tbuckley/cabot-search huggingface dataset:
Eradication Efforts Need Needle-Free Delivery
Authors: Rebecca Voelker
Journal: JAMA (1999)

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
PTU-248 A specialist cirrhosis clinic improves screening, patient satisfaction and attendance of patients with advanced liver disease
Authors: N K Fenton, S A Khan, H Marcinkowski, M L Cowan
Journal: Gut (2012)

<h3>Introduction</h3> Cirrhosis represents the end stage of progressive liver disease and is associated with potentially lethal complications. Early detection and management of these complications can improve outcome. In July 2008, a dedicated Cirrhosis Clinic was instigated at St. Mary9s Hospital, London, with the aim of enhancing the standard of care by improving the diagnosis and management of liver complications. We investigated the clinical impact of this novel clinic dedicated for patients with cirrhosis. <h3>Methods</h3> We compared the demographics, clinical outcomes and patient satisfaction among 50 patients attending the Cirrhosis Clinic and 30 patients with cirrhosis attending a general Hepatology outpatient clinic. Clinical information and rates of screening for complications were assessed from the case notes and the hospital databases. Attendance rates were collected prospectively and patient satisfaction assessed with a standardised questionnaire. <h3>Results</h3> The mean age, gender and ethnicity of patients in the Cirrhosis Clinic were identical to those in the general Hepatology clinic (57 years; 70% male; 62% Caucasian). Patients in the Cirrhosis Clinic were more likely to have alcoholic liver disease (58% vs 23%; p&lt;0.05). Cirrhosis Clinic patients were more likely to have ascites (56% vs 17%; p&lt;0.05), varices (60% vs 26%; p&lt;0.05), encephalopathy (20% vs 3%; p&lt;0.05), Child stage B or C (52% vs 19%; p&lt;0.05) and had higher UKELD (47 vs 43; p&lt;0.05). Screening rates were higher in the Cirrhosis Clinic patients for hepatocellular carcinoma (70% vs 57%; p&lt;0.05), vitamin D deficiency (86% vs 40%; p&lt;0.05) and varices (90% vs 77%; p=0.11). Attendance rates in the Cirrhosis Clinic improved substantially after the introduction of a telephone reminder (86% vs 64%; p&lt;0.05). Attendance rates were better than the general clinic (86% vs 77%) but this was not statistically significant (p=0.27). The Cirrhosis Clinic was rated excellent by 67% of patients vs 34% of patients in the general clinic (p=0.06). <h3>Conclusion</h3> A dedicated clinic serving patients with cirrhosis improved screening rates for complications, boosted attendance rates and led to increased patient satisfaction. Further work is required to evaluate the impact on long-term outcomes and cost-effectiveness. <h3>Competing interests</h3> None declared.
Does this patient have appendicitis?
Authors: J. M. Wagner
Journal: JAMA (1996)

Appendicitis is a common cause of abdominal pain for which prompt diagnosis is rewarded by a marked decrease in morbidity and mortality. The history and physical examination are at least as accurate as any laboratory modality in diagnosing or excluding appendicitis. Those signs and symptoms most helpful in diagnosing or excluding appendicitis are reviewed. The presence of a positive psoas sign, fever, or migratory pain to the right lower quadrant suggests an increased likelihood of appendicitis. Conversely, the presence of vomiting before pain makes appendicitis unlikely. The lack of the classic migration of pain, right lower quadrant pain, guarding, or fever makes appendicitis less likely. This article reviews the literature evaluating the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis.
Cytogenetic findings on shoe workers exposed long-term to benzene.
Authors: B T Tunca, U Egeli
Journal: Environmental Health Perspectives (1996)

Cytogenetic analysis of peripheral blood lymphocytes was performed to detect cytogenetical alterations in 58 shoe workers (57 male and 1 female) who had been exposed to particular mutagenic or carcinogenic agents and in 20 subjects selected from the general population as a control group. Frequencies of damaged cells, including gaps, breaks, and rearrangements (acentric fragment, deletion, translocations) were scored for both groups. The incidence of chromosomal aberrations (particularly chromatid gaps and breaks) in the study group was significantly higher than in the control group. No effects of smoking were observed and breaks alone were found to be influenced by alcohol consumption. No significant correlation was detected between the working period in the group exposed to benzene and frequency of chromosomal aberrations. Benzene content was determined to be between 0 and 28.5% in eight kinds of glues studied by fractional distillation. Hexane content ranged between 0 and 68.35% using the same method. This study indicated that the content of benzene and hexane in the glues are above normal limits.
Molecular Phylogeny of Living Xenarthrans and the Impact of Character and Taxon Sampling on the Placental Tree Rooting
Authors: Frédéric Delsuc, Mark Scally, Ole Madsen, Michael J. Stanhope, Wilfried W. de Jong, François M. Catzeflis, Mark S. Springer, Emmanuel J. P. Douzery
Journal: Molecular Biology and Evolution (2002)

Extant xenarthrans (armadillos, anteaters and sloths) are among the most derived placental mammals ever evolved. South America was the cradle of their evolutionary history. During the Tertiary, xenarthrans experienced an extraordinary radiation, whereas South America remained isolated from other continents. The 13 living genera are relicts of this earlier diversification and represent one of the four major clades of placental mammals. Sequences of the three independent protein-coding nuclear markers α2B adrenergic receptor (ADRA2B), breast cancer susceptibility (BRCA1), and von Willebrand Factor (VWF) were determined for 12 of the 13 living xenarthran genera. Comparative evolutionary dynamics of these nuclear exons using a likelihood framework revealed contrasting patterns of molecular evolution. All codon positions of BRCA1 were shown to evolve in a strikingly similar manner, and third codon positions appeared less saturated within placentals than those of ADRA2B and VWF. Maximum likelihood and Bayesian phylogenetic analyses of a 47 placental taxa data set rooted by three marsupial outgroups resolved the phylogeny of Xenarthra with some evidence for two radiation events in armadillos and provided a strongly supported picture of placental interordinal relationships. This topology was fully compatible with recent studies, dividing placentals into the Southern Hemisphere clades Afrotheria and Xenarthra and a monophyletic Northern Hemisphere clade (Boreoeutheria) composed of Laurasiatheria and Euarchontoglires. Partitioned likelihood statistical tests of the position of the root, under different character partition schemes, identified three almost equally likely hypotheses for early placental divergences: a basal Afrotheria, an Afrotheria + Xenarthra clade, or a basal Xenarthra (Epitheria hypothesis). We took advantage of the extensive sampling realized within Xenarthra to assess its impact on the location of the root on the placental tree. By resampling taxa within Xenarthra, the conservative Shimodaira-Hasegawa likelihood-based test of alternative topologies was shown to be sensitive to both character and taxon sampling.
Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India
Authors: J. J Rodrigues, S. M Mehendale, M. E Shepherd, A. D Divekar, R. R Gangakhedkar, T. C Quinn, R. S Paranjape, A. R Risbud, R. S Brookmeyer, D. A Gadkari, M. R Gokhale, A. M Rompalo, S. G Deshpande, M M Khalandkar, N. Mawar, R. C Bollinger
Journal: BMJ (1995)

<h3>Abstract</h3> <b>Objective</b>: To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. <b>Design</b>: Descriptive study of HIV serology, risk behaviour, and findings on physical examination. <b>Subjects</b>: 2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July 1994. <b>Setting</b>: Two clinics and the National AIDS Research Institute, in Pune, Maharashtra State, India. <b>Main outcome measure</b>: HIV status, presence of sexually transmitted diseases, and sexual behaviour. <b>Results</b>: The overall proportion of patients infected with HIV was 23.4% (655/2800); 34% (184) of the women and 21% (459) of the men were positive for HIV infection. Of the 560 women screened, 338 (60%) had a reported history of sex working, of whom 153 (45%) were infected with HIV-1. The prevalence of HIV-1 infection in the 222 women who were not sex workers was 14%. The significant independent characteristics associated with HIV infection based on a logistic regression analysis included being a female sex worker, sexual contact with a sex worker, lack of formal education, receptive anal sex in the previous three months, lack of condom use in the previous three months, current or previous genital ulcer or genital discharge, and a positive result of a Venereal Disease Research Laboratory test. <b>Conclusions</b>: In India the prevalence of HIV infection is alarmingly high among female sex workers and men attending clinics for sexually transmitted diseases, particularly in those who had recently had contact with sex workers. A high prevalence of HIV infection was also found in monogamous, married women presenting to the clinics who denied any history of sex working. The HIV epidemic in India is primarily due to heterosexual transmission of HIV-1 and, as in other countries, HIV infection is associated with ulcerative and non-ulcerative sexually transmitted diseases
Book Review Platelets in Hematologic and Cardiovascular Disorders: A Clinical Handbook Edited by Paolo Gresele, Valentin Fuster, José A. López, Clive P. Page, and Jos Vermylen. 511 pp., illustrated. New York, Cambridge University Press, 2008. $150. 978-0-521-88115-9
Authors: Carlo Patrono
Journal: New England Journal of Medicine (2008)
Sick Absence Certification. Analysis of one Group Practice in 1967
Authors: S. Carne
Journal: BMJ (1969)

Certificates of inability or fitness to work were issued on 6,161 occasions in one year in one group practice. Half the episodes of illness lasted for seven days or less, and two thirds of the episodes ended on a Sunday. Clearly in most cases the doctor does no more than countersign the patient's declaration of his fitness or not to work. Abolition of short-term medical certification would probably have little effect on absenteeism or the sums paid out as sick benefit.
Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database
Authors: M. Moore, H. M. Yuen, N. Dunn, M. A Mullee, J. Maskell, T. Kendrick
Journal: BMJ (2009)

To explore the reasons behind the recent increase in antidepressant prescribing in the United Kingdom. Design Detailed retrospective analysis of data on general practitioner consultations and antidepressant prescribing. Data source Data were obtained from the general practice research database, which contains linked anonymised records of over 3 million patients registered in the UK. Data were extracted for all new incident cases of depression between 1993 and 2005. Review methods Detailed analysis of general practitioner consultations and antidepressant prescribing was restricted to 170 practices that were contributing data for the full duration of the study.In total, 189 851 people within the general practice research database experienced their first episode of depression between 1993 and 2005, of whom 150,825 (79.4%) received a prescription for antidepressants in the first year of diagnosis. This proportion remained stable across all the years examined. The incidence of new cases of depression rose in young women but fell slightly in other groups such that overall incidence increased then declined slightly (men: 7.83 cases per 1000 patient years in 1993 to 5.97 in 2005, women: 15.83 cases per 1000 patient years in 1993 to 10.06 in 2005). Antidepressant prescribing nearly doubled during the study period-the average number of prescriptions issued per patient increased from 2.8 in 1993 to 5.6 in 2004. The majority of antidepressant prescriptions were given as long term treatment or as intermittent treatment to patients with multiple episodes of depression.The rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment. Previous clinical guidelines have focused on antidepressant initiation and appropriate targeting of antidepressants. To address the costly rise in antidepressant prescribing, future research and guidance needs to concentrate on appropriate long term prescribing for depression and regular review of medication.
Normal muscle strength and fatigability in patients with effort syndromes.
Authors: M. J. Stokes, R. G. Cooper, R. H. Edwards
Journal: BMJ (1988)

To examine fatigue mechanisms in an unselected series of patients with excess fatigue ("effort syndromes") their muscle function was compared with that of normal subjects. Voluntary performance was assessed with a cycle ergometer to exhaustion and by maximal isometric contractions of the quadriceps femoris. The mean maximal heart rate in patients during ergometry was 89% of the predicted rate, and quadriceps strength was either normal or was inappropriate for the available muscle, which suggested submaximal effort. Contractile performance was examined in the absence of volition with stimulated contractions of the adductor pollicis. During stimulated fatiguing activity patients were neither weaker nor more fatigable than controls; thus the excess fatigue experienced by the patients was not due to a defect of the contractile apparatus. The increased perception of effort must therefore be due to impairment of central rather than peripheral mechanisms. The optimal approach to treatment of effort syndromes combines physical and psychological techniques.
A mechanism of haloalkene-induced renal carcinogenesis.
Authors: W Dekant, S Vamvakas, M Koob, A Köchling, W Kanhai, D Müller, D Henschler
Journal: Environmental Health Perspectives (1990)

Several halogenated alkenes are nephrotoxic; some others induce renal tubular adenocarcinomas in rodents after lifelong administration. A bioactivation mechanism accounting for the organ-selective tumor induction has been elucidated: conjugation of the parent compounds with glutathione (GSH), catalyzed by hepatic GSH S-transferases, results in the formation of haloalkyl and halovinyl glutathione S-conjugates. Formation of S-conjugates (identified by NMR and mass spectrometry) could be demonstrated with trichloroethene, tetrachloroethene, hexachlorobutadiene, perfluoropropene, trichlorotrifluoropropene, and dichloroacetylene in incubations with rat liver microsomes and in the isolated perfused rat liver. The GSH conjugates formed are eliminated from the rat liver with the bile and may be translocated to the kidney, intact or after metabolism to the corresponding cysteine S-conjugates that are metabolized in the kidney by renal tubular cysteine conjugate beta-lyase (beta-lyase) to reactive intermediates, most likely thioacylchlorides and thioketenes. Interaction of these potent electrophiles with DNA [demonstrated for intermediates formed from S-(1,2,3,4,4-pentachlorobutadienyl)-L-cysteine] causes mutagenicity in bacteria, genotoxicity in cultured renal cells, and cytotoxicity in kidney cells. As an alternative to beta-lyase-catalyzed cleavage, the cysteine S-conjugates may be acetylated to the corresponding mercapturic acids, which have been identified in urine. The ability of the kidney to concentrate GSH and cysteine S-conjugates and the intensive metabolism of GSH S-conjugates to cysteine S-conjugates in this organ are evidently responsible for the organotropic carcinogenicity.
The Protective Effect of the Sebaceous Layer.
Authors: U. Schmid, N. Hunziker, R. Brun, W. Jadassohn
Journal: British Journal of Dermatology (1964)

Journal Article The Protective Effect of the Sebaceous Layer. Get access U. Schmid, U. Schmid Geneva Search for other works by this author on: Oxford Academic Google Scholar N. Hunziker, N. Hunziker Geneva Search for other works by this author on: Oxford Academic Google Scholar R. Brun, R. Brun Geneva Search for other works by this author on: Oxford Academic Google Scholar W. Jadassohn W. Jadassohn Geneva Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 76, Issue 8-9, 1 August 1964, Pages 395–397, https://doi.org/10.1111/j.1365-2133.1964.tb14552.x Published: 01 August 1964
HOW GENDER AND AGE AFFECT TOLERANCE OF COLONOSCOPY
Authors: W Lai, M Fung, J Vatish, R Pullan, M Feeney
Journal: Gut (2013)

<h3>Introduction</h3> The aim of a colonoscopist is to perform the procedure safely within a reasonable time limit, and minimise any discomfort/pain caused to their patients. It is therefore useful to recognise factors that can influence patients9 tolerance of colonoscopy as part of pre-procedure planning. <h3>Aims/Background</h3> We collected data from a local endoscopy unit to evaluate the effect of gender and age on patients9 experience of the procedure. <h3>Method</h3> 354 patients who had bowel cancer screening colonoscopy (and found to have polyps) between January 2010 and December 2011 were identified from the BCSP database (Oracle BI Interactive Dashboards). Endoscopy reports were drawn from Scorpio© reporting system, with the patients9 comfort level recorded using the Modified Gloucester Discomfort Score (Figure 1). <h3>Results</h3> Male patients had a lower mean comfort score (i.e. better tolerated) than female patients (−0.5, 95% CI −0.47, −0.53) (Table 2). This is consistent with the lower mean fentanyl requirement in men compare to women (−6 mcg+/−0.1072). The comfort score also showed a positive correlation when plotted against age, length of procedure and fentanyl requirement (Tables&nbsp;3 and Figure&nbsp;1). <h3>Conclusion</h3> The reason for the less-tolerated colonoscopies for women might be due to previous gynaecological operations and possible longer colon 1 (which predispose to looping). Elderly patients may tolerate the procedure less due to previous abdominal surgery and looping of laxer and longer colons 1. The longer length of procedure suggests a more difficult examination which could contribute to patient discomfort. The amount of Fentanyl used was directly proportional to the comfort score as the endoscopists responded to the patients9 discomfort.
Performance of 11 biomarkers for liver fibrosis assessment in HIV/HBV co-infected patients
Authors: Julie Bottero, Karine Lacombe, Jérôme Guéchot, Lawrence Serfaty, Patrick Miailhes, Philippe Bonnard, Dominique Wendum, Jean-Michel Molina, Caroline Lascoux-Combe, Pierre-Marie Girard
Journal: Journal of Hepatology (2009)
Diagnosing Obstructive Airways Disease From the Clinical Examination-Reply
Authors: Donald R. Holleman
Journal: JAMA (1995)

<h3>In Reply.</h3> —We agree that all clinicians should strive to eliminate wasted efforts in their clinical examinations. This was the motivation for our critical review of the literature on the clinical diagnosis of airflow limitation. We wish to clarify a section of our article that may have contributed to the misconception that we recommend a skillful and time-wasting examination. In our section on "How to Elicit Symptoms and Signs of Airflow Limitation," we describe a complete pulmonary history and physical examination. We do not advocate that this entire process be performed on all patients. On the contrary, we recommend that clinicians carefully choose history and physical examination items using the data presented in the article and our recommendations in "The Bottom Line." We outline an examination that includes inquiring about cigarette smoking, a history of airflow limitation, and symptoms of wheezing; inspecting for a barrel chest; and auscultating for breath
CN-07 * PREDICTORS OF ACUTE SEVERE LYMPHOPENIA DURING RADIOTHERAPY AND TEMOZOLOMIDE FOR HIGH-GRADE GLIOMA
Authors: J. Huang, C. Robinson, T. DeWees, J. Campian, D. Mullen, S. Fergus, A. Kim, G. Dunn, D. Tran, J. Simpson
Journal: Neuro-Oncology (2014)

BACKGROUND: Acute severe lymphopenia (ASL) frequently develops during radiotherapy and temozolomide (RT + TMZ) for high-grade glioma (HGG) and has been shown to be correlated with survival. This study is designed to identify potential predictors of ASL, especially RT-specific parameters that can be modified. METHODS: From January 2007 to December 2012, 194 patients with HGG were treated RT + TMZ and had available data including lymphocyte count and radiation dose-volume histogram (DVH) parameters. RT was delivered to 2 planning target volumes (PTV1) over a median of 43 days (range 19-75): 60Gy (40.05-66) to PTV 1 and 51Gy (30-54) to PTV2. Concurrent TMZ was given daily at a dose of 75 mg/m2 for the duration of RT. ASL was defined as less than 500/ul (Common Toxicity Criteria version 4.0, grade 3-4) within the first two months from the start of RT. Peripheral blood including lymphocyte count was typically assessed weekly during RT and then monthly thereafter. DVH parameters were determined for brain, brainstem and PTV from the original RT plan. The stepwise logistic regression analysis (SLRA) was used to determine the most important predictors of ASL. RESULTS: Forty-five patients (23%) developed ASL. Patients with ASL had significantly worse OS than those without (median 11.2 vs 18.3 months, respectively, p < 0.001). The SLRA showed that female gender (odd ratio [OR], 5.21; 95% confidence interval [CI], 2.34-11.63), elder age (1.05; 1.01-1.08), higher V25Gy (volume receiving 25Gy) of brain (1.04; 1.01-1.06), lower pretreatment lymphocyte count (1.001; 1.00-1.002) were the most significant predictors for ASL. ASL rate was 40% for patients with V25Gy ≥ 66% and 15% for V25Gy < 66%. CONCLUSIONS: Female gender, elder age, increased V25Gy of brain, and low pretreatment lymphocyte count are significant predictors of ASL during treatment of HGG. Maintaining V25Gy of brain below 66% may reduce the rate of ASL.