tbuckley/cabot-search huggingface dataset:
Predictors of Broad-Spectrum Antibiotic Prescribing for Acute Respiratory Tract Infections in Adult Primary Care
Authors: Michael A. Steinman, C. Seth Landefeld, Ralph Gonzales
Journal: JAMA (2003)

<h3>Context</h3> Broad-spectrum antibiotics are commonly prescribed, but little is known about the physicians who prescribe and the patients who take these agents. <h3>Objective</h3> To identify factors associated with prescribing of broad-spectrum antibiotics by physicians caring for patients with nonpneumonic acute respiratory tract infections (ARTIs). <h3>Design, Setting, and Patients</h3> Cross-sectional study using data from the National Ambulatory Medical Care Survey between 1997 and 1999. Information was collected on a national sample of 1981 adults seen by physicians for the common cold and nonspecific upper respiratory tract infections (URTIs) (24%), acute sinusitis (24%), acute bronchitis (23%), otitis media (5%), pharyngitis, laryngitis, and tracheitis (11%), or more than 1 of the above diagnoses (13%). <h3>Main Outcome Measure</h3> Prescription of broad-spectrum antibiotics, defined for this study as quinolones, amoxicillin/clavulanate, second- and third-generation cephalosporins, and azithromycin and clarithromycin. <h3>Results</h3> Antibiotics were prescribed to 63% of patients with an ARTI, ranging from 46% of patients with the common cold or nonspecific URTIs to 69% of patients with acute sinusitis. Broad-spectrum agents were chosen in 54% of patients prescribed an antibiotic, including 51% of patients with the common cold and nonspecific URTIs, 53% with acute sinusitis, 62% with acute bronchitis, and 65% with otitis media. Multivariable analysis identified several clinical and nonclinical factors associated with choice of a broad-spectrum agent. After adjusting for diagnosis and chronic comorbid illnesses, the strongest independent predictors of broad-spectrum antibiotic prescribing were physician specialty (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.6-3.5 for internal medicine physicians compared with general and family physicians) and geographic region (OR, 2.6; 95% CI, 1.4-4.8 for Northeast and OR, 2.4; 95% CI, 1.4-4.2 for South [both compared with West]). Other independent predictors of choosing a broad-spectrum agent included black race, lack of health insurance, and health maintenance organization membership, each of which was associated with lower rates of broad-spectrum prescribing. Patient age, sex, and urban vs rural location were not significantly associated with prescribing choice. <h3>Conclusions</h3> Broad-spectrum antibiotics are commonly prescribed for the treatment of ARTIs, especially by internists and physicians in the Northeast and South. These high rates of prescribing, wide variations in practice patterns, and the strong association of nonclinical factors with antibiotic choice suggest opportunities to improve prescribing patterns.
The cervical spine in patients with psoriatic arthritis: a clinical, radiological and immunogenetic study.
Authors: C Salvarani, P Macchioni, T Cremonesi, W Mantovani, B Battistel, F Rossi, N Capozzoli, R Baricchi, I Portioli
Journal: Annals of the Rheumatic Diseases (1992)

The radiological changes of the cervical spine were evaluated in 57 patients with psoriatic arthritis and were correlated with clinical, radiological, and immunogenetic features of the disease. Forty patients (70%) showed radiological evidence of the cervical spine being affected by the disease. Two patterns of cervical spine abnormalities were noted. Fifteen patients (26%) had erosive and/or subluxing cervical rheumatoid like lesions; 25 patients (44%) had a more frequently reported pattern similar to ankylosing spondylitis. Although subaxial subluxations were the most frequently observed cervical abnormalities (53%) in the inflammatory subgroup, none of the patients studied had cord compression. Ankylosing cervical spine disease was the only form of axial involvement in nine (36%) of 25 patients with the ankylosing form of psoriatic arthritis. All of these patients had peripheral disease and were B27 negative. Predictors of cervical spine disease patterns were considered using clinical, demographic, and radiological features and HLA antigens. The results of a multivariate analysis showed that the best predictors of inflammatory cervical spine disease are the presence of HLA-B39 and HLA-DR4 antigens, radiocarpal erosions, and the absence of the HLA-DR5 antigen.
39 BONE MORPHOGENETIC PROTEINS (BMP) AND BMP SIGNALLING ARE SIGNIFICANTLY INCREASED IN EXPERIMENTAL MODELS OF CIRRHOSIS AND PORTAL HYPERTENSION
Authors: A. De Gottardi, M. Mejias, E. Garcia-Pras, A. Rodríguez-Vilarrupla, J.-C. Garcia-Pagan, M. Fernandez, J. Bosch
Journal: Journal of Hepatology (2009)
Vitamin and energy injections in the Indian subcontinent.
Authors: E H Boxall
Journal: BMJ (1987)

Deux observations: femmes asiatiques residant normalement en Grande Bretagne, faisant un sejour en Inde et recevant des traitements «traditionnels» locaux d'injections de «vitamines». Toutes deux sont atteintes d'hepatite virale B transmise par les injections
THE CONSERVATIVE UTILIZATION OF THE WASSERMANN REACTION
Authors: D. M. KAPLAN
Journal: JAMA (1910)

The statements in this communication are based on a study of over 3,200 reactions, and in view of the confu- sion and uncertainty that still prevail in the minds of many physicians as to the significance and value of the Wassermann test I am hopeful that this work will tend to render clear some obscure points and enable us to handle the question of syphilis from a serologic point of view with greater accuracy than heretofore.The
The Little Duck That Wasn't There
Authors: G. G. Liddle
Journal: JAMA (1966)

<h3>To the Editor:—</h3> Somewhere down in upstate New Pennsylvania there is a duck problem, and I believe it's serious. A group of scientists reports that Whether one conceptualizes the registration process of the concealed form as "fleeting" perception or discrimination without awareness, the results, etc, etc... Well! If you think this has nothing to do with ducks, guess again. Several hundred university students contributed to mankind and his science by sitting at desks while silhouettes of a tree trunk were flashed at them for a brief moment. For half of these worthies the outline was only that of an amputated old stump, with a built-in outline of the stern of a duck. For the other half, the silhouette of the entire duck emerged. These were flashed the magic number of three times. Immediately, the students seized their palettes and each drew an imaginary nature scene, and Behold! Those who had
Heparin-Induced Thrombocytopenia
Authors: ETHAN A. NATELSON
Journal: Annals of Internal Medicine (1969)

The consumption coagulopathy syndrome occurred in a patient with prostatic carcinoma. Treatment of this syndrome with heparin sodium was associated with return of the plasma fibrinogen concentration to normal but resulted in a reduction in the number of circulating platelets. In vitro studies supported the clinical impression of heparin-induced thrombocytopenia.
Improvement in Glucose Tolerance After 1 Wk of Exercise in Patients With Mild NIDDM
Authors: Marc A Rogers, Chikashi Yamamoto, Douglas S King, James M Hagberg, Ali A Ehsani, John O Holloszy
Journal: Diabetes Care (1988)

We investigated the effects of 1 wk of intense exercise on glucose tolerance in 10 men with abnormal glucose tolerance [7 had mild non-insulin-dependent diabetes mellitus (NIDDM), and 3 had impaired glucose tolerance]. The 7 days of exercise did not result in significant changes in body weight or maximal oxygen uptake. Plasma glucose concentration at 120 min averaged 227 ± 23 mg/dl in an oral glucose tolerance test (OGTT) before and 170 ± 18 mg/dl after the 7 days of exercise (P &amp;lt; .001). There was a 36% reduction in the area under the glucose tolerance curve. Plasma insulin concentration at 120 min of the OGTT averaged 172 ± 27μU/ml before and 106 ± 13 μU/ml after 7 days of exercise (P &amp;lt; .001); the area under the insulin curve was decreased by 32%. In contrast to the response to 7 days of exercise, one bout of exercise did not result in an improvement in glucose tolerance. These results provide evidence that regularly performed, vigorous exercise can be effective in decreasing insulin resistance and improving glucose tolerance within 7 days in some patients with mild NIDDM.
The Woman from County Meath
Authors: Frank Brennan
Journal: Annals of Internal Medicine (2006)

Ad Libitum6 June 2006The Woman from County MeathFrank Brennan, MBBSFrank Brennan, MBBSFrom Calvary Hospital, Kogarah, Sydney NSW 2217, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-11-200606060-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Woman from County MeathThe warmth of the Dublin day caught everyone by surprise. Through the window I could see children playing in the garden. We had walked into the visitors' room. The family was waiting. They were from County Meath. He was a farmer, only 54, she a teacher. They had 7 children. It was clear that he was dying. He had battled seemingly intractable pain but now over the past few days was much more settled.I spoke about the past days and what to expect from this point onward. I then concentrated on the family themselves and ... Author, Article, and Disclosure InformationAffiliations: From Calvary Hospital, Kogarah, Sydney NSW 2217, Australia.Current Author Address: Frank Brennan, MBBS, Calvary Hospital, Rocky Point Road, Kogarah, Sydney NSW 2217, Australia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySuffering Seeks a Voice 6 June 2006Volume 144, Issue 11Page: 864KeywordsBirthChildrenEmotionsHeartMemoryNursesPalliative careSleepStormsWalking ePublished: 6 June 2006 Issue Published: 6 June 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Ly phenotype and mechanism of action of mouse neonatal suppressor T cells.
Authors: D E Mosier, B J Mathieson, P S Campbell
Journal: The Journal of Experimental Medicine (1977)

Neonatal suppressor T cells were isolated from the thymuses of 10- to 14-day old BDF mice infected at birth with mouse thymic virus. Such cells were enriched for suppressive activity directed against antibody formation by adult B cells and represented a relatively homogenous population of outer cortical cells. Their surface antigen phenotype was found to be: Ly 1+, Ly 2+, TL+, Thy 1+, and H-2+. The cells were larger and contained more DNA than thymocytes from age-matched controls. These findings identify neonatal suppressor T cells as a unique subpopulation separate from most inducible suppressor cells in the adult mouse. The mechanism of action of neonatal suppressor T cells seems to be a reduction in the number of B cells initially triggered by antigen.
Preparation and in vitro evaluation of the antiviral activity of the Acyclovir complex of a β-cyclodextrin/poly(amidoamine) copolymer
Authors: Marco Bencini, Elisabetta Ranucci, Paolo Ferruti, Francesco Trotta, Manuela Donalisio, Maura Cornaglia, David Lembo, Roberta Cavalli
Journal: Journal of Controlled Release (2007)
THE LAURENCE-MOON-BIEDL SYNDROME
Authors: RICHARD GREEN
Journal: American Journal of Psychiatry (1966)

The Laurence-Moon-Biedi syndrome is an ill-defined symptom complex usually presenting the signs of obesity, hypogenitalism, retinitis pigmentosa, polydactyly and mental deficiency. The case reported here is the first presented to a psychiatric hospital as a behavior disorder. In addition, this same patient, on the basis of behavior, physical appearance and laboratory determinations had been previously misdiagnosed as having Cushing's syndrome. The literature pertaining to the Laurence-Moon-Biedl syndrome is reviewed with particular reference to psychiatric and endocrinologic data. Closer psychologic scrutiny of this patient revealed that his mental deficiency may have been secondary to brain damage and not part of a genetically linked symptom complex. An appraisal of previous reports indicates a lack of effort at making this distinction in the past. The question of the usefulness and validity of viewing the symptom aggregate of Laurence-Moon-Biedl patients as a discrete, genetically transmitted syndrome is discussed.
Physicians' Attitudes about the Care of Patients in the Persistent Vegetative State: A National Survey
Authors: Kirk Payne, Robert M. Taylor, Carol Stocking, Greg A. Sachs
Journal: Annals of Internal Medicine (1996)

Objective: To study the attitudes and beliefs of physicians who have experience caring for patients in the persistent vegetative state (PVS). Design: Mailed questionnaire survey. Participants: 500 physicians, 250 from the American Academy of Neurology and 250 from the American Medical Directors Association. Measurements: Physicians' beliefs about diagnosis of the PVS, patient awareness and suffering, treatment withdrawal, appropriate use of health maintenance and life-prolonging therapies, organ donation, lethal injection, and the treatment they would want if they were in the PVS. Results: 68% of surveyed neurologists and 60% of medical directors responded. Thirteen percent of responders believe that patients in the PVS have awareness and experience hunger and thirst; 30% believe they experience pain. Fewer than 9% believe that respiratory failure, cardiogenic shock, acute renal failure, or cancer should be aggressively treated. Eighty-nine percent believe that it is ethical to withdraw artificial hydration and nutrition. Almost two thirds of responders believe that it would be ethical to use the vital organs of patients in the PVS for transplantation, and 20% believe that it would be ethical to hasten the patient's death by lethal injection. Conclusions: When evaluating the appropriateness of treatments for patients in the PVS, neurologists and medical directors largely concur. Most physicians in both groups believe that patients in the PVS would be better off dead; that it is not necessary to provide aggressive therapeutic interventions; and that all therapeutic interventions, including artificial nutrition and hydration, can be withheld in certain circumstances. The areas of consensus are remarkable and suggest that an ethical standard that physicians believe should be followed when caring for these patients may be emerging.
Bias related to funding source in statin trials
Authors: L. Bero
Journal: BMJ (2014)

The biases are clear if you know where to look

One of the fundamental principles of pharmacology is that the effects of drugs (both efficacy and harms) are dose related. In a linked paper (doi:10.1136/bmj.g5741), Naci and colleagues use network meta-analysis as a technique to confirm that the effects of statins on serum levels of low density lipoprotein (LDL) cholesterol are dose related.1 They also conclude that industry sponsorship of statin trials is not associated with increased efficacy estimates and that there are no differences in risks of bias between industry and non-industry sponsored trials. They incorrectly argue that this finding differs from our previously published study examining industry bias in drug-drug comparisons of statins.2 

Like Naci and colleagues, we also found no differences in the results of industry and non-industry sponsored studies comparing statins with statins or other drugs. We did not include placebo comparisons. In addition, we found no differences in the adequacy of concealment of allocation, blinding, and inclusion of all subjects in the analysis between industry and non-industry sponsored studies.

However, we went on to analyse a pre-specified subset of studies—all of which were industry sponsored—to determine whether the results favoured the drug of the company sponsoring the study.2 Naci …
Clinicopathological differences of laterally spreading tumors of the colorectum according to gross appearance
Authors: B. Kim, H. Chang, K. Su Han, D. Sohn, C. Hong, J. Park, S.-C. Park, H. Choi, J. Oh
Journal: Endoscopy (2010)

See also: Commentaire de travail de B. C. Kim et al., pp. 100Endoscopy 2011; 43(02): 173-173DOI: 10.1055/s-0031-1291814
Hepatitis B surface antigen (HBsAg) levels in the prediction of spontaneous HBsAg seroclearance
Authors: Yi-Cheng Chen
Journal: Hepatology (2012)

We read with interest the article on a large case-control study that a hepatitis B surface antigen (HBsAg) level <200 IU/mL is predictive of HBsAg seroclearance within 3 years.1 Their results confirmed our earlier observation that serum HBsAg level ≤200 IU/mL has a negative predictive value (NPV) of 100% and 92% for HBsAg seroclearance at 1 and 3 years, respectively, with a positive predictive value (PPV) of 97% and 100% if combined with a ≥1 log10 IU/mL reduction in the preceding 2 years.2 Both studies have shown that HBsAg level <200 IU/mL is an optimal level for the prediction of HBsAg seroclearance at 1 and 3 years. Interestingly, Seto et al.1 further showed that a 0.5 log reduction in HBsAg during the next year in those with serum HBsAg >200 IU/mL may predict HBsAg seroclearance in 3 years with a sensitivity of 74% and a specificity of 89.4%.1 Reanalyzing our data also showed that an HBsAg decline of 1 log10 IU/mL in the following 2 years (equivalent to 0.5 log/year) had an NPV of 98% and a PPV of 67% for HBsAg seroclearance. Using the receiver operating characteristic and the area under curve (0.966; 95% confidence interval [CI] 0.915-1.000; P < 0.001), 2-year HBsAg decline of 1 log (0.5 log/year) is a good predictor for HBsAg seroclearance in those with HBsAg >200 IU/mL. Prediction of HBsAg seroclearance using HBsAg levels has attracted much attention recently. Two Asian studies used an HBsAg level <100 IU/mL as a remote predictor of HBsAg seroclearance within 6 to 10 years.3, 4 Obviously, prediction of spontaneous HBsAg seroclearance within a much shorter period of 1-3 years, using an HBsAg level of 200 IU/mL,1, 2 is more useful in daily clinical practice. Yi-Cheng Chen M.D.*, * Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Some Apparent Anomalies of Potassium Metabolism
Authors: I. W. MacPhee
Journal: BMJ (1953)

<h3>Introduction</h3> There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults. <h3>Methods</h3> MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018. <h3>Results</h3> 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias. <h3>Conclusions</h3> The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.
TI-201 SPECT in Pseudotumoral Multiple Sclerosis
Authors: VICTOR OBACH, JORDI GONZALEZ-MENACHO, SERGI VIDAL, FRANCESC LOMEÑA, FRANCESC GRAUS
Journal: Clinical Nuclear Medicine (1999)

A patient with multiple sclerosis had a pseudotumoral plaque evident on a brain MRI that was indistinguishable from a malignant brain tumor. TI-201 SPECT showed uptake of TI-201 in the lesion with indices of 1.55 and 1.96 at 30 minutes and 3 hours, respectively. The retention index was 26.4%. The patient had clinical and radiologic spontaneous improvement, and the results of TI-201 SPECT performed 3 months later were negative. TI-201 uptake in multiple sclerosis pseudotumoral plaques has not been described before. In this patient, TI-201 SPECT could not differentiate a large multiplesclerosis plaque from a malignant brain tumor.
CYP2D6 Genotype, Antidepressant Use, and Tamoxifen Metabolism During Adjuvant Breast Cancer Treatment
Authors: Y. Jin, Z. Desta, V. Stearns, B. Ward, H. Ho, K.-H. Lee, T. Skaar, A. M. Storniolo, L. Li, A. Araba, R. Blanchard, A. Nguyen, L. Ullmer, J. Hayden, S. Lemler, R. M. Weinshilboum, J. M. Rae, D. F. Hayes, D. A. Flockhart
Journal: JNCI Journal of the National Cancer Institute (2005)

Background: The efficacy of tamoxifen therapy for the treatment of breast cancer varies widely among individuals. Plasma concentrations of the active tamoxifen metabolite endoxifen are associated with the cytochrome P450 (CYP) 2D6 genotype. We examined the effects of concomitant use of selective serotonin reuptake inhibitor antidepressants, which are CYP2D6 enzyme inhibitors commonly prescribed to treat hot flashes in women who take tamoxifen, and genotypes for genes that encode tamoxifen-metabolizing enzymes on plasma concentrations of tamoxifen and its metabolites. Methods: Eighty patients with newly diagnosed with breast cancer who were beginning tamoxifen therapy (20 mg/day orally), 24 of whom were taking CYP2D6 inhibitors, were genotyped for common alleles of the CYP2D6, CYP2C9, CYP3A5, and sulfotransferase (SULT) 1A1 genes. Plasma concentrations of tamoxifen and its metabolites were measured after 1 and 4 months of tamoxifen therapy. Differences in plasma concentrations of tamoxifen and its metabolites between genotype groups were analyzed by the Wilcoxon rank sum test. All statistical tests were two-sided. Results: Among all women, plasma endoxifen concentrations after 4 months of tamoxifen therapy were statistically significantly lower in subjects with a CYP2D6 homozygous variant genotype (20.0 nM, 95% confidence interval [CI] = 11.1 to 28.9 nM) or a heterozygous genotype (43.1 nM, 95% CI = 33.3 to 52.9 nM) than in those with a homozygous wild-type genotype (78.0 nM, 95%CI = 65.9 to 90.1 nM) (both P = .003). Among subjects who carried a homozygous wild-type genotype, the mean plasma endoxifen concentration for those who were using CYP2D6 inhibitors was 58% lower than that for those who were not (38.6 nM versus 91.4 nM, difference = –52.8 nM, 95% CI = –86.1 to –19.5 nM, P = .0025). The plasma endoxifen concentration was slightly reduced in women taking venlafaxine, a weak inhibitor of CYP2D6, whereas the plasma endoxifen concentration was reduced substantially in subjects who took paroxetine (a potent inhibitor of CYP2D6). Genetic variations of CYP2C9, CYP3A5, or SULT1A1 had no statistically significant associations with plasma concentrations of tamoxifen or its metabolites. Conclusion: Interactions between CYP2D6 polymorphisms and coadministered antidepressants and other drugs that are CYP2D6 inhibitors may be associated with altered tamoxifen activity.