tbuckley/cabot-search huggingface dataset:
Protocols for managing the victims of sexual assault
Authors: Emma Wall, Jan Welch
Journal: BMJ (2004)

As doctors, we will undoubted meet people who have been sexually assaulted and this requires specialist care. Emma Wall and Jan Welch explain how to manage victims of rape Rape is common and victims may present in any number of medical settings (box 1). As well as victims' need for good medical care, evidence collection should be considered so that rapists can be identified and convicted. Throughout most of the United Kingdom, services for people who have been sexually assaulted are uncoordinated, of poor quality, and conviction rates are low. This is beginning to change as more specialist sexual assault referral centres are developed, which can provide care tailored to individual needs and concerns (box 2). ### Box 1: Key factsRETURN TO TEXT ### Box 2: Integrated care of victims of sexual assault Distress caused by the initial assault may be exacerbated by prolonged waiting and poor continuity of care in an environment not conducive to recovery.12 These problems have been tackled by sexual assault referral centres, which offer an integrated specialist service for victims of sexual assault. Facilities available include the treatment of minor injuries, emergency contraception, screening and treatment of sexually transmitted infection, psychosocial care, and forensic examination. Reporting of sexual assaults is encouraged and some centres provide opportunities for victims to provide anonymous evidence and intelligence. It is hoped that, as well as promoting recovery following assault, these centres may also help in increasing the number of convictions for sexual crimes. There are now eight sexual assault referral centres in the United … RETURN TO TEXT
Minerva: February 2001
Authors: Richard Wheeler, Peter Shah
Journal: BMJ (2001)

Researchers who conduct meta analyses may have to look again at the funnel plot as a way of checking for selection bias. A study of 198 meta-analyses suggests that the shape of funnel plots depends as much on how they are calculated as on the presence or absence of biases ( Journal of Clinical Epidemiology 2000;53:477–84). Researchers man. aged to convert 37 asymmetrical plots (indicating bias) into symmetrical ones just by tweaking the calculations.

Two randomised trials in Emergency Medicine Journal, the new incarnation of Accident and Emergency Medicine , compare midazolam and ketamine for sedating children needing emergency procedures. The first concludes that oral ketamine works better than oral midazolam for children with wounds that need suturing under local anaesthetic (2001;18:30–3). The second finds intranasal midazolam inferior to a combination of intravenous ketamine and midazolam (2001;18:39–45). Both teams of authors say that careful monitoring of sedated children is essential, including pulse oximetry.

It seems likely that children who were breast fed as babies have a small but detectable cognitive advantage over children who were bottle fed. The latest study in a long line of inquiry, which began in 1929, looks at the IQ of children …
The role of diastolic function in the quality of life and functional capacity of patients with heart failure undergoing a combined exercise program
Authors: M. G. Roscani, T. Fabri, A. M. Catai, F. H. O. Ribeiro, J. A. Araujo, J. M. Mattos, D. A. A. Rossi, R. C. Borra, S. G. Z. Bazan, M. T. S. Peracoli, J. C. Hueb, B. B. Matsubara
Journal: European Journal of Heart Failure (2017)
Acute care: Brain failure
Authors: Nicola Cooper
Journal: BMJ (2004)

In the final part of our series, Nicola Cooper focuses on the D for disability in the ABCDE system of managing acutely ill patients The most common reason for a reduced conscious level is critical illness--not necessarily a primary brain problem. Patients who have a serious problem with A (airways), B (breathing), or C (circulation) can be drowsy or unresponsive--for example, obstruction of the airway, any severe lung problem, or shock from any cause. Coma, by definition, is when the Glasgow coma score is less than 9 (box 1). This is associated with potentially life-threatening complications which require urgent intervention. Such patients have reduced airway reflexes and are considered unable to protect their own airway from aspiration of obstruction. Intubation with a cuffed endotracheal tube is the definitive method of protecting the airway. ### Box 1: Glasgow coma score #### Eye opening: #### Best motor response #### Best verbal responseRETURN TO TEXT Head injury is a common cause of coma. In non-trauma patients who have been unconscious for six hours, 40% will have taken some form of sedative and of the remaining 60%, about a third have hypoxic brain injury (for example, after cardiac arrest), a third have a cerebrovascular cause (infarct or haemorrhage), and a third have a metabolic cause for coma (for example, in diabetes or liver disease). Coma has many causes, and no history is available from the patient. A systematic approach is therefore required:
Computer talks like a toddler
Authors: Kay Brennan
Journal: BMJ (2001)

A computerised toddler could soon let us talk to our computers and do away with keyboards for good, say its creators.

The toddler called Hal is an artificial intelligence program that can understand everyday language. It was developed by Artificial Intelligence Enterprises (Ai), an Israeli company that claims that its program has the vocabulary and grasp of language of a 15 month old child.



PRN/ SONY ELECTRONICS INC.



Hal gets its ability to converse by being trained by a “carer” who feeds in stories and responds to questions, as if …
Television company wants terminally ill patient to plastinate
Authors: Anja Weidmann
Journal: BMJ (2002)

Plans have been announced to televise the rebuilding of a donated human corpse by the television production company Mentorn. The company is currently searching for a palliative care patient donor who is willing to be “filmed, preserved, dissected, and modified into a new improved human form.”

The programme's aim will be to identify “design flaws” in the body and to explore how they could be overcome. A panel of as yet unnamed experts will identify problems and suggest potential alterations. It is likely that the panel will include some non-medical professionals such as mechanical engineers and architects, as …
Multi-sensitization to hymenoptera venoms in a group of Brazilian patients
Authors: K. M. De Amicis, A. S. Watanabe, C. E. Galvao, D. D. Figo, J. R. A. dos Santos-Pinto, M. S. Palma, F. F. Castro, J. Kalil, F. Ferreira-Briza, G. Gadermaier, K. S. Santos
Journal: Allergy (2015)
The Centers for Medicare &amp; Medicaid Services Oncology Care Model Halfway Through: Perspectives from Diverse Participants
Authors: Ronald M Kline, Michelle Brown, Nikolas Buescher, John Cox, Elizabeth Horenkamp, Russell Hoverman, Marcus Neubauer, Randall Oyer, Anne Marie Fraley Rainey, Larisa Strawbridge
Journal: JNCI Journal of the National Cancer Institute (2019)

The Oncology Care Model (OCM) is a 5-year model developed and tested by the Centers for Medicare & Medicaid Services that uses an episode-based payment model triggered by the receipt of chemotherapy to test if changing payment mechanisms, in conjunction with a requirement for enhanced patient services, can generate clinical transformation that will orient practices toward more patient-centered, high-value care to reduce expenditures and preserve or enhance quality of care for beneficiaries. The model is geographically diverse with practices in 34 states and encompasses practices ranging in size from 1 to more than 400 practitioners, with a multitude of business structures. Given these varied clinical and business environments, we believe that OCM-participating practices will have different opportunities and challenges as they work toward practice transformation, but they will likely share similarities with other practices in similar clinical and business settings. This commentary shares the experiences of four diverse groups participating in OCM-three practices and one network of practices-halfway through the model's projected 5-year life cycle in the expectation that these experiences will be of value to other practices embarking toward patient-centered, high-value practice transformation.
Abstract MP92: Processed and Unprocessed Red Meat Consumption and Incident Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis
Authors: Martha Tamez, Renata Micha, Martin Lajous, Dariush Mozaffarian
Journal: Circulation (2013)

Background: Several studies have recently evaluated the relation of processed and unprocessed red meat consumption and type 2 diabetes mellitus (DM). An updated review and quantitative assessment of these studies is crucial for public health recommendations. Methods: We performed a systematic review and meta-analysis of the relation of processed (salted or otherwise preserved), unprocessed, and total red meat consumption with DM. We updated a prior systematic search (to Mar 2009) for additional cohort, case-control, or randomized studies through Oct 2012. Among prior identified studies and 208 newly identified abstracts, 13 studies, all prospective cohorts, met inclusion criteria. These included 4 prior identified studies, 3 updated analyses, and 6 new cohorts. Data were extracted independently in duplicate. Random-effects generalized least squares models for trend were used to derive pooled dose-response estimates. Statistical heterogeneity between studies was tested with goodness of fit (λ2), and publication bias by funnel plots and Begg’s test. Results: The 13 studies provided 34 separate estimates for relations of processed, unprocessed, and total red meat consumption with incident DM. These included 574,212 individuals and 33,482 DM cases. In pooled analyses, per 50-g serving/d of processed meats, DM risk was 35% higher (13 studies; 34,077 cases; RR 1.35; 95% CI, 1.24-1.55; P&lt;0.001). The latter corresponded to 82% higher DM risk (RR 1.82; 95% CI, 1.64-2.02; P&lt;0.001) for each 100-g serving/d of processed meats. Per 100-g serving/d of unprocessed red meats, 13% higher risk of DM was seen (12 studies; 31 591 cases; RR 1.13; 95% CI, 1.08-1.17; P&lt;0.001). Fewer studies evaluated total red meat, with intermediate results (5 studies; 16,747 cases; RR per 100-g serving/d 1.16; 95% CI, 1.11-1.21; P&lt;0.001). Heterogeneity was evident by study location, with stronger risk estimates in US vs European populations. Evidence for publication bias was not seen. Conclusions: Consumption of red meat is associated with high incidence of DM. Per gram, risk is highest for processed meats, highlighting the need for investigation of key responsible constituents and informing policy priorities.
Extended prophylaxis for venous thromboembolism after hospitalization for medical illness: A trial sequential and cumulative meta-analysis
Authors: Navkaranbir S. Bajaj, Muthiah Vaduganathan, Arman Qamar, Kartik Gupta, Ankur Gupta, Harsh Golwala, Javed Butler, Samuel Z. Goldhaber, Mandeep R. Mehra
Journal: PLoS Medicine (2019)

Background The efficacy, safety, and clinical importance of extended-duration thromboprophylaxis (EDT) for prevention of venous thromboembolism (VTE) in medical patients remain unclear. We compared the efficacy and safety of EDT in patients hospitalized for medical illness. Methods and findings Electronic databases of PubMed/MEDLINE, EMBASE, Cochrane Central, and ClinicalTrials.gov were searched from inception to March 21, 2019. We included randomized clinical trials (RCTs) reporting use of EDT for prevention of VTE. We performed trial sequential and cumulative meta-analyses to evaluate EDT effects on the primary efficacy endpoint of symptomatic VTE or VTE-related death, International Society on Thrombosis and Haemostasis (ISTH) major or fatal bleeding, and all-cause mortality. The pooled number needed to treat (NNT) to prevent one symptomatic or fatal VTE event and the number needed to harm (NNH) to cause one major or fatal bleeding event were calculated. Across 5 RCTs with 40,247 patients (mean age: 67–77 years, proportion of women: 48%–54%, most common reason for admission: heart failure), the duration of EDT ranged from 24–47 days. EDT reduced symptomatic VTE or VTE-related death compared with standard of care (0.8% versus 1.2%; risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.44–0.83; p = 0.002). EDT increased risk of ISTH major or fatal bleeding (0.6% versus 0.3%; RR: 2.04, 95% CI: 1.42–2.91; p < 0.001) in both meta-analyses and trial sequential analyses. Pooled NNT to prevent one symptomatic VTE or VTE-related death was 250 (95% CI: 167–500), whereas NNH to cause one major or fatal bleeding event was 333 (95% CI: 200–1,000). Limitations of the study include variation in enrollment criteria, individual therapies, duration of EDT, and VTE detection protocols across included trials. Conclusions In this systematic review and meta-analysis of 5 randomized trials, we observed that use of a post-hospital discharge EDT strategy for a 4-to-6-week period reduced symptomatic or fatal VTE events at the expense of increased risk of major or fatal bleeding. Further investigations are still required to define the risks and benefits in discrete medically ill cohorts, evaluate cost-effectiveness, and develop pathways for targeted implementation of this postdischarge EDT strategy. Trial registration PROSPERO CRD42018109151.
Brief Report: Smoking in Systemic Sclerosis: A Longitudinal European Scleroderma Trials and Research Group Study
Authors: Veronika K. Jaeger, Gabriele Valentini, Eric Hachulla, Franco Cozzi, Oliver Distler, Paolo Airó, Laszlo Czirják, Yannick Allanore, Elise Siegert, Edoardo Rosato, Marco Matucci‐Cerinic, Cristian Caimmi, Jörg Henes, Patricia E. Carreira, Vanessa Smith, Francesco del Galdo, Christopher P. Denton, Susanne Ullman, Ellen De Langhe, Valeria Riccieri, Juan J. Alegre‐Sancho, Simona Rednic, Ulf Müller‐Ladner, Ulrich A. Walker
Journal: Arthritis & Rheumatology (2018)

Objective Data on the role of tobacco exposure in systemic sclerosis ( SS c; scleroderma) severity and progression are scarce. We aimed to assess the effects of smoking on the evolution of pulmonary and skin manifestations, based on the European Scleroderma Trials and Research group database. Methods Adult SS c patients with data on smoking history and a 12–24‐month follow‐up visit were included. Associations of severity and progression of organ involvement with smoking history and the Comprehensive Smoking Index were assessed using multivariable regression analyses. Results A total of 3,319 patients were included (mean age 57 years, 85% female); 66% were never smokers, 23% were ex‐smokers, and 11% were current smokers. Current smokers had a lower percentage of antitopoisomerase autoantibodies than previous or never smokers (31% versus 40% and 45%, respectively). Never smokers had a higher baseline forced expiratory volume in 1 second/forced vital capacity ( FEV 1 / FVC ) ratio than previous and current smokers ( P &lt; 0.001). The FEV 1 / FVC ratio declined faster in current smokers than in never smokers ( P = 0.05) or ex‐smokers ( P = 0.01). The baseline modified Rodnan skin thickness score ( MRSS ) and the MRSS decline were comparable across smoking groups. Although heavy smoking (&gt;25 pack‐years) increased the odds of digital ulcers by almost 50%, there was no robust adverse association of smoking with digital ulcer development. Conclusion The known adverse effect of smoking on bronchial airways and alveoli is also observed in SS c patients; however, robust adverse effects of smoking on the progression of SS c‐specific pulmonary or cutaneous manifestations were not observed.
Tumour‐cell‐derived complement components C1r and C1s promote growth of cutaneous squamous cell carcinoma
Authors: P. Riihilä, K. Viiklepp, L. Nissinen, M. Farshchian, M. Kallajoki, A. Kivisaari, S. Meri, J. Peltonen, S. Peltonen, V.‐M. Kähäri
Journal: British Journal of Dermatology (2019)

The incidence of epidermal keratinocyte‐derived cutaneous squamous cell carcinoma (cSCC) is increasing worldwide. To study the role of the complement classical pathway components C1q, C1r and C1s in the progression of cSCC. The mRNA levels of C1Q subunits and C1R and C1S in cSCC cell lines, normal human epidermal keratinocytes, cSCC tumours in vivo and normal skin were analysed with quantitative real‐time polymerase chain reaction. The production of C1r and C1s was determined with Western blotting. The expression of C1r and C1s in tissue samples in vivo was analysed with immunohistochemistry and further investigated in human cSCC xenografts by knocking down C1r and C1s. Significantly elevated C1R and C1S mRNA levels and production of C1r and C1s were detected in cSCC cells, compared with normal human epidermal keratinocytes. The mRNA levels of C1R and C1S were markedly elevated in cSCC tumours in vivo compared with normal skin. Abundant expression of C1r and C1s by tumour cells was detected in invasive sporadic cSCCs and recessive dystrophic epidermolysis bullosa‐associated cSCCs, whereas the expression of C1r and C1s was lower in cSCC in situ, actinic keratosis and normal skin. Knockdown of C1r and C1s expression in cSCC cells inhibited activation of extracellular signal‐related kinase 1/2 and Akt, promoted apoptosis of cSCC cells and significantly suppressed growth and vascularization of human cSCC xenograft tumours in vivo. These results provide evidence for the role of tumour‐cell‐derived C1r and C1s in the progression of cSCC and identify them as biomarkers and putative therapeutic targets in cSCC. What's already known about this topic? The incidences of actinic keratosis, cutaneous squamous cell carcinoma (cSCC) in situ and invasive cSCC are increasing globally. Few specific biomarkers for progression of cSCC have been identified, and no biological markers are in clinical use to predict the aggressiveness of actinic keratosis, cSCC in situ and invasive cSCC. What does this study add? Our results provide novel evidence for the role of complement classical pathway components C1r and C1s in the progression of cSCC. What is the translational message? Our results identify complement classical pathway components C1r and C1s as biomarkers and putative therapeutic targets in cSCC.
Picture Quiz: A smoker's hand
Authors: Rameen Shakur, Ashraf Khan, Mohammed Atcha, Nikhil Hirani, Faheem Shakur
Journal: BMJ (2005)

A 64 year old man with a 40 pack year smoking history presented to an outpatient clinic after an acute asthma attack. He had no other relevant medical history. Upon general examination, however, doctors noted abnormalities on his right hand (see figure). He described a loss of sensation confined to this area that had lasted for 10 years. But, for the past couple of years, this area of his hand had become dry and itchy. The man was a painter-decorator. He said that he did not always wear gloves when decorating and that he used white spirit to remove paint. 1. Describe the abnormality seen in the picture. 2. What are the differential diagnoses? 3. What aspects of the patient's history are important? 1. There is an area of erythema (redness) running mid-way up the dorsal (back) surface of the middle finger of the right hand. 2. Differential diagnoses:
Picture quiz: Unilateral pleural effusion with history of asbestos exposure
Authors: Tauseef S Mehdi, Mike Apps
Journal: BMJ (2007)

A previously fit and healthy 67 year old man presented with a two week history of shortness of breath on exertion. He did not have pleuritic chest pain, cough with purulent sputum, or pyrexia. He had worked as a builder in the London docklands 40 years ago and said that he had been heavily exposed to asbestos. He had never smoked. Cardiovascular and abdominal examinations were normal. Expansion of the chest was less on the right side, the right middle to lower region was stony dull on percussion, and no breath sounds were heard in the corresponding area. Full blood count, liver function tests, and biochemistry were within normal parameters. His chest radiograph is shown in fig 1. Chest radiograph
Dealing with stress
Authors: Jason O'Neale Roach, Elspeth Guthrie
Journal: BMJ (2000)

Medical schools should teach us how to cope > “It is hopeless trying to keep up.” > > “I feel stupid.” > > “I felt so discouraged by failure that I considered changing course.” > > First year medical students, University of Edinburgh 1 Many recommendations have been made and implemented to counter the stresses of studying medicine since these students spoke out (see box). But medical schools should consider integrating training in coping skills as part of the medical curriculum, to make sure help reaches those most in need. ### The unique problems faced by medical students face (BMA 1992)RETURN TO TEXT
Canada needs more medical students
Authors: Alex Brooks
Journal: BMJ (2000)

The Canadian Medical Forum, an umbrella organisation which includes the major medical associations of Canada, has published a report stating that 400 more medical students should be admitted to universities each year. This follows a call from Hugh Scully, the president of the Canadian Medical Association (CMA), for 2000 undergraduate places by 2000 at the association's annual general meeting last August.

Canada's 16 medical schools accept 1577 students a year, …
Pub medic - Warning: Christmas can seriously damage your health
Authors: Stephanie Gapper
Journal: BMJ (2006)

Every year we're inundated with information about the inherent dangers of the festive season—and apparently with good reason. A study in the United States showed a mortality spike on Christmas and New Year's Day due to cardiac and respiratory conditions.1 Oddly, European figures don't show this, and a similar study in the United Kingdom (based in the north east) showed that we have a higher than average mortality on New Year's Day but not on Christmas Day.2 Bizarre as this discrepancy is, over the holiday period, binge drinking goes up, leading to more drink fuelled crimes and road traffic injuries and sparking fresh debates about heart disease, stroke, and liver disease.

We also eat too many mince pies and Yorkshire puddings, piling on the pounds; then we spend January frantically trying to lose them, wreaking havoc with our metabolism and perpetuating the general trend towards obesity. The endless round of present buying, social engagements and visits from the in-laws, not to mention “spouse saturation syndrome,”3 resulting from prolonged overexposure to your nearest and dearest, all lead to increased stress, fatigue, and depression. And that's just if you're healthy.



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Is there still a reason to celebrate?



A wide variety of chronic illnesses require careful management around the holiday season. Here are a few snippets with which to while away the hours (and presumably the pints) in the pub on Christmas Eve.

Around Christmas or any other party season, this gets a lot more difficult, partly because there's so much more food around to be tempted with, and, …
HIV cases have increased in the United Kingdom
Authors: Samena Chaudhry
Journal: BMJ (2001)

The number of newly diagnosed cases of HIV in the United Kingdom has reached an all time high, according to figures published by the Public Health Laboratory Service (PHLS). Figures show that there were 3435 new cases in 2000. This represents a 14% increase over the previous year's figures. The PHLS also said that about 10 000 people in the UK were infected with HIV, but had not been diagnosed. These figures were released a week before the 20th anniversary of the first …