tbuckley/cabot-search huggingface dataset:
Certification of the Essential Components of Clinical Competence by the American Board of Internal Medicine
Authors: JOHN A. BENSON
Journal: Annals of Internal Medicine (1986)

Position Paper1 October 1986Certification of the Essential Components of Clinical Competence by the American Board of Internal MedicineJOHN A. BENSON Jr., M.D., O. DAVID TAUNTON, M.D., NICHOLAS E. DAVIES, M.D.JOHN A. BENSON Jr., M.D.Search for more papers by this author, O. DAVID TAUNTON, M.D.Search for more papers by this author, NICHOLAS E. DAVIES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-4-616 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe goal of the American Board of Internal Medicine is to improve the quality of medical care in the United States. It does this by developing standards to ensure that the certified internist possesses the knowledge, skills, and attitudes essential for providing excellent care. Board certification is recognition by peers of a superior level of ability.The Board considers six qualities to be essential for overall clinical competence and, therefore, certification.1. Sound clinical judgment.2. Broad medical knowledge.3. Good diagnostic skills, including history taking and comprehensive physical examinations, and proficiency in performing appropriate technical procedures.4. Personal integrity,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JOHN A. BENSONJr., M.D.; O. DAVID TAUNTON, M.D.; NICHOLAS E. DAVIES, M.D.Affiliations: Portland, Oregon▸These policies were adopted by the Board of Governors, American Board of Internal Medicine, on 3 December 1985, on the recommendation of its Committee on Evaluation of Clinical Competence: Harold J. Fallon, Chairman; Linda L. Blank; Sidney Cohen; Nicholas E. Davies; Elizabeth A. Hopkins; Muriel Houston; Leonard D. Hudson; Robert E. Reisman; Lloyd H. Smith, Jr.; Jay H. Stein; O. David Taunton; John S. Thompson; Gerald E. Thomson; and George D. Webster. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinical skills assessment with standardized patientsClinical Skills Assessment (CSA) in Undergraduate Medical Education in Catalonia, 1995Evaluating internists’ clinical competence 1 October 1986Volume 105, Issue 4Page: 616-617KeywordsHealth care quality ePublished: 1 December 2008 Issue Published: 1 October 1986 Copyright & Permissions©1986 American College of PhysiciansPDF downloadLoading ...
Easing the Suffering Caused by Sickle Cell Disease
Authors: Orah S. Platt
Journal: New England Journal of Medicine (1994)

Pain is such a regular feature of sickle cell anemia that in some African languages the disease is referred to as “a state of suffering.” Biopsies in patients with severe acute bone pain reveal that the underlying lesion is marrow necrosis with infiltration of polymorphonuclear leukocytes.To borrow an analogy from the heart, mild, brief, “anginal” episodes of pain reflect limited ischemia, and more severe episodes reflect infarction and necrosis. Although patients with either myocardial infarction or the severe pain of a sickle cell crisis typically require narcotic analgesia, there is no equivalent of nitroglycerin, thrombolysis, angioplasty, or bypass surgery . . .
Papers show how tobacco companies stopped airline's smoking ban
Authors: A. Tuffs
Journal: BMJ (2008)

The tobacco industry in Germany, working with the popular German daily newspaper Bild , stopped the airline Lufthansa from banning smoking on its domestic flights in the early 1990s, an analysis of internal tobacco industry documents shows.

The tobacco company Philip Morris has had to publish thousands of internal documents on the internet as a consequence of a US court sentence against it in 1998. A paper in a German public health journal has used the documents to shed light on the tobacco industry’s successful lobbying strategies in Germany ( Gesundheitswesen 2008;70:315-24, doi:10.1055/s-2008-1078752).

The documents also show how the German Association of the Cigarette Industry (Verband der Cigarettenindustrie) managed …
Proteinuria, the Podocyte, and Insulin Resistance
Authors: Alessia Fornoni
Journal: New England Journal of Medicine (2010)

Diabetic nephropathy is a chronic progressive disease that affects 20 to 40% of patients with diabetes mellitus. Clinical trials have shown that strict control of hyperglycemia and hypertension can slow the progression of diabetic nephropathy and that insulin resistance correlates with the onset and severity of albuminuria. This correlation has also been found in normotensive persons who do not have diabetes, suggesting that insulin resistance per se may cause albuminuria. On the basis of these observations, Welsh and colleagues1 recently investigated the role of insulin signaling in the kidney and report that podocyte-specific deficiency of insulin receptors leads to a . . .
Effect of argon laser irradiation on rabbit aortic smooth muscle: evidence for endothelium independent contraction and relaxation
Authors: P G. STEG, D. GAL, A. J RONGIONE, S. R DEJESUS, R. H CLARKE, H. J LEVINE, J. M ISNER
Journal: Cardiovascular Research (1988)

To study the effect of argon laser irradiation on vascular smooth muscle reactivity, ring segments of rabbit thoracic aorta were mounted isometrically in Krebs bicarbonate buffer. Laser irradiation was performed via a 200-micron core optical fibre interfaced with an argon ion gas laser. Laser irradiation at powers greater than 1.0 watt (W) (n = 34) produced contraction in each case, regardless of the duration of exposure. Conversely, irradiation at powers less than 0.1 W (n = 41) consistently produced relaxation. When the power employed ranged from 0.1 to 1.0 W (n = 100), the typical response consisted of a combination of low amplitude contraction and relaxation. At each power level, the responses observed were independent of the presence or absence of intact endothelium, assessed functionally by the response to acetylcholine and anatomically by scanning electron microscopy. Recordings of tissue temperature profiles performed during continuous-wave laser irradiation suggest that the findings observed in this study may be explained by a combination of heat induced contraction and light induced relaxation. At powers greater than 1.0 W, heat generated by laser irradiation is predominant, causing contraction. At powers less than 0.1 W, light predominates over heat, causing relaxation. When the power range is intermediate between these values, the heterogeneous response recorded reflects the combination of light and heat. In all cases, contraction and relaxation are endothelium independent.
THE SURGICAL TREATMENT OF CHRONIC GLAUCOMA.
Authors: S. D. RISLEY
Journal: JAMA (1907)

There is probably no form of ocular disease which has excited more interest or which affords, in some of its clinical features, more reasonable opportunity for opposing opinions than chronic glaucoma. Although it is my purpose in this paper to discuss the surgical treatment of the disease, it is, first of all, important that we should entertain a common understanding of the clinical picture had in mind. For a generation there has been no doubt in the minds of experienced surgeons as to the necessity and signal value of iridectomy in the treatment of the inflammatory types of glaucoma. But in so-called chronic, simple, or non-inflammatory glaucoma there has been much diversity of opinion as to the value of surgical interference. It is probable that the adverse views which have been and are still entertained by different surgeons depend, in large measure, on the mental concept entertained by the individual
Angiotensin II causes formation of platelet activating factor in cultured rat mesangial cells.
Authors: R Neuwirth, J A Satriano, S DeCandido, K Clay, D Schlondorff
Journal: Circulation Research (1989)

Angiotensin II may contribute to the progression of renal glomerular diseases. Beneficial effects of converting enzyme inhibition in models of renal disease are, however, not always explicable by hemodynamic consequences of angiotensin II inhibition. Angiotensin increases intracellular calcium in glomerular mesangial cells and activates phospholipase A2, factors required for the formation of the lipid mediator of inflammation platelet activating factor (PAF). We therefore examined whether angiotensin II could stimulate PAF production in cultured rat mesangial cells. During a 15-minute incubation angiotensin II caused formation of PAF in a dose-dependent manner with a threshold around 10(-9) M. In four experiments PAF formation in response to angiotensin II (10(-8) M) occurred within 5 minutes and was 29 +/- 8 pmol PAF/mg protein. The amount of PAF detected then declined to 9 +/- 2 and 13 +/- 3 pmol after 15 and 30 minutes of incubation with angiotensin II. More than 90% of the PAF remained cell-associated. The PAF formation was confirmed by negative ion chemical ionization mode of mass spectrometry. A single species of PAF was detected and identified as hexadecyl PAF. We speculate that part of the detrimental effects of angiotensin II in progressive renal disease may relate to PAF formation. The PAF generated may in turn influence glomerular function, platelets, and eicosanoid synthesis, all factors implicated in renal disease. Furthermore, we speculate that angiotensin II-induced PAF formation may contribute to microvasculature pathology in general.
Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System
Authors: Donna Bergen
Journal: JAMA (1984)

The subject of autonomic dysfunction has come under serious and systematic scrutiny relatively recently, partly owing to the efforts of Sir Roger Bannister, the editor of<i>Autonomic Failure</i>. Far too often, the diagnosis is either ignored on one hand or invoked vaguely on the other to explain a variety of otherwise inexplicable symptoms, particularly in the diabetic or elderly person. Even when the diagnosis of autonomic failure is accurately made, therapeutic maneuvers are limited or sometimes misdirected. With the publication of this book, there is no further excuse for such a state of affairs. This is a wide-ranging, comprehensive review of the causes, presentations, diagnosis, and pathophysiology of disorders of the autonomic nervous system, assembled from 31 contributors around the world. Most chapters are well written. Particularly fine are the practical and readable chapters by D. J. Ewing on bedside tests of autonomic dysfunction, the discussion of autonomic failure in
Development of Lipidoid–siRNA Formulations for Systemic Delivery to the Liver
Authors: Akin Akinc, Michael Goldberg, June Qin, J Robert Dorkin, Christina Gamba-Vitalo, Martin Maier, K Narayanannair Jayaprakash, Muthusamy Jayaraman, Kallanthottathil G Rajeev, Muthiah Manoharan, Victor Koteliansky, Ingo Röhl, Elizaveta S Leshchiner, Robert Langer, Daniel G Anderson
Journal: Molecular Therapy (2009)
Predictive Accuracy of Peanut Specific IgE classes for Corresponding Prick Skin Test and Clinical Reactivity
Authors: K.E. Meyer, L. Arguelles, D.M. Caruso, A. Oest, J.S. Birne, K.E. Schwarz, M. Konopka, R. Kumar, J.A. Pongracic, X. Wang
Journal: Journal of Allergy and Clinical Immunology (2010)
Better education for women would slash child mortality in India, says UN
Authors: A. Gulland
Journal: BMJ (2014)

Lewis rats can be rendered unresponsive to experimental autoimmune encephalomyelitis by immunization with myelin basic protein (MBP), or MBP68–86, the dominant encephalitogenic MBP epitope for this strain, administered in IFA. However, protected rats harbor potentially encephalitogenic T cells, which are maintained in an inactive state. We investigated whether these quiescent effector cells could be activated in vitro. Although these T cells respond poorly to MBP68–86, they proliferate vigorously whether cocultured with MBP68–86 and either IL-2 or IL-12, suggesting that the T cells are in a state of anergy. Moreover, we could activate these anergic T cells with peptide and cytosine-guanine dinucleotide (CpG) oligonucleotide, but not control oligonucleotide, suggesting that products of the innate immune response are capable of activating anergic autoreactive T cells. The activated T cells produced the proinflammatory cytokine, IFN-γ in response to IL-12, and IL-6 was secreted in response to CpG oligonucleotide. IL-6 has been reported to play a role in T cell activation by blocking T regulatory/suppressor (Treg) cell-mediated suppression through a Toll-like receptor-dependent pathway. However, anti-IL-6 mAb did not block CpG activation of the anergized cells. In contrast, anti-TGF-β<sub>1</sub> Ab released the unresponsive T cells from the anergic state in the presence of MBP68–86, whereas TGF-β<sub>1</sub> inhibited proliferation of MBP68–86- plus CpG-activated T cells. Because TGF-β<sub>1</sub> has previously been implicated in Treg activity, this finding is consistent with a role for Treg cells in maintaining autoreactive T cells in the anergic state.
Potentially Lethal Arrhythmias and Driving
Authors: Kevin F. Browne
Journal: Annals of Internal Medicine (1992)

Letters1 May 1992Potentially Lethal Arrhythmias and DrivingKevin F. Browne, MDKevin F. Browne, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-9-776_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors:After reading the article about resumption of driving after ventricular arrhythmia (1), I wrote to the Department of Highway Safety and Motor Vehicles for the state of Florida. I was informed that, in Florida, patients who have a seizure are restricted from driving for 1 year; the cases of patients who have syncopal episodes that are not thought to be related to seizure or to be secondary to arrhythmias are reviewed on an individual basis. The etiology, frequency, and severity of episodes as well as the treatment regimen are taken into consideration. The treating physician's recommendations about...Reference1. Strickberger S, Cantillon C, and Friedman P. When should patients with lethal ventricular arrhythmia resume driving? Ann Intern Med. 1991;115:560-3. LinkGoogle Scholar1. Strickberger S, Cantillon C, and Friedman P. When should patients with lethal ventricular arrhythmia resume driving? Ann Intern Med. 1991;115:560-3. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Kevin F. Browne, MDAffiliations: The Watson Clinic Lakeland, FL 33804-5000 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1992Volume 116, Issue 9Page: 776-776KeywordsArrhythmiaEpileptic seizuresEtiologySafetySyncope ePublished: 1 December 2008 Issue Published: 1 May 1992 PDF downloadLoading ...
Effects of inhibition of nitric oxide formation on basal vasomotion and endothelium-dependent responses of the coronary arteries in awake dogs.
Authors: A Chu, D E Chambers, C C Lin, W D Kuehl, R M Palmer, S Moncada, F R Cobb
Journal: Journal of Clinical Investigation (1991)

The role of nitric oxide in basal vasomotor tone and stimulated endothelium-dependent dilations in the coronary arteries in chronically instrumented awake dogs was studied by examining the consequences of inhibiting endogenous nitric oxide formation with the specific inhibitor of nitric oxide formation, NG-monomethyl-L-arginine (L-NMMA). In four awake dogs, coronary dimension crystals were chronically implanted on the circumflex artery for the measurement of epicardial coronary diameter, and Doppler flow probes were implanted for quantitation of phasic coronary blood flow (vasomotion of distal regulatory resistance vessels). Basal epicardial coronary diameter, acetylcholine-stimulated endothelium-dependent dilation, and flow-induced endothelium-dependent dilation of the epicardial arteries and phasic blood flow were recorded before, and after 5, 15, 50, and 120 mg/kg of L-NMMA. L-NMMA induced a dose-related increase in basal epicardial coronary vasomotor tone. There was an accompanying increase in aortic pressure and a decrease in heart rate. At doses greater than or equal to 50 mg/kg, rest phasic coronary blood flow was also decreased. Left ventricular end-diastolic pressure and contractility were not significantly changed. In contrast, the flow-induced or acetylcholine-stimulated endothelium-dependent responses were attenuated only after infusion of the highest does of L-NMMA (120 mg/kg). The changes in the basal vasomotor tone and acetylcholine-stimulated endothelium-dependent responses returned towards the control states in the presence of L-arginine (660 mg/kg). These data support the view that nitric oxide plays a significant role in modulating basal vasomotion and endothelial-dependent dilation stimulated by acetylcholine or increase in blood flow in epicardial coronary arteries and also influence the regulation of coronary blood flow during physiologic conditions.
Resistance to Chemotherapy: Patient Variability and Cellular Heterogeneity
Authors: David A. Kessler, Robert H. Austin, Herbert Levine
Journal: Cancer Research (2014)

Abstract The issue of resistance to targeted drug therapy is of pressing concern, as it constitutes a major barrier to progress in managing cancer. One important aspect is the role of stochasticity in determining the nature of the patient response. We examine two particular experiments. The first measured the maximal response of melanoma to targeted therapy before the resistance causes the tumor to progress. We analyze the data in the context of a Delbruck–Luria type scheme, wherein the continued growth of preexistent resistant cells are responsible for progression. We show that, aside from a finite fraction of resistant cell-free patients, the maximal response in such a scenario would be quite uniform. To achieve the measured variability, one is necessarily led to assume a wide variation from patient to patient of the sensitive cells' response to the therapy. The second experiment is an in vitro system of multiple myeloma cells. When subject to a spatial gradient of a chemotherapeutic agent, the cells in the middle of the system acquire resistance on a rapid (two-week) timescale. This finding points to the potential important role of cell-to-cell differences, due to differing local environments, in addition to the patient-to-patient differences encountered in the first part. See all articles in this Cancer Research section, “Physics in Cancer Research.” Cancer Res; 74(17); 4663–70. ©2014 AACR.
Giardiasis
Authors: Roy W. Overton
Journal: JAMA (1963)

LEEUWENHOEK is credited with describing<i>Giardia</i>in his stool in 1681.<sup>1</sup>It was redescribed in 1859, placed in the genus<i>Giardia</i>, and called<i>Giardia lamblia</i>in 1915. For many years this organism was considered a harmless invader in humans. Reports have shown, however, that it may cause gastrointestinal and hepatobiliary symptoms. Recently we had the opportunity to treat a patient who had giardiasis of the gastrointestinal tract with no gastrointestinal symptoms. The main sign was intermittent fever of 11 years' duration. Treated with quinacrine hydrochloride (Atabrine), the fever subsided promptly, and the patient has since remained afebrile. In American literature we have found no previous report of a case of giardiasis in which the only sign was fever. <h3>Report of a Case</h3> The patient was a 39-year-old white female whose case was followed from 1950 to 1961 because of recurrent chills and fever. During this time the patient had
Notes of a Case of Erythema Multiforme
Authors: H. E. Spencer
Journal: BMJ (1884)

SptLAr,1884lT -4t r 4(,.' miserable, and the fairest pro~sects, of .-esscompletoly, marred, by.this unfortunate ailment.Ogl the preseni occasion, however: d,slre to confine my remarks to a cau8e of, i4qogtinence of urinew,"]¢l asar as I am aware, has not been oticepd by aiiynrevions writer on.he subject, and which is exemplified by a case still under my care.In this instance, the patient is a young lady, now in her s;ixteeth year, about whom I was first consulted four or five years since.She was then going abroad, and, her ailment being only casually mentioned to me when vi4itng another member of her 'family I merely advised the usual routine treatment-namely, iron with befla- donna, blistering the sacrum, etc. No'benefit whatever followed this.; and, as her family were leaving home, I lost sight of her for some years, when I learned that she had been at first taken to a school in Belgium, where the incontinence of urine became so troublesome to herself and so unpleasant to others, and expksed her to such derision on the part of the other children, that, after a short time, she had to be removed to another school, and thence again to another, with thesame result.Ultimately, she was brought over to London for medical advice, and went the round of several eminent physicians and surgeons.Still the incontinence of urine re- mained uncured.Finally, she was brought back to Dublin, and I again saw her.
Greater exposure to viruses increases risk of heart disease
Authors: S. Gottlieb
Journal: BMJ (2002)

Greater exposure to bacteria and viruses seems to be related to the acceleration of atherosclerosis, the degeneration of the inner lining of the walls of blood vessels in heart disease, and a worse prognosis, the latest research shows. The findings add to growing evidence that inflammation and infection have a key role in the development of heart disease.

The study ( Circulation 2002;105:15-21), led by Dr Christine Espinola-Klein from the Mainz University Clinic, Germany, looked at 572 patients who were admitted to the hospital for cardiac catheterisation. All the patients were tested for antibodies to several bacteria and viruses, including herpes simplex …
Simplified Determination of Arterial Insufficiency
Authors: TRAVIS WINSOR
Journal: Circulation (1951)

Reactive hyperemia following 15 minute arterial occlusion at the ankle was studied in plethysmographic tracings using the venous occlusion technic. The resulting curves present an essentially different pattern in normal subjects and patients with various types of peripheral arterial disease. Several characteristic features can be distinguished, notably the level of highest blood flow after release of arterial occlusion, the time required until the highest blood flow is reached, and the degree of secondary vasoconstriction. Evaluation of these factors permits an estimate of the therapeutic value of lumbar sympathectomy.
Effect of 16,16-dimethyl prostaglandin E2 on the gastric mucosal barrier.
Authors: J P Bolton, M M Cohen
Journal: Gut (1979)

16,16-dimethyl prostaglandin E2 (16DM) can protect the gastric mucosa from injury and yet apparently damages the gastric mucosal barrier. The effect on the gastric mucosal barrier of 16DM (26.2 micromol/l), a dose 50 times the ED50 for inhibition of acid secretion, was investigated in Heidenhain pouches in four dogs by measuring plasma shedding from the pouches after the topical application of histamine (2.7 mmol/l) and ionic fluxes. The results were compared with those using 30% ethanol, a known barrier breaker. The topical application of histamine after three hours9 perfusion with 30% ethanol led to plasma shedding at a rate of 7.5 (+/-2.6) ml/h, which was significantly greater than the rate of 1.2 (+/-1.4) ml/h after three hours9 perfusion with 16DM and of 1.5 (+/-1.7) ml/h in the control group. Ethanol also caused an increase in the flux of H+, Na+, and Cl-, indicating an increase in mucosal permeability, whereas 16DM increased the flux of Na+ and Cl- but not of H+. It is concluded that 16DM does not damage the gastric mucosal barrier but stimulates the secretion of fluid containing Na+ and Cl-.