tbuckley/cabot-search huggingface dataset:
Use of Health Maintenance Organization Data Bases to Study Pharmacy Resource Usage in Diabetes Mellitus
Authors: Harry S Glauber, Jonathan B Brown
Journal: Diabetes Care (1992)

To evaluate use of medications by patients with diabetes.We analyzed the computerized pharmacy data base of a large health maintenance organization to evaluate cost impact and patterns of usage for all pharmacy products by a defined population of diabetic patients.Diabetic patients received 31.2 dispenses/yr compared with 11.5 for control patients. Total pharmacy costs were threefold higher for diabetic patients ($621 vs. 207/yr) and accounted for approximately 17% of their total health-care costs. Products specifically for the care of diabetes averaged $175/yr or approximately 4.5% of their total health-care costs: 57% received an oral hypoglycemic agent, 34% received insulin, and 6% received both. Cardiovascular drugs accounted for 29% of total costs. There was increased use of most classes of medication by patients with diabetes.Health maintenance organization management data bases, particularly those storing pharmacy dispensing data, provide useful information on the impact of chronic disease. People with diabetes receive a greater number of most types of medication with a greater overall cost than do nondiabetic people. Previous studies have underestimated the contribution of pharmacy purchases to the costs of caring for a diabetic population.
The Challenge of Surgery in an Era of Confusion
Authors: George R. Dunlop
Journal: New England Journal of Medicine (1967)

FIFTY years ago, 18 surgeons from the New England States met at the Harvard Club in Boston and organized the New England Surgical Society. Dr. Samuel J. Mixter, the Society's first president, stated that "scientific and social intercourse was its chief objective."In those early years, such objectives were enough to justify the existence of any surgical gathering and if the minutes of those early meetings were reviewed, it would be fair to conclude that these aims were realized.During the first twenty-five years of the Society's existence, its members, either individually or through committees, supported the promotion of the . . .
Suppressible and nonsuppressible autocrine mast cell tumors are distinguished by insertion of an endogenous retroviral element (IAP) into the interleukin 3 gene.
Authors: H H Hirsch, A P Nair, C Moroni
Journal: The Journal of Experimental Medicine (1993)

After v-H-ras expression, the interleukin 3 (IL-3)-dependent PB-3c mast cells progress in vivo to two different classes of IL-3 autocrine tumors. Class I tumors show a germline configuration of the IL-3 gene and represent more than 90% of tumors analyzed so far. Somatic cell fusion of class I tumor lines with the nontumorigenic parental PB-3c resulted in loss of oncogenic IL-3 expression by a posttranscriptional mechanism with concomitant tumor suppression. Class II tumors arise rarely and contain an insertion in one IL-3 allele. This alteration was linked to enhanced IL-3 gene transcription. For one tumor, the insertion was shown to be an endogenous retroviral element (intracisternal A-particle). Cell hybrids of class II tumors with PB-3c remained IL-3 independent, expressed IL-3, and formed tumors rapidly. These results suggest that the v-H-ras oncogene synergizes with a recessive and a dominant lesion in class I and II tumors, respectively, both of which lead to the autocrine production of IL-3.
Coexistent hyperparathyroidism and thyroid disease
Authors: S. S. Stoffer
Journal: JAMA (1979)

To the Editor.—  It has always been our practice to determine serum calcium levels in patients who have undergone thyroid surgery to exclude the possibility of postsurgical hypoparathyroidism. In three cases, however, we were surprised to find hypercalcemia, after thyroid surgery, later demonstrated to be previously undetected hyperparathyroidism. We apprehensively advised parathyroid surgery in these three cases, knowing quite well that the risk of an unsuccessful operation is greater in patients with prior neck surgery. In one case, we elected to do parathyroid catheterization studies with differential parathyroid hormone determinations to accurately localize the lesion prior to surgery because the patient had severe angina. Fortunately, all three patients had successful parathyroid surgery with resumption of normal calcium values.  Because of this experience, we have recently started to determine serum calcium values in all patients with thyroid nodules to exclude possible coexisting hyperparathyroidism prior to thyroid surgery. Recently, we encountered a
A Method for Measuring Plasma Levels of Digitalis Glycosides
Authors: JEROLD M. LOWENSTEIN
Journal: Circulation (1965)

A method is described for measuring plasma levels of cardiac glycosides, utilizing their inhibitory effect on the rubidium-86 uptake of human red cells. As little as 0.05 mµg. of digoxin/ml. of plasma produces detectable inhibition, but due to the variable effect of other substances in human plasma the practical limit of the method is 1.0 mµg./ml., about 20 times as sensitive as the duck embryo heart or the C 14 -labeled technics. Patients on digitalis leaf were found to have much higher circulating levels than patients on digoxin (average value 7.5 mµg./ ml. of digoxin equivalent for digitalis leaf, 0.05 mµg./ml. for digoxin). Patients toxic on digoxin averaged 6 mµg./ml. Of patients not taking digitalis, 7 per cent had significant levels of digitalis-like substances in their plasma; these were mostly individuals with metastatic carcinoma, severe fluid and electrolyte disturbances, or heart failure. No drug (other than cardiac glycosides) gave consistent high levels by this test.
A CLINICAL STUDY OF 450 CASES OF SCARLET FEVER.
Authors: ANNIE STURGES DANIEL
Journal: JAMA (1900)

In presenting this study of scarlet fever, I have limited it to those cases occurring in children under 12 years old, attended in the tenement houses of the East Side in New York City, an overcrowded district containing chiefly a foreign population, in sanitary surroundings varying from moderately good to very bad. The nursing has been of a most varied character, from that of an intelligent mother to that of a drunken woman. No patient has been considered who did not present the typical physical symptoms of a well-marked scarlet fever, and none that was not seen during the period of eruption and attended until convalescence or death. Each presented the symptoms of redness of the fauces, a definite eruption of red pin points scarlet in color, very close to each other, with a general appearance of a diffuse redness—this followed by desquamation, and the disease accompanied by fever. The
Two Fillips for Human Embryonic Stem Cells
Authors: Elizabeth G. Phimister, Jeffrey M. Drazen
Journal: New England Journal of Medicine (2004)

Although there has been a lot of debate about the use of human embryonic stem cells, there has been little action until very recently, when a group from South Korea described the derivation of human embryonic stem cells obtained from a cloned blastocyst.1 This represents a significant step toward the cure of diseases that involve the loss of a particular cell type — diseases such as type 1 diabetes and Parkinson's disease. Such a cure would entail transplanting differentiated embryonic stem cells derived from a cloned blastocyst, itself derived from the somatic nucleus of the patient's cell. This approach has . . .
The effects of an anti–IL-13 mAb on cytokine levels and nasal symptoms following nasal allergen challenge
Authors: Grant C. Nicholson, Harsha H. Kariyawasam, Andrew J. Tan, Jens M. Hohlfeld, Deborah Quinn, Christoph Walker, David Rodman, John Westwick, Stipo Jurcevic, Onn Min Kon, Peter J. Barnes, Norbert Krug, Trevor T. Hansel
Journal: Journal of Allergy and Clinical Immunology (2011)
Public health information on world wide web is hard to find
Authors: D. A Agbamu, E. Sim
Journal: BMJ (1997)

Progress in reducing inpatient mortality from acute myocardial infarction is slowEditor-Brown et al report a substantial increase in the use of beneficial interventions for patients admitted to hospital with acute myocardial infarction in Nottingham from 1982 to 1992. 1 However, they found no change in inpatient mortality adjusted for age and sex.This contrasts with findings in Ontario, Canada, where hospital discharge abstracts show that inpatient mortality fell from 1981 to 1991 2 and has since fallen further (data on request).Brown et al suggest that the disparate results may reflect coding errors in the Ontario administrative data.Our group has assessed the classification of deaths from acute myocardial infarction in inpatients in the Ontario discharge abstracts.Matching Ontario administrative data to data from the GUSTO-I and LATE trials, we found the specificity of the administrative data to be 100% (1403/1403 alive), with overall sensitivity of 94% (104/111 deaths detected). 3he classification of acute myocardial infarction itself is more problematic.The sensitivity of the primary diagnosis of acute myocardial infarction is high, but specificity varies. 4 5There are two common reasons for false positive coding.Firstly, patients may be admitted to a coronary care unit with possible acute myocardial infarction but this diagnosis is ruled out and they are sent home quickly.Alternatively, patients recently admitted to hospital with acute myocardial infarction are readmitted for coronary angiography or with complications other than overt reinfarction, and the code for acute myocardial infarction is wrongly used again.Thus the analysis of outcomes in Ontario excluded both patients with a primary diagnosis of acute myocardial infarction who were discharged in under four days and patients who had been admitted to hospital for acute myocardial infarction in the preceding three months. 2t is therefore doubtful that imprecise coding explains the improving outcomes of acute myocardial infarction in Ontario.Indeed, only systematic coding errors could explain the observed trends in inpatient mortality, and we have found neither evidence nor a rationale for this.Ontario's administrative data do mirror the findings of Brown et al in two respects 2 : admissions for acute myocardial infarction, particularly among elderly patients, increased over the period studied, and inpatient mortality ranged from 16% to 21%, which is much higher than in the large randomised trials of thrombolytic treatment.Thus while the trends in Ontario are more positive than those in Nottingham, we agree with Brown et al that the cardiovascular megatrials have been enrolling skewed patient populations 3 and that progress in the battle to reduce inpatient mortality from acute myocardial infarction remains slow.
Chemotherapy of Systemic Mycoses
Authors: John E. Bennett
Journal: New England Journal of Medicine (1974)

PROGRESS in chemotherapy of systemic mycoses has been sufficiently slow to recall the lament of Ecclesiastes: "The thing that hath been, it is that which shall be; and that which is done is that which shall be done; and there is no new thing under the sun." Comparison of this review with another published in the Journal in 19631 may reinforce such a conviction. Still, something remains to be said for broadening our knowledge of old drugs and gleaning what one can about newer agents.Polyene AntibioticsThis large group of antibiotics includes three drugs commercially available in this country: . . .
Helping the Abused Child
Authors: Douglas A. Sargent
Journal: JAMA (1985)

Children with injuries inflicted on them by their caretakers are difficult for physicians to treat because they arouse in us strong ambivalence. As we try to diagnose and treat them, we have to struggle with our own feelings, hardly able to believe that parents could savage their children yet bring them to us for repair. Often we fight down anger as we try to obtain a medical history and give the child-victim appropriate care. Planning the next step beyond crisis care is hampered by our lack of trust in the caretakers' ability to refrain from further violence. Unfortunately, we also lack confidence if the alternative to parental care is a child protection system with a reputation for ineffectuality.  Faced with daunting uncertainties and a violated child, most physicians welcome help from any quarter. Fortunately, help is now available from the American Medical Association (AMA) in the article entitled Diagnostic and
Localization of histamine N-methyltransferase messenger RNA in human nasal mucosa
Authors: Michiko Okayama, Kohei Yamauchi, Kiyohisa Sekizawa, Hiroshi Okayama, Hidetada Sasaki, Naoki Inamura, Kazutaka Maeyama, Takehiko Watanabe, Tamotsu Takishima, Kunio Shirato
Journal: Journal of Allergy and Clinical Immunology (1995)
Intermittent versus Continuous Androgen Deprivation in Prostate Cancer
Authors: Maha Hussain, Catherine M. Tangen, Donna L. Berry, Celestia S. Higano, E. David Crawford, Glenn Liu, George Wilding, Stephen Prescott, Subramanian Kanaga Sundaram, Eric Jay Small, Nancy Ann Dawson, Bryan J. Donnelly, Peter M. Venner, Ulka N. Vaishampayan, Paul F. Schellhammer, David I. Quinn, Derek Raghavan, Benjamin Ely, Carol M. Moinpour, Nicholas J. Vogelzang, Ian M. Thompson
Journal: New England Journal of Medicine (2013)

Castration resistance occurs in most patients with metastatic hormone-sensitive prostate cancer who are receiving androgen-deprivation therapy. Replacing androgens before progression of the disease is hypothesized to prolong androgen dependence.
Hashimotos Thyroiditis
Authors: R. M. Blizzard, W. Hung, R. W. Chandler, T. Aceto, M. Kyle, T. Winship
Journal: New England Journal of Medicine (1962)

BECAUSE high titers of circulating thyroid antibodies are present in the serums of patients with Hashimoto's thyroiditis, and a similar lymphocytic thyroiditis occurs in animals immunized with Freund's adjuvant and saline extracts of homologous thyroid glands, Hashimoto's thyroiditis has been considered an autoimmune disease.1 , 2 Cortisol (hydrocortisone) or cortisol-like compounds3 , 4 have been used in the treatment of other diseases that some investigators believe are associated with autoimmunity. Therefore, we treated 3 adolescent females with Hashimoto's thyroiditis for six months with pharmacologic doses of cortisone. This was done in an attempt to disrupt the autoimmune process and the possible progressive destruction of . . .
Studies of pyrophosphate metabolism in relation to chondrocalcinosis
Authors: A. M. Caswell, M. K. B. McGuire, R. G. G. Russell
Journal: Annals of the Rheumatic Diseases (1983)

of the Rheumatic Diseases observations on light microscopy.More interestingly, smaller crystals were seen pericellularly and in the intercellular matrix.Some crystals were seen adjacent to the chondrocytes and located in the lacuna (Fig. 1).Electron probe analysis of the crystals in various locations, and differing in size, gave a consistent calcium to phosphorus ratio of approximately 1-15: 1 similar to that of the calcium pyrophosphate standard.This ratio is quite different and much lower than the ratio of calcium and phosphorus in the three different types of apatite crystals found in human osteoarthritic articular cartilage.4 5There were various non-specific changes in the cells and in the matrix components that were indicative of a
Response to Rimiterol and Salbutamol Aerosols Administered by Intermittent Positive-pressure Ventilation
Authors: N. J. Cooke, J. A. Kerr, R. F. Willey, M. V. Hoare, I. W. B. Grant, G. K. Crompton
Journal: BMJ (1974)

The bronchodilator and cardiac effects produced by aerosols of 0·5% salbutamol and 0·5% and 1% rimiterol administered for three minutes in 40% oxygen by intermittent positive-pressure ventilation (I.P.P.V.) were compared in 15 asthmatic patients. Salbutamol and both the concentrations of rimiterol were equipotent in peak bronchodilator effect, but salbutamol had a significantly longer duration of bronchodilator action. There was significantly less increase in heart rate after rimiterol than after salbutamol. Aerosols of 0·5% rimiterol, 0·5% salbutamol, and saline were administered by I.P.P.V. to 10 normal volunteers. There was no difference between the mean heart rates after 0·5% rimiterol and saline but a highly significant increase in mean heart rate was observed after 0·5% salbutamol. It was concluded that 0·5% rimiterol was an effective short-acting bronchodilator drug with little or no cardiac beta<sub>1</sub>-adrenergic activity when administered for three minutes by I.P.P.V. in 40% oxygen.
Endothelin production and effects of endothelin antagonism during experimental airway inflammation.
Authors: F Finsnes, O H Skjønsberg, T Tønnessen, O Naess, T Lyberg, G Christensen
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Endothelin (ET) has strong bronchoconstrictor properties, stimulate mucus secretion and mucosal edema, and may also exert proinflammatory effects. Therefore, ET may play a pathogenic role in inflammatory airway diseases such as bronchial asthma. The production and localization of ET and the effect of blocking ET receptors was investigated in rats during airway inflammation induced by intratracheal instillation of dextran (Sephadex). We observed a considerable increase in the concentration of ET in bronchoalveolar lavage fluid (BALF) during the early phase of inflammation, with an increase from 2.2 +/- 0.6 pg/ml in controls to 40.0 +/- 6.7 pg/ml at Day 1, declining to 5.3 +/- 1.1 pg/ml at Day 14. Correlated with the ET response in BALF was a considerable increase in total cell count (r = 0.61), eosinophils (r = 0.83), and neutrophils (r = 0.81). Plasma ET was not elevated. Immunohistochemical analyses revealed ET-like staining in the bronchial epithelium. Treatment with the ET receptor antagonist bosentan inhibited the increase in eosinophils in BALF and reduced the inflammatory reaction in the lung tissue. In summary, a considerable increase in the ET concentration in BALF was demonstrated during the acute phase of an experimental eosinophilic airway inflammation, coinciding with an increased ET-like immunostaining in the bronchial epithelium. Treatment with an ET receptor antagonist inhibited the inflammatory response in BALF and in the tissue.
A Decade of Short-Term Outcomes in Post–Cardiac Surgery Ventricular Assist Device Implantation
Authors: Adrian F. Hernandez, Joshua D. Grab, James S. Gammie, Sean M. O’Brien, Bradley G. Hammill, Joseph G. Rogers, Margarita T. Camacho, Mercedes K. Dullum, T. Bruce Ferguson, Eric D. Peterson
Journal: Circulation (2007)

Previous studies showed 75% mortality before hospital discharge in patients with a ventricular assist device (VAD) placed for post-cardiac surgery shock. We examined a large national clinical database to assess trends in the incidence of post-cardiac surgery shock requiring VAD implantation, survival rates, and risk factors for mortality.We identified patients undergoing a VAD procedure after cardiac surgery at US hospitals participating in the Society of Thoracic Surgeons' National Cardiac Database during the years 1995 to 2004. Baseline characteristics and operative outcomes were analyzed in 2.5-year increments. Logistic regression modeling was performed to provide risk-adjusted operative mortality and morbidity odds ratios. A total of 5735 patients had a VAD placed during the 10-year period (0.3% cardiac surgeries). Overall survival rate to discharge after VAD placement was 54.1%. With the earliest period (January 1995 through June 1997) used as reference, the mortality odds ratio declined to 0.72 (July 1997 through December 1999) and eventually to 0.41 (July 2002 through December 2004; P<0.0001). The combined mortality/morbidity odds ratio also declined, to 0.84 and 0.48 over identical periods (P<0.0001). Preoperative characteristics associated with increased mortality were urgency of procedure, reoperation, renal failure, myocardial infarction, aortic stenosis, female sex, race, peripheral vascular disease, New York Heart Association class IV, cardiogenic shock, left main coronary stenosis, and valve procedure (c index=0.755).After adjustment for clinical characteristics of patients requiring mechanical circulatory support, rates of survival to hospital discharge have improved dramatically. Insertion of a VAD for post-cardiac surgery shock is an important therapeutic intervention that can salvage most of these patients.
DNR in the OR
Authors: C. Franklin
Journal: JAMA (1992)

To the Editor.  —While encouraging flexibility in DNR policies for the OR, both the article by Walker 1 and the accompanying editorial by Youngner et al 2 failed to mention an important aspect of such policies—the patient's option to have life support discontinued when it is acknowledged to be death-delaying rather than life-prolonging. Our experience suggests that most terminally ill patients request DNR orders not out of a desire to die, but because they do not want to be kept alive on life support with little or no hope of recovery. In this respect, we believe that few patients with DNR orders who consent to operative procedures expect to die as a result of their surgery.  In recognition of this, as part of the preoperative informed consent process, patients should be given the option to have intubation and/or vasopressors instituted when needed during surgery with the guarantee that they will
Mallory–Denk Bodies Are Associated With Outcomes and Histologic Features in Patients With Chronic Hepatitis C
Authors: Mina O. Rakoski, Morton B. Brown, Robert J. Fontana, Herbert L. Bonkovsky, Elizabeth M. Brunt, Zachary D. Goodman, Anna S. Lok, M. Bishr Omary
Journal: Clinical Gastroenterology and Hepatology (2011)