tbuckley/cabot-search huggingface dataset:
Error in Medicine-Reply
Authors: David Blumenthal
Journal: JAMA (1995)

<h3>In Reply.</h3> —The letters from Dr Bell, Dr Cunnington, Dr Fetters, and Mr Shaw-Taylor make a series of helpful additions to Dr Leape's article and my accompanying Editorial. However, in particular comments, they illustrate how easy it is to lose sight of the forest for the trees when the subject is prevention of error in medicine. As Bell points out, the conditions under which physicians-in-training work may be conducive to medical error, and systems of medical education could almost certainly be redesigned in ways that reduce medical error. However, the process of doing so should be methodical and scientific, and it should take advantage of all available information from nonmedical and medical disciplines on how such training should proceed. One wonders, for example, whether the use of flight simulators to minimize pilot error would have some analogous application in medical training. The essential insight is to see training as a
Improved electrocardiographic detection of echocardiographic left ventricular hypertrophy: results of a correlated data base approach
Authors: James E. Norman, Daniel Levy
Journal: Journal of the American College of Cardiology (1995)

We used electrocardiographic (ECG) and echocardiographic measurements from 3,351 adults from the Framingham Heart Study to evaluate the performance of 10 ECG criteria in detecting left ventricular hypertrophy before and after adjustment for gender, age and obesity.Significant improvement in the sensitivity and specificity of ECG voltage-based criteria for detection of echocardiographic left ventricular hypertrophy using gender-specific criteria adjusted for age and obesity has been demonstrated.Gender-specific correlation and regression analyses were used to identify the five most sensitive ECG criteria and to adjust them for age and obesity. Standard and truncated receiver operating characteristic curves were used to compare the selected criteria.Linear regression of left ventricular mass on ECG voltages, body mass index and age yielded considerably stronger relations for women than for men because of the greater correlation between ventricular mass and body mass index in women. Obesity and age adjustment of the five voltage criteria produced considerable improvement in their performance. The voltage sum of the R wave in lead aVL and the S wave in lead V3, alone and in combination with QRS duration, had a sensitivity at 95% specificity of 32% and 39%, respectively, in men and 46% and 51%, respectively, in women after adjustment. Tables of critical voltages for the adjusted criteria and representative performance values are presented.Incorporation of obesity and age in ECG algorithms consistently improves their performance in the detection of hypertrophy. The development of such criteria will enhance the utility of this inexpensive screening test. Such ECG approaches should be used in clinical trials to assess the efficacy of antihypertensive treatment to effect regression of left ventricular hypertrophy. A search for further improvements in the efficacy of ECG criteria for this purpose is warranted. Independent validation of this approach is needed.
Urate Deposition Disease
Authors: JAMES R. KLINENBERG
Journal: Annals of Internal Medicine (1973)

Hyperuricemia may be associated with various diseases; clinical gout occurs when urate crystals deposit from supersaturated body fluids. Although all the factors responsible for urate deposition are not yet known, local pH, ionic strength, and temperature, as well as the influence of protein-binding of urate, have received attention recently. The binding of urate to plasma protein may influence not only urate deposition but also the renal excretion of uric acid. Many drugs interfere with this plasma-urate binding; all these agents are uricosuric. An experimental model of gouty nephropathy in the rat has been developed to explore further the relations between hyperuricemia, plasmaurate binding, and deposition of urate in the kidney.
Malaria researchers say global fund is buying "useless drug"
Authors: G. Yamey
Journal: BMJ (2003)

The Global Fund to Fight AIDS, Tuberculosis and Malaria is under intense scrutiny from malaria researchers, who say that its limited resources are being wasted on useless malaria drugs.

The controversy was sparked by the latest figures on the fund's spending on malaria treatment in Africa. More is being spent on chloroquine, which costs just $0.10 (£0.06; €0.08) for each dose but which is largely ineffective in Africa, than on combination treatments based on artemisinin, which are highly effective but cost at least 10 times as much. The result, say the researchers, is that lives are being lost needlessly.

“It is terrible to waste lives and money deploying a useless drug,” said Professor Nick White, director of the Wellcome Trust's South-East Asia Overseas Unit.

Dr Amir Attaran, associate fellow at the Royal Institute of International Affairs in London, believes that the fund's reputation is at stake. “In Africa extensive resistance means that chloroquine therapy is almost everywhere a contradiction in terms, such that financing chloroquine is both a waste of the fund's very limited money and is tantamount to medical malpractice.”

The fund argues that its critics have misunderstood the way it operates and the way in which the chloroquine it has bought is being used in each country.

Individual countries send proposals to the fund asking it to finance specific projects to …
Selective depletion and activation of CD8+ lymphocytes from peripheral blood of patients with polymyalgia rheumatica and giant cell arteritis.
Authors: B Dasgupta, O Duke, A.M Timms, C Pitzalis, G.S Panayi
Journal: Annals of the Rheumatic Diseases (1989)

A prospective study of 33 patients with polymyalgia rheumatica/giant cell arteritis (PMR/GCA) was undertaken, firstly, to monitor sequentially peripheral blood CD8+ lymphocyte levels and, secondly, to assess the expression of activation markers on T lymphocyte subsets. The results indicated that there was a significant decrease in absolute numbers and relative percentages of CD8+ T lymphocytes, which returned to normal ranges after approximately 24 months' treatment, and that there was an increased percentage of CD8+ lymphocytes in PMR/GCA which express HLA class II antigens.
Surveillance of surgical site infections after thyroidectomy in a one-day surgery setting
Authors: G. Dionigi, F. Rovera, L. Boni, R. Dionigi
Journal: International Journal of Surgery (2008)

Different studies underline the importance of hospital stay on the development of infectious complications. We performed an audit of surgical site infections (SSI) after thyroidectomy was performed in a one-day surgery setting. One hundred and twelve consecutive patients admitted between April 2007 and discharged before May 2008 were studied. Patient selection criteria for one-day surgery were specific medical and social-logistic status. The technique of thyroidectomy was standardized. SSI affect 2.6% of patients undergoing thyroid surgery with short hospitalization. The incidence of SSI was 3.2% following thyroidectomy, 2% for lobectomy. Mean time interval to symptom onset was 3 days (range 2–6). Most likely organism was Staphylococcus aureus. WI was associated with prolonged ambulatory medications. Rates of SSI are similar to those described in the literature with longer hospitalization. All SSI become evident only after patient discharge. Prevention of SSI is very much the responsibility of the persons working in the operating theater. Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops postoperatively.
Human Tumors: Histology, Diagnosis and Technique
Authors: William B. Ober
Journal: JAMA (1971)

Successor to Lobstein and von Recklinghausen, the late Pierre Masson (1880-1959) held the chair of pathology at Strasbourg from 1918 to 1926. In 1927 he became professor and chairman of the department of pathologic anatomy at the University of Montreal, bringing the classical tradition of Franco-German morbid anatomy to North America. The first edition of<i>Human Tumors</i>appeared in French in 1923; the second, a complete revision, in 1957. Now in English, it makes accessible to American pathologists both the systematic, deductive approach to oncologic taxonomy and the detailed microscopical observations supporting it which characterize that school. The publication serves as testament to the memory of a distinguished scholar and teacher. But American pathology marches to the beat of a different drum, and has an empirical, less schematically conceptualized approach. Masson's own approach has won few adherents in American schools. Since the book is outdated for classroom teaching and not
Full annual checks for diabetes are a postcode lottery, finds audit
Authors: Z. Kmietowicz
Journal: BMJ (2012)

The likelihood of diabetes patients having all nine essential checks that are recommended every year varies widely across England and Wales with a full battery of tests four times more common in some areas than in others, an audit has found.1

The National Diabetes Audit report on care processes shows that in 2010-11 more patients (54% in England and 60% in Wales) received the nine annual checks and services recommended by the National Institute for Health and Clinical Excellence than in 2009-10 (51% and 58% respectively).

However, 36 primary care trust areas in England …
Ethnic difference in the prevalence of monoclonal B-cell proliferation in patients affected by hepatitis C virus chronic liver disease
Authors: Gabriele Pozzato, Oscar Burrone, Kiyoshi Baba, Masahiro Matsumoto, Minako Hijiiata, Yakihiro Ota, Lucia Mazzoran, Stefano Baracetti, Francesca Zorat, Shunji Mishiro, Dimitar G Efremov
Journal: Journal of Hepatology (1999)
Pharmaceuticals in Tap Water: Human Health Risk Assessment and Proposed Monitoring Framework in China
Authors: Ho Wing Leung, Ling Jin, Si Wei, Mirabelle Mei Po Tsui, Bingsheng Zhou, Liping Jiao, Pak Chuen Cheung, Yiu Kan Chun, Margaret Burkhardt Murphy, Paul Kwan Sing Lam
Journal: Environmental Health Perspectives (2013)

Pharmaceuticals are known to contaminate tap water worldwide, but the relevant human health risks have not been assessed in China.
Cryptogenic Hemoptysis
Authors: MARK ADELMAN
Journal: Annals of Internal Medicine (1985)

We reviewed the clinical outcome of 67 patients with hemoptysis and a normal or nonlocalizing chest roentgenogram and nondiagnostic fiberoptic bronchoscopic examination. During a 38 +/- 22 (SD) month period after bronchoscopy, 57 (85%) patients remained well without evidence of active tuberculosis or overlooked bronchogenic carcinoma, and 9 patients died of nonpulmonary conditions. One patient developed bronchogenic carcinoma 20 months after bronchoscopy and resolution of symptoms. Hemoptysis had resolved completely before hospital discharge in 38 (57%) patients, within 6 months in 60 (90%), and recurred in only 3. Five patients (7.5%) had intermittent episodes of bleeding for more than 1 year. Fiberoptic bronchoscopy effectively excludes specific underlying causes of hemoptysis in the setting of a normal chest roentgenogram. The prognosis for patients with cryptogenic hemoptysis is generally good, usually with resolution of bleeding within 6 months of evaluation.
THE USE OF FULL CORRECTION CYLINDRIC GLASSES IN ALL CASES OF ASTIGMATISM.
Authors: LOUIS J. LAUTENBACH
Journal: JAMA (1898)

I believe that the entire correction of the astigmatism present in every eye, is a necessity, that is, provided the eye is used at all for near work. If there is no use for a knife there is no need to sharpen it, but just as soon as the eye is used as an instrument for seeing, its refraction must be so adjusted that the ciliary muscle fibers act equally, and not unequally as in astigmatism, to produce a clear, distinct image on the retina. The disturbances of the recti muscles of which we hear so much today are in a great part but a development of nature's effort to allow the tired ciliary muscle some rest by presenting on the retina an image which requires other fibers of the muscle than those previously exhausted, to do an extra share of work, relieving those which have become tired from overuse.
AN INHALER FOR THE ORDINARY SEQUENCES AND MIXTURES OF ANESTHETICS.ON THE PRINCIPLE OF UNOBSTRUCTED RESPIRATION.
Authors: VICTOR C. PEDERSEN
Journal: JAMA (1907)

plan.The Hamburg Hospital at Eppendorf, which was com- pleted nineteen years ago, has stood as a model of this system of hospital construction ever since its completion.It was planned under the supervision of Professor Kurschmann, who followed very largely
Access to Care for Poor Children: Necessary but Not Sufficient-Reply
Authors: Robert F. St. Peter
Journal: JAMA (1992)

<h3>In Reply.</h3> —We agree with the points made by Dr Sissman on the desirability of distinguishing barriers to access from barriers to utilization of available services. While access to adequate medical care is necessary to enable appropriate utilization, it is not sufficient. However, these two concepts are often difficult to distinguish. If a clinic is identified as a child's usual source of care, but the family does not have insurance, or the clinic is not located within a reasonable distance, or is not open at convenient hours, or does not provide services in a culturally sensitive manner, or waiting times are excessive, then the family may not appropriately utilize the available care. Does this represent lack of access or underutilization? Is this attributable to the family or to the system of medical care itself? The data from our study show clearly that poor children who do not have Medicaid are
Psychic Factors Determining the Long-Term Adaptation of Colostomy and Ileostomy Patients
Authors: Liisa Keltikangas-Järvinen, Eija Loven, Carl Möller
Journal: Psychotherapy and Psychosomatics (1984)

The long-term psychosocial adaptation of 34 colostomy patients, operated on for rectal or colonic cancer, and 32 ileostomy patients, operated on for colitis ulcerosa, was examined on average 6.5 years after the operation. The methods used were Heidelberg Colostomy Questionnaire, Beck's Depression Inventory, Block's Ego Resiliency Scale and the Rorschach Inkblot Test. The results showed that the first pre- and postoperative psychic reactions were particularly strong and similar in both groups but the later adaptation was in every respect better in the ileostomy group. The necessity of guidance and psychic support was obvious.
The 12-item well-being questionnaire. An evaluation of its validity and reliability in Dutch people with diabetes.
Authors: F Pouwer, H M van der Ploeg, H J Adèr, R J Heine, F J Snoek
Journal: Diabetes Care (1999)

OBJECTIVE: The objective of this study was to investigate the validity and reliability of the short-form 12-Item Well-Being Questionnaire (W-BQ12). The 12 items were used to construct the three 4-item subscales Negative Well-Being (NWB), Energy (ENE), and Positive Well-Being (PWB), and the 12-item overall scale General Well-Being (GWB). RESEARCH DESIGN AND METHODS: A total of 1,472 patients with diabetes completed the W-BQ12, the Hospital Anxiety and Depression scale, and the State Trait Anxiety Inventory. Statistics covered Cronbach's alpha, Pearson's correlation, t tests, and logistic regression. Test-retest reliability was studied in a sample of 202 patients who twice completed the W-BQ12, which was supplemented with the Center for Epidemiological Studies Depression scale and the Short Form (SF)-36 Health Survey. RESULTS: Of the tested subjects, 739 were defined as having type 1 diabetes and 701 as having type 2 diabetes. Cronbach's alpha proved to be high and stable across sex and type of diabetes for all W-BQ12 scales. Test-retest reliability ranged from 0.66 (PWB) to 0.83 (GWB), with a mean interval of 66 +/- 14 days. Convergent validity of the W-BQ12 scales was supported by high correlations with other measures of affect. Of all scales of the first measurement, ENE proved to have the strongest association with self-reported chronic fatigue. NWB and trait anxiety both had the strongest associations with self-reported depression and current treatment by a psychologist/psychiatrist. CONCLUSIONS: The W-BQ12 appeared to be a reliable and valid measure of psychological well-being. This short instrument is easy to administer and may be considered a useful tool for both clinicians and researchers to assess the psychological well-being of patients with diabetes.
Vitamin D: A Reawakening
Authors: Paul A. Palmisano
Journal: JAMA (1973)

Clear descriptions of the clinical picture of rickets were published in the 17th century although mention of various aspects of the syndrome goes back even further. That a chemical factor could reverse the rachitic process was well settled by the mid-1920s. It is now clear that a number of sterols can be rendered antirachitic under the influence of ultraviolet irradiation. The significant sterols, in this regard, are ergosterol (derived from plant sources) and 7-dehydrocholesterol (from animals). When appropriately irradiated, these compounds form ergocalciferol (vitamin D<sub>2</sub>) and cholecalciferol (vitamin D<sub>3</sub>), respectively. Historically, "vitamin D<sub>1</sub>" was really found to be a mixture of substances and not a separate entity. <h3>Vitamin D in Man</h3> Of course, irradiating many types of plant or animal sterols will produce therapeutic amounts of D<sub>2</sub>or D<sub>3</sub>that can prevent or cure rickets when ingested. But it has been known for generations that irradiating
Ninety nine per cent of emergency consultants report abuse by drunk patients
Authors: D. Singh
Journal: BMJ (2003)

Ninety nine per cent of consultants in accident and emergency departments in England said in a recent survey that either they or members of their staff have been victims of physical or verbal abuse from drunken patients, a new study reports.

The report from the Alcohol Reduction Group–a newly formed coalition of the charities Alcohol Concern, Turning Point, and the London Drug and Alcohol Network–says that alcohol misuse is putting an enormous strain on emergency departments and on emergency services across the country.

The coalition is urging the government to …
The risk of hospitalization and modality failure with home dialysis
Authors: Rita S. Suri, Lihua Li, Gihad E. Nesrallah
Journal: Kidney International (2015)

While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67–0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85–1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61–0.77)), while infectious and access hospitalizations were higher (1.15 (1.04–1.29) and 1.25 (1.08–1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15%; 3.4 (2.9–4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.
Pharmacological modulation of gastric emptying rate of solids as measured by the carbon labelled octanoic acid breath test: influence of erythromycin and propantheline.
Authors: B D Maes, M I Hiele, B J Geypens, P J Rutgeerts, Y F Ghoos, G Vantrappen
Journal: Gut (1994)

The *C (13C or 14C) labelled octanoic acid breath test was recently developed to measure the gastric emptying rate of solids. This study aimed to investigate whether it is sensitive enough to detect pharmacologically induced changes in the gastric emptying rate. Nine healthy volunteers were studied in basal condition, after intravenous administration of 200 mg erythromycin, and after peroral administration of 30 mg propantheline. Erythromycin significantly enhanced gastric emptying in all subjects, with an increase of the gastric emptying coefficient (p = 0.0043) in eight of nine and a fall in both the gastric half emptying time (p = 0.0020) and the lag phase (p = 0.0044) in all nine. Propantheline significantly reduced the gastric emptying rate, with a decreased gastric emptying coefficient (p = 0.0007) and an increased gastric half emptying time (p = 0.0168) in all subjects, but no change in the lag phase (p = 0.1214). Further mathematical analysis showed that breath sampling at 15 minutes intervals over a four hour period is recommended to guarantee accuracy and the discriminative value of the breath test in various gastric emptying patterns. In conclusion the *C labelled octanoic acid breath test is sufficiently sensitive to show pharmacologically induced changes of gastric emptying rates of solids.
Review: In type 2 diabetes, dipeptidyl peptidase-4 inhibitors do not increase pancreatitis
Authors: Oscar L. Morey-Vargas, Victor M. Montori
Journal: Annals of Internal Medicine (2014)

Source Citation Monami M, Dicembrini I, Mannucci E. Dipeptidyl peptidase-4 inhibitors and pancreatitis risk: a meta-analysis of randomized clinical trials. Diabetes Obes Metab. 2013;Jul 9 [Epub ahead of print]. 23837679
Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas
Authors: R. Barendse, F. van den Broek, E. Dekker, W. Bemelman, E. de Graaf, P. Fockens, J. Reitsma
Journal: Endoscopy (2011)

<b>Background and study aims:</b> Large ( > 2 cm) rectal adenomas are currently treated by either transanal endoscopic microsurgery (TEM) or piecemeal endoscopic mucosal resection (EMR). The potential lower morbidity of EMR may become irrelevant if EMR is less effective. The aim of this study was to compare the safety and effectiveness of EMR and TEM for large rectal adenomas. <b>Patients and methods:</b> A systematic review of the literature published between January 1980 and January 2009 was conducted. Pooled estimates of the proportion of patients with recurrence or complications in EMR and TEM studies were compared using random effects meta-regression analysis. <i>Early</i> (after single intervention) and <i>late</i> (excluding re-treatment of residual adenoma detected within 3 months) recurrence rates were calculated. <b>Results:</b> A total of 20 EMR studies and 48 TEM studies were included. No studies directly compared EMR with TEM. Mean polyp size was 31 mm (range 2 – 86 mm) for EMR vs. 37 mm (range 3 – 182 mm) for TEM (<i>P</i> = 0.02). Early recurrence rates were 11.2 % (95 % confidence interval [CI] 6.0 – 19.9) for EMR vs. 5.4 % (95 %CI 4.0 – 7.3) for TEM (<i>P</i> = 0.04). Late recurrence rates were 1.5 % (95 %CI 0.6 – 3.9) for EMR vs. 3.0 % (95 %CI 1.3 – 6.9) for TEM (<i>P</i> = 0.29). Postoperative complication rates were 3.8 % (95 %CI 2.8 – 5.3) for EMR vs. 13.0 % (95 %CI 9.8 – 17.0) for TEM (<i>P</i> < 0.001). <b>Conclusions:</b> After single intervention, EMR for large rectal adenomas appears to be less effective but safer than TEM. When outcome data for re-treatment of residual adenoma within 3 months are included, EMR and TEM seem equally effective. Nevertheless, the added morbidity of additional EMRs could not be accounted for in this analysis. A prospective randomized trial seems imperative before making recommendations concerning the treatment of large rectal adenomas.