tbuckley/cabot-search huggingface dataset:
Defining and Understanding “Co-Management” Care
Authors: Sheldon Greenfield
Journal: Diabetes Care (2002)

Comparisons of the care delivered by specialists versus generalists suffers from several methodological problems that have not been resolved. These problems, which have persisted in the absence of sustained interest coupled with lack of funding for studies of specialty care, have made such comparisons difficult to perform and to interpret. Defining and understanding “ co-management” is one of these vexing issues. A single consultation with a specialist could have a major impact on an outcome. Having more percent time or having “principal” care delivered by one provider may not be the most influential factors in improving outcomes of chronic disease care. The recommendations by the provider, the intensity of follow-up when treatment is changed, the timeliness of appropriate elements of care and of consultations, the level of interpersonal care, and even the relationship between the generalist and the specialist may be far more important than the actual time spent or the number of visits made to one or the other type of doctor.

Probably the most problematic issue in specialist/generalist comparisons is that of assessing the severity or complexity of the condition and the relevant comorbidities. Specialists have more experience, skill, and knowledge in the care for patients who have diseases in their area of expertise—the more difficult the management, the higher the degree of complexity of the conditions, the more obscure the …
Should children be evacuated during times of war?
Authors: D. Silove
Journal: BMJ (2015)

A fusion protein consisting of the endothelin B (ET<sub>B</sub>) receptor and the enhanced green fluorescent protein (EGFP) in conjunction with Cyanin3- or fluorescein-conjugated endothelin 1 (Cy3-ET1, Fluo-ET1) was used to investigate the ligand-mediated internalization of the ET<sub>B</sub> receptor. The ET<sub>B</sub>receptor and the ET<sub>B</sub>/EGFP fusion protein displayed very similar pharmacological properties when expressed in Chinese hamster ovary cells. The integrity of the fusion protein was verified by low temperature PAGE analysis of the <sup>125</sup>I-ET1-bound ET<sub>B</sub> receptor and the <sup>125</sup>I-ET1-bound ET<sub>B</sub>/EGFP fusion protein. Fluorescence microscopy of Chinese hamster ovary cells expressing the ET<sub>B</sub>/EGFP fusion protein demonstrated strong signals at the plasma membrane. On addition of Cy3-ET1, internalization of ligand and receptor occurred within 5 min via a sucrose-sensitive (i.e., clathrin-mediated) pathway. On further incubation, ET<sub>B</sub>/EGFP and Cy3-ET1 fluorescences were found in the perinuclear region, colocalized with fluorescent low density lipoproteins, a marker of the late endosomal/lysosomal pathway, but not with fluorescent transferrin, a marker of the recycling pathway. No dissociation of Cy3-ET1 from the receptor was seen within 4 h. Using <sup>125</sup>I-ET1 or Cy3-ET1, binding sites were again demonstrable at the cell surface within 2 h. The reappearance of binding sites was abolished by prior treatment of the cells with cycloheximide, an inhibitor of protein synthesis. The data demonstrate that the ligand-occupied ET<sub>B</sub> receptor is internalized; however, it does not recycle like most of the G protein-coupled receptors but is sorted to the late endosomal/lysosomal pathway in a manner similar to that of the family of protease-activated receptors.
Abstract P5-04-16: Extracellular matrix 1 (ECM1) knockdown alters cellular characteristics, CD44 expression and other metastasis associated genes in breast cancer cells
Authors: PC Gomez-Contreras, FE Domann, RJ Weigel, G Lal
Journal: Cancer Research (2013)

Abstract Introduction: ECM1 is known to be over-expressed in multiple tumor cell lines and primary tumors, including breast cancers. ECM1 overexpression is also an independent predictor of poor prognosis in primary breast carcinomas. While similar associations have also been reported in other tumors, the mechanisms by which ECM1 affects prognosis have not been elucidated. Methods: ECM1 was silenced in the Hs578t and MDA-MB231 breast cancer cell lines using siRNA. The cells were evaluated for morphological changes, migration (wound-healing assay, TScratch program), matrigel invasion and cell attachment. Real Time RT-PCR using a 94-geneTumor Metastasis Array (TaqMan), was performed to assess the effects of ECM1 downregulation on in Hs578t cells. Alterations in RNA expression were validated at the protein level using western blots. Differences between groups were evaluated using the student's t-test and p&amp;lt;0.05 was considered statistically significant. Results: ECM1 silenced cells demonstrated altered morphology with a more elongated appearance to the cells, when compared those transfected with non-targeting siRNA. Reduced cell migration was noted for both silenced Hs578t and MB231 cell lines (both p&amp;lt;0.0001). Matrigel invasion was reduced in the Hs578t cell line only (p&amp;lt;0.002). however, cell attachment was decreased in both cell lines. (p &amp;lt;0.0001 for Hs578t, and &amp;lt; 0.01 for MB231). ECM1 downregulation affected the expression of several metastasis associated genes including CD44, Metalloproteinase-2, fibronectin at the RNA level. CD44 expression was significantly reduced in ECM1-silenced cells by western blot. Conclusion: ECM1 appears to be involved in maintenance of tumor cell shape, migration, invasion and attachment properties in the cell lines tested, and also affects expression of CD44 protein, a known tumor prognostic factor. ECM1 may be a key molecule affecting tumor progression and metastasis, which is a complex process involving these components. Our findings suggest mechanisms by which ECM1 overexpression may affect tumor prognosis. Further work is needed to evaluate if altering ECM1 expression may be a novel therapeutic option for these tumors. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-04-16.
Consultant physician to outpatients.
Authors: H M Noble
Journal: BMJ (1978)

lymphoma, increased levels of serum IgE (often very high) compared with controls have been reported by at least two groups of workers.1 2 In the four patients with mycosis fungoides seen in this department during the past two years the serum IgE levels have all been raised (range 979->5000 U/ml).As with Hodgkin's disease, the pathogenesis of these high serum IgE levels (in the presence of normal levels of IgG, IgA, and IgM) is at the moment unclear.
Acute lymphoblastic leukemia cells treated with CpG oligodeoxynucleotides, IL-4 and CD40 ligand facilitate enhanced anti-leukemic CTL responses
Authors: D Fabricius, L Breckerbohm, A Vollmer, M Queudeville, S M Eckhoff, S Fulda, G Strauss, K-M Debatin, B Jahrsdörfer, L H Meyer
Journal: Leukemia (2011)
X. The Changing Scene
Authors: Lester S. King
Journal: JAMA (1983)

If we had to find a single date to distinguish the old medicine from the new, the year 1886 would serve quite well. Of the innumerable events that occurred in that year, I would regard two as especially symbolic: the death of Austin Flint, Sr (1812-1886) and the founding of the American Association of Physicians (AAP). Austin Flint, still remembered in connection with the heart murmur that bears his name, represented the old school of physicians that included William Gerhard (1809-1872), Alfred Stillé (1813-1900), William Pepper, Sr (1810-1864), Alonzo Clark (1807-1887), and Henry I. Bowditch (1808-1892). Oliver Wendell Holmes (1809-1894) could also be included in this group. These men were all teachers, and they contributed to the medical literature with textbooks or essays or both. With the exception of Holmes, all these men were practicing physicians, leaders in the profession at a time when laboratory investigation had made no impression
Abstract 4065: Concrete Symptom Clusters are Identifiable and Identical in Women and Men with Heart Failure, and Predict Health Outcome
Authors: Kyoung Suk Lee, Terry A Lennie, Barbara Riegel, Seongkum Heo, Jia-Rong Wu, Misook Chung, Mary Kay Rayens, Debra K Moser
Journal: Circulation (2008)

Background: Although symptoms in patients (pts) with heart failure (HF) are often viewed in isolation, pts usually have multiple, concurrent symptoms. Identification of symptom clusters could improve pts’ recognition of worsening HF, and enhance pt care. Given gender differences in outcomes in HF, examination of potential differences in clusters and their impact on outcomes is reasonable. Purpose: To identify HF symptom clusters in women and men and examine the impact of clusters on total number of all-cause hospitalizations per pt during 12 month follow-up. Methods: Data from 513 pts with HF (61 ± 12 yrs, 31.7% female, 53.6% NYHA III/IV) were used. Seven symptoms (i.e., edema, dyspnea, fatigue, trouble sleeping, worry, depression, and memory problems) were analyzed for clustering using an agglomerative hierarchical clustering approach and Ward’s method. Validity of cluster solution was assessed with split-sample replication. Symptoms were clustered, and pts were grouped based on symptom burden in clusters. Results: Two symptom clusters were identified in both men and women: physical symptom cluster - dyspnea, fatigue, trouble sleeping; and emotional/cognitive symptom cluster - worry, memory problems, depression. Pts were grouped into 4 based on their symptom burden in each of the 2 clusters: low burden related to both clusters; burden from physical cluster &gt; than that from emotional cluster; burden from the emotional cluster &gt; than that from physical cluster; and high and equal burden from both clusters. ANOVA revealed a difference in number of hospitalizations in both men and women based on the groups (p=.002); there were no gender differences. Pts in group 3 (emotional symptoms &gt; than physical) were most frequently hospitalized (1.8 ± 2.8 hospitalizations/pt in group 3 compared to 1.7 ± 2.5/pt in group 4 vs .88 ± 1.6/pt in group 2 vs .66 ± 1.3/pt in group 1; post hoc Tukey indicates p &lt;.05 for all comparisons except group 3 with 4). Conclusion: HF symptoms cluster in two identifiable groups: a physical and an emotional/cognitive cluster. Pts with the most burden from the emotional cluster have the worst outcomes, suggesting that increased attention needs to be paid by clinicians to emotional symptoms and the fact that they occur in clusters.
Antibiotic Prescribing for Adults With Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians
Authors: Ralph Gonzales
Journal: JAMA (1997)

<h3>Context.</h3> —Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of all antibiotic prescribing by ambulatory care physicians. How frequently antibiotics are prescribed for these conditions and for and by whom is not known. <h3>Objectives.</h3> —To measure antibiotic prescription rates and to identify predictors of antibiotic use for adults diagnosed as having colds, upper respiratory tract infections, and bronchitis in the United States. <h3>Design.</h3> —Sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1992. <h3>Setting.</h3> —Office-based physician practices. <h3>Subjects.</h3> —Physicians (n=1529) completing patient record forms for adult office visits (n=28 787). <h3>Main Outcome Measures.</h3> —Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. <h3>Results.</h3> —Office visits for colds, upper respiratory tract infections, and bronchitis resulted in approximately 12 million antibiotic prescriptions, accounting for 21% of all antibiotic prescriptions to adults in 1992. A total of 51% of patients diagnosed as having colds, 52% of patients diagnosed as having upper respiratory tract infections, and 66% of patients diagnosed as having bronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibiotic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower antibiotic prescription rates. Patient age, Hispanic ethnicity, geographic region, physician specialty, and payment sources were not associated with antibiotic prescription rates in the bivariate analysis. Multivariate logistic regression analysis identified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to be independently associated with more frequent antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. <h3>Conclusion.</h3> —Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States. Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based.
Banana Fibers in Colonic Mucus May Puzzle the Endoscopist
Authors: S. Ladas, D. Polymeros, C. Tzathas, T. Emmanuel, H. Malamou
Journal: Endoscopy (2005)

Fig. 1 A 53-year-old woman was evaluated with colonoscopy for diarrhea. Bowel preparation was with sodium phosphate solution and the patient's having a liquid diet the day before colonoscopy. The colonic mucosa was normal, but odd filament-like, brown, immobile bands within mucus, measuring 1 - 3 cm in length, were noted in the transverse and the sigmoid colon. These resembled parasite or worm bodies, and one of them was grasped with the biopsy forceps and sent for microscopy within saline.
Weighing the Hazards of Erythropoiesis Stimulation in Patients with Cancer
Authors: Fadlo R. Khuri
Journal: New England Journal of Medicine (2007)

Interview with James Doroshow on the possible risks associated with erythropoiesis-stimulating agents. (06:49)Download On May 10, 2007, the Food and Drug Administration (FDA) convened a meeting of its Oncology Drug Advisory Committee to discuss concerns about risks associated with the erythropoiesis-stimulating agents (ESAs) used to treat anemia caused by chemotherapy. The principal ESAs under scrutiny were epoetin alfa (Procrit, Eprex, and Epogen) and darbepoetin alfa (Aranesp), and the risks — actual or potential — were thromboembolic disease, promotion of tumor growth, and decreased survival. The actual risk of thromboembolic events was shown in two phase 3 clinical trials, reported in the Journal in 2006, that unequivocally showed an increased risk of death or . . .
Biological Rhythms and Shift Work
Authors: David R. Liskowsky
Journal: JAMA (1992)

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 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
A piece of my mind. A physician's dilemma
Authors: J. Svenson
Journal: JAMA (1988)

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 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
Falling sperm quality: fact or fiction?
Authors: S Farrow
Journal: BMJ (1994)

Epidemiologists should be able to tell us whether sperm quality has changed over time, or at least whether the quantity has changed. In 1992 Carlsen and colleagues concluded that sperm concentration per unit volume had fallen by 40% over the previous 50 years.1 This finding led to much speculation about the cause: oestrogens or pesticides in meat or water were the popular culprits (Horizon, “Assault on the Male: a Horizon Special,” BBC, 1993 Oct 31). In an article in this week's journal Bromwich and colleagues argue that Carlsen et al applied the wrong form of analysis and that an artefact explains nearly all of the putative “fall” (p 19).2

Before we enter the modern debate it is worth being reminded that the hypothesis of falling sperm quality attracted most attention in the 1970s, but it was debated in the peaceful obscurity of the specialist journals.3 Macleod and Wang temporarily silenced that debate; on the basis of a 10 year study of over 15000 men they concluded that there had been no decline.4 They considered all the large scale studies and compared them with their unique series from New York, where men had been analysed in the same laboratory for 30 years, with the same selection criteria and the same analytical methods being used.

This time around, …
Meet Ms Managed Care
Authors: D. Woods
Journal: BMJ (1997)

Managed care in the United States is under attack from politicians, the press, doctors, and the public. Karen Ignagni tells David Woods how she is trying to improve its image



Karen Ignagni sees herself as a consensus builder



Karen Ignagni heads an organisation that is one of the most visible and vulnerable in Washington—visible because it represents about a thousand managed care companies, and vulnerable because managed care is under constant attack from politicians and the media.

Managed care is a system of fixed prepayment for comprehensive healthcare coverage in which the companies providing it control costs by curbing use. Another definition is that it is the application of standard business practices to the delivery of health care in the best—or, depending on your point of view, the worst—traditions of untrammelled American free enterprise. More than 140 million Americans are now covered by some kind of managed care arrangemen

Karen Ignagni might reasonably lay claim to the title Ms Managed Care. As executive director of the American Association of Health Plans (AAHP), she handles both the high profile and the low esteem of her industry with grace and diplomacy. During the summer …
WHO urges more countries to adopt large graphic health warnings on tobacco products
Authors: J. Zarocostas
Journal: BMJ (2011)

More countries need to introduce large graphic health warnings on packages of tobacco and launch hard hitting media campaigns, both of which have proved highly effective at reducing tobacco use, says a report by the World Health Organization.

“We urge all countries to follow best practices for reducing tobacco consumption,” said Ala Alwan, WHO’s assistant director general for non-communicable diseases and mental health. “We are pleased that more and more people are being adequately warned . . . At the same time we can’t be satisfied that the majority of countries are doing nothing or not enough.” 

WHO says that tobacco will kill nearly six million people this year, of whom more than five million will be users and former users and …
TCT-773 Flow Characteristics of the CoreValve Self-Expanding Transcatheter Aortic Valve: Echocardiographic Assessment of In-Stent Pre-cusp Flow Acceleration
Authors: Konstantinos P. Koulogiannis, Leo Marcoff, Robert Kipperman, Barry Cohen, Lillian Aldaia, Linda D. Gillam
Journal: Journal of the American College of Cardiology (2014)
Thiazide Diuretic Agents and the Incidence of Hip Fracture
Authors: Andrea Z. LaCroix, Jan Wienpahl, Lon R. White, Robert B. Wallace, Paul A. Scherr, Linda K. George, Joan Cornoni-Huntley, Adrian M. Ostfeld
Journal: New England Journal of Medicine (1990)

Thiazide diuretic agents lower the urinary excretion of calcium. Their use has been associated with increased bone density, but their role in preventing hip fracture has not been established. We prospectively studied the effect of thiazide diuretic agents on the incidence of hip fracture among 9518 men and women 65 years of age or older residing in three communities.
Cholera toxin discriminates between T helper 1 and 2 cells in T cell receptor-mediated activation: role of cAMP in T cell proliferation.
Authors: E Muñoz, A M Zubiaga, M Merrow, N P Sauter, B T Huber
Journal: The Journal of Experimental Medicine (1990)

CD4+ T helper (Th) clones can be divided into interleukin 2 (IL-2)-secreting Th1 and IL-4-secreting Th2 cells. We show in the present report that these two Th subsets have different activation requirements for lymphokine production and proliferation: namely, cholera toxin (CT) as well as forskolin inhibit T cell receptor (TCR)-mediated IL-2 production and proliferation in Th1 cells, while the same reagents fail to block IL-4 production and proliferation in Th2 cells. In addition, CT and forskolin differentially influence the proto-oncogene mRNA expression in Th1 vs. Th2 cells after stimulation with Con A. Since both reagents lead to elevated levels of intracellular cAMP, it is likely that Th1 and Th2 cells differ in their sensitivity to an increase in cAMP. Our results indicate that the two Th subsets use different transmission signal pathways upon TCR-mediated activation.
Sulphonamide Treatment of Bacterial and Trachomatous Conjunctivitis
Authors: A. F. MacCallan
Journal: BMJ (1940)

1. Female and male hormone can be implanted in tablet form in as large amounts as desired without injury.2. Female hormone was implanted to allow a small infantile uterus to develop and to make it ready for con- ception, and this was done successfully.3. Male hormone was implanted to control serious menorrhagia caused by fibroids.Good results were ob- tained in the case of women near the menopause.4. Male hormone was unable to influence successfully existing recurrences of carcinoma of the breast following an operation or x-ray treatment.To what extent male hormone can have a prophylactic action against such recurrence is not yet determined.5. The general effect of implants of male hormone on women is discussed.I am highly indebted to Dr. Macbeth of Organon Labora- tories, and Dr. Neuman of Schering Ltd. for supplying these tablets.