tbuckley/cabot-search huggingface dataset:
Care at the End of Life
Authors: Eric J. Gertner
Journal: Annals of Internal Medicine (1997)

Letters1 October 1997Care at the End of LifeEric J. Gertner, MD, Jolanta E. Lukawski, MD, and Jeanne Isaacson, MDEric J. Gertner, MDAllegheny University of the Health Sciences; Medical College of Pennsylvania Division; Philadelphia, PA 19129Allegheny University of the Health Sciences; Hahnemann Division; Philadelphia, PA 19102Search for more papers by this author, Jolanta E. Lukawski, MDAllegheny University of the Health Sciences; Medical College of Pennsylvania Division; Philadelphia, PA 19129Allegheny University of the Health Sciences; Hahnemann Division; Philadelphia, PA 19102Search for more papers by this author, and Jeanne Isaacson, MDAllegheny University of the Health Sciences; Medical College of Pennsylvania Division; Philadelphia, PA 19129Allegheny University of the Health Sciences; Hahnemann Division; Philadelphia, PA 19102Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-7-199710010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with interest Hanson and colleagues review [1] on clinical interventions and care at the end of life. It is encouraging to see that many studies have increased the documentation of advance directives through both patient education and physician education. It is distressing, however, that despite our proven ability to document a patient's wishes, little or no proven benefit is enjoyed by a patient in his or her last days of life.One possible explanation for our inability to change clinical outcomes through better documentation of advance directives has been the language in which the documents ...References1. Hanson LC, Tulsky JA, Danis M. Can clinical interventions change care at the end of life? Ann Intern Med. 1997; 126:381-8. Google Scholar2. Doukas DJ, McCullough LB. The values history. The evaluation of a patient's values and advance directives. J Fam Pract. 1991; 32:145-53. Google Scholar Author, Article, and Disclosure InformationAffiliations: Allegheny University of the Health Sciences; Medical College of Pennsylvania Division; Philadelphia, PA 19129Allegheny University of the Health Sciences; Hahnemann Division; Philadelphia, PA 19102 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAdvance Directives in Critically III Cancer PatientsGoal Planning in Stroke Rehabilitation: Evidence 1 October 1997Volume 127, Issue 7Page: 574KeywordsDo not resuscitate ordersEnd of life careIntubationPatientsQuality of life Issue Published: 1 October 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Hypophosphatemia in Hospitalized Patients
Authors: David Juan
Journal: JAMA (1979)

Hypophosphatemia is common in hospitalized patients and occurs under a variety of circumstances other than parathyroid hormone excess. Charts of 100 inpatients with hypophosphatemia were reviewed and the patients divided into five groups on the basis of serum phosphate level: 18, 2.1 to 2.4 mg/dL; 49, 1.6 to 2.0 mg/dL; 20, 1.1 to 1.5 mg/dL; 12, 0.6 to 1.0 mg/dL; 1, 0.1 to 0.5 mg/dL. The effect of glucose ingestion on serum phosphate level was shown in one normal patient. Whenever carbohydrate was administered intravenously (45 cases), this was considered the primary cause of the hypophosphatemia. Other causes were as follows: diuretics, hyperalimentation, alcoholism, respiratory alkalosis, dialysis, insulin, corticosteroids, diabetic ketoacidosis, vomiting, phosphate-binding antacid, Gram-negative sepsis, primary hyperparathyroidism, saline, epinephrine, gastrointestinal malabsorption, and unknown. Hypophosphatemia in hospitalized patients may have multiple causes.
Treatment of Hyperthyroidism With Sodium Iodide I 131
Authors: Edward M. Kreps
Journal: JAMA (1973)

A 38-year-old woman had papillary carcinoma of the thyroid when surgery for adenomatous goiter was performed 20 years after treatment of hyperthyroidism with sodium iodide I 131. To our knowledge, this is the ninth reported case of microscopically proved cancer following such therapy, and it is the one with the longest interval since treatment.
POISONING DUE TO THALLIUM SULPHATE
Authors: EDWIN P. JORDAN
Journal: JAMA (1935)

Poisoning with thallium is still a rarity as contrasted with that of lead and mercury, owing in all probability to the relatively infrequent use of the former for industrial purposes. The toxicity of thallium is however well recognized and cases of poisoning have been described in both the domestic and the foreign literature. 1 Because of the infrequency, the strange symptomatology, the fact that treatment is not well standardized, and the probability that more widespread commercial use of thallium compounds is foreshadowed, the case reported here is of exceptional interest.  REPORT OF CASE  The patient was a man, aged 38. I was called to his home, June 24, 1934. The following history was obtained: The patient's previous health had been good, the only previous complaint being of relatively easy gastro-intestinal upsets and moderately frequent sore throats. About June 10 the patient had a slight sore throat lasting a few days.
It's Important, but Don't Bank on Exercise Alone to Prevent Osteoporosis, Experts Say
Authors: Andrew Skolnick
Journal: JAMA (1990)

ALTHOUGH exercise is essential for building and maintaining sound bones, it is not a panacea for preventing osteoporosis, as portrayed by some reports in the lay news media, says Barbara L. Drinkwater, PhD, a research physiologist at Pacific Medical Center, Seattle, Wash. Relying on exercise instead of estrogen replacement therapy for postmenopausal women, who are at risk for developing osteoporosis, "is like playing Russian roulette with their bones," she warned at the Second International Research Advances in Osteoporosis Conference, in Arlington, Va. While ample evidence exists that long periods of immobility can lead to serious bone loss (irreversible bone loss also occurs during extended periods of weightlessness and is a serious problem confronting American and Soviet manned space programs), there is no evidence that intensive exercise will prevent the rapid bone loss many women experience during the first decade following menopause, Drinkwater says. <h3>Exercise and Estrogen?</h3> "If you look at
Effect of Thymectomy on Skin-Homograft Survival in Children
Authors: Robert M. Zollinger, Martin C. Lindem, Robert M. Filler, Joseph M. Corson, Richard E. Wilson
Journal: New England Journal of Medicine (1964)

RECENT investigations have indicated that the thymus gland has an important role in the initiation of immune potential in animals.1 Specifically, thymectomy in the neonatal period2 , 3 and thymectomy combined with total-body irradiation in adult animals4 have permitted prolonged survival of skin homografts. The latter principle has been utilized in an effort to prolong survival of human adult renal autografts as reported by Starzl et al.5 There is no information available regarding neonatal thymectomy in man, but a study of the effect of thymectomy on skin homografts in immunologically competent children appeared practical from the point of view of clinical transplantation. . . .
Aspirin and Accidental Poisoning
Authors: W. P. Sweetnam
Journal: BMJ (1966)

MEDIBALORNand thrombosed, biopsy of the temporal arteries would not have been carried out, and I would have missed the discovery of a new disease entity.In the original description' my coauthors and I stated, " The two cases which form the basis for this report probably represent a new clinical syndrome the aetiology of which is still obscure.It [temporal arthritis] is appar- ently a focal localization of some systemic diseases. . .At the present time no name can be given to the condition, but other cases will probably be found and the condition dignified by nomenclature."Our prediction that " other cases will probably be found" and reported proved to be true.
Relevance in Medical Education
Authors: Sidney P. Kent
Journal: JAMA (1970)

The fallacy of current practices in medical education becomes clearer when we consider their relevance. In essence, students have been saying to us for years, "I am going to Loachapoka [a small town in southeast Alabama] to practice, I want to know how to treat patients. Skip the useless learning and tell me how to solve patient problems. To me, what helps me to serve the patient is relevant." When we examine what we have taught and expected students to learn, we find that<i>any</i>of this factual and conceptual information which is valid is potentially useful in solving some patient's problem. For example, the body of information about the cardiac cycle is useful in solving certain types of problems. But after learning this in the first year, satisfactorily regurgitating it on the final physiology examination, and going over the material again in the second year, many students in their
Double jeopardy: the influence of excessive daytime sleepiness and impaired cognition on health‐related quality of life in adults with heart failure
Authors: Barbara Riegel, Sarah J. Ratcliffe, William S. Weintraub, Steven L. Sayers, Lee R. Goldberg, Sheryl Potashnik, Terri E. Weaver, Susan J. Pressler
Journal: European Journal of Heart Failure (2012)
Fuseli's Nightmare
Authors: Fred B. Charatan
Journal: JAMA (1969)

<h3>To the Editor:—</h3> I was interested in Dr. Schneck's excellent article on Henry Fuseli (<b>207</b>:725, 1969). "The Nightmare" is, of course, his best known work. Dr. Schneck has argued convincingly that "The Nightmare" represents the well-known clinical syndrome of sleep paralysis. Critics of Fuseli's work, eg, Sacheverell Sitwell, have also commented on the quality of "static horror" that they project. Did Fuseli himself suffer from sleep paralysis, which as Dr. Schneck points out, can be accompanied by terrifying hypnagogic hallucinations? There is another feature of Fuseli's work which is worthy of comment. This is the frequent juxtaposition of large and small figures. The demoniac figure squatting on the abdomen and chest of the sleeping woman in "The Nightmare" is a dwarf. In Fuseli's drawing "The Fireplace," a woman of normal proportions with a statuesque body is standing in front of a fireplace. She is attended on each side by
Costs and benefits of female aggressiveness in humans and other mammals
Authors: Dario Maestripieri, Kelly A. Carroll
Journal: Behavioral and Brain Sciences (1999)

Sex differences in aggressive behavior are probably adaptive but the costs and benefits of risky aggression to women and men may be different from those suggested in Campbell's target article. Moreover, sex differences are more likely to reflect differences in the costs of aggression to females and males rather than differences in its benefits.
Tuberculous Meningitis in a Puerperal Woman
Authors: Robert D. Brandstetter
Journal: JAMA (1980)

ALTHOUGH tuberculous meningitis (TBM) rarely complicates pregnancy and seldom occurs in puerperal women,<sup>1</sup>the prognosis for such patients has been surprisingly poor. Despite a younger patient population and the availability of effective antituberculous therapy, between 32% and 68% of pregnant or puerperal women with TBM have died.<sup>1,2</sup>We report a case of TBM in a previously healthy woman whose signs and symptoms developed immediately after delivery and were initially attributed to postpartum depression and a puerperal-acquired bacterial infection. Although unusual, this case illustrates another clinical setting in which reactivated tuberculosis may first be manifested. <h3>Report of a Case</h3> After 39 weeks of pregnancy, a previously healthy, 24-year-old woman spontaneously gave birth to a healthy infant. One day later, low-grade fever developed. During the next three days, she became withdrawn and noncommunicative and was thought to be depressed. Fever persisted despite oral cephalexin monohydrate therapy; on the fourth hospital
Effect of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S. Population–Based Cohort of Men With Prostate Cancer
Authors: Timothy J. Daskivich, Kang-Hsien Fan, Tatsuki Koyama, Peter C. Albertsen, Michael Goodman, Ann S. Hamilton, Richard M. Hoffman, Janet L. Stanford, Antoinette M. Stroup, Mark S. Litwin, David F. Penson
Journal: Annals of Internal Medicine (2013)

Accurate estimation of life expectancy is essential to offering appropriate care to men with early-stage prostate cancer, but mortality risks associated with comorbidity are poorly defined.To determine the effect of age, comorbidity, and tumor risk on other-cause and prostate cancer-specific mortality in men with early-stage disease.Prospective cohort study.A nationally representative, population-based cohort.3183 men with nonmetastatic prostate cancer at diagnosis.Baseline self-reported comorbidity (scored as a count of 12 major comorbid conditions), tumor characteristics, initial treatment, and overall and disease-specific mortality through 14 years of follow-up. Survival analyses that accounted for competing risks were performed.Fourteen-year cumulative other-cause mortality rates were 24%, 33%, 46%, and 57% for men with 0, 1, 2, and 3 or more comorbid conditions, respectively. For men diagnosed at age 65 years, subhazard ratios for other-cause mortality among those with 1, 2, or 3 or more comorbid conditions (vs. none) were 1.2 (95% CI, 1.0 to 1.4), 1.7 (CI, 1.4 to 2.0), and 2.4 (CI, 2.0 to 2.8), respectively. Among men with 3 or more comorbid conditions, 10-year other-cause mortality rates were 26%, 40%, and 71% for those aged 60 years or younger, 61 to 74 years, and 75 years or older at diagnosis, respectively. Prostate cancer-specific mortality was minimal in patients with low-risk (3%) and intermediate-risk (7%) disease but appreciable in those with high-risk disease (18%) and did not vary by number of comorbid conditions (10% to 11% in all groups).Comorbid conditions were self-reported.Older men with multiple major comorbid conditions are at high risk for other-cause mortality within 10 years of diagnosis and should consider this information when deciding between conservative management and aggressive treatment for low- or intermediate-risk prostate cancer.National Cancer Institute.
P233 Efficacy and safety of once-daily glycopyrronium compared with blinded tiotropium in patients with COPD: the GLOW5 study
Authors: KR Chapman, K Beeh, ED Bateman, J Beier, AD D'Urzo, R Nutbrown, H Chen, M Henley, T Overend, P D'Andrea
Journal: Thorax (2013)

<h3>Background</h3> Glycopyrronium, a once-daily long-acting muscarinic antagonist (LAMA), has demonstrated a similar efficacy and safety profile to open-label tiotropium in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD).<sup>1</sup> The GLOW5 study compared the efficacy and safety of glycopyrronium with blinded tiotropium. <h3>Methods</h3> In this multicentre, 12-week, blinded study, patients ≥ 40 years with moderate-to-severe COPD (post-bronchodilator FEV<sub>1</sub> ≥ 30% and &lt; 80% of the predicted normal, post-bronchodilator FEV<sub>1</sub>/FVC &lt; 0.70) and a smoking history of ≥10 pack-years were randomised to glycopyrronium 50μg (via Breezhaler<sup>®</sup> device) or tiotropium 18μg (via HandiHaler<sup>®</sup> device). The primary objective was to demonstrate non-inferiority of glycopyrronium versus tiotropium for trough FEV<sub>1</sub> at Week 12 (non-inferiority margin: –50 mL). Other endpoints included FEV<sub>1</sub> area under the curve from 0 to 4 hours (AUC<sub>0–4hr</sub>) on Day 1, Transition Dyspnoea Index (TDI), St George9s Respiratory Questionnaire (SGRQ), rescue medication use, exacerbation rate, safety and tolerability. <h3>Results</h3> Of the 657 patients randomised, (glycopyrronium [n = 327]; tiotropium [n = 330]; mean age: 63.5 years, mean post-bronchodilator FEV<sub>1</sub>: 53.5% predicted), 95.9% completed the study. Glycopyrronium demonstrated non-inferiority to tiotropium for trough FEV<sub>1</sub> at Week 12 (Least Squares Mean [LSM] = 1.41L for both the groups; 95% confidence interval [CI]: –0.032, 0.031L). Glycopyrronium had a rapid onset of bronchodilation in the morning as demonstrated by a higher FEV<sub>1</sub> AUC<sub>0–4hr</sub> on Day 1 compared to tiotropium (LSM treatment difference [Td] = 58mL; p &lt; 0.001). At Week 12, TDI total score (Td = –0.188; p = 0.385), SGRQ total score (Td = 0.65; p = 0.488) and percentage of days with no rescue medication use (Td = –1.5; p = 0.528) were comparable between the groups. No significant treatment difference was observed with respect to rate of moderate/severe COPD exacerbations per year (glycopyrronium 0.38 versus tiotropium 0.35 [rate ratio = 1.10, 95% CI: 0.62, 1.93]; p = 0.754). Overall, the incidence of adverse events was similar in the glycopyrronium (40.4%) and tiotropium (40.6%) groups. <h3>Conclusion</h3> Glycopyrronium and blinded tiotropium showed similar improvements in lung function, dyspnoea, health status, exacerbation rate and rescue medication use, with a similar safety and tolerability profile. Onset of bronchodilation with glycopyrronium was significantly more rapid following the first dose. <h3>Reference</h3> Kerwin, E. <i>et al.</i> Eur Resp J 2012;40:1106–1114.
The Care of Patients With Oral Cavity and Lip Cancer
Authors: Edgar L. Frazell
Journal: JAMA (1971)

Both surgery and irradiation have a role in the treatment of mouth cancer. Alone or in combination, they are the only effective means currently available. Depending on the facilities at hand and the experience and skill of the clinician, small lesions (3 cm or less) may be successfully treated by either local surgery or local irradiation. High cure rates may be expected in almost equal numbers by either method.<sup>6</sup>Their relative merits are not the subject of this discussion. In a significant portion of patients with oral cancer—the majority in our experience — the initial clinical presentation is unfavorable. Extensive infiltration at the primary site plus invasion of adjacent structures lessens the chance of local control of the disease by either irradiation alone or surgery alone. Likewise, clinical evidence of regional lymph node spread indicates a poor prognosis. Just how poor it is is seldom appreciated.<sup>7</sup> The shortcomings
What Really Happened: A Tribute to John C. Fletcher
Authors: Mary Faith Marshall
Journal: The American Journal of Bioethics (2004)

John C. Fletcher, a pioneer in the field of bioethics and friend and mentor to many generations of bioethicists, died tragically on May 27th at the age of 72. The son of an Episcopal priest from Bryan, TX, Fletcher graduated in 1953 with a degree in English Literature from the University of the South in Sewanee, TN. After completing a Masters in Divinity degree from the Virginia Theological Seminary and a stint as a Fulbright scholar at the University of Heidelberg in 1956, he was ordained in the Episcopal Church and received a doctorate in Christian ethics from the Union Theological Seminary in New York. After ordination, Fletcher worked in various Episcopal churches and founded the Interfaith Metropolitan Theological Seminary in Washington, D.C. However, despite his religious faith, he was also a skeptic, and renounced his ordination in the mid-1990s due to his need for ‘intellectual honesty.’ Fletcher began his bioethics contributions in the early 1970's, when he became a founding Fellow of the Hastings Center and eventually the first Chief of the Bioethics Program at the Clinical Center of the National Institutes of Health. At the University of Virginia in Charlottesville, he was the Founding Director of the Center for Bioethics and a professor of biomedical ethics at the medical school, and became the Kornfeld Professor of Biomedical Ethics until his retirement in 1999. Fletcher was a prominent authority and voice in the national and international bioethical dialogue through his talks, his testimonies before scientific and congressional panels, his many articles, and his bioethical and religiously-orientated books, including: An Introduction to Clinical Ethics (1997), Coping with Genetic Disorders: a Guide for Clergy and Parents (1982), Ethics and Human Genetics: A Cross-Cultural Perspective (1989), which he wrote with sociologist Dorothy C. Wertz. Dr. Fletcher received the Lifetime Achievement Award from the American Society of Bioethics and Humanities in 2000. With the passing of Dr. John C. Fletcher, bioethics has lost one of its great voices, a dedicated teacher and mentor, and a friend and colleague to scholars in bioethics and a host of other fields. Below is a touching tribute from one of his former students.
P154Wortmannin abolishes the protective effect of simvastatin against the ischaemia and reperfusion-induced ventricular arrhythmias in the anaesthetized canine
Authors: G Kisvari, GY Seprenyi, A Vegh
Journal: Cardiovascular Research (2014)

In a previous study we have shown that a single dose of simvastatin markedly reduced the severity of ventricular arrhythmias that resulted from a 25 min ischaemia and reperfusion (I/R) in anaesthetized dogs. This protection seems to involve the generation of nitric oxide (NO) via the activation of NO synthase (NOS), since the antiarrhythmic effect of simvastatin was abolished by L-NAME. The signaling pathways, which are involved in the rapid activation of NOS by simvastatin, are however, not fully elucidated; some studies have suggested that the stimulation of the PI3/Akt pathway may play a role. Thus, the present study has now examined whether this signaling pathway has an importance in the acute antiarrhythmic effect of simvastatin. Mongrel dogs, anaesthetized with chloralose and urethane (i.v.) were subjected to a 25 min occlusion of the left anterior descending (LAD) coronary artery, which was followed in some cases by reperfusion. The control animals were infused either with the solvent of simvastatin (C1; n=16) or DMSO (the solvent of wortmannin; C2; n=11). In three other groups simvastatin (S; 0.1 mg/kg; n=15) and wortmannin a selective inhibitor of phosphatidyl-inositol-3-kinase (W; 1.5 mg/kg; n=10) were administered alone or together (W+S; n=9) in slow intracoronary injection just prior to the occlusion. The severity of ischaemia (degree of inhomogeneity of electrical activation, epicardial ST-segment) and of arrhythmias, as well as the plasma NOx levels in blood samples taken from the coronary sinus were assessed. The activity of eNOS was determined by Western blot, the tissue superoxide production was evaluated by dihydroethidium fluorescence staining using confocal microscopy. Compared with controls (C1+C2), simvastatin significantly decreased the number of VPBs (272±73 vs. 94±25) and episodes of VT (4.7±1.6 vs. 0.3±0.2), the incidence of VT (76% vs. 20%) and VF (28% vs. 0%) during the occlusion, and increased survival following reperfusion (17% vs 38%). This protective effect of simvastatin was abolished in the presence of wortmannin (VPBs: 257±113, VT episodes: 4.6±2.2, VT and VF%: 67% and 83%, survival: 17%). Simvastatin also enhanced eNOS activity and preserved NO bioavailability during occlusion and reduced superoxide production following reperfusion. We conclude from these results that the antiarrhythmic effect of simvastatin is due to an increased NO bioavailability resulting from the rapid activation of eNOS via the activation of the PI3K/Akt signaling pathway.
Determinants of Seeking of Primary Care for Lower Urinary Tract Symptoms: The Krimpen Study in Community-Dwelling Men
Authors: Esther T. Kok, Frans P.M.J. Groeneveld, Jochem Gouweloos, Rikkert Jonkheijm, J.L.H. Ruud Bosch, Siep Thomas, Arthur M. Bohnen
Journal: European Urology (2006)