tbuckley/cabot-search huggingface dataset:
Evaluation of colonoscopy performance based on post-procedure bleeding complications: application of procedure complexity-adjusted model
Authors: Roger Blanks, Claire Nickerson, Julietta Patnick, Colin Rees, Matthew Rutter
Journal: Endoscopy (2015)

<b>Background and study aim:</b> High quality colonoscopy requires low complication rates. However in quality assurance, evaluation of individual colonoscopist complication rates is limited because complications are relatively rare events and there is variation in average procedure complexity. The aim of the study was to develop a quality system that adjusted for procedure complexity to monitor bleeding adverse events at both the screening center and colonoscopist levels. <b>Methods: </b>The study examined the risk factors for post-procedure bleeding from 130 831 colonoscopies conducted between August 2006 and January 2012. Binomial and logistic regression models were used to examine the risk of events against explanatory variables including age, sex, polyps resected, and polyp size. The models were used to produce a procedure-adjusted standardized adverse event ratio (PASAER) based on the ratio of the observed to expected number of adverse events. The primary outcome of interest was to identify centers that were outside a funnel plot outlier level of 99.8 % (3 SDs). <b>Results:</b> Mulivariate models showed that the risk of bleeding was associated with largest resected polyp size, sex, polyp location, and degree of co-morbidity. These variables were used to calculate PASAERs for the 59 screening centers and 286 colonoscopists. The method highlighted one center with a high PASAER of 3.08 (32 observed compared with 10.4 expected events) and one with a low PASAER of 0.34 (10 observed compared with 29.8 expected events), which merited further investigation. <b>Conclusions: </b>The PASAER provided additional certainty that a crude adverse event rate was not confounded by procedure complexity, thus objectively identifying centers or colonoscopists that required further performance evaluation.
Peer Review
Authors: Constance Azzi
Journal: JAMA (1975)

<h3>To the Editor.—</h3> In an article concerning peer review (230:1161, 1974), it is difficult to understand whether or not the writer, Dr. Coulter, is angry with the American Psychiatric Association (APA) or with the legislation as it appears in PL 92-603. Dr. Coulter does not explain why there is an "impossibility of coexistence... between effective techniques of authoritative control and... education." It is clear that Dr. Coulter does have a very comprehensive knowledge of the positions of all the organizations that are affected by the present brouhaha about peer review. His references attest to this fact. Certainly, from the quotes that Dr. Coulter himself has given, it is not understanding of the Department of Health, Education, and Welfare of PL 92-603 (viz, the quote from Senator Bennett, "educational process resulting from the broadest possible participation") that lends itself to elitism but, rather, statements by the APA. What I really wanted
Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?
Authors: Jonas K Eriksson, Lennart Jacobsson, Karin Bengtsson, Johan Askling
Journal: Annals of the Rheumatic Diseases (2016)

Aims To assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population. Methods Using linkages of national and population-based registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models. Results Based on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% CI 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population. Conclusions Prevalent patients with AS are at a 30%–50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.
Overtube-assisted ERCP in a patient with a dilated atonic stomach
Authors: Nuretdin Suna, Ufuk Kuzu, Serkan Torun, Erkin Öztaş, Selçuk Dişibeyaz, Erkan Parlak
Journal: Endoscopy (2015)

Endoscopic retrograde cholangiopancreatography (ERCP) is usually difficult and sometimes impossible in patients with altered anatomy, whether due to gastrointestinal surgery or for other reasons. Various techniques have been used to facilitate ERCP in patients with anatomy that makes the procedure difficult [1] [2] [3] [4] [5]. There is no information in the literature regarding the use of an overtube during the ERCP procedure, although these are already used for various indications during upper gastrointestinal endoscopy. We hereby present details of a successful overtube-assisted ERCP in a patient in whom it was impossible to pass the endoscope beyond the pylorus because of excessive looping of the duodenoscope in a dilated atonic stomach.
Case 21-1968
Authors: Kurt J. Block, Martin H. Flax
Journal: New England Journal of Medicine (1968)

Presentation of Case First admission. A seventy-year-old man was admitted to the hospital because of weight loss, hemoptysis and pain in the chest.X-ray films of the chest revealed a mass, 8.5 cm in greatest diameter, in the left-middle-lung field. An intravenous pyelographic study disclosed minimal blunting of the minor calyxes; there was incomplete emptying of the bladder, and the floor of the bladder was elevated. Digoxin was administered. A left pneumonectomy disclosed a squamous-cell carcinoma and a tumor thrombus in the artery to the lingula; the 8 lymph nodes removed and the resection margins were free of tumor. Second . . .
AB0203 Possible Role of Fractalkine/CX3CL1 (FKN) in the Microvascular Damage of Systemic Sclerosis (SSC)
Authors: K. Stefanantoni, I. Sciarra, C. Corinaldesi, M. Caucci, M. Vasile, N. Iannace, M.C. Saturno, C. Crescioli, G. Valesini, V. Riccieri
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic Sclerosis (SSc) is a severe autoimmune disease characterized by tissue fibrosis, immune dysregulation and vascular dysfunction. Nailfold Videocapillaroscopy (NVC) is a simple diagnostic tool that is commonly used to assess microvascular changes in SSc (1). Fractalkine/CX3CL1 (FKN) is a member of CX3C chemokine family and is expressed on tumor necrosis factor α (TNF-α) and IL-1 stimulated endothelial cells (2,3). In SSc it seems to be expressed on endothelial cells in the affected skin and in lung tissue and raised serum levels of FKN are associated with higher erythrocyte sedimentation rates, presence of digital ischemia, and severity of pulmonary fibrosis (4) and pulmonary arterial hypertension (5). <h3>Objectives</h3> To assess the role of Fractalkine/CX3CL1 in the development of the different capillaroscopic patterns in SSc. <h3>Methods</h3> We enrolled 39 patients with SSc, diagnosed according to 2013 ACR/EULAR criteria. All patients underwent clinical, instrumental and laboratory evaluations. NVC was defined as "early", "active" and "late" patterns (1). FKN levels were assessed by Bioplex Luminex platform. <h3>Results</h3> We found significantly higher FKN serum levels in patients with "early" and "active"capillaroscopic patterns ("non late" patterns) respect to those with "late" pattern (355.6±176.3 ng/ml vs 307.2±104.2 ng/ml; p&lt;0.0001). <h3>Conclusions</h3> Our results suggest that FKN, a chemokine highly expressed on activated endothelial cells, is involved in the early phases of the microvascular damage in our patients, as identified by the "early" and "active"capillaroscopic patterns. Further investigations are needed to determine if FKN may be considered as a useful biomarker, at least at the beginning of the vascular manifestations in SSc. <h3>References</h3> Cutolo M: J Rheumatol. 2000 Jan;27(1):155-60. Fraticelli P et al: J Clin Invest 2001; 107: 1173-81 Garcia GE at al: J LeukocBiol 2000; 67: 577-84 Hasegawa M et al: Ann Rheum Dis 2005; 64: 21-8 Marasini B et al: Clinical &amp; Developmental Immunology, December 2005; 12(4): 275-279 <h3>Disclosure of Interest</h3> None declared
Kidney Cancer
Authors: Janet M. Torpy, Cassio Lynm, Robert M. Golub
Journal: JAMA (2011)

Renal arteryRenal vein C ancer of the kidneys, also known as renal cancer, is often curable when detected early.However, some patients may not be diagnosed until the tumor is large or has metastasized (spread to other organs) and becomes difficult to treat.Most kidney cancers are renal cell carcinomas.In children, the most common type of kidney cancer is called Wilms tumor.This Patient Page is based on one published in the July 7, 2004, issue of JAMA.
AB0590 Prolactin Levels are Associated with a Pro-Inflammatory Body Mass Distribution Among Systemic Lupus Erythematosus Female Patients: Table 1.
Authors: M.F. Ugarte-Gil, R.V. Gamboa-Cardenas, F. Zevallos, J.M. Cucho-Venegas, R.A. Perich-Campos, J.L. Alfaro-Lozano, M. Medina, Z. Rodriguez-Bellido, G.S. Alarcόn, C.A. Pastor-Asurza
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Chronic inflammatory conditions are associated with a decrease of bone mineral density (BMD) and lean mass (in particular low appendicular lean mass) and an increase of fat mass (in particular areas considered more pro-atherogenic, like trunk fat mass or trunk-to-leg fat ratio). As prolactin (PRL) has a pro-inflammatory function in systemic lupus erythematosus (SLE) and it is associated with disease activity and damage, it would be expected that PRL could be associated with a decrease of BMD and lean mass and an increase of fat mass. <h3>Objectives</h3> To determine whether PRL levels are associated with a pro-inflammatory body mass distribution in female SLE patients. <h3>Methods</h3> This cross-sectional study was conducted in consecutive SLE female patients seen in our Rheumatology Department from 2012 to 2014. For the purpose of this study, baseline visits were included. Overweight patients (more than 115 kg), those with metallic implants or pregnant were excluded for this analysis. Disease activity was ascertained using the SLEDAI and disease damage with the SLICC/ACR damage index (SDI). PRL was measured in ng/ml. Body mass distribution was measured by DXA and it was divided into sub-total (whole body without the head) BMD, sub-total bone mineral content (BMC), lean mass index (appendicular lean mass/height<sup>2</sup>, LMI), sub-total, trunk and leg fat percentages and trunk-to-leg fat ratio. A pro-inflammatory body mass distribution is defined as a decrease of BMD, BMC and LMI and an increase of fat mass, in particular trunk fat mass and trunk-to-leg fat mass ratio. The association between PRL levels and body mass distribution components was evaluated by univariable and multivariable linear regression models, the last one adjusted for age, disease duration, SLEDAI, SDI, use of prednisone, antimalarials and immunosuppressive drugs. <h3>Results</h3> One hundred and fifty-five patients were evaluated; their mean (SD) age was 42.7 (13.4) years; nearly all patients were Mestizo. Patients included in this study had a lower body mass index than the rest of the cohort. Age, disease duration, SLEDAI and SDI were similar than the rest of the cohort. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.5 (4.1) and the SDI 0.8 (1.3). PRL levels were 18.8 (14.3) ng/ml. BMD was 0.9 (0.1) g/cm<sup>2</sup>, BMC was 1.4 (0.3) kg, LMI 6.1 (1.1) kg/m<sup>2</sup>, percentage of subtotal fat 36.7 (6.7), trunk fat 34.3 (7.6), leg fat 37.9 (6.7), trunk-to-leg fat ratio 1.5 (0.6). Multivariable analysis is depicted in Table 01. <h3>Conclusions</h3> Higher PRL levels are associated with a pro-inflammatory body mass distribution in SLE patients. <h3>Disclosure of Interest</h3> None declared
Cholera in the Mediterranean: outbreak in Albania
Authors: D Greco, I Luizzi, A Sallabanda, A Dibra, E Kacarricy, L Shapo
Journal: Eurosurveillance (1995)

In the 1990s, an epidemic of cholera caused by Vibrio cholerae 01 El Tor has spread from northern Pakistan to the Mediterranean. In 1993 sporadic cases of cholera, and epidemic foci, were recorded in many countries of the southern part of Eastern Europe.
A case of tuberculosis on a long distance flight: the difficulties of the investigation
Authors: A Vassiloyanakopoulos, G Spala, E Mavrou, C Hadjichristodoulou
Journal: Eurosurveillance (1999)

Transmission of Mycobacterium tuberculosis from passenger to passenger aboard a long airplane flight was reported in 1996. Other cases were previously published, in particular by the Centers for Disease Control which had then suggested criteria for epidem
An evaluation of the Cleveland criteria for inpatient treatment of substance abuse
Authors: J R McKay, A T McLellan, A I Alterman
Journal: American Journal of Psychiatry (1992)

This study examined the validity of the Cleveland Admission, Discharge, and Transfer Criteria, a comprehensive system for assigning alcohol- and drug-abusing patients to appropriate levels of care.The subjects were 143 alcoholic and cocaine-dependent male patients in an intensive Veterans Administration day treatment program for substance abusers. Patients who should have received inpatient treatment according to the Cleveland criteria were compared with those who were properly "matched" to day treatment according to the criteria. The outcome measures were treatment completion, results of urine toxicology screens, and self-reports of substance use and psychosocial functioning.Patients who met the criteria for inpatient care were not more likely to drop out of day hospital treatment, and there was no evidence that they were drinking or using cocaine more frequently during follow-up. Furthermore, they did not appear to be doing worse on any of the other outcome measures, with the exception of psychological status.The results suggest that for male substance abusers in the lower socioeconomic levels, the Cleveland criteria may not be effective in differentiating patients who can manage well with day hospital treatment and those who require inpatient treatment.
Bioassay of the Virus of Visceral Lymphomatosis. I. Use of Short Experimental Period
Authors: Burmester, B. R.
Journal: JNCI Journal of the National Cancer Institute (1956)

Journal Article Bioassay of the Virus of Visceral Lymphomatosis. I. Use of Short Experimental Period Get access B. R. Burmester B. R. Burmester Regional Poultry Research Laboratory, Agricultural Research Service, U. S. Department of Agriculture, East Lansing, Mich. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 16, Issue 5, April 1956, Pages 1121–1127, https://doi.org/10.1093/jnci/16.5.1121 Published: 01 April 1956 Article history Received: 25 November 1955 Published: 01 April 1956
Single Cell Developmental Classification of B Cell Precursor Acute Lymphoblastic Leukemia (BCP ALL) Reveals Link Between Phenotype, Signaling, and Drug Response
Authors: Kara L. Davis, Nikolay Samusik, Astraea Jager, Sean C. Bendall, Erin F. Simonds, Wendy J. Fantl, Garry P. Nolan
Journal: Blood (2014)
PTU-166 An audit of the prevalence of faecal incontinence in hospital patients
Authors: A Gumber, M Redman, M Elsharif, G Kaur
Journal: Gut (2015)

<h3>Introduction</h3> Faecal incontinence (FI) is a common and under-reported problem, with many patients too embarrassed to seek help. Optimal management relies on first identification of these patients and only then- a thorough diagnosis that identifies all contributory factors, and a systematic approach to treatment. Management options include drug therapy, topical applications, containment products, behavioural techniques and surgery. Many patients do not receive optimal care due to lack of identification. In-hospital identification when they are admitted for other reasons may be one method of improving the care of such patients. <h3>Method</h3> We assessed the identification of continence problems in our hospital patients via a simple ‘spot check’ audit of the different wards; we used the case notes for checking the documentation by both nursing and medical staff. We looked at care plans, stool charts, follow up plans etc. <h3>Results</h3> Overall, 163 patient case notes were examined. 90% had nursing documentation about faecal continence documented in comparison to 48% for medical documentation. Of the 147 patients where nursing documentation was found, 10.8% were found to have FI. Only 31% of these patients would have been identified by medical documentation. If only medical documentation had been used, this would have dropped to 6.5%. Most of the patients that were identified as having FI were, as expected, elderly and on the stroke unit (44%), general elderly medical wards (37.5%), orthopaedic (12.5%) and gastroenterology (6%) wards. All patients (100%) were then referred appropriately for further management. <h3>Conclusion</h3> Faecal incontinence has considerable impact on patients’ lifestyle and quality of life, and can cause profound distress. It is important to identify these patients with FI, establish the cause and initiate appropriate management, whilst maintaining their privacy and dignity. The impact of FI on the patient’s quality of life needs to be assessed prior to planning management/specialist referral etc. Written documentation in the form of care plans, follow up arrangements, advice leaflets etc is vital to providing optimal care for our patients. We found that our nursing documentation was much better than the medical documentation which needs to be improved. Once identified, all our patients were managed appropriately. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Thomas TM, Egan M, Walgrove A, Meade TW. The prevalence of faecal and double incontinence. J Public Health 1984;6(3):216-220 National audit of continence care (NACC) Pilot audit evaluation report. June 2012
Second-Look Endoscopy During Percutaneous Endoscopic Gastrostomy by Passing a Laryngofiberscope Through the Inserted Feeding Tube
Authors: L. Lujber, J. Pytel
Journal: Endoscopy (2003)

Percutaneous endoscopic gastrostomy (PEG) [1] has been widely accepted as a means of providing nutritional support for patients with head and neck cancer. Most techniques require a second-look gastroscopy to check that the feeding tube has been correctly positioned and to exclude complications [2], and many endoscopists carry these out. However peroral gastroscopy may be difficult in patients with large tumors or anatomical changes caused by surgery or irradiation. In addition, the procedure is unpleasant for the patient when it is done under local anesthesia, and also every pass of the gastroscope can increase the incidence of some procedure-related risks and complications, such as contamination of the feeding tube with oropharyngeal bacteria [3], and stomal tumor cell seeding [4] [5].
Temperament and intellectual development: a longitudinal study from infancy to four years
Authors: M Maziade, R Côté, P Boutin, H Bernier, J Thivierge
Journal: American Journal of Psychiatry (1987)

Using three temperamentally different subgroups from a large birth cohort, the authors undertook a longitudinal study of the association between temperament measured in children at 4 and 8 months and IQ assessed at 4.7 years. The data suggested a strong effect of extreme temperament traits on IQ development in middle and upper socioeconomic classes and in families with superior functioning in terms of communication. The temperamentally difficult group unexpectedly displayed higher IQs, and the well-replicated effect of socioeconomic status on IQ development was observed mainly in this group. These data support the hypothesis that difficult infants activate special family resources, which stimulates intellectual development over the years.
Australian perspective
Authors: J Jill Gordon
Journal: BMJ (2006)

Hutchinson explores the likely educational impact of changes in health service design and delivery on the part of the NHS in England.1 In Australia, we envy the way in which centralist arrangements in the UK help to disseminate improvements to services and training.2 Here, funding is split between the Commonwealth and the states and between the public and private sectors. Despite the differences, however, many similar concerns and problems prevail.

Rather than a patient led environment, Australia is still working toward one that is more patient centred. Patient centred care is embedded in the national patient safety framework developed under the auspices of the Australian Council for Quality and Safety in Health Care.3 It is designed to address the educational needs of managers, clinicians, and support staff at all levels. Ensuring its dissemination remains the biggest challenge.