tbuckley/cabot-search huggingface dataset:
Half of all doctors are below average
Authors: J. Poloniecki
Journal: BMJ (1998)

See Editor's choice

A heart operation can put a very ill patient on the road to a long and healthy life, or it can kill the patient. Major surgery is just one of many instances when treatment can result in a failure more serious than the consequences of doing nothing. The balance of risk requires a responsible attitude from all the many parties to an operation: the patient, the general practitioner, the specialist physician, the surgeon, theatre nurses, and the anaesthetist; supervisors, such as the chief medical officer and chief executive of the hospital; and the funders of the operation.

This article considers the advantages of having an authoritative estimate of the current failure rate for an operation and reflects on the problems that have arisen where there was a lack of interest in doing this.

#### Summary points

Even if all surgeons are equally good, about half will have below average results, one will have the worst results, and the worst results will be a long way below average

With imperfect allowance for differences in case mix, differences in performance figures for surgeons or hospitals do not necessarily reflect differences in risk to an individual patient

All prospective parties to a major operation should have access to a numerical estimate of the risk of the patient not surviving

A numerical estimate of the failure rate is a number, not a statement like “The operation is nearly always successful.” It is also a single number, not a range like “5-20%.” The estimate should relate to the doctor who will perform the operation, and it should be a current estimate, especially if there have been recent failures. It will be different from the national average for last year, and from the rates for other surgeons at the same hospital. The source of the estimate …
Acute appendicitis: Leaving normal looking appendices
Authors: Faheez Mohamed, Kevin K Khoo
Journal: BMJ (2006)

EDITOR—In their clinical review of acute appendicitis Humes and Simpson point out that complications can occur after removal of a normal appendix.1 To decrease the rate of negative appendicectomies, the use of diagnostic laparoscopy followed by either laparoscopic or open appendicectomy may be beneficial. Diagnostic laparoscopy allows the doctor to leave a normal …
Maintenance Therapy for Lupus Nephritis — Something Old, Something New
Authors: James E. Balow, Howard A. Austin
Journal: New England Journal of Medicine (2004)

From a historical perspective, there are few diseases for which the cause, natural history, and response to treatment have been as complex or difficult to define as those of systemic lupus erythematosus (SLE). In large part, this is because SLE represents a clinical syndrome rather than a unique disease entity. The apparent diversity of pathogenic mechanisms operating in individual patients, which parallels the diversity observed in various animal models of SLE, underscores the fact that the disease phenotype arises from a variable mixture of environmental factors, the hormonal milieu, genes that contribute to an autoimmune diathesis, and other causes of . . .
Hyperuricemia Due to Ethambutol
Authors: Arnold E. Postlethwaite, Alan G. Bartel, William N. Kelley
Journal: New England Journal of Medicine (1972)

ETHAMBUTOL has found wide clinical acceptance as an effective agent for the treatment of Mycobacterium tuberculosis infections in man. Of the recognized "side effects" associated with the administration of ethambutol, ophthalmic toxicity has received the most attention.We have found a substantial increase in the serum urate concentration in patients being treated with ethambutol. The present study was undertaken to establish the frequency, mechanism and importance of this effect in man.Materials and MethodsThe effect of prolonged therapy with ethambutol in a daily dose of 12 to 19 mg per kilogram of body weight on the metabolism of uric . . .
Antinuclear antibodies and the diagnosis of systemic lupus erythematosus in patients with acute intermittent porphyria.
Authors: S A Allard, P J Charles, A L Herrick, K E McColl, J T Scott
Journal: Annals of the Rheumatic Diseases (1990)

To investigate the previously postulated association of systemic lupus erythematosus (SLE) and porphyria 38 patients with various types of porphyria were investigated for clinical and laboratory evidence of a connective tissue disease. Antinuclear antibodies (ANAs) were found in 8/15 (53%) patients with acute intermittent porphyria. These patients were more likely to have had a recent acute attack of porphyria, but only one patient had clinical evidence of SLE. Antinuclear antibodies were not found in any patients with latent acute intermittent porphyria or appreciably in any of the other types of porphyria studied. This finding of ANAs in patients with acute intermittent porphyria may explain the previously described association with SLE. Strict diagnostic criteria need to be used in any one patient as these two disorders have many similar clinical manifestations.
Multiple extra-articular manifestations are associated with poor survival in patients with rheumatoid arthritis
Authors: C Turesson, R L McClelland, T J H Christianson, E L Matteson
Journal: Annals of the Rheumatic Diseases (2006)

Rheumatoid arthritis is associated with an increased mortality compared with the general population.1 Disability2 and severe extra-articular rheumatoid arthritis (ExRA) manifestations3 predict mortality in patients with rheumatoid arthritis. In a previous study of a community-based sample of patients with rheumatoid arthritis, we showed that ExRA was a strong predictor of mortality, whereas the survival of patients with rheumatoid arthritis without severe ExRA was not largely different from the background population.4 We have now studied the effect of multiple ExRA manifestations on mortality.

Using the resources of the Rochester Epidemiology Project, all patients with rheumatoid arthritis residing in Rochester, Minnesota, with a disease onset between 1 January 1955 and 31 December 1994 were …
Complications of Acupuncture
Authors: Harold Carron
Journal: JAMA (1974)

Advocates of acupuncture therapy have claimed that no danger exists in acupuncture and that it can never be harmful. The inappropriate use of this treatment and its performance without adequate supervision, however, may result in complications that can be disfiguring, painful, and life-threatening. Six such incidents are described. It is recommended that the procedure be considered experimental and performed only in a study setting. Patients undergoing such therapy should be advised of its potential hazards.  (JAMA228:1552-1554, 1974)
The Clinician's Guide to Asthma: Kian Fan Chung. London: Arnold. 165 pp. pound29.99. ISBN 0 340 76287 X
Authors: C M Richardson
Journal: Thorax (2003)

This is an easy to read and thorough guide to asthma which covers a wide range of topics from prevalence to treatment, pharmacology to pathology. The text is engaging and interesting. It is well illustrated with numerous pictures and diagrams …
Fatal Human Cerebral Coenurosis
Authors: John A. Hermos
Journal: JAMA (1970)

<i>A 2-year-old boy from South Dakota died from an intracranial infection due to a parasitic cyst. The cyst was identified as the larval cyst, or coenurus, of the dog tapeworm</i>Taenia multiceps.<i>To our knowledge this is only the second case of cerebral coenurosis reported in the United States. Evidence suggests that rabbits were the intermediate host in this case.</i>
Leptin receptor expression on T lymphocytes modulates chronic intestinal inflammation in mice
Authors: B Siegmund
Journal: Gut (2004)

<b>Background:</b> Leptin regulates appetite through the long isoform of its receptor in the hypothalamus. Although leptin regulates immune responses, it is still unknown whether a direct effect of leptin on lymphocytes is required. <b>Aims:</b> To clarify whether expression of leptin receptors on T lymphocytes modulates intestinal inflammation in mice. <b>Methods:</b> The model of colitis induced by transfer of CD4<sup>+</sup>CD45RB<sup>high</sup> (RB<sup>high</sup>) cells into <i>scid</i> mice was used. Wild-type (WT) or leptin receptor deficient (<i>db/db</i>) RB<sup>high</sup> cells were transferred into <i>scid</i> mice and development of colitis evaluated. <b>Results:</b> Leptin receptors were expressed on both RB<sup>high</sup> and RB<sup>low</sup> cells. Intestinal lymphocytes of mice with colitis expressed high leptin levels compared with healthy controls whereas the opposite was true for serum leptin levels. Transfer of RB<sup>high</sup> cells from <i>db/db</i> mice induced delayed disease compared with transfer of WT cells. A high rate of apoptosis in lamina propria lymphocytes and reduced cytokine production were observed early on in <i>scid</i> mice receiving <i>db/db</i> RB<sup>high</sup> cells. These effects were not due to the high levels of glucocorticoids present in <i>db/db</i> mice as administration of corticosterone to WT mice failed to reproduce this phenomenon. High expression of peroxisome proliferator activated receptor γ was observed in the colon of recipients of <i>db/db</i> compared with WT cells. Freshly isolated <i>db/db</i> RB<sup>high</sup> cells produced low levels of interferon γ. Despite delayed onset of colitis, as disease progressed differences between mice receiving WT or <i>db/db</i> cells were no longer apparent. <b>Conclusions:</b> These results suggest that leptin affects the immune response, partly by acting on the long isoform of its receptor expressed on T lymphocytes.
The First Three Years of Life: An Overview of a New Frontier of Psychiatry
Authors: REGINALD S. LOURIE
Journal: American Journal of Psychiatry (1971)

Psychiatry must become more concerned with the first three years of life if the roots of later pathology are to be identified so that preventive measures can be undertaken. In this overview the author interweaves newer information with what is already known about early development. He includes the concept of "organizers" in the infant's experience, which form the beginnings of integration of functions; these include vision, pain, separation anxiety, body image development, learning of body control, and exploration of property rights.
Nodule Formation in Rheumatic Disease
Authors: G. D. Kersley, H. J. Gibson, M. H. L. Desmarais
Journal: Annals of the Rheumatic Diseases (1946)

The literature on nodule formation in rheumatic disease is confused by the absence of co-ordination of clinical data and pathological material.Nodules of one sort or another are found in many rheumatic syndromes, and also in conditions which are barely within the scope of that designation.Parkes Weber (1943) classified nodules into eight types: those occurring in acute rheumatism, rheumatoid arthritis, gout, xanthomata, calcinosis, amyloidosis, mucinous (in thyroid dysfunction), and those occurring in the Ehlers-Danlos syndrome of laxity, abnormal elasticity, atrophy, and friability of the skin and ligaments.While the types of nodule found in acute rheumatism and rheumatoid arthritis are becoming fairly well defined (Dawson, 1933; Collins, 1939; and Bennett, 1943), there is still much debate on their structure in fibrositis, Copeman and Ackerman (1944) believing them to be fatty herniations, and Elliott (1944) supporting the view that they are only areas of spasm of muscle fibres.
Localisation of neuropeptide Y in nerves of the rat cardiovascular system and the effect of 6-hydroxydopamine
Authors: J. M ALLEN, J. M POLAK, J. RODRIGO, K. DARCY, S. R BLOOM
Journal: Cardiovascular Research (1985)

Journal Article Localisation of neuropeptide Y in nerves of the rat cardiovascular system and the effect of 6-hydroxydopamine Get access JANET M ALLEN, JANET M ALLEN **From the Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London Search for other works by this author on: Oxford Academic PubMed Google Scholar JULIA M POLAK, JULIA M POLAK ††From the Department of Histochemistry, Royal Postgraduate Medical School, Hammersmith Hospital, London Search for other works by this author on: Oxford Academic PubMed Google Scholar JOSE RODRIGO, JOSE RODRIGO ††From the Department of Histochemistry, Royal Postgraduate Medical School, Hammersmith Hospital, London Search for other works by this author on: Oxford Academic PubMed Google Scholar KENNETH DARCY, KENNETH DARCY **From the Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London Search for other works by this author on: Oxford Academic PubMed Google Scholar STEPHEN R BLOOM STEPHEN R BLOOM ‡ **From the Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London ‡Address for correspondence and reprint requests: Professor S R Bloom, 2nd Floor Francis Fraser Laboratories. Royal Postgraduate Medical School, Hammersmith Hospital. Du Cane Road. London W12 0HS. UK. Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 19, Issue 9, September 1985, Pages 570–577, https://doi.org/10.1093/cvr/19.9.570 Published: 01 September 1985
Chorionic Gonadotropin β-Subunit and Core Fragment in Bladder Cancer: mRNA and Protein Expression in Urine, Serum and Tissue
Authors: Kristina Hotakainen, Caj Haglund, Annukka Paju, Stig Nordling, Henrik Alfthan, Erkki Rintala, Ulf-Håkan Stenman
Journal: European Urology (2002)
The Anesthetist as a Physician
Authors: Henry K. Beecher, Henrik H. Bendixen, Phillips Hallowell, Henning Pontoppidan, Donald P. Todd
Journal: JAMA (1964)

IN THE first century following Morton's public demonstration of the effect of ether in man, the anesthetist found sufficient challenge in activities limited to simple anesthesia conducted as safely as possible for surgical procedures. In the last two or three decades, time spent outside the operating room has been largely confined to devising equipment or in studies of the physiologic and pharmacologic effects of old and new anesthetic agents. But, especially in the last decade, the physiciananesthetist has expanded his activities. This report will deal with these expanded activities, with emphasis on new concepts, in order to indicate the growth of anesthesia as a medical specialty. In several instances points have been illustrated with cases or studies from our own department and laboratory. The advances described are common to many departments; local and specific examples are used since we know them best. Every major department could likewise have presented its
Manipulation of the Growth Hormone Axis in Patients with HIV Infection
Authors: Marc R. Blackman
Journal: New England Journal of Medicine (2007)

Patients with human immunodeficiency virus (HIV) infection often have a reduced mass of skeletal muscle and bone and a maldistribution of body fat. Loss of muscle mass, strength, and function are integral to the AIDS wasting syndrome and are associated with resistance to the anabolic effects of growth hormone. Administration of growth hormone in relatively high daily doses for 12 weeks improves muscle mass, strength, and function but leads to excess salt and water retention, the carpal tunnel syndrome, glucose intolerance, and insulin resistance, whereas the use of somewhat lower doses or an alternate-day regimen elicits similar beneficial effects with . . .
Too many labels
Authors: T. Groves
Journal: BMJ (2013)

Is that really the right title?" asked a colleague at a recent editorial meeting, spotting this week's Personal View on the list of forthcoming articles.See what you think.In "Admission to hospital could be considered a disease," Hugh McIntyre argues that being in hospital doesn't simply put patients at risk of further illness and early readmission; rather, it is itself an abnormal health status associated with physiological and psychological stresses (doi:10
Mitochondrial transcription factors TFAM and TFB2M regulate Serca2 gene transcription
Authors: Atai Watanabe, Masashi Arai, Norimichi Koitabashi, Kazuo Niwano, Yoshiaki Ohyama, Yoshihumi Yamada, Noriko Kato, Masahiko Kurabayashi
Journal: Cardiovascular Research (2010)

AimsSarco(endo)plasmic reticulum Ca2+-ATPase 2a (SERCA2a) transports Ca2+ by consuming ATP produced by mitochondrial respiratory chain enzymes. Messenger RNA (mRNA) for these enzymes is transcribed by mitochondrial transcription factors A (TFAM) and B2 (TFB2M). This study examined whether TFAM and TFB2M coordinately regulate the transcription of the Serca2 gene and mitochondrial genes.
Lineages of Oncogenic Human Papillomavirus Types Other Than Type 16 and 18 and Risk for Cervical Intraepithelial Neoplasia
Authors: Long Fu Xi, Mark Schiffman, Laura A. Koutsky, James P. Hughes, Rachel L. Winer, Constance Mao, Ayaka Hulbert, Shu-Kuang Lee, Zhenping Shen, Nancy B. Kiviat
Journal: JNCI Journal of the National Cancer Institute (2014)

Data on clinical outcomes of infection with variants of oncogenic human papillomavirus (HPV) types other than HPV16 and HPV18 are rare. We investigated intratypic variations in non-HPV16/18 oncogenic types and their corresponding relationships with cervical intraepithelial neoplasia grades 2-3 (CIN2/3).Study subjects were women who were positive for one or more of 11 non-HPV16/18 oncogenic types. Subjects were followed every six months for two years for detection of HPV and cervical lesions. Variant lineages were defined by sequencing the 3' part of the long control region and the entire E6/E7 region of HPV genome. Lineage-associated risk of CIN2/3 was assessed using logistic regression with generalized estimating equations.A total of 4591 type-specific HPV infections among 2667 women were included in the analysis. The increase in risk of CIN2/3 was statistically significant for women with HPV31 A or B compared with C variants, HPV33 A1 compared with B variants, HPV45 A3 or B2 compared with B1 variants, HPV56 B compared with A2 variants, and HPV58 A1 or A3 compared with C variants. For these five types, the adjusted odds ratio associated with CIN2/3 was 2.0 (95% confidence interval [CI] = 1.5 to 2.6) for infections with single-type high-risk (HR) variants, 1.7 (95% CI = 1.0 to 2.7) for infections with two or more types but only one HR variant, and 5.3 (95% CI = 3.1 to 8.4) for infections with HR variants of two or more types as compared with those with single-type non-HR variants. The likelihood of CIN2/3 was similar for women with HPV16 infection and for those with HPV58 A1 variant infection.These findings suggest that for a given HPV type, intratypic nucleotide changes may alter phenotypic traits that affect the probability of neoplasia.
Encephalitis after Measles with Parkinsonian Rigidity: Recovery
Authors: B. Meyer
Journal: BMJ (1943)

MEDICAL MEMORANDAMEDICAL JOURAL is less than 3 it is usually considered not to be significant.When the drug was administered immediately after a meal the percentage excretion in urine was 5.5 greater than when taken between meals.The standard deviations were 15.4 and 13.5 iespectively.The above-mentioned ratio in this case is 6.5, an(d hence the difference can be considered to be statistically significant, although from the clinical point of view it is scarcely of importance.Conclusions The data presented here would appear to show that there is no advantage with respect to the blood concentration or urinary excretion, and hence absorption, in giving acid or alkali with sulphapyridine.Nor was any significant effect observed on the blood concentration by timing the administration ot the drug in relation to meals.The excretion of the drug was greater when taken immediately after as opposed to two hours before a meal.This difference was statistically significant, but clinically can scarcely be of much importance.I desire to thank Dr. Stanley G.
Essential fatty acid deficient hairless mouse: the effects of topical agents on the epidermis
Authors: NICHOLAS J. LOWE
Journal: British Journal of Dermatology (1977)

Essential fatty acid deficient (EFA deficient) hairless mice were used to test the ability of topical agents to reduce the high epidermal DNA synthesis and acanthosis present in EFA deficiency. An established therapeutic agent known to be effective in psoriasis (betamethasone 17‐valerate) significantly reduced the epidermal DNA synthesis, mitotic count and epidermal cell thickness. Linoleic acid reduced DNA synthesis and returned epidermal histology towards that of normal skin. Prostaglandin E2 analogue (15 (S)‐15‐methyl PGE2 methyl ester) reduced epidermal DNA synthesis both in treated and distant skin sites. Prostaglandin E2 was less effective than the analogue but slightly reduced epidermal DNA synthesis and thickness. Prostaglandin F2α had no obvious effect on the epidermis. Chlorambucil reduced epidermal DNA synthesis and thickness. Vitamin A acid increased DNA synthesis and epidermal cell thickness but reduced the hypcrkcratosis of EFA deficiency. A rapid epidermal cell transit was found in EFA deficient mice, approximately three times faster than in normal mouse epidermis.
Relationship Between Cancer of Stomach and the ABO Blood Groups
Authors: I. Aird, H. H. Bentall, J. A. F. Roberts
Journal: BMJ (1953)

Chronic opioid receptor (OR) activation by morphine causes distinct cellular adaptations responsible for the development of tolerance. The present study examines the effect of chronic morphine exposure on the ability of high-efficacy agonists to mediate δ-OR (DOR) and μ-OR (MOR) uncoupling and internalization, two regulatory mechanisms contributing to rapid desensitization of OR function. Chronic morphine treatment (1 μm; 72 hr) of DOR carrying neuroblastoma x glioma (NG108-15) hybrid cells, a prototypical model system frequently used to study cellular aspects of opioid tolerance, completely blocked the capacity of [d-Ala<sup>2</sup>,d-Leu<sup>5</sup>]enkephalin (DADLE) and etorphine to desensitize opioid-stimulated [<sup>35</sup>S]GTPγS binding and to mediate DOR internalization. Similar findings were obtained on stably DOR- and MOR-transfected human embryonic kidney (HEK) 293 cells. Chronic morphine treatment also heterologously impaired agonist regulation of non-opioid G-protein-coupled receptors, such as the m<sub>4</sub>-muscarinic acetylcholine receptor and the brain-type cannabinoid receptor. As a possible underlying mechanism, we found that chronic morphine treatment completely blocked agonist-induced redistribution of β-arrestin1 in both NG108-15 and stably MOR-transfected HEK293 cells. Moreover, attenuation of β-arrestin1 function appears to depend on persistent stimulation of MAP kinase activity during the course of chronic morphine treatment, because coincubation of the cells together with the MAP kinase blocker PD98059 fully restored β-arrestin1 translocation and receptor internalization. These results demonstrate that chronic morphine treatment produces adaptational changes at the β-arrestin1 level, which in turn attenuates agonist-mediated desensitization and internalization of G-protein-coupled receptors.
Lack of GPR88 enhances medium spiny neuron activity and alters motor- and cue-dependent behaviors
Authors: Albert Quintana, Elisenda Sanz, Wengang Wang, Granville P Storey, Ali D Güler, Matthew J Wanat, Bryan A Roller, Anna La Torre, Paul S Amieux, G Stanley McKnight, Nigel S Bamford, Richard D Palmiter
Journal: Nature Neuroscience (2012)