tbuckley/cabot-search huggingface dataset:
Development of a Comprehensive Supportive Care Team for the Hopelessly Ill on a University Hospital Medical Service
Authors: Richard W. Carlson
Journal: JAMA (1988)

We developed a supportive care service for a university hospital medical service that serves a socially and medically disadvantaged urban population. The team includes a faculty physician and a clinical nurse specialist who provide primary medical care, family support, and in-service guidance to hospital staff about ethical issues. A multidisciplinary approach incorporates nursing, pastoral care, social work, and other hospital services. We report our experience from November 1985 through May 1987, during which time 222 patients were referred to the team; 212 patients were accepted. The goals and operation of the service are described. The most common (n = 62, 29%) diagnosis on referral was global central nervous system anoxia following cardiopulmonary arrest. Other severe neurological conditions accounted for an additional 79 patients (37%). Comparison of patients on the service with a similar group revealed no difference in survival rate, although hospital length of stay and charges were progressively reduced after implementation of the service. This approach to the care of hopelessly ill patients may serve as an alternative method of treatment in similar hospital settings.The authors document the first 19 months of a service dedicated to the care of hopelessly ill patients in a teaching hospital. A comprehensive supportive care team (CSCT) was established to ensure a humane, uniform, and consistent approach to the care of patients for whom aggressive care is no longer warranted. The goals and operation of the CSCT are described, including the components of patient evaluation and development of treatment plans. Results of a study of 212 patients accepted by the CSCT are reported. The authors conclude that the service successfully provided conservative but comprehensive care for the hopelessly ill, and that it increased awareness of ethical issues among hospital personnel, patients, and families.
Response to oral theophylline in severe chronic obstructive airways disease: Authors' reply
Authors: M D Peake, H Chrystyn, B A Mulley
Journal: BMJ (1989)

evaporate completely.Is it a total waste of time to hope that the profession will abandon complacency and itself introduce the important reforms?Disappointingly, there seem to be some who remain so beguiled by the system that they continue to extol their fairness and honesty while choosing to ignore the damning evidence for arbitrary practices,4 8 for prejudice both geographical' and toward specialties,9 and for the extraordinary discrimination against women.
Etiquette: Preaching and Teaching
Authors: Mitchell T. Rabkin
Journal: JAMA (1988)

At the medical schools and teaching hospitals and at community hospitals, too, senior physicians not only educate their juniors in the substance of medicine but communicate as well<i>how</i>to be a doctor. While the former leans heavily on data and facts, the latter is conveyed largely by individual example, that is, by the physician serving as role model. Being an example to others is not an option; it is inevitable in virtually every interaction on the part of the physician. Even walking the hospital corridor, conversing with a colleague, patient, or visitor, the physician is registering with passersby. The impact is more intense, of course, on those enmeshed with the physician in the tasks of the moment, but always the physician is demonstrating how he or she behaves in specific circumstances. To your juniors, your actions take on normative qualities. Who does not recall mentors from medical school and
Dutch inspectors slam standards of preoperative care
Authors: Tony Sheldon
Journal: BMJ (2007)

Lester Crawford, former commissioner of the US Food and Drug Administration, was last week fined $89 377 (£45 800; €67 000), sentenced to three years of supervised probation, and required to do 50 hours of community service by Judge Deborah Robinson of the US District Court for the District of Columbia.Last October Dr Crawford (below) pleaded (below) pleaded pleaded guilty to two charges: failing to report that he and his wife owned shares in companies regulated by the agency and filing false
Congenital 6-phosphogluconate dehydrogenase (6PGD) deficiency associated with chronic hemolytic anemia in a Spanish family
Authors: J. Ll. Vives Corrons, D. Colomer, A. Pujades, A. Rovira, M. Aymerich, A. Merino, J. Ll. Aguilar i Bascompte
Journal: American Journal of Hematology (1996)

Clinical and metabolic studies were performed in four members of a Spanish family with partial (50%) 6 phosphogluconate dehydrogenase (6PGD) deficiency. In all cases the activities of 6 phosphogluconolactone (6PGL) and glutathione reductase (GR) were normal, and the molecular characterization performed in the partially purified 6PGD from the propositus showed normal kinetic and electrophoretic patterns. Two females (the propositus and her sister) suffered from a well-compensated chronic nonspherocytic hemolytic anemia (CNSHA) and exhibited decreased RBC glutathione (GSH) stability with increased oxidative susceptibility, defined by enhanced malonyldialdehyde (MDA) generation "in vitro." The other two members of the family (the propositus's mother and brother) were clinically asymptomatic. In the propositus and her sister, RBC metabolism exhibited a markedly abnormal concentration of glycolytic intermediates, mainly characterized by striking increases in fructose 1,6 bisphosphate (50-fold), dihydroxiacetone-phosphate (20-fold) and glyceraldehyde 3-phosphate (tenfold). Although the precise mechanism of the hemolysis in the two patients is unknown, the enhanced oxidative threat observed in their RBCs may interfere in some way with the glycolytic pathway function, leading to a marked increase in certain metabolic intermediates located before the glyceraldehyde 3 phosphate dehydrogenase (GA3PD) step. Since it seems that GA3PD half-life is modulated by fluctuations of the cytosolic redox status, an "in situ" approach was simulated by using permeabilized RBCs. In these conditions, GA3PD activity was significantly lower in the propositus and her sister than in the asymptomatic members of the family and the simultaneous normal control.
Regional perfusion, glucose metabolism, and wall motion in patients with chronic electrocardiographic Q wave infarctions: evidence for persistence of viable tissue in some infarct regions by positron emission tomography.
Authors: R Brunken, J Tillisch, M Schwaiger, J S Child, R Marshall, M Mandelkern, M E Phelps, H R Schelbert
Journal: Circulation (1986)

Positron-emission tomography with 13N-ammonia and 18F-2-deoxyglucose was used to assess regional perfusion and glucose utilization in 31 chronic electrocardiographic Q wave regions in 20 patients. With previously published criteria, regions of infarction were identified by a concordant reduction in regional perfusion and glucose utilization, and regions of ischemia were identified by preservation of glucose utilization in regions of diminished perfusion. Only 10 of the 31 regions (32%) exhibited myocardial infarction tomographically. In contrast, positron tomography revealed ischemia in six regions (20%) and was normal in 15 regions (48%). Even when Q wave regions were reassigned and consolidated to enhance the specificity of the electrocardiogram, uptake of 18F-2-deoxyglucose was noted in the majority (54%) of the regions. Neither electrocardiographic ST-T changes nor severity of associated wall motion abnormality reliably distinguished tomographically identified regions of ischemia from infarction. Thus positron tomography reveals evidence of persistent tissue metabolism in a high proportion of chronic electrocardiographic Q wave regions, and commonly used clinical tests do not reliably distinguish hypoperfused but viable regions from tomographically defined regions of myocardial infarction.
[124] 76 WEEK FOLLOW UP OF HBeAg-POSITIVE CHRONIC HEPATITIS B PATIENTS TREATED WITH TELBIVUDINE, ADEFOVIR OR SWITCHED FROM ADEFOVIR TO TELBIVUDINE
Authors: P. Marcellin, H.L.Y. Chan, C.-L. Lai, M. Cho, Y.-M. Moon, Y.-C. Chao, J. Heathcote, R. Myers, G. Harb, N.A. Brown
Journal: Journal of Hepatology (2007)
Kinetics of RNA synthesis in toad bladder epithelium: action of aldosterone during the latent period
Authors: Pavel Van̆cra, Geoffrey W. G. Sharp, Ronald A. Malt
Journal: Journal of Clinical Investigation (1971)

Processing of RNA in the toad bladder was analyzed by polyacrylamide-gel electrophoresis to determine whether aldosterone causes any changes in the 1 hr before it potentiates transport of sodium ion. No change was found in the quantity or in the specific activity of bulk RNA labeled with uridine-5-(3)H. In vivo and in vitro with either uridine-5-(3)H or with methionine-(methyl)-(3)H as precursors, processing of RNA was extremely slow. Heterodisperse RNA was obvious after 30 min of continuous labeling, but labeling of the 40S precursor of ribosomal RNA was not apparent for 60 min. Labeling of mature 28S and 18S RNA first became apparent after 8 hr. approximately 7S RNA was the principal fastmigrating species labeled at 30 min, and 4S RNA was not heavily labeled until 1 hr. Aldosterone (5 x 10(-7) mole/liter) produced no changes. If care were not taken to inhibit metabolism of native bacteria colonizing the bladder, bacterial RNA of high specific activity predominated. We conclude that RNA metabolism in the toad bladder is extraordinarily slow, that a major acceleration of de novo synthesis in response to physiologic doses of aldosterone was not demonstrable, and that some reports to the contrary may have been influenced by artifacts from bacterial RNA metabolism. Earlier evidence for obligatory alterations in RNA metabolism during the latent period is not strong.
Abstract P3-10-04: Prevalence of pain and barriers to pain management in breast cancer survivors in Vietnam
Authors: J Nguyen, TT Tran, TV Ta, O Ginsburg
Journal: Cancer Research (2013)

Abstract Introduction: Breast cancer-related pain significantly affects quality of life and is well-documented in developed countries. However, little is known about the extent of breast cancer-related pain in developing countries. A study at the National Cancer Institute of Vietnam reported that 44% of breast cancer patients experienced moderate to severe pain. However, this study did not include breast cancer survivors, and little is known about the prevalence of pain and its management in this patient population. Objectives: Determine the prevalence of pain, adequacy of pain management, and barriers to care in breast cancer survivors in Vietnam. Methods: We administered previously validated and published symptom assessment tools (the BPI and MDASI) to 160 unselected Vietnamese women diagnosed and treated for breast cancer in 2007. Here we present a preliminary description of the results for the first 40 breast cancer survivors enrolled in this study. Results: The most frequently reported symptoms were pain (62.5%, with 40% reporting the pain as severe), memory loss (50%), numbness/tingling (50%), sleep disturbance (45%), and appetite loss (32.5%). Only 23% reported adequate symptom management, with the costs of treatment and the false belief that no treatments existed for the pain being frequently cited as barriers to care. Discussion: Cancer-related pain is highly prevalent in breast cancer survivors treated at the largest cancer hospital in Vietnam. The majority of patients report inadequate management of pain, often attributable to costs and false beliefs regarding pain management. Initiatives aimed at patient education and improving accessibility to pain management could significantly improve the quality of life in this patient population. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-04.
GE-04 * MGMT METHYLATION IS A POSITIVE PROGNOSTIC MARKER IN PATIENTS WITH ANAPLASTIC ASTROCYTOMA TREATED WITH CONCURRENT TEMOZOLOMIDE AND RADIATION
Authors: D. Blumenthal, F. Bokstein, B. Zelikovitsh, A. Mordechai, A. Lossos, A. Taliansky, L. Zach, T. Tzuk-Shina, I. Lavon
Journal: Neuro-Oncology (2014)

BACKGROUND: Concurrent radiation (RT) and temozolomide (TMZ) has been accepted as standard first-line therapy for glioblastoma since publication of results of the phase III EORTC/NCIC trial in 2005. In the same NEJM issue, data were presented which showed the prognostic significance of MGMT methylation status in these patients. Trials for first-line treatment of anaplastic (grade III) glioma are currently underway, but until these trials complete accrual and mature, the role of concurrent chemotherapy and the prognostic significance of MGMT methylation status for patients with anaplastic glioma is unclear. METHODS: We hypothesized that methylated MGMT promoter may be a prognostic factor for anaplastic astrocytomas treated with chemoradiation (RT+ TMZ). We retrospectively reviewed data from 53 patients with anaplastic astrocytoma tested for MGMT methylation status by Methylation-Specific PCR (MSP) in our Neuro-oncology laboratory from 2007- 2014. Most patients were treated with concurrent TMZ and RT as first-line therapy (with a few selected cases treated with radiation alone). Survival curves of the groups of methylated and unmethylated tumors were compared using Logrank test. RESULTS: Twenty-one of 53 patients (39%) had MGMT methylation. The median survival in patients with MGMT methylation was 32.2 months and for unmethylated tumors, 23.7 months (p = 0.0947). Patients 45 years and younger showed more favorable prognosis with a median survival of 33.9 months compared to 24.3 in patients older than 45. CONCLUSIONS: The results of this study support the hypothesis that patients with anaplastic astrocytoma who have MGMT methylation have a more favorable prognosis when treated with concomitant TMZ and RT than do their unmethylated counterparts. Further analysis regarding progression- free survival; the effect of other chemotherapy or biologic agents given as second-line or adjuvant therapy; the pattern of response in anaplastic gliomatosis; and the impact of 1p19q and IDH status in these patients will be presented.
Effects of two slimming drugs on sleep.
Authors: I. Oswald, H. S. Jones, J. E. Mannerheim
Journal: BMJ (1968)

advantages as a screening method, and remains the best single test which does not require an experienced ophthalmologist to perform it.All surveys produce the problem of borderline cases, and this problem with glaucoma surveys has been previously discussed by one of us (Perkins, 1966).No easy solution can be proffered, and only further research will provide clearer indications of methods of reducing the number of patients requiring long-term follow-up. SummaryA glaucoma screening survey using applanation tonometry was carried out on 5,941 persons in Bedford.The distribution of ocular tensions showed a divergence from a Gaussian curve for tensions of 21 mm.Hg and above.Age, sex, time of day, and menstruation were found to influence the tonometric readings.Fifty-five cases of primary glaucoma (0.93% of those screened) were detected as a result of the survey; these included 42 cases of chronic simple glaucoma, 3 cases of low- tension glaucoma, and 10 cases of closed-angle glaucoma.An additional 180 persons (3% of the population studied) were found to have applanation tensions of 21 mm.Hg or more but without other evidence of glaucoma.Nearly 80% of the patients with glaucoma were over 60 years of age, suggesting that glaucoma detection programmes should concentrate on the older age groups.As over 10% of the population screened required further investigation, large-scale screening of the population would throw a heavy burden on the ophthalmological services of the country.In spite of the difficulty of interpreting tonometric results, tonometry is the most reliable screening procedure which does not require an experienced ophthalmologist to perform it.We should like to acknowledge the skilful technical assistance of Miss E. Verkoczy, Mrs.
The GMC: expediency before principle
Authors: Birte Twisselmann
Journal: BMJ (2005)

Editor—The three articles discussing the forensic examination of the General Medical Council conducted by Dame Janet Smith as part of her inquiry into the issues arising from the case of general practitioner Harold Shipman sparked considerable controversy.1-3

Most respondents focused on the GMC rather than the report, although some took issue with the suggestion of having more medical members appointed than elected to the council. Another worry was that the conflict was playing into the government's and Department of Health's hands and becoming politicised, to the detriment of the medical profession.

One strand of the debate was whether the remit of the GMC should in fact be protecting patients (in addition to regulating doctors). Sufficiently strong self regulation would arguably protect patients, which would, in turn, protect doctors. Mostly, however, the GMC was severely criticised. Anecdotal examples of the GMC's conduct, especially towards those who expressed criticism of it, were numerous.

Several correspondents were in favour of some sort of revalidation system, and the GMC president, Graeme Catto, invited suggestions for refining the revalidation procedures. Numerous doctors pointed out that the atmosphere in the wake of revalidation was threatening and mistrustful and not in any way congenial to good medical practice or a happy professional life. One argued that the council has not acknowledged all the revisions and improvements that have happened in medical training, and the plans for revalidation are therefore bureaucratic and vague.

The GMC was perceived as having lost the trust of the public and the professionals it regulates. Must it be staffed by doctors or could it be staffed by other types of professionals—“inspectors,” even?

The belief underlying most responses was that the GMC rather than the workforce it regulates is in need of reform. But expediency before principle is common because to think that no patient will ever be harmed by a doctor's incompetence is pretending. It comes down to whether the profession wants to keep the privilege of regulating itself or give it up, a way forward favoured by some. However, as one general practitioner in Leeds concludes, there will always be Shipmans—no matter what regulatory processes are in place.
Right Ventricular Aneurysm Due to Ischemic Disease Diagnosis by Radionuclide Angiography with Localization of the Site of PVC Origin by Phase Analysis
Authors: PHILLIP B. SHAFFER, THOMAS M. BASHORE, ANGELA M. NOTO, GARY DIBLASIO, JOHN O. OLSEN, STEPHEN F. SCHALL
Journal: Clinical Nuclear Medicine (1987)

A case of right ventricular aneurysm due to coronary artery disease in a 69-year-old male with no prior history of surgery or chest trauma is reported. The presence of the aneurysm was diagnosed by gated radionuclide angiography and confirmed by contrast angiography. This is the first description of an isolated right ventricular aneurysm on the basis of ischemic disease. In addition, the patient had recurrent ventricular tachycardia and frequent premature ventricular contractions (PVC's). Using radionuclide angiographic phase analysis of the PVC's, their apparent origin was localized to the margin of the right ventricular aneurysm.
Children at risk for asthma: Home allergen levels, lymphocyte proliferation, and wheeze
Authors: Patricia W. Finn, Jacques O. Boudreau, Hongzhen He, Yunsheng Wang, Martin D. Chapman, Carey Vincent, Harriet A. Burge, Scott T. Weiss, David L. Perkins, Diane R. Gold
Journal: Journal of Allergy and Clinical Immunology (2000)
Heterogeneity in Regional GC Content and Differential Usage of Codons and Amino Acids in GC-Poor and GC-Rich Regions of the Genome of Apis mellifera
Authors: F. G. Jorgensen, M. H. Schierup, A. G. Clark
Journal: Molecular Biology and Evolution (2006)

The honeybee (Apis mellifera) has a genome with a wide variation in GC content showing 2 clear modal GC values, in some ways reminiscent of an isochore-like structure. To gain insight into causes and consequences of this pattern, we used a comparative approach to study the genome-wide alignment of primarily coding sequence of A. mellifera with Drosophila melanogaster and Anopheles gambiae. The latter 2 species show a higher average GC content than A. mellifera and no indications of bimodality, suggesting that the GC-poor mode is a derived condition in honeybee. In A. mellifera, synonymous sites of genes generally adopt the GC content of the region in which they reside. A large proportion of genes in GC-poor regions have not been assigned to the honeybee assembly because of the low sequence complexity of their genome neighborhood. The synonymous substitution rate between A. mellifera and the other species is very close to saturation, but analyses of nonsynonymous substitutions as well as amino acid substitutions indicate that the GC-poor regions are not evolving faster than the GC-rich regions. We describe the codon usage and amino acid usage and show that they are remarkably heterogeneous within the honeybee genome between the 2 different GC regions. Specifically, the genes located in GC-poor regions show a much larger deviation in both codon usage bias and amino acid usage from the Dipterans than the genes located in the GC-rich regions.
Abnormal chest radiograph in pregnancy
Authors: B. Ziso, S. J. Quantrill
Journal: BMJ (2011)

A 28 year old woman of Pakistani origin, who was 18 weeks pregnant, presented with a four week history of dry cough, breathlessness, and intermittent wheeze. Antibiotics and inhaled bronchodilators had been prescribed with no improvement in symptoms. She was a never smoker and drank no alcohol. Six years previously she had been treated for smear and culture positive, fully sensitive, pulmonary tuberculosis. After this she had developed a right-sided pneumothorax, which resolved after insertion of an intercostal chest drain. She had no history of pre-existing airways disease. On examination she was able to talk in full sentences, she had a normal temperature but was tachypnoeic, with a respiratory rate of 24 breaths/min and oxygen saturation of 91% on room air. Respiratory examination showed scattered wheeze throughout. Her pulse was 74 beats/min and blood pressure was 103/71 mm Hg. The rest of the cardiovascular examination was normal. Abdominal examination was consistent with 18 weeks of pregnancy. Arterial blood gases on room air showed mild hypoxia, with partial pressure of oxygen at 7.98 kPa. Peak expiratory flow rate on admission was 150 L/min. Spirometry (done at a later date when she was clinically stable) showed a forced expiratory volume in one second of 0.89 L (34% of predicted). A chest radiograph was performed (fig 1⇓), followed by bronchoscopy, which showed a necrotic tumour in the right upper lobe.