tbuckley/cabot-search huggingface dataset:
Analysts Differ Over Implications of More Hospital Closings Than Openings Since 1987
Authors: Emily Friedman
Journal: JAMA (1990)

SIX HUNDRED ninety-eight hospitals closed from 1980 through 1989, according to the American Hospital Association (AHA). This is not a simple case of a steadily diminishing number of US hospitals. A small number of facilities open each year, and in the early part of the decade, more hospitals opened than closed. However, since 1987, closings have been more common than openings. Between 1980 and 1989, of the 698 hospitals that closed, 508 were "community" hospitals (that is, general acutecare facilities) and 190 were "noncommunity" (specialty or other non—acutecare facilities). Of the community hospitals, 256 were urban and 252 were rural; 43.1% were not-for-profit, 37.4% were for-profit, and 19.5% were nonfederal government facilities. They tended to be small; 81.1% had fewer than 100 beds, and 54.1% had fewer than 50 beds. <h3>Every State</h3> The largest numbers of community hospitals closed in Texas (95), California (52), New York (37), Illinois (24), Michigan
Acute Anaphylactoid Reaction to Probenecid
Authors: Norbert A. Hillecke
Journal: JAMA (1965)

PROBENECID is one of the most widely used drugs for the treatment of chronic gouty arthritis. Few reports of untoward reactions, especially reports dealing with severe allergic or anaphylactoid reactions, have appeared in the literature. To our knowledge there have been only two cases of severe anaphylactoid reaction reported. Austrian and Boger 1 reported one patient whom they desensitized and who continued probenecid therapy.  Reynolds et al 2 reported a case of massive liver necrosis due to hypersensitivity to probenecid. This report concerns a patient who suffered prolonged anaphylactic shock after ingestion of one tablet of a probenecid-colchicine preparation.  Report of a Case  A 61-year-old man was seen Oct 15, 1964, in the emergency room of the St. Francis Hospital, Lynwood, Calif, with a presumptive diagnosis of myocardial infarction. He was in shock, with a blood pressure of 70/0 mm Hg, and extreme restlessness.  An electrocardiogram (ECG) showed ST- and T-wave abnormalities compatible with myocardial ischemia and
Safety and Efficacy of Endoscopic Balloon Dilation for Treatment of Crohn’s Disease Strictures
Authors: A. Ferlitsch, W. Reinisch, A. Püspök, C. Dejaco, M. Schillinger, R. Schöfl, R. Pötzi, A. Gangl, H. Vogelsang
Journal: Endoscopy (2006)

Background and Study Aims: Strictures are a substantial cause of morbidity in patients with Crohn's disease. Endoscopic balloon dilation is a therapeutic option in limited strictures to avoid intestinal surgery, although there have been few reports regarding the long-term outcome. Patients and Methods: Balloon dilation was scheduled for 46 patients (26 women, 20 men; median age 34) with Crohn's-associated symptomatic and radiographically confirmed intestinal stenosis. The study plan envisaged up to four consecutive treatments within the first 2 months until relief of symptoms, and thereafter dilations depending on clinical requirements. Results: Dilation was not possible in seven of the 46 patients (15 %), due to technical problems (n = 2), internal fistulas (n = 3), or absence of a stenosis (n = 2). Thirty-nine patients received at least one treatment. The site of obstruction was the ileocolonic anastomosis in 23 of the 39 patients (59 %) and surgically untreated areas in 16 patients (41 %). After the initial dilation series (median 1, interquartile range 1-2), strictures were traversed in 37 of the 39 patients (95 %). During a median follow-up period of 21 months (range 3-98 months), 24 of the 39 patients (62 %) underwent a repeat intervention, including 12 (31 %) with repeat dilation, 11 (28 %) with surgical resection, and one patient who received an intestinal stent. The cumulative percentages of patients without a repeat intervention or surgery at 6, 12, 24, and 36 months were 68 %, 48 %, 36 %, and 31 %, and 97 %, 91 %, 84 % and 75 %, respectively. Two perforations and one case of severe bleeding were seen in the 73 dilation procedures (4 %) performed. Conclusions: Endoscopic balloon dilation is a safe and effective method that allows surgery to be avoided in approximately 75 % of patients with Crohn's-associated short intestinal strictures. However, recurrent symptoms frequently make it necessary to repeat the procedure.
Why Did We Do That?
Authors: Ian Kunkler
Journal: BMJ (2005)

BBC Radio 4, 14 February, 8 to 8 30 pm Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> P ublic awareness of antibiotic resistance is perhaps higher than any other aspect of health, possibly with the exception of cancer. The tabloid newspapers lambast dirty hospitals infested with resistant “killer bugs.” History, however, is often forgotten. Stepping back a generation, doctors were familiar with hospital wards full of patients succumbing to sepsis in the pre-penicillin era. Indeed, a finger run down the roll of honour of any first world war regiment often testifies to as many who “died from wounds” as were killed in … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
The Cost of Quality
Authors: Susan A. Glod
Journal: Annals of Internal Medicine (2013)

On Being a Doctor15 January 2013The Cost of QualitySusan A. Glod, MDSusan A. Glod, MDFrom Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-2-201301150-00011 Audio Reading - “The Cost of Quality” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Cost of Quality," by S.A. Glod. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail “May I come in? There's something very important that we need to talk about.”It was my first time on the wrong side of the prerounding ritual. I had plenty of firsthand knowledge about how unpleasant the intern experience could be, but I had never before played the role of patient, and I quickly decided that it was much worse. I fought against a sleepless night and several doses of oxycodone, too frightened and tired to be embarrassed by the fetid smell of plastic sheets, stale povodine-iodine, and unwashed human that pervaded my hospital room. All I knew was that ... Author, Article, and Disclosure InformationAffiliations: From Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.Corresponding Author: Susan A. Glod, MD, Division of General Internal Medicine, Penn State Milton S. Hershey Medical Center, Mail Code H106, 500 University Drive, PO Box 850, Hershey, PA 17033-0850. PreviousarticleNextarticle Advertisement Audio Reading - “The Cost of Quality” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Cost of Quality," by S.A. Glod. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 15 January 2013Volume 158, Issue 2Page: 135KeywordsContraceptivesDo not resuscitate ordersLung and intrathoracic tumorsMemoryNeonatal intensive care unitsOxycodonePatientsPneumoniaSmellSmoking cessation ePublished: 15 January 2013 Issue Published: 15 January 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Integrated defense system overlaps as a disease model: with examples for multiple chemical sensitivity.
Authors: S C Rowat
Journal: Environmental Health Perspectives (1998)

The central nervous, immune, and endocrine systems communicate through multiple common messengers. Over evolutionary time, what may be termed integrated defense system(s) (IDS) have developed to coordinate these communications for specific contexts; these include the stress response, acute-phase response, nonspecific immune response, immune response to antigen, kindling, tolerance, time-dependent sensitization, neurogenic switching, and traumatic dissociation (TD). These IDSs are described and their overlap is examined. Three models of disease production are generated: damage, in which IDSs function incorrectly; inadequate/inappropriate, in which IDS response is outstripped by a changing context; and evolving/learning, in which the IDS learned response to a context is deemed pathologic. Mechanisms of multiple chemical sensitivity (MCS) are developed from several IDS disease models. Model 1A is pesticide damage to the central nervous system, overlapping with body chemical burdens, TD, and chronic zinc deficiency; model 1B is benzene disruption of interleukin-1, overlapping with childhood developmental windows and hapten-antigenic spreading; and model 1C is autoimmunity to immunoglobulin-G (IgG), overlapping with spreading to other IgG-inducers, sudden spreading of inciters, and food-contaminating chemicals. Model 2A is chemical and stress overload, including comparison with the susceptibility/sensitization/triggering/spreading model; model 2B is genetic mercury allergy, overlapping with: heavy metals/zinc displacement and childhood/gestational mercury exposures; and model 3 is MCS as evolution and learning. Remarks are offered on current MCS research. Problems with clinical measurement are suggested on the basis of IDS models. Large-sample patient self-report epidemiology is described as an alternative or addition to clinical biomarker and animal testing.
Bridging the divide: global governance of trade and health
Authors: Kelley Lee, Devi Sridhar, Mayur Patel
Journal: The Lancet (2009)

SummaryThe main institutions responsible for governing international trade and health—the World Trade Organization (WTO), which replaced the General Agreement on Tariffs and Trade (GATT) in 1995, and WHO—were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them. The growth and expansion of world trade over the past half century amid economic globalisation, and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together.
Identification of EZH2 as a Molecular Marker for a Precancerous State in Morphologically Normal Breast Tissues
Authors: Lei Ding, Christine Erdmann, Arul M. Chinnaiyan, Sofia D. Merajver, Celina G. Kleer
Journal: Cancer Research (2006)

Abstract The discovery of molecular markers to detect the precancerous state would have profound implications in the prevention of breast cancer. We report that the expression of the Polycomb group protein EZH2 increases in histologically normal breast epithelium with higher risk of developing cancer. We identify EZH2 as a potential marker for detecting preneoplastic lesions of the breast in vivo and as a possible target for preventative intervention. (Cancer Res 2006; 66(8): 4095-9)
Of Mugs and Marketing
Authors: Michael J. Kelly
Journal: JAMA (1991)

<h3>To the Editor.</h3> —In Dr Rennie's recent response<sup>1</sup>to Dr Goldstein's commentary,<sup>2</sup>it appeared that the excessive cost of an association-sponsored journal over one with drug company advertising was said to justify the impropriety or the "appearance" of impropriety involved in accepting advertising. It was further suggested that editorial decisions are somehow separated from advertising decisions, making a peer-reviewed journal somehow immune from the undue influence of the pharmaceutical industry. These explanations seem to be ones of convenience, not ethical arguments. Although I pay dues to the AMA, as a family physician I cannot receive the<i>Archives of Internal Medicine</i>without paying an extra fee each year. An internist who is not a member of the AMA can receive the<i>Archives of Internal Medicine</i>free each month. The reason this happens relates to the type of circulation the AMA must provide in order to attract and hold certain
Airway response of asthmatic subjects to inhaled allergen after exposure to pollutants.
Authors: C Rusznak, J L Devalia, R J Davies
Journal: Thorax (1996)

Recent studies have suggested that air pollutants resulting from vehicle exhaust emissions and burning of fossil fuels, either in combination or individually, may enhance the airway response of asthmatic subjects to inhaled allergen. It was hypothesised that the airway response to inhaled allergen after exposure to a combination of 400 ppb nitrogen dioxide (NO2) and 200 ppb sulphur dioxide (SO2) is increased 24-48 hours after exposure.Thirteen mild atopic asthmatic volunteers were exposed for six hours to a single exposure of air and three exposures of the combination of 400 ppb NO2 + 200 ppb SO2 in randomised order, and then challenged with increasing concentrations of Dermatophagoides pteronyssinus allergen either immediately after exposure to air, or immediately, 24 hours or 48 hours after exposure to the combination of the two pollutants, until a 20% fall in forced expiratory volume in one second (FEV1) was recorded.Exposure to 400 ppb NO2 + 200 ppb SO2 significantly decreased the dose of D pteronyssinus allergen required to produce a 20% fall in FEV1 (PD20FEV1) at all times after exposure when compared with air. The mean percentage changes in allergen PD20FEV1 immediately, 24 hours, and 48 hours after exposure to 400 ppb NO2 + 200 ppb SO2 were -37% (95% confidence intervals (CI) -50 to -23), -63% (CI -75 to -51), and -49% (CI -75 to -28.8), respectively, when compared with the PD20FEV1 after air exposure and were significant at all time points studied. The allergen PD20FEV1 at 24 hours after exposure to the combination of the two pollutants was also found to be significantly lower when compared with that immediately after exposure to the two pollutants.These results demonstrate that exposure to a combination of NO2 and SO2, at concentrations which can be encountered during episodes of increased outdoor and indoor air pollution, enhances the airway response to inhaled allergen in asthmatic subjects. This effect persists over a period of 24-48 hours and is maximal 24 hours after exposure to these air pollutants.
Influence of age on metal metabolism and toxicity.
Authors: K Kostial, D Kello, S Jugo, I Rabar, T Maljković
Journal: Environmental Health Perspectives (1978)

The metabolism and toxicity of lead, cadmium, mercury, and manganese in the postnatal period was studied in rats. Absorption, whole body retention, and organ distribution of 203Pb, 115mCd, 203Hg, and 54Mn were determined after oral and parenteral administration of these radioisotopes. The acute oral toxicity (LD50) was determined after a single application of metal chlorides. The results obtained in sucklings show a very high intestinal absorption of all metals which is partly attributed to milk diet; a higher whole body retention, higher blood levels and a much higher accumulation in the brain; and a higher oral toxicity. These results indicate age specific differences in the pharmacokinetics of metals in sucklings. It seems reasonable to consider the early neonatal age as a critical period for metal accumulation and therefore for metal toxicity. The results are interpreted on the basis of current concepts of developmental physiology and pharmacology and suggestions for future research trends are made.
Genomic Correlate of Exceptional Erlotinib Response in Head and Neck Squamous Cell Carcinoma
Authors: Eliezer M. Van Allen, Vivian W. Y. Lui, Ann Marie Egloff, Eva M. Goetz, Hua Li, Jonas T. Johnson, Umamaheswar Duvvuri, Julie E. Bauman, Nicolas Stransky, Yan Zeng, Breean R. Gilbert, Kelsey P. Pendleton, Lin Wang, Simion Chiosea, Carrie Sougnez, Nikhil Wagle, Fan Zhang, Yu Du, David Close, Paul A. Johnston, Aaron McKenna, Scott L. Carter, Todd R. Golub, Gad Getz, Gordon B. Mills, Levi A. Garraway, Jennifer R. Grandis
Journal: JAMA Oncology (2015)

<h3>Importance</h3> Randomized clinical trials demonstrate no benefit for epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in unselected patients with head and neck squamous cell carcinoma (HNSCC). However, a patient with stage IVA HNSCC received 13 days of neoadjuvant erlotinib and experienced a near-complete histologic response. <h3>Objective</h3> To determine a mechanism of exceptional response to erlotinib therapy in HNSCC. <h3>Design, Setting, and Participants</h3> Single patient with locally advanced HNSCC who received erlotinib monotherapy in a window-of-opportunity clinical trial (patients scheduled to undergo primary cancer surgery are treated briefly with an investigational agent). Whole-exome sequencing of pretreatment tumor and germline patient samples was performed at a quaternary care academic medical center, and a candidate somatic variant was experimentally investigated for mediating erlotinib response. <h3>Intervention</h3> A brief course of erlotinib monotherapy followed by surgical resection. <h3>Main Outcomes and Measures</h3> Identification of pretreatment tumor somatic alterations that may contribute to the exceptional response to erlotinib. Hypotheses were formulated regarding enhanced erlotinib response in preclinical models harboring the patient tumor somatic variant<i>MAPK1 </i>E322K following the identification of tumor somatic variants. <h3>Results</h3> No<i>EGFR</i>alterations were observed in the pretreatment tumor DNA. Paradoxically, the tumor harbored an activating<i>MAPK1 </i>E322K mutation (allelic fraction 0.13), which predicts ERK activation and erlotinib resistance in<i>EGFR</i>-mutant lung cancer. The HNSCC cells with<i>MAPK1 </i>E322K exhibited enhanced EGFR phosphorylation and erlotinib sensitivity compared with wild-type<i>MAPK1</i>cells. <h3>Conclusions and Relevance</h3> Selective erlotinib use in HNSCC may be informed by precision oncology approaches.
Active commuting is important in raising exercise levels
Authors: Roger Dobson
Journal: BMJ (2006)

Less than a third of men and women in the Europe Union take enough healthy exercise, a research article says. The Netherlands, where 44% of people take sufficient exercise, tops the league, but Sweden comes bottom of the 15 countries surveyed, with only 23% taking what the authors considered an adequate amount ( Journal of Public Health 2006, doi: 10.1007/s10389-006-0031-y).

The authors defined sufficient total activity as 30 minutes of exercise on five days a …
Observations ON THE TREATMENT OF GUNSHOT WOUNDS OF THE SPINE
Authors: A. J. Hull
Journal: BMJ (1916)

=WHEN considering thje place in thje thieatre of war at whiichi -spinal injuries shiould receive operative treatment it is necessary to weigh thle advantages of early operation, which will limit the spread of septic infection And relieve the central nervou^s system of deleterious pressure, against certain disadvantages.These injuries require careful examination, and in some cases prolonged observation, before t the are submitted to operation; a specially trained staff is required for their operative and after treatment.It is usually considered desirable that the patients shiould remain in the hospital in whichi thiey are operated upon for a considerable ti'Me.I tiink it is extremely doubtful that transport will be more injurious after an operation thlan before it.Of one thing I am co nvinced, and that is that the relief from pain whiich follows successful -laminectom y places the patient in amuchi better position -to withistand ths e strain of thje journey.It is inevitable that, with the exception of certai 'nconditions in siege warfare, when special units can b o organized for particular branch'es of surgery, the treatment of these cases will have to be relegated to thie base hospitals.The following case is not without interest from the fact -'hat the missile was removed from a portion of thle vertebrae inaccessible by laminectomy: CASE Pte. C. was woundled by a rifle bullet, which enteredI the right loin 2 in.below the extremity of the last rib, and fracturing the transverse process of the second lumbar vertebra, lodged to the -right of the body of the same vertebra.The patient suffered fronm severe local pain, which radiated down the branches of the lumbar plexus.There was.partial Motor and sensory impair- ment of the right leg.Five'-daysafater the injury a long incision nwas made in the right loin and peritoneum exposed by muscle splitting.A hand was then inserted by a retroperitoneal ro'ute and the fractured vertebra felt for as a guiide to the bullet.A scoop was passed down the same track and the bullet removed.A counter-incision was made from the back to the site of the buillet and the cavity drained by salt.sac "-a tube made of gauze and bandage filled with common salt.Pain disappeared
Chronic Peritoneal Dialysis in the United States
Authors: Rajnish Mehrotra, Dulcie Kermah, Linda Fried, Kamyar Kalantar-Zadeh, Osman Khawar, Keith Norris, Allen Nissenson
Journal: Journal of the American Society of Nephrology (2007)

In the United States, chronic peritoneal dialysis take-on has declined among incident ESRD patients. Although increasing age, co-morbidity, and body size may explain part of this decline, other factors likely contribute. Among incident ESRD patients in the United States, we found that peritoneal dialysis take-on significantly decreased from 11% in 1996 to 1997 to 7% in 2002 to 2003 (P < 0.001 for the trend). This decrease remained after adjusting for patient demographics, case-mix, and laboratory data, suggesting the involvement of other factors. This decline in utilization occurred during a time of improving outcomes for incident peritoneal dialysis patients, measured as reduced hazards for death or for the need to transfer to hemodialysis. In contrast, among patients initially treated with hemodialysis, the 12-month adjusted hazards for death or transfer to peritoneal dialysis slightly worsened or were unchanged over this same period. Therefore, the decline in peritoneal dialysis take-on cannot be entirely explained by increasing age, co-morbidity and body size of incident ESRD patients. The decline in utilization has occurred at a time when the early outcomes of CPD patients have improved.