tbuckley/cabot-search huggingface dataset:
Death Due to Cardiac Disease Following the Use of Emetine Hydrochloride in Conditioned-Reflex Treatment of Chronic Alcoholism
Authors: Egon E. Kattwinkel
Journal: New England Journal of Medicine (1949)

BECAUSE of the increasing use of emetine hydrochloride in the conditioned-reflex treatment of chronic alcoholism, because the cardiac manifestations of toxicity have not been stressed in the literature and because deaths can probably be avoided by consideration of certain gastrointestinal and neuromuscular warning symptoms of toxicity, the following fatal case of myocardial damage after emetine administration is being reported.Case ReportA 33-year-old man was first seen on November 10, 1947, at 11 p.m., 1 week after his last of a series of ten emetine injections for conditioned-reflex treatment of chronic alcoholism at a nearby mental institution. His complaints were . . .
Incorporating the Patient’s Voice in the Continuum of Care
Authors: Bradford R Hirsch, Amy P Abernethy
Journal: Journal of the National Comprehensive Cancer Network (2013)

Clinicians may not want to admit it, but we aren't always the best source of information regarding a cancer patient's symptoms and experience with their disease.When it comes to the interpretation of laboratory results and imaging abnormalities, our input is a critical piece of the puzzle.But when it comes to reporting a patient's perception of their experience and the impact of interventions on it, we often misinterpret the responses. 1Although many feel that this has limited impact on the care being delivered, a growing body of evidence and opinion argues otherwise.The gold standard for documenting a patient's experience can only be the patient's own voice, so it is imperative that they be queried directly. 2In a setting of breakneck technologic advances, the pressing question is not whether the patient's voice can be heard, but how to most efficiently and reliably record it.
Famotidine for the Prevention of Gastric and Duodenal Ulcers Caused by Nonsteroidal Antiinflammatory Drugs
Authors: Ali S. Taha, Nicholas Hudson, Christopher J. Hawkey, Anthony J. Swannell, Penelope N. Trye, Jeremy Cottrell, Stephen G. Mann, Thomas J. Simon, Roger D. Sturrock, Robin I. Russell
Journal: New England Journal of Medicine (1996)

Acid suppression with famotidine, a histamine H2–receptor antagonist, provides protection against gastric injury in normal subjects receiving short courses of aspirin or naproxen. The efficacy of famotidine in preventing peptic ulcers in patients receiving long-term therapy with nonsteroidal antiinflammatory drugs (NSAIDs) is not known.
Case 19-1995
Authors: D.M. Systrom, E.J. Mark
Journal: New England Journal of Medicine (1995)

Presentation of CaseA 55-year-old woman was admitted to the hospital because of acute respiratory distress and thrombocytopenia.The patient had been in stable health until several weeks earlier, when an upper respiratory tract infection developed, with vague, diffuse abdominal pain; ofloxacin and ketorolac were prescribed. One week before admission nausea and vomiting occurred.Three days before admission the patient was admitted to another hospital, where physical examination was normal except for dehydration. Laboratory studies were performed (Table 1 and Table 2). Ofloxacin was discontinued, and fluids were administered intravenously. During the next two days the platelet count declined to 27,000 per . . .
P125 Tiotropium plus olodaterol combination therapy provides lung-function benefits when compared to tiotropium alone, irrespective of prior treatment with a long-acting bronchodilator: post hoc analyses of two 1-year studies: Abstract P125 Table 1
Authors: R Buhl, R Abrahams, L Grönke, L Korducki, M Fležar, GT Ferguson
Journal: Thorax (2015)

<h3>Rationale</h3> Tiotropium plus olodaterol (T+O) is a novel once-daily combination of the long-acting muscarinic antagonist (LAMA) tiotropium (T) and the recently approved long-acting β<sub>2</sub>-agonist (LABA) olodaterol, for use as maintenance treatment in chronic obstructive pulmonary disease (COPD). These <i>post hoc</i> analyses of data from the two pivotal 1-year TONADO studies determined whether treatment with a long-acting bronchodilator (LABD) prior to randomisation affected the lung-function benefits of T+O 5/5 µg (via Respimat®) compared to T 5 µg (via Respimat®). <h3>Methods</h3> In the studies, 2124 patients had not received prior LABD treatment (T+O n = 426; T n = 454) and 3038 patients had (T+O n = 603, T n = 579; 60.6% LAMA, 78.8% LABA). Baseline characteristics for all patients and a sub-group with Global initiative for chronic Obstructive Lung Disease (GOLD) 2 lung-function impairment are presented in the Table 1. Forced expiratory volume in 1 s (FEV<sub>1</sub>) area under the curve from 0–3 h (AUC<sub>0–3</sub>) response (change from baseline) and trough FEV<sub>1</sub> response were primary end points in the studies. <h3>Results</h3> Comparable responses for both FEV<sub>1</sub> AUC<sub>0–3</sub> and trough FEV<sub>1</sub> were observed in patients previously treated and untreated with LABD (see Table 1). The between-treatment differences (adjusted mean response [SE]; mL) for no prior LABD and prior LABD treatment, respectively, were: 116 (13) and 105 (11) for FEV<sub>1</sub> AUC<sub>0–3</sub>, and 76 (14) and 49 (11) for trough FEV<sub>1</sub>. In the GOLD 2 subgroup, the between-treatment differences (adjusted mean response [SE]; mL) for no prior LABD and prior LABD treatment, respectively, were: 114 (19) and 123 (17) for FEV<sub>1</sub> AUC<sub>0–3</sub>, and 79 (20) and 61 (18) for trough FEV<sub>1</sub>. <h3>Conclusions</h3> Our analyses demonstrate the robust lung-function efficacy of T+O, compared to T alone, independent of the requirement for, or prior use of, LABD. These findings suggest a benefit of combination therapy over the mono-product as a first-line maintenance treatment. <h3>Funding</h3> Boehringer Ingelheim.
Renal Disease Associated with Prolonged Use of Acetophenetidin-Containing Compounds
Authors: Malcolm M. Fifield
Journal: New England Journal of Medicine (1963)

ACETOPHENETIDIN has been for the past half century a common constituent of proprietary headache and analgesic mixtures. These mixtures, most frequently a combination of caffeine, acetophenetidin and acetylsalicylic acid, are widely marketed under various trade names directly to the public over the counter.The best known toxic effect of acetophenetidin is on the red blood cells (methemoglobinemia, sulfhemoglobinemia and anemia). Toxicity may also be manifested in disturbances of the central nervous system (headache, tremor, lability of temperament, irritability, muscular twitching, confusion and insomnia). More recently, an often fatal nephrotoxicity associated with the prolonged use of acetophenetidin has been reported, primarily . . .
P169 FDG PET-CT scans – Who best uses this expensive resource?
Authors: N Nwosu, M Ledson, MJ Walshaw
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> FDG PET-CT scans are a valuable tool in the diagnosis and staging of lung cancer, but their growing use in other diseases can cause resource issues, and in some cases they may be ordered by non-specialists further congesting the patient pathway. To study this further, we looked at referral patterns for PET-CT scans in the diagnosis of lung cancer at our hospital, paying particular attention to the reason for the scan and the referring clinician. <h3>Methods</h3> A retrospective audit was undertaken of all PET-CT scans performed for the investigation of suspected lung cancer in 2014 by the Liverpool Lung Cancer Unit (LLCN). The LLCN consists of Liverpool Heart and Chest Hospital, a specialist cardiothoracic centre in the North West of England and the Royal Liverpool University Hospital, a teaching hospital. <h3>Results</h3> All 253 PET-CT scans (186 for outpatients) carried out during 2014 for the investigation of suspected lung cancer were reviewed. One hundred and seventy five (69%) found malignancy. Scans ordered by lung cancer specialists were more likely to demonstrate a cancer diagnosis (145 cancer versus 52 benign) compared to those requested by non-specialists (30 cancer versus 26 benign), (Chi2 = 8.21, P &lt; 0.01) (Figure 1). The commonest causes for a negative scan result were mass 27 (34%), nodule follow up 17 (22%) and new nodule assessment 14 (18%) respectively. Of 31 patients (39%) who had a PET-CT scan for nodule assessment, 8 (26%) were &lt;10 mm in diameter. Overall, 22% of all negative scans were for nodule surveillance. <h3>Conclusions</h3> We have shown that scans arranged by lung cancer specialists are more likely to give a positive yield, and also that the guidance for their use in nodule investigation is not being strictly followed. The results indicate that there is a need for better guidelines and patient pathways to ensure the most appropriate use of expensive resources.
Soundings: Auntie Pat
Authors: James Owen Drife
Journal: BMJ (2000)

As a medical student you have to develop an understanding of what is common and what is rare. “Look out of the window,” our teachers would say with elaborate sarcasm. “Is that a sparrow or a lesser sulphur-crested cockatoo?”

Knowing what was normal was especially hard in the trendy 1960s. For those of us who clung to our tweed jackets, there was the medical students' society. In Edinburgh, it had a royal charter. Enterprising predecessors had petitioned George III, and, ever since, the Royal Medical Society had flourished quietly, with small numbers of members electing large numbers of office bearers.

After centuries of people donating books, the society had a valuable collection but nowhere dry to keep it. The decision to sell was difficult but meant that we could buy our own premises and hire a permanent secretary. Legend has it that most of the candidates appeared for interview in miniskirts. All the more surprising that the new secretary was a woman of uncertain age with a no-nonsense hairstyle, a throaty laugh, and children almost ready for university themselves.

Mrs Strong became Auntie Pat and then “AP,” moving with the society from a tiny basement to purpose built rooms on campus. Her glass-fronted office became its politically incorrect heart, with AP enjoying regular ciggies, and one of the white pillars decorated with a filter tip.

Not everyone likes students. Those of us who do still find it difficult to relax without trying too hard to be young or taking refuge in age and experience. For AP it came naturally. She had her likes and dislikes, and she never patronised. She took her job and her young colleagues seriously but was always ready for a joke.

Last summer there was a party celebrating her three decades in post and her 80th birthday. Among the presents was an album with photographs of her 31 student presidents. She laughed about her age, commenting that the cigarettes had not got her yet.

When she died recently of a smoking related illness, her handwritten invitations to the annual dinner were in the post. For those of us who left Edinburgh years ago, the sense of bereavement is strangely acute. The end of a matter-of-fact relationship always catches you by surprise. This one, we now realise, was not so much rare as unique.
M14 Surgical interventions for emphysema: The experience of a community based COPD service
Authors: AB Hardy, S Cowdell, P Griffiths
Journal: Thorax (2015)

<h3>Methodology</h3> Surgical interventions for emphysema have become more accessible in the last few years.<sup>1</sup> We have reviewed the referral rate and outcomes from our community based COPD service to a tertiary surgical centre. Our COPD service includes a respiratory consultant and nurse specialist and has access to secondary care respiratory investigations such as HRCT and pulmonary function testing. <h3>Results</h3> During the period April 2013–March 2015 202 new referrals were made to the consultant led clinic of which 181 were subsequently diagnosed with COPD. 10 referrals for consideration of surgical intervention were made, a referral rate of 6%. The referral rate from the same consultants secondary care clinic during this period was 8% (10 referrals from 126 new COPD patients). Referred patients had a mean age of 60 years (range 45–72), mean COPD Assessment Test (CAT) score 19 (8–32), mean FEV1 38% predicted (22–64%) and mean RV 196% (163–246%). All referred patients are discussed at a regional COPD MDT. 5 patients have subsequently received an intervention- 2 lung volume reduction surgery and 3 endobronchial valve placement. 2 patients declined further assessment following discussion with surgeons. 3 patients currently undegoing further investigation to assess operative risk. Outcomes from secondary care referrals were similar (3 had an intervention, 5 were declined and 2 awaiting further assessment). Post operative CAT scores improved by an average of 9 points. Uncomplicated recovery is rare with complications ranging from wound infection to coughing up a valve. Patients felt the information given pre-operatively by the community and surgical services was at the right level, although it was noted by the community respiratory nurse that patients required significant psychological support before and after surgery. <h3>Summary</h3> Management of complex emphysema is possible in a community setting. 6% of COPD patients were referred for assessment for surgical intervention for their emphysema. Objective and subjective patient reported outcome measures improved post operatively. Patients needed more intensive support from the community team in the peri- and post-operative periods. <h3>Reference</h3> 1 Zoumot, <i>et al</i>. Emphysema: time to say farewell to therapeutic nihilism. <i>Thorax</i> 2014;<b>69</b>:973–5
Case 36-1999
Authors: W. Hardy Hendren, Eugene J. Mark
Journal: New England Journal of Medicine (1999)

Presentation of CaseA 32-day-old girl was admitted to the hospital because of a retroperitoneal mass.The patient had been born to a 31-year-old woman (gravida 4, para 3) after a 39-week gestation. A prenatal ultrasonographic study, performed at four months of gestation, showed an abdominal mass. An ultrasonographic study performed on the first day of life showed no increase in the size of the mass. The alpha-fetoprotein level was 35,000 IU per milliliter. A computed tomographic (CT) scan of the abdomen obtained the next day, after the oral and intravenous administration of contrast material (Figure 1), showed a mass, . . .
Symptoms of PTSD in 124 survivors of the Holocaust
Authors: K Kuch, B J Cox
Journal: American Journal of Psychiatry (1992)

Survivors of the Holocaust are expected to be at risk for posttraumatic stress disorder (PTSD), but few empirical data are available. This study investigated PTSD symptoms in Holocaust survivors with well-documented exposure to trauma.The German files of 124 Jewish Holocaust survivors who were judged to be free from bipolar affective disorder, obsessive-compulsive disorder, and organic brain syndrome were selected from those of 145 applicants to West German compensation boards. The psychiatric assessments were reexamined for explicit descriptions of current PTSD symptoms according to the DSM-III-R diagnostic criteria. A subgroup of 20 Auschwitz survivors with tattooed identification numbers were also compared with the 45 survivors who had not been in concentration camps.Sixty-three percent of the total sample had been detained in concentration camps, and an average of 78% of their first-degree relatives were reported killed in the Holocaust. Forty-six percent of the total sample met the DSM-III-R criteria for PTSD. The most common symptoms were sleep disturbance, recurrent nightmares, and intense distress over reminders. The tattooed Auschwitz survivors had significantly more symptoms and were three times more likely to meet diagnostic criteria for PTSD than the survivors who had not been in concentration camps.The results suggest a greater risk of chronic PTSD in survivors who were exposed to atrocities. Most survivors had not received adequate psychiatric care.
Doctor gets the green light to pursue GMC for mishandling case against her
Authors: Clare Dyer
Journal: BMJ (2016)

A doctor who won nearly £4.5m in compensation from an NHS trust for unfair dismissal, discrimination, and victimisation in 20111 has been given the go-ahead to take the General Medical Council (GMC) to an employment tribunal for the way it dealt with the trust’s complaints against her.

Ewa Michalak accused the GMC; its chief executive, Niall Dickson; and an investigation officer of harassment and sex, race, and disability discrimination after the trust referred her to the regulator.

The GMC argued that she was not entitled to take the case to the employment tribunal but would have to seek judicial review in the High Court instead. The employment appeal tribunal originally backed Michalak but the GMC appealed and the …
PWE-087 Development of an auto-fluorescence index to improve the efficacy of auto-fluorescence endoscopy in detection of early neoplasia in patients with Barrett's oesophagus
Authors: V Subramanian, J Mannath, L Alvarez-Herrero, W L Curvers, J J Bergman, K Ragunath
Journal: Gut (2010)

<h3>Introduction</h3> Auto-fluorescence imaging (AFI) endoscopy is a novel imaging technique that can identify neoplastic tissue by highlighting differences in tissue fluorescence properties and detect early neoplasia not detectable by conventional white light endoscopy. Normal areas appear “green” and abnormal areas are highlighted as “red” when using AFI endoscopy. Although it has a high sensitivity, it is associated with high false positive rates up to 80%.1 <h3>Methods</h3> To determine if auto-fluorescence index, defined as the ratio of the intensity of red and green tone between normal and abnormal AFI areas in patients with Barrett9s oesophagus (BO), can improve the specificity and accuracy of AFI endoscopy. Images of patients with both AFI true and false positive areas of BO were selected from two prospectively collected data sets using the Olympus Lucera-Hyperpro video endoscopy systems and GIF Q240FZ and GIFQ260FZ gastroscopes and used as training and test data sets, respectively. Biopsies from these areas had been confirmed by two specialist GI pathologists to have no dysplasia or high-grade dysplasia/carcinoma. Lesions with indefinite or low grade dysplasia were excluded. The images were de-gamma corrected, split into component channels and the mean intensity of the red and green tone at the abnormal area and background (normal areas) were quantified blinded using Image J software (NIH). Statistical analysis was done using SPSS V.17 (SPSS Inc). An optimal cut off was developed from the training set and applied blinded to the test set in order to determine the usefulness of the AFI index. <h3>Results</h3> There were 82 images from of AFI abnormalities in the training set. Of these 19 had high-grade dysplasia (HGD), 18 had carcinoma (CA), 38 had intestinal metaplasia (IM) and seven were from areas of gastric mucosa. The test set comprised of 40 images from 27 patients of which 24 had IM, six had HGD and 10 had CA. The area under the receiver operating curve (AUROC) for the auto-fluorescence index ratio (AFI ratio) in the training set was 0.9 (SE=0.3) with an optimal cut off of 1.3. Using an AFI ratio of 1.3 on the 40 images in the test set only one AF area with IM and 1 area with CA were misclassified. The sensitivity of AFI in the test set was 94% (95% CI 80 to 98), specificity was 96% (95% CI 86 to 99), the likelihood ratio of a positive test was 22.5 (95% CI 5.8 to 85). Using the AFI index reduces the false positive rate in the test set from 60% to 6%. <h3>Conclusion</h3> The AFI ratio shows promise as a tool to improve the diagnostic capabilities of AFI endoscopy. AFI index of &gt;1.3 resulted in a 10-fold reduction in the false positive rate of AFI endoscopy.
PWE-431 Training our trainees: the north west deanery model
Authors: KL White, WJ Gashau, EE Shuttleworth, P Shields, C Summerton
Journal: Gut (2015)

<h3>Introduction</h3> The North West Deanery has always had a strong educational ethos (until recently offering a Gastroenterology MSc to all trainees). We aimed to review the current ways in which our trainees are educated and supported. <h3>Method</h3> A review of the educational events and support systems in place for our trainees from February 2014 to February 2015 was performed. <h3>Results</h3> Trainees attend monthly training days. Content is matched to the national GI training curriculum, with a specific theme in each academic year (e.g. small bowel and nutrition). Expert speakers are local and national. A two-day regional GI Conference is organised annually and has now been running for 12 years. In July 2014, this was attended by 21 consultants and 35 trainees and followed the year’s theme of upper gastrointestinal disease. Trainees presented abstracts in poster (12) and oral (10) format. Feedback scores for all speakers was a mean of 4.5/5 for interest and 4.5/5 for relevance. Feedback for all other aspects of the event was 4–5/5 and 100% of responders would attend the conference again. The trainees benefit from an annual ‘Enhancing your training’ event, which was introduced to give trainees guidance in the opportunities available to them outwith the training programme. The topics covered include the process for going out of programme, clinical fellowships, basic and clinical research and preparing for the transition to consultancy. We conduct an annual survey of trainees. In 2014, this was performed online and response rates were improved by 50% compared to the 2013 paper format. In the 2014 survey, endoscopy training received positive feedback with 78% trainees rating supervision level as good or excellent, 96% felt the case mix was reasonable or good and 85% felt the balance between service and training was reasonable or good. 100% had access to JETs. However 30% of trainees felt that opportunities to manage patients with gastrointestinal bleeding were poor or deficient. The annual survey results are collated and fed back to the Specialty Training Committee at their bi-annual meeting by the trainee representatives. In 2012 a mentorship programme was set up for the trainees. All new trainees are given the option of being matched to a mentor who is ST5 or later in their training. The 2014 trainee survey showed that 46% of the respondents had a mentor. <h3>Conclusion</h3> We feel the North West Deanery provides a successful model for support and education of Gastroenterology trainees. <h3>Disclosure of interest</h3> None Declared.