tbuckley/cabot-search huggingface dataset:
Supporting hospital staff to provide compassionate care: Do Schwartz Center Rounds work in English hospitals?
Authors: Joanna Goodrich
Journal: Journal of the Royal Society of Medicine (2012)

Objective To assess (1) whether the Schwartz Center Rounds (“Rounds”), a multidisciplinary forum which brings together hospital staff to discuss the nonclinical, social and emotional aspects of caring for patients, could transfer from the US to a UK setting; and (2) whether UK Rounds would achieve a similar positive impact on individuals and teams, and hospital culture. Design The results reported are based on 41 qualitative interviews with context provided by additional quantitative research. Setting We introduced Rounds at two pilot sites, both NHS hospitals providing acute care. Participants Over the one-year, ten-Rounds pilot period, Rounds were attended by 1250 staff across the two sites. We conducted qualitative research into the experiences of staff involved in implementing Rounds at the outset and the end of the pilot. Main outcome measures Interviewees' assessment of the effects of Rounds on participants, their relationships with colleagues, and the wider hospital. Results The findings show that in the two pilot trusts, Rounds are perceived by participants as a source of support and that their benefit may translate into benefits for patients and team working; and that Rounds have the potential to effect change in the hospital culture. Conclusion Rounds appear to transfer successfully from the US to the UK, and there is some evidence that they are having a similarly positive impact, but more research is needed.
Dual Inhibition Of PI3K and mTOR Shows Preferential Antileukemic Activity In MLL-Rearranged AML
Authors: Nadine Sandhöfer, Klaus H. Metzeler, Tanja Hinrichsen, Sebastian Tiedt, Evelyn Zellmeier, Volker Groiß, Oliver Wachter, Hanns-Georg Klein, Wolfgang Hiddemann, Irmela Jeremias, Karsten Spiekermann
Journal: Blood (2013)
Rationale and Public Health Implications of Changing CHD Risk Factor Definitions
Authors: Robert M. Kaplan, Michael Ong
Journal: Annual Review of Public Health (2007)

The definition of disease is central to the practice of medicine and to public health policy. Practice guidelines set standards for disease identification and treatment. Quality care is often defined as adherence to these guidelines. Over the past few years, the diagnostic thresholds for several common medical conditions have been lowered, resulting in a substantial expansion in the market for health care. The most recent guidelines for high blood pressure, high cholesterol, and impaired fasting glucose each define a high percentage of the adult population as in need of regular medical attention. Under the latest proposed thresholds, virtually the entire adult population qualifies for a chronic condition diagnosis. We evaluate the health and financial outcomes associated with changes in diagnostic thresholds for the prevention of three risk factors for cardiovascular disease and stroke: blood pressure, serum cholesterol, and fasting plasma glucose. Estimates of the numbers of people affected, the cost implications, and the overall public health consequences are offered.
Exercise Testing in Asymptomatic Adults
Authors: Michael Lauer, Erika Sivarajan Froelicher, Mark Williams, Paul Kligfield
Journal: Circulation (2005)

Along with coronary artery calcium scanning, ankle-brachial index measurement, and carotid artery ultrasound, exercise electrocardiography has been proposed as a screening tool for asymptomatic subjects thought to be at intermediate risk for developing clinical coronary disease. A wealth of data indicate that exercise testing can be used to assess and refine prognosis, particularly when emphasis is placed on nonelectrocardiographic measures such as exercise capacity, chronotropic response, heart rate recovery, and ventricular ectopy. Nevertheless, randomized trial data on the clinical value of screening exercise testing are absent; that is, it is not known whether a strategy of routine screening exercise testing in selected subjects reduces the risk for premature mortality or major cardiac morbidity. The writing group believes that a large-scale randomized trial of such a strategy should be performed.
Synergistic Neovascularization by Mixed Transplantation of Early Endothelial Progenitor Cells and Late Outgrowth Endothelial Cells
Authors: Chang-Hwan Yoon, Jin Hur, Kyung-Woo Park, Ji-Hyun Kim, Choon-Soo Lee, Il-Young Oh, Tae-Youn Kim, Hyun-Jai Cho, Hyun-Jae Kang, In-Ho Chae, Han-Kwang Yang, Byung-Hee Oh, Young-Bae Park, Hyo-Soo Kim
Journal: Circulation (2005)

Two types of cells are cultured from the human peripheral blood, early endothelial progenitor cells (EPCs) and outgrowth endothelial cells (OECs), as previously reported. Here, we further characterize these cells, especially with respect to their different origins and functions both in vitro and in vivo. We also investigated whether the combination of these different cell types shows synergism during neovascularization.Early EPCs were heterogeneously made up of both CD14+ monocyte-derived cells, which secrete cytokines, and CD14(-)-derived cells, which contain high levels of (CD34+)KDR+ cells. OECs were cultured almost exclusively from CD14- cells, not CD14+ cells, and were distinct from mature endothelial cells in terms of proliferation potential, KDR+ expression level, and telomerase activity. A portion of cells from CD14- cells and early EPCs produced rapidly proliferating, capillary-forming cells in both the Matrigel plug and the ischemic hind limb similar to OECs. Early EPCs and OECs expressed receptors for vascular endothelial growth factor and interleukin-8, cytokines secreted by early EPCs. There was a differential increase in matrix metalloproteinases (MMPs): MMP-9 in early EPCs and MMP-2 in OECs. In vitro, the angiogenic capability of the 2 cell types was augmented by mutual interaction through cytokines and MMPs. Injection of a mixture of the 2 cells resulted in superior neovascularization in vivo to any single-cell-type transplantation.Distinct origins of the different types of EPCs exist that have different functions in neovascularization. Mixed transplantation of these cells results in synergistic neovascularization through cytokines and MMPs.
Immune Responses to Hydralazine and Nuclear Antigens in Hydralazine-Induced Lupus Erythematosus
Authors: BEVRA H. HAHN
Journal: Annals of Internal Medicine (1972)

Immune responses to hydralazine were detected in patients with hydralazine-induced lupus but not in patients taking hydralazine without developing toxicity, patients with systemic lupus erythematosus, or normal persons. Patients with active hydralazine lupus had circulating antibodies to hydralazine; in vitro their lymphocytes transformed to hydralazine. These responses were not detectable in the other groups. Circulating antibodies to native DNA, characteristic of systemic lupus, were found in patients with hydralazine lupus. Serial studies in a woman who developed two episodes of hydralazine lupus showed that antibodies against hydralazine appeared during the symptomatic periods and disappeared during the asymptomatic interval; lymphocyte transformation and antibodies to native DNA appeared only during the asymptomatic period and signaled the onset of the second episode. These data suggest that hydralazine lupus may represent a unique hypersensitivity reaction in which antibodies to native DNA occur. These antibodies may account for the clinical similarities between hydralazine lupus and systemic lupus.
Intraoperative evaluation of coronary artery bypass graft anastomoses with high-frequency epicardial echocardiography: experimental validation and initial patient studies.
Authors: L F Hiratzka, D D McPherson, W C Lamberth, B Brandt, M L Armstrong, E Schröder, M Hunt, R Kieso, M D Megan, P K Tompkins
Journal: Circulation (1986)

There is currently no accepted approach for intraoperative evaluation of the technical adequacy of coronary artery bypass graft anastomoses. High-frequency epicardial echocardiography performed intraoperatively could assess coronary artery bypass graft anastomoses by providing on-line short-axis (cross-sectional) and longitudinal two-dimensional images of the vessels. To validate measurements of anastomoses with high-frequency epicardial echocardiography, luminal diameter determined by high-frequency epicardial echocardiography was compared with that determined histologically after perfusion fixation in 12 dogs studied after coronary artery bypass grafting. Technical errors were deliberately created in some grafts. The results of these animal validation studies showed that maximum luminal diameter of the anastomosis by high-frequency epicardial echocardiography correlated well with histologic measurements (r = .92; high-frequency epicardial echocardiography = 0.8 histology + 0.3). All deliberately created technical errors were detected by an independent observer using high-frequency epicardial echocardiography. After completion of the animal studies, we demonstrated the clinical applicability of this approach in 12 patients. Fifteen coronary artery bypass graft anastomoses were examined intraoperatively with high-frequency epicardial echocardiography. The measured maximum luminal diameter of the anastomosis was greater than the maximum luminal diameter of the native artery, as expected, in all end-to-side anastomoses. However, the maximum luminal diameter of the side-to-side anastomoses was equal to or slightly less than that of the native artery. In this initial patient group, minor technical errors were noted in two of 15 graft anastomoses. In conclusion, high-frequency epicardial echocardiography can accurately measure coronary arterial bypass graft anastomoses and has potential for intraoperative detection of technical errors and inadequacies.
Plasma Epstein-Barr Viral Deoxyribonucleic Acid Quantitation Complements Tumor-Node-Metastasis Staging Prognostication in Nasopharyngeal Carcinoma
Authors: Sing-fai Leung, Benny Zee, Brigette B. Ma, Edwin P. Hui, Frankie Mo, Maria Lai, K.C. Allen Chan, Lisa Y.S. Chan, Wing-hong Kwan, Y.M. Dennis Lo, Anthony T.C. Chan
Journal: Journal of Clinical Oncology (2006)

Purpose To evaluate the effect of combining circulating Epstein-Barr viral (EBV) DNA load data with TNM staging data in pretherapy prognostication of nasopharyngeal carcinoma (NPC). Patients and Methods Three hundred seventy-six patients with all stages of NPC were studied. Pretreatment plasma/serum EBV DNA concentrations were quantified by a polymerase chain reaction assay. Determinants of overall survival were assessed by multivariate analysis. Survival probabilities of patient groups, segregated by clinical stage (I, II, III, or IV) alone and also according to EBV DNA load (low or high), were compared. Results Pretherapy circulating EBV DNA load is an independent prognostic factor for overall survival in NPC. Patients with early-stage disease were segregated by EBV DNA levels into a poor-risk subgroup with survival similar to that of stage III disease and a good-risk subgroup with survival similar to stage I disease. Conclusion Pretherapy circulating EBV DNA load is an independent prognostic factor to International Union Against Cancer (UICC) staging in NPC. Combined interpretation of EBV DNA data with UICC staging data leads to alteration of risk definition of patient subsets, with improved risk discrimination in early-stage disease. Validation studies are awaited.
High-dose VP-16-213 monotherapy for refractory germinal malignancies: a phase II study.
Authors: S N Wolff, D H Johnson, J D Hainsworth, F A Greco
Journal: Journal of Clinical Oncology (1984)

VP-16-213 at standard dose is one of the more active agents for the treatment of germ cell tumors. In previous phase I studies, VP-16-213 has been investigated in suprastandard dose when hematopoietic reconstitution was assured by autologous bone marrow transplantation (ABMT). This phase II study was performed to explore the possibility that an augmented dose of VP-16-213 may be more active than standard dose against germ cell tumors. Eleven patients with progressive refractory germ cell tumors were treated with high-dose VP-16-213: 2,400 mg/m2 with ABMT every three to four weeks followed by 1,200 mg/m2 without ABMT. Seven patients had received VP-16-213 at standard dose prior to high-dose VP-16-213. Toxicity to high-dose VP-16-213 included severe myelosuppression, nausea, vomiting, alopecia, mucositis, and hepatitis. Of 10 evaluable patients, two complete responses and four partial responses, all of short duration, were obtained. However, some patients unresponsive to standard-dose VP-16-213 exhibited responses to the augmented-dose VP-16-213. Therefore, although more myelosuppressive, VP-16-213 may have increased activity against germ cell tumors when administered at augmented dose. High-dose VP-16-213 may be considered in designing new approaches for initial management of patients with germ cell tumors not expected to be cured with standard chemotherapy.
Multiple microcrystal deposition within a family.
Authors: M Doherty, P A Dieppe
Journal: Annals of the Rheumatic Diseases (1985)

A family is described in which four members in three generations showed evidence of crystal deposition disease: two developed calcium pyrophosphate dihydrate (CPPD) crystal deposition, one calcific periarthritis, and one mixed crystal deposition disease (gout + chondrocalcinosis). This previously undescribed observation supports a possible role for nonspecific heritable connective tissue factors in predisposing to crystal deposition.
Empiric Antimicrobial Regimens for Fever When Profound (&lt; 100/μL) Granulocytopenia Persists
Authors: Jai H. Joshi
Journal: Journal of Clinical Oncology (2014)

TO THE EDITOR: There have been many trials evaluating empiric antimicrobial regimens for efficacy in granuloctopenic patients with cancer experiencing fever. The most difficult to treat febrile episodes are seen when profound ( 100/ L) granulocytopenia persists for the duration of antimicrobial therapy. In that circumstance, in which numbers of patients are usually inadequate to determine statistical significance, our premise for using two synergistic antibiotics empirically for all febrile episodes was based on the significantly better responses we saw for Gram-negative bacteremia in those with persistent profound granulocytopenia. It is in this setting that comparative efficacy should be determined. Only then can investigators claim first-line empiric antibiotic status for their study regimen (even for epidemiologic settings characterized by a high prevalence of infections caused by MDR microorganisms). Superiority must be shown for infections when profound ( 100/ L) granulocytopenia does not remit. At the onset of a febrile episode in the setting of profound granulocytopenia, neither the infecting pathogen nor the duration of granulocytopenia is known, but the choice of antibiotics is crucial. For episodes in which fever almost always resolves with granulocyte recovery and antibiotics can be discontinued, the choice of antibiotics is not crucial. The same is also true for episodes where antimicrobial therapy can be prudently discontinued even when both fever and profound granulocytopenia persist but an infection has not been documented. The subgroup for whom the choice is crucial is patients in whom a potentially severe, life-threatening infection can occur and profound granulocytopenia does not resolve.
Prevalence and Predictors of Sexual Dysfunction in Patients With Type 1 Diabetes
Authors: Paul Enzlin, Chantal Mathieu, Annick Van den Bruel, Dirk Vanderschueren, Koen Demyttenaere
Journal: Diabetes Care (2003)

This study aimed to 1) measure the prevalence of sexual dysfunction in patients with diabetes; 2) describe how descriptive variables, psychological variables, diabetic complications, and sexual dysfunction relate in patients with diabetes; and 3) describe the predictors of sexual dysfunction in patients with diabetes.A total of 240 adult type 1 diabetic patients visiting the outpatient diabetes clinic of a university hospital completed questionnaires evaluating psychological adjustment to diabetes and sexual functioning. Medical records were used to obtain HbA(1c) values as well as information on microvascular diabetic complications.Sexual dysfunction was reported by 27% of women and 22% of men. No differences were found between sexes in type of reported sexual dysfunction. In men, but not in women, sexual dysfunction was related to age, BMI, duration of diabetes, and diabetic complications. No correlation with HbA(1c) was found in either sex. In women, but not in men, sexual dysfunction was related to depression and the quality of the partner relationship. Binary logistic regression demonstrated that, in men, the significant predictors of sexual dysfunction were higher age and presence of complications, whereas, in women, sexual dysfunction was related to depression.Both women and men with diabetes are at increased risk for sexual dysfunction. This study suggests that in men with diabetes, sexual dysfunction is related to somatic and psychological factors, whereas in women with diabetes, psychological factors are more predominant.
Relationship between Dialysis Modality and Mortality
Authors: Stephen P McDonald, Mark R Marshall, David W Johnson, Kevan R Polkinghorne
Journal: Journal of the American Society of Nephrology (2008)

Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. In this study, mortality was compared between patients treated with PD and HD (including home HD) using data from 27,015 patients in the Australia and New Zealand Dialysis and Transplant Registry, 25,287 of whom were still receiving PD or HD 90 d after entry into the registry. Overall mortality rates were significantly lower during the 90- to 365-d period among those being treated with PD at day 90 (adjusted hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.81 to 0.99]; P < 0.001). This effect, however, varied in direction and size with the presence of comorbidities: Younger patients without comorbidities had a mortality advantage with PD treatment, but other groups did not. After 12 mo, the use of PD at day 90 was associated with significantly increased mortality (adjusted HR 1.33; 95% CI 1.24 to 1.42; P < 0.001). In a supplementary as-treated analysis, PD treatment was associated with lower mortality during the first 90 d (adjusted HR 0.67; 95% CI 0.56 to 0.81; P < 0.001). These data suggest that the effect of dialysis modality on survival for an individual depends on time, age, and presence of comorbidities. Treatment with PD may be advantageous initially but may be associated with higher mortality after 12 mo.
Oxidative Phosphorylation in Mitochondria Isolated from Chronically Stressed Dog Hearts
Authors: CLINTON D. STONER, MEHDI M. RESSALLAT, HOWARD D. SIRAK
Journal: Circulation Research (1968)

Oxidative and phosphorylative activities were measured polarographically in mitochondria isolated from the right and left ventricles of normal and chronically stressed dog hearts. Chronic myocardial stress was produced experimentally by surgical procedures (combined tricuspid insufficiency and pulmonary stenosis, pulmonary insufficiency, aortic stenosis, aortic insufficiency, Potts's anastomosis) and by inducing thyrotoxicosis. Experimental stress periods ranged from 332 to 608 days. Some of the dogs had overt symptoms of congestive heart failure at the time they were killed. Mitochondria isolated from the stressed hearts had abnormally high values for oxidative activity and respiratory control ratios when incubated in the presence of malate-pyruvate. In the presence of succinate, they had either normal or slightly elevated values for oxidative activity and respiratory control ratios. No differences were found between mitochondria from normal and stressed hearts with regard to the efficiency (ADP/O) of oxidative phosphorylation. Estimates of mitochondrial protein per gram of myocardial tissue indicated that the stressed hearts contained normal amounts of mitochondria. The results of this study suggest that the mitochondrial oxidative and phosphorylative capabilities of the chronically stressed myocardium are not impaired.
A1C but Not Serum Glycated Albumin Is Elevated in Late Pregnancy Owing to Iron Deficiency
Authors: Kunihiko Hashimoto, Sanai Noguchi, Yasuhiko Morimoto, Shinichi Hamada, Kenshi Wasada, Shiro Imai, Yuji Murata, Soji Kasayama, Masafumi Koga
Journal: Diabetes Care (2008)

A1C levels have been shown to be elevated in relation to glycemia in late pregnancy, although the precise mechanisms remain undetermined. We hypothesized that iron deficiency is involved in the A1C increase in late pregnancy.In study 1, A1C, serum glycated albumin, erythrocyte indexes, and iron metabolism indexes were determined in 47 nondiabetic pregnant women not receiving iron supplementation who were divided into four groups according to gestational period (group I, 21-24 weeks; group II, 25-28 weeks; group III, 29-32 weeks; and group IV, 33-36 weeks). In study 2, these determinants were obtained at two gestational periods (20-23 weeks and 32-33 weeks) in 17 nondiabetic pregnant women.In study 1, A1C levels were higher in groups III and IV than those in groups I and II, whereas serum glycated albumin levels were not different among these four groups. Hemoglobin, mean corpuscular hemoglobin (MCH), serum transferrin saturation, and serum ferritin were lower in groups III and IV. A1C levels were negatively correlated with MCH, serum transferrin saturation, and serum ferritin. In study 2, A1C levels were significantly increased at gestational weeks 32-33 from those at weeks 20-23, whereas serum glycated albumin levels did not differ between the two gestational periods. MCH, serum transferrin saturation, and serum ferritin were decreased at gestational weeks 32-33. A1C levels showed a negative correlation with MCH, serum transferrin saturation, and serum ferritin.A1C levels were elevated in late pregnancy owing to iron deficiency. Serum glycated albumin may offer a better index for monitoring glycemic control in pregnancy.
Evidence for a Population Expansion in the West Nile Virus Vector Culex tarsalis
Authors: M. Venkatesan, C. J. Westbrook, M. C. Hauer, J. L. Rasgon
Journal: Molecular Biology and Evolution (2007)

Population genetic structure of the West Nile Virus vector Culex tarsalis was investigated in 5 states in the western United States using 5 microsatellite loci and a fragment of the mitochondrial reduced form of nicotinamide adenine dinucleotide dehydrogenase 4 (ND4) gene. ND4 sequence analysis revealed a lack of isolation by distance, panmixia across all populations, an excess of rare haplotypes, and a star-like phylogeny. Microsatellites revealed moderate genetic differentiation and isolation by distance, with the largest genetic distance occurring between populations in southern California and New Mexico (FST = 0.146). Clustering analysis and analysis of molecular variance on microsatellite data indicated the presence of 3 broad population clusters. Mismatch distributions and site-frequency spectra derived from mitochondrial ND4 sequences displayed pattern's characteristic of population expansion. Fu and Li's D* and F*, Fu's FS, and Tajima's D statistics performed on ND4 sequences all revealed significant, negative deviations from mutation-drift equilibrium. Microsatellite-based multilocus heterozygosity tests showed evidence of range expansion in the majority of populations. Our results suggest that C. tarsalis underwent a range expansion across the western United States within the last 375,000–560,000 years, which may have been associated with Pleistocene glaciation events that occurred in the midwestern and western United States between 350,000 and 1 MYA.