tbuckley/cabot-search huggingface dataset:
A hypoglycaemic baby on the postnatal ward
Authors: S. Ray
Journal: BMJ (2010)

A baby girl, weighing 3520 g (91st centile) was born at 38+1 weeks’ gestation by instrumental delivery. Apgar scores were normal. The pregnancy had been uneventful with no history of maternal diabetes mellitus. She was taking breast and bottle feeds well. The midwife on the postnatal ward noted that she was jittery and sweating excessively at 34 hours of age and referred her to the paediatric team on call.

Examination on the neonatal unit showed that she was jittery and sweaty with mid-facial hypoplasia, “cherubic” facies, abnormal ear lobe creases, neonatal teeth, and right hemi-hypertrophy. Her occipito-frontal circumference measured 32.5 cm (9th centile). Other observations were oxygen saturations 95% in air, respiratory rate 45-60 breaths/min (normal range 35-55), heart rate 133-140 beats/min (normal range 100-150),1 and blood pressure 83/39 mm Hg (50th centile for systolic and diastolic cuff blood pressure measurement at this age is 70 mm Hg and 55 mm Hg, respectively).2 A capillary blood gas showed mild respiratory acidosis. The bedside blood glucose concentration was 0.8 mmol/l. She was given an intravenous dextrose bolus and a dextrose infusion was started. Despite this, she remained hypoglycaemic.



### 1 What are the causes of hypoglycaemia in neonates?

#### Short answer

Causes of neonatal hypoglycaemia can be broadly grouped into those related to a lack of substrate (ketotic) and those related to excess insulin (non-ketotic). Ketotic causes include prematurity, being small for gestational age, sepsis, polycythaemia, hypoxic ischaemic encephalopathy, maternal labetalol intake, and enzymatic defects that affect glucose metabolism. Non-ketotic causes include maternal diabetes, fatty acid oxidation defects, and transient or persistent …
Patterns of Self-Definition of Asthma Patients and Normal Persons in the Freiburg Personality Inventory
Authors: H.-C. Deter, H. Schepank
Journal: Psychotherapy and Psychosomatics (1991)

The concept of the specificity of psychosomatic diseases (Alexander) is being differentiated at the time. In order to clarify some aspects of this problem, we want to investigate whether types of self-rating of normal persons differ from those of patients with bronchial asthma. In a second step we shall examine whether those types of self-rating can be found also in expert rating and third the differences between the two groups concerning their help-seeking behavior. For the purpose of this investigation the data of 135 patients with bronchial asthma (who had been investigated at the Heidelberg University Medical Department between 1979 and 1982) and of 330 persons of the Mannheim Cohort Study (who are a representative sample of the average urban population) have been reanalyzed. By means of the Freiburg Personality Inventory (FPI) data cluster analyses have been done. Evaluated by a group of 5 (5-cluster solution) the patterns of self-rating of patients with bronchial asthma do not differ significantly from those of normal persons. They had a high correlation to the expert rating and to other social-medically important outer criteria. The results indicate that the specificity of psychosomatic patients in relation to normal persons is not very convincing in a pattern of self-rating on the level of the FPI. Therefore, further research in this field seems to be necessary.
Conservation of the cardiostimulant effects of (−)-norepinephrine across Ser49Gly and Gly389Arg beta1-adrenergic receptor polymorphisms in human right atrium in vitro
Authors: Peter Molenaar, Glenn Rabnott, Ian Yang, Kwun M. Fong, Santiyagu M. Savarimuthu, Li Li, Malcolm J. West, Fraser D. Russell
Journal: Journal of the American College of Cardiology (2002)
Trial begins in Kansas of man who killed abortion doctor
Authors: J. H. Tanne
Journal: BMJ (2010)

The trial of Scott Roeder for murder began in Wichita, Kansas, last week. Although he pleaded not guilty, Mr Roeder has publicly admitted shooting and killing George Tiller, one of the few US doctors who provided late term abortions, in May 2009.

The trial had been expected to be about premeditated first degree murder. However, Judge Warren Wilbert has allowed Mr Roeder’s lawyers to plead that he killed Dr Tiller in “voluntary manslaughter” to protect fetuses. Under Kansas law voluntary manslaughter is a killing committed in “an unreasonable but honest belief that circumstances existed that justified deadly force.”

The penalty for a conviction on voluntary manslaughter could be five years …
S31 Pepsin detection despite the use of acid suppressant medication in patients with airway reflux related chronic cough
Authors: GL Crossfield, W Jackson, J Burke, AD Woodcock, V Strugala, C Ward, JP Pearson, PW Dettmar, AH Morice
Journal: Thorax (2013)

<h3>Background</h3> Chronic cough (CC) is an increasing problem that is not easy to treat with medication. Associated symptoms include hoarse voice, dysphonia, persistent tickling and irritation of the throat or chest. These lead to poor sleeping and eating patterns, loss of vocal independence and social isolation all resulting in an impaired quality of life. Airway reflux is a common cause of unexplained chronic cough and proton pump inhibitor (PPI) medication is commonly prescribed as initial therapy. The following study assessed pepsin identification in CC patients as a marker of airway reflux on PPI. <h3>Methods</h3> Symptomatic expectorated saliva samples were obtained from 16 patients (6 male/10 female, 50 years (37–76), Body Mass Index (BMI) 30 (24–44), median (range)) attending clinical appointment with symptoms of chronic cough. Pepsin was identified using the Peptest<sup>TM</sup> an <i>in vitro</i> diagnostic medical device specific for human pepsin A (RD Biomed Ltd, UK). All patients completed the Hull Airways Reflux Questionnaire (HARQ) to determine airway reflux related cough (range 0–70; &lt;13 normal). Patient demographics and medication data was provided on sample collection. <h3>Results</h3> Fourteen (88%) of the CC patients were positive for pepsin in saliva samples (median 83ng/ml; range 25–250), providing non-invasive verification of presence of reflux in this CC population. Thirteen pepsin positive patients were symptomatic of airway reflux related cough according to abnormal HARQ score (median 40; range 25–59) and all were taking PPI (20–60mg/d range collected from referral letter and patient questionnaire). The median BMI of the pepsin positive patients was 30 (range 25–44). <h3>Conclusion</h3> Pepsin was present in 88% of suspected airway reflux related chronic cough patients therefore corroborating the diagnosis of reflux. Airway reflux is associated with unexplained chronic cough in patients receiving PPI highlighting that symptoms and reflux are still present despite acid suppression. Overweight and obese BMI status is a common feature of airway reflux related chronic cough patients. A reconsideration of the empiric use of acid suppression use maybe warranted for unexplained chronic cough.
General practitioner attendance at emergencies notified to ambulance control.
Authors: J Cox, T G Chapman
Journal: BMJ (1984)

For two years doctors from a small village went to the scene of emergency calls received by ambulance control. On 80% of the occasions when the doctor was called at the same time as the ambulance was dispatched the doctor arrived before the ambulance. There were 24 incidents, 16 of which were road traffic accidents. In two cases the doctor established a clear airway in an unconscious patient before the ambulance arrived. Two patients were trapped in their vehicles and were given parenteral analgesics. Four patients required intravenous fluids. The call out system provided first aid for patients before the ambulance arrived and medical assistance to the emergency services at serious accidents. Patients who did not require hospital attention could be examined and treated at the scene, making the ambulance available for other duties and reducing the number of patients taken to the hospital accident and emergency department.
Surgical Skill and Complication Rates after Bariatric Surgery
Authors: John D. Birkmeyer, Jonathan F. Finks, Amanda O'Reilly, Mary Oerline, Arthur M. Carlin, Andre R. Nunn, Justin Dimick, Mousumi Banerjee, Nancy J.O. Birkmeyer
Journal: New England Journal of Medicine (2013)

Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes.
US institute announces initiative to put all its research on the web
Authors: Marwick Charles
Journal: BMJ (2005)

The US National Institutes of Health (NIH) is taking a major step to provide free, public access to peer reviewed scientific publications.

The new policy, announced by the NIH director, Dr Elias Zerhouni, asks investigators publishing NIH funded research to submit their manuscripts to the National Library of Medicine's (NLM) PubMed Central for electronic transmission as soon as possible after acceptance and in any event within 12 months of publication. Compliance is voluntary and there are no penalties if investigators fail to comply. “We believe they will [comply],” Dr Zerhouni said.

A system is being set up by the NLM to receive manuscripts …
Idiopathic Cardiac Hypertrophy — A Treacle Well?
Authors: Gordon S. Myers
Journal: New England Journal of Medicine (1974)

In Alice in Wonderland, the Dormouse tells the story of three little sisters who lived at the bottom of a treacle well. ''There's no such thing!" Alice at first cried angrily, but when admonished by the Hatter and the Hare, continued humbly, "I dare say there may be one."About 15 years ago, a clinical syndrome was recognized that was often, but not invariably, associated with systolic narrowing of the left ventricular outflow tract resulting from the abnormal apposition of the anterior leaflet of the mitral valve toward an asymmetrically hypertrophied ventricular septum. Inflow obstruction due to reduced left . . .
A novel protein that participates in nonself discrimination of malignant cells by homologous complement
Authors: Misako Matsumoto, Junji Takeda, Norimitsu Inoue, Tomoko Hara, Michiyo Hatanaka, Kazuhiko Takahashi, Shigeharu Nagasawa, Hitoshi Akedo, Tsukasa Seya
Journal: Nature Medicine (1997)
Flunisolide nasal spray for perennial rhinitis in children.
Authors: J K Sarsfield, G E Thomson
Journal: BMJ (1979)

Twenty-seven children with perennial rhinitis entered a double-blind cross-over study comparing nasal sprays of flunisolide---a new topical corticosteroid---and placebo. Symptoms were assessed over two consecutive monthly periods with each treatment. Weekly diary cards, monthly clinical assessments, and end-of-trial preferences all favoured the active drug. At the end of the trial 20 patients preferred the treatment month with flunisolide, four preferred the placebo month, and two rated the periods equally. Side effects were mild, the commonest being transient nasal stinging. Seventeen children who derived benefit from flunisolide continued with the treatment for a six-month open-study period. Many reduced the dosage from three times to twice or once daily without losing benefit. The effect of flunisolide on the pituitary-adrenal axis was assessed in seven children by measuring the 0900 blood cortisol concentrations at two-month intervals over the six months. No effect was observed. The results show that flunisolide is effective and safe for the treatment and prophylaxis of perennial rhinitis in children.
Patients' Expectations and Demand Management
Authors: Richard L. Kravitz
Journal: Annals of Internal Medicine (1997)

Letters1 May 1997Patients' Expectations and Demand ManagementRichard L. Kravitz, MD, MSPH and Edward J. Callahan, PhDRichard L. Kravitz, MD, MSPHUniversity of California, Davis, Sacramento, CA 95817Search for more papers by this author and Edward J. Callahan, PhDUniversity of California, Davis, Sacramento, CA 95817Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-9-199705010-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Drs. Vickery and Lynch's comments about demand management. They assert that the purpose of demand management is to encourage the appropriate use of health care services by helping patients and physicians to make wise medical decisions. Defined in this way, the concept may well be unassailable. Our disagreement is not with demand management as the authors idealize it but rather with how it has been promoted and implemented in actual practice. There is no doubt that “understanding the perceptions, attitudes, and beliefs that determine patient behavior is essential for improving health care.” The difficulty comes in ... Author, Article, and Disclosure InformationAffiliations: University of California, Davis, Sacramento, CA 95817 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTool Development for Measuring Caller Satisfaction and Outcome with Telephone Advice Nursing 1 May 1997Volume 126, Issue 9Page: 744KeywordsBehaviorHealth careMedical servicesMotivationPerception Issue Published: 1 May 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Health services research
Authors: J. Lomas
Journal: BMJ (2003)

More lessons from Kaiser Permanente and Veterans'Affairs healthcare system 

Imagine a health system that improved diabetes control from 51% to 94%, screening for cervical cancer from 62% to 93%, and use of blockers for myocardial infarction at discharge from hospital from 70% to 95%. Imagine another system that costs the same as the NHS but has consistently higher quality of care as measured by process and outcome measures. Actually you don't have to imagine them because these two systems already exist—in the United States. Between 1995 and 2000 the Veterans' Affairs healthcare system achieved these remarkable improvements in quality for its more than 3.5 million users while reducing costs per patient by 25%.1 2 In the second case, the starkly better results for the 9 million members of the Kaiser Permanente health system compared with the NHS were documented in a 2002 study published in this journal.3

That both these systems invest heavily in health services research is probably no coincidence. The Veterans' Affairs system puts in $50m (£29m; €;42m) …
Diseases of the Ear: A Textbook of Otology
Authors: Robert W. Cantrell
Journal: JAMA (1980)

It is difficult for a reviewer to be objective about a textbook with which he has been familiar for many years. For me<i>Diseases of the Ear</i>is such a book. As a resident I read the second edition and was impressed with its style and content. Mawson's description of the various otologic problems, rendered in flawless, eloquent English, let me understand what previously had been unclear. This was particularly true regarding vestibular disorders. In 1975 I reviewed the third edition of this book for<i>JAMA</i>and found it to be better than the second. It is pleasing, therefore, to see that Mawson has continued to update his book, which is now coauthored by Harold Ludman, formerly assisting and illustrating editor. In this fourth edition, the sections on basic anatomy and operative technique have been shortened to allow more material on audiology, acoustics, and neuro-otology. Recently acquired knowledge in cochlear
Congenital Diverticulum of the Left Ventricle Associated with Hypoplastic Right Ventricle and Ventricular Septal Defect
Authors: GARTH S. ORSMOND, HYMIE S. JOFFE, ELLIOT CHESLER
Journal: Circulation (1973)

A case of congenital diverticulum of the left ventricle associated with a ventricular septal defect and severe hypoplasia of the right ventricle without tricuspid or pulmonary atresia is described and the relevant literature is reviewed. The distinction between true muscular diverticulae and congenital apical aneurysms is made, the latter term being preferred for similar abnormalities described as fibrous diverticulae or congenital epicardial cysts. Rupture is rare in true muscular diverticulae and the high pressure recorded in our case is thought to have been caused by catheter entrapment.
An Uncommon Endoscopic Finding: Bleeding Secondary Aortoenteric Fistula
Authors: J. Banai, G. Salfay, M. Szeleczky, M. Kun
Journal: Endoscopy (1982)

Aortoenteric fistula is a complication of aortic reconstructive surgery. Here, the authors describe a case of a secondary aortoduodenal fistula causing haemorrhage. Diagnosis was made by upper gastrointestinal endoscopy.
CONGENITAL CUTANEOUS DYSTROPHY (THOMSON'S TYPE)
Authors: ARTHUR ROOK, IAN WHIMSTER
Journal: British Journal of Dermatology (1949)

Journal Article CONGENITAL CUTANEOUS DYSTROPHY (THOMSON'S TYPE) Get access ARTHUR ROOK, M.A., M.B.Cantab., M.R.C.P.Lond., ARTHUR ROOK, M.A., M.B.Cantab., M.R.C.P.Lond. Department for Diseases of the Skin and the Department of Pathology, St. Thomas's Hospital Search for other works by this author on: Oxford Academic Google Scholar IAN WHIMSTER, M.B., B.Ch.Cantab. IAN WHIMSTER, M.B., B.Ch.Cantab. Department for Diseases of the Skin and the Department of Pathology, St. Thomas's Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology and Syphilis, Volume 61, Issue 6, 1 June 1949, Pages 197–205, https://doi.org/10.1111/j.1365-2133.1949.tb11084.x Published: 01 June 1949
Abdominal Fat and Sleep Apnea: the Chicken or the Egg?
Authors: Kerstin M. Oltmanns
Journal: Diabetes Care (2008)

I read with great interest the article by Pillar and Shehadeh (1) on the coherences between obstructive sleep apnea (OSA) syndrome and associated metabolic alterations apparently linked by obesity. The authors give a good overview of the current literature about sleep disturbances in OSA and various aspects related to the metabolic syndrome, particularly obesity, such as glucose intolerance and insulin resistance. Notwithstanding, as the authors correctly mention, the clinical picture of OSA is characterized by both sleep fragmentation and recurrent hypoxic periods, which were somewhat neglected in their …
Reply to S.A. Ñamendys-Silva et al
Authors: Elie Azoulay, Djamel Mokart, Virginie Lemiale, Frédéric Pène, François Vincent, Michael Darmon
Journal: Journal of Clinical Oncology (2014)

We have read the letter from N ˜amendys-Silva et al 1 with interest.Although use of the severity score for triage purposes is a compelling idea, we disagree with the authors with regard to its feasibility.First, N ˜amendys-Silva et al cite positive studies that suggest the severity score to be discriminant in predicting outcome.However, several studies 2-4 have indicated that the usual severity scores, including the Acute Physiology and Chronic Health Evaluation score, were neither discriminant nor well calibrated in critically ill patients with cancer.We believe that these studies should be taken into consideration.Additionally, the inability of these scores to predict individual outcomes because of their lack of calibration was demonstrated two decades ago. 5,6In keeping with these findings, and although we agree that reliance on physician predictions of outcome remains imperfect, 7,8 we would strongly discourage outdated triage practices that are based on severity scores.We fully agree that the prioritization of admission policy might be in order in low income countries.However, this can only be performed according to objective criteria.We believe that if intensive care unit admission of patients with cancer is limited, it is first necessary to carefully assess the outcomes of these patients.Our study provides convincing evidence that the prognosis of these patients is no longer
Jakob-Creutzfeldt Disease
Authors: S. Nevin
Journal: BMJ (1969)

Timely medical assessment is integral to the safety and quality of healthcare delivery in acute medicine. Medical staff are an expensive resource. This study aimed to develop a modelling system that facilitated efficient workforce planning according to patient need on the acute medical unit. A realistic 24-hour ‘supply’ of junior doctors was calculated by adjusting the theoretical numbers on the rota for leave allowances, natural breaks and other ward duties by a combination of direct observation of working practice and junior doctor interviews. ‘Demand’ was analysed using detailed admission data. Supply and demand were then integrated with data from a survey of the time spent on the process of clerking and assessment of medical admissions. A robust modelling system that predicted the number of unclerked patients was developed. The utility of the model was assessed by demonstrating the impact of a regulation-compliant redesign of the rota using existing staff and by predicting the most efficient use of an additional shift. This simple modelling system has the potential to enhance quality of care and efficiency by linking workforce planning to patient need.
Construction and Use of Retroviral Vectors Encoding the Toxic Gene Barnase
Authors: Sumit Agarwal, Bryan Nikolai, Tomoyuki Yamaguchi, Patrycja Lech, Nikunj V. Somia
Journal: Molecular Therapy (2006)

Suicide genes for negative selection of cells have been powerful tools in somatic cell genetic studies and in gene therapy. Here we report on the construction, characterization, and utilization of retroviral vectors encoding barnase, a ribonuclease from Bacillus amyloliquefaciens, expression of which results in apoptosis of transduced mammalian cells. High-titer viral vector production was enabled by expression of an inhibitor of barnase (barstar) in transfected cells generating murine leukemia virus (MLV)- and HIV-1-based vectors. To identify cellular genes required for infection we used barnase-encoding vectors in a genetic screen to isolate mutant mammalian cells that are resistant to infection by MLV and HIV-1. We describe one such mutant clone that is inhibited in the infection process after reverse transcription. These results suggest that barnase-encoding vectors should be useful for negative selection strategies examining retroviral infection from entry to integration. Furthermore these vectors could have utility in approaches for gene therapy that require specific cell ablation.
Lupus anticoagulants in systemic lupus erythematosus: prevalence and clinical associations.
Authors: K Padmakumar, R R Singh, R Rai, A N Malaviya, A K Saraya
Journal: Annals of the Rheumatic Diseases (1990)

The prevalence of lupus anticoagulant (LAC) and its relation with reported clinical associations has been determined in 55 patients with systemic lupus erythematosus (SLE) from northern India who were studied prospectively. Kaolin clotting time was used to screen for LAC, which was detected in seven (13%) of the patients. Significant associations were found between LAC and thrombotic events, onset of disease at an early age, and disease of shorter duration. No statistically significant association could be found between LAC and recurrent abortions, pulmonary hypertension, thrombocytopenia, and neurological manifestations. It is concluded that LAC is a useful marker for a subset of patients with SLE at risk of thromboembolic events.