tbuckley/cabot-search huggingface dataset:
Clinical freedom and management accountability.
Authors: M Rendall
Journal: BMJ (1985)

Administration or management? Relations between clinicians and administrators in the National Health Service have always been awkward and in some senses unsatisfactory. Doctors have acknowledged the need for adminis? trators in hospitals but have seen them as facilitators, whose role is to enable clinicians to get on with the business of seeing and treating patients. Success or failure has largely been judged by whether the patients' notes were in the outpatient clinic at the right time, the ward sisters had sufficient linen for patients' needs, and the hospital looked clean and cared for. The task of administration was to ensure that whatever policies were adopted were put into practice as smoothly, efficiently, and unobtrusively as possible. Today's problems are different and demand different solutions. The overriding concerns of all hospitals are their cash limit and getting the best possible value for money. This must be seen against a background of enormously increased organisational complexity and an ever widening range of ways in which money can profitably be spent on the care of patients. The inquiry into the management of the NHS headed by Roy Griffiths was inevitable and desirable.1 Management must be concerned with finding the best possible solution to the dilemma of matching finite resources to the rising cost of medical progress. It must identify new and imaginative ways in which things can be done, defining where the organisation is, where it wants to go, and how best to get there. The introduction of general management into the health service will be seen as a logical and beneficial step, but its impact will be crucially dependent on attracting the necessary talent. This year will be regarded as the watershed between administration and management in the health service, and few doctors can imagine the rigours that he ahead. It seems unlikely that hospitals will escape the radical action faced by troubled commercial enterprises, and the immunity that hospitals have traditionally enjoyed from finance driven intervention will be a thing of the past.
SUGAR THRESHOLD IN ONE HUNDRED CASES OF DIABETES
Authors: JOSEPH H. ROE
Journal: JAMA (1925)

That the threshold point of glycuresis in diabetes shows wide variations is an important fact, clinically, because it reveals the inadequacy of urinary sugar examinations and the necessity for blood sugar findings in the management of this disease. Marked variations in the blood sugar level at which glucosuria occurs are observed in groups of patients, and even in the same patient the sugar threshold often manifests striking changes. In order to demonstrate these facts, a statistical study was made on 100 patients with diabetes receiving dietetic and insulin therapy at the George Washington University Hospital and Dispensary. The sugar threshold was determined in each patient by selecting the lowest blood sugar at which simultaneously a positive qualitative Benedict's test was obtained from the twenty-four hour specimen of urine. Only cases were selected in which there were adequate blood and urinary sugar estimations to establish a consistent value for the so-called
Multiple Extraosseous Metastases from Osteogenic Sarcoma Demonstrated on Bone Scintigraphy
Authors: CHRISTOPHER J. PALESTRO, ALFRED J. SWYER, STANLEY J. GOLDSMITH
Journal: Clinical Nuclear Medicine (1992)

A 23-year-old man who had left lower extremity amputation for osteogenic sarcoma underwent Tc-99m MDP bone scintigraphy as part of his diagnostic workup. In addition to bony metastases, multiple extraosseous lesions were identified.
Nephroblastoma: treatment during 1970-3 and the effect on survival of inclusion in the first MRC trial.
Authors: E L Lennox, C A Stiller, P H Jones, L M Wilson
Journal: BMJ (1979)

In 1970-3 313 children were diagnosed as having nephroblastoma in Great Britain. From the start of the first Medical Research Council nephroblastoma study in October 1970 until the end of 1973, 98 children (57% of all eligible children) were included in the trial. Of the 313 children, 288 (92%) had a nephrectomy, 248 (79%) received a course of radiotherapy, and 267 (85%) were given at least four days9 chemotherapy. The three-year survival rate was 58%; the rate among children in the trial (77%) was significantly better than that among children who were eligible for the trial but not included (58%). Children who had nephrectomies at specialised children9s and teaching hospitals had a higher survival rate than those treated elsewhere. All children with nephroblastoma should be treated according to well-defined protocols which take into account the age of the child and the stage of the tumour and include a full course of maintenance chemotherapy.
The Doctor-Manager
Authors: R. B Hopkinson
Journal: BMJ (1995)

John Sutherst, Veronica Glascott Churchill Livingstone, £12.95, pp 256 ISBN 0 443 04862 2

The notes on the attractive cover of this book advise that “The Doctor-Manager will be essential reading for all doctors in training, and especially those about to assume management responsibilities for the first time….” I disagree for I found it verbose, platitudinous, and without the clear structure needed to help the novice in medical management.

The book throughout shows a failure to define the roles and responsibilities of the posts mentioned, whether medical, nursing, business, or the infrequently mentioned “financial assistant.” Where should line management relationships exist? What of …
Do general practitioners have different "referral thresholds"?
Authors: R O Cummins, B Jarman, P M White
Journal: BMJ (1981)

One of the most interesting puzzles in general practice is why doctors differ so greatly in the frequency with which they refer patients to hospital. Published figures range from less than 0-5 to more than 15 per 100 consultations,1 and from only 0-6% to 25-9% of patients on a practice list a year. ? Obvious differences in patient characteristics, such as age, sex, social class, type and severity of problem, and distance from the practice; in doctor characteristics, such as age, years in general practice and in a particular practice, special medical interests, and postgraduate training ; and in practice characteristics, such as size of list, work load, urban or rural setting, partnership or single-handed structure, and distance from hospital1'11 may explain many of these marked variations. These differences in  rates may also be explained by what other authors have called a referral threshold' * >*? that is, doctors have a personal level at which the stimulus of a consultation produces a referral. This concept would be supported if doctors were observed to refer at dissimilar rates even when patient, doctor, and practice characteristics were the same. Unfortunately, only a few studies* ' of the  process have controlled for more than one of these characteristics at a tame. Since 1971, the general practice partnership of one of us (BJ) has kept extensive records on every consultation. The size and detail of these data allowed us to carry the observations of previous workers one step further?we compared the  rates of several doctors while a number of patient and practice variables were controlled. Our purpose was to examine the hypothesis that general practitioners have a personal  threshold. Practice characteristics were the same for each
Clues from wildlife to create an assay for thyroid system disruption.
Authors: Theo Colborn
Journal: Environmental Health Perspectives (2002)

In 1996 the U.S. Congress charged the U.S. Environmental Protection Agency to develop a screening program to test chemicals for their possible estrogenic and other endocrine effects. Shortly thereafter, the Chemical Guidelines Program of the Organisation for Economic Co-operation and Development's (OECD) Environmental Directorate organized a Task Force on Endocrine Disruption Testing and Assessment to coordinate development of internationally harmonized screening and testing protocols. Most of the research devoted to this effort has focused on detecting impaired estrogenicity, androgenicity, and/or steroidogenesis, with little progress toward developing assays to detect chemicals that might interfere with thyroid function. Despite the fact that wildlife biologists have been reporting abnormal thyroid gland development and unusual thyroid hormone (TH) and retinoid ratios in fish and birds since the early 1960s, few studies have demonstrated an association between an environmental contaminant and a particular health end point other than reduced reproductive success at the population level. This article is a review of the literature that specifically examines THs and their role in normal behavior and development in wildlife. It presents several studies that associated changes in the thyroid gland, TH concentrations, and behavior with contaminant exposure. The goal of this article is to provide fodder for the creation of simple screens to detect possible thyroid system agonists and antagonists.
Efficacy and Safety of Single-Agent Pertuzumab, a Human Epidermal Receptor Dimerization Inhibitor, in Patients with Non–Small Cell Lung Cancer
Authors: Roy S. Herbst, Angela M. Davies, Ronald B. Natale, Thao P. Dang, Joan H. Schiller, Linda L. Garland, Vincent A. Miller, David Mendelson, Annick D. Van den Abbeele, Yulia Melenevsky, Daniel J. de Vries, David A. Eberhard, Benjamin Lyons, Stuart G. Lutzker, Bruce E. Johnson
Journal: Clinical Cancer Research (2007)

Pertuzumab, a first-in-class human epidermal receptor 2 (HER2) dimerization inhibitor, is a humanized monoclonal anti-HER2 antibody that binds HER2's dimerization domain and inhibits HER2 signaling. Based on supporting preclinical studies, we undertook a Phase II trial of pertuzumab in patients with recurrent non-small cell lung cancer (NSCLC).Patients with previously treated NSCLC accessible for core biopsy and naive to HER pathway inhibitors were treated with pertuzumab i.v. once every 3 weeks. Tumor assessments were done at 6 and 12 weeks and then every 3 months thereafter. The primary efficacy end point was overall response rate by Response Evaluation Criteria in Solid Tumors. Measurement of tumor glucose metabolism (SUVmax) by F-18-fluorodeoxyglucose positron emission tomography was used as an exploratory pharmacodynamic marker of drug activity.Of 43 patients treated with pertuzumab, no responses were seen; 18 of 43 (41.9%) and 9 of 43 (20.9%) patients had stable disease at 6 and 12 weeks, respectively. The median and 3-month progression-free survival rates (PFS) were 6.1 weeks (95% confidence interval, 5.3-11.3 weeks) and 28.4% (95% confidence interval, 14.4-44.2%), respectively. Of 22 patients who underwent F-18-fluorodeoxyglucose positron emission tomography, six (27.3%) had a metabolic response to pertuzumab as evidenced by decreased SUV max. These patients had prolonged PFS (HR = 0.11, log-rank P value = 0.018) compared with the 16 patients who had no metabolic response. Four patients (9.3%) experienced a grade 3/grade 4 adverse event judged related to pertuzumab; none exhibited grade 3/grade 4 cardiac toxicity.Pertuzumab is well tolerated as monotherapy. Pharmacodynamic activity correlated with prolonged PFS was detected in a moderate percentage of patients (27.3%). Further clinical development of pertuzumab should focus on rational combinations of pertuzumab with other drugs active in NSCLC.
Angina Pectoris in Patients With Aortic Stenosis and Normal Coronary Arteries
Authors: Barbara K. Julius, Martin Spillmann, Giuseppe Vassalli, Bruno Villari, Franz R. Eberli, Otto M. Hess
Journal: Circulation (1997)

Background The incidence of angina pectoris (AP) in patients with severe aortic stenosis (AS) and normal coronary arteries has been reported to be 30% to 40%. The exact pathophysiological mechanism, however, is not known. The purpose of this work was to evaluate the various hemodynamic and angiographic determinants of myocardial perfusion in 61 patients with severe AS. Methods and Results In a retrospective analysis, 61 patients with severe AS and without significant coronary artery disease were studied. Thirty-three patients with atypical chest pain and angiographically normal arteries served as control subjects. Patients were divided into two groups: 32 with AP and 29 without AP. Quantitative coronary angiography was performed in 59 patients and 22 control subjects. Coronary flow reserve was determined in 29 patients and 7 control subjects by use of coronary sinus thermodilution technique. Patients with AP had a lower left ventricular (LV) muscle mass, an increased LV peak systolic pressure, and increased wall stress than those without AP. Vessels of the left coronary artery were smaller and coronary flow reserve was lower in patients with AP than in those without. Inadequate LV hypertrophy with an increased wall stress was found in patients with AP but not in patients without AP. Conclusions Myocardial ischemia in patients with severe AS can occur in the absence of coronary artery disease and appears to be due to inadequate LV hypertrophy with high systolic and diastolic wall stresses and a reduced coronary flow reserve. The cause of inadequate LV hypertrophy, however, remains unclear.
THE INDICATIONS FOR OPERATION IN CALCULOUS NEPHRITIS AND URETERITIS.
Authors: CHARLES LESTER LEONARD
Journal: JAMA (1901)

Recent advances in the diagnosis of calculus conditions of the kidneys and ureters show that more than half the calculi that originate in the kidneys pass into the ureters before they occasion sufficient symptoms to make their presence known. This increased frequency of ureteral calculi, which a more accurate method of diagnosis has shown, and the numerous small calculi that are passed with but slight symptoms, make it probable that many such calculi remain throughout life in the urinary tract, neither producing notable symptoms, nor interfering with the function of the kidneys. Although these calculi may remain quiescent in the ureter and give rise to no functional derangement, they may, on the contrary, entirely destroy the function of one kidney without the recognition of the fact by the patient. The onset of calculous anuria, especially unilateral anuria, so closely mimics in symptomatology the process of recovery, that the integrity of
Lead in Printed Matter
Authors: Arthur Sohler
Journal: JAMA (1977)

<h3>To the Editor.—</h3> The hazards of lead pigments in paints have been well publicized and measures instituted to reduce the amount of lead in paint. Another source of lead that has not been well publicized is lead that may be present in printed matter. The ingestion of printed matter by children with pica is not uncommon. In two studies, about half the children with pica ingested paper.<sup>1,2</sup>Lead in printed matter could therefore appreciably add to the lead burden of these children. Hankin et al<sup>3</sup>have referred to three cases of lead intoxication owing to pica involving the ingestion of newsprint. Analyses were made on representative samples of printed matter that would be attractive to children: Sunday comics, comic books, children's books, toy catalogs, and picture magazines. Lead determinations were carried out on acetic acid extracts of the printed matter using a graphite furnace in conjunction with an
Trauma registries. Current status and future prospects
Authors: D. A. Pollock
Journal: JAMA (1989)

Hospital trauma registries are evolving rapidly as a result of a renewed focus on trauma care evaluation and recent advances in microcomputer technology. In theory, trauma registries can serve as the principal tool for the systematic audit of the quality of patient care provided by a hospital or a trauma system and as a potential source of part of the data needed for injury surveillance. In practice, however, there is a tendency to underestimate the resources needed to initiate and maintain a registry. Herein, we describe the purposes, resource requirements, and limitations of trauma registries. We conclude that standardization of case criteria, core data content, data definitions, and coding conventions can enhance the utility of trauma registries. (<i>JAMA</i>. 1989;262:2280-2283)
ALK Mutations Conferring Differential Resistance to Structurally Diverse ALK Inhibitors
Authors: Johannes M. Heuckmann, Michael Hölzel, Martin L. Sos, Stefanie Heynck, Hyatt Balke-Want, Mirjam Koker, Martin Peifer, Jonathan Weiss, Christine M. Lovly, Christian Grütter, Daniel Rauh, William Pao, Roman K. Thomas
Journal: Clinical Cancer Research (2011)

Abstract Purpose: EML4–ALK fusions define a subset of lung cancers that can be effectively treated with anaplastic lymphoma kinase (ALK) inhibitors. Unfortunately, the duration of response is heterogeneous and acquired resistance limits their ultimate efficacy. Thus, a better understanding of resistance mechanisms will help to enhance tumor control in EML4–ALK-positive tumors. Experimental Design: By applying orthogonal functional mutagenesis screening approaches, we screened for mutations inducing resistance to the aminopyridine PF02341066 (crizotinib) and/or the diaminopyrimidine TAE684. Results: Here, we show that the resistance mutation, L1196M, as well as other crizotinib resistance mutations (F1174L and G1269S), are highly sensitive to the structurally unrelated ALK inhibitor TAE684. In addition, we identified two novel EML4–ALK resistance mutations (L1198P and D1203N), which unlike previously reported mutations, induced resistance to both ALK inhibitors. An independent resistance screen in ALK-mutant neuroblastoma cells yielded the same L1198P resistance mutation but defined two additional mutations conferring resistance to TAE684 but not to PF02341066. Conclusions: Our results show that different ALK resistance mutations as well as different ALK inhibitors impact the therapeutic efficacy in the setting of EML4–ALK fusions and ALK mutations. Clin Cancer Res; 17(23); 7394–401. ©2011 AACR.
Characteristics of conduction of premature impulses during acute myocardial ischemia and reperfusion: a comparison of epicardial and endocardial activation.
Authors: H Hamamoto, T Peter, W J Mandel
Journal: Circulation (1981)

The epicardial and endocardial conduction of premature impulses were studied during acute myocardial ischemia and reperfusion.The left anterior descending artery was ligated below the second diagonal branch and 30 minutes later, below the first diagonal branch; the second ligation was released 30 minutes later.Five transmural electrode needles were introduced into the anterior wal of the left ventricle, each with an epicardial, endocardial and a midwall bipole.During fixed atrial pacing, premature stimuli were delivered at the midwall at each needle site in series.Conduction times were defined as the interval between the premature pacing artifact and the first high-frequency deflection in the epicardial and in the endocardial electrograms.Thus, myocardial conduction was assessed in myocardial segments representing normal, ischemic and reperfused myocardium and their borders.In the normal myocardium, epicardial conduction was slower than endocardial conduction.Ischemia slowed conduction transmurally; however, the epicardial conduction was consistently slower than endocardial conduction.Ischemia-induced changes in conduction differed con- siderably, depending on the proximity of the ischemic segment to normal or ischemic or reperfused myocardium.Reperfusion returned these changes toward normal; however, the rate of recovery was slower than the rate of depression of conduction seen with the onset of ischemia.Borders between ischemic segments of different duration showed significant disparity between epicardial and endocardial conduction.We concluded that there is significant disparity between epicardial and endocardial conduction of premature impulses in the normal myocardium, but more importantly, during ischemia.These observations are relevant in view of the re- cent interest in mapping of ventricular arrhythmias for surgical ablation of reentrant circuits.
Regulation by adrenal corticosteroids of sodium and potassium transport in loop of Henle and distal tubule of rat kidney.
Authors: B A Stanton
Journal: Journal of Clinical Investigation (1986)

Studies were conducted to examine the effects of adrenalectomy (ADX) and selective, physiological adrenal corticosteroid replacement on sodium and potassium transport by the superficial loop of Henle and distal tubule of rat kidney in vivo. In the loop of Henle, ADX inhibited sodium reabsorption by 33%. Whereas dexamethasone had no effect on reabsorption, aldosterone increased sodium transport to control levels. Thus, physiological levels of mineralocorticoids, but not glucocorticoids, control a fraction of sodium reabsorption in the loop of Henle. ADX also inhibited potassium reabsorption in the loop of Henle. Both dexamethasone and aldosterone reversed the inhibition, although only aldosterone increased reabsorption to control levels. In the distal tubule, ADX reduced sodium reabsorption by 44%. Both aldosterone and dexamethasone stimulated reabsorption: however, only aldosterone increased transport to control. Potassium secretion by the distal tubule was also reduced 34% by ADX. Aldosterone, but not dexamethasone, stimulated secretion. Thus, physiological levels of aldosterone regulate a fraction of sodium reabsorption and potassium secretion in the distal tubule.
SERUM PROSTATIC ACID PHOSPHATASE (PAP) AND PROSTATIC SPECIFIC ANTIGEN (PSA) FOR DETECTION AND MONITORING RECURRENT PROSTATE CANCER
Authors: L. R. Witherspoon, J. C. Winters, S. E. Shuler, H. A. Fuselier, H. Neely, R. Sonnemaker
Journal: Clinical Nuclear Medicine (1991)

Witherspoon, L. R.; Winters, J. C.; Shuler, S. E.; Fuselier, H. A.; Neely, H.; Sonnemaker, R. Author Information
Newly licensed drugs
Authors: R E Ferner
Journal: BMJ (1996)

The Medicines Act 1968 set up a licensing authority that grants a marketing authorisation (product licence) for a medicinal product only if it is effective and safe and of good quality. Once licensed, a drug can usually be prescribed by any doctor under the NHS. But general use of a newly licensed drug may be undesirable.

Firstly, the licensing process cannot define uncommon adverse effects. It is easier to measure common therapeutic benefits than rare, but important, reactions. The numerical problem is daunting. If n patients have been treated, and none has suffered a particular adverse effect, then we can be 95% sure that the true incidence of that adverse effect is between 0/n and 3/n.1 Licensing decisions are based on trials involving on average around 1500 patients,2 so at the time of licensing, a serious reaction that affects as many as 1 in 500 patients could be undetected, and undetectable. Britain's Committee on Safety of Medicines asks for “yellow card” reports of any reactions to newly licensed medicines, marked with an inverted black triangle. A post marketing surveillance scheme, which monitors prescriptions and adverse events, exists only in general practice. Both schemes rely on the good will of prescribers rather …
Long-term effects of angiotensin-converting enzyme inhibition and metabolic control in hypertensive type 2 diabetic patients
Authors: Juliana C.N. Chan, Gary T.C. Ko, Denis H.Y. Leung, Robert C.K. Cheung, Margaret Y.F. Cheung, Wing-Yee So, Ramasmyiyer Swaminathan, M. Gary Nicholls, Julian A.J.H. Critchley, Clive S. Cockram
Journal: Kidney International (2000)
Normative benchmarks are useful for studying individual differences in reasoning
Authors: Edward J. N. Stupple, Linden J. Ball
Journal: Behavioral and Brain Sciences (2011)

Abstract We applaud many aspects of Elqayam &amp; Evans' (E&amp;E's) call for a descriptivist research programme in studying reasoning. Nevertheless, we contend that normative benchmarks are vital for understanding individual differences in performance. We argue that the presence of normative responses to particular problems by certain individuals should inspire researchers to look for converging evidence for analytic processing that may have a normative basis.