tbuckley/cabot-search huggingface dataset:
NHS Direct did not emerge from an evidence free void
Authors: Geoff H Royston
Journal: BMJ (2006)

EDITOR—The claim by McDonnell et al, that the implementation of NHS Direct ran ahead of the evidence has little basis.1

Preceding the observational study cited by McDonnell et al, a wide range of evidence existed about the successful operation of similar services both in the United Kingdom and internationally.2 3 There was also survey evidence of strong public demand for such services, plus additional design and evaluative work.4

The observational …
Supporting High-Value Part D Medicare Choices for Low-Income Beneficiaries
Authors: Karen L. Margolis
Journal: JAMA Internal Medicine (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Psoriatic lesions in patients with chronic liver disease are distinct from psoriasis vulgaris lesions, as judged on basis of integrin adhesion receptors
Authors: Gianluigi Giannelli, Paola Savoia, Oronzo Schiraldi, Mario Lospalluti, Michele De Luca, Pier Carlo Marchisio, Vito Quaranta
Journal: Hepatology (1994)

Psoriatic lesions are relatively frequent in patients with chronic liver disease. Furthermore, therapy with interferons tends to exacerbate the symptoms. The pathogenesis of psoriatic lesions is unclear. An important question is whether such lesions may be linked to the underlying chronic liver disease in these patients, or whether they are incidental manifestations of psoriasis vulgaris. We collected biopsy specimens from involved and uninvolved skin areas of chronic liver disease patients with psoriatic manifestations, as well as from psoriasis vulgaris patients, and investigated the patterns of integrin adhesion receptors by means of immunohistochemical methods. Integrin expression is known to be characteristically altered in psoriasis vulgaris. We found some of these changes in chronic liver disease psoriatic lesions-namely pericellular redistribution and suprabasal expression of the basement membrane receptor alpha 6 beta 4 and of the intercellular integrins alpha 2 beta 1 and alpha 3 beta 1. However, psoriasis vulgaris causes two other typical changes: One is the induction of the prototype fibronectin receptor alpha 5 beta 1, and the other is the alteration of integrin expression in areas of the epidermis that are macroscopically normal. These two changes were not found in chronic liver disease psoriasis biopsy specimens in 14 patients investigated. Thus integrin expression may be useful in differentiating chronic liver disease psoriatic lesions from psoriasis vulgaris lesions. Even though the two types of lesions are indistinguishable on inspection or by their histological features, they may be caused by distinct pathogenetic mechanisms. It remains to be seen whether the underlying chronic liver disease has a role, albeit indirect, in such mechanisms.
Effect of quinidine on plasma concentration of digoxin.
Authors: P M Hooymans, F W Merkus
Journal: BMJ (1978)

Menstrual problems in women starting or changing pill No(% Regimen No of complaining women of menstrual problems Women first starting pill (on lst day of cycle) 228 47 (21) Women changing pill: Starting new pill on 1st day of cycle 125 23 (18) Starting new pill immediately 214 31 (15) Total 567 101 (18)clinic for their three-monthly appointment and about whom, therefore, we have no informa- tion.The table summarises the results for the remaining 567 women, none of whom became pregnant.Of the 101 women complaining of menstrual problems, 82 had spotting or breakthrough bleeding, 10 had amenorrhoea, and 9 had heavy periods.Although we did not include a control group in our study, the rate ofreporting of menstrual problems (18%) is not abnormally high in comparison with the rates reported during the first cycle of use of low-dose contraceptives in other investigations.2-4Seventeen doctors using the new regimens were asked their opinion of them; 15 thought they worked well, particularly the "immediate change-over" regimen.It was found to be easier to persuade patients to switch to lower- dose pills if extra precautions were not needed.Patients liked the new regimens and were not upset by spotting or breakthrough bleeding.Since an average supply of sheaths and pessaries for two weeks costs about C1, a saving of £645 was made during the course of the study.Though the manufacturers of pills have expressed their opposition to the new regimens,-' we believe them to be effective, acceptable, and economical.
Interaction between Levodopa and Methyldopa
Authors: F. B. Gibberd, E. Small
Journal: BMJ (1973)

The interaction between methyldopa and levodopa was studied in 18 patients with Parkinsonism. Together they produced a fall in blood pressure in doses which when given alone had no effect or only a slight hypotensive effect. Severe hypotension never occurred. It is reasonable to give methyldopa to hypertensive patients on levodopa but the regimen should be initiated in hospital.
DEVELOPMENT OF THE FACULTY OF BINOCULAR FUSION.
Authors: EDWARD JACKSON
Journal: JAMA (1905)

The fusion faculty, which controls the ocular movements in the interest of binocular vision, is one of the most delicate and exact, yet one of the most constant and rigid co-ordinations that the human being acquires. That it is not commonly possessed at birth seems to be well established by the agreement of all careful observers. That it is normally developed in early childhood, and only during early childhood, is equally certain. Persistent intelligent efforts have failed to give any indication of its acquirement in adult life. I believe it is well established generally before the age of 2 years, and practically always before 6. The earlier age is that of normal development; the later is the limit of delayed or obstructed development, beyond which its appearance or development is impossible. Although development of the fusion faculty occurs after birth, it is, I believe, determined essentially by congenital tendency.
BONY DEFECTS AND FISTULÆ IN THE EXTERNAL MEATUS.
Authors: H. RGRADLE
Journal: JAMA (1901)

The occurrence of artificial communicating passages between the meatus and attic of the middle ear is, on the whole, little referred to in literature; it is mentioned, but not commented upon, in some of the larger text-books. Some illustrations of it are given in Politzer's "Beleuchtungsbilder des Trommelfells," etc. Yet it is not a rare lesion, as I have seen considerably over 20 instances, and can refer now to some 20 complete records. The last 12 cases were found amongst 2000 ear patients. The defect is, usually a fissure of variable size in the external wall of the attic, opening through the upper wall of the meatus above Shrapnell's membrane. In some instances it seemedto be a fistula instead of a complete gap, but it is not always possible to distinguish between two conditions. Small defects are difficult to recognize by sight and may be found only by the use
Patients cope at home after shorter rehabilitation stays but are more likely to die
Authors: Scott Gottlieb
Journal: BMJ (2004)

The time spent by US patients in rehabilitation facilities after illnesses such as stroke or injury is decreasing, but the shorter stays have not affected their function on discharge, a study has found.

Changes in reimbursement have reduced the length of stay for patients receiving inpatient medical rehabilitation. The news from the study, which examined outcomes that included the patients' functional status, whether they were living at home at follow up, and mortality, was not all good, however. The study found that the death rate among patients undergoing inpatient rehabilitation increased by about 4% between 1994 and 2001 ( JAMA 2004; 292:1687-95).

In the study Dr Kenneth Ottenbacher of the University of Texas Medical Branch, Galveston, …
Mortality and Causes of Death in a National Sample of Diabetic Patients in Taiwan: Response to Tseng
Authors: Tsung-Hsueh Lu, Pei-Yuen Hsu, Robert N. Anderson, Chien-Ning Huang
Journal: Diabetes Care (2005)

Tseng’s study (1) indicated that only 19.8% of deaths among Taiwanese diabetic patients had an underlying cause of death attributed to cardiovascular disease (CVD), which was relatively low compared with the U.S. (49.4%) and U.K. (49.1%). One possible explanation was that Taiwanese diabetic patients were less likely to experience CVD than their counterparts in western countries. An Asia Pacific Collaboration cohort study did not support this hypothesis: no discernible differences were found between the hazard ratios for CVD deaths in Asian and Australasian populations (2).

The underlying cause of death is determined by a combination of factors, including both the physician’s …
Primary Treatment of Acquired Aplastic Anemia: Outcomes with Bone Marrow Transplantation and Immunosuppressive Therapy
Authors: Kristine Doney
Journal: Annals of Internal Medicine (1997)

Background: Both immunosuppressive therapy and bone marrow transplantation are accepted treatments for patients with aplastic anemia. Choosing one of these therapies for a given patient depends not only on donor availability but also on such factors as patient age. Objective: To compare survival rates and long-term complications after bone marrow transplantation or immuno-suppressive therapy in patients with acquired aplastic anemia and to identify prognostic factors associated with improved survival. Design: Center-based, retrospective analysis. Setting: Referral center for patients with aplastic anemia. Patients: 395 patients with acquired aplastic anemia. Intervention: Bone marrow transplant from an HLA-identical, related donor or immunosuppressive therapy. Measurements: Kaplan-Meier survival curves, results of log-rank tests, and cumulative incidence curves. Results: Of 168 bone marrow transplant recipients, 89% had sustained engraftment. Forty-six patients developed grade II to IV acute graft-versus-host disease, and 68 developed chronic graft-versus-host disease that required therapy. Of 227 patients who received immunosuppressive therapy, 44% achieved a complete, partial, or minimal response. Fifty-four percent died or had no response to therapy. Actuarial survival at 15 years was 69% for bone marrow transplant recipients and 38% for patients receiving immunosuppressive therapy (P < 0.001). Improved survival was associated with having bone marrow transplantation as primary therapy, being younger, having no transfusion before transplantation, and having a higher absolute neutrophil count. Disease duration, year of therapy, sex, refractoriness to platelet transfusions, and previous treatment with androgens or corticosteroids did not significantly affect survival. Conclusions: Data from this center suggest that bone marrow transplantation may be preferred for younger patients with acquired aplastic anemia who have matched, related donors. Long-term survival is excellent for patients who respond to either form of therapy.
IMMUNOTRANSFUSION IN SCARLET FEVER
Authors: J. E. GORDON
Journal: JAMA (1933)

Present-day scarlet fever in the United States is a relatively mild disease. In certain sections of the world, notably the Balkan countries and northern China, the fatality continues high. In most parts of Europe and in the United States the case fatality rate ranges from one death per hundred reported cases to perhaps three or four among hospital patients. In general, the days no longer exist when from 6 to 10 per cent of cases terminate fatally.  Under present conditions, a further decrease in the number of deaths can seemingly be best accomplished by centering attention on patients who are critically ill. That effort might well reflect more strongly on the general death rate than would refinement in methods applicable to all patients, because so many mild illnesses terminate favorably under any circumstance.  The method of immunotransfusion has been developed with this in view. In certain unusual circumstances it is
The role of hyperparathyroidism, erythropoietin therapy, and CMV infection in the failure of arteriovenous fistula in hemodialysis
Authors: Giuseppe Grandaliano, Annalisa Teutonico, Arcangelo Allegretti, Riccardo Losappio, Andrea Mancini, Loreto Gesualdo, Francesco Paolo Schena, Giovanni Pertosa
Journal: Kidney International (2003)
Abstract 2534: Long-term (up To 6 Years) Results Of Drug-eluting Stents For The Treatment Of Diabetic Patients - Insights From The Drug Eluting Stents In The Real World(desire) Registry
Authors: Adriana Moreira, Amanda Sousa, José Costa, Ricardo Costa, Manuel Cano, Galo Maldonado, Luiz Alberto Mattos, Fausto Feres, Ricardo Pavanello, Enilton Egito, Ieda Liguori, J Eduardo Sousa
Journal: Circulation (2008)

Background: Diabetic patients are traditionally related to higher rates of major adverse cardiac events (MACE) after percutaneous coronary intervention even in the drug-eluting stent (DES) era. We sought to evaluate the impact of diabetes status in the very long-term clinical outcomes after DES implantation in a complex, non-selected diabetic cohort. Methods and Results: Between May/2002 and May/2007, 2,500 patients treated exclusively with DES were consecutively enrolled in the non-randomized, single-center DESIRE Registry. Among them, 1,705 elective patients have completed 6 month-follow-up and were divided into 3 groups according to their Diabetes mellitus status. Primary endpoint was long-term combined MACE and stent thrombosis rate classified according to ARC definitions. Clinical follow-up was obtained at 1, 6 and 12 months and then annually up to 6 years. Mean follow-up time was 2.6±1.2 years and was achieved in 98% of the eligible cohort. Baseline clinical and procedure characteristics as well as late outcomes are displayed in the table . In the multivariate logistic regression analysis, Diabetes mellitus (OR=1.45; 95%Confidence interval-CI 1.00 –2.11) and moderate/severe calcification at lesion site (OR=3.06;95%CI,1.47– 6.34) were independent predictors of MACE . Conclusions: In the DESIRE registry both insulin and non-insulin requiring diabetics carried poorer long-term outcomes (MACE) when compared to non-diabetic patients. Importantly, there was a tendency for higher stent thrombosis among diabetics. However, the type of diabetes (insulin vs. non-insulin) did not seem to impact the prognosis of PCI with DES.
Total Therapy 3 for multiple myeloma: prognostic implications of cumulative dosing and premature discontinuation of VTD maintenance components, bortezomib, thalidomide, and dexamethasone, relevant to all phases of therapy
Authors: Frits van Rhee, Jackie Szymonifka, Elias Anaissie, Bijay Nair, Sarah Waheed, Yazan Alsayed, Nathan Petty, John D. Shaughnessy, Antje Hoering, John Crowley, Bart Barlogie
Journal: Blood (2010)
Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy
Authors: Amanda RA Adegboye, Sigmund A Anderssen, Karsten Froberg, Luis B Sardinha, Berit L Heitmann, Jostein Steene-Johannessen, Elin Kolle, Lars B Andersen
Journal: British Journal of Sports Medicine (2010)

Objective To define the optimal cut-off for low aerobic fitness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents. Design Study of diagnostic accuracy using a cross-sectional database. Setting European Youth Heart Study including Denmark, Portugal, Estonia and Norway. Participants 4500 schoolchildren aged 9 or 15 years. Main Outcome Measure Aerobic fitness was expressed as peak oxygen consumption relative to bodyweight (mlO 2 /min/kg). Results Risk factors included in the composite risk score (mean of z-scores) were systolic blood pressure, triglyceride, total cholesterol/HDL-cholesterol ratio, insulin resistance and sum of four skinfolds. 14.5% of the sample, with a risk score above one SD, were defined as being at risk. Receiver operating characteristic analysis was used to define the optimal cut-off for sex and age-specific distribution. In girls, the optimal cut-offs for identifying individuals at risk were: 37.4 mlO 2 /min/kg (9-year-old) and 33.0 mlO 2 /min/kg (15-year-old). In boys, the optimal cut-offs were 43.6 mlO 2 /min/kg (9-year-old) and 46.0 mlO 2 /min/kg (15-year-old). Specificity (range 79.3–86.4%) was markedly higher than sensitivity (range 29.7–55.6%) for all cut-offs. Positive predictive values ranged from 19% to 41% and negative predictive values ranged from 88% to 90%. The diagnostic accuracy for identifying children at risk, measured by the area under the curve (AUC), was significantly higher than what would be expected by chance (AUC &gt;0.5) for all cut-offs. Conclusions Aerobic fitness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fitness level lower than the suggested cut-points might improve their health.
A Phase II Study of AT-101 (Gossypol) in Chemotherapy-Sensitive Recurrent Extensive-Stage Small Cell Lung Cancer
Authors: Maria Q. Baggstrom, Yingwei Qi, Marianna Koczywas, Athanassios Argiris, Elizabeth A. Johnson, Michael J. Millward, Sara C. Murphy, Charles Erlichman, Charles M. Rudin, Ramaswamy Govindan
Journal: Journal of Thoracic Oncology (2011)
Management of Carcinoma of the Bronchus
Authors: N. C. Oswald
Journal: BMJ (1956)

Twenty-five years ago the management of carcinoma of the bronchus was almost entirely in the hands of physicians and general practitioners. Since then con siderable advances have been made in diagnosis and treatment, but the majority of patients can still be offered no more than palliative medical measures. Physicians have a duty to keep abreast of recent advances because they are largely responsible for the form that treatment shall take. This is illustrated by reviewing some 272 cases seen personally since 1947, of which 166 (61%) came to light as a result of a medical consultation ; these represent a small fraction of the vast number of patients with respiratory symptoms who are referred for routine clinical and radiological examination. The remainder, having already been radiographed, were sent for diag nostic and therapeutic assessment. Clearly, physicians have a very great responsibility in relation to early diag nosis, and this becomes progressively more important as methods of treatment improve. Before considering in detail the place of the physician, it is necessary to give a brief outline of the clinico-pathological background of the disease and the present stage of development of effective surgical and radiotherapeutic measures.
Overexpression of thioredoxin prevents acute hepatitis caused by thioacetamide or lipopolysaccharide in mice
Authors: Hiroaki Okuyama, Hajime Nakamura, Yasuyuki Shimahara, Shinichi Araya, Norifumi Kawada, Yoshio Yamaoka, Yunji Yodoi
Journal: Hepatology (2003)

Thioredoxin (Trx) is a small redox–active protein with antioxidant and antiapoptotic effects. Trx transgenic (Tg) mice are more resistant to cerebral infarction and survive longer than wild–type (WT) C57BL/6 mice. The aim of the present study was to investigate the protective role of Trx in acute hepatitis models. The expression of endogenous Trx was decreased in thioacetamide (TAA)–induced acute hepatitis. TAA (100 μg/g) was injected intraperitoneally in WT and Tg mice. Survival rate after TAA injection was higher in Tg mice than in WT mice. The level of oxidative stress was significantly less in Tg mice than in WT mice, as shown by the protein carbonylation assay and lipid peroxidation assay. Terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick–end labeling (TUNEL)–positive cells were less in Tg mice than in WT mice, which was consistent with DNA laddering assay. Caspase–3 and caspase–9 activities and cytochrome c release were significantly inhibited in Tg mice compared with those in WT mice. In addition, lipopolysaccharide (LPS) plus d–galactosamine (GalN), or anti– Fas antibody (Jo2) were injected. Survival rate after LPS plus GalN injection was much higher in Tg mice than in WT mice. In contrast, there was no difference in survival rate after Jo2 injection between WT and Tg mice. In conclusion, transgene of Trx attenuated TAA– or LPS–induced acute lethal hepatitis. In addition to an antioxidant effect, Trx has the potential to protect acute liver injury via an antiapoptotic effect, which mainly inhibits mitochondria–mediated apoptosis signaling.
Roles of insulin resistance and beta-cell dysfunction in dexamethasone-induced diabetes.
Authors: A Ogawa, J H Johnson, M Ohneda, C T McAllister, L Inman, T Alam, R H Unger
Journal: Journal of Clinical Investigation (1992)

The roles of insulin resistance and beta-cell dysfunction in glucocorticoid-induced diabetes were determined in Wistar and Zucker (fa/fa) rats. All Wistar rats treated with 5 mg/kg per d of dexamethasone for 24 d exhibited increased beta-cell mass and basal and arginine-stimulated insulin secretion, indicating insulin resistance, but only 16% became diabetic. The insulin response to 20 mM glucose was normal in the perfused pancreas of all normoglycemic dexamethasone-treated rats but absent in every diabetic rat. Immunostainable high Km beta-cell transporter, GLUT-2, was present in approximately 100% of beta-cells of normoglycemic rats, but in only 25% of beta cells of diabetic rats. GLUT-2 mRNA was not reduced. All Zucker (fa/fa) rats treated with 0.2-0.4 mg/kg per d of dexamethasone for 24 d became diabetic and glucose-stimulated insulin secretion was absent in all. High Km glucose transport in islets was 50% below nondiabetic controls. Only 25% of beta cells of diabetic rats were GLUT-2-positive compared with approximately 100% in controls. Total pancreatic GLUT-2 mRNA was increased twofold suggesting a posttranscriptional abnormality. We conclude that dexamethasone induces insulin resistance, whether or not it induces hyperglycemia. Whenever hyperglycemia is present, GLUT-2-positive beta cells are reduced, high Km glucose transport into beta cells is attenuated and the insulin response to glucose is absent.
The analysis of the ultraviolet radiation doses required to produce erythemal responses in normal skin
Authors: L.A. MACKENZIE
Journal: British Journal of Dermatology (1983)

When the abnormality of a skin response to sunlight is expressed in terms of a decreased minimum erythemal dose (MED) on photo-testing, it is essential to know the range of response in normal skin. In any homogeneous population, the statistical distribution of the MED is skewed and is not Gaussian (normal), but a Gaussian distribution tan be fitted to the logarithm of the MED. Using established methods of probit analysis, such ‘lognormal’ distributions have been fitted to the observed proportions of erythemal responses to a series of test exposure doses of UV radiation (250–365 nm), thus providing estimates of the average log MED for normal skin, the standard deviations of the distributions and associated confidence limits. These estimates, in arithmetical terms, are available for quantitative comparison with the results of other test exposures on skin which may be abnormal.