tbuckley/cabot-search huggingface dataset:
Diagnosis at all costs won't make Bentham turn in his grave
Authors: Richard Lehman
Journal: BMJ (2006)

Solution is flawedEditor-Conroy et al offer a challenging solution to advance decisions on cardiopulmonary resuscitation (CPR), but the basis for that solution is fundamentally flawed. 1 They start from the premise that all institutions should provide cardiopulmonary resuscitation unless an overt decision has been made to the contrary. 2 3This is a common position in most UK NHS trusts, but there is no ethical, legal, or clinical demand on professionals that they must provide CPR.Current UK guidelines describe a presumption in favour of CPR in the absence of an advance decision but are equally clear that it would be unreasonable to resuscitate anyone in whom the burdens of treatment clearly outweigh the potential benefits.The presumption in favour of CPR has been interpreted by many health authorities as a default for CPR, but such a position is not supported by the guidelines and runs counter to personalised decision making by removing personal choice.It is also exceptional, since no other medical treatment comes with a default position.Unfortunately, Conroy et al's solution is to suggest an equally unacceptable position, a default against CPR.Conroy et al are right that the current guidelines need to be reviewed, but not for the reasons they state.Current UK guidelines are the source of much confusion among clinicians. 4They contain many contradictions and confusing statements and provide no framework for making clinical decisions.It is possible to make sense of advance decisions on CPR, and had the authors done so they would have arrived at a framework that individualises decisions, involves patients or relatives and partners when appropriate, and does so without placing an unnecessary burden on patients and carers. 4Instead the authors try to work through this confusion, and by offering a default against CPR they fail to reach a caring solution.
Vitamin D genes and mortality
Authors: P. Welsh, N. Sattar
Journal: BMJ (2014)

Harnessing genetics to re-examine the case for vitamin D

Readers of medical journals would be forgiven for a experiencing a sense of deja vu—another study investigating of the role of vitamin D in chronic disease, another editorial. They might also be forgiven for thinking that little is left to say about vitamin D that has not already become a cliche. The wealth of research articles written on vitamin D in recent times is not the result of a comedic temporal loop designed to make one feel like Bill Murray relentlessly reliving the same experience in the 1993 cult movie Groundhog Day . Rather it reflects the collective will of the academic community to investigate this topical public health question as rapidly as possible. Afzal and colleagues therefore need make no apology for coming back to the vitamin D question again in the linked paper (doi:10.1136/bmj.g6330), here using a mendelian randomisation approach.1

What is mendelian randomisation, and why might it be better than classical observational epidemiology? We now know that approaches linking circulating 25-hydroxyvitamin D (25-(OH)D) to health outcomes are seriously hampered by confounding and reverse causality.2 The circulating …
Verapamil in the management of supraventricular tachyarrhythmias occurring after a recent myocardial infarction.
Authors: F Hagemeijer
Journal: Circulation (1978)

In 16 patients, a sustained supraventricular tachyarrhythmia occurring less than 72 hours after the first symptom of an acute myocardial infarction was treated with titrated doses of verapamil. The drug was given intravenously in 1 mg increments every minute under continuous monitoring of electrocardiogram and blood pressure. Endpoints for the administration of verapamil were the following: reversion to sinus rhythm; a ventricular rate slower than 100/min; hypotension; a pulmonary capillary wedge pressure rising above 15 mm Hg; signs of intolerance; a maximum dose of 20 mg. Reversion to sinus rhythm was observed in 7/8 patients in atrial flutter and in 1/8 patients in atrial fibrillation; in all the ventricular rate could be slowed below 100/min without untoward effects.
Long-term parenteral nutrition
Authors: K. Ladefoged, S. Jarnum
Journal: BMJ (1978)

Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities.Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life.
Dosage Effects of Diabetes Self-Management Education for Mexican Americans
Authors: Sharon A. Brown, Shelley A. Blozis, Kamiar Kouzekanani, Alexandra A. Garcia, Maria Winchell, Craig L. Hanis
Journal: Diabetes Care (2005)

OBJECTIVE—The objective of this study was to compare two diabetes self-management interventions designed for Mexican Americans: “extended” (24 h of education, 28 h of support groups) and “compressed” (16 h of education, 6 h of support groups). Both interventions were culturally competent regarding language, diet, social emphasis, family participation, and incorporating cultural beliefs. RESEARCH DESIGN AND METHODS—We recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes ≥1 year. Intervention groups of eight participants and eight support persons were randomly assigned to the compressed or extended conditions. The interventions differed in total number of contact hours over the yearlong intervention period, with the major difference being the number of support group sessions held. The same information provided in the educational sessions of the extended intervention was compressed into fewer sessions, thus providing more information during each group meeting. RESULTS—The interventions were not statistically different in reducing HbA1c; however, both were effective. A “dosage effect” of attendance was detected with the largest HbA1c reductions achieved by those who attended more of the extended intervention. For individuals who attended ≥50% of the intervention, baseline to 12-month HbA1c change was −0.6 percentage points for the compressed group and −1.7 percentage points for the extended group. CONCLUSIONS—Both culturally competent diabetes self-management education interventions were effective in promoting improved metabolic control and diabetes knowledge. A dosage effect was evident; attending more sessions resulted in greater improvements in metabolic control.
Contempo '81. Internal medicine: cardiology
Authors: L. Resnekov
Journal: JAMA (1981)

Every decade lays claim to important conceptual and practical advances in medicine. Perhaps it is no exaggeration to believe that the last 30 years may well be considered the "golden years" of modern cardiology. New knowledge is part of a continuum of studies and investigations previously conducted, and there are times when such advances continue at an exciting pace such as we have seen during the last three decades. How has this come about? The clinician has had the challenge of a seemingly endless number of patients who suffer cardiac disease; the basic researcher has met the challenge of a parallel and equally exciting development in cellular biology. This dual approach has resulted in a better fundamental understanding by the cardiologist of the disease entities he is striving to cure; the many unanswered questions posed by the clinician become, in turn, an important challenge to the basic scientist. Lasting advances
1159-183 Circulating T cell perturbation and macrophage activation in stable coronary artery disease patients: Effect of atorvastatin therapy
Authors: Hannes F Alber, Jakob Dörler, Matthias Frick, Wolfgang Dichtl, Ralf-Harun Zwick, Otmar Pachinger, Franz Weidinger
Journal: Journal of the American College of Cardiology (2004)
Autologous Myoblast Transplantation for Oculopharyngeal Muscular Dystrophy: a Phase I/Iia Clinical Study
Authors: Sophie Périé, Capucine Trollet, Vincent Mouly, Valérie Vanneaux, Kamel Mamchaoui, Belaïd Bouazza, Jean Pierre Marolleau, Pascal Laforêt, Françoise Chapon, Bruno Eymard, Gillian Butler-Browne, Jérome Larghero, Jean Lacau St Guily
Journal: Molecular Therapy (2013)

Oculopharyngeal muscular dystrophy (OPMD) is a late-onset autosomal dominant genetic disease mainly characterized by ptosis and dysphagia. We conducted a phase I/IIa clinical study (ClinicalTrials.gov NCT00773227) using autologous myoblast transplantation following myotomy in adult OPMD patients. This study included 12 patients with clinical diagnosis of OPMD, indication for cricopharyngeal myotomy, and confirmed genetic diagnosis. The feasibility and safety end points of both autologous myoblast transplantation and the surgical procedure were assessed by videoendoscopy in addition to physical examinations. Potential therapeutic benefit was also assessed through videoendoscopy and videofluoroscopy of swallowing, quality of life score, dysphagia grade, and a drink test. Patients were injected with a median of 178 million myoblasts following myotomy. Short and long-term (2 years) safety and tolerability were observed in all the patients, with no adverse effects. There was an improvement in the quality of life score for all 12 patients, and no functional degradation in swallowing was observed for 10 patients. A cell dose-dependant improvement in swallowing was even observed in this study. This trial supports the hypothesis that a local injection of autologous myoblasts in the pharyngeal muscles is a safe and efficient procedure for OPMD patients. Oculopharyngeal muscular dystrophy (OPMD) is a late-onset autosomal dominant genetic disease mainly characterized by ptosis and dysphagia. We conducted a phase I/IIa clinical study (ClinicalTrials.gov NCT00773227) using autologous myoblast transplantation following myotomy in adult OPMD patients. This study included 12 patients with clinical diagnosis of OPMD, indication for cricopharyngeal myotomy, and confirmed genetic diagnosis. The feasibility and safety end points of both autologous myoblast transplantation and the surgical procedure were assessed by videoendoscopy in addition to physical examinations. Potential therapeutic benefit was also assessed through videoendoscopy and videofluoroscopy of swallowing, quality of life score, dysphagia grade, and a drink test. Patients were injected with a median of 178 million myoblasts following myotomy. Short and long-term (2 years) safety and tolerability were observed in all the patients, with no adverse effects. There was an improvement in the quality of life score for all 12 patients, and no functional degradation in swallowing was observed for 10 patients. A cell dose-dependant improvement in swallowing was even observed in this study. This trial supports the hypothesis that a local injection of autologous myoblasts in the pharyngeal muscles is a safe and efficient procedure for OPMD patients.
c-JUN promotes BCR-ABL–induced lymphoid leukemia by inhibiting methylation of the 5′ region of Cdk6
Authors: Karoline Kollmann, Gerwin Heller, Rene Georg Ott, Ruth Scheicher, Eva Zebedin-Brandl, Christine Schneckenleithner, Olivia Simma, Wolfgang Warsch, Eva Eckelhart, Andrea Hoelbl, Martin Bilban, Sabine Zöchbauer-Müller, Marcos Malumbres, Veronika Sexl
Journal: Blood (2011)
Risk of cervical intraepithelial neoplasia in women with glomerulonephritis.
Authors: F Hartveit, B Bertelsen, S Thunold, B O Maehle, E Skaarland, J Christensen
Journal: BMJ (1991)

OBJECTIVE--To investigate the occurrence of cervical intraepithelial neoplasia in women with glomerulonephritis and its possible association with immunosuppressive treatment. DESIGN--Retrospective study of cytological or histological specimens from women presenting with glomerulonephritis and a group of case and age matched controls. SETTING--University department of pathology, Norway. PATIENTS--81 women presenting with glomerulonephritis from 1981 to 1988, from whom gynaecological cytological or histological specimens were available. A group of 162 case and age matched controls. MAIN OUTCOME MEASURES--Age when glomerulonephritis of cervical intraepithelial neoplasia was diagnosed, type and characteristics of kidney lesion, stage of cervical intraepithelial neoplasia and presence of human papillomavirus, use of immunosuppressive treatment. RESULTS--Cervical intraepithelial neoplasia was more common in women with glomerulonephritis than in their controls (16/81 (20%) v 7/162 (4%), p less than 0.001) and was more advanced in those with glomerulonephritis than in the controls (9/81 (11%) of the study group had grade III cervical intraepithelial neoplasia compared with 1/162 (1%) of the controls). The increased occurrence of cervical lesions was independent of the use of immunosuppressive treatment, but the individual lesions tended to be more advanced when it was used (four of the seven cervical lesions in women with glomerulonephritis who had received immunosuppressive treatment were carcinoma in situ). Of the nine cervical lesions tested, seven were virus associated. CONCLUSION--Women with glomerulonephritis should have regular cervical smears, irrespective of their use of immunosuppressive treatment.
A randomized, placebo-controlled pilot trial of armodafinil for fatigue in patients with gliomas undergoing radiotherapy
Authors: Eudocia Q. Lee, Alona Muzikansky, Jan Drappatz, Santosh Kesari, Eric T. Wong, Camilo E. Fadul, David A. Reardon, Andrew D. Norden, Lakshmi Nayak, Mikael L. Rinne, Brian M. Alexander, Nils D. Arvold, Lisa Doherty, Jennifer Stefanik, Debra LaFrankie, Sandra F. Ruland, Julee Pulverenti, Katrina H. Smith, Sarah C. Gaffey, Samantha Hammond, Patrick Y. Wen
Journal: Neuro-Oncology (2016)

Fatigue is common among glioma patients undergoing radiotherapy (RT) and impacts quality of life (QOL). We evaluated whether armodafinil, a wakefulness-promoting medication, improves fatigue in glioma patients undergoing RT. Eligibility criteria included age ≥18 years, Karnofsky performance status ≥60, and grade 2–4 glioma undergoing RT to a total dose of 50–60 Gy. Patients were randomized 1:1 to armodafinil or placebo for 8 weeks beginning within 10 days of starting RT. Fatigue and QOL were assessed at baseline, day 22, day 43, and day 56 with the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), the Functional Assessment of Cancer Therapy – General (FACT-G), the Brief Fatigue Inventory (BFI), and the Cancer Fatigue Scale (CFS). The primary aim was to detect a difference in the 42-day change in FACIT-F fatigue subscale between the 2 groups using a 2-sample Wilcoxon statistic. We enrolled 81 patients total (42 armodafinil and 39 placebo). Armodafinil did not significantly improve fatigue or QOL based on the 42-day change in FACIT-F fatigue subscale, FACT-G, CFS, or BFI. Further analysis suggests no difference between the arms even after accounting for the potential bias of missing data. Treatment was well tolerated with few grade 3 or 4 toxicities. While treatment was well-tolerated, an 8-week course of armodafinil did not improve fatigue or QOL in glioma patients undergoing RT in this pilot study. Further studies are needed to determine whether pharmacologic treatment improves fatigue in glioma patients undergoing RT.
Activists call for public health to take central role in UN climate change talks
Authors: M. Jara
Journal: BMJ (2009)

Environmental health activists have been campaigning for public health aspects of climate change to be incorporated into any agreement reached when world leaders meet to discuss global warming in Copenhagen next month.

Roberto Bertollini, director of the special programme on health and environment at the World Health Organization’s regional office in Europe, said, “In the 1992 agreement [made at the Earth Summit in Rio de Janeiro], in articles 1 and 2, human health was mentioned in relation to global warming, but this topic has been lost over the years, and now we are making sure it gets back into the agenda.” 

He was speaking at climate change talks in Barcelona ahead of the United Nations meeting in Copenhagen from 7 to 18 December.

“At WHO we would like to see greater attention given to the social and health impacts of climate change in the current negotiations,” said Dr …
Gene expression profiling of laser microdissected airway smooth muscle tissue in asthma and atopy
Authors: C. Y. Yick, A. H. Zwinderman, P. W. Kunst, K. Grünberg, T. Mauad, S. Chowdhury, E. H. Bel, F. Baas, R. Lutter, P. J. Sterk
Journal: Allergy (2014)

Abstract Background Asthma and atopy share common characteristics including type 2 helper‐T‐cell‐mediated inflammation. However, only asthma is associated with variable airways obstruction. The complex cellular and molecular pathways distinguishing asthma and atopy can now be captured by transcriptomic analysis ( RNA ‐Seq). We hypothesized that the transcriptomic profile of airway smooth muscle ( ASM ) distinguishes atopic asthma from atopic healthy controls. First, we compared the ASM transcriptomic profiles of endobronchial biopsies between glucocorticoid‐free, atopic asthma patients, and atopic and nonatopic healthy controls. Second, we investigated the association between ASM transcriptomic profiles and airway function. Methods Twelve asthma patients and 12 control subjects (six atopic, six nonatopic) underwent bronchoscopy. RNA of laser‐dissected ASM from 96 bronchial biopsy specimens was sequenced with Roche GS FLX . Gene networks were identified using Ingenuity Pathway Analysis. RNA ‐Seq reads were assumed to follow a negative binomial distribution. With the current sample size, the estimated false discovery rate was approximately 1%. Results One hundred and seventy four ASM genes were differentially expressed between asthma patients and atopic controls, 108 between asthma patients and nonatopic controls, and 135 between atopic and nonatopic controls. A set of eight genes discriminated asthma patients from nonasthmatic controls, irrespective of atopy. Four of these genes ( RPTOR , VANGL 1 , FAM 129A , LEPREL 1 ) were associated with airway hyper‐responsiveness ( P &lt; 0.05). Conclusion Airway smooth muscle from asthma patients can be distinguished from that of atopic and nonatopic control subjects by a specific gene expression profile, which is associated with airway hyper‐responsiveness.
Woman challenges NHS refusal to fund egg freezing before treatment that may make her infertile
Authors: C. Dyer
Journal: BMJ (2014)

A 25 year old woman who is due to undergo “imminent” bone marrow transplantation and chemotherapy for Crohn’s disease has gone to the High Court in London to challenge a refusal by her local clinical commissioning group (CCG) to pay for her to freeze her eggs before the treatment.

Lawyers for Elizabeth Rose, an artist, told Mr Justice Jay that she feared the treatment would leave her infertile and was challenging the “unlawful” …
Acute Hemorrhagic Pancreatitis
Authors: Irwin S. Eskwith, Vincent A. Cacace, Alexander Sollosy
Journal: New England Journal of Medicine (1955)

A REVIEW of the American literature to date1 2 3 has failed to reveal any report of acute pancreatitis treated by either cortisone or ACTH. The following case was considered to be of interest, for it satisfied the criteria for acute hemorrhagic pancreatitis and the patient made an excellent recovery.Case ReportA 40-year-old railroad brakeman was admitted to St. Vincent's Hospital on March 21, 1954. One hour before admission a sudden, severe epigastric pain that radiated up beneath the sternum developed. Simultaneously, he became nauseated, perspired profusely and became extremely restless. Morphine was administered, and he was sent to the hospital. . . .
Long term sickness absence: Motivation rather than ability to work may be key
Authors: Ulf R Dahle, Fernanda C Petersen
Journal: BMJ (2005)

This week in the BMJ for the paper by Walsh et al are offered the conclusion that investment in intermediate care in community hospitals may be more cost effective than financing nurse led care for post-acute patients in acute hospitals. 1 2But the study itself, which confirms existing evidence on the costs of nurse led intermediate care in acute settings, 3 4 tackles neither the effect nor the cost of intermediate care in community hospitals.How then can such a conclusion be drawn?Walsh et al do not make this assertion.The author of the comment offers no support.Our own review of the evidence on nurse led intermediate care found no quality evidence for either the effect or cost of intermediate care in community settings. 5 The BMJ has been at the forefront of setting standards for the reporting of primary research.However, the editors must be aware that many readers simply pick up a take home message from comment, like this, 1 in the journal.