tbuckley/cabot-search huggingface dataset:
Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved
Authors: Earl Berman
Journal: Annals of Internal Medicine (2010)

Letters4 May 2010Teaching Health Centers and the Primary Care Workforce Crisis for the UnderservedEarl Berman, MDEarl Berman, MDFrom PRGX, Atlanta, GA 30339.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-9-201005040-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:One of the proposed models for national health care is to expand into the natural adjacency of the Medicare and Medicaid systems. However, the influx of new patients will cause an even greater burden on a failing system, and the current workforce of physicians and nonphysician providers will be unable to properly care for these patients. The model proposed by Rieselbach and colleagues (1) seems viable and operationally sound, but the funding mechanism remains a challenge.A plausible funding mechanism would be to allocate a portion of recoveries from the Recovery Audit Contractor (RAC) program to this ...References1. Rieselbach RE, Crouse BJ, Frohna JG. Teaching primary care in community health centers: addressing the workforce crisis for the underserved. Ann Intern Med. 2010;152:118-22. [PMID: 20008743] LinkGoogle Scholar2. Centers for Medicare & Medicaid Services. The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-Year Demonstration. June 2008. Accessed at www.cms.hhs.gov/RAC/02_ExpansionStrategy.asp#TopOfPage on 16 March 2010. Google Scholar3. Centers for Medicare & Medicaid Services. Physician Quality Reporting Initiative (PQRI). Accessed at www.cms.hhs.gov/PQRI/05_StatuteRegulationsProgramInstructions.asp#TopOfPage on 16 March 2010. Google Scholar Author, Article, and Disclosure InformationAffiliations: From PRGX, Atlanta, GA 30339.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTeaching Primary Care in Community Health Centers: Addressing the Workforce Crisis for the Underserved Richard E. Rieselbach , Byron J. Crouse , and John G. Frohna Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved Lucinda Leung Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved Mahesh Krishnamurthy Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved Tonya L. Fancher , Mark C. Henderson , Tracie Harris , and Dorothy Pitman Teaching Health Centers and the Primary Care Workforce Crisis for the Underserved Frederick M. Chen , Sarah A. Lesko , and Bruce Gray Metrics 4 May 2010Volume 152, Issue 9Page: 614KeywordsConflicts of interestElectronic medical recordsHealth careHealth care facilitiesMedicarePatientsPhysiciansPrevention, policy, and public health ePublished: 4 May 2010 Issue Published: 4 May 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
964 THE FARNESOID X RECEPTOR (FXR) AGONIST OBETICHOLIC ACID (OCA) INCREASES PLASMA FGF-19 CONCENTRATIONS AND DECREASES BILE ACID SYNTHESIS IN PRIMARY BILIARY CIRRHOSIS (PBC)
Authors: H.-U. Marschall, V. Luketic, A. Lovgren-Sandblom, L. Benthin, K. Kowdley, G. Hirschfield, A. Mason, K. Lindor, S. Gordon, C. Vincent, R. Chapman, M. Mayo, A. Burroughs, A. Pares, D. Jones, C. Schramm, L. Eliot, A.F. Hofmann, D. Shapiro
Journal: Journal of Hepatology (2012)
UK beef bone ban to stay
Authors: J. Warden
Journal: BMJ (1999)

An intervention by the chief medical officer, Professor Liam Donaldson, last week stopped the UK government lifting its ban on beef on the bone.

An assessed “negligible risk” from eating British beef on the bone had to be balanced against the continuing possibility of a “very large” epidemic of Creutzfeldt-Jakob disease, Professor Donaldson reported.

There have now been 35 deaths from new variant CJD, probably caused by eating meat infected with bovine spongiform encephalopathy.

Professor Donaldson states: “It is impossible to …
Profit rather than science is driving cardiac tests, says US consumer group
Authors: J. Lenzer
Journal: BMJ (2011)

Profit rather than science is behind the large number of tests and procedures for heart disease carried out in the United States, concludes a new report from the independent consumer group Consumer Reports. These procedures are endangering the health of many people who are at low risk of developing heart disease, it says.

A survey carried out for the report of 8056 members of Consumer Report, aged 40 to 60, found that nearly half (44%) of those at low risk of heart disease had undergone at least one screening test, such as electrocardiography, an exercise stress test, or carotid artery ultrasonography.

Around 600 000 percutaneous coronary interventions are done each year in the US, at a cost in excess of $12bn (£7.3bn; €8.5bn). …
Abstract 5378: Inhibition of 15-hydroxyprostaglandin dehydrogenase by <i>Helicobacter pylori</i> in human gastric carcinogenesis.
Authors: Yeon Mi Ryu, Seung-Jae Myung, Young Soo Park3, Ho June Song, Dong-Hoon Yang, Jin-Yong Jeong, Sun Mi Lee, Miyeoun Song, Do Hoon Kim, Hyo-Jeong Lee, Stephen P. Fink, Sandy D. Markowitz, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Jung-Sik Byeon, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim
Journal: Cancer Research (2013)

Abstract Helicobacter pylori (H pylori) infection induces a chronic inflammatory response, which promotes gastric carcinogenesis. 15-hydroxyprostaglandin dehydrogenase (15-PGDH) plays a key role as a tumor suppressor in gastrointestinal cancers. The aim of this study was to elucidate the role of 15-PGDH in gastric carcinogenesis associated with H pylori. 15-PGDH expression in gastric biopsies from H pylori-infected (n=25) and non-infected (n=15) subjects was analyzed by quantitative real-time PCR, western blot analysis, and immunohistochemisty. 15-PGDH DNA methylation was evaluated by methylation specific PCR and pyrosequencing. The expression of 15-PGDH, Snail, ERK1/2, TLR4 and MyD88 in response to H pylori infection was assessed by immunoblot analysis. Compared to negative specimens, H pylori positive specimens had 2-fold lower 15-PGDH mRNA levels and significantly less 15-PGDH protein. In four H pylori infected subjects with longitudinal follow-up, the suppression of 15-PGDH expression was reversed by H pylori eradication therapy. In parallel with suppressing 15-PGDH expression, H pylori infection activated expression of TLR4 and MyD88 expression, increased levels of phospho-ERK1/2, and increased expression of Snail. Inhibition of MyD88 reversed suppression of 15-PGDH expression and reduced phosphorylated ERK1/2. Similarly, treatment with an ERK1/2 inhibitor also restored 15-PGDH expression. Heliocobacter pylori appeared to promote gastric carcinogenesis by suppressing15-PGDH. This process is mediated by the TLR4/MyD88 pathway via ERK1/2 and Snail transcriptional regulation. 15-PGDH may be a useful marker and a potential therapeutic target in H pylori-induced gastric carcinogenesis. Citation Format: Yeon Mi Ryu, Seung-Jae Myung, Young Soo Park3, Ho June Song, Dong-Hoon Yang, Jin-Yong Jeong, Sun Mi Lee, Miyeoun Song, Do Hoon Kim, Hyo-Jeong Lee, Stephen P. Fink, Sandy D. Markowitz, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Jung-Sik Byeon, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim. Inhibition of 15-hydroxyprostaglandin dehydrogenase by Helicobacter pylori in human gastric carcinogenesis. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5378. doi:10.1158/1538-7445.AM2013-5378
Epidemiology of "Sudden, Unexpected, or Rapid" Deaths in Children
Authors: J. L. Emery
Journal: BMJ (1959)

MRaffis 925 endocrine tissues as well as those of other structures, such as liver, kidney, skin, bone, etc.The post-mortem appearances noted were those of microsplanchnia comparable to a state of severe and premature senescence.The combination of the typical skin changes with gonadal atrophy is distinctive.The biochemical investigations strongly suggest functional hypopituitarism with adrenal hypofunction in this case.The multiple features and variation around a common and unforgettable clinical pattern cannot, however, be explained on a purely endocrine basis nor by the effects of reduced function of the liver or kidney alone.The clinical picture of the syndrome varies as a result of other factors superimposed on what is probably a single inherited trait.Modifications of the final syndrome may then be largely dictated by the relative degrees of hypofunction of various vital endocrine and metabolic organs and their resulting imbalances.The basic cellular disturbance as shown in the skin, hair, and body structure remains constant and determines the typical physical features.A deficiency of synthesis in one enzyme system vital to all cells may be responsible and so set, in train the diverse pathological consequences encountered.This is probably an inherited heterozygous recessive character, and an analogy may perhaps be drawn to galactosaemia, Hartnup disease and Wilson's disease-conditions in which a tissue enzyme defect has been established. SummaryThe biochemical investigations and necropsy findings are described in a male patient of 62 years with Werner's syndrome.It is suggested that the condition is due to a generalized enzyme defect which causes premature senescence.Our thanks are due to Dr. G. Scarlett, who referred this case to us, to Dr. Cotton Kennedy and Mr. D
Assessment of human exposure and human health effects after indoor application of methyl parathion in Lorain County, Ohio, 1995-1996.
Authors: Carol Rubin, Emilio Esteban, Stephanie Kieszak, Robert H Hill, Boadie Dunlop, Rebecca Yacovac, Janine Trottier, Kathy Boylan, Terri Tomasewski, Ken Pearce
Journal: Environmental Health Perspectives (2002)

In January 1995 the U.S. Environmental Protection Agency declared methyl parathion-contaminated homes in Lorain County, Ohio, as a Superfund cleanup site. During the 2-year cleanup, the Centers for Disease Control and Prevention in collaboration with county and city health officials conducted a study of exposure and health effects among residents. We administered 254 household and 747 individual questionnaires; urine analysis for p-nitrophenol (PNP, a metabolite of methyl parathion) was available for 626 participants. We also reviewed medical records of 49 people who were hospitalized or died after their homes were sprayed. People living in homes sprayed <180 days previously were most likely to have the highest PNP levels (22.9% > 100 ppb PNP), but even people living in homes sprayed more than a year previously appeared to be highly exposed (8.5% > 100 ppb PNP). The National Health and Nutrition Examination Survey reference range is 0-63 ppb. Median detectable PNP levels among children younger than 3 years of age were 93.9 ppb compared with 41.6 ppb among people older than 3 years. Younger children appeared to be at greatest risk of exposure. In none of the medical records that we reviewed did a health care provider consider pesticide poisoning as a potential etiology.
Asthma: pointing the way toward finding a cure. Report of the ALA/ATS workshop on future directions in asthma research.
Authors: A Munzer
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

"Asthma: pointing the way toward finding a cure. Report of the ALA/ATS workshop on future directions in asthma research.." American journal of respiratory and critical care medicine, 152(1), p. 3
Infiltration With Epinephrine and Local Anesthetic Mixture in the Hand
Authors: Hugh A. Johnson
Journal: JAMA (1967)

I STRONGLY SUSPECT that the current misconceptions concerning the use of a local anesthetic and epinephrine (Adrenalin) mixture in the hand stem from Bunnell's<i>Surgery of the Hand</i>. It states: Local anesthesia, especially with adrenalin content, is best avoided as it lowers the resistance of the tissues. Tissues must have maximum vitality. Adrenalin should never be injected into a digit because from this gangrene has often resulted. The subsequent edition of this book<sup>2</sup>has mitigated this arbitrary wording, "If used in a digit it should not contain epinephrine," but two statements are made that contradict one another: "A tourniquet is essential," and then a few pages later, "Protection of and preservation of optimum blood supply is a most important factor in all extremity surgery." I feel that a very useful adjunct to hand surgery has been maligned. And surely because of this attitude, many unnecessary general anesthetics have been
Commission finds that trust failed to look into high death rates
Authors: Lynn Eaton
Journal: BMJ (2004)

The Healthcare Commission, an independent body that monitors standards in the NHS, has taken unprecedented action against a Yorkshire hospital for its poor management of gastroenterology and related surgery. It has called on the secretary of state for health, John Reid, to put the trust “under special measures.”

Meanwhile the clinicians involved—who are not named in the report and who remain in post—should have their skills reassessed and should, where appropriate, receive extra training, it recommends.

The commission (formerly known as the Commission for Health Improvement) launched …
Contribution to the Pathology of Heart Diseases
Authors: W. O. Markham
Journal: BMJ (1857)

THIs case of diseased aortic valves, which was presented to the Pathological Society, is interesting, because it illustrates, as I believe, one of the modes of origin of valvular diseases, not frequently observed.The aortic valves are all incompetent.Two of them are partially destroyed by ulceration; the eroded
Are trust doctors the new lost tribe?
Authors: N. Cooper
Journal: BMJ (2002)

EDITOR—The number of trust doctors (doctors in non-training grades) in the United Kingdom is rising as trusts try to meet both service and hours requirements and are unable to employ more doctors in training. The Department of Health has no code for trust doctors so its annual census cannot show how many there are.

We surveyed the human resource departments in each acute trust in Yorkshire by postal questionnaire; nine out of 10 replied. We found that the number of trust doctor posts has increased at …
Peak oxygen uptake in arm ergometry: effects of testing protocol.
Authors: R Walker, S Powers, M K Stuart
Journal: British Journal of Sports Medicine (1986)

The purpose of this investigation was to determine if a new proposed arm ergometer protocol was advantageous in eliciting higher peak oxygen uptake (peak VO2) when compared with two protocols currently referred to in the literature. Ten male subjects were tested on three different exercise protocols; a discontinuous test (DT), a continuous test (CT) and a new proposed jump-max test (JMT). The CT began at a work rate of 33 watts (W) (40 rpm) with the power output (PO) being increased 16 W every 3 minutes. The DT began without resistance on the ergometer flywheel (50 rpm) and the work rate was increased by 25 W every 3 minutes with a 1-minute rest between stages. The JMT began with a 3-minute pretest to determine a PO which elicited a HR of 120 +/- 5 beat min-1. After a 2-minute rest, subjects began exercise at the predetermined work rate (80 rpm) with the PO being increased 20 W each minute of the test. Oxygen uptake was measured minute by minute via open circuit spirometry. Peak VO2 was higher (p less than 0.05) in the JMT (mean +/- SEM = 2.36 +/- 0.06 l.min-1) when compared with either (means +/- SEM = 2.16 +/- 0.07 l.min-1) or the CT (means +/- SEM = 2.04 +/- 0.10 l.min-1). No difference (p greater than 0.05) existed in peak VO2 between the CT and the DT. These data suggest that the proposed JMT may result in a higher measured peak VO2 in subjects when compared with either DT or CT of moderate to long duration.
Cryptosporidiosis in Homosexual Men
Authors: ROSEMARY SOAVE
Journal: Annals of Internal Medicine (1984)

Between April 1982 and June 1983, cryptosporidiosis was diagnosed in six homosexual men. Four patients with the acquired immunodeficiency syndrome had lymphopenia, cutaneous anergy, and profoundly impaired cellular immunity; their cryptosporidiosis was severe, unremitting, and refractory to all therapy. Two patients without other opportunistic infections or Kaposi's sarcoma had moderately impaired cellular immunity but not lymphopenia or anergy; their enteric illness was self-limited. Cryptosporidium recently has been recognized as a human pathogen that is transmitted through fecal-oral contamination. The severity of human cryptosporidiosis appears to be determined primarily by immunocompetence of the patient. These six homosexual men, with different degrees of immunologic impairment, had two clinically divergent forms of crytosporidiosis. Their cases raise questions about human transmission of Cryptosporidium and the prognostic significance of this disease in patients who are at high risk for developing the acquired immunodeficiency syndrome.
Direct Communication of a Pulmonary Artery with the Left Atrium
Authors: RUSSELL V. LUCAS, GEORGE W. LUND, JESSE E. EDWARDS
Journal: Circulation (1961)

Direct communication of a pulmonary artery with the left atrium is described and considered a variant of pulmonary arteriovenous fistula. A 3-year-old girl presented with clinical evidence of a lesion of the central nervous system. The history revealed that she had been cyanotic and had had clubbing of the digits and polycythemia. A rounded mass was noted in the region of the right pulmonary hilus in the posteroanterior thoracic roentgenogram. A pulmonary arteriovenous fistula was suspected, but the patient succumbed with a cerebral abscess before definitive diagnostic studies and therapy were undertaken. Anatomic examination revealed an unusual variant of pulmonary arteriovenous fistula, namely, direct communication of the right lower pulmonary artery with the left atrium and absence of the middle and lower lobes of the right lung. It is important that pulmonary arteriovenous fistulas be suspected clinically, since definitive diagnosis and therapy are now possible. While the hemodynamic effects of this type of lesion are usually not severe, untreated patients suffer a high morbidity and mortality through systemic arterial oxygen desaturation, paradoxic embolization, cerebral abscess, and rupture of the fistula.
Charles A Crenshaw
Authors: J. H. Tanne
Journal: BMJ (2001)

Surgeon who was among the teams that tried to save the lives of John F Kennedy and Lee Harvey Oswald

Charles Crenshaw was a third year surgery resident at Parkland Memorial Hospital in Dallas, a city hospital, when President John F Kennedy was rushed to the emergency room after being shot on Friday 22 November 1963. Crenshaw, a junior member of the team, did a cutdown on Kennedy's right leg to insert an intravenous line and watched others trying to save the president.

Two days later, on Sunday 24 November 1963, Crenshaw was part of the team that tried to save Lee Harvey Oswald, thought to be the Kennedy assassin, after Oswald was shot by Jack Ruby.

The Warren Commission investigating Kennedy's death did not call Crenshaw because Parkland officials did not want to publicise the role of residents in providing care on weekends, says Bradley Kizzia, Crenshaw's lawyer and co-author. Crenshaw and others kept silent about what they felt were inconsistencies between their view of Kennedy's wounds and the official autopsy account because of pressure and fear for their careers, Kizzia says.


Charles Crenshaw completed his residency at Parkland and went on to a distinguished career at John Peter Smith Hospital in neighbouring Fort Worth, where he established the surgery department. When he became chairman emeritus in 1992, he had time to write his memoir of that day in Dallas—JFK: Conspiracy of Silence (1992)—adding his information to the record. This contradicted the official view that Oswald had acted alone. 




Crenshaw did not expect the firestorm that followed. One day his book was the number one paperback on the New York Times bestseller list; soon it dropped off the charts when the Journal of the American Medical Association held a press conference denouncing his book. Crenshaw asked for space for a rebuttal and then for a letter to the editor, but was denied. Eventually he sued the American Medical Association and won a settlement. He was dismayed that, although he had built a reputation as a skilled and caring surgeon, colleagues came out against his book.

In the last year of his life, Trauma Room One: The JFK Medical Coverup Exposed (Paraview Press, 2001) was published. In this, Crenshaw expanded on his first book and included photographic evidence that showed Kennedy had been shot twice from the front, not once from the back as the Warren Commission concluded. Oliver Stone, who produced the film JFK, wrote an introduction praising the book.

Crenshaw leaves a wife, Susan; two children; and two grandchildren.

Charles A Crenshaw, emeritus chief of surgery John Peter Smith Hospital, Fort Worth, Texas; b Paris, Texas, 1933; q University of Texas Southwestern Medical School, Dallas, 1960; died 15 November 2001.
The view from the queue
Authors: T. Davies
Journal: BMJ (1996)

”Where's Danny?” The words were out before I was conscious of what prompted them. My wife and older son were waiting for me as I emerged from the customs hall at Heathrow airport, but my accident prone younger son was prominently absent. I had been lecturing at a medical school in the Middle East for a week and as I waited in the queues at Heathrow anxiety about my family, and Danny in particular, had begun nagging at the back of my mind.

A month later I took Danny for his follow up appointment at the fracture clinic of our local hospital. The fracture of his clavicle, caused during a wicked stunt involving a mountain bike and a large log, was healing without problems and there was no reason to expect any hitches at the clinic. We live within half a mile of the hospital and arrived early. The receptionist took Danny's appointment card in a rather absentminded way and asked us to sit down. At that moment, the notes trolley entered the clinic and Danny's appointment card—in fact, our entire existence was forgotten.

I was not aware that we had been overlooked. I was …
Posttraumatic Lumbar Cerebrospinal Fluid Leak
Authors: PATRICK M. COLLETTI, MICHAEL E. SIEGEL
Journal: Clinical Nuclear Medicine (1981)

A case of lumbar cerebrospinal fluld (CSF) extravasation with an unsuspected traumatic meiningocele after a gunshot wound was detected by means of retrograde myeloscintography using isobaric in-111-DTPA. Our experience and a review of the literature have provided evidence retrograde myeloscintography may be useful for detecting and delineaing significant traumatic thoracic and lumbar CSF leaks.
A different light
Authors: L. Farrell
Journal: BMJ (1995)

Like Woody Allen, I now believe only in sex and death, except that after death you don't feel like a smoke. So when the local Lourdes committee invited me to travel with the Armagh Diocesan Pilgrimage as one of the medical officers, I agreed only out of a sense of duty. I did not look forward to it, expecting mostly to be revolted by the squalid commerciality and exploitation of other people's suffering.

The pilgrimage is a major event in Crossmaglen; fundraising goes on all year, and a large party of nurses, lay helpers, and ordinary pilgrims accompanies the sick. The local doctors help to prioritise and choose the patients who might benefit …