tbuckley/cabot-search huggingface dataset:
Improving the Use of Hospice Services in Nursing Homes
Authors: David Casarett, Jason Karlawish, Knashawn Morales, Roxane Crowley, Terre Mirsch, David A. Asch
Journal: JAMA (2005)

Hospice care may improve the quality of end-of-life care for nursing home residents, but hospice is underutilized by this population, at least in part because physicians are not aware of their patients' preferences.To determine whether it is possible to increase hospice utilization and improve the quality of end-of-life care by identifying residents whose goals and preferences are consistent with hospice care.Randomized controlled trial (December 2003-December 2004) of nursing home residents and their surrogate decision makers (N=205) in 3 US nursing homes.A structured interview identified residents whose goals for care, treatment preferences, and palliative care needs made them appropriate for hospice care. These residents' physicians were notified and asked to authorize a hospice informational visit.The primary outcome measures were (1) hospice enrollment within 30 days of the intervention and (2) families' ratings of the quality of care for residents who died during the 6-month follow-up period.Of the 205 residents in the study sample, 107 were randomly assigned to receive the intervention, and 98 received usual care. Intervention residents were more likely than usual care residents to enroll in hospice within 30 days (21/107 [20%] vs 1/98 [1%]; P<.001 [Fisher exact test]) and to enroll in hospice during the follow-up period (27/207 [25%] vs 6/98 [6%]; P<.001). Intervention residents had fewer acute care admissions (mean: 0.28 vs 0.49; P = .04 [Wilcoxon rank sum test]) and spent fewer days in an acute care setting (mean: 1.2 vs 3.0; P = .03 [Wilcoxon rank sum test]). Families of intervention residents rated the resident's care more highly than did families of usual care residents (mean on a scale of 1-5: 4.1 vs 2.5; P = .04 [Wilcoxon rank sum test]).A simple communication intervention can increase rates of hospice referrals and families' ratings of end-of-life care and may also decrease utilization of acute care resources.
Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d'Etude des Lymphomes de l'Adulte (GELA)
Authors: Catherine Sebban, Nicolas Mounier, Nicole Brousse, Coralie Belanger, Pauline Brice, Corinne Haioun, Herve Tilly, Pierre Feugier, Redah Bouabdallah, Chantal Doyen, Gilles Salles, Bertrand Coiffier
Journal: Blood (2006)
Time out of Mind
Authors: S. Dosani
Journal: BMJ (2003)

Jane Lapotaire Virago, £16.99, pp 320 ISBN 1 86049 977 5 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> I confess a certain dread before settling down to read this book. Another celebrity falls foul of an illness and charts her decline or recovery. Almost always doctors come out of these accounts less favourably than we like to see ourselves. But Time out of Mind is in a league of its own. Jane Lapotaire, an eminent film and television actor and a member of the Royal Shakespeare Company, uses skills and techniques acquired in her job to dramatise her life since just after … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif
A Novel Site-Targeted Ultrasonic Contrast Agent With Broad Biomedical Application
Authors: Gregory M. Lanza, Kirk D. Wallace, Michael J. Scott, William P. Cacheris, Dana R. Abendschein, Donald H. Christy, Angela M. Sharkey, James G. Miller, Patrick J. Gaffney, Samuel A. Wickline
Journal: Circulation (1996)

Background In this work, we report a novel targetable ultrasonic contrast agent with the potential to noninvasively define and localize myriad pathological tissues for diagnosis or therapy. The agent is a biotinylated, lipid-coated, perfluorocarbon emulsion that has low inherent echogenicity unless bound to a surface or itself. Methods and Results In study 1, emulsions with and without biotin were suspended in buffered saline and imaged with a 7.5-MHz linear-array transducer. Neither emulsion manifested significant ultrasonic backscatter until avidin was added. Avidin-induced aggregation produced a marked enhancement in backscatter from the biotinylated but not from the control emulsion. In study 2, porcine fibrin clots in vitro were pretargeted with biotinylated antifibrin monoclonal antibodies and then exposed to avidin and then to biotinylated or control perfluorocarbon emulsions. The basal acoustic reflectivity of clots imaged with a 7.5-MHz linear-array transducer was uniformly low and was increased substantially by exposure to the targeted biotinylated emulsion. In study 3, partially occlusive arterial thrombi were created in dogs and then exposed to antifibrin antibodies and avidin in situ. Biotinylated or control emulsion was administered either in situ or systemically. At baseline, all thrombi were undetectable with a 7.5-MHz linear-array transducer. Thrombi exposed to antifibrin-targeted contrast exhibited increased echogenicity ( P &lt;.05); control thrombi remained acoustically undetectable. Conclusions These data provide the first in vivo demonstration of a site-specific ultrasonic contrast agent and have potential for improved sensitivity and specificity for noninvasive diagnosis of thrombi and other pathological diseases.
Protective Equipment for in-Line Skaters
Authors: Robert S. Thompson, Frederick P. Rivara
Journal: New England Journal of Medicine (1996)

In-line skating has burgeoned in popularity in the United States, with participation increasing from 6.2 million in 1991 to 22.5 million by 1995.1,2 For the uninitiated, in-line skates differ from roller skates in that the wheels — four or five of them — are mounted in series on a frame attached to the skating boot. Speeds of 10 to 17 mph (16 to 27 km per hour) are quite common for routine cruising, and speeds of up to 30 mph (48 km per hour) are not unusual.3,4 This compares with speeds of 9 mph (15 km per hour) . . .
Low‐dose local nasal immunotherapy in children with perennial allergic rhinitis due to <i>Dermatophagoides</i>
Authors: F. Marcucci, L.G. Sensi, C. Caffarelli, G. Cavagni, R. Bernardini, A. Tiri, G. Riva, E. Novembre
Journal: Allergy (2002)

Background: Allergen specific immunotherapy was known to be useful in the treatment of respiratory allergic disease. Local nasal immunotherapy (LNIT) offers advantages such as a good efficacy/safety ratio and a more convenient allergen delivery. The aim of this study was to assess the safety and clinical efficacy of a modified scheduling of LNIT in 32 children with allergic rhinitis due to Dermatophagoides . Methods: A multicentre, randomized, double‐blind placebo controlled study carried out for two years, with a modified schedule of LNIT treatment: a build‐up phase at increasing dosages from 2.5 AU to 80 AU and a maintenance period at low dosage (80 AU) once a week. Symptom and medication scores, threshold dose with specific nasal provocation test (NPT) and immunological parameters (IgE and IgG 4 ) were evaluated. Results: No important local or systemic side‐effects were observed in children who completed the study. Compared to placebo, the active treatment group showed significant improvement in rhinitis symptoms and a reduction of drug consumption after 18 months of LNIT. These results were confirmed by a significant reduction of allergen specific nasal reactivity. Serum and nasal specific IgE and IgG 4 did not show any difference in the two groups. Conclusions: The safety and clinical efficacy of low‐dose LNIT suggests that this therapy may be useful in the treatment of allergic rhinitis disease in children.
Importance of Refractory Pain and Hypertension in Acute Type B Aortic Dissection
Authors: Santi Trimarchi, Kim A. Eagle, Christoph A. Nienaber, Reed E. Pyeritz, Frederik H.W. Jonker, Toru Suzuki, Patrick T. O'Gara, Stuart J. Hutchinson, Vincenzo Rampoldi, Viviana Grassi, Eduardo Bossone, Bart E. Muhs, Arturo Evangelista, Thomas T. Tsai, Jim B. Froehlich, Jeanna V. Cooper, Dan Montgomery, Gabriel Meinhardt, Truls Myrmel, Gilbert R. Upchurch, Thoralf M. Sundt, Eric M. Isselbacher
Journal: Circulation (2010)

In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection.Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. "High-risk" patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P=0.0003). Mortality rates after surgical (20% versus 28%; P=0.74) or endovascular management (3.7% versus 9.1%; P=0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P=0.041).Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
IMMUNOGLOBULIN E IN "HEALED" ATOPIC DERMATITIS AND AFTER TREATMENT WITH CORTICOSTEROIDS AND AZATHIOPRINE
Authors: Gunnar S, Johansson O, Juhlin L
Journal: British Journal of Dermatology (1970)

SUMMARY.— In patients with atopic dermatitis, eczema and urticaria, systemic treatment with prednisone had no effect on the serum immunoglobulin E level (IgE) but improved their clinical condition. Neither was there any effect on the IgE level after the immunosuppressive, azathioprine. The increased level of IgE found in patients with atopic dermatitis was not seen in those who had been free from symptoms for more than a year even if they had a persistent or recurring eczema of the hands or nummular eczema.
Liver stiffness values in healthy subjects: Implications for clinical practice
Authors: Jeremy F.L. Cobbold, Simon D. Taylor-Robinson
Journal: Journal of Hepatology (2008)

Liver stiffness measurement (LSM) using transient elastography is considered a promising technique for the assessment of severity of chronic liver disease, having been shown in a number of disease settings to be correlated with the fibrosis stage as assessed histologically [1–4]. Although a number of studies have included groups of subjects without evidence of fibrosis histologically, none has examined the range of liver stiffness values in a cohort of healthy subjects. The paper by Roulot and colleagues in this edition of the Journal examines a large cohort of subjects with no evidence of liver disease to establish estimates for normal values and to investigate possible factors in the apparently normal population, which may affect the LSM [5]. In previously published multivariate analyses of cohorts of patients with chronic liver disease, fibrosis was found to be the only factor to correlate significantly with increasing LSM [1,2,6]. However, the authors of the original proof-of-principle in vitro study recognised that a single physical parameter (i.e. stiffness) was unlikely to describe fully a complex biological system in which fibrosis is just one part [7]. Subsequent studies have demonstrated that portal pressures, as assessed by the hepatic venous pressure gradient (HVPG) [8] and inflammation, as assessed by the histological necro-inflammatory grade [9] also correlate with liver stiffness. Indeed, a paper by Pinzani’s group has demonstrated an increase of LSM in the cirrhotic range in patients with acute viral hepatitis with no history of liver disease and, furthermore, reduction of liver stiffness, corresponding to biochemical improvement of the hepatitis [10]. The effect of steatosis on LSM has not been investigated in depth, although histological evidence of steatosis has not been found to affect liver stiffness on multivariate analysis of cohorts of patients with chronic liver disease. The knowledge that factors other than fibrosis affect liver stiffness makes analysis of subjects in whom there is no fibrosis all the more relevant. Roulot and colleagues examined a cohort of apparently healthy individuals attending a free health check. This study has considerable strengths. The population studied exceeded 400 subjects, making it by far the largest study of liver stiffness in ‘‘normal” individuals. LSMs were acquired according to published criteria, by a single operator who was blinded to the clinical data. By taking a population of subjects attending a health check, rigorous clinical and biological data collection was attainable from subjects, who could be classified as healthy on the basis of exclusion of factors predisposing to, or associated with, liver disease. In addition, the diagnosis of metabolic syndrome used validated diagnostic criteria.
Hemolytic-Uremic Syndrome after Shigellosis
Authors: Frederick Koster, Jack Levin, Lesley Walker, Kenneth S. K. Tung, Robert H. Gilman, M. Mujibur Rahaman, M. Abdul Majid, Sirajul Islam, Ralph C. Williams
Journal: New England Journal of Medicine (1978)

To investigate three possible causes of the acute hemolysis in the hemolytic-uremic syndrome, we studied prospectively 207 children and 34 adults with shigellosis in Bangladesh. Nineteen children showed acute hemolytic anemia, a leukemoid reaction, thrombocytopenia and oliguria; nine other had, in addition, a serum urea nitrogen level of over 100 mg per diciliter. Eight of the nine had pseudomembranous colitis, and six of the nine died. The frequency of bacteremia was similar in all grades of shigellosis. Circulating immune complexes were found in 10 of 20 patients with uncomplicated shigellosis and in four of six with severe hemolytic-uremic syndrome. Limulus assay for endotoxemia was positive in nine of 18 patients with hemolysis (50 per cent) and three of 61 with uncomplicated shigellosis (5 per cent) (P less than 0.001). These data support the hypothesis that severe colitis in shigellosis is associated with circulating endotoxin from the colon producing coagulopathy, renal microangiopathy and hemolytic anemia.
Does This Dizzy Patient Have a Serious Form of Vertigo?
Authors: David A. Froehling
Journal: JAMA (1994)

<h3>CLINICAL SCENARIOS: COMMON CAUSES OF VERTIGO</h3><h3>Patient 1</h3> A 52-year-old woman was admitted to the hospital because of nausea, a constant spinning sensation, and vomiting of 24 hours' duration. Any movement of her head made these symptoms worse. On examination, she had bilateral horizontal spontaneous nystagmus. Two days later, after symptomatic improvement, she was dismissed. At follow-up 2 weeks later, her symptoms and nystagmus had completely resolved. <h3>Patient 2</h3> A 70-year-old woman had a 4-month history of an intermittent whirling sensation when turning her head and especially when rolling over in bed. On examination, a left-side-down head-hanging maneuver elicited rotatory nystagmus, with the fast component to the left ear (Figure). There was a latency of about 3 seconds before the onset of nystagmus, which lasted approximately 10 seconds. <h3>WHY EVALUATE VERTIGO?</h3> "Vertigo" is defined in Webster's dictionary<sup>2</sup>as a disturbance "in which the external world seems to revolve around
EXPERIMENTAL GLOMERULONEPHRITIS
Authors: Emil R. Unanue, Sun Lee, Frank J. Dixon, Joseph D. Feldman
Journal: The Journal of Experimental Medicine (1965)

Rats with nephrotoxic serum nephritis were studied for the presence of a possible autoimmune response to renal antigens formed and/or liberated during the immunologic reactions taking place in the glomeruli. The experiments consisted of transplantation of a normal isologous kidney to a nephritic rat and parabiosis of a normal rat to a nephritic rat. Neither functional nor morphologic abnormalities were noted in the normal kidneys in either situation. Transfer of the rabbit nephrotoxic antibody to the normal kidneys was noted in both experiments, indicating a continual dissociation and reassociation of nephrotoxic antibody with the tissue antigens of the host. Some of the nephritic rats showed a decrease in proteinuria and a slowing in the progression of the nephritis during the period in which the normal kidney was transplanted or a normal rat was united in parabiosis.
OC-023 Specialist Care of in-Patients with Non-Variceal upper Gastrointestinal Bleeding is Associated with a Dramatically Shorter Length of Stay: Abstract OC-023 Table
Authors: S V Venkatachalapathy, N Grasso, G Chung-faye, P Dubois, I Forgacs, R P Logan, B Hayee
Journal: Gut (2013)

<h3>Introduction</h3> Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency that has a 10% mortality rate [1], requiring specialist input and management [2]. It is not known if the care, outcome and length of stay of UGIB is influenced by whether patients are primarily cared for by Gastroenterologists or General physicians. We conducted a retrospective study to assess these aspects of care for in-patients with UGIB. <h3>Methods</h3> A retrospective review of case-notes (Electronic patient record-EPR) was conducted for all patients admitted to Kings College hospital with suspected UGIB between February and September 2012. Patients were divided as to whether they came immediately under the care of Gastroenterologists (GI) or general physicians (non-GI) after initial evaluation in the Acute Admission Unit. Patients were assigned on the basis of bed availability in a ward-based system. Statistical comparisons were made as appropriate with t-test or Fisher’s exact test. <h3>Results</h3> 109 patient episodes were reviewed. 14 had no evidence of UGIB and were excluded from further analysis. 59 (76.6%) of patients had an initial risk assessment (including documented score) completed on admission. After excluding patients with major non-medical (‘social’) issues, 53 (69%) GI and 24 non-GI patients were compared. The two groups were broadly similar in their baseline characteristics. Mean length of stay (days) was significantly shorter in the GI group: 5.5 ± 5.7 vs 15.7 ± 20.8 (p = 0.02). Other comparators are shown in the table. <h3>Conclusion</h3> The length of stay of patients with UGIB is dramatically shorter when receiving specialist care. This was statistically significant even after adjusting for social issues. Further data regarding the specific management of each case will be forthcoming. In line with previous reports [3], we found that the incidence of UGIB was higher in males. There was a trend toward better risk assessment, shorter time to endoscopy, reduced need for surgery and mortality in the GI group. Mortality rates in both groups compared favourably to the national average. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> CG141 Scope for improvement: A toolkit for a safer Upper Gastrointestinal Bleeding (UGIB) service. www.bsg.org.uk Lanas A, García-Rodríguez LA, Polo-Tomás M etal; Am J Gastroenterol 2009; 104:1633–41.
Prevention of doxorubicin-induced alopecia by scalp cooling in patients with advanced breast cancer.
Authors: J E Anderson, J M Hunt, I E Smith
Journal: BMJ (1981)

Scalp cooling with gel packs was used to try to prevent alopecia in 31 patients being treated with doxorubicin (Adriamycin), 29 for advanced breast carcinoma and two for carcinoid tumour. Twenty-eight of the 31 patients tolerated the procedure well, and 22 of these had either no hair loss or only slight loss which remained acceptable and did not require a wig. The main factor limiting success was biochemical impairment of liver function, which occurred in nine patients; of these, six had severe or total alopecia despite scalp cooling. Conversely, the technique was successful in all 19 patients with normal liver function. Carried out properly, this simple and effective technique greatly diminishes socially unacceptable alopecia associated with doxorubicin, and merits wider use.
Multilineage hematopoietic reconstitution without clonal selection in ADA-SCID patients treated with stem cell gene therapy
Authors: Alessandro Aiuti, Barbara Cassani, Grazia Andolfi, Massimiliano Mirolo, Luca Biasco, Alessandra Recchia, Fabrizia Urbinati, Cristina Valacca, Samantha Scaramuzza, Memet Aker, Shimon Slavin, Matteo Cazzola, Daniela Sartori, Alessandro Ambrosi, Clelia Di Serio, Maria Grazia Roncarolo, Fulvio Mavilio, Claudio Bordignon
Journal: Journal of Clinical Investigation (2007)

Gene transfer into HSCs is an effective treatment for SCID, although potentially limited by the risk of insertional mutagenesis. We performed a genome-wide analysis of retroviral vector integrations in genetically corrected HSCs and their multilineage progeny before and up to 47 months after transplantation into 5 patients with adenosine deaminase–deficient SCID. Gene-dense regions, promoters, and transcriptionally active genes were preferred retroviral integrations sites (RISs) both in preinfusion transduced CD34+ cells and in vivo after gene therapy. The occurrence of insertion sites proximal to protooncogenes or genes controlling cell growth and self renewal, including LMO2, was not associated with clonal selection or expansion in vivo. Clonal analysis of long-term repopulating cell progeny in vivo revealed highly polyclonal T cell populations and shared RISs among multiple lineages, demonstrating the engraftment of multipotent HSCs. These data have important implications for the biology of retroviral vectors, the dynamics of genetically modified HSCs, and the safety of gene therapy.
Sir Hans Sloane: Collector, Scientist, Antiquary
Authors: C. Booth
Journal: BMJ (1995)

Ed Arthur MacGregor British Museum Press, pounds sterling50, pp 308 ISBN 0 7141 2085 5

There has been no full length and comprehensive biography of Sir Hans Sloane. Perhaps the task is too formidable for a single person. He lived, after all, to the age of 92, so that, being born in the year of the Restoration, he did not die until the later years of the reign of George II. He first established himself with his Voyage to the Island Madera, Barbados, Nieves, S. Christophers and Jamaica…with the natural history of the…last of those islands…, derived from his journey to the Caribbean with the Duke of Albermarle between 1687 and 1689. Later he was to become not only president of the Royal Society after Sir Isaac Newton for …