tbuckley/cabot-search huggingface dataset:
PWE-434 Evaluation of the impact of the learning context on the acquisition of complex professional skills through simulation based training courses
Authors: MG Keane, TJ Allain, HC Mwandumba, PA O'Toole, D Gill, MA Gordon
Journal: Gut (2015)

<h3>Introduction</h3> Rates of upper gastrointestinal pathology requiring diagnostic and therapeutic intervention in Southern Malawi are high, resources and endoscopy services are limited, and there are very few independently practicing endoscopists. Endoscopy is recognised to be a complex cognitive and technical skill that requires a dedicated period of training to achieve proficiency. An endoscopy-training programme developed for UK trainees that includes simulation, was introduced to Malawi in 2009. This study explores the commonalities and differences in the way simulation training was experienced and made use of by endoscopy trainees in both countries. It also explores what modifications are needed to make current courses maximally beneficial in a resource limited environment. <h3>Method</h3> Trainees and trainers from the UK and Malawi were invited to participate in semi-structured interviews. During the interview trainees were asked to describe the structure of their endoscopy training, experiences of simulation training and outline perceived benefits and drawbacks of their programme. Trainers were asked about their views on endoscopy training, experiences as course faculty and any modifications they felt were necessary to current training programmes to make them maximally beneficial in each country. Interview data was transcribed in full and analysed using a thematic analysis approach. <h3>Results</h3> 17 people participated in the study: 4 trainers (3 with experience of training in Europe and Malawi), 2 Endoscopy sisters and 11 trainees (4 from Malawi and 7 from the UK – two of the Malawi trainees subsequently became local trainers). Although there were considerable differences in the learning environment between the UK and Malawi, trainees recognised simulation based endoscopy-training courses as an important opportunity for intensive skill based training, which supplemented their on-going departmental endoscopy training. Factors that improved the trainee learning experience during the courses included: being taught by skilled trainers; trainees identifying a need or clinical application for their endoscopy training; and course design, specifically having access to simulation models prior to being exposed to live cases. Suggested modifications to the training programme in Malawi included; implementing robust candidate selection to prevent “drop-out” from the training programme and improving local equipment. <h3>Conclusion</h3> UK designed simulation based endoscopy-training courses were well received by Malawian trainees and needed only minor modification to be applicable and beneficial in their new environment. <h3>Disclosure of interest</h3> None Declared.
Double-blind, placebo-controlled study of a once-a-day, sustained- release preparation of alprazolam for the treatment of panic disorder
Authors: E Schweizer, W Patterson, K Rickels, M Rosenthal
Journal: American Journal of Psychiatry (1993)

The goals of this study were to assess the antipanic efficacy of a new, sustained-release formulation of alprazolam and to assess the safety and tolerability of once-a-day administration of 1-10 mg of sustained-release alprazolam.One hundred ninety-four patients with diagnosis of agoraphobia with panic attacks or panic disorder with limited phobic avoidance underwent a 1-week placebo washout before being randomly assigned to groups receiving 8 weeks of double-blind treatment with either sustained-release alprazolam or placebo.There was a significant treatment effect favoring sustained-release alprazolam (highest mean dose = 4.7 mg/day) across almost all measures of anxiety, panic, and phobic avoidance, despite a significantly higher dropout rate in patients receiving placebo. Eighty-five percent of the patients treated with sustained-release alprazolam, compared with 61% of the patients given placebo, reported complete blockade of panic attacks by the end of 6 weeks of treatment. Sedation was the most commonly reported adverse effect. Discontinuation of sustained-release alprazolam was associated with moderate but transient levels of distress in 48% of the patients; discontinuation of placebo led to distress in only 10% of the patients. Nonetheless, there was no difference in the proportion of patients who were able to remain off the study drug for at least 2 weeks.These results suggest that sustained-release alprazolam is highly effective in the acute treatment of panic disorder at doses comparable to those in the originally marketed compressed tablet of alprazolam. The medication was well tolerated but showed rebound effects during a rapid drug taper after 6 weeks of treatment.
PTU-162 “coeliac disease screening in ‘2 week wait’ patients: biopsy or serology?”
Authors: S Kotha, K McLaren, C Holohan, A McNair
Journal: Gut (2015)

<h3>Introduction</h3> Patients with iron deficiency anaemia (IDA) or weight loss are usually referred to gastroenterology services through the 2 week wait (2ww) referral pathway. When these patients undergo an oesophagogastroduodenoscopy (OGD) it is common practice to take biopsies from the second part of the duodenum (D2) to exclude coeliac disease. Both BSG (British Society of Gastroenterology) and NICE (National Institute for Health and care Excellence) guidelines recommend that patients with suspected coeliac disease should be screened with serology initially. If coeliac serology is negative then small bowel biopsies are generally not necessary. Despite this D2 are routinely taken which results in an increased workload and cost. <h3>Method</h3> The aim of this study was to determine if D2 biopsies were necessary and cost effective in patients with IDA or weight loss referred on the 2ww pathway. We analysed retrospective data collected from the endoscopy database (Adam) at Queen Elizabeth Hospital for 400 patients referred through 2ww pathway (200 for IDA and 200 for weight loss) who underwent an OGD. Demographic data, histological findings and cost of analysing histology were evaluated. <h3>Results</h3> Of the 200 IDA patients who had D2 biopsy during the study period, 2 patients were excluded (1 had a prior diagnosis of coeliac and 1 did not have histology results on our system). 3 patients had villous atrophy (serology was not checked in 1 patient, 2 had positive serology). The overall pick up rate for significant pathology on D2 biopsies for IDA was 1.5% With D2 biopsy for weight loss, 2 patients were excluded (no histology results was available), 2 patients had villous atrophy (serology was not checked in 1 patient and was negative in 1 patient who had a low IgA), 1 patient had Crohn’s disease on histology. The overall pick up rate for significant pathology on D2 biopsies for weight loss was 1.0%. The cumulative cost of analysing these biopsies was £ 13,440 (£33.6/biopsy). <h3>Conclusion</h3> Overall only a single patient with villous atrophy would have been missed if celiac serology was used in place of D2 biopsies. The cost of performing these biopsies is considerable and burdens the histopathology with large numbers of specimens that have to be processed urgently. Coeliac serology should therefore be done in place of D2 biopsies in 2ww patients undergoing OGD. <h3>Disclosure of interest</h3> None Declared.
SAT0317 Correlation Between Serum Uric Acid and Left Ventricular Mass in Essential Hypertension
Authors: E.R. Rinaldi, C. Bentivenga, E. Cosentino, S. Corvaglia, M. Rosticci, L. Magnani, I. Ricci Iamino, A.F. Cicero, N. Malavolta, C. Borghi
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Left ventricular hypertrophy (LVH) is an independent and powerful risk factor for cardiovascular events and death. Serum uric acid (SUA) may induce LVH, on one hand, through an inflammatory effect which promotes cardiac hypertrophy and, on the other, through an activation of the renin-angiotensin-aldosterone system which generates hypertrophy and hyperplasia of myocytes and fibrosis of the heart <h3>Objectives</h3> Aim of the study was to investigate the correlation between SUA levels and left ventricular mass in a group of hypertensive patients <h3>Methods</h3> We evaluated 51 patients (mean age 74±10 years; range 49-87, F 37.7%; M 62.3%) with essential hypertension. Each patient underwent a standardized medical history and clinical examination, laboratory tests and echocardiographic assessment with the determination of left ventricular mass index (LVMI) <h3>Results</h3> Mean value of SUA was 6.68±2 mg/dl. Mean blood pressure (MAP) was 95±12 mmHg. A positive significant correlation between SUA and LVMI (P=0.029) was observed. After adjusting for MAP and age in standard multiple linear regression analysis, SUA level remains independently associated with LVMI suggesting that increased urate levels are associated with a higher myocardial mass. <h3>Conclusions</h3> Our results demonstrate that SUA is independently associated with LVMI and suggest that the combination of hyperuricemia with LVH could be a powerful predictor of cardiovascular events <h3>References</h3> Yoshio Iwashima, Takeshi Horio, Kei Kamide, Hiromi Rakugi, Toshio Ogihara and Yuhei Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension. Hypertension 2006;47:195-202; Ayako Yoshimura, Hisashi Adachi, Yuji Hirai, Mika Enomoto, Ako Fukami, Eita Kumagai, Kyoko Ohbu, Sachiko Nakamura, Aya Obuchi, Yume Nohara, Tsutomu Imaizumi. Serum Uric Acid Is Associated With the Left Ventricular Mass Index in Males of a General Population. Int Heart J, January 2014 Cristiana Catena, GianLuca Colussi, Frine Capobianco, Gabriele Brosolo and Leonardo A. Sechi. Uricaemia and left ventricular mass in hypertensive patients. Eur J Clin Invest 2014;44(10):972-981 <h3>Disclosure of Interest</h3> None declared
Influenza Activity — United States, 2015–16 Season and Composition of the 2016–17 Influenza Vaccine
Authors: Stacy L. Davlin, Lenee Blanton, Krista Kniss, Desiree Mustaquim, Sophie Smith, Natalie Kramer, Jessica Cohen, Charisse Nitura Cummings, Shikha Garg, Brendan Flannery, Alicia M. Fry, Lisa A. Grohskopf, Joseph Bresee, Teresa Wallis, Wendy Sessions, Rebecca Garten, Xiyan Xu, Anwar Isa Abd Elal, Larisa Gubareva, John Barnes, David E. Wentworth, Erin Burns, Jacqueline Katz, Daniel Jernigan, Lynnette Brammer
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

During the 2015-16 influenza season (October 4, 2015-May 21, 2016) in the United States, influenza activity* was lower and peaked later compared with the previous three seasons (2012-13, 2013-14, and 2014-15). Activity remained low from October 2015 until late December 2015 and peaked in mid-March 2016. During the most recent 18 influenza seasons (including this season), only two other seasons have peaked in March (2011-12 and 2005-06). Overall influenza activity was moderate this season, with a lower percentage of outpatient visits for influenza-like illness (ILI),(†) lower hospitalization rates, and a lower percentage of deaths attributed to pneumonia and influenza (P&I) compared with the preceding three seasons. Influenza A(H1N1)pdm09 viruses predominated overall, but influenza A(H3N2) viruses were more commonly identified from October to early December, and influenza B viruses were more commonly identified from mid-April through mid-May. The majority of viruses characterized this season were antigenically similar to the reference viruses representing the recommended components of the 2015-16 Northern Hemisphere influenza vaccine (1). This report summarizes influenza activity in the United States during the 2015-16 influenza season (October 4, 2015-May 21, 2016)(§) and reports the vaccine virus components recommended for the 2016-17 Northern Hemisphere influenza vaccines.
PTH-058 Nutrition guidelines in practice in a district general hospital in 2009: Abstract PTH-058
Authors: V Mitra, N Dunford, C Bailey, V Sakellariou
Journal: Gut (2010)

<h3>Introduction</h3> Malnutrition is both a cause and consequence of ill-health and affects 15-40% of hospital admissions.1 The National Health Service could save £226 million pounds per annum by providing nutritional support to undernourished patients.2 NICE guidelines for “nutrition support for adults” advocate screening of all hospital inpatients on admission, weekly thereafter and action depending on the risk score.3 Our hospital uses “nutritional risk score” (NRS) chart as a screening tool. <h3>Methods</h3> We wanted to assess whether our hospital practice complies with these guidelines. A pro-forma was developed in collaboration with the clinical governance department and a snap shot audit was carried out in May 2009. NRS data were collected prospectively for all medical inpatients on the same day, while outcome and length of stay were examined at a later date. Waiting times, nutritional supplementation and outcome were recorded and analysed using SPSS system. <h3>Results</h3> 226 case notes were reviewed of which 55% patients were females. Mean age was 77 (±12 SD) years.78% were admitted from their own home, 20% from nursing home and 2% were transferred from other units. Only 15% of patients were weighed on admission. The NRS charts were partially filled in 17% of patients, completely in 38%, while 45% had no chart. 33% of NRS charts were reviewed weekly, 33% were reviewed intermittently but not weekly and the remaining were not reviewed. Based on the NRS score, patients were divided into groups and the results are demonstrated in the Abstract 058. <h3>Conclusion</h3> The data show that we are poorly compliant with the NICE guidelines for “nutrition support for adults” in the acute inpatient setting. The length of stay and high mortality in patients with moderate and high NRS scores emphasises the need for vigerous screening for malnutrition. We suggest that the NRS is a mandatory tool in the admission documentation of all patients.
Schizophrenia and cerebral asymmetry detected by computed tomography
Authors: D J Luchins, D R Weinberger, R J Wyatt
Journal: American Journal of Psychiatry (1982)

The authors nonblindly assessed occipital cerebral asymmetry on computed tomography (CT) scans of 79 schizophrenic or schizoaffective patients and 100 neurological or medical patients. More of the schizophrenic patients had reversals of the normal asymmetry than did controls. The schizophrenics with CT evidence of brain atrophy has a higher frequency of normal asymmetrics than did controls, and the schizophrenics without atrophy had more reversed asymmetries. The schizophrenics with reversed asymmetry, compared with those with normal asymmetry, had lower verbal than performance IQ. Comparison of occipital asymmetry and lateral ventricular asymmetry indicated that reversed asymmetry in the schizophrenic patients was probably not due to localized atrophy.
Case 11-1972
Authors: Richard C. Cabot, Benjamin Castleman, Robert E. Scully, Betty U. McNeely, George S. Richardson, Robert E. Scully
Journal: New England Journal of Medicine (1972)

Presentation of CaseA 13-year-old girl was admitted to the hospital because of an abdominal mass.She had been well until five months previously, when amenorrhea occurred after a single normal menstrual period. Two months later her facial acne, which had been mild for one year, became more severe, her voice became deeper, and a beard began to grow. She gained 9 kg in weight over a four-month period. During the two weeks before admission she experienced recurrent abdominal cramps, which increased in frequency and severity. Because of the acne she was seen by a dermatologist, who palpated a mass . . .
Longevity protein klotho is induced by a single bout of exercise
Authors: Alana Santos-Dias, BreAnne MacKenzie, Manoel Carneiro Oliveira-Junior, Rosa Maria Moyses, Fernanda Marciano Consolim-Colombo, Rodolfo Paula Vieira
Journal: British Journal of Sports Medicine (2016)

Physical activity clearly reduces disease-specific mortality in patients with diabetes.1The mechanism responsible for reduced mortality appears to be linked to exercise-induced improvement in oxidation and reduction (redox) responses, as well as the halting or reversal of arterial and venal calcifications 2 ,3 in diabetes-associated cardiovascular diseases (CVD)—currently the world's leading cause of mortality. 4 A recent review established a relationship between decreased bioavailability of the protein klotho with CVD and with chronic kidney disease (CKD) disease states. 5 Reduced levels of klotho are related to CVD and CKD complications, involving vascular calcification, inflammation, endothelial dysfunction and redox imbalance. 5 

Klotho is primarily expressed in the kidneys, but also found in other organs as well as cerebrospinal fluid, urine and blood. 6Reduced plasma levels of klotho are found in elderly persons, and klotho deficient mice display an ageing …
Salmonella Mitigates Oxidative Stress and Thrives in the Inflamed Gut by Evading Calprotectin-Mediated Manganese Sequestration
Authors: Vladimir E. Diaz-Ochoa, Diana Lam, Carlin S. Lee, Suzi Klaus, Judith Behnsen, Janet Z. Liu, Nicholas Chim, Sean-Paul Nuccio, Subodh G. Rathi, Jennifer R. Mastroianni, Robert A. Edwards, Christina M. Jacobo, Mauro Cerasi, Andrea Battistoni, André J. Ouellette, Celia W. Goulding, Walter J. Chazin, Eric P. Skaar, Manuela Raffatellu
Journal: Cell Host & Microbe (2016)
Treating psychiatric problems in medical students
Authors: L R Hays, L R Dickson, M R Lyles, A M Ludwig, C A Martin, M A Bird
Journal: American Journal of Psychiatry (1986)

The medical school educational experience is very stressful for many students, prompting some to seek formal psychiatric care. The authors describe the Medical Student Support Services program of the University of Kentucky College of Medicine. From July 1983 to June 1985, this program served 66 patients, representing 417 visits. On the basis of retrospective chart review with the examining clinicians, the authors present DSM-III diagnoses, types of problems seen, descriptive profiles of the patients, duration of treatment, types of therapy used, and data on marital issues. They discuss the intricacies of providing psychiatric services to medical students and make recommendations for program development for such patients.
OC-081 3d rectal plotgram in controls and patients with functional anorectal disorders: new manometric tool
Authors: K Elgendy
Journal: Gut (2015)

<h3>Introduction</h3> This study aims to analyse rectal and anal pressure changes in relation to different rectal volumes and relation to patients’ symptoms with 3d plotting, illustrating the dynamic interaction between the rectum and anal canal. <h3>Method</h3> The study involved 10 controls, 10 incontinent patients and 10 patients with constipation. Anorectal manometry was done using 8 channels spirally arranged with increasing rectal volume of 10 ml/10 sec, with 3d plotting of rectal volume versus different anorectal pressures. <h3>Results</h3> In the control group, reproducible non-linear characteristic rectal plotgram is produced, in which changes in the curves divided into phases are correlated with patient symptoms and illustrating changes in rectal compliance. In patients with constipation, low rectal pressures were associated with less changes in anal sphincter relaxation illustrating how rectal inertia may contribute to difficult evacuation. Patients with pelvic dyssynerigia were associated with normal rectal curves but with abnormal anal relaxation. In patients with anal incontinence, different categories of patients are classified according to the curves. Abnormal rectal curves are associated with abnormal reflex relaxation of the anal sphincters. In patients with severe sphincteric injury, abnormally low rectal pressures are produced. In patients with rectal prolapse, higher rectal pressures are found. In patients with normal resting and squeeze pressures, abnormally low rectal compliance curves are produced with marked changes in anal pressures. <h3>Conclusion</h3> Manometry is not a simple measure of anal pressures. Rectal plotgram and 3d graphical representation provide a new tool in anorectal manometry. It points to the importance of rectum and give us better insight into the complex relation between rectum and anal canal in health and disease. <h3>Disclosure of interest</h3> None Declared.
Primary Amebic Meningoencephalitis Associated with Hot Spring Exposure During International Travel — Seminole County, Florida, July 2014
Authors: Peggy J. Booth, Dean Bodager, Tania A. Slade, Swannie Jett
Journal: MMWR Morbidity and Mortality Weekly Report (2015)

Epilepsy is a brain disorder characterized by recurrent seizures; an estimated 2.9 million persons in the United States have active epilepsy (1).A seizure is a brief change in normal brain activity that changes awareness, behavior, or body movement.More than 30 different types of seizures have been described (2).A report in this issue characterizes seizures in children and adolescents aged 6-17 years in the United States.Because seizures can affect anyone, members of the public need to know how to safely assist a person having a seizure.Not all seizures are emergencies, and most will end within a few minutes.The first response to witnessing a seizure should be to remain calm and provide care and comfort.A person with a convulsive seizure might cry out, fall, stiffen, shake, or lose awareness.If possible, the person should be helped to sit safely or should be guided gently to the floor.Once on the floor, a person should be turned on the side to keep the airway clear; nearby objects should be moved to prevent injury, and the head should be cushioned.A person witnessing a seizure in someone should call 911 if a seizure lasts more than 5 minutes, causes an injury, occurs in a person with another known condition (e.g., pregnancy or low blood sugar in diabetes), or causes a person to have difficulty breathing or waking after the seizure is over.CDC works to improve the health and well-being of persons with epilepsy and to educate the public about this disorder (3).Additional information about providing first aid for seizures is available at http://www.cdc.gov/epilepsy/basics/first-aid.
Streptococcus pyogenes cluster in a care home in England April to June 2010
Authors: L M Milne, T Lamagni, A Efstratiou, C Foley, J Gilman, M Lilley, S Guha, F Head, T Han
Journal: Eurosurveillance (2011)

Two fatal cases of Streptococcus pyogenes emm st22.6 bacteraemia occurred in a care home in England during April and June 2010, initiating a cluster investigation. The first case had left the home 13 days before the second case took up residence. We sought further cases and carriers. We swabbed throat and chronic skin lesions from residents and staff and examined these specimens for the presence of S. pyogenes. 61 specimens were taken from 18 of 19 residents and 39 of 39 staff. All results from swabbing were culture negative. We observed infection control practices and the environment at the care home for deficiencies. Issues were identified relating to the correct use of personal protective equipment, hand hygiene, clinical waste and laundry. Infection control practices were improved and training given. Infection control practices and the environment at a care home should be examined as part of the investigation of a S. pyogenes cluster. Screening for carriage of S. pyogenes should be done before antibiotic chemoprophylaxis is issued to care home residents and staff.