tbuckley/cabot-search huggingface dataset:
Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity
Authors: Gregg C. Fonarow, Wenqin Pan, Jeffrey L. Saver, Eric E. Smith, Mathew J. Reeves, Joseph P. Broderick, Dawn O. Kleindorfer, Ralph L. Sacco, DaiWai M. Olson, Adrian F. Hernandez, Eric D. Peterson, Lee H. Schwamm
Journal: JAMA (2012)

There is increasing interest in reporting risk-standardized outcomes for Medicare beneficiaries hospitalized with acute ischemic stroke, but whether it is necessary to include adjustment for initial stroke severity has not been well studied.To evaluate the degree to which hospital outcome ratings and potential eligibility for financial incentives are altered after including initial stroke severity in a claims-based risk model for hospital 30-day mortality for acute ischemic stroke.Data were analyzed from 782 Get With The Guidelines-Stroke participating hospitals on 127,950 fee-for-service Medicare beneficiaries with ischemic stroke who had a score documented for the National Institutes of Health Stroke Scale (NIHSS, a 15-item neurological examination scale with scores from 0 to 42, with higher scores indicating more severe stroke) between April 2003 and December 2009. Performance of claims-based hospital mortality risk models with and without inclusion of NIHSS scores for 30-day mortality was evaluated and hospital rankings from both models were compared.Model discrimination, hospital 30-day mortality outcome rankings, and value-based purchasing financial incentive categories.Across the study population, the mean (SD) NIHSS score was 8.23 (8.11) (median, 5; interquartile range, 2-12). There were 18,186 deaths (14.5%) within the first 30 days, including 7430 deaths (5.8%) during the index hospitalization. The hospital mortality model with NIHSS scores had significantly better discrimination than the model without (C statistic, 0.864; 95% CI, 0.861-0.867, vs 0.772; 95% CI, 0.769-0.776; P < .001). Among hospitals ranked in the top 20% or bottom 20% of performers by the claims model without NIHSS scores, 26.3% were ranked differently by the model with NIHSS scores. Of hospitals initially classified as having "worse than expected" mortality, 57.7% were reclassified to "as expected" by the model with NIHSS scores. The net reclassification improvement (93.1%; 95% CI, 91.6%-94.6%; P < .001) and integrated discrimination improvement (15.0%; 95% CI, 14.6%-15.3%; P < .001) indexes both demonstrated significant enhancement of model performance after the addition of NIHSS. Explained variance and model calibration was also improved with the addition of NIHSS scores.Adding stroke severity as measured by the NIHSS to a hospital 30-day risk model based on claims data for Medicare beneficiaries with acute ischemic stroke was associated with considerably improved model discrimination and change in mortality performance rankings for a substantial portion of hospitals.
Isolated left ventricular non‐compaction in adults: clinical and echocardiographic features in 105 patients. Results from a French registry
Authors: Gilbert Habib, Philippe Charron, Jean‐Christophe Eicher, Roch Giorgi, Erwan Donal, Thierry Laperche, Dominique Boulmier, Cécile Pascal, Damien Logeart, Guillaume Jondeau, Alain Cohen‐Solal
Journal: European Journal of Heart Failure (2010)
<i>BRAF</i> Mutations in Erdheim-Chester Disease
Authors: Jean-François Emile, Frédéric Charlotte, Zahir Amoura, Julien Haroche
Journal: Journal of Clinical Oncology (2012)

TO THE EDITOR: Blombery et al recently published the case report of a patient with Erdheim-Chester disease (ECD). It confirms results from our series of 24 patients for whom we reported a frequency of 54% of p.V600E mutations in patients with ECD. In our article, we also showed by immunohistochemistry that the foamy histiocytes of ECD were the mutated cells. Since publication of our article, we have analyzed more patients. We used a pyrosequencing method that proved to be more sensible than Sangersequencingonmelanomasamples. TheactualfrequencyofBRAF p.V600E mutations in our series is 19 (51%) of 37 ECD samples. This frequency is not different from the 91 (47%) of 195 samples in the published cases of Langerhans cell histiocytosis (LCH). BRAF mutations are present in half the samples of ECD and LCH, but absent in most other histiocytoses. This suggests that ECD and LCH may have a specific common cellular origin. Interestingly, in LCH, BRAF mutations are present in cells at different maturation stages; however, BRAF mutations were not detected in blood monocytes. Finally, the high frequency of mutations and the poor prognosis of ECD argue for a clinical evaluation of BRAF inhibitors in patients with resistant and progressive life-threatening ECD.
Assessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs
Authors: T. Ingvarsson
Journal: Annals of the Rheumatic Diseases (2000)

<h3>OBJECTIVE</h3> To compare the reliability of quantitative measurement of minimum hip joint space with a qualitative global assessment of radiological features for estimating the prevalence of primary osteoarthritis (OA) of the hip in colon radiographs. <h3>METHODS</h3> All colon radiographs from patients aged 35 or older, taken at three different radiographic departments in Iceland during the years 1990–96, were examined. A total of 3002 hips in 638 men and 863 women were analysed. Intraobserver and interobserver reliability was assessed by measuring 147 randomly selected radiographs (294 hips) twice by the same observer, and 87 and 98 randomly selected radiographs (174 and 196 hips) by two additional independent observers. Minimum hip joint space was measured with a millimetre ruler, and global assessment of radiological features by a published atlas. <h3>RESULTS</h3> With a minimum joint space of 2.5 mm or less as definition for OA, 212 hips were defined as having OA. When the global Kellgren and Lawrence assessment with grade 2 (definite narrowing in the presence of definite osteophytes) or higher as definition for OA was used, 202 hips showed OA. However, only 166 hips were diagnosed as OA with both systems. With 2.0 or 3.0 mm minimum joint space as cut off point, the difference between the two methods increased. Both intrarater and interrater reliability was significantly higher with joint space measurement than with global assessment. <h3>CONCLUSIONS</h3> Overall prevalence of radiological OA was similar with the two methods. However, the quantitative measurement of minimum hip joint space had a better within-observer and between-observer reliability than qualitative global assessment of radiographic features of hip OA. It is thus suggested that minimum joint space measurement is a preferable method in epidemiological studies of radiological hip OA.
Asthma and respiratory symptoms in urban and rural Saudi Arabia
Authors: N Hijazi, B Abalkhail, A Seaton
Journal: European Respiratory Journal (1998)

The aim of this study was to contrast the prevalence of allergic symptoms in children living in urban and rural areas of Saudi Arabia and to investigate factors associated with any differences found. A cross-sectional questionnaire survey was conducted of a social class-stratified sample of 1,020 urban and 424 rural 12 yr old children, recording symptoms of current and past allergic disease and doctors' diagnoses, together with nationality and the fathers' educational level and occupations. A significantly greater prevalence of allergic symptoms was found in urban than in rural children and in Saudi than in non-Saudi Arab children. Males were more likely to have some respiratory symptoms and females had more eye and skin symptoms. Educational level and occupation of the father did not influence the likelihood of having symptoms. Logistic regression analyses showed that urban residence and Saudi nationality were the two main risk factors associated with asthmatic symptoms. There is likely to have been a recent increase in the prevalence of allergic disease in Saudi children associated with increased affluence, which has not affected non-Saudi migrants moving into the same environment to the same extent. This is consistent with the hypothesis that the environment, possibly through changes in lifestyle and patterns of infection, influences the expression of allergic disease.
Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial
Authors: Penella J Woll, Peter Reichardt, Axel Le Cesne, Sylvie Bonvalot, Alberto Azzarelli, Harald J Hoekstra, Michael Leahy, Frits Van Coevorden, Jaap Verweij, Pancras CW Hogendoorn, Monia Ouali, Sandrine Marreaud, Vivien HC Bramwell, Peter Hohenberger
Journal: The Lancet Oncology (2012)
Government delays revalidation by a further year
Authors: A. O'Dowd
Journal: BMJ (2010)

The government has delayed the introduction of medical revalidation by at least a year saying it is not convinced by the current proposals or the costs and practicalities involved.

Earlier this week health secretary Andrew Lansley wrote to Peter Rubin, chairman of the General Medical Council, expressing concerns and announcing that he intends to extend the current pilots of the new system by 12 months.

The letter precedes a formal response by the Department of Health to the GMC’s consultation on revalidation, which …
Validation of a numerical rating scale to assess functional impairment in hip and knee osteoarthritis: comparison with the WOMAC function scale
Authors: P. Ornetti, M. Dougados, S. Paternotte, I. Logeart, L. Gossec
Journal: Annals of the Rheumatic Diseases (2010)

<h3>Objectives</h3> (1) To investigate the psychometric properties of a patient-reported numerical rating scale (NRS) for evaluating functional disability in osteoarthritis (OA), in comparison with the WOMAC function scale and with a physician-reported function NRS; (2) to estimate the patient acceptable symptomatic state (PASS) and the minimal clinically important improvement (MCII) values for treatment with non-steroidal anti-inflammatory drugs (NSAIDs). <h3>Methods</h3> Data were extracted from a prospective multicentre study involving 1186 patients with knee or hip OA. The psychometric properties assessed were <i>feasibility</i>: percentage of responses, floor and ceiling effects; <i>construct validity</i> by examining the correlations with classically used OA outcomes measures; <i>responsiveness</i> by comparing the results of before and 1 month after treatment with NSAIDs using standardised response mean (SRM) and effect size (ES). The MCII and PASS values of each function scale were calculated by an anchoring method. <h3>Results</h3> No floor or ceiling effect was observed. High correlations were observed as expected between the patient NRS and WOMAC function, pain visual analogue scale and patient global assessment. The responsiveness was moderate to large, with SRM and ES ranging from 0.6 (hip OA) to 0.9 (knee OA) and higher than that of the WOMAC function scale. The PASS was close to 3 for the NRS scales. The MCII appears to be the change that makes the OA functional disability decrease from baseline to the PASS. <h3>Conclusion</h3> The patient-reported NRS demonstrated good psychometric properties, similar to the WOMAC function scale and can be regarded as a promising tool in therapeutic evaluation and decision-making in OA.
Cellular Senescence Markers p16INK4a and p21CIP1/WAF Are Predictors of Hodgkin Lymphoma Outcome
Authors: Anna Caliò, Alberto Zamò, Maurilio Ponzoni, Maria Elisabetta Zanolin, Andrés J.M. Ferreri, Serena Pedron, Licia Montagna, Claudia Parolini, Vadim E. Fraifeld, Marina Wolfson, Hagai Yanai, Giovanni Pizzolo, Claudio Doglioni, Fabrizio Vinante, Marco Chilosi
Journal: Clinical Cancer Research (2015)

There is evidence that Hodgkin Reed-Sternberg (HRS) cells in classical Hodgkin lymphoma (cHL) could display some molecular and morphologic markers of cellular senescence (CS). We hypothesized that CS mechanisms may have potential prognostic relevance in cHL and investigated whether the expression of the well-established CS biomarkers p21(CIP1/WAF1) and p16(INK4a) by HRS cells might be predictive of the probability of event-free survival (EFS).The study analyzed a retrospective cohort of 147 patients and the results were validated on a cohort of 91 patients independently diagnosed and treated in a different institution. p16(INK4a) and p21(CIP1/WAF1) were categorized as dichotomous variables (< or ≥ 30% of HRS cells at diagnosis) and evaluated in univariate and multivariate analysis.Both molecules were independent prognostic factors. A positive staining of one of the two molecules in more than 30% HRS cells predicted a better EFS (P < 0.01). p16(INK4a)/p21(CIP1/WAF1) together as a unique categorical variable (both <30%, either <30%, both ≥ 30%) sorted out three prognostic groups with better, intermediate, or worse outcome either overall or within I-II, bulky and advanced stages. The presence or the lack of the robust expression of p21(CIP1/WAF1) and/or p16(INK4a) defined the prognosis in our series.These findings point to (i) the relevance of CS-related mechanisms in cHL, and to (ii) the prognostic value of a simple, reproducible, and low-cost immunohistochemical evaluation of p16(INK4a) and p21(CIP1/WAF1) expression.
Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms
Authors: Michael J. Barry, Sreelatha Meleth, Jeannette Y. Lee, Karl J. Kreder, Andrew L. Avins, J. Curtis Nickel, Claus G. Roehrborn, E. David Crawford, Harris E. Foster, Steven A. Kaplan, Andrew McCullough, Gerald L. Andriole, Michael J. Naslund, O. Dale Williams, John W. Kusek, Catherine M. Meyers, Joseph M. Betz, Alan Cantor, Kevin T. McVary
Journal: JAMA (2011)

Saw palmetto fruit extracts are widely used for treating lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH); however, recent clinical trials have questioned their efficacy, at least at standard doses (320 mg/d).To determine the effect of saw palmetto extract (Serenoa repens, from saw palmetto berries) at up to 3 times the standard dose on lower urinary tract symptoms attributed to BPH.A double-blind, multicenter, placebo-controlled randomized trial at 11 North American clinical sites conducted between June 5, 2008, and October 10, 2010, of 369 men aged 45 years or older, with a peak urinary flow rate of at least 4 mL/s, an American Urological Association Symptom Index (AUASI) score of between 8 and 24 at 2 screening visits, and no exclusions.One, 2, and then 3 doses (320 mg/d) of saw palmetto extract or placebo, with dose increases at 24 and 48 weeks.Difference in AUASI score between baseline and 72 weeks. Secondary outcomes included measures of urinary bother, nocturia, peak uroflow, postvoid residual volume, prostate-specific antigen level, participants' global assessments, and indices of sexual function, continence, sleep quality, and prostatitis symptoms.Between baseline and 72 weeks, mean AUASI scores decreased from 14.42 to 12.22 points (-2.20 points; 95% CI, -3.04 to -1.36) [corrected]with saw palmetto extract and from 14.69 to 11.70 points (-2.99 points; 95% CI, -3.81 to -2.17) with placebo. The group mean difference in AUASI score change from baseline to 72 weeks between the saw palmetto extract and placebo groups was 0.79 points favoring placebo (upper bound of the 1-sided 95% CI most favorable to saw palmetto extract was 1.77 points, 1-sided P = .91). Saw palmetto extract was no more effective than placebo for any secondary outcome. No clearly attributable adverse effects were identified.Increasing doses of a saw palmetto fruit extract did not reduce lower urinary tract symptoms more than placebo.clinicaltrials.gov Identifier: NCT00603304.
Use of nebulised liposomal amphotericin B in the treatment of Aspergillus fumigatus empyema.
Authors: I F Purcell, P A Corris
Journal: Thorax (1995)

A 28 year old man with asthma, bronchopulmonary aspergillosis, pulmonary thromboembolic disease, and pulmonary hypertension developed Aspergillus fumigatus empyema complicating a pneumothorax. His condition progressively deteriorated despite treatment with intravenous and intrapleural amphotericin B, but improved promptly after substituting nebulised liposomal amphotericin B and oral itraconazole. This experience suggests that nebulised liposomal amphotericin B is well tolerated and merits further assessment in the treatment of pulmonary fungal disease.
A broad-based metabolic approach to study VLDL apoB100 metabolism in patients with ESRD and patients treated with peritoneal dialysis
Authors: Berthil H.C.M.T. Prinsen, Ton J. Rabelink, Johannes A. Romijn, Peter H. Bisschop, Martina M.J. de Barse, José de Boer, Timon W. van Haeften, P. Hugh R. Barrett, Ruud Berger, Monique G.M. de Sain-van der Velden
Journal: Kidney International (2004)
Benefits and Harms of CT Screening for Lung Cancer
Authors: Peter B. Bach, Joshua N. Mirkin, Thomas K. Oliver, Christopher G. Azzoli, Donald A. Berry, Otis W. Brawley, Tim Byers, Graham A. Colditz, Michael K. Gould, James R. Jett, Anita L. Sabichi, Rebecca Smith-Bindman, Douglas E. Wood, Amir Qaseem, Frank C. Detterbeck
Journal: JAMA (2012)

<h3>Context</h3>Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer.<h3>Objective</h3>To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline.<h3>Data Sources</h3>MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012).<h3>Study Selection</h3>Of 591 citations identified and reviewed, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation.<h3>Data Extraction</h3>Critical appraisal using predefined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus.<h3>Results</h3>Three randomized studies provided evidence on the effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer−specific mortality, 247 vs 309 events per 100 000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P = .004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare.<h3>Conclusion</h3>Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.
Polycythemia vera in childhood: Case report and review of the literature
Authors: Elizabeth H. Danish, Cleo A. Rasch, John W. Harris
Journal: American Journal of Hematology (1980)

A patient presented at 5 years of age with polycythemia vera. He subsequently developed splenic infarctions and died at 20 years of age following cerebral hemorrhage and infarctions. Two months before his death, he developed hypertension and had biochemical evidence of primary hyperparathyroidism and possibly pheochromocytoma. Only nine reported childhood cases of polycythemia vera fulfill the criteria of the Polycythemia Vera Study Group. These cases are summarized and the complications discussed. Although none have progressed to myeloid metaplasia or acute leukemia, these patients are at risk of developing thrombo-hemorrhagic complications; available evidence indicates that they should be managed to keep the hematocrit between 40 and 45%.
Outpatient<i>versus</i>inpatient treatment in patients with pulmonary embolism: a meta-analysis
Authors: Wendy Zondag, Judith Kooiman, Frederikus A. Klok, Olaf M. Dekkers, Menno V. Huisman
Journal: European Respiratory Journal (2012)

Our aim was to study the safety of outpatient treatment in low risk patients with acute pulmonary embolism compared with inpatient treatment, the current clinical standard. We searched Medline, Web of Science, Cochrane and EMBASE databases and included studies on outpatient treatment of pulmonary embolism. The outcomes were 3-month recurrent venous thromboembolism, major bleeding and all-cause mortality. We identified 13 studies (1657 patients) with outpatients (discharge <24 h), three studies (256 patients) with early discharge patients (discharged within 72 h) and five studies (383 patients) with inpatients. The pooled incidence of recurrent venous thromboembolism was 1.7% (95% CI 0.92-3.1%) in outpatients, 1.1% (0.22-5.4%) in patients discharged early and 1.2% (0.16-8.1%) in inpatients. The pooled incidence of major bleeding was 0.97% (0.58-1.6%) in outpatients, 0.78% (0.16-3.7%) in early discharge patients and 1.0% (0.39-2.8%) in inpatients. The pooled incidence of mortality was 1.9% (0.79-4.6%) in outpatients, 2.3% (1.1-5.1%) in early discharge patients and 0.74% (0.04-11%) in inpatients. Incidences of recurrent venous thromboembolism, major bleeding and, after correction for malignancies, mortality were comparable between outpatients, patients discharged early and inpatients. We conclude that home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment.
Cerebellar, Prefrontal Cortex, and Thalamic Volumes Over Two Time Points in Adolescent-Onset Schizophrenia
Authors: Anthony C. James, Susan James, David M. Smith, Auxi Javaloyes
Journal: American Journal of Psychiatry (2004)

OBJECTIVE: Structural and functional studies implicate multiple brain lesions as a basis for a functional dysconnectivity underlying the cognitive and symptom profiles in schizophrenia. The aim of this study was to examine the hypothesis that early-onset schizophrenia is associated with structural abnormalities in the prefrontal cortex, thalamus, and cerebellum, compatible with a dysconnectivity syndrome. METHOD: Two magnetic resonance imaging scans of 16 patients and 16 normal comparison subjects were undertaken on average 2 to 3 years apart. The participants were all from a defined geographic area in the United Kingdom with a population of 2.5 million. RESULTS: In comparison to the normal adolescents, the schizophrenic subjects demonstrated low prefrontal cortex and thalamic volumes. The relatively large difference in prefrontal and thalamic volumes in these adolescents with schizophrenia implies a more severe disease process than in adult subjects. CONCLUSIONS: The thalamic and frontal lobe findings provide preliminary, supportive structural evidence for a neurodevelopmental basis for a dysconnectivity syndrome, although the cerebellar findings were inconclusive.