tbuckley/cabot-search huggingface dataset:
The Agnew Clinic, 1889, American. Oil on canvas
Authors: M. T. Southgate
Journal: JAMA (1986)

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 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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
Health effects questions raised by VDT `epidemic'
Authors: Phil Gunby
Journal: JAMA (1981)

There may be a video display terminal (VDT) in the future of many Americans, if not in their present, but controversy continues over possible health effects resulting from regular use of this device. The Food and Drug Administration has called the VDT a "typewriter-television hybrid." And indeed, the VDT does consist of a keyboard as well as a screen that both looks and operates essentially like a TV set (often using cathode ray tube-generated electrons) except that it is linked to a computer and numbers or letters appear on the screen instead of pictures. Moreover, the VDT is enjoying increasing use by businesses, newspapers, libraries, financial institutions, government, the transportation industry, and others. The FDA foresees the day when "the technology creeps from the office to the home, where microcomputers help balance the household budget, displaying income and expenses for the family to fret over on a video screen." In
Cigarette Smoking and Cancer of the Mouth, Pharynx, and Larynx
Authors: Condict Moore
Journal: JAMA (1971)

A total of 203 smokers "cured" of cancers of the oral cavity, pharynx, or larynx were divided into two groups: those who continued smoking and those who stopped. Within an average follow-up period of approximately seven years, 40% of patients who continued to smoke tobacco developed second cancers in tobacco-contact tissues, whereas 6% of patients who stopped smoking tobacco acquired second cancers. The death rate from second cancers was high; deaths from other causes occurred more often and earlier among the continuing smokers. These results strongly support previous evidence that (1) tobacco plays a major role in cancers of the oral cavity, pharynx, and larynx; and (2) cessation of smoking reduces the risk of second such cancers. Stopping smoking may reduce premature deaths from some other common diseases.
Improving response rates among doctors: randomised trial
Authors: M. Sloan, N. Kreiger, B. James
Journal: BMJ (1997)

Institutional review boards often require the consent of a patient's doctor before a patient can be included in research studies. The process of obtaining consent can be long and costly, and excluding patients when consent cannot be obtained could limit the generalisability of results. We examined strategies (over which investigators might have control) to increase the response rate of doctors asked to provide consent to contact their patients.

We identified the doctors of patients with cancer who were being asked to participate in a population based case-control study. These doctors were randomly assigned to one of eight treatments within two groups (affiliation with teaching hospital or non-teaching hospital). The eight treatments were combinations of signatory of the request letter (MD v PhD), letterhead (university v cancer agency), and presence or absence of a handwritten note thanking the doctor for …
Adrenal suppression with chronic dosing of fluticasone propionate compared with budesonide in adult asthmatic patients
Authors: D. J. Clark, B. J. Lipworth
Journal: Thorax (1997)

BACKGROUND: In a previous single dosing comparison between fluticasone propionate and budesonide differences in cortisol levels measured at 08.00 hours were observed at doses in excess of 1000 micrograms. The aim of this study was to compare the adrenal suppression caused by chronic twice daily dosing with inhaled fluticasone propionate (FP) and budesonide (B) given on a microgram equivalent basis by metered dose inhaler to asthmatic patients. METHODS: Twelve stable asthmatic patients of mean age 29.7 years with forced expiratory volume in one second (FEV1) 89.0% predicted and mid forced expiratory flow (FEF25-75) 58.9% predicted, on 400 micrograms/day or less of inhaled corticosteroid, were studied in a double blind, placebo controlled, crossover design comparing inhaled budesonide and fluticasone propionate in doses of 250 micrograms, 500 micrograms, and 1000 micrograms twice daily. Each dose was given at 08.00 hours and 22.00 hours for four days by metered dose inhaler with mouth rinsing. Measurements were made of overnight urinary cortisol excretion and plasma cortisol levels at 08.00 hours, 10 hours after the eighth dose. RESULTS: The plasma cortisol levels (nmol/ l) at 08.00 hours showed that fluticasone propionate produced lower cortisol levels than budesonide at all three dose levels: F500 333.8, B500 415.2 (95% CI 28.9 to 134.0); F1000 308.3, B1000 380.3 (95% CI 10.5 to 133.5); F2000 207.3, B2000 318.5 (95% CI 5.8 to 216.7); placebo 399.9. Fluticasone produced greater effects than budesonide on the overnight urinary cortisol/creatinine ratio (nmol/mmol) at all three dose levels: F500 3.12, B500 5.55 (95% CI 0.16 to 3.79); F1000 2.54, B1000 6.12 (95% CI 1.25 to 5.91); F2000 2.07, B2000 6.09 (95% CI 0.88 to 7.18); placebo 5.23. CONCLUSIONS: With repeated dosing across a dose range of 250-1000 micrograms twice daily, fluticasone propionate produced significantly greater adrenal suppression than budesonide for both plasma and urinary cortisol. It was therefore possible to demonstrate differences between fluticasone and budesonide at lower doses with chronic dosing from those previously found with single dosing when given on a microgram equivalent basis in asthmatic patients. Factors contributing to the systemic adverse activity profile of fluticasone comprise enhanced receptor potency, prolonged receptor residency time, greater tissue retention, and a longer elimination half life.
Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis.
Authors: H Dieplinger, P Y Schoenfeld, C J Fielding
Journal: Journal of Clinical Investigation (1986)

Plasma cholesterol metabolism was investigated in normotriglyceridemic patients with end-stage renal disease treated by hemo- or continuous ambulatory peritoneal dialysis (CAPD), and compared with that in a control group with normal renal function. A reversed net transport of free cholesterol from plasma to cultured fibroblasts, as well as greatly reduced levels of plasma cholesterol esterification and cholesterol ester transfer rates to low and very low density lipoproteins (LDL and VLDL), was found in the hemodialysis group compared to the controls. The LDL and VLDL contained increased amounts of free cholesterol and inhibited cholesterol ester transfer when recombined with control plasma. The LDL triglyceride content was doubled in the hemodialysis group, whereas cholesterol esters were decreased. Patients treated by CAPD, in marked contrast, had cholesterol metabolic rates that were within the normal range, as well as normal lipoprotein composition.
Multistep process of squamous differentiation in tracheobronchial epithelial cells in vitro: analogy with epidermal differentiation.
Authors: A M Jetten
Journal: Environmental Health Perspectives (1989)

The lung, in particular the bronchial epithelium, is a major site for tumor formation in humans. Environmental factors, such as cigarette smoke, in conjunction with genetic factors are important determinants in this disease. Malignant cells exhibit alterations in their control of proliferation and differentiation. It is believed that the acquisition of defects in the regulation of these processes is important in the process of carcinogenesis. A clear insight into the basic mechanisms of the regulation of proliferation and differentiation is required to understand the molecular mechanisms involved in tumor development and in other pathological conditions. Studies using in vitro cell culture systems of tracheobronchial epithelial cells provide useful models in which to study the regulation of differentiation and proliferation. The clonogenic cells derived from the treacheobronchial epithelium are pluripotent: They have self-renewal capacity and can differentiate along either a normal, mucosecretory, or a squamous cell pathway. Squamous differentiation in tracheobronchial epithelial cells has many morphological, biochemical, and regulatory properties in common with epidermal differentiation. This pathway of differentiation is a multistep process consisting of at least three stages. In the initial stage, cells become committed to terminal cell division. This is followed by the expression of the squamous differentiated phenotype and finally cornification. Various factors, such as several growth factors, retinoids, calcium ions, and phorbol esters, regulate the program of differentiation at different stages. Studies have indicated that the controls of proliferation and differentiation are interrelated. Cell lines established from tracheobronchial epithelial cells expressing SV 40 large T-antigen, as well as carcinoma cell lines, exhibit altered responses to growth and differentiation regulatory factors. Alterations in the commitment to terminal cell division must be a crucial step in the transition of a normal to a malignant cell.
A New Orally Active Quaternary Ammonium, Ganglion Blocking Drug Capable of Reducing Blood Pressure, SU-3088
Authors: KEITH S. GRIMSON, ANTONE K. TARAZI, JOE W. FRAZER
Journal: Circulation (1955)

Experiments were performed in animals to evaluate 4,5,6,7-tetrachloro-2-(2 dimethylaminoethyl)-isoindoline dimethochloride, (Su-3088), as an orally effective ganglion blocking drug. These demonstrated reduction of blood pressure, suppression of vasopressor reflexes and potentiation of the pressor action of epinephrine. Neostigmine deblocked drug effects and returned responses toward normal. Experiments in patients produced reduction of blood pressure, warming of extremities and delay of gastric emptying. Preliminary trial as a treatment for hypertension suggested that the drug may be useful. It has a long period of action, 12 hours or more and a small dose requirement, 50 to 100 mg.
From the medical academic conference Performance related pay is strongly opposed
Authors: L Beecham
Journal: BMJ (1994)

Medical academic staff believe that the proposal to introduce performance related pay into the NHS and the academic sector would be demotivating, divisive, and destructive. At their annual conference on 6 June they called on the BMA to oppose it. The chairman of the Medical Academic Staff Committee, Dr Colin Smith, a senior lecturer in medicine in Southampton, said that he could see no reason for the continuation of the review body system if performance related pay was implemented and warned that the whole system of a national pay award for doctors could be destroyed. Although some speakers at the conference thought that the proposal was inevitable, the chairman of the BMA council, Dr Sandy Macara, pledged to stop it. “We know that the secretary of state does not want it,”he said. “This will be a crunch fight, and it is a war which we intend to win.”

The conference took its decision after Mr Barrie Brown, one of the BMA's provincial secretaries, gave a presentation on performance related pay. The proponents of the system maintain that it motivates employees; helps to recruit and retain staff; links work output and financial rewards; may effect a cultural change in the organisation; and improves an organisation's performance. The options were individual performance related pay, rewarding group performance by team bonuses or gain shares, or rewarding organisation performance by profit sharing.

There was little evidence, Mr Brown said, that any system worked. Few of the organisations that had introduced it had evaluated it. Any system had to be judged on its effectiveness, economy, and equity. There was no evidence that it improved effectiveness or controlled the pay bill. Other factors, such as job security, influence, and good relations, motivated people as much as or more than pay. So far as equity was concerned …
Abstract P5-15-04: CTX and CTX-related direct medication costs saved by testing biomarkers uPA and PAI-1 in primary breast cancer: Results of a prospective multi-center study at Certified Breast Centers in Germany
Authors: VR Jacobs, D Augustin, A Wischnik, M Kiechle, C Hoess, O Steinkohl, B Rack, T Kapitza, P Krase
Journal: Cancer Research (2012)

Abstract Background: Biomarkers uPA and PAI-1 are guideline recommended by ASCO, USA, and AGO, Germany, to be used in primary breast cancer to avoid unnecessary CTX in medium risk recurrence patients [G2, N−, HR+, HER2neu−, &amp;gt;35 years]. This study was performed to verify in normal clinical settings how many CTX cycles and how much CTX-related direct medication costs can be avoided by uPA/PAI-1 testing. Methods: Prospective, non-interventional, multi-center study over two years among six Certified Breast Centers in Germany to analyze application of uPA/PAI-1 and consecutive decision making in the clinical setting for AOK Bayern-insured patients. CTX regimen and cycles avoided were identified for each case and direct costs for CTX and CTX-related medication costs for concomitant medication calculated for each patient individually according to body weight and body surface as well as potential FN prophylaxis according to physicians' decision. All medication costs were taken from the pharmaceutical price list for Germany Rote Liste of 2012. EURO [€] to US Dollar conversion rate as of June 12 2012: € 1.00 = US$ 1.25. Results: In n=93 breast cancers n=35 CTX (37.6%; FEC n=25, FEC+DOC n=8 and TC n=2) were avoided according to uPA/PAI-1 test result. Consecutively 210 CTX cycles or 12.1 years of CTX application were saved improving patients' quality of life. uPA/PAI-1 testing saved direct medication costs for avoided CTX of US$ 221.816, CTX-related concomitant medication of US$ 34.353 and G-CSF prophylaxis of US$ 25.749, overall US$ 281.918. At process costs for a single uPA/PAI-1 test calculated at US$ 359, uPA/PAI-1 testing resulted in additional costs of US$ 33.387 for all breast cancer cases. Overall, testing of uPA/PAI-1 has been proven to be cost-effective regarding direct medication costs alone at a return-on-investment ratio of 8.4:1. Indirect cost savings further increase this ROI. Conclusions: Innovative and individual cancer diagnostics like biomarkers uPA/PAI-1 can decrease need of CTX and increase patients' quality of life and thereby reduce costs for health care systems. Since application of this test is inadequate at present time measures are suggested to fully implement such cost-effective diagnostics. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-15-04.
Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial
Authors: Michal F Kaminski, John Anderson, Roland Valori, Ewa Kraszewska, Maciej Rupinski, Jacek Pachlewski, Ewa Wronska, Michael Bretthauer, Siwan Thomas-Gibson, Ernst J Kuipers, Jaroslaw Regula
Journal: Gut (2015)

<h3>Objective</h3> Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomised trial. <h3>Design</h3> 40 colonoscopy screening centres with suboptimal performance in the Polish screening programme (centre leader ADR ≤25% during preintervention phase January to December 2011) were randomised to either a Train-Colonoscopy-Leaders (TCLs) programme (assessment, hands-on training, post-training feedback) or feedback only (individual quality measures). Colonoscopies performed June to December 2012 (early postintervention) and January to December 2013 (late postintervention) were used to calculate changes in quality measures. Primary outcome was change in leaders' ADR. Mixed effect models using ORs and 95% CIs were computed. <h3>Results</h3> The study included 24 582 colonoscopies performed by 38 leaders and 56 617 colonoscopies performed by 138 endoscopists at the participating centres. The absolute difference between the TCL and feedback groups in mean ADR improvement of leaders was 7.1% and 4.2% in early and late postintervention phases, respectively. The TCL group had larger improvement in ADR in early (OR 1.61; 95% CI 1.29 to 2.01; p&lt;0.001) and late (OR 1.35; 95% CI 1.10 to 1.66; p=0.004) postintervention phases. In the late postintervention phase, the absolute difference between the TCL and feedback groups in mean ADR improvement of entire centres was 3.9% (OR 1.25; 95% CI 1.04 to 1.50; p=0.017). <h3>Conclusions</h3> Teaching centre leaders in colonoscopy training improved important quality measures in screening colonoscopy. <h3>Trial registration number</h3> NCT01667198.
Postoperative Hyponatremia despite Near-Isotonic Saline Infusion: A Phenomenon of Desalination
Authors: Andrew Steele
Journal: Annals of Internal Medicine (1997)

Background: It is widely presumed that the development of postoperative hyponatremia (which may be severe) results from administration of hypotonic fluids while antidiuretic hormone is acting. Objective: To show that hyponatremia would occur in patients 24 hours after surgery if only near-isotonic solutions are given and to evaluate the mechanisms responsible for hyponatremia in this setting. Design: Prospective cohort study. Setting: University medical center. Patients: 22 women who were having uncomplicated gynecologic surgery with infusion of near-isotonic solutions only (sodium chloride, 154 mmol/L, or Ringer lactate [sodium, 130 mmol/L, and potassium, 4 mmol/L]). Measurements: Plasma electrolyte levels were measured at the time of induction of anesthesia and 24 hours later. Data on the balance of water and electrolytes were obtained for the same 24-hour period. Results: At the time of induction of anesthesia, the plasma sodium concentration was 140 ± 1 mmol/L; 24 hours later, it decreased in 21 of 22 patients (mean decrease, 4.2 ± 0.4 mmol/L [P < 0.001]; lowest level, 131 mmol/L in 2 patients). The urine remained hypertonic (peak sodium plus potassium concentration in urine, 294 ± 9 mmol/L) in all patients for the first 16 hours after induction of anesthesia. Conclusions: Postoperative hyponatremia occurred within 24 hours of induction of anesthesia when only near-isotonic fluids were infused. Hyponatremia was generally caused by generation of electrolyte-free water during excretion of hypertonic urine-a desalination process. This electrolyte-free water was retained in the body because of the actions of antidiuretic hormone. If the pathophysiology of this hyponatremic state is understood, recommendations for its prevention and treatment can be deduced.
Usefulness of 64-Slice Multislice Computed Tomography Coronary Angiography to Assess In-Stent Restenosis
Authors: Filippo Cademartiri, Joanne D. Schuijf, Francesca Pugliese, Nico R. Mollet, J. Wouter Jukema, Erica Maffei, Lucia J. Kroft, Alessandro Palumbo, Diego Ardissino, Patrick W. Serruys, Gabriel P. Krestin, Ernst E. Van der Wall, Pim J. de Feyter, Jeroen J. Bax
Journal: Journal of the American College of Cardiology (2007)
Recombinant Human Hyaluronidase Facilitates Dispersion of Subcutaneously Administered Gammagard Liquid and Enables Administration of a Full Monthly Dose in a Single Site to Patients with Immunodeficiency Diseases
Authors: I MELAMED, M STEIN, R WASSERMAN, H LEIBL, W ENGL, R YOCUM, R SCHIFF
Journal: Journal of Allergy and Clinical Immunology (2008)
A Milestone in Tuberculosis Control
Authors: Jeffrey M. Drazen
Journal: New England Journal of Medicine (2002)

This issue of the Journal contains a description of a remarkable tuberculosis-control program that was launched in India just over nine years ago.1 In the years since its inception, over 20,000 medical officers and over 100,000 related personnel have been trained and over 3000 laboratories set up for the diagnosis of tuberculosis. Each day in these clinics, which serve just about half the Indian population, 1300 patients start treatment. At any given time, more than 200,000 people are receiving treatment, most of which is directly observed. Over half a million people have been cured of tuberculosis. Although these services are . . .
Cardiac Complications in Patients With Community-Acquired Pneumonia
Authors: Vicente F. Corrales-Medina, Daniel M. Musher, George A. Wells, Julio A. Chirinos, Li Chen, Michael J. Fine
Journal: Circulation (2012)

Background— Community-acquired pneumonia (CAP) affects &gt;5 million adults each year in the United States. Although incident cardiac complications occur in patients with community-acquired pneumonia, their incidence, timing, risk factors, and associations with short-term mortality are not well understood. Methods and Results— A total of 1343 inpatients and 944 outpatients with community-acquired pneumonia were followed up prospectively for 30 days after presentation. Incident cardiac complications (new or worsening heart failure, new or worsening arrhythmias, or myocardial infarction) were diagnosed in 358 inpatients (26.7%) and 20 outpatients (2.1%). Although most events (89.1% in inpatients, 75% in outpatients) were diagnosed within the first week, more than half of them were recognized in the first 24 hours. Factors associated with their diagnosis included older age (odds ratio [OR]=1.03; 95% confidence interval [CI], 1.02–1.04), nursing home residence (OR, 1.8; 95% CI, 1.2–2.9), history of heart failure (OR, 4.3; 95% CI, 3.0–6.3), prior cardiac arrhythmias (OR, 1.8; 95% CI, 1.2–2.7), previously diagnosed coronary artery disease (OR, 1.5; 95% CI, 1.04–2.0), arterial hypertension (OR, 1.5; 95% CI, 1.1–2.1), respiratory rate ≥30 breaths per minute (OR, 1.6; 95% CI, 1.1–2.3), blood pH &lt;7.35 (OR, 3.2; 95% CI, 1.8–5.7), blood urea nitrogen ≥30 mg/dL (OR, 1.5; 95% CI, 1.1–2.2), serum sodium &lt;130 mmol/L (OR, 1.8; 95% CI, 1.02–3.1), hematocrit &lt;30% (OR, 2.0; 95% CI, 1.3–3.2), pleural effusion on presenting chest x-ray (OR, 1.6; 95% CI, 1.1–2.4), and inpatient care (OR, 4.8; 95% CI, 2.8–8.3). Incident cardiac complications were associated with increased risk of death at 30 days after adjustment for baseline Pneumonia Severity Index score (OR, 1.6; 95% CI, 1.04–2.5). Conclusions— Incident cardiac complications are common in patients with community-acquired pneumonia and are associated with increased short-term mortality. Older age, nursing home residence, preexisting cardiovascular disease, and pneumonia severity are associated with their occurrence. Further studies are required to test risk stratification and prevention and treatment strategies for cardiac complications in this population.