tbuckley/cabot-search huggingface dataset:
Doctor-patient relationships in chronic illness: insights from forensic psychiatry
Authors: Colin Campbell, Gill McGauley
Journal: BMJ (2005)

Collaborative management of chronic illness is undermined by neglect of emotional and psychological factors in both the patient and doctor 

Chronic diseases are the world's leading cause of death and are projected to increase substantially to become the main cause of disability by 2020.1 In response, a common core of strategies for managing chronic illnesses has been identified that emphasises the importance of collaborative care.2 However, less attention has been given to the effect of managing chronic illness on the doctor and how this manifests in the therapeutic relationship. We draw on our work with patients in a high secure psychiatric hospital to highlight this gap and suggest how it may be addressed in medical education.

Most medical students want to become doctors to heal patients.3 In reality, most will spend much of their time caring for patients for whom no cure is possible. Medicine's success in the pursuit of cure has fundamentally changed the expectations of doctors; medical success has often become equated with cure and medical failure with the absence of effective treatments and resort to palliative care.4 The treatment of chronic disease conflicts so fundamentally with these expectations that it tends to be neglected.

Medical education may contribute to the development of negative attitudes towards people with chronic illness. Studies report medical students' ambivalence towards the management of chronic illnesses, even if these attitudes were absent before medical school, and a trend towards cynical and self protective strategies as training progresses.5 Furthermore, medical students are deterred from choosing specialties that involve managing chronically ill patients.4 This is perhaps unsurprising given that the dominant model of medical education remains disease oriented, hospital based, and intent on cure. This mismatch between the way that medical education is delivered and the reality of medical …
Subcutaneous Facial Emphysema
Authors: Charles J. Wolfe
Journal: JAMA (1963)

<h3>To the Editor:</h3> —We should like to report an unusual case of subcutaneous emphysema of the face and neck in a 75-yr-old man after trauma to the left zygomatic complex and without radiologically proved fracture. The patient fell in the bathtub, hitting the lateral aspect of his left orbital rim. Shortly after the accident he asked for medical aid because of swelling of his left cheek. One of us (C. J. W.) first saw the patient about 3 hr after the accident. He complained of some "stiffness" of the neck and showed a well-defined hematoma of the left side of his face. There was also minimal abrasion in the left temporal area. Streptokinase-streptodornase (Varidase), 5,000 units four times a day, was prescribed. The next morning the patient was seen in the office. He complained of stiffness of the neck and difficulty in swallowing and even breathing. He noticed that when
Progress in Medical Laboratory Technique-4
Authors: John C. Smith
Journal: JAMA (1968)

This new volume on medical laboratory technique is written and published in Great Britain. There are several pages of refreshingly lowpressure advertising in the front that presumably defray some of the purchase price. Rather than a definitive work on any of its subjects, it is a series of 12 articles written by technologists who seem well versed in their subject. This volume and some of the previous ones lean more heavily toward anatomical pathology and histology than one might expect from such a title published in this country. The present volume deals with paraffin techniques, histochemistry of anaerobic dehydrogenases, fungus staining, chromosome studies, and asbestosis studies. Bacteriology is also rather heavily represented with articles on gram-negative rods, newer antibiotics, and fluorescent antibody techniques. The remaining articles are on serology and platelet counting, leaving clinical chemistry surprisingly ignored. The individual articles, however, are well organized and some contain interesting sidelights such
Health and the Family: A Medical-Sociological Analysis
Authors: Gert H. Brieger
Journal: JAMA (1971)

Until fairly recent times only the occasional sociologist or medical man interested in the problems of medicine and society or the institutional or organizational aspects of medicine wrote about them. Medical sociology, as a specialty within sociology, is of recent vintage. In the last few years an increasingly sophisticated and interesting literature has arisen, including some widely read and quoted books, such as those by David Mechanic or Eliot Freidson, for instance. Authors in this field have established a high standard to which any new book may be fairly compared. Viewed in these terms, this book cannot receive very high marks. In 13 essays, some previously published as articles, the editor has attempted to bring together in one book a broad discussion on the interrelationships of "two important institutional structures in American society," namely, health and family. All the authors write clearly, avoiding the all-tooprevalent jargon. Yet they remain, for
The Treatment of Hyperlipidemia
Authors: Robert S. Lees, Dana E. Wilson
Journal: New England Journal of Medicine (1971)

INCREASED concentrations in plasma of certain lipoproteins or of plasma lipids, which indirectly reflect lipoprotein concentration, are associated with an increased risk of atherosclerotic heart and peripheral vascular disease.1 2 3 Risk of heart attack is related to the plasma concentration of low-density or β-lipoproteins (LDL) and, therefore, to the plasma cholesterol concentration, since the cholesterol carried by LDL usually accounts for two thirds or more of the total plasma cholesterol.3 4 5 Coronary disease risk may also be related to the concentration of very-low-density or pre-β-lipoproteins (VLDL), although the correlation is less convincing than that of LDL.1 2 3,6In addition to its association with . . .
Simple rule for calculating normal erythrocyte sedimentation rate.
Authors: A Miller, M Green, D Robinson
Journal: BMJ (1983)

Cochlear hair cells (HCs) are mechanosensory receptors that transduce sound into electrical signals. HC damage in nonmammalian vertebrates induces surrounding supporting cells (SCs) to divide, transdifferentiate and replace lost HCs; however, such spontaneous HC regeneration does not occur in the mammalian cochlea. Here, we acutely ablate the retinoblastoma protein (Rb), a crucial cell cycle regulator, in two subtypes of postmitotic SCs (pillar and Deiters9 cells) using an inducible Cre line, <i>Prox1-CreER<sup>T2</sup></i>. Inactivation of Rb in these SCs results in cell cycle reentry of both pillar and Deiters9 cells, and completion of cell division with an increase in cell number of pillar cells. Interestingly, nuclei of <i>Rb</i><sup>−/−</sup> mitotic pillar and Deiters9 cells migrate toward the HC layer and divide near the epithelial surface in a manner similar to the SCs in the regenerating avian auditory epithelium. In contrast to postmitotic <i>Rb</i><sup>−/−</sup> HCs which abort cell division, postmitotic <i>Rb</i><sup>−/−</sup> pillar cells can proliferate, maintain their SC fate and survive for more than a week. However, no newly formed HCs are detected and SC death followed by HC loss occurs. Our studies accomplish a crucial step toward functional HC regeneration in the mammalian cochlea <i>in vivo</i>, demonstrating the critical role of Rb in maintaining quiescence of postmitotic pillar and Deiters9 cells and highlighting the heterogeneity between these two cell types. Therefore, the combination of transient Rb inactivation and further manipulation of transcription factors (i.e., Atoh1 activation) in SCs may represent an effective therapeutic avenue for HC regeneration in the mammalian cochlea.
Prognostic Value of Circulating Melanoma Cells Detected by Reverse Transcriptase–Polymerase Chain Reaction
Authors: Giuseppe Palmieri, Paolo A. Ascierto, Francesco Perrone, Sabrina M.R. Satriano, Alessandro Ottaiano, Antonio Daponte, Maria Napolitano, Corrado Caracò, Nicola Mozzillo, Maria T. Melucci, Antonio Cossu, Francesco Tanda, Ciro Gallo, Rocco A. Satriano, Giuseppe Castello
Journal: Journal of Clinical Oncology (2003)

Factors that are predictive of prognosis in patients who are diagnosed with malignant melanoma (MM) are widely awaited. Detection of circulating melanoma cells (CMCs) by reverse transcriptase-polymerase chain reaction (RT-PCR) has recently been postulated as a possible negative prognostic factor. Two main questions were addressed: first, whether the presence of CMCs, defined as the patient being positive for any of the three markers, had a prognostic role; and second, what the predictive value of each individual marker was.A consecutive series of 200 melanoma patients observed between January 1997 and December 1997, with stage of disease ranging from I to IV, was analyzed by semiquantitative RT-PCR. Tyrosinase, p97, and MelanA/MART1 were used as markers to CMCs on baseline peripheral blood samples. Progression-free survival (PFS) was used as a unique end point and was described by the product limit method. Multivariable analysis was applied to verify whether the auspicated prognostic value of these markers was independent of the stage of disease, and a subgroup analysis was performed that excluded patients with stage IV disease.Overall, 32% (64 of 200) of patients progressed, and a median PFS of 52 months in the whole series was observed. The presence of CMCs and the markers individually or combined was predictive of prognosis in the univariate analysis but did not provide additional prognostic information to the stage of disease in multivariable models. In the subgroup analysis of stage (ie, I-III subgroup), similar results were observed.Detection of CMCs in peripheral blood samples at the time of MM diagnosis by semiquantitative RT-PCR does not add any significant predictive value to the stage of disease. Thus, this approach should not be used in clinical practice, and further studies are required to determine its usefulness.
History of the American College of Physicians: Executive Perspectives
Authors: Gert H. Brieger
Journal: JAMA (1985)

One of the reasons it has been so difficult to write about medical history of the 20th century is that the incredible amounts of material and the rapidity of developments have made organization difficult. This is all too well illustrated by this very useful compilation of the affairs of the American College of Physicians between 1959 and 1977, the 18-year period of Dr Rosenow's tenure as executive director.  Contained in his 400-page book is a wealth of important material for anyone interested in the activities of one of our most important professional assocations. Here are facts and figures and positions of the College on many issues, trends, and reflections. Because of the sheer amount of material, it is not a book one can easily read through. But in reading it, one may learn much.  Just one example, for instance, concerns the College's response to the pressures for more primary medical
GPs should not sit on CCG boards if they have substantial conflicts of interest, government says
Authors: G. Iacobucci
Journal: BMJ (2013)

GPs should not be on the boards of clinical commissioning groups (CCGs) if they have a financial interest in an organisation that provides or is likely to provide “substantial business” to their group, says new guidance from NHS England.

It also advises CCGs that doctors should not sit on their boards if the doctors have interests that would leave them “unable to make a full and proper contribution to the governing body.”1

NHS England issued the guidance after a recent BMJ investigation found that more than a third …
Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease
Authors: Li Wei, Thomas M. MacDonald, Brian R. Walker
Journal: Annals of Internal Medicine (2004)

Background: Glucocorticoids have adverse systemic effects, including obesity, hypertension, and hyperglycemia, that may predispose to cardiovascular disease. The effect of glucocorticoid use on cardiovascular disease has not been quantified. Objective: To test the hypothesis that users of exogenous glucocorticoids have an increased risk for cardiovascular disease. Design: A cohort study using a record linkage database. Setting: Tayside, Scotland, United Kingdom. Patients: 68 781 glucocorticoid users and 82 202 nonusers without previous hospitalization for cardiovascular disease who were studied between 1993 and 1996. Measurements: The average daily dose of glucocorticoid exposure during follow-up was categorized as low (inhaled, nasal, and topical only), medium (oral, rectal, or parenteral <7.5 mg of prednisolone equivalent), or high (≥7.5 mg of prednisolone equivalent). Poisson regression model, sensitivity analysis, and propensity score methods were used to investigate the asso- ciation between glucocorticoid exposure and cardiovascular outcome. Results: 4383 cardiovascular events occurred in 257 487 person-years of follow-up for a rate of 17.0 (95% CI, 16.5 to 17.5) per 1000 person-years in the comparator group, and 5068 events occurred in 212 287 person-years for a rate of 23.9 (CI, 23.2 to 24.5) per 1000 person-years in the group exposed to glucocorticoids (22.1, 27.2, and 76.5 in low, medium, and high groups, respectively). The absolute risk difference was 6.9 (CI, 6.0 to 7.7) per 1000 person-years (5.1, 10.1, and 59.4, respectively). After adjustment for known covariates, the relative risk for a cardiovascular event in patients receiving high-dose glucocorticoids was 2.56 (CI, 2.18 to 2.99). Limitations: Because the data were observational, residual confounding cannot be excluded. Conclusion: Treatment with high-dose glucocorticoids seemed to be associated with increased risk for cardiovascular disease.
Interferon-γ and tumor necrosis factor-α induce an immunoinhibitory molecule, B7-H1, via nuclear factor-κB activation in blasts in myelodysplastic syndromes
Authors: Asaka Kondo, Taishi Yamashita, Hideto Tamura, Wanhong Zhao, Takashi Tsuji, Masumi Shimizu, Eiji Shinya, Hidemi Takahashi, Koji Tamada, Lieping Chen, Kazuo Dan, Kiyoyuki Ogata
Journal: Blood (2010)
Monitoring Quality of Care-Reply
Authors: Kathleen N. Lohr
Journal: JAMA (1988)

<h3>In Reply.</h3> —Dr Taylor's letter raises an important point regarding the lack of an<i>epidemiology</i>of quality of care for elderly people, although a large number of discrete studies have appeared in the literature. Some years ago, Williamson<sup>1</sup>summarized the literature about quality of care for the general population, as did we.<sup>2</sup> More recently, Siu<sup>3</sup>provided an overview of work that focused on the elderly. That federal policymakers take seriously the real concern about poor quality of care for the elderly is made evident by several activities they now support; these include efforts as diverse as (1) a study that we and our colleagues are now conducting about the quality of care provided to Medicare patients for six conditions in acute-care hospitals across the United States and (2) the second release of hospital-specific mortality data.<sup>4</sup> Specific samples may be instructive; some relate directly to the elderly
Multiple end point procedure to evaluate risk from pesticides.
Authors: G Cantelli-Forti, M Paolini, P Hrelia
Journal: Environmental Health Perspectives (1993)

Because of the potential environmental impact of pesticides and the large population potentially exposed, the effects of chronic exposure to pesticides need to be determined. Mutagenicity studies have been used to identify specific agents as potential carcinogens or other human health hazards. However, short-term tests are only theoretically correlated to carcinogenesis because their end points can measure only the genotoxic potential of chemicals, i.e., their activities as initiating agents in multistep carcinogenesis. The objective of our research presented here is to provide a comprehensive examination of the mechanism of toxicity of a series of pesticides. These are substances for which toxicity, at both the genetic and metabolic level, has not been adequately described. Preliminary results on a broad series of compounds belonging to different biological classes (herbicide, insecticide, fungicide) seem to indicate that pesticides are toxic but are poor initiating agents, as shown by negative or weak positive results on different genetic end points (gene mutations, DNA effects, and chromosome aberrations in vitro and in vivo). Immunochemical and biochemical studies, however, seem to indicate the cocarcinogenic and promoting potential of these chemicals. As an example, the genotoxic and biochemical effects induced by Fenarimol (a fungicide) are discussed. The results reported stress the importance of identifying chemicals that act at different levels of the multistep carcinogenesis process to ascertain the risk associated with exposure.
Identification of pancreatic type I secreted phospholipase A2 in human epidermis and its determination by tape stripping
Authors: J. Mazereeuw-Hautier, D. Redoules, R. Tarroux, M. Charveron, J.P. Salles, M.F. Simon, I. Cerutti, M.F. Assalit, Y. Gall, J.L. Bonafe, H. Chap
Journal: British Journal of Dermatology (2000)

Abstract Phospholipases A2 (PLA2) catalyse the release of fatty acids from the sn-2 position of phospholipids and have been suggested to play a key part in permeability barrier homeostasis. Using a sensitive and versatile fluorometric method, significant PLA2 activity has been detected in both human skin homogenates and tape strippings of stratum corneum. Based on various properties (resistance to heat and sulphuric acid treatment, neutral optimal pH, absolute requirement for millimolar calcium concentrations, inhibition by dithiothreitol and p-bromophenacyl bromide, and resistance to a trifluoromethyl ketone derivative of arachidonic acid, AACOCF3, a specific inhibitor of cytosolic PLA2), this enzyme was characterized as a secretory PLA2 (sPLA2). Immunohistochemistry revealed strong labelling of type I pancreatic sPLA2 at the stratum corneum–stratum granulosum junction, type II sPLA2 being undetectable. An increase in PLA2 activity in tape-stripped material from the deepest level of the stratum corneum was correlated with partial morphological disappearance of type I sPLA2 immunolabelling. Our data thus provide the first convincing evidence that pancreatic sPLA2 is significantly expressed in human epidermis, where it might participate in the accumulation of free fatty acids contributing to the permeability barrier. In addition, our method for determining PLA2 activity in easily available tape strippings should allow further clinical studies aimed to explore possible PLA2 abnormalities in various dermatoses.
Production of infectious hepatitis C virus in tissue culture from a cloned viral genome
Authors: Takaji Wakita, Thomas Pietschmann, Takanobu Kato, Tomoko Date, Michiko Miyamoto, Zijiang Zhao, Krishna Murthy, Anja Habermann, Hans-Georg Kräusslich, Masashi Mizokami, Ralf Bartenschlager, T Jake Liang
Journal: Nature Medicine (2005)
Relational problems are not fully solved by a temporal sequence of statistical learning episodes
Authors: A. Vinter, P. Perruchet
Journal: Behavioral and Brain Sciences (1997)

Clark &amp; Thornton's conception finds an echo in implicit learning research, which shows that subjects may perform adaptively in complex structured situations through the use of simple statistical learning mechanisms. However, the authors fail to draw a distinction between, on the one hand, subjects' representations which emerge from type-1 learning mechanisms, and, on the other, their knowledge of the genuine abstract “recoding function” which defines a type-2 problem.
The leukemogenicity of Hoxa9 depends on alternative splicing
Authors: C R Stadler, N Vegi, M A Mulaw, K E Edmaier, V P S Rawat, A Dolnik, L Bullinger, B Heilmeier, L Quintanilla-Fend, K Spiekermann, W Hiddemann, K Döhner, H Döhner, M Feuring-Buske, C Buske
Journal: Leukemia (2014)
Intracardiac pressure-sound correlates of echographic aortic valve closure.
Authors: S Hirschfeld, J Liebman, G Borkat, C Bormuth
Journal: Circulation (1977)

Echographic aortic valve closure was compared to the dicrotic notch of the aortic pressure and intracardiac A2 to define the exact temporal relationship of the echographic, pressure, and sound parameters of aortic valve closure. Sixteen children, ages 3--20 years, were evaluated by simultaneous aortic valve echograms, micromanometric aortic root pressure tracings, and intracardiac phonocardiograms recorded at paper speeds of 200 mm/sec. Our observations demonstrated that echographic coaptation of the aortic valve leaflets coincides with the trough of the aortic pressure incisura and the onset of A2. The data suggest that A2 is a result of valve closure.
Control of Uric Acid Excretion
Authors: Thomas H. Steele
Journal: New England Journal of Medicine (1971)

SINCE the rate of urate excretion normally approximates 10 per cent of the amount filtered by the glomeruli, it originally seemed appropriate to consider urinary uric acid as filtered urate that had escaped reabsorption. Berliner and his associates showed that the calculated amount of urate "reabsorbed" increased until the plasma urate concentration exceeded 15 mg per 100 ml.1 At higher plasma urate values, urate reabsorption seemed to approach a maximum rate, in a manner similar to glucose titration experiments. In 1950 Praetorius and Kirk described a hypouricemic young man whose uric acid excretion rate was more than 40 per cent . . .
Leaving against Medical Advice
Authors: Viviany R. Taqueti
Journal: New England Journal of Medicine (2007)

It was the first day of my cardiology subinternship, and I was trying to catch details of the 29-year-old patient's complex history. Juan Perez, a heroin addict who had undergone aortic-valve replacement years earlier, had been admitted overnight after presenting to the emergency department with acute onset of fever, chills, anorexia, and malaise; he was thought to have infectious endocarditis and severe aortic insufficiency. He was Puerto Rican and spoke only Spanish, despite having lived in Boston for many years.Mr. Perez quickly became the focus of morning rounds. Through the open door, I glimpsed him half-lying on the hospital . . .