tbuckley/cabot-search huggingface dataset:
Patients don't understand question often used to measure satisfaction in NHS
Authors: Z. Kmietowicz
Journal: BMJ (2012)

The “net promoter score,” which is widely used across the NHS in England to gauge patients’ satisfaction with health services and asks, “How likely is it that you would recommend this service,” is poorly understood and yields inaccurate answers, researchers have found.

The best way to gauge patients’ satisfaction with health services is to ask them to score their overall experience of care from 0 (“I had a very poor experience”) to 10 (“I had a very good experience”), says a report from the Picker Institute Europe and the Care Quality Commission.1

The research, done on behalf of the Department of Health, tested six potential questions with 85 people who had recently used the NHS to identify the best single “overarching” question to …
Should antidiabetic treatment of type 2 diabetes in patients with heart failure differ from that in patients without?
Authors: Anselm K. Gitt, Martin Halle, Markolf Hanefeld, Monika Kellerer, Nikolaus Marx, Juris J. Meier, Petra‐Maria Schumm‐Draeger, Peter Bramlage, Diethelm Tschöpe
Journal: European Journal of Heart Failure (2012)
Prevention of HIV Infection
Authors: Jeff Stryker
Journal: JAMA (1995)

For some, the occurrence of as many as 40,000 new human immunodeficiency virus (HIV) infections in the United States each year is evidence that HIV education and prevention efforts have failed. To the contrary, more than a decade of experience with HIV has demonstrated that lasting changes in behavior needed to avoid infection can occur as a result of carefully tailored, targeted, credible, and persistent HIV risk-reduction efforts. Given experience in other health behavior change endeavors, no interventions are likely to reduce the incidence of HIV infection to zero; indeed, insisting on too high a standard for HIV risk-reduction programs may actually undermine their effectiveness. A number of social, cultural, and attitudinal barriers continue to thwart the implementation of promising HIV risk-reduction programs. The remote prospects for a successful prophylactic vaccine for HIV and the difficulty in finding effective drug treatments have underscored the importance of sustained attention to HIV prevention and education. A series of "correlates of immunity" are identified--precedents that must exist to establish effective HIV prevention programs. These include sound policies promoting HIV risk reduction; access to health and social services, condoms, needles, and syringes; interventions shown to motivate behavioral change; organizations capable of reaching those at risk; and development and diffusion of technologies to interrupt the spread of the virus.
Induction of Asthma and the Environment: What We Know and Need to Know
Authors: MaryJane K. Selgrade, Robert F. Lemanske, M. Ian Gilmour, Lucas M. Neas, Marsha D.W. Ward, Paul K. Henneberger, David N. Weissman, Jane A. Hoppin, Rodney R. Dietert, Peter D. Sly, Andrew M. Geller, Paul L. Enright, Gillian S. Backus, Philip A. Bromberg, Dori R. Germolec, Karin B. Yeatts
Journal: Environmental Health Perspectives (2005)

The prevalence of asthma has increased dramatically over the last 25 years in the United States and in other nations as a result of ill-defined changes in living conditions in modern society. On 18 and 19 October 2004 the U.S. Environmental Protection Agency and the National Institute of Environmental Health Sciences sponsored the workshop "Environmental Influences on the Induction and Incidence of Asthma" to review current scientific evidence with respect to factors that may contribute to the induction of asthma. Participants addressed two broad questions: a) What does the science suggest that regulatory and public health agencies could do now to reduce the incidence of asthma? and b) What research is needed to improve our understanding of the factors that contribute to the induction of asthma and our ability to manage this problem? In this article (one of four articles resulting from the workshop), we briefly characterize asthma and its public health and economic impacts, and intervention strategies that have been successfully used to prevent induction of asthma in the workplace. We conclude with the findings of seven working groups that focus on ambient air, indoor pollutants (biologics), occupational exposures, early life stages, older adults, intrinsic susceptibility, and lifestyle. These groups found strong scientific support for public health efforts to limit in utero and postnatal exposure to cigarette smoke. However, with respect to other potential types of interventions, participants noted many scientific questions, which are summarized in this article. Research to address these questions could have a significant public health and economic impact that would be well worth the investment.
Human CD4 helper T cell activation: functional involvement of two distinct collagen receptors, 1F7 and VLA integrin family.
Authors: N H Dang, Y Torimoto, S F Schlossman, C Morimoto
Journal: The Journal of Experimental Medicine (1990)

In the present study, we showed that activation of human CD4 T cells can be induced by anti-CD3 and collagen in a serum-free system. This activation was inhibited by the addition of peptides containing the RGD or Gly-Pro-X sequences. Significantly, we demonstrated that both the 1F7 (CD26) structure and the VLA integrin family, particularly the VLA-3 complex, contribute to the functional interaction between collagen and CD4 cells since anti-1F7 and anti-VLA-3 specifically inhibited this collagen-induced CD4 cell activation. Biochemical studies showed that the 1F7 structure is not a member of the VLA integrin family. These results thus indicated that two different families of antigens serve as functional collagen receptors for CD4 T cell activation.
A CASE OF DERMATITIS ARTEFACTA, AND ITS SEQUEL
Authors: R. O. Adamson
Journal: BMJ (1910)

TEa following case was so atypical, and presented a train of symptoms so unlike one'd expectations, that I think it safficiently interesting to record.A lady aged 24, married three years, no children, one mis- carriage, gave a historv of frequent so-called " bilious attacks,"dating from the age of 12, when she had an attack of jaundice.The attacks consisted of headache, naasea, and some vomit- ing, and usually lasted a day, occurring at intervals of several months.
Thyroid Storm After Cardiac Angiography With Iodinated Contrast Medium
Authors: Manfred Blum
Journal: JAMA (1976)

THYROID storm (thyroid crisis), a life-endangering, severe aggravation of thyrotoxicosis and intensification of the peripheral effects of thyroid hormone, is generally observed in patients known to be hyperthyroid but may occur in unrecognized hyperthyroidism, especially after infections, trauma, or surgery.
ACUTE CORONARY SYNDROMES IN THE VERY OLD: THERAPIES AND OUTCOME IN THE LONG-TERM FOLLOW-UP
Authors: Jose C. Nicolau, Andre Franci, Carlos Barbosa, Luciano Baracioli, Remo Furtado, Natali Giannetti, Roberto Giraldez, Felipe Lima, Marcelo Franken, Jose Ramires, Roberto Kalil-Filho, Thiago Ferraz
Journal: Journal of the American College of Cardiology (2014)
Somatization Disorder
Authors: Timothy E. Quill
Journal: JAMA (1985)

Patients with somatization disorders are frequently unrecognized and misdiagnosed. The diagnosis depends on recognizing a long-standing pattern of seeking medical intervention for vague, multisystemic symptoms, often without clear physical cause. These patients use symptoms as a way to communicate, express emotion, and be taken care of. Instead of recognizing the disorder and exploring psychosocial contributors to illness, nonpsychiatric physicians tend to repeatedly pursue organic possibilities through multiple tests, procedures, medications, and operations. In patients with somatization disorders, the dollar costs of this strategy are only exceeded by its potential for iatrogenic harm. More productive treatment strategies are presented, emphasizing the need for a long-term relationship with a primary care provider who will treat the patient and his symptoms seriously and respectfully but who is not compelled to invasively evaluate all symptoms. (<i>JAMA</i>1985;254:3075-3079)
Doctors and the drug industry
Authors: P B Schofield
Journal: BMJ (1983)

does not provide data on individuals taking drugs in such a way that it would be possible to relate drug taking to disease incidence over a 10-20 year span.A national system for the monitoring of safety of drugs when given over years should be established and established soon.The UK is no different in regard to this deficiency than any other country, and none has yet established an adequate system of surveillance.Perhaps an international agency, such as the World Health Organisation, might help establish a wider monitoring system which would produce results more quickly.You rightly emphasise the public's concern for safety.Only when more comprehensive monitoring is achieved will it be known when the risk of correcting risk by drugs is greater than the uncorrected risk.6 M F
Activity and safety of bortezomib in multiple myeloma patients with advanced renal failure: a multicenter retrospective study
Authors: Asher A. Chanan-Khan, Jonathan L. Kaufman, Jayesh Mehta, Paul G. Richardson, Kena C. Miller, Sagar Lonial, Nikhil C. Munshi, Robert Schlossman, Joseph Tariman, Seema Singhal
Journal: Blood (2006)
THE VALUE OF SYSTEMIC ENDOTHELIAL DYSFUNCTION AND INCREASED ARTERIAL STIFFNESS FOR IDENTIFYING WALL MOTION ABNORMALITIES DURING STRESS ECHOCARDIOGRAPHY TESTING IN HYPERTENSIVE MEN WITH VASCULAR ERECTILE DYSFUNCTION
Authors: Nikolaos Ioakeimidis, Charalambos Vlachopoulos, Constadina Aggeli, Dimitrios Terentes-Printzios, Athanasios Aggelis, George Roussakis, Konstantinos Rokkas, Konstantinos Aznaouridis, Alexios Samentzas, Christodoulos Stefanadis
Journal: Journal of the American College of Cardiology (2010)
Investigation of anal function in patients with systemic sclerosis.
Authors: A L Herrick, J D Barlow, A Bowden, N Williams, A R Hobson, M Irving, M I Jayson
Journal: Annals of the Rheumatic Diseases (1996)

To investigate anorectal function in women patients with systemic sclerosis (SSc), with and without lower gastrointestinal symptoms.Anorectal manometry was performed in 16 patients with SSc: six with no or minimal bowel symptoms, seven with constipation, and three with diarrhoea and faecal incontinence. Eleven healthy women acted as control subjects. Pressure data were recorded via an eight lumen polyvinylchloride water perfused catheter. Station and rapid pull through techniques were used.In the patients with SSc, mean resting pressure, maximal voluntary squeeze effort, and squeeze vector volume were lower, and squeeze asymmetry was greater, compared with the healthy controls. Differences were significant in the subgroup with constipation.Radial asymmetry and vector volume parameters provide detailed analysis of segmental anal canal function. Our findings suggest significant segmental deficits in those patients with SSc who have lower gastrointestinal symptoms. The trend towards smaller pressures and squeeze vector volumes in the asymptomatic SSc group suggests subclinical dysfunction in these patients.
Posterior fossa subarachnoid cyst due to choroid plexus papilloma.
Authors: I. P. Cast, M. A. Falconer
Journal: BMJ (1968)

Preliminary communications MEDICALJOURNAL reasonable to regard all recurrences noted in the first week as treatment failures regardless of history, and those after this time as reinfections.If only the recurrences in the first week (6) are counted the failure rate in those followed would be 6.7%.Others have preferred two weeks as being more realistic, and if this period is chosen the number of recurrences in the first 14 days (10) in this series would be identical with that obtained if a history of further sexual exposure is used, and the failure rate (11.2 %) is therefore also the samne.No significant differences between the results in Negro and non-Negro patients were noted.Analysis of the results in rela- tion to the time of the last meal before administration of rifampicin in the 101 cases for which data are available suggested that the percentage failure rate increased as the time elapsing since the last meal increased, but this did not reach statistical significance.These results are only slightly less successful than those obtained with single injections of 1.2 mega units of procaine penicillin and therefore this new antibiotic provides an alterna- tive treatment agent for single-session therapy for persons in whom penicillin is contraindicated.Our thanks are due to CIBA Laboratories and Lepetit Labora- tories for supplies of rifampicin used in this trial.
Oral tolerization to adenoviral proteins permits repeated adenovirus-mediated gene therapy in rats with pre-existing immunity to adenoviruses
Authors: Yaron Ilan, Bernhard Sauter, Namita Roy Chowdhury, Bhoompally V. Reddy, Narsing R. Thummala, Gustavo Droguett, Anne Davidson, Michael Ott, Marshall S. Horwitz, Jayanta Roy Chowdhury
Journal: Hepatology (1998)

Exposure to wild-type adenoviruses is common in humans and results in immune response against adenoviruses. The pre-existing antibodies and a strong secondary humoral and cellular immune response would interfere with gene transfer using recombinant adenoviral vectors. To test whether the secondary immune response can be abrogated by oral tolerization to adenoviral antigens, we immunized bilirubin-UDP-glucuronosyltransferase (BUGT)-deficient jaundiced Gunn rats with a recombinant adenovirus (5 × 10 9 pfu/rat) expressing the human UDP-glucouronosyltransferase (BUGT 1 ) gene (Ad-hBUGT). Transgene expression was shown by reduction of mean serum bilirubin levels from 7.0 mg/dL to 2.3 mg/dL in 14 days, which then increased gradually to pretreatment levels in 6 weeks. All recipients developed antibodies (1:2 10 ) and cytotoxic lymphocytes against the adenovirus. For oral tolerization, we administered to the immunized rats protein extracts of a recombinant adenovirus type 5 (1-1.5 mg/day) via duodenostomy tubes 10 to 40 days after the initial virus injection; control rats received bovine serum albumin. In rats fed adenoviral proteins and the BSA-fed controls, the antibody titers decreased to 1:2 7 and 1:2 9 , respectively, in 70 days. Lymphocytes from the tolerized rats expressed TGF-β 1 upon exposure to antigen-presenting cells primed with adenoviral antigens, whereas IFN-γ expression was undetectable. In contrast, lymphocytes from the BSA-treated control rats expressed IFN-γ but not transforming growth factor β 1 (TGF-β 1 ). Seventy days after the first injection in the orally tolerized rats, but not in the controls, a second Ad-hBUGT injection caused human BUGT 1 expression again, reducing serum bilirubin levels to those observed after the first injection. In the tolerized rats, serum antibody titers and anti-adenoviral cytotoxic lymphocyte activities continued to decline despite the second injection, whereas the antibody levels were boosted in the non-tolerized group. This results show that by preventing the secondary booster response, oral tolerization permits repeated adenovirus-directed gene transfer despite the presence of a residual antibody titer from a previous adenoviral exposure.
NHS should stop funding homoeopathy, MPs say
Authors: Z. Kmietowicz
Journal: BMJ (2010)

<h3>Abstract</h3> The polyaneuploid cancer cell (PACC) state represents a recently-described paradigm in the study of therapy resistance. Cancer cells in this state are physically enlarged, acquire polyaneuploid genomes resulting from whole-genome doubling, and have been shown to be present in metastatic prostate cancer lesions as well as in the tumors of a variety of cancer types. Initiation of the PACC state begins when a cancer cell experiences a stressor, such as a genotoxic chemotherapy, and ends after a period of recovery following the release of the treatment cells exit the PACC state and resume proliferation to repopulate the tumor cell pool. One notable characteristic of cancer cells in the PACC state is their distinctive nuclear morphologies. Evidence in the literature demonstrates that abnormal nuclear morphology is associated with more aggressive metastasis and disease recurrence. We characterized nuclear morphology and function over time as prostate cancer cells underwent chemotherapeutic treatment and recovery to identify the unique characteristics that allow a cancer cell under stress to survive in the PACC state. We found that mononucleated cancer cells dominate the pool of cells in the PACC state that survive days after cisplatin treatment. Additionally, by examining markers of DNA damage and the DNA damage response, we found that cells that access the PACC state likely employ more successful DNA damage repair. Lastly, while many prostate cancer cells treated with a genotoxic agent succumb to apoptosis in the days following treatment release, our data suggest that surviving cancer cells must regulate a balance autophagy levels to restore cellular homeostasis while not initiating autophagic cell death. Together, our findings present a course of events that take place as a treated cancer cell recovers from chemotherapy and access the PACC state, representing an important set of findings to the understanding of therapy resistance and recurrence.
Correlation, regression, and repeated data
Authors: R Persaud, J M Bland, D G Altman
Journal: BMJ (1994)

EDITOR, - J Martin Bland and Douglas G Altman's note on correlation, regression, and repeated measures draws attention to the problem of calculating a correlation coefficient based on repeated observations of the same subject.1 But they fall prey themselves to the common misjudgment of placing too much importance on the significance of the correlation coefficient.

The basic problem is the way in which significance is calculated as the correlation coefficient is strongly affected by the number of cases for which there are pairs of data. If, for example, you have about 500 cases the correlation coefficient needs only to be 0.088 to be significant at …
OBSTETRIC CASES IN PRIVATE PRACTICE
Authors: G. B. Masfen
Journal: BMJ (1856)

G. D., aged 55 yes, with an old hernia of som years gnding, stad that, while engaged before tmas lst he fll against a table, and injured his rupture.He went to work agan, as if nothing had happened; but then began to eomplain of symptoms of incarceration.He was ad- mitted October 17th into the London Hospital.The tu- mour was then quite irreducible.The intestine during operation gave way, and he was ill for weeks; a singular protusion of the gut, with the remarkable and beautiful perstaltic action quite visible, continually going on.Had this accident occurred without opening the sac, and had the intestine burst into the peritoneal cavity, Mr. Adams thought that death would have been inevitable.
Primary care: core values Primary care in an imperfect market
Authors: J. Roberts
Journal: BMJ (1998)

This is the fifth in a series of six articles reflecting on the core values that will underpin the development of primary care

Series editor: Mike Pringle

Doctors generally disdain the word “market” when it is applied to the work they do. A market is an encounter controlled by supply and demand.1 In most markets there is a purchaser, who pays for the specific goods he or she will receive, and a seller, who has the goods and will provide them to the purchaser.

Medicine is an imperfect market. In health care the purchaser is usually not the consumer, and the goods provided by the seller are difficult to define and often contingent on other aspects of care such as results of tests and treatments.2 In addition, the medical marketplace does not follow the classic rules of supply and demand. Doctors (to a diminishing extent) set the demand of the care that they will provide and therefore can artificially increase demand for the goods they supply, as highlighted by Roemer's law: “The supply of beds creates the demand for those beds.”3

Economic theory also assumes that the buyer-consumer will be knowledgeable about the goods to be purchased and can compare sellers' quality and prices. This is difficult in medicine. Firstly, seller-doctors have until recently controlled all the information about health care. Secondly, consumer-patients tend to avoid using medical services until they need them acutely, and by then, shopping is virtually impossible. Thirdly, even if payer-insurers or consumer-patients try hard to compare seller-doctors and their products, data are expensive to collect and complex to interpret. Finally, in the United Kingdom and in the non-urban and poorer parts of the United States, seller-doctors can set up monopolies or oligopolies in which neither purchasers nor consumer-patients can shop or even …
Does Housestaff Discontinuity of Care Increase the Risk for Preventable Adverse Events?
Authors: Laura A. Petersen
Journal: Annals of Internal Medicine (1994)

Objective: To study the relation between housestaff coverage schedules and the occurrence of preventable adverse events. Design: Case-control study. Setting: Urban teaching hospital. Patients: All 3146 patients admitted to the medical service during a 4-month period. Measurements: A previously tested confidential self-report system to identify adverse events, which were defined as unexpected complications of medical therapy that resulted in increased length of stay or disability at discharge. A panel of three board-certified internists confirmed events and evaluated preventability based on case summaries. Housestaff coverage was coded according to the day in the usual intern's schedule and to cross-coverage status. Cross-coverage was defined as care by a house officer who was not the patient's usual intern and not a member of the usual intern's patient care team. Coverage for an adverse event was assigned according to who was covering during the proximate cause of that event. Clinical data were collected for each patient and two matched controls. Results: Of the 124 adverse events reported and confirmed, 54 (44%) were judged potentially preventable. In the univariate analysis, patients with potentially preventable adverse events were more likely than their controls to be covered by a physician from another team at the time of the event (26% compared with 12% [odds ratio, 3.5; P = 0.01]). In the multivariate analysis, three factors were significant independent correlates of potentially preventable adverse events: cross-coverage (odds ratio, 6.1; 95% CI, 1.4 to 26.7), Acute Physiology and Chronic Health Evaluation II score (odds ratio per point, 1.2; CI, 1.1 to 1.4), and history of gastrointestinal bleeding (odds ratio, 4.7; CI, 1.2 to 19.0). Conclusion: Potentially preventable adverse events were strongly associated with coverage by a physician from another team, which may reflect management by housestaff unfamiliar with the patient. The results emphasize the need for careful attention to the outcome of work-hour reforms for housestaff.
SPECIALTIES, AND THEIR RELATION TO THE MEDICAL PROFESSION.
Authors: L. DUNCAN BULKLEY
Journal: JAMA (1884)

Read before the American Academy of Medicine, August, 1884. The title chosen for this paper is purposely a little ambiguous and possibly a trifle ungrammatical; but it was desired to express by means of the title certain aspects of the subject of specialism in medicine which are worthy of consideration, and which are better indicated by this title than by one worded differently. The topic is not "<i>specialists</i>specialists and their relation to the members of the medical profession," but the broader one of specialism, or the concentration of thought and work in one direction, however it is accomplished. Nor is the topic "specialties and their relation to the science of medicine," but is broader even than this, and looks toward the relations which those who are practicing and advancing medicine should bear toward the development of its science and art, by developing the separate or special portions of that