tbuckley/cabot-search huggingface dataset:
Rationing and the health authority
Authors: T. Hope, N. Hicks, D J M Reynolds, R. Crisp, S. Griffiths
Journal: BMJ (1998)

Most governments would like to pretend that health care rationing does not exist. Those working in the NHS know that it does. There is simply not enough money for all patients to receive the best treatment.1 A few governments—the Netherlands, New Zealand, and Sweden, in particular—have grasped the nettle.2–4 In the United Kingdom, major decisions about what to fund or, more critically, what not to fund have been made at local level by health authorities, fundholding general practices, and, under the provision of the new white paper, primary care groups. There is very little central guidance on how these decisions are to be made. Health authorities are continually faced with reasonable requests for extra funding. To fund something new, something else of value has generally to be sacrificed, and this happens despite all efforts to eliminate ineffective health care. This paper describes one health authority's approach to this problem.

#### Summary points

Oxfordshire Health Authority has set up a priorities forum to provide advice on rationing decisions in health care

The forum aims to ensure a reasonable and evidence based process for decision making

The decision process focuses on three key areas: evidence of effectiveness, equity, and patient choice

A wide range of policy issues and individual cases has now been considered

Key issues that remain include determining relative funding for each area of health care, achieving consistency in spending for treatments with broadly similar effects, and involving the public

Health authorities and primary care groups will increasingly need to be able to justify their decisions to the wider community. There are two key questions:

Oxfordshire Health Authority has set up a priorities forum to provide advice on rationing decisions. One …
Improved neurologic recovery and survival after early defibrillation.
Authors: W D Weaver, M K Copass, D Bufi, R Ray, A P Hallstrom, L A Cobb
Journal: Circulation (1984)

Eighty-seven patients who had out-of-hospital cardiac arrests received defibrillating shocks delivered by minimally trained first responders before the arrival of paramedics in a city with short emergency response times. Their outcomes were compared with those of 370 other victims who received only basic life support by first responders until paramedics arrived. Survival was improved by early defibrillation in cases in which there was a delay in initiating cardiopulmonary resuscitation and in which paramedic response times exceeded 9 min; there was 62% survival after early defibrillation by first responders and 27% if first responders provided only basic life support (p less than .02). Neurologic recovery was also improved after early defibrillation. Eighteen of 46 resuscitated patients (39%) receiving early defibrillation were awake at 24 hr compared with 49 of 204 patients (24%) who received only basic life support while awaiting paramedics (p less than .02). Incorporating defibrillation as part of basic life support can reduce both mortality and morbidity from cardiac arrest, even in cities with established, rapidly responding emergency care systems.
Ca <sup>2+</sup> and Inositol 1,4,5-Trisphosphate–Mediated Signaling Across the Myoendothelial Junction
Authors: Brant E. Isakson, Susan I. Ramos, Brian R. Duling
Journal: Circulation Research (2007)

Second messenger signaling between endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) is poorly understood, but intracellular Ca2+ concentrations ([Ca2+]i) in the 2 cells are coordinated, possibly through gap junctions at the myoendothelial junction. To study heterocellular calcium signaling, we used a vascular cell coculture model composed of monolayers of ECs and VSMCs. Stimulation of either cell type leads to an increase in [Ca2+]i in the stimulated cell and a secondary increase in [Ca2+]i in the other cell type that was blocked by gap junction inhibitors. To determine which second messengers are involved, we initially depleted Ca2+ stores in the endoplasmic reticulum Ca2+ with thapsigargin in ECs or VSMCs, but this had no effect on heterocellular calcium signaling. Alternatively, we loaded ECs or VSMCs with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA) to buffer changes in [Ca2+]i. BAPTA loading of ECs inhibited agonist-induced increases in intracellular calcium concentration ([Ca2+]i), in both ECs and VSMCs. In contrast, BAPTA loading of the VSMCs blunted the VSMC response but did not alter the secondary increase in EC [Ca2+]i. Xestospongin C (an inositol 1,4,5-trisphosphate receptor inhibitor) had no effect on the secondary Ca2+ response, but when xestospongin C or thapsigargin was loaded into ECs and BAPTA into VSMCs, intercellular Ca2+ signaling was completely blocked. We conclude that 1,4,5-trisphosphate and Ca2+ originating in the VSMCs induces the secondary increase in EC [Ca2+]i but stimulation of the ECs generates a Ca2+ dependent response in the VSMCs.
Isotonic vs Isosmotic Solutions A Clarification of Terms
Authors: Donald P. Doemling
Journal: JAMA (1968)

<h3>To the Editor:—</h3> The plasma membrane of the biological cell serves the useful purpose of separating the cellular fluid from the cell's environment. By selective permeability, facilitated diffusion, and active transport, the living cell is able to maintain the composition of its fluid quite constant and distinct from the surrounding fluid. Biological membranes are selectively permeable rather than semipermeable; that is, they are permeable not only to water but to lesser and varying degrees to certain solutes. Because of this selective permeability to solute, two sets of terms need to be employed when comparing solutions in regard to their osmotic pressure; one set involves relative osmolality and the other involves relative tonicity. Relative osmolality — isosmotic, hypo-osmotic, and hyperosmotic—is concerned only with the total concentration of dissolved particles (osmotically active molecules or ions) in a particular solution as compared to the total concentration of dissolved particles in the reference solution.
Insulin resistance is not a relevant predictor of sustained virological response to pegylated interferon plus ribavirin in HIV/HCV co-infected patients
Authors: Nicolás Merchante, Ignacio de los Santos-Gil, Dolores Merino, Mercedes González-Serrano, José A. Mira, Jesús Sanz-Sanz, Elisa Fernández-Fuertes, Josefa Ruiz-Morales, José del Valle, Juan Macías, Antonio Moro, Juan A. Pineda
Journal: Journal of Hepatology (2008)
Relation of monophasic action potential recorded with contact electrode to underlying transmembrane action potential properties in isolated cardiac tissues: a systematic microelectrode validation study
Authors: T. INO, H. S KARAGUEUZIAN, K. HONG, M. MEESMANN, W. J MANDEL, T. PETER
Journal: Cardiovascular Research (1988)

Monophasic action potentials, recorded with contact non-suction electrodes, have been used both clinically and experimentally. However, to date no systematic microelectrode validation studies have been done to underlying myocardial cell populations from different myocardial regions with different transmembrane potential profiles. In the present study transmembrane action potential properties, recorded with standard microelectrodes, were compared with monophasic action potentials recorded with contact electrodes in three different (endocardium, epicardium, and free running Purkinje fibre) isolated canine preparations during pacing and during spontaneous automatic activity. The mean transmembrane durations at 50% and 90% repolarisations (APD50 and APD20) of 19-30 cells at a monophasic action potential recording site was not statistically significant from monophasic action potential duration in all three tissue preparations studied. However, in endocardial preparations, composed of superficial (1-2 cell layers) Purkinje fibres with deeper ventricular muscle cells, the APD50 (139(17) ms) and APD90 (181(26) ms) of monophasic action potentials more closely reflected (but not significantly different) the underlying deeper ventricular muscle cells (APD50 134(14) ms and APD90 167(15) ms) rather than the mean transmembrane action potential durations of the underlying most superficial Purkinje fibres (166(22) ms for APD50 and 210(30) ms for APD90) (p<0.025). Tetrodotoxin (TTX) at 1 X 10−6 mol·litre−1 shortened Purkinje fibre action potential duration and slightly lengthened that of ventricular muscle. Simultaneously recorded monophasic action potential showed an intermediate change in action potential duration. Incremental pacing and applied single premature stimuli resulted in similar degrees of shortening of action potential duration for both monophasic action potential and transmembrane potential in all three preparations. In endocardial preparations, barium chloride (4 mmol·litre−1) superfusion induced early afterdepolarisations, and spontaneous phase 4 depolarisations (n=6) in both Purkinje and ventricular muscle cells giving rise to spontaneous automatic activity. These abnormal automatic activities were accurately detected by simultaneous monophasic action potential recordings. Suppression of automaticity by verapamil (0.2–0.5 μg·ml−1) as confirmed by transmembrane action potential recordings were similarly detected by monophasic action potential recordings. It is concluded that (a) monophasic action potentials recorded with contact electrodes closely resemble transmembrane action potential duration of the preponderant cell population underlying the contact electrode, and (b) spontaneous automatic activity may be monitored with contact monophasic action potential with reasonable accuracy.
Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults.
Authors: M A Ruder, J C Davis, M Eldar, J A Abbott, J C Griffin, J J Seger, M M Scheinman
Journal: Circulation (1986)

Junctional ectopic tachycardia has been described in infants but not in adults. Five adults with rapid symptomatic paroxysmal junctional tachycardia, distinct from the more common slower nonparoxysmal junctional tachycardia, were recently evaluated. The tachycardia was irregular (rate 120 to 250) and accompanied by periods of atrioventricular dissociation and narrow QRS complexes. A junctional origin was documented during electrophysiologic study in four of the five patients. Analysis of Holter recordings; the response to exercise, isoproterenol, and propranolol; and the effects of atrial and ventricular stimulation appeared to implicate abnormal automaticity of a high junctional focus that was catecholamine sensitive or dependent as the tachycardia mechanism. All patients responded somewhat to beta-blockers, although a combination of procainamide and propranolol proved to be the most effective therapy in one patient and another chose electrode catheter ablation of the atrioventricular junction rather than continued drug therapy. Thus, junctional ectopic tachycardia may occur in adults and its mechanism appears to be related to abnormal automaticity that is catecholamine sensitive or dependent. Initial therapy should include beta-blockers but selected patients may require more aggressive management.
Regression of the Systemic Vasculature to the Lung after Removal of Pulmonary Artery Obstruction
Authors: Elie Fadel, Edo Wijtenburg, René Michel, Jean-Xavier Mazoit, Renée Bernatchez, Benoit Decante, Edouard Sage, Michel Mazmanian, Philippe Hervé
Journal: American Journal of Respiratory and Critical Care Medicine (2005)

Pulmonary artery occlusion stimulates angiogenesis in the systemic circulation of the ipsilateral lung and increases systemic- to-pulmonary blood flow. Whether this systemic neovascularization decreases after lung revascularization is unknown.To assess the influence of lung revascularization on anatomy and flow of bronchial vessels supplying a chronically ischemic lung in piglets.Piglets were studied before (control) and 5 wk after left pulmonary artery ligation and 5 wk after left pulmonary artery reimplantation into the pulmonary artery trunk. The systemic blood flow to the right and left lungs was measured using colored microspheres, and the bronchial vasculature was assessed using light-microscopic morphometry. Renal and total blood flow, systemic blood pressure, and pulmonary blood pressure were measured in each experimental condition.Systemic blood flow to the left lung increased from 0.4 +/- 0.1 to 11.5 +/- 3.8 ml/min/g (p < 0.05) after left pulmonary artery ligation and returned toward the control value (1.2 +/- 0.6 ml/min/g) after revascularization, whereas it remained unchanged in the right lung. The number of bronchial vessels increased twofold in the ligated lung (p = 0.01), and did not decrease after reperfusion; however, vessel diameters decreased markedly. Renal and total blood flows, as well as mean pulmonary and systemic arterial pressures, were similar in the three experimental conditions.Revascularization after a period of left pulmonary artery occlusion normalizes the systemic blood flow to the left lung and induces partial loss of collateral vessels.
Olfactory Deficits in Patients With Mild Cognitive Impairment Predict Alzheimer’s Disease at Follow-Up
Authors: D.P. Devanand, Kristin S. Michaels-Marston, Xinhua Liu, Gregory H. Pelton, Margarita Padilla, Karen Marder, Karen Bell, Yaakov Stern, Richard Mayeux
Journal: American Journal of Psychiatry (2000)

OBJECTIVE: This study evaluated the predictive utility of olfactory identification deficits in patients with mild cognitive impairment for follow-up diagnosis of probable Alzheimer’s disease. METHOD: Ninety outpatients with mild cognitive impairment were examined at 6-month intervals. Matched healthy comparison subjects (N=45) were examined annually. The University of Pennsylvania Smell Identification Test was given at baseline. RESULTS: Olfaction scores were lower in patients with mild cognitive impairment than in healthy comparison subjects. Seventy-seven patients were followed up; 19 were diagnosed with Alzheimer’s disease by 2 years. Patients with low olfaction scores (≤34 of 40), and patients with low olfaction scores who reported no subjective problems smelling, were more likely to develop Alzheimer’s disease than other patients. In a Cox proportional hazards model adjusted for age, sex, modified Mini-Mental State score, and education, low olfaction scores did not predict time until development of Alzheimer’s disease, but low olfaction scores accompanied by lack of awareness of olfactory deficits predicted time to development of Alzheimer’s disease. This effect remained when attention or memory measures replaced modified Mini-Mental State score in the model. In patients with high Mini-Mental State scores (≥27 of 30), low olfaction with lack of awareness remained a significant predictor of Alzheimer’s disease. Olfaction scores of 30–35 showed moderate to strong sensitivity and specificity for diagnosis of Alzheimer’s disease at follow-up. CONCLUSIONS: In patients with mild cognitive impairment, olfactory identification deficits, particularly with lack of awareness of olfactory deficits, may have clinical utility as an early diagnostic marker for Alzheimer’s disease.
Heparin and Heparan Sulfate Block Angiotensin IIInduced Hypertrophy in Cultured Neonatal Rat Cardiomyocytes
Authors: Hajime Akimoto, Hiroshi Ito, Masato Tanaka, Susumu Adachi, Mimi Hata, Meihong Lin, Hiroyuki Fujisaki, Fumiaki Marumo, Michiaki Hiroe
Journal: Circulation (1996)

Background Heparan sulfate, one of the primary components of extracellular matrix, is a potent antigrowth factor in certain types of cells. To elucidate a possible role of endogenous heparin-like molecules in regulating cardiomyocyte hypertrophy, we investigated the effects of heparin and heparan sulfate on angiotensin (Ang) II–induced hypertrophy in cultured neonatal rat cardiomyocytes. Methods and Results Competitive [ 3 H]heparin binding assay showed that cardiomyocytes had specific binding sites for heparin. In situ [ 3 H]heparin binding assay demonstrated that heparin, which rapidly bound to the cardiomyocyte surface, was subsequently accumulated around the nuclei, suggesting that heparin might work in the nucleus. Cotreatment with heparin (20 μg/mL) completely inhibited increased cell surface area by Ang II (10 −6 mol/L). Increased [ 3 H]leucine incorporation by Ang II was reduced by heparin dose-dependently. The inhibitory effect of heparin on Ang II–induced cardiomyocyte hypertrophy also was confirmed by Northern blot analysis: heparin dose-dependently inhibited skeletal α-actin and atrial natriuretic peptide gene expression, genetic markers for cardiomyocyte hypertrophy. Heparan sulfate showed similar inhibitory effects on cell surface area, [ 3 H]leucine incorporation, and skeletal α-actin gene expression. Treatment with heparinase I or III, which specifically digests the disaccharide chains of endogenous heparin-like molecules, upregulated protein synthesis and skeletal α-actin and atrial natriuretic peptide gene expression in cardiomyocytes. Conclusions Our findings in this study strongly suggest that heparin and heparan sulfate are potent inhibitors of cardiomyocyte hypertrophy and that endogenous heparin-like substances negatively regulate cardiomyocyte hypertrophy.
Rupture of the Uterus Involving the Bladder
Authors: M. A. Majekodunmi
Journal: BMJ (1957)

treated with chlorophyll and antibiotics healed more quickly than when treated with either agent alone.This effect may partly be due to an enhancement of the antibiotic's activity by the surface active properties of the chlorophyll.1,i9000/ C006 9,00 v z 0. 0 a:900, 0.
Annual mammography screening did not reduce long-term breast cancer mortality in women 40 to 59 years of age
Authors: Suzanne W. Fletcher
Journal: Annals of Internal Medicine (2014)

Source Citation Miller AB, Wall C, Baines CJ, et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014;348:g366. 24519768
A Possible Oxazepam Abstinence Syndrome
Authors: Julian W. Selig
Journal: JAMA (1966)

OXAZEPAM (Serax) is a relatively new therapeutic agent. It is a 3-hydroxybenzodiazepin described as providing versatility and flexibility in control of common emotional disturbances, especially for the relief of anxiety. It is recommended that, when excessive dosage is continued for weeks or months, dosage should be reduced gradually rather than stopped abruptly. Sudden discontinuance of doses which are in excess of the recommended dose may result in epileptiform seizures. In the investigational work, a withdrawal psychosis was never observed. In studies with chlordiazepoxide hydrochloride, a related benzodiazepin compound, Hollister et al<sup>1</sup>have reported withdrawal symptoms in psychotic patients who were abruptly switched to placebo. Ten of 11 patients abruptly switched to placebo after several months of high daily doses (300 to 600 mg) experienced new symptoms and signs. Two patients had seizures at seven and eight days. Hollister et al<sup>2</sup>in one study evaluating diazepam (another related compound)
Chick embryo pancreatic transplants reverse experimental diabetes of rats.
Authors: R Eloy, K Haffen, M Kedinger, J F Grenier
Journal: Journal of Clinical Investigation (1979)

The effectiveness of xenogeneic embryonic tissue in the treatment of experimental diabetes has been investigated in rats. The splenic lobes (80) of 15- to 18-d-old chick embryos, composed almost exclusively of endocrine tissue, were implanted directly into the hepatic parenchyma of the rat recipient. The biochemical and metabolic changes in the recipients suggest that embryonic transplants of 15-d-old chick pancreases were able to significantly improve, for a prolonged period of time (18 mo), the diabetic state of nonimmunosuppressed rats. None of the recipients of 18-d-old embryos splenic lobes exhibited a long-term improvement of the diabetic state after transplantation. The complete destruction of the pancreatic B cells of the recipients was assessed by: (a) immunocytochemical investigations of the recipient's pancreas, (b) measurement of insulin in the liver and pancreas of the recipients and (c) in situ vascular perfusion of their pancreas submitted to high glucose challenge. The results suggest that pancreatic tissue of the 15-d-old embryos is immunologically immature lacking one or several lymphocyte subsets implicated in the afferent lood of "non-self" recognition.
Maintaining a Healthy Body Weight Is Paramount
Authors: Chandra L. Jackson, Meir J. Stampfer
Journal: JAMA Internal Medicine (2013)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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 Internal Medicine journal
Correspondence Is Maximal Lung Recruitment Worth It?
Authors: Guillermo Bugedo, Alejandro Bruhn
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

In their recent article, Borges and colleagues nicely show by computed tomography (CT) that nearly complete lung recruitment may be achieved in most mechanically ventilated patients with acute lung injury/acute respiratory distress syndrome (ALI/ ARDS) (1). Unfortunately, the authors failed to prove that their maximal lung recruitment strategy is safe. To obtain full recruitment, which was defined as PaO2 PaCO2 400 mm Hg, they use an aggressive strategy consisting of a sequential increase in inspiratory pressures up to 60 cm H2O if necessary. However, the extreme values of PaCO2 and pH observed during recruitment can hardly be considered as safe. Furthermore, the minimal gain in reversing collapse beyond 45 cm H2O (Figure 2 of their article) indicates that unnecessarily high distending pressures were probably used. The low rates of barotrauma and hyperinflation on CT do not exclude overdistension, which is easily identified in their data by the increase in PaCO2 and the decrease in cardiac output. More important, overdistension may worsen lung injury, release inflammatory mediators, and induce distant organ failure and death (2, 3). In fact, despite the low number of patients, the 57% mortality rate is unexpectedly high compared with most recent trials and with previous data of the same group. Decades of research have moved us toward a more gentle and rational ventilation (4). Overdistension may be a high price to pay for maximal recruitment.
Pancreatic Sphincter Hypertension Increases the Risk of Post-ERCP Pancreatitis
Authors: P. Tarnasky, J. Cunningham, P. Cotton, B. Hoffman, Y. Palesch, J. Freeman, N. Curry, R. Hawes
Journal: Endoscopy (1997)

Background and Study Aims: The reason for the increased risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with Sphincter of Oddi dysfunction is not known. This study sought to determine whether pancreatic sphincter hypertension might explain some of the increased risk.