tbuckley/cabot-search huggingface dataset:
Antibody to Mycobacterium tuberculosis 65 kDa heat shock protein in patients with rheumatoid arthritis--a survey of antigen-specific antibody isotypes and subclasses in an endemic area of previous tuberculosis infection.
Authors: N S Lai, J L Lan, C L Yu, R H Lin
Journal: Annals of the Rheumatic Diseases (1995)

OBJECTIVE--To clarify the significance of the humoral immune response triggered by the Mycobacterium tuberculosis (M.tb) 65 kDa heat shock protein (hsp) in the pathogenesis of rheumatoid arthritis (RA). METHODS--M.tb 65 kDa hsp-specific IgG, IgA, IgM, and IgG subclass antibodies in serum or synovial fluid (SF) of RA and other disease patients were determined by enzyme linked immunosorbent assay (ELISA). RESULTS--RA patients did not show any characteristic increase in mycobacterial 65 kDa hsp-specific antibodies compared with healthy individuals. In contrast, antigen-specific IgG and IgG2 antibody titres in the serum of RA patients were significantly lower than those of patients with tuberculosis and normal controls. In addition, there was also no significant difference in antibody titre between the serum and SF of RA patients, nor was any significant difference found between the SF of RA and Reiter9s patients. CONCLUSION--The failure to detect a significant increase in IgG anti-M.tb 65 kDa hsp antibodies in RA patients does not exclude the possibility of microbial immunity in the aetiology of RA. Nevertheless, anti-M.tb 65 kDa hsp antibodies clearly do not appear to be the disease specific markers for RA and their relatively reduced concentrations may argue against their playing a major role in the disease pathogenesis.
Leukocytes from four patients with complete or partial Leu-CAM deficiency contain the common beta-subunit precursor and beta-subunit messenger RNA.
Authors: N Dana, L K Clayton, D G Tennen, M W Pierce, P J Lachmann, S A Law, M A Arnaout
Journal: Journal of Clinical Investigation (1987)

Deficiency of a family of three leukocyte adhesion molecules (Leu-CAM) is associated with recurrent and life-threatening bacterial infections in man. Each of the three antigens, Mo1, LFA-1, and Leu M5 has a distinct alpha subunit noncovalently associated with a common beta subunit that appears to be required for the expression of these antigens on the cell surface. To investigate the molecular basis of Leu-CAM deficiency, we studied leukocytes from four unrelated patients suffering from complete or partial Leu-CAM deficiency using immunoprecipitation of metabolically labeled proteins, RNA extraction, and Northern blot analysis. We found that B cells from all four patients synthesized a normal sized beta subunit precursor that either failed to "mature" or matured only partially to the membrane expressed form. B cells from all four patients also had a single normal sized beta subunit mRNA of approximately 3.4 kb. Leu-CAM deficiency, in these unrelated patients, is not due to the absence of the beta chain gene or to aberrant splicing of its mRNA and are consistent with a defective beta subunit gene resulting in abnormal posttranslational processing of the synthesized molecule.
Glycosylated haemoglobin concentrations in mothers of large babies.
Authors: J M Steel, P Thomson, F Johnstone, A F Smith
Journal: BMJ (1981)

Mothers who have big babies may have had abnormal glucose tolerance during pregnancy. Glycosylated haemoglobin (HbA1) concentrations were measured on the first or second day after delivery in 50 women who had had babies weighing over the 95th centile for gestational age and in 50 women who had had normal-sized babies (controls). Nine of the mothers of big babies but only one of the controls had an HbA1 concentration above the normal range. All the women had normal glucose tolerance and HbA1 concentrations six weeks after delivery. Measuring HbA1 concentration in the first two days after delivery in mothers of large babies may identify gestational diabetics.
Physicians and the Growth of Managed Care
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1994)

Many physicians, torn between their fidelity to fee-for-service medicine and the realities of a more competitive health insurance market, are taking a reluctant professional step: they are becoming involved in the rapidly growing phenomenon known as managed care. Managed care refers to a variety of methods of financing and organizing the delivery of comprehensive health care in which an attempt is made to control costs by controlling the provision of services. The term encompasses health maintenance organizations (HMOs), preferred-provider organizations (PPOs), and point-of-service financing and delivery systems. The rapid growth of managed care reflects the increasing determination of employers to . . .
The PROGRESS trial three years later: HOPE trial may shed some light
Authors: John Attia, Catherine D'Este, Christopher R Levi
Journal: BMJ (2004)

Physiotherapy compared with advice for low back painTargeting "physical factors" alone is not evidence based practice Editor-Frost et al's conclusion that "routine physiotherapy" based on physical factors was no more effective than one session of assessment and advice from a physiotherapist in the management of low back pain is not surprising. 1 But the defensive nature of the responses to this research is. 2 3 This defensiveness arises partly from the perceived rivalry between healthcare professions managing low back pain and the attention grabbing headlines used.In recent years the evidence base has highlighted that low back pain is a multifaceted phenomenon incorporating physical impairment, psychological distress, and social interruption.Thus the effective biopsychosocial management of low back pain should reflect its multifaceted nature and not just focus on the "physical factors," as was done by Frost et al.Being an evidence based practitioner should entail identifying and managing patients' risk factors because risk factors are clinical predictors of outcome and efforts to manage them may reduce the burden of low back pain for those who consult physiotherapists.Because of the recurrent nature of low back pain, talk of a "cure" is unrealistic.Thus the Physiotherapy Pain Association emphasises that patients should be taught skills to self manage their low back problem so that in the long term they are less likely to experience pain related disability and depression, thus improving their quality of life.Receiving passive treatments focusing on physical factors, which show only slight short term benefits, is not in the personal or economic interest of patients with low back pain.As is highlighted by the responses to the study by Frost et al, 3 beliefs about treatment preferences for low back pain vary across professions and can be traced to beliefs about the cause of the problem.
The Public Health Burden of Diabetes and the Reality of Limits
Authors: Frank Vinicor
Journal: Diabetes Care (1998)

Improvements in diabetes surveillance, diagnosis, and treatment have, in recent years, heightened awareness of the burden of diabetes and aroused concern about the amount of health care resources that will be necessary to manage this disease effectively in the future. Examination of diabetes from the twin perspectives of economics and public health challenges basic notions of the health care tradition in the Western world: the real-world combination of finite resources and the growing need/demand for health services forces the consideration of limits in the provision of health care. The growing need to rationally allocate limited health care resources poses emotional, potentially divisive questions of science, politics, economics, and ethics that patients and physicians must each address.
Increase in walk distance is not enough evidence to add a walk to the 6-minute walk test
Authors: N.A. Hernandes, E.F.M. Wouters, K. Meijer, J. Annegarn, F. Pitta, M.A. Spruit
Journal: European Respiratory Journal (2011)

From the authors:

H.S. Kulkarni and coworkers argue that a mean increase in 6-min walk distance (6MWD) of 27 m during a second 6-min walk test (6MWT) in 1,514 patients with chronic obstructive pulmonary disease (COPD) still does not provide enough evidence to consider performing two 6MWTs [1]. Even though we very much appreciate this correspondence, we disagree with the arguments and conclusions of H.S. Kulkarni and coworkers.

H.S. Kulkarni and coworkers state that we implied that only the result of the second 6MWT should …
High cost, low volume care: the case of haemophilia
Authors: C. Lee, C. Sabin, A. Miners
Journal: BMJ (1997)

Haemophilia is a rare and expensive condition. In Britain it affects 5418 males with factor VII deficiency and 1109 with factor IX deficiency, and in 1994 they used 158 million units of factor VIII and 9 million of factor IX at an average cost of 30p per unit. Over the past 20 years the amount of clotting factor used per patient has increased, and both the quality of the clotting factors and methods of administration have improved.

In theory the nature and level of treatment is specified in contracts between purchasers and providers, but at our centre, which cares for 14% of the haemophilic population of England and Wales, contract revenue is regularly outweighed by the cost of care. Our cost pressures are similar to those of any high cost, low volume clinical service in any general trust. Accumulating experience suggests that the present funding arrangements are failing; the danger is that such services will become a liability and be eliminated by both providers and purchasers.

Clotting factor concentrate represents 50-80% of the total direct cost of haemophilia care.1 Over the past 15 years the use of concentrate in Britain has risen threefold. …
The standard of care. 3
Authors: A. R. Holder
Journal: JAMA (1973)

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
Phoenix in Flight
Authors: Hiram B. Curry
Journal: JAMA (1972)

The occasion of this lectureship offers a yearly opportunity to review a major issue facing our profession. In the 1970s the unavoidable issue is the problem of change. The challenge is not just to describe changes as they occur, but to search for ways of controlling change—of building on what has gone before, rather than permitting older institutions to be torn down; of achieving orderly evolution, rather than submitting to revolution. In the insignia of the American Board of Family Practice we find a symbol of change. It is the phoenix, the mythical bird of ancient Egypt, said to be as large as an eagle, with plumage of brilliant scarlet and gold. This legendary bird, as it grew old, would fashion a nest of aromatic boughs and spices. Then, by flapping its wings, the phoenix would set itself ablaze, to be consumed in its own flames. But, invariably, a new
Pediatric Transport Medicine
Authors: Walter E. Edge
Journal: JAMA (1996)

This timely text is the first to cover the title topic. Very sick children are more likely than adults to require moving from less specialized to tertiary care centers, and they may be more susceptible to morbidity during transport.<i>Pediatric Transport Medicine</i>addresses many of the important issues that have arisen owing to the rapid expansion of the field. The authors have organized the book into three sections. The first deals with administration, the second with specific medical management, and the third with miscellaneous issues, including psychological concerns, community outreach, equipment, and others. Such subjects as legal ramifications and training of nurses and house staff are not neglected. In general, the book suffers from its format. The first section is overly long and repetitive, and some of its subjects are again taken up in the third section. I don't think one can avoid overlap when three successive chapters cover "Responsibilities
Predictors of Disease Course in Patients With Acute Myocarditis
Authors: Koichi Fuse, Makoto Kodama, Yuji Okura, Masahiro Ito, Satoru Hirono, Kiminori Kato, Haruo Hanawa, Yoshifusa Aizawa
Journal: Circulation (2000)

Background —Clinical manifestations of acute myocarditis, with distinct onset, vary from asymptomatic to fatal. The predictors of the course of the disease in patients with acute myocarditis at initial presentation have not yet been established. In this study, we examined the predictive values of various parameters in the disease course of patients with myocarditis. Methods and Results —Twenty-one consecutive patients who had been diagnosed as having acute myocarditis by histological examinations were analyzed. The patients with myocarditis were divided into the survival group (n=13) and the fatal group (n=8). We examined the parameters of the clinical state, hemodynamic variables, required therapies, biochemical laboratory data, and cytokines. The control groups were composed of 23 patients with old myocardial infarction and 20 healthy volunteers. The fatal group had lower blood pressure and higher pulmonary capillary wedge pressure compared with those values in the survival group. Mechanical ventilation support was more frequently required in the fatal group. Serum levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) were significantly higher in the myocarditis group than in the 2 control groups. Furthermore, levels were significantly higher in the fatal group than in the survival group for sFas (13.93±4.77 versus 3.77±0.52 ng/mL, respectively; P &lt;0.001) and sFasL (611.4±127.7 versus 269.5±37.3 pg/mL, respectively; P &lt;0.05). Other clinical states, hemodynamic variables, required therapies, and biochemical laboratory parameters were not different between the 2 groups. Conclusions —Elevation of sFas and sFasL levels at initial presentation appear to be a good serological marker to predict the prognosis of acute myocarditis.
Evaluation of Chlorothiazide Alone in the Treatment of Moderately Severe and Severe Hypertension
Authors: FRANK A. FINNERTY, JOACHIM H. BUCHHOLZ, JOHN TUCKMAN, GEORGE T. HAJJAR, GLORIA DECARLO MASSARO
Journal: Circulation (1959)

The effectiveness of alternate 6-month courses of chlorothiazide alone with standard antihypertensive therapy is compared in 11 patients with severe hypertension and 30 patients with moderately severe hypertension. These results are then compared with those of a 6-month combined treatment period when the patients received both chlorothiazide and standard antihypertensive therapy.
Eosinophilia in a Patient From South America
Authors: Kathleen R. Page, Jonathan Zenilman
Journal: JAMA (2008)

Asymptomatic eosinophilia is a common finding in returning travelers and immigrants from parasite-endemic areas. We present a 49-year-old man from Guyana who immigrated to the United States 4 years prior to examination. He had persistent asymptomatic eosinophilia, and multiple stool examinations were negative for ova and parasites. Although the list of parasitic diseases associated with eosinophilia is extensive, the differential diagnosis of asymptomatic eosinophilia with negative stool evaluations is rather limited. We discuss herein elements of the clinical history and examination essential for evaluating eosinophilia in patients at risk of parasitic diseases and present a simple algorithm to guide diagnostic testing. Despite the importance of repeated stool examinations for the presence of ova and parasites, in practice this test is not sensitive. Serologic testing for chronic parasitic infections is often necessary. Most cases without a definitive diagnosis can be conservatively managed with serial monitoring or empirically treated with antihelminthic therapy, but patients with an absolute eosinophil count of more than 3000/microL or more than 1500/microL for more than 6 months are at risk of end organ damage and should be referred for specialized parasitic and/or hematology consultation.
UK pill compensation claim collapses
Authors: C. Dyer
Journal: BMJ (2002)

The compensation claim by more than 100 women over side effects of third generation contraceptive pills collapsed in the high court in London last week when the judge told lawyers he did not want to hear further evidence.

Last month Mr Justice Mackay finished hearing expert evidence and submissions on whether women taking the third generation pills were more than twice as likely to develop venous thromboembolism as those taking second generation pills.

Lawyers said his decision not to continue with the trial, which had been scheduled to last until early …
Atypical Atrioventricular Node Reciprocating Tachycardia Masquerading as Tachycardia Using a Left-Sided Accessory Pathway
Authors: Chun Hwang, David J Martin, Jeffrey S Goodman, Eli S Gang, William J Mandel, Charles D Swerdlow, C.Thomas Peter, Peng-Sheng Chen
Journal: Journal of the American College of Cardiology (1997)
Clonal analysis of lung and blood T cells in patients with sarcoidosis.
Authors: M J Garlepp, A H Rose, J E Dench, B W Robinson
Journal: Thorax (1994)

BACKGROUND--Sarcoidosis is a disease characterised by clinical "anergy" to delayed type hypersensitivity antigens and the formation of non-caseating granulomas, which frequently manifests in the lungs as a T lymphocyte/mononuclear cell alveolitis. Although there is an increased proportion of T cells in bronchoalveolar lavage (BAL) samples from these patients, and these T cells often show evidence of activation and spontaneous secretion of cytokines such as interleukin 2 (IL-2) and interferon gamma (IFN gamma)--a pattern similar to delayed type hypersensitivity reactions--it is unclear whether both cytokines are produced by the majority of T cells derived from the lungs of patients with sarcoidosis or whether unique subpopulations of T cells produce each cytokine. In this study the properties of T cells cloned from BAL fluid samples of patients with sarcoidosis have been analysed. METHODS--T cells were cloned by limiting dilution using IL-2, phytohaemagglutinin, and irradiated feeder cells. Cloning efficiencies were compared and phytohaemagglutinin induced clonal production of IL-2, IFN gamma, and IL-4 was determined by bioassay (IL-2 and IFN gamma) or ELISA (IL-4). RESULTS--T cells derived from the BAL fluid of patients with sarcoidosis cloned less efficiently than those from blood of the same individuals. Lung derived clones (CD4+ or CD8+) produced IFN gamma more frequently and to a higher titre than blood derived clones, whereas IL-2 production by CD4+ clones derived from BAL fluid was less than that from blood derived clones. Interestingly, IL-4 production by clones from both sites was similar. Analysis of the co-production of IL-2, IFN gamma, and IL-4 by these BAL fluid clones did not demonstrate a predominant "Th1"-like population which has been suggested to underlie delayed type hypersensitivity reactions. CONCLUSIONS--The reduced cloning efficiency of T cells from the lung compared with the blood in sarcoidosis is consistent with, although probably more pronounced than, previous observations in normal lungs and shows that T cell hyporesponsiveness is not overcome in the lungs of patients with sarcoidosis. Furthermore, major differences exist between the cytokine producing potential of T cells derived from the lung and the blood in sarcoidosis, and these parallel the differences in the properties of blood and lung T cells seen in healthy individuals.
Cough-Syrup Addiction
Authors: Richard J. Rosenwald, Donald H. Russell
Journal: New England Journal of Medicine (1961)

DURING the past two years 10 boys have been referred to the court clinic in Framingham‡ for evaluation because of prolonged use of a specific cough syrup. This preparation, containing dihydrocodeinone bitartrate, was formerly sold as an "exempt narcotic," needing no prescription. This opium derivative has recently been receiving increasing attention because of its use or misuse, not only in this preparation but also as a substitute for "higher" narcotics that are more difficult to obtain. In fact, the Federal Narcotics Bureau has taken note of the danger from dihydrocodeinone and cough syrups containing it, and under new legislation has . . .
Patients' Rights in Managed Care -- Exit, Voice, and Choice
Authors: George J. Annas
Journal: New England Journal of Medicine (1997)

The ability of consumers to complain effectively about services and products is a key ingredient of the market. In Exit, Voice, and Loyalty,1 economist Albert O. Hirschman argues that the ability to take one's business elsewhere may not be enough to empower consumers in markets where all providers act similarly. Instead of simply going elsewhere, consumers need to have an effective way to voice their complaints, in order to give providers an incentive to be more responsive to consumers' interests.1 Marc Rodwin has suggested that the Hirschman analysis may be particularly relevant to members of managed-care organizations and ``individuals with . . .
On Policymaking in Medicine
Authors: John F. Farrington
Journal: JAMA (1981)

To  Editor.—  Although we agree with much of what Charles N. Verheyden, MD, PhD (1981;245:825), espouses in his COMMENTARY, we would like to point out that there is at least one exception to  generality that the membership of  governing and policymaking bodies in these organizations (national specialty, state and county medical societies; specialty certifying boards; and medical schools) largely consists of full-time or near-full-time 'physician politicians' rather than active practitioners.  The American Society of Internal Medicine (ASIM) represents more than 17,000 practicing internists nationwide. As an organization of practicing internists, ASIM's democratically elected physician-leaders recognize a personal obligation to participate in organized medicine. Twelve of ASIM's 13 trustees devote 100% of their professional time to direct patient care, and last year's members of ASIM's board spent anywhere from 30 to 60 days away from their practices on ASIM business. Members of ASIM's numerous committees and task forces
A 47-Year-Old Woman With Ductal Carcinoma In Situ of the Breast
Authors: Alfred Tinger
Journal: JAMA (1996)

<h3>To the Editor.</h3> —Dr Morrow's<sup>1</sup>discussion of a 47-year-old woman with DCIS of the left breast who was treated with a left mastectomy was excellent. The patient opted for a prophylactic right mastectomy to allay her fear of cancer in that breast and her fear of death. Prophylactic mastectomy is an option available to women, but we feel strongly that a patient's decision should rely on facts rather than fear. Surveillance of the contralateral breast is equivalent to mastectomy in terms of survival in this patient's situation.<sup>2,3</sup>No data are available to prove or suggest that prophylactic mastectomy improves overall survival or survival free of breast cancer in women with DCIS or early invasive breast cancer.<sup>3</sup>A woman should not be led to believe that sacrificing her breast(s) will ensure her survival with or without breast cancer. The chance of finding invasive carcinoma in addition to the