tbuckley/cabot-search huggingface dataset:
Pushing the Outpatient Quality Envelope
Authors: Tara F. Bishop
Journal: JAMA (2013)

In its 2001 report Crossing the Quality Chasm, the Institute of Medicine outlined six domains of quality in medical care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. 1 Anyone practicing medicine or receiving care probably agrees that quality should be defined broadly, as broadly as the Institute outlined.However, current quality measures for the outpatient setting do not encompass many of these domains.As a result, quality measurement and quality improvement efforts in the outpatient setting have neglected critical areas of high quality care.The majority of outpatient quality measures focus on preventive care, chronic disease care, and patient experience.In 2005, the Ambulatory Care Quality Alliance Workgroup (an organization that included stakeholders from the American Academy of Family Physicians, American College of Physicians, America's Health Insurance Plans, and Agency for Healthcare Research and Quality) endorsed 25 ambulatory care measures. 2Only two measures (testing for pharyngitis and appropriate treatment for upper respiratory infections in children) were for the diagnosis and management of acute conditions.The remaining 23 measures were for preventive care and chronic disease management.Similarly, of the 47 effectiveness of care measures in the 2013 Healthcare Effectiveness Data and Information Set (HEDIS), 36 are for preventive care and chronic disease management. 3Patient experience surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey focus on domains such as timeliness of care and patient-centeredness.
Effect of Diet upon Intestinal Disaccharidases and Disaccharide Absorption*
Authors: J. J. Deren, S. A. Broitman, N. Zamcheck
Journal: Journal of Clinical Investigation (1967)

The administration of a carbohydrate-containing diet for 24 hours to rats previously fasted for 3 days led to a twofold increase in total intestinal sucrase and sucrase specific activity. The specific activity of maltase was similarly increased, but lactase activity was unaffected. The sucrose-containing diet led to a greater increase in sucrase than maltase activity, whereas the converse was true of the maltose-containing diet. A carbohydrate-free isocaloric diet led to a slight increase in the total intestinal sucrase, but sucrase specific activity was unchanged. Assay of sucrase activity of mixed homogenates from casein-fed and sucrose-fed rats or fasted and sucrose-fed animals yielded activities that were additive. The Michaelis constant (Km) of the enzyme hydrolyzing sucrose was similar in the fasted, casein-fed, and sucrose-fed rats. The maximal velocity (Vmax) was twice greater in sucrose-fed as compared to casein-fed or fasted rats, suggesting an increased quantity of enzyme subsequent to sucrose feeding. Adrenalectomized rats maintained on 1.0% salt intake had sucrase and maltase levels comparable to those of controls. Steroid administration did not significantly increase their activities. The response to sucrose feeding was similar in both control and adrenalectomized rats, indicative of the absence of steroidal control on sucrase and maltase activity in the adult animal. Studies using intestinal ring preparations indicated that sucrose hydrolysis by the intact cells proceeded more rapidly when animals were fed sucrose. Additional corroboration of the physiologic significance of the increased enzyme levels in homogenates was afforded by intestinal perfusion studies. Sucrose hydrolysis increased twofold and fructose absorption fourfold in animals fed sucrose when compared to either fasted or casein-fed rats.
Prevention of Metabolic Alterations by Insulin Supplements Administered Either Before or After 2-h Nocturnal Interruption of CSII
Authors: André J Scheen, Philippe Henrivaux, Bernard Jandrain, Giuseppe Paolisso, Pierre J Lefèbvre
Journal: Diabetes Care (1987)

To evaluate the efficacy of a bolus insulin injection to prevent the metabolic alterations induced by a 2-h nocturnal interruption of a continuous subcutaneous insulin infusion (CSII), nine type I (insulindependent) C-peptide-negative diabetic patients were studied from 2200 to 0800 h during two randomized tests. An insulin bolus (2.1 ± 0.2 U) was administered via the pump either at 2300 h, just before CSII interruption, or at 0100 h, after reactivating the pump at its usual basal rate (1.05 ± 0.11 U/ h). The insulin bolus at 2300 h induced a significant rise in plasma free-insulin levels at 2400 h (+ 6.9 ± 1.8 mU/L, P &amp;lt; .01), resulting in an early and marked fall in blood glucose concentrations between 2300 and 0100 h (−2 .7 ± 0.5 mM, P &amp;lt; .001), with hypoglycemic values in five patients. The insulin bolus at 0100 h counteracted the fall in plasma free-insulin levels observed between 2300 and 0100 h and significantly increased plasma insulin at 0200 h (+ 3.2 ± 0.8 mU/L, P &amp;lt; .01). Blood glucose concentrations that remained stable during the 2-h arrest of the pump fell significantly between 0100 and 0400 h (- 2.1 ± 0.5 mM, P &amp;lt; .005). This fall rate was significantly lower than that measured within the 3 h after the insulin bolus given before CSII interruption but significantly higher than that observed in a reference control group of patients whose pump was functioning normally throughout the night. Thus, an insulin bolus equivalent to the amount of insulin not infused during a 2-h CSII interruption is able to prevent the metabolic alterations resulting from the pump arrest. However, to reduce the risk of hypoglycemia, the insulin bolus should preferably be administered after rather than before the 2-h CSII interruption.
It's Over, Debbie
Authors: Charles B. Clark
Journal: JAMA (1988)

To the Editor.  —I was deeply impressed by the article entitled It's Over, Debbie. 1 I would like to extend my most enthusiastic congratulations to the author for having the courage to submit this account.  Faced with a similar situation as a resident some years ago, the morphine approach seemed to be the obvious solution. But I just didn't have the strength to relieve a young man's suffering in view of the possible repercussions of such an action. It is encouraging to learn that at least one of us has risked his career to relieve the suffering of another.
Severe Antibody-Mediated Human Insulin Resistance: Successful Treatment With the Insulin Analog Lispro: A case report
Authors: Jorma T Lahtela, Mikael Knip, Robert Paul, Jaakko Antonen, Jorma Salmi
Journal: Diabetes Care (1997)

OBJECTIVE To evaluate the efficacy of the insulin analog lispro (Lys B28, Pro B29) in severe insulin resistance caused by human insulin antibodies. CASE: A 27-year-old man with a history of diabetes treated with human insulin for 3 years developed severe immunological insulin resistance caused by human insulin antibodies. Throughout follow-up (12 months) the insulin analog lispro was administered with an infusion pump as the only insulin therapy. The insulin dose decreased from an average of 300 U/day to 58 U/day, HbA1c decreased from 12.6 to 7.4%, and human insulin antibodies decreased from 8,057 to 1,860 nU/ml. Hypoglycemic episodes during early morning disappeared. CONCLUSIONS The insulin analog lispro might be suitable for the treatment of diabetic patients with substantially increased insulin antibody levels Apparently, the structural difference between the lispro and human insulin molecules prevented lispro from binding to the human insulin antibodies in this patient and consequently was nonimmunogenic.
Effect of population-based screening on breast cancer mortality
Authors: Karin Bock, Bettina Borisch, Jenny Cawson, Berit Damtjernhaug, Chris de Wolf, Peter Dean, Ard den Heeten, Gregory Doyle, Rosemary Fox, Alfonso Frigerio, Fiona Gilbert, Gerold Hecht, Walter Heindel, Sylvia Helen Heywang-Köbrunner, Roland Holland, Fran Jones, Anders Lernevall, Silvia Madai, Adrian Mairs, Jennifer Muller, Patric Nisbet, Ann O'Doherty, Julietta Patnick, Nick Perry, Lisa Regitz-Jedermann, Mary Rickard, Vitor Rodrigues, Marco Rosselli Del Turco, Astrid Scharpantgen, Walter Schwartz, Brigitte Seradour, Per Skaane, Laszlo Tabar, Sven Tornberg, Giske Ursin, Erik Van Limbergen, Anne Vandenbroucke, Linda J Warren, Lee Warwick, Martin Yaffe, Marco Zappa
Journal: The Lancet (2011)

Although the wider scientific community has long embraced the benefits of population-based breast screening, there seems to be an active anti-screening campaign orchestrated in part by members of the Nordic Cochrane Centre. These contrary views are based on erroneous interpretation of data from cancer registries and peer-reviewed articles. Their specific aim seems to be to support a pre-existing opposition to all forms of screening.1
The IASLC/ITMIG Thymic Malignancies Staging Project: Development of a Stage Classification for Thymic Malignancies
Authors: Frank C. Detterbeck, Hisao Asamura, John Crowley, Conrad Falkson, Giuseppe Giaccone, Dori Giroux, James Huang, Jhingook Kim, Kazuya Kondo, Marco Lucchi, Mirella Marino, Edith M. Marom, Andrew Nicholson, Meinoshin Okumura, Enrico Ruffini, Paul van Schil, Kelly Stratton
Journal: Journal of Thoracic Oncology (2013)
Severe Heart Failure and Early Mortality in a Double-Mutation Mouse Model of Familial Hypertrophic Cardiomyopathy
Authors: Tatiana Tsoutsman, Matthew Kelly, Dominic C.H. Ng, Ju-En Tan, Emily Tu, Lien Lam, Marie A. Bogoyevitch, Christine E. Seidman, J.G. Seidman, Christopher Semsarian
Journal: Circulation (2008)

Background— Familial hypertrophic cardiomyopathy (FHC) is characterized by genetic and clinical heterogeneity. Five percent of FHC families have 2 FHC-causing mutations, which results in earlier disease onset, increased cardiac dysfunction, and a higher incidence of sudden death events. These observations suggest a relationship between the number of gene mutations and phenotype severity in FHC. Methods and Results— We sought to develop, characterize, and investigate the pathogenic mechanisms in a double-mutant murine model of FHC. This model (designated TnI-203/MHC-403) was generated by crossbreeding mice with the Gly203Ser cardiac troponin I (TnI-203) and Arg403Gln α-myosin heavy chain (MHC-403) FHC-causing mutations. The mortality rate in TnI-203/MHC-403 mice was 100% by age 21 days. At age 14 days, TnI-203/MHC-403 mice developed a significantly increased ratio of heart weight to body weight, marked interstitial myocardial fibrosis, and increased expression of atrial natriuretic factor and brain natriuretic peptide compared with nontransgenic, TnI-203, and MHC-403 littermates. By age 16 to 18 days, TnI-203/MHC-403 mice rapidly developed a severe dilated cardiomyopathy and heart failure, with inducibility of ventricular arrhythmias, which led to death by 21 days. Downregulation of mRNA levels of key regulators of Ca 2+ homeostasis in TnI-203/MHC-403 mice was observed. Increased levels of phosphorylated STAT3 were observed in TnI-203/MHC-403 mice and corresponded with the onset of disease, which suggests a possible cardioprotective response. Conclusions— TnI-203/MHC-403 double-mutant mice develop a severe cardiac phenotype characterized by heart failure and early death. The presence of 2 disease-causing mutations may predispose individuals to a greater risk of developing severe heart failure than human FHC caused by a single gene mutation.
Detection of Epstein-Barr virus in Korean peripheral T-cell lymphoma
Authors: Jooryung Huh, Kwanghyun Cho, Dae Seog Heo, Ji Eun Kim, Chul Woo Kim
Journal: American Journal of Hematology (1999)

One hundred thirty-seven patients with peripheral T-cell lymphomas (PTL) were examined for the presence of Epstein-Barr virus (EBV) using in situ hybridization for EBV-encoded RNA (EBER) and Bam H-fragment, lower strand frame (BHLF) and immunohistochemical stain for latent membrane protein (LMP). EBER was detected in tumor cells in 79 cases (58%); 26/66 PTL, unspecified (39%), 3/4 AILD (75%), 47/51 angiocentric lymphomas (AL) (92%), and 3/13 anaplastic large cell lymphoma (ALCL) (23%) by Revised European-American Lymphoma (REAL) classification. EBER was detected in 17/36 nodal (47%) vs. 62/101 extranodal PTLs (61%); 21/24 nasal, 12/32 Waldeyer's ring, 9/13 gastrointestinal, and 20/32 skin and soft tissue PTL. AL was consistently associated with the highest frequency of EBER among the extranodal PTL: nose (19/20), GI tracts (3/3), skin (14/15), and Waldeyer's ring (11/14). In extranodal lymphomas, coagulative-type zonal necrosis was seen almost exclusively in AL and showed correlation with EBER-positivity (P < 0.01). LMP was detected in 24 among 107 cases tested (22%). No signal for BHLF was detected in 76 cases tested, implying absent or negligible incidence of lytic infection. In conclusion, high incidence of EBV was observed in PTL among Koreans, with predilection for angiocentric lymphomas and extranodal presentation, especially involving nose, skin, and gastrointestinal tract. Am. J. Hematol. 60:205–214, 1999. © 1999 Wiley-Liss, Inc.
Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group
Authors: J. F. Plouffe
Journal: JAMA (1996)

To determine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the serotypes and antimicrobial susceptibilities of the pneumococcal isolates.Prospective case ascertainment and procurement of S pneumoniae isolates between January 1991 and April 1994.Ten adult care hospitals in Franklin County, Ohio.Patients (N = 590) in whom S pneumoniae was isolated from blood cultures.Demographic data from patients with pneumococcal bacteremia were obtained by chart review. Pneumococcal serotyping and antimicrobial susceptibility testing were performed on 499 bacteremic isolates.Among residents of Franklin County, the annual incidence of pneumococcal bacteremia was higher in patients at least 65 years old (83.0 per 100,000 population) compared with younger adults (9.6 per 100,000 population) (odds ratio [OR], 8.74; 95% confidence interval [CI], 7.19 to 10.62) and more common among African Americans than whites (OR, 1.36; 95% CI, 1.06 to 1.75). The relative risk of pneumococcal bacteremia among persons infected with the human immunodeficiency virus was 41.8 times (CI, 19.0 to 92.0) that of county residents 18 to 64 years of age. The overall mortality rate was 19% and was age-dependent, reaching 38% in patients at least 85 years old. The distribution of pneumococcal serotypes causing bacteremia was remarkably consistent over time. The incidence of drug-resistant strains increased during the study period; by 1994 14% were resistant to penicillin, 12% to ceftazidime, and 24% to trimethoprim-sulfamethoxazole. The resistant strains included several serotypes of S pneumoniae. Most serotypes (89.8%) of S pneumoniae causing bacteremia are contained in the pneumococcal vaccine.Increased use of pneumococcal vaccine and recognition of antimicrobial resistance patterns may assist physicians in treating patients with S pneumoniae bacteremia. Educational programs to discourage unnecessary antimicrobial drug use should be developed for patients and physicians.
Strangulated obturator hernia with acute gangrenous appendicitis.
Authors: E. Q. Archampong
Journal: BMJ (1969)

demonstrated in silver-impregnated sections of foetal tissues of experimentally infected guinea-pigs by Babudieri and Biocca (1941) and in the foetuses of pigs and cattle by other workers, but they have been isolated only from animal foetuses examined immediately or very shortly after death (Ryley and Simmons, ,954).Though we have no proof that the human foetus was infected there is sufficient evidence in previous work on human and animal abortions to indicate that it probably was.In any case it is reasonable to suppose that the mother's leptospiral infection in one way or another resulted in the death of the foetus.It is important, therefore, to be aware of the possibility of leptospirosis in cases of feverish illness during pregnancy in persons living or working in situations where sources of infec- tion are known to exist.One can then endeavour to suppress the septicaemia by prompt antibiotic treatment and so reduce the risk of the foetus becoming infected.
PRINCIPLES GOVERNING THE LOCAL TREATMENT OF CARCINOMA OF THE BLADDER
Authors: EDWARD L. KEYES
Journal: JAMA (1928)

Bladder tumors are interesting only as they are malignant. What, then, is meant by malignant?  In the broadest sense, malignancy is that characteristic in a tumor which makes it threaten life unless it is destroyed or excised. The pathologist finds that certain cellular characteristics are associated with varying degrees of malignancy, and he has taught us to appeal to him for a decision as to whether a tumor is benign or malignant, and, if the latter, as to its degree of malignancy.  But malignancy is also a clinical condition, and therefore its diagnosis may not be wholly relegated to the laboratory. There is a clinical malignancy the degrees of which do not run quite parallel to those of cellular malignancy. It is true that some tumors are so excessively malignant that clinic and laboratory find no difficulty in agreeing about them. The melanoma is perhaps the most characteristic of these.
Recombinant interferon α2a is effective in the treatment of discoid and subacute cutaneous lupus erythematosus
Authors: J. THIVOLET, J.F. NICOLAS, J. KANITAKIS, S. LYONNET, B. CHOUVET
Journal: British Journal of Dermatology (1990)

Journal Article Recombinant interferon α2a is effective in the treatment of discoid and subacute cutaneous lupus erythematosus Get access J. THIVOLET, J. THIVOLET Clinique Dermatologique, Hôpital E. Herriot, Lyon, France Corresponsence: Professor J. Thivolet, Hôpital E. Herriot, Pavillon R,69374 lyon Cedex 03, France. Search for other works by this author on: Oxford Academic Google Scholar J.F. NICOLAS, J.F. NICOLAS Clinique Dermatologique, Hôpital E. Herriot, Lyon, France Search for other works by this author on: Oxford Academic Google Scholar J. KANITAKIS, J. KANITAKIS Clinique Dermatologique, Hôpital E. Herriot, Lyon, France Search for other works by this author on: Oxford Academic Google Scholar S. LYONNET, S. LYONNET Clinique Dermatologique, Hôpital E. Herriot, Lyon, France Search for other works by this author on: Oxford Academic Google Scholar B. CHOUVET B. CHOUVET Clinique Dermatologique, Hôpital E. Herriot, Lyon, France Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 122, Issue 3, 1 March 1990, Pages 405–409, https://doi.org/10.1111/j.1365-2133.1990.tb08290.x Published: 01 March 1990
The return of Questions and answers
Authors: T. Delamothe
Journal: BMJ (2003)

Twenty years ago, questions and answers filled the awkward sized spaces at the ends of columns in the paper journal. Readers would send us medical questions that had been bothering them; we would send them out to our chosen expert on the topic. If and when we received an answer we would publish it. The service gradually fell into disuse, but this week sees its return, although with a twist.

We're asking inquirers to submit their questions not by letter but via our website (bmj.com). The questions will then be posted on the website. Anyone who wants to answer the question can do so, also via the website. As long as contributions are unlikely to land us in legal trouble we'll post them. As shown by similar features in New Scientist and the Guardian, even the most abstruse questions are likely to get answered.

This revived feature aims to capitalise on our website visitors' enormous willingness to share their ideas, opinions, and experience with others. Each week about 200 people respond to published articles via our rapid response facility, providing, in aggregate and for free, the most exacting form of peer review. Hundreds more participate in our online surveys—for example, nearly 1500 people voted on a recent series of questions about disentangling doctors from the drug industry.2 Our two interactive case reports have drawn 220 responses between them. These examples show how the world wide web is enabling people to act together in ways that were impossible before.1



Questions inaugurating the new feature

Are there national or international databases that allow people with specific medical problems to volunteer for relevant research? My problem is permanent double vision following a shotgun injury 20 years ago.

My arcus senilis of two years' duration disappeared completely after 18 months of atorvastatin (taken for a moderately raised serum cholesterol concentration). Has this been described before?

How long can a person go without water before dying?



The box gives examples of some of the unanswered questions “out there“ that have already been sent to us. If you have an answer, or a question of your own, or are just curious to see how this whole thing works: go to “Q&A“ on bmj.com. The most interesting and intriguing contributions will be selected for publication in the paper journal—so inveterate paper readers can expect to see the return of questions and answers to the nooks and crannies of their weekly BMJ.
Adoptive transfer of immunity to hepatitis B virus in mice by bone marrow transplantation from immune donors
Authors: Daniel Shouval, Ruth Adler, Yaron Ilan
Journal: Hepatology (1993)

Recipients of allogeneic bone marrow transplantation are immunosuppressed as a result of their primary disease and by myeloablative therapy. Such patients are dependent on multiple blood products and are at risk for hepatitis B virus infection. Active immunization against hepatitis B in the immediate pre- and post-transplant periods is ineffective, presumably because of decreased T cell-dependent B-cell responses. This study was designed to evaluate, in a mouse model system, the transfer of immunity against hepatitis B to bone marrow transplant recipients through immunization of bone marrow donors against hepatitis B before transplantation. Bone marrow donor BALB/c mice were immunized with a recombinant hepatitis B vaccine. Seroconversion to HBs antibody occurred within 4 wk of primary immunization, and antibody levels in treated donor mice rose above 300 mIU/ml after a single booster injection. Bone marrow recipient mice, conditioned by sublethal irradiation, were injected intravenously with bone marrow cells obtained from syngeneic HBs antibody-positive immune donors. Antibody was detected in 10% of bone marrow recipients within 30 days of transplantation and in 56% 1 mo after a booster injection that led to a secondary rise in HBs antibody. Adoptive transfer of immunity to hepatitis B also occurred after transplantation of T cell-depleted bone marrow cells from hepatitis B-immune donors, albeit at a lower HBs antibody level. These results indicate that immunity to hepatitis B can be transferred in mice by bone marrow transplantation from hepatitis B-immune donors to immunosuppressed recipients.(ABSTRACT TRUNCATED AT 250 WORDS)