tbuckley/cabot-search huggingface dataset:
Pass It On?
Authors: Des Spence
Journal: BMJ (2007)

It was 3 am and the six of us had been playing Dungeons and Dragons, a fantasy role-playing game. We were nerds, one and all. She passed the joint. I inhaled and passed it on. We laughed and munched on packets of crisps.

I smoked cannabis about a dozen times at university. I am not the home secretary but I am a responsible professional. Is it inappropriate for a doctor to admit to having smoked cannabis or can this be seen as tacit acceptance and normalising of drug use? My rationale, however, is honesty, without which there is only hypocrisy and the stifling of any meaningful debate. Drug use by the young is, perhaps, the widest schism between the generations.

Age comes at a cost but it has a great gift—experience. My young life was a conveyor belt of predictable and cliched mistakes—I was 18, so of course I knew best. But many of these wrong choices were my most important ones. Scalded and scarred by our mistakes we limp into middle age, weary but a lot wiser. Seeking to spare our young some pain we proffer them some unsolicited advice but omit the story behind the lecturing. Every single generation of the young happily jump onto the old conveyor belt full of bold and contemptuous certainty, smiling and waving at a despairing family, heading for the check out marked “Ten stupid things you must do before you grow up and admit that your parents were right and then apologise.” So what should be done about the young and cannabis?

Despite my use of cannabis as a young man I question the logic of liberalising the law. Health worries to one side, the real issue is that looser laws would surely lead to increased consumption and availability. Our communities are already saturated with mind altering drugs, be they illegal, prescribed, or cheap vodka. Our society is greatly undermined by drug use; we simply do not need any more.

I have never denied my cannabis use to my patients, and rather than undermining my position I feel that honesty has made my advice more credible. Perhaps it is time that we are a little more honest as a profession and come out of that bulging and over crowded closet marked “medical drug use.” Who knows, some of the young might even jump from the conveyor belt and be spared some pain.
PWE-358 Factors affecting uptake of bowel screening
Authors: H Heard, F Dunstan, R Fox, S Hillier, P Gunning
Journal: Gut (2015)

<h3>Introduction</h3> Uptake of UK bowel screening programmes has been lower than anticipated. To improve uptake we need to identify strategies for defined population groups which could be targeted with an intervention. <h3>Method</h3> Data on approximately 170,000 subjects in the first year of the Wales Bowel Screening programme were linked to data on other population based screening programmes, the Patient Episode Database for Wales on hospital admissions and routine data on consultations in General Practice using the Secure Anonymised Information Linkage Databank held in Swansea University. From these data sets measures of health usage and health status were derived. <h3>Results</h3> Socio-demographic factors associated with uptake were in line with previous studies; women were more likely to take up screening invitations and there was a strong gradient of uptake with area deprivation. Women who regularly attended screening sessions for breast and cervical cancer were much more likely to take up bowel screening and people with a small number chronic conditions were generally more likely to take up screening. Exceptions were obese subjects and those with diabetes who had a lower uptake than average. Smokers had lower uptake than non-smokers and heavy drinkers also had a low uptake. Subjects living in households with more than one eligible person were more likely to be screened, as were those who received influenza immunisations. Those who had an emergency hospital admission in the year preceding the invitation for screening were less likely to take up screening, while those with an elective admission were more likely to be screened. <h3>Conclusion</h3> Those who take up screening invitations are in more regular contact with health services than those who decline invitations. Although targeting low response through existing health service contacts may not work as the only strategy, there were defined groups who have contacts who could be targeted. <h3>Disclosure of interest</h3> None Declared.
Plasma Angiotensinase Activity in Normal and Toxemic Pregnancy
Authors: R LANDESMAN, P BIRON, R CASTELLANOS, R LARUSSA, K H WILSON
Journal: JAMA (1963)

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
PWE-340 Anastomotic leakage in patients operated for colorectal cancer in a high volume UK centre within an enhanced recovery programme setting
Authors: K Goonetilleke, J Ng, V Decaro, S Bassiony, D Nicol
Journal: Gut (2015)

<h3>Introduction</h3> Anastomotic leak is one of the serious complications in colorectal cancer surgery. It is associated with reduced 5-year cancer-specific survival, higher recurrence, a source of morbidity and mortality (20 to 23%) with an extra cost to healthcare: £1 million–£3.5 million annually. The purpose of this study was to determine the anastomotic leakage in a high volume centre in the United Kingdom with an established laparoscopic and enhanced recovery programme. <h3>Method</h3> A retrospective analysis of patients undergoing colorectal cancer resections in our hospital was performed from 2013 to 2014 from a prospectively maintained enhanced recovery database. Anastomotic leak was defined as requiring further clinical intervention (antibiotics +/− radiological drainage +/− surgery) AND confirmed radiologically. <h3>Results</h3> A total of 187 patients underwent cancer resection with an anastomosis. 103 patients had anterior resections and 84 had hemicolectomies. 157 patients (84%) were laparoscopic resections. 5 (6%) anterior resections leaked and 4 (3.8%) hemicolectomies leaked with an overall leakage of 4.8%. 4 patients who leaked were taken back to theatre (2%) with 1 treated with radiological drainage and 4 treated with antibiotics. <h3>Conclusion</h3> Leak rates for both anterior resection and other colonic resections are below recommended targets by ACPGBI. Based on this data a safe service can be provided in a high volume centre with a high provision of laparoscopic resections within an enhanced recovery programme. <h3>Disclosure of interest</h3> None Declared.
The heterogeneity of schizoaffective disorder: implications for treatment
Authors: J J Levitt, M T Tsuang
Journal: American Journal of Psychiatry (1988)

Until the 1970s, schizophrenia tended to be broadly defined in the United States, and the diagnosis subsumed patients who had affective as well as schizophrenic symptoms. With the introduction of lithium, however, manic-depressive illness became susceptible to treatment and gained attractiveness as a diagnosis. The ambiguous position of patients with schizoaffective disorder became clear. Cross-sectionally they were seen to resemble schizophrenic patients, but longitudinally they were more akin to patients with affective disorder. Numerous studies have attempted to establish that they are diagnostically distinct, but without clear results. The authors suggest that schizoaffective disorder is heterogeneous and that its treatment should be determined by specific indices as to its subtype.
Outcomes for cocaine abusers after once-a-week psychosocial therapy
Authors: S Y Kang, P H Kleinman, G E Woody, R B Millman, T C Todd, J Kemp, D S Lipton
Journal: American Journal of Psychiatry (1991)

The authors studied the efficacy of once-weekly psychotherapy, family therapy, or group therapy led by paraprofessionals among patients with cocaine use disorders.Of subjects who sought outpatient treatment, 168 consented to participate in the study and were each randomly assigned to one of the three forms of therapy; 122 patients were interviewed 6-12 months later. Their pre- and posttreatment scores on the Addiction Severity Index were compared.Significant improvements were observed for the cohort as a whole, but virtually all of the improvement was restricted to the 23 subjects (19%) who were not using cocaine at follow-up. There was a strong relationship between abstinence from cocaine use and absence of addiction-related problems, especially psychiatric symptoms and family problems.The results of the study indicate that outpatient therapy once a week is ineffective for cocaine use disorder. The 19% abstinence rate probably represents spontaneous remission among patients with enough motivation to seek treatment, as the number of therapy sessions attended was not related to improvement. Either an intense level of outpatient contact or residential treatment followed by aftercare is probably needed, at least initially, while the patient is attempting to initiate and sustain abstinence.
Scabies
Authors: Patrick C Carr, Robert T Brodell
Journal: New England Journal of Medicine (2016)

A 61-year-old woman presented with a severe pruritic rash. Excoriated papules with honey-colored crusting were present on the abdomen, arms, and legs. Treatment for suppurative folliculitis and prurigo nodularis produced no improvement. A biopsy of the rash was performed.
Massachusetts Medical Society
Authors: John Figgis Jewett
Journal: New England Journal of Medicine (1957)

COMMITTEE ON MATERNAL WELFAREHeart Disease with Aortic InsufficiencyThis thirty-one-year-old patient had had rheumatic fever in childhood; a diagnosis of heart disease with mitral-valve and aortic-valve involvement was made subsequently. During her first pregnancy at twenty-four years of age heart disease caused no difficulty, but she was advised against further pregnancies.The second and fatal pregnancy was uneventful until the thirty-seventh week, when an upper respiratory infection with cough and a temperature of 103°F. developed. The lungs were clear, but there was bronchial breathing and edema of the legs. She was treated at home with tetracycline, 250 mg. every . . .
AB1226-HPR Psychological and Behavioral Reactions When Patients with Rheumatoid Arthritis Start Biological Dmards
Authors: T. Motonaga, M. Mori, M. Mabuchi, Y. Sakai, Y. Iijima, T. Hidaka, H. Kameda, Y. Kawahito
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Patients with rheumatoid arthritis (RA) must often deal with a multitude of sometimes contradictory thoughts and feelings when doctors introduce the use of biological disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of active RA. As these emotional responses can positively or negatively influence a patient9s attitude toward such medication, we argue that medical staff should consider the psychological processes of patients who are making decisions regarding treatment using biological DMARDs. <h3>Objectives</h3> This study aimed to qualitatively examine the psychological and behavioral reactions of patients with RA to the commencement of biological DMARDs. <h3>Methods</h3> Twenty patients (mean age: 56.5±10.8 years) were recruited between February and August 2011 from a patient group and from four medical institutions. Sixteen of the 20 patients were treated with biological DMARDs. We interviewed the patients using a semi-structured protocol, asking them about their thoughts, feelings, and opinions regarding biological therapy. We also conducted a qualitative content analysis to discover codes and categories about psychological and behavioral reactions to biological DMARDs. <h3>Results</h3> Common patient feelings included worry and anxiety toward the use of these drugs. This is because the proposed introduction of "serious" biological treatment made patients see their conditions in a more negative light. However, patients sometimes exhibited positive reactions to DMARDs as they were hopeful that biological treatment could reduce their pain and improve their quality of life. Thus, they experienced both positive and negative feelings. The patients experienced fluctuations of anxiety regarding the use of these drugs over time, and these fluctuations influenced their attitudes toward treatment more generally. Their anxiety increased at first, caused by worry about pain, but after some coping exercises, these negative feelings were temporarily alleviated. Their trust in the doctor tended to reduce anxiety, whereas their negative impression to the doctor lead to their increased anxiety for using the drugs. <h3>Conclusions</h3> Trustful mutual relationships between patients and physicians might be an important factor when helping patients cope with fluctuations in anxiety for the use of biological DMARDs, and it is possible that such relationships can help lead to adequate treatment. <h3>Disclosure of Interest</h3> None declared
PTU-190 Dissociation of upper limb temperature sensation in functional gastrointestinal disorders compared to blood relatives and unrelated controls
Authors: KJ Etherson, C Emmett, P Syme, Y Yiannakou
Journal: Gut (2015)

<h3>Introduction</h3> Temperature sensations from the upper limbs are transmitted through the contralateral spinothalamic tract in the cord to the ventral posterior lateral nucleus of the thalamus and then the primary somatic sensory cortex. Autonomic dysfunction arising in the central nervous system is known to affect the sympathetic function of skin which can result in a unilateral dissociation of temperature sensation. Autonomic dysfunction is also increasingly being hypothesised as a component of the functional gastrointestinal disorders (FGIDs). <h3>Aims</h3> To assess the bilateral upper limb temperature sensation of a consecutive cohort of FGID patients and compare the incidence of temperature dissociation with controls. <h3>Method</h3> Clinic attenders with a FGID diagnosis were sequentially invited to undertake the temperature sensation test. This comprised holding a bag of ice in both hands for 5 s and stating if they perceived the temperature to be either unilaterally colder or bilaterally equally cold. Unilaterally colder was considered to be evidence of upper limb temperature sensory dissociation. If a relative, spouse or friend was present they were also invited to participate as either a blood relative or un-related control. <h3>Results</h3> 58 FGID patients and 58 controls undertook the temperature sensation test. 42 patients (72.4%) had upper limb temperature dissociation compared with 20 controls (34.4%) [P = 0.005]. 18/22 (81.8%) patients had dissociation compared to 8/22 (36.3%) blood relative controls [P = 0.049], and 24/36 (66.6%) patients had dissociation compared to 12/36 (33.3%) unrelated controls [P = 0.045]. There was no significant difference in the incidence of dissociation between blood relatives and unrelated controls, 36.3% and 33.3% respectively [P = 0.84]. <h3>Conclusion</h3> Upper limb temperature dissociation seems to be more prevalent in patients with FGIDs than their blood relatives or unrelated controls. It may be associated with autonomic dysfunction as a result of a central nervous process. These findings are an interesting observation in our clinic, but do not constitute formal research and are limited by possible biases (selection and assessment) and a relatively small sample size. The observed proportions of temperature dissociation in these groups could be used to calculate an adequate sample size to detect whether this may be true in a formal research study of autonomic dysfunction in FGIDs. <h3>Disclosure of interest</h3> None Declared.
AB0511 Discontinuation of Methotrexate Treatment in Patients with Rheumatoid Arthritis and Relatiomships with Candidate Single Nucleotide Polymorphisms
Authors: T. Soukup, M. Dosedel, P. Pavek, J. Nekvindova, A.A. Kubena, I. Barvik, J. Vlcek, P. Bradna
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Some single nucleotide polymorphisms (SNPs) might be predictive of methotrexate (MTX) therapeutic outcome in rheumatoid arthritis (RA). <h3>Objectives</h3> The aim of this study was to determine whether SNPs in key MTX pathway genes might be predictive of an adverse drug reactions (ADR) and MTX discontinuation in RA patients treated with peroral MTX. <h3>Methods</h3> There were 185 patients enrolled in the retrospective study, all of whom fulfilled the 1987 RA criteria of the American College of Rheumatology. The patients were currently or previously treated with peroral MTX. Genotyping was performed by quantitative PCR with allelic discrimination using commercial TaqMan (allele-specific) assays (Life Technologies, USA): (<i>ADORA2A</i>, rs2298383), (<i>ADORA2A</i>, rs3761422), (<i>ADORA2A</i>, rs2267076), (<i>ADORA2A</i>, rs2236624), (<i>AMPD1</i>, rs17602729), (<i>ATIC</i>, rs2372536), (<i>ITPA</i>, rs1127354), (<i>MTHFD1</i>, rs2236225), (<i>MTHFR</i>, rs1801131), (<i>MTHFR</i>, rs1801133), (<i>SLC01B1</i>, rs4149056). <h3>Results</h3> Clinical data were available in 185 patients: mean age 58.7 years, SD ±12.17, age of 29-85 years. 30.3% of patients were male. MTX treatment was discontinued in 33 (17.8%) patients owing to ADR (hepatopathy, n=12; infection, n=10; dyspepsia, n=9; leucopenia, n=1; alopecia, n=1). 83 patients were treated by MTX monotherapy or MTX together with glucocorticoids. Other patients were treated by MTX in a combination with conventional synthetic or biologic DMARDs. Presence and absence of ADR were evaluated in relation to the identified genotypes. We revealed no evidence to support association of the presence of ADR and the following SNPs: <i>ATIC</i> rs2372536, <i>AMPD1</i> rs17602729, <i>ITPA</i> rs1127354, SNPs of <i>ADORA2A</i> (rs2298383, rs3761422, rs2267076, and rs2236624), <i>MTHFD1</i> rs2236225, <i>MTHFR</i> rs1801131, <i>MTHFR</i> rs1801133 and <i>SLC01B1</i> rs4149056. Stratification of different ADRs in ITPA 94CC and ITPA 94CA genotypes showed association with dyspepsia P=0.01 using Kendall9s test, in case of MTX DMARDs monotherapy P=0.046 respectively. ITPA 94AA genotype have not been found. <h3>Conclusions</h3> In conclusion, we found for the first time that ITPA 94CC genotype is associated with a higher risk of dyspepsia in Caucasian RA patients treated with peroral MTX. <h3>Acknowledgements</h3> This work was supported by a research project MH CZ - DRO (UHHK, 00179906) to T.S. and supported by research project PRVOUK P37-08 (from Charles University). <h3>Disclosure of Interest</h3> None declared
PTU-132 An audit of the accuracy of endoscopic reporting and tissue sampling of oesophagogastric cancer
Authors: B Markandey, A Kapour, EA Griffiths
Journal: Gut (2015)

<h3>Introduction</h3> The treatment of oesophageal and gastric cancer can depend on the location of the tumour, especially around the gastro-oesophageal junction (GOJ). Accurate measurements at endoscopy are critical, especially in patients who are surgical candidates or in those who need radiotherapy. It is also important that a diagnosis is achieved at first endoscopy and adequate biopsies taken to ensure repeat endoscopy is minimised. <h3>Method</h3> OGD reports of patients with oesophagogastric cancers diagnosed between 2013–2014 at a tertiary referral centre were retrospectively reviewed. Main audit standards for oesophageal cancers included:<sup>1</sup>upper and lower tumour margin to be reported as a distance from the incisor teeth (100%) and GOJ should be measured from the incisor teeth (100%). For gastric cancers; the location and size should be stated (100%). For both tumours, a minimum of 6 biopsies should be taken (100%) and less than 10% of patients should require repeat endoscopy for diagnostic purposes. <h3>Results</h3> 153 endoscopy results were analysed. Patient demographics consisted of: 68% oesophageal or GOJ cancers and 32% gastric cancers. For oesophageal/GOJ cancers; 84% had upper tumour margins stated, 56% had lower tumour margins stated and GOJ junction was measured in 27%. Endoscopy reports for gastric cancers revealed that 96% stated the location and 35% stated size of the tumour. 73% of oesophageal /GOJ cancers had a minimum of 6 biopsies taken and 11% had a repeat OGD due to inadequate biopsies/diagnosis. For gastric cancers, 73% had minimum of 6 biopsies and 4% of endoscopies were repeated due to inadequate biopsies/diagnosis. Brush cytology was used in 10% of patients with oesophageal cancers and was not used for gastric cancers. Reasons for sub-optimal biopsies included; unknown (59%), patient unable to tolerate procedure (12%), too tight to pass scope due to neoplasm or stricture (10%), patient on clopidogrel (10%), inadequate stomach emptying (5%), bleeding (2%) and malignancy not clinically suspected (2%). <h3>Conclusion</h3> It is critical that oesophagogastric cancers are accurately measured and biopsied as this impacts on treatment decisions and disease management. For both oesophageal/GOJ and gastric cancers, around a quarter of the patients did not have the minimum number of diagnostic biopsies. Overall, 8.5% of endoscopies had to be repeated due to inadequate biopsies. We plan to disseminate our findings to our endoscopists and update departmental protocols and re-audit this important topic. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> LCA Oesophageal and Gastric Cancer Clinical Guidelines. 2014[cited 2014 Feb 19]; Available from URL; http://www.londoncanceralliance.nhs.uk/media/71819/LCA%20OG%20Cancer%20Clinical%20Guidelines%20April%202014.pdf