tbuckley/cabot-search huggingface dataset:
Prescribing costs in dispensing practices.
Authors: T J Morton-Jones, M A Pringle
Journal: BMJ (1993)

OBJECTIVE--To examine differences in prescribing between dispensing and non-dispensing practices. SETTING--The 108 practices covered by Lincolnshire Family Health Services Authority. DESIGN--Analysis of prescribing data for 1990-1 from PD2 reports from the Prescription Pricing Authority in relation to data on practice characteristics obtained from Lincolnshire Family Health Services Authority; and aggregated level 3 prescribing and cost information (PACT data) for 10 selected drugs from the Prescription Pricing Authority to examine amounts prescribed. MAIN OUTCOME MEASURES--Prescribing cost per patient, items per patient, and cost per item in dispensing and non-dispensing practices. RESULTS--Dispensing practices had higher prescribing costs per patient than non-dispensing practices. This difference held for non-dispensing patients within dispensing practices. Structural features failed to explain the differences in prescribing cost, except for the higher numbers of elderly patients in dispensing practices (which explained 13% of the difference) and the number of partners (5%). The main determinant of the difference was the lower use of generic drugs in dispensing practices (84%). Dispensing patients were prescribed lower quantities of drugs on average for each item. CONCLUSIONS--Dispensing practices could reduce their prescribing expenditure to that of non-dispensing practices by increasing their prescribing of generic drugs. The shorter prescribing intervals for dispensing patients may be due to dispensing fees being related to the number of prescribed items.
Management of Dyslipidemia in IPPM Patients
Authors: Abhimanyu Garg
Journal: Diabetes Care (1994)

Patients with insulin-dependent diabetes mellitus (IDDM) are at an increased risk for coronary heart disease. Factors that may enhance the risk include dyslipidemia, hypertension, and hyperglycemia. Until recently, the importance of dyslipidemia in IDDM was ignored because the prevalence of high cholesterol levels was similar to that in the nondiabetic population. However, unique abnormalities in the composition and metabolism of lipoproteins may occur in IDDM patients. Management of IDDM patients, therefore, should include control of dyslipidemia as well as control of hyperglycemia and hypertension. The therapeutic goals for serum cholesterol reduction in IDDM patients should be lower than that for nondiabetic patients, and the goals for children should be even lower than those for adults. Both very-low-density lipoprotein and low-density lipoprotein (LDL) levels should be the targets for therapeutic interventions and not just the LDL alone. Because of the unique features of dyslipidemia in IDDM patients, the therapeutic options may not be the same as that for nondiabetic patients. Hyperglycemia should be controlled by matching daily be low in saturated fats and cholesterol. If dyslipidemia persists despite diet and hyperglycemia management, drug therapy may be initiated. For IDDM children ≥ 10 years of age with elevated LDL-cholesterol levels, the first-line therapy should be bile acid sequestrants. For adults with IDDM, bile acid sequestrants also may be the drugs of choice, particularly for normotriglyceridemic patients. Nicotinic acid therapy should be avoided. Among other drugs, hydroxymethyl-glutaryl coenzyme A reductase inhibitors may be preferable for patients with elevated LDL cholesterol and borderline hypertriglyceridemia. Fibric acid derivatives should be used for markedly hypertriglyceridemic patients. The role of probucol for dyslipidemia in IDDM patients is not clear.
PSYCHIATRIC FINDINGS OF THE STIRLING COUNTY STUDY
Authors: D. C. LEIGHTON, J. S. HARDING, D. B. MACKLIN, C. C. HUGHES, A. H. LEIGHTON
Journal: American Journal of Psychiatry (1963)

1. As in Manhattan the prevalence of psychiatric symptoms in the general population of this rural area is higher than one might expect, with only 17% of adults free of all symptoms of psychiatric significance. About a third of the population shows significant impairment from psychiatric disorder, while twenty-plus percent stand in need of some sort of psychiatric attention. 2. The amount of disorder differs with the biologic variables of age and sex. Except in the disintegrated communities, women tend to show more psychiatric disorder than men though the proportion with significant impairment is approximately the same. Older people tend to show more than younger people until they reach 70 years or so. 3. Considering the 1010 county survey respondents as a whole, our indicator of social class showed what has been found in other studies, namely that better mental health is associated with higher social class. This relationship could not be demonstrated, however, in the largest town in the county. 4. Intensive studies of communities that are polar with respect to level of social integration showed a far stronger association of better mental health with higher level of integration than with higher social class within these communities. 5. It is not poverty or limited education or lower class status, per Se, that makes the difference to mental health, but rather a whole group of factors that tend to be associated with these and that create a social environment that lacks features that are vitally important to mental health. To improve mental health, economic resources must be mobilized up to a point, education must be provided up to a point, but this will not be enough unless these factors bring with them the other environmental forces which add up to giving the individual the feeling that he is a worthwhile member of a worthwhile group. Something like this is probably the most important contribution of such endeavors as Hull House or the Peckham Experiment, which by various means served to re-integrate the social environment for many of their patrons.
Smoking while Wearing a Nicotine Patch
Authors: James G. Warner Jr
Journal: Annals of Internal Medicine (1995)

Letters15 March 1995Smoking while Wearing a Nicotine PatchJames G. Warner Jr and William C. LittleJames G. Warner JrInstitute for Prevention of Cardiovascular Disease, New England Deaconess Hospital, Boston, MA 02215. The Bowman Gray School of Medicine, Winston-Salem, NC 27157.Search for more papers by this author and William C. LittleInstitute for Prevention of Cardiovascular Disease, New England Deaconess Hospital, Boston, MA 02215. The Bowman Gray School of Medicine, Winston-Salem, NC 27157.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-6-199503150-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Mittleman's comments and agree with his summary of the limitations of interpreting causation from a single clinical observation.In addition to our patient [1], several other patients whose cardiac events were temporally related to smoking while wearing a nicotine patch have been described [2]. The combination of smoking and transdermal nicotine can produce high nicotine levels [3, 4]. Because nicotine produces vasoconstriction, catecholamine release, and platelet aggregation, it may also trigger plaque rupture, leading to the formation of an occlusive thrombus and resulting in myocardial infarction. Although our observation and physiologic plausibility do not establish ...References1. Warner JG Jr, Little WC. Myocardial infarction in a patient who smoked while wearing a nicotine patch (Letter). Ann Intern Med. 1994; 120:695. Google Scholar2. Orleans CT, Ockene JK. Routine hospital-based quit-smoking treatment for the postmyocardial infarction patient: an idea whose time has come. J Am Coll Cardiol. 1993; 22:1703-5. Google Scholar3. Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. N Engl J Med. 1988; 319:1318-30. Google Scholar4. Gorsline J, Gupta SA, Dye D, Rolf CN. Steady-state pharmacokinetics and dose relationship of nicotine delivered from Nicoderm (Nicotine Transdermal System). J Clin Pharmacol. 1993; 33:161-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: Institute for Prevention of Cardiovascular Disease, New England Deaconess Hospital, Boston, MA 02215. The Bowman Gray School of Medicine, Winston-Salem, NC 27157. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRisk of acute first myocardial infarction and use of nicotine patches in a general population 15 March 1995Volume 122, Issue 6Page: 476-477KeywordsCatecholaminesHeart diseasesMyocardial infarctionNicotinePlatelet aggregationStable coronary artery diseaseThrombosisVasoconstriction Issue Published: 15 March 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Think 'Trismus-Pseudocamptodactyly,' Say 'Dutch-Kentucky.' But 'Dutch-Kennedy'?-Reply
Authors: Stanley I. Samuels
Journal: JAMA (1989)

<h3>In Reply.—</h3> I was intrigued and somewhat concerned by Dr Trimble's failure to find any reference to the Dutch-Kentucky syndrome, since my initial review of some standard texts also failed to reveal the existence of this disorder.<sup>1</sup>On further exploration, I was relieved to discover that the syndrome was in fact alive and well. It was originally described in 1968.<sup>2,3</sup>However, it may be better known to your erudite readers as the trismus-pseudocamptodactyly syndrome or Dutch-Kentucky syndrome.<sup>4</sup> The point I wished to make in my review of<i>Anesthesia and Co-existing Disease</i>was that the text discussed in fine detail the problems in anesthesia, ranging from the exquisitely rare (hence Dutch-Kentucky syndrome) to the more commonplace. I thank Dr Trimble's keen eye for helping to emphasize this point. I will leave the elucidation of the Dutch-Kennedy syndrome to others.
Long-term maintenance therapy with sucralfate.
Authors: M C Allison
Journal: Gut (1991)

target biopsy specimens can be obtained from an abnormal area.It is true that a small proportion of patients develop carcinoma in colitis without dysplasia elsewhere in the colon and that dysplasia, when present, is usually patchy.The paper by Rasonhoff et al, however, is quoted as evidence that dysplasia at a distance from the cancerous lesion occurs in only 50% of colectomy speci- mens.This paper was based on histological blocks from only 22 specimens with cancer in colitis, complete resections were performed in only 11 of the patients, and more than five blocks were available from only 13 of the specimens.Some dysplasia at a distance from the tumour was found in 73% of specimens and high grade dysplasia in 50%.The authors suggest that one reason why the incidence of dysplasia was less than in other reports may have been due to limited sampling.Careful examination of 62 colectomy specimens with cancer in colitis at St Mark's Hospital has shown dysplasia at a distance from the tumour in 87%.Dr Gyde selected three clinical studies for comment and we appreciate her remarks about the importance of high levels of follow up and of clinical care in regard to our surveillance programme.It is a pity that she made no reference to two excellent Swedish series,4 one recently updated,6 in which there has been no cancer death and in which the three tumours treated surgically were at an early stage (Dukes's A).Like Dr Gyde, we would welcome the development of a new marker of neoplastic potential in colitis.Apart possibly from analysis of aneuploidy, which is complex and expensive, no such marker has been identified.Despite its limitations, dysplasia is still the only thoroughly tested marker we have and it should not be rejected.
Human immunodeficiency virus-associated psoriasis and psoriatic arthritis treated with infliximab
Authors: U. Bartke, I. Venten, A. Kreuter, S. Gabbay, P. Altmeyer, N.H. Brockmeyer
Journal: British Journal of Dermatology (2004)

Sir, Patients infected with human immunodeficiency virus (HIV) may develop psoriasis and psoriatic arthritis. These patients often present more severe clinical manifestations than the non‐HIV population and treatment is difficult. We report a 46‐year‐old HIV+ man (CDC B3, World Health Organization) who presented with widespread psoriatic lesions (Fig. 1A) and inflammation of the knee and ankle joints. Laboratory examination revealed a CD4+ lymphocyte cell count of 68 mm−3, CD8+ lymphocytes of 839 mm−3, CD4/CD8 ratio 0·1. On initial examination, the plasma HIV‐1 RNA count was 1040 copies mL−1. After initiation of highly active antiretroviral therapy (HAART) with didanosine, lamivudine and lopinavir, the CD4+ cell count increased to 193 mm−3, CD8+ lymphocytes to 1388 mm−3, ratio 0·1. Simultaneously the psoriasis and polyarthritis worsened. The patient developed progressive swelling and redness of the knees (Fig. 1B), ankles, fingers and phalanges of the feet (Fig. 1C). Examination showed extensive psoriatic plaques all over his body. He exhibited scaly plaques on the palms and soles, accompanied by fluid‐filled pustules and dystrophy of all 20 nails.
Abstract 5641: Dual roles for ganoderic acid A in inducing apoptosis and enhancing HLA class II presentation in leukemia and lymphoma cells
Authors: Azizul Haque, Faisal F.Y. Radwan, Azim Hossain, Jason M. God
Journal: Cancer Research (2012)

Abstract Ganoderic acid A (GA-A), a natural extract isolated from the medicinal mushroom Ganoderma lucidum, was found to induce a remarkable cytotoxicity in various leukemia and lymphoma cell lines and primary tumors, with a minor toxicity to nonmalignant B-cells. The GA-A cytotoxicity and growth inhibitory effects resulted from an induction of apoptosis, which was characterized by a dose-dependent increase in expression and activity of activated caspases 3, 8, and 9. Mechanistic studies showed that GA-A treatment upregulated pro-apoptotic protein Bax proteins while downregulating anti-apototic proteins Bcl-2 and survivin. Data also demonstrated that cytochrome c and apoptotic protease activating factor-1 (Apaf-1) were significantly elevated in the cytoplasmic fractions of GA-A-treated cells, which may have activated caspases for cell death. Despite GA-A's notable cytotoxic effects on leukemia and lymphoma cells, GA-A treatment enhanced HLA class II antigen (Ag) presentation and CD4+ T cell recognition of both malignant and nonmalignant B-cells. These data suggest that GA-A administration may play dual roles in inducing apoptosis and enhancing HLA class II Ag presentation, and could be used as novel adjunctive therapy for the treatment of hematological malignancies. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5641. doi:1538-7445.AM2012-5641
B.M.A. and Hospital Junior Staff
Authors: R. Gibson
Journal: BMJ (1970)

the size of constituencies is making it more and more difficult for Council members to keep in effective touch with the divisions for which they are responsible.This means that divisions are being increasingly isolated from activities at the centre and less aware of the reasons for decisions taken there.This in turn is making it more difficult for the periphery to make its views and wishes known to Council.The regional councils which were postu- lated have not yet appeared, and at a time when the Association's finances are under heavy pressure it is doubtful whether they can really be afforded.It seems to be time to take another long, hard look at our constitutional changes, and the advantages which we were told would accrue from them are not, as yet, very apparent.-Iam, etc., VICTOR RUSSELL.
Tissue uptake of docetaxel loaded hydrophobically derivatized hyperbranched polyglycerols and their effects on the morphology of the bladder urothelium
Authors: Clement Mugabe, Peter A. Raven, Ladan Fazli, Jennifer H.E. Baker, John K. Jackson, Richard T. Liggins, Alan I. So, Martin E. Gleave, Andrew I. Minchinton, Donald E. Brooks, Helen M. Burt
Journal: Biomaterials (2011)
An Epidemic of Acute Toxoplasmosis
Authors: B. H. Kean
Journal: JAMA (1969)

An epidemic of acute lymphadenitic toxoplasmosis involved five medical students. Fever, headache, myalgia, lymphadenopathy, splenomegaly, and extremely high and rising Sabin-Feldman dye test and complement fixation titers characterized the illness. The students all ate rare hamburger at the same place, on the same night, and evidence indicates that this was the way in which the infections were acquired.
ECT in the Treatment of a Patient With Catatonia: Consent and Complications
Authors: Marc H. Zisselman, Richard L. Jaffe
Journal: American Journal of Psychiatry (2010)

Acute catatonia in an adolescent or young adult can present complex clinical challenges. Prominent issues include those involving diagnosis, timely and effective treatment, and diminished capacity to provide consent. The authors describe a 19-year-old woman presenting initially with manic excitement followed by a lengthy period of mutism, immobility, and food and fluid refusal. Elevated temperature, an elevated creatine phosphokinase level, and autonomic dysfunction led to consideration of a malignant catatonic syndrome. The patient manifested rigidity accompanied by posturing and waxy flexibility. Neurologic, medical, and laboratory evaluations failed to identify an organic cause for the likely catatonia. Treatment with amantadine, bromocriptine, and lorazepam was unsuccessful. ECT was deemed appropriate but required emergency guardianship because of the patient's inability to provide consent. At the initial ECT session, the elicited seizure was followed by an episode of torsade de pointes requiring immediate cardioversion. In reviewing the ECT complication, it appeared that muscle damage due to catatonic immobility led to acute hyperkalemia with the administration of succinylcholine. Discussions were held with the patient's guardian outlining the clinical issues and the risks of additional ECT. The patient responded to eight subsequent ECT sessions administered with rocuronium, a nondepolarizing muscle relaxant. The authors provide a brief review of the diagnosis and treatment of catatonia and address issues surrounding ECT, cardiac effects, use of muscle relaxants, and the consent process.
The GAAP in Quality Measurement and Reporting
Authors: Peter J. Pronovost, Marlene Miller, Robert M. Wachter
Journal: JAMA (2007)

CATALYZED BY EVIDENCE OF POOR-QUALITY CARE AND remarkable variations in processes and outcomes, the interest in quality measurement has increased exponentially. Manifestations of this interest include widespread promulgation of quality measures, an increase in public reporting of these measures, and early experiments in paying for quality. Now that quality of care is being measured rather than assumed, there seems little doubt that better quality scores will lead to major competitive advantages for clinicians and organizations. Although many quality measures are used internally by health care organizations to improve quality of care, an increasing number of measures are being reported publicly. Yet the measurement of quality in health care is neither standardized nor consistently accurate and reliable. Because any organization or company can advertise the quality of its products, it is important to hold health care quality measures to a higher standard than claims about, for example, household products. Without such assurances, publicly reported quality measures may misinform and possibly erode the trust that underlies the medical profession. If patients cannot trust what is reported, they may lose confidence in the quality of care that is provided. Invalid publicly reported quality-of-care measures pose significant risks to patients, clinicians, and potentially to payers. Patients might choose care according to misinformation and make poor decisions. Health care organizations may become overconfident about the quality of care provided and reduce or eliminate improvement efforts and introduce preventable harm. Payers may mistakenly provide financial rewards, channel patients to low-quality clinicians, or make inaccurate inferences about the value (quality per cost) they purchase.
Race and Therapeutic Drug Response
Authors: W. Kalow
Journal: New England Journal of Medicine (1989)

The study by Zhou et al. in this issue of the Journal 1 compares the physiologic effects and the pharmacologic disposition of propranolol in a group of American whites and a group of Orientals of Chinese descent. The reason for the study was the perception that Chinese patients tended to respond to lower doses of propranolol than did Western patients. The surprising finding was not one but two differences — namely, the Chinese subjects responded more strongly to the drug, with a larger reduction in the heart rate and blood pressure, although they also metabolized propranolol more efficiently than did their . . .
Prospects for Organ and Tissue Replacement
Authors: Laura E. Niklason
Journal: JAMA (2001)

Damage or loss of a tissue or organ is common, costly, and tragic. Advances in mechanical artificial organs and organ transplantation have improved the treatment of organ failure, and advances in molecular immunology, tissue engineering, and stem cell biology offer the promise of even better therapeutic modalities for treating organ failure in the future. Enhancement of immune tolerance of transplanted tissues, improved understanding of cellular differentiation and tissue development, and advances in biomaterials may enable the de novo creation of implantable tissue and organs for transplantation. Innovative techniques for prevention and treatment of tissue loss and organ failure should improve the quality and length of life.
The Lid Is Off
Authors: Philip L. White
Journal: JAMA (1977)

A case of vitamin A toxicity in a young boy is reported in this issue (p 1749). The events leading to the poisoning together with recent developments in food and drug law portend more problems with vitamin toxicity.  Shaywitz et al, of the Yale University School of Medicine report the case of a 4-year-old boy being treated for minimal brain dysfunction. Ten months before their observation, the boy may have been treated with megavitamin therapy, a regimen of massive doses of certain vitamins. The boy's grandmother, owner of a health food store, apparently kept him well supplied with vitamin pills, which he ingested continuously. Following four months of fever and irritability, the boy was taken under observation by the Yale group. In addition to the conventional array of assays, a technetium Tc 99m polyphosphate bone scan showed abnormalities suggestive of hypervitaminosis A. It is suggested that the scan showed abnormal
Donor-associated malignancy in kidney transplant patients
Authors: Cai-Bin Cui, David A. Gerber
Journal: Journal of Clinical Investigation (2013)

Skin cancer cells with donor genotype have been identified in allogeneic transplant patients; however, the donor contribution to the recipient’s epithelial malignancy remains to be established. In this issue of the JCI, Verneuil et al. provide the first evidence for donor contribution to the malignant epithelium of skin squamous cell carcinoma in a kidney transplant recipient. This case report may have important implications for cancer research and clinical care of long-surviving kidney transplant patients.