tbuckley/cabot-search huggingface dataset:
Out of hours workload of a suburban general practice: deprivation or expectation.
Authors: J Pitts, M Whitby
Journal: BMJ (1990)

The out of hours workload of a training practice in a suburban and semirural area on the south coast of England was studied for one year. An overall rate of contact of 273/1000 patients was found, which indicated a workload greater than that reported in most other studies. The duty doctor received over 35 telephone calls from patients during some Saturdays (1200 Saturday to 0800 Sunday) and Sundays (0800 to 0800 Monday), up to five being between 2300 and 0700. Of the patients who contacted a general practitioner, 44% were given advice by telephone and 4.9% were admitted to hospital. The admission rate was lower than that given in other studies. A considerable proportion of the workload arose from doctors covering the casualty department of a cottage hospital. Patients having a high expectation of 24 hour care by general practitioners in an area of comparative affluence (Jarman indices -13.8 to 1.7) may account for this aspect of the workload.
Coronary-Artery Disease in Identical Twins
Authors: James J. Sidd, Arthur A. Sasahara, David Littmann
Journal: New England Journal of Medicine (1966)

PERSONS with a common genetic origin normally grow up together and share similar environmental influences. One consequence of such a common background is the difficulty in separating etiologic environmental from genetic factors of coronary disease when it occurs in several members of one family. This report deals with 4 siblings, 2 relatively young identical twins with important coronary disease and their 2 healthy brothers of comparable age.Case ReportsCase 1. A.D., a 43-year-old Irish male court reporter, was referred for study with a 6-month history of exertional retrosternal chest pain, which occurred 2 or 3 times per day and . . .
Whose Death Is It, Anyway
Authors: Jerome S. Reich
Journal: Annals of Internal Medicine (1997)

Letters1 April 1997Whose Death Is It, AnywayJerome S. Reich, MDJerome S. Reich, MDNorth Miami Beach, FL 33169Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-7-199704010-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The essay by Hansot [1] on the intensive care given to her dying, 87-year-old mother was very moving and informative. However, in the context of the trenches of medical practice in communities around the United States, the essay did not address three major issues. In all fairness, Dr. Hansot should deal with these issues if this discussion is to be a source of information and education to physicians.First, Dr. Hansot neglected to deal with the issue of malpractice. Many malpractice suits have resulted from withdrawing life support, even when legal documents clearly expressed the patient's wishes ...REFERENCE1. Hansot E. A letter from a patient's daughter. Ann Intern Med. 1996; 125:149-51. Google Scholar Author, Article, and Disclosure InformationAuthors: Jerome S. Reich, MDAffiliations: North Miami Beach, FL 33169 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1997Volume 126, Issue 7Page: 587KeywordsElderlyEmotionsQuality of life ePublished: 15 August 2000 Issue Published: 1 April 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Trends in Androgen Prescribing in the United States, 2001 to 2011
Authors: Jacques Baillargeon, Randall J. Urban, Kenneth J. Ottenbacher, Karen S. Pierson, James S. Goodwin
Journal: JAMA Internal Medicine (2013)

Although commercial sales of androgen replacement therapy (ART) have increased substantially in recent years,1,2 to our knowledge, no national population-based studies of this treatment have been reported. In view of the conflicting evidence on the risks and benefits of ART,3-7 understanding androgen prescribing patterns in the United States is important from both a clinical and a public health perspective. We used data from Clinformatics DataMart (CDM), one of the nation's largest commercial health insurance populations, to examine androgen prescribing patterns in the United States over the past decade.
Nosocomial Bacteremia and Drug Theft
Authors: John E. McGowan
Journal: JAMA (1991)

The past few years have seen an expansion of the risks with which hospitals must deal.<sup>1</sup>Nosocomial infection has been a long-term concern that can adversely affect patient welfare and the financial well-being, accreditation, licensure, and reputation of a hospital.<sup>2</sup>Another threat is inappropriate, and in some cases criminal, acts by employees.<sup>3</sup>Sometimes these acts result from substance abuse by physicians, nurses, pharmacists, and other hospital workers.<sup>4</sup>It is not clear whether such episodes are occurring more frequently today or just being recognized more often. Occasionally, both these plagues attack simultaneously. For example, the article in this issue ofThe Journalby Maki and colleagues<sup>5</sup>reports an adverse outcome for hospitalized patients (hospital-acquired bacteremia due to<i>Pseudomonas pickettii</i>) that apparently resulted from an illegal employee action (stealing narcotic solutions used in the operating room). The episode in question occurred more than 5 years ago, and
Widespread Coronary Inflammation in Unstable Angina
Authors: Antonino Buffon, Luigi M. Biasucci, Giovanna Liuzzo, Giuseppe D'Onofrio, Filippo Crea, Attilio Maseri
Journal: New England Journal of Medicine (2002)

Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. In unstable angina, activated leukocytes may be found in peripheral and coronary-sinus blood, but it is unclear whether they are selectively activated in the vascular bed of the culprit stenosis.
Cold Precipitable Haemagglutinating Factor in Serum from patients with Rheumatoid Arthritis
Authors: Nanna Svartz, Karl Schlossmann
Journal: Annals of the Rheumatic Diseases (1955)

The agglutination test with sensitized sheep erythrocytes, first described by Meyer (1922) and rediscovered by Waaler (1940), and by Rose and others (1948), has attracted increasing interest.Since 1948 the present authors have been making various types of investigations into the test in question (Svartz, 1952).The correlation between the haemagglutinating serum factor and rheumatoid arthritis is extremely interesting in view of our observations that this factor is a component present in almost all specimens of blood sera from patients suffering from this disease.Joint fluid from patients suffering from rheumatoid arthritis gave the same results as serum (Svartz and Schlossmann, 1950).Cortisone and ACTH have no-or only a very slight-influence on the test (Svartz, 1950) (Table I).It was shown with ever-increasing clarity that not infrequently the reaction turned out to be positive in other diseases besides rheumatoid arthritis (Svartz and Schlossmann, 1952).Next to rheumatoid arthritis, lupus erythematosus disseminatus is the disease that has given the largest number of positive reactions.In addition, other "collagen diseases" (such as scleroderma, dermatomyositis, and periarteritis nodosa) give with relative frequency a positive haemagglutination test.The test is usually negative in ankylosing spondylitis, and the same is true of rheumatic fever, but here a slightly positive test is sometimes recorded.Septic arthritis and tuberculous arthritis showed negative results in our series.
18F-FDG PET/CT in a 16-Year-Old Patient With Hydranencephaly
Authors: Ryan G. Short, Arash Kardan
Journal: Clinical Nuclear Medicine (2014)

A 16-year-old male patient with a past medical history of congenital brain malformation presented for surveillance F-FDG PET/CT scan of left parotid acinic cell adenocarcinoma. F-FDG PET/CT revealed absence of gray matter activity in the bilateral cerebral hemispheres most consistent with hydranencephaly. Hydranencephaly is a rare congenital condition characterized by absent cerebral hemispheres replaced by cerebrospinal fluid-filled sacs. The etiology is hypothesized to be secondary to intrauterine bilateral internal carotid artery compromise. Most affected individuals die in utero or within weeks of birth; however, there are rare reported cases of prolonged survival as in our patient.
Healthcare lessons from Australia: what can Michael Howard learn from John Howard?
Authors: Jane Hall, Alan Maynard
Journal: BMJ (2005)

Australia is held up as a model of how to increase use of private health care in the United Kingdom, but the effects of its reforms are not all beneficial 

The Australian prime minister, John Howard, has engineered a major expansion in private healthcare insurance and been re-elected. The electorally popular Medicare provides universal coverage for free public hospital treatment, out of hospital medical services, and pharmaceuticals. Private insurance is limited to private treatment in hospital and some ancillary services, including dental care.1 Yet the two decade trend of falling insurance cover has been reversed, and over three years the proportion of the population insured grew from 30% to 45%.2 What can the leader of the British opposition, Michael Howard, and other European conservatives learn from an Australian colleague who has deliberately sought to enhance the role of the private sector?

John Howard and the Liberal party have been opposed to Medicare since its introduction in the early 1980s. In 1996, when the Liberal party was returned to government, it promised to maintain Medicare while strengthening private insurance. In fact, government policy has supported private health insurance. It introduced a 30% subsidy of the cost of premiums, which has been associated with a growth in use of private hospitals, private dental care, and other ancillary services while public hospitals and general practice, essential components of Medicare, faced growing difficulties with increased waiting time for hospital care and growing gaps between the cost to patients of primary care and Medicare reimbursements.3 4

The Australian private health insurance industry is heavily regulated; only approved insurance funds can offer health insurance, insurers (generally) are obliged to take all comers, premiums are community rated (that is, individuals pay the same rate regardless of their individual risk), and premium increases require government …
Doxorubicin-loaded highly porous large PLGA microparticles as a sustained- release inhalation system for the treatment of metastatic lung cancer
Authors: Insoo Kim, Hyeong Jun Byeon, Tae Hyung Kim, Eun Seong Lee, Kyung Taek Oh, Beom Soo Shin, Kang Choon Lee, Yu Seok Youn
Journal: Biomaterials (2012)
Slow Response to Vancomycin or Vancomycin plus Rifampin in Methicillin-resistant <i>Staphylococcus aureus</i> Endocarditis
Authors: Donald P. Levine, Barbara S. Fromm, B. Ramesh Reddy
Journal: Annals of Internal Medicine (1991)

Objective: To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. Design: Cohort analysis of a randomized study. Setting: University medical center. Patients: Forty-two consecutive patients with MRSA endocarditis were randomly assigned to receive either vancomycin (group I) or vancomycin plus rifampin (group II) for 28 days. Measurements: Clinical signs and symptoms were recorded, and blood cultures were obtained daily to determine the duration of bacteremia. Main Results: The median duration of bacteremia was 9 days (7 days for group I and 9 days for group II). The median duration of fever for all patients and for each treatment group was 7 days. Six patients failed therapy, including three patients who died 5, 6, and 9 days after therapy was started, respectively. The other three patients who failed therapy required valve surgery on days 2, 22, and 27, respectively. Although patients had sustained bacteremia, no unusual complications were seen in either treatment group, and most patients responded to continued antibiotic therapy. Conclusions: Slow clinical response is common among patients with MRSA endocarditis who are treated with vancomycin or vancomycin plus rifampin. Nevertheless, few complications appear to be related solely to this sustained bacteremia.
Cutaneous localization of chronic lymphocytic leukemia at the site of chickenpox
Authors: Marie-Sylvie Doutre, Marie Beylot-Barry, Claire Beylot, Pierre Dubus, Marie-Edith Lafont, Geneviève Belleannee, Antoine Broustet, Jean-Philippe Merlio
Journal: Journal of the American Academy of Dermatology (1997)
Evidence for T Cell-dependent Immunity to Bacteroides fragilis in an Intraabdominal Abscess Model
Authors: Andrew B. Onderdonk, Richard B. Markham, Dori F. Zaleznik, Ronald L. Cisneros, Dennis L. Kasper
Journal: Journal of Clinical Investigation (1982)

It has been shown that active immunization of rats with the capsular polysaccharide of Bacteroides fragilis protects these animals against abscess development following intraperitoneal challenge with this species. Passive transfer of hyperimmune globulin from immunized animals to nonimmune recipients provided protection against B. fragilis bacteremia in challenged animals, but did not confer protection against abscess development. On the other hand, adoptive transfer of spleen cells from immunized animals to nonimmunized recipients resulted in protection against abscesses following challenge with B. fragilis. These data suggested that a T cell-dependent immune response was involved in protection against abscess development after immunization with B. fragilis capsular antigen.
Unique Topographical Distribution of M Cells Underlies Reentrant Mechanism of Torsade de Pointes in the Long-QT Syndrome
Authors: Fadi G. Akar, Gan-Xin Yan, Charles Antzelevitch, David S. Rosenbaum
Journal: Circulation (2002)

Background — Specific ion channel mutations underlie the congenital long-QT syndrome (LQTS). However, the mechanisms by which dysfunction at the molecular level translates into functional electrical instability leading to torsade de pointes (TdP) in LQTS are poorly understood. Methods and Results — The cellular basis of TdP was investigated using a novel approach of transmural optical imaging in the canine wedge preparation (n=14). The spatial organization of repolarization and arrhythmogenesis were determined in a surrogate model of LQT2. Action potentials were recorded simultaneously from 128 sites spanning the transmural wall of the left ventricle. In LQT2, QT interval prolongation was paralleled by an abrupt rise in transmural dispersion of repolarization (DOR) from 2.7±0.9 ms/mm (controls) to 12.2±2.1 ms/mm (LQT2). Islands of midmyocardial (M) cells formed zones of increased refractoriness in LQT2, producing steep spatial gradients of repolarization that were directly responsible for conduction block and self-sustained intramural reentrant circuits underlying TdP. Conclusions — These data provide direct evidence supporting the functional expression of M cells in intact myocardium and a central role for M cells in the development of reentrant TdP arrhythmias in LQTS.
Surgery, in the Days of Controversy
Authors: George Crile
Journal: JAMA (1989)

My father was George Crile, a world-famous surgeon who participated in the founding of the American College of Surgeons and was one of its first presidents. I was his first son and I never had a chance of growing up to be anything but a surgeon. The years at Harvard Medical School (Boston, Mass), from 1929 to 1933, were exciting because in those days students were sent out to "the district" with no significant training to deliver babies. Although we had access to backup by residents, they were about an hour away. I had one tragedy after another, all the way from a tiny preemie, who barely made it, to a 15-lb baby of a diabetic who did not. Then and there I vowed not to go into obstetrics. Surgery at the Harvard Hospitals was unspecialized in those days. Mastectomies in Boston always were radical and took 3 to 4
Neutropenia in an HIV-1—Infected Renal Transplant Recipient Treated With Zidovudine
Authors: Alejo Erice
Journal: JAMA (1988)

To the Editor.  —Infection with the human immunodeficiency virus type 1 (HIV-1) has been described in transplant recipients.1Zidovudine constitutes the only agent active against HIV-1 that has shown some therapeutic benefit in controlled trials of patients with acquired immunodeficiency syndrome or advanced related complex.2However, zidovudine therapy has been associated with secondary effects, most importantly bone marrow toxicity.3  Guidelines for use of zidovudine in HIV-1—infected transplant recipients do not yet exist. Some investigators have suggested that these patients should be prime candidates for experimental anti-HIV therapies, including zidovudine.1The efficacy and toxicity of zidovudine therapy in HIV-1—infected transplant recipients are presently unknown. In addition, the optimal mode of zidovudine administration when treating HIV-1 infections is unknown. We report herein our experience with an HIV-1—infected renal transplant recipient in whom acute neutropenia developed early during zidovudine therapy.  Report of a Case.  —A 28-year-old man with hemophilia
Impact of congenital colour vision deficiency
Authors: Jugnoo S Rahi, Phillippa Cumberland, Catherine S Peckham
Journal: BMJ (2005)

Evidence based medicine: does it make a difference? Use wiselyEditor-The term "evidence based medicine" entered the scientific lexicon only a little more than a decade ago. 1 What caused its remarkable spread, and what are the implications of its broad and rapid diffusion?The team that coined the term at first considered using the phrase "scientific medicine" but rejected it because it implied that other approaches were by definition unscientific. 2However, critics have argued that the term evidence based medicine carries a similar moral valence and linguistic slipperiness. 3 Who could argue against the notion of providing care that integrates individual clinical skill and the best external evidence? 4 Originally developed as a method for teaching medical residents, evidence based medicine is being applied ever more broadly to the organisation and delivery of medical services.Multiple stakeholders now seek to assume its mantle for purposes that often contradict its original intent.Managers, equating lack of evidence with lack of effectiveness, use it as a rationale for cutting services.Industry generates evidence of questionable quality to promote its products.Medical researchers come to believe that they hold a monopoly on generating and interpreting evidence.Evidence based medicine, developed as a means of taming the unscientific and messy world of clinical practice, has itself entered the unscientific and messy world of politics. 5ike any technology, evidence based medicine carries risks and benefits and can be used appropriately or inappropriately.Overly inclusive definitions threaten to deprive the term of meaning, and unchecked use increases the risk of misuse.In the past decade, evidence based medicine has contributed much to how we teach, deliver, and think about clinical services.In the coming decade, we must continue to ensure that it is not only used widely but wisely.
Colonic Perforation due to Oral Mannitol
Authors: Frank M. Moses
Journal: JAMA (1988)

To the Editor.—  Oral mannitol has been used as a colonic cleaning agent to prepare patients for surgery and for roentgenographic and endoscopic procedures and as a hyperosmotic agent to treat constipation. 1 The following case report describes the previously unreported hazard of pneumatic explosion of the colon following the use of oral mannitol as a cathartic agent.  Report of a Case.—  A 52-year-old man was admitted for evaluation of chronic low-back pain and modification of analgesic usage. Constipation requiring over-the-counter laxatives was incidentally noted. Medications, which on admission included up to 150 Percodan and Tylox tablets per month, were changed to methadone hydrochloride; dexamethasone hydrochloride; amitriptyline hydrochloride; fluphenazine hydrochloride; intravenous plasma protein fraction, human (Plasmanate); clonidine hydrochloride; oxybutynin chloride; Naldecon; Urised; and tolmetin sodium. He was initially treated for constipation with Fleet enemas, oral mineral oil, milk of magnesia, and bisacodyl tablets, with minimal results. An abdominal roentgenogram, performed
Splenic Scintiscans With Merisoprol Hg 197
Authors: George Hermann
Journal: JAMA (1966)

A new radiopharmaceutical, merisoprol Hg 197, permits visualization of the spleen with a reliability, speed, and simplicity hitherto impossible with other agents. Forty-two scintiscans performed on 35 patients have proved useful in assessing splenic size, shape, and position, in demonstrating focal abnormalities, and in differentiating left upper abdominal masses. In this group, however, the spleen scan has played its most valuable role as a sensitive method of following splenic response to therapeutic regimens in those patients suffering from disorders of the hematopoietic system. Morbidity incident to spleen scanning with this new agent was nil.
Health care needs of transgendered patients
Authors: A. A. Lawrence
Journal: JAMA (1996)

<h3>In Reply.</h3> —As indicated in the acknowledgment section of my article, this study was designed with help from Dr Decktor himself. The study was a pharmacodynamic investigation in normal volunteers and not a symptom-relief study in patients with heartburn. Drs Decktor and Ciccone cite internal documents that suggest the onset of action of 10 mg of famotidine for significant heartburn relief may be more rapid than the onset of action for significant acid reduction in my pharmacodynamic study. Apparent onset of action is related not only to experimental design, but also to sample size. In my pharmacodynamic study (n=18) and that of Laskin et al<sup>1</sup>(n=2), apparent onset of action with 10 mg of famotidine was approximately 90 minutes. In the personal communication and internal report referred to by Decktor and Ciccone, sample size was much larger, perhaps making it easier to show significant differences between placebo and famotidine at earlier
Abstract 2948: c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38 MAPK) are involved in local anesthetics-induced apoptosis in human thyroid cancer cells.
Authors: Shih-Ping Cheng, Yuan-Ching Chang, Yi-Chiung Hsu, Shih-Yuan Huang, Meng-Chun Hu, Chin-Wen Chi, Sung-Liang Yu
Journal: Cancer Research (2013)

Abstract Local anesthetics are known to induce apoptosis in clinically relevant concentrations. However, it is unknown whether the effects are also present in thyroid cancer cells and the mechanisms are not well uncharacterized. We sought to explore the effects of lidocaine and bupivacaine on thyroid cancer cells in terms of cell growth, colony formation, cell cycle, induction of apoptosis, and mitochondrial injury. At 24 hour, lidocaine had an IC50 value of 6.8 mM to 7.3 mM, whereas bupivacaine had an IC50 value of 1.3 mM to 3.1 mM. In search for a molecular mechanism, based on microarray and pathway analysis, we determined that apoptotic activity is mediated by the c-jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38 MAPK). Our data suggest that induction of apoptosis by local anesthetics has the potential to improve the regional control of thyroid cancer. Citation Format: Shih-Ping Cheng, Yuan-Ching Chang, Yi-Chiung Hsu, Shih-Yuan Huang, Meng-Chun Hu, Chin-Wen Chi, Sung-Liang Yu. c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38 MAPK) are involved in local anesthetics-induced apoptosis in human thyroid cancer cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2948. doi:10.1158/1538-7445.AM2013-2948