tbuckley/cabot-search huggingface dataset:
Changing physician performance. A systematic review of the effect of continuing medical education strategies
Authors: D. A. Davis
Journal: JAMA (1995)

<h3>Objective.</h3> —To review the literature relating to the effectiveness of education strategies designed to change physician performance and health care outcomes. <h3>Data Sources.</h3> —We searched MEDLINE, ERIC, NTIS, the Research and Development Resource Base in Continuing Medical Education, and other relevant data sources from 1975 to 1994, using<i>continuing medical education</i>(CME) and related terms as keywords. We manually searched journals and the bibliographies of other review articles and called on the opinions of recognized experts. <h3>Study Selection.</h3> —We reviewed studies that met the following criteria: randomized controlled trials of education strategies or interventions that objectively assessed physician performance and/or health care outcomes. These intervention strategies included (alone and in combination) educational materials, formal CME activities, outreach visits such as academic detailing, opinion leaders, patient-mediated strategies, audit with feedback, and reminders. Studies were selected only if more than 50% of the subjects were either practicing physicians or medical residents. <h3>Data Extraction.</h3> —We extracted the specialty of the physicians targeted by the interventions and the clinical domain and setting of the trial. We also determined the details of the educational intervention, the extent to which needs or barriers to change had been ascertained prior to the intervention, and the main outcome measure(s). <h3>Data Synthesis.</h3> —We found 99 trials, containing 160 interventions, that met our criteria. Almost two thirds of the interventions (101 of 160) displayed an improvement in at least one major outcome measure: 70% demonstrated a change in physician performance, and 48% of interventions aimed at health care outcomes produced a positive change. Effective change strategies included reminders, patient-mediated interventions, outreach visits, opinion leaders, and multifaceted activities. Audit with feedback and educational materials were less effective, and formal CME conferences or activities, without enabling or practice-reinforcing strategies, had relatively little impact. <h3>Conclusion.</h3> —Widely used CME delivery methods such as conferences have little direct impact on improving professional practice. More effective methods such as systematic practice-based interventions and outreach visits are seldom used by CME providers. (<i>JAMA</i>. 1995;274:700-705)
Decisions at the End of Life
Authors: Jeffrey M. Drazen
Journal: New England Journal of Medicine (2003)

In the more than 30 years that I have been practicing medicine, the most difficult task for me has been speaking to the family members of patients whose health is failing. In the 1970s, there was less medical technology that I could use to help my patients, but I usually knew the patients, their families, and their mutual wishes. At that time, physicians generally took the lead in deciding what to do, but when we had done all we could do that was consistent with both our own sense of the best options and our understanding of what the patient . . .
Peter George Montgomery Gaffikin
Authors: Peter Jones, Jane Philippson
Journal: BMJ (2005)

Neurologist who discovered and gave his name to a hereditary form of amyloidosis While working at the Santo António General Hospital in Porto (which had hired him as an unpaid neurologist to head the hospital's first department of neurology) Corino de Andrade noticed patients presenting with features that were characteristic of a peripheral neuropathy but did not fit any established clinical entity.During the next decade he came across dozens of similar cases and did extensive research on the epidemiology and pattern of transmission of this as yet unidentified disease.In 1942 the autopsy of one of his patients revealed the presence of an amyloid substance in several body tissues.This led him to describe a new hereditary amyloid polyneuropathy-particularly prevalent not only in the fishing areas of northern Portugal, but also in coastal regions of other countries, including Japan and Sweden.This familial amyloid polyneuropathy type I (Portuguese) also became known as Corino de Andrade's disease.Andrade's efforts were widely acknowledged by the international scientific community and attracted leading neurology gurus to Portugal.At a reception in Lisbon, Corino de Andrade met the editor of the British journal Brain, who expressed extreme interest in his research, prompting him to start writing his landmark 1952 paper.Politically, Corino de Andrade was a bothersome opponent of the repressive fascist regime that ruled Portugal at the time.He belonged to the Movement of Democratic Unity, and advocated the free discussion of ideas and projects that could lead to a fair and developed society.Having tapped his phone, the political police arrested him in 1951, just when he had finished writing his paper.He was jailed on charges of "subversive activities" and secret links with the Communist Party.He remained in prison for several months, which slowed the publication of his paper.Nevertheless, he managed to review the paper while behind bars, and some of his colleagues submitted two short versions of the article to other international publications.He was released after a few months, possibly thanks to the diligence of an influential colleague and of his English second wife, Gwendoline, a teacher at the British Institute in Porto.The paper remains today the most
Response to Letter Regarding Article, “Lipoprotein Particle Profiles by Nuclear Magnetic Resonance Compared With Standard Lipids and Apolipoproteins in Predicting Incident Cardiovascular Disease in Women”
Authors: Samia Mora, Julie E. Buring, Paul M. Ridker, Nader Rifai, James D. Otvos, Robert S. Rosenson
Journal: Circulation (2009)
The effects of familial relationships, age, body weight, and diet on blood pressure and the 24 hour urinary excretion of sodium, potassium, and creatinine in men, women, and children of randomly selected families.
Authors: S L Connor, W E Connor, H Henry, G Sexton, E J Keenan
Journal: Circulation (1984)

Two hundred thirty-three randomly selected families provided a population for studying the effects of familial relationships, age, diet, body weight, and urinary electrolyte excretion on blood pressure. There was a strong familial component for urinary sodium, potassium, and creatinine excretion and for systolic blood pressure. In individuals, age, heart rate, and body weight were independently related to blood pressure. In women, urinary sodium and potassium levels were related to diastolic blood pressure. These individual relationships persisted when age was accounted for but were no longer significant after adjusting for both age and body weight, suggesting that heavier people eat more food, which in our culture means greater sodium intake. In fact, our randomly selected families were eating as much sodium (130 to 170 meq/day) and as little potassium (50 to 70 meq/day) as consumed by Americans several decades ago. Furthermore, this study again documented the rise in blood pressure with age, which may represent the effect of environmental influences on blood pressure over time. The familial aggregation of urinary sodium, potassium, and creatinine excretion, along with the well-established familial aggregation of body weight, emphasizes the importance of the entire family in the treatment and prevention of hypertension.
Epigenetic Inactivation of the Dioxin-Responsive <i>Cytochrome P4501A1</i> Gene in Human Prostate Cancer
Authors: Steven T. Okino, Deepa Pookot, Long-Cheng Li, Hong Zhao, Shinji Urakami, Hiroaki Shiina, Mikio Igawa, Rajvir Dahiya
Journal: Cancer Research (2006)

Abstract 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD; dioxin) is a toxic environmental contaminant that works through dioxin response elements (DRE) to activate gene expression. We tested the hypothesis that cancer-related epigenetic changes suppress dioxin activation of the cytochrome P4501A1 (CYP1A1) gene. 5-Aza-2′-deoxycytidine (5-aza-CdR), an inhibitor of DNA methylation, increases TCDD-inducible CYP1A1 mRNA expression in cancerous LNCaP cells but not in noncancerous PWR-1E and RWPE-1 cells (all human prostate cell lines). Bisulfite DNA sequencing shows that the TCDD-responsive CYP1A1 enhancer is highly methylated in LNCaP cells but not in RWPE-1 cells. In vivo footprinting experiments reveal that unmethylated DRE sites do not bind protein in response to TCDD in LNCaP cells, whereas inducible DRE occupancy occurs in RWPE-1 cells. Pretreatment of LNCaP cells with 5-aza-CdR partially restores TCDD-inducible DRE occupancy, showing that DNA methylation indirectly suppresses DRE occupancy. Chromatin immunoprecipitation experiments reveal that LNCaP cells lack trimethyl histone H3 lysine 4, a mark of active genes, on the CYP1A1 regulatory region, whereas this histone modification is prevalent in PWR-1E and RWPE-1 cells. We also analyzed CYP1A1 enhancer methylation in human prostate tissue DNA. We do not detect CYP1A1 enhancer methylation in 30 DNA samples isolated from noncancerous prostate tissue. In contrast, 11 of 30 prostate tumor DNA samples have detectable CYP1A1 enhancer methylation, indicating that it is hypermethylated in prostate tumors. This is the first report that shows that CYP1A1 is aberrantly hypermethylated in human prostate cancer and has an altered, inaccessible chromatin structure that suppresses its dioxin responsiveness. (Cancer Res 2006; 66(15): 7420-8) (Cancer Res 2006; 66(15): 7420-8)
Metabolic and functional effects of the nucleoside transport inhibitor R75231 in the ischaemic and blood reperfused rabbit heart
Authors: M. Galinanes, Y. Qiu, H. V. Belle, D. J Hearse
Journal: Cardiovascular Research (1993)

Objective: The ability of R75231, a nucleoside transport inhibitor, to influence adenine nucleotide metabolism and enhance postischaemic functional recovery was assessed in the blood perfused rabbit heart. Methods: Hearts (n=8 per group) from donor animals were excised and perfused with blood at 37°C from a support rabbit. After 20 min of aerobic perfusion hearts were arrested with St Thomas' Hospital cardioplegic solution (2 min at 37°C) and rendered globally ischaemic for 60 min. This was followed by 60 min of reperfusion. R75231 (0.1 mg·kg−1, intravenously) was given to donor and support rabbits 1 h before the experiment, control rabbits receiving the same volume of vehicle. Results: Treatment with R75231 resulted in a 45% reduction in coronary vascular resistance in aerobically perfused control hearts, an effect that was absent during postischaemic reperfusion. Thus, before ischaemia, coronary flow was greater in R75231 treated hearts [6.6(SEM 0.8) ml·min−1] than in controls [4.3(0.6) ml·min−1; p<0.05] but during reperfusion no significant difference was observed [4.0(0.6) v 3.6(0.3) ml·min−1]. The mean time to onset and extent of contracture during ischaemia was similar in R75231 treated and control groups, at 42(4) v 41(4) min and 27(3) v 26(6) mm Hg, respectively. Left ventricular developed pressure recovered to approximately 50% of its preischaemic value during the first 40 min of reperfusion in both groups; however, after longer durations of reperfusion, it tended to deteriorate in the R75231 treated group whereas it was maintained at a constant level in the controls [37(10) v 53(6) mm Hg, respectively; NS]. At the end of reperfusion, tissue adenosine content was 13-fold greater in the R75231 treated group, at 0.40(0.09) v 0.03(0.01) μmol·g−1 dry wt in controls; p<0.05; the nucleotide pool, nicotinamide adenine dinucleotide phosphate content, and the energy charge potential were similar in both groups. Conclusions: R75231 decreased coronary vascular resistance and increased coronary flow during aerobic perfusion in control hearts, an effect that was lost after ischaemia and reperfusion. R75231 also increased greatly the tissue content of adenosine but, despite this, failed to improve either the recovery of cardiac contractile function or the replenishment of the adenine nucleotide pool. Cardiovascular Research 1993;27:90-95
X-Ray Limitations and Requirements
Authors: G. G. Kopstein
Journal: JAMA (1963)

<h3>To the Editor:</h3> —I take exception to some of the contents of an excerpted article, "X-Rays Can Lie," in the Medical News section of the May 11 issue ofThe Journal(<b>184:</b>adv p 40). X-rays, like any other method in medicine, may fail to give one all the pertinent information or easily mislead the uninitiated. However, they do not lie.—A lie, according to Webster, is a falsehood uttered or acted to deceive.—Undesirable as shortcomings or limitations of a method are, they do not constitute lies. As to the "requirements" listed, most of them are truisms and do not represent a new orientation. Specifically, the suggestion to take special views, or even pointing out the necessity of taking lateral views, form an old-established part of any x-ray examination. Every trained radiologist or physician dealing with trauma is familiar with these suggestions. What needs to be pointed out, however, is the
In vivo leukemic transformation: Cytogenetic evidence of in vivo leukemic transformation of engrafted marrow cells
Authors: Kong‐Oo Goh, Martin R. Klemperer
Journal: American Journal of Hematology (1977)

Abstract A 4‐year‐old girl with acute myeloblastic leukemia was treated with 50 mg/kg cyclophosphamide daily for 4 days before being given 1.7 × 10 8 bone marrow cells/kg from her HL‐A identical, MLC nonreactive, cytogenetically normal brother. The patient died 92 weeks after the marrow graft. Postmortem examination showed increased myeloblasts and promyelocytes. Cytogenetic studies before transplantation showed that all sex determination metaphases had an XX pattern, and 41% of the hyperdiploid metaphases had an additional 19–20(F) chromosome. At autopsy all hyperdiploid metaphases with XY pattern and 43% of the hyperdiploid metaphases with an XX pattern had an additional F chromosome. Occasional metaphases with 47,XX,+F or 47,XY,+F were seen during the follow‐up studies. These findings indicated that an acute leukemia had developed in the XY cell line of this artifically induced sex chimeric child. This suggests that a leukemic stimulus other than that proposed to be induced by total‐body irradiation existed in this patient and transformed the engrafted cells.
Thyroid Nodularity in Children-Reply
Authors: Marvin L. Rallison
Journal: JAMA (1976)

In Reply.—  Estimates of radiation exposure to the thyroid in the children with thyroid nodularity included in our report may be found in our earlier epidemiologic reports. 1,2 The actual measurement of iodine 131 in milk was not made during the period of above-ground nuclear testing. Estimates based on calculations from gross fission-yield data vary from 18 to 120 rads to the thyroid. From a comparison of observed vs expected excess nodularity, 3 it appears likely that exposure was closer to the lower estimate.
Franz Kafka--his father's son. A study in literary sexuality
Authors: N. Y. Hoffman
Journal: JAMA (1974)

FRANZ KAFKA wrote some of the most brilliant, disturbing, difficult, harrowing—and prophetic—literature of the twentieth century. Fragmentary though much of his work may be, for many of his fictions are in the form of diaries and reflections, and many of his diaries ask questions about the nature of reality, still his strange genius is imprinted on every page. While all writing is, in a sense, autobiographical, and while literary critics must avoid the biographical fallacy of interpreting a writer's work in relation to his life, Kafka's terrifying novels, stories, and sketches blur the crucial line between personal commentary and literary artifact. And Kafka himself, fearfully private, was well aware how much of his inner being, how much of his tortured relationship with his father, how much of his sexual impotence and anxiety was in his work.  Kafka made Max Brod, his literary executor and one real friend, promise to destroy
Sonic hedgehog is a critical mediator of erythropoietin-induced cardiac protection in mice
Authors: Kazutaka Ueda, Hiroyuki Takano, Yuriko Niitsuma, Hiroshi Hasegawa, Raita Uchiyama, Toru Oka, Masaru Miyazaki, Haruaki Nakaya, Issei Komuro
Journal: Journal of Clinical Investigation (2010)

Erythropoietin reportedly has beneficial effects on the heart after myocardial infarction, but the underlying mechanisms of these effects are unknown. We here demonstrate that sonic hedgehog is a critical mediator of erythropoietin-induced cardioprotection in mice. Treatment of mice with erythropoietin inhibited left ventricular remodeling and improved cardiac function after myocardial infarction, independent of erythropoiesis and the mobilization of bone marrow–derived cells. Erythropoietin prevented cardiomyocyte apoptosis and increased the number of capillaries and mature vessels in infarcted hearts by upregulating the expression of angiogenic cytokines such as VEGF and angiopoietin-1 in cardiomyocytes. Erythropoietin also increased the expression of sonic hedgehog in cardiomyocytes, and inhibition of sonic hedgehog signaling suppressed the erythropoietin-induced increase in angiogenic cytokine expression. Furthermore, the beneficial effects of erythropoietin on infarcted hearts were abolished by cardiomyocyte-specific deletion of sonic hedgehog. These results suggest that erythropoietin protects the heart after myocardial infarction by inducing angiogenesis through sonic hedgehog signaling.
Single-Dose Packaging of Meningococcal Vaccine-Reply
Authors: James E. Froeschle
Journal: JAMA (1988)

<h3>In Reply.—</h3> Connaught Laboratories, Inc, has recognized the need for unitdose packaging of meningococcal polysaccharide vaccine (Menomune). Testing requirements mandated by the Food and Drug Administration for licensure of the single-dose formulation are currently in progress. We anticipate that Menomune will be available in a single-dose container by March 1989.
Nexilin mutations destabilize cardiac Z-disks and lead to dilated cardiomyopathy
Authors: David Hassel, Tillman Dahme, Jeanette Erdmann, Benjamin Meder, Andreas Huge, Monika Stoll, Steffen Just, Alexander Hess, Philipp Ehlermann, Dieter Weichenhan, Matthias Grimmler, Henrike Liptau, Roland Hetzer, Vera Regitz-Zagrosek, Christine Fischer, Peter Nürnberg, Heribert Schunkert, Hugo A Katus, Wolfgang Rottbauer
Journal: Nature Medicine (2009)
Book: Medical Error: What Do We Know? What Do We Do?
Authors: D. Woods
Journal: BMJ (2002)

Eds Marilynn M Rosenthal, Kathleen M Sutcliffe Jossey-Bass, $45, pp 368 ISBN 0 7879 6395 X Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> For ordering details, see www.josseybass.com The causes of medical error are well documented: stress, burnout, and loss of autonomy among physicians; nurses' unwillingness to challenge or question doctors' actions; the complexity and interdependence of medical procedures; fear of litigation; and strained resources. More than 80% of medical error, though, according to this book, can be blamed on non-communication or miscommunication. And what we do about all this is, like medicine itself, not entirely an exact science. This book emerged from a conference at the … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
Israel: Government endorses back to sleep policy
Authors: J. Siegel-Itzkovich
Journal: BMJ (1995)

The Israeli ministry of health has officially accepted and endorsed the policy of laying babies on their backs or sides to reduce the incidence of the sudden infant death syndrome. Dr Alex Levinthal, head of the ministry's public health department, said: “We believe that this state policy will reduce the number of crib deaths, which even prior to it has been extraordinarily low—and we don't know why.”

The new guidelines have been recommended for about a year in all the country's obstetrics departments and family health centres. Although Israeli doctors and nurses are somewhat conservative, almost all have agreed to promote the supine or side positions, even though they previously offered the opposite …
THE EQUILIBRATION OF RADIOSODIUM (Na24), RADIOPOTASSIUM (K42), AND DEUTERIUM OXIDE (D2O) IN HYDROPIC HUMAN SUBJECTS 1
Authors: M. P. O'Meara, L. W. Birkenfeld, F. A. Gotch, I. S. Edelman
Journal: Journal of Clinical Investigation (1957)

Isotope dilution methods have been described for the determination of total exchangeable sodium (Nae) (1, 2), total exchangeable potassium (Ke) (3-5), and total body water (T.B.W.) (6-8) with Na24, K42 and D20 as tracers.The time required for equilibrium of distribution of each of the isotopes must be determined experimentally, since uniform mixing is an ex- plicit assumption with these methods (9).In normal human subjects the times required for 95 to 100 per cent equilibration were found to be 12 to 20 hours for Na24, 18 to 40 hours for K42, and 2 to 3 hours for D20 (1-7).The presence of ab- normal fluid collections, however, may produce significant delays in diffusion equilibrium.The present study was undertaken to determine the equilibration time of Na24, K42 and D20 in patients with edema or abnormal fluid collec- tions.Equilibrium of distribution was evaluated by comparisons of specific activities between vari- ous body fluids and by determinations of apparent exchangeable quantities as a function of time.METHODS A total of 78 hydropic patients, 57 males and 21 fe- males, was studied.Each subject received only one of the three isotopes.The group was divided into patients with congestive heart failure, designated as cardiacs, and those with hepatic cirrhosis and ascites, as well as a few with the nephrotic syndrome, designated as non- cardiacs.Subjects receiving Na' or K" were fed an analyzed diet, containing 10 mEq. of Na and 28 mEq. of K, for the 2 days preceding and the 2 days of the study.