tbuckley/cabot-search huggingface dataset:
Regional Variations in Health Care Intensity and Physicians' Perceptions of Care Quality
Authors: John C. Peirce
Journal: Annals of Internal Medicine (2006)

Letters21 November 2006Regional Variations in Health Care Intensity and Physicians' Perceptions of Care QualityJohn C. Peirce, MD, MA, MSJohn C. Peirce, MD, MA, MSFrom the University of Michigan Medical School, Ann Arbor, Michigan.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-10-200611210-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Sirovich and colleagues (1) and Berenson in an associated editorial (2) make known important findings bringing us closer to understanding determinants of higher-quality health care and cost containment. To extend this, I performed a secondary analysis, regressing the percentage of generalists on the Dartmouth investigators' End-of-Life Expenditure Index (EOL-EI) in dollars by using data from their Table 1. This showed that for every percentage increase in generalist physicians from 26% to 31%, there is a change in EOL-EI of −$1056 (95% CI, −$1796 to −$406; R2 = 0.90; P = 0.006). With the model accounting for 90% of the ...References1. Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Regional variations in health care intensity and physician perceptions of quality of care. Ann Intern Med. 2006;144:641-9. [PMID: 16670133] LinkGoogle Scholar2. Berenson RA. Does more health care spending produce better health and happier doctors? [Editorial]. Ann Intern Med. 2006;144:694-6. [PMID: 16670141] LinkGoogle Scholar3. Mayes R. Universal Coverage: The Quest for National Health Insurance. Ann Arbor, MI: The University of Michigan Pr; 2004. Google Scholar4. Arthur WB. Positive feedbacks in the economy.. In: Arthur WB, eds. Increasing Returns and Path Dependency in the Economy. Ann Arbor, MI: The University of Michigan Pr; 1994:1-12. Google Scholar5. Brody H. Duct tape cures warts, or crazy ways to pay doctors. The Grand Rapids Press. 4 April 2006:E3. Google Scholar Author, Article, and Disclosure InformationAuthors: John C. Peirce, MD, MA, MSAffiliations: From the University of Michigan Medical School, Ann Arbor, Michigan.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRegional Variations in Health Care Intensity and Physician Perceptions of Quality of Care Brenda E. Sirovich , Daniel J. Gottlieb , H. Gilbert Welch , and Elliott S. Fisher Does More Health Care Spending Produce Better Health and Happier Doctors? Robert A. Berenson Regional Variations in Health Care Intensity and Physicians' Perceptions of Care Quality Brenda Sirovich and Elliott S. Fisher Metrics 21 November 2006Volume 145, Issue 10Page: 788-789KeywordsBehaviorConflicts of interestHealth careHealth care qualityPerceptionRiversWarts ePublished: 21 November 2006 Issue Published: 21 November 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The Management of Strokes
Authors: F. A. Elliott
Journal: BMJ (1958)

SPONTANEOUS INTRACRANIAL HAEMORRHAGEAby lowering the blood pressure to 70 mm.Hg for a short period by hypotensive drugs.Alternatively, the sac of the aneurysm can be wrapped around with hammered muscle or with gauze to reinforce its walls.This has to be done
Tobacco Smoking and Serum Lipids in Old Men
Authors: R. M. Acheson, W. J. E. Jessop
Journal: BMJ (1961)

SMOKING AND VENTILATORY FUNCTION BRITISII homozygotes in each group.Among smokers, genotype would determine whether a subject remained asympto- matic and lost a moderate amount of ventilatory capacity, or developed bronchitic symptoms and lost a good deal more.On such an all-or-none basis for symptoms the amount and duration of smoking would ceazse to be a prime factor as in the present and in Higgins's data.Among ex-smokers the incidence of cough plus sputum was the same as that among smokers, but the incidence of cough alone was much less; it is suggested on this basis that the persistence or otherwise of symptoms in ex-smokers depends on their relative severity.At present this hypothesis is offered as a speculative but not unsupported alternative to a direct and quantitative deleterious effect of tobacco smoking on the bronchial mucosa.It appears to merit further investigation. SummaryVentilatory capacity has been assessed in 302 subjects in Sydney in relation to smoking habits and respiratory symptoms.Among males, smoking, in the absence of symptoms, leads to some reduction of ventilatory capacity.The presence of cough or cough and sputum is associated with further impairment of ventilatory function.These same symptoms are associated with loss of ventilatory capacity among non-smokers.The ventilatory loss appears to be largely reversible in those who cease smoking.Among females there are similar trends, but the results are not nearly so clear-cut.The data are not apparently explicable on the basis of a simple quantitative effect of smoking on the bronchial mucosa.As alternative hypothesis based on a combina- tion of genetic and environmental factors is offered, and this alternative hypothesis is supported by the present findings.We are grateful for helpful statistical
Effect of cimetidine and pirenzepine in combination on 24 hour intragastric acidity in subjects with previous duodenal ulceration.
Authors: J G Williams, M Deakin, J K Ramage
Journal: Gut (1986)

Intragastric pH was monitored during 24 hours in eight volunteers with duodenal ulcer disease in remission, while on placebo, cimetidine 400 mg bd, pirenzepine 50 mg bd, cimetidine 400 mg bd + pirenzepine 50 mg bd, cimetidine 200 mg bd + pirenzepine 25 mg bd. The control of intragastric acidity during the 24 hour period by the combination of low dose cimetidine and pirenzepine was significantly better than with cimetidine, or pirenzepine alone in full dosage. This difference was most apparent after breakfast but was still present after lunch when cimetidine had no significant effect. Combination treatment is a logical approach when continuous control of intragastric acidity is needed, but a three times daily regimen will be necessary to cover the 24 hours.
The ghost of Edwin Chadwick.
Authors: D Porter, R Porter
Journal: BMJ (1990)

mobility, intelligence, continence, and renal damage.Others too have found that determining the neurological function, by charting the activity of specific muscles, is useful postnatally in predicting mortality and quality of life among survivors.'But, as with the sensory level, muscle activity cannot be determined in utero.It is hard to think what factor might be used.Flexion and
Value of attenuation correction in interpretation of stress only exercise Tc-99m sestamibi SPECT imaging: results of a multicenter trial
Authors: Gary V. Heller, Timothy M. Bateman, Elias H. Botvinick, Matthew Fish, William P. Follansbee, Ami Iskandrian, James Gait, Christopher Haddock, Carlos Poston, James A. Case
Journal: Journal of the American College of Cardiology (2002)
Arthritis of the Hip
Authors: A. J. Harrold
Journal: BMJ (1969)

Arthritis of the hip can be one of the most disabling and troublesome of joint afflictions.Though quite common, it often presents difficulties in diagnosis and considerable problems in treatment often follow.Symptoms of Hip Disease Pain.-Confusion over hip pain is twofold.Pain in the region of the hip does not necessarily arise in the joint itself, and, conversely, pain arising in the joint is not necessarily felt in the region of the hip.Hip disease can cause pain in the buttock, but pain at this site is far more commonly referred from the spine, when it characteristically spreads down the back or outer side of the thigh.True hip pain is usually felt on the outer side or front of the joint and in the groin, and radiates down the front of the thigh to the knee and occa- sionally to the shin.Sometimes pain in the knee is the patient's presenting or only complaint.Such pain is often indicated with a characteristic rubbing gesture over the front of the thigh just above the patella, an uncommon spot for pain from a knee disorder.Questioning often elicits the in- formation that the pain spreads up the limb to the groin- again unlike a true knee-joint pain.Any patient complaining of knee pain but showing no local abnormality on examination should have the corresponding hip closely examined.The pain of arthritis of the hip invariably bears a relation to walking and weight-bearing, though this can also be a feature of pain of spinal origin.True hip pain is not usually affected by attempts at bending or lifting, nor is it made worse by coughing or sneezing.Limp.-The limp of arthritis of the hip is caused by the pain, the limitation of movement, and the secondary deformi- ties, particularly shortening.Stiffness.-Squatting and kneeling are first affected, and later there is difficulty in reaching the feet or toe-nails and difficulty with shoes and stockings.The patient is unable to sit forward in a chair without slipping the affected leg off the side to lower the knee.When both hips are involved stiffness is more of a problem, there being difficulty in separating the legs, and, in advanced cases, difficulty in negotiating steps and stairs. Clinical Examination of the HipThis favourite test for examination candidates presents little difficulty if approached methodically, but it has many traps for the unwary.The value of the information that may be obtained fully justifies the trouble taken.The hips cannot be efficiently examined without full exposure of the lower limbs and lower trunk, though a modesty towel over the pubis confers worthwhile advantages in improved patient co-operation.The examination follows traditional lines.
The Inhibition of Coronary Atherosclerosis by Estrogens in Cholesterol-Fed Chicks
Authors: R. PICK, J. STAMLER, S. RODBARD, L. N. KATZ
Journal: Circulation (1952)

Chronic administration of estrogens parenterally inhibits coronary atherogenesis in cockerels fed a cholesterol-supplemented diet, although no such prophylactic effect was observed against aorta atherogenesis. This protection of the coronary vessels is associated with depression of the plasma total cholesterol-lipid phosphorus ratio toward normal levels consequent upon estrogen-induced hyperphospholipemia.
Trichloroethylene Cancer Epidemiology: A Consideration of Select Issues
Authors: Cheryl Siegel Scott, Weihsueh A. Chiu
Journal: Environmental Health Perspectives (2006)

A large body of epidemiologic evidence exists for exploring causal associations between cancer and trichloroethylene (TCE) exposure. The U.S. Environmental Protection Agency 2001 draft TCE health risk assessment concluded that epidemiologic studies, on the whole, support associations between TCE exposure and excess risk of kidney cancer, liver cancer, and lymphomas, and, to a lesser extent, cervical cancer and prostate cancer. As part of a mini-monograph on key issues in the health risk assessment of TCE, this article reviews recently published scientific literature examining cancer and TCE exposure and identifies four issues that are key to interpreting the larger body of epidemiologic evidence: a) relative sensitivity of cancer incidence and mortality data; b) different classifications of lymphomas, including non-Hodgkin lymphoma; c) differences in data and methods for assigning TCE exposure status; and d) different methods employed for causal inferences, including statistical or meta-analysis approaches. The recent epidemiologic studies substantially expand the epidemiologic database, with seven new studies available on kidney cancer and somewhat fewer studies available that examine possible associations at other sites. Overall, recently published studies appear to provide further support for the kidney, liver, and lymphatic systems as targets of TCE toxicity, suggesting, as do previous studies, modestly elevated (typically 1.5–2.0) site-specific relative risks, given exposure conditions in these studies. However, a number of challenging issues need to be considered before drawing causal conclusions about TCE exposure and cancer from these data.
Air pollution and hospital admissions for the elderly in Detroit, Michigan.
Authors: J Schwartz
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

Several studies in recent years have suggested that exposure to airborne particles and to ozone are associated with increases in respiratory hospital admissions. Few of those studies have used inhalable particles as their measure of exposure, and the studies did not always examine both particle and ozone exposure. This study examined the association between both PM10 and ozone and respiratory hospital admissions for persons 65 yr of age and older in the Detroit, Michigan, metropolitan area during the years 1986 to 1989. After controlling for seasonal and other long-term temporal trends, temperature, and dew point temperature, both PM10 (RR = 1.012, 95% CI = 1.019-1.004) and 24-h ozone concentrations (RR = 1.026, 95% CI = 1.040-1.013) were associated with daily admissions for pneumonia. The relative risks are for a 10-microgram/m3 increase in PM10 and a 5-ppb increase in 24-h ozone concentration and from models including both pollutants. Admissions for COPD other than asthma were associated with PM10 (RR = 1.020, 95% CI = 1.032-1.009) and ozone (RR = 1.028, 95% CI = 1.049-1.007) as well. Asthma admissions were not associated with either pollutant. Controlling for one pollutant did not effect the magnitude of the association with the other pollutant. The magnitude of these relative risks are very similar to those recently reported in Birmingham, Alabama, Ontario, and New York State. This suggests that the associations with both pollutants are likely to be causal.
Effects in the mouse and rat of prenatal exposure to arsenic
Authors: R. D. Hood, G. T. Thacker, B. L. Patterson
Journal: Environmental Health Perspectives (1977)

Initial experiments involving mouse development employed single IP injections of 45 mg/kg sodium arsenate on one of days 6-12 of gestation and produced a spectrum of developmental defects. Embryotoxicity was indicated by high prenatal mortality and decreased fetal weights. A chelating agent, 2,3-dimercaptopropanol (BAL), was then employed in an attempt to alleviate the adverse effects of prenatal arsenate. BAL was administered 4 hr before, concurrently with, or 4 hr after arsenate. All BAL treatments diminished arsenate-induced gross malformations and growth retardation; the concurrent treatment alleviated skeletal malformation. Injection of rats IP with arsenate has also been reported to result in teratogenicity, including renal agenesis. Further reports indicated that 40 mg/kg arsenate administered to mice by gavage on days 9–11 increased prenatal mortality, reduced fetal weights, and was associated with minor malformations. According to our recent work, however, single oral doses of arsenate must be around 120 mg/kg to cause prenatal toxicity. Multiple doses of 60 mg/kg on 3 days had little effect. Sodium arsenite has also been found to be fetotoxic and teratogenic. Such effects were seen at IP doses of 10–12 mg/kg.
Clinical Procedures in Emergency Medicine
Authors: Richard O. Cummins
Journal: JAMA (1985)

This book was an outstanding surprise. Emergency department libraries abound with how-to manuals and handbooks on clinical procedures for emergencies. Roberts and Hedges, however, assistant professors of emergency medicine at the University of Cincinnati, have produced the first<i>textbook</i>of such procedures. This is an impressive, 1,100-page hardback, with more than 80 contributors. The textbook format allows them to expand beyond the simple indications / equipment / procedure / complications format used in typical procedure handbooks. The contributors present not only fascinating historical background and superb photographs and illustrations but also the rationale and physiologic theory behind the procedures. This is, in short, an academic book that carries the reader far beyond the standard "see one, do one, teach one" approach with which so much misinformation and personal opinion is passed down from house officer to house officer. The editors have organized the work by specialty area: respiratory care, cardiology, general surgery, orthopedics,
Manganese and Parkinson’s Disease: A Critical Review and New Findings
Authors: Tomás R. Guilarte
Journal: Environmental Health Perspectives (2010)

Excess accumulation of manganese (Mn) in the brain results in a neurological syndrome with cognitive, psychiatric, and movement abnormalities. The highest concentrations of Mn in the brain are achieved in the basal ganglia, which may precipitate a form of parkinsonism with some clinical features that are similar and some that are different to those in Parkinson's disease (PD). Recently, scientists have debated the possibility that Mn may have an etiological role in PD or that it may accelerate the expression of PD.The goal of this review was to examine whether chronic Mn exposure produces dopamine neuron degeneration and PD or whether it has a distinct neuropathology and clinical presentation.I reviewed available clinical, neuroimaging, and neuropathological studies in humans and nonhuman primates exposed to Mn or other human conditions that result in elevated brain Mn concentrations.Human and nonhuman primate literature was examined to compare clinical, neuroimaging, and neuropathological changes associated with Mn-induced parkinsonism.Clinical, neuroimaging, and neuropathological evidence was used to examine whether Mn-induced parkinsonism involves degeneration of the nigrostriatal dopaminergic system as is the case in PD.The overwhelming evidence shows that Mn-induced parkinsonism does not involve degeneration of midbrain dopamine neurons and that l-dopa is not an effective therapy. New evidence is presented on a putative mechanism by which Mn may produce movement abnormalities. Confirmation of this hypothesis in humans is essential to make rational decisions about treatment, devise effective therapeutic strategies, and set regulatory guidelines.
A4.7 Prevalence of vertebral fractures, after 50 years old
Authors: K Nassar, S Janani, W Rachidi, O Mkinsi
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Introduction</h3> Fragility fractures are number growing. They reduced quality life and increased mortality. After 50 years, one woman and two men will have an osteoporotic fracture in their lifetime. The presence of a vertebral fracture (VF) multiplied by 4-5, the risk of new vertebral fracture occurrence, and by 3 the risk of hip fracture. They are pauci or asymptomatic. <h3>Study purpose</h3> Evaluate the prevalence of fragility vertebral fractures after 50 years, the number of asymptomatic fractures, and eventually other forms of spinal disease which may constitute a differential diagnosis. <h3>Materials and Methods</h3> Prospective study conducted at the rheumatology department at the Hospital University of Ibn Rochd in Casablanca. The study included 51 patients ≥ 50 years old. Stady was done between December 2012 and March 2013. Patients made thoracolumbar spine radiograph X-Rays requested among the 73 cases. Last history factors, personal or family bone fragility were research. After physical examination, analysis of radiographs was based on the semi-quantitative method of Genant, specifying the grade, the seat and the number of FV. They were correlated with clinical and laboratory data. The prevalence of FV was calculate,and the percentage of asymptomatic fractures. <h3>Results</h3> Our population was predominantly female (86.2%). The mean age was 61 years. 66.6% of patients had back pain. 19 cases had at least one VF. Among them, six were asymptomatic. In the FV group, 6 patients had a personal history of bone fragility factors. 2 cases had a history of non-traumatic fracture and one case among parents. One patient was treated and cured for breast neoplasis. The majorities of patients were in vitamin D or already supplemented. 5 cases treated for osteoporosis, 10 patients were under anti-osteoporotic, 4 unknown osteoporotic. 11 cases followed for osteoarthritis. 3 cases had the notion of loss in size between 2 and 5 cm. 13 had a fracture grade I, 4 grade II and two grade III. 10 patients had a single fracture, 8 two fractures, and only one patient, 3 fractures. All fractures were lumbar seat and attributed to osteoporosis. Treatment was symptomatic and by orthopedic immobilization. Regarding the group without VF, in the subgroup without back pain, one case had a degenerative spinal deformity and 10 had no spine abnormality. As for the subgroup with back pain, 10 had spinal scoliosis, 4 cases had a degenerative spine, and 8 normal spine. <h3>Discussion and Conclusion</h3> The clinical signs of vertebral fractures are not specific. Their severity is variable. They pose problem of differential diagnosis of vertebral deformities or neoplastic. View prognosis, research vertebral fractures after 50 years is essential.
Clinical and immunologic evaluation of workers exposed to glutaraldehvde
Authors: A. D. Curran, P. S. Burge, K. Wiley
Journal: Allergy (1996)

We describe immunologic responses in subjects exposed to glutaraldehyde (GA) who were diagnosed as having occupational asthma, or who described work-related respiratory symptoms. A series of GA-modified proteins was characterized, and used to analyse sera from 20 GA-exposed workers and 21 unexposed workers for IgE antibodies. Inhibition studies were used to determine the specificity of binding. The reaction of GA with albumin in different molar ratios produced a range of modified proteins, which were used to measure specific IgE antibodies. A significant difference between exposed and unexposed subjects with serum IgE less than 150 kU/l could be detected for GA-specific IgE antibodies (P - 0.026), and 31% of exposed workers with occupational asthma had antibody levels greater than the unexposed population (mean +2.5 SD). False-positive results were obtained with serum from unexposed workers who had total IgE levels greater than 150 kU/l, but this binding was not inhibited by GA-modified proteins. We report the first evidence of immunologic sensitization in some workers exposed to GA. However, GA may behave like many other low-molecular-weight chemicals in that specific antibodies can be detected in only a small percentage of exposed workers who report work-related respiratory symptoms.