tbuckley/cabot-search huggingface dataset:
Topical 8-methoxypsoralen photochemotherapy of psoriasis: a clinical study
Authors: K. DANNO, T. HORIO, M. OZAKI, S. IMAMURA
Journal: British Journal of Dermatology (1983)

Topical psoralen plus UV-A irradiation (topical PUVA) was re-evaluated with regard to the timing of UV-A exposure. Symmetrical lesions of fifteen patients with psoriasis were treated with topical PUVA. One side was exposed to UV-A 2 h after topical application of 1% 8-methoxypsoralen (2-h interval therapy), while the other side was exposed to the same doye of UV-A within 5 min of the topical application (non-interval therapy). Both regimens were effective. The non-interval therapy was preferred in one ease, the 2-hour interval was preferred in three cases, and there was no clear difference in the other eleven cases. There was less tendency to burning with the non-interval therapy, and our study suggests that this is a useful regimen in the out-patient treatment of psoriasis.
Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries From Managed Care Organizations
Authors: Thomas S. Rector
Journal: JAMA (2000)

ContextMany Medicare beneficiaries enroll in managed care health plans to obtain outpatient drug benefits. Increasing pharmaceutical utilization and costs and decreasing drug benefits increase the likelihood that medication use by such enrollees will exceed drug benefits, which may lead to health plan disenrollment.ObjectiveTo test the hypothesis that exhaustion of managed care drug benefits by Medicare beneficiaries is associated with disenrollment from the health plan.DesignRetrospective cohort study followed up for 1 year (1998) using an enrollment/claims database.SettingFour geographically diverse network-model health plans that had annual drug benefits of $300, $500, $600, or $1000.ParticipantsA total of 61,412 elderly Medicare beneficiaries.Main Outcome MeasureVoluntary disenrollment from health plans by members who did or did not exhaust their drug benefits.ResultsThe likelihood of exhausting 1998 drug benefits ranged from 17% to 25% across health plans (P<.001). The relative hazards of disenrollment from the 4 plans when drug benefits had been exhausted were 2.5 (95% confidence interval [CI], 2.3-2.8), 1.9 (95% CI, 1.7-2.1), 2.7 (95% CI, 2.0-3.6), and 2.1 (95% CI, 1.9-2.4). Statistical adjustments for age, sex, prior enrollment, hospital admissions, physician visits, and county of residence did not alter these estimates.ConclusionsExhaustion of drug benefits was associated with a significant increase in the likelihood of disenrollment of Medicare beneficiaries. This finding arouses concern that Medicare beneficiaries must change plans to have financial access to medications, which can lead to discontinuity in care and diversion of resources from care to administrative matters. Policymakers should strive to avoid fragmented systems of providing drug benefits.
A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Authors: Mihai Gheorghiade
Journal: JAMA (2011)

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Complaints against doctors
Authors: Paul Kinnersley, Adrian Edwards
Journal: BMJ (2008)

Complaints against doctorsCould be reduced by identifying and remedying poor communication skills early on Clinical communication skills are at the heart of medical practice, and poor performance is an important factor in the origins of complaints and litigation. 1 2 A recent study from Canada shows that poorly performing doctors can be identified early in their careers and possibly given targeted support and appropriate further training. 3 Tamblyn and colleagues followed up a cohort of newly qualified doctors in Ontario and Quebec for two to 12 years. 3They found a link between both communication and quality of care scores on the clinical skills examination of the Medical Council of Canada (taken shortly after graduation) and subsequent complaints registered with the medical regulatory authorities.A decrease of two standard deviations in communication score on the examination was associated with one additional complaint per 100 years of practice.People whose scores of communication skills were in the bottom quartile had a significantly increased risk of subsequent complaints from patients (excess complaint rate 2.15 per 100 practice years compared with the three other quartiles).Although the rate of complaints per 100 years might seem low, complaints were made against 17% of doctors at least once during the average 10 year follow-up period.Factors that were significantly associated with increased numbers of complaints were the clinician being male and working in family practice or surgery (rather than general medicine).Most of these doctors would have received training in communication skills during their medical school training, although this may have been of variable quality, and they were well aware of the content of the clinical skills examination.Considerable resources are currently devoted to teaching and assessing the communication skills of medical students.The Calgary Cambridge guide is well established as a generic guide to consultations and the skills needed for effective communication. 4 Students are often tested for communication skills-for example, taking a history; exploring the patient's perspective, concerns, and expectations; explaining diagnoses and treatment; and discussing options for treatment or care.Students also cover specific tasks such as breaking bad news.Tamblyn and colleagues' results suggest that doctors whose communication skills need to be improved could be identified before problems are encountered in clinical practice.Stricter thresholds for passing graduate medical examinations or postgraduate qualifications could be enforced.However, as these researchers point out, the reliability of many assessments of communication skills is low (and lower than assessments of clinical skills, for example), especially if relatively few
Exercise electrocardiogram in myxoedema.
Authors: R. D. Cohen, H. G. Lloyd-Thomas
Journal: BMJ (1966)

Sixteen further patients have been treated with allopurinol, because it was thought to be specially indicated in preference to uricosuric treatment.The main reasons for this were adverse reactions to uricosuric agents, renal failure, and inadequate control of gout by uricosuric drugs.The response to allopurinol was again very satisfactory.No serious toxic effects were encountered.Scvere attacks of acute gout can follow the rapid lowering of serum uric acid either by allopurinol or by uricosuric drugs.This makes it worth while starting with low doses and giving an additional drug-for example, colchicine-to suppress acute attacks during early months of treatment.An unexpectedly high -incidence of abnormalities in the sulphobromophthalein (Bromsulphalein) excretion test, and to a smaller extent in other tests of liver function, was found in patients taking allopurinol and in those on uricosuric treatment.The reason for this is not apparent, but there is no evidence that either type of drug treatment was responsible.It is as yet uncertain whether allopurinol will replace uricosuric treatment as the standard method of lowering the serum uric acid.Certain situations are discussed where allopurinol seems to be clearly the treatment of choice.
Urban High School Youth and Handguns
Authors: Charles M. Callahan
Journal: JAMA (1992)

<h3>Objective.</h3> —To determine the prevalence of handgun ownership among urban high school youth and investigate associations with socioeconomic status, ethnicity, and deviant behaviors. <h3>Design.</h3> —Survey of half of the Seattle, Wash, public high schools, which enroll 50% of the school district's 11th-grade students (N=970). <h3>Main Outcome Measures.</h3> —Self-reports of handgun ownership, perceived access to handguns, racial/ethnic identity, social status (Hollingshead's Two Factor Index of Social Position), and social deviance (Seattle Self-Report Instrument) were determined. <h3>Results.</h3> —Thirty-four percent of the students reported easy access to handguns (47% of males, 22% of females) and 6.4% reported owning a handgun (11.4% of males, 1.5% of females). Reported firearm experiences indicated a high rate of handgun utilization: 33% of handgun owners had fired at someone, 9.7% of female students reported a firearm homicide or suicide in family members or close friends, and 6% of male students reported carrying a handgun to school sometime in the past. Handgun ownership was more common among students who reported deviant behaviors. Adjusting for age, gender, and racial/ethnic group and controlling for covariation among the problem behaviors, gang membership (odds ratio [OR], 8.8; 95% confidence interval [Cl], 3.7 to 20.8), sentencing by a judge (OR, 4.6; 95% Cl, 1.3 to 15.5), selling drugs (OR, 3.7; 95% Cl, 1.8 to 7.8), suspension or expulsion from school (OR, 3.5; 95% CI, 1.7 to 7.0), and assault and battery (OR, 2.5; 95% Cl, 1.1 to 5.9) were associated with handgun ownership. However, 22% of male handgun owners did not report any of the above behaviors. <h3>Conclusion.</h3> —The availability of handguns to the urban high school students surveyed is pervasive, and it is not limited to high-risk groups. (<i>JAMA</i>. 1992;267:3038-3042)
A new noninvasive method for the estimation of peak dP/dt.
Authors: J Rhodes, J E Udelson, G R Marx, C H Schmid, M A Konstam, Z M Hijazi, S A Bova, D R Fulton
Journal: Circulation (1993)

BACKGROUND Peak dP/dt is a good index of ventricular performance that is not influenced by afterload, wall motion abnormalities, or the variations in ventricular anatomy and morphology commonly encountered among patients with congenital heart disease. Unfortunately, the clinical utility of peak dP/dt has been limited by the fact that its measurement generally requires an intraventricular catheter. However, peak dP/dt occurs during isovolumetric contraction, and the pressure rise during isovolumetric contraction is almost linear. Therefore, the mean dP/dt during isovolumetric contraction (mean dP/dtic), ie, the ratio of the rise in pressure during isovolumetric contraction (aortic diastolic pressure minus the systemic ventricular end-diastolic pressure [VEDP]) over the isovolumetric contraction time, should provide a good estimate of peak dP/dt that could be generated noninvasively. METHODS AND RESULTS Echo/phonocardiography was used to measure the isovolumetric contraction time and a blood pressure cuff to estimate aortic diastolic pressure of 27 patients (age, 1 day to 77 years) with congenital or acquired heart disease. VEDP was determined by three methods: (1) intraventricular catheter, (2) assumed VEDP of 10 mm Hg, and (3) assignment of a normal or elevated value on the basis of clinical history. The three estimates of mean dP/dtic thus generated were compared with simultaneous measurements of peak dP/dt obtained during cardiac catheterization. Invasively measured peak dP/dt correlated well with the indirect determinations (r = .95, .89, and .92 for methods 1, 2, and 3, respectively; P &lt; .0001). CONCLUSIONS Echo/phonocardiography can be used in conjunction with a blood pressure cuff and indirect estimates of VEDP to generate mean dP/dtic, an index of ventricular function that approximates and closely correlates with peak dP/dt. This noninvasive measurement can be obtained in almost any patient and may be useful in the assessment of ventricular performance in a variety of cardiovascular disorders.
A Potential Rapid Screening Test for Paroxysmal Nocturnal Hemoglobinuria
Authors: Leonard H. Brubaker, Dennis R. Schaberg, Devenia H. Jefferson, Charles E. Mengel
Journal: New England Journal of Medicine (1973)

THE diagnosis of paroxysmal nocturnal hemoglobinuria is not obscure in the patient with classic early morning hemoglobinuria, which clears as the day progresses. However, many patients present confusing clinical features, including thrombotic complications, unexplained transfusion reactions and "refractory cytopenias" with marrow hypoplasia or iron deficiency.1 Thus, there is a need to develop simple screening tests that can be easily performed by the physician who considers paroxysmal nocturnal hemoglobinuria as a possible diagnosis.Crystalline inulin has been shown to activate the late-acting components of complement via the C3 activator system.2 Cells from patients with the disorder are unusually sensitive to hemolysis . . .
Collaborative Effort Seeks to Curb Hospital Infections
Authors: Bridget M. Kuehn
Journal: JAMA (2012)

HOSPITAL-ACQUIREDINFECTIONSREmainapersistentproblem,affecting about 1 in 20 patients each year, according to estimates from the US Department of HealthandHuman Services.Butefforts to curb such infections have had mixed results. To achieve better results, 2 groups critical to the management of hospital-acquired infections—infection controlprofessionals, or infection preventionists (IPs), and laboratory professionals—are working together on a project to promote better collaboration between their respective professions. To improve communication between these 2 specialties, the IP Col-labboration Project (http://labproject.site .apic.org/) is using online resources, such as webinars and tools that outline best practices in such areas as sample collection and processing. The Association for Professionals in InfectionControl (APIC) and the American Society for Microbiology (ASM) are working together on the effort, which is being funded by an unrestricted grant from Roche. Initially, an e-mail survey of members of both organizations assessed how interprofessional interactions could be improved. About 1800 individuals responded (just 8.9% of the sample), most of whom work in hospitals. Furthermore, a disproportionate number of APIC members were represented among the respondents (78%). Some members of each organization may have opted not to participate because they may not work in a relevant specialty. About half of the IPs surveyed said they need to evaluate results of tests for methicillin-resistant Staphylococcus aureus (MRSA) within 12 hours to enable timely initiation of precautions to prevent the spread of such infections. However, it takes take 24 to 48 hours for results from MRSA cultures, a common screening method used to detect these microbes, to be finalized. Although the low response rate for the study may limit the generalizability of the results because the responses may have been skewed toward those with greater or lesser concerns, the findings suggested that greater communication between IPs and laboratory professionals may help address this issue. “Thesesurveyresultsindicatethatthere areareasfor improvementintherelationshipbetweenIPsandlabprofessionals to ensure the best patient outcomes,” said Lance Peterson, MD, an advisor to ASM and director of microbiology and infectiousdiseasesresearchatNorthShoreUniversity HealthSystem in Evanston, Ill, in a statement. Ja ni ce H ar ve y C ar r/ C D C news@JAMA From JAMA’s Daily News Site
Oxypurinol Nephrolithiasis in Regional Enteritis Secondary to Allopurinol Therapy
Authors: ROBERT M. STOTE
Journal: Annals of Internal Medicine (1980)

A patient with regional enteritis and recurrent uric acid nephrolithiasis was treated with allopurinol. While on 600 mg of allopurinol daily, she began to pass many small, soft, yellow stones. Analysis of the stones by liquid chromatographic and gas chromatograph/mass spectrometric techniques revealed that their major constituent was oxypurinol, a metabolite of allopurinol. Metabolic studies of the patient indicated that increasing doses of allopurinol were associated with increases in xanthine and oxypurinol excretion, while uric acid excretion was not reduced. This case illustrates a complication of high-dose allopurinol therapy in the treatment of uric acid nephrolithiasis.
Review: Glucosamine (sulfate or hydrochloride) does not reduce pain in knee or hip osteoarthritis
Authors: Emilio B. Gonzalez
Journal: Annals of Internal Medicine (2013)

Source Citation Wu D, Huang Y, Gu Y, Fan W. Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials. Int J Clin Pract. 2013;67:585-94. 23679910
An unusual cutaneous-polyposis syndrome stabilized with acitretin
Authors: L. Schmulewitz, N. Attard, L. Fearfield, D. Westaby, P. Prasad, H.J.W. Thomas, C.B. Bunker
Journal: British Journal of Dermatology (2008)

We present a patient with an unusual enterocutaneous syndrome. Long-term, low-dose acitretin treatment has stabilized the development of gastrointestinal lesions while synchronously reducing cutaneous morbidity.
Preventing Mother-to-Child HIV Transmission
Authors: Pornsinee Amornwichet, Achara Teeraratkul, R. J. Simonds, Thananda Naiwatanakul, Nartlada Chantharojwong, Mary Culnane, Jordan W. Tappero, Siripon Kanshana
Journal: JAMA (2002)

Each year in Thailand, about 10,000 children are born at risk for mother-to-child human immunodeficiency virus (HIV) transmission. In 2000, Thailand implemented a national program to prevent mother-to-child HIV transmission.To describe the results of implementation of the program.Monthly collection of summary data from hospitals.Public health hospitals (n = 822) in all 12 regions of Thailand, representing 75 provinces, excluding Bangkok.Women giving birth from October 2000 through September 2001, including HIV-seropositive women and their neonates.Percentages of women giving birth who were tested for HIV, HIV-seropositive women giving birth who received antenatal prophylactic antiretroviral drugs, and HIV-exposed neonates who received prophylactic antiretroviral drugs and infant formula.Among 573,655 women (range, 27,344-77,806 by region) giving birth, 554,912 (96.7%) received antenatal care (range, 91.9%-98.8% by region). Of 554,912 women giving birth who had antenatal care, 517,488 (93.3%) were tested for HIV (range, 87.7%-99.4% by region) before giving birth; of 18,743 women giving birth who did not have antenatal care, 13,314 (71.0%) were tested for HIV (range, 21.7%-92.9% by region). Of 6646 HIV-seropositive women giving birth, 4659 (70.1%) received prophylactic antiretroviral drugs before delivery (range, 55.3%-81.2% by region). Of 6475 neonates of HIV-seropositive women, 5741 (88.7%) received prophylactic antiretroviral drugs (range, 67.4%-96.9% by region) and 5386 (83.2%) received infant formula (range, 65.3%-100% by region).Major program components of Thailand's national program for preventing mother-to-child HIV transmission were implemented. Thailand's experience may encourage other developing countries to implement or expand similar national programs.
Commentary: Bad medicine and bad law
Authors: S. Bewley
Journal: BMJ (1997)

Pregnancy and mental illness frighten doctors, and, for different reasons, both sets of patients are at risk of losing basic human rights. Law exists to protect patients from well intentioned but overenthusiastic doctors. We override long established law on consent, the legal status of fetuses, and the enforced treatment for mental conditions at our peril. The recent spate of cases of caesarean sections poses a serious threat to the therapeutic relationship and takes place against a background already coloured by accusations of unnecessary intervention by a male dominated profession. There is no trusting relationship if an obstetrician says: “I recommend a particular course of action (but I can force it on you if you do not agree).”

Obstetricians are passionate advocates of fetal health and wellbeing, and we have worked well for a long time with heavy duty persuasion as our most powerful weapon. Standing back is terribly painful, and the inability to perform caesarean sections without consent means that we will occasionally care for …
Continued high incidence of coronary artery disease at autopsy in Olmsted County, Minnesota, 1950 to 1979.
Authors: L Elveback, J T Lie
Journal: Circulation (1984)

The autopsy records of all people over 30 years old who died and underwent autopsy in Olmsted County from 1950 through 1979 were reviewed (n = 5558, autopsy rate approximately 50%). The hearts of 530 subjects were reexamined for the severity of coronary artery disease and this determination was compared with the recorded grade. After both record and specimen the three major coronary arteries were graded according to percent reduction in luminal area (1 = 0 to 25%; 2 = 26% to 50%; 3 = 51% to 75%; 4 = 76% to 99%; 5 = occlusion). Grades 4 and 5 were designated as significant coronary disease (SCD), and 94% to 99% of diagnoses of SCD were confirmed on reexamination. The percentage of people with SCD increased during the period 1950 to 1969 and remained high in the 1970s. Cohort analysis showed an increase in the disease in all age groups (except in the 30- to 49-year-old group for the later decades of birth). There was no change in the prevalence of myocardial infarction scars over the study period.
Onset of psoriatic arthritis during ustekinumab treatment for psoriasis: a case series of seven patients
Authors: B.B. Jones, J.W. Millsop, J.A. Walsh, G.G. Krueger, K. Callis Duffin
Journal: British Journal of Dermatology (2014)

Funding sources: None. Conflicts of interest: K.C.D. has served on the scientific and marketing advisory boards of Amgen; served as a consultant to Amgen, Janssen, Pfizer and Eli Lilly receiving honoraria; received payments for lectures from AbbVie, Amgen and Janssen; and served as an investigator for AbbVie, Amgen, Janssen, Pfizer, Eli Lilly and Vascular Biologics Limited. G.G.K. has received fees as a consultant or advisory board member for AbbVie, Amgen, ApoPharma, Astellas, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Idera, Isis, Janssen, L'Oréal, Novartis, Pfizer, UCB and Vascular Biologics Limited. G.G.K. has also received partial stipend support for a clinical research fellowship from AbbVie, Amgen and Centocor/Janssen, and in the last 12 months has received lecture fees from Abbott, Amgen and Janssen. Dear Editor, Psoriasis is an inflammatory skin disease that affects approximately 2–3% of the population.1 Patients with psoriasis are at risk of developing psoriatic arthritis (PsA), an inflammatory arthritis with a recently estimated prevalence of 30% in patients with psoriasis.2 In recent years tumour necrosis factor (TNF)‐α inhibitors (TNFIs) have been used to treat both psoriasis and PsA. More recently, ustekinumab, a monoclonal antibody that binds to p40, the shared subunit of interleukin (IL)‐12 and IL‐23, was approved for psoriasis and PsA. Clinical trials have demonstrated that ustekinumab is a safe and efficacious therapy for both psoriasis3 and PsA.4 5