tbuckley/cabot-search huggingface dataset:
Conducting a survey
Authors: Wai-Ching Leung
Journal: BMJ (2001)

Wai-Ching Leung explains how to conduct a good survey Most medical students carry out at least one project involving a survey in either a core module - for example, in public health or primary care - or a special study module. The survey methodology is popular among students for two reasons. Firstly, it seems familiar and easy to do. Most students have taken part in either an interview or questionnaire survey, and many have conducted a survey in their secondary school days. Secondly, people are interesting, and the survey is a useful tool to gather a wide range of information about them. It can be used for a range of disciplines, such as medical or health studies, business studies, education, biology, and sociology. It is indeed easy to administer questionnaires and carry out interviews. However, there are so many potential pitfalls in conducting a survey that few of them produce valid and meaningful results. The purpose of this article is to outline briefly the basic steps in carrying out a survey and the potential pitfalls. A survey is a method of collecting information from a sample of the population or sometimes the organisations we are interested in. This may involve gathering information either at one point in time - that is, cross sectional studies - or following a group of people over a period of time - that is, longitudinal studies. Most non-academic surveys - for example, surveys in market research - are usually of the first type. The type of information that we can gather from people include factual information, their level of knowledge, attitude, personalities, beliefs, and preferences. The box shows the steps in conducting a survey. Potential pitfalls occur in each of these stages and it is important to consider each of them in detail. ### Stages of conducting a survey
Britain is worst in Europe for teenage pregnancy rates
Authors: Kay Brennan
Journal: BMJ (2002)

Britain has the second highest teenage birth rate in the developed world, according to a new report from the United Nations.

The United States is the only country with a higher proportion of teenage mothers, with 52 per 1000 compared with 32/1000 in the United Kingdom. The lowest birth rates were found in Korea, Japan, Switzerland, the Netherlands, and Sweden, where less than 7 girls per 1000 gave birth.

A league table of teenage births in rich nations , a report compiled by Unicef's Innocenti research centre in …
Abstract 2128: Hypothermic Circulatory Arrest with Selective Antegrade Cerebral Perfusion in Aortic Arch Surgery: A Risk Factor Analysis for Adverse Outcome in 501 Patients
Authors: Nawid Khaladj, Christian Hagl, Sara Meck, Klaus Kallenbach, Malakh Shrestha, Michael Winterhalter, Axel Haverich, Matthias Karck
Journal: Circulation (2006)

Introduction: This study was undertaken to identify pre- and perioperative risk factors influencing outcome after operations requiring hypothermic circulatory arrest (HCA) in a single center. Metho...
UK medical students arrested in Israel
Authors: Clare Hughes
Journal: BMJ (2003)

Two fourth year medical students were arrested in the Middle East during their elective. Israeli authorities held Ayaz Ghani and Tahseen Chaudhry, who are studying at Birmingham University, for 11 days as they tried to enter Israel from Jordan.

Chaudhry said, “They told us we were being arrested because we looked suspicious; I think because we were two British Asians. We were constantly asking for access to the British Embassy but they initially told us they wanted to ask questions because we looked suspicious so I thought we would only be …
The blood doctor
Authors: Helen Barratt
Journal: BMJ (2003)

Dr Henry Nanther was physician in ordinary to Queen Victoria's haemophiliac son, Prince Leopold. At the end of the 19th century, Nanther's interventional options were extremely restricted; he could do little for his patients. However, he was much loved by the Royal Family and a renowned expert on “the bleeding disease.” He was also obsessed with blood. Almost 100 years later his great grandson, Martin, sets about writing a biography of …
An unusual renal mass
Authors: Balakrishnan Saravanan, Siddharth Neminathan, Kevin J Thomas
Journal: BMJ (2006)

A woman aged 52, otherwise fit and well, was admitted as an emergency with the history of a sudden onset constant back pain on the right hand side, for the past four hours.

On examination her vital signs were blood pressure: 130/78 mm Hg; pulse 80/minute.

Abdominal examination was unremarkable, except for mild tenderness in the right renal angle. All blood investigations including inflammatory markers and liver function tests were within normal limits, with a haemoglobin of 12×10 g/l. The haemoglobin suddenly dropped to 8×10 g/l a day after admission. The patient was stabilised with fluid resuscitation and blood transfusion. She had an ultrasound scan of the abdomen (fig 1) and subsequently a computed tomography scan (fig 2).



Fig 1 
Ultrasound scan of abdomen





Fig 2 
Computed tomography scan of abdomen



1.  What do the ultrasound and computed tomography scans show?

2.  What is the incidence, mean age, and sexual distribution of this condition, and does it affect one side more than the other?

3.  Name two conditions associated with it.

4.  What procedure does the images below show?

1.  The ultrasound shows a highly echogenic tumour in the right kidney, due to high fat content, and the computed tomography scan shows a heterogeneous tumour predominantly of fat density, both suggesting the …
UK doctor profile changes
Authors: Rhona MacDonald
Journal: BMJ (2001)

There are 67 000 hospital doctors, 33 000 general practitioners, and 3500 public health doctors working with a permanent contract in the United Kingdom, according to Medical and Dental Workforce Data.

These data have been compiled for the first time, by collating the monthly reports from Employing Doctors and Dentists, but the most recent UK figures are available only to September 1999.

The number of hospital doctors increased by 42% over the past decade, while the number of GPs increased by only 8%. …
Reply to Satoru Taguchi, Tohru Nakagawa, and Hiroshi Fukuhara's Letter to the Editor re: Jürgen E. Gschwend, Matthias M. Heck, Jan Lehmann, et al. Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol 2019;75:604–11
Authors: Jürgen E. Gschwend, Matthias Heck
Journal: European Urology (2019)
Get stuck in
Authors: Ademola Olaitan
Journal: BMJ (2009)

When applying to medical school, few applicants realise that as a clinical medical student you will spend a substantial proportion of your time waiting for things to happen. This may be waiting for tutorials to begin, waiting for patients to arrive, or waiting for the inevitable grilling from the consultant about a topic that is beyond your powers of recall.

Occasionally during these mundane periods of waiting, something dramatic and totally unexpected occurs. I recently found myself in exactly this situation. I had been waiting for a ward …
Minerva: December 1999
Authors: Gordon J A Morris
Journal: BMJ (1999)

Prayer is a cheap and universally available treatment, but does it work? A double blind randomised controlled trial in Archives of Internal Medicine (1999;159:2273–8) suggests that it can. Researchers recruited a cross denominational team of Christians to pray for half the patients admitted to one coronary care unit. The patients they prayed for, who were unaware of the prayers, had lower scores than controls on an unvalidated instrument for measuring adverse outcomes. Prayer had no impact on length of stay, and the researchers didn't look into its effects on mortality alone. Controversially, patients were denied informed consent.

Fire is the third commonest cause of accidental death in children and smoke alarms are an effective way of preventing it. The people who most need smoke alarms, however, rarely have them (Archives of Diseases in Childhood 1999;81:400–3). In one study, only 16% of council tenants in London's deprived electoral wards had functioning smoke alarms. Substantially more people owned an alarm, but only half were properly installed. The commonest problem was a lack of batteries.

Visual impairment is a common problem in India's rural villages. Yet, even where treatment is readily available, uptake of ophthalmology services is poor (Archives of Ophthalmology 1999;117:1393–9). In one blindness prevention programme, eye …
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society
Authors: Fred M. Kusumoto, Mark H. Schoenfeld, Coletta Barrett, James R. Edgerton, Kenneth A. Ellenbogen, Michael R. Gold, Nora F. Goldschlager, Robert M. Hamilton, José A. Joglar, Robert J. Kim, Richard Lee, Joseph E. Marine, Christopher J. McLeod, Keith R. Oken, Kristen K. Patton, Cara N. Pellegrini, Kimberly A. Selzman, Annemarie Thompson, Paul D. Varosy
Journal: Circulation (2019)
Bendamustine in Combination with Rituximab As First-Line Treatment of Splenic Marginal Zone Lymphoma (BRISMA). Results of the IELSG-36 Phase II Study
Authors: Emilio Iannitto, Monica Bellei, Andrés J M Ferreri, Luigi Marcheselli, Marina Cesaretti, Corinne Haioun, Salvatrice Mancuso, Krimo Bouabdallah, Remy Gressin, Claudio Tripodo, Alexandra traverse-Glehen, Lucile Baseggio, Simonetta Zupo, Caterina Stelitano, Barbara Castagnari, Caterina Patti, Francesco Merli, Anna Marina Liberati, Michele Merli, Guido Gini, Maria Giuseppina Cabras, Jehan Dupuis, Francesca Re, Emanuele Zucca, Massimo Federico, Catherine Thieblemont
Journal: Blood (2017)
Abstract P086: Circulating MicroRNAs are Associated with Abdominal Adiposity and Fatty Liver in Asian Indians
Authors: Kevin Miles, Alka M Kanaya, Elena Flowers
Journal: Circulation (2016)

Background: Fatty liver is associated with abdominal adiposity, insulin resistance, and risk for diabetes and liver disease. Asians Indians have a high prevalence of fatty liver and abdominal visceral adiposity compared to other racial groups, and the causes are not well understood. Circulating microRNAs (miRs) identify latent risk factors for diabetes and biologic mechanisms underlying disease. Previous studies identified associations between circulating microRNAs and obesity in Caucasians. No prior studies evaluated association between circulating microRNAs and fatty liver and abdominal adiposity in Asian Indians. Hypothesis: Circulating microRNAs are associated with the presence of fatty liver and elevated waist circumference in Asian Indians. Methods: We studied 136 participants (49% women, age 56 ± 8 years) from the Metabolic syndrome and Atherosclerosis in South Asians Living in America (MASALA) pilot study. Elevated waist circumference at baseline was defined as &gt;90cm for men and &gt;80cm for women. Fatty liver was measured using computed tomography images of the liver and spleen (in Hounsfield units) and was defined as liver to spleen ratio &lt;1. Circulating microRNAs (n=30) were measured from plasma collected during the baseline visit using the Firefly Circulating microRNA assay. Unadjusted and multivariate-adjusted logistic regression models were created. Results: Elevated waist circumference was present in 115 (85%) and fatty liver was present in 24 (18%). In age and sex adjusted models, miR-423 was inversely associated with elevated waist circumference (p&lt;0.05). This miR was also inversely associated with metabolic syndrome (p&lt;0.1) in the subset of individuals not taking hypertension or diabetes medications (n=88). MiR-146a, miR-146b, miR-197, miR-20b, miR-21, miR-222, and miR-24 were inversely associated with fatty liver (p&lt;0.05 for all). These microRNAs show moderate to high inter-correlations (r=0.4-0.9). None of these miRs were significantly associated with metabolic syndrome or diabetes. MiR-486, which is associated with glycemic impairment and progression in Asian Indians and insulin resistance and response to thiazolidenidones, was positively associated with fatty liver (p&lt;0.1). Conclusions: We found significant relationships between fatty liver and waist circumference and numerous circulating microRNAs. MicroRNAs inversely associated with fatty liver are correlated and may be co-expressed in order to regulate biologic pathways related to fatty liver. There is no overlap between miRs associated with fatty liver and miRs associated with diabetes and metabolic syndrome. Additional studies are needed to determine whether circulating microRNAs might be useful biomarkers for the detection of fatty liver, which biologic pathways are implicated, and whether there are differences between race/ethnic groups.
Association of Intrathecal Immunoglobulin G Synthesis With Disability Worsening in Multiple Sclerosis
Authors: Christiane Gasperi, Anke Salmen, Gisela Antony, Antonios Bayas, Christoph Heesen, Tania Kümpfel, Ralf A. Linker, Friedemann Paul, Martin Stangel, Björn Tackenberg, Florian Then Bergh, Clemens Warnke, Frank Weber, Heinz Wiendl, Brigitte Wildemann, Uwe K. Zettl, Ulf Ziemann, Frauke Zipp, Hayrettin Tumani, Ralf Gold, Bernhard Hemmer
Journal: JAMA Neurology (2019)

<h3>Importance</h3> Reliable biomarkers associated with disability worsening in multiple sclerosis (MS) are still needed. <h3>Objective</h3> To determine a possible association of intrathecal IgG synthesis and early disability worsening as measured by Expanded Disability Status Scale (EDSS) scoring in patients with relapsing-remitting MS or clinically isolated syndrome. <h3>Design, Setting, and Participants</h3> Cerebrospinal fluid measurements and clinical data from the observational longitudinal German national multiple sclerosis cohort were analyzed. Patients were recruited between August 2010 and November 2015 from 18 centers. Data analysis was completed from August 2018 to December 2018. <h3>Exposure</h3> Patients were offered standard immunotherapies per national treatment guidelines. <h3>Main Outcomes and Measures</h3> A possible association between intrathecal IgG synthesis and risk of EDSS worsening 4 years after study inclusion was tested as the primary end point by multivariable binomial regression analysis. Kaplan-Meier analysis with a log-rank test was used to assess the association of intrathecal IgG synthesis with the time to EDSS worsening. Associations between intrathecal IgM or IgA synthesis and other cerebrospinal fluid parameters and EDSS worsening were analyzed as exploratory end points. Data collection began before the hypotheses were formulated. <h3>Results</h3> Of all 1376 patients in the German Competence Network of Multiple Sclerosis cohort, 703 patients were excluded owing to missing cerebrospinal fluid or EDSS data. Of the 673 included patients, 459 (68.2%) were women. The mean (SD) age at baseline was 34 (10) years. Intrathecal IgG synthesis was associated with a higher risk of EDSS worsening after 4 years (odds ratio, 2.02 [95% CI, 1.15-3.58];<i>P</i> = .01), independent of the occurrence of relapses and disease-modifying therapy. Additionally, intrathecal IgG synthesis was associated with earlier EDSS worsening; 4 years after study entry, worsening occurred in 28.4% (95% CI, 22.7%-34.1%) and 18.1% (95% CI, 12.4%-23.9%) of patients with and without intrathecal IgG synthesis, respectively. No association of other routine cerebrospinal fluid parameters with EDSS worsening was found. <h3>Conclusions and Relevance</h3> Patients with new diagnoses of relapsing-remitting multiple sclerosis or clinically isolated syndrome with intrathecal IgG synthesis had a higher risk of and shorter time to EDSS worsening across a 4-year period of follow-up. Intrathecal IgG synthesis is a potentially useful marker for disability worsening in patients with multiple sclerosis and may be useful for early treatment decisions.
A patient with dysphagia
Authors: Rishi Singhal, Norzin Angmo, Chris Ayshford, Marcelle Macnamara
Journal: BMJ (2006)

A 19 year old man presented to the accident and emergency department with acute onset inability to swallow and a feeling of a lump in his throat after having a meal. On examination he was distressed and was drooling saliva. The patient showed marked dysphagia when asked to take sips of water.

A lateral neck radiograph was taken to confirm the diagnosis (figure).



Lateral radiograph of the neck



1.  What is the diagnosis?

2.  What are the classic features of this on a radiograph?

3.  What is the management?

1.  The diagnosis is a foreign body at the level of the cricopharynx. The lateral radiograph of the soft tissues of the neck shows soft tissue thickening at the cricopharynx, representing a food bolus (A), and marked presence of air in the upper oesophagus inferior to the food bolus (B).

2.  A lateral soft tissue radiograph of a foreign …
Anaesthesia: Regional anaesthesia
Authors: Jonathan M Behar, Petrut Gogalniceanu, Lesley Bromley
Journal: BMJ (2007)

In the fourth and final part of our series on anaesthesia, Jonathan M Behar and colleagues discuss regional anaesthesia General anaesthesia is the systemic administration of a central nervous system depressant, which leads to loss of consciousness and complete absence of sensation. The trauma associated with surgery activates nociceptors and the nerve fibres emerging from them. But these are not perceived under the influence of a general anaesthetic-the exact underlying mechanism, however, is unknown. Regional anaesthesia, by contrast, is a method of providing local analgesia by infiltration of a local anaesthetic into tissues adjacent to regional nerves. Regional anaesthetics can be given to central structures, such as the spinal cord, or peripheral nerves, which emanate from the cord. This varies according to the purpose of the anaesthetic “block” and the area that needs to be anaesthetised. Fig 1 Cross section of the spinal cord, its covering membranes, and spaces; spinothalamic tracts encircled. Adapted from www.unm.edu/[sim]jimmy/spinal_notes.htm ### Box 1: Important anatomy (fig 1)RETURN TO TEXT
Role of Apelin in Glioblastoma Vascularization and Invasion after Anti-VEGF Therapy: What Is the Impact on the Immune System?
Authors: Zohreh Amoozgar, Rakesh K. Jain, Dan G. Duda
Journal: Cancer Research (2019)

Abstract The limited efficacy of current antiangiogenic therapies calls for a better understanding of the specific resistance mechanisms in glioblastoma (GBM) and the urgent development of new therapeutic strategies targeting these pathways. In this issue of Cancer Research, Mastrella and colleagues reported that expression of the proangiogenic peptide apelin (APLN) was decreased and GBM cell invasion was increased after anti-VEGF therapy in preclinical models of GBM. Using the mutant form of the natural apelin-13 peptide, the authors showed reduction of both angiogenesis and invasion in the GBM models, and further increased the efficacy of anti-VEGF therapy. VEGF blockade is still widely used as salvage therapy for recurrent GBM, therefore these intriguing results have potential translational implications as they point to a potential new strategy to overcome VEGF blockade resistance; however, they also raise important questions for the clinical translation of this strategy, and its impact on antitumor responses, in particular immune responses. See related article by Mastrella et al., p. 2298
An algorithm strategy for precise patient monitoring in a connected healthcare enterprise
Authors: Xiao Hu
Journal: npj Digital Medicine (2019)

Abstract This perspective paper describes the building elements for realizing a precise patient monitoring algorithm to fundamentally address the alarm fatigue problem. Alarm fatigue is well recognized but no solution has been widely successful. Physiologic patient monitors are responsible for the lion’s share of alarms at the bedside, most of which are either false or non-actionable. Algorithms on patient monitors lack precision because they fail to leverage multivariate relationship among variables monitored, to integrate rich patient clinical information from electronic health record system, and to utilize temporal patterns in data streams. Therefore, a solution to patient monitor alarm fatigue is to open the black-box of patient monitors to integrate physiologic data with clinical data from EHR under a four-element algorithm strategy to be described in this paper. This strategy will be presented in this paper in the context of its current status as described in our prior publications.
Come join the good samaritans
Authors: Anahita Kirkpatrick
Journal: BMJ (2002)

Planning to leave the UK for your elective? Or perhaps you9re staying domestic. No matter where you are, would you and should you intervene to help in an unexpected situation? <b>Anahita Kirkpatrick</b>, a senior medicolegal adviser with the Medical Defence Union, says that you may have to and gives some advice on what to do in a good samaritan act
Doctor on Everest
Authors: Suzie Thompson
Journal: BMJ (2002)

When New York surgeon Kenneth Kamler got the call to go to Everest in 1996 he packed a huge box of medical supplies, with something for every eventuality, but not even he, who had attempted to climb Everest four times, could have imagined what the mountain had in store that year.

The months of acclimatisation brought all the usual cases to the medical tent: mountain sickness, broken bones, …
Surgeon sued for branding women with initials of university
Authors: Karen Hebert
Journal: BMJ (2003)

James Guiler, a surgeon from Lexington, Kentucky, in the United States is being sued by 10 women for branding their uteruses with the initials “UK” of the University of Kentucky, where he trained.

The first woman to file the lawsuit against Guiler was Stephanie Means, who had a hysterectomy done in August 2002 at the …
Is there a doctor on the plane?
Authors: Kiran Somani
Journal: BMJ (2002)

Kiran Somani knows what it's like to be faced with a real emergency

In the movies, and occasionally in the news, doctors are depicted as heroic figures capable of performing amazing life saving feats. They appear out of the crowd at just the right moment, and with their knowledge and resourcefulness return an ill fated stranger to perfect health. But in fact although doctors everywhere provide a huge service, few real life medics find themselves in situations as dramatic as those seen on the television and in the movies.

At the end of May I completed my intercalated course and was looking forward to a last long trip abroad before returning to the fourth year of medicine. A friend and I had decided a long …