tbuckley/cabot-search huggingface dataset:
Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists
Authors: David Meltzer
Journal: Annals of Internal Medicine (2002)

Background: Hospitalists may decrease costs and improve outcomes in hospitalized patients, but existing evidence is limited and has not identified mechanisms for such effects. Objective: To study the costs and outcomes for patients on an academic general medicine service assigned to teams led by hospitalists and nonhospitalists. Design: Cohort study. Setting: Academic general medicine service. Patients: 6511 patients admitted to the hospital from July 1997 through June 1999. Intervention: All patients admitted every fourth day were assigned to 1 of 2 hospitalists caring for inpatients 6 months each year or 1 of 58 nonhospitalists caring for inpatients 1 to 2 months each year. Measurements: Length of stay; inpatient costs; and 30-, 60-, and 365-day mortality. Results: Patients assigned to hospitalists (24.8%) and nonhospitalists (75.2%) did not differ in age, race, sex, diagnosis mix, or Charlson index score. In year 1, average adjusted length of stay was 0.29 day shorter for patients cared for by hospitalists than by nonhospitalists (95% CI, −0.66 to 0.06 day; P = 0.06); in year 2, average adjusted length of stay was 0.49 day shorter for patients cared for by hospitalists (CI, −0.79 to −0.15 day; P = 0.01). Average adjusted costs were not significantly reduced for hospitalists compared with nonhospitalists in year 1 but were reduced by $782 in year 2 (CI, −$1313 to −$187; P = 0.01). When years 1 and 2 were combined or when year 1 was analyzed alone, 30-day mortality was not significantly different for hospitalists and nonhospitalists; however, 30-day mortality was 4.2% for hospitalists compared with 6.0% for nonhospitalists in year 2 (CI for difference, 1.8 percentage points [−3.6 to −0.1 percentage points]; P = 0.04) and the adjusted relative risk was 0.65 (CI, 0.44 to 0.96; P = 0.03). In multivariate analyses, resource use decreased with the physician's cumulative experience in caring for a patient's primary diagnosis. Mortality showed a similar pattern. Conclusions: Hospitalist care was associated with lower costs and short-term mortality in the second but not the first year of hospitalists' experience. Disease-specific physician experience may reduce resource use and improve patient outcomes; in addition, it may be an important determinant of the effectiveness of hospitalists.
Social Inequalities in Health: New Evidence and Policy Implications
Authors: Petter Kristensen
Journal: BMJ (2006)

Do we really welcome one more book on social inequalities in health now? Or have we had sufficient explanations, suggestions, and “beyond-the-Black-Report” analyses? There will be some that think so. None the less, I strongly commend this book. It is the result of a five year European Science Foundation Programme on “Social Variation in Health Expectancy in Europe,” and includes contributors who are among the most distinguished scientists in the field. In nine chapters, they present state of …
Intravenous Glucose Tolerance in Negro Men Deficient in Glucose-6-Phosphate Dehydrogenase
Authors: R. Bennett Eppes, A. M. Lawrence, James V. McNamara, Robin D. Powell, Paul E. Carson
Journal: New England Journal of Medicine (1969)

Standard intravenous, cortisone-modified intravenous and oral glucose tolerance tests were carried out in 10 Negro men with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and in 10 normal Negro men. The mean age and weight were identical in the G-6-PD-deficient and the normal men. No significant differences were demonstrated between mean blood glucose levels in the G-6-PD-deficient men and those in the normal men during standard oral glucose tolerance tests. In contrast, the results of both the standard and the cortisone-modified intravenous glucose tolerance tests revealed significantly higher blood glucose levels in the G-6-PD-deficient men at 20, 30, 40, 50 and 60 minutes. Despite the higher blood glucose levels, mean serum immunoreactive insulin levels in the G-6-PD-deficient men were not significantly different from those in the normal men. Additional evidence of altered glucose metabolism associated with G-6-PD deficiency is thus provided.
Enthesitis in patients with psoriatic arthritis, axial spondyloarthritis and healthy subjects assessed by ‘head-to-toe’ whole-body MRI and clinical examination
Authors: René Panduro Poggenborg, Iris Eshed, Mikkel Østergaard, Inge Juul Sørensen, Jakob M Møller, Ole Rintek Madsen, Susanne Juhl Pedersen
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Objectives</h3> To investigate the ability of whole-body MRI (WBMRI) to detect axial and peripheral enthesitis in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), and in healthy subjects (HS). Furthermore, to develop MRI enthesitis indices based on WBMRI and validate these by use of clinical measures of disease activity. <h3>Methods</h3> Prospective cross-sectional study of patients with PsA (n=18) and axSpA (n=18) with moderate to high disease activity, and HS (n=12). Enthesitis at 35 individual sites located at upper and lower limbs, chest and pelvis were evaluated by WBMRI and clinical examination, and compared. Three new WBMRI enthesitis indices were developed. <h3>Results</h3> WBMRI allowed evaluation of 888 (53%) of 1680 sites investigated, and 19 (54%) of 35 entheses had a readability &gt;70%. The percentage agreement between WBMRI and clinical enthesitis was 49–100%, when compared at the level of the individual entheses. Enthesitis on WBMRI was observed in 148 (17%) of the entheseal sites, and was frequently present at greater trochanters (55%) and Achilles (43%) and supraspinate (23%) tendon insertions in patients and HS. At the first mentioned two locations enthesitis often appeared without clinical signs of enthesitis. Patients and HS differed significantly in one of the new WBMRI enthesitis scores. Patients and HS differed significantly in one of the new WBMRI enthesitis scores, and this score correlated weakly with BASDAI question 4 (tenderness in relation to entheses), BASDAI and patient global (ρ=0.29–0.31, p&lt;0.05). <h3>Conclusions</h3> WBMRI is a promising new imaging modality for evaluation of enthesitis in patients with PsA and axSpA, but requires further investigation before clinical use.
Abstract 5570: Targeted drug delivery system and magnetic resonance imaging with intrinsic ferromagnetic nano-particle compound.
Authors: Haruki Eguchi, Kunio Hirata, Reiko Kurotani, Hidenobu Fukumura, David J. Singh, Masahiro Yamamoto, Itaru Sato, Masanori Umemura, Masaki Yamamoto, Yoji Nagashima, Yoshihiro Ishikawa
Journal: Cancer Research (2013)

Abstract First principles calculations based on structures obtained by X-ray crystallography analysis are applied to identifying the intrinsic ferromagnetic nano-particle compound. We have found that this organic based nano-particle compound (EI236) exhibits anti-cancer property and, more important, possesses a magnetic property as it was readily attached to a magnet. EI236 exhibited intrinsic ferromagnetic behaviors from -268 celcius degree to 37 celsius degree and inhibited melanoma expansion in mouse tails when delivered to the melanoma lesion using a commercially available magnet. The local accumulation of the compound, as induced by the magnet, was readily visualized by magnetic resonance imaging (MRI) in mice. (n=4) Thus, EI236 acted as both an anti-cancer drug and an MRI contrast, and had pharmacological effects that could be delivered in a controlled manner. The identification of such compounds can overcome the long-standing problems of controlled drug delivery by magnetic force and may dramatically alter our concept of pharmacotherapy in the future, i.e., drug-targeting using a magnet and drug-dosing using MRI. Citation Format: Haruki Eguchi, Kunio Hirata, Reiko Kurotani, Hidenobu Fukumura, David J. Singh, Masahiro Yamamoto, Itaru Sato, Masanori Umemura, Masaki Yamamoto, Yoji Nagashima, Yoshihiro Ishikawa. Targeted drug delivery system and magnetic resonance imaging with intrinsic ferromagnetic nano-particle compound. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5570. doi:10.1158/1538-7445.AM2013-5570
Detection of herpes simplex and varicella-zoster infection from cutaneous lesions in different clinical stages with the polymerase chain reaction
Authors: George T Nahass, Mitchell J Mandel, Sandra Cook, Wei Fan, Craig L Leonardi
Journal: Journal of the American Academy of Dermatology (1995)

Background: The polymerase chain reaction (PCR) can be used to diagnose a variety of infectious processes. Objective: We sought to determine whether Tzanck smear debris, vesicle fluid swabs, crusts, or fixed tissue specimens are the best source for template herpes simplex virus (HSV) or varicella-zoster virus (VZV) DNA for the PCR. Methods: Patients with both clinical and histologic evidence of HSV (n = 6) or VZV (n = 16) infection were examined. Stained Tzanck smears, vesicle fluid swabs, dried crusts, and skin biopsy specimens were obtained at the same time from each patient. DNA was extracted from the different clinical specimens and then examined for HSV or VZV DNA with PCR. Fifteen control subjects did not have clinical or histologic evidence of herpesvirus infection. Results: In cases of suspected VZV infection, PCR detected VZV DNA sequences from all 15 Tzanck smears, all 15 vesicle swabs, one of one crust, and 14 of 16 fixed tissue specimens. HSV DNA sequences were detected from all six Tzanck smears, all four vesicle fluid swabs, two of two crusts, and five of six fixed tissue specimens. Conclusion: PCR can detect VZV and HSV DNA sequences from a variety of sources including formalin-fixed tissue specimens. Although viral DNA was detected slightly more frequently from Tzanck smear debris, crusts, and vesicle fluid swabs compared with fixed tissue specimens, each was an excellent source of target DNA for the PCR to confirm the diagnosis of herpesvirus infection.
THE INDICATION OF NEPHROSTOMY PRELIMINARY TO URETERORECTONEOSTOMY
Authors: FRANK HINMAN
Journal: JAMA (1926)

The transplantation of ureters into the bowel is regarded as justifiable in a relatively small group of cases. Freed from the many dangers both immediate and remote, the applicability would jump immediately to a respectable figure. As it now is, the procedure may be used only as a desperate means of relief of last resort. The widest application has been in exstrophy of the bladder and similar anomalies, and no doubt a short life of continence and comfort is preferable to the shorter one of pain and misery inevitable to the unfortunate children born with this deformity. Yet ureterorectal transplantation for exstrophy is not an ideal surgical procedure nor ever will be even if freed from its present dangers. Such an individual is at once removed from the service of modern urologic methods, well illustrated by a patient of my own who had lived six years comfortably with the ureter
Neuropsychiatric Symptoms as Predictors of Progression to Severe Alzheimer’s Dementia and Death: The Cache County Dementia Progression Study
Authors: Matthew E. Peters, Sarah Schwartz, Dingfen Han, Peter V. Rabins, Martin Steinberg, Joann T. Tschanz, Constantine G. Lyketsos
Journal: American Journal of Psychiatry (2015)

Objective: Little is known about factors influencing the rate of progression of Alzheimer’s dementia. Using data from the Cache County Dementia Progression Study, the authors examined the link between clinically significant neuropsychiatric symptoms in mild Alzheimer’s dementia and progression to severe dementia or death. Method: The Cache County Dementia Progression Study is a longitudinal study of dementia progression in incident cases of this condition. Survival analyses included unadjusted Kaplan-Meier plots and multivariate Cox proportional hazard models. Hazard ratio estimates controlled for age at dementia onset, dementia duration at baseline, gender, education level, General Medical Health Rating, and apolipoprotein E epsilon 4 genotype. Results: Three hundred thirty-five patients with incident Alzheimer’s dementia were studied. Sixty-eight (20%) developed severe dementia over the follow-up period. Psychosis (hazard ratio=2.007), agitation/aggression (hazard ratio=2.946), and any one clinically significant neuropsychiatric symptom (domain score ≥4, hazard ratio=2.682) were associated with more rapid progression to severe dementia. Psychosis (hazard ratio=1.537), affective symptoms (hazard ratio=1.510), agitation/aggression (hazard ratio=1.942), mildly symptomatic neuropsychiatric symptoms (domain score of 1–3, hazard ratio=1.448), and clinically significant neuropsychiatric symptoms (hazard ratio=1.951) were associated with earlier death. Conclusions: Specific neuropsychiatric symptoms are associated with shorter survival time from mild Alzheimer’s dementia to severe dementia and/or death. The treatment of specific neuropsychiatric symptoms in mild Alzheimer’s dementia should be examined for its potential to delay time to severe dementia or death.
Renal transplantation in patients treated with haemodialysis and short term and long term continuous ambulatory peritoneal dialysis.
Authors: J B Evangelista, D Bennett-Jones, J S Cameron, C Ogg, D G Williams, D H Taube, G Neild, C Rudge
Journal: BMJ (1985)

Forty two adult patients who had been treated with continuous ambulatory peritoneal dialysis for one to 142 weeks (mean (SD) 38 (36)) received a total of 44 allografted kidneys. Twenty one had been treated with continuous ambulatory peritoneal dialysis for less than 26 weeks (mean 11 (8)) and the other 21 for longer than 26 weeks (mean 64 (35)). These two groups were compared with 55 patients who had been treated with haemodialysis and received a total of 63 grafts. In the group of patients treated with continuous ambulatory peritoneal dialysis azathioprine and low dose prednisolone were used as the immunosuppressive regimen for 20 transplantations in 18 patients, and 24 patients receiving 24 grafts were treated with cyclosporin A and low dose prednisolone. In the group of patients treated with haemodialysis 38 patients receiving 43 grafts were treated with azathioprine and low dose prednisolone, and 20 patients receiving 20 grafts were treated with cyclosporin A and low dose prednisolone. Actuarial survival of patients and grafts at two years was 95% and 72%, respectively, in the continuous ambulatory peritoneal dialysis group compared with 89% and 58%, respectively, in the haemodialysis group. No difference was found in graft survival between short term treatment with continuous ambulatory peritoneal dialysis (72% graft survival) and long term treatment (65% graft survival). In conclusion, continuous ambulatory peritoneal dialysis is suitable treatment for patients awaiting renal transplantation.
Detection of xenoestrogens in serum after immunoprecipitation of endogenous steroidal estrogens.
Authors: Kala Natarajan, James W Overstreet, Jane M Rogers, Michael S Denison, Jiangang Chen, Peter N Lohstroh, Daniel S McConnell, Bill L Lasley
Journal: Environmental Health Perspectives (2002)

In this article we report a simple and efficient method for detecting nonsteroidal estrogens in a biologic sample. This method uses polyclonal antibodies to estradiol (E2) to immunoprecipitate these major biologically active steroidal estrogens, leaving behind the nonsteroidal estrogens, which are then detected in a cell-based transcriptional activation bioassay for estrogen receptor agonist. The immunoprecipitation method efficiently removed 99% of radiolabeled E2 and estrone (E1) from human serum. In experiments in which supraphysiologic concentrations of E2 and E1 to human serum, all of the immunoreactive estrogens were still removed by the immunoprecipitation protocol. We carried out an in vivo validation study of this method in which we treated female macaques with the xenoestrogen nonylphenol (NP), during the late follicular phase of the menstrual cycle. We used blood samples collected before and after treatment to evaluate and characterize endogenous and exogenous serum estrogens. An immunoassay for E2 did not detect the NP in treated monkeys. The cell-based bioassay also did not detect the estrogenic activity of NP because of its saturation by the endogenous serum steroidal estrogens. However, when steroidal estrogens were removed by immunoprecipitation, we detected the estrogenic activity of NP in the bioassay. Thus, this approach is appropriate for detecting exogenous, nonsteroidal estrogens in serum samples.
Cost of Orthopedic Injuries Sustained in Motorcycle Accidents
Authors: Timothy Bray
Journal: JAMA (1985)

Fifty-one serial admissions to the orthopedic services at the University of California, Davis, Medical Center, Sacramento, for motorcycle accident trauma with open fractures were reviewed. Fifty-five percent of those tested were alcohol intoxicated at the time of admission. Seventy-five percent carried no insurance of any kind, and for the total group, 72% of the cost of acute hospitalization ($17,704 per patient) was paid by the state of California, with an additional 10% paid by other tax-based sources. Care of motorcycle trauma consumes a substantial portion of public health care funds in California. This could be reduced by legislative action concerning helmet use, licensing, and rigid enforcement of compulsory insurance. (<i>JAMA</i>1985;254:2452-2453)
Carnitine deficiency myopathy
Authors: S. Vaisrub
Journal: JAMA (1973)

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Reimbursement, Beneficence, and Advance Directives-Reply
Authors: Margot L. White
Journal: JAMA (1991)

In Reply.  —In response to Dr Spielberg that a separate billing category be created for  directives consultation, we could not agree more. Reimbursement to physicians for time spent in relevant discussions with patients regarding personal values, health care goals, and treatment preferences is essential and long overdue. Reimbursement would not only recognize the fact that such discussions are time consuming and preclude income from performing physical procedures, but would also acknowledge the real value of the communication itself. Without some method of compensation for this time, many physicians, already overburdened by burgeoning paperwork and administrative responsibilities in addition to patient care, will simply not engage in these crucial dialogues. An advance directives consultation billing category for both Medicaid and private insurers would remove one of the most significant barriers to these discussions.  Fervent support of new creative methods for enabling and encouraging patient-physician communication does not mean, however,
Addiction to aerosol treatment.
Authors: J M Raine
Journal: BMJ (1984)

risk of giving double the usual starting dose of a new agent in conjunction with the underlying benorylate should have been considered potentially dangerous.That these patients were both in their 70s should have invited particular care.Regardless of the attributes, or otherwise, of Osmosin or any new anti-inflammatory agent, it is unfortunate that a new drug should fall into disrepute as a result of inadequate attention to dosage, unwarranted polypharmacy, or lack of concern for the patient's age.
THE BRANCHED FORM OF THE BACILLUS TUBERCULOSIS IN SPUTUM
Authors: Charles F. Craig
Journal: The Journal of Experimental Medicine (1898)

The first * to draw especial attention to branching and budding forms of the tubercle bacillus were Nocard and Roux (1) in 1887.In the following year Metchnikoff (2) described and figured long, threadlike, branching forms with bulbous ends, observed in old glycerineagar cultfires cultivated at 43.6o-44 ° C. It is probable that these were cultures from avian tuberculosis.)/[etchnikoff suggested the name Sclerothrix kochii for the tubercle bacillus.In 1889 Klein (3) described and photographed filamentous, club-shaped and branching tubercle bacilli in old cultures, and S. G. Dixon (4) reported making in Klein's laboratory observation of these forms.In 1892 A. Maffucci (5) described and depicted similar forms of the bacillus of fowl tuberculosis, which he considered to be thereby distinguished from the bacillus of mammalian tuberculosis.Especial attention was directed to pleomorphism and variability of the tubercle bacillus by the monograph of Fischel (6) published in 1893, in which he described in detail thread-like, branching and club-shaped forms both of mammalian and of avian tubercle bacilli, and emphasized the analogies between this organism and the ray-fungus of actinomycosis.Among the most valuable contributions to this subject are those of Coppen Jones (7), dating from 1893.In glycerine-agar cultures three to four months old he finds constantly filamentous, branching forms of the tubercle bacilhls, and directs especial attention to the * Cornil and Babes noted and p i c t u r e d ramification and swelling of t h e tubercle bacillus in the first and second editions of t h e i r " B a e t ~r i e s " in 1883 and 1886.
Moral and Professional Accountability for Clinical Ethics Consultants
Authors: William Simkulet
Journal: The American Journal of Bioethics (2014)

How does access to this work benefit you? Let us know! Publisher's Statement This is an Accepted Manuscript of an article published by Taylor & Francis in the American Journal of Bioethics in 2014, available online: http://wwww.tandfonline.com/10.1080/ 15265161.2014.900142. Follow this and additional works at: http://engagedscholarship.csuohio.edu/clphil_facpub Part of the Ethics and Political Philosophy Commons, and the Philosophy of Science Commons
594 Natural course of treated and untreated chronic HCV infection: Results of the nationwide HEPNET. Greece cohort study
Authors: E.K. Manesis, G.V. Papatheodoridis, G. Touloum, A. Karafoulidou, J. Ketikoglou, G.E. Kitis, A. Antoniou, S. Kanatakis, S.J. Koutsounas, I. Vafiadis
Journal: Journal of Hepatology (2006)