tbuckley/cabot-search huggingface dataset:
Resource Use and Guideline Concordance in Evaluation of Pulmonary Nodules for Cancer
Authors: Renda Soylemez Wiener, Michael K. Gould, Christopher G. Slatore, Benjamin G. Fincke, Lisa M. Schwartz, Steven Woloshin
Journal: JAMA Internal Medicine (2014)

<h3>Importance</h3> Pulmonary nodules are common, and more will be found with implementation of lung cancer screening. How potentially malignant pulmonary nodules are evaluated may affect patient outcomes, health care costs, and effectiveness of lung cancer screening programs. Guidelines for evaluating pulmonary nodules for cancer exist, but little is known about how nodules are evaluated in the usual care setting. <h3>Objective</h3> To characterize nodule evaluation and concordance with guidelines. <h3>Design, Setting, and Participants</h3> A retrospective cohort study was conducted including detailed review of medical records from pulmonary nodule detection through evaluation completion, cancer diagnosis, or study end (December 31, 2012). The participants included 300 adults with pulmonary nodules from 15 Veterans Affairs hospitals. <h3>Main Outcomes and Measures</h3> Resources used for evaluation at any Veterans Affairs facility and guideline-concordant evaluation served as the main outcomes. <h3>Results</h3> Twenty-seven of 300 patients (9.0%) with pulmonary nodules ultimately received a diagnosis of lung cancer: 1 of 57 (1.8%) with a nodule of 4 mm or less, 4 of 134 (3.0%) with a nodule of 5 to 8 mm, and 22 of 109 (20.2%) with a nodule larger than 8 mm. Nodule evaluation entailed 1044 imaging studies, 147 consultations, 76 biopsies, 13 resections, and 21 hospitalizations. Radiographic surveillance (n = 277) lasted a median of 13 months but ranged from less than 0.5 months to 8.5 years. Forty-six patients underwent invasive procedures (range per patient, 1-4): 41.3% (19 patients) did not have cancer and 17.4% (8) experienced complications, including 1 death. Notably, 15 of the 300 (5.0%) received no purposeful evaluation and had no obvious reason for deferral, seemingly “falling through the cracks.” Among 197 patients with a nodule detected after release of the Fleischner Society guidelines, 44.7% received care inconsistent with guidelines (17.8% overevaluation, 26.9% underevaluation). In multivariable analyses, the strongest predictor of guideline-inconsistent care was inappropriate radiologist recommendations (overevaluation relative risk, 4.6 [95% CI, 2.3-9.2]; underevaluation, 4.3 [2.7-6.8]). Other systems factors associated with underevaluation included receiving care at more than 1 facility (2.0 [1.5-2.7]) and nodule detection during an inpatient or preoperative visit (1.6 [1.1-2.5]). <h3>Conclusions and Relevance</h3> Pulmonary nodule evaluation is often inconsistent with guidelines, including cases with no workup and others with prolonged surveillance or unneeded procedures that may cause harm. Systems to improve quality (eg, aligning radiologist recommendations with guidelines and facilitating communication across providers) are needed before lung cancer screening is widely implemented.
The Ingredients for Prostate Cancer Nomograms: The Addition of Biomarkers Sets the Table for Future Recipes
Authors: Mary-Ellen Taplin, Philip W. Kantoff
Journal: Journal of Clinical Oncology (2003)

Article Tools EDITORIALS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2003.07.083 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12913104 The Ingredients for Prostate Cancer Nomograms: The Addition of Biomarkers Sets the Table for Future Recipes Mary-Ellen TaplinxMary-Ellen TaplinSearch for articles by this author , Philip W. KantoffxPhilip W. KantoffSearch for articles by this author Show More Genitourinary Oncology, Dana Farber Cancer Center, Boston, MA https://doi.org/10.1200/JCO.2003.07.083 Full Text PDF Figures and Tables "The Ingredients for Prostate Cancer Nomograms: The Addition of Biomarkers Sets the Table for Future Recipes." Journal of Clinical Oncology, 21(19), pp. 3552–3553© 2003 by American Society of Clinical Oncology
A cholecystokinin-releasing factor mediates ethanol-induced stimulation of rat pancreatic secretion.
Authors: A K Saluja, L Lu, Y Yamaguchi, B Hofbauer, M Rünzi, R Dawra, M Bhatia, M L Steer
Journal: Journal of Clinical Investigation (1997)

The mechanisms by which short-term ethanol administration alters pancreatic exocrine function are unknown. We have evaluated the effects of ethanol administration on pancreatic secretion of digestive enzymes. In our studies, anesthetized as well as conscious rats were given ethanol at a rate sufficient to cause the blood ethanol concentration to reach levels associated with clinical intoxication. Ethanol was administered over a 2-h period during which blood ethanol levels remained stably elevated. We report that intravenous administration of ethanol results in a transient increase in pancreatic amylase output and plasma cholecystokinin (CCK) levels. The ethanol-induced increase in amylase output can be completely inhibited by the CCK-A receptor antagonist L-364,718 and partially inhibited by the muscarinic cholinergic antagonist atropine. The ethanol-induced rise in amylase output can be completely prevented by instillation of trypsin into the duodenum or by lavage of the duodenum with saline during ethanol administration. Furthermore, the intraduodenal activity of a CCK-releasing factor is increased by infusion of ethanol. These studies indicate that administration of ethanol causes rat pancreatic exocrine secretion to increase. This phenomenon is mediated by a trypsin-sensitive CCK-releasing factor which is present within the duodenal lumen. These observations lead us to speculate that repeated CCK-mediated ethanol-induced stimulation of pancreatic digestive enzyme secretion may play a role in the events which link ethanol abuse to the development of pancreatic injury.
The continuing global challenge of injury
Authors: D. H Stone
Journal: BMJ (2001)

News p 1561

At the start of the 21st century injury prevention in most countries (including industrialised ones) is poorly targeted, inadequately funded, and seldom evaluated. Too many people—particularly children—continue to die or suffer unnecessarily. Unsurprisingly, the impact of this public health failure on health services is colossal: in the United States, for example, injuries were first out of 29 conditions ranked according to hospital days in 1994.1 The lack of interest in injury prevention is puzzling as there is evidence that when governments act much can be done to prevent this leading cause of premature death and disability.

Part of the problem is inadequate information on which to estimate the incidence and outcomes of most forms of injury. We know too little about the underlying causes, incidence, prevalence, long term consequences, and costs of injury. Most of what we do know relates to mortality. Of the 50.5 million deaths worldwide in 1990, 10% were due to injury,2 and such deaths are projected to increase from 5.1 million in 1990 to 8.4 …
An Intervention to Delay Nursing Home Placement
Authors: Robert N. Butler
Journal: JAMA (1997)

<h3>To the Editor.</h3> —In their Editorial,<sup>1</sup>Drs Beck and Stuck commented on the article by Dr Mittelman and colleagues<sup>2</sup>entitled, "A Family Intervention to Delay Nursing Home Placement of Patients With Alzheimer Disease." The study by Mittelman et al was conducted as a randomized controlled trial with 206 spouse-caregivers of patients with Alzheimer disease. The intervention delayed nursing home placement by almost a year. The authors concluded that these findings suggest that a program designed to provide counseling and social support on a long-term basis can have a substantial impact on how long spouse-caregivers continue to care for patients with Alzheimer disease at home. The Editorial by Drs Beck and Stuck emphasized that the value of the findings was limited because many patients with Alzheimer disease do not have spouses and lack financial resources. However, more than half of all patients are cared for by spouses who will
Non–Small Cell Lung Cancers with Kinase Domain Mutations in the Epidermal Growth Factor Receptor Are Sensitive to Ionizing Radiation
Authors: Amit K. Das, Mitsuo Sato, Michael D. Story, Michael Peyton, Robert Graves, Stella Redpath, Luc Girard, Adi F. Gazdar, Jerry W. Shay, John D. Minna, Chaitanya S. Nirodi
Journal: Cancer Research (2006)

Abstract Non–small cell lung cancers (NSCLCs) bearing mutations in the tyrosine kinase domain (TKD) of the epidermal growth factor receptor (EGFR) often exhibit dramatic sensitivity to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. Ionizing radiation (IR) is frequently used in the treatment of NSCLC, but little is known how lung tumor–acquired EGFR mutations affect responses to IR. Because this is of great clinical importance, we investigated and found that clonogenic survival of mutant EGFR NSCLCs in response to IR was reduced 500- to 1,000-fold compared with wild-type (WT) EGFR NSCLCs. Exogenous expression of either the L858R point mutant or the ΔE746-E750 deletion mutant form of EGFR in immortalized human bronchial epithelial cells, p53 WT NSCLC (A549), or p53-null NSCLC (NCI-H1299) resulted in dramatically increased sensitivity to IR. We show that the majority of mutant EGFR NSCLCs, including those that contain the secondary gefitinib resistance T790M mutation, exhibit characteristics consistent with a radiosensitive phenotype, which include delayed DNA repair kinetics, defective IR-induced arrest in DNA synthesis or mitosis, and pronounced increases in apoptosis or micronuclei. Thus, understanding how activating mutations in the TKD domain of EGFR contribute to radiosensitivity should provide new insight into effective treatment of NSCLC with radiotherapy and perhaps avoid emergence of single agent drug resistance. (Cancer Res 2006; 66(19): 9601-07)
Population toxicokinetics of benzene.
Authors: F Y Bois, E T Jackson, K Pekari, M T Smith
Journal: Environmental Health Perspectives (1996)

In assessing the distribution and metabolism of toxic compounds in the body, measurements are not always feasible for ethical or technical reasons. Computer modeling offers a reasonable alternative, but the variability and complexity of biological systems pose unique challenges in model building and adjustment. Recent tools from population pharmacokinetics, Bayesian statistical inference, and physiological modeling can be brought together to solve these problems. As an example, we modeled the distribution and metabolism of benzene in humans. We derive statistical distributions for the parameters of a physiological model of benzene, on the basis of existing data. The model adequately fits both prior physiological information and experimental data. An estimate of the relationship between benzene exposure (up to 10 ppm) and fraction metabolized in the bone marrow is obtained and is shown to be linear for the subjects studied. Our median population estimate for the fraction of benzene metabolized, independent of exposure levels, is 52% (90% confidence interval, 47-67%). At levels approaching occupational inhalation exposure (continuous 1 ppm exposure), the estimated quantity metabolized in the bone marrow ranges from 2 to 40 mg/day.
Allogeneic Bone Marrow Transplantation in Chronic Lymphocytic Leukemia
Authors: Fred Rosner
Journal: Annals of Internal Medicine (1996)

Letters1 November 1996Allogeneic Bone Marrow Transplantation in Chronic Lymphocytic LeukemiaFred Rosner, MDFred Rosner, MDMt. Sinai School of Medicine New York, NY 10029.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-9-199611010-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I question the propriety of bone marrow transplantation in patients with chronic lymphocytic leukemia (CLL) in Rai stages 0, 1, or 2 who may be asymptomatic for years without any specific treatment. As reported by Michallet and colleagues [1], 23 of the 54 transplant recipients had disease in Rai stage 0, 1, and 2 at the time of transplantation. Nonetheless, 25 (46%) died of treatment-related complications. How can one justify such a risk–benefit ratio? Although Rai stage 3 or 4 disease is associated with a relatively short median survival, this is not the case for early-stage CLL, ...REFERENCE1. Michallet M, Archimbaud E, Bandini G, Rowlings PA, Deeg HJ, Gahrton G, et al. HLA-identical sibling bone marrow transplantation in younger patients with chronic lymphocytic leukemia. Ann Intern Med. 1996; 124:311-5. Google Scholar Author, Article, and Disclosure InformationAuthors: Fred Rosner, MDAffiliations: Mt. Sinai School of Medicine New York, NY 10029. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1996Volume 125, Issue 9Page: 780KeywordsBone marrow transplantationChronic lymphocytic leukemiaDeath ratesTransplantation ePublished: 15 August 2000 Issue Published: 1 November 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Hepato-splanchnic metabolic effects of the stable prostacyclin analogue iloprost in patients with septic shock
Authors: Peter Kiefer, Ilyas Tugtekin, Heide Wiedeck, Hendrik Bracht, Josef Vogt, Ulrich Wachter, Manfred Weiss, Cigdem Altin, Michael Georgieff, Peter Radermacher
Journal: Intensive Care Medicine (2001)
Working in a Very Small Place: The Making of a Neurosurgeon
Authors: Oscar Sugar
Journal: JAMA (1990)

Peter Jannetta, MD, professor and chairman, Department of Neurological Surgery at the University of Pittsburgh, is the subject of this book by science writer Mark L. Shelton. The "very small space" is the cerebellopontine angle, and the "working," described in great detail, is the decompression of cranial nerves 5, 7, 8, 9, and 11 in the posterior fossa, using the operating microscope. The syndromes discussed include trigeminal and glossopharyngeal neuralgia, hemifacial spasm, disequilibrium vertigo, spasmodic torticollis—and essential hypertension! Despite reading the entire book twice, and some parts several more times, I am unable to decide for whom it has been written. For the "informed layperson" or the general "health professional," it has the appeal of exploring and explaining a complex neuroanatomic situation for somewhat uncommon disorders without obvious cause. However, the exposition lacks the clarity that could have been achieved with the aid of the line drawings or sketches used
Cruelty may be a self-control device against sympathy
Authors: George Ainslie
Journal: Behavioral and Brain Sciences (2006)

Dispassionate cruelty and the euphoria of hunting or battle should be distinguished from the emotional savoring of victims' suffering. Such savoring, best called negative empathy , is what puzzles motivational theory. Hyperbolic discounting theory suggests that sympathy with people who have unwanted but seductive traits creates a threat to self-control. Cruelty to those people may often be the least effortful way of countering this threat.
Reviews and Notes: Nuclear Medicine: Effects of Atomic Radiation
Authors: Leonard Rosenthall
Journal: Annals of Internal Medicine (1996)

Literature of Medicine15 July 1996Reviews and Notes: Nuclear Medicine: Effects of Atomic RadiationLeonard Rosenthall, MDLeonard Rosenthall, MDThe Montreal General Hospital, Montreal, Canada H3G 1A4Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-2-199607150-00038 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail WJ Schull. 396 pages. New York: Wiley-Liss; 1995. $45.00. ISBN 0471125245. Order phone 800-225-5945.More than 50 years ago, on August 6 and 9, 1945, Hiroshima and Nagasaki were each visited by a single atomic bomb that caused massive destruction and huge loss of life. Thousands of survivors received various amounts of radiation. In October 1945, 2 months after the bombing, a Joint Committee for the Investigation of the Effects of the Atomic Bomb in Japan was established in the United States, and it recommended a long-term study of the sequelae of the bombings. Through the National Academy of Sciences, ... Author, Article, and Disclosure InformationAffiliations: The Montreal General Hospital, Montreal, Canada H3G 1A4 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1996Volume 125, Issue 2Page: 160KeywordsAdultsBiologicsBrain damageChildrenChromosomesIntellectual disabilityMolecular biologyPregnancyResearch laboratories ePublished: 15 August 2000 Issue Published: 15 July 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effect of captopril on kidney function in insulin-dependent diabetic patients with nephropathy.
Authors: E Hommel, H H Parving, E Mathiesen, B Edsberg, M Damkjaer Nielsen, J Giese
Journal: BMJ (1986)

The influence of angiotensin II on kidney function in diabetic nephropathy was assessed by studying the effect of 12 weeks9 monotherapy with captopril (25-50 mg twice a day) in 16 hypertensive insulin dependent diabetic patients with persistent albuminuria. In an initial one week randomised single blind trial of captopril versus placebo, captopril (for nine patients) reduced arterial blood pressure from 148/94 (SD11/6) to 135/88 (8/7) mm Hg (p less than 0.05) and albuminuria from 1549 (range 352-2238) to 1170 (297-2198) micrograms/min (p less than 0.05), while glomerular filtration rate remained stable. No significant changes occurred in seven patients treated with placebo. During the 12 weeks of captopril treatment arterial blood pressure in all patients fell from 147/94 (11/6) to 135/86 (13/7) mm Hg (p less than 0.01), albuminuria fell from 1589 (range 168-2588) to 1075 (35-2647) micrograms/min (p less than 0.01), and glomerular filtration rate fell from 99 (SD19) to 93 (25) ml/min/1.73 m2 (p less than 0.01). The renin-angiotensin system showed suppressed plasma concentrations of angiotensin II and increased concentrations of angiotensin I and renin. The study showed that glomerular filtration rate is not dependent on angiotensin II, that captopril reduces albuminuria, probably by lowering glomerular hypertension, and that captopril represents a valuable new drug for treating hypertension in diabetics dependent on insulin with nephropathy.
Failure to Transilluminate the Stomach is Not an Absolute Contraindication to PEG Insertion
Authors: J. A. D. Stewart, P. Hagan
Journal: Endoscopy (1998)

Percutaneous endoscopic gastrostomy (PEG) tubes are now a well established method of enteral feeding. With the introduction of nurse endoscopists it has been possible to site PEG tubes with only one member of medical staff being present. Furthermore transillumination of the stomach is considered by many to be essential prior to gastric puncture. We present a series of 62 consecutive PEG tube sitings performed by the same nurse endoscopist/doctor team without transillumination of the stomach prior to gastric puncture. Sixty of the 62 patients (97%) had successful PEG tube insertion. There were no immediate complications. There were two failures, neither of which related to the technique. It is concluded that failure of transillumination is not an absolute contraindication to PEG tube insertion.
Responding to Scientific Misconduct Due Process and Prevention
Authors: Barbara Mishkin
Journal: JAMA (1988)

Mishkin argues that the imposition of harsher penalties for scientific misconduct will require additional due process protection in disciplinary proceedings at the institutional level, such as adequate notice about both the generally accepted standards of conduct and the sanctions that may be imposed for failure to meet those standards, procedural protections during the investigation and hearing phases of an inquiry, and mechanisms for the restoration of scientists' reputations if they are subsequently cleared of all charges. Academic institutions have an equally important responsibility to be open about confirmed or admitted instances of misconduct, so that those guilty of misconduct are not allowed to move on to other, unsuspecting, institutions.
Clinically Oriented Anatomy
Authors: Charles B. Clayman
Journal: JAMA (1981)

This text is written expressly for the medical student studying anatomy for the first time. Using the regional approach and diagrams and illustrations from the late Professor Grant's publications, Moore's book maintains a logical and pedagogically beneficial continuity. A clinical justification for the massive effort of the study of anatomy is fulfilled by many of the clinically oriented comments. They relate the anatomy to a variety of circumstances that might arise in a clinical setting and are interspersed frequently among anatomic considerations of each region (chapter). These comments are set off by a light gray color and are from one to five paragraphs in length. It is presumed the student's interest is maintained and an awareness of the clinical significance of the anatomy heightened. There is no doubt that the comments clarify the anatomy for the clinician. At the end of each chapter, several cases are presented which correlate patient-oriented
Naturalization of Foreign Medical Graduates
Authors: Kishore J. Thampy
Journal: JAMA (1974)

STATISTICS, however objective, have the unforgiveable tendency of stirring dormant but powerful emotions in all of us. The current figures on licenses awarded in the past year will undoubtedly foment new fears and rekindle old grievances. The report disclosing foreign medical graduates to be the numerically dominant group among the new licentiates is bound to alarm segments of the medical profession concerned about the influx of these physicians into the private practice of medicine. Their entry into private practice, long impossible because of restrictive licensure laws, will provide more flexibility in the career choice of foreign medical graduates and will stimulate increased competition within the field of private practice. On the other hand, the pointed inclusion of failure ratios of foreign physicians as compared with those of American graduates will exacerbate the resentment prevalent in this already embattled medical minority. It is quite likely that many foreign physicians will interpret
Performance of Endoscopic Ultrasound in Staging Rectal Adenocarcinoma Appropriate for Primary Surgical Resection
Authors: Nitin K. Ahuja, Bryan G. Sauer, Andrew Y. Wang, Grace E. White, Andrew Zabolotsky, Ann Koons, Wesley Leung, Savreet Sarkaria, Michel Kahaleh, Irving Waxman, Ali A. Siddiqui, Vanessa M. Shami
Journal: Clinical Gastroenterology and Hepatology (2014)