tbuckley/cabot-search huggingface dataset:
Finding and Applying Evidence During Clinical Rounds&lt;SUBTITLE&gt;The "Evidence Cart"&lt;/SUBTITLE&gt;
Authors: David L. Sackett
Journal: JAMA (1998)

Physicians need easy access to evidence for clinical decisions while they care for patients but, to our knowledge, no investigators have assessed use of evidence during rounds with house staff.To determine if it was feasible to find and apply evidence during clinical rounds, using an "evidence cart" that contains multiple sources of evidence and the means for projecting and printing them.Descriptive feasibility study of use of evidence during 1 month (April 1997) and anonymous questionnaire (May 1997).General medicine inpatient service.Medical students, house staff, fellows, and attending consultant.Evidence cart that included 2 secondary sources developed by the department (critically appraised topics [CATs] and Redbook), Best Evidence, JAMA Rational Clinical Examination series, the Cochrane Library, MEDLINE, a physical examination textbook, a radiology anatomy textbook, and a Simulscope, which allows several people to listen simultaneously to the same signs on physical examination.Number of times sources were used, type of sources searched and success of searches, time needed to search, and whether the search affected patient care.The evidence cart was used 98 times, but could not be taken on bedside rounds because of its bulk; hard copies of several sources were taken instead. When the evidence cart was used during team rounds and student rounds, some sources could be accessed quickly enough (10.2-25.4 seconds) to be practical on our service. Of 98 searches, 79 (81%) sought evidence that could affect diagnostic and/or treatment decisions. Seventy-one (90%) of 79 searches regarding patient management were successful, and when assessed from the perspective of the most junior team members responsible for each patient's evaluation and management, 37 (52%) of the 71 successful searches confirmed their current or tentative diagnostic or treatment plans, 18 (25%) led to a new diagnostic skill, an additional test, or a new management decision, and 16 (23%) corrected a previous clinical skill, diagnostic test, or treatment. When the cart was removed, the perceived need for evidence rose sharply, but a search for it was carried out only 12% of the time (5 searches performed out of the 41 times evidence was needed).Making evidence quickly available to clinicians on a busy medical inpatient service using an evidence cart increased the extent to which evidence was sought and incorporated into patient care decisions.
Workshop for Disabled Survivors of Severe Head Injury
Authors: P. S. London
Journal: BMJ (1973)

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.
Hepatocellular Carcinoma and Partial Deficiency of Alpha-1 Antitrypsin (MZ)
Authors: WILLIAM RAWLINGS
Journal: Annals of Internal Medicine (1974)

Z allele alpha-1 antitrypsin deficiency has been associated with hepatic fibrosis and cirrhosis. Previous case reports have suggested an association between the homozygous (ZZ) state and hepatocellular carcinoma. Two patients are presented who had cryptogenic liver disease and alpha-1 antitrypsin deficiency of the MZ phenotype. At postmortem both were found to have hepatocellular carcinoma. The rarity of both the Z allele and hepatocellular carcinoma may suggest an association between heterozygous Z allele alpha-1 antitrypsin deficiency and this malignancy.
Low molecular weight pollutants and asthma: pathogenetic mechanisms and genetic factors
Authors: CE Mapp, M Saetta, P Maestrelli, A Ciaccia, LM Fabbri
Journal: European Respiratory Journal (1994)

Imidazenil is a highly potent partial allosteric modulator of gamma-aminobutyric acid action at a great variety of gamma-aminobutyric acid(A) receptors, whereas alprazolam is a full allosteric modulator at these receptors. Data in rats indicate that imidazenil, like alprazolam, has pharmacological effects in animals indicative of anxiolytic, antipanic and anticonvulsant activity in humans, but unlike alprazolam, in animals imidazenil does not produce ataxia, sedation, tolerance or dependence nor does it potentiate the effects of ethanol. To extend the study of the imidazenil pharmacological profile, we administered this drug and alprazolam, alone and in combination, in monkeys working in a complex behavioral task. In one component of a multiple schedule (repeated acquisition or "learning"), patas monkeys acquired a different four-response chain each session by responding sequentially on three keys in the presence of four discriminative stimuli (geometric forms or numerals). In the other component (performance), the four-response chain was the same each session. The response chain in each component was maintained by food presentation under a fixed-ratio schedule. When alprazolam (0.01-0.32 mg/kg, p.o.) was administered alone, the overall response rate in both learning and performance decreased and the percent errors in both components increased with increasing doses. Learning, however, was more sensitive than performance; i.e., error-increasing effects were seen in learning at doses that had no effect on performance accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of acrodermatitis enteropathica-like dermatosis caused by ornithine transcarbamylase deficiency∗
Authors: Jeong-Yeob Lee, Sung-Eun Chang, Chi-Woo Suh, Jee-Ho Choi, Kyung-Jeh Sung, Kee-Chan Moon, Jai-Kyoung Koh
Journal: Journal of the American Academy of Dermatology (2002)
Drug combinations and all cause mortality in heart disease: Dosages and types of ACE inhibitors need to be known
Authors: Frank A Snyder
Journal: BMJ (2005)

Drug combinations and all cause mortality in heart disease No new insights were gainedEditor-Hippisley-Cox and Coupland conclude that the addition of angiotensin converting enzyme (ACE) inhibitors to combinations of drugs conferred no additional benefit in their study of patients in primary care with ischaemic heart disease. 1 However, such a conclusion should be reached with caution.The drugs were given to the patients with the highest risk of death.A higher percentage of patients who died were treated with ACE inhibitors, and the greatest improvement in risk of death after adjustment for risk factors was seen in the patients treated with these drugs.ACE inhibitors might thus have been given to the patients with the most severe disease in each comorbidity group-for example, to diabetic patients with kidney disease and to patients with the most severe heart failure.Therefore the study can give no indication of the crucial question whether the outcome would have been equally good for the group of 463 patients who probably had the most severe disease and received statins, aspirin, blockers, and ACE inhibitors if they had not been given ACE inhibitors.Replacement of yes or no for comorbidity factors with more discriminating variables, such as presence of microalbuminuria and a severity measure for heart disease, would probably have improved the study.However, this cannot replace the quality of a randomised, placebo controlled study comparing the effect of adding ACE inhibitors to the other study drugs.Therefore the study by Hippisley-Cox and Coupland adds no new knowledge to how patients with ischaemic heart disease in primary care should be treated.
Risk Factors for Exacerbations in Pediatric Asthmatic Patients Receiving Montelukast Monotherapy (MON) Who Step Up to an Inhaled Corticosteriod (ICS) or a Fixed-Dose Combination of ICS and Long-Acting Beta Agonist (ICSLABA)
Authors: G. Reardon, P. Navaratnam
Journal: Journal of Allergy and Clinical Immunology (2010)
CERTAIN ASPECTS OF THE DIAGNOSIS AND TREATMENT OF DIABETES
Authors: S. C. Dyke
Journal: BMJ (1929)

4., Tuberculous -Ulceratioit ol thle Bowels.-This is generally secondary to pulmonary disease, resultilng from the swallowing of infected sputum.In childreni it can occur as a primary infectioni, and is theen usua'lly associated witlh severe involvement of the meseniteric glands.In either case diarrhoea is the most striking symptomii.5. Intestintal Obstiuction.-Thismay result from iulcera- tion of bowel, or from kinking and narrowing of its lumen thlrouglh peritoneal adhesions.6. Acutte Peritonitis.-This is sh-imulatedl occa ioiallHy whenl an initestinal ulcer perforates into the surrounding aidlhesiois, or when a tuberculous gland breaks doown completely or becomes infected with other organisms.Clin ical Maniifestatioiis.The symptoms depend largely oni thie I)art first anid miost, severely affected, but generally they are gradual and insidiouls.The child's streingth is noti(ced to be failing; he is pale and thin, feverislh at nlight, and(i the abdomenl is progressively enlarging.The al)l)etite is capriciouts, the stools are often unihealthv, anid( tlher e may be alternating constipation and diarrlloea.Attacks of colic are not unicommon, and wheni associated witlh v-omitinig may be mistaken for subacute appendicitis.In those cases which simulate acute peritonitis the on_set of sym- ptoms is very abrupt, witlhlhigli temperature, vomiting, acute abdominal paini, and genieralized tendernuess and rigidity.Wheil the acutte inflamrn.ation is prilicipally
Effects of N-(4-Hydroxyphenyl)retinamide on hTERT Expression in the Bronchial Epithelium of Cigarette Smokers
Authors: J.-C. Soria, C. Moon, L. Wang, W. N. Hittelman, S. J. Jang, S.-Y. Sun, J. J. Lee, D. Liu, J. M. Kurie, R. C. Morice, J. S. Lee, W. K. Hong, L. Mao
Journal: JNCI Journal of the National Cancer Institute (2001)

Background: Telomerase activation plays a critical role in tumorigenesis. To determine the role of telomerase in early lung carcinogenesis and as a potential biomarker in chemoprevention trials, we analyzed the expression of the human telomerase reverse transcriptase catalytic subunit (hTERT) in bronchial biopsy specimens from cigarette smokers who were enrolled in a randomized, double-blinded, placebo-controlled chemoprevention trial of N-(4-hydroxyphenyl)retinamide (4-HPR). Methods: We obtained biopsy specimens from six predetermined sites in the bronchial tree from the 57 participants, before treatment and 6 months after treatment with 4-HPR or placebo. We used in situ hybridization to examine hTERT messenger RNA (mRNA) expression in 266 pretreatment (baseline) and post-treatment site-paired biopsy specimens from 27 patients in the 4-HPR-treated group and from 30 patients in the placebo-treated group. All statistical tests were two-sided. Results: At baseline, 62.4% (95% confidence interval [CI] = 53.9% to 71%) of the biopsy specimens obtained from the group treated with 4-HPR and 65.2% (95% CI = 57.4% to 73.1%) of the biopsy specimens obtained from the placebo-treated group expressed hTERT mRNA. After 6 months, 45.6% (95% CI = 36.9% to 54.3%) of the biopsy specimens obtained from the 4-HPR-treated group and 68.1% (95% CI = 60.4% to 75.8%) of the biopsy specimens obtained from the placebo-treated group expressed hTERT mRNA. The reduction in hTERT expression observed between the two treatment groups over time was statistically significant (P = .01) when we used the biopsy site as the unit of analysis, but not when we used the individual as the unit of analysis (P = .37). Conclusions: Telomerase is frequently reactivated in the lungs of cigarette smokers. The modulation of hTERT expression in 4-HPR-treated smokers suggests that a novel molecular mechanism underlies the potential chemopreventive properties of 4-HPR. hTERT expression is a promising potential biomarker for risk assessment and for the evaluation of the efficacy of chemopreventive agents in lung carcinogenesis.
A CASE OF CHOLERA GRAVIS WITH COMPLICATIONS
Authors: A. C. Selmon
Journal: JAMA (1922)

The patient was a Chinese woman, aged 35. In addition to being eight and one-half months' pregnant, she had also an active tuberculous lesion in one apex, with recent hemoptysis. The attack of cholera came on with malaise, mild diarrhea, noises in the ears and pains in the legs, which continued for two days. Acute cholera symptoms began during Monday night. When first seen, early Tuesday morning, she was very restless, tossing about on the bed and passing frequent and copious rice-water stools. Every few minutes she vomited material very similar to that passed in the stools, only of a darker color. There was almost complete anuria. The mind was clear, and her chief complaint was the torturing pains in the calf of the leg and the uncomfortable, dry, parched feeling inside the nose. The mouth temperature was 38.5 C. (101.5 F.). The pulse was 108 and barely palpable at
Multiple drug resistance
Authors: Lester A. Mitscher, Segaran P. Pillai, Elmer J. Gentry, Delbert M. Shankel
Journal: Medicinal Research Reviews (1999)

Multiple drug resistance to antibacterial agents, antifungals, antivirals, antiprotozoals, and antitumor agents has risen spectacularly in the last decade or so and presently threatens eventually to put an end to successful chemotherapy in all of the above fields. This review summarizes the known origins of the problem, its present dimensions, the means employed to combat the phenomenon and promising avenues for future developments. © 1999 John Wiley & Sons, Inc. Med Res Rev, 19, No. 6, 477–496, 1999
A NEEDLE HOLDER, WHICH CARRIES A CONSTANTLY THREADED NEEDLE.
Authors: SELDEN I. RAINFORTH
Journal: JAMA (1906)

The necessity of repeatedly threading the needles that are commonly used and of inserting them in holders, when many sutures have to be placed, led me to devise an instrument which I have used for over a year with great satisfaction. The needle is set at right angles to the shank of the holder, is fastened in its socket by a small thumbscrew, and need be released only when the operator desires to replace it by another needle of different size or shape. The eye is near the point of the needle. Suture material, silk or catgut, is sterilized on a bobbin made to fit into the handle of the instrument and the thread unwinds as it is used. From the bobbin the suture passes through the hollow shank of the holder to an opening near its distal end, then across to and through the eye of the needle. Sutures
Biomedical models and healthcare systems
Authors: Ellen S Wright
Journal: BMJ (2005)

Editor—Wade and Halligan's new model will be useful if it encourages alternative ways of managing so called functional illnesses.1 Take the example of low back pain as a condition where context is all important.

Patients with typical mechanical low back pain aggravated by prolonged standing will have a serious problem if, say, they work as a hairdresser but not if they have an office job. Thus their occupation rather than the disease will probably determine whether they seek medical attention. The new model implies that changing the context (suggesting the patient change jobs) is an equally valid way of managing the problem as looking for a “cure” for the low back pain. However, the model will be of real benefit only if policy makers transfer resources from diagnostic and treatment modalities to rehabilitative, educative, and occupational programmes, making the option of retraining realistic and achievable.

The new model also highlights the tension between the responsibility of individuals and that of society in managing “dysfunction.” As a society we seem to be moving much more to the viewpoint that society's duty is to adapt to the dysfunction of individuals—see current disability regulations—rather than the individual's responsibility is to find ways of coping with a disability. Inevitably this view affects the range of “dysfunction” that healthcare systems are expected to deal with, and, as Wade and Halligan suggest, this needs to be openly debated.
I'm a celebrity, get me the best treatment here
Authors: K. Patel
Journal: BMJ (2009)

It’s amazing what you remember from medical school. I’m not referring, of course, to the Krebs cycle or the branches of the external carotid artery: who actually remembers those?

I remember being at a bar directly opposite the hospital, enjoying a drink with a few friends after a full day on the wards. Suddenly our conversation was cut short by the sound of a multitude of police sirens rapidly approaching our location. A few seconds later at least six police cars were parked in front of the hospital and black …
LEKTI demonstrable by immunohistochemistry of the skin: a potential diagnostic skin test for Netherton syndrome
Authors: C. Ong, E.A. O'Toole, L. Ghali, M. Malone, V.V. Smith, R. Callard, J.I. Harper
Journal: British Journal of Dermatology (2004)

Netherton syndrome (NS) is a rare autosomal recessive condition characterized by ichthyosiform erythroderma, trichorrhexis invaginata and atopic manifestations. Confirming the diagnosis may be difficult in the early stages. Mutations in the SPINK5 gene which encodes for the serine protease inhibitor LEKTI are associated with NS. These mutations create premature termination codons which result in absent or abnormal expression of LEKTI in patients with NS.To investigate the expression of LEKTI in the skin of patients with NS in comparison with normal controls and patients with other skin conditions, namely atopic dermatitis, psoriasis and nonbullous ichthyosiform erythroderma.Immunohistochemistry was performed on skin sections from four patients with NS, four normal controls, four with atopic dermatitis, two with psoriasis and two with nonbullous ichthyosiform erythroderma, using a primary rabbit polyclonal antibody against LEKTI.LEKTI was localized to the stratum granulosum in normal skin. All four skin sections from patients with NS showed absent or very reduced staining for LEKTI. Staining in the other disorders showed positive LEKTI expression in varying patterns.NS can be difficult to diagnose especially in the early stage, which can lead to inappropriate treatments particularly if it is misdiagnosed as atopic dermatitis. Immunohistochemistry of skin with an antibody against LEKTI is a potentially useful diagnostic test for NS.
NICE says that patients' age should affect treatment
Authors: Susan Mayor
Journal: BMJ (2005)

The age of patients should be considered in assessing the potential benefits and risks of healthcare interventions, according to a consultation document from the National Institute for Health and Clinical Excellence (NICE), which advises on the use of treatments in the NHS in England and Wales.

The consultation report was designed to clarify the social value judgments—defined as ethical principles, preferences, culture, and aspirations—that should be used by NICE in conjunction with clinical judgments in deciding what the NHS should provide.

The report proposed that age should be taken …
Variation in services is bound to result from commissioners' obligation to heed local needs, doctors are told
Authors: N. Hawkes
Journal: BMJ (2012)

Clinicians who are unsure about how the new NHS in England is going to work may not have been reassured by a seminar at the Royal College of Surgeons on 10 October. How will doctors commission care, and what evidence is there that they will do it any better than the managers they replace? Many concrete questions were raised, and many abstract answers given.

The doubts included the conflict between locally determined priorities and the national “offer” the NHS is supposed to provide, the complexity of the new structures, the apparently contradictory roles of the NHS Commissioning Board (charged with both cooperating with clinical commissioning groups (CCGs) and “performance managing” them) and the perennial difficulty of reconfiguring services. “Have faith” sums up the responses provided by representatives of the Commissioning Board and the NHS Trust Development Authority.

Charles Alessi, although a prominent supporter of clinical commissioning and interim chair of NHS Clinical Commissioners, was scarcely reassuring. He warned …
Sulfasalazine: a potent and specific inhibitor of nuclear factor kappa B.
Authors: C Wahl, S Liptay, G Adler, R M Schmid
Journal: Journal of Clinical Investigation (1998)

Transcription factors of the NF-kappaB/Rel family are critical for inducible expression of multiple genes involved in inflammatory responses. Sulfasalazine and its salicylate moiety 5-aminosalicylic acid are among the most effective agents for treating inflammatory bowel disease and rheumatoid arthritis. However, the mode of action of these drugs remains unclear. Here we provide evidence that the transcription factor NF-kappaB is a target of sulfasalazine-mediated immunosuppression. Treatment of SW620 colon cells with sulfasalazine inhibited TNFalpha-, LPS-, or phorbol ester- induced NF-kappaB activation. NF-kappaB-dependent transcription was inhibited by sulfasalazine at micro- to millimolar concentrations. In contrast, 5-aminosalicylic acid or sulfapyridine did not block NF-kappaB activation at all doses tested. TNFalpha-induced nuclear translocation of NF-kappaB was prevented by sulfasalazine through inhibition of IkappaBalpha degradation. When blocking proteasome-mediated degradation of IkappaBalpha, we could demonstrate that sulfasalazine interfered with IkappaBalpha phosphorylation, suggesting a direct effect on an IkappaBalpha kinase or on an upstream signal. Inhibition of NF-kappaB activation seems to be specific since other DNA-binding activities such as AP1 were not affected. These results demonstrate that sulfasalazine is a potent and specific inhibitor of NF-kappaB activation, and thus may explain some of the known biological properties of sulfasalazine.
Researchers identify gene associated with airways remodelling in asthma
Authors: S. Mayor
Journal: BMJ (2002)

A joint US and UK consortium of researchers has identified a gene associated with airways remodelling in asthma, which offers a potential new target for developing drugs that can prevent changes in lung tissue that result in hyper-responsiveness.

The researchers performed a genome-wide scan on 460 white families with “sib-pairs” (children having the same biological parents) diagnosed with asthma and being treated for the condition. They identified a locus on chromosome 20p13 that was linked to asthma (log10 of the likelihood ratio 2.94) and bronchial hyper-responsiveness (3.93).

The gene—ADAM33 (a disintegrin and …