tbuckley/cabot-search huggingface dataset:
OC-014 Management of low-grade dysplasia in ulcerative colitis in the uk national health service: the cost-effectiveness of immediate surgery versus ongoing surveillance
Authors: B Parker, J Buchanan, S Wordsworth, J East, S Keshav, B George
Journal: Gut (2015)

<h3>Introduction</h3> Ongoing surveillance is a potential treatment strategy in the UK National Health Service (NHS) for ulcerative colitis patients who are diagnosed with low-grade dysplasia (LGD) of the flat mucosa, with no associated endoscopically visible lesion. However, given the increased cancer risk following a finding of flat LGD, the costs associated with long-term surveillance and the likely eventual need for surgery, immediate proctocolectomy for flat LGD may both improve health outcomes and also save healthcare costs. The aim of this study was to establish the cost-effectiveness of ongoing surveillance versus immediate surgery for this patient group in the UK NHS. <h3>Method</h3> Economic modelling was used to address this decision problem. A Markov model was constructed in which cohort analysis was used to evaluate costs and health outcomes for patients aged from 25–75 years with none, one or two comorbidities affecting surgical risk. Two outcome measures were used: life years and quality adjusted life years (QALYs). The model reflected current UK clinical practice, considered a timeframe of 20 years and adopted a health service perspective. Incremental cost-effectiveness ratios for surveillance versus surgery were calculated. One-way sensitivity analysis was used to establish the key model parameters, while probabilistic sensitivity analysis and cost-effectiveness acceptability curves were used to quantify the overall decision uncertainty. <h3>Results</h3> Ongoing surveillance was cost-effective at a threshold of £30,000/QALY gained at age 62 in the presence of no comorbidities, age 60 in the presence of one comorbidity and at age 51 in the presence of two comorbidities. These results are sensitive to both the colorectal cancer incidence rate for patients under surveillance and to the quality of life in remission post-surgery. There is, however, uncertainty around the results in some age groups: the probability of surveillance being cost-effective is 56.6% at age 65 in the presence of neither of the comorbidities considered (Table 1). <h3>Conclusion</h3> This study represents the first economic evaluation of surveillance versus surgery in this patient population. As such, this study adds clarity to a decision around which best practice is currently uncertain, and clearly demonstrates which factors are most important for decision-making in this area. Ongoing surveillance may be a cost-effective strategy in this patient population, but only in specific patient subgroups (older patients with multiple comorbidities). In younger patients with fewer comorbidities, surgery likely saves healthcare costs and improves health outcomes. <h3>Disclosure of interest</h3> None Declared.
Minimal Physical Health Risk Associated With Long-term Cannabis Use—But Buyer Beware
Authors: Kevin P. Hill, Roger D. Weiss
Journal: JAMA (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
A Patient with Syncope
Authors: Michelle C. Fox, Monica Sircar, Anand Vaidya, Joel T. Katz, Neal Lakdawala
Journal: New England Journal of Medicine (2013)

A 35-year-old man presented to the emergency department after a sudden loss of consciousness while playing soccer with friends. He recalled the sudden onset of lightheadedness and a tingling sensation across his forehead for a few seconds before he lost consciousness. He had no history of head trauma, chest pain, palpitations, dyspnea, anxiety, nausea, lightheadedness, or loss . . .
A New Method for the Histochemical Demonstration of Acid Phosphatase&lt;xref ref-type="fn" rid="fn1"&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/xref&gt;
Authors: Seligman, Arnold M., Manheimer, Leon H.
Journal: JNCI Journal of the National Cancer Institute (1949)

Journal Article A New Method for the Histochemical Demonstration of Acid Phosphatase Get access Arnold M. Seligman, Arnold M. Seligman assistant professor of surgery Search for other works by this author on: Oxford Academic PubMed Google Scholar Leon H. Manheimer Leon H. Manheimer research associate Kirstein Laboratory for Surgical Research, Beth Israel Hospital, Boston, and the Department of Surgery, Harvard Medical School Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 9, Issue 5-6, April-June, Pages 427–434, https://doi.org/10.1093/jnci/9.5-6.427 Published: 01 April 1949 Article history Received: 29 October 1948 Published: 01 April 1949
Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study
Authors: Matthew Maddocks, Samantha S C Kon, Jane L Canavan, Sarah E Jones, Claire M Nolan, Alex Labey, Michael I Polkey, William D-C Man
Journal: Thorax (2016)

Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown.To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation.816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex.209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty.Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term.
AB1198 Effect of Underwater Ultrasound Therapy on Hand Function and Quality of Life in Patients with Rheumatoid Arthritis
Authors: M. Kiraly, F. Szanyό, T. Bender
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Rheumatoid arthritis (RA) is a progressive inflammatory disease leading to joint destruction. Treatment goals include reducing pain and inflammation as well as preventing joint destruction and maintain working ability. Not only conventional and biological disease-modifying anti-rheumatic drugs (DMARDs) but also non-pharmacologic treatment, such as physiotherapy, can contribute to pain relief, reduction of inflammation, improvement in function and quality of life. <h3>Objectives</h3> The aim of this study was to evaluate the effect of underwater ultrasound therapy on function and quality of life in RA patients. We conducted a randomized, placebo-controlled, double-blind, follow-up study. <h3>Methods</h3> The study included 50 RA outpatients with low disease activity (3.2 Outcome measures included disease activity parameters, such as DAS28, ESR, CRP, swollen and tender joint counts; hand function assessments, as well as Health Assessment Questionnaire (HAQ) and a Self-Report Questionnaire. Study parameters were recorded at baseline, immediately after treatment and three months later. <h3>Results</h3> Disease activity parameters, DAS28 (3.9±0.6 and 3.3±1.1 p&lt;0.001), ESR (23.6±18.1 mm/h and 19.1±12.8 mm/h p=0.023) and CRP (11.1±9.4 mg/l and 6.0±8.3 mg/l p=0.01) showed a significant decrease from baseline to the third month in the treated group compared to the placebo group (DAS28: 4.1±0.6 and 3.8±0.8 p=0.061 ESR: 22.3±12.2 mm/h and 22.9±12.5 mm/h p=0.819 CRP: 6.1±7,8 mg/l and 6.1±7,5 mg/l p=0.987). HAQ also decreased significantly from baseline to the third month (1,3±0.8 and 1.1±0.8 p=0.018) in the treated group. Patients in both groups reported improvement in Self-Report Questionnaire either by the second week or by the third month, respectively (64% and 52% vs 61% and 61%). Hand function improved during the study period in the treated group and statistically significant improvement was revealed in the extension of the left wrist by the third month in group I (59.9±18.9 degree and 64.7±16.8 degree p=0.044). <h3>Conclusions</h3> Underwater ultrasound treatment of patients with RAs can be an additional therapy apart from conventional and biological DMARDs resulting in improvement of function and quality of life. <h3>Disclosure of Interest</h3> None declared
OC-090 Quality of life and cleanliness – the key factors for patients undergoing urgent cholecystectomy
Authors: E Parkin, M Stott, S Galloway, I Welch, A Macdonald
Journal: Gut (2015)

<h3>Introduction</h3> Ten to 15% of the population have gallstones. Surgery is the mainstay of treatment with around 60,000 cholecystectomies being performed every year in the UK. The recent AUGIS commissioning guideline for gallstone disease lists readmission rates, day-case rates, and the proportion undergoing laparoscopic surgery as key quality specifications. In the national CholeS study, data was collected on antibiotic prophylaxis, laparoscopic versus SILS versus open, operative duration and degree of difficulty for the surgeon. But do these outcomes really matter to patients? The aim of this study was to identify a “top-5” list of factors important to patients presenting with acute gallstone disease. <h3>Method</h3> We performed a systematic review and identified all outcomes used in surgical trials for gallstone disease in the last 5 years. We also conducted a preliminary study whereby 10 patients with gallstones were asked to document their “top 5” outcomes on a blank sheet of paper. These results were combined to produce a 41-item survey that was given to patients presenting as an emergency with gallstone pathology (excluding severe pancreatitis). Patients were surveyed on the admissions ward after reading an information leaflet and prior to surgery being performed. They were asked to score each outcome (for example, “having gallstones treated on the same admission”) on a visual analogue scale of 0–100 in terms of importance to them at that time. Research and Development approval was obtained. <h3>Results</h3> Twenty-six patients were prospectively surveyed. The median age was 46.5 years (range 21–77); 23 patients were female. Fourteen had cholecystitis, 5 had pancreatitis, 6 had biliary colic, 1 had a CBD stone. The joint top-scoring outcomes (median = 96/100) were “long-term quality of life after surgery” and “cleanliness of the ward/theatre”; followed by “standards of nursing care” (95), “pain control” and “overall satisfaction with the procedure” (both 94). The lowest scoring outcome was “being treated as a day-case” (53); followed by “stories about the hospital in local/national press” (54), “cosmetic outcome” (60), “short time before returning to normal diet” (61) and “the hospital’s ranking in NHS surveys” (66). <h3>Conclusion</h3> This pilot study has shown that for patients with acute gallstone pathology requiring cholecystectomy, the most important factors centre on cleanliness of the ward environment and long-term satisfaction and quality of life. Outcomes that surgeons perceive to be important (day-case rates, cosmesis) were actually ranked very low. When deciding upon end-points and quality metrics, future studies and guidelines need to take in to account the opinions of patients as well as those of the surgical community. <h3>Disclosure of interest</h3> None Declared.
Computational Exposure Science: An Emerging Discipline to Support 21st-Century Risk Assessment
Authors: Peter P. Egeghy, Linda S. Sheldon, Kristin K. Isaacs, Halûk Özkaynak, Michael-Rock Goldsmith, John F. Wambaugh, Richard S. Judson, Timothy J. Buckley
Journal: Environmental Health Perspectives (2015)

Computational exposure science represents a frontier of environmental science that is emerging and quickly evolving.In this commentary, we define this burgeoning discipline, describe a framework for implementation, and review some key ongoing research elements that are advancing the science with respect to exposure to chemicals in consumer products.The fundamental elements of computational exposure science include the development of reliable, computationally efficient predictive exposure models; the identification, acquisition, and application of data to support and evaluate these models; and generation of improved methods for extrapolating across chemicals. We describe our efforts in each of these areas and provide examples that demonstrate both progress and potential.Computational exposure science, linked with comparable efforts in toxicology, is ushering in a new era of risk assessment that greatly expands our ability to evaluate chemical safety and sustainability and to protect public health.Egeghy PP, Sheldon LS, Isaacs KK, Özkaynak H, Goldsmith M-R, Wambaugh JF, Judson RS, Buckley TJ. 2016. Computational exposure science: an emerging discipline to support 21st-century risk assessment. Environ Health Perspect 124:697-702; http://dx.doi.org/10.1289/ehp.1509748.
Therapy of patients with human T-cell lymphotrophic virus I-induced adult T-cell leukemia with anti-Tac, a monoclonal antibody to the receptor for interleukin-2
Authors: TA Waldmann, CK Goldman, KF Bongiovanni, SO Sharrow, MP Davey, KB Cease, SJ Greenberg, DL Longo
Journal: Blood (1988)
Observations on Inclusion Bodies in Normal and Pathologic Mucosa of the Colon in Man&lt;xref ref-type="fn" rid="FN1"&gt;2&lt;/xref&gt;
Authors: Benito Monis, M.D., Albert I. Mendeloff, M.D.
Journal: JNCI Journal of the National Cancer Institute (1961)

Specimens of histologically normal and pathologic colonic mucosa in man with diseases such as ulcerative colitis, adenomatous polyps, carcinoma, acute and chronic diverticulitis, and acute suppurative appendicitis revealed similar spheroidal bodies demonstrable with the Feulgen's technique. These bodies were found intracellularly in epithelial cells and extracellularly in the adjacent lamina propria or stroma and in luminal material. They were localized mostly in cytoplasm but in certain cases were also found within nuclei. The presence of inclusion bodies in benign and malignant intestinal polyps and in ulcerative colitis has been previously reported by others, who suggested that they are evidence of the viral nature of these diseases. The reactivity of inclusion bodies with the Feulgen's technique is merely cytochemical evidence that they contain deoxyribonucleic acid (DNA). Since this technique does not indicate the origin and pathway of formation of the DNA shown in inclusion bodies, more factual evidence is required to support the stimulating hypotheses that they are cytologic evidence of the viral nature of intestinal polyps and ulcerative colitis. Inclusion bodies were found in 66 percent of the cases of ulcerative colitis in this study. The incidence of carcinoma in patients with ulcerative colitis is 3 to 6 percent in various series. Therefore, the suggested relationship between ulcerative colitis and intestinal polyps and carcinoma, on the basis of the finding of inclusion bodies in all these conditions, seems not to be supported by the correlation frequency of inclusion bodies and incidence of carcinoma in ulcerative colitis. It is suggested that degenerating cell processes and migration of leukocytes through the epithelium of the intestinal mucosa may account for the particles of DNA in the intestinal mucosa of man reported in this and other studies.
Case 48-1970
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Herbert J. Levine, Benjamin Castleman
Journal: New England Journal of Medicine (1970)

PRESENTATION OF CASEA 45-year-old woman was admitted to the hospital because of a changing cardiac murmur.At the age of 17 years she had been informed that she had a heart murmur. No restrictions were imposed upon her, and she underwent two eventful pregnancies at 23 and 26 years of age. Ten years before admission she began to have episodes of pallor and cyanosis of the hands on exposure to cold; cyanosis was never observed elsewhere. Eight months before entry she was informed that she had hypertension, and treatment with hydroclorothiazide and spironolactone was begun. Three months before admission . . .
FRI0157 Discrepancies Between Clinical and Antidestructive Effects of Rituximab in Rheumatoid Arthritis (RA)
Authors: A.V. Pivanova, G.V. Lukina, Ya.A. Sigidin, A.V. Smirnov, K.H. Kuzikyants, A.Yu. Kuznetsova, E.L. Nasonov
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Rheumatoid arthritis is a chronic autoimmune disease characterised by inflammation of the synovial tissue and destruction of the underlying cartilage and bone. The goal of antirheumatic treatment is not only to attenuate the clinical symptoms of joint inflammation, but also to inhibit the progression of joint destruction. Rituximab treatment slowed joint damage without clinical improvement. Noteworthy, clinical and antidestructive effects often did not coincide. <h3>Objectives</h3> Comparison of clinical and antidestructive effect of Rituximab (RTX). <h3>Methods</h3> Clinical and radiological study of 61 patients (pts) with RA (mean disease duration 10,1±7,7 years, mean DAS28 6,3±0,94, RF-positive 87%, ACCP-positive 93%) treated with RTX (1000 mgx2 or 500 mgx2). Clinical effect was assessed by EULAR criteria; radiological progression by SVH method. <h3>Results</h3> Pronounced therapeutic effect of RTX was noted. By the 48-th week after receiving 2 courses of RTX good clinical response was registered in 29.7% (remissions – 14,6%); good and satisfactory responses in 85.3%. Antidestructive effect of RTX was also significant. After 48 weeks of treatment progression of articular destruction was absent in all pts in clinical remission, in 83% of pts with low disease activity, and in 43% of pts with moderate activity. Narrowing of joint space was more pronounced than bone destruction – 32% and 25% respectively. Clinical and antidestructive effects often did not coincide. Noteworthy, RTX treatment slowed joint damage in 54% of pts without clinical improvement. There were no significant correlations between clinical outcomes and doses of RTX. The inhibition of radiological progression was more pronounced in pts treated with higher doses of RTX. <h3>Conclusions</h3> Clinical and antidestructive results did not always coincide which suggests different mechanisms of clinical and antidestructive effects of anti-B-cell therapy. The therapeutic effect of different doses of RTX was practically the same but the antidestructive effect of higher doses was significantly greater. <h3>Disclosure of Interest</h3> None declared
Separation Anxiety
Authors: Hedy S Wald
Journal: JAMA (2009)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal