tbuckley/cabot-search huggingface dataset:
The primary-secondary care divide fails older patients
Authors: John Hughes
Journal: BMJ (2012)

Since the United Kingdom’s NHS formed in 1948, general practice has assumed the role of gatekeeper so that only patients in need of secondary care have access to it. This system has, arguably, worked well for elective care, although varying referral practices has led to the development of triages and intermediate tier services. For unscheduled care, general practice’s gatekeeper role has changed over the years, without any accompanying full scale reorganisation.

Gone are the days when general practitioners were responsible for their patients’ care 24 hours a day, seven days a week, and could, at least theoretically, minimise unnecessary admissions to hospital. That responsibility has gradually eroded, and it was eventually destroyed altogether with the 2004 contract that transferred 24 hour responsibility to primary care trusts. General practitioners now act as gatekeepers for only 30% of the week (that is, from 8 am to 6 30 pm on weekdays only), which is not an effective filter. 

Many patients, particularly those with recurring exacerbations of chronic illnesses (of which chronic obstructive pulmonary disease is probably …
Myeloid suppressor cells regulate the adaptive immune response to cancer
Authors: A. B. Frey
Journal: Journal of Clinical Investigation (2006)

Inflammation resultant from tumor growth, infection with certain pathogens, or in some cases, trauma, can result in systemic release of cytokines, especially GM-CSF, that in turn stimulate the abundant production and activation of a population of immature myeloid cells, termed myeloid suppressor cells (MSCs), that have potent immunosuppressive functions. In this issue of the JCI, Gallina and colleagues have illuminated some complex issues concerning the development, activation, and function of MSCs (see the related article beginning on page 2777). They show that activation of MSCs is initiated in response to IFN-γ, presumably produced in situ by antitumor T cells in the tumor microenvironment. After this triggering event, MSCs express 2 enzymes involved in l-arginine metabolism, Arginase I and iNOS, whose metabolic products include diffusible and highly reactive peroxynitrites, the ultimate biochemical mediators of T cell immune suppression. The multifaceted regulation of this complex suppressive effector system provides several potential therapeutic targets.
Fas-induced apoptosis in mouse hepatocytes is dependent on C/EBPβ
Authors: Debjani Mukherjee, Klaus H. Kaestner, Kellen K. Kovalovich, Linda E. Greenbaum
Journal: Hepatology (2001)

Apoptotic cell death in the liver in response to activation of the Fas pathway has been implicated in human disease states as well as liver remodeling and tissue repair. C/EBPβ, a member of the CCAAT enhancer binding protein family of bZIP transcription factors has been linked to both growth response and apoptotic targets in the liver, and, therefore, is a likely candidate for the regulation of apoptotic liver injury. We investigated differences in apoptotic cell death in the livers of C/EBPβ–null mice using the Jo–2 agonistic anti–Fas antibody. Apoptotic injury was dramatically reduced in C/EBPβ -/- livers as shown by a nearly 20–fold reduction in apoptotic hepatocytes 6 hours post–Jo–2 treatment in C/EBPβ -/- hepatocytes compared with controls ( P &lt; .04) and reduced activation of caspase 3. Bid cleavage occurred in Jo–2 treated C/EBPβ -/- livers indicating a block of Fas–induced injury distal to the death–inducing signaling complex. The level of the antiapoptotic protein bcl–x L was increased greater than tenfold in the mutant animals ( P &lt; .04), which can, at least in part, account for the protection from Fas–mediated apoptosis. In contrast, bcl–x L mRNA levels were unchanged. These observations link C/EBPβ to Fas–induced hepatocyte apoptosis through a mechanism that likely involves translational or posttranslational regulation of bcl–x L .
A paraneoplastic mixed bullous skin disease: breakdown in tolerance to multiple epidermal antigens
Authors: P. Musette, P. Joly, D. Gilbert, E. Marinho, B. Crickx, F. Tron, S. Belaich, V. Descamps
Journal: British Journal of Dermatology (2000)

We report a new type of paraneoplastic mixed bullous skin disease in a patient with a B-cell lymphoma associated with monoclonal IgM kappa paraproteinaemia. The patient's clinical and histological features were reminiscent of bullous pemphigoid. Characterization of antiepidermal antibodies by immunoblotting and indirect immunoelectron microscopy demonstrated a novel pattern of reactivity: IgG antibodies were directed against desmoplakins I-II and BPAG2, and were associated with antidesmoglein 3 polyclonal IgM antibodies. Such an autoreactive pattern involving antidesmoplakins, anti-BPAG2 and antidesmoglein 3 antibodies has not been previously reported. It reflects the breakdown of tolerance to multiple epidermal antigens observed in some patients with malignancy.
Evidence-Based Clinical Practice: Concepts and Approaches
Authors: Eleanor Z. Wallace
Journal: Annals of Internal Medicine (2000)

Medical Writings: Book Notes2 May 2000Evidence-Based Clinical Practice: Concepts and ApproachesEleanor Z. Wallace, MDEleanor Z. Wallace, MDState University of New York Health Sciences Center, Brooklyn, New York. (Wallace)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-9-200005020-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Geyman JP, Deyo RA, Ramsey SD, eds. 177 pages. Boston: Butterworth-Heinemann; 2000. $35.00. ISBN 0750670975. Order phone 800-366-2665.Field of medicine: Evidence-based practice in primary care.Format: Softcover book.Audience: Primary care physicians, trainees, and other decision makers in primary care.Purpose: To emphasize the importance of incorporating evidence-based medicine into clinical decision making; to teach how to assess the literature, practice guidelines, and cost and outcome measures; and to show how to efficiently apply evidence-based medicine to individual practice settings and the populations they serve.Content: Seventeen chapters provide a rational and accessible explanation of the basis for evidence-based ... Author, Article, and Disclosure InformationAuthors: Eleanor Z. Wallace, MDAffiliations: State University of New York Health Sciences Center, Brooklyn, New York. (Wallace) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEntwicklung – Struktur, Inhalt und Sprache von Gesundheitsinformationen 2 May 2000Volume 132, Issue 9 Page: 768 Keywords Computers Decision analysis Decision making Evidence based medicine Health care quality Information technology Population statistics Primary care physicians Software tools Treatment guidelines ePublished: 15 August 2000 Issue Published: 2 May 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Tobacco and end stage diabetic nephropathy:: Authors' reply
Authors: B. Stegmayr, F. Lithner
Journal: BMJ (1987)

Asthma is characterised by inflammation and respiratory symptoms. Current asthma treatment is based on severity of asthma symptoms only. Exhaled nitric oxide fraction (<i>F</i><sub>eNO</sub>) is not recommended by the Global Initiative for Asthma guidelines. The aim was to compare the usefulness of a <i>F</i><sub>eNO</sub> guided <i>versus</i> symptom-based treatment in achieving improved asthma control assessed by airway hyperresponsiveness (AHR). 80 asthmatic patients were included in a double-blinded, parallel, randomised controlled trial with follow-up visits after 8, 24 and 36 weeks. Treatment was tailored using either a <i>F</i><sub>eNO</sub> or Asthma Control Questionnaire (ACQ) based algorithm. Inclusion criteria were asthma symptoms and a provocative dose causing a 15% fall in forced expiratory volume in 1 s &lt;635 mg mannitol. At each visit AHR, <i>F</i><sub>eNO</sub>, ACQ and blood tests were performed. No differences between the two groups were found at inclusion. AHR from 8 to 24 weeks was improved in the <i>F</i><sub>eNO</sub> group compared to the ACQ group (response dose ratio (RDR) geometric mean (95% CI): 0.02 (0.01–0.04) <i>versus</i> 0.05 (0.03–0.07), respectively, p=0.015). AHR to mannitol at 36 weeks showed no differences between the two groups (mean difference RDR (95% CI): −0.02 (−0.05–0.02), p=0.3). Total doses of inhaled steroid and number of exacerbations were similar (p&gt;0.05). When using <i>F</i><sub>eNO</sub> as a treatment management tool, lowering of airway responsiveness occurred earlier than using ACQ. However, airway responsiveness and asthma control after 9 months were similar.
Treatment Options for Breast Cancer — Beyond Survival
Authors: Patricia A. Ganz
Journal: New England Journal of Medicine (1992)

During the past two decades there have been enormous changes in the care of women with primary breast cancer. We have learned that breast cancer is usually microscopically disseminated at the time the diagnosis is first made and that the degree of dissemination dominates the prognosis for most women. This fundamental change in the understanding of the natural history of breast cancer has provided an opportunity to study the relative advantages and disadvantages of various forms of local treatment for the disease. The Halsted radical mastectomy was largely replaced by the modified radical mastectomy or total mastectomy in the late . . .
Tuberculosis in Cuba
Authors: A M GARCIA-ZAMALLOA
Journal: Thorax (2001)

Myositis associated with graft-versus-hostdisease (GVHD) typically presents with proximal muscle weakness, myalgias, and a raised creatinine phosphokinase (CPK) level.We report a case of a 51 year old man who developed respiratory muscle weakness five years after an allogeneic bone marrow transplant for multiple myeloma.His symptoms included tachypnoea, abdominal paradox, and orthopnoea.Pulmonary function tests revealed diminished vital capacity and maximal inspiratory and expiratory pressures.Serum CPK levels were raised and a peripheral muscle biopsy specimen was consistent with GVHD.He improved with immunosuppressive therapy.
Art, Anatomy, Learning, and Living
Authors: Samantha Stewart, Rita Charon
Journal: JAMA (2002)

played by Cary Grant, is followed everywhere by a large, silent man.The man is with him as he addresses an anatomy class, as he conducts the student orchestra, as he stands over a patient in the operating room.The man speaks only at rare moments, each crucial, coming to Noah's aid as the voice of wisdom, of conscience, or of the past.When Noah is finally challenged by a university tribunal to defend his relationship with the odd man he calls "my friend," the story comes out: the man is a convicted murderer, executed by hanging and sent 20 years earlier to Noah, a medical student who needed "a cadaver of my own."The "cadaver" awakened as soon as Noah stuck a gloved finger in his mouth, and has never since left his side.Early experiences in the anatomy laboratory underpin later practice in ways that are not easy to articulate.The knowledge gained there guides diagnosis, allows us to link phenomena that seem on the body's surface to be unrelated, and gives us fluency in a discourse that lets us to describe what is happening to our patients.Visualizing the structures hidden beneath the skin allows us to identify conditions otherwise beyond our grasp.Although the overwhelming bulk of the knowledge we use to care for patients is learned outside the lab, and the centrality of the experience wanes even by the end of first year, what we learn in anatomy lab is somehow, quietly, always there.In this issue of MSJAMA, literature professor John Bender recounts his season as an outsider in the lab and describes how the process serves as a ritual entry into the medical profession.Beyond the technical knowledge it affords, anatomy lab links us to the past and begins our socialization to future practice.We dissect knowing that we are making the same cuts and seeking the same structures as physicians centuries earlier.But today, we pride ourselves on taking more from the experience, on engaging with the gift that is the donation.Samantha Stewart and Rita Charon describe anatomy study as an initial confrontation with life and death that will follow us throughout our careers, and discuss a way these early lessons might be retrieved.S. Ryan Gregory and Thomas Cole describe the history of dissection across centuries, while Aaron Tward and Hugh Patterson account for the shift from grave robbing to cadaver donation in the United States.Finally, to launch our new creative writing section murmur, Matthew Ehrlich evaluates his cadaver's chief complaint.The first body in our care has neither the needs nor the agency of a patient, and yet for many of us, it is the body we will envision as we examine the intact surface of each patient who comes to us.Whether it is our initiation into "the professional tribe of physicians" (Bender), "the scientific method" (Gregory and Cole), or "the use of affective responses" (Stewart and Charon), anatomy lab is as much a part of how we see as what we know."The trouble with you, Elwell," Noah's ally says to his accuser at the end, "is you've never had a cadaver of your own."
Ecotoxicity in the Reconquista River, province of Buenos Aires, Argentina: a preliminary study.
Authors: J Herkovits, C S Perez-Coll, F D Herkovits
Journal: Environmental Health Perspectives (1996)

The Reconquista River in Argentina is considered a "supercritical" river basin due to environmental degradation. Within its valley of 1.547 km2, there are more than 3 million inhabitants and 12,000 industries. Using early-life-stage toxicity tests with Bufo arenarum embryos (the most sensitive of three native species), we determined the water quality at six sampling stations of the river valley and expressed the results as acute and chronic toxicity units. Along most of the river, the toxicity was higher than the allowable level of whole industrial effluent toxicity recommended by U.S. EPA. In a tributary stream, Arroyo Moron, the water was about 10 times more toxic than the criteria maximum concentration (CMC) recommended by U.S. EPA for industrial effluents. Similar degradation of the water quality was found taking as a reference value an upstream sampling station. In all places where the water quality was worse than the CMC, no macroorganisms were found, and in one of these places, a large number of dead fishes was observed. Our study points out that amphibian early-life-stage toxicity tests could be appropriate for assessing water contamination and water quality, which is essential for diagnosis, protection of environmental services, monitoring, and restoration purposes.
Environmental tobacco smoke and low birth weight: a hazard in the workplace?
Authors: D P Misra, R H Nguyen
Journal: Environmental Health Perspectives (1999)

Low birth weight (LBW) increases infant morbidity and mortality worldwide. One well-established risk factor is maternal smoking. Environmental tobacco smoke (ETS) exposure has recently been focused on as another potential risk factor. In this article, we review epidemiologic literature on the effects of ETS on LBW and intrauterine growth retardation (IUGR), the cause of LBW related to maternal smoking. As we consider the feasibility of modifying women's exposure, we focus our discussion on workplace exposure to ETS. The workplace is particularly important to consider because women of child-bearing age are present in the workplace in greater numbers now than ever before. In addition, certain subgroups of working women may be particularly at risk from the effects of ETS on pregnancy because they work in environments with higher exposure or they are more susceptible to its effects. We conclude that there is consistent evidence to relate maternal ETS exposure to an increased risk of adverse pregnancy outcomes and that this association may be generalized to the work environment. In studies with positive findings, infants exposed to ETS antenatally were 1.5-4 times more likely to be born with LBW, but few studies examined LBW. Most studies looked at measures of IUGR. ETS was associated with reductions in birth weight (adjusted for gestational age) ranging from 25 to 90 g. Infants born to women exposed to ETS were generally 2-4 times more likely to be born small-for-gestational age. ETS exposure in the workplace can and should be minimized to protect pregnant women from its adverse effects.
Designing an Experientially Based Continuing Education Program
Authors: WILLIAM H. BARBER, HUGH JAMES LURIE
Journal: American Journal of Psychiatry (1973)

Based on their experience in leading continuing education workshops for various mental health workers, the authors recommend the use of experiential learning techniques in such programs to accomplish attitude change, personal involvement, and the development of specific clinical skills. The authors outline elements of design that they feel to be essential to all such training programs, including techniques used in sensitivity groups, and present examples of two possible workshop formats.
What Is the Cause of the Loud Snoring—and What Should Be Done?
Authors: Abdul Ghani Sankri-Tarbichi, M. Safwan Badr
Journal: American Journal of Respiratory and Critical Care Medicine (2011)

A 42-year-old male with hypertension and asthma was evaluated for excessive daytime sleepiness and loud snoring. On exam it was found that BMI was 35 kg/m2, neck circumference was 41 cm, upper airway was crowded, and there was no audible wheezing on lung auscultation. A nocturnal polysomnogram revealed moderate obstructive sleep-disordered breathing. On continuous positive airway pressure (CPAP) of 9 cm H2O using full face mask, the patient exhibited the breathing pattern shown in Figure 1.



Figure 1.



The combination of snoring and flow limitation during expiration (as seen in Figure 1) indicates expiratory pharyngeal narrowing that requires higher distending pressure with CPAP. Increasing CPAP to 15 cm H2O during the same stage of sleep and body position eliminated expiratory snoring and flow limitation, as shown in Figure 2.



Figure 2.
A STUDY OF THE INFLUENCE OF EMOTIONS AND AFFECTS ON THE SURFACE TEMPERATURE OF THE HUMAN BODY
Authors: Lloyd H. Ziegler, Paul T. Cash
Journal: American Journal of Psychiatry (1938)

(1) A brief review of the literature is presented, including the history of factors affecting body temperature. (2) The heat regulatory capacity of children and schizophrenics is discussed. (3)Some surface temperature readings of twenty patients are presented. The most outstanding effects of emotional influence on surface temperature occurred in a schizophrenic, and in two psychoneurotics, one of which showed the major hysterical reaction. Weeping caused a noticeable change in the surface temperature of one patient. The temperature of the two sides in hemiplegics was remarkably similar. The electrothermograph of one patient, preoccupied by unpleasant aspects of her life-history, shows a sharp drop in the temperature of the right cheek. (4)Emotional reactions appear to have an inconstant effect on surface temperature, as Pembrey had concluded. It seems fairly well established that emotions or affects may conspire to produce surface temperature deviations, variable in duration, even to the extent of fever, or outspoken hypothermia. (5) The face appears to be the zone of most marked temperature fluctuation which may account for the frequency of blushing in this region. Reactions quite the opposite of blushing may occur. (6) The centers in the brain having some effect on heat control seem to be in the hypothalamus. Localization of cortical representation (if there be one) for the peripheral sympathetic nervous system has not been adequately demonstrated. (7) Emotional, or affective, life as seen by the clinician is a relatively crude objective and subjective chain of events. To the physiologist, surface temperature variation is only one of many reactions of the individual to the external and internal environment.
Splenic Implants Detected by SPECT Images of Tc-99m Labeled Damaged Red Blood Cells
Authors: Gethin Williams, Max P. Rosen, J Anthony Parker, Gerald M. Kolodny
Journal: Clinical Nuclear Medicine (2006)

A 51-year-old woman with a history of splenectomy for traumatic splenic rupture as a child presented with right-sided abdominal pain. A pelvic and renal ultrasound (US) did not demonstrate a cause of the pain, although a complex left ovarian cyst was noted. A double-contrast abdominal and pelvic CT revealed multiple soft tissue implants within the peritoneum, raising the possibility of metastatic disease or, given the history of splenectomy, splenosis. SPECT images of Tc-99m labeled damaged red blood cells clearly showed multiple ectopic splenic implants.
EFFECT OF PENICILLIN ON GROUP A STREPTOCOCCI IN VIVO IN THE ABSENCE OF LEUCOCYTES 1
Authors: James E. Darnell, Barbara B. Pesch, Robert J. Glaser
Journal: Journal of Clinical Investigation (1955)

Studies of penicillin action in vitro have indi- cated that, under given experimental conditions, the antibiotic is bactericidal rather than bacterio- static (1-5), and it has been further demonstrated that it exerts its bactericidal effect on susceptible microorganisms only when they are actively me- tabolizing, a state indicated usually by rapid growth (6-9).Although there is also evidence that when it is administered in the initial phase of experimental infections due to susceptible organ- isms penicillin is bactericidal (10, 11), elucidation of its effect in vivo has been complicated by the participation of host cellular defenses which, under certain circumstances, may in themselves be ex- tremely efficient (12).The recent description by Werner, Knight, and McDermott of a method by which bacteria can be localized in tivo in a cell- free milieu (13) suggested the means by which the effect of penicillin on group A streptococci, in the absence of leucocytes, could be assayed at various stages of growth in the peritoneal cavity of the rabbit. METHODS AND MATERIALSPreparation of agar disks.The techniques employed were patterned after those described by Werner, Knight, and McDermott (13).A 2 per cent suspension of non- nutrient agar (Difco Bactoagar) in distilled water at pH 7.8 was sterilized in flasks in the autoclave and stored at 20 C. The disks were made by pouring melted agar, at 390 C to 410 C, under aseptic precautions, into thin- walled cylindrical aluminum molds measuring 22 mm. in diameter and 15 to 20 mm. in height.The sterile cylinders were placed in petri dishes and a 1 ml.layer of agar introduced.The petri dish was then covered and cooled at 20 C for 15 minutes.The second layer, containing the inoculum in 0.2 ml. of agar, was poured onto the hardened first layer, care being taken to prevent any of the bac- teria-containing suspension from reaching the wall of the mold; the desired result was easily achieved because the 0.2 ml.layer solidified
Bile Salt Micelles: Nuclear Magnetic Resonance Spectroscopy and Crystallographic Studies
Authors: Stephen Barnes
Journal: Hepatology (1984)

Studies of bile salt structure using nuclear magnetic resonance (NMR) and X-ray crystallography have suggested that micellar association of bile salts is a function of side chain length and of packing of the side chain and the steroid nucleus. Lanthanide NMR probe analysis has been used to determine the structure of what is probably the monomer of the bile salt glycocholate. These approaches to the structural chemistry of bile salt intra- and intermolecular interactions are providing the basis for the design of artificial bile salt-like compounds for use in the study and treatment of human gallstone disease.