tbuckley/cabot-search huggingface dataset:
Primary Care: The Next Renaissance
Authors: Jonathan Showstack, Nicole Lurie, Eric B. Larson, Arlyss Anderson Rothman, Susan Hassmiller
Journal: Annals of Internal Medicine (2003)

Three decades ago, a renaissance helped create the foundations of primary care as we know it today. In recent years, however, new challenges have confronted primary care. We believe that the current challenges can be overcome and may, in fact, present an opportunity for a new renaissance of primary care to address the needs of our population. In this paper, we suggest seven core principles and a set of actions that will support a renaissance in, and a positive future for, primary care. The seven principles are 1) Health care must be organized to serve the needs of patients; 2) the goal of primary care systems should be the delivery of the highest-quality care as documented by measurable outcomes; 3) information and information systems are the backbone of the primary care process; 4) current health care systems must be reconstructed; 5) the health care financing system must support excellent primary care practice; 6) primary care education must be revitalized, with an emphasis on new delivery models and training in sites that deliver excellent primary care; and 7) the value of primary care practice must be continually improved, documented, and communicated. At the start of the 21st century, a vital, patient-centered primary care system has much to offer a rapidly changing population with increasingly diverse needs and expectations. If we keep the needs of persons and patients clearly in sight and design systems to meet those needs, primary care will thrive and our patients will be well served.
Sleep and Ventricular Premature Beats
Authors: BERNARD LOWN, MARK TYKOCINSKI, ANDRE GARFEIN, PHILLIP BROOKS
Journal: Circulation (1973)

Sixty-nine 24-hour electrocardiographic monitoring sessions were conducted in 54 ambulatory subjects. Thirty-one had coronary heart disease (CHD); 11 had miscellaneous heart ailments; and 12 were free of any heart disease. Monitoring was accomplished with a miniaturized cassette recorder and ventricular premature beats (VPBs) were analyzed as to incidence and grade. The occurrence of VPBs during sleep hours was compared to the awake state. In 22 patients, the incidence of VPBs was reduced by at least 50% during sleep. An additional 13 patients showed a reduction of 25 to 50%. If patients free of ectopic activity during 24-hour monitoring sessions are excluded from analysis, then in 35 of 45 patients, or in 78%, sleep was associated with a lowered occurrence of ventricular extrasystoles. During sleep the VPB grade was likewise lowered. Thus the mean grade for 45 patients changed from 2.75 while awake to 1.78 while asleep. It is of interest that in a number of these patients, trials of various antiarrhythmic drugs were less effective than sleep in reducing the incidence and grade of VPBs. It is concluded that treatment of sporadically occurring ventricular ectopic activity in some patients may require attention to the neurophysiologic trigger rather than the cardiac target.
SODIUM AMYTAL AND OTHER DERIVATIVES OF BARBITURIC ACID
Authors: L. G. Zerfas
Journal: BMJ (1930)

APPRoxIiMATELY tWo years lhave elapsed sinice the fiirst studies were made oni the clinical use of sodium iso-anmylethyl-barbituric acid (sodium amytal ).In a preliminary report' certain clinical observationis were recorded, and attention was called to the need of further pharmacological and clinical work before definite conclusionis could be drawni as to the safety, contrainidications, and limitations of this compound.Since that time v-arious experimental and clinical observationis have been made by different in- vestigators, so that the status of this drug is now moro clearly defined.Tle puripose of this paper is to review briefly the data relating to sodiumn ansytal and similar compoun1ds.CHARACTERISTICS COMYON TO DERIVATIVES OF BARBITURIC ACID.All derivatives of barbituric acid hav-e certain character- istics in common which have long been recognized.1.They are primarily hypnotics; only occasionally will amiounts ordinarily producing hypnosis produce analgesia
A To-Do List for the Next US Surgeon General
Authors: Nathaniel P. Morris
Journal: JAMA Internal Medicine (2013)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Internal Medicine journal
Circulating miRNA markers show promise as new prognosticators for multiple myeloma
Authors: A Rocci, C C Hofmeister, S Geyer, A Stiff, M Gambella, L Cascione, J Guan, D M Benson, Y A Efebera, T Talabere, V Dirisala, E M Smith, P Omedè, G Isaia, L De Luca, D Rossi, S Gentili, G Uccello, J Consiglio, R Ria, G Benevolo, S Bringhen, V Callea, B Weiss, A Ferro, V Magarotto, H Alder, J C Byrd, M Boccadoro, G Marcucci, A Palumbo, F Pichiorri
Journal: Leukemia (2014)
Patient-Controlled Analgesia-Reply
Authors: Paul F. White
Journal: JAMA (1988)

<h3>In Reply.</h3> —The letter by Drs Grey and Sweeney describes the apparent accidental overdosing of a postoperative patient using a PCA device. Given the pump settings (meperidine bolus doses of 10 to 15 mg [1.0 to 1.5 mL] at minimum intervals of 15 minutes), it is difficult to understand how the patient could have received 495 mg of meperidine within 20 minutes of initiating PCA therapy. Since PCA devices administer<i>fixed</i>bolus doses, it is not possible to set "a dose volume of 1.0 to 1.5 mL." Assuming the patient was<i>not</i>accidentally (or intentionally) overdosed at the time that the opiate-containing syringe was loaded into the PCA device, it would seem that either siphoning of the drug (eg, failure of the one-way valve at the Y-connector) or a mechanical malfunction of the pump (eg, "runaway") occurred. Unfortunately, the State of Utah Office of the Medical Examiner did not have
Localization of a molecule immunochemically similar to eosinophil major basic protein in human placenta.
Authors: D E Maddox, G M Kephart, C B Coulam, J H Butterfield, K Benirschke, G J Gleich
Journal: The Journal of Experimental Medicine (1984)

We have recently reported that human pregnancy is characterized by a 10- to 20-fold elevation of eosinophil major basic protein (MBP) immunoreactivity in maternal blood. Here we show, by immunofluorescence, that placental tissue specifically binds antibody to MBP in and around the placental X cells and placental-site giant cells and, using thin plastic sections, that placenta has no infiltrating eosinophils. The X cells line the inner aspects of placental septal cysts, and the cyst fluid, obtained by aspiration, contains immunoreactive MBP at concentrations of 100 micrograms/ml, a sixfold greater concentration than the highest levels measured in maternal blood. The soluble MBP immunoreactivities in placental homogenates and in maternal serum chromatograph identically on Sephadex G-50, and both these gestational MBP molecules migrate as though substantially larger than the MBP found in serum from patients with hypereosinophilic syndrome or purified from the eosinophil granule. Our inability to demonstrate eosinophils in maternal blood or placental tissue, coupled with the large quantities of immunoreactive MBP highly localized in placental cysts and the chromatographic behavior of this molecule, suggest that the MBP detected in human gestation is produced by placenta.
The Morphologic and Functional Features of LAD Myocardial Bridging at 64-Detector MDCT Coronary Angiography: Correlation with Coronary Artery Disease
Authors: Ömer Çelik, Alper Aydın, Ahmet Arif Yalçın, Mehmet Ertürk, Hale Ünal Aksu, Ibrahim Faruk Aktürk, Hamdi Püşüroğlu, Ali Birand
Journal: Journal of the American College of Cardiology (2013)
Methicillin-Resistant<i>Staphylococcus aureus</i>at Boston City Hospital
Authors: Fred F. Barrett, Read F. McGehee, Maxwell Finland
Journal: New England Journal of Medicine (1968)

Twenty-two isolates of methicillin-resistant Staphylococcus aureus were obtained from 18 patients; 21 of the strains were phage nontypable, exhibited methicillin resistance to other penicillins and cephalosporins tested, and had characteristics similar to those of previously reported methicillin-resistant strains. These staphylococci were isolated from patients on seven of the 42 hospital wards. Fifteen of the 18 patients acquired their infection in the hospital. Thirteen of the 22 isolates were from the sputum of 12 patients with pulmonary superinfection, and four from the urine of two patients with catheter-associated urinary-tract infections. Evidence of patient-to-patient spread of infection was found during a ward outbreak involving four clinical cases and a nurse who was a nasopharyngeal carrier.
Preventing colorectal cancer and cancer mortality with colonoscopy: what we know and what we don’t know
Authors: D. Rex
Journal: Endoscopy (2010)

The goal of most colonoscopies is the prevention of incident colorectal cancer and especially death from colorectal cancer. The effectiveness of colonoscopy is now justly under attack following the publication of studies showing that colonoscopy reduces the risk of distal colorectal cancer and advanced neoplasms but has no [1] [2] or limited [3] effect on the incidence of proximal neoplasms. The reasons for no or limited proximal colon protection by colonoscopy are uncertain, but there are two broad categories of possible explanations. One category is altered biology in the proximal colon. Interval cancers in the proximal colon are more likely to be microsatellite unstable (MSI) and to bear the CpG Island Methylator Phenotype (CIMP) [4]. MSI is known to push tumors through the adenoma–carcinoma sequence rapidly, and CIMP tumors are believed to be the end product of serrated polyps, a group of lesions that are endoscopically subtle and about which little is known compared with adenomas.
A CASE OF BULLET IN THE HEART
Authors: J. W. Steckbauer
Journal: JAMA (1925)

A number of case reports, particularly in the literature of military surgery, record the presence of foreign bodies in the cavity and musculature of the heart. The present report is made solely to place on record an unusual case of this condition in which the bullet traversed the abdominal cavity from the buttock to its lodgment in the heart muscle. The heart injury was always secondary in importance to numerous lesions of the abdominal viscera. <h3>REPORT OF CASE</h3> A fairly well developed and nourished boy, aged 14 years, was brought to the emergency room of the St. Louis City Hospital, Dec. 2, 1923, having been shot in the buttock by a boy companion about two hours before, while he stooped over to pick something off the ground. The bullet entered the left gluteal region midway on a line drawn from the anterior superior spine to the tuberosity of the ischium.
Influenza Immunization in Adults with Diabetes Mellitus
Authors: Brian J Feery, Leonard J Hartman, Alan W Hampson, Joseph Proietto
Journal: Diabetes Care (1983)

The antibody responses to influenza vaccination of a group of adult diabetic patients were compared with responses in a healthy group of regular volunteer vaccinees. The initial and final geometric mean hemagglutination-inhibiting antibody titers were lower in the patient group, but the relative increase in titers was greater for each of the vaccine components. The percentage of fourfold rises in individual titers was greater in the diabetic group than in the control group. It was concluded that patients with diabetes mellitus responded normally to influenza vaccination. This was confirmed in an additional study. There was no significant difference in the antibody responses of patients treated with insulin or oral antidiabetic agents. There was no impairment of diabetic control as a result of influenza vaccination when this was evaluated by measuring the concentration of glycosylated hemoglobin, or by random blood glucose estimations. There was no significant change in the serum insulin level after immunization in patients on oral diabetic agents. It was concluded that influenza vaccination was safe and effective in adult diabetic patients.
Necrotizing Enteropathy
Authors: George D. Amromin
Journal: JAMA (1962)

Necrotizing enteric lesions (necrotizing enteropathy) were encountered in 63 of 280 leukemia patients and in 6 of 128 lymphoma patients autopsied within a 5-year period. Four pathogenic mechanisms were implicated: (1) shock, (2) therapeutic necrosis of tumor or leukemic infiltrates of intestinal mucosa, (3) hemorrhage with necrosis of gastrointestinal mucosa, and (4) traumatic mucosal erosions. Combinations of these 4 were frequent. Invasion of enteric bacteria through the mucosal breaks with ensuing bacteremia and bacterial shock was not unusual. Chemotherapy and adrenal corticoids, individually or in combination, were probably responsible for some of the initial lesions, inhibition of host resistance, and promotion of bacterial dissemination. Twelve patients had surgical complications.
Acute on Chronic Respiratory Failure
Authors: Gregory A. Schmidt
Journal: JAMA (1989)

Patients with acute on chronic respiratory failure exhibit severe pulmonary impairment as a baseline characteristic. Additional minor insults can precipitate cardiopulmonary failure that requires hospital admission and possibly mechanical ventilation. Our approach to these patients emphasizes evaluation of the imbalance between neuromuscular competence and mechanical load on the respiratory system. In this way, reversible factors can be identified and corrected before they progress to inspiratory muscle fatigue and respiratory failure. For cases in which deterioration is inexorable, guidelines for mechanical ventilation are given and approaches to eventual liberation from the ventilator are reviewed. (<i>JAMA</i>. 1989;261:3444-3453)
Conditional Deletion of Krüppel-Like Factor 4 Delays Downregulation of Smooth Muscle Cell Differentiation Markers but Accelerates Neointimal Formation Following Vascular Injury
Authors: Tadashi Yoshida, Klaus H. Kaestner, Gary K. Owens
Journal: Circulation Research (2008)

Phenotypic switching of smooth muscle cells (SMCs) plays a key role in vascular proliferative diseases. We previously showed that Krüppel-like factor 4 (Klf4) suppressed SMC differentiation markers in cultured SMCs. Here, we derive mice deficient for Klf4 by conditional gene ablation and analyze their vascular phenotype following carotid injury. Klf4 expression was rapidly induced in SMCs of control mice after vascular injury but not in Klf4-deficient mice. Injury-induced repression of SMC differentiation markers was transiently delayed in Klf4-deficient mice. Klf4 mutant mice exhibited enhanced neointimal formation in response to vascular injury caused by increased cellular proliferation in the media but not an altered apoptotic rate. Consistent with these findings, cultured SMCs overexpressing Klf4 showed reduced cellular proliferation, in part, through the induction of the cell cycle inhibitor, p21(WAF1/Cip1) via increased binding of Klf4 and p53 to the p21(WAF1/Cip1) promoter/enhancer. In vivo chromatin immunoprecipitation assays also showed increased Klf4 binding to the promoter/enhancer regions of the p21(WAF1/Cip1) gene and SMC differentiation marker genes following vascular injury. Taken together, we have demonstrated that Klf4 plays a critical role in regulating expression of SMC differentiation markers and proliferation of SMCs in vivo in response to vascular injury.
Donor-specific anti-HLA antibodies predict outcome in double umbilical cord blood transplantation
Authors: Corey Cutler, Haesook T. Kim, Lixian Sun, Doreen Sese, Brett Glotzbecker, Philippe Armand, John Koreth, Vincent Ho, Edwin Alyea, Karen Ballen, Jerome Ritz, Robert J. Soiffer, Edgar Milford, Joseph H. Antin
Journal: Blood (2011)
Environmental Exposure to Endotoxin and Its Relation to Asthma in School-Age Children
Authors: Charlotte Braun-Fahrländer, Josef Riedler, Udo Herz, Waltraud Eder, Marco Waser, Leticia Grize, Soyoun Maisch, David Carr, Florian Gerlach, Albrecht Bufe, Roger P. Lauener, Rudolf Schierl, Harald Renz, Dennis Nowak, Erika von Mutius
Journal: New England Journal of Medicine (2002)

In early life, the innate immune system can recognize both viable and nonviable parts of microorganisms. Immune activation may direct the immune response, thus conferring tolerance to allergens such as animal dander or tree and grass pollen.Parents of children who were 6 to 13 years of age and were living in rural areas of Germany, Austria, or Switzerland where there were both farming and nonfarming households completed a standardized questionnaire on asthma and hay fever. Blood samples were obtained from the children and tested for atopic sensitization; peripheral-blood leukocytes were also harvested from the samples for testing. The levels of endotoxin in the bedding used by these children were examined in relation to clinical findings and to the cytokine-production profiles of peripheral-blood leukocytes that had been stimulated with lipopolysaccharide and staphylococcal enterotoxin B. Complete data were available for 812 children.Endotoxin levels in samples of dust from the child's mattress were inversely related to the occurrence of hay fever, atopic asthma, and atopic sensitization. Nonatopic wheeze was not significantly associated with the endotoxin level. Cytokine production by leukocytes (production of tumor necrosis factor alpha, interferon-gamma, interleukin-10, and interleukin-12) was inversely related to the endotoxin level in the bedding, indicating a marked down-regulation of immune responses in exposed children.A subject's environmental exposure to endotoxin may have a crucial role in the development of tolerance to ubiquitous allergens found in natural environments.
Health-Related Quality of Life After Transcatheter Aortic Valve Replacement in Inoperable Patients With Severe Aortic Stenosis
Authors: Matthew R. Reynolds, Elizabeth A. Magnuson, Yang Lei, Martin B. Leon, Craig R. Smith, Lars G. Svensson, John G. Webb, Vasilis C. Babaliaros, Bruce S. Bowers, William F. Fearon, Howard C. Herrmann, Samir Kapadia, Susheel K. Kodali, Raj R. Makkar, Augusto D. Pichard, David J. Cohen
Journal: Circulation (2011)

Background— Transcatheter aortic valve replacement (TAVR) has been shown to improve survival compared with standard therapy in patients with severe aortic stenosis who cannot have surgery. The effects of TAVR on health-related quality of life have not been reported from a controlled study. Methods and Results— The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgical valve replacement to TAVR (n=179) or standard therapy (n=179). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 12-item Short Form-12 General Health Survey (SF-12). The primary end point was the KCCQ overall summary score (range, 0–100; higher=better). At baseline, mean KCCQ summary scores (35±20) and SF-12 physical summary scores (28±7) were markedly depressed. Although the KCCQ summary score improved from baseline in both groups, the extent of improvement was greater after TAVR compared with control at 1 month (mean between-group difference, 13 points; 95% confidence interval, 8–19; P &lt;0.001) with larger benefits at 6 months (mean difference, 21 points; 95% confidence interval, 15–27; P &lt;0.001) and 12 months (mean difference, 26 points; 95% confidence interval, 19–33; P &lt;0.001). At 12 months, TAVR patients also reported higher SF-12 physical and mental health scores with mean differences compared with standard care of 5.7 and 6.4 points, respectively ( P &lt;0.001 for both comparisons). Conclusions— Among inoperable patients with severe aortic stenosis, compared with standard care, TAVR resulted in significant improvements in health-related quality of life that were maintained for at least 1 year. Clinical Trials Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00530894.
Cholera in Brazil.
Authors: J. L. Ashworth, S. A. Shields
Journal: BMJ (1992)

Medline search.This showed that during 1982-6 nine papers included the phrase in their titles with a further 59 using it in the abstract.During 1987- 91 these figures jumped to 35 and 373 respectively.These figures do not include other papers that use the phrase elsewhere in the text.A close inspection of these 35 recent publications indicates that the use is subject to considerable criticism.In 19 cases the designation gold standard is questioned in such varied conditions as depres- sion,' left ventricular function,4 osteoporosis,5 and gastro-oesophageal reflux.! This is not surprising, I suppose, as these are clinical conditions that are not amenable to the certainty implied in the term.Because the phrase smacks of dogma its use should be discontinued in medical science.After all, the financiers gave up the idea of a gold standard decades ago.
THE USE OF SEWAGE AS FERTILIZER
Authors: Nathaniel Bercovitz
Journal: JAMA (1918)

<h3>To the Editor:</h3> —The present world crisis calls for the exertion of every effort to meet the unusual demands made on the people of our nation. Nowhere is this realized with greater force than in the matter of food production. On the one hand, the demands of our allies and our own demands call for a great increase in production. And on the other hand, the problems of transportation, labor and fertilizer are all working to make the task of increased production more difficult. Of the latter, the matter of fertilizer has become an acute problem. In the first place, intensive farming calls for an increase in the amount of fertilizer used. And in the second place there is a serious shortage of fertilizer due to the fact that America has been dependent for so long a time on that imported from Germany. The supply from Germany being cut off,
PSEUDO-AGGLUTINATION IN BLOOD
Authors: Alexander S. Wiener
Journal: JAMA (1933)

<h3>To the Editor:</h3> —InThe Journal, August 19, page 627, a correspondent writes concerning the difficulties he is encountering when determining the blood groups of pregnant and anemic patients. In your reply you point out that the blood group of an individual remains constant throughout life and is unaffected by disease or pregnancy. However, there are other phenomena that have been mistaken for true iso-agglutination, and one of these (rouleau formation) is particularly pronounced in pregnant women. Rouleau formation is a phenomenon occurring in normal individuals (but only to a mild degree), which is characterized by a piling up of the blood cells, resembling piles of coins. In conditions associated with a rapid sedimentation time, this phenomenon is much more marked. In pregnancy and severe anemias, rouleau formation may be so pronounced that the clumps become large and irregular, resembling superficially the clumping caused by true iso-agglutination. Such pronounced rouleau