tbuckley/cabot-search huggingface dataset:
Time to audit audit
Authors: D. Sellu
Journal: BMJ (1996)

Aprime reason for including audit in the recent NHS reforms was the immense variation of clinical practice, outcome, resource utilisation, and other measures of performance among hospitals. Britain may take comfort from the fact that despite the numerous indictments of its health service, it is one of the few countries boasting anything approaching uniform health care. But diversities do occur—the management of breast cancer is one example—and audit presented an opportunity to improve the performance of the under-performers.

Two types of audit, often confused, were implied in the 1990 white paper, Working for Patients. The first, practised for many years, focused on morbidity and mortality in which deaths, complications, problems with admissions, and delays in discharge were discussed. The reforms made this type of audit compulsory for all clinicians—it is meant to happen once a month during the working day. This has resulted in the loss of one session from each clinical team every month, equivalent to closing the hospital for one day every two months to all but emergencies. Adverse events monitoring has its proponents, but one shortcoming is that lack of adverse events does not necessarily mean good practice or satisfactory outcome. Too many events are audited, no clear goals are set, …
IMPACT OF HYPERGLYCEMIA ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROMES TREATED WITH PERCUTANEOUS CORONARY INTERVENTION
Authors: Ryan J. Magnuson, Justin B. Lundbye, Francis J. Kiernan, Abdul Alkeylani, Thomas Schultz, Daniel S. Stewart, Kevin Dougherty, Dadong Li, Jeffrey Mather, Deborah Murphy, Raymond G. McKay
Journal: Journal of the American College of Cardiology (2010)
Antiretroviral combinations do not eliminate HIV entirely
Authors: D. Josefson
Journal: BMJ (1997)

Researchers in the United States have confirmed that, although combinations of potent antiretroviral drugs are effective in arresting replication of HIV, they fail to eliminate the virus entirely.

The drug combinations-typically a mixture of reverse transcriptase and protease inhibitors-act synergistically to disable the reproductive capacity of the virus and have helped to prolong the life of patients with AIDS. With HIV infection suppressed, patients' immune systems …
Prevention of Fatty Streak Formation of 17β-Estradiol Is Not Mediated by the Production of Nitric Oxide in Apolipoprotein E– Deficient Mice
Authors: R. Elhage, F. Bayard, V. Richard, P. Holvoet, N. Duverger, C. Fiévet, J.-F. Arnal
Journal: Circulation (1997)

Estrogens have atheroprotective properties, the mechanisms of which remain obscure. Estrogens have recently been reported to increase endothelial NO synthase expression in castrated animals and to prevent the degradation of NO by decreasing superoxide anion production in cultured endothelial cells. In both cases, increased NO bioavailability would promote vasodilation, inhibit proliferation of the adjacent vascular smooth muscle, reduce platelet aggregation, and inhibit monocyte adhesion to the endothelium and the inflammatory reaction induced by cytokines, all key contributors in the development of atherosclerosis.In the present work, the respective roles of 17beta-estradiol and NO in the development of the atherosclerotic process were investigated in castrated apolipoprotein E-deficient (apo E KO) mice, which spontaneously develop fatty streak lesions within 3 months. N(omega)-Nitro-L-arginine methyl ester (L-NAME), an NO synthase inhibitor, 50 mg x kg(-1) x d(-1), increased arterial blood pressure and decreased cerebellum cGMP content, demonstrating the blockade of NO production, but did not influence the atherogenic process in castrated apo E KO mice.17Beta-estradiol decreased the size of the aortic lesions approximately threefold, and the magnitude of this vasculoprotective effect was not altered by L-NAME. Moreover, L-NAME increased circulating malonyldialdehyde (MDA)-modified LDL, which was not altered by 17beta-estradiol, leading to a complete dissociation between circulating MDA-modified LDL and parietal lesions.
The pathophysiological relationship and clinical significance of left atrial function and left ventricular diastolic dysfunction in β‐thalassemia major
Authors: Anna G. Kostopoulou, Dimitrios P. Tsiapras, Antigoni S. Chaidaroglou, Dimitrios E. De giannis, Dimitrios Farmakis, Dimitrios Th. Kremastinos
Journal: American Journal of Hematology (2013)

Iron deposition in combination with inflammatory and immunogenetic factors is involved in the pathophysiology of cardiac dysfunction in β-thalassemia major. We investigated the mechanical and endocrine function of the left atrium and ventricle to identify early signs of dysfunction. We studied 90 patients (mean age: 29 ± 11 years) with β-thalassemia and normal left ventricular function and 90 age and sex-matched healthy controls. Patients and controls underwent a thorough cardiac echocardiographic study and measurements of the b-type (NT-proBNP) and atrial natriuretic peptides (proANP). Patients underwent 24-hr Holter recordings for arrhythmia monitoring. In the patient group, atria were affected early during the course of the disease, prior to diastolic and systolic left ventricular dysfunction. The E/E'ratio (E Doppler mitral fast inflow to the corresponding tissue Doppler E) continually increased with age (P < 0.05) and reached levels indicating left ventricular diastolic dysfunction (E/E' > 15) in the third decade whereas indexes of active and passive atrial function decreased gradually throughout life. In controls, the E/E' ratio continually increased with age but with later (fifth decade) appearance of diastolic dysfunction and a compensatory increase in atrial active function. Both natriuretic peptides were significantly increased in patients compared to controls (558 ± 141 and 2,580 ± 1,830 fmol/mL for NT-proBNP and proANP versus 332 ± 106 and 1,331 ± 1,134 fmol/mL, respectively). Atrial fibrillation was found in a subgroup of 23 (26%) patients, older in age with mild diastolic function and enlarged, depressed atria. In conclusion, atrial mechanical depression seems to be a very early sign of cardiac damage. It may become echocardiographically evident even before diastolic and systolic dysfunction and is associated to supraventricular arrhythmias.
Preventing infections from cannulas reduces MRSA
Authors: Mark Melzer, Lindsey Bain, Yasmin J Drabu
Journal: BMJ (2008)

We have shown through bacteraemia surveillance (June 2003-December 2006) that 19 of 118 episodes (16.1%) of bacteraemia due to hospital acquired MRSA on medical and surgical wards were secondary to infected insertion sites of peripheral cannulas. In June 2007, King George Hospital, Barking, Havering and Redbridge Trust implemented a programme aimed to reduce these infections. This followed guidance in the “Saving Lives” programme.1 Skin decontamination devices …
QUALITY OF CARE AND OUTCOMES AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND CHRONIC RENAL INSUFFICIENCY: REPORT FROM THE GET WITH THE GUIDELINES PROGRAM
Authors: Samip Vasaiwala, Christopher P. Cannon, Gregg C. Fonarow, Frank Peacock, Warren Laskey, Lee Schwamm, Li Liang, Adrian F. Hernandez, Eric D. Peterson, Deepak L. Bhatt
Journal: Journal of the American College of Cardiology (2011)
Death After Use of Cupric Sulfate as Emetic
Authors: Richard S. Stein
Journal: JAMA (1976)

<h3>To the Editor.—</h3> Cupric sulfate as an emetic in the management of drug poisoning<sup>1</sup>has generally been replaced by safer agents, ie, ipecac syrup and apomorphine hydrochloride. Despite recognized toxicity of cupric sulfate,<sup>2</sup>it has been used as an emetic because it produces gastric irritation and vomiting, thus preventing absorption. This report of fatal sequelae of the use of cupric sulfate as an emetic illustrates the danger of this practice. <h3>Report of a Case.—</h3> A 44-year-old woman was brought to the emergency room following ingestion of alcohol and diazepam. Vital signs and results of a physical examination were unremarkable. Cupric sulfate, 10 ml of a 10% solution, was administered twice. When the patient failed to vomit, her stomach was lavaged with 2 liters of saline; green material was obtained. Approximately one hour later, the patient was lethargic, blood pressure was 88/64 mm Hg; pulse rate, 90 beats per
The Rumination Syndrome in Adults
Authors: RATHNA P. AMARNATH
Journal: Annals of Internal Medicine (1986)

The rumination syndrome is defined as a process in which a person chews regurgitated gastric contents and then either partially ejects or swallows them. We report 12 cases of rumination in which the clinical diagnosis was supported by esophageal and gastrointestinal motility studies. These patients showed a characteristic pressure spike-wave pattern that was associated with regurgitation and was recorded simultaneously at all manometric sites. These spike waves increased significantly in frequency (p < 0.001) and amplitude (p < 0.04) during the postprandial period. The underlying gastrointestinal motility was normal except for a small decrease in postprandial antral motility index, with mean ( ±SE) values of 13.2 ±0.3 for patients compared with 14.2 ±0.3 for eight healthy adult controls (p < 0.03). Nine patients had significant personality disturbances, including six whose scores on the Minnesota Multiphasic Personality Inventory for hypochondriasis and depression were significantly above the reference population (p < 0.02). The rumination syndrome should be considered in adult patients with long-standing postprandial vomiting. The manometric pattern is characteristic.
Getting Supervisory Experiences with ‘Socialization’ and Professional Training of Young Medical Doctors in Psychiatric Care Units
Authors: A. Zintl-Wiegand
Journal: Psychotherapy and Psychosomatics (1990)

Relations with psychiatric and psychotherapeutic patients call for a high degree of social competency on the part of the staff and the patient's physician. Successful education and socialization of young physicians therefore depend to a large extent on the milieu and structure of the institution and the team they are working in. Material from supervisory hours in two different psychiatric units was collected over several years. It could be shown that the choice of cases presented very often reflected the team's situation, covertly and to a certain extent unconsciously mirroring the challenges, fears and other emotional problems. The work of a supervisor should tend to make such covert and generally burdensome reactions to institution-bound influences and structure accessible and more conscious.
Overexpression of human aspartyl(asparaginyl)beta-hydroxylase in hepatocellular carcinoma and cholangiocarcinoma.
Authors: L Lavaissiere, S Jia, M Nishiyama, S de la Monte, A M Stern, J R Wands, P A Friedman
Journal: Journal of Clinical Investigation (1996)

To characterize genes that become upregulated with malignant transformation of human hepatocytes, a library of monoclonal antibodies was produced against the FOCUS hepatocellular carcinoma cell line. Antibody FB-50 reacted with an antigen that was highly expressed in 4 of 10 primary hepatocellular carcinomas, in all 20 cholangiocarcinomas we studied, and in a variety of transformed cell lines. This antigen was also highly expressed in neoplastic epithelial cells of breast and colon carcinomas in contrast to its low level of expression in normal hepatocytes and in non-neoplastic epithelial cells. Among the normal adult tissues studied, high levels were observed only in proliferating trophoblastic cells of the placenta and in adrenal glands. A 636-bp partial cDNA, isolated from a gamma GT11 expression library generated with HepG2 human hepatoblastoma cells, and a complete cDNA, generated by reverse transcriptase-PCR, identified the antigen as the human form of aspartyl(asparaginyl)beta-hydroxylase. This enzyme catalyzes posttranslational hydroxylation of beta carbons of specific aspartyl and asparaginyl residues in EGF-like domains of certain proteins. Analyses of extracts prepared from several human tumor cell lines compared to their normal tissue counterparts indicate that the increase in hydroxylase, approximately 10-fold, is controlled at the level of transcription and the protein is expressed in an enzymatically active form. In similar analyses, comparing hepatocellular carcinomas to adjacent uninvolved liver from five patients, enzymatic activity was much higher in the tumor tissue from the four patients whose immunoblots revealed increased hydroxylase protein in the malignant tissue. EGF repeats in the extracellular domain of Notch or its homologs contain the consensus sequence for hydroxylation. Deletion mutants lacking this domain are gain-of-function mutants, suggesting that the domain modulates signal transduction by the cytoplasmic domain. While the function imparted by beta hydroxylation is unknown, our studies raise the possibility that beta hydroxylation is regulated in proteins like the mammalian Notch homologs, whose cytoplasmic domains have been shown to be oncogenic.
Alterations in CD46-mediated Tr1 regulatory T cells in patients with multiple sclerosis
Authors: Anne L. Astier, Gregory Meiffren, Samuel Freeman, David A. Hafler
Journal: Journal of Clinical Investigation (2006)

Loss of Treg function appears to be a critical factor in the pathogenesis of human autoimmune diseases. Attention has focused on defects of CD4+CD25high Tregs, and techniques have been developed to determine their function. In contrast, the role of Tr1 regulatory T cells, which secrete the antiinflammatory cytokine IL-10, in autoimmune disease has not been well assessed. CD46 is a newly defined costimulatory molecule for T cell activation, and CD46-costimulated human T cells induce a Tr1 Treg phenotype with considerable amounts of IL-10 secretion. Here, we examined the role of Tr1 cells in patients with multiple sclerosis (MS) by stimulating CD4+ T cells with anti-CD3 and -CD46 mAbs and measuring IL-10 secretion. There were striking defects in the induction of Tr1 cells with CD46 costimulation as measured by IL-10 but not IFN-γ secretion in patients with MS compared with healthy subjects. This loss of Tr1 cell–associated IL-10 secretion was specific to CD46 and not CD28 costimulation and was associated with an altered regulation of the CD46-Cy2 isoform that differentially regulates T cell function in a CD46-transgenic murine model. These data demonstrate a second major Treg defect in human autoimmune disease associated with the CD46 pathway.
Administration of low-dose dopamine to nonoliguric patients with sepsis syndrome does not raise intramucosal gastric pH nor improve creatinine clearance.
Authors: D Olson, A Pohlman, J B Hall
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Tissue hypoxia resulting from regional blood flow abnormalities and oxygen extraction defects may underlie the pathogenesis of multiple system organ failure (MSOF) in sepsis. Low-dose dopamine (LDD) is widely employed to enhance splanchnic perfusion although data to support this approach are lacking. We assessed the effect of LDD on surrogate markers of renal and gastric perfusion. Sixteen nonoliguric mechanically ventilated patients with sepsis syndrome received LDD (3 micrograms/kg/min) or placebo in a double-blind crossover design experiment. Hemodynamics, gastric intramucosal pH (pHi) urine volumes, urinary sodium excretion, and cimetidine-corrected creatinine clearance were compared. Mortality for the group was 63%. LDD caused a significant increase in urine volume (88 +/- 58 to 115 +/- 70 ml/h, p = 0.02, 95% confidence interval for change 4.7 to 49 ml/h), but no significant change in any other parameter. We conclude that use of LDD results in diuresis but does not improve other markers of renal or gut perfusion. These data do not support the use of LDD to reduce risk of progression to MSOF in sepsis.
Emergence of insulin receptors upon alloimmune T cells in the rat.
Authors: J H Helderman, T B Strom
Journal: Journal of Clinical Investigation (1977)

Insulin, as well as other ligands which increase intracellular guanosine 3',5'-cyclic monophosphate (cGMP), augments thymic-derived (T)- lymphocyte effector activity as revealed by alloimmune lymphocyte-mediated cytotoxicity. The observation that insulin binds only to monocytes among circulating nonimmune human mononuclear cells fosterd reexamination of the mechanism by which insulin augments T-lymphocyte function. This report concerns a test of the hypothesis that the T cell is directly affected by insulin and that an insulin receptor emerges upon T lymphocytes consequent to immune activation. Spleens were removed from rats skin grafted across a major histocompatibility barrier. Lymphocytes were harvested from Ficoll-Hypaque density gradients and subsequently enriched for T cells by passage over one or two nylon wool columns. This population was composed of more than 98% T cells as assessed by surface marker techniques (Ig staining, erythrocyte antibody, and erythrocyte antibody complement rosetting, anti-T staining). There was no loss of augmentation of lymphocyte-mediated cytotoxicity induced by insulin, carbamycholine, and 8-bromo-cGMP in the purified cells when compared to unfractionated cells 7 days after transplantation. 125I-insulin bound saturably to the allostimulated T-enriched lymphocytes with maximum binding at 12.8 +/- 0.2 pg and a dissociation constant at equilibrium of 1.3 nM. In contrast, insulin receptors were not present on nonimmune T-enriched cells or on T cells from animals that received syngeneic grafts. The affinity of the lymphocyte insulin receptor was similar to that of more conventional insulin-sensitive tissues e.g., liver, adipocyte. After 89% of T cells from spleens on day 7 were lysed with anti-thy 1.1 antibody and complement, the ability to measure specific insulin binding was lost. These data confirm a physiologic role for insulin in T-lymphocyte effector function and describe the emergence of insulin receptors concomitant with cell sensitivity to ligand. Such receptors may play a role in hormonal modulation of the immune response.
Phase II Trial of Pralatrexate (10-Propargyl-10-deazaaminopterin, PDX) in Patients with Unresectable Malignant Pleural Mesothelioma
Authors: Lee M. Krug, Robert T. Heelan, Mark G. Kris, Ennapadam Venkatraman, F.M. Sirotnak
Journal: Journal of Thoracic Oncology (2007)
EPIDEMIOLOGY OF EPIDEMIC ENCEPHALITIS, ST. LOUIS TYPE
Authors: J. P. LEAKE
Journal: JAMA (1934)

Final opinion regarding the exact nature of the encephalitis epidemic in St. Louis City and County in the late summer of 1933 and regarding its pathogenesis and spread must await further study, although some information has been obtained that may give more definite trends to the estimation on these points.  TYPE OF DISEASE  In recent years, encephalitis, like poliomyelitis, has been always present, and at every season, in communities of large size. A survey of the more important cities of the United States reveals that many of the cases currently being reported as epidemic or lethargic encephalitis lack the characteristics either of the disease as seen in St. Louis in 1933 or of the disease as originally called lethargic encephalitis by von Economo or epidemic encephalitis since Economo's first description. Some of these current cases prove to be some other condition in their further course; in others, on account of
Tuberculosis in a Community Hospital
Authors: Warren W. Furey
Journal: JAMA (1976)

Between January 1969 and December 1973, at a community hospital in Chicago, 129 patients had cultures positive for Mycobacterium tuberculosis. On admission to the hospital, only 36% of the patients were suspected of having tuberculosis, even after the initial chest x-ray film was available. Ten patients, in whom a positive culture was reported, were still living and had not been treated for tuberculosis as of June 1974. Five of these patients probably never had the disease, and the other five patients had overlooked-disease or had refused treatment. Nine patients died as a result of tuberculosis.
Prenatal Polycyclic Aromatic Hydrocarbon (PAH) Exposure and Child Behavior at Age 6–7 Years
Authors: Frederica P. Perera, Deliang Tang, Shuang Wang, Julia Vishnevetsky, Bingzhi Zhang, Diurka Diaz, David Camann, Virginia Rauh
Journal: Environmental Health Perspectives (2012)

Airborne polycyclic aromatic hydrocarbons (PAH) are widespread urban air pollutants from fossil fuel burning and other combustion sources. We previously reported that a broad spectrum of combustion-related DNA adducts in cord blood was associated with attention problems at 6-7 years of age in the Columbia Center for Children's Environmental Health (CCCEH) longitudinal cohort study.We evaluated the relationship between behavioral problems and two different measures of prenatal exposure--both specific to PAH--in the same cohort.Children of nonsmoking African-American and Dominican women in New York City (NYC) were followed from in utero to 6-7 years. Prenatal PAH exposure was estimated by personal air monitoring of the mothers during pregnancy as well as by the measurement of DNA adducts specific to benzo[a]pyrene (BaP), a representative PAH, in maternal and cord blood. At 6-7 years of age, child behavior was assessed using the Child Behavior Checklist (CBCL) (n = 253). Generalized linear models were used to test the association between prenatal PAH exposure and behavioral outcomes.In multivariate analyses, high prenatal PAH exposure, whether characterized by personal air monitoring (greater than the median of 2.27 ng/m³) or maternal and cord adducts (detectable or higher), was positively associated with symptoms of Anxious/Depressed and Attention Problems (p ≤ 0.05).These results provide additional evidence that environmental levels of PAH encountered in NYC air can adversely affect child behavior.
Application of Lymphocyte Transformation Test (LTT) in Delayed Drug Hypersensitivity Reactions in a Drug Allergy Unit in Spain: a Descriptive Study
Authors: N. Prior, R. Cabañas, A. Fiandor, T. Caballero, I. Bobolea, M. López Serrano, S. Quirce, T. Bellon
Journal: Journal of Allergy and Clinical Immunology (2010)
Amantadine Effect on Peripheral Airways Abnormalities in Influenza
Authors: JOHN W. LITTLE
Journal: Annals of Internal Medicine (1976)

Amantadine HCl administration has resulted in accelerated resolution of influenza A illness. Prolonged abnormalities in pulmonary function have been described in uncomplicated influenza A. To study the effect of amantadine on these changes, we evaluated young adults with documented natural influenza A with clear chest examinations and X rays. Subjects received placebo or amantadine in random, doubleblind fashion. Physiologic studies included maximal expiratory flow volume curves with air and helium-oxygen mixtures. Air flow rates were unchanged in all subjects throughout. Initially, both groups showed comparable decreases in mean helium-oxygen maximal expiratory flow rates. The amantadine group showed accelerated physiologic improvement: significant increase in helium-oxygen flow rates occurred within 7 days (P < 0.05). The rate of improvement in the helium-oxygen flow rates in the placebo group was not statistically significant. These studies confirm peripheral airways dysfunction after uncomplicated influenza A and suggest that amantadine is associated with accelerated resolution of this dysfunction.