tbuckley/cabot-search huggingface dataset:
Attempt at deriving a formula for setting general practitioner fundholding budgets
Authors: T A Sheldon, P Smith, M Borowitz, S Martin, R C Hill
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objective</b>: To explore the possibility of using routine Hospital Episode Statistics, census data, and vital statistics to derive weights for an equitable capitation formula for setting general practitioner fundholding budgets for buying acute hospital services. <b>Design</b>: Analysis of a routine dataset of 9 million hospital episodes in 1991–2, extracting elective general practitioner fundholding procedures, combined with 1991 census variables, vital statistics, and data on supply of health care at ward level. Costs were attached to each procedure according to the average cost of the relevant "Mersey" band category. Main outcome measures - Variation in age and sex adjusted expenditure per head on fundholding procedures across wards modelled for the impact of health and social needs variables after adjusting for variations in supply. <b>Results</b>: No sensible simple model including determinants of use other than age and sex could be derived. The most parsimonious but statistically acceptable model showed that though standardised mortality ratio and self reported illness and several social class variables were associated with utilisation, the signs and the size of the coefficients were20coutradictory. The most important explanation of variation was provided by age and sex differences between wards. Conclusions - An equitable system of setting general practitioner fundholders9 budgets is needed. In the short term age and sex weighted capitation should form the principal basis of fundholder budgets. Utilisation data at ward level are inadequate for developing a formula which adequately20adjusts for the differences in the health care needs of populations. A capitation formula based on information derived from individual cohort data may be the only means of promoting equity and efficiency and of avoiding discriminating against patients with known high cost health problems.
Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as a manifestation of visceral varicella zoster virus infection in a patient with non‐Hodgkin's lymphoma
Authors: Fusako Ohara, Yukio Kobayashi, Daigo Akabane, Dai Maruyama, Kazuki Tanimoto, Sung‐Won Kim, Takashi Watanabe, Kensei Tobinai
Journal: American Journal of Hematology (2006)

To the Editor: I am puzzled by the comment of Gu¨rkan and Genc¸[1], in their description of a case of Bardet-Biedel syndrome, that a Philadelphia chromosome was detected.The Philadelphia chromosome is a derivative chromosome 22, resulting from a t(9;22)(q34;q11) translocation.This abnormality would not be expected in a patient with this syndrome and the fact that BCR-ABL fusion was not detected by PCR indicates that a Philadelphia chromosome was not present.Some further explanation appears to be needed.
An Address on Medical Affairs
Authors: T. B. Curling
Journal: BMJ (1874)

THEb BRIJTIH MEDICAL _JOURNAL.133 for practice, is a serious evil, discreditable to the profession and injuriou ANA D D R E S S ~~~~~to the public.The course of education, the time required for its pur- suit, the character and quality of the examination tests differ considerably ON in the nineteen licensing bodies.
Lyell's toxic epidermal necrolysis: a staphylococcal aetiology?
Authors: J. Jefferson
Journal: BMJ (1967)

oxalate, phosphate, ammonium, magnesium, or carbonate-that is, the composition did not differ from that of stones found in a population denying the consumption of analgesics.It may be argued that as we have accepted renal colic and radiotranslucent material in the urinary passages as criteria for urinary stone formation, a number of patients may have been included whose renal colic and radiological appearances were due to necrotic papillae (Lindholm, 1960).However, all female patients in the " heavy " analgesic group had radiological evidence of calcified material in the urinary tract.While papillary debris may have been initially responsible for the calcification, this does not seem to us a good reason for not calling this material a " stone." SummaryForty-five of a series of 266 patients with renal calculi gave a history of heavy consumption of analgesics.A mechanism is suggested for the association between the two conditions.Prolonged consumption of analgesics with calcification of necrotic papillary material should be included among the causes of renal calculi.
Intravascular haemolysis with acute renal failure after angiocardiography.
Authors: J R Catterall, R J Ferguson, H C Miller
Journal: BMJ (1981)

Intravascular haemolysis with acute renal failure after angiocardiography Complications of coronary angiography are uncommon and usually cardiovascular.'We report a case of intravascular haemolysis with acute renal failure after angiocardiography.
Acetanilide Oxidation in Phenylbutazone-associated Hypoplastic Anaemia
Authors: J. L. Cunningham, M. J. Leyland, I. W. Delamore, D. A. P. Evans
Journal: BMJ (1974)

Acetanilide like phenylbutazone is paraoxidized by the liver endoplasmic reticulum as a primary biotransformation step. Both compounds were given at different times to each of 10 healthy volunteer subjects and the plasma disappearances measured. Correlation was shown between plasma clearance values of the two compounds (r = + 0.7067; P < 0.05).Eight patients with hypoplastic anaemia after phenylbutazone therapy were investigated. Plasma clearance values and half lives of acetanilide were measured in this group of patients and compared with those of a group of 30 healthy volunteer controls. There was a significant decrease in clearance (P < 0.01) and lengthening of half lives (P < 0.001 in the patients with phenylbutazone-associated hypoplasia. Five patients with idiopathic aplastic anaemia-that is, without history of antecedent phenylbutazone ingestion-were similarly investigated with acetanilide and there was no significant difference between the results in these patients and those in the control group.It is suggested that relatively poor paraoxidation of phenylbutazone producing high blood concentrations on a given dose may be a factor responsible for the drug-associated hypoplasia even though it does not explain the similar pattern of adverse reactions reported in association with oral administration of the metabolite oxyphenbutazone.
Newer Methods for Localization of Obscure Small-Bowel Bleeding
Authors: Randolph P. Pillow
Journal: JAMA (1962)

A bleeding site in the small intestine is sometimes difficult to detect by conventional x-ray diagnostic techniques. Radioactive-tagged red blood cells will appear in the blood and can be obtained from the region of the bleeding site by segmental tubal aspiration. A standardized procedure will yield useful information preoperatively, provided that active bleeding takes place during the period of aspiration. The case history of a woman, aged 60, who had suffered for 9 years with a severe anemia of undetermined origin, illustrates the principles involved.
S59 The Role of Lymphocytes in Acute Lung Injury
Authors: R Muir, M Cross, CM O’Kane, TR Craig, M Shyamsundar, DF McAuley, RJ Ingram
Journal: Thorax (2012)

<h3>Introduction</h3> Acute lung injury (ALI) is caused by the uncontrolled activation immune cells, resulting in dysregulated inflammation which irreversibly damages the lung architecture and function. Whilst the role of myeloid cells in the pathophysiology of ALI is well established, the function of lymphoid cells is less well understood. <h3>Hypothesis</h3> Lymphocytes may play a role inthe regulation of inflammation in acute lung injury. <h3>Methods</h3> We have utilised both human and murine <i>in vivo</i> models of lipopolysaccharide(LPS) induced ALI, as well as patient samples, to characterise lung infiltrating cells by flow cytometry. Lymphocyte associated cytokines were quantified by luminex or via ex vivo stimulation andintra-cellular cytokine staining. <h3>Results</h3> Rapid infiltration of T cells(both <i>a</i>β and <i>a</i>β T cells), including regulatory T cells (Tregs), NKT and NKcells was observed. The cytokine Interleukin (IL)-17 is a potent recruiter of neutrophilsto sites of inflammatory sites. We observed a significant elevation in IL-17 levels in bronchoalveolar lavage fluid (BALF) in the humans postLPS inhalation; high levels of IL-17 were also seen in BALF from ALI patients. AnIL-17 KO mouse was utilised to confirm the key role for this cytokine in neutro philrecruitment to the lung during ALI. The transcription factor RORγt induces transcription of the genes encoding IL-17. Flow cytometric analysis revealed RORγt+ lung lymphocytes were predominantly CD4+ T cells (18%), CD8+ T cells (20%)and the recently described innate lymphoid cells (40%). Small percentages of RORγt+natural killer (NK) cells, NK T cells, gamma delta T cells were also seen. The role of Tregs in the early regulation of ALI was examined using a Treg inducibleKO murine model (FOXP3GFP DTR). When Tregs were depleted prior to LPS administration there was an increased recruitment of neutrophils into the lung. <h3>Conclusion</h3> We have demonstrated that both lymphocyte released IL-17 and Tregs modulate the recruitment of neutrophils to the lung in ALI. These results reveal the importance of lymphocytes in the immunopathology of ALI. Increased understanding of the lymphocyte function could open new avenues of exploration for therapeutic strategies to regulate immune responses in ALI.
THE RELIEF OF PAIN IN HERPES ZOSTER BY PARAFFIN
Authors: HOWARD FOX
Journal: JAMA (1922)

Herpes zoster is a self-limited disease whose course, it is generally conceded, cannot be modified by treatment. Medical assistance is, however, of value in protecting the eruption from traumatism and subsequent infection and in relieving pain. For the average case of zoster in which the pain is not intense, the local application of a dusting powder is all that is required. In some cases, however, the pain may be intense enough to warrant the use of an opiate. The numerous remedies suggested for the relief of pain in this disease would seem to indicate that no one is entirely satisfactory. Galvanism, so highly praised by Duclos, is undoubtedly of considerable value. Other methods of treatment include faradism, high frequency currents, roentgen rays, wet and dry cupping over the affected ganglions, cocain salves and injections and freezing with ethyl chlorid spray, as suggested by Howard Morrow. The statement of Darier that
Reply to V. Maunoury et al.
Authors: I. Gralnek
Journal: Endoscopy (2007)

We wish to thank Drs. Maunoury and Bulois for their insightful comments. We are in complete agreement and do indeed recommend that, in addition to duodenal biopsies being obtained at the time of esophagogastroduodenoscopy (EGD), gastric biopsies are taken as well. Gastric biopsies should be obtained from both the gastric antrum and body. Histopathological evaluation of gastric biopsies may well provide important additional information, including microscopic evidence for atrophic gastritis and Helicobacter pylori infection, as to the cause of the iron deficiency anemia. Additional serological testing, including that for fasting gastrin levels, anti-parietal cell antibodies, and celiac disease, may also be carried out on a case-by-case basis at the discretion of the treating physician.
Large intramural colonic hematoma after polypectomy
Authors: O. Nogales Rincón, I. Yepes Barreto, A. Hernando Alonso, C. González Asanza, P. Menchén Fernández-Pacheco
Journal: Endoscopy (2009)

A 77-year-old man, who had undergone surgery 1 year previously for a colorectal carcinoma of the sigmoid colon, came to our endoscopy unit for surveillance colonoscopy. A 10-mm, pedunculated, polyp was observed at 45 cm from the anus. The patient was not receiving anticoagulation or antiaggregation treatment, and his platelet count and prothrombin activity were normal.
On the Sources and the Excretion of Carbonic Acid in the Economy
Authors: J. J. Charles
Journal: BMJ (1885)

<h3>Abstract</h3> Randomization tests are often used with species niche and distribution models to estimate model performance, test hypotheses, and measure methodological biases. Many of these tests involve building null models representing the hypothesis that there is no association between the species’ occurrences and the environmental predictors, then comparing the empirical model to null distributions built from these models. These null models are commonly based on points randomly selected with a uniform probability from the study area. However, spatial sampling bias, a near-universal feature of the occurrence data used to build niche and distribution models, results in a non-uniform probability of observing species in different areas even when species occurrences are unrelated to environmental predictors. Failing to account for this bias in randomization tests results in null distributions that do not accurately represent the null hypothesis, potentially leading to incorrect conclusions. In this study, we use simulations to demonstrate that uniform sampling in randomization tests can lead to unacceptable rates of type I error and poor estimates of methodological bias when spatial sampling bias is present in the occurrence data. We present a new method that incorporates a bias estimate into replicate simulations for these randomization tests, and show that this adjustment can reduce type I error rates to an acceptable level.
Prison Inmates and Palliative Care—Reply
Authors: John Linder, Frederick J. Meyers
Journal: JAMA (2007)

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Setting limits to infinite error
Authors: T. Delamothe
Journal: BMJ (2008)

If the journal were to print an epigram over each of its sections then for Letters I’d plump for Bertolt Brecht’s description of the purpose of science. “The aim of science is not to open the door to infinite wisdom, but to set a limit to infinite error,” said the protagonist in his Life of Galileo . Setting a limit to infinite error just about sums up what Letters are for.

All BMJ letters begin their lives as (online) rapid responses to articles, and in a generous week we select about 10% of these to publish as letters in the print journal. Our main criterion for selection …
Vasonatrin peptide: a unique synthetic natriuretic and vasorelaxing peptide.
Authors: C M Wei, C H Kim, V M Miller, J C Burnett
Journal: Journal of Clinical Investigation (1993)

This study reports the cardiovascular and renal actions of a novel and newly synthesized 27-amino acid peptide termed vasonatrin peptide (VNP).VNP is a chimera of atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP).This synthetic peptide possesses the 22-amino acid structure of CNP, which is a cardiovascular selective peptide of endothelial origin and is structurally related to ANP.VNP also possesses the five-amino acid COOH terminus of ANP.The current study demonstrates both in vitro and in vivo that VNP pos- sesses the venodilating actions of CNP, the natriuretic actions of ANP, and unique arterial vasodilating actions not associated with either ANP or CNP. (
Hematologic Adverse Effects of Aminoglutethimide
Authors: Aman U. Buzdar, Giuseppe Fraschini, George R. Blumenschein
Journal: Annals of Internal Medicine (1984)

Letters and Corrections1 January 1984Hematologic Adverse Effects of AminoglutethimideAMAN U. BUZDAR, M.D., GIUSEPPE FRASCHINI, M.D., GEORGE R. BLUMENSCHEIN, M.D.AMAN U. BUZDAR, M.D.Search for more papers by this author, GIUSEPPE FRASCHINI, M.D.Search for more papers by this author, GEORGE R. BLUMENSCHEIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-100-1-159_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Aminoglutethimide has been increasingly used in the treatment of hormonally responsive breast cancer instead of surgical adrenalectomy or hypophysectomy. The common side effects of the drug include skin rash and central-nervous-system side effects (lethargy, ataxia, and dizziness). These side effects are usually transient and rarely require discontinuation of the therapy. Hematotoxicity has been reported in few patients (1, 2), but the magnitude of this side effect has been emphasized in earlier publications. We would like to report our experience with three patients who developed severe, unexcepted, hematologic complications during treatment with aminoglutethimide. At our institution, 163 patients...References1. LIPTONHARVEYSANTEN AHR. Randomized trial of aminoglutethimide versus tamoxifen in metastatic breast cancer. Cancer Res. 1982;42(8 suppl):3434s-6s. MedlineGoogle Scholar2. INGLEGREENAHMANN JSD. Progress report on two clinical trials in women with advanced breast cancer: Trial I: tamoxifen versus tamoxifen plus aminoglutethimide. Trial II: aminoglutethimide in patients with prior tamoxifen exposure. Cancer Res. 1982;42(8 suppl):3461s-7s. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: The University of Texas System Cancer Center Houston, TX 77030 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited BySevere thrombocytopenia in patients treated with suramin: Evidence for an immune mechanism in oneN-acetyltransferaseAminoglutethimide, Alveolar Damage, and HemorrhageDAVID M. RODMAN, M.D., MICHAEL HANLEY, M.D., POLLY PARSONS, M.D.Aminoglutethimide-induced myelosuppressionTreatment of Adrenocortical Carcinoma: A Case Report and Review of the LiteratureAminoglutethimide (with hydrocortisone) induced agranulocytosis in primary breast cancer. 1 January 1984Volume 100, Issue 1Page: 159-159KeywordsAdrenalectomyAdverse reactionsAtaxiaBreast cancerCancer treatmentHematologic malignanciesRashes Issue Published: 1 January 1984 PDF DownloadLoading ...
The effect of nedocromil sodium on childhood asthma during the viral season.
Authors: P König, H Eigen, M H Ellis, E Ellis, K Blake, D Geller, G Shapiro, M Welch, C Scott
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

Viral-induced symptomatic respiratory infections (SRI) frequently cause exacerbations of asthma in children. This study investigated the protective effects of 0.5% nedocromil sodium nebulizer solution given three times a day in preventing asthma exacerbations associated with SRI. Ninety-three mild-moderate asthmatic children (6 to 12 yr of age) received either 0.5% nedocromil sodium or placebo for 24 wk during the viral season. The nedocromil sodium group was symptom-free 58% of the days, and the placebo-treated patients were symptom-free 45% of the days (p = 0.027). During Weeks 1-12, significant differences favored nedocromil sodium for asthma summary score (means: nedocromil sodium = 0.61, placebo = 0.92; p = 0.026), and daytime asthma (nedocromil sodium = 0.78, placebo = 1.22; p = 0.03). Significant differences were noted during monthly intervals for cough (Weeks 1-4: nedocromil sodium = 0.61, placebo = 0.92, p = 0.027) and peak expiratory flow rate (PEFR) (nedocromil sodium 262, placebo = 254 L/min, p = 0.041 Weeks 9-12). Patients in the active treatment group reduced their need for rescue inhaled beta 2-agonist by 10%, whereas patients treated with placebo demonstrated a 24% increase. There was a strong correlation between asthma symptoms and SRI symptoms (r = 0.47; p < 0.001). During SRIs, patients in the nedocromil sodium group demonstrated more rapid resolution of asthma symptoms immediately following infection (p = 0.033 summary score, p = 0.039 sleep difficulty). No serious adverse events were noted. Nedocromil sodium did not prevent the infection or exacerbation of asthma symptoms during SRI.(ABSTRACT TRUNCATED AT 250 WORDS)
Medical errors and medical culture
Authors: Peter A Singer, Albert W Wu, Seena Fazel, John McMillan
Journal: BMJ (2001)

# Medical errors and medical culture {#article-title-2}

A junior doctor fails to read an electrocardiogram that has been ordered and the patient dies, undiagnosed and in pain, from a myocardial infarction. We asked a professor of medical ethics, an expert in medical errors, and two clinicians to comment on the ethical implications of covering up the mistake.

# An error of omission {#article-title-3}

The patient, an elderly lady, was blind and deaf without speech. She had been brought in as an emergency case, clutching her abdomen and moaning. She had been like that for a couple of hours and had also vomited a few times. On examination she had some epigastric tenderness, her heart and lungs were normal, and her blood pressure was slightly low. Routine investigations were ordered; a drip was set up; and the team moved on.

On the next round the patient was still in severe pain. Nothing new had turned up. Her serum haemoglobin concentration, blood biochemistry, and chest and abdominal radiographs were normal. We hesitated about whether to provide pain relief. Antispasmodic drugs had been ineffective. An ultrasound scan ruled out problems with the patient's gallbladder. Endoscopy took another day to organise and produced negative results. The patient's pain and sickness continued. On the fifth day she died: the causes undiagnosed, her suffering unrelieved.

As house officer on the ward I had to prepare a case summary. Fishing in the pack of x ray films for the reports I caught the long strip of an electrocardiogram. It bore the date of admission. I had asked a nurse to do it as part of the routine work up but had not remembered to check the results. The textbook signs of an extensive acute myocardial infarction were plain even to my untrained eye.

I took the tracing to the senior consultant's office. He cast a glance over it then stared … 

Correspondence to: S Fazel