tbuckley/cabot-search huggingface dataset:
Continuing medical education and continuing professional development: international comparisons
Authors: C. Peck
Journal: BMJ (2000)

Editorials by du Boulay and Asbjorn Holm 

Continuing professional development is the process by which health professionals keep updated to meet the needs of patients, the health service, and their own professional development. It includes the continuous acquisition of new knowledge, skills, and attitudes to enable competent practice. There is no sharp division between continuing medical education and continuing professional development, as during the past decade continuing medical education has come to include managerial, social, and personal skills, topics beyond the traditional clinical medical subjects. The term continuing professional development acknowledges not only the wide ranging competences needed to practise high quality medicine but also the multidisciplinary context of patient care.

#### Summary points

Internationally there is a move from continuing medical education (or clinical update) to continuing professional development, including medical, managerial, social, and personal skills

Continuing professional development is a process of lifelong learning in practice

Although the international systems vary in detail, there are many common features of content and process that allow international mutual recognition of activities in professional development

Most systems are based on an hours related credit system

Where revalidation or recertification of practitioners is required, demonstration of continuing professional development is an important integral part of the process

We obtained information from an assessment of the relevant policies, and interviews with directors of continuing professional development of the UK medical royal colleges, the UK Joint Centre for Education in Medicine, the European Union of Medical Specialties, the Royal College of Physicians and Surgeons of Canada, the American Medical Association and other American specialty societies, and the US Accreditation Committee for Continuing Medical Education. We also assessed research by the Australian and New Zealand Committee for the Maintenance of Professional Standards.

Although there are wide variations across systems for professional development in different countries and healthcare systems, …
Acute Insulin Response to Glucose and Glucagon in Subjects at Risk of Developing Type I Diabetes
Authors: Bernard Vialettes, Catherine Zevaco-Mattei, Xavier Thirion, Véronique Lassmann-Vague, Henri Pieron, Pierre Mercier, Philippe Vague
Journal: Diabetes Care (1993)

Objective— To determine if knowledge of characteristics of insulin response to various secretagogues during the preclinical phase of type I diabetes may facilitate the diagnosis of subjects at risk. Research Design and Methods— A test consisting of sequential intravenous challenge with glucose (0.3 g/kg) and glucagon (1 mg, 10 min after the end of glucose injection) was performed on 171 ICA− relatives of type I diabetic patients, 18 ICA+ relatives of type I diabetic patients, and 5 transiently hyperglycemic subjects. Acute response to glucose was expressed as the sum of plasma insulin at 2 and 5 min and response to glucagon as the increase in plasma insulin after 10 min. Results— Responses below the lower 95% confidence interval in the ICA− population (40 and 43 μU/ml for glucose and glucagon, respectively) were considered abnormal. The two values were correlated (r = 0.62). Abnormalities coexisted in 2.3% of the ICA− group, 11% of the ICA+ group, and 100% of the transiently hyperglycemic group. All the relatives who subsequently developed diabetes or hyperglycemic subjects who required insulin exhibited combined abnormalities. Some ICA− and ICA+ relatives were tested repeatedly over a follow-up period of 1.5–4 yr. Although the intraindividual coefficient of variation for the two responses was high (28 and 30%), values tended to run parallel in both ICA+ and ICA− relatives. In 2 patients monitored for 2 and 4 yr before diabetes developed, both responses declined at the same rate. In terms of prediction of diabetes, sensitivity of combined abnormalities was high (100%). But compared with the intravenous glucose tolerance test, improvement of specificity by the double challenge was not statistically significant. Conclusions— Both insulin responses to glucose and glucagon are related. They depend on the secretory capacity of β-cells and simultaneously become abnormal in the prediabetic phase.
GATA2 haploinsufficiency caused by mutations in a conserved intronic element leads to MonoMAC syndrome
Authors: Amy P. Hsu, Kirby D. Johnson, E. Liana Falcone, Rajendran Sanalkumar, Lauren Sanchez, Dennis D. Hickstein, Jennifer Cuellar-Rodriguez, Jacob E. Lemieux, Christa S. Zerbe, Emery H. Bresnick, Steven M. Holland
Journal: Blood (2013)
Cost-Effectiveness of Digital Mammography Breast Cancer Screening
Authors: Anna N.A. Tosteson, Natasha K. Stout, Dennis G. Fryback, Suddhasatta Acharyya, Benjamin A. Herman, Lucy G. Hannah, Etta D. Pisano
Journal: Annals of Internal Medicine (2008)

Background: The DMIST (Digital Mammography Imaging Screening Trial) reported improved breast cancer detection with digital mammography compared with film mammography in selected population subgroups, but it did not assess the economic value of digital relative to film mammography screening. Objective: To evaluate the cost-effectiveness of digital mammography screening for breast cancer. Design: Validated, discrete-event simulation model. Data Sources: Data from DMIST and publicly available U.S. data. Target Population: U.S. women age 40 years or older. Time Horizon: Lifetime. Perspective: Societal and Medicare. Intervention: All-film mammography screening; all-digital mammography screening; and targeted digital mammography screening, which is age-targeted digital mammography (for women <50 years of age) and age- and density-targeted digital mammography (for women <50 years of age or women ≥50 years of age with dense breasts). Outcome Measures: Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: All-digital mammography screening cost $331 000 (95% CI, $268 000 to $403 000) per QALY gained relative to all-film mammography screening but was more costly and less effective than targeted digital mammography screening. Targeted digital mammography screening resulted in more screen-detected cases of cancer and fewer deaths from cancer than either all-film or all-digital mammography screening, with cost-effectiveness estimates ranging from $26 500 (CI, $21 000 to $33 000) per QALY gained for age-targeted digital mammography to $84 500 (CI, $75 000 to $93 000) per QALY gained for age- and density-targeted digital mammography. In the Medicare population, the cost-effectiveness of density-targeted digital mammography screening varied from a base-case estimate of $97 000 (CI, $77 000 to $131 000) to $257 000 per QALY gained (CI, $91 000 to $536 000) in the alternative-case analyses, in which the sensitivity of film mammography was increased and the sensitivity of digital mammography in women with nondense breasts was decreased. Results of Sensitivity Analysis: Results were sensitive to the cost of digital mammography and to the prevalence of dense breasts. Limitations: Results were dependent on model assumptions and DMIST findings. Conclusion: Relative to film mammography, screening for breast cancer by using all-digital mammography is not cost-effective. Age-targeted screening with digital mammography seems cost-effective, whereas density-targeted screening strategies are more costly and of uncertain value, particularly among women age 65 years or older.
Effect of Oxygen on Patients with Pulmonary Emphysema
Authors: Gustav J. Beck
Journal: JAMA (1962)

The minute volume of ventilation was determined in 35 patients with pulmonary emphysema, as they inhaled air or 40% oxygen during and after exercise. The average minute volume increased 38% following exercise with oxygen, as compared to 60% with air over the resting control. Exercise with oxygen induced less dyspnea than with air. At rest, the minute volume while breathing 100% oxygen was 16% lower than while breathing air. A program of graded walking exercises while inhaling 40% oxygen resulted in an increase in exercise tolerance of patients with pulmonary emphysema. Signs of uncompensated respiratory acidosis were avoided in most instances, while hypoxia and cardiac decompensation complicating this disease were improved by supervised oxygen inhalations using flows of 1 liter per minute, followed by daily increments of 1 liter per minute up to 5 liters per minute, by nasal cannula.
IMMUNOGENICITY OF (S) AND (R) ENANTIOMERS OF A MACROCYCLIC BIFUNCTIONAL CHELATING AGENT WITH IMMUNOCONJUGATES IN RABBITS
Authors: N Watanabe, D A Goodwin, C F Meares, M McTigue, W Chaovapong, C Ransone, O Renn
Journal: Clinical Nuclear Medicine (1992)

Watanabe, N.; Goodwin, D. A.; Meares, C. F.; McTigue, M.; Chaovapong, W.; Ransone, C; Renn, O. Author Information
P316Expression and functional role of Ccdc80 in developing heart and in cardiomyopathies.
Authors: D Iaccarino, M Fedrigo, C Castellani, I Della Noce, S Carra, F Cotelli, G Thiene, A Angelini, F Schepis
Journal: Cardiovascular Research (2014)

Purpose: The gene Coiled Coil Domain Containing 80 (Ccdc80) is highly expressed in the hearts of vertebrates and its role is well defined in tumor suppression, glucose homeostasis and adipocyte differentiation. Our aims are to define its functional role during embryonic development and in cardiomyopathies. Methods: We used 3 different models: 1. Morpholino gene knock-down in Zebrafish to characterize Ccdc80 role in embryonic development; 2. Immunohistochemistry on heart ventricles from monocrotaline (MCT) injected rats (6 decompensated vs 6 normal animals); and 3. on human four chambers hearts from patients affected by dilated cardiomyopathy (DCM) (14 samples vs 2 controls from donor hearts which were not transplanted). Results: In Zebrafish Ccdc80 was widely expressed in the forming heart, during all the developmental stages and Ccdc80-morphants showed defects in the developing heart, with impaired cardiac looping, atrium enlargement, blood stasis and peripheral congestion (heart failure). These phenotypical alterations were due to a disorder of the late phase of cardiac development, after myocytes differentiation. MCT injected rats showed evident cytosplasmic overexpression of Ccd80 protein in hypertrophic right ventricles (high pressure overload site) in comparison to controls. Human samples from DCM patients showed cytosplamic overexpression of Ccdc80 protein particularly evident at the level of atria, where the staining pattern from mild and patchy in controls became strong and homogeneous in diseased hearts. Conclusions: Our results demonstrated that Ccdc80 has an important role for correct heart development in a model of vertebrates. In adult hearts under stress and/or pressure overload, Ccdc80 showed increased expression as a likely adaptive role to be further investigated.
Audience issues were not considered in editorial on WikiProject Medicine
Authors: M. L. Jenkinson
Journal: BMJ (2011)

Trevena’s editorial on some of the strengths of WikiProject Medicine does not address the audience.1 It also assumes that one trusted source of predigested reviewed information should be striven for for a medical audience rather than encouraging cross validation of review articles.

Contrast the self reported top 10 most viewed articles in WikiProject Medicine and GANFYD, a much …
The effect of fibrin-stabilizing factor on the subunit structure of human fibrin
Authors: Martin L. Schwartz, Salvatore V. Pizzo, Robert L. Hill, Patrick A. McKee
Journal: Journal of Clinical Investigation (1971)

The formation of human fibrin from fibrinogen has been examined by polyacrylamide gel electrophoresis in sodium dodecyl sulfate, a method which separates a mixture of proteins on the basis of differences in molecular weight. It has been found that the plasma from a patient with a congenital deficiency of fibrin-stabilizing factor forms clots lacking the cross links among the alpha- and gammachains found in normal, cross-linked human fibrin. The addition of purified fibrin-stabilizing factor or normal plasma to the deficient plasma results in extensive cross-linking of the chains. Thus, the fibrinogen in the fibrin-stabilizing factor deficient plasma appears to be normal and forms fibrin which contains dimeric, cross-linked gamma-chains and polymeric, high molecular weight forms of alpha-chains. By the use of these electrophoretic methods, it has also been possible to develop a highly sensitive method for measuring the content of fibrin-stabilizing factor in plasma. This method depends upon the use of urea-treated fibrinogen, which is completely devoid of fibrin-stabilizing factor, but which forms the usual cross-linked subunits after conversion to fibrin by thrombin in the presence of fibrin-stabilizing factor.
Efficacy of the HSP90 inhibitor 17-AAG in human glioma cell lines and tumorigenic glioma stem cells
Authors: Claire Marie-Elisabeth Sauvageot, Jessica Leigh Weatherbee, Santosh Kesari, Susan Elizabeth Winters, Jessica Barnes, Jamie Dellagatta, Naren Raj Ramakrishna, Charles Dean Stiles, Andrew Li-Jen Kung, Mark W. Kieran, Patrick Yung Chih Wen
Journal: Neuro-Oncology (2008)

Glioblastoma multiforme (GBM) arises from genetic and signaling abnormalities in components of signal transduction pathways involved in proliferation, survival, and the cell cycle axis. Studies to date with single-agent targeted molecular therapy have revealed only modest effects in attenuating the growth of these tumors, suggesting that targeting multiple aberrant pathways may be more beneficial. Heat-shock protein 90 (HSP90) is a molecular chaperone that is involved in the conformational maturation of a defined group of client proteins, many of which are deregulated in GBM. 17-allylamino-17-demethoxygeldanamycin (17-AAG) is a well-characterized HSP90 inhibitor that should be able to target many of the aberrant signal transduction pathways in GBM. We assessed the ability of 17-AAG to inhibit the growth of glioma cell lines and glioma stem cells both in vitro and in vivo and assessed its ability to synergize with radiation and/or temozolomide, the standard therapies for GBM. Our results reveal that 17-AAG is able to inhibit the growth of both human glioma cell lines and glioma stem cells in vitro and is able to target the appropriate proteins within these cells. In addition, 17-AAG can inhibit the growth of intracranial tumors and can synergize with radiation both in tissue culture and in intracranial tumors. This compound was not found to synergize with temozolomide in any of our models of gliomas. Our results suggest that HSP90 inhibitors like 17-AAG may have therapeutic potential in GBM, either as a single agent or in combination with radiation.
Posttranscriptional deregulation of signaling pathways in meningioma subtypes by differential expression of miRNAs
Authors: Nicole Ludwig, Yoo-Jin Kim, Sabine C. Mueller, Christina Backes, Tamara V. Werner, Valentina Galata, Elke Sartorius, Rainer M. Bohle, Andreas Keller, Eckart Meese
Journal: Neuro-Oncology (2015)

Background.Micro (mi)RNAs are key regulators of gene expression and offer themselves as biomarkers for cancer development and progression.Meningioma is one of the most frequent primary intracranial tumors.As of yet, there are limited data on the role of miRNAs in meningioma of different histological subtypes and the affected signaling pathways.Methods.In this study, we compared expression of 1205 miRNAs in different meningioma grades and histological subtypes using microarrays and independently validated deregulation of selected miRNAs with quantitative real-time PCR.Clinical utility of a subset of miRNAs as biomarkers for World Health Organization (WHO) grade II meningioma based on quantitative real-time data was tested.Potential targets of deregulated miRNAs were discovered with an in silico analysis.Results.We identified 13 miRNAs deregulated between different subtypes of benign meningiomas, and 52 miRNAs deregulated in anaplastic meningioma compared with benign meningiomas.Known and putative target genes of deregulated miRNAs include genes involved in epithelial-to-mesenchymal transition for benign meningiomas, and Wnt, transforming growth factor -b, and vascular endothelial growth factor signaling for higher-grade meningiomas.Furthermore, a 4-miRNA signature (miR-222, -34a*, -136, and -497) shows promise as a biomarker differentiating WHO grade II from grade I meningiomas with an area under the curve of 0.75. Conclusions.Our data provide novel insights into the contribution of miRNAs to the phenotypic spectrum in benign meningiomas.By deregulating translation of genes belonging to signaling pathways known to be important for meningioma genesis and progression, miRNAs provide a second in line amplification of growth promoting cellular signals.MiRNAs as biomarkers for diagnosis of aggressive meningiomas might prove useful and should be explored further in a prospective manner.
Fatal Injuries after Cocaine Use as a Leading Cause of Death among Young Adults in New York City
Authors: Peter M. Marzuk, Kenneth Tardiff, Andrew C. Leon, Charles S. Hirsch, Marina Stajic, Laura Portera, Nancy Hartwell, M. Irfan Iqbal
Journal: New England Journal of Medicine (1995)

Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries.Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause.Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City.Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.
The Intractable Female Patient
Authors: JOHN H. HOUCK
Journal: American Journal of Psychiatry (1972)

The author discusses how normally positive circumstances in the treatment process—family, therapist, and hospital—can unite to obstruct the progress of the intractable female patient. This patient's hospitalization should be comparatively brief; her therapy supportive and aggressively reality oriented, but not intensive; and her attention firmly fixed on home, family, and adult obligations. There should be early, aggressive work with the spouse, concentrating on his passivity and lack of dominance. Control, maturity, and independence should be emphasized.
Medicinal marijuana provided at cost price
Authors: T. Sheldon
Journal: BMJ (1997)

Dozens of Dutch “coffee shops” have organised a national campaign to provide medicinal marijuana at cost price after the government banned doctors and pharmacists from prescribing the drug.

The health inspectorate banned the prescribing of marijuana in August, acting on a recent report by the Dutch Health Council which concluded that there was insufficient proof of its medicinal benefits. The health minister, Professor Els Borst Eilers, said that she was unable to make a medical exception to the Netherlands' opium law controlling drugs. Although marijuana …
Leiomyoblastoma of the Stomach: Endoscopic Treatment
Authors: A. Papazian, J.L. Gineston, J.P. Capron, C. Quenum
Journal: Endoscopy (1984)

Since 1960, about 250 cases of leiomyoblastoma of the stomach have been reported. The diagnosis was always made after surgical resection or necropsy. We report the first case of gastric leiomyoblastoma successfully treated by endoscopic resection, in a 76-year-old woman presenting with upper gastrointestinal bleeding. This therapeutic procedure would seem to be the one of choice, in view of the age of the patient, the limited size and the pedunculated form of the tumor. Endoscopic follow-up should be instituted since local recurrence of the tumor and distal metastases have been reported.
Cerebrovascular accident and myocardial infarction associated with anticardiolipin antibodies in a young woman with systemic lupus erythematosus.
Authors: Y Maaravi, E Raz, D Gilon, A Rubinow
Journal: Annals of the Rheumatic Diseases (1989)

A 26 year old woman with systemic lupus erythematosus, including malar rash, photosensitivity, and arthritis, developed a cerebrovascular accident and acute myocardial infarction. High titres to antinuclear factor, anti-DNA antibodies, positive Venereal Disease Research Laboratory (VDRL) test, and anticardiolipin antibodies were found in her serum. A possible association between the presence of anticardiolipin antibodies and the two major thrombotic events is discussed.
Treatment of Parkinsonism with Levodopa
Authors: JOHN E. LEE
Journal: Annals of Internal Medicine (1971)

One hundred patients with Parkinson's disease began taking levodopa in 1968; 72 of them have continued treatment under close supervision for at least 2 years. After treatment for 2 years 82% of the patients were improved 25% or more compared with their pretreatment condition; 49% were improved 50% or more. Tremor improved more than did rigidity or akinesia. The average dose at 2 years was 4.5 g/day. Side effects were frequent but required treatment to be stopped in only three patients. Commonest were involuntary movements, nausea and transient delirium, and confusion and memory loss. The dementia associated with parkinsonism improved in some patients but progressed in others. Although parkinsonism did not appear to progress during levodopa treatment, a 2-year treatment experience does not permit us to draw conclusions as to the effect of levodopa on the natural history of Parkinson's disease. Levodopa continues to be the most effective treatment available.