tbuckley/cabot-search huggingface dataset:
Effects of Interventions Involving the Family in the Treatment of Adult Patients with Chronic Physical Diseases: A Meta-Analysis
Authors: Mechthild Hartmann, Eva Bäzner, Beate Wild, Ivan Eisler, Wolfgang Herzog
Journal: Psychotherapy and Psychosomatics (2010)

&lt;i&gt;Background:&lt;/i&gt; Families can have considerable influence on the health of a patient with a chronic physical disease, and attempts have been made to optimise treatment by involving family members. This meta-analysis aimed to systematically assess the effects of family-oriented interventions on adults with chronic physical diseases. &lt;i&gt;Methods:&lt;/i&gt; A systematic literature search was conducted to identify randomised clinical trials that have evaluated the effects of family-based interventions for adult patients compared to standard treatment. Interventions were classified as psychoeducation or addressing family relationships. The outcomes studied were the patient’s physical and mental health and the health of the family members. The effect sizes were calculated as Hedges’ &lt;i&gt;g&lt;/i&gt; and combined using random-effects models. &lt;i&gt;Results:&lt;/i&gt; Fifty-two relevant randomised controlled trials (including 8,896 patients) were extracted. The main disease groups were cardiovascular diseases including stroke, cancer and arthritis. Meta-analysis showed that family involvement resulted in significantly better health than standard treatment for all outcomes. The mean overall effect sizes were 0.32 for the patients’ physical health, 0.28 for the patients’ mental health and 0.35 for the family members’ health. Overall, the effects were not large, but they were broad, significant and stable over a long period of time. There was a tendency towards higher effects in favour of relationship-focused family interventions compared to educational interventions. &lt;i&gt;Conclusions:&lt;/i&gt; Psychosocial interventions involving family members in the treatment of chronic physical diseases have positive effects on the health outcome for both the patient and his/her family. Further high-quality research is necessary to investigate differential effects.
Frailty in Dialysis-Dependent Patients With End-Stage Renal Disease
Authors: Nancy G. Kutner, Rebecca Zhang
Journal: JAMA Internal Medicine (2013)

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Cadmium, Lead, and Mercury in Relation to Reproductive Hormones and Anovulation in Premenopausal Women
Authors: Anna Z. Pollack, Enrique F. Schisterman, Lynn R. Goldman, Sunni L. Mumford, Paul S. Albert, Robert L. Jones, Jean Wactawski-Wende
Journal: Environmental Health Perspectives (2011)

Metals can interfere with hormonal functioning by binding at the receptor site and through indirect mechanisms; thus, they may be associated with hormonal changes in premenopausal women.We examined the associations between cadmium, lead, and mercury, and anovulation and patterns of reproductive hormones [estradiol, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone] among 252 premenopausal women 18-44 years of age who were enrolled in the BioCycle Study in Buffalo, New York.Women were followed for up to two menstrual cycles, with serum samples collected up to eight times per cycle. Metal concentrations were determined at baseline in whole blood by inductively coupled mass spectroscopy. Marginal structural models with stabilized inverse probability weights and nonlinear mixed models with harmonic terms were used to estimate the effects of cadmium, lead, and mercury on reproductive hormone levels during the menstrual cycle and anovulation.Geometric mean (interquartile range) cadmium, lead, and mercury levels were 0.29 (0.19-0.43) μg/L, 0.93 (0.68-1.20) μg/dL, and 1.03 (0.58-2.10) μg/L, respectively. We observed decreases in mean FSH with increasing cadmium [second vs. first tertile: -10.0%; 95% confidence interval (CI), -17.3% to -2.5%; third vs. first tertile: -8.3%; 95% CI, -16.0% to 0.1%] and increases in mean progesterone with increasing lead level (second vs. first tertile: 7.5%; 95% CI, 0.1-15.4%; third vs. first tertile: 6.8%; 95% CI, -0.8% to 14.9%). Metals were not significantly associated with anovulation.Our findings support the hypothesis that environmentally relevant levels of metals are associated with modest changes in reproductive hormone levels in healthy, premenopausal women.
Obstructive sleep apnea and insight into mechanisms of sympathetic overactivity
Authors: François Abboud, Ravinder Kumar
Journal: Journal of Clinical Investigation (2014)

Nearly two decades ago, we evaluated ten patients with obstructive sleep apnea (OSA). We determined that alarming nocturnal oscillations in arterial pressure and sympathetic nerve activity (SNA) were caused by regulatory coupling and neural interactions among SNA, apnea, and ventilation. Patients with OSA exhibited high levels of SNA when awake, during normal ventilation, and during normoxia, which contributed to hypertension and organ damage. Additionally, we achieved a beneficial and potentially lifesaving reduction in SNA through the application of continuous positive airway pressure (CPAP), which remains a primary therapeutic approach for patients with OSA. With these results in hindsight, we herein discuss three concepts with functional and therapeutic relevance to the integrative neurobiology of autonomic cardiovascular control and to the mechanisms involved in excessive sympathoexcitation in OSA.
Increased risk of cognitive impairment in patients with diabetes is associated with metformin. Diabetes Care 2013;36:2981–2987
Authors: EM Moore, AG Mander, D Ames, MA Kotowicz, RP Carne, H Brodaty, M Woodward, K Boundy, KA Ellis, AI Bush, NG Faux, R Martins, C Szoeke, C Rowe, DA Watters
Journal: Diabetes Care (2013)

Moore EM, Mander AG, Ames D, Kotowicz MA, Carne RP, Brodaty H, Woodward M, Boundy K, Ellis KA, Bush AI, Faux NG, Martins R, Szoeke C, Rowe C, …
Évaluation de la qualité de la coloscopie dans un centre d endoscopie digestive: Mode d emploi pour la mise en place d une méthode simple d évaluation et de suivi
Authors: E Pommaret, R Coriat, A Chryssostalis, S Viennot, M Gaudric, C Brezault, H Roche, D Verdier, D Parlier, F Prat, S Chaussade
Journal: Endoscopy (2008)

But: L'évaluation des pratiques professionnelles (EPP) est une obligation et une nécessité dans le domaine de l'endoscopie digestive. Cette EPP doit évaluer l'ensemble des procédures rentrant en jeu avant, pendant et après l'acte. Des techniques d'audit ciblées souvent complexes ont été proposées (1). Le but de ce travail prospectif est de décrire une méthode simple et originale d'EPP dans le domaine de la coloscopie pouvant être utilisée dans tous centres d'endoscopie privés ou publics, et peu consommatrices de temps.
Effects of naloxone, an opiate receptor antagonist, on coxsackievirus B3 myocarditis in the mouse
Authors: Chiharu Kishimoto, Hitoshi Takada, Yuji Hiraoka, Kimiyashu Shiraki
Journal: Cardiovascular Research (1995)

The aim was to test the therapeutic efficacy of naloxone, an opiate receptor antagonist, upon murine coxsackievirus B3 myocarditis with the analysis of neurohumoral kinetics.Two week old C3H/He mice were inoculated with 10(3) plaque forming units of coxsackie B3 virus. Naloxone, 1 mg.kg-1.d-1, was given intraperitoneally daily on days 0-14 in experiment I, and on days 14-28 in experiment II. The treated groups were compared to infected controls in each experiment. For the analysis of the endogenous opiate and neurohumoral system, plasma beta endorphin and catecholamines were measured.In experiment I, survival rate did not differ significantly between naloxone treated and untreated groups (11/15 v 8/15, p = NS). Pathological scores (infiltration and necrosis), myocardial virus titres, and plasma beta endorphin and catecholamine concentrations did not differ significantly between the two groups. In experiment II, survival rate (13/16 v 6/14, P < 0.05) was higher and cardiac pathology was less severe, with a lower incidence of congestive heart failure, in naloxone than in controls groups. In addition, beta endorphin and noradrenaline were significantly increased in the naloxone group compared to the control.The endogenous opiate system is activated in congestive heart failure caused by severe myocardial damage in murine coxsackie B3 myocarditis, where an associated limitation of the sympathetic system may be present. Naloxone is beneficial in congestive heart failure caused by coxsackie B3 myocarditis because of its neurohumoral modulating effect.
Canada's Health Care System
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1986)

Canada's health care system, the nation's most popular publicly financed service, has for years demonstrated a capacity to deliver universal, high-quality medical care for considerably less than the cost of care in several other Western industrialized nations, particularly the United States. Rich or poor, young or old, all of Canada's 25.5 million citizens receive care through its health scheme, which stands as the bulwark of its social programs. But now new strains — perhaps the inevitable consequence of a system that was designed to protect Canada's population from the economic consequences of illness, to limit the government's financial commitment, and . . .
Gianturco-Z Stents in the Palliative Treatment of Malignant Esophageal Obstruction and Esophagotracheal Fistulas
Authors: C. Ell, A. May, E. G. Hahn
Journal: Endoscopy (1995)

The palliative endoscopic treatment of malignant obstruction of the upper gastrointestinal tract, including esophagorespiratory fistulas, is often difficult. The efficacy of polyethylene-coated [corrected] Gianturco-Z stents in these sometimes complicated tumor stenoses was investigated.Twenty patients with malignant obstruction of the esophagus and the cardia, including six patients with esophagotracheal fistulas, were treated with Gianturco-Z stents. Five patients had previously been provided with another type of self-expanding metal endoprosthesis (two with Wallstents and three with Ultra-flex memory metal stents), and needed retreatment because of tumor ingrowth or overgrowth, esophagotracheal fistulas, or insufficient stent expansion. All data acquired prior to and during stent implantation, as well as during the follow-up period, were recorded prospectively.No technical problems occurred during the implantation of the stents. Nineteen of 20 Gianturco-Z stents (95%) spontaneously showed sufficient expansion at the endoscopic control, which was conducted within the following 48 hours. All patients, with the exception of one, reported immediate improvement of their dysphagia. The sealing of the six fistulas was also achieved. Severe early complications, such as bleeding or perforation, did not occur, but one stent migration was encountered. Two types of minor problems were observed: short-term retrosternal and epigastric pain (11 patients) and formation of a pouch at the upper rim of the stent (one patient). In the follow-up, tumor overgrowth of the stent ends was found in one patient, who was retreated with electrocoagulation. Tumor infiltration of the wire mesh has not been observed so far. In one patient, dislocation of a stent into the stomach occurred (probably as a result of endoscopic measures being performed to control tumor bleeding).We conclude that the treatment of malignant esophageal obstructions, including esophagorespiratory fistulas, with Gianturco-Z stents is effective, and that implantation is safe, especially in the case of tumor stenoses in the proximal esophagus. The expansile force of the stent is sufficient even for very firm strictures; and the polyethylene [corrected] covering of the stent seems to prevent tumor ingrowth.
People with mild asthma can control symptoms without daily steroids
Authors: Scott Gottlieb
Journal: BMJ (2005)

Adults with longstanding, mild, but persistent asthma who used corticosteroids only when their symptoms worsened were no worse off than those who used regularly scheduled treatment to control symptoms with either inhaled budesonide (Pulmicort) or oral zafirlukast (Accolate), a study has found.

Although treatment guidelines recommend daily corticosteroids as anti-inflammatory treatment to control mild, persistent asthma, research already indicates that most patients with mild asthma are using their treatment intermittently because they do not see the need for daily treatment.

The new results show that this strategy is acceptable if patients follow a strict action plan based on symptoms to guide the use …
Chimpanzees as Original Source for HIV
Authors: Thomas M. Folks
Journal: JAMA (2000)

The human AIDS viruses human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) represent cross-species (zoonotic) infections. Although the primate reservoir of HIV-2 has been clearly identified as the sooty mangabey (Cercocebus atys), the origin of HIV-1 remains uncertain. Viruses related to HIV-1 have been isolated from the common chimpanzee (Pan troglodytes), but only three such SIVcpz infections have been documented, one of which involved a virus so divergent that it might represent a different primate lentiviral lineage. In a search for the HIV-1 reservoir, we have now sequenced the genome of a new SIVcpz strain (SIVcpzUS) and have determined, by mitochondrial DNA analysis, the subspecies identity of all known SIVcpz-infected chimpanzees. We find that two chimpanzee subspecies in Africa, the central P. t. troglodytes and the eastern P. t. schweinfurthii, harbour SIVcpz and that their respective viruses form two highly divergent (but subspecies-specific) phylogenetic lineages. All HIV-1 strains known to infect man, including HIV-1 groups M, N and O, are closely related to just one of these SIVcpz lineages, that found in P. t. troglodytes. Moreover, we find that HIV-1 group N is a mosaic of SIVcpzUS- and HIV-1-related sequences, indicating an ancestral recombination event in a chimpanzee host. These results, together with the observation that the natural range of P. t. troglodytes coincides uniquely with areas of HIV-1 group M, N and O endemicity, indicate that P. t. troglodytes is the primary reservoir for HIV-1 and has been the source of at least three independent introductions of SIVcpz into the human population.
Variation at 10p12.2 and 10p14 influences risk of childhood B-cell acute lymphoblastic leukemia and phenotype
Authors: Gabriele Migliorini, Bettina Fiege, Fay J. Hosking, Yussanne Ma, Rajiv Kumar, Amy L. Sherborne, Miguel Inacio da Silva Filho, Jayaram Vijayakrishnan, Rolf Koehler, Hauke Thomsen, Julie A. Irving, James M. Allan, Tracy Lightfoot, Eve Roman, Sally E. Kinsey, Eamonn Sheridan, Pamela Thompson, Per Hoffmann, Markus M. Nöthen, Thomas W. Mühleisen, Lewin Eisele, Martin Zimmermann, Claus R. Bartram, Martin Schrappe, Mel Greaves, Martin Stanulla, Kari Hemminki, Richard S. Houlston
Journal: Blood (2013)
Are we creating a health pariah class?
Authors: Des Spence
Journal: BMJ (2004)

When I was a boy my parents smoked—as did most adults who I knew. People lived and then they died. I lived in a council house and went to a comprehensive school. I ate pies, cakes, and pastries, all washed down with full fat milk. When we could afford it we ate butter, but most of the time it was Stork Special Blend margarine. We had free school dinners and I loved spam fritters, sausage pie, stew, corned beef, or meat loaf, followed by pink custard and sponge. I loved our dinner ladies, and I often had third helpings. All my spare money went on Cabana bars, crisps, and a “quarter” of boiled sweets. My first McDonald's burger sent me delirious with its flavour.

> I found that my nagging was patronising and pointless

Regardless of the weather, we fought and played …
Science of overdiagnosis to be served up with a good dose of humility
Authors: R. Moynihan
Journal: BMJ (2013)

The Preventing Overdiagnosis international scientific conference gets under way next month



The Preventing Overdiagnosis conference (www.preventingoverdiagnosis.net) is close to capacity and may have to close registrations even before it opens its doors in a couple of weeks. It’s pleasing that so many people will gather within the grounds of Dartmouth College’s picturesque campus in New England to share the science of this problem and its potential solutions.

The meeting is hosted by the Dartmouth Institute for Health Policy and Clinical Practice, in partnership with the BMJ , the influential US consumer organisation Consumer Reports, and Bond University in Australia. It will feature more than 90 presentations, with participants from almost 20 nations. The twin aims are to share what we know about overdiagnosis and how we might best respond to it. And as we sit down to try to work out how to wind back the harms of too much medicine safely and fairly, if there’s an overarching theme, let it be humility . . . for there are no simple quick fixes and no panaceas.

As interest …
Anomalous Origin of Left Coronary Artery Diagnosed by a Lung Scan
Authors: George N. Sfakianakis, Eleni Damoulaki-Sfakianaki, Richard E. McClead, Josepha Craenen
Journal: New England Journal of Medicine (1977)

Anomalous origin of the left coronary artery from the pulmonary trunk is suspected with electrocardiographic evidence of myocardial infarction in patients with left ventricular failure and cardiomegaly; the diagnosis is made by selective angiography.1 , 3 Visualization of the myocardium on a lung scan in the case reported below provided the necessary information for the diagnosis before the patient's condition permitted catherization.Case HistoryA two-month-old girl, clinically normal at birth, was referred to our hospital after a two-week history of progressive dyspnea and nonproductive cough without fever. Clinical examination revealed cardiomegaly, a Grade 2 of 6 apical systolic murmur, dyspnea, tachypnea . . .
Marked mortality risk of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction
Authors: H. Mehrdad Sadeghi, Cindy L. Grines, Roxana Mehran, Simon R. Dixon, Alexandra J. Lansky, Martin Fahy, David A. Cox, Eulogio Garcia, James E. Tcheng, John J. Griffin, Giulio Guagliumi, Thomas D. Stuckey, Mark Turco, John D. Carroll, Barry D. Rutherford, Gregg W. Stone
Journal: Journal of the American College of Cardiology (2003)
Airway neutrophilia in COPD is not associated with increased neutrophil survival
Authors: P. Rytilä, M. Plataki, F. Bucchieri, M. Uddin, G. Nong, V. L. Kinnula, R. Djukanović
Journal: European Respiratory Journal (2006)

Neutrophilic airway inflammation is a prominent feature of chronic obstructive pulmonary disease (COPD) and correlates with disease severity. The mechanisms that determine the extent of neutrophilia could involve increased influx or prolonged survival of neutrophils. The aim of the study was to assess whether neutrophil pro-survival mechanisms are increased in the airways of subjects with COPD owing to the presence of anti-apoptotic factors in the bronchial lining fluid. Induced sputum samples were collected from 20 subjects with stable COPD, 14 healthy smokers and 14 healthy controls. Quantification of apoptotic neutrophils was based on typical morphological cell changes. Anti-apoptotic, pro-survival activity in the sputum was studied by culturing peripheral blood neutrophils with the fluid phase of induced sputum. Apoptosis was assessed both by morphology and flow cytometry using Annexin V/7-aminoactinomycin D staining. COPD patients and healthy smokers had significantly higher percentages of sputum neutrophils than healthy controls. However, there were no significant differences between the three subject groups in either the proportion of apoptotic neutrophils in sputum or the in vitro anti-apoptotic activity detected in the sputum fluid phase. In conclusion, prolonged survival of neutrophils in sputum is not a feature of chronic obstructive pulmonary disease and cannot explain the increased numbers of airway neutrophils in this disease.
Use of Antibiotics in Preventing Recurrent Acute Otitis Media and in Treating Otitis Media With Effusion
Authors: Robert L. Williams
Journal: JAMA (1993)

<h3>Objective.</h3> —To determine the efficacy of antibiotics for prophylaxis of recurrent otitis media and treatment of otitis media with effusion (OME) in children. <h3>Data Sources.</h3> —MEDLINE from 1966 through April 1993, textbooks,<i>Current Contents</i>, and bibliographies of selected articles. <h3>Study Selection.</h3> —Thirty-three studies initially identified were reviewed by three blinded reviewers assessing study quality and suitability for inclusion. Twenty-seven met inclusion criteria for the meta-analyses. <h3>Data Extraction.</h3> —We abstracted quantitative data and calculated rate differences (RDs) using tympanometry as the preferred outcome measure. <h3>Data Synthesis.</h3> —Nine studies of antibiotic prophylaxis of recurrent otitis media with 958 subjects had an RD of 0.11 (95% confidence interval [CI], 0.03 to 0.19) favoring antibiotic treatment. Twelve studies of short-term patient outcomes of OME with 1697 subjects had an RD favoring antibiotics of 0.16 (95% CI, 0.03 to 0.29), while eight studies using the ear as the outcome measure with 2052 ears studied had an RD of 0.25 (95% CI, 0.10 to 0.40). No significant difference was shown between placebo and antibiotics (RD, 0.06; 95% CI, -0.03 to 0.14) in the eight studies of longer-term outcome of OME. Subgroup analyses by antibiotic grouping, duration of treatment, and duration of disease did not show significant differences. <h3>Conclusions.</h3> —Antibiotics appear to have beneficial but limited effect on recurrent otitis media and short-term resolution of OME. Longer-term benefit for OME has not been shown. The findings are limited by the failure of most studies to consider potential confounders and by inability to identify groups of patients most likely to benefit. (<i>JAMA</i>. 1993;270:1344-1351)
Only doing my duty?
Authors: G. Adshead
Journal: BMJ (1995)

This week, the General Medical Council publishes its guidance to doctors on their professional duties.1 Previously, doctors seeking clarification about ethical dilemmas would have turned to the Council's “Blue Book”2; a thin volume from which it was sometimes difficult to extract user-friendly information. This may have contributed to a perception of the General Medical Council as a grim institution filled with medical grandees handing out discipline like a Victorian grandparent.

The “Blue Book” placed little emphasis on relationships in health care and seemed to make ethical dilemmas somewhat peripheral to good practice. By contrast, in Duties of a Doctor good relationships with patients and observance of ethical obligations become essential elements of medical practice. This is an important development; by putting ethics and the doctor patient relationship at the heart of good practice, a doctor …