tbuckley/cabot-search huggingface dataset:
Individuals' contributions to cost of social care in England should be capped, review says
Authors: A. Gulland
Journal: BMJ (2011)

An independent review into the funding of social care for adults in England has recommended that a cap of £35 000 (€38 700; $56 000) be set on the contribution that any individual makes for care during his or her lifetime.

The report by the Commission on the Funding of Care and Support said that to protect people from “extreme care costs” it was recommending that the lifetime contribution to adult social care costs be set at between £25 000 and £50 000, with £35 000 being an “appropriate and fair figure.” After the cap is reached, people would be eligible for full state support.

Those deemed by means testing not able to pay £35 000 would be subject to a sliding scale of contributions. The maximum personal contribution would be £9000, for example, for those with accumulated wealth of no more than £40 000. Those with assets and income less than £14 250 would not have to pay anything towards the cost of social care.

People in residential care should also pay between £7000 and £10 000 a year for general living costs, such as food and accommodation, on top of the £35 000 contribution, as they would have to pay this if they were living in their own home.

The commission, which began its investigation last July, was also keen to advise on the means test for state support in residential care, which the commission’s chairman, Andrew Dilnot, a former director of the Institute for Fiscal Studies, described as one of the “ugliest” he had seen.

At present some residents in England with savings of more than £23 250 have been obliged to sell their homes to pay for the cost of residential care in old age, a situation that has caused widespread dissatisfaction.

The report recommends …
Physician Attitudes Toward Applications of Computer Data Base Systems
Authors: Joseph Singer
Journal: JAMA (1983)

To determine the attitudes of internists and surgeons to problems in clinical information management and to the use of a computer data base, a survey of 529 internists and 487 otolaryngologists was conducted. The survey group consisted of a national distribution of academic physicians, private practitioners, and residents. Results of 296 completed questionnaires were analyzed for this report. More than one third of all responders were not satisfied with their ability to keep up with new developments; less than 10% were very satisfied. Ninety percent thought that a computer data base would improve their access to information in the literature, and 85% thought it would improve their practice of medicine. Among internists, randomized control trials (RCTs) were viewed as clearly the most useful source of data. Otolaryngologists indicated that RCTs and patient registries were both very helpful. Most physicians indicated significantly greater preference for literature summary and patient registry features over probability estimation capabilities of a computer data base. Sources of data to be incorporated into a successful data base would be different for systems designed for internists and otolaryngologists. (<i>JAMA</i>1983;249:1610-1614)
Understanding the NSAID related risk of vascular events
Authors: Harald E Vonkeman, Jacobus R B J Brouwers, Mart A F J van de Laar
Journal: BMJ (2006)

Concern is growing about an increased risk of thrombotic events (including myocardial infarction and stroke) during the use of non-steroidal anti-inflammatory drugs (NSAIDs), in particular the so called selective cyclo-oxygenase-2 (COX 2) inhibitors. Although clinical trials give conflicting results with respect to the incidence of vascular events, increasing evidence shows that a class effect might exist for selective COX 2 inhibitors. Even before the massive introduction of selective COX 2 inhibitors, observational studies showed that the use of NSAIDs causes congestive heart failure in elderly patients.1,2 Conversely, the discontinuation of NSAIDs has also been associated with increased risk of myocardial infarction, especially in the first several weeks after stopping chronic NSAID treatment.3Many different mechanisms could explain the different effects of classic NSAIDs and selective COX 2 inhibitors in relation to thrombotic vascular events. In this review we link biochemical facts concerning NSAIDs and COX inhibitors with data from clinical trials.
Papal policy, poverty, and AIDS
Authors: M. Potts
Journal: BMJ (1990)

Theatre and ward costs incurred for patients having either hysterectomy or endomnetrial resection for menorrhagia Endometrial Hysterectomy resection Mean theatre time (h) 1-24 0-75 Mean length of stay (days) 10-6 1 Mean cost (£): Theatre time* 253.37 153.25 Central sterile supply department 19.06 11.20 Sutures 20.00 Dressing 0.30 Gloves 4.00 1.00 Glycine 6.93 Syringes 0.14 Double irrigation system 5.00 Suction tubing 0.70 Sterile water 1.20 1.20 Medical assistantt 11.92 Anaesthetic 12.07 9.47 Cost of operation 321.92 188.89Mean ward costs (£)t 1140.67 107.61Total cost (£) 1462.59296.50 *The costs of theatre time (£204.33/hour)are based on an ideal 90% use of scheduled theatre time and incorporate operating time plus the time for induction and reversal of anaesthesia.tCalculated at an hourly rate from the midpoint on the senior house officer pay scale multiplied by the mean theatre time taken to perform hysterectomy.tCalculated at £107.61 a day.
Hepatitis viruses and liver failure related deaths in human immunodeficiency virus infected patients
Authors: M. Puoti, A. Spinetti, A. Ghezzi, S. Rossi, M.A. Forleo, S. Zaltron, V. Putzolu, B. Zanini, A. Donisi, D. Tomasoni, G. Carosi
Journal: Journal of Hepatology (1998)
Platelet satellitism—An ultrastructural study
Authors: L. F. Skinnider, C. E. Musclow, W. Kahn
Journal: American Journal of Hematology (1978)

Ultrastructural studies by scanning and transmission electron microscopy were carried out on one of four cases of platelet satellitism. Adherence to the neutrophils was mainly by focal contact between small surface projections of the platelets and neutrophils. Phagocytosis was not seen with the neutrophils but was evident in the monocytes. The degree of satellitism noted increased with the time the blood anticoagulated with EDTA was left at room temperature. Mixing experiments with a patient's plasma and control cells and the patient's cells and control plasma were inconclusive but suggested that the abnormality may reside in the plasma.
Isolation of an acidic protein from cholesterol gallstones, which inhibits the precipitation of calcium carbonate in vitro.
Authors: S Shimizu, B Sabsay, A Veis, J D Ostrow, R V Rege, L G Dawes
Journal: Journal of Clinical Investigation (1989)

In seeking to identify nucleating/antinucleating proteins involved in the pathogenesis of cholesterol gallstones, a major acidic protein was isolated from each of 13 samples of cholesterol gallstones. After the stones were extracted with methyl t-butyl ether to remove cholesterol, and methanol to remove bile salts and other lipids, they were demineralized with EDTA. The extracts were desalted with Sephadex-G25, and the proteins separated by PAGE. A protein was isolated, of molecular weight below 10 kD, which included firmly-bound diazo-positive yellow pigments and contained 24% acidic, but only 7% basic amino acid residues. The presence of N-acetyl glucosamine suggested that this was a glycoprotein. This protein at concentrations as low as 2 micrograms/ml, but neither human serum albumin nor its complex with bilirubin, inhibited calcium carbonate precipitation from a supersaturated solution in vitro. This protein could be precipitated from 0.15 M NaCl solution by the addition of 0.5 M calcium chloride. Considering that cholesterol gallstones contain calcium and pigment at their centers, and that small acidic proteins are important regulators in other biomineralization systems, this protein seems likely to play a role in the pathogenesis of cholesterol gallstones.
High Level Expression of Cd43 Inhibits T Cell Receptor/CD3-Mediated Apoptosis
Authors: You-Wen He, Michael J. Bevan
Journal: The Journal of Experimental Medicine (1999)

In a screen designed to identify genes that regulate T cell receptor (TCR)/CD3-mediated apoptosis, we found that high level expression of CD43 protected T cell hybridomas from activation-induced cell death. The protection appears to result from its capacity to block Fas-mediated death signals rather than from inhibition of the upregulation of Fas and/or Fas ligand after T cell stimulation. We found that peripheral CD4+ T cells can be divided into two subsets based on the level of CD43 surface expression. The CD4+CD43low subset exhibits a naive T cell phenotype, being CD62LhighCD45RBhighCD44low, whereas CD4+CD43high cells exhibit a memory phenotype, being CD62LlowCD45RBlowCD44high. Recent studies have demonstrated that engagement of TCR and Fas induces naive CD4+ T cells to undergo apoptosis, and the same treatment enhances the proliferation of memory CD4+ T cells. We confirm here that peripheral CD4+CD43high T cells are resistant to TCR/CD3-mediated cell death. These results suggest that the expression levels of CD43 on naive and memory CD4+ T cells determine their susceptibility to Fas-dependent cell death and that high level expression of CD43 may be used as a marker to define CD4+ memory T cells. Expression of CD43 provides a novel mechanism by which tumor cells expressing abnormally high levels of CD43 may escape Fas-mediated killing.
Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension
Authors: B. Degano, A. Yaïci, J. Le Pavec, L. Savale, X. Jaïs, B. Camara, M. Humbert, G. Simonneau, O. Sitbon
Journal: European Respiratory Journal (2008)

Bosentan has proven 4-month efficacy in patients with HIV-associated pulmonary arterial hypertension (PAH-HIV). Herein, the long-term outcome of unselected PAH-HIV patients treated with first-line bosentan is described. Data for 59 consecutive World Health Organization (WHO) functional class II-IV PAH-HIV patients treated with first-line bosentan between May 2002 and July 2007 were analysed. HIV status, 6-min walk distance and haemodynamics were assessed at baseline, after 4 months and every 6-12 months thereafter. After 4 months, 6-min walk distance increased from 358+/-98 to 435+/-89 m and pulmonary vascular resistance decreased from 737+/-328 to 476+/-302 dyn x s x cm(-5). At the final evaluation (29+/-15 months), 6-min walk distance remained stable and pulmonary vascular resistance decreased further to 444+/-356 dyn x s x cm(-5). Haemodynamics normalised in 10 patients. At their last evaluation, these 10 patients were in WHO functional class I, with a 6-min walk distance of 532+/-52 m. Overall survival estimates were 93, 86 and 66% at 1, 2 and 3 yrs, respectively. Bosentan was safe when combined with highly active antiretroviral therapy, with no negative impact on HIV infection control. The present data confirm the long-term benefits of bosentan therapy in HIV-associated pulmonary arterial hypertension patients with improvements in symptoms, 6-min walk distance and haemodynamics, and with favourable overall survival.
EVALUATION OF PLATELET INHIBITION WITH POINT-OF-CARE DEVICE VERIFYNOW IN CHINESE PATIENTS WITH ACUTE CORONARY SYNDROME TREATED WITH CLOPIDOGREL AND PRASUGREL: A PROSPECTIVE COHORT STUDY
Authors: Chor Cheung Tam, Hon Wah Raymond Chan, Shun Ling Kong, Linda Lam, Arthur Yung, Ka Lam Wong, Simon Lam, Pak Hei Chan, Jo Jo Hai, Kelvin Chan, Yiu Tung Wong, Stephen Lee
Journal: Journal of the American College of Cardiology (2012)
Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography
Authors: Charlotte Bjork Ingul, Ellen Rozis, Stig A. Slordahl, Thomas H. Marwick
Journal: Circulation (2007)

Wall motion score at dobutamine stress echocardiography is an independent predictor of mortality. We sought to determine whether quantification of DSE by strain rate imaging was incremental to wall motion score for predicting outcome.In 646 patients undergoing dobutamine stress echocardiography for the evaluation of known or suspected coronary disease, customized software was used to automatically measure peak systolic strain rate (SR(s)) and end-systolic strain (S(es)) in 18 segments. Results were expressed as the number of abnormal segments and the mean SR(s) and S(es) per patient. All-cause mortality was identified over 7 years of follow-up (mean, 5.2+/-1.5 years). Contributions of clinical, wall motion, and SR(s) and S(es) data to outcome were analyzed with Cox models, which also were used to define cut points for SR(s) and S(es). Ischemia (new or worsening wall motion abnormalities) was detected in 45%, and 39% had a previous myocardial infarction. In patients with no ischemia, annualized mortality without and with previous myocardial infarction were 2% and 3% compared with 5% in patients with ischemia. Peak wall motion score index, mean SR(s), segmental S(es), and segmental SR(s) were all predictors of mortality, but only segmental SR(s) (hazard ratio, 3.6; 95% CI, 1.7 to 7.2) was independently predictive. In sequential Cox models, the model based on clinical data (overall chi2, 12.7) was improved by peak wall motion score index (18.4, P=0.002) and further increased by either segmental SR(s) (31.8, P<0.001) or mean SR(s) (25.7, P=0.009).Segmental analysis by SR(s), derived from automated strain rate imaging analysis of dobutamine stress echocardiography response, offers prognostic information that is independent and incremental to standard wall motion score index.
Recent advances: Paediatric surgery
Authors: P. D Losty
Journal: BMJ (1999)

Paediatric surgery—the surgical care of children from the fetus to adolescent—is a comparatively new surgical specialty, which began shortly after the second world war.1,2 Pioneering work during the formative years of the specialty has enabled many lethal congenital malformations to be corrected. The surgical treatment of childhood disease has also progressed enormously. This review focuses on recent advances in paediatric surgery and its relation with scientific research, which is rapidly translating state of the art care from research to the patient. 


Summary points


Exploring mechanisms to modulate abnormal fetal development pharmacologically may provide alternatives to fetal surgery and invasive fetal interventions


Progress in neonatal surgery has resulted in the survival of children with many types of congenital lethal malformations


Advances in paediatric gastroenterology include a greater understanding of biological mechanisms regulating normal and abnormal gut motility


New treatments are needed to induce biological regression of tumours and tumour maturation


Several laparoscopic techniques are now feasible, safe, and effective


Future developments include tissue engineering, antiangiogenic agents, scarless healing, in utero gene replacement, and treatments with growth factors








Methods
This article is based on a personal awareness of developments in paediatric surgery and relevant contributions from major paediatric surgical journals, review articles, and the proceedings from meetings of various international associations.
Is Informed Consent Always Necessary for Randomized, Controlled Trials?
Authors: Robert D. Truog, Walter Robinson, Adrienne Randolph, Alan Morris
Journal: New England Journal of Medicine (1999)

Consider this paradox: if a physician reads a case report about a novel method of ventilation for critically ill patients and wants to try it in the next several patients with respiratory failure he or she treats, the physician may do so provided the patients have given general consent for treatment. On the other hand, if a physician is interested in performing a randomized, controlled trial to determine rigorously which of two widely used antibiotics is more effective at treating bronchitis, he or she must prepare a formal protocol, obtain approval from the institutional review board, and seek written informed . . .
Remarks on a Mode of Applying the Short Midwifery-Forceps: Productive of less Pain to, and Disturbance of, the Patient, than that Usually Adopted
Authors: J. Braithwaite
Journal: BMJ (1869)

THERE is a large class of cases, especially in primiparae, in which, per- haps from some slight disproportion between the head of the child and the pelvis of the mother, from constitutional debility, or from accidental rupture of the membranes early in the case, the labour is exceedingly tedious, and the recovery afterwards correspondingly tardy and im- perfect.Now although, as an obstetric instrument, the forceps is everything that can be desired in cases of a severe type, yet for those in question it is hardly suitable.The instrument is seldom at hand when wanted, and has to be sent for, to the great alarm of the patient and her friends.It is, moreover, necessary, before it can be used, to move the patient to the edge of the bed, to empty the bladder, and to make other prepara- tions, which arouse her fears still more; and they are not lessened if she hear the metallic click of the blades.
Pregnancy Length May Vary by 5 Weeks
Authors: Bridget M. Kuehn
Journal: JAMA (2013)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2022 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
Cerebral protection during open-heart surgery.
Authors: T Aberg, M Kihlgren
Journal: Thorax (1977)

To reduce the incidence of cerebral damage after open-heart surgery measures were undertaken based on physiological principles and consideration of the possible injury caused by microemboli. Intellectual function was measured by psychometric tests before and after operation. The results were compared with those of an earlier series. There was a striking reduction in the incidence of neurolocial complications. There was also a considerable reduction in the degree of impairment of intellectual function previously shown to develop after open-heart surgery. However, there are still signs that cardiopulmonary bypass brings about subclinical cerebral injuriies. The measures taken and their rationale are discussed. Psychometric testing is a useful method for evaluating the quality of cardiopulmonary bypass as it allows a quantitative assessment of postoperative cerebral function.
The Director of Medical Education in the Nonuniversity Community Teaching Hospital
Authors: Henry S. M. Uhl
Journal: New England Journal of Medicine (1962)

GRADUATE medical education in the United States has grown rapidly since the close of World War II. The most recent intern and residency issue of the journal of the American Medical Association 1 listed 12,547 approved internship and 32,786 approved residency positions in more than 1300 university and nonuniversity hospitals, over half of these training programs being located in institutions that have no affiliation with a medical school. In contrast with these numbers, about 28,000 students are currently enrolled in the 85 schools of the country.The Council on Medical Education and Hospitals of the American Medical Association has expressed increasing . . .
A Multicenter Randomized, Placebo-Controlled Trial of Surfactant Therapy for Respiratory Distress Syndrome
Authors: Jeffrey D. Hobar, Roger F. Soll, James M. Sutherland, Uma Kotagal, Alistair G.S. Philip, Dale L. Kessler, George A. Little, William H. Edwards, Dharmapuri Vidyasagar, Tonse N.K. Raju, Alan H. Jobe, Machiko Ikegami, Martha D. Mullett, David Z. Myerberg, Timothy L. McAuliffe, Jerold F. Lucey
Journal: New England Journal of Medicine (1989)

We carried out a multicenter randomized, placebo-controlled trial to evaluate the efficacy and safety of surfactant in the treatment of respiratory distress syndrome. The study population was made up of newborn infants weighing 750 to 1750 g who were receiving assisted ventilation with 40 percent or more oxygen. The eligible infants received a single dose of either surfactant (100 mg of phospholipid per kilogram of body weight [4 ml per kilogram]) or an air placebo (4 ml per kilogram), administered into the trachea within eight hours of birth by an investigator not involved in the clinical care of the infant. When compared with the infants who received the placebo(n = 81), the infants who were treated with surfactant (n = 78) had a 0.12 greater average increase in the ratio of arterial to alveolar oxygen tension (P<0.0001), a 0.20 greater average decrease in the fractional inspiratory oxygen concentration (P<0.0001), and a 0.26-kPa greater average decrease in the mean airway pressure (P<0.0001) during the 72 hours after treatment. Pneumothorax was less frequent among the infants treated with surfactant than in the control group (13 percent vs. 37 percent; P = 0.0005). There were no statistically significant differences between the groups in the proportion of infants in each of five ordered clinical-status categories on day 7 (P = 0.08) or day 28 (P = 0.75) after treatment. There were also no significant differences between the groups in the frequency of bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or periventricular–intraventricular hemorrhage. In each group, 17 percent of the infants died by day 28. We conclude that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 72 hours after treatment and decreases the frequency of pneumothorax, but that it does not significantly improve clinical status later in the neonatal period and does not reduce neonatal mortality. Further study of different surfactant regimens and patient-selection criteria will be required to determine whether this initial improvement can be translated into reductions in mortality or serious morbidity. (N Engl J Med 1989; 320:959–65.)
Medicare Funding of Nursing Education
Authors: Alexis K. Weber
Journal: JAMA (1995)

<h3>To the Editor.</h3> —I agree with Dr Aiken and Ms Gwyther<sup>1</sup>that a percentage of Medicare funding should go to advanced practice nursing, but I do not support Medicare funding for baccalaureate nursing education. The educational and economic changes in our society favor diploma schools of nursing where a large percentage of students already have earned a baccalaureate degree and have limited financial resources. They paid the price for "higher education" only to find themselves in debt and without a decent income. The emerging trend in nursing education is the RN to MSN program whereby diploma and associate degree nurses bypass the redundant, expensive BSN and move to advanced practice. The mission of diploma schools is to provide quality bedside nurses, not practitioners, researchers, educators, or managers. The graying of America is here and the graying of nursing is right around the corner. Who will care for our elderly