tbuckley/cabot-search huggingface dataset:
Can Health Care Teams Improve Primary Care Practice?
Authors: Kevin Grumbach
Journal: JAMA (2004)

In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.
A Novel Strategy in Prevention and Delay of Type I Diabetes Mellitus (T1DM) Onset by Autoimmunization
Authors: M.S. Lin, C. Wong, S. Bertera, J. Pignelli, H. Tse, M. Pietroppaolo, M. Milton, L. He, Y. Chang, Y. Zhang, R. Lakomy, J. Chang, M. Trucco
Journal: Journal of Allergy and Clinical Immunology (2008)
The amphioxus rab GDP-dissociation inhibitor (GDI) gene is neural- specific: implications for the evolution of chordate rab GDI genes
Authors: Z. Sedlacek, S. M. Shimeld, E. Munstermann, A. Poustka
Journal: Molecular Biology and Evolution (1999)

The rab GDP-dissociation inhibitor (rab GDI) proteins are involved in the regulation of vesicle-mediated cellular transport. We isolated the amphioxus rab GDI gene, analyzed its expression during amphioxus development, and performed a phylogenetic analysis of the rab GDI family. In contrast to the two major rab GDI forms in mammals, the alpha and beta forms, there is only one rab GDI isoform in amphioxus. Our analysis indicates that the occurrence of the alpha and beta forms of rab GDI preceded the divergence of lineages leading to birds and mammals, and that the amphioxus rab GDI may have evolved directly from the common ancestor of both forms. While the mammalian rab GDI beta-genes are ubiquitously expressed, the rab GDI alpha genes are predominantly expressed in neural tissues. The expression analysis of the amphioxus rab GDI gene shows predominantly neural expression similar to that of the mammalian rab GDI alpha form, suggesting that the ancestral expression pattern of chordate rab GDI was neural. In addition, the chicken rab GDI beta-like gene also shows neural-specific expression, which indicates that the neural expression was retained in both early postduplication alpha and beta isoforms and that a novel function associated with ubiquitous expression may have evolved uniquely in mammals. These results reveal a likely scenario of functional divergence of the rab GDI genes after duplication of the ancestral gene. A similar pattern of evolution, in which one of the duplicated genes retained a role similar to that of the ancestral one while other genes were recruited into novel roles, was also observed in the analysis of chordate Otx and hedgehog genes. In the rab GDI, hedgehog, and Otx gene families, the gene retaining the ancestral role shows a lower rate of sequence evolution than its counterpart, which was recruited for a novel function.
Thoughts on Future Contributions of Virology to Medicine
Authors: John F. Enders
Journal: New England Journal of Medicine (1964)

TO be chosen as its orator by this society confers upon any member a high distinction and at the same time imposes a heavy responsibility. For me, an associate member, the honor becomes overwhelming, and the task of offering a discourse that might be in general interesting to you as physicians appears highly formidable. I have therefore given much thought to the choice of subject. I first considered rather broad topics that might seem timely to anyone with a concern for the future of medicine, such as the present state of the marital relations between medicine and natural science. It . . .
Serum Cholinesterase Activity and Arterial Blood Pressure
Authors: LOUIS J. VORHAUS
Journal: Circulation (1952)

Conflicting data have appeared in the literature regarding serum cholinesterase and blood pressure. The studies reported here were undertaken to establish or refute the existence of a direct relationship between these two factors. Two types of studies were performed. First, serum cholinesterase activity was measured in 63 unselected hypertensive patients. Second, a selected group of seven hypertensive patients and three healthy subjects was studied with a variety of drugs known to influence either blood pressure or serum cholinesterase. Results indicate that no direct relationship exists between blood pressure and serum cholinesterase and that fluctuations in these two factors occur independently of each other.
Effect of Antecedent Hypoglycemia on Cognitive Function and on Glycemie Thresholds for Counterregulatory Hormone Secretion in Healthy Humans
Authors: Michael J Mellman, Maris R Davis, Michelle Brisman, Harry Shamoon
Journal: Diabetes Care (1994)

OBJECTIVE To determine whether reduced hormonal, symtomatic, and/or cognitive responses to hypoglycemia are caused by an increase in the plasma glucose concentration required to stimulate these counterregulatory parameters after antecedent hypoglycemia. RESEARCH DESIGN AND METHODS We studied nine healthy volunteers during stepped hypoglycemia clamps (plasma glucose targets from 80 to 50 mg/dl in 10 mg/dl steps) on two separate days. The study was preceded either by a 2-h period of hypoglycemia (plasma glucose 58 ± 2 mg/dl) or a 2-h period of euglycemia (plasma glucose 94 ± 2 mg/dl) for 90 min. RESULTS The plasma glucose that triggered secretion of-plasma norepinephrine (NE) was lower after antecedent hypoglycemia (control = 74 ± 2 and experimental = 67 ± 2 mg/dl, respectively, P &amp;lt; 0.005). In contrast, a relatively higher plasma glucose stimulated secretion of other counterregulatory hormones after anteceden hypoglycemia: growth hormone (GH) (65 ± 2 to 72 ± 2 mg/dl, P &amp;lt; 0.01); glucagon (63 ± 2 to 70 ± 2 mg/dl, P &amp;lt; 0.01); and epinephrine (EPI) (68 ± 2 to 76 ± 2 mg/dl, P &amp;lt; 0.01) when comparing control days with experimental days. Hypoglycemic symptoms were first observed at a plasma glucose plateau of 59 ± 2 mg/dl. Motor function reflected by Digit Symbol Substitution deteriorated equally whether there had been antecedent hypoglycemia or euglycemia. Logical (immediate) memory deteriorated in the control study at a plasma glucose of 54 ± 2 mg/dl but remained unchanged at equivalent hypoglycemia in the experimental study (P / 0.03). CONCLUSIONS Our conclusions are as follows: 1) symptoms of moderate hypoglycemia occur at plasma glucose levels averaging ∼5-15 mg/dl lower than the plasma glucose concentrations required to trigger counterregulatory hormone release; 2) after acute antecedent hypoglycemia, glucagon, EPI, and GH secretion occur at higher plasma glucose concentrations and NE is released at lower plasma glucose concentrations; and 3) there may be CNS adaptation to prior hypoglycemia reflected in preservation of logical memory function at plasma glucose levels of ∼50 mg/dl. These findings suggest that thresholds for hormone secretion and for changes in cognitive function can be altered very acutely by foregoing hypoglycemia in healthy humans.
Improving women doctors' ability to achieve their full leadership potential
Authors: V. Nath, C. Marx, P. Lees, K. Kasaraneni, S. Davies
Journal: BMJ (2014)

Very many variations of facial grading systems have been developed, but none address the ophthalmic complications of facial nerve weakness adequately. The important priorities for ophthalmic surgeon are protecting the ocular surface, maintaining sight and peripheral vision, as well as improving the cosmesis of periocular area. The absence of a universally agreed grading system on the ophthalmic plastic complications of facial nerve paralysis is an obstacle to standardised treatment. It is time for clinicians to recognise this need.
THE TREATMENT OF GASTRIC AND DUODENAL ULCER
Authors: FRANK H. LAHEY
Journal: JAMA (1930)

The incidence of gastric and duodenal ulcer is considerable. Between January, 1924, and May, 1930, 900 patients with gastric or duodenal ulcers have entered the clinic. Of these ulcers, 771, or 85 per cent, were duodenal; 87, or 10 per cent, were gastric; 42, or 5 per cent, were gastrojejunal.  In a series of 759 cases occurring between 1924 and 1929, massive hemorrhage had occurred during or prior to entrance in 139, or 18 per cent, of the cases. Hemorrhage occurred in 119 of the duodenal ulcers, or 18 per cent; in 12 of the gastric ulcers, or 18 per cent; in 7 of the gastrojejunal ulcers, or 32 per cent; and in the combined gastric and duodenal ulcers in one, or 10 per cent. Obstruction occurred in 66 cases, or 8.6 per cent. Of the patients with duodenal ulcers, 7.8 per cent showed obstruction on entering the clinic. Of
Medical care in inner cities.
Authors: A Elliott
Journal: BMJ (1978)

discharged no matter how overcrowded the hospital might have been.(5) The complaint is primarily against the authority and not against the individual doctor.Of course the Select Committee said it would have been "appropriate" for the commissioner to have contacted the doctor and that the authority should have done so initially, and they "note" that the authority did not contact the doctor when the draft report was submitted for comment.But they confirmed the decision and they confirmed it without contacting the doctor themselves.Meanwhile, in America, the senior house officer comes off best.He now lives in a country where all men can defend themselves if complaints are made against them.But we don't.
127 PREVALENCE AND FACTORS ASSOCIATED WITH LIVER STIFFNESS MEASUREMENT FAILURE AND UNRELIABLE RESULTS USING FIBROSCAN: A 5 YEAR EXPERIENCE IN 13369 EXAMINATIONS
Authors: L. Castera, J. Foucher, P.-H. Bernard, F. Carvalho, D. Allaix, W. Merrouche, P. Couzigou, V. de Ledinghen
Journal: Journal of Hepatology (2009)
Levels and Changes of HDL Cholesterol and Apolipoprotein A-I in Relation to Risk of Cardiovascular Events Among Statin-Treated Patients
Authors: S. Matthijs Boekholdt, Benoit J. Arsenault, G. Kees Hovingh, Samia Mora, Terje R. Pedersen, John C. LaRosa, K.M.A. Welch, Pierre Amarenco, David A. DeMicco, Andrew M. Tonkin, David R. Sullivan, Adrienne Kirby, Helen M. Colhoun, Graham A. Hitman, D. John Betteridge, Paul N. Durrington, Michael B. Clearfield, John R. Downs, Antonio M. Gotto, Paul M. Ridker, John J.P. Kastelein
Journal: Circulation (2013)

Background— It is unclear whether levels of high-density lipoprotein cholesterol (HDL-C) or apolipoprotein A-I (apoA-I) remain inversely associated with cardiovascular risk among patients who achieve very low levels of low-density lipoprotein cholesterol on statin therapy. It is also unknown whether a rise in HDL-C or apoA-I after initiation of statin therapy is associated with a reduced cardiovascular risk. Methods and Results— We performed a meta-analysis of 8 statin trials in which lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up. Individual patient data were obtained for 38 153 trial participants allocated to statin therapy, of whom 5387 suffered a major cardiovascular event. HDL-C levels were associated with a reduced risk of major cardiovascular events (adjusted hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.81–0.86 per 1 standard deviation increment), as were apoA-I levels (HR, 0.79; 95% CI, 0.72–0.82). This association was also observed among patients achieving on-statin low-density lipoprotein cholesterol levels &lt;50 mg/dL. An increase of HDL-C was not associated with reduced cardiovascular risk (HR, 0.98; 95% CI, 0.94–1.01 per 1 standard deviation increment), whereas a rise in apoA-I was (HR, 0.93; 95% CI, 0.90–0.97). Conclusions— Among patients treated with statin therapy, HDL-C and apoA-I levels were strongly associated with a reduced cardiovascular risk, even among those achieving very low low-density lipoprotein cholesterol. An apoA-I increase was associated with a reduced risk of major cardiovascular events, whereas for HDL-C this was not the case. These findings suggest that therapies that increase apoA-I concentration require further exploration with regard to cardiovascular risk reduction.
Anti-HIV drug resistance is increasing in US patients
Authors: S. Gottlieb
Journal: BMJ (2002)

Widespread misuse of anti-HIV drugs has led to the development of drug resistant viruses in at least half the people being treated for HIV in the United States.

Most striking, researchers told the recent Interscience Committee on Antibiotics and Chemotherapy meeting in Chicago, is the demographic breakdown of drug resistance. Contrary to forecasts made in 1996, when combination drug treatment was introduced, it is not poor people and intravenous drug …
Prevalence, Distribution, and Impact of Mild Cognitive Impairment in Latin America, China, and India: A 10/66 Population-Based Study
Authors: Ana Luisa Sosa, Emiliano Albanese, Blossom C. M. Stephan, Michael Dewey, Daisy Acosta, Cleusa P. Ferri, Mariella Guerra, Yueqin Huang, K. S. Jacob, Ivonne Z. Jiménez-Velázquez, Juan J. Llibre Rodriguez, Aquiles Salas, Joseph Williams, Isaac Acosta, Maribella González-Viruet, Milagros A. Guerra Hernandez, Li Shuran, Martin J. Prince, Robert Stewart
Journal: PLoS Medicine (2012)

A set of cross-sectional surveys carried out in Cuba, Dominican Republic, Peru, Mexico, Venezuela, Puerto Rico, China, and India reveal the prevalence and between-country variation in mild cognitive impairment at a population level.
Combining Milatuzumab with Bortezomib, Doxorubicin, or Dexamethasone Improves Responses in Multiple Myeloma Cell Lines
Authors: Rhona Stein, Mitchell R. Smith, Susan Chen, Maria Zalath, David M. Goldenberg
Journal: Clinical Cancer Research (2009)

Abstract Purpose: The humanized anti-CD74 monoclonal antibody, milatuzumab, is in clinical evaluation for the therapy of multiple myeloma (MM). The ability of milatuzumab to increase the efficacy of bortezomib, doxorubicin, and dexamethasone was examined in three human CD74+ MM cell lines, CAG, KMS11, KMS12-PE, and one CD74-MM cell line, OPM-2. Experimental Design: Activity of milatuzumab as a monotherapy and combined with the drugs was evaluated by studying in vitro cytotoxicity, signaling and apoptotic pathways, and in vivo therapeutic activity in severe combined immunodeficient (SCID) mouse models of MM. Results: Given as a monotherapy, cross-linked milatuzumab, but not milatuzumab alone, yielded significant antiproliferative effects in CD74+ cells. The combination of cross-linked milatuzumab with bortezomib, doxorubicin, or dexamethasone caused more growth inhibition than either cross-linked milatuzumab or drug alone, producing significant reductions in the IC50 of the drugs when combined. Efficacy of combined treatments was accompanied by increased levels of apoptosis measured by increases of activated caspase-3 and hypodiploid DNA. Both milatuzumab and bortezomib affect the nuclear factor-κB pathway in CAG MM cells. In CAG- or KMS11-SCID xenograft models of disseminated MM, milatuzumab more than doubled median survival time, compared with up to a 33% increase in median survival with bortezomib but no significant benefit with doxorubicin. Moreover, combining milatuzumab and bortezomib increased survival significantly compared with either treatment alone. Conclusions: The therapeutic efficacies of bortezomib, doxorubicin, and dexamethasone are enhanced in MM cell lines when given in combination with milatuzumab, suggesting testing these combinations clinically.
PREVALENCE OF CHRONOTROPIC INCOMPETENCE IN PATIENTS UNDERGOING EXERCISE TESTING IN A CONTEMPORARY CARDIOLOGY PRACTICE
Authors: Arun Kundra, Vasant Patel, Jugalkishor (Jay) Shah, Pradeep Singh, Sushil Singhi, Talal Baki, Naresh Mori, Tammy Guinea, Maria Allman, Michael Elfert, Jonathan M. Hubbard, Donald L. Hopper
Journal: Journal of the American College of Cardiology (2014)
MICROBIAL PERSISTENCE
Authors: Robert M. McCune, Floyd M. Feldmann, Walsh McDermott
Journal: The Journal of Experimental Medicine (1966)

The capability of tubercle bacilli to assume a long continued sterile state in the tissues when exposed to pyrazinamide and isoniazid is a highly specific drug-microbe phenomenon in which host participation is not critical. Although it is the pyrazinamide that possesses the sterilizing type of action, the role of the isoniazid is specific and essential. The isoniazid serves to convert a phenomenon that occurs irregularly with pyrazinamide alone into one that occurs with a high degree of uniformity. The observations suggest a competition between isoniazid and the pyrazinamide (or its parent nicotinamide) for a site or entrance in or on the tubercle bacilli and for sterilization, the isoniazid apparently must reach the site first. The rare failures to attain complete sterilization, appear to depend on the emergence of pyrazinamide-resistance which prevents the necessary dependent action of the two drugs. Populations already in the sterile state are nevertheless subject to a continued drug influence. Whether this represents a direct action on the sterile bacilli or an indirect effect produced by making the environment hostile to microbial revival, cannot be determined from the present observations.
Multiple ADH genes are associated with upper aerodigestive cancers
Authors: Mia Hashibe, James D McKay, Maria Paula Curado, Jose Carlos Oliveira, Sergio Koifman, Rosalina Koifman, David Zaridze, Oxana Shangina, Victor Wünsch-Filho, Jose Eluf-Neto, Jose Eduardo Levi, Elena Matos, Pagona Lagiou, Areti Lagiou, Simone Benhamou, Christine Bouchardy, Neonilia Szeszenia-Dabrowska, Ana Menezes, Marinel Mór Dall'Agnol, Franco Merletti, Lorenzo Richiardi, Leticia Fernandez, Juan Lence, Renato Talamini, Luigi Barzan, Dana Mates, Ioan Nicolae Mates, Kristina Kjaerheim, Gary J Macfarlane, Tatiana V Macfarlane, Lorenzo Simonato, Cristina Canova, Ivana Holcátová, Antonio Agudo, Xavier Castellsagué, Ray Lowry, Vladimir Janout, Helena Kollarova, David I Conway, Patricia A McKinney, Ariana Znaor, Eleonora Fabianova, Vladimir Bencko, Jolanta Lissowska, Amelie Chabrier, Rayjean J Hung, Valerie Gaborieau, Paolo Boffetta, Paul Brennan
Journal: Nature Genetics (2008)
The Trainee as a Teacher in the Community Hospital
Authors: Howard M. Spiro, Vincent A. DeLuca
Journal: New England Journal of Medicine (1967)

CURRENT views of the Cancer, Stroke and Heart Disease Program suggest that vital to the improvement of the health of the American public is closer communication between physicians. Discussion of ways by which the free flow of thoughts between physicians in university hospitals and those in community hospitals may be stimulated has included such complicated programs as bidirectional television, radio broadcasts, educational tapes and other paraphernalia of the automated age.There is no effective substitute for face-to-face dialogue; the interposition of mechanical technics between physicians diverts attention from the message to the procedure. For the teaching of clinical medicine, the . . .
Allogeneic hematopoietic cell transplant in HCV-infected patients
Authors: Régis Peffault de Latour, Patricia Ribaud, Marie Robin, Dominique Valla, Patrick Marcellin, Gérard Socié, Tarik Asselah
Journal: Journal of Hepatology (2008)

Hepatitis C virus (HCV) is a major cause of liver disease worldwide. After allogeneic Hematopoietic Cell Transplant (HCT), HCV is known to be associated with transient hepatitis in the immediate post-transplant period, and a potential risk factor of veno-occlusive disease (SOS). Very recently, HCV-infected HCT recipients have been shown to be at higher risk of earlier cirrhosis, leading to greater morbidity and mortality. Long-term survivors after HCT are thus at a high risk for HCV-related complications and, as a consequence, the treatment of HCV infection becomes critical. We describe here the potential clinical complications in HCV-infected recipients, in the short, but also the long-term follow-up after HCT. The pathophysiology of liver fibrosis is discussed as well as the present recommended therapy in this particular population.
Norman Dallas MacRorie
Authors: Roderick MacRorie
Journal: BMJ (2006)

​FormerFormer general practitioner Brighton (b 1931; q Glasgow 1955), died from motor neurone disease on 16 January 2006.



Figure 1



After an early postgraduate interest in neuropsychiatry and to avoid call-up for national service Norman MacRorie emigrated to the United States. He worked for more than 10 years as a staff psychiatrist in New York City. Disillusioned by the “anti-psychiatry” movement, he retrained in general practice in Sussex and worked singlehanded until his 70th birthday. Three months later he developed foot drop, eventually diagnosed as motor neurone disease. He converted his surgery premises into a disabled flat and died in bed in his former consulting room. He leaves a wife, four children, and four grandchildren.
Skeletal muscle metabolism is a major determinant of resting energy expenditure.
Authors: F Zurlo, K Larson, C Bogardus, E Ravussin
Journal: Journal of Clinical Investigation (1990)

Energy expenditure varies among people, independent of body size and composition, and persons with a "low" metabolic rate seem to be at higher risk of gaining weight. To assess the importance of skeletal muscle metabolism as a determinant of metabolic rate, 24-h energy expenditure, basal metabolic rate (BMR), and sleeping metabolic rate (SMR) were measured by indirect calorimetry in 14 subjects (7 males, 7 females; 30 +/- 6 yr [mean +/- SD]; 79.1 +/- 17.3 kg; 22 +/- 7% body fat), and compared to forearm oxygen uptake. Values of energy expenditure were adjusted for individual differences in fat-free mass, fat mass, age, and sex. Adjusted BMR and SMR, expressed as deviations from predicted values, correlated with forearm resting oxygen uptake (ml O2/liter forearm) (r = 0.72, P less than 0.005 and r = 0.53, P = 0.05, respectively). These findings suggest that differences in resting muscle metabolism account for part of the variance in metabolic rate among individuals and may play a role in the pathogenesis of obesity.
Appropriateness Criteria and Elective Procedures — Total Joint Arthroplasty
Authors: Hassan M.K. Ghomrawi, Bruce R. Schackman, Alvin I. Mushlin
Journal: New England Journal of Medicine (2012)

The implementation of appropriateness criteria that help to identify the patients likely to benefit most from a given procedure could help to combat increasing health care costs while enhancing access and quality. Total joint arthroplasty offers a prime example.
MEASUREMENT OF CARDIAC OUTPUT IN MAN USING THE TECHNIQUE OF CATHETERIZATION OF THE RIGHT AURICLE OR VENTRICLE
Authors: A. Cournand, R. L. Riley, E. S. Breed, E. DeF. Baldwin, D. W. Richards, M. S. Lester, M. Jones
Journal: Journal of Clinical Investigation (1945)

Determination of cardiac output on the basis of the so-called Fick principle requires the measurement of oxygen or of carbon dioxide content of arterial blood, and of mixed venous blood, and the total oxygen intake or carbon dioxide elimination by the lungs, per unit of time.With these values, cardiac output is obtained from either of the following two equations:(a) Cardiac output (ml.per minute) 02 intake, ml. per minute X 100 Arterial 02, volumes per cent -venous 02, volumes per cent (b) Cardiac output (ml.per minute) CO2 output, ml. per minute X 100Venous C02, volumes per cent -arterial C02, volumes per cent