tbuckley/cabot-search huggingface dataset:
Does the district general hospital have a future?
Authors: Chris Ham
Journal: BMJ (2005)

Increased patient choice and a bigger role for the independent sector threaten the future of district general hospitals. As the public remains firmly attached to these hospitals, a managed transition represents a huge political challenge 

It was in 1962 that Enoch Powell, then minister of health, published the Hospital Plan for England and Wales .1 The plan served as a framework for the development of hospital services in the decades that followed, leading to the building of many new hospitals and the refurbishment of others. At the heart of this framework was the district general hospital, designed to provide a comprehensive range of inpatient and outpatient services to populations of 100 000 to 150 000. District general hospitals have formed the backbone of NHS hospital care ever since.

Today, many of these hospitals face an uncertain future. The uncertainty has arisen as a result of advances in healthcare technology enabling more specialist services to be provided outside the hospital, changes in the workforce (particularly a reduction in the hours worked by doctors in training), evidence that some services are better concentrated in fewer centres able to achieve superior outcomes, and government policies designed to increase patient choice and stimulate greater efficiency in the use of resources. Here, I focus on the effect of government policies.

The over-riding objective of health policy since the election of the Labour government in 1997 has been reducing waiting lists and waiting times for treatment. In pursuit of this objective, the government has procured extra treatment capacity and introduced reforms to increase patient choice. These reforms include a new approach to funding hospitals, payment by results, under which money will follow patients to the hospitals of their choice. Patient choice and payment by results create the conditions in which hospitals will compete with each …
Staying Is Harder Than Getting There
Authors: William R. Barclay
Journal: JAMA (1978)

Regular exercise that improves general physical fitness may lessen the risk of a heart attack and may increase one's capability of dealing with illness should it occur. Therefore, although a desk-bound editor, I elected to engage in a program of physical conditioning, and from the many programs widely publicized, selected that recommended by Kenneth H. Cooper.<sup>1</sup>Jogging in the early morning was pleasant during the summer, and the anticipation of reaching a goal, modestly set at a 3-km run each morning in 17 minutes, made the effort seem easy and worthwhile. Friends and family remarked on my improved appearance, I felt fitter and more energetic, and having reached the preset goal, I felt some smug satisfaction. However, the lovely summer mornings gave way to the dark, cold, and wet mornings of late fall, and the realization finally dawned that in pursuing a goal, it is much harder to stay than
Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: A clinical validation study
Authors: Daniel S. Berman, Hosen Kiat, John D. Friedman, Fan Ping Wang, Kenneth Van Train, Lisa Matzer, Jamshid Maddahi, Guido Germano
Journal: Journal of the American College of Cardiology (1993)
Abstract 930: p38 MAPK is required for the antitumor activity of the vascular disrupting agent DMXAA
Authors: Liguang Lou, Qiong Wu, Haitian Quan, Yongping Xu
Journal: Cancer Research (2012)

Abstract 5, 6-Dimethylxanthenone-4-acetic acid (DMXAA), a potent vascular disrupting agent, selectively destroys established tumor vasculature, causing a rapid collapse in blood flow that ultimately leads to inhibition of tumor growth. In this study, we explored the role of p38 MAPK in the antitumor activity of DMXAA. It was found that p38 MAPK was critically involved in DMXAA-induced cytoskeleton reorganization in endothelial cells and TNF-α production in macrophages, both of which were essential for DMXAA-induced vascular disruption. Inhibition of p38 MAPK significantly attenuated DMXAA-induced actin cytoskeleton reorganization in human umbilical vein endothelial cells and TNF-α production in macrophages. In vivo, p38 MAPK inhibition attenuated the immediate reduction in tumor blood flow induced by DMXAA treatment (&amp;lt;30 min) by inhibiting actin cytoskeleton reorganization in tumor vascular endothelial cells, and blunted the long-lasting (&amp;gt;4 h) DMXAA-induced shutdown of the tumor vasculature by inhibiting intratumoral TNF-α production. Our results indicate that p38 MAPK is required for DMXAA-induced endothelial cell cytoskeleton reorganization and TNF-α production, and thus regulates DMXAA-induced antitumor activity. 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 930. doi:1538-7445.AM2012-930
Serum Guanase in Differential Diagnosis of Jaundice.
Authors: Eugene L. Coodley
Journal: Annals of Internal Medicine (1969)

s1 May 1969Serum Guanase in Differential Diagnosis of Jaundice.Eugene L. Coodley, M.D., F.A.C.P.Eugene L. Coodley, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-5-1066_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPreliminary studies have suggested that serum guanase may be a sensitive index of liver cell damage, and the development of newer, simplified analytic procedures has stimulated this study of the new enzyme procedure in a series of patients with hepatobiliary diseases.A series of 75 patients with either hepatitis or other causes of jaundice were studied with simultaneously performed serum guanase, serum glutamic-oxalacetic transaminase, serum glutamic-pyruvic transaminase, and serum bilirubin determinations.Serum guanase was significantly elevated in 48 of 54 patients with hepatitis and in only 5 of 21 patients with various other causes of jaundice, including cirrhosis, extrahepatic obstruction,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Eugene L. Coodley, M.D., F.A.C.P.Affiliations: Philadelphia, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1969Volume 70, Issue 5Page: 1066-1066KeywordsAminotransferasesBilirubinCirrhosisEnzymesHepatitisHepatitis ALiverLiver diseases ePublished: 1 December 2008 Issue Published: 1 May 1969 PDF downloadLoading ...
THERAPEUTIC PROGRAMMING FOR THE NON-PSYCHOTIC PATIENT
Authors: CARROLL M. BRODSKY, AMES FISCHER
Journal: American Journal of Psychiatry (1964)

Forty-seven patients suffering from personality disorders manifested through somatic symptoms or behavioral crises were treated by short-term hospitalization on a ward reserved primarily for acute psychotic disorders. The patients had been refractory to previous treatment approaches. The average hospitalization lasted 16 days and consisted of a highly structured program designed to restore the patient to social functioning and to provide a setting and a vocabulary for converting somatic and behavioral expression into verbal expression. Family members were involved in the treatment. In most of the cases there was a complete loss of presenting symptoms and disturbance at the time of discharge. A follow-up study 18-30 months after discharge revealed that the gains persisted in 2/3 of the group evaluated. The results are attributed to specific social, psychological, and educational processes requiring a particular kind of ward structure and staff attitude for successful results.
&lt;emph type="ital"&gt;A Cup of Water and a Rose on a Silver Plate&lt;/emph&gt;
Authors: Janet M. Torpy
Journal: JAMA (2009)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Effects of Diuretic Therapy on the Development of Tolerance to Nitroglycerin and Exercise Capacity in Patients With Chronic Stable Angina
Authors: John D. Parker, Andrea B. Parker, Bernice Farrell, John O. Parker
Journal: Circulation (1996)

Background Therapy with diuretics has been reported to prevent the development of nitrate tolerance. Importantly, diuretics may have independent antianginal effects through their effects on intravascular volume. The present investigation was designed to determine whether diuretic therapy could prevent the development of tolerance to continuous transdermal nitroglycerin. The study was also designed to examine whether diuretic therapy has an independent antianginal effect. Methods and Results Twelve patients with chronic stable angina were studied in a randomized, double-blind, crossover trial. Patients received diuretic (hydrochlorothiazide plus amiloride) or placebo for 14 to 20 days. During each double-blind treatment period, patients underwent treadmill exercise testing on three separate occasions. The first exercise testing was performed after 7 to 10 days of single-blind, placebo transdermal nitroglycerin therapy. Subsequently, exercise testing was repeated on the first day of active transdermal nitroglycerin therapy and following 7 to 10 days of continuous transdermal nitroglycerin application. Therapy with a diuretic was associated with an increase in exercise capacity but had no effect on nitroglycerin tolerance. During therapy with placebo transdermal nitroglycerin, diuretic therapy caused an increase in treadmill walking time to the development of moderate angina compared with placebo (371±26 versus 288±16 seconds, diuretic versus placebo, P &lt;.01). Similar results were obtained during both acute and sustained nitroglycerin therapy. Conclusions The results of this study demonstrate that therapy with a diuretic has no effect on the development of tolerance to continuous transdermal nitroglycerin. Interestingly, diuretic therapy itself has important antianginal effects and improves exercise capacity in patients with stable angina.
Structure-activity relationships in the free-radical metabolism of xenobiotics.
Authors: C F Chignell
Journal: Environmental Health Perspectives (1985)

Many xenobiotics, including naturally occurring compounds, drugs, and environmental agents, are metabolized both in vivo and in vitro to free-radical intermediates. The one-electron reduction of nitroaromatic compounds, quinones, and a wide variety of other chemicals is catalyzed enzymatically by a number of reductases and dehydrogenases. Structure-activity studies have shown that the cytotoxicities of nitroaromatic compounds and quinones are related to their one-electron reduction potentials (E1(7)). Other factors such as oil:water partition coefficients may also be important. Xenobiotics may also be oxidized to free radicals by peroxidases. Hammett's rules apply to the one-electron oxidation of simple meta- or para-substituted phenols and amines by horseradish peroxidase, compound I.
Access to HIV drugs should be widened, says WHO
Authors: A. Gulland
Journal: BMJ (2013)

Antiretrovirals to treat adults with HIV should be given earlier and to more people, new guidelines from the World Health Organization have said.

The guidelines, which are aimed at low and middle income countries, state that all countries should start treatment in adults with HIV when their CD4 cell count falls to 500 cells/mm3 or fewer, even if they are not sick or showing any symptoms.1 The previous recommendation, published in 2010, was to offer treatment at 350 CD4 cells/mm3 or fewer.

For the first time the guidelines also state that regardless of the stage of the disease all HIV positive children aged under 5 years, all HIV positive pregnant and breastfeeding women, and all HIV positive patients with an HIV negative …
Anaphylactoid Reactions to Oral Administration of Penicillin
Authors: Jack M. Batson
Journal: New England Journal of Medicine (1960)

PENICILLIN reactions may be immediate, delayed or accelerated. Those that are immediate occur within minutes of the administration of the agent; the others take place much later. The term "anaphylactoid reactions" refers only to severe immediate systemic reactions associated with hypotension and often a shocklike state.The possibility of an anaphylactoid reaction to parenterally administered penicillin is well known. Reactions of all types seem to be more prevalent after the parenteral than after the oral therapy. However, reactions to oral administration occur, and these may reach alarming proportions.Few studies of the incidence of penicillin reactions have been made, but . . .
India: no homosexuals here
Authors: Balaji Ravichandran
Journal: BMJ (2005)

T hat homosexuality is still a criminal offence under section 377 of India's penal code is a sad reality. Perhaps what is even more sad is that many if not most Indian medical educators, including practising doctors, are homophobic and believe that homosexuality is a mental deviation that needs treatment.

In my sophomore year much teaching focused on the effect of HIV and AIDS on the health of Indians. I was shocked when my professor declared, “In Western countries, it primarily spreads among homosexuals. Of course, in our country, we don't have any homosexuals.” I protested, declaring that homosexuality is very much prevalent in our country. He was indifferent, and my colleagues were annoyed.

> Sexuality in general is a big taboo in India 

Later I approached the professor and asked him what he thought of homosexual people. He declared his belief that there is no such thing as homosexuality and that it was a US invention. To see if this was echoed by others I tried …
Abstract 10355: Electrocardiographically Determined Left Ventricular Mass Index and Incident Diabetes
Authors: Mercedes R Carnethon, Cora E Lewis, Kiang Liu, Hongyan Ning, Pamela J Schreiner, Stephen Sidney, Elsayed Z Soliman, Donald M Lloyd-Jones
Journal: Circulation (2010)

Objective: Electrocardiography (ECG) is a measure of cardiac damage that can predict clinical cardiovascular events. In a post-hoc analysis of the Losartan Intervention for Endpoint Reduction (LIFE...
Interest Surging in Electroconvulsive and Other Brain Stimulation Therapies
Authors: Lynne Lamberg
Journal: JAMA (2007)

San Diego—A course of electroconvulsive therapy (ECT) every 9 or 10 months keeps her cyclic depression at bay, Kitty Dukakis said in an invited lecture at the annual meeting of the American Psychiatric Association (APA) here in May.
Withdrawal of Anticonvulsant Drugs in Patients Free of Seizures for Two Years
Authors: N Callaghan, A Garrett, T Goggin
Journal: New England Journal of Medicine (1988)

We discontinued anticonvulsant drugs in 92 patients who had been free of seizures during two years of treatment with a single drug. All the patients had epilepsy that had previously been untreated, and had been randomly assigned to receive carbamazepine, phenytoin, or sodium valproate. Thirty-one patients relapsed, and 61 remained free of seizures. The mean duration of the follow-up in the patients remaining free of seizures was 35 months (range, 6 to 62). There was no significant difference between the relapse rate among adults (35 percent) and that among children (31 percent). Our results suggest that the number of seizures a patient had before control was achieved, the number of drugs tried as single-drug therapy, and the type of treatment withdrawn all influenced the outcome. Among the various types of seizures, complex partial seizures with secondary generalization carried the worst prognosis. In comparison, the risk of relapse was 65 percent lower in patients with generalized seizures and 97 percent lower in patients with complex or simple partial seizures in the absence of secondary generalized attacks. Among the four electroencephalographic classes, class 4 (abnormal before treatment and unchanged before withdrawal) carried the worst prognosis. The risk of relapse was 94 to 99 percent lower in patients in the other three electroencephalographic classes. Among the three anticonvulsants, withdrawal of sodium valproate carried the worst prognosis. In comparison, the odds of relapsing were 28 percent lower after withdrawal of phenytoin and 85 percent lower after withdrawal of carbamazepine. We conclude that withdrawal of anticonvulsant medication should be considered in patients free of seizures for two years.
Letter: Ventricular dysrhythmias and thioridazine in alcohol withdrawal.
Authors: R W Newton
Journal: BMJ (1973)

<b>Objective</b> To determine from a societal perspective the risk of sudden cardiac death associated with running in an organised marathon compared with the risk of dying from a motor vehicle crash that might otherwise have taken place if the roads had not been closed. <b>Design</b> Population based retrospective analysis with linked ecological comparisons of sudden death. <b>Setting</b> Marathons with at least 1000 participants that had two decades of history and were on public roads in the United States, 1975-2004. <b>Main outcome measures</b> Sudden death attributed to cardiac causes or to motor vehicle trauma. <b>Results</b> The marathons provided results for 3 292 268 runners on 750 separate days encompassing about 14 million hours of exercise. There were 26 sudden cardiac deaths observed, equivalent to a rate of 0.8 per 100 000 participants (95% confidence interval 0.5 to 1.1). Because of road closure, an estimated 46 motor vehicle fatalities were prevented, equivalent to a relative risk reduction of 35% (95% confidence interval 17% to 49%). The net reduction in sudden death during marathons amounted to a ratio of about 1.8 crash deaths saved for each case of sudden cardiac death observed (95% confidence interval: 0.7 to 3.8). The net reduction in total deaths could not be explained by re-routing traffic to other regions or days and was consistent across different parts of the country, decades of the century, seasons of the year, days of the week, degree of competition, and course difficulty. <b>Conclusion</b> Organised marathons are not associated with an increase in sudden deaths from a societal perspective, contrary to anecdotal impressions fostered by news media.
Issues in clinical practice
Authors: N. A. Mir
Journal: BMJ (2010)

<h3>Abstract</h3> <h3>Background</h3> Vaccinations are the best hope to control the COVID-19 pandemic and save lives. Due to the high demand and failure to share vaccines equitably, there were not enough vaccine supplies to cover the majority of people in low- and middle-income countries during the early stage of vaccination. To cope with this problem, Thailand, an upper-middle-income country, decided to employ a heterologous vaccination strategy as the primary COVID-19 vaccination regimen in the country. The CoronaVac (CV) vaccine was administered as the first dose, followed by the ChAdOx1 nCoV-19 (AZ) vaccine as the second dose. However, there is no study to assess the effectiveness of the heterologous vaccination employed in Thailand compared to the standard homologous vaccination. <h3>Methods</h3> We delineated the course and timeline of COVID-19 vaccination in Thailand. An age-structured compartmental model for COVID-19 transmission and vaccination was constructed and employed to assess the effectiveness of the heterologous vaccination strategy. The impact of the vaccine prioritization strategies on COVID-19 mortality and infections was also investigated. <h3>Results</h3> We found that the CV+AZ heterologous vaccination strategy outperforms the separate CV and AZ homologous vaccinations in reducing cumulative cases and deaths when combined with other non-pharmaceutical interventions. Furthermore, the results suggested that prioritizing vaccines for the elderly could be optimal in reducing COVID-19 mortality for a wide range of vaccination rates and disease transmission dynamics. <h3>Conclusions</h3> Our modeling results suggested that to minimize the impacts of inequity in early COVID-19 vaccine access in low- and middle-income countries, those countries may use early accessible but maybe lower-efficacy vaccines as the first dose of heterologous vaccination in combination with higher-efficacy vaccines as the second dose when they are available.
A Paper That Changed My Thinking: Are patients a myth?
Authors: D. Misselbrook
Journal: BMJ (1997)

The big idea of this paper is that medical histories, as presented on ward rounds, are part of a historic oral narrative tradition.1 The paper uses the oral-formulaic theory of two classical scholars (Parry and Lord) to compare the narrative of a typical case presentation to Homer's Iliad .

An oral formula is “a group of words which is regularly employed under the same metrical conditions to express a given essential idea.” A bardic performer would use a series of formulae (often noun adjective phrases–for example, “much enduring divine Odysseus” or “the goddess grey eyed Athene”). These are then linked together by verbs or brief snatches of free text. Starting from a source story, the skilled bard would create a …
Influence on immunoreactive folate-binding proteins of extracellular folate concentration in cultured human cells.
Authors: M A Kane, P C Elwood, R M Portillo, A C Antony, V Najfeld, A Finley, S Waxman, J F Kolhouse
Journal: Journal of Clinical Investigation (1988)

The influence of extracellular folate concentration on cellular levels of the folate transport protein and its soluble product was studied directly in cultured human nasopharyngeal carcinoma (KB) cells. As determined by radioimmunoassay, levels of the folate transport protein and the soluble folate-binding protein were 58 +/- 17 (mean +/- SD) and 5 +/- 2 pmol/mg cell protein, respectively, in KB cells maintained in standard medium (containing 2,300 nM folic acid). These levels significantly increased to 182 +/- 34 and 26 +/- 6 pmol/mg cell protein, respectively, in KB cells serially passaged in low folate medium (containing 2-10 nM 5-methyltetrahydrofolate). Increases in folate-binding protein levels occurred more rapidly in KB cells serially passaged in very low folate medium containing less than 2 nM folate and were prevented by the addition of 100 nM 5-methyltetrahydrofolate or 0.1-1 microM 5-formyltetrahydrofolate to this medium. When KB cells which had been passaged in low folate medium were passaged back into either standard medium or low folate medium supplemented with reduced folates, the levels of both folate-binding proteins fell linearly towards the levels in KB cells continuously maintained in standard medium. The folate transport protein was identified in and underwent similar changes in human and mouse mammary tumor cells. These studies indicate that the folate transport system is probably regulated by the extracellular folate concentration through changes in intracellular metabolite levels.