tbuckley/cabot-search huggingface dataset:
Medical Education in the United States and Canada
Authors: Walter S. Wiggins
Journal: JAMA (1960)

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
Integrin-Linked Kinase Inhibitor KP-392 Demonstrates Clinical Benefitsin an Orthotopic Human Non-small Cell Lung Cancer Model
Authors: Jiang Liu, Penny C. Costello, Nhu-An Pham, Melania Pintillie, Mogjan Jabali, Jasbinder Sanghera, Ming-Sound Tsao, Michael R. Johnston
Journal: Journal of Thoracic Oncology (2006)
Commentary: Traffic exposure and asthma: problems of interpretation
Authors: D. P Strachan
Journal: BMJ (1996)

Neither air pollution nor asthma is a new problem, but in the past decade there has been increasing concern that the apparent increase in the prevalence of asthma may be due to increasing exposure to pollution, particularly from motor vehicles.1

Vehicles emit many pollutants, but in relation to asthma interest has focused on particulate matter and nitrogen oxides (mainly nitrogen monoxide). Nitrogen monoxide is rapidly oxidised to nitrogen dioxide, which in turn, and at a distance, catalyses the formation of ozone. Proximity to major roads or estimates of local traffic density have been used as indicators of exposure to vehicle exhaust …
Weight Training Improves Walking Endurance in Healthy Elderly Persons
Authors: Philip A. Ades
Journal: Annals of Internal Medicine (1996)

Objective: To determine the effect of a resistance-training program on walking endurance in a healthy, community-dwelling elderly population. Design: 12-week randomized, controlled trial comparing a resistance-training group with a nonexercising control group. Setting: Hospital-affiliated outpatient exercise facility. Patients: 24 healthy men and women who were 65 years of age or older (mean age ±SD, 70.4 ± 4 years; range, 65 to 79 years). Measurements: The primary outcome variable was exhaustive submaximal walking time measured at an intensity of 80% of baseline peak aerobic capacity. Results: Participants in the resistance-training program increased submaximal walking endurance by 9 minutes (from 25 ± 4 minutes to 34 ± 9 minutes; P = 0.001), a 38% increase, whereas no change was seen in controls (20 ± 5 minutes to 19 ± 10 minutes; P > 0.2; P = 0.005 between groups). The relation between change in leg strength and change in walking endurance was significant (r = 0.48; P = 0.02). Neither group showed a change in peak aerobic capacity or in whole-body composition, although fat-free mass of the leg increased in the exercise group. Conclusions: Resistance training for 3 months improves both leg strength and walking endurance in healthy, community-dwelling elderly persons. This finding is relevant to older persons at risk for disability, because walking endurance and leg strength are important components of physical functioning.
A Randomized Controlled Trial of Academic Group Practice
Authors: Richard F. Afable
Journal: JAMA (1987)

To the Editor.—  Goldberg et al 1 must be commended for their study of alternative methods of organizing the teaching medical clinic. Those of us who are actively involved in supervising teaching clinics know that organization is generally an exception to the rule. Attempts to expedite patient care and satisfaction while maintaining resident participation and education often meet with obstacles. Cleveland General Hospital's system of firms within a group practice seems to be a feasible and apparently successful alternative to traditional methods.  However, I feel the authors have failed to comment on another important reason to change to a group practice. The major challenge facing medical education in the ambulatory setting is financial: who pays? Good will and philanthropy on the part of hospitals have given way to diagnosis related groups and discount medicine. Thus, the medicine clinic must become more self-sufficient. Many institutions have organized their clinic supervisory staff
How can good general practitioner care be achieved?
Authors: D C Morrell, M O Roland
Journal: BMJ (1987)

It has been shown that to provide a high standard of care general practitioners probably need to book consultations at intervals of at least 10 minutes. In this study the maximum list size for which a general practitioner might be expected to provide a high standard of care was determined from calculations of the time spent consulting, based on various consultation rates and list sizes and assuming that consultations were 10 minutes long. If good quality care is to be provided and is to include the range of services suggested in the government's recent green paper average list sizes should probably be no more than 1750, and lower in areas of high demand and high need. In addition to this, minimum standards could be determined for such measures as facilities available in surgeries, practice records, and accessibility of doctors to ensure that basic services were offered by all general practitioners.
Motility of the pelvic colon: Part III Motility responses in patients with symptoms following amoebic dysentery
Authors: A. M. Connell, M. Gaafer, M. A. Hassanein, M. A. Khayal
Journal: Gut (1964)

EDITORIAL SYNOPSIS Post-dysenteric irritability of the bowel is a well-known clinical entity.This paper is a joint British and Egyptian study of a group of patients with this condition, the work being carried out in Cairo.The motility response of the post-amoebic group to prostigmine was greater than in a control group but the basal motility and the response to the physiological stimuli and to change of posture were the same.
"THE PASSING OF THE PESSARY"
Authors: Lucius E. Burch
Journal: JAMA (1928)

<h3>To the Editor:</h3> —I have read with a great deal of interest the editorial on this subject inThe Journal, April 14. This is an excellent editorial if closely analyzed. The rank and file of the profession, however, will draw the conclusion from the editorial that the pessary is an obsolete instrument and that surgery is the proper treatment for all cases of retrodisplacement. The pessary serves its most useful purpose in uncomplicated cases of retrodisplacements that can be put back in place. In cases of this kind the pessary should be inserted and if the symptoms do not disappear one may arrive at the conclusion that the retrodisplacement is not the cause of the symptoms and under these circumstances an operation will be of no benefit. On the other hand, if the symptoms disappear one may be certain that the retrodisplacement is producing the symptoms present and under these
Hepatocellular carcinoma and hepatitis C in the United States
Authors: Hashem B. El-Serag
Journal: Hepatology (2002)

Chronic infection with hepatitis C virus (HCV) is a major risk factor for development of hepatocellular carcinoma (HCC). In general, HCC develops only after 2 or more decades of HCV infection and the increased risk is restricted largely to patients with cirrhosis or advanced fibrosis. Factors that predispose to HCC among HCV-infected persons include male sex, older age, hepatitis B virus (HBV) coinfection, heavy alcohol intake, and possibly diabetes and a transfusion-related source of HCV infection. Viral factors play a minor role. The likelihood of development of HCC among HCV-infected persons is difficult to determine because of the paucity of adequate long-term cohort studies; the best estimate is 1% to 3% after 30 years. Once cirrhosis is established, however, HCC develops at an annual rate of 1% to 4%. Successful antiviral therapy of patients with HCV-related cirrhosis may reduce the future risk for HCC. The incidence of and mortality caused by all HCC has doubled in the United States over the past 25 years, an increase that has affected all ethnic groups, both sexes, and younger age groups. Given the current prevalence of HCV infection among persons 30 to 50 years of age, the incidence and mortality rates of HCC are likely to double in the United States over the next 10 to 20 years. Future research should focus on improving understanding of the incidence and risk factors for HCC, causes of HCV-related carcinogenesis, means of early detection, and better treatment for HCC.
Substrate Requirements for Angiotensin I Conversion In Vivo and In Vitro
Authors: SUZANNE OPARIL, TERRY KOERNER, GEOFFREY W. TREGEAR, BENJAMIN A. BARNES, EDGAR HABER
Journal: Circulation Research (1973)

The substrate requirements for angiotensin I-converting enzyme were studied in vivo in the dog lung and in vitro in plasma, using angiotensin I (AI), 5- D -Ile-AI, 7- D -Pro-AI, and 8-D-Phe-AI which had been synthesized by the solid-phase technique. All peptides were inactive in the rabbit aortic strip preparation. None of the D-amino acid-substituted peptides gave a pressor response in the anesthetized dog; none showed significant immunologic cross-reactivity with anti-AI serum or antiangiotensin II serum. Each peptide was labeled with 125 I, and the monoiodinated species was isolated. The iodinated peptides were incubated with diluted dog plasma or injected into the right ventricle of intact anesthetized dogs. In vitro, 125 I-AI, 125 I-5-D-IIe-AI, and 125 I-7-D-Pro-AI were converted to angiotensin II (AII). 8-D-Phe-AI was not converted. In vivo, 15 seconds after injecting 125 I-AI, 125 I-5-D-IIe-AI, or 125 I-7-D-Pro-AI into the right ventricle, 125 I-AJI accounted for 70, 60, and 45%, respectively, of the radioactive material in aortic blood. These results and our previous observations on the importance of the C-terminal sequence of AI for conversion indicate that the enzymatic binding sites for AI-converting enzyme in vivo and in vitro extend from position 10 to position 8 but not to position 7. D-amino acid substitution at positions 7 and 5 abolishes biologic and immunologic activity without interfering with conversion.
STUDIES ON AUTONOMIC BLOCKADE. II. OBSERVATIONS ON THE NATURE OF BLOOD PRESSURE FALL WITH HIGH SELECTIVE SPINAL ANESTHESIA IN PREGNANT WOMEN 1
Authors: N. S. Assali, Harry Prystowsky
Journal: Journal of Clinical Investigation (1950)

In the preceding report (p. 1354 of this issue) it was demonstrated that normal pregnant females at term respond with a striking fall in blood pressure to autonomic blockade with high selective spinal anesthesia or TEAC. With the former, severe side effects, such as nausea, vomiting, cyanosis, fatigue and other symptoms of imminent circulatory collapse, were present while with the latter, these symptoms were absent although the hypotensive levels were the same. This suggested to us the necessity for further investigation on the nature of blood pressure fall with high selective spinal anesthesia in pregnant women.
Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children
Authors: Joanne E. Sordillo, Christina V. Scirica, Sheryl L. Rifas-Shiman, Matthew W. Gillman, Supinda Bunyavanich, Carlos A. Camargo, Scott T. Weiss, Diane R. Gold, Augusto A. Litonjua
Journal: Journal of Allergy and Clinical Immunology (2014)
Large-bowel Perforations in Patients Undergoing Sigmoidoscopy and Barium Enema
Authors: J. F. Fielding, K. Lumsden
Journal: BMJ (1973)

Perforation of the large bowel can occur as a complication of sigmoidoscopy, rectal or sigmoid biopsy, and even of a simple cleansing enema. If the perforation is extraperitoneal there may be no early symptoms and consequently there may be delay in diagnosis. The risk of perforation during these procedures is small but it should not be ignored. The performance of a barium enema shortly after a rectal or sigmoid biopsy may slightly increase the risk by converting a partial perforation into a complete one. Precautions can be taken to minimize the hazard.
GAP JUNCTION MODULATION PREVENTS ENDOTHELIAL DYSFUNCTION INDUCED BY ISCHEMIA-REPERFUSION INJURY IN MAN
Authors: Christian M. Pedersen, Ninian Lang, Gareth D. Barnes, Michael R. Schmidt, Hans Erik Botker, Rajesh K. Kharbanda, Nick L. Cruden, David E. Newby
Journal: Journal of the American College of Cardiology (2010)
Patient reactions to long-term outpatient treatment with continuous subcutaneous insulin infusion.
Authors: J C Pickup, H Keen, G C Viberti, R W Bilous
Journal: BMJ (1981)

Fourteen of the first 15 insulin-dependent diabetics to be treated in our unit by three weeks or more of outpatient continuous subcutaneous insulin infusion with a portable syringe pump completed a questionnaire about their reactions to the system. Motivation was more important to a favourable response than occupation or intelligence. Most patients thought that diabetic control was better with the pump than conventional injection treatment and several felt subjectively better. Features such as the greater flexibility of diet and insulin delivery rates during continuous subcutaneous infusion were appreciated. The most consistent adverse criticism was about the size of the device used, nearly all patients thinking that smaller and lighter infusion systems should be developed. Psychological reactions to the infusion and difficulties with interpersonal relationships were identified; these must be clearly appreciated and discussed with patients and family before and during treatment. Nine of the 14 patients said they would undertake continuous subcutaneous infusion for one year and a further two said they would do so if the infuser was smaller. These results provide guidance on future technological development of continuous subcutaneous insulin infusion and indicate that the major constraint to long-term trials of the present system is the size of the pump.
The Institute of Medicine Report, "A Manpower Policy for Primary Health Care": A Commentary from the American College of Physicians
Authors: MALCOLM L. PETERSON
Journal: Annals of Internal Medicine (1980)

In 1978 the Institute of Medicine issued "A Manpower Policy for Health Care," the report of a study of major issues bearing on the availability of an adequate number of physicians for provision of primary care and on potential strategies for an appropriate manpower policy. The report was analyzed by committees of the American College of Physicians, and they prepared a response to the Institute's recommendations that illuminates the position of the College on the fundamental principles of manpower policy. The "Commentary" that sets forth the College position is presented here. Some introductory comments and discussion provide a useful background to the "Commentary" for readers not familiar with these developments.
Endoscopic Treatment of Postoperative Colonic Strictures Using an Achalasia Dilator: Short-Term and Long-Term Results
Authors: C. Virgilio, S. Cosentino, C. Favara, V. Russo, A. Russo
Journal: Endoscopy (1995)

Background and Study Aims: Endoscopic dilation has proven to be a valid therapeutic alternative to surgery for treating postoperative anastomotic colonic strictures. The authors here evaluate retrospectively the short and long-term clinical results obtained in such patients by pneumatic dilation.
THE RELATION OF THE SPLEEN TO BLOOD DESTRUCTION AND REGENERATION AND TO HEMOLYTIC JAUNDICE
Authors: Edward B. Krumbhaar, John H. Musser
Journal: The Journal of Experimental Medicine (1916)

1. Dogs whose splenic veins or portal vein (Eck fistula) have been transplanted into the inferior vena cava, or whose splenic veins have been ligated, show a lessened tendency to jaundice similar to that exhibited by splenectomized animals. 2. Although the previously existing anemia and the concomitant increased resistance of the red cells of these animals are undoubtedly factors in the greater resistance to hemolytic agents, the lessened tendency to jaundice is, in part at least, due to a mechanical factor dependent on the course of the blood supply to the liver. 3. The additional anemia caused in the test animals by hemolytic agents is usually less than in the controls, although the total fall from the original normal may be greater. This applies to the splenectomized as well as the other test animals and is a modification of our former statements in regard to the severity of the anemia in splenectomized dogs. 4. Although the destruction of blood in these animals is less than in the normal controls, the repair of the same takes considerably longer than in the controls. This confirms similar results previously obtained in splenectomized animals. 5. The white cells exhibit much the same changes as they do following the administration of hemolytic agents to splenectomized or normal animals. As these changes are not unlike those following uncomplicated splenectomy or the operations here discussed, they cannot be considered as characteristic of any of the above procedures, but perhaps as an accompaniment of any temporary increased blood destruction. 6. The reaction of test and control animals is substantially the same, whether the jaundice is caused by toluylenediamin or hemolytic immune serum.
Minimising pain during intravenous cannulation
Authors: A. Moore, S. Straube, H. McQuay
Journal: BMJ (2009)

The NF-κB inhibitor IκB-ε is a new member of the IκB protein family, but its functional role in regulating NF-κB-mediated induction of adhesion molecule expression is unknown. In vascular endothelial cells, IκB-ε associates predominantly with the NF-κB subunit Rel A and to a lesser extent with c-Rel, whereas IκB-α and IκB-β associate with Rel A only. Following stimulation with TNF-α, pyrrolidine dithiocarbamate (PDTC), <i>N</i>-acetylcysteine, and dexamethasone prevented IκB kinase-induced IκB-α, but not IκB-β or IκB-ε phosphorylation and degradation. Since the activation of NF-κB is required for the induction of adhesion molecule expression, we examined the role of IκB-ε in the transactivation of promoters from VCAM-1, ICAM-1, and E-selectin. Using reporter gene constructs of adhesion molecule promoters, PDTC inhibited VCAM-1 and E-selectin, but to a lesser extent, ICAM-1 promoter activity. Subcloning of κB <i>cis</i>-acting elements of VCAM-1, E-selectin, and ICAM-1 into a heterologous promoter construct revealed that PDTC inhibited VCAM-1 and E-selectin, but to a lesser extent, ICAM-1 κB promoter activity. By electrophoretic mobility shift assay, NF-κB heterodimers containing c-Rel specifically bind to the κB motif in the ICAM-1, but not VCAM-1 or E-selectin promoter. Indeed, overexpression of c-Rel induced ICAM-1 κB promoter activity to a greater extent than that of E-selectin and overexpression of IκB-ε inhibited ICAM-1 and VCAM-1 promoter activity in endothelial cells. These findings indicate that c-Rel-associated IκB-ε is involved in the induction of ICAM-1 expression.
Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics
Authors: Maria C.E. Rossi, Antonio Nicolucci, Adolfo Arcangeli, Antonino Cimino, Gualtiero De Bigontina, Carlo Giorda, Illidio Meloncelli, Fabio Pellegrini, Umberto Valentini, Giacomo Vespasiani
Journal: Diabetes Care (2008)

OBJECTIVE—To describe patterns of diabetes care and implement benchmarking activities at the national level. RESEARCH DESIGN AND METHODS—A total of 86 clinics participated, all using electronic medical records. Quality indicators were identified, and software was developed, enabling the extraction of the information needed for quality-of-care profiling. RESULTS—Overall, 114,249 patients with type 2 diabetes were seen during 2004. A1C was measured at least once in 88.0% of the patients, lipid profile in 64.6%, blood pressure in 77.2%, and microalbuminuria in 48.1%. Overall, 43.1% of individuals had A1C ≤7.0%, 36.6% had blood pressure ≤130/85 mmHg, and 29.8% had LDL cholesterol &amp;lt;100 mg/dl. Only 5.5% of the patients had achieved all the favorable outcomes. Wide between-center variation was documented for all indicators. CONCLUSIONS—This study is the first step of a nationwide quality-improvement effort and documents the possibility of obtaining standardized information to be used for diabetes care profiling and benchmarking activities.
Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis
Authors: Ronald F van Vollenhoven, Mikkel Østergaard, Marjatta Leirisalo-Repo, Till Uhlig, Marita Jansson, Esbjörn Larsson, Fiona Brock, Karin Franck-Larsson
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The aim of the Dose Reduction or Discontinuation of Etanercept in Methotrexate-Treated Rheumatoid Arthritis Patients Who Have Achieved a Stable Low Disease Activity-State study was to investigate the effect of etanercept (ETN) dose maintenance, reduction or withdrawal on patients with rheumatoid arthritis (RA) who had already achieved stable low disease activity (LDA) on ETN 50 mg+methotrexate (MTX). <h3>Methods</h3> Patients with RA (n=91) and stable LDA with ETN 50 mg once weekly (QW)+MTX were included. After 8 weeks with unchanged treatment, 73 patients were randomised in a double-blind design to ETN 50 mg QW+MTX (ETN50), ETN 25 mg QW+MTX (ETN25) or placebo QW+MTX (PBO) for 48 weeks. Patients who flared were declared failures and treated with open-label ETN50 until week 48. The primary outcome was the proportion of patients on ETN50 versus PBO who were non-failures after 48 weeks. <h3>Results</h3> The proportion of non-failure patients was significantly lower with ETN50 (52%; p=0.007) and ETN25 (44%; p=0.044) versus PBO (13%). Median time to failure was significantly shorter with PBO (6 weeks) compared with ETN50 (48 weeks; p=0.001) and ETN25 (36 weeks; p&lt;0.001). The majority of patients who flared regained LDA with open-label ETN50 quickly. Adverse events were consistent with the known side effect profiles of these medications. <h3>Conclusions</h3> In patients with established RA who have achieved stable LDA on ETN50+MTX, continuing both is superior to PBO+MTX. Reduced dose ETN was also more effective than PBO in maintaining a favourable response, suggesting that a maintenance strategy with reduced dose ETN may be possible in a number of patients with established RA. <h3>Trial registration number</h3> NCT00858780.
Preventing the Last Epidemic
Authors: Howard H. Hiatt
Journal: JAMA (1980)

In a 1980 editorial, Hiatt urged physicians to regard nuclear war as an epidemic for which treatment is lacking and costs unacceptable, and so to direct their efforts at prevention. Here, he expands on that position, describing the disastrous medical consequences to be expected and recommending that the American Medical Association and other medical organizations publicize these medical realities to the leaders and peoples of the world.
TCT-86 The 2011-12 Pilot European Sentinel Registry of Percutaneous Edge-to-Edge Mitral Valve Repair: In-hospital results and mid-term follow up of 587 patients
Authors: Rodrigo Estevez, Georg Nickenig, Stephan Baldus, Magnus Settergren, Carlo Di Mario, Neil Moat, Anna Sonia Petronio, Salvatore Scandura, Klaus Tiroch, Olaf Franzen
Journal: Journal of the American College of Cardiology (2013)