tbuckley/cabot-search huggingface dataset:
Prescribing of Chloramphenicol in Ambulatory Practice
Authors: WAYNE A. RAY
Journal: Annals of Internal Medicine (1976)

During the 1-year period from July 1973 through June 1974, 1761 chloramphenicol prescriptions were written for 992 outpatients in the Tennessee Medicaid program. Six percent (205 of 3409) of participating physicians prescribed chloramphenicol; 20 physicians wrote 55% of the prescriptions. Both family practice and rural location were independently associated with increased rates of prescribing chloramphenicol for outpatients. Among rural family practitioners, 21% prescribed chloramphenicol. Physicians graduating since 1955 were as likely to have prescribed chloramphenicol as were earlier graduates. Almost half the adult patients received 6 grams or less, while 2 received more than 250 grams. Approximately half of the prescriptions were for treatment of upper respiratory infections. Most prescriptions were interdicted by good medical practice. Analysis of the prescribing of chloramphenicol (and perhaps other drugs) in ambulatory practice will help identify those physicians most in need of remedial medical education.
Reforming Graduate Medical Education
Authors: Kenneth M. Ludmerer, Michael M. E. Johns
Journal: JAMA (2005)

Because of the traditional subordination of education to service, graduate medical education (GME) in the United States has never realized its full educational potential. This article suggests 4 strategies for reasserting the primacy of education in GME: limit the number of patients house officers manage at one time, relieve the resident staff of noneducational chores, improve educational content, and ease emotional stresses. Achieving these goals will require regulatory reform, adequate funding, and institutional competency in the use of educational resources. Modern medicine grows ever more complex. The need to address the deficiencies of GME is urgent.
Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function?
Authors: I Yasuda
Journal: Gut (2001)

<h3>BACKGROUND</h3> Endoscopic papillary balloon dilation (EPBD) is assumed to preserve sphincter of Oddi function because it causes little trauma to the papilla. However, few studies have addressed this issue specifically. In this study, we investigated whether EPBD can preserve sphincter function, and evaluated whether or not such preservation has clinical significance. <h3>METHODS</h3> Seventy patients with common bile duct (CBD) stones were randomly assigned to EPBD or endoscopic sphincterotomy (EST). Sphincter of Oddi (SO) function was measured by endoscopic manometry before, one week after, and one year after treatment. Incidence of pneumobilia and later complications were compared between the two groups at one year. Series manometric data were compared within each group and between the two groups. For a more detailed analysis of the cumulative incidence of later complications, retrospective cohorts were added to the study groups, giving a total number of 235 patients in the EPBD group and 126 in the EST group. <h3>RESULTS</h3> Baseline characteristics did not differ significantly between the 35 EPBD and 35 EST patients. CBD stones were discharged successfully in all cases. CBD pressure, SO basal and peak pressures, and contraction frequency decreased significantly at one week in both groups. The damage was more severe in the EST group, and SO contraction completely disappeared in 23 patients in this group. The incidence of pneumobilia was significantly lower in the EPBD group than in the EST group (p&lt;0.01) whereas CBD stones recurred and cholecystitis appeared at a similar rate in both groups at one year. A complete series of manometric data up to one year was obtained in 55 patients; 28 in the post-EPBD and 27 in post-EST groups. In the post-EPBD group, SO basal and peak pressures significantly recovered at one year compared with data at one week but these measures still remained significantly lower than those before EPBD (p&lt; 0.01). In the post-EST group, SO contraction did not recover even after one year. A Kaplan-Meier analysis of 235 EPBD and 126 EST patients for a median follow up of 37 months revealed significantly lower incidences of biliary complications such as recurrent CBD stones and cholangitis, and cholecystitis in the EPBD group than in the EST group (p&lt;0.05). The risk of pneumobilia was also significantly lower in the EPBD group (p&lt;0.01). <h3>CONCLUSIONS</h3> Preservation of papillary function after EPBD was not complete but remained somewhat reduced. However, preservation was more successful with EPBD than with EST. Such preservation may be clinically beneficial for the prevention of later complications.
Population red blood cell folate concentrations for prevention of neural tube defects: bayesian model
Authors: Krista S Crider, Owen Devine, Ling Hao, Nicole F Dowling, Song Li, Anne M Molloy, Zhu Li, Jianghui Zhu, Robert J Berry
Journal: BMJ (2014)

<b>Objective</b> To determine an optimal population red blood cell (RBC) folate concentration for the prevention of neural tube birth defects. <b>Design</b> Bayesian model. <b>Setting</b> Data from two population based studies in China. <b>Participants</b> 247 831 participants in a prospective community intervention project in China (1993-95) to prevent neural tube defects with 400 μg/day folic acid supplementation and 1194 participants in a population based randomized trial (2003-05) to evaluate the effect of folic acid supplementation on blood folate concentration among Chinese women of reproductive age. <b>Intervention</b> Folic acid supplementation (400 μg/day). <b>Main outcome measures</b> Estimated RBC folate concentration at time of neural tube closure (day 28 of gestation) and risk of neural tube defects. <b>Results</b> Risk of neural tube defects was high at the lowest estimated RBC folate concentrations (for example, 25.4 (95% uncertainty interval 20.8 to 31.2) neural tube defects per 10 000 births at 500 nmol/L) and decreased as estimated RBC folate concentration increased. Risk of neural tube defects was substantially attenuated at estimated RBC folate concentrations above about 1000 nmol/L (for example, 6 neural tube defects per 10 000 births at 1180 (1050 to 1340) nmol/L). The modeled dose-response relation was consistent with the existing literature. In addition, neural tube defect risk estimates developed using the proposed model and population level RBC information were consistent with the prevalence of neural tube defects in the US population before and after food fortification with folic acid. <b>Conclusions</b> A threshold for “optimal” population RBC folate concentration for the prevention of neural tube defects could be defined (for example, approximately 1000 nmol/L). Population based RBC folate concentrations, as a biomarker for risk of neural tube defects, can be used to facilitate evaluation of prevention programs as well as to identify subpopulations at elevated risk for a neural tube defect affected pregnancy due to folate insufficiency.
Metals in lung tissue from autopsy cases in Mexico City residents: comparison of cases from the 1950s and the 1980s.
Authors: T I Fortoul, L S Osorio, A T Tovar, D Salazar, M E Castilla, G Olaiz-Fernández
Journal: Environmental Health Perspectives (1996)

In autopsies performed on residents of Mexico City during the 1950s and 1980s (45 males and 24 females and 42 males and 42 females, respectively), concentrations of cadmium, copper, cobalt, nickel, and lead in the lungs were studied by atomic absorption spectrometry. Sharp increases were noted in samples taken in the 1980s compared to those from the 1950s. In samples from both time periods, the concentrations were influenced by gender. Smoking was not associated with higher levels of the metals. Only lead seemed to have a relation with age. The enormous differences by gender in the 1950s could be due to different patterns of exposure. The differences among samples from both periods appear to be associated with the increase of air pollutants in the metropolitan areas of Mexico City during the years under study. These results reinforce the importance of studying lung tissue to monitor air pollution by metals.
Jejunal Feeding Tubes via Gastrostomy in Children
Authors: T. Doede, S. Faiss, F. Schier
Journal: Endoscopy (2002)

The implantation of a jejunal feeding tube, via percutaneous endoscopic gastrostomy (PEG), is a possible method for the treatment of inadequate oral feeding in patients who are affected by gastroesophageal reflux.This study involves a retrospective analysis of all the patients up to 18 years of age, who were treated by means of jejunal feeding tubes at the Universitätsklinikum Benjamin Franklin, Berlin, between 15 September 1995 and 1 August 2000.In all, 76 patients received a PEG, and 12 of them were also given jejunal feeding tubes. One of these patients has experienced no complications. In the other 11 children, 52 changes of jejunal tube have been required. The most important reason for these changes was displacement of the tube into the gastrointestinal tract, resulting from technical problems with the connecting section.Jejunal feeding tubes in patients with gastrostomy are an alternative to fundoplication and drugs. However, a high rate of changes is to be expected.
SOME NEUROPHYSIOLOGIC ASPECTS OF SCHIZOPHRENIA: AN ELECTROMYOGRAPHIC STUDY
Authors: GEORGE B. WHATMORE, RICHARD M. ELLIS
Journal: American Journal of Psychiatry (1964)

The present study is directed toward investigating whether the hyperponesis found in schizophrenics plays some type of etiologic role in the schizophrenic process or is merely a consequence of the disorder. Hyperponesis is a neurophysiologic state measurable electromyographically. Four schizophrenic patients were followed chronologically by means of serial multi-channel integrated EMGs so that time relationships between neurophysiologic state and clinical condition could be determined. Results were analyzed statistically. It was found that schizophrenics in remission exhibited an intermittent hyperponesis whose lability increased and/or baseline rose prior to relapse. A persistent hyperponesis was present during the exacerbation. A reduction in the hyperponesis, whether chlorpromazine-induced or spontaneous, was followed by improvement in the patient's clinical condition. After a consideration of several possibilities and the available evidence, the followig hypothesis was suggested: Hyperponesis is a form of energy expenditure within the nervous system, a way of reacting to environment and self, that has detrimental effects on nervous system function. It can trigger a schizophrenic exacerbation in a nervous system prone to schizophrenic reactions through inherited or acquired characteristics. When the hyperponesis is diminished adequately, by whatever means, the nervous system is freed from this deleterious influence and can return to a state of better functioning.
Collaborative Care for Adolescents With Depression in Primary Care
Authors: Laura P. Richardson, Evette Ludman, Elizabeth McCauley, Jeff Lindenbaum, Cindy Larison, Chuan Zhou, Greg Clarke, David Brent, Wayne Katon
Journal: JAMA (2014)

Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression.To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care.Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013.Nine primary care clinics in the Group Health system in Washington State.Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist.Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health.The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5).Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007).Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care.clinicaltrials.gov Identifier: NCT01140464.
The Future General Internist
Authors: Henry L. Harrell
Journal: Annals of Internal Medicine (1995)

Letters15 July 1995The Future General InternistHenry L. HarrellHenry L. HarrellSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-2-199507150-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I would like to thank the authors and the Task Force on Physician Supply for the balanced and reasoned position paper on the role of the future general internist [1]. I offer one additional thought for the consideration of the College's leadership.In years past, the nation's general practitioners decided that they needed to redefine themselves to receive the respect that they deserved; as a result, the specialty of family practice was born. These practitioners developed standards of residency training, a board examination, and academy fellowships to establish that their members were actively specialized in general practice, ...REFERENCE1. American College of Physicians. The role of the future general internist defined. Ann Intern Med. 1994; 121:616-22. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1995Volume 123, Issue 2Page: 156-158KeywordsDermatologyFellowshipsForecastingNeurologyPrimary careResidencySub-specialty care ePublished: 15 August 2000 Issue Published: 15 July 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Differential Effects of Sodium Acetoacetate and Acetoacetic Acid Infusions on Alanine and Glutamine Metabolism in Man
Authors: Françoise Féry, Edmond O. Balasse
Journal: Journal of Clinical Investigation (1980)

It has been suggested that ketone bodies might participate in the nitrogen-sparing process occurring during prolonged starvation by inhibiting the muscular production of alanine and glutamine, which are the main gluconeogenic amino acids. The results of the ketone infusion studies on which this theory is based have been reevaluated in this study by following the plasma levels of ketone bodies, alanine, glutamine, and other substrates during 11.5 h in five groups of normal overnight-fasted subjects. Subjects of groups I, II, and III were infused for 3 h, respectively, with Na acetoacetate, Na bicarbonate, or free acetoacetic acid administered in comparable amounts (about 20 μmol/kg per min), whereas group IV was infused with hydrochloric acid (7.0 μmol/kg per min). A control group (V) received no infusion. Na acetoacetate induced a rise in blood pH (+0.1±0.003) and a fall in the plasma levels of alanine (−41.8±4.6%) and glutamine (−10.6±1.4%), whereas free acetoacetic acid had a barely detectable lowering effect on blood pH and induced a rise in alanine (+22.5±8.0%) and glutamine (+14.6±3.2%) levels. Both infusions were associated with a lowering of plasma glucose, which therefore seems independent of the changes in alanine and glutamine concentrations. Sodium bicarbonate reproduced the alkalinizing effect and the hypoalaninemic action of Na acetoacetate, which seems thus unrelated to hyperketonemia. On the other hand, acidification of blood with hydrochloric acid did not mimic the effects of acetoacetic acid.
Echocardiographic diagnosis of left ventricular hypertrophy.
Authors: T M McFarland, M Alam, S Goldstein, S D Pickard, P D Stein
Journal: Circulation (1978)

Echocardiograms were obtained on 27 adults with electrocardiographic criteria of left ventricular hypertrophy (LVH) to determine how echocardiograms might best identify LVH. Both the left ventricular (LV) posterior wall thickness and interventricular septal thickness were found by echocardiography to be increased (greater than or equal to 12 mm) in only 13 of 27 patients (48%) with LVH. The LV was dilated (greater than or equal to 58 mm) in the absence of posterior wall thickening in 9 of 27 patients (33%). The LV mass, estimated from standardly measured dimensions, was increased (greater than 200 g) in 21 of 27 patients (78%) and when measurements were made by the Penn method, mas was increased in all patients. These observations indicate that the echocardiographic estimation of LV mass is a more sensitive indicator of LVH than LV posterior wall and septal thickness. Since LVH is defined as an increased mass of LV muscle, these observations are consistent with this fundamental definition of left ventricular hypertrophy.
Treatment of the Elderly When Cure is the Goal: The Influence of Age on Treatment Selection and Efficacy for Stage III Non-small Cell Lung Cancer
Authors: Linda E. Coate, Christine Massey, Andrew Hope, Adrian Sacher, Katherine Barrett, Andrew Pierre, Natasha Leighl, Anthony Brade, Marc de Perrot, Tom Waddell, Geoffrey Liu, Ronald Feld, Ronald Burkes, B. C. John Cho, Gail Darling, Alexander Sun, Shaf Keshavjee, Andrea Bezjak, Frances A. Shepherd
Journal: Journal of Thoracic Oncology (2011)
Pain Control in Obstetrics
Authors: Rudolph H. de Jong, Mary R. Baker
Journal: JAMA (1978)

Dr Abouleish, assisted by seven contributors, has put together a wellrounded text on pain control in obstetrics. The book is divided into three sections: anatomy and physiology of pain control in parturition, techniques of obstetric anesthesia, and care of the newborn. Throughout, there is laudable concern for the psychological impact of labor and delivery.  The basic science section deals well with the altered circulation and respiration during pregnancy, and the way the cardiovascular system compensates for anesthetic blockade. Local anesthetics and their maternal and fetal effects receive particularly detailed consideration because of their importance in obstetric anesthesia. Other aspects of parturition are presented with an eye to problems of special concern to anesthesiologists/p vomiting and aspiration, amniotic fluid embolism, placental transfer of drugs, and complete care of the neonate.  Perhaps the greatest strength of this book is the second section, where techniques of conduction anesthesia for parturition are discussed and
Lactic Dehydrogenase Isoenzyme Electrophoresis
Authors: Allan L. Louderback
Journal: JAMA (1968)

The clinical usefulness of measuring specific enzyme levels in serum is well established. Depending on the enzyme being studied, quantitative elevation in the serum is a relatively sensitive indication that tissue damage has occurred. However, such quantitative measurements fail to demonstrate the specific tissue involved, and in the case of the "total" lactic dehydrogenase (LDH) determination, elevated serum levels may be seen in a number of clinical conditions. Because enzymes occur in multiple molecular forms called<i>isoenzymes</i>or<i>isozymes</i>which have similar biologic activity, they may be distinguished by electrophoretic techniques. Electrophoresis separates LDH into its constituent isoenzymes and provides the physician with organ-specific information because the proportion of these individual isoenzymes varies in different organs. Identification of isoenzymes is of additional value since there may be diagnostically significant changes in the isoenzyme patterns (zymograms) without any change in the total serum level.
Lipoprotein metabolism during acute inhibition of lipoprotein lipase in the cynomolgus monkey.
Authors: I J Goldberg, N A Le, H N Ginsberg, R M Krauss, F T Lindgren
Journal: Journal of Clinical Investigation (1988)

To clarify the role of lipoprotein lipase (LPL) in the catabolism of nascent and circulating very low density lipoproteins (VLDL) and in the conversion of VLDL to low density lipoproteins (LDL), studies were performed in which LPL activity was inhibited in the cynomolgus monkey by intravenous infusion of inhibitory polyclonal or monoclonal antibodies. Inhibition of LPL activity resulted in a three- to fivefold increase in plasma triglyceride levels within 3 h. Analytical ultracentrifugation and gradient gel electrophoresis demonstrated an increase predominantly in more buoyant, larger VLDL (Sf 400-60). LDL and high density lipoprotein (HDL) cholesterol levels fell during this same time period, whereas triglyceride in LDL and HDL increased. Kinetic studies, utilizing radiolabeled human VLDL, demonstrated that LPL inhibition resulted in a marked decrease in the catabolism of large (Sf 400-100) VLDL apolipoprotein B (apoB). The catabolism of more dense VLDL (Sf 60-20) was also inhibited, although to a lesser extent. However, there was a complete block in the conversion of tracer in both Sf 400-100 and 60-20 VLDL apoB into LDL during LPL inhibition. Similarly, endogenous labeling of VLDL using [3H]leucine demonstrated that in the absence of LPL, no radiolabeled apoB appeared in LDL. We conclude that although catabolism of dense VLDL continues in the absence of LPL, this enzyme is required for the generation of LDL.