tbuckley/cabot-search huggingface dataset:
Barriers and Decisions When Answering Clinical Questions at the Point of Care
Authors: David A. Cook, Kristi J. Sorensen, John M. Wilkinson, Richard A. Berger
Journal: JAMA Internal Medicine (2013)

<h3>Importance</h3> Answering clinical questions affects patient-care decisions and is important to continuous professional development. The process of point-of-care learning is incompletely understood. <h3>Objective</h3> To understand what barriers and enabling factors influence physician point-of-care learning and what decisions physicians face during this process. <h3>Design</h3> Focus groups with grounded theory analysis. Focus group discussions were transcribed and then analyzed using a constant comparative approach to identify barriers, enabling factors, and key decisions related to physician information-seeking activities. <h3>Setting</h3> Academic medical center and outlying community sites. <h3>Participants</h3> Purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians, interviewed in 11 focus groups. <h3>Results</h3> Insufficient time was the main barrier to point-of-care learning. Other barriers included the patient comorbidities and contexts, the volume of available information, not knowing which resource to search, doubt that the search would yield an answer, difficulty remembering questions for later study, and inconvenient access to computers. Key decisions were whether to search (reasons to search included infrequently seen conditions, practice updates, complex questions, and patient education), when to search (before, during, or after the clinical encounter), where to search (with the patient present or in a separate room), what type of resource to use (colleague or computer), what specific resource to use (influenced first by efficiency and second by credibility), and when to stop. Participants noted that key features of efficiency (completeness, brevity, and searchability) are often in conflict. <h3>Conclusions and Relevance</h3> Physicians perceive that insufficient time is the greatest barrier to point-of-care learning, and efficiency is the most important determinant in selecting an information source. Designing knowledge resources and systems to target key decisions may improve learning and patient care.
Effect of Meal Dilution on the Postprandial Glycemic Response: Implications for glycemic testing
Authors: John L Sievenpiper, Vladimir Vuksan, Evelyn YY Wong, Rena A Mendelson, Charles Bruce-Thompson
Journal: Diabetes Care (1998)

OBJECTIVE To investigate the effect of varying the volume of sugar meals on the postprandial glycemic response (PGR). RESEARCH DESIGN AND METHODS On six separate occasions, after an overnight fast, blood glucose concentrations were measured in eight healthy subjects (34 ± 4 years of age, BMI 22.9 ± 0.9 kg/m2) after the consumption of 25 g glucose, sucrose, or fructose dissolved in either 200 or 600 ml of water. Blood was obtained at fasting and then at times 15, 30, 45, 60, and 90 min after the start of the test meal. RESULTS PGR was found to be influenced by carbohydrate type (P &amp;lt; 0.001). Mean response areas (min · mmol · l−1) to the three sugars were statistically different (P &amp;lt;0.05). Glucose had the highest response area (90.0 ± 8.1), followed by sucrose (61.3 ± 5.0) and then fructose (14.7 ± 2.8). Independent of this effect, PGR was also found to be influenced by volume dose (P &amp;lt; 0.01). By tripling meal volume from 200 to 600 ml, PGR areas were significantly increased for all three sugars, glucose (79.3 ± 10.3 vs. 100.8 ± 12.0, P = 0.035), sucrose (52.6 ± 5.5 vs. 70 ± 7.4, P = 0.0094), and fructose (11.0 ± 3.8 vs. 18.4 ± 3.9, P = 0.012). Where the effects of time (P &amp;lt; 0.05) and dose (P &amp;lt; 0.05) were determined to be independent (interaction nonsignificant) for all three sugars, this increase in volume also significantly increased glycemic concentrations at 15 min, for glucose (P = 0.033) and sucrose (P = 0.026), suggesting that changes in gastric emptying time may be a mechanism of action. CONCLUSIONS Varying the volume of liquid sugar meals alters PGR.Understanding this concept may help to reduce variability both in the glycemic testing of foods and oral glucose tolerance testing.
Verapamil and Its Derivative Trigger Apoptosis through Glutathione Extrusion by Multidrug Resistance Protein MRP1
Authors: Doriane Trompier, Xiu-Bao Chang, Régis Barattin, Amaury du Moulinet d’Hardemare, Attilio Di Pietro, Hélène Baubichon-Cortay
Journal: Cancer Research (2004)

Abstract This study demonstrates that verapamil and a newly synthesized verapamil derivative, NMeOHI2, behave as apoptogens in multidrug resistance protein 1 (MRP1)-expressing cells. When treated with either verapamil or NMeOHI2, surprisingly, baby hamster kidney-21 (BHK) cells transfected with human MRP1 were killed. Because parental BHK cells were not, as well as cells expressing an inactive (K1333L) MRP1 mutant, this indicated that cell death involved functional MRP1 transporter. Cell death was identified as apoptosis by using annexin V-fluorescein labeling and was no longer observed in the presence of the caspase inhibitor Z-Val-Ala-Asp(OMe)-CH2F (Z-VAD-FMK). In vitro, both verapamil and its derivative inhibited leukotriene C4 transport by MRP1-enriched membrane vesicles in a competitive manner, with a Ki of 48.6 μm for verapamil and 5.5 μm for NMeOHI2, and stimulated reduced glutathione (GSH) transport 3-fold and 9-fold, respectively. Treatment of MRP1-expressing cells with either verapamil or the derivative quickly depleted intracellular GSH content with a strong decrease occurring in the first hour of treatment, which preceded cell death beginning at 8–16 h. Furthermore, addition of GSH to the media efficiently prevented cell death. Therefore, verapamil and its derivative trigger apoptosis through stimulation of GSH extrusion mediated by MRP1. This new information on the mechanism of induced apoptosis of MDR cells may represent a novel approach in the selective treatment of MRP1-positive tumors.
Health Services Innovation
Authors: Barry Zuckerman, Peter A. Margolis, Kedar S. Mate
Journal: JAMA (2013)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2022 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
Holiday companies improve their health advice.
Authors: J H Cossar, J McEachran, D Reid
Journal: BMJ (1993)

all that is private is bad-an unfortunate throwback to Nehru's era of pseudosocialism.Reality is very different, with most government teaching hospitals being poorly equipped, maintained, and staffed.On the other hand, some private institu- tions, like the Kasturba Medical College at Manipal, are acknowledged to be among the best in the country.Thirdly, the judgment provides that half of the seats will be filled by students who will pay the same fee as that levied by the state subsidised government colleges.This ignores the fact that the private colleges do not enjoy any subsidy and that therefore, in effect, the educational expenses of these students will be met by the other half, who will pay a higher fee, and this is in no way fair.Instead of taking a futuristic view the Supreme Court has taken an unfortunate step backwards.
The "compensatory pause" of atrial fibrillation.
Authors: E L Pritchett, W M Smith, G J Klein, S C Hammill, J J Gallagher
Journal: Circulation (1980)

A long pause after an abnormal heat during atrial fibrillation has been called a "compensatory pause" and has been used to identify premature ventricular complexes (PVCs) and to differentiate them from supraventricular beats with aberration. The diagnostic value of the compensatory pause is controversial and has not been tested systematically with programmed stimulation and intracardiac recordings. In this study we used these methods to determine if PVCs induced during atrial fibrillation were followed by compensatory pauses. Five patients were studied who had ECGs with a normal PR interval and a normal QRS duration and morphology during sinus rhythm. Atrial fibrillation was induced by rapid atrial pacing. PVCs were induced by coupling a ventricular extrastimulus to every eighth or tenth QRS complex during atrial fibrillation. The coupling interval of the PVC was changed in 10- or 20-msec increments until the entire cardiac cycle was scanned. The mean duration of recorded atrial fibrillation was 15.7 minutes. Fifty-seven to 163 PVCs were induced in each patient. The mean cycle after the induced PVC was calculated and compared with the mean control cycle. The mean cycle after the PVC was 107-136 msec longer than the mean control cycle (p &lt; 0.001 in every patient). This study confirms the presence of a compensatory pause after stimulated PVCs in atrial fibrillation.
Signals from the somatising patient.
Authors: J. Price
Journal: BMJ (1989)

Sick doctorsSIR,-Like others before him,' 2 Dr Clive Richards has drawn attention to the stress problems, emo- tional difficulties, and preventive care needs of general practitioners.'A national counselling service for sick doctors already exists,4 but Dr Richards rightly pointed out that coping includes "trying to prevent problems before they occur."Risk factors have been identified.For example, Walton recently noted, "it is commonly accepted that achievement-oriented compulsive people are attracted to medicine" and that this preselection of vulnerable individuals may contribute to the high incidence of mental illness, stress, and drug dependence.'Student selection methods should therefore be reconsidered as part of primary prevention.Current student selection procedures have been criticised6 and contrasted with the thorough personality assessment and psychological testing used by organisations such as IBM.7 In 1988 the World Federation of Medical Education recommended that medical schools should "use selection methods for medical students which 'go beyond intellectual ability and academic achievement to include the evaluation of personal qualities.'"" Including personality assessment in student selection might therefore provide effective primary prevention to help reduce long term unhappiness, stress, and mental illness in the profession.
Abstract 2272: Comparison of metformin, pheformin and buformin in mammary carcinogenesis in non-obese, non-diabetic rats.
Authors: Zongjian Zhu, Weiqin Jiang, John N. McGinley, Henry J. Thompson
Journal: Cancer Research (2013)

Abstract Emerging evidence from studies of human pharmacoepidemiology indicate that metformin, an antidiabetic drug, is associated with reduced breast cancer risk in diabetic individuals. Data from preclinical mammary carcinogenesis studies in the rat indicate that metformin also has protective activity against chemically-induced mammary cancer in non diabetic rats, but the dose required for inhibition is above that used clinically for the treatment of diabetes. Human breast cancer cell growth also is inhibited by metformin, but at concentrations far in excess of anti-diabetic plasma concentrations of the drug. It is likely that pharmacokinetic/pharmacodyanmic factors contribute to this blunted sensitivity, possibly due to carcinogenesis-associated down regulation of organic cationic transporters (OCT) required for cellular uptake of metformin. Since some biguanides such as phenformin and buformin are not dependent on OCT for cellular accumulation, their effects against mammary carcinogenesis were evaluated in comparison to metformin as a proof-in-concept study that could set the stage for development of second generation biguanides. The hypothesis evaluated was that inhibition of mammary carcinogenesis by phenformin and buformin would be superior to metformin. Female Sprague Dawley rats (n=30/group) were injected with 1-methyl-1-nitrosourea (50 mg/kg) at 21 days of age and 7 days thereafter randomized to metformin, phenformin or buformin dietary groups and fed respective biguanides (10 mmol/kg) diets for 6 weeks. Both phenformin and buformin significantly reduced the number of mammary adenocarcinoma per rat (3.6, 1.6, and 0.7 cancers/rat for metformin, phenformin and buformin respectively) and tumor burden (1.61, 0.63, and 0.12 g/rat for metformin, phenformin and buformin respectively) and elongated cancer latency compared to metformin (40, 45, and 48 days post carcinogen for metformin, phenformin and buformin respectively) (p&amp;lt;0.05). Mammary cancer incidence was also lower in animals fed phenformin (77%) or buformin (43%) diet vs metformin (93%), but the difference was only significant between metformin and buformin (p&amp;lt;0.001). Cell culture experiments confirmed the carcinogenesis data. The comparative effects of these biguanides on the LKB1/AMPK axis will be reported. The associated mechanisms of cell growth inhibiton are under investigation. Supported by PHS grant CA52626 from the National Cancer Institute. Citation Format: Zongjian Zhu, Weiqin Jiang, John N. McGinley, Henry J. Thompson. Comparison of metformin, pheformin and buformin in mammary carcinogenesis in non-obese, non-diabetic rats. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2272. doi:10.1158/1538-7445.AM2013-2272
Endoscopic therapy of gallstones ileus
Authors: H. Schwacha, H. Blum, P. Hafkemeyer
Journal: Endoscopy (2008)

Gallstone ileus is a rare clinical complication of gallstone disease and is primarily treated surgically. We describe three cases of gallstone ileus, including the first report of successful treatment of jejunal gallstone ileus by endoscopically applied electrohydraulic lithotripsy (EHL).
Anthrax Vaccine
Authors: A M Friedlander, P R Pittman, G W Parker
Journal: JAMA (1999)

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
Closed-Chest Cardiac Massage in the Treatment of Venous Air Embolism
Authors: Judith A. Ericsson, Joel D. Gottlieb, Robert B. Sweet
Journal: New England Journal of Medicine (1964)

VENOUS air embolism is a dreaded complication of a variety of surgical, therapeutic and diagnostic technics. In one series it accounted for 1 in 108 operating-room deaths.1 It is almost always the result of human error.2 The diagnosis is usually made by the detection of the "mill-wheel" murmur, said to be pathognomonic of the condition.3 The murmur represents the right ventricle beating against the bubbles of air, and this sign is frequently the precursor of cardiovascular collapse.Previous treatment has consisted of placing of the patient in the left lateral decubitus position to dislodge the bubble of air from the . . .
X-ray Seminar
Authors: J. Malcolm McNeill
Journal: JAMA (1972)

To the Editor.—  This issue ofThe Journalcontains the final number of the X-RAY SEMINAR series which was begun in 1961 under the guidance of Dr. Laurence L. Robbins. Judging by the number of requests received from all over the world, this ten-year-old feature ofThe Journalhas been a very popular one. In addition to the requests for individual Seminars, several teaching centers as well as individuals left standing orders, periodically renewed, requesting that a reprint of each Seminar be automatically sent to them. This popular demand resulted in a collection of the first 100 cases of this series.1  It seems that a brief historical note regarding the X-ray Seminar at the Massachusetts General Hospital might be appropriate at this time. They were begun at some time prior to 1927 when Dr. George W. Holmes was Radiologist-in-Chief. During 1938 and 1939, Dr. James R. Lingley published a
Optimization of Skin Electroporation in Mice to Increase Tolerability of DNA Vaccine Delivery to Patients
Authors: Anna-Karin Roos, Fredrik Eriksson, Derin C Walters, Pavel Pisa, Alan D King
Journal: Molecular Therapy (2009)

Electroporation has, during the last years, proven to be a very successful delivery method for DNA vaccines and has now reached clinical evaluation. Although intramuscular electroporation is practical in animal models, intradermal electroporation might be more suitable for clinical administration. Skin is the most accessible organ of the body and has professional antigen-presenting cells in large amounts; thus, skin is an ideal target for DNA vaccine delivery. Moreover, intradermal electroporation has clear clinical benefits such as improved safety and tolerability. This article describes improvements for effective and tolerable DNA delivery to skin. The time of pulse delivery has been shortened by 90% and even pulse programs of 240-ms total duration generate robust immune responses. We show that a single vaccination using an optimized gene delivery generates (i) high and consistent protein expression in vivo, (ii) cytotoxic antigen-specific T cells expressing both IFNγ and CD107a (lysosomal-associated membrane protein 1). Furthermore, application of a topical anesthetic cream prior to vaccination does not affect the number or function of the antigen-specific T cells induced. This suggests that local anesthesia can be used to further decrease the sensation of pulse delivery in patients. Electroporation has, during the last years, proven to be a very successful delivery method for DNA vaccines and has now reached clinical evaluation. Although intramuscular electroporation is practical in animal models, intradermal electroporation might be more suitable for clinical administration. Skin is the most accessible organ of the body and has professional antigen-presenting cells in large amounts; thus, skin is an ideal target for DNA vaccine delivery. Moreover, intradermal electroporation has clear clinical benefits such as improved safety and tolerability. This article describes improvements for effective and tolerable DNA delivery to skin. The time of pulse delivery has been shortened by 90% and even pulse programs of 240-ms total duration generate robust immune responses. We show that a single vaccination using an optimized gene delivery generates (i) high and consistent protein expression in vivo, (ii) cytotoxic antigen-specific T cells expressing both IFNγ and CD107a (lysosomal-associated membrane protein 1). Furthermore, application of a topical anesthetic cream prior to vaccination does not affect the number or function of the antigen-specific T cells induced. This suggests that local anesthesia can be used to further decrease the sensation of pulse delivery in patients.
A phase II study of adoptive immunotherapy using dendritic cells pulsed with tumor lysate in patients with hepatocellular carcinoma
Authors: Daniel H. Palmer, Rachel S. Midgley, Noweeda Mirza, Elizabeth E. Torr, Forhad Ahmed, Jane C. Steele, Neil M. Steven, David J. Kerr, Lawrence S. Young, David H. Adams
Journal: Hepatology (2008)

This is a phase II clinical trial investigating the safety and efficacy of intravenous vaccination with mature autologous dendritic cells (DCs) pulsed ex vivo with a liver tumor cell line lysate (HepG2) in patients with advanced hepatocellular carcinoma (HCC). HCC is an attractive target for immunotherapy as evidenced by an active recruitment of tumor-infiltrating lymphocytes that are capable of lysing autologous tumor cells in ex vivo studies. DCs are the most potent antigen-presenting cells, with the capacity to take up, process, and present tumor antigens to T cells and stimulate an immune response, thus providing a rational platform for vaccine development. Thirty-five patients with advanced HCC and not suitable for radical or loco-regional therapies received a maximum of six DC vaccinations each at 3-week intervals. In total, 134 DC infusions were administered with no significant toxicity and no evidence of autoimmunity. Twenty-five patients who received at least three vaccine infusions were assessed clinically for response. The radiologically determined disease control rate (combined partial response and stable disease ≥3 months) was 28%. In 17 patients the baseline serum α-fetoprotein (AFP) was ≥ 1,000 ng/mL; in four of these patients, it fell to <30% of baseline following vaccination. In one patient there was a radiological partial response associated with a fall in AFP to <10% of baseline. Immune responses were assessed using an ELIspot assay of interferon-γ (IFN-γ) release. In several cases there was induction of T cell responses to the vaccine and/or AFP following vaccination. Conclusion: Autologous DC vaccination in patients with HCC is safe and well tolerated with evidence of antitumor efficacy assessed radiologically and serologically, with generation of antigen-specific immune responses in some cases. (HEPATOLOGY 2009;49:124-132.)