tbuckley/cabot-search huggingface dataset:
Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors
Authors: S. Horrocks
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objective:</b> To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting. <b>Design:</b> Systematic review of randomised controlled trials and prospective observational studies. <b>Data sources:</b> Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies. <b>Included studies:</b> Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care. <b>Results:</b> 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations. <b>Conclusion:</b> Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care. <h3>What is already known on this topic</h3> Nurse practitioners have existed in North America for many years An increasing number of such nurses are being employed in the United Kingdom in general practice, emergency departments, and other primary care settings Reviews suggest that nurse practitioners are equivalent to doctors on most variables studied, but the relevance of this in the context of the NHS is unclear <h3>What this study adds</h3> Patients are more satisfied with care from a nurse practitioner than from a doctor, with no difference in health outcomes Nurse practitioners provide longer consultations and carry out more investigations than doctors Most recent research has related to patients requesting same day appointments for minor illness, which is only a limited part of a doctor9s role
A survey of asthma mortality in patients between ages 35 and 64 in the Greater London hospitals in 1971.
Authors: G M Cochrane, J H Clark
Journal: Thorax (1975)

We have examined the death certificates from all patients aged 35-64 years who were recorded as dying from asthma in Greater London Council hospitals in 1971. Of the 47 death certificates studied, nine suggested that the primary cause of death was not asthma. From the remaining 38 deaths we have obtained 36 case records and found that 15 deaths occurred outside hospital and another two patients died in hospital having been admitted in a stable state. We have examined the remaining 19 case records to find out the circumstances of death in patients with asthma who die in hospital. We have been unable to exclude the possibility that many of the deaths in hospital were avoidable. Assessment of severity in most patients was incomplete, as judged by a retrospective analysis of case records, and many of the patients would be regarded as having had insufficient treatment. Four patients did not receive corticosteroids and in a further three the dose given was small. No physiological assessment of airflow obstruction was made in over half the patients. A comparison with 19 survivors of an admission to hospital with asthma did not provide enough information to account for the deaths. The survivors were in hospital for a shorter period of time, were slightly less ill, and were given comparable treatment regimens. Both groups of patients were inadequately assessed, and sedatives were given to approximately 70% of all subjects studied. The deaths in hospital usually occurred suddenly in the early morning in general medical wards.
Checklists for myocardial infarction should be precise
Authors: G A. Cooke
Journal: BMJ (2003)

EDITOR—Savage and Channer highlight a serious problem in their editorial on managing acute myocardial infarction.1 Doctors are under increasing pressure to reduce door to needle times to below 30 (possibly 20) minutes and often now delegate this task to thrombolysis nurses. Such nurses are accountable for the door to needle time and are often blamed if the …
Cholinergically mediated tachyarrhythmias induced by a single extrastimulus in the isolated canine right atrium.
Authors: R B Schuessler, T M Grayson, B I Bromberg, J L Cox, J P Boineau
Journal: Circulation Research (1992)

Cholinergic agonists and vagal stimulation potentiate the inducibility of atrial fibrillation. To describe the activation patterns and determine the mechanisms that sustain cholinergic fibrillation, tachyarrhythmias were induced with a single extrastimulus in the isolated Krebs-Henseleit-perfused canine right atrium (n = 11) at increasing concentrations of acetylcholine (from 10(-7.5) to 10(-4.5) M). Bipolar electrograms were recorded from 250 epicardial sites simultaneously during control conditions and during extrastimulation (S1S1, 300 msec; S1S2, effective refractory period+5 msec) with and without acetylcholine. Activation sequence maps were constructed from each recording. Without acetylcholine, no tachyarrhythmias were induced. With increasing concentrations of acetylcholine, the refractory period decreased, and nonsustained (< 2 seconds) rapid repetitive responses were induced. At higher concentrations, a sustained (> 2-minute) fibrillation was induced. Activation sequence maps revealed that the rapid repetitive responses were characterized by multiple reentrant circuits. The number of circuits and wavelets increased in a dose-dependent fashion. However, unexpectedly, this trend did not continue when the tachyarrhythmia became sustained. Instead, the reentry tended to stabilize to a small, single, relatively stable reentrant circuit. In conclusion, the data suggest that, in this model, below a critical level of refractory period (< 95 msec) atrial reentrant circuits, unassociated with anatomic obstacles, can become stable and dominate activation.
The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis
Authors: T.E.M. Verhagen, D.J. Hendriks, L.F.J.M.M. Bancsi, B.W.J. Mol, F.J.M. Broekmans
Journal: Human Reproduction Update (2008)

To review the accuracy of multivariate models for the prediction of ovarian reserve and pregnancy in women undergoing IVF compared with the antral follicle count (AFC) as single test. We performed a computerized MEDLINE and EMBASE search to identify articles published on multivariate models for ovarian reserve testing in patients undergoing IVF. In order to be selected, articles had to contain data on the outcome of IVF in terms of either pregnancy and/or poor response and on the prediction of these events based on a multivariate model. For the selected studies, sensitivity and specificity of the test in the prediction of poor ovarian response and non-pregnancy were calculated. Overall performance was assessed by estimating a summary receiver operating characteristic (ROC) curve, which was compared with the ROC curve for the AFC as the current best single test. We identified 11 studies reporting on the predictive capacity of multivariate models in ovarian reserve testing. All studies reported on the prediction of poor ovarian response, whereas none reported on the occurrence of pregnancy. The sensitivity for prediction of poor ovarian response varied between 39% and 97% and the specificity between 50% and 96%. Logistic regression analysis indicated that cohort studies provided a significantly better discriminative performance than case–control studies. As cohort studies are superior to case–control studies, further analysis was limited to the cohort studies. For the cohort studies, a summary ROC curve could be estimated, which had a shape similar to that previously made for the AFC. The accuracy of multivariate models for the prediction of ovarian response in women undergoing IVF is similar to the accuracy of AFC. No data are available on the capacity of these models to predict pregnancy, let alone live birth. On the basis of these findings, the use of more than one single test for the assessment of ovarian reserve cannot currently be supported.
Enhancement of blood coagulation by soluble fibrin complexes.
Authors: M S Hansen, N U Bang, R D Barton, L E Mattler
Journal: The Journal of Experimental Medicine (1975)

We have detected a species of soluble fibrin complexes with significant biological properties. Agarose gel chromatography of normal plasma or purified fibrinogen previously incubated with small amounts of thrombin revealed the presence of a species of high molecular weight soluble fibrin complexes, which contained only small quantities of fibrinogen by immunological assays but which exhibited enhanced sensitivity to thrombin. In addition, these complexes substantially shortened the thrombin-clotting time of normal plasma and enhanced the resistance of normal plasma to heparin action. Similar thrombin-sensitive soluble fibrin complexes were demonstrated in vivo in rabbits for up to 10 min after the infusion of 50 U of thrombin. Thrombin-sensitive soluble fibrin complexes were also demonstrated in 3 of 12 patients with documented thromboembolic disease and in 2 of 20 patients after major surgery. High molecular weight soluble fibrin complexes, which exhibit enhanced thrombin sensitivity and which are capable of increasing the rate of normal fibrinogen-to-fibrin conversion by thrombin, may appear consequent to clinical thrombosis and situations involving trauma (e.g., major surgery). Such soluble complexes, although they have no proven role in the primary pathogenesis of intravascular thrombosis, may contribute to a temporary "hypercoagulable state" and may accelerate the build-up and extension of already existing thrombotic deposits.
Analysis of the Amborella trichopoda Chloroplast Genome Sequence Suggests That Amborella Is Not a Basal Angiosperm
Authors: V. V. Goremykin
Journal: Molecular Biology and Evolution (2003)

Phylogenetic analyses based on comparison of a limited number of genes recently suggested that Amborella trichopoda is the most ancient angiosperm. Here we present the complete sequence of the chloroplast genome of this plant. It does not display any of the genes characteristic of chloroplast DNA of the gymnosperm Pinus thunbergii (chlB, chlL, chlN, psaM, and ycf12). The majority of phylogenetic analyses of protein-coding genes of this chloroplast DNA suggests that Amborella is not the basal angiosperm and not even the most basal among dicots.
Critical Contribution of Tumor Necrosis Factor–Related Apoptosis-Inducing Ligand (Trail) to Apoptosis of Human Cd4+T Cells in HIV-1–Infected Hu-Pbl-Nod-Scid Mice
Authors: Yoshiharu Miura, Naoko Misawa, Naoyoshi Maeda, Yoshio Inagaki, Yuetsu Tanaka, Mamoru Ito, Nobuhiko Kayagaki, Naoki Yamamoto, Hideo Yagita, Hidehiro Mizusawa, Yoshio Koyanagi
Journal: The Journal of Experimental Medicine (2001)

Apoptosis is a key for CD4+ T cell destruction in HIV-1–infected patients. In this study, human peripheral blood lymphocyte (PBL)-transplanted nonobese diabetic (NOD)-severe combined immunodeficient (SCID) (hu-PBL-NOD-SCID) mice were used to examine in vivo apoptosis after HIV-1 infection. As the hu-PBL-NOD-SCID mouse model allowed us to see extensive infection with HIV-1 and to analyze apoptosis in human cells in combination with immunohistological methods, we were able to quantify the number of apoptotic cells with HIV-1 infection. As demonstrated by terminal deoxynucleotidyl transferase–mediated dUTP nick-end labeling (TUNEL), massive apoptosis was predominantly observed in virus-uninfected CD4+ T cells in the spleens of HIV-1–infected mice. A combination of TUNEL and immunostaining for death-inducing tumor necrosis factor (TNF) family molecules indicated that the apoptotic cells were frequently found in conjugation with TNF-related apoptosis-inducing ligand (TRAIL)-expressing CD3+CD4+ human T cells. Administration of a neutralizing anti-TRAIL mAb in HIV-1–infected mice markedly inhibited the development of CD4+ T cell apoptosis. These results suggest that a large number of HIV-1–uninfected CD4+ T cells undergo TRAIL-mediated apoptosis in HIV-infected lymphoid organs.
Rexinoid-Triggered Differentiation and Tumor-Selective Apoptosis of Acute Myeloid Leukemia by Protein Kinase A–Mediated Desubordination of Retinoid X Receptor
Authors: Lucia Altucci, Aurélie Rossin, Oliver Hirsch, Angela Nebbioso, Dominique Vitoux, Emmanuelle Wilhelm, Fabien Guidez, Mariacarla De Simone, Ettore Mariano Schiavone, David Grimwade, Arthur Zelent, Hugues de Thé, Hinrich Gronemeyer
Journal: Cancer Research (2005)

Abstract Apart from PML–retinoic acid receptor-α (RARα) acute promyelocytic leukemia all other acute myeloid leukemias (AML) are unresponsive to retinoid differentiation therapy. However, elevating the levels of cyclic AMP (cAMP) confers onto retinoid X receptor (RXR)–selective agonists (“rexinoids”) the ability to induce terminal granulocyte differentiation and apoptosis of all-trans retinoic acid–resistant and insensitive AML cells and patients' blasts. Protein kinase A activation leads to corepressor release from the RAR subunit of the RAR-RXR heterodimer, resulting in “desubordination” of otherwise silent RXR, which acquires transcriptional competence in response to cognate ligands. Rexinoid-cAMP induction of endogenous RARβ is blunted in mouse embryo fibroblasts lacking RARs, but reintroduction of exogenous RARα reestablishes responsiveness, thus confirming that the RARα-RXR heterodimer is the rexinoid mediator. The apoptogenic effect of this treatment involves enhanced expression of the death receptor DR5 and its cognate ligand, tumor necrosis factor–related apoptosis inducing ligand, both of which are known to induce apoptosis in a tumor cell–selective manner and lead to the activation of initiator caspases. Immunohistochemistry confirmed induction of tumor necrosis factor–related apoptosis inducing ligand and DR5 in AML patient blasts cultured ex vivo. AML patients' blasts responded to rexinoid-cAMP combination treatment with induction of maturation and apoptosis, independent of karyotype, immunophenotype, and French-American-British classification status. Clonogenic assays revealed complete inhibition of blast clonogenicity in four out of five tested samples. Our results suggest that despite the genetic, morphologic, and clinical variability of this disease, the combination of rexinoids and cAMP-elevating drugs, such as phosphodiesterase inhibitors, might lead to a novel therapeutic option for AML patients by inducing a tumor-selective death pathway.
PinX1 inhibits the invasion and metastasis of human breast cancer via suppressing NF-κB/MMP-9 signaling pathway
Authors: Meilin Shi, Menghan Cao, Jun Song, Qinghua Liu, Hailong Li, Fei Meng, Zhenqiang Pan, Jin Bai, Junnian Zheng
Journal: Molecular Cancer (2015)

PinX1 (PIN2/TRF1-interacting telomerase inhibitor 1) was suggested to be correlated with tumor progression. This study was designed to evaluate the role of PinX1 in human breast cancer. To evaluate the function of PinX1 in breast cancer, we used a tissue microarray (TMA) of 405 human breast cancer patients and immunohistochemistry to analyze the correlation between PinX1 expression and clinicopathologic variables and patient survival. We also detected the abilities of cell migration and invasion in breast cancer by performing cell migration and invasion assay, gelatin zymography and western blot analysis. Lastly, we set up the nude mice model by Tail vein assay to exam the functional role of PinX1 in breast cancer metastasis. We found that low PinX1 expression was associated with lymph node metastasis (P = 0.002) and histology grade (P = 0.001) in patients, as well as with poorer overall and disease-specific survival (P = 0.010 and P = 0.003, respectively). Moreover, we identified that PinX1 inhibited the migration and invasion of breast cancer by suppressing MMP-9 expression and activity via NF-κB-dependent transcription in vitro. Finally, our mice model confirmed that PinX1 suppressed breast cancer metastasis in vivo. Our data revealed that low PinX1 expression was an independent negative prognostic factor for breast cancer patients. These findings suggested that PinX1 might be function as a tumor metastasis suppressor in the development and progression of breast cancer by regulating the NF-κB/MMP-9 signaling pathway, and might be a prognostic marker as well as a therapeutic target for breast cancer.
Psychotherapy for severe personality disorder: exploring the limits of evidence based purchasing Commentary: Mix of perspectives needed in purchasing of care
Authors: S Kisely
Journal: BMJ (1999)

# Psychotherapy for severe personality disorder: exploring the limits of evidence based purchasing {#article-title-2}

The growing emphasis on practising evidence based medicine has led to debate about how generalisable the findings from experimental studies are to clinical practice. Patients with severe personality disorders, who often pose difficult management problems in both primary and secondary care, illustrate the potential limits of practising evidence based medicine in the commissioning of services. The Department of Health has recently announced the development of therapeutic communities as part of providing a specialist service in England for patients with severe personality disorders (Department of Health, press release, 23 October 1997). This paper looks at the evidence for the option chosen by the department, examines alternatives, and discusses possible consequences.

### Summary points

Patients with severe personality disorders can pose management problems in both primary and secondary care

Much of the literature on treating these disorders has been descriptive or qualitative rather than quantitative, and there have been few randomised controlled trials

Consensus statements by expert groups have come to contradictory conclusions about the best ways to treat patients with severe personality disorders

When the decision to favour one treatment modality is made in the absence of evidence from randomised controlled trials, the development of alternative, and possibly more cost effective, approaches will be hampered

Individuals with a personality disorder show an enduring pattern of inner experience and behaviour that deviates markedly from cultural expectations. These patterns are inflexible and pervasive across a wide range of social and personal situations and lead to clinically significant distress or impairment in social, occupational, and other important areas of functioning.1 Cluster B personality disorders (also termed “dramatic” or severe personality disorders) are one of three clusters of personality disorders. Individuals with severe personality disorders have major difficulties in establishing and maintaining adequate social relationships because of their emotional lability and impulsive behaviour. This cluster includes individuals …
Probiotics in prevention of IgE-associated eczema: A double-blind, randomized, placebo-controlled trial
Authors: Thomas R. Abrahamsson, Ted Jakobsson, Malin Fagerås Böttcher, Mats Fredrikson, Maria C. Jenmalm, Bengt Björkstén, Göran Oldaeus
Journal: Journal of Allergy and Clinical Immunology (2007)
TOXIC AND ESSENTIAL METAL INTERACTIONS
Authors: Robert A. Goyer
Journal: Annual Review of Nutrition (1997)

▪ Abstract Cadmium, lead, mercury, and aluminum are toxic metals that may interact metabolically with nutritionally essential metals. Iron deficiency increases absorption of cadmium, lead, and aluminum. Lead interacts with calcium in the nervous system to impair cognitive development. Cadmium and aluminum interact with calcium in the skeletal system to produce osteodystrophies. Lead replaces zinc on heme enzymes and cadmium replaces zinc on metallothionein. Selenium protects from mercury and methylmercury toxicity. Aluminum interacts with calcium in bone and kidneys, resulting in aluminum osteodystrophy. Calcium deficiency along with low dietary magnesium may contribute to aluminum-induced degenerative nervous disease.
Emotional and Behavioral Symptoms in Neurodegenerative Disease: A Model for Studying the Neural Bases of Psychopathology
Authors: Robert W. Levenson, Virginia E. Sturm, Claudia M. Haase
Journal: Annual Review of Clinical Psychology (2014)

Disruptions in emotional, cognitive, and social behavior are common in neurodegenerative disease and in many forms of psychopathology. Because neurodegenerative diseases have patterns of brain atrophy that are much clearer than those of psychiatric disorders, they may provide a window into the neural bases of common emotional and behavioral symptoms. We discuss five common symptoms that occur in both neurodegenerative disease and psychopathology (i.e., anxiety, dysphoric mood, apathy, disinhibition, and euphoric mood) and their associated neural circuitry. We focus on two neurodegenerative diseases (i.e., Alzheimer's disease and frontotemporal dementia) that are common and well characterized in terms of emotion, cognition, and social behavior and in patterns of associated atrophy. Neurodegenerative diseases provide a powerful model system for studying the neural correlates of psychopathological symptoms; this is supported by evidence indicating convergence with psychiatric syndromes (e.g., symptoms of disinhibition associated with dysfunction in orbitofrontal cortex in both frontotemporal dementia and bipolar disorder). We conclude that neurodegenerative diseases can play an important role in future approaches to the assessment, prevention, and treatment of mental illness.