tbuckley/cabot-search huggingface dataset:
Professionalism in Medicine: Can Patients Trust in Managed Care?-Reply
Authors: Mark Schlesinger
Journal: JAMA (1996)

<h3>In Reply.</h3> —Dr La Puma is correct in noting the gap between our vision of how medicine should be practiced and uncomfortable realities. Leaders in medicine have a responsibility to forcefully articulate appropriate norms and use their leverage to influence practice arrangements and the education of future physicians. We believe our recommendations have more potential (and are more controversial) than La Puma's characterization suggests. We called for disclosure of physician incentive payments and suggested that the Health Care Financing Administration's proposed regulations were too limited, but even these regulations face vigorous opposition. We oppose physician-sponsored health care plans because they further confuse conflicting interests between plan financing and organization and physicians' responsibilities to their patients. Even more important, we believe that the profession of medicine must use its educational and regulatory opportunities to reaffirm repeatedly its commitment to full and open communication with patients and speak vigorously in support of this ethic.
Internet-Guided Self-Help with or without Exposure Therapy for Phobic and Panic Disorders
Authors: Andreas J. Schneider, David Mataix-Cols, Isaac M. Marks, Martin Bachofen
Journal: Psychotherapy and Psychosomatics (2005)

&lt;i&gt;Background:&lt;/i&gt; As many sufferers from phobic and panic (phobia/panic) disorders cannot get to suitable therapists, routine aspects of therapy were delegated to internet-accessed computer-aided self-help with or without exposure instructions. &lt;i&gt;Methods:&lt;/i&gt; Phobia/panic referrals were randomised to computer-aided self-help via the internet at home in a 2:1 ratio either by self-exposure cognitive behaviour therapy (CBT) [&lt;i&gt;FearFighter (FF),&lt;/i&gt; n = 45] or by minimal CBT without exposure [&lt;i&gt;Managing Anxiety (MA),&lt;/i&gt; n = 23]. All had brief backup phone advice from a clinician concerning their computer guidance. &lt;i&gt;Results:&lt;/i&gt; On self-ratings and blinded assessor ratings, patients improved equally with each form of self-help over 10 treatment weeks but significantly more on 5 out of 10 measures by week 14 (1-month follow-up) when the self-help included self-exposure instructions than when it did not. In accord with this, standardised effect sizes (Cohen’s d) indicated superiority of &lt;i&gt;FF&lt;/i&gt; over &lt;i&gt;MA&lt;/i&gt; on 5 measures by week 14. Satisfaction with treatment in all patients pooled correlated positively with improvement after treatment and at 1-month follow-up. &lt;i&gt;Conclusions:&lt;/i&gt; At the end of treatment, computer-aided CBT self-help at home via the internet plus brief live helpline support was effective with or without exposure instructions, and at 1-month follow-up it was more effective on some measures if exposure instructions had been included. Analysis is needed of how non-exposure CBT produced its shorter-term effect.
Endothelial Nitric Oxide Synthase Overexpression Provides a Functionally Relevant Angiogenic Switch in Hibernating Pig Myocardium
Authors: Christian Kupatt, Rabea Hinkel, Marie-Luise von Brühl, Tilmann Pohl, Jan Horstkotte, Philip Raake, Chiraz El Aouni, Eckehard Thein, Stefanie Dimmeler, Olivier Feron, Peter Boekstegers
Journal: Journal of the American College of Cardiology (2007)
I tweet, therefore I am
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2010)

In the past, human beings spoke to each other, now we stoop over handheld devices sending messages to friends and followers around the globe. A colleague in Outer Mongolia will receive a quicker response than your wife on the next sofa. First was text messaging which allows a one-to-one conversation, now Twitter enables simultaneous conversations between thousands of friends, or ‘followers’ as Twitter describes them.

For the uninitiated, twitter.com is a website where anybody can set up an online account. The account can be personal or corporate. You can have as many accounts as the number of email addresses you possess. Once set up on Twitter you can broadcast your thoughts or ‘tweets’ to the world, provided that you can stick to a limit of 140 characters. Any one of Twitter's 100 million plus users can read what you have to say. If they are attracted to the inner workings of your mind they might start ‘following’ you, by which they will be automatically updated every time you post a comment. In turn, you can follow others.

What's the point, you might wonder? Well, there are several. You might consider yourself a thought leader in a particular subject. If so, you can pick up a dedicated following that allows you to update your knowledge, share expertise, and exchange views by communicating with your followers. You might wish to remain abreast of a range of topics from the latest announcements from the Department of Health to the latest gossip about your favourite football club. You might have something to sell or market, a product or an idea. You might just be curious about how others live their lives, be they celebrities or the great unwashed. You might simply view it as fun – people make fools of themselves on Twitter every second.

I might not have sold it to you but Twitter is a phenomenon in social media. It has tapped the rich seam of increasing sophistication of mobile devices, which have greater global penetration than personal computers. People want to communicate and others want to listen, but in our busy lives the briefer the conversation the better. The importance of Twitter is such that the United States government has decided to archive every single tweet. This is some undertaking as the number of users and tweets is rising fast.

Inevitably, the JRSM has decided to enter this virtual Aladdin's cave. If you have a Twitter account you can stay informed about the JRSM and our new online open-access journal, JRSM Short Reports. All you need to do is go to http://twitter.com/EditorJRSM and follow my tweets. Both journals have moved to a system of continuous online publication and Twitter is the easiest way to let the world know.
Postal questionnaire study of disability in the community associated with psoriasis
Authors: P. O'Neill, P. Kelly
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To study the disability caused by psoriasis in patients recorded as having psoriasis by their general practitioner. <b>Design</b>: Postal questionnaire survey using the psoriasis disability index and SF-36. <b>Setting</b>: Five general practices in Cleveland. <b>Subjects</b>: Of 767 patients identified, 546 completed the questionnaire and 435 were eligible and gave informed consent. <b>Main outcome measures</b>: Scores on SF-36 and psoriasis disability index. <b>Results</b>: The psoriasis disability index score was highly negatively correlated with all eight of the SF-36 health measures (P&lt;0.0001 for each), and the manual social classes scored higher than the non-manual social classes (P&lt;0.0001). The manual social class group scored significantly lower scores than the controls on all the SF-36 scales, and the non-manual group scored significantly lower for physical and mental role limitation (P&lt;0.0004 and P = 0.026), mental health (P&lt;0.0001), energy and vitality (P&lt;0.0004), and health perception (P&lt;0.0001). Also, the manual group had poorer health perception on five of the SF-36 variables when compared with the non-manual group. <b>Conclusions</b>: Patients with psoriasis have an overall lower perception of their quality of life than healthy controls, and those in the lower social classes suffer a greater degree of disability from their disease than the higher social classes. <h3>Key messages</h3> In this study people with psoriasis had a greater disability than healthy controls These patients did not consult about their skin condition frequently, yet most used some treatment The manual social classes suffer greater disability than non-manual classes The psoriasis disability index may help measure disability in general practice
APPENDICITIS—THE DECREASING INCIDENCE?
Authors: J. D. Martin
Journal: JAMA (1960)

Various reports have implied that there is a decreasing incidence of appendicitis. Palumbo<sup>1</sup>reported a series of 1,600 cases of acute appendicitis from 1947 to 1958. The number seen in 1948 was 252, and only 45 in 1958. There is incomplete evidence, at the present, as to whether this is in reality a fact or only a supposition. During the era from 1939 to 1957, the mortality has shown a steady decline from 9.9 to 1.2 per 100,000.<sup>2</sup> The usually subscribed causes for such an improvement may again be enumerated: increasing awareness of the disease on the part of the public, a better understanding of its natural course, and proper preoperative preparation of the patient, with fluids, electrolytes, blood, and antibiotics. Early operative intervention permits the removal of the diseased organ at a time which should result in the least harmful sequela. However, too many are not being
Position Paper: Ethics Manual
Authors: William E. Golden, Robert B. Doherty
Journal: Annals of Internal Medicine (2005)

Letters18 October 2005Position Paper: Ethics ManualWilliam E. Golden, MD and Robert B. Doherty, BAWilliam E. Golden, MDFrom the ACP Ethics and Human Rights Committee and ACP Governmental Affairs and Public Policy.Search for more papers by this author and Robert B. Doherty, BAFrom the ACP Ethics and Human Rights Committee and ACP Governmental Affairs and Public Policy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-8-200510180-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Rajput for his letter. The author attribution used for the Ethics Manual is the standard form that the ACP uses for all of its position papers. Staff prepared the document in collaboration with the ACP Ethics and Human Rights Committee, whose members served as coauthors of the Manual—hence the listing of Snyder and Leffler as authors for the ACP Ethics and Human Rights Committee.The Ethics Manual is the product of 2 years of dedicated work of the members of the Ethics and Human Rights Committee. The policies in the Manual were discussed, debated, and ... Author, Article, and Disclosure InformationAffiliations: From the ACP Ethics and Human Rights Committee and ACP Governmental Affairs and Public Policy.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEthics Manual Lois Snyder , Cathy Leffler , and Position Paper: Ethics Manual Vijay Rajput Metrics 18 October 2005Volume 143, Issue 8Page: 618KeywordsBioethicsConflicts of interest ePublished: 18 October 2005 Issue Published: 18 October 2005 CopyrightCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Global functions at the World Health Organization
Authors: Jennifer Prah Ruger, Derek Yach
Journal: BMJ (2005)

In New York state, adjusted mortality rates for cardiac surgery have been publicly disseminated since 1990.Although some evidence exists that this programme has resulted in a lower than expected cardiac surgery mortality rate for the state, what is not clear is if public dissemination of the information was necessary.Few patients who have bypass surgery are aware of the publicly available mortality rates of their surgeon or hospital. 4Even when they do know the rates, other factors may be more important.The hospital chosen by Bill Clinton for coronary bypass surgery, for example, had the highest mortality rate for this procedure in New York state in 2001, the most recent results available to Mr Clinton at the time of his surgery. 5For non-cardiac procedures, most hospitals do not have sufficient case loads to compare reliably mortality at the individual hospital (let alone surgeon) level. 6ublication of mortality audits in this setting serves little purpose-other than, perhaps, to create a false sense of doing something to improve quality.In fact, the underlying assumption of report card programmes may be misguided; clinically significant errors are committed at all institutions and by all surgeons, not just by the outliers with poor results.To build a framework for trust, the development and systematic adoption of effective methods to minimise errors for every patient must be a priority of the entire surgical community.
Challenging Behaviour: Analysis and Intervention in People with Learning Difficulties
Authors: A. H Reid
Journal: BMJ (1996)

Eric Emerson Cambridge University Press, pounds sterling19.95, pp 233 ISBN 0 521 40665 X

The term “challenging behaviour” is a product of the 1980s and of political correctness. As defined by Eric Emerson it is: “Culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit the use of, or result in the person being denied access to, ordinary community facilities.” In the context …
Familial Hepatoma with Hepatitis-Associated Antigen
Authors: EDWARD K. DENISON
Journal: Annals of Internal Medicine (1971)

Two adult male siblings died of primary hepatocellular carcinoma. Both had macronodular cirrhosis with features of subacute progressive viral hepatitis. The hepatitis-associated antigen was present in the serum of one patient; the death of the other preceded the clinical use of this test. The father of these two men died 23 years ago, and his death was attributed to primary hepatocellular carcinoma. Chronic infection with the hepatitis virus and impaired immunity of genetic determination are likely factors in the disease of these family members.
Ninth Biannual Report of the Cochrane Haematological Malignancies Group--Focus on Hematopoietic Growth Factors
Authors: N. Skoetz, O. Weingart, I. Monsef, K. Bauer, C. Brillant, C. Herbst, S. Kluge, A. Engert
Journal: JNCI Journal of the National Cancer Institute (2009)
Sodium uptake across basolateral membrane of rat distal colon. Evidence for Na-H exchange and Na-anion cotransport.
Authors: V M Rajendran, M Oesterlin, H J Binder
Journal: Journal of Clinical Investigation (1991)

This study sought to characterize the mechanism of Na transport across basolateral membrane vesicles of rat distal colon. Both an outward proton gradient and an inward bicarbonate gradient stimulated 22Na uptake. Proton gradient-stimulated 22Na uptake was activated severalfold by the additional presence of an inward bicarbonate gradient, and bicarbonate gradient-stimulated 22Na uptake was significantly enhanced by an imposed intravesicular membrane positive potential. 0.1 mM amiloride inhibited both proton gradient- and bicarbonate gradient-stimulated 22Na uptake by 80 and 95%, respectively, while 1 mM 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) inhibited both proton gradient- and bicarbonate gradient-stimulated 22Na uptake by 40 and 80%, respectively. Both proton gradient- and bicarbonate gradient-stimulated 22Na uptake saturated as a function of increasing Na concentration: the apparent kinetic constants (Km) for Na for the DIDS-insensitive component of proton gradient-stimulated 22Na uptake was 46.4 mM, while the DIDS-sensitive component of proton gradient- and bicarbonate gradient-stimulated 22Na uptake had Km for Na of 8.1 and 6.4 mM, respectively. Amiloride inhibited both DIDS-insensitive proton gradient- and bicarbonate gradient-stimulated 22Na uptake with an inhibitory constant (Ki) of approximately 35 and 1 microM, respectively. We conclude from these results that proton gradient-stimulated 22Na uptake represents both DIDS-insensitive Na-H exchange and DIDS-sensitive electrogenic Na-OH cotransport, and that the DIDS-sensitive component of proton gradient-stimulated 22Na uptake and bicarbonate gradient-stimulated 22Na uptake may represent the same electrogenic Na-anion cotransport process.
Medicine: Its Young Practitioners and Future Advances
Authors: J. Y. Simpson
Journal: BMJ (1868)

indications for stimulants, which are usually considered to be such, and at one time I was in the habit of administenng ammonia, wine, and brandy accordingly.I have abstained from giving them, and had more recoveries, therefore the weakness of the patient is no test for their use.I have had cases of pneumonia, in which I could say nothing against the propriety of giving stimutlants, by considering alone the want of power of the patient; nevertheless, I have been more than satisfied by a persevering effort to withhold tlhcm; on the other hand, I have had no reason to regret an universal order for brandy and wine in all cases of erysipelas.Let me say, finally, there is often more knowledge of the effects of remedies evinced by the man who may consider it judicious in a particular case to do nothing, than there is shewn by him whose only resources are those which tend to ' keep up' the patient.The latter may believe in physic, but knows notliing of its operation.
Hookworm Disease in Immigrants
Authors: S. N. Salem, S. C. Truelove
Journal: BMJ (1964)

Hookworm disease is an important cause of ill-health in many tropical and subtropical countries, especially when conditions are insanitary.It may also occur in mining communities in Europe if there is a combination of hot moist conditions and poor hygiene (Adams and Maegraith, 1960).The disease causes iron-deficiency anaemia because of loss of blood.The worm attaches itself to the mucosa of the small intestine and sucks the blood of the human host, passing it through its own lumen into the lumen of the gut.In addition, there is oozing of blood from the sites of attachment of the worm.The average loss of blood is about 0.3 ml. per worm per day.It is obvious that if the infestation is heavy, with hundreds of worms present, the loss of blood is considerable (Foy and Kondi, 1960Kondi, , 1961)).There may also be gastro- intestinal symptoms, which sometimes occur even when there is no anaemia.Symptoms resembling those of chronic peptic ulcer are comparatively common.Until quite recently, hookworm disease was a rarity in Great Britain.For example, in a review of 5,000 cases of anaemia, French and Isramls (1955) had no examples of this condition.The recent flood of immigrants into Great Britain from tropical countries of the Commonwealth means that hookworm disease must enter into the differential diagnosis when a patient presents with anaemia or gastro-intestinal symptoms.We illustrate this contention by describing four cases recently seen by us; in one the presentation was unusual and took the form of haematemesis and melaena, while the others suffered from the usual type of chronic iron-deficiency anaemia.Case 1 An unmarried male Pakistani aged 23, a confectioner by occupation and resident in this country for 16 months, was referred to us because of the rapid onset of dizziness, double vision, and tiredness after an episode of vomiting blood and passing dark stools a week before.His blood had been examined by his general practitioner and was found to show severe anaemia, the haemoglobin value being 5.4 g./100 ml.On 13 July 1963 he was seen by us in the out-patient clinic.He was pale but well built and alert.Examination.-Conjunctivaepale.Tongue and mouth normal.No palpable lymph nodes.Finger-nails normal.No breathlessness and no ankle oedema.Cardiovascular system: pulse 90/min., regular; B.P. 120/60; soft mid-systolic murmur but heart sounds otherwise normal.Lungs clear.Abdomen normal; liver and spleen impalpable; no tender areas.Rectal examination normal.Central nervous system normal.Fundi normal.Blood: haemoglobin 5.4 g./100 ml; P.C.V. 25% ; film: marked hypochromia, increased number of polychromatic cells, and tendency to macrocytosis suggestive of multiple deficiency anaemia; 24% of the white cells were eosinophils.
Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature: The Last Century
Authors: Jennifer Tieman, Ruth Sladek, David Currow
Journal: Journal of Clinical Oncology (2008)

Purpose To objectively quantify the literature and the clinical trial basis for palliative and hospice practice given a perception that its evidence base is not well developed. Methods Using Ovid Medline, the study looked at cumulative and absolute numbers of articles in the general medical literature and the palliative and hospice care literature. The same comparisons were made exploring clinical trials from 1902 to 2005. Data were collated in five year groups from 1970 onward using a highly specific search phrase. Results The proportion of all Ovid Medline publications relating to palliative and hospice care rose from 0.08% in 1970 to 0.38% of the literature in 2005. In the same time, clinical trials increased from 0.96% to 7.22% of the palliative care literature published. By 2005, one in every 122 clinical trials published in the literature as a whole was in palliative or hospice care. The rate of growth in palliative care clinical trials as a proportion of all palliative and hospice publications was on average 1.4 times greater than in the corresponding general literature. More than one half of these studies were reported in just 43 journals, most of which were not specialist palliative and hospice care journals. Discussion Given the diversity of journals in which clinical studies related to hospice and palliative care appear, there is a key challenge for clinicians in finding ways that will allow currency of practice in a broad and rapidly changing field.
Duration of abnormal SPECT myocardial perfusion imaging following resolution of acute ischemia: an angioplasty model
Authors: Daniel B Fram, Rabih R Azar, Alan W Ahlberg, Linda D Gillam, Joseph F Mitchel, Francis J Kiernan, Jeffrey A Hirst, Jeffrey F Mather, Edward Ficaro, Gizelle Cyr, David Waters, Gary V Heller
Journal: Journal of the American College of Cardiology (2003)
"THE CUNNINGHAM TANK TREATMENT"
Authors: Franklin C. McLean
Journal: JAMA (1928)

<h3>To the Editor:</h3> —With reference to the report on the Cunningham "Tank Treatment" (The Journal, May 5, p. 1494), two additional points should be made for the sake of completeness. 1. The treatment is not new. Similar installations have been in use over a period of some years in some of the German watering places, and the method is still in use, on a moderately large scale, at Bad Reichenhall. It should be observed, however, that such claims as are now made for the treatment at Bad Reichenhall are limited to the effect of increased atmospheric pressure in bronchial asthma, that no claim is made that the method influences the oxygen supply to the tissues, and that even in bronchial asthma the claims made for the efficacy of the treatment are only poorly supported by any clinical or scientific evidence. In addition to the installation at Bad Reichenhall there is