tbuckley/cabot-search huggingface dataset:
Maintenance of Licensure
Authors: Connie Nugent, Kenneth M. Nugent
Journal: Annals of Internal Medicine (2013)

Letters5 February 2013Maintenance of LicensureConnie Nugent, MLS and Kenneth M. Nugent, MDConnie Nugent, MLSFrom Texas Tech University Health Sciences Center, Lubbock, Texas.Search for more papers by this author and Kenneth M. Nugent, MDFrom Texas Tech University Health Sciences Center, Lubbock, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-3-201302050-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Chaudhry and colleagues (1) present a thoughtful analysis of the cognitive processes involved in CME. In brief, they identify 3 components—reflective self-assessment, assessment of knowledge and skills, and performance in practice. Their examples include participation in CME, completion of computer-based simulations, and patient or peer surveys. We suggest modifications that should clarify this process.The first component requires critical self-assessment of clinical skills and knowledge necessary for the physician's current practice. This almost certainly involves more than participation in the usual CME activities and probably requires practice review and relevant testing (in effect, pretests). Based on this ...Reference1. Chaudhry HJ, Talmage LA, Alguire PC, Cain FE, Waters S, Rhyne JA. Maintenance of licensure: supporting a physician's commitment to lifelong learning. Ann Intern Med. 2012;157:287-9. [PMID: 22733035] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Texas Tech University Health Sciences Center, Lubbock, Texas.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMaintenance of Licensure: Supporting a Physician's Commitment to Lifelong Learning Humayun J. Chaudhry , Lance A. Talmage , Patrick C. Alguire , Frances E. Cain , Sandra Waters , and Janelle A. Rhyne Maintenance of Licensure Humayun J. Chaudhry , Lance A. Talmage , and Janelle A. Rhyne Maintenance of Licensure Paul Kempen Maintenance of Licensure Marc S. Frager Maintenance of Licensure James J. Glazier Metrics 5 February 2013Volume 158, Issue 3Page: 220KeywordsConflicts of interestDecision makingHand strengthMedical servicesPatientsPeer reviewProblem solvingSimulation and modeling ePublished: 5 February 2013 Issue Published: 5 February 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Hypertension in the Inner City
Authors: FRANK A. FINNERTY, EDWARD C. MATTIE, FRANCIS A. FINNERTY
Journal: Circulation (1973)

Sixty dropouts from hypertensive clinics were interviewed in depth to determine reasons for noncompliance. Waiting time and a poor doctor-patient relationship were the major reasons given. The average waiting time prior to examination by the doctor was 2.5 hours, and the average waiting time at the pharmacy was 1.8 hours. In contrast the average time spent with the doctor was 7.5 min. The poor doctor-patient relationship deteriorated further since patients were examined by a different physician on each visit. A physician was not essential for compliance, however, since 54% of the patients readily accepted a health aide. In order to enhance compliance our group reorganized its hypertensive clinic using the patients' complaints as guidelines. Operating the clinic with emphasis on a personalized doctor-patient relationship and utilizing a meaningful appointment system has reduced the number of dropouts from 42% in 1966-69 to 8% in 1970-71.
Effects of Chronic Right Ventricular Volume and Pressure Loading on Left Ventricular Performance
Authors: DAVID T. KELLY, HENRY M. SPOTNITZ, G. DAVID BEISER, JOSEPH E. PIERCE, STEPHEN E. EPSTEIN
Journal: Circulation (1971)

The effects of chronic right ventricular (RV) distension on left ventricular (LV) function were assessed in dogs 3 weeks after pressure and volume loading of the RV had been produced by the emplacement of a constricting band around the pulmonary artery and the creation of tricuspid insufficiency. This resulted in ascites, RV hypertrophy and dilatation, an increase in RV end-diastolic pressure (EDP), and a reduction of RV and LV norepinephrine concentrations. Peak LV pressure, wall stress, and dp/dt were measured during isovolumic beats at LVEDP's of 1 to 20 mm Hg, and comparisons at matched EDP's were made among the normal, sham-operated, and RV stressed dogs. Under these circumstances, LV function appeared to be depressed appreciably. The effects of RV volume loading on the pressure-volume curve of the LV in the potassium-arrested heart were assessed in a separate group of dogs. The pressure-volume curve of the LV was shifted so that any given LV volume was associated with a higher LV pressure. Thus, when peak pressure and wall stress were related to LV end-diastolic volume rather than to LVEDP, the relationship did not appear to differ from normal; peak dp/dt and peak V CE , however, remained depressed. This depression may represent a decrease in LV contractility consequent to the chronic RV stress or may reflect alterations in LV geometry. Thus, when the RV is subjected to a chronic flow and pressure load, assessment of LV function may be unreliable when indices of contractility are employed that require measurements of LVEDP.
Hemiparesis in a 36 year old man
Authors: M. V Holmes, A. Mehta, M. Y Morgan
Journal: BMJ (2009)

A 36 year old man presented in May 2006 with sudden onset of left facial droop, together with weakness and numbness affecting his left side. There were no prodromal symptoms and no history of trauma. His Glasgow coma score was 15/15, the left nasolabial fold was partially obliterated, and there was a left sided hemiparesis (Medical Research Council (MRC) grade 4/5) with pronator drift and an extensor plantar reflex. His pulse was 72 beats/min and regular, his blood pressure was 116/71 mm Hg; a non-radiating aortic ejection systolic murmur was heard, but no carotid bruits. The rest of the examination was unremarkable.

His haemoglobin was 228 g/l (reference range 133-170 g/l); his packed cell volume was 0.68% (0.39-0.52%), and his erythrocyte count 6.96×1012/l (4.3-5.6×1012/l); his red cell indices were normal; his white cell count was normal at 5.3×109/l (3.5-11×109/l) but his platelet count was low at 92×109/l (140-400×109/l). His urea and electrolytes were normal; his serum γ glutamyl transpeptidase (GGT) was 81 U/l (9-54 U/l).

After daily venesection for the next five days his haemoglobin was 147 g/l and his platelet count was 152×109/l. His neurological signs resolved by the third day.



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Fig 1  Infarction in the territory of the right middle cerebral artery …
A Latin American perspective of periodontology
Authors: Raúl G. Caffesse
Journal: Periodontology 2000 (2014)

Abstract Periodontal diseases occur worldwide, and Latin American populations are significantly affected by different manifestations of periodontal disease. The interest in periodontics and periodontal therapy first developed in the early 1930s in the southernmost countries of Latin America, and spread, as the years went by, throughout the region. Today, periodontal research is vibrant in Latin America. The aim of this volume of Periodontology 2000 was to present an overview of the periodontal research currently being performed in different countries of Latin America. The epidemiology of periodontal diseases in adults, children and adolescents, and the pathogenesis of such diseases (including microbiological characteristics and risk factors), are discussed. The role of systemic antibiotic therapy and the effect of smoking are discussed in relation to the progression and the treatment of periodontitis. In addition, the benefit of lasers in periodontal therapy is evaluated. Latin American research groups have been active in exploring new venues of regenerative periodontal treatment, addressing the role of cementum proteins, growth factors and oral mesenchymal stem cells in tissue engineering. Finally, basic research to study cancerization is reported.
Selective FLT3 inhibition of FLT3-ITD+ acute myeloid leukaemia resulting in secondary D835Y mutation: a model for emerging clinical resistance patterns
Authors: A S Moore, A Faisal, D Gonzalez de Castro, V Bavetsias, C Sun, B Atrash, M Valenti, A de Haven Brandon, S Avery, D Mair, F Mirabella, J Swansbury, A D J Pearson, P Workman, J Blagg, F I Raynaud, S A Eccles, S Linardopoulos
Journal: Leukemia (2012)
Clinical performance measurement: part 2--avoiding the pitfalls
Authors: M. Goddard, H. T O Davies, D. Dawson, R. Mannion, F. McInnes
Journal: Journal of the Royal Society of Medicine (2002)

In part 1 of this paper we explored what aspects of performance should be measured and how1. The key to success is to maximize the beneficial consequences while minimizing the unwanted side-effects. In this second and concluding part we discuss strategies for avoiding the pitfalls and highlight examples of good practice. In particular, we argue that the success of policies to improve clinical performance will depend critically on the extent to which the top-down, externally imposed, approach is complemented by devolved systems of performance measurement that encourage learning and improvement amongst frontline clinicians.
Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients
Authors: C. Alves, J.M. Nicolás, J.M. Miró, A. Torres, C. Agustì, J. Gonzalez, A. Rañó, N. Benito, A. Moreno, F. Garcìa, J. Millá, J.M. Gatell
Journal: European Respiratory Journal (2001)

The introduction of highly active antiretroviral therapy with protease inhibitors in 1996 has changed the morbidity and mortality of acquired immune deficiency syndrome patients. Therefore, the aetiologies and prognostic factors of human immunodeficiency virus (HIV)-infected patients with life-threatening respiratory failure requiring intensive care unit (ICU) admission need to be reassessed. From 1993 to 1998, we prospectively evaluated 57 HIV patients (mean±sem age 36.5±1.3 yrs) admitted to the ICU showing pulmonary infiltrates and acute respiratory failure. A total of 21 and 30 patients were diagnosed as having Pneumocystis carinii and bacterial pneumonia, respectively, of whom 13 and eight died during their ICU stay (p=0.01). Both groups of patients had similar age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and severity in respiratory failure. The number of cases with bacterial pneumonia admitted to ICU decreased after 1996 (p=0.05). Logistic regression analysis showed that (APACHE) II score &gt;17, serum albumin level &lt;25 g·L −1 , and diagnosis of P. carinii pneumonia were the only factors at entry associated with ICU mortality (p=0.02). Patients with bacterial pneumonia are less frequently admitted to the intensive care unit after the introduction of highly active antiretroviral therapy with protease inhibitors in 1996. Compared to the previous series, it was observed that the few Pneumocystis carinii pneumonia patients that need intensive care still have a bad prognosis.
Targeting Vascular Injury Using Hantavirus-Pseudotyped Lentiviral Vectors
Authors: Zhong Qian, Makalah Haessler, Julio A. Lemos, Jody R. Arsenault, Jennifer E. Aguirre, James R. Gilbert, Russell P. Bowler, Frank Park
Journal: Molecular Therapy (2006)

Restenosis is a pathological condition involving intimal hyperplasia and negative arterial remodeling. Gene therapy vectors have shown modest therapeutic effects, but the level of infectivity has been relatively poor. In the present study we have designed a modified lentiviral vector (LV) pseudotyped with a strain of Hantavirus (HTNV) to improve the transduction efficiency into vascular smooth muscle and endothelial cells in vitro and in vivo. In vivo studies using adult New Zealand White rabbits demonstrated that local delivery of HTNV-pseudotyped LV (2 x 10(7) TU) into balloon-injured carotid arteries led to highly efficient transduction into endothelial and smooth muscle cells more effectively than VSV-G-pseudotyped LV (2 x 10(7) TU) or replication-defective adenoviral vectors (1-1.5 x 10(9) pfu) as determined by beta-gal immunohistochemistry. Overexpression of extracellular superoxide dismutase in balloon-injured carotid arteries 6 weeks after LV administration resulted in a significant reduction (P = 0.0024) of the intima/media ratio (0.18 +/- 0.09; n = 4) compared to vehicle-infused carotid arteries (0.69 +/- 0.08; n = 7). No beta-gal immunostaining was detected in other systemic organs, including the spleen, liver, heart, lung, kidneys, and brain. Moreover, no changes in plasma alanine aminotransferase or aspartate aminotransferase were detected following LV administration. In all, these data show that LV pseudotyped with Hantaviral glycoproteins can be a useful vector for targeting therapeutic genes to the vasculature in vivo.
A SIMPLIFIED CITRATE-DEXTROSE BLOOD PRESERVATIVE
Authors: FRANK E. BARTON
Journal: JAMA (1941)

In the Oct. 14, 1939 issue ofThe Journalthe Transfusion Service of the Massachusetts Memorial Hospitals, Boston, reported on  Use of Placental Blood for Transfusion. 1 This article emphasized among other things the advantage obtained by the addition of dextrose to the preservative. We reported that the addition of dextrose retarded hemolysis from fourteen and four-tenths days to twenty-two and threetenths days. This same paper stated that we were confident a series of blood specimens then being studied would show an even more delayed hemolysis. It is on this series of 250 blood specimens that we are now reporting.  The Rous and Turner 2 solution consisting of dextrose, citrate and blood, as described by Robertson, 3 was efficacious in delaying hemolysis. There were two outstanding disadvantages in their technic: (1) the large amount of preservative that was required; (2) the concentration of sodium citrate in the mixture, which
Increased Platelet Reactivity and Circulating Monocyte-Platelet Aggregates in Patients With Stable Coronary Artery Disease
Authors: Mark I Furman, Stephen E Benoit, Marc R Barnard, C.Robert Valeri, Marie L Borbone, Richard C Becker, Herbert B Hechtman, Alan D Michelson
Journal: Journal of the American College of Cardiology (1998)

Objectives. We sought to examine whether patients with stable coronary artery disease (CAD) have increased platelet reactivity and an enhanced propensity to form monocyte-platelet aggregates. Background. Platelet-dependent thrombosis and leukocyte infiltration into the vessel wall are characteristic cellular events seen in atherosclerosis. Methods. Anticoagulated peripheral venous blood from 19 patients with stable CAD and 19 normal control subjects was incubated with or without various platelet agonists and analyzed by whole blood flow cytometry. Results. Circulating degranulated platelets were increased in patients with CAD compared with control subjects (mean [±SEM] percent P-selectin–positive platelets: 2.1 ± 0.2 vs. 1.5 ± 0.2, p < 0.01) and were more reactive to stimulation with 1 μmol/liter of adenosine diphosphate (ADP) (28.7 ± 3.9 vs. 16.1 ± 2.2, p < 0.01), 1 μmol/liter of ADP/epinephrine (51.4 ± 4.6 vs. 37.5 ± 3.8, p < 0.05) or 5 μmol/liter of thrombin receptor agonist peptide (TRAP) (65.7 ± 6.8 vs. 20.2 ± 5.1, p < 0.01). Patients with stable CAD also had increased circulating monocyte-platelet aggregates compared with control subjects (percent platelet-positive monocytes: 15.3 ± 3.0 vs. 6.3 ± 0.9, p < 0.01). Furthermore, patients with stable CAD formed more monocyte-platelet aggregates than did control subjects when their whole blood was stimulated with 1 μmol/liter of ADP (50.4 ± 4.5 vs. 28.1 ± 5.3, p < 0.01), 1 μmol/liter of ADP/epinephrine (60.7 ± 4.3 vs. 48.0 ± 4.8, p < 0.05) or 5 μmol/liter of TRAP (67.6 ± 5.7 vs. 34.3 ± 7.0, p < 0.01). Conclusions. Patients with stable CAD have circulating activated platelets, circulating monocyte-platelet aggregates, increased platelet reactivity and an increased propensity to form monocyte-platelet aggregates.
Spirometry and Diabetes
Authors: David A. Kaminsky
Journal: Diabetes Care (2004)

The association of reduced lung function and diabetes has been described for many years (1). Although the clinical significance of this association is not known, it is intriguing to think of the lung as another end organ adversely affected by diabetes. It is also interesting to consider that reduced lung function may be present before the clinical recognition of diabetes (2) or insulin resistance (3,4), suggesting that the lung may be involved in the pathogenesis of diabetes.

The issue of lung function and diabetes is addressed in the current study by Davis et al. (5). Taking advantage of an extensive population database in western Australia, this group has conducted the largest prospective longitudinal survey to date of the pulmonary function of a cohort of patients with type 2 diabetes who had no history of lung disease. A total of 125 patients had spirometry measured at baseline and then again 7 years later. The key finding was that the average rate of decline of lung function as measured by forced expiratory volume in 1 s (FEV1) was 71 ml/year compared with an expected decline in healthy nonsmokers of 25–30 ml/year. This change in lung function was similar whether or not smokers were included in the analysis, indicating its independence from smoking status. Although the follow-up group clearly represented healthy survivors, their lung function decline was still greater than expected, which would likely only underestimate the true rate of decline …
Surgical ablation of ventricular tachycardia: improved results with a map-directed regional approach.
Authors: J Krafchek, G M Lawrie, R Roberts, S A Magro, C R Wyndham
Journal: Circulation (1986)

To determine whether a regional approach to surgery for ventricular tachycardia would improve on the results of previously reported methods of endocardial resection, an analysis was performed of our surgical experience over a 5 year period. Of 46 consecutive patients operated on for recurrent sustained ventricular tachycardia or ventricular fibrillation, 39 patients with ischemic heart disease underwent subendocardial resection and/or cryoablation. The mean age of the patients was 61 +/- 8 (SD) years, the mean left ventricular ejection fraction was 32 +/- 11%, and the mean number of ineffective antiarrhythmic drugs was 3.8 +/- 1.2 per patient. In 35 of 39 patients in whom mapping data were obtainable, 56 (86%) tachycardias had earliest sites of activation in the left ventricle and nine (14%) had earliest sites in the right ventricle. Ten patients had 14 tachycardias (21%) mapped to areas outside visible dense scar. Of these 35 patients, 10 underwent localized subendocardial resection and 25 underwent a regional procedure in which all areas activated before the surface QRS during ventricular tachycardia were excised and/or cryoablated. In the operative survivors of electrophysiologically guided surgery, three of eight (38%) patients with the localized and one of 24 (4%) patients who underwent the regional procedure had recurrence of ventricular tachycardia during a follow-up period of 1 to 59 (mean 22 +/- 17) months (p = .04). The favorable outcome of regional surgery was not influenced by the presence of multiple morphologies in 54%, disparate sites of origin in 29%, or inferior wall foci in 46% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Mutations in CCNO result in congenital mucociliary clearance disorder with reduced generation of multiple motile cilia
Authors: Julia Wallmeier, Dalal A Al-Mutairi, Chun-Ting Chen, Niki Tomas Loges, Petra Pennekamp, Tabea Menchen, Lina Ma, Hanan E Shamseldin, Heike Olbrich, Gerard W Dougherty, Claudius Werner, Basel H Alsabah, Gabriele Köhler, Martine Jaspers, Mieke Boon, Matthias Griese, Sabina Schmitt-Grohé, Theodor Zimmermann, Cordula Koerner-Rettberg, Elisabeth Horak, Chris Kintner, Fowzan S Alkuraya, Heymut Omran
Journal: Nature Genetics (2014)
Peer Confrontation Groups: What, Why, and Whether
Authors: WILLIAM W. VAN STONE, ROBERT GILBERT
Journal: American Journal of Psychiatry (1972)

The authors describe a program using the principles and methods of peer confrontation groups—treatment settings for addicts, alcoholics, ex-convicts, etc., in which nontraditional control by the participants is used to try to bring about radical changes in the values and life-style of the members. Their program appears to counteract and contain the severe authority conflicts, dependency, underlying hostility, and profound narcissism associated with certain patients who have character disorders. A preliminary follow-up indicated that about half of those who entered the program had benefited significantly.
Management of co-infection with HIV and TB
Authors: R Colebunders
Journal: BMJ (2002)

About a third of the 36 million people living with HIV worldwide are co-infected with mycobacterium tuberculosis; 70% of those co-infected live in sub-Saharan Africa.1 In developing countries half of people with HIV infection will develop active tuberculosis; in some countries in sub-Saharan Africa more than 70% of patients with active tuberculosis are also HIV seropositive.1 Tuberculosis is the leading cause of death among people with HIV infection, accounting for a third of deaths due to AIDS world wide.2 The introduction of highly active antiretroviral therapy has decreased death and opportunistic infections by 60% to 90% among people living with HIV in affluent countries,3 but in developing countries highly active antiretroviral therapy is available to a tiny minority of those who need it. Today there is a shocking inequality worldwide in the prognosis of HIV and tuberculosis co-infection, and it depends on whether patients or their country have access to highly active antiretroviral therapy.

Many regimens have been proposed for treating latent tuberculosis infection; the preferred option is still isoniazid, recommended for nine months.4 In settings …
A CASE OF ATROPIA POISONING, WITH HIGH TEMPERATURE AND RECOVERY.
Authors: L. L. BEEHLER
Journal: JAMA (1902)

rain water collected from the roof.A few years ago there were four cases of leprosy in British Honduras, at present only one.Anchylostoma was reported for the first time in the colony in 1898.Since that time it has been frequently observed.I was given an opportunity to examine two cases in the Public Hospital.In both instances the disease was characterized clinically by puffiness of the face and pronounced anemia.
A Method for the Detection and Quantification of Impaired Sodium Excretion
Authors: EUGENE BRAUNWALD, WILLIAM H. PLAUTH, ANDREW G. MORROW
Journal: Circulation (1965)

An oral sodium tolerance test was devised to detect and quantify impaired Na excretion in patients with heart failure. Following a 4-day period during which daily Na intake was limited to 10 mEq., 80 mEq. of Na were administered daily for 4 days and 150 mEq. for another 4 days. The total urinary Na excretion during the 8-day test period was determined. Thirteen normal subjects excreted between 550 and 734 mEq. of Na. Of 41 patients with heart disease, 31 excreted subnormal amounts of Na, between 10 and 550 mEq. and only 10 excreted normal quantities. An alternate plan, in which 320 mEq. of Na was administered in 8 days, was also utilized in patients in whom the standard 920-mEq. Na load was considered inadvisable. There was no correlation between the impairment of Na excretion, as estimated by the Na tolerance test, and the etiology of the heart disease, the glomerular filtration rate, or any hemodynamic variable. Patients with marked functional disability excreted less Na than those with few symptoms, and the patients with the most severe impairment of Na excretion all had a history of edema. Striking improvement in Na tolerance followed corrective cardiac operations. The Na tolerance test was found of particular usefulness in the evaluation of patients in whom clinical examination and hemodynamic studies gave no conclusive evidence as to the presence or absence of congestive heart failure.