tbuckley/cabot-search huggingface dataset:
Incidence and Prognostic Significance of Thrombocytopenia Developed During Acute Coronary Syndrome in Contemporary Clinical Practice
Authors: Tracy Y. Wang, Fang-Shu Ou, Matthew T. Roe, Robert A. Harrington, E. Magnus Ohman, W. Brian Gibler, Eric D. Peterson
Journal: Circulation (2009)

Prior studies examining thrombocytopenia among patients with acute coronary syndromes (ACS) evaluated highly selected patients in a clinical trial setting using varying definitions of thrombocytopenia. The incidence, severity, and prognostic significance of acquired thrombocytopenia during ACS in community practice have not been well defined.We examined 36 182 patients with non-ST-segment elevation ACS enrolled at 379 US hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) quality improvement initiative between June 2004 and December 2006. Patients with baseline platelet counts <150x10(9)/L were excluded. Overall, 4697 patients (13%) developed new thrombocytopenia, defined as nadir platelet count <150x10(9)/L (referenced lower limit of normal), during their ACS hospitalization. Risks of in-hospital mortality and bleeding correlated directly with severity of thrombocytopenia; even mild thrombocytopenia (nadir 100 to 149x10(9)/L) was associated with increased risks of mortality (adjusted odds ratio [OR], 2.01; 95% CI, 1.69 to 2.38) and bleeding (adjusted OR, 3.76; 95% CI, 3.43 to 4.12). Each 10% drop in platelet count was associated with increased mortality and bleeding risks (adjusted ORs, 1.39 [95% CI, 1.33 to 1.46] and 1.89 [95% CI, 1.83 to 1.95], respectively). A >/=50% drop in platelet count was associated with higher risk of adverse outcomes regardless of the nadir count. A novel combined definition of acquired thrombocytopenia-nadir <150x10(9)/L or platelet count drop >or=50%-identifies a population of ACS patients at higher risk of mortality and major bleeding (adjusted ORs, 2.58 [95% CI, 2.23 to 2.98] and 4.32 [95% CI, 3.97 to 4.70], respectively).Thrombocytopenia, a common complication of ACS, is associated with increased mortality and bleeding risks. Even mild thrombocytopenia or a platelet count drop >/=50% in the setting of normal nadir values is clinically significant. Application of a combined definition for thrombocytopenia using both absolute and relative thresholds permits increased sensitivity for patients at high risk of adverse outcomes.
Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass
Authors: Pietro Lucotti, Lucilla Monti, Emanuela Setola, Giovanni La Canna, Alessandro Castiglioni, Alessandra Rossodivita, Maria Grazia Pala, Francesco Formica, Giovanni Paolini, Alberico Luigi Catapano, Emanuele Bosi, Ottavio Alfieri, PierMarco Piatti
Journal: Metabolism (2009)
257 ESTROGEN RECEPTOR IS INVOLVED IN THE IMPAIRMENT OF BILE SALT SECRETION INDUCED BY ESTRADIOL-17β-GLUCURONIDE IN ISOLATED RAT HEPATOCYTE COUPLETS
Authors: I. Barosso, A. Zucchetti, D. Taborda, E. Sánchez Pozzi, F. Crocenzi
Journal: Journal of Hepatology (2009)
Serum thyrotrophin concentration: an unreliable test for detection of early hypothyroidism after thyroidectomy.
Authors: G Hennemann, M Van Welsum, B Bernard, R Docter, T J Visser
Journal: BMJ (1975)

Three groups of patients who had undergone subtotal thyroidectomy for Graves's disease, toxic multinodular goitre, or euthyroid multinodular goitre 12 to 15 years before and in whom a normal serum thyroxine (T-4) level was found were each divided into two subgroups on the basis of a normal or a raised serum thyrotrophin concentration. There was no difference in mean serum T-4 concentration between patients with normal and those with raised serum thyrotrophin concentrations, and the values were similar to the mean T-4 values of the normal population. The mean serum triiodothyronine values of all groups were higher than normal, but the mean values of the groups with a normal and a raised serum thyrotrophin were similar. After thyroidectomy a mildly raised serum thyrotrophin does not in itself indicate the presence of hypothyroidism.
Review: First-line low-dose thiazides and ACE inhibitors reduce mortality and morbidity in adults with hypertension
Authors: Nirav R. Shah
Journal: Annals of Internal Medicine (2010)

ACP Journal Club19 January 2010Review: First-line low-dose thiazides and ACE inhibitors reduce mortality and morbidity in adults with hypertensionNirav R. Shah, MD, MPH, Gbenga Ogedegbe, MD, MPH, MSNirav R. Shah, MD, MPHNew York University School of Medicine, New York, New York, USA (N.R.S., G.O.)Search for more papers by this author, Gbenga Ogedegbe, MD, MPH, MSNew York University School of Medicine, New York, New York, USA (N.R.S., G.O.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-2-201001190-02004 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationWright JM, Musini VM. First-line drugs for hypertension. Cochrane Database Syst Rev. 2009;(3):CD001841. https://pubmed.ncbi.nlm.nih.gov/19588327Clinical Impact RatingsGIM/FP/GP: Cardiology: References1 Fretheim A, Oxman AD. International variation in prescribing antihypertensive drugs: its extent and possible explanations. BMC Health Serv Res. 2005;5:21. [PMID: 15762983] Google Scholar2 ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-97. [PMID: 12479763] Google Scholar3 Furmaga EM, Cunningham FE, Cushman WC, et al. National utilization of antihypertensive medications from 2000 to 2006 in the Veterans Health Administration: focus on thiazide diuretics. J Clin Hypertens (Greenwich). 2008;10:770-8. [PMID: 19090878] Google Scholar4 Fretheim A, Aaserud M, Oxman AD. The potential savings of using thiazides as the first choice antihypertensive drug: cost-minimisation analysis. BMC Health Serv Res. 2003;3:18. [PMID: 12959644] Google Scholar Author, Article, and Disclosure InformationAuthors: Nirav R. Shah, MD, MPH; Gbenga Ogedegbe, MD, MPH, MSAffiliations: New York University School of Medicine, New York, New York, USA (N.R.S., G.O.)This article was published at Annals.org on 5 January 2010. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAssessment of carotid intima-media thickness and carotid plaque formation among patients with ischemic stroke and hepatitis C virus infection 19 January 2010Volume 152, Issue 2 Page: JC1-4 Keywords ACE inhibitors Angiotensin converting enzyme Antihypertensive drug therapy Coronary heart disease Drugs Hypertension Mortality Stroke Systematic reviews Treatment guidelines ePublished: 19 January 2010 Issue Published: 19 January 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
US cancer patients have problems with insurance and care, says survey
Authors: Janice Hopkins Tanne
Journal: BMJ (2006)

Patients with cancer in the United States are poorly served by their health insurance companies and healthcare systems and often suffer financially, says a national survey by the newspaper USA Today , the Kaiser Family Foundation, and the Harvard School of Public Health. 

Half of US cancer patients and their families had problems with coordination of care. Most patients were treated well by their employers, but 25% of families (including both the insured and the uninsured) said that the person with the disease used up most or all of their savings and some money borrowed from relatives. 

Having health insurance during treatment limited the financial consequences, but, even so, …
Should journals publish systematic reviews that find no evidence to guide practice? Examples from injury research
Authors: P. Alderson
Journal: BMJ (2000)

Many systematic reviews are inconclusive and reinforce the message that there is clinical uncertainty. Phil Alderson and Ian Roberts argue that journals should make a point of publishing such reviews rather than waiting for reviews that show marked benefit or harm. Some experts disagree, however, but we failed to persuade them to commit their views to print.

Studies with dramatic findings make interesting reading. Journal editors understandably want to publish articles that their readers will enjoy. This is one cause of publication bias, where research with less dramatic results tends to be published in journals with a smaller circulation, if indeed it is published at all. Systematic reviews are no less vulnerable to this bias than other types of research. Should journals resist this pressure and make a point of publishing systematic reviews even if all they show is continuing clinical uncertainty? The answer will depend on the importance we attach to demonstrating uncertainty in medical practice.

#### Summary points

Denying uncertainty does not benefit patients and may increase health service costs

More large scale randomised trials need to be conducted based on the “uncertainty principle”

Systematic reviews with more dramatic results tend …
Duodenal mucosal architecture in non-specific and ulcer-associated duodenitis.
Authors: M Hasan, W Sircus, A Ferguson
Journal: Gut (1981)

This study was done to determine the severity and extent of abnormalities of duodenal mucosal architecture in non-specific (non-ulcerative) and ulcer-associated duodenitis. The effect of successful treatment with cimetidine on these changes has also been assessed. A method of microdissection and measurement of villus height, crypt depth, and mitotic figure count per crypt was applied to endoscopic biopsies from the duodenum. Five groups of patients were studied: untreated ulcer-associated duodenitis, untreated non-specific duodenitis, healed ulcer-associated and non-specific duodenitis after cimetidine treatment, and controls. Significant reduction in villus height, increase in crypt length, and increase in mitotic figure count per crypt were all found in both ulcer-associated and severe non-specific duodenitis as compared with controls. These changes were localised to visually inflamed areas and regressed after healing of these lesions with cimetidine. This is the first quantitative comparison of the architectural features between diseased states in the duodenum and control in the same study. Identical morphological changes in the form of crypt hyperplasia and villus atrophy were demonstrated in areas of non-specific and ulcer-associated duodenitis. No evidence could be found from this study that non-specific duodenitis constitutes a different disease from ulcer-associated duodenitis.
Standard Nomenclature for Primary Hepatic Tumors
Authors: Kamal G. Ishak
Journal: JAMA (1977)

<h3>To the Editor.—</h3> I wholeheartedly agree with Dr Mays (236:1469, 1976) that there is a great deal of confusion regarding the terminology of benign tumors of the liver. This state of affairs, however, is the result of lack of experience with these tumors, rather than the absence of clearly defined morphologic criteria. In reference to those tumors that have been discovered in women receiving oral contraceptives, the confusion has been compounded by histologic reinterpretations (and sometimes reinterpretations of the reinterpretations) of the published cases. The two tumors that have been frequently confused, viz, hepatocellular adenoma and focal nodular hyperplasia, have been well characterized and clearly distinguished morphologically for many years.<sup>1-3</sup>Also, an internationally accepted classification of hepatic tumors has been completed by the World Health Organization. Although the illustrated monograph has not yet been published, that classification has been incorporated into the recently published<i>Standardized Nomenclature, Diagnostic Criteria and</i>
The COMA report: what it left out
Authors: J H Baron
Journal: BMJ (1985)

We examined brain biopsy tissue from five patients with a neurologic syndrome consistent with Creutzfeldt-Jakob disease using Western blot analysis and immunohistochemistry for the detection of protease-resistant prion protein, in addition to histopathologic examination. Our results indicate that the formation of protease-resistant prion protein is an early event in disease pathogenesis and Western blot analysis can detect protease-resistant prion protein in the absence of structural lesions using a small amount of brain biopsy tissue. <b>NEUROLOGY 1996;46: </b> 1690-1693
Intermittent Warm Blood Cardioplegia
Authors: Samuel V. Lichtenstein, C. David Naylor, Christopher M. Feindel, Kathy Sykora, James G. Abel, Arthur S. Slutsky, C. David Mazer, George T. Christakis, Bernard S. Goldman, Stephen E. Fremes
Journal: Circulation (1995)

Background Warm heart surgery implies continuous perfusion with normothermic blood cardioplegia. Interruption of cardioplegia, however, facilitates construction of distal coronary anastomoses and is the method practiced by many surgeons. To determine whether intermittency is harmful, we present results from 720 coronary bypass patients, protected with intermittent antegrade warm blood cardioplegia, that were derived from a previous study of normothermic versus hypothermic cardioplegia. Methods and Results Mean±SD age was 60.8±9.0 years; 27% of cases were urgent; 16% of patients had &gt;50% left main stenosis, and 19% had grade III or IV ventricles. A mean of 3.2±0.9 grafts was constructed. The average aortic cross-clamp time was 61.8±22.2 minutes. The longest single time off cardioplegia (LTOC) averaged 11.4±4.0 minutes per patient. The cumulative time off cardioplegia as a percentage of the cross-clamp time (PTOC) was 48.2±18.6% per patient. LTOC and PTOC were divided into quartiles (LTOC, &lt;10, 10 to 11, 12 to 13, and &gt;13 minutes; PTOC, &lt;36%, 36% to 49%, 50% to 62%, and &gt;62%) and related to the prespecified composite outcome of mortality, myocardial infarction according to serial CK-MB sampling, and low-output syndrome (LOS). Longer LTOC was harmful (event rates per quartile, 13.5%, 10.3%, 10.9%, and 19.0%; P =.046), whereas longer PTOC was protective (16.1%, 17.2%, 9.4%, and 10.6%; P =.07). Stepwise logistic regression was performed, controlling for demographic and angiographic predictors. In the multivariate models, LTOC remained detrimental ( P =.07) and PTOC remained beneficial ( P =.053). Additional modeling after entering surgeon identity ( P &lt;.001) into the risk equation eliminated the PTOC effect, whereas LTOC remained predictive of adverse outcomes ( P =.053; odds ratio, 1.06; 95% CI, 1.00, 1.13). Conclusions The data indicate that a reasonable margin of safety exists with intermittent, antegrade warm blood cardioplegia. Repeated interruptions of warm blood cardioplegia are unlikely to lead to adverse clinical results if single interruptions are ≤13 minutes.
Quality of UK consumer health tests to be scrutinised
Authors: Caroline White
Journal: BMJ (2004)

Concerns that consumer health tests offered by UK retail outlets fail to meet quality standards routinely used in NHS laboratories have prompted calls for regulations to be tightened to guarantee public safety.

The move follows a small amount of anecdotal evidence on cholesterol testing submitted to the Royal College of Pathologists and the National Patient Safety Agency amid fears that this might signal a wider problem.

Cholesterol testing has joined the range of point of sale tests, since the government made the cholesterol lowering drug simvastatin available over the counter in England and Wales …
A 35 year old woman with diabetic nephropathy who wants a baby: case outcome
Authors: Giorgina Barbara Piccoli, Elisabetta Mezza, Giorgio Grassi, Manuel Burdese, Tullia Todros
Journal: BMJ (2004)

Four weeks ago, we presented the case of Maria Tomasa, who had requested in vitro fertilisation (18 September, p 674). As none of us had any direct experience of assisted conception in patients with overt diabetic nephropathy we searched the literature to determine the risk (25 September, p 729). The data were limited, and after extensively discussing the odds and risks with Tommy on three occasions, we decided to support her decision to have in vitro fertilisation and organised treatment.

Two embryos were placed and one implanted. Two weeks after the procedure, Tommy developed ovarian hyperstimulation syndrome with ascites. When proteinuria increased to 9 g/day in the third month of pregnancy, she …
Research in the Teaching-Learning Process — Two Experimental Modules
Authors: Thomas Hale Ham
Journal: New England Journal of Medicine (1964)

THE role of the educator is the translation of a purpose by the planning of an educational program to accomplish this purpose. Then comes the construction, the use and the evaluation of the effectiveness of the education. The purpose of the education must be clearly drawn because from it comes the plan for such diverse programs as primary education, technical training, professional education, graduate education, education in research education in engineering, and nursery school and theologic education.Planning of the program finally relates to its use by the student. Accordingly, the educator considers the detailed effects on the student of . . .
Interstitial lung diseases in infants and children
Authors: A. Clement, E. Eber
Journal: European Respiratory Journal (2008)

Interstitial lung disease (ILD) in infants and children represents a heterogeneous group of respiratory disorders that are mostly chronic and associated with high morbidity and mortality. Typical features of ILD include dyspnoea, the presence of diffuse infiltrates on chest radiographs and abnormal pulmonary function tests with evidence of a restrictive ventilatory defect (in older children) and/or impaired gas exchange. ILD is difficult to diagnose, as no classification scheme is entirely satisfactory. Recently, it has been proposed to categorise paediatric ILD as either primary pulmonary disorders or systemic disorders with pulmonary involvement. However, this classification leaves the difficult problem of which clinical conditions should be included or excluded in infants and children. The present article reviews interstitial lung disease in infants and children, placing emphasis on current concepts of pathophysiological mechanisms and approaches to treatment.
Remarks on a Case of Relapsing or Intermittent Pneumonia Occurring in an Aged Man
Authors: A. Clark
Journal: BMJ (1884)

was summioned to see a gentlemani who, five days, had been complaining of disordered digestion, geneial malaise, aching of the limbs, and feverishness.The patient was 82 years of ag, tall, spare, likht.eyed)ands in-health, vivacious, temperate almost to abstinence, actively'L pied with private and public business, going out weathers, never sparing hitself when summoned to work.In 1877, the patient had anattack of pneumonia, the greater lengtll of its prodro 'al stage, closely attack whioh is now to be described.On that occasion, patient was attended by Mr. Potts, and was seen from William Gull and myself.Thepatient made light of the illness for which.ee him, and referred it to a chill, which he had, caught down in. the park, without an overcoat, when ride.At the time of the examination, the patient and ill; the eyes were dul; the face was yellowish; loaded ; the appetite gone * there was thirst ; bowels'were inadequately relieved; the abdomen was full; and high urine, freefrom albumen,was loaded with lithates.breathing at theposterior.base of the 'right nothihg covered in the chest.The heart, fairly strong, sounds, and withoutmurmur, eighty-six times sufficient amount of blood reached the smaller arteries, exceptionally soft, and' 6therwise sound.The mouth was 102'.The 'skin was hot, pungent, dry.Nothing was discovered in the nervous system; but the a dull headache,and of difficulty of mental exertionl.guinal hernia had existed for some years.
The Annual of Psychoanalysis
Authors: Winnifred F. Storey
Journal: JAMA (1979)

There are some 20 essays in this collection authored by professionals on the current diffusion of Freudian metapsychology into other fields of study—history, philosophy, physics and mathematics, the humanities, religion, and sociology. Stephen Toulmin's<i>Psychoanalysis, Physics, and the Mind-body Problem</i>is discussed by Paul Ricoeur and by Don Swanson. This tripartite essay has the tight and lucid thought of the scholar. Throughout, the reader is caught up in the vigor of the rereading of Freud's writings that is in progress in Western Europe now that three quarters of a century has elapsed since Freud's ostracism by European scholars and medical colleagues. A panoramic view of the growth of the metapsychology in America during the past 75 years is presented by John Demos in his<i>Oedipus in America: Historical Perspectives on the</i><i>Reception of Psychoanalysis in the United States</i>. The psychohistory of America during the last two centuries is outlined in
Review: Sumatriptan plus naproxen improves acute migraine more than placebo, sumatriptan, or naproxen
Authors: Alexander W. Chessman
Journal: Annals of Internal Medicine (2014)

ACP Journal Club18 February 2014Review: Sumatriptan plus naproxen improves acute migraine more than placebo, sumatriptan, or naproxenAlexander W. Chessman, MDAlexander W. Chessman, MDMedical University of South Carolina, Charleston, South Carolina, USA (A.W.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-160-4-201402180-02008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationLaw S, Derry S, Moore RA. Sumatriptan plus naproxen for acute migraine attacks in adults. Cochrane Database Syst Rev. 2013;(10):CD008541. https://pubmed.ncbi.nlm.nih.gov/24142431Clinical Impact RatingsGIM/FP/GP: Emergency Med: Neurology: References1 Law S, Derry S, Moore RA. Naproxen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;10:CD009455. [PMID: 24142263] Google Scholar2 Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev. 2012;2:CD008615. [PMID: 22336849] Google Scholar3 Derry S, Moore RA. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;4:CD008040. [PMID: 23633349] Google Scholar4 Rabbie R, Derry S, Moore RA. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;4:CD008039. [PMID: 23633348] Google Scholar5 Derry S, Rabbie R, Moore RA. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;4:CD008783. [PMID: 23633360] Google Scholar6 Kirthi V, Derry S, Moore RA. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2013;4:CD008041. [PMID: 23633350] Google Scholar Author, Article, and Disclosure InformationAffiliations: Medical University of South Carolina, Charleston, South Carolina, USA (A.W.C.)This article was published at Annals.org on 4 February 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByTriptans and migraine: advances in use, administration, formulation, and development 18 February 2014Volume 160, Issue 4Page: JC8KeywordsAdverse eventsDatabasesDrugsHeadachesMigraineNSAIDsSafety ePublished: 18 February 2014 Issue Published: 18 February 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...