tbuckley/cabot-search huggingface dataset:
Reflections on a Death
Authors: Theodore Tsomides
Journal: Annals of Internal Medicine (2001)

On Being a Patient6 February 2001Reflections on a DeathTheodore Tsomides, MD, PhDTheodore Tsomides, MD, PhDDr. Tsomides: Maine Medical Center; Portland, ME 04102Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-3-200102060-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As a resident in internal medicine at a 600-bed teaching hospital, I have cared for many dying patients and their families. These will be my most powerful and enduring memories, lasting long after the stressful call nights, the zebra cases, and any minor annoyances have faded. But nothing could have prepared me for the experience of taking care of my dying father or taught me more about the art of medicine.My father, the son of an immigrant tailor, went to college and medical school on the GI Bill after serving 3 years in World War II. After a year ... Author, Article, and Disclosure InformationAffiliations: Dr. Tsomides: Maine Medical Center; Portland, ME 04102Corresponding Author: Theodore Tsomides, MD, PhD, Department of Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDeath and Mental IllnessLife on the Receiving End: A Qualitative Analysis of Health Providers??? Illness NarrativesEnd of life is a public health issue“The nature is all there”—Cultural Influences on Care of the Dying 6 February 2001Volume 134, Issue 3Page: 246-248KeywordsAnxietyChemotherapyDeliriumFearFoodHospital medicineNursesRadiologistsSurgeryWeight loss ePublished: 6 February 2001 Issue Published: 6 February 2001 CopyrightCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Iron deficiency due to excessive therapeutic phlebotomy in hemochromatosis
Authors: James C. Barton, Sylvia S. Bottomley
Journal: American Journal of Hematology (2000)

Thirteen adults (eight men, five women) with hemochromatosis had undergone routine iron depletion therapy but while on maintenance phlebotomies developed iron deficiency which persisted for 25 ± 13 (mean ± 1 SD) months before diagnosis. All had symptoms and signs of iron deficiency. Levels of transferrin saturation were 10% ± 5% (1 SD), and serum ferritin concentrations were 8 ± 3 ng/mL. Eleven had anemia; eight had hypochromia and microcytosis. Bone marrow specimens obtained in five patients revealed no stainable iron. Medical records indicated that parameters of body iron status were infrequently or incorrectly used for adjusting the frequency of phlebotomies. Two patients developed iron deficiency due to additional blood loss from esophageal varices and bilateral hip replacement, respectively. Ten of the patients were treated with ferrous sulfate, 325 mg daily, for 2–6 weeks when anemia was corrected. In patients who were not given iron, anemia and microcytosis recovered in 8–24 months. We conclude that (i) sustained iron deficiency in hemochromatosis patients should be prevented by monitoring hemoglobin levels and serum ferritin; and (ii) hemoglobin concentrations and values of mean corpuscular hemoglobin may be higher in iron-deficient persons with hemochromatosis than in individuals without hemochromatosis. Symptomatic iron deficiency in hemochromatosis patients may be treated safely with a brief course of ferrous sulfate. Recovery is slower when iron is not given. However, iron supplementation is unnecessary and not recommended for the mild, self-limited anemia and decreased serum iron and ferritin concentrations encountered after initial iron depletion therapy for hemochromatosis. Am. J. Hematol. 65:223–226, 2000. © 2000 Wiley-Liss Inc.
Natalizumab-Induced Progressive Multifocal Leukoencephalopathy
Authors: Ashesh A. Thaker, Sarah E. Schmitt, John R. Pollard, Jacob G. Dubroff
Journal: Clinical Nuclear Medicine (2013)

A 55-year-old woman with known relapsing-remitting multiple sclerosis (RRMS) on natalizumab (Tysabri®) for 3 years was admitted to the hospital with worsening word-finding difficulties and gait instability. Neurologic examination revealed right hemianopia, right arm hemiplegia, right-sided sensory loss, and global aphasia. The patient underwent MRI and PET imaging with concurrent electroencephalogram. She was subsequently diagnosed with natalizumab-induced progressive multifocal leukoencephalopathy (PML) and treated with plasmapheresis, intravenous immunoglobulin, and high-dose intravenous steroids. Steroids were continued over a 3-month hospital course and tapered upon discharge. Speech, arm strength, and ambulation have since improved.
S61 High Levels Of Latent Tb Infection, Blood Borne Viruses, Poor Treatment Outcomes And Unmet Need Among Hard To Reach Groups In London: The Tb Reach Study
Authors: G. Ferenando, S. Hemming, S. Yates, L. Possas, E. Garber, V. Gant, R. Aldridge, A. Geretti, J. Harvey, A. Hayward, M. Lipman, T. McHugh, A. Story
Journal: Thorax (2014)

<h3>Background</h3> There are high rates of active tuberculosis (TB) in London’s hard to reach groups (homeless people, substance misusers and prisoners). However no systematic data are available regarding the prevalence of latent TB infection (LTBI) and blood borne viruses (BBV) - HIV, Hepatitis B and C (HBV, HCV). Hard to reach groups often present late for healthcare. We undertook a TB/BBV screening programme to assess the prevalence of LTBI and co-infection with BBVs within homeless hostels, drug services and a prison in London. We also investigated management outcomes in those referred on to healthcare services. <h3>Design/method</h3> Recruitment took place from May 2011–June 2013. Service users screened for TB on a mobile chest x-ray unit and in prison using the static digital x-ray machine were approached and, with consent, blood was drawn for IGRA (Quantiferon In-Tube) and HIV, HCV and HBV. Results were provided to participants with onward referral to healthcare services in line with current guidance. Treatment outcomes were collected via telephone follow up one year post referral for the positive cases. <h3>Results</h3> Prison (n = 511) (Table 1) LTBI: 65(13%) participants were IGRA positive [3(5%) co-infected with HCV]. Of these, 37(57%) were referred for preventive treatment, 16(43%) did not attend (DNA) appointments and were discharged or were lost to follow up (LFU). Of the 15 who commenced treatment, 9(60%) completed treatment. HCV: 22 participants were positive and referred, of which 11(50%) DNA/LFU, 11(50%) were under review and none commenced treatment. HBV: 10 participants were positive, of which 6(60%) DNA/LFU, 4(40%) were under review and none commenced treatment. There were no HIV positives. Community (N=696) (Table 1) LTBI: 116(17%) participants were IGRA positive [22(19%) co-infected with HCV]. Of the 14(12­%) referred to services, 8(57%) DNA/LFU and 3(21%) commenced treatment (2 completed). HCV: 84 were positive and referred (8 new diagnosis), 42(50%) DNA/LFU/declined referral, and 37(44%) under review. Five (6%) commenced treatment, one completed. HBV: 9 participants had current infection, none started treatment; 6 were under review and 3 DNA/LFU. HIV: 9 participants were positive and known to healthcare services. <h3>Conclusion</h3> The prevalence of LTBI, BBVs and co-infection within the hard to reach group is high compared to the general population with fewer patients starting TB prophylaxis/HCV treatment. The high overall rates of DNA/LFU (47%) seen indicate that current approaches to onward referral and retention in care for this group appear to be poor and effective measures to improve engagement with clinical services are essential. This study was supported by NIHR Programme Grant for Applied Research (RP-PG-0407–10340).
Effects of Childbearing on Glucose Tolerance and NIDDM Prevalence
Authors: Edward J Boyko, Beth W Alderman, Ellen M Keane, Anna E Baron
Journal: Diabetes Care (1990)

The goal of this study was to estimate the effects of childbearing on subsequent glucose tolerance and non-insulin-dependent diabetes mellitus (NIDDM) prevalence. A sample of subjects from 64 different locations in the United States were recruited for inclusion in the Second National Health and Nutrition Examination Survey. A complex survey design was used to select a probability sample of subjects from each location. A total of 4577 women were recruited, of whom 3057 underwent clinical and laboratory evaluation for the presence of diabetes mellitus. Women were classified as to their glucose tolerance based on the results of an oral glucose tolerance test or previous physician diagnosis of diabetes mellitus combined with current use of hypoglycemic medication. Childbearing was defined as number of live births experiencedby each woman at the time of the interview. Fasting plasma glucose increasedlinearly with increasing number of live births (coefficient 0.009, 95% confidence interval [Cl] 0.006–0.012), as did the 2-h value (coefficient 0.015, 95% Cl 0.009–0.021). Adjustment for age, body mass index (BMI), education, and income substantially reduced the magnitude of the association between childbearing and either plasma glucose measurement. When the prevalence of NIDDM in relation to childbearing was examined with logistic regressionanalysis, a significant linear increase in diabetes prevalence was seen withincreasing number of live births (relative prevalence of NIDDM, 1 birth vs. 0 = 1.73, 95% Cl 1.39-2.15), but adjustment for age, BMI, education, and income greatly reduced the magnitude of this association (relative prevalence of NIDDM, 1 birth vs. 0 = 1.07, 95% Cl 0.98-1.17). These data do not support a role for childbearing in the subsequent development of NIDDM.
FDA calls for reforms to bridge the gap between bench and bedside
Authors: B. Roehr
Journal: BMJ (2010)

The head of the US Food and Drug Administration has called for major reforms in the regulation and approval of new medicines to help bridge the gap between the advances being made in basic science and patient care.

Margaret Hamburg, director of the agency, was speaking at the National Press Club in Washington DC on 6 October at the launch of a white paper that provides a framework for such reform.

In 2008 the private sector invested $80bn (£50.6bn; €58.2bn) in biomedical research and the US National Institutes of Health another $30bn. Discoveries in fields such as genomics, biologics, …
Predicting Pathological Stage of Localized Prostate Cancer
Authors: John Naitoh
Journal: JAMA (1997)

To the Editor.  —Dr Partin and colleagues 1 recently updated their experience using prostate-specific antigen (PSA) level, clinical stage, and tumor grade for predicting the pathological stage of prostate cancer determined at the time of radical prostatectomy.  The authors are to be commended for this herculean effort. However, in examining our own series of radical prostatectomies, our data did not correspond to the outcomes listed in the article. Focusing the analysis of tumors with a Gleason score of 6 or 7, clinical stage of T2b, and PSA levels ranging between 4 and 10 ng/mL, the chance of having organ-confined disease was greater than that reported by Partin et al (70% vs 38% for tumors with Gleason scores of 6 and 50% vs 22% for tumors with Gleason scores of 7). This may be because of the high rate of interobserver variability that exists in clinical staging based on the digital
Impaired ability of neutrophils to produce oxygen-derived free radicals in patients with chronic liver disease and hepatocellular carcinoma
Authors: Masahiro Uehara, Noriyuki Sato
Journal: Hepatology (1994)

To evaluate whether neutrophil bactericidal function, the ability to produce oxygen-derived free radicals, is altered in patients with chronic liver disease, we measured chemiluminescence amplified by a luciferin analog (Cypridina luciferin analog-dependent chemiluminescence) and luminol (luminol-dependent chemiluminescence) in response to N-formyl-Met-Lue-Phe by neutrophils from patients with chronic liver diseases due to C and/or B type hepatitis: chronic active hepatitis, cirrhosis and hepatocellular carcinoma. Both Cypridina luciferin analog-dependent chemiluminescence and luminol-dependent chemiluminescence were significantly decreased in neutrophils from patients with chronic liver disease (hepatocellular carcinoma < cirrhosis < chronic active hepatitis) when they were compared with normal healthy subjects. The reduction of Cypridina luciferin analog-dependent chemiluminescence in chronic active hepatitis and cirrhosis was more sensitive than Cypridina luciferin analog-dependent chemiluminescence; however, in hepatocellular carcinoma, luminol-dependent chemiluminescence was more reduced than luminol-dependent chemiluminescence. Although there were not significant correlations between glutamic pyruvic transaminase and Cypridina luciferin analog-dependent chemiluminescence/luminol-dependent chemiluminescence, there were significant negative correlations between total bilirubin and Cypridina luciferin analog-dependent chemiluminescence/luminol-dependent chemiluminescence. Furthermore, there were significant positive correlations between albumin/prothrombin time and Cypridina luciferin analog-dependent chemiluminescence/luminol-dependent chemiluminescence. These data suggest that an impaired ability to produce oxygen-derived free radicals may contribute to the susceptibility to infection in patients with chronic liver disease.
Death Certificate Reporting of Colon and Rectal Cancers
Authors: Wong-Ho Chow
Journal: JAMA (1992)

<h3>To the Editor.</h3> —Cancer mortality data have been used in a variety of epidemiological studies, including analyses of time trends and geographic variations, ecological correlations, casecontrol studies, and for ascertainment of outcomes in cohort studies. The validity of these studies in large part depends on the quality of information reported on the death certificates. The accuracy of death certificate reporting of cancer causes of death has been examined previously, and it has been noted that sizable numbers of reported colon cancer deaths were actually rectal in origin, and vice versa.<sup>1-3</sup> Comparing certificate-reported causes of death with the hospital cancer diagnoses from the Second<sup>1</sup>and Third National Cancer Surveys as reported in Percy et al<sup>2</sup>and additional data from the Surveillance, Epidemiology, and End Results Program<sup>4</sup>at the National Cancer Institute, we found that during the period 1947 through 1986, an increasing proportion of rectal cancer was
A Well-Circumscribed, Painless Abdominal Mass
Authors: Brian A. Boone, Giselle G. Hamad
Journal: JAMA Surgery (2013)

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 Surgery HomeNew OnlineCurrent IssueFor Authors Podcast 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 Surgery journal
Controlled trial of aerobic exercise in hypertension.
Authors: J E Martin, P M Dubbert, W C Cushman
Journal: Circulation (1990)

To determine the antihypertensive efficacy of aerobic exercise training in mild essential hypertension, a prospective randomized controlled trial was conducted comparing an aerobic exercise regimen to a placebo exercise regimen, with a crossover replication of the aerobic regimen in the placebo exercise group. The study took place in an outpatient research clinic in a university-affiliated Veterans Administration medical center. Twenty-seven men with untreated diastolic blood pressure (DBP) of 90-104 mm Hg were randomized to the two exercise regimens. Ten patients completed the aerobic regimen. Nine patients completed the control regimen, seven of whom subsequently entered and completed the aerobic regimen. The aerobic regimen consisted of walking, jogging, stationary bicycling, or any combination of these activities for 30 minutes, four times a week, at 65-80% maximal heart rate. The control regimen consisted of slow calisthenics and stretching for the same duration and frequency but maintaining less than 60% maximal heart rate. DBP decreased 9.6 +/- 4.7 mm Hg in the aerobic exercise group but increased 0.8 +/- 6.2 mm Hg in the placebo control exercise group (p = 0.02). Systolic blood pressure (SBP) decreased 6.4 +/- 9.1 mm Hg in the aerobic group and increased 0.9 +/- 9.7 mm Hg in the control group (p = 0.11). Subsequently, seven of the nine controls entered a treatment crossover and completed the aerobic regimen with significant reductions in both DBP (-6.1 +/- 3.2 mm Hg, p less than 0.01) and SBP (-8.1 +/- 5.7 mm Hg, p less than 0.01). BP changes were not associated with any significant changes in weight, body fat, urinary electrolytes, or resting heart rate. This randomized controlled trial provides evidence for the independent BP lowering effect of aerobic exercise in unmedicated mildly hypertensive men.
Abstract A5: Characterizing and targeting B cells in lung cancer patients
Authors: Tullia C. Bruno, Jeffrey Kern, Jill E. Slansky
Journal: Clinical Cancer Research (2012)

Abstract Lung cancer is the leading cause of cancer death in men and women, both in the United States and the world. The current 5-year survival rate for lung cancer in the United States for all races is a discouraging 16% and has not changed dramatically during the past 30 years. The biggest reason for the discouraging survival statistics is that the majority of lung cancer subjects present with late-stage disease that is not curable by current therapies i.e. chemotherapy and radiation. However, in the last several years novel therapies have emerged to make lung cancer therapy better tolerated and more effective. As tumor immunologists, we are particularly interested in developing an immunotherapy that will help to engage the immune system in targeting and destroying tumor cells. In a comprehensive survey of the immune infiltrate in non-small cell lung cancer (NSCLC) patients, we discovered that the frequency of the B cell infiltrate in the tumor versus the normal tumor-adjacent tissue was significantly increased in comparison to other immune subsets, specifically, CD4, CD8, and regulatory T cells as well as NK and NKT cells. Further preliminary studies on the characterization of these B cells suggest that they have proliferated and acquired a memory phenotype. We will continue to characterize the B cells in the tumor microenvironment to determine if they are activated as well as functional. If the B cells in the tumor microenvironment are activated, we will test if the cells are responsive to antigens currently in clinical trial like MUC-1 as well as new antigens in the cancer-testis classification like XAGE-1b. We will test if the antigens are stimulating the B cells through the BCR and if these antigens will be presented to CD4 T cells in vitro, which would lead to the stimulation of the CD4 T cells. If the B cells are not activated, we will then query whether or not the B cells could have a suppressive phenotype, which will be determined by assaying the types of cytokines produced by the B cells using a cytokine array. As we continue to further characterize the B cells, we will also continue to monitor the various immune subsets in the three subtypes of NSCLC: adenocarcinoma, squamous cell carcinoma and large cell carcinoma. This immunophenotyping of the immune subsets will aid us in the identification of the appropriate immune cell populations to target for immunotherapy in the three subtypes of NSCLC. Ultimately, we aim to identify a novel target for an immunotherapy clinical trial in lung cancer patients.
A Simulated Patient-Physician Encounter Using a Talking Computer
Authors: Richard B. Friedman
Journal: JAMA (1977)

Computer-based clinical simulations provide a means for evaluating the information-gathering and patient-management competencies of physicians. The need for expensive computer terminals has restricted physician use of these simulations. This computer-based program permits physicians to complete computer-based encounters using a standard touch-tone telephone. (<i>JAMA</i>238:1927-1929, 1977)
China admits its AIDS crisis
Authors: T. Plafker
Journal: BMJ (2001)

With unprecedented frankness China's top health officials have acknowledged that the world's most populous country faces an HIV and AIDS crisis, and they have vowed to bring new resources to bear in their campaign to limit the spread of the virus.

China's vice minister of health, Yin Dakui, presented alarming data at a Beijing press conference last month indicating that rates of HIV infection are far higher than previously reported, and also that increased percentages of specific groups, such as drug misusers, are now testing positive.

“Like many other countries, we are facing a very serious epidemic of HIV and AIDS,” Mr Yin said as he announced that …
Abstract 5027: Steadily improving survival in lung cancer
Authors: Robert O. Dillman, Stephanie E. McClure, Douglas R. Zusman, Louis A. VanderMolen, Khosrow Mahdavi, Russell A. Hafer, Craig A. Cox, Colin I. Joyo, Neil M. Barth
Journal: Cancer Research (2011)

Abstract Background and Purpose: There have been many improvements in the diagnosis and management of lung cancer during the past 25 years, including better imaging and the potential for earlier diagnosis, better surgical staging and introduction of minimally invasive surgery, improved radiation technology, and introduction of several systemic cancer drugs, including targeted therapies, and acceptance of multidisciplinary approaches rather than focusing on single modalities of therapy. We examined how treatment has changed in successive eras and how this relates to survival. Patients and Methods: The Hoag Cancer Institute data base was used to identify patients with lung cancer diagnosed during 1986-2009, who were diagnosed and/or received some or all of their lung cancer treatment at Hoag Hospital within four months of diagnosis. For the four successive 5-year periods, data was summarized for patient demographics and treatment, and observed and relative 5-year survival rates were calculated. Results: Data is summarized in the table below. Conclusion: Over time there have been steady increases in median age, and in the proportion that have adenocarcinoma, are female, have local stage disease, undergo surgery alone as therapy, and receive systemic therapy with surgery as initial treatment. These changes have been associated with a 13.3 percentage point absolute increase in observed survival and an 81% relative increase. Relative 5-year survival increased from 18% to 34%, which contrasts with national data showing an increase from only 14% to 16% in the U.S. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5027. doi:10.1158/1538-7445.AM2011-5027