tbuckley/cabot-search huggingface dataset:
Leading by example
Authors: Daniel M Henderson
Journal: BMJ (2009)

“You understand that you probably shouldn’t drink as much as you do at the moment Mr Smith. The maximum amount is 21 units a week.” On a recent placement I was faced with this situation—one many medical students may have encountered. Possibly not the finest example of motivational speaking, however, I was going to follow with the usual blurb about liver damage and units and blah blah blah. No wonder patients don’t act on this advice; they probably barely listen to it all anyway. …
Online experiment to study the psychology of humour
Authors: Samantha Chan
Journal: BMJ (2001)

Scientists have set up an online experiment where jokes will be submitted and then rated on a “Laughometer” in a bid to take a serious look at the psychology of humour. Anyone can participate by logging on to the project's website www.laughlab.co.uk to submit favourite jokes or rate the ones that are already in the lab's archives. If all goes according to plan, Laugh Lab …
Medical students develop software for pioneering electronic patient records
Authors: Clare Hughes
Journal: BMJ (2003)

Two London medical students have designed a computer system allowing patients to access their electronic medical records at the scan of a fingerprint.

The Patient Access Electronic Record System (PAERS), which recognises patients using a fingerprint and identification number, is now available to patients at Wells Park Surgery in Sydenham, south east London.

Patients can also avoid queuing at reception to book in for …
Rammya Mathew: GPs are doing too much
Authors: Rammya Mathew
Journal: BMJ (2019)

GPs in the UK are well known for providing a comprehensive service.But the demands just keep growing.Much of the additional work making its way into general practice is in the guise of "new models of care," driven by an ambition to provide "care closer to home."But, if we consider the current landscape in general practice-workforce shortages and high rates of burnout-policy makers might be accused of a little wishful thinking.
A guide to medical etiquette: coping with loss
Authors: David McAllister
Journal: BMJ (2000)

It doesn't take long to forget the basic medical knowledge you learn. Time during an intercalated degree is long enough. So too are summer holidays, special study module blocks, or time spent in medical specialties. Knowledge and understanding you once possessed seem to have left you without a trace when you are confronted with a patient or a question from a clinician. In this article I will attempt to show you ways to minimise the problem. First of …
Making do in Nigeria
Authors: David Ejibe
Journal: BMJ (2008)

Practising clinical medicine comes with its challenges, especially in settings of limited resources and infrastructure, excessive working hours, and relatively low income. On encountering some of these as an intern in a Nigerian teaching hospital, I wondered how much I could take.

A study in JAMA found that 24 hours without sleep results in psychomotor impairment similar to someone with a blood alcohol concentration over the legal driving limit (2005;29:1104-6). Imagine what that implies for someone who has been at it for a whole month. When I started as a house officer in surgery, I worked in the paediatric surgery unit for a month, which meant that I was on call everyday for a month not having a regular place to sleep. Efficiency is not easy in such conditions. I remember dozing off on one occasion while taking a history from a patient.

Where most facilities are lacking, improvisation becomes the norm to get the job done. Don't worry if you don't find a tourniquet, a drip set will do just fine. If you can't find an inhaler spacer device, look for a cut plastic bottle or if you can't find a gastrostomy tube, a Foley's catheter might just help you out. …
Early brain screening may predict schizophrenia
Authors: Tracey Maher
Journal: BMJ (2000)

Screening for early brain changes may predict schizophrenia, scientists have claimed. A new brain imaging study published in the American Journal of Psychiatry (2000;157(111);1829-34) shows that there are substantial brain changes in schizophrenia at the earliest stages of the illness, implying that these changes pre- cede the appearance of psychotic symptoms.



PET scans also show changes in the schizophrenic human brain (DR MONTY BUSCHBAUM, PETER ARNOLD INC/ SCIENCE PHOTO LIBRARY)



The findings from the Institute of Psychiatry indicate that brain …
Prescription patterns of anti‐diabetic medications and clinical outcomes in Asian patients with heart failure and diabetes mellitus
Authors: Yvonne M.F. Chia, Tiew‐Hwa K. Teng, Wan T. Tay, Inder Anand, Michael R. MacDonald, Jonathan Yap, Chanchal Chandramouli, A. Mark Richards, Jasper Tromp, Wouter Ouwerkerk, Lieng H. Ling, Carolyn S.P. Lam
Journal: European Journal of Heart Failure (2019)
Mosul suicide bomber was a medical student
Authors: Kunal Khanna
Journal: BMJ (2005)

The suicide bomber who blew up a mess hall in Mosul was a medical student. Ahmed Said Ahmed al-Ghamdi, aged 20, was identified by the Saudi owned newspaper Asharq—Al-Awsat. He launched the deadly attack in a US mess hall in Mosul, northern Iraq, on 21 December 2004.

As well as blowing himself up, he killed 22 US soldiers, who were eating their lunch, at noon in what …
Multi-arm, multi-stage randomised controlled trials for evaluating therapeutic HIV cure interventions
Authors: Cecilia L Moore, Wolfgang Stöhr, Angela M Crook, Laura Richert, Jean-Daniel Leliévre, Giuseppe Pantaleo, Felipe García, Stefano Vella, Yves Lévy, Rodolphe Thiébaut, Sheena McCormack
Journal: The Lancet HIV (2019)
Risk of Malignancy According to the Sub-classification of Atypia of Undetermined Significance and Suspicious Follicular Neoplasm Categories in Thyroid Core Needle Biopsies
Authors: Sae Rom Chung, Jung Hwan Baek, Jeong Hyun Lee, Yu-Mi Lee, Tae-Yon Sung, Ki-Wook Chung, Suck Joon Hong, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Won Bae Kim, Won Gu Kim, Dong Eun Song
Journal: Endocrine Pathology (2019)
Bedside Stories: Confessons of a Junior Doctor
Authors: Syed M A Sohaib
Journal: BMJ (2004)

Every junior doctor has his or her own collection of hilarious, dark, and tragic anecdotes, and every doctor despairs about ward politics, working hours, and other stresses of the NHS. Under his pseudonym, Michael Foxton has entertained and enlightened with his take on this in his column in the Guardian , which charted his first three or so years as a junior doctor. This has now been brought together in Bedside Stories: Confessions of a Junior Doctor .

The book begins with Foxton's first day as a medical house officer …
Abstract 16098: Aortomitral Calcification Volume Predicts Mortality in Transcatheter Aortic Valve Replacement
Authors: Martin J Willemink, Eva Maret, Kegan J Moneghetti, Juyong B Kim, Yukari Kobayashi, Francois Haddad, Alan C Yeung, Anson M Lee, D. Craig Miller, Michael P Fischbein, William F Fearon, Dominik Fleischmann
Journal: Circulation (2017)

Introduction: Aortic valve calcification (AVC) - a known predictor of mortality in patients with aortic stenosis (AS) - is yet one manifestation of left sided valvular and annular calcification, which has been associated with systemic atherosclerosis, inflammation and cardiovascular events. Hypothesis: We hypothesize that the volume of aortomitral calcifications (AMC) as quantified by CT rather than echocardiographic aortic valve area (AVA) and mean aortic valve pressure gradient (AVG) predicts mortality in patients undergoing TAVR. Methods: 154 consecutive patients undergoing TAVR were included. All patients underwent pre-procedural echocardiography and a CT angiography. AMC volume was quantified on non-contrast thin section CT images using commercially available software. Patients were followed for all-cause mortality. Baseline characteristics were evaluated with Mann-Whitney U and Chi square tests. A multivariable prediction model was derived using Cox proportional hazards (PH) regression analysis. Res...
Addressing Medication Costs During Primary Care Visits: A Before–After Study of Team-Based Training
Authors: Jennifer K. Carroll, Subrina Farah, Robert J. Fortuna, Angela M. Lanigan, Mechelle Sanders, Jineane V. Venci, Kevin Fiscella
Journal: Annals of Internal Medicine (2019)

Background: Medications contribute to patients' out-of-pocket costs, yet most clinicians do not routinely screen for patients' cost-of-medication (COM) concerns. Objective: To assess whether a single training session improves COM conversations. Design: Before–after cross-sectional surveys of patients and qualitative interviews with clinicians and staff. Setting: 7 primary care practices in 3 U.S. states. Participants: In total, 700 patients were surveyed from May 2017 to January 2018: 50 patients per practice before the intervention and another 50 patients per practice after the intervention. Eligibility criteria included age 18 years or older and taking 1 or more long-term medications. Qualitative interviews with 45 staff members were conducted. Intervention: A single 60-minute training session for clinicians and staff from each practice on COM importance, team-based screening, and cost-saving strategies. Measurements: Patient data (demographics, number of long-term medications, total monthly out-of-pocket medication costs, and history of cost-related medication nonadherence) were obtained immediately before and 3 months after the intervention. Practice staff were interviewed 3 months after the intervention. Results: A total of 700 patient surveys were completed. Frequency of COM discussion improved in 6 of the 7 practices and remained unchanged in 1 practice. Overall, COM conversations with patients increased from 17% at baseline to 32% postintervention (P = 0.00). There was substantial heterogeneity among sites in before–after differences in patient-reported out-of-pocket COM. Qualitative analyses from key informant interviews showed wide variation in implementation of screening approaches, workflow, adoption of a team-based approach, and strategies for addressing COM. Limitation: It is not known whether improvements in COM conversations were sustained beyond 3 months. Conclusion: A single team training to screen and address patients' medication cost concerns improved COM discussions over the short term. Further research is needed to assess sustained effects and impact on patient costs and medication adherence and to determine whether more intensive, scalable interventions are needed. Primary Funding Source: Robert Wood Johnson Foundation.
Cases in Precision Medicine: When Patients Present With Direct-to-Consumer Genetic Test Results
Authors: Michael G. Artin, Deborah Stiles, Krzysztof Kiryluk, Wendy K. Chung
Journal: Annals of Internal Medicine (2019)

A couple is planning to start a family, and they decide to order a 23andMe test after reading about the company's carrier screening test and the new BRCA1/BRCA2 test. They bring the results to their internist for advice on how to proceed. Given the rise in public interest in human genetics and precision medicine, direct-to-consumer genetic testing is becoming increasingly popular, and clinicians should expect patients to present the results of these tests more frequently. This article uses a case scenario to provide information about what the results of these tests mean, and what they do not mean.
Soundings: Miss Medicine
Authors: Debashis Singh
Journal: BMJ (2000)

It was as though I had woken to find myself face to face with an award winningly ugly person and had no recollection of how I got there. That is exactly how I would describe the heart stopping feeling of realising that the days as a medical student are numbered. Where has all the time gone?

I suppose it all came about when the year got letters requesting people to conduct medical school interviews. I remember thinking how together the fifth year medical …
Glasgow coma scale explained
Authors: Rhea Mehta, Krishna Chinthapalli
Journal: BMJ (2019)

The Glasgow coma scale (GCS) is a tool used to assess and calculate a patient’s level of consciousness. It was developed more than 40 years ago by two neurosurgeons in Glasgow and is widely applied today.1 The GCS uses a triple criteria scoring system: best eye opening (maximum 4 points), best verbal response (maximum 5 points), and best motor response (maximum 6 points). These scores are added together to provide a total score between 3 and 15 (fig 1).



Fig 1 
Glasgow coma scale. Score the best level of response seen for each component. Adapted from Teasdale G. Forty years on: updating the Glasgow Coma Scale. Nursing Times 2014;110:42;12-16



The GCS was initially used to assess level of consciousness in patients after head injury, but the scale is now used in many acutely unwell patients. In hospitals it is also used to monitor patients in intensive care units. During placements you may hear the GCS used to describe confused patients on care of the elderly wards, trauma patients in the emergency department, or patients seen by the “crash” medical emergency team. As a student, you might be asked to calculate the GCS score as part of the general or neurological examination of a patient, especially if the patient is confused, drowsy, or unresponsive.

As you gain experience in calculating a GCS score in practice, you will become more confident and the score will become more accurate. Assessment of a GCS score can be deemed subjective, so it is best practice that two independent clinicians calculate a GCS score to mitigate subjective bias.

Clinically, the GCS may help streamline trauma services through major trauma bypass protocols. In parts of the United Kingdom patients with a GCS score of 13 or less can be transported directly by ambulance to specialist major …
Elevation of plasma tRNA fragments precedes seizures in human epilepsy
Authors: Marion C. Hogg, Rana Raoof, Hany El Naggar, Naser Monsefi, Norman Delanty, Donncha F. O’Brien, Sebastian Bauer, Felix Rosenow, David C. Henshall, Jochen H.M. Prehn
Journal: Journal of Clinical Investigation (2019)

Transfer RNAs (tRNAs) are a major class of noncoding RNA. Stress-induced cleavage of tRNA is highly conserved and results in tRNA fragments. Here we find specific tRNA fragments in plasma are associated with epilepsy. Small RNA sequencing of plasma samples collected during video-EEG monitoring of focal epilepsy patients identified significant differences in three tRNA fragments (5', 5'AlaTGC, and 5'GluCTC) from controls. Levels of these tRNA fragments were higher in pre-seizure than post-seizure samples, suggesting they may serve as biomarkers of seizure risk in epilepsy patients. In vitro studies confirmed that production and extracellular release of tRNA fragments was lower after epileptiform-like activity in hippocampal neurons. We designed PCR-based assays to quantify tRNA fragments in a cohort of pre- and post-seizure plasma samples from focal epilepsy patients and healthy controls (n = 32/group). Receiver operating characteristic analysis indicated that tRNA fragments potently distinguished pre- from post-seizure patients (area under the curve of 0.8-0.95). Elevated tRNA fragments levels were not detected in patients with psychogenic non-epileptic seizures, and did not result from medication tapering. This study identifies a novel class of epilepsy biomarker and reveals the potential existence of prodromal molecular patterns in blood that could be used to predict seizure risk.
Endoscopic ultrasound-guided radiofrequency ablation for management of gastric gastrointestinal stromal tumor
Authors: Sergio Bazaga Pérez de Rozas, Mario Alberto Gallardo Ramírez, Francisco Javier García-Alonso, Ana Yaiza Carbajo, Manuel Pérez-Miranda Castillo, Carlos de la Serna Higuera
Journal: Endoscopy (2019)

A 56-year-old man presented with abdominal pain and dyspepsia. On upper digestive endoscopy, a submucosal lesion was found in the distal gastric lesser curvature, but no conclusive diagnosis could be achieved with conventional biopsies. Endoscopic ultrasound (EUS) showed a 12 × 7 mm well-defined, homogeneous, hypoechoic nodule without signs of infiltration into the muscularis propria, suggestive of benign gastrointestinal stromal tumor (GIST) ([Fig. 1]). Fine-needle aspiration with a 22-gauge needle (Expect; Boston Scientific, Marlborough, Massachusetts, USA) was performed, confirming a low risk GIST. Histopathological examination revealed a GIST presenting less than 5 mitoses per high-power field.
Correction to: Sarecycline: First Global Approval
Authors: Emma D. Deeks
Journal: Drugs (2019)

The article Sarecycline: First Global Approval, written by Emma D. Deeks, was originally published Online First without open access. After publication in volume 79, issue 3, pages 325–329 Almirall, LLC., requested that the article be Open Choice to make the article an open access publication. Post-publication open access was funded by Almirall, LLC.
Living with a stoma
Authors: Russell Goodall
Journal: BMJ (2004)

Astoma is just where the ileum is brought out through an opening in the right iliac fossa and attached to the skin,1 right? Wrong. For many patients, a stoma is life changing but for all the wrong reasons.

Medical textbooks tell us that “problems associated with ileostomies include mechanical problems, dehydration, psychosexual problems, infertility in men, and recurrence of Crohn's disease.”1 So do you know what it's like to have a stoma yet? Does this allow us to really be in a position to offer empathy?

In fact, …
Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack
Authors: M. Julia Machline-Carrion, Eliana Vieira Santucci, Lucas Petri Damiani, M. Cecilia Bahit, Germán Málaga, Octávio Marques Pontes-Neto, Sheila Cristina Ouriques Martins, Viviane Flumignan Zétola, Karina Normilio-Silva, Gabriel Rodrigues de Freitas, Alessandra Gorgulho, Antônio De Salles, Beatriz Gonzales Pacheco da Silva, Juliana Yamashita Santos, Isabella de Andrade Jesuíno, Priscila Regina Torres Bueno, Alexandre Biasi Cavalcanti, Hélio Penna Guimarães, Ying Xian, Janet Prvu Bettger, Renato D. Lopes, Eric D. Peterson, Otávio Berwanger
Journal: JAMA Neurology (2019)

Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries.To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA.This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle.The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster.The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale).A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01).A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies.ClinicalTrials.gov identifier: NCT02223273.
Cumulative Psychosocial Stress and Ideal Cardiovascular Health in Older Women
Authors: Melissa S. Burroughs Peña, Rachel S. Mbassa, Natalie B. Slopen, David R. Williams, Julie E. Buring, Michelle A. Albert
Journal: Circulation (2019)

Background: Research implicates acute and chronic stressors in racial/ethnic health disparities, but the joint impact of multiple stressors on racial/ethnic disparities in cardiovascular health is unknown. Methods: In 25 062 women (24 053 white; 256 Hispanic; 440 black; 313 Asian) articipating in the Women’s Health Study follow-up cohort, we examined the relationship between cumulative psychosocial stress (CPS) and ideal cardiovascular health (ICH), as defined by the American Heart Association’s 2020 strategic Impact Goals. This health metric includes smoking, body mass index, physical activity, diet, blood pressure, total cholesterol, and glucose, with higher levels indicating more ICH and less cardiovascular risk (score range, 0–7). We created a CPS score that summarized acute stressors (eg, negative life events) and chronic stressors (eg, work, work-family spillover, financial, discrimination, relationship, and neighborhood) and traumatic life event stress reported on a stress questionnaire administered in 2012 to 2013 (score range, 16–385, with higher scores indicating higher levels of stress). Results: White women had the lowest mean CPS scores (white: 161.7±50.4; Hispanic: 171.2±51.7; black: 172.5±54.9; Asian: 170.8±50.6; P overall &lt;0.01). Mean CPS scores remained higher in Hispanic, black, and Asian women than in white women after adjustment for age, socioeconomic status (income and education), and psychological status (depression and anxiety) ( P &lt;0.01 for each). Mean ICH scores varied by race/ethnicity ( P &lt;0.01) and were significantly lower in black women and higher in Asian women compared with white women (β-coefficient [95% CI]: Hispanics, −0.02 [−0.13 to −0.09]; blacks, −0.34 [−0.43 to −0.25]; Asians, 0.34 [0.24 to 0.45]); control for socioeconomic status and CPS did not change these results. Interactions between CPS and race/ethnicity in ICH models were not significant. Conclusions: Both CPS and ICH varied by race/ethnicity. ICH remained worse in blacks and better in Asians compared with whites, despite taking into account socioeconomic factors and CPS.
The National Medical Dictionary
Journal: JAMA (1890)

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