tbuckley/cabot-search huggingface dataset:
Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery
Authors: Jarod P. McAteer, Cabrini A. LaRiviere, George T. Drugas, Fizan Abdullah, Keith T. Oldham, Adam B. Goldin
Journal: JAMA Pediatrics (2013)

<h3>Importance</h3>Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.<h3>Objective</h3>To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.<h3>Evidence Review</h3>A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted.<h3>Findings</h3>Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures.<h3>Conclusions and Relevance</h3>Data on experience-related outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies should seek both to standardize definitions, making results more applicable, and to differentiate procedures affected by surgeon experience from those more affected by hospital resources and system-level variables.
Comparison of nasal immunohistology in patients with seasonal rhinoconjunctivitis treated with topical steroids or specific allergen immunotherapy
Authors: S. Rak, C. Heinrich, A. Scheynius
Journal: Allergy (2005)

Background: Specific allergen immunotherapy (SIT) and nasal steroids (NS) are considered effective anti‐inflammatory treatments for allergic rhinitis, although their mechanism of action differs. Objective: The aim of this study was to examine the effect of treatment with NS and SIT on different populations of inflammatory cells in the nasal mucosa and to compare cell numbers before and during the birch pollen season in patients with seasonal allergic rhinitis. Methods: In a randomized, double‐blind, double dummy comparative study, 41 patients with seasonal rhinoconjunctivitis were treated with birch SIT or NS (budesonide 400 μ g daily). Treatment with NS started before the birch pollen season and at the same time SIT‐treated patients reached the maintenance dose. Nasal biopsies for immunohistochemistry were obtained before the season and start of the treatments and at the peak of the pollen season during treatment. Results: Symptoms of rhinoconjunctivitis increased significantly in both groups during the pollen season but less in the NS‐treated group and the difference between the treatment groups was significant at the end of the season ( P = 0.03). Immunohistochemistry of nasal biopsies from NS‐treated patients showed significantly fewer CD1a + , IgE + and Fc ɛ RI + cells during the season compared with preseason ( P = 0.02, P = 0.001 and P = 0.0004, respectively) and with seasonal values of the SIT‐treated group ( P = 0.002, P = 0.002 and P = 0.0004 respectively). Conclusion: Treatment with NS but not SIT decreased the numbers of CD1a + , IgE + and Fc ɛ RI + cells during the birch pollen season. Our data indicate that treatment with NS has a broader anti‐inflammatory range than SIT.
Effects of ouabain on myocardial oxygen supply and demand in patients with chronic coronary artery disease. A hemodynamic, volumetric, and metabolic study in patients without heart failure.
Authors: H DeMots, S H Rahimtoola, E L Kremkau, W Bennett, D Mahler
Journal: Journal of Clinical Investigation (1976)

The effects of digitalis glycosides on myocardial oxygen supply and demand are of particular interest in the presence of obstructive coronary artery disease, but have not been measured previously in man. We assessed the effects of ouabain (0.015 mg/kg body weight) on hemodynamic, volumetric, and metabolic parameters in 11 patients with severe chronic coronary artery disease without clinical congestive heart failure. Because the protocol was long and involved interventions which might affect the determinations, we also studied in nine patients using an identical protocol except that ouabain administration was omitted. Left ventricular end-diastolic pressure and left ventricular end-diastolic volume fell in each patient given ouabain, even though they were initially elevated in only two patients. Left ventricular end-diastolic pressure fell from 11.5+/-1.4 (mean+/-SE) to 5.6+/-0.9 mm Hg (P less than 0.001) and left ventricular end-diastolic volume fell from 100+/-17 to 82+/-12 ml/m2 (P less than 0.01) 1 h after ouabain infusion was completed. The maximum velocity of contractile element shortening increased from 1.68+/-0.11 ml/s to 2.18+/-0.21 muscle-lengths/s (P less than 0.05) and is consistent with an increase in contractility. No significant change in these parameters occurred in the control patients. No significant change in myocardial oxygen consumption occurred after ouabain administration but this may be related to a greater decrease in mean arterial pressure in the ouabain patients than in the control patients. We conclude that in patients with chronic coronary artery disease who are not in clinical congestive heart failure left ventricular end-diastolic volume falls after ouabain administration even when it is initially normal. Though this fall would be associated with a decrease in wall tension, and, therefore, of myocardial oxygen consumption, it may not be of sufficient magnitude to prevent a net increase in myocardial oxygen consumption. Nevertheless, compensatory mechanisms prevent a deterioration of resting myocardial metabolism.
Advising Patients Who Seek Alternative Medicine
Authors: Gordon D. Heinrichs
Journal: Annals of Internal Medicine (1998)

Letters15 February 1998Advising Patients Who Seek Alternative MedicineGordon D. Heinrichs, DCGordon D. Heinrichs, DCFresno, CA 93726Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-4-199802150-00046 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read Dr. Eisenberg's article [1] with interest because I am one of those alternative providers whose “safety and efficacy remains largely unknown.” I am a chiropractor. The article is a very good example of what I have to do on a regular basis because we do know the morbidity and mortality rates of conventional medicine's safest treatments. I am as apprehensive when going to my family physician as most patients should be when going to theirs.Traditional medicine has lost sight of one of the most basic tenets of medicine, “first do no harm.” This has ...References1. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997; 127:61-9. Google Scholar Author, Article, and Disclosure InformationAuthors: Gordon D. Heinrichs, DCAffiliations: Fresno, CA 93726 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 February 1998Volume 128, Issue 4Page: 328KeywordsAspirinDeath ratesDrugsMorbidityMortalitySafetyTraditional medicine ePublished: 15 August 2000 Issue Published: 15 February 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Methods to identify increased risk of coronary disease in the general population: Conclusion is oversimplification
Authors: G. Assmann
Journal: BMJ (2003)

Editor—Wilson et al assert that measuring cholesterol concentration only in people of at least 50 efficiently identifies those at high risk of coronary heart disease.1 This oversimplification results from a study with important defects.

Firstly, Wilson et al determined absolute risk of coronary heart disease by using the Sheffield tables and the underlying Framingham algorithm. However, in the German prospective cardiovascular Munster (PROCAM) study and the Augsburg cohort of the World Health Organization's monitoring trends and determinants in cardiovascular disease (MONICA) study, Framingham overestimated coronary risk about twofold.2 Even allowing for the higher incidence of coronary heart disease in Britain compared with Germany,3 Wilson et al should have calculated risk by using either a British algorithm or a corrected Framingham formula.

Secondly, Wilson et al considered men and women together, even though risk of coronary heart disease in women is two to four times less than in age matched men aged up to about the age of 60. This error dilutes male risk of coronary heart disease, which is substantial even in early middle age. In the PROCAM study, for example, no fewer than 8% of men under 50 had a 10 year risk of coronary heart disease of more than 15% with the Framingham formula.

A particular aim in preventing coronary heart disease is to stop the early events that produce an especially high burden of morbidity and cost. Moreover, since the risk increases sharply with age, patients at borderline risk below the age of 50 require attention if they are not to proceed inexorably into a high risk group. Limiting cholesterol measurements to the over 50s will increase costs and disease burden.
SCRUPULOSITY : RELIGION AND OBSESSIVE COMPULSIVE BEHAVIOR IN CHILDREN
Authors: WAYNE M. WEISNER, PIUS ANTHONY RIFFEL
Journal: American Journal of Psychiatry (1960)

In this paper, a clearer picture of severe chronic scrupulosity as a pathological condition is presented. Children actually referred to a child guidance clinic for their scrupulosity are seriously disturbed. What became clear to us was that the scrupulous children presented a consistent picture in terms of symptoms and underlying personality traits. It usually appears as an obsessive compulsive disturbance involving fears and doubts. However, the constriction and inhibitions of these scrupulous children were frequently indicative of a schizoid personality and, in some instances, of an underlying schizophrenic matrix. This consistent picture of the scrupulous child which emerged from our research, enabled us to obtain a more immediate and fuller understanding of any new child referred to our clinic for his scrupulosity, and to work with the scrupulous child in a more confident and effective manner.
Intrauterine Contraceptive Device and Ovarian Thecoma
Authors: M. Steven Piver
Journal: JAMA (1966)

DESPITE the widespread universal use of intrauterine contraceptive devices, serious complications are infrequent. This report is of a patient whose pelvic pain and excessive uterine bleeding, thought to be due to an intrauterine device, were caused by a functioning thecoma that became evident after the device had been in use for more than a year. Furthermore, from the findings at operation, the device (a Birnberg bow) lay outside the uterus.  Report of a Case  A 26-year-old Negro woman was seen in the Family Planning Clinic of the Pennsylvania Hospital in November 1964, six weeks after the delivery of her fourth child. The past history was notable only for nephrectomy at age 11 for renal cell carcinoma. The findings of both general, physical, and pelvic examinations were normal; a No. 5 Birnberg bow was inserted without difficulty on the third day of the menstrual period. A stained cervical smear (Papanicolaou class
Beta adrenoceptor binding and induced relaxation in airway smooth muscle from patients with chronic airflow obstruction.
Authors: C J van Koppen, J F de Miranda, A J Beld, C L van Herwaarden, J W Lammers, C A van Ginneken
Journal: Thorax (1989)

Beta adrenoceptor function in central airway smooth muscle of patients with chronic airflow obstruction was investigated by radioligand binding studies and isoprenaline relaxation experiments. Receptor characteristics were determined in tracheal smooth muscle preparations obtained at necropsy from 12 patients and in bronchial tissue obtained at thoracototomy from 21 patients with chronic airflow obstruction. Receptor characteristics were compared with those obtained in airway tissue preparations from 65 control subjects without chronic airflow obstruction. The number of beta adrenoceptors, their binding affinity for the radioligand [125I]-(-)-cyanopindolol, and the tissue binding characteristics of isoprenaline were similar in tissue from patients with chronic airflow obstruction and from control subjects. Isoprenaline induced relaxation of tracheal smooth muscle without precontraction by methacholine showed slightly (though not significantly) less sensitivity to isoprenaline in patients with chronic airflow obstruction than in control subjects (mean (SEM) pD2--the negative logarithm of the concentration producing 50% relaxation--6.32 (0.16) v 6.62 (0.15)). The same pattern of pD2 values was found in segmental bronchial strips without precontraction by methacholine (chronic airflow obstruction 6.55 (0.27), control 7.14 (0.12)). Isoprenaline relaxation in segmental bronchial strips when contracted maximally was significantly less in the patients with airflow obstruction than in the control subjects (pD2 value 5.99 (0.18) v 6.45 (0.07)). These results suggest that beta adrenoceptors in airway smooth muscle of patients with chronic airflow obstruction are not abnormal in number or in binding affinity but that there is less effective coupling between components of the relaxant system distal to the beta adrenoceptor. The possibility that the reduced isoprenaline sensitivity is a consequence of previous bronchodilator treatment cannot be excluded.
Hot spots of retroviral integration in human CD34+ hematopoietic cells
Authors: Claudia Cattoglio, Giulia Facchini, Daniela Sartori, Antonella Antonelli, Annarita Miccio, Barbara Cassani, Manfred Schmidt, Christof von Kalle, Steve Howe, Adrian J. Thrasher, Alessandro Aiuti, Giuliana Ferrari, Alessandra Recchia, Fulvio Mavilio
Journal: Blood (2007)
Partial muscle carnitine palmitoyltransferase-A deficiency. Rhabdomyolysis associated with transiently decreased muscle carnitine content after ibuprofen therapy
Authors: Nathan S. Ross, Charles L. Hoppel
Journal: JAMA (1987)

After initiation of ibuprofen therapy, a 45-year-old woman developed muscle weakness and tenderness with rhabdomyolysis, culminating in respiratory failure. A muscle biopsy specimen showed a vacuolar myopathy, and markedly decreased muscle carnitine content and carnitine palmitoyltransferase activity. Following recovery, muscle carnitine content was normal but carnitine palmitoyltransferase activity was still abnormally low. The ratio of palmitoyl-coenzyme A plus carnitine to palmitoylcarnitine oxidation by muscle mitochondria isolated from the patient was markedly decreased. We conclude that transiently decreased muscle carnitine content interacted with partial deficiency of carnitine palmitoyltransferase-A to produce rhabdomyolysis and respiratory failure and that ibuprofen may have precipitated the clinical event.
Challenging professional opinion: the use of independent arbitration
Authors: E A Scott, R A Stokoe
Journal: BMJ (1994)

The handling of patient referrals made to hospitals with which a health authority has no contract - so called extracontractual referrals - has been a subject of much debate. Some argue that anything other than automatic approval of an extracontractual referral represents a restriction on the freedom of choice of both health professionals and patients. Health authorities are, however, obliged to maintain strict budgetary control. As a consequence some extracontractual referrals are refused and this may give rise to disputes between patients or professionals and their health authority.

Such a situation arose in North West Hertfordshire, where the dispute was resolved by using an independent arbitrator.

The patient had been receiving treatment from a non-NHS institution for several years. The institution asked the health authority to continue funding her treatment as an extracontractual referral, but the authority refused. Considerable correspondence ensued, with no prospect of resolution. A meeting took place between the health authority's chief executive and acting director of public health, and the patient and her husband. During the meeting it became apparent that no …
Are Short-Term or Long-Term Recurrence Rates More Important in Breast Cancer Screening?
Authors: Steven N. Goodman, Luigi Marchionni, Antonio C. Wolff
Journal: Annals of Internal Medicine (2008)

Letters2 September 2008Are Short-Term or Long-Term Recurrence Rates More Important in Breast Cancer Screening?Steven N. Goodman, MD, MHS, PhD, Luigi Marchionni, MD, PhD, and Antonio C. Wolff, MDSteven N. Goodman, MD, MHS, PhDFrom Johns Hopkins University School of Medicine, Baltimore, MD 21287., Luigi Marchionni, MD, PhDFrom Johns Hopkins University School of Medicine, Baltimore, MD 21287., and Antonio C. Wolff, MDFrom Johns Hopkins University School of Medicine, Baltimore, MD 21287.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-5-200809020-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the points made by Dr. Rutgers and colleagues, which underscore messages of our article and the editorial by Simon (1). The authors are correct that the populations on which the 2 tests were validated differed in terms of pretreatment. They also differed by estrogen receptor status: The 70-gene test was validated on a mixed population of estrogen receptor–positive and –negative patients, whereas all of the OncotypeDX patients were estrogen receptor–positive. Although there may be an explanation for the reported differences, these are the numbers reported from the validation studies on which women have to base decisions, ...Reference1. Simon R. Development and evaluation of therapeutically relevant predictive classifiers using gene expression profiling [Editorial]. J Natl Cancer Inst. 2006;98:1169-71. [PMID: 16954463] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Steven N. Goodman, MD, MHS, PhD; Luigi Marchionni, MD, PhD; Antonio C. Wolff, MDAffiliations: From Johns Hopkins University School of Medicine, Baltimore, MD 21287.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Gene Expression Profiling Assays in Early-Stage Breast Cancer Luigi Marchionni , Renee F. Wilson , Antonio C. Wolff , Spyridon Marinopoulos , Giovanni Parmigiani , Eric B. Bass , and Steven N. Goodman Are Short-Term or Long-Term Recurrence Rates More Important in Breast Cancer Screening? Emiel J.T. Rutgers , Lajos Pusztai , and René Bernards Metrics Cited bySurveillance après traitement de cancer du sein (hors mutation) 2 September 2008Volume 149, Issue 5Page: 357-358KeywordsBreast cancer screeningChemotherapyConflicts of interestEstrogensMorbidityMortalityPopulation statistics ePublished: 2 September 2008 Issue Published: 2 September 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract 498: Blunting the radical scavenging property of mitochondria-targeted, triphenylphosphonium-linked antioxidants failed to mitigate their anti-proliferative and antitumor effects
Authors: Gang Cheng, Jacek Zielonka, Joy Joseph, Balaraman Kalyanaraman
Journal: Cancer Research (2014)

Abstract Reactive oxygen species (ROS), including superoxide and hydrogen peroxide, are implicated in cancer cell proliferation. Therefore, strategies to mitigate ROS levels were proposed as a viable mechanism to inhibit cancer cell proliferation. As mitochondria are believed to be a major contributor to intracellular ROS production, mitochondria-targeted antioxidants (MTAs) (e.g., Mito-Q, Mito-CP, Mito-Vitamin-E or Mito-chromanol) were successfully used to stop proliferation and kill cancer cells in vitro and attenuate tumor growth in vivo. MTAs also inhibited mitochondrial oxygen consumption and ATP production. In this study, we tested whether the antioxidant moiety and related antioxidant function of MTAs or other mitochondrial mechanism is responsible for inhibiting tumor cell proliferation and resulting cytotoxicity. To this end, we compared the anti-proliferative and antitumor effects of Mito-CP, a mitochondrially-targeted nitroxide exhibiting superoxide dismutase (SOD)-like activity, and a synthetic analog of Mito-CP (Mito-CP acetamide), lacking the nitroxide moiety and SOD-like activity. Both Mito-CP and Mito-CP acetamide were equally potent in different cancer cell types (breast, pancreatic, colon, skin, bladder and lung). Additionally, both compounds inhibited mitochondrial function and decreased intracellular ATP levels to the same extent. We conclude that MTAs such as Mito-CP, Mito-Vitamin-E exert their antiproliferative effects in cancer cells due to mitochondrial localization and targeting cellular bioenergetics and not due to their antioxidative activity. Results from this study strongly question the present dogma on mitochondrial ROS involvement in cancer cell proliferation. Citation Format: Gang Cheng, Jacek Zielonka, Joy Joseph, Balaraman Kalyanaraman. Blunting the radical scavenging property of mitochondria-targeted, triphenylphosphonium-linked antioxidants failed to mitigate their anti-proliferative and antitumor effects. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 498. doi:10.1158/1538-7445.AM2014-498
Strategies for reducing coronary risk factors in primary care
Authors: A S Wierzbicki, T M Reynolds
Journal: BMJ (1995)

EDrroR,-In their article on osteoporosis Nicola Peel and Richard Eastell state that "a nasal pre- paration [of calcitonin] . . . is being developed."'In fact, a nasal spray formulation of salmon calcitonin was first introduced
Are Physicians Advising Smokers to Quit?-Reply
Authors: Robert F. Anda
Journal: JAMA (1987)

In Reply.—  The success of Dr Duh's approach to smoking cessation is probably related to his including most of the key elements of the minimal smokingcessation procedure, which are as follows: (1) asking all patients about their smoking habits, (2) delivering a firm quit-smoking message, (3) agreeing on a quitting date, and (4) following up on the patient's progress during each visit. 1 If every medical student were taught this basic approach to smoking cessation (just as they are taught the ABCs of resuscitation), more physicians would feel prepared to counsel patients to quit smoking.  With regard to Dr Duh's comments on the issue of financial reimbursement for counseling smokers, it is important to note that most smokers are healthy early in the course of their smoking history and thus may not have regular contact with their physicians. For those patients who are trying to quit, appropriate reimbursement for follow-up