tbuckley/cabot-search huggingface dataset:
The Creation of Time to Heal
Authors: Kenneth M. Ludmerer
Journal: Annals of Internal Medicine (2000)

Medical Writings5 September 2000The Creation of Time to HealKenneth M. Ludmerer, MDKenneth M. Ludmerer, MDFrom Washington University, St. Louis, MO 63110Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-5-200009050-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In November 1999, Oxford University Press published my book Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care(1). The purpose of this book is twofold. First, it provides a comprehensive account of the evolution of medical education, medical schools, and teaching hospitals in the United States from the turn of the 20th century to the present, and second, it describes the negative impact of the marketplace on the way in which physicians learn and practice medicine in the era of managed care. The overarching thesis is that academic health centers are ...References1. Ludmerer KM. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford Univ Pr; 1999. Google Scholar2. Rosenberg CE. The Care of Strangers: The Rise of America's Hospital System. New York: Basic Books; 1987. Google Scholar3. Fox DM. Health Policies, Health Politics: The British and American Experience, 1911-1965. Princeton, NJ: Princeton Univ Pr; 1986. Google Scholar4. Fox DM. Power and Illness: The Failure and Future of American Health Policy. Berkeley, CA: Univ of California Pr; 1993. Google Scholar5. Stevens R. American Medicine and the Public Interest. New Haven, CT: Yale Univ Pr; 1971. Google Scholar6. Stevens R. In Sickness and in Wealth: American Hospitals in the Twentieth Century. New York: Basic Books; 1989. Google Scholar7. Ludmerer KM. Learning to Heal: The Development of American Medical Education. New York: Basic Books; 1985. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University, St. Louis, MO 63110Grant Support: In part by the Charles E. Culpeper Foundation.Corresponding Author: Kenneth M. Ludmerer, MD, Washington University, Department of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110; e-mail, [email protected]wustl.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byInfusing the Interdisciplinary into Medical/ Health Sciences Education: Vitamins or Vaccines?Spirituality and Medicine: A Proposal 5 September 2000Volume 133, Issue 5Page: 396-399KeywordsAnxietyForecastingGraduate medical educationHealth careHistory of medicineMedical educationPatientsPrevention, policy, and public healthScientistsVision ePublished: 5 September 2000 Issue Published: 5 September 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Curriculum Change in the 1980s
Authors: Terrence T. Kuske
Journal: JAMA (1985)

Forty southern medical schools were surveyed to evaluate the nature and mechanisms of curricular change during 1980 to 1983. Ninety percent of schools experienced change in some aspect of curriculum. Faculty, curriculum committees, the dean, and external forces were stimuli for change. Internal self-review or self-criticism seemed to be the most important reasons for change. Proposals were considered by curriculum committees and the dean, but veto power often rested with the dean, although departmental chairmen and faculty occasionally had veto power. Types of change were divided equally between content, timing of courses, and the educational process. Half the schools stated that they had evaluated the changes or planned to do so. Thirteen of 38 changes in curriculum were in the direction of curricular innovations of the 1960s and 1970s and 25 were in the opposite direction. (<i>JAMA</i>1985;254:2783-2786)
THE PROGNOSIS AND TREATMENT OF CROUPOUS PNEUMONIA: WITH AN ANALYSIS OF THE CASES TREATED IN COOK COUNTY HOSPITAL FOR FIFTEEN MONTHS PRECEDING APRIL 1, 1902.
Authors: E. FLETCHER INGALS
Journal: JAMA (1902)

There is a prevalent belief that the course of pneumonia is not very greatly influenced by treatment, yet there are few general practitioners who would be willing to admit that they could do nothing to shorten the attacks of this disease or to improve the chances for recovery of those affected by it. Nevertheless, the fact that the disease is self-limited, and that among large numbers treated in hospitals those who have received little or no treatment appear to have done about as well as those who have received much seems to justify the belief. However, I may say in the beginning, that I do not belong to the pessimistic class who believe that nothing can be done to improve the condition of these patients. In most diseases, but especially in those of a self-limited character, the tendency is to recovery, and if the patient's powers of resistance are sufficient
Financial Incentive–Based Approaches for Weight Loss
Authors: Kevin G. Volpp, Leslie K. John, Andrea B. Troxel, Laurie Norton, Jennifer Fassbender, George Loewenstein
Journal: JAMA (2008)

<h3>Context</h3>Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity.<h3>Objective</h3>To determine whether common decision errors identified by behavioral economists such as prospect theory, loss aversion, and regret could be used to design an effective weight loss intervention.<h3>Design, Setting, and Participants</h3>Fifty-seven healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008.<h3>Main Outcome Measures</h3>Weight loss after 16 weeks.<h3>Results</h3>The incentive groups lost significantly more weight than the control group (mean, 3.9 lb). Compared with the control group, the lottery group lost a mean of 13.1 lb (95% confidence interval [CI] of the difference in means, 1.95-16.40; P=.02) and the deposit contract group lost a mean of 14.0 lb (95% CI of the difference in means, 3.69-16.43; P =.006). About half of those in both incentive groups met the 16-lb target weight loss: 47.4% (95% CI, 24.5%-71.1%) in the deposit contract group and 52.6% (95% CI, 28.9%-75.6%) in the lottery group, whereas 10.5% (95% CI, 1.3%- 33.1%; P = .01) in the control group met the 16-lb target. Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups (9.2 lb; t = 1.21; 95% CI, −3.20 to 12.66; P = .23, in the lottery group and 6.2 lb; t = 0.52; 95% CI, −5.17 to 8.75; P = .61 in the deposit contract group) than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start (P = .01 for the lottery group; P = .03 for the deposit contract group) whereas controls did not.<h3>Conclusions</h3>The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained. The longer-term use of incentives should be evaluated.<h3>Trial Registration</h3>clinicaltrials.gov Identifier: NCT00520611
The microenvironment in hepatocyte regeneration and function in rats with advanced cirrhosis
Authors: Liping Liu, Govardhana Rao Yannam, Taichiro Nishikawa, Toshiyuki Yamamoto, Hesham Basma, Ryotaro Ito, Masaki Nagaya, Joyeeta Dutta-Moscato, Donna B. Stolz, Fenghai Duan, Klaus H. Kaestner, Yoram Vodovotz, Alejandro Soto-Gutierrez, Ira J. Fox
Journal: Hepatology (2011)

In advanced cirrhosis, impaired function is caused by intrinsic damage to the native liver cells and from the abnormal microenvironment in which the cells reside. The extent to which each plays a role in liver failure and regeneration is unknown. To examine this issue, hepatocytes from cirrhotic and age-matched control rats were isolated, characterized, and transplanted into the livers of noncirrhotic hosts whose livers permit extensive repopulation with donor cells. Primary hepatocytes derived from livers with advanced cirrhosis and compensated function maintained metabolic activity and the ability to secrete liver-specific proteins, whereas hepatocytes derived from cirrhotic livers with decompensated function failed to maintain metabolic or secretory activity. Telomere studies and transcriptomic analysis of hepatocytes recovered from progressively worsening cirrhotic livers suggest that hepatocytes from irreversibly failing livers show signs of replicative senescence and express genes that simultaneously drive both proliferation and apoptosis, with a later effect on metabolism, all under the control of a central cluster of regulatory genes, including nuclear factor κB and hepatocyte nuclear factor 4α. Cells from cirrhotic and control livers engrafted equally well, but those from animals with cirrhosis and failing livers showed little initial evidence of proliferative capacity or function. Both, however, recovered more than 2 months after transplantation, indicating that either mature hepatocytes or a subpopulation of adult stem cells are capable of full recovery in severe cirrhosis. Transplantation studies indicate that the state of the host microenvironment is critical to the regenerative potential of hepatocytes, and that a change in the extracellular matrix can lead to regeneration and restoration of function by cells derived from livers with end-stage organ failure.
Increasing incidence and mortality from myocardial infarction in Stockholm county.
Authors: L Alfredsson, A Ahlbom
Journal: BMJ (1983)

A study was undertaken to examine trends in the incidence and mortality of myocardial infarction in Sweden. All cases (n = 19908) of myocardial infarction diagnosed in the population of Stockholm county during 1974-80 were identified by means of the cause of death register and the inpatient care register. Information on patients at risk was obtained from the civil registration system. The relative risk of developing, or dying of, myocardial infarction in one specific year, compared with the average for the whole period, was taken as the basis for describing the trends. For men in Stockholm the incidence as well as the mortality was appreciably increased; the annual increase in incidence was 3% and in mortality 4%. There were no signs of decreasing lethality. For women there was an appreciable increase in incidence; for mortality the result was less specific but was compatible with an increase. The observed increases in incidence and mortality appeared to be real and were probably not due to an increasing tendency for patients to seek hospital treatment or for doctors to make the diagnosis. The reason for the increase is unknown.
Emetine in Appendicular Abscess
Authors: N. N. Iovetz-Tereshchenko
Journal: BMJ (1964)

MEDIALSOURNAL 759over the swelling was incised and a sac con- taining altered blood was found, but with no connexion between the sac and the femoral artery.The sac was dissected out and excised.I had the privilege of seeing this operation as I was anaesthetizing the patient.On micro- scopy of the contents the typical layers of a thrombus were apparent.The patient made an uneventful recovery.It must be apparent to all concerned with large series of angiogram studies that perivascular leakage though small must be rela- tively commonplace.How then can one sup- port large-scale routine arterial puncture as being without hazard ?I am most grateful for the advice and valuable help given to me
Unusual rhombencephalitis in relapsing polychondritis.
Authors: J B Wasserfallen, M D Schaller
Journal: Annals of the Rheumatic Diseases (1992)

Unusual rhombencephalitis in relapsing polychondritisSir: Relapsing polychondritis is a rare disorder, resulting from chronic immunologically mediated inflammation of various cartilaginous structures.The nervous system is affected by a broad range of dysfunctions,2 as well as idiopathic cerebral spinal pleocytosis,-4 often unresponsive to immunosuppressive treat- ment.4
Room for improvement
Authors: D. Spence
Journal: BMJ (2008)

I am a trained medical educationist, having jumped through the hoops of countless educational events over the past decade. These are nursery school affairs, full of team building exercises, dressing up for imaginary roleplay, and musical movement. Normally I try to find a tree to hide in, away from the mayhem, but eventually they round us all up for healthy snacks and juice. Then it’s circle time, devoted to the tedium of adult learning theory or the latest …
Agreement between written and video questions for comparing asthma symptoms in ISAAC
Authors: J. Crane, J. Mallol, R. Beasley, A. Stewart, M.I. Asher
Journal: European Respiratory Journal (2003)

Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC) has reported the prevalence of asthma, rhinitis and eczema symptoms in children. In 99 centres from 40 countries, a total of just under 317,000 13–14-yr-old children also completed a video questionnaire, showing the symptoms and signs of asthma. This first video sequence has been compared to the ISAAC written question asking about current wheezing to explore variations in agreement and the contribution of each questionnaire to wheezing prevalence between centres, by region and language groups. In general, responses to the video questionnaire gave a lower prevalence than the written questionnaire and responses were closely correlated. The overall proportion of agreement was high, mean 0.89, but unbalanced, with good negative agreement but poor positive agreement. Chance corrected agreement using Cohen's kappa coefficient, was generally low, with only 20 centres with kappa &gt;0.4. The contribution of each questionnaire to wheezing prevalence also varied between centres and suggests that written questions about wheezing are variably understood and interpreted by 13–14 yr olds. International comparisons of wheezing and its audiovisual presentation suggest that adolescents interpret a written question about wheezing differently from its audiovisual presentation and that this interpretation shows variation between centres. This relationship and the interpretation of both written and audiovisual presentation of symptoms requires further study in order to better predict asthma.
The house dust mite protease allergen Der p 1 induced IL-8 production in human airway epithelial cells through activation of ERK1/2 mitogen-activated protein kinase and AP-1 signaling pathways*1
Authors: Emmanuelle Adam, Ludivine Coulon, Erika Jaumotte, Xavier Duhant, Morley D Hollenberg, Alain Jacquet
Journal: Journal of Allergy and Clinical Immunology (2004)
Textbook of Anxiety Disorders
Authors: Frans G. Zitman
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
The nucleotide transporter MRP4 (ABCC4) is highly expressed in human platelets and present in dense granules, indicating a role in mediator storage
Authors: Gabriele Jedlitschky, Konstanze Tirschmann, Lena E. Lubenow, Hendrik K. Nieuwenhuis, Jan W. N. Akkerman, Andreas Greinacher, Heyo K. Kroemer
Journal: Blood (2004)
Absence of Integrin αvβ3 Enhances Vascular Leak in Mice by Inhibiting Endothelial Cortical Actin Formation
Authors: George Su, Amha Atakilit, John T. Li, Nanyan Wu, Mallar Bhattacharya, Jieling Zhu, Jennifer E. Shieh, Elizabeth Li, Robert Chen, Stephen Sun, Cynthia P. Su, Dean Sheppard
Journal: American Journal of Respiratory and Critical Care Medicine (2011)

Sepsis and acute lung injury (ALI) have devastatingly high mortality rates. Both are associated with increased vascular leak, a process regulated by complex molecular mechanisms.We hypothesized that integrin αvβ3 could be an important determinant of vascular leak and endothelial permeability in sepsis and ALI.β3 subunit knockout mice were tested for lung vascular leak after endotracheal LPS, and systemic vascular leak and mortality after intraperitoneal LPS and cecal ligation and puncture. Possible contributory effects of β3 deficiency in platelets and other hematopoietic cells were excluded by bone marrow reconstitution experiments. Endothelial cells treated with αvβ3 antibodies were evaluated for sphingosine-1 phosphate (S1P)–mediated alterations in barrier function, cytoskeletal arrangement, and integrin localization.β3 knockout mice had increased vascular leak and pulmonary edema formation after endotracheal LPS, and increased vascular leak and mortality after intraperitoneal LPS and cecal ligation and puncture. In endothelial cells, αvβ3 antibodies inhibited barrier-enhancing and cortical actin responses to S1P. Furthermore, S1P induced translocation of αvβ3 from discrete focal adhesions to cortically distributed sites through Gi- and Rac1-mediated pathways. Cortical αvβ3 localization after S1P was decreased by αvβ3 antibodies, suggesting that ligation of the αvβ3 with its extracellular matrix ligands is required to stabilize cortical αvβ3 focal adhesions.Our studies identify a novel mechanism by which αvβ3 mitigates increased vascular leak, a pathophysiologic function central to sepsis and ALI. These studies suggest that drugs designed to block αvβ3 may have the unexpected side effect of intensifying sepsis- and ALI-associated vascular endothelial leak.
SURGEONS-DON'T FORGET TO CALIBRATE! FINDINGS FROM A SACRAL NERVE TEST STIMULATOR
Authors: K Etherson, A Davidson, Y Yiannakou, J Mason
Journal: Gut (2013)

Introduction Sacral nerve stimulation testing (TSNS) for chronic constipation is not accurately predictive of a long-term response1. The decision to implant a permanent device relies on these results. Aims/Background We recognised that the testing stimulator was an analogue device with potentially inaccurate dial settings. We sought verification of the output waveform. Method 19 test stimulators were connected to a cross-calibrated oscilloscope. The output Frequency (f), and Pulse Width (pw) of the waveforms generated were measured according to: run 1) the physician's best attempt to set the dials correctly (pw=210 µ Sec, f=14 Hz), and run 2) the closest dial increment to these settings (pw=200 µ Sec, f=10 Hz). Output Voltage (V) was measured in run 3 at dial increments of 0V, 1V, 2V, 5V, and 10V. Results We assumed an acceptable margin of error of 20% in runs 1 and 2, and 0.5V in run 3. There was a marked range of frequency values; run 1) 10.6 to 29.0 Hz (26% failed), and run 2) 7.9 to 13.0 Hz (11% failed). Findings for pulse width were similarly variable; run 1) 242 to 326 µ Sec (89% failed), and run 2)215 to 274 µ Sec (63% failed). All devices had a residual positive voltage at zero(range:0.29 to 1.00V), and the failure rates at 0,1,2,5 and 10V were 53%, 100%, 100%, 68% and 47% respectively. Conclusion All fields of clinical practice and research have their instrumentation which requires calibration to provide verifiable readings. Failure to calibrate during TSNS results in patients receiving variable stimulation, potentially reducing the clarity of research findings, and may be a factor in the poor predictive power of testing in chronic constipation.
NICE recommends that the food industry cut salt, sugar, and fat to save lives
Authors: J. Carlowe
Journal: BMJ (2010)

The National Institute for Health and Clinical Excellence has issued guidance aimed at saving “tens of thousands of lives” in England by focusing on the effect that food production has on the nation’s diet.

The guidance, launched on Tuesday 22 June, targets three “toxic components” of our diet: salt, trans fats, and saturated fats.

Key recommendations include speeding up the reduction of salt intake in the population—aiming for a maximum intake per person of 6 g a day by 2015 and 3 g a day by 2025. This alone could save 20 000 lives every year, claim members of NICE’s guidance development group.

The guidance also encourages manufacturers to substantially reduce hidden …
Miracle hiccough cure gets the attention it deserves
Authors: Rhys H Thomas, Naomi J P Thomas
Journal: BMJ (2006)

How much will Herceptin really cost? Balancing local and national priorities is not newEditor-Herceptin for early stage breast cancer is a cost effective treatment, and it is right that the NHS should make it available.The challenge of funding new treatments and balancing local and national priorities is one the NHS has faced since its inception. 1 The process the National Institute for Health and Clinical Excellence (NICE) follows for evaluating new medicines is the most rigorous anywhere in the world, and local NHS organisations can have confidence that implementing our recommendations is an effective use of their resources.NICE's independent advisory committees do not rubber stamp decisions.They make them based on an objective and impartial interpretation of the evidence.Those who suggest otherwise should come forward with their evidence for doing so.It is wrong to suggest that a single recommendation from NICE will necessarily cause other services to be reduced and that these decisions are made by clinicians only.Many demands are made on available funds in any hospital at any one time and it is the responsibility of local NHS management, working with their clinical teams, to make the best use of these resources.This difficult job is made easier by NICE guidance and the support tools we offer, such as our commissioning guides and our forthcoming advice on shifting spending from less to more effective treatments.