tbuckley/cabot-search huggingface dataset:
A National Assessment of Pediatric Readiness of Emergency Departments
Authors: Marianne Gausche-Hill, Michael Ely, Patricia Schmuhl, Russell Telford, Katherine E. Remick, Elizabeth A. Edgerton, Lenora M. Olson
Journal: JAMA Pediatrics (2015)

<h3>Importance</h3> Previous assessments of readiness of emergency departments (EDs) have not been comprehensive and have shown relatively poor pediatric readiness, with a reported weighted pediatric readiness score (WPRS) of 55. <h3>Objectives</h3> To assess US EDs for pediatric readiness based on compliance with the 2009 guidelines for care of children in EDs; to evaluate the effect of physician/nurse pediatric emergency care coordinators (PECCs) on pediatric readiness; and to identify gaps for future quality initiatives by a national coalition. <h3>Design, Setting, and Participants</h3> Web-based assessment of US EDs (excluding specialty hospitals and hospitals without an ED open 24 hours per day, 7 days per week) for pediatric readiness. All 5017 ED nurse managers were sent a 55-question web-based assessment. Assessments were administered from January 1 through August 23, 2013. Data were analyzed from September 12, 2013, through January 11, 2015. <h3>Main Outcomes and Measures</h3> A modified Delphi process generated a WPRS. An adjusted WPRS was calculated excluding the points received for the presence of physician and nurse PECCs. <h3>Results</h3> Of the 5017 EDs contacted, 4149 (82.7%) responded, representing 24 million annual pediatric ED visits. Among the EDs entered in the analysis, 69.4% had low or medium pediatric volume and treated less than 14 children per day. The median WPRS was 68.9 (interquartile range [IQR] 56.1-83.6). The median WPRS increased by pediatric patient volume, from 61.4 (IQR, 49.5-73.6) for low-pediatric-volume EDs compared with 89.8 (IQR, 74.7-97.2) for high-pediatric-volume EDs (<i>P</i> &lt; .001). The median percentage of recommended pediatric equipment available was 91% (IQR, 81%-98%). The presence of physician and nurse PECCs was associated with a higher adjusted median WPRS (82.2 [IQR, 69.7-92.5]) compared with no PECC (66.5 [IQR, 56.0-76.9]) across all pediatric volume categories (<i>P</i> &lt; .001). The presence of PECCs increased the likelihood of having all the recommended components, including a pediatric quality improvement process (adjusted relative risk, 4.11 [95% CI, 3.37-5.02]). Barriers to guideline implementation were reported by 80.8% of responding EDs. <h3>Conclusions and Relevance</h3> These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. The physician and nurse PECCs play an important role in pediatric readiness of EDs, and their presence is associated with improved compliance with published guidelines. Barriers to implementation of guidelines may be targeted for future initiatives by a national coalition whose goal is to ensure day-to-day pediatric readiness of our nation’s EDs.
Clinical relevance of an unfused pancreatic duct system.
Authors: C J Mitchell, D J Lintott, W S Ruddell, M S Losowsky, A T Axon
Journal: Gut (1979)

In man, the main pancreatic duct is normally derived from ventral and dorsal embryological buds of the pancreas. In a minority of people, failure of fusion of the two buds results in separate drainage of the dorsal and ventral pancreas, so that the accessory duct provides the main drainage for the gland. Patients with this anomaly demonstrated at endoscopic retrograde pancreatography (ERP) have been investigated to assess whether non-fusion of the main pancreatic duct predisposes to the development of pancreatitis. A failure of fusion of the pancreatic ducts was seen in 21 out of 449 (4.7%) successful pancreatograms; four of these 21 patients had definite clinical evidence of pancreatitis and two patients had possible pancreatic disease, but in the remainder the anomaly was not considered to be clinically relevant. An abnormal pancreatogram suggesting pancreatitis was present in 116 out of the 428 patients (27.1%) with a normally fused duct system. The anomaly was found as frequently in the whole series as it was seen in patients with pancreatitis. These findings suggest that embryological failure of pancreatic duct fusion does not predispose to the development of pancreatitis. However, the presence of this anomaly may lead to misinterpretation of ultrasonographic and CT scan findings.
VAGINAL HYSTERECTOMY—TWENTY-ONE CONSECUTIVE, SUCCESSFUL CASES.
Authors: CHARLES GILBERT DAVIS
Journal: JAMA (1896)

In looking back over the history of surgical progress it is interesting to note the process of evolution which has so gradually brought order out of chaos and from the crude methods of the past evolved the brilliant results which to-day are crowning modern surgery. It is right and just that much credit should be given to antisepsis and yet a large percentage may be justly attributed to improvement of technique and simplicity of procedure. This is an age of brevity. All the world is seeking a more direct route to the point of destination. Unnecessary complications are avoided. To no part of surgery do we find these facts more applicable than in that which relates to the abdominal and pelvic regions. It is unnecessary to state that far too many operations have been performed on the organs in these localities and that many blunders have been necessarily committed. But
Increasing Patient Compliance With Prescriptions
Authors: Connie L. Peck
Journal: JAMA (1982)

In this review, we address the problem of patient noncompliance with taking prescribed medication. Eight methods of improving patient compliance are outlined as follows: (1) improving the physician-patient interaction, (2) fear-arousing health messages, (3) education, (4) written instructions, (5) special drug packaging, (6) tailoring, (7) self-monitoring, and (8) contingency management. Several problems associated with the use of compliance-enhancing strategies are mentioned. Finally, the Health Belief Model is suggested as a framework capable of integrating some of the research findings in this area.
Liver Transplantation in Man--II, a Report of two Orthotopic Liver Transplants in Adult Recipients
Authors: R. Y. Calne, R. Williams, J. L. Dawson, I. D. Ansell, D. B. Evans, P. T. Flute, P. M. Herbertson, V. Joysey, G. H. W. Keates, R. P. Knill-Jones, S. A. Mason, P. R. Millard, J. R. Pena, B. D. Pentlow, J. R. Salaman, R. A. Sells, P. A. Cullum
Journal: BMJ (1968)

Two patients with primary hepatic malignancy were treated by hepatectomy and orthotopic liver transplantation. In both cases the donor liver was infused with cold solutions and kept chilled without continuous perfusion. There was immediate satisfactory hepatic function in both transplants.The first patient died after 11 weeks from overwhelming bacterial and fungal infections probably secondary to hepatic infarction due to thrombosis of the recipient hepatic artery. The thrombus occurred at the site of the arterial clamp. In an attempt to control the growth before transplantation, the patient had been treated with large doses of chlorambucil, which resulted in extreme marrow depression and septicaemia.The second patient developed cholestatic jaundice during the second and third weeks after transplantation, with histological evidence of mild rejection, which was controlled by increasing the dose of immunosuppressive agents. He is now well, having returned to work six weeks after the operation.Though the first patient showed no evidence of rejection, it is concluded that patients receiving liver allografts should receive immunosuppressive therapy.
Ambulatory oxygen in interstitial lung disease
Authors: D. Visca, A. Montgomery, A. de Lauretis, P. Sestini, H. Soteriou, T.M. Maher, A.U. Wells, E.A. Renzoni
Journal: European Respiratory Journal (2011)

our knowledge, ILD has never previously been related to heterozygous SFTPB mutation in either adults or children.The patient's clinical situation was characterised by a normal pulmonary pressure and a transient need for oxygen supplementation; only low doses of oral prednisone were required.Presently, it is not possible to predict the patient's clinical course, as no other similar cases have been reported.Lung transplantation currently represents the only treatment option for this disease, but it is hoped that new treatments will be developed that are based on a better understanding of the disease.
Comparison of In Vivo Carotid 3.0-T Magnetic Resonance to B-Mode Ultrasound Imaging and Histology in a Porcine Model
Authors: Raphaël Duivenvoorden, Eric de Groot, Hamid Afzali, Ed T. VanBavel, Onno J. de Boer, Johan S. Laméris, Zahi A. Fayad, Erik S.G. Stroes, John J.P. Kastelein, Aart J. Nederveen
Journal: JACC. Cardiovascular imaging (2009)
Stimulation of Gastrin Secretion and Synthesis in Antral Organ Culture
Authors: Richard F. Harty, Jan C. van der Vijver, James E. McGuigan
Journal: Journal of Clinical Investigation (1977)

The purpose of the present study was to examine stimulation of gastrin release and the synthesis of gastrin directly by measurement of incorporation of [3H]tryptophan into gastrin in rat antral mucosal explants maintained in organ culture. Gastrin synthesis and secretion were assessed simultaneously at intervals over the 24-h duration of explant culture. Antral mucosal explants from fed female Wistar rats (4-5 wk, 100-150 g) were cultured at 37°C (95% O2/5% CO2) in medium containing 70% Trowell-T8 and 10% NCTC-135 without unlabeled tryptophan, 10% dialyzed fetal calf serum and [3H]tryptophan (100 μCi/ml). Antral tissue was harvested at regular intervals during 24-h culture periods. Incorporation of [3H]tryptophan into immunoreactive gastrin was determined by techniques utilizing double-antibody immunoprecipitation. Antral tissue protein synthesis was assessed by measurements of incorporation of [3H]tryptophan into tissue protein of cultured antral explants. In paired experiments, gastrin synthesis and secretion in the presence of dibutyryl cAMP (DBCAMP) were compared to those observed under control conditions. Gastrin and protein specific activity progressively increased with time. Gastrin specific activity at 30 min increased from 3.3±0.5 (SEM) to 55.2±10.6 fmol [3H]tryptophan/pmol gastrin (or from 1.57±0.48 to 26.28±5.05 pmol [3H]tryptophan/μg gastrin) at 24 h: specific activity of antral tissue protein at 30 min increased from 33.6±8.4 to 1,660±236 fmol [3H]tryptophan/μg protein at 16 h. Culturing of explants for 4 h in the presence of cycloheximide (100 μg/ml) inhibited both gastrin synthesis and protein synthesis by greater than 90 and 95%, respectively. DBCAMP (10 mM) significantly increased both the synthesis and secretion of antral gastrin when compared with control cultured explants. Results of these experiments provide direct demonstration of gastrin synthesis by rat antral mucosal explants in organ culture, indicate that both gastrin and total antral protein synthesis are inhibited by cycloheximide, and demonstrate DBCAMP-induced stimulation of both gastrin synthesis and secretion, suggesting the potentially important role of cyclic AMP in gastrin cell function.
Aseptic Meningitis and Paralytic Disease Due to Newly Recognized Enterovirus
Authors: Herman Kleinman, Marion K. Cooney, C. Barton Nelson, Richard R. Owen, Lloyd Boyd, Glenna Swanda
Journal: JAMA (1964)

A newly recognized enterovirus, Giles virus, is held responsible for 58 cases of aseptic meningitis, three of them with paralysis. The new agent is distinguished by its affinity for human amnion cells in tissue culture. The virus was isolated from 45 cases; in 15 of these a rise in antibody titer was demonstrated. Clinically, the cases were typical. Giles virus appears to be more neurotropic than Coxsackie or ECHO viruses. There is evidence to suggest that experience with this virus is new in Minnesota.
Fatal Hypocalcemia From Phosphate Absorption From Laxative Preparation
Authors: Thomas H. McConnell
Journal: JAMA (1971)

<h3>To the Editor.—</h3> Proprietary laxative preparations are generally considered safe self-therapy for those "... hard... to move." Sodium phosphate compounds are among the most popular laxatives in this country. For example, one company in 1969 sold 100,000 gal of a mixture of sodium biphosphate and sodium phosphate (Phospho-Soda). An unintentional fatal overdose with this common laxative product is reported. <h3>Report of a Case.—</h3> A 48-year-old housewife, because of chronic constipation, ingested this preparation "daily," in "huge" doses. Two days before admission, severe constipation, pain, and distention led to consumption of "large amounts," until she was found semicomatose at home. She previously had been in good health. The blood pressure was 72/40 mm Hg; pulse rate, 110 beats per minute; respirations, 44 per minute; and temperature, 38 C. She responded poorly to deep pain, was semicomatose with abdominal distention, tympanites, absence of bowel sounds, and a few rhonchi. Muscle tone was decreased
Consultant who ran car export and property business through NHS computer is struck off
Authors: C. Dyer
Journal: BMJ (2014)

A consultant histopathologist has been struck off for “continuous systematic abuse” of the confidence placed in him by his employer, Mid Essex Hospital Services NHS Trust.

Joseph Kaluba ran a car export business from his hospital computer and used it to deal in property in the United Kingdom and Zambia. An investigation at Broomfield Hospital in Chelmsford showed that nearly a third of his emails were not related to his duties. He used his computer extensively while on duty …
PAPILLOMA OF THE LIMBUS CONJUNCTIVÆ.
Authors: GEORGE H. HEILMULLER
Journal: JAMA (1903)

I was consulted by an optician about the case here illustrated and as I could not see the patient until three days later a collyrium containing boric acid and suprarenalin was ordered. The suprarenalin constricted the blood vessels of the wart, producing the intense white appearance. The larger vessels were not contracted to the same extent and hence appear more prominently on the photograph. The patient had no warts on other parts of the body. It first appeared in October, 1902, and was then the size of a pin head. The photograph being life size, the tumor needs no description, it being a simple cauliflower-like wart. The tumor is on the patient's right side, the white irregular spots on the left being the image of the photographer's screens. It is interesting on account of the extreme rarity of its appearance in the limbus. Usually tumors of this region are malignant.
Doctors who look and speak differently may be mistrusted
Authors: Satheesh Mathew
Journal: BMJ (2007)

suicide riskBipolarity is important during treatment with antidepressants Rubino et al have identified that most (if not all) of the excess risk of suicide in a group of patients treated with venlafaxine could be explained by a higher burden of risk factors for suicide.It may be true that this group of patients had more severe or "difficult to treat" unipolar depression, but it is also possible that bipolar features in this group may be responsible for the observed raised rates of suicidality.Perhaps because of limitations of space, the authors do not discuss this as a possibility, despite an adjusted relative risk of completed suicide of 4.94 (95% confidence interval 1.30 to 18.84) for "past history of bipolar disorder" (table 3). 1 Recent work shows that at least 50% of difficult to treat unipolar depressed patients may have an undetected bipolar disorder, 2 and it is now well documented that antidepressant monotherapy for bipolar depression runs a high risk of precipitating hypomanic or mixed affective states, 3 which have been strongly associated with self harm and completed suicide. 4 It is also the case that venlafaxine seems more likely than other antidepressants to precipitate a switch into hypomania or mania in bipolar depression. 5Furthermore, many of the variables reported by Rubino et al could be considered to point towards high levels of bipolarity in the venlafaxine treated group, including higher rates of a family history of psychiatric disorder, more frequent prescription of antipsychotics and mood stabilisers, a history of non-response to several different antidepressants, and more frequent lifetime depressive episodes.
High Fiber Diet in Hyperlipemia
Authors: P. J. Palumbo
Journal: JAMA (1978)

Fourteen patients with type Ila hyperlipoproteinemia were treated with a high fiber intake (powdered cellulose or soy hulls or both) for six months. Eight of the patients were treated with 16 g of cholestyramine resin daily without the high fiber intake for an additional six months. The cholesterol intake was comparable in both treatment programs. The mean serum cholesterol levels decreased during both, but the decrease occurred and was more pronounced in all patients treated with cholestyramine. Responsiveness to the high fiber diet was not related to an increased responsiveness to cholestyramine treatment. In most patients the serum triglyceride levels increased, and the fasting plasma glucose level did not change substantially during either treatment program. Both regimens were free of adverse side effects. (<i>JAMA</i>240:223-227, 1978)
Predicting Mortality Among Patients Hospitalized for Heart Failure
Authors: Douglas S. Lee, Peter C. Austin, Jean L. Rouleau, Peter P. Liu, David Naimark, Jack V. Tu
Journal: JAMA (2003)

A predictive model of mortality in heart failure may be useful for clinicians to improve communication with and care of hospitalized patients.To identify predictors of mortality and to develop and to validate a model using information available at hospital presentation.Retrospective study of 4031 community-based patients presenting with heart failure at multiple hospitals in Ontario, Canada (2624 patients in the derivation cohort from 1999-2001 and 1407 patients in the validation cohort from 1997-1999), who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study.All-cause 30-day and 1-year mortality.The mortality rates for the derivation cohort and validation cohort, respectively, were 8.9% and 8.2% in hospital, 10.7% and 10.4% at 30 days, and 32.9% and 30.5% at 1 year. Multivariable predictors of mortality at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen level (all P<.001), and hyponatremia (P<.01). Comorbid conditions associated with mortality included cerebrovascular disease (30-day mortality odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.98; P =.03), chronic obstructive pulmonary disease (OR, 1.66; 95% CI, 1.22-2.27; P =.002), hepatic cirrhosis (OR, 3.22; 95% CI, 1.08-9.65; P =.04), dementia (OR, 2.54; 95% CI, 1.77-3.65; P<.001), and cancer (OR, 1.86; 95% CI, 1.28-2.70; P =.001). A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low-risk scores (< or =60) had a mortality rate of 0.4% at 30 days and 7.8% at 1 year. Patients with very high-risk scores (>150) had a mortality rate of 59.0% at 30 days and 78.8% at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year (log-rank, P<.001). For the derivation cohort, the area under the receiver operating characteristic curve for the model was 0.80 for 30-day mortality and 0.77 for 1-year mortality. Predicted mortality rates in the validation cohort closely matched observed rates across the entire spectrum of risk.Among community-based heart failure patients, factors identifiable within hours of hospital presentation predicted mortality risk at 30 days and 1 year. The externally validated predictive index may assist clinicians in estimating heart failure mortality risk and in providing quantitative guidance for decision making in heart failure care.
Lower oesophageal sphincter tone in patients with peptic stricture.
Authors: R Lobello, M Stekelman, D A Edwards
Journal: Thorax (1978)

Radiographic studies of 161 patients with a stricture within the cardiac sphincter segment showed that in appropriate circumstances all patients could herniate stomach and reflux barium freely, but that the sphincter could obliterate the lumen and sustain this contraction by its basal tone in at least 122. The sphincter could also relax and contract in response to a swallow. The capacity to remain closed depended on the position of the patient and on circumstances in which hiatal flow and reflux did not occur. Manometric studies of the cardiac sphincter were made in a further 14 patients with a stricture in the sphincter segment, and appropriate circumstances the "basal tone" of the sphincter was found to be within our range of normal.
Hepatitis B virus replication modulates pathogenesis of hepatitis D virus in chronic hepatitis D
Authors: Antonina Smedile, Floriano Rosina, Giorgio Saracco, Elisabetta Chiaberge, Valter Lattore, Antonina Fabino, Maurizia R. Brunetto, Giorgio Verme, Mario Rizzetto, Ferruccio Bonino
Journal: Hepatology (1991)

Hepatitis D virus and hepatitis B virus nucleic acids were detected by Northern and Southern blot hybridization in the sera and livers of 85 chronic carriers of HBsAg and anti-hepatitis D followed up for a mean of 10 yr. We identified three subsets of patients: 13 with hepatitis D virus and hepatitis B virus viremia, 53 with serum hepatitis D virus RNA, but without hepatitis B virus DNA and 19 negative for both nucleic acids. Genomic and subgenomic forms of hepatitis D virus RNA were detected only in patients with hepatitis D virus and hepatitis B virus viremia. Histological findings and disease activity at admission were comparable in the three groups of patients, but the outcome was significantly worse in patients with active replication of both viruses; two of them died of terminal liver failure and hepatocellular carcinoma developed in two; the remaining patients had an uneventful course. These results suggest that active hepatitis B virus replication represents an important previously unrecognized determinant of severe liver damage in patients with chronic hepatitis D virus infection. Since hepatitis B virus provides the means for hepatitis D virus secretion and release from infected cells, active hepatitis B virus multiplication favoring the spread of hepatitis D virus from cell to cell may increase the pathogenetic potential of the defective agent.
Intravesical Instillations with Bacillus Calmette-Guérin for the Treatment of Carcinoma In Situ Involving Prostatic Ducts
Authors: Juan Palou Redorta, Peter Schatteman, Jorge Huguet Pérez, Joséph Segarra Tomás, Antonio Rosales Bordes, Ferran Algaba, Humberto Villavicencio Mavrich
Journal: European Urology (2006)
Abstract 14188: Long-term Benefit After Myectomy Combined With Anterior Mitral Leaflet Extension In Obstructive Hypertrophic Cardiomyopathy
Authors: Michelle Michels, Osama Soliman, Lex Van Herwerden, Marcel Kofflard, Peter De Jong, Marcel Geleijnse, Folkert Ten Cate
Journal: Circulation (2010)

Objectives: In patients with obstructive HCM, enlarged anterior mitral valve leaflet may result in suboptimal outcome after isolated myectomy. We describe the long-term course after myectomy combin...
Retropharyngeal Parathyroid Adenoma
Authors: Calvin L. Strand
Journal: JAMA (1973)

<h3>To the Editor.—</h3> The patient described below had the rare finding of a parathyroid adenoma with hemorrhage presenting as a retropharyngeal mass. The clinical picture, with fever and leukocytosis, suggested the diagnosis of a retropharyngeal abscess. <h3>Report of a Case.—</h3> A 50-year-old obese woman was admitted to the Memphis Naval Hospital with a three-day history of increasing dysphagia. For the 36 hours prior to admission the patient had been unable to swallow her own secretions and had taken nothing by mouth. The patient denied trauma or ingestion of a foreign body. There was no pertinent medical history. The temperature was 38.6 C. Generalized cervical swelling with mild tenderness in each supraclavicular area was present, and there was a mild right otitis externa. The throat showed ecchymosis of the posterior pharynx, without fluctuation. The white blood cell count was 15,400/cu mm, with 78% neutrophils, 20% lymphocytes, and 2% monocytes. The calcium