tbuckley/cabot-search huggingface dataset:
OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?
Authors: Mark G. Jameson
Journal: Annals of Internal Medicine (1994)

Letters1 November 1994OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?Mark G. Jameson, MD, MPHMark G. Jameson, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-9-199411010-00035 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The excellent review by Ouslander and Osterweil [1] and the accompanying editorial by Besdine and colleagues [2] encourage internists to expand their nursing home practice. The OBRA act is specifically revered by the authors as a “gift” to nursing home patients.As an internist who devotes half of his practice to nursing home patients, I believe OBRA is responsible for physician reticence to practice in nursing homes. To my mind, OBRA stands for “Oppressive Bureaucratic Requirement Act” because it coerces physicians to devote far more time to completing paperwork and attending meetings than to caring for patients. ...References1. Ouslander JG, Osterweil D. Physician evaluation and management of nursing home residents. Ann Intern Med. 1994; 120:584-92. Google Scholar2. Besdine RW, Rubenstein LZ, Cassel C. Nursing home residents need physician's services (Editorial). Ann Intern Med. 1994; 120:616-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1994Volume 121, Issue 9Page: 724-725KeywordsMedicareNursing homesPatients Issue Published: 1 November 1994 CopyrightCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Overexpression of miR-125b, a Novel Regulator of Innate Immunity, in Eosinophilic Chronic Rhinosinusitis with Nasal Polyps
Authors: Xin-Hao Zhang, Ya-Na Zhang, Hua-Bin Li, Chun-Yan Hu, Nan Wang, Ping-Ping Cao, Bo Liao, Xiang Lu, Yong-Hua Cui, Zheng Liu
Journal: American Journal of Respiratory and Critical Care Medicine (2011)

Rationale: Eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) represents a hard-to-treat subtype of CRS.Objectives: To determine the pattern of expression and biologic role of microRNAs (miRNAs) in CRS, particularly in eosinophilic CRSwNP.Methods: Global miRNA expression in sinonasal mucosa from controls, CRS without nasal polyps (CRSsNP), and patients with eosinophilic CRSwNP was compared using miRNA microarrays. MiR-125b expression was detected by means of quantitative reverse-transcriptase polymerase chain reaction. The cellular localization of miR-125b was determined by in situ hybridization. MiR-125b functional assays were performed on airway epithelial cells and mice. MiR-125b expression regulation was studied by tissue and cell culture.Measurements and Main Results: CRSsNP and eosinophilic CRSwNP exhibited distinct miRNA expression profiles. MiR-125b was specifically up-regulated in eosinophilic CRSwNP. MiR-125b was mainly expressed by sinonasal and bronchial epithelial cells. EIF4E-binding protein 1 (4E-BP1) was identified as a direct target of miR-125b. MiR-125b mimic or inhibitor enhanced or decreased IFN-α/β production elicited by dsRNA in vitro or in vivo, respectively. 4E-BP1 expression was decreased, whereas IFN regulatory factor-7 and IFN-β expression was increased, in eosinophilic CRSwNP. IFN-β mRNA levels positively correlated with IL-5 mRNA levels and eosinophil infiltration in sinonasal mucosa. IFN-β stimulated B cell–activating factor of the tumor necrosis factor family production in airway epithelial cells. miR-125b could be induced by lipopolysaccharide, dsRNA, and IL-10.Conclusions: The up-regulated expression of miR-125b may enhance type I IFN expression through suppressing 4E-BP1 protein expression in airway epithelial cells, which potentially contributes to mucosal eosinophilia in eosinophilic CRSwNP.
Imagery in Healing: Shamanism and Modern Medicine
Authors: Charles P. Ledergerber
Journal: JAMA (1986)

Imagery in Healing highlights an important issue that we as healers have sometimes neglected. In our search to identify the causes of disease, we often reduce our focus of attention down to the tiniest molecule. By operating with proverbial blinders on, we have neglected to see how important the mental state of the patient is in relation to recovery.  In my experience as a physician, it is this intervening variable of hope and positive mental attitude that has led to a far speedier recovery in my patients. It was welcoming to see the statistical evidence throughout the book that supported the notion that we all have this healing power within us.  However, imagery and positive thinking should not be utilized alone as a replacement for medical treatments. It would be naive to focus solely on beliefs, as the shamans did (chapters 1 through 3), without considering the benefits of scientific
Stroke patients take part in "milestone" UK trial of stem cell therapy
Authors: J. Wise
Journal: BMJ (2010)

Doctors in Glasgow have administered stem cell therapy to a patient who became disabled after an ischaemic stroke as part of a groundbreaking trial.

The pilot investigation of stem cells in stroke (PISCES) is thought to be the world’s first fully regulated clinical trial of a neural stem cell therapy for disabled stroke patients. It is the first stem cell based clinical trial to have received regulatory approval in the United Kingdom.

The trial’s lead investigator, Keith Muir, said, “Stroke is a common and serious condition that leaves a large number of people with significant disability. In this trial we are seeking to establish the safety and feasibility of stem cell implantation, which will require careful follow-up of the patients who take part.”

Professor Muir, who holds the Sinapse chair of clinical imaging at the University of Glasgow’s Institute of Neuroscience and Psychology, added, “We hope that in future it will lead on to larger studies to determine the effects of stem cells on the disabilities that result from stroke.” …
Treatment of acute paracetamol poisoning.
Authors: G Jones, P Thomas
Journal: BMJ (1977)

hypoxia and decreased renal perfusion so that urea formation is increased and excretion hindered.This could lead to a moderately elevated plasma urea and slightly elevated plasma creatinine, which might account for the apparently inferior dis- criminating power of the urea :creatinine ratio observed by your contributors when compared with the individual measurements of urea and creatinine.Incidentally, the correlation between plasma urea and creatinine in the 350 unselected patients may have been adversely affected if the authors included patients with ketoacidosis.It is well known that acetoacetate and acetone interfere in the Jaffe reaction for creatinine i and the plot of urea versus creatinine showed a number of points with seemingly disproportionate high creatinine concentrations.
Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study
Authors: S. Weich, H. L. Pearce, P. Croft, S. Singh, I. Crome, J. Bashford, M. Frisher
Journal: BMJ (2014)

<b>Objective</b> To test the hypothesis that people taking anxiolytic and hypnotic drugs are at increased risk of premature mortality, using primary care prescription records and after adjusting for a wide range of potential confounders. <b>Design</b> Retrospective cohort study. <b>Setting</b> 273 UK primary care practices contributing data to the General Practice Research Database. <b>Participants</b> 34 727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69 418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years). <b>Main outcome</b> All cause mortality ascertained from practice records. <b>Results</b> Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription. <b>Conclusions</b> In this large cohort of patients attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding.
Hyperphagia in intestinal disease
Authors: R. J. C. Hall, B. Creamer
Journal: Gut (1974)

Six patients with hyperphagia (ingestion of 5-11 000 Kcals/day) associated with severe malabsorption and steatorrhoea are described. The cause of the malabsorption was coeliac disease in three patients, Crohn9s disease with ileal resection in two, and carcinoma of the pancreas in one patient. There was no evidence of neurological or endocrine disease (apart from mild diabetes mellitus in the patient with carcinoma of the pancreas) but three patients suffered from severe depression. This association may be commoner than previously realized and be revealed in patients with steatorrhoea of unexplained severity by careful dietary assessment. Its detection has therapeutic implications since restriction of caloric and fat intake decreased steatorrhoea without weight loss in several of the patients described.
Inappropriate intrinsic muscle action in the rheumatoid hand.
Authors: R L Swezey, D S Fiegenberg
Journal: Annals of the Rheumatic Diseases (1971)

Phototherapy was used to treat 20 newborn babies whose birthweight was below 1500 g and whose plasma bilirubin exceeded 8 mg/100 ml. The plasma bilirubin level was maintained below 13 mg/100 ml except in 4 babies whose level exceeded 13 mg/100 ml before treatment was started. In 60% of an untreated group of larger babies previously reported the plasma bilirubin level exceeded this figure. Phototherapy seems to control the plasma bilirubin level satisfactorily in very low birthweight infants, but frequent measurements on the second and third days of life are advised in order that treatment may be started promptly when it exceeds 8 mg/100 ml.
Alterations of T-lymphocyte subsets, soluble IL-2 receptor, and IgE in peripheral blood of children with acute asthma attacks
Authors: Hong-Zhen Shi, Jun-Jiang Sun, Huai-Ling Pan, Jia-Qin Lu, Jian-Ling Zhang, Jian-Dong Jiang
Journal: Journal of Allergy and Clinical Immunology (1999)
149. Coxsackie and Adenovirus Receptor Binding Ablation Reduces Adenovirus Liver Tropism and Toxicity
Authors: Minjung Kim, A-Rum Yoon, Ji Young Yoo, Min-Ju Kim, Yoon-A Kang, Joo-Hang Kim, Chae-Ok Yun
Journal: Molecular Therapy (2006)

Human adenovirus-based vectors have emerged as a new promising vehicle for in vivo gene transfer-mediated therapy. However, the full potential of this methodology has not been fully realized because of the nonspecific tissue distribution of adenoviral vectors. Adenovirus infection is initiated by forming a complex between the fiber protein and a ubiquitously expressed host cell membrane protein, coxsackie B virus and adenovirus receptor (CAR). Therefore, ablating the adenovirus vector's ability to bind to the CAR is the first step in redirecting adenoviral tropism.
Sleep of death
Authors: I. H Robertson
Journal: BMJ (1994)

BBC2 Horizon: “Against the Clock” 25 April

Question: What do Winston Churchill and a marmoset have in common?

Answer: They are both polyphasic strategists. Get it? Oh.

Well, a polyphasic strategist is someone who takes catnaps. And apart from helping you collect nuts and win wars, catnaps also stop you crashing airliners quite so readily. While British and European pilots are allowed to take little naps while flying us around, American pilots are not, even if there are several people perfectly capable of flying the plane crammed into the cockpit goggling at the same nothingness for hours at a stretch.

When American aircrew are allowed to take 40 minute planned …
Vaginal Douching and Ectopic Pregnancy
Authors: Laurence Meyer, Catherine Soulat, Isabelle Gros, Catherine Brouselle
Journal: JAMA (1991)

<h3>To the Editor.—</h3> We were very interested by the results of Chow et al<sup>1</sup>showing that douching is a risk factor for ectopic pregnancy. We were surprised by the high (30%) percentage of douching among the mostly Hispanic control group. We conducted a study<sup>2</sup>in a suburb of Paris, France, among 677 women who came for contraception or abortion, to assess the prevalence of different genital infections. Part of the questionnaire was devoted to vaginal hygiene behavior. Thirty-two percent of women practiced vaginal washing; less than 1% practiced actual douching, by means of a syringe. Vaginal washing appeared less frequent among French women (24%) than among those from North Africa (55%) or from black Africa (71%). The frequency differed with nationality (respectively, 36%, 43%, and 74% of French, North Africans, and black Africans who practiced vaginal washing did it at least daily). Women used water in 57% of
Staging of Regional Lymph Nodes in Melanoma
Authors: Anna M. Leung, Donald L. Morton, Junko Ozao-Choy, Danielle M. Hari, Myung Shin-Sim, Andrew L. Difronzo, Mark B. Faries
Journal: JAMA Surgery (2013)

Survival varies widely in patients with stage III melanoma. The existence of clinical significance for positive nonsentinel lymph node (NSLN) status would warrant consideration for incorporation into the American Joint Committee on Cancer staging system and better prediction of survival.To evaluate whether disease limited to sentinel lymph nodes (SLNs) represents different clinical significance than disease spread into NSLNs.The database of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, was queried for all patients with SLNs positive for cutaneous melanoma who subsequently underwent completion lymph node dissection.Disease-free survival, melanoma-specific survival (MSS), and overall survival.A total of 4223 patients underwent SLN biopsy from 1986 to 2012. Of these patients, 329 had a tumor-positive SLN. Of the 329, 250 patients (76.0%) had no additional positive nodes and 79 (24.0%) had a tumor-positive NSLN. Factors predictive of NSLN positivity included older age (P = .04), greater Breslow thickness (P < .001), and ulceration (P < .02). Median overall survival was 178 months for the SLN-only positive group and 42.2 months for the NSLN positive group (5-year overall survival, 72.3% and 46.4%, respectively). Median MSS was not reached for the SLN-only positive group and was 60 months for the NSLN positive group (5-year MSS, 77.8% and 49.5%, respectively). On multivariate analysis, NSLN positivity had a strong association with recurrence (hazard ratio [HR], 1.75; 95% CI, 1.23-2.50; P = .002), shorter overall survival (HR, 2.24; 95% CI, 1.48-3.40; P < .001), and shorter MSS (HR, 2.23; 95% CI, 1.46-3.07; P < .001). To further control for the effects of total positive lymph nodes, comparison was done for patients with only N2 disease (2-3 total positive lymph nodes); the results of this comparison confirmed the independent effect of NSLN status (MSS; P = .04).Nonsentinel lymph node positivity is one of the most significant prognostic factors in patients with stage III melanoma. Subclassification of melanoma by NSLN tumor status should be considered for the American Joint Committee on Cancer staging system.
Relationship between motor function of the proximal stomach and transient lower oesophageal sphincter relaxation after morphine
Authors: R Penagini, M Allocca, P Cantù, M Mangano, D Savojardo, S Carmagnola, P A Bianchi
Journal: Gut (2004)

<b>Background:</b> Morphine reduces the rate of transient lower oesophageal sphincter (LOS) relaxations but its site of action is presently unknown. There are no data available concerning its motor effects on the proximal stomach, an important site for triggering transient LOS relaxations. <b>Aim:</b> To evaluate the effect of morphine on the rate of transient LOS relaxations and motor function of the proximal stomach. <b>Subjects and methods:</b> In 19 healthy subjects, concurrent transient LOS relaxations with a sleeve sensor and motor function of the proximal stomach with a bag connected to an electronic barostat were recorded during pressure controlled (n = 9) and volume controlled (n = 10) gastric distensions after intravenous administration of placebo and morphine 100 μg/kg. <b>Results:</b> During pressure controlled distensions, intrabag volume was markedly decreased by morphine (median 189 ml (interquartile range 101–448) <i>v</i> 404 (265–868) after placebo; p&lt;0.01) as was the rate of transient LOS relaxations (0.5/30 minutes (0.4–2) <i>v</i> 2.5 (2–4); p&lt;0.01). When intrabag volume was kept constant (525 ml (490–600)) (that is, in volume controlled distensions), the rate of transient LOS relaxations was not affected by morphine (2/30 minutes (2–3) <i>v</i> 2.5 (2–3)). Gastric contractions decreased after morphine similarly during pressure controlled and volume controlled distensions (8.5/30 minutes (4–10) <i>v</i> 15.5 (9.5–20.5), p&lt;0.02; and 6.5 (0–24) <i>v</i> 19.5 (12–22), p&lt;0.05). <b>Conclusions:</b> The effect of morphine on transient LOS relaxations is dependent on the decrease in volume of the proximal stomach. Our data suggest that pharmacological interventions which decrease fundal volume should result in control of transient LOS relaxation mediated gastro-oesophageal reflux.
MPs demand action on "significant" conflicts of interest in GP out-of-hours care
Authors: G. Iacobucci
Journal: BMJ (2014)

Clinical commissioning groups (CCGs) are failing to adequately manage the “significant” conflicts of interest when buying GP out-of-hours services from organisations in which their board members hold a financial stake, MPs have warned.

A report from the House of Commons Public Accounts Committee1 questioned the current safeguards in place for managing competing interests and urged NHS England to introduce tougher scrutiny by seeking “documentary evidence” of how commissioning decisions were reached.

The report, Out-of-Hours GP Services in England , said that the “inherent risk of conflicts of interest” in allowing CCGs to commission GP out-of-hours care “should have been properly addressed before clinical commissioning groups were introduced [in April 2013].” This comes after an …
Lesson of the Week: Bacterial endocarditis: a complication of gastroscopy
Authors: R F Logan, J G M Hastings
Journal: BMJ (1988)

Fibreoptic gastroscopy is a valuable and widely used diagnostic procedure.Certain complications such as perforation and haemor- rhage are well recognised, but the risks of bacterial endocarditis are less appreciated.We report on a man in whom this complication developed.
Requirement of Stat3 but not Stat1 activation for epidermal growth factor receptor- mediated cell growth In vitro.
Authors: J R Grandis, S D Drenning, A Chakraborty, M Y Zhou, Q Zeng, A S Pitt, D J Tweardy
Journal: Journal of Clinical Investigation (1998)

Stimulation of epidermal growth factor receptor (EGFR) by ligand(s) leads to activation of signaling molecules including Stat1 and Stat3, two members of the signal transducers and activators of transcription (STAT) protein family. Activation of Stat1 and Stat3 was constitutive in transformed squamous epithelial cells, which produce elevated levels of TGF-alpha, and was enhanced by the addition of exogenous TGF-alpha. Targeting of Stat3 using antisense oligonucleotides directed against the translation initiation site, resulted in significant growth inhibition. In addition, cells stably transfected with dominant negative mutant Stat3 constructs failed to proliferate in vitro. In contrast, targeting of Stat1 using either antisense or dominant-negative strategies had no effect on cell growth. Thus, TGF-alpha/EGFR-mediated autocrine growth of transformed epithelial cells is dependent on activation of Stat3 but not Stat1.
The Relation of Heart Size to the Time Intervals of the Heart Beat, with Particular Reference to the Elephant and the Whale
Authors: Paul D. White, Robert L. King, James Jenks
Journal: New England Journal of Medicine (1953)

ONE of the moot questions in human electrocardiography is that of the normal upper limit of the atrioventricular conduction time (PR interval) and of the duration of the spread of the excitation wave through the ventricles (QRS complex). It is the general consensus that the former may measure from 0.10 second or even a little less in the healthy newborn infant to 0.20 second or even a little more in the healthy full-grown adult, and that the latter may measure from about 0.05 second in the infant to about 0.10 second in the adult. The change from the shorter measurements . . .
Newer fashions in illegitimacy.
Authors: R H Edmunds, A Yarrow
Journal: BMJ (1977)

In 1968 Illsley and Gill examined the rise in illegitimacy in the decade 1955-65 and showed that this rise, unlike rises in the first and second world wars, had not been accompanied by a fall in prenuptial conceptions but by a rise. Statistics from 1970 to 1975 have been examined and a third parameter, legal abortion, added. After a period characterised by an apparent rise in the total of extramarital conceptions there has since 1972 been a decline; and in the age group 20-24 this fall dates from 1971. Improved contraceptive practice is probably the reason.
Leaking Mycotic Aneurysms Identified on RBC Venography
Authors: J. DUPONT, I. D. GREENBERG
Journal: Clinical Nuclear Medicine (1992)

An 11-year-old boy with bacterial endocarditis complicated by multiple septic emboli underwent Tc-99m RBC venography to investigate possible deep venous thrombosis of the lower extremities. The imaging technique involved in vivo RBC labeling combined with pedal intravenous injections of Tc-99m pertechnetate. The Tc-99m pertechnetate was administered in three boluses while venous flow images were acquired over the pelvis, thighs, and calves in sequence. Equilibrium blood pool images of the same areas were then acquired as needed. The equilibrium images suggested the presence of aneurysms in the right femoral and left popliteal arteries, which were seen to enlarge on delayed images. False aneurysms were identified on digital subtraction angiography, and surgical exploration revealed leaking mycotic aneurysms, culture-positive for Staphylococcus aureus, the offending organism found in previous blood and joint aspirate cultures.