tbuckley/cabot-search huggingface dataset:
Perceptions of pain relief after surgery.
Authors: S Kuhn, K Cooke, M Collins, J M Jones, J C Mucklow
Journal: BMJ (1990)

To assess patients' satisfaction with postoperative pain relief.A descriptive and questionnaire study of patients' experience.Two surgical and two gynaecological wards.50 Patients admitted to hospital for cholecystectomy and 51 admitted for hysterectomy.Visual analogue scales with no divisions were completed by the patients immediately after each dose of postoperative analgesia was administered throughout their stay in hospital. A questionnaire completed on the fifth postoperative day recorded patients' recollections of their experience. Opinions were also sought from medical and nursing staff.During the first 24 hours after surgery recorded pain levels were 60% of the maximum and were not influenced by age, sex, or the type of operation performed. The median interval between the return of pain and a further injection of analgesic was 2 hours (interquartile range 1 to 3.5 hours). Expectations of pain relief were low, and for 70% of the patients the pain was at least as bad as they had expected. Only half of the medical and nursing staff questioned thought that postoperative analgesia should relieve pain completely; drugs were prescribed and administered with too little attention to the patient's response and too much concern about adverse effects and opioid dependence.The results suggest that the standard of postoperative pain relief is poor because of inadequate education of patients in what to expect (and demand), and of medical and nursing staff in how to prescribe and administer analgesia with reference to individual drug response.
THE ABSENCE OF STATIN TREATMENT IS ASSOCIATED WITH AN INCREASED RISK FOR EARLY DEVELOPMENT OF NEW-ONSET DIABETES IN THE EARLY STAGES OF HYPERTENSION: A 6-YEAR FOLLOW-UP STUDY
Authors: E. Andrikou, K. Tsioufis, C. Thomopoulos, D. Tsiachris, I. Andrikou, D. Flessas, A. Kordalis, S. Kyvelou, D. Tousoulis, C. Stefanadis
Journal: Journal of the American College of Cardiology (2011)
Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial
Authors: D. Griffin, N. Parsons, E. Shaw, Y. Kulikov, C. Hutchinson, M. Thorogood, S. E. Lamb
Journal: BMJ (2014)

<b>Objective</b> To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. <b>Design</b> Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). <b>Setting</b> 22 tertiary referral hospitals, United Kingdom. <b>Participants</b> 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. <b>Main outcome measures</b> The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. <b>Results</b> 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group <i>v</i> 65.7 in non-operative group; adjusted 95% confidence interval of difference −7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). <b>Conclusions</b> Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures. <b>Trial registration </b>Current Controlled Trials ISRCTN37188541.
Live and laugh: a journey through motor neurone disease
Authors: Felicia Davis, Julian Verbov
Journal: Journal of the Royal Society of Medicine (2010)

It was the neurologist who first suggested that I write about my life with motor neurone disease (MND). Other medical professionals, friends and family agreed. I started to believe I could, but in the back of my mind was the thought they were just humouring me. After all, when you have a degenerative disease like MND, everyone is more than nice to you. How I long to go back to people treating me as they did before. I forget I cannot speak now, although my brain still appears to work in the same way it always did.
Two Ounces of Potassae Nitras Taken in Mistake for Epsom Salts
Authors: Wm. Gillard
Journal: BMJ (1846)

slowly yielded to the application of two large issues orer the epigastrium, and the use of catechu internally.Finally, in some patients, the disease chiefly shewved itself in the middle or lower portions of the digestive tube; in these, the appetite was not affected, the tongue scarcely furred, the epigastrium free from pain, but digestion was accompanied with colic, secretion of foetid gases, and irregularity in the action of the bowels.Several cases of serous diarrhoea without symptoms of inflammation occurred in children, and yielded to the use of quinine and animal diet.
Moving the research agenda to where it matters
Authors: D. Kernick, J. Stead, M. Dixon
Journal: BMJ (1999)

Ninety per cent of healthcare contacts take place in primary care, and the importance of undertaking research in this setting is well recognised.1 2 Primary care research is not new but has evolved around university departments of general practice. Here, academics work within a fixed hierarchical structure—which may inhibit flexibility and innovation. Funding spirals, assessment exercises, and internal politics often divorce research practitioners from their service commitments and there remains a dissonance between the view of the world of those who guide decision making in health care and those who commission and provide it.

General practitioners are reluctant to follow evidence based guidelines3; health economists continue to develop technical solutions that are inaccessible and unacceptable to end users4; university academics remain trapped in a paradigm of hypothesis generation, experimental design, and interpretation of data as they seek to make reality fit their disciplinary matrices. Although research general practices and research practice networks have evolved to foster research that …
Diabetic Ácidosis
Authors: Reed Harwood
Journal: New England Journal of Medicine (1951)

A REVIEW of the results of treatment of diabetic coma on the Medical Service at the Massachusetts General Hospital in the pre-insulin era shows that the mortality rate was close to 100 per cent. In the period from January, 1942, to November, 1944, there was a mortality of 20 per cent in a series of 35 severe and moderately severe cases of diabetic acidosis. This drop in mortality in the twenty years following the discovery of insulin represents a tremendous improvement. However, such a mortality in any acute illness constitutes a serious challenge. At that time we had tended to . . .
Flow‐cytometric analysis of peripheral blood neutrophils: A simple, objective, independent and potentially clinically useful assay to facilitate the diagnosis of myelodysplastic syndromes
Authors: Sindhu Cherian, Jonni Moore, Andrew Bantly, Jo‐Anne Vergilio, Peter Klein, Selina Luger, Adam Bagg
Journal: American Journal of Hematology (2005)

Abstract The diagnosis of myelodysplastic syndromes (MDS) is based upon cytopenias, morphologic dysplasia, and cytogenetic abnormalities. Because morphologic dyspoiesis may be subtle, and many cases have normal cytogenetics, additional objective diagnostic tools are needed. We previously developed a novel peripheral blood neutrophil flow‐cytometric (FCM) scoring system to identify patients with MDS. Here, in an analysis of 25 patients, we demonstrate that FCM abnormalities are independent of currently measured parameters in MDS, including cytopenias, marrow blast percent, and IPSS score. Importantly, FCM abnormalities were seen in 9/16 MDS patients with normal cytogenetics, suggesting that this simple, non‐invasive assay could play a central role in the diagnosis of MDS. Am. J. Hematol. 79:243–245, 2005. © 2005 Wiley‐Liss, Inc.
Injection immunotherapy. British Society for Allergy and Clinical Immunology Working Party.
Authors: A J Frew
Journal: BMJ (1993)

A working party of the British Society for Allergy and Clinical Immunology has reviewed the role of specific allergen immunotherapy in the treatment of allergic disease and produced a position statement summarising the available evidence for efficacy and safety. The working party recommends specific allergen immunotherapy for treating summer hay fever uncontrolled by conventional medication and for wasp and bee venom hypersensitivity. It is not recommended for asthma or for allergic rhinitis due to other allergens. For the recommended indications the risk:benefit ratio is acceptable provided patients are carefully selected; in particular, patients with asthma should be excluded as they are especially vulnerable to adverse reactions. Injections should be given only by doctors experiences in this form of treatment in a clinic where full resuscitative facilities are immediately available. Provided patients remain symptom free a 60 minute observation period after injection is sufficient to detect all serious adverse reactions.
Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings.
Authors: P N Casale, R B Devereux, D R Alonso, E Campo, P Kligfield
Journal: Circulation (1987)

In a previous study of 543 patients we developed, using echocardiographic left ventricular mass as the reference standard, two new sets of criteria that improve the electrocardiographic diagnosis of left ventricular hypertrophy (LVH). One set of criteria, which is suitable for routine clinical use, detects LVH when the sum of voltage in RaVL + SV3 (Cornell voltage) exceeds 2.8 mV in men and 2.0 mV in women. The second set of criteria, suitable for use in interpretation of the computerized electrocardiogram, uses logistic regression models based on electrocardiographic and demographic variables with independent predictive value for LVH, with separate equations for patients in sinus rhythm and atrial fibrillation. To test these criteria prospectively with use of a different reference standard, antemortem electrocardiograms were compared with left ventricular muscle mass measured at autopsy in 135 patients. Sensitivity of standard Sokolow-Lyon voltage (SLV) criteria (SV1 + RV5 or RV6 greater than 3.5 mV) for LVH was only 22%, but specificity was 100%. The Cornell voltage criteria improved sensitivity to 42%, while maintaining high specificity at 96%. Higher sensitivity (62%) was achieved by use of the new regression criteria, with a specificity of 92%. Overall test accuracy was 60% for SLV criteria, 68% for the Cornell voltage criteria, and 77% for the new regression criteria (p less than .005 vs SLV). We conclude that the Cornell voltage criteria improve the sensitivity of the electrocardiogram for detection of LVH and are easily applicable in clinical practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Studies on N5-methyltetrahydrofolate-homocystein methyltransferase in normal and leukemia leukocytes.
Authors: R Peytremann, J Thorndike, W S Beck
Journal: Journal of Clinical Investigation (1975)

A cobalamin-dependent N5-methyltetra-hydrofolate-homocysteine methyltransferase (methyl-transferase) was demonstrated in unfractioned extracts of human normal and leukemia leukocytes. Activity was substantially reduced in the absence of an added cobalamin derivative. Presumably, this residual activity reflects the endogeneous level of holoenzyme. Enzyme activity was notably higher in lymphoid cells than in myeloid cells. Thus, mean specific activities (+/-SD) were: chronic lymphocytic leukemia lymphocytes, 2.15+/-1.16; normal lymphocytes, 0.91+/-0.59; normal mature granulocytes, 0.15+/-0.10; chronic myelocytic leukemia granulocytes, barely detectable activity. Properties of leukocytes enzymes resembled those of methyltransferases previously studied in bacteria and other animal cells. Granulocytes and chronic myelocytic leukemia cells contain a factor or factors that inhibits Escherichia coli enzyme. The data suggest that the prominence of this cobalamin-dependent enzyme in lymphocytes and other mononuclear cell types may be related to their potential for cell division.
Cesarean Section-Reply
Authors: David N. Danforth
Journal: JAMA (1985)

<h3>In Reply.—</h3> The ACOG guidelines are not intended to be restrictive; their purpose is to emphasize the practices that can be expected to provide the most favorable outcomes. However, the mere fact of a previous cesarean section places the woman in a risk category requiring the kind of surveillance and readiness that are simply not available in a 55-bed hospital that has no blood bank, no anesthesiologist, no obstetrician, and no 24hour obstetric nursing coverage. Under these circumstances, a planned trial of labor for women with a previous cesarean section is not appropriate. It is agreed that prophylactic antibiotics are not indicated for cesarean section patients unless they are at risk of infection. Also, it appears to be the consensus that for those who are at risk, both aerobic and anaerobic coverage is needed. Cefazolin, which is clearly superior to placebo, is primarily an antiaerobic antibiotic. In the review, cefoxitin
Commentary: Genes for osteoarthritis: interpreting twin data
Authors: J. Hopper
Journal: BMJ (1996)

components by comparing the similarity within each pair between zygosities.Intraclass correlation coefficients (r) were used as a measure of similarity.One way analysis of variance was used to partition the total variation of osteo- arthritis into between pair (B) and within pair (W) variations.The estimate of r is given by the difference between B and W over their sum-that is, (B-W)/(B+W) where the approximate SE=I(1 -r)2(1 +r)2/(n-1) (where r=intraclass correlation, n=number of pairs).A path maximum likelihood (PATH-ML) method was used to estimate the genetic effect.The variances-covariances are expressed as a function of four main effects: additive genetic (A), dominant genetic (D), common environment (C), and specific environment for an individual, including measurement error (E).There was no evidence of a dominant effect and the models tested were, firstly, yij = +Aij+Cij+Eij, secondly, yij = p+Aj+Eij, thirdly, yij=,u+Cij+Eij (i=family cluster; j=individual within family).There was no significant improvement of the first over the second, suggesting no significant effect of C. The AE model was therefore tested against E to obtain a level of significance with the goodness offit likelihood ratio statistic.
Plastic isolators for treatment of acute leukaemia patients under "germ-free" conditions.
Authors: P C Trexler, A S Spiers, H Gaya
Journal: BMJ (1975)

A gnotobiotic isolation system based on those developed in veterinary research has been constructed for hospital use. Fifteen patients with leukaemia and neutropenia spent a total of 110 weeks in plastic isolators, and none acquired any infection. Endogenous flora was effectively suppressed by topical antiseptics and gastrointestinal decontamination effected with nonabsorbable antibiotics. The isolator system was acceptable to patients and staff and much cheaper than the use of sterile rooms. Other advantages of the system are portability, easy storage, and use on ordinary open wards without prejudice to the microbiological protection afforded. It is as yet uncertain whether protective environments of this type will substantially improve the outcome of treatment for the acute leukaemias.
Histiocytosis
Authors: Faris J. Azoury, Richard J. Reed
Journal: New England Journal of Medicine (1966)

HISTIOCYTIC proliferations may result from errors of metabolism, as exemplified by Gaucher's or Niemann–Pick disease; they may appear as primary, apparently neoplastic proliferations, such as histiocytosis X,1 or as localized visceral or cutaneous tumors, which are generally benign,2 or they may be associated with diseases characterized by abnormal responses to infection, such as those reported by Landing and Shirkey.3 The present report describes an unusual form of histiocytosis manifested clinically by testicular enlargement, severe lymphadenopathy, transient hepatomegaly, hypergammaglobulinemia, recurrent infections and rheumatoid arthritis. The clinical and histologic manifestations do not correspond to any previously recognized variants of histiocytosis.Case Report . . .
Different hematologic phenotypes are associated with the leftward (-alpha 4.2) and rightward (-alpha 3.7) alpha+-thalassemia deletions.
Authors: D K Bowden, A V Hill, D R Higgs, S J Oppenheimer, D J Weatherall, J B Clegg
Journal: Journal of Clinical Investigation (1987)

We have compared the phenotypes of the two common deletion forms of alpha+-thalassemia by analysis of umbilical cord blood samples from Melanesia. Homozygotes for the leftward, 4.2-kilobase, deletion (-alpha 4.2) had significantly higher levels of Hb Bart's at birth than homozygotes for the rightward, 3.7-kilobase, deletion (-alpha 3.7). Compound heterozygotes for each deletion had intermediate values. Although deletion forms of alpha 0 thalassemia were not found in this survey, nondeletion alpha-thalassemia was present at low frequency. Since the predominant rightward deletion in this population, -alpha 3.7III, entirely removes the alpha 1-gene and the 4.2-kilobase deletion deletes the alpha 2-gene, these data indicate that the alpha 2-globin gene has a higher output than the alpha 1-gene, on single alpha-gene chromosomes.
Doctors and politicians must unite in public health messages on Ebola, says expert
Authors: Z. Kmietowicz
Journal: BMJ (2014)

The UK doctor who is leading efforts to control the outbreak of Ebola virus disease in west Africa and to ensure that the NHS is ready to deal with cases that might emerge in the United Kingdom has called for doctors and politicians to be consistent in their messages to the public.

Brian McCloskey, director of global health for Public Health England and currently working in Geneva to help coordinate the global response to the crisis, said that the right balance of public health and politics had not been found across the globe. He was referring to the move by the Australian government to withhold visas for people from the affected countries in west Africa and the decision by some US states to require health staff who had had contact with people infected with the …
Premonitory Hypercalcemia in Leukemia
Authors: DAVID STEINBERG
Journal: Annals of Internal Medicine (1972)

Letters, Comments, and Corrections1 April 1972Premonitory Hypercalcemia in LeukemiaDAVID STEINBERG, M.D.DAVID STEINBERG, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-4-670_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: To his compilation of "Premonitory Signs for an Impending Blastic Crisis" in chronic myelocytic leukemia, Dr. Theologides [Ann Intern Med76:95-99, 1972] might add hypercalcemia. This complication has been seen in chronic myelocytic leukemia with multiple skeletal myeloblastomas (1) and can herald frank blastic transformation....Reference1. STEINBERGOSOFSKYRUBIN DMA: Acute phase of chronic granulocytic leukemia. Onset signaled by hypercalcemia and multiple osteolytic lesions. N Y State J Med 71:583-586, 1971 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDisorders of Mineral Metabolism in Malignancy 1 April 1972Volume 76, Issue 4Page: 670-671KeywordsChronic myelocytic leukemiaHypercalcemia Issue Published: 1 April 1972 PDF DownloadLoading ...
Low-dose combination chemotherapy for acute myeloid leukemia in elderly patients: A novel approach
Authors: Arumugam Manoharan, Ross I. Baker, Peter W. Kyle
Journal: American Journal of Hematology (1997)

Eighteen patients aged 60-84 years with acute myeloid leukemia were treated with low-dose combination chemotherapy comprising cytarabine, etoposide, and mitozantrone or 6-thioguanine; seven of these patients had a pre-existing myelodysplastic syndrome. Nine patients achieved a complete remission, and five had a partial remission. The duration of survival in these 14 responding patients has ranged from 2+ to 19+ months. Myelotoxicity occurred regularly, with time to recovery (neutrophils ≥0.5 × 109/L, platelets ≥50 × 109/L) from nadir being 10-14 days in 12 of the 14 patients. This novel approach with an overall response rate of 78% appears to be a simple and effective form of therapy for elderly patients. Am. J. Hematol. 55:115-117, 1997. © 1997 Wiley-Liss, Inc.
Desialylated sex hormone-binding globulin (D-SHBG) in chronic liver diseases: a possible vector of sex steroids in hepatocytes
Authors: L. Rakotomalala, M. Pontet, N. Ganne-Carrié, J. Vaysse, C. Christidis, JC. Trinchet, M. Beaugrand
Journal: Journal of Hepatology (1998)
Liver Function Tests and Esophageal Hemorrhage
Authors: Paul Davidson
Journal: JAMA (1968)

ABSTRACT To the Editor:— In Sulfobromophthalein (202:979, 1967) Dr. Charm states that  results from a sodium sulfobromophthalein test (BSP) effectively rule out varices [esophageal] as a source of bleeding [upper gastrointestinal]. The BSP and other liver function tests, however, may be normal in hemorrhage from esophageal varices secondary to extrahepatic portal venous block, eg, acquired portal venous thrombosis.