tbuckley/cabot-search huggingface dataset:
The hospital of the future: Is bigger better? Concentration in the provision of secondary care
Authors: J. Posnett
Journal: BMJ (1999)

A close observer of the NHS over the past 10 years might be forgiven for thinking that the debate about the concentration of acute hospital services has been driven more by the needs of NHS managers and the medical professions than by the needs of the local populations that they are supposed to serve. Managers have faced pressures to reduce unit costs and, in particular, the “wasteful” costs of management itself. The medical professions, through their respective royal colleges, have encouraged the closure or rationalisation of smaller units through pressures for greater subspecialisation.

The result has been pressure for further concentration in the provision of hospital services through rationalisation and trust mergers. The logic is inescapable: larger units reduce average costs through the operation of economies of scale and larger units improve patient outcomes by increasing average volumes of activity by clinicians. Unfortunately, this logic is not supported by the evidence.

#### Summary points

NHS managers have been subject in recent years to considerable pressure to increase concentration and trust mergers

This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes

Evidence from research does not support any general presumption that larger hospitals benefit from economies of scale or that service concentration leads to improved outcomes for patients

Service planners would do well to give more prominence to the importance of ensuring that hospital services are local and easily accessible

Even the most committed believers accept that there is a limit to the operation of economies of scale. Otherwise, the most efficient solution would be to concentrate all acute hospital services for the United Kingdom at a new mega-hospital somewhere around Leeds.

The empirical literature on economies of scale …
Reasons for increased incidence of tuberculosis
Authors: A. S Pym, D. R Churchill, R. J Coker, V. Gleissberg
Journal: BMJ (1995)

When comparing the recent report by Olsen et all with the original paper by Carlsen et al I noticed differences in the graphs.Figure 1 of the original paper contains data for only 31 of the 61 publications listed in the table: 30 data points are missing.Furthermore, the difference in the circles' areas is greater than expected: the ratio of the maximum to the minimum number of subjects in the studies, expressed as a logarithm, is 4 3, but the difference in the areas of the circles is far larger (fig 1 a).Using the data given in the original paper's table, I redrew the figure (fig Ib).The overall impression is
Abstract 1853: Desmopressin Acetate Reduces Blood Loss After Cardiac Surgery: A Double-bind Randomized Controlled Trial
Authors: Ludhmila A Hajjar, Filomena Galas, Monica Fortim, Renato Melo, Rosa Ferreira, Jose Otavio Auler
Journal: Circulation (2007)

It has been suggested that desmopressin acetate (DDAVP) administration reduces blood loss after cardiac surgery. It acts by releasing von Willebrand factor multimers from endothelial cells, leading to an increase in plasma levels of von Willebrand factor and an enhancement of primary hemostasis. We have investigated the effect of DDAVP administration in a double-blind, randomized, prospective trial including 150 patients placed on cardiopulmonary bypass. Seventy-five patients received 0.3 micrograms/kg DDAVP and 75 patients received a placebo administered in a 50 ml saline solution over 15 min immediately after end of surgery. Results showed significant differences in total blood loss per square meter (258 +/− 106 ml in the DDAVP group vs 526 +/− 314 ml in the placebo group, p&lt;0.001), and in necessity for red cell transfusions (1142 +/− 205 ml in the DDAVP group vs 1774 +/− 385 ml in the placebo group, p&lt;0.005) in the first 72 hr after surgery. The prolongation of bleeding time and the decrease of factor VIII:C and factor VIII:von Willebrand factor 90 min after treatment were significantly lower (p less than .001) in the DDAVP group as compared with the placebo group. The rate of thrombosis and cardiac necrosis did not differ significantly between groups (p&gt;0.05). In conclusion, the administration of DDAVP in patients placed on cardiopulmonary bypass reduces total blood loss and needing of transfusion, without resulting in higher rates of complications.
Test method validation requirements under CLIA
Authors: Penny Keller
Journal: Clinical Cancer Research (2008)

PL08-01    CLIA Program  Congress passed the Clinical Laboratory Improvement Amendments (CLIA) in 1988 establishing quality standards for all laboratory testing to ensure the accuracy, reliability and timeliness of patient test results regardless of where the test was performed. A laboratory is defined as any facility which performs laboratory testing on specimens derived from humans for the purpose of providing information for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health. CLIA is user fee funded; therefore, all costs of administering the program must be covered by the regulated facilities, including certificate and survey costs.  The final CLIA regulations were published on February 28, 1992 and are based on the complexity of the test method; thus, the more complicated the test, the more stringent the requirements. Three categories of tests have been established: waived complexity, moderate complexity, including the subcategory of provider-performed microscopy (PPM), and high complexity. CLIA specifies quality standards for proficiency testing (PT), patient test management, quality control, personnel qualifications and quality assurance for laboratories performing moderate and/or high complexity tests. Waived laboratories must enroll in CLIA, pay the applicable fee and follow manufacturers9 instructions. Because problems in cytology laboratories were the impetus for CLIA, there are also specific cytology requirements.  The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation of CLIA, including laboratory registration, fee collection, surveys, surveyor guidelines and training, enforcement, approvals of PT providers, accrediting organizations and exempt states. The Centers for Disease Control and Prevention (CDC) is responsible for the CLIA studies, convening the Clinical Laboratory Improvement Amendments Committee (CLIAC) and providing scientific and technical support/consultation to DHHS/CMS. The Food and Drug Administration (FDA) is responsible for test categorization.  To enroll in the CLIA program, laboratories must first register by completing an application, pay fees, be surveyed, if applicable, and become certified. CLIA fees are based on the certificate requested by the laboratory (that is, waived, PPM, accreditation, or compliance) and, for moderate and high complexity laboratories, the annual volume and types of testing performed. Waived and PPM laboratories may apply directly for their certificate as they aren9t subject to routine inspections. Those laboratories which must be surveyed routinely; i.e., those performing moderate and/or high complexity testing, can choose whether they wish to be surveyed by CMS or by a private accrediting organization. The CMS survey process is outcome oriented and utilizes a quality assurance focus and an educational approach to assess compliance.
Abstract P4-04-01: A new breast cancer classification scheme based on novel classes of tumor stroma
Authors: Crista Thompson, Nicholas Bertos, Tina Gruosso, Greg Finak, Robert Lesurf, Sadiq M Saleh, Hong Zhao, Margarita Souleimanova, Sarkis Meterissian, Atilla Omeroglu, Michael T Hallett, Morag Park
Journal: Cancer Research (2015)

Abstract A major challenge in cancer treatment is the heterogeneous nature of the disease. This is particularly evident in breast cancer where gene expression profiling of whole tumours has identified multiple intrinsic subtypes of breast cancer. These subtypes are associated with differential prognoses and are correlated with previously identified clinical biomarkers (i.e., ER and HER2 status) used to stratify patients for targeted therapy. Despite recent studies demonstrating that elements within the tumour microenvironment can affect breast cancer progression and outcome, and that information contained within this compartment carries significant prognostic information for patient stratification above and beyond the information supplied by the intrinsic subtypes and existing therapeutic biomarkers, a limited understanding of stromal heterogeneity across the population has hindered the development of effective prognostic tools and targeted therapies directed against these processes. Here we perform expression profiling of the microdissected tumour-associated stromal components of 49 human breast tumours, and demonstrate that stromal heterogeneity can be captured by categorization into six classes which bear distinct molecular phenotypes. These stromal classes exhibit distinct biological functions and carry prognostic information independent of existing tumor-intrinsic biomarkers and molecular breast cancer subtypes. Specific combinations of stromal class and tumour subtype are significantly over- and under-represented; furthermore, simultaneous stratification of tumors in external datasets by both tumour subtype and stroma class identifies good- and poor-outcome cohorts within four of the five molecular breast cancer subtypes. The stroma classes identified here form the basis for an improved breast cancer classification scheme which takes the contribution of the microenvironment into account. Citation Format: Crista Thompson, Nicholas Bertos, Tina Gruosso, Greg Finak, Robert Lesurf, Sadiq M Saleh, Hong Zhao, Margarita Souleimanova, Sarkis Meterissian, Atilla Omeroglu, Michael T Hallett, Morag Park. A new breast cancer classification scheme based on novel classes of tumor stroma [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-04-01.
Preliminary results of guanfacine treatment of acute opiate withdrawal
Authors: H Schubert, W W Fleischhacker, U Meise, C Theohar
Journal: American Journal of Psychiatry (1984)

Ten patients experiencing sudden opiate withdrawal received low doses of guanfacine. Improvement was noticeable within the first 4 days and was most evident in moderate to severe cases. The major effect was on autonomic symptoms. Tolerance to guanfacine was excellent.
834. Tumor Targeted Gene Delivery Using a Non-Viral Vector System
Authors: Puthupparampil V. Scaria, Raymond M. Schiffelers, Aslam Ansari, Gert Storm, Qin Zhou, Martin Woodle
Journal: Molecular Therapy (2004)

Gene therapy, in principle, can be applicable to the management and cure of a variety of diseases, but efficient and targeted delivery of the therapeutic gene to the disease site has been a formidable challenge. Local delivery of genes has some limited utility. But development of a delivery vector that provides tissue and cell targeted gene delivery from systemic administration is critical for the success of gene therapy. This is extremely important in the treatment of cancer where access to metastasized cancer is critical for an effective treatment. Much of the efforts in vector development thus far have been in the area of viral vectors. Viruses are natural gene delivery agents, but they lack the high tissue specificity required for targeted delivery of a therapeutic gene. In addition, they are highly immunogenic, which reduces their utility as a repeatable treatment modality, and also some of them have highly undesirable effect of non-specific insertion into the chromosome. As a result, viral vectors for gene therapy have significant hurdles to cross before they can ever be acceptable. As an alternative to viral vectors, non-viral vectors constituting synthetic molecules have been developed. They do not share some of the major drawbacks of viral vectors. They are expected to be less immunogenic and less toxic compared to viral vectors. But they are in general less efficient in their delivery efficiency. First generation synthetic vector systems have been largely an extension of transfection reagents for cell culture. These reagents were developed to transfect wide variety of cell types and hence not suitable for targeted delivery of the therapeutic genes. Development of systemic targetable vector systems for nucleic acid delivery is extremely important for the success of nucleic acid based therapeutics.
For and against: Public health does not need to be led by doctors For Against
Authors: K. McPherson
Journal: BMJ (2001)

# Public health does not need to be led by doctors {#article-title-2} For years lead positions in public health have been restricted to those with a medical background, and it is still impossible for individuals to be accredited as specialists in public health without medical training. But does such exclusivity have repercussions? Here a professor of epidemiology and two directors of public health present their views. # For {#article-title-3} Public health is the science and art of promoting, protecting, and improving health and wellbeing through organised efforts of society.1 It encompasses all influences throughout life and, because the diversity is crucial, must be multidisciplinary.2 Whether medical training enables unique qualities for leadership in public health is certainly plausible but unproved, and justifications have so far been little more than special pleading. Public health in the United Kingdom is, and has been, led by many people from several core disciplines: Chadwick, Chalmers, Cochrane, Day, Davey Smith, Doll, Farr, Greenwood, Hill, Morris, Nightingale, Peto, Rose, Titmus, Stacey to name but a few. It will surely continue to do so. Yet for half a century a medical hegemony (legitimate or otherwise) has implied medical ownership and protection of careers, training, and accreditation in public health. All top public health jobs in the NHS and elsewhere from the chief medical officer down are protected, if not by law, by the BMA. It remains impossible to be accredited as a specialist in public health and, until quite recently, to attend postgraduate public health courses without a medical training. Funding for training and career opportunities are still grossly unequal and all this has clearly tended to confine others to roles different from, or ancillary to, public health. Until the need for this is satisfactorily justified it is a scandal. The academic sector is only now becoming an exception, where for too long the research, the teaching (exclusively of doctors), … Correspondence to: Edward Coyle
Rapid benefit of intravenous pulse loading of clomipramine in obsessive- compulsive disorder
Authors: L M Koran, F R Sallee, S Pallanti
Journal: American Journal of Psychiatry (1997)

The authors conducted a randomized, double-blind, placebo-controlled trial of intravenous versus oral pulse loading of clomipramine in patients with obsessive-compulsive disorder to test two hypotheses: 1) intravenous pulse loading will cause greater immediate improvement than oral pulse loading and 2) patients who respond to pulse loading will continue to improve during 8 weeks of oral clomipramine treatment.Fifteen patients with DSM-III-R obsessive-compulsive disorder of at least 1 year's duration and baseline Yale-Brown Obsessive Compulsive Scale scores of 17 or higher were enrolled in the study. Yale-Brown scale ratings were made 4.5 days after double-blind oral or intravenous pulse loading of clomipramine, and patients were then given 150 mg/day of oral clomipramine with increases of 25 mg every 4 days to 250 mg/day as tolerated or, in two cases, other selective serotonin reuptake inhibitors (SSRIs).The first hypothesis was confirmed: 4.5 days after the second pulse-loaded dose, six of seven patients given intravenous clomipramine but only one of eight given oral medication responded to the drug. After 8 weeks of oral clomipramine, the results partially supported the second hypothesis: four of six patients who had responded to intravenous clomipramine continued their improvement, but those who had responded to pulse loading did not improve statistically significantly more than those who had not.Intravenous pulse loading of clomipramine may be a valuable new treatment for obsessive-compulsive disorder, particularly for patients who have failed oral treatment trials.
Medical vs Surgical Treatment of Gastroesophageal Reflux—Reply
Authors: Ronald A. Hinder
Journal: JAMA (2001)

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
EpiSouth: a network for communicable disease control in the Mediterranean region and the Balkans
Authors: M G Dente, M Fabiani, R Gnesotto, G Putoto, C Montagna, F Simon-Soria, C Martin de Pando, P Barboza, F Ait-Belghiti, M Kojouharova, N Vladimirova, R Vorou, K Mellou, G Thinus, S Declich, Collective for the EpiSouth Network
Journal: Eurosurveillance (2009)

Binary file ES_Abstracts_Final_ECDC.txt matches
Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)
Authors: M O Leach, C R M Boggis, A K Dixon, D F Easton, R A Eeles, D G R Evans, F J Gilbert, I Griebsch, R J C Hoff, P Kessar, S R Lakhani, S M Moss, A Nerurkar, A R Padhani, L J Pointon, D Thompson, R M L Warren
Journal: The Lancet (2005)
The Blood Sugar During Remission in Pernicious Anemia
Authors: Matthew C. Riddle
Journal: Annals of Internal Medicine (1930)

Article1 May 1930The Blood Sugar During Remission in Pernicious AnemiaMATTHEW C. RIDDLE, M.D.MATTHEW C. RIDDLE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-3-11-1097 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONThe similarity of the symptoms of hunger, headache, restlessness and sweating seen in early remission in patients with pernicious anemia after liver therapy and in hypoglycemia has been mentioned by Blotner and Murphy.1Investigating the blood sugar reducing properties of whole liver and liver extracts, these authors find an insulin-like, blood sugar reducing action common to whole liver and certain extracts of liver which are in-effective in the treatment of pernicious anemia. The liver extract fraction (G) of Cohn2which is effective in the treatment of pernicious anemia, they find does not exhibit this blood sugar reducing effect. In...Bibliography1 BLOTNERMURPHY HWP: Jour. Am. Med. Assn., 92, 1332, (1929). CrossrefGoogle Scholar2 COHNMINOTALLESSALTER EJGRGAWT: Jour. Biol. Chem., 77, 325. (1928). CrossrefGoogle Scholar3 CURTIS AC: Jour. Clin. Investigation, 7, 518, (1929). Google Scholar4 FOLINWU OH: Jour. Biol. Chem., 41, 367, (1920). CrossrefGoogle Scholar5 WALINSKEY F: Deutsch. med. Wochenschr., 52, 1462, (1926). CrossrefGoogle Scholar6 WEIL PE: Bull. et Mem. Soc. Med. d. hôp. de Paris, 51, 1169, (1927). Google Scholar7 VON VAGRA L: Deutsch. med. Wochenschr., 55, 433, (1929). CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Ann Arbor, Michigan*From the Thomas Henry Simpson Memorial Institute for Medical Research, University of Michigan, Ann Arbor, Michigan.†Fellow in Medicine of the National Research Council. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAmino-Acid and Protein Metabolism in Pernicious AnaemiaPhysiologie und Pathologie des AntiperniciosaprinzipsGastric acidity in relation to biliary tract disease 1 May 1930Volume 3, Issue 11Page: 1097-1103KeywordsBlood sugarHeadachesHypoglycemiaInsulinLiverPernicious anemia ePublished: 1 December 2008 Issue Published: 1 May 1930 PDF downloadLoading ...
Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology
Authors: Pascal de Groote, Richard Isnard, Pierre Clerson, Guillaume Jondeau, Michel Galinier, Patrick Assyag, Nacima Demil, Alain Ducardonnet, Jean‐François Thebaut, Michel Komajda
Journal: European Journal of Heart Failure (2009)
Abstract 17926: Non-Invasive Wave Intensity Analysis to Assess Ventricular Function in Children With Normal Ejection Fraction
Authors: Giovanni Biglino, Hopewell N Ntsinjana, Paolo Ciliberti, Vivek Muthurangu, Silvia Schievano, Robin Chung, Jan Marek, Kim H Parker, Andrew M Taylor
Journal: Circulation (2014)

Introduction:  Evaluating systolic and diastolic dysfunction in children is challenging, with a gold standard method currently lacking. We propose a novel non-invasive potential biomarker, derived from cardiac magnetic resonance (CMR) imaging data, comparing its diagnostic performance against other echocardiographic and CMR parameters.   Methods:  Patients with presumed diastolic dysfunction (n=18; 9 aortic stenosis, 5 hypertrophic cardiomyopathy, 4 restrictive cardiomyopathy) were compared with age-matched control subjects (n=18). All patients had no mitral regurgitation, aortic incompetence, significant residual aortic stenosis or reduced systolic ejection fraction (EF). E/A ratio, E/E’ ratio, deceleration time and isovolumic contraction time (IVCT) were assessed from echocardiography, and left atrial volume (LAVi), acceleration time (AT), ejection time (ET) and wave intensity analysis were calculated from CMR. Wave intensity was obtained from CMR phase-contrast flow data, defining a novel biomarker from the ratio of the peaks of the early systolic forward compression wave and the end-systolic forward expansion (FCW/FEW).   Results:  Significant differences between patients and controls were seen in the E/E’ ratio (8.7±4.0 vs. 5.1±1.3, p=0.001), LAVi (80.7±22.5 vs. 51.0±10.9 mL/m2, p   Conclusions:  This study shows that the wave intensity derived novel biomarker can provide insight into ventricular function in children, on top of CMR and echocardiography, and it was able to identify ventricular dysfunction in a small group of patients with preserved EF.
Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty11The authors have no proprietary interest in the development or marketing of this or any competing instrument or piece of equipment.
Authors: Berthold Seitz, Achim Langenbucher, Murat M Kus, Michael Küchle, Gottfried O.H Naumann
Journal: Ophthalmology (1999)