tbuckley/cabot-search huggingface dataset:
"MOVEMENT OF DIAPHRAGM WITH PATIENT IN LATERAL POSTURE"
Authors: Gerald B. Webb
Journal: JAMA (1924)

<h3>To the Editor:</h3> —InThe Journal, April 19, appears a paper on this subject by Dr. Tasker Howard. It is probable that the author failed to study the movement of the diaphragm on the recumbent side in a sufficient number of cases, and the studies reported were probably not made when the subjects had been in the lateral position for a long time. With Dr. J. A. Sevier, I have carefully studied the questions raised by Howard. In a paper, "The Diaphragmatic Excursion and Mediastinum in Lateral Recumbent Posture," by Drs. Gerald B. Webb and J. A. Sevier (<i>Tr. A. Am. Phys.</i>, 1923;<i>Am. Rev. Tuberc.</i>, March, 1924) the following conclusions were reached: In all subjects studied, the heart and mediastinum become displaced toward the chest wall of the dependent side. In most subjects—but not in all—the diaphragm on the dependent side at first increases its excursion. In all cases
What Can Practitioners Do?
Authors: CHARLES M. EPSTEIN
Journal: Annals of Internal Medicine (1974)

Comments and Correction1 August 1974What Can Practitioners Do?CHARLES M. EPSTEIN, M.D.CHARLES M. EPSTEIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-2-269 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: It was with growing incredulity that I read and reread the February lead article by Sackett and his dozen collaborators (Ann Intern Med80:137-142, 1974), in which general practitioners and nurse practitioners were solemnly compared by their ability to influence "self esteem . . . telephone calls from . . . other individuals . . . interactions with police, the courts, or welfare agencies." To my knowledge, no one has ever before considered that the average physician is instrumental in managing these portions of his patients' lives. I am content with the conclusion that nurse practitioners are...Reference1. THOMAS L: Your very good health. N Engl J Med 287:761-762, 1972 CrossrefMedlineGoogle Scholar1. LEWISRESNICKSCHMIDT CBG: Activities, events and outcomes in ambulatory patient care. N Engl J Med 280: 645-649, 1969 CrossrefMedlineGoogle Scholar2. KATZVIGNOSMOSKOWITZ SPR: Comprehensive outpatient care in rheumatoid arthritis: a controlled study. JAMA 206:1249-1254, 1968 CrossrefMedlineGoogle Scholar3. SPITZERSACKETTSIBLEY WDJ: The Burlington randomized trial of the nurse practitioner. N Engl J Med 290: 251-256, 1974 CrossrefMedlineGoogle Scholar4. RICHARDSSCHMALE AA: Psychosocial conferences in medical oncology: role in a training program. Ann Intern Med 80:541-545, 1974 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: CHARLES M. EPSTEIN, M.D.Affiliations: Department of Medicine Grady Memorial Hospital Atlanta, Georgia 30303 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 August 1974Volume 81, Issue 2Page: 269-270KeywordsNurses ePublished: 1 December 2008 Issue Published: 1 August 1974 PDF downloadLoading ...
Suppression of hemostatic system activation by oral anticoagulants in the blood of patients with thrombotic diatheses.
Authors: E M Conway, K A Bauer, S Barzegar, R D Rosenberg
Journal: Journal of Clinical Investigation (1987)

RIAs for hemostatic system activation were employed to study patients who were anticoagulated with warfarin. The mean prothrombin fragment F1 + 2 concentration in stably anticoagulated individuals without an inherited thrombotic diathesis (mean prothrombin time [PT] ratio [PT of patient/PT of normal plasma pool] = 1.74) was 0.231 nM as compared with a mean plasma F1 + 2 level of 1.68 nM for a nonanticoagulated control group (P less than 0.0001). The initiation of oral anticoagulants in two subjects who did not exhibit protein C deficiency led to a paradoxical increase in F1 + 2 levels during the first day of therapy. We have also shown that a relatively low intensity regimen of warfarin (PT ratio less than 1.2) may reduce elevated concentrations of F1 + 2 into the normal range in patients with a history of recurrent thromboembolism. The mean F1 + 2 level in antithrombin-deficient individuals on warfarin was significantly elevated (mean = 0.714 nM) as compared with that in anticoagulated subjects with protein C deficiency (mean = 0.205 nM) or in those without an inherited thrombotic disorder (P less than 0.01) at equivalent levels of intensity of oral anticoagulation. We therefore conclude that the effect of warfarin on hemostatic system activation is modulated by the endogenous heparan sulfate-antithrombin mechanism.
A Less Toxic Fluorouracil Dosage Schedule
Authors: Fred J. Ansfield
Journal: JAMA (1964)

THE DRUG 5-fluorouracil (5-FU) was first synthesized by Heidelberger and associates<sup>1</sup>and has had extensive experimental studies and clinical trials during the past several years.<sup>2</sup>There has been almost universal agreement by many investigators<sup>2</sup>that it is a useful drug in a variety of disseminated cancers. Our report<sup>3</sup>of our first five years of clinical experience in 1,091 patients given this drug indicated that 22 deaths were directly attributable to drug toxicity. An additional ten deaths with equivocal evidence of drug toxicity as the cause were included in this group because they occurred within one month following 5-FU therapy. This resulted in a maximum mortality rate of 2.9%. Poor-risk patients received four or less doses of 15 mg/kg per day and average risk patients received five such doses followed by half doses or 7.5 mg/kg every other day until early toxicity appeared. Only the rapid injection
Patient commentary: What I need to self manage my care
Authors: Alex Silverstein
Journal: BMJ (2015)

International Diabetes Federation' s Young Leaders in Diabetes ProgrammeManaging my health has, and always will be, a partnership.I had type 1 diabetes diagnosed at age 18 months and I am now 27.Along the way my diabetes has been managed in a partnership between family (mainly my mother), friends, school, college, the workplace, the charity sector, health professionals, drug companies (who provide insulin, test strips, etc), the patient community (through peer support and online resources), and, most importantly, me, the person at the centre.
Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects
Authors: A Gupta, J McBeth, G J Macfarlane, R Morriss, C Dickens, D Ray, Y H Chiu, A J Silman
Journal: Annals of the Rheumatic Diseases (2006)

<b>Background:</b> : Tender points are a general measure of distress both in the community and in clinic subjects. It has been suggested that multiple tender points should be regarded as the early stages of somatisation of distress. Similarly, recent evidence suggests that chronic widespread pain (CWP) is one manifestation of the somatisation of distress. <b>Objective:</b> Given that a high tender point count and CWP are clinical hallmarks of the fibromyalgia syndrome, it was hypothesised that in somatising subjects, a high tender point count or a low pain threshold would predict the development of CWP in the future. <b>Methods:</b> In this population-based prospective study, 245 adults aged 25–65 years, free of CWP, were identified on the basis of a detailed questionnaire on pain and a psychosocial questionnaire comprising the Somatic Symptom Checklist and the Illness Behaviour subscale of the Illness Attitude Scales. These subjects took part in a pain threshold examination with a Fischer pressure algometer. Tender point counts were computed by including all areas with a pain threshold &lt;4 kg/cm<sup>2</sup>. Individuals were followed up at 15 months, at which time 231 (93% of subjects still living at their baseline address) provided data on pain status, using the same instruments. <b>Results:</b> At follow-up, 26 (11%) subjects developed new CWP. Although subjects with a low baseline pain threshold were not at increased risk of developing symptoms, a high tender point count, adjusted for age, sex, baseline pain status and other confounding factors, predicted the development of new CWP. <b>Conclusion:</b> Subjects free of CWP are at an increased risk of its development if they have a high tender point count. However, a low-pressure pain threshold does not predict the onset of symptoms. Data from this population-based prospective study suggest that a low pain threshold in subjects with CWP is likely to be a secondary phenomenon as a result of pain or associated distress rather than the antecedent of symptoms.
Human Lymphocyte Subpopulations in Metastatic Neoplasia — Six Years Later
Authors: D. S. Robbins, H. H. Fudenberg
Journal: New England Journal of Medicine (1983)

IN 1977, Yu and associates reported the existence of an inhibitory T lymphocyte in patients with osteogenic sarcoma. This cell type suppressed in vitro tumor-specific cytotoxicity mediated by non-T, non-B, non-monocyte effector cells from the same patients.1 The authors posed two provocative questions based on their finding that three of the four patients in whom suppressor cells were detected had pulmonary metastases at the time: Does the production of inhibitory lymphocytes play a part in oncogenesis? and, Would it be reasonable to treat patients with agents that selectively reduce the numbers of circulating suppressor T cells?In our accompanying editorial, . . .
Adrenal Hemorrhage During Anticoagulant Therapy
Authors: Franklin D. McDonald
Journal: JAMA (1966)

In six cases of adrenal hemorrhage during anticoagulant therapy studied and 25 cases reported in the English literature, the most common symptoms were abdominal and back pain, anorexia, nausea and vomiting. Frequent signs are hypotension, fever, and disturbed sensorium. Helpful laboratory findings are depressed urine corticosteroid levels, elevated total eosinophil count, elevated white blood cell count, reduced serum sodium and chloride levels and elevated serum potassium level. Pathogenetic mechanisms for this syndrome probably include the increased capillary fragility of old age, shock resulting from the primary pathologic process, adrenal vein thrombosis, and adrenal cortical degeneration. Coagulation values outside the therapeutic range are more common than has been suspected in the past. This too may be important in the pathogenesis of this syndrome.
Day surgery facilities in England are underused
Authors: Susan Mayor
Journal: BMJ (2005)

More efficient use of day surgery could reduce pressure on hospital beds and waiting lists in English hospitals, according to a review published this week that showed that nearly half of theatre time allocated for day surgery is not being used. The Healthcare Commission, a body that audits NHS services, assessed the way that day surgery was conducted in 313 NHS day surgery units in England.

The commission found that 45% of the theatre time allocated for day surgery was not being used because of cancelled operations, late starts, and excessive delays …
Opposite gene by environment interactions in Karelia for <i>CD14</i> and <i>CC16</i> single nucleotide polymorphisms and allergy
Authors: G. Zhang, S.‐K. Khoo, T. Laatikainen, P. Pekkarinen, E. Vartiainen, L. Von Hertzen, C. M. Hayden, J. Goldblatt, M. Mäkelä, T. Haahtela, P. N. Le Souëf
Journal: Allergy (2009)

Background: Finnish Karelians have a higher prevalence of allergic disease than Russian Karelians. As both populations are generally from the same ethnic group, the Karelian population offers a unique opportunity to analyse genetic and allergic disease interactions between ‘Western’ and ‘Eastern’ environments. Objectives: We investigated associations between allergic diseases and CD14 and CC16 polymorphisms in Finnish vs Russian Karelian women. Methods: Adult female Karelians (330 Finnish and 274 Russian) were recruited, examined for a range of symptoms and conditions including rhinitis, itchy rash, asthma and atopy and genotyped for CD14 C‐159T and CC16 A38G. Results: For both CD14 C‐159T and CC16 A38G, the risk allele for atopic phenotypes in Finnish Karelia was the protective allele in Russian Karelia. For CD14 C‐159T, an interactive effect on ever itchy rash ( P interaction = 0.004), itchy rash &lt;12 mo ( P interaction = 0.001) and dry cough at night in the past 12 months (&lt;12 months) ( P interaction = 0.011) was found; the risk allele was C in Russians and T in Finns. For CC16 A38G, an interaction was significant for ever rhinitis ( P interaction = 0.006), rhinitis &lt;12 mo ( P interaction = 0.004), and marginally significant for ever hayfever ( P interaction = 0.07), allergic eye symptoms &lt;12 mo ( P interaction = 0.09); their risk allele was G in Russians and A in Finns. Conclusion: An Eastern vs Western environment appears to exert an effect via opposite alleles on risk of allergic diseases in adult women.
NHS fails to provide care for patient with stroke
Authors: J Warden
Journal: BMJ (1994)

A patient who was severely incapacitated after a stroke has been placed back under NHS care after the health service ombudsman criticised Leeds Health Authority for failing to provide long term care. The ombudsman, Mr William Reid, made the case the subject of a special report because of the wider public interest about the responsibilities of health authorities for such patients and variations in the interpretation of their obligations under the law. His report has gone to the secretary of state for health, Virginia Bottomley, who has to …
BENEFICIAL EFFECT OF PHYSICAL ACTIVITY ON ENDOTHELIAL FUNCTION IN MIDDLE-AGED AND ELDERLY HABITANTS IN AN AREA WITH INCREASED RATES OF LONGEVITY: IKARIA STUDY
Authors: Gerasimos Siasos, Christina Chrysohoou, Evangelos Oikonomou, Dimitris Tousoulis, Marina Zaromitidou, Elias Gialafos, Konstantinos Zisimos, Georgios Marinos, Stamatios Kioufis, Antigoni Miliou, Nikolaos Papageorgiou, Athanasios G. Papavassiliou, Christos Pitsavos, Christodoulos Stefanadis
Journal: Journal of the American College of Cardiology (2012)
Detection of IgE antibody to a radiocontrast medium
Authors: H. Mita, K. Tadokoro, K. Akiyama
Journal: Allergy (1998)

Background Very little is known about the mechanistns underlying adverse reactions to radiocontrast medium. On the basis of the clinical features of the adverse reactions, il has generally been considered that an IgE‐dependent mechanism is not involved in these adverse reactions, and only a few studies have demonstrated the presence of IgE antibody to radiocontrast medium iti patient sera. Methods We assayed for IgE antibody to ioxaglie acid (Hexabrix®), a representative radiocontrast medium, in the sera of patients who had developed adverse reactions to ioxaglie acid. A conjugate was prepared by coupling succinyl ioxaglie acid to human serum albumin. Enzyme immunoassay and radioimmunoassay for the detection of IgE antibody to ioxaglie acid in patient sera were constructed by physical adsorption or by eovalent eoupling of the conjugate on solid supports. Results When the radioactivity or the absorbance exceeding the mean plus 3 SD for normal healthy subjects was regarded as positive, IgE antibody was detected in the sera of 47.1% of the patients who had a past history of adverse reactions to ioxaglie acid and 16.2% of those who had experienced adverse reactions to ioxaglie acid within 24 h before the blood collection, although the IgE antibody levels were low. On the other hand, IgE antibody to ioxaglie acid was not detected in the sera of patients with no history of adverse reaetions to ioxaglie acid. Inhibition experiments revealed the presenee of IgE antibody speeific to ioxaglie acid in the serum defined as positive for IgE antibody to ioxaglie acid. The presenee of IgE antibody to ioxaghe acid did not always eorrelate with the activation of mast eells due t o the occurrence of adverse reaelions to ioxaglie acid. Conclusions A small amount of IgE antibody to ioxaglie acid was detected n i the sera of some patients with a history of adverse reactions to ioxaglie acid, and these adverse reactions may be partly explained by the presence of IgE antibody in the serum of at least some patients.
Ward Rounds: Poems
Authors: Lester S. King
Journal: JAMA (1969)

Only rarely does a physician prove himself to be a gifted poet. Kenneth Dale Beernink, with a slender posthumous volume of verse, has unquestionably joined that select group. He died in his 30th year, not long after finishing his hospital training.  A poet must be involved in what he sees and feels, and in his verse he must share his emotions and insights. A sensitive young physician, serving as a house officer, has an unrivalled opportunity to puzzle over  larger questions in life, questions often having to do with birth, death, suffering, and the meaningfulness of one man's relationship to another. And when the house officer has great poetic talent as well as insight and compassion, there will result a volume of unusual and intense appeal.  Beernink's poems recreate his hospital experiences. During his own [terminal] illness, his patients, he said, reappeared to me and I lived again in
HEMOLYSIS FOLLOWING TRANSFUSION
Authors: PHILIP S. ASTROWE
Journal: JAMA (1922)

The occurrence of isohemolysis without iso-agglutination has not been observed in man. Experimentally, however, Ottenberg and Thalheimer<sup>1</sup>have produced isohemolysis in cats whose serum did not agglutinate. This was done by transfusing blood from one cat to another, whose blood before the transfusion was entirely compatible with that of the first. This has not yet been shown to be true for man. The production of isohemolysins and the iso-agglutinins in human blood by means of transfusion is demonstrated by the following case reports: <h3>Case 1.</h3> —J. H., a girl, aged 18 months, a first child, born of healthy parents, was admitted to the hospital with signs and symptoms indicating a nasopharyngitis and bilateral acute otitis media. Both ear drums were incised, and much pus was evacuated. One week after admission there were signs of involvement of the mastoid process, and it was decided to perform a blood transfusion because
Cryoprecipitate as a Reliable Source of Fibrinogen Replacement
Authors: Paul M. Ness
Journal: JAMA (1979)

The recent withdrawal of commercial fibrinogen from the market makes alternate sources most important. Although it has been previously reported that single-donor cryoprecipitate contains appreciable amounts of fibrinogen, most clinicians need to be reminded of the reliability of cryoprecipitate for replacement of both fibrinogen and factor VIII. We assayed fibrinogen from 88 bags of cryoprecipitate prepared by five different blood banks in California and Oregon; we found that the average bag of cryoprecipitate contains at least 250 mg of fibrinogen depending on the volume of plasma processed. Cryoprecipitate was found to be a poor source of factors II, V, IX, X, XI, and XII.
Detection of Gastric Cancer by Repeat Endoscopy Within a Short Time after Negative Examination
Authors: O. Hosokawa, K. Watanabe, M. Hatorri, K. Douden, H. Hayashi, Y. Kaizaki
Journal: Endoscopy (2001)

Background and Study Aims: Although a large number of patients are examined using endoscopy in order to identify gastric cancer, it is unclear how individuals should be managed after they are not diagnosed as having gastric cancer at the time of their initial examinations. This study was conducted to identify the group at high risk for gastric cancer who should be examined by repeat endoscopy within a short time after obtaining negative results.
Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure
Authors: Christopher O. Phillips, Scott M. Wright, David E. Kern, Ramesh M. Singa, Sasha Shepperd, Haya R. Rubin
Journal: JAMA (2004)

Comprehensive discharge planning plus postdischarge support may reduce readmission rates for older patients with congestive heart failure (CHF).To evaluate the effect of comprehensive discharge planning plus postdischarge support on the rate of readmission in patients with CHF, all-cause mortality, length of stay (LOS), quality of life (QOL), and medical costs.We searched MEDLINE (1966 to October 2003), the Cochrane Clinical Trials Register (all years), Social Science Citation Index (1992 to October 2003), and other databases for studies that described such an intervention and evaluated its effect in patients with CHF. Where possible we also contacted lead investigators and experts in the field.We selected English-language publications of randomized clinical trials that described interventions to modify hospital discharge for older patients with CHF (mean age > or =55 years), delineated clearly defined inpatient and outpatient components, compared efficacy with usual care, and reported readmission as the primary outcome.Two authors independently reviewed each report, assigned quality scores, and extracted data for primary and secondary outcomes in an unblinded standardized manner.Eighteen studies representing data from 8 countries randomized 3304 older inpatients with CHF to comprehensive discharge planning plus postdischarge support or usual care. During a pooled mean observation period of 8 months (range, 3-12 months), fewer intervention patients were readmitted compared with controls (555/1590 vs 741/1714, number needed to treat = 12; relative risk [RR], 0.75; 95% confidence interval [CI], 0.64-0.88). Analysis of studies reporting secondary outcomes found a trend toward lower all-cause mortality for patients assigned to an intervention compared with usual care (RR, 0.87; 95% CI, 0.73-1.03; n = 14 studies), similar initial LOS (mean [SE]: 8.4 [2.5] vs 8.5 [2.2] days, P =.60; n = 10), greater percentage improvement in QOL scores compared with baseline scores (25.7% [95% CI, 11.0%-40.4%] vs 13.5% [95% CI, 5.1%-22.0%]; n = 6, P =.01), and similar or lower charges for medical care per patient per month for the initial hospital stay, administering the intervention, outpatient care, and readmission (-359 dollars [95% CI, -763 dollars to 45 dollars]; n = 4, P =.10 for non-US trials and -536 dollars [95% CI, -956 dollars to -115 dollars]; n = 4, P =.03, for US trials).Comprehensive discharge planning plus postdischarge support for older patients with CHF significantly reduced readmission rates and may improve health outcomes such as survival and QOL without increasing costs.
Cholesterol and strokes
Authors: M. F Oliver
Journal: BMJ (2000)

Strong correlations between plasma lipoprotein concentrations and the risk of stroke have never been clearly established. Unlike coronary heart disease, there is no significant direct relation between an increased risk of stroke and increased plasma total cholesterol or low density lipoprotein (LDL) cholesterol; nor is there an inverse relation with high density lipoprotein (HDL) cholesterol.1 Indeed, an inverse relation exists between total cholesterol concentrations and cerebral haemorrhage.2

The reasons for this weak or absent relation are several. The most compelling is that virtually all coronary heart disease can be ascribed to coronary atheroma, whereas less than half the incidence of stroke is due to large vessel atheroma. Non-atheromatous causes such as cardiac arrhythmias, small cerebral artery disease, and cortical degeneration are responsible for most of the rest. Another is that, in general, coronary deaths occur at a younger age than strokes, so the population with raised plasma lipids and large vessel atheroma, such as carotid artery disease, is …