tbuckley/cabot-search huggingface dataset:
Simulated patients in general practice: a different look at the consultation.
Authors: J J Rethans, C P van Boven
Journal: BMJ (1987)

To develop a better empirical basis for developing quality assessment in general practice three simulated patients made appointments with 48 general practitioners during actual surgery hours and collected facts about their performance. The simulated patients were indistinguishable from real patients and presented a standardised story of a symptomatic urinary tract infection. Two months later the same general practitioners received a written simulation about a patient who had the same urinary tract infection and were asked how they would handle this in real practice. Both results were scored against an existing consensus standard. The overall score for both methods did not show any substantial differences. A more differentiated analysis, however, showed that general practitioners performed significantly better with simulated patients. It also showed that general practitioners answering the written simulation performed significantly more unnecessary and superfluous actions. The results of this study show that the use of simulated patients seems to show the efficient performance of general practitioners in practice.
Mechanism of iron potentiation of hepatic uroporphyria: Studies in cultured chick embryo liver cells
Authors: Herbert L. Bonkovsky
Journal: Hepatology (1989)

Effects of iron were studied in cultured chick embryo liver cells to help elucidate the effect of hepatic iron in the human disease porphyria cutanea tarda and in toxic porphyria caused by chemicals. These cultures have proven useful because (a) phenobarbital and phenobarbital-like drugs induce a common form(s) of cytochrome P-450 (P-450-phenobarbital) in these cultures; (b) 20-methylcholanthrene and certain other polycyclic hydrocarbons induce a different form(s) (P-450-methylchol-anthrene), and (c) uroporphyria can be produced rapidly by exposure to suitable chemicals. In these cultures, treatment with iron alone did not produce porphyrin accumulation, and treatment with iron + 5-aminolevulinate caused accumulation of protoporphyrin, as did treatment with 5-aminolevulinate alone. However, treatment with phenobarbital-like drugs and iron, the latter at a concentration as low as 0.2 μ M , led to accumulation of uro- and heptacarboxylporphyrins. Potentiation of uroporphyrin accumulation by iron began before there was a detectable synergistic increase in activity of 5-aminolevulinate synthase, the rate-controlling enzyme of heme synthesis. In contrast, treatment of cultures with 20-methylcholanthrene, in the presence or absence of iron, did not result in uroporphyrin accumulation or an increase in the activity of 5-aminolevulinate synthase. Uroporphyrinogen decarboxylase activity was unchanged by drug and iron treatments. Inhibitors of P-450-phenobarbital, SKF525A and piperonyl butoxide, as well as cadmium and cycloheximide prevented the porphyrin accumulation produced by glutethimide + iron, even though, except with cycloheximide, these substances further increased 5-amino-levulinate synthase activity. In vitro , uroporphyrin was oxidized autocatalytically by iron. In intact hepatocytes, even low concentrations of iron (0.2 to 20 γ M ), in the presence of a form of cytochrome P-450 induced by phenobarbital-like chemicals, produces uroporphyria primarily by enhancing uroporphyrinogen oxidation, not by inhibition of the decarboxylase. Induction of 5-aminolevulinate synthase amplifies the porphyrin overproduction.
Rabies of 1968
Authors: Howard S. Weiss
Journal: JAMA (1968)

<h3>To the Editor:—</h3> This letter concerns your recent editorial, "Rabies 1968 Model" (<b>203</b>:420, 1968). The subject of recovery from<i>clinical</i>human rabies has now reached those columns, and I suspect will become one of the preferred references on this subject. Five articles were listed in the reference cited.<sup>1</sup> First was an interesting article<sup>2</sup>referring to what appears to be antirabies antibody in people who have<i>not</i>had clinical rabies. I am sure that this information would be unacceptable as proof of recovery from clinical rabies. The second article<sup>3</sup>can hardly be accepted as anything else but several excellent examples of recovery from rabies<i>hysteria</i>. The most interesting problem arises when one reads the remaining three references.<sup>4,5,6</sup>It is immediately apparent that they represent not three new cases of recovery from clinical rabies but three descriptions of the same illness of a single Pittsburgh physician. I
Hemodynamic characteristics of the intrahepatic portal vascular bed over an extended flow range: A study in the isolated perfused rat liver
Authors: Howard J. Grossman, Virginia L. Grossman, Prithi S. Bhathal
Journal: Hepatology (1995)

The relationship between the perfusion pressure (P) and resistance (R) of the intrahepatic portal vascular bed was determined in isolated rat liver preparations perfused with fresh, heparinized rat blood (hematocrit 30%), with rat blood containing a vasodilator agent (sodium nitroprusside, 1 X 10(-3) mol/L), or with 2.5% bovine serum albumin in Krebs-Henseleit buffer (BSA-KH). Pressure-flow curves were constructed over an extended range of portal venous inflow (0 to 70 mL.min-1, corresponding to a flow rate per gram liver wet weight, Q, of approximately 0 to 7 mL.min-1.g-1). Subsequent analysis showed that two mathematical expressions adequately described the data over the full range of flow. Thus, the pressure-flow curve could be represented by (a) the sum of a linear plus a hyperbolic function, i.e., P = Q.R' + Pmax.Q/(Q + Km), where R', Pmax, and Km are constants, or (b) by the simple equation G = C.P, where G is the conductance (Q/P), and C is a conductivity constant. The values of R', Pmax, Km, and C were significantly different under each of the circumstances investigated, but the form of the curve was not altered. Hence, it is proposed that these parameters can be used to describe the fundamental hemodynamic properties of the portal vascular bed of the isolated rat liver. The results are discussed in terms of the microvascular recruitment and distensible resistance vessel models of the hepatic microcirculation.
Mental Health and the Army
Authors: Mark C. Russell, Sue Nicholson Butkus
Journal: JAMA Psychiatry (2014)

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 Psychiatry HomeNew OnlineCurrent IssueFor Authors Podcast 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 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Psychiatry journal
The patient's charter and the triage nurse.
Authors: T. Keighley, J. Maycock
Journal: BMJ (1992)

The improved use of Electronic Health Record (EHR) Systems provides an opportunity to improve the overall efficiency and quality of care of patients with epilepsy. Tools and strategies that may be incorporated into the use of EHRs include utilizing patient generated data, clinical decision support systems and natural language processing systems. Standardization of data from EHR systems may lead to improvement in clinical research through the creation of data collections and multi-center collaborations. Challenges to collaborative use of EHR Systems across centers include costs and the diversity of EHR systems.
Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine
Authors: L Fritsche
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objective:</b> To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. <b>Design:</b> Development and validation of an assessment instrument and before and after study. <b>Setting:</b> Various postgraduate short courses in evidence based medicine in Germany. <b>Participants:</b> The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. <b>Intervention:</b> Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. <b>Main outcome measure:</b> Increase in knowledge and skills. <b>Results:</b> The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) <i>v</i> 9.9 (SD 2.8), P&lt;0.001). No difference was found among experts or students in absence of an intervention. <b>Conclusions:</b> The instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.
Inquests into patients who die while under a deprivation of liberty order
Authors: S. Ormond-Walshe, R. Furniss, A. Harris, K. Winfield, D. A. Haigh
Journal: BMJ (2015)

Thirty-eight of 58 patients with skeletal tuberculosis (TB) reviewed were immigrants and 20 were of British indigenous origin. Spinal involvement i 28 cases was less common than involvement of peripheral joints, bones, or tendon sheaths (30 cases). Predisposing factors, including previous TB, were present in 70% of British patients and 31% of immigrants. Follow-up study of 23 cases showed that a complete clinical recovery of the skeletal disease was more likely in immigrants than indigenous cases and also in cases referred to hospital early. Immigrants presented usually within 5 years after arrival in Britain and at a younger age than indigenous cases; a quarter had within 5 sites of infection outside the skeletal system. Skeletal tuberculosis in the indigenous population remains very uncommon, and in half of these cases a history of previous TB was given. The need for continued awareness of skeletal TB is stressed, especially in immigrants, and also the importance of early diagnosis and institution of appropriate therapy.
The Kidney and Infectious Mononucleosis: Light and Electron Microscopic Study.
Authors: Sheldon Alter, Raoul Fresco, William J. Jacoby, Phillip Freedman
Journal: Annals of Internal Medicine (1968)

s1 May 1968The Kidney and Infectious Mononucleosis: Light and Electron Microscopic Study.Sheldon Alter, Raoul Fresco, M.D., William J. Jacoby, Phillip Freedman, M.D.Sheldon AlterSearch for more papers by this author, Raoul Fresco, M.D.Search for more papers by this author, William J. JacobySearch for more papers by this author, Phillip Freedman, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1178_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe electron microscopic study of the kidneys of patients with infectious mononucleosis and urinary abnormalities has not been reported previously. Four patients with infectious mononucleosis as diagnosed by the presence of heterophil antibodies and positive Davidson differential test and who had mild hematuria were biopsied.The biopsies were studied with the light and electron microscope. Only minimal changes were seen by light microscopy, consisting of moderate glomerular swelling and congestion without hypercellularity and having small foci of interstitial mononuclear cell infiltration.The electron microscopic studies to date have been confined to the glomerulus. These studies show normal cellularity confirming the... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Great Lakes and Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1178-1178KeywordsAntibodiesBiopsyElectron microscopyInflammationKidneysLight microscopyUrinary tract infections Issue Published: 1 May 1968 PDF DownloadLoading ...
Drug-Induced Esophagitis
Authors: Paul M. Jost
Journal: JAMA (1985)

To the Editor.—  I read with great interest the report by Amendola and Spera 1 on esophagitis caused by doxycycline. Their discussion indicates that complete resolution of the problem should occur within one week after discontinuation of therapy with the drug. Other sources, 2 as well as a current gastroenterology text, 3 agree with this time frame. Recent personal experience reveals that the course may be prolonged.  The morning after completing a course of doxycycline, I awakened with marked midline substernal chest pain. I also experienced severe pain on swallowing. Despite use of ranitidine, antacids, and oral viscous lidocaine, the pain and discomfort with swallowing continued. Four days after the onset of pain, I was hospitalized with dehydration. Esophagoscopy revealed a discrete full-thickness mucosal ulcer at 30 to 32 cm from the incisors in midesophagus, without evidence of reflux injury or infectious agents. Not until ten days after the onset
Translocation of Pagetʼs Disease to the Tibia in an Iliac Crest Bone Graft
Authors: GIUSEPPE T. CARDACI
Journal: Clinical Nuclear Medicine (1994)

A 75-year-old man had right hip and knee pain for 18 months. Seven years earlier, he underwent bone grafting to the lateral condyle of the right proximal tibia after a fracture. The bone graft was harvested from the right ilium. A Tc-99m MDP study showed intense uptake in the right proximal tibia, particularly in the lateral aspect. Increased uptake was also noted throughout the pelvis, as well as the humeri, right scapula, and thoracic spine.
Spontaneous Bacterial Peritonitis
Authors: John C. Hoefs, Hanna N. Canawati, Francisco L. Sapico, Randy R. Hopkins, John Weiner, John Z. Montgomerie
Journal: Hepatology (1982)

Forty-three patients with spontaneous bacterial peritonitis (SBP) between 1973 and 1978 were identified. Criteria for SBP included a positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3. Chronic liver disease was documented by varices in 91%, severe histologic fibrosis or cirrhosis in 94%, splenomegaly in 91%, and past hospitalization for liver disease in 57% of the patients. SBP was detected within 7 days of admission in 17 patients (40%) and within 35 days in 38 patients. Single organisms were isolated from 38 patients and multiple organisms from 5 patients. Twenty-six of 43 patients survived the episode of SBP, but only 13 survived the hospitalization. Analysis of the survival curve from the onset of SBP revealed a rapid death rate and a slow death rate set of patients. Rapid death (less than or equal to 7 days from SBP onset) correlated with a lack of prior hospitalization for liver disease (p less than 0.001), hepatomegaly (p less than 0.001), increased serum bilirubin (p less than 0.005), serum creatinine (p less than 0.05), and peripheral white blood cell concentrations (p less than 0.05). Survival during hospitalization was associated with prior hospitalization with liver disease (p less than 0.001) and chills during the episode of SBP (p less than 0.001). The 43 patients were divided into Group 1 patients on the basis of a serum bilirubin greater than 8 mg% and/or serum creatinine greater than 2.1 mg%; Group 2 patients had lower values. Survival was greater in Group 2 patients with advanced, relatively quiescent liver disease compared to Group 1 patients for both the episode of SBP (91 vs. 29%; p less than 0.001) and for hospitalization (50 vs. 9%; p less than 0.05). Death in Group 2 patients was related to inadequate antibiotic therapy (p less than 0.05), nonhepatic factors, and new onset of renal failure. Although SBP in the setting of severe acute liver injury has a dismal prognosis, SBP with minimal acute liver injury has a relatively good prognosis for hospital survival even with advanced chronic liver disease. Long-term survival is also possible since 4 of 9 patients with prolonged follow-up have survived 3 years.
Spotlight on gender
Authors: Peter Collins, John C Stevenson, Lori Mosca
Journal: Cardiovascular Research (2002)

It is well established that important differences exist between women and men with regard to the function and diseases of the cardiovascular system. Women appear to be protected from the most common form of cardiovascular disease, coronary heart disease, when compared to men. The reason(s) for this apparent protection in women are not fully understood and may not solely be related to hormonal differences. Data generated from epidemiological studies and basic science research about steroid hormone receptors and ion channels in cells provide evidence for distinct differences with regard to gender. Despite a wealth of surrogate endpoint and observational data suggesting hormones may play a cardioprotective role in women, clinical trials have yielded unexpected findings and at this time do not provide evidence to assert that hormone replacement therapy reduces the risk of cardiovascular events in women. We hope that this series of articles in the Spotlight issue will highlight some of the interesting gender differences in cardiovascular disease. We are pleased to present both invited reviews and original data.

The issue is divided into five sections covering a number of topics:

The issue begins with an overview of coronary heart disease comparing differences in risk factors between men and women, with an emphasis on menopause and cardiovascular risk [1]. It is salutary to consider that most women are unaware that, particularly in later ages, their risk of suffering from or dying of coronary heart disease is greater than any other disease process. The specific effect of age is discussed and gender differences in plasma lipids are highlighted to explain some of the differences [2]. Wenger [3] summarises current issues in the presentation, investigation and treatment of coronary heart disease in women and focuses on the specific management and assessment of coronary heart disease in women. Cigarette smoking … 

* Corresponding author. Tel.: +44-207-351-8112; fax: +44-207-823-3392 peter.collins{at}ic.ac.uk j.stevenson{at}ic.ac.uk ljm10{at}columbia.edu
Letter: Death in hemophiliacs
Authors: J. H. Lewis
Journal: JAMA (1976)

<h3>To the Editor.—</h3> Approximately five years ago (214:1707, 1970), we reviewed the causes of death in hemophiliacs who had been examined here. This was before many of the recent improvements in therapy, which include the use of potent coagulationfactor concentrates prepared from pooled plasma on an early or regular basis—usually at home, extensive patient education, and the dissemination of information to the medical community. A further review of causes and ages at death should prove an indicator of the success of the new therapeutic programs. In the last 20 years, 378 hemophiliacs have been studied here. Attempts have been made to trace all of those not currently active (93 of 272) or known to be dead (65). Of 41 deaths, 15 occurred in University hospitals, 13 in area hospitals, seven in out-of-state hospitals, and six at home. Satisfactory information was obtained for all except five of the six who died
Effects of Combined Exposure to Lead and High-Fat Diet on Bone Quality in Juvenile Male Mice
Authors: Eric E. Beier, Jason A. Inzana, Tzong-Jen Sheu, Lei Shu, J. Edward Puzas, Robert A. Mooney
Journal: Environmental Health Perspectives (2015)

BackgroundLead (Pb) exposure and obesity are co-occurring risk factors for decreased bone mass in the young, particularly in low socioeconomic communities.ObjectivesThe goal of this study was to determine whether the comorbidities of Pb exposure and high-fat diet–induced obesity amplify skeletal deficits independently associated with each of these risk factors, and to explore associated mechanisms of the observed deficiencies.MethodsFive-week-old male C57BL/6J mice were placed on low-fat (10% kcal, LFD) or high-fat (60% kcal, HFD) diets for 12 weeks. Mice were exposed to lifetime Pb (50 ppm) through drinking water.ResultsHFD was associated with increased body mass and glucose intolerance. Both HFD and Pb increased fasting glucose and serum leptin levels. Pb and HFD each reduced trabecular bone quality and together had a further detrimental effect on these bone parameters. Mechanical bone properties of strength were depressed in Pb-exposed bones, but HFD had no significant effect. Both Pb and HFD altered progenitor cell differentiation, promoting osteoclastogenesis and increasing adipogenesis while suppressing osteoblastogenesis. In support of this lineage shift being mediated through altered Wnt signaling, Pb and non-esterified fatty acids in MC3T3 cells increased in vitro PPAR-γ activity and inhibited β-catenin activity. Combining Pb and non-esterified fatty acids enhanced these effects.ConclusionsPb and HFD produced selective deficits in bone accrual that were associated with alterations in progenitor cell activity that may involve reduced Wnt signaling. This study emphasizes the need to assess toxicants together with other risk factors relevant to human health and disease.CitationBeier EE, Inzana JA, Sheu TJ, Shu L, Puzas JE, Mooney RA. 2015. Effects of combined exposure to lead and high-fat diet on bone quality in juvenile male mice. Environ Health Perspect 123:935–943; http://dx.doi.org/10.1289/ehp.1408581