tbuckley/cabot-search huggingface dataset:
Community-Oriented Primary Care: The Cuban Plan
Authors: William Ventres
Journal: JAMA (1993)

<h3>To the Editor.</h3> —Population-based needs assessments and community-based clinics by themselves are not sufficient to fulfill the potential of community-oriented primary care (COPC). In his thoughtful article, Dr Wright<sup>1</sup>unfortunately fails to provide sufficient emphasis on the role of accountability as the driving force of COPC. His own acknowledgment that community and migrant health centers have largely declined to accept responsibility for the health status of communities is testimony to this. There is at least one clear example in which COPC has been successfully implemented, and physicians are held accountable for health care outcome measures of the community members they serve. In Cuba, a growing cadre of family physicians is being trained to work as part of a health care team trained to provide health education and preventive services, offer comprehensive medical care, and conduct population-based research. Each team cares for 600 to 800 people in a system-oriented approach
Inguinal Hernia: Advances or Controversies?
Authors: Martin S. Litwin
Journal: JAMA (1995)

<b>Hernia</b>, edited by Lloyd M. Nyhus and Robert E. Condon, 4th ed, 615 pp, with illus, $140, ISBN 0-397-51286-4, Philadelphia, Pa, JB Lippincott Co, 1995. The contents of the first book,<i>Inguinal Hernia</i>, are based on an international conference held in May 1993 in Indianapolis, Indiana, entitled "Hernias 93: Advances or Controversies?" This reviewer has not previously received a book that begins with a publisher's note stating "... only the most vigilant of our readers will notice that we have had to compromise on the high standards of production normally associated with our publications." In fact, the layout, paper quality, and format are excellent, even though many of the photographic illustrations appear fuzzy. There are several excellent chapters on the anatomy and development of inguinal hernias and more classical hernia repairs, such as Bassini's operation, Cooper's ligament, the Lichtenstein, and the Shouldice. The chapters on pitfalls and complications of inguinal hernia
Global changes in interleukin-6–dependent gene expression patterns in mouse livers after partial hepatectomy
Authors: Wei Li, Xianping Liang, Julie I. Leu, Kellen Kovalovich, Gennaro Ciliberto, Rebecca Taub
Journal: Hepatology (2001)

Liver regeneration following 70% partial hepatectomy leads to rapid activation of genes in the remnant liver. Interleukin–6 deficient (IL–6 -/-) mice have impaired liver regeneration and abnormalities in immediate early gene expression. In this study, the gene expression program in the IL–6 +/+ and -/- livers at 2 hours posthepatectomy was examined with a cDNA array representing 588 highly regulated mouse genes. Thirty–six percent of the 103 immediate early genes were induced differently in IL–6 +/+ compared with IL–6 -/- livers, implying regulation by IL–6. IL–6 treatment of the IL–6 -/- mice in the absence of hepatectomy induced a much smaller set of genes in the liver, suggesting that IL–6 cooperates with other hepatectomy–induced factors to activate the large number of genes. Northern blot analyses were used to verify gene expression data obtained from the arrays. The expression of urokinase type plasminogen activator receptor (uPAR) and plasminogen activator inhibitor–1 (PAI–1), critical components of the urokinase plasminogen activator (uPA) system, was lower and delayed in IL–6 -/- livers. Despite the fact that active uPAR/uPA complex is critical for hepatocyte growth factor (HGF) activation, no differences were detected between the IL–6 +/+ and -/- livers in HGF activation as measured by receptor phosphorylation. On the contrary, the mitogen–activated protein kinase (MAPK) pathway was activated in IL–6 +/+ livers early during regeneration but remarkably delayed in IL–6 -/- livers. Defective liver regeneration may be explained by the large number of gene activation pathways altered in IL–6 -/- livers and further supports the finding that IL–6 is necessary for normal liver regeneration.
US researchers fail to get informed consent
Authors: J Roberts
Journal: BMJ (1994)

The National Institutes of Health (NIH) has ruled that researchers at the University of California at Los Angeles (UCLA) failed to get adequate informed consent from schizophrenic patients who are participating in a study in which some patients have been taken off their psychotropic drugs. So far several patients have relapsed, one threatened to kill his parents, and another committed suicide, according to a government report leaked to the New York Times and Los Angeles Times.

The study of 50 schizophrenic patients began in 1981. Data collection stopped last May, and patients are still being followed up. Patients were entered into the study, in which psychotropic drugs were withdrawn, so that researchers …
Rest and exercise hemodynamic effects of oral hydralazine in patients with coronary artery disease and left ventricular dysfunction.
Authors: M C Hindman, D A Slosky, R H Peter, G E Newman, R H Jones, A G Wallace
Journal: Circulation (1980)

To determine the hemodynamic effects of afterload reduction at rest and during upright exercise in patients with coronary artery disease and left ventricular dysfunction, 12 patients were studied before and after taking 50-75 mg of oral hydralazine every 6 hours for 48 hours. Oxygen consumption and heart rate were unchanged from control both at rest and during two work loads on a bicycle ergometer. Cardiac output was significantly increased at rest and during both workloads. The arteriovenous oxygen difference was significantly reduced at rest and during exercise. Pulmonary capillary wedge pressure was also significantly lower at rest and during exercise. Systemic vascular resistance was reduced at rest, and exercise-induced vasodilation was augmented by the administration of hydralazine. Left ventricular end-diastolic volume and ejection fraction assessed by radionuclide angiocardiography were not significantly changed at rest or during exercise after hydralazine. Seven of the 12 patients have maintained clinical improvement during a follow-up of 6-12 months. Hemodynamic improvement provided by oral hydralazine at rest is maintained during moderate exertion in patients with coronary artery disease and left ventricular dysfunction. In selected patients, chronic afterload reduction with oral hydralazine may result in increased cardiac reserve, decreased pulmonary congestion or decreased myocardial oxygen demands, thereby improving or abolishing resting or exertional dyspnea or angina.
An introduction to advance care planning in practice
Authors: A. Mullick, J. Martin, L. Sallnow
Journal: BMJ (2013)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following An introduction to advance care planning in practice Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Oxidation of Plasma Low-Density Lipoprotein Accelerates Its Accumulation and Degradation in the Arterial Wall In Vivo
Authors: Klaus Juul, Lars B. Nielsen, Klaus Munkholm, Steen Stender, Børge G. Nordestgaard
Journal: Circulation (1996)

Background The aim of the present study was to investigate whether oxidized LDL (ox-LDL) in the arterial intima could be derived from LDL already oxidized in plasma. Methods and Results Rabbits received an intravenous injection of 125 I-labeled normal LDL (N-LDL) mixed with 131 I-labeled LDL that had been mildly oxidized through exposure to Cu 2+ . The aortic accumulation of undegraded labeled LDL was expressed as plasma equivalents and calculated as radioactivity in the intima/inner media (cpm/cm 2 ) divided by the time-averaged concentration of radioactivity in plasma (cpm/nL): for the thoracic aorta, the accumulation of undegraded ox-LDL in the intima/inner media exceeded that of undegraded N-LDL by 286% (n=6, P &lt;.04), 863% (n=7, P &lt;.02), and 364% (n=8, P &lt;.01) after 1, 3, and 24 hours of exposure, respectively. There was a strong positive association between the extent of oxidation and the excess accumulation of undegraded ox-LDL compared with N-LDL (thoracic aorta; 3 hours of exposure: r =.97, n=14, P &lt;.00001). To measure degradation of N-LDL and ox-LDL, 125 I-LDL labeled with 131 I-tyramine cellobiose was injected intravenously 24 hours before the aortic intima/inner media was removed: for the thoracic aorta, the accumulation of degradation products from ox-LDL (n=6) exceeded that from N-LDL (n=6) by 301% ( P &lt;.04). Conclusions The present data suggest a novel mechanism: mildly oxidized LDL may circulate in plasma for a period sufficiently long to enter, accumulate, and be degraded in the arterial intima in preference to N-LDL.
Kidney and Electrolytes: Foundations of Clinical Diagnosis and Physiologic Therapy
Authors: Albert N. Brest
Journal: JAMA (1966)

This monograph deals with the principles and current concepts of renal physiology and electrolyte metabolism. The initial chapter is devoted to a survey of cardiac, pulmonary, and renal function, including electrolyte metabolism, together with body composition. Subsequent chapters discuss (1) sodium depletion and dehydration, (2) acidosis, (3) hypokalemia and alkalosis, (4) the edematous state, (5) impaired renal function and uremia, and (6) calcium and magnesium. The final chapter reviews some selected clinical topics.  It has always seemed to this reviewer that monographs dealing with fluid balance and electrolyte metabolism suffer commonly from being either too detailed or too perfunctory. This book attempts to weave an in-between approach to the subject matter. The material is well articulated but does suffer from an attempt to present the clinical approach in a digest form. Accordingly, the chapter on sodium depletion fails to detail the application of hypertonic saline solutions; the chapter on acidosis
Melanoma in people aged 65 and over in Scotland, 1979-89.
Authors: P. M. McHenry, D. J. Hole, R. M. MacKie
Journal: BMJ (1992)

OBJECTIVE--Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN--Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland in the 11 years 1979-89 with similar data for patients aged under 65. SETTING--Data were obtained from the Scottish Melanoma Group9s database, established in 1979, which aims to record detailed clinical, pathological, and surgical follow up details of all primary cutaneous melanomas registered in Scotland. PATIENTS--1430 patients (954 women, 476 men) aged 65 and over; comprising over a third of the 3903 patients with primary melanoma recorded for all age groups in Scotland during this period. RESULTS--The overall incidence of melanoma in patients aged 65 and over increased from 12.2/100,000 in 1979 to 20.7/100,000 in 1989, with the greatest increase seen in older men, from 7.8/100,000 in 1979 to 18.0/100,000 in 1989. The site most commonly affected was the face in both men and women (33% of all tumours). The most common histogenetic type was superficial spreading melanoma. 526 patients (37%) had melanomas with a tumour thickness of 3.5 mm or greater in the older age group, compared with 453 patients (18%) in those aged under 65. The highest proportion of thick tumours was seen in older men. Five year survival figures for 616 patients diagnosed between 1979 and 1984 were 88%, 66%, and 47% for thin, intermediate, and thick tumours respectively. Overall five year survival for the older age group was 64% compared with 78% for the younger age group. CONCLUSION--The increase in melanoma in the elderly and the high proportion of thick tumours, especially in men, require a specific educational programme for both primary and secondary prevention directed towards the older population.
Report Outlines Steps to Address Antibiotic Resistance
Authors: M. J. Friedrich
Journal: JAMA (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Tc-99m MDP Uptake on Bone Scintigraphy by a Giant Rhabdomyosarcoma Involving the Lower Extremity in an Elderly Woman
Authors: Myung-Hee Sohn, Seok Tae Lim, Young Jin Jeong, Dong Wook Kim, Hwan-Jeong Jeong, Chang-Yeol Yim
Journal: Clinical Nuclear Medicine (2010)

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. However, RMS rarely affects adults. A 68-year-old woman was admitted for evaluation of a huge mass in the left lower leg. A biopsy confirmed RMS. Tc-99m MDP bone scintigraphy was obtained to evaluate bone metastases, and diffusely increased uptake was noted in the huge soft tissue mass of the left lower extremity with linear increased uptake along the left tibia and fibula corresponding to the bony destructive lesion on the radiograph. This case presents extraosseous uptake of Tc-99m MDP by a giant RMS with bone invasion of the left lower extremity in an elderly woman.
Overexpression of c-maf is a frequent oncogenic event in multiple myeloma that promotes proliferation and pathological interactions with bone marrow stroma
Authors: Elaine M Hurt, Adrian Wiestner, Andreas Rosenwald, A.L Shaffer, Elias Campo, Tom Grogan, P.Leif Bergsagel, W.Michael Kuehl, Louis M Staudt
Journal: Cancer Cell (2004)
PATIENT FREEDOM: A VIEW FROM MICHIGAN
Authors: IVER F. SMALL
Journal: American Journal of Psychiatry (1961)

A statement of policy regarding patient freedom is given by a Michigan hospital. It is the result of long and considered planing. We have considered both the open and the closed door concepts. In our opinion both present major defects. The basic defect of the open door is "open to what ?" or "for what purpose?" The defect of the closed door is that it is not only inhumane but also is not so useful in getting a patient well. We are now attempting to institute a policy that will hopefully combine elements of social living into therapy and rehabilitation. To date, in our setting, the policy appears reasonably successful.
An arteriographic study of mesenteric arterial disease. I. Large vessel changes.
Authors: A P Dick, R Graff, D M Gregg, N Peters, M Sarner
Journal: Gut (1967)

EDITORIAL COMMENT This is an important study of large vessel changes causing chronic arterial insufficiency of the intestines.Symptoms of intestinal ischaemia have not been seen in this series in patients in whom the cross-sectional area of the arteries was greater than two-thirds of the normal.Arteriography is demonstrated as a valuable procedure in assessing the possibility of intestinal ischaemia as a cause of symptoms.ever, been carried out.Maljatzkaja (1934), in a patho- logical investigation of 85 cases at necropsy, found 206 on July 19,
Familial Hypercholesterolemia in a Large Kindred
Authors: Helmut G. Schrott, Joseph L. Goldstein, William R. Hazzard, Michael M. Mcgoodwin, Arno G. Motulsky
Journal: Annals of Internal Medicine (1972)

The traditional view that familial hypercholesterolemia (type II hyperlipoproteinemia) is inherited as an autosomal-dominant trait has been recently questioned. Instead, it has been suggested that multiple genes (polygenic inheritance) rather than a single gene (monogenic) might be involved. Investigation of a large Aleutian kindred consisting of 92 members provides evidence that at least one type of familial hypercholesterolemia is determined by a monogenic mechanism. Bimodality in the distribution of total plasma cholesterol values was demonstrated for both near and distant relatives at all ages. The mutant gene in this kindred [1] segregates as an autosomal-dominant trait, [2] specifies elevations in cholesterol of plasma low-density lipoprotein, [3] does not affect the level of plasma triglyceride, and [4] leads to early appearance of xanthomas and coronary atherosclerosis.
Effect of Maintenance Therapy With Varenicline on Smoking Cessation&lt;SUBTITLE&gt;A Randomized Controlled Trial&lt;/SUBTITLE&gt;
Authors: Serena Tonstad
Journal: JAMA (2006)

The majority of cigarette smokers who achieve abstinence relapse within the first year and require many attempts before achieving permanent abstinence. Evidence to support pharmacological treatment for relapse prevention is insufficient.To determine whether smokers who quit after 12 weeks of treatment with varenicline, a selective alpha4beta2 nicotinic acetylcholine receptor partial agonist, maintain greater continuous abstinence rates (defined as not a single "puff" of a cigarette) than placebo controls during an additional 12 weeks of treatment and until 52 weeks after treatment initiation.Randomized controlled trial conducted at multiple medical clinics in 7 countries with follow-up to 52 weeks after study baseline. Of 1927 cigarette smokers recruited between April 2003 and February 2004 and treated for 12 weeks with open-label varenicline titrated to 1 mg twice per day, 1236 (64.1%) did not smoke, use tobacco, or use nicotine replacement therapy during the last week of treatment and 62.8% (n = 1210) were randomized to additional treatment or placebo.Participants were randomly assigned to receive either double-blind varenicline, 1 mg twice per day (n = 603), or placebo (n = 607) for an additional 12 weeks.Carbon monoxide-confirmed continued abstinence during weeks 13 to 24 and weeks 13 to 52 of the study.The carbon monoxide-confirmed continuous abstinence rate was significantly higher for the varenicline group than for the placebo group for weeks 13 to 24 (70.5% vs 49.6%; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.95-3.16; P<.001) as well as for weeks 13 to 52 (43.6% vs 36.9%; OR, 1.34; 95% CI, 1.06-1.69; P = .02). Adverse events reported in the open-label period were mostly mild; no difference in adverse events between varenicline and placebo was observed during the double-blind period.Smokers who achieved abstinence for at least 7 days at the end of 12 weeks of open-label varenicline treatment and were randomized to receive an additional 12 weeks of varenicline treatment showed significantly greater continuous abstinence in weeks 13 to 24 compared with placebo. This advantage was maintained through the nontreatment follow-up to week 52. Varenicline may be an efficacious, safe, and well-tolerated agent for maintaining abstinence from smoking.clinicaltrials.gov Identifier: NCT00143286.
Letter: Driving and medical fitness.
Authors: J Taylor
Journal: BMJ (1976)

<h3>Abstract</h3> <b>Objective</b> To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. <b>Design</b> Systematic review and meta-analyses. <b>Data sources</b> Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. <b>Data extraction</b> Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. <b>Results</b> 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01;2.7). <b>Conclusions</b> Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.
Fatal hyperkalemia and hyperchloremic acidosis. Association with spironolactone in the absence of renal impairment
Authors: D. A. Feinfeld
Journal: JAMA (1978)

SPIRONOLACTONE is used commonly in conditions associated with secondary hyperaldosteronism. Hyperkalemia is a frequent complication of such therapy, particularly in patients with impaired renal function.<sup>1</sup>The one reported case of fatal hyperkalemia associated with spironolactone therapy occurred in a patient with renal failure.<sup>2</sup> This report concerns a patient without noteworthy renal disease in whom fatal hyperkalemia and hyperchloremic acidosis developed during treatment with spironolactone. <h3>Report of a Case</h3> A 64-year-old man with chronic alcoholism was brought to the emergency room at Bronx Municipal Hospital Center after becoming confused and lethargic. He had had two admissions to another hospital for ascites during the previous four months and was being treated with spironolactone (300 mg/day) and hydrochlorothiazide (50 mg/day). During those admissions he had had a serum creatinine level of 1.0 mg/dl, a BUN level of 23 to 30 mg/dl, and creatinine clearance of 119 ml/min. In the emergency room