearly established the specificity of the antibody response to the strain of virus recovered from each patient under investigation. Five of the 9 patients, whose sera were studied with both viruses, had no antibody for the Lansing virus during the acute phase and none 3 months later. Two had antibody during the acute phase but serum dilution tests showed no increase in titer in the 3 month convalescent specimen. In 2 others, who were without antibody for the Lansing virus during the acute phase but had it at 3 months after onset, it was possible to show that this antibody appeared later than 1 month after the illness and that the virus recovered from these patients during their illness was not antigenically of the Lansing type.
The Nurse's Role in Treating Hypertension
Authors: Frank A. Finnerty
Journal: New England Journal of Medicine (1975)

A frequently voiced objection to screening programs for hypertension is fear of "overloading the system"—i.e., if less than 10 per cent of the estimated 23 million hypertensive patients are currently under care, who is going to treat these newly discovered patients, and where are they going to be followed? Doctors' offices are overcrowded, and the situation in clinics is even worse. In this issue of the Journal Alderman demonstrates one method for handling the problem of finding and treating patients without overloading the system.Backed by the union, he dovetailed a screening and treatment facility for department-store employees at their . . .
"The patient's interests always come first"? Doctors and society.
Authors: R Gillon
Journal: BMJ (1986)

In one of a series of articles on philosophical medical ethics, Gillon considers the implications for medical ethics of the social context in which doctors practice. Such implications often contradict a common and absolutist medico-moral cliché that "the patient's interests always come first." He notes that moral obligations to a particular patient may at times be superseded by the social obligation to allocate health care resources justly; to pursue research to benefit future patients; and to engage in preventive medicine to benefit potential patients. Gillon also reflects on three more hidden aspects of medicine's relation with society that may conflict with the interests of the individual patient--the contribution of social factors to disease and health, social determinants of physician's attitudes, and the struggle for power between the medical profession and other social groups