tbuckley/cabot-search huggingface dataset:
THE THERAPEUTIC ABUSE OF OPIUM.
Authors: G. WALTER BARR
Journal: JAMA (1896)

While the writer desires to be enrolled among the conservatives in the midst of the present enthusiasm regarding the newer materia medica; that is, among those who insist upon rational evidence and clinical proof to a critical degree before a verdict in favor of some new chemical compound is added to the certainties of our therapeutic knowledge; yet it seems to him that in one direction at least there is too much leaning upon the old standards. While our knowlof pathology and physiologic action has long since passed the point of the treatment of symptoms, yet we still cling to one drug which does most of its work in relieving symptoms only. Of course a drug which has the dynamic energy of opium must always be an equally potent power for therapeutic good; but it is not what can be legitimately done with opium, but what is actually done that
N-Terminal Pro–B-Type Natriuretic Peptide and Long-Term Mortality in Stable Coronary Heart Disease
Authors: Charlotte Kragelund, Bjørn Grønning, Lars Køber, Per Hildebrandt, Rolf Steffensen
Journal: New England Journal of Medicine (2005)

The level of the inactive N-terminal fragment of pro-brain (B-type) natriuretic peptide (BNP) is a strong predictor of mortality among patients with acute coronary syndromes and may be a strong prognostic marker in patients with chronic coronary heart disease as well. We assessed the relationship between N-terminal pro-BNP (NT-pro-BNP) levels and long-term mortality from all causes in a large cohort of patients with stable coronary heart disease.NT-pro-BNP was measured in baseline serum samples from 1034 patients referred for angiography because of symptoms or signs of coronary heart disease. The rate of death from all causes was determined after a median follow-up of nine years.At follow-up, 288 patients had died. The median NT-pro-BNP level was significantly lower among patients who survived than among those who died (120 pg per milliliter [interquartile range, 50 to 318] vs. 386 pg per milliliter [interquartile range, 146 to 897], P<0.001). Patients with NT-pro-BNP levels in the highest quartile were older, had a lower left ventricular ejection fraction (LVEF) and a lower creatinine clearance rate, and were more likely to have a history of myocardial infarction, clinically significant coronary artery disease, and diabetes than patients with NT-pro-BNP levels in the lowest quartile. In a multivariable Cox regression model, the hazard ratio for death from any cause for the patients with NT-pro-BNP levels in the fourth quartile as compared with those in the first quartile was 2.4 (95 percent confidence interval, 1.5 to 4.0; P<0.001); the NT-pro-BNP level added prognostic information beyond that provided by conventional risk factors, including the patient's age; sex; family history with respect to ischemic heart disease; the presence or absence of a history of myocardial infarction, angina, hypertension, diabetes, or chronic heart failure; creatinine clearance rate; body-mass index; smoking status; plasma lipid levels; LVEF; and the presence or absence of clinically significant coronary artery disease on angiography.NT-pro-BNP is a marker of long-term mortality in patients with stable coronary disease and provides prognostic information above and beyond that provided by conventional cardiovascular risk factors and the degree of left ventricular systolic dysfunction.
Changes in Plasma HIV RNA Levels and CD4+ Lymphocyte Counts Predict Both Response to Antiretroviral Therapy and Therapeutic Failure
Authors: William A. O'Brien
Journal: Annals of Internal Medicine (1997)

Background: Markers are needed for assessing response to antiretroviral therapy over time. The CD4+ lymphocyte count is one such surrogate, but it is relatively weak. Objective: To assess the association of changes in plasma human immunodeficiency virus (HIV) RNA level and CD4+ lymphocyte count with progression to the acquired immunodeficiency syndrome (AIDS). Design: Analysis of data from a subset of patients in a multicenter, randomized, clinical trial. Setting: Six Veterans Affairs medical centers and one U.S. Army medical center. Patients: 270 symptomatic HIV-infected patients from the Veterans Affairs Cooperative Study on AIDS. Intervention: Patients were randomly assigned to receive zidovudine or placebo initially; a cross-over protocol was established for patients receiving placebo who had disease progression. Measurements: Reverse transcriptase polymerase chain reaction on cryopreserved plasma samples, previously obtained CD4+ lymphocyte counts, and clinical events. Results: For each decrease of 0.5 log10 copies/mL in plasma HIV RNA level, averaged over the 6 months after randomization, the relative risk (RR) for progression to AIDS was 0.67 (P < 0.001). In a subset of 70 treated patients with long-term follow-up, a return to baseline plasma HIV RNA levels within 6 months of randomization was associated with progression to AIDS (RR, 4.28; P = 0.004). Plasma HIV RNA levels or CD4+ lymphocyte counts over time were more strongly associated with progression to AIDS than were baseline levels or counts. Conclusions: An adequate virologic response after initiation of antiretroviral therapy seems to require a decrease in plasma HIV RNA level of at least 0.5 log10 copies/mL that is sustained for at least 6 months. The independent relation between plasma HIV RNA level and CD4+ lymphocyte count over time and clinical outcome suggests that the measurement of plasma HIV RNA level, in addition to the CD4+ lymphocyte count, has a role in guiding the management of antiretroviral therapy.
Textbook of Coronary Care
Authors: Thomas A. Bruce
Journal: JAMA (1973)

In his great novel,<i>The Magic Mountain</i>, Thomas Mann comments, "A man lives not only his personal life, as an individual, but also, consciously or unconsciously, the life of his epoch and his contemporaries." On reflection, it seems incredible that coronary care units have existed in our hospitals for no more than ten years, since medical practice for many of us has been so profoundly affected by the concepts of continuous cardiac monitoring and aggressive preventive care. The editors have invited contributors from eight nations to discuss 50 subjects related to coronary care, including the diagnosis and clinical course of acute myocardial infarction and the management of its major complications. An attempt has been made throughout to provide hard data about the subject material, such as the incidence of each complication and a critical appraisal of the recommended therapy. Indeed, the effectiveness of the entire system of coronary care is
Photosensitive Dermatitis from Soaps
Authors: A. E. Ison, J. B. Tucker
Journal: New England Journal of Medicine (1968)

Antibacterial soaps containing halogenated salicylanilides cause photosensitive skin eruptions that can be reproduced by a simplified photopatch testing technic. Twelve patients with photosensitive reactions due to soaps had positive tests to either dibromosalicylanilide or tribromosalicylanilide, or a soap solution containing these substances, but tests were negative if soap solutions free of halogenated salicylanilides were used. Of 21 patients with other dermatologic disease only one had a positive test to halogenated salicylanilides. Comparative photopatch tests in sensitive patients with a series of halogenated salicylanilides in current use showed no significant difference in the number of positive reactions to the several agents tested.
Psychiatry's Agenda for the '80s
Authors: John A. Talbott
Journal: JAMA (1984)

It is often said that psychiatry as a science is in its infancy. To me, however, it seems that we've passed through infancy and a very stormy adolescence and are now looking somewhat eagerly yet apprehensively at adulthood—with all the opportunities and problems that phase of life contains. Certainly, much of psychiatry's future parallels that of the rest of medicine. We are all preoccupied with cost containment and its inevitable impact on our practices, patients, and personal incomes. Whether it's the alphabet soup of governmental initiatives such as DRGs, PPOs, or PROs, the increasing impact of third-party constraints, or the specter of proprietary businesses intruding into medicine, we know we will never practice medicine again in the way we have grown accustomed to. Our members are moving from solo practice to "organized settings," our patients are paying with insurance and not personal savings, and our practices are burdened by increasing
Forward, Cautiously, with the Forward Plan for Health
Authors: Daniel S. Greenberg
Journal: New England Journal of Medicine (1975)

The predicament of government health planners is that they have singled out the profit motive as a serious troublemaker in the national health enterprise, and they believe only government can tame it. But they work for a President who is seeking to neutralize the conservative Reagan threat to his nomination by campaigning against government, a tactic that is popular even in the absence of Reagan.With that background, we are on the way to understanding the mismatch between diagnosis and remedy that characterizes a newly issued and important government document, HEW's second annual Forward Plan for Health, Fiscal Years 1977–81 . . .
Age-related Prevalence and Met Need for Correctable and Uncorrectable Near Vision Impairment in a Multi-country Study
Authors: Mingguang He, Amza Abdou, Leon B. Ellwein, Kovin S. Naidoo, Yuddha D. Sapkota, R.D. Thulasiraj, Rohit Varma, Jialiang Zhao, Ivo Kocur, Nathan G. Congdon
Journal: Ophthalmology (2013)
Relationship of Infantile Vesicoureteric Reflux to Renal Damage
Authors: G. L. Rolleston, F. T. Shannon, W. L. F. Utley
Journal: BMJ (1970)

A group of patients known to have had vesicoureteric reflux of varying severity in infancy were followed up over a period of five years. Gross vesicoureteric reflux was found to be accompanied by a high incidence of initial and progressive renal damage. Progressive renal damage was not found in infants showing moderate or slight reflux.
Direct In Vivo Evidence Demonstrating Neointimal Migration of Adventitial Fibroblasts After Balloon Injury of Rat Carotid Arteries
Authors: Guohong Li, Shi-Juan Chen, Suzanne Oparil, Yiu-Fai Chen, John A. Thompson
Journal: Circulation (2000)

Background —Clinical and experimental evidence suggest that the adventitia participates in the response to endoluminal vascular injury. The current study used a direct approach to test the hypothesis that, after balloon injury of the rat carotid artery, adventitial fibroblasts migrate in a luminal direction and contribute to neointima formation. Methods and Results —Primary syngeneic adventitial fibroblasts were stably transduced with retroviral particles coordinating expression of β-galactosidase (LacZ) and introduced into the adventitia of right carotid arteries of rats immediately after balloon injury. At defined times after injury and fibroblast implantation, rats were euthanized, and arterial tissue was examined for detection of LacZ mRNA (reverse transcription polymerase chain reaction), DNA (polymerase chain reaction), and in situ enzymatic activity. LacZ expression was detected in the media 5 days postinjury and in both media and neointima at 7, 10, and 14 days postinjury. LacZ was undetectable in injured vessels that had not been seeded with transduced fibroblasts and was restricted to the adventitia in seeded vessels that were not injured. Conclusions —These observations provide direct demonstration of adventitial fibroblast migration into neointima of arteries after endoluminal injury.
Liver and Vertebral Uptake of Tc-99m Macroaggregated Albumin (MAA)
Authors: Jan-Paul Esser, H Yoe Oei, Hein G. de Bruin, Eric P. Krenning
Journal: Clinical Nuclear Medicine (2004)

An unusual phenomenon during lung scintigraphy is presented. Besides visualization of the lungs, accumulation of Tc-99m macroaggregated albumin (MAA) was seen in a small part of the liver and in and around several thoracic vertebrae. Contrast-enhanced radiographic computed tomography revealed extensive collateral pathways, which were caused by a partially obstructed superior vena cava. Shunting of systemic venous blood flow through chest wall veins to the portal system was responsible for accumulation of MAA in the liver. Retrograde blood flow through dilated thoracic vertebral veins resulted in visualization of the bone marrow.
Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education
Authors: Cara Tannenbaum, Philippe Martin, Robyn Tamblyn, Andrea Benedetti, Sara Ahmed
Journal: JAMA Internal Medicine (2014)

The American Board of Internal Medicine Foundation Choosing Wisely Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older. The effect of direct patient education to catalyze collaborative care for reducing inappropriate prescriptions remains unknown.To compare the effect of a direct-to-consumer educational intervention against usual care on benzodiazepine therapy discontinuation in community-dwelling older adults.Cluster randomized trial (EMPOWER [Eliminating Medications Through Patient Ownership of End Results] study [2010-2012, 6-month follow-up]). Community pharmacies were randomly allocated to the intervention or control arm in nonstratified, blocked groups of 4. Participants (303 long-term users of benzodiazepine medication aged 65-95 years, recruited from 30 community pharmacies) were screened and enrolled prior to randomization: 15 pharmacies randomized to the educational intervention included 148 participants and 15 pharmacies randomized to the "wait list" control included 155 participants. Participants, physicians, pharmacists, and evaluators were blinded to outcome assessment.The active arm received a deprescribing patient empowerment intervention describing the risks of benzodiazepine use and a stepwise tapering protocol. The control arm received usual care.Benzodiazepine therapy discontinuation at 6 months after randomization, ascertained by pharmacy medication renewal profiles.A total of 261 participants (86%) completed the 6-month follow-up. Of the recipients in the intervention group, 62% initiated conversation about benzodiazepine therapy cessation with a physician and/or pharmacist. At 6 months, 27% of the intervention group had discontinued benzodiazepine use compared with 5% of the control group (risk difference, 23% [95% CI, 14%-32%]; intracluster correlation, 0.008; number needed to treat, 4). Dose reduction occurred in an additional 11% (95% CI, 6%-16%). In multivariate subanalyses, age greater than 80 years, sex, duration of use, indication for use, dose, previous attempt to taper, and concomitant polypharmacy (10 drugs or more per day) did not have a significant interaction effect with benzodiazepine therapy discontinuation.Direct-to-consumer education effectively elicits shared decision making around the overuse of medications that increase the risk of harm in older adults.clinicaltrials.gov Identifier: NCT01148186.
Virtual Reality Training in Laparoscopic Surgery: A Preliminary Assessment of Minimally Invasive Surgical Trainer Virtual Reality (MIST VR)
Authors: None Gallagher, None McClure, None McGuigan, None Crothers, None Browning
Journal: Endoscopy (1999)

Background: The "fulcrum effect" of the body wall on surgical instrument manipulation is a major hurdle for novice endoscopic surgeons. Virtual reality training has not previously been evaluated as a means to overcome this problem.
Right Atrial Volume Index in Chronic Systolic Heart Failure and Prognosis
Authors: John A. Sallach, W.H. Wilson Tang, Allen G. Borowski, Wilson Tong, Tama Porter, Maureen G. Martin, Susan E. Jasper, Kevin Shrestha, Richard W. Troughton, Allan L. Klein
Journal: JACC. Cardiovascular imaging (2009)
Re: Phillip J. Gray, Stacey A. Fedewa, William U. Shipley, et al. Use of Potentially Curative Therapies for Muscle-invasive Bladder Cancer in the United States: Results from the National Cancer Data Base. Eur Urol 2013;63:823–9
Authors: Manuel S. Eisenberg, Bradley C. Leibovich, Simon P. Kim
Journal: European Urology (2013)
Relationship Between Dairy Product Consumption and Incidence of IDDM in Childhood in Italy
Authors: Danila Fava, R David G Leslie, Paolo Pozzilli
Journal: Diabetes Care (1994)

To test the hypothesis that the consumption of dairy products, including fluid cows' milk and cheese, is related to the incidence of insulin-dependent diabetes mellitus (IDDM), we correlated incidence rates in children 0-14 years of age with cows' milk and cheese consumption in nine regions of a single country, Italy.Data on the incidence of IDDM were derived from the only nine Italian regions where primary and secondary sources of ascertainment were available for 1991. Data on fluid cows' milk and cheese consumption in the corresponding year in each region were obtained from the National Institute of Statistics.The correlation between fluid milk consumption and incidence of IDDM in Italy was 0.84 (P < 0.004, Poisson regression analysis). Cheese consumption was not related to IDDM incidence.The results indicate that there is a relationship, even in a single country, between dairy product consumption and the incidence of IDDM that is confined to fluid milk consumption. Cows' milk may contain a triggering factor for the development of diabetes, but the high incidence of IDDM in Sardinia and in other countries worldwide cannot be explained simply by the quantity of fluid cows' milk consumed.
Observations on the NHS reforms: an American perspective.
Authors: D W Light
Journal: BMJ (1991)

men: explaining the U-shaped curve. Lancet 1988;ii: 1267-73. IS Dyer AR, Stamler J, Paul O. Lepper M, Shekelle RB, et al. Alcohol consumption and 17-year mortality in the Chicago Western Electric Company study. J Prev Med 1980;9:78-90. 19 Friedman LA, Kimball AW. Coronary heart disease mortality and alcohol consumption in Framingham. Am J Epidemiol 1986;124:481-9. 20 Yano K, Rhoads (IG, Kagan A. Cotice, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. \' Engl J Med 1977;297: 405-9. 21 Kono S, Ikeda M, Tokudome S, Nishizumi M, Karatsune M. Alcohol and mortality: a cohort study of male Japanese physicians. Int J Epidemiol 1986;15:527-31. 22 Kittner SJ, Garcia-Palmieri MR, Costas R, Cruz-Vidal M, Abbott RI), Havlik RJ. Alcohol and coronary heart disease in Puerto Rico. Am J Epidemiol 1983;117:538-50. 23 Cnqui MH, Cowan LD, Tyroier HA, Bangdiwala S, Heiss G, Wallace RB, et al. Lipoproteins as mediators tor the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results from the lipid research clinics follow-up study. AmJ Epidemiol 1987;126:629-37. 24 Miller GJ. Heckles GLA, Maude GH, Carson DC. Alcohol consumption: protection against coronary heart disease and risks to health. IntJ Epidemiol 1990;19:^23-30. 25 Marmot MG, Rose G, Shipley MJ, Thomas BS. Alcohol and mortality: a u-shaped curve. Lancet 1981;i:580-3. 26 Kozarevic D. Vojvodic N, Gordon T, Kaelber C, McGee D, Zukel WJ. Drinking habits and death. IntJ Epidemiol 1983;12:145-50. 27 Cullen K, Stenhouse NS, Wearne KL. Alcohol and mortality in the Busselton study. ImJEpidemiol 1982;11:67-70. 28 Klatsky AL, Armstrong MA, Friedman (il). Relations of alcoholic beverage use to subsequent coronarv artery disease hospitalizaron. Am J Cardiol 1986;58:710-4. 29 Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N EnglJ Med 1988;319:267-73. 30 Criqui MH. The reduction of coronarv heart disease with light to moderate alcohol consumption: effect or artifact? BrJ Addict 1990;85:854-6. 31 Shaper AG. Alcohol and mortality: a review of prospective studies. BrJ Addict 1990;85:837-47. 32 Klatsky AL, Armstrong MA, Friedman GD. Alcohol and cardiovascular deaths. Circulation 1989;80:611-4. 33 Klatsky AL, Armstrong MA, Friedman GD. Mortality in ex-drinkers. Circulation 1990;81:720. 34 Castelli WP, Doyle JT, Gordon T. Alcohol and blood lipids. The cooperative lipoprotein phenotyping study. Lancet 1977;ii: 153-5. 35 Meade TW, Chakrabarti R, Haines AP. Characteristics affecting fibrinolytic activity and plasma fibrinogen concentrations. BMJ 1979;i: 153-6. 36 Duffy JC. Fallacy of the distribution of alcohol consumption. Psychol Rep 1982;50:125-6. 37 Rose (i, Day S. The population mean predicts the number of deviant individuals. BMJ 1990;301:1031-4.
US, French AIDS test patent rights renegotiated
Authors: C. Marwick
Journal: JAMA (1994)

THE UNITED STATES' National Institutes of Health (NIH) has finally yielded to the French Institut Pasteur's persistent pleas that it receive a more generous proportion of the royalties from sales of the respective nations' antibody tests for human immunodeficiency virus (HIV) than it has been receiving since the 1987 Reagan-Chirac agreement between the two countries ( JAMA . 1987; 258:3482-3487).  At the annual meeting of the French and American AIDS Foundation (set up to administer the royalties from the blood tests), held last month on the NIH campus in Bethesda, Md, its board of trustees adopted a resolution that redistributes the royalties. This will be done so that during the remainder of the lifetime of the patent, which expires in 2002, the French will end up with approximately the same amount as the Americans. If this resolution had failed approval, Pasteur's lawyers say they would have gone to court—a move they have
Human lung parenchyma retains PM2.5.
Authors: A Churg, M Brauer
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

There is extensive epidemiologic evidence that increased levels of the inhalable particulate fraction of air pollution (PM10) are associated with increased morbidity and mortality. The mechanisms of these effects are unknown, and the exact types and sizes of particles responsible are a matter of intense dispute. To obtain an idea of the sizes of particles retained in human lung parenchyma, we used analytical electron microscopy to count, size, and identify particles in the upper lobe apical segment parenchyma of autopsy lung tissue from 10 never-smoking long-term residents of Vancouver. The overall geometric mean particle diameter (GSD) was 0.38 microm (2.4); within this broad distribution, silica and silicate particles had a geometric mean diameter of 0.49 microm (2.2), whereas metals had a geometric mean diameter of 0.17 microm (2.0). Ultrafine particles (those with diameter < or = 0.1 microm) constituted less than 5% of the total, and most of these were metals. Translation of these projected area diameters into aerodynamic diameters (d(a)) revealed that 96% of the particles had d(a) less than 2.5. These data indicate that human lung parenchyma effectively retains PM2.5, suggesting that attempts to determine the particles responsible for chronic particulate pollutant effects should concentrate on this size range. These data also suggest that several different type/size classes of particle are present in human parenchyma, but that ultrafine particles make up only a small fraction of the total.
Rethinking Medical Training — The Critical Work Ahead
Authors: Jeffrey M. Drazen, Arnold M. Epstein
Journal: New England Journal of Medicine (2002)

What physicians do on a daily basis has evolved considerably in the past quarter-century, but the format of postgraduate medical training has changed relatively little. When we trained in internal medicine in the 1970s, our clinical rotations included every-second-or-third-night on-call schedules. At that time, completing all the tasks expected of a trainee routinely required 100 hours of work a week or more. Although the duty hours of house-staff trainees in internal medicine have decreased during the past 25 years, they remain substantial. Moreover, many of the other building blocks of medical training — work rounds, attending rounds, specialty conferences, and . . .