tbuckley/cabot-search huggingface dataset:
'Doing What Is Best for Patients': A Sesquicentennial Rededication
Authors: Marsha F. Goldsmith
Journal: JAMA (1997)

EMPHASIZING professionalism, participants in the conference entitled "Ethics and American Medicine: History, Change, and Challenge" rededicated themselves, in a phrase used by American Medical Association (AMA) President Daniel H. Johnson, MD, in his welcoming address and reiterated throughout the event, to "doing what is best for patients." The symposium, held last month in Philadelphia, Pa, where the association was founded, commemorated the AMA's 1847<i>Code of Ethics</i>and initiated a year-long sesquicentennial celebration. In addition to the AMA, the meeting was also sponsored by the Center for Bioethics at the University of Pennsylvania Medical Center, College of Physicians of Philadelphia, Philadelphia Academy of Natural Sciences, and Philadelphia County Medical Society. As befits such an occasion, looks back to the past afforded new insights to guide the future. What Johnson called "a dream team of medical ethicists" addressed such issues as the relevance for today and tomorrow of the AMA<i>Code</i>
Enhancing Credibility of Chemical Safety Studies: Emerging Consensus on Key Assessment Criteria
Authors: James W. Conrad, Richard A. Becker
Journal: Environmental Health Perspectives (2010)

We examined the extent to which consensus exists on the criteria that should be used for assessing the credibility of a scientific work, regardless of its funding source, and explored how these criteria might be implemented.Three publications, all presented at a session of the 2009 annual meeting of the Society for Risk Analysis, have proposed a range of criteria for evaluating the credibility of scientific studies. At least two other similar sets of criteria have recently been proposed elsewhere.In this article we review these criteria, highlight the commonalities among them, and integrate them into a list of 10 criteria. We also discuss issues inherent in any attempt to implement the criteria systematically.Recommendations by many scientists and policy experts converge on a finite list of criteria for assessing the credibility of a scientific study without regard to funding source. These criteria should be formalized through a consensus process or a governmental initiative that includes discussion and pilot application of a system for reproducibly implementing them. Formal establishment of such a system should enable the debate regarding chemical studies to move beyond funding issues and focus on scientific merit.
The Potential Therapeutic Role of Insulin in Acute Myocardial Infarction in Patients Admitted to Intensive Care and in Those With Unspecified Hyperglycemia
Authors: Paresh Dandona, Ahmad Aljada, Arindam Bandyopadhyay
Journal: Diabetes Care (2003)

While acute myocardial infarction and patients admitted to intensive care units carry a serious risk of mortality and morbidity, the concomitant occurrence of hyperglycemia enhances this risk. This has been established through various studies over the past decade (1–3). More recently, it has been shown that the treatment of these conditions with intravenous infusions of insulin results in marked improvements in clinical outcomes (3–5). While the normalization of blood glucose concentration may be one factor in the improvement of these outcomes, insulin may exert benefits of its own, independently of the plasma glucose concentrations.

Both septicemia and acute myocardial infarction are inflammatory states with markedly enhanced catabolism. There may be hyperglycemia and an increase in plasma free fatty acid (FFA) concentrations in both of these conditions. Increased FFA concentrations are known to be associated with a deterioration of clinical outcomes and may have toxic effects of their own on vascular reactivity and on the myocardium (6–9). FFAs may have effects on endothelial nitric oxide (NO) production (6), prostacyclin production (10), and the stability of prostacyclin in plasma (11). FFAs may also induce a state of insulin resistance through the induction of protein kinase C and inflammation through the suppression of inhibitor κB (IκB) in the skeletal muscle (12). Proinflammatory changes are also induced in the mononuclear cells by FFAs as reflected in an increase in nuclear factor-κB (NF-κB), the major proinflammatory transcription factor, an increase in reactive oxygen species (ROS) generation, and an increase in p47 phox (13). Thus, the normalization of FFA concentrations by insulin may produce a benefit. Similarly, it can be argued that insulin administration may facilitate the uptake of glucose by insulin-responsive organs, including the myocardium, thus providing for their metabolic needs. These mechanisms are based on our understanding of …
Mitral regurgitation: relationship of noninvasive descriptors of right and left ventricular performance to clinical and hemodynamic findings and to prognosis in medically and surgically treated patients.
Authors: C Hochreiter, N Niles, R B Devereux, P Kligfield, J S Borer
Journal: Circulation (1986)

To determine objective predictors of survival, 53 patients with chronic, hemodynamically severe mitral regurgitation underwent rest and exercise radionuclide cineangiography, echocardiography, treadmill exercise testing, and ambulatory electrocardiographic monitoring before prospective (average 30 month) follow-up. At entry, symptom status correlated best with radionuclide-based right ventricular ejection fraction (RVEF) and left atrial size, while treadmill exercise tolerance correlated best with RVEF during exercise (r = .48, p less than .005). Correspondingly, in 23 patients who underwent cardiac catheterization, pulmonary arterial systolic and wedge pressures were significantly inversely related to RVEF. On the 24 hr ambulatory electrocardiogram, nonsustained ventricular tachycardia was present in 29% of patients, most frequently when both RVEF and left ventricular ejection fraction (LVEF) were subnormal (p = .03 vs other patients). Since entry, 35 patients have been managed without surgery for 9 to 57 months (average 28); three of these who subsequently underwent operation also are among the 21 patients who have undergone mitral valve replacement (MVR). During the average 28 months of observation under medical treatment five of 35 nonoperated patients have died; all five were among the six nonoperated patients with RVEFs of 30% or less at entry, a descriptor that significantly identified those at high mortality risk (p less than .0001 vs patients with RVEFs greater than 30%). All five also were among the eight nonoperated patients with LVEFs of 45% or less (lower limit of normal), a descriptor that also significantly predicted mortality. Three of the 21 patients who underwent surgery have died, all late after MVR. Among operated patients, only age was a predictor of postoperative survival. A trend toward improved survival was found in the patients with depressed right or left ventricular ejection fraction who underwent surgery compared with those who did not.
The B-aminopropionitrile-fed turkey: a model for detecting potential drug action on arterial tissue
Authors: C. F SIMPSON, R. J BOUCEK
Journal: Cardiovascular Research (1983)

Broad-breasted white male turkeys develop hypertension, tachycardia and aortic arteriosclerosis spontaneously by approximately 5 weeks of age. When fed B-aminopropionitrile (BAPN), aortic tensile strengths are lowered, and a high percentage of the turkeys die from aortic dissecting aneurysms. There are essentially no deaths from aneurysms when either dl-propranolol or reserpine is fed in concert with BAPN; practolol and soltalol partially protect the BAPN-fed turkey from lethal aneurysms while hydralazine and phenelzine sulphate potentiate mortality from aneurysms. Dl-propranolol decreases and reserpine increases dP/dtmax and both drugs lower arterial pressure and heart rate when fed with BAPN. Such diets also decrease the ultrastructural disarray of collagenous and elastic fibres in the media of the abdominal aorta that occurs from the feeding of BAPN and thereby raise aortic tensile strength. Sotalol and practolol when fed to BAPN-fed turkeys lower blood pressure and dP/dtmax, but neither drug affects aortic tensile strength and both counteract the deleterious effect of BAPN on the ultrastructure of collagenous and elastic fibres to a minor degree. Phenelzine sulphate does not affect arterial pressure while hydralazine reduces arterial pressure; both drugs decrease aortic tensile strength and increase the ultrastructural disruption of aortic elastin and collagen in the BAPN turkey. The results suggest that dl-propranolol, reserpine, phenalzine sulphate, and hydralazine have an action on aortic tissue and indicate the usefulness of the BAPN-fed turkey as a model for identifying potential drug effects on aortic elastin and collagen.
Physiological changes in ageing skin
Authors: D. CERIMELE, L. CELLENO, F. SERRI
Journal: British Journal of Dermatology (1990)

The principal functions of the skin include protection, excretion, secretion, absorption, thermoregulation, pigmentogenesis, accumulation, sensory perception and regulation of immunological processes. These functions are all affected by the structural changes in the skin with ageing and, after middle age, most functions are reduced, some by as much as 50–60%. The physiological changes associated with these reductions include impairment of the barrier function, decreased turnover of epidermal cells, reduced numbers of keratinocytes and fibroblasts, and a reduced vascular network particularly around hair bulbs and glands. These changes result in fibrosis and atrophy, and decreases in hair and nail growth, vitamin D synthesis and the density of Langerhans cells. Production of epidermal thymocyte-activating factor, which enhances the T-cell response, is reduced leading to a decrease in the immune response; there is also a decreased functioning of Meissner's and Pacinian corpuscles. An increased generation of free radicals is observed. Certain environmental factors, particularly exposure to sun, accelerate the ageing of skin and are important in cutaneous carcinogenesis.
PET/CT Imaging of Integrin αvβ3 Expression in Human Carotid Atherosclerosis
Authors: Ambros J. Beer, Jaroslav Pelisek, Peter Heider, Antti Saraste, Christian Reeps, Stephan Metz, Stefan Seidl, Horst Kessler, Hans-Jürgen Wester, Hans Henning Eckstein, Markus Schwaiger
Journal: JACC. Cardiovascular imaging (2014)
Stimulation of glycosaminoglycan synthesis in cultured human dermal fibroblasts by interleukin 1. Induction of hyaluronic acid synthesis by natural and recombinant interleukin 1s and synthetic interleukin 1 beta peptide 163-171.
Authors: A E Postlethwaite, G N Smith, L B Lachman, R O Endres, H M Poppleton, K A Hasty, J M Seyer, A H Kang
Journal: Journal of Clinical Investigation (1989)

Hyaluronic acid (HA) is believed to play a critical role in wound healing and in morphogenesis. Factors controlling the production of HA by fibroblasts in normal and pathological states are not completely understood. In this report we have observed that natural human interleukin (IL-1)1 beta and human recombinant (hrIL)-1 alpha and beta are potent stimulators of HA production by fibroblasts in vitro. Hyaluronic acid is the major species of glycosaminoglycan (GAG) stimulated by IL-1 in fibroblasts. PGE2 does not appear to be involved directly in this IL-1 effect on fibroblasts, but stimulation of HA production by IL-1 is dependent on protein synthesis. The synthetic human IL-1 beta peptide 163-171 (Val-Gln-Gly-Glu-Glu-Ser-Asn-Asp-Lys), which has been previously shown to stimulate thymocyte proliferation but not fibroblast PGE2 production, is also able to stimulate fibroblast HA production. The synthesis and secretion of IL-1 by mononuclear phagocytes at sites of inflammation and immune reactions in vivo could potentially serve as a signal for fibroblasts to synthesize HA, which in turn could serve to facilitate and modulate reparative and immune processes by virtue of its ability to alter cell-cell, cell matrix, and cell-membrane receptor interactions.
The Relationship Between Method of Physician Payment and Patient Trust
Authors: Audiey C. Kao
Journal: JAMA (1998)

Context.—Trust is the cornerstone of the patient-physician relationship. Payment methods that place physicians at financial risk have raised concerns about patients' trust in physicians to act in patients' best interests.Objective.—To evaluate the extent to which methods of physician payment are related to patient trust.Design.—Cross-sectional telephone interview survey done between January and June 1997.Setting.—Health plans of a large national insurer in Atlanta, Ga, the Baltimore, Md–Washington, DC, area, and Orlando, Fla.Participants.—A total of 2086 adult managed care and indemnity patients.Main Outcome Measure.—A 10-item scale (α=.94) assessing patients' trust in physicians.Results.—More fee-for-service (FFS) indemnity patients (94%) completely or mostly trust their physicians to "put their health and well-being above keeping down the health plan's costs" than salary (77%), capitated (83%), or FFS managed care patients (85%) (P&lt;.001 for pairwise comparisons). In multivariate analyses that adjusted for potentially confounding factors, FFS indemnity patients also had higher scores on the 10-item trust scale than salary (P&lt;.001), capitated (P&lt;.001), or FFS managed care patients (P&lt;.01). The effects of payment method on patient trust were reduced when a measure based on patients' reports about physician behavior (eg, Does your physician take enough time to answer your questions?) was included in the regression analyses, but the differences remained statistically significant, except for the comparison between FFS managed care and FFS indemnity patients (P=.08). Patients' perceptions of how their physicians were paid were not independently associated with trust, but the 37.7% who said they did not know how their physicians were paid had higher levels of trust than other patients (P&lt;.01). A total of 30.2% of patients were incorrect about their physicians' method of payment.Conclusions.—Most patients trusted their physicians, but FFS indemnity patients have higher levels of trust than salary, capitated, or FFS managed care patients. Patients' reports of physician behavior accounted for part of the variation in patients' trust in physicians who are paid differently. The impact of payment methods on patient trust may be mediated partly by physician behavior.
Thousands of medical students in "unacceptable" situation after foundation school allocation error
Authors: C. Thomas
Journal: BMJ (2013)

Thousands of final year medical students in the United Kingdom face uncertainty over their foundation programme jobs after an error in the scoring system used to allocate them to foundation schools.

On 26 February applicants to the foundation programme were told of a “potential error” in the marking of the situational judgment test (SJT) that may have affected their job allocation.

The SJT element of the foundation programme application process is a multiple choice examination that requires candidates to rank a set of clinical scenarios. This score, together with an educational performance measure score, is used …
SEBACEOUS GLAND SECRETION IN CIRRHOSIS
Authors: R. S. GREENE, P. E. POCHI, J. S. STRAUSS
Journal: British Journal of Dermatology (1971)

SUMMARY.— Sebum production tests were performed in 10 hospitalized male patients with cirrhosis of the liver. Sebum secretion in these patients did not differ significantly from that of normal subjects. No inverse correlation was evident between sebum levels and the presence or severity of oestrogenic physical signs.
Life-tables for cystic fibrosis.
Authors: L. George, A. P. Norman
Journal: BMJ (1969)

CBICorrspoUnAL dent body in case doctors run the risk of practising " State-controlled medicine."The examples of judiciary and many Government subsidized universities can be cited where interference of the State is not tolerated, and they discharge their function admirably.Lastly, when all is said and done, I see the inevitability of the situation.It is a question of earning one's livelihood.After all those years in medical schools and then in hospital service, the doctor has to practise his or her trade, and it seems there will soon be a day when one practically pays all one earns to loudly announce once again to the whole world, " It is a sacrifice which I promise unto death."-Iam, etc.,
Vasodilator dysfunction in aged spontaneously hypertensive rats: changes in NO synthase III and soluble guanylyl cyclase expression, and in superoxide anion production
Authors: Johann Bauersachs, Anne Bouloumié, Alexander Mülsch, Gabriele Wiemer, Ingrid Fleming, Rudi Busse
Journal: Cardiovascular Research (1998)

Objective/Methods: Genetic hypertension is associated with an apparent endothelial dysfunction and impaired endothelium-dependent vasodilatation in response to increased flow and receptor-dependent agonists. However, the link between impaired vasodilatation and nitric oxide (NO) synthase expression is still unclear. In the present study, dilator responses were determined in the aorta and coronary circulation of 16 month old spontaneously hypertensive (SHR) and Wistar Kyoto rats (WKY). Changes in vascular reactivity were compared with alterations in superoxide anion production as well as endothelial NO synthase (NOS III) and soluble guanylyl cyclase expression. Results: In the isolated perfused heart both the bradykinin- and sodium nitroprusside-induced vasodilator responses were attenuated in SHR compared to WKY. Western blot analysis revealed a parallel reduction in NOS III expression in coronary microvascular endothelial cells from SHR. Superoxide anion production in aortae from SHR was markedly elevated over that of aortae from WKY, and was almost completely abolished by pretreatment with superoxide dismutase. Superoxide dismutase induced similar relaxations in phenylephrine-preconstricted aortic rings from both SHR and WKY, but failed to restore the attenuated acetylcholine- and sodium nitroprusside-induced relaxations in SHR. No difference in NOS III expression was detected in the aortae from either strain whereas soluble guanylyl cyclase expression was markedly decreased in SHR. Conclusions: These results demonstrate that NOS III expression in different tissues is differentially affected by hypertension. Moreover, althoug an elevated superoxide anion production is apparent in the aorta, a reduced soluble guanylyl cyclase expression appears to account for the observed vasodilator dysfunction in SHR.
Localization of Metastatic Adrenal Carcinoma Utilizing 67Ga-Citrate
Authors: K L PARTHASARATHY, SURAJ P. BAKSHI, SHIRISH PARIKH
Journal: Clinical Nuclear Medicine (1978)

Soft tissue metastases from left adrenal cortical carcinoma in a 30-year-old white man were localized on a gallium scintigram six weeks following left adrenalectomy.
Brentuximab vedotin demonstrates objective responses in a phase 2 study of relapsed/refractory DLBCL with variable CD30 expression
Authors: Eric D. Jacobsen, Jeff P. Sharman, Yasuhiro Oki, Ranjana H. Advani, Jane N. Winter, Celeste M. Bello, Gary Spitzer, Maria Corinna Palanca-Wessels, Dana A. Kennedy, Pamela Levine, Jing Yang, Nancy L. Bartlett
Journal: Blood (2015)
Treatment of Orthostatic Hypotension with Dihydroergotamine and Caffeine
Authors: ROBERT D. HOELDTKE
Journal: Annals of Internal Medicine (1986)

Eight patients with orthostatic hypotension were treated with subcutaneous dihydroergotamine. Two doses of the drug (6.5 and 13 µg/kg) or placebo were given in a random sequence at 0600 h, and blood pressures were measured hourly throughout the day with patients in both supine and upright positions. To assess the effect of postprandial hypotension on the therapeutic response to dihydroergotamine, we gave breakfast, lunch, and supper on a fixed schedule at 0900 h, 1200 h, and 1700 h. Dihydroergotamine had a pressor effect in seven of the eight patients during the fasting period (0600 h to 0900 h), but this agent did not counteract the hypotensive effect of eating. Concomitant administration of caffeine (250 mg, 30 minutes before breakfast), however, maintained the beneficial effect of dihydroergotamine during the postprandial period. The combination of subcutaneous dihydroergotamine and caffeine represents a new therapeutic option for patients with severe autonomic neuropathy.
Terminating the Physician-Patient Relationship in Primary Care
Authors: Ralph B. Freidin
Journal: JAMA (1979)

Primary care and family practice training programs stress the importance of establishing and maintaining the physician-patient relationship in providing longitudinal health care. However, the limited duration of these three-year programs builds discontinuity into the relationship. To our knowledge, the process of terminating the physician-patient relationship in primary care practice has not been addressed in the medical literature. We studied eight different patterns of patients' responses to learning of the departure of their primary care physicians. We have developed a set of guidelines for terminating the physician-patient relationship in an ambulatory, primary care setting. (<i>JAMA</i>241:819-822, 1979)
The “Hot Nose” Sign on Brain Death Nuclear Scintigraphy
Authors: Eric A. Appelt, Won S. Song, William T. Phillips, Darlene F. Metter, Umber A. Salman, Ralph Blumhardt
Journal: Clinical Nuclear Medicine (2008)

Nuclear scintigraphy has been used in patients with brain death since the 1970s. Many studies report a "hot nose" sign as predictive of brain death and lack of cerebral flow. Current nuclear medicine textbooks state that increased flow to the nose occurs secondary to occlusion of the internal carotid artery with flow rerouted to the nose via the external carotid artery. This explanation has been provided for decades assuming that the blood flow is actually increased to the nose. We performed a study to determine whether flow is really seen in the nose when a hot nose sign is present.
Why do pharmacists sell homoeopathic remedies?
Authors: Fred Kavalier
Journal: BMJ (2011)

I am a great believer in the ability of the human body to heal itself, and I think it is sensible to stay away from doctors and take as little medicine as possible. This is why I support the homoeopathic practice of not giving any medicine to patients who don’t have much wrong with them. But I like to think that I am more honest than most homoeopaths, so I tell patients that their vague feeling of malaise is likely to sort itself out if they are prepared to wait. Rather than going through the charade of prescribing a few sugar pills to be taken on a clean tongue, it seems simpler to prescribe nothing at all.

But a problem arises when a patient has an illness that won’t get better without treatment. Modern scientific medicine, for all its failings, has a few treatments that really do make a difference.

This came home to me a few years ago when I had a patient who was planning to travel to the Sahara desert to make …