tbuckley/cabot-search huggingface dataset:
Doctor of Primary Medicine
Authors: Myron C. Greengold
Journal: JAMA (1972)

<h3>To the Editor.—</h3> The Proger EDITORIAL is right on the money. Those of us who long have dabbled in primary physician propagation applaud his timely "PMD" thaumaturgy (178: adv p 11, 1961). But why stop there? While we're removing from the traditional medical school the mission of training the primary care candidate who loves his mother and is kind to animals, why not other separate and distinct, but coordinated, schools for those who do, or are, not? The decisive teenager who opportunely discovers his interest in rat fibrinolysis certainly deserves a parallel institution where he can earn his Doctorate of Secondary Medicine in euglobulin precipitation without all that humanities garbage. The introduction of the SMD would not mean the end of the present notomnicompetent investigatorshipman; indeed, he could be called upon to provide some on-the-job training for the new breed. What attractions would motivate a young man or woman of
Tuberculosis: Yesterday, Today, and Tomorrow
Authors: Deborah K. Riley
Journal: Annals of Internal Medicine (1996)

Letters15 February 1996Tuberculosis: Yesterday, Today, and TomorrowDeborah K. Riley, MD, Timothy J. Babinchak, MD, and Edward B. Rotherams, Jr., MDDeborah K. Riley, MDAllegheny General Hospital; Pittsburgh, PA 15212Search for more papers by this author, Timothy J. Babinchak, MDAllegheny General Hospital; Pittsburgh, PA 15212Search for more papers by this author, and Edward B. Rotherams, Jr., MDAllegheny General Hospital; Pittsburgh, PA 15212Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-4-199602150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In his editorial on tuberculosis, Sbarbaro [1] states that directly administered therapy has become the standard of care in the treatment of tuberculosis. He goes on to say that “Physicians deviating from this standard put their patients and society at risk.” We report the case of a 61-year-old male farmer who was diagnosed with cavitary tuberculosis in November 1994. He received isoniazid, rifampin, and ethambutol daily for 2 months, followed by isoniazid (900 mg) and rifampin (600 mg twice weekly) under the direct observation of public health authorities. Two months into his intermittent therapy, he began to ...References1. Sbarbaro JA. Tuberculosis: yesterday, today, and tomorrow [Editorial]. Ann Intern Med. 1995; 122:955-6. Google Scholar2. Poole G, Stradling P, Worlledge S. Potentially serious side effects of high-dose twice-weekly rifampicin. Br Med J. 1971; 3:343-7. Google Scholar3. Aquinas M, Allan WGL, Horsfall PAL, Jenkins PK, Hung-Yan W, Girling D, et al. Adverse reactions of daily and intermittent rifampin regimens for pulmonary tuberculosis in Hong Kong. Br Med J. 1972; 1:765-71. Google Scholar4. Levine M, Collin K, Kassen BO. Acute hemolysis and renal failure following discontinuous use of rifampin. DICP Ann Pharmacother. 1991; 25:743-4. Google Scholar Author, Article, and Disclosure InformationAffiliations: Allegheny General Hospital; Pittsburgh, PA 15212 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHow to control the Tuberculosis and HIV/AIDS dual epidemicTuberculosis and HIV Infection: The Global Setting 15 February 1996Volume 124, Issue 4Page: 455KeywordsAcute renal failureAtaxiaDrugsFeversIngestionIsoniazidPrevention, policy, and public healthRenal failure Issue Published: 15 February 1996 CopyrightCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
The Improving Access to Psychological Therapies programme in Bolton, UK: a qualitative realist analysis
Authors: Ashley Sharp, Rumona Dickson, Richard Whittington
Journal: The Lancet (2014)

BackgroundThink Positive is a recently developed service in Bolton, UK, within the Improving Access to Psychological Therapies (IAPT) programme. With any national policy such as IAPT, local implementation is heavily shaped by the ideas and theories of stakeholders. Realist evaluation seeks to identify and articulate the theories that underpin programmes, so that they can be refined, tested, and used to guide programme development. Realist theories are presented as causal statements about the mechanisms by which a programme produces observed outcomes, dependent on their operational context. Realist evaluation goes beyond simply asking whether the programme works but rather seeks to explain what works, for whom, and in what circumstances. The first step in this process, and the focus of this research, involves eliciting and articulating stakeholders' programme theories.MethodsEight semi-structured interviews were conducted with a purposive sample of key policy makers and practitioners to elicit and probe the programme theories underpinning their decisions. Interviews were transcribed and analysed within the realist framework, and a series of causal hypotheses were created.FindingsInterviews predominantly focused on the ways in which Think Positive is designed to facilitate access, by reducing barriers to presentation and raising awareness. There are several distinct mechanisms through which increased access can be achieved and several contexts in which these mechanisms can operate. For example, in communities with high levels of stigma around mental health problems (context), the provision of this service in a non-medical setting such as a community centre (mechanism) can facilitate increased access (outcome). Other hypothesised mechanisms involved: self-referral, workforce development, location of the service, and use of language, all of which could lead to increased access, depending on the physical and social context in which operate. Findings are presented with supporting quotations to clearly illustrate the source of the theory.InterpretationRealist evaluation begins with programme theory and ends with refined programme theory; its findings are always provisional. The theories presented here could be used by policy makers to shape their local programmes, thereby creating an opportunity to test these hypotheses. Evaluators could direct their data collection to finding evidence to support, refute, or adjudicate between them. These refined theories could help to guide policy makers implementing similar programmes, within their own unique and changing local contexts. They may also be transferrable beyond IAPT to a range of similar programmes.FundingThis work was undertaken as part of a Masters in Public Health at Liverpool University. Fees were covered by Mersey Deanery. There was no other funding source.
Relationship of Serum Antioxidants to Asthma Prevalence in Youth
Authors: Rachel N. Rubin, Livia Navon, Patricia A. Cassano
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

The relationship of serum vitamin E, beta-carotene, vitamin C, and selenium to asthma was investigated among 7,505 youth (4-16 years old) in the Third National Health and Nutrition Examination Survey. Logistic regression models adjusted for potentially confounding variables, which generally had no effect on the coefficients for the antioxidants. Serum vitamin E had little or no association with asthma. In separate models, a SD increase in beta-carotene (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.7, 1.0), vitamin C (OR, 0.8; 95% CI, 0.7, 0.9), and selenium (OR, 0.9; 95% CI, 0.7, 1.1) was associated with a 10-20% reduction in asthma prevalence. Serum cotinine was used to identify youth with no cigarette smoke exposure and passive exposure (7%): Active smokers were too few to be studied further. The selenium-asthma association was stronger in youth who were smoke exposed (p = 0.075). A SD increase in selenium was associated with a 50% reduction in asthma prevalence (OR, 0.5; 95% CI, 0.2, 1.4) in youth with passive smoke exposure compared with a 10% reduction in youth with no smoke exposure. The findings support an association of antioxidants with prevalent asthma, which for some antioxidants is stronger among children exposed to cigarette smoke.
MITRAL REGURGITATION RECOVERY AND ATRIAL REVERSE REMODELING FOLLOWING PULMONARY VEIN ISOLATION PROCEDURE IN PATIENTS WITH ATRIAL FIBRILLATION: A PROOF OF CONCEPT CLINICAL OBSERVATION CARDIAC MRI STUDY
Authors: Sahadev T. Reddy, M. William Belden, Mark Doyle, Diane Vido, Ronald Williams, M. June Yamrozik, Moneal Shah, Robert Biederman
Journal: Journal of the American College of Cardiology (2012)
817-6 Delineation of the pericardiophrenic vein for optimal left ventricular lead placement
Authors: Marmar Vaseghi, David Cesario, Sen Ji, Kevin Shannon, Isaac Wiener, Gregg Fonarow, Jonah Odim, Miguel Valderrabano, Kalyanam Shivkumar
Journal: Journal of the American College of Cardiology (2004)
Short- and long-term effects of transcatheter ablation of the coronary sinus by radiofrequency energy.
Authors: S K Huang, A R Graham, S Bharati, M A Lee, G Gorman, M Lev
Journal: Circulation (1988)

Catheter ablation of left-sided atrioventricular accessory pathways through the coronary sinus by direct-current shock may be complicated by rupture and thrombosis of the coronary sinus and injury to the coronary arteries. This study examined short and long-term effects of radiofrequency catheter ablation of the coronary sinus in 20 closed-chest dogs to determine whether this technique is feasible for potential interruption of left-sided accessory pathways. Single-pulsed radiofrequency energy (750 kHz, 85-293 J) was delivered to three sites in the distal and middle coronary sinus between the distal (1) or the proximal electrodes (2 or 3) of a standard 6 French quadripolar catheter and a chest-wall patch electrode. Single-pulsed radiofrequency energy (78-293 J) was also applied to two sites near the ostium of the coronary sinus with the proximal (4) or the distal (1) electrode of the same catheter. Coronary artery and levophase coronary sinus angiograms obtained before and immediately after ablation, as well as before killing, showed intact vascular structures in all dogs. Right atrial, pulmonary arterial, and aortic pressures measured in three dogs did not change significantly at the time of energy delivery. No significant changes were found in atrioventricular nodal refractoriness and conduction. None of the dogs had significant rhythm disturbances during and after ablation as evaluated by ambulatory electrocardiographic monitoring and periodic rhythm strips at follow-up. Ten dogs were killed 1-7 days after ablation, three dogs were killed at 4 weeks, three dogs at 6 weeks, two dogs at 8 weeks, and two dogs at 12 weeks. Discrete lesions ranging in size from 3 x 3 to 8 x 10 mm2 in surface area and 0.5-4.5 mm in depth were found in the coronary sinus with most of the lesions extending to the left atrial and left ventricular myocardium. There was neither rupture of the coronary sinus nor occlusion of the coronary arteries. Mural thrombus was found in the coronary sinus on five acute lesions in two dogs, but none was noted on the chronic lesions, which was characterized by chronic granulation tissue and fibrosis. Two dogs in the study during chronic conditions had damage to branches of the underlying coronary artery that showed necrotizing arteritis and arterial sclerosis. Conduction system studies in four dogs showed some chronic inflammatory and fibrotic changes. Similar discrete lesions were found in situ in the coronary sinus of four postmortem human hearts with radiofrequency catheter ablation.(ABSTRACT TRUNCATED AT 400 WORDS)
Changes in serum potassium concentration in asthmatic and normal subjects during exercise.
Authors: M Gugger
Journal: Thorax (1989)

Serum potassium concentrations were measured before, during, and after exercise in 32 patients with asthma (12 with exercise induced asthma), and in seven normal subjects. The changes in serum potassium in response to exercise did not differ significantly in the two groups or between those with and without exercise induced asthma. The potassium response to exercise is unlikely to be relevant to the mechanism underlying exercise induced bronchoconstriction.
Comparison of Silent and Symptomatic Ischemia during Exercise Testing in Men
Authors: Cres P. Miranda, Kenneth G. Lehmann, Bruce Lachterman, Eugene M. Coodley, Victor F. Froelicher
Journal: Annals of Internal Medicine (1991)

To compare angina and ST-segment depression during exercise testing, as markers for coronary artery disease.Retrospective analysis of exercise test responses and cardiac catheterization results.A U.S. Veterans Affairs medical center.Four hundred and sixteen men who were referred for the evaluation of symptoms, postmyocardial infarction testing, or both. Two hundred patients had no clinical or electrocardiographic evidence of previous myocardial infarction, whereas 216 were survivors of a previous myocardial infarction.All patients did a standard exercise test and had diagnostic coronary angiography with ventriculography within an average of 32 days (range, 0 to 90 days) of their exercise test.Two hundred patients without a previous myocardial infarction were divided into four groups: the no ischemia group had 80 patients; the angina pectoris only group had 23 patients; the silent ischemia group had 40 patients; and the ST-segment depression and angina pectoris group had 57 patients. In patients without a previous myocardial infarction, exercise-induced ST-segment depression was a better marker than exercise-induced angina for the presence of any coronary artery disease (P less than 0.005). Patients with symptomatic exercise-induced ischemia had a higher prevalence of severe coronary artery disease than did those with only silent ischemia (30% compared with 20%; 95% CI, - 7.3% to 27.0%; P = 0.005). For the 216 survivors of a myocardial infarction, divided into the same four groups, ST-segment depression again was a better marker for the presence of severe coronary artery disease compared with angina alone (P = 0.08). The prevalence rates of severe coronary artery disease in the no ischemia plus myocardial infarction group, the angina pectoris only plus myocardial infarction group, the silent ischemia plus myocardial infarction group, and the ST-segment depression and angina pectoris plus myocardial infarction group were 10%, 9%, 23%, and 32%, respectively (P less than 0.01).Exercise-induced ST-segment depression is a better marker for coronary artery disease than is exercise-induced angina. Symptomatic ischemia during the exercise test is a better marker for severe coronary artery disease than is silent ischemia.
Combination Chemotherapy using L-Asparaginase, Daunorubicin, and Cytosine Arabinoside in Adults with Acute Myelogenous Leukaemia
Authors: D. Crowther, C. J. T. Bateman, C. P. Vartan, J. M. A. Whitehouse, J. S. Malpas, G. H. Fairley, R. B. Scott
Journal: BMJ (1970)

Cytosine arabinoside and daunorubicin used in an intensive intermittent regimen have been shown to be an effective combination for the induction of complete remissions in 14 out of 23 adult patients with acute myelogenous leukaemia. This gives an overall complete remission rate of 60%. A further patient had a good partial remission. The addition of L-asparaginase to the regimen has not increased the incidence of remission and there were more side effects in the L-asparaginasetreated group. Of the 10 patients treated with L-asparaginase in addition to cytosine arabinoside and daunorubicin, five achieved a complete remission. Of the 13 patients treated with cytosine arabinoside and daunorubicin without L-asparaginase, nine achieved a complete remission and one a good partial remission.
Death in Texas
Authors: V Nathanson
Journal: BMJ (1994)

Holidays are a time of escape from the routine of home and workplace, a time to relax and recharge the batteries, to become enthused again for the nitty gritty of everyday life. So visiting a prisoner on Death Row in America is not everyone's idea of a perfect holiday.

In 1987 a Panorama programme, Fourteen Days in May that followed the last 14 days in the life of an inmate in Parchman Penitentiary, Mississippi, aroused such sympathy in one viewer that he began to write to other inmates who had been interviewed and were awaiting execution. From simple beginnings, Lifelines has expanded so that today several thousand people write to penpals, mainly prisoners on Death Row in the United States, but also in the West Indies and some serving life sentences in British prisons.

Lifelines does not campaign and seeks little publicity for its work. It provides a link to the normal world for prisoners and shows that they are valued as people by at least one other person. Those who become penpals do so for many reasons, but principally because they want to show that they do not reject anyone as unworthy of or unfit for human kindness and compassion. The exchange is not unequal; most penpals get an enormous amount out of the correspondence, often coming to care deeply for this friend.

Sadly, all too many penpals are now sharing the reality that executions are becoming increasingly common in many American states. In Texas there was more than one execution every …
Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction.
Authors: F H Sheehan, D G Mathey, J Schofer, H T Dodge, E L Bolson
Journal: Circulation (1985)

The coronary and ventricular angiograms of 47 patients with acute myocardial infarction in whom reperfusion was achieved by intracoronary streptokinase were quantitatively analyzed to determine the factors that affect recovery of regional left ventricular function after reperfusion. Hypokinesis in the infarct region was measured by the centerline method and expressed in terms of standard deviations (SDs) from normal. Severity of coronary artery stenosis was measured quantitatively. Hypokinesis showed more significant improvement after thrombolysis in patients with minimum stenosis diameter of greater than 0.4 mm than in those with severe residual stenosis, i.e., stenosis producing a minimum diameter of 0.4 mm or less (1.0 +/- 1.3 SD/chord, n = 31, vs 0.0 +/- 0.9 SD/chord, n = 7; p less than .05). Improvement in hypokinesis was greater in patients who received thrombolytic therapy within 2 hr than in those treated later (2.1 +/- 1.1, n = 8, vs 0.7 +/- 1.0 SD/chord, n = 28; p less than .001). These results indicate that angiographic reperfusion alone may not be sufficient: reperfusion must provide adequate flow and be achieved early to salvage myocardial function.
Safety and Accuracy of Dobutamine-Atropine Stress Echocardiography for the Detection of Residual Stenosis of the Infarct-Related Artery and Multivessel Disease During the First Week After Acute Myocardial Infarction
Authors: Steven C. Smart, Thomas Knickelbine, Thomas R. Stoiber, Michael Carlos, John C. Wynsen, Kiran B. Sagar
Journal: Circulation (1997)

Background The safety of dobutamine-atropine echocardiography early after acute myocardial infarction is unknown. Its accuracy for the early detection of infarct artery stenosis and multivessel coronary artery disease is also unclear. The objective of the present study was to document its safety and accuracy during the first week after acute myocardial infarction. Methods and Results Multistage dobutamine-atropine stress echocardiography was performed in 232 patients (age, 58±13 years; 58 women) at 5±2 days after acute myocardial infarction. The peak heart rate was 116±20 bpm. There were no episodes of sustained ventricular tachycardia, myocardial infarction, or death. Atropine with dobutamine was tolerated well. Coronary angiography was performed in 206 patients (89%). There were 171 patients (83%) with infarct artery stenosis of ≥50% and 114 patients (55%) with multivessel disease. Ischemic or biphasic responses in the infarction zone were 82% (140 of 171) sensitive and 80% (28 of 35) specific for residual stenosis. Sensitivity was similar for occluded arteries (77%, 36 of 47) and patent but stenotic arteries (84%, 104 of 124). Wall motion abnormalities outside the infarction zone were specific (97%, 89 of 92) and moderately sensitive (68%, 77 of 114) for multivessel disease. The only determinant of sensitivity for residual infarct artery stenosis was improved wall motion at low dose ( P &lt;.01). The determinants of sensitivity for multivessel disease were peak heart rate and infarct size ( P &lt;.01). Conclusions Dobutamine-atropine stress echocardiography was safely used to detect residual infarct artery stenosis and multivessel disease during the first week after acute myocardial infarction. The test may be very effective for evaluating patients with acute myocardial infarction because sensitivity for residual stenosis and multivessel disease was maximal in the high-risk subsets of patients with viable, jeopardized myocardium and large infarct size.
Longitudinal Changes in Pancreatic β-Cell Function and Metabolic Clearance Rate of Insulin in Pregnant Women With Normal and Abnormal Glucose Tolerance
Authors: Patrick M Catalano, Noreen M Drago, Saeid B Amini
Journal: Diabetes Care (1998)

OBJECTIVE To evaluate basal pancreatic β-cell secretion and suppression during infused insulin and the metabolic clearance rate of insulin in women with normal and abnormal glucose tolerance prior to conception and during pregnancy. RESEARCH DESIGN AND METHODS Seven women with normal glucose tolerance and nine women with abnormal glucose tolerance during gestation were evaluated prior to conception, in early (12–14 weeks) and late (34–36 weeks) gestation. Basal insulin and C-peptide were measured after an 11-h fast and during the last 40 min of a 2-h hyperinsulinemic-euglycemic clamp at 40 mU·m−2·m−1. Suppression of basal C-peptide was calculated as the steady-state C-peptide/basal C-peptide. The metabolic clearance rate of insulin was calculated by dividing the insulin infusion rate by the steady-state insulin concentration, which was corrected for residual β-cell secretion. RESULTS No significant differences were noted in the following parameters between women with normal and abnormal glucose tolerance with advancing gestation: increase in basal insulin (P = 0.20) and C-peptide (P = 0.12), ability of infused insulin to decrease basal C-peptide concentration (P = 0.22), and metabolic clearance rate of insulin (P = 0.76). There was a significant 65% increase in both basal insulin (P = 0.0005) and C-peptide (P = 0.0002) concentrations in all subjects with advancing gestation. There was a significant (P = 0.0001) decrease in the ability of the infused insulin to decrease basal C-peptide concentration. C-peptide as a percentage of the basal was 64% before conception, 74% in early pregnancy, and 108% in late pregnancy. The metabolic clearance rate of insulin significantly (P = 0.0005) increased with advancing gestation: pregravid 442 ml·m−2 · min−1, early pregnancy 514 ml·m−2· min−1, and 526 ml·m−2 · min−1 in late pregnancy. CONCLUSIONS Pregnancy is accompanied by progressive alterations in insulin kinetics, which are partly responsible for the hyperinsulinemia of this condition. These alterations are more likely a homeostatic response to the increased physiological insulin resistance of pregnancy.