tbuckley/cabot-search huggingface dataset:
Assume the physician
Authors: Debashis Singh
Journal: BMJ (2000)

It was on a recent shopping trip with Veronica that it dawned on me what I had become. Although it initially seemed to be just another day, much like any other, I was to be proved wrong. I placed my purchase on the counter and waited patiently while the young assistant concluded the heated debate about nail varnish that she was having via the telephone. There was something odd about her. She caught me staring, and we exchanged perfunctory smiles. Initially I thought it was simply because she had overplucked one of her eyebrows (her right) and kept her wild left eyebrow to be tamed for a rainy day that she caught my eye, but no, there was something else going on. Then it hit me like a frying pan … she had a strabismus. I attempted to catch Veronica's attention, by subtly waving both arms in the air. Veronica, who was trying on …
Self sacrifice only benefits patients short term
Authors: Teresa Pun
Journal: BMJ (2004)

I met Paul on a bed in the residents' lounge. The resident I was following told a guilty looking Paul to stay put as he drew the curtains shut, ‘I don't want to see you on rounds, do you hear me? You're useless right now.’

Amro, another resident, told me that Paul had been on call the previous night, ‘Not sleeping is the worst feeling ever. I'm so tired after that I call patients by different names and you can make so many mistakes.’

I already knew that residents and doctors led hard lives, but I had no idea that quite a bit of it was self imposed. Only one out of five residents that I've shadowed has actually stopped to take a drink of water, and I have yet to catch someone on a bathroom break. As a junior medical student, I am afraid that these habits are creeping up on me as well. Looking back on my numerous shadowing experiences, I cannot recall ever being thirsty.

Back at lunch, a resident of the emergency room was telling Paul about a recent neurosurgical consult. ‘What are we doing eating?’

Five minutes later, the residents had reviewed the computed tomography scan and Paul and I were on our way to emergency. I had overheard someone telling Paul that he should be at home, and I asked him about this.

‘You're supposed to go home at 12 noon the day after …
Risk Factors for Functional Decline and Impaired Quality of Life after Pediatric Respiratory Failure
Authors: R. Scott Watson, Lisa A. Asaro, Larissa Hutchins, G. Kris Bysani, Elizabeth Y. Killien, Derek C. Angus, David Wypij, Martha A. Q. Curley
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

Rationale: Poor outcomes of adults surviving critical illness are well documented, but data in children are limited.Objectives: To identify factors associated with worse postdischarge function and health-related quality of life (HRQL) after pediatric acute respiratory failure.Methods: We assessed functional status at baseline, discharge, and 6 months after pediatric ICU discharge and HRQL 6 months after discharge in 2-week- to 17-year-olds mechanically ventilated for acute respiratory failure in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial. We assessed HRQL via Infant and Toddler Quality of Life Questionnaire-97 (<2 yr old) or Pediatric Quality of Life Inventory (≥2 yr old). We categorized patients with normal baseline function as having impaired HRQL if scores were greater than 1 SD below mean norms for Infant and Toddler Quality of Life Questionnaire-97 growth and development or Pediatric Quality of Life Inventory total score.Measurements and Main Results: One-fifth (n = 192) of 949 patients declined in function from baseline to postdischarge; 20% (55/271) had impaired growth and development; 19% (64/343) had impaired HRQL. In multivariable analyses, decline in function was associated with baseline impaired function, prematurity, cancer, respiratory failure etiology, ventilation duration, and clonidine (odds ratio [OR] = 2.14; 95% confidence interval [CI] = 1.22–3.76). Independent predictors of impaired growth and development included methadone (OR = 2.27; 95% CI = 1.18–4.36) and inadequate pain management (OR = 2.94; 95% CI = 1.39–6.19). Impaired HRQL was associated with older age, non-white or Hispanic race, cancer, and inadequate sedation management (OR = 3.15; 95% CI = 1.74–5.72).Conclusions: Postdischarge morbidity after respiratory failure is common and associated with admission factors, exposure to critical care therapies, and pain and sedation management.
High life in the lowlands
Authors: Erlangga Yusuf
Journal: BMJ (2006)

The Netherlands is a great place for an elective or even a medical career. Erlangga Yusuf tells you all you need to know

The Netherlands is a small European country, of no more than 42 000 km2, in which about 16 million people live. It is by far the most densely populated country in the European Union.1 Just like the United Kingdom, it is a constitutional monarchy. The capital is Amsterdam, but the government resides in the Hague.

The Netherlands was home to the painter Rembrandt, one of the Dutch masters, who celebrates his 400th birthday this year, and the country is also famous for tulips, which bloom each spring.



PHOTOS.COM

Medical schools 



The Netherlands has eight medical faculties, two in Amsterdam and one in each of Rotterdam, Utrecht, Groningen, Maastricht, Nijmegen, and Leiden (table 1). Seven of these are part of the world's top 200 universities.2 To enter a medical school, you need to do well at secondary school. A minimum score of 8 out of 10 is needed to enter medical school directly. If your grade is less than 8, you must count on your luck: you need to participate in a national lottery weighted by score. A higher average mark means a better chance, and this game requires a score of at least 6. So, you also need to be lucky to become a doctor in the Netherlands. Because this system is unfair, the government is trying a system to let the universities select their students by their own criteria, but this new system is not yet widely accepted and used.3 Curriculums differ. Some, as at Maastricht University, teach using problem based learning,4 and in Amsterdam they are using a mixture of problem based and traditional teaching. Four years …
Arthur B. Pardee: In Memoriam (1921–2019)
Authors: Judith Campisi, Khandan Keyomarsi, Heide L. Ford
Journal: Cancer Research (2019)

![][1] 

On February 24, 2019, the biomedical research community lost Dr. Arthur B. Pardee, whose numerous and diverse contributions to molecular and cancer biology will never be forgotten. In a field where most of us would be thrilled to make one major contribution, Art Pardee's legacy
Urinary incontinence after prolonged labour and caesarean section
Authors: Ayesha Noorani, Khurshid Noorani
Journal: BMJ (2008)

A 30 year old woman, who had had five children and two abortions, presented to the outpatients' department with a one year history of constant dribbling of urine after her last delivery. This was a caesarean section after a prolonged obstructed labour. The baby had a transverse lie and a two day history of an impacted shoulder and hand prolapse. He had a subsequent intrauterine death. Fig 1 Gynaecological examination of the patient under anaesthesia Fig 2 Intravenous urogram in the premicturition phase
The Blood of Strangers
Authors: Navin Chohan
Journal: BMJ (2001)

This small hardback publication is easy to overlook when browsing the crowded shelves in the bookshop. Its austere cover, a photo of a darkened, empty operating theatre, does not scream at you for attention. However, the book is worth hunting down as Frank Huyler's first foray into popular literature is a gem.

Huyler is almost certainly an unknown to most of us; he is a full time physician, part time poet who works in an emergency department in New Mexico. What then, you might ask, has he got to offer …
A new Borrelia on the block: Borrelia miyamotoi – a human health risk?
Authors: Sally Cutler, Muriel Vayssier-Taussat, Agustín Estrada-Peña, Aleksandar Potkonjak, Andrei Daniel Mihalca, Hervé Zeller
Journal: Eurosurveillance (2019)

Background Borrelia miyamotoi clusters phylogenetically among relapsing fever borreliae, but is transmitted by hard ticks. Recent recognition as a human pathogen has intensified research into its ecology and pathogenic potential. Aims We aimed to provide a timely critical integrative evaluation of our knowledge on B. miyamotoi , to assess its public health relevance and guide future research. Methods This narrative review used peer-reviewed literature in English from January 1994 to December 2018. Results Borrelia miyamotoi occurs in the world’s northern hemisphere where it co-circulates with B. burgdorferi sensu lato, which causes Lyme disease. The two borreliae have overlapping vertebrate and tick hosts. While ticks serve as vectors for both species, they are also reservoirs for B. miyamotoi . Three B. miyamotoi genotypes are described, but further diversity is being recognised. The lack of sufficient cultivable isolates and vertebrate models compromise investigation of human infection and its consequences. Our understanding mainly originates from limited case series. In these, human infections mostly present as influenza-like illness, with relapsing fever in sporadic cases and neurological disease reported in immunocompromised patients. Unspecific clinical presentation, also occasionally resulting from Lyme- or other co-infections, complicates diagnosis, likely contributing to under-reporting. Diagnostics mainly employ PCR and serology. Borrelia miyamotoi infections are treated with antimicrobials according to regimes used for Lyme disease. Conclusions With co-infection of tick-borne pathogens being commonplace, diagnostic improvements remain important. Developing in vivo models might allow more insight into human pathogenesis. Continued ecological and human case studies are key to better epidemiological understanding, guiding intervention strategies.
Declining incidence of keratinocyte carcinoma in organ transplant recipients
Authors: S. Menzies, E. O'Leary, G. Callaghan, M. Galligan, S. Deady, B. Gadallah, P. Lenane, A. Lally, D.D. Houlihan, P.G. Morris, D.J. Sexton, P.A. McCormick, J.J. Egan, J.P. O'Neill, P.J. Conlon, F.J. Moloney
Journal: British Journal of Dermatology (2019)

BackgroundAll organ transplant populations are predisposed to increased rates of keratinocyte carcinoma (KC). Since this increased risk was first appreciated, immunosuppressive regimens have changed and organ transplant recipients (OTRs) have been aggressively screened for KC. There is a perception that these measures have impacted on KC incidence but there is a paucity of population‐based studies on post‐transplant rates of basal cell carcinoma (BCC).
www.medicine.com
Authors: Debashis Singh
Journal: BMJ (2000)

It was while watching an episode of Star Trek: the Next Generation with Shamina, who was dressed as a Borg (she is a diehard “trekkie”), that I wondered if future doctors would be like Dr Beverly Crusher. For those of you who are unfamiliar with the programme, Dr Crusher is the ship's doctor, who supports a head of firmly set ginger hair and wears blue, space age lycra tops. All she seems to do is flirt rather outrageously (and rather shamefully, if you ask me) with Captain Picard. The intensity of a phaser even at the “kill” setting is unmatched by the strength of her sultry stare - one can almost …
Severe Hyponatremia After Drinking Horsetail Juice
Authors: Matthew R. Norris
Journal: Annals of Internal Medicine (2019)

Letters7 May 2019Severe Hyponatremia After Drinking Horsetail JuiceMatthew R. Norris, MDMatthew R. Norris, MDOverlook Medical Center, Summit, New Jersey (M.R.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0071 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Grim and colleagues' case report (1) was thought provoking, but the suggested relationship between horsetail and acute hyponatremia seems circumstantial. The adverse event took place 8 hours after the suspected ingestion of wild horsetail and was not identified in the emergency department 6 hours earlier. Because no laboratory test is able to confirm the presence of horsetail in body fluid, the case hinges on the patient's ability to properly identify Equisetum species in her local woods after attending a course on edible plants. In addition, there are no conclusive reports on this reaction or strong data suggesting ...References1. Grim CCA, Meynaar IA, Hammer S, Soonawala D. Severe hyponatremia after drinking horsetail juice. Ann Intern Med. 2018;169:507-8. [PMID: 29809246]. doi:10.7326/L18-0028 LinkGoogle Scholar2. Carneiro DM, Freire RC, Honório TC, Zoghaib I, Cardoso FF, Tresvenzol LM, et al. Randomized, double-blind clinical trial to assess the acute diuretic effect of Equisetum arvense (field horsetail) in healthy volunteers. Evid Based Complement Alternat Med. 2014;2014:760683. [PMID: 24723963] doi:10.1155/2014/760683 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Overlook Medical Center, Summit, New Jersey (M.R.N.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0071. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSevere Hyponatremia After Drinking Horsetail Juice Chloe C.A. Grim , Iwan A. Meynaar , Sebastiaan Hammer , and Darius Soonawala Severe Hyponatremia After Drinking Horsetail Juice Chloe C.A. Grim Metrics 7 May 2019Volume 170, Issue 9Page: 667-668KeywordsBody fluidsConflicts of interestDisclosureDiureticsEmergency departmentExcretionHyponatremiaIngestionLaboratory testsSalts ePublished: 7 May 2019 Issue Published: 7 May 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A Randomized Trial of Magnesium Oxide and Oral Carbon Adsorbent for Coronary Artery Calcification in Predialysis CKD
Authors: Yusuke Sakaguchi, Takayuki Hamano, Yoshitsugu Obi, Chikako Monden, Tatsufumi Oka, Satoshi Yamaguchi, Isao Matsui, Nobuhiro Hashimoto, Ayumi Matsumoto, Karin Shimada, Yoshitsugu Takabatake, Atsushi Takahashi, Jun-Ya Kaimori, Toshiki Moriyama, Ryohei Yamamoto, Masaru Horio, Koichi Yamamoto, Ken Sugimoto, Hiromi Rakugi, Yoshitaka Isaka
Journal: Journal of the American Society of Nephrology (2019)

Significance Statement Developing strategies for managing coronary artery calcification (CAC) in patients with CKD remains a clinical challenge. Previous experimental studies showed that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it. In a 2-year, open-label, randomized, controlled trial with a two-by-two factorial design, the authors investigated whether oral magnesium oxide or the oral carbon adsorbent AST-120 affected CAC progression in patients with stage 3−4 CKD with risk factors for CAC. In an interim analysis with 125 enrolled patients (96 of whom completed the trial), patients taking magnesium oxide experienced a significantly smaller percentage change in CAC score compared with controls (11.3% versus 39.5%). AST-120 was not associated with a similar significant slowing of CAC. Larger-scale trials are warranted to confirm these findings. Background Developing strategies for managing coronary artery calcification (CAC) in patients with CKD is an important clinical challenge. Experimental studies have demonstrated that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it. Methods To assess the efficacy of magnesium oxide (MgO) and/or the oral carbon adsorbent AST-120 for slowing CAC progression in CKD, we conducted a 2-year, open-label, randomized, controlled trial, enrolling patients with stage 3−4 CKD with risk factors for CAC (diabetes mellitus, history of cardiovascular disease, high LDL cholesterol, or smoking). Using a two-by-two factorial design, we randomly assigned patients to an MgO group or a control group, and to an AST-120 group or a control group. The primary outcome was percentage change in CAC score. Results We terminated the study prematurely after an interim analysis with the first 125 enrolled patients (of whom 96 completed the study) showed that the median change in CAC score was significantly smaller for MgO versus control (11.3% versus 39.5%). The proportion of patients with an annualized percentage change in CAC score of ≥15% was also significantly lower for MgO compared with control (23.9% versus 62.0%). However, MgO did not suppress the progression of thoracic aorta calcification. The MgO group’s dropout rate was higher than that of the control group (27% versus 17%), primarily due to diarrhea. The percentage change in CAC score did not differ significantly between the AST-120 and control groups. Conclusions MgO, but not AST-120, appears to be effective in slowing CAC progression. Larger-scale trials are warranted to confirm these findings.
The white cut: Egas Moniz, lobotomy, and the Nobel prize
Authors: Seye Abimbola, Obafemi Awolowo
Journal: BMJ (2006)

In 1949 the Nobel prize was awarded to Egas Moniz, the neurologist who carried out the first lobotomy, a procedure that caused severe physical and psychological impairment. <b>Seye Abimbola</b> investigates the ongoing debate.
Abstract 11263: Delayed Hypothermia Reduces the No-Reflow Phenomenon Independently of Effect on Infarct Size: Evidence that Microvascular Damage Represents True Reperfusion Injury
Authors: Sharon L Hale, Robert A Kloner
Journal: Circulation (2012)

Hypothermia initiated during myocardial ischemia limits necrosis and no-reflow. However, studies from our lab and others have shown that when hypothermia is started after coronary artery reperfusio...
Working together online
Authors: Alistair Patton
Journal: BMJ (2008)

Students need to collaborate for the presentations and audits that are needed in medical school. My experience has been that organising meetings and keeping everyone up to date is half the struggle. Online tools can streamline data collection and even facilitate global projects at a postgraduate level, although there are concerns about posted data remaining secure and anonymous. Productivity can be enhanced by having a central point where a document can be edited by anyone, at any time, from any place. The internet lends itself to …
Life and loathes of a new doctor
Authors: Stephen Goldie
Journal: BMJ (2005)

Surgical shift night

Night 1 of 7

Time: 23:03

Number of venflons: 37 (it seems that many anyway)

Pyrexial patients: 7

I've just finished a grand round of the wards, writing up fluids and night sedation. How ironic that I will soon crave sleep while my patients are insomniacs. I make a mental note to prescribe paracetamol, anti-emetics, and temazepam as needed when clerking patients in.

Night 4 of 7

Number …
Mature but poor
Authors: Saleyha Ahsan
Journal: BMJ (2001)

One term down, another 14 to go. My creative financial plans are going to have to become more artistic as the year proceeds. I do not remember having to use such tactics 10 years ago when I was a university student first time round. Money wasn't really an issue. That's not because my parents are loaded or because I worked day and night in some student labour camp. Everything just seemed that much simpler. Local authority cheques would obediently wait for me at the start of every term, and with a couple of signatures across a cheque book, fees and accommodation were taken care of. Banks practically begged me to take an overdraft and student loans fell from the sky.

Six years of work followed with a rather comfort. able salary. Among other things, this went towards paying for various grown up toys, such as cars, flats, and houses as well as clearing student debts. When I at last hit zero, I some. how found myself in a bizarre state of deja vu. Exactly a decade later, I …
Abstract 11985: C1q / tnf-Related Protein 9 Protects Against Acute Myocardial Injury
Authors: Takahiro Kambara, Rei Shibata, Koji Ohashi, Yuusuke Joki, Satoko Hayakawa, Mizuho Ito, Daisuke Yuasa, Noriyuki Ouchi, Toyoaki Murohara
Journal: Circulation (2014)

Background: Obesity-related disorders are associated with an increased risk for cardiovascular disease. C1q/TNF-related protein (CTRP) 9 is an anti-diabetic adipokine that is downregulated in obese mice. Recently, we have reported that CTRP9 prevents adverse vascular remodeling in response to injury. Here, we investigated the effect of CTRP9 on acute cardiac injury with loss-of-function genetic manipulations. Methods and Results: CTRP9-deficient (CTRP9-KO) mice at the age of 12 weeks were indistinguishable from Wild-type (WT) mice under basal conditions. CTRP9-KO mice showed increased myocardial infarct size and elevated expression of inflammatory cytokines including TNF-α and IL-6 in ischemic heart following ischemia-reperfusion compared with WT mice. CTRP9-KO mice also had exacerbated contractile left ventricle (LV) dysfunction and increased myocardial expression of inflammatory cytokines following intraperitoneal injection of lipopolysaccharide (LPS) compared with WT mice. Conversely, systemic delivery of an adenoviral vector expressing CTRP9 (Ad-CTRP9) attenuated inflammatory responses to myocardial ischemia-reperfusion or LPS administration in WT mice. In cultured cardiac myocytes, treatment with CTRP9 protein suppressed LPS-stimulated expression of TNF-α and IL-6 with an accompanying reduction of NFkB phosphorylation. Treatment of cardiac myocytes with CTRP9 enhanced AMPK phosphorylation, and transduction with dominant-negative mutant form of AMPK reversed the suppressive effect of CTRP9 on TNF-α and IL-6 expression. Furthermore, systemic administration of Ad-CTRP9 improved LPS-induced cardiac dysfunction in WT mice but not in muscle-specific transgenic mice expressing dominant-negative mutant form of AMPK. Conclusions: These findings suggest that CTRP9 protects against acute cardiac damage in response to pathological stimuli by suppressing inflammatory reactions through AMPK-dependent mechanisms.
Lung sounds online
Authors: Fathi Ramly
Journal: BMJ (2009)

“Can you auscultate this man’s lung?” A doctor points at you in the early morning ward round. What if this happens to you in your first clinical year? As you put your new stethoscope diaphragm to your patient’s chest, you might struggle to differentiate vesicular from bronchial breathing, stridor, wheezing, pleural friction rub, or crackles.

It is hard to appreciate the variation in breathing sounds especially when you have never heard them clearly …
Book review: The Face
Authors: Ben Mills
Journal: BMJ (2000)

The vast majority of our interaction with the outside world takes place through a 10 cm square patch of our total surface area. Hide it away and we become almost anonymous. Take away all the sensations perceived through it and life for most of us would be unimaginable and unbearable. The importance of the face in our lives and society is almost incalculable.

McNeill's book covers a vast range of topics, from evolutionary and man made …
Studying medicine is good for your health
Authors: Antony D'Angelo
Journal: BMJ (2003)

Scientists and medics have a substantially lower risk of mortality, according to new research.

A report by Peter McCarron and colleagues at Queen's University, Belfast claims science and engineering students have the best chances of living a longer, healthier life, followed by medical students, and then those in law and art.

The study, published in the Journal of the Royal Society of …