tbuckley/cabot-search huggingface dataset:
Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries
Authors: J. Michael McWilliams, Michael E. Chernew, Alan M. Zaslavsky, Pasha Hamed, Bruce E. Landon
Journal: JAMA Internal Medicine (2013)

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care.To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers.Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics.Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care.Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.
Increased 5-HT<sub>2A</sub>Receptor Binding in Euthymic, Medication-Free Patients Recovered From Depression: A Positron Emission Study With [<sup>11</sup>C]MDL 100,907
Authors: Zubin Bhagwagar, Rainer Hinz, Matthew Taylor, Sabrina Fancy, Philip Cowen, Paul Grasby
Journal: American Journal of Psychiatry (2006)

Objective: A previous positron emission tomography (PET) study reported increased serotonin 5-HT 2A receptor binding in unmedicated depressed patients with high scores on the Dysfunctional Attitudes Scale. The purpose of the present study was to use the highly selective 5-HT 2A receptor ligand [ 11 C]MDL 100,907 in a PET imaging paradigm to assess 1) 5-HT 2A receptor binding potential in euthymic subjects with a history of recurrent depression and 2) the relationship between receptor binding and scores on the Dysfunctional Attitudes Scale. Method: Cortical 5-HT 2A receptor binding was measured in 20 unmedicated, fully recovered unipolar depressed patients and 20 age- and gender-matched comparison subjects. Regional estimates of binding potential were obtained using a reversible plasma input function compartmental model and the cerebellum as a reference region to estimate the free and non-specifically bound [ 11 C]MDL 100,907 in brain tissue. Results: Relative to the comparison subjects, the recovered depressed patients demonstrated significantly higher 5-HT 2A receptor binding potential in the frontal cortex (mean increase: 19%), parietal cortex (mean increase: 25%), and occipital cortex (mean increase: 19%). 5-HT 2A receptor binding potential correlated negatively with age in both patients and comparison subjects and positively with the Dysfunctional Attitudes Scale in the recovered patients. Conclusions: These findings should be considered preliminary but suggest that recovered subjects with a history of recurrent major depression have elevated binding potential of cortical 5-HT 2A receptors. The correlation of increased 5-HT 2A receptor binding potential with increased scores on Dysfunctional Attitudes Scale supports earlier work suggesting that increased 5-HT 2A receptor availability characterizes a group of depressed patients with high levels of dysfunctional attitudes.
Pulmonary Embolism Without Arterial Hypoxemia
Authors: JOHN MILLS
Journal: Annals of Internal Medicine (1971)

Letters, Comments, and Corrections1 December 1971Pulmonary Embolism Without Arterial HypoxemiaJOHN MILLS, M.D., DENIS DREW, B.S.JOHN MILLS, M.D.Search for more papers by this author, DENIS DREW, B.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-75-6-972_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In the February 1971 issue Szucs and associates (1) reported that in 50 patients with angiographically proved pulmonary emboli the partial pressure of oxygen (PO2), with room air, was less than 80 mm Hg and that lung scans were abnormal in all patients tested. They concluded that the diagnosis of pulmonary embolism could be excluded if findings in either of these tests were normal.We have seen two patients with angiographically proved pulmonary emboli but normal arterial PO2:A 64-year-old woman was admitted because of progressive ankle edema, right-sided pleuritic chest pain, shortness of breath, and sweating,...References1. SZUCSBROOKSGROSSMAN MHW: Diagnostic sensitivity of laboratory findings in acute pulmonary embolism. Ann Intern Med 74:161-166, 1971 LinkGoogle Scholar2. SAGELGREENSPAN SR: Nonuniform pulmonary arterial perfusion. Pulmonary embolism? Radiology 99:541-548, 1971 CrossrefMedlineGoogle Scholar3. POULOUSEREBAGILDAY KRD: Diagnosis of pulmonary embolism. A correlative study of the clinical, scan and angiographic findings. Br Med J 3:67-71, 1970 CrossrefMedlineGoogle Scholar4. WELLMANMACKROMHILD HJD: Evaluation of the relative efficacy of pulmonary scintigraphy and pulmonary angiography in the diagnosis of pulmonary arterial obstructive disease. J Nucl Med 10:380-381, 1969 Google Scholar5. SASAHARASTEINSIMON AMM: Pulmonary angiography in the diagnosis of thromboembolic disease. N Engl J Med 270:1075-1081, 1964 CrossrefMedlineGoogle Scholar6. WILSONPIERCEJOHNSON JAR: Hypoxemia in pulmonary embolism, a clinical study. J Clin Invest 50:481-490, 1971 CrossrefMedlineGoogle Scholar7. MORGANROTHDEISSEROTHWINOKUR JAS: Laboratory findings in pulmonary embolism (letter). Ann Intern Med 75:138, 1971 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Medical Service San Francisco General Hospital San Francisco, Calif. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMassive pulmonary embolism without arterial hypoxaemia 1 December 1971Volume 75, Issue 6Page: 972-972KeywordsAnklesDyspneaEdemaHypoxiaIschemiaLungsPartial pressure of oxygenPatientsPulmonary embolism Issue Published: 1 December 1971 PDF downloadLoading ...
ENTEROSPASM: OPERATION: DEATH
Authors: V. Pendred
Journal: BMJ (1909)

an uncontrollable desire to go to stool and much tenesmus.She had been under medical treatment for years, and all the recognized forms had been tried.On examining the bowel with the sigmoidoscope I found the mucosa quite normal in appearance.In the middle of the sigmoid, hovw ever, the bowel was found to be firtrl.yfixed and angulated, apparently by adhe- sions.The uterus was also found to be markedly retroflexed.It seemed probable that the tenesmus from which she suffered was due to the condition of the uterus, and a gynaecologist who saw her with me confirmed this view.
Side Effects of Minoxidil-Reply
Authors: George Dunea
Journal: JAMA (1976)

<h3>In Reply.—</h3> It is only fair to point out that the patient in question has been on maintenance dialysis for three years, and that she has had no complications and has never required admission to the hospital. Once her blood pressure was controlled with minoxidil, she was able to return to nearnormal life and was spared the side effects of maximal doses of conventional antihypertensive drugs. We believe now, however, that we were mistaken to include the old photograph, and we compounded the error by implying that it was taken several months before minoxidil treatment was started, when in fact it was taken several months before the onset of dialysis. We tried to show the hypertrichosis and skin changes, but the general change in appearance actually reflects many months of untreated hypertension as well as the time spent receiving dialysis. Even so, it is questionable whether because of "sensitivity to
THE TREATMENT OF HYPERPIESIA
Authors: A. H. Douthwaite
Journal: BMJ (1929)

TREATMENT OF HYPERPIESIA.[ THEDflsl'su had been senit to a hospital without previous vaginal ex,amination and operated -upon in time.To miiy uinderstandingfflthe efforts of Dr. Hirsch are creditable in so far that the early removal of comiiplicated cases to lhospitals anid tlle omllittinlg of unnecessary vaginal examiiniiationis would certainly bring about a decreasing puerperal miiorbiditv anid mortality.But to me it seems exaggerate(l to go) so far as Hirsch wants to do.The new orientation that he so strolngly advocates and wishes to initroduce is already partly realized, and the surgical tenidenicies in obstetrics are notlling new.I my-self lhave peLformed Caesarean section in 20 out of 200 patients witlh placenta praevia.I believe that no experienced obstetrician would hesitate about Caesarean section if lie was really convinced that this operation wvould conifer a better prognosis wlitlhout increasinig the risks for motlher or clhild.Neither do I believe in the necessity or possibility of transferring all cases to hospitals, as Hirsclh insists upon.The majority of labours go well by means of nXitural forces alone, anid there is indeed no, branch of
Genetic susceptibility to murine collagen II autoimmune arthritis. Proposed relationship to the IgG2 autoantibody subclass response, complement C5, major histocompatibility complex (MHC) and non-MHC loci.
Authors: W C Watson, A S Townes
Journal: The Journal of Experimental Medicine (1985)

Analysis of the IgG autoantibody subclass response in the collagen II autoimmune arthritis (CII AIA)-susceptible D1 strain mice revealed that the onset of disease was associated with a predominance of IgG2a autoantibody. In a comparative study, resistance in the B6 strain was associated with a deficient IgG2a autoantibody response. B6 IgG1, 2b, and 3 autoantibody responses generally overlapped those of arthritic D1 mice, and estimates of antibody crossreactivity and affinity were similar for both strains. In crosses between D1 and B6, arthritis developed only in those F1 mice with IgG2a autoantibody responses approximating or exceeding those in arthritic D1 mice. Additional studies with B6 and B10 strains suggested an alternate role for the IgG2b autoantibody response. In inbred strains with known genetic backgrounds, a dissociation between the magnitude of the total IgG autoantibody response and the percent of total as IgG2a was demonstrated. The H-2q, Ig-1c D1 strain was a high-total and high-percent IgG2a responder, while the H-2d, Ig-1c D2 strain was a low-total but high-percent IgG2a responder. The H-2b, Ig-1b B6 strain was a low-total and low-percent IgG2a responder, while the H-2b/q, Ig-1b/c (B6D1)F1 hybrid was a low-total but high-percent IgG2a responder. A further dissociation between high-percent IgG2a autoantibody responsiveness and the H-2 haplotype was demonstrated by the H-2 congenic B10.D2/n (H-2d, Ig-1b) strain, in which a low-percent IgG2a response was observed to differ from the D2 strain. High-percent IgG2a autoantibody responsiveness also appeared to be inherited as a dominant trait based upon high responses in all (B6D1)F1 hybrids and backcrosses to D1. These findings suggest that the H-2 haplotype is involved in the total IgG autoantibody response but that the relative fraction of the total response as IgG2a is independent of the H-2 haplotype and possibly related to Igh-C genes. C5-deficient SWR (H-2q, Ig-1c) mice were found to have a high total autoantibody response to mouse CII and IgG2a comparable to arthritic D1 mice, but these mice did not develop arthritis. Based upon these observations, we conclude that susceptibility to CII AIA requires the interaction of multiple genes, both major histocompatibility complex (MHC) and non-MHC, which influence the magnitude (total IgG) and the quality (IgG subclass) of the autoimmune response and the availability of appropriate mediators (C5) to initiate the inflammatory reaction.
rTPA: Why Do We Waste These Hundreds of Millions of Dollars?
Authors: Sidney Goldstein
Journal: JAMA (1991)

<h3>To the Editor.</h3> —The article by the Cardiology Working Group<sup>1</sup>raises issues relevant to the decision making of cardiologists and is both searching and appropriate. Missing, however, is the exclusion of a major contemporary issue that has a significant effect on the economics of treating acute myocardial infarction. I refer specifically to the widespread use, almost exclusively in the United States, of recombinant tissue plasminogen activator (rTPA), as the primary thrombolytic agent of choice. Clinical trials of over 66 000 patients in hospitals around the world indicate that there is no benefit of rTPA when compared with streptokinase. The report of the International Study of Infarct Survival-3 (ISIS-3) at the 40th Annual Meeting of the American College of Cardiology in Atlanta, Ga, further supports this conclusion (<i>New York Times National Edition</i>. March 4, 1991:B9). The 5-week mortality in ISIS-3 of 46 092 patients with suspected or definite acute myocardial
Surgical Therapy of Variant Angina Associated with Nonobstructive Coronary Disease
Authors: ELLIOT J. SUSSMAN
Journal: Annals of Internal Medicine (1981)

Patients with variant angina refractory to medical therapy pose a difficult management problem. We report two patients with variant angina who had focal spasm in coronary arteries with fixed obstructions of less than 20% of the luminal diameter. Ischemic episodes were accompanied by malignant ventricular arrhythmias and third degree atrioventricular block. Symptoms were refractory to intensive medical management with nitrates and calcium blocking agents in one patient and with nitrates in the other who was treated before calcium blockers were available. Surgery was done; a bypass graft was placed distal to the area of focal spasm and the native artery was ligated proximally. Both patients are asymptomatic 24 and 66 months after surgery and neither takes anginal medication regularly. The surgical procedure outlined should be considered only if therapy to control life threatening ischemic symptoms with nitrates and calcium blocking agents fails.
CHLORATE OF POTASH POISONING, WITH REPORT OF A CASE.
Authors: J. T. McSHANE
Journal: JAMA (1894)

At 6 o'clock, p.m., July 31, 1894, I was called to see Marie O'Neal, aged llyears,whom I found suffering from thirst, nausea, vomiting, pain in the stomach, loins and head. Temperature in the axilla 102 degrees; extremities and face cold; pulse at the wrists imperceptible; heart's action rapid and feeble, and a marked cyanotic condition of the whole surface of the body. The patient had been out with her mother calling on friends until 4 o'clock, when, on account of feeling ill, she returned home. At 8 o'clock p.m. on August 1, the temperature was 102.5 degrees F., pulse 130 and fairly strong, frequent vomiting and insatiable thirst. No evacuation of the bowels or bladder. Cyanosis still present, hands and feet cold, ends of fingers and toes shrunken. The color of the patient was striking, presenting a bluish-ashen hue, very like that of an anemic person whose skin has been
ACCF/AHA 2011 Key Data Elements and Definitions of a Base Cardiovascular Vocabulary for Electronic Health Records
Authors: William S. Weintraub, Ronald P. Karlsberg, James E. Tcheng, Jeffrey R. Boris, Alfred E. Buxton, James T. Dove, Gregg C. Fonarow, Lee R. Goldberg, Paul Heidenreich, Robert C. Hendel, Alice K. Jacobs, William Lewis, Michael J. Mirro, David M. Shahian
Journal: Circulation (2011)
Fundamentals of Endoscopic Laser Therapy (ELT) for G.I. Tumors - New Aspects with Endoscopic Ultrasonography (EUS)
Authors: K. Yasuda, K. Kiyota, M. Nakajima, K. Kawai
Journal: Endoscopy (1987)

The possibility of employing endoscopic laser therapy (ELT) to cure early gastric cancer is discussed from the viewpoint of using endoscopic ultrasonography (EUS). Using EUS the digestive tract wall was seen as a 5-layered structure corresponding to the histological layers. On the basis of this layered structure of the gastric wall, the depth of cancer invasion and the results of laser treatment were evaluated. In 128 cases of gastric cancer examined by EUS and confirmed histologically, when the depth of cancer invasion was classified as mucosal, submucosal, muscularis propria, and deeper-than-subserosal invasion, the accuracy rate was 80%. In 26 cases of early gastric cancer, in the EUS images of the lesions before and after ELT, a lack of the gastric wall caused by the laser irradiation was observed. Furthermore, in the long-term follow-up study using EUS, the residual growth of the extraluminal cancer was detectable. EUS is one of the most promising methods for the evaluation of curative laser treatment of early gastric cancer.
Campus Tragedy Prompts Closer Look at Mental Health of College Students
Authors: Rebecca Voelker
Journal: JAMA (2007)

THE PATTERN HAS BECOME AS CONsistent as the perennial rhythm of mortarboards and commencement speakers. As spring arrives, so do the phone calls. Richard Kadison, MD, chief of mental health services at Harvard University, in Cambridge, Mass, fields about 20 to 30 calls every spring and summer from parents of incoming students concerned that a son or daughter will need help from the university to maintain psychotherapy sessions or obtain refills of psychiatric medications. “I’m delighted when I get called in the spring,” Kadison says. “I congratulate [parents] for calling and encourage them, whatever is working [for their child], to continue that and to make contact with us early in the fall when they arrive.” If the family lives nearby, he suggests they visit Harvard’s campus and make arrangements for care before school starts. “We’ll talk to them and get things in place,” he says. “It’s really reassuring.” As the current school year comes to an end, the need for reassurance is in the spotlight on college campuses. In the initial weeks following the tragic shootings at Virginia Polytechnic Institute and State University, in Blacksburg, many schools immediately focused on reviewing their safety policies and crisis response procedures. But the episode also raises broader questions about how students’ mental health care is being monitored and whether schools are adequately equipped to oversee their students’ mental well-being as well as their education. EVERYDAY STRUGGLES Every fall, thousands of students who come to campus are already taking a psychiatric medication or involved in regular psychotherapy sessions. While extreme violence to others by individuals with mental health disorders is rare—suicide is far more frequent than homicide at colleges—campus health
Prosthetic valve endocarditis: a review of 24 cases
Authors: I. S. Petheram, J. M. H. Boyce
Journal: Thorax (1977)

<b>Petheram, I. S. and Boyce, J. M. H. (1977).</b><i>Thorax</i>, <b>32</b>, 478-485. <b>Prosthetic valve endocarditis: a review of 24 cases.</b> Twenty-four episodes of prosthetic valve endocarditis occurred in 23 patients in a 10-year period. Fifteen patients presented within four months and nine from 14 months to seven years after surgery. The commonest pathogens in the early group were <i>Candida albicans</i> (five), but in three of these patients other organisms were found; diphtheroid species in five and <i>Staphylococcus aureus</i> in three. Four patients in the late group had <i>Streptococcus viridans</i> infection. Antistaphylococcal operative prophylaxis has been successful, but opportunist organisms of low virulence in health have emerged as pathogens. Continuous monitoring of antibiotic prophylaxis may reduce the incidence of early cases, and antibiotic cover for dental procedures should be as meticulous after valve replacement as before operation. The most frequent cause of death in both groups was delayed or inadequate treatment because of failure to isolate the pathogens from blood cultures with consequent severe haemodynamic upset or uncontrolled infection. Previous courses of antibiotics were the usual reason for negative blood cultures. Successful management requires close liaison with an interested clinical bacteriologist and aggressive surgery for haemodynamic faults or failure to control infection.
Treatment of Gonorrhea
Authors: Hans H. Neumann
Journal: JAMA (1972)

Broad spectrum antibiotics, given orally, were compared with penicillin for treatment of uncomplicated gonorrhea in male patients at the New Haven Health Department VD Clinic. Treatment success appeared more favorable with doxycycline than with penicillin, although the differences between the two drugs were not statistically significant. In addition to the acceptable therapeutic results, several public health considerations suggest the broad spectrum antibiotics as the drugs of first choice in the routine care of uncomplicated gonorrhea. Penicillin appears too valuable a drug to be used injudiciously for a disease which is as widespread and as likely to recur as gonorrhea.
Clinical, Pathologic, and Molecular Characterization of Familial Eosinophilic Esophagitis Compared With Sporadic Cases
Authors: Margaret H. Collins, Carine Blanchard, J. Pablo Abonia, Cassie Kirby, Rachel Akers, Ning Wang, Philip E. Putnam, Sean C. Jameson, Amal H. Assa'ad, Michael R. Konikoff, Keith F. Stringer, Marc E. Rothenberg
Journal: Clinical Gastroenterology and Hepatology (2008)
A Prospective Randomized Trial of Switching to Telbivudine Plus Adefovir in HBeAg-positive Lamivudine-resistant Chronic Hepatitis B Patients Who Have Suboptimal Response to Lamivudine Plus Adefovir
Authors: Hana Park, Jun Yong Park, Seung Up Kim, Do Young Kim, Kwang-Hyub Han, Chae Yoon Chon, Sang Hoon Ahn
Journal: Clinical Gastroenterology and Hepatology (2013)
Variations and increase in use of statins across Europe: data from administrative databases
Authors: Tom Walley, Pietro Folino-Gallo, Ulrich Schwabe, Eric van Ganse
Journal: BMJ (2004)

on behalf of the EuroMedStat groupCoronary heart disease remains a major cause of death in most European countries. 1 Statins lower blood cholesterol concentration and reduce the relative risk of coronary events by about 30% in both primary and secondary prevention. 2 Statins are widely and increasingly used in most European countries, although data on the extent of this are not generally available.