tbuckley/cabot-search huggingface dataset:
Public Policy and the Supply of Primary Care Physicians
Authors: Paul G. Barnett
Journal: JAMA (1989)

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.
Efficacy of borage oil in patients with atopic eczema
Authors: R. Kapoor, A. Klimaszewski
Journal: British Journal of Dermatology (2000)

Journal Article Efficacy of borage oil in patients with atopic eczema Get access R. Kapoor, R. Kapoor Bioriginal Food and Science Corporation, 102 Melville Street, Saskatoon, SK S7J 0R1, CanadaE‐mail: rkapoor@bioriginal.com Search for other works by this author on: Oxford Academic Google Scholar A. Klimaszewski A. Klimaszewski Bioriginal Food and Science Corporation, 102 Melville Street, Saskatoon, SK S7J 0R1, CanadaE‐mail: rkapoor@bioriginal.com Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 143, Issue 1, 1 July 2000, Page 200, https://doi.org/10.1046/j.1365-2133.2000.03619.x Published: 01 July 2000
Sunlight Protection for Erythropoietic Protoporphyria Patients
Authors: Ramon M. Fusaro
Journal: JAMA (1974)

To the Editor.—  In the treatment of any disorder, the simultaneous use of two different therapies usually does little more than either individually. It is only occasionally that the effect of two different modes of treatment are additive. Yet, such an occurrence may be available in erythropoietic protoporphyria (EPP). Just recently, Mathews-Roth et al (228:1004, 1974) reported sevenfold (median) photoprotection in sunlight in EPP patients using orally administered β-carotene. In 1970 ( Br Med J 1:730, 1970), a 15-fold (median) increase in sunlight protection was reported in seven EPP patients using a topically administered dihydroxyacetone and lawsone preparation. Since then, we have treated six additional EPP patients with a stable preparation of dihydroxyacetone and lawsone (Duoshield). The Table summarizes the results.  Since β-carotene is taken orally and the dihydroxyacetone and lawsonepreparation is used topically, the total photoprotective effect should be additive. Thus, we can approximately double the time these patients
Decreased T lymphocyte migration in patients with malignancy mediated by a suppressor cell population.
Authors: D G Hesse, D J Cole, D E Van Epps, R C Williams
Journal: Journal of Clinical Investigation (1984)

The migration and concentration of lymphocytes at sites of antigenic challenge are an integral part of the expression of delayed cutaneous hypersensitivity, as well as of tumor and graft rejection. In this study, we have analyzed the migration of T lymphocytes from patients with malignancy. We used casein and concanavalin A (Con A)-stimulated mononuclear cell supernatants to stimulate T cell locomotion. Peripheral blood T lymphocytes from 30 patients with established malignancy, 10 patients with indolent malignancy or benign tumor, and 42 normal adult controls were tested. Data are expressed as a migration index (MI), which represents the difference in micrometers between the distance migrated in response to a stimulus and the distance migrated in response to media alone. We observed a marked depression in casein-stimulated T lymphocyte migration in patients with established malignancy (mean MI +/- 1 SD = 17.0 +/- 9 microns) as compared with normal adult controls (mean MI +/- 1 SD = 35.3 +/- 10 microns). Similar results were observed with migration in response to Con A supernatants. T cells from patients with established malignancy had a mean MI of 5.8 +/- 4 microns to Con A supernatants as compared with 24.5 +/- 5 for controls. This depressed migration was apparent both in the distance that cells migrated and in the number of cells that migrated into the membrane. Of 10 patients with indolent malignancy or benign tumor, T cell migration in 8 was not significantly decreased as compared with controls. When we mixed equal concentrations of normal control T lymphocytes with T lymphocytes from patients with cancer and added the mixture directly to the upper compartment of the chemotaxis chamber, the response of the normal T cells to casein was inhibited by an average of 48%. We observed inhibition of this migration of normal cells when we added as little as 10% of patient cells to normal cells. When we mixed normal control T lymphocytes from different donors and added them directly to the upper compartment of the chemotaxis chamber, T lymphocyte migration in response to casein was not significantly altered. If T cells from patients with cancer were cultured overnight, the suppressive effect on lymphocyte locomotion was lost. Our results indicate that there is a population of T lymphocytes in patients with cancer that suppress normal T lymphocyte migration. This suppressor activity may partially explain the subversion of immunosurveillance in established neoplastic states, as well as the defective inflammatory reaction to intradermal injection of antigen observed in many patients with malignancy.
Lung is an important source of atrial natriuretic factor in experimental cardiomyopathy.
Authors: J Gutkowska, M Nemer, M J Sole, J Drouin, P Sirois
Journal: Journal of Clinical Investigation (1989)

The regulation of water and electrolyte homeostasis is multifactorial and includes the heart and kidneys as important regulatory centers. Within the heart, a recently discovered hormone, atrial natriuretic factor (ANF), has been implicated in the maintenance of water and salt balance. Primarily found in mammalian atria, ANF has been detected in low amounts in several tissues, including lungs. A disorder of the ANF system has been demonstrated in genetically cardiomyopathic hamsters, a model for human congestive cardiomyopathy. Atrial ANF gene expression and storage are decreased during development of this disease, while paradoxically, circulating levels of ANF are increased. We have hypothesized that an extracardiac source may contribute to ANF production in these pathological conditions. In this paper we provide evidence that ANF synthesis is stimulated in the lungs of hamsters during development of cardiomyopathy as revealed by increased ANF mRNA and peptide levels. Furthermore, we show that ANF synthesized in lungs is secreted and has identical chromatographic and biological properties to circulating ANF. The increased production of ANF in lungs may be physiologically important in preventing pulmonary edema. Alternatively, during cardiac dysfunction, lungs may play a compensatory role by increasing their contribution to plasma ANF levels.
Electrocardiographic Changes During Hypothermia and Circulatory Occlusion
Authors: CLARENCE E. HICKS, MALCOLM C. MCCORD, S. GILBERT BLOUNT
Journal: Circulation (1956)

An analysis of the electrocardiograms from 25 patients during reduction of body temperature and total occlusion of circulation reveals marked abnormalities in conduction and rhythmicity. Hypothermia thermia was accompanied by slowing of the heart rate, depression of intracardiac conductivity, and by inhibition of the normal centers of impulse formation with resultant atrial arrhythmias. Circulatory occlusion during hypothermia was associated with a high incidence of ventricular arrhythmias. Changes noted in electric activity of the myocardium tended to return to normal with release of occlusion and warming of the patient.
Female genital mutilation/cutting
Authors: H. L. Moore
Journal: BMJ (2013)

In December 2012 the United Nations General Assembly adopted a resolution to intensify global efforts to eliminate female mutilation/cutting. As the recent Unicef report argues evidence played a major part in driving this resolution through. But what is the character of the available evidence and what is known about how to accelerate change to bring about the desired result? Although the tone of the report is resolutely upbeat the reality on the ground seems more uncertain and fragile.
Presence of Anti-Pituitary Antibodies and GAD Antibodies in NIDDM and IDDM
Authors: Takeo Kobayashi, Shigeki Yabe, Takashi Kikuchi, Tsugiyasu Kanda, Isao Kobayashi
Journal: Diabetes Care (1997)

To evaluate the clinical significance of the presence of anti-pituitary antibodies (APAs) in patients with NIDDM or IDDM and to examine the relationship of APAs to GAD antibodies (GADAs).Serum samples were obtained from patients with NIDDM and IDDM. APAs, determined by Western blot analysis, and GADAs, determined by radioimmunoassay, were detected in the patients' sera and control sera. Urinary levels of C-peptide (U-CPR) were measured.The prevalence of APAs was significantly higher in patients with NIDDM (24.2%) or IDDM (56.8%) than in healthy control subjects (6%). In patients with NIDDM, the levels of U-CPR were significantly lower, and the prevalence of insulin deficiency was higher in APA+ patients than in APA- patients.This is the first study to demonstrate that the prevalence of APAs is increased in patients with NIDDM and IDDM. The presence of APAs may be related to reduced secretion of insulin in NIDDM patients.
Can health visitors prevent fractures in elderly people?
Authors: N. J. Vetter, P. A. Lewis, D. Ford
Journal: BMJ (1992)

OBJECTIVES--To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN--Randomised, controlled trial; randomisation by household. SETTING--General practice in a market town. SUBJECTS--Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION--The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE--Fracture rate over four years. RESULTS--The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS--A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.
Responsibility in a Troubled World
Authors: John S. Millis
Journal: JAMA (1960)

A well-organized and meaningful address, like a well-organized and meaningful sermon, frequently requires a text. Rather than quote sentences from the writings of a great sage, I would prefer to focus your attention on the fundamental character of this occasion. We are gathered to witness and to participate in a ceremony of the installation of the President of the American Medical Association. We have paid honor to the man who has carried that responsibility in the past year, and we have expressed our good will and our confidence in the man who will discharge the responsibilities of that high office for the coming year. Our attention, therefore, is centered upon those who choose and are called to responsibility. The theme of this evening and the text for my remarks is the importance of the voluntary assumption of responsibility. Therefore I have chosen the title, "Responsibility in a Troubled World." It
The Uniform Clinical Data Set: An Evaluation of the Proposed National Database for Medicare's Quality Review Program
Authors: Anne-Marie Audet
Journal: Annals of Internal Medicine (1993)

The accuracy, reliability, and validity of the Medicare Peer Review Organization (PRO) review process have all been questioned. Evidence concerning the PRO program's effect on cost and quality of care remains lacking. The Health Care Financing Administration has thus committed itself to reform, and the Uniform Clinical Data Set (UCDS) has been proposed as the national database for Medicare's quality review program. The UCDS is an automated, computerized data set designed to standardize the evaluation of quality. It should allow an objective, consistent, and efficient process for peer review, based on explicit decision criteria and on aggregated information about patterns of care and quality. But is this truly so? We review the existing evidence on the UCDS and compare it with the current PRO reviews of quality, concluding that although the UCDS can potentially improve the accuracy and the reliability of data abstraction and the validity of reviews, this remains to be shown. Preliminary data on the UCDS suggest that work is needed before it can meet appropriate expectations for a national database for quality assessments. We also propose a model for reviews of quality in which we show that reviews of care done in the context of internal quality improvement programs will differ in goals and intensity from reviews of care done at the national level. We suggest that the UCDS has a unique, but limited rolethat of national surveillance of practice patterns. Detailed assessments of quality are more appropriately done at local or institutional levels.
Prevalence of depression and anxiety in patients requesting physicians' aid in dying: cross sectional survey
Authors: L. Ganzini, E. R Goy, S. K Dobscha
Journal: BMJ (2008)

<b>Objective</b> To determine the prevalence of depression and anxiety in terminally ill patients pursuing aid in dying from physicians. <b>Design</b> Cross sectional survey. <b>Setting</b> State of Oregon, USA. <b>Participants</b> 58 Oregonians, most terminally ill with cancer or amyotrophic lateral sclerosis, who had either requested aid in dying from a physician or contacted an aid in dying advocacy organisation. <b>Main outcome measures</b> Diagnosis of depression or anxiety according to the hospital anxiety and depression scale and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders. <b>Results</b> 15 study participants met "caseness" criteria for depression, and 13 met criteria for anxiety. 42 patients died by the end of the study; 18 received a prescription for a lethal drug under the Death with Dignity Act, and nine died by lethal ingestion. 15 participants who received a prescription for a lethal drug did not meet criteria for depression; three did. All three depressed participants died by legal ingestion within two months of the research interview. <b>Conclusion</b> Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.
Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors
Authors: H Lunde, T Hedner, O Samuelsson, J Lotvall, L Andren, L Lindhom, B E Wilholm
Journal: BMJ (1994)

To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors.Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised.Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions.Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea.In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors.Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.
Identification of four novel potato (<i>Solanum tuberosum</i>) allergens belonging to the family of soybean trypsin inhibitors
Authors: U. Seppälä, H. Majamaa, K. Turjanmaa, J. Helin, T. Reunala, N. Kalkkinen, T. Palosuo
Journal: Allergy (2001)

Background: We have previously identified patatin (Sol t 1) of potato tubers as a major food allergen among atopic children. In addition to Sol t 1, concomitant IgE binding to other, then unidentified, potato proteins was observed. Methods: Purification and identification of the putative allergens were done by both standard and advanced methods of protein chemistry. The patient series comprised 39 children with positive skin prick test (SPT) to raw potato. Immunoblotting and ELISA were used to examine IgE‐binding ability and skin prick testing to assess in vivo reactivity of the purified potato proteins. Results: Four IgE‐binding potato proteins with molecular masses ranging from 16 to 20 kDa were purified and identified as cathepsin D‐, cysteine‐, and aspartic protease inhibitors belonging to the family of soybean trypsin inhibitors (Kunitz type). The proteins were designated Sol t 2, Sol t 3.0101, Sol t 3.0102, and Sol t 4. In ELISA, 51% of the sera of the 39 atopic children showed specific IgE to Sol t 2, 43% to Sol t 3.0101, 58% to Sol t 3.0102, and 67% to Sol t 4, respectively. All these four allergens were able to produce positive wheal‐and‐flare responses in SPT. Conclusions: In addition to Sol t 1, potato tubers contain several proteins belonging to the family of soybean trypsin inhibitors against which atopic children with positive SPT responses to raw potato have in vitro and in vivo reactive IgE antibodies.
Effect of simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, on α-fetoprotein gene expression through interaction with the ras-mediated pathway
Authors: Hiroyuki Mazume, Keisuke Nakata, Daisaku Hida, Keisuke Hamasaki, Shotaro Tsuruta, Kazuhiko Nakao, Yuji Kato, Katsumi Eguchi
Journal: Journal of Hepatology (1999)
Detection of Recurrent Pancreatic Primitive Neuroectodermal Tumor by Tc-99m Hydrazinonicotinyl-Tyr3-Octreotide Scan
Authors: Hongli Jing, Fang Li, Libo Chen, Taiping Zhang, Yupei Zhao
Journal: Clinical Nuclear Medicine (2010)

A 24-year-old asymptomatic female with a history of exophytic primitive neuroectodermal tumor in the uncinate process of the pancreas was evaluated by Tc-99m hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) imaging as a part of the routine check-up. The images revealed focally increased activity in the head of the pancreas, indicating possible recurrent tumor. However, the results of all examinations considered, especially because of negative results from anatomic imaging, the finding from the HYNIC-TOC scan was regarded as likely false positive, and no new actions were taken. Eighteen months later, the patient developed abdominal mass. Repeat HYNIC-TOC imaging redemonstrated the focus of abnormal activity, which was confirmed as recurrent primitive neuroectodermal tumor pathologically.
C-Reactive Protein, Interleukin 6, and Risk of Developing Type 2 Diabetes Mellitus
Authors: Aruna D. Pradhan, JoAnn E. Manson, Nader Rifai, Julie E. Buring, Paul M Ridker
Journal: JAMA (2001)

ContextInflammation is hypothesized to play a role in development of type 2 diabetes mellitus (DM); however, clinical data addressing this issue are limited.ObjectiveTo determine whether elevated levels of the inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) are associated with development of type 2 DM in healthy middle-aged women.DesignProspective, nested case-control study.SettingThe Women's Health Study, an ongoing US primary prevention, randomized clinical trial initiated in 1992.ParticipantsFrom a nationwide cohort of 27 628 women free of diagnosed DM, cardiovascular disease, and cancer at baseline, 188 women who developed diagnosed DM over a 4-year follow-up period were defined as cases and matched by age and fasting status with 362 disease-free controls.Main Outcome MeasuresIncidence of confirmed clinically diagnosed type 2 DM by baseline levels of IL-6 and CRP.ResultsBaseline levels of IL-6 (P&lt;.001) and CRP (P&lt;.001) were significantly higher among cases than among controls. The relative risks of future DM for women in the highest vs lowest quartile of these inflammatory markers were 7.5 for IL-6 (95% confidence interval [CI], 3.7-15.4) and 15.7 for CRP (95% CI, 6.5-37.9). Positive associations persisted after adjustment for body mass index, family history of diabetes, smoking, exercise, use of alcohol, and hormone replacement therapy; multivariate relative risks for the highest vs lowest quartiles were 2.3 for IL-6 (95% CI, 0.9-5.6; P for trend = .07) and 4.2 for CRP (95% CI, 1.5-12.0; P for trend = .001). Similar results were observed in analyses limited to women with a baseline hemoglobin A1c of 6.0% or less and after adjustment for fasting insulin level.ConclusionsElevated levels of CRP and IL-6 predict the development of type 2 DM. These data support a possible role for inflammation in diabetogenesis.
Doctors are accused of plagiarising a medical guide to produce a smartphone app
Authors: C. Dyer
Journal: BMJ (2013)

Three doctors are accused of plagiarising a book on critical appraisal to create a smartphone application, in a misconduct hearing that began this week at the Medical Practitioners Tribunal Service.

Afroze Khan, Zishan Sheikh, and Shahnawaz Khan face charges of dishonesty in knowingly copying structure, contents, and material from the Doctor’s Guide to …