tbuckley/cabot-search huggingface dataset:
Doctors' confusion over ratios and percentages in drug solutions: the case for standard labelling
Authors: D. W. Wheeler, D. D. Remoundos, K. D. Whittlestone, M. I. Palmer, S. J. Wheeler, T. R. Ringrose, D. K. Menon
Journal: Journal of the Royal Society of Medicine (2004)

The different ways of expressing concentrations of drugs in solution, as ratios or percentages or mass per unit volume, are a potential cause of confusion that may contribute to dose errors.To assess doctors' understanding of what they signify, all active subscribers to doctors.net.uk, an online community exclusively for UK doctors, were invited to complete a brief web-based multiple-choice questionnaire that explored their familiarity with solutions of adrenaline (expressed as a ratio), lidocaine (expressed as a percentage) and atropine (expressed in mg per mL), and their ability to calculate the correct volume to administer in clinical scenarios relevant to all specialties.2974 (24.6%) replied.The mean score achieved was 4.80 out of 6 (SD 1.38).Only 85.2% and 65.8% correctly identified the mass of drug in the adrenaline and lidocaine solutions, respectively, whilst 93.1% identified the correct concentration of atropine.More would have administered the correct volume of adrenaline and lidocaine in clinical scenarios (89.4% and 81.0%, respectively) but only 65.5% identified the correct volume of atropine.The labelling of drug solutions as ratios or percentages is antiquated and confusing.Labelling should be standardized to mass per unit volume.
Risk of hepatitis C virus infections through household contact with chronic carriers: Analysis of nucleotide sequences
Authors: Masao Honda, Shuichi Kaneko, Masashi Unoura, Kenichi Kobayashi, Seishi Murakami
Journal: Hepatology (1993)

We evaluated the risk of hepatitis C virus transmission through household contact with chronic carriers using nucleotide sequence analysis. Chronic hepatitis C patients (76 patients) were divided into two groups: familial transmission of hepatitis C virus was studied in group A (53 patients); group B (23 patients) served as nonfamilial controls for group A. Of 88 family members of group A patients, 18 (20%) had elevated serum ALT levels, 20 (23%) had antibodies against hepatitis C virus and 16 (18%) had hepatitis C virus RNA in serum. Nucleotide sequences of the region of the hepatitis C virus genome spanning the core and envelope genes were compared among the three groups. In group B, the average nucleotide sequence homology was 91.0% +/- 2.29% (a pairwise comparison was made for each of the patients; n = 253). Isolates from two family members were significantly more homologous to isolates from corresponding patients in group A than to isolates from group B patients. Of the two isolates from family members, one was from a child whose mother was a patient (97.7% homology) and one was from a spouse (98.1% homology). These results strongly suggest familial transmission of the same hepatitis C virus strain. Further studies are necessary to elucidate the route of intrafamilial transmission.
1022-105 TIMI Grade 2 Flow is not Equivalent to TIMI 3: Implications for the Use of Thrombolytic Therapy. A Meta-Analysis of the Trials
Authors: Farzin Fath-OrdDubadi, Tanya Y. Huehns, Abdullah AI-Mohammad, K.J. Beall
Journal: Journal of the American College of Cardiology (1995)
Withdrawal of Long-Term Cabergoline Therapy for Tumoral and Nontumoral Hyperprolactinemia
Authors: Annamaria Colao, Antonella Di Sarno, Paolo Cappabianca, Carolina Di Somma, Rosario Pivonello, Gaetano Lombardi
Journal: New England Journal of Medicine (2003)

Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, microprolactinomas, or macroprolactinomas is safe and effective has been unclear. We performed an observational, prospective study of cabergoline (a dopamine-receptor agonist) withdrawal in such patients.The study population included 200 patients--25 patients with nontumoral hyperprolactinemia, 105 with microprolactinomas, and 70 with macroprolactinomas. Withdrawal of cabergoline was considered if prolactin levels were normal, magnetic resonance imaging (MRI) showed no tumor (or tumor reduction of 50 percent or more, with the tumor at a distance of more than 5 mm from the optic chiasm, and no invasion of the cavernous sinuses or other critical areas), and if follow-up after withdrawal could be continued for at least 24 months.Recurrence rates two to five years after the withdrawal of cabergoline were 24 percent in patients with nontumoral hyperprolactinemia, 31 percent in patients with microprolactinomas, and 36 percent in patients; with macroprolactinomas. Renewed tumor growth did not occur in any patient; in 10 female patients (22 percent) and 7 male patients (39 percent) with recurrent hyperprolactinemia, gonadal dysfunction redeveloped. In all diagnostic groups, prolactin levels at the time of recurrence were significantly lower than at diagnosis (P<0.001). The Kaplan-Meier estimated rate of recurrence at five years was higher among patients with macroprolactinomas and those with microprolactinomas who had small remnant tumors visible on MRI at the time of treatment withdrawal than among patients whose MRI scans showed no evidence of tumor at the time of withdrawal (patients with macroprolactinomas, 78 percent vs. 33 percent, P=0.001; patients with microprolactinomas, 42 percent vs. 26 percent, P=0.02).Cabergoline can be safely withdrawn in patients with normalized prolactin levels and no evidence of tumor. However, because the length of follow-up in our study was insufficient to rule out a delayed increase in the size of the tumor, we suggest that patients be closely monitored, particularly those with macroprolactinomas, in whom renewed growth of the tumor may compromise vision.
Brain and Upper Extremity PET/CT Findings of Hyperglycemia-Induced Hemiballism-Hemichorea
Authors: Ba D. Nguyen
Journal: Clinical Nuclear Medicine (2007)

Hyperglycemia-induced hemiballism-hemichorea is an uncommon movement disorder probably related to vascular insult of the basal ganglia in patients with poorly controlled diabetes. This rare clinical entity has been reported with abnormal brain findings on CT, MR, and F-18 FDG PET. The author presents additional PET/CT features of such an unusual dyskinetic syndrome with increased radiotracer uptake in the left motor cortex and musculature of the right shoulder girdle and upper extremity from hemiballism-hemichorea.
Ankle taping improves proprioception before and after exercise in young men.
Authors: S Robbins, E Waked, R Rappel
Journal: British Journal of Sports Medicine (1995)

Ankle sprains are common sports injuries. Inadequate foot position awareness is thought to be the fundamental cause of these injuries. Ankle taping may decrease risk of injury through improving foot position awareness. The benefit of taping is thought to decrease with duration of exercise because of poor tape adherence to human skin. This study was a randomized, crossover, controlled comparison experiment that tested the hypothesis that ankle taping improves foot position awareness before and after exercise. A sample of 24 healthy young blindfolded volunteers, wearing their own athletic shoes, indicated perceived slope direction and estimated slope amplitude when bearing full body weight and standing on a series of blocks. The top slope of the blocks varied between 0 degree and 25 degrees, in 2.5 degrees increments, to orient the plantar surface with respect to the leg toward pronation, supination, plantarflexion, and dorsiflexion, relative to its position on a flat surface. Foot position awareness, which was considered the reciprocal of surface slope estimate error, varied with testing condition, particularly when surface slope was greater than 10 degrees, presumably the most important range considering ankle injuries. In this higher range absolute position error was 4.23 degrees taped, and 5.53 degrees untaped (P &lt; 0.001). Following exercise, in the higher range absolute position error was 2.5% worse when taped and 35.5% worse when untaped (P &lt; 0.001). These data support the hypothesis that ankle taping improves proprioception before and after exercise. They also indicate that foot position awareness declines with exercise. Compared to barefoot data (position error 1.97 degrees), foot position error was 107.5% poorer with athletic footwear when untaped (absolute position error 4.11 degrees), and 58.1% worse when taped (position error 3.13 degrees). This suggests that ankle taping partly corrects impaired proprioception caused by modern athletic footwear and exercise. Footwear could be optimized to reduce the incidence of these injuries.
Fake medicines are undermining global efforts to combat infectious disease, says US journal
Authors: M. McCarthy
Journal: BMJ (2015)

Counterfeit and poor quality medicines threaten to undermine decades of progress in global health, particularly in the areas of HIV/AIDS, tuberculosis, and malaria, say papers published on 20 April in a special supplement of the American Journal of Tropical Medicine and Hygiene .1

“The pandemic of falsified and substandard medicines is pervasive and underestimated, particularly in low and middle income countries where …
Study confirms results of systematic review of care in stroke unit
Authors: R. Lane, K. Burrell, C. Dennis
Journal: BMJ (1997)

Editor—The paper from the Stroke Unit Trialists' Collaboration, based on a systematic review of randomised trials that compared organised inpatient stroke care with contemporary conventional care, suggested that management in an integrated stroke unit reduced the frequency of poor outcomes, including death, dependency, and requirement for institutional care.1 We had the opportunity to gather data on outcome of stroke prospectively, in anticipation of the opening of a dedicated stroke unit in our newly constructed hospital. We have compared treatment in …
Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension
Authors: Dawn Smiley, Guillermo Umpierrez
Journal: Diabetes Care (2007)

We reported that hypertension affects nearly 70% of patients with type 2 diabetes at our institution and that 45% of them require three or more antihypertensive agents (1). Despite the multidrug approach, one-third of patients do not achieve the recommended blood pressure goal of <130/80 mmHg. These findings led us to investigate the prevalence of primary hyperaldosteronism (PHA), the most common cause of endocrine hypertension, in diabetic patients with resistant hypertension. We found that 14% of diabetic patients with resistant hypertension had biochemical evidence of PHA. Thus, select patients with diabetes should …
Proposals for Ballistocardiographic Nomenclature and Conventions: Revised and Extended
Authors: WILLIAM R. SCARBOROUGH, SAMUEL A. TALBOT, JOHN R. BRAUNSTEIN, MAURICE B. RAPPAPORT, WILLIAM DOCK, WILLIAM R. SCARBOROUGH, W. F. HAMILTON, JOHN E. SMITH, JOHN L. NICKERSON, SAMUEL A. TALBOT, ISAAC STARR
Journal: Circulation (1956)

The committee's first report, published in Circulation for June 1953, recommended a terminology and certain conventions for recording ballistocardiograms of the type then in use. However, it soon became apparent that the committee's work was far from complete. Increasing knowledge of ballistic theory soon began to throw light on the relations of records secured by various instruments to one another, and a rapid advance in instrumentation began to provide records related to, but often not identical with, those which had been provided with a standard terminology by the committee in its first report. Accordingly, the committee has continued its labors to provide the rapidly advancing field with a uniform terminology. While they were thus engaged, attention was called to the fact that the designation of spatial axes previously recommended for vector ballistocardiograms differed from that which had been recommended for electrocardiograms by another committee of the American Heart Association. The advantages of a common system for designating spatial axes were obvious to all. Accordingly, as the electrocardiographic usage had priority and as little had been published in the field of ballistocardiographic vectors the committee voted to withdraw their original recommendation and substitute one conforming to that in use by electrocardiographers. In the present communication this new convention is also set forth. All members of the committee have shared in the deliberations and taken part in the decisions which form the basis of this report; but so much of the larger proportion of the actual work fell on Dr. Scarborough and Dr. Talbot that it was agreed without dissenting vote that only their names should appear as authors. This report has the endorsement of the committee as a whole, and the terminology it suggests is recommended as the official terminology of the American Heart Association.
Humanitarianism survives, despite being under the gun
Authors: R. Mishori
Journal: JAMA (1997)

To the Editor.  —I read the article by Drs Sharp and Shenson 1 with great interest. As a journalist I have visited many trouble spots and war zones, often traveling with relief workers and volunteer physicians. Journalists, as well as humanitarian workers, have frequently been harassed, jailed, and even killed trying to tell stories of refugees, displaced persons, and other victims—dead or alive—of armed conflicts around the world. 2 Those incidents, too, have many times been met with a deafening silence on the part of Western governments. Throughout my journalistic career, I have been deeply impressed by the work of relief agencies, such as Doctors of the World, and touched by the dedication and enthusiasm of the medical personnel despite the great risk to their lives. It was during one of my assignments—to Bosnia in the winter of 1994—that I was inspired by some volunteer physicians in a dingy and
Manual of Clinical Nephrology
Authors: Anil K. Mandal
Journal: JAMA (1983)

<i>Manual of Clinical Nephrology</i>by David P. Earle, MD, and colleagues is intended as a concise, yet complete, discussion of the topics in nephrology, with particular emphasis on clinical aspects. The author achieves this goal admirably. The first portion of the text is devoted to a description of the many studies that are relevant to the clinical evaluation of the patient with possible renal disease. Topics such as urinalysis, urine culture techniques and timed urine collections, radionuclide imaging, and ultrasonography are discussed with regard to clinical applications and usefulness. The next portion of the book deals with the common clinical syndromes (eg, nephrotic syndrome). The differential diagnosis and the pathogenetic mechanisms of each syndrome are discussed, and a logical scheme for further evaluation is present. Appropriate tables supplement the text. Fluid and electrolytes and acidbase homeostasis are discussed next, with an appropriate allotment of space to theoretical and practical considerations.
Changing to A4 folders and updating records in a "busy" general practice.
Authors: G N Marsh, J R Thornham
Journal: BMJ (1980)

When the FP5/6 record envelopes were converted to A4 folders in a busy practice a system of updating preventative health measures was begun and a disease index constructed. All the day-to-day work was delegated to lay staff, and the whole primary health care team participated in the updating procedures. The exercise, although expensive, was considered to be most worth while and has improved the quality of patient care.
Effects of a change in the pattern of insulin delivery on carbohydrate tolerance in diabetic and nondiabetic humans in the presence of differing degrees of insulin resistance.
Authors: A Basu, A Alzaid, S Dinneen, A Caumo, C Cobelli, R A Rizza
Journal: Journal of Clinical Investigation (1996)

While it is well established that people with non-insulin dependent diabetes mellitus have defects in both insulin secretion and action, the relative contribution of each to glucose intolerance is not known. Therefore, nondiabetic (lean and obese) and non-insulin dependent diabetes mellitus subjects were studied on two occasions. On each occasion, insulin secretion was inhibited with somatostatin and glucose was infused in a pattern and amount that mimicked the systemic delivery rate normally observed after ingestion of 50 g of glucose. Insulin also was infused so as to mimic postprandial insulin profiles observed in separate groups of diabetic and nondiabetic subjects after food ingestion. Glucose turnover was measured using the isotope dilution method. A delayed pattern of insulin delivery (i.e., a "diabetic" insulin profile) led to higher (P < 0.05) glucose concentrations in all groups; however, the effects were transient, resulting in only a modest increase in the integrated glycemic responses. An isolated defect in insulin action had little effect on peak glucose concentration; however, it prolonged the duration of hyperglycemia, leading to a 2.5-4.2-fold increase (P < 0.05) in the integrated glycemic response. A combined defect in the pattern of insulin secretion and action was additive rather than synergistic. Both defects caused hyperglycemia by altering suppression of endogenous glucose release and stimulation of glucose disposal. Whereas obese diabetic and nondiabetic subjects had comparable defects in glucose clearance, non-insulin dependent diabetes mellitus subjects also had defects in hepatic insulin action. Thus, abnormalities in the pattern of insulin secretion and action alone or in combination impair glucose tolerance. An isolated defect in insulin action has a more pronounced and prolonged effect than does an isolated change in the pattern of insulin secretion. Hepatic and extrahepatic insulin resistance results in marked and sustained hyperglycemia.
Is birth weight determined genetically?
Authors: R Carr-Hill, D M Campbell, M H Hall, A Meredith
Journal: BMJ (1987)

Birthweight correlations were analysed among 505 intergenerational pairs of first births to women aged 18-25 identified from a large obstetric data bank. After standardisation for fetal sex, maternal height, gestational age, and proteinuric pre-eclampsia residual correlations of between 0.1402 and 0.1725 were found, suggesting only a small genetic effect. It is concluded that genetic factors play only a small part in determining birth weight.
Adjusting for multiple testing in studies is less important than other concerns
Authors: T. V Perneger
Journal: BMJ (1999)

EDITOR—In a paper in the American Journal of Public Health Aickin stated that “there is substantial debate… concerning when (if ever) adjustment for multiple testing is warranted.”1 I am glad that he has joined the debate in the BMJ over Bonferroni adjustments but find his arguments unconvincing.2 Yes, “researchers who adjust P values almost always present them for their individual hypotheses,” as he says. This is why they should not worry about unrelated tests and renounce a statistical technique that focuses …
Effect of an Educational Toolkit on Quality of Care: A Pragmatic Cluster Randomized Trial
Authors: Baiju R. Shah, Onil Bhattacharyya, Catherine H. Y. Yu, Muhammad M. Mamdani, Janet A. Parsons, Sharon E. Straus, Merrick Zwarenstein
Journal: PLoS Medicine (2014)

Printed educational materials for clinician education are one of the most commonly used approaches for quality improvement. The objective of this pragmatic cluster randomized trial was to evaluate the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes.All 933,789 people aged ≥40 years with diagnosed diabetes in Ontario, Canada were studied using population-level administrative databases, with additional clinical outcome data collected from a random sample of 1,592 high risk patients. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The primary outcome in the administrative data study, death or non-fatal myocardial infarction, occurred in 11,736 (2.5%) patients in the intervention group and 11,536 (2.5%) in the control group (p = 0.77). The primary outcome in the clinical data study, use of a statin, occurred in 700 (88.1%) patients in the intervention group and 725 (90.1%) in the control group (p = 0.26). Pre-specified secondary outcomes, including other clinical events, processes of care, and measures of risk factor control, were also not improved by the intervention. A limitation is the high baseline rate of statin prescribing in this population.The educational toolkit did not improve quality of care or cardiovascular outcomes in a population with diabetes. Despite being relatively easy and inexpensive to implement, printed educational materials were not effective. The study highlights the need for a rigorous and scientifically based approach to the development, dissemination, and evaluation of quality improvement interventions.http://www.ClinicalTrials.gov NCT01411865 and NCT01026688.
Pruritic Urticarial Papules and Plaques of Pregnancy
Authors: Herschel E. Stoller
Journal: JAMA (1980)

<h3>To the Editor.—</h3> Lawley et al (241: 1696, 1979) presented seven cases of a heretofore undescribed rash that they designated "pruritic urticarial papules and plaques of pregnancy (PUPPP)." The following three cases were subsequently seen and are submitted as instances of PUPPP. <h3>Report of Cases.—</h3> Case1.—A 25-year-old woman (gravida 1, para 2) in the 35th week of pregnancy showed development of an intensely itchy rash over the abdomen. The rash progressed to her buttocks, thighs, and legs, and eventually her arms. The lesions consisted of red urticarial plaques and papules with a surrounding pale halo. The histopathological findings of a biopsied lesion showed a normal-appearing epidermis with a superficial dermal perivascular lymphocytic infiltrate with eosinophils. The eruption promptly resolved with prednisone therapy. Several weeks later normal twins were born weighing 6 lb 10 oz and 3 lb 8 1/4 oz. Case2.—A 23-year-old woman (gravida 1, para 1) in
Traumatic Brain Injury and Concussion in Sports
Authors: James P. Kelly
Journal: JAMA (1999)

The applicability of these findings is obscured by the different entry criteria of the various studies and the ongoing confusion that arises when studies of recurrent AOM are compared with COME. Is OM 1 disease with 2 faces—acute and chronic—or does the pathophysiology of recurrent AOM and COME differ sufficiently to preclude such comparisons? The debate undoubtedly will continue for a long time. Where, then, does this leave parents of children with recurrent AOM? Clearly, parents shoulder the burden of care of fretful infants and children who cannot sleep due to ear pain, and they incur costs that far exceed health care expenditures. 19 Are there subgroups of children who are severely affected with OM for whom aggressive therapy is appropriate? If so, how can these cases be identified? Children younger than age 4 years are at the greatest risk of recurrent AOM, and adenoidectomy performed by experienced clinicians has been shown to be safe in this patient group. 20 However, the effectiveness of adenoidectomy in preventing recurrent AOM has not been studied in this age group. As the incidence of AOM due to resistant organisms increases, outcomes research and effectiveness clinical trials should focus on this problem. In selected cases of recurrent AOM with multiple risk factors, early adenoidectomy and tympanostomy tube placement might prove to be the most rational therapy. However, such a hypothesis must await validation by further research. For now, physicians should rely on environmental control, vaccines, and episodic antimicrobial therapy for prevention and treatment, with tympanostomy tube placement and selected use of adenoidectomy when nonoperative therapy fails.