tbuckley/cabot-search huggingface dataset:
Need for expertise based randomised controlled trials
Authors: Simon Hatcher
Journal: BMJ (2005)

Editor—Of course the expertise based randomised trial, mooted for surgical procedures by Devereaux et al,1 is the norm in psychotherapy research when comparing two different psychotherapies. A similar debate on the interpretation of such trials occurred in the psychotherapy literature.2

Research in surgery and psychotherapy share other similarities beyond having to account for practitioner expertise. There is the issue of blindness—hard to achieve for both patient and doctor in these disciplines—as well as the “why test it, it's obvious it makes a difference” argument. Both disciplines could learn from each other about the design and analysis of clinical research.
Shaw's Textbook of Operative Gynæcology
Authors: S. Leon Israel
Journal: JAMA (1961)

This is a comprehensive rewriting of a well-known surgical textbook. Dedicated to the memory of the author of the original treatise, Wilfred Shaw, this instructive volume aims to describe the "standard, orthodox and accepted British practice" in gynecological surgery. Howkins does not attempt to include all operative procedures available but presents rather those most acceptable from his own personal experience and that of his colleagues. The surgical anatomy is clearly delineated in the several steps of each operation. The opening chapter, dealing with preoperative preparations, lays proper emphasis on the requisite medical measures but stresses also the psychological preparation of the patient and her family. There follow several well-written chapters on procedures ancillary to operation (anesthesia, blood transfusion, and selection of instruments), gynecological anatomy, and special diagnostic investigations (exfoliative cytology, colposcopy, and culdoscopy). The preliminary group of chapters, those not devoted to descriptions of surgical techniques, concludes with excellent discussions
Therapy of Ischemic Cerebrovascular Disease
Authors: JOHN A. BYER
Journal: Annals of Internal Medicine (1980)

Major advances are being made in our understanding of the pathophysiology of ischemic stroke. In the past 25 years anticoagulation, carotid endarterectomy, and antiplatelet aggregation agents, along with less well-accepted therapies, have been introduced for the management of this complex disorder. Also, noninvasive diagnostic methods have been developed for evaluating these patients. This article reviews the pathophysiology of cerebral ischemia and the data on the effectiveness of the various therapies advocated for its management.
Sensors in medicine
Authors: C. B Wilson
Journal: BMJ (1999)

Sensors are devices that detect physical, chemical, and biological signals and provide a way for those signals to be measured and recorded.1 Physical properties that can be sensed include temperature, pressure, vibration, sound level, light intensity, load or weight, flow rate of gases and liquids, amplitude of magnetic and electronic fields, and concentrations of many substances in gaseous, liquid, or solid form Although sensors of today are where computers were in 1970 medical applications of sensors are taking off because of advances in microchip technologies and molecular chemistry. 2 3

Sensors have played an important role in many industries, providing the mechanical “vision” used for counting, sorting, reading, and robotic guidance. Tactile sensors, typically piezoelectric materials, generate voltage when touched, squeezed, or bent, or when their temperature is changed. Other sensors can detect specific chemical pressures and fluid levels. Cars, homes, and offices are loaded with sensors. In the short term, sensors used in medical applications will emit a signal that can be read at the point of determination or transferred by wire or wireless transmission to remote locations Advances in microprocessor technologies have created a smart sensor that unites sensing capability and data processing in a single integrated circuit chip. The next step is combining sensing and processing with an actuator, such as microelectromechanical systems 4 5

#### Summary points

Sensors are all around us

Now sensors are moving into health care

Leading the way are sensors for the monitoring of glucose and vital signs

Sensors will change the site of health care

Smart sensors will initiate an appropriate response, including treatment

Many sensor technologies used in industry can be applied in medicine, and in the future, as unique sensors and sensor dependent microelectromechanical systems are designed and tested, non-medical industries will adapt them for industrial applications. Within the medical world …
Myeloperoxidase and superoxide dismutase 2 polymorphisms comodulate the risk of hepatocellular carcinoma and death in alcoholic cirrhosis
Authors: Pierre Nahon, Angela Sutton, Pierre Rufat, Marianne Ziol, Hassan Akouche, Christelle Laguillier, Nathalie Charnaux, Nathalie Ganne-Carrié, Véronique Grando-Lemaire, Gisèle N'Kontchou, Jean-Claude Trinchet, Liliane Gattegno, Dominique Pessayre, Michel Beaugrand
Journal: Hepatology (2009)

Abstract Alcohol increases reactive oxygen species (ROS) formation in hepatocyte mitochondria and by reduced nicotinamide adenine dinucleotide phosphate oxidases and myeloperoxidase (MPO) in Kupffer cells and liver-infiltrating neutrophils. Manganese superoxide dismutase (MnSOD) converts superoxide anion into hydrogen peroxide, which, unless detoxified by glutathione peroxidase or catalase (CAT), can form the hydroxyl radical with iron. Our aim was to determine whether Ala16Val-superoxide dismutase 2 (SOD2), G-463A-MPO, or T-262C-CAT dimorphisms modulate the risks of hepatocellular carcinoma (HCC) and death in alcoholic cirrhosis. Genotypes and the hepatic iron score were assessed in 190 prospectively followed patients with alcoholic cirrhosis. During follow-up (61.1 ± 2.7 months), 51 patients developed HCC, and 71 died. The T-262C-CAT dimorphism did not modify hepatic iron, HCC, or death. The GG-MPO genotype did not modify iron but increased the risks of HCC and death. The hazard ratio (HR) was 4.7 (2.1–10.1) for HCC and 3.6 (1.9–6.7) for death. Carriage of one or two Ala-SOD2 allele(s) was associated with higher liver iron scores and higher risks of HCC and death. The 5-year incidence of HCC was 34.4% in patients with both the GG-MPO genotype and one or two Ala-SOD2 alleles, 5.1% in patients with only one of these two traits, and 0% in patients with none of these traits. Corresponding 5-year death rates were 37.6%, 11.6%, and 5%. Conclusion: The combination of the GG-MPO genotype (leading to high MPO expression) and at least one Ala-SOD2 allele (associated with high liver iron score) markedly increased the risks of HCC occurrence and death in patients with alcoholic cirrhosis. (Hepatology 2009.)
Retrobulbar T cells from patients with Graves' ophthalmopathy are CD8+ and specifically recognize autologous fibroblasts.
Authors: B Grubeck-Loebenstein, K Trieb, A Sztankay, W Holter, H Anderl, G Wick
Journal: Journal of Clinical Investigation (1994)

Graves' ophthalmopathy is an autoimmune condition characterized by T cell infiltration of the retrobulbar tissue. Phenotypic and functional analysis of these infiltrating cells may provide insight into the pathogenesis of the disease. IL-2-responsive cells were therefore grown out of the retrobulbar tissue from two patients with severe Graves' ophthalmopathy undergoing orbital decompression surgery, and six T cell lines were established and characterized. They consisted predominantly of CD8 + CD45RO+ cells and secreted IL-4, IFN-gamma, and IL-10 upon activation. When screened for their antigen reactivity, all lines proliferated in response to stimulation with autologous retrobulbar fibroblasts in an HLA class I-restricted manner, but did not recognize autologous peripheral blood mononuclear cells, crude eye muscle extract, allogeneic cells, or purified protein derivate of Mycobacterium tuberculosis. In contrast, PBMC from the same patients responded readily to purified protein derivate of Mycobacterium tuberculosis and allogeneic PBMC, but did not recognize autologous fibroblasts. Interestingly, only one of the six retrobulbar T cell lines displayed cytotoxicity towards its specific target cell population. These results suggest that the retrobulbar fibroblasts are a major T cell target in Graves' ophthalmopathy. Pronounced cytokine production in the absence of target cell cytotoxicity may explain fibroblast proliferation, glycosaminoglycan secretion, and secondary eye muscle enlargement in this condition.
On the influence of extracellular fluid volume expansion and of uremia on bicarbonate reabsorption in man
Authors: Eduardo Slatopolsky, Phillip Hoffsten, Mabel Purkerson, Neal S. Bricker
Journal: Journal of Clinical Investigation (1970)

The patterns of bicarbonate reabsorption during increasing plasma concentrations were studied in subjects with a range of glomerular filtration rates (GFR) from 170 to 2 ml/min. In a group of five subjects with GFR values above 30 ml/min, paired bicarbonate titration studies were performed first under conditions which minimized extracellular fluid (ECF) volume expansion, and second under conditions which were conducive to exaggerated expansion of ECF volume. In patients with GFR values below 30 ml/min, a single protocol was employed. Studies also were performed on two patients with far advanced renal disease who were nephrotic and exhibited a sodium-retaining state. When ECF volume expansion was minimized in the nonuremic subjects, values for bicarbonate reabsorption were well in excess of the usually accepted Tm level and over the range of plasma bicarbonate concentrations employed, no evidence of a Tm phenomenon was observed. A similar pattern emerged in the two nephrotic patients despite the presence of uremia. However, with both exaggerated expansion of ECF volume (GFR greater than 30) and in patients with advanced renal disease in the absence of exaggerated ECF volume expansion a tendency towards saturation kinetics for bicarbonate reabsorption was demonstrable. In comparing the minimized with the exaggerated expansion studies, evidence emerged for a decrease in both bicarbonate reabsorption per unit of GFR and the absolute rate of bicarbonate reabsorption. When ECF volume expansion was exaggerated in uremic patients after stable rates of bicarbonate reabsorption had been achieved, a decrease in reabsorption per unit of GFR and in absolute bicarbonate reabsorption occurred. The possible relationship of the factors controlling sodium excretion to the observed patterns of bicarbonate reabsorption is considered in the text.
Firm Papules on the Auricular Helix—Quiz Case
Authors: Hye Jin Chung, Kristin Cam, Laurel Schwartz
Journal: JAMA Dermatology (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 Dermatology 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 Dermatology journal
Paying patients with psychosis to improve adherence
Authors: T. Kendall
Journal: BMJ (2013)

This approach can work 

Poor adherence to treatment is a problem across the whole of medicine, with people not attending appointments, not taking their drugs as prescribed, or not taking them at all. More than 50% of people with schizophrenia have been estimated not to adhere to prescribed drugs,1 leading to higher rates of relapse and hospital admission, as well as increased costs.2 3 Attempts to improve adherence in this population using interventions such as “compliance/adherence therapy,”4 along with the development of long acting depot antipsychotics, have not produced the expected benefits. In a linked paper (doi:10.1136/bmj.f5847), Priebe and colleagues found that modest financial incentives significantly improved adherence in people treated with depot drugs for schizophrenia and other psychoses in the United Kingdom.5

It is difficult to achieve adherence to antipsychotic drugs in people with psychoses for several reasons. Many do not accept that they are ill so do not believe that they need treatment. Antipsychotics are associated with serious side effects including diabetes, obesity, and neurological problems, especially if used at higher doses. Although other effective treatments …
Effects of caffeine and ryanodine on delayed afterdepolarizations and sustained rhythmic activity in 1-day-old myocardial infarction in the dog.
Authors: M Boutjdir, N el-Sherif, W B Gough
Journal: Circulation (1990)

Caffeine and ryanodine are known to modulate oscillatory release of Ca2+ from the sarcoplasmic reticulum. The effects of caffeine and ryanodine on delayed afterdepolarizations (DADs) and sustained rhythmic activity in subendocardial Purkinje fibers surviving 1-day-old myocardial infarction in the dog were studied with standard microelectrode techniques. In preparations that showed sustained rhythmic activity, a high concentration of caffeine (10 mM) and ryanodine (10(-7) and 10(-6) M) slowed and terminated the sustained rhythmic activity and markedly suppressed DADs. An increase in the temperature of the tissue bath from 37 degrees to 39 degrees C did not change these results. In quiescent normal and infarcted preparations, a low concentration of caffeine (0.5 mM) differentially induced DADs in ischemic but not in normal Purkinje fibers, increased the amplitude of existing DADs, and brought subthreshold DADs to threshold potential that caused triggered activity. Our results are consistent with the hypothesis that triggered activity arising from DADs characterizes the sustained rhythmic activity in endocardial preparations 1 day after infarction and indicate an important role for the sarcoplasmic reticulum in the genesis of DADs and triggered activity in this model.
Standardization of Spirometry: A Summary of Recommendations from the American Thoracic Society
Authors: REED M. GARDNER
Journal: Annals of Internal Medicine (1988)

The spirometer is used to measure forced vital capacity in pulmonary, occupational, and general medicine. Results of spirometry affect decisions regarding patient treatment and disability compensation. Accurate spirometers are also required for epidemiologic studies. The recommendations of the American Thoracic Society cover equipment selection, validation, and quality control; maneuver performance recommendations; measurement procedures; and reference values and interpretation standardization.
The importance of testing colour vision in identifying brain tumours in children
Authors: I. Georgalas, D. Pagoulatos, A. Rouvas, C. Koutsandrea
Journal: BMJ (2013)

We would like to add some useful information for paediatricians and GPs to supplement Wilne and colleagues’ comprehensive review of brain tumours in children and young adults.1

Firstly, when a brain tumour is suspected, funduscopy is mandatory because optic disc oedema may be the first and only sign of raised intracranial pressure. …
The Brain Hospital
Authors: Christopher Martyn
Journal: BMJ (2006)

Medical soap operas are a gift for television directors and script writers, which is presumably why they are so common. There is the inherent drama of sudden illness and urgent need for treatment. A constant stream of patients makes it easy to introduce new characters and kill off old ones. And the setting allows new or bizarre situations to be engineered without taxing the viewers' suspension of disbelief. If that is not enough, the medical and nursing staff can always sleep with each other. 

Medical documentaries are a more difficult proposition. First, the underlying intent to inform and educate demands that the content is as correct as it can be for an inexpert audience. No director of a documentary could get away with the capricious diagnostic suggestions that Dr House, for example, inflicts on his junior staff. Second, the programme must avoid descending into the medical equivalent of pornography. Nowadays, it's unacceptable for …
Nonsteroidal Antiinflammatory Drugs and the Risk of Alzheimer's Disease
Authors: Bas A. in 't Veld, Annemieke Ruitenberg, Albert Hofman, Lenore J. Launer, Cornelia M. van Duijn, Theo Stijnen, Monique M.B. Breteler, Bruno H.C. Stricker
Journal: New England Journal of Medicine (2001)

Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) may help to prevent Alzheimer's disease. The results, however, have been inconsistent.
The Isolation of Active Principles in Pure Form by Partition
Authors: Lyman C. Craig
Journal: JAMA (1963)

FAMILIAR WORDS, such as some of those in the title of this report, can communicate different ideas, depending on the training and experience of the person to whom they are addressed. To a biochemist the term "active principle" usually refers to a single chemical compound, either simple or complex, but it may refer to a particular organization of chemical compounds, even to a living unit such as a virus or bacterium. Since the singular term "principle" is used rather than the plural, a direct relationship with the word "pure" is implied. The term "pure," however, is considerably more difficult to define, since it will vary greatly depending on the chemical nature of the active principle. If it refers to a single chemical compound it is intended to mean that all or practically all of the molecules in a given preparation are identical. If it refers to an organized complex it
Manufacturer stands by Xpert tuberculosis test after India study questions its reliability
Authors: G. Mudur
Journal: BMJ (2014)

A study in India that failed to detect drug resistant tuberculosis in over a third of samples has raised questions about the reliability of a molecular diagnostic test for the disease endorsed by the World Health Organization more than three years ago.

In the study of patients from Punjab the Xpert test, which was designed to simultaneously diagnose tuberculosis and detect resistance to rifampicin—a key first line drug for the infection—falsely classified 21 of 59 samples (35.5%) as susceptible to rifampicin.1

Doctors at the All India Institute of Medical Sciences in New Delhi, who conducted the study, said their findings showed that the test might not detect certain genetic mutations that could be associated with drug resistant tuberculosis.

Sarman Singh, professor of clinical microbiology at the institute who led the study, told The BMJ , “These are disturbingly high false negative …
Cross-Country Skiing
Authors: Robert S. Clark
Journal: JAMA (1978)

<h3>To the Editor.—</h3> I appreciate Lyons and Porter's article "Cross Country Skiing: A Benign Sport?" I managed to sustain a spiral fracture of the tibia as the result of a twisting fall in deep, powder snow while wearing ankle-top boots and cable bindings when I was indulging in this "completely safe" sport in 1970. Since then my veracity has been in serious doubt, as I have been told by innumerable cross-country skiers that they have never heard of anyone fracturing anything in this most benign of sports. I can now restore my reputation as a reasonably reliable informant even if not an outstanding cross-country skier.
The new NHS: first year's experience. East Birmingham: the beast was fed.
Authors: T. Delamothe
Journal: BMJ (1992)

The New NHS: firstyear's experience East Birmingham: the beast was fed Tony Delamothe "We fed the beast.We turned the money around.What difference has it made?Not a lot."Few people I spoke to would have dissented from this verdict on the reforms' first year, delivered by Dr Anne McConville, East Birmingham's director of public health.Despite predictions made six and 12 months ago that "some- thing" would have happened by now (and the pos- sibilities ranged from the dire to the paradisical)' 2 the real action was once again being deferred until some time in the future.The general election-two weeks away-over- shadowed my visit.If the findings of local opinion polls had predicted the outcome of the election then Labour would have won, and trusts and fundholding practices would have disappeared overnight.East Birmingham Hospital's acute unit, due to become a trust from 1 April, would have enjoyed its new status for less than a fortnight.Instead of concentrating minds wonderfully this threat of execution distracted them.Purchasing, providing, and fundholding had required prodigious effort.If they were to disappear without trace then never would so many people in the health service have worked so hard for so little.Supporters and detractors of the reforms were unanimous that one year was too soon to judge whether they were working."It would take at least another three years to decide," said Dr Rowland Hopkinson, East Birmingham Hospital's clinical director of anaesthetics and a supporter of his hospital's applica- tion for trust status."Ultimately, they will be judged by the balance sheet."What can we learn from an early peek?
Sexually Transmitted Diseases in Victims of Rape
Authors: Carole Jenny, Thomas M. Hooton, Ann Bowers, Michael K. Copass, John N. Krieger, Sharon L. Hillier, Nancy Kiviat, Lawrence Corey, Walter E. Stamm, King K. Holmes
Journal: New England Journal of Medicine (1990)

The risk of acquiring a sexually transmitted disease as a result of rape is not known, in part because it is difficult to ascertain whether infections were present before the assault or acquired during it. To investigate this question, we examined female victims of rape within 72 hours of the assault and again at least one week after the assault. Of the 204 girls and women initially examined within 72 hours of the rape, 88 (43 percent) were found to have at least one sexually transmitted disease. These diseases included infections caused by Neisseria gonorrhoeae (6 percent of those tested), cytomegalovirus (8 percent), Chlamydia trachomatis (10 percent), Trichomonas vaginalis (15 percent), herpes simplex virus (2 percent), Treponema pallidum (1 percent), and the human immunodeficiency virus type 1 (HIV-1; 1 percent) and bacterial vaginosis (34 percent). Among the 109 patients (53 percent) who returned for at least one follow-up visit (excluding those who were found to be infected at the first visit or who were treated prophylactically), the incidence of new disease was as follows: gonorrhea, 4 percent (3 of 71); chlamydial infection, 2 percent (1 of 65); trichomoniasis, 12 percent (10 of 81); and bacterial vaginosis, 19 percent (15 of 77). There were no new infections with herpes simplex virus, cytomegalovirus, Trep. pallidum, or HIV-1, but follow-up serologic testing was performed in only 26 percent of the patients. On the basis of our assumptions that most venereal infections present within 72 hours of a rape were preexisting and that new infections identified 1 to 20 weeks later were acquired during the assault, we conclude that the prevalence of preexisting sexually transmitted diseases is high in victims of rape and that they have a lower but substantial additional risk of acquiring such diseases as a result of the assault.