tbuckley/cabot-search huggingface dataset:
Quality Assurance in Capitated Physician Groups
Authors: Eve A. Kerr
Journal: JAMA (1996)

<h3>Objective.</h3> —To describe quality assurance (QA) programs implemented by capitated physician groups; to measure their relative emphasis on monitoring of overuse compared with underuse and monitoring and improving preventive services compared with chronic disease care; and to examine how group characteristics influence QA activity. <h3>Design.</h3> —Cross-sectional questionnaire. <h3>Setting.</h3> —A large network-model health maintenance organization in California (133 contracting physician groups). <h3>Participants.</h3> —Ninety-four physician groups (71%) caring for 2.9 million capitated patients. <h3>Main Outcome Measures.</h3> —Self-reported use of quality monitoring and improvement methods. <h3>Results.</h3> —All capitated physician groups conducted some QA. Groups' QA programs monitored areas subject to overuse, such as cesarean delivery and angioplasty rates, more than areas subject to underuse, such as childhood immunization rates and performance of retinal examinations for diabetic patients (64% vs 43%,<i>P</i>&lt;.001). They monitored underuse of preventive services more than follow-up services for chronic diseases (54% vs 31%,<i>P</i>&lt;.001). Groups also used reminders for preventive services more than they monitored follow-up services for chronic diseases (26% vs 15%,<i>P</i>&lt;.01). Physician group characteristics independently associated with higher overall QA activity were greater number of years in existence, higher profitability, and capitated care penetration. <h3>Conclusion.</h3> —Capitation places a large share of responsibility for QA in the hands of physician groups, but not all aspects of QA are being equally addressed. The emphasis on overuse may result from financial incentives inherent in capitation, while the focus on preventive services may stem from lack of adequate quality measurement tools for monitoring chronic disease care. Further research efforts should address how capitated physician groups might expand their QA programs to include monitoring of underuse, especially for patients with chronic disease.
Patent rules must not hinder access to cheap drugs in poor countries, experts say
Authors: J. Zarocostas
Journal: BMJ (2011)

New ways are needed to enable manufacturers to produce cheaper, generic products while ensuring that innovation is encouraged through appropriate patent protection, experts say. This would ensure that public health systems in poor countries can provide universal access to lifesaving drugs, they argue.

The patent status of drugs is becoming a pressing issue for healthcare providers, as the production of a growing number of drugs is affected by stricter intellectual property protection being imposed in countries that are major producers of generic drugs, such as India.

Margaret Chan, director general of the World Health Organization, warned that stricter rules will reduce access to affordable drugs for the world’s poorest people. She was speaking …
A Short Sad Clinical Note
Authors: John Ritter
Journal: JAMA (1971)

<h3>To the Editor.—</h3> The medical facts are as common as cornbread. A 70-year-old man came to my office in the middle of December. He was healthy except for a small hydrocele that he wanted me to fix. I told him that surgery was not necessary and he left without protest. The human facts are less clear. I knew that he was old and lonely and poor. I saw no depression and he was certainly not out of contact with reality. Somehow he must have had a desperate need, because on Christmas day in a tar-paper shack in an abandoned coal camp he blew out his brains with a shotgun. Perhaps I should have put him in a warm hospital full of Christmas decorations and young nurses happy with holiday plans. Perhaps I should have accepted the sacrifice of his small hydrocele in exchange for a good meal and a kind
Propylene glycol-induced side effects during intravenous nitroglycerin therapy
Authors: H. E. Demey, R. A. Daelemans, G. A. Verpooten, M. E. De Broe, Ch. M. Van Campenhout, F. V. Lakiere, P. J. Schepens, L. L. Bossaert
Journal: Intensive Care Medicine (1988)
Pulmonary regurgitation in large atrial shunts without pulmonary hypertension.
Authors: R R Liberthson, M J Buckley, C A Boucher
Journal: Circulation (1976)

Seven patients with pulmonary regurgitation (PR), normal pulmonary artery (PA) pressures and large left-to-right atrial shunts are reported. Six had secundum atrial septal defects (ASD) and one had anomalous pulmonary venous drainage. These comprised 4% of 180 patients with atrial shunts and normal PA pressures. Pulmonary regurgitation was diagnosed clinically by mid-frequency diastolic decrescendo murmurs beginning after the pulmonic component of the second heart sound, and diagnoses were confirmed by catheterization. In two patients who had serial preoperative catheterizations over 8 and 16 years, PR progressed in one and was present only on the second study in the other. All patients underwent shunt correction, at which time the pulmonic anulus and artery appeared dilated, but the pulmonic valves were normal and did not require revision. In all patients the PR murmur disappeared after shunt correction alone, and on chest X-ray both PA and overall heart size decreased. Although it is known that pulmonary regurgitation occurs with atrial septal defects and pulmonary hypertension, the present study demonstrates that it also occurs with high flow atrial shunts, in which setting it has different implications and is reversible with shunt correction alone.
Induction of plasminogen activator synthesis by antibodies.
Authors: D Becker, L Ossowski, E Reich
Journal: The Journal of Experimental Medicine (1981)

We have purified the immunoglobulins (IgG) from rabbit antisera raised against two cell lines--LLC-PK1 derived from pig kidney and from Kirsten sarcoma virus-transformed BALB/3T3--and have studied the effects of IgG on cultures of the respective target cells. The following observations were made with both cell types: (a) The addition of purified IgG produced a rapid change in morphology within 2 h. This consisted of cell rounding, agglutination, and detachment from the surface of the dish. (b) Beginning approximately 2 h after IgG addition there was a progressive rise in plasminogen activator production for 24--36 h. (c) Both the morphological change and the induction of plasminogen activator (PA) synthesis were reversible and required the continued presence of IgG for their maintenance. The increase in PA production, but not morphological change, depended on genetic transcription and translation, being inhibited by actinomycin and/or cycloheximide. (d). These effects of IgG were specific: they were not observed with preimmune or indifferent IgG and occurred only after interaction between an IgG preparation from antisera and the cells used to generate the particular antiserum. The divalent IgG fragments F(ab')2 retained fully the activities of the native IgG molecules from which they were derived.
Vaccination Success Rate and Reaction Profile With Diluted and Undiluted Smallpox Vaccine
Authors: Thomas R. Talbot, Jack T. Stapleton, Rebecca C. Brady, Patricia L. Winokur, David I. Bernstein, Teresa Germanson, Sandra M. Yoder, Michael T. Rock, James E. Crowe, Jr, Kathryn M. Edwards
Journal: JAMA (2004)

ContextAdditional smallpox vaccine doses are needed to augment current US national stockpile. Aventis Pasteur smallpox vaccine (APSV), initially manufactured in the 1950s from the New York Board of Health vaccinia strain in a frozen preparation, appears as effective as lyophilized vaccine but the effectiveness of diluted doses of APSV is unclear.ObjectiveTo compare the vaccination success rate and the reaction profile of various APSV dilutions.Design, Setting, and ParticipantsA double-blind, randomized controlled trial of 340 healthy vaccinia-naive adults aged 18 to 32 years from 3 academic medical centers who were vaccinated with 1 of 3 strengths of APSV dilutions (undiluted, 1:5, and 1:10) between October 9, 2002, and February 24, 2003. Volunteers were followed up every 3 to 5 days until the vaccination site healed for bandage changes, vaccine response assessment, and adverse event evaluation, followed by 1- and 2-month clinic evaluations and 6-month telephone interview.Main Outcome MeasuresSuccessful vaccination, defined by presence of a vesicle or pustule at the inoculation site 6 to 11 days postvaccination, and local and systemic reactions to vaccination.ResultsA total of 340 volunteers were vaccinated (vaccine dose: undiluted, n = 113; 1:5 dilution, n = 114; and 1:10 dilution, n = 113). Following vaccination, 99.4% (95% confidence interval [CI], 97.9%-99.9%) of all volunteers had successful vaccinations. Success rates did not differ between the dilution groups (undiluted, 100.0%; 95% CI, 96.8%-100.0%; 1:5 dilution, 98.2%; 95% CI, 93.8%-99.8%; 1:10 dilution, 100.0% 95% CI, 96.8%-100.0%; P = .33). Overall, 99.7% of volunteers reported at least 1 local symptom at the vaccination site, and 61.8% had axillary lymphadenopathy, 15.0% developed satellite lesions, and 7.6% developed a rash away from the vaccination site. Fever developed in 21.5%. No differences were noted in local or systemic reactions between the 3 dilution groups (P>.05 for each comparison). A total of 25% of volunteers missed scheduled duties due to vaccine-related symptoms.ConclusionsEven at diluted doses, APSV is an effective smallpox vaccine, allowing for expansion of the current stockpile. However, reactogenicity was not reduced with dilution of the vaccine and, as with other smallpox vaccines, may impair daily activities.
EXPLORATIONS IN ALTERNATIVES TO HOSPITALIZATION
Authors: ROBERT F. MOORE, ROBERT S. ALBERT, MARY JANE MANNING, BETTY ANN GLASSER
Journal: American Journal of Psychiatry (1962)

During a 6-month period, the Community Extension Service sought alternatives to hospitalization for 37 persons awaiting admission to the Massachusetts Mental Health Center; 18 (49%) were successfully treated as outpatients, and remained in the community for at least 12 months, and 19 (51%) were hospitalized. It is concluded that alternatives to inpatient care can be provided for a significant number of persons who are referred for admission, and that the cost of these alternatives is no greater than the cost of ward care. Special personnel, unusual techniques, and elaborate resources are not required for these alternatives. What is required is a different view of the function of the mental hospital. When the treatment team decides that hospitalization often can and should be circumvented, and adopts prevention of admission as one of its primary functions, it will find practical alternatives to admission right at hand. The team will need a willingness to take responsibility for the patient's care promptly; a willingness to be flexible with regard to how and where treatment is to be given; and a willingness to consider together the patient, his family, and his environment in diagnosis and treatment.
Interactive effects of environmentally relevant polychlorinated biphenyls and dioxins on [3H]phorbol ester binding in rat cerebellar granule cells.
Authors: P R Kodavanti, T R Ward
Journal: Environmental Health Perspectives (1998)

Polychlorinated biphenyls (PCBs) are persistent contaminants that exist as complex mixtures in the environment. One problem faced by risk assessors is that the possible interactive effects of specific PCB congeners and related chemicals found in environmental and biological samples have not been systematically investigated. Some PCBs perturb Ca2+ homeostasis and cause protein kinase C (PKC) translocation in neuronal cell cultures and in brain homogenate preparations at concentrations where no cytotoxicity is observed, and these systems are necessary for the growth and normal functioning of neurons. The changes in second messenger systems appear to be associated with the extent of noncoplanarity of the PCB molecule. We studied the interactive effects of selected PCB congeners, a PCB metabolite, and a dioxin on PKC translocation, as determined by [3H]phorbol ester binding in cerebellar granule cells. The binary combinations included coplanar and noncoplanar PCB congeners or PCB congeners with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)/PCB metabolite. In addition, we tested the interactive effects of several PCB congeners (three or more) found in environmental samples such as human milk and blood, contaminated fish, and brain samples from PCB-treated animals. The results indicated that 1) the coplanar congener [3,3',4, 4'-tetrachlorobiphenyl (TeCB)] did not alter the in vitro activity of the noncoplanar (2,2',5,5'-TeCB) or coplanar [4, 4'-dichlorobiphenyl (DCB)] congeners; 2) binary mixtures of active PCB congeners (2,2',4,4'-TeCB and 2,2'-DCB; 2,2'-DCB and 3,5-DCB; 2,2',3,5',6-PeCB and 2,2',4,4',5-PeCB) interact in a dose-additive manner; 3) TCDD did not alter the activity of either coplanar (3,3', 4,4'-TeCB) or noncoplanar (2,2',5,5'-TeCB) congeners; 4) the interaction between the parent PCB congener and hydroxy metabolite of PCB is additive; 5) PCB congener mixtures at the ratios found in environmental samples are biologically active; and 6) there was no indication of synergism in any of the combinations studied. These results suggest that the biological effects of binary mixtures of PCB congeners fit a dose-additive model, indicating that there is a specific site of action for these PCB congeners which is independent of the aryl hydrocarbon receptor. Environmental mixtures contain mostly noncoplanar PCB congeners, and because they appear to be biologically active, the potential human health risk by this group of chemicals should be considered in the risk assessment of PCBs.
PUBLIC HEALTH POWERS.WHERE UNDER OUR FORM OF GOVERNMENT DO THEY RESIDE AND HOW SHOULD THEY BE EXERCISED?
Authors: W. H. SANDERS
Journal: JAMA (1903)

Industrial education is, therefore, a movement capable of doing great good for the race.They should be taught to economize, to save their money and put it in homes and farms.That for their race the dangers of Sodom lie in the towns and cities; that there lurk consumption and death.
Amyloid Deposition in a Renal Transplant in Familial Mediterranean Fever
Authors: MERRILL D. BENSON
Journal: Annals of Internal Medicine (1977)

A patient with familial Mediterranean fever and amyloidosis who received a cadaver renal transplant 6½ years ago was studied to determine the relation of the serum precursor of secondary amyloid (SAA) to the clinical course and to the deposition of amyloid in the transplant. Amyloid fibrils extracted from the patient's kidneys contained protein AA as a major constituent, which identified the amyloid as secondary. Protein AA antiserum was used in an indirect immunofluorescent technique to stain amyloid deposits in sections of the original kidney. A renal biopsy at 2 years showed no amyloid, but a renal biopsy at 4 years showed amyloid. Serum levels of SAA from 3 years before transplant to 6 years after transplant were elevated throughout most of the course.
BMA Annual Representative Meeting: “Black hole” is opening up for 11 500 junior doctors
Authors: Annabel Ferriman
Journal: BMJ (2006)

Doctors at the BMA annual representatives' meeting in Belfast this week expressed outrage at the probable shortage of 11 500 training posts for junior doctors next year.

Jo Hilborne, who chairs the BMA's Junior Doctors Committee, appealed to the 550 representatives to save junior doctors from “the career black hole currently looming before them.”

The senior house officer grade will cease to exist next summer as part of Modernising Medical Careers, the NHS's new training and careers structure for doctors, and more than 21 000 doctors will be looking for posts in specialist training programmes, she said.

The Modernising Medical Careers team announced …
PTH-197 Long-Term Efficacy of Lubiprostone Demonstrated in Patients with Constipation Regardless of age, Gender or Race: Abstract PTH-197 Table 1
Authors: T Joswick, G Dolecek, P Lichtlen, D Panigrahi, R Ueno
Journal: Gut (2013)

<h3>Introduction</h3> Constipation affects millions globally and may require chronic treatment. In 24- and 48-week trials, lubiprostone demonstrated safety and efficacy in long-term treatment of adults with chronic idiopathic constipation. Analyses of lubiprostone's (24 mcg BID) efficacy in age, gender and race subgroups were performed. <h3>Aims and Methods</h3> Pooled data from three Phase 3 open-label safety studies were reviewed to analyse efficacy in the following subpopulations: non-elderly (&lt; 65 years) and elderly (≥65 years); male and female; and non-white and white. Constipation severity, abdominal bloating, and abdominal discomfort were rated on a 5-point scale ranging from absent = 0, mild = 1, moderate = 2, severe = 3 and very severe = 4, and changes from baseline following treatment with lubiprostone were analysed. <h3>Results</h3> In the non-elderly and elderly, lubiprostone improved constipation severity (p≤0.0001) each week beginning at Week 1 and continuing through Week 48. Among males and females, lubiprostone improved (p≤0.0001) constipation severity each week with similar findings (p≤0.0001) for non-whites and whites, For abdominal discomfort, significant changes were seen at all weeks in the non-elderly (p≤0.0001) and for all weeks in the elderly (p≤0.0001 to p = 0.0150) except Week 8 (p = 0.0530). Among the genders, improvements occurred at all weeks in males (p≤0.0001 to p = 0.0220) and in females (p≤0.0001). By race, improvements occurred at all weeks among non-whites (p≤0.0001 to p = 0.0020) and among whites (p≤0.0001). Significant changes in abdominal bloating were seen in the non-elderly (p≤0.0001) and for the elderly (p≤0.0001 to p = 0.0180) at all weeks. Abdominal bloating improved at all weeks for males (p≤0.0001 to p = 0.0010) and females (p≤0.0001). For non-whites and whites, abdominal bloating improved (p≤0.0001) at all weeks. <h3>Conclusion</h3> Lubiprostone demonstrated long-term efficacy through an overall improvement in constipation severity for up to 12 months regardless of age, gender, or race. Similarly, improvements were noted in abdominal bloating and abdominal discomfort for both race and gender subpopulations along with some significant and positive trend for improvement in the age group analyses. <h3>Disclosure of Interest</h3> None Declared.
Unproven diagnostic procedures in IgE‐mediated allergic diseases
Authors: B. Niggemann, C. Grüber
Journal: Allergy (2004)

A considerable body of literature on therapeutic aspects of complementary and alternative medicine has been published in recent years, but little is known on diagnostic procedures. This short review lists complementary and alternative diagnostic procedures for the diagnosis of allergic diseases and presents an assessment of their usefulness for the daily practice. The review of the literature revealed that neither the determination of specific immunoglobulin G‐antibodies in serum, the hair‐analysis, the cytotoxic test, kinesiology, iridology, or electrodermal testing represent useful tests for the daily practice. To date, no complementary or alternative diagnostic procedure can be recommended as a meaningful element in the diagnostic work‐up of allergic diseases. This is especially true for food allergy: properly performed oral food challenges still represent the gold standard for implementing specific diets in food allergic individuals. Ineffective diagnostic approaches may be costly for the consumer and delay appropriate therapy.
Abstract 2756: Targeted inhibition of Chromosomal Maintenance Region Protein (CRM1) potently suppresses growth of human neuroblastoma cell line models.
Authors: Edward F. Attiyeh, Aaron McKeon-Fish, Yosef Landesman, William Senapedis, Dilara McCauley, Trinayan Kashyap, Sharon Shacham, Michael Kauffman, John M. Maris
Journal: Cancer Research (2013)

Abstract Background: Neuroblastoma is a childhood malignancy of the peripheral nervous system, and most patients with high-risk disease are not cured. New therapies are needed, but recurrent somatic mutations indicative of a tractable therapeutic target are rare. Translocation of p53, FOXO, IκB and other critical tumor suppressor proteins (TSPs) from the nucleus to the cytosol is mediated by exportin 1 (CRM1, XPO1), suggesting that inhibition of CRM1 is a rational anti-cancer strategy. KPT-330 is a Selective Inhibitor of Nuclear Export (SINE) that irreversibly binds CRM1 and is currently in Phase 1 clinical trials. SINE inhibits CRM1-mediated nuclear export across multiple tumor types leading to activation of TSPs and cancer cell death. Methods: A panel of 14 well-characterized neuroblastoma cell lines was treated with KPT-330 across a 5-log range. Growth inhibition was measured using CellTiter-Glo (Promega) viability assays and a real time growth monitoring system (xCELLigence, Roche). NOD/SCID mice with neuroblastoma xenografts were treated orally with KPT-330 and tumor size was monitored. Results: KPT-330 showed cytotoxicity against 14 neuroblastoma cell lines with a median IC50 of 289±47.5 nM. Sensitivity to KPT-330 was independent of MYCN amplification status. Combination of KPT-330 with commonly used cytotoxic agents (irinotecan, topotecan, cisplatin, doxorubicin) showed additive effects. In xenograft models using the neuroblastoma cell lines IMR-32 and SH-SY5Y, oral administration of KPT-330 (10 or 20 mg/kg, twice or thrice weekly) was well tolerated and showed significant tumor growth inhibition (p&amp;lt;0.001). KPT-330 treatment resulted in decreased Myc family protein levels as well as activation of apoptotic pathways. Conclusions: Neuroblastomas show sensitivity to CRM1 inhibition both in vitro and in vivo. Ongoing work is focused on discovering the cellular and genomic factors responsible for increased sensitivity to nuclear export inhibition. With the expected completion of the first in human phase I trials by mid 2013, treatment with KPT-330 has the potential to be rapidly translated into a clinical trial for children with neuroblastoma. Citation Format: Edward F. Attiyeh, Aaron McKeon-Fish, Yosef Landesman, William Senapedis, Dilara McCauley, Trinayan Kashyap, Sharon Shacham, Michael Kauffman, John M. Maris. Targeted inhibition of Chromosomal Maintenance Region Protein (CRM1) potently suppresses growth of human neuroblastoma cell line models. [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 2756. doi:10.1158/1538-7445.AM2013-2756
Letter: Treatment of C.N.S. involvement in systemic lupus erythematosus.
Authors: Y Levo
Journal: BMJ (1974)

were found in one family and one more (in a girl of 15) in the other family.The parents did not consider there was anything wrong with the child, but both the girls complained of low backache and vague limb pains for which they had been taking aspirin tablets.Serum calcium and phosphate levels were within the normal range but all had markedly raised serum alkaline phosphatase levels.Rickets during rapid pubertal growth has al,o been freauently reDortedl 2 in Asian immigrants, especially in young girls.In ad- dition to the language problems the custo- mary seclusion of young girls in Pakistani families put them at additional risk of missed diagnosis till the appearance of deformities of the legs and pelvis or perhaps even later.A case, I think, therefore exists for the routine screening of young immigrant girls for rickets before leaving school and also for the screening of other children in the family when a case of rickets is found.There may be a genetic predisposition to rickets.