tbuckley/cabot-search huggingface dataset:
Prevention of Bleeding in Older Patients Taking Warfarin
Authors: Samuel Kajubi
Journal: Annals of Internal Medicine (2001)

Letters2 October 2001Prevention of Bleeding in Older Patients Taking WarfarinSamuel Kajubi, MDSamuel Kajubi, MDLincoln Hospital; Bronx, NY 10451Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-7-200110020-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The paper by Beyth and colleagues (1) described a clever innovation that attempts to circumvent the delay that bedevils the process of transmitting the results of prothrombin testing from the laboratory to the provider, who then chooses the appropriate warfarin dose. Indeed, this home monitor is similar to the glucometer used by patients with diabetes.While applauding this innovation, however, I wish to reiterate my observations (2) favoring extra monitoring for patients taking long-term warfarin therapy and suggesting that the fecal occult blood test and tests for hematocrit are two additional monitoring tools that could improve patient ...References1. Beyth RJ, Quinn L, Landefeld CS. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. A randomized, controlled trial. Ann Intern Med. 2000;133:687-95. [PMID: 11074901] LinkGoogle Scholar2. Kajubi SK. Additional monitoring tools to improve the quality of anticoagulation management [Letter]. Arch Intern Med. 2000;160:3006. [PMID: 11041916] CrossrefMedlineGoogle Scholar3. . Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. 1991;84:527-39. [PMID: 1860198] CrossrefMedlineGoogle Scholar4. Rockey DC. Occult gastrointestinal bleeding. N Engl J Med. 1999;341:38-46. [PMID: 10387941] CrossrefMedlineGoogle Scholar5. Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989;87:144-52. [PMID: 2787958] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Samuel Kajubi, MDAffiliations: Lincoln Hospital; Bronx, NY 10451 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCurrent Awareness 2 October 2001Volume 135, Issue 7 Page: 548-549 Keywords Anticoagulant therapy Blood Gastrointestinal tract Heart Hematocrit Hematologic tests Hemorrhage International normalized ratio Phlebotomy Research laboratories ePublished: 2 October 2001 Issue Published: 2 October 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Case 21-1964
Authors: Stephen M. Krane, Sanford I. Roth
Journal: New England Journal of Medicine (1964)

Presentation of CaseA seventy-five-year-old man entered the hospital because of a mass in the neck.Three weeks previously he became aware of a painless mass growing in the right side of the neck. He had no symptoms and had always been well, working daily as a building superintendent until shortly before admission. He smoked two packs of cigarettes daily and drank one pint of whiskey each week.Physical examination revealed a well nourished man who appeared chronically ill. Over the lateral aspect of the right side of the neck there was a firm, movable, nontender mass, 15 by 5 . . .
No extra government funding for NHS staff over millennium period
Authors: C. White
Journal: BMJ (1999)

There will be no additional central funding or national guidelines for incentive payments for NHS staff over the millennium period, the government has decided. Employers will be expected to draw on the tradition of public service and commitment among staff as part of their effort to maintain services, the NHS circular issued last week advises.

The number of people who will attend non-ticketed events over the millennium period is unknown, and the NHS has not yet overcome its current shortage of nursing staff.

“It's a nice sentiment, but relying solely …
Impact of Untreated Obstructive Sleep Apnea on Glucose Control in Type 2 Diabetes
Authors: Renee S. Aronsohn, Harry Whitmore, Eve Van Cauter, Esra Tasali
Journal: American Journal of Respiratory and Critical Care Medicine (2009)

Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes.
Legal considerations of clinical guidelines
Authors: D. Marjot
Journal: Journal of the Royal Society of Medicine (2004)

I agree with Dr Walden1 and Dr Doney2 that guidelines can be dangerous as they can have a spurious authority. In time all guidelines will be shown to be partly or wholly wrong. They may even be politically engineered. The 1999 publication Drug Misuse and Dependence—Guidelines on Clinical Management3 is an example. It contains serious errors of fact and ignores good evidence that conflicts with its 'consensus' views. These guidelines are published by the Department of Health as '... clinical interventions for drug misuse and dependence are subject to a number of regulations for the prescribing of controlled drugs...' (p. xiv). If that were so then guidelines on palliative care would also be written by the Department of Health. It is clear that these guidelines are subject to political scrutiny and if unacceptable to the Department of Health they would not be published.

The guidelines then state (p.xv) '... any doctor not fulfilling the standards and quality of care in the appropriate treatment of drug users that are set out in these Clinical Guidelines, will have this taken into account if, for any reason consideration of their performance in this clinical area is undertaken...'. The guidelines then say '... in that these Guidelines do represent a consensus view of good clinical practice, it is expected they will be a significant reference point in assisting the General Medical Council [GMC] in its power to examine reports of poor performance by medical practitioners...'.

These guidelines are concealed government regulation that in this context is an act of deception. Also, the GMC must have been involved in discussions about these guidelines before their publication, thus gravely impairing the GMC's impartiality. Beware of guidelines!
THE CLINICAL RECOGNITION OF PULSUS ALTERNANS
Authors: ROGER S. MORRIS
Journal: JAMA (1926)

It is now an accepted fact that, in the absence of tachycardia, pulsus alternans in cardiac or cardiorenal disease indicates a grave prognosis. Lewis<sup>1</sup>says: Alternation of the pulse belongs to a small group of phenomena witnessed by those who attend the sick, which, treated as isolated signals, are in themselves emphatic and portentous. It ranks with subsultus tendinum, with optic neuritis, with the risus sardonicus, and other ill omened messengers. It is the faint cry of an anguished and fast failing muscle, which, when it comes, all should strain to hear, for it is not long repeated. A few months, a few years at most, and the end comes. A perusal of the litearture is apt to convey the impression that pulsus alternans is uncommon and that a tracing of the radial pulse is necessary for its detection. Vaquez 2 refers to it as "at once the rarest
Dobutamine: A New Synthetic Cardioactive Sympathetic Amine
Authors: Jan Koch-Weser, Edmund H. Sonnenblick, William H. Frishman, Thierry H. LeJemtel
Journal: New England Journal of Medicine (1979)

Dobutamine* is a new, synthetic, intravenously administered catecholamine that acts directly to increase myocardial contractility without inducing marked tachycardia or greatly changing peripheral arterial resistance.1 These features make it useful for treating acute cardiac failure characterized by low cardiac output and elevated diastolic filling pressures, and in July, 1978, it was approved for clinical use in this country.Norepinephrine is the endogenous catecholamine that is synthesized and stored in granules in adrenergic nerve endings in the myocardium. When sympathetic nerves to the heart are activated, norepinephrine is released from its stores and stimulates specific sites on the myocardial cell surface, . . .
Plasma levels of immunoreactive atrial natriuretic factor in healthy subjects and in patients with edema.
Authors: Y Shenker, R S Sider, E A Ostafin, R J Grekin
Journal: Journal of Clinical Investigation (1985)

Atrial natriuretic factor (ANF), a recently sequenced cardiac peptide, has been shown to have potent natriuretic, diuretic, and vasodilating effects in several species. We have developed a radioimmunoassay to measure the levels of immunoreactive ANF in human plasma. Plasma levels of ANF in healthy volunteers on a low sodium diet were 9.8 +/- 1.4 pmol/liter and increased to 21.9 +/- 3.0 on a high sodium diet. The levels of atrial natriuretic factor correlated directly with urinary sodium and inversely with plasma renin activity and plasma aldosterone levels. Patients with marked edema due to congestive heart failure had plasma levels of atrial natriuretic factor five times higher than normal (P less than 0.05), whereas patients with cirrhosis and edema had levels that were not different from normal. These results suggest that atrial natriuretic factor plays an important role in the adaptation to increased sodium intake.
Abstract 573: Ionizing radiation activates IFN signaling in tumor cells
Authors: Nikolai Khodarev, Sean Pitroda, Ravi Sood, Sajid Khan, Matthew Filippo, Ruchika Gutt, Samantha Perakis, Thomas Darga, Renuka Malik, Aaron Pederson, Ralph Weichselbaum
Journal: Cancer Research (2011)

Abstract Ionizing radiation (IR) uses multiple pathways to mediate killing in tumor cells. We found that fractionated irradiation leads to the constitutive overexpression of Interferon Stimulated Genes (ISGs) which are controlled by Signal Transducer and Activator of Transcription 1 (Stat1). Stat1 mediated IFN signal transduction and at the same time was involved in the production of Type I and Type II IFNs. IR-induced ISGs represent the following groups: 1) mitochondrial-related genes with pro- and anti-apoptotic functions, 2) cell cycle control and regulators of transcription, 3) protein modification and degradation, 4) cytoplasmic sensors of nucleic acids, and 5) anti-viral defense. Fractionated or single-dose IR induced the IFN pathway mediated by activation of Stat1 in breast, colon, prostate and head and neck tumor xenografts. Depletion of tumor-derived IFNs led to the suppression of IR response indicating that IFN production/signaling is a component of anti-tumor IR action. Cell-autonomous experiments indicated that tumor cells up-regulate Stat1 and ISGs and produce IFNα in response to single dose IR (3Gy). Up-regulated Stat1 in irradiated tumor cells was not phosphorylated at Tyr701 position compared to Stat1 activation following interferon stimulation. In a syngeneic tumor model of B16F1, IR-induced activation of IFN signaling in tumors (assessed both by up-regulation of the Stat1-dependent pathway and induction of Type I and Type II IFNs) was dependent on TNFα signaling in the host and was impaired in TNFR1,2-/- mice. We therefore conclude that IR induces IFN signaling in tumor cells as a component of the cytotoxic response. This interferon induction depends on TNFα signaling in host cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 573. doi:10.1158/1538-7445.AM2011-573
Inactivation of PI3Kγ and PI3Kδ distorts T-cell development and causes multiple organ inflammation
Authors: Hong Ji, Felix Rintelen, Caroline Waltzinger, Dominique Bertschy Meier, Antonio Bilancio, Wayne Pearce, Emilio Hirsch, Matthias P. Wymann, Thomas Rückle, Montserrat Camps, Bart Vanhaesebroeck, Klaus Okkenhaug, Christian Rommel
Journal: Blood (2007)
209 MICRORNA-519D IS UP-REGULATED IN HEPATOCELLULAR CARCINOMA AND SENSITIZES HCC CELLS TO DOXORUBICIN TREATMENT BY TARGETING CDKN1A/P21
Authors: F. Fornari, L. Gramantieri, M. Milazzo, G. Pallocca, S. Francia, M. Cescon, M. Negrini, L. Bolondi
Journal: Journal of Hepatology (2011)
The Mammalian Kidney
Authors: D. N. S. Kerr
Journal: BMJ (1975)

<b>Objective</b> To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom. <b>Design</b> Population based longitudinal cohort study using nationwide clinical registries. <b>Setting and participants</b> Nationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119 786 patients) and the UK (NICOR/MINAP, n=242; 391 077 patients), 2004-10. <b>Main outcome measures</b> Between hospital variation in 30 day mortality of patients admitted with acute myocardial infarction. <b>Results</b> Case mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% <i>v</i> 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% <i>v</i> 6.6% in Sweden; 12.7% <i>v</i> 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals’ use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries. <b>Conclusion</b> Between hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction. <b>Clinical trials registration</b> Clinical trials NCT01359033.
PTH-176 Audit to Evaluate the Gastroenterology Registrar of the Week Service in University Hospitals of Leicester
Authors: V M Gordon, D Rogers, P Hooper
Journal: Gut (2013)

<h3>Introduction</h3> The ‘Registrar of the Week’ service initially started in response to a Primary Care Trust initiative for Gastroenterology advice to GP’s. This started as project ‘Batphone’. The Gastroenterology department saw an ideal opportunity to start a Gastroenterology phone advice service which would be manned by an allocated Gastroenterology Registrar of the week, running Monday to Friday, 9–5pm excluding bank holidays. This started in August 2011. We give advice and see patients within the Leicester Royal Infirmary (LRI) as well as give advice to GP’s and across site at the Leicster General Hospital (LGH) and Glenfield General Hospital (GGH). <h3>Methods</h3> We collected data using a designed proforma to document all calls including origin, date time and also a summary sheet for the day. 262 days documentation was reviewed as these were complete. These were analysed. <h3>Results</h3> The number of calls in 262 days was 2652. The range was 1- 36 calls per day, but on average 10 per day. 512 patients were identified for a Gastroenterology ward. There were 607 patients physically reviewed. 1870 calls came from the LRI, 165 from LGH, 195 from GGH and 276 GP calls. This works out roughly 1 call per day from each of the latter. <h3>Conclusion</h3> We have seen a great increase in the usage of our service. We think that the audit data may well be an under reflection of the work done as people forget to fill the sheets in. The intensity is unpredictable. The number of GP calls is far lower than the number of hospital calls. It was felt overall the service was being avidly utilised by mainly medical and surgical teams and that it was also good experience for our Gastroenterology specialist Registrars. There were misuses of the telephone for example patients and relatives being put though. We are hoping to reduce this by education and circulation of further guidelines. The things we intend to change are the actual telephone as the reception is poor. Referrals that need to be seen the same day should be referred before 12pm. Guidelines for referral will be circulated. There will be more formalised consultant back-up in the future. We believe our service has been a success especially in the sense that we are able to know about and manage patients earlier although we think the efficiency of the service could be improved. We intend on re-auditing this service in the future so that we can continually improve it. <h3>Disclosure of Interest</h3> None Declared.
China is still not open enough about SARS, says WHO
Authors: J. Parry
Journal: BMJ (2003)

Whereas the outbreaks of severe acute respiratory syndrome (SARS) in Singapore and Hong Kong are showing signs of coming under control, the spread of the disease in both China and Taiwan remains a major cause for concern, the World Health Organization says.

By 12 May there were 6583 reported probable cases and 364 deaths worldwide. More than 67% of the world's cases have occurred in China, with major outbreaks in Beijing …
DIFFERENCES IN CLINICAL OUTCOMES BASED ON ADHERENCE TO VALVE SIZING CRITERIA USING 2D ECHOCARDIOGRAPHY OR 3D COMPUTED TOMOGRAPHY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION
Authors: Nicolo Piazza, Alexander Hill, Gernot Brockmann, Anke Opitz, Domenico Mazzitelli, Yacine Elhmidi, Hendrik Ruge, Sabine Bleiziffer, Rudiger Lange
Journal: Journal of the American College of Cardiology (2012)
Abstract 860: In vitro and in vivo studies of a novel, functionalized, completely human serine protease targeting Her2/neu. Activity against Herceptin- and multi-drug resistant tumor cells .
Authors: Yu Cao, Khalid A. Mohamedali, John W. Marks, Lawrence H. Cheung, Walter N. Hittelman, Michael G. Rosenblum
Journal: Cancer Research (2013)

Abstract A number of recombinant fusion constructs and drug conjugates demonstrate excellent efficacy in preclinical studies but the long-term clinical applicability of these agents may be limited by tolerability issues and the emergence of multi-drug resistance. To address these issues, we employed the human serine protease granzyme B (GrB) as a cytotoxic effector and the humanized scFv designated 4D5 targeting the Her2/neu extracellular domain. A human fusion construct designated GrB/4D5/26 containing the fusogenic peptide 26 was constructed. The GrB/4D5/26 fusion construct showed specific and rapid cellular uptake into Her2/neu positive but not Her2/neu negative cells. We demonstrated efficient, specific delivery of GrB to the cytosol of Her2/neu positive cells. Against a panel of Her2/neu-positive tumor cells, IC50 values of the fusion construct ranged from 10∼100 nM, compared to that of GrB which was in the μM range. Treatment with GrB/4D5/26 resulted in specific cell killing accompanied by activation of caspases, PARP cleavage and cytochrome C release from mitochondria. In contrast to studies from other groups, the cytotoxic effects of the GrB/4D5/26 fusion construct did not require the assistance of the endosomolytic reagent chloroquine. Treatment with GrB/4D5/26 also caused efficient downregulation of the PI3K/Akt and Ras/ERK signaling pathways. Tumor cell lines highly resistant to Lapatinib, Herceptin or chemotherapeutic agents were not cross-resistant to the GrB-based fusion protein. Consecutive intravenous injections of GrB/4D5/26 into nude mice bearing BT474 M1 tumors resulted in significant, long-term tumor growth suppression. Twenty-four hours after i.v. administration, excised tumors displayed an increase in GrB/4D5/26 concentration and apoptotic nuclei compared to saline controls. These studies demonstrate the impressive in vitro and in vivo activity of the the completely human Her2/neu targeted construct and suggest its further evaluation for clinical use. Research conducted, in part, by the Clayton Foundation for Research. Citation Format: Yu Cao, Khalid A. Mohamedali, John W. Marks, Lawrence H. Cheung, Walter N. Hittelman, Michael G. Rosenblum. In vitro and in vivo studies of a novel, functionalized, completely human serine protease targeting Her2/neu. Activity against Herceptin- and multi-drug resistant tumor cells . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 860. doi:10.1158/1538-7445.AM2013-860
Providing health services to indigenous peoples
Authors: M. Durie
Journal: BMJ (2003)

A combination of conventional services and indigenous programmes is needed 

Although indigenous health is influenced by many factors outside the formal health sector, access to quality health services is none the less an important determinant of good health.1 In New Zealand, efforts to improve Maori health have resulted in substantial shifts across the entire health sector. The primary driver for reorienting health services is linked to health gains and a reduction in disparities between Maori and non-Maori. However, the position of Maori as indigenous people adds another dimension, reflected in section 8 of the New Zealand Public Health and Disability Act (2000), requiring health services to recognise the principles of the Treaty of Waitangi, an 1840 agreement that saw sovereignty exchanged for Crown protection. Because of the treaty, Maori occupy a position that is not afforded other non-indigenous ethnic minority groups, even where comparable standards of health exist.

Of the several approaches to improving health services for indigenous health two broad directions can be identified: increasing the responsiveness of conventional services and establishing dedicated indigenous programmes. Both approaches are endorsed in legislation and government health policy. The …
Diabetes Mellitus 75 Years Ago
Authors: Neill F. David
Journal: JAMA (1976)

<h3>To the Editor.—</h3> Your compulsion to publish "<i>JAMA</i>75 Years Ago" in each issue fascinates. Anyway, you have set me to browsing at the National Library of Medicine, to learn whether you or I might be missing some tidbits that we should know about. The issue of Sept 7, 1901 (37:638, 1901) contained an article that describes attempts to treat a child afflicted with diabetes mellitus. Physicians of the present generation should read that article or at least learn more about it and thereby appreciate fully the contribution made by Banting and Best.