tbuckley/cabot-search huggingface dataset:
All main political parties' pledges for NHS will prove inadequate, says former chief executive
Authors: G. Iacobucci
Journal: BMJ (2015)

The NHS faces a “substantial financial problem” this year that will require significant upfront investment to maintain current services, the former chief executive of the NHS in England has warned.

David Nicholson, who led the service from 2006 to 2014, said that it would be “helpful” for the NHS if Labour joined the Conservatives and Liberal Democrats in committing to his successor Simon Stevens’s call for an additional £8bn (€11.1bn; $11.8bn) of funding above inflation by 2020.

But he said that the current pledges from all main political parties would prove inadequate …
General Practice in America and Great Britain
Authors: C. M. Fleming
Journal: BMJ (1954)

I paid a short but very profitable visit to Washington, where most of my time was spent with officials of the U.S. Public Health Service.From them I received a great deal of background information which was invalu- able in assessing much of what I saw and heard during my whole visit.I also saw something there of group practice, and learned from an authoritative source about the work of the American Academy of General Practice.The next stage of my journey took me to Cleveland, Ohio, where I was privileged to attend the annual meet- ing of the American College of Physicians.In itself this was a fascinating and instructive experience, but it also proved an enormous saving of time by enabling me to meet teachers from several widely separated American medical schools.From Cleveland I went to the South, where I spent a week in New Orleans and a week in Jackson, Mississippi, and paid a flying visit to Chattanooga, Tennessee.The officials of the two medical schools whom I met in New Orleans took the greatest pains to help me in every possible way, and my visit there was one of the most useful of the whole tour.I was able to see general practitioners at work in urban and suburban practices.Jackson proved a valuable base for visits to rural doc- tors, and the State Health Department took endless trouble to provide information and assistance.Returning to New York, I made short visits to Toronto and Boston.
Postprandial Hypoglycemia
Authors: Fred D. Hofeldt
Journal: JAMA (1975)

HYPOGLYCEMIA enjoys a popular position in the public's eye as a nonspecific medical condition that frequently provides an explanation for the varied symptoms that occur in daily life. Patients with reactive hypoglycemia tend to manifest variations of the neurotic triad with abnormally high Minnesota Multiphasic Personality Inventory scales of hysteria and hypersomatization as part of their personality profile. The magnitude of these complaints may lead a physician to be overzealous in searching for a cause to account for the patient's symptoms. Clinical studies of reactive hypoglycemia have been hampered by its vagueness in definition, and by the remarkably different criteria used in selection of patients. Some investigators use clinical symptoms alone in choosing patients for study, while others include patients who have had blood glucose values below a certain arbitrary limit, whether or not concomitant symptoms of hypoglycemia exist. Very few investigators use objective evidence to verify the pathophysiologic nature
Systemic lupus erythematosus and sickle hemoglobinopathies: A report of two cases and review of the literature
Authors: Emmanuel Katsanis, Elizabeth Hsu, Koon‐Hung Luke, James A. McKee
Journal: American Journal of Hematology (1987)

Abstract Two adolescent black females with sickle cell disease who developed systemic lupus erythematosus (SLE) are presented. The recognition of SLE was delayed because all new symptoms were initially attributed to their underlying sickle cell disease. Nine similar cases have been previously reported. The hypothesis that a deficiency of the alternative complement pathway in some patients with sickle hemoglobinopathies predisposes them toward immune complex disorders was not confirmed in our study. Our first patient had normal and our second increased activity of the alternative pathway of complement activation.
Mitochondrial permeability transition in acetaminophen-induced necrosis and apoptosis of cultured mouse hepatocytes
Authors: Kazuyoshi Kon, Jae-Sung Kim, Hartmut Jaeschke, John J. Lemasters
Journal: Hepatology (2004)

Acetaminophen overdose causes massive hepatic failure via mechanisms involving glutathione depletion, oxidative stress, and mitochondrial dysfunction. The ultimate target of acetaminophen causing cell death remains uncertain, and the role of apoptosis in acetaminophen-induced cell killing is still controversial. Our aim was to evaluate the mitochondrial permeability transition (MPT) as a key factor in acetaminophen-induced necrotic and apoptotic killing of primary cultured mouse hepatocytes. After administration of 10 mmol/L acetaminophen, necrotic killing increased to more than 49% and 74%, respectively, after 6 and 16 hours. MPT inhibitors, cyclosporin A (CsA), and NIM811 temporarily decreased necrotic killing after 6 hours to 26%, but cytoprotection was lost after 16 hours. Confocal microscopy revealed mitochondrial depolarization and inner membrane permeabilization approximately 4.5 hours after acetaminophen administration. CsA delayed these changes, indicative of the MPT, to approximately 11 hours after acetaminophen administration. Apoptosis indicated by nuclear changes, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and caspase-3 activation also increased after acetaminophen administration. Fructose (20 mmol/L, an adenosine triphosphate–generating glycolytic substrate) plus glycine (5 mmol/L, a membrane stabilizing amino acid) prevented nearly all necrotic cell killing but paradoxically increased apoptosis from 37% to 59% after 16 hours. In the presence of fructose plus glycine, CsA decreased apoptosis and delayed but did not prevent the MPT. In conclusion, after acetaminophen a CsA-sensitive MPT occurred after 3 to 6 hours followed by a CsA-insensitive MPT 9 to 16 hours after acetaminophen. The MPT then induces ATP depletion–dependent necrosis or caspase-dependent apoptosis as determined, in part, by ATP availability from glycolysis. (HEPATOLOGY 2004;40:1170–1179.)
Disseminated intravascular coagulation: old disease, new hope
Authors: Cheng Hock Toh, Michael Dennis
Journal: BMJ (2003)

Disseminated intravascular coagulation has long been associated with increased mortality in patients with sepsis. An effective treatment is now available, and the authors of this review describe how improved understanding and earlier diagnosis could lead to targeted treatment and improved prognosis

Although the first clinical observations on disseminated intravascular coagulation (DIC) were reported in the 19th century,1 this condition of widespread and disordered coagulation has probably afflicted mankind for as long as trauma and infection have beset us. Indeed, DIC is generally associated with an adverse outcome by most clinicians, and its acronym has been synonymous with “death is coming.” However, a drug targeted at the coagulopathy of severe sepsis (activated protein C) has now emerged as the first successful treatment for the condition.2 We provide an updated overview of DIC and how its onset may indicate the turning point from which an adaptive response becomes maladaptive and potentially injurious to the host. Precise laboratory definition of this process could provide a therapeutic window in critical illness that may finally deliver an improved outcome.

A systematic search of PubMed with the search term “disseminated intravascular coagulation” and related keywords yielded 10 262 publications, most of which related to pathophysiology and case reports. Owing to a lack of systematic controlled clinical trials, many recommendations are based on expert opinion and consensus driven guidelines rather than a secure evidence base. However, an increasing number of randomised controlled trials studying the diagnosis and management of DIC have been reported in the past five years, and we have incorporated these in the review.

DIC represents a continuum in clinical-pathological severity, characterised by the increasing loss of localisation or compensated control in intravascular activation of coagulation. It has definable phases that characterise patients at risk for increased mortality. The International Society of Thrombosis …
Quinidine and Unidirectional Cation Fluxes in Atria
Authors: RICHARD L. KLEIN, WILLIAM C. HOLLAND, BETTY TINSLEY
Journal: Circulation Research (1960)

The effect of quinidine on unidirectional fluxes of Na and K in isolated rabbit atria has been investigated and correlated with known effects of the drug on the electrical and mechanical properties of the heart. Quinidine caused a rapid inhibition of Na entry, which secondarily depressed K efflux. In addition, the drug depressed membrane permeability to K and caused a marked inhibition of active transport, both of which were relatively slow in onset.
Medicine in Charleston at the Time of the Revolution
Authors: Joseph I. Waring
Journal: JAMA (1976)

Settled670, Charleston could 1 lay no claim to medical distinction until after the first quarter of the 18th century. The usual difficulties of the early period of settlement had been met with moderate success. Among them were numerous unhappy experiences with serious disease of epidemic nature—smallpox, malaria, yellow fever, respiratory tract infection, scarlet fever, diphtheria, and dysentery—to mention the worst offenders. To combat these, the limited talents of a modest number of physicians of doubtful skill were available, although their effectiveness was restricted by the state of medical knowledge of the time. The appointment in 1712 of a health officer to inspect incoming ships did not succeed in protecting the town from imported disease. After the first quarter of the century, Charleston acquired a better quality of practitioners, including some few who displayed a scientific curiosity. Thomas Dale of England, graduate of Leyden, translator of medical treatises, later to be
Effects of Endovascular Radiation From a β-Particle–Emitting Stent in a Porcine Coronary Restenosis Model
Authors: Andrew J. Carter, John R. Laird, Lynn R. Bailey, Timothy G. Hoopes, Andrew Farb, David R. Fischell, Robert E. Fischell, Tim A. Fischell, Renu Virmani
Journal: Circulation (1996)

Background Neointimal formation causes restenosis after intracoronary stent placement. Endovascular radiation delivered via a stent has been shown to reduce neointimal formation after placement in porcine and rabbit iliac arteries. The objective of this study was to evaluate the dose-related effects of a β-particle–emitting radioactive stent in a porcine coronary restenosis model. Methods and Results Thirty-seven swine underwent placement of 35 nonradioactive and 39 β-particle–emitting stents with activity levels of 23.0, 14.0, 6.0, 3.0, 1.0, 0.5, and 0.15 μCi of 32 P. Treatment effect was assessed by histological analysis 28 days after stent placement. Neointimal and medial smooth muscle cell density were inversely related to increasing stent activity. The neointima of the high-activity (3.0- to 23.0-μCi) stents consisted of fibrin, erythrocytes, occasional inflammatory cells, and smooth muscle cells with partial endothelialization of the luminal surface. In the 1.0-μCi stents, the neointima was expanded and consisted of smooth muscle cells and a proteoglycan-rich matrix. The neointima of the low-activity (0.15- and 0.5-μCi) stents was composed of smooth muscle cells and matrix with complete endothelialization of the luminal surface. At low and high stent activities, there was a reduction in neointimal area (low, 1.63±0.67 mm 2 and high, 1.73±0.97 mm 2 versus control, 2.40±0.87 mm 2 ) and percent area stenosis (low, 26±7% and high, 26±12%) compared with control stents (37±12%, P ≤.01). The 1.0-μCi stents, however, had greater neointimal formation (4.67±1.50 mm 2 ) and more luminal narrowing (64±16%) than the control stents ( P &lt;.0001). Conclusions The differential response to the doses of continuous β-particle irradiation used in this experimental model suggests a complex biological interaction of endovascular radiation and vascular repair after stent placement. Further study is required to determine the clinical potential for this therapy to prevent stent restenosis.
P43 Assessing the validity of a home activity monitor in patients with COPD
Authors: C. Rogers, G. Balanos, A. M. Wood
Journal: Thorax (2011)

<h3>Background</h3> Self-reported physical activity equivalent to at least 2 h a week is associated with reduction in the risk of hospital admission and death in COPD.1 However, whether self reported activity is accurate in COPD is uncertain. The gold standard objective measures of physical activity in daily life are direct observation and assessment of energy expenditure by calorimetry or the doubly labelled water method.2 We sought to test the validity of a home activity monitor (Actigraph)—for measurement of physical activity levels by comparing to calorimetry, the 6MWT and an activity questionnaire. <h3>Methods</h3> 20 patients with COPD and five healthy elderly subjects underwent home activity monitoring over a period of 5 days, a 6MWT and were questioned twice regarding activity levels using the modified Baecke questionnaire (MBQ).3 Time spent non-sedentary according to the Actigraph was compared to perceived activity from the MBQ and 6MWT. A sub-group also underwent concurrent measurement of energy expenditure by indirect calorimetry and the Actigraph during a walk at steady state on a treadmill. <h3>Results</h3> Actigraph output is summarised in Abstract P43 table 1. MBQ score did not relate to actual time active in patients (p=0.54), and was less reproducible on retest than in controls. Furthermore when patients were ranked according to activity level by MBQ and Actigraph, it was clear that patients both under and over-estimated their activity level. Actigraph activity levels related well to 6MWT (p=0.04). Accuracy of the Actigraph at measuring energy expenditure, compared to the gold standard of calorimetry, varied with walking speed, such that it was less accurate in those walking slowly. <h3>Conclusions</h3> Patients self reported activity levels are likely to be inaccurate. Home activity monitoring is accurate at measuring exercise capacity, but not at measuring energy expenditure, due to slow speed of movement.
ON THREADWORMS IN THE VERMIFORM APPENDIX
Authors: C. Wilson
Journal: BMJ (1912)

Y-TMBBor-- Other foreign bodies recorded are the following: Pieces of bone, pieces of fish-fin, bristles of a toothbrush, fislhbones, a nail, and parasites-A8caris Iumlbricoides, Oxyziris vermicularis-and a segment of tapeworom.Barniet and Macfie 2 have published a case of gangrenous appendicitis in a hernial sac in which a clove was found pro- truding from the perforation in the appendix.The
Temporal changes in insulin sensitivity following the development of acute liver failure secondary to acetaminophen
Authors: Sarah J. Clark, Fariba Shojaee-Moradie, Premila Croos, Paul T. Seed, Margot A. Umpleby, Julia A. Wendon, John Miell
Journal: Hepatology (2001)

Insulin resistance in chronic liver disease (CLD) is well documented. This study investigated whether similar changes occur in acute liver failure (ALF). Patients with ALF (n = 10) were recruited within 72 hours of their peak prothrombin time (range 42–120 seconds). All patients were ventilated for encephalopathy (grade III-IV). Peripheral and endogenous insulin sensitivity were assessed by a hyperinsulinemic euglycemic clamp (Human Actrapid 1.5 mU/min/kg) with an infusion of d–[6,6– 2 H 2 ] glucose. The clamp was performed on day 0 and then on day 7 and day 14. During the insulin infusion, the mean total peripheral glucose uptake (area under the curve [AUC]) was 1,422 (SD, 1,253), 2,244 (SD, 1,392), and 4,500 (SD, 1,120) μmol/kg on days 0, 7, and 14, respectively. Significant changes occurred from day 0 to 14 (day 14-day 0: 3,078 [95% CI, 1,798 to 4,359]; P = .001) and day 7 to 14 (day 14-day 7: 2,256 [95% CI, 923 to 3,589]; P = .001). No significant difference in endogenous glucose production was demonstrated over time. Mean peripheral insulin sensitivity altered over time, increasing from 0.09 (SD, 0.09) μmol/kg/min/mU/L on day 0 to 0.24 (SD, 0.16) on day 7 and 0.5 (SD, 0.1) on day 14. Significant changes occurred between days 0, 7, and 14 (day 7-day 0: 0.15 [95% CI, 0.04 to 0.26], P = .006; day 14-day 0: 0.4 [95% CI, 0.28 to 0.5], P = .001; day 14-day 7: 0.2 [95% CI, 0.12 to 0.38], P = .001). This study demonstrates that in ALF, impaired peripheral uptake of glucose occurs, peripheral insulin sensitivity being restored at 2 weeks in subjects who survived.
Erythropoietin, but not the correction of anemia alone, protects from chronic kidney allograft injury
Authors: Paola Cassis, Lorenzo Gallon, Ariela Benigni, Marilena Mister, Anna Pezzotta, Samantha Solini, Elena Gagliardini, Daniela Cugini, Mauro Abbate, Sistiana Aiello, Federica Rocchetta, Pierangela Scudeletti, Norberto Perico, Marina Noris, Giuseppe Remuzzi
Journal: Kidney International (2012)
Medicine: A Caring Profession?
Authors: Michael A. LaCombe
Journal: Annals of Internal Medicine (1998)

Letters15 April 1998Medicine: A Caring Profession?Michael A. LaCombe, MDMichael A. LaCombe, MDBridgton, ME 04009Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-8-199804150-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Through the telling of stories, I have had the good fortune to visit more than 40 training programs. Prompted by questions from housestaff at earlier visits, I began to hold private sessions at later visits with housestaff only-faculty excluded-sessions I called “Forbidden Topics,” where nothing discussed leaves the room. We talk about money medical malpractice, and medical marriages.Soon, they tell me what they cannot tell their faculty: of the absolute lack of mentoring, the dearth of role models, the paucity of wise counsel. Reluctantly, they admit to an attitude of patient as onus. They learn that attitude ... Author, Article, and Disclosure InformationAffiliations: Bridgton, ME 04009 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1998Volume 128, Issue 8Page: 698KeywordsEmotions Issue Published: 15 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Integrative molecular profiling of routine clinical prostate cancer specimens
Authors: C.S. Grasso, A.K. Cani, D.H. Hovelson, M.J. Quist, N.J. Douville, V. Yadati, A.M. Amin, P.S. Nelson, B.L. Betz, C-J. Liu, K.E. Knudsen, K.A. Cooney, F.Y. Feng, A.S. McDaniel, S.A. Tomlins
Journal: Annals of Oncology (2015)
How to Perform a Lumbar Puncture
Authors: Jeffrey L. Kaufman
Journal: JAMA (2007)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Cryptogenic Stroke and Patent Foramen Ovale
Authors: Robert G. Holloway, Ralph F. Józefowicz
Journal: Annals of Internal Medicine (2006)

Letters5 September 2006Cryptogenic Stroke and Patent Foramen OvaleRobert G. Holloway Jr., MD, MPH and Ralph F. Józefowicz, MDRobert G. Holloway Jr., MD, MPHFrom University of Rochester School of Medicine, Rochester, NY 14642.Search for more papers by this author and Ralph F. Józefowicz, MDFrom University of Rochester School of Medicine, Rochester, NY 14642.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-5-200609050-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: In our article, we do state that “warfarin therapy is generally not indicated for secondary stroke prevention except for patients with transient ischemic attack or stroke in the setting of persistent or paroxysmal atrial fibrillation and for some patients with a documented hypercoagulable state, left ventricular ejection fraction of 0.3 or less, carotid or vertebral artery dissection, or patent foramen ovale with an atrial septal defect.” We do not make this recommendation for patients with only a patent foramen ovale.The American Academy of Neurology guideline states, “It is possible that the combination of a patent foramen ovale ...Reference1. Messe SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G, et al. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;62:1042-50. [PMID: 15078999] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Robert G. HollowayJr., MD, MPH; Ralph F. Józefowicz, MDAffiliations: From University of Rochester School of Medicine, Rochester, NY 14642.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUpdate in Neurology Robert G. Holloway Jr. and Ralph F. Józefowicz Cryptogenic Stroke and Patent Foramen Ovale Ashok K. Malani and Hussam Ammar Metrics 5 September 2006Volume 145, Issue 5Page: 394KeywordsAneurysmsAtrial fibrillationConflicts of interestIschemic strokeNeurologyStrokeTransient ischemic attacks ePublished: 5 September 2006 Issue Published: 5 September 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...