tbuckley/cabot-search huggingface dataset:
National guidelines for capsule endoscopy: cost implications of non-compliance
Authors: C. Cook, C. Hatton, P. Hendy, R. Makins
Journal: Gut (2011)

<h3>Introduction</h3> Capsule endoscopy (CE) is the investigation of choice to visualise the small intestinal mucosa. The British Society of Gastroenterology (BSG) published guidelines in 2008 concerning the use of CE. It recommended, in the setting of iron deficiency anaemia and obscure GI bleeding that all patients should have an upper GI endoscopy (OGD) and colonoscopy, if negative, further bleeding warranted a ‘second-look’ OGD. All patients with 2 negative OGDs and negative colonoscopy should undergo CE. The aim of this study was to assess local compliance with the BSG guidelines, and the cost implication of non-compliance. <h3>Methods</h3> The authors retrospectively identified patients who had undergone CE at Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) over a 12-month period for the investigation of IDA and obscure GI bleeding. GHNHSFT is a split site 1000 bed district general hospital consisting of Gloucestershire Royal and Cheltenham General Hospitals, serving a population of 600 000 in a rural setting in the west of England. The authors identified all endoscopic and relevant radiological procedures the patients had undergone in relation to timing of CE to determine whether this complied with BSG guidelines. <h3>Results</h3> 88 cases were identified. The hospital notes of 55 were available for scrutiny. The point at which CE should have been performed was determined (ie, after 2 OGDs and 1 colonoscopy, as stipulated above) and those patients who had undergone ‘extra’ endoscopies were identified. Also identified were the ‘extra’ admissions (ie, those that occurred after the CE should have been performed). The outcome of the CE was reviewed, with endoscopic findings graded on relevance. 8/55 (14.5%) patients had more than 2 OGDs (mean 1.69) there were a total of 16 excess OGDs. 12/55 patients (22%) had more than 1 colonoscopy (mean 0.56 as not all patients had a colonoscopy). There were a total of 17 ‘excess colonoscopies’. Other investigations included abdominal CT scanning (42 in total, 4 in 1 patient alone), barium studies (8 in 8 patients), CT angiography (2), Meckel9s scan (1 study). There were 23 admissions, 7 of these in 5 patients after CE should have been performed. In all of the cases involving ‘extra’ admissions, the CE findings were highly relevant. The cost of a gastroscopy and colonoscopy was coded as £465 (550€) and £532 (630€) respectively; with total excess costs incurred by extra unnecessary endoscopy alone of £17 500 (20 000€). Estimation of excess admissions costs is difficult but assuming £500 per night, with on average a 3 night stay suggests an additional £10 500, an excess of £30 000 (€35 000). <h3>Conclusion</h3> CE should be utilised early in the diagnostic pathway for iron deficiency anaemia as recommended by national guidelines. Delays and unnecessary repeated bidirectional endoscopy leads to unacceptable resource waste.
A piece of my mind. Margo's logo
Authors: A. D. Firlik
Journal: JAMA (1991)

If she stands as straight as she can, Margo measures nearly five feet tall. Ordinarily, though, her spine assumes the curve of her wooden rocking chair, arching her over like an unwatered houseplant. Margo is 55 years old. If you ever saw her ambling unsteadily down the street on a windy day, a knit scarf whipping at her neck, something might compel you to cross the street, walk up behind her, and get ready to catch her in case an especially strong gust blew her off her feet. That's sort of what happened to me. I met Margo last summer during a gerontology elective after my first year in medical school. Margo has Alzheimer's disease. Like her body, her mind is shrinking. I observed Margo, leaning into winds of her disease, fighting them off; Alzheimer's blows a relentless course. So I crossed the street. I became close to Margo. I
PAR-1 contributes to the innate immune response during viral infection
Authors: Silvio Antoniak, A. Phillip Owens, Martin Baunacke, Julie C. Williams, Rebecca D. Lee, Alice Weithäuser, Patricia A. Sheridan, Ronny Malz, James P. Luyendyk, Denise A. Esserman, JoAnn Trejo, Daniel Kirchhofer, Burns C. Blaxall, Rafal Pawlinski, Melinda A. Beck, Ursula Rauch, Nigel Mackman
Journal: Journal of Clinical Investigation (2013)

Coagulation is a host defense system that limits the spread of pathogens. Coagulation proteases, such as thrombin, also activate cells by cleaving PARs. In this study, we analyzed the role of PAR-1 in coxsackievirus B3-induced (CVB3-induced) myocarditis and influenza A infection. CVB3-infected Par1(-/-) mice expressed reduced levels of IFN-β and CXCL10 during the early phase of infection compared with Par1(+/+) mice that resulted in higher viral loads and cardiac injury at day 8 after infection. Inhibition of either tissue factor or thrombin in WT mice also significantly increased CVB3 levels in the heart and cardiac injury compared with controls. BM transplantation experiments demonstrated that PAR-1 in nonhematopoietic cells protected mice from CVB3 infection. Transgenic mice overexpressing PAR-1 in cardiomyocytes had reduced CVB3-induced myocarditis. We found that cooperative signaling between PAR-1 and TLR3 in mouse cardiac fibroblasts enhanced activation of p38 and induction of IFN-β and CXCL10 expression. Par1(-/-) mice also had decreased CXCL10 expression and increased viral levels in the lung after influenza A infection compared with Par1(+/+) mice. Our results indicate that the tissue factor/thrombin/PAR-1 pathway enhances IFN-β expression and contributes to the innate immune response during single-stranded RNA viral infection.
Abstract 1536: Whole genome sequencing of high-grade treatment-naïve prostate tumors
Authors: Brennan J. Decker, Danielle M. Karyadi, Eric Karlins, Brian W. Davis, Lori S. Tillmans, Stephen N. Thibodeau, Elaine A. Ostrander
Journal: Cancer Research (2014)

Abstract Prostate cancer (PCa) will impact one in six American men and many low-risk men endure therapy, while other men die of PCa. Optimal treatment selection depends on distinguishing indolent tumors from those that will cause prostate cancer specific mortality (PCSM). To date, sequencing of prostate tumor DNA has highlighted the fact that prostate tumors develop differently than other cancers. Instead of recurrent protein-altering mutations, many prostate tumors harbor “closed chain” structural rearrangements that may mediate tumor evolution. However, we do not yet understand which somatic mutations are involved in aggressive disease and PCSM. To address this crucial question, we are using whole genome sequencing to pinpoint somatic genetic features in tumor/normal paired samples from four PCSM and six non-PCSM patients with treatment-naïve, Gleason 8+ tumors. Tumor and normal DNA were sequenced to a mean coverage of 95.3X and 48.3X, respectively. Tumor DNA purity ranged from 49%-79% and tumor ploidy ranged from 1.96 to 2.22. To define the genomic landscape of aggressive PCa, we will compare our findings with published studies and genotype high-priority candidates in at least 50 additional low- and high-grade tumors. We will also compare somatic mutations in PCSM versus non-PCSM cases and use network analysis to identify pathways that may be involved in progression and metastasis. Finally, we will characterize the clonal evolution of PCa tumors using deep digital sequencing to distinguish mutations that were present in the original tumor clone from subclonal mutations that arose after oncogenesis. In this way, we aim to identify potential oncogenic drivers and candidate mediators of progression and metastasis. Ultimately, we aim to 1) Uncover somatic mutations that are specific to aggressive tumors 2) Determine whether PCSM tumors have unique genetic features, and 3) Understand the role of clonal evolution in oncogenesis and progression. As more tumors are sequenced, this approach may yield valuable markers for diagnosis, prognosis and treatment selection. Note: This abstract was not presented at the meeting. Citation Format: Brennan J. Decker, Danielle M. Karyadi, Eric Karlins, Brian W. Davis, Lori S. Tillmans, Stephen N. Thibodeau, Elaine A. Ostrander. Whole genome sequencing of high-grade treatment-naïve prostate tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1536. doi:10.1158/1538-7445.AM2014-1536
Disclosing Medical Errors Does Not Mean Greater Liability Costs, New Study Finds
Authors: Mike Mitka
Journal: JAMA (2010)

to donors. “We will be looking at those samples to see if we can demonstrate any transmission,” he said. Schaffner said it would be helpful for the NIH to recruit additional wellqualified researchers to the CFS field. He explained that many investigators may have shied away from the area in the past because they were uncertain about the disease or were concerned about dealing with passionate members of support organizations devoted to the illness. “We have to keep our minds open,” Schaffner said. “Iempathizeenormously with patients and families dealing with CFSandtheirdesiretounderstandthedisorderandhavetreatmentoptions,butwe can’t let that trump the investigation to understand the etiology.”
Recurrent Tandem Gene Duplication Gave Rise to Functionally Divergent Genes in Drosophila
Authors: C. Fan, Y. Chen, M. Long
Journal: Molecular Biology and Evolution (2008)

Tandem gene duplication is one of the major gene duplication mechanisms in eukaryotes, as illustrated by the prevalence of gene family clusters. Tandem duplicated paralogs usually share the same regulatory element, and as a consequence, they are likely to perform similar biological functions. Here, we provide an example of a newly evolved tandem duplicate acquiring novel functions, which were driven by positive selection. CG32708, CG32706, and CG6999 are 3 clustered genes residing in the X chromosome of Drosophila melanogaster. CG6999 and CG32708 have been examined for their molecular population genetic properties (Thornton and Long 2005). We further investigated the evolutionary forces acting on these genes with greater sample sizes and a broader approach that incorporate between-species divergence, using more variety of statistical methods. We explored the possible functional implications by characterizing the tissue-specific and developmental expression patterns of these genes. Sequence comparison of species within D. melanogaster subgroup reveals that this 3-gene cluster was created by 2 rounds of tandem gene duplication in the last 5 Myr. Based on phylogenetic analysis, CG32708 is clearly the parental copy that is shared by all species. CG32706 appears to have originated in the ancestor of Drosophila simulans and D. melanogaster about 5 Mya, and CG6999 is the newest duplicate that is unique to D. melanogaster. All 3 genes have different expression profiles, and CG6999 has in addition acquired a novel transcript. Biased polymorphism frequency spectrum, linkage disequilibrium, nucleotide substitution, and McDonald–Kreitman analyses suggested that the evolution of CG6999 and CG32706 were driven by positive Darwinian selection.
Re: Eija Laurikainen, Antti Valpas, Pauliina Aukee, et al. Five-year Results of a Randomized Trial Comparing Retropubic and Transobturator Midurethral Slings for Stress Incontinence. Eur Urol 2014;65:1109–14
Authors: Isaac Thangasamy, Henry H. Woo
Journal: European Urology (2014)
Assessing the quality of care
Authors: H. T O Davies, I. K Crombie
Journal: BMJ (1995)

Measuring well supported processes may be more enlightening than monitoring outcomes

Everyone wants information on clinical outcomes.1 These measures have an intuitive appeal: high quality care should be reflected by good outcomes. Therefore, poorer outcomes should indicate deficiencies in care, including missed opportunities or wasted resources. The hope is that data on outcomes will provide a barometer for health care, indicating the effectiveness and efficiency of service delivery.

Many purchasers are pushing to include outcomes criteria in their contracts as a means of assessing effectiveness. In clinical audit, measurement of outcome is generally considered superior to audits that simply assess the process of care.2 But perhaps this emphasis on outcomes is being overplayed. Are outcomes data always so enlightening?

Outcome measures have a major weakness: interpretation. Suppose a hospital reported that patients admitted with coronary heart disease in 1994 had a 30 day mortality of 25%. This can be interpreted only by comparison with …
World Review of Nutrition and Dietetics
Authors: Ogden C. Johnson
Journal: JAMA (1961)

The second volume of this series reflects the introduction given in the first. These reviews are not designed to catalogue new information or to simply discuss the work that has been done. Each author is expected to review, to criticize, and to theorize within the area of his interest. By using authors from many parts of the world, the editors hope that this volume is truly an international review. Volume 2 covers topics such as "Proteins and Haemotopoiesis," "Dietary Factors and Adrenocortical Hormone Secretion," "Parathyroid Glands and Calcium Metabolism," and "Microbiology of Digestion." The "Vitamin Interrelations of Ascorbic Acid" by Therese Terroine contains—to a greater degree—the theorizing and criticism which were suggested in the introduction to the first volume. The final chapter, "Fluorine," by Professors T. Gordonoff and W. Minder should be of extreme interest in the United States. It presents a critical study of the importance of fluorine, and
Remote Treatment of Panic Disorder: A Randomized Trial of Internet-Based Cognitive Behavior Therapy Supplemented With Telephone Calls
Authors: Per Carlbring
Journal: American Journal of Psychiatry (2006)

This study evaluated a 10-week Internet-based bibliotherapy self-help program with short weekly telephone calls for people suffering from panic disorder with or without agoraphobia.After the authors confirmed the diagnosis by administering the Structured Clinical Interview for DSM-IV by telephone, 60 participants were randomly assigned to either a wait-listed control group or a multimodal treatment package based on cognitive behavior therapy plus minimal therapist contact via e-mail. A 10-minute telephone call was made each week to support each participant. Total mean time spent on each participant during the 10 weeks was 3.9 hours. The participants were required to send in homework assignments before receiving the next treatment module.Analyses were conducted on an intention-to-treat basis, which included all randomly assigned participants. From pretreatment to posttreatment, all treated participants improved significantly on all measured dimensions (bodily interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). Treatment gains on self-report measures were maintained at the 9-month follow-up. A blind telephone interview after the end of treatment revealed that 77% of the treated patients no longer fulfilled the criteria for panic disorder, whereas all of the wait-listed subjects still suffered from it.This study provides evidence to support the use of treatment distributed via the Internet with the addition of short weekly telephone calls to treat panic disorder. Replication should be made to compare self-help and telephone treatment based on cognitive behavior methods with nonspecific interventions.
Double‐blind placebo‐controlled challenges for peanut allergy the efficiency of blinding procedures and the allergenic activity of peanut availability in the recipes
Authors: J. Van Odijk, S. Ahlstedt, U. Bengtsson, M. P Borres, L. Hulthén
Journal: Allergy (2005)

Background: A firm diagnosis of double‐blind placebo‐controlled food challenge (DBPCFC) would facilitate the diagnosis in patients with uncertain history of reaction. Guidelines are lacking for an upper provoking dose and how to hide high concentrations of peanuts. Aim: To develop and evaluate a double‐blind recipe with minimum 10% of peanut. To compare the recipe with published recipes regarding blindness, taste, texture and immunoglobulin (Ig)E antibody binding to peanut. Methods: A recipe (I) with 10% of peanut was developed evaluated and used in DBPCFC. The challenges were followed by development of a concentrated recipe (II) (15% peanut, 25% fat). Recipe II was compared with the only published recipe (III) (11% peanut, 7% fat) regarding taste, texture and availability of peanut. Recipe IV (12% peanut, 10% fat) was developed using the same methods. The binding of IgE in the recipes was measured using an inhibition method. Results: During challenges, one patient reacted after 4 g, emphasizing the need for blinding recipes containing high doses of peanut. Evaluation between recipes II and III, only recipe II was regarded as blind by the taste panels. A tenfold lower availability of peanut protein in the recipe II was found at 50% of inhibition. Recipe IV had a better IgE binding that did not differ from the original peanut extract. Conclusion: The peanut taste and texture can be hidden in a challenge medium. The fat content was important for the availability of the allergenic protein in challenges. The availability of allergens must be taken into consideration when used for DBPCFC.
ARE DIPHTHEROIDS A FACTOR IN FEMALE STERILITY?
Authors: T. C. STELLWAGEN
Journal: JAMA (1918)

The problem of sterility is of great importance to the human race. This is especially true at the present time when the flower of manhood and womanhood is being destroyed or maimed by war. We believe that the question of sterility does not receive sufficient study from investigators. With the dawn of peace will come the problem of the rehabilitation of mankind, and we feel that any procedure that offers assistance to humanity should be discussed. On matters of such magnitude as generation, we believe we shall be pardoned if we submit a single rather striking case for consideration. We aim to place before the profession a clinicolaboratory experience, hoping thereby to induce investigators of greater ability to study along this line. Valuable work has been done on the bacterial flora of the female genitalia. Little, if any, appears to have been done to ascertain the possible effects of such
Salt-poor Human Albumin in Management of Nephrotic Syndrome
Authors: A. M. Davison, A. T. Lambie, A. H. Verth, J. D. Cash
Journal: BMJ (1974)

Thirteen patients with the nephrotic syndrome were treated with a high-protein diet, a 0.5 g sodium intake (equivalent to 1.3 g sodium chloride), and frusemide in increasing dosage. One became oedema-free with frusemide 240 mg daily, three became oedema-free with frusemide 500 mg daily, and two required a combination of high-dose frusemide and spironolactone. In three there was an appreciable increase in the blood urea, one patient developed hyponatraemia, and in two there was no weight loss. In these six patients infusions of human salt-poor albumin produced a prompt diuresis, loss of weight, and correction of the abnormal biochemical findings. In the seventh severely oedematous patient combined albumin and diuretic therapy led to a loss of 27 kg in 14 days.
What are the mechanisms of photoreceptor adaptation?
Authors: M. Deric Bownds, Vadim Y. Arshavsky
Journal: Behavioral and Brain Sciences (1995)

Abstract This article evaluates each of the reactions known to be involved in visual transduction as a potential site for the regulation of light adaptation. Extensive evidence suggests that calcium acts as a feedback messenger at several different points and recent work suggests a role for cGMP in regulating the primary excitatory pathway. A conclusion is that adaptation is likely to be regulated by multiple and redundant mechanisms. The goal of future experimentation will be to determine the relative importance of each of these.
Capillary Fragility and Diabetic Retinitis
Authors: Rafael Rodriguez, Howard F. Root
Journal: New England Journal of Medicine (1948)

AN INCREASED incidence of retinal changes among patients with diabetes has been noted in recent years. Diabetes of long duration has been associated with the greatest increase in retinal hemorrhages, although hypertension or other evidences of generalized vascular or renal disease may be present or develop subsequently. The importance of this subject is well known to students of diabetes and to internists, who see increasing numbers of diabetic patients, old and young, with impaired vision from this cause.The term "capillary vessels" includes the endothelial tubing that lies between the arterioles and the small veins. There is no marked distinction . . .
Mammography Screening in Women Under Age 50 Years-Reply
Authors: John C. Bailar
Journal: JAMA (1988)

<h3>In Reply.—</h3> Beijerinck et al find that the specificity of clinical examination (97%) nearly equals that of clinical examination plus mammography (99%) but that sensitivity of the clinical examination alone is much lower (41% vs 96%). This information cannot be evaluated without additional information about the kinds of lesions that are found by mammography but not by palpation. There is extensive evidence, some of it referred to in my editorial, that mammography frequently detects lesions that look bad under a microscope but that are not life-threatening. This could produce just such a difference in sensitivity and is a major flaw in arguments that mammography must be a good thing because it detects so many "cancers" not found by clinical examination. Tabar et al note that mammographic techniques have changed over time. It is true that images are better now than, say, 20 years ago, but does this improve patient outcome?
Specialty Imaging: Breast MRI: A Comprehensive Imaging Guide
Authors: Jessica Torrente
Journal: JAMA (2011)

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