tbuckley/cabot-search huggingface dataset:
Programme budgeting and marginal analysis: bridging the divide between doctors and managers
Authors: Danny Ruta, Craig Mitton, Angela Bate, Cam Donaldson
Journal: BMJ (2005)

Recent NHS reforms give doctors increased responsibility for efficient and fair use of resources. Programme budgeting and marginal analysis is one way to ensure the views of all stakeholders are properly represented 

Tensions between doctors and managers and the differences between medical and managerial cultures have existed since the earliest provision of organised health care.1 In a resource allocation context, doctors are caricatured as taking the role of patient advocate while managers take the corporate, strategic view. Delivery of efficient (and in the case of the NHS, equitable) health care requires doctors to take responsibility for resources and to consider the needs of populations while managers need to become more outcome and patient centred. One economic approach, called programme budgeting and marginal analysis, has the potential to align the goals of doctors and managers and create common ground between them. We describe how the approach works and why it should be more widely used.

Programme budgeting and marginal analysis is an approach to commissioning and redesign of services that can accommodate both medical and managerial cultures and the widest constituency of professional, patient, and public values within a single decision making framework. It allows for the complexities of health care while adhering to the two key economic concepts of opportunity cost and the margin. When having to make choices within limited resources, certain opportunities will be taken up while others must be forgone. The benefits associated with forgone opportunities are opportunity costs. Thus, we need to know the costs and benefits of various healthcare activities, and this is best examined at the margin—that is, the benefit gained from an extra unit of resources or benefit lost from having one unit less. If the marginal benefit per pound spent from programme A is greater than that for B, resources should …
Parental Visiting of Children with Burns
Authors: J. M. Woodward
Journal: BMJ (1962)

MEDICAL JOURNALwas carried out with end-to-end anastomosis of the bowel.After 18 months' follow-up the patient was well.The decision to advise resection in our patient was made after considerable hesitation, particularly in view of the result in Hale and Schatzki's (1944) case, where the obstruction persisted.We thought that the reason for this was that anastomosis of the normal ileum to the abnormal duodenum resulted in a functional block to peristalsis.For this reason, in our case the ileum was anastomosed to the stomach, the duodenum being implanted end-to-side into the ileum.We are not suggesting that we have in any way cured this patient, but that surgery has afforded relief of a serious complication which gives rise to gross disability that would probably have resulted in very early death.ADDENDUM.-Thepatient remained in good health until about July, 1962, when she deteriorated, dying suddenly at the end of that month.Sumnmary A case is reported of progressive systemic sclerosis presenting as malabsorption and subacute obstruction, surgical relief being given by resection of the affected segment of small intestine.The relevant literature is reviewed.A plea is made for the term " progressive systemic sclerosis" in preference to "scleroderma " on the grounds that the latter may act as a diagnostic barrier.We are grateful to Dr. Kenneth Robertson, who first suggested the correct diagnosis in this case, and who referred the patient to StlThomas's Hospital; and to Dr. Brian Creamer, under whose care the patient was admitted, for his advice and encouragement.
A NOTE ON THE ETIOLOGY OF GRANULOMA PUDENDI
Authors: K. S. Wise
Journal: BMJ (1906)

I96infection by the Diplococcus pneumoniae rather than by other forms of organism.As might be expected, the treatment by antistreptococcic serum was without any appreciable result on the course of the illness.Though the temperature fell slightly after the injections, tlle pulse and respirations were not affected.The identification of the Diplococcus pneumoniae was only completed by the result of the inoculation experiments, and so came too late to modify the vigorous antistreptococcic treatment pursued.
Advances in Migraine Research and Therapy
Authors: Charles M. Poser
Journal: JAMA (1983)

For the past several years, Clifford Rose has edited a series of remarkable volumes dealing with a variety of topics all characterized by the astute selection of authors and the high quality of contents. If the term<i>smorgasbord</i>evokes visions of tempting and tasteful morsels, it is indeed laudatory, and it is in this vein that it applies to this volume. The chapters are all extremely brief, yet concise and to the point. They contain an unusually large number of clinical pearls, which will prove of great value to the harassed clinician struggling with mankind's most common complaint. So many of the chapters deserve special mention that only a few can be listed: the proposed new classification; the excellent analysis of features of muscle contraction and migraine headaches by Ziegler and Hassanein supporting the idea, already known to many neurologists, that the dichotomy between these two types of headaches is
364 HBsAg SERUM LEVELS ARE ASSOCIATED WITH THE PHASE OF HBV-INFECTION
Authors: J. Jaroszewicz, B. Calle Serrano, K. Deterding, K. Wursthorn, R. Raupach, M.P. Manns, R. Flisiak, H. Wedemeyer, M. Cornberg
Journal: Journal of Hepatology (2009)
HIV enteropathy: comparative morphometry of the jejunal mucosa of HIV infected patients resident in the United Kingdom and Uganda
Authors: P A Batman, M S Kapembwa, A R O Miller, P M Sedgwick, S Lucas, N K Sewankambo, D Serwadda, J Pudney, A Moody, J R W Harris, G E Griffin
Journal: Gut (1998)

Aims —To compare jejunal mucosal morphometry in HIV infected patients resident in London and Uganda. Patients —Twenty HIV positive patients from London and 16 from Uganda were studied, and compared with HIV negative control subjects from both sites. Methods —Stools and biopsy specimens were examined for enteropathogens. Surface area to volume (S:V) ratio was estimated morphometrically, mean crypt length of jejunal biopsy specimens was measured, and HIV infected cells detected immunohistochemically were quantified. Results —Enteric pathogens were detected in none of the London patients, and in three Ugandan patients. S:V ratio was lower, and mean crypt length higher, in the specimens of London patients than in normal subjects, but there was no difference in S:V ratio or mean crypt length between Ugandan patients and controls. A negative correlation was present between S:V ratio and mean crypt length in all biopsy specimens analysed. HIV infected cells were detected only in lamina propria. Conclusion —Infection of cells in the lamina propria of the jejunum with HIV stimulates crypt cell proliferation, and a fall in villous surface area. The mucosal response to HIV is masked by other pathogens in the African environment.
THE CONTRIBUTION OF EXPERIMENTAL TO HUMAN POLIOMYELITIS
Authors: SIMON FLEXNER
Journal: JAMA (1910)

Epidemic poliomyelitis has within three years become a common and widely distributed disease in the United States. Prior to 1907 the epidemic disease occurred rarely, only, in this country. Since 1907 it has prevailed from the Atlantic to the Pacific Ocean, and probably few states have entirely escaped its ravages. Judging from the fragmentary reports which have come to my attention it would seem as though the southern states had escaped wholly or in large part, but this apparent discrepancy may result from failure either to recognize the nature of the epidemic disease or to report on it, or may be due simply to the circumstance that the fact of its occurrence in the South has not chanced to come to my attention. It is significant in respect to this point that within the period mentioned epidemic poliomyelitis has prevailed in Cuba. Before 1907 epidemic poliomyelitis had been becoming more
Evaluation of Left Ventricular Contractile State in Childhood
Authors: THOMAS P. GRAHAM, JAY M. JARMAKANI, RAMON V. CANENT, PAGE A. W. ANDERSON
Journal: Circulation (1971)

Left ventricular contractile state was evaluated in 20 children ages 3 to 11 years with normal left hearts and in 15 children ages 2 to 16 years with a left ventricular pressure overload. All patients were studied during diagnostic cardiac catheterization with catheter-tip micromanometry. Pressure-velocity curves were obtained during isovolumic systole by plotting (dp/dt)/28 P versus developed or total pressure (P). Computer analysis of five cardiac cycles was used to yield one composite pressure-velocity curve for each patient with both linear and second-degree polynomial curve analysis. The developed pressure method yielded higher values for the calculated V max index, (dp/dt)/28 P at zero P than the total-pressure method for all patients. Normal standards were defined for both methods. The V max index calculated with total pressure as well as peak (dp/dt)/28 P was significantly less than normal for the hypertrophy group. The V max index calculated with developed pressure was not significantly different from normal for the entire hypertrophy group, but four of the 15 patients showed a depression of contractile state defined as a value for the V max index less than 2 sd of normal. These results indicate the potential importance of preoperative and postoperative estimation of contractile state in patients with a left ventricular pressure overload in evaluation of possible irreversible alterations of contractility that may accompany myocardial hypertrophy.
Serum interleukin 18 and interleukin 18 binding protein in rheumatoid arthritis
Authors: B Bresnihan
Journal: Annals of the Rheumatic Diseases (2002)

To measure serum interleukin 18 (IL18) and IL18 binding protein (IL18BP) levels in patients with inflammatory arthropathies, and to identify associations with disease status and the response to treatment.Serum samples were obtained before and after methotrexate treatment from patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) attending an early arthritis clinic. IL18 and IL18BP were measured by enzyme linked immunosorbent assay (ELISA).Sixty patients with RA and 13 with PsA were evaluated. Serum IL18 levels were significantly higher in RA than in PsA (p<0.001). After six months' treatment with methotrexate, IL18 levels were reduced, but the differences were not significant (p=0.052). In cross sectional analyses, no correlations between IL18 levels and measures of disease activity or structural damage in RA were found. In longitudinal analyses, no correlations between IL18 levels and the response to treatment or the degree of progressive joint damage were found. Similarly, IL18BP levels were raised in RA, and were not associated with measures of the clinical status or the response to treatment.Raised serum levels of IL18 are consistent with a pathophysiological role in RA. However, in this study measurement of circulating IL18 and IL18BP did not correlate significantly with clinical measures of disease activity or the response to treatment in patients with early RA.
Life-Threatening Childhood Obesity and Legal Intervention
Authors: Robert M. Siegel
Journal: JAMA (2011)

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
Consent for research in hyperacute stroke
Authors: Lynne Stobbart, Madeleine J Murtagh, Stephen J Louw, Gary A Ford, Helen Rodgers
Journal: BMJ (2006)

Essential studies in the first six hours are hampered by rules on consent 

S troke accounts for 11% of deaths in England and Wales each year.1 Without improvements in strategies for prevention or treatment in an increasingly ageing society the incidence of vascular events, particularly stroke, will increase by 33% by 2020.2 Yet, according to the National Audit Office, “An emergency response to stroke with efficient and effective acute care is generally lacking.”1

Increased research capacity will be essential to developing such a response, and the recently established Stroke Research Network aims to develop this capacity to improve prevention, treatment, and rehabilitation in stroke. But recent European legislation may curtail participation by patients with stroke in such clinical trials.

The Medicines for Human Use (Clinical Trials) Regulations 20043 implement the European Union Clinical Trials Directive (2001/20/EC),4 potentially restricting research with incapacitated adults. A considerable proportion of patients with stroke are unable to give informed consent owing to their neurological impairment. Most interventions in acute stroke have short therapeutic time windows, hence the maxim “Time is …
EFFECTS OF MECHANICAL AGITATION AND OF TEMPERATURE UPON COMPLEMENT
Authors: Hideyo Noguchi, J. Bronfenbrenner
Journal: The Journal of Experimental Medicine (1911)

1. Under certain conditions, mechanical agitation destroys the complementary activity of guinea pig serum. It is most injurious when carried out constantly at a temperature of 37 degrees C., but it is extremely insignificant at 10 degrees C. After the first few hours at 37 degrees C., the destruction of complement proceeded much more rapidly, and after six hours it was almost complete. On the other hand, within one hour shaking had almost no destructive effect on complement, even at 37 degrees C. From this we may conclude that the several shakings which are necessary for fixation experiments during incubation do not modify perceptibly the outcome of the reactions. 2. The rate of destruction of the complement of guinea pig serum at temperatures above 45 degrees C. is progressively greater as it approaches 55 degrees C., at which temperature the activity is reduced in thirty minutes to one-thirtieth to one-fortieth of the original strength of the unheated serum; but it is not completely destroyed, as is commonly assumed. The velocity of destruction of guinea pig complement when exposed to 55 degrees C. for various lengths of time is found to be quite irregular, and not proportional to the length of time. This irregularity, however, presents a certain rhythm, a period of greater destruction alternating with one of less destruction.
A REPORT OF TEN SELECTED CASES OF LAPAROTOMY, WITH REMARKS.Read in the Section of Obstetrics and Diseases of Women, at the Forty-second Annual Meeting of the American Medical Association, held at Washington, D. C., May, 1891.
Authors: JNO. H. McINTYRE
Journal: JAMA (1891)

The following brief report of laparotomies is made in the hope that its variety may not be wholly devoid of interest: <i>Case 1</i>.—Mrs. D., æt. 38, presented herself at my office in the early part of April of last year, suffering considerable pain and inconvenience from a rapidly growing tumor in the abdomen, situated immediately to the right of the umbilicus. The growth was somewhat movable, and the size of a fœtal head. She presented an anxious expression, suffered from insomnia, and was rapidly losing flesh. A short time previous to this interview, a council of several gentlemen had decided that her trouble was floating kidney, and had advised, and she had submitted to, tight bandaging with compresses, to keep the supposed floating kidney in place; this was worn for several days, until she rebelled on account of the pain which it occasioned. As at that time there was no
Colombia is confused over legalisation of euthanasia
Authors: A. D Ogilvie
Journal: BMJ (1997)

Last month Colombia became only the second country in the world, and the first in the Americas, to legalise euthanasia. Even as the law was passed, however, there was confusion about its constitutionality.

In late May a majority ruling by Colombia's highest court legalised euthanasia when a “patient who suffers from a terminal disease authorises such a clinical procedure, in full use of his mental …
Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding
Authors: Andrew Holmes, Paul J Fitzgerald, Kathryn P MacPherson, Lauren DeBrouse, Giovanni Colacicco, Shaun M Flynn, Sophie Masneuf, Kristen E Pleil, Chia Li, Catherine A Marcinkiewcz, Thomas L Kash, Ozge Gunduz-Cinar, Marguerite Camp
Journal: Nature Neuroscience (2012)
Frequency and Effect of Adjuvant Radiation Therapy Among Women With Stage I Endometrial Adenocarcinoma
Authors: Christopher M. Lee
Journal: JAMA (2006)

The benefit of adjuvant radiation therapy (RT) in stage I endometrial adenocarcinoma remains controversial despite several phase 3 trials.To evaluate the frequency and effect of adjuvant RT on overall and relative survival within a large US population database.A retrospective analysis that used data from the Surveillance, Epidemiology, and End Results program of the US National Cancer Institute from January 1, 1988, to December 31, 2001. A total of 21,249 patients with American Joint Committee on Cancer stage IA-C node-negative endometrial adenocarcinoma comprised the study population.Overall survival curves were constructed using Kaplan-Meier method and compared via stratified log-rank test within T stage/grade combinations, adjusted for age. Relative survival was performed to assess the effects of age, race, stage, grade, whether nodes were examined, and whether adjuvant RT was administered.Of 21,249 women, 4080 received adjuvant RT (19.2%) and 17,169 did not receive adjuvant RT (80.8%). The mean age at diagnosis was 63.2 years (range, 14-99 years). Adjuvant RT significantly improved overall survival for patients with stage IC/grade 1 (P<.001) and stage IC/grades 3 and 4 (P<.001). Cox proportional hazards regression analysis revealed a statistically detectable association of adjuvant RT with improved relative survival in patients with stage IC/grade 1 and stage IC/grades 3 and 4 (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.31-0.63; P<.001; and HR, 0.72; 95% CI, 0.57-0.92; P = .009; respectively). A separate analysis of those patients with a surgical lymph node examination at the time of total abdominal hysterectomy and bilateral salpingo-oophorectomy revealed similar estimates (HR, 0.59; 95% CI, 0.39-0.90; P = .01; and HR, 0.73; 95% CI, 0.55-0.96; P = .02; respectively).As the largest reported population analysis to date of adjuvant RT in early stage endometrial adenocarcinoma, our study reveals a statistically significant association between improved overall and relative survival and adjuvant RT in stage IC disease (grades 1 and 3-4). Future work is needed to continue to delineate clinical and biological factors, which can guide treatment decisions and account for disparities in outcome between varied subsets of patients.
Impact of digestive and oropharyngeal decontamination on the intestinal microbiota in ICU patients
Authors: Robin F. Benus, Hermie J. Harmsen, Gjalt W. Welling, Rob Spanjersberg, Jan G. Zijlstra, John E. Degener, Tjip S. van der Werf
Journal: Intensive Care Medicine (2010)

Selective digestive microbial decontamination (SDD) is hypothesized to benefit patients in intensive care (ICU) by suppressing Gram-negative potential pathogens from the colon without affecting the anaerobic intestinal microbiota. The purpose of this study was to provide more insight to the effects of digestive tract and oropharyngeal decontamination on the intestinal microbiota by means of a prospective clinical trial in which faecal samples were collected from ICU patients for intestinal microbiota analysis. The faecal samples were collected from ICU patients enrolled in a multicentre trial to study the outcome of SDD and selective oral decontamination (SOD) in comparison with standard care (SC). Fluorescent in situ hybridization (FISH) was used to analyze the faecal microbiota. The numbers of bacteria from different bacterial groups were compared between the three regimens. The total counts of bacteria per gram faeces did not differ between regimens. The F. prausnitzii group of bacteria, representing an important group among intestinal microbiota, was significantly reduced in the SDD regimen compared to the SC and SOD. The Enterobacteriaceae were significantly suppressed during SDD compared to both SOD and SC; enterococci increased in SDD compared to both other regimens. The composition of the intestinal microbiota is importantly affected by SDD. The F. prausnitzii group was significantly suppressed during SDD. This group of microbiota is a predominant producer of butyrate, the main energy source for colonocytes. Reduction of this microbiota is an important trade-off while reducing gram-negative bacteria by SDD.
[621] THE USE OF GROWTH FACTORS (GF) IN THE RE-TREATMENT OF PATIENTS WITH CHRONIC HEPATITIS C (CHC) WHO ARE PREVIOUS NON RESPONDERS (NR) TO COMBINATION THERAPY
Authors: F. Nader, C. Bai, K. Terra, C. Gurung, M. Srishord, Y. Fang, R. Collantes, S. Makay, J.P. Ong, R. Sjogren, Z.M. Younossi
Journal: Journal of Hepatology (2007)
Lacunar infarcts in polycythaemia with raised packed cell volumes.
Authors: J M Pearce, C P Chandrasekera, E J Ladusans
Journal: BMJ (1983)

Lacunar (small deep cerebral infarcts) infarction is described in association with raised packed cell volumes. Two patients had polycythaemia vera, one stress polycythaemia. They presented with transient ischaemic episodes and were shown by computed tomography to have lacunes deep in the basal ganglia and internal capsule. Such lesions may be caused by small vessel occlusions related to increased viscosity and impaired oxygen consumption by adjacent tissues. Finding a raised packed cell volume in patients with lacunes and transient ischaemic attacks offers a further possibility of treatment.