tbuckley/cabot-search huggingface dataset:
Public opinion and purchasing.
Authors: A. Richardson, M. Charny, S. Hanmer-Lloyd
Journal: BMJ (1992)

To explore the use of a questionnaire to obtain representative public opinions on health services. To examine residents' priorities, knowledge, and views on the public's role in decision making.Self administered postal questionnaire.Random sample of 1500 residents in Bath District Health Authority, drawn from electoral registers.Levels of agreement or disagreement with statements provided and degree of importance given to services and aspects of services.70 questionnaires were returned unopened. Completed questionnaires were returned by 704 (49.2%) of the 1430 remaining residents. Kidney dialysis was thought very important by 559 (87%) respondents and family planning by only 58 (9%). Public priorities did not seem to reflect value for money. Clear information about treatment was rated as very important by 530 (76%) and comfortable waiting areas by 70 (10%). 372 (53%) of respondents said that they would definitely travel to a hospital outside the district to reduce their wait for surgery. Knowledge of the services provided by the authority and the money available to it was poor. 446 (65%) respondents wanted greater public involvement in decision making.A postal questionnaire can provide useful information about public priorities and perceptions about the services provided. More information about health services and their costs and benefits should be given to the public to assist greater public participation in decision making.
Neuregulin-1/erbB-Activation Improves Cardiac Function and Survival in Models of Ischemic, Dilated, and Viral Cardiomyopathy
Authors: Xifu Liu, Xinhua Gu, Zhaoming Li, Xinyan Li, Hui Li, Jianjie Chang, Ping Chen, Jing Jin, Bing Xi, Denghong Chen, Donna Lai, Robert M. Graham, Mingdong Zhou
Journal: Journal of the American College of Cardiology (2006)
Sonar Measurement of Fetal Crown-Rump Length as Means of Assessing Maturity in First Trimester of Pregnancy
Authors: H. P. Robinson
Journal: BMJ (1973)

A method is reported by which the “in utero” crown-rump length of the fetus may be determined by sonar in the first trimester of pregnancy. The accuracy of the technique was assessed by comparing the sonar and the direct postabortum measurements of fetuses in cases of missed abortion. A normal curve of fetal crown-rump length was derived from 214 examinations on 80 patients and by using these values in a further “blind” series it was found possible to predict the maturity of pregnancy to within three days, between the sixth and the 14th weeks of pregnancy.
Increased plasma pancreastatin-like levels in gestational diabetes: correlation with catecholamine levels.
Authors: V Sánchez-Margalet, J A Lobón, A González, M L Fernández-Soto, F Escobar-Jiménez, R Goberna
Journal: Diabetes Care (1998)

OBJECTIVE: To investigate plasma pancreastatin (a chromogranin A-derived peptide) and catecholamine levels (counterregulatory hormones) in subjects with gestational diabetes compared with normal pregnant subjects. RESEARCH DESIGN AND METHODS: Fasting blood samples were obtained from 11 normal pregnant and 12 nonobese gestational diabetic subjects at late pregnancy (30+/-1 weeks). Selection criteria were those recommended by the National Diabetes Data Group (modified from O'Sullivan original criteria). Plasma glucose, insulin, glucagon, pancreastatin-like, epinephrine, and norepinephrine were measured. RESULTS: Gestational diabetic subjects had significantly higher insulin levels than control pregnant subjects (18+/-1 vs. 15+/-1 microU/ml), whereas glucose and glucagon levels where comparable in the two groups. However, increased catecholamine levels (epinephrine and norepinephrine) were found in the gestational diabetic group. We also found increased pancreastatin-like levels in these patients compared with the pregnant control group (46+/-2 vs. 30+/-2 pmol/l). Actually, pancreastatin levels positively correlated with both epinephrine (r = 0.34) and norepinephrine (r = 0.80) levels. CONCLUSIONS: Catecholamine and pancreastatin-like levels were found elevated in gestational diabetic subjects. These counterregulatory hormones may play a role in the insulin resistance syndrome of gestational diabetes.
Shared Risk Factors for Falls, Incontinence, and Functional Dependence
Authors: Mary E. Tinetti
Journal: JAMA (1995)

To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence.Population-based cohort with a 1-year follow-up.General community.A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews.At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living.At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three.Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.
Relationship Between Selective Cyclooxygenase-2 Inhibitors and Acute Myocardial Infarction in Older Adults
Authors: Daniel H. Solomon, Sebastian Schneeweiss, Robert J. Glynn, Yuka Kiyota, Raisa Levin, Helen Mogun, Jerry Avorn
Journal: Circulation (2004)

Background— Although cyclooxygenase-2 inhibitors (coxibs) were developed to cause less gastrointestinal hemorrhage than nonselective nonsteroidal antiinflammatory drugs (NSAIDs), there has been concern about their cardiovascular safety. We studied the relative risk of acute myocardial infarction (AMI) among users of celecoxib, rofecoxib, and NSAIDs in Medicare beneficiaries with a comprehensive drug benefit. Methods and Results— We conducted a matched case-control study of 54 475 patients 65 years of age or older who received their medications through 2 state-sponsored pharmaceutical benefits programs in the United States. All healthcare use encounters were examined to identify hospitalizations for AMI. Each of the 10 895 cases of AMI was matched to 4 controls on the basis of age, gender, and the month of index date. We constructed matched logistic regression models including indicators for patient demographics, healthcare use, medication use, and cardiovascular risk factors to assess the relative risk of AMI in patients who used rofecoxib compared with persons taking no NSAID, taking celecoxib, or taking NSAIDs. Current use of rofecoxib was associated with an elevated relative risk of AMI compared with celecoxib (odds ratio [OR], 1.24; 95% CI, 1.05 to 1.46; P =0.011) and with no NSAID (OR, 1.14; 95% CI, 1.00 to 1.31; P =0.054). The adjusted relative risk of AMI was also elevated in dose-specific comparisons: rofecoxib ≤25 mg versus celecoxib ≤200 mg (OR, 1.21; 95% CI, 1.01 to 1.44; P =0.036) and rofecoxib &gt;25 mg versus celecoxib &gt;200 mg (OR, 1.70; 95% CI, 1.07 to 2.71; P =0.026). The adjusted relative risks of AMI associated with rofecoxib use of 1 to 30 days (OR, 1.40; 95% CI, 1.12 to 1.75; P =0.005) and 31 to 90 days (OR, 1.38; 95% CI, 1.11 to 1.72; P =0.003) were higher than &gt;90 days (OR, 0.96; 95% CI, 0.72 to 1.25; P =0.8) compared with celecoxib use of similar duration. Celecoxib was not associated with an increased relative risk of AMI in these comparisons. Conclusions— In this study, current rofecoxib use was associated with an elevated relative risk of AMI compared with celecoxib use and no NSAID use. Dosages of rofecoxib &gt;25 mg were associated with a higher risk than dosages ≤25 mg. The risk was elevated in the first 90 days of use but not thereafter.
Chain-reaction Ca2+ signaling in the heart
Authors: Sandor Györke, Brian M. Hagen, Dmitry Terentyev, W. Jonathan Lederer
Journal: Journal of Clinical Investigation (2007)

Mutations in Ca2+-handling proteins in the heart have been linked to exercise-induced sudden cardiac death. The best characterized of these have been mutations in the cardiac Ca2+ release channel known as the ryanodine receptor type 2 (RyR2). RyR2 mutations cause "leaky" channels, resulting in diastolic Ca2+ leak from the sarcoplasmic reticulum (SR) that can trigger fatal cardiac arrhythmias during stress. In this issue of the JCI, Song et al. show that mutations in the SR Ca2+-binding protein calsequestrin 2 (CASQ2) in mice result not only in reduced CASQ2 expression but also in a surprising, compensatory elevation in expression of both the Ca2+-binding protein calreticulin and RyR2, culminating in premature Ca2+ release from cardiac myocytes and stress-induced arrhythmia (see the related article beginning on page 1814). In the context of these findings and other recent reports studying CASQ2 mutations, we discuss how CASQ2 influences the properties of Ca2+-dependent regulation of RyR2 and how this contributes to cardiac arrhythmogenesis.
Investing in Exposure
Authors: Abdul Moiz Khan
Journal: PLoS Medicine (2006)

The problems of the overwhelming amount of medical literature have been thoughtfully highlighted in the PLoS Medicine editorial “Drowning or Thirsting: The Extremes of Availability of Medical Information” [ 1]. It is of vital importance to medical professionals that they improve on their skills of sifting through the huge amounts of literature that are made available to them every month. But this task becomes exponentially more difficult in the less-developed world, where basic knowledge of medical literature is limited [ 2]. 

There are no alternatives to the good analytical skills that come through continued exposure to medical literature. This exposure should begin at the medical student level. Exercises such as those requiring medical students to analytically criticize medical literature can go a long way in developing reading skills.

The second issue is that of disseminating the literature that has been published. Access to reliable health information has been described as “the single most cost-effective and achievable strategy for sustainable improvement in health care” [ 3]. 

A useful strategy could be making less-expensive paper versions of medical journals widely available in less-developed countries. Publishers should be willing to look into this approach. Regional copies of journals can be produced locally and inexpensively. This will boost the circulation of medical journals. Medical professionals will not mind a little compromise in the quality of paper in a journal, so long as they are able to afford it at a low price.

The business model of offshore call centers can serve as a useful one in the case of publishing low-cost copies of medical journals. Companies have shifted their call centers to less-developed countries where services are available at very low costs. The costs of publishing are likewise bound to be cheaper in the less-developed countries; therefore, journals can be produced at affordable prices. If this model can be followed by multinationals, why is it not possible for a cause as noble as publishing medical literature?

Another approach could be that journal volumes could be condensed, so that only research relevant to the local area is published in the local version of the journal.

The Internet's widely spreading use as a resource can be of vital value in substantially quenching the thirst of professionals. The wide availability of Internet access in Pakistan [ 4], for example, helps the cause of disseminating information. Internet access such as that given through the platform of HINARI or the Ptolemy project [ 5] is also a viable option. But these networks need to be expanded to include more countries and individuals [ 6]. 

One should hope that investing in improving exposure of health professionals to medical literature will help improve their practices and the quality of healthcare that they provide to impoverished populations in their local area. The need of the hour is to be innovative and be ready to embrace new and thoughtful ideas for the collective good of humanity.
Regular Aerobic Exercise Augments Endothelium-Dependent Vascular Relaxation in Normotensive As Well As Hypertensive Subjects
Authors: Yukihito Higashi, Shota Sasaki, Satoshi Kurisu, Atsunori Yoshimizu, Nobuo Sasaki, Hideo Matsuura, Goro Kajiyama, Tetsuya Oshima
Journal: Circulation (1999)

Background —Several nonpharmacological interventions, including exercise, are recommended in primary prevention of hypertension and other cardiovascular diseases in which the pathogenetic role of endothelial dysfunction has been suggested. We studied the effects of long-term aerobic exercise on endothelial function in patients with essential hypertension. Methods and Results —The forearm blood flow was measured by strain-gauge plethysmography. The responses of forearm vasculature to acetylcholine were smaller in the hypertensive patients than in the normotensive subjects. There was no significant difference in forearm vascular responses to isosorbide dinitrate in the normotensive and hypertensive subjects. We evaluated the effects of physical exercise for 12 weeks on forearm hemodynamics in untreated patients with mild essential hypertension who were divided randomly into an exercise group (n=10) and a control group (n=7). After 12 weeks, the forearm blood flow response to acetylcholine increased significantly, from 25.8±9.8 to 32.3±11.2 mL · min −1 · 100 mL tissue −1 ( P &lt;0.05), in the exercise group but not in the control group. The increase in the forearm blood flow after isosorbide dinitrate was similar before and after 12 weeks of follow-up in both groups. The infusion of N G -monomethyl- l -arginine abolished the exercise-induced enhancement of forearm vasorelaxation evoked by acetylcholine in the exercising group. In normotensive subjects also, long-term aerobic exercise augmented acetylcholine-stimulated nitric oxide release. Conclusions —These findings suggest that long-term physical exercise improves endothelium-dependent vasorelaxation through an increase in the release of nitric oxide in normotensive as well as hypertensive subjects.
Estradiol in Breast Cancer Treatment
Authors: Pamela N. Munster, John T. Carpenter
Journal: JAMA (2009)

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Crohn's disease of the colon and its distinction from diverticulitis.
Authors: G T Schmidt, J E Lennard-Jones, B C Morson, A C Young
Journal: Gut (1968)

Crohn's disease may affect segments of the colon (Brooke, 1959; Lindner, Marshak, Wolf, and Janowitz, 1963; Lockhart-Mummery and Morson, 1960, 1964) where diverticula are a common finding in the middle-aged and elderly (Dearlove, 1954; Pemberton, Black, and Maino, 1947). It would thus be surprising if Crohn's disease did not sometimes occur in the region of colonic diverticula and the object of this paper is to describe 26 such patients. Some of these patients presented little diagnostic difficulty. Others, with colonic diverticula, presented as 'diverticulitis' but the inflammation of the colon was subsequently shown to be due to Crohn's disease. Patients have also been seen who were diagnosed as diverticulitis but were later found to have Crohn's disease without any diverticula being present.
Circadian variation of plasma fibrinopeptide A level in patients with variant angina.
Authors: H Ogawa, H Yasue, S Oshima, K Okumura, K Matsuyama, K Obata
Journal: Circulation (1989)

Plasma levels of fibrinopeptide A (FPA), beta-thromboglobulin (BTG), and platelet factor 4 (PF4) were examined on venous plasma samples taken every 4 hours for 24 hours in 20 patients with variant angina and 20 patients with stable exertional angina together with 24-hour Holter recordings. The mean plasma FPA levels (ng/ml) at 2:00 PM, 6:00 PM, 10:00 PM, 2:00 AM, 6:00 AM, and 10:00 AM were 4.6 +/- 1.0, 3.1 +/- 0.5, 6.1 +/- 1.6, 9.9 +/- 2.4, 8.7 +/- 1.4, and 4.2 +/- 0.8 in patients with variant angina (p less than 0.01) and 1.8 +/- 0.2, 2.3 +/- 0.3, 1.9 +/- 0.3, and 2.3 +/- 0.2 in those with stable exertional angina. In seven patients with variant angina, we also examined the effects of heparin (3,000 units), given subcutaneously at 6:00 PM, 10:00 PM, and 2:00 AM, on the plasma FPA levels and the anginal attacks. Although heparin suppressed the elevation and circadian variation of plasma FPA levels, it did not suppress the attacks and their circadian variation in these patients. Plasma FPA levels increased significantly from 3.7 +/- 0.5 to 12.5 +/- 2.7 ng/ml during or immediately after an attack in the seven patients with no heparin. On the other hand, the plasma levels of BTG and PF4 were increased in patients with variant angina as compared with those with stable exertional angina but did not show a significant circadian variation in both groups. We conclude that 1) plasma levels of FPA, BTG, and PF4 were increased in patients with variant angina as compared with those with stable exertional angina; 2) there was a significant circadian variation in the plasma levels of FPA in parallel with that of the frequency of the attacks with the peak level occurring from midnight to early morning in patients with variant angina; and 3) elevated levels of plasma FPA are the result and not the cause of coronary spasm.
Vagal Reflexes Referred from the Upper Aerodigestive Tract: An Infrequently Recognized Cause of Common Cardiorespiratory Responses
Authors: Emmett T. Cunningham, William J. Ravich, Bronwyn Jones, Martin W. Donner
Journal: Annals of Internal Medicine (1992)

Objective: To review the physiologic basis for normal and abnormal vagal reflexes arising from the pharynx, larynx, and esophagus, as well as the relevance of vagal reflexes to the pathogenesis of such clinically common cardiorespiratory responses as bradycardia, tachycardia, dysrhythmia, coronary angiospasm, bronchospasm, laryngospasm, prolonged apnea, and singultus (hiccups). Data Sources: Pertinent articles and reviews were identified through a MEDLINE search (April 1966 to October 1991). Older studies and others not identified in the MEDLINE search were found through a manual search of the bibliographies of the retrieved articles. Study Selection: Experimental studies in both humans and animals, as well as case series and single case reports, were selected for evaluation and citation. In instances where a similar phenomenon was described in multiple independent reports, only studies that provided a novel finding or interpretation were cited. More authoritative book chapters and peerreviewed summaries were also cited in support of commonly accepted principles. Data Extraction and Synthesis: Most of the clinical data are derived from case reports and small case series and are therefore anecdotal; equal weight was given to all such studies. Reports of conflicting observations or interpretations were clearly identified and were cited without exception. Conclusions: Stimulation of the upper aerodigestive tract can lead to clinically significant cardiorespiratory responses. Although the prevalence of and risk factors for such responses have not been established, we suggest that a pharyngeal, a laryngeal, or an esophageal source for abnormal cardiorespiratory responses be sought whenever a detailed clinical evaluation fails to reveal a cause, particularly when there are concurrent symptoms or signs of upper aerodigestive tract disease, such as dysphagia or gastroesophageal reflux.
Lymph node iron in rheumatoid arthritis. Histology, ultrastructure, and chemical concentration.
Authors: K D Muirden
Journal: Annals of the Rheumatic Diseases (1970)

Lymph node enlargement occurs frequently in rheumatoid arthritis and a recent study has indicated that this is more marked in the area of drainage of actively inflamed joints (Robertson, Hart, White, Nuki, and Boardman, 1968).Our observations of iron deposits in the synovium in this disease (Muir- den, 1966; Muirden and Senator, 1968) have led us to wonder whether the regional nodes are a possible further area of iron storage.Standard pathological descriptions do not mention the presence of iron pigmentation in rheumatoid lymph nodes (Motul- sky, Weinberg, Saphir, and Rosenberg, 1952; Cruickshank, 1958; Gardner, 1965), although Gardner and Roy (1961) did find iron in patients who had received iron therapy or blood transfusions.In patients who had not been given iron there was no significant difference in concentration between rheumatoid and control nodes.
Abstract 2343: Outcomes in Children with Noonan Syndrome and Cardiomyopathy
Authors: James D Wilkinson, April M Lowe, Bonnie A Salbert, Lynn A Sleeper, Jeffrey A Towbin, Steven D Colan, Gerald F Cox, David M Connuck, Elizabeth Cadregari, Sarah K Clunie, Jane Messere, Steven E Lipshultz
Journal: Circulation (2007)

OBJECTIVE: The presence of cardiomyopathy in some children with Noonan syndrome (NS) has been well described. The objective of this analysis was to determine the survival experience of these childr...
Prescription pricing authority aims to promote high quality prescribing
Authors: J. Ferguson, C M Harris, G England, N Hough, M G Lee, D Archer, T Ewington, P Clappison
Journal: BMJ (1995)

EDITOR,—Dermot Ryan and Mark Levy, in their letter about the reports sent by the Prescription Pricing Authority, make three main comments about the centre page report on asthma sent to all general practitioners in England in August 1994.2

The Prescribing Research Unit and the General Practitioners in Asthma Group, of which Ryan and Levy are members, jointly undertook the research on which the comment from the Prescribing Research Unit was based. It would not have been appropriate to cite the level …