tbuckley/cabot-search huggingface dataset:
Meeting the challenges facing research ethics committees: some practical suggestions
Authors: J. Blunt, J. Savulescu, A. J M Watson
Journal: BMJ (1998)

The local research ethics committee is the most independent body regulating the ethical conduct of research.1 The committee works on behalf of the subjects of research, to protect them from unacceptable risks and practices. However, the effectiveness of local research ethics committees in fulfilling their role has been challenged increasingly (see 1).2 3 4 5 6 7 8 9 10 View this table: Key challenges for local and multicentre research ethics committees and possible solutions ### Volume and nature of research Because of the volume and varied nature of the research reviewed, members of local research ethics committees have a demanding task maintaining a coherent approach.11 The committee workload varies considerably, from fewer than 10 to more than 40 protocols for review at each meeting. The workload also depends on the type of research community within which the committee operates.12 A snapshot of the work of the former Salford Local Research Ethics Committee (box) illustrates the difficulties. #### Work of the Salford Local Research Ethics Committee RETURN TO TEXT
Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava
Authors: Chin-Feng Tsai, Ching-Tai Tai, Ming-Hsiung Hsieh, Wei-Shiang Lin, Wen-Chung Yu, Kwo-Chang Ueng, Yu-An Ding, Mau-Song Chang, Shih-Ann Chen
Journal: Circulation (2000)

Background —The superior vena cava (SVC) has cardiac musculature extending from the right atrium. However, no previous study in humans has given details regarding the ectopic foci that initiate paroxysmal atrial fibrillation (PAF), which may originate from the SVC. Methods and Results —A total of 130 patients with frequent attacks of PAF initiated by ectopic beats were included. Eight patients (6%) had spontaneous AF initiated by a burst of rapid ectopic beats from the SVC (located 19±7 mm above the junction of the SVC and right atrium), which was confirmed by multiplane angiographic and intracardiac echocardiographic visualization and was marked by a sharp SVC potential preceding atrial activity. During initial repetitive discharges, the group with SVC ectopy had a higher incidence of intravenous conduction block than the group with pulmonary vein ectopy (75% versus 37%; P =0.03). The activation time of the earliest intracardiac ectopic activities relative to ectopic P wave onset was significantly shorter in the SVC ectopy than the pulmonary vein ectopy group (37±15 versus 84±32 ms; P &lt;0.001). After 5±3 applications of radiofrequency energy, AF was eliminated. SVC angiography after ablation revealed a local indentation of the venous wall in one patient. Two patients manifested coexisting sinus rhythm and a “focal” fibrillating activity confined inside the SVC after radiofrequency ablation. During a follow-up period of 9±3 months, all 8 patients were free of antiarrhythmic drugs, without tachycardia recurrence or symptoms of SVC obstruction. Conclusions —Ectopic beats initiating PAF can originate from the SVC. A radiofrequency current delivered to eliminate these ectopies is a highly effective and safe way to prevent PAF.
Should the Smallpox Virus Be Allowed to Survive?
Authors: William H. Foege
Journal: New England Journal of Medicine (1979)

Even before the last case of naturally occurring smallpox was recorded in Merka Town, Somalia, in October, 1977, appeals were made in the scientific and popular news media for "total" eradication of the smallpox virus, including the destruction of all strains being kept in laboratory freezers throughout the world. Such strains were perceived to be the only remaining source of virus and the last deterrent to eradication of the disease, which for centuries had caused disfigurement and death. These concerns were heightened by the unfortunate events in Birmingham, England, in August, 1978. Two persons became ill, one fatally, apparently the . . .
High-Dose Chemotherapy for Breast Cancer
Authors: Elisabeth G.E. de Vries
Journal: Annals of Internal Medicine (1997)

Letters1 June 1997High-Dose Chemotherapy for Breast CancerElisabeth G.E. de Vries, Carel C. Mastenbroek, and Sjoerd RodenhuisElisabeth G.E. de VriesUniversity Hospital Gronigen, Gronigen, the Netherlands.Dutch Health Insurance Council, the Netherlands.Netherlands Cancer Institute, Amsterdam, the Netherlands.Search for more papers by this author, Carel C. MastenbroekUniversity Hospital Gronigen, Gronigen, the Netherlands.Dutch Health Insurance Council, the Netherlands.Netherlands Cancer Institute, Amsterdam, the Netherlands.Search for more papers by this author, and Sjoerd RodenhuisUniversity Hospital Gronigen, Gronigen, the Netherlands.Dutch Health Insurance Council, the Netherlands.Netherlands Cancer Institute, Amsterdam, the Netherlands.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-11-199706010-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Gradishar and colleagues [1] focused on the rationale for the randomized studies evaluating adjuvant high-dose chemotherapy in the early stages of breast cancer. They express the concern that few patients are entered into randomized trials even though there is no definite proof of the value of high-dose chemotherapy in the adjuvant setting. The authors reviewed the efforts to overcome physician and patient biases so that the trials can be completed. Somewhat to our surprise, the authors did not indicate that this patient and physician bias is particularly a problem in the United States but that several well-accruing, ...References1. Gradishar WJ, Tallman MS, Abrams JS. High-dose chemotherapy for breast cancer. Ann Intern Med. 1996; 125:599-604. Google Scholar2. De Vries EG, Ten Vergert EM, Mastenbroek CG, Dalesio O, Rodenhuis S. Breast cancer studies in the Netherlands. Lancet. 1996; 348:407-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: University Hospital Gronigen, Gronigen, the Netherlands.Dutch Health Insurance Council, the Netherlands.Netherlands Cancer Institute, Amsterdam, the Netherlands. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHigh dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancerHigh dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer 1 June 1997Volume 126, Issue 11Page: 917-918KeywordsBreast cancerCyclophosphamideData managementDrugsForecastingGrowth factorsHealth insuranceHigh-dose chemotherapyLymph nodesRandomized trials Issue Published: 1 June 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Effect of gold treatment on cytokine expression in synovium.
Authors: M D Smith
Journal: Annals of the Rheumatic Diseases (1995)

Effect of gold treatment on cytokine expression in synoviumA recent paper in this journal described the effect of intramuscular gold treatment on cytokine expression in synovial membranes from patients with rheumatoid arthritis.1In that paper, the authors described changes in synovial membrane expression of interleukins (IL) IL-1a, IL-1,, IL-6, and tumour necrosis factor a in patients who had received intra- muscular gold treatment.However, the authors failed to mention that some of the results had been published in another journal by a similar group of authors.2Neither paper is cross referenced in the other, and it is not clear from these two papers whether the authors are reporting the same set of results in two different papers.In one paper,2 the authors described a significant failure rate with blind needle biopsy of the synovial membrane, which is particularly a problem with studies involving sequential biopsying as was performed in these two studies.Our experience is similar with this technique and we have now changed to performing all synovial biopsying under direct vision through a needle arthroscope under local anaesthesia.However, despite the fact that the two patient groups appear to be similar, if not identical, in these two papers, one paper states that only seven of 18 patients recruited in the study gave three satisfactory sequential synovial biopsy specimens,2 while the other paper implies, though does not clearly state, that satisfactory synovial biopsy specimens were obtained in all 10 patients for all time points (0, 2, and 12 weeks).1This suggests either that the authors' biopsying technique or success rate has changed dramatically during the period between preparation of the two papers, or that additional patients were obtained to 'make up the numbers'.Could the authors please confirm whether:(1) The patient groups studied in these two papers are, in fact, identical.(2) The same results for IL-1,B have been published in two different papers in two different journals.(3) All the patients reported in one paper' provide adequate synovial biopsy specimens for all three time points and, if so, how was this possible in view of the results and discussion in the other paper from the same group.
Recent developments in vascular surgery
Authors: J. Crane
Journal: BMJ (2003)

The authors of this review discuss the changing role of vascular surgery and the impactof developments such as endovascular interventions and new techniques for treating varicose veins 

Vascular surgery has come of age over the past two decades. The specialty has increasingly separated from general surgery as evidence accrues that outcomes for patients are better when arterialoperations are done by a specialist.1 In the United Kingdom,this has meant an increasing number of consultant posts for purely vascular surgery being advertised. As a result of the expanding ageing population and historical under-provision of vascular intervention in the United Kingdom, vascular workload is expected to rise and the need for specialistswill grow.2

Recognition of the multisystem nature of vascular disease has increased integration of vascularsurgery into multidisciplinary teams of allied specialties. Surgical decisions are now often made jointly with the input of the renal physician, diabetologist, radiologist, cardiologist, neurologist, and specialist nurse. As a result, the role of the vascular surgeon as a sole player within hospital medicine is changing.

To identify emerging trends in vascular surgery, we searched Medline and the Cochrane database and discussed developments with surgical colleagues. We also reviewed published abstracts of presentations from the Vascular Surgical Society of Great Britain and Ireland, the European Society of Vascular and Endovascular Surgery, and the Society for Vascular Surgery (USA) in the past two years.

### Endovascular aortic repair

Endovascular repair of abdominal aortic aneurysms was introduced a decade ago. This operation involves radiographically guided intraluminal placement of a prosthetic graft on a wire mesh into the abdominal aorta. This is done via a small groin incision, thus avoiding the morbidity and mortality associated with major open abdominal surgery. As with conventional repair, the goal of endovascular treatment is to prevent further expansion by excluding flow within the aneurysm, thus reducing the …
Hypoxia-Induced Pulmonary Blood Redistribution in Subjects With a History of High-Altitude Pulmonary Edema
Authors: Masayuki Hanaoka, Masao Tanaka, Ri-Li Ge, Yunden Droma, Atsuko Ito, Takashige Miyahara, Tomonobu Koizumi, Keisaku Fujimoto, Tadashige Fujii, Toshio Kobayashi, Keishi Kubo
Journal: Circulation (2000)

Pulmonary hypertension has been suggested to play an important role in development of high-altitude pulmonary edema (HAPE), and individual susceptibility has been suggested to be associated with enhanced pulmonary vascular response to hypoxia. We hypothesized that much greater pulmonary vasoconstriction would be induced by acute alveolar hypoxia in HAPE-susceptible (HAPE-s) subjects and that changes in pulmonary blood flow distribution could be demonstrated by radionuclide study.We performed ventilation-perfusion scintigraphy in 8 HAPE-s subjects and 5 control subjects while each was in the supine position and acquired functional images of pulmonary blood flow and ventilation under separate normoxic and hypoxic (arterial oxygen saturation, 70%) conditions. We also measured acceleration time/right ventricular ejection time (AcT/RVET) with Doppler echocardiography under each condition in both groups. Moreover, we assayed human leukocyte antigen (HLA) alleles serologically in the HAPE-s group. Pulmonary blood flow was significantly shifted from the basal lung region to the apical lung region under hypoxia in HAPE-s subjects, although no significant change in regional ventilation was observed. With Doppler echocardiography, HAPE-s subjects showed increased pulmonary arterial pressure during hypoxia compared with control subjects. The magnitude of cephalad redistribution of lung blood flow was significantly higher in the HLA-DR6-positive than in HLA-DR6-negative HAPE-s subjects.These findings suggest that acute hypoxia induces much greater cephalad redistribution of pulmonary blood flow that results from exaggerated vasoconstriction in the basal lung in HAPE-s subjects. Furthermore, pulmonary vascular hyperreactivity to hypoxia may be associated with HLA-DR6.
1116-34 Inhibition of 3-Hydroxy-3-methylglutaryl coenzyme a reductase attenuates expression of inducible nitric oxide synthase in cardiac myocytes: A possible link with direct myocardial protection during ischemia-reperfusion
Authors: Rosalinda Madonna, Pericle Di Napoli, Marika Massaro, Alfredo Grilli, Mario Felaco, Yong-Jian Geng, Rafffaele De Caterina
Journal: Journal of the American College of Cardiology (2004)
Hepatitis Associated With Ranitidine
Authors: Marcos A. Souza Lima
Journal: JAMA (1984)

To the Editor.—  The letter about hepatitis presumably associated with ranitidine was interesting. Several aspects of the report merit comment. First, a well-accepted generalization in drug-induced hepatitis is that if a drug causes extrahepatic manifestations of hypersensitivity (fever, rash, and eosinophilia) in some persons, it can be predicted that it will cause hepatitis in others. 1 The flu vaccine given to this particular patient three days before the start of symptoms would obviously fall into this category and should be strongly suspected as the causative agent. Second, if the clinical picture was truly related to ranitidine, the presence of systemic symptoms following two weeks of drug administration would suggest a hypersensitivity-type drug reaction. A positive rechallenge is a sine qua non when defining drug toxicity. This was not done. Third, the emphasized hepatotoxicity because of the furan ring present in ranitidine is speculative. In addition, a theoretical potentiation of acetaminophen
CONSORT adoption and quality of reporting of randomized controlled trials: a systematic analysis in two dermatology journals
Authors: F. Alvarez, N. Meyer, P.A. Gourraud, C. Paul
Journal: British Journal of Dermatology (2009)

CONSORT (Consolidated Standards for Reporting Trials) guidelines were constructed to ensure optimal reporting quality of randomized controlled trials (RCTs).To determine the effect of the adoption of CONSORT on the reporting quality of RCTs, we performed a systematic evaluation of RCTs published in two dermatology journals pre- and post-CONSORT adoption.The journals selected for the study were the Journal of the American Academy of Dermatology and the British Journal of Dermatology. We selected RCTs published in 1997 and 2006 using both Medline and hand searching. The following critical CONSORT criteria were recorded: sample size, type of disease studied, type of control, single-centre or multicentre study, type of funding, blinding, methods and type of randomization, definition of a primary endpoint, justification for sample size selection and power calculation, population for analysis, and adequacy of group comparison. A multivariable analysis was conducted to determine factors associated with optimal reporting quality.In total, 98 studies were included. Improvement in reporting quality was evident for the specification of the randomization method (20% in 1997 vs. 45% in 2006, P < 0.01) and for the justification of sample size (22% in 1997 vs. 43% in 2006, P = 0.027). The percentage of studies with optimal reporting quality increased from 11% in 1997 to 28% in 2006 (P = 0.03). Factors significantly associated with a good methodological quality were pharmaceutical industry funding and publication in 2006 vs. 1997.There is a need to improve the reporting quality of RCTs published in dermatology journals.
Gastric Emptying of a Physiologic Mixed Solid-Liquid Meal
Authors: Robert S. Fisher, Leon S. Malmud, Paul Bandini, Elizabeth Rock
Journal: Clinical Nuclear Medicine (1982)

The purposes of this study were to use a noninvasive scintigraphic technique to measure gastric emptying of liquids and solids simultaneously, to study the interactions between emptying of the liquid and solid components of meals in normal subjects, and to employ dual isotope gastric scintigraphy to evaluate gastric emptying of liquids and solids in patients with clinical evidence of gastric outlet obstruction. The solid component of the test meal consisted of chicken liver, labeled in vivo with Tc-99m sulfur colloid, and the liquid component was water mixed with ln-111 DTPA. The rates of emptying were quantitated using a gamma camera on line to a digital computer. Twenty normal subjects were studied using this combined solid-liquid meal. Ten of them also ingested a liquid meal alone and ten a solid meal alone. Liquid emptied from the stomach significantly more rapidly than did solids. The emptying curve for liquids was exponential compared to a linear emptying curve for solids. The gastric emptying rate of the liquid component was slowed significantly by simultaneous ingestion of solids, but the emptying rate of solids was not affected by liquids. Several patients with clinical gastric outlet obstruction were evaluated. Both combined and selective abnormalities for gastric emptying of liquids and solids were demonstrated.
Prospective assessment of left ventricular adaptation with electron beam computed tomography (EBT) in high vs. low exercise rehabilitation after first anterior myocardial infarction
Authors: T.C. Gerber, T. Allison, T.D. Miller, R.J. Gibbons, P.F. Sheedy, J.A. Rumberger, T. Behrenbeck
Journal: Journal of the American College of Cardiology (1998)
Effects of Viral Infection on the Developing Nervous System
Authors: Daniel Deykin, Christine Balko, Richard T. Johnson
Journal: New England Journal of Medicine (1972)

THE vulnerability of immature tissues to viral infection is nowhere more detrimental to future health and potential than in the developing nervous system. In man several fetal and neonatal infections arc known to cause acute or chronic encephalitis, but in laboratory animals, such infections have been shown to cause a wider spectrum of disease, including major malformations of the brain and spinal cord.Viral infections of the gravid mother or neonate have the potential to affect development by a variety of mechanisms (Table 1). Abortion can probably result solely from the constitutional effects of infection on the mother,1 and abortion . . .
“Right to die”: Sensitivity and humility are needed when dealing with dying people
Authors: Lesley A M Evans
Journal: BMJ (2005)

Right to die" Legal view of right to life and death could threaten philosophy of palliative careEditor-Grayling claims that the "right to life" means quite a rich life; withholding treatment with death as the result and giving treatment that causes death are indistinguishable; and death is the ultimate analgesic. 1 Grayling also implies that the double effect is widely abused.The EC Convention for the Protection of Human Rights and Fundamental Freedoms protects against intentional deprivation of life. 2 Quality of life is not mentioned, and terminating a life at a person's request is clearly not permitted."Right to life" is perhaps a "right not to be killed," in medicine, generally relating to survival and not assisted death.However, some interpret it as giving patients a right to cardiopulmonary resuscitation regardless of the clinical circumstances 3 ; extrapolation to all potential interventions at the life-death interface could have disastrous consequences for the medical profession.Patients obviously can wish for their life to be terminated without needing to explain why, and they arguably have a right to attempt suicide.However, a right to assisted dying equates to a right that somebody else will kill or help to kill them on request-very different from withholding treatment or the double effect.Withholding treatment relates to interventions unable to produce the desired benefit. 4 In palliative care withholding treatment does not directly cause death that arises from an irreversible and unsustainable pathological burden.And death without adequate analgesia is possibly the ultimate pain for everyone.Judicious use of analgesia is an essential part of good terminal care, and, in 15 years as a doctor, I have yet to see a death attributable to deliberate analgesic overdose by a doctor.Palliative care affirms life until the moment of death, regarding death from advanced incurable disease as a natural process. 5 It aims to relieve pain and other distressing symptoms, enhance remaining quality of life, and neither hasten nor postpone death.These human "death rights" should perhaps be protected by legislation.Ill-conceived legislative changes that take the right to life or the right to death beyond sensible limits or give certain doctors the right to kill on request could jeopardise palliative care.