tbuckley/cabot-search huggingface dataset:
A138: Clinical Decision Support to Improve Preventive Care in Pediatric Systemic Lupus Erythematosus
Authors: Brittany Nelson
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Quality indicators, such as infection and cardiovascular disease (CVD) preventive care, for patients with systemic lupus erythematosus (SLE) have recently been published and can be utilized for assessing quality of care. Implementation of tools such as clinical decision support (CDS) within the electronic health record (EHR) can be utilized in quality care improvement efforts. The purpose of this quality improvement study is to test the chronic care model to study the relationship between CDS and rates of compliance with infection and CVD preventive care quality indicators for pediatric SLE patients at an outpatient rheumatology clinic.



Methods:

The study is a pilot retrospective design with a convenience sample. Documentation in the EHR of up to date vaccinations and lipid screen was measured before and after implementation of an electronic documentation template. Data for the comparative hypothesis was analyzed using Chi-square test.



Results:

Baseline data was collected from 48 (70%) patient charts and post-CDS data were collected from 20 (30%) patient charts. Before intervention, 15 (31.3%) patients received pneumonia vaccine and 17 (81.0%) of patients received vaccine after intervention. Sixteen (33.3%) patients received influenza vaccine before intervention and 20 (95.2%) received vaccine after intervention. Before intervention, 12 (25.0%) patients received lipid panels and 16 (76.2%) patients received lipid panels after intervention. All three differences were significantly different (Fisher's Exact p < 0.001). Patents were 9 times more likely to receive the pneumococcal vaccination and lipid panels and 40 times more likely to receive the influenza vaccination post intervention than before intervention.1


Table 1. Baseline QI rates, Post-intervention QI rates, and statistical differences between groups	 	PVX Vaccine	Influenza Vaccine	Lipid Panel


a

Pretest n = 48 (70%), poster intervention n = 20 (30%); p value < 0.1




	
Baseline patients meeting QI, n (%)	15 (31.3)	16 (33.3)	12 (25)	
Post CDS patients meeting QI, n (%)	17 (81)	20 (95)	16 (76)	
Fischer's Exact test significance	.000	.000	.000	
Cramer's V	.459	.570	.480	
Odds Ratio (95% CI)	9.35 (2.683–32.587)	40 (4.917–325.378)	9.6 (2.897–31.810)	



Conclusion:

Use of EHR CDS was associated with improved rates of preventive care for pSLE patients in the Pediatric Rheumatology outpatient setting. Our results suggested that patients were more likely to receive a screening lipid panel, influenza vaccination and pneumococcal vaccination if the health care provider used the EHR template with CDS.
Corruption among doctors
Authors: P L Towers
Journal: BMJ (1983)

expiratory flow rate measurements, there is no doubt that the commonest deficiency in the management of asthma in general practice is the failure to use objective means to estimate severity of airflow obstruction and its responsiveness to different classes of anti- asthmatic drugs.This applies to patients of all ages, for, as Dr C K Connolly has pointed out (27 May, p 1745), underdiagnosis and undertreatment are equally common in adults.We hope that our findings may convince all general practitioners that measurement of peak expiratory flow is a mandatory part of the assessment, treatment, and follow up of every patient with a history of wheeze.While it is possible that an extension of open access to hospitals might achieve a reduction in mortality, improvement in the long term care of asthma and a reduction in the number of patients in whom it remains undiagnosed will come about only when rational principles of assessment and treatment are applied much more widely in general practice.
USEFULNESS OF IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY IN PATIENTS AGED OVER 75 YEARS AS COMPARED WITH OPTIMAL MEDICAL THERAPY
Authors: Marcelino Cortes, Paloma Avila, Elena de la Cruz, Jose Joel Hernandez, Ignacio Hernandez, Miguel Angel Navas, Juan Benezet-Mazuecos, Jose Manuel Rubio, Rosa Rabago, Manuel Rey, Maria Esther Martinez, Miguel Orejas, Jeronimo Farre
Journal: Journal of the American College of Cardiology (2013)
Once daily fluticasone furoate nasal spray is effective in seasonal allergic rhinitis caused by grass pollen
Authors: W. J. Fokkens, R. Jogi, S. Reinartz, I. Sidorenko, B. Sitkauskiene, C. Van Oene, M. A. Faris, A. Ellsworth, M. F. Caldwell
Journal: Allergy (2007)

Background: Fluticasone furoate is a new enhanced‐affinity glucocorticoid with a unique combination of pharmacodynamic and physicochemical properties suitable for topical activity. Methods: In this multicentre, randomized, double‐blind, placebo‐controlled, parallel‐group study, patients [adults and adolescents ≥12 years of age with seasonal allergic rhinitis (SAR)] received once‐daily (od) treatment for 2 weeks with either fluticasone furoate nasal spray 110 μg ( n = 141) or placebo nasal spray ( n = 144) administered in a unique, side‐actuated device. Efficacy measures included total nasal symptom score (TNSS) and total ocular symptom score (TOSS). Patients also reported their overall response to therapy and rated their quality of life using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results: Fluticasone furoate significantly improved the mean change from baseline in daily reflective TNSS compared with placebo (treatment difference of −1.757; P &lt; 0.001). Fluticasone furoate was also significantly more effective in improving the morning predose instantaneous TNSS (treatment difference of −1.898; P &lt; 0.001) and daily reflective TOSS (treatment difference of −0.741; P = 0.001). A significant treatment effect was observed as early as day 1. Compared with placebo‐treated patients, fluticasone furoate‐treated patients showed significantly greater improvements in overall evaluation of response to therapy ( P &lt; 0.001), as well as in overall RQLQ score ( P &lt; 0.001). Fluticasone furoate was well tolerated. Conclusion: Fluticasone furoate nasal spray 110 μg od was effective in improving the nasal symptoms of SAR. It also produced significant improvements in ocular symptoms.
The Children's Hospital of Boston: `Built Better Than They Knew
Authors: Lester S. King
Journal: JAMA (1984)

The history of hospitals is becoming an increasingly important part of medical literature. Such works are placed on record data buried in various places: annual reports and committee minutes, correspondence, newspaper accounts, obituaries, contemporary biographies, and other documents. There are descriptions of buildings; enumeration of staff, with thumbnail biographical sketches of important figures; fund-raising activities; and important relations to the community. Such compendia furnish useful data—facts—for the historian who wants to understand the progress and development of medicine in its scientific, practical, and social contexts. They also provide gratification for all those who have, throughout the years, participated in the work of the institution. These are the conventional histories. Sometimes an author will enhance our understanding of the historical currents, of the social, scientific, intellectual, and cultural transformations that form the marrow of medical history. But all too often a history of a hospital is in essence a largely anecdotal
Bambuterol: clinical effects of three doses of bambuterol once daily in asthmatic patients
Authors: I. H. Clelmmensen, B. K. Pedersen, S. Ravn, L. C. Laursen, B. Weeke
Journal: Allergy (1988)

Twenty‐two asthmatics received bambuterol solution, a terbutaline pro‐drug, once every evening. The following doses were each given orally for 7 days in a double‐blind crossover study: 0.185, 0.270 and 0.400 mg/kg. Bambuterol 0.270 mg/kg was preferable regarding clinical effects and side effects. The plasma concentration of generated terbutaline showed a slow linear decrease at all doses. Tests of two methods for objective measurements of tremor in five patients did not add any new data compared with the subjective recordings.
PBDE Concentrations in Women’s Serum and Fecundability
Authors: Kim G. Harley, Amy R. Marks, Jonathan Chevrier, Asa Bradman, Andreas Sjödin, Brenda Eskenazi
Journal: Environmental Health Perspectives (2010)

Exposure to polybrominated diphenyl ether (PBDE) flame retardants is widespread, with 97% of Americans having detectable levels. Although PBDEs have been associated with reproductive and hormonal effects in animals, no human studies have examined their association with fertility.This study was designed to determine whether maternal concentrations of PBDEs in serum collected during pregnancy are associated with time to pregnancy and menstrual cycle characteristics.Pregnant women (n = 223) living in a low-income, predominantly Mexican-immigrant community in California were interviewed to determine how many months they took to become pregnant. Blood samples were collected and analyzed for PBDEs. PBDE concentrations were lipid adjusted and log10 transformed. Analyses were limited to PBDE congeners detected in > 75% of the population (BDEs 47, 99, 100, 153). Cox proportional hazards models modified for discrete time were used to obtain fecundability odds ratios (fORs) for the association of PBDEs and time to pregnancy.We detected all four congeners in > 97% of women. Increasing levels of BDEs 47, 99, 100, 153 and the sum of these four congeners were all associated with longer time to pregnancy. We observed significantly reduced fORs for BDE-100 [adjusted fOR = 0.6; 95% confidence interval (CI), 0.4-0.9], BDE-153 (adjusted fOR = 0.5; 95% CI, 0.3-0.8), and the sum of the four congeners (adjusted fOR = 0.7; 95% CI, 0.5-1.0). PBDEs were not associated with menstrual cycle characteristics.We found significant decreases in fecundability associated with PBDE exposure in women. Future studies are needed to replicate and confirm this finding.
Current Medical Diagnosis and Treatment 1982
Authors: Richard S. Foster
Journal: JAMA (1982)

The editors, Krupp and Chatton, clinical professors of medicine at Stanford University, with 35 associated authors have succeeded in updating and improving this annual resume of medicine. The softbound volume is "intended to serve health practitioners as a useful desk reference on widely accepted methods currently available for diagnosis and treatment." There are 33 chapters and a useful appendix covering therapeutics for the older patient, immunizations, normal laboratory and clinical values, resuscitation, nomograms, and conversion tables. Chapters range through the classic internal medicine specialties and also obstetrics, gynecology, ophthalmology, medical orthopedics, otorhinolaryngology, breast disease, and toxicology. Directed at an international readership, this volume contains an extraordinary amount of well-organized material aided by frequent graphs, tables, and a minimum of appropriate references. The work has a fairly consistent pattern of thoroughness, conciseness, and readability. It would be of value to a primary care physician, resident, or subspecialist desiring an initial acquaintance
Cost and Benefit of Secondary Prophylaxis for Pneumocystis carinii Pneumonia
Authors: Abel R. Castellano
Journal: JAMA (1991)

<h3>Objective.</h3> —To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprim sulfate as secondary prophylaxis for<i>Pneumocystis carinii</i>pneumonia. <h3>Design.</h3> —A Markov-based cost-benefit analysis was performed. Drug efficacies, toxicities, and mortality rates were drawn from the current literature. <h3>Setting.</h3> —Hypothetical. <h3>Patient Population.</h3> —Patients infected with the human immunodeficiency virus who had had at least one episode of<i>P carinii</i>pneumonia. <h3>Interventions.</h3> —Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. <h3>Main Outcome Measures.</h3> —Net cost, median patient survival, and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. <h3>Main Results.</h3> —Regimen 2 was dominant, with a net cost of $6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis, regimen 2 resulted in a savings of $16 503 per patient and a 0.696-year increase in median survival. Compared with regimen 1, regimen 2 resulted in a savings of $2904 and a 0.067-year increase in median survival. <h3>Conclusions.</h3> —Secondary prophylaxis for<i>P carinii</i>saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy. (<i>JAMA</i>. 1991;266:820-824)
China executes Briton who allegedly has mental illness
Authors: J. Parry
Journal: BMJ (2009)

Mental health experts, lawyers, and the British government have condemned the execution of Akmal Shaikh, 53, by lethal injection in Urumqi, Xinjiang, China on 29 December without first assessing his mental condition.

UK legal action charity Reprieve repeatedly made representations to the Chinese government stating that Mr Shaikh appeared to be mentally ill and had been duped into being a drug mule with promises of a career in pop music if he smuggled heroin to China.

The UK Foreign Office had provided the Chinese authorities with strong evidence of Mr Shaikh’s long history of bizarre behaviour, but its pleas for a medical assessment of his condition were ignored.

Peter Schaapveld, consultant clinical and forensic psychologist with Park Royal Secure Services, who offered his services free to Reprieve, told the BMJ that he was certain Shaikh, who lived what has been described as a “colourful” lifestyle, was suffering from a mental disorder. Had his mental illness been diagnosed and accepted by the Chinese courts, Shaikh may have escaped the death sentence—although he would still have been imprisoned.

Dr Schaapveld had tried to see Shaikh in May 2009, but was denied access during the consular visit. He briefed the consular staff on mental illness, however, and gave them specific questions to ask Shaikh.

“The next day was the Court of Appeal hearing, to which I was also denied access,” he told the BMJ . “But a consular staff member took notes and immediately afterwards I sat with the staff member for three hours and got a verbatim account of [Shaikh’s] …
A School for Medicine Men
Authors: ROBERT L. BERGMAN
Journal: American Journal of Psychiatry (1973)

The author discusses the establishment and training program of a Navajo school for medicine men and his involvement in it. From a psychiatrist's point of view, he describes the nature of the curative ceremonies and a few of what he perceives as their effects. He also discusses his role in teaching the medicine men and trainees something about medicine and psychiatry and their reactions to these.
Losers Can Win at Weight Maintenance
Authors: Rebecca Voelker
Journal: JAMA (2007)

LOSING WEIGHT AND KEEPING IT OFF is a tough business—no one succeeds without really trying. But some long-held beliefs about the difficulties of maintaining weight loss are changing. As a result, experts are developing a more complete picture of weight loss maintenance and a more hopeful message for millions who are overweight or obese. Experts who presented data on maintaining weight loss during the Endocrine Society’s annual meeting in Toronto last month said the proportion of overweight individuals who succeed at long-term weight loss—losing at least 10% of body weight and keeping the weight off for 1 year—is higher than many might expect, about 20% (McGuire MT et al. Int J Obes Relat Metab Disord. 1999;23[12]:1314-1319). An even more optimistic outlook appears in a recent study. Researchers from the Centers for Disease Control and Prevention report that nearly 60% of 1310 individuals in the National Health and Nutrition Examination Survey who lost 10% of body weight maintained 95% of the loss for 1 year (Weiss EC et al. Am J Prev Med. 2007;33[1]: 34-40). “Weight maintenance following weight loss is doable,” lead author Edward C. Weiss, MD, MPH, said in a statement. Holly Wyatt, MD, an associate professor at the University of Colorado Health Sciences Center, Denver, agreed. “A lot of people say you can’t succeed at maintaining weight loss long-term,” she noted during a press briefing at the meeting in Toronto. “We do have some data now that say that’s not true.” METABOLIC ROLE Wyatt said the theory that weight loss lowers the resting metabolic rate (RMR), which in turn pushes the body to regain lost pounds, is not a catchall explanation for weight regain. She examined the existing medical literature and found several studies that contradict the theory. Among them is a study of 24 overweight, postmenopausal women who, after 4 phases of weight loss and weight maintenance, lost a mean of 12.9 kg (Weinsier RL et al. Am J Clin Nutr. 2000; 72[3]:1088-1094). After measuring changes in the women’s RMR and thyroid hormone levels compared with 24 control participants, researchers from the University of Alabama School of Medicine, Birmingham, and the Mayo Clinic, in Rochester, Minn, reported a temporary decline in RMR and thyroid hormones in the study participants. However, measures of both returned to baseline after the women stopped losing weight. The RMR in the women who had lost weight was not significantly different than in controls, and women with lower RMRs were not more likely than those with higher rates to regain more weight over the next 4 years. “The idea that absolutely, your body is fighting you, I don’t think really holds out in the literature,” said Wyatt. “Other things like our environment or other behaviors may overpower [metabolic] change.”
Fatal complications of central venous catheters.
Authors: R Adar, M Mozes
Journal: BMJ (1971)

The use of central venous catheters has become indispensable in the management of severely ill and injured patients. Their main use is in central venous pressure monitoring, rapid infusion of fluids, and intravenous hyperalimentation. Regardless of the route of insertion of the central venous catheter, complications arise from injury to the vein wall or neighbouring structures, from thromboembolism and sepsis, and from air and catheter embolism. Most of these are not serious, but fatal complications have been reported by Schapira and Stern (1967), Friedman and Jurgeleit (1968), Flannagan et al. (1969), Thomas et al. (1969), and Raffensperger and Ramenofsky (1970). During a two-year period ending 31 December 1970, 141 patients had central venous catheters inserted while on a surgical ward of 36 beds. The catheter was inserted prophylactically for monitoring central venous pressure during 94 major operations. In 45 patients it was inserted in the course of resuscitation from shock, and in two patients it was utilized for intravenous hyperalimentation. The cases of two patients who died from the use of a central venous catheter are reported here.
Int-2, an Autocrine and/or Ultra--Short-Range Effector in Transgenic Mammary Tissue Transplants
Authors: D. M. Ornitz, R. D. Cardiff, A. Kuo, P. Leder
Journal: JNCI Journal of the National Cancer Institute (1992)

Background : Previous studies have shown associations between over-expresion of int-2 messenger RNA (mRNA) and murine mammary tumors and between amplification of the int-2 genomic locus and human breast cancers. The Int-2 protein (fibroblast growth factor 3) is a member of the heparin-binding growth factor family of proteins. The export of these growth factors from cells may depend on the presence of amino terminal sequences containing hydrophobic signal peptides. Although Int-w has a putative signal sequence, it is not known whether or how this protein is secreted from cells. Purpose : Assuming that the Int-2 protein is secreted from mammary epithelial cells in a basolateral direction so that it is available to affect adjacent cells, we investigated whether it acts in a paracrine manner, exerting its effect externally on adjacent cells, or in an autocrine manner, exerting its effect internally within the same cell. Methods : Using in situ hybridization with 35 S-labeled RNA antisense probes that specifically detect mRNA coding for the Int-2 protein, we determined the cell-specific localization of int-2 mRNA expression in the mammary gland of transgenic FVB/N mice overexpressing int-2 mRNA. Then we transplanted pieces of mammary epithelial tissue expressing int-2 mRNA into the mammary fat-pad of wild-type, syngeneic animals. The mammary glands of host animals were examined as whole-mounts and as histologic sections 2–6 months after transplantation. In situ hybridization was used to confirm which cells continued to express int-2 mRNA following transplantation. Results : Int-2 mRNA expression in transgenic mice was localized to the mammary epithelial cells. Transplants expressing int-2 mRNA were similar to wild-type transplants in that they had no observable effect on either the growth or the morphology of host mammary epithelium. Abnormal growth occurred only in transplanted tissue expressing int-2 mRNA but not in adjacent host mammary epithelium. Conclusion : Given the limitations of our experimental system and the limited information available to date on the secretion of Int-2 protein, these results suggest that, although the Int-2 protein contains a putative signal pep-tide, it may act primarily as an autocrine or as an ultra—short-range paracrine growth factor in mammary epithelium. [J Natl Cancer Inst 84: 887–892, 1992]
Dynein-Driven Transport of T Cell Receptor Microclusters Regulates Immune Synapse Formation and T Cell Activation
Authors: Akiko Hashimoto-Tane, Tadashi Yokosuka, Kumiko Sakata-Sogawa, Machie Sakuma, Chitose Ishihara, Makio Tokunaga, Takashi Saito
Journal: Immunity (2011)
1224 FACTORS AFFECTING HCV VIRAL LOAD RESPONSE TO THE NON-NUCLEOSIDE POLYMERASE INHIBITORS ABT-072 AND ABT-333
Authors: T. Middleton, Y. He, J. Beyer, I.A. Gaultier, D.E. Cohen, T.J. Podsadecki, B. Bernstein, C. Collins
Journal: Journal of Hepatology (2011)
ABC of sleep disorders. "I don't get enough sleep, doctor".
Authors: G E Berrios, C M Shapiro
Journal: BMJ (1993)

About a third ofpeople who go to see their general practitioners and about q0 ffi .t two thirds of those who see psychiatrists complain that they are dissatisfied with the restorative quality oftheir sleep.Despite the size ofthese groups and the advances made by research workers, practical knowledge about the 1WA ,\ diagnosis and management of sleep related complaints is limited.Patterns and habits of sleep are established in infancy, and core sleep variables (the proportions of stage 4 and rapid eye movement (REM) sleep), 53 92 which are partly genetically controlled, enter a steady state by the late teens.