tbuckley/cabot-search huggingface dataset:
Risk Factors for Early or Delayed Stroke After Cardiac Surgery
Authors: Charles W. Hogue, Suzan F. Murphy, Kenneth B. Schechtman, Victor G. Dávila-Román
Journal: Circulation (1999)

Background —Stroke after cardiac surgery is a devastating complication that leads to excess mortality and health resource utilization. The purpose of this study was to identify risk factors for perioperative stroke, including strokes detected early after cardiac surgery or postoperatively. Methods and Results —Data were obtained from 2972 patients undergoing coronary artery bypass graft and/or valve surgery. Patients ≥65 years old and those with a history of symptomatic neurological disease underwent preoperative carotid artery ultrasound scanning. Intraoperative epiaortic ultrasound to assess for ascending aorta atherosclerosis was performed in all patients. New strokes were considered as a single end point and were categorized with respect to whether they were detected immediately after surgery (early stroke) or after an initial, uneventful neurological recovery from surgery (delayed stroke). Strokes occurred in 48 patients (1.6%); 31 (65%) were delayed strokes. By multivariate analysis, prior neurological event, aortic atherosclerosis, and duration of cardiopulmonary bypass were independently associated with early stroke, whereas predictors of delayed stroke were prior neurological event, diabetes, aortic atherosclerosis, and the combined end points of low cardiac output and atrial fibrillation. Female sex was associated with a 6.9-fold increased risk of early stroke and a 1.7-fold increased risk of delayed stroke. In-hospital mortality of patients with early (41%) and delayed (13%) strokes was higher than that of other patients (3%, P =0.0001). Conclusions —Most strokes after cardiac surgery occurred after initial uneventful recovery from surgery. Women were at higher risk to suffer early and delayed perioperative strokes. Atrial fibrillation had no impact on postoperative stroke rate unless it was accompanied by low cardiac output syndrome.
A New Wound-Based Severity Score for Diabetic Foot Ulcers: A prospective analysis of 1,000 patients
Authors: S. Beckert
Journal: Diabetes Care (2006)

Several well-accepted classification systems are available for diabetic foot ulcers. However, there are only a few and scientifically not validated severity scores. The aim of this study was to establish a new wound-based clinical scoring system for diabetic foot ulcers suitable for daily clinical practice anticipating chances for healing and risk of amputation.Four clinically defined parameters, namely palpable pedal pulses, probing to bone, ulcer location, and presence of multiple ulcerations, were prospectively assessed in 1,000 consecutive patients. In the next step, a new diabetic ulcer severity score (DUSS) was created from these parameters. Palpable pedal pulses were categorized by the absence (scored as 1) or presence (scored as 0) of pedal pulses, while probing to bone was defined as yes (scored as 1) or no (scored as 0). The site of ulceration was defined as toe (scored as 0) or foot (scored as 1) ulcer. Patients with multiple ulcerations were graded as 1 compared with those with single ulcers (scored as 0). The DUSS was calculated by adding these separate gradings to a theoretical maximum of 4. Wounds were followed-up for 365 days or until healing or amputation if earlier. Probability of healing and risk of amputation were calculated by the Kaplan-Meier method.Uni- and multivariate analyses showed a significantly higher probability of healing for patients with palpable pulses, no probing to bone, toe ulcers, and absence of multiple ulcerations. When patients were divided into subgroups with the same DUSS, we found significantly different probabilities for healing. We showed a decreasing probability of healing for ulcers with a high DUSS, concurrent with increasing amputation rates. An increase in the DUSS by one score point reduced the chance for healing by 35%. Similarly, the higher the ulcer score, the larger the initial wound area, the longer the wound history, and the more likely the need for surgery or hospitalization.The DUSS categorizes different ulcers into subgroups with specific severity and similar clinical outcome. Using this score, the probabilities for healing, amputation, need for surgery, and hospitalization are predictable with high accuracy. This might be useful for the anticipation of health care costs and for comparison of subgroups of patients in clinical studies.
A 40-Year-Old Woman Considering Contraception, 1 Year Later
Authors: Thomas Delbanco
Journal: JAMA (1999)

An Obstetrics and Gynecology Grand Rounds (1998) discussed contraceptive options for a 40-year-old married US nurse with three children.  Despite use of oral contraceptives (OCs) the IUD a diaphragm and a combination of condoms and a diaphragm the woman had experienced four unplanned pregnancies.  18 months before the consultation the patient developed severe premenstrual emotional lability.  Although the symptom was ameliorated by OC use the pill induced intermittent headaches.  The risks and benefits of emergency contraception vasectomy and depot medroxyprogesterone acetate were presented.  Soon after the consultation the patients husband underwent vasectomy.  A year later the patient reported she was relived to be free from anxiety about unplanned pregnancy but remained bothered by premenstrual symptoms especially moodiness.  Strategies recommended to address this symptom included a progesterone-only OC or a low dosage of a selective serotonin re-uptake inhibitor antidepressant.
Threats to health and safety in the workplace in Britain
Authors: A. Watterson
Journal: BMJ (1994)

Time for doctors to speak up

The Health of the Nation paid scant attention to occupational health but noted that better working conditions had contributed to better health.1 The government is now, however, pursuing a strategy hostile to improvements in working conditions.

The strategy has taken three forms. Firstly, the chancellor has cut the budgets of the Health and Safety Commission and Health and Safety Executive by 2.6% for 1994-5; this is double the cut imposed on public expenditure generally. This means that the Health and Safety Executive faces job losses and cuts in services.2 Secondly, the leadership of the Health and Safety Commission has changed: its new part time chairman, who apparently has no experience of occupational health and safety, works just three days a week, and one new commission member is a former member of parliament committed to privatisation.3 Thirdly, the ideology of deregulation is being promulgated by health and safety deregulation task groups and a Deregulation and Contracting Bill published early this year.4

No one would object to deregulation as a way of removing out of date and superfluous regulations.5 6 Yet none of the documentation from government departments justifies substantial changes in health and safety controls and enforcement.6 Weaker laws on health and safety have been mooted, and certain groups of workers--especially construction workers and temporary workers--seem likely …
Clinical Trial Acronyms
Authors: Michael Berkwits
Journal: Annals of Internal Medicine (2001)

Letters4 December 2001Clinical Trial AcronymsMichael Berkwits, MDMichael Berkwits, MDUniversity of Pennsylvania; Philadelphia, PA 19103Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-11-200112040-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Roda makes the important point that acronyms were a part of medicine long before their proliferation in clinical trials. Used to designate symptoms (DOE), diagnoses (ROMI), therapies (BIDS) (1), procedures (CABG), even the medical record itself (SOAP), they are inescapable elements of patient care. Physicians' long familiarity with the form of acronyms and with the practice of using them to convey medical information is a key condition underlying their continued use as names for clinical trials. Synergy with the commercial practice of naming for product placement or effect may have initially been (and in many instances may ...References1. Riddle MC, Hart JS, Bouma DJ, Phillipson BE, Youker G. Efficacy of bedtime NPH insulin with daytime sulfonylurea for subpopulation of type II diabetic subjects. Diabetes Care. 1989;12:623-9. [PMID: 2507265] CrossrefMedlineGoogle Scholar2. Schwartz GG, Oliver MF, Ezekowitz MD, Ganz P, Waters D, Kane JP, et al . Rationale and design of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study that evaluates atorvastatin in unstable angina pectoris and in non-Q-wave acute myocardial infarction. Am J Cardiol. 1998;81:578-81. [PMID: 9514453] CrossrefMedlineGoogle Scholar3. . Rationale and design of the magnesium in coronaries (MAGIC) study: A clinical trial to reevaluate the efficacy of early administration of magnesium in acute myocardial infarction. The MAGIC Steering Committee. Am Heart J. 2000;139:10-4. [PMID: 10618556] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania; Philadelphia, PA 19103 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCAPTURE! SHOCK! EXCITE! Clinical Trial Acronyms and the “Branding” of Clinical Research Michael Berkwits Clinical Trial Acronyms Paul I. Roda Clinical Trial Acronyms Tsung O. Cheng Metrics 4 December 2001Volume 135, Issue 11Page: 1005-1006KeywordsClinical trialsPatientsSoaps ePublished: 4 December 2001 Issue Published: 4 December 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Transplantation for alcoholic liver disease.
Authors: J. M. Neuberger
Journal: BMJ (1989)

Transplants are appropriate for selected people with alcohol induced liver damage 

Liver transplantation for patients with alcoholic liver disease raises issues and controversies not seen with other indications. This is partly based on the perception that alcoholic liver disease is self induced, despite the fact that clear genetic and environmental influences exist, but also because the recipient may return to a pattern of drinking that will damage the graft. Although such medical issues should be discussed openly, uninformed debate risks undermining public confidence in the use of the donated livers and may result in fewer organ donations.

Though many recipients return to some degree of alcohol consumption after transplantation overall this is to a degree similar to that in patients grafted for other conditions. Fewer than 10% return to drinking more than 21 units per week.1 2 At five years, less than 5% of grafts are lost as a direct or indirect consequence of alcohol misuse.3 This contrasts with graft loss of 10% from recurrent hepatitis C virus infection.4

Most, if not all, transplant …
Reporting of Randomized Clinical Trial Descriptors and Use of Structured Abstracts
Authors: Roberta W. Scherer, Barbara Crawley
Journal: JAMA (1998)

Context.—Structured abstracts, that is, abstracts that describe a study using requisite content headings, provide more informative content. Concomitant reporting in the text of the report might improve with structured abstract use because of increased awareness by authors or editors of important study areas associated with content headings.Objective.—To assess whether structured abstract use is associated with improved reporting of randomized clinical trials.Design and Setting.—Survey of trial reports published the year preceding, of, and following new use of structured abstracts, found by hand searching Archives of Ophthalmology (1992-1994) and Ophthalmology (1991-1993), as well as trial reports published concurrently without change in abstract format (American Journal of Ophthalmology, 1991-1994).Main Outcome Measures.—We measured the inclusion of 56 criteria derived from Consolidated Standards of Reporting Trials (CONSORT) descriptors (JAMA 1996;276:637-639) in the text of each report and calculated the number of criteria included per report and the proportion of reports including individual criteria. Reports with structured abstracts were compared with those without, and reports published in 1993 and 1994 in the American Journal of Ophthalmology were compared with those published in 1991 and 1992.Results.—The mean (SEM) number of criteria included by authors was 15.8 (0.4) per report in 125 trial reports. We found no difference in the mean number of criteria included or the proportion of reports that included specific criteria by journal. Following structured abstract use, there was no difference in either the mean number of criteria per report or the proportion of reports including a majority of criteria within each CONSORT subheading. Four criteria were included more often and 2 less often following structured abstract use in individual journals.Conclusion.—Using CONSORT descriptor criteria to evaluate reporting quality, we found no difference in text reporting associated with structured abstract use in the journals examined.
Immune responses to herpes simplex virus in patients with facial herpes simplex and those with eczema herpeticum
Authors: J.P. VESTEY, S.E.M. HOWIE, M. NORVAL, J.P. MAINGAY, W.A. NEILL
Journal: British Journal of Dermatology (1988)

Journal Article Immune responses to herpes simplex virus in patients with facial herpes simplex and those with eczema herpeticum Get access J.P. VESTEY, J.P. VESTEY Department of Dermatology University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, U.K. Dr J.P.Vestey. Search for other works by this author on: Oxford Academic Google Scholar S.E.M. HOWIE, S.E.M. HOWIE Bacteriology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, U.K. Search for other works by this author on: Oxford Academic Google Scholar M. NORVAL, M. NORVAL Bacteriology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, U.K. Search for other works by this author on: Oxford Academic Google Scholar J.P. MAINGAY, J.P. MAINGAY Bacteriology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, U.K. Search for other works by this author on: Oxford Academic Google Scholar W.A. NEILL W.A. NEILL Bacteriology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 118, Issue 6, 1 June 1988, Pages 775–782, https://doi.org/10.1111/j.1365-2133.1988.tb02595.x Published: 01 June 1988
Childhood disability and social policies
Authors: P. Rosenbaum
Journal: BMJ (2009)

Developmental rehabilitation needs to extend beyond the biomedical dimensions of disease

Participation (people’s engagement in life) is an essential component of the World Health Organization’s International Classification of Functioning, Disability and Health .1 The classification connects body structure and function (including the impairments caused by any disease) with their effects on activity and participation, and it puts them in the context of personal and environmental factors. This biopsychosocial framework reflects a social model of disability in which a person may be disabled by external factors, including environmental and social forces beyond their control.

Children and young people with disabilities constitute about 4-6.5% of the population in many countries.2 3 4 They are disadvantaged in terms of their participation and engagement in life,5 and the limitations in their activity may be two to three times greater than for typically developing children. …
Evaluation of Pneumococcal Vaccine
Authors: Michael S. Simberkoff
Journal: JAMA (1981)

To the Editor.—  Regarding the article entitled A Cost-Benefit Analysis of Immunization of  Pneumonia by Patrick and Woolley (1981; 245:473), this analysis and one published previously 1 required estimation of a number of variables, including incidence of vaccine reactions and vaccine-type Streptococcus pneumoniae infections in vaccine recipients and control subjects. Unfortunately, data concerning efficacy of the pneumococcal vaccine in the populations for which its use has been suggested 2 are limited.  In the editorial Pneumococcal Vaccine: To Use or Not (1981; 245:498), Fraser and Broome have pointed out the shortcomings of the available information and urged randomized prospective trials to settle some of the unresolved questions of efficacy. One such study has recently been initiated by the Veterans Administration Cooperative Studies Program. Patients older than 55 years or with chronic renal, hepatic, cardiac, or pulmonary diseases, diabetes mellitus, or chronic alcoholism at five VA Medical Centers will be asked
Femoral-Shaft Fracture Below Hip Prosthesis
Authors: Otto E. Aufranc
Journal: JAMA (1965)

Dr. Turner: An 80-year-old woman fell and injured her left hip. Prior to her fall, she had been an active nursing-home resident who was able to walk about freely and care for her basic needs. She was treated initially by bed rest, but was referred to the Massachusetts General Hospital 21 days following her injury because of progressively severe left hip pain. Physical examination showed a healthy 80-yearold woman who was generally cooperative, but demonstrated occasional episodes of disorientation and confusion, especially after sundown. General medical evaluation, laboratory data, electrocardiogram, and chest x-ray were all normal. Hip x-rays revealed a displaced fracture of the left femoral neck with some early heterotopic new bone superior and lateral to the hip joint (Fig 1). A Moore prosthesis was inserted through a lateral approach on the day following admission (Fig 2). Postoperatively the patient required considerable attention to pulmonary hygiene, and a Foley
Changes in Doppler ultrasound sonagrams at varying distances from stenoses
Authors: D H EVANS, D S MACPHERSON, M J ASHER, S BENTLEY, P R F BELL
Journal: Cardiovascular Research (1982)

The effect of different degrees of arterial stenosis on Doppler ultrasound sonagrams recorded from various distances downstream has been investigated in a canine model. It has been found that even mild stenoses give rise to considerable disturbances close to the stenosis, and that more severe stenoses give rise to greater disturbances which propagate further downstream. The distance the disturbances travelled was not related to stroke volume, and it was only for stenoses of 88% area reduction and greater that such disturbances ever propagated beyond one stroke-length. Quantitative assessment of moderate degrees of proximal stenosis using continuous wave Doppler ultrasound will not be reliable unless the distance between the major stenosis and the recording site is known.
Human leucocyte antigens A, B, C, and DRW in idiopathic "warm" autoimmune haemolytic anaemia.
Authors: A Abdel-Khalik, L Paton, A G White, S J Urbaniak
Journal: BMJ (1980)

Twenty patients with idiopathic "warm" autoimmune haemolytic anaemia and 40 controls were types concurrently for human leucocyte antigens (HLA) A, B, C, and DRW. There was a significantly stronger association of HLA-B8 with the disease (chi 2 = 10.39; p = 0.018) than HLA-DRW3 (chi 2 = 3.71; P = 0.35) and the patients also showed a significant increase in BW6 homozygosity (chi 2 = 7.13; P = 0.01) and a corresponding reduction in BW4 (chi 2 = 7.13; P = 0.02). (All p values corrected for number of antigens at each locus.) These findings suggest that susceptibility to idiopathic autoimmune haemolytic anaemia is associated more closely with the HLA-B locus than with DRW3.
Brain Researchers Bullish on Prospects for Preserving Mental Functioning in Elderly
Authors: Andrew A. Skolnick
Journal: JAMA (1992)

OPTIMISM is growing among some brain researchers that ways of slowing or preventing loss of cognitive function associated with aging and with neurodegenerative diseases soon may be within reach.  Recent research on the mechanisms of neurodegeneration has suggested a variety of possible treatments, some of which are already being tested in phase 1 trials, and has provided a rationale for creating and testing new pharmaceutical agents.  What's more, say some researchers, the recent findings suggest that, for some people, cognitive functioning may be preserved or even enhanced without resorting to drugs.  Simple measures, such as maintaining adequate blood glucose levels, taking vitamin E, and keeping mentally active, these researchers suggest, may help prevent loss of mental functioning and may even help delay or slow the progression of Alzheimer's disease, Parkinson's disease, and other neurodegenerative disorders.  Bright Future?  Overall, there's a lot of good news coming, says Carl W. Cotman, PhD,
Persistent testicular delta5-isomerase-3beta-hydroxysteroid dehydrogenase (delta5-3beta-HSD) deficiency in the delta5-3beta-HSD form of congenital adrenal hyperplasia.
Authors: G Schneider, M Genel, A M Bongiovanni, A S Goldman, R L Rosenfield
Journal: Journal of Clinical Investigation (1975)

A partial testicular defect in testosterone secretion has been documented in a pubertal male with a congenital adrenal hyperplasia due to hereditary deficiency of the delta5-isomerase-3beta-hydroxysteroid dehydrogenase enzyme complex (delta5-3beta-HSD). Diagnosis of the enzymatic defect is based on the clinical picture of ambiguous genitalia and salt-losing crisis in infancy, together with high urinary delta5-pregnenetriol and plasma dehydroepiandrosterone when the patient was taken off replacement corticoid treatment. No hormonal response to ACTH or salt deprivation was demonstrable. In addition, in vivo studies revealed a partial enzymatic defect in the testis. Although plasma testosterone was low-normal (250 ng/100 ml), plasma delta5-androstenediol was markedly elevated and rose to a greater extent than testosterone after human chorionic gonadotropin administration. In vitro testicular incubation studies suggested a testicular delta5-3beta-HSD enzyme defect with less delta4 products formed from delta5 precursors than in a control testis. Histochemical studies of the testis were also consistent with this defect. Testicular biopsy revealed spermatogenic arrest, generally diminished Leydig cells, but with focal areas of Leydig cell hyperplasia as well as benign Leydig cell hyperplasia as well as benign Leudig cell nodules within the spermatic cord. In vivo studies of steroid metabolism suggested intact peripheral or hepatic delta5-3beta-HSD activity. These studies imply that delta5-3beta-HSD activity differs in the gonad, adrenal, and peripheral organs. These findings are compatible with the concept that the enzyme complex consists of subunits and/or that enzymes in these organs are under different genetic control.
EFFECTS OF CHRONIC EXCESS SALT FEEDING
Authors: L. K. Dahl
Journal: The Journal of Experimental Medicine (1960)

Among female rats and dogs which were fed excess salt for periods of about 1 and 4 years, respectively, elevations in plasma cholesterol concentrations were frequent and in some cases, quite marked. Rats on a similar regimen for only 2 and 6 months had less frequent and significantly lesser elevations of cholesterol. The lipid changes did not appear to be related primarily to increased blood pressure, kidney disease, differences in body weight or food consumption. There is no present evidence which suggests that this phenomenon is related to atherogenesis although it was speculated that this was possible.