tbuckley/cabot-search huggingface dataset:
Promise and Performance in Managed Care: The Prepaid Group Practice Model
Authors: G. Rich
Journal: BMJ (1995)

Donald K Freeborn, Clyde R Pope Johns Hopkins University Press, pp 169 ISBN 0 8018 4819 9

The prepaid group practice is but one of the various systems of financing and delivering health care that make up the managed care industry in the United States. Most definitions of managed care include some reference to the use of contracts with selected physicians and hospitals that provide comprehensive health care services to members for a monthly premium. It usually means that doctors agree to some form of quality control and minor restrictions on clinical freedom and accept some financial risk. There are extra costs for patients who choose …
Topical Phenytoin in Diabetic Foot Ulcers
Authors: M Govindraj Muthukumarasamy, Gurumurthy Sivakumar, Govindan Manoharan
Journal: Diabetes Care (1991)

Objective The efficacy of topical phenytoin in the treatment of diabetic foot ulcers was evaluated in a controlled inpatient study. Research Design and Methods Fifty patients were treated with topical phenytoin, and 50 patients matched for age, sex, and ulcer areas, depth, chronicity, and infection were dressed with dry sterile occlusive dressing. Results Both groups improved, but the ulcers treated with topical phenytoin healed more rapidly. Mean time to complete healing was 21 days with phenytoin and 45 days with control. The differences seen were statistically significant (P &amp;lt; 0.05) via the chi 2 test. Conclusions Phenytoin appears to be useful as a topical agent in promoting the healing of diabetic foot ulcers.
Medical courses in the Czech Federal Republic: Registration lasts only five years
Authors: P L Towers
Journal: BMJ (1993)

Two drugs are better than one EDITOR,-We disagree with some of D E Price's views on managing erectile dysfunction in diabetes.'The erectile dysfunction is not always organic in origin since psychogenic factors based on anxiety are as common in diabetic patients as in the general population.A total lack of erections under all circumstances, including during sleep and on waking, may indeed be due to neurogenic impotence, but patients with this are a minority.Patients more commonly complain of a partial erection during sexual activity, which suggests a vasculogenic rather than a neurogenic cause.Intracavernous injection of a vasoactive agent is a simple means of distinguishing vasculogenic from psychogenic and neurogenic impotence.More sophisticated investigations are rarely neces- sary except to investigate the possibility of occult neurological problems or of arterial disease worth treating surgically-that is, in young non-smoking men under 40 who do not have diabetes or hypertension.The use of intracavernous agents for erectile dysfunction has indeed revolutionised the management of this problem, but, at least in theory, papaverine should not now be used alone because of the occurrence of penile fibrosis and priapism.The incidence of these complications is diminished by the addition of phentolamine, but prostaglandin E1 is safer, although a suitable formulation for general use is not yet available.
Topical suplatast tosilate (IPD) ameliorates Th2 cytokine-mediated dermatitis in caspase-1 transgenic mice by downregulating interleukin-4 and interleukin-5
Authors: T. Murakami, K. Yamanaka, K. Tokime, I. Kurokawa, H. Tsutsui, K. Nakanishi, H. Mizutani
Journal: British Journal of Dermatology (2006)

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by elevated serum levels of IgE. AD is associated with Th2 cytokines including interleukin (IL)-4, IL-5, IL-13 and IL-10. Systemic administration of suplatast tosilate (IPD) is currently used to treat Th2 cytokine-mediated AD.To evaluate the effect of topical IPD on skin lesions of AD using a genetically engineered AD mouse model (K14/caspase-1 transgenic mouse: KCASP1Tg).IPD ointment (3%) and white petrolatum (WP) were applied to KCASP1Tg mice every other day from 6 to 14 weeks after birth. Histopathological analysis of skin lesions and measurement of mRNA expression of cytokines in skin lesions and spleen cells were carried out. We also compared changes in serum parameters between IPD-treated and WP-treated KCASP1Tg mice.WP-treated mice developed dermatitis at 8 weeks after birth. However, skin lesions in IPD-treated mice were limited. Histopathologically, skin lesions in WP-treated KCASP1Tg mice showed marked inflammatory changes with increased mast cell infiltration. However, mice treated with IPD showed minimum skin lesions with scarce mast cell infiltration. WP-treated KCASP1Tg mice had significant elevation in the serum levels of histamine, IgE and IL-18 as compared with IPD-treated KCASP1Tg mice. mRNA expression of IL-4 and IL-5 in the skin lesions from WP-treated KCASP1Tg mice was significantly higher than in those from IPD-treated mice. In the spleen, the expression of IL-4, IL-5 and interferon-gamma was significantly increased in WP-treated KCASP1Tg mice as compared with their IPD-treated counterparts.This study shows that topical therapy with IPD inhibits the expression of IL-4 and IL-5 and ameliorates skin manifestations in an AD mouse model, suggesting the potential usefulness of topical IPD for the treatment of AD.
Abstract P3-10-16: Quantitative Subtractive Immunofluorescence To Develop a Surrogate for Mena Inv(asive) Isoform Is Associated with Poor Outcome in Breast Cancer
Authors: S Agarwal, JG Jones, M Oktay, M Balsamo, J Condeelis, F Gertler, DL Rimm
Journal: Cancer Research (2010)

Abstract Introduction: Previous work has shown that the inv isoform of Mena, an actin binding protein, is associated with invasion at the cellular level and metastasis in the context of the microenvironment in both animal models and humans (Robinson, B.D. et al. Clin Cancer Res 15, 2433-2441 (2009). However, the prognostic value for metastasis of MenaINV itself is unknown because there is no antibody that directly recognizes this isoform. Here we describe a method to assess a surrogate for MenaINV by measuring total Mena and subtracting the levels of the 11a (non-invasive) isoform. Method: Total Mena and Mena11a were measured in two independent retrospective breast cancer cohorts with 20 year follow-up using tissue microarray and quantitative immunofluorescence (AQUA) technology in a previously described multiplexed mode. AQUA scores for each marker were converted into z scores followed by subtraction of Mena 11a (noninvasive form of Mena) from total Mena (invasive and non-invasive) = Mena(inv) surrogate. This was calculated for each patient and correlated with clinical and pathological characteristics as well as disease-free survival in both cohorts. Results: In the older Yale cohort, Kaplan Meier analysis dividing the Mena(inv) surrogate by quartiles suggested collapse of the top three quartiles followed by comparison to the fourth quartile (log rank p= 0.0003, n=501). The 4th quartile was also significant in node positive (log rank p=0.0047, n=267) and estrogen negative (ER) patient subgroups (log rank p=0.0003, n=234). Cox multivariate analysis showed Mena(inv) was independent of age, tumor size, nuclear grade, nodal status, ER, PR, Her2 (HR=0.636, 95% CI=0.47-0.86, p=0.0038, n=420). The newer Yale cohort showed similar results, but that cohort also had data on local vs. distant recurrence. The relative risk of distant recurrence in this cohort is 2.56 (p=0.011) for patients with high Mena (inv) compared to 1.96 (p=0.055) for any recurrence. Conclusions: High Mena (inv) surrogate shows prognostic value for poor survival in two independent breast cancer cohorts with some suggestion of preferential prognostic value for distant recurrence. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-16.
Influence of cimetidine on pharmacokinetics of propranolol.
Authors: A M Heagerty, M A Donovan, C M Castleden, J F Pohl, L Patel, A Hedges
Journal: BMJ (1981)

Whole-blood propranolol concentrations were estimated for 12 hours after a single 80 mg oral dose was given in six patients taking cimetidine and two weeks after they had stopped the drug. Mean blood propranolol concentrations were higher throughout the sampling period when the patients were taking cimetidine than when they were not, and the difference was statistically significant between one and four hours (p less than 0.05). The mean relative bioavailability of propranolol, measured as the area under the concentration time curve, was significantly higher when the patients were taking cimetidine (p less than 0.025). The mean increase in bioavailability was 136.5 +/- 57.6%, and the results were consistent in each subject. It is concluded from these results that cimetidine reduces the hepatic first-pass extraction of propranolol.
PREVENTION OF DISEASE VS. COST OF LIVING
Authors: THOMAS F. HARRINGTON
Journal: JAMA (1913)

It is now pretty generally accepted that the increase in the cost of living must be reckoned with as a necessary consequence of the social, economic, and political development of the world. The problem is made up of so many complex items that little hope need be expected that a reduction in the cost of the several factors is likely or possible. Neither is there much promise of success in a fight to reduce the total cost of these various component elements. The situation is quite analogous to that which has developed in preventive medicine. Here we have found that germs of disease and microbes are so numerous and are so ubiquitous that their complete eradication is impossible. Some of them are helpful to health; others are powerful allies in combating certain diseases if rightly marshaled. The successful campaign against the harmful germs has been so to raise the inherent
639 THE USEFULNESS OF MEASUREMENT OF LIVER STIFFNESS INTERVAL CHANGE IN PREDICTION OF THE THERAPEUTIC RESPONSE OF PROPRANOLOL IN CLINICAL SIGNIFICANT PORTAL HYPERTENSION
Authors: S.Y. Park, M.Y. Kim, S.K. Baik, J.H. Hong, S.O. Kwon, G.J. Cheon, Y.D. Kim, Y.-O. Jang, H.K. Hwang, H.A. Kim, H.W. Kang, J.M. Jo
Journal: Journal of Hepatology (2012)
Abstract IA19: Understanding the dynamics of cancer: From developmental pathways to in vivo imaging
Authors: Tannishtha Reya
Journal: Cancer Research (2013)

Abstract Our research focuses on the signals that control hematopoietic stem cell self-renewal and differentiation, how these signals are utilized during regeneration and how their dysregulation may lead to cancer. Using a multitude of genetic models, we have shown that classic developmental signaling pathways such as Wnt, Hedgehog and Notch play key roles in stem cell growth and regeneration and are dysregulated during leukemia development. In addition, we have used real-time imaging strategies to show that hematopoietic stem cells have the capacity to undergo both symmetric and asymmetric division, and that shifts in the balance between these modes of division are controlled by the microenvironment and subverted by oncogenes. Importantly, we have shown that regulators of this process, including the cell fate determinant Musashi, can promote aggressive cancers and could serve as critical targets for diagnostics and therapy. Most recently, we have developed a high resolution in vivo imaging system that has allowed us to begin to map the behavior and interactions of hematopoietic stem cells with the microenvironment within living animals, and to define how these change during regeneration and cancer formation. Citation Format: Tannishtha Reya. Understanding the dynamics of cancer: From developmental pathways to in vivo imaging. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr IA19.
Bronchial hyperresponsiveness and airway inflammation in adolescents with <i>asymptomatic</i> childhood asthma
Authors: Y. Obase, T. Shimoda, T. Kawano, S. Saeki, S. Tomari, K. Izaki, C. Fukushima, H. Matsuse, S. Kohno
Journal: Allergy (2003)

About 70% of childhood asthmatics become free of asthma-related symptoms during adolescence. Little is known about bronchial hyperresponsiveness (BHR) and airway inflammation in young adults with "outgrown" childhood asthma.We studied 61 nonsmoking medical students (18 intermittent mild asthmatics, 23 students with outgrown childhood asthma but free of asthma-related symptoms for 10 years (asymptomatic asthmatics) and 20 healthy students). BHR and lung function were measured, and induced sputum samples analyzed for eosinophil count, eosinophilic cationic protein (ECP), granulocyte-macrophage colony stimulating factor (GM-CSF), and tumor necrosis factor-alpha (TNF-alpha).BHR was still present in most asymptomatic asthmatics, but it was milder compared with healthy students. Only three subjects with previous asthma had no BHR and no signs of airway inflammation. Percentages of eosinophil, and ECP, TNF-alpha and GM-CSF concentrations in induced sputum of mild asthmatics and asymptomatic asthma groups were higher than in the healthy group. In asymptomatic asthmatics group, the duration of asthma, sputum eosinophil percentage, and the level of TNF-alpha in sputum correlated significantly with BHR.Only a few subjects with longstanding asymptomatic asthma could be considered as cured; most asymptomatic asthmatics continued to exhibit BHR and signs of airway inflammation. The outcome of childhood asthma and BHR was associated with the degree of airway inflammation and the duration of childhood asthma.
Norway tries naloxone in spray form to prevent deaths from drug overdose
Authors: A. Hansen
Journal: BMJ (2014)

Norway’s two biggest cities, Oslo and Bergen, plan to offer drug users naloxone in the form of a nasal spray. Naloxone is an antidote to opiates and is used to treat opiate overdoses, such as overdoses of heroin.

An advantage of giving naloxone as a nasal spray rather than an injection is that it is easy to use and can, in the case of an overdose, be administered by people without a …
Probing the Dynamics of Münchausen's Syndrome Detailed Analysis of a Case
Authors: PETER G. JUSTUS
Journal: Annals of Internal Medicine (1980)

During a 10-week period we made in-depth observations of a patient with Münchausen's syndrome who had chronic myelogenous leukemia. Probably because he perceived that his life expectancy was brief, he disclosed his wanderings and regularly used methods of deception. These methods were usually based on his knowledge of pathophysiology. He exploited the desire of medical personnel to be helpful. Through interviews with the patient, family members, and previous physicians and review of 14 kg of medical records, we attempted to reconstruct his life to gain insight into his conscious and unconscious motivations. Most features of Münchausen's syndrome appear to be explainable by the patient's attempts to have control over his immediate environment.
Potential association between the recent increase in campylobacteriosis incidence in the Netherlands and proton-pump inhibitor use – an ecological study
Authors: M Bouwknegt, W van Pelt, M E Kubbinga, M Weda, A H Havelaar
Journal: Eurosurveillance (2014)

The Netherlands saw an unexplained increase in campylobacteriosis incidence between 2003 and 2011, following a period of continuous decrease. We conducted an ecological study and found a statistical association between campylobacteriosis incidence and the annual number of prescriptions for proton pump inhibitors (PPIs), controlling for the patient's age, fresh and frozen chicken purchases (with or without correction for campylobacter prevalence in fresh poultry meat). The effect of PPIs was larger in the young than in the elderly. However, the counterfactual population-attributable fraction for PPIs was largest for the elderly (ca 45% in 2011) and increased at population level from 8% in 2004 to 27% in 2011. Using the regression model and updated covariate values, we predicted a trend break for 2012, largely due to a decreased number of PPI prescriptions, that was subsequently confirmed by surveillance data. Although causality was not shown, the biological mechanism, age effect and trend-break prediction suggest a substantial impact of PPI use on campylobacteriosis incidence in the Netherlands. We chose the ecological study design to pilot whether it is worthwhile to further pursue the effect of PPI on campylobacteriosis and other gastrointestinal pathogens in prospective cohort studies. We now provide strong arguments to do so.
Impact of Recommendations to Suspend the Birth Dose of Hepatitis B Virus Vaccine
Authors: Ronda J. Oram
Journal: JAMA (2001)

ContextIn July 1999, due to concerns about thimerosal content, the American Academy of Pediatrics (AAP) and the Public Health Service (PHS) recommended suspending hepatitis B virus (HBV) vaccination at birth except for mothers who had positive or unknown hepatitis B surface antigen (HBsAg) status.In September 1999, the Centers for Disease Control and Prevention recommended that hospitals resume HBV vaccination at birth with a new thimerosal-free vaccine.Whether the 2 changes in recommendations within 3 months led to less-than-optimal compliance in hospital nurseries is unknown.Objective To determine hospital HBV vaccination policy before the recommendation for delay of HBV vaccination and 1 year later.Design, Setting, and Participants Survey of all 46 hospitals with obstetric services and neonatal nurseries in Cook County, Illinois.Main Outcome Measures Hepatitis B virus immunization practices before July 1999 and in August 2000; hospital factors associated with routine HBV immunization and compliance with AAP and PHS recommendations.Results Before July 1999, 74% of surveyed hospital nurseries offered HBV vaccine to all neonates; only 39% did so in August 2000.Being located in the Chicago city limits (88% vs 57%; P=.02) and having an academic affiliation (93% vs 66%; P=.05) were positively associated with routine neonatal immunization before July 1999.Both academic affiliation and city location were associated with routine immunization in August 2000 (71% vs 25% [P=.003] and 60% vs 14% [P=.002], respectively) and with compliance with recommendations for suspension (57% vs 25% [P=.03] and 56% vs 10% [P=.001]). ConclusionsWe documented a 35% decrease in hospital nurseries that routinely offered HBV immunization 1 year after the AAP and PHS recommendations were made.Special efforts may be required to make at-birth administration of HBV vaccination universal.
Measurement of Plasma Cortisol in the Diagnosis of Cushing's Syndrome
Authors: CLARK T. SAWIN
Journal: Annals of Internal Medicine (1968)

Measurement of plasma cortisol is helpful in the diagnosis of Cushing's disease but not as a single determination. Stimulation with corticotropin, suppression with dexamethasone, and measurement in the evening as well as the morning are maneuvers that will help in the diagnosis, but all have problems of interpretation in certain patients. A combination of the last two, measurement of the diurnal variation of plasma cortisol and of plasma cortisol after suppression with dexamethasone, offers a useful combination of tests that is still simple enough to use as a screening procedure. The results of testing must still be correlated with the clinical findings and should be confirmed by further testing if the diagnosis of Cushing's syndrome is suggested.
The Microbe's View of Infection
Authors: Stanley Falkow
Journal: Annals of Internal Medicine (1998)

Editorials1 August 1998The Microbe's View of InfectionStanley Falkow, PhDStanley Falkow, PhDStanford University School of Medicine; Stanford, CA 94305-5124Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-3-199808010-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The First International Conference on Emerging Infectious Diseases was held in Atlanta, Georgia, on 8 to 11 March 1998. It was organized by the Centers for Disease Control and Prevention with the sponsorship of the American Society for Microbiology.Although the U.S. Surgeon General claimed in the mid-1970s that infectious diseases had been conquered, the ensuing years have brought us Legionnaires disease; the toxic shock syndrome; an awareness of Lyme disease; an outbreak of hantavirus infection; and, of course, HIV. The discovery that peptic ulcer and gastric cancer are manifestations of Helicobacter pylori infection has led to an increasing search ... Author, Article, and Disclosure InformationAuthors: Stanley Falkow, PhDAffiliations: Stanford University School of Medicine; Stanford, CA 94305-5124Corresponding Author: Stanley Falkow, PhD, Department of Microbiology and Immunology, Fairchild, Room D039, Stanford University School of Medicine, 299 Campus Drive, Stanford, CA 94305-5124. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCell morphology as a virulence determinant: lessons from Helicobacter pyloriDiscovery of Novel Drug Targets in Microbial Pathogens Among Hypothetical Proteins: Methods and SignificanceOral Mucosal InfectionsA Molecular Perspective of Microbial PathogenicityAntigenic Variation and the Persistence of Extracellular Bacteria in Vertebrate HostsBacterial Skin and Soft Tissue Infections in Older AdultsRickettsia felis , an emerging flea-transmitted human pathogenA Molecular Perspective of Microbial PathogenicityChildren's Views of MicrobesDefense mechanisms against infectionsClinical Significance of Antimicrobial Resistance 1 August 1998Volume 129, Issue 3Page: 247-248KeywordsBacillusFood poisoningGeneticsInfectious diseasesOpportunistic pathogensPathogensPopulation statisticsSalmonellaSyphilisToxic shock syndrome ePublished: 15 August 2000 Issue Published: 1 August 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A Randomized Controlled Trial on Cognitive Restructuring and Imagery Modification to Reduce the Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse Suffering from Posttraumatic Stress Disorder
Authors: Kerstin Jung, Regina Steil
Journal: Psychotherapy and Psychosomatics (2013)

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; The feeling of being contaminated (FBC) is a common phenomenon in survivors of childhood sexual abuse (CSA) suffering from posttraumatic stress disorder (PTSD). Thus far, this symptom has been neglected in research and therapy. For this reason, we developed Cognitive Restructuring and Imagery Modification (CRIM), a two-session treatment (lasting 90 and 50 min) that specifically targets the FBC. The present study examined the efficacy of the treatment.&lt;b&gt;&lt;i&gt; Methods:&lt;/i&gt;&lt;/b&gt; Thirty-four women with CSA-related PTSD (mean age = 37 years) were randomized to either the CRIM group or a waitlist control group. Primary outcomes were intensity, vividness, and uncontrollability of the FBC, associated distress, and PTSD symptoms, which were assessed using the Clinician-Administered PTSD Scale and the Posttraumatic Diagnostic Scale. Outcomes were measured pre- and posttreatment, and at the 4-week follow-up. (M)ANOVAs were used to compare improvements across conditions. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; All FBC scores yielded a greater reduction in the CRIM group than the waitlist control (WL) group. Between-group effect sizes at follow-up were large and highly significant (intensity: &lt;i&gt;d&lt;/i&gt; = 1.52, p &lt; 0.001; vividness: &lt;i&gt;d &lt;/i&gt;= 1.28, p &lt; 0.001; uncontrollability: d = 1.77, p &lt; 0.001; distress: d = 1.80, p &lt; 0.001). PTSD symptoms also yielded a greater reduction in the CRIM group than the WL group, with large between-group effect sizes (Clinician-Administered PTSD Scale: &lt;i&gt;d&lt;/i&gt; = 0.93, p &lt; 0.001). &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Our findings support the efficacy of the newly developed CRIM in reducing the FBC and PTSD symptoms in adult survivors of CSA.