tbuckley/cabot-search huggingface dataset:
Large Change in Voltage at Phase Reversal Improves Biphasic Defibrillation Thresholds
Authors: Yoshio Yamanouchi, Kent A. Mowrey, George R. Nadzam, Donald G. Hills, Mark W. Kroll, James E. Brewer, Ann M. Donohoo, Bruce L. Wilkoff, Patrick J. Tchou
Journal: Circulation (1996)

Multiple factors contribute to an improved defibrillation threshold of biphasic shocks. The leading-edge voltage of the second phase may be an important factor in reducing the defibrillation threshold.We tested two experimental biphasic waveforms with large voltage changes at phase reversal. The phase 2 leading-edge voltage was twice the phase 1 trailing-edge voltage. This large voltage change was achieved by switching two capacitors from parallel to series mode at phase reversal. Two capacitors were tested (60/15 microfarads [microF] and 90/22.5 microF) and compared with two control biphasic waveforms for which the phase 1 trailing-edge voltage equaled the phase 2 leading-edge voltage. The control waveforms were incorporated into clinical (135/135 microF) or investigational devices (90/90 microF). Defibrillation threshold parameters were evaluated in eight anesthetized pigs by use of a nonthoracotomy transvenous lead to a can electrode system. The stored energy at the defibrillation threshold (ion joules) was 8.2 +/- 1.5 for 60/15 microF (P < .01 versus 135/135 microF and 90/90 microF), 8.8 +/- 2.4 for 90/22.5 microF (P < .01 versus 135/135 microF and 90/90 microF), 12.5 +/- 3.4 for 135/135 microF, and 12.6 +/- 2.6 for 90/90 microF.The biphasic waveform with large voltage changes at phase reversal caused by parallel-series mode switching appeared to improve the ventricular defibrillation threshold in a pig model compared with a currently available biphasic waveform. The 60/15-microF capacitor performed as well as the 90/ 22.5-microF capacitor in the experimental waveform. Thus, smaller capacitors may allow reduction in device size without sacrificing defibrillation threshold energy requirements.
Long-Term Renal Function in Kidney Donors
Authors: LAWRENCE J. SPRECHER
Journal: Annals of Internal Medicine (1986)

Letters and Corrections1 December 1986Long-Term Renal Function in Kidney DonorsLAWRENCE J. SPRECHER, M.D.LAWRENCE J. SPRECHER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-6-975_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Williams and coworkers' article on long-term renal function in kidney donors (1) is a provoking and logical study; however, certain flaws weaken its validity. To begin with, the title might effectively have focused on the more primary issue of hypertension rather than on renal disease.Unfortunately, only 17 sibling pairs were studied, a somewhat small number representing at most only 61% of the potential participant pool. Furthermore, the authors elicited follow-up from only 76% of donors (34 of 50). Established clinical epidemiologic theory suggests that a study that purports to follow the natural course of a disease...References1. WILLIAMS S, OLER J, and JORKASKY D. Long-term renal function in kidney donors: a comparison of donors and their siblings. Ann Intern Med. 1986;105:1-8. LinkGoogle Scholar2. . How to read clinical journals: III. To learn the clinical course and prognosis of disease. Can Med Assoc J. 1981;124:866-72. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: LAWRENCE J. SPRECHER, M.D.Affiliations: Medical College of Ohio Toledo, OH 43699 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1986Volume 105, Issue 6Page: 975-975KeywordsClinical epidemiologyHypertensionKidneysRenal diseases ePublished: 1 December 2008 Issue Published: 1 December 1986 PDF downloadLoading ...
FDA Approves First Celecoxib Generics
Authors: Bridget M. Kuehn
Journal: JAMA (2014)

and the National Academy of Sciences (NAS) showed that even without seat belts, school busesarethesafestmodeof transportationto school. Inaddition, theanalysesfoundthatthe costsof installingseatbeltswouldbehighcompared with the lives they would save (http://1 .usa.gov/1mrXluz). Ultimately, the NAS argued that spending the money on other interventions would save more lives and do more to reduceschool transportation injuries. Reinhardtacknowledgedthatsettingvaluesonhealthstatusandlifeisataskfraughtwith ethicalandotherchallenges.Forexample,heexplained, if you ask the public for input on how muchadditionalyearsof lifeareworth,youwill getdifferent answers frompeoplewithdifferent perspectives. People with a disability will ratetheirhealthstatushigherthanpeoplewithoutthatdisability.Somepeoplewithdisabilities will argue that able-bodied individuals are biasedagainst them,he said. Similarly, a popular economic measure, quality-adjustedlife-year(QALY),hasbeencriticizedasbiasedagainsttheelderly.Reinhardtexplainedthatadministeringatherapyonan80year-old person will yield fewer QALYs than doing the same procedure on a 50-year-old. “You have to guard against age bias,” he said.
A New Approach to Student Mental Health in Small Colleges: A Multiple-College Mental Health Center
Authors: PHILIP SOLOMON, VERNON D. PATCH, JOHN B. STURROCK, DONALD WEXLER
Journal: American Journal of Psychiatry (1967)

A cooperative venture for the provision of comprehensive mental health care to students and faculty of the many small colleges in the Boston community is described. In addition to offering the major advantages of a single-college mental health unit, this multiple-college center also affords a means of pooling meager resources, anonymity to those seeking help, and a unique opportunity for research on college populations.
Abstract P1-01-15: Intraoperative Imprint Cytology Examination of Sentinel Lymph Nodes after Neoadjuvant Chemotherapy in Breast Cancer Patients
Authors: E Monrigal, M-M Dauplat, X Durando, C Abrial, G Le Bouedec, M-A Mouret-Reynier, F Cachin, F Kwiatkowski, A Tchirkov, J Dauplat, F Penault-Llorca, P. Gimbergues
Journal: Cancer Research (2010)

Abstract Background: Intraoperative imprint cytology (IC) is one of several accurate, proved methods to detect tumor cells in sentinel lymph nodes (SLN) from patients with operable breast cancer. In patients treated by neoadjuvant chemotherapy (NAC), studies have demonstrated the feasibility and accuracy of SLN biopsy procedure. The aim of this study was to evaluate the validity of tumor cell detection using IC in SLN from patients who underwent NAC. Material and methods: Patients with infiltrating breast carcinoma receiving NAC (n= 132) were studied prospectively. At surgery, SLN biopsy followed by axillary lymph node dissection was performed. Intraoperative SLN evaluation using IC was performed in 80 out of 132 patients (60%). In the same period, IC has been evaluated at random for 100 chemonaïve patients in the same institution. Results: Sentinel lymph node metastases were correctly identified using IC in 58 of 80 (72%) patients. False negative results were observed in 21 patients. The overall sensitivity and specificity of IC for the identification of lymph node metastases was respectively 38.2% and 97.8%. The positive predictive value was 92.9% and the negative predictive value was 68.2%. In univariate analysis and multivariate logistic regression analysis, patients with micrometastases or ITC in SLN have 2.3 times higher risk of a false negative IC result than patients with macrometastases of the SLN (P= 2.1.10-4; RR= 2.3; 95% confidence interval [1.37-3.85]). For chemonaïve patient, sensitivity, specificity, PPV and NPV were respectively 47.4%, 98.8%, 90% and 88.9%. Conclusion: The accuracy of intraoperative IC observed in our study is similar to that reported previously in patients without NAC, indicating that IC is a clinically acceptable method for intraoperative pathological examination of SLN for patients after NAC. Variations in sensitivity are related to the proportion of cases with micrometastases and ITC, as it was also shown in chemonaive patients. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-15.
Europe needs two or three years to prepare for pandemic flu
Authors: Rory Watson
Journal: BMJ (2007)

Cyclo-oxygenase-2 (COX 2) inhibitors should be used only as the last choice after other types of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve chronic pain in people with heart disease or at high risk of it, the American Heart Association has recommended.Its statement, published online in Circulation on 26 February (http://circ.ahajournals.orgdoi:10.1161/circulationaha.106.181424), was designed to end any remaining confusion about the cardiovascular risk of these agents.The association has recommended a stepped approach to treatment.The first step should be non-pharmacological approaches, such as physical therapy and weight loss, for patients with known cardiovascular disease or with risk factors for ischaemic heart disease.Drug treatment should start with agents with the lowest reported risk of cardiovascular events, before other agents are prescribed, and at each step account should be taken of the risk-benefit balance.First line drug choices include paracetamol (acetaminophen), aspirin, tramadol, and short term use of other narcotic analgesics.If these fail to achieve adequate pain control, the next option is non-acetylated salicylates, such as naproxen.The association recommended NSAIDs that aren't COX 2 inhibitors if pain is still inadequately controlled, then NSAIDs with some COX 2 activity as the next step, and lastly COX 2 selective NSAIDs.The committee considered the risk of all three of these classes to be sufficiently high to require that patients taking them should be monitored regularly for sustained hypertension (or worsening of prior blood pressure control), oedema, worsening renal function, or gastrointestinal bleeding.See pp 436, 450. Save COX 2 inhibitors till last for cardiac patientsUK NEWS HFEA allows women to donate eggs for research, p445 World NEWS repeal law that puts "FdA on the payroll of the industry", p447 bmj.comUK government defeated on community treatment forms
Understanding Physicians’ Challenges When Treating Type 2 Diabetic Patients’ Social and Emotional Difficulties
Authors: Elizabeth A. Beverly, Brittney A. Hultgren, Kelly M. Brooks, Marilyn D. Ritholz, Martin J. Abrahamson, Katie Weinger
Journal: Diabetes Care (2011)

To explore physicians' awareness of and responses to type 2 diabetic patients' social and emotional difficulties.We conducted semistructured interviews with 19 physicians. Interviews were transcribed, coded, and analyzed using thematic analysis.Three themes emerged: 1) physicians' awareness of patients' social and emotional difficulties: physicians recognized the frequency and seriousness of patients' social and emotional difficulties; 2) physicians' responses to patients' social and emotional difficulties: many reported that intervening with these difficulties was challenging with few treatment options beyond making referrals, individualizing care, and recommending more frequent follow-up visits; and 3) the impact of patients' social and emotional difficulties on physicians: few available patient treatment options, time constraints, and a perceived lack of psychological expertise contributed to physicians' feeling frustrated, inadequate, and overwhelmed.Recognition and understanding of physicians' challenges when treating diabetes patients' social and emotional difficulties are important for developing programmatic interventions.
Pediatric T- and NK-cell lymphomas: new biologic insights and treatment strategies
Authors: N K El-Mallawany, J K Frazer, P Van Vlierberghe, A A Ferrando, S Perkins, M Lim, Y Chu, M S Cairo
Journal: Blood Cancer Journal (2012)

T- and natural killer (NK)-cell lymphomas are challenging childhood neoplasms. These cancers have varying presentations, vast molecular heterogeneity, and several are quite unusual in the West, creating diagnostic challenges. Over 20 distinct T- and NK-cell neoplasms are recognized by the 2008 World Health Organization classification, demonstrating the diversity and potential complexity of these cases. In pediatric populations, selection of optimal therapy poses an additional quandary, as most of these malignancies have not been studied in large randomized clinical trials. Despite their rarity, exciting molecular discoveries are yielding insights into these clinicopathologic entities, improving the accuracy of our diagnoses of these cancers, and expanding our ability to effectively treat them, including the use of new targeted therapies. Here, we summarize this fascinating group of lymphomas, with particular attention to the three most common subtypes: T-lymphoblastic lymphoma, anaplastic large cell lymphoma, and peripheral T-cell lymphoma-not otherwise specified. We highlight recent findings regarding their molecular etiologies, new biologic markers, and cutting-edge therapeutic strategies applied to this intriguing class of neoplasms.
The Philosophy of Psychiatry: A Companion
Authors: Raj Persaud
Journal: BMJ (2005)

Every day doctors have to make difficult decisions, often when on the run and under great pressure, that have serious repercussions for their patients; and no one seems grateful when the messy process is all over. So the profession understandably rolls its collective eyeballs skywards when philosophers start pontificating about medicine. It's all very well to wallow in the niceties of philosophical analysis—but what is the practical help to us, doctors will demand impatiently, when yet another book on philosophy and medicine thumps onto the ever growing (dusty?) pile in this category.

Philosophy attracts intense suspicion from those who are deeply impressed by medicine's apparent progress, driven by conventional science, because philosophy has a nasty tendency to show that we doctors are not forging forward quite as quickly as we like to imagine.

For example, this collection of philosophical contributions asks some uncomfortable questions that are usually too quickly glossed over in modern medical practice. But perhaps the reason this volume is better than conventional philosophical analyses …
Trial of levodopa in senile dementia.
Authors: C Lewis, B R Ballinger, A S Presly
Journal: BMJ (1978)

Trial of levodopa in senile dementiaConcentrations of various neurotransmitter enzymes in the brain may be reduced in patients suffering from Alzheimer's disease or senile dementia.' 2 Levodopa may alleviate the dopamine deficiency in the striatum in Parkinsonism, but there have been conflicting reports about its effect on any associated dementia.3The drug has also been reported to improve the intellectual function of some patients suffering from senile dementia associated with extrapyramidal features.3We have further assessed the effect of levodopa on senile dementia. Patients, methods, and resultsThe patients studied were all women inpatients diagnosed as suffering from senile dementia, whose mean age was 78-9 years.None had serious extrapyramidal disease, and patients with severe heart disease, glaucoma, liver disease, or peptic ulcer were excluded.The study was a double-blind crossover trial, patients receiving four weeks' treatment with placebo and four weeks' treatment with the active drug.The starting dose was 125 mg daily, which was increased over two weeks to 875 mg daily.None of the patients were receiving phenothiazines, haloperidol, antidepressants, antihypertensive agents, or sympathomimetic drugs.The Crichton Geriatric Behaviour Rating Scale was used at regular intervals by the same ward nursing staff, and the Crichton Intellectual Rating Scale4 was used by one member of the medical staff; the ratings were made blind at the end of weeks 0, 2, 4, 6, and 8.A checklist of side effects was also completed.Sixteen patients started the trial but two were withdrawn, one because of cholecystitis that developed during the placebo period and one because of a fractured femur that occurred during levodopa treatment, though there was no clear association with the drug.Fourteen patients completed the trial, and no other serious side effects were reported, although one patient became more irritable while taking the active preparation.Analysis of variance was used to test the significance of differences between mean scores in patients during the drug and placebo periods (see table ).The results indicated a significant improvement in intellectual function during the drug phase; there was no significant change in any other area of behaviour with the exception of continence.Indices assessed by the intellectual rating scale and the com- munication part of the behaviour rating scale were broadly similar. CommentAfter our experience with this boy we are concerned that many more patients on topical steroid treatment are at risk of this on 22 July
Physician Support Personnel in the 70's-Economic Implications
Authors: Chris N. Theodore
Journal: JAMA (1970)

As accelerated demand continues to outstrip the supply of services in the 1970's, American medicine is confronted by two problems: (1) how to increase the availability of services, and (2) how to contain the rising prices. It has been suggested recently that the introduction of physician's assistants on a massive scale will help to solve the imbalance of supply and demand by first, increasing the number of personnel and second, expanding the efficiency of existing manpower. It is necessary to do both to meet the challenge of the 1970's. When physicians recognize that they may increase their productivity and their number of patients through the utilization of assistants, additional demand for support personnel will be created. To those who doubt this concept, we need merely point out that it is not new in American medicine. Its prototype existed in many individual practices long before the formal establishment of physician's assistant
Tiotropium Respimat increases the risk of mortality
Authors: Christine R Jenkins, Richard Beasley
Journal: Thorax (2012)

In the 10 years since tiotropium was introduced into clinical practice, it has become the mainstay long-acting bronchodilator for maintenance treatment in Chronic Obstructive Pulmonary Disease (COPD). Multiple randomised controlled trials have demonstrated its efficacy as an intervention which improves lung function, quality of life, symptom control and exercise capacity, and reduces exacerbations in patients with COPD.1 

Subsequent to the introduction of tiotropium, evidence emerged from the Lung Health Study that ipratropium, the short-acting anticholinergic medication widely used prior to tiotropium, was associated with a greater risk of cardiac death in the smoking intervention-ipratropium (SI-A) arm compared with the smoking intervention-placebo (SI-P) arm.2 There was a preponderance of arrhythmias as a cause of hospitalisation in the SI-A group because of a relatively high prevalence of supraventricular tachycardia. Because smoking cessation rates were similar in both groups, ipratropium looked to be the likely cause.

Following this, the United States Food and Drug Administration, being made aware of an increased risk of stroke in pooled data from 29 trials of tiotropium through a report supplied to it by the manufacturer, issued an early warning in March 2008.3 Later that year, a meta-analysis of 17 trials (ipratropium (n=5) and tiotropium (n=12)) showed an increased risk of the primary composite endpoint of cardiovascular death, myocardial infarction or stroke (relative risk 1.60, 95% CI 1.22 to 2.10) and of all-cause mortality (relative risk 1.29, 95% CI 1.00 to 1.65).4 Inhaled anticholinergics significantly increased the risk of myocardial infarction (relative risk 1.52, 95% CI 1.04 to 2.22) and cardiovascular death (relative risk 1.92, 95% CI 1.23 to 3.00), but not stroke (relative risk 1.46, 95% CI 0.81 to 2.62).

However, also later in 2008 the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) study,5 the largest randomised trial of tiotropium, showed …
Effect of Television Violence on Children and Youth
Authors: Michael B. Rothenberg
Journal: JAMA (1975)

One hundred forty-six articles in behavioral science journals, representing 50 studies involving 10,000 children and adolescents from every conceivable background, all showed that violence viewing produces increased aggressive behavior in the young and that immediate remedial action in terms of television programming is warranted. Four major issues are covered: effects on learning, emotional effects, the question of catharsis, and effects on aggressive behavior. The research findings regarding each of these issues are summarized, as well as the controversial 1972 Surgeon General's report, Television and Social Behavior. The time is long past due for a major, organized cry of protest from the medical profession in relation to what, in political terms, I consider a national scandal.
Free Time for Physicians
Authors: James A. Burdette
Journal: JAMA (1971)

<h3>To the Editor.—</h3> The letter of Dr. Beychok (<b>215</b>:2112, 1971) concerning a way to reduce the consumption of time by busy physicians struck a responsive chord and I think requires further discussion and consideration. I am sure that all physicians in practice feel that they spend an unnecessary amount of their time on paperwork which could be simplified or taken care of by other personnel. I have often thought that insurance reports could be further simplified and standardized and that all medical insurance programs could issue credit cards to each of their policyholders. These could then be stamped on the form whenever they are used, in the manner of other widely used credit cards, thus saving some time for the physician and his secretary. I would certainly hope that someone in our national headquarters or some committee from the House of Delegates might give official consideration to thoughts such