tbuckley/cabot-search huggingface dataset:
Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.
Authors: M. Muijen, I. Marks, J. Connolly, B. Audini
Journal: BMJ (1992)

OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months9 follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients9 and relatives9 satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay six days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.
Genomic and molecular characterization of esophageal squamous cell carcinoma
Authors: De-Chen Lin, Jia-Jie Hao, Yasunobu Nagata, Liang Xu, Li Shang, Xuan Meng, Yusuke Sato, Yusuke Okuno, Ana Maria Varela, Ling-Wen Ding, Manoj Garg, Li-Zhen Liu, Henry Yang, Dong Yin, Zhi-Zhou Shi, Yan-Yi Jiang, Wen-Yue Gu, Ting Gong, Yu Zhang, Xin Xu, Ori Kalid, Sharon Shacham, Seishi Ogawa, Ming-Rong Wang, H Phillip Koeffler
Journal: Nature Genetics (2014)
Testing for Streptococcal Pharyngitis-Reply
Authors: James A. Kellogg
Journal: JAMA (1986)

In Reply.—  We share Dr Odio's concerns that evaluations of group A streptococcal antigen-detection kits should provide clinically relevant information and that comparisons of the new procedures be made using a welldocumented reference method, or the gold standard. As Dr Odio noted, a confirmed diagnosis of streptococcal pharyngitis requires a significant rise in antibody titer between acute and convalescent serum samples. Not being willing to wait the two to three weeks following onset of symptoms required for collection of convalescent serum samples, physicians have looked to the traditional culture and investigated the faster antigen-detection products as more practical alternatives.  In the absence of a rapid serological test to confirm infection, the throat culture is merely a screen to determine the presence or absence of group A streptococci, and the rapid antigendetection kits serve the same purpose. Since the objectives of the two tests are identical, a competently performed throat culture
Follow the Money — Controlling Expenditures by Improving Care for Patients Needing Costly Services
Authors: Thomas Bodenheimer, Rachel Berry-Millett
Journal: New England Journal of Medicine (2009)

In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental, or psychosocial challenges. Some well-researched programs have been shown to reduce costs for these patients with complex health care needs, but major payment reform would be needed to spread these programs throughout the United States.In 2002, Medicare beneficiaries with five or more chronic conditions accounted for 76% of Medicare expenditures. Health care spending . . .
CLINICAL AND PATHOLOGIC FEATURES OF TWO CASES OF TYPHOID MENINGITIS.
Authors: A. P. OHLMACHER
Journal: JAMA (1897)

It will scarcely be necessary to point out, to an audience composed of clinicians and pathologists of large experience, the comparative rarity with which typhoid meningitis is encountered. In fact, the presence of an actual meningitis was so rarely demonstrated in typhoid fever that much doubt existed, only a few years ago, as to the occurrence of this lesion purely typhoidal in its origin. Since 1890, however, several cases of typhoid meningitis have been studied by careful bacteriologic and pathologic methods, so that there can no longer be a reasonable doubt concerning the identity of this complication of typhoid fever. In a comparatively small number of autopsies on typhoid fever cases, it has fallen to my lot to meet with three instances in which a cerebral meningitis could be demonstrated, and in two of these cases a thorough bacteriologic analysis revealed only the bacillus of typhoid fever as the infecting
Count me in even if I am old!
Authors: Veena S Raleigh, Anthony Deery
Journal: Journal of the Royal Society of Medicine (2007)

Shah and McKenzie (JRSM 2007;100:352-3)1 note that the ‘Count Me In’ census2 does not present separate analyses for older patients. The census is a requirement of DRE, providing a one-day snapshot of mental health inpatients. It is not a research database, and has caveats.2

Shah and McKenzie raise an important issue. Admissions for dementia and depression in older black and minority ethnic (BME) patients can be explored readily and effectively through routinely available datasets such as Hospital Episode Statistics (HES), which provide a complete picture of inpatient activity and much supplementary information (e.g. on diagnosis). Ethnicity coding in HES 2005/06 was over 90% complete/valid for mental health specialty patients.

In response to the letter, we analysed admission rates for ages 65 and over from the 2006 census data, and also admissions in HES. Our findings are:



In the 2006 census, age-standardized admission rates for minority ethnic groups at older ages (results available on request) show similar patterns to those reported for all ages. Results for a few minority groups failed to reach significance because of small numbers. Older BME patients in the census are too few in most ethnic groups to support analyses of subgroups within them (e.g. those detained).


Compared with 10,334 inpatients aged 65 and over in the 2006 census, of whom 1098 were BME patients, there were about five times more admissions in HES (51,598 of whom 4850 were BME patients).






We support calls for better information on users of mental health services.3 We've made recommendations for information developments2 that, along with other information initiatives, we are pursuing with the relevant agencies, including the Department of Health. In the interim, researchers may want to draw on the possibilities offered by data sets such as HES, which are widely used for analysing access to and outcomes of inpatient care.4,5
Recurrence of Silicone Lymphadenopathy
Authors: Adrian J. Christie
Journal: JAMA (1981)

To the Editor.—  We wish to report the recurrence in October 1980 of axillary silicone lymphadenopathy in the same patient we described earlier in JAMA (1977;237:1463). The original adenopathy was seen in April 1976, five years after implantation of ipsilateral silicone elastomer finger joint prostheses, and the implants are still in place. Although this occasional complication is now well documented and confirmed by Laser-Raman microprobe, 1 physicians should be aware of the possibility of its developing nine years or more after the implantation, with possible recurrence.  To the Editor.—  A falling hematocrit value three or four days after the admission of a critically ill patient to the hospital is a cause of great concern. Several possible causes must be considered. Bleeding into a surgical
Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy, 5th edn: M A Meyers. Germany: Springer-Verlag, 2000. ISBN 0-387-98845-9
Authors: D Nolan
Journal: Gut (2003)

Osteoporosis and liver disease: additional reasons for coeliac disease screeningWe read with great interest the recently published guidelines on the management of osteoporosis associated with chronic liver disease (Gut 2002;50(suppl I):i1-9).However, we would like to add a few words of comment.Associations between coeliac disease (CD) and primary biliary cirrhosis in particular and other autoimmune liver diseases in general have been reported. [1]2][3] In addition, it has been suggested that these individuals should be considered as an at risk group for whom serological testing for CD is indicated. 1Patients with CD are at high risk of developing low bone mineral density and bone turnover impairment, 1 and it has been shown that adherence to a gluten free diet has a significant positive impact on these parameters. 4 Thus we suggest that physicians caring for patients with the above mentioned liver diseases should screen them for CD in the presence of signs and symptoms suggestive of malabsorption such as osteoporosis.This seems a reasonable strategy as detection of CD will allow for a more rational therapeutic approach to the risks determined by this association.Complications due to the presence of CD, such as malnutrition, anaemia, and osteoporosis, may have a considerable impact on liver disease management and the need/success of transplantation.
Biochemical characterization of tyrosinase inhibitors using tyrosinase binding affinity chromatography
Authors: GENJI IMOKAWA, YUTAKA MISHIMA
Journal: British Journal of Dermatology (1981)

Purification of tyrosinase inhibitors of hamster melanomas was carried out using tyrosinase binding affinity column chromatography. This method enables the isolation of tyrosinase inhibitors with a 124-fold purification index as compared to that of crude preparation after dialysation. The purified inhibitors consist of a mixture of 5000-6000 and a 310 molecular weight fraction. They also show characteristics of polypeptides which contain glycine, glutamic acid, serine, proline and alanine as main amino acids.
At What Price?
Authors: Irving S. Wright
Journal: New England Journal of Medicine (1972)

The ferment that is brewing in education generally and medical education in particular appears to be progressing in a most irregular and unorganized fashion. The results are proving to be unpredictable and are already disconcerting. At every level of education the direction has been turning away from achievement and toward mass leveling. In many areas students with the least possible background and experience to prepare them for sound judgment regarding their future needs are making many of the key decisions regarding educational policy. They frequently dictate what they want to study and how much they study. Achievement grades and standards . . .
Eosinophil protein in airway macrophages: A novel biomarker of eosinophilic inflammation in patients with asthma
Authors: Neeta S. Kulkarni, Fay Hollins, Amanda Sutcliffe, Ruth Saunders, Sachil Shah, Salman Siddiqui, Sumit Gupta, Pranab Haldar, Ruth Green, Ian Pavord, Andrew Wardlaw, Christopher E. Brightling
Journal: Journal of Allergy and Clinical Immunology (2010)
European subsidies and developing countries
Authors: Kelechi E Nnoaham
Journal: BMJ (2005)

Rationing in response to NHS deficits: rural patients are likely to be affected most See News, p 1426Editor-News that pressing financial problems have caused NHS trusts in Suffolk to set new "thresholds" to treatments such as joint replacements reinforces concerns raised by a recent BMA survey of medical directors of trusts in which over a third of respondents anticipated reductions of key services in response to funding shortfalls. 1 2 What has hitherto escaped comment is how cuts in services are far more likely to be felt in some parts of the country than others.Deficits in the NHS are invariably presented as a problem of financial mismanagement, but the pattern of deficits shows that the current resource allocation model discriminates against particular communities.According to the recently published accounts for 2004-5, 3 89 out of 303 (30%) English primary care trusts ended the year in deficit.The table shows how 301 of these trusts are distributed accorded to fifths of deprivation and rurality.Primary care trusts serving populations that are in both the most rural and the least deprived fifth were most likely to be in financial difficulties.Seventeen of the 25 (68%) in this category were in deficit.These trusts received the lowest funding allocation per head (£995).By contrast, only 3% (one of 34) of the primary care trusts serving populations that are in both the most urban and the most deprived fifths failed to break even in 2004-5.These trusts received the highest funding allocations per head (£1405).This shows that poor financial management can at best only partly explain why some trusts are in deficit.The pattern of deficits implies that NHS funding provides insufficient resources for rural areas, for comparatively affluent areas, and, most particularly, for areas that are both rural and affluent.The risk is that such measures will result in NHS services being subject to a new postcode lottery, in which rural residents are more likely to lose out.
Reply to Giuseppe Di Lorenzo’s Letter to the Editor re: Börje Ljungberg, Damian C. Hanbury, Marcus A. Kuczyk, Axel S. Merseburger, Peter F.A. Mulders, Jean-Jaques Patard and Ioanel Sinescu. Renal Cell Cacinoma Guideline. Eur Urol 2007;51:1502–10
Authors: Börje Ljungberg, Damian C. Hanbury, Marcus A. Kuczyk, Axel S. Merseburger, Peter F.A. Mulders, Jean-Jacques Patard, Ioanel C. Sinescu
Journal: European Urology (2007)
The Monetarization of Medical Care
Authors: Eli Ginzberg
Journal: New England Journal of Medicine (1984)

CLOSE observers of the health-care system, among them Arnold Relman1 2 3 and David Rogers,4 are alarmed at how fast American medicine appears to be turning from a profession into a business. The evidence of history and economics suggests that a related and more pervasive trend, the monetarization of medical care, has been proceeding apace for the past several decades and dominates the present scene.Monetarization can be defined as the rapid penetration since 1950 of the "money economy" into all facets of the health-care system. Its influence is reflected in the following developments: the order of magnitude of growth in the . . .
Prevention and Treatment of Pressure Ulcers
Authors: Seymour M. Gluck
Journal: JAMA (1987)

<h3>To the Editor.—</h3> The "update" on pressure ulcers in Feb 6 MEDICAL NEWS &amp; PERSPECTIVES section<sup>1</sup>failed to reflect at least two notable developments in this field—the Clinitron suspension bed for the treatment of extensive or resistant ulcers and the local use of synthetic hydrophilic agents (eg, dextranomer [Debrisan], the mixture polyisobutene, carboxymethylcellulose sodium, pectin, gelatin, and outer layer of polyurethane [DuoDERM]) to promote active granulation and healing. While various factors leading to the development of pressure ulcers were summarized, no mention was made of the pivotal role of nutrition in prevention and treatment. A recent study of 232 elderly nursing home patients reaffirmed the extremely close correlation between progressive nutritional impairment and the development of pressure sores.<sup>2</sup> The update went on to suggest that preparations containing 10% povidoneiodine interfere with wound healing and should not be used. I am not aware of any data supporting such a broad
Abstract 5052: Maximal SHH-driven medulloblastoma growth requires coordinate CXCR4 activation.
Authors: Stacey Ward, Rajarshi Sengupta, Josh Rubin
Journal: Cancer Research (2013)

Abstract Medulloblastoma is the most common malignant brain tumor of childhood. Even with current intensive treatments there is still significant morbidity and mortality associated with this diagnosis. Recent hope for improved outcome derives from the stratification of medulloblastoma into four molecular subtypes and the promise that subtype-specific targeted therapy will be more efficacious and less toxic. However, even within specific subtypes there can be variable outcomes suggesting that further subclasification will be required. We have shown that CXCR4, a G-protein coupled receptor important for neuronal cell migration, is differentially expressed within the Sonic hedgehog (SHH) subtype of medulloblastoma (CXCR4hi and CXCR4lo) and that activation of CXCR4 was required for maximal medulloblastoma growth in vitro and in vivo. Here we investigate the molecular basis for the interaction between the SHH and CXCR4 pathways and the therapeutic potential of combined SHH and CXCR4 antagonism for the treatment of medulloblastoma. Using primary cultures of SHH-driven medulloblastoma cells as well as their normal developmental counterpart, cerebellar granule precursor cells (GPCs), we found that SHH activation enhances CXCR4 surface localization and promotes prolonged CXCL12-induced GαI signaling. We hypothesized that this was due to SHH inhbition of CXCR4 desensitization and investigated the effects of SHH treatment on proteins involved in CXCR4 trafficking including: ferritin heavy chain, GRKs, arrestins and CXCR7. We found that while SHH had no effect on ferritin heavy chain expression, It did alter the abundance of a subset of GRKs, arrestins and CXCR7. In light of these data we developed a model for multi-tiered regulation of CXCR4 signaling by the SHH pathway that suggested combined SHH and CXCR4 antagonism would have a superior anti-tumor effect compared to SHH antagonism alone. We verified this by in vivo treatment of primary murine SHH-driven (SmoA1) medulloblastoma xenografts with the SHH and CXCR4 antagonists vismodegib and plexiflor. Together these data identify new targets and a new approach for the treatment of SHH-driven medulloblastoma. Citation Format: Stacey Ward, Rajarshi Sengupta, Josh Rubin. Maximal SHH-driven medulloblastoma growth requires coordinate CXCR4 activation. [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 5052. doi:10.1158/1538-7445.AM2013-5052
Health technology transfer
Authors: E. Harris
Journal: BMJ (2000)

Global health relies on biomedical scientists and public health workers to solve infectious disease and other health problems at a local level. Yet investigators in developing countries face tremendous obstacles; scientific isolation, insufficient technical training and research tools, a lack of up to date scientific information, and limited financial, material, and human resources. To build local scientific capacity to monitor and control disease and to promote health, research on locally relevant issues must be supported and sustainable partnerships built to facilitate these efforts. We discuss key elements for transfer of technologies in health research and present two case studies of such programmes.

#### Summary points

More funding must be made available to scientists in developing countries and to organisations that support in-country training and research

Genuine partnership and mutual trust is a prerequisite for the sustainable transfer of technology from developed to developing countries

Building local scientific capacity and long term North-South and South-South partnerships are important in establishing effective health research programmes

Research topics should have local relevance and priority, and technology transfer should be participatory, equitable, and sustained

Autonomous research centres attract funding and reduce administrative burdens

Though 93% of the world's burden of preventable mortality occurs in developing countries,1 too little research funding is targeted to health problems of developing countries, creating a dangerous funding differential.2 In addition, many modern laboratory technologies remain inaccessible in these nations. Both utilitarian and humanitarian arguments can be made for training scientists and health professionals in developing countries in the use of modern laboratory and epidemiological skills. It takes only a day or two for a pathogen to get from any one place on the planet to any other; thus, building capacity in developing countries is a necessary strategy for preventing the global spread of infectious agents.3 Additionally, as a matter …
Timing of transplantation for primary biliary cirrhosis
Authors: Piotr Krzeski, Adrzej Habior
Journal: Hepatology (1999)

Kim et al. described in the July issue of HEPATOLOGY the application of the Mayo Clinic survival model for optimal timing of liver transplantation in patients with primary biliary cirrhosis. 1 I would like to note that their application of the model for follow-up data, although widely used, is formally improper.The same opinion was presented by Neuberger in European Journal of Gastroenterology and Hepatology. 2 The original Mayo Clinic survival model was based on data from a single time point of randomization to a clinical trial. 3 The average risk index for the 418 patients on whom the model was developed was 5.07.The average risk index for patients undergoing orthotropic liver transplantation in Dr. Kim' s series was 7.5, a value that, according to the original Mayo Clinic model, leads to an estimated 1-and 2-year survival probability of 70% and 50%, respectively.For patients with such a high risk of death, the estimated survival has wide confidence limits and tends to be overestimated. 4For this reason the same group of investigators developed an updated model based on repeated patient visits. 5he use of the updated model for optimal timing of OLT would have been formally justified for follow-up data and would have given more accurate predicted survival estimation.Although the prediction of survival with the updated model can only be made for 2 years in advance, it is this time from OLT that accounted for about 80% of deaths in the series studied by Kim et al.I have every reason to believe that the application of the original Mayo Clinic survival model for the primary biliary cirrhosis patients undergoing OLT overestimates the survival benefit and that the accuracy of the estimated survival can be improved using the updated model.
UTILIZATION AND MORTALITY TRENDS FOR BALLOON MITRAL VALVULOPLASTY IN THE UNITED STATES: AN EIGHT–YEAR PERSPECTIVE
Authors: Abhijit Ghatak, Nileshkumar Patel, Kathan Mehta, Ankit Chothani, Abhishek Deshmukh, Neeraj Shah, Vikas Singh, Peeyush Grover, Ankit Rathod, George Marzouka, Ghanshyam Savani, Rajeev Sudhakar, Sidak Panaich, Tushar Tuliani, Apurva Badheka, Mauricio Cohen, William O'Neill, Eduardo De Marchena
Journal: Journal of the American College of Cardiology (2013)