tbuckley/cabot-search huggingface dataset:
No one knows who is accountable for England's midwife shortage, MPs say
Authors: J. Wise
Journal: BMJ (2014)

England is short of 2300 midwives, and no one knows who should be held to account for this, says a report from the parliamentary public accounts committee.1

The report calls on the Department of Health to set out clearly its objectives for maternity care and explicitly state who is accountable. Since April 2013 maternity services have been commissioned by clinical commissioning groups, which are overseen by NHS England.

Margaret Hodge, the committee’s chairwoman, described the shortage as “truly worrying.” She said, “The Department of Health and NHS England struggled to tell my committee who is accountable for ensuring something as fundamental as whether the NHS has enough midwives.”

Cathy Warwick, chief executive of the Royal College of Midwives, described the report as another wake-up call for the government. “It is a concern that no one appears to …
Laboratory Errors and the Misdiagnosis of Tuberculosis
Authors: Katherine Kaye
Journal: JAMA (1997)

<h3>To the Editor.</h3> —We commend Dr Nitta and colleagues<sup>1</sup>for their analysis of factors that may contribute to the misdiagnosis of multidrug-resistant tuberculosis (MDR TB). The New York City Department of Health Bureau of Tuberculosis Control has identified several cases in which a misdiagnosis of TB resulted from contamination of a laboratory specimen. To minimize the possibility of misdiagnosis based on a contaminated laboratory specimen, we have instituted routine clinical and laboratory investigations of all cases that have only 1 positive culture for<i>Mycobacterium tuberculosis</i>, regardless of the drug susceptibilities of the microorganism and the patient's smear results for acid-fast bacilli. Medical records are reviewed to determine whether the patient in question has clinical evidence of TB, and laboratory log books are reviewed to determine whether any specimens from patients with confirmed TB were processed immediately before the specimen in question. If appropriate, DNA typing by restriction fragment length
THE USE OF DEMEROL IN ARTIFICIAL FEVER
Authors: THOS. J. HELDT, NICHOLAS P. DALLIS, WILLIAM J. O'CONNELL
Journal: American Journal of Psychiatry (1945)

The use of demerol hydrochloride in 22 cases receiving artificial fever therapy in the Kettering hypertherm is reported. This represented a total of 165 treatments. The youngest patient was seventeen years and the oldest was sixty-five years of age. Treatments were usually given at weekly intervals with the temperature maintained between 105 and 107 degrees Fahrenheit for three to five hours. In 5 cases there was opportunity to compare demerol with the use of other drugs. In all such clinical comparisons demerol was found to be superior from a standpoint of management, safety and comfort of the patient. [See table In Source PDF].
Myocardial infarction due to amphetamine.
Authors: P Carson, K Oldroyd, K Phadke
Journal: BMJ (1987)

Our patient presented with typical features ofpyomyositis: fever, malaise, and a tender hard mass.Ultrasonography suggested either an abscess or a necrotic tumour, and the diagnosis was made by open biopsy.No causative organism was identified.He had none of the known risk factors.He was, however, positive for HIV antibodies, and associated immunosuppression was possibly a factor in the development of the muscle abscess, although at the time of writing he had not developed any further infections apart from oropharyngeal candidiasis.Pyomyositis has not been reported in association with HIV.Pyomyositis is uncommon in Britain and is not usually recognised.Familiarity with its features should result in the diagnosis being made more readily.It may prove to be a well recognised feature of infection with HIV and require differentiation from sarcoma.1 Gibson RK, Rosenthal SJ, Lukert BP.Pyomyositis: increasing recognition in temperate climates.
Ranolazine Improves Angina in Women With Evidence of Myocardial Ischemia But No Obstructive Coronary Artery Disease
Authors: Puja K. Mehta, Pavel Goykhman, Louise E.J. Thomson, Chrisandra Shufelt, Janet Wei, YuChing Yang, Edward Gill, Margo Minissian, Leslee J. Shaw, Piotr J. Slomka, Melissa Slivka, Daniel S. Berman, C. Noel Bairey Merz
Journal: JACC. Cardiovascular imaging (2011)
Decrease in peripheral type 1 over type 2 T cell cytokine production in patients with rheumatoid arthritis correlates with an increase in severity of disease
Authors: J. A G van Roon, C. M Verhoef, J. L A M van Roy, F. H J Gmelig-Meyling, O. Huber-Bruning, F. P J G Lafeber, J. W J Bijlsma
Journal: Annals of the Rheumatic Diseases (1997)

<i>Objectives</i>—To compare peripheral type 1 (T1) and type 2 (T2) T cell activities in rheumatoid arthritis (RA) patients with that found for osteoarthritic (OA) patients and healthy controls and to correlate peripheral T1/T2 cell activity in RA with parameters of the disease. <h3>METHODS</h3> Peripheral blood mononuclear cells were isolated from patients with RA (n=66), OA (n=19), and healthy controls (n=15). Primary T cell activity in these mononuclear cells was enhanced by means of anti-CD3/anti-CD28, which mimicks stimulation of T cells by activation of the T cell receptor and a major co-stimulatory signal. Interferon gamma (IFNγ) production and interleukin 4 (IL4) production in the three groups were quantified as measures of T1 and T2 cell activity, respectively, and compared. Serum tumour necrosis factor α (TNFα), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and joint destruction assessed radiographically of RA patients were determined as parameters of disease activity and correlated with T1/T2 cell activity. <h3>RESULTS</h3> Peripheral T cells from RA patients produced significantly less IFNγ and more IL4 than T cells from both age and sex matched OA patients and healthy controls. Moreover, in RA patients both a decrease in IFNγ and an increase in IL4 production correlated with an increase in serum TNFα, ESR, CRP, and joint destruction. <i>Conclusions</i>—These results suggest a role for differential T cell activity in RA. In view of the intra-articular T1 cell predominance the results might be explained by selective T1 cell migration into the joint or peripheral suppression of T1 cell activity.
Organisation of telephone services and patients' access to doctors by telephone in general practice.
Authors: L Hallam
Journal: BMJ (1991)

To assess how accessible general practitioners are to patients by telephone and to examine the relations between organisation, number of lines, and number of patient-doctor calls.Postal survey of a random sample of general practitioners stratified by rural and urban practice areas, with differential sampling fractions.General practices in England and Wales.2000 general practitioners, of whom 1459 (74%) responded.Number of calls received by general practitioner a day, time reserved for patients' calls, and communication of availability of telephone contact.1421 general practitioners said that they accepted non-emergency calls from patients during the day and 285 reported reserving specific times of the day for this purpose. 848 estimated that they received four or fewer patient calls a day. The number of calls was significantly related to reserving time for calls (p less than 0.001), informing patients that the doctor was accessible by telephone (p less than 0.00001), and the number of periods when calls were accepted (p less than 0.00001). On average there were 3659 patients per incoming line; the number of patients per incoming line rose significantly as practice size increased (p less than 0.00001).The apparent willingness of general practitioners to accept calls was not reflected in the number of calls received. Reserving time, increasing periods of availability, and publicising telephone access increased the number of doctor-patient telephone contacts. Line congestion may be a problem, and impartial advice and guidance on telephone organisation and line requirements would be helpful.
The Nature of the Fibrinolytic-Enzyme Defect in Hyaline-Membrane Disease
Authors: Jack Lieberman
Journal: New England Journal of Medicine (1961)

IT has been demonstrated that pulmonary hyaline membranes in newborn infants have a basic fibrin composition that resembles a plasma clot.1 , 2 The presence of fibrin in the lungs of these infants is considered by some investigators to be the end result of failure of the left side of the heart and pulmonary edema.3 4 5 6 7 8 9 Others believe that a more important factor is the inability of certain fetuses to dissolve intra-alveolar fibrin deposits,10 11 12 13 and it has been postulated that this fibrin may be precipitated from a capillary transudate during the formation of a portion of amniotic fluid by the lungs.12 In earlier . . .
The last “oxygenless” ascent of Mt Everest
Authors: D M Bailey
Journal: British Journal of Sports Medicine (2001)

<h3>Summary</h3> Molybdenum, as a component of the iron-molybdenum cofactor of nitrogenase, is essential for symbiotic nitrogen fixation. This nutrient has to be provided by the host plant through molybdate transporters. Members of the molybdate transporters family MOT1 were identified in the model legume <i>Medicago truncatula</i> and their expression in nodules determined. Yeast toxicity assays, confocal microscopy, and phenotypical characterization of a <i>Tnt1</i> insertional mutant line were carried out in the one <i>M. truncatula</i> MOT1 family member expressed specifically in nodules. Among the five MOT1 members present in <i>M. truncatula</i> genome, <i>MtMOT1.3</i> is the only one uniquely expressed in nodules. MtMOT1.3 shows molybdate transport capabilities when expressed in yeast. Immunolocalization studies revealed that MtMOT1.3 is located in the plasma membrane of nodule cells. A <i>mot1.3-1</i> knockout mutant showed an impaired growth concomitant with a reduction in nitrogenase activity. This phenotype was rescued by increasing molybdate concentrations in the nutritive solution, or upon addition of an assimilable nitrogen source. Furthermore, <i>mot1.3-1</i> plants transformed with a functional copy of <i>MtMOT1.3</i> showed a wild type-like phenotype. These data are consistent with a model in which MtMOT1.3 would be responsible for introducing molybdate into nodule cells, which will be later used to synthesize functional nitrogenase.
PRELIMINARY REPORT ON SODIUM NITRITE THERAPY IN SEASICKNESS
Authors: Daniel B. Hayden
Journal: JAMA (1928)

During a study of the effects of blood pressure on the labyrinthine function, we were impressed by the depressant effect of sodium nitrite on the vestibular responses. The results of these studies are in process of preparation for publication. In these studies it was shown that by lowering normal blood pressure to between 95 and 105 mm. of mercury the nystagmus after rotation was greatly diminished, and past pointing was also much diminished and even disappeared entirely in some instances. Believing that seasickness is due mostly, if not completely, to overstimulation of the vestibule, we felt that the nitrites offered a direct attack at the long sought but never attained cure for the terrible malady of the ocean voyage. Consequently, as one of us (D. B. H.) was about to cross the Atlantic, we decided to put the theory to the test. Fate was against us on the trip across for no one suffered mal de mer.
Premature Mortality From Coronary Heart Disease
Authors: Tavia Gordon
Journal: JAMA (1971)

Since 1948, a cohort of 5,209 residents of Framingham, Mass, have been examined biennially. In the first 14 years, 120 died of coronary heart disease (CHD) before reaching 65 years of age. Two thirds of these deaths occurred outside the hospital—the majority suddenly— within one hour of onset of the terminal event. Nearly one half of the deaths from the initial coronary attack were sudden and unexpected. One half of all persons with sudden deaths had no prior clinical heart disease. While nonsudden coronary deaths were ordinarily preceded by clinical CHD, the disease was frequently first manifest close to the final episode. Only a small percentage of persons were seriously disabled six months before their death. Even among persons with known CHD, nearly one half of the deaths occurred outside the hospital. It is concluded that the only road to a substantial reduction in premature CHD mortality is prevention of CHD.
Health, health promotion, and homelessness
Authors: R. Power, R. French, J. Connelly, S. George, D. Hawes, T. Hinton, H. Klee, D. Robinson, J. Senior, P. Timms, D. Warner
Journal: BMJ (1999)

Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture.1 The recent green paper Our Healthier Nation stresses a more coordinated approach to health promotion for people who are socially excluded, emphasising behavioural change through targeted interventions at the level of the community.2 There have been extensive reviews of homelessness and health, 3 4 along with calls for urgent action,5–7 but little attention has been paid to the health promotion needs of homeless people, and there is no firm evidence base for practice. One challenge for health promotion is to develop and deliver appropriate initiatives to a heterogeneous population that is not always easy to categorise but has a wide range of needs. The healthcare priorities of a young man sleeping on the streets differ from those of a single mother in temporary accommodation. To be homeless means more than just the absence of secure accommodation. Homelessness has as much to do with social exclusion as with bricks and mortar, and demands a range of health promotion strategies.

#### Summary points

At one level, the health condition of homeless people is a product of housing policy.3 Over the past two decades in …
Risks for Renal Dysfunction with Cardiac Angiography
Authors: Charles P. Taliercio, Ronald E. Vlietstra, Lloyd D. Fisher, John C. Burnett
Journal: Annals of Internal Medicine (1986)

In 139 patients with preexisting abnormal renal function (serum creatinine level of 2.0 mg/dL or greater) undergoing cardiac angiography (141 examinations), the incidence of contrast nephropathy, defined as a 1 mg/dL or greater rise in serum creatinine, was 23% (95% confidence interval, 17% to 30%). Stepwise logistic regression analysis showed that contrast nephropathy was independently associated with class IV heart failure with low cardiac output (71% incidence in this subgroup; p < 0.0001), multiple radiocontrast studies within 72 hours (50%; p = 0.002), dose of radiocontrast administered (p = 0.009), and insulin-dependent diabetes mellitus (44%; p = 0.007). Age, hypertension, and hyperuricemia were not associated. In patients without low cardiac output, other radiocontrast tests, or insulin-dependent diabetes mellitus, there was a 2% incidence of contrast nephropathy in those who received less than 125 mL radiocontrast and a 19% incidence in those who received 125 mL or greater.
MEPs fight to reinstate EU health funding
Authors: Rory Watson
Journal: BMJ (2006)

A major battle is looming between members of the European parliament and European Union governments over the level of European funding for the health sector for the next seven years.

Various organisations are warning that the budget cuts that EU leaders made shortly before Christmas could sound the death knell for many public health policies funded by the EU ( BMJ 2006;332:257, 4 Feb).

At stake is the level of funding that the EU should give to health and consumer protection programmes between 2007 and 2013. The European Commission had initially proposed an …
Niacin Inhibits Vascular Inflammation via the Induction of Heme Oxygenase-1
Authors: Ben J. Wu, Kang Chen, Philip J. Barter, Kerry-Anne Rye
Journal: Circulation (2011)

Heme oxygenase-1 (HO-1) is a cytoprotective protein whose expression is consistently associated with therapeutic benefits in a number of pathological conditions such as atherosclerotic vascular disease and inflammation. Niacin is a pleiotropic drug that slows the progression of coronary artery disease and increases serum levels of the HO-1 enzymatic product bilirubin. This study asks if the cardioprotective properties of niacin involve the induction of HO-1.New Zealand White rabbits received chow or chow supplemented with 0.6% (wt/wt) niacin for 2 weeks. Acute vascular inflammation was induced in the animals by placing a nonocclusive silastic collar around the left common carotid artery. At 24 hours after collar implantation, serum bilirubin and vascular, liver, and spleen HO-1 messenger RNA levels were significantly increased. Vascular inflammation was decreased in the niacin-supplemented animals compared with control. Treatment of the animals with tin protoporphyrin-IX, a global HO inhibitor, or HO-1 small interfering RNA to knock down carotid artery HO-1 attenuated the ability of niacin to inhibit vascular inflammation. Treatment of cultured human coronary artery endothelial cells with niacin increased HO-1 expression by activating the nuclear factor-E2-related factor 2/p38 mitogen-activated protein kinase signaling pathway and inhibiting tumor necrosis factor α-induced endothelial inflammation. The antiinflammatory effects of niacin in human coronary artery endothelial cells were mimicked by bilirubin and abolished by incubation with tin protoporphyrin-IX and knock down of nuclear factor-E2-related factor 2.Niacin activates HO-1 in vivo and in vitro. Induction of HO-1 may be partly responsible for the vascular protective properties of niacin.
The rules of retraction
Authors: M. Newman
Journal: BMJ (2010)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following The rules of retraction Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Influence of a multidisciplinary paediatric allergy clinic on parental knowledge and rate of subsequent allergic reactions
Authors: S. Kapoor, G. Roberts, Y. Bynoe, M. Gaughan, P. Habibi, G. Lack
Journal: Allergy (2004)

Studies have demonstrated that families of children with food allergy have significant deficiencies in their knowledge of how to avoid allergen exposure and how to manage allergic reactions. This study aims to assess the impact of a multidisciplinary paediatric allergy clinic consultation on parental knowledge of food allergy and to determine the rate of subsequent allergic reactions.Sixty-two subjects (<17 years) referred with food allergy were prospectively enrolled. Parental knowledge was assessed by questionnaire and EpiPen trainer. Families saw a paediatric allergist, clinical nurse specialist and dietician. Knowledge was reassessed after 3 months and rate of allergic reactions after 1 year.After one visit to the paediatric allergy clinic, there was a significant improvement in parental knowledge of allergen avoidance (26.9%, P < 0.001), managing allergic reactions (185.4%, P < 0.0001) and EpiPen usage (83.3%, P < 0.001). Additionally, there was a significant reduction in allergic reactions (P < 0.001). Children with egg, milk or multiple food allergies were more likely to suffer subsequent reactions.A single visit to a multidisciplinary allergy clinic considerably improves families' abilities to manage allergic reactions to foods with an accompanying reduction in allergic reactions. Young children with egg, milk or multiple food allergies were at greatest risk of further reactions.
TB Picture Brightening, but Dark Spots Remain
Authors: Brian Vastag
Journal: JAMA (2002)

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Care not health should be centre of more integrated system, former health ministers agree
Authors: I. Torjesen
Journal: BMJ (2012)

A “fundamental reimagining” of health and social care is required to give the public a system that focuses primarily on care but is supported by health services, and not the other way round, past health ministers of all parties agreed at a meeting at the King’s Fund on Thursday 15 November.

The meeting was held to launch the King’s Fund’s “Time to think differently” programme, which aims to stimulate debate about the changes needed in health and social care to meet future demands.1

All political parties had acknowledged that care services needed to be revamped to ensure adequate service provision, quality, and affordability as the population ages and that social care needed to be more closely integrated with NHS services, speakers said. Although the NHS was designed around the delivery of transient episodes of healthcare to generally healthy people, most of the demand for health services now …
THE EVILS OF PROPRIETARY MEDICINES.
Authors: JOSEPH A. PETTIT
Journal: JAMA (1906)

ample flap to form loose covering over end stump and to bring scar well back out of line of pressure.I be- lieve that an ideal leg amputation is superior to many Chopart or Symes and most Pirogoff amputations.The Lisfranc, especially the Hey modification, gives a very satisfactory stump.I wish to suggest, however, that in making this amputation, it is wise to preserve the attach- ment of the tibialis anticus, when possible, and if not, to attach its tendons to the plantar flap.This same rule applies also to the peroneus tertius.In making amputations of the leg, there are a few important details which we should not lose sight of:1. Be certain of sufficient flap to properly cover end of bone, regardless of how close this may come to the knee joint.Flap must be considered first, length of stump second.2. The most uniform good results are obtained by making the long anterior with short posterior flap, bringing the scar well away from end of stump.3. Bedundancy is always undesirable. 4. When the length of stump is at the discretion of the operator, it should be from six to nine inches below lower border of patella. 5. Periosteal flap with coaptation of muscles over end of bone is always desirable.6. Always cut the fibula one inch shorter than the tibia and when the amputation is near the knee joint, disarticulate and remove the fibula.7. In all these amputations, nerves should be drawn out and cut as short as possible.
TCT- 344 IVUS Features of Coronary Plaques with Intraplaque hemorrhage
Authors: Mitsuaki Matsumura, Gary S. Mintz, Soo-Jin Kang, Stephen Sum, Sean Madden, Gregg W. Stone, James E. Muller, Renu Virmani, Akiko Maehara
Journal: Journal of the American College of Cardiology (2014)