tbuckley/cabot-search huggingface dataset:
The rise of trust doctors
Authors: N. Cooper
Journal: BMJ (2003)

Stop exploiting them and start rewarding their input 

Non standard grade doctors–more commonly called trust doctors–are a relatively new phenomenon in the United Kingdom. They have several different titles, but essentially they have arisen as a means by which hospital trusts can employ additional junior doctors, despite the Department of Health's ceiling on training grade numbers, which exists to prevent a bottleneck at specialist level. Trust doctors are employed by trusts (local hospitals) for service and are therefore not regulated by the royal colleges or the deaneries (departments of postgraduate medical education). There were few posts for trust doctors in the United Kingdom until the introduction of stricter regulations of hours for junior doctors. Trusts most commonly state that they employ trust doctors as a direct result of these changes. However, the big picture regarding trust doctors is only just emerging 1 2–they are employed mainly in the acute specialties, a significant number work at specialist registrar level, and their numbers are growing fast. Most want to be consultants in the United Kingdom and are in post as a temporary measure. Their work is often indistinguishable from that of the training grades yet few trust doctors have regular appraisals, and …
An insight into eating disorders
Authors: Rhona MacDonald
Journal: BMJ (2002)

A paper in this week's BMJ reports on the results of using a screening tool for anorexia and bulimia nervosa in primary care (p 755).

There are many sites about the facts and figures and “medicalisation” of eating disorders. A few give a disturbing insight into the perplexing private hell of the person with the eating disorder.

“Her body, aching with pain, drowned …
Fast track admission for children with sickle cell crises
Authors: P. Daggett, S D'Sa, N Parker, M. A Ware, C. Fertleman, A. Gallagher, M. Rossiter
Journal: BMJ (1998)

# Should morphine or pethidine be given? {#article-title-2} EDITOR—Davies and Oni's review of the management of sickle cell disease1 was published in the same issue of the BMJ as the evaluation by Fertleman et al of a fast track admission policy for children with sickle cell crises.2 The review is based on the practice at the Central Middlesex Hospital, where pethidine has been associated with fits, and morphine is the preferred analgesic.1 At the North Middlesex Hospital, only a few miles away, pethidine is evidently preferred in children.2 Was this difference of approach noted by the editorial staff? Which group is right? 1. 1.↵1. Davies SC, 2. Oni L . Management of patients with sickle cell disease. BMJ 1997;315:656-660. (13 September.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Fertleman CR, 2. Gallagher A, 3. Rossiter MA . Evaluation of fast track admission policy for children with sickle cell crises: questionnaire survey of parents' preferences. BMJ 1997; 315: 650. (13 September). [OpenUrl][3][FREE Full Text][4] # Opiates other than pethidine are better {#article-title-5} EDITOR—We applaud the fast track admission policy for children with sickle cell crises that has been set up by Fertleman et al at the North Middlesex Hospital.1 We fully agree that early delivery of adequate analgesia by specialised staff should be the objective of all units managing acute sickle crises. However, we disagree with the choice of pethidine. While being an effective analgesic, pethidine is a well documented cause of unpredictable neurotoxicity, … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DDavies%26rft.auinit1%253DS.%2BC%26rft.volume%253D315%26rft.issue%253D7109%26rft.spage%253D656%26rft.epage%253D660%26rft.atitle%253DFortnightly%2Breview%253A%2BManagement%2Bof%2Bpatients%2Bwith%2Bsickle%2Bcell%2Bdisease%26rft_id%253Dinfo%253Apmid%252F9310570%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=315/7109/656&atom=%2Fbmj%2F316%2F7135%2F934.atom [3]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DFertleman%26rft.auinit1%253DC.%2BR%26rft.volume%253D315%26rft.issue%253D7109%26rft.spage%253D650%26rft.epage%253D650%26rft.atitle%253DEvaluation%2Bof%2Bfast%2Btrack%2Badmission%2Bpolicy%2Bfor%2Bchildren%2Bwith%2Bsickle%2Bcell%2Bcrises%253A%2Bquestionnaire%2Bsurvey%2Bof%2Bparents%2527%2Bpreferences%26rft_id%253Dinfo%253Apmid%252F9310567%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=315/7109/650&atom=%2Fbmj%2F316%2F7135%2F934.atom
Heart rate variability and its sympatho-vagal modulation
Authors: F Lombardi
Journal: Cardiovascular Research (1996)

The activity of sinus node pacemaker cells is under continuous regulation mainly effected by neural mechanisms. Hence the study of the variability of heart period, especially when assessed in the frequency domain with spectral analysis, was proposed about 15 years ago [l] as a probe for the evaluation of its autonomic control. Initially three spectral components of heart rate variability (HRV) were defined, while the factors considered as modulating them included sympathetic and parasympathetic activities, humoral factors such as the renin-angiotensin system or complex patterns like thermoregulation. On the basis of (i) an attempt to analyse cardiovascular neural regulation in closed-loop conditions, (ii) a different spectral methodology using autoregressive algorithms [21, (iii> simultaneous spectral analysis of both heart rate and arterial pressure variabilities providing the possibility of calculating crossspectra and their coherence, we reached the conclusion that only two spectral components were soundly analysable in a time span of a few hundred cycles-i.e., the time series usually selected to afford an adequate number of events, adequate stationarity and some appraisal of dynamic changes [3]. Hence, apart from a very low frequency (VLF) component [41, short-term variability appeared to consist mainly of an oscillation at low frequency (LF), usually around 0.1 Hz largely related to vasomotor activity, and of a high frequency (HF) oscillation, related to respiratory activity and under control conditions often around 0.25 Hz. Since our initial studies [2], we observed that the power of the LF component was percentually increased during manoeuvres exciting sympathetic activity while HF was
Abstract 5197: RIN1 suppresses apoptosis in melanoma cells and is a potential therapeutic target.
Authors: Pamela Y. Ting, John Colicelli
Journal: Cancer Research (2013)

Abstract The RAS effector RIN1 is frequently overexpressed in melanoma tumor samples. This aberrant overexpression is associated with tumor thickness, lymph node metastasis and poor prognosis. RIN1 is a multifunctional protein that has been shown to regulate growth factor receptor signaling and endocytosis, as well as the activity of the non-receptor tyrosine kinase ABL, which functions in actin remodeling and the DNA damage response. Here, we identify RIN1 as a suppressor of apoptosis in melanoma. shRNA-mediated knockdown of RIN1 in the melanoma cell line A375 suppressed proliferation and induced apoptosis. We found RIN1 to be commonly overexpressed in melanomas, with elevated levels of the protein detected in 10 of 13 melanoma cell lines tested in comparison with human neonatal melanocytes. Additionally, depletion of RIN1 in several primary cell types does not affect cell viability. This supports the hypothesis that some melanoma cells are addicted to RIN1 and suggests its potential as a therapeutic target. To examine the role of RIN1 in melanoma cell survival, point mutations were made to disrupt several known functions. These include receptor tyrosine kinase binding, ABL binding, Rab5 GEF activity and RAS association. The mutants have been stably transduced into melanoma cells under the control of a tetracycline-responsive promoter and they will be used to elucidate the contribution of different RIN1-dependent pathways to oncogenic activity. Overall, our goal is to determine the molecular mechanisms governing oncogenic addiction to RIN1 as well as points of vulnerability that could be therapeutically targeted. Citation Format: Pamela Y. Ting, John Colicelli. RIN1 suppresses apoptosis in melanoma cells and is a potential therapeutic target. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5197. doi:10.1158/1538-7445.AM2013-5197
Proposal for new definition of health
Authors: T. Shilton, M. Sparks, D. McQueen, M.-C. Lamarre, S. Jackson
Journal: BMJ (2011)

Huber and colleagues rightly challenge the validity, in the 21st century, of the World Health Organization’s definition of health.1

Adaptation and self management are important qualities, but a contemporary definition should include health being a human right protected by certain entitlements and a resource for life that is affected by social, political, economic, and environmental factors.2 …
Doctors and Overpopulation
Authors: A. D. Clift
Journal: BMJ (1972)

Dr. J.A.D. Anderson and others (January 8 p. 108) although apparently genuinely concerned about possible  pressures give the impression of having been misled by the report of the Select Committee on Science and Technology.  Though it is true that the Committee concluded that the country was overpopulated this was at variance with the opinion of the majority of the expert witnesses examined most of whom could find no evidence for the recommendation of   control and it remains unexplained how the Committee came to its extraoridnary conclusion.  I recommend this report to your readers who will then realize that no Government reading the full report could possibly endorse the Committees proposals.  The letter contains other statements likely to arouse panic in the uninformed reader.  How can they possibly write of sheer overcrowding in cities with its attendant  when the latest Census returns show that nearly all the conurbations experienced a decline in  from 1961 to 1971.  At the same time massive efforts have been made to combat pollution which in certain aspects such as smoke and sewage control has decreased dramatically over the last 50 years; this subject has been reviewed by Mellanby who claims that the  prospects for successful pollution control  even with a greatly increased population are good.  Doctors have an important duty to promote responsible parenthood but it is not part of that duty to engender guilt in those parents who in normal exercise of their marriage rights have a size of family in excess of an artifically contrived  norm.(FULL TEXT)
Intra-arterial monitoring of critically ill patients in ambulances.
Authors: G Waddell, B Stuart, M A Tehrani, G McGarrity, A Reyes, H C Smith, I M Ledingham, H L Green, C Weller
Journal: BMJ (1975)

rapidly advancing spinal cord compression.4A normal cell count in the C.S.F., an increase in protein, and a more or less complete block on myelography are to be expected.5According to Arseni and Samitca4 it is difficult, if not impossible, to differentiate between extramedullary and intramedullary tuberculoma before surgery as the radiological picture in both is identical.To the best of our knowledge this is the first case described showing the true intramedullary nature of a tuberculoma before surgery.It draws attention to the unusual presentations of tuberculosis in the immigrant population and adds another cause to the radiological list of intramedullary spinal lesion.
Staphylococcal septicaemia after insertion of an intrauterine contraceptive device.
Authors: A M Geddes
Journal: BMJ (1980)

Your recent lead article on toxic shock and tampons (November 1, p. 1161) prompts me to report a case of pelvic infection and staphylococcal septicemia 8 days after the insertion of a Lippes loop. Pelvic infection is a recognized complication of IUDs; although there have been 2 reports of endocarditis occurring in susceptible patients following the insertion of an IUD, septicemia is rare. A previously healthy 31-year old married woman had a loop inserted at a family planning clinic. 3 days later she developed sweating, vomiting, confusion, and cough and during the following 48 hours became disoriented with hallucinations. She was referred to the hospital with suspected encephalitis and on admission was febrile (38.8 degrees Celsius) and stuporose but responded to simple commands. Blood pressure was 95/60 mmHg but there were no other abnormal signs. Hemoglobin was 12.2 g/dl, white blood count 4.0x109/1 (80% neutrophils), erythrocyte sedimentation rate 70mm in the 1st hour; cerebrospinal fluid normal. Chest x-ray examination revealed patchy consolidation in the upper lobes of both lungs and an electroencephalogram showed bilateral nonspecific abnormality. 3 blood cultures taken on admission yielded penicillin-resistant Staphylococcus aureus. She was treated with high-dose intravenous cloxacillin and 24 hours after starting the antibiotic had improved markedly and the IUD was removed. Culture from the coil and also from a high vaginal swab yielded Staph aureus with a similar antibiogram to that of the organism cultured from the blood. Subsequent recovery was uneventful, although repeat chest x-ray examination showed small abscess cavities in the upper lobes of both lungs. The patient was discharged 4 weeks after admission and serial chest radiographs have confirmed complete resolution of the pneumonia and abscesses. There is little doubt that this patients' septicemia with lung abscess formation and encephalopathy originated in the genital tract. The patient was both toxic and shocked but was different from patients with the recently described toxic shock syndrome in that her blood culture was positive for Staph aureus. The case provides another example of the importance of this organism as a cause of infection associated with the insertion of foreign bodies into or through the vagina.
Effect of Parathyroid Hormone on Osmotic Fragility of Human Erythrocytes
Authors: Eitan Bogin, Shaul G. Massry, Joseph Levi, Meir Djaldeti, Greg Bristol, Jacqueline Smith
Journal: Journal of Clinical Investigation (1982)

The survival of erythrocytes (RBC) is shortened in uremia, and it has been shown that calcium influx into RBC evoked crenation and increased their rigidity. The high blood levels of parathyroid hormone (PTH) may augment entry of calcium into RBC and hence affect their integrity. We examined the effect of PTH on osmotic fragility of human RBC and investigated the mechanisms through which PTH interacts with RBC.
The global burden of psoriatic skin disease
Authors: K.L. Goff, C. Karimkhani, L.N. Boyers, M.A. Weinstock, J.P. Lott, R.J. Hay, L.E. Coffeng, S.A. Norton, L. Naldi, C. Dunnick, A.W. Armstrong, R.P. Dellavalle
Journal: British Journal of Dermatology (2015)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
The Production of a Renal Lesion in Dogs by Injection of Plasma from Patients with Lupus Erythematosus.
Authors: G. O. Clifford
Journal: Annals of Internal Medicine (1961)

s1 May 1961The Production of a Renal Lesion in Dogs by Injection of Plasma from Patients with Lupus Erythematosus.G. O. Clifford, M.D., J. McClure, M.D.G. O. Clifford, M.D.Search for more papers by this author, J. McClure, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-5-1062_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt has been reported that infusion of plasma from patients with systemic lupus erythematosus produces L.E. cells in some dogs so treated. We have infused plasma (average 60 ml.) from patients with systemic lupus erythematosus at various stages of activity and treatment. L.E. preps were positive in about half the patients. The animals were infused once or twice on alternate days and sacrificed three to 10 days later. Control animals were infused with plasma from normal patients.A renal lesion was seen in the majority of animals given plasma from patients with systemic lupus irrespective of the presence or absence... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, Mich. (CI) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1961Volume 54, Issue 5Page: 1062-1062KeywordsBlood plasmaCellsLesionsLupus erythematosusPreexposure prophylaxis ePublished: 1 December 2008 Issue Published: 1 May 1961 PDF downloadLoading ...
UK inquiry should establish why contaminated blood products were given to people with haemophilia
Authors: K. Pappenheim
Journal: BMJ (1999)

Children born after intracytoplasmic sperm injection What do authors mean by control infants?Editor-Sutcliffe et al compare babies born through intracytoplasmic sperm injection with control babies (matched for social class, maternal education, region, and sex) born after unassisted conception. 1 In their table they give means, standard deviations, and 95% confidence intervals for the two groups separately.These confidence intervals tell us about the estimation of the mean in the population of which the babies are a random sample, which they are not.They tell us nothing about the comparison between the cases and controls.These controls have been chosen to be similar to the study babies in many ways; they are not a representative sample of babies.It is the difference between the study babies and the control babies that is of interest, and the confidence interval we should have is that for this difference in mean.We cannot work this out from the data given, because this is a paired study and we have unpaired standard deviations.All we have for the comparison is the implication, not actually stated, that the differences are not significant.What we should be given are confidence intervals that tell us how different the cases and controls are.
Complications of the Pump Pocket May Represent a Significant Cause of Incidents With Implanted Systems for Intraperitoneal Insulin Delivery
Authors: Eric Renard, Jacques Bringer, Dominique Jacques-Apostol, Dominique Lauton, Christéle Mestre, Guy Costalat, Claude Jaffiol
Journal: Diabetes Care (1994)

OBJECTIVE To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs). CASES There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors. RESULTS Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explantations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to &amp;gt;2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor. CONCLUSIONS From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.
Dedifferentiation and Proliferation of Surviving Epithelial Cells in Acute Renal Failure
Authors: Joseph V. Bonventre
Journal: Journal of the American Society of Nephrology (2003)

In contrast to the heart or brain, the kidney can completely recover from an ischemic or toxic insult that results in cell death. During recovery from ischemia/reperfusion injury, surviving tubular epithelial cells dedifferentiate and proliferate, eventually replacing the irreversibly injured tubular epithelial cells and restoring tubular integrity. Repair of the kidney parallels kidney organogenesis in the high rate of DNA synthesis and apoptosis and in patterns of gene expression. As has been shown by proliferating cell nuclear antigen and 5-bromo 2′-deoxyuridine labeling studies and, in unpublished studies, by counting mitotic spindles identified by labeling with antitubulin antibody, the proliferative response is rapid and extensive, involving many of the remaining cells of the proximal tubule. This extensive proliferative capacity is interpreted to reflect the intrinsic ability of the surviving epithelial cell to adapt to the loss of adjacent cells by dedifferentiating and proliferating. Adhesion molecules likely play important roles in the regulation of renal epithelial cell migration, proliferation, and differentiation, as do cytokines and chemokines. Better understanding of all of the characteristics resulting in dedifferentiation and proliferation of the proximal tubule epithelial cell and cell–cell and cell–matrix interactions important for this repair function will lead to novel approaches to therapies designed to facilitate the processes of recovery in humans. E-mail: joseph_bonventre@hms.harvard.edu
Management of the Patient With Hemorrhaging Esophageal Varices
Authors: John P. Cello
Journal: JAMA (1986)

Bleeding from esophageal varices remains a difficult clinical problem, carrying a high likelihood both of rebleeding and of mortality. The initial approach requires adequate but not overly vigorous volume replacement with blood and other fluids. Once the patient is resuscitated, upper gastrointestinal endoscopy should be performed to establish the source of bleeding. Both endoscopic variceal sclerotherapy and balloon tamponade appear to be effective in achieving temporary control of acute ongoing hemorrhage from esophageal varices. The value of intravenous vasopressin remains controversial. Rebleeding can be prevented in most patients by shunt surgery. However, surgery carries both considerable early morbidity and mortality (related mainly to the severity of the underlying liver disease) and substantial longer-term morbidity and mortality from hepatic encephalopathy and liver failure. The role of pharmacologic agents (eg, propranolol) intended to prevent variceal hemorrhage by reducing portal pressure remains to be established. At present, we recommend use of endoscopic variceal sclerotherapy for the control of active variceal bleeding, with employment of balloon tamponade and intravenous vasopressin if sclerotherapy is successful. Emergency shunt surgery should be reserved only for those patients whose bleeding cannot be controlled by these other means. For prevention of rebleeding in Child class C patients, we attempt to obliterate the varices by repeated endoscopic sclerotherapy. Patients who have two to three episodes of rebleeding despite this approach are considered for shunt surgery. For better-risk patients who do not have ascites, which is difficult to control, we are currently recommending a distal splenorenal shunt. Alternatively, repeated endoscopic variceal sclerotherapy is used for these better-risk patients (Child class A or B) in some centers, with shunt surgery reserved for patients who continue to rebleed. Which approach to preventing rebleeding in the better-risk patient is more effective, as well as the role of pharmacologic therapy with propranolol or other agents, remains to be settled by well-controlled randomized clinical trials.