tbuckley/cabot-search huggingface dataset:
Development and validation of a clinical scale for the diagnosis of drug-induced hepatitis
Authors: V A Maria, R M Victorino
Journal: Hepatology (1997)

The objective of this study is to present and validate a clinical scale for the diagnosis of drug-induced liver injury (DILI). Five components were selected to be included in the scale: temporal relationship between drug intake and the onset of clinical picture, exclusion of alternative causes, extrahepatic manifestations, rechallenge or accidental re-exposure, and previous report in medical literature. The relative importance of each component was weighed, and arbitrary scores were attributed. The probability of the diagnosis of DILI was expressed as a final score, which could vary from -6 to 20. Content validity, criterion validity, construct validity, and inter-rater reliability were studied. To analyze validity and reliability, a random sample of 50 cases of suspected DILI was drawn from a series of 120 cases reported to our unit. The classification of the 50 cases by three experts in DILI was used as the external standard in the study of criterion validity. Agreement between the scale and the standard, and agreement between two independent raters (inter-rater reliability) was analyzed by weighted kappa coefficient. There was agreement between the scale and the standard in 42 cases (84%) with a weighted kappa coefficient of 0.90. A good discriminatory capacity of the scale was found when construct validity was studied. Agreement between raters was observed in 86% of the cases, corresponding to the weighted kappa of 0.93. In conclusion, the clinical scale was shown to have a high-level of validity and inter-rater reliability as well as a good discriminatory capacity between different levels of probability. These data suggest that the scale is suitable for use in clinical practice and may contribute to overcome the difficulties in the process of causality assessment in DILI.
Safety and feasibility of prehospital thrombolysis carried out by paramedics
Authors: P. Keeling
Journal: BMJ (2003)

The benefits of thrombolysis in patients with acute myocardial infarction are time dependent, with a potential 48% reduction in mortality if treatment is received within an hour of onset of symptoms.1 The benefits diminish thereafter. However the “call to needle” standard set by the national service framework2 has been achieved for only a third of patients nationally because of lengthy ambulance journeys and delays in hospital. Prehospital thrombolysis may be the most feasible means of achieving timely reperfusion, and all published studies have shown the accuracy of diagnosis, patient selection, and administration of thrombolysis.3 The Joint Royal Colleges Ambulance Liaison Committee favours autonomous prehospital thrombolysis by paramedics as a long term objective.4 We tested the feasibility of physician assisted and autonomous models of paramedic prehospital thrombolysis.M

View this table:

Summary statistics for time from event to response (minutes)



All 64 paramedics serving the study hospital took part in the study. Of these, 48 (75%) received formal training in recording 12 lead electrocardiograms, diagnosing ST …
Abuse of prescription drugs is second only to abuse of cannabis in US, UN drugs panel says
Authors: J. Zarocostas
Journal: BMJ (2009)

The misuse of illicit drugs and prescription drugs continues unabated in rich and poor nations, a report by the International Narcotics Control Board warns.

The expert panel says governments must seriously tackle drug misuse and invest more in its prevention, especially in young people and vulnerable groups. 

Professor Hamid Ghodse, the board’s president, says treatment of addicts “remains a difficult medical task” and adds that such treatment should be carried out in line with sound medical practice.

With regard to drug substitution programmes, he says that although they have their place in drug control policy, “they should not necessarily be regarded as the ultimate goal but an interim stage that would eventually lead to a healthy drug-free lifestyle.”

“Drug substitution programmes should be supported by psychosocial care . . . providing that this is …
No improvement in a pilot study of tai chi exercise in rheumatoid arthritis
Authors: T Uhlig
Journal: Annals of the Rheumatic Diseases (2004)

Tai chi, originally a Chinese martial arts, practises physical and mental integration with large, slow, and gracious movements. Tai chi has been shown to improve balance and prevent falls,1 increase flexibility,2 improve physical function,3,4 and has recently been applied in osteoarthritis.5,6 Little is known about possible beneficial effects of tai chi in rheumatoid arthritis (RA). We therefore performed an 8 week pilot study to explore the efficacy of a tai chi instruction programme on disease related measures in patients with RA.

Fifteen women with RA aged 40–70 years (mean (SD) age 57.0 (8.6) years, mean (SD) disease duration 12.3 (5.7) years) with at least moderate disability (modified Health Assessment Questionnaire (MHAQ) …
Abstract MS01-1: Using T cell receptor engineered T cells for the treatment of cancer
Authors: RA Morgan
Journal: Cancer Research (2013)

Abstract Adoptive cellular immunotherapy involves the administration of autologous or allogenic tumor reactive T cells into patients to achieve tumor regression and has been successful in transplant-related malignancies, leukemia, and melanoma. The molecule responsible for the recognition of tumor antigens is the T cell receptor (TCR). Best studied in melanoma, this process involves the identification of lymphocytes with high affinity for tumor antigens that can be selected in vitro and expanded and administered to patients. The administration of naturally occurring T cells has been shown to have an objective response rate ranging from 50-70% in metastatic melanoma patients; including bulky invasive tumors at multiple sites including liver, lung, soft tissue and brain. A major limitation to the widespread application of adoptive cell therapy is the difficulty in generating human T cells with anti-tumor reactivity. To overcome this limitation, we can now insert highly active TCR genes into T cells that can recognize tumor antigens. Genetic engineering of TCR genes into normal T cells is a powerful new strategy to generate large numbers of defined antigen-specific cells for therapeutic application. This approach has evolved beyond experimental stage into a clinical reality. The feasibility of TCR engineered T cells has been shown to be an effective clinical strategy resulting in the regression of established tumors in recent clinical trials. Ultimately it may be possible to establish a collection of defined TCR genes that could be used to treat a diverse set of cancers tailored to each patient depending on the expression pattern of their tumor antigens. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr MS01-1.
TOXIC EFFECTS OF PERCUTANEOUSLY ABSORBED ESTROGENS
Authors: MAX A. GOLDZIEHER
Journal: JAMA (1949)

The fact that steroid hormones, particularly estrogens, can pass through the skin is well known, but the potential dangers of this route of absorption have not been noted previously. For this reason, we believe that the case reported here is of considerable theoretical as well as practical interest. <h3>REPORT OF A CASE</h3> The patient, a 44 year old Scotsman, presented himself with the complaint of impotence of four months' duration. He had been married for twenty-three years and had fathered four children. His sexual activity had always been regular and satisfactory. Eighteen months before seeking medical advice he had started working as a chemist for a small pharmaceutic concern; his assignment was to extract and purify estrogenic substances from pregnancy urine. During this process his hands came in frequent contact with alcoholic solutions of high estrogenic potency, and he also admitted that occasionally he scraped freshly crystallized estrogenic materials from
Beneficial effects of curcumin on hyperlipidemia and insulin resistance in high-fat–fed hamsters
Authors: Eun-Mi Jang, Myung-Sook Choi, Un Ju Jung, Myung-Joo Kim, Hye-Jin Kim, Seon-Min Jeon, Su-Kyung Shin, Chi-Nam Seong, Mi-Kyung Lee
Journal: Metabolism (2008)
Effect of obstructive sleep apnea versus sleep fragmentation on responses to airway occlusion.
Authors: D Brooks, R L Horner, R J Kimoff, L F Kozar, C L Render-Teixeira, E A Phillipson
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Although the acute physiologic responses to apnea in patients with obstructive sleep apnea (OSA) have been well documented, the changes in these responses over the course of the disease have not been investigated. The purpose of this study was to use a canine model of OSA to examine the long-term effects of sleep apnea on the acute responses to airway occlusion during sleep. Four dogs were studied during a control period before induction of OSA, during a period of OSA (83-133 d), and following cessation of OSA. At least 6 mo after completion of the OSA protocol, the dogs were re-studied on a sleep fragmentation protocol (30-60 d) to determine the impact of a similar degree of sleep disruption, without OSA, on the acute responses to airway occlusion. OSA and sleep fragmentation both resulted in lengthening of the time to arousal in response to acute airway occlusion (p < 0.02) and in greater arterial oxygen desaturation (p < 0.05), peak inspiratory pressures (p < 0.003), and surges in maximum systolic and diastolic blood pressure during airway occlusion (p < 0.01). There were no differences between the changes observed during OSA and during sleep fragmentation. We conclude that the changes in the acute responses to airway occlusion resulting from OSA are primarily the result of the associated sleep fragmentation.
PUVA bath therapy strongly suppresses immunological and epidermal activation in psoriasis: a possible cellular basis for remittive therapy.
Authors: V P Vallat, P Gilleaudeau, L Battat, J Wolfe, R Nabeya, N Heftler, E Hodak, A B Gottlieb, J G Krueger
Journal: The Journal of Experimental Medicine (1994)

Psoriasis is characterized by alterations in both the epidermis and dermis of the skin. Epidermal keratinocytes display marked proliferative activation and differentiate along an "alternate" or "regenerative" pathway, while the dermis becomes infiltrated with leukocytes, particularly interleukin 2 (IL-2) receptor-bearing "activated" T cells. Psoralens, administered by the oral route, have therapeutic effects in psoriasis when photochemically activated by ultraviolet A light (PUVA therapy). Recently psoralen bath therapy has been introduced to more effectively deliver this agent to the diseased skin. We have correlated the efficacy of PUVA bath therapy with its effects on specific molecular and cellular parameters of disease, in 10 consecutive patients with recalcitrant psoriasis. Rapid clearing of lesions occurred in 8 out of 10 patients. Biopsies were taken from lesional and nonlesional skin before and after a single round of therapy, and observation was continued in our Clinical Research Center at The Rockefeller University. Enumeration of cycling keratinocytes with the Ki-67 monoclonal antibody showed that PUVA reduced cell proliferation by 73%. The pathological increase in insulin-like growth factor 1 (IGF-1) receptors was reversed, whereas epidermal growth factor (EGF) receptors, which are also increased in psoriasis, remained unchanged. Keratinocyte proteins that are expressed in abnormal sites of the epidermis during psoriasis, i.e., keratin 16, filaggrin, and involucrin, were, after PUVA treatment, localized to their normal sites. Epidermal and dermal T-lymphocytes (CD3+), as well as CD4+, CD8+, and IL-2 receptor+ subsets, were strongly suppressed by PUVA, with virtual elimination of IL-2 receptor+ T cells in some patients. Consistent with diminished lymphocyte activation, HLA-DR expression by epidermal keratinocytes was markedly reduced in treated skin. In comparison to cyclosporine treatment of psoriasis, PUVA therapy leads to more complete reversal of pathological epidermal and lymphocytic activation, changes which we propose to be the cellular basis for a more sustained remission of disease after PUVA treatment.
Cutaneous, perivulvar and perianal ulcerations induced by nicorandil
Authors: A. Claeys, F. Weber-Muller, P. Trechot, J-F. Cuny, M-Y. Georges, A. Barbaud, J-L. Schmutz
Journal: British Journal of Dermatology (2006)

Journal Article Cutaneous, perivulvar and perianal ulcerations induced by nicorandil Get access A. Claeys, A. Claeys Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar F. Weber‐Muller, F. Weber‐Muller Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar P. Trechot, P. Trechot Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar J‐F. Cuny, J‐F. Cuny Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar M‐Y. Georges, M‐Y. Georges Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar A. Barbaud, A. Barbaud Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar J‐L. Schmutz J‐L. Schmutz Department of Dermatology, Hôpital Fournier, CHR Nancy, 36 quai de la Bataille, 54035 Nancy, France *Department of Pharmacology, Hôpital Central, CHR Nancy, 54035 Nancy, France †Department of Geriatrics, Hôpital Saint‐Charles, 54000 Nancy, France E‐mail: riclaeys@hotmail.com Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 155, Issue 2, 1 August 2006, Pages 494–496, https://doi.org/10.1111/j.1365-2133.2006.07363.x Published: 01 August 2006
Does the Pericardium Become Invariably Adherent to the Heart after Acute Pericarditis and Recovery?
Authors: W. Hinds
Journal: BMJ (1861)

perceptive faculties of the mind with the external world or Nature.All our ideational activities, appertaining to man as an individual emotional and social, as well as a moral and religious being, are duly evolved and brought into play in the development of the perceptive conscious- ness; for, before all teaching, he has not only an
Multicenter Pilot Treatment Trial for Psychogenic Nonepileptic Seizures
Authors: W. Curt LaFrance, Grayson L. Baird, John J. Barry, Andrew S. Blum, Anne Frank Webb, Gabor I. Keitner, Jason T. Machan, Ivan Miller, Jerzy P. Szaflarski
Journal: JAMA Psychiatry (2014)

There is a paucity of controlled treatment trials for the treatment of conversion disorder, seizures type, also known as psychogenic nonepileptic seizures (PNES). Psychogenic nonepileptic seizures, the most common conversion disorder, are as disabling as epilepsy and are not adequately addressed or treated by mental health clinicians. To evaluate different PNES treatments compared with standard medical care (treatment as usual). Pilot randomized clinical trial at 3 academic medical centers with mental health clinicians trained to administer psychotherapy or psychopharmacology to outpatients with PNES. Thirty-eight participants were randomized in a blocked schedule among 3 sites to 1 of 4 treatment arms and were followed up for 16 weeks between September 2008 and February 2012; 34 were included in the analysis. Medication (flexible-dose sertraline hydrochloride) only, cognitive behavioral therapy informed psychotherapy (CBT-ip) only, CBT-ip with medication (sertraline), or treatment as usual. Seizure frequency was the primary outcome; psychosocial and functioning measures, including psychiatric symptoms, social interactions, quality of life, and global functioning, were secondary outcomes. Data were collected prospectively, weekly, and with baseline, week 2, midpoint (week 8), and exit (week 16) batteries. Within-group analyses for each arm were performed on primary (seizure frequency) and secondary outcomes from treatment-blinded raters using an intention-to-treat analysis. The psychotherapy (CBT-ip) arm showed a 51.4% seizure reduction (P = .01) and significant improvement from baseline in secondary measures including depression, anxiety, quality of life, and global functioning (P < .001). The combined arm (CBT-ip with sertraline) showed 59.3% seizure reduction (P = .008) and significant improvements in some secondary measures, including global functioning (P = .007). The sertraline-only arm did not show a reduction in seizures (P = .08). The treatment as usual group showed no significant seizure reduction or improvement in secondary outcome measures (P = .19). This pilot randomized clinical trial for PNES revealed significant seizure reduction and improved comorbid symptoms and global functioning with CBT-ip for PNES without and with sertraline. There were no improvements in the sertraline-only or treatment-as-usual arms. This study supports the use of manualized psychotherapy for PNES and successful training of mental health clinicians in the treatment. Future studies could assess larger-scale intervention dissemination. clinicaltrials.gov Identifier: NCT00835627.
An Educational Intervention for Contextualizing Patient Care and Medical Students' Abilities to Probe for Contextual Issues in Simulated Patients
Authors: Alan Schwartz, Saul J. Weiner, Ilene B. Harris, Amy Binns-Calvey
Journal: JAMA (2010)

A contextual error occurs when a physician does not identify elements of a patient's environment or behavior, such as access to care, that must be addressed to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients.To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors.Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n = 124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010 participated and were assessed.A 4-hour course on contextualization.Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant and were adjusted for subinternship site, academic year, time of year, and case scenario.Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87%-94% ] vs 62% [95% CI, 54%-69%], respectively) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57%-81%] vs 22% [95% CI, 12%-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75%-85%] vs 81% [95% CI, 76%-86%]) or developing appropriate treatment plans for standardized patients with medical issues (54% [95% CI, 42%-67%] vs 66% [95% CI, 53%-79%]).Medical students who underwent an educational intervention were more likely to contextualize care for individual standardized patients.
Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis
Authors: M. King, C. Essick, P. Bearman, J. S. Ross
Journal: BMJ (2013)

<b>Objective</b> To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. <b>Design</b> Difference-in-differences approach. <b>Setting</b> 14 US medical schools with an active gift restriction policy in place by 2004. <b>Participants</b> Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. <b>Main outcome measure</b> Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. <b>Results</b> For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. <b>Conclusion</b> Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications.
550 DETECTABILITY OF CONTRAST-ENHANCED ULTRASONOGRAPHY USING SONAZOID FOR HEPATOCELLULAR CARCINOMA
Authors: E. Goto, R. Masuzaki, R. Tateishi, K. Uchino, T. Arano, K. Enooku, H. Nakagawa, Y. Kondo, T. Goto, H. Yoshida, M. Omata, K. Koike
Journal: Journal of Hepatology (2010)