tbuckley/cabot-search huggingface dataset:
The Quality of Care Is Unmeasurable: An Equation, a Paralogism, a Paraphrasis, a Quackery... and a Reply
Authors: Manfred Sinnreich
Journal: JAMA (1989)

<h3>To the Editor.—</h3> The article entitled "Quality Medical Care"<sup>1</sup>contains misconceptions about the terms<i>quality, capacity</i>, and<i>outcome</i>. Subverted language subverts perceptions, understanding, and, last but not least, policy. At just about the same time the<i>Medical Tribune</i>reported in a news brief (June 30, 1988) that Dr Paul Ellwood, president of Inter Study, proposed a "national computerized outcomes analysis"; that Dr Arnold S. Relman, editor of the<i>New England Journal of Medicine,</i>termed outcome analysis "potentially the third revolution of medicine"; and that Dr William Roper, administrator of the Health Care Financing Administration, announced a government study of "quality of care" rating for each of the 280 000 physicians treating Medicare patients and that eventually patients would be steered to "quality doctors." First, there is an article taking liberties with the facts, followed by a "computerized outcomes analysis" constituting a "revolution," and, finally, a policy to label physicians.
Some Advice on Using Condoms Against STDs: What Every Man (and Woman) Should Know
Authors: Marsha F. Goldsmith
Journal: JAMA (1987)

TO PREVENT sexual transmission of disease, it's important to use condoms, and use them properly. Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine, Atlanta, says many people are trying them for the first time and don't know what they should do to make the best use of condoms. The following checklist is taken from Hatcher's book<i>Contraceptive Technology 1986-1987</i>, ed 13. New York, Irvington Publishers, 1987. It gives physicians a guide to follow in discussing condom use with male patients. It may also be used as a guide for discussing, with female patients, how they may initiate condom use to protect themselves and their partners from sexually transmitted diseases. <h3>Hatcher's "Condom Sense" Rules</h3> Use a condom every single time you have intercourse. There is no "safe" time with regard to transmitting disease. Put the condom on as soon as erection
Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region
Authors: Belinda E. Ostrowsky, William E. Trick, Annette H. Sohn, Stephen B. Quirk, Stacey Holt, Loretta A. Carson, Bertha C. Hill, Matthew J. Arduino, Matthew J. Kuehnert, William R. Jarvis
Journal: New England Journal of Medicine (2001)

In late 1996, vancomycin-resistant enterococci were first detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997 the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of vancomycin-resistant enterococci in the region's facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region.The infection-control intervention was evaluated in October 1998 and October 1999. We performed point-prevalence surveys, conducted a case-control study of gastrointestinal colonization with vancomycin-resistant enterococci, and compared infection-control practices and screening policies for vancomycin-resistant enterococci at the acute care and long-term care facilities in the Siouxland region.Perianal-swab samples were obtained from 1954 of 2196 eligible patients (89 percent) in 1998 and 1820 of 2049 eligible patients (89 percent) in 1999. The overall prevalence of vancomycin-resistant enterococci at 30 facilities that participated in all three years of the study decreased from 2.2 percent in 1997 to 1.4 percent in 1998 and to 0.5 percent in 1999 (P<0.001 by chi-square test for trend). The number of facilities that had had at least one patient with vancomycin-resistant enterococci declined from 15 in 1997 to 10 in 1998 to only 5 in 1999. At both acute care and long-term care facilities, the risk factors for colonization with vancomycin-resistant enterococci were prior hospitalization and treatment with antimicrobial agents. Most of the long-term care facilities screened for vancomycin-resistant enterococci (26 of 28 in 1998 [93 percent] and 23 of 25 in 1999 [92 percent]) and had infection-control policies to prevent the transmission of vancomycin-resistant enterococci (22 of 25 [88 percent] in 1999). All four acute care facilities had screening and infection-control policies for vancomycin-resistant enterococci in 1998 and 1999.An active infection-control intervention, which includes the obtaining of surveillance cultures and the isolation of infected patients, can reduce or eliminate the transmission of vancomycin-resistant enterococci in the health care facilities of a region.
Simulation of high-resolution QRS complex using a ventricular model with a fractal conduction system. Effects of ischemia on high-frequency QRS potentials.
Authors: S Abboud, O Berenfeld, D Sadeh
Journal: Circulation Research (1991)

Recent studies have analyzed the high-fidelity surface electrocardiographic signal, and efforts have been made to increase the diagnostic sensitivity of the electrocardiogram by observing its high-frequency components. It was found that the high-frequency (150-250-Hz) electrocardiogram appears to detect evidence of transient ischemia with greater sensitivity than visual inspection of the surface electrocardiogram. A finite-element three-dimensional model of the ventricles with a self-similar (fractal) conduction system has been introduced as a bridge to the understanding of electrocardiographic phenomena related to high-frequency potentials. The model was activated, and the dipole potential generated by adjacent activated and resting cells was calculated to obtain a high-resolution QRS complex. Normal and ischemic activation processes was stimulated by regional reduction in conduction velocity. It was found that although the resulted low-frequency QRS complex was not significantly altered from normal conditions, the high-frequency components exhibited morphological changes similar to the ones observed during animal experiments and human studies. Based on the results obtained from the model, it can be concluded that these morphological changes can be attributed to a slowing of conduction velocity in the region of ischemia and that the model is adequate for meeting the challenges imposed by the requirements of high-frequency methods applied in clinical cardiology.
Diagnostic-Therapeutic Cascade Revisited
Authors: F.L. Lucas, A.E. Siewers, D.J. Malenka, D.E. Wennberg
Journal: Circulation (2008)

Background— There is wide geographic variation in the use of coronary revascularization in the United States. Rates are closely related to rates of coronary angiography. We assessed the relationship between coronary angiography and coronary artery revascularization by procedure type (coronary artery bypass graft surgery or percutaneous coronary intervention). Methods and Results— Using Part B claims for a 20% sample of the Medicare population, we calculated population-based rates of testing and treatment by region, using events identified in Part B claims as the numerator and the total number of Medicare beneficiaries residing in the area as the denominator and adjusting for regional differences in demographic characteristics with the indirect method. Cardiac catheterization rates varied substantially across regions, from 16 to 77 per 1000 Medicare beneficiaries. The relationship between coronary angiography rates and total coronary revascularization rates was strong ( R 2 =0.84). However, there was only a modest association between coronary angiography rates and coronary artery bypass graft surgery rates ( R 2 =0.41) with the suggestion of a threshold effect. The association between coronary angiography rates and percutaneous coronary intervention rates was strong ( R 2 =0.78) and linear. Conclusions— The diagnostic-therapeutic cascade for coronary artery disease differs by therapeutic intervention. For coronary artery bypass graft surgery, the relationship is modest, and there appears to be a testing threshold beyond which additional tests do not result in additional surgeries. For percutaneous coronary intervention, the relationship is very tight, and no threshold appears to exist. Given the results of recent studies of medical versus invasive management of stable coronary disease, patients living in high-diagnostic-intensity regions may be getting more treatment than they want or need.
Effect of Doxepin on Basal Gastric Acid and Salivary Secretion in Patients with Duodenal Ulcer
Authors: DEBBIE BROWN-CARTWRIGHT
Journal: Annals of Internal Medicine (1986)

We compared the effect of 50- or 100-mg doses of oral doxepin or a placebo on basal gastric acid secretion, salivary flow, and pulse rate in seven asymptomatic patients with chronic duodenal ulcer disease. Acid secretion and salivary flow were measured for four 1-hour periods beginning at 3.5, 5.5, 7.5, and 9.5 hours after medication, with plasma sampling for measurement of doxepin at the midpoint of each collection period. Compared to placebo, the 50- and 100-mg doses of doxepin reduced mean basal acid output by 46% and 37%, respectively. There was no significant difference in the effect of the 50- or 100-mg dose on acid secretion even though mean plasma concentrations of doxepin were higher with the 100-mg than with the 50-mg dose (p < 0.01). Salivary flow was reduced by 62% and 84% with the 50- and 100-mg doses, respectively, whereas doxepin had no effect on mean pulse rate.
aplastic anemia and hepatitis C: Molecular biology exonerates another suspect Hibbs J, Frickhofen N, Rosenfeld S, Feinstone S, Kojima S, Bacigalupo A, Locasciulli A, et al. Aplastic anemia and viral hepatitis: non-A, non-B, non-C? JAMA 1992;267:2051–2054
Authors: D Bachwich
Journal: Hepatology (1993)
NF-E2-related factor 2 promotes compensatory liver hypertrophy after portal vein branch ligation in mice
Authors: Keiichi Shirasaki, Keiko Taguchi, Michiaki Unno, Hozumi Motohashi, Masayuki Yamamoto
Journal: Hepatology (2014)

Hepatectomy is a standard therapy that allows liver cancer patients to achieve long-term survival. Preceding hepatectomy, portal vein embolization (PVE) is frequently performed to increase the remnant liver size and reduce complications. Although the clinical importance of PVE is widely accepted, molecular mechanisms by which PVE leads to compensatory hypertrophy of nonembolized lobes remain elusive. We hypothesized that NF-E2-related factor 2 (Nrf2), a master regulator of cytoprotection, promotes compensatory liver hypertrophy after PVE. To address this hypothesis, we utilized three mouse lines and the portal vein branch ligation (PVBL) technique, which primarily induces the redistribution of the portal bloodstream in liver in a manner similar to PVE. PVBL was conducted in Kelch-like ECH-associated protein 1 (Keap1) conditional knockout (Keap1-CKO) mice in which Nrf2 is constitutively activated, along with Nrf2-deficient (Nrf2-KO) mice. We found that hypertrophy of nonligated lobes after PVBL was enhanced and limited in Keap1-CKO and Nrf2-KO mice, respectively, compared to wild-type mice. In Keap1-CKO mice, Nrf2 activity was increased, consistent with transient activation of the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway, and reactive hepatocyte proliferation was significantly prolonged after PVBL. Importantly, Nrf2 activation by a chemical inducer was also effective for enhancement of hypertrophy after PVBL. Nrf2 supports compensatory liver hypertrophy after PVBL. This finding is particularly intriguing, because the primary effect of PVBL is limited to the alteration of bloodstream; this effect is much milder than changes resulting from hepatectomy, in which intrahepatic bloodstream and bile production cease. Our results suggest that premedication with an Nrf2 inducer may be a promising strategy to improve the outcome of PVE; this approach expands the indication of hepatectomy to patients with poorer liver function.
A New Technique for Replacing an Obstructed Biliary Endoprosthesis
Authors: N. Soehendra, A. Maydeo, B. Eckmann, M. Brückner, V. Ch. Nam, H. Grimm
Journal: Endoscopy (1990)

We report on a new method of stent exchange using a threaded device that enables removal of the clogged stent while simultaneously maintaining the original pathway without withdrawing the endoscope. With this method stent replacement has become more reliable, safer, simpler and quicker. This technique is also suitable for removal of stents dislodged inside the duct.
CD4+ and CD8+ T Cells Of Allergic Humans Express Increased Phosphorylated p38 MAP Kinase (p38MAPK), Substance P Suppresses T Cell Expression Of p38MAPK and Memory IgE Responses
Authors: Bryan McCarthy, Jonathan I. Silverberg, Seto M. Chice, Ankuri Desai, Tamar A. Smith-Norowitz, Mark Stewart, Rauno Joks, Helen G. Durkin
Journal: Journal of Allergy and Clinical Immunology (2014)
Anatomy for Surgeons: vol 1, The Head and Neck
Authors: Edward A. Edwards
Journal: JAMA (1969)

Those who believe anatomy is a dead subject will be astonished to find out how many studies Dr. Hollinshead and his readers find important among those that have been published since 1954, the year of the first edition of this work. This revision of the first of the three volumes expands and improves on a superb and unique text of surgical anatomy. It is of particular value as a book of reference with emphasis on variations in location, and neural and vascular connections of anatomic structures. References are numerous and up to date. The division of the entire text into three volumes gives a roomy format, with easily readable print, and clear and perfect significant illustrations. Many of the illustrations are new to this edition. The work will appeal particularly to the older surgeon. It is less well suited to guide the medical student or young house staff member than
Lectures ON THE SYMPATHETIC INNERVATION OF STRIATED MUSCLE
Authors: J. I. Hunter
Journal: BMJ (1925)

BRiTim blood t hen resuilts in an urgent attempt to prevent further accumulations of CO2 in the tissues.This hyperpnoea is one of the clinical syimiptoms of aoidosis.(B) The acids whicih gain access to the blood are intermediate products in fat katabolism.(C) The imperfect combustion of fats is associated with, and is perhaps due to the absence, or diminution, of, that product of carbohydrate metabolism whlieh sets alight this combustion. (D) A primary deficiency in carbohydrates is therefore an essential preliminary fault in cases of acidosis. (E) This deficiency may be due to an insufficient supply of carbohydrates to the body, such as occurs in cases of, say, pyloric obstruction with copious vomiting, or to an imperfect metabolism of carboliydrates of which there is no lack.The anaesthetic chloro- form probably interferes with carbohydrate metabolism by its direct action upon the liver cell.( F) In cases of carbohydrate deprivation the deficiency may be at once made good by the administration of glucose.This cannot be given in adequate quantities by the mouth to patients afflicted with acidosis, on account of the vomiting which is so persistent.If administered by the rectum its absorption, when considered in relation to the urgency of the patient's need, may appear slow.If it is given subcutaneously the quantity taken up is small, owing to the enfeebled systemic and lymphatic circulations.When administered intravenously there is no reasonable limit set to the amount which can be given.Either a 5 or a 10 per cent.solution may be irijected; an isotonic solution contains 4.15 per cent. of glucose.Matas of New Orleans, a surgeon to whom our debt of gratitude is very heavy, was the first to suggest (in 1911) that glucose might be given by continuous instillation.He has recently3 described an apparatus which renders easy the " continuous drip intravenous administration of a glucose solution maintained at an equable temperature.About 8 pints may be introduced in the period of twenty-four hours; I have once introduced as much as 18 pints.A reaction is seen not infrequently-the patient shivers and then sweats, a miniature rigor occurring; no anxiety need be felt on this account.The cause of the reaction is doubtful; it may perhaps be the too rapid administration of the fluid.(G) The mere accumulation of glucose within the blood is not, lhowever, all that is necessary.The glucose must be utilized by the tissues.We owe to Thalhimer of Milwaukee4 the supremely important suggestion that this may be done by the injection of insulin.My experience of the method is small, but it is enough to say that a new remedy of considerable importance is now at our dis- posal.Insulin must not be injected until there is a good store of
Atrial fibrillation in athletes: towards a changing therapeutic approach in the era of catheter ablation
Authors: N Saoudi, M Arnoult, T Hugues, D G Latcu, I Popescu, P Ricard, J P Rinaldi, K Yaïci, N Zarqane
Journal: British Journal of Sports Medicine (2011)

Background The Prevalence of atrial fibrillation (AF) is increasing and its incidence in professional and amateur athletes seems higher than in the general population (OR=2–10 after adjustment for other risk factors). A U shaped relationship of physical activity with incident AF suggests that the positive antiarrhythmic effects of sport are partially negated by prolonged heavy endurance exercise. AF is also more prevalent in middle-aged former competitive athletes. Design A review of the literature of AF in athletes is presented. AF may be due to sympathetic activity, volume load during exercise, vagotonia at rest but also atrial hypertrophy and dilatation. Anticoagulation cannot be used in sporting activities with a risk of bodily collision. Rate control during AF is difficult to reach in athletes: -blockers are not well tolerated or even prohibited in some competitive sports, and digoxin or calcium antagonists are poorly effective during exertion. In paroxysmal AF athletes, the flecainide or propafenone ‘pill-in the pocket approach’ can be used, but transient sport practice limitations ensue. Intervention Several reports of the new pulmonary vein catheter ablation have demonstrated encouraging results. Using radiofrequency current, the latter is as efficacious in lone AF amateur athletes as in controls. Representative examples from our AF ablation patient database will be presented. Conclusion A review of the literature and our own experience suggest that catheter ablation of AF in athletes will probably develop in the near future. This is also supported by the recent European guidelines which state that ‘where appropriate, AF ablation should be considered to prevent recurrent AF in athletes' without requiring prior drug therapy.
P1-17-09: A Phase 1/2 Dose-Escalation Study of SAR245408 (S08) or SAR245409 (S09) in Combination with Letrozole (L) in Subjects with Hormone Receptor-Positive and HER2−Negative (HR+/HER2−) Breast Cancer (BC) Refractory to a Nonsteroidal Aromatase Inhibitor (AI).
Authors: J Baselga, S Tolaney, L Hart, P Gomez, E Gartner, A DeCillis, R Ruiz-Soto, J Lager, H Burris
Journal: Cancer Research (2011)

Abstract Background: Upregulation of PI3K activity is a common molecular mechanism involved in resistance to AIs. S08 is a potent, orally bioavailable, pan-PI3K inhibitor. S09 is a potent, orally bioavailable inhibitor of PI3K which also possesses mTOR inhibitory activity. Both compounds exhibit robust PI3K and ERK pathway inhibition in paired human tumor biopsy samples from phase 1 studies (Edelman G, et al. ASCO 2010; Brana I, et al. ASCO 2010). Methods: This ongoing, open-label, multicenter, phase 1/2 study (NCT01082068) was designed to evaluate the safety and tolerability of L in combination with either S08 (Arm 1) or S09 (Arm 2). Eligible female patients (pts) were ≥18 yrs, ECOG PS 0–1, with advanced or recurrent HR+/HER2− BC whose disease is refractory to nonsteroidal AIs. Phase 1 used an ascending 3+3 dose-escalation design and pts were accrued to each arm until no more than 1/3 pts or ≥33% of 3–6 pts at a given dose level experienced a dose-limiting toxicity (DLT) during the first 28-day cycle. Pts were alternately assigned to Arm 1 or Arm 2 and received 2.5 mg L PO (qd) in combination with different dose levels of either S08 (Arm 1; starting dose 200 mg tablets, PO, qd) or S09 (Arm 2; starting dose of 30 mg capsules, PO, bid). After reaching a preliminary maximum tolerated dose (MTD) for each combination, pts will accrue to the phase 2 portion of the study. A two-stage design will be used evaluate the phase 2 co-primary endpoints of ORR and PFS. Each arm will be evaluated independently and no formal comparisons between arms are planned. Results: As of June 1st 2011, 17 pts were enrolled to Arm 1 (8 pts) or Arm 2 (9 pts). Median age was 54 yrs. Based on preliminary data, the adverse event profile in both arms were similar to those reported in the single agent phase I studies for S08 and S09 respectively. SAEs reported in Arm 1 (2 subjects) included 2 cases of Gr1 pneumothorax and 1 Gr4 pneumonitis; in Arm 2 (2 subjects) included Gr4 lumbar pain and Gr4 elevation of ALT and AST. No DLTs were reported in Arm 1 while one DLT (Gr3 skin rash) was reported in Arm 2 at a dose level of S09 50 mg bid (table 1). Arm 1 dosing data from S08 400 mg qd + L 2.5 mg qd dose level (maximum dose level allowed per protocol) will be completed by August 2011. For Arm 2, the MTD was S09 50 mg bid + L 2.5 mg, qd. Discussion. Both S08 and S09 can be combined with L, and maximal doses for both combinations were established. Additional safety, PK and efficacy data will be presented from phase 1. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-17-09.
Induction of rhythm abnormalities in the fetal rat heart. A tentative mechanism for the embryotoxic effect of the class III antiarrhythmic agent almokalant
Authors: C. Abrahamsson, M. Palmer, B. Ljung, G. Duker, C. Baarnhielm, L. Carlsson, B. Danielsson
Journal: Cardiovascular Research (1994)

The aim was to test the hypothesis that the recently reported embryotoxic effect of class III antiarrhythmic agents may be a result of electrophysiological disturbances induced by these agents.Comparative studies of drug effects in the adult and fetal rat were performed using three experimental models: (1) effects of almokalant upon pregnancy and fetal mortality in rats given daily doses of 0, 10, 50, 100, or 400 mumol.kg-1 orally in the diet on days 6-15 of pregnancy; (2) effects of d-sotalol (1-1000 microM), almokalant (0.1-100 microM) and dofetilide (0.01-10 microM) on the adult and fetal cardiac action potential in vitro; (3) voltage clamp recordings in single fetal and adult ventricular myocytes superfused with almokalant (0.5 microM).In the groups of rats treated with 100 and 400 mumol.kg-1, respectively, the body weight gain was decreased from day 12 of gestation, and there were no viable fetuses at termination of pregnancy. In atrial as well as ventricular tissue, the class III agents induced a concentration dependent prolongation of the fetal action potential duration, accompanied by a reduction in heart rate and eventually the appearance of rhythm abnormalities and/or early afterdepolarisations. The adult action potential duration remained unaffected. An almokalant sensitive current (probably the delayed rectifier, IK) could be evoked both in the fetal and in the adult ventricular cells.Class III antiarrhythmic agents were shown to induce fetal mortality and rhythm abnormalities in the rat heart. Although they do not prove a causal relationship between these effects, our observations may have implications for the clinical use of class III antiarrhythmic agents in women of childbearing potential.