tbuckley/cabot-search huggingface dataset:
Competence development in ERCP: the learning curve of novice trainees
Authors: Vivian Ekkelenkamp, Arjun Koch, Erik Rauws, Gerard Borsboom, Robert de Man, Ernst Kuipers
Journal: Endoscopy (2014)

Measures for competence in endoscopic retrograde cholangiopancreatography (ERCP) during training are poorly defined. Currently, various training and accreditation programs base verification of competence on performance of a minimum number of procedures. There is a general awareness that procedural competence certification should be based on objective performance criteria. Continuous self-assessment using a Rotterdam Assessment Form for ERCP (RAF-E) can provide insight into trainee performance. The study aim was to express development in ERCP competence as a learning curve.ERCP trainees at a tertiary referral center in the Netherlands were invited to participate. Performed procedures were appraised using RAF-E. Indication for each ERCP and presence of a virgin papilla were documented. Complexity was graded on a 3-point scale. The primary outcome parameter was common bile duct (CBD) cannulation success rate. Success of the intended therapeutic interventions was additionally expressed as a learning curve.15 trainees were included. 1541 ERCPs (624 procedures in native papillary anatomy) were assessed through RAF-E. Unassisted CBD cannulation success rate improved from 36 % at baseline to 85 % after 200 procedures (P < 0.001), and in 624 patients with a virgin papilla from 22 % at baseline to 68 % after 180 procedures (P < 0.001). Learning curves for therapeutic interventions showed significant improvements for successful sphincterotomy (P = 0.01) and stent placement (P < 0.001).Learning curves are a valuable means for assessing competence in ERCP. Differences in learning curves can be shown with RAF-E. Verification of competence should be based on actual performance, instead of minimum numbers.
A VISIT TO "JESUS HILFE" OR THE LEPROUS HOSPITAL OF JERUSALEM.
Authors: JACOB E. SCHADLE
Journal: JAMA (1901)

During a recent visit to Palestine it was my pleasure to inquire into the condition of the lepers of that country and pay a visit to the "Jesus Hilfe" Asylum. Through the courtesy of our American consul, I was most cordially received by the superintendent and physician in charge, Dr. Einsler, and conducted through the institution. Every available opportunity was given me to study the disease with a view of bringing home to the profession of Minnesota, where the affection at present exists, some information as to its prevalence in the Orient, where from time immemorial, so to speak, it has had its home. Notwithstanding the fact that "Jesus Hilfe" Hospital is one of the best equipped of its kind in the world, and is an imposing stone building surrounded by luxuriantly blooming gardens, the average tourist is content to view it from a distance. Infact, it is somewhat difficult
Douglas Alton Chandler
Authors: R Terry
Journal: BMJ (2002)

Former general practitioner Herefordshire (b 1921; q Westminster Hospital 1945), died in a car crash on 8 March 2002.

After house posts in Birmingham he joined the Royal Air Force and became station medical officer at the wartime airfield at Madley. During this time he was also leader of the mountain rescue team covering the Black Mountains. He subsequently became a partner in a two man practice. Doug started an infant welfare clinic and later took a diploma in child development. A keen ornithologist, in the early 1960s he made a 40 minute film of the Pembrokeshire seabirds. Predeceased by his wife, Sylvia, he leaves two sons and two grandchildren.
Current Emergency Therapy '85
Authors: J. E. Tintinalli
Journal: JAMA (1986)

Drs Edlich and Spyker, editors of<i>Current Emergency Therapy '85</i>, are well known for their clinical and research contributions to their specialties of plastic surgery and toxicology, as well as to emergency medicine. This large volume is primarily directed to medical-surgical emergencies in adults, although important topics in emergency pediatrics are generally assimilated throughout. The editors do not indicate the audience for whom this work was written. However, the vast majority of the chapter authors are traditional specialists or subspecialists. The selection of authors, then, and the general direction of the contents suggest this text is directed at the specialty resident who is called to the emergency department for consultation on cases in which the major diagnosis or stabilization has already been accomplished. Most chapters are written so that the discussion begins with an established diagnosis, not the acute symptom complex, the differential diagnosis, or the major life threats. For
Priorities to Improve Health Outcomes—Reply
Authors: Steven H. Woolf
Journal: JAMA (2007)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Late Intravascular Embolization of a Chemo Port Catheter
Authors: Alexander Loch, Ramesh Veriah Singh, Imran Zainal Abidin, Chee Kok Han, Wan Azman Wan Ahmad
Journal: Journal of Thoracic Oncology (2011)

A 51-year-old woman was referred for angiographic extraction of a foreign body. She underwent left mastectomy with axillary clearance for breast cancer followed by chemotherapy and radiotherapy 8 years before this. A chemotherapy port was implanted below the right clavicle with catheter access into the right subclavian vein at that time. After she had completed chemotherapy, she was lost to follow-up, until she represented 8 years later with persistent cough. The chest x-ray (Figure 1A) showed a foreign body comprising an ellipsoid head and a flagellating tail on fluoroscopy (see video, Supplemental Digital Content 1 [http://links.lww.com/JTO/A86]; see video, Supplemental Digital Content 2 [http://links.lww.com/JTO/A87] for a close-up; and see video, Supplemental Digital Content 3 [http://links.lww.com/JTO/A88] for a 180° surround view). A computed tomography scan of chest demonstrated embolization of the fractured chemo port catheter. The catheter segment (Figure 1B, arrow) was lodged between the pulmonary artery trunk and a branch of the left pulmonary artery. The distal end of the catheter was surrounded by a 3.7-mm-diameter calcified tissue mass (Figure 1B, arrowhead). The patient declined angiography in view of the risks associated with extracting a heavily calcified and embedded catheter tip. The chemo port was still located below the right clavicle with a stump of the catheter connected to it. We hypothesize that entrapment (“pinch off”) and friction of the catheter between clavicle and first rib over many years resulted in fracture and embolization of the catheter. Increasingly, specialist nurses are responsible for the care of patients with central venous catheters and the removal of the devices.1Ingram P Sinclair L Edwards T The safe removal of central venous catheters.Nurs Stand. 2006; 20: 42-46Crossref PubMed Scopus (8) Google Scholar Current guidelines recommend the removal of unused ports.2Bishop L Dougherty L Bodenham A et al.Guidelines on the insertion and management of central venous access devices in adults.Int J Lab Hematol. 2007; 29: 261-278Crossref PubMed Scopus (192) Google Scholar Case reports of embolized port catheters or so-called totally implanted venous devices are rare. Only about a third of the embolic events reported were localized in the pulmonary arteries, and about a quarter of patients were asymptomatic at the time of diagnosis.3Surov A Wienke A Carter JM et al.Intravascular embolization of venous catheter—causes, clinical signs, and management: a systematic review.JPEN J Parenter Enteral Nutr. 2009; 33: 677-685Crossref PubMed Scopus (100) Google Scholar Catheter embolism may go undetected for prolonged periods of time and is often diagnosed incidentally. The risk of serious complications for patients with asymptomatic catheter embolism is unknown. Embolized catheter fragments should be removed to prevent further complications.
Reversal of Reflex-Induced Myocardial Ischemia by Median Nerve Stimulation
Authors: Peng Li, Koullis F. Pitsillides, Stephen V. Rendig, Hui-Lin Pan, John C. Longhurst
Journal: Circulation (1998)

Background —Acupuncture is reported to reduce myocardial ischemia, arrhythmias, and hypertension. To investigate the physiological mechanisms underlying these observations, a model of reflex-induced, reversible myocardial ischemia was developed to test the effects of median nerve stimulation as a surrogate for electroacupuncture. Methods and Results —Chloralose-anesthetized cats were instrumented to measure arterial blood pressure, left ventricular pressure, left ventricular dP/dt, heart rate, left anterior descending (LAD) coronary blood velocity, and regional wall motion. The LAD artery either was partially occluded or a small diagonal branch was ligated. Subsequently, transient reflex activation of the cardiovascular system was evoked by application of bradykinin (typically 1 μg/mL) to the gallbladder, which significantly increased myocardial oxygen demand (double product), left ventricular dP/dt, and coronary blood velocity and caused ischemia-induced regional dysfunction, evidenced by significant ( P &lt;.05) reduction in normalized wall thickening (10.7±4.2% versus −23.6±2.9%; control versus ischemia; n=7). However, when median nerves were stimulated with low frequency (5 Hz) to mimic electroacupuncture, bradykinin-induced change in normalized wall thickening was significantly improved (−23.6±2.9% versus 9.8±4.9%; ischemia versus median nerve stimulation, P &lt;.05) and remained augmented ≥1 hour. Results were similar in partial and complete occlusion groups. Significant improvement in wall thickening was associated with unchanged increment of coronary blood velocity and significantly diminished increments of double product and diastolic blood pressure. Conclusions —These results suggest that stimulation of the median nerve to mimic electroacupuncture diminishes regional myocardial ischemia triggered by a sympathetically mediated increase in cardiac oxygen demand. The mechanism of this effect is related to reduction in cardiac oxygen demand, secondary to a diminished pressor response. These data provide the first documentation of the physiological mechanisms underlying the possible beneficial effect of electroacupuncture in the context of restricted coronary blood flow and augmented myocardial oxygen demand.
Significance of Bright Plaques in the Retinal Arterioles
Authors: Robert W. Hollenhorst
Journal: JAMA (1961)

Bright, orange-colored plaques were found at bifurcations of the retinal arterioles in 27 of 235 patients with occlusive disease within the carotid arterial system and in 4 of 93 patients with occlusive disease of the vertebral-basilar arterial system. Some of these plaques later disappeared from the retina, some remained stationary, and still others were observed to move distally. In 6 of 35 patients with recent carotid endarterectomy, new plaques appeared during or shortly after the operation. An occasional plaque caused occlusion of the arteriole. These plaques apparently consist of embolic material from atheromatous lesions in the aorta or carotid arteries. The finding of such plaques on routine ophthalmoscopy constitutes an important sign of atherosclerosis even in an otherwise asymptomatic person.
Who cares for young carers?
Authors: C Sturge, A Frank, T Coster
Journal: BMJ (1994)

EDITOR, - Sue Jenkins and Candida Wingate discuss the needs of children and young people who help to support adults with disabilities in the community,1 emphasising “the strains of practical everyday caring.” We believe that the emotional strains may need even greater consideration and that they vary, depending on the illness of the person being supported at home.

In 1988 we undertook a pilot study of the …
S64 The Cost of Refractory Asthma in the UK - a Preliminary Analysis
Authors: S O'Neill, J Sweeney, C O Neill, C Brightling, A Menzies-Gow, R Niven, R Chaudrai, C Bucknall, A Mansur, C Patterson
Journal: Thorax (2012)

<h3>Introduction</h3> Refractory asthma poses a potentially significant burden in terms of healthcare costs. Relatively little is known about the cost of treatment or what factors explain variations in treatment costs. This study uses data from the British Thoracic Society (BTS) Difficult Asthma Registry to estimate the healthcare costs associated with a sample of well-characterised refractory asthmatics and examines the role of a range of factors in explaining variations in healthcare. <h3>Methods</h3> In this analysis data were extracted from the Registry on 689 patients and examined healthcare utilisation including all prescribed medicines, hospital inpatient stays, ITU stays, A&amp;E/GP visits and CT scans over a 12 month period prior to the patient first being assessed at the specialist clinics. Patient characteristics included age, gender, lung function, clinical centre were care was provided, adherence status, BMI and whether or not the patient was on maintenance oral steroids. Unit costs were based on standard published sources. Costs were examined by category with respect to patient characteristics and total cost with respect to patient characteristics in multivariate regression analyses. <h3>Results</h3> Mean total treatment cost among refractory asthmatics ranged between £3,402 (SD=2,680) to £4,234 (SD=£3,036). In a comparator non-refractory group mean total cost ranged from £1,944 (SD= £1,728) and £2,565 (£2,065). Drug costs comprised approximately 58% of all costs in refractory asthmatics and approximately 55% in the non-refractory group. In the refractory group significant predictors of total costs were FEV1, clinical centre in which care was provided, maintenance oral steroids and BMI. Patients who were on maintenance steroids cost 48% more than those who were not. Patients who were morbidly obese cost approximately 23% more than those who were normal weight. <h3>Conclusion</h3> Treating individuals with refractory asthma presents a significant cost to the health service. The role of maintenance steroids in cost is dramatic and may relate to the impact of steroid induced morbidity and warrants further investigation.
Diagnosis and Treatment of Multiple Myeloma
Authors: Kurt Stern
Journal: JAMA (1970)

When we approach this monograph authored by a brilliant clinical investigator who has contributed fundamental information on immunoglobulins, our expectations understandably run high—and they are not disappointed. The exposition combines thorough bedside and laboratory study of 140 patients with multiple myeloma, and a highly critical evaluation of pertinent world literature. Thus, a comprehensive picture emerges of the disease, encompassing incidence, cytologic, hematologic, roentgenologic features, and clinical symptoms and course. Particular attention is given to structure, quantitation, and classification of abnormal serum proteins. The author questions many previously claimed correlations between morphologic and biochemical findings and diagnosis and prognosis, including recent data purporting to show characteristic chromosomal abnormalities in multiple myeloma and other "gammapathies." On the other hand, his studies confirmed that plasma cells with strongly eosinophilic cytoplasm—"flaming cells"—are frequently associated with prevalence of the IgA serum fraction. The book offers much more than promised in the title. Many fascinating aspects
Septic Arthritis Mimicking Cellulitis: Distinction Using Radionuclide Bone Imaging
Authors: STEVEN G. ATCHESON, R EDWARD COLEMAN, JOHN R. WARD
Journal: Clinical Nuclear Medicine (1979)

Two patients originally diagnosed as having cellulitis involving the dorsum of the foot actually had bacterial arthritis of an underlying joint. In both patients, even after pyarthrosis was suspected, the wrong joint was aspirated. The arthropathies were located by subsequent 99mTc-phosphate bone imaging at a time when roentgenograms were normal. Early diagnosis and aggressive therapy of septic arthritis are essential to prevent joint destruction and osteomyelitis. Radionuclide bone imaging can identify inflammatory joint disease but it cannot specify etiology. In our patients, however, the differential diagnosis was between skin and joint infection. Radionuclide imaging was of great help in making this distinction.
More on Fever Shapes
Authors: HOBART A. REIMANN
Journal: Annals of Internal Medicine (1976)

Comments1 March 1976More on Fever ShapesHOBART A. REIMANN, M.D., F.A.C.P.HOBART A. REIMANN, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-84-3-344_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Doctors Murray and Mann (Ann Intern Med83:740-741, 1975) do not like the term "humpfever." But why not "butte" or "mesa" fever? Either adjective fits in appended Figure 1. The tracings remind one of cross-sections of Arizona landscape. The correspondents guessed rightly. I am not a football fan and read a book at the only game (Army-Navy) ever attended. But I have seen buttes and mesas. Anyway, all three terms exceed the descriptive value of "goalpost" fever.... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine Hahnemann Medical College and Hospital Philadelphia, Pennsylvania 19102 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1976Volume 84, Issue 3Page: 344-344KeywordsFeversGames Issue Published: 1 March 1976 PDF DownloadLoading ...
ATM regulates a DNA damage response posttranscriptional RNA operon in lymphocytes
Authors: Krystyna Mazan-Mamczarz, Patrick R. Hagner, Yongqing Zhang, Bojie Dai, Elin Lehrmann, Kevin G. Becker, Jack D. Keene, Myriam Gorospe, Zhenqui Liu, Ronald B. Gartenhaus
Journal: Blood (2011)
HLA B27 in Rheumatoid Factor-Negative Polyarthritis
Authors: J. M. ESDAILE
Journal: Annals of Internal Medicine (1977)

Eighty-three consecutive patients with rheumatoid factor-negative polyarthritis seen during a 1-year period were evaluated clinically, radiologically, and with the B27 test. Patients with definite spondylitis, juvenile chronic polyarthritis, a collagen disease, a known metabolic arthropathy, or primary generalized osteoarthritis were excluded. The patients could be classified into two groups independent of any knowledge of B27 testing. Twenty-five had a spondylitic "variant" syndrome. These could be diagnosed on clinical grounds, and included a male preponderance and a high frequency of B27 positivity. Fifty-eight patients, who could generally be classified by American Rheumatism Association criteria as having definite or classic rheumatoid arthritis, included a female preponderance and a normal prevalence of B27. Thus the B27 test was not more helpful than clinical diagnosis in the classic spondylitic variant syndromes, nor did it separate out a population of patients from among the seronegative rheumatoid arthritis group.
The Effect of <i>Aspergillus fumigatus</i> Infection on Vitamin D Receptor Expression in Cystic Fibrosis
Authors: Catherine A. Coughlan, Sanjay H. Chotirmall, Julie Renwick, Tidi Hassan, Teck Boon Low, Gudmundur Bergsson, Ahmed Eshwika, Kathleen Bennett, Katie Dunne, Catherine M. Greene, Cedric Gunaratnam, Kevin Kavanagh, Patrick M. Logan, Philip Murphy, Emer P. Reeves, Noel G. McElvaney
Journal: American Journal of Respiratory and Critical Care Medicine (2012)

Rationale: Aspergillus fumigatus (A. fumigatus) in cystic fibrosis (CF) is increasingly recognized. Although allergic bronchopulmonary aspergillosis (ABPA) leads to deterioration of pulmonary function, the effect of A. fumigatus colonization in the absence of ABPA remains unclear.Objectives: To address this, we examined individuals with CF with A. fumigatus who were ABPA negative to identify the effects of itraconazole therapy on Aspergillus-induced lung inflammation.Methods: The effect of A. fumigatus on nuclear vitamin D receptor (VDR) expression was investigated using qRT-PCR and Western blotting. IL-5 and IL-13 levels were quantified by ELISA. The effect of itraconazole was assessed by a combination of high-resolution computed tomography, lung function test, and microbiological analysis.Measurements and Main Results: We demonstrate that A. fumigatus down-regulates VDR in macrophages and airway epithelial cells and that the fungal metabolite gliotoxin (Gt) is the main causative agent. Gt overcame the positive effect of 1,25-OH vitamin D3 on VDR expression in vitro, resulting in increased IL-5 and IL-13 production. In vivo, A. fumigatus positivity was associated with increased Gt in CF bronchoalveolar lavage fluid and increased bronchoalveolar lavage fluid levels of IL-5 and IL-13. After airway eradication of A. fumigatus with itraconazole, we observed decreased Gt, IL-5 and IL-13, improved respiratory symptoms, and diminished high-resolution computed tomography mosaic pattern consistent with sustained pulmonary function.Conclusions: This study provides a rationale for the therapeutic effect of itraconazole and implied that the therapeutic potential of vitamin D supplementation in preventing ABPA is only feasible with concurrent elimination of A. fumigatus to permit VDR expression and its positive functional consequences.
Long-term exercise performance after percutaneous transluminal coronary angioplasty and coronary artery bypass grafting.
Authors: B Meier, A R Gruentzig, W E Siegenthaler, M Schlumpf
Journal: Circulation (1983)

In our first 169 consecutive patients admitted to undergo percutaneous transluminal coronary angioplasty (PTCA) serial bicycle ergometric exercise sessions were scheduled to assess long-term-exercise performance. In 160 of these 169 patients (95%) an average of seven ergometric measurements were available during a mean follow-up period of 29 months (range 1 to 60 months). Two groups were formed. One consisted of 132 patients in whom PTCA was successful and the other consisted of 28 patients with failure of PTCA who subsequently underwent coronary artery bypass grafting (CABG) either on an emergency basis (12 patients) or as an elective procedure (16 patients). Exercise performance was expressed as work capacity in watts according to the highest completed exercise stage. In the successful PTCA group the actual work capacities increased from 74 +/- 42 W (mean +/- SD) before PTCA to 122 +/- 47 W at the most recent follow-up examination. In patients who underwent emergency or elective CABG the respective figures were 73 +/- 34 or 65 +/- 37 W before surgery and 120 +/- 41 or 119 +/- 41 W at the most recent follow-up examination (p less than .005 for all preprocedure to postprocedure comparisons). Successful PTCA and CABG after failed PTCA improve work capacity significantly. Comparison of our results with those of surgical studies indicates that a failed attempt at PTCA before CABG does not compromise the functional outcome of the operation, regardless whether it is done on an emergency or on an elective basis.