tbuckley/cabot-search huggingface dataset:
Mitral Stenosis in Facsimile
Authors: Frank W. Davis, E. Cowles Andrus
Journal: New England Journal of Medicine (1954)

SINCE surgical treatment for mitral stenosis has become an accepted procedure it behooves the clinician to exert the utmost diligence in selecting all candidates who could conceivably be benefited by commissurotomy. With the increased interest in recent years, it has been more widely recognized that the "classic signs"—that is, apical mid-diastolic and presystolic murmur, accentuated mitral first sound, loud and reduplicated pulmonic second sound and mitral "opening snap"—are not always present in mitral stenosis, and means of ascertaining with certainty the presence or absence of physiologically significant obstruction are being sought. Cardiac catheterization, angiocardiography, roentgenokymography and electrokymography, and other means . . .
Soundings: There is no evidence that...
Authors: Kevin Barraclough
Journal: BMJ (2003)

I was in a medical meeting discussing the extent to which mental attitude influences the natural history of disease. In an interesting debate the mantra “there is no evidence that...” was repeated at diverse moments by several colleagues. Although I am an enthusiast of evidence based medicine I must admit that I have begun to find it irritating that the phrase is used like some sort of runic spell to negate all opposition. Surely it encompasses two totally different situations. The first context (and overwhelmingly the commonest) is that there is no evidence because no one has looked. The second is that someone has done the relevant study and found a negative result. The first is merely noteworthy and the latter persuasive, but neither is the word of God.

Recently I have been hobbling around, in a mildly depressed state, on a rather damaged knee. I have surreptitiously asked a colleague to prescribe some anti-inflammatory gel and slipped away to distant, anonymous chemists to obtain the nefarious unguent. The stuff is much loathed by prescribing leads and the Drug and Therapeutics Bulletin. It is definitely a “there is no evidence...” treatment. In this case some studies have been done and have shown limited or no effect overall. But again the bland “no effect” assertion conceals two possible situations: no one benefited at all (a narrow spread of effect) or overall no one benefited but there was large spread in biological response and some did benefit. I'm certainly going to continue to use the stuff (with the slightest frisson of guilt).

The difficulty, I suppose, is the disparity between the subtlety of the questions required to manage individual patients, and the inevitable crudity of methods that must aggregate large numbers of cases to answer relatively one dimensional questions. The tricky thing about answers is knowing what they mean and, just as importantly, what they don't mean.

One of my permanent regrets is that I didn't buy a book I saw in a second hand bookshop when I was a student. I have no idea what the subject matter of the book was, but I feel sure it would have helped me through life. Its title was Right Answers—A Short Guide to Obtaining Them. I particularly like the fact that it was a Short Guide.
How Did Medicare's Prospective Payment System Affect Hospitals?
Authors: Judith Feder, Jack Hadley, Stephen Zuckerman
Journal: New England Journal of Medicine (1987)

Abstract Using data from 1982 and 1984, we examined how Medicare's prospective payment system affected hospitals. The study showed that hospitals paid through the prospective payment system had significantly lower increases in Medicare costs and greater declines in Medicare use than did other hospitals. Unlike these other hospitals, for which Medicare costs approximately equaled Medicare revenues, hospitals receiving prospective payment kept Medicare costs from rising as fast as Medicare revenues, earning the profit that the prospective payment system allowed. The opportunity to earn a profit led hospitals to slow increases in Medicare costs, regardless of the level of revenue constraint. However, the more the prospective payment system constrained hospitals' revenues, the more hospitals slowed increases in Medicare costs. In the most constrained hospitals, slower increases in Medicare costs were accompanied by slower increases in total hospital spending. The least constrained hospitals slowed Medicare cost increases the least and did not slow their overall spending. These hospitals nevertheless increased their profit margins the most, since the prospective payment system's federal rate paid them the highest rates relative to base-year costs. Since federal rates produced extra profits, not extra cost containment, their appropriateness is questionable. The prospective payment system should be modified to eliminate windfalls while continuing to promote cost containment. (N Engl J Med 1987; 317:867–73.)
Is short interval mammogram necessary after breast-conservation surgery and radiation treatment in breast cancer patients?
Authors: R. V. Hymas, D. K. Gaffney, B. T. Parkinson, T. Belnap, W. T. Sause
Journal: Journal of Clinical Oncology (2010)

603 Background: The optimum timing and frequency of mammograms in breast cancer patients following breast-conserving therapy (BCT) are controversial. The National Comprehensive Cancer Network (NCCN) guidelines currently recommend a mammogram 6-12 months following radiation. The American Society of Clinical Oncology (ASCO) recommends the first posttreatment mammogram 1 year after diagnosis but no earlier than 6 months after completion of radiotherapy. This retrospective study was undertaken to determine the yield of the short interval mammogram (SIM) in patients receiving BCT. Methods: 1,454 patients were identified from Intermountain Healthcare's patient database as having received BCT between January 1, 2003 and December 31, 2007. The SIM is defined as a mammogram occurring less than 1 year following the patient's diagnosis of breast cancer, and the yield is determined by the number of breast cancer recurrences identified from the SIM. Tumor grade, stage, size, location, and surgical margin status of the initial tumor were evaluated for their association with recurrence. Results: Of the 1,454 patients diagnosed with breast cancer over the 5- year study period, 1,386 had a SIM. The median time from diagnosis to first follow-up mammogram was 6.0 months. There were 3 ipsilateral recurrences and 1 contralateral tumor identified by SIM. Over the course of the study there were 16 ipsilateral recurrences, 5 contralateral failures, and 4 distant failures. Median follow-up time was 19.8 months and median time to failure was 18.1 months. The one and two-year ipsilateral breast tumor failure rates were 0.21% and 0.89%, respectively. Of the 25 recurrences, 17 were found by mammogram alone. High tumor grade (odds ratio 4.0, p = 0.001), negative ER status (odds ratio 7.2, p = 0.0006), and negative PR status (odds ratio 3.1, p = 0.046) were correlated with increased recurrence. Conclusions: The short-interval mammogram yielded 2.9 cancers per 1,000 patients, which was lower than the 4.4 cancers per 1,000 patients from annual screening mammograms over the same time frame. The annual mammogram was found to be adequate following BCT. No significant financial relationships to disclose.
Abstract P062: Ten Weeks of Daily Consumption of Common Fructose Containing Sugars Does Not Increase Liver Fat Content
Authors: Stephen Bravo, Joshua Lowndes, Zhiping Yu, James Rippe
Journal: Circulation (2013)

Purpose: Evaluate the effect of addition of commonly consumed fructose containing sugars to the usual diet on liver fat content. Background: Fructose induced triglyceride synthesis has been argued to be augmented when accompanied by glucose. As the most common sources of fructose, high fructose corn syrup HFCS) and sucrose, also contain glucose such a response would be particularly detrimental to metabolic health due to the known role of excess fat in the liver in the induction of abnormalities in glucose homeostasis, insulin resistance and the subsequent development of type II diabetes. Methods: For ten weeks, sixty-eight individuals (42.16 ± 11.66 years) consumed low-fat milk sweetened with either HFCS or sucrose such that the added sugar matched the 25th, 50th and 90th percentile population consumption levels of fructose. Fat content of the liver was obtained before and after the ten week intervention. Imaging was performed on a Philips 64-slice CT scanner. Region of interest measurements in the four sectors of the liver delineated by the hepatic veins were obtained in all patients, and converted to hepatocellular fat content percentages. Fat content of the liver remained unchanged (13.32 ±10.49 vs 13.32 ± 10.75%, p &gt; 0.05). Group assignment did not affect the result interaction p &gt; 0.05). Conclusions: These data suggest that ectopic fat storage in the liver is not promoted when fructose is consumed as part of a normal diet, even in amounts as high as the 90th percentile consumption level.
Case 24-1994
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Cathy G. Rosenfield, Mark A. Kaplan
Journal: New England Journal of Medicine (1994)

Presentation of CaseA two-year-old boy was admitted to the hospital because of thrombocytopenia, leukocytosis, and hepatosplenomegaly.The boy had been born of an uncomplicated full-term pregnancy and delivery, with a birth weight of 3.5 kg. He was in excellent health until two or three weeks before admission, when a cough and coryza developed. One week before admission, a physician diagnosed otitis media and prescribed amoxicillin, with improvement of the symptoms; the child was playful and happy, although he remained warm to the touch. Three days before admission, a petechial rash appeared.Two days before entry, the patient was admitted . . .
Thromboxane Biosynthesis and Platelet Function in Type I Diabetes Mellitus
Authors: Paola Alessandrini, John McRae, Stephen Feman, Garret A. FitzGerald
Journal: New England Journal of Medicine (1988)

It has been speculated that platelet activation may contribute to the evolution of vascular complications in patients with Type I diabetes mellitus. To address this hypothesis, we measured the plasma and urinary metabolites of thromboxane, presumably of platelet origin, and of prostacyclin, derived from endothelial cells, in addition to more conventional indexes of platelet function. Urinary excretion of the metabolites 2,3-dinor-thromboxane B2 and 2,3-dinor-6-keto-prostaglandin F1α did not differ between diabetics with or without retinopathy and nondiabetic controls. Furthermore, measurement of platelet granule constituents, the aggregation response to ADP or arachidonic acid, and levels of serum thromboxane B2 failed to discriminate between the groups. The institution of tight diabetic control with multiple daily injections of insulin failed to alter either urinary metabolite excretion or plasma levels of 11-dehydro-thromboxane B2. Conversely, insulin-induced hypoglycemia failed to alter the concentrations of plasma or urinary thromboxane metabolites in nondiabetic volunteers, despite a mean 60-fold increase in plasma epinephrine. These studies suggest that platelet activation does not precede the development of microvascular complications in patients with Type I diabetes who lack clinical evidence of macrovascular disease and have normal renal function. Furthermore, it is unlikely that platelet activation due to intermittent hypoglycemia contributes to the reportedly accelerated development of retinopathy in such patients, when they are subject to tight diabetic control. (N Engl J Med 1988;319:208–12.)
Fatty Liver, Alcoholic Hepatitis and Cirrhosis Produced by Alcohol in Primates
Authors: Emanuel Rubin, Charles S. Lieber
Journal: New England Journal of Medicine (1974)

Abstract Because previous experimental studies in which alcohol was fed to rats or volunteers led only to fatty liver, alcohol, 4.5 to 8.3 g per kilogram as isocaloric substitution for carbohydrate, was fed to 13 baboons for nine months to four years. The entire spectrum of alcoholic liver injury was produced, including fatty liver in all animals, alcoholic hepatitis in four and cirrhosis (in two). The data suggest that a nutritious diet will not prevent the development of alcoholic hepatitis and cirrhosis when excessive alcohol is chronically consumed. (N Engl J Med 290:128–135, 1974)
Intrathecal Administration of Amethopterin in Leukemic Encephalopathy of Young Adults
Authors: Edward Shanbrom, Sherwood Miller, Virgil F. Fairbanks
Journal: New England Journal of Medicine (1961)

THE neurologic manifestations of Central-nervous-system involvement in acute leukemia have been very well described.1 2 3 4 5 6 7 Although involvement of the brain is not rare7 , 8 greater emphasis has been placed on its occurrence in young children than in adults. This may well be related to the general view that children are more responsive to antileukemic therapy than adults9 and that their longer periods of survival may allow for the more frequent appearance of complications. Of particular interest is the fact that leukemic encephalopathy may develop in the face of complete hematologic remission, frequently in association with 6-mercaptopurine or antifolic acid therapy.10 This can . . .
Protection of Granulocytes by Vitamin E in Glutathione Synthetase Deficiency
Authors: Laurence A. Boxer, Janet M. Oliver, Stephen P. Spielberg, John M. Allen, Joseph D. Schulman
Journal: New England Journal of Medicine (1979)

The administration of vitamin E (alpha-tocopherol) was found to improve polymorphonuclear leukocyte function in an infant with congenital deficiency of glutathione synthetase activity. Before therapy with vitamin E the abnormal leukocytes exposed to phagocytic challenge showed oxidant damage. They released 60 per cent more hydrogen peroxide than did normal leukocytes, iodinated only 20 to 25 per cent of the normal number of particles, and were unable to kill bacteria as effectively as normal leukocytes although the rates of phagocytosis were normal. These functional abnormalities disappeared when the patient was placed on 400 IU of alpha-tocopherol daily for three months. Associated with the functional improvement was a normalization of microtubule assembly during phagocytic challenge.
Lack of consultant obstetrician is not associated with worse outcomes in babies, UK study shows
Authors: Susan Mayor
Journal: BMJ (2016)

No difference was found in maternal or neonatal morbidity according to whether a baby was delivered in normal working hours with a consultant present on the labour ward or delivered out of hours when care was managed by other members of the obstetric team, a UK study has shown.1

Concerns have arisen that a lack of senior obstetricians on labour wards outside normal hours may lead to poorer outcomes in babies delivered during these times.

To investigate any differences in obstetric outcomes and interventions between babies born out of hours and those born in normal working hours, researchers carried out a multicentre cohort study using electronic patient data from 19 obstetric units from across the United Kingdom from 1 April 2012 to 31 March 2013. …
Predictive Value of a Single Diagnostic Test in Unselected Populations
Authors: Thomas J. Vecchio
Journal: New England Journal of Medicine (1966)

WHEN a new test for a disease is being evaluated it is customary to perform the test in two selected groups of subjects: those with an indisputable diagnosis of the disease by other criteria; and those from the normal population who have no evidence of the disease and in whom all the factors known to result in a higher than normal risk of the disease can be excluded.1 2 3 The test results may be expressed dichotomously as "positive" or "negative," or by some numerical units along a scale, usually with the bulk of values on either side of an arbitrary dividing . . .
P219 Potential impact of air pollution coverage in the media on respiratory disease admissions
Authors: PS Tang, D Shaw, G Smith, J Goulding
Journal: Thorax (2015)

<h3>Introduction</h3> Air pollution can exacerbate respiratory disease. However, when air quality warnings are provided by authoritative bodies (e.g. MET office) media coverage may be disproportionate. We explored whether there is an association between respiratory admissions and media pollution coverage via non-linear predictive models, to potentially predict respiratory admissions. <h3>Methods</h3> The association was examined as follows: Baseline regression models were generated to predict daily respiratory admission episodes from 1<sup>st</sup> January 2009–9<sup>th</sup> April 2014. Predictors consisted of daily logs for PM10 particulate matter, PM2.5, Nitric oxide, Nitrogen dioxide, Ozone, Black carbon, Mean Temperature, Precipitation (obtained from <i>National Oceanic and Atmospheric Administration</i> data) and the DAQI Air Pollution Index. Models were optimised via cross-validation using daily respiratory admission levels sourced from Nottingham University Hospitals Trust data (ICD10 codes J39 – J9999). Time series of levels of media coverage were generated by applying kernel density estimation at a range of bandwidths (using linear and exponential kernels at bandwidths of 1, 10, 25, 50 and 100 days) to daily counts of online news articles featuring pollution and air quality issues over the period 01.01.2013 – 9.04. 2014. Predictive model accuracies were compared following integration of these time series of media coverage levels as an additional predictor. <h3>Results</h3> Of the predictive models tested, random forests parameterized provided optimal results for air-quality predictors. When predicting daily respiratory admissions, the model’s accuracy was 19.90% better than simply predicting mean daily admissions, with an average root mean square error (RMSE) of 7.5031. However, on introduction of the media-coverage variable, RMSE was reduced to 7.3210, representing a 21.85% improvement over mean prediction. While this reflected a slight improvement in admissions forecasting, a corrected t-test suggested these differences were not statistically significant, with a p-value of 0.0633. <h3>Conclusion</h3> Initial results indicate that consideration of media coverage may offer minor improvements in predicting respiratory admissions, but this effect was not statistically significant. While such a relationship requires further investigation, models informed by media coverage cannot currently be considered to be accurate enough for use in a practical setting. Better media data collection may improve prediction accuracy.
Chad Cook
Authors: Johann Windt
Journal: British Journal of Sports Medicine (2016)

Definitely completing my PhD training. For my PhD education in Texas, I drove 2 h each way to classes from Midland to night school at Lubbock, 3–4 days a week. I was working a full time day job as an academic in Odessa. Driving home after I successfully defended my dissertation I was almost delirious thinking I would never have to do that again. Ever.

Be nice to everyone, be patient, and relish the failures. My failures are instrumental in any of the accomplishments I've had thus far.

A 31 min drive to work, listening to sports talk on the radio, opening 150 or so emails from predatory journals and drinking about four cups of coffee.

I watched the 1980 US Hockey team (Miracle on Ice) beat the Soviet Union on an old Philco television when I was 15 years old. I remember how proud it made everyone in the USA and how much we needed a boost as a country.

I think I have a unique skill in taking complex information and simplifying it in a way that is useable to rehabilitative clinicians. At present, I think I've most influenced the understanding of diagnostic accuracy.

My heroes are those individuals who are service oriented, who do so in anonymity, and who sacrifice so that others can gain. I've …
Targeting Carcinoembryonic Antigen with DNA Vaccination: On-Target Adverse Events Link with Immunologic and Clinical Outcomes
Authors: Katy J. McCann, Ann Mander, Angelica Cazaly, Lindsey Chudley, Jana Stasakova, Stephen M. Thirdborough, Andrew King, Paul Lloyd-Evans, Emily Buxton, Ceri Edwards, Sarah Halford, Andrew Bateman, Ann O'Callaghan, Sally Clive, Alan Anthoney, Duncan I. Jodrell, Toni Weinschenk, Petra Simon, Ugur Sahin, Gareth J. Thomas, Freda K. Stevenson, Christian H. Ottensmeier
Journal: Clinical Cancer Research (2016)

We have clinically evaluated a DNA fusion vaccine to target the HLA-A*0201-binding peptide CAP-1 from carcinoembryonic antigen (CEA
Obesity and the Relative Risk of Knee Replacement Surgery in Patients With Knee Osteoarthritis: A Prospective Cohort Study
Authors: Kirsten M. Leyland, Andrew Judge, M. Kassim Javaid, Adolfo Diez‐Perez, Andrew Carr, Cyrus Cooper, Nigel K. Arden, Daniel Prieto‐Alhambra
Journal: Arthritis & Rheumatology (2015)

It is unclear what impact obesity has on the progression of knee osteoarthritis (OA) from diagnosis to knee replacement surgery. This study was undertaken to examine the relative risk of knee replacement surgery in overweight and obese patients who were newly diagnosed as having knee OA in a community setting.Subjects were selected from the Information System for Development of Primary Care Research database, which compiles comprehensive clinical information collected by health care professionals for >5.5 million people in Catalonia, Spain (80% of the population). Patients newly diagnosed as having knee OA in primary care between 2006 and 2011 were included. Knee replacement was ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification codes from linked hospital admissions data. Multivariable Cox regression models were fitted for knee replacement according to body mass index (BMI), and were adjusted for relevant confounders. Population proportional attributable risk was calculated.A total of 105,189 participants were followed up for a median of 2.6 years (interquartile range 1.3-4.2). Of these patients, 7,512 (7.1%) underwent knee replacement. Adjusted hazard ratios and 95% confidence intervals (95% CIs) for knee replacement for the World Health Organization BMI categories were 1.41 (95% CI 1.27-1.57) for overweight, 1.97 (95% CI 1.78-2.18) for obese I, 2.39 (95% CI 2.15-2.67) for obese II, and 2.67 (95% CI 2.34-3.04) for obese III compared to normal weight. The effect of BMI on risk of knee replacement was stronger among younger participants. The population attributable risk of obesity for knee OA-related knee replacement was 31.0%.Overweight and obese patients are at >40% and 100% increased risk of knee replacement surgery, respectively, compared to patients with normal weight. This association is even stronger in younger patients. Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee OA.