tbuckley/cabot-search huggingface dataset:
New NICE guidance on referral for cancer
Authors: Kevin Barraclough
Journal: BMJ (2015)

Monumental, evidence based, but not “less is more”

It is difficult to recall the 1990s, when patients in the United Kingdom with suspected cancer sometimes waited months for investigation. In 2000 the Department of Health introduced guidelines for referral, structured pathways, and a waiting time target of two weeks for patients with suspected cancer. Fifteen years later guidelines published by the National Institute for Health and Care Excellence (NICE) represent an enormous overhaul, which reflect monumental scholarship and are unique in the world.1 2 3 This latest guidance differs greatly from its forebears in methodology, form, tone, and content.

The authors have painstakingly trawled the literature to pin down the positive predictive values of many of the presenting features of cancer. Adults with clinical features that are associated with a positive predictive value of 3% or more for cancer (less for children) should be referred urgently for investigation.

The wording is less prescriptive than in previous guidance. Many patients with cancer do not fit the classical referral criteria but still need easily accessible investigation—currently only about half of cancers are diagnosed via the suspected cancer pathway.4 The authors distinguish between advice supported by evidence and …
Abstract 12159: Titrating Management for Typically Older Patients With Chronic Heart Failure Management Using a Holistic, Traffic-Light Tool: The Which Heart Failure Intervention is Most Cost-Effective in Reducing Hospital Stay (WHICH?) II Trial
Authors: Simon Stewart, Melinda Carrington, Tracey Gerber, Yih Kai Chan, Florentia Socratous
Journal: Circulation (2014)

Background:  The worldwide burden of chronic heart failure (CHF) continues to rise. In Australia there are >40,000 primary hospitalizations (>300,000 days) and 47,000 secondary hospitalizations (~ 700,000 days), 51% of which involve typically older women.   Methods:  To explore the potential value of titrating nurse-led CHF management relative to individual need (compared to a “one-size fits all” strategy) we initiated the multicentre WHICH? II Trial (target >1000 subjects). Using a validated tool, the Green Amber Red Delineation of Individual of risk And Need (GARDIAN), we assess 3 domains (holistic profile, management relative to gold-standard and clinical stability) to determine risk of premature mortality and recurrent hospitalization within 12 months.   Results:  Of 202 initially randomized subjects (mean age 70±11 years), 64 (36%) are female, 29 (14%) live in a regional setting and 56 (28%) have preserved ejection fraction. Based on GARDIAN profiling, 71% are very high risk (red), 19% medium risk and 10% are low risk subjects. Common markers of high risk status at index hospitalization are aged >75 years (59%); sex-specific anemia (42%); cognitive impairment ± self-care issues (37%); English as a second language ± moderate to severe renal dysfunction (34%); acute pulmonary edema on presentation (32%); extended hospital stay (30%); and intensive care stay (20%). Post-discharge, 30% have overt clinical instability and 28% elevated BNP (> 600pg/mL) within 7-14 days. Within the trial intervention group, subjects designated as high risk are subject to incremental home visits and more structured telephone support relative to low risk cases. As a broadly representative cohort of individuals with CHF, these data suggest that ~25,000 high risk patients with CHF are discharged from an Australian hospital each year; often with residual social, management and clinical issues that may respond to more intensive and individualized follow-up.   Conclusions:  These data reinforce the potential to alter the intensity of nurse-led, multidisciplinary management to cost-effectively improve outcomes in a sub-set of CHF cases at very high risk of poor health outcomes. Any positive results from the trial will be immediately applicable to whe wider CHF patient population.
Abstract 8634: Serial Changes of Neointimal Coverage Conditions and Characteristics are different between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Implantation: Follow-Up Optical Coherence Tomography Study
Authors: Daisuke Nakamura, Masami Nishino, Yasuharu Lee, Takahiro Yoshimura, Masayuki Taniike, Nobuhiko Makino, Hiroyasu Kato, Yasuyuki Egami, Ryu Shutta, Jun Tanouchi, Yoshio Yamada
Journal: Circulation (2011)

Background: The long-term detailed changes of neointima coverage and characteristics in Sirolimus-eluting stent(SES) and Paclitaxel-eluting stent(PES) remains to be clarified. Methods: Of 18 SES (14 patients) and 13 PES (12 patients), OCT was used to visualize 2486 and 1361 stent-struts at 8 months after implantation 2199 and 1309 stent-struts at 20 months after respectively. The OCT parameters, including incidence of uncovered struts and malapposed struts and neiointimal hyperplasia thickness (NIH thickness) and NIH% were compared between SES and PES and between 8 months after and 20 months after for SES and PES.,The neointimal charecteristics were classified into 3 groups:high without PLIA(high density neointima without peri-strut low-intensity area(PLIA),high with PLIA and non-high .PLIA was defined as a region around stent struts with a homogeneous,lower intensity appearance Results: Uncovered ratio and malapposed ratio was significantly higher in SES than in PES both at both follow-up. NIH thickness and %NIH was higher in PES than in SES at both follow-up. Uncovered ratio significantly decreased in SES from 8months to 20months after, and in PES nonsiginificantly decreased . Malapposed ratio nonsignificantly decreased in both groups. NIH% and NIH thickness significantly increased in SES ,but NIH% and NIH thickness significantly decreased in PES from 8months after to 20months after. High signal neointima accounts for more than 90% in both groups.However it decreased in SES ,while increased in PES. High with PLIA nonsignificantly increased in SES ,but decreased in PES. Non-high signal neointima decreased both in SES and in PES.(Table) Conclusions: Uncovered struts and malapposed struts gradually alleviated in both SES and PES while neointimal hyperplasia condition and characteristics showed different patters; increasing in SES but decreasing in PES.
Abstract 16161: Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: Good for Any Age?
Authors: Jacob C Townsend, Eric R Powers, William H Spencer, Daniel H Steinberg, Chetan A Patel, Robert A Leonardi, Valerian Fernandes, Christopher D Nielsen
Journal: Circulation (2011)

Introduction:  Alcohol septal ablation (ASA) is an accepted non-surgical therapy for septal reduction in patients with medically refractory Hypertrophic Obstructive Cardiomyopathy (HOCM). We sought to determine the relative efficacy of ASA across ages.   Methods:  We divided 405 consecutive patients treated with ASA at our institution into age groups of those    Results:  Compared with the patients 65 compared with those 45-64 years old (22.5% vs 9.6%, p=0.004; Figure 1B). All groups had a significant reduction in gradients from baseline (Figure 1C). At 3 months, the average NYHA score was lower in the middle age group compared with those    Conclusions:  Despite a patient population with more comorbidities at baseline and a higher rate of procedural complications, older patients showed a sustained improvement in symptoms and gradients similar to their younger counterparts.
乏力-肌痛-肾衰竭
Authors: 张欣, 周福德, 高燕明, 邹万忠, 高妍
Journal: BMJ (2008)

患者男，52岁，河北农民。主因“纳差、乏力2个月余，颜面部浮肿10余天”于2007年3月15日入院。患者2个月前无明显诱因出现鼻塞、咳嗽、咯痰。在当地诊所给予乙胺碘呋酮（0．2g每天1次，共5d）及左氧氟沙星治疗6d后鼻塞、咳嗽减轻，但出现纳差与乏力、四肢肌肉胀痛。
Biorhythms: fact or superstition?
Authors: D K Winstead, B D Schwartz, W E Bertrand
Journal: American Journal of Psychiatry (1981)

Although much has appeared in the lay literature regarding the role of biorhythms in life events, few empirical data exist to support the notion that biorhythms affect our lives. The authors first examined the relationship between biorhythms and date of psychiatric hospitalization for 218 patients. They then compared the dates of psychiatric emergency room visits for 386 patients with each patient's biorhythms. The results from both studies failed to reveal a significant relationship between time of psychiatric admission or psychiatric emergency room visit and various phases of the biorhythm cycle. The biorhythm theory is much too simplistic to account for the complexities of everyday life. Therefore, belief in the theory is likely to be an expression of superstitious behavior.
Abstract 1: Derivation of a Novel Hypothermic to Ischemic Ratio as an Indicator for Predicting and Improving Survival from Out of Hospital Cardiac Arrest
Authors: Kelly N Sawyer, Michael C Kurz, Michelle Gossip, Charlotte Roberts, Harinder Dhindsa, Renee Reid, Joseph P Ornato, Mary Ann Peberdy
Journal: Circulation (2011)

Objectives:  Therapeutic hypothermia (TH) is recommended by the 2010 AHA guidelines but there is little evidence to guide the duration of therapy required to realize benefit after out-of-hospital cardiac arrest (OOH-CA). We sought to evaluate a novel Hypothermic to Ischemic Ratio (H/I Ratio = total hypothermic time / total ischemic time (TIT)) as a predictor of survival.   Methods:  Adult, non-traumatic, OOH-CA patients surviving to hospital admission between January 2008 and January 2011 were included, and structured data including Utstein variables were collected retrospectively. Total hypothermic time was composed of 1) induction interval from ROSC to target temperature (T2T), 2) TH interval, from target temperature until rewarming, and 3) rewarming interval. TIT was measured from pulselessness to ROSC. Backwards stepwise logistic regression was used to fit the most parsimonious models, and odds ratios (OR) were obtained to examine the effects of the predictor variables on survival. The final models were evaluated by Hosmer-Lemeshow and Receiver-Operating Characteristic (ROC) curves.   Results:  Overall, 84 patients (49.7%) survived to hospital discharge. The odds of survival for VF were 6.53 times greater than PEA (95% CI 3.28 to 13.01), so separate models were constructed. For VF, longer T2T, shorter TIT, and lower initial patient temperature were significant for predicting survival (R² = 0.41, area under curve = 0.89). H/I Ratio was the most powerful predictor and attained 100% sensitivity at 25:1. For PEA, longer T2T, shorter TIT, and higher initial temperature were significant predictors (R² = 0.45, AUC= 0.91). H/I Ratio was a significant predictor and reached 100% sensitivity at 37:1.   Conclusions:  The novel H/I Ratio predicts survival to hospital discharge significantly and suggests that OOH-CA patients may directly benefit from a simple, individualized approach, tailoring total hypothermic time according to presenting rhythm and TIT.
Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients
Authors: Diederik G. P. J. Geboers, Friso M. de Beer, Anita M. Tuip-de Boer, Tom van der Poll, Janneke Horn, Olaf L. Cremer, Marc J. M. Bonten, David S. Y. Ong, Marcus J. Schultz, Lieuwe D. J. Bos
Journal: Intensive Care Medicine (2015)
Book: The General Practice Management Handbook
Authors: R. Petchey
Journal: BMJ (1998)

Eds P Orton, C Hill W B Saunders, £18.95, pp 276 ISBN 0 7020 2204 7 Rating: ![Graphic][1]</img>![Graphic][2]</img> Management handbooks are a peculiar literary genre. They are obliged to present management as straightforward and commonsensical (in order to appeal to the pragmatic nature of managers), but beneath this veneer of practicality they are intensely ideological texts. They offer a particular and partial perspective on organisations and the world of work. Typically, they portray organisations as consensual and the managerial perspective as unconditionally legitimate. Crucially, they seek to reduce the processes of … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif
Multitrial Evaluation of Progression-Free Survival as a Surrogate End Point for Overall Survival in First-Line Extensive-Stage Small-Cell Lung Cancer
Authors: Nathan R. Foster, Lindsay A. Renfro, Steven E. Schild, Mary W. Redman, Xiaofei F. Wang, Suzanne E. Dahlberg, Keyue Ding, Penelope A. Bradbury, Suresh S. Ramalingam, David R. Gandara, Taro Shibata, Nagahiro Saijo, Everett E. Vokes, Alex A. Adjei, Sumithra J. Mandrekar
Journal: Journal of Thoracic Oncology (2015)
Abstract 1360: A Potential Role for Nuclear-Delimited Signaling via Nuclear-Envelope Angiotensin Receptors in the Control of Cardiac Gene Expression
Authors: Artak Tadevosyan, Bruce G Allen, Stanley Nattel
Journal: Circulation (2008)

Angiotensin-II (A-II) regulates cardiac homeostasis via AT1 (AT1R) and AT2 (AT2R) receptors. A-II mitogenic and growth promoting effects contribute to various cardiac remodeling paradigms, largely by altering gene expression. Here, we assessed the possibility that A-II effects on gene expression may be mediated by intracellular A-II acting on AT1Rs or AT2Rs in the nuclear envelope. Western blots of nucleus-enriched rat heart fractions indicated the presence of AT1R and AT2R proteins that preferentially copurified with a nuclear-membrane marker (Nup 62) but not markers of plasma (Calpactin I), Golgi (GM130) or endoplasmic-reticulum (GRP78) membranes. Confocal immunoflorescent microscopy of adult rat and dog cardiomyocytes revealed AT1R and AT2R proteins on nuclear membranes and T tubules. Microinjection of AngII-Alexa488 into single cardiomyocytes indicated preferential binding of A-II to nuclear vs cytoplasmic sites (197 ± 7* vs 110 ± 7 respectively; *p&lt;0.05). Ca 2+ i -recordings on nuclear preparations (Fura-2 AM) revealed AT1R-mediated Ca 2 + release (e.g. 17 ± 2 nM control, 264 ± 13 nM* Ang-II and 177±6 nM* for the AT1-selective agonist L-162313). AT1R ligands enhanced de novo RNA synthesis in isolated cardiac nuclei incubated with [ α 32 P]-UTP (eg 45±1 CPM/ng DNA control vs 244±3 CPM/ng DNA* with A-II, N=6/group, P&lt;0.001). NF κ B mRNA expression (RT-qPCR, relative to β -actin) was enhanced by A-II or L-162313 applied to isolated cardiac nuclei, a response that was suppressed by co-administration of valsartan (AT1-selective antagonist). Dose-response experiments with A-II applied to purified nuclei vs whole myocytes showed a 1.5-fold* greater increase in NF κ B mRNA levels at saturating concentrations with similar EC50 values, suggesting preferential nuclear signaling. Cardiac nuclear membranes possess AT2Rs and AT1Rs that are coupled to nuclear signaling pathways and regulate transcription. Intracellularly synthesized A-II signaling through cardiac nuclear envelopes may be particularly important for A-II regulation of cardiac gene expression, suggesting potential differential actions of A-II from intra- vs extracellular sources, with important mechanistic and therapeutic implications.
Resting Heart Rate as Predictor for Left Ventricular Dysfunction and Heart Failure
Authors: Anders Opdahl, Bharath Ambale Venkatesh, Veronica R.S. Fernandes, Colin O. Wu, Khurram Nasir, Eui-Young Choi, Andre L.C. Almeida, Boaz Rosen, Benilton Carvalho, Thor Edvardsen, David A. Bluemke, João A.C. Lima
Journal: Journal of the American College of Cardiology (2014)
WHO stimulates a commitment to tackling inequalities in health
Authors: M. Whitehead
Journal: BMJ (1995)

EDITOR,—In her article on the World Health Organisation in Europe Fiona Godlee fails to appreciate just how large a contribution the European office has made to one of the key issues in health policy today: social inequalities in health.1 Before the 1980s it was easy for European countries to be complacent about their “fully fledged health infrastructure and high overall levels of health.”1

But it is no longer possible for countries to ignore uncomfortable facts about the existence of inequalities …
Assessment of regional and global left ventricular function by reinjection Tl-201 and rest Tc-99m sestamibi ECG-gated SPECT
Authors: Eiji Tadamura, Takashi Kudoh, Makoto Motooka, Masayuki Inubushi, Seiji Shirakawa, Naoya Hattori, Tomohisa Okada, Tetsuya Matsuda, Takaaki Koshiji, Kazunobu Nishimura, Katsuhiko Matsuda, Junji Konishi
Journal: Journal of the American College of Cardiology (1999)
Deaths outside hospital from acute coronary events
Authors: A Absalom, P Bradley, J Soar, A. Round, M. Backett, C. Hunter, A. Marshall
Journal: BMJ (1998)

Editor—We wish to comment on some of the strategies suggested by Norris et al to reduce mortality from acute coronary attacks.1 Recently we reviewed outcomes for all cardiac arrests in adults presenting to the emergency department at the Norfolk and Norwich Hospital during 1991 and 1996. The region served by this hospital is semirural, with a single tier response ambulance service. Between 1991 and 1996 several changes were made to the organisation and delivery of prehospital care. Foremost was the amalgamation of the three ambulance services covering East Anglia. The proportion of calls answered by a paramedic crew also changed, increasing from 70% to 100%. Ninety five per cent of calls were answered within 16 minutes in 1991 and within 22 minutes in 1996. Despite these changes there was no significant difference in outcome. Fifteen out of 113 victims survived to discharge in 1991 compared with 11 out of 147 in 1996.

Early access to defibrillation is a key to survival. The NHS target of an ambulance response within 8 minutes for 90% of calls2 is probably too long. None the less in semirural regions such as Norfolk, early access would be difficult to achieve without resorting to some of the options mentioned by Norris et al, such as a dual response system. Elsewhere police and fire service staff have been trained in the use of automated external defibrillators and included in a rapid response tier.3 For an urban area such as Norwich, the fire service has a statutory obligation to attend to all fires within 5 minutes,4 and if included in such a rapid response system may help to reduce significantly the delay before defibrillation.

Norris et al suggested intensified citizen training in cardiopulmonary resuscitation. In our series, among the cardiac arrests witnessed by members of the public, the proportion receiving immediate basic life support was significantly smaller in 1996 than in 1991 (34% (27/79) v 67% (33/49)). This suggests increased hesitance on the part of the public to initiate resuscitation attempts. Perhaps public education campaigns should focus on this issue. Finally, we agree with Norris et al on the importance of educating the public to interpret premonitory signs of coronary events and to summon the emergency services without delay. Most of our survivors (10 in 1991, 9 in 1996) called for help early, had their cardiac arrest in an ambulance or doctor’s surgery, and were defibrillated promptly.
Abstract 1125: Differential Influence of Distinct Fatty Acids on Cardiomyocyte Metabolic Gene Expression
Authors: Joseph B Lockbridge, David J Durgan, Oluwaseun Egbejimi, William C Stanley, Martin E Young
Journal: Circulation (2006)

Diabetes mellitus increases risk for cardiovascular disease, and exposes the heart to high plasma fatty acid (FA) levels, which induce genes promoting FA oxidation (e.g. malonyl-CoA decarboxylase; ...
Similar Outcome of Upfront Unrelated and Matched Sibling Donor Hematopoietic Stem Cell Transplantation in Idiopathic Aplastic Anaemia of Childhood and Adolescence: A Cohort Controlled Study on Behalf of the UK Paediatric BMT WP, of the PD WP and of the SAA WP of the EBMT
Authors: Carlo Dufour, Marta Pillon, Elisa Carraro, Neha Bhatnagar, Rob Wynn, Brenda Gibson, Ajay J Vora, Colin G Steward, Anna Maria Ewins, Rachael E Hough, Josu de la Fuente, Mark Velangi, Paul Veys, Persis J Amrolia, Roderick Skinner, Andrea Bacigalupo, Antonio M. Risitano, Gerard Socie, Regis Peffault de Latour, Jakob Passweg, Alicia Rovo, André Tichelli, Hubert Schrezenmeier, Britta Hochsmann, Peter Bader, Anja van Biezen, Judith C Marsh, Mahmoud D. Aljurf, Sujiith Samarasinghe
Journal: Blood (2014)
Examination success and opinions on American Board of Psychiatry and Neurology certification
Authors: S K Quick, C B Robinowitz
Journal: American Journal of Psychiatry (1981)

Psychiatrists who completed residency between 1967 and 1978 completed questionnaires about their experiences with the American Board of Psychiatry and Neurology (ABPN). Although the 1,160 respondents were basically positive about the ABPN, performance on the Board examinations was strongly related to their degree of satisfaction with the examination process. The opinions of psychiatrists who had not sought certification mirrored those of respondents who had failed the exams. The oral examination was uniformly seen as stressful, but respondents also wanted the Board to provide more clear criteria for the judgment of competence as well as detailed feedback on performance. Women and foreign medical graduates were less apt to be certified than male psychiatrists who had graduated from United States medical schools, and psychiatrists engaged in research, education, and/or administration tended to be more successful at passing the Board examination than were clinicians.
Children's memories in the wake of Challenger
Authors: L C Terr, D A Bloch, B A Michel, H Shi, J A Reinhardt, S Metayer
Journal: American Journal of Psychiatry (1996)

The Challenger spacecraft explosion of Jan. 28, 1986, offered an opportunity to study the memories of normal latency and adolescent children of different emotional involvements following one sudden and distant disaster. How would children of various levels of concern express their memories? And if studied over time, how would these narratives change? Would there be developmental differences? And would there be false details of memory?The authors set out to compare the memories of 153 children from Concord, N.H. (who watched the explosion on television), and Porterville, Calif. (who heard about it). The structured-interview responses of involved and less involved children; latency-age versus adolescent children; and those seen initially (5-7 weeks after the explosion) versus those same children seen later (at 14 months) were statistically compared.The vast majority of children's memories of Challenger were clear, consistent, and detailed, with highlighting of personal placement, who else was there, and personal occurrences linked to the event. Those children who were less emotionally involved demonstrated significantly less clarity, consistency, and correct ordering of sequences and were less likely to remember personal placement, other people who were there, and related personal incidents. About 30% of all children in this study misunderstood something about Challenger and incorporated these misunderstandings into their memories as false details. Latency-age children continued to harbor false details for 14 months, as opposed to the adolescents.Childhood memories of the Challenger space shuttle explosion appeared predictable, were related to patterns of memory that have been observed following single, unrepeated traumas, and reflected age and stage differences.
Corticotropin-Releasing Hormone in the Hypercortisolism of Depression and Cushing's Disease
Authors: Eve Van Cauter, Florian Holsboer, Brian Harris, D. R. Thomas, Richard P. Levy, Philip W. Gold, Mitchel A. Kling, Joseph R. Calabrese, Robert M. Post, Alec Roy, Lynnette K. Nieman, Gordon B. Cutler, D. Lynn Loriaux, George P. Chrousos
Journal: New England Journal of Medicine (1987)
Mycophenolate or Azathioprine Maintenance in Lupus Nephritis
Authors: Pedro R Chocair, John A Duley
Journal: New England Journal of Medicine (2012)

Intravenous (IV) cyclophosphamide has been first-line treatment for inducing disease remission in lupus nephritis. The comparative efficacy and toxicity of newer agents such as mycophenolate mofetil (MMF) and calcineurin inhibitors are uncertain.
多发骨质硬化-皮肤变黑-手足麻木
Authors: 阮洁, 沈敏, 曾学军
Journal: BMJ (2010)

患者男性，50岁，因“发现骨密度增高6年，皮肤变黑2年，手足麻木5个月”于2008年4月入院。患者于2002年常规体检时，经X线胸透及胸部CT检查发现胸骨、肋骨、胸椎散在高密度成骨样影，提示骨硬化。无发热、骨痛等不适。2004年复查胸部CT：骨硬化影较前增多增大。2006年始出现全身皮肤变黑，乳晕颜色加深。