tbuckley/cabot-search huggingface dataset:
Metiamide, an H<sub>2</sub>-Receptor Blocker, as Inhibitor of Basal and Meal-Stimulated Gastric Acid Secretion in Patients with Duodenal Ulcer
Authors: Michael Mainardi, Vernon Maxwell, Richard A. L. Sturdevant, Jon I. Isenberg
Journal: New England Journal of Medicine (1974)

The effect of oral metiamide, a new drug that selectively inhibits effects of histamine not inhibited by conventional antihistaminic drugs, on basal and peptone-meal-stimulated gastric acid secretion was studied in 17 patients with duodenal ulcer. All three doses tested (100, 200, and 300 mg) significantly inhibited acid secretion. Basal acid secretion decreased by more than 80 per cent after 200 or 300 mg. Stimulated acid secretion decreased by more than 80 per cent after 300 mg. Inhibition of acid secretion correlated better with peak blood level than with ingested dose. H2-receptor antagonists may be useful in treatment of patients with peptic ulcer. (N Engl J Med 291:373–376, 1974)
OC-002 Team simulation training for medical emergencies in the endoscopy unit
Authors: S Ray, K Hills
Journal: Gut (2012)

<h3>Introduction</h3> Medical simulation is as an attractive way to practice clinical skills to improve confidence, teamwork and outcomes.<sup>1</sup> The endoscopy unit is an arena in which a heterogenous group of patients present with complex medical comorbidities. While emergencies are uncommon, they require prompt &amp; seamless management. Simulation is common in industries such as aeronautics to practice rare but predictable incidents. Simulation is also used for teaching endoscopy. We therefore piloted novel simulation training in medical emergencies for our own unit9s endoscopy staff (ES) before rolling this out across our trust in East Kent. <h3>Methods</h3> We conducted three half-day sessions in a dedicated simulation complex. ES were divided into teams of two nurses and a healthcare assistant rotating through scenarios such as anaphylaxis and angina followed by feedback, tutorials &amp; literature. The scenario room was equipped with a sophisticated mannequin capable of speech &amp; respiration attached to monitoring including pulse, oxygen saturations &amp; blood pressure manipulated from a control room. The room was fitted with cameras and microphones to assist feedback. There was a viewing chamber in which ES could watch their colleagues. Written candidate feedback was obtained. <h3>Results</h3> In April 2010, six of our ES completed the pilot session. In September 2010 &amp; 2011, 12 ES from two hospitals in our trust completed the session. None of the ES had ever had specific training in this area and were not confident in their abilities prior to the session. The vast majority found the training to be enjoyable, useful and that it enhanced their confidence. <h3>Conclusion</h3> Simulation is becoming recognised as an important training tool in rehearsing responses to a variety of clinical settings. Our experience demonstrates that our ES did not feel confident in recognising and managing medical emergencies perhaps as they do not encounter them as frequently as ward nurses. The absence of such training is an omission in improving patient safety. The use of training in teams which work together on a daily basis helped reduce anxiety and improved confidence and the overall realism of the simulation. The staff strongly felt that this training was realistic and targetted to their learning needs and experience. While the use of our sophisticated simulation facility was advantageous in running our programme this is not critical to propagating this to other trusts. The mannequin and much of the equipment is portable and our next aim is to bring the simulation inside the endoscopy room to enhance realism and facilitate transfer to any endoscopy unit. <h3>Competing interests</h3> None declared. <h3>Reference</h3> 1. <b>Ruesseler M</b>, Weinlich M, Müller MP, <i>et al.</i> Simulation training improves ability to manage medical emergencies. <i>Emerg Med J</i> 2010;<b>27</b>:734–8.
FRI0588-HPR Are multidisciplinary inpatient rehabilitation programmes effective for chronic musculoskeletal conditions?: a service evaluation
Authors: W. J. Mccuish, L. Bearne
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Chronic musculoskeletal (MSK) conditions impair health and function. Clinical guidelines recommend a Multidisciplinary Team (MDT) approach for the optimum management of chronic MSK conditions. The efficacy of inpatient MDT care on the health and disease status of people with chronic musculoskeletal conditions is unclear. <h3>Objectives</h3> To evaluate the efficacy of a MDT inpatient service for people with chronic musculoskeletal conditions. <h3>Methods</h3> Patients with Rheumatoid Arthritis (RA), Osteoarthritis (OA), Low Back Pain (LBP) and Chronic Widespread Pain (CWP) admitted for inpatient MDT rehabiiltation to a rheumatology unit in a UK hopsital completed the Multi-Dimensional Health Assessment Questionnaire (MDHAQ)<sup>1</sup>, visual analogue scale (VAS 0-10cm) for pain and for global wellbeing on admission and discharge. The rehabilitation programme consisted of a personalised regime of exercise including hydrotherapy and MDT input. RAPID3 scores (Routine Assessment of Patient Index Data)<sup>1</sup> were calculated then analysed using descriptive statistics and paired sample t-tests. A 20% improvement in RAPID3 was considered a clinically significant change. <h3>Results</h3> 183 patients (Mean Age 62 [Range 18-97], 145 females) were admittted (median length of stay 10 days [Range 5-15]) between January 2010 and September 2011. Overall there was a 28% improvement in RAPID3 (mean difference 5.01 [4.3, 5.8] (95%CI), P&lt;0.05) on discharge. Clinically signifiicant changes were noted in people with RA (32%), OA (35%), CWP (25%) and LBP (22%) (all P&lt;0.05, Table). <h3>Conclusions</h3> This inpatient MDT rehabilitation programme improved self reported disease status and function in patients with RA, OA, LBP and CWP. The long term efficacy and cost effectiveness of inpatient MDT care requires further investigation. <h3>References</h3> Pincus T et al. Towards a multidimentional health assessment questionnaire (MDHAQ). Assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis and Rheumatism 1999; 42(10): 2220-2230. <h3>Acknowledgements</h3> The authors would like to thank the patients and clinicians at Bognor Regis War Memorial Hospital. <h3>Disclosure of Interest</h3> None Declared
Endoscopic features of radiation gastritis after irradiation of hepatocellular carcinoma
Authors: C.-J. Chao, J.-S. Shin, W.-C. Hsu, P.-M. Wang
Journal: Endoscopy (2013)

Radiation gastritis has rarely been reported [1]. In this study, radiation gastritis was defined on endoscopy as a red lesion, usually larger than 2 cm, that was sharply demarcated from the surrounding normal mucosa, and was found in a focal area of the stomach when erosive gastritis had been excluded. Overall, 31 patients were diagnosed as having radiation gastritis. Of these, 22, 13, and 3 also developed gastroduodenal ulcers, radiation duodenitis, and radiation colitis, respectively.
P1081 VACCINE ESCAPE MUTANTS AND SUBOPTIMAL HEPATITIS B VIRUS RESPONSE IN HIV–HBV COINFECTED PATIENTS FROM SUB-SAHARAN AFRICA
Authors: A. Boyd, R. Moh, P. Dény, M. Issoufou, C. Danel, X. Anglaret, S. Eholié, P.-M. Girard, F. Zoulim, K. Lacombe
Journal: Journal of Hepatology (2014)
FRI0400 Efficacy of anakinra in calcium pyrophosphate crystal arthritis
Authors: S. Ottaviani, L. Brunier, J. Sibilia, F. Maurier, K. Dawidowicz, E. Palazzo, G. Hayem, M. Ardizzone, D. Wendling, O. Meyer, P. Dieudé
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Calcium pyrophosphate (CPP) associated arthritis is common in elderly patients. Non-steroidal anti-inflammatory drugs (NSAID), colchicine, oral or local steroids are recommended (1), but in some patients these therapies are non-effective or contra-indicated and therapeutic alternatives are limited. Recently, the pivotal role of IL-1β in the crystal-induced inflammation has been demonstrated, and IL-1β inhibitors such as anakinra, has been shown to be effective in the treatment of acute gout arthritis (2). <h3>Objectives</h3> To evaluate the efficacy of anakinra on refractory CPP arthritis. <h3>Methods</h3> In a multicentric retrospective study, patients having proven acute or chronic CPP arthritis by CPP crystal demonstration in synovial fluid or typical X-rays were included. All the patients had failure or contra-indication to conventional therapies and received subcutaneous anakinra (100mg/day). All individuals provided informed written consent as approved by the recruiting site institutional review boards at each of the affiliate institutions. Ultrasonographic assessment, measure of pain by Visual Analogic Scale (0-100 mm VAS pain), CRP level and consummation of corticosteroids were assessed at baseline and at day 4. <h3>Results</h3> A total of 16 patients were included in this open study. Mean age was 80.2±11.1 year-old and mean symptoms duration was 3.9±3.8 months. Arthritis was localized to wrists (n=15, 88%), shoulders (n=12, 71%), knees (n=11, 65%), ankles (n=11, 59%), elbows (n=7, 47%), cervical spine (n=7, 41%), tarsal joints (n=6, 29%) and MCPs (n=4, 24%). Between baseline and day 4, IL-1β blockade led to a significant decrease of VAS pain (76.6±12.3 to 33.0±14.5 mm; P&lt;0.0001) and CRP level (97.3±57.4 to 20.0±15.2 mg/l; P&lt;0.0001). The consummation of corticosteroids between baseline and day 4 decreased from 22.8±7.5 mg/day to 5.2 mg ± 4.2 (P&lt;0.0005). Relapse occurred in 6 patients (mean delay of relapse: 3.3±4.5 months) and infectious complication (uncomplicated pyocyanic pneumonitis) was noted in one patient 3 weeks after the IL-1β blockade was stopped. <h3>Conclusions</h3> Anakinra is an effective and relatively well-tolerated treatment of refractory CPP arthritis and should be an alternative in individuals having non-response or contra-indication to conventional therapies. <h3>References</h3> Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis 2011;70(4):571-5. So A, De Smedt T, Revaz S, Tschopp J. A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther 2007;9(2):R28. <h3>Disclosure of Interest</h3> None Declared
Radio: Vital Signs
Authors: H. Scott, G. Bennett
Journal: BMJ (1999)

T he contrived subtitle, "drugs, demons, and delinquents," might lead one to suspect that this book is a superficial and clichéd analysis of the subject and best avoided.Most books that set out to cover treatment of drug dependence, even those without melodramatic titles, are probably best avoided-other than by those preparing for examinations.This book, however, is a careful analysis of the subject that reveals the remarkable similarities in the dilemmas recognised, and alleged solutions offered, by different countries.A "global" review such as this offers the opportunity to analyse what really constitutes treatment of drug depend-ence, but the opportunity has not been taken here.The question of what dependence treatment is tends to be ignored-probably out of fear that the lack of an answer might become evident.Success of treatment of drug dependence is generally seen as analogous to that of any physical disease.That successful "treatment" for this condition, unlike that for any other, leaves patients more (socially) impaired than when they had the "disease" is not acknowledged.The "recovered" alcoholic, for example, stands out as different in social situations where most or all others drink: he or she is expected to join in the drinking and feels obliged to give an excuse when refusing, even if none is overtly demanded.Success of "treatment" therefore is much more a function of the extent of covert or overt social pressure to drink than is recognised.The same is true for the "recovered" drug user in a drug using milieu.A global view should provide unusual opportunities to examine cultural and social factors influencing the success of treatment.In this book, 47 authors from 20 countries provide "information on the development of drug treatment from a global perspective," but the opportunity for synthesis and shedding light on unseen premises is missed.Of the 20 countries chosen to provide the global perspective, 14 are European; the others are Canada, China, Colombia, Japan, Peru, and the United States.
Abstract P4-01-17: Ductolobular breast carcinoma and the role of preoperative magnetic resonance imaging
Authors: EL Postma, Sharouni MA El, HM Verkooijen, AJ Witkamp, MA van den Bosch, R van Hillegersberg, PJ van Diest
Journal: Cancer Research (2012)

Abstract Introduction: Lobular carcinoma is the second most frequently diagnosed type of invasive breast cancer (about 10%) after the ductal NOS type (80%). In patients with lobular carcinoma, magnetic resonance imaging (MRI) plays an important role in the pre-operative work up, since mammography and ultrasound often underestimate the tumor extent and have a high false negative rate for additional foci in the ipsi- or contra lateral breast when compared to MRI. As the histological spectrum of invasive breast cancers is however a continuum with gradual transitions between types, mixed type invasive carcinomas with both ductal and lobular histologic features occur and are usually denoted ductolobular cancer. In our institution, MRI is part of the routine pre-operative work up in patients with ductolobular breast cancer, but the value of MRI in the pre-operative work up of ductolobular carcinoma has yet to be determined. Purpose: We set out to determine the probability of detecting additional, clinically relevant, findings on MRI in patients diagnosed with ductolobular carcinoma. Methods: We retrospectively searched the pathology database for all patients diagnosed with histologically proven ductolobular breast cancer at our institution between 2008-Sept 2012. Findings on mammography and ultrasound were compared with the findings on the pre-operative MRI. Additional findings on MRI (larger tumor size, additional ipsi- and contralateral lesions) were verified by pathology evaluation. Results: Out of the 121 patients diagnosed with ductolobular cancer, 91 (75%) underwent MRI for pre-operative work-up. With MRI, 67 additional findings were detected in 56 (62%) patients. In 23 patients a contralateral additional lesion was seen, of which 12 turned out malignant. Ipsilateral lesions were seen in 28 patients, 20 of which were malignant at histology. In 16 patients, more extensive disease was seen on MRI compared to conventional imaging (mean difference was 18 mm, range 6–67 mm). MRI correlated better with the histological extent of these tumors (r = 0.97) than conventional imaging (r = 0.79). Of all MRI detected additional findings, 69% (46/67) was proven malignant after histology assessment. On patient-level, MRI led to the detection of one or more malignant finding(s) in 41/91 (45%) patients. Conclusion: For patients diagnosed with invasive ductolobular breast cancer, the probability of detecting clinically relevant additional findings on MRI is high. Preoperative MRI should therefore be part of the routine work up of this breast cancer type. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-01-17.
Abstract 5135: Functional genomic shRNA screens reveal that the canonical Wnt pathway protects lung cancer cells from EGFR inhibition
Authors: Matias Casas
Journal: Cancer Research (2012)

Abstract Lung cancers are the leading cause of cancer deaths globally. In particular, non-small cell lung cancer (NSCLC) is a devastating disease, and is rarely curable. Hyperactivation of mitogenic signaling cascades is a hallmark of cancer development, including for lung cancers. Targeted therapies inhibiting specific receptor tyrosine kinases have shown clinical promise, but rarely produce complete responses and are not curative, suggesting the existence of escape mechanisms promoting cell survival. Using a loss-of-function, whole genome shRNA screen, we identified various components and mediators of the canonical Wnt pathway that contribute to the maintenance of NSCLC cells during inhibition of the epidermal growth factor receptor (EGFR). Modulation of tankyrases, casein kinases and different components of the Wnt pathway with shRNAs or small molecules, in vitro and in vivo, significantly increased the efficacy of EGFR inhibitors, thus revealing a critical role for the canonical Wnt pathway in maintaining lung cancer cells during EGFR inhibition. Targeting the Wnt/β-catenin pathway together with EGFR inhibition in the clinic could lead to more durable remissions for non-small cell lung cancers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5135. doi:1538-7445.AM2012-5135
Avoiding Pitfalls in the Diagnosis of Subarachnoid Hemorrhage
Authors: Jonathan A. Edlow, Louis R. Caplan
Journal: New England Journal of Medicine (2000)

"For it happens in this, as the physicians say it happens in hectic fever, that in the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated in the beginning, it becomes easy to detect but difficult to cure." — Niccolò Machiavelli, The Prince Patients with headache account for 1 to 2 percent of visits to the emergency department14 and up to 4 percent of visits to physicians' offices.5 Most have primary headache disorders, such as migraine and tension-type headaches. Only a few . . .
PTU-008 Dedicated Colonoscopy Training Lists Improve Trainee Completion Rates To Match A Consultant Benchmark: Abstract PTU-008 Table 1
Authors: I Ewing, J Lim, K Bryce, A Muddu
Journal: Gut (2014)

<h3>Introduction</h3> Colonoscopy is the gold standard modality for investigation of colonic disease.<sup>1</sup> The procedure can be challenging to perform.<sup>1</sup> Complete colonoscopy, defined as intubation of the terminal ileum, neo-terminal ileum, or caecum, should be achieved in greater than 90% of cases on an intention to complete basis.<sup>1</sup> Historically trainees have performed colonoscopy on service lists, and ad hoc training lists and may have had incomplete access to training.<sup>2</sup> Trainees currently working in our unit perform colonoscopy on dedicated training lists prior to JAG certification of independence. We performed a large retrospective study of colonoscopy completion rate, comparing two groups of gastroenterology trainees with consultant Gastroenterologists. <h3>Methods</h3> 5307 consecutive colonoscopies, from a five-year period in a single centre, were triaged by first endoscopist. Groups identified were 1) consultant Gastroenterologists 2) previous trainees (individuals who trained in the unit in the past, performing colonoscopy on service, adhoc training, and dedicated training lists) 3) Current trainees (employed in the unit at time of study, performing colonoscopy on dedicated training lists). Colonoscopy completion rate, as defined above, was determined for each group. Odds ratios and 95% confidence intervals were calculated to compare the completion rate between groups. <h3>Results</h3> Results are summarised in the table <h3>Conclusion</h3> Consultants were more likely to achieve complete colonoscopy than previous trainees, who did not achieve &gt;90% completion rate. In contrast, there was no statistical difference when consultants were compared to current trainees on dedicated training lists. The observed effect is likely to reflect additional allocated time, and immediate consultant trainer availability. Procedures were grouped by first endoscopist. Extent of examination by trainee or trainer in each case is not known: assistance may have been required on a greater proportion of procedures performed on training lists. Colonoscopy completion rate is an important marker of quality. Other indicators include adenoma detection rate, comfort score, and withdrawal time.<sup>1</sup> Inclusion of these indices would provide further comparative performance data. Trainees performing colonoscopy on dedicated training lists delivered comparable completion rates to consultants and outperformed their predecessors. Our data supports dedicated colonoscopy training prior to certification of independence. <h3>References</h3> Gavin <i>et al</i>.<i> Gut</i> 2013:62:2 242 Bowles <i>et al</i>.<i> Gut</i> 2004:53:2 277 <h3>Disclosure of Interest</h3> None Declared.
Sensory gating deficits in schizophrenia: new results
Authors: L L Judd, L McAdams, B Budnick, D L Braff
Journal: American Journal of Psychiatry (1992)

It has been widely hypothesized that sensory gating failures and sensory overload occur in schizophrenic patients compared to normal subjects. The authors of this study sought to confirm and extend results of earlier studies that showed specific sensory gating deficits in schizophrenic patients.Age- and sex-matched schizophrenic patients (N = 20) and normal subjects (N = 20) were tested using electrophysiologically recorded P50 event-related potentials to assess the overall competence of the subjects' central sensory inhibitory capacity by measuring sensory filtering or gating. P50 area responses to two 75-dB (conditioning and test) click stimuli of 0.04-msec duration, averaged over 60 trials, were recorded for each subject. Normally, the first (conditioning) click stimulus induces gating mechanisms that result in diminished or gated P50 event-related potentials in response to the second click stimulus.The schizophrenic subjects manifested a significant sensory gating deficit at frontal, central, and parietal electrode placement sites, with a nonsignificant tendency for the deficit to be most prominent in the frontal areas of the brain.These data reflect a regionally diffuse loss of normal sensory gating in schizophrenic patients.
Some Observations on the Incidence of Thyroid Cancer in the United States
Authors: Piero Mustacchi, Sidney J. Cutler
Journal: New England Journal of Medicine (1956)

THE present report is prompted by the absence in the medical literature of reliable data on the risk of papillary and nonpapillary cancer of the thyroid gland and on sex, age and geographic region as modifying factors of this risk.Many articles have been published describing the occurrence of thyroid cancer. They are based on the records of individual hospitals or on the aggregate experience of several institutions. Authors interested in this subject have used clinical, surgical or autopsy observations as material for analysis. Indeed, it is hard to visualize how any study in the biology of a human disease . . .
Prevention and Control of Postoperative Wound Infections Owing to<i>Staphylococcus aureus</i>
Authors: Chester W. Howe
Journal: New England Journal of Medicine (1956)

ATTENTION was called in a previous paper1 to the increasing number of antibiotic-resistant strains of Staphylococcus aureus, or Micrococcus pyogenes (var. aureus), being recovered from hospital patients and personnel since the introduction of penicillin. Data were presented showing that the postoperative infection rate of clean wounds had increased over a five-year period (1949–1953) at the Massachusetts Memorial Hospitals despite the use of prophylactic antibiotics. Analysis of the hospital carrier rate and the floras of infected wounds at that time suggested that the increase in sepsis was related to an abnormally high carrier rate of penicillin-resistant Staph. aureus as . . .