tbuckley/cabot-search huggingface dataset:
The death of the long case?
Authors: J. J Norcini
Journal: BMJ (2002)

The long case has tested the clinical skills of students for many years, yet inherent problems preclude it from being the sole source of decision making

For most of the past century the long case has been an essential tool in the evaluation of clinical skills, being used to make important judgments about the education and practice of doctors throughout the world. Despite its widespread use and rich tradition, the long case has major flaws, making it unwise to use it as the sole basis for making decisions of consequence. In this article I describe the strengths and weaknesses of the long case and report on some of the modifications that have been introduced to improve its performance.

#### Summary points

The long case has been an essential tool in the assessment of clinical skills

It evaluates performance with real patients and enables students to gather information and develop treatment plans under realistic conditions

Problems have been found with the reproducibility of scores generated by the long case

The long case can be improved by increasing the number of encounters, examiners, or aspects of a competence assessed

Organisations responsible for high stakes testing are increasingly abandoning the long case or using it only in combination with other forms of assessment

Although there are numerous variations on the long case, traditionally a student is given unobserved time with a real patient in a clinical setting. During that time the student conducts an interview and performs a physical examination as appropriate. The student then presents his or her findings and plans to the examiners, who ask about the patient and related topics enabling them to judge the quality of the student's …
&lt;emph type="ital"&gt;Vsevolod Mikhailovich Garshin&lt;/emph&gt;
Authors: Janet M. Torpy
Journal: JAMA (2011)

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
Right Job, Wrong Tool: A Commentary on Designing Clinical Trials for Ebola Virus Disease
Authors: Robert M. Nelson, Michelle Roth-Cline, Kevin Prohaska, Edward Cox, Luciana Borio, Robert Temple
Journal: The American Journal of Bioethics (2015)

We agree on the common goal of finding safe and effective treatments for Ebola virus disease (EVD) “using rigorous methods and simple but properly designed clinical trials” (World Health Organizati...
Diagnosis of hepatic encephalopathy: Willin vivo proton MRS play a role?
Authors: Jacquelyn Maher, Rajiv Jalan, Steven W.M. Olde Damink, Peter C. Hayes, Joanna M. Wardlaw
Journal: Hepatology (1999)

BACKGROUND AND PURPOSE: MR imaging and MR spectroscopy are increasingly being used to determine response to pharmacologic therapy.Hepatic encephalopathy (HE) is characterized by abnormal cerebral metabolites, yet the response to lactulose and other anti-HE measures is still primarily determined by using arbitrary categorical clinical rating scales, rather than MR spectroscopy.The purpose of this study was to determine whether MR spectroscopy could demonstrate relevant neurometabolic changes associated with lactulose therapy and thereby provide further support for the use of MR spectroscopy in clinical trials.METHODS: Ten control subjects and 23 patients with grades I to III HE were studied by proton MR spectroscopy with imaging parameters of 2000/26 (TR/TE).Metabolic ratios were calculated for myo-inositol (mI)/ creatine (Cre), choline (Cho)/Cre, (glutamine ؉ glutamate) (Glx)/Cre, N-acetylaspartate (NAA)/Cre, and (Cho ؉ mI)/ Glx.A time series design trial was used in which eight patients with HE were compared before and after lactulose therapy (60 mL by mouth three times per day).RESULTS: Relative to control subjects, HE was characterized by 43%, 64%, and 5% reductions, respectively, in mI/Cre, (Cho ؉ mI)/Glx, and Cho/Cre.In comparison, Glx/Cre was increased by 75% and NAA/Cre was not changed.Therapy with lactulose was associated with increases of 29%, 37%, and 7%, respectively, in mI/Cre, (Cho ؉ mI)/Glx, and Cho/Cre, as well as respective decreases of 15% and 42%, respectively, in Glx/Cre and HE grade.NAA/Cre did not change with lactulose therapy.CONCLUSION: MR spectroscopy detects neurometabolic changes associated with pharmacologic therapy for HE.The metabolic ratios ml/Cre and (Cho ؉ mI)/Glx are the most sensitive measures of lactulose effect.These data support the expanded use of MR spectroscopy as an adjunctive technique in pharmaceutical development and clinical trials for HE.COMMENTS
A question of euthanasia
Authors: T. Dalrymple
Journal: BMJ (2010)

Richard Hughes (1900-76) is now mainly remembered for his novel A High Wind in Jamaica , published in 1929, and for having been the friend of Dylan Thomas. Kingsley Amis and Philip Larkin made slighting reference to him in their correspondence, but that is no evidence of any bad qualities on his part.

Initially, however, Hughes wanted to be a dramatist, and it was as such that he first came to prominence. George Bernard Shaw called Hughes’s first work, The Sisters’ Tragedy , which he wrote aged 22 in 1922, the finest one act play ever written. It was produced at the Royal Court Theatre. Hughes went on two years later to …
Rheumatoid factors and amyloidosis in rheumatoid arthritis.
Authors: C P Maury, A M Teppo
Journal: BMJ (1985)

diabetic whose plasma glucose concentrations were >11 mmol/l (198 mg/ 100 ml) were in group 3.Mortality and clinical findings did not differ significantly between groups 1 and 2 (p > 0 5) or groups 3 and 4. Accordingly, groups 1 and 2 and groups 3 and 4 were combined for analysis.The diabetics (groups 3 and 4) showed significantly greater mortality at one week (x2== 11 2, p< 0.001) than the non- diabetic patients.All the deaths in the diabetic group occurred within a week of stroke, whereas deaths continued to occur throughout the follow up period in groups 1 and 2 (table ).Admission characteristics and mortality of combined groups Non-diabetics Diabetics (groups 1 and 2) (groups 3 and4) (n = 86) (n = 14) Significance Mean (SD) age (years) 75 (10) 70 (13) NS No (%°) of men 39 (45) 6 (43) NS No (°) of smokers 34 (40) 4 (28) NS No (%,) being treated for hypertension 35 (41) 5 (36) NS No (%) with past ischaemic heart disease/stroke/ transient ischaemic attack 34 (40) 8 (57) NS Mean (SD) blood pressure on admission (mm Hg): Systolic 160 (31) 170 (51) NS Diastolic 92 (17) 92 (18) NS Mean (SD) packed cell volume 0 43 (0 06) 0 41 (0 04) NS No (%) with atrial fibrillation on admission 21 (24) 3 (22) NS No (%) with stupor/coma on admission 24 (28) 6 (43) NS Median stroke score 15 18 NS No (%) of deaths: At 1 week 14 (16) 9 (64) p<0001 At 1 month 27 (31) 9 (64) p<0-05 At 3 months 33 (38) 9 (64) NS
COMPLICATIONS OF IMPLANTING IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ON THE SAME DAY OF ELECTROPHYSIOLOGY STUDY
Authors: Madhu Reddy, Senthil Thambidorai, Manu Kaushik, Suman Pasupuleti, Mahesh Alla, Kelly Airey, Nazih Kadri
Journal: Journal of the American College of Cardiology (2010)
Effect of second phase duration on biphasic defibrillation efficacy in humans
Authors: B. Merkley, A. Lubiňski, T. Gyōngy, E. Lewicka-Nowak, F. Horkay, G. Swiatecka, L. Geller, E. Bodor, J. Pilz, M. Schaldach
Journal: Journal of the American College of Cardiology (1998)
DNA adduct formation in relation to lymphocyte mutations and lung tumor induction in F344 rats treated with the environmental pollutant 1,6-dinitropyrene.
Authors: B A Smith, N F Fullerton, A Aidoo, R H Heflich, F A Beland
Journal: Environmental Health Perspectives (1993)

Epidemiological studies suggest an association between exposure to diesel emissions and an increased incidence of lung and bladder cancer in humans. Of the compounds associated with diesel emissions, 1,6-dinitropyrene is a particularly potent mutagen and carcinogen. In these experiments we administered [4,5,9,10-3H]1,6-dinitropyrene (30 or 100 micrograms) directly to the lungs of F344 rats according to a protocol known to induce lung tumors and characterized the DNA adducts present in the target tissue. In addition, we examined the adducts present in spleen lymphocytes and assayed for the induction of mutations at the hypoxanthine-guanine phosphoribosyltransferase locus in these cells, as measured by the frequency of 6-thioguanine-resistant (TGr) T-lymphocytes. Adduct formation was detected in both lung and spleen lymphocyte DNA, with the extent of binding being dose-dependent in the lymphocytes but not the lung. 32P-Postlabeling analyses indicated the formation of a major DNA adduct, N-(deoxyguanosin-8-yl)-1-amino-6- nitropyrene, in both tissues. 1,6-Dinitropyrene treatment resulted in a dose-dependent increase in TGr T-lymphocytes, with the increase being detected for at least 21 weeks after treatment. These data indicate that 1,6-dinitropyrene is metabolically activated by nitroreduction to form DNA adducts in both the target tissue and spleen lymphocytes and that a tumorigenic dose results in a significant induction of TGr T-lymphocytes.
INJURIES TO THE EYES FROM ELECTRIC-LIGHT FLASH.
Authors: WILLIAM H. FOX
Journal: JAMA (1899)

Injuries from electricity are becoming more and more common, as its use extends in all directions. The eyes are often implicated in these injuries, and give a peculiar train of symptoms, which are more or less characteristic. Many names have been given to this condition, but the best seems to be that used by Ljubinski<sup>1</sup>, "Ophthalmia photo-electrica." We may look upon this subject as presenting two points of interest to the physician: The prevention of these injuries as far as possible, and their relief when they occur. I shall not discuss the question of the ordinary use of electric light and its effect on the eyes, but only such cases as have been exposed to more or less intense action of the light, and where the symptoms are so striking that there is no question as to the cause. Such cases are found among electric workers, or spectators at
Inhibition of Endothelial Nitric Oxide Synthase Activity by Proline-Rich Tyrosine Kinase 2 in Response to Fluid Shear Stress and Insulin
Authors: Beate Fisslthaler, Annemarieke E. Loot, Annisuddin Mohamed, Rudi Busse, Ingrid Fleming
Journal: Circulation Research (2008)

In native and primary cultures of endothelial cells, fluid shear stress elicits the tyrosine phosphorylation of the endothelial NO synthase (eNOS), however, the consequences of this modification on enzyme activity are unclear. We found that fluid shear stress induces the association of eNOS with the proline-rich tyrosine kinase 2 (PYK2) in endothelial cells and that the eNOS immunoprecipitated from eNOS- and PYK2-overexpressing HEK293 cells was tyrosine-phosphorylated on Tyr657. In mouse carotid arteries, the overexpression of wild-type PYK2, but not a dominant-negative PYK2, decreased eNOS activity (≈50%), whereas in murine lung endothelial cells, the downregulation of PYK2 (small interfering RNA) increased ionomycin-induced NO production. Mutation of Tyr657 to the phosphomimetic residues aspartate (D) or glutamate (E) abolished enzyme activity, whereas a nonphosphorylatable mutant (phenylalanine [F]) showed activity comparable to the wild-type enzyme. Moreover, normal flow-induced vasodilatation was apparent in carotid arteries from eNOS −/− mice overexpressing either the wild-type eNOS or the Y657F mutant, whereas no flow-induced vasodilatation was apparent in arteries expressing the Y657E eNOS mutant. Insulin also activated PYK2 and stimulated eNOS in endothelial cells expressing the Y657F mutant but not wild-type eNOS. These data indicate that PYK2 mediates the tyrosine phosphorylation of eNOS on Tyr657 in response to fluid shear stress and insulin stimulation and that this modification attenuates the activity of the enzyme. The PYK2-dependent inhibition of NO production may serve to keep eNOS activity low and limit the detrimental consequences of maintained high NO output, ie, the generation of peroxynitrite.
THE EVALUATION OF AN EFFECTIVE DOSAGE OF CARONAMIDE (4-CARBOXYPHENYLMETHANESULFONANILIDE) FOR THE SUPPRESSION OF TUBULAR EXCRETION OF PENICILLIN IN CHILDREN 1234
Authors: F. Bruce Corneal, Gavin Hildick-Smith, Mary B. Fell, T. F. McNair Scott
Journal: Journal of Clinical Investigation (1948)

It has been shown by Beyer et al. in a recent series of papers ( 1 to 4) that the compound 4-carboxyphenylmethanesulfonanilide, known as Caronamide, is effective in increasing the penicillin plasma concentration and in prolonging the pe- riod of time over which detectable penicillin plasma concentrations are maintained following adminis- tration of penicillin, orally and by venoclysis, to dogs.In these experiments it was demonstrated that the renal tubular excretion of penicillin could be completely suppressed (2) when the anti- biotic was given concomitantly with adequate amounts of Caronamide.In a series of experiments in children (5), Caronamide used in conjunction with penicillin administered orally was effective in increasing the penicillin plasma concentration from 2.8-to 14.5fold over the penicillin controls and was also found to be of a low order of toxicity at the dos- ages employed.The purpose of the present research was to de- termine an optimum dose of Caronamide for children.METHODS Method of administration.Afebrile convalescent pa- tients, aged two to nine years, with normal renal function were selected.Single doses of approximately 300,000 units of penicillin/sq.M. -of body surface (equivalent to approximately 10,000 units/Kg. of body weight) were given intramuscularly as a control, and blood was drawn
Recent Work on Leukaemia in Man
Authors: L. J. Witts
Journal: BMJ (1957)

In this lecture I shall confine myself to human leukaemia, and in particular to recent work on the aetiology, course, and treatment.This work has been mainly inspired by two events.The first is the apparent steep rise in the incidence of leukaemia in Western Europe, North America, and Australasia.The second is the discovery of new and powerful drugs for the treatment of acute and chronic leukaemia.Connecting these two events is the use of the numerical or statistical method to study the incidence of leukaemia at different epochs and in different places, to define the natural history of the disease and its individual variations, and to control the large-scale trials which have proved to be necessary if methods of treatment are to be satisfactorily evaluated. Classification of LeukaemiaSo far I have talked about leukaemia, but in fact we should talk about the leukaemias, for the different forms of leukaemia differ from each other at least as much as the different forms of malaria.The classification of leukaemia offers difficulties, some of which are semantic and others technical.The two parameters used in classification are the acuteness of the disease process and the type of cell involved.Demographers are not fond of the words "acute " and "chronic," and it must be confessed that the definitions given by the Committee for Clarification of the Nomenclature of Cells and Diseases of Blood-forming Organs in 1950 have not proved entirely adequate to deal with the subsequent course of events.With modern therapy an occasional acute leukaemia may last for more than five years, or longer than many patients with chronic leukaemia.The type of cell involved in acute leukaemia is also sometimes difficult to decide.Fashions in the diagnosis of myeloblastic, lymphoblastic, monocytic, and erythro- blastic leukaemia have changed too often for one to have much confidence in ex catiledra statements based on a look down the microscope.It is probable that in atypical cases a group of characteristics should be determined before a decision is made-the microscopical appear- ances of the cells, their physical, histochemical, and immunological reactions, and their cultural charac- teristics.This would be impracticable as a routine procedure, but it might be of value if it was used as a method of sampling from time to time-to keep a check on working diagnoses.In the seventh revision of the International List of Causes of Death leukaemia is classified under the head- ings of lymphatic leukaemia, myeloid leukaemia, mono-
The Role of Nurses
Authors: John W. Runyan
Journal: JAMA (1972)

<h3>To the Editor.—</h3> It was with a great deal of interest that I read the EDITORIAL by Egeberg and Pesch, "The Role of Nurses" (220:1237, 1972). Our experience of nearly ten years in Memphis and Shelby County would support this EDITORIAL and the report upon which it is based. The first published report on the expanded, but still limited, role of the nurse was based upon our initial experiences in our chronic disease program begun in February 1963.<sup>1</sup>Our second article detailed the greatly expanded duties and responsibilities of the nurses in the decentralized facilities in the continuing care of patients with chronic disease.<sup>2</sup>An attempt was made in my LETTER TO THE EDITOR to clarify the means of monitoring the care provided and the physician and medical center back-up, since an EDITORIAL inThe Journal<sup>4</sup>expressed some reservations about this expanded nurse's role. With physician and
Thyroid Abnormalities in Renal Failure
Authors: GERMÁN RAMÍREZ
Journal: Annals of Internal Medicine (1973)

Fifty-three patients with renal failure on chronic hemodialysis were screened for the presence of goiter. Thirty-one had enlarged thyroid glands, a prevalence of goiter of 58% not previously reported. Thyroid function studies showed low131I uptakes, low serum thyroxine and normal serum triiodothyronine and thyrotrophic hormone levels. Serum concentrations of thyroxine-binding globulin were normal; serum albumin concentration was only slightly reduced. Administration of synthetic thyrotrophin-releasing hormone was followed by a rise in serum thyrotrophin and triiodothyronine levels. The cause of the goiter is not known. The possibility that goitrogenic substances are involved is discussed.
DUTY OF RAILROADS IN TRANSPORTATION OF TUBERCULOUS PASSENGERS.
Authors: JOHN R. HAYNES
Journal: JAMA (1907)

isolation and control of each individual case removes one more focus of infection from the community.Many cities have free dispensaries, especially those in which medical schools are situated, but they should be in every city, supported by municipal funds, and placed under competent medical direction.At such dispensaries it should be possible for poor consumptives to obtain free milk and eggs, as well as medical advice and treatment.The Parker Hill Experiment.-During the summer of 1905 the Boston Association for the Relief and Control of Tuberculosis conducted an experiment worthy of more than passing notice, in establishing the Parker Hill Day Sanatorium.This was under the supervision of, and its success was largely due to, Dr. David Town- send.I quote from the report of the committee ap- pointed by the Suffolk District Medical Society to in- vestigate the crusade against tuberculosis in Boston :In an orchard on Parker Hill rude structures and tents were erected, and here consumptives from the tenement districts of the city were provided for during the day.They were given lunches and dinner, medical supervision and nurses' care, and at night returned to their homes, to repeat the same thing the next day.This new departure has met with the approval both of the public and the profession, and has accomplished two ob- jects, the improvement of the patient's condition, and his edu- cation, and, through him, that of his family, in the open air cure and hygienic modes of living.
Exposure at high altitude and exercise altered membrane diffusion capacity of the lung
Authors: H. Guenard
Journal: European Respiratory Journal (2010)

To the Editors:

In an article published in a recent issue of the European Respiratory Journal , Dehnert et al. 1 report various measurements made after climbing at high altitude. Among them were carbon monoxide (CO) transfer measurements. I was surprised by the finding of an increase in the transfer factor of the …
Deep hypothermia for infant open heart surgery: pros and cons
Authors: E. R. Gonzalez
Journal: JAMA (1979)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) 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
Bromocriptine in management of large pituitary tumours.
Authors: J A Wass, J Williams, M Charlesworth, D P Kingsley, A M Halliday, I Doniach, L H Rees, W I McDonald, G M Besser
Journal: BMJ (1982)

Bromocriptine has an accepted place in the management of small pituitary tumours that secrete either prolactin or growth hormone. The treatment of large tumours with extrasellar extensions is more difficult, however: though surgery is the standard treatment, it is often unsuccessful in returning excessive hormone secretion to normal and may cause hypopituitarism. A prospective trial was undertaken to assess the frequency with which changes in pituitary function and size of large tumours occurs. Nineteen patients were studied before and during treatment with bromocriptine (7.5 to 60 ml/day) for three to 22 months, using contrast radiology and a detailed assessment of pituitary function. Eighteen patients had hyperprolactinaemia and two of these also had raised concentrations of growth hormones; one patient had an apparently non-functioning tumour. In 12 patients (63%) tumour size decreased with bromocriptine and no tumour enlarged. Nine patients had visual-field defects, which improved in seven, becoming normal in five. Pituitary function improved in nine patients (47%) becoming entirely normal in three. Bromocriptine should be the treatment of choice in patients with large pituitary tumours with extrasellar extensions, provided close supervision is maintained.
709 A RANDOMIZED, CONTROLLED, OPEN-LABELED, MULTI-CENTER STUDY OF HBEAG-POSITIVE CHRONIC VIRAL HEPATITIS B PATIENTS TREATED BY ADEFOVIR DIPIVOXIL OR COMBINED WITH BICYCLOL
Authors: J. Cheng, G.-F. Shi, H.-F. Zhang, G.-M. Zhao, Z.-J. Yu, Z.-W. Lang
Journal: Journal of Hepatology (2011)