tbuckley/cabot-search huggingface dataset:
The Human Factor as a Cause of Delay in Diagnosis in General Practice
Authors: C. P. E. Elliott-Binns
Journal: BMJ (1958)

This article is a record of delays in the diagnosis of major organic disease by a general practitioner during the two years 1956 and 1957.As minor delays of diagnosis, in the strictest sense, occur from day to day, the following criteria have been adopted and all cases filling them have been included.(1) The case must be one of serious organic disease, which was for a time thought to be a minor or neurotic illness, or some illness not allied to the true condition.(2) The delay in diagnosis must be actually or potentially dangerous to the patient.(3) The practitioner must feel in retrospect that he might have diagnosed the case earlier, and feel worried on that account ; this may seem a strange criterion, but in actual fact it is very important, as any practitioner who is reasonably conscientious and honest with himself will know if he might have made an earlier diagnosis with the evidence available.The third criterion would not, therefore, include a patient with carcinoma of the lung who is sent for x-ray examination only when his cough becomes persistent; a patient complaining of abdominal pain who on obser- vation develops signs of appendicitis, which at operation proves to be an " early appendix"; a patient who is sent to hospital for diagnosis, and the diagnosis is deter- mined by special investigations.It is difficult to assess cases in retrospect, and great pains have been taken to be as fair and frank as possible by trying to avoid distortions of memory and by refer- ring carefully to notes made about the patient at the time.This is not an attempt to excuse delays of diag- nosis, but to assess the factors that led to the delay.I have long formed the impression that many delays of this sort are due not only to the intrinsic difficulties of the diagnosis but also to a " human factor " which for some reason has obscured the issue.The following cases are recorded to determine if that impression is true.Case 1This patient was admitted to hospital with a compound fracture of the tibia and fibula.While in hospital he had considerable difficulty with his bowels, and in spite of the administration of purgatives his constipation was trouble- some.When he returned home his practitioner visited him ,once a week in order to inquire after his leg, which was in plaster, and give him his certificate.During this time he complained of troublesome diarrhoea, which did not respond to treatment with mist.kaolin.et morph.or, later, to a course of succinylsulphathiazole.It was only on the sixth visit that careful questioning showed that he was actually suffering from tenesmus and faecal incontinence, and a rectal examination revealed a carcinoma of the rectum.This proved to be inoperable, and a palliative colostomy was performed.It is quite clear that the correct diagnosis would have been made earlier if the patient had not fractured his leg.The practitioner and the hospital staff were concerned with the leg, and the bowel symptoms were regarded as an awkward side issue, and hence did not receive sufficient attention.Case 2
The Effect of HFE Genotypes on Measurements of Iron Overload in Patients Attending a Health Appraisal Clinic
Authors: Ernest Beutler
Journal: Annals of Internal Medicine (2000)

Background: The gene that causes most cases of hereditary hemochromatosis is designated HFE. Three mutations exist at this locus at a relatively high gene frequency. Objective: To determine the gene frequency of the three HFE mutations and to relate genotypes to various clinical and laboratory variables. Design: Observational study. Setting: Health appraisal clinic. Patients: 10 198 adults who registered for health appraisal and consented to DNA examination for hemochromatosis. Consenting patients were slightly older and had attained a slightly higher educational level than nonconsenting patients. Measurements: Extensive medical history and laboratory tests, including complete blood count, transferrin saturation, and other chemistries; serum ferritin levels; and HFE genotype. Results: In white participants, the gene frequencies were 0.063 for the C282Y mutation, 0.152 for the H63D mutation, and 0.016 for the S65C mutation. Gene frequencies were lower in other ethnic groups. In participants with HFE mutations, the average serum transferrin saturation and ferritin levels were slightly increased, as were mean hemoglobin levels and mean corpuscular volume. A transferrin saturation of 50% had a sensitivity of only 0.52 (95% CI, 0.345 to 0.686) and a specificity of 0.908 (CI, 0.902 to 0.914) for detection of homozygosity. A ferritin level of 200 µg/L in women and 250 µg/L in men had a sensitivity of 0.70 (CI, 0.540 to 0.854) and a specificity of 0.803 (CI, 0.796 to 0.811). The prevalence of iron deficiency anemia was lower in women who carried HFE mutations. Conclusions: Screening for transferrin saturation and ferritin levels does not detect all homozygotes for the major hemochromatosis mutation. Heterozygotes for HFE mutations had a lower prevalence of iron deficiency anemia.
PERIODICALS FOR FOREIGN PHYSICIANS
Authors: Claude H. Castle
Journal: JAMA (1952)

<h3>To the Editor:</h3> —Having been retired from active practice of my profession for a number of years I have derived considerable pleasure and interest from correspondence with men from foreign countries. The names and addresses of these men came to me through letters they had written to various sporting publications in this country asking for magazines of that type. In many cases they are not allowed to send money abroad for such purposes. I have a limited number of medical and surgical publications that I would gladly send abroad at my expense to either medical associations or contemporary practitioners.
Author's response to influenza vaccination: policy <i>v</i> evidence
Authors: Tom Jefferson
Journal: BMJ (2006)

Physical activity to prevent obesity in young children Negative outcome or protocol problem?Editor-Although the article by Reilly et al on physical activity to prevent obesity in young children emphasises that adherence to protocol was good, 1 an interview with Reilly on the Today programme (7.20 am, 6 October 2006) cited the difficulty in getting children to increase their activity as much as required-that is, not a negative outcome, but a problem in achieving sufficient increase to make the intervention effective.Which was the case?
Long-term Safety Of A 300IR Sublingual Tablet Of 5-grass-pollen Allergen Extract In Adults With Grass-pollen-induced Allergic Rhinoconjunctivitis
Authors: A. Didier, M. Worm, F. Horak, H. Malling, A. Montagut, R.K. Zeldin
Journal: Journal of Allergy and Clinical Immunology (2012)
John Anthony Parrish
Authors: J. R. Parrish
Journal: BMJ (2014)

John Anthony Parrish (“Tony”) grew up in Tadworth, where his father, the local GP, had his surgery at their house, Killaser.

The end of the war meant the end of Tony’s dream to join the Royal Air Force, and after a period of dithering he decided to follow in his father’s footsteps and become a doctor. After a year of learning the basic sciences, he went to St Bartholomew’s medical school in London. After qualifying he joined the Royal Army Medical Corps and served in the Middle East, rising to the rank of major.

Tony did not have to look far for a wife—“EJ” was the younger sister of his best friend since childhood, Mike. Tony and EJ married in 1958 and moved to Ann Arbor in Michigan, US, for a year, while Tony did a doctorate, and then they returned to live in Barnet. When Tony took a post in Croydon as a medical consultant, they moved to Oakwood Avenue, Purley.

Every …
Extensively Drug-Resistant Tuberculosis and Public Health
Authors: Timothy Brewer
Journal: JAMA (2007)

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
Response of tuberculous stricture to antituberculous treatment.
Authors: B S Anand, R Nanda, G K Sachdev
Journal: Gut (1988)

Tuberculous infection of the gastrointestinal tract results in a variety of histopathological lesions. Some patients develop intestinal strictures and present with subacute intestinal obstruction. The treatment is controversial and vary from a trial of antituberculous drugs to early surgery:the response to medical therapy is not clear. To examine this issue the present prospective therapeutic trial was carried out on 39 patients with symptoms of bowel obstruction and radiological evidence of intestinal stricture. All patients were treated with conventional antituberculous drugs (streptomycin, rifampicin, and isoniazid) under close supervision. Thirty four (87%) patients completed the trial, five were lost to follow up. Thirty one (91%) of these showed significant clinical improvement:26 became completely symptom free, while the remaining five complained of only vague abdominal discomfort. Only three (8%) patients failed to respond to treatment and were subjected to surgery. Barium series were repeated in 23 of 31 who completed the treatment; the remaining eight refused further investigations. Complete resolution of the radiological abnormality was seen in 16 (70%) patients. In the remaining seven (30%) the stricture persisted; in two of these the treatment was continued for another year and both showed substantial radiological improvement. It is concluded that most patients with tuberculous strictures respond well to medical treatment and surgery should be resorted to only if drug therapy fails.
Shared intentions without a self
Authors: Michael Lewis
Journal: Behavioral and Brain Sciences (2005)

Shared knowledge of intentionality as well as shared knowledge of anything depends on the organism's understanding of itself, others, and the possible relations between self and other. This understanding involves mental representations of me , which emerges in the second half of the second year in the human infant, and it is this ability that gives rise to humanlike social understanding and complex self-conscious emotions.
A multicenter randomized study of the efficacy of transfusions with platelets stored in platelet additive solution II versus plasma
Authors: Jean-Louis H. Kerkhoffs, Jeroen C. Eikenboom, Martin S. Schipperus, Rinie J. van Wordragen-Vlaswinkel, Ronald Brand, Mark S. Harvey, Rene R. de Vries, Renee Barge, Dick J. van Rhenen, Anneke Brand
Journal: Blood (2006)
The concentration-response relation between air pollution and daily deaths.
Authors: J Schwartz, F Ballester, M Saez, S Pérez-Hoyos, J Bellido, K Cambra, F Arribas, A Cañada, M J Pérez-Boillos, J Sunyer
Journal: Environmental Health Perspectives (2001)

Studies on three continents have reported associations between various measures of airborne particles and daily deaths. Sulfur dioxide has also been associated with daily deaths, particularly in Europe. Questions remain about the shape of those associations, particularly whether there are thresholds at low levels. We examined the association of daily concentrations of black smoke and SO(2) with daily deaths in eight Spanish cities (Barcelona, Bilbao, Castellón, Gijón, Oviedo, Valencia, Vitoria, and Zaragoza) with different climates and different environmental and social characteristics. We used nonparametric smoothing to estimate the shape of the concentration-response curve in each city and combined those results using a metasmoothing technique developed by Schwartz and Zanobetti. We extended their method to incorporate random variance components. Black smoke had a nearly linear association with daily deaths, with no evidence of a threshold. A 10 microg/m(3) increase in black smoke was associated with a 0.88% increase in daily deaths (95% confidence interval, 0.56%-1.20%). SO(2) had a less plausible association: Daily deaths increased at very low concentrations, but leveled off and then decreased at higher concentrations. These findings held in both one- and two-pollutant models and held whether we optimized our weather and seasonal model in each city or used the same smoothing parameters in each city. We conclude that the association with particle levels is more convincing than for SO(2), and without a threshold. Linear models provide an adequate estimation of the effect of particulate air pollution on mortality at low to moderate concentrations.
Further nurses' notes on ER
Authors: S. Summers
Journal: BMJ (2004)

EDITOR—Lenzer's article describes efforts to persuade ER to treat nursing more accurately and fairly.1 Warner Brothers says its show goes to great lengths to portray medical situations accurately. To the extent ER is accurate about technical medical elements such as diagnosis and treatment, it leads viewers to believe that other healthcare elements on the show are equally true to life—including the portrayal of nursing. …
Risk factors for hepatitis C virus infection in United States blood donors
Authors: Edward L. Murphy, Stephen M. Bryzman, Simone A. Glynn, Dannie I. Ameti, Ruth A. Thomson, Alan E. Williams, Catharie C. Nass, Helen E. Ownby, George B. Schreiber, Fanhui Kong, Keith R. Neal, George J. Nemo
Journal: Hepatology (2000)

Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV + and 1,039 (45%) control subjects ( P = .001). The final multivariate model included only the following independent HCV risk factors: IDU (OR = 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR = 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR = 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR = 2.9; 95% CI: 1.3-6.6), religious scarification (OR = 2.8; 95% CI: 1.2-7.0), having been stuck or cut with a bloody object (OR = 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR = 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR = 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution.
Abstract 2276: Serum endoglin and uPA change predicts PFS and overall survival in first line trastuzumab-treated breast cancer
Authors: Matthew S. Evans, Hui Ying Hou, Uchechi Anyanwu, Kim Leitzel, Suhail M. Ali, Wolfgang Koestler, Eva-Maria Fuchs, Sheryl Brown-Shimer, Peter Hamer, Walter Carney, Allan Lipton
Journal: Cancer Research (2011)

Abstract Background: About half of HER2-positive breast cancer patients will respond to first-line trastuzumab-containing therapy, but of these most will progress within a year with acquired resistance. Since trastuzumab treatment is now used in the HER2-positive adjuvant breast cancer setting, trastuzumab resistance will continue to be a recurring clinical problem, and better predictive and prognostic biomarkers are urgently needed. Methods: Serum TIMP-1, uPA, carbonic anhydrase 9 (CA9), and endoglin (co-receptor for TGF- β) were measured using ELISA in 60 metastatic breast cancer patients before starting first-line trastuzumab-containing therapy, and at the closest 1 month post-trastuzumab blood draw. The TIMP-1, uPA and CA9 ELISAs were from Oncogene Science/Siemens Healthcare Diagnostics, and the endoglin ELISA was from R&amp;D Systems. Progression-free (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox modeling. Results: When serum biomarker change (pretreatment to 1 month post-trastuzumab treatment) was analyzed on a continuous basis, change in serum TIMP-1 and CA 9 were not significant for PFS or OS. However the change in serum endoglin (HR = 1.017, p = 0.013) and serum uPA (HR 1.018, p = 0.006) were significant predictive factors for PFS to first-line trastuzumab treatment. The change in serum endoglin (HR = 1.021, p = 0.004) and serum uPA (HR 1.016, p = 0.03) were also significant prognostic factors for OS: declining serum endoglin or uPA predicted for increased PFS and OS. Changes in serum endoglin and uPA were positively correlated (r = 0.7, p &amp;lt;0.0001). Due to the significant correlation between the change in serum endoglin and uPA levels, these 2 serum biomarkers were analyzed separately along with the change in serum TIMP-1 and CA9 in multivariate analysis. In these analyses, only the change in serum endoglin or uPA was significant. Conclusions: The change in serum endoglin and uPA level from pretreatment to 1 month post-trastuzumab treatment predicted PFS and overall survival in metastatic breast cancer patients treated with first-line trastuzumab-containing therapy. Endoglin (CD105) is a co-receptor for TGF-β, is expressed by human vascular endothelial cells, and plays a major role in angiogenesis. These angiogenesis-related serum biomarkers deserve further study in larger trials of HER2-targeted breast cancer treatment. Supported by a grant from Komen for the Cure. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2276. doi:10.1158/1538-7445.AM2011-2276
Recent Advances in Community Psychiatry
Authors: Alvin Becker, N. Michael Murphy, Milton Greenblatt
Journal: New England Journal of Medicine (1965)

THE past decade has witnessed a phenomenal growth of interest in community mental health in the United States. Articles concerning community treatment of the mentally ill were rare ten years ago. In contrast, the recent literature, both professional and lay, is replete with descriptions of new community programs. This decade of heightened interest culminated in President Kennedy's message to Congress1 in February, 1963, which resulted in the passage, in the following October, of Public Law 88–164, the Mental Retardation Facilities and Community Mental Health Centers Act. The act provides $329,000,000 to help states build community mental-health centers and develop programs . . .
A butterfly mega-book for mini-bucks
Authors: Jim Mallet
Journal: Trends in Ecology & Evolution (2003)

Every time I agree to review a multi-author volume, when the book comes thudding in through the letterbox, I wonder how one can possibly do justice to all the authors. This whopping volume, with 740 pages, is no exception. Butterflies covers butterfly ecology and evolution, and stems from the Third International Butterfly Ecology and Evolution Symposium. It therefore has authors from around the world – well, not around the whole world exactly, because most of the topics are about North American butterflies (∼38%), with Europe (24%), South America (15%) and Africa (8%) trailing behind. The remaining 16% of the text comprises reviews of world-wide topics, but there is little information primarily about butterflies from Asian or Australian regions. However, the overall coverage of themes in which butterflies have provided insights into ecology and evolution is good: they are arranged into sections dealing with behaviour, ecology, genetics and 'evolutionary dynamics' (aka 'evolution'?), phylogeny and taxonomy, and conservation and biodiversity.
Low levels of SIV infection in sooty mangabey central memory CD4+ T cells are associated with limited CCR5 expression
Authors: Mirko Paiardini, Barbara Cervasi, Elane Reyes-Aviles, Luca Micci, Alexandra M Ortiz, Ann Chahroudi, Carol Vinton, Shari N Gordon, Steven E Bosinger, Nicholas Francella, Paul L Hallberg, Elizabeth Cramer, Timothy Schlub, Ming Liang Chan, Nadeene E Riddick, Ronald G Collman, Cristian Apetrei, Ivona Pandrea, James Else, Jan Munch, Frank Kirchhoff, Miles P Davenport, Jason M Brenchley, Guido Silvestri
Journal: Nature Medicine (2011)
Iron-Containing Vitamin Preparations
Authors: Barbara F. Murphy
Journal: JAMA (1974)

To the Editor.—  The editorial was written to remind the physician of safety considerations when prescribing iron-containing preparations.  Dr. Macgregor may be correct in his assessment of the current mortality risk. However, the key words of the quoted sentence read, Unless treated promptly, mortality from acute iron poisoning has been reported to be approximately 50% in these young  (under 5 years of age). This figure was taken from a review of the literature prior to the introduction of deferoxamine, which when used within a few hours after overingestion, has reduced mortality considerably. Nevertheless, there seems to be no justification for subjecting young children to the inherent dangers of iron overdosage.  The editorial was based on data published by one poison information center, that of the Ottawa (Ontario) Civic Hospital, where only one case of overingestion of chewable vitamin preparations with iron was reported in children under 5 years of