tbuckley/cabot-search huggingface dataset:
A Controlled Trial of Educational Outreach to Improve Blood Transfusion Practice
Authors: Stephen B. Soumerai
Journal: JAMA (1993)

To determine whether brief, face-to-face educational outreach visits can improve the appropriateness of blood product utilization.Randomized, controlled multicenter trial with 6-month follow-up.Surgical and medical services of two pairs of matched community and teaching hospitals in Massachusetts.One hundred one transfusing staff surgeons and attending medical physicians.A professionally based transfusion specialist presented one surgical- or medical-service-wide lecture emphasizing appropriate indications, risks, and benefits of red blood cell transfusions; brief, graphic, printed educational guidelines; and one 30-minute visit with each transfusing physician. No data feedback was provided. Educational messages emphasized the lack of utility of the traditional threshold for red blood cell transfusions (hematocrit, 30%) and transfusion risks (eg, viral hepatitis).Proportion of red blood cell transfusions classified as compliant or noncompliant with blood transfusion guidelines, or indeterminate 6 months before and 6 months after an experimental educational intervention.Based on analyses of 1449 medical record audits of red blood cell transfusions that occurred 6 months before and 6 months after the educational intervention, the average proportion of transfusions not in compliance with criteria declined from 0.40 to 0.24 among study surgeons (-40%) compared with an increase from 0.40 to 0.44 (+9%) among control surgeons (P = .006). These effects were consistent across procedure type and specialty. On average, study surgeons in the postintervention period performed transfusions when hematocrits were 2.0 percentage points lower than before the intervention (28.3% preintervention vs 26.3% postintervention), and lower than in the control group (28.3% preintervention and postintervention; P = .04). Likely savings in blood use for surgical services probably exceeded program costs, even without considering reduced risks of infection. No effects were observed among transfusions occurring in medical services, possibly because of substantially lower transfusion rates and lower pretransfusion hematocrits.Brief, focused educational outreach visits by transfusion specialists can substantially improve the appropriateness and cost-effectiveness of blood product use in surgery. More data are needed regarding the durability of changes in practice patterns and the health and economic benefits of such interventions.
Stents for Palliation of Dysphagia Due to Esophageal Cancer
Authors: H. Worth Boyce
Journal: New England Journal of Medicine (1993)

Stenting and related techniques for palliation of esophageal cancer are being used with increasing frequency16. Peroral stenting opens the lumen of the obstructed esophagus to a diameter sufficient to allow the pleasures and potential nutritional benefit of oral food intake; it maintains patency and reduces the risks of regurgitation. The majority of patients with esophageal cancer are poor candidates for surgery and have incurable disease. Without an adequate esophageal lumen, they suffer great misery from dysphagia, sialorrhea, regurgitation of saliva and food, malnutrition, and aspiration. Patency also can be achieved by peroral dilation, endoluminal irradiation, or lesion ablation . . .
Health ministers subpoenaed in libel case
Authors: O. Dyer
Journal: BMJ (1995)

Two former health ministers have been subpoenaed to appear in a libel case brought by the former chairwoman of the Cornwall Health Care Trust, Mrs Abigail Kirby-Harris. Dr Brian Mawhinney, formerly minister for health and now chairman of the Conservative party, and Mrs Virginia Bottomley, formerly health secretary and now heritage secretary, will be summoned to explain their reasons for appointing Mrs Kirby-Harris, a former army captain and a Conservative activist, in 1993.

Mrs Kirby-Harris, 44, held the post for seven months. Her appointment was resisted by all five Cornish members of parliament, Conservative and Liberal, and …
Detection of Breast Cancer by Periodic X-Ray Examinations
Authors: J. Gershon-Cohen
Journal: JAMA (1961)

CAN delayed diagnosis and treatment of breast tumors be avoided by periodic x-ray examinations of women over 40 years of age? The results of a 5-year study, reported and interpreted here, indicated "yes." Since January, 1956, a program for routine examination of the breast for the detection of cancer has been conducted as a separate unit in the Radiology Department of the Albert Einstein Medical Center.<sup>1</sup>Appeals for volunteers were made to local civic and social organizations of women. There was but one stipulation—that any candidate wishing to participate in the program be free of breast symptoms. All x-ray examinations in the survey were provided without cost to the volunteer. During this time we enlisted 1,312 women. At present 1,055 women still remain in the program; 257 dropped out after one or more examinations. Each volunteer is examined every 6 months. At the initial examination each volunteer is
Rhesus monkeys are radical behaviorists
Authors: Gordon G. Gallup
Journal: Behavioral and Brain Sciences (1996)

Abstract The data reviewed in Barresi &amp; Moore's treatment of social understanding is recast in terms of a model of social intelligence that was advanced some time ago (Gallup 1982). When it comes to their analysis of the behavior of other individuals, most primates (and humans younger than 18 months of age) appear to function as radical behaviorists, whereas chimpanzees and older infants show evidence of becoming primitive cognitive psychologists.
Scintigraphic Demonstration of Postural Induced Drainage Stasis in an En Bloc Renal Allograft
Authors: EDDY K. DUNN, ANTHONY G. MATTHEWS, ARNOLD M. STRASHUN
Journal: Clinical Nuclear Medicine (1997)

Within 6 months after an en bloc transplantation of two kidneys from a cadaveric pediatric donor, the recipient was referred for further scintigraphic evaluation because of clinical suspicion of having a postural related functional impairment of the grafted kidneys. Tc-99m MAG3 imaging, modified by varying the position of the patient during the procedure, resulted in detection of drainage stasis only with the patient standing. This drainage stasis had not been appreciated in the preceding routine examinations performed with the patient supine. Although the positional outflow stasis by itself may not be severe enough to cause alarming dysfunction of the grafted kidneys, it could conceivably be a significant contributing factor.
Donald John Carr Horwood
Authors: J. Scott-Jones
Journal: BMJ (2013)

Donald John Carr Horwood (“Don”) was born in Harrow, England, and after prolonged childhood illnesses interrupted his schooling he became determined to become either an engineer or a doctor. Despite humble beginnings, he persisted with his education, was admitted to and survived medical school through the war years, and went on to complete his clinical training at Charing Cross Hospital in London.

His starting salary in 1952 was four pounds ten a week, four pounds of which the hospital kept for board and lodging. During this time Don became interested and skilled in surgery and married Ruth, a fellow student.

Don and his young dentist wife moved to Uganda in …
Two Cases of Obstruction of the Small Intestine by Gall Stones
Authors: J. B. Bradbury
Journal: BMJ (1897)

centres and these associated centres, which for the sake of convenience may (inclusive with the speech centres) be termed the seat of consciousness, intelligence, memory, judgment, andthewill, are functionallyactive. 5 The points of detail which are to be noted in connection with each of these headings are elaborated in the text. 6 I have actually seen a house-surgeon, in a case of aphasia in which the condition of the audi- tory speeeh centre was being tested (by requesting the patient to put out his tongue), touch the patient's lips, and in one case put out his own tongue, so as to aid the patient to comprehend what he was being told to do.This gentleman did not seem to understand that the object was not to make the patient put out his tongue, but to see whether he understood the spoken request (the language) addressed to him by the physician.X Thomas, Roux, and Miralli6 have directed attention to this point.
In vivo and ex vivo inhibitory effects of loratadine on histamine release in patients with allergic rhinitis
Authors: A. Miadonna, M. Cottini, N. Milazzo, D. Tosi, M. Danzig, A. Tedeschi
Journal: Allergy (1998)

Background The aim of this study was to evaluate the in vivo and ex vivo effects of the H.‐antagonist loratadine on histamine release. Methods The study was designed as a double‐blind, crossover trial. Ten patients with allergic rhinitis due to Dermatophagoides pteronyssinus were treated with loratadine (10 mg daily p.o.) and with placebo for 1 week, with a 2‐week interval between the two treatments. Nasal lavages with saline solution were done before and after challenge with the relevant allergen at the end of treatments with loratadine and placebo. Venous blood was taken after treatments, and basophil histamine release induced by anti‐IgE (10 μg/ml), N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP, 1 μM). and Ca 2+ ionophore A23187 (1 μM) was evaluated by ati automated fluorometric method. Results Treatment with loratadine attenuated early antigen‐tnduced nasal obstruction, rhinorrhea. and itching. Nasal symptoms were accompanied by a significant histamine release in the nasal lavages collected 5 min after stimulation when the patients received placebo (median 4 ng/ml, range 1‐28; P&lt;0.05). After treatment with loratadine, histamine release in the 5‐min postchallenge lavages was almost abrogated (median 0.5 ng/ml, range 0‐3; P&lt;0.01 vs placebo). Median anti‐IgE‐induced histamine release from basophils was 41.9% (range 27.8‐79.2) after placebo and 30.0% (range 1.7‐73.3, P &lt; 0.05) after loratadine. Active treatment exerted an inhibitory effect also on basophil histamine release induced by fMLP and Ca 2+ ionophore A23187. Conclusions Treatment for 1 week with loratadine reduces allergen‐mduced nasal symptoms and inhibits in vivo and ex vivo histamine release in patients with allergic rhinitis.
How Have Patients Reacted to the Implications of the DCCT?
Authors: Chris J Thompson, J Fraser Cummings, John Chalmers, Craig Gould, Ray W Newton
Journal: Diabetes Care (1996)

OBJECTIVES To assess the reactions of people with insulin-treated diabetes (ITD) to the results of the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS A leaflet documenting the purpose and results of the DCCT was circulated to all 771 patients ages 15–60 years with ITD attending our clinic. Patients were invited to complete and return a questionnaire on their responses. RESULTS Of 550 respondents, 330 felt encouraged to improve glycemic control. Female respondents (P = 0.003) and younger age-groups (15–25 years, P = 0.001) were most likely to want to improve control. Patients with long duration of diabetes (&amp;gt; 20 years, P = 0.00001), hypoglycemia unawareness (P = 0.0001), or previous severe hypoglycemia (P = 0.001) were less likely to want to improve their control. Fear of hypoglycemia concerned all age-groups, whereas female respondents were most likely to be worried about the potential for weight gain (P = 0.00006). CONCLUSIONS Knowledge of the results of the DCCT encourages significant numbers of patients to want to improve glycemic control. Fear of hypoglycemia and, in women, weight gain may prove significant impediments to the clinical implementation of the results of the DCCT.
Stages of Change and Eating Behaviors
Authors: Linda Snetselaar
Journal: Diabetes Care (2003)

Stages of Change and Eating BehaviorsIssues on categorizing T he concept that one size fits all or even that one size is always appropriate for each individual at all times is discounted in the research presented by Vallis et al. (1) in this issue of Diabetes Care.Often, the clinician's short-sighted view of compliance to diet or other medical regimens is too simplistic.It fails to include the nuances of personal behavior that derail perfect adherence.This article includes research that more carefully dissects human behavior related to stages of change.Important aspects of willingness to change are correlated with sex, age, marital status, BMI, diabetes education, quality of life, and social support.The article by Vallis et al. provides an assessment of dietary change and the transtheoretical model.It provides added research on the applicability of this model to dietary counseling.The study design is a multifactorial split-plot with two randomized between-subject factors: treatment and usual care.Results focus on medically treated participants with type 2 diabetes in the treatment arm of the study.In this group, 75% of women were in the preparation stage compared with 51.8% for men.Those study participants who were married were in more advanced stages of change.Older people were more likely to be in the action phase.BMI was highest for those in contemplation and significantly lower in precontemplation and maintenance.Looking at health care use, those study participants with type 2 diabetes on medication and in the action stage were more likely to have participated in diabetes education.Quality of life was highest for study participants in maintenance and lowest for those in the action stage.This was rationalized by the authors stating that the action stage is a time of transition and may interfere with quality of life.Social support was highest for those in contemplation and lowest for those in action stage.The authors suggest that when the individual is actively thinking about change but has not yet begun change, support is easy to give.Also, the person in the action stage may be seen as
The History of Urology
Authors: Ronnie Beth Bush
Journal: JAMA (1972)

The history of a medical specialty should be more than a listing of the firsts in a field. This is particularly true of urology, which provides a unique opportunity to study shifts in the theory and practice of medicine, surgery, and public health over 4,000 years. Uroscopy was the earliest clinical laboratory test of which we have a written record. Lithotomy was one of the first surgical procedures man performed involving the direct surgical intervention into a body cavity. Attempts at litholysis made during the centuries provided a focus for the practical application of chemical theory. Leonard J. T. Murphy's contribution combines two separate works. The first part is an edited, abbreviated translation of<i>L'histoire d'urologie</i>, by Ernest Desnow, which appeared as part one of volume one of the<i>Encyclopédie française d'urologie</i>(1914). Dr. Murphy's translation of this erudite classic secondary source reads well. His own insertions are pertinent and
ARE YEAST EXTRACTS JUSTIFIABLE AS SUBSTITUTES FOR EXTRACT OF MEAT?
Authors: A. Gamgee
Journal: BMJ (1908)

THERE are few features of everyday English life which *impress one whio has for some years not resided in Eng- -land more forcibly than the mad rush after cheap goods, almost irrespective of their actual worth.A necessary -stimulus to this.unreasonable striving to obtain that which -is eheap without any conscientious attempt to consider whether that which is bought possesses any, or what, .value, is the unscrupulous manner in which some articles are advertised.Whilst legitimate advertisement is of the
From the Assistant Secretary for Health, US Public Health Service
Authors: J. O. Mason
Journal: JAMA (1992)

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
EU centre calls for policies to help female drug users
Authors: R. Watson
Journal: BMJ (2000)

Patterns of drug misuse in the European Union are changing, with a chronically ageing population among heroin addicts and a wider use of cocaine, cannabis, and combinations of amphetamines, ecstasy, and medicines.

The picture is contained in the annual report of the European Union's European Monitoring Centre for Drugs and Drug Addiction in Lisbon. It estimates that the number of drug addicts has …
Scintillation Camera Renography in Superior Infundibular Obstruction
Authors: John C. Harbert
Journal: JAMA (1969)

Five patients with superior infundibular obstruction were studied with scintillation camera renography. The renogram tracings in all patients showed prolonged transit time and flattening of the excretory phase. The scintiphotos accurately localized the site of tracer retention to the superior collecting system of the involved kidney.
Bullous lesions in poisoning.
Authors: B I Hoffbrand, C M Ridley
Journal: BMJ (1972)

suspected until a few months before death when increased pain necessitated surgery.All these patients had severe anaemia (Hb 55-60%) at diagnosis.All had a longstanding history of duodenal ulcer and were then found to have gastric cancer.It seems, therefore, that such cases need very careful examination if they come to operation for a duodenal ulcer.Tragically, all were late diagnoses chiefly because dyspeptic symp- toms were wrongly interpreted in the 16-12 months before laparotomy.It is said that duodenal ulcer and gastric cancer only rarely coexist,' and a report from the Birmingham Regional Cancer Registry and the United Birmingham Hos- pitals stated that no association was found between cancer and peptic ulcer.2-Iam, etc.,
A TONSIL PILLAR SEPARATOR.
Authors: DANIEL S. HAGER
Journal: JAMA (1907)

Since the tonsil snare has come into general use for removing the faucial tonsil the problem of separating the adhesions of the tonsil and pillar has brought out many instruments. I have tried a number of the different makes and none has given me as good satisfaction as the one here shown, devised by me about one and one-half years ago. It can be used equally well for separating the pillars of either the hypertrophic or atrophic variety. The blade is set at such an angle as to conform to the anatomic curvature of the tonsil and fossa and by reversing is adapted to the curvature of either back or front pillar. The top or fossa is started with a special knife (not shown here) and then continued down with this knife. The knife is shown with the double edges sharp, and this, in my experience, is desirable in separating
Relationship of plasma alpha tocopherol to index of clinical severity in individuals with sickle cell anemia
Authors: George Phillips, Christine C. Tangney
Journal: American Journal of Hematology (1992)

Abstract Several parameters of micronutrition related to antioxidant activity are reduced in individuals with sickle cell anemia (SCA). The data presented here suggest that vitamin E, specifically alpha tocopherol, has a significant correlation (r = –0.38, P &lt; 0.04) with a retrospective survey of clinical events and a significant correlation with a prospective survey of clinical events (r = –0.42, P &lt; 0.03). The survey of clinical events score takes into account important vaso‐occlusive manifestations in SCA. Differences in plasma vitamin E levels explained about 15% of the variability in the clinical manifestations of SCA in the population studied. Previously reported data from our lab suggests that the differences in alpha tocopherol levels are not related to dietary intake. Vitamin E may play an important role in modulating the ability of sickle hemoglobin containing erythrocytes to produce vaso‐occlusion. Alternatively, it may simply be a marker of disease activity. Studies are ongoing at our center to determine if the relationship of alpha tocopherol to clinical events is causal. © 1992 Wiley‐Liss, Inc.
Treatment of Septic Shock with Human Monoclonal Antibody HA-1A
Authors: Richard V. McCloskey
Journal: Annals of Internal Medicine (1994)

Objective: To compare the effectiveness of 100 mg of HA-1A and placebo in reducing the 14-day all-cause mortality rate in patients with septic shock and gram-negative bacteremia in the Centocor: HA-1A Efficacy in Septic Shock (CHESS) trial, and to assess the safety of 100 mg of HA-1A given to patients with septic shock who did not have gram-negative bacteremia. Design: Large, simple, group-sequential, randomized, double-blind, multicenter, placebo-controlled trial. Setting: 603 investigators at 513 community and university-affiliated hospitals in the United States. Patients: Within 6 hours before enrollment, the patients had been in shock with a systolic blood pressure of less than 90 mm Hg after adequate fluid challenge or had received vasopressors to maintain blood pressure. These episodes of shock began within 24 hours of enrollment. A presumptive clinical diagnosis of gram-negative infection as the cause of the shock episode and a commitment from the patients' physicians to provide full supportive care were required. Measurements: Blood cultures were obtained within 48 hours of enrollment, and death at day 14 after treatment was recorded. Adverse events occurring within 14 days after enrollment were also tabulated. Results: 2199 patients were enrolled; 621 (28.2%) met all enrollment criteria, received HA-1A or placebo, and had confirmed gram-negative bacteremia. Mortality rates in this group were as follows: placebo, 32% (95 of 293) and HA-1A, 33% (109 of 328) (P = 0.864, Fisher exact test, two-tailed; 95% CI for the difference, −6.2% to 8.6%). Mortality rates in the patients without gram-negative bacteremia were as follows: placebo, 37% (292 of 793) and HA-1A, 41% (318 of 785) (P = 0.073, Fisher exact test, one-tailed; CI, −0.8% to 8.8%). Conclusions: In this trial, HA-1A was not effective in reducing the 14-day mortality rate in patients with gram-negative bacteremia and septic shock. These data do not support using septic shock as an indication for HA-1A treatment. If HA-1A is effective in reducing the mortality rate in patients dying from endotoxemia, these patients must be identified using other treatment criteria.
PULMONARY TUBERCULOSIS ASSOCIATED WITH BRONCHIAL OBSTRUCTION
Authors: Carl J. Bucher
Journal: JAMA (1928)

Rupture of a tuberculous lymph node into a bronchus, while not an uncommon lesion, rarely simulates the condition found when a foreign body lodges in a bronchus. The following case illustrates such an occurrence. <h3>REPORT OF CASE</h3> A child, aged 3 years, was admitted to the service of Dr. Chevalier Jackson with a diagnosis of bronchial obstruction. The essential features of the clinical history were a rapid onset of the disease, a duration of the illness for ten months, marked loss of weight, an unproductive cough, wheezing respiration without dyspnea, an irregular septic fever, slight pain in the right side of the chest, and night sweats. Before admission the child had been under the care of several physicians; and diagnoses of influenza, malaria, diphtheria and bronchial obstruction were made. Several times tuberculosis was considered and four Pirquet tests were performed, but all were negative. A roentgen-ray study of