tbuckley/cabot-search huggingface dataset:
RECENT ADVANCES IN THE PROBLEM OF BLOOD COAGULATION APPLICABLE TO MEDICINE
Authors: WILLIAM H. HOWELL
Journal: JAMA (1941)

For a generation or more it has been accepted by most of the workers in this field that clotting of blood takes place in two steps: first, the formation of thrombin from prothrombin and, second, a reaction between thrombin and fibrinogen which leads to the deposition of fibrin needles and the gelatination of the blood. The factors entering into these reactions are expressed in the schema first used by Morawitz, as follows: prothrombin + Ca ions + thromboplastin = thrombin thrombin + fibrinogen = fibrin The schema is incomplete in that it fails to give the nature of the reactions in the two equations. On this point at present there is great diversity of opinion. It would be interesting to discuss the different views that have been proposed, but it would scarcely be profitable, since the weight of evidence at present does not incline to one view more than to another. Such a discussion, moreover,
How Will Graduate Medical Education Reform Affect Specialties and Geographic Areas?
Authors: David A. Kindig
Journal: JAMA (1994)

To project specialty and geographic impacts of workforce reform proposals on the practice output of graduate medical education (GME).A demographic life-table model to predict GME output was developed using 1987 cohort data from the Association of American Medical Colleges Annual GME Census. The 1992 GME cohort was used as a baseline to compare the simulated impact of alternate specialty and regional policies.Allopathic and osteopathic GME programs in the United States.Projected number of physicians (MDs and DOs) entering nine categories of practice specialty at the conclusion of GME.If GME input is reduced to 110% of US medical graduates with 55% entering practice as generalists (including obstetrics and gynecology), then the total number of first-year positions will decline from 24,433 to 18,783, and the total number of residents in GME would decline from 103,858 to 80,699 at equilibrium. Even with a 110% restriction on GME input, the overall physician-to-population ratio will continue to grow, albeit at a much slower rate. The number of generalists leaving GME annually would increase by 742 (9%) and the number of specialists would decline by 6517 (44%). At the regional level, allocating GME positions by prorating to the current distribution results in less change than would prorating positions to regional populations.Achieving national goals of reduced aggregate physician production, reduced specialist supply, and generalist increases will require significant alterations in the GME pool. Adequate time and funding for resident substitution will be required for hospitals to develop alternate models of providing service to allow national workforce goals to be met.
The prognosis and treatment of angiosarcoma of the face and scalp
Authors: C.A. Holden, I.M. Leigh, M.F. Spittle, E. Wilson Jones
Journal: British Journal of Dermatology (1985)

Angiosarcoma of the face and scalp (AS) is a rare but well-recognized vascular tumour, generally accepted to have a very poor prognosis. However, most previous studies have been limited because of small patient numbers. We have collected clinical data on 71 patients with AS from the time of initial histological diagnosis. Information obtained included age at diagnosis, sex, race, clinical appearance and size of lesions, therapeutic procedures, clinical course, incidence of metastases, survival time and response to therapy. All the patients were Caucasian with a mean age of 74 years (range 56–72 years) and a male to female ratio of 1:5:1. Tumours occurred predominantly on the upper face and scalp but male patients frequently presented with central facial lesions. Three main clinical patterns were confirmed: nodules, bruise-like induration and areas of ulceration with bleeding. Most patients were treated by radiotherapy (64%) or by excision alone (10%). The remainder received no therapy or combined therapy. Radiotherapy-treated patients fell into two groups: group I (71%) had short survival times (x= 13.5 months), large lesions (63% < 10 cm), and a high incidence of metastatic disease (50% of patients); group 2 patients (29%) survived longer (x = 5.5 years) and had a low proportion of large tumours (8%) with a low incidence of metastatic disease (8%). Patients treated by excision alone had a high incidence (86%) of metastatic disease. Our data suggests that AS remains a disease of poor prognosis in elderly patients with large lesions. However, small (< 5 cm) lesions have a far better prognosis and the use of radiotherapy may be associated with prolonged survival and a lower incidence of metastases than simple excision.
Emergency Medical Services for Children: Children and their Accidents
Authors: E J S Durch, K N Lohr, J G Avery, R H Jackson
Journal: BMJ (1994)

<h3>Objective</h3> Previous studies examine clinical outcomes of insulin therapy in neonatal intensive care units (NICUs), without first developing safe and effective control protocols. This research quantifies the safety and performance of a computerised model-based control algorithmSTAR-GRYPHON (Stochastic TARgeted Glucose Regulation sYstem to Prevent Hyper- and hypO-glycaemia in Neonates). <h3>Design</h3> Retrospective observational study of glycaemic control in very/extremely low birthweight infants treated with insulin from Christchurch Women’s Hospital NICU between January 2013 and June 2017. Blood glucose (BG) outcomes and control performance is compared with retrospective data (n=22) and literature. <h3>Interventions</h3> Insulin infusion doses were calculated from 3 to 4 hourly BG measurements using a computerised model-based control algorithm, STAR-GRYPHON. <h3>Main outcome measures</h3> Mean BG, time in targeted range and incidence of hypoglycaemia. <h3>Results</h3> STAR-GRYPHON (n=35) had lower mean BG concentration (7.0mmol/L vs 7.9 mmol/L), higher %BG within the 4.0–8.0 mmol/L target range (71.1% vs 50.9%) and lower %BG &lt;4.0 mmol/L (0.6% vs 2.1%). There were only 2 BG &lt;2.6 mmol/L (over n=2, 5.5% of patients, 0.03% of all BG outcomes), one of which may be attributed to clinical error. These results show better control to target and lower incidence of hypoglycaemia than most literature results from intensive insulin therapy protocols or study groups in children and infants. <h3>Conclusions</h3> Model-based protocols can safely and effectively control BG in very premature infants and should be used in future studies to determine the effect of insulin therapy on clinical outcomes.
Clot contraction: compression of erythrocytes into tightly packed polyhedra and redistribution of platelets and fibrin
Authors: Douglas B. Cines, Tatiana Lebedeva, Chandrasekaran Nagaswami, Vincent Hayes, Walter Massefski, Rustem I. Litvinov, Lubica Rauova, Thomas J. Lowery, John W. Weisel
Journal: Blood (2013)
Prognostic Models Abound, but How Useful Are They?
Authors: Tom Reynolds
Journal: Annals of Internal Medicine (2001)

Current Clinical Issues18 September 2001Prognostic Models Abound, but How Useful Are They?Tom ReynoldsTom ReynoldsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-6-200109180-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Hippocratic physicians of ancient Greece prized the skill of prognostication above all others. As cited by medical historian Roy Porter in The Greatest Benefit to Mankind, they deemed it “a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling … the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick, so that men will have confidence to intrust themselves to such a physician.”Some two millennia later, after a relatively brief ... Author, Article, and Disclosure InformationAuthors: Tom Reynolds PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPredicción de supervivencia en el paciente con cáncer avanzadoPrognostic Scoring in MDSAPACHE II Predicts long-term survival in COPD patients admitted to a general medical wardPrognostic Importance of Elevated Jugular Venous Pressure and a Third Heart Sound in Patients with Heart Failure 18 September 2001Volume 135, Issue 6Page: 473-476KeywordsElectronic medical recordsHead and neck cancersHealth careHospital medicineLife expectancyPatientsPneumoniaStatistical modelsSurgeryTumor node metastasis ePublished: 18 September 2001 Issue Published: 18 September 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Reevaluating the Accelerated Approval Process for Oncology Drugs
Authors: Wyndham H. Wilson, David P. Schenkein, Cheryl L. Jernigan, Janet Woodcock, Richard L. Schilsky
Journal: Clinical Cancer Research (2013)

For a new therapy to qualify for the accelerated approval pathway, it must treat a serious disease for which there is "unmet medical need"--defined as providing a therapy where none exists or providing a therapy that may be potentially superior to existing therapy. The increasing number of available therapies, coupled with the lack of accepted endpoints considered "reasonably likely to predict clinical benefit" and the lack of clarity early in development about circumstances in which a new product will qualify for accelerated approval, is pushing developers to pursue accelerated approval in heavily pretreated patients to fulfill an unmet need. To optimize the accelerated approval pathway, we propose here a reevaluation of what constitutes "unmet medical need" and "available therapy" in oncology. We also discuss ways for new endpoints to become qualified for use in supporting accelerated approval, and propose a structured process for pursuing accelerated approval.
Efficacy, Safety and Patient-Reported Outcomes of Oxaliplatin-Based Chemotherapy in Elderly Patients with Colorectal Cancer (CRC): A Post-Hoc Analysis of the Glutox Study
Authors: Samson Benoit, Dube Pierre, Aucoin Nathalie, Wierzbicki Rafal, Maroun Jean, Letourneau Richard, Chen Eric, Charpentier Danielle, Couture Felix, Vincent Mark, Lepine Jean, Whitlock Pierre, Grassin Helene, Leblond Francois, Zhou Wei, Kavan Petr
Journal: Annals of Oncology (2014)
Combination Chemotherapy with Irinotecan and Cisplatin for Large-Cell Neuroendocrine Carcinoma of the Lung: A Multicenter Phase II Study
Authors: Seiji Niho, Hirotsugu Kenmotsu, Ikuo Sekine, Genichiro Ishii, Yuichi Ishikawa, Masayuki Noguchi, Fumihiro Oshita, Shun-ichi Watanabe, Ryu Nakajima, Hirohito Tada, Kanji Nagai
Journal: Journal of Thoracic Oncology (2013)
Dynamics of oxygen uptake during exercise in adults with cyanotic congenital heart disease.
Authors: K E Sietsema, D M Cooper, J K Perloff, M H Rosove, J S Child, M M Canobbio, B J Whipp, K Wasserman
Journal: Circulation (1986)

The dynamic increase in oxygen uptake (VO2) at the start of exercise reflects the circulatory adjustments to metabolic changes induced by the exercise. Because VO2 measured at the lungs is the product of pulmonary blood flow and arteriovenous oxygen difference, pathologic conditions affecting the capacity of these factors to change would be expected to alter VO2 kinetics. To determine whether measurement of VO2 kinetics can detect conditions in which the pulmonary blood flow response to exercise is abnormal, VO2 was measured, breath-by-breath, during the transition from rest to exercise in 13 adults with cyanotic congenital heart disease (central venoarterial shunting) and in nine normal subjects. The increase in VO2 above baseline during the first 20 sec of exercise (phase I), reflecting the immediate increase in pulmonary blood flow, was diminished in the patients compared with that in normal subjects (14.8 +/- 10.9 vs. 49.8 +/- 19.2 ml of oxygen) (p less than .001). The patients' phase I responses correlated with their reported physical activity tolerance (p less than .01). In addition, the second phase of the VO2 response kinetics was prolonged in patients compared with normal subjects (half-time = 63 +/- 13 vs 15 +/- 13 sec) (p less than .001). We conclude that striking disturbances in VO2 kinetics occur in patients with cyanotic congenital heart disease and that these measurements provide a useful noninvasive means of evaluating the degree to which the increase in pulmonary blood flow is constrained in response to exercise.
Corticosteroid Treatment of Diffuse Interstitial Pulmonary Fibrosis
Authors: Douglas R. Gracey
Journal: JAMA (1970)

Lung biopsy during the course of intensive steroid therapy in a case of idiopathic interstitial pulmonary fibrosis (Hamman-Rich syndrome) showed no evidence of the changes seen in the initial biopsy specimen. This was in keeping with the improvement experienced by the patient and evidenced by the results of pulmonary-function tests and serial thoracic roentgenograms. Massive doses of corticosteroids may be useful in this disease if initial response to treatment is disappointing.
Noninvasive measurement of rate of left ventricular relaxation by Doppler echocardiography. Validation with simultaneous cardiac catheterization.
Authors: R A Nishimura, R S Schwartz, A J Tajik, D R Holmes
Journal: Circulation (1993)

BACKGROUND The instantaneous pressure gradient between the left ventricle and left atrium during systole can be calculated from the mitral regurgitation Doppler velocity curve. The purpose of our study was to determine the accuracy of measuring the time constant of relaxation (TAU) derived from the Doppler mitral regurgitation signal by comparing it with simultaneous high-fidelity left ventricular pressure measurements in humans. METHODS AND RESULTS Twenty-five patients had continuous-wave Doppler mitral regurgitation recordings performed with simultaneous high-fidelity left ventricular pressure measurements. Fifteen of these patients had measurements of six to eight beats at various RR intervals. Doppler velocity curves were converted to left ventricular pressure curves by different methods through application of the modified Bernoulli equation at 3-msec intervals. The correlation between catheter-derived and Doppler-derived TAU was best when a zero asymptote and knowledge of the left ventricular end-diastolic pressure were used. A less optimal but acceptable method used the addition of 20 mm Hg to the Doppler-derived ventriculoatrial gradient. Use of a nonzero asymptote for calculation of TAU yielded poor correlation between catheter and Doppler measurements. The correlation of percentage change in Doppler-derived TAU plotted against percentage change in catheter-derived TAU was poor. CONCLUSIONS The descending limb of the Doppler-derived mitral regurgitation velocity signal can be used as a semiquantitative estimate of the rate of ventricular relaxation. This method requires knowledge of left atrial pressure and may not be sufficiently accurate for detecting small changes in the rate of relaxation on a beat-to-beat basis.
Evaluation of a call programme for cervical cytology screening.
Authors: N. R. Waugh, A. J. Robertson
Journal: BMJ (1989)

family to be in excess of that in his two brothers.We counted all moles (incluiding those <3 mm and ¢3 mm diameter) in the patient, his identical twin, and his other brother aged 16 years (table) and observed an excess of moles in the patient.All three brothers had identical skin types and had had the same lifestyle and exposure to sun in that all had spent their earl childhood in Germanx, four weeks in Hong Kong and two weeks in Spain, but the rest of their lives in the United Kingdom.Nu mbers oJ moles in the threev siblitlgs Patient Idenitical twin Brother
Results of a phase 2 study of pacritinib (SB1518), a JAK2/JAK2(V617F) inhibitor, in patients with myelofibrosis
Authors: Rami S. Komrokji, John F. Seymour, Andrew W. Roberts, Martha Wadleigh, L. Bik To, Robyn Scherber, Elyce Turba, Andrew Dorr, Joy Zhu, Lixia Wang, Tanya Granston, Mary S. Campbell, Ruben A. Mesa
Journal: Blood (2015)
Inflammation and Glucose Intolerance
Authors: Myles Wolf, Jenny Sauk, Anand Shah, Karen Vossen Smirnakis, Ricardo Jimenez-Kimble, Jeffrey L. Ecker, Ravi Thadhani
Journal: Diabetes Care (2004)

OBJECTIVE—Increased leukocyte count is a marker of inflammation that has been associated with the development of type 2 diabetes in prospective studies. Although gestational diabetes mellitus (GDM) and type 2 diabetes share certain pathophysiological mechanisms, few studies have examined inflammation and risk of GDM. RESEARCH DESIGN AND METHODS—We prospectively examined routine leukocyte counts collected at the first prenatal visit in a cohort of 2,753 nulliparous euglycemic women, 98 (3.6%) of whom were later diagnosed with GDM. Subjects were divided into quartiles of leukocyte count, and the results of third-trimester glucose screening tests and the incidence of GDM among these quartiles were compared. Logistic regression was used to calculate univariate and multivariable-adjusted relative risks (RRs) of GDM according to leukocyte quartiles. RESULTS—Leukocyte counts were increased among women who subsequently developed GDM compared with those who remained free of GDM (10.5 ± 2.2 vs. 9.2 ± 2.2 × 103 cells/ml; P &amp;lt; 0.01). There was a linear increase in postloading mean glucose levels (P for trend &amp;lt;0.01), the area under the glucose tolerance test curves (P for trend &amp;lt;0.01), and the incidence of GDM (quartile 1, 1.1; quartile 2, 2.5; quartile 3, 4.2; and quartile 4, 6.4%; P for trend &amp;lt;0.01) with increasing leukocyte quartiles. In the multivariable-adjusted analysis, the linear trend in the RR of GDM with increasing leukocyte quartiles remained statistically significant (quartile 1, reference; quartile 2, RR 2.3 [95% CI 0.9–5.7]; quartile 3, 3.3 [1.4–7.8]; quartile 4, 4.9 [2.1–11.2]; P for trend &amp;lt;0.01). CONCLUSIONS—Increased leukocyte count early in pregnancy is independently and linearly associated with the results of GDM screening tests and the risk of GDM. Although overlap in the leukocyte count distributions precludes it from being a clinically useful biomarker, these data suggest that inflammation is associated with the development of GDM and may be another pathophysiological link between GDM and future type 2 diabetes.
A Mathematician Reads the Newspaper
Authors: Mark L. Mitchell
Journal: JAMA (1995)

John Paulos, a professor of mathematics at Temple University and the author of the best-selling book<i>Innumeracy: Mathematical Illiteracy and its Consequences</i>, has written a new book to offer "novel perspectives, questions, and recommendations to coffee drinkers, straphangers, policy makers, gossip mongers, bargain hunters, trendsetters, and others" who read the daily newspaper. The book is a collection of 51 brief chapters organized into five sections whose titles reflect the subject matter of a newspaper: "Politics, Economics, and the Nation," "Local, Business, and Social Issues," "Lifestyle, Spin, and Soft News," "Science, Medicine, and the Environment," and "Food, Book Reviews, Sports, Obituaries." Paulos uses his considerable talents and a breezy style to discuss many ways to apply simple, or at least simply explained, mathematics and logic to analyze the contents of the newspaper. For instance, a review of voting systems explains the benefits and drawbacks of approval voting, in which voters may
German ethics council backs religious circumcision if specific conditions met
Authors: N. Stafford
Journal: BMJ (2012)

The German ethics council has voiced support for religious circumcision, a procedure that a court in Cologne ruled illegal in June if performed on boys too young to give consent.

After a public hearing on 23 August in Berlin, the 26 ethics council members voted unanimously on a compromise recommendation that circumcision on boys should be legal in Germany if four conditions are met.1 The conditions are: that the procedure is explained to both parents and that they both agree to it; that the boy has the right to veto the procedure; that a suitably qualified person carries out the procedure; and that pain relief is administered.

The Cologne court decision in June related to a case involving a charge of bodily harm against a doctor after a 4 year old Muslim boy …
Choosing Wisely: Changing Clinicians, Patients, or Policies?
Authors: Diana J. Mason
Journal: JAMA (2015)

As a nurse, I know to rely on primary care providers who understand my health risks and will talk with me about what tests and treatments I should avoid, as well as those I need. But what do people do who are not health professionals? Choosing Wisely (www.choosingwisely .org), an initiative of the American Board of InternalMedicine (ABIM)Foundation, is designed to spark conversations among patients, physicians, and other health professionals about appropriate tests and procedures (http://bit.ly/1st8yRt)—those “supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” That sounds like common sense, but our system doesn’talwayssupportacommon-senseapproach. A May 2014 telephone survey of 600 primary care and specialist physicians, commissioned by the ABIM Foundation, found that 72% said that at least once a week, the average physician prescribes unnecessary tests or procedures; 47% said that patients request these services; and when the patient insists, even after a discussion of the low value of a test or procedure, 53% order it (http://bit.ly/1nMITz8). (The survey used a random sample of physicians in the American Medical Association’s Physician Masterfile. No response rate was reported. The margin of sampling error was ±4.0 percentage points.) Choosing Wisely proposes that reducing these low-value services is the responsibility of both the clinician and the patient. But will relying on the good intentions of clinicians and patients be sufficient to reduce the use of unnecessary, costly, and potentially harmful services?