tbuckley/cabot-search huggingface dataset:
Objective measures and the diagnosis of asthma
Authors: J. Britton, S. Lewis
Journal: BMJ (1998)

Diseases represent extremes of continuously distributed characteristics, and defining exactly where and why in that distribution normality ends and disease begins may be difficult. The use of objective markers can be helpful, but these often force us to change our concept of a disease to accommodate the new information they provide—such as the identification of subclinical disease or adverse prognostic factors in otherwise healthy people. These conceptual changes are part of the natural evolution of disease definition and are justified if, in the long run, patients benefit.

Asthma has always been a clinical diagnosis, recognised on the basis of a characteristic history of variable wheezing, cough, and breathlessness and supported by objective, though non-standardised, evidence of variations in airflow. Many attempts have been made to define this diagnosis. Since 19581 all have highlighted the fundamental abnormality of variable airflow obstruction, and some have also invoked concepts such as airway hyperresponsiveness2 or airway pathology.3 None has yet provided objective criteria for the component parts of this process, and there remains no standardised definition of the …
Primary care: opportunities and threats: Distributing primary care fairly
Authors: M. Pringle
Journal: BMJ (1997)

The new legislation based on Primary Care: The Future. Choice and Opportunity 1 offers flexibility in the methods used to provide primary care services in England and Wales. Providers perceive more threats than opportunities. Though no changes are without pain, the greatest threat may well be to general practitioners' complacent assumption that all will be well if they are left alone to continue as they are. This article argues that there are systematic problems with the current system of delivering primary care which may be addressed through new ways of designing and delivering services.

### “It ain't broke, so don't fix it”

There is a contention that primary care is doing just fine and there is no need to change it. In particular, there is no reason to destabilise it with innovations in service delivery, even those that have been evaluated. Such complacency runs counter to the reality of primary care experienced by patients and health service managers throughout Britain.

There are still practices which provide poor quality clinical care-such that general practitioners would not recommend them to patients who are moving. There are still practices that offer an inadequate range of services-no screening, prevention, family planning, and minor surgery-while the doctors pursue a strategy of high list size and high personal income. And there are practices where health service resources are wasted through high referral rates,2 poor prescribing,3 4 5 and inappropriate investigations6 or through inefficient catchment areas.7 8 Provided such practices comply with their conditions of service, the health service has neither the will nor the way to stop contracting with them.

And then there are the restrictions that prevent other practices from enhancing their quality of care-for example, the inability to move resources with patient care; the limitations on changing skill mix (such as replacing a retiring partner with a part …
Implantation of Insulin Infusion Devices
Authors: Robert A. Rizza, John E. Gerich
Journal: JAMA (1982)

During the past several years, there has been an accumulation of evidence indicating that portable insulin infusion devices have the potential to provide an approximation of normoglycemia in the compliant, insulin-dependent diabetic patient.<sup>1-5</sup>The greatest experience with these devices has been obtained using the subcutaneous route for insulin administration,<sup>1-3</sup>with considerably fewer patients having been given insulin by the peripheral venous<sup>4</sup>and intraperitoneal routes.<sup>5,6</sup>In addition to its effect on blood glucose concentrations, continuous subcutaneous insulin infusion has been reported to normalize or improve peripheral venous concentrations of other substrates (eg, free fatty acids, ketone bodies, and amino acids)<sup>7</sup>and hormones (glucagon and growth hormone) whose levels are often abnormal in patients treated conventionally.<sup>8,9</sup>Whether the flux of substrates and their disposition in specific tissues are comparably affected has not been established. Unfortunately, some serious adverse effects such as severe hypoglycemia<sup>10</sup>and ketoacidosis
Relationship Between Inflammation and Venous Thromboembolism as Studied by Microparticle Assessment in Plasma**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.
Authors: Désiré Collen, Marc F. Hoylaerts
Journal: Journal of the American College of Cardiology (2005)
Biosimilar Erythropoietin Alpha Is Effective As Originator Erythropoietin Alpha Plus Liposomial Iron and B12 and Folates in Patients with Refractory Anemia: A Retrospective Real-Life Approach
Authors: Giulio Giordano, Patrizia Mondello, Rosa Tambaro, Nicola Perrotta, Fabio D'amico, Giuseppe Berardi, Bruno Carabellese, Francesco Equitani
Journal: Blood (2014)
Abstract 46: Guidelines Changes and Improvement of Survival to Hospital Discharge After Out-of-Hospital Cardiac Arrest: A Meta-Analysis from the Literature
Authors: Simone Savastano, Catherine Klersy, Roberto Rordorf, Karen Langord, Vincenzo Vanni, Alessandro Vicentini, Barbara Petracci, Luca Ballerini, Enrico Chieffo, Luca Poggio, Laura Striuli, Maurizio Landolina, Luigi Oltrona Visconti, Peter J Schwartz
Journal: Circulation (2011)

Introduction. Every year 350.000 to 750.000 cases of cardiac arrest occur in the US and in Europe. Since 1974 seven editions of CPR-ECC guidelines have been published and many aspects have been changed. In particular more and more empahis has been given on CPR and the suggested compression to ventilation ratio has progressively been increased (5:1 before 2000, 15:2 from 2000 to 2005 and 30:2 after 2005). The aim of our study is to evaluate, based on a review of the literature, the impact of changes in guidelines on survival to hospital discharge after out of hospital cardiac arrest (OHCA). Material and methods. We searched PubMed for studies on “survival to hospital discharge after OHCA”. Mandatory inclusion criteria included the report of survival to hospital discharge in all patients regardless of presenting rhythm. All data were analyzed according to the year of inclusion: group 1 before 2000; group 2 between 2000 and 2005 and group 3 after 2005. Survival/mortality rates were computed for each group, together with their 95% binomial confidence interval (95%CI). In-hospital mortality rates were compared between groups by means of a group frequency weighted log linear model. Risk ratios (RR) and 95%CI were reported. Results. Among 558 studies retrieved, 45 met our inclusion criteria, with a total of 119,111 of OHCA patients evaluable (65,601 in group 1; 35,954 in group 2 and 17,556 in group 3). The mean call to response time was similar in the three groups: 7.9 ± 2.7 min,; 7.5 ± 2.3 min and 6.9 ± 2.0. min in group 1, 2 and 3, respectively. Survival to hospital discharge in the 3 groups was 6.2% (95%CI 6.0-6.4), 6.4% (95%CI 6.2-6.7) and 9.9% (95%CI 9.5-10.4), respectively (log linear model p&lt;0.001). Specifically a significant decrease in risk of hospital death was observed in group 3 vs group 2 (RR 0.69 (95%CI 0.95-0.97, p&lt;0.001), but not in group 2 vs group 1 (RR 1.00 (0.99-1.00, p=0.14). Conclusion. This quantitative review of the literature demonstrated that survival to hospital discharge after OHCA has significantly increased after 2005 guidelines changes. The cardio-centric revolution in CPR and in advanced care with more high quality CPR resulted in a 30% improvement in survival after OHCA.
Abstract 17968: Concomitant Atrial Fibrillation Surgery Does Not Increase the Risk for Mortality and Morbidity After Coronary Artery Bypass Grafting
Authors: Kazuaki Fukahara, Hiroaki Miyata, Noboru Motomura, Toshio Doi, Saori Nagura, Naoki Yoshimura, Shinichi Takamoto
Journal: Circulation (2011)

Introduction: As a result of the increasing age of patients requiring myocardial revascularization for ischemic heart disease, preexisting atrial fibrillation (AF) is increasing among the patients who undergo coronary artery bypass grafting (CABG). However the impact of concomitant AF surgery on the early outcomes in patients after CABG remains unknown. The aim of this study was to assess the influences of concomitant AF surgery on the risk for mortality and morbidity after CABG. Methods: By using the Japan Adult Cardiovascular Surgery Database (JACVSD), the outcomes of patients with preoperative AF who underwent CABG were analyzed and compared between patients who underwent concomitant AF surgery with CABG and isolated CABG without AF surgery. A logistic regression model was used to assess whether concomitant AF surgery increased risk in CABG cohort and propensity-matched analysis was also performed based on preoperative variables. Results: From January 2004 to December 2008, a total of 19,495 patients underwent first-time CABG and 905 (4.6%) patients of them had preoperative AF. Of these, 253 (28.0%) patients had a concomitant AF surgery (AF surgery group) and 652 patients underwent isolated CABG (isolated CABG group). Overall, operative mortality (2.0% in AF surgery group, 3.1% in isolated CABG group) and major morbidity (18.6% in AF surgery group, 20.9% in isolated CABG group) were similar, and concomitant AF surgery did not have a significantly higher risk of mortality (odds ratio =0.78, 95% confidence interval 0.22-2.73; p=0.70) or major morbidity (odds ratio =1.11, 95% confidence interval 0.67-1.82; p=0.69).The propensity score matching analysis identified each 144 patients in both groups and neither operative mortality (2.8% in AF surgery group, 2.1% in isolated CABG group, p=0.70) nor major morbidity (18.8% in AF surgery group, 19.4% in isolated CABG group, p=0.88) had significant deference. Conclusions: From the analysis of overall data of JACVSD, mortality and major morbidity were slightly higher in isolated CABG group and it supposed that AF correction surgery might be performed in lower risk patients. Even after propensity matching, concomitant AF surgery was performed safely without increasing the risk for mortality and morbidity.
Abstract 12391: The Extent of Myocardial Fibrosis Assessed With Cardiac Magnetic Resonance Correlates With Cardiac Troponin T Release in Patients With Nonischemic Heart Failure
Authors: Seiji Takashio, Megumi Yamamuro, Daisuke Utsunomiya, Tomoaki Uemura, Yasuhiro Izumiya, Sunao Kojima, Shinji Tayama, Koichi Kaikita, Seiji Hokimoto, Osamu Yasuda, Hisao Ogawa
Journal: Circulation (2013)
Abstract 3650: Angular ("Gothic") Aortic Arch after "Successful" Coarctation Repair Predisposes to Exercise-Induced and Resting Hypertension
Authors: Phalla Ou, David S Celermajer, Elie Mousseaux, Elisa Pedroni, Francis Brunelle, Pascal Vouhe, Daniel Sidi, Damien Bonnet
Journal: Circulation (2006)
Drug points: Intranasal chlorhexidine resulting in anaphylactic circulatory arrest
Authors: D G Chisholm, I Calder, D Peterson, M Powell
Journal: BMJ (1997)

was 12.6 weeks and at counselling 15.3 weeks.Three out of four further couples referred to the specialist centre had prenatal diagnosis (at 11, 11.3, and 17.3 weeks).No fetus was diagnosed as affected, but one pregnancy miscarried.One woman declined prenatal testing because of a poor obstetric history, and she later miscarried.Two out of 17 liveborn children had a sickle cell disorder.Overall, 1 in 10 affected pregnancies was detected prenatally and terminated.
Abstract 14311: Liver Stiffness Measurement Using Transient Elastography Provides a Noninvasive and Reliable Method to Assess Right-Sided Filling Pressure
Authors: Tatsunori Taniguchi, Yasushi Sakata, Tomohito Ohtani, Yasuharu Takeda, Isamu Mizote, Shozo Konishi, Yasuhiro Ichibori, Machiko Kanzaki, Issei Komuro
Journal: Circulation (2013)
Absence of Cardiac Toxicity of Zidovudine in Infants
Authors: Lewis W
Journal: New England Journal of Medicine (2001)

Background-Some evidence suggests that perinatal exposure to zidovudine may cause cardiac abnormalities in infants.We prospectively studied left ventricular structure and function in infants born to mothers infected with the human immunodeficiency virus (HIV) in order to determine whether there was evidence of zidovudine cardiac toxicity after perinatal exposure.Methods-We followed a group of infants born to HIV-infected women from birth to five years of age with echocardiographic studies every four to six months.Serial echocardiograms were obtained for 382 infants without HIV infection (36 with zidovudine exposure) and 58 HIVinfected infants (12 with zidovudine exposure).Repeated-measures analysis was used to examine four measures of left ventricular structure and function during the first 14 months of life in relation to zidovudine exposure.
Optimization of intrinsic and extrinsic tendon healing through controllable water-soluble mitomycin-C release from electrospun fibers by mediating adhesion-related gene expression
Authors: Xin Zhao, Shichao Jiang, Shen Liu, Shuai Chen, Zhi Yuan (William) Lin, Guoqing Pan, Fan He, Fengfeng Li, Cunyi Fan, Wenguo Cui
Journal: Biomaterials (2015)
Sources of conflict in the medical marriage
Authors: G O Gabbard, R W Menninger, L Coyne
Journal: American Journal of Psychiatry (1987)

The authors surveyed a sample of 134 physicians and 125 physicians' spouses regarding marital satisfaction, sources of marital conflict, and complaints about their spouses. Contrary to conventional wisdom, the number of hours at work did not relate to the degree of marital satisfaction. The chief sources of conflict in the medical marriage appear to revolve around differences in the partners' needs for intimacy, perceptions of the problems in the marital relationship and in each other, and communication styles. Lack of time due to the demands of practice seems to be a complaint that serves the function of externalizing the conflicts in the marriage onto factors outside the marriage.
Psychiatric consultation: concepts and controversies
Authors: Z J Lipowski
Journal: American Journal of Psychiatry (1977)

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.
Abstract 2969: Altered Intestinal Barrier Function and Immune Activation in Patients with Chronic Heart Failure Compared to Controls
Authors: Anja Sandek, Juergen Bauditz, Sabine Buhner, Wieland Schroedl, Alexander Swidsinski, Jutta Weber-Eibel, Tim Karhausen, Wolfram Doehner, Mathias Rauchhaus, Hans-Dieter Volk, Stephan von Haehling, Herbert Lochs, Stefan D Anker
Journal: Circulation (2006)
The 20210A Allele of the Prothrombin Gene Is an Independent Risk Factor for Perception Deafness in Patients With Venous Thromboembolic Antecedents
Authors: Eric Mercier, Isabelle Quere, René Chabert, Jean-Gabriel Lallemant, Jean-Pierre Daures, Jacques Berlan, Jean-Christophe Gris
Journal: Blood (1999)
Nutritional Deficiency and Anemia in Latin America: A Collaborative Study
Authors: J. D. COOK, J. ALVARADO, A. GUTNISKY, M. JAMRA, J. LABARDINI, M. LAYRISSE, J. LINARES, A. LORíA, V. MASPES, A. RESTREPO, C. REYNAFARJE, L. SÁNCHEZ-MEDAL, H. VÉLEZ, F. VITERI
Journal: Blood (1971)
Experimentally Induced Alterations in Affinity of Hemoglobin for Oxygen. II. In Vivo Effect of Inosine, Pyruvate, and Phosphate on Oxygen-Hemoglobin Affinity in Rhesus Monkey
Authors: Harvey J. Sugerman, Thomas W. Pollock, Ernest F. Rosato, Maria Delivoria-Papadopoulos, Leonard D. Miller, Frank A. Oski
Journal: Blood (1972)
Assessing the impact of the 2009 H1N1 influenza pandemic on reporting of other threats through the Early Warning and Response System
Authors: A Cox, P Guglielmetti, D Coulombier
Journal: Eurosurveillance (2009)

Since the start of 2009 H1N1 influenza pandemic, a notable surge in messages communicated through the Early Warning and Response System (EWRS) for the prevention and control of communicable diseases in the European Union has been recorded. In order to measure the impact of this increase on the reporting of other events, we compared the messages posted in the EWRS since April 2009 with those posted in the previous years (2004-2008). The analysis revealed that a ten-fold increase in messages was recorded during the pandemic period, from April to September 2009, and that the reporting of other threats dropped to a significantly low rate. These results suggest an important impact on the notification process of events in case of a situation requiring extensive mobilisation of public health resources. It emphasises the importance keeping an appropriate balancing of resources during sustained emergencies, in particular in view of a possible second wave of pandemic influenza cases, to ensure prompt detection and reporting of potential concomitant emerging threats.
Soundings: A secret revealed
Authors: Liam Farrell
Journal: BMJ (2003)

Two months ago I went to France for the European rugby semi-final between Munster and Toulouse. As francophile as Belloc (every civilised man has two native countries, his own and France), I wanted to look like a local, so I wore a pair of stylish shorts.

At half time, like the other 40 000 in attendance, I had to visit the bathroom, and it was there that I had a most revealing and refreshing experience. As we stood shoulder to shoulder in the men's urinal, rejoicing in the sensual delights of what Thomas More described in Utopia as one of life's great pleasures, I began to feel little droplets tinkling pitter-patter, like the tap-dancing feet of Astaire, on my bare legs.

I should emphasise that, unsanitary as this may seem, of itself it was not an unpleasant nor disturbing experience, like having a controversial obituary written about me in the BMJ. The droplets, no doubt influenced by the vast amounts of beer and wine consumed, were softened and diluted, like a renaissance fountain in an Italian piazza on a hot and humid day or like the caress of gentle rain on naked and hungover skin on a soft Irish morning in spring. The sunlight created whimsical little rainbows in the mist, and despite a few shoves from behind and many playful cries of “vite, vite,” a congenial ambience of masculine bonhomie and good fellowship thrived.

But I have been brooding, and what once seemed innocent has since opened a Pandora's box of doubt and excessive personal daintiness. There is a bigger, less romantic picture; obviously this is happening all the time. It is happening to each one of us, but we don't notice it because we are wearing trousers, and it is our unfortunate trousers that bear the brunt of other people's enthusiasm and exuberance and inaccuracy.

The experience has significantly modified my behaviour. I'd always had an insouciant attitude to other people's body fluids, and been quite comfortable with my body, outgoing and chatty even in those most intimate moments as the sphincters open, whereas now I am reserved and taciturn and require large amounts of space and privacy before voiding.

I am particularly circumspect of those in the company with a vigorous stream. Can you identify the streamer in your group? He could be sitting next to you right now.
Abstract 16996: Red Cell Distribution Width and C-Reactive Protein in Predicting Mortality in Patients with Coronary Disease and in a Normal Comparison Population
Authors: Jason M Lappe, Benjamin D Horne, Svati H Shah, Heidi T May, Joseph B Muhlestein, Donald L Lappe, Abdallah G Kfoury, John F Carlquist, Deborah Budge, Rami Alharethi, Tami L Bair, William E Kraus, Jeffrey L Anderson
Journal: Circulation (2010)

Background: The red cell distribution width (RDW) is associated with increased morbidity and mortality in patients with coronary artery disease (CAD) and heart failure. Early evidence linking an el...
Abstract 023: The Effect of Dietary Protein on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials
Authors: Casey M Rebholz, Eleanor E Friedman, Lindsey J Powers, Whitney D Arroyave, Jiang He, Tanika N Kelly
Journal: Circulation (2012)

Lifestyle modifications such as weight loss, increasing physical activity, and reducing alcohol consumption and salt intake have been consistently shown to decrease blood pressure. Less well understood is whether increased dietary protein intake may also reduce blood pressure and the risk of hypertension. We conducted a meta-analysis of randomized controlled trials to assess the hypothesis that increased dietary protein intake decreases systolic and diastolic blood pressure in adults. MEDLINE, EMBASE, Cochrane Library, Web of Science, a registry of soy research trials, bibliography review, and expert consultation were the sources of English and non-English articles published before April 2011. Search terms included randomized controlled trial, blood pressure, dietary proteins, dietary supplements, casein, soy, and meat. Forty randomized controlled trials including 3,277 participants in which amount or source of protein was the only difference between the intervention and comparison groups and that examined blood pressure were included. Using a standardized protocol and data extraction form, two investigators independently abstracted data on study design, participant characteristics, intervention, and treatment outcomes. Net effects of protein on blood pressure were pooled across trials and weighted by the inverse of the variance using random-effects models. Compared to carbohydrate, dietary protein was associated with significant decreases in mean systolic and diastolic blood pressure (95% confidence intervals) of -1.75 (-2.31, -1.19) and -1.16 (-1.60, -0.72) mmHg, respectively (all P&lt;0.001). Blood pressure lowering effects of both vegetable and animal sources of protein were observed with significant decreases of -2.22 (-3.18, -1.26) and -2.54 (-3.55, -1.53) mmHg for systolic blood pressure, respectively (all P&lt;0.001), and -1.25 (-2.12, -0.39) and -0.95 (-1.72, -0.19) mmHg for diastolic blood pressure, respectively (P=0.005 and 0.01, respectively). Blood pressure reduction was not significantly different when vegetable protein was compared directly to animal protein. In conclusion, dietary protein intake reduces systolic and diastolic blood pressure in adults. Replacement of carbohydrate intake with protein intake, from either vegetable or animal sources, could be an important strategy for helping to curb the growing pandemic of hypertension and related cardiovascular disease morbidity and mortality. Future research is indicated to assess potential differential effects of protein on blood pressure according to hypertension status.
Abstract 2638: Intracoronary Beta Blockade (BB) During Percutaneous Coronary Intervention (PCI): 30 Day Results of the Randomized Angioplasty Beta Blocker Intracoronary Trial II (RABBIT II)
Authors: Barry F Uretsky, Ernst R Schwarz, Abdulfatah Osman, Adnan Afzal, Angelo Anzuini, Charles Y Lui, Eli-Israel Lev, Rajiv Gupta, Todd McGehee, Fen Wei Wang
Journal: Circulation (2006)