tbuckley/cabot-search huggingface dataset:
Abstract 19180: Targeted Simulation and Education to Improve Cardiac Arrest Recognition and Telephone Cpr in an Emergency Medical Dispatch Centre
Authors: Camilla Hardeland, Linda Soilammi, Christiane Skåre, Jo Kramer-Johansen, Tonje Birkenes, Helge Myklebust, Andreas E Hansen, Theresa M Olasveengen
Journal: Circulation (2015)

Introduction: Patient outcome after out of hospital cardiac arrest (OHCA) is dependent on emergency medical dispatchers ability to recognize OHCA and provide effective telephone-assisted CPR instructions to bystanders. The American Heart Association recommends continuous quality monitoring to ensure implementation of educational interventions in emergency medical dispatch centres. Objective: Improve dispatcher recognition of OHCA and time to first telephone assisted chest compression. Method: Weak aspects of cardiac arrest calls in our dispatch centre were identified, and targeted interventions to improve recognition of agonal respiration and cardiac arrest and to shorten time to first chest compression were implemented. Specifically; 1) Video-based lectures focusing on agonal respiration and continuous coaching 2) Simulation training 3) Structured dispatcher feedback 4) Electronic telephone-assisted CPR training program. Dispatch logs, ambulance records and audio files of confirmed OHCA’s were analyzed before and after the intervention. Recognition of cardiac arrest was reported as (1) recognized, (2) not recognized and (3) delayed recognition (defined as failure to initially clarify consciousness or abnormal breathing before moving on to further questioning). Results: 289 and 221calls were included before and after intervention, respectively. Recognition of cardiac arrest improved from 74% to 89% (p&lt;0.001), and delayed recognition was reduced from 14% to 5% (p=0.001). Agonal respiration continues to challenge dispatchers, but misinterpretation of abnormal breathing decreased from 25% to 8% (p&lt;0.001) of calls. Median time to first chest compression was reduced by 30 seconds (204 vs. 174 seconds, respectively, p=0,039) Conclusion: Targeted simulation and education significantly increased recognition of OHCA and reduced time to first chest compression. Continuous focus and targeted dispatcher training are important to ensure quality of care for OHCA patients.
Is PBL better than traditional curriculum?
Authors: Wai-Ching Leung
Journal: BMJ (2001)

Since the problem based learning (PBL) curriculum was first introduced at McMaster medical school in the late 1960s it has been widely recognised as a progressive learner-centred active learning approach and currently underpins the philosophy of the entire medical curriculum in over 10% of medical schools worldwide.1 In the United Kingdom medical schools in Manchester, Glasgow, and Liverpool have already adopted the PBL curriculum as recommended by the General Medical Council,2 and several other schools have partially done so or are planning to do so.

But what is PBL? Although many medical teachers hold strong views on what counts as PBL, there is no universal definition.3 Typically, students working in small groups are given written real life problems. From these problems the students identify phenomena which require explanations, agree on learning objectives, research individually on identified issues, report back, and apply newly acquired information to the problem.4 The term PBL is often used to describe a curriculum based entirely on the problem based philosophy—that is, the PBL curriculum—but it …
HIV cases rise in UK
Authors: Kay Brennan
Journal: BMJ (2002)

The number of people in the United Kingdom infected with HIV is expected to rise by almost a half by 2005, according to the latest Public Health Laboratory Service (PHLS) projections.

New estimates suggest that almost 34 000 people will be infected with the AIDS virus by 2005 compared with 23 000 in 2001, an increase of 47%. Cases of HIV reached a new high in 2001 with 3330 new diagnoses, up 17% against the previous year.

Dr Barry Evans, head of the HIV …
Human rights: more than avoiding torture
Authors: César Augusto Ugarte Gil
Journal: BMJ (2003)

Despite medical students often having good relationships with their patients, we sometimes forget about a patients humanity. Consciously or unconsciously, we talk about patients as “complicated cases,” “textbook cases,” or “journal cases.” If we were a patient, would we like being talked about like that?

We form these attitudes at home, at university, in clinics, in our social lives—in all aspects of our world. How can we avoid these types of attitude? Something that is often forgotten in our medical education is teaching human rights.

We tend to think of human rights as liberty of expression and struggle against torture. But we forget that one fundamental human right is the right to health; as health …
SOUNDINGS: Medical necessity
Authors: Carl Morris
Journal: BMJ (2001)

I've been finding it hard to think of anything funny to write since 11 September. I was going to write something on the overuse of the word “appropriate” in modern society. In the end though that didn't seem, well, appropriate.

Why should I feel this way exactly? I don't remember losing the ability to be flippant in the weeks after I heard of the 8000 Muslims killed in Srebrenica, or the million Tutsis …
Plague Time: the New Germ Theory of Disease
Authors: Sanjay Pai
Journal: BMJ (2003)

Yesterdays heresy is often tomorrows fact and vice versa. This makes medical research exciting and, of course, necessary. Many examples support this statement, from the anatomist Vesaliuss findings to the very latest research.

Paul Ewald is a biologist at Amherst College, Massachusetts, who, to put it mildly, suggests something controversial. Ewalds thesis is that in addition to many acute illnesses, germs are also responsible …
A-Z of Medical Writing
Authors: Sally-Ann S Price
Journal: BMJ (2001)

Not a list of great medical literature or a book on how to write it. This book will help you to write more effectively: for most medics, it is getting the message across that counts.

“Doctors. They are highly trained in medical matters; they are not usually highly trained in writing matters.” Over a period of years, we have each been trained to write ineffectively. In school, teachers impose rules of grammar-though it is now accept. able to boldly split an infinitive. As undergraduates we write stilted experimental …
Junior doctors leaving medical school have knowledge gaps
Authors: Claire McKenna
Journal: BMJ (2002)

Preregistration house officers and senior house officers have notable knowledge gaps in basic aspects of acute care, according to a recent study published in the Postgraduate Medical Journal .

The study assessed the skills of 185 preregistration house officers and senior house officers at six hospitals in England through a questionnaire containing 12 questions on acute care topics.

Many of the doctors tested were unaware of the signs of …
Picture quiz: End of the bed
Authors: Stephen Goldie, Stephen Bicknell
Journal: BMJ (2004)

During a clinical placement on a medical ward, the specialist registrar challenges you to make “an end of the bed diagnosis.” The patient is a 49 year old man, a former smoker, who presented with severe dyspnoea and pitting oedema in the lower limbs. He has a history of recurrent deep venous thrombosis and pulmonary embolism. From the end of the bed you can see the patient is wearing a face mask providing high flow oxygen, his jugular venous pressure is markedly raised, and the appearance of his abdomen is grossly abnormal (figure below).

### Questions

1.  Describe the gross abnormality seen on the patient's abdomen.

2.  What diagnosis can be made from the end of the bed?

3.  What is the most likely cause of this condition?

### Answers

1.  The patient's abdomen is abnormal because of several grossly dilated tortuous veins. One especially prominent vessel runs through the centre of the epigastrium.

2.  Given the extent of the abnormality and the pattern of distribution of the vessels, the patient has a serious obstruction of the inferior vena cava.

3.  The most likely cause of obstruction of …
Activated hepatic stellate cells and portal fibroblasts contribute to cholestatic liver fibrosis in MDR2 knockout mice
Authors: Takahiro Nishio, Ronglin Hu, Yukinori Koyama, Shuang Liang, Sara B. Rosenthal, Gen Yamamoto, Daniel Karin, Jacopo Baglieri, Hsiao-Yen Ma, Jun Xu, Xiao Liu, Debanjan Dhar, Keiko Iwaisako, Kojiro Taura, David A. Brenner, Tatiana Kisseleva
Journal: Journal of Hepatology (2019)
Anti-BCMA CAR T-Cell Therapy bb2121 in Relapsed or Refractory Multiple Myeloma
Authors: Noopur Raje, Jesus Berdeja, Yi Lin, David Siegel, Sundar Jagannath, Deepu Madduri, Michaela Liedtke, Jacalyn Rosenblatt, Marcela V. Maus, Ashley Turka, Lyh-Ping Lam, Richard A. Morgan, Kevin Friedman, Monica Massaro, Julie Wang, Greg Russotti, Zhihong Yang, Timothy Campbell, Kristen Hege, Fabio Petrocca, M. Travis Quigley, Nikhil Munshi, James N. Kochenderfer
Journal: New England Journal of Medicine (2019)

Preclinical studies suggest that bb2121, a chimeric antigen receptor (CAR) T-cell therapy that targets B-cell maturation antigen (BCMA), has potential for the treatment of multiple myeloma.
NICE guidance aims to reduce misdiagnosis and delayed referral for neurological conditions
Authors: Elisabeth Mahase
Journal: BMJ (2019)

GPs should consider neuroimaging for adults with unexplained loss of sense of smell or taste that lasts more than three months, new guidance from the National Institute of Health and Care Excellence (NICE) aimed at reducing misdiagnosis and delayed referrals for people with neurological conditions says.1

The guidance says that adults with tics should …
Our girl in Havana
Authors: Anna Ellis
Journal: BMJ (2002)

Cigars, salsa, old American cars, and socialism. Anna Ellis spent her elective in Cuba to learn about this fascinating Caribbean island

Cuba's healthcare system is one of the successes of the revolution of 1959. Its doctors are highly skilled and very dedicated, and the concept of waiting for an operation or even an appointment is alien to a Cuban. Yet Cuba suffers from its dismal economy and remains an arch enemy of the United States, even finding itself on the US list of terrorist states. My interest in this contradiction and discovery of Cuban salsa took me to Havana in the sweltering heat of July and August 2002.

Cuba is a poor country. It is hard to fit around the traditional concept of a “developing” country because it has highly advanced health and education systems. Yet it is by no means on a par with the developed world.



Health care in Cuba is totally free. Private medicine is illegal, and even corrective laser eye surgery and plastic surgery are available at no charge. The emphasis is truly on primary care and community based medicine. Each city is divided up into areas called municipios , and each of these has a policlinic. Each policlinic serves 32 family doctors, who work in their own consultario , serving between 450 and 600 patients. A policlinic is like an outpatient department; various specialists run clinics such as general medicine, paediatrics, rheumatology, obstetrics and gynaecology, psychiatry, and dermatology. An emergency department caters for minor injuries and emergencies such as …
Comparison of Scheduled vs Emergency-Only Dialysis in Undocumented Immigrants With End-stage Renal Disease—Reply
Authors: Oanh Kieu Nguyen, Anil N. Makam
Journal: JAMA Internal Medicine (2019)

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U.S. Internists' Perspectives on Discussing Cost of Care With Patients: Structured Interviews and a Survey
Authors: Susan L. Perez, Arlene Weissman, Susan Read, Cynthia Daisy Smith, Lisa Colello, Doris Peter, Wendy Nickel
Journal: Annals of Internal Medicine (2019)

Background: Rising out-of-pocket costs are creating a need for cost conversations between patients and physicians. Objective: To understand the factors that influence physicians to discuss and consider cost during a patient encounter. Design: Mixed-methods study using semistructured interviews and a survey. Setting: United States. Participants: 20 internal medicine physicians were interviewed; 621 internal medicine physician members of the American College of Physicians completed the survey. Measurements: Interviews were analyzed by using thematic analysis, and surveys were analyzed by using descriptive statistics. Results: From the interviews, 4 themes were identified: Physicians are 1) aware that patients are struggling to afford medical care; 2) relying on clues from patients that hint at their cost sensitivity; 3) relying on experience to anticipate potentially high-cost treatments; and 4) aware that patients are making financial trade-offs to afford their care. Three quarters (n = 466) of survey respondents stated that they consider out-of-pocket costs when making most clinical decisions. For 31% (n = 191) of participants, there were times in the past year that they wanted to discuss out-of-pocket prescription drug costs with patients but did not. The most influential factors for ordering a test are the desire to be as thorough as possible (71% [n = 422]) and insurance coverage for the test (68% [n = 422]). Limitation: Findings are self-reported, the sample is limited to a single specialty, the survey response rate was low, information on the patient population was limited, and the survey instrument is not validated. Conclusion: Physicians are attuned to the burden of health care costs and are willing to consider alternative options based on a patient's cost sensitivity. Primary Funding Source: Robert Wood Johnson Foundation.
The Press: Class War
Authors: Jason O'Neale Roach
Journal: BMJ (2000)

“An absolute scandal” was the phrase Gordon Brown used to embroil the government in a class war with Oxford University ( Times 26 May). With the emphatic backing of the Sun (26 May), which enjoyed “his blistering assault on stuck up Oxbridge 110%,” Mr Brown had ignited a much larger media debate on education, elitism, and class.

Laura Spence, a sixth former at Monkseaton Community High School in North Tyneside, was “unhesitatingly spat out” by the Oxbridge admissions system, according to Peter Wilby, editor of the New Statesman , in his letter to the Guardian (28 May). The 17 year old's application to study medicine was rejected after an interview at Magdalen College, Oxford. She went on to secure a place at Harvard University in the United States.



Laura “lacked confidence,” according to one member of the Oxford interview panel (NORTH NEWS AND PICTURES)



The debate intensified when the BBC gained exclusive access to the comments of Dr Ajit Lalvani, a member of …
Minerva: May 2003
Authors: F Mommintern, A Tsekosconsultant
Journal: BMJ (2003)

When researchers asked patients to compare a “virtual colonoscopy” (using computed tomography) with the real thing, they were surprised that most patients said neither test was particularly painful or embarrassing, despite bowel insufflation with gas for the “virtual” procedure. When pressed to make a choice, 58% of patients said they would go for the virtual option next time. Bowel preparation was most patients least favourite bit ( American Journal of Gastroenterology 2003;98:578-85).

Minerva buys organic vegetables for their flavour. She could also buy them for their flavonoids, according to food chemists from California. Their study of corn, strawberries, and marionberries found that organically grown fruit and vegetables contained more flavonoid antioxidants than regular varieties ( Journal of Agricultural and Food Chemistry 2003;51:1237-41). Flavonoid production, part of a plants stress response, is suppressed by pesticides.

A bad case of the yips can ruin your golfing handicap. The involuntary flinching, jerking, or freezing usually happens just before an important putt, but experts cant decide whether its psychological or some kind of dystonia. Most golfers think that yips are a physical problem, although about a fifth of respondents in one survey blamed performance anxiety. Golfers said they treated themselves—usually with a stiff …
Cognitive Implications of Ototoxicity in Pediatric Patients With Embryonal Brain Tumors
Authors: Traci W. Olivier, Johnnie K. Bass, Jason M. Ashford, Rebecca Beaulieu, Sarah M. Scott, Jane E. Schreiber, Shawna Palmer, Donald J. Mabbott, Michelle A. Swain, Melanie Bonner, Robyn Boyle, Mary Lynn Chapeiski, Karen D. Evankovich, Carol L. Armstrong, Sarah J. Knight, Shengjie Wu, Arzu Onar-Thomas, Amar Gajjar, Heather M. Conklin
Journal: Journal of Clinical Oncology (2019)

Sensorineural hearing loss (SNHL) is associated with intellectual and academic declines in children treated for embryonal brain tumors. This study expands upon existing research by examining core neurocognitive processes that may result in reading difficulties in children with treatment-related ototoxicity.Prospectively gathered, serial, neuropsychological and audiology data for 260 children and young adults age 3 to 21 years (mean, 9.15 years) enrolled in a multisite research and treatment protocol, which included surgery, risk-adapted craniospinal irradiation (average risk, n = 186; high risk, n = 74), and chemotherapy, were analyzed using linear mixed models. Participants were assessed at baseline and up to 5 years after diagnosis and grouped according to degree of SNHL. Included were 196 children with intact hearing or mild to moderate SNHL (Chang grade 0, 1a, 1b, or 2a) and 64 children with severe SNHL (Chang grade 2b or greater). Performance on eight neurocognitive variables targeting reading outcomes (eg, phonemics, fluency, comprehension) and contributory cognitive processes (eg, working memory, processing speed) was analyzed.Participants with severe SNHL performed significantly worse on all variables compared with children with normal or mild to moderate SNHL (P ≤ .05), except for tasks assessing awareness of sounds and working memory. Controlling for age at diagnosis and risk-adapted craniospinal irradiation dose, performance on the following four variables remained significantly lower for children with severe SNHL: phonemic skills, phonetic decoding, reading comprehension, and speed of information processing (P ≤ .05).Children with severe SNHL exhibit greater reading difficulties over time. Specifically, they seem to struggle most with phonological skills and processing speed, which affect higher level skills such as reading comprehension.
Junkies, druggies, addicts, scum?
Authors: Bruno Rushforth
Journal: BMJ (2004)

What do you call people who inject illicit drugs? How does your consultant refer to these patients? “Scum” was the preferred term of one doctor on our team. But dehumanising people in this way is a dangerous step, falling well short of professional obligations to treat all patients with care and respect. This attitude also implicitly sanctions substandard care to a group of patients who have multiple healthcare needs.



SEAN LONGDEN/REX

Fear and loathing in Glasgow



These thoughts came to me before I embarked on a medical career. In a previous life in the mid-1990s, I worked with drug users in Glasgow, interviewing them for an annual Scottish drug use and HIV study. I heard about their experiences of the healthcare system-they felt treated as second class citizens or dismissed as malingerers.

To recruit people for the study we would drive out to some of the most deprived parts of Glasgow in our “interview unit”-a small mobile home-and encourage those hanging around the streets to come into the warmth for a cup of tea and to complete a questionnaire.

Having grown up in the leafy suburbs of London, I couldn't quite believe my eyes as we parked near burnt out homes and shops protected with razor …
Effects of the anti-RANKL antibody denosumab on joint structural damage in patients with rheumatoid arthritis treated with conventional synthetic disease-modifying antirheumatic drugs (DESIRABLE study): a randomised, double-blind, placebo-controlled phase 3 trial
Authors: Tsutomu Takeuchi, Yoshiya Tanaka, Satoshi Soen, Hisashi Yamanaka, Toshiyuki Yoneda, Sakae Tanaka, Takaya Nitta, Naoki Okubo, Harry K Genant, Désirée van der Heijde
Journal: Annals of the Rheumatic Diseases (2019)

Objective To evaluate the efficacy of denosumab in suppressing joint destruction when added to conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy in patients with rheumatoid arthritis (RA). Methods This was a multi-centre, randomised, double-blind, parallel-group, placebo-controlled phase 3 study in Japan. Patients with RA aged ≥20 years receiving csDMARDs were randomly assigned (1:1:1) to denosumab 60 mg every 3 months (Q3M), denosumab 60 mg every 6 months (Q6M) or placebo. The change in the modified total Sharp score (mTSS) and effect on bone mineral density (BMD) at 12 months was evaluated. Results In total, 654 patients received the trial drugs. Denosumab groups showed significantly less progression of joint destruction. The mean changes in the mTSS at 12 months were 1.49 (95% CI 0.99 to 1.99) in the placebo group, 0.99 (95% CI 0.49 to 1.49) in the Q6M group (p=0.0235) and 0.72 (95% CI 0.41 to 1.03) in the Q3M group (p=0.0055). The mean changes in bone erosion score were 0.98 (95% CI 0.65 to 1.31) in the placebo group, 0.51 (95% CI 0.22 to 0.80) in the Q6M group (p=0.0104) and 0.22 (95% CI 0.09 to 0.34) in the Q3M group (p=0.0001). No significant between-group difference was observed in the joint space narrowing score. The per cent change in lumbar spine (L1–L4) BMD in the placebo, Q6M and Q3M groups were −1.03%, 3.99% (p&lt;0.0001) and 4.88% (p&lt;0.0001). No major differences were observed among safety profiles. Conclusions Denosumab inhibits the progression of joint destruction, increases BMD and is well tolerated in patients with RA taking csDMARD.
On the edge of the world
Authors: Jean Adams
Journal: BMJ (2001)

Next stop Sitka. It has been a long journey. Thirty six hours of trains, planes, and airports. I hope that Sitka is worth it. Nestled on a strip of flat ground between the mountains of Baranof Island and the Pacific Ocean, in the far south east of Alaska, Sitka was once the capital of Russian America, but now survives on fishing and tourism.

I have come here to experience life and medicine in rural north America and to satisfy my longing for isolation. The road in Sitka is 12 miles long. The town is accessible only by plane or boat, has 8000 inhabitants, and a 10 bed hospital. I hope that I will feel suitably isolated.

Even while loitering around the airport waiting for my lift, I get the feeling that this is going to be a weird place. There are people wheeling huge boxes of freshly caught salmon to the check-in desk. It is pouring rain and yet everybody is wearing shorts and sandals.



Sitka harbour CORBIS/DAVID MUENCH



“Hi, I'm Jean Adams. I'm a student working with Dr Hunter at the moment. Tell me what's been going on.” I …