tbuckley/cabot-search huggingface dataset:
Patients as a direct source of information on adverse drug reactions.
Authors: A. S. Mitchell, D. A. Henry, R. Sanson-Fisher, D. L. O'Connell
Journal: BMJ (1988)

To determine whether patients should participate directly in detecting adverse reactions to drugs their ability to provide written reports of symptoms experienced during treatment with amoxycillin or trimethoprim-sulphamethoxazole was investigated. When compared with telephone interviews forms on which patients reported events were reliable (the observed agreement with the same statements posed during telephone calls was 85%, kappa = 0.56) and valid (sensitivity = 54%, specificity = 94%). Patients were also supplied with forms that invited them to report adverse reactions, and their perceptions were compared with those of a panel of experts, who were informed of all clinical events that had been reported during the detailed telephone interviews. Patients were more conservative than the experts in attributing clinical events to drug treatment. The extent of agreement varied and was notably poor for skin and bowel complaints (kappa = 0.13 in each case). The performance of event report forms and reaction report forms as instruments of detection was compared in a hypothetical situation in which the experts9 views represented the "truth" about adverse reactions to a new drug. Event reporting had a higher sensitivity than reaction reporting (42% v 24%) but a lower specificity (58% v 98%). National centres monitoring adverse drug reactions should probably resist pressure to accept reports of reactions directly from the public, but a system based on large scale reporting of events might be valuable in aiding the early detection of symptomatic reactions to new drugs.
Primary care groups: Modernising primary and community health services
Authors: D Wilkin, T Dowswell, B Leese
Journal: BMJ (2001)

This is the second in a series of five articles 

The government's plan for the NHS, published in July 2000, sets out an ambitious programme of investment, recognising that “the development of primary care services is key to the modernisation of the NHS.”1 Since the founding of the NHS primary care has been one of its greatest strengths but also its weakness. It has provided low cost, easily accessible care, but it has also been characterised by wide variability in quantity and quality, fragmentation, and a lack of coordination. The Labour government's 1997 white paper on the NHS proposed sweeping away the internal market and promoting a culture of collaboration and partnership.2

The establishment of primary care groups in England in 1999—which were charged with developing primary and community health services, commissioning hospital services, and improving the health of communities of around 100 000 people—represented a radical change in the organisation of primary and community health services. By 2004 all of these groups will become fully fledged primary care trusts, controlling most of the budget for providing health care to the populations that they serve. These organisations, led by local health professionals, will play a vital role in delivering the changes to primary and community services that the government sees as key to modernising the NHS. Within a framework of goals and performance standards set at the national level, the NHS plan asserts that the responsibility for decisions about services should be devolved to those who best understand local needs and circumstances.1 In this article, we focus on three key components of the government's strategy for modernising primary and community services: promoting a more efficient use of resources through collaboration and sharing, improving access to primary care, and enhancing the capacity of the workforce.

#### Summary points

Developing primary and …
Postemetic Rupture of Herniated Cardia of the Stomach-Reply
Authors: Gregory J. Gallivan
Journal: JAMA (1984)

In Reply.—  Comments by E. C. James, MD, reiterating some points of his excellent article entitled Postemetic Rupture of Herniated Cardia of the Stomach: A Variant of Boerhaave's Syndrome are noted and appreciated. His conjectures concerning the case described in my Letter to the Editor are not precisely accurate, but his remarks about Belsey and Nissen procedures are cogent.  To set the record straight, the modified Belsey repair of my patient's hiatal hernia was done in August 1972. It was done through a right transthoracic approach at the time of pulmonary surgery, leaving the left hemidiaphragm unscathed. Her singular postemetic rupture into the left pleural cavity of a herniated cardia of her stomach occurred almost three years later , in 1975. After she had vomited all ingested materials for three days in 1975, a stat barium swallow examination disclosed an intact hiatal hernia repair with no esophagogastric abnormalities noted. Her continued
Alternate pathways to pulmonary venous flow in left-sided obstructive anomalies.
Authors: C B Beckman, J H Moller, J E Edwards
Journal: Circulation (1975)

In cardiac anomalies causing severe obstruction in the left side of the heart, such as aortic atresia, mitral atresia, or occasionally severe aortic stenosis, maintenance of circulation depends upon shunting of pulmonary venous blood into the right atrium. The usual pathway by which the shunt is achieved is across the atrial septum through the foramen ovale. When this route is closed or severely narrowed, alternate but less common pathways may exist. These involve either anomalous connections of pulmonary veins to systemic veins or communications with the coronary venous system. In the latter, as commonly occurs in aortic atresia, left ventricular myocardial sinusoids carry pulmonary venous blood from the left ventricular cavity and into the cardiac veins. In other instances of severe left-sided obstruction, a direct communication may exist between the left atrium and the coronary sinus.
Lightning Stroke
Authors: Mark M. Ravitch, Richard Lane, Peter Safar, Felicien M. Steichen, Paul Knowles
Journal: New England Journal of Medicine (1961)

THE power delivered in a bolt of lightning has been a subject of awe since primitive times. It is therefore not unusual to find that most ancient accounts of persons struck by the lightning bolts of Zeus bear testimony to the deity's unfailing accuracy and the inevitable death of his victim. Lightning, in fact, presumably delivered without vindictive purpose, is anything but invariably fatal. Cases have been reported of one person struck by lightning and merely stunned, while his companion, who received the discharge after it emerged from the elbow of the target, was killed1; of the wholesale electrocution . . .
More Than Your Average Wheeze
Authors: Carey Conley Thomson, Andrew M. Tager, Peter F. Weller
Journal: New England Journal of Medicine (2002)

A 59-year-old man with a history of a nonproductive cough and wheezing presents with increasing shortness of breath. His symptoms have not responded to treatment with bronchodilators and inhaled corticosteroids or to treatment for sinusitis and esophageal reflux, but they improve when he takes oral prednisone.
Transfer of Fetal Cells With Multilineage Potential to Maternal Tissue
Authors: Kiarash Khosrotehrani, Kirby L Johnson, Dong Hyun Cha, Robert N Salomon, Diana W Bianchi
Journal: JAMA (2004)

During pregnancy, fetal CD34+ cells enter the maternal circulation, persist for decades, and create a state of physiologic microchimerism. Many studies have confirmed the residual presence of fetal cells in maternal blood and tissues following pregnancy. Fetal cells may respond to maternal injury by developing multilineage capacity in maternal organs.To verify that fetal microchimeric cells express markers of epithelial, leukocyte, and hepatocyte differentiation within maternal organs.Archived paraffin-embedded tissue section specimens from 10 women who had male offspring and were previously found to have high numbers of microchimeric cells, and 11 control women who had no prior male pregnancies. Male cells were identified by fluorescence in situ hybridization, using X and Y chromosome-specific probes, followed by histologic and immunochemical studies using anticytokeratin (AE1/AE3) as a marker of epithelial cells, anti-CD45 as a leukocyte marker, and heppar-1 as a hepatocyte marker.Percentage of microchimeric cells expressing nonhematopoietic markers.A total of 701 male (XY+) microchimeric cells were identified (mean [SD], 227 [128] XY+ cells per million maternal cells). In maternal epithelial tissues (thyroid, cervix, intestine, and gallbladder), 14% to 60% of XY+ cells expressed cytokeratin. Conversely, in hematopoietic tissues, such as lymph nodes and spleen, 90% of XY+ cells expressed CD45. In 1 liver sample, 4% of XY+ cells expressed heppar-1. Histologic and immunochemical evidence of differentiation, as assessed by independent observers, was highly concordant (kappa = 0.72).The detection of microchimeric male cells, bearing epithelial, leukocyte, or hepatocyte markers, in a variety of maternal tissue specimens suggests the presence of fetal cells that may have multilineage capacity.
Cezanne Regulates Inflammatory Responses to Hypoxia in Endothelial Cells by Targeting TRAF6 for Deubiquitination
Authors: Le A. Luong, Maria Fragiadaki, Jennifer Smith, Joseph Boyle, Jens Lutz, Jonathan L.E. Dean, Sarah Harten, Margaret Ashcroft, Sarah R. Walmsley, Dorian O. Haskard, Patrick H. Maxwell, Henning Walczak, Charles Pusey, Paul C. Evans
Journal: Circulation Research (2013)

Hypoxia followed by reoxygenation promotes inflammation by activating nuclear factor κB transcription factors in endothelial cells (ECs). This process involves modification of the signaling intermediary tumor necrosis factor receptor-associated factor 6 with polyubiquitin chains. Thus, cellular mechanisms that suppress tumor necrosis factor receptor-associated factor 6 ubiquitination are potential therapeutic targets to reduce inflammation in hypoxic tissues.In this study, we tested the hypothesis that endothelial activation in response to hypoxia-reoxygenation can be influenced by Cezanne, a deubiquitinating enzyme that cleaves ubiquitin from specific modified proteins.Studies of cultured ECs demonstrated that hypoxia (1% oxygen) induced Cezanne via p38 mitogen-activated protein kinase-dependent transcriptional and post-transcriptional mechanisms. Hypoxia-reoxygenation had minimal effects on proinflammatory signaling in unmanipulated ECs but significantly enhanced Lys63 polyubiquitination of tumor necrosis factor receptor-associated factor 6, activation of nuclear factor κB, and expression of inflammatory genes after silencing of Cezanne. Thus, although hypoxia primed cells for inflammatory activation, it simultaneously induced Cezanne, which impeded signaling to nuclear factor κB by suppressing tumor necrosis factor receptor-associated factor 6 ubiquitination. Similarly, ischemia induced Cezanne in the murine kidney in vascular ECs, glomerular ECs, podocytes, and epithelial cells, and genetic deletion of Cezanne enhanced renal inflammation and injury in murine kidneys exposed to ischemia followed by reperfusion.We conclude that inflammatory responses to ischemia are controlled by a balance between ubiquitination and deubiquitination, and that Cezanne is a key regulator of this process. Our observations have important implications for therapeutic targeting of inflammation and injury during ischemia-reperfusion.
Sports injuries: recognition and management, 3rd edn
Authors: D Humphries
Journal: British Journal of Sports Medicine (2004)

M A Hutson, Oxford University Press, 2001, £34.50, soft cover, pp 251. ISBN 0192632728

Sports injuries: recognition and management is now in its third edition. It has a single major author and some specialist chapters written by other authors either independently or in collaboration with the major author.

According to the preface: “This book is not an encyclopaedia of medical conditions associated with sport. It is designed primarily for the clinician who requires a method of learning a suitable approach towards the musculoskeletal problems encountered in sport”. Unfortunately this approach means the book …
Na <sup>+</sup> -H <sup>+</sup> Exchange Inhibition Protects Against Mechanical, Ultrastructural, and Biochemical Impairment Induced by Low Concentrations of Lysophosphatidylcholine in Isolated Rat Hearts
Authors: A.N. Ehsanul Hoque, James V. Haist, Morris Karmazyn
Journal: Circulation Research (1997)

Lysophophatidylcholine (LysoPC) accumulates rapidly in the ischemic myocardium and is an important mediator of ischemia-induced cell injury. Na + -H + exchange (NHE) inhibition has been demonstrated to protect the ischemic and reperfused myocardium. We determined whether NHE inhibition can also modulate cardiotoxicity produced by LysoPC (3 and 5 μmol/L) in isolated rat hearts. At 3 μmol/L, LysoPC produced a depression in left ventricular developed pressure (LVDP) and elevation in left ventricular end-diastolic pressure (LVEDP), which were 19±7% and 1290±205% of pre-LysoPC values, respectively, after 30 minutes of treatment. In the presence of the NHE inhibitor 4-isopropyl-3-methylsulfonylbenzoyl-guanidine methanesulfonate (HOE 642, 5 μmol/L), LVDP was reduced to only 80.8±8.6%, and LVEDP increased to 270±32% ( P &lt;.05 for both parameters). LysoPC significantly depressed tissue ATP, creatine phosphate, and glycogen contents and increased lactate levels, all of which were significantly attenuated by HOE 642. Moreover, marked LysoPC-induced ultrastructural abnormalities, including mitochondrial and myofibrillar disruption, were totally prevented by HOE 642. This protection was mimicked by another NHE inhibitor, methylisobutylamiloride (5 μmol/L). HOE 642 was also effective against injury produced by 5 μmol/L LysoPC although, generally, the protection was less marked than that observed against 3 μmol/L; LVDP depression after 30 minutes was 10.1±4.3% and 41.4±10.4% of pre-LysoPC values in control and HOE 642-treated hearts, respectively ( P &lt;.05), whereas corresponding LVEDP elevations were 1629±393% and 990±144% ( P &gt;.05). In myocytes superfused with bicarbonate-free buffer subjected to acid loading by NH 4 Cl pulsing, pH recovery (as measured by acid flux) was significantly stimulated by 3 μmol/L LysoPC, indicative of NHE activation. Our study shows that cardiac injury produced by low concentrations of LysoPC can be effectively attenuated by NHE inhibition. The results also suggest that the beneficial effects of NHE inhibitors on the ischemic myocardium may be, at least partially, mediated by inhibiting the deleterious effects of LysoPC.
Confronting the Stigma of Opioid Use Disorder—and Its Treatment
Authors: Yngvild Olsen, Joshua M. Sharfstein
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Jar With Both a Plumed Serpent and a Macaw-Headed Serpent
Authors: Robert M. Golub
Journal: JAMA (2006)

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 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care–Sensitive Conditions
Authors: Andrew B. Bindman
Journal: Annals of Internal Medicine (2008)

Many low-income U.S. citizens experience interruptions in health insurance coverage.To determine the rate of hospitalization for ambulatory care-sensitive conditions among Medicaid beneficiaries with interruptions in coverage.Retrospective cohort study.California Medicaid population.4,735,797 adults in California age 18 to 64 years who received a minimum of 1 month of Medicaid coverage between 1998 to 2002.Time to hospitalization for an ambulatory care-sensitive condition.Sixty-two percent of Medicaid beneficiaries experienced at least 1 interruption in coverage during the study period. The 3 most common ambulatory care-sensitive conditions resulting in a hospitalization were heart failure, diabetes, and chronic obstructive pulmonary disease. Interruptions in coverage were associated with a higher risk for hospitalization for an ambulatory care-sensitive condition (adjusted hazard ratio, 3.66 [95% CI, 3.59 to 3.72]; P < 0.001). In subgroup analyses, the association between interrupted coverage and hospitalization was stronger for beneficiaries eligible through the Temporary Aid to Needy Families program (adjusted hazard ratio, 8.56 [CI, 8.06 to 9.08]) than for beneficiaries eligible through the Supplemental Security Income program (adjusted hazard ratio, 1.72 [CI, 1.67 to 1.76]), who typically retain Medicare coverage even when their Medicaid coverage is interrupted.The study lacked information on why interruptions occurred and whether beneficiaries with interruptions transitioned to other insurance coverage.Interruptions in Medicaid coverage are associated with a higher rate of hospitalization for ambulatory care-sensitive conditions. Policies that reduce the frequency of interruptions in Medicaid coverage might prevent some of the health events that trigger hospitalization and high-cost health care spending.
H2 blockers in the intensive care unit: ignoring the evidence? Telephone survey
Authors: D L A Wyncoll, P C Roberts, R J Beale, A McLuckie
Journal: BMJ (1997)

Stress ulcers are gastroduodenal erosions that occur commonly in critically ill patients. Although once thought to be due to excess acid production, they are now thought to result from gastric mucosal ischaemia and the value of using pH altering drugs to prevent them has been questioned.1 Cook et al showed that only critically ill patients who have a coagulopathy or who are ventilated for more than 48 hours are at increased risk of developing serious bleeding due to stress ulceration.2 Prophylaxis is usually with either an H2 receptor antagonist or sucralfate, and these agents appear equally efficacious in terms of reducing bleeding complications.3 A recent meta-analysis has, however, shown that sucralfate is associated with a lower …
Clustering of chromosomal aneuploidy and tracing of nondisjunction in man.
Authors: I Hansmann
Journal: Environmental Health Perspectives (1979)

Chromosomal aneuploidy is the most frequent genetic damage observed in newborn children and originates as a rule from nondisjunction during maternal or paternal germ cell development. The error of chromosome segregation could be allocated in the past--at least in cases of 47,XXY--to maternal meiosis I (50%) or meiosis II (10%) and to paternal meiosis I (40%). Recent cytological improvements with various banding techniques enabled a further study on the origin of nondisjunction. Summarizing the published data one can argue that errors in Downs' syndrome are most often due to cleavage errors during maternal meiosis I. Approximately 70% of errors occur in oogenesis and only 30% in spermatogenesis. Maternal meiosis I seems also to be involved in most cases of fetal trisomy 16. Such a preferential missegregation of chromosomes offers the possibility of studying more closely the very mechanisms of nondisjunction in mammalian meiosis and early cleavages.
Oral lesions in dermatitis herpetiformis
Authors: N.G. FRASER, N.W. KERR, D. DONALD
Journal: British Journal of Dermatology (1973)

The oral mucosa was examined in fifteen patients with active dermatitis herpetiformis. The lesions seen were classified as erythematous, pseudo-vesicular, purpuric, and erosive in type. The only symptom experienced was of a painful, burning sensation in lesions on the tongue and upper alveolar ridge in two patients. The distribution of lesions, predominantly on the buccal mucosa adjacent to the occlusal plane or beneath existing dentures, suggested that trauma was a factor in their pathogenesis. Histologically, the features noted were similar to those occurring in skin lesions, except that sub-epithelial microvesicle formation was seen in only one of nine biopsies, and that purpura was a predominant feature. Also, the presence of granular IgA deposits in the submucosal papillae of early lesions was similar to the reported skin findings with the direct immunofluorescence technique. Oral lesions were found in over 70% of patients examined; an incidence much higher than previously supposed.