tbuckley/cabot-search huggingface dataset:
Physicians as Leaders in Improving Health Care: A New Series in Annals of Internal Medicine
Authors: Donald M. Berwick
Journal: Annals of Internal Medicine (1998)

Searching for one word to describe the state of mind of the physician in the United States today, we might choose beleaguered. Threats appear from all sides--from payers, would-be managers of care, the growth of technology, and even patients. The rhetoric is one of siege and battle, and the dynamic seems to be a clash of values from which only one winner can emerge. But scientific and health services research suggest otherwise. Science suggests that health care could, indeed, perform a great deal better than it does today and that a shared aim of improving health outcomes for patients at a cost that society can afford is sensible and within reach. However, achievement of these improvements will require of physicians not handwringing and resistance to change but concerted, positive, capable leadership. The goal of this series in Annals is to describe a new knowledge base that will help physicians participate effectively in the redesign of the health care system. The series is intended to raise the curiosity of physicians about the skills they will need to become more active and influential citizens of the health care community in accomplishing improvements. These skills will help physicians better deploy their clinical expertise and professional purpose in a debate that has heretofore been informed primarily by economics.
OBJECTIONS TO THE ANTIVIVISECTION BILL NOW BEFORE THE SENATE OF THE UNITED STATES.
Authors: WILLIAM H. WELCH
Journal: JAMA (1898)

The following statement has been prepared by the writer in order to meet the requests of several Senators of the United States and of physicians for objections to Senate bill 1063, which has been reported unanimously by the Committee on the District of Columbia. It is believed that many have been misled by efforts of advocates of the proposed legislation to make it appear that the bill is intended only to check alleged abuses of animal experimentation and not to interfere with its proper uses. A main purpose of this statement is to show the error of this assumption.<sup>1</sup>Much of the same ground has already been covered by others in various protests and publications. The provisions of Senate Bill 1063 are so complicated and in several instances doubtful in their interpretation, and the objections to the bill are so numerous and their full presentation would require so much
An Economic Evaluation of Activated Protein C Treatment for Severe Sepsis
Authors: Braden J. Manns, Helen Lee, Christopher James Doig, David Johnson, Cam Donaldson
Journal: New England Journal of Medicine (2002)

Recombinant human activated protein C was shown in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study to reduce mortality among patients with severe sepsis. A post hoc reanalysis by the Food and Drug Administration (FDA) of data from this study suggested that the reduction in mortality was restricted to patients with Acute Physiology and Chronic Health Evaluation (APACHE II) scores of 25 or more.We estimated the cost effectiveness of activated protein C as compared with conventional care for patients with severe sepsis. We performed an economic analysis involving all patients, as well as analyses of subgroups defined according to age and severity of illness. The probabilities of transition between clinical states and the estimates of resource use were derived from a population-based cohort of patients with severe sepsis. We used data on the effectiveness of activated protein C from the PROWESS study and analyses by the FDA.The cost per life-year gained by treating all patients with activated protein C was $27,936. It was more cost effective to treat patients with an APACHE II score of 25 or more ($24,484 per life-year gained) than those with a lower APACHE II score ($35,632 per life-year gained). The cost effectiveness of treating patients with an APACHE II score of 24 or less increased to $575,054 per life-year gained when the FDA's estimates of effectiveness were considered. For patients with an APACHE II score of 25 or more, the cost per life-year gained increased with age ($16,309 for patients less than 40 years of age; $28,100 for those 80 years of age or older).Activated protein C is relatively cost effective when targeted to patients with severe sepsis, greater severity of illness (an APACHE II score of 25 or more), and a reasonable life expectancy if they survive the episode of sepsis. Further research is needed to determine the cost effectiveness of activated protein C for patients with sepsis and less severe illness.
Treatment of Pulmonary Emphysema by Pneumoperitoneum
Authors: B. Mann, E. A. Murphy
Journal: BMJ (1953)

from the original Latin).or how the deception was not apparently commented upon by those familiar with Vicary's book.Caius has been blamed for instigating the plagiarism of Vesalius's great work, and it has also been suggested that Geminus is a punning pseudonym hiding the identity of Dr.
Sarcoidosis, Liver Transplantation, and Cyclosporine
Authors: Thomas Papo
Journal: Annals of Internal Medicine (1993)

Letters1 December 1993Sarcoidosis, Liver Transplantation, and CyclosporineThomas Papo, MD, Jean-Charles Piette, MD, and Dominique Valla, MDThomas Papo, MDSearch for more papers by this author, Jean-Charles Piette, MDSearch for more papers by this author, and Dominique Valla, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-11-199312010-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Casavilla and colleagues [1] describe nine patients with sarcoidosis that was improved by immunosuppressive treatment given for prevention of liver allograft rejection. When compared with patients who had had transplants and did not have sarcoidosis, survival of these patients and their grafts was good. They concluded that cyclosporine may be beneficial in treating sarcoidosis, but several questions are unanswered. First, the favorable course may have been related to a benign form of sarcoidosis. What was the status of such prognostic variables as age, race, duration of disease, and type of visceral involvement? Comparison with control patients who ...References1. Casavilla FA, Gordon R, Wright HI, Galaver JS, Starzl TE, Van Thiel DH. Clinical course after liver transplantation in patients with sarcoidosis. Ann Intern Med. 1993; 118:865-6. Google Scholar2. Cunnah D, Chew S, Wass J. Cyclosporin for central nervous system sarcoidosis. Am J Med. 1988; 85:580-1. Google Scholar3. York FL, Kovithavongs T, Man P, Rebuck AS, Sproule BJ. Cyclosporine and chronic sarcoidosis. Chest. 1990; 98:1026-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1993Volume 119, Issue 11Page: 1148-1149KeywordsCorticosteroid therapyDrugsImmunosuppressivesLiverLiver transplantationRacial and ethnic issuesSarcoidosis Issue Published: 1 December 1993 CopyrightCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
The Swedish Prostate Cancer Paradox
Authors: Patrick C. Walsh, James D. Brooks
Journal: JAMA (1997)

In this issue ofTHE JOURNAL, investigators from Sweden present their 15-year results of expectant management of prostate cancer.<sup>1</sup>They conclude that localized prostate cancer has a favorable outlook following watchful waiting and that the number of deaths potentially avoidable by initial radical treatment is limited. These results sound encouraging and suggest that the aggressive approach to early diagnosis and therapy currently used by many physicians in the United States may constitute overtreatment. However, prostate cancer is far from being a benign disease in Sweden. Sweden has the fourth-highest age-adjusted mortality rate from prostate cancer in the world, 21% higher than the United States, which ranks 13th.<sup>2</sup>This article thus presents a conundrum: if watchful waiting in localized disease results in few deaths, why is the overall mortality from prostate cancer in Sweden high? See also p 467. In the 223 cases of localized prostate cancer managed with
Hypoparathyroidism in a Patient with Longstanding Iron Storage Disease
Authors: Laurence A. Sherman, Adolf Pfefferbaum, Elmer B. Brown
Journal: Annals of Internal Medicine (1970)

A patient with iron storage disease secondary to transfusions for temporary aplastic anemia was found to have hypoparathyroidism. The patient had minimal signs or symptoms of his marked hypocalcemia. The development of such an endocrine disturbance has not been reported previously in iron storage disease. The appearance of parathyroid dysfunction in this patient may be related to his long survival after transfusional iron overload (at least 11 years before the onset of hypoparathyroidism).
Hyperglycemia Inhibits Cardiac Stem Cell–Mediated Cardiac Repair and Angiogenic Capacity
Authors: André S.D. Molgat, Everad L. Tilokee, Ghazaleh Rafatian, Branka Vulesevic, Marc Ruel, Ross Milne, Erik J. Suuronen, Darryl R. Davis
Journal: Circulation (2014)

Background— The impact of diabetes mellitus on the cardiac regenerative potential of cardiac stem cells (CSCs) is unknown yet critical, given that individuals with diabetes mellitus may well require CSC therapy in the future. Using human and murine CSCs from diabetic cardiac tissue, we tested the hypothesis that hyperglycemic conditions impair CSC function. Methods and Results— CSCs cultured from the cardiac biopsies of patients with diabetes mellitus (hemoglobin A1c, 10±2%) demonstrated reduced overall cell numbers compared with nondiabetic sourced biopsies ( P =0.04). When injected into the infarct border zone of immunodeficient mice 1 week after myocardial infarction, CSCs from patients with diabetes mellitus demonstrated reduced cardiac repair compared with nondiabetic patients. Conditioned medium from CSCs of patients with diabetes mellitus displayed a reduced ability to promote in vitro blood vessel formation ( P =0.02). Similarly, conditioned medium from CSCs cultured from the cardiac biopsies of streptozotocin-induced diabetic mice displayed impaired angiogenic capacity ( P =0.0008). Somatic gene transfer of the methylglyoxal detoxification enzyme, glyoxalase-1, restored the angiogenic capacity of diabetic CSCs (diabetic transgenic versus nondiabetic transgenic; P =0.8). Culture of nondiabetic murine cardiac biopsies under high (25 mmol/L) glucose conditions reduced CSC yield ( P =0.003), impaired angiogenic ( P =0.02) and chemotactic ( P =0.003) response, and reduced CSC-mediated cardiac repair ( P &lt;0.05). Conclusions— Diabetes mellitus reduces the ability of CSCs to repair injured myocardium. Both diabetes mellitus and preconditioning CSCs in high glucose attenuated the proangiogenic capacity of CSCs. Increased expression of glyoxalase-1 restored the proangiogenic capacity of diabetic CSCs, suggesting a means of reversing diabetic CSC dysfunction by interfering with the accumulation of reactive dicarbonyls.
Doctors and company to be held liable for contraceptive failure
Authors: Tony Sheldon
Journal: BMJ (2005)

A court in Holland has ruled that 15 women who became pregnant despite using the contraceptive implant Implanon are entitled to be paid damages for their “unintentional pregnancy.” But whether Organon, the Netherlands based company that marketed Implanon, or the individual doctors who inserted it are liable remains unanswered.

The court concluded that both should pay damages unless either can bring further evidence. The doctors need to prove that the product was faulty and that they inserted it properly, Organon the opposite.

The decision covers 15 cases brought by the women against Organon and 13 brought against their …
Desmoid Tumor Presenting as a Parotid Mass
Authors: Bhagirath Majmudar
Journal: JAMA (1978)

THE DESMOID tumor is an aggressively proliferating, musculoaponeurotic tumor commonly arising from the abdominal musculature. Infrequently, it may arise from other locations such as the shoulder girdle<sup>1</sup>or pelvic musculature.<sup>2</sup>The rarity of this lesion in the parotid area prompted us to report this case. <h3>Report of a Case</h3> A 26-year-old woman was admitted to Grady Memorial Hospital complaining of a mass behind her right jaw bone. She had noticed this mass six months prior to admission and it had been enlarging progressively since then. Significant past history included extraction of carious teeth six years previously and childhood illnesses such as mumps, measles, and chickenpox. Her last pregnancy had been eight years prior to admission. She had no history of nor was she presently taking any medications including methysergide maleate. Physical examination results showed a 6×4-cm hard, slightly tender mass in the right parotid area extending below the
PROGRESSIVE LEFT VENTRICULAR CHANGES PREDICT THE LIKELIHOOD OF SURVIVAL IN PEDIATRIC DILATED CARDIOMYOPATHY: FINDINGS FROM THE PEDIATRIC CARDIOMYOPATHY REGISTRY
Authors: Paul Fraser Kantor, Endel Orav, James Wilkinson, Steven Webber, Charles Canter, Steven Colan, Jeffrey Towbin, Melanie Everitt, Elfriede Pahl, Stephanie Ware, Beth Kaufman, Paolo Rusconi, Jacqueline Lamour, John Jefferies, Linda Addonizio, Steven Lipshultz
Journal: Journal of the American College of Cardiology (2012)
Acute pancreatitis associated with a nontraumatic, intramural duodenal hematoma
Authors: N. Veloso, P. Amaro, M. Ferreira, J. Romãozinho, C. Sofia
Journal: Endoscopy (2013)

Intramural duodenal hematoma is a rare disease, first described in 1838 by MacLauchlan. More than 70 % of intramural duodenal hematomas are secondary to blunt abdominal trauma [1]. Nontraumatic intramural duodenal hematoma was first reported by Sutherland in 1904 and is associated with anticoagulation (most commonly) or antiplatelet therapy, coagulation disorders, and endoscopic hemostasis. An association between intramural duodenal hematoma and acute pancreatitis has been rarely reported [2].
Governments need to be more aware of human rights implications of health care
Authors: F. Fleck
Journal: BMJ (2002)

Governments around the world need to be more aware of human rights issues when developing healthcare policy, says the World Health Organization in a new pamphlet on the subject.

The pamphlet says that the link between human rights and health has started only recently to get the attention it deserves, because of the growing demand for greater accountability in health.

The 36 page pamphlet–part of a WHO campaign to make health officials and practitioners more aware of the connection …
Progress in Preventing Venous Thromboembolism
Authors: Edwin W. Salzman
Journal: New England Journal of Medicine (1983)

Despite occasional disagreement,1 small subcutaneous doses of heparin are widely used to prevent venous thromboembolism in patients at risk. A large literature proclaims the efficacy of giving 5000 units of heparin two or three times daily to reduce the rate of venous thrombosis, and there is much, although less, evidence that such a program also prevents pulmonary embolism, including the large and often fatal emboli that arise from large veins in the thigh or pelvis.2 The routine use of "mini-heparin" in general surgical patients appears to be cost effective, with an estimated marginal cost of $870 (in 1980 dollars) per . . .
P198 Is there a role for MRI cranial imaging in patients with non-small cell lung cancer being considered for radical treatment?
Authors: D. Laws, K. Adeniji, N. Ranaweera
Journal: Thorax (2011)

<h3>Introduction</h3> Prior to undergoing radical treatment for Non-Small Cell Lung cancer (NSCLC) it is important to have accurate staging and exclude distal metastases to prevent patients undergoing futile inappropriate treatment. Guidelines1 have recommended consideration of MRI or CT imaging of the brain, especially in stage III disease. However, routine use in non-symptomatic patients has not been studied, particularly in conjunction with PET-CT scanning. In addition it is recognised that MRI is more likely to detect more and smaller lesions than CT brain. Our local policy is to offer MRI cranial imaging in all patients being considered for radical treatment in conjunction with PET scanning. We present a retrospective analysis of all these cases including follow-up and survival. <h3>Method</h3> All patients discussed at lung cancer multi-disciplinary meeting (MDT) who were considered suitable for radical treatment were identified and offered PET-CT and MRI brain. Results of the scans, treatment received and disease free survival data were collected. <h3>Results</h3> There was data available on 115 cases. Eight were found to have cerebral metastasis on MRI scanning. 6/8 (75%) had with lung lesions of more than 3 cm and or a nodal status more than N&gt;1 on initial CT staging. All eight died within 6 months of diagnosis. 2/8 failed to meet criteria with one patient9s intracranial lesions probably due to co-existing breast cancer and the other refusing biopsy and therefore may not have been NSCLC. <h3>Conclusion</h3> Eight patients would have had radical treatment inappropriately if MRI brains had not been performed. Previous studies suggest &lt;10% pick up of cerebral metastases in non-symptomatic patients pre-PET scanning era. Our series shows 7%. We therefore suggest a cut-off from stage 1B –11A in the 7th TNM classification as an indication to request a contrasted MRI brain as part of the staging protocol with NSCLC where radical therapy is being contemplated.
Hourly rate for some doctors proposed in Germany
Authors: H. L Karcher
Journal: BMJ (1995)

The president of the German chamber of physicians has proposed that doctors who are contracted with the national health insurance scheme should be paid on an hourly basis. Dr Ellis Huber's scheme would replace the traditional system whereby doctors are paid on the basis of the number of patients they see and the services they perform. At present the official scale of fees for doctors lists about 2500 items, ranging from a …
Monitoring for myocardial ischemia during noncardiac surgery. A technology assessment of transesophageal echocardiography and 12-lead electrocardiography. The Study of Perioperative Ischemia Research Group
Authors: M. J. Eisenberg
Journal: JAMA (1992)

<h3>Objective.</h3> —Transesophageal echocardiography (TEE) and 12-lead electrocardiography (ECG) are sophisticated techniques that are increasingly being used to monitor for myocardial ischemia during noncardiac surgery. We examined whether the routine use of these techniques has incremental clinical value in identifying patients at high risk for perioperative ischemic outcomes when compared with preoperative clinical data and intraoperative monitoring using continuous two-lead bipolar ECG. <h3>Design.</h3> —Cohort study. <h3>Setting.</h3> —Veterans Affairs medical center. <h3>Patients.</h3> —A total of 332 men undergoing noncardiac surgery who had or were at high risk for coronary artery disease. <h3>Interventions.</h3> —TEE, 12-lead ECG, and two-lead ECG were performed continuously during noncardiac surgery (47% vascular, 53% nonvascular). Monitoring results were not available to anesthesiologists or surgeons, and data were blindly analyzed after surgery. <h3>Main Outcome Measure.</h3> —Perioperative ischemic outcomes (cardiac death, nonfatal myocardial infarction, unstable angina). <h3>Results.</h3> —In a subset of 285 patients who were adequately studied by all three techniques, 111 patients (39%) were identified as having intraoperative myocardial ischemia (by one or more monitoring techniques). By univariate analysis, intraoperative ischemia was associated with all perioperative cardiac outcomes, including ischemic outcomes, congestive heart failure, and ventricular tachycardia (<i>P</i>≤.02 for each of the three monitoring techniques). However, when monitoring results for TEE and 12-lead ECG were added to a multivariate model that included preoperative clinical data and continuous two-lead ECG results, the incremental value of TEE was small (odds ratio, 2.6; 95% confidence interval [Cl], 1.2 to 5.7;<i>P</i>=.02) and that of 12-lead ECG was not significant (odds ratio, 1.5; 95% Cl, 0.6 to 3.8). Furthermore, when the multivariate analysis was repeated with only ischemic outcomes, neither TEE nor 12-lead ECG retained significant associations (odds ratio, 2.2; 95% Cl, 0.5 to 9.4, and odds ratio, 1.1; 95% Cl, 0.2 to 6.1, respectively). <h3>Conclusion.</h3> —When compared with preoperative clinical data and intraoperative monitoring using two-lead ECG, routine monitoring for myocardial ischemia with TEE or 12-lead ECG during noncardiac surgery has little incremental clinical value in identifying patients at high risk for perioperative ischemic outcomes. (<i>JAMA</i>. 1992;268:210-216)
PLA2R Autoantibodies and Recurrent Membranous Nephropathy after Transplantation
Authors: Rolf A.K. Stahl, Elion Hoxha, Kai Fechner
Journal: New England Journal of Medicine (2010)

To the Editor: Membranous nephropathy is a leading cause of the nephrotic syndrome in adults. One third of patients have a progressive loss of renal function and reach end-stage renal disease.1 Mem...
Treatment of Post-operative Pulmonary Atelectasis
Authors: R. C. Brock
Journal: BMJ (1947)

lie was a capable sketcher tind pastel painter, and some of his portraits of-his father, mother, and friends are shown.Striking mo-dels illustrate the preparation of antisera in laboratories in France's Oriental possessions, and enlarged photographs and dis- play panels show phically the signifiCanCe 0 is diovenes of micro-organisms and irmuniiy factors.The Wellcome Museum exhibit includes crystals and diagrams showing the foundations of stereochemistry which Pasteur laid.Much of his oijginal apparatus in on view., together with some of his personal possessions.