tbuckley/cabot-search huggingface dataset:
Accident and emergency medicine
Authors: J. Wardrope
Journal: BMJ (1998)

Accident and emergency is a young specialty. It is only 25 years since the first ‘experimental' posts were established, with full time consultants being responsible for the proper running of accident and emergency departments.1

There are now about 350 posts, and the specialty is still expanding. Perhaps the major challenge facing the NHS is the rising tide of emergency work, especially in acute medicine. The A&E department is in the front line, leading initiatives to provide the best and most appropriate management for the sickest of patients.

From cardiac arrest to sprained ankle, from multiple trauma to a child with a wheezy chest, the variety of clinical problems is huge. The A&E department sees more new patients than any other clinical department. An average A&E department will see 40,000-60,000 new patients each year.2 Half of these will have minor injury or illness requiring no further follow up or medical care, 10% will have fractures, and 10-20% will need admission to hospital. The department will be led by two or three consultants, and they have a responsibility to ensure that each patient receives an accurate assessment of their condition, proper initial treatment, and appropriate ongoing care.

To meet these responsibilities, A&E medicine demands structure and organisation. If there is one attribute of successful A&E consultants then it is organisational ability, both of their department and of themselves. Most clinical days start with routine review processes. This may be of patients admitted the previous day to the observation ward, a review clinic, or going through case notes. Quality control and audit are daily routines, with x ray reports to review, blood results to check, and notes and electrocardiograms to review. The rest of the day may include seeing routine new patients, moving the large mountain of mail, and administrative tasks …
The Resting Electrocardiogram as a Screening Test
Authors: Harold C. Sox
Journal: Annals of Internal Medicine (1989)

Purpose: To review the evidence that a resting electrocardiogram (ECG) predicts cardiac disease in healthy persons and to discuss the role of this test in screening for coronary artery disease. Data Identification: A manual search of the Englishlanguage literature using Index Medicus (1970-1988) and a bibliographic review of identified articles. Study Selection: We found 40 articles that described longterm survival of healthy individuals who either had had an abnormal finding on a resting ECG or had not had an abnormal finding. Data Extraction: We pooled the pertinent studies and calculated the relative risk for coronary artery disease if an ECG finding was present and the 95% confidence limits (CI) on the relative risk. Results of Analysis: One reason for doing a screening ECG is to detect disease whose effects can be prevented by early treatment. In population studies of healthy middle-aged men, frequent ventricular premature beats, left axis deviation, left ventricular hypertrophy (ECG-LVH), and changes indicative of myocardial ischemia are all associated with a small but statistically significant increase in the risk of dying from coronary artery disease. There is no evidence that early detection of these findings leads to a clinical intervention that improves health outcomes. A screening ECG can also serve as a "baseline" tracing. Two studies have shown that the baseline tracing has little effect on decision making in the emergency room. Conclusion: The evidence does not support doing a screening ECG in men without evidence of cardiac disease or cardiovascular risk factors.
Maternal Brain Death During Pregnancy
Authors: David R. Field
Journal: JAMA (1988)

We present in detail a case of a 27-year-old primigravida who was maintained in a brain-dead state for nine weeks. An apparently normal and healthy male infant weighing 1440 g was delivered. The newborn did well and was found to be growing and developing normally at 18 months of age. Although the technical aspects of prolonged life support are demanding and the economic costs are very high (+217,784), there are ample ethical arguments justifying the separation of brain death and somatic death and the maintenance of the brain-dead mother so that her unborn fetus can develop and mature.Physicians and an ethicist at the University of California, San Francisco, present the details of the case of a pregnant, brain-dead woman whose vital functions were maintained for nine weeks until the delivery of a healthy infant at 31 weeks' gestation. Despite the technical difficulties involved and the economic costs incurred ($183,031 for maternal care and $34,703 for neonatal care), the authors conclude that ethical considerations support the decision on care. They argue that the woman was not injured; that nonmaleficence and beneficence toward the fetus require a rescue attempt if there is a reasonable chance of reaching fetal maturity; that maternal medical care may be more cost effective than prolonged neonatal support; and that the father's wishes were respected. Rather than proposing guidelines, they hold that decisions on prolonged maternal support should be based on the circumstances of each case.
Incorporation of Radiolabelled Fibrinogen into Venous Thrombi Induced in Dogs
Authors: THOMAS C. KRAVIS, ELAINE M. SHIBEL, JOHN D. BROOKS, KENNETH M. MOSER
Journal: Circulation (1974)

The time course and locus of radiolabelled fibrinogen (RLF) incorporation into venous thrombi were studied in dogs. Incorporation of radiolabelled fibrinogen (RLF) into fresh venous thrombi induced in vivo was studied by serial autoradiography, well-counting and surface counting. Autoradiographs disclosed diffuse incorporation of RLF into thrombi formed before and after RLF injection. Well-counting data also reflected thrombus RLF accumulation in both instances, although this accumulation was discernible earlier in thrombi induced in the presence of circulating RLF. Thrombi induced prior to RLF injection were detectable by surface counting after six hours. These studies support the potential value of RLF in detecting human venous thrombosis but also point out the limitations of the technique as well as questions which require clarification.
Gonorrhea in Preschooland School-Aged Children
Authors: John D. Nelson, Edgar Mohs, Adnan S. Dajani, Stanley A. Plotkin
Journal: JAMA (1976)

Single-dose antibiotic therapy was evaluated in 108 episodes of culture-confirmed, uncomplicated gonorrhea in 100 prepubertal children. There were 15 boys and 85 girls between 14 months and 14 years of age. Penicillin G procaine, 100,000 units/kg intramuscularly, was compared with amoxicillin trihydrate, 50 mg/kg orally. Probenecid, 25 mg/kg, was given simultaneously. Both drugs provided prompt bacteriological and clinical response. Multiple episodes of gonorrhea, presumably caused by reexposure, occurred in six girls. Oral and anal cultures were negative in all of 47 Costa Rican cases but were commonly positive in US children. Anal cultures yielded gonococci in 52% of girls and 25% of boys, and oral cultures were positive in 18% and 13%, respectively. In three instances, rectal cultures confirmed the diagnosis when vaginal cultures were negative. Gonorrhea should be considered in every child with vaginal or urethral discharge. Single-dose penicillin-probenecid or amoxicillin-probenecid treatment is curative. (<i>JAMA</i>236:1359-1364, 1976)
OSSIFICATION OF THE CHOROID LEADS TO THE IDENTIFICATION OF THE BODY IN AN INSURANCE CASE.
Authors: ROBERT L. RANDOLPH
Journal: JAMA (1900)

Early in October, five years ago, a well-known wholesale sale clothier of Baltimore telegraphed to his wife from a point in Canada to meet him on a Saturday, at 4 p.m., in the Grand Central Station, New York. She was there on time, but failed to find her husband. She ascertained from the sleeping-car conductor and porter that her husband had occupied a berth on the train, and some of his clothes were found in the berth. The porter said that he had seen Mr. A. passing through the car door, presumably on his way to the car ahead, and that the train at this time was crossing the Niagara River. The following week the wife appeared at the office of the insurance companies and claimed the insurance, which the companies refused until more conclusive evidence was forthcoming of the man's death. Weeks passed and still the family were unable
The utilization of decellularized tendon slices to provide an inductive microenvironment for the proliferation and tenogenic differentiation of stem cells
Authors: Liang-Ju Ning, Ya-Jing Zhang, Yi Zhang, Quan Qing, Yan-Lin Jiang, Jie-Liang Yang, Jing-Cong Luo, Ting-Wu Qin
Journal: Biomaterials (2015)
Unmet Health Needs of Uninsured Adults in the United States
Authors: John Z. Ayanian
Journal: JAMA (2000)

In 1998, 33 million US adults aged 18 to 64 years lacked health insurance. Determining the unmet health needs of this population may aid efforts to improve access to care.To compare nationally representative estimates of the unmet health needs of uninsured and insured adults, particularly among persons with major health risks.Random household telephone survey conducted in all 50 states and the District of Columbia through the Behavioral Risk Factor Surveillance System.A total of 105,764 adults aged 18 to 64 years in 1997 and 117,364 in 1998, classified as long-term (>/=1 year) uninsured (9.7%), short-term (<1 year) uninsured (4.3%), or insured (86.0%).Adjusted proportions of participants who could not see a physician when needed due to cost in the past year, had not had a routine checkup within 2 years, and had not received clinically indicated preventive services, compared by insurance status.Long-term- and short-term-uninsured adults were more likely than insured adults to report that they could not see a physician when needed due to cost (26.8%, 21.7%, and 8.2%, respectively), especially among those in poor health (69.1%, 51.9%, and 21.8%) or fair health (48.8%, 42.4%, and 15.7%) (P<.001). Long-term-uninsured adults in general were much more likely than short-term-uninsured and insured adults not to have had a routine checkup in the last 2 years (42.8%, 22.3%, and 17.8%, respectively) and among smokers, obese individuals, binge drinkers, and people with hypertension, elevated cholesterol, diabetes, or human immunodeficiency virus risk factors (P<.001). Deficits in cancer screening, cardiovascular risk reduction, and diabetes care were most pronounced among long-term-uninsured adults.In our study, long-term-uninsured adults reported much greater unmet health needs than insured adults. Providing insurance to improve access to care for long-term-uninsured adults, particularly those with major health risks, could have substantial clinical benefits. JAMA. 2000;284:2061-2069
Inhibition of the bronchial response to respiratory heat exchange by increasing doses of terbutaline sulphate.
Authors: P M O'Byrne, M Morris, R Roberts, F E Hargreave
Journal: Thorax (1982)

Ten asthmatic patients inhaled terbutaline sulphate (250, 500, or 1000 micrograms) or placebo on separate days, double blind and in random order, 30 minutes before isocapnic hyperventilation induced by cold air inhaled in doses that increased in a precisely controlled manner. The respiratory heat exchange (RHE) was calculated for each level of ventilation and the results were expressed as the RHE causing a fall in FEV1 of 10% (PD10RHE). The PD10RHE after placebo was highly reproducible. After terbutaline inhalation there was a highly significant shift in the RHE dose-response curves to the right and a trend towards a linear increase in PD10RHE with increasing doses of terbutaline. The subjects who were most responsive to the RHE required more terbutaline to inhibit the response completely. The results indicate that RHE dose-response curves are a precise method to examine the effects of drugs on hyperventilation-induced asthma, that increasing doses of terbutaline can produce increasing protection, and that the degree of protection is dependent on the level of increased bronchial responsiveness to RHE.
Annual screening with CA-125 and transvaginal ultrasonography did not reduce ovarian cancer incidence or mortality
Authors: Donna Fedorkow
Journal: Annals of Internal Medicine (2011)

Source Citation Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305:2295-303. 21642681
A Post-Graduate Lecture ON THE TREATMENT OF VENOUS THROMBOSIS MAINLY FROM THE SURGICAL ASPECT: Delivered at the London School of Clinical Medicine (Seamen's Hospital)
Authors: W. Bennett
Journal: BMJ (1911)

GENTLEMEN,-The point at which medical treatment in thrombosis ends and surgical treatment begins is a very difflcult thing to determine.For thrombosis is one of those conditions which show quite clearly that a surgeon, if he is to effect much useful purpose, should be some-
"Anovlar" as an Oral Contraceptive
Authors: E. Mears, E. C. G. Grant
Journal: BMJ (1962)

166 women received the oral contraceptive Anovlar (4 mg norethisterone acetate plus .05 mg ethinyl estradiol) on Cycle Days 5-24 for a total of 1023 cycles.  A 100% efficiency rate was encountered.  Side effects were few.  Nausea occurred in 22% the first cycle and in only 7% by the seventh cycle.  Dysmenorrhea improved or disappeared in 36% of the cases and got worse in none.  The most frequent side effect was weight gain (more than 3 pounds in 45% of the cases).  Breakthrough bleeding occurred in 5.1% spotting 9% and amenorrhea in 2.5% of all cycles.  More than 60% reported a decrease in menstrual flow and premenstrual tension improved in 26% of the patients.  No evidence of virilization was noted.
Choice of Antihypertensive Therapy During Pregnancy-Reply
Authors: Norman Kaplan
Journal: JAMA (1996)

In Reply.  —The cautions noted by Drs Casele and Laifer are appropriate; fortunately, the problems they mention are neither common nor serious. Hypertension is relatively uncommon in women of childbearing age, and most women who are hypertensive are beyond the age when unscheduled pregnancies are more common.  As they note, the only antihypertensive drugs currently used that pose a serious threat to fetal health are the ACE inhibitors (and likely the angiotensin II-receptor blockers). Clearly, ACE inhibitors should not be prescribed for women who may become pregnant. There is little evidence that any of the other classes of antihypertensive drugs pose the threat raised by Casele and Laifer that patients with hypertension may conceive while taking a drug that could cause serious adverse effects in the fetus.  Once the patient conceives, most US obstetricians prefer to use methyldopa or hydralazine because these drugs are the only drugs approved for use in pregnancy.
Epidemiologic and Genetic Studies of Congenital Heart Disease in the Dog
Authors: D. F. PATTERSON
Journal: Circulation Research (1968)

The prevalence rate for cardiovascular malformations in dogs presented to a large university veterinary clinic was 6.8 per 1000. Patent ductus arteriosus, as in man, was found predominantly in females. Breed-specific prevalence rates were significantly greater in purebred dogs than in mongrels, and the breed distributions of patent ductus arteriosus, pulmonic stenosis, subaortic stenosis, persistent right aortic arch, and tetralogy of Fallot were significantly different than would be expected if all breeds were equally susceptible to each type of malformation. On the basis of these observations, two hypotheses were made: (1) Genetic factors are determinants of certain types of congenital heart disease in the dog. (2) These genetic factors have specific effects on cardiac morphogenesis, resulting in specific types of cardiovascular malformations. Preliminary genetic studies confirmed the specific hereditary transmission of valvular pulmonic stenosis in beagles, persistent right aortic arch in German shepherds, and conal septal defects (including ventricular septal defects and tetralogy of Fallot) in keeshonden. The pattern of inheritance of these defects was not consistent with any simple genetic hypothesis. Patent ductus arteriosus in dogs of poodle ancestry and fibrous subaortic stenosis in Newfoundlands were shown provisionally to be transmitted in a manner consistent with autosomal dominant inheritance. The significance of these findings is considered in relation to present and future understanding of the etiology and pathogenesis of congenital heart disease.
An evaluation of itraconazole in the management of onychomycosis
Authors: R. J. HAY, Y. M. CLAYTON, M. K. MOORE, G. MIDGELY
Journal: British Journal of Dermatology (1988)

At present the reported use of itraconazole, a new oral triazole antifungal, has been confined to short-term treatments. This investigation is an appraisal of itraconazole in the treatment of three different forms of onychomycosis. Six patients with nail infections due to Candida albicans not associated with paronychia affecting a total of 20 nails received itraconazole (100 mg daily) for a mean period of 5.9 months. Complete remission was achieved in all cases. Twenty six patients with dermatophyte onychomycosis affecting a total of 45 finger and 80 toe-nails were treated with itraconazole (100-200 mg daily). In 24 cases the causative organism was Trichophyton rubrum. Remission was achieved in 64% of finger and 73% of toe-nails in 5 and 9.4 months, respectively. Treatment failures were experienced in patients with finger-nail infections due to T. violaceum (I) and those concurrently receiving phenytoin and phenobarbitone (3). Three patients with infections due to Hendersonula toruloidea failed to respond to treatment. Adverse effects were experienced by four patients (abdominal discomfort 3, diarrhoea I), but none were serious enough to lead to abandonment of treatment. No persistent changes were seen in serum biochemical values. This study suggests that itraconazole is potentially effective in the long-term treatment of superficial fungal infections such as onychomycosis, and comparative studies with alternatives such as griseofulvin should now be carried out.
AN IMPROVISED REFLECTOR FOR THROAT EXAMINATION.
Authors: J. HARVIE DEW
Journal: JAMA (1907)

I have used the following simple device for a number of years in making examinations of the throat: It will prove of exceeding value whenever it is difficult to secure satisfactory light. The idea was not original with myself nor was it obtained from any professional sources. A candle, a tablespoon and another spoon suitable for depressing the tongue are the several essentials needed. The accompanying cut illustrates the procedure. Hold the candle between the middle and ring fingers and the fore and little fingers of the left hand; then place the tablespoon between the thumb and fore and little fingers of the same hand. The concave bowl of the spoon should be placed immediately in rear of the flame. In this way a bright light can be thrown on any desired point. <h3>Eczema of Extremities.</h3> —N. E. Aronstam, in<i>Medical Fortnightly</i>, says that, in acute erythematous eczema of the
The Age Threshold for Isoniazid Chemoprophylaxis
Authors: David N. Rose, Clyde B. Schechter, Alan L. Silver
Journal: JAMA (1986)

Isoniazid chemoprophylaxis recommendations include its use in persons who have positive tuberculin reactions, but neither recent conversion nor other activation risk factors, only if they are under age 35 years. Above this threshold, the isoniazid hepatitis risk is said to outweigh the benefit of preventing activation. Because this policy is controversial, we performed a decision analysis contrasting those who take with those who decline isoniazid therapy according to three outcome measures: life expectancy, likelihood of illness (isoniazid hepatitis and active tuberculosis), and likelihood of fatal illness. We found no threshold between ages 10 and 80 years by the measures of life expectancy and likelihood of fatal illness; isoniazid benefits outweigh risks for all, though the margin is small for the elderly. A threshold exists only in the likelihood of illness: isoniazid risks outweigh benefits for those aged 50 to 65 years. Only extreme variations of assumptions affect these findings. Chemoprophylaxis recommendations should include low-risk tuberculin reactors over age 35 years.
Hemodynamic and autonomic nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension.
Authors: L A Lipsitz, S M Ryan, J A Parker, R Freeman, J Y Wei, A L Goldberger
Journal: Circulation (1993)

Although postprandial hypotension is a common cause of falls and syncope in elderly persons and in patients with autonomic insufficiency, the pathophysiology of this disorder remains unknown.We examined the hemodynamic, splanchnic blood pool, plasma norepinephrine (NE), and heart rate (HR) power spectra responses to a standardized 400-kcal mixed meal in 11 healthy young (age, 26 +/- 5 years) and nine healthy elderly (age, 80 +/- 5 years) subjects and 10 dysautonomic patients with symptomatic postprandial hypotension (age, 65 +/- 16 years). Cardiac and splanchnic blood pools were determined noninvasively by radionuclide scans, and forearm vascular resistance was determined using venous occlusion plethysmography. In healthy young and old subjects, splanchnic blood volume increased, but supine blood pressure remained unchanged after the meal. In both groups, HR increased and systemic vascular resistance remained stable. Forearm vascular resistance and cardiac index increased after the meal in elderly subjects, whereas these responses were highly variable and of smaller magnitude in the young. Young subjects demonstrated postprandial increases in low-frequency HR spectral power, representing cardiac sympatho-excitation, but plasma NE remained unchanged. In elderly subjects, plasma NE increased after the meal but without changes in the HR power spectrum. Patients with dysautonomia had a large postprandial decline in blood pressure associated with no change in forearm vascular resistance, a fall in systemic vascular resistance, and reduction in left ventricular end diastolic volume index. HR increased in these patients but without changes in plasma NE or the HR power spectrum.1) In healthy elderly subjects, the maintenance of blood pressure homeostasis after food ingestion is associated with an increase in HR, forearm vascular resistance, cardiac index, and plasma NE. In both young and old, systemic vascular resistance is maintained. 2) Dysautonomic patients with postprandial hypotension fail to maintain systemic vascular resistance after a meal. This impairment in vascular response to meal ingestion may underlie the development of postprandial hypotension. 3) The measurement of mean HR or plasma NE does not adequately characterize autonomic cardiac control. Power spectral analysis suggests an impairment in the postprandial autonomic modulation of HR in healthy elderly and dysautonomic subjects, possibly predisposing to hypotension when vascular compensation is inadequate.