tbuckley/cabot-search huggingface dataset:
Communication and navigation around the healthcare system
Authors: Jeremy C Wyatt, Frank Sullivan
Journal: BMJ (2005)

However good a doctor's clinical skills, record keeping abilities, and mastery of evidence, before they can start work they need directory information. This is the information patients and professionals use to find their way around the healthcare system. Different grades of staff have different demands for this information, and all staff are often interrupted by colleagues' requests for this information.

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A hospital switchboard in 1995—shows the operators' directory and temporary notes. With permission from Martin Loach

You are a general practice locum and need to fix an outpatient assessment for Mrs Smith's bronchitis. The receptionist mentions that before you organise the assessment you need to book certain tests that vary according to which chest physician you refer Mrs Smith to. The receptionist does not know the names of local chest physicians nor their investigation preferences. You spend 15 minutes trying to call the chest clinic in the nearest hospital before discovering it moved six weeks ago to another site 15 miles (24 km) away. Your phone is not cleared for long distance calls, and the practice manager is not around, so you wait to use a colleague's phone. Mrs Smith takes umbrage at the delay and walks out while shouting across the waiting room, “Call yourself a doctor. You don't even know what goes on in the hospitals round here.” 

Directory information includes information about local services, how to book them, contact details, and specialists' preferences for tests that they need patients to have had done before they see them. Variations in stationery, laboratory and therapeutic services, and how those services are organised (including what type …

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Transient ischemic small-bowel ulcers secondary to acute superior mesenteric artery branch thromboembolism diagnosed by double balloon enteroscopy
Authors: Y. Hashimoto, Y. Endo, Y. Kuroki, H. Yoshikumi, M. Yoshiba
Journal: Endoscopy (2008)

Acute insufficiency of mesenteric arterial blood flow has many etiologies but the mechanism of injury is the same regardless of the cause. Acute mesenteric ischemia is generally diagnosed with computed tomography (CT) imaging [1]. It results in mortality rates exceeding 60 %. Many cases require urgent surgery for the removal of necrotic bowel [2]. Endoscopic images of the ischemic small bowel have rarely been reported [3]. We present a case of multiple jejunal ulcers secondary to acute superior mesentric artery (SMA) branch thromboembolism diagnosed by double balloon enteroscopy.
Bacterial Infection and Tuberculin Reactivity
Authors: ROBERT E. PIERONI
Journal: Annals of Internal Medicine (1975)

Comments and Correction1 February 1975Bacterial Infection and Tuberculin ReactivityROBERT E. PIERONI, M.D.ROBERT E. PIERONI, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-82-2-283_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In a recent letter Siasoco, Chen, and Chang (1) reported that in patients with typhoid fever there was a statistically significant reduction in skin reactivity to purified protein derivative (PPD) as compared with normal controls matched by age, sex, and geographic location. Two explanations were offered for this difference: a transient suppression of tuberculin reactivity during typhoid fever and the possibility that persons with negative tuberculin reactions are more susceptible to this infection.Although the latter possibility cannot be ruled out, some recent studies strongly suggest that bacterial infections can indeed suppress the tuberculin response, as well...References1. SIASOCOCHENCHANG RCT: Tuberculin reaction in typhoid fever (letter). Ann Intern Med 81:400, 1974 LinkGoogle Scholar2. PIERONISTEVENSSTOJANOVIć RDA: Investigation of the responsiveness of BCG-vaccinated children with whooping-cough to tuberculin. Int Arch Allergy Appl Immunol 42:583-589, 1972 CrossrefMedlineGoogle Scholar3. HEISSPALMER LD: Anergy in patients with leukocytosis. Am J Med 56:323-332, 1974 CrossrefMedlineGoogle Scholar4. MITCHELLNELSONLEBLANC AWT: Studies in immunity. V. Effect of acute diseases on the reaction of the skin to tuberculin. Am J Dis Child 49:695-702, 1935 CrossrefGoogle Scholar5. PALMERREED DW: Delayed hypersensitivity skin testing. I. Response rates in hospitalized population. II. Clinical correlates and anergy. J Infect Dis 130:132-143, 1974 CrossrefMedlineGoogle Scholar1. DUBOSSCHAEDLER RR: Reversible changes in the susceptibility of mice to bacterial infections. I. Changes brought about by injection of pertussis vaccine or of bacterial endotoxins. J Exp Med 104:53-65, 1956 CrossrefMedlineGoogle Scholar2. HOWARDBIOZZIHALPERN JGB: The effect of mycobacterium tuberculosis (BCG) infection on the resistance of mice to bacterial endotoxin and Salmonella enteritidis infection. Br J Exp Pathol 40:281-290, 1959 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ROBERT E. PIERONI, M.D.Affiliations: College of Community Health Sciences The University of Alabama University, Alabama 35486 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1975Volume 82, Issue 2Page: 283-284KeywordsGeographic areasSkin infectionsTuberculinTyphoid ePublished: 1 December 2008 Issue Published: 1 February 1975 PDF downloadLoading ...
Lovastatin in X-Linked Adrenoleukodystrophy
Authors: Marc Engelen, Rob Ofman, Marcel G W Dijkgraaf, Michiel Hijzen, Lucinda A van der Wardt, Bjorn M van Geel, Marianne de Visser, Ronald J A Wanders, Bwee Tien Poll-The, Stephan Kemp
Journal: New England Journal of Medicine (2010)

To the Editor: As reported previously in the Journal, lovastatin lowers levels of very-long-chain fatty acids in plasma in patients with X-linked adrenoleukodystrophy (X-ALD).1 Further studies did ...
Loss of Major Molecular Response As a Trigger for Restarting Tyrosine Kinase Inhibitor Therapy in Patients With Chronic-Phase Chronic Myelogenous Leukemia Who Have Stopped Imatinib After Durable Undetectable Disease
Authors: Philippe Rousselot, Aude Charbonnier, Pascale Cony-Makhoul, Philippe Agape, Franck E. Nicolini, Bruno Varet, Martine Gardembas, Gabriel Etienne, Delphine Réa, Lydia Roy, Martine Escoffre-Barbe, Agnès Guerci-Bresler, Michel Tulliez, Stéphane Prost, Marc Spentchian, Jean Michel Cayuela, Josy Reiffers, Jean Claude Chomel, Ali Turhan, Joëlle Guilhot, François Guilhot, François-Xavier Mahon
Journal: Journal of Clinical Oncology (2013)

More than half of patients with chronic-phase chronic myelogenous leukemia (CP-CML) in complete molecular response (CMR) experience molecular relapse after imatinib discontinuation. We investigated loss of major molecular response (MMR) as a criterion for resuming therapy.A multicenter observational study (A-STIM [According to Stop Imatinib]) evaluating MMR persistence was conducted in 80 patients with CP-CML who had stopped imatinib after prolonged CMR.Median time from imatinib initiation to discontinuation was 79 months (range, 30 to 145 months);median duration of CMR before imatinib discontinuation was 41 months (range, 24 to 96 months); median follow-up after discontinuation was 31 months (range, 8 to 92 months). Twenty-nine patients (36%) lost MMR after a median of 4 months off therapy (range, 2 to 17 months). Cumulative incidence of MMR loss was estimated as 35% (95% CI, 25% to 46%) at 12 months and 36% (95% CI, 26% to 47%) at 24 months, whereas probability of losing CMR was higher. Fluctuation of BCR-ABL transcript levels below the MMR threshold (≥ two consecutive positive values) was observed in 31% of patients after imatinib discontinuation. Treatment-free remission was estimated as 64% (95% CI, 54% to 75%) at 12 and 24 months and 61% (95% CI, 51% to 73%) at 36 months. Median to time to second CMR was estimated as 7.3 months in re-treated patients.Loss of MMR is a practical and safe criterion for restarting therapy in patients with CML with prolonged CMR.
Epilepsy Experts Focus on Treatment Gaps
Authors: Tracy Hampton
Journal: JAMA (2010)

end points,” she said. Pina added that the findings from both studies show that physicians and researchers still do not know a lot about the relationship of anemia or iron deficiency to cardiovascular risk. “My residents will look at a patient with heart failure and see that he has been anemic, and they say it is chronic, and they do not do anything about it,” she said. “I will tell them, ‘Do not just assume it is chronic; it can be iron deficiency.’” For Pfeffer, another lesson to be learned from the TREAT trial is that therapies approved based on a beneficial effect on a surrogate end point need further testing to prove clinical efficacy. He said some members of the research community called for the discontinuation of his study because they believed the benefits of ESAs were so apparent that any trial using a placebo was unethical. “The clinical community has to ask for outcomes data and has to get behind well-done clinical trials,” Pfeffer said. “I should not have had to fight an uphill battle to complete my study.”
Aids and adaptations for the elderly at home: underprovided, underused, and undermaintained
Authors: J George, V E Binns, A D Clayden, G P Mulley
Journal: BMJ (1988)

A random sample of 140 elderly people aged over 75 was selected from the age-sex register of an urban general practice to assess the provision and use of aids and adaptations in their homes. Many of the aids that the elderly had were faulty, including half of the walking aids and 15% of hearing aids, reading spectacles, and dentures, and up to half of the aids were not used. Yet despite this underuse there were many disabled elderly people who required aids for the bath and toilet. When screening of elderly people is carried out in general practice assessment of aids and adaptations should be included to see that they are provided where needed, are used, and are adequately maintained.
Prevalence of Antibody to Human Immunodeficiency Virus and Hepatitis B Surface Antigen in Blood Samples Submitted to a Hospital Laboratory
Authors: H. Hunter Handsfield
Journal: JAMA (1987)

The prevalence of hepatitis B surface antigen (HBsAg) and antibody to human immunodeficiency virus (HIV) was determined in serum or plasma specimens of 506 patients submitted to the clinical chemistry laboratory of an urban teaching hospital, and the results were correlated with "biohazard" warning labels on the specimens. Hepatitis B surface antigen, HIV antibody, or either of these were present in 32 (6.3%), 15 (3.0%), and 44 specimens (8.7%), respectively. Ten (67%) of 15 specimens with HIV antibody and nine (28%) of 32 with HBsAg bore biohazard labels. Among 473 unlabeled specimens, HIV antibody was present in five (1.1%), HBsAg was present in 23 (4.9%), and 27 (5.7%) contained either or both of these markers. All clinical and laboratory personnel should be vaccinated against hepatitis B and should handle all blood specimens as if they were infected, regardless of biohazard labeling. By fostering complacency in handling unlabeled specimens, the use of biohazard labels may paradoxically increase the risk that health care workers will be exposed to HIV and hepatitis B virus. (<i>JAMA</i>1987;258:3395-3397)
MENSTRUATION AND OVULATION-Reply
Authors: Emil Novak
Journal: JAMA (1934)

To the Editor:—  My paper was an evaluation of a method of contraception which is now widely practiced, more especially by those who, for such reasons as religion, are not willing to resort to the more commonly employed mechanical and chemical methods of birth control. For example, it is the only one, aside from absolute continence, which can be employed by the conscientious Catholic. My appraisal of it was based on the available evidence, clinical and physiologic. Contrary to Dr. Sophian, I feel that anatomic evidence indicates the general reliability of the plan of periodic abstinence, especially in women with regular cycles. To take extreme examples, I have never, in the study of many thousands of ovaries, seen the earliest stage of corpus luteum formation (indicative of recent ovulation) in the immediately premenstrual or immediately postmenstrual phase. When dealing with later stages of corpus luteum development, no one would care
Cluster randomised controlled trial of expert system based on the transtheoretical ("stages of change") model for smoking prevention and cessation in schools
Authors: P. Aveyard, K K Cheng, J. Almond, E. Sherratt, R. Lancashire, T. Lawrence, C. Griffin, O. Evans
Journal: BMJ (1999)

<h3>Abstract</h3> <b>Objectives:</b> To examine whether a year long programme based on the transtheoretical model of behaviour change, incorporating three sessions using an expert system computer program and three class lessons, could reduce the prevalence of teenage smoking. <b>Design:</b> Cluster randomised trial comparing the intervention to a control group exposed only to health education as part of the English national curriculum. <b>Setting:</b> 52 schools in the West Midlands region. <b>Participants:</b> 8352 students in year 9 (age 13-14 years) at those schools. <b>Main outcome measures:</b> Prevalence of teenage smoking 12 months after the start of the intervention. <b>Results:</b> Of the 8352 students recruited, 7444 (89.1%) were followed up at 12 months. The intention to treat odds ratio for smoking in the intervention group relative to control was 1.08 (95% confidence interval 0.89 to 1.33). Sensitivity analysis for loss to follow up and adjustment for potential confounders did not alter these findings. <b>Conclusions:</b> The smoking prevention and cessation intervention based on the transtheoretical model, as delivered in this trial, is ineffective in schoolchildren aged 13-14. <h3>Key messages</h3> The transtheoretical model proposes that individuals move through a series of stages in behaviour change A computer programme gave 13 and 14 year old school students tailored information about what stage they were in and what to do to move to the next stage Students given this information were no more likely to move stage, refrain from smoking, or stop smoking than those exposed to ordinary classroom health education There is no evidence that the computerised expert system based on the transtheoretical model is effective in smoking prevention and cessation
Hematopoietic cell transplantation in patients with myelodysplastic syndrome or acute myeloid leukemia arising from myelodysplastic syndrome: similar outcomes in patients with de novo disease and disease following prior therapy or antecedent hematologic disorders
Authors: ChunKang Chang, Barry E. Storer, Bart L. Scott, Eileen M. Bryant, Howard M. Shulman, Mary E. Flowers, Brenda M. Sandmaier, Robert P. Witherspoon, Richard A. Nash, Jean E. Sanders, Antonio Bedalov, John A. Hansen, Bruce E. Clurman, Rainer Storb, Frederick R. Appelbaum, H. Joachim Deeg
Journal: Blood (2007)
Nudging Without Ethical Fudging: Clarifying Physician Obligations to Avoid Ethical Compromise
Authors: Emily Bell, Veljko Dubljevic, Eric Racine
Journal: The American Journal of Bioethics (2013)

Click to increase image sizeClick to decrease image size Acknowledgments Support for the writing of this commentary comes from the Canadian Institutes of Health Research (ER and EB) and the Social Sciences and Humanities Research Council of Canada (ER and VD). We thank Allison Yan for editorial support and comments on the commentary.
An Address on Arterial Sclerosis and Hypertonus in their Relation to Diet and to the Digestive System
Authors: W. Russell
Journal: BMJ (1904)

PERMIT me at the outset of my remarks to indicate the meaning I attach to the term arterio-sclerosis."Clinic- ally, the word means a thickening or induration arterial wall, perceptible to the sense of touch, the ordinary clinical method of examining vessels.My own observations1 on persons who have shown
Posterior Subcapsular Cataracts Induced by Corticosteroids in Patients with Rheumatoid Arthritis
Authors: Roger L. Black
Journal: JAMA (1960)

POSTERIOR subcapsular cataracts (PSC) are generally associated with exposure to toxic agents, posterior intraocular disease, ionizing radiation, or blunt trauma. As a rule these lenticular lesions are differentiated from senile cataracts by their location and appearance on slit lamp examination. The discovery of PSC, in the absence of any of the above etiologic factors, in four rheumatoid arthritis patients who were receiving prolonged administration of synthetic corticosteroids prompted a careful review and examination of rheumatoid arthritis patients available for study between June, 1959, and April, 1960. This survey revealed that 39% of patients with rheumatoid arthritis who had received long-term corticosteroid therapy developed PSC, whereas those who had not were free of this type of lenticular opacity. This ocular lesion, to date, has been relatively benign and has not caused severe impairment of vision. Since formation of PSC has not been described previously as one of the adverse effects of
Antenatal Exposure to Meprobamate and Chlordiazepoxide in Relation to Malformations, Mental Development, and Childhood Mortality
Authors: Stuart C. Hartz, Olli P. Heinonen, Samuel Shapiro, Victor Siskind, Dennis Slone
Journal: New England Journal of Medicine (1975)

In a follow-up study of 50,282 pregnancies (lasting at least five lunar months) and the offspring, malformations identified before the first birthday, or at death before the fourth birthday, were identified in 3248 children (6.5 per cent). A total of 1870 children exposed in utero to meprobamate or chlordiazepoxide were compared with 48,412 children who were not. No significant differences were found either overall or in specific outcomes; rates were also similar when exposures occurred during the first trimester or at other times during pregnancy. Deaths (stillbirth to the fourth birthday) occurred in 2227 children (4.4 per cent), and there was no evidence that antenatal exposure to either drug increased the death rate. Finally, as judged by mental and motor scores at the age of eight months, and intelligence quotient scores at four years, there was no evidence that the drugs cause brain damage.
It's time to be honest about NHS funding for the next five years
Authors: R. Webster
Journal: BMJ (2015)

If we had all the money in the world we would still need to change the NHS

Whoever wins the UK general election in May, funding for health is expected to stay below the long term NHS average. Even where a new government is willing to commit to additional funding—and there has been much debate this week, some of it acrimonious, over the various political pledges1—it is likely that unprecedented savings will still be required from the NHS, in line with figures set out in the Five Year Forward View .2

Politicians may experience deja vu. Before the 2010 election the former NHS chief executive David Nicholson wrote to set out the efficiency challenge over the next parliament, stating, “We need to look at 2010-11 as the first year of this new five-year strategy, not just the final year of growth.”3 Despite this notice, a debate on funding was absent from the political campaign, and NHS finances were barely mentioned in the main parties’ manifestos.

The NHS met the challenge and has delivered around £19bn (€26bn; $28bn) of efficiency savings. In doing so it has continued to increase its productivity by 1.5% a year, from a …
Atlas of Clinical Hematology
Authors: William Dameshek
Journal: JAMA (1961)

Professor Kato has had two medical lives, one in Chicago for many years until the outbreak of the War with Japan, and the second in Tokyo. While in Chicago, where he was one of the first pediatric hematologists, his hobbies were the collection of interesting blood smears and the meticulous painting of blood cells. In more recent years, he has been director of a hematology service in Tokyo, in direct supervision of a blood bank, and has been interested in hemorrhagic disorders. This atlas was begun years ago when Kato was in Chicago. There was then a long interval in which a war was fought. When it was concluded, the old work was resumed. The atlas was first published in Japan. Fortunately, the colored lithographs are the same as in the Japanese editions. The paintings of blood and bone marrow smears are beautifully reproduced at × 1,000 magnification and possess
The Comparative Oncology Trials Consortium: Using Spontaneously Occurring Cancers in Dogs to Inform the Cancer Drug Development Pathway
Authors: Ira Gordon, Melissa Paoloni, Christina Mazcko, Chand Khanna
Journal: PLoS Medicine (2009)

Chand Khanna and colleagues describe the work of the Comparative Oncology Trials Consortium (COTC), which provides infrastructure and resources to integrate naturally occurring dog cancer models into the development of new human cancer drugs, devices, and imaging techniques.
Introducing Statistics in Clinical Cancer Research
Authors: Steven Piantadosi
Journal: Clinical Cancer Research (2008)

Clinical Cancer Research is pleased to introduce a new feature in this issue, Statistics in Clinical Cancer Research. This new feature represents a part of the strategic focus of the American Association for Cancer Research (AACR) on the expanding importance of biostatistics in all aspects of cancer science. Statistics in Clinical Cancer Research will offer a forum for communication between biostatisticians and oncologists and an opportunity to inform researchers on statistical methods, to improve statistical methodology at all levels of the research process, and to offer new perspectives on statistical methods in cancer research. Articles will range from original research reports to full review articles to tutorials on topics presented at the AACR meetings and workshops.The first article in this feature, “Randomized Phase III Clinical Trial Designs for Targeted Agents,” was contributed by Dr. Antje Hoering and colleagues and examines the performance of several phase III clinical trial designs. These researchers evaluate three different trial designs, targeted, strategy, and randomize-all, and discuss the benefits of employing each.The second article is a review by Freidlin and colleagues, “Multi-arm Clinical Trials of New Agents: Some Design Considerations.” This article discusses the need in the development of anticancer therapies for more efficient randomized clinical trials designs that accelerate development, minimize costs, and make trials more appealing to patients.Our hope is that Statistics in Clinical Cancer Research will be viewed by both biostatisticians and cancer researchers as a mutually beneficial medium for the discussion of statistical methods and their use in cancer medicine. We look forward to submitted manuscripts as well as suggestions from our readers for future topics and to feedback from them on how we can make this feature more useful to their work.