tbuckley/cabot-search huggingface dataset:
Annual league tables of mortality in neonatal intensive care units: longitudinal study
Authors: G. J Parry, C. R Gould, C. J McCabe, W. O Tarnow-Mordi
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objective:</b> To assess whether crude league tables of mortality and league tables of risk adjusted mortality accurately reflect the performance of hospitals. <b>Design:</b> Longitudinal study of mortality occurring in hospital. <b>Setting:</b> 9 neonatal intensive care units in the United Kingdom. <b>Subjects:</b> 2671 very low birth weight or preterm infants admitted to neonatal intensive care units between 1988 and 1994. <b>Main outcome measures:</b> Crude hospital mortality and hospital mortality adjusted using the clinical risk index for babies (CRIB) score. <b>Results:</b> Hospitals had wide and overlapping confidence intervals when ranked by mortality in annual league tables; this made it impossible to discriminate between hospitals reliably. In most years there was no significant difference between hospitals, only random variation. The apparent performance of individual hospitals fluctuated substantially from year to year. <b>Conclusions:</b> Annual league tables are not reliable indicators of performance or best practice; they do not reflect consistent differences between hospitals. Any action prompted by the annual league tables would have been equally likely to have been beneficial, detrimental, or irrelevant. Mortality should be compared between groups of hospitals using specific criteria—such as differences in the volume of patients, staffing policy, training of staff, or aspects of clinical practice—after adjusting for risk. This will produce more reliable estimates with narrower confidence intervals, and more reliable and rapid conclusions. <h3>Key messages</h3> League tables are being used increasingly to evaluate hospital performance in the United Kingdom In annual league tables the rankings of nine neonatal intensive care units in different hospitals had wide and overlapping confidence intervals and their rankings fluctuated substantially over six years Annual league tables of hospital mortality were inherently unreliable for comparing hospital performance or for indicating best practices The UK government9s commitment to using annual league tables of outcomes such as mortality to monitor services and the spread of best practices should be reconsidered Prospective studies of risk adjusted outcome in hospitals grouped according to specific characteristics would provide better information and be a better use of resources
Clinical Diagnosis: A Textbook of Physical Signs and Symptoms for Medical Students and Practitioners
Authors: R. Drew Miller
Journal: JAMA (1964)

In a concise but surprisingly comprehensive work, Dr. Vakil describes and illustrates many well-known symptoms and signs in physical diagnosis as well as a number of those which are somewhat less common. The volume is noteworthy for two reasons. First, the author has considered in each case how symptoms relate to disease states and their physical findings. This logical approach is not frequently utilized in many textbooks of physical diagnosis. Second, he describes a variety of special techniques for eliciting disease signs. In speaking of myxedema, for example, he notes the slow return of the ankle tendon reflex, a less commonly appreciated but valuable physical sign. Such basic items are generously sprinkled through the book. Liberal use of photographs and simple line diagrams have complemented the text. The volume is unique in emphasizing diseases widespread in India. For this reason, the book is recommended especially for students and physicians going
Peer Review—An Educational Necessity?
Authors: Rutledge W. Howard
Journal: JAMA (1973)

Historically, peer review has had many uses, with equals double-checking equals for various reasons. One of its purposes in medicine has been to determine how well a physician is doing in his care of patients. Peer review is carving a new niche for itself in the field of medical education, especially in continuing medical education. It is beginning to serve as a useful tool in helping physicians determine their educational needs and thereby to know<i>what</i>to learn that will improve their performance as practicing physicians. Other modalities can be employed to assist the individual to identify his level of knowledge or the quality of his techniques, or even his lines of reasoning in patient care management. For example, self-evaluation techniques in these areas have been organized and refined by many of the speciality medical societies. Forums, conferences, seminars, workshops, courses, and other types of continuing medical education permit a
Health library in India works to empower patients
Authors: A. Malpani
Journal: BMJ (1999)

EDITOR—The main reason patients have not been treated as partners1 in India is that traditionally it has always been the doctor who has had all the information about medical problems: the patient simply followed the doctor's orders. However, today we know that if we empower patients with information about their medical problems, they can become educated partners in their own medical care.2

Thus, the Health Education Library for People (HELP) in Bombay was launched in May 1996. This is India's first consumer …
Intravital Imaging Reveals Transient Changes in Pigment Production and Brn2 Expression during Metastatic Melanoma Dissemination
Authors: Sophie Pinner, Peter Jordan, Kirsty Sharrock, Laura Bazley, Lucy Collinson, Richard Marais, Elise Bonvin, Colin Goding, Erik Sahai
Journal: Cancer Research (2009)

Abstract How melanoma acquire a metastatic phenotype is a key issue. One possible mechanism is that metastasis is driven by microenvironment-induced switching between noninvasive and invasive states. However, whether switching is a reversible or hierarchical process is not known and is difficult to assess by comparison of primary and metastatic tumors. We address this issue in a model of melanoma metastasis using a novel intravital imaging method for melanosomes combined with a reporter construct in which the Brn-2 promoter drives green fluorescent protein (GFP) expression. A subpopulation of cells containing little or no pigment and high levels of Brn2::GFP expression are motile in the primary tumor and enter the vasculature. Significantly, the less differentiated state of motile and intravasated cells is not maintained at secondary sites, implying switching between states as melanoma cells metastasize. We show that melanoma cells can switch in both directions between high- and low-pigment states. However, switching from Brn2::GFP high to low was greatly favored over the reverse direction. Microarray analysis of high- and low-pigment populations revealed that transforming growth factor (TGF)β2 was up-regulated in the poorly pigmented cells. Furthermore, TGFβ signaling induced hypopigmentation and increased cell motility. Thus, a subset of less differentiated cells exits the primary tumor but subsequently give rise to metastases that include a range of more differentiated and pigment-producing cells. These data show reversible phenotype switching during melanoma metastasis. [Cancer Res 2009;69(20):7969–77]
TCTAP A-041 Inhibiting Mobilization of Ly6Chigh Monocytes After Acute Myocardial Infarction Enhanced the Efficacy of Mesenchymal Stromal Cells Transplantation and Curbed Myocardial Remodeling
Authors: Wenbin Lu, Fu Cong, Wang Xin, Genshan Ma
Journal: Journal of the American College of Cardiology (2015)
SHOULD CULTURES FOR BACTERIOLOGIC EXAMINATIONS BE TAKEN FROM THE NASAL CHAMBERS AS WELL AS FROM THE THROAT IN CASES OF SUSPECTED DIPHTHERIA.
Authors: E. LARUE VANSANT
Journal: JAMA (1897)

Recently I commenced to take cultures for bacteriologic examination from the nasal chambers as well as from the membranous deposits in the throat in cases of suspected diphtheria. The nasal cultures were made by pushing the swab back to the posterior portion of the nasal chambers, but not going through to the pharynx. Those from the throat were made by rubbing the swab over the surface of the membranes before any remedial application had been made. In the following two instances the bacteriologic examination showed diphtheria bacilli in the cultures from the nose, and gave negative results in those from the throat. The bacteriologic examinations were made by Dr. W. J. Gillespie, to whom I acknowledge my indebtedness: <h3>Case 1.</h3> —Mr. M. H., age 46 years, seen Nov. 25, 1896, has a history of several attacks of quinsy during his life. His present illness dates from a chill three days
Chromosome Studies During Early and Terminal Chronic Myeloid Leukaemia
Authors: N. H. Kemp, J. L. Stafford, R. Tanner
Journal: BMJ (1964)

Case IThe patient was a man aged 39 in 1959.Polycythaemia rubra vera was first diagnosed in March 1959, when albuminuria, noted when he was undergoing treatment for chronic eczema, was being investigated.The findings at this time were: haemoglobin (Hb) 19.4 g./100 ml.; packed-cell volume (P.C.V.) 59%; white-cell count (W.B.C.) 25,200/c.mm. (neutrophils 68%, lymphocytes 25%, monocytes 7%); platelets 486,000/c.mm.The patient was effectively treated, initially by venesection; later, in addition, he received three injections each of 5 mc. of 32P.The haematological findings in this patient from the time of diagnosis until death are shown in Fig. 1.
Effects of beta-adrenergic receptor blockade in normal subjects before, during, and after triiodothyronine-induced hypermetabolism.
Authors: W R Wilson, E O Theilen, J H Hege, M R Valenca
Journal: Journal of Clinical Investigation (1966)

Adequate oral or intravenous doses of a beta- adrenergic receptor-blocking drug, nethalide,' pro- duce no significant changes in the resting oxygen consumption, heart rate, cardiac output, and sys- temic mean arterial or mean right atrial pressures of patients with spontaneous hyperthyroidism (1).These findings do not support the concept that the hemodynamic changes in hyperthyroidism are mediated through adrenergic stimulation of beta- adrenergic receptors.The work of Brewster, Isaacs, Osgood, and King, however, supported the hypothesis that the sympathetic nervous system may be responsible for the metabolic and hemo- dynamic changes associated with the hypermeta- bolic state, since the alterations induced by thyroid feeding to dogs could be abolished by epidural blockade (2).The possibility exists that spontaneous hyperthyroidism and drug-induced hyper- metabolism may have similar hemodynamic findings but different mechanisms.This study was designed to test the effects of beta-adrenergic blockade in normal subjects before, during, and after the induction of hypermetabolism with triio-*
INVERSE RELATIONSHIP BETWEEN THE PRESENCE OF TRADITIONAL RISK FACTORS AND INHOSPITAL MORTALITY FOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION &amp;ndash; PARADOX OR PARADIGM!
Authors: Abhishek Deshmukh, Sadip Pant, Gagan Kumar, Karthik Murugiah, Parloop Bhatt, Rajesh Sachdeva, Jawahar Mehta
Journal: Journal of the American College of Cardiology (2012)
Letter: Metabolism of barbiturate after overdosage.
Authors: D J Sumner, J Kalk, B Whiting
Journal: BMJ (1975)

Acute Calf Swelling SIR,-Dr.B. Thalayasingam and others (21 December, p. 719) point out that acute synovial rupture of the knee joint may cause an acute swelling of the calf which closely mimics deep vein thrombosis.They add that this condition is underdiagnosed and blame in part its poor documentation in the general medical literature.However, there may be a further reason for its underdiagnosis.We have recently described a patient who presented with an acute swelling of the calf.'This was diagnosed as due to a deep vein thrombosis and the diagnosis was apparently confirmed by the elevated uptake of '5I-radiofibrinogen measured over the affected area.During treatment with heparin he developed a haematoma of the calf, and the true diagnosis of ruptured synovium of the knee joint was then established by arthrography.The false positive result of the radiofibrinogen test was probably due to the radioactive material in blood and synovial fluid trucking down into the muscles of the calf.
The Effect of Funding Source on Outcome Reporting Among Drug Trials
Authors: Adam Jacobs
Journal: Annals of Internal Medicine (2011)

Letters18 January 2011The Effect of Funding Source on Outcome Reporting Among Drug TrialsAdam Jacobs, PhD, MScAdam Jacobs, PhD, MScFrom Dianthus Medical Limited, London SW19 2RL, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-2-201101180-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read the recent article by Bourgeois and colleagues (1) and had questions about the analysis of how many trials were published within 2 years.First, what was the rationale for choosing 2 years as the cutoff? The choice clearly affects the conclusions, as the authors' Table 3 shows that the publication rate of industry-funded studies was no longer lagging behind other categories if the outcome “ever published” is considered. In fact, if you include posting of electronic results as a form of publication, then industry-funded studies had the highest publication rate. It seems that choosing 3 ...References1. Bourgeois FT, Murthy S, Mandl KD. Outcome reporting among drug trials registered in ClinicalTrials.gov. Ann Intern Med. 2010;153:158-66. [PMID: 20679560] LinkGoogle Scholar2. Jacobs A. More on industry vs non-industry publications. Accessed at dianthus.co.uk/more-on-industry-vs-non-industry-publications on 24 November 2010. Google Scholar Author, Article, and Disclosure InformationAuthors: Adam Jacobs, PhD, MScAffiliations: From Dianthus Medical Limited, London SW19 2RL, United Kingdom.Disclosures: Dr. Jacobs is the Director of Dianthus Medical Limited, which provides publication writing services both to pharmaceutical companies and academic researchers. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOutcome Reporting Among Drug Trials Registered in ClinicalTrials.gov Florence T. Bourgeois , Srinivas Murthy , and Kenneth D. Mandl The Effect of Funding Source on Outcome Reporting Among Drug Trials Deborah A. Zarin and Tony Tse The Effect of Funding Source on Outcome Reporting Among Drug Trials Florence T. Bourgeois , Kenneth D. Mandl , and Srinivas Murthy The Effect of Funding Source on Outcome Reporting Among Drug Trials Erick H. Turner Metrics 18 January 2011Volume 154, Issue 2Page: 137KeywordsConflicts of interestDrugsMultivariate analysis ePublished: 18 January 2011 Issue Published: 18 January 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
REPEATED EXTRA-UTERINE PREGNANCY WITH THE REPORT OF A CASE.Read in the Section of Obstetrics and Diseases of Women, at the Forty-fourth Annual Meeting of the American Medical Association.
Authors: GEORGE I. McKELWAY
Journal: JAMA (1893)

On the 14th of February, 1891, Mrs. M., the wife of a lawyer, consulted me, giving me the following history: She was 30 years old, had been married the previous September, had been perfectly well and had believed herself two months pregnant, when, on the 25th of January, 1891, while staying at Atlantic City, she had a profuse hemorrhage from her uterus. A physician was called who, from her statement of probable pregnancy and hemorrhage alone, diagnosticated an abortion. The patient did not remember having passed any mass, or having at that time had any severe pam or colic. This physician saw her only once more in the ten days that followed. On the tenth day she sat up and for one week thereafter the hemorrhage continued. She said that the physician made no examination at any time and gave her no treatment except to order her to keep her
Nursing and medicine: cooperation or conflict?
Authors: A. Bradshaw
Journal: BMJ (1995)

Two years ago a newspaper's foreign correspondent in Russia described her observations of health care in post-communist Moscow. Through her visits to a sick friend in hospital and conversations with her taxi driver, whose mother was in hospital, the correspondent came to see a system of health care based on contractual, material rewards: flowers, chocolates, and perfume for the nurses; crates of whisky for the doctors. Sitting on her friend's bed (for which the patient had to provide her own linen and pillows), the correspondent watched in horror as nurses provided the expected “tender loving care” to some patients—changing bedclothes, taking temperatures, and giving tea—but ignored other patients completely, even if their sheets were horribly soiled and they were crying out for a glass of water. These patients, or their relatives, had failed to give the nurses any presents: no presents, no nursing. The correspondent concluded that we should be thankful for our own NHS.1

But I wonder if the correspondent's horror at the cold hearted contractual nursing she witnessed was the result of her own assumed and inherited expectations that nurses are inducted into a tradition of “tender loving care”? Does she still taste the fruit of a tree which is now almost cut down? British nursing, under the powerful influence of North American sociological, psychological, and educational nursing theory, has undergone a rapid transformation since the 1970s, which makes such assumptions questionable. Indeed the past 20 years have seen a revision of nursing history and a rejection of the traditional nursing ethos. Contemporary British nursing theorists …
Treatment Failure After Substitution of Generic Pancrelipase Capsules-Reply
Authors: L. Hendeles, A. Stecenko, M. Weinberger
Journal: JAMA (1990)

<h3>In Reply.—</h3> Drs Haymes and Levy have made a distinction between pharmaceutical alternates and pharmaceutical equivalents. In our report, Creon and Pancrease (McNeil Pharmaceutical, Spring House, Pa) would be examples of pharmaceutical alternates since Creon was designed specifically to contain twice the lipase content of Pancrease. In contrast, the generic formulation manufactured by Anabolic Inc and Pancrease would be examples of pharmaceutical equivalents since Anabolic manufacturedthe product with the intention of it being substituted for the McNeil formulation. Moreover, Rugby Laboratories (Rockville Center, NY), a distributor of generic drug products, advertised the Anabolic product as a generic equivalent to Pancrease in their 1989-1990 catalog, and pharmacists dispensed it as a generic equivalent. Once the generic product sold by Anabolic Inc was removed from the market-place, Rugby and Goldline, each distributors of generic products, replaced it with a formulation manufactured by Pharmaceutical Delivery Systems Inc (Creve Coeur, Mo). Technically,
THE ASSOCIATION OF BETA-BLOCKER USE AND SELECTIVITY WITH OUTCOMES IN HEART FAILURE PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FINDINGS FROM THE ORGANIZED PROGRAM TO INITIATE LIFE-SAVING TREATMENT IN HOSPITALIZED PATIENTS WITH HEART FAILURE
Authors: Robert J. Mentz, Daniel Wojdyla, Mona Fiuzat, Karen Chiswell, Tariq Ahmad, Gregg Fonarow, Christopher O&apos;Connor
Journal: Journal of the American College of Cardiology (2012)
Matrix stiffness determines the fate of nucleus pulposus–derived stem cells
Authors: Yosi Navaro, Nadav Bleich-Kimelman, Lena Hazanov, Iris Mironi-Harpaz, Yonatan Shachaf, Shai Garty, Yoav Smith, Gadi Pelled, Dan Gazit, Dror Seliktar, Zulma Gazit
Journal: Biomaterials (2015)
Second opinion reduces hysterectomies for uterine fibroids, study shows
Authors: S. Mayor
Journal: BMJ (2014)

Seeking a second opinion reduces the number of women undergoing a hysterectomy for symptomatic uterine fibroids, shows a study that indicates that multidisciplinary evaluation increases the use of less invasive treatments for this common condition.1

The researchers retrospectively reviewed treatment pathways for 205 women who were consecutively evaluated at a tertiary care multidisciplinary fibroid centre at the University of California in Los Angeles between July 2008 and August 2011. Most of the women had already …
Adiponectin protects LPS-induced liver injury through modulation of TNF-? in KK-Ay obese mice
Authors: Takayuki Masaki, Seiichi Chiba, Hiroshi Tatsukawa, Tohru Yasuda, Hitoshi Noguchi, Masataka Seike, Hironobu Yoshimatsu
Journal: Hepatology (2004)

Adiponectin, an adipocytokine, has been identified in adipose tissue, and its receptors are widely distributed in many tissues, including the liver. The present study was performed to clarify the role of adiponectin in lipopolysaccharide (LPS)-induced liver injury using KK-Ay obese mice. We analyzed the effects of adiponectin pretreatment on liver injury induced by D-galactosamine/LPS (GalN/LPS) in KK-Ay obese mice. GalN/LPS treatment induced significant increases in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in the blood, apoptotic and necrotic changes in hepatocytes, and/or showed a high degree of lethality. The GalN/LPS-induced liver injury was more pronounced in KK-Ay obese mice than in lean controls. Pretreatment with adiponectin ameliorated the GalN/LPS-induced elevation of serum AST and ALT levels and the apoptotic and necrotic changes in hepatocytes, resulting in a reduction in lethality. In addition, pretreatment with adiponectin attenuated the GalN/LPS-induced increases in serum and hepatic tumor necrosis factor alpha (TNF-alpha) levels and increased peroxisome proliferator-activated receptor (PPAR) alpha messenger RNA expression in the liver. Furthermore, abdominal macrophages from KK-Ay obese mice pretreated with adiponectin in vitro exhibited decreased LPS-induced TNF-alpha production compared with controls. Finally, adiponectin pretreatment also ameliorated TNF-alpha-induced liver injury. In conclusion, these findings suggest that adiponectin prevents LPS-induced hepatic injury by inhibiting the synthesis and/or release of TNF-alpha of KK-Ay obese mice.
HISTOLOGICAL CHANGES FOLLOWING OVARIECTOMY IN MICE
Authors: Elizabeth Fekete, George Woolley, C. C. Little
Journal: The Journal of Experimental Medicine (1941)

1. In dba mice ovariectomized at birth the vagina, uterus, and mammary glands showed a gradual recovery from the castrate state, and finally reached the stage which they presumably can attain only under the influence of estrogenic hormones. Tumors of the mammary glands developed in 37 animals, of 75 examined, between the ages of 14 and 28 months (3 adenomas and 34 carcinomas). 2. As ovarian regeneration had not taken place the probability that estrogen originated in some other organ in the absence of the ovaries is suggested. 3. The consistent nodular hyperplasia of the suprarenal cortex and close morphological similarity of cells of these nodules to lutein-like cells of the ovaries points to the abnormal suprarenals as possible sources of the estrogenic hormones.
Accounting for female strategic variation
Authors: J. Michael Bailey
Journal: Behavioral and Brain Sciences (2000)

Gangestad &amp; Simpson's theory accounts for the existence of male strategic variation admirably well, although it does not specify the precise nature of the adaptation linking male developmental stability to strategic pluralism. In contrast, female strategic variation remains elusive. Empirical data suggest that genetic variation partly underlies such variation, but the causes of female strategic differences largely remain unexplained.