tbuckley/cabot-search huggingface dataset:
Performance Measurement in the Small Office Practice: Challenges and Potential Solutions
Authors: Bruce E. Landon, Sharon-Lise T. Normand
Journal: Annals of Internal Medicine (2008)

Great strides have been made in the creation of programs aimed at improving the safety and quality of health care in the United States, including measurement systems and corresponding standards in the ambulatory setting that are used for public reporting or pay-for-performance. The diversity of physician practices in the United States makes measurement challenging. In many parts of the country, substantial proportions of both primary care and specialist physicians continue to practice in solo or small group practices. This article reviews the practice landscape in the United States; describes performance measurement challenges in small practice settings, including financial and staffing implications; discusses statistical issues that affect assessment of practice quality; and describes potential solutions to the issues raised. Challenges of performance measurement in small practice settings include lack of infrastructure and health information technology, lack of support staff, and increased burden. These issues are compounded by the difficulty of assessing a smaller number of patients spread over multiple payers. To overcome some of these challenges, design and measure selection recommendations for the performance assessment system are presented and practice-level and health plan–level interventions are suggested that might facilitate the inclusion of small practice settings in performance assessment programs. Because a high proportion of U.S. physicians practice in small settings, programs and policies based on physician performance measurement should incorporate features that facilitate the inclusion of these physicians.
Opsoclonus and Occult Neuroblastoma
Authors: Gail E. Solomon, Abe M. Chutorian
Journal: New England Journal of Medicine (1968)

TWO children with opsoclonus and occult neuroblastoma were seen on the Pediatric Neurology Service of Columbia–Presbyterian Medical Center. A report of opsoclonus in association with occult bronchogenic carcinoma1 has recently appeared.Opsoclonus, defined as irregular, hyperkinetic, multidirectional spontaneous eye movements, is often accompanied by myoclonic jerks of the face and body, and at least as frequently by cerebellar ataxia. The eye movements are not always in unison in opsoclonus and can be present in sleep with lower amplitude and rate.2 Opsoclonus has been ascribed to encephalitis,3 , 4 chiefly affecting the brain-stem. It has been included among the acute cerebellar ataxias,5 and . . .
Early Post-operative Endoscopy of the Operated Intestine
Authors: D. Waldmann, K. Rückauer, R. Salm
Journal: Endoscopy (1981)

Endoscopy in the early post-operative stage after an intestinal operation is seldom indicated, in contrast to control endoscopy carried out at a later stage. Experiments with animals show that endoscopy of intestinal anastomoses may be performed as early as 24 hours after an operation, if carried out carefully by an experienced endoscopist. During this early post-operative period, endoscopy is indicated only when complications arise. The most important application is the endoscopic insertion of an intestinal tube in cases of post-operative ileus. However, coloscopic suction in meteorism of the colon, and the introduction of tubes through swollen anastomoses are also possible. Bleeding of an anastomosis in the early post-operative stage is rare, whereas bleeding due to teleangiectatic granulomas in the later post-operative stage is more common. Both cases are indications for endoscopic hemostasis.
The ontogeny and asymmetry of the highest brain skills and the pathogenesis of schizophrenia
Authors: Vadim S. Rotenberg
Journal: Behavioral and Brain Sciences (2004)

The most developed and the latest-to-mature mental skills represented in the creation of mono- versus polysemantic contexts are related respectively to the left and right frontal lobe. A polysemantic way of thinking is responsible for the subject's successful integration in the polydimensional world. The functional insufficiency of this right-hemispheric way of thinking displays a predisposition toward the development of mental disorders, including schizophrenia.
Place of tricyclics in depression of young people is not proved
Authors: I. Anderson
Journal: BMJ (1995)

was screened by a nurse (and possibly many fewer if patient self screening was feasible) this would cost £4000 in a practice of four partners, in which 8-16 melanomas would be diagnosed over 10 years.If one of these melanomas could be prevented or diagnosed earlier, and other costs minimised, 15-20 life years could be saved with a cost effectiveness comparable with screening for that of hypertension.Although Keeley reinforces some valid points, he ignores suitable study design, automatically assumes pessimistic outcomes, and unnecessarily polarises the debate when research is at such an early stage.
Some Remarks on the Venereal Disease, Chiefly in Reference to Its Evolution
Authors: F. le Gros Clark
Journal: BMJ (1886)

sis is primarily by the lymphatics.Both growths are, however, equally malignant, but cachexia is seldomi observed so early in the sarcomata as in the cancers.I have another specimen here which I wish you to look at.It is one of historical interest, and wvas placed in the museum by my pre- decessor, the late Dr. Foulis.It is also one of sarcoma, but not precisely the samre as the last preparation.It is the first larynx excised in this country for malignlant disease.On examining the parts, you will find that the tumour is situated on the under surface of the left vocal cord, and forms a pendulous mass, which bangs into the trachea as far down as the first ring.From the upper part of the tumour, an extension has taken place upwards, and it presents a soft pale appearance.Its structure is that of a spindle-celled sarcoma.This larynx was excised by Dr. Foulis, on September 10th, 1877, and you will find a detailed account of the ease in the Lancet for October 13th, 1877, and January 26th, 1878.
A simple case of peptic ulcer
Authors: Ajit Singh Kashyap, Kuldip Parkash Anand
Journal: BMJ (2005)

Adolescence is generally a healthy period of life compared with early childhood and old age.However, the recent improvements in mortality seen in young children have not been matched in teenagers, and adolescent morbidity shows worrying trends in key areas such as mental health, sexual health, and cardiovascular risk.As behaviours that both increase and protect against poor health outcomes in later life are laid down in adolescence, increased public health, policy, and clinical focus on the health of young people will have important benefits for the long term health of the population. Health problems in adolescence, and adolescent behavioural and health problems that may lead to major health problems in later life*Problems affecting young people disproportionately-Accidental injury, intentional injury, substance misuse, teenage
Elevated glucose stimulates TGF-β gene expression and bioactivity in proximal tubule
Authors: Michael V. Rocco, Ying Chen, Stanley Goldfarb, Fuad N. Ziyadeh
Journal: Kidney International (1992)

Our previous studies have demonstrated that raising ambient glucose from 100 to 450 mg/dl significantly inhibited the proliferation of mouse renal proximal tubule cells in culture. This effect was demonstrated after a latent period of 24 to 48 hours. Because transforming growth factor-beta (TGF-beta) inhibits cell proliferation in most epithelial cell lines, we hypothesized that the inhibitory effect of high glucose levels on cell proliferation may be mediated by TGF-beta. The present studies were performed to test the hypothesis that TGF-beta is an autocrine cytokine whose activity can be modulated by ambient glucose. Exogenous TGF-beta inhibited [3H]-thymidine incorporation in a dose-dependent fashion and with high affinity (picomolar range), but with slightly lower potency in high versus normal glucose media. Northern analysis of mRNA demonstrated that proximal tubule cells constitutively express TGF-beta 1 transcripts, and that the steady state level of TGF-beta 1 mRNA was, on average, 63% higher in the cells grown for 48 hours in high versus normal glucose media. Furthermore, the conditioned media of cells exposed to 450 mg/dl glucose exhibited endogenous TGF-beta bioactivity as measured by inhibition of cell proliferation. The addition of a rabbit antiporcine TGF-beta neutralizing antibody significantly increased basal thymidine incorporation in high glucose media to levels approaching those of cells grown in normal glucose media. In contrast, the anti-TGF-beta antibody did not have a significant effect on the growth of cells in the normal glucose media.(ABSTRACT TRUNCATED AT 250 WORDS)
Rush oral immunotherapy in children with persistent cow's milk allergy
Authors: Ute Staden, Katharina Blumchen, Nike Blankenstein, Nicole Dannenberg, Helen Ulbricht, Kerstin Dobberstein, Mandy Ziegert, Bodo Niggemann, Ulrich Wahn, Kirsten Beyer
Journal: Journal of Allergy and Clinical Immunology (2008)
Bad press over Liverpool care pathway has scared patients and doctors, say experts
Authors: I. Torjesen
Journal: BMJ (2013)

The media furore over the Liverpool care pathway, the widely used protocol for the care of dying patients that has been branded “euthanasia by the backdoor” in some sections of the press, has scared patients and their families and made some doctors reluctant to use it, experts in palliative care have said.

At a press briefing on Tuesday in London aimed at dispelling the myths surrounding palliative care, Bee Wee, president of the Association for Palliative Medicine, said that although she “would not want to overstate it” she had heard reports from colleagues of relatives frightened by what they had read and of terminally ill patients too afraid to go into hospital. …
SPONTANEOUS RUPTURE OF THE NORMAL SPLEEN
Authors: James R. Watson
Journal: JAMA (1942)

Rupture of the spleen may result from trauma or it may occur spontaneously. Spontaneous rupture is uncommon and usually occurs in the presence of splenomegaly, in most instances the result of malaria or typhoid. It has been reported less frequently during the course of puerperal sepsis, relapsing fever, pneumonia, cirrhosis of the liver, leukemia, typhus and infectious mononucleosis. Several cases have been reported in which it occurred during a normal pregnancy. In a few instances rupture had occurred spontaneously in a healthy individual with a normal spleen. Attempts to explain this phenomenon are confusing and, from a practical point of view, purely academic. Hamilton Bailey dismissed the subject by stating that only the spleen can behave in this curious manner, a remark reminiscent of Galen, who spoke of the spleen as an organ full of mystery.  The following report illustrates most of the diagnostic problems involved and bears out another
One in four deaths from heart disease and stroke in the US is preventable
Authors: M. McCarthy
Journal: BMJ (2013)

More than 200 000 of the 800 000 deaths from heart disease and stroke in the United States each year are preventable, the US Centers for Disease Control and Prevention (CDC) has said in a report. 

The CDC’s director, Tom Frieden, said in a telephone press briefing, “These findings are really striking because we’re talking about hundreds of thousands of deaths that don’t have to happen when they happen.”

The report looked at deaths from heart disease and stroke in Americans under age 75 that could have been prevented by lifestyle changes, medical care, or public health measures.1

The report found that the annual total number of avoidable deaths from heart disease, stroke, and hypertensive disease in the US was 200 070, for an …
Charles Barkley's Dilemma: A Response to “The Professionalism Movement: Can We Pause?” by Delese Wear and Mark G. Kuczewski (AJOB 4:2)
Authors: Howard Trachtman
Journal: The American Journal of Bioethics (2004)

"Charles Barkley's Dilemma: A Response to “The Professionalism Movement: Can We Pause?” by Delese Wear and Mark G. Kuczewski (AJOB 4:2)." The American Journal of Bioethics, 4(3), pp. W38–W39 Acknowledgement Thanks to Rachel Frank, RN, for her thoughtful review of this essay.
PRACTICAL URETHROSCOPY WITH THE EXHIBITION OF A NEW INSTRUMENT.
Authors: EUGENE CARSON HAY
Journal: JAMA (1898)

Urethroscopy has been practiced, by a few of our profession, since the first attempt to inspect the urethra was made by Bozzini of Frankfort at the beginning of this century, but it was not placed on a truly scientific basis until Desormeaux invented his instrument in 1853, and named it the endoscope. It was far from perfect, and since then many different varieties have been invented, some with the light reflected from without, and others with it placed within the tube. It is not my object to discuss the merits of all these different instruments. I will briefly mention two, but at best they are all far from satisfactory in the hands of most of us, and this is the true reason I believe why the endoscope has not been more generally adopted by the profession as a method of examination and treatment of all chronic urethral troubles. The Otis
Secondary prevention of coronary heart disease in older patients after the national service framework: population based study
Authors: Sheena E Ramsay, Peter H Whincup, Debbie A Lawlor, Olia Papacosta, Lucy T Lennon, Mary C Thomas, Shah Ebrahim, Richard W Morris
Journal: BMJ (2006)

<h3>Abstract</h3> <b>Objective</b> To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998-2001) and after (2003) the implementation of the national service framework. <b>Design</b> Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. <b>Participants</b> Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. <b>Main outcome measures</b> Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003. <b>Results</b> Between 1998-2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins (from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. <b>Conclusions</b> Between 1998-2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment (particularly with β blockers and ACE inhibitors).
High-Dose Crizotinib for Brain Metastases Refractory to Standard-Dose Crizotinib
Authors: Young Hak Kim, Hiroaki Ozasa, Hiroki Nagai, Yuichi Sakamori, Hironori Yoshida, Yoshitaka Yagi, Takashi Nakaoku, Michiaki Mishima
Journal: Journal of Thoracic Oncology (2013)
Amikacin Serum Concentrations: Prediction of Levels and Dosage Guidelines
Authors: Sarubbi Fa, Hull Jh
Journal: Annals of Internal Medicine (1978)

Amikacin is a new aminoglycoside antibiotic that behaves pharmacokinetically similar to kanamycin, gentamicin, and tobramycin. Our study was designed to test whether a digital computer program could correctly predict amikacin serum concentrations in the clinical setting. A significant relation (P < 0.0001) was found between 153 measured (bioassayed) and computer-predicted levels from 26 patients. The computer program reliably estimated amikacin serum levels after either intravenous or intramuscular doses. Prediction accuracy was not significantly affected by patient sex, hematocrit, or periods of unstable renal function. Predicted levels were most accurate when based on creatinine clearance corrected to 70 kg body weight or corrected to body surface area. The pharmacokinetic parameters in the computer program were used to generate a new aminoglycoside dosing chart. Ten patients were given amikacin according to this guideline, and the mean peak serum level for the group was 25.6 μg/ml.
Cigarette Smoking and Upper Respiratory Infection among Recruits in Basic Combat Training
Authors: Gregory H. Blake, Troy D. Abell, Wayne G. Stanley
Journal: Annals of Internal Medicine (1988)

Study Objective: To determine the relation between cigarette smoking and upper respiratory infection or viral syndrome. Design: A prospective cohort study of soldiers during 13 weeks of basic combat training. Each soldier received a smoking questionnaire before the beginning and at the conclusion of basic combat training. The incidence of respiratory illness among the recruits was evaluated. Setting: Fort Benning, Georgia. Participants: 1230 soldiers met the criteria for inclusion and completed the study. Interventions: None. Measurements and Main Results: According to the definition of smoking status in the initial questionnaire, smokers had a relative risk for upper respiratory infection of 1.46 (95% CI, 1.1 to 1.8). This effect was not substantially altered by different definitions of smoking status. Conclusions: Young military recruits who smoked during basic combat training had more upper respiratory infections than nonsmokers. Cigarette smoking can substantially increase the risk for upper respiratory infection in young men.
Effects of high‐dose furosemide and small‐volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure
Authors: Salvatore Paterna, Pietro Di Pasquale, Gaspare Parrinello, Piera Amato, Antonella Cardinale, Giuseppe Follone, Alfonso Giubilato, Giuseppe Licata
Journal: European Journal of Heart Failure (2000)
ADHD is a behavioural construct, not a psychiatric condition
Authors: I. McClure
Journal: BMJ (2013)

In their helpful overview, Thomas and colleagues explain that attention-deficit/hyperactivity disorder (ADHD) is probably being overdiagnosed because ascertainment of degree of impairment (mild, moderate, or severe) is subjective and therefore unreliable.1

However, the ADHD concept itself is inherently subjective. ADHD is diagnosed according to the recorded presence (or absence) of attention deficit, hyperactivity, and impulsivity. …
Mesothelin-family proteins: a novel diagnostic marker for malignant mesothelioma?
Authors: A B Rajasekaran
Journal: Thorax (2004)

▴ Robinson BWS, Creaney J, Lake R, et al . Mesothelin-family proteins and diagnosis of mesothelioma. Lancet 2003;362:1612–6 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] The pathological diagnosis of malignant mesothelioma (MM) remains difficult and special immunohistochemistry based stains are often required. This paper describes the role of mesothelin—a cell surface protein—and related soluble proteins in the diagnosis and monitoring of MM. The serum concentration of soluble mesothelin related proteins (SMR) was measured by sandwich ELISA … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DRobinson%26rft.auinit1%253DB.%2BW.%26rft.volume%253D362%26rft.issue%253D9396%26rft.spage%253D1612%26rft.epage%253D1616%26rft.atitle%253DMesothelin-family%2Bproteins%2Band%2Bdiagnosis%2Bof%2Bmesothelioma.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252803%252914794-0%26rft_id%253Dinfo%253Apmid%252F14630441%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(03)14794-0&link_type=DOI [3]: /lookup/external-ref?access_num=14630441&link_type=MED&atom=%2Fthoraxjnl%2F59%2F2%2F143.atom [4]: /lookup/external-ref?access_num=000186637400009&link_type=ISI
POST-DISCHARGE BLEEDING IS ASSOCIATED WITH EARLY MYOCARDIAL INFARCTION AND DEATH AFTER DRUG-ELUTING STENT IMPLANTATION: INSIGHTS FROM THE HMO RESEARCH NETWORK- STENT REGISTRY (HMORN-STENT)
Authors: Thomas Tehsin Tsai, P. Michael Ho, Thomas M. Maddox, Nikki M. Carroll, Susan M. Shetterly, Stanley Xu, J. David Powers, Karen Margolis, John S. Rumsfeld, Alan S. Go, David J. Magid
Journal: Journal of the American College of Cardiology (2010)
when dominance and sex are both right
Authors: james a. schirillo, melissa fox
Journal: Behavioral and Brain Sciences (2005)

we have found that the left side of faces displayed in rembrandt's portraits capture how humans rank male dominance, helping to coordinate avoidance behaviors among asymmetric individuals. moreover, the left side of faces may also coordinate approach responses, like attractiveness, in human females. therefore, adding sexual selection to dominance paints a more realistic picture of what the contralateral right hemisphere is doing.
New Effort Hopes to Boost Mental Health Research
Authors: Tracy Hampton
Journal: JAMA (2014)

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Penicillin in the Treatment of Tetanus
Authors: Louis Weinstein, Conrad Wesselhoeft
Journal: New England Journal of Medicine (1945)

TETANUS is an extremely serious disease, whose mortality rate remains extremely high in spite of the institution of heroic measures for combating the intoxication and controlling the convulsive seizures that it produces. Treatment of this infection necessitates the careful control of at least five factors if a successful outcome is to be expected. Often, even with the most rigid adherence to these principles, failure results.Of the greatest importance is the rapid and effective neutralization of absorbed tetanus toxin. If this has already been fixed to nervous tissue, it apparently cannot be inactivated by antitoxin, regardless of how large a . . .