tbuckley/cabot-search huggingface dataset:
Using care bundles to reduce in-hospital mortality: quantitative survey
Authors: E. Robb, B. Jarman, G. Suntharalingam, C. Higgens, R. Tennant, K. Elcock
Journal: BMJ (2010)

<b>Problem</b> To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. <b>Design</b> Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths. <b>Setting</b> Acute hospital trust in north west London. <b>Strategies for change</b> Use of clinical guidelines in care bundles in eight targeted clinical areas. <b>Interventions</b> Use of care bundles in treatment areas for the diagnoses leading to most deaths in the trust in 2006-7. <b>Key measures for improvement</b> Change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardised mortality ratio (HSMR) during the intervention year compared with the preceding year. <b>Effect of the change</b> The standardised mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-8 for the HSMR diagnoses than if the 2006-7 HSMR had been applicable. From 2006-7 to 2007-8 there was a 5.7% increase in admissions, 7.9% increase in expected deaths, and 14.5% decrease in actual deaths. <b>Lessons learnt</b> Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.
Afflictions of a Vestigial Appendage
Authors: Kenneth M. Halprin
Journal: JAMA (1967)

Despite lavish care, human nails like human hair are not essential. These appendages, which were presumably more appropriate to our ancestors, are subject to a bewildering variety of abnormalities and diseases which we as physicians are asked to treat and correct. This and succeeding communications are an attempt to present a simplified orderly approach to the more common nail disorders.  New nail is formed under the posterior nail fold by the nail matrix and pushes the already formed nail distally over the nail bed at a rate of approximately 0.13 mm per day. This process of nail formation can best be appreciated by observing the appearance and movement of the transverse ridges or Beau's lines (Fig 1) which form in all nails during periods of severe systemic illness. These ridges emerge from under the posterior nail fold, move distally, and are followed by normal nail as the internal problem is
Heart Disease, Workmen's Compensation and the Practicing Physician
Authors: Elliot L. Sagall
Journal: New England Journal of Medicine (1961)

IN recent years the number of claims for "cardiac injury" under workmen's compensation laws has shown a steady and rapid increase. A continuation of this trend is likely because of the constantly increasing proportion of older workers covered by these laws and by the more liberal definitions of compensable heart disorders currently being adopted by the judicial authorities. Because many of the problems arising in the interpretation and administration of compensation statutes depend primarily upon medical opinion for their solution, the practicing physician will find himself called upon more and more often by either employee or employer to testify in . . .
Mass Enteric Live Adenovirus Vaccination During Epidemic ARD
Authors: Robert O. Peckinpaugh
Journal: JAMA (1968)

During an epidemic of acute adenovirus respiratory disease (ARD) in a naval recruit population, mass immunization with an enteric live adenovirus type 4 vaccine resulted in an early dramatic reduction in illness. The decrease of disease in immunized men occurred before a detectable increase in serum antibody developed and a concurrent benefit was observed in the nonimmunized controls. This result is attributed to a blocking or ecological effect of the live vaccine virus. Greater protection was afforded when all men were immunized than when only half were immunized. Administration of the vaccine to new recruits was associated with continued suppression of ARD. When vaccination was discontinued after 16 weeks, the disease rate continued at lower than the usual endemic incidence. No reduction was seen in the incidence of nonbacterial pneumonia.
THE EXTERNAL PREPARATIONS OF THE U. S. P. AND THE NATIONAL FORMULARY
Authors: C. S. N. HALLBERG
Journal: JAMA (1910)

ure to sunliglt as an exciting factor in the production of alopecia.I have noticed that many of these patients apply for treatment in the autumn, after they had gone bare¬ headed throughout the summer, and I was also led to this idea through the analogy of the effect of the sun's rayi with those of the »-rays.We know that with highly actinic energy we can produce baldness, and I am inclined to believe that free exposure to sunlight will have the same effect.
Honesty about new screening programmes is best policy
Authors: A E Raffle
Journal: BMJ (2000)

EDITOR—Austoker's editorial on gaining informed consent for screening is timely.1 The National Screening Committee has commissioned two pilot sites for screening for bowel cancer, and there has been hot debate about what information should be given to potential participants and how.

If we follow past practice we would give very general information aimed at encouraging an invited age group to attend. “Screening for bowel cancer is effective; thousands of lives can be saved; the test is painless and free and can be done in the privacy of your home; cancers can …
US journal attacks unethical HIV trials
Authors: D. Josefson
Journal: BMJ (1997)

The New England Journal of Medicine (337:847-9, 853-6) has questioned the ethics of United States sponsored experiments in developing countries that test various methods of reducing the vertical transmission of HIV. The studies are controversial because some of the control groups are denied antiretroviral drugs.

About 300 000 cases of transmission of AIDS from mother to child occur annually, mostly in developing countries. Three years ago the AIDS Clinical Trials Group showed that zidovudine substantially reduces perinatal transmission of HIV, decreasing the rate of infection by 66%. Giving zidovudine in the last trimester to …
Neisseria gonorrhoeae Treatment Failure and Susceptibility to Cefixime in Toronto, Canada
Authors: Vanessa G. Allen, Leo Mitterni, Christine Seah, Anuradha Rebbapragada, Irene E. Martin, Colin Lee, Heather Siebert, Lynn Towns, Roberto G. Melano, Donald E. Low
Journal: JAMA (2013)

<h3>Importance</h3>Although cephalosporins are the cornerstone of treatment of Neisseria gonorrhoeae infections, cefixime is the only oral antimicrobial option. Increased minimum inhibitory concentrations (MICs) to cefixime have been identified worldwide and have been associated with reports of clinical failure.<h3>Objective</h3>To assess the risk of clinical treatment failure of N gonorrhoeae infections associated with the use of cefixime.<h3>Design, Setting, and Population</h3>A retrospective cohort study of culture-positive N gonorrhoeae infections at a single sexual health clinic in Toronto, Canada, that routinely performs test of cure. The cohort comprised N gonorrhoeae culture-positive individuals identified between May 1, 2010, and April 30, 2011, treated with cefixime as recommended by Public Health Agency of Canada guidelines.<h3>Main Outcome Measures</h3>Cefixime treatment failure, defined as the repeat isolation of N gonorrhoeae at the test-of-cure visit identical to the pretreatment isolate by molecular typing and explicit denial of reexposure.<h3>Results</h3>There were 291 N gonorrhoeae culture-positive individuals identified. Of 133 who returned for test of cure, 13 were culture positive; 9 patients were determined to have experienced cefixime treatment failure, involving urethral (n = 4), pharyngeal (n = 2), and rectal (n = 3) sites. The overall rate of clinical treatment failure among those who had a test of cure was 6.77% (95% CI, 3.14%-12.45%; 9/133). The rate of clinical failure associated with a cefixime MIC of 0.12 μg/mL or greater was 25.0% (95% CI, 10.69%-44.87%; 7/28) compared with 1.90% (95% CI, 0.23%-6.71%; 2/105) of infections with cefixime MICs less than 0.12 μg/mL, with a relative risk of 13.13 (95% CI, 2.88-59.72; P &lt; .001).<h3>Conclusion and Relevance</h3>The rate of clinical failure following treatment of N gonorrhoeae infections with cefixime was relatively high at a Toronto clinic and was associated with elevated MICs.
Mitral Obstruction by Vegetations of Staphylococcal Endocarditis
Authors: Richard Reeve
Journal: JAMA (1974)

ACUTE valvular insufficiency during active endocarditis is a well-recognized complication that may require surgical intervention. The development of acute valvular obstruction as a result of vegetations is a rare complication of endocarditis, and to our knowledge has not been treated surgically. Mitral obstruction caused by vegetations of bacterial endocarditis has been reported in only one patient, a 21-year-old woman with group B β-hemolytic streptococcal endocarditis.<sup>1,2</sup>At physical examination, apical systolic and diastolic murmurs were heard. Autopsy disclosed a mildly scarred mitral valve with severe obstruction due to the vegetation alone. Roberts et al<sup>1,2</sup>also reported one case of aortic obstruction caused by vegetations of<i>Candida parapsilosis</i>endocarditis of 11 months' duration in a 26-year-old narcotic addict and one case of possible tricuspid obstruction<sup>3</sup>from the vegetations of<i>Staphylococcus aureus</i>endocarditis in a 35-year-old heroin addict. We have observed a patient in whom severe mitral obstruction developed in
Medicine Stone: Poems
Authors: S. Poirier
Journal: JAMA (2003)

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
Abstract 3541: Pharmacological chaperones increase membrane expression of ABCG2 harboring the Q141K single nucleotide polymorphism
Authors: Akina Tamaki, Ierano Caterina, Suneet Shukla, Robert W. Robey, Suresh V. Ambudkar, Susan E. Bates
Journal: Cancer Research (2010)

Abstract ABCG2 is an ATP-binding cassette half-transporter that functions as a xenobiotic transporter. Since ABCG2's discovery in multidrug-resistant cancer cells, the transporter has garnered interest in pharmacogenomics as a component of the blood-brain barrier and the maternal-fetal barrier as well as a modulator of oral drug absorption. A single nucleotide polymorphism (SNP) C421A in ABCG2, resulting in a glutamic acid to leucine mutation at amino acid 141 (Q141K), has been extensively studied and has been found to affect protein expression and ATPase activity, but may also affect protein folding. As misfolded ABCG2 has been shown to be degraded through the endoplasmic reticulum associated protein degradation (ERAD) system (T. Furukawa et al., Pharm Res., 26(2): 469-479, 2008), we postulated that pharmacological chaperones such as mitoxantrone, a known substrate of ABCG2, might increase surface expression of Q141K ABCG2. In this study, we used HEK293 stably transfected with Q141K ABCG2 to examine whether incubating cells expressing the mutated transporter with mitoxantrone or other ABCG2 substrates would serve to “rescue” Q141K ABCG2 and improve trafficking to the cell surface, as we have demonstrated in other mutations that impair trafficking (O. Polgar et al., Biochemistry, 43(29): 9448-9456, 2004). Expression of ABCG2 in cells transfected with wild-type or Q141K ABCG2 was measured by immunoblot analysis and flow cytometry. After treatment with 5 μM of mitoxantrone, cell surface expression of ABCG2 in cells transfected with vector containing Q141K ABCG2 increased, while cells transfected with wild-type ABCG2 showed no change. Increased ABCG2 expression was also observed in membrane preparations from mitoxantrone-treated cells transfected with Q141K ABCG2 compared to wild-type ABCG2 transfected cells. Interestingly, immunoblot analysis showed that when cells transfected with Q141K ABCG2 were incubated with 50 μM of the dietary compounds tert-butyl hydroquinone (TBHQ) and dibenzoylmethane (DBM), increased expression of ABCG2 was observed in membrane preparations, while no change was observed for cells expressing wild-type ABCG2. These results suggest that some dietary compounds may promote proper folding and membrane localization of mutant forms of ABCG2. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3541.
A surgical emergency
Authors: P. G Sorelli, D. Thomas, H. Hoque
Journal: BMJ (2009)

A 91 year old man presented with acute onset right sided abdominal pain that radiated to his right groin. He reported having had an urge to urinate and had subsequently collapsed on his way to the toilet. He had no back pain or incontinence of urine or faeces. His medical history included controlled hypertension, but he was otherwise fit and well and living independently. On examination, the patient had a normal temperature but was tachycardic, with a pulse rate of 110 beats/min. His blood pressure was 85/50 mm Hg, which improved to 110/70 mm Hg after fluid resuscitation with 2 l of crystalloid solution. His chest was clear. Examination of his abdomen revealed a tender and non-pulsatile 15×10 cm mass in the right iliac fossa that extended to the groin. There were strong femoral pulses bilaterally. Chest radiograph did not show any evidence of free intraperitoneal air, suggestive of perforation. Blood tests showed a normal white blood cell count and a haemoglobin level of 9.1 g/dl. Urea, creatinine, electrolytes, and amylase concentrations were all in the normal range. An urgent computed tomogram with intravenous contrast was performed on the abdomen and pelvis (figs 1 and 2).⇓ ⇓ Fig 1 Abdominal computed tomogram of the abdomen and pelvis; axial view Fig 2 Abdominal computed tomogram of the abdomen and pelvis; coronal view ### Short answers
Erythropoietin and Polycythemias
Authors: BRUCE M. SMALL
Journal: Annals of Internal Medicine (1981)

Letters and Corrections1 August 1981Erythropoietin and PolycythemiasBRUCE M. SMALL, M.D.BRUCE M. SMALL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-95-2-243_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Koeffler and Goldwasser (1) have applied a sensitive radioimmunoassay for erythropoietin to the problem of distinguishing between primary and secondary polycythemias. Although they report a clear separation between patients with polycythemia vera and those belonging to a mixed group with secondary erythrocytoses, their results as stated need further comment.Their patients with polycythemia vera had a mean hematocrit of 54%, and their patients with secondary polycythemia had a mean hematocrit of 56% at the time erythropoietin measurement. Although the authors state that no patient had received phlebotomy for 5 weeks, or chemotherapy for an unspecified time before...References1. KOEFFLERGOLDWASSER HE. Erythropoietin radioimmunoassay in evaluating patients with polycythemia. Ann Intern Med. 1981;94:44-7. LinkGoogle Scholar2. BERLIN N. Diagnosis and classification of the polycythemias. Semin Hematol. 1975;12:339-51. MedlineGoogle Scholar1. KOEFFLERGOLDWASSER HE. Erythropoietin radioimmunoassay in evaluating patients with polycythemia. Ann Intern Med. 1981;94:44-7. LinkGoogle Scholar2. ADAMSON J. The erythropoietin/hematocrit relationship in normal and polycythemic man: implications of marrow regulation. Blood 1968;32:597-609. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Erie County Laboratory Buffalo, NY 14215 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByExperimental and Clinical Evaluation of Erythropoietin 1 August 1981Volume 95, Issue 2Page: 243-243KeywordsChemotherapyErythropoietinHematocritPhlebotomyPolycythemiaPolycythemia veraRadioimmunoassays Issue Published: 1 August 1981 PDF DownloadLoading ...
Assignment of patients into the classification of cardiomyopathies.
Authors: A Keren, R L Popp
Journal: Circulation (1992)

The original classifications of the cardiomyopathies based on anatomic criteria from radiographic and necropsy studies, as well as hemodynamic criteria from clinical and catheterization data, have been supplemented in recent years by information from noninvasive techniques. Echocardiography, radionuclide methods, and ambulatory ECG, in particular, have facilitated the ethical screening of family members and those less symptomatic than patients on whom the original classification was based. These powerful methods show a broad spectrum of anatomy and ventricular physiology along the natural history of and within the traditional categories of the cardiomyopathies. They also provide data on the effect of ventricular loading conditions affecting a range of diastolic filling patterns. This review has attempted to point out the areas of overlap among and/or controversy about the categories that have led us to a feeling of frustration when trying to neatly classify individual patients. The addition of filling patterns from Doppler echocardiography and nuclear angiography to the standard methods has been reviewed and hopefully will lend more perspective to the range of physiology seen in these conditions. The categories of cardiomyopathy should not be seen as excluding patients with the newly recognized variations in anatomy and ventricular filling patterns. Rather, the classification provides a framework on which to build and expand our understanding of these important conditions.
The Human Genome Project and the Future of Health Care
Authors: Charles R. MacKay
Journal: Annals of Internal Medicine (1997)

Medical Writings: Book Notes1 August 1997The Human Genome Project and the Future of Health CareCharles R. MacKay, PhD, ReviewerCharles R. MacKay, PhD, ReviewerNational Institutes of Health, Bethesda, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-3-199708010-00034 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Human Genome Project and the Future of Health CareMurray TH, Rothstein MA, Murray RF Jr; eds. 284 pages. Bloomington, IN: Indiana Univ Pr; 1996. $29.95. ISBN 0253332133. Order phone 800-842-6796.Field of medicine: Ethics and genetics.Format: Hardcover book.Audience: Ethicists and persons with a stake in the societal implications of the Human Genome Project will find many issues thoughtfully and knowledgeably presented. Practitioners will be less satisfied because of the pronounced academic tilt of the chapters.Purpose: To outline, probe, and analyze the potential for significant shifts in the delivery of health care and medical practice as ... Author, Article, and Disclosure InformationAffiliations: National Institutes of Health, Bethesda, Maryland. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 August 1997Volume 127, Issue 3Page: 256KeywordsDNAForecastingGeneticsHealth careHealth information technologyInformation technologyMedical servicesResearch laboratoriesResearch quality assessmentTraditional medicine ePublished: 15 August 2000 Issue Published: 1 August 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
SIGNIFICANCE AND TREATMENT OF ITCHING.
Authors: L. DUNCAN BULKLEY
Journal: JAMA (1907)

Itching, or pruritus, is an unpleasant sensation which most individuals have undoubtedly experienced at some time, and yet which it is difficult to describe, any more than pain can be described. But all recognize and know that as a sensation in the skin it may be very disquieting, and that it is one often urgently calling for relief; at times also it may be so distressing that the sufferer will submit to almost anything in order to be freed from it, and will frequently claim that any amount of pain would be preferable. Nature's treatment of itching is by scratching, and in the effort to get relief from intolerable itching animals and human beings, the latter especially, will often indulge in this, even until great injury, followed by much pain, is inflicted on the delicate tissues of the skin, as is especially seen in infants with eczema. But this alleviation