tbuckley/cabot-search huggingface dataset:
Do GPs deserve their pay rise?
Authors: Graham Wheatley
Journal: BMJ (2005)

Editor—Timmins' article on general practitioners' recent pay rise voiced the common view that if targets are exceeded then they were undoubtedly too easy.1

Since 1997 funding for the hospital sector has grown quickly, with general practice funding becoming a successively smaller proportion of NHS spending. During this time, hospitals have been adept at transferring responsibility for chronic disease management and follow-ups to general practice, with no corresponding transfer of funding. Now, when general practice has the opportunity to receive funding for this work, under a far more stringent and detailed performance management framework than has ever been accepted elsewhere in the NHS, the idea that success in this framework might be due to good organisation, teamwork, and hard work is simply not considered.

A further misconception is that the relation between this funding for additional work and pay rises for general practitioners is simple. Practices have invested (often heavily) in additional staff in the knowledge that funding would only be forthcoming if the targets were reached. This degree of personal business risk taking is almost unknown elsewhere in the NHS, or in the workplaces of the health economists quoted.

The idea of giving groups of clinicians extensive control over budgets and teamworking, carrying personal financial risk but also the possibility of reward for success, is not new or unique to British general practice. It lies behind the success of the Kaiser Permanente health maintainance organisation in the US. Many NHS managers visited California to see Kaiser Permanente, but few if any subsequently seem to have recognised or valued the same features in British general practice.​practice.




Figure 1



Credit: DAILY EXPRESS 27 SEPT




So, why not be a bit more upbeat about how well at least one part of the NHS can perform in a framework of 146 separate targets, if allowed modest but adequate funding support?
THE CIRCULATION OF ARSENIC IN THE CEREBROSPINAL FLUID
Authors: JOHN B. RIEGER
Journal: JAMA (1918)

The infrequency with which arsenic has been found in the cerebrospinal fluid, following the intravenous injection of arsphenamin, forces the conclusion that this dye does not as a rule pass from the blood into the cerebrospinal spaces. Barbat<sup>1</sup>believes that the transition is aided by drainage of the lumbar cistern shortly after the injection. By this technic, he was able at the end of twenty-four hours to demonstrate 0.25 part of arsenic per million in twenty-three fluids of twenty-six examined. His deduction, however, is vitiated by the fact that, as early as twenty minutes after the intravenous injection, and unaided by the auxiliary puncture, 42 per cent. of the fluids examined showed 0.20 part of arsenic per million, which is practically as much as was found in twenty-four hours. The results reported in Table 1 are based on an examination of 123 cerebrospinal fluids collected from random neurosyphilitic patients,
Medical Management of Peripheral Arterial Disease
Authors: Thomas E. Finucane
Journal: JAMA (2006)

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
Diagnosis and Treatment of Ejaculatory Duct Obstruction in Male Infertility
Authors: Ya&scedil;ar &Ouml;zg&ouml;k, Ya&scedil;ar &Ouml;zg&ouml;k, &Ouml;zg&uuml;r Tan, &Ouml;zg&uuml;r Tan, Mete Kilciler, Mete Kilciler, L&uuml;fti Tahmaz, L&uuml;fti Tahmaz, Yusuf Kibar, Yusuf Kibar
Journal: European Urology (2001)
Variability of the plateau response to methacholine in subjects without respiratory symptoms.
Authors: M D Lougheed, G Pearce-Pinto, N H de Klerk, G Ryan, A W Musk, A James
Journal: Thorax (1993)

Interpretation of measurements of limited maximal airway narrowing, or plateau response, requires knowledge of its variability within subjects and between methods.The repeatability of the plateau response to inhaled methacholine with a dosimeter (D) method (maximal dose 210 mumol) and a tidal breathing (T) method (730 mumol), and the agreement of the two methods, were measured in 16 subjects with mild or no asthma. Two tests by each method (D1,D2,T1,T2) were performed in random order over four consecutive days, with a third dosimeter (D3) test one week later. The dose producing a decrease in forced expiratory volume in one second (FEV1) of 10% (PD10) and the plateau were calculated from each dose-response curve.A plateau was reached in all five tests in 12 subjects and in all tests except D3 in 14 subjects. PD10 was inversely related to the plateau (r = -0.95 for D, r = -0.77 for T). The 95% ranges for differences between two determinations of the plateau in a subject were +/- 11.9% (change in FEV1), +/- 19.2%, and +/- 20.3%, estimated from D1-2 and 1-3, and T1-2 tests, respectively. From the same tests the 95% ranges for the difference of a single determination from an individual's true mean value were +/- 8.3%, +/- 13.6%, and +/- 14.3%. The limits of agreement between methods indicated that 95% of the measurements of the plateau by tidal breathing ranged from 15.2% below to 13.3% above those obtained by dosimeter. There was no significant bias between methods. Tachyphylaxis over 24 hours occurred with PD10 but not with the plateau response.The plateau response is a subject characteristic which is independent of the method of inhalation challenge testing. Repeatability of the plateau is low in this group of subjects with low airway responsiveness.
Evidence for Elevated IL-6 and its Signaling Components in Chronic Rhinosinusitis with Nasal Polyps
Authors: A.T. Peters, B. Tancowny, L. Suh, M. Agashe, K. Harris, D. Conley, R. Kern, L. Grammer, R. Schleimer
Journal: Journal of Allergy and Clinical Immunology (2007)
Adenocarcinoma Arising from an Ectopic Pancreas in the Stomach
Authors: H. Y. Jeong, H. W. Yang, S. W. Seo, J. K. Seong, B. K. Na, B. S. Lee, G. S. Song, H. S. Park, H. Y. Lee
Journal: Endoscopy (2002)

Ectopic pancreas is rare, being found in between 0.6 % and 15 % at autopsy. Heterotopic pancreas is usually an asymptomatic condition which is found incidentally at surgery or at autopsy. Occasionally, significant symptoms arise from complications, such as recurrent upper gastrointestinal bleeding, biliary or intestinal obstruction, or malignant degeneration. Malignant change is very rare. We report a case of malignant change (adenocarcinoma) in an ectopic pancreas in the stomach. In the literature, there are eight reported cases of malignant change in ectopic gastric pancreas. The prognosis in the other reported cases is unknown, but in our patient, the tumor was confined to the muscle of the stomach and there was no lymph node invasion.
Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial
Authors: Bronagh Walsh, Andrea Steiner, Ruth M Pickering, Jilly Ward-Basu
Journal: BMJ (2005)

<h3>Abstract</h3> <b>Objective</b> To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients. <b>Design</b> Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial. <b>Setting</b> Nurse led unit and acute general medical wards in large, urban, UK teaching hospital. <b>Participants</b> 238 patients. <b>Outcome measure</b> Costs to acute hospital trusts and to the NHS over six months. <b>Results</b> On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care £7892 ($14 970; €11 503), standard care £4810, difference £3082 (95% confidence interval £1161 to £5002)). During the readmission period, costs were similar (nurse led care £1444, standard care £1879, difference -£435, -£1406 to £536). Total costs at six months were significantly higher (nurse led care £10 529, standard care £7819, difference £2710, £518 to £4903). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant. <b>Conclusion</b> Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.
Parental Diabetes and the Child
Authors: James W. Farquhar
Journal: New England Journal of Medicine (1969)

Everyone knows that diabetes mellitus is strongly familial but the mode of inheritance is still a matter for speculation.1 Is it wholly genetic? What is the role of environment, in particular the prenatal environment, when the mother is diabetic? This environmental factor may possibly create pancreatic islet changes that are still functional two years later.2 According to White3 (1959) nine of every 100 children born to diabetic mothers are already diabetic by adolescence, and a further 14 have "chemical diabetes," by which is meant offspring without a previous record of blood glucose abnormality who are shown to have definitely impaired . . .
Safety Levels of Oxygen Flows
Authors: Alvan L. Barach
Journal: JAMA (1967)

<h3>To the Editor:—</h3> In a recent editorial on the dangers of administering high concentrations of oxygen (<b>199</b>: 494, 1967), no mention was made that low flow rates of oxygen are not only lifesaving, but safe. Too many deaths occur because oxygen is withheld from severely ill patients with pulmonary emphysema. Cherniak and Hakimpour recently presented inThe Journal(<b>199</b>: 178, 1967) their studies revealing the safety of low flow rates of oxygen. At the same time, Cullen had a similar paper in the<i>American Review of Respiratory Disease</i>(<b>95</b>: 116, 1967). Simpson in England specifically states that since he has used low flow rates of oxygen with a graded increase in the oxygen concentration, he has not encountered ill effects. I have employed this procedure since 1938 and have never seen coma or adverse effects from its use. Naturally, it is disturbing to see reference to one side of a
Abstract 3492: γ-secretase inhibitor PF-03084014 diminishes the tumor-initiating cells and demonstrates synergy with docetaxel in breast cancer xenograft models
Authors: Cathy C. Zhang, Zhengming Yan, Qing Zong, Douglas Fang, Cory Painter, Qin Zhang, Adam Pavlicek, Maruja E Lira, Annette John-Baptiste, James Christensen
Journal: Cancer Research (2012)

Abstract Notch signaling is known to be a survival pathway for tumor-initiating cells. In this report, we demonstrate that the γ-secretase inhibitor PF-03084014 significantly enhances the antitumor activity of docetaxel in multiple xenograft models of triple-negative breast cancer. Mechanistic evaluation revealed that PF-03084014 perturbs the Notch signaling pathway and suppresses the function of tumor initiating cells (TIC). In MDA-MB-231Luc model, treatment of docetaxel led to a significant increase of CD133+/CD44+ and ALDH+ subpopulations by FACS analysis. In combination with PF-03084014, these two unique cell subpopulations were significantly diminished. Correspondingly, the functional analyses by tumor re-implant and mammosphere-forming efficiency assays revealed that docetaxel-therapy promoted the tumor initiating capability of the remaining cells, in which an increased stem cell property and Notch pathway activation were observed through gene signature changes. In contrast, PF-03084014 co-treatment with docetaxel substantially hampered the self-renewal ability of these cells. Notch target gene analysis demonstrated the biological relevance of PF-03084014-induced activity. To characterize the function of CD133+/CD44+ subpopulation, MDA-MB-231Luc tumors were de-bulked by the treatment with docetaxel. Subsequently, the CD133+/CD44+ and CD133-/CD44- subpopulatons were isolated and re-implanted in SCID-bg mice using a limiting dilution approach. The results showed that CD133+/CD44+ cells gave rise to tumors with a 100 % take rate (10/10), whereas CD133-/CD44- cells were not tumorgenic (0/10). In addition, CD133+/CD44+ cells exhibited much higher tumorigenicity compared with the respective adherent parental cell line. PF-03084014 treatment caused a significant delay of CD133+/CD44+ tumor growth. The ability of PF-03084014 to suppress TICs was also observed in other breast cancer xenografts, including patient derived models. This data suggests that anti-TIC is one of the contributing mechanisms for the synergistic activities of PF-03084014 in combination with docetaxel. Our work provides potential therapeutic opportunities for PF-03084014 to improve conventional cytotoxic therapy by inhibiting Notch signaling in tumor-initiating cells and other bulk tumor cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3492. doi:1538-7445.AM2012-3492
Abstract 2929: HIF is necessary, but not sufficient for the hypoxia response.
Authors: Cheng-Jun Hu, Matthew Pawlus, Johnny Sena, Liyi Wang
Journal: Cancer Research (2013)

Abstract Hypoxia is a common characteristic of many solid tumors. Hypoxia inducible factor HIF1α and HIF2α have been shown to drive malignant progression by activating genes involved in angiogenesis, proliferation, anaerobic metabolism, and other processes that enable tumor cells to survive or to escape their O2-deficient microenvironments. While the major players in the hypoxia-mediated HIFα protein stability and the functions of HIF1α/ARNT and HIF2c/ARNT proteins in activating hypoxia-inducible genes are well established, the role of other transcription factors and how HIF regulates its target genes in the hypoxic transcriptional response are much less understood. We report here that the “Signal Transducer and Activator of Transcription-3” (STAT3) and the basic-helix-loop-helix-leucine-zip transcription factor, upstream stimulatory factor-2 (USF2) are required for the hypoxic transcriptional response, specifically for hypoxic activation of HIF1 and HIF2 target genes respectively. Mechanistically, STAT3 (or USF2) activates HIF1 (or HIF2) target genes by binding to HIF1 (or HIF2) target gene promoters, interacting with HIF1α (or HIF2α) protein and recruiting co-activators CBP and p300 to form enhanceosome complexes that contain HIFα, USF2, CBP, p300 and RNA Pol II on HIF target gene promoters. Interestingly, we found that HIF1α/ARNT and HIF2α/ARNT activate their target genes by recruiting Brm/Brg-1 SWI/SNF complexes to remodel HIF target gene promoter and thus increase HIF target gene activation. These studies established additional players in hypoxic transcriptional response post HIFα protein stabilization by hypoxia. In addition, our studies also showed that co-activators USF2/STAT3 and HIF cooperatively promote the hypoxia response by recurring histone acetylases and chromatin remolding complexes respectively. Uncovering the role of STAT3 and USF2 in the hypoxia response established the foundation to specifically inhibit HIF1 or HIF2 activity for solid tumor treatment. Citation Format: Cheng-Jun Hu, Matthew Pawlus, Johnny Sena, Liyi Wang. HIF is necessary, but not sufficient for the hypoxia response. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2929. doi:10.1158/1538-7445.AM2013-2929 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.
Changing Concepts and Practices in the Approach to Diseases of the Digestive Tract
Authors: Chester M. Jones
Journal: New England Journal of Medicine (1956)

ONE hundred and two years ago, at the age of seventy, Gerge Cheyne Shattuck, the elder, died in his house at the corner of Stamford and Cambridge Streets in the West End of Boston. Born in Templeton, the youngest son of Dr. Benjamin Shattuck, he was educated at Dartmouth. He received his M.B. from that institution in 1806, and in 1807 he received his M.D. from the University of Pennsylvania. From Dartmouth he received two honorary degrees — M.D. in 1812 and LL.D. in 1853. Harvard awarded him an honorary A.M. in 1807, the year in which lie began to . . .
Acute renal failure after eating raw fish gall bladder.
Authors: D W Chan, C K Yeung, M K Chan
Journal: BMJ (1985)

Acute renal failure after eating raw fish gall bladder Various fishes are poisonous, the most commonly recognised being ciguatera and scombroid poisoning.'The raw gall bladder of the grass carp (Ctenopharyngodon idellus) has both nephrotoxic and hepatotoxic properties, which are less known. Case reportsCase 1-A 37 year old housewife ate the raw gall bladder of a grass carp and six hours later had central colicky abdominal pain, vomiting, and watery diarrhoea for several hours.She was admitted to hospital three days later because of oliguria.Physical examination showed nothing abnormal except for jaundice.There was no dehydration.Results of investigations were: serum urea concentration 37-5 mmol/l (226 mg/100 ml), creatinine 1350 tumol/l (15-3 mg/100 ml), bilirubin 75 ,umol/l (4-4 mg/l00 ml) (direct 56 Lmol/l; 3-3 mg/100 ml), aspartate aminotransferase (AST) activity
Utility of the SPECT Tc-99m Labeled RBC Blood Pool Scan in the Detection of Hepatic Hemangiomas
Authors: BARRY H. GUZE, RANDALL A. HAWKINS
Journal: Clinical Nuclear Medicine (1989)

The sensitivity of SPECT imaging of hepatic blood pool activity using Tc-99m labeled RBCs was contrasted with magnetic resonance and CT imaging in 22 cases. SPECT is a noninvasive technique with a high sensitivity for the diagnosis of hepatic hemangiomas. It is helpful for clarifying equivocal magnetic resonance imaging results.
Patient Violence and the Clinician
Authors: David I. Joseph
Journal: JAMA (1995)

I strongly encourage all psychiatrists and emergency department physicians to read this concise, timely book. However, even if my review arouses your interest, smart money says that you will pass it by. Denial of the threat posed by some patients and a grandiose conviction that you already know how to assess and manage the violent patient will lead you to assume that you can read this review and not the book itself. In so doing, you will demonstrate the major theme that runs through this collection of 11 papers, written by members of the American Psychiatric Association's Task Force on the Violent Patient. Repeatedly, the authors emphasize how the potent combination of denial and grandiosity results in unfortunate and sometimes lethal outcomes. As stressed in the introduction, most psychiatric patients will never pose a threat to medical personnel, but some will, and to ensure that we are adequately informed and
Purified protein derivative of Mycobacterium tuberculosis and excretory-secretory antigen(s) of Toxocara canis expand in vitro human T cells with stable and opposite (type 1 T helper or type 2 T helper) profile of cytokine production.
Authors: G F Del Prete, M De Carli, C Mastromauro, R Biagiotti, D Macchia, P Falagiani, M Ricci, S Romagnani
Journal: Journal of Clinical Investigation (1991)

A large series of T cell clones (TCC) specific for purified protein derivative (PPD) of Mycobacterium tuberculosis (total 60) or Toxocara canis excretory/secretory (TES) antigen (total 69) were established from the peripheral blood of two healthy individuals and analyzed for their profile of cytokine production in response to stimulation with either the specific antigen or the polyclonal activator phorbol myristate acetate plus anti-CD3 antibody. Under both these experimental conditions, the great majority of PPD-specific TCC secreted IL-2 and IFN-gamma but not, or limited amounts of, IL-4 and IL-5. In contrast, most TES-specific TCC secreted IL-4 and IL-5 but not, or limited amounts of, IL-2 and IFN-gamma. PPD-specific TCC that failed to secrete IL-4 and IL-5, and TES-specific TCC that failed to secrete IL-2 and IFN-gamma, were found to lack transcripts for IL-4 and IL-5, or for IL-2 and IFN-gamma, respectively. During the course of the study, over a 6-mo period, the functional phenotype of both TES- and PPD-specific TCC was repeatedly assessed and remained constant. These data demonstrate that T cells with stable Th1 or Th2 functional pattern exist not only in mice but also in humans and suggest that in the course of natural immunization certain infectious agents preferentially expand T cell subsets with stable and definite profile of cytokine production.
A new method of counting airborne Japanese cedar (<i>Cryptomeria japonica</i>) pollen allergens by immunoblotting
Authors: Y. Takahashi, T. Nagoya, M. Watanabe, S. Inouye, M. Sakaguchi, S. Katagiri
Journal: Allergy (1993)

We have devised a new method of counting pollen allergen particles, modified from the fluorescent immunoblotting technique of Schumacher et al. Airborne Japanese cedar pollen allergens collected on Burkard's sampling tape were transferred onto a nitrocellulose membrane. The membrane was then treated with antiallergen mouse monoclonal antibody conjugated with alkaline phosphatase. Pollen allergens were detected as purple spots on the nitrocellulose membrane after phosphate substrate staining was performed. Pollen allergen particles were visible under a stereoscopic microscope or to the naked eye and could thus be counted easily. This new counting method takes less time than previous methods and requires no special skill.