tbuckley/cabot-search huggingface dataset:
Could a randomised trial answer the controversy relating to elective caesarean section? National survey of consultant obstetricians and heads of midwifery
Authors: Tina Lavender, Carol Kingdon, Anna Hart, Gill Gyte, Mark Gabbay, James P Neilson
Journal: BMJ (2005)

International concerns about rising rates of caesarean section are counterbalanced by arguments that planned caesarean section without specific clinical indication (such as breech presentation or HIV infection) falls within legitimate maternal choice. 1 Professional opinion is divided.To perform a caesarean section without clinical reason is seen as ethical, in response to maternal request, by the American College of Obstetricians and Gynecologists; is enshrined in law in Italy; but is viewed as unethical by the International Federation of Gynecology and Obstetrics.The National Institute for Health and Clinical Excellence recommends that a second opinion should be offered. 2A well designed, randomised controlled trial of planned caesarean section compared with planned vaginal birth could provide important evidence. 3
Physician Referrals in a Competitive Environment-Reply
Authors: Lawrence M. Markman
Journal: JAMA (1988)

<h3>In Reply.—</h3> Dr Barham questions our study on physician referrals for failure to "identify referrals as appropriate or necessary." Who is in a better position to decide this than the patient's family physician? We feel that well-trained and experienced family physicians practiced cost-effective case management long before the advent of managed health care plans in our community. Our study merely confirms that the restrictions and controls posed by these plans have not changed the way most of us care for our patients. We have not experienced the type of referral abuses described by Dr Barham. Undoubtedly these and other abuses do occur, and such abuses should be addressed by managed health care plans. Yet, we believe there is also a need to guard against excessive controls placed on primary care physicians by third-party medical managers in the name of cost control. Most of us are already doing a good job
Anomalies in General Practice Scheme
Authors: W. Freeland
Journal: BMJ (1965)

SIR,-The Times of 6 September had an interesting article concerning medical matters under the title " If Single-Handed Doctors Go."It was regretted that much of the personal touch will be lost.The grouping would, however, diminish the strain of unlimited liability which presses heavily on the single doctor.What other individuals or organization in the country would accept unlimited liability for service, particularly when the liability carries heavy penalties for the doctor and none for the individuals who abuse the service ?Surely this matter deserves more attention ?Could even a full-time salaried service carry the burden without restrictions on the user's side ?At present the sky is the limit.Some need aid, but that is no reason for giving it to all without restraint.There is no need, in effect, to burn the house down to get roast pig.-I am, etc.,
Methionine Loading, Vitamin B_6 Status, and Premature Thromboembolic Disease
Authors: Andrew G. Bostom
Journal: Annals of Internal Medicine (1996)

Letters1 September 1996Methionine Loading, Vitamin B6 Status, and Premature Thromboembolic DiseaseAndrew G. Bostom, MD, MSAndrew G. Bostom, MD, MSTufts New England Medical Center, Boston, MA 02111Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-5-199609010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Fermo and colleagues [1] clearly showed the importance of determining postmethionine loading (PML) levels of total homocysteine as a way to assess the risk for premature thromboembolic disease attributable to moderate hyperhomocysteinemia. Unfortunately, they did not measure plasma levels of pyridoxal 5′-phosphate (the active metabolic form of vitamin B6). Pyridoxal 5′-phosphate is the co-factor for cystathionine synthase, the key enzyme responsible for the irreversible trans-sulfuration of homocysteine. Furthermore, the presentation of the PML total homocysteine levels as absolute values (rather than as the net increase above fasting levels [2]) blurs the distinction between isolated re-methylation defects (inadequate ...References1. Fermo I, Vigano'D'Angelo S, Paroni R, Mazzola G, Calori G, D'Angelo A. Prevalence of moderate hyperhomocysteinemia in patients with early-onset venous and arterial occlusive disease. Ann Intern Med. 1995; 123:747-53. Google Scholar2. Bostom AG, Jacques PF, Nadeau MR, Williams RR, Ellison RC, Selhub J. Post-methionine load hyperhomocysteinemia in persons with normal fasting total plasma homocysteine initial results from the NHLBI Family Heart Study. Atherosclerosis. 1995; 59:1033-9. Google Scholar3. Selhub J, Miler JW. The pathogenesis of homocysteinemia: interruption of the coordinate regulation by S-adenosylmethionine of the remethylation and transsulfuration of homocysteine. Am J Clin Nutr. 1992; 55:131-8. Google Scholar4. Miller JW, Nadeau MR, Smith D, Selhub J. Vitamin B6 deficiency vs. folate deficiency: comparison of responses to methionine loading in rats. Am J Clin Nutr. 1994; 59:1033-9. Google Scholar5. Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995; 274:1049-57. Google Scholar Author, Article, and Disclosure InformationAffiliations: Tufts New England Medical Center, Boston, MA 02111 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byVitamin B6 1 September 1996Volume 125, Issue 5Page: 419KeywordsBlood plasmaEnzymesFolic acidInborn errors of metabolismMethionineVascular diseases Issue Published: 1 September 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Private healthcare providers in India are above the law, leaving patients without protection
Authors: S. Nandraj
Journal: BMJ (2015)

Many states have not ratified or do not enforce the central Clinical Establishments (Registration and Regulation) Act 2010, leaving patients exposed to irrational and unethical practice, writes <b>Sunil Nandraj</b>. The objections of private providers and doctors’ associations don’t stand up to scrutiny
Experimental Therapy-Reply
Authors: Richard P. Bergen
Journal: JAMA (1965)

Despite a second look I am constrained to adhere to my original opinion. It is generally well settled that any departure from the standard and accepted medical procedures prevailing among the reputable members of the medical profession in the community may be legally classified as "experimental." Regardless of what term may be used, a physician who departs from such standard and accepted procedures is likely to be held liable if there is an untoward result, unless such departure is medically and legally justified. The safeguards I suggested are substantially in conformity with those that are generally recognized as necessary. By "established drug," I would understand one which is in general use by the medical profession. Certainly such a drug would have been subjected to much testing and investigation. If it is put to an entirely new use, however, its effects cannot be known. There are many drugs in common use for
Hypertension and Its Treatment
Authors: Oglesby Paul
Journal: JAMA (1983)

The topic of hypertension is one that has received an enormous amount of attention during the past 50 years. The pathology has been extensively described and investigated, and the role of the kidney, including the thousands of studies on the renin-angiotensin system, has been of continuing intense interest. The contributions of neurohumoral influences on hypertension have also been vigorously studied, and the clinical and epidemiologic features have been subject to intense scrutiny—to mention only some of the areas of concern. Great expectations for an early cure of hypertension when the Goldblatt kidney preparation (1934) and renin (1939) were first described were not realized with the passage of time. The mosaic theory of Page<sup>1</sup>emphasized the complexity of the problem and the existence and the interrelations of multiple forces leading to a common event—raised arterial BP. Forms of treatment existing in the 1930s and 1940s were not satisfactory, including the
Biomarkers in epidemiology: scientific issues and ethical implications.
Authors: P A Schulte
Journal: Environmental Health Perspectives (1992)

The current generation of biologic markers have three characteristics that differentiate them from previous ones. These include the ability to detect xenobiotics at concentrations at the cellular and molecular level, to detect earlier biologic changes presumptive of disease or disease risk, and to identify a detailed continuum of events between an exposure and resultant disease. If biomarkers are to enhance cancer epidemiology, they must be valid, reliable, and practical. When these characteristics have not been previously demonstrated, pilot studies should be conducted prior to the primary study. Interdisciplinary communication and collaboration is required so that useful markers are selected and that collection and handling, assay, and interpretation are appropriate. The status of many biomarkers is that they have been developed in the laboratory but lack validation for field use. Validation of a marker for use in a population requires attention to issues of background prevalence, sample size, natural history, persistence, variability, confounding factors, and predictive value. Additionally, practical features such as subject preparation, access to specimens, specimen storage aspects, and costs must be clarified. Ultimately, the use of biologic markers in epidemiologic studies will depend on how well the markers increase ability to reduce misclassification, provide for better interpretation of exposure-disease associations, and increase opportunities for prevention. Validation studies and general research using biomarkers also have clinical, ethical, and legal implications. These range from communicating uncertainty about the meaning of a marker to the kinds of societal response that result when groups or individuals are identified as having an "abnormal" marker frequency.
Right of disabled people to independent living are threatened by government's reforms, MPs and peers say
Authors: C. Dyer
Journal: BMJ (2012)

The rights of disabled people in the United Kingdom are threatened by a lack of domestic laws to enforce them, together with government reforms of benefits and cuts to public services, an influential committee of MPs and peers concluded this week.

The parliament’s joint committee on human rights called on the government to do more to implement the United Nations Convention on the Rights of Persons with Disabilities, which the previous Labour government ratified in April 2009.

The committee’s chairman, the Labour MP Hywel Francis, said, “We are concerned to learn that the right of disabled people to independent living may be at risk through the cumulative impact of current reforms. Even though the UK ratified the convention in 2009 with cross party support, the government is unable …
Thrombophlebitis
Authors: Janet M Torpy, Alison E Burke, Richard M Glass
Journal: JAMA (2011)

Thrombophlebitis B lood clots can form in arteries or veins.When inflammation due to a blood clot occurs in a vein, it is called thrombophlebitis.Thrombophlebitis usually occurs in the veins of the legs.Rarely, it can occur in the veins of the arms or neck.Superficial (on the surface) thrombophlebitis occurs in the visible veins just under the skin.The area of inflammation is usually reddened, tender, and warm to the touch and can be painful.The extremity may swell and fever may occur.Deep vein thrombosis (DVT) is more dangerous than superficial thrombophlebitis.Deep vein thrombosis often cannot be seen or felt by the individual.Swelling of the leg or fever may alert a person to the presence of a DVT, especially if risk factors for DVT exist.Pulmonary embolism, a condition that can be fatal, results from a DVT that becomes loose in the veins and travels to the lungs.There, it blocks proper blood flow to the lungs and decreases oxygen levels in the body.The April 6, 2011, issue of JAMA includes an article about thromboembolism (clots being carried by the bloodstream).This Patient Page is based on one previously published in the July 26, 2006, issue of JAMA.
Comparing Physicians on Efficiency
Authors: Arnold Milstein, Thomas H. Lee
Journal: New England Journal of Medicine (2007)

Over the past decade, public reporting on health care performance has become increasingly common. But whereas most reporting has concentrated on the quality of care in health maintenance organizations, hospitals, or large medical practices, health care purchasers are now focusing on identifying which individual physicians deliver good care most efficiently. The appropriate way to measure physicians' efficiency — and the proper uses for such measurements — is a matter of disagreement between those who pay for health care and those who provide it.Knowledge about physicians' efficiency could be helpful to patients who increasingly struggle to afford premiums, deductibles, and . . .
Widespread use of condoms and low prevalence of sexually transmitted diseases in Danish non-drug addicts.
Authors: H Ward, S Day, J R Harris
Journal: BMJ (1987)

Dr. Kim Krogsgaard and colleagues (December 6 p. 1473) document the  prevalence of human immunodeficiency virus (HIV) infection among a group of prostitutes studied in Copenhagen.  The study is limited because the authors investigated only those women working in massage parlors and escort agencies.  These women represent only a small number of the workplaces generally associated with prostitution.  Because sexual practices and the potential range of infection vary with the type of prostitution it would be inaccurate to draw any very general conclusions from this study.  Notably lacking are any investigations into the most common infections Chlamydia trachomatis and Neisseria gonorrhea.  Consequently it is hard to find any evidence for the conclusion that there is a low prevalence of sexually transmitted diseases in Danish nondrug addict prostitutes.  The authors conclude further that the widespread use of condoms may be responsible for the  rates of infection.  They mention that only 3 of the 101 women studied engaged in vaginal intercourse without a condom which means that all the other 98 do use condoms during intercourse.  Since this is unusually high a comment would have been expected.  Any information about condom use requires detailed prospective records because reports of 100% condom use in 1 random interview are rarely supported in records created over a number of meetings.  Finally nothing is said about prostitutes other sexual relationships.  In our own studies very few women report condom use with their nonpaying partners (unpublished data).  (authors modified)
Effects of various microbubble composition on the interactions with activated leukocytes
Authors: Hiroto Takeuchi, Koji Ohmori, Isao Kondo, Akira Oshita, Kaori Shinomiya, Kazushi Yukiiri, Yuichiro Takagi, Yang Yu, Katsufumi Mizushige, Masakazu Kohno
Journal: Journal of the American College of Cardiology (2002)
Prescribing at the hospital-general practice interface. I: Hospital outpatient dispensing policies in England.
Authors: P. Wilkie, B. Sibbald, J. Raftery, S. Anderson, P. Freeling
Journal: BMJ (1992)

OBJECTIVE--To describe the outpatient dispensing policies of major acute hospitals in England. DESIGN--Postal questionnaire survey in November 1990. SETTING--All (278) major acute hospitals in England with more than 250 beds, excluding maternity, paediatric, or psychiatric hospitals; nine hospitals declined. PARTICIPANTS--Hospital chief pharmacists. MAIN OUTCOME MEASURES--Current dispensing policy and exceptions to it; when the policy was formed; and who was involved in its formation. RESULTS--Completed questionnaires were received from 200 (72%) of the hospitals approached. The quantities of drugs dispensed to outpatients ranged from zero in 12 hospitals to unlimited amounts in nine; nearly half (92) dispensed a 14 days9 supply of drugs. The greater the restriction on outpatient dispensing, the more recently the policy had been introduced (chi 2 for trend = 7.15; df = 1; p less than 0.01). Permissible exceptions to the policy included the consultant9s specific request (134 hospitals), difficulty in obtaining drugs in the community (102), urgent need for start of treatment (49), and certain types of patients (41) or drugs or their regimens (104). Groups who were neither represented on the hospital committee concerned with policy formation nor consulted before policy changes included regional health authorities in 122 hospitals, district health authorities in 101 hospitals, and general practitioners in 32 hospitals. CONCLUSIONS--Outpatient dispensing policies varied considerably among the hospitals surveyed, but they seemed to be moving towards greater restrictions on the supply of drugs given to outpatients.
Preimplantation Diagnosis for Sonic Hedgehog Mutation Causing Familial Holoprosencephaly
Authors: Yury Verlinsky, Svetlana Rechitsky, Oleg Verlinsky, Seckin Ozen, Tatyana Sharapova, Christina Masciangelo, Randy Morris, Anver Kuliev
Journal: New England Journal of Medicine (2003)

Mutations in the sonic hedgehog gene have been linked to holoprosencephaly. Mosaicism for the sonic hedgehog mutation was identified by single-sperm testing in a man who had fathered two affected children. Genomic DNA was normal in both parents on screening. The use of preimplantation genetic diagnosis led to the birth of a healthy girl who was confirmed to be free of the sonic hedgehog mutation.
MyD88-dependent, superoxide-initiated inflammation is necessary for flow-mediated inward remodeling of conduit arteries
Authors: Paul C.Y. Tang, Lingfeng Qin, Jacek Zielonka, Jing Zhou, Catherine Matte-Martone, Sonia Bergaya, Nico van Rooijen, Warren D. Shlomchik, Wang Min, William C. Sessa, Jordan S. Pober, George Tellides
Journal: The Journal of Experimental Medicine (2008)

Vascular remodeling normalizes abnormal hemodynamic stresses through structural changes affecting vessel size and wall thickness. We investigated the role of inflammation in flow-mediated vascular remodeling using a murine model of partial outflow reduction without flow cessation or neointima formation. Common carotid arteries decreased in size after ipsilateral external carotid artery ligation in wild-type mice, but not in myeloid differentiation protein-88 (MyD88)–deficient mice. Inward remodeling was associated with MyD88-dependent and superoxide-initiated cytokine and chemokine production, as well as transient adventitial macrophage accumulation and activation. Macrophage depletion prevented flow-mediated inward vascular remodeling. Expression of MyD88 by intrinsic vascular cells was necessary for cytokine and chemokine production and changes in vessel size, whereas MyD88 expression by bone marrow–derived cells was obligatory for changes in vessel size. We conclude that there are at least two distinct roles for MyD88 in flow-mediated inward remodeling of conduit arteries. Our findings suggest that inflammation is necessary for vascular adaptation to changes in hemodynamic forces.
Hydrallazine-induced lupus erythematosus-like syndrome in a patient of the rapid acetylator phenotype.
Authors: S J Harland, V Facchini, J A Timbrell
Journal: BMJ (1980)

thereby permitting the fairly confident exclusion of hypertension as such as the precipitating factor.It was considered possible that phenobarbitone present in the serum might interfere with the laboratory procedure and result in artificially low oestriol values, but this was discounted after evidence showed that the behaviour of the assay was not appreciably affected by the in-vitro addition of phenobarbitone in amounts considerably above those reached during normal treatment.
Cultured human synovial fibroblasts rapidly metabolize kinins and neuropeptides.
Authors: J M Bathon, D Proud, S Mizutani, P E Ward
Journal: Journal of Clinical Investigation (1992)

Kinins and substance P have been implicated in the pathogenesis of inflammatory arthritis by virtue of their abilities to induce vasodilation, edema, and pain. The relative biological potencies of these peptides in vivo would depend at least in part upon their rates of catabolism in the joint. We hypothesized that human synovial lining cells may regulate intraarticular levels of kinins and neuropeptides via degradation by cell surface-associated peptidases. We exposed intact human synovial fibroblasts to kinins and substance P, in the presence or absence of specific peptidase inhibitors, and measured the amount of intact substrate remaining and degradation product(s) generated over time. Aminopeptidase M (AmM; EC 3.4.11.2), neutral endopeptidase-24.11 (NEP-24.11; EC 3.4.24.11), and dipeptidyl(amino)peptidase IV (DAP IV; EC 3.4.14.5) were identified on the cell surface of synovial cells. Bradykinin degradation was due entirely to NEP-24.11 (1.39 +/- 0.29 nmol/min per well). Lysylbradykinin was also degraded by NEP-24.11 (0.80 +/- 0.19 nmol/min per well); however, in the presence of phosphoramidon, AmM-mediated conversion to bradykinin (3.74 +/- 0.46 nmol/min per well) could be demonstrated. The combined actions of NEP-24.11 (0.93 +/- 0.15 nmol/min per well) and DAP IV (0.84 +/- 0.18 nmol/min per well) were responsible for the degradation of substance P. AmM (2.44 +/- 0.33 nmol/min per well) and NEP-24.11 (1.30 +/- 0.45 nmol/min per well) were responsible for the degradation of the opioid peptide, [Leu5]enkephalin. The identity of each of the three peptidases was confirmed via synthetic substrate hydrolysis, inhibition profile, and immunological identification. The profiles of peptidase enzymes identified in cells derived from rheumatoid and osteoarthritic joints were identical. These data demonstrate the human synovial fibroblast to be a rich source of three specific peptidases and suggest that it may play a prominent role in regulating peptide levels in the joint.
Levalbuterol toxicity: no reason to be jittery
Authors: A.K. Biswas, W.C. Fruedenthal
Journal: European Respiratory Journal (2003)

To the Editor: 

Levalbuterol, the R-isomer of racemic albuterol, is a more effective bronchodilator with fewer side-effects than racemic albuterol 1–3. We present a paediatric patient in status asthmaticus who received twelve times the prescribed dose of levalbuterol and manifested only mild systemic side-effects.

This 4-yr-old African-American male was admitted to the Pediatric Intensive Care Unit (Portsmouth, VA, USA) where continuous nebulised levalbuterol was ordered at 0.63 mg·h−1. The nebuliser chamber was erroneously filled with twelve 0.63 mg unit-dose ampoules, delivering 7.56 mg·h−1 of levalbuterol. This dosing regimen was continued for twelve hours before it was discovered.

On the morning rounds, the child was noted to be tachypneic …
Mumps of the Heart
Authors: WILLIAM C. ROBERTS, SAMUEL M. FOX
Journal: Circulation (1965)

The clinical and pathologic findings of a patient who died from diffuse myocardial disease 8 months after an attack of mumps is presented. His illness was complicated by myocarditis, meningoencephalitis, pancreatitis, and orchitis. A study of past reports discloses that electrocardiographic evidence of myocardial involvement in mumps is common, that clinical evidence of myocardial involvement is unusual, and that death from myocardial involvement is extremely rare.