tbuckley/cabot-search huggingface dataset:
Payment for medical care should be linked to outcomes that patients value, meeting concludes
Authors: T. Richards
Journal: BMJ (2012)

Rapidly rising spending on healthcare in the Netherlands has not been shown to bring added benefit to patients, a meeting in Nijmegen, organised by the Scientific Institute for Quality of Healthcare, was told last week.

Dutch healthcare costs have been rising at 7% a year, and hospital expenditure has doubled since 2000, said Gert Westert, director of the institute. But quality of care varies across the country, and the effect on health outcomes of greater use of diagnostic tests and interventions, which differ markedly between regions, is not known, he said. “Outcomes are not systematically logged and fed back to providers; healthcare is a volume industry not a value one.”

Drawing on data collected by the Dutch Atlas of Healthcare Variation (http://emc3dev.com/depraktijkindex), he cited treatment for gallstones as an example. Cholecystectomy rates vary between 50 and 250 per 100 000 …
Trends in Resource Utilization by Children with Neurological Impairment in the United States Inpatient Health Care System: A Repeat Cross-Sectional Study
Authors: Jay G. Berry, Annapurna Poduri, Joshua L. Bonkowsky, Jing Zhou, Dionne A. Graham, Chelsea Welch, Heather Putney, Rajendu Srivastava
Journal: PLoS Medicine (2012)

Jay Berry and colleagues report findings from an analysis of hospitalization data in the US, examining the proportion of inpatient resources attributable to care for children with neurological impairment.
Improving the Public's Health — Some Further Reflections
Authors: Robert F. Meenan
Journal: New England Journal of Medicine (1976)

In a recent Sounding Board article,1 Leon White argues that life style is the major national health problem of our time, and he suggests that future efforts to improve the nation's health should focus on changing health behavior rather than continuing the present emphasis on the delivery system. Similar views have been advanced by a number of respected observers of the health-care field.2 3 4 This emphasis on life style is gaining acceptance in professional and political circles, and it may well lead to important changes in health-care policy and medical practice. It seems appropriate, therefore, to point out some negative effects . . .
OC-076 Syringe Size influences the Amount of Midazolam Administered during Sedated Endoscopy: Abstract OC-076 Table 1
Authors: D Haldar, N Quraishi, K Glover, S Keen, A D Farmer
Journal: Gut (2013)

Introduction Endoscopy remains important diagnostic tools for evaluating disease, early detection of malignant lesions and the delivery of therapy within the gastrointestinal (GI) tract. There are a number of regimens that are utilised for the administration of intra-venous sedation, including benzodiazepines (BDZ). However, sedation for endoscopy is not without its risks with an influential report suggesting that many major complications arise from patients being over-sedated (1). Thus, factors that are utilised to reduce the amount of sedation, without a detrimental effect on intra-procedural comfort, are important. Thus the aim of our study was to assess the impact of a change in syringe size of BDZ offered to endoscopists on the amount of BDZ administered in sedated GI endoscopy. View this table: Abstract OC-076 Table 1 Methods A 2 centre, prospective trial comparing BDZ use across all forms of sedated endoscopy across two time periods. In the first period (1st November 2010- 31st October 2011) endoscopists were given a single 5 ml syringe containing 5 mg midazolam. In the second time period (1st November 2011- 31st October 2012) endoscopists were given two 2.5 ml syringes each containing 2.5 mg midazolam. BDZ use, comfort scores and complications were compared across the two time periods. Patients who had a general anaesthetic, and those who did not have sedation, of their endoscopy were excluded. Results Table 1 details the results. Significantly less BDZ was administered in the second time period without an impact on comfort scores. Complications related to sedation were not different. Conclusion Offering endoscopists smaller syringes reduces BDZ use but not at the expense of comfort levels. Further longitudinal study is required to further evaluate whether reduced BDZ usage has an impact on complications. Disclosure of Interest None Declared Reference 1. Scoping Our Practice, The 2004 National Confidential Enquiry into Patient Outcomes and Death (NCEPOD), London, UK.
Pre-eclampsia is associated with sleep-disordered breathing and endothelial dysfunction
Authors: D. Yinon
Journal: European Respiratory Journal (2006)

Pre-eclamptic toxaemia (PET) may be associated with both endothelial dysfunction (ED) and sleep-disordered breathing (SDB). It was hypothesised that females with PET would demonstrate both SDB and ED, and that a correlation between these two would suggest a potential causative association. A total of 17 females with PET and 25 matched females with uncomplicated pregnancy were studied. They underwent a nocturnal ambulatory sleep study (using Watch_PAT100) and noninvasive evaluation of endothelial function utilising the reactive hyperaemia test (using Endo_PAT 2000). A higher ratio of post- to pre-occlusion pulse-wave amplitude (endothelial function index (EFI)) indicated better endothelial function. Females with PET had a significantly higher respiratory disturbance index (RDI) and lower EFI than controls (18.4±8.4 <i>versus</i> 8.3±1.3·h<sup>−1</sup>, and 1.5±0.1 <i>versus</i> 1.8±0.1, respectively). Blood pressure significantly correlated with RDI and with EFI. EFI tended to correlate with RDI. In conclusion, these results suggest that both sleep-disordered breathing and endothelial dysfunction are more likely to occur in females with pre-eclamptic toxaemia than in females with uncomplicated pregnancies. The current authors speculate that respiratory disturbances contribute to the functional abnormality of the blood vessels seen in females with pre-eclamptic toxaemia, although causality cannot be determined based on this study.
Suicide in Released Prisoners of War
Authors: David Lester
Journal: JAMA (1973)

<h3>To the Editor.—</h3> The recent suicide of CAPT E. A. Brudno, a Vietnam prisoner of war (POW), has led psychiatrists to comment about the trauma of captivity (<i>Time</i>, 101(25):67, 1973), the publicity upon return, and difficulty in adjusting to spouses and family. In addition, mention might be made of a hypothesis previously proposed in a LETTER (219:757, 1972) that amelioration of suffering can facilitate suicidal behavior, since the loss of suffering removes an external apparent cause of the individual's distress and suffering. The individual is then forced to confront the internal causes of the distress—that his own unhappiness has its source in his own personality. Suicide thereby becomes a more viable option. Patients who were blind but who had their sight restored them were used to illustrate the hypothesis. Returning POWs may well serve as good examples of the hypothesis also.
Psychological and Physiological Reactivity to Stress: An Experimental Study on Bulimic Patients, Restrained Eaters and Controls
Authors: Brunna Tuschen-Caffier, Claus Vögele
Journal: Psychotherapy and Psychosomatics (1999)

&lt;i&gt;Background: &lt;/i&gt;Binge eating behavior in bulimic patients is thought to play a crucial role in the regulation of psychophysiological arousal in stressful situations. Previous results suggest that interpersonal stress and achievement challenge are perceived as particularly stressful by bulimic individuals. It is not clear, however, whether bulimic individuals respond to stress with an increased desire to binge, and whether this increase is accompanied by higher psychophysiological reactivity compared to healthy controls. &lt;i&gt;Methods: &lt;/i&gt;Twenty-seven patients with bulimia nervosa (DSM-IV), 27 restrained eaters, and 27 controls participated in two experimental sessions in which continuous measures of heart rate, blood pressure, respiration rate, and electrodermal activity were monitored under conditions of achievement challenge (mental arithmetic, Stroop test) and interpersonal stress provoking feelings of loneliness and social rejection (film, imagery task). Ratings of desire to binge, negative mood, and hunger were obtained between experimental trials. Groups were matched for age and body mass index. &lt;i&gt;Results: &lt;/i&gt;There was a marked difference in subjective ratings during interpersonal stress. Bulimic patients responded to the imagery task with increases in both desire to binge and hunger, whereas restrained eaters and controls showed no change. There were no substantial group differences in psychophysiological reactivity. &lt;i&gt;Conclusions: &lt;/i&gt;The dissociation between emotional responses and physiological activation may have important therapeutic implications.
CHILDREN'S DENTISTRY
Authors: CLIFFORD SWEET
Journal: JAMA (1930)

Dental care of the highest grade is necessary if the health problem of the child is to be solved.  No single health measure counts for more in preventive medicine than the maintenance of a healthy state within the mouth. It is evident that the mouth and its structures are the outposts along the route for the entrance of air and food into the body, and these necessities may at any time carry a cargo of pathogenic bacteria. If the outposts are impregnable, no foothold can be gained and invasion is prevented. On the other hand, if ready lodgment is offered within carious teeth and the diseased tissue that always surrounds them, the invaders find shelter, warmth, moisture and food in which to multiply and await the convenient season for forays into deeper and more vital structures.  Carious teeth not only become foci of infection but serve as avenues for the
In vitro tumor-pulsed or in vivo Flt3 ligand–generated dendritic cells provide protection against acute myelogenous leukemia in nontransplanted or syngeneic bone marrow–transplanted mice
Authors: Anna B. Pawlowska, Satoshi Hashino, Hilary McKenna, Brenda J. Weigel, Patricia A. Taylor, Bruce R. Blazar
Journal: Blood (2001)
Improved Mechanoenergetics and Cardiac Rest and Reserve Function of In Vivo Failing Heart by Calcium Sensitizer EMD-57033
Authors: Hideaki Senzaki, Takayoshi Isoda, Nazareno Paolocci, Ulf Ekelund, Joshua M. Hare, David A. Kass
Journal: Circulation (2000)

Myofilament Ca(2+) sensitizers enhance contractility but can adversely alter diastolic function through sensitization to low intracellular Ca(2+) concentration. Concomitant phosphodiesterase III inhibition (PDE3I) may offset diastolic changes but limit the mechanoenergetic benefits. We tested whether selective Ca(2+) sensitization in vivo with the use of EMD-57033 enhances both systolic and diastolic function in failing hearts at minimal energetic cost.Pressure-dimension data were measured with sonomicrometry/micromanometry in conscious dogs before (CON, n=9) and after tachycardia-induced heart failure (HF, n=11). In contrast to blunted dobutamine (DOB) responses in HF, low-dose EMD-57033 (0.4 mg. kg(-1). min(-1) for 20 minutes) markedly enhanced contractility, doubling end-systolic elastance and raising fractional shortening similarly in CON-treated and HF hearts. EMD-57033 effects were achieved at a reduced heart rate, without vasodilation. EMD-57033 augmented blunted heart rate-dependent contractility responses in HF at a rate of twice that of DOB, despite matched basal inotropic responses. EMD-57033 also improved diastolic function, lowering left ventricular end-diastolic pressure and increasing the filling rate. At equipotent inotropic doses and matched preload, EMD-57033 lowered the oxygen cost of contractility by -11.4+/-5.8%, whereas it rose 64+/-18% with DOB (P=0.001) and 28+/-11% with milrinone. Doubling EMD-57033 dose further augmented positive inotropy in CON and HF, accompanied by vasodilation, increased heart rate, and other changes consistent with PDE3I coactivity, but the oxygen cost of contractility remained improved compared with the use of DOB.Selective Ca(2+) sensitization with minimal PDE3I in vivo is achieved with the use of EMD-57033, improving basal and rate-stimulated contractility and mechanoenergetics of HF without compromising diastolic function. Despite PDE3I activity at higher doses, energetic benefits persist.
Monocyte expression of MICA enhances the Natural Killer Cell response to antibody-coated tumor targets
Authors: Amanda Harper, Neela Bhave, Kallan Opheim, Eric Leudke, Robin Parihar, Prashant Trikha, William Carson
Journal: Journal for ImmunoTherapy of Cancer (2014)

Meeting abstracts Natural Killer (NK) cells are large granular lymphocytes that are uniquely equipped to promote the anti-tumor response via communication with other immune cell types in the tumor microenvironment. We have shown that NK cells secrete a distinct profile of immune stimulatory factors
Quality Improvement with an Electronic Health Record: Achievable, but Not Automatic
Authors: Richard J. Baron
Journal: Annals of Internal Medicine (2007)

With 68% of all physician-patient encounters occurring in physician groups of 4 or fewer, improvements in small practices will be necessary to close the well-documented national gaps in consistent delivery of high-quality care. Many believe that adoption of electronic health records (EHRs) is the key to success, and that improvement will almost automatically follow. However, EHR adoption occurs today in an environment shaped by paper chart thinking, which may limit success. Having successfully implemented an EHR in their small practice, the author and his practice colleagues attempted to use it to support a simple project to improve their mammography rate. Although they achieved a real 10% improvement in their rate with only modest additional expense, their experience highlighted critical elements for success beyond the adoption of the EHR, including physician appreciation of structured data, the need for widespread adoption of standards, and a restructuring of the primary team with additional resources. An approach supporting EHR adoption along with these system changes could substantially affect public health.
The Polish Physicians of Chicago.
Authors: W. Statkiewicz
Journal: JAMA (1896)

tity of sodic carbonate and potassio carbonate required "to bring [Does he mean reduce?] the solution to the proper degree of acidity?"In the event of failure to secure the expected therapeutic results, would rural practitioners like myself, who live far from chemic laboratories, be expected to draw their sup¬ plies of this new "fluid" from an expert who prepares it under the immediate supervision of the author and inventor of the "fluid?"If not, why is a formula presented which would be compounded exactly alike by probably no two pharmacists out of a thousand, who might attempt to follow its directions?It seems to me if the Doctor reports his discovery for the benefit of humanity and for the instruction of the medical profession, he should supply a plain working formula of the "fluid."But if it is to be made only by experts and under his own personal supervision, and is to be had on the market at so much a bottle, then the Journal should send its bill to the laboratory for advertising, at regular rates.
Soft Tissue Sarcoma Guidelines
Authors: George D Demetri, Laurence H Baker, Robert S Benjamin, Ephraim S Casper, Ernest U Conrad, Gina Z D'Amato, Thomas F DeLaney, David S Ettinger, Robert Heck, Martin J Heslin, Ray J Hutchinson, Charlotte D Jacobs, Krystyna Kiel, William G Kraybill, G Douglas Letson, Richard J O'Donnell, I Benjamin Paz, John Pfeifer, Raphael E Pollock, R Lor Randall, Aaron R Sasson, Karen D Schupak, Douglas S Tyler, Margaret von Mehren, Jeffrey Wayne
Journal: Journal of the National Comprehensive Cancer Network (2007)

Soft tissue sarcomas are the most frequent sarcomas; the annual incidence for 2007 in the United States is estimated at about 9220 cases, with an overall mortality rate of approximately 3560 cases per year. Important updates for the 2007 version of the guidelines include the addition of epirubicin (single agent) and the combination of epirubicin, ifosfamide, and mesna as generally accepted systemic therapy. Imatinib was added as an option for desmoid tumors. For the most recent version of the guidelines, please visit NCCN.org
PREVALENCE AND DETERMINANTS OF INTRA-STENT THROMBUS AFTER EVEROLIMUS-ELUTING STENT IMPLANTATION ASSESSED BY ANGIOSCOPY AND OPTICAL COHERENCE TOMOGRAPHY
Authors: Masamichi Iwasaki, Toshiro Shinke, Hiromasa Otake, Masayuki Nakagawa, Hirotoshi Hariki, Tsuyoshi Osue, Takumi Inoue, Yu Taniguchi, Ryo Nishio, Hiroto Kinutani, Akihide Konishi, Noritoshi Hiranuma, Masaru Kuroda, Ken-ichi Hirata
Journal: Journal of the American College of Cardiology (2013)
Medical Education Reform
Authors: Sam Bhayani
Journal: JAMA (1991)

<h3>To the Editor.—</h3> The recent article by Cantor et al<sup>1</sup>is of great interest to premedical students as well as medical educators. As medical education undertakes reforms, college students become increasingly excited about the field of medicine. The revised Medical College Admission Test and bold changes at Harvard Medical School are both hailed by premedical students. We feel that these changes better test and improve our ability to become good physicians. However, we wonder if enough fundamental changes will be made before we enter medical school. It is hoped that medical educators will proceed rapidly and efficiently in providing a revised curriculum. In return they are likely to receive highly motivated students who will embrace, celebrate, and benefit from the reforms.
Die historischen Grundlagen der Leberforschung, part 2: Die Geschichte der Leberforschung von Galen bis Claude Bernard
Authors: Lester S. King
Journal: JAMA (1967)

In this interesting and well illustrated book we have, so to speak, an epitome of medical history, achieved through the history of a particular organ—the liver. Dr. Mani, in a fascinating account, narrates with great clarity our knowledge about the liver, its anatomy and physiology, the views regarding its status in the bodily economy. He does not, however, take up any pathological or clinical problems. The present volume covers the period from the Middle Ages to the latter part of the 19th century. A previous volume discussed knowledge of the liver in antiquity, and we fervently trust that a further volume will bring the story up to the very present. Various observations and speculations, and discoveries and new thought modes leading to new observations, get woven together in an interesting fabric. The medieval period was dominated by Galenic concepts, in which the liver was the principal organ of the vegetative
Controversy in Obstetrics and Gynecology
Authors: John W. Huffman
Journal: JAMA (1969)

A controversy, to be stimulating, ought to be truly disputatious. This requires conflicting opinions. The discussants should have firm convictions and vigorously marshall facts to support their viewpoints and to refute those of their adversaries. I am sure Drs. Reid and Barton thought about these things when they planned their book. They chose 58 knowledgeable contributors for it, 35 from New England and the eastern United States and only 12 from west of the Alleghenies. This sectionalism may explain why some of the discussions lack the sharpness and aggressiveness that would be expected from the book's title. Authors farther removed from the eastern seaboard might have offered a greater diversity of opinion. The editors selected only five gynecologic subjects for discussion, compared with 15 on obstetrics. Most gynecologists could easily come up with a dozen topics for debate. Most of the contributions are relatively short reviews of the assigned subjects,
Progression of hepatic fibrosis in patients with hepatitis C: a prospective repeat liver biopsy study
Authors: S D Ryder
Journal: Gut (2004)

The natural history of hepatitis C virus (HCV) infection remains uncertain. Previous data concerning rates of progression are from studies using estimated dates of infection and single liver biopsy scores. We prospectively studied the rate of progression of fibrosis in HCV infected patients by repeat liver biopsies without intervening treatment.We studied 214 HCV infected patients (126 male; median age 36 years (range 5-8)) with predominantly mild liver disease who were prospectively followed without treatment and assessed for risk factors for progression of liver disease. Interbiopsy interval was a median of 2.5 years. Paired biopsies from the same patient were scored by the same pathologist.Seventy of 219 (33%) patients showed progression of at least 1 fibrosis point in the Ishak score; 23 progressed at least 2 points. Independent predictors of progression were age at first biopsy and any fibrosis on first biopsy. Factors not associated with progression were: necroinflammation, duration of infection, alcohol consumption, alanine aminotransferase levels, current or past hepatitis B virus infection, ferritin, HCV genotype, and steatosis or iron deposition in the initial biopsy.One third of patients with predominantly mild hepatitis C showed significant fibrosis progression over a median period of 30 months. Histologically, mild hepatitis C is a progressive disease. The overall rate of fibrosis progression in patients with hepatitis C was low but increased in patients who were older or had fibrosis on their index biopsy. These data suggest that HCV infection will place an increasing burden on health care services in the next 20 years.
Bioassay of complex mixtures derived from fossil fuels.
Authors: E Bingham, W Barkley
Journal: Environmental Health Perspectives (1979)

The conversion or processing of shale, coal, or petroleum involves elevated temperatures and altered pressures, and under these conditions polynuclear aromatic hydrocarbons are likely to form. Certain compounds of this type exhibit carcinogenic activity for a variety of organ sites in experimental animals and epidemiological evidence strongly implicates their role as carcinogens in man. It is then not unexpected that many liquid fractions derived from shale and coal are carcinogenic when subjected to bioassay. Benzo(a)pyrene, [B(a)P], is frequently considered to be an indicator substance. It is clear that when a small quantity of B(a)P is present in a fraction, the fraction will exhibit carcinogenic activity in a bioassay (mouse skin). However, it does not follow that the lack of detectable B(a)P insures that the fraction will be noncarcinogenic. Several fractions have been analyzed for their content of B(a)P and then subjected to bioassay. A method for testing complex mixtures for their carcinogenic potential is described. The carcinogenic potency of these fractions are compared to petroleum fractions.