tbuckley/cabot-search huggingface dataset:
Long Hours and Risks to and From Residents
Authors: Amy E. Pollack
Journal: JAMA (1988)

To the Editor.—  Three cheers for Dr Giardino 1 for his response to the letter by Drs Wendt and Yen 2 about house staff moonlighting. He has addressed the concerns of many residents, recent graduates, and patients. The current method of residency training is antiquated. As technology has advanced and malpractice liability has demanded increasing documentation in medical settings, the modern-day resident struggles with rapidly increasing responsibilities.  Is the residency training program adhering to its goals? Dr Giardino's arguments might be pushed one step further to define those goals and shed light on the bigger picture. Of all the excuses for perpetuation of the current system, economics is the most well founded. Between 13% and 14% of the US population (30 to 35 million people) lack medical insurance. 3 More than a half million women who have no coverage give birth each year. In 1986 in Washington State an estimated
Truth or Consequences
Authors: Norman G. Levinsky
Journal: New England Journal of Medicine (1998)

Several years ago, I served as a panelist at a conference on health care ethics at a university-affiliated community hospital. The chief of orthopedic surgery asked my opinion of a proposal made to him by the hospital's chief executive officer (CEO). The CEO explained that the hospital was losing money on hip-replacement surgery, because the payment the hospital received from Medicare, which paid for nearly all hip replacements, was less than the hospital's cost. A major component of the cost was the price of the hip prosthesis. The CEO requested that the orthopedic surgeons use a much less expensive prosthesis . . .
Reviews and Notes: Ethics: Medical Ethics: Policies, Protocols, Guidelines and Programs
Authors: Allan S. Brett
Journal: Annals of Internal Medicine (1994)

Literature of Medicine1 March 1994Reviews and Notes: Ethics: Medical Ethics: Policies, Protocols, Guidelines and ProgramsAllan S. BrettAllan S. BrettNew England Deaconess Hospital, Boston, MA 02215Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-5-199403010-00048 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medical Ethics: Policies, Protocols, Guidelines and ProgramsJohn F. Monagle and David C. Thomasma. Gaithersburg, Maryland: Aspen Publishers; 1992. $189.00.Written policies addressing the ethical dimensions of medical practice are increasingly becoming a part of the bureaucratic landscape in American hospitals and health care institutions. Such policies range from straightforward descriptions of established practices to more controversial documents that authorize fundamental changes in institutional practice. One might question whether many of the written policies on bioethical matters are beneficial for clinicians or patients. Useful or not, they are a fact of life because they are increasingly mandated by accrediting agencies.... Author, Article, and Disclosure InformationAffiliations: New England Deaconess Hospital, Boston, MA 02215 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1994Volume 120, Issue 5Page: 448KeywordsChildrenHealth careHealth care policyMedical ethicsTransplantation ePublished: 15 August 2000 Issue Published: 1 March 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A genetic dichotomy model for the inheritance of Alzheimer’s disease and common age-related disorders
Authors: Rudolph E. Tanzi
Journal: Journal of Clinical Investigation (1999)

Alzheimer’s disease (AD), already one of the most serious health problems in the U.S., will carry an ever burgeoning impact as the proportion of elderly continues to increase. Clinically, AD is a progressive neurodegenerative disorder characterized by global cognitive decline. Neuropathologically, the brains of AD patients contain abundant amounts of neurofibrillary tangles (NFT) and β-amyloid in the form of senile plaques (SP) and blood vessel deposits. While the etiological events that lead to AD have not been clearly resolved, genetic factors clearly play a major role; there is an emerging consensus that AD is a complex and genetically heterogeneous disorder that is best explained by an age-dependent dichotomous model. On one hand, early-onset (<60) AD is caused by defects in any of three different genes: presenilin 1 (PSEN1) on chromosome 14 (1), presenilin 2 (PSEN2) on chromosome 1 (2), and the amyloid β protein precursor (APP) on chromosome 21 (3). On the other hand, late-onset AD is associated with genetic polymorphisms that appear to operate as risk factors and/or genetic modifiers.
Morphological changes of heart muscle caused by successive perfusion with calcium-free and calcium-containing solutions (calcium paradox)
Authors: W Hülsmann
Journal: Cardiovascular Research (2000)

Perfusion of isolated rat hearts with a modified Tyrode solution followed by perfusion with a calcium-free perfusate results in an electromechanical dissociation and causes no significant morphological changes. However, reinstitution of calcium ions leads to gross morphological changes, as shown by histological and electron-microscopical evidence. Contractility is not restored and electrical activity disappears (calcium paradox). Some of the cells are reduced to empty spaces containing swollen mitochondria. Other cells appear to be intact, but show signs of hypercontraction. Cardiac damage due to the calcium paradox could also be demonstrated by x-ray angiography.
THE RESULTS OF THE OPERATION OF SUBMUCOUS RESECTION OF THE SEPTUM IN PRIVATE PRACTICE
Authors: FRANCIS P. EMERSON
Journal: JAMA (1910)

In order that we may reach definite conclusions in regard to the value of the submucous resection of the septum, it is necessary that we should know what indications, in the operator's opinion, justify its performance. These can be classified under two heads: first, the mechanical indications that lead to the selection of a particular operation in order that we may remove undue redunancy, correct displacement and overcome the resiliency of the septum; this division will not be discussed, as it is understood that all cases in this series were corrected by means of the window resection method; and second, the clinical indications. It is obvious that not every deflected septum is necessarily pathologic, for we must bear in mind that the patient does not consult us for the deflection itself, but for conditions that have resulted from the unequal ingress of air, which has produced hypertrophies, contact, insufficient drainage
Tc-99m MDP Uptake in Staphylococcus aureus Paraspinal Abscess
Authors: TURGUT TUROGLU, PETER SAADEH, RICHARD RAYNOR, CAROLYN A. MARTIN, SLEIMAN NADDAF, M. FATIH AKISIK,, HUSSEIN M. ABDEL-DAYEM,
Journal: Clinical Nuclear Medicine (1997)

The collection of accurate information regarding the extent of paraspinal abscesses originating in the spine from various imaging modalities is of utmost importance before attempting any surgical drainage or manipulation. In this report, a patient is presented who had a lumbar laminectomy that was complicated by Staphylococcus aureus infection causing osteomyelitis of the vertebra and developed a paraspinal abscess in the lumbar spine which extended into the psoas muscle. The patient had two surgical operations procedures, the first for drainage of the abscess, and later an L-3 carpectomy for decompression of the cauda equina and fusion of L2 to L4. Computed tomography and MRI of the lumbar spine and Tc-99m MDP three-phase bone imaging with SPECT of the lumbar spine were performed. The reprojection display of the SPECT study was the most helpful preoperative finding in outlining the borders and extension of the abscess and for modifying the surgical approach.
PREVENTION OF INFLUENZA BY OSMOTIC ACTION IN AIR PASSAGES
Authors: James A. Bach
Journal: JAMA (1918)

<h3>To the Editor:</h3> —The infection of influenza unquestionably enters the system through the nasal spaces and upper air passages. This fact is practically proved by a mode of disinfection and cleansing of those spaces and surfaces which I have suggested and used in the case of many thousand individuals who would ordinarily be considered likely subjects to infection. Infection was prevented in practically 100 per cent, when the treatment was properly used. The tortuosities of the nasal and postnasal spaces and their great extent make the use of the many remedies suggested ineffective, because, however excellent they may be in themselves, they do not reach all the surfaces involved and they furthermore lack certain physical qualities necessary to invite a sufficient and strong osmotic action. A powder composed of impalpable boric acid, 95 parts, sodium bicarbonate, 3 parts, and calomel, 2 parts, thoroughly triturated, is the basis of treatment. With
Massive Dilation of the Inferior Vena Cava
Authors: Sudhir K. Dutta
Journal: JAMA (1978)

THE DIFFERENTIAL diagnosis of a retroperitoneal abdominal mass generally includes primary or metastatic tumors of retroperitoneal lymph nodes, neoplasms of the kidney, paravertebral tumors, pancreatic masses, and aortic aneurysms. A patient was admitted for the evaluation of a retroperitoneal mass, which during further investigation was found to be a massively dilated inferior vena cava (IVC) (megacava) associated with severe tricuspid regurgitation.  Report of a Case  A 69-year-old man was referred for evaluation of a retrogastric mass seen on upper gastrointestinal (GI) series. He had a 20-year history of severe venous insufficiency of the lower extremities and poorly controlled congestive heart failure. The patient was an elderly, emaciated man with normal vital signs except for an irregularly irregular pulse. There were jugular venous pulsations to the angle of the jaw at 90°, with dominant 'C-V' waves. Examination of the heart showed massive cardiomegaly, a pronounced parasternal lift, a 3/6 holosystolic
A Behavioral Intervention to Improve Obstetrical Care
Authors: Fernando Althabe, Pierre Buekens, Eduardo Bergel, José M. Belizán, Marci K. Campbell, Nancy Moss, Tyler Hartwell, Linda L. Wright
Journal: New England Journal of Medicine (2008)

Implementation of evidence-based obstetrical practices remains a significant challenge. Effective strategies to disseminate and implement such practices are needed.We randomly assigned 19 hospitals in Argentina and Uruguay to receive a multifaceted behavioral intervention (including selection of opinion leaders, interactive workshops, training of manual skills, one-on-one academic detailing visits with hospital birth attendants, reminders, and feedback) to develop and implement guidelines for the use of episiotomy and management of the third stage of labor or to receive no intervention. The primary outcomes were the rates of prophylactic use of oxytocin during the third stage of labor and of episiotomy. The main secondary outcomes were postpartum hemorrhage and birth attendants' readiness to change their behavior with regard to episiotomies and management of the third stage of labor. The outcomes were measured at baseline, at the end of the 18-month intervention, and 12 months after the end of the intervention.The rate of use of prophylactic oxytocin increased from 2.1% at baseline to 83.6% after the end of the intervention at hospitals that received the intervention and from 2.6% to 12.3% at control hospitals (P=0.01 for the difference in changes). The rate of use of episiotomy decreased from 41.1% to 29.9% at hospitals receiving the intervention but remained stable at control hospitals, with preintervention and postintervention values of 43.5% and 44.5%, respectively (P<0.001 for the difference in changes). The intervention was also associated with reductions in the rate of postpartum hemorrhage of 500 ml or more (relative rate reduction, 45%; 95% confidence interval [CI], 9 to 71) and of 1000 ml or more (relative rate reduction, 70%; 95% CI, 16 to 78). Birth attendants' readiness to change also increased in the hospitals receiving the intervention. The effects on the use of episiotomy and prophylactic oxytocin were sustained 12 months after the end of the intervention.A multifaceted behavioral intervention increased the prophylactic use of oxytocin during the third stage of labor and reduced the use of episiotomy. (ClinicalTrials.gov number, NCT00070720 [ClinicalTrials.gov]; Current Controlled Trials number, ISRCTN82417627 [controlled-trials.com].).
Insulin Receptor Isoforms and Insulin Receptor/Insulin-Like Growth Factor Receptor Hybrids in Physiology and Disease
Authors: Antonino Belfiore, Francesco Frasca, Giuseppe Pandini, Laura Sciacca, Riccardo Vigneri
Journal: Endocrine Reviews (2009)

In mammals, the insulin receptor (IR) gene has acquired an additional exon, exon 11. This exon may be skipped in a developmental and tissue-specific manner. The IR, therefore, occurs in two isoforms (exon 11 minus IR-A and exon 11 plus IR-B). The most relevant functional difference between these two isoforms is the high affinity of IR-A for IGF-II. IR-A is predominantly expressed during prenatal life. It enhances the effects of IGF-II during embryogenesis and fetal development. It is also significantly expressed in adult tissues, especially in the brain. Conversely, IR-B is predominantly expressed in adult, well-differentiated tissues, including the liver, where it enhances the metabolic effects of insulin. Dysregulation of IR splicing in insulin target tissues may occur in patients with insulin resistance; however, its role in type 2 diabetes is unclear. IR-A is often aberrantly expressed in cancer cells, thus increasing their responsiveness to IGF-II and to insulin and explaining the cancer-promoting effect of hyperinsulinemia observed in obese and type 2 diabetic patients. Aberrant IR-A expression may favor cancer resistance to both conventional and targeted therapies by a variety of mechanisms. Finally, IR isoforms form heterodimers, IR-A/IR-B, and hybrid IR/IGF-IR receptors (HR-A and HR-B). The functional characteristics of such hybrid receptors and their role in physiology, in diabetes, and in malignant cells are not yet fully understood. These receptors seem to enhance cell responsiveness to IGFs.
What are the causes of excessive daytime sleepiness in patients with sleep-disordered breathing?
Authors: P. Castiglioni, C. Lombardi, M. Di Rienzo, E. Lugaresi, P. Montagna, P. Cortelli, G. Parati
Journal: European Respiratory Journal (2008)

To the Editors: 

Recently, the European Respiratory Journal published a study by Mediano et al. 1 on the determinants of excessive daytime sleepiness (EDS) in obstructive sleep apnoea (OSA) patients. The study did not find differences in body mass index (BMI), age or apnoea/hypopnoea index (AHI) between OSA patients with and without EDS, but found significantly more pronounced nocturnal hypoxaemia in patients with EDS, and concluded that nocturnal oxygen desaturation is involved in the pathogenesis of EDS. In his letter commenting on this work, Bahammam 2 pointed out that the possible role of obesity hypoventilation syndrome (OHS), a known cause of EDS, was not ruled out by Mediano et al. 1. OHS patients have the same AHI of pure OSA patients matched by age and BMI, but are characterised by apnoeas of longer duration and more severe nocturnal hypoxaemia 3, like the EDS patients studied by Mediano …
HYBRID CORONARY REVASCULARIZATION COMBINING OFF–PUMP LEFT INTERNAL MAMMARY GRAFTING AND PCI
Authors: Leif Thuesen, Ivy I. Modrau, Per Hostrup Nielsen, Hans Erik Botker, Evald H. Christiansen, Lars R. Krusell, Steen D. Kristiansen, Anne K. Kaltoft, Michael Maeng, Christian J. Terkelsen, Jens F. Lassen
Journal: Journal of the American College of Cardiology (2013)
Virus Hepatitis and Its Control
Authors: George Gee Jackson
Journal: JAMA (1979)

New understanding of the causes, prevalence, clinical course, and epidemiology of viral hepatitis has been developing at a phenomenal rate during the past two decades. Better separation and definition of the clinical course of type A and B viral hepatitis and their respective epidemiology have been complemented by new techniques in virology, permitting detailed antigenic characterization of the viruses, more knowledge of their biology, and discernment of protective substances and procedures. It is into this fast-moving stream of information that the author entered her book in 1977. From the literature and knowledge up to that time, it accomplishes well its goal of providing a general background about hepatitis A and B viruses with some detailed specific information and its goal of describing situations where hepatitis has been a particular problem with the control measures that have been found successful in practice. The virological component of the book has become quickly
Diagnosis and Management of Patient Noncompliance
Authors: Jeff M. Jellin
Journal: JAMA (1974)

<h3>To the Editor.—</h3> Drs. Gillum and Barsky identified a very real disease, patient noncompliance (228:1563, 1974). As the authors suggest, "The practicing physician must be educated and sensitized to this major problem and provided with an approach to the diagnosis and management of patient noncompliance." It concerns me to read this entire article and find no mention of an often-overlooked but efficacious treatment for the problem. I am referring to the efforts of pharmacists to increase patient compliance with the physician's orders. The article points out three true observations: first, that outpatients, in particular, have a great unmet need for explanation about the nature of their condition, its cause, and the therapeutic measures undertaken; second, "that patients with either extremely low or high levels of anxiety have been shown to remember less of what their physicians told them and be less likely to comply with medical advice"; third, that patients
Are there Causes for Criticism in the Sanitary Management of the Late War?
Authors: J. F. Jenkins
Journal: JAMA (1899)

Tecumseh, Mich., Dec. 12, 1898. <h3>To the Editor:</h3> —That there are good grounds for criticising the sanitary management of military camps there is every reason to believe, but when one reads the editorial article in last week'sJournal(Dec. 10, 1888, p. 1425) comparing the sickness of the British Soudan forces with our own, he certainly finds the field of comparison a narrow one, because the elements for comparison scarcely exist. The principal fault found has not been so much from mismanagement of field-hospitals, either before a battle or immediately after, but from the gross mismanagement of the sanitary conditions of the soldiers in camp. Camp Thomas, Chickamauga was a veritable pesthole. Soldiers returning home on furlough bore the appearance of those who were so happy as to make their escape from Old Libby or Andersonville prisons of thirty-five years ago. The fault was not with Surgeon-General Sternberg, nor the
Brain MRI Correlates of Cognitive Dysfunction in Type 2 Diabetes: The Needle Recovered From the Haystack?
Authors: Geert Jan Biessels
Journal: Diabetes Care (2013)

The risk of dementia is increased by approximately 50% in people with type 2 diabetes (1,2). Assuming a prevalence of type 2 diabetes of approximately 15–25% in people aged over 65 years (3), this translates into a diabetes attributable risk of dementia of 7–11% at the population level. In light of these numbers, better understanding of the links between diabetes and dementia is of great importance. This understanding starts by acknowledging that diabetes is a risk factor rather than a cause for dementia: Diabetes by itself is neither sufficient nor required for dementia to develop. Therefore, the increased dementia risk in diabetes is most likely to be due to added or synergistic effects of processes related to diabetes and its comorbidities on top of other more generic, causative mechanisms for dementia. Identifying these processes is important because this may provide leads for dementia prevention in people with diabetes and possibly also in those without. This has, however, proven to be complex. The key mechanisms thought to be involved in the etiology of dementia are Alzheimer-type processes, in which amyloid β peptides are considered to play a central role (4), and vascular brain damage (5). Importantly, in most cases Alzheimer-type and vascular pathologies co-occur (6). These mixed pathologies evolve on a background of aging-related changes in the brain. The total burden of cerebral pathologies, in interaction with structural and functional compensatory processes, also referred to as brain reserve or cognitive reserve (7), determine when cognitive dysfunction becomes clinically manifest. Where does diabetes come into this picture? It is certainly a challenge to pick up diabetes-related processes among these other pathological …
499 CLINICAL PRESENTATION AND CAUSES OF CENTRAL NERVOUS SYSTEM COMPLICATIONS AFTER LIVER TRANSPLANT
Authors: M. Asaro, G. Vizzini, S. Gruttadauria, D. Filì, G. Pietrosi, R. Miraglia, M. Milazzo, A. Luca, D. Pagano, B. Gridelli
Journal: Journal of Hepatology (2010)
Cardiac Effects of Doxorubicin Therapy of Neoplasms
Authors: Richard J. Ugoretz
Journal: JAMA (1976)

PROGRESS in cancer chemotherapy has been attended by a challenging variety of potentially toxic side effects. The recent entry of the antitumor antibiotic doxorubicin hydrochloride (Adriamycin) in the standard formulary has added drug-induced cardiac damage to the realm of clinical cardiology. A product of the microbe streptomyces peucetius var<i>caesius</i>, this anthracycline compound has achieved an important role in the therapy of soft tissue sarcoma and advanced breast cancer. It also is active in acute leukemia, malignant lymphoma and an unusually wide variety of solid tumors.<sup>1</sup>Doxorubicin differs only by 14-hydroxylation from daunomycin, which shares only the potential for producing cardiac damage but not the wide spectrum of antitumor activity. Daunomycin still is an investigational compound. Bone-marrow suppression and the risk of severe mucositis limit the size and frequency of individual doses of doxorubicin. A commonly employed dose schedule in the treatment of adults has called for a single
Angioedema induced by a peptide derived from complement component C2.
Authors: C J Strang, S Cholin, J Spragg, A E Davis, E E Schneeberger, V H Donaldson, F S Rosen
Journal: The Journal of Experimental Medicine (1988)

Synthetic peptides that correspond to the COOH-terminal portion of C2b enhance vascular permeability in human and guinea pig skin. In human studies, 1 nmol of the most active peptide of 25-amino acid residues produced substantial local edema. A pentapeptide and a heptapeptide corresponding to the COOH-terminal sequence of C2b each induced contraction of estrous rat uterus in the micromole range; a peptide of 25 amino acids from this region induced a like contraction of rat uterus at a concentration 20-fold lower than the smaller peptides. The vascular permeability of guinea pig skin was enhanced by doses of these synthetic peptides in a similar fashion as that observed for the concentration of rat uterus. The induction of localized edema by intradermal injection in both the guinea pig and the human proceeds in the presence of antihistaminic drugs, suggesting that there is a histamine-independent component to the observed increase in vascular permeability. Cleavage of C2 with the enzymic subcomponent of C1, C1s, yields only C2a and C2b, and no small peptides, whereas cleavage of C2 with C1s and plasmin yields a set of small peptides. These plasmin-cleaved peptides are derived from the COOH terminus of C2b, and they induce the contraction of estrous rat uterus.