tbuckley/cabot-search huggingface dataset:
Dirty, deluded, and dangerous
Authors: G. L. French
Journal: BMJ (2012)

Left to their own devices, doctors don’t always do the right thing

Obstetricians were outraged when, in 1846, Ignaz Semmelweis reduced mortality from puerperal fever in Viennese women from 16% to 3% by making doctors and medical students disinfect their hands between performing postmortems and delivering babies: they could not accept any criticism of their professional practice. Semmelweis lost his job and died in a lunatic asylum, while his dirty, deluded, and dangerous colleagues abandoned his policies, continued with their distinguished careers, and returned puerperal mortality to its previous appalling level.

Of course they did not know then, as we do now, that puerperal fever is caused by group A streptococcus, or that normal human skin is colonised by high concentrations of bacteria that transfer to the hands of staff during routine patient care and then on to other patients.1 2 They would have been shocked to discover that we now have incontrovertible evidence that hand decontamination significantly reduces the transfer of pathogens and the incidence of hospital and healthcare associated infections,2 and that Semmelweis has been vindicated.

Between the 1890s and the 1950s, the epidemiology of common bacterial pathogens was elucidated. This led to the universal introduction of standard hygiene measures, such as handwashing, no touch technique, gloving and gowning, instrument sterilisation, environmental …
Optimizing patient selection for myeloablative allogeneic hematopoietic cell transplantation in chronic myeloid leukemia in chronic phase
Authors: Jiří Pavlů, Andrea K. Kew, Beatrice Taylor-Roberts, Holger W. Auner, David Marin, Eduardo Olavarria, Edward J. Kanfer, Donald H. MacDonald, Dragana Milojkovic, Amin Rahemtulla, Katayoun Rezvani, John M. Goldman, Jane F. Apperley, Richard M. Szydlo
Journal: Blood (2010)
Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial
Authors: I. G Stiell, C. M Clement, J. Grimshaw, R. J Brison, B. H Rowe, M. J Schull, J. S Lee, J. Brehaut, R D. McKnight, M. A Eisenhauer, J. Dreyer, E. Letovsky, T. Rutledge, I. MacPhail, S. Ross, A. Shah, J. J Perry, B. R Holroyd, U. Ip, H. Lesiuk, G. A Wells
Journal: BMJ (2009)

<b>Objective</b> To evaluate the effectiveness of an active strategy to implement the validated Canadian C-Spine Rule into multiple emergency departments. <b>Design</b> Matched pair cluster randomised trial. <b>Setting</b> University and community emergency departments in Canada. <b>Participants </b>11 824 alert and stable adults presenting with blunt trauma to the head or neck at one of 12 hospitals. <b>Interventions</b> Six hospitals were randomly allocated to the intervention and six to the control. At the intervention sites, active strategies were used to implement the Canadian C-Spine Rule, including education, policy, and real time reminders on radiology requisitions. No specific intervention was introduced to alter the behaviour of doctors requesting cervical spine imaging at the control sites. <b>Main outcome measure</b> Diagnostic imaging rate of the cervical spine during two 12 month before and after periods. <b>Results</b> Patients were balanced between control and intervention sites. From the before to the after periods, the intervention group showed a relative reduction in cervical spine imaging of 12.8% (95% confidence interval 9% to 16%; 61.7% <i>v</i> 53.3%; P=0.01) and the control group a relative increase of 12.5% (7% to 18%; 52.8% <i>v</i> 58.9%; P=0.03). These changes were significant when both groups were compared (P&lt;0.001). No fractures were missed and no adverse outcomes occurred. <b>Conclusions</b> Implementation of the Canadian C-Spine Rule led to a significant decrease in imaging without injuries being missed or patient morbidity. Final imaging rates were much lower at intervention sites than at most US hospitals. Widespread implementation of this rule could lead to reduced healthcare costs and more efficient patient flow in busy emergency departments worldwide. <b>Trial registration</b> Clinical trials NCT00290875.
Postmenopausal Estrogen for Treatment of Hot Flashes
Authors: Heidi D. Nelson
Journal: JAMA (2004)

Use of postmenopausal estrogen has changed since the release of the first results from the Women's Health Initiative in 2002. Professional organizations, the US Food and Drug Administration, and the US Preventive Services Task Force have issued new recommendations against use of estrogen and progestin or progesterone for prevention of chronic conditions. This article applies the current state of evidence for postmenopausal estrogen use to management decisions in 2 clinical scenarios initiating therapy in a perimenopausal woman with hot flashes and discontinuing estrogen use in a long-term user.
INTRASPINAL OPERATIONS IN COMPENSATION CASES
Authors: ARTHUR ECKER
Journal: JAMA (1942)

In the past seven years there has been rapid progress in knowledge concerning intractable low back and sciatic pain due to intraspinal pressure on the nerve roots. The lesions are intraspinal protusion of the intervertebral disk, thickening of the ligamentum flavum, or both. Whereas the scientific aspects of these cases have been adequately reviewed elsewhere, 1 this paper is being presented to emphasize the features of the management of such operable intraspinal lesions which have to do with workmen's compensation.  For best results, cooperation between the insurance carrier and the responsible surgeon is essential. However, many managers of insurance companies have had the impression, based perhaps on unfortunate experiences with osteoplastic and other spinal operations, that any spinal operation is rarely successful in a compensation case. It is natural that these men, in all sincerity, have urged injured workmen to avoid any spinal operation whatsoever. It is hoped that this
Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation
Authors: John R. Wingard, Shelly L. Carter, Thomas J. Walsh, Joanne Kurtzberg, Trudy N. Small, Lindsey R. Baden, Iris D. Gersten, Adam M. Mendizabal, Helen L. Leather, Dennis L. Confer, Richard T. Maziarz, Edward A. Stadtmauer, Javier Bolaños-Meade, Janice Brown, John F. DiPersio, Michael Boeckh, Kieren A. Marr
Journal: Blood (2010)
Anomalous Origin of the Left Coronary Artery
Authors: J. Warren Harthorne, J. Gordon Scannell, Robert E. Dinsmore
Journal: New England Journal of Medicine (1966)

IN its usual form untreated congenital origin of the left coronary artery from the pulmonary artery leads to neonatal angina, infarction, congestive heart failure and death as originally described by Bland, White and Garland1 in 1933. The purpose of this report is to illustrate an example of this condition in an unusually large and active adult who underwent successful surgical correction.Case ReportAlthough this 18-year-old star basketball player had a congenital heart murmur, he was well until the age of 17. He then became increasingly dyspneic while playing basketball and required the administration of oxygen at "halftime." Shortly before . . .
Abstract 5135: Analysis of formalin-fixed paraffin-embedded (FFPE) samples.
Authors: Petar Stojanov, Scott L. Carter, Ivan Imaz Rosshandler, Andrey Sivachenko, Alberto Salido Guadarrama, Karla Vazquez, Sandra Romero Cordoba, Kristian Cibulskis, Carrie Sougnez, Douglas Voet, Gordon Saksena, Lee Lichtenstein, Lihua Zou, Scott Frazer, Chip Stewart, Rameen Beroukhim, Matthew Meyerson, Michael S. Lawrence, Gad Getz
Journal: Cancer Research (2013)

Abstract The availability of large numbers of formalin-fixed, paraffin-embedded (FFPE) tumor DNA samples, together with accurate and specific clinical annotations, can be a great resource for in-depth analysis of correlations of somatic and germline DNA alterations with clinical outcome. However, the effects of this tissue preservation technique on next-generation DNA sequencing technologies and downstream analyses are still being investigated. Furthermore, usually the archives of such FFPE samples do not include matched normal tissue, which complicates the process of identifying somatic alterations. We are in the process of analyzing lung adenocarcinoma, colorectal and prostate patient datasets, which contain both an FFPE and a fresh-frozen tumor together with a matched blood normal sample. The availability of both a frozen and an FFPE tumor sample enables us to compare the detected somatic point mutations and indels, taking into account the fact that these pairs are produced from different aliquots of DNA. This analysis includes calculating the power to detect variants in the FFPE sample given that they have been observed in the fresh frozen tumor, as well as the validation rate of clonal SNVs between the two samples. We are also developing a method for classification of SNVs as germline or somatic without a paired normal sample by taking advantage of the fact that most tumor samples contain a substantial fraction of normal cells. Because stromal contamination has a different effect on the allelic fraction of somatic vs. germline SNVs, we can apply algorithms to estimate tumor purity and absolute somatic copy numbers in order to distinguish the two types of events. We present preliminary results from these analyses. Citation Format: Petar Stojanov, Scott L. Carter, Ivan Imaz Rosshandler, Andrey Sivachenko, Alberto Salido Guadarrama, Karla Vazquez, Sandra Romero Cordoba, Kristian Cibulskis, Carrie Sougnez, Douglas Voet, Gordon Saksena, Lee Lichtenstein, Lihua Zou, Scott Frazer, Chip Stewart, Rameen Beroukhim, Matthew Meyerson, Michael S. Lawrence, Gad Getz. Analysis of formalin-fixed paraffin-embedded (FFPE) samples. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5135. doi:10.1158/1538-7445.AM2013-5135
Babies born after preimplantation genetic diagnosis need follow-up
Authors: Susan Mayor
Journal: BMJ (2006)

Use of genetic testing and reproductive techniques by people who have difficulty in having children or who are concerned about the possible genetic consequences if they do should be monitored carefully with long term follow-up of their children, says a UK report.

The report was developed after national consultation by the Human Genetics Commission, the body that advises the UK government on genetic technologies. …
Molecular analysis of new mutations for Huntington's disease: intermediate alleles and sex of origin effects
Authors: Y. Paul Goldberg, Berry Kremer, Susan E. Andrew, Jane Theilmann, Rona K. Graham, Ferdinando Squitieri, Håkan Telenius, Shelin Adam, Anaar Sajoo, Elizabeth Starr, Arvid Heiberg, Gerhard Wolff, Michael R. Hayden
Journal: Nature Genetics (1993)
Genome-Wide Association Study on Overall Survival of Advanced Non-small Cell Lung Cancer Patients Treated with Carboplatin and Paclitaxel
Authors: Yasunori Sato, Noboru Yamamoto, Hideo Kunitoh, Yuichiro Ohe, Hironobu Minami, Nan M. Laird, Noriko Katori, Yoshiro Saito, Sumiko Ohnami, Hiromi Sakamoto, Jun-ichi Sawada, Nagahiro Saijo, Teruhiko Yoshida, Tomohide Tamura
Journal: Journal of Thoracic Oncology (2010)
High Sensitive Cardiac Troponin T Levels in Newly Diagnosed Hypertensive Patients with Different Left Ventricle Geometry
Authors: Hakan Uçar, Mustafa Gür, Taner Şeker, Caner Türkoğlu, Onur Kaypaklı, Durmuş Yıldıray Şahin, Zafer Elbasan, Murat Çaylı
Journal: Journal of the American College of Cardiology (2013)
Biopsychosocial Study of Diabetes mellitus
Authors: Arcangelo Calobrisi
Journal: Psychotherapy and Psychosomatics (1983)

Historically the medical literature has made reference to psychogenic factors involved in the onset and course of diabetes mellitus. Today, as the reductionistic psychogenic theories are vanishing, one can envision a multicausal interactive model. This includes factors related to life experience mediated by genetic, neurophysiological, endocrine, immune, and psychological functions. New insights into psychophysiological mechanisms and a pluralistic approach will assist the clinician in a more effective therapeutic management of the illness.
Effect of Lead Exposure and Ergonomic Stressors on Peripheral Nerve Function
Authors: Margit L. Bleecker, D. Patrick Ford, Christopher G. Vaughan, Karen N. Lindgren, Michael J. Tiburzi, Karin Scheetz Walsh
Journal: Environmental Health Perspectives (2005)

In this study we investigated the effect of recent and chronic lead exposure, and its interaction with ergonomic stressors, on peripheral nerve function. In a cross-sectional design, we used retrospective exposure data on 74 primary lead smelter workers. We measured blood and bone lead levels and, from historical records, calculated lead dose metrics reflecting cumulative lead exposure: working-lifetime integrated blood lead (IBL) and working-lifetime weighted-average blood lead (TWA). We additionally created five metrics related to IBL that cumulated exposure only above increasing blood lead levels ranging from 20 to 60 μg/dL (IBL20–IBL60). Current perception threshold (CPT) assessed large myelinated (CPT2000), small myelinated (CPT250), and unmyelinated (CPT5) sensory nerve fibers. Using multiple linear regression, we modeled CPT on the different measures of lead dose after adjusting for relevant covariates. CPT had a curvilinear relationship with TWA, with a minimum at a TWA of 28 μg/dL. Both TWA and IBL accounted for a significant percentage of the variance of CPT2000 (ΔR2 = 8.7% and 3.9%, respectively). As the criterion blood lead level increased from IBL20 through IBL60, so did the percentage of CPT2000 variance explained, with ΔR2 ranging from 5.8% (p &lt; 0.03) for IBL20 to 23.3% (p &lt; 0.00) for IBL60. IBL60 also significantly contributed to the explanation of variance of CPT250 and significantly interacted with ergonomic stressors. Measures of chronic blood lead exposure are associated with impairment of large and small myelinated sensory nerve fibers. This effect is enhanced at the highest doses by ergonomic stressors.
Angiotensin II, distal nephron acidification, acid retention, and possibly increased ammonia levels?
Authors: Maurizio Gallieni, Ida Molfino
Journal: Kidney International (2013)

To the Editor: We read with great interest results of the experimental work by Wesson et al.,1.Wesson D.E. Jo C.H. Simoni J. Angiotensin II receptors mediate increased distal nephron acidification caused by acid retention.Kidney Int. 2012; 82: 1184-1194Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar showing that H+ retention caused by 2/3 nephrectomy augments distal nephron acidification predominantly through increased angiotensin II (ATII) activity. A normal renal response to acidemia includes an increase in urinary ammonium excretion.2.Kurtzman N.A. Disorders of distal acidification.Kidney Int. 1990; 38: 720-727Abstract Full Text PDF PubMed Scopus (60) Google Scholar As the urine pH cannot decrease below ∼4.5, the acid must be excreted in buffered form as titratable acid or as ammonium. Urinary acidification is impaired if ammonium excretion does not rise, irrespective of how low the urine pH decreases. In other words, a normal renal response to acidemia is associated with an increase in urinary ammonium excretion. We recently described a clinical case3.Oertelt-Prigione S. Crosignani A. Gallieni M. et al.Severe hepatic encephalopathy in a patient with liver cirrhosis after administration of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy: a case report.J Med Case Reports. 2010; 4: 141Crossref PubMed Scopus (5) Google Scholar that might be related to the findings of Wesson et al.1.Wesson D.E. Jo C.H. Simoni J. Angiotensin II receptors mediate increased distal nephron acidification caused by acid retention.Kidney Int. 2012; 82: 1184-1194Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar and to findings of another animal model,4.Nagami G.T. Ammonia production and secretion by S3 proximal tubule segments from acidotic mice: role of ANG II.Am J Physiol Renal Physiol. 2004; 4: F707-F712Crossref Scopus (29) Google Scholar suggesting that ATII is essential to the control of ammonia production and excretion by the renal tubule. We observed the occurrence of severe hepatic encephalopathy after administration of a combination of angiotensin converting enzyme inhibitor and ATII receptor blocker to a patient with nephrotic syndrome and liver cirrhosis. Thus, when both renal and hepatic function are impaired, acidemia might increase both ATII and ammonia production, but then pharmacological ATII antagonism can block acid and ammonia excretion, increasing serum ammonia levels and potentially precipitating hepatic encephalopathy. The experimental model of Wesson et al.1.Wesson D.E. Jo C.H. Simoni J. Angiotensin II receptors mediate increased distal nephron acidification caused by acid retention.Kidney Int. 2012; 82: 1184-1194Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar might be a precious tool to explore the relationship between the renin–angiotensin–aldosterone system and ammonia production in animals affected by liver and kidney impairment.
Decision aids and uptake of screening
Authors: H. L. Bekker
Journal: BMJ (2010)

Aids improve informed decision making, but not necessarily uptake

Two linked papers assessed patient information in the prevention of bowel cancer: Kirkegaard and colleagues (doi:10.1136/bmj.c5504) encouraged adherence with lifestyle recommendations,1 and Smith and colleagues (doi:10.1136/bmj.c5370) facilitated informed screening choices.2 Smith and colleagues’ study evaluated a decision aid to inform adults’ choices about faecal occult blood testing. The results raise the possibility that uncritical acceptance of informed choice initiatives may cause more harm than good.

Decision aids help people decide between two or more options. They are based on evidence from the decision sciences on how judgments and decisions are altered when facts are presented in different ways. Decision aids include several components that limit the influence that the style of presentation has on judgments and choices, encourage people to attend to the pertinent facts, encourage people to think explicitly about the facts and how they fit with their existing beliefs, and help them use these evaluations to reach a decision.3 

Decision aids help patients clarify why the treatment or test option they choose is better for them than the …
24-hour glucose profiles during continuous or oscillatory insulin infusion. Demonstration of the functional significance of ultradian insulin oscillations.
Authors: J Sturis, A J Scheen, R Leproult, K S Polonsky, E van Cauter
Journal: Journal of Clinical Investigation (1995)

Under basal and stimulated conditions, normal insulin secretion oscillates with periods in the ultradian 100-150-min range. To test the hypothesis that oscillatory insulin delivery is more efficient in reducing blood glucose levels than continuous administration, nine normal young men were each studied on two occasions during a 28-h period including a period of polygraphically recorded sleep. Endogenous insulin secretion was suppressed by somatostatin, a constant intravenous glucose infusion was administered, and exogenous insulin was infused either at a constant rate or in a sinusoidal pattern with a period of 120 min. The mean glucose level over the 28-h period was 0.72 +/- 0.31 mmol/liter lower when insulin was infused in an oscillatory pattern than when the rate of infusion was constant (P < 0.05). The greater hypoglycemic effect of oscillatory versus constant infusion was particularly marked during the daytime, with the difference averaging 1.04 +/- 0.38 mmol/liter (P < 0.03). Serum insulin levels tended to be lower during oscillatory than constant infusion, although the same amount of exogenous insulin was administered under both conditions. Ultradian insulin oscillations appear to promote more efficient glucose utilization.
Simple Test for Ingested Iron in Hospital and Domiciliary Practice
Authors: A. M. Afifi, G. S. Banwell, R. J. Bennison, K. Boothby, P. D. Griffiths, R. G. Huntsman, G. C. Jenkins, R. G. L. Smith, J. McIntosh, A. Qayum, I. R. Russell, J. N. Whittaker
Journal: BMJ (1966)

Widespread use of iron preparations has resulted from recog nition of the greater metabolic requirement of iron in pregnancy. The side-effects ascribed to these drugs by patients have made many practitioners doubt that all their patients carry out the prescribed treatment. Indeed, one practitioner has observed that when the antenatal patients were given an iron preparation and told that these tablets were  vitamins  they would remind liim that they had finished the supply. This was a rare occurrence before the subterfuge was practised. Failure to take the tablets results in a toxic substance lingering in a household often containing children. Also patients may be labelled improperly as cases of iron-resistant pregnancy anaemia, with consequent resort to parenteral iron or blood transfusion?
Mr Holloway's marvellous medicines
Authors: T. Dalrymple
Journal: BMJ (2011)

He who expects honesty in advertising expects palm trees in Antarctica and penguins in the Congo: in other words, marvels never to be found. Though many know this, however, many are influenced by advertising, and the two groups probably overlap. People are inclined to believe that because there is no smoke without fire, no encomium can be entirely without foundation.

This is particularly true of advertising of patent medicines. I happened recently, for research purposes, to be leafing through a provincial newspaper of the 1840s, much of the advertising space of which was occupied by encomiums to patent medicines. The advertisement for Lord Eldon’s aperient pills, for example, starts with a quotation from John Abernethy, late surgeon to St Bartholomew’s: …
Chemical changes of human knee joint menisci in various stages of degeneration.
Authors: J Herwig, E Egner, E Buddecke
Journal: Annals of the Rheumatic Diseases (1984)

Human knee joint menisci graded according to degenerative alterations were submitted to chemical analysis. Normal menisci contained 72% water, 0.12% DNA, 22% collagen, and 0.8% total glycosaminoglycans with the following glycosaminoglycan distribution pattern: 40% chondroitin 6-sulphate, 10-20% chondroitin 4-sulphate, 20-30% dermatan sulphate, and 15% keratan sulphate. The water content increased with increasing degeneration, whereas the collagen and glycosaminoglycan contents decreased with relative increase of chondroitin 6-sulphate.
Englerin A Stimulates PKCθ to Inhibit Insulin Signaling and to Simultaneously Activate HSF1: Pharmacologically Induced Synthetic Lethality
Authors: Carole Sourbier, Bradley T. Scroggins, Ranjala Ratnayake, Thomas L. Prince, Sunmin Lee, Min-Jung Lee, Peter Literati Nagy, Young H. Lee, Jane B. Trepel, John A. Beutler, W. Marston Linehan, Len Neckers
Journal: Cancer Cell (2013)
Surgeons and safety
Authors: William G Notcutt
Journal: Journal of the Royal Society of Medicine (2009)

So surgeons are looking to the airline industry now for guidance on safety.1 What a pity they don't glance over the screen at the top of the operating table to the anaesthetist. We have been doing ‘Cockpit Drills’ for 30 years or more. The parallels between the processes of flying and anaesthesia are closer than with surgery.

Over the years I have observed that anaesthetists in general spend far more time than the surgeon in undertaking pre-assessment, both of the patient and of the work environment. How long have I waited in theatre for the X-rays or a favoured surgical tool to be found, which a little forethought would have made available when needed.

Learn about preparation by all means but don't bother to go to the hangar, ask on the other side of the screen.