tbuckley/cabot-search huggingface dataset:
A Method for Estimating the Preservice and Postservice Work of Physicians' Services
Authors: Daniel Dunn
Journal: JAMA (1988)

The goal of the Resource-Based Relative Value Scale is to measure the resource costs of physicians' services, or, more centrally, the physician's total work. This article describes the estimation of relative values for physicians' work before and after the performance of a service (preservice and postservice work). For methodological and practical reasons, we could not obtain direct ratings of preservice and postservice work except for a few services. We therefore developed a systematic process to estimate preservice and postservice time and rate of work per unit of time. Then time and work per unit of time were multiplied to estimate work. The major finding of our investigation is that preservice and postservice work make up a substantial portion of total work. The typical percentages of total work accounted for by preservice and postservice work range from 26% and 33% for imaging services and evaluation and management services, respectively, to 46% for invasive services performed in a hospital inpatient setting. (<i>JAMA</i>1988;260:2371-2378)
Models of Madness, Models of Medicine
Authors: Marjorie C. Meehan
Journal: JAMA (1975)

No one will deny that there is widespread disagreement among psychiatrists, psychologists, and lawyers about the nature of psychiatric disorder. Siegler and Osmond attempt to clarify the situation by pointing out that mental illness and addiction are conceptualized in terms -of different models. In the moral model, the patient's behavior is viewed as "bad," to be corrected by punishment or reward. This viewpoint is especially common in regard to alcoholism and drug addiction, but also directs much of the everyday handling of patients in mental hospitals. It forms the background of the increasingly popular behavior modification therapy. The impaired model is applied to long-term patients who are regarded as suffering from an untreatable and probably incurable defect that requires them to receive special protection (custodial care). In the psychoanalytic model, patients are viewed not as suffering from a specific disease but from a lifelong disorder probably due to errors in
Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes
Authors: Amit X. Garg, Neill K. J. Adhikari, Heather McDonald, M. Patricia Rosas-Arellano, P. J. Devereaux, Joseph Beyene, Justina Sam, R. Brian Haynes
Journal: JAMA (2005)

Developers of health care software have attributed improvements in patient care to these applications. As with any health care intervention, such claims require confirmation in clinical trials.To review controlled trials assessing the effects of computerized clinical decision support systems (CDSSs) and to identify study characteristics predicting benefit.We updated our earlier reviews by searching the MEDLINE, EMBASE, Cochrane Library, Inspec, and ISI databases and consulting reference lists through September 2004. Authors of 64 primary studies confirmed data or provided additional information.We included randomized and nonrandomized controlled trials that evaluated the effect of a CDSS compared with care provided without a CDSS on practitioner performance or patient outcomes.Teams of 2 reviewers independently abstracted data on methods, setting, CDSS and patient characteristics, and outcomes.One hundred studies met our inclusion criteria. The number and methodologic quality of studies improved over time. The CDSS improved practitioner performance in 62 (64%) of the 97 studies assessing this outcome, including 4 (40%) of 10 diagnostic systems, 16 (76%) of 21 reminder systems, 23 (62%) of 37 disease management systems, and 19 (66%) of 29 drug-dosing or prescribing systems. Fifty-two trials assessed 1 or more patient outcomes, of which 7 trials (13%) reported improvements. Improved practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system (success in 73% of trials vs 47%; P = .02) and studies in which the authors also developed the CDSS software compared with studies in which the authors were not the developers (74% success vs 28%; respectively, P = .001).Many CDSSs improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent.
Electron microscopic evaluation of brain edema in rabbits with galactosamine-induced fulminant hepatic failure: Ultrastructure and integrity of the blood-brain barrier
Authors: Peter G. Traber, Mauro Dal Canto, Daniel R. Ganger, Andres T. Blei
Journal: Hepatology (1987)

Brain edema is a major complication of fulminant hepatic failure and is responsible for death in a large percentage of patients. We previously demonstrated the progressive accumulation of water in grey matter areas of the brain in the rabbit with galactosamine-induced fulminant hepatic failure. We now report the electron microscopic morphology of the brain in the same model of acute hepatic failure following the intravenous injection of horseradish peroxidase, an intravascular tracer which forms an electron-dense reaction product. Rabbits with both mild and severe encephalopathy had normal blood pressures and blood gases at the time of study. Fixation of brain tissue was obtained by whole-body perfusion. Marked swelling of the cytoplasm, perineuronal and perivascular processes of astrocytes were noted in cortical gray, but not white, matter areas; the other cellular components of the brain had normal morphology. Capillary endothelial cells were normal, and there was no evidence of horseradish peroxidase in endothelial cell vesicles, basement membranes or the brain parenchyma, suggesting that the blood-brain barrier was impermeable to large molecules. Histologic evidence of brain edema is seen in this model, with swelling of astrocytes as the primary manifestation of the accumulation of water. Damage to astrocytes or inhibition of their function may contribute to the pathogenesis of hepatic encephalopathy in this model.
NIDDM Patients' Fears and Hopes About Insulin Therapy: The basis of patient reluctance
Authors: Linda M Hunt, Miguel A Valenzuela, Jacqueline A Pugh
Journal: Diabetes Care (1997)

OBJECTIVE This study examines NIDDM patients' attitudes toward insulin injections, the basis of these attitudes, and how they may affect patients' willingness to take insulin. RESEARCH DESIGN AND METHODS Forty-four low-income Mexican American NIDDM patients were interviewed using open-ended in-depth interviewing techniques. Transcripts were analyzed using techniques of content analysis. Data classification was cross-checked in analysis conferences and through a second researcher coding 50% of the cases, comparing the results, then resolving any discrepancies. RESULTS Patients' positive attitudes toward insulin focus on its efficacy and efficiency, the avoidance of complications, and feeling better and more energetic. Negative attitudes were much more frequently discussed and include “technical concerns”: anxiety about the pain, proper techniques, and general hassles of taking injections; about hypoglycemic symptoms; and about insulin causing serious health problems; and “experimental concerns”: sensing that the disease has progressed into a serious phase, that past treatment efforts have failed, and that the patient has not taken proper care. Attitudes were based on personal experience, observation, what others say, and interactions with health care professionals. CONCLUSIONS Results from the few published reports on NIDDM patients' attitudes about insulin from various cultural settings were consistent with our findings, indicating that these themes may be generally applicable to a wider population. It is recommended that health care providers take care to avoid unwitting promotion of negative attitudes toward insulin and actively elicit and respond to patient attitudes to reduce reluctance to take the medication.
A Suggestion to Preparatory Schools Regarding Morality from the Common-sense Standpoint.
Authors: G. Totten-McMaster
Journal: JAMA (1901)

New Haven, Conn., May 23, 1901.  To the Editor:  —The prevention of venereal diseases is an important subject. Legalized prostitution has its advantages and disadvantages, but the teaching our young men the results of common venereal disorders, has never been attempted in the curriculum of our preparatory schools. If an obligatory course of lectures on the common complications of gonorrhea, chancroid, and syphilis were to be given in our large schools where young men are prepared for the universities, it seems as if it might have much weight.  The lectures should be given by a physician of experience and should cover the common dangers incident to the disorders, viz.: etiology, symptoms. complications, and sequels. If these lectures were delivered to the graduating class of the preparatory schools, it might have a good effect on the future actions of its members.  The lectures should not be intended to intimidate men, but
Letter from Chicago: Trifles soothe the mind
Authors: G. Dunea
Journal: BMJ (1983)

<h3>ABSTRACT</h3> <h3>Background</h3> The capacity of the general internal medicine clinical teaching units has been strained by decreasing resident supply and increasing patient demand. The objective of our study was to quantitatively compare the number of residents (supply) with the volume and duration of patient care activities (demand) to identify inefficiency. <h3>Methods</h3> Using the most recently available data from an academic teaching hospital, we identified each occurrence of a set of patient care activities that took place on the clinical teaching unit. We completed a descriptive analysis of the frequencies of these activities and how the frequencies varied by hour, day, week, month, and year. Patient care activities included admissions, rounds, responding to pages, meeting with patients and their families, patient transfers, discharges, and responding to cardiac arrests. The estimated time to complete each task was based on the available data in our electronic healthcare system and interviews with general internal medicine physicians or trainees. To calculate resident utilization, the person-hours of patient care tasks was divided by the person-hours of resident supply. Resident utilization was computed for three scenarios corresponding to varying levels of resident absenteeism. <h3>Results</h3> Between 2015 and 2019 there were 14,581 consultations to general internal medicine from the emergency department. Patient volumes tended to be highest during January and lowest during May and June; and highest on Monday morning and lowest on Friday night. Daily admissions into hospital from the emergency department were higher on weekdays than on weekends, and hourly admissions peaked at 8:00 AM and between 3:00 PM and 1:00 AM. Weekday resident utilization was generally highest between 8:00 AM and 2:00 PM and lowest between 1:00 AM and 8:00 AM. In a scenario where all residents were present apart from those who were post-call, resident utilization generally never exceeded 100%; in scenarios where at least one resident was absent due to illness and/or vacation, it was common for resident utilization to approach or exceed 100%, particularly during daytime working hours. <h3>Interpretation</h3> Analyzing supply and demand on a general internal medicine ward has allowed us to identify periods where supply and demand are not aligned and to empirically demonstrate the vulnerability of current staffing models. These data have the potential to inform and optimize scheduling on an internal medicine ward.
Chorioamnionitis and Early Childhood Outcomes Among Extremely Low-Gestational-Age Neonates
Authors: Athina Pappas, Douglas E. Kendrick, Seetha Shankaran, Barbara J. Stoll, Edward F. Bell, Abbott R. Laptook, Michele C. Walsh, Abhik Das, Ellen C. Hale, Nancy S. Newman, Rosemary D. Higgins
Journal: JAMA Pediatrics (2013)

Chorioamnionitis is strongly linked to preterm birth and neonatal infection. The association between histological and clinical chorioamnionitis and cognitive, behavioral, and neurodevelopmental outcomes among extremely preterm neonates is less clear. We evaluated the impact of chorioamnionitis on 18- to 22-month neurodevelopmental outcomes in a contemporary cohort of extremely preterm neonates. To compare the neonatal and neurodevelopmental outcomes of 3 groups of extremely low-gestational-age infants with increasing exposure to perinatal inflammation: no chorioamnionitis, histological chorioamnionitis alone, or histological plus clinical chorioamnionitis. Longitudinal observational study at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Two thousand three hundred ninety extremely preterm infants born at less than 27 weeks' gestational age (GA) between January 1, 2006, and December 31, 2008, with placental histopathology and 18 to 22 months' corrected age follow-up data were eligible. Chorioamnionitis. Outcomes included cerebral palsy, gross motor functional limitation, behavioral scores (according to the Brief Infant-Toddler Social and Emotional Assessment), cognitive and language scores (according to the Bayley Scales of Infant and Toddler Development, Third Edition), and composite measures of death/neurodevelopmental impairment. Multivariable logistic and linear regression models were developed to assess the association between chorioamnionitis and outcomes while controlling for important variables known at birth. Neonates exposed to chorioamnionitis had a lower GA and higher rates of early-onset sepsis and severe periventricular-intraventricular hemorrhage as compared with unexposed neonates. In multivariable models evaluating death and neurodevelopmental outcomes, inclusion of GA in the model diminished the association between chorioamnionitis and adverse outcomes. Still, histological plus clinical chorioamnionitis was associated with increased risk of cognitive impairment as compared with no chorioamnionitis (adjusted odds ratio [OR], 2.38 [95% CI, 1.32 to 4.28] without GA; adjusted OR, 2.00 [95% CI, 1.10 to 3.64] with GA as a covariate). Histological chorioamnionitis alone was associated with lower odds of death/neurodevelopmental impairment as compared with histological plus clinical chorioamnionitis (adjusted OR, 0.68 [95% CI, 0.52 to 0.89] without GA; adjusted OR, 0.66 [95% CI, 0.49 to 0.89] with GA as a covariate). Risk of behavioral problems did not differ statistically between groups. Antenatal exposure to chorioamnionitis is associated with altered odds of cognitive impairment and death/neurodevelopmental impairment in extremely preterm infants.
Immunotherapy in Allergy to Insect Stings in Children
Authors: Rebecca S. Gruchalla
Journal: New England Journal of Medicine (2004)

The earliest reported death from an allergic reaction to a stinging insect was that of King Menes of Egypt, who died in 2641 B.C., purportedly as the result of a wasp or hornet sting.1 Currently, there are at least 40 fatal stings per year in the United States,2 and it is likely that many others go unrecognized.3 Stinging insects are found in the Hymenoptera order, and three particular families, the Apidae, the Vespidae, and the Formicidae, are of greatest importance in allergy. The Apidae family includes honeybees and bumblebees, the Vespidae family yellow jackets, yellow hornets, white-faced hornets, and paper . . .
Dose dependence and time course of the immunologic response to administration of standardized cat allergen extract
Authors: Anil Nanda, Maeve O'Connor, Miriam Anand, Stephen C. Dreskin, Lening Zhang, Brittany Hines, Diana Lane, William Wheat, John M. Routes, Richard Sawyer, Lanny J. Rosenwasser, Harold S. Nelson
Journal: Journal of Allergy and Clinical Immunology (2004)
Clinical Trial of Two Coronary Vasodilator Drugs
Authors: E. H. O. Parry, P. G. Wells
Journal: BMJ (1960)

Glyceryl trinitrate is now widely used for the rapid relief of acute episodes of cardiac pain. It is not of value in preventing pain except when taken immediately before effort. The search continues for a long-acting nitrate drug which, if taken regularly throughout he day, would prevent cardiac pain. Two such drugs have been prepared and used in trials recently. A sustained-action nitroglycerin ( nitroglyn ) was found by Huppert and Boyd (1955) to be moderately effective, while Fuller and Kassel (1955) and Heller (1956) reported good results in using triethanol amine trinitrate biphosphate ( metamine ). However, Russek et al (1955a, 1955b) and Riseman et al (1958) found that these two drugs were ineffective, and other clinical reports have produced further conflicting evidence.
Isolation and characterization of resident stromal macrophages and hematopoietic cell clusters from mouse bone marrow.
Authors: P R Crocker, S Gordon
Journal: The Journal of Experimental Medicine (1985)

In situ studies with the mouse macrophage (M phi)-specific antibody, F4/80, have shown that resident M phi in femoral bone marrow (RBMM) form hematopoietic islands with immature myelomonocytic and erythroid cells (Hume, D. A., et al. 1983. J. Exp. Med. 158: 1522). We have isolated these islands (clusters) by collagenase digestion, purified them from single cells by velocity sedimentation, and analyzed their cellular content. The clusters, ranging from 5- to 100 cells, constituted approximately 7% of the total nucleated cells, and greater than 70% contained at least one strongly staining, F4/80+ central M phi. In comparison, less than 26% showed reactivity for alkaline phosphatase, a marker of fibroblastoid reticulum cells. Compared with the nonclustering population, clusters were enriched with RBMM, fibroblastoid cells, and immature hematopoietic cells, but depleted of mature granulocytes and erythrocytes. The RBMM population was purified from other cells in clusters by selective adherence to glass and was compared with resident peritoneal M phi (RPM) for morphology and the presence of antigens, receptors, and enzymes. RBMM spread more extensively than RPM and frequently extended delicate plasma membrane processes. These and subsequent differences were not attributable to the collagenase treatment. Both M phi populations stained positively with antibodies F4/80 and 2.4G2 (Fc receptor IgG1/2b), bore mannosyl/fucosyl receptors, and showed reactivity for acid phosphatase and nonspecific esterase I. In contrast to RPM, RBMM had no detectable Mac-1 antigen (CR3) or complement receptors, but bore higher levels of Fc receptors (IgG2a and IgG2b) and Ia antigens. In addition, RBMM possessed a novel hemagglutinin activity for unopsonized sheep erythrocytes, which was not present on RPM. RBMM showed no respiratory burst activity in response to zymosan particles, but ingested them avidly. The growth properties of clustering and nonclustered populations were compared by measurement of [3H]thymidine incorporation and progenitor assays. Cells in clusters incorporated three- to fourfold more thymidine than nonclustered cells even in the absence of exogenous growth factors, and autoradiography demonstrated that RBMM made contact with proliferating cells. In contrast, the clusters contained over threefold fewer granulocyte/M phi progenitors compared with nonclustering cells. When clusters were cultivated for up to 3 d, there was rapid outgrowth of monocytes and fibroblastoid cells. These studies demonstrate that RBMM bear a distinct morphology and phenotype.(ABSTRACT TRUNCATED AT 400 WORDS)
Efficacy and tolerability of multiple-dose SDZ IMM 125 in patients with severe psoriasis
Authors: L. WITKAMP, I. M. ZONNEVELD, E. G. JUNG, R. E. SCHOPF, E. CHRISTOPHERS, R. GROSSMAN, H. MEFFERT, S. BELAICH, G. MAHRLE, TH. JOOST, T. STOOF, J. D. BOS, H. MAYER, S. TAESCH, G. FEUTREN
Journal: British Journal of Dermatology (2006)

Although cyclosporin is effective in immunosuppression following organ transplantation and in the treatment of psoriasis, its use is limited by its side-effects, notably impaired renal function and hypertension. As SDZ IMM 125, a new derivative of the cyclosporin family, showed considerable immunosuppressive activity in experimental studies, with less effect on renal function, it was considered a potential successor to cyclosporin for both indications. In this multicentre, double-blind, placebo-controlled study, the efficacy and tolerability of 40, 100, 200 and 400 mg SDZ IMM 125 daily were studied in 59 patients with psoriasis. Patients were followed for a period of 5 weeks (4 weeks treatment, and 1 week post-treatment observation). A dose-dependent effect of SDZ IMM 125 was observed. A significant correlation was found between the dose of SDZ IMM 125 and changes in the sum of severity scores of three indicator plaques. There was a significant decrease in the body surface area affected by psoriasis in the 400-mg group (P < or = 0.01), whereas a decrease of the global psoriasis severity was observed in the 200-mg (P < or = 0.01) and the 400-mg groups (P < or = 0.001). No serious adverse events occurred during the 4 weeks of treatment. Three patients discontinued treatment because of adverse events (one sore throat, two influenza). Clinical adverse events were similar to those reported with cyclosporin, the most frequent being gastrointestinal disturbances. Estimation of renal function indices showed that increases from baseline values were dose-dependent, and appeared to be similar to those seen with cyclosporin.(ABSTRACT TRUNCATED AT 250 WORDS)
Brown bowel syndrome: an unusual cause of massive dilatation of the colon.
Authors: M H Robinson, B L Dowling, J V Clark, C H Mason
Journal: Gut (1989)

We report a case of the brown bowel syndrome presenting as major dilatation of the colon which resembled 9toxic dilatation9 and necessitated subtotal colectomy. We confirm the reported association between the brown bowel syndrome, malabsorption, and hypovitaminosis E. Furthermore we document failure of the brown pigmentation to resolve after six months in spite of vitamin E supplements and correction of the malabsorption. Finally we suggest that, although the brown bowel syndrome is rare, it should be considered in cases of major colonic dilatation where the patient is or may be suffering from a malabsorption syndrome, and where the sigmoidoscopic appearances do not suggest severe inflammatory bowel disease.
The problem with ISTCs
Authors: T. Delamothe
Journal: BMJ (2009)

“Perfidious financial idiocy” was how a previous editor of this journal described the private finance initiative (PFI), a way of securing private funding for public projects, notably hospital building ( BMJ 1999;319:2-3, www.bmj.com/cgi/content/full/319/7201/2). Richard Smith based his assessment largely on the work of Allyson Pollock, who, Cassandra-like, found her message ridiculed when it wasn’t ignored. But that was then. The current unravelling of PFI, with the government bailing out projects in trouble, makes her analysis look prescient. So we should at least take notice of what Professor Pollock has since turned her attention to.

Her latest target is independent sector treatment centres (ISTCs), the beneficiaries of the British government’s policy of contracting out clinical …