tbuckley/cabot-search huggingface dataset:
Soundings: Endless evaluation
Authors: Kevin Barraclough
Journal: BMJ (2004)

I have just been going through some hospital notes on a case. There were, of course, pages and pages of necessary documentation of drugs given, fluids, results, and clinical findings. More distressing were the huge volumes of paper work taken up with entries such as the following: “Problem—maintaining patient dignity. Plan of action—local and national codes to be adhered to.” This was then followed by a handwritten note stating, “Dignity maintained.” There were numerous other examples: “Problem—patient in pain. Plan of action—assess patient's pain, administer analgesia, assess result.” Beside this was handwritten, “Patient's pain assessed.”

When I started as a trainer in general practice the necessary documentation I had to provide of a trainee's competency was a signature on a form and a date. This was, possibly, a little Spartan if I subsequently had to justify my decision. But now the assessment process—and, more importantly, the documentation of that process—takes a huge proportion of the time available for training. I spend much less time teaching and much more time documenting everything that I do.

The same is true of my practice of medicine. The process of documenting what I do, as opposed to doing it, takes an ever increasing fraction of my time. Personal development plans are a particular bugbear of mine. Any decent doctor has spent his or her whole career reflecting on their practice. To be forced to spend time documenting this in a PC format seems patronising and a complete waste of time. The idea that a bad doctor will become a good one by writing a reflective diary is frankly ludicrous.

It is obvious that assessment of performance and competency is important. But evaluation must be done sparingly. It is expensive in time and resources.

I think that all Department of Health apparatchiks should be forced to write out the following a thousand times: “Excessive evaluation harms patient care. Do not introduce more of it unless there is some evidence of benefit.” This useful task would mean that those in the NHS who don't see patients will waste less of the time of those who do.

When they have finished their lines they should memorise the following old chestnut for a test: “You do not make a pig fatter by weighing it.”
Trends in American mental health
Authors: F Redlich, S R Kellert
Journal: American Journal of Psychiatry (1978)

Using the data collected by Hollingshead and Redlich in 1950 and their own recent data, the authors describe trends in the mental health field over a 25-year period. They found a marked increase in admissions and readmissions to inpatient facilities and a significant decrease in the average length of stay; a considerable increase in outpatient treatment services; a shift in major diagnostic categories from schizophrenia to alcoholism; an unequal allocation of services to young versus elderly patients; discharge of many chronic patients to nursing homes; the increased involvement of psychiatrists in administrative work and decreased time spent in direct patient care; and an increase in third-party insurance as a source of patient fees.
Triple-Modal Imaging of Magnetically-Targeted Nanocapsules in Solid Tumours <i>In Vivo</i>
Authors: Jie Bai, Julie T.-W. Wang, Noelia Rubio, Andrea Protti, Hamed Heidari, Riham Elgogary, Paul Southern, Wafa' T. Al-Jamal, Jane Sosabowski, Ajay M. Shah, Sara Bals, Quentin A. Pankhurst, Khuloud T. Al-Jamal
Journal: Theranostics (2015)

Triple-modal imaging magnetic nanocapsules, encapsulating hydrophobic superparamagnetic iron oxide nanoparticles, are formulated and used to magnetically target solid tumours after intravenous administration in tumour-bearing mice. The engineered magnetic polymeric nanocapsules m-NCs are ~200 nm in size with negative Zeta potential and shown to be spherical in shape. The loading efficiency of superparamagnetic iron oxide nanoparticles in the m-NC was ~100%. Up to ~3- and ~2.2-fold increase in tumour uptake at 1 and 24 h was achieved, when a static magnetic field was applied to the tumour for 1 hour. m-NCs, with multiple imaging probes (e.g. indocyanine green, superparamagnetic iron oxide nanoparticles and indium-111), were capable of triple-modal imaging (fluorescence/magnetic resonance/nuclear imaging) in vivo. Using triple-modal imaging is to overcome the intrinsic limitations of single modality imaging and provides complementary information on the spatial distribution of the nanocarrier within the tumour. The significant findings of this study could open up new research perspectives in using novel magnetically-responsive nanomaterials in magnetic-drug targeting combined with multi-modal imaging.
Relationships between biomedical companies and guideline makers are often undisclosed
Authors: Jacqui Wise
Journal: BMJ (2016)

Financial relationships between organisations that produce clinical guidelines and biomedical companies are common and often not disclosed in the guidelines, according to research published in PLOS Medicine .1

The Canadian researchers conducted a cross sectional survey and a website review of 290 clinical practice guidelines produced by 95 national or international medical organisations.

All the guidelines were published in 2012 on the National Guideline Clearinghouse …
Routine detection of EGFR mutations in patients with NSCLC: A comparative study of three alternative methods in 105 patients
Authors: G. Zalcman, N. Richard, A. Hardouin, R. Gervais, M. Antoine, H. Mittre, J. J. Baumann, F. Galateau-Salle, J. Cadranel, M. Kottler
Journal: Journal of Clinical Oncology (2006)

7184 Background: The efficacy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) has been reported in lung adenocarcinoma patients with tumoral EGFR mutations. Those mutations were found mainly by direct genomic sequencing on snap-frozen surgical specimens. Conversely, TKIs are used in metastatic patients who do not undergo tumor resection. In these patients, there is a need for routine sensitive molecular procedures, to overcome the small size of non-surgical bronchoscopy paraffin-embedded biopsy samples. Methods: Patients were selected on clinical and pathological characteristics: never (n = 43) or former smokers, patients with non-squamous NSCLC (n = 105) or patients with bronchioloalveolar adenocarcinoma (n = 34). Direct genomic sequencing assay was performed as reported elsewhere. Denaturing, high-performance, liquid chromatography (DHPLC) assay was performed with EGFR-specific primers that amplify exons 18, 19, and 21. A multiplex, allele-specific, oligonucleotide PCR (MASO-PCR) assay was carried out with a set of primers that identify the 14 most frequent molecular events described for the EGFR gene, which covers 90% of EGFR gain-of-function mutations described to date. Results: 123 samples were screened from 105 non-squamous NSCLC patients (female/male ratio = 0.84). Non-surgical biopsy specimens were available in 38 patients. EGFR mutations were detected by at least two of three procedures in 18/105 patients (17%). In paraffin-embedded specimens with low tumor content, EGFR heterozygous mutations were found either by MASO-PCR alone (n = 2, confirmed in the matched surgical sample by another procedure), or both by MASO-PCR and DHPLC (n = 16); they were missed by nucleotidic sequencing in 6 samples. 18 patients received TKI. 6 dramatic responses were achieved in patients with EGFR mutation, while no mutation could be found in non-responsive patients. Overall disease control was obtained in 8/18 patients (44%). Conclusions: MASO-PCR and DHPLC appear more sensitive than direct sequencing in non-surgical paraffin-embedded biopsies, which represent the bulk of samples in lung cancer patients. We propose that the cost-effective MASO-PCR be used for routine screening of EGFR mutations in NSCLC patients. No significant financial relationships to disclose.
PTU-072 The influence of iron supplementation on the severity of a murine model of colitis
Authors: A Mahalhal, S Reade, B Campbell, DM Pritchard, C Probert
Journal: Gut (2015)

<h3>Introduction</h3> Iron deficiency anaemia is a common complication in inflammatory bowel disease (IBD). There is evidence that iron supplementation induces inflammation both in normal rats and in rodent models of IBD (Carrier J <i><i>et al</i></i>, Aliment Pharmacol Ther. 2001 Dec; 15(12): 1989–99.). Changes in the gut microbiota [dysbiosis] are common in IBD patients, but the mechanism is unclear. Iron may be a factor, as it is a growth factor for some bacteria. We have therefore investigated the effect of dietary iron intake upon a murine model of colitis. <h3>Method</h3> Animal studies were performed on 6 groups of female C57BL/6 mice. Acute colitis was induced with 2% Dextran Sodium Sulphate (DSS) for 5 days in drinking water before go back on a normal water for a another 5 days. Two modifications of diet (normal chow 200 ppm iron) were used: low iron (100 ppm) and high iron (400 ppm). The groups were 1 controls; 2 acute DSS normal diet; 3 acute DSS with low iron diet for 10 days; 4 acute DSS with high iron diet for 10 days; 5 low iron diet for 4 weeks; 6 high iron diet for 4 weeks. Daily weight and clinical features were logged. Histology was performed at day 10 for groups 1–4 and day 28 for the rest. Colitis was scored using the Bauer score (Bauer <i><i>et al</i></i>, Gut 2010; 59:9 1192–1199). Faecal Calprotectin measured by ELISA (Biohit Healthcare Ltd.), and faecal iron by immunoassay. One ANOVA and t tests were performed to compare groups or pairs of samples. <h3>Results</h3> <b>Weight loss: </b>DSS induced colitis in groups 2–4; it was most severe in the low iron group. Mean changes in weight were +4% in control, -5.3% in group 2, -9.2% in group 3, and -1% in group 4. Post-hoc testing showed p values of 0.0005, 0.16 and 0.01 for low iron diet vs groups 1, 2 and 4, respectively. <b>Histology:</b>mean colitis scores were; 0, 1.4, 1.9, 1.4, 0, 0 for groups 1–6, respectively. The score to low iron DSS mice was significantly worse than that in untreated mice and marginally worse than those on normal or high iron diets. <b>Calprotectin:</b>calprotectin concentrations were greatest in DSS mice on the low iron diet. <b>Faecal iron: </b>this was increased in a dose-dependent manner within 4 weeks in the groups of mice that did not receive DSS. In DSS treated mice, the low iron diet mice resulted in the highest faecal iron results p = 0.010, 0.0024, and 0.0019 for groups 1, 2 and 4 respectively. <h3>Conclusion</h3> Clinical observation and histological scoring showed that a low iron diet exacerbated DSS colitis. Mice consuming 50% of the normal amount of iron lost more weight and developed more severe colitis than other mice given DSS. The high iron diet had no measureable effect on the severity of DSS colitis. We will now investigate the effects of iron on the intestinal microbiota in the 6 groups. <h3>Disclosure of interest</h3> None Declared.
Time course of antipsychotic effects of neuroleptic drugs
Authors: P E Keck, B M Cohen, R J Baldessarini, S L McElroy
Journal: American Journal of Psychiatry (1989)

The authors reviewed relevant studies in an attempt to define the onset and time course of antipsychotic effects of neuroleptic drugs. After excluding open trials, studies of chronically psychotic patients, and studies not using a placebo or nonneuroleptic sedative as a control, they found only five reports suitable for analysis. Among these, the degree of patients' improvement during neuroleptic treatment was similar regardless of the duration of the study. Also, in studies comparing neuroleptics with sedatives, similar improvement was observed with both treatments. Although neuroleptic drugs have been used clinically for 35 years, the timing of their specific therapeutic effects remains unclear.
Family history and CSF homovanillic acid pattern during neuroleptic treatment
Authors: M B Bowers
Journal: American Journal of Psychiatry (1984)

In 24 patients receiving neuroleptics, the 11 patients whose CSF homovanillic acid showed no tolerance to neuroleptics at 1 month had significantly more residual symptoms, extrapyramidal side effects, and history of psychiatric hospitalization in first-degree relatives.
P0908 : Adherence to ombitasvir/paritaprevir/r, dasabuvir, and ribavirin is &gt;98% in the Sapphire-I and Sapphire-II trials
Authors: T. Hassanein, S. Roberts, S.D. Shafran, M. Makara, M. Bennett, B. Müllhaupt, F. Poordad, S. Ryder, A.M. Di Bisceglie, B. Fu, E. Coakley, B.H. McGovern, G.R. Foster
Journal: Journal of Hepatology (2015)
PTU-005 Double incision and snare: a new approach for flexible endoscopic treatment of zenker’s diverticulum. description of a new technique and preliminary results
Authors: S Ishaq, A Antonello, S Realdon, M Costantini, G Battaglia
Journal: Gut (2015)

<h3>Introduction</h3> Flexible endoscopic septum division is a well established and safe approach for the treatment of Zenker’s diverticulum (ZD). The main downside of this approach is the high rate of relapsing patients, regardless of the devices and techniques employed. We have developed a new technique for ZD endotherapy in which a wider part of the diverticular septum is excised. It is aimed at improving both the short-term efficacy of the procedure and the long term results. <h3>Method</h3> 21 consecutive patients with a symptomatic ZD and did not receive previous treatments were included in this study. Demographic and clinical data were collected. All patients were treated with our new technique. Briefly, two parallel incisions, about 1 cm deep and 1.5 cm apart from each other, are performed on the septum, and a polypectomy snare is then used to remove the septum in between. Two to three clips are then positioned to prevent mucosal dissection at the site of the incision (Figure 1). Any complications that developed during the procedure were recorded. The patients were contacted 2 and 6 months after the procedure, and were advised to contact us if symptoms relapsed/worsened afterwards. <h3>Results</h3> Before treatment 19 patients (90.48%) had dysphagia, 17 (80.95%) had regurgitation and 17 (80.95%) had aspiration. All procedures were carried out without complications. After treatment 15 patients (71.4%) had a complete symptom remission and 6 (28.6%) reported a substantial improvement. Of these, 3 refused further treatments and 3 underwent another treatment which led to symptom remission in 2 patients and to a further improvement in one. The median follow-up was 15 months (IQR 8, range 8–31). Two patients (9.5%) had relapsing symptoms (at 8 and 11 months from treatment) and underwent a further treatment that led to an almost complete symptom remission in both. <h3>Conclusion</h3> Double incision septum division is a safe and effective procedure for ZD endotherapy. Our preliminary results suggests that it yields better long term results, with a reduced relapse rate in comparison to the standard technique. Further studies are needed to fully assess the efficacy and safety of this technique. <h3>Disclosure of interest</h3> None Declared.
Canada's Health Care System
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1986)

Canada and the United States, neighboring countries whose health care systems have gone their separate ways over the past decade, still share with other Western industrialized nations a major public-policy task: deciding how many physicians are enough. Most Western nations are training more physicians than they seem prepared to accommodate, but because of a commitment to educational opportunity and a belief in the medical model, they are finding it exceedingly difficult to pare their production capacity. Caught in the middle of this issue are medical schools, teaching hospitals, and their trainees, who must cope with an uncertain future.Canada and . . .
New directions and added dimensions in home psychiatric treatment
Authors: S M Soreff
Journal: American Journal of Psychiatry (1983)

In addition to preventing or shortening psychiatric hospitalization, home psychiatric treatment allows family collaborative therapy, crisis resolution, therapy for nonresponders to hospitalization, treatment of family members other than the identified patient, work with the entire environment, treatment of patients with both medical and psychiatric disorders, work with the elderly, and educational advantages for medical students and residents. The author believes that home treatment is the treatment of choice in cases where family dynamics have a major role, preserving the patient's autonomy is paramount, and hospitalization would be deleterious.
Biological Studies on the Rous Sarcoma Virus: I. General Introduction, II. Review of Sources of Experimental Variation and of Methods for Their Control
Authors: W. Ray Bryan
Journal: JNCI Journal of the National Cancer Institute (1955)

Journal Article Biological Studies on the Rous Sarcoma Virus: I. General Introduction, II. Review of Sources of Experimental Variation and of Methods for Their Control Get access W. Ray Bryan W. Ray Bryan National Cancer Institute,2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 16, Issue 1, August 1955, Pages 285–315, https://doi.org/10.1093/jnci/16.1.285 Published: 01 August 1955 Article history Received: 25 March 1955 Published: 01 August 1955
Caring for the Whole Patient
Authors: Kim Thiboldeaux
Journal: Journal of the National Comprehensive Cancer Network (2013)

is President and CEO of the Cancer Support Community (CSC) (www.cancersupportcommunity. org), which works to support patients and families in 3 key areas.First, CSC provides direct patient and family support through face-to-face, online, and telephonic support services delivered by licensed mental health professonals.Second, CSC backs its service delivery arm with research generated by the Research and Training Institute, whose staff conducts cuttingedge psychosocial and behavioral research about the cancer patient experience.Finally, the Cancer Policy Institute at CSC unites the experience of research and direct services to
Colonic visualization during renal scintigraphy secondary to ureterosigmoidostomy.
Authors: ELGIN OZKAN, N. OZLEM, K. KUCUK, KEMAL KIR, G. ERBAY
Journal: Clinical Nuclear Medicine (2001)

ÖZKAN, ELGIN M.D.; ÖZLEM, N. M.D.; KÜÇÜK, K. M.D.; KIR, KEMAL METIN M.D.; ERBAY, G. M.D. Author Information
PWE-124 Role of acoustic radiation force impulse (arfi) elastography in non-invasive assessment of liver fibrosis in iron overload: a single centre experience
Authors: A Saifuddin, M Jagtiani, P Tadrous, P Bassett, P Shorvon, D Sherman
Journal: Gut (2015)

<h3>Introduction</h3> The predictive accuracy of ARFI elastography (virtual touch quantification, VTq<b>™) </b>for the non-invasive assessment of liver fibrosis is increasingly recognised, particularly in viral hepatitis. There is less information on its role in other aetiologies of chronic liver disease. We report the results of a preliminary study examining liver stiffness (LS) measurements by ARFI in patients with iron overload. <h3>Method</h3> Forty-nine measurements of LS in 43 patients were performed to investigate possible iron overload. LS estimation by ARFI was performed using a standard validated protocol with a Siemens Acuson S2000 + 4C1 probe. Biopsies were performed in 19 (39%) from the same region of liver, immediately after LS measurement. Clinical, biochemical, ultrasonic and histopathological data were collated retrospectively. Predictive accuracy variables were determined for fibrosis stage, using both standard published and local<sup>1</sup>calibrations. <h3>Results</h3> Aetiologies of iron overload in the biopsy cohort were: genetic haemochromatosis (n = 4); hyperferritinaemia with NAFLD or alcohol excess (8); hyperferritinaemia of unknown cause (3); transfusion-dependent thalassaemia (2); C282Y/H63D compound heterozygote (1); and high ferritin from renal cell carcinoma (1). Validation criteria for ARFI technical quality (SD/mean &lt;0.3) were reached in all 19 biopsy patients, but were exceeded in 3/49 (6%) examinations overall; one procedure failed due to poor reproducibility. Metavir stages were F0/1/2/3/4 in 6/3/3/2/5, respectively. Sensitivity, specificity, positive and negative predictive values for: a) the prediction of F4 (cirrhosis) by ARFI were 1.0, 0.71, 0.56 and 1.0, respectively, using published reference standards, and 0.80, 0.79, 0.57 and 0.92, respectively, using local calibration<sup>1</sup>; b) the exclusion of ≥F2 fibrosis were 0.80, 0.78, 0.80 and 0.78, respectively, with both calibrations. No correlation was seen between LS and either a) necro-inflammation, histological grade of siderosis or scan technical quality; or b) serum ferritin levels. <h3>Conclusion</h3> ARFI elastography may prove a useful non-invasive technique for excluding F2 fibrosis and identifying F4 cirrhosis secondary to iron overload. The high incidence of dual pathology, particularly NAFLD and alcohol-related, may have influenced predictive accuracy in this small “real world” cohort. The degree of hepatic iron overload did not correlate with LS. Further biopsy-controlled studies are needed to validate the role of ARFI in this patient group. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Sherman D, <i>et al</i>. J Hepatol. 2014;60(1):S413
Influence of Perforation Design on Growth of Tissue Cells under Perforated Cellophane Sheets in Vitro
Authors: W R EARLE, V J EVANS
Journal: JNCI Journal of the National Cancer Institute (1949)

Influence of Perforation Design on Growth of Tissue Cells under Perforated Cellophane Sheets in Vitro Wilton R. Earle, Wilton R. Earle Search for other works by this author on: Oxford Academic PubMed Google Scholar Virginia J. Evans, Virginia J. Evans Search for other works by this author on: Oxford Academic PubMed Google Scholar Mary-Frances Edward, Mary-Frances Edward Search for other works by this author on: Oxford Academic PubMed Google Scholar Emily Duchesne Emily Duchesne National Cancer Institute, National Institutes of Health, Public Health Service, Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 10, Issue 2, October 1949, Pages 291–295, https://doi.org/10.1093/jnci/10.2.291 Published: 01 October 1949 Article history Received: 16 August 1949 Published: 01 October 1949
Pediculosis capitis
Authors: D M Driscoll, B Tronic
Journal: New England Journal of Medicine (1996)

Figure 1. A 14-year-old girl and her 6-year-old sister presented with pruritus in the postauricular area. Multiple small, white capsules were found firmly attached to their hair. Examination of the hair under a light microscope at a magnification of 100 showed unhatched, tulip-shaped eggs, or nits, on the hair shaft (Panel A). The patients were infested with Pediculus humanus subspecies capitis, or head lice, blood-sucking ectoparasites of the order Anoplura. A female head louse (Panel B) is about 4 mm in length and remains confined to the scalp, attached to the hair shaft with its pincer-like claws (arrow).