tbuckley/cabot-search huggingface dataset:
CPR for OHCA Is Rarely Successful, and What Is “Success” Anyway?
Authors: Samantha L. Gelfand, Nwamaka D. Eneanya, Amanda K. Leonberg-Yoo, Jeffrey S. Berns
Journal: Journal of the American Society of Nephrology (2019)

The analysis by Pun et al.1 on outcomes of patients who suffered a cardiac arrest at a dialysis unit is certain to generate attention and possibly concern among medical and lay communities. The authors’ discussion of the complex logistic, procedural, and cultural factors that may delay dialysis staff from initiating cardiopulmonary resuscitation (CPR) is insightful. Additionally, the finding that CPR is initiated at lower rates in women than in men uncovers an important disparity. However, as these nuances are explored, studies like these need to be careful about how data are presented, as the implications may have serious consequences regarding the perceived effectiveness of CPR in general. Presenting data purely in terms of relative odds minimizes the fact that most people die after out-of-hospital cardiac arrest (OHCA).2 In absolute terms, the death rate among people who had CPR initiated by dialysis unit staff was 71% (230 out of 324), compared with 86% (64 out of 74) among those who had CPR initiated by emergency medical services, an absolute risk reduction of 15%. This makes for a much more modest headline compared with the “three-fold increase in the odds of survival” quoted in the significance statement and highlighted in the visual abstract, which obscures the high mortality regardless of who performs CPR. Additionally, although survival to hospital discharge is considered a “success,” we question the impact on quality of life from the patient’s perspective. We have come to understand that living longer is often less important to patients with serious illness compared with how well they are living.3 Of the 104 patients who survived to discharge, 86 had a favorable neurologic status, but this is defined as mild to moderate disability. Their own perception of their quality of life is unknown. Furthermore, details about the 18 patients who survived with a presumably unfavorable neurologic status were not included in the paper, but it is highly likely that meaningful patient-reported outcomes were dire. Although delaying death and surviving cardiac arrest will always be seductive goals, we need to prioritize future studies that identify barriers to regular reassessments of code status preferences in the hemodialysis population, as well as patient and caregiver understanding of the best, worst, and most likely outcomes of attempted resuscitation. It is our hope that this study will lead to increased focus on advanced care planning and communication about prognosis as the best means of ensuring goal-concordant and patient-centered care among patients on hemodialysis. Disclosures None.
Dans Le Noir?
Authors: Sadat Edroos
Journal: BMJ (2008)

Have you ever lost your sense of smell? Or temporarily not been able to taste? Have you ever lost your sense of touch? Or had a problem with your hearing? We rely on our senses for every interaction with the world. They are by their very nature taken for granted, and any loss, however transient, can lead to a drastic change in a person's life. But the ability to switch senses off remains in the realm of fantastical comic books and specialist neurology wards.

Until now. Dans Le Noir? is a concept restaurant, transported from Paris to London. It serves …
Becoming a live kidney donor: a doctor's perspective
Authors: B S Fernando
Journal: BMJ (2008)

Renal transplantation offers the best outcome for most patients with end stage renal failure, and this is reflected in national strategy and the 2006 Human Tissue Act. As the number of deceased donors has progressively fallen, the emphasis on living donors—who tend to be relatives or partners—has increased. Most transplant units have established clinical pathways for live related organ donation, which focus on ensuring that the donor completely understands the risks and benefits for informed consent, and confirming the donor's suitability as well as the recipient's health. Implementing these pathways has put pressure on existing infrastructure.



Annabel's generous offer to donate a kidney was a wonderful altruistic gift for both Raymond and society because it frees up a kidney from a deceased donor for someone else. However, donation carries an attendant risk of death (<0.01%), postoperative thromboembolic disease, wound pain, hypertension, and proteinuria. …
Abstract 004: The Cost-Effectiveness of Blood Pressure Control in Young Adulthood to Prevent Later Life Coronary Heart Disease: A Computer Simulation Study
Authors: Sonia Singh, Ciaran Kohli-Lynch, YiYi Zhang, Anusorn Thanataveerat, Eric Vittinghoff, Mark J Pletcher, Kirsten Bibbins-Domingo, Andrew E Moran
Journal: Circulation (2018)

Introduction: Prehypertension defined as blood pressure (BP) 120-139/80-89 mmHg, has a prevalence of 23% in U.S. young adults (age 20-39 years). Young adult high diastolic blood pressure (DBP) has been associated with later life coronary heart disease (CHD), but it is unclear if lifelong benefits of early blood pressure control outweigh costs and side-effect risks. Objective: We estimated CHD events and life-long cost-effectiveness of U.S. Preventive Service Task Force recommended lifestyle modification (LM) or pharmacotherapy in young adults with DBP ≥80mmHg, incremental to later life hypertension treatment. Methods: A microsimulation model simulated CHD events from age 20 until death for 20-year olds selected from 1999-2014 NHANES. Individual risk factor trajectories were assigned, and risk functions predicted CHD based on Framingham Offspring Study data, accounting for both age 20-39 time-weighted average DBP and later life systolic blood pressure (SBP). Simulated interventions lowered DBP ≥80mmHg for age 20-39 years, and SBP ≥140mmHg for age ≥40 years. Cost-effectiveness was measured as incremental cost-effectiveness ratios (ICERs) and net health benefit (NHB) at willingness to pay (WTP) threshold $50,000/quality adjusted life year (QALY). Results: In 40,000 young adults with DBP ≥80 mmHg (50% women), pharmacologic BP control in young adulthood and later life prevented the most CHD events (Table). The strategy that yielded highest NHB in women was pharmacologic control after age 40 (ICER $26,536/QALY). In men, lifestyle modification to control DBP in young adulthood plus pharmacotherapy for later life hypertension (ICER $42,481/QALY) yielded highest NHB. Conclusion: Early DBP control in young adults could achieve substantial health benefits over the life course but standard interventions to achieve this goal are costly. Innovative strategies to reduce pharmacotherapy costs and improve sustainability of lifestyle modification could make early BP control a higher-value prevention strategy in young adults.
Glycolytic activation of peritumoral monocytes fosters immune privilege via the PFKFB3-PD-L1 axis in human hepatocellular carcinoma
Authors: Dong-Ping Chen, Wan-Ru Ning, Ze-Zhou Jiang, Zhi-Peng Peng, Ling-Yan Zhu, Shi-Mei Zhuang, Dong-Ming Kuang, Limin Zheng, Yan Wu
Journal: Journal of Hepatology (2019)
PTU-047 Creation of a dedicated proforma aimed at improving management of acute upper gi bleeding in a busy district general hospital
Authors: J Fox, A Smith, G Lipscomb
Journal: Gut (2017)

Introduction  Upper GI bleeding is a commonly-encountered medical emergency for which clear national guidelines exist. Prompt assessment, resuscitation and initiation of appropriate medical and endoscopic therapy is vital in improving patient outcomes.  We aimed to improve management of both variceal and non-variceal upper GI bleeding in our district general hospital through the production of a dedicated proforma to assist clinician decision making and management of this common medical emergency. We hypothesised that management of this condition was frequently not performed in line with dedicated hospital and national guidelines due to poor awareness amongst medical staff of when to initiate specific therapies.  Method  We created a questionaire designed to assess knowledge of key selected points from the hospital’s guidelines for management of acute variceal and non-variceal GI bleeding. The questions spanned a range of key topics including resuscitation with blood products, the role of PPI therapy in acute upper GI bleeding, and timing of endoscopic therapy.  A range of clinical staff, from consultants to Foundation year 1 doctors, were asked to complete the questionnaire which was marked out of 10. Correct answers were agreed upon, based on local and national guidelines. On the basis of results obtained, we identified the requirement for a proforma designed to assist in the management of patients with acute upper GI bleeding.  Results  We obtained 30 responses to our questionnaire which covered different aspects of GI bleeding management. We broke down average scores by grade of doctor undertaking the survey as follows:  FY1 4.25/10  SHO 4.5/10  SpR 7/10  Consultants 6/10  Questions which were most frequently answered incorrectly related to medical therapies for variceal bleeding, correct use of blood products, and timing of endoscopy based upon Blatchford score.  Conclusion  Our study demonstrates that awareness of new recommendations for the management of acute upper GI haemorrhage is lacking amongst medical professionals of all grades. As such, patients may often not receive recommended therapies in a timely manner in order to maximise their chances of recovery and minimise complications. We feel that the production of a specific proforma will help to guide decision-making and bring management of this gastroenterological emergency uniformly in line with current guidelines.  Reference  . NICE guidelines for acute upper gastrointestinal bleeding: https://www.nice.org.uk/guidance/cg141  Disclosure of Interest  None Declared
Assessment of Use, Specificity, and Readability of Written Clinical Informed Consent Forms for Patients With Cancer Undergoing Radiotherapy
Authors: Subha Perni, Michael K. Rooney, David P. Horowitz, Daniel W. Golden, Anne R. McCall, Andrew J. Einstein, Reshma Jagsi
Journal: JAMA Oncology (2019)

Appropriate informed consent processes are crucial to preservation of patient autonomy and shared decision making. Although half of patients with cancer receive radiotherapy, it is unknown whether current consent practices are comprehensible for patients.To characterize use, specificity, and readability of clinical informed consent forms for radiotherapy, hypothesizing that forms would be higher than the recommended sixth- to eighth-grade readability level.This nationwide cross-sectional survey study and readability analysis was conducted from 2016 to 2018 and included 89 academic radiation oncology departments that were part of the 2016 Electronic Residency Application Service. Department leaders (clinical directors, chairs, and personal contacts of study authors) at academic radiation oncology departments were contacted via email.Readability levels were measured by 7 validated readability indices, including the Ford, Caylor, Sticht (FORCAST) index for nonnarrative texts. Difficult words were identified using The Living Word Vocabulary, which describes the readability grade levels of 40 000 common words.Of 89 departments, 67 (75%) responded to questions and 57 (64%) provided 113 forms for analysis. Departments providing forms did not differ substantially from others in terms of region, residency size, research output, rural vs urban location, or public vs private institution status. All departments obtained patient written informed consent before radiotherapy; 38 (57%) used body site-specific forms. Using the most conservative (low-score) estimate, mean form readability ranged from grade level 10.6 to 14.2. By 7 distinct indices, only 9 (8%) of 113 forms met the recommended eighth-grade readability level, and 4 (4%) forms met a sixth-grade level. Not a single form met either recommendation based on the FORCAST index. Forms used an average of 7.2 difficult words. Body site-specific forms had considerably better readability than general consent forms.This nationwide study of informed consent practices for cancer treatment with radiotherapy demonstrates that while all US academic radiotherapy departments use written consent forms, it is rare for templates to meet the recommended readability levels for patient materials. These data suggest the need for reevaluation and modification of the approach to radiotherapy consent, ideally with guidance and templates designed by national professional organizations.
Is studying for an intercalated degree a wise career move?
Authors: Wai-Ching Leung
Journal: BMJ (2001)

Wai-Ching Leung helps you to decide by discussing the evidence Just over a third of all British medical students obtain an intercalated degree1--mostly BSc degrees, with a few medical schools offering BMedSci--for example, Nottingham, Birmingham, and Newcastle--and BA degrees--for example, Oxford and Cambridge. The proportion of students taking the intercalated degrees varies widely among medical schools. In some medical schools it is obligatory--for example, Oxford, Cambridge, Nottingham, and some London schools. In other schools, it is open only to students who performed well in the first two years--for example, Liverpool. In medical schools where it is not compulsory, students need to decide quite early on in their careers whether to take up this option. However, the advice they receive is often conflicting and confusing.2 What subjects are studied in the intercalated year? Before the 1990s most students took basic science subjects, such as physiology or pathology, although a minority chose subjects such as medical law, medical anthropology, or even subjects unrelated to medicine. With the introduction of an integrated medical curriculum, a wider range of subjects including clinical subjects such as general practice gradually became available.3 The General Medical Council identified two main purposes for the intercalated year--the development of research skills and in depth study in areas of particular interests over an extended period.4 Currently, the degree is intercalated over a discrete time period, usually after the second or third year of study. However, the GMC highlighted that it could run as a thread throughout the medical curriculum. From information gathered from United Kingdom medical school websites, I have summarised a selective range of subjects currently offered, in box 1. ### Box 1: Selection of subjects currently offered #### Basic sciencesRETURN TO TEXT
Abstract 13999: Prognostic Significance of Albuminuria on Cardiovascular Outcomes in Patients with Mild Renal Dysfunction who Underwent Elective PCI
Authors: Ayako Kunimura, Tadayuki Uetani, Masataka Kato, Bunichi Kato, Tomohiro Yoshida, Ken Harada, Yusaku Shimbo, Katsuhide Kitagawa, Kazuhiro Harada, Hiroaki Takashima, Hirohiko Ando, Akihiro Suzuki, Hideki Ishii, Tatsuaki Matsubara, Tetsuya Amano, Toyoaki Murohara
Journal: Circulation (2012)

Background: The aim of this study was to investigate the association between elevated urinary albumin excretion rate and clinical cardiovascular outcomes in patients with mild renal dysfunction who underwent elective PCI. Methods: A total of 120 consecutive patients with early stage CKD ( estimated GFR ≧ 60ml/min/1.73m2 ) who underwent elective PCI were enrolled. Urinary albumin to creatinin ratio ( ACR; mg/gCr) was measured and patients were divided into three groups as follows; patients without albuminuria (ACR < 30 mg/gCr, 81 patients ), those with microalbuminuria (30 ≦ ACR ≦300 mg/gCr, 30 patients ) and those with macroalbuminuria ( 300 < ACR mg/gCR, 9 patients ). The endpoint of this study was MACE defined as the composite of cardiovascular death, myocardial infarction and any revascularization. Results: During the median follow-up of 1048 days, total 42 events occurred. The 3-year rates for MACE were 25.9% in the patients without albuminuria, 50.0% in those with microalbuminuria, and 66.7% in those...
From Mozambique to the world
Authors: Kaushal Raj Pandey
Journal: BMJ (2007)

<b>Francisco Songane</b> has been health minister of Mozambique, and he is now director of the Partnership for Maternal, Newborn, and Child Health. This global organisation aims to achieve the fourth and fifth Millennium Development Goals-to reduce mortality in children under 5 by two thirds and maternal mortality by three quarters by 2015 from their levels in 1990. <b>Kaushal Raj Pandey</b> interviews him
Sydney Brenner: Nobel laureate and molecular biologist who specialised in comparative genomics
Authors: Barbara Kermode-Scott
Journal: BMJ (2019)

Andrew Cutraro/Redux Eyevine

When 92 year old Nobel laureate Sydney Brenner died in Singapore in April, media outlets worldwide published the news. Brenner was honoured as a hero, a giant in science, a founding father of modern biology, and a pioneer of molecular genetics. The South African scientist and physician certainly inspired copious headlines during his seven decade career for his achievements. After all, Brenner had helped decipher the genetic code. His trailblazing scientific discoveries have improved our understanding of the pathogenesis of many diseases, including cancer, neurogenerative disorders, cardiovascular disease, and AIDS. Brenner’s research, his early and active role in the Human Genome Project, and his mentoring of so many younger scientists changed science and medicine globally.

Sydney Brenner was born in Germiston, a small town near Johannesburg. His parents, Morris and Lena, were Jewish immigrants to South Africa. Morris was Lithuanian, and Lena was Latvian. Their son grew up in rooms behind his father’s shoe repair shop. Morris never learnt to read or write, but he did speak five languages—English, Yiddish, Russian, Afrikaans, and Zulu. Sydney Brenner learned to read at the age of 3. One of his father’s customers, a Miss Walkinshaw, saw the young boy …
Boc Acts via Numb as a Shh-Dependent Endocytic Platform for Ptch1 Internalization and Shh-Mediated Axon Guidance
Authors: Julien Ferent, Fanny Giguère, Christine Jolicoeur, Steves Morin, Jean-Francois Michaud, Shirin Makihara, Patricia T. Yam, Michel Cayouette, Frederic Charron
Journal: Neuron (2019)
Medical students have too little social and cultural awareness
Authors: Irina Haivas
Journal: BMJ (2003)

Learning about social and cultural issues makes little or no difference to medical students, according to a recent study published in Academic Medicine (2003;78:605-14).

The study found that a new course addressing social and cultural issues in medicine had an insignificant effect on medical students from Dalhousie University, Canada. The researcher, Brenda Beagan, used questionnaires and interviews to compare a …
Abstract 341: The P2Y2 Nucleotide Receptor Regulates Vascular Calcification
Authors: Cheikh Seye, Maxwell Sheldon, Shaomin Qian
Journal: Circulation Research (2015)

Objective: Vascular calcification is widespread in individuals with atherosclerosis, and is associated with inflammatory changes and expression of osteoblast-like cell phenotypes. Recent studies identified extracellular nucleotides and P2Y receptor cascade as important regulators of bone remodeling. We investigated the potential role of the P2Y2 receptor (P2Y2R) in vascular calcification. Methods and Results: P2Y2R-null mice were crossed with ApoE-null mice to generate P2Y2R/ApoE double knock-out mice. When fed a standard mouse chow diet for 16 weeks, P2Y2R–/–/ApoE–/– mice showed significant higher intimal calcification as compared to their APOE–/– counterparts. Smooth muscle cells (SMCs) isolated from aortas of P2Y2R +/+ and P2Y2R -/- mice were identical in morphology and stained positively for SM lineage proteins including, desmin, smooth muscle and SM22alpha. When cultured in medium containing high concentrations of inorganic phosphate, an inducer of vascular calcification, a remarkably higher calcification was observed in P2Y2R -/- SMCs compared to P2Y2R +/+ SMCs. Furthermore, retroviral transduction of mouse P2Y2RcDNA into P2Y2R -/- SMCs rescued the calcification phenotype of the cells. Conclusion: These results demonstrate that inactivation of the P2Y2R gene regulates vascular calcification both in vivo and in vitro, suggesting that drugs targeting this receptor could prevent complications associated with vascular calcification
A subtle wisdom
Authors: Balaji Ravichandran
Journal: BMJ (2006)

<b>Kavery Nambisan</b>, a surgeon and acclaimed novelist, did her undergraduate training in Bangalore and trained as a surgeon at the university of Liverpool. Despite other more lucrative opportunities, she returned to work in the rural heart of her homeland. <b>Balaji Ravichandran</b> caught up with her after the release of her latest, partly autobiographical, novel
Complications: a Surgeon's Notes on an Imperfect Science
Authors: Andy Conway Morris
Journal: BMJ (2003)

Weve all read stories in newspapers about patients whose diseases are misdiagnosed and about some who even die. To some journalists, everything looks clear. How could they have missed the incipient rash of meningococcal septicaemia or not realised that the abdominal pain was due to a leaking aneurysm? I cant be the only one who has thought, “That could be me.”

Medicine is practised prospectively; working out what is wrong with a patient takes a …
Hepatitis E epidemic looms in Darfur
Authors: Karen Hebert
Journal: BMJ (2004)

At the time of going to press the World Health Organization confirms that 625 cases of infection with hepatitis E virus and 22 deaths have been documented in western Sudan. The UN Population Fund and WHO both warned that the virus--which is usually transmitted through water contaminated with human waste--could spread quickly in Darfur, where hundreds of thousands of refugees live in overcrowded camps with poor sanitation.

Three quarters of the fatalities in one camp were pregnant women. warns that pregnant women are particularly vulnerable and fear that maternal deaths may skyrocket.

This message comes shortly after Rowan Gillies, president of Medecins Sans Frontieres, warned that Darfur was “An epidemic waiting to happen.”

Dr Gillies explained that the number of latrines available in the whole of western south Darfur is minimal at best. In addition, water is in very short supply, with people getting only 8-10 of the 20 litres needed per day. He expressed concern over the potential for an epidemic: “To be honest, if you want to create the environment for an epidemic it's are all there and very …
Abstract 18987: Domain Specific Interaction of Kir2.2 and Cav3: Implications for Atrial Fibrillation
Authors: Ravi Vaidyanathan, Hanora Van Ert, Samuel Esch, Jarrett Warden, Sara Abozeid, Ravi C Balijepalli, Lee L Eckhardt
Journal: Circulation (2016)

Introduction: In human ventricle Kir2.1 comprises the major component of IK1, but the Kir2.2 isoform dominates in the atria. Thus Kir2.2 regulation may have specific impact in atrial arrhythmias such as atrial fibrillation. Caveolin-3 (Cav3) forms caveolar rafts and plays a key role in assembling macromolecular signaling complexes for cardiac ion channels. Cav3 is implicated in ion channel misplacement in heart failure leading to atrial fibrillation. In our previous report, Kir2.1 and Cav3 associate and LQT9 Cav3 mutations decreased IK1 density by ~60% when co-expressed in heterologous expression systems. Hypothesis: Kir2.2 is also part of the Cav3 macromolecular signaling complex and that LQT9 causing Cav3 mutation can affect the function of Kir2.2 channels. Methods: Co-immunoprecipitation(Co-IP), cellular electrophysiology, and On-Cell Western (OCW) blotting techniques were used. Results: Kir2.2 and Cav3 Co-IP. To investigate, which domain of Cav3 associates with Kir2.2, we separated the N-terminal (NT)...