tbuckley/cabot-search huggingface dataset:
PTH-132 Iron Deficiency Anaemia Nurse Led Clinic: Audit of 1st Year
Authors: C Daker, H McAuley, I Mason, T Shepherd, M Hamilton, O Epstein, C Murray
Journal: Gut (2013)

<h3>Introduction</h3> Iron deficiency anaemia accounts for 4–13% of gastrointestinal referrals occurring in 2–5% of adult men and post menopausal women. Current guidelines suggest that the work up of asymptomatic anaemia remains incomplete and often inappropriate with important diagnoses of malignancy and malabsorption being missed. In an effort to improve our handling of these patients from primary care and reconfigure services, a nurse led clinic was established in 2009 with the aim to provide rapid access to appropriate investigations and management. <h3>Methods</h3> All clinic patients between 01/06/2009–05/07/2010 were included in the study. Patients were triaged into the clinic via the GP referral letter. End points examined were:patient demographics, anaemia, microcytosis and iron deficiency, whether oral iron preparations were being used, investigations (OGD/colonoscopy), wait times for investigations and pathology identified. Data were collected using patient notes, pathology results database, clinic letters and endoscopy reports. Anaemia was classified as an Hb of &lt; 11.5g/dL. <h3>Results</h3> 110 patients were included (no exclusions); 81 female and 29 male (73.6%,43.2%).Age range 21 –90yrs, mean 57yrs, median 58yrs.62% were made up of men (29) and post-menopausal women (47); 33%(13) menstruating females with GI symptoms and 46%(21) menstruating females without GI symptoms.62% were in receipt of oral iron supplementation at referral.66% of referrals included the blood results revealing 92% anaemic; 54% microcytic; 50% iron deficient. This compared to 68% of patients anaemic bled in the clinic of whom 20% were not anaemic but on iron supplementation leaving 12% neither anaemic nor on iron supplements. Of those not on iron (42 –13men,29 women)21% had renal disease (GRF &lt; 60),12(29%) were iron deficient,10(24%)were iron deficient and anaemic.A total of 61 patients underwent endoscopic investigation (47post menopausal and male group; 6 menstruating females with GI symptoms and 8 menstruating females without GI symptoms).We identified 4 mailgnancies; 3 polyps,3 colitics,9 upper Gi pathologies (GAVE, varices, ulcers, small bowel Crohns),2 with Helicobacter pylori infection and 5 with celiac disease.12 had gynaecological causes,2 renal causes.46 resolved on oral iron and 8 needed parentral iron infusions. Mean time from clinic to investigation was 9.5 weeks (SD 14.8) and median 4.86 weeks. <h3>Conclusion</h3> Of the cohort a total of 55%(61) underwent endoscopy with an overt GI pathology yield (deemed causative for the anaemia) in 26(42%).The nurse led clinic has facilitated a decreased waiting time to appropriate test so improving patient outcomes in terms patient satisfaction, time to diagnosis and management strategy implementation, decreased clinic and investigation waiting times, reduced pressure on physicians lists and most importantly morbidity and mortality. <h3>Disclosure of Interest</h3> None Declared.
Medical Experiences with American Troops in the Pacific
Authors: Harold D. Levine
Journal: New England Journal of Medicine (1946)

THIS report is based on patients seen during two years at a large United States Army general hospital in the rich Lockyer River Valley of southern Queensland, seventy miles west of Brisbane, Australia, and during a year and a half of service with another general hospital located first at Lae, on the Huon Gulf in northeastern New Guinea, and later at San Fernando, at the upper extremity of the Lingayen Gulf, Province of La Union, on the Island of Luzon, in the Philippines. Many of the observations made were new to us as individuals; others, to the best of my . . .
Structure-activity relationships of heparin. Independence of heparin charge density and antithrombin-binding domains in thrombin inhibition by antithrombin and heparin cofactor II.
Authors: R E Hurst, M C Poon, M J Griffith
Journal: Journal of Clinical Investigation (1983)

To better understand how heparin structure affects its activity the relationships between the functional domains for inhibitor binding and charge density were investigated to determine how these domains affect heparin-mediated thrombin inhibition by two different heparin-dependent protease inhibitors, antithrombin (AT) and heparin cofactor II (HC II). A series of heparins, fractionated systematically by charge density, was further fractionated on antithrombin agarose to isolate more homogeneous subfractions that were either inactive or highly active with respect to thrombin inhibition by AT. With AT, the activities of the AT-active subfractions increased sharply with heparin charge density, while those with little or no affinity for AT were virtually inactive. In contrast, with HC II inhibitor, the activities of the heparins depended only upon their charge densities and were independent of AT affinity. At any given charge density, the heparin before fractionation by AT affinity and the fractions that were highly active and inactive with AT were all equally active with HC II. The two inhibitors also differed in their reactivity with heparan sulfate and dermatan sulfate. A charge-density effect with the subfractions having similar high affinity for AT demonstrates that charge density represents a heparin functional domain that is independent of the AT-binding domain. The behavior of the AT-inactive heparins, being fully active with HC II, demonstrates the functional domain necessary for AT binding is not needed to produce HC II activity.
CICATRIZATION OF WOUNDS
Authors: A. Vincent
Journal: The Journal of Experimental Medicine (1917)

Of twenty infected cases treated with Dakin's solution or chloramine paste, seven were bacteriologically sterile. This proves that, in general, 35 per cent of the cases thus treated become bacteriologically aseptic. This degree of asepsis is not necessary in order to suture the wound, the absence of bacteria in films being sufficient. Complete sterilization of wounds, can, therefore, now be accomplished.
Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder
Authors: David H. Barlow, Jack M. Gorman, M. Katherine Shear, Scott W. Woods
Journal: JAMA (2000)

ContextPanic disorder (PD) may be treated with drugs, psychosocial intervention, or both, but the relative and combined efficacies have not been evaluated in an unbiased fashion.ObjectiveTo evaluate whether drug and psychosocial therapies for PD are each more effective than placebo, whether one treatment is more effective than the other, and whether combined therapy is more effective than either therapy alone.Design and SettingRandomized, double-blind, placebo-controlled clinical trial conducted in 4 anxiety research clinics from May 1991 to April 1998.PatientsA total of 312 patients with PD were included in the analysis.InterventionsPatients were randomly assigned to receive imipramine, up to 300 mg/d, only (n=83); cognitive-behavioral therapy (CBT) only (n=77); placebo only (n=24); CBT plus imipramine (n=65); or CBT plus placebo (n=63). Patients were treated weekly for 3 months (acute phase); responders were then seen monthly for 6 months (maintenance phase) and then followed up for 6 months after treatment discontinuation.Main Outcome MeasuresTreatment response based on the Panic Disorder Severity Scale (PDSS) and the Clinical Global Impression Scale (CGI) by treatment group.ResultsBoth imipramine and CBT were significantly superior to placebo for the acute treatment phase as assessed by the PDSS (response rates for the intent-to-treat [ITT] analysis, 45.8%, 48.7%, and 21.7%; P=.05 and P=.03, respectively), but were not significantly different for the CGI (48.2%, 53.9%, and 37.5%, respectively). After 6 months of maintenance, imipramine and CBT were significantly more effective than placebo for both the PDSS (response rates, 37.8%, 39.5%, and 13.0%, respectively; P=.02 for both) and the CGI (37.8%, 42.1%, and 13.0%, respectively). Among responders, imipramine produced a response of higher quality. The acute response rate for the combined treatment was 60.3% for the PDSS and 64.1% for the CGI; neither was significantly different from the other groups. The 6-month maintenance response rate for combined therapy was 57.1% for the PDSS (P=.04 vs CBT alone and P=.03 vs imipramine alone) and 56.3% for the CGI (P=.03 vs imipramine alone), but not significantly better than CBT plus placebo in either analysis. Six months after treatment discontinuation, in the ITT analysis CGI response rates were 41.0% for CBT plus placebo, 31.9% for CBT alone, 19.7% for imipramine alone, 13% for placebo, and 26.3% for CBT combined with imipramine.ConclusionsCombining imipramine and CBT appeared to confer limited advantage acutely but more substantial advantage by the end of maintenance. Each treatment worked well immediately following treatment and during maintenance; CBT appeared durable in follow-up.
A conserved microRNA module exerts homeotic control over Petunia hybrida and Antirrhinum majus floral organ identity
Authors: Maria Cartolano, Rosa Castillo, Nadia Efremova, Markus Kuckenberg, Jan Zethof, Tom Gerats, Zsuzsanna Schwarz-Sommer, Michiel Vandenbussche
Journal: Nature Genetics (2007)
Depression, suicide, and the national service framework
Authors: S. Davies
Journal: BMJ (2001)

The National Service Framework for Mental Health1 seeks to cut the suicide rate by a further fifth from Health of the Nation targets. Standard 7, preventing suicide, advises about health promotion and improved services, including assessment and treatment of depression in primary care and assessing risk among individuals at greatest risk. Will these improvements deliver results? Are there other more promising strategies?

It is widely assumed that early and accurate identification of depressive episodes will reduce suicides. This follows from a belief that suicide is a common adverse outcome in depressive disorders: a 15% lifetime risk is often cited. However, clinical experience and population based studies challenge this view. Every week 10% of the UK population aged 16–65 report significant depressive symptoms, and one in 10 of these admits to suicidal thinking.2 But fewer than two people in a million will kill themselves. A typical primary care group of 100 000 expects 10 suicides a year.1 …
Chitotriosidase is the primary active chitinase in the human lung and is modulated by genotype and smoking habit
Authors: Max A. Seibold, Samantha Donnelly, Margaret Solon, Anh Innes, Prescott G. Woodruff, Rolf G. Boot, Esteban González Burchard, John V. Fahy
Journal: Journal of Allergy and Clinical Immunology (2008)
Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid Diseases
Authors: Cynthia M. Boyd, Jonathan Darer, Chad Boult, Linda P. Fried, Lisa Boult, Albert W. Wu
Journal: JAMA (2005)

Clinical practice guidelines (CPGs) have been developed to improve the quality of health care for many chronic conditions. Pay-for-performance initiatives assess physician adherence to interventions that may reflect CPG recommendations.To evaluate the applicability of CPGs to the care of older individuals with several comorbid diseases.The National Health Interview Survey and a nationally representative sample of Medicare beneficiaries (to identify the most prevalent chronic diseases in this population); the National Guideline Clearinghouse (for locating evidence-based CPGs for each chronic disease).Of the 15 most common chronic diseases, we selected hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis, which are usually managed in primary care, choosing CPGs promulgated by national and international medical organizations for each.Two investigators independently assessed whether each CPG addressed older patients with multiple comorbid diseases, goals of treatment, interactions between recommendations, burden to patients and caregivers, patient preferences, life expectancy, and quality of life. Differences were resolved by consensus. For a hypothetical 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis, we aggregated the recommendations from the relevant CPGs.Most CPGs did not modify or discuss the applicability of their recommendations for older patients with multiple comorbidities. Most also did not comment on burden, short- and long-term goals, and the quality of the underlying scientific evidence, nor give guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, the hypothetical patient would be prescribed 12 medications (costing her 406 dollars per month) and a complicated nonpharmacological regimen. Adverse interactions between drugs and diseases could result.This review suggests that adhering to current CPGs in caring for an older person with several comorbidities may have undesirable effects. Basing standards for quality of care and pay for performance on existing CPGs could lead to inappropriate judgment of the care provided to older individuals with complex comorbidities and could create perverse incentives that emphasize the wrong aspects of care for this population and diminish the quality of their care. Developing measures of the quality of the care needed by older patients with complex comorbidities is critical to improving their care.
A Pill Turned into a Foreign Body in a Patient in a Hurry
Authors: M. Tuncer, Y. Erzin, A. F. Celik, U. Korman, N. Mandel, E. Oktay
Journal: Endoscopy (2001)

Figure 1A 55-year-old woman was referred to our endoscopy unit with a 1-month history of continuous retrosternal pain, dysphagia, and odynophagia located in the upper half of the esophagus. She had been suf- fering from these symptoms after swallowing three pills at once because of a troublesome headache. As she was in a hurry, she did not notice that one of them was still in its plastic cover. On barium meal examination, the pill was seen as a sharply radiolucent, round, filling defect (indicated by black arrowhead) in the upper thoracic esophagus. It was removed by endoscopy.
Soundings: The history of box ticking
Authors: James Owen Drife
Journal: BMJ (2006)

No one knows when or where the first human being ticked the first box. The word “tick” does not appear in the Bible. Archaeologists have found no traces of boxes—ticked, crossed, or otherwise—in Egyptian papyruses, French caves, or Asian temples. Someone has even proposed the highly implausible theory that in the past great civilisations flourished without questionnaires.

Aerial photography in Peru, however, has revealed regular rows of box like shapes covering an area of several square miles and headed by pre-Inca glyphs for the sun (“Yes”), the moon (“No”), and a cloud (“Don't know”). Yet none of these boxes appears to have been ticked, leading some to suggest that this is the first recorded example of a non-responder.

The modern questionnaire was developed in the 19th century by psychologists studying small children who could not read or write. By the end of the 20th century questionnaires were widely used in Britain to monitor the medical profession. Logical as this progression seems to us now, it was not without controversy.

Early in the 21st century there was a wave of early retirement among British medical teachers. They complained that no matter how inspiring their teaching, students always reacted by asking them to tick a box in a logbook. Older teachers grumbled that assessment of the infinitely subtle art of medicine had been reduced to computerised sudoku.

In 2012 the Third International Congress on Medical Box-Ticking achieved the remarkable feat of agreeing a single generic form for all medical questionnaires—psychosocial research, undergraduate and postgraduate training, peer review, and performance feedback from colleagues, patients, patients' relatives, and managers.

This proved to be box ticking's high-water mark. A backlash developed among lay people, who initially expressed discontent by ticking all the middle boxes, regardless of the questions. Resistance then crystallised into a global movement called “Stick Your Boxes” (“SYB”—or, in some countries, “SYBB”), demanding more free space for comments. Questionnaires slowly evolved into blank sheets and became extinct because nobody could be bothered to read them.
Dynamical systems and mating decision rules
Authors: Douglas T. Kenrick, Norman Li, Jonathan E. Butner
Journal: Behavioral and Brain Sciences (2000)

Dynamical simulations of male and female mating strategies illustrate how traits such as restrictedness constrain, and are constrained by, local ecology. Such traits cannot be defined solely by genotype or by phenotype, but are better considered as decision rules gauged to ecological inputs. Gangestad &amp; Simpson's work draws attention to the need for additional bridges between evolutionary psychology and dynamical systems theory.
Multiphoton imaging reveals a new leukocyte recruitment paradigm in the glomerulus
Authors: Sapna Devi, Anqi Li, Clare L V Westhorpe, Camden Y Lo, Latasha D Abeynaike, Sarah L Snelgrove, Pam Hall, Joshua D Ooi, Christopher G Sobey, A Richard Kitching, Michael J Hickey
Journal: Nature Medicine (2012)
Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation.
Authors: K L Richards, S R Cannon, J F Miller, M H Crawford
Journal: Circulation (1986)

The continuity equation suggests that a ratio of velocities at two different cardiac valves is inversely proportional to the ratio of cross-sectional areas of the valves. To determine whether a ratio of mitral/aortic valve orifice velocities is useful in determining aortic valve area in patients with aortic stenosis, 10 control subjects and 22 patients with predominant aortic stenosis were examined by Doppler echocardiography. The ratio of (mean diastolic mitral velocity)/(mean systolic aortic velocity), (Vm)/(Va), and the ratio of (mitral diastolic velocity-time integral)/(aortic systolic velocity-time integral), (VTm)/(VTa), were determined from Doppler spectral recordings. Aortic valve area determined at catheterization by the Gorlin equation was the standard of reference. High-quality Doppler recordings were obtained in 30 of 32 subjects (94%). Catheterization documented valve areas of 0.5 to 2.6 (mean 1.1) cm2. There was good correlation between Doppler-determined (Vm)/(Va) and Gorlin valve area (r = .90, SEE = 0.23 cm2); a better correlation was noted between (VTm)/(VTa) and Gorlin valve area (r = .93, SEE = 0.18 cm2). The data demonstrate the usefulness of Doppler alone in the determination of aortic valve area in adults with absent or mild aortic or mitral regurgitation and no mitral stenosis. Although the use of mean velocity and velocity-time integral ratios requires accurate measurement of mitral and aortic velocities, it does not require squaring of these velocities or measurement of the cross-sectional area of flow.
Healthcare Commission slams proposed merger with two other NHS inspectorates
Authors: Rebecca Coombes
Journal: BMJ (2008)

An “unnecessary” £140m (€184m; $274m) shake-up of healthcare regulation in England will threaten patient safety, the chairman of the NHS healthcare inspectorate told MPs last week.

Professor Sir Ian Kennedy, who chairs the Healthcare Commission, said that merging his organisation with the social care and mental health inspectorates in a “bonfire of the regulators” was a hugely misjudged plan that would dent confidence in regulation among patients, clinicians, and NHS leaders.

In his speech to the Labour Party conference last year, Prime Minister Gordon Brown said that a stronger …
Cutaneous Hypersensitivity to Sporotrichin in Louisiana
Authors: John D. Schneidau, Lucius M. Lamar, Melvin A. Hairston
Journal: JAMA (1964)

Cutaneous sensitivity to sporotrichin antigen was tested in 383 people without any previous history of overt sporotrichosis. Positive reactions were observed in 11.2% of 349 prison inmates and hospital ward patients, and in 32.3% of 34 nursery employees. Considering only those nursery workers employed for more than ten years, the incidence of positive reactors rose to 58.3%. There was no significant correlation between reactions to the sporotrichin antigen and reactions to other fungal antigens. These findings suggest that infection with<i>Sporotrichum schenckii</i>is probably more common than previously suspected, and that a direct relationship exists between the incidence of infection and prolonged opportunity for contact with the infecting agent.
P1282 A COST–CONSEQUENCE ANALYSIS OF SCREENING AND TREATMENT FOR CHRONIC HEPATITIS B (CHB) VIRUS INFECTION IN RESIDENT IMMIGRANTS OF AN ITALIAN NORTH-EAST REGION
Authors: E. Rosa-Rizzotto, A. Buja, D. Martines, A. Vinelli, G. Bardelle, S. Lopatriello, L. Peraro, L. Scribano, D. Caroli, F. De Lazzari, S. Lobello, V. Baldo
Journal: Journal of Hepatology (2014)
The Increasing Representativeness of AMA Leaders
Authors: George D. Lundberg
Journal: JAMA (1990)

Remarkable changes are occurring as the American Medical Association (AMA) continues to rid itself of its image of a stodgy, ultraconservative defender of the status quo. The recent election of officers and trustees has provided a more balanced representation of actual members (and American physicians) than ever before. Once largely the domain of white, private practice male physicians (and especially surgeons), the current 19 officers and trustees include 7 family/general practitioners, 5 internists, 2 pathologists, 1 diagnostic radiologist, 4 women, 1 black man, 1 resident, 1 medical student, 1 international medical graduate (IMG) from Italy, and 2 medical administrators. Surgeons are not left out——there are three—and the new Executive Vice President, James S. Todd, MD, is a surgeon. Officers and trustees are from all regions of the United States. The new President, C. John Tupper, MD, is a former highly successful dean of a medical school.<sup>1</sup> These changes at