tbuckley/cabot-search huggingface dataset:
Explaining variations in hospital death rates. Randomness, severity of illness, quality of care
Authors: R. E. Park
Journal: JAMA (1990)

We used administrative (Part A Medicare) data to identify a representative sample of 1126 patients with congestive heart failure and 1150 with acute myocardial infarction in hospitals with significant unexpectedly high inpatient, age-sex-race-disease—specific death rates ("targeted") vs all other ("untargeted") hospitals in four states. Although death rates in targeted hospitals were 5.0 to 10.9 higher per 100 admissions than in untargeted hospitals, 56% to 82% of the excess could result from purely random variation. Differences in the quality of the process of care (based on a medical record review) could not explain the remaining statistically significant differences in mortality. Comparing targeted hospitals with subsets of untargeted ones, eg, those with lower than expected death rates, did not affect this conclusion. Severity of illness explained up to 2.8 excess deaths per 100 admissions for patients with myocardial infarction. Identifying hospitals that provide poor-quality care based on administrative data and single-year death rates is unlikely; targeting based on time periods greater than 1 year may be better. (<i>JAMA</i>. 1990;264:484-490)
A Real Pocket Book
Authors: Phil Gunby
Journal: JAMA (2000)

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
New mechanism of selective killing of activated hepatic stellate cells
Authors: Milan Dodig, Kevin D. Mullen
Journal: Hepatology (2003)

Background &amp; Aims: Hepatic stellate cells play an important role in liver fibrogenesis, and hepatic stellate cell death may be involved in the termination of this response. Methods: Molecular mechanisms of hepatic stellate cell killing were studied in hepatic stellate cell/Kupffer cell cocultures. Results: Lipopolysaccharide stimulation of hepatic stellate cell/Kupffer cell cocultures, but not of hepatic stellate cell monocultures, induced profound alterations of hepatic stellate cell morphology and hepatic stellate cell death. Kupffer cell–induced hepatic stellate cell killing required hepatic stellate cell/Kupffer cell contacts and was prevented by dexamethasone, prostaglandin E(2), tumor necrosis factor–related apoptosis–inducing ligand (TRAIL) receptor 2 antagonists, and down–regulation of receptor–interacting protein, but not by antioxidants, tumor necrosis factor receptor, or CD95 antagonists. Hepatic stellate cell death was characterized by activation of caspases 3, 8, and 9, terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick–end labeling negativity, lack of gross calcium overload, and TRAIL trafficking to the plasma membrane. Inhibition of caspase 9, but not of caspases 3, 8, or 10, prevented hepatic stellate cell death. Lipopolysaccharide induced a dexamethasone– and prostaglandin E(2)–sensitive expression of TRAIL in Kupffer cells. TRAIL receptors 1 and 2, FLIP (caspase 8–inhibitory protein), and receptor–interacting protein were up–regulated during hepatic stellate cell transformation; however, TRAIL addition did not induce hepatic stellate cell death. Hepatic stellate cell susceptibility toward Kupffer cell–induced death paralleled receptor–interacting protein and TRAIL–receptor expression levels. Conclusions: Activated Kupffer cell can effectively kill hepatic stellate cell by a caspase 9– and receptor–interacting protein–dependent mechanism, possibly involving TRAIL. The data may suggest a novel form of hepatic stellate cell death.
Large-scale genome-wide association analysis of bipolar disorder identifies a new susceptibility locus near ODZ4
Authors: Pamela Sklar, Stephan Ripke, Laura J Scott, Ole A Andreassen, Sven Cichon, Nick Craddock, Howard J Edenberg, John I Nurnberger, Marcella Rietschel, Douglas Blackwood, Aiden Corvin, Matthew Flickinger, Weihua Guan, Morten Mattingsdal, Andrew McQuillin, Phoenix Kwan, Thomas F Wienker, Mark Daly, Frank Dudbridge, Peter A Holmans, Danyu Lin, Margit Burmeister, Tiffany A Greenwood, Marian L Hamshere, Pierandrea Muglia, Erin N Smith, Peter P Zandi, Caroline M Nievergelt, Rebecca McKinney, Paul D Shilling, Nicholas J Schork, Cinnamon S Bloss, Tatiana Foroud, Daniel L Koller, Elliot S Gershon, Chunyu Liu, Judith A Badner, William A Scheftner, William B Lawson, Evaristus A Nwulia, Maria Hipolito, William Coryell, John Rice, William Byerley, Francis J McMahon, Thomas G Schulze, Wade Berrettini, Falk W Lohoff, James B Potash, Pamela B Mahon, Melvin G McInnis, Sebastian Zöllner, Peng Zhang, David W Craig, Szabocls Szelinger, Thomas B Barrett, René Breuer, Sandra Meier, Jana Strohmaier, Stephanie H Witt, Federica Tozzi, Anne Farmer, Peter McGuffin, John Strauss, Wei Xu, James L Kennedy, John B Vincent, Keith Matthews, Richard Day, Manuel A Ferreira, Colm O'Dushlaine, Roy Perlis, Soumya Raychaudhuri, Douglas Ruderfer, Phil H Lee, Jordan W Smoller, Jun Li, Devin Absher, William E Bunney, Jack D Barchas, Alan F Schatzberg, Edward G Jones, Fan Meng, Robert C Thompson, Stanley J Watson, Richard M Myers, Huda Akil, Michael Boehnke, Kim Chambert, Jennifer Moran, Ed Scolnick, Srdjan Djurovic, Ingrid Melle, Gunnar Morken, Michael Gill, Derek Morris, Emma Quinn, Thomas W Mühleisen, Franziska A Degenhardt, Manuel Mattheisen, Johannes Schumacher, Wolfgang Maier, Michael Steffens, Peter Propping, Markus M Nöthen, Adebayo Anjorin, Nick Bass, Hugh Gurling, Radhika Kandaswamy, Jacob Lawrence, Kevin McGhee, Andrew McIntosh, Alan W McLean, Walter J Muir, Benjamin S Pickard, Gerome Breen, David St. Clair, Sian Caesar, Katherine Gordon-Smith, Lisa Jones, Christine Fraser, Elaine K Green, Detelina Grozeva, Ian R Jones, George Kirov, Valentina Moskvina, Ivan Nikolov, Michael C O'Donovan, Michael J Owen, David A Collier, Amanda Elkin, Richard Williamson, Allan H Young, I Nicol Ferrier, Kari Stefansson, Hreinn Stefansson, Þorgeir Þorgeirsson, Stacy Steinberg, Ómar Gustafsson, Sarah E Bergen, Vishwajit Nimgaonkar, Christina Hultman, Mikael Landén, Paul Lichtenstein, Patrick Sullivan, Martin Schalling, Urban Osby, Lena Backlund, Louise Frisén, Niklas Langstrom, Stéphane Jamain, Marion Leboyer, Bruno Etain, Frank Bellivier, Hannes Petursson, Engilbert Sigur∂sson, Bertram Müller-Mysok, Susanne Lucae, Markus Schwarz, Janice M Fullerton, Peter R Schofield, Nick Martin, Grant W Montgomery, Mark Lathrop, Högni Óskarsson, Michael Bauer, Adam Wright, Philip B Mitchell, Martin Hautzinger, Andreas Reif, John R Kelsoe, Shaun M Purcell
Journal: Nature Genetics (2011)
What Are We Teaching About Indigent Patients?
Authors: Gilbert G. Eade
Journal: JAMA (1993)

To the Editor.  —I do not share Miles' pessimism that there is a decrease in charity care by physicians and that physicians put their own advantaged financial interests ahead of their patient's immediate needs. That this occasionally happens is true, but it is certainly not universal. Miles' case in point was a patient with an arm fracture who was refused care by an orthopedic surgeon, allegedly because Medicaid did not pay enough.  Charity is giving care because you want to—not because you have to. Medicaid and Medicare health care reforms were introduced to help the elderly, the young, and those without means. But to make the programs work, physicians, hospitals, and conventional medical insurance are expected to subsidize them. Doing so is not a charitable act, but a response to coercion. Let's not get the two mixed up.  I recently received a letter from our Medicare intermediary stating that it
Pediatric Outpatient Procedures
Authors: Jonathan D. K. Trager
Journal: JAMA (1992)

Although pediatricians may not be known for their technical prowess, there are, unquestionably, a great many procedures that must be mastered if one is to provide comprehensive and efficient pediatric outpatient care. This multiauthored text is a collection of such procedures, and they are assembled in a simple, thoughtful, detailed, and well-illustrated fashion. The book's 25 chapters cover technical skills used in all aspects of pediatric outpatient care. The initial chapters deal with basic topics, such as growth and vital sign measurements, immunization and medication administration, and developmental screening. Then follow chapters describing procedures relating to each body system—skin, eye, ear, nose, throat, etc. The final chapters address specialty procedures such as sexual abuse evaluation, allergy evaluation and treatment, and toxicologic, surgical, and radiologic procedures. Within each chapter, the procedures are arranged as primarily screening, diagnostic, or therapeutic measures. Virtually all are presented in the same reader-friendly format: purpose; selection
NARCOLEPSY OCCASIONALLY A POSTENCEPHALITIC SYNDROME
Authors: WILLIAM G. SPILLER
Journal: JAMA (1926)

Since Gelineau described narcolepsy in 1880, the recognition of this disorder as a distinct entity has been much disputed. By some it has been considered a symptom-complex occurring with epilepsy or hysteria.  In narcolepsy the patient not only drops off to sleep at frequent and often at most inopportune times, but also he may experience a sudden feeling of weakness, even paralysis, from emotional disturbance, especially laughter, and the lower limbs may give way beneath him. This has been described as the cataleptic paralysis of Henneberg or as blockage of tonus. There is also a persistent muscular asthenia which is present even after the night's sleep. The patient may go to sleep while walking in the street or eating, or even when his position may expose him to great danger of death, as in case 2, in which a locomotive fireman would fall asleep while holding to the grabirons by
Temporal Trends and Climatic Factors Associated with Bacterial Enteric Diseases in Vietnam, 1991–2001
Authors: Louise A. Kelly-Hope, Wladimir J. Alonso, Vu Dinh Thiem, Do Gia Canh, Dang Duc Anh, Hyejon Lee, Mark A. Miller
Journal: Environmental Health Perspectives (2007)

ObjectiveIn Vietnam, shigellosis/dysentery, typhoid fever, and cholera are important enteric diseases. To better understand their epidemiology, we determined temporal trends, seasonal patterns, and climatic factors associated with high risk periods in eight regions across Vietnam.MethodsWe quantified monthly cases and incidence rates (IR) for each region from national surveillance data (1991–2001). High- and low-disease periods were defined from the highest and lowest IRs (1 SD above and below the mean) and from outbreaks from positive outliers (4 SDs higher in 1 month or 2 SDs higher in ≥ 2 consecutive months). We used general linear models to compare precipitation, temperature, and humidity between high- and low-risk periods.ResultsShigellosis/dysentery was widespread and increased 2.5 times during the study period, with the highest average IRs found between June and August (2.1/100,000–26.2/100,000). Typhoid fever was endemic in the Mekong River Delta and emerged in the Northwest in the mid-1990s, with peaks between April and August (0.38–8.6). Cholera was mostly epidemic along the central coast between May and November (0.07–2.7), and then decreased dramatically nationwide from 1997 onward. Significant climate differences were found only between high- and low-disease periods. We were able to define 4 shigellosis/dysentery, 14 typhoid fever, and 8 cholera outbreaks, with minimal geotemporal overlap and no significant climatic associations.ConclusionsIn Vietnam, bacterial enteric diseases have distinct temporal trends and seasonal patterns. Climate plays a role in defining high- and low-disease periods, but it does not appear to be an important factor influencing outbreaks.
Pulmonary complications of HIV disease: 10 year retrospective evaluation of yields from bronchoalveolar lavage, 1983-93.
Authors: I K Taylor, R J Coker, J Clarke, F M Moss, R Nieman, D J Evans, D Veale, R J Shaw, D S Robinson, D M Mitchell
Journal: Thorax (1995)

BACKGROUND--Pulmonary disease is a major contributor to morbidity and mortality in patients with HIV infection and AIDS. The aim of this study was to describe bronchoscopic findings and the spectrum of pulmonary pathogens in HIV seropositive patients undergoing investigation of respiratory disease over a 10 year period in a major UK referral centre. METHODS--Recruitment was procedure based with data being captured when bronchoscopy was clinically indicated. Data were evaluated from 580 HIV seropositive patients (559 men, age 13-65 years) over a 10 year period from June 1983 to March 1993. RESULTS--A total of 947 bronchoscopies was performed. The most frequent pulmonary pathogen isolated from bronchoalveolar lavage (BAL) fluid in 44% of all bronchoscopies was Pneumocystis carinii. Of all patients studied, 324 (55%) had at least one cytologically confirmed episode of P carinii pneumonia; this was AIDS defining in 219 (38%) of patients who underwent bronchoscopy. Between 1987 and 1993 the overall diagnostic yield from BAL fluid was 76%; 25% of all bronchoscopies yielded positive microbiological results, the most frequent isolates being Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas spp, and Haemophilus influenzae. Mycobacteria were identified in 8% of patients; M tuberculosis was the most common being identified in 3% of lavage samples and in 4% of patients. No drug-resistant M tuberculosis was found. Viral isolates (mainly cytomegalovirus) were identified in up to 31% of BAL fluid samples. Endobronchial Kaposi9s sarcoma was seen in 15% of patients at bronchoscopy. CONCLUSIONS--Of the 1956 newly diagnosed HIV seropositive patients receiving clinical care at St Mary9s Hospital over this period, approximately 30% underwent bronchoscopy. Diagnostic rates for P carinii pneumonia, endobronchial Kaposi9s sarcoma, and bacterial and mycobacterial infection have remained largely constant since 1989. Bronchoalveolar lavage produces high diagnostic yields generally, and P carinii pneumonia remains a common cause of pulmonary disease in these patients.
Gait Abnormalities in Diabetic Neuropathy
Authors: Evangelos C Katoulis, Mark Ebdon-Parry, Hakan Lanshammar, Loreta Vileikyte, Jarne Kulkarni, Andrew J M Boulton
Journal: Diabetes Care (1997)

OBJECTIVE To investigate the effect of peripheral neuropathy on gait in diabetic patients. RESEARCH DESIGN AND METHODS Gait analysis was performed in the following groups matched for age, sex, and BMI: 20 normal healthy control subjects (NC), 20 non-neuropathic diabetic control subjects (DC), 20 neuropathic diabetic subjects (DN), and 20 neuropathic diabetic subjects with a history of foot ulceration (DNU). All subjects with orthopedic foot problems were excluded from the study. The following gait parameters were investigated: 1) walking speed; 2) stance phase duration; 3) joint angles and moment arms for the ankle, knee, and hip joints in both sagittal and frontal planes; 4) the components of the ground reaction force (GRF) vector; and 5) the ankle, knee, and hip joint moments originating from the GRF vector in both planes. RESULTS There were no statistical differences in any of the parameters studied between the NC and DC groups. Walking speed was significantly slower in the DNU group compared with the two control groups (P &amp;lt; 0.02). The maximum knee joint angle was smaller in the sagittal plane for the DNU group compared with the DC group values (P &amp;lt; 0.05). The maximum value of the vertical component of GRF was found to be higher (P &amp;lt; 0.03) in the two control groups compared with the DNU group. The maximum value of the anteroposterior forces was also found to be higher (P &amp;lt; 0.001) in the DC group compared with the DNU group. The maximum frontal plane ankle joint moment was significantly higher (P &amp;lt; 0.05) in the DN compared with the NC group. CONCLUSIONS Diabetic subjects with peripheral neuropathy demonstrate alterations in some gait parameters during walking. These alterations could facilitate foot injuries, thus contributing to frequent foot ulceration.
Diurnal Blood Pressure Pattern and Risk of Congestive Heart Failure
Authors: Erik Ingelsson, Kristina Björklund-Bodegård, Lars Lind, Johan Ärnlöv, Johan Sundström
Journal: JAMA (2006)

High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown.To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements.Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF.First hospitalization for CHF.Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio > or =1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up.Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.
Oral lichen planus.
Authors: J A Savin
Journal: BMJ (1991)

oocyte development have been found to correlate with a poor outcome.2"122Once again an explanation is lacking, although the associ- ation may be secondary to the polycystic ovary syndrome, which is present in 23% of all women and in some 80% of patients with recurrent miscarriage (diagnosed with ultra- sonography).2'Alternatively, it may be explained by the effect of luteinising hormone on the production of ovarian steroids or on the maturation of oocytes.24Whichever it is, knowing that a raised concentration of serum luteinising hormone increases the risk of miscarriage provides us with a predictive test for women before pregnancy.An abnormal result may identify a subgroup of patients with a potentially remediable cause for their pregnancy losses: hypersecretion of luteinising hormone, which may be suppressed by gonadotrophic releasing agonists,2526 ovarian diathermy,27 and somatostatin.Clinicians must remember that women who have miscarried recurrently from one cause are not protected from a further miscarriage from another cause.Most importantly, when assessing the efficacy of treatment for patients with recurrent miscarriage we must remember that even without treatment about 60% of these women will be successful in their next pregnancy.
Should India launch a national immunisation programme against rotavirus? No
Authors: J. M. Puliyel, J. L. Mathew
Journal: BMJ (2012)

India is considering including rotavirus vaccine in its national childhood immunisation programme. <b>Johnie Rose</b> and <b>Umesh Parashar</b> (doi:10.1136/bmj.e7818) support the move, but <b>Jacob Puliyel</b> and <b>Joseph Mathew</b> question the evidence used to support vaccination
Population based study of fatigue and psychological distress
Authors: T Pawlikowska, T Chalder, S R Hirsch, P Wallace, D J M Wright, S C Wessely
Journal: BMJ (1994)

Objectives : To determine the prevalence of fatigue in the general population and the factors associated with fatigue. Design : Postal survey. Setting : Six general practices in southern England. Subjects : 31 651 men and women aged 18-45 years registered with the practices. Main outcome measures : Responses to the 12 item general health questionnaire and a fatigue questionnaire which included self reported measures of duration, severity, and causes of fatigue. Results - 15 283 valid questionnaires were returned, giving a response rate of 48.3%, (64% after adjustment for inaccuracies in the practice registers). 2798 (18.3%) of respondents reported substantial fatigue lasting six months or longer. Fatigue and psychological morbidity were moderately correlated (r=0.62). Women were more likely to complain of fatigue than men, even after adjustment for psychological distress. The commonest cited reasons for fatigue were psychosocial (40% of patients). Of 2798 patients with excessive tiredness, only 38 (1.4%) attributed this to the chronic fatigue syndrome. Conclusion : Fatigue is distributed as a continuous variable in the community and is closely associated with psychological morbidity.