tbuckley/cabot-search huggingface dataset:
Use of the Plasma Acid Phosphatase Value in the Differentiation of Thrombocytopenic States
Authors: Frank A. Oski, J. Lawrence Naiman, Louis K. Diamond
Journal: New England Journal of Medicine (1963)

THROMBOCYTOPENIA may result from impaired production of platelets, increased destruction of platelets or a combination of these factors. At the present time this etiologic distinction is generally made on the basis of the number and appearance of the megakaryocytes in the bone marrow. Rarely, a more exact classification can be made only after performance of platelet-survival studies.1 Platelets are rich in the enzyme acid phosphatase,2 3 4 5 and therefore their excessive destruction in vivo might lead to elevations in the plasma levels of this enzyme. In a group of patients with thrombocytopenia from a variety of causes the assay of acid phosphatase . . .
Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data
Authors: A. Esmail, C. Roberts
Journal: BMJ (2013)

To determine the difference in failure rates in the postgraduate examination of the Royal College of General Practitioners (MRCGP) by ethnic or national background, and to identify factors associated with pass rates in the clinical skills assessment component of the examination.Analysis of data provided by the Royal College of General Practitioners and the General Medical Council.Cohort of 5095 candidates sitting the applied knowledge test and clinical skills assessment components of the MRCGP examination between November 2010 and November 2012. A further analysis was carried out on 1175 candidates not trained in the United Kingdom, who sat an English language capability test (IELTS) and the Professional and Linguistic Assessment Board (PLAB) examination (as required for full medical registration), controlling for scores on these examinations and relating them to pass rates of the clinical skills assessment.United Kingdom.After controlling for age, sex, and performance in the applied knowledge test, significant differences persisted between white UK graduates and other candidate groups. Black and minority ethnic graduates trained in the UK were more likely to fail the clinical skills assessment at their first attempt than their white UK colleagues (odds ratio 3.536 (95% confidence interval 2.701 to 4.629), P<0.001; failure rate 17% v 4.5%). Black and minority ethnic candidates who trained abroad were also more likely to fail the clinical skills assessment than white UK candidates (14.741 (11.397 to 19.065), P<0.001; 65% v 4.5%). For candidates not trained in the UK, black or minority ethnic candidates were more likely to fail than white candidates, but this difference was no longer significant after controlling for scores in the applied knowledge test, IELTS, and PLAB examinations (adjusted odds ratio 1.580 (95% confidence interval 0.878 to 2.845), P=0.127).Subjective bias due to racial discrimination in the clinical skills assessment may be a cause of failure for UK trained candidates and international medical graduates. The difference between British black and minority ethnic candidates and British white candidates in the pass rates of the clinical skills assessment, despite controlling for prior attainment, suggests that subjective bias could also be a factor. Changes to the clinical skills assessment could improve the perception of the examination as being biased against black and minority ethnic candidates. The difference in training experience and other cultural factors between candidates trained in the UK and abroad could affect outcomes. Consideration should be given to strengthening postgraduate training for international medical graduates.
Screening for Tuberculosis
Authors: Michael E. Fleenor
Journal: JAMA (1995)

<h3>To the Editor.</h3> —Those of us involved in TB control programs at the local level appreciate the implications of the cost-benefit analysis by Dr Mohle-Boetani and colleagues.<sup>1</sup>Conducting more directed screening of childhood-aged subpopulations rather than routine mass screening of children at presumed high risk has become a much needed recommendation and has substantial cost savings to TB programs. We recently conducted a smaller analysis of the effectiveness of and cost to our local TB program in fulfilling the early periodic screening, diagnosis, and treatment (EPSDT) mandate to routinely screen children enrolled in Medicaid in the state of Alabama. During 1993 and 1994, Jefferson County Department of Health pediatric clinics performed 18441 EPSDT tine tests to screen for TB in children between the ages of 1 and 19 years. All patients with positive tine tests were retested by our TB staff using intermediate-strength purified-protein derivative (IPPD) tests. Only one
Critical (Panic) Value Notification: An Established Laboratory Practice Policy (Parameter)
Authors: George D. Lundberg
Journal: JAMA (1990)

A laboratory test begins when a clinician (or patient) asks a question that requires a laboratory result to answer. It ends with an appropriate action being taken on the patient's behalf based on that result. There are at least 11 steps in the performance of that test (Figure). We have called that sequence the brain-to-brain  1 A chain is known to be only as strong as its weakest link. Thus, anything that interferes with the complete closing of this loop for every laboratory test requested produces at the least, a waste, and at the most, a tragedy.  Historically, most laboratory personnel have concentrated on the analytic portion of the loop. However, modern quality assurance requires that laboratory personnel consider all steps, actively participating in preanalytic and postanalytic components.  The critical value reporting system is an early example of this expanded approach. Nearly 20 years ago we organized such a
Optimal Timing of Coronary Invasive Strategy in Non–ST-Segment Elevation Acute Coronary Syndromes
Authors: Eliano P Navarese, Paul A Gurbel, Felicita Andreotti, Udaya Tantry, Young-Hoon Jeong, Marek Kozinski, Thomas Engstrøm, Giuseppe Di Pasquale, Waclaw Kochman, Diego Ardissino, Elvin Kedhi, Gregg W Stone, Jacek Kubica
Journal: Annals of Internal Medicine (2013)

The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.To do the most comprehensive meta-analysis of current evidence on early versus delayed invasive treatment in NSTE-ACS.MEDLINE, PubMed Central, and Google Scholar databases; conference proceedings; ClinicalTrials.gov registry; and Current Controlled Trials registry through May 2012.Available randomized, controlled trials (RCTs) and observational studies comparing early versus delayed intervention in the NSTE-ACS population.Data were extracted for populations, interventions, outcomes, and risk of bias. All-cause mortality was the prespecified primary end point. The longest follow-up available in each study was chosen. The odds ratio with 95% CI was the effect measure.Seven RCTs (5370 patients) and 4 observational studies (77 499 patients) were included. Early intervention was less than 20 hours after hospitalization or randomization for RCTs and 24 hours or less for observational studies. Meta-analysis of the RCTs was inconclusive for a survival benefit associated with the early invasive strategy (odds ratio, 0.83 [95% CI, 0.64 to 1.09]; P = 0.180); a similar result emerged from the observational studies. With early versus late intervention, the odds ratios in the RCTs were 1.15 (CI, 0.65 to 2.01; P = 0.63) and 0.76 (CI, 0.56 to 1.04; P = 0.090) for myocardial infarction and major bleeding during follow-up, respectively.Current evidence from RCTs is limited by the small overall sample size, low numbers of events in some trials, and heterogeneity in the timing of intervention and in patient risk profiles.At present, there is insufficient evidence either in favor of or against an early invasive approach in the NSTE-ACS population. A more definitive RCT is warranted to guide clinical practice.
Finding a doctor: too much of a lottery
Authors: I. Loudon
Journal: BMJ (1989)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Finding a doctor: too much of a lottery Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Strategies for promoting judicious use of antibiotics by doctors and patients
Authors: E. A Belongia, B. Schwartz
Journal: BMJ (1998)

Recent antibiotic use is a well documented risk factor for infection or colonisation with resistant pathogens.1–7 Despite this recognition, unnecessary antibiotic prescribing remains common. In the United States more than a fifth of all antibiotic prescriptions for children and adults are written for upper respiratory tract infections or bronchitis, conditions that are almost always viral. 8 9 Similar rates of unnecessary antibiotic use have been described in Britain.10 These findings are consistent with results from focus groups among doctors, in which participants have estimated that 10% to 50% of outpatient antibiotic prescriptions are unnecessary.11

Only limited data are available to evaluate whether reducing antibiotic prescribing will reduce the spread of resistance. In Finland the proportion of group A streptococcal infections resistant to macrolides was nearly halved after a successful campaign to reduce the use of macrolide antibiotics.12 A cross sectional survey in Iceland found that carriage of penicillin resistant pneumococci was strongly associated with both individual and community-wide levels of antimicrobial use,13 and there is some evidence that an intervention programme has decreased the proportion of pneumococcal infections caused by penicillin resistantstrains.14

#### Summary points

Unnecessary antibiotic use for viral illness is common and has led to increasing rates of antibiotic resistance among Streptococcus pneumoniae and other community acquired pathogens

Factors that contribute to antibiotic overuse include lack of education, patients' expectations, past experience, and economic incentives

Multifaceted interventions are needed to reduce unnecessary antibiotic use; peer education and feedback on doctors' use of antibiotics can promote behaviour change

Educational interventions for the public should include a public relations campaign with simple messages, clinic based patient education, and community outreach activities

Health organisations should develop policies to support judicious antibiotic use and evaluate whether existing policies may unintentionally promote overuse of antibiotics

Achieving more judicious …
Integrin-Mediated Mechanotransduction in Vascular Smooth Muscle Cells
Authors: Marc E. Goldschmidt, Kenneth J. McLeod, W. Robert Taylor
Journal: Circulation Research (2001)

Abstract —Blood vessels are continuously exposed to mechanical forces that lead to adaptive remodeling and atherosclerosis. Although there have been many studies characterizing the responses of vascular cells to mechanical stimuli, the precise mechanical characteristics of the forces applied to cells to elicit these responses are not clear. We designed a magnetic exposure system capable of producing a defined normal force on ferromagnetic beads that are specifically bound to cultured cells coated with extracellular matrix proteins or integrin-specific antibodies. Rat aortic smooth muscle cells were incubated with engineered fibronectin–coated ferromagnetic beads and then exposed to a magnetic field. With activation of extracellular signal–regulated mitogen-activated protein kinase 1/2 (ERK 1/2 MAPK ) used as a prototypical marker for cell responsiveness to mechanical forces, Western blot analysis demonstrated an increase in phosphorylated ERK 1/2 MAPK expression reaching a maximal response of a 3.5-fold increase at a total force of ≈2.5 pN per cell. The peak response occurred after 5 minutes of exposure and slowly decreased to baseline after 30 minutes. A cyclic, rather than static, force was required for this activation, and the frequency-response curve increased ≈2-fold between 0.5 and 2.0 Hz. Vitronectin- and β 3 antibody–coated beads showed a response nearly identical to those coated with engineered fibronectin, whereas forces applied to beads coated with α 2 and β 1 antibodies did not significantly activate ERK 1/2 MAPK . Mechanical activation of the ERK 1/2 MAPK system in rat aortic smooth muscle cells occurs through specific integrin receptors and requires a cyclic force with a magnitude estimated to be in the piconewton range.
PATHOGENESIS OF CONSTRICTIVE PERICARDIUM
Authors: Eli Moschcowitz
Journal: JAMA (1953)

We are well conversant with the clinical and anatomic aspects of the fully developed constrictive pericardium, but, so far as I am aware, no study has been made of the pathogenesis or the clinical phases of the early and intermediate stages. Inasmuch as the course of constrictive pericardium covers many years, the opportunity to observe its development from the beginning to the terminal phase must come but rarely. For the most part, we are forced to reconstruct the pathogenesis by a study of the anatomy and incidence of pericardial adhesions under all conditions. Such a program obviously necessitates an inquiry into the still unsettled cause of constrictive pericardium. With these objects in view, I investigated the autopsy findings and some of the clinical aspects of all the cases of adherent pericardium found at post mortem in the Mount Sinai Hospital during the past 25 years. <h3>DEFINITION</h3> A constrictive pericardium is
Increased tumor necrosis factor-α receptor number in chronic hepatitis B virus infection
Authors: Johnson Y. N. Lau, Nick Sheron, Kayhan T. Nouri-Aria, Graeme J. M. Alexander, Roger Williams
Journal: Hepatology (1991)

Production of the antiviral cytokine, tumor necrosis factor-α is increased in chronic hepatitis B virus infection, and clinical studies of tumor necrosis factor-α have indicated a proviral effect at higher doses. To determine whether this might be related to abnormal cell surface tumor necrosis factor-α receptor expression, binding characteristics of cell surface tumor necrosis factor-α receptor on peripheral blood mononuclear cells in chronic hepatitis B virus carriers were studied using radioiodinated recombinant tumor necrosis factor-α. The specific binding curves generated were analyzed according to the method of Scatchard to determine cell surface receptor numbers and dissociation constants. A single class of cell surface tumor necrosis factor-α receptor was demonstrated on peripheral blood mononuclear cells and mononuclear subsets. The median number (range) of cell surface tumor necrosis factor-α receptors on peripheral blood mononuclear cells from controls (n = 11), chronic hepatitis B virus patients seropositive for hepatitis B virus DNA (n = 8) and seronegative for hepatitis B virus DNA (n = 8) were 2,329 (range = 1,538 to 3,133), 3,375 (range = 2,300 to 6,718) (p &lt; 0.01) and 3,113 (range = 2,229 to 5,246) (p &lt; 0.05) sites/cell, respectively. They all had similar dissociation constants of 8.4 × 10 −10 mol/L (range = 4.1 to 16.9), respectively. Further dissection of the peripheral blood mononuclear cells showed that this increase in cell surface receptor number was confined to the monocyte fraction (p &lt; 0.01). Plasma tumor necrosis factor-α levels in five patients with increased monocyte cell surface tumor necrosis factor-α receptor numbers were also elevated. No correlation between cell surface tumor necrosis factor-α receptor number and serum AST, HBsAg, hepatitis B virus DNA or liver histology was observed. These data indicate that cell surface tumor necrosis factor-α receptor number is increased in monocytes but normal in lymphocytes and support previous observations that monocytes are activated in chronic hepatitis B virus infection. (HEPATOLOGY 1991;14:44-50.)
Medical Management of Advanced Heart Failure
Authors: Anju Nohria
Journal: JAMA (2002)

ContextAdvanced heart failure, defined as persistence of limiting symptoms despite therapy with agents of proven efficacy, accounts for the majority of morbidity and mortality in heart failure.ObjectiveTo review current medical therapy for advanced heart failure.Data SourcesWe searched MEDLINE for all articles containing the term advanced heart failure that were published between 1980 and 2001; EMBASE was searched from 1987-1999, Best Evidence from 1991-1998, and Evidence-Based Medicine from 1995-1999. The Cochrane Library also was searched for critical reviews and meta-analyses of congestive heart failure.Study SelectionRandomized controlled trials of therapy for 150 patients or more were included if advanced heart failure was represented. Other common clinical situations were addressed from smaller trials as available, trials of milder heart failure, consensus guidelines, and both published and personal clinical experience.Data ExtractionData quality was determined by publication in peer-reviewed literature or inclusion in professional society guidelines.Data SynthesisA primary focus for care of advanced heart failure is ongoing identification and treatment of the elevated filling pressures that cause disabling symptoms. While angiotensin-converting enzyme inhibitors and β-adrenergic agents can slow disease progression and prolong survival, titration and tolerability often present challenges. Most patients are not eligible for surgical intervention but do benefit from a medical regimen tailored to individual clinical and hemodynamic profiles and from heart failure management programs that reduce rehospitalization. Survival ranges from 80% at 2 years for patients rendered free of congestion to less than 50% at 6 months for patients with refractory symptoms, in whom end-of-life options may include hospice care and inactivation of implantable defibrillators.ConclusionsCurrent management of advanced heart failure is based more on consensus than on randomized trials. Systematic investigation should address not only new therapies but also strategies for selecting and optimizing therapies already available.
A RAPID AND SIMPLE METHOD OF STAINING SPIROCHÆTA PALLIDA.
Authors: WARD J. MACNEAL
Journal: JAMA (1907)

In a former paper<sup>1</sup>I pointed out that a solution of methylene violet (Bernthsen's), methylene blue and eosin in methyl alcohol makes an excellent stain for blood films, and suggested the use of such a solution for staining<i>Spirochæta pallida</i>. With the very limited number of film preparations then at hand, some fair results were obtained by this method. Recently it has been possible to get a large number of films from a case of primary syphilis and to test more thoroughly this stain. The result has been so good that it seems the method may be of value in diagnosis. The case occurred in the practice of Dr. Simpson, and he has very kindly furnished the following history: <h3>Patient.</h3> —Male, aged 21, presented himself Jan. 2, 1902, on account of a sore on penis. <h3>History.</h3> —Father living and well; mother dead of tuberculosis; one brother and one sister
Worsening of Felty's syndrome with methotrexate.
Authors: F Guillemin, J Pourel
Journal: Annals of the Rheumatic Diseases (1991)

Worsening of Felty's syndrome with methotrexate Sir: Drs Hughes and Abdulla recently reported a favourable response to low dose oral metho- trexate treatment in a patient with Felty's syndrome,' confirming earlier reports.2 3 In contrast, we found such treatment failed, with worsening of neutropenia.
Does HIV Testing Raise Levels of Suicidal Ideation?-Reply
Authors: Samuel Perry
Journal: JAMA (1990)

<h3>In Reply.—</h3> We appreciate the two criticisms raised by Drs Neugebauer and Johnson because they provide an opportunity to correct common misunderstandings. In regards to retest artifact, our colleagues are refuted by the very study they cite,<sup>1</sup>which extensively examined measures that assess psychiatric symptoms and found that retest artifact is confined to only a few orally administered measures and is not present at all on self-report scales such as the standardized measure we used.<sup>2</sup> In regards to the second criticism, "regression to the mean" is a consequence of choosing to predict a linear regression by using the criterion of least squares.<sup>3</sup>However, our colleagues remind us of four ways this mathematical concept can be misapplied. First, it is not relevant in every longitudinal study. For example, if we found that the mean height of 20 subjects was 6.3 ft, we would not expect that their
Galectin-1 inhibits the viability, proliferation, and Th1 cytokine production of nonmalignant T cells in patients with leukemic cutaneous T-cell lymphoma
Authors: Filiberto Cedeno-Laurent, Rei Watanabe, Jessica E. Teague, Thomas S. Kupper, Rachael A. Clark, Charles J. Dimitroff
Journal: Blood (2012)