tbuckley/cabot-search huggingface dataset:
What Price Better Health? Hazards of the Research Imperative
Authors: Christopher Martyn
Journal: BMJ (2004)

Daniel Callahan University of California Press, $29.95/£19.95, pp 341 ISBN 0 520 22771 9 Rating:![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> Also available as a digital download for $12.95 www.ucpress.edu/books/pages/9295.html Thirty years ago, Ivan Illich, with his book Medical Nemesis , launched a powerful attack on modern medicine ( BMJ 2002;324: 923). There were three strands to his argument. The first, which he greatly exaggerated, was that much of the disease that doctors treated was iatrogenic. The second, less easily refuted, was that when they placed themselves and their trust in the medical profession, people relinquished the qualities of fortitude and resourcefulness that allowed them to cope when bad things happened to them. The third was about how medicine had escaped its traditional role of looking after the sick to interfere … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
Franz Ingelfinger, Editor Emeritus
Authors: Claude E. Welch
Journal: New England Journal of Medicine (1977)

Franz Ingelfinger, soon to become editor emeritus of the New England Journal of Medicine, is honored by this commemorative issue.Future students of medical history will regard his birth on August 20, 1910, in Dresden, Germany, as a highly significant event.* In the hectic years surrounding World War I no seer could have been prescient enough to foresee that this child would develop into a man with the stamp of a German scientist, with the prolific pen of a Swift, and with an alleviating sense of Puckish humor.After graduation from Phillips Andover Academy, Yale and finally Harvard Medical . . .
<i>Borrelia miyamotoi</i>Infection Presenting as Human Granulocytic Anaplasmosis
Authors: Hanumara Ram Chowdri, Joseph L. Gugliotta, Victor P. Berardi, Heidi K. Goethert, Philip J. Molloy, Sherri L. Sterling, Sam R. Telford
Journal: Annals of Internal Medicine (2013)

The diverse tickborne infections of the northeastern United States can present as undifferentiated flu-like illnesses. In areas endemic for Lyme and other tickborne diseases, patients presenting with acute febrile illness with myalgia, headache, neutropenia, thrombocytopenia, and elevated hepatic aminotransferase levels are presumptively diagnosed as having human granulocytic anaplasmosis (HGA).To assign a cause for illness experienced by 2 case patients who were initially diagnosed with HGA but did not rapidly defervesce with doxycycline treatment and had no laboratory evidence of Anaplasma phagocytophilum infection.Case report.2 primary care medical centers in Massachusetts and New Jersey.2 case patients acutely presenting with fever.Identification of the causative agent by polymerase chain reaction and DNA sequencing.Molecular diagnostic assays detected Borrelia miyamotoi in the peripheral blood of both patients. There was no evidence of infection with other tickborne pathogens commonly diagnosed in the referral areas.One of the case patients may have had concurrent Lyme disease.The presence of B. miyamotoi DNA in the peripheral blood and the patients' eventual therapeutic response to doxycycline are consistent with the hypothesis that their illness was due to this newly recognized spirochete. Samples from tick-exposed patients acutely presenting with signs of HGA but who have a delayed response to doxycycline therapy or negative confirmatory test results for HGA should be analyzed carefully for evidence of B. miyamotoi infection.
Hospital Use and Survival among Veterans Affairs Beneficiaries
Authors: Carol M. Ashton, Julianne Souchek, Nancy J. Petersen, Terri J. Menke, Tracie C. Collins, Kenneth W. Kizer, Steven M. Wright, Nelda P. Wray
Journal: New England Journal of Medicine (2003)

Initiatives to reduce hospital care were part of the reorganization of the Department of Veterans Affairs (VA) medical care system undertaken in the mid-1990s. We examined changes in the use of VA health services and survival from 1994 through 1998 among VA beneficiaries with serious chronic diseases. We postulated that if access to hospital care was reduced too much, or if decreased hospital use was not offset by improvements in ambulatory care, urgent care visits would increase or survival rates would fall.We tracked changes in risk-adjusted VA bed-day rates, rates of medical visits, rates of visits for testing and consultation, and rates of urgent care visits per patient-year among VA beneficiaries in nine disease cohorts (a total of 342,300 beneficiaries). Trends in non-VA hospital use by VA beneficiaries 65 years of age or older who were enrolled in fee-for-service Medicare were also studied. VA and Medicare vital-status data were used to calculate one-year survival rates.From 1994 through 1998, VA bed-day rates fell by 50 percent, rates of medical-clinic visits and visits for testing and consultation increased moderately, and rates of urgent care visits fell by 35 percent. The sharp decline in the use of VA hospitals was not compensated for by increases in the use of Medicare-reimbursed non-VA hospital care by veterans eligible for both VA care and Medicare, and the use of non-VA hospitals actually declined in four cohorts. The survival rates were essentially unchanged over the study period.The marked decline in VA hospital use from 1994 through 1998 did not curtail access to needed services and was not associated with serious consequences for chronically ill VA beneficiaries.
Testing tenure: Let the market decide
Authors: Michael Shermer
Journal: Behavioral and Brain Sciences (2006)

Tenure debates and disputes are often irresolvable because of the complex and multivariate nature of contractual relationships between faculty and administration, and the nuanced and varying beliefs about tenure held by the professoriate. The Ceci et al. study leads this commentator to suggest a simple solution – allow individual institutions to define the parameters of tenure according to their unique core values.
Potential new targets in arthritis therapy: interleukin (IL)-17 and its relation to tumour necrosis factor and IL-1 in experimental arthritis
Authors: M I Koenders, L A B Joosten, W B van den Berg
Journal: Annals of the Rheumatic Diseases (2006)

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by chronic joint inflammation and destruction. Interleukin (IL)-17 is a T cell cytokine expressed in the synovium and synovial fluid of patients with RA. IL-17 is a potent inducer of various cytokines such as tumour necrosis factor (TNF) and IL-1. IL-17 has been shown to have additive or even synergistic effects with TNF and IL-1 during the induction of cytokine expression and joint damage in vitro and in vivo. TNFα and IL-1 are considered powerful targets in the treatment of RA because of their leading role in driving the enhanced production of cytokines, chemokines, and degradative enzymes. Besides anti-TNF and anti-IL-1 therapies, whose clinical efficacy is now established, new targets have been proposed for RA which is not responding to conventional treatments. This paper discusses the role of IL-17 in experimental arthritis and its interrelationship with TNF and IL-1, currently the most targeted cytokines in the treatment of RA. IL-17 is involved in both initiation and progression of murine experimental arthritis. Studies have shown that IL-17 not only synergises with TNF, but also enhances inflammation and destruction independent of IL-1 and TNF. On the basis of these studies, the authors propose IL-17 as an interesting additional target in the treatment of RA.
Length of hospital stay after hip fracture
Authors: Peter Cram, Raphael Philip Rush
Journal: BMJ (2015)

How low can we go before patients are at risk?

The modern healthcare system is a victim of its own success. The number of elderly people globally is higher than at any point in history in both relative and absolute terms. As populations age, their care needs increase. Healthcare costs have increased commensurately.

Acute care hospitals play an outsized role in health system economics. They deliver life saving treatments at enormous cost. The inpatient setting has therefore become an obvious target for efforts to improve efficiency and reduce costs.

One way to reduce costs is to reduce bed capacity, moving patients more rapidly through the hospital by reducing length of stay. Different nations have used different strategies to reduce length of hospital stay. Some have used regulation and policy to reduce the number of inpatient beds, restricting supply of beds, and forcing hospitals and healthcare professionals to reduce length of stay to accommodate patient demand. Other nations have used incentives such as diagnosis related group (DRG) based hospital reimbursement, in which hospitals receive a lump sum payment for an admission regardless of length of stay or resources consumed.1 Under this model, hospitals face strong financial incentives to reduce length …
What patients want: the full facts, please
Authors: Phil Gunby
Journal: JAMA (1982)

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research has concluded, based on national surveys of physician and public attitudes and on studies of physician-patient decision making, that patients are more likely to consent to treatment if they are kept fully informed by their physicians. The Commission has recommended to Congress and the President that increased communication, public education, and governmental support for efforts to improve the "human side" of medicine should be given priority over legal approaches to resolving disagreements about treatment.
Prevention trials with tamoxifen may be delayed in US
Authors: J Roberts
Journal: BMJ (1994)

A North American trial to establish whether the antioestrogen drug tamoxifen effectively prevents breast cancer is being threatened with delay because of fears that the drug may be too dangerous for the purpose. The study is being administered by the same group that ran a controversial trial of lumpectomy.

Officials from the National Institutes of Health (NIH), in a hearing last Wednesday before a subcommittee of the US Congress, admitted that breast cancer research leaders had been slow to acknowledge that some patients had been inappropriately entered into a trial that established lumpectomy as effective treatment for early breast cancer (BMJ, 9 April). …
Phase II, Randomized, Open-Label Study of Pegfilgrastim-Supported VDC/IE Chemotherapy in Pediatric Sarcoma Patients
Authors: Sheri L. Spunt, Helen Irving, Jami Frost, Leonard Sender, Matthew Guo, Bing-Bing Yang, Lyndah Dreiling, Victor M. Santana
Journal: Journal of Clinical Oncology (2010)

This multicenter, randomized, open-label study evaluated the efficacy, safety, and pharmacokinetics of a single subcutaneous pegfilgrastim injection with daily subcutaneous filgrastim administration in pediatric patients receiving myelosuppressive chemotherapy for sarcoma. PATIENTS AND METHODS Forty-four patients with previously untreated, biopsy-proven sarcoma stratified into three age groups (0-5, 6-11, and 12-21 years) were randomly assigned in a 6:1 randomization ratio to receive a single pegfilgrastim dose of 100 microg/kg (n = 38) or daily filgrastim doses of 5 microg/kg (n = 6) after chemotherapy (cycles 1 and 3: vincristine-doxorubicin-cyclophosphamide; cycles 2 and 4: ifosfamide-etoposide). The duration of grade 4 neutropenia, time to neutrophil recovery, incidence of febrile neutropenia, and adverse events were recorded. Results Pegfilgrastim and filgrastim were similar for all efficacy and safety end points, and their pharmacokinetic profiles were consistent with those in adults. Younger children experienced more protracted neutropenia and had higher median pegfilgrastim exposure than older children. CONCLUSION A single dose of pegfilgrastim at 100 microg/kg administered once per chemotherapy cycle is comparable to daily injections of filgrastim at 5 microg/kg for pediatric sarcoma patients receiving myelosuppressive chemotherapy.
Genetic factors in lipoprotein metabolism. Analysis of a genetic cross between inbred mouse strains NZB/BINJ and SM/J using a complete linkage map approach.
Authors: D A Purcell-Huynh, A Weinreb, L W Castellani, M Mehrabian, M H Doolittle, A J Lusis
Journal: Journal of Clinical Investigation (1995)

A genetic cross was constructed from two parental inbred strains of mice, NZB/BINJ and SM/J, which differ markedly in their plasma lipoprotein levels. Plasma lipid and apolipoprotein values were measured in 184 F2 progeny on a normal chow diet and on an atherogenic diet. Genetic markers were typed at 126 loci spanning all chromosomes except the Y. Statistical analysis revealed significant linkage or suggestive linkage of lipoprotein levels with markers on a number of chromosomes. Chromosome 1 markers were linked to levels of total cholesterol (lod 5.9) and high density lipoprotein (HDL) cholesterol (lod 8.1), chromosome 5 markers were linked to levels of total cholesterol (lod 6.7) and HDL cholesterol (lod 5.6), and chromosome 7 markers were linked to levels of total plasma triglycerides (lod 5.1) and free fatty acids (lod 5.6). Plasma apoAII levels were linked to the apoAII gene (lod score 19.6) and were highly correlated with plasma HDL cholesterol levels (r = 0.63, P = 0.0001), indicating that apoAII expression influences HDL cholesterol levels. Molecular studies suggested that structural differences in the apoAII polypeptide of the two strains may contribute to differences in clearance of the protein.
NMP22 and Surveillance for Recurrent Bladder Cancer—Reply
Authors: H. Barton Grossman
Journal: JAMA (2006)

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
Should obesity be treated?
Authors: A P G Lake, E G N Williams, J Garrow
Journal: BMJ (1994)

Peptic ulceration has always been a clear contraindication to working on an offshore installation, and ready access to H2 antagonists over the counter would have two consequences: firstly, people would treat symptoms without a definitive diag- nosis being made, and, secondly, people would not take the drug properly even when the treatment was correct.These facts would increase the risks of employees continuing to work offshore with undiagnosed or masked peptic ulceration.The incidence ofmedical evacuations for gastrointestinal emergencies is not insignificant, and if the patient is in the remoter regions of the North Sea, for example, evacuation may result in considerable danger to the many people involved.
Expression in systemic lupus erythematosus of an idiotype common to DNA-binding and nonbinding monoclonal antibodies produced by normal human lymphoid cells.
Authors: E Cairns, H Massicotte, D A Bell
Journal: Journal of Clinical Investigation (1989)

Rabbit antiserum raised against a normal-derived monoclonal anti-DNA antibody KIM 4.6.3 (IgM lambda) was used for idiotype analyses. This anti-serum (anti-4.6.3 ID) was rendered specific for KIM 4.6.3 idiotype (4.6.3 ID) by absorption with normal human IgM and IgG. The specificity of anti-4.6.3 was shown by its ability to bind to KIM 4.6.3 antibody but not to normal human IgM and IgG, by inhibition of anti-4.6.3 ID reactivity with KIM 4.6.3 antibody by the homologous monoclonal antibody and by the ability of anti-4.6.3 ID to inhibit the binding of single stranded DNA with KIM 4.6.3 antibody. The 4.6.3 ID was found to be commonly expressed since it was detected among 33% (10/30) DNA and 32% (23/72) non-DNA-reactive monoclonal antibodies that were obtained from five different unrelated normal individuals. The binding to ssDNA of the majority of idiotype positive anti-DNA antibodies however was not blocked by anti-4.6.3 ID suggesting that among these other monoclonal antibodies its expression is outside of the antigen binding site. The 4.6.3 ID, which was present among some normal-derived monoclonal IgM molecules was also found at a high frequency (90%) in the sera of patients with systemic lupus erythematosus (SLE) but only at a low frequency (24%) and concentration in normal sera. The level of 4.6.3 ID in SLE did not correlate with serum IgM and IgG nor with anti-DNA antibody concentrations. Idiotypic relatedness between SLE serum antibodies and monoclonal anti-DNA antibodies of normals implies the existence of a cross-reactive idiotype family and implies that a conserved common gene or closely related genes exist in the germ line encoding these 4.6.3 ID positive antibodies some of which are not exclusively associated with nucleic acid reactivity. The expression of these germ line genes in vivo thus distinguishes SLE from normals.
Advanced atherosclerosis in predialysis patients with chronic renal failure
Authors: Tetsuo Shoji, Masanori Emoto, Tsutomu Tabata, Eiji Kimoto, Kayo Shinohara, Kiyoshi Maekawa, Takahiko Kawagishi, Hideki Tahara, Eiji Ishimura, Yoshiki Nishizawa
Journal: Kidney International (2002)
A Case of Generalized Juvenile Gastrointestinal Polyposis Associated with Gastric Carcinoma
Authors: T. Yoshida, Y. Haraguchi, A. Tanaka, A. Higa, Y. Daimon, Y. Mizuta, M. Tamaki, Y. Uehara, K. Tanaka
Journal: Endoscopy (1988)

A case of generalized juvenile gastrointestinal polyposis associated with gastric adenocarcinoma is described. A 31-year-old male patient developed polyposis of the stomach complicated by gastric carcinoma and multiple polyps in the colon. Polyps of the stomach and colon were pathologically consistent with juvenile polyp, but adenomatous changes were also present in a very small percentage of the juvenile polyps. This case strongly suggests the possibility of carcinoma developing in patients with generalized juvenile gastrointestinal polyposis.
Buccal and sublingual vaccine delivery
Authors: Heleen Kraan, Hilde Vrieling, Cecil Czerkinsky, Wim Jiskoot, Gideon Kersten, Jean-Pierre Amorij
Journal: Journal of Controlled Release (2014)

Because of their large surface area and immunological competence, mucosal tissues are attractive administration and target sites for vaccination. An important characteristic of mucosal vaccination is its ability to elicit local immune responses, which act against infection at the site of pathogen entry. However, mucosal surfaces are endowed with potent and sophisticated tolerance mechanisms to prevent the immune system from overreacting to the many environmental antigens. Hence, mucosal vaccination may suppress the immune system instead of induce a protective immune response. Therefore, mucosal adjuvants and/or special antigen delivery systems as well as appropriate dosage forms are required in order to develop potent mucosal vaccines. Whereas oral, nasal and pulmonary vaccine delivery strategies have been described extensively, the sublingual and buccal routes have received considerably less attention. In this review, the characteristics of and approaches for sublingual and buccal vaccine delivery are described and compared with other mucosal vaccine delivery sites. We discuss recent progress and highlight promising developments in the search for vaccine formulations, including adjuvants and suitable dosage forms, which are likely critical for designing a successful sublingual or buccal vaccine. Finally, we outline the challenges, hurdles to overcome and formulation issues relevant for sublingual or buccal vaccine delivery.
Thymoma Associated with Erythroid Aplasia, Bullous Skin Eruption, and the Lupus Erythematosus Cell Phenomenon
Authors: ROBERT H. KOUGH
Journal: Annals of Internal Medicine (1964)

ExcerptThe constellation of anomalies and disease processes associated in unusual frequency with thymomas has been growing. It now includes myasthenia gravis (1-3), erythroid aplasia (4-8), and agammaglobulinemia (9, 10) as the best established associations. Less firmly established associations are hypoplasia of other marrow elements (11-13), the lupus erythematosus (LE) cell phenomenon (14-16), carditis (5, 14), positive Coombs' test (6, 15), and Cushing's syndrome (3, 17, 18). A patient is presented who developed erythroid aplasia, demonstrated the LE cell phenomenon, and had a thymoma removed while under treatment for a bullous skin eruption believed initially to be pemphigus vulgaris. Association of...
Assessment of Mitral Regurgitation Severity by Doppler Color Flow Mapping of the Vena Contracta
Authors: Shelley A. Hall, M. Elizabeth Brickner, DuWayne L. Willett, Waleed N. Irani, Imran Afridi, Paul A. Grayburn
Journal: Circulation (1997)

Although Doppler color flow mapping is widely used to assess the severity of mitral regurgitation (MR), a simple, accurate, and quantitative marker of MR by color flow mapping remains elusive. We hypothesized that vena contracta width by color flow mapping would accurately predict the severity of MR.We studied 80 patients with MR. Vena contracta width was measured in multiple views with zoom mode and nonstandard angulation to optimize its visualization. Flow volumes across the left ventricular outflow tract and mitral annulus were calculated by pulsed-Doppler technique to determine regurgitant volume. Effective regurgitant orifice area was calculated by dividing the regurgitant volume by the continuous-wave Doppler velocity-time integral of the MR jet. The cause of MR was ischemia in 24, dilated cardiomyopathy in 34 mitral valve prolapse in 12, endocarditis in 2, rheumatic disease in 2, mitral annular calcification in 1, and uncertain in 5. Regurgitant volumes ranged from 2 to 191 mL. Regurgitant orifice area ranged from 0.01 to 1.47 cm2. Single-plane vena contracta width from the parasternal long-axis view correlated well with regurgitant volume (r = .85, SEE = 20 mL) and regurgitant orifice area (r = .86, SEE = 0.15 cm2). Biplane vena contracta width from apical views correlated well with regurgitant volume (r = .85, SEE = 19 mL) and regurgitant orifice area (r = .88, SEE = 0.14 cm2). A biplane vena contracta width > or = 0.5 cm was always associated with a regurgitant volume > 60 mL and a regurgitant orifice area > 0.4 cm2. A biplane vena contracta width < or = 0.3 cm predicted a regurgitant volume < 60 mL and a regurgitant orifice area < 0.4 cm2 in 24 of 29 patients. No other parameter, including jet area, left atrial size, pulmonary flow reversal, or semiquantitative MR grade, correlated significantly with regurgitant volume or regurgitant orifice area in a multivariate analysis.Our results demonstrate that careful color flow mapping of the vena contracta of the MR jet provides a simple quantitative assessment of MR that correlates well with quantitative Doppler techniques.