tbuckley/cabot-search huggingface dataset:
Too little compassion in health care?
Authors: P. Hadridge
Journal: Journal of the Royal Society of Medicine (2006)

I have been visiting one of England's major teaching hospitals a couple of times every week for most of this year. My father in law is a ‘frequent flier’ with heart failure and various comorbidities. Seeing the NHS through the lens of his care is sobering. The NHS's addiction to structural change as a way of sorting things out seems unlikely to shift his shoddy support. This obsession with moving the resources around seems to know no bounds and yet is useless for him.

In the media we see continued coverage about sacking unaffordable staff this year and senior NHS and DoH leaders encouraging the closure of hospitals in the tail end of this decade. Others offer rationing services and big projects (like the national IT programme) as the only routes to sustainability. From my experience these are pretty irrelevant—what is really needed is a fundamental shift in how people relate to each other: staff to staff, patients to staff. And this is measured in the small things: the nurse who phones social services (again) to try to get a completed and accurate assessment—not the nurse who refused to go to the hospital shop to buy the barriernursed patient a bottle of orange squash.

If everyone who works in NHS did one extra act of kindness a day (the GP on a home visit who boils that egg for a housebound patient, the consultant who buys a phone card for a bed-bound patient and helps them to use it) and took one extra step to make things join up better for a patient (the SHO who phones the GP, the ward clerk who talks to the X-ray department, the sister who phones the relatives to brief them on a change in regime), the whole system would take a massive step forward in terms of service and smoothness, and would seem simpler to patients and more satisfying for staff. Once the NHS shifts out of its chaotic turbulence it is possible to try other improvements. Structural change is a side alley en route to giving patients and carers greater and greater value from the skills of staff. Process improvements with IT are only part of the answer. Changing the way that compassion is shown, kindness demonstrated, conflict is handled and decisions managed would be totally transforming. Starting with the little things is critical. It doesn't need a government policy or mandate from the top. This is a strategy that everyone can create—and all can implement.
Localized Non–Small Cell Lung Cancer: Adjuvant Radiotherapy in the Era of Effective Systemic Therapy
Authors: Jeffrey A. Bogart, Jesse N. Aronowitz
Journal: Clinical Cancer Research (2005)

Investigators in Europe, Canada, and the United States recently established a definitive role for adjuvant systemic chemotherapy following resection of early-stage non-small cell lung cancer (NSCLC). This was no small accomplishment, as upward of 20 randomized trials had previously been conducted. The role of postoperative radiotherapy (PORT) has been studied with far less vigor in the modern era. A 1998 meta-analysis of randomized trials suggesting that PORT was detrimental to survival included studies of doubtful quality. The value of PORT should be considered in the same context as recent chemotherapy trials. Advances in imaging have improved the accuracy of staging, patient selection, and target definition. Modern dosimetry and accelerator technologies have advanced the capacity to deliver radiation to the target with less tissue toxicity. Evolving philosophies in dosing and fractionation should improve the therapeutic ratio. Finally, it is reasonable to assume that the importance of local control will be enhanced in the setting of better systemic therapies. We will review the data on PORT and address critical issues in the design of trials to assess the role of modern radiotherapy in the integrated approach to management of early-stage NSCLC.
Interpreting raised serum ferritin levels
Authors: Marianna Koperdanova, Jonathan O Cullis
Journal: BMJ (2015)

#### The bottom line

A 60 year old businessman attended his general practitioner after an insurance medical examination at which abnormal liver function tests had been noted (alanine aminotransferase 70 IU/L (normal range 10-40 IU/L) and γ-glutamyltransferase 120 IU/L (normal range 0-37 IU/L)). He was otherwise fit and well and not taking regular medication. His general practitioner noted that his full blood count and renal function were normal, and requested hepatitis B and C serology (which were negative) and serum ferritin level, which was 567 µg/L (normal range 24-300 µg/L).

Ferritin is an intracellular iron storage protein and a marker of iron stores. Normal serum ferritin levels vary between laboratories but generally concentrations >300 µg/L in men and postmenopausal women and >200 µg/L in premenopausal women are regarded as elevated.1 Low ferritin values provide absolute evidence of iron deficiency.2 Raised levels often indicate iron overload, but they are not specific, as ferritin is an acute phase protein and is also released from damaged hepatocytes; thus levels are elevated in inflammatory disorders, liver disease, alcohol excess, or malignancy.3 4 Raised ferritin levels therefore require further investigation in primary care to determine if they truly represent iron overload. It is critical …
Developing obstructive change over time is dominant in small airways in severe asthma
Authors: Kazuto Matsunaga, Keiichiro Akamatsu, Masakazu Ichinose
Journal: European Respiratory Journal (2012)

Background:  The clinical features, physiology, and pathology of severe asthma are poorly understood. Recently, the forced vital capacity (FVC) has been shown to be reduced in severe asthma compared to mild asthma, possibly due to air trapping. However, the natural history of airway obstructive change for such asthmatic patients has not been fully elucidated.  Objective:  To assess the pattern and risk factors of developing airway obstruction over time in severe asthma.  Methods:  We examined the data of a retrospective analysis of lung function changes over a 10-year period in 54 patients with severe asthma. The risk factors that might contribute to the progression of obstructive changes were also investigated.  Results:  The rate of change in both FVC and FEV1 (forced expiratory volume in one second) was highly variable among the patients with severe asthma. The faster obstructive changes detected by decline in FEV1 were accompanied by excessive loss of FVC (r = 0.85, p  Conclusions:  These data indicate that the decline in FVC is more evident than FEV1 in severe asthma, suggesting that small airway susceptibility may be the cause of rapid disease progression. Aging, exacerbations of asthma, and use of systemic corticosteroids are associated with excess FVC decline, particularly if FVC is still normal.
The prognostic impact of variant histology in nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG)
Authors: Sylvia Hartmann, Dennis A. Eichenauer, Annette Plütschow, Anja Mottok, Roshanak Bob, Karoline Koch, Heinz-Wolfram Bernd, Sergio Cogliatti, Michael Hummel, Alfred C. Feller, German Ott, Peter Möller, Andreas Rosenwald, Harald Stein, Martin-Leo Hansmann, Andreas Engert, Wolfram Klapper
Journal: Blood (2013)
Innovations in Serum and Urine Markers in Prostate Cancer
Authors: M.P.M.Q. van Gils, U.H. Stenman, J.A. Schalken, F.H. Schröder, T.M. Luider, H. Lilja, A. Bjartell, F.C. Hamdy, K.S.I. Pettersson, R. Bischoff, H. Takalo, O. Nilsson, P.F.A. Mulders, C.H. Bangma
Journal: European Urology (2005)
Influence of the fast-acting inhibitor of plasminogen activator on in vivo thrombolysis induced by tissue-type plasminogen activator in rabbits. Interference of tissue-derived components.
Authors: M Colucci, J A Paramo, J M Stassen, D Collen
Journal: Journal of Clinical Investigation (1986)

The influence of endotoxin-induced elevated plasma levels of the fast-acting inhibitor of plasminogen activator (PA-inhibitor) on thrombolysis was investigated in rabbits with a jugular vein thrombus. Infusion of human tissue-type plasminogen activator (t-PA) produced similar degrees of thrombolysis in control and endotoxin-treated rabbits, although no free t-PA could be demonstrated in plasma of endotoxin-treated animals. Infusion of t-PA in an extracorporeal arteriovenous shunt resulted in loss of thrombolytic activity in endotoxin-treated animals but not in control animals. Blood clots superfused in vitro with mixtures of t-PA and normal plasma lysed in contrast to clots superfused with t-PA and PA-inhibitor-rich plasma. However, addition of rabbit lung slices to the plasma surrounding the blood clot, reversed the inhibition of thrombolysis by PA-inhibitor-rich plasma. This indicates that tissue-derived factor(s) are involved in the regulation of in vivo thrombolysis. These hypothetical factor(s) are, however, very unstable in plasma, which has thus far precluded their further characterization.
Cannabinoids for Medical Use
Authors: Penny F. Whiting, Robert F. Wolff, Sohan Deshpande, Marcello Di Nisio, Steven Duffy, Adrian V. Hernandez, J. Christiaan Keurentjes, Shona Lang, Kate Misso, Steve Ryder, Simone Schmidlkofer, Marie Westwood, Jos Kleijnen
Journal: JAMA (2015)

<h3>Importance</h3> Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. <h3>Objective</h3> To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. <h3>Data Sources</h3> Twenty-eight databases from inception to April 2015. <h3>Study Selection</h3> Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. <h3>Data Extraction and Synthesis</h3> Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. <h3>Main Outcomes and Measures</h3> Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. <h3>Results</h3> A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.12 [95% CI, −0.24 to 0.01]; 5 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. <h3>Conclusions and Relevance</h3> There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.
Injuries to Hip Joint in Car Occupants
Authors: E. Grattan, J. A. Hobbs
Journal: BMJ (1969)

Four varieties of fracture, of dislocation, or of fracture dislocation of the hip are described that occur in car occupants after road accidents. It is suggested that, whereas most hip injuries to car occupants are produced by application of force to the knee, one important variety (central fracture dislocation) is the result of the direct application of force to the great trochanter. Central fracture dislocations might be prevented, or their severity minimized, by strengthening the sides of cars and of car doors and by improving the energy absorption characteristics of the facia panel.
Celecoxib But Not Rofecoxib Inhibits the Growth of Transformed Cells <b> <i>in Vitro</i> </b>
Authors: Diana Kazanov, Hadas Dvory-Sobol, Marjorie Pick, Eliezer Liberman, Ludmila Strier, Efrat Choen-Noyman, Varda Deutsch, Talya Kunik, Nadir Arber
Journal: Clinical Cancer Research (2004)

Nonsteroidal anti-inflammatory drugs reduce the risk of colorectal cancer. The cyclooxygenase (COX) pathway of arachidonic acid metabolism is an important target for nonsteroidal anti-inflammatory drugs. Increased expression of COX-2 was recently shown to be an important step in the multistep process of colorectal cancer carcinogenesis. The new COX-2-specific inhibitors offer the benefit of cancer protection without the gastrointestinal toxicity reported for the old drugs. The purpose of this study was to compare the growth effects of two specific COX-2 inhibitors, celecoxib (Pfizer, Inc., New York, NY), and rofecoxib (Merck, White House Station, NJ) in normal and transformed enterocytes.Cultures of normal rat intestinal epithelial cell line, IEC-18, vector control cells, c-K-ras, c-K-ras-bak, and antisense-bak derivatives were treated with different dosages of celecoxib (0-60 micro M) and rofecoxib (0-20 micro M). Cell cycle analysis and apoptosis were assessed by fluorescence-activated cell sorting analysis. Protein expression was assessed by Western blot analysis and caspases 3 and 8 activities by ELISA.Celecoxib inhibited cell growth and induced apoptosis in a time- and dose-dependent manner. IEC18 parental cells were two to four times more resistant to celecoxib than ras, ras-bak, and antisense bak transformed cells that overexpress the COX-2 protein. The induction of apoptosis by celecoxib involved the caspase pathways. Rofecoxib, up to its maximal concentration of 20 micro M, did not inhibit cell growth or induce apoptosis.Celecoxib may prove to be a very efficient component in the prevention and treatment of gastrointestinal tumors because it inhibits the growth of cancerous cells without affecting the growth of normal cells.
The natural history of chronic obstructive pulmonary disease
Authors: D. M. Mannino, G. Watt, D. Hole, C. Gillis, C. Hart, A. McConnachie, G. Davey Smith, M. Upton, V. Hawthorne, D. D. Sin, S. F. P. Man, S. Van Eeden, D. W. Mapel, J. Vestbo
Journal: European Respiratory Journal (2006)

This paper explores the natural history of chronic obstructive pulmonary disease (COPD), including our present understanding of COPD risk factors, phenotypes, and burden, along with COPD progression, including the traditional 'accelerated lung function decline' paradigm, to newer paradigms that include other factors. Questions remain unanswered, and there is considerable room for improvement. One of those questions is how the disease should best be defined. While this question has generated lively debate in the literature, it may not be the most important area with regard to advancing our understanding of the disease. The different phenotypes of COPD, particularly with regard to differential interventions and outcomes, is an area that should receive much more attention. Finally, a more holistic view of what comprises COPD progression, looking well beyond the traditional lung function decline paradigm, may also provide additional insights in how to better care for our patients.
IL-13 alters mucociliary differentiation and ciliary beating of human respiratory epithelial cells
Authors: Jamila Laoukili, Eric Perret, Tom Willems, Adrian Minty, Eef Parthoens, Odile Houcine, Andre Coste, Mark Jorissen, Francelyne Marano, Daniel Caput, Frédéric Tournier
Journal: Journal of Clinical Investigation (2001)

In animal models of asthma, interleukin-13 (IL-13) induces goblet cell metaplasia, eosinophil infiltration of the bronchial mucosa, and bronchial hyperreactivity, but the basis of its effects on airway epithelia remain unknown. Lesions of the epithelial barrier, frequently observed in asthma and other chronic lung inflammatory diseases, are repaired through proliferation, migration, and differentiation of epithelial cells. An inflammatory process may then, therefore, influence epithelial regeneration. We have thus investigated the effect of IL-13 on mucociliary differentiation of human nasal epithelial cells in primary culture. We show that IL-13 alters ciliated cell differentiation and increases the proportion of secretory cells. IL-13 downregulates the actin-binding protein ezrin and other cytoskeletal components. IL-13 also impairs lateral cell contacts and interferes with the apical localization of ezrin seen in differentiated ciliated cells. In addition, an IL-4 antagonistic mutant protein (Y124D), which binds to the IL-4 receptor α subunit, a common chain of IL-4 and IL-13 receptors, inhibits IL-13's effects. IL-13 also decreases ciliary beat frequency in a time- and dose-dependent manner. These results suggest that, in human allergic asthmatic responses, IL-13 affects both ciliated and secretory cell differentiation, leading to airway damage and obstruction.
Significant reduction in end‐stage liver diseases burden through the national viral hepatitis therapy program in Taiwan
Authors: Chun‐Ju Chiang, Ya‐Wen Yang, Jin‐De Chen, San‐Lin You, Hwai‐I Yang, Mei‐Hsuan Lee, Mei‐Shu Lai, Chien‐Jen Chen
Journal: Hepatology (2014)

A national viral hepatitis therapy program was launched in Taiwan in October 2003. This study aimed to assess the impact of the program on reduction of end‐stage liver disease (ESLD) burden. Profiles of national registries of households, cancers, and death certificates were used to derive incidence and mortality of ESLDs from 2000 to 2011. Age‐gender–adjusted incidence and mortality rates of hepatocellular carcinoma (HCC) and chronic liver diseases (CLDs) and cirrhosis of adults ages 30‐69 years were compared before and after launching the program using Poisson's regression models. A total of 157,570 and 61,823 patients (15%‐25% of those eligible for reimbursed treatment) received therapy for chronic hepatitis B and C, respectively, by 2011. There were 42,526 CLDs and cirrhosis deaths, 47,392 HCC deaths, and 74,832 incident HCC cases occurred in 140,814,448 person‐years from 2000 to 2011. Male gender and elder age were associated with a significantly increased risk of CLDs and cirrhosis and HCC. Mortality and incidence rates of ESLDs decreased continuously from 2000 to 2003 (before therapy program) through 2004‐2007 to 2008‐2011 in all age and gender groups. The age‐gender–adjusted rate ratio (95% confidence interval; P value) in 2008‐2011 was 0.78 (0.76‐0.80; P &lt; 0.001) for CLDs and cirrhosis mortality, 0.76 (0.75‐0.78; P &lt; 0.005) for HCC mortality, and 0.86 (0.85‐0.88; P &lt; 0.005) for HCC incidence using 2000‐2003 as the reference period (rate ratio = 1.0). Conclusions : The national viral hepatitis therapy program has significantly reduced the mortality of CLDs and cirrhosis and incidence and mortality of HCC. (H epatology 2015;61:1154–1162)
Obesity and adiposity are associated with the rate of patella cartilage volume loss over 2 years in adults without knee osteoarthritis
Authors: A J Teichtahl, A E Wluka, Y Wang, F Hanna, D R English, G G Giles, F M Cicuttini
Journal: Annals of the Rheumatic Diseases (2008)

The aim of this study was to determine whether measures of obesity and adiposity are associated with the rate of patella cartilage volume loss in healthy adults.297 community-based adults aged 50-79 years with no clinical knee osteoarthritis were recruited at baseline (2003-4). 271 (62% female) subjects were re-examined at follow-up (2006-7). Measures of obesity (body mass index (BMI) and weight) and adiposity (fat mass and percentage fat mass), as well as patella cartilage volume, were determined by established protocols.Patella cartilage volume was lost at an annual rate of 1.8% (95% CI 1.4% to 2.1%). Increased baseline BMI, weight, fat mass and percentage fat mass were all associated with an increased rate of patella cartilage volume loss after adjustment for confounders (all p< or =0.04). The direction and magnitude of the effects were similar for both sexes but the number of men examined was considerably smaller and the associations were not statistically significant. There were no significant associations observed between change in any of the obesity and adiposity measures and the rate of patella cartilage volume loss.This study demonstrated that increased levels of obesity and adiposity are associated with an increased annual rate of patella cartilage volume loss in healthy adults. Weight-loss interventions that reduce body mass, or specifically target a reduction in fat mass, may help to reduce the rate at which patella cartilage volume is lost, and subsequently the risk of patellofemoral osteoarthritis.
Medical ethics: four principles plus attention to scope
Authors: R Gillon
Journal: BMJ (1994)

The "four principles plus scope" approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments--respect for autonomy, beneficence, nonmaleficence, and justice--plus concern for their scope of application. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work.
Sleep/Wake Patterns of Individuals With Advanced Cancer Measured by Ambulatory Polysomnography
Authors: Kathy P. Parker, Donald L. Bliwise, Maria Ribeiro, Sanjay R. Jain, Catherine I. Vena, Mary Kay Kohles-Baker, Andre Rogatko, Zhiheng Xu, Wayne B. Harris
Journal: Journal of Clinical Oncology (2008)

Sleep/wake disturbances are prevalent in patients with advanced cancer, but 24-hour polysomnography (PSG) examinations of these patterns have not been undertaken. The purpose of this study was to describe these sleep/wake patterns using continuous PSG and to explore relationships with selected demographic and clinical variables.The sample included patients with advanced cancer (solid tumors); those with neurologic disorders or psychosis, substance abuse, or brain metastasis were excluded. The final sample included 114 participants with a mean age of 51.1 years (+/- 9.1 years). Participants underwent continuous, ambulatory PSG for 42 hours in their home environments. Standard PSG measures were calculated. Analysis included data from 2 nights and the intervening day. Descriptive statistics were used to summarize sleep/wake parameters of the average of the 2 nights and the intervening day. Nonparametric analyses were used to detect differences and relationships among the variables.Compared with normative data, participants had reduced quantity and quality of nocturnal sleep and episodes of sleep scattered throughout the day. Increased daytime sleep was negatively associated with several key parameters of nocturnal sleep quantity and quality. Women, whites, and those who were married/partnered and had more education had better nocturnal sleep. Cancer type and selected medications may be risk factors for disturbed sleep and waking.Participants experienced severe difficulty with "state maintenance", or the ability to maintain both the sleep and waking states. Research designed to identify the etiology of these problems is needed to develop effective interventions.