tbuckley/cabot-search huggingface dataset:
Nonattendance at Outpatient Endoscopy
Authors: L. Adams, J. Pawlik, G. Forbes
Journal: Endoscopy (2004)

Background and Study Aims: Nonattendance at outpatient endoscopy leads to inefficiency and delay in diagnosis. We aimed to identify factors associated with failure to attend outpatient gastroscopy and colonoscopy. Patients and Methods: We carried out a retrospective audit of nonattendance at outpatient endoscopy over a 12-month period at our tertiary hospital endoscopy unit. Attending patients on the same endoscopy list were used as controls. Patient charts and referral letters were reviewed. The information collected included referral source, time between referral and procedure, indication and type of procedure, reason for nonattendance and history of previous endoscopy. Following the audit a trial of telephone reminders was implemented over a 3-month period. Results: From 2157 outpatient procedures that were scheduled, 263 nonattendees (12.2 %) were identified with 261 controls. Of the nonattendees, 109 (41 %) did not attend for colonoscopy, 121 (46 %) did not attend for gastroscopy and 33 (13 %) failed to turn up for combined procedures. Monday was the most common day of the week for nonattendance (40 % of nonattenders). Nonattendees were younger (46 ± 14 vs. 55 ± 16, P < 0.001), less likely to be referred from a gastroenterologist (P < 0.001) or private practice (P = 0.02) and more likely to be referred from the emergency department (P = 0.007). Subsequent to this, a 3-month period of telephone reminder reduced nonattendance rates from 12.2 % to 9 % (P = 0.03). Conclusions: Younger patients scheduled for outpatient endoscopy on Mondays who are not referred by a gastroenterologist or private physician are more likely not to attend. These patients should be targeted for interventions designed to increase attendance. Telephone reminders have a modest effect on reducing nonattendance rates.
Bone-marrow transplantation for severe aplastic anaemia using histocompatible unrelated volunteer donors.
Authors: E C Gordon-Smith, S M Fairhead, P M Chipping, J Hows, D C James, A Dodi, J R Batchelor
Journal: BMJ (1982)

Two patients with severe aplastic anaemia received bone-marrow transplants from unrelated donors selected for HLA compatibility. Graft-versus-host disease occurred in both patients but responded to treatment. Both patients had stormy courses after grafting, but subsequently their conditions improved, and one was not receiving any treatment at follow-up after day 330 while the other had mild chronic graft-versus-host disease at day 150. These results show that unrelated, histocompatible volunteers may successfully donate marrow for the treatment of severe aplastic anaemia, though many problems remain to be solved.
Inspectors to investigate baby's death in Sicily after neonatal bed could not be found
Authors: Michael Day
Journal: BMJ (2015)

Concern over the state of Italy’s healthcare system has been raised after the death of a newborn baby who was transported across Sicily in search of an intensive care cot.

The row grew on the evening of 11 February as the new head of state, President Sergio Mattarella, telephoned the governor of Sicily, Rosario Crocetta, to express his “incredulity and sadness” that the baby girl died in an ambulance during her 110 km journey to Ragusa because no hospital in Catania had room for her.

Experts say that Italy’s health system, until recently ranked as one of the world’s best by the World Health Organization, …
Outcomes Among Patients Discharged From Busy Intensive Care Units
Authors: Jason Wagner, Nicole B. Gabler, Sarah J. Ratcliffe, Sydney E.S. Brown, Brian L. Strom, Scott D. Halpern
Journal: Annals of Internal Medicine (2013)

Chinese translation Background: Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions. Objective: To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post–ICU discharge outcomes. Design: Retrospective cohort study from 2001 to 2008. Setting: 155 ICUs in the United States. Patients: 200 730 adults discharged from ICUs to hospital floors. Measurements: Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post–ICU discharge LOS, and hospital discharge destination. Results: Increases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P < 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS. Limitation: Long-term outcomes could not be measured. Conclusion: When ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes. Primary Funding Source: Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.
"Portraits of Guy's men".
Authors: F. J. Miller
Journal: BMJ (1968)

arrangements.Although this figure accounted for only 11% of staff, it had grown from 3.4% in just over two years, and the trend appears to be continuing.Pioneers naturally stimulate interest and enthusiasm and one should therefore be cautious about accepting their judgement of the value of their developments.However, detailed studies`' examining the work of local authority staff in attached and un- attached situations, and in particular a study by this unite conducted simultaneously in Oxford (where there was general attachment) and other towns where there were no attach- ments, seem to bear out Dr. Warin's generally favourable conclusions about this method of working.The next step appears to be the link with hospital services.-Weare, etc.,
MECHANISMS OF RESPIRATORY FAILURE UNDER BARBITURATE ANESTHESIA (EVIPAL, PENTOTHAL) 1
Authors: Henry K. Beecher, Carl A. Moyer
Journal: Journal of Clinical Investigation (1941)

With the growing use of the barbiturates in anesthesia and in medicine in general, it becomes increasingly important to understand the hazards this entails, not only so that accidents of the past may be explained but, chiefly, so that they can be prevented in the future.In this study our atten- tion has been directed to the respiration.While other systems may also be affected adversely by the barbiturates, the respiration frequently gives the first warning of impending difficulties.Re- spiratory failure often plays an important part in death under these agents.This study was de- signed primarily to investigate the mechanisms leading to respiratory failure under evipal and pentothal anesthesia.Since the barbiturates are qualitatively very similar in their actions, it is probable that the mechanisms described here ap- ply to many members of the group.EQUIPMENT AND PROCEDURES Animals.Mongrel dogs weighing about 10 kilograms were employed.Blood pressure was recorded by means of a Ludwig manometer from the femoral artery.The representative material presented here was chosen from that obtained in experiments on 43 dogs under the two anesthetic agents considered.Aniesthesia.Evipal sodium [1 methyl 5A' cyclohexenyl 5 methyl barbiturate] in 10 per cent aqueous solution was administered intravenously in an initial dose of 50 mgm.per kgm.body weight.This was supplemented intra- venously as needed during the preparation of the animal and the course of the experiment.Pentothal sodium [ethyl (1-methyl-butyl) thiobarbiturate] in 5 per cent aqueous solution was administered intravenously in an initial dose of 25 mgm.per kgm.body weight.Additional anesthetic was added intravenously as needed.The points illustrated hold true for both agents.Sometimes one agent, sometimes the other, is used to demon- strate a given point.Depth of anesthesia was controlled as carefully as pos- sible by observation of the state of a spinal reflex.The flexion reflex of the left semitendinous muscle was
Detection of hyperparathyroidism.
Authors: A. Heffernan, H. Carty
Journal: BMJ (1969)

splitting of the finger-nails provided me with a clue to the diagnosis in these cases.The coexistence of nail changes and a raised serum uric acid in 19 cases would appear to suggest that reeding and splitting and brittle- ness, either individually or together, may be a frequent physical sign in hyperuricaemia and might warrant further investigation-I am, etc.,
Reduced serum vitamin B-12 in patients taking metformin
Authors: J. Vidal-Alaball, C. C. Butler
Journal: BMJ (2010)

The binding of allosteric modulators to G protein-coupled receptors (GPCRs) is often described by an equilibrium allosteric ternary complex model (ATCM). This study evaluated the effects of three modulators on the binding of [<sup>3</sup>H]<i>N</i>-methylscopolamine ([<sup>3</sup>H]NMS) to the human M<sub>2</sub> muscarinic acetylcholine receptor (mAChR). The binding of each modulator was more complex than predicted by the ATCM; the inhibitors heptane-1,7-bis-(dimethyl-3-phthalimidopropyl)-ammonium bromide and gallamine yielded biphasic curves that were described empirically by a two-site binding model, whereas the enhancer alcuronium yielded a bell-shaped curve. Radioligand dissociation assays revealed that the modulators retarded [<sup>3</sup>H]NMS kinetics such that the system never attained equilibrium. Subsequent application of a kinetic ATCM accommodated and quantified all experimental observations. Our findings confirm and extend previous studies on the use of a kinetic ATCM for mAChR allosteric enhancers, but also highlight how complex curves displayed by allosteric inhibitors can be misinterpreted in terms of multisite orthosteric binding. It is possible that similar behavior of other allosteric modulators at GPCRs may reflect nonequilibrium binding artifacts rather than deviation from an ATCM.
Trigeminal Neuropathy and Neuritis
Authors: Norman P. Goldstein
Journal: JAMA (1963)

Trigeminal neuropathy is a syndrome in which there is a disorder of sensation (and occasionally of motility) confined to the distribution of the fifth cranial nerve. Treatment for this condition depends upon understanding of its causes, which are various. Sixty-one cases of trigeminal neuropathy were separated into six groups, according to the presumed cause. The neuropathy followed a dental procedure in 21 patients and resulted from the pressure of a denture on the mental nerve in another eight. Surgical (other than dental) or mechanical trauma caused eight instances. Hydroxystilbamidine isethionate produced bilateral trigeminal neuropathy in seven cases. Ten patients made up a miscellaneous group, of whom three had tumors, two had intracranial aneurysms, and two had herpetic lesions. There was also a group of seven in which no cause was discovered.
EMPYEMA AND PULMONARY ABSCESS.
Authors: P. C. REMONDINO
Journal: JAMA (1890)

Your interesting editorial on the necessity of a careful diagnosis in these affections, so as not to overlook the possibility of an empyema, are to the point. Too many patients are sent to sanitoriums with an hepatized lung requiring<i>absolute rest</i>even to the point of strapping the chest at times, and are simply told that they will not require any medical advice, but on their arrival they are simply to take all exercise possible—advice that they not only take but are sure to overdo—a weakened heart and an impervious lung, with its tissues on the balance as to whether they shall go towards health by proper resolution or go into softening and decay, very soon render a simple case of the most common results of pneumonia that would otherwise recover, into one simulating a case of advanced phthisis, and with the same disastrous results. Eighteen years of practice among
Effect on the Quality of Peer Review of Blinding Reviewers and Asking Them to Sign Their Reports
Authors: Fiona Godlee, Catharine R. Gale, Christopher N. Martyn
Journal: JAMA (1998)

Context.—Anxiety about bias, lack of accountability, and poor quality of peer review has led to questions about the imbalance in anonymity between reviewers and authors.Objective.—To evaluate the effect on the quality of peer review of blinding reviewers to the authors' identities and requiring reviewers to sign their reports.Design.—Randomized controlled trial.Setting.—A general medical journal.Participants.—A total of 420 reviewers from the journal's database.Intervention.—We modified a paper accepted for publication introducing 8 areas of weakness. Reviewers were randomly allocated to 5 groups. Groups 1 and 2 received manuscripts from which the authors' names and affiliations had been removed, while groups 3 and 4 were aware of the authors' identities. Groups 1 and 3 were asked to sign their reports, while groups 2 and 4 were asked to return their reports unsigned. The fifth group was sent the paper in the usual manner of the journal, with authors' identities revealed and a request to comment anonymously. Group 5 differed from group 4 only in that its members were unaware that they were taking part in a study.Main Outcome Measure.—The number of weaknesses in the paper that were commented on by the reviewers.Results.—Reports were received from 221 reviewers (53%). The mean number of weaknesses commented on was 2 (1.7, 2.1, 1.8, and 1.9 for groups 1, 2, 3, and 4 and 5 combined, respectively). There were no statistically significant differences between groups in their performance. Reviewers who were blinded to authors' identities were less likely to recommend rejection than those who were aware of the authors' identities (odds ratio, 0.5; 95% confidence interval, 0.3-1.0).Conclusions.—Neither blinding reviewers to the authors and origin of the paper nor requiring them to sign their reports had any effect on rate of detection of errors. Such measures are unlikely to improve the quality of peer review reports.
Exacerbations of chronic obstructive pulmonary disease
Authors: J Kidney
Journal: Thorax (2002)

Respiratory diseases are the most common cause of death in the UK but, while targets are set for every other major disease category, lung diseases do not get a mention.

Respiratory diseases are the most common cause of death with a 16% higher mortality rate than with coronary heart disease. Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory illness. At the end of its long course over 30 000 people die from COPD each year in the UK. It is a disease of the poor, with a death rate in men of working age 14 times higher in unskilled manual workers than in professionals.1

The burden to the health service is enormous. In the UK acute respiratory admissions account for 25% of all emergency medical admissions2 and cost £1.1 billion.3 COPD exacerbations account for more than half of these admissions,2 so are likely to cost in excess of £500 million per annum. In planning for service delivery, COPD admissions throw a spanner in the works. During the summer there is a steady number of admissions but in winter this rises by up to threefold (unpublished data, Mater Hospital). This is the time of year when images of patients waiting on trolleys in AE beds in medical …
Functional and phenotypic evidence for a selective loss of memory T cells in asymptomatic human immunodeficiency virus-infected men.
Authors: C J van Noesel, R A Gruters, F G Terpstra, P T Schellekens, R A van Lier, F Miedema
Journal: Journal of Clinical Investigation (1990)

In addition to a well-documented depletion of CD4+ T helper cells in later stages of human immunodeficiency virus (HIV) infection, evidence has been provided for a specific unresponsiveness to triggering either by specific antigen in the context of autologous major histocompatibility molecules (self + X) or anti-CD3 monoclonal antibodies (MAb) in both CD4 and CD8 cells from asymptomatic HIV-infected individuals. In the present study we analyzed this unresponsiveness using mitogenic antibodies to distinct T cell membrane receptors. T cells from HIV-infected men who had normal numbers of CD4+ T cells responded poorly to activation signals via the CD3 membrane antigen in both accessory cell-dependent as well as accessory cell-independent culture systems. A similar low response was observed in an anti-CD2-driven system. In contrast, proliferation induced by anti-CD3, anti-CD2, or the phorbol ester Phorbol myristate acetate could be normally enhanced by anti-CD28 MAb. We demonstrated that this unresponsiveness is not due to a failure to induce early events required for activation, such as increased intracellular concentration of free calcium and activation of protein kinase C, but is caused by an imbalance between naive and memory T cells. In HIV-infected asymptomatic men, CD29+ memory T cells are selectively depleted which results in a poor responsiveness to self + X. These findings provide new insights that may have implications for our understanding of the immunopathogenesis of AIDS.
Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial
Authors: Michael R. Rudnick, Stanley Goldfarb, Lewis Wexler, Philip A. Ludbrook, Mary J. Murphy, Elkan F. Halpern, James A. Hill, Michael Winniford, Martin B. Cohen, Douglas B. VanFossen, None for the Iohexol Cooperative Study
Journal: Kidney International (1995)
Violent crime among mentally ill people is due more to substance misuse than inherent factors, study shows
Authors: M. Day
Journal: BMJ (2010)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Violent crime among mentally ill people is due more to substance misuse than inherent factors, study shows Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
A Flavoprotein Mechanism Appears to Prevent an Oxygen-Dependent Inhibition of cGMP-Associated Nitric Oxide–Elicited Relaxation of Bovine Coronary Arteries
Authors: Takafumi Iesaki, Sachin A. Gupte, Michael S. Wolin
Journal: Circulation Research (1999)

Abstract —The redox state of the heme of soluble guanylate cyclase (sGC) may regulate the sensitivity of vascular tissue to nitric oxide (NO). In this study, diphenyliodonium (DPI) is used as an inhibitor of flavoprotein oxidoreductases to examine their potential role in the expression of NO-elicited cGMP-associated arterial relaxation and sGC stimulation. The relaxation of endothelium-removed bovine coronary arteries (BCAs) precontracted with 30 mmol/L KCl to the NO donor S -nitroso- N -acetyl-penicillamine (SNAP) or to NO is markedly suppressed by 10 μmol/L DPI under an atmosphere of 21% O 2 (5% CO 2 ). In contrast, DPI has minimal effects on the relaxation to SNAP under 95% N 2 (5% CO 2 ). If BCAs are treated with DPI under 21% O 2 and then exposed to the hemoprotein reductant sodium dithionite (1 mmol/L) under N 2 , there is a partial reversal of the inhibitory effects of DPI compared with BCAs that were not treated with dithionite. DPI did not inhibit relaxation elicited by 8-bromo-cGMP or forskolin. Increases in tissue cGMP levels stimulated by SNAP were eliminated by pretreatment of BCAs with DPI under 21% O 2 but not under N 2 . Activation of sGC by SNAP in BCA homogenate was also eliminated when vessels were pretreated with 10 μmol/L DPI under 21% O 2 , but DPI did not have an inhibitory effect when directly added to the assay of sGC activity. These observations are consistent with a flavoprotein-dependent oxidoreductase functioning to prevent the expression of a novel O 2 -dependent process from oxidizing the heme on sGC and inhibiting NO-elicited cGMP-mediated BCA relaxation.
Upper Ottawa street landfill site health study.
Authors: C Hertzman, M Hayes, J Singer, J Highland
Journal: Environmental Health Perspectives (1987)

This report describes the design and conduct of two sequential historical prospective morbidity surveys of workers and residents from the Upper Ottawa Street Landfill Site in Hamilton, Ontario. The workers study was carried out first and was a hypothesis-generating study. Workers and controls were administered a health questionnaire, which was followed by an assessment of recall bias through medical chart abstraction. Multiple criteria were used to identify health problems associated with landfill site exposure. Those problems with highest credibility included clusters of respiratory, skin, narcotic, and mood disorders. These formed the hypothesis base in the subsequent health study of residents living adjacent to the landfill site. In that study, the association between mood, narcotic, skin, and respiratory conditions with landfill site exposure was confirmed using the following criteria: strength of association; consistency with the workers study; risk gradient by duration of residence and proximity to the landfill; absence of evidence that less healthy people moved to the area; specificity; and the absence of recall bias. The validity of these associations were reduced by three principal problems: the high refusal rate among the control population; socioeconomic status differences between the study groups; and the fact that the conditions found in excess were imprecisely defined and potentially interchangeable with other conditions. Offsetting these problems were the multiple criteria used to assess each hypothesis, which were applied according to present rules. Evidence is presented that supports the hypothesis that vapors, fumes, or particulate matter emanating from the landfill site, as well as direct skin exposure, may have lead to the health problems found in excess. Evidence is also presented supporting the hypothesis that perception of exposure and, therefore, of risk, may explain the results of the study. However, based on the analyses performed, it is the conclusion of the authors that the adverse effects seen were more likely the result of chemical exposure than of perception of risk.
THE TREATMENT AND PROGNOSIS OF LEPROSY
Authors: P. Harper
Journal: BMJ (1922)

rTREATMENT AND PROGNOSIS OF LEPROSt rY=.' 39 From this time onwards the findings became less pathological, anid when the cerebro-spinal fluid was examined at the end of February, 1920, it was found to be perfectly normal.This, of course, was a case of meningitis with involvement of both vestibular and cochlear branches of the auditory inerve.From the first drainage the physical signs improved enormously, and, when examinied fourteen days after the last, the headache, deafness, and nystagmus had entirely disappeared.The tinnitus aurium, however, persisted, as always happens in this type of case.The rise in the cell count after the first tapping is worth noting, as it was almost a constant phenomenon, especially in cases of meningitis. CASE II.A man, aged 34, developed a papulo-erosive chancre on the fraenum in 1917.When seen in February, 1920, he complained of intolerable headache and almost complete loss of memory for recent events.He had had two epileptic fits in the previous month.Clinical examination revealed nothing abnormal except that the deep reflexes were rather exaggerated.His cerebro- spinal fluid was examined on February 2nd and 3rd, 1920, and a-gain on March 27th, 1921.The results are shown in the following table ; Feb. 2,