tbuckley/cabot-search huggingface dataset:
Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research
Authors: Mary E. Johnston
Journal: Annals of Internal Medicine (1994)

Objective: To review the evidence from controlled trials of the effects of computer-based clinical decision support systems (CDSSs) on clinician performance and patient outcomes. Data Sources: The literature in the MEDLARS, EMBASE, SCISEARCH, and INSPEC databases was searched from 1974 to the present. Conference proceedings and reference lists of relevant articles were reviewed. Evaluators of CDSSs were asked to identify additional studies. Study Selection: 793 citations were examined, and 28 controlled trials that met predefined criteria were reviewed in detail. Data Extraction: Study quality was assessed, and data on setting, clinicians and patients, method of allocation, computer system, and outcomes were abstracted and verified using a structured form. Separate summaries were prepared for physician and patient outcomes. Within each of these categories, studies were classified further according to the primary purpose of the CDSS: drug dose determination, diagnosis, or quality assurance. Results: Three of 4 studies of computer-assisted dosing, 1 of 5 studies of computer-aided diagnosis, 4 of 6 studies of preventive care reminder systems, and 7 of 9 studies of computer-aided quality assurance for active medical care that assessed clinician performance showed improvements in clinician performance using a CDSS. Three of 10 studies that assessed patient outcomes reported significant improvements. Conclusions: Strong evidence suggests that some CDSSs can improve physician performance. Additional well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient outcomes.
An Electrochemically Actuated MEMS Device for Individualized Drug Delivery: an In Vitro Study
Authors: Peiyi Song, Danny Jian Hang Tng, Rui Hu, Guimiao Lin, Ellis Meng, Ken‐Tye Yong
Journal: Advanced Healthcare Materials (2013)

Individualized disease treatment is a promising branch for future medicine. In this work, we introduce an implantable microelectromechanical system (MEMS) based drug delivery device for programmable drug delivery. An in vitro study on cancer cell treatment has been conducted to demonstrate a proof-of-concept that the engineered device is suitable for individualized disease treatment. This is the first study to demonstrate that MEMS drug delivery devices can influence the outcome of cancer drug treatment through the use of individualized disease treatment regimes, where the strategy for drug dosages is tailored according to different individuals. The presented device is electrochemically actuated through a diaphragm membrane and made of polydimethylsiloxane (PDMS) for biocompatibility using simple and cost-effective microfabrication techniques. Individualized disease treatment was investigated using the in vitro programmed delivery of a chemotherapy drug, doxorubicin, to pancreatic cancer cell cultures. Cultured cell colonies of two pancreatic cancer cell lines (Panc-1 and MiaPaCa-2) were treated with three programmed schedules and monitored for 7 days. The result shows that the colony growth has been successfully inhibited for both cell lines among all the three treatment schedules. Also, the different observations between the two cell lines under different schedules reveal that MiaPaCa-2 cells are more sensitive to the drug applied. These results demonstrate that further development on the device will provide a promising novel platform for individualized disease treatment in future medicine as well as for automatic in vitro assays in drug development industry.
P18.09 * STRESS INDUCED IMMUNE DYSFUNCTION IN NEURO-ONCOLOGY CAREGIVERS
Authors: P. R. Sherwood, J. Weimer, T. Price, D. Ren, F. Lieberman, H. Donovan
Journal: Neuro-Oncology (2014)

Family caregivers are vital in the care of persons with a primary malignant brain tumor (PMBT) and also report high levels of psychological distress. The impact of psychological distress on caregivers' physical health has not been explored in neuro-oncology. The aims of the study were to determine profiles of proinflammatory cytokines (IL-6 and IL-1ra) over time in caregivers of persons with a PMBT and to identify the effect of caregivers' psychological distress on their cytokine levels. After institutional review board approval, sociodemographic data, measures of psychological distress (depressive symptoms, anxiety, caregiver burden) and blood samples were collected from 103 caregivers at baseline (time of patient diagnosis), 4, 8, and 12 months. Caregivers were >21, not a primary caregiver for anyone else, and caring for a person diagnosed with a PMBT verified via pathology (NIH R01CA117811). Plasma was batch analyzed using high sensitivity and regular ELISA. Trajectory analyses of log transformed cytokine levels were performed. Then, univariate analyses evaluated potential confounding variables; variables with p < .10 were included in model testing. Multiple logistic regression analyses used high versus low cytokine group membership as outcome variables to determine the impact of psychological distress on cytokine level. With IL-1ra, two groups of caregivers were identified (BIC= -235.28). One-third (34%) had high IL-1ra levels (M = 575.91pg/ml); two-thirds had low levels (M = 252.80pg/ml). With IL-6, two groups of caregivers were identified (BIC= -299.44); 59% had high IL-6 levels (M = 2.30pg/ml) and 41% had low levels (M = .90pg/ml). None of the groups significantly changed over time (baseline to 1 year). After controlling for confounding variables, all female caregivers and those male caregivers reporting increased anxiety were significantly (p = .02) more likely have high IL-1ra. Caregivers that reported higher levels of caregiver burden were significantly more likely to have both high IL-1ra (p = .01) and high IL-6 (p = .03) levels. Depressive symptoms did not significantly affect IL-1ra or IL-6 levels. Poor physical health in family caregivers has the potential to increase institutionalization rates for patients, affect the quality of care delivered in the home, and place a new burden on the healthcare system. These data provide support for mechanistic pathways of stress-induced immune dysfunction and are among the first of their kind to highlight the health risks for neuro-oncology family caregivers.
Measuring exposure to injury risk in schoolchildren aged 11-14
Authors: E M L Towner, S N Jarvis, S S M Walsh, A Aynsley-Green
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objective</b> : To apply a measure of exposure to injury risk for schoolchildren aged 11-14 across a population and to examine how risk factors vary with sex, age, and affluence. <b>Design</b> : Self completion questionnaire survey administered in schools in May 1990. <b>Setting</b> : 24 schools in Newcastle upon Tyne. <b>Subjects</b> : 5334 pupils aged 11-14, of whom 4637 (87%) completed the questionnaire. <b>Results</b> : Boys were exposed to greater risk than girls in journeys to places to play outdoors: they took longer trips and were more likely to ride bicycles (relative risk 5.30 (95% confidence interval 4.23 to 6.64) and less likely to travel by public transport or car. Younger pupils (aged 11-12) were less exposed to traffic during journeys to and from school: their journeys were shorter, they were less likely to walk (trip to school, relative risk 0.88 (0.83 to 0.94), and they were more likely to travel by car (trip to school, relative risk 1.33 (1.13 to 1.56)) or school bus (1.33 (1.10 to 1.62)). Poorer children were exposed to greater risk than affluent children (from families that owned a car and a telephone): they were less likely to travel to school by car (relative risk 0.26 (0.20 to 0.33)) or to be accompanied by an adult (0.39 (0.32 to 0.48)). <b>Conclusion</b> : Injury risk data can provide useful information on child injury prevention and can be used to identify priorities and target resources for injury prevention on a citywide scale or for an individual school.
Adult Identified with Congenital Central Hypoventilation Syndrome–Mutation in <i>PHOX2b</i> Gene and Late-Onset CHS
Authors: Debra E. Weese-Mayer, Elizabeth M. Berry-Kravis, Lili Zhou
Journal: American Journal of Respiratory and Critical Care Medicine (2005)

In light of our recent review of the genetic basis for congenital central hypoventilation syndrome (CCHS) (1), we bring to your attention a 35-year-old adult recently identified as having had late-onset CHS and the CCHS-mutation in PHOX2b. One year ago this patient presented with a history of snoring “for his whole life,” nocturnal gasping, and “stopping breathing and turning blue.” During polysomnography he had 46 obstructive events (38 hypopneas, 8 apneas), 16 central apneas, and an apnea–hypopnea index of 77 events/hour, with an SaO2 nadir of 65% in room air and 80% with supplemental oxygen. He temporarily responded to Bi-Pap with supplemental oxygen during sleep, but within 6 months was referred for uvulopalatopharyngoplasty. He was readmitted 48 hours after discharge with intermittent confusion, difficulty staying awake, and respiratory failure (awake arterial Pco2 of 73 mm Hg). His admission hematocrit was 73%, body temperature was 35.5 C, chest X-ray revealed cardiomegaly, and ECG revealed right axis deviation, enlargement, and hypertrophy. He required intubation and mechanical ventilation, then a tracheostomy; however, mechanical ventilation was discontinued. We were contacted by the family when an arterial blood gas assay upon awakening revealed a Pco2 of 129 mm Hg (pH 7.03). Because of his daughter’s diagnosis of late-onset CHS 3 years before, and documentation that she is heterozygous for the CCHS-related PHOX2b polyalanine expansion mutation, we conducted the same assay with the father’s DNA. Figure 1 demonstrates the identical mutation in the 4-year-old daughter and the father, as well as in the 2-yearold daughter, who also has alveolar hypoventilation (all three have a genotype of 20/25). In retrospect, we learned that the father uses Dexadrine to “stay on task,” has symptoms compatible with autonomic nervous system dysregulation (low body temperature, postural hypotension, pinpoint pupils minimally reactive to light, no shortness of breath despite markedly increased carbon dioxide levels), and has awakened with headaches and periods of disorientation for several years. On the basis of this remarkably late presentation of the alveolar hypoventilation component of CHS, we suggest that adult pulmonologists and intensivists consider the possibility of lateonset CHS, confirmable by PHOX2b assay, when caring for adults with hypercarbia of unknown etiology. From a scientific perspective, this case raises the possibility of a regulatory gene that modifies the expression or activity of PHOX2b, determining the severity of the autonomic dysregulation in late-onset CHS.
Hyperglycaemia and complications of diabetes
Authors: C. Fox, S C Darby, P H Sonksen, J. T Ireland
Journal: BMJ (1977)

dissemination of Gaussian-based "signifi- cance" tests.If or when the percentile method of expressing interindividual differences has been widely adopted, there will still remain two much more difficult problems: (a) the collection, from healthy and diseased subjects, of data that are reliable and are applicable to the particular patient under investigation; and (b) the question of where to make the cut-off points between "normal" and "abnormal"what risks of error (false-positives and false- negatives) are acceptable.For the balancing of these risks-often a different balance with respect to different disorders, different consequences of error, and even different patients -we must look to clinicians, not to biochemists or other laboratory workers, or to statisticians as such.It would be interesting if the SI units compensated somewhat for their adverse effects by promoting the use of a sensible method of expressing intermeasurement variation and by allowing us to focus attention on how to collect data and apply them to individual patients.
Decreased sickle red blood cell adhesion to laminin by hydroxyurea is associated with inhibition of Lu/BCAM protein phosphorylation
Authors: Pablo Bartolucci, Vicky Chaar, Julien Picot, Dora Bachir, Anoosha Habibi, Christine Fauroux, Frédéric Galactéros, Yves Colin, Caroline Le Van Kim, Wassim El Nemer
Journal: Blood (2010)
Sustained complete response and low complication rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis
Authors: Yun Ku Cho, Jae Kyun Kim
Journal: Hepatology (2008)

My colleagues and I read with great interest the article by Livraghi et al., where the authors stated that radiofrequency ablation (RFA) could be considered the treatment of choice for patients with a singe hepatocellular carcinoma ≤ 2 cm, even when surgical treatment is possible.1 We agree with the main conclusion of the authors. As the authors have pointed out, RFA seems to be equivalent to surgery in terms of local disease control and survival.1 In addition, RFA is generally much less invasive than surgery and is associated with a lower complication rate.2 It is no longer unusual that RFA can be the treatment of choice for patients with a single small hepatocellular carcinoma nodule. The investigators must be congratulated for their difficult work. However, we have a question concerning the statistical analysis. In the study, multivariate analysis demonstrated that the appearance of one or more new lesions was the only statistically significant factor. However, the appearance of any new lesion is a delayed phenomenon after RFA. We think that prognosis prediction based on a delayed phenomenon would be of little value in treatment planning and survival prediction at the initial stage of interventional management. We would like to know the results of multivariate analysis after exclusion of this factor. After the exclusion, other factors such as operability might become statistically significant as determined by multivariate analysis. Yun Ku Cho M.D.*, Jae Kyun Kim M.D.*, * Department of Radiology, Seoul Veterans Hospital, Seoul, Republic of Korea.
S43 Fractal analysis of whole blood incipient clot confirms an early morning prothrombotic state in patients with untreated Obstructive Sleep Apnoea Syndrome
Authors: M Wilczynska, K Lewis, M Lawrence, S Stanford, L Nicolle, PA Evans
Journal: Thorax (2012)

<h3>Introduction</h3> Obstructive sleep apnoea syndrome (OSAS) independently increases cardiovascular risk and a pro-thrombotic state has been at least partly implicated. Using fractal analysis we have developed a new biomarker called fractal dimension (<b><i>Df</i></b>) to assess the microstructure of incipient clot in whole blood. <b><i>Df</i></b> relates to the kinetics of clot formation and quantifies clot fibrin network microstructure as it forms. A higher <b><i>Df</i></b> represents a more pro-coaguable state. Healthy volunteers have a reproducible <b><i>Df</i></b> of 1.74 ±0.07. (1) <h3>Aim</h3> To see if <b><i>Df</i></b> changes after sleep in OSAS and symptomatic snorers. <h3>Methods</h3> 28 patients with newly diagnosed and untreated OSAS: 24 males, mean+SD BMI=38±7.3 kg/m2, age 56.8±10.7 years, 4% Dip-rate (DR)=47.8±32.9 events/hour, Epworth Sleepiness Score (ESS)13.1±5.0. 17 symptomatic Controls with symptoms of OSAS but who had negative sleep studies: 14 males, BMI=32.1±6.8 kg/m2, age 52.7±13.6 years, 4% DR=5.6±3.2 events/hour, ESS 11.3±6.6. We excluded anyone on warfarin, heparin or with a family history of bleeding, thromboses. 36% in the OSAS group and 24% in the Controls were prescribed aspirin but there were no changes in medications throughout the study. Blood was collected at 4pm then 8am the following morning, immediately after an inpatient limited channel overnight sleep study (Visilab, Stowood Instruments, UK). Samples were tested for fractal analysis (AR-G2 Rheometer, TA Instruments, UK) and routine APTT, PT, fibrinogen levels, platelet aggregation. NCT01525160. <h3>Results</h3> <b><i>Df</i></b> was significantly higher in the early am (post sleep) (p&lt;0.001) than in the afternoon in OSAS but there was no diurnal variation in the Control group (p= NS) Figure 1. There were no statistically significant differences for routine coagulation and platelet function tests both within and between groups. <h3>Conclusion</h3> OSAS is associated with a significantly increased prothrombotic state in the morning that is only detected by <b><i>Df</i></b>. Larger numbers will allow sub-group analyses (e.g. severity of OSAS, aspirin effects) and seeing possible response to CPAP therapy. This preliminary data suggest <b><i>Df</i></b> could be used as a new sensitive biomarker to assess vascular risk. <h3>Reference</h3> Evans PA et al. <i>Blood</i>. 2010; 116:3341–3346.
UK government hopes to introduce new "fit note" in 2009
Authors: A. McGauran
Journal: BMJ (2008)

The National COPD Audit Programme collects data on the care received by COPD patients. The programme ran an audit between February and April 2014, to capture all acute exacerbations of COPD (AECOPD). <b>Aims:</b> The prevalence/ impact of COPD have been linked to poor socioeconomic status in many countries. The audit aimed to investigate the effect of socioeconomic deprivation on clinical outcomes following hospitalisation for AECOPD. <b>Methods:</b> Patient postcodes were used to obtain deprivation indices for the area of residence at the time of admission. Records of the English audit cohort (n=12594) were linked to external sources of outcome data, including hospital admission data held by Hospital Episode Statistics, used to ascertain readmissions in the 30-90 days following the index spell, and national mortality data. <b>Results:</b> There was a clear relationship between readmission and deprivation. - 26% of patients residing in the most deprived areas (IMD quintile 1) were readmitted within 30 days for any cause, versus 21% from the least deprived areas (IMD quintile 5) [p=0.01]. A similar pattern was seen at 90 days (45% versus 39% [p=0.01]). - 13% of patients residing in the most deprived areas were readmitted within 30 days due to COPD, versus 9% from the least deprived areas [p&lt;0.001]. The relationship at 90 days was equivalent (25% versus 18% [p&lt;0.001]).&lt;br /&gt; There was no relationship between deprivation and inpatient death or 30 day mortality. <b>Conclusion:</b> Patients from deprived areas are more likely to be readmitted post AECOPD. It is unclear whether this is due to health or social care infrastructure factors.
Non-invasive screening method for simultaneous evaluation of in vivo growth factor release profiles from multiple ectopic bone tissue engineering implants
Authors: Diederik H.R. Kempen, Lichun Lu, Kelly L. Classic, Theresa E. Hefferan, Laura B. Creemers, Avudaiappan Maran, Wouter J.A. Dhert, Michael J. Yaszemski
Journal: Journal of Controlled Release (2008)
Failure of regeneration of the steatotic rat liver: disruption at two different levels in the regeneration pathway
Authors: Markus Selzner, Pierre-Alain Clavien
Journal: Hepatology (2000)

Hepatic resection or transplantation in patients with fatty liver is associated with increased morbidity and mortality. The regenerative capacity of fatty livers after major tissue loss is unknown. Interleukin 6 (IL-6) is a potent inducer of hepatic regeneration in normal and ischemic livers. Therefore, we studied hepatic regeneration at day 1, day 2, and day 4 in a model of 70% hepatectomy in obese and lean Zucker rats, and obese Zucker rats pretreated with recombinant interleukin 6 (rIL-6). The mitotic cycle in hepatocytes was investigated by 4 different markers of regeneration representing distinct phases of mitosis (proliferating cell nuclear antigen [PCNA] = G(1) phase, bromodeoxy uridine [BrdU] = S phase, mitotic index, and regenerated liver weight = M phase). Obese Zucker rats had significantly decreased regenerative capacity compared with lean Zucker rats (PCNA, BrdU, mitotic index, regenerated liver weight) at days 1 and 2 after surgery. Four days after resection fatty animals showed an increase in the mitotic index indicating a delay of regeneration in steatotic livers. Animal survival after 70% hepatectomy was significantly decreased in obese rats compared with lean animals. Pretreatment of obese animals with rIL-6 normalized PCNA expression (G(1) phase) in steatotic hepatocytes but failed to increase DNA synthesis (BrdU, S phase), mitosis (mitotic index and regenerated liver weight, M phase), and animal survival. These results indicate major impairment of hepatic regeneration in steatotic livers. Two different blockages of regeneration must be present, one rIL-6 sensitive, at the level of IL-6 or upstream, and a second, rIL-6 resistant, at the level of G(1)/S-phase transition.
Cystic Duct Reduplication
Authors: Harry Perelman
Journal: JAMA (1961)

PLINYin 31 B. C. first recorded mention of a double gallbladder in an animal sacrificed during the celebration of Augustus' victory over Antony and Cleopatra.1Boyden2and Lee3each pointed out that congenital abnormalities of the gallbladder and the biliary ducts are found much more commonly in domestic animals, notably cats and cattle, than in humans. Boyden studied the dissections of 19,000 human beings and found only five duplications. Lee stated that, with the possible exception of congenital atresia, major congenital malformations of the extra-hepatic bile system are rare in human beings. One hundred and fifty-eight cases of congenital abnormalities of the gallbladder reported in the literature were reviewed by Gross4in 1936. Flannery and Caster1reviewed the literature from 1936 to 1956 and added 101 additional cases. Skielboe5reviewed 101 cases of double gallbladder, of which only 66 were proven by operation
Does Aminophylline Benefit Adults Admitted to the Hospital for an Acute Exacerbation of Asthma?
Authors: David Huang
Journal: Annals of Internal Medicine (1993)

Objective: To determine the effect of adding intravenous theophylline (administered as aminophylline) to nebulizations of albuterol and intravenous methylprednisolone in adults hospitalized for acute asthma. Design: Randomized, placebo-controlled, double-blind study. Setting: Inpatient service of a tertiary-care, university teaching hospital. Patients: 21 adults (22 to 48 years old)10 in the aminophylline group and 11 in the placebo group. Interventions: Nebulized albuterol, 2.5 or 5.0 mg every 0.5 to 4 hours; intravenous methylprednisolone, 60 mg every 6 hours; and either individualized doses of aminophylline or placebo for 48 hours. Measurements: Forced expiratory volume in 1 second (FEV1), the number of as needed albuterol nebulizations and total dose, asthma symptom scores, and adverse effects. Results: At admission from the emergency department, the mean SD baseline FEV1 was 49% 19% of the predicted value in the aminophylline group and 43% 13% of the predicted value in the placebo group. The improvement in FEV1 at 3 hours was greater in the aminophylline group (29% 23% compared with 10% 10% in the placebo group; mean difference, 19 percentage points; 95% CI, 3 to 35 percentage points; P = 0.023). At 48 hours, FEV1 was 75% 19% of the predicted value in the aminophylline group and 58% 15% of the predicted value in the placebo group (mean difference, 17 percentage points; CI, 0.2 to 34.8 percentage points; P = 0.048). Aminophylline-treated patients required fewer nebulizations of albuterol (10.3 3.8 compared with 16.4 5.3; mean difference, 6.1;CI, 10.3 to 1.8) and less total dosage (34 16 mg compared with 70 34 mg; mean difference, 36 mg; CI, 60.6 to 11.3 mg P = 0.02). No statistical differences were observed in asthma symptom scores or frequency of adverse effects. Conclusions: Individualized doses of intravenous theophylline added to frequent nebulizations of albuterol and intravenous methylprednisolone appear to benefit adults admitted to the hospital with acute asthma and are well tolerated when serum concentrations are maintained in the therapeutic range.