tbuckley/cabot-search huggingface dataset:
P4-11-07: Feasibility and Acceptability of Offering Breast Cancer Risk Estimation in the Context of the UK National Health Service Breast Cancer Screening Programme: A New Paradigm for Cancer Prevention.
Authors: DGR Evans, S Astley, P Stavrinos, S Sahin, S Ingham, H McBurney, B Eckersley, M Wilson, U Beetles, M Harvie, R Warren, J Sergeant, A Hufton, J Warwick, W Newman, I Buchan, J Cuzick, A Howell
Journal: Cancer Research (2011)

Abstract Background: Currently there are no real attempts internationally to tailor breast screening programmes to individual risk Methods: We have assessed the feasibility of collecting breast cancer risk information during routine mammographic screening in the National Health Service Breast Screening Programme (NHSBSP) in England, in order to consider, ultimately, adapting the screening interval to risk of breast cancer and introducing preventive strategies in women at high risk. The study Predicting Risk Of Cancer At Screening (PROCAS) aims to recruit 60,000 women over 3 years. Results: 26,000 women (June 8th 2011) have so far given consent to join the study. Thirty six percent of the first 20,000 women in nineteen screening sites in Manchester consented to enter the study and completed a risk factor questionnaire. The median 10 year breast cancer risk was 2.65%, with 926 (9.26%) of the first 10,000 women having a 10 year risk of ≥5% and 92 (0.92%) having a 10 year risk of ≥8% (Tyrer-Cuzick), IQR:1.35. 832 (8.32%) women had a mammographic density of 60% or greater (Visual Analogue Scale). We collected saliva samples from 1019 women for genetic analysis and will extend this to 18% of participants. Of those who agreed to participate in the study, 94% indicated that they wished to know their breast cancer risk. Women with a 10-year risk of ≥8%, and women with a 10-year risk of ≥5% and mammographic density ≥60% were invited to attend or be telephoned to be counselled. To date 138 have accepted with 135, so far, having received risk counselling. Nineteen percent of the high-risk women identified subsequently decided to enter a randomised breast cancer prevention study with either a dietary or drug intervention (IBIS2, anastrazole vs placebo). Results from the first 1,000 women who provided DNA samples suggest that the risk information from the 18 validated SNPS may enhance existing risk models. Conclusion: This study demonstrates that it is feasible to determine individual breast cancer risk and offer women appropriate risk-reducing interventions within the context of a population-based mammographic screening programme. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-07.
The Pathology of Peer Review
Authors: Gordon M. Greenblatt
Journal: JAMA (1971)

To the Editor.—  Peer  in medicine is not a recent event. Every hospital traditionally sponsocs review by staff committees, medical and hospital associations. In the recent emphasis by governmental agencies, in order to lower medical care costs, it should not be forgotten in haste that the healthy review committee must be kept free of pathogens. The obvious misuses of a review system have been kept to a minimum only by constant  and reliance on strict adherence to due process and the rights of the individual physician.  Review can be accomplished by a complaint system, or a vigilance system. In the first, a specific medical or ethical problem is referred to a committee. In the second, the committee constantly selects hospital charts and reviews hospital activities to discover possible transgressions. Both methods recognize that ( 1) professional jealousies exist, ( 2) self-importance and powerseeking are human traits, ( 3 ) personality conflicts abound,
Medicare's Nursing-Home Benefit: Variations in Interpretation
Authors: Helen L. Smits, Judith Feder, William Scanlon
Journal: New England Journal of Medicine (1982)

Abstract The use of skilled-nursing facilities by Medicare beneficiaries as measured in days of care per thousand elderly persons varies considerably from one state to another. To explore the possibility that this variation reflects differences in the administrative interpretation of rules governing coverage, we developed nine hypothetical cases and presented them by telephone to claims reviewers in fiscal intermediaries and professional standards review organizations. Cases were designed to illuminate the reviewers' use of discretion. We observed marked differences both in the reviewers' decisions to cover or not cover patients and in the reasoning behind their decisions. Three of the 18 reviewers decided to cover very few cases; almost half the reviewers decided to cover most of the cases, but not the same ones. In only two cases did the 18 reviewers approach consensus. This variation is a reflection of the complexity of Medicare's coverage rules and its decentralized administration. To reduce variation, we recommend more centralized review with oversight by Medicare's central office rather than by its 10 regional offices. This oversight should include the training of reviewers in a way that focuses on complex cases to improve the consistency of judgment. (N Engl J Med. 1982; 307: 855–62.)
On the Mortality of the Government Convict Prisons of England
Authors: J. D. Rendle
Journal: BMJ (1871)

THE accompanying tables arp designed for the purpose of giving a general idea of the mortality-rate of male andl female prisoners under sentence of penal servitude.The facts thereon recorded are gathered from materials which, in past years, have been collected yearly for future publication.Details, therefore, have been avoided ; but it is hoped that 'the evidlence conveyed in the following fiorms will prove that the [April 8, 1871."Iunworkecl mine" referred to in the BRITISH MEDICAL JOUaNAL, on the 24th December, has not been entirely neglected.The late Sir Joshua Jebb broke up "the hulks" towards the end of the year i856.Since then, all prisoners under sentence of penal servitude have been confined in prisons.In the Public Works Prisons the men work in the open air, but take their meals and sleep in separate cells.The first table gives the yearly mortality of the prisons since the abo- lition of "Ithe hulks," together with the number of deaths from each of the diseases mentioned.The number of insane cases yearly per 1,000 prisoners is also given.It ought to be stated that, of necessity, typhus and typhoid fevers are included in the column for " fever."Acute and chronic bronchitis and cancer are returned in the same way.The yearly reports from which I obtain my information, make no dis- Table L.Number of Deaths.Deaths per iooo Prisoners.
Alternate Routes of Insulin Delivery
Authors: Karl Irsigler, Harrald Kritz
Journal: Diabetes Care (1980)

The relative merits of intraperitoneal (i.p.) and subcutaneous (s.c.) insulin delivery compared with intravenous (i.v.) delivery were investigated in seven diabetic patients using a combination of glucosecontrolled closed-loop (Biostator) and portable open-loop (Siemens minipump) insulin infusion systems. With appropriate algorithms for feedback-controlled insulin infusion, it could be shown that each of the three approaches was able to achieve satisfactory blood glucose levels. After glucose challenge, i.p. administration required almost twice as much insulin and twice as much time as i.v. to return to normal blood glucose (BG) levels. When the insulin dosage profile determined with Biostator feedback control is transformed to a simpler program consisting of basal rate and rectangularly shaped supplementary profiles for the open-loop system, good control was achieved during observation periods of about 1 wk with both s.c. and i.p. delivery. Subcutaneous infusion with the minipump was also carried out for a period of 70 days in one patient on an outpatient basis. In this long-term study s.c. infusion was not superior to twice-daily s.c. injections with frequent monitoring of BG and self-adjustment of insulin dosage by the patient. The optimal method of delivery appeared to be i.v., with i.p. and s.c. in second and third place. Intraperitoneal delivery seems to be a viable alternative that might help to solve some problems in the development of implantable devices. Further investigations should be carried out.
WHO returns to Iraq to find major problems among 2.8 million internally displaced Iraqis
Authors: J. Zarocostas
Journal: BMJ (2008)

The World Health Organization announced on Thursday 17 July that in late June it had re-established, after a five year absence, a permanent international staff in Iraq to help the country meet urgent humanitarian needs and to strengthen its fragile healthcare system.

International personnel of United Nations agencies left Iraq after a suicide attack at the UN’s Iraq headquarters in Baghdad in August 2003 left 22 dead and 150 wounded.

“WHO will intensify its recovery and relief assistance to Iraq and help its people obtain the health care they deserve,” said Eric Laroche, WHO’s chief for health action in crises.

Two of the agency’s international staff recently went …
Small molecule RITA binds to p53, blocks p53–HDM-2 interaction and activates p53 function in tumors
Authors: Natalia Issaeva, Przemyslaw Bozko, Martin Enge, Marina Protopopova, Lisette G G C Verhoef, Maria Masucci, Aladdin Pramanik, Galina Selivanova
Journal: Nature Medicine (2004)
Estimation of the Glomerular Filtration Rate in Cancer Patients: A New Formula for New Drugs
Authors: Patrick T. Murray, Mark J. Ratain
Journal: Journal of Clinical Oncology (2003)

Article Tools EDITORIALS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2003.04.083 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12860937 Estimation of the Glomerular Filtration Rate in Cancer Patients: A New Formula for New Drugs Patrick T. MurrayxPatrick T. MurraySearch for articles by this author , Mark J. RatainxMark J. RatainSearch for articles by this author Show More University of Chicago, Chicago, IL https://doi.org/10.1200/JCO.2003.04.083 First Page Full Text PDF Figures and Tables © 2003 by American Society of Clinical Oncology
Moving house: a risk factor for the development of childhood asthma?
Authors: C H Hughes, J H Baumer
Journal: BMJ (1995)

Infornation from asthma patients indicates substantial continuing morbidity due to asthma * Despite rising prescribing of inhaled steroids there is still considerable room for more active treatment of asthma in general practice * Feedback of information collected systematically from patients with asthma does not influence the pattern of attendance, prescribing, or morbidity * As access to information increases, processes must be developed within which information can be used to augment strategies to bring about change
Malignant Lymphomas of Waldeyer's Ring: Natural History and Survival after Radiotherapy
Authors: A. Banfi, G. Bonadonna, S. B. Ricci, F. Milani, R. Molinari, S. Monfardini, R. Zucali
Journal: BMJ (1972)

The natural history of 292 consecutive cases of reticulum cell sarcoma and lymphosarcoma of Waldeyer's ring and the survival rate after radiotherapy are reported. In our institute since 1928 from 30 to 35% of pharyngeal neoplasms have been lymphomas, and of these 55% have been reticulum cell sarcomas, 21% lymphosarcomas, and 1% Hodgkin's disease. This high incidence may probably be ascribed to the fact that in all malignant lymphomas, irrespective of the clinical presentation, a systematic biopsy of the whole Waldeyer's ring was carried out. Pharyngeal lymphomas were confined to Waldeyer's ring in 19.6% of cases, with initial spread to contiguous cervical nodes in 43.8%, to distant nodes in 24.2%, and to extranodal tissues in 12.4%. Lymphography showed abnormal retroperitoneal lymph nodes in 38.3% of cases. There was gastrointestinal involvement either initially or later in 17.6% of cases. High-energy radiation therapy to both sides of the neck was the treatment of choice for local and regional disease. It achieved a five-year survival rate of 41.9% in the group of 97 patients treated during the past decade. The incidence of relapse (recurrence and new manifestations) was highest in the first year after treatment.
Asthma Induced by Nickel
Authors: Jeffrey R. Fisher
Journal: JAMA (1982)

To the Editor.—  Block and Yeung (1982;247:1600) reported the case of a metal polisher in whom immediate hypersensitivity (type I reaction) with bronchospasm developed on inhalation of nickel sulfate particles in his work environment. Loffler's syndrome 1 and asthma 2 have also been observed following occupationally related inhalation of nickel carbonyl and nickel sulfate, respectively. We have seen a case of asthma resulting from internal exposure to nickel.  Report of a Case.—  A 33-year-old woman was hospitalized with a nine-month history of right upper quadrant (RUQ) abdominal discomfort and swelling of her face, lips, and hands, accompanied by stridor and wheezing, but without skin rash or urticaria. Ten months previously, a routine cholecystectomy had been performed. Her symptoms began four weeks after surgery and worsened, despite administration of various antihistamines. She denied allergies, but stated that she could not wear jewelry because it caused swelling and pruritus at contact areas.
Using Quality-Control Analysis of Peak Expiratory Flow Recordings To Guide Therapy for Asthma
Authors: Peter G. Gibson
Journal: Annals of Internal Medicine (1995)

Objective: To compare the action points in published asthma management plans with those derived from quality-control analysis of peak expiratory flow recordings. Design: Longitudinal observational study. Setting: An ambulatory asthma education and management program in a tertiary care hospital. Patients: 35 adults with asthma and exacerbation of asthma. Measurements: Peak expiratory flow diaries and symptom recordings. Results: Asthma action points from published asthma management guidelines had poor operating characteristics. The success rate was 35% when the action point was a peak expiratory flow rate less than 60% of the patient's best peak flow. The success rate improved to 88% when the action point was a peak expiratory flow rate less than 80% of the patient's best peak flow. Published action points had a high failure rate. Peak flow decreased to below the published action points during a stable period of asthma in 7% to 51% of patients studied. Action points defined using quality-control analysis did significantly better. A peak flow value less than 3 standard deviations below the patient's mean peak flow detected 84% of exacerbations and had a low failure rate (19%). Other quality-control tests had sensitivities of 91% and 71%. Quality-control action points could detect exacerbations up to 4.5 days earlier than conventional methods. Conclusions: Individualized action points can be derived for patients with asthma by applying quality-control analysis to peak flow recordings. These action points are more sensitive in detecting exacerbations of asthma and have fewer false-positive results. Action plans developed in this manner should be more useful for the early detection of deteriorating asthma.
CHILDBIRTH AFTER APPARENT MENOPAUSE
Authors: L. BUCKLE
Journal: JAMA (1910)

C. H., a well preserved and healthy looking woman, aged 50 years, always menstruated regularly and never had any genital troubles till 15 years ago. At that time she gave birth to twins, making the number of children seven in all. About a year later menstruation returned but with considerable irregularity; and in another year it ceased altogether. Two years ago, 11 years after the cessation of menstruation, she began to feel out of sorts; she lost her appetite, had nausea and felt weak. She was examined and treated by several physicians, including myself, at various times, but her true condition was not diagnosed and she remained unrelieved. One doctor told her that she had a growth and an operation would be necessary to remove it. The others treated her for gastritis, nervous dyspepsia, etc. She began to worry over her troubles and became much emaciated, anemic and nervous. One
Effect of 1–2 mmol/1 calcium, triamcinolone acetonide, and retinoids on low-calcium regulated keratinocyte differentiation
Authors: CYNTHIA L. MARCELO, R. C. GOLD, JANET A. FAIRLEY
Journal: British Journal of Dermatology (1984)

Journal Article Effect of 1–2 mmol/1 calcium, triamcinolone acetonide, and retinoids on low‐calcium regulated keratinocyte differentiation Get access CYNTHIA L. MARCELO, CYNTHIA L. MARCELO University of Michigan Medical School, Department of Dermatology, Ann Arbor, Michigan 48109–0010, U. S. A. Cynthia L. Marcelo, Ph. D., Director of Dermatology Research Laboratories, University of Michigan Medical School, Kresge I, R6558, Box 056, Ann Arbor, Michigan 48109–0010, U. S. A. Search for other works by this author on: Oxford Academic Google Scholar R. C. GOLD, R. C. GOLD University of Michigan Medical School, Department of Dermatology, Ann Arbor, Michigan 48109–0010, U. S. A. Search for other works by this author on: Oxford Academic Google Scholar JANET A. FAIRLEY JANET A. FAIRLEY University of Michigan Medical School, Department of Dermatology, Ann Arbor, Michigan 48109–0010, U. S. A. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 111, Issue s27, 1 July 1984, Pages 64–72, https://doi.org/10.1111/j.1365-2133.1984.tb15583.x Published: 01 July 1984
System allows patients to complain about NHS and seek compensation at the same time
Authors: C. Dyer
Journal: BMJ (2009)

<h3>Background</h3> The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs. <h3>Objective</h3> To examine the association between SBP and HF risk in the elderly. <h3>Design</h3> Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989–90 and 1992–3) and the Health ABC Study (inception: 1997–8). <h3>Setting</h3> Community-based cohorts. <h3>Participants</h3> 4408 participants (age, 72.8 (4.9) years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive drugs at baseline. <h3>Main outcome measures</h3> Incident HF, defined as first adjudicated hospitalisation for HF. <h3>Results</h3> Over 10 years, 493 (11.2%) participants developed HF. Prehypertension (120–139 mm Hg), stage 1 (140–159 mm Hg), and stage 2 (≥160 mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (&lt;120 mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI 1.23 to 2.16; p=0.001), 2.21 (95% CI 1.65 to 2.96; p&lt;0.001) and 2.60 (95% CI 1.85 to 3.64; p&lt;0.001), respectively. Overall 255/493 (51.7%) HF events occurred in participants with SBP &lt;140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race–SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women. <h3>Conclusions</h3> There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as &lt;115 mm Hg; over half of incident HF events occur in individuals with SBP &lt;140 mm Hg.
β–Amino Ester Polymers Facilitate in Vivo DNA Transfection and Adjuvant Plasmid DNA Immunization
Authors: John R. Greenland, Huining Liu, David Berry, Daniel G. Anderson, Woong-Ki Kim, Darrell J. Irvine, Robert Langer, Norman L. Letvin
Journal: Molecular Therapy (2005)

Increased in vivo expression of intramuscularly delivered plasmid DNA will be essential for clinical success in gene therapy and plasmid DNA vaccination. We screened polymers from a library of beta-amino esters for their ability to augment transgene expression as measured by beta-galactosidase activity and cellular immune responses. Among the candidates identified in this screen, poly[(1,6-di(acryloxyethoxy)hexane)-co-(4-aminobutanol)] enhanced plasmid DNA transgene expression by sevenfold (P=0.0001) and its immunogenicity by 70% (P=0.03). We found that polymers with moderately hydrophobic backbones and terminal alcohol groups facilitated transfection most effectively in vivo. We also observed a log-linear correlation (R2=0.93) between peak cellular immune responses and transgene activity in all evaluated polymer-plasmid DNA formulations, clarifying the relationship between immunogenicity and the quantity of expressed antigen.
AB0621 Fraxture – does frax reflect the risk of fracture in real practice?
Authors: R. Aguiar, R. Pinho, T. Meirinhos, C. Ambrósio, J. Brenha, A. Barcelos
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The Fracture Risk Assessment Tool (FRAX) has been developed as an algorithm to evaluate the 10-year risk of hip and major osteoporotic fractures, based on clinical risk factors, with or without bone mineral density (BMD) at the femoral neck. In a context where costs are increasingly taken into account, the availability of such tool which requires no costs (when performed without BMD) comes up as a valuable resource that weights greatly on the clinicians’ decision to treat a patient with an antiosteoporotic drug. The FRAX tool has recently been validated for the Portuguese population. <h3>Objectives</h3> With this work, the authors intended to assess FRAX accuracy when retrospectively performed in patients with hip fracture. <h3>Methods</h3> A retrospective cohort study was run, in which 100 patients with hip fracture randomly selected from an Orthopedics Department were enrolled. FRAX tool (without BMD) was performed and patients were questioned about previous or current treatment with antiosteoporotic drugs. <h3>Results</h3> From the 100 patients enrolled, 31 couldn’t cooperate (because of dementia or other medical intercurrences). Amongst the 69 patients who could collaborate, 15 were male and 55 were female; mean age was 77.4±9.1 years; mean body mass index (BMI) was 25.9±4.6 kgs/m<sup>2</sup>. 21 patients had a history of previous fracture; 5 patients reported parents hip fracture; 2 patients were current smokers and 5 were current alcohol drinkers; 4 patients had systemic corticosteroid therapy history and 4 had secondary osteoporosis; none of the patients had rheumatoid arthritis. Only 8 patients were under treatment with antiosteoporotic drugs. Mean risk for major osteoporotic fracture at 10 years was 14.9±9.7% and for hip fracture was 8.0±8.4%. 55 patients had a risk for major osteoporotic fracture &lt;20% and 15 patients had a mean risk for hip fracture at 10 years &lt;3%. All treated patients had a FRAX calculated risk for hip fracture at 10 years &gt;3%. <h3>Conclusions</h3> In this cohort, established threshold for high risk for hip fracture FRAX algorithm missed 21.7% of the patients who actually had a hip fracture. However, our cohort was small and the study was retrospective, which were the main limitations of this study. Only 14.8% of the patients with high risk for hip fracture were already being treated with antiosteoporotic drugs. This number demonstrates that clinicians are underdiagnosing and undertreating osteoporosis, and the use of FRAX in clinical practice – especially in primary healthcare – could improve the intervention on these patients. <h3>References</h3> Kanis JA et al. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:1395–1408 <h3>Disclosure of Interest</h3> None Declared