tbuckley/cabot-search huggingface dataset:
Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?
Authors: R. S Barbour
Journal: BMJ (2001)

Qualitative research methods are enjoying unprecedented popularity.Although checklists have undoubtedly contributed to the wider acceptance of such methods, these can be counterproductive if used prescriptively.The uncritical adoption of a range of "technical fixes" (such as purposive sampling, grounded theory, multiple coding, triangulation, and respondent validation) does not, in itself, confer rigour.In this article I discuss the limitations of these procedures and argue that there is no substitute for systematic and thorough application of the principles of qualitative research.Technical fixes will achieve little unless they are embedded in a broader understanding of the rationale and assumptions behind qualitative research. Summary pointsChecklists can be useful improving qualitative research methods, but overzealous and uncritical use can be counterproductive Reducing qualitative research to a list of technical procedures (such as purposive sampling, grounded theory, multiple coding, triangulation, and respondent validation) is overly prescriptive and results in "the tail wagging the dog" None of these "technical fixes" in itself confers rigour; they can strengthen the rigour of qualitative research only if embedded in a broader understanding of qualitative research design and data analysis Otherwise we risk compromising the unique contribution that systematic qualitative research can make to health services research
Chlorinated hydrocarbons in women with repeated miscarriages.
Authors: I Gerhard, V Daniel, S Link, B Monga, B Runnebaum
Journal: Environmental Health Perspectives (1998)

This study was conducted to investigate a possible etiological role of chlorinated hydrocarbons in the pathogenesis of repeated miscarriages. The blood levels of chlorinated hydrocarbons [CHCs: pentachlorophenol, hexachlorocyclohexane, hexachlorobenzene, the dichlorodiphenyltrichloroethane (DDT) group, polychlorinated biphenyls] were determined in 89 women with repeated miscarriages, who were referred to the University Hospital of Obstetrics and Gynecology of Heidelberg for investigations between 1989 and 1993, and compared to a previously investigated reference population. In more than 20% of the women, at least one of the CHC levels exceeded the reference range. CHC levels did not differ significantly between women with primary or secondary and early or late miscarriages; neither did they differ between women with hormonal or immunological disorders as causes of repeated miscarriages or women with idiopathic repeated miscarriages. No significant associations were detected between CHC levels and further conceptions or the outcome of further pregnancies. As significant associations were found between increasing CHC blood concentrations and immunological and hormonal changes, CHCs may have an impact on the pregnancy course in certain cases.
ABC of Work Related Disorders: BACK PAIN
Authors: M. I V Jayson
Journal: BMJ (1996)

Epidemiology of back disabilityThe number of workdng days lost due to back problems has increased 2 r 2 e.7 dramatically in recent years.Over 80 million days a year are now lost due to registered disability,' but the total estimate, including short spells, is probably in the order of 150 million.This is some four times the figure for 20 years ago.This increase does not reflect an increased incidence of back problems, which has changed little over the period, but rather increased disability associated with episodes of back pain.Much of the increase in disability is probably due to an altered reaction to the problem, with increases in sick certification and state benefit perhaps reflecting patients' and doctors' expectations, concerns by -,I, _g -iT ; E employers, and social and medicolegal pressures.The costs of back pain are huge.Current estimates suggest the global cost to our economy is about C6bn a year.' Improved management and Changes in sickness and invalidity benefit for back better outcomes would lead to major financial, as well as medical, pain since 1955 (from report of Clinical Standards benefits.Advisory Group1).Who gets back pain?. *The problem affects workers of all ages.It usually starts between the 4>:.ng 0 _ -late teens and the 40s, with the peak prevalence in 45-60 year olds and BMJ voLuME 313 10 AUGUST 1996 Characteristics of simple backache *Onset generally at ages 20-55 * Pain in lumbosacral region, buttocks, and thighs * Pain is mechanical in nature-varies with physical activity and with time * Patient is well .Prognosis is good-90% of patients recover from acute attack in six weeks Characteristics of nerve root pain * Unilateral leg pain worse than back pain * Pain generally radiates to foot or toes * Numbness and paraesthesia in same distribution * Signs of nerve irritation-reduced straight leg raise which reproduces leg pain .Motor, sensory, or reflex change-limited to one nerve root * Prognosis reasonable-50% of patients recover from acute attack in six weeks Indications for emergency referral * Difficulty with micturition * Loss of anal sphincter tone or faecal incontinence * Saddle anaesthesia about anus, perineum, or genitals * Widespread (more than one nerve root) or progressive motor weakness in legs or disturbed gaitRed flags suggesting possible serious spinal pathology * Age at onset <20 or >55 * Violent trauma-such as fall from height or road traffic accident * Constant, progressive, non-mechanical pain * Thoracic pain * Past history of cancer * Use of systemic corticosteroids * Misuse of drugs, infection with HIV * Patient systemically unwell * Weight loss * Persisting severe restriction of lumbar flexion * Widespread neurological signs * Structural deformity * Prior history of low back pain * Previous time off work because of back pain * Radicular pain, possibly with reduced straight leg raise and neurological signs .Poor physical fitness .Poor general health .Smoking * Psychological distress and
"Acute" asthma in adults.
Authors: D Bellamy, J V Collins
Journal: Thorax (1979)

Forty-four adult patients with acute severe asthma were studied on admission to a general hospital to determine the mode of presentation and clinical severity of the acute illness. Most patients described poorly controlled wheezing for a mean period of five weeks before a more rapid deterioration, usually over 24 hours, caused them to seek medical attention. The clinical severity of the acute attach was not related to the duration of acute wheezing before admission to hospital. Recovery, studied in 11 of the patients, was slow, and most had reached only 70% of their predicted spirometric values after seven days9 treatment in hospital. The rate of recovery was not influenced by the antecedent history of acute wheezing. Very sudden deterioration from a background of good control appears to be uncommon in adults with asthma who present to hospital as emergencies, and it is likely that improvement in the standard of routine management of asthmatics at home would prevent many such admissions.
REPORT OF TWO CASES OF CATHETERS, BROKEN OFF IN THE PROSTATIC PORTION OF THE URETHRA, REMOVED BY THE USE OF A NEW INSTRUMENT.
Authors: ABNER HARD
Journal: JAMA (1883)

In the winter or spring of 1881 a Norwegian between 60 and 70 years of age, who had been in the habit of using a catheter in consequence of enlarged prostrate gland, was brought to my office, having broken the catheter in the prostatic portion of the urethra. I could not feel the catheter by external manipulation, but by passing a sound into the urethra, I discovered the end of the broken catheter in the position indicated. The catheter was what is known as a gum, or soft catheter, No. 7. Not having seen or known of such an occurrence, I confess I was at a loss as to what course to pursue. There was danger of pushing the fragment into the bladder, and I possessed no instrument constructed to meet such an emergency. It is said “necessity is the mother of invention,” and calling upon my inventive powers, I
Colon cancer progression is driven by APEX1-mediated upregulation of Jagged
Authors: Mi-Hwa Kim, Hong-Beum Kim, Sang Pil Yoon, Sung-Chul Lim, Man Jin Cha, Young Jin Jeon, Sang Gon Park, In-Youb Chang, Ho Jin You
Journal: Journal of Clinical Investigation (2013)

Aberrant expression of apurinic-apyrimidinic endonuclease–1 (APEX1) has been reported in numerous human solid tumors and is positively correlated with cancer progression; however, the role of APEX1 in tumor progression is poorly defined. Here, we show that APEX1 contributes to aggressive colon cancer behavior and functions as an upstream activator in the Jagged1/Notch signaling pathway. APEX1 overexpression or knockdown in human colon cancer cell lines induced profound changes in malignant properties such as cell proliferation, anchorage-independent growth, migration, invasion, and angiogenesis in vitro and in tumor formation and metastasis in mouse xenograft models. These oncogenic effects of APEX1 were mediated by the upregulation of Jagged1, a major Notch ligand. Furthermore, APEX1 expression was associated with Jagged1 in various colon cancer cell lines and in tissues from colon cancer patients. This finding identifies APEX1 as a positive regulator of Jagged1/Notch activity and suggests that it is a potential therapeutic target in colon cancers that exhibit high levels of Jagged1/Notch signaling.
Decrease of Foxp3+ Treg Cell Number and Acquisition of Effector Cell Phenotype during Lethal Infection
Authors: Guillaume Oldenhove, Nicolas Bouladoux, Elizabeth A. Wohlfert, Jason A. Hall, David Chou, Liliane Dos santos, Shaun O'Brien, Rebecca Blank, Erika Lamb, Sundar Natarajan, Robin Kastenmayer, Christopher Hunter, Michael E. Grigg, Yasmine Belkaid
Journal: Immunity (2009)
Thoracic-Disk Protrusions
Authors: J. Grafton Love
Journal: JAMA (1965)

Sixty-one cases of surgically verified thoracic-disk protrusions (0.5% incidence) revealed that this condition affected both sexes equally, and that it was most common in patients in the fourth to sixth decade and at the lower four thoracic interspaces. The most common symptoms were pain, motor weakness, numbness, and visceral disturbances. Physical examination often revealed sensory loss, spastic paraparesis, hyperreflexia, and Babinski reflexes. Myelography was the most useful diagnostic aid, giving positive results for an intraspinal mass in 49 of 50 patients. The diagnosis is difficult to make clinically because thoracic-disk protrusion mimics many diseases. The surgical procedure most frequently used was complete laminectomy, and when possible the disk was removed extradurally. Postoperative results in patients with minimal neurological deficit have been gratifying, but in those with severe deficits they have been rather discouraging.
Activation of the Raf-1/MEK/ERK cascade by bile acids occurs via the epidermal growth factor receptor in primary rat hepatocytes
Authors: Yi-Ping Rao, Elaine J. Studer, Todd R. Stravitz, Seema Gupta, Liang Qiao, Paul Dent, Phillip B. Hylemon
Journal: Hepatology (2002)

Bile acids have been reported to activate several different cell signaling cascades in rat hepatocytes. However, the mechanism(s) of activation of these pathways have not been determined. This study aims to determine which bile acids activate the Raf-1/MEK/ERK cascade and the mechanism of activation of this pathway. Taurodeoxycholic acid (TDCA) stimulated (+235%) the phosphorylation of p 74 Raf-1 in a time (5 to 20 minutes) and concentration-dependent (10 to 100 μmol/L) manner. Raf-1 and ERK activities were both significantly increased by most bile acids tested. Deoxycholic acid (DCA) was the best activator of ERK (3.6-fold). A dominant negative Ras (N17) construct expressed in primary hepatocytes prevented the activation of ERK by DCA. The epidermal growth factor receptor (EGFR)-specific inhibitor (AG1478) significantly inhibited (˜81%) the activation of ERK by DCA. DCA rapidly (30 to 60 seconds) increased phosphorylation of the EGFR (˜2-fold) and Shc (˜4-fold). A dominant negative mutant of the EGFR (CD533) blocked the ability of DCA to activate ERK. In conclusion, these results show that DCA activates the Raf-1/MEK/ERK signaling cascade in primary hepatocytes primarily via an EGFR/Ras-dependent mechanism.
The Future of Medical Care-Reply
Authors: James S. Todd
Journal: JAMA (1991)

<h3>In Reply.</h3> —I appreciate the opportunity to comment on the letter from Dr Manthous suggesting that the "AMA's recommendations for dealing with the crisis of the medically uninsured fail to address many central health issues that will face our society in the next century." Not surprisingly, I disagree. Here's why. The AMA's proposal for system reform, Health Access America, is the most comprehensive proposal advanced to date. Among its 16 points, it provides for Medicaid reform, required employer insurance, Medicare reform, professional liability reform, repeal of mandated benefits, reduction of hassle factors, the implementation of professionally developed practice parameters and insurance underwriting reforms. Health Access America makes no attempt to blame anybody for past system failures. Rather, it starts with the system's strengths and works to aggressively attack the system's weaknesses. Manthous complains that we in the medical profession have "failed to police ourselves so the government has had to
A rare cause of ascites
Authors: M. Afzal, P. Neild
Journal: Gut (2010)

A 33-year-old man presented with a 2-week history of abdominal pain, vomiting and weight loss. There was no history of fever, diarrhoea or travel. In his medical history, he had had end-stage renal failure secondary to malignant hypertension and had been on peritoneal dialysis for 8 years before having a cadaveric renal transplant in 2008. He was taking tacrolimus and prednisolone since his renal transplant. 

On examination he was afebrile, but tachycardic with a heart rate of 110 per minute and blood pressure of 90/70 mm Hg. Abdominal examination revealed normal bowel sounds and moderate ascites. A diagnostic tap of ascites …
Two antithrombin mutations in a compound heterozygote: Met20Thr and Tyr166Cys
Authors: D. J. Perry, M. E. Daly, B. T. Colvin, K. Brown, R. W. Carrell
Journal: American Journal of Hematology (1995)

Abstract The molecular basis for a family with Type I antithrombin deficiency has been established. Amplification and sequencing of the antithrombin gene identified two mutations: Met20Thr (2523T°C) within exon 2 and Tyr166Cys (5493A→G) within exon 3a. Further analysis indicated that the propositus was a compound heterozygote but in addition provided evidence for phase disruption during the amplification and/or cloning procedure. The Met20Thr mutation appears to be a neutral mutation with no functional consequences. In contrast, the Tyr166Cys mutation is associated with a Type I phenotype.
Cutaneous Anthrax Infection
Authors: K J Roche, M W Chang, H Lazarus
Journal: New England Journal of Medicine (2001)

Figure 1. A seven-month-old male infant was hospitalized with a two-day history of swelling of the left arm and a weeping lesion at the left elbow (Panel A). The patient was afebrile but had a 2-cm open sore, with surrounding erythema and induration, that oozed clear yellow fluid. There was nontender swelling and erythema of the entire arm. The white-cell count was 28,100 per cubic millimeter. Incision and drainage of the lesion produced 10 ml of dark red fluid. A coronal, T1-weighted sequence from a magnetic resonance imaging study (Panel B) demonstrated diffuse, severe edema of the subcutaneous tissues extending . . .
Chronic osteomyelitis due to Clostridium difficile.
Authors: T V Riley, K T Karthigasu
Journal: BMJ (1982)

Osteomyelitis caused by anaerobic bacteria is rarely reported, and a case of chronic osteomyelitis of the femur may be the first in which Clostridium difficile was the causative agent. The organism was isolated over several months and, although initially sensitive to penicillin, it developed resistance during this time. The organism9s repeated isolation may have been due to the presence of resistant spores. Although the patient had no gastrointestinal symptoms the source of the organism was probably the patient9s own gastrointestinal tract. Infection from the environment cannot, however, be excluded. Treatment was finally successful with metronidazole.
Bone Composition in Senile Osteoporosis
Authors: James B. Wray, Edward D. Sugarman, A. J. Schneider
Journal: JAMA (1963)

FOR YEARS, OSTEOPOROSIS has been widely assumed to result from a deficiency in matrix formation with a proportionate reduction in mineral. More recently, Nordin has challenged the theory of matrix deficiency as the primary cause of osteoporosis. He suggests that osteoporosis may be due to prolonged dietary deficiency of calcium, with a resultant decrease in bone formation. Most of the work leading to these conflicting postulates has been based upon metabolic and balance studies, and has not included determinations of bone composition. The gross composition of bone may be described in terms of three major components: mineral, organic material, and water. Whereas the composition of normal bone in these terms seems well established, the authors have found very limited information in the literature pertaining to bone composition in osteoporosis. The only study that we have found relevant to the gross composition of osteoporotic bone, presumably dealt with mild cases
Data on the Cause of Leukemia
Authors: Dane R. Boggs
Journal: New England Journal of Medicine (1971)

The paper by Greenberg et al. in this issue of the Journal contributes data to a long standing, but until recently dataless, controversy: whether leukemia is due to a mutation in a single cell resulting in the re-population of the hematopoietic system by progeny of this "bad seed" (clonal theory), or whether the evident cellular abnormality in many leukemias is due to external and potentially reversible influences on hematopoietic cells (externalinfluence theory). The time-honored example given in support of external influences is the finding of morphologically and functionally abnormal cells in pernicious anemia, a disease that some investigators once considered . . .
Misoprostol and Nonsteroidal Anti-Inflammatory Drugs
Authors: Michael R. Bubb
Journal: Annals of Internal Medicine (1996)

Letters1 June 1996Misoprostol and Nonsteroidal Anti-Inflammatory DrugsMichael R. Bubb, MDMichael R. Bubb, MDUniversity of Florida; Gainesville, FL 32610Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-11-199606010-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent editorial by Levine [1] implies that the use of misoprostol in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis is justified only if the dollar value accrued by preventing hospitalizations due to serious gastrointestinal complications exceeds the costs of the medication for the entire population at risk. This “rudimentary” cost-effectiveness analysis does not reflect other potential benefits of misoprostol therapy, such as the prevention of death in patients with serious bleeding, the avoidance of a medical work-up for patients with gastrointestinal symptoms but no serious complications, and the avoidance of gastrointestinal symptoms ...References1. Levine JS. Misoprostol and nonsteroidal anti-inflammatory drugs: a tale of effects, outcomes, and costs [Editorial]. Ann Intern Med. 1995; 123:309-10. Google Scholar2. Silverstein FE, Graham DY, Senior JR, Davies HW, Struthers BJ, Bittman RM, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995; 123:241-9. Google Scholar Author, Article, and Disclosure InformationAuthors: Michael R. Bubb, MDAffiliations: University of Florida; Gainesville, FL 32610 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 June 1996Volume 124, Issue 11Page: 1015KeywordsDrugsHemorrhageHospitalizationsNSAIDsRheumatoid arthritis ePublished: 15 August 2000 Issue Published: 1 June 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Confidence of NHS finance directors to meet targets has plummeted
Authors: G. Iacobucci
Journal: BMJ (2013)

NHS finance directors are losing faith in their ability to deliver against financial efficiency targets, with confidence plummeting in the past 12 months, says the latest Quarterly Monitoring Report from the health think tank the King’s Fund.1

Just a third (33%) of NHS trust finance directors surveyed for the report were confident about achieving their cost improvement plans for 2013-14, down from almost three quarters (73%) surveyed in the same period last year. …
Urticaria-like lesions associated with systemic lupus erythematosus: response to dapsone
Authors: C.N.A. MATTHEWS, E.M. SAIHAN, R.P. WARIN
Journal: British Journal of Dermatology (1978)

A case of systemic lupus erythematosus is reported, presenting with urticaria‐like lesions and complement deficiencies, which was completely controlled by dapsone.
Government strategy on HIV and AIDS in developing countries lacks detail, say MPs
Authors: O. Mashta
Journal: BMJ (2008)

A committee of MPs has criticised a £6bn (€7.1bn; $8.9bn) UK strategy on tackling HIV and AIDS in developing countries for failing to provide details of how it will work in practice to achieve its goals.

The House of Commons International Development Committee said in a new report that the plan was “strong on rhetoric” but lacked vital information on how the effects of what it did would be measured. The government has pledged the money over seven years to achieve universal access to prevention and treatment of HIV by 2010.

The strategy was published …
Munchausen's Syndrome
Authors: John S. Chapman
Journal: JAMA (1963)

To the Editor:—  Since the peregrinating problem patient with Munchausen's syndrome was described in the Oct. 26, 1957, issue ofThe Journal, I have received additional information about his activities. At the time the article was published, the patient was at Johns Hopkins Hospital receiving an intravenous heparin drip for presumed pulmonary infarction. The patient was being considered for inferior vena cava ligation and the patient did not indicate that he had already had this procedure. The bilateral thrombophlebitis was present as usual and his behavior was as dramatic at Johns Hopkins as it had been in the numerous hospitals described in the article. The man was recognized by a medical student who had read the article inThe Journal. Transfer to the Maryland State Mental Hospital was arranged, but the patient was discharged from that institution. He hitchhiked west but was recognized in South Bend, Ind.; Minneapolis; Rochester, Minn.;
Lansley fails to see impact and damage of his reforms
Authors: N. Mann
Journal: BMJ (2012)

Andrew Lansley seems to recognise neither the impact his pre-legislation reforms are already having on NHS service provision nor the further damage that the proposed legislation will cause.1

His unchanging rhetoric—“free at the point of use, and based on need and not ability to pay”—is already proved to be wrong. Foundation trusts have already introduced charges for standard operations formerly carried out for no charge. No doubt, more will follow. We have …