tbuckley/cabot-search huggingface dataset:
Underrecognition of patients' psychosocial distress in a university hospital medical clinic
Authors: T L Thompson, A Stoudemire, W D Mitchell, R L Grant
Journal: American Journal of Psychiatry (1983)

Seventeen areas of psychosocial distress were evaluated in 87 university hospital internal medicine clinic patients by a self-administered questionnaire and a psychiatric interview. These patients' internists then predicted the patients' distress level in each area. Their predictions correlated significantly with their patients' self-reports of distress-level problems in only 3 of the 17 areas. Even when the internists felt that they had sufficient information to make an accurate prediction, their perceptions were often erroneous, including evaluations of such areas as suicidal ideation and drug use. These data suggest the need for active psychiatric education components in internal medicine training programs.
AB0614 Infection and Disease Activity in a Cohort of Egyptian Systemic Lupus Erythematosus Patients
Authors: S.M.G. Sherif
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Infections are among the most important causes of morbidity and mortality in SLE patients [1]. Despite the availability of newer therapeutic measures to improve clinical outcome in SLE patients, the incidence of infections as a cause of morbidity and mortality has not changed over the past 30 years [2], and infection is still considered as one of the leading causes of morbidity and mortality in SLE patients [3]. Infection is responsible for approximately 25% of all deaths in patients with SLE, making it a leading cause of mortality in SLE [4]. <h3>Objectives</h3> To determine the prevalence of infections, to describe their sites, relation of infection to disease activity in this group of Egyptian Systemic lupus erythematosus (SLE) patients. <h3>Methods</h3> Medical records of 175 Systemic lupus erythematosus (SLE) patients attending the Rheumatology &amp; Rehabilitation Department, Cairo University hospital were reviewed retrospectively for the demographic information, clinical features of the disease, immune profile, laboratory features, systemic lupus erythematosus disease activity index (SLEDAI) and medical treatment with special reference to the relation of infection to disease activity in this group of Egyptian SLE patients. All of the patients fulfilled the updated American College of Rheumatology (ACR) revised criteria for the classification of SLE. <h3>Results</h3> 87 patients (49.71%), experienced infection. The most common site of infection was the skin in 36% then UTI in 22%, chest in 15%. Highly significant statistical difference was found between infection and non infection group regarding (SLEDAI) P&lt;0.001 (after regression analysis P=0.000). <h3>Conclusions</h3> Disease activity is an important risk factor for infection in SLE patients. <h3>References</h3> Ruiz-Irastorza G, Olivares N, Ruiz-Arruza I, et al. Predictors of major infections in systemic lupus erythematosus. Arthritis Res Ther. 2009;11(4):R109. doi: 10.1186/ar2764. Epub 2009 Jul 15. Enberg G M, Kahn Ch M, Goity FC, et al. Infections in patients with Systemic Lupus Erythematosus. Rev Med Chil. 2009 Oct;137(10):1367-74. Sciascia S, Ceberio L, Garcia-Fernandez C, et al. Systemic lupus erythematosus and infections: Clinical importance of conventional and upcoming biomarkers. Autoimmun Rev. 2012 Dec;12(2):157-63. doi: 10.1016/j.autrev.2012.03.009. Epub 2012 Apr 1. Kamen DL. How can we reduce the risk of serious infection for patients with systemic lupus erythematosus?. Arthritis Res Ther. 2009;11(5):129. <h3>Disclosure of Interest</h3> None declared
PTU-303 Impact of implementing a symptom-guided alcohol withdrawal regimen on length of stay in a district general hospital
Authors: F Rhodes, J Palit, K Greenan, I Nyathi, E Alstead
Journal: Gut (2015)

<h3>Introduction</h3> Around 12% of emergency department attendances are directly related to alcohol, with associated cost to the NHS. Historically, fixed-rate chlordiazepoxide regimens have been used for alcohol withdrawal, but recent trials have suggested that symptom-triggered regimens may be more cost-effective, and reduce length-of-stay without adverse effect. We aimed to evaluate the efficacy and safety of introducing a symptom-guided regimen to a district general hospital (DGH) Acute Assessment Unit (AAU). <h3>Method</h3> Data were collected prospectively for consecutive admissions requiring alcohol withdrawal in 2-month periods before and after training to reinforce the symptom-guided regimen. During a 2-week intervention period after the initial 2-month data collection, training on the symptom-guided protocol was delivered to the AAU nursing staff by the alcohol liaison nurse and ongoing support to clinicians was given by the alcohol liaison team. CIWA(Ar) protocols were made available on the intranet and in paper form on the ward. The primary outcome measure was length of stay (days), with secondary outcome measures including adverse events and milligrams of chlordiazepoxide (or equivalent benzodiazapine) given in first 24 h. We also surveyed the nursing staff on ease of implementation of the regimen. <h3>Results</h3> Pre-intervention group: 20 patients identified as at risk of withdrawal, with 13/20 given fixed rate chlordiazepoxide regimes. Post-intervention group: 42 patients identified as at risk of withdrawal (4 patients excluded as data incomplete) with 32/38 given symptom-guided regimes. Analysis by intention to treat showed length of stay reduced from a median of 5 to 3 days post intervention (Mann Whitney u, 2-tailed p = 0.047). Analysis on a per-protocol basis, showed length of stay reduced from (median) 6 days in fixed rate pre-intervention group (N = 13) to 3 days symptom-guided post-intervention group (N = 32) (2-tailed p = 0.021). Median chlordiazepoxide use per patient post-intervention (per-protocol) was 65 mg/24 hrs compared with median 110 mg/24 h pre-intervention, p = 0.012). Seven of 13 post-intervention patients required no chlordiazepoxide. There were no adverse events in either group. Thirteen of 15 (86.7%) nursing staff on AAU found the CIWA(Ar) score/symptom guided withdrawal regimen ‘easy’ or ‘moderately easy’ to use. <h3>Conclusion</h3> The symptom-guided withdrawal regimen was readily introduced to a busy AAU in a DGH with no adverse events, and was accompanied by substantially reduced length of hospital stay and amount of chlordiazepoxide used, with positive feedback from nursing staff. <h3>Disclosure of interest</h3> None Declared.
SAT0334 Patient-Physician Discordance in Global Assessment in Rheumatoid Arthritis: A Systematic Review of the Literature
Authors: C. Desthieux, B. Fautrel, L. Gossec
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The integration of the patient in therapeutic decisions (shared decision-making) is an important aspect of management of chronic inflammatory diseases. However, the patient9s opinion does not always reflect the physician9s opinion. Patient-physician discordance in the global assessment of disease can lead to patient dissatisfaction regarding treatment decisions and negatively affect medical care with potentially poor adherence, and costs for society. Published data on patient-physician discordance appears heterogeneous. <h3>Objectives</h3> The aim of our study was to assess in the published literature the discordance between patients and physicians in the global assessment of rheumatoid arthritis (RA). <h3>Methods</h3> A systematic review of articles published from January 2000 to January 2015 was performed using PUBMED. Keywords used were [rheumatoid arthritis and (discordance or discrepancy) and global assessment]. The outcomes collected were i) definitions used for discordance, ii) percentage of discordance and iii) drivers of global assessment. <h3>Results</h3> In all, 15 articles were identified, 7 were selected. The 7 articles reported on 8532 patients. The weighted mean age was 55.5±13.8 years, 80.5% were women, weighted mean RA duration was 10.8±9.6 years. Five articles (71%) had a cut-off. The cut-off defined as the absolute difference between patient global assessment and physician global assessment was very heterogeneous varying between 0.5 to 3cm on 0-10 visual analog scale. The mean percentage of patients with discordance was 40.3% but varied between 36% and 76%; there was more discordance with a lower cut-off to define discordance. However, a cut-off of 2cm versus 2.5cm or 3cm didn9t change the percentage of discordance (around 36%). The drivers of patient global assessment were pain and functional incapacity. Whereas, drivers of physician global assessment were acute phase reactants (ESR, CRP), tender and swollen joints count. <h3>Conclusions</h3> Discordance has a heterogeneous definition in literature. Around one third of patients with RA have a significant discordance with the physician in global asseessment of disease. This work suggests that patient global assessement is based more heavily on patients9 subjective perception of pain and functional incapacity. In contrast, physicians are more focused on "RA-specific outcomes" and such as swollen and tender joints count and acute phase reactants. Taking into account the patient perspective is important but aspects such as widespread pain syndrome, personal factors and culture may play a role in discordance. <h3>Disclosure of Interest</h3> None declared
OC-027 Buried barrett’s dysplasia: rfa is not the only culprit: Abstract OC-027 Table 1
Authors: R Bhattacharyya, F Chedgy, K Kandiah, S Tholoor, P Bhandari
Journal: Gut (2015)

<h3>Introduction</h3> Buried Barrett’s’ or Subsquamous Intestinal Metaplasia (SSIM) refers to glands which are ‘buried’ underneath the squamous epithelium. Buried Barrett’s can pose significant diagnostic and surveillance challenges. Buried Barrett’s has mainly been reported in the post ablation context (APC, RFA, PDT). We aim to evaluate its prevalence in patients who are ablation naïve, and understand the reasons behind it. <h3>Method</h3> This is a prospective cohort study. We investigated our Barrett’s database for patients who were referred for endoscopic treatment (EMR) of Barrett’s neoplasia between June 2006 to June 2014. We assessed histology reports before and after endoscopic therapy (EMR), specifically looking for evidence of buried Barrett’s. Biopsy: Biopsies were first obtained from any suspicious looking area. Following this, biopsies were then obtained from the neosquamous area. Finally, random biopsies were obtained. These were sent in separate cassettes. Histopathology was reported by two independent GI pathologists and was prospectively recorded on a central pathology database. Buried Barrett’s was defined as any metaplastic or glandular tissue beneath the squamous epithelium. Pathology specimens were reported by 2 independent, accredited GI pathologists. <h3>Results</h3> Our study shows that in the pre-EMR cohort, there was an overall prevalence of 12.2% of buried Barrett’s and a 9.1% prevalence of buried Barrett’s with high grade neoplasia (HGD or IMC). Our results in the post EMR cohort shows an overall prevalence of 16.8% of buried Barrett’s with 6.1% prevalence of buried high grade neoplasia (HGD or IMC). This has significant implications for post EMR endoscopic assessment and surveillance. <h3>Conclusion</h3> Buried Barrett’s and Barrett’s cancer are seen in endotherapy naïve patients. This is likely to be related to intensive biopsies. EMR, despite being a non ablation technique, still results in buried Barrett’s and Barrett’s cancer. The overall prevalence of buried Barrett’s is higher than previously reported. We need to be aware of this while assessing Barrett’s patients. Buried Barrett’s glands after ablation (APC/RFA/PDT) are well reported. This is the first study to report on the prevalence of Barrett’s in endotherapy naïve patients and in the post EMR cohort. <h3>Disclosure of interest</h3> None Declared.
Soundings: Old bones
Authors: Trisha Greenhalgh
Journal: BMJ (1999)

A 79 year old patient was referred to an orthopaedic surgeon with osteoarthritis of both hips. He confirmed the diagnosis, but regretted that at her age she was hardly top priority for elective surgery. “Thanks anyway, doctor,” she said, and asked the nurse to pass her crash helmet. The surgeon must have looked surprised, so she explained, “How else do you expect me to get to work, young man?”
Psychiatric aspects of patients with malignant ventricular arrhythmias
Authors: G L Fricchione, S C Vlay
Journal: American Journal of Psychiatry (1986)

The major cause of cardiac mortality in the United States is sudden cardiac death, most often the result of ventricular tachycardia-ventricular fibrillation. Transient risk factors for sudden cardiac death include psychiatric conditions mediated through the CNS. Major advances in the evaluation and treatment of patients who have survived malignant ventricular arrhythmias have been accompanied by challenging management and therapy issues for the psychiatrist involved in the care of such patients. The authors suggest ways to meet these challenges, especially in the care of patients with concomitant anxiety, depression, delirium, or psychosis.
Prevention of activation of blood coagulation during acute coronary ischemic syndromes beyond aspirin and heparin
Authors: S Bates
Journal: Cardiovascular Research (1999)

Many of the acute coronary ischemic syndromes are triggered by spontaneous or mechanical disruption of atherosclerotic plaques with resultant activation of platelets and coagulation. Given the central role of platelets and thrombin in arterial thrombosis, current strategies for its prevention and treatment focus on both inhibition of platelet aggregation and control of thrombin generation and activity. Although aspirin and unfractionated heparin are the cornerstones of current treatment strategies, both have limitations. This review will describe these limitations and discuss new antithrombotic agents developed for use in acute coronary ischemic syndromes and as adjuncts for percutaneous coronary revascularization procedures.
New blood test could personalise depression treatment
Authors: Jacqui Wise
Journal: BMJ (2016)

Scientists have developed a blood test to predict whether depressed patients will respond to common antidepressants. They said that this could herald a new area of personalised treatment for people with depression, where patients who have blood inflammation above a certain threshold could receive more aggressive treatment.

The research, published in the International Journal of Neuropsychopharmacology ,1 focused on two biomarkers that measure blood inflammation: macrophage migration inhibitory factor and interleukin 1β. Previous research has shown that patients with depression who are resistant to conventional antidepressants have higher concentrations of …
S6K1 regulates hematopoietic stem cell self-renewal and leukemia maintenance
Authors: Joydeep Ghosh, Michihiro Kobayashi, Baskar Ramdas, Anindya Chatterjee, Peilin Ma, Raghuveer Singh Mali, Nadia Carlesso, Yan Liu, David R. Plas, Rebecca J. Chan, Reuben Kapur
Journal: Journal of Clinical Investigation (2016)

Hyperactivation of the mTOR pathway impairs hematopoietic stem cell (HSC) functions and promotes leukemogenesis. mTORC1 and mTORC2 differentially control normal and leukemic stem cell functions. mTORC1 regulates p70 ribosomal protein S6 kinase 1 (S6K1) and eukaryotic initiation factor 4E–binding (eIF4E-binding) protein 1 (4E-BP1), and mTORC2 modulates AKT activation. Given the extensive crosstalk that occurs between mTORC1 and mTORC2 signaling pathways, we assessed the role of the mTORC1 substrate S6K1 in the regulation of both normal HSC functions and in leukemogenesis driven by the mixed lineage leukemia (MLL) fusion oncogene MLL-AF9. We demonstrated that S6K1 deficiency impairs self-renewal of murine HSCs by reducing p21 expression. Loss of S6K1 also improved survival in mice transplanted with MLL-AF9–positive leukemic stem cells by modulating AKT and 4E-BP1 phosphorylation. Taken together, these results suggest that S6K1 acts through multiple targets of the mTOR pathway to promote self-renewal and leukemia progression. Given the recent interest in S6K1 as a potential therapeutic target in cancer, our results further support targeting this molecule as a potential strategy for treatment of myeloid malignancies.
SP0179 The Scleroderma-Cancer Connection: New Insights
Authors: A. Rosen
Journal: Annals of the Rheumatic Diseases (2015)

Although the mechanisms of the autoimmune rheumatic diseases remain incompletely understood, there is a striking association of autoimmune responses against specific antigens with distinct clinical phenotypes. In some instances, specific immune responses are associated with an increased prevalence of cancer, with the diagnosis of both processes frequently occurring within a short time. For example, scleroderma patients with antibodies against the large subunit of RNA polymerase-3 (<i>POLR3A</i>, RPC1) have an increased prevalence of cancer, which is frequently coincident with the onset of severe, diffuse scleroderma. In cancers from scleroderma patients, we have found genetic alterations of the <i>POLR3A</i> locus in six of eight patients with antibodies to RPC1 but not in eight patients without these antibodies. 3 RPC1 antibody-positive patients had somatic mutations in <i>POLR3A</i>; 5 RPC1 patients had loss of heterozygosity at the <i>POLR3A</i> locus. Analyses of peripheral blood lymphocytes and serum suggested that POLR3A mutations sparked cellular immunity and cross-reactive humoral immune responses. These results offer insight into the pathogenesis of scleroderma, and potentially other autoimmune syndromes. They also provide support for the idea that acquired immunity helps to control naturally occurring cancers in patients with autoimmune rheumatic diseases; it is possible that this immune response may sometimes be fully effective, preventing the emergence of cancer. <h3>Disclosure of Interest</h3> None declared
Asymmetric and Diffuse Uptake of Left Femur in a 3-Year-Old Child Bone Scan
Authors: Olivier Morel, Constantin Ungureanu, Pierre Padoin, Romain Laurent, Hatem Boulahdour
Journal: Clinical Nuclear Medicine (2015)

Acute leukemia is a severe disease frequently encountered in childhood, often diagnosed in later stages because of nonspecific symptoms. It is known to produce uptake in bone scan, and previously described patterns have shown symmetrical abnormalities. However, we report the unusual aspect of the bone scan in a 3-year-old child who was referred to explore an isolated pain of his lower left limb, with hyperthermia and markers of inflammation. A bone scan showed an intense, asymmetrical uptake of the entire left femur. A few days later, his blood count showed circulating blast cells, leading to the diagnosis of leukemia.
Growth of Animal Tissue Cells on Three-Dimensional Substrates
Authors: Wilton R. Earle, Edward L. Schilling, John E. Shannon, Jr.
Journal: JNCI Journal of the National Cancer Institute (1951)

Journal Article Growth of Animal Tissue Cells on Three-Dimensional Substrates Get access Wilton R. Earle, Wilton R. Earle National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward L. Schilling, Edward L. Schilling National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar John E. Shannon, Jr. John E. Shannon, Jr. National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 12, Issue 1, August 1951, Pages 179–196, https://doi.org/10.1093/jnci/12.1.179 Published: 01 August 1951 Article history Received: 26 April 1951 Published: 01 August 1951
No Development of Neutralizing Antibodies Against Recombinant Interferon-Alpha in Ph-Negative Myeloproliferative Neoplasms - a Prospective Study
Authors: Lukas Frans Ocias, Dennis Lund Hansen, Thomas Kielsgaard Kristensen, Karin de Stricker, Daniel El Fassi, Jesper Stentoft, Jørn Starklint, Mikael Frederiksen, Marianne Tang Severinsen, Ole Weis Bjerrum, Peter Møller, Torben Mourits-Andersen, Ulrik Malthe Overgaard, Hans Carl Hasselbalch, Klaus Bendtzen, Thomas Stauffer Larsen
Journal: Blood (2015)
The future of alcohology: craft or science?
Authors: M Kalb, M S Propper
Journal: American Journal of Psychiatry (1976)

The authors discuss the problems that have resulted from the influx of professionals into the field of alcoholism, which has historically been dominated by paraprofessional workers. The interaction of the professional alcohologist, who operates from a scientific model, with the paraprofessional worker, whose model of treatment has followed craft lines, has created unique problems and tensions. A synergism has been created which has been detrimental rather than complementary. The authors suggest that the future of the alcoholism field will have to be established along craft (paraprofessional) or scientific (professional) lines because the two models cannot profitably co-exist.
SP0104 Discussion: Innovative Approaches to Managing Clinically Suspect Arthralgia
Authors: K. Raza
Journal: Annals of the Rheumatic Diseases (2015)

As awareness of the "window of opportunity" in early rheumatoid arthritis (RA) is raised amongst general practitioners and members of the public, Rheumatologist are increasing seeing patients at earlier stages in the natural history of RA; in particular at the phase of clinically suspect arthralgia (CSA) where patients have inflammatory sounding musculoskeletal symptoms but without clinically apparent joint swelling. Managing such patients is challenging, with particular issues related to outcome prediction and treatment. This talk will review the differential diagnosis of CSA with a focus on strategies that can be applied in a secondary care setting to predict future RA development including the role autoantibody testing and imaging. Potential treatment options will be discussed and ongoing research studies aimed at preventing progression to RA will be highlighted. The patient perspective in relation to the impact of their symptoms and their views about predictive testing will also be addressed. <h3>Disclosure of Interest</h3> None declared
Investigation of Tumor Variants Recovered From Mice With Systemic Leukemia (L1210) After Extensive Therapy With 3′,5′-Dichloroamethopterin and 3′-Bromo-5′-Chloroamethopterin&lt;xref ref-type="fn" rid="FN1"&gt;2&lt;/xref&gt;
Authors: Stewart R. Humphreys, Abraham Goldin
Journal: JNCI Journal of the National Cancer Institute (1959)

Studies were conducted on the growth behavior and sensitivity to therapy of tumors recovered from mice with systemic leukemia (L1210) after a prolonged increase in their lifespan, by treatment with 3′,5′-dichloroamethopterin and 3′-bromo-5′-chloroamethopterin. The tumors were recovered from various sites including the spleen and the blood. They were histologically similar to the original L1210, but showed a wide range of growth rates and sensitivities to treatment. Some of the recovered tumors grew and killed rapidly like the original sensitive leukemia L1210. Others grew slowly, and the mice showed prolonged survival times, the local tumor at the subcutaneous site of injection becoming quite large (20–35 mm.) prior to death. Some of the tumors retained the original sensitivity to treatment with amethopterin, while others showed a high degree of resistance. Resistant variants resulting from treatment with 3′,5′-dichloroamethopterin, or with amethopterin, showed greater sensitivity to 3′,5′-dichloroamethopterin than to amethopterin. 6-Mercaptopurine retained its effectiveness against the resistant variants. These observations are discussed with respect to therapy.