tbuckley/cabot-search huggingface dataset:
PWE-244 The financial burden of narcotic bowel syndrome: a local experience
Authors: MW Johnson, T Prouse, M Gibbons
Journal: Gut (2015)

<h3>Introduction</h3> Narcotic drugs are widely prescribed by both GPs and hospital physicians, but little consideration is afforded to the potential longterm issues when starting patients off on these addictive therapies. has escalated throughout UK. Between June–November 2014, 32,956 prescriptions had been provided for strong opioid therapy in the Luton CCG catchment area. Not only is this a costly unchecked market, but much of this is taken for abdominal pain. Narcotic Bowel Syndrome (NBS) is under recognised and believed to be increasing in prevalence worldwide. NBS is a subset of opioid bowel dysfunction, characterised by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. We attempted to assess some of the financial cost implications of this condition on our local district general hospital in 2014. <h3>Method</h3> In 2014 we started to collect the names of patients seen in gastroenterology clinics or during hospital admission where the clinician felt the patient was suffering from NBS. This was either thought to be the main cause or contributing factor to their symptomatology. During that year a retrospective analysis was performed reviewing the burden and cost of outpatient appointments and inpatient hospital admissions, using the hospital coding system and financial analysis. <h3>Results</h3> A database collated the names of 41 patients with NBS. From the 1st of January to the 31st of December 2014, this cohort of patients made 78 hospital admissions (1.9 per patient) with an average length of stay (LOS) of 4.1 days. This was costed at £91,310, or an average of £2,227 per patient per year. In addition to that the same 41 patients made 159 outpatient appointments (3.9 per patient), costing £15,639, or an average of £381 per patient per year. This small group of 41 patients cost a total of £106,949 in 2014 or an average of £2,608 per patient per year, in hospital inpatients admissions and outpatient appointments alone, before adding in their prescription costs. <h3>Conclusion</h3> NBS is a poorly recognised condition that places a huge demand on the NHS system with regards to time, resources and finances. The prevalence of this condition is thought to be increasing. Early recognition could prevent a costly and potentially fatal pathway of deterioration. On average the annual financial cost of hospital base care for each NBS patients is £2,608. <h3>Disclosure of interest</h3> None Declared.
Soundings: The demise of the British classic
Authors: Trisha Greenhalgh
Journal: BMJ (2005)

Old friends from medical school often greet me with “Hi Trish, how's the bike?”

I had a Japanese motorcycle that worked and a British vintage classic that spent most of its time laid out on newspaper in my room. I was no great mechanic, but with British bikes you didn't need to be. You undid the nuts and bolts, blew hard through any hollow tubes, replaced worn parts with better ones from a breaker's yard, and polished everything with a toothbrush and Brasso before reassembling.

I once decoked an exhaust pipe overnight in a communal bathroom, having stuck a potato in one end, poured a noxious substance siphoned from the chemistry lab into the other, and labelled it “Please leave—carcinogenic.”

Those were the days. Yesterday, the headlamp bulb blew in my Volkswagen Golf. The casing contained no discernible screws and had “please refer to your dealer for servicing” branded on it. The manual stated: “Headlamp bulbs can explode without warning; potentially fatal accidents have been known to occur. Under no circumstances should owners...”etc. I booked the car into a garage to have the bulb replaced.

Over the past 20 years, I've seen a few hundred people with mild knee pain, many of whom have small effusions and weedy little thighs. The treatment is simple: get a pair of old socks and place a tin of baked beans in each. Tie the socks together. Sit on the edge of a firm chair and hook the socks over your ankle. Raise the foot with the knee straight. Thirty times, morning and night. Come back if you don't get better.

I wish I had kept records of the proportion of patients who find this management unacceptable. Increasingly, patients don't want to poke the side of their own knee and see the fluid bulge appear. They want a knee diagnostics package (centrepiece magnetic resonance imaging). The physiotherapy must take place in a specialist knee centre and be supervised by someone with a postgraduate diploma in isometric quadriceps exercises.

As I look back mistily on the days before human bodies were dealer serviced, I remember my BSA motorcycle—less sophisticated and less reliable than the Honda, but producing infinitely more fulfilment for the enthusiastic generalist who cared for it.
Ankle Brachial Pressure Index
Authors: J G Jones
Journal: Journal of the Royal Society of Medicine (2007)

The Editorial by Bhasin and Scott1 made a persuasive case for measuring the Ankle Brachial Pressure Index (ABPI). They told the reader, five times, that this was a ‘quick, easy, simple, accurate, non-invasive, tool,’ so I couldn't wait to rush to the surgery to measure this entity. However, the article didn't tell me what equipment, if any, I would need nor how to derive the index. The reader was told that the topic is either ‘briefly covered in most undergraduate text books’ (but mine are 40 years old) or mentioned a reference that is not available in my local hospital library (if I could only find somewhere to park). Consequently I could only guess about the meaning of the information in Table 1 and the patients whose peripheral vascular disease I might have diagnosed have long since shuffled off. I eventually tracked something down in Wikipedia.
Postictal excitement following bilateral and right-unilateral ECT
Authors: H A Sackeim, P Decina, S Malitz, N Hopkins, S C Yudofsky, I Prohovnik
Journal: American Journal of Psychiatry (1983)

Postictal excitement was observed in two patients following bilateral and/or right-unilateral ECT but not following left-unilateral ECT. The findings agree with reports associating a similar syndrome with right-side brain insult.
Current medical treatment for tuberculosis
Authors: L. P Ormerod
Journal: BMJ (2003)

Editor—We take issue with some of the comments made by Chan and Iseman in their clinical review of current medical treatment for tuberculosis.1 These points have already been covered in the evidence based guidelines on both the chemotherapy and management and the control and prevention of tuberculosis by the Joint Tuberculosis Committee of the British Thoracic Society, but we believe that they bear restatement.2,3

Supplementation with pyridoxine (up to 50 mg/day) as routine—Peripheral neuropathy from isoniazid is very uncommon. Pyridoxine is appropriate for patients at increased risk of peripheral neuropathy.2 However, pyridoxine antagonises isoniazid on a milligram for milligram basis. Studies have shown that only 6 mg/day prevents peripheral neuropathy, so only 10 mg (the smallest tablet size available) should be used, if indicated.


Routine liver function monitoring—Detailed advice on liver function monitoring has been given and is incorporated in the 1998 code of practice,2,4 but regular liver function measurements are not required in patients with normal pretreatment liver function, unless symptoms, in an informed patient, suggest hepatic upset. 




Monthly visual acuity checks of patients taking ethambutol—Ocular toxicity is extremely rare in patients with normal visual acuity (Snellen chart) and renal function who are taking an ethambutol dose of 15 mg/kg, and there is no evidence that regular ocular checks prevent events.5 Detailed advice is again incorporated in the 1998 treatment guidelines.2

Negative pressure isolation for all suspected or confirmed cases of tuberculosis admitted to hospital—Of the 7300 patients with tuberculosis in England and Wales, some 4000 are culture confirmed; of these 1.3% have multidrug resistant tuberculosis (Scotland 0.3%, Northern Ireland 0). A detailed algorithm is given in the 2000 code of practice,3 with risk stratification for the patient, type of ward or room used, and risk of multidrug resistant tuberculosis.
THU0489 Morphometric Study of Algerian Hips: An Etiological Study to Explain the Low Prevalence of HIP Osteoarthritis in Algeria: Table 1
Authors: S. Slimani, K. Testas, I. Bencharif, M. Boukredera, R. Chiheub
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> In western countries, knee osteoarthritis (OA) is the third osteoarthritic location in terms of prevalence, with a ratio hip/knee OA of 1:2 to 1:3. However, in Asian/African countries, this ratio is much lower, of 1:27 in Algeria and 1:40 in China. A comparative study between American and Chinese hips in elderly women found more impingement and asphericity in hips of white women. <h3>Objectives</h3> We conducted this study to find out morphometric differences between Algerian and American hips that may explain such differences in hip OA prevalence. <h3>Methods</h3> A morphometric study was performed on 200 hips of 100 Algerian healthy female subjects, aged ≥60 years and compared with values of 200 American hips of the Study of Osteoporotic Fractures (SOF). Were mesured and compared the following dysplasia and impingement parameters: lateral center-edge angle, impingement angle, acetabular slope, femoral head-to-femoral neck ratio and crossover sign. Comparisons were made using t tests for continuous variables and z tests for proportions. Inta- and inter-observer intraclass correlation for Algerian measures were calculated. <h3>Results</h3> The intra- and inter-observer intraclass correlation were good to excellent (0.91 to 0.97 and 0.79 to 0.89, resp.). Different values are shown in Table 1. <h3>Conclusions</h3> Compared with American women &gt;60 years, Algerian women have distinct differences in their morphometric values, with lower mean impingement angles and more important Lateral center-edge angles. These data suggest a more common asphericity and impingement in Algerians, which theoritically predisposes to more hip OA lesions. We think that this abnormality is largely offset by the almost total lack of acetabular retroversion in Algerians (3% in Algerians VS 81% in Americans), which may play a protective role against the anterior femoroacetabular impingement. <h3>Disclosure of Interest</h3> None declared
Mitral valve prolapse and thyroid abnormalities in patients with panic attacks
Authors: W Matuzas, J Al-Sadir, E H Uhlenhuth, R M Glass
Journal: American Journal of Psychiatry (1987)

Panic disorder has been associated with mitral valve prolapse and thyroid abnormalities. Mitral valve prolapse has also been associated with thyroid abnormalities. The authors studied a consecutive series of 65 patients self-referred for evaluation of panic attacks, who were examined for cardiac and thyroid abnormalities. Fifty percent of the patients had mitral valve prolapse according to both cardiac auscultation and echocardiography. Twenty-six percent of the women had some thyroid abnormality; 17% had thyroid microsomal antibodies. There was no apparent relationship between mitral valve prolapse and thyroid abnormalities. These observations suggest that panic attacks, mitral valve prolapse, and autoimmune thyroid disorders are associated.
Roentgenographic Manifestations of Tumors of the Glomus Jugulare (Chemodectoma)
Authors: R P RICE, C B HOLMAN
Journal: JAMA (1963)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Psychotherapy patient transfer: secondhand rose
Authors: L Sederer
Journal: American Journal of Psychiatry (1975)

The author uses the analogy of the marketplace to examine the dynamics of the transfer of psychotherapy patients in university clinic settings. The outgoing therapist is the seller, the prospective therapist the buyer, and the patient the commodity--the secondhand Rose. Marketing techniques that are used in this buyers' market allow no active patient participation and are therefore antithetical to the tenets of psychotherapy. The author suggests early clarification of therapeutic goals, assignment of therapists on the basis of patient choice, and explanation of time frames and limits as means for ameliorating the problems he describes.
Efficacy and Safety of Antidepressants Added to Antipsychotics for Schizophrenia: A Systematic Review and Meta-Analysis
Authors: Bartosz Helfer, Myrto T. Samara, Maximilian Huhn, Elisabeth Klupp, Claudia Leucht, Yikang Zhu, Rolf R. Engel, Stefan Leucht
Journal: American Journal of Psychiatry (2016)

The authors examined the safety and efficacy of antidepressants added to antipsychotic drugs in the treatment of schizophrenia.Multiple databases and previous publications were searched through June 2015 to identify all randomized controlled trials of any add-on antidepressants compared with placebo or no-treatment in schizophrenia. Depressive and negative symptoms (primary outcomes), overall symptoms, positive symptoms, side effects, exacerbation of psychosis, and responder rates were examined. Subgroup, meta-regression, and sensitivity analyses were performed, as well as investigations of publication bias and risk of bias.Eighty-two randomized controlled trials with a total of 3,608 participants were included. Add-on antidepressants appeared more efficacious than controls for depressive symptoms (standardized mean difference: -0.25, 95% CI=-0.38 to -0.12), negative symptoms (standardized mean difference: -0.30, 95% CI=-0.44 to -0.16), overall symptoms (standardized mean difference: -0.24, 95% CI=-0.39 to -0.09), positive symptoms (standardized mean difference: -0.17, 95% CI=-0.33 to -0.01), quality of life (standardized mean difference: -0.32, 95% CI=-0.57 to -0.06), and responder rate (risk ratio: 1.52, 95% CI=1.29 to 1.78; number-needed-to-treat-to-benefit: 5, 95% CI=4 to 7). The effects on depressive and negative symptoms appeared more pronounced when minimum thresholds of these symptoms were inclusion criteria (standardized mean difference: -0.34, 95% CI=-0.58 to -0.09 and standardized mean difference: -0.58, 95% CI=-0.94 to -0.21, respectively). There were no significant differences between antidepressants and controls in terms of exacerbation of psychosis, premature discontinuation, and the number of participants with at least one adverse event. More patients taking add-on antidepressants suffered from abdominal pain, constipation, dizziness, and dry mouth.Analysis of primary outcomes (depressive and negative symptoms) suggests small, beneficial effects of adjunctive antidepressants. It would appear that this augmentation can be accomplished with a low risk of exacerbation of psychosis and adverse effects. However, secondary and subgroup analyses should be interpreted cautiously and considered exploratory.
THU0390 Management of Primary and Secondary Non-Response to B Cell Depletion Therapy in Systemic Lupus Erythematosus: 10-Year Experience at a Single Centre
Authors: M.Y. Md Yusof, D. Shaw, Y. El-Sherbiny, S. Dass, A.C. Rawstron, E.M. Vital, P. Emery
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Rituximab (RTX) is widely used for refractory SLE based on strong evidence for efficacy of remission induction in open label case series [1,2]. In first-cycle responders, data are required on the outcome of repeat cycles and management of patients who lose response. In first-cycle non-responders there are few data on whether repeat cycles would be effective (as previously shown in RA). <h3>Objectives</h3> To evaluate the outcome of repeat cycles of rituximab in SLE responders and non-responders. <h3>Methods</h3> We conducted a retrospective observational study of SLE patients treated with RTX in a single centre between September 2004 and September 2014 (total follow-up: 406 patient-years). Each cycle of RTX consisted of 2x1000mg infusions repeated on clinical relapse. Patients who demonstrated features of human anti-chimeric antibody (HACA, ie: infusion reaction &gt;24 hours after the second infusion with &lt;50% B cell depletion) were treated either with RTX desensitising regimen or 2x1000mg ocrelizumab. Response was defined as improvement to ≤1 persistent BILAG B and no A/B flare. <h3>Results</h3> 82 patients were studied (75 female and 7 male; median age prior to RTX: 40 (range 20-79) and median (IQR) disease duration: 6 (2-10) years). Median time-to-retreatment for cycles 1-4 were 52, 60, 57 and 51 weeks respectively. In cycle 1 (C1), there were 8/82 (10%) primary non-responders. Of these, 3 were retreated at 6 months but none responded to retreatment. The remaining 5 patients were treated with different therapies. Of the 74/82 (90%) primary responders in C1, 60 were treated on relapse. Of these, 51 continued to respond (median time to C1 relapse: 49 IQR (34-89) weeks) while 9 were secondary non-responders (median time to C1 relapse: 58 (IQR 47-123) weeks). Of the secondary non-responders, 3/9 were treated with ocrelizumab, which resulted in complete peripheral B cell depletion and response in 3/3; while 1 patient was retreated using RTX desensitising regimen but still experienced HACA. <h3>Conclusions</h3> Although initial responses were good, duration of response may not necessarily be predictive to response in a subsequent cycle. Retreatment of first cycle non-responders did not appear to be effective in SLE, in contrast to rheumatoid arthritis. Humanised anti CD-20 antibodies induce depletion in RTX-resistant patients and may be more effective than RTX in SLE. <h3>References</h3> Vital et al. Arthritis and Rheumatism 2011 [2] Ramos-Casals et al. Lupus 2009 <h3>Acknowledgements</h3> Dr Sudipto Das, Dr Mike Martin, Dr Maya Buch, Dr Jacqueline Andrews, Dr Colin Pease, Dr Sinisa Savic, Dr Emma Dunn, Dr Mark Goodfield, Dr Paul Beirne and Dr John Bamford and Dr Miriam Wittmann. <h3>Disclosure of Interest</h3> None declared
An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients
Authors: Carlo Barbieri, Manuel Molina, Pedro Ponce, Monika Tothova, Isabella Cattinelli, Jasmine Ion Titapiccolo, Flavio Mari, Claudia Amato, Frank Leipold, Wolfgang Wehmeyer, Stefano Stuard, Andrea Stopper, Bernard Canaud
Journal: Kidney International (2016)
Messages
Authors: M T Southgate
Journal: JAMA (1999)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
European Perspectives
Authors: Rein Kolk
Journal: Circulation (2007)

E stonia celebrated its 16th anniversary of the restoration of independence on August 20, 2007, with a public holiday."Since 1991," says consultant cardiologist Dr Rein Kolk, "things have changed pretty rapidly, to the point where there is now steady development of the economy and the medical system."Estonia (Figure 1) has an estimated population of 1.36 million, of which 18% are 15 years of age or younger and 15% are at least 65 years old.Two thirds of the people live in urban areas.It has the highest gross domestic product of the Baltic countries and one of the lowest rates of unemployment (4.2%) in the European Union (EU).Like the other Baltic countries, Estonia has high cardiovascular morbidity and mortality.The main risk factors include diet, low physical activity, tobacco consumption, and lifestyle habits."Estonia has been an agricultural country for centuries.People's dietary habits have been very difficult to change," comments Dr Falk, "but in the last decade there have been some positive developments."Tobacco and alcohol consumption have decreased, and people now pay more attention to their diets, with a decline in the consumption of fatty acids and products containing sugar.Physical activity also has increased."To date, these changes have not impacted cardiovascular mortality," says Dr Kolk, adding that "it will take time to filter through."Cardiovascular diseases represent the number one killer in Estonia, accounting for 54% of deaths.Malignancies rank second, with 19% of deaths.So, Estonians see the tackling of cardiovascular disease as a priority.A national programme of cardiovascular disease prevention began in 2002,