tbuckley/cabot-search huggingface dataset:
Interphalangeal Joint Infections
Authors: I. J. Cunningham, E. R. Hitchcock, A. B. Watson
Journal: BMJ (1959)

Comparatively little attention has previously been paid to the uncommon but disabling condition of interphalangeal joint infection.Lowden (1955) stated that it was rare, and Riddell (1950), in a survey of 2,000 septic conditions of the hand, was able to describe only five cases, although Bentley (1950) considered that it was not uncommon following direct injury to the fingers, or as a complication of spread of infection to the joint from local sepsis.It is less rare in our experience than acute suppurative tenosynovitis, to which more
Identification of Susceptibility to Malignant Hyperpyrexia
Authors: R. F. W. Moulds, M. A. Denborough
Journal: BMJ (1974)

While the serum level of creatine phosphokinase is useful as a screening test for malignant hyperpyrexia it does not provide certain identification of susceptible individuals. A much more accurate prediction may be made by pharmacological testing in vitro of muscle biopsy specimens. Individuals susceptible to malignant hyperpyrexia have muscle with heightened sensitivity to halothane, caffeine, succinylcholine, potassium chloride, and temperature change. Use of this test allows separation of susceptible individuals from those not at risk in families of patients who have experienced malignant hyperpyrexia.
Global commissioning by general practitioners
Authors: J. Shapiro
Journal: BMJ (1996)

The purchaser-provider split was introduced to allow “money to follow patients”1 and to move control away from hospital providers towards those making the purchasing decisions. General practitioner referrals were seen as being at the core of those decisions, and general practitioner fundholding aimed to bring the decision making directly into the consulting room. The range of services purchased by fundholders has grown steadily and will cover virtually all elective services from April 1996.2 Conceptually, it makes sense to test the idea of general practitioner purchasing to the limit by applying it to the purchasing of all services, and various models are being explored. Some involve the direct purchasing of secondary care services. Others aspire to more strategic commissioning for larger populations and longer time scales. But all involve general practitioners on the “purchaser” side of the purchaser-provider split. How are these experiments shaping up to evaluation and what can they tell us about the future shape of healthcare in Britain?

Existing models of general practitioner purchasing range from the four current “pioneer” total purchasing projects (in Berkshire, Bromsgrove, Runcorn, and Worth Valley and the 50 or so sites planned for the “second wave” of total purchasing3; through the gamut of different locality projects (exemplified by Newcastle and North Tyneside's …
Patient Requests for Nonbeneficial Care
Authors: Ami Laws
Journal: JAMA (2012)

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
Republican leaders outline plan to replace Affordable Care Act
Authors: M. McCarthy
Journal: BMJ (2015)

Three top Republican Congressional leaders released a nine page document on 5 February that outlines how Republicans might replace the Affordable Care Act should the law be repealed by legislation or gutted by an upcoming Supreme Court ruling.1

Although Republicans have repeatedly vowed “to repeal and replace” the Affordable Care Act—with the US House of Representatives voting 56 times to repeal all or parts of the law since its passage in 2010—party leaders have failed to present an alternative to the law, which has made it possible for 19 million Americans to obtain health insurance.

Now that they have gained control of both the House and the Senate, and the Supreme Court is soon to hear a case challenging the legality of the Affordable Care Act’s subsidies that currently help millions of low and middle income consumers purchase insurance,2 Republicans have come under increasing pressure to tell voters how they would replace the law should it be repealed or severely undermined by the court.

The proposal, which was released by Utah’s Senator Orrin Hatch, chairman of the Senate Finance Committee, North Carolina’s Senator Richard Burr, a member of the Finance Committee, and Representative Fred Upton, a Republican from Michigan and chairman of the House Energy and …
Autonomic reflexes and non‐allergic rhinitis
Authors: A.S. Jones
Journal: Allergy (1997)

Functions traditionally ascribed to the nose include warming, humidification, and filtration of inspired air prior to its passage to the lower respiratory tract. The nose thus conditions inspired air, making it suitable for pulmonary gas exchange. In order to carry out these functions, the nose is subject to a complex series of reflexes mediated via the autonomic nervous system. The effector tissues are the nasal blood vessels and glands. Perennial non‐allergic rhinitis may be divided into two types based on the presence or absence of eosinophilia in nasal secretions. Much circumstantial evidence suggests that non‐eosinophilic non‐allergic rhinitis (NENAR) may be a disease of autonomic imbalance. In a series of studies carried out at the University of Liverpool, patients with perennial non‐allergic rhinitis, and NENAR in particular, were found to have qualitative and quantitative abnormalities in their nasal response to various stimuli as manifested by changes in nasal patency. The nasal response to axillary pressure is much reduced in NENAR patients compared with normal controls, and the normal decrease in nasal resistance in response to standing is abrogated. Isometric exercise has little effect in normal subjects, but those with NENAR demonstrate an increase in nasal resistance. A similar effect is seen in response to the cold pressor test. Of great importance for therapy is the effect of topical fluticasone propionate in patients with NENAR. Treatment normalrzes the damaged nasal reflexes seen in this condition, whereas placebo has no effect. However, abnormalities in other non‐nasal autonomic reflexes (systemic parameters) are not affected by treatment.
US hospital patients with poor English have more serious adverse events than proficient speakers
Authors: Roger Dobson
Journal: BMJ (2007)

Hospital patients in the United States who have limited English proficiency are more likely to be harmed by adverse events than other patients, a new study shows.

Nearly half of the adverse events looked at in the study that occurred in patients with limited English involved physical harm to these patients, whereas only 30% of adverse events recorded as having occurred in proficient English speakers resulted in harm, says the study, which was published online on 2 February in the International Journal for Quality in Health Care (http://intqhc.oxfordjournals.org, doi: 10.1093/intqhc/mzl069).

The authors, who say that the absence …
Connective tissue proteins and phagocytic cell function. Laminin enhances complement and Fc-mediated phagocytosis by cultured human macrophages.
Authors: J F Bohnsack, H K Kleinman, T Takahashi, J J O'Shea, E J Brown
Journal: The Journal of Experimental Medicine (1985)

Brief exposure of culture-derived human macrophages to laminin, a glycoprotein component of all mammalian basement membranes that has a molecular weight of 1,000,000, led to enhancement of subsequent macrophage phagocytosis of EAC4b, EAC3bi, and EAIgG (sheep erythrocytes sensitized with IgG anti-Forssman antibody). This effect on macrophage phagocytosis occurred with both substrate-adherent and fluid phase laminin. Preincubation of macrophages, but not of EAC4b, with laminin led to augmentation of phagocytosis, suggesting that interaction with the phagocytic cell, but not with the opsonized particle, was required for laminin's effect. Laminin-stimulated phagocytosis of EAC4b was blocked entirely by a monoclonal antibody to CR1. Direct comparison of the phagocytic ability of macrophages adherent to laminin- and fibronectin-coated glass slides showed that fibronectin had a somewhat greater enhancing effect on phagocytosis. Nonetheless, the phagocytosis-enhancing effect of laminin was not due to contamination of the purified laminin preparation by fibronectin, since the laminin preparation was free of fibronectin, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and enzyme-linked immunosorbent assay; in addition, laminin-enhanced phagocytosis was decreased in the presence of laminin-specific antibodies. Laminin inhibited macrophage adherence and spreading, but selection of a laminin-binding macrophage subpopulation could not account for the laminin-induced increases in phagocytosis. We hypothesize that interaction with extracellular matrix proteins may represent an important activation stimulus both to the macrophages normally present in the extravascular compartment and to the phagocytic cells that have emigrated from the blood-stream into areas of inflammation.
The Patient-Centered Medical Home Neighbor: A Primary Care Physician's View
Authors: Christine A. Sinsky
Journal: Annals of Internal Medicine (2011)

The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.
Shift-Work Sleep Disorder — The Glass Is More Than Half Empty
Authors: Robert C. Basner
Journal: New England Journal of Medicine (2005)

As many as 20 percent of workers in industrialized nations are shift workers — in other words, people who work either at night or on rotating shifts.1 Shift-work sleep disorder, defined as a primary complaint of insomnia or excessive sleepiness temporally associated with a work period that occurs during the habitual sleep phase,2 has been diagnosed in as many as 10 percent of shift workers.3 Shift workers overall appear to be at increased risk for peptic ulcer disease, coronary heart disease, insulin resistance, and the metabolic syndrome,4,5 as well as for sleep deprivation, depression, sleepiness-related accidents, and curtailed family . . .
Primary care team of the year: saving money and improving care
Authors: C. Mahony
Journal: BMJ (2014)

The BMJ Primary Care Team of the Year Award recognises primary care teams who through some project or initiative have had a substantial effect on the health and wellbeing of the wider community. Judges will be looking for teams who identified a need within a population, created a programme or intervention to meet that need in some way, and can demonstrate that their work produced results that are relevant to UK healthcare.

This project seeks to tackle the rise in the numbers of people with impaired glucose tolerance and type 2 diabetes by making dietary treatment a reality for this group. David Unwin and colleagues at Norwood Surgery in Southport sought to educate and support 18 patients with impaired glucose tolerance or diabetes as they tested a low carbohydrate, higher fat diet that international studies have suggested could benefit them. Little research has been done in the UK. 

A lot of the work was done in groups with patients’ families, which staff say was scary at first but became great fun. Several members of staff also joined the patients on the diet. By using group work and a relatively pleasurable diet emphasising food with healthier fats, vegetables, and protein, the team hoped that the process would be enjoyable for participants. Around half of the 18 met as a group for reviews of progress while the remainder had individual meetings with a GP or practice nurse.

Over nine months there were clinically and statistically significant improvements in weight, waist circumference, glycated haemoglobin, and γ-glutamyl transferase results. Mean weight fell from 100.2 kg to 91 kg and glycated haemoglobin levels also fell steadily. There has …
Magnetic resonance imaging/angiography and transcranial Doppler velocities in sickle cell anemia: results from the SWiTCH trial
Authors: Kathleen J. Helton, Robert J. Adams, Karen L. Kesler, Alex Lockhart, Banu Aygun, Catherine Driscoll, Matthew M. Heeney, Sherron M. Jackson, Lakshmanan Krishnamurti, Scott T. Miller, Sharada A. Sarnaik, William H. Schultz, Russell E. Ware
Journal: Blood (2014)
Fine structural changes in the fibroblasts of canine heart valves prepared for grafting
Authors: J. B. Gavin, J. L. Monro, F. M. Wall, S. C. W. Chalcroft
Journal: Thorax (1973)

<b>Gavin, J. B., Monro, J. L., Wall, F. M., and Chalcroft, S. C. W. (1973).</b><i>Thorax</i>, <b>28</b>, 748-755. <b>Fine structural changes in the fibroblasts of canine heart valves prepared for grafting.</b> Fibroblasts in canine heart valves were examined by light and electron microscopy after one, two, and three weeks9 exposure to Hanks9s balanced salt solution and to three series of antibiotic solutions used in preparing heart valve allografts. Condensation of chromatin, degeneration of mitochondria, dilatation and loss of endoplasmic reticulum, and rupture of cellular membranes were observed in a proportion of fibroblasts exposed to Hanks9s solution for longer than one week and in all specimens treated with antibiotics. These changes became more frequent and severe as the exposure to these solutions increased and they were not reversed nor inhibited by the inclusion of a tissue culture medium in the mixture. These findings are discussed in relation to the role of donor fibroblasts in heart valve allografts.
Allergic hypersensitivity to topical and systemic corticosteroids: a review
Authors: M. Baeck, L. Marot, J.‐F. Nicolas, C. Pilette, D. Tennstedt, A. Goossens
Journal: Allergy (2009)

Corticosteroids, which are potent anti‐inflammatory and immunomodulator agents used in the treatment of various inflammatory diseases including allergic diseases, can in some cases produce immediate or delayed hypersensitivity reactions. This review summarizes the epidemiological and clinical characteristics of such reactions, including related diagnostic issues. It also presents a detailed analysis of the proposed immunological mechanisms including underlying cross‐reactions.
Use of complementary and alternative treatment for allergic contact dermatitis
Authors: E. Noiesen, M.D. Munk, K. Larsen, M. Høyen, T. Agner
Journal: British Journal of Dermatology (2007)

Previous studies show that use of complementary and alternative medicine (CAM) is frequent among dermatological patients in general and that the use of CAM is linked to disease severity and duration.To investigate factors influencing the use of CAM and visits to alternative practitioners among patients with allergic contact dermatitis.The study was a postal questionnaire survey among 485 patients with allergic contact dermatitis to fragrances and preservatives in consumer products. The questionnaire included questions about use of conventional treatment, use of CAM and visits to alternative therapists. It also included questions about eczema severity and duration as well as social factors. The patients were recruited from one dermatological clinic in the capital city area and two clinics in smaller cities.The response rate was 79%. Forty per cent of respondents were users of CAM, predominantly in combination with conventional treatment, and 29% had visited an alternative practitioner. Women were found to be significantly more frequent users of CAM and visitors to alternative practitioners than men, and patients from urban/rural districts reported more frequent use of CAM than patients from the capital city area. Frequent eczema eruptions, hand eczema, long duration of disease and work-related problems were positively associated with use of CAM and/or visits to alternative practitioners.The typical CAM user is female, lives in a rural district or town (not the capital area), has long disease duration and often work-related problems. Overall, the use of CAM is not an alternative to conventional treatment, but is a supplement.
Hypersensitivity Reaction to Antituberculosa Drugs with Hepatitis, Lupus Phenomenon and Myocardial Infarction
Authors: John N. Bickers, Howard A. Buechner, Bobby J. Hood, Gilbert Alvarez-Chiesa
Journal: New England Journal of Medicine (1961)

HYPERSENSITIVITY reactions to the drugs employed in the chemotherapy of tuberculosis are not uncommon, but fortunately the patient rarely suffers permanent harm. It is the purpose of this brief report to describe a unique and unusually severe reaction, resulting in permanent residual damage, which was associated with the administration of isoniazid (INH) and para-aminosalicylic acid (PAS). This is apparently the first time that the lupus phenomenon has been reasonably attributed to these drugs.Case ReportK.D. (N.O.V.A.H. A-6342), a 32-year-old Negro, was admitted to the hospital on August 2, 1960, for elective repair of an internal derangement of the left . . .
“You're Not a Victim of Domestic Violence, Are You?” Provider–Patient Communication about Domestic Violence
Authors: Karin V. Rhodes, Richard M. Frankel, Naomi Levinthal, Elizabeth Prenoveau, Jeannine Bailey, Wendy Levinson
Journal: Annals of Internal Medicine (2007)

Background: Women who are victims of domestic violence frequently seek care in an emergency department. However, it is challenging to hold sensitive conversations in this environment. Objective: To describe communication about domestic violence between emergency providers and female patients. Design: Analysis of audiotapes made during a randomized, controlled trial of computerized screening for domestic violence. Setting: 2 socioeconomically diverse emergency departments: one urban and academic, the other suburban and community-based. Participants: 1281 English-speaking women age 16 to 69 years and 80 providers (30 attending physicians, 46 residents, and 4 nurse practitioners). Results: 871 audiotapes, including 293 that included provider screening for domestic violence, were analyzed. Providers typically asked about domestic violence in a perfunctory manner during the social history. Provider communication behaviors associated with women disclosing abuse included probing (defined as asking ≥1 additional topically related question), providing open-ended opportunities to talk, and being generally responsive to patient clues (any mention of a psychosocial issue). Chart documentation of domestic violence was present in one third of cases. Limitations: Nonverbal communication was not examined. Providers were aware that they were being audiotaped and may have tried to perform their best. Conclusion: Although hectic clinical environments present many obstacles to meaningful discussions about domestic violence, several provider communication behaviors seemed to facilitate patient disclosure of experiences with abuse. Illustrative examples highlight common pitfalls and exemplary practices in screening for abuse and response to disclosures of abuse.
TISSUE CHARACTERIZATION WITH 40 MHZ INTRAVASCULAR ULTRASOUND IMAGING CAN PREDICT TRANSIENT NO REFLOW PHENOMENON DURING CORONARY INTERVENTION
Authors: Makoto Utsunomiya, Masato Nakamura, Mami Nakanishi, Tadashi Araki, Masaki Hori, Nobutaka Ikeda, Kunihiko Makino, Hideki Itaya, Naohiko Nemoto, Raisuke Iijima, Hidehiko Hara, Takuro Takagi, Kaoru Sugi
Journal: Journal of the American College of Cardiology (2011)
The effect of regular inhaled albuterol on exercise-induced bronchoconstriction.
Authors: M D Inman, P M O'Byrne
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Pretreatment with inhaled beta 2-agonists is often recommended for the prevention of exercise-induced bronchoconstriction. Regular treatment with inhaled beta 2-agonists has been associated with worsened baseline airway caliber and increased airway responsiveness. In this study, we have investigated the effects of regular inhaled albuterol on the severity of exercise-induced bronchoconstriction using a double-blind, placebo-controlled, randomized, crossover design. Ten subjects inhaled either albuterol or placebo (2 x 100 micrograms, four times per day) for 7 d. On the eighth and ninth days of treatment periods, subjects performed 5-min constant work rate cycle ergometry exercise challenges after inhaling 200 micrograms of placebo (eighth day) or albuterol (ninth day). Forced expired volume in 1 s (FEV1) was measured on arrival in the laboratory as well as before and for 1 h after exercise. One week of regular inhaled albuterol compared with placebo resulted in: (1) a lower baseline FEV1 (mean difference, 230 ml) (p = 0.02); (2) a lower minimum postexercises FEV1 without inhaled albuterol pretreatment (mean difference, 390 ml; range, -50 ml to 1,250 ml) (p = 0.01); (3) a lower minimum postexercise FEV1 with inhaled albuterol pretreatment (p < 0.01). The smallest degree of exercise-induced bronchoconstriction occurred after a week of regular placebo and pretreatment with inhaled albuterol immediately before exercise. Inhalation of albuterol four times daily for 1 wk worsens exercise-induced bronchoconstriction; however, it remains extremely effective when used immediately before exercise for preventing bronchoconstriction.