tbuckley/cabot-search huggingface dataset:
Outcome Assessment 70 Years Later: Are We Ready?
Authors: Steven A. Schroeder
Journal: New England Journal of Medicine (1987)

AT the beginning of this century, a distinguished Boston surgeon, Ernest Amory Codman, waged a courageous but unsuccessful campaign to have surgeons and hospitals record and publicize the results of their operations. Some seven decades later, the Joint Commission on Accreditation of Hospitals (JCAH) has announced its intent to include outcome criteria as part of its accreditation procedures for hospitals in the United States. Until now, the commission has relied on structure and process criteria to assess the quality of care. In examining structure, JCAH reviewers check the existence, for example, of monitoring equipment in operating rooms, the adequacy of . . .
Pearly Penile Papules
Authors: Priya Sapra, Sheetal Sapra, Amanda Singh
Journal: JAMA Dermatology (2013)

<h3>Importance</h3>Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Treatments have varied in the past; however, to our knowledge, the use of the pulsed dye laser (PDL) for this condition has never been reported in the literature. Such papules are histologically analogous to angiofibromas; thus, we report PDL is an appropriate, effective, and nonablative method of treatment.<h3>Observations</h3>Four patients diagnosed with PPPs were treated with PDL. Each patient reported little to no discomfort during the procedure. Minimal bruising was found in all 4 patients, which diminished over time. One patient stated slight discomfort after the procedure; this however, resolved in a weeks' time. Complete clearance of the papules was noted after 2 to 3 treatments in 2 patients and a reduction of the papules in 2 patients.<h3>Conclusions and Relevance</h3>These 4 case reports illustrate the advantages of using PDL when treating PPP. In each patient, the appearance of the papules was either completely diminished or significantly reduced after the procedure. This result was achieved with only minimal discomfort felt by the patients. The use of PDL offers dermatologists a new treatment modality for PPPs that is safe, easily performed, and produces excellent aesthetic results.
Streptococcal M protein extracted by nonionic detergent. I. Properties of the antiphagocytic and type-specific molecules.
Authors: V A Fischetti, E C Gotschlich, G Siviglia, J B Zabriskie
Journal: The Journal of Experimental Medicine (1976)

Group A streptococcal M protein was extracted with nonionic detergent and subjected to a number of physical, chemical, and immunological tests. M protein thus extracted was composed of multiple protein bands, ranging from 35,000 down to 6,000 daltons, all having type-specific precipitating activity. The anti-phagocytic proteins, however, were limited to three molecular species having mol wt of 28,000, 31,000, and 35,000 daltons, and could be separated from those proteins that had only type specificity. Physical studies indicated that these proteins existed as individual asymmetrical molecules which were not aggregated. By radiolabeling M protein on living streptococci, it was determined that these protein bands were found on the streptococcal cell wall in this multiple form. Also, by pulse chase experiments supported by chemical and immunological data, evidence was obtained strongly suggesting that the smaller, type-specific molecules are used to assemble the larger, antiphagocytic proteins.
Prognostic Factors According to the Treatment Schedule in Malignant Pleural Mesothelioma
Authors: Guntulu Ak, Selma Metintas, Muzaffer Metintas, Huseyin Yildirim, Sinan Erginel, Emel Kurt, Fusun Alatas, Omer Cadirci
Journal: Journal of Thoracic Oncology (2009)
GDNF-Transduced Schwann Cell Grafts Enhance Regeneration of Erectile Nerves
Authors: Florian May, Kaspar Matiasek, Maurice Vroemen, Christiane Caspers, Thomas Mrva, Christian Arndt, Boris Schlenker, Peter Gais, Thomas Brill, Alexander Buchner, Armin Blesch, Rudolf Hartung, Christian Stief, Bernd Gansbacher, Norbert Weidner
Journal: European Urology (2008)
Sign of Leser-Trélat
Authors: Forrest C. Brown
Journal: JAMA (1978)

<h3>To the Editor.—</h3> There continues to be some confusion about the definition of the sign of Leser-Trélat. As has been pointed out in the past, it has generally been defined as the sudden appearance and rapid increase in the number of seborrheic keratoses on a skin that was blemish-free, and it is taken to indicate an internal malignant tumor.<sup>1</sup>In a recent issue of<i>JAMA</i>(238:236, 1977), Doll et al have described a case of a 69-year-old man with an erythematous, pruritic, ichthyosiform rash on the trunk and arms; after an unstated time, papular verrucose lesions said to be consistent with seborrheic keratosis developed on the trunk. At the time the verrucose papules were noted, he was found to have a squamous cell carcinoma of the lung. After removal of the tumor, there was improvement of the rash and regression of the verrucose papules in the area of the
Involuntary Jaw Movements in Elderly Patients
Authors: David G. Sherman
Journal: JAMA (1977)

To  Editor.—  We believe  reply by Dr Laskin in  QUESTIONS AND ANSWERS section (236:2447, 1976) regarding cause and treatment of involuntary chewing-like movements in geriatric patients contains errors and misconceptions. Dr Laskin implies that  most common cause for  condition is parkinsonism. While patients with Parkinson disease occasionally have involuntary movements of  face and mouth other than rhythmic tremor,  is uncommon. It is true that during  epidemic of von Economo encephalitis, afflicted patients commonly experienced such involuntary movements during  active stages of  disease. It is also true that levodopa therapy frequently produces oral dyskinesias in patients being treated for Parkinson disease.  Dr Laskin then goes on to say that the next most common condition is orofacial dyskinesia, and that this extrapyramidal disorder usually is a sequela of encephalitis. We do not agree that  is  case. In fact, if one
Marital pathology and the choice of partner.
Authors: P Tomson
Journal: BMJ (1979)

In February 1978 the patient went skiing with his school colleagues, and being afraid of taking drugs in the presence of his friends he stopped taking his immunosuppressive therapy for two weeks.Seen again at the end of March 1978 he was azotaemic, with a plasma creatinine of 884 ,umol/l (10-0 mg/100 ml).An open biopsy of the transplant showed the signs of an acute interstitial graft rejection.Under high-dose steroids administered in addition to his continuous immunosuppressive regimen the graft function improved again, and since June 1978 the plasma creatinine is stable at about 256 tmol/l (2 9 mg/100 ml).
The Effect of Preexisting Conditions on Mortality in Trauma Patients
Authors: John A. Morris
Journal: JAMA (1990)

A case-control design was used to investigate the effects of preexisting chronic conditions on in-hospital mortality in adult trauma patients. Cases consisted of all trauma deaths (n = 3074) that occurred in 1983 in any of the 331 acute care hospitals in California. Three to four control patients (injured survivors) were matched to each case patient on the basis of injury severity, age, and individual hospital (n = 9869). The data source consisted of hospital discharge abstract data uniformly collected on all admissions to acute care hospitals in the state. Conditional logistic regression techniques were used to estimate the relative odds of dying for patients with and without one or more of 11 preexisting chronic conditions identified as potentially detrimental to outcome. The presence of cirrhosis (relative odds = 4.5), congenital coagulopathy (relative odds = 3.2), ischemic heart disease (relative odds = 1.8), chronic obstructive pulmonary disease (relative odds = 1.8), and diabetes (relative odds = 1.2) all significantly increased the risk of dying. These data provide statistical evidence to support the recommendation of the American College of Surgeons that the presence of underlying disease be considered in decisions to triage and transfer patients to trauma centers. They also underscore the importance of underlying disease in the case-mix adjustment of case-fatality rates and the identification of unexpected deaths for quality assurance review.
NICE consults on improving consent rates for organ donation
Authors: H. Mooney
Journal: BMJ (2011)

<h3>Abstract</h3> High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine9s adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions and which ADEs most frequently led to discontinuation. Spine surgery was chosen because of its association with moderate to severe pain and a relatively high use of ketamine infusions in this population at our hospital.
OP36 * CONCORDANCE OF PATIENT AND CLINICIAN REPORTED PRESENTING SYMPTOMS AT INITIAL NEURO-ONCOLOGY ASSESSMENT
Authors: J. E. C. Collins, T. Santarius, C. Watts, F. M. Walter, S. J. Price, A. J. Joannides
Journal: Neuro-Oncology (2014)

INTRODUCTION: Health-related quality of life (HRQoL) is increasingly recognised as an important component of neuro-oncology assessment. The EORTC QLQ-C30 is a well-validated instrument for measuring global health domains and cancer-related symptoms. On this background we sought to evaluate questionnaire symptom reporting as compared to standard clinical assessment. METHOD: Patients presenting for initial assessment in neurosurgical oncology clinic were asked to complete the QLQ-C30 and BN20 brain cancer module questionnaires prior to their appointment. Clinician reported symptoms were determined retrospectively from outpatient clinic letters. Statistical significance was determined using paired t-test and Fisher's exact test. RESULTS: A total of 181 patients were included in the analysis (96 male, 86 female; median age 61). Commonest diagnoses included high-grade glioma (n = 63; 34.6%), metastatic disease (n = 33; 18.1%) and low-grade glioma (n = 29; 15.9%). A higher average number of symptoms was reported by patients (8.2 ± 0.3) compared to clinicians (2.1 ± 0.1; p < 0.0001). Reporting rate for all symptoms was significantly higher from the questionnaire (all p < 0.002) with the exception of seizures which had a higher reporting rate from clinician review (p < 0.0001). Positive symptoms showing the highest concordance included motor dysfunction (43.0%), communication deficit (30.4%) and visual disorder (29.5%). CONCLUSION: Measuring HRQoL with the QLQ-C30 and BN20 enabled detection of more presenting symptoms than by clinician review alone, with concordance highest for gross neurological deficits. Routine collection of HRQoL data thus adds a further dimension to clinical assessment that enhances and complements current practice.
EU attempts to tackle parallel pricing of drugs
Authors: R. Watson
Journal: BMJ (1998)

The European Union is conducting a major investigation into the different prices charged for the same medicines in its 15 member states. Pressure for the exercise has come from EU governments after complaints from the pharmaceutical industry that a parallel trade has grown that undercuts the price of many domestic products.

Drug prices are set by governments. The rate is determined by what a national health service can afford and by the importance of the pharmaceutical industry in a particular country. If the price for a particular drug is considerably lower in one member state, however, an enterprising trader will buy it there and export …
INFERENCE TESTING IN PSYCHOTHERAPY
Authors: JOHN R. REID, JACOB E. FINESINGER
Journal: American Journal of Psychiatry (1951)

"Psychotherapy" may be defined as the use of psychological means to mitigate symptoms, to resolve conflicts, and to improve generally the patient's adjustment. In doing psychotherapy, the doctor makes inferences from both the verbal and nonverbal behavior of the patient. These inferences help the doctor to understand the patient and are used for purposes of interpretation. It is necessary to establish the validity of these inferences in order to make reliable predictions or to institute rational therapy. All this, we realize, is easier said than done. But if we are going to be able to do it as well as possible, in spite of the limitations imposed by the nature of the material, we must formulate our inferences in words that are clear and unambiguous so that the statements in which they occur will be intelligible. Furthermore, if these statements are going to be not only intelligible but technically verifiable, we must be able to get at, and to identify, the facts inferred. When and only when these two logical conditions are fulfilled, are we in a position rigorously to establish the existence of causal laws of human behavior. But we must admit that these statements express a scientific ideal that can be approached but hardly attained in the field of psychotherapy. Ideally, to be sure, inferences should be so formulated that they can be decisively verified (or disverified) by reference to public, reproducible facts, which can be precisely measured. But in view of the private status and inherent obscurity of some of the relevant data, we cannot, in the field of psychotherapy, achieve such logical perfection, but must be guided by the greater weight of evidence and be satisfied with a degree of confirmation that is pragmatically sufficient. However, without being neurotically perfectionistic about it, we may reasonably strive to increase the reliability of our inferences in this field. To do this, we must first define our terms, we must second verify the claim that referents for these terms exist, and we must third show that these referents stand in the empirical relations claimed. Only in this way can we know, with a sufficient degree of clarity, what things we are talking about, and how these things are related in nature—which is the kind of knowledge that, in its applications, gives us increased power to help our patients.
Contribution to the Study of Paraldehyde
Authors: J. Gordon
Journal: BMJ (1889)

THE clinical aspects of paraldehyde have now been under observa- tion for several years, and reports on some of its actions have been published by various observers, who have given the drug a trial in suitable cases.It was introduced by Dr. Cervello, of Palermo, about 1883.Its use as a valuable hypnotic has been claimed in cases of sleeplessness following such acute diseases as croupous pneumonia, bron- chitis, and various heart diseases, as well as in the insomnia of nervous irritability or overwork, and also in cases of cerebral disease-for example, mania and hypochondriasis.The sleep which it induces is said to be prompt, tranquil, and prolonged; there is no stage of excitement preceding its action, and during sleep the patient can easily be brought round without any feeling of stupidity, while there is no headache, nor disordered digestion, nor period of depression.Over hydrate of chloral the advantages claimed are that it diminishes the frequency of the heart's contractions, and at the same time strengthens the beats; that it does not cause the diminished blood-pressure which hydrate of chloral produces, and that its action on the respiration is to diminish its frequency.It seemed, however, that certain points regarding its, hypnotic action, as well as its influence in causing increase or decrease of the amount of urine, and its effects on the excretion'of the nitro- genous constituents of urine and the chlorides, had not been in- vestigated, and it was with reference to these points that part of the following investigations and experiments were conducted.It also seemed desirable, so as to complete the pharmacology of the drug under observation, to undertake a series of experiments and investigations to ascertain its influence on sensory and motor nerves, on the functions of the spinal cord, as well as on muscle substance itself, and to observe its action on blood-pressure and respiration.Paraldehyde has the formula C,HI,20.It is a polymeric form of aldehyde, and its formula may be looked on as a combination of three molecules of aldehyde; thus C,H,O = aldehyde.(C,H40)3 =C,H12O, = paraldehyde.It is obtained by the action of con- centrated sulphuric acid on aldehyde, which causes the liquid to become warm.On cooling to 00 C., the paraldehyde separates as crystals.At ordinary temperatures it is a transparent, colourless, volatile fluid.At 100 C. it passes into crystalline form, and it boils at 1240 C. Its specific gravity at 150°C. is 0.998.Its odour is like that of parsley, while its taste is pungent and somewhat dis- agreeable.
Developing skills for the broadcast media
Authors: P. Stillman
Journal: BMJ (1997)

There is no middle ground for most doctors: getting on television or radio is either your nightmare or your dream. But whatever you feel, in a media age, you need media skills. General practitioner and broadcaster Paul Stillman pitches some advice for the novice 

Ask most sane people to appear on television or radio in the guise of some sort of expert, and they will decline: politely at first, and with increasing firmness if you persist. The idea of exposing yourself to large numbers of people in a potentially hostile environment, with little control and numerous opportunities for misrepresentation seems to court disaster. Such reason defying behaviours should clearly be left to foolhardy egocentrics who spend their spare time bungee jumping or dangling over rock precipices.

Yet despite the fact that all of the above is possible, doctors do it. For some the rewards outweigh the risk, or at least the hope that a knowledge of the process and adequate preparation may reduce it to proportions that can be lived with. The media industry is huge. Its many branches have at their disposal the most influential communication tools yet invented. Those of us who have devoted many hours of explanation one to one in the consulting room, or who have tried to respond to the anxieties generated by the latest pill, meningitis, or flesh eating bug scare, must have wondered at some time whether the media could not be harnessed to provide sensible balanced advice. For some this thought becomes an obsession. To do what is a core part of any doctor's job, but for much larger numbers and with the instant authority that the media confers, is a prize meriting very serious consideration.

The media has its lighter side. For many it is fun, despite the reservations. Writing is …
Expression of type II cGMP-dependent protein kinase in rat kidney is regulated by dehydration and correlated with renin gene expression.
Authors: S Gambaryan, C Häusler, T Markert, D Pöhler, T Jarchau, U Walter, W Haase, A Kurtz, S M Lohmann
Journal: Journal of Clinical Investigation (1996)

cGMP-based regulatory systems are vital for counteracting the renin-angiotensin system (RAS) which promotes volume expansion and high blood pressure. Natriuretic peptides and nitric oxide acting through their second messenger cGMP normally increase natriuresis and diuresis, and regulate renin release; however, the severe pathological state of cardiac heart failure is characterized by elevated levels of atrial natriuretic peptide that are no longer able to effectively oppose exaggerated RAS effects. There is presently limited information on the intracellular effectors of cGMP actions in the kidney. Recently we reported the cloning of the cDNA for type II cGMP-dependent protein kinase (cGK II), which is highly enriched in intestinal mucosa but was also detected for the first time in kidney. In the present study, cGK II was localized to juxtaglomerular (JG) cells, the ascending thin limb (ATL), and to a lesser extent the brush border of proximal tubules. An activator of renin gene expression, the angiotensin II type I receptor inhibitor, losartan, increased cGK II mRNA and protein three to fourfold in JG cells. In other experiments, water deprivation increased cGK II mRNA and protein three to fourfold in the inner medulla where both cGK II, and a kidney specific CI- channel shown by others to be regulated by dehydration, are localized in the ATL. Whereas additional data suggest that cGK I may primarily mediate cGMP-related changes in renal hemodynamics, cGK II may regulate renin release and ATL ion transport.
Natural variation in a homolog of Antirrhinum CENTRORADIALIS contributed to spring growth habit and environmental adaptation in cultivated barley
Authors: Jordi Comadran, Benjamin Kilian, Joanne Russell, Luke Ramsay, Nils Stein, Martin Ganal, Paul Shaw, Micha Bayer, William Thomas, David Marshall, Pete Hedley, Alessandro Tondelli, Nicola Pecchioni, Enrico Francia, Viktor Korzun, Alexander Walther, Robbie Waugh
Journal: Nature Genetics (2012)
BLOOD CELL FORMATION AND DISTRIBUTION IN RELATION TO THE MECHANISM OF THYROID-ACCELERATED METAMORPHOSIS IN THE LARVAL FROG
Authors: H. E. Jordan, C. C. Speidel
Journal: The Journal of Experimental Medicine (1923)

1. Thyroid-accelerated metamorphosis in the larval frog is accompanied by changes in the hemopoietic centers and in the blood cell distribution in the various regions of the body. These changes are interpreted as results of the fundamental change in basal metabolic rate induced by the thyroid treatment. 2. There is initiation of the shift of hemopoietic locus from the kidney, the larval hemopoietic organ, to the spleen, the adult hemopoietic organ. The spleen, being chiefly an erythrocyte producer, becomes of greater importance with the transition from the lower metabolic rate to the higher, since greater erythropoiesis becomes necessary to supply the physical basis for the maintenance of the higher metabolic rate. 3. It is suggested that the appearance of red bone marrow in the later history of the frog is correlated with a still higher metabolic rate. Phylogenetically, in the vertebrate series, red bone marrow is also associated with higher metabolic rate. 4. The new metabolic rate initiated in tadpoles by thyroid administration sets up a demand for (a) erythrocytes, (b) granulocytes and lymphoid phagocytes for distribution to regions of regressive change, (c) lymphocytes, (1) as progenitors of erythrocytes, granulocytes and phagocytes, (2) for promoting growth of cells in regions of progressive change. 5. Upon the hemopoietic reserve, which in the last analysis is the lymphocyte (and its mesenchymal precursor), depends the extent to which metamorphosis will proceed. Inability on the part of the hemopoietic centers, chiefly the spleen, to keep pace with the demand for blood cells during metamorphosis results in metamorphic stasis, a condition of anemia which is usually followed by death. 6. The growth-promoting function of leucocytes, as demonstrated by Carrel, is probably to be ascribed to the lymphocyte component of leucocytes. 7. The granulocytes have probably also a glandular function, and may exert a lytic effect upon adjacent tissues in regions of regressive change.