tbuckley/cabot-search huggingface dataset:
IN-HOSPITAL MORTALITY IN CIRRHOSIS IS RELATED TO NOSOCOMIAL INFECTIONS INDEPENDENT OF MELD SCORE: THE NORTH AMERICAN CONSORTIUM FOR THE STUDY OF END-STAGE LIVER DISEASE (NACSELD) STUDY
Authors: J.S. Bajaj, J.G. O'Leary, K.R. Reddy, J.C. Olson, F. Wong, G. Brown, R. Subramanian, R. Malik, L.R. Thacker, N.A. Noble, P.S. Kamath
Journal: Journal of Hepatology (2012)
NICE issues guidance to tackle multimorbidity
Authors: Jacqui Wise
Journal: BMJ (2016)

GPs should offer a tailored approach for people with multiple long term conditions to reduce the number of prescribed medicines and minimise side effects, new draft guidance from the National Institute for Health and Care Excellence (NICE) has said.1

The number of people in England with three or more long term health conditions is predicted to rise from 1.9 million in 2008 to 2.9 million in 2018. Care for people with multiple conditions is often complicated because the conditions themselves, and …
To screen or not to screen?
Authors: K. Abbasi
Journal: BMJ (1998)

It's that man again. Dr Thomas Stuttaford, medical columnist for the Times and former Conservative member of parliament, has reopened the debate on screening.

In 1995 Dr Stuttaford used his column to advocate a battery of yearly screening tests—from liver function tests to abdominal ultrasound scans—and suggested that these tests would “set your mind at rest,” ignoring the mental distress that screening tests can cause (BMJ 1995;310: 1417). One of the tests he proposed in 1995 was a blood test for prostatic specific antigen (PSA), which is often raised in prostate cancer.

Although asymptomatic, Dr Stuttaford followed his own advice: he had his PSA checked, which was high, and had surgery. On 9 December 1997, as part of the Times Christmas appeal for research into prostate cancer, he described his ordeal with: “A hidden killer that can strike without warning.” He suggested that while radical prostatectomy is a routine procedure in the United States, where screening for prostate cancer is available for people aged over 50, this operation is less common in Britain because of financial considerations. He added that if demand for radical prostatectomy increased in Britain—presumably as a result of a national screening programme—surgeons “may lack the necessary technique” and “anaesthetists may not have …
AB0963 Shoulder Involvement in Daily Practice – an Ultrasound Study
Authors: F. Vreju, B. Chisalau, I. Gofita Cojocaru, M. Ivan, A. Rosu, P. Ciurea
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Objectives</h3> To investigate what is the type of shoulder involvement in daily practice and in what kind of diseases it occurs <h3>Methods</h3> We enrolled 40 consecutive patients with shoulder US findings, with a mean age 59,42±7,5 years and different comorbidities. All patients underwent clinical, biologic and ultrasonographic assessment and they all signed the informed consent. The mean ESR was 26,6±24,6 and the cholesterol level was 212,74±49,6. <h3>Results</h3> The most frequent US finding was subacromial-subdeltoid (SASD) boursitis, which we found in 19 out of 40 patients (47,5%), followed by the supraspinatus tendon involvement, in 15 out of 40 patients (33,3%) and long head of biceps brahialis tendinitis in 11 patients (27,5%). Patients with bilateral SASD bursitis had rheumatoid arthritis (RA) as a main diagnosis. Between the 21 patients with any SASD boursitis, the most frequent diagnosis was RA (11 patients, 52,4%), followed by traumatic involvement of the shoulder (6 patients, 28,6%). In the same way, supraspinatus tendon lesion was mainly found in RA patients (8, 57,14%), followed by traumatic involvement of the shoulder (4,28,6%). Calcifications were found mainly in traumatic involvement of the shoulder, followed by gout and RA patients. <h3>Conclusions</h3> Most patients with shoulder involvement were rheumatoid arthtritis patients and those with traumatic lesions. Patients with boursitis or fluid in the BB tendon sheet were mainly rheumatoid arthritis patients and in the same time, patients with calcifications were mainly those with traumatic shoulder history. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.6067
ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND LONG TERM SURVIVAL IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE: A POST-HOC ANALYSIS OF THE COURAGE TRIAL
Authors: Mandeep S. Sidhu, Pamela Hartigan, David Maron, G.B. John Mancini, John Spertus, Koon Teo, Steven Sedlis, Bernard Chaitman, William Weintraub, William Boden
Journal: Journal of the American College of Cardiology (2016)
P4-12-05: Impact of the Lifestyle Intervention Study in Adjuvant Treatment of Early Breast Cancer (LISA) Weight Loss Intervention upon Physical Activity.
Authors: JA Ligibel, R Segal, G Pond, M-J Dion, KI Pritchard, M Levine, PJ Goodwin
Journal: Cancer Research (2011)

Abstract Observational evidence shows a relationship between obesity and poor prognosis in breast cancer (BC). Physical activity (PA) is an important component of weight loss and maintenance, but most large-scale interventions in BC patients have produced only modest improvements in activity. We sought to evaluate changes in PA in women participating in LISA, a randomized trial coordinated by the Ontario Clinical Oncology Group which was designed to examine the impact of a telephone-based weight loss intervention (WLI) upon disease free survival in BC patients. Methods: Participants were randomized 1:1 to the WLI or educational control (EC) group. Eligibility included diagnosis of Stage I-III BC, BMI ≥24 kg/m2, and treatment with letrozole. The WLI, based on the Diabetes Prevention Program, focused on weight reduction through calorie restriction and increased physical activity. Delivery involved 19 calls, mailings and a participant manual. The PA goal was 150 minutes/week. PA was measured using the International Physical Activity Questionnaire (Short Form) at baseline, 6, 12, and 18 months. Changes in time (minutes/week) spent sitting and engaging in moderate, vigorous, and walking activities were compared between groups. Results 338 women were randomized to WLI (n=171) or EC (n=167) from 20 centers in Canada and the USA. The study was discontinued due to loss of funding. The WLI arm lost significantly more weight than EC arm, with mean weight loss of 6.1% of body weight vs. 0.6% at 12 months (p&amp;lt;0.001). Activity data are presented in Table 1. At baseline, participants were inactive; median vigorous activity was zero minutes/week and median time spent sitting was more than 35 hours/week. WLI participants reported significantly higher participation in vigorous, moderate and walking activities, and lower levels of sedentary behavior, compared to controls at 6 and 12 months. Higher levels of PA were significantly associated with increased weight loss at all time periods. Factors associated with increases in activity included higher baseline BMI (p=0.014), lower baseline activity (p&amp;lt;0.001) and assignment to the WLI arm (p=0.02). Women assigned to WLI increased their PA during the intervention period (p=0.017) even after adjusting for other significant baseline factors. Conclusion Participants in the LISA WLI reported significantly higher levels of PA compared with controls. Activity increased most in women who were heavier and less active at baseline. Further study of this WLI as a potential means to improve BC outcomes is warranted. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-05.
Growing wealth has resulted in greater spending on health, report argues
Authors: N. Hawkes
Journal: BMJ (2013)

<h3>Objective</h3> Obtaining informed consent is a cornerstone requirement of conducting ethical research. Traditional paper-based consent is often excessively lengthy and may fail to achieve the desired participant understanding of study requirements. Multimedia tools including video and audio may be a useful alternative. This study aimed to determine the efficacy, usability and acceptability of self-directed multimedia delivery of participant consent. <h3>Design</h3> It is a single-centre, randomised, prospective study to determine the efficacy, usability and acceptability of a self-directed multimedia consent process (intervention) compared with the traditional paper-based approach (control). The intervention was free of research staff, with computer-based finger-signed consent. <h3>Setting</h3> Pathology blood collection services in Tasmania, Australia. <h3>Participants</h3> 298 participants (63±8 years; 51% female individuals) referred from general practice were randomised to intervention (n=146) and control (n=152). <h3>Outcome measures</h3> Efficacy, usability and acceptability of the allocated consent process were assessed by a questionnaire. <h3>Results</h3> All participants successfully completed the allocated interventions. Efficacy parameters were higher among intervention participants, including a better understanding of study requirements compared with controls (p&lt;0.05 all). Intervention participants were more likely to engage with the study information and spend more time on the consent process (p=&lt;0.001 and p=0.006, respectively). Both groups reported similar levels of acceptability, although more control participants reported that the study information was too long (24% vs 14%; p=0.020). <h3>Conclusion</h3> A self-directed multimedia consent process is effective for achieving participant understanding and obtaining consent free of research staff. Thus, multimedia represents a viable method to reduce the burden on researchers, meet participant needs and achieve informed consent in clinical research.
Yogurt — An Autodigesting Source of Lactose
Authors: Joseph C. Kolars, Michael D. Levitt, Mostafa Aouji, Dennis A. Savaiano
Journal: New England Journal of Medicine (1984)

Large quantities of yogurt are consumed by some lactase-deficient population groups. We used breath hydrogen measurements to determine whether lactase-deficient subjects absorbed lactose in yogurt better than lactose in milk. Ingestion of 18 g of lactose in yogurt resulted in only about one third as much hydrogen excretion as a similar load of lactose in milk or water, indicating a much better absorption of lactose in yogurt. Ingestion of yogurt also resulted in fewer reports of diarrhea or flatulence than did a similar quantity of lactose ingested in milk or a water solution. The enhanced absorption of lactose in yogurt appeared to result from the intraintestinal digestion of lactose by lactase released from the yogurt organisms. This autodigesting feature makes yogurt a well-tolerated source of milk for lactase-deficient persons and may explain the widespread consumption of yogurt by lactase-deficient population groups.
Abstract 1409: Overexpression of inhibitor of DNA (Id-1) correlates with the invasiveness of colon cancer cells
Authors: Ambarish Pandey, Michael Oh, Shiladitya Sengupta
Journal: Cancer Research (2011)

Abstract Background: Id-1 gene expression has been shown to be involved in carcinogenesis in several types of human cancers. It belongs to a family of helix loop helix proteins that has been shown to induce cell proliferation, increase DNA synthesis and changes in gene expression to promote tumor growth and metastasis. In this Study we look into the expression of Id-1 in human colon cancer cell lines and its effect on the invasive potential of the cancer cells. Methods: Id-1 gene expression in human colon cancer cell line HT-29 was analyzed by real time Polymerase chain reaction. The expression of Id-1 protein in colon cancer tissue array samples was examined by immunohistochemical assay and its relationship with the clincopathological staging of the tumor was analyzed. Id-1 gene knockdown was carried out in HT-29 cells using siRNA transfection and the knock down cells were subjected to matrigel invasion assay. Results: A significant overexpression of id-1 gene was observed in the colon cancer cell line HT-29 as compared to normal epithelial cells. Immunohistochemical analysis showed that id-1 protein expression in malignant tissue was significantly more than the normal variant and there was a significant correlation between the degree of Id-1 expression and the stage of the colon cancer. Knockdown of Id-1 in the cancer cells significantly decreased the invasiveness potential in the matrigel after 72 hours as compared to the controls. Conclusion: The level of id-1 expression is correlated to the malignant potential of colon cancer cells and its expression seems to be critical for the invasiveness and more aggressive behavior of the tumor cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1409. doi:10.1158/1538-7445.AM2011-1409
The Surgical Treatment of Mitral Stenosis
Authors: Dwight E. Harken, Laurence B. Ellis, Paul F. Ware, Leona R. Norman
Journal: New England Journal of Medicine (1948)

NEARLY fifty years ago the possibility of relieving the obstruction to blood flow through a narrowed mitral valve was first suggested. Subsequent attempts have been made to accomplish this.1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 The surgical technics employed in these bold but disappointing adventures have been variously described as valvulotomy and valvulectomy. Much of the discussion of the theoretical value of this procedure has been concerned with the problem whether the patient would tolerate a surgically induced mitral insufficiency better than his existing stenosis. This, however, is an oversimplification of the situation. Many factors produce the symptoms and determine the course of the disease in . . .
S103 Microbial community composition in the lungs of patients with Cystic Fibrosis and non-CF bronchiectasis
Authors: G. G. Einarsson, E. Klem, A. A. Fodor, L. Wei, M. Drain, M. C. Wolfgang, J. S. Elborn, M. M. Tunney
Journal: Thorax (2011)

<h3>Introduction and Aims</h3> Persistent bacterial infection is a major cause of morbidity and mortality in patients with both Cystic Fibrosis (CF) and non-CF Bronchiectasis (non-CFBX). Numerous studies have shown that CF and non-CFBX airways are colonised by a complex microbiota. However, many bacteria are difficult, if not impossible, to culture by conventional laboratory techniques. Therefore, molecular detection techniques offer a more comprehensive view of bacterial diversity within clinical specimens. The objective of this study was to characterise and compare bacterial diversity and relative abundance in patients with CF and non-CFBX during exacerbation and when clinically stable. <h3>Methods</h3> Sputum samples were collected from CF (n=50 samples) and non-CFBX (n=52 samples) patients at the start and end of treatment for an infective exacerbation and when clinically stable. Pyrosequencing was used to assess the microbial diversity and relative genera (or the closest possibly taxonomic order) abundance within the samples. Each sequence read was defined based on 3% difference. <h3>Results</h3> High-throughput pyrosequencing allowed a sensitive and detailed examination of microbial community composition. Rich microbial communities were apparent within both CF (171 species-level phylotypes <i>per</i> genus) and non-CFBX airways (144 species-level phylotypes <i>per</i> genus). Relative species distribution within those two environments was considerably different; however, relatively few genera formed a core of microorganisms, representing approximately 90% of all sequences, which dominated both environments. Relative abundance based on observed operational taxonomic units demonstrated that the most abundant bacteria in CF were <i>Pseudomonas</i> (28%), <i>Burkholderia</i> (22%), <i>Streptococcus</i> (13%), family <i>Pseudomonadaceae</i> (8%) and <i>Prevotella</i> (6%). In contrast, the most commonly detected operational taxonomic units in non-CFBX were <i>Haemophilus</i> (22%), <i>Streptococcus</i> (14%), other (unassigned taxa) (11%), <i>Pseudomonas</i> (10%), <i>Veillonella</i> (7%) and <i>Prevotella</i> (6%). <h3>Conclusions</h3> These results suggest that distinctive microbial communities are associated with infection and/or colonisation in patients with both CF and non-CFBX. Although relatively high species richness was observed within the two environments, each was dominated by different core taxa. This suggests that differences in the lung environment of these two diseases may affect adaptability of the relevant bacterial taxa.
A memorable patient: Passing time
Authors: Wesley Michael Hicks
Journal: BMJ (2006)

He had been an active farm labourer until his admission to hospital in his late 70s. He was tall (though when I met him he was no longer strong enough to stand) and, by all accounts, had had an impressive physique at admission. His elective admission had been with a colovesical fistula, a complication of diverticular disease. Unfortunately, he had had a troubled postoperative course which lasted many months. After the initial repair there had been an anastamotic leak with subsequent peritonitis, and he required a defunctioning ileostomy. Things became worse when he developed an enteric fistula to the wound and another from proximal to distal small bowel.

The cascade continued as his nutrition deteriorated. His weight chart showed a dramatic U-shaped curve—catabolic losses initially and now increasing fluid retention owing to his gross oedema. He picked up several infections, and his wounds never healed. He was not well enough for further intervention. Total parenteral nutrition failed on two occasions after line infections, and, as I'm sure you can imagine, peripheral access was by now impossible. Thankfully, careful nursing meant he was spared the added insult of bedsores.

Throughout his ordeal, however, he remained dignified—his eyes truly sparkled, he always smiled, and he thanked staff for the most simple of duties that he could no longer do for himself. He seemed genuinely to look forward to our daily chat and review. I, unfortunately, was starting to dread my ward round. He was dying slowly, and watching this happen was unbearable. It seemed even worse that there was nothing I could do for him: I could not hoist him, turn him, or feed him, and I could not prescribe him analgesia as he was not in pain. I felt I was failing him. All I could do was talk to him on my round, when he would ask about my girlfriend, my family, and my work. We said goodbye when I moved to another hospital.

Shortly after he died I received a parcel from his family. It contained a cigar (we had talked about my elective to Cuba) and a set of wine glasses for my first house that I was buying. It reminds me that, while our practices are increasingly audited and rationalised, some of our most important efforts remain far less tangible.
THU0574-HPR A Questionnaire Assessment of Knowledge about Methotrexate of Patients with Rheumatoid Arthritis
Authors: F. Fayet, C. Savel, M. Rodere, B. Pereira, D. Abdi, M. Couderc, S. Mathieu, A. Tournadre, S. Malochet-Guinamand, M. Soubrier, J.-J. Dubost
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Methotrexate is the reference treatment for rheumatoid arthritis (RA). It has potentially serious side effects which can be prevented by an improvement in patient9s information. <h3>Objectives</h3> To assess the knowledge of patients suffering from RA about their methotrexate treatment with a questionnaire. <h3>Methods</h3> A questionnaire containing 21 closed questions and 2 situation studies about the medication (mechanism of action, method of administration, therapeutic interactions, side effects, monitoring and implications on lifestyle) was given to all RA patients treated with methotrexate who consulted between March and September 2013 in the rheumatology department of Clermont-Ferrand Hospital. <h3>Results</h3> 183 patients were recruited, including 143 women (79%), with a mean age of 60 years ±13.5 and a median RA duration of 12 years (IQR: 7-20). Methotrexate has been initiated for a mean of 8 years (IQR: 5-13). Methotrexate was identified as a DMARD by 78% of participants. The weekly administration method was well known (97%) and 67% said that the folic acid was to reduce the toxicity of treatment. Only 21% knew that trimethoprim was contraindicated. Half of the patients knew about the haematological risks and 36% about the risks of hypersensitivity pneumonia. The frequency of laboratory assessments was known (80%) but 54% thought that the only purpose of these tests was to assess the RA activity. Only 13% of men (n=38) knew that contraception was essential compared to 90% of women of child-bearing age (n=20), 75% reported that alcohol consumption should be reduced. In multivariate analysis, a low knowledge score correlated significantly, with age and low educational status. Scores were independent of sex, duration of treatment or of the RA. <h3>Conclusions</h3> Patients9 knowledge about methotrexate, particularly about the interaction with trimethoprim, risk of hypersensitive pneumonia and need for men to use a couple contraception should be increased by the treatment education programme instruments, especially in the elderly and the lower socio-educational status population. <h3>Disclosure of Interest</h3> : None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4930
Abstract P1-15-05: GSTP1 polymorphism is associated with chemotherapy induced neuropathy
Authors: NC Miltenburg, M Opdam, M Winter, M van Geer, HM Oosterkamp, W Boogerd, SC Linn
Journal: Cancer Research (2012)

Abstract Background: Peripheral neuropathy is a common and potentially debilitating side-effect of microtubule-stabilizing agents like docetaxel and is characterized by sensory symptoms like numbness, tingling and burning pain. Docetaxel induced neuropathy may occur in up to 37% of patients and can be dose limiting, thus potentially reducing its chemotherapeutic efficacy. Doxorubicine has occasionally been described to be associated with neuropathy. With this background we investigated the role of various single nucleotide polymorphisms (SNPs) to predict chemotherapy-induced neuropathy. The exploration of SNPs and an association with incidence or severity of neuropathy is important, because it can result in identifying individuals being at higher risk of neurotoxicity. Methods: The MATADOR study is a prospective, non-blinded randomized phase II/III trial for patients with invasive breast cancer, comparing TAC (docetaxel 75 mg/m2 as 1 hour i.v. infusion q 3 weeks, in combination with doxorubicin and cyclophosphamide for 6 cycles) with AC dose dense (doxorubicin and cyclophosphamide q 2 weeks)(ISRCTN61893718). In total 180 interesting SNPs were selected that are involved in metabolism, distribution and excretion of drugs and tested on DNA that was isolated from tumor or from tumor surrounding tissue. We selected 20 SNPs for further analyses because of reported associations with chemotherapy-induced neuropathy (see table). In the first analysis DNA of 45 patients was analyzed as a pilot, comparing DNA of 23 neuropathy patients with that of 22 controls. The primary hypothesis was to identify SNPs associated with NCI-CTC grade ≥2 neuropathy. Results: Interim toxicity data from the MATADOR study demonstrated that 30 of 580 patients had grade ≥2 neuropathy. GSTP1 114Ala/114Val genotype was associated with grade ≥2 neuropathy. Twelve out of 14 (86%) patients with this genotype had chemotherapy-induced neuropathy compared to 11 out of 31 (35%) without this genotype (chi-square test p = 0.002). Conclusion: We found a correlation between GSTP1 114Ala/114Val genotype, involved in detoxification, and development of grade ≥2 neuropathy during treatment with chemotherapy. Updated results will be presented at the meeting. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-15-05.