tbuckley/cabot-search huggingface dataset:
Withdrawal of life sustaining treatment
Authors: T. Sensky
Journal: BMJ (2002)

Ms B, as she was called in court and in the media, was a 43 year old professional woman who in 1999 had a haemorrhage in a cavernous haemangioma in her upper spinal cord. After an almost complete recovery she had a re-bleed in February 2001, which rendered her quadriplegic and dependent on artificial ventilation. Specialists who reviewed her all agreed that she had a negligible chance of substantial recovery, and she was advised to consider specialist rehabilitation. Ms B went to great lengths to gather information about her prognosis. She remained adamant that living on a ventilator would be intolerable to her because of the level of dependence on others and the lack of control over her own body she would have, and she requested to have her ventilation discontinued. The clinicians treating her felt unable to carry out her wishes, and Ms B eventually took to court the NHS Trust treating her.

Dame Elizabeth Butler-Sloss judged that Ms B was indeed competent to decide on her treatment, and therefore her decisions about her treatment, whatever they were, must be respected.1 The judgment reviewed precedents for this, including the judge's own previous statement that “a mentally competent patient has an absolute right to refuse …
Myeloma and benign intracranial hypertension: Author's reply
Authors: D. Cunningham
Journal: BMJ (1992)

control.The indicators of prostaglandin metabolism are related to the HbAI concentrations- namely, to the different stages of diabetic control.It is reasonable to suppose that the uncontrolled diabetic state and the shift in the balance of two antagonistic prostaglandins towards pathogenic direction might have a role in diabetic microangiopathy.Our observations support the authors' opinion.
Communicating Benefits and Harms of Treatment
Authors: David A. Nardone
Journal: Annals of Internal Medicine (2011)

Letters6 December 2011Communicating Benefits and Harms of TreatmentDavid A. Nardone, MD (Retired)David A. Nardone, MD (Retired)From VHA Medical Center and Oregon Health & Sciences University, Hillsboro, OR 97124-5094.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-11-201112060-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:After reading the article by Woloshin and Schwartz (1) on communicating risk, I reviewed a similar publication by the same authors (2). I do not disagree with the findings of either study, but I do believe that there is a problem with the choice of methods used to present scenarios to patients. The key is to use concrete and personalized images that give meaning to abstract concepts of benefit and harm (3).Begin with using an appropriate frame of reference. If the denominator is 100, use the number of U.S. senators. If 1000, cite the number of ...References1. Woloshin S, Schwartz LM. Communicating data about the benefits and harms of treatment: a randomized trial. Ann Intern Med. 2011;155:87-96. [PMID: 21768582] LinkGoogle Scholar2. Woloshin S, Schwartz LM, Welch HG. The effectiveness of a primer to help people understand risk: two randomized trials in distinct populations. Ann Intern Med. 2007;146:256-65. [PMID: 17310049] LinkGoogle Scholar3. Covello VT, Sandman PM, Slovic P. Risk Communication, Risk Statistics, and Risk Comparisons: A Manual for Plant Managers. Washington, DC: Chemical Manufacturers Association; 1988:15. Google Scholar Author, Article, and Disclosure InformationAffiliations: From VHA Medical Center and Oregon Health & Sciences University, Hillsboro, OR 97124-5094.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effectiveness of a Primer to Help People Understand Risk Steven Woloshin , Lisa M. Schwartz , and H. Gilbert Welch Communicating Data About the Benefits and Harms of Treatment Steven Woloshin and Lisa M. Schwartz Communicating Benefits and Harms of Treatment Steven Woloshin and Lisa M. Schwartz Metrics 6 December 2011Volume 155, Issue 11Page: 793KeywordsConflicts of interestGamesMyocardial infarction ePublished: 6 December 2011 Issue Published: 6 December 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
More than half of drugs sold online are fake or substandard
Authors: S. Mayor
Journal: BMJ (2008)

More than 60% of drugs sold by online pharmacies are counterfeit or substandard, a report published today says.

Researchers from the European Alliance for Access to Safe Medicines ordered a range of prescription only drugs from 100 websites. The online pharmacies were chosen on the basis of factors likely to appeal to the general public, such as good use of English, apparent access to a pharmacist, and provision of a phone contact.

Their analysis showed that 62% of the drugs bought online were substandard or counterfeit and that only 38% were genuine branded drugs. Moreover, 16% of the branded drugs were illegal imports from outside the European Union, and 33% had no information leaflet in the pack delivered to the …
On Human Papillomaviruses
Authors: Peter M. Howley
Journal: New England Journal of Medicine (1986)

Even Lewis Thomas, who concluded his essay "On Warts" by proposing a National Institute of Warts,1 did not envisage the recent explosion in papillomavirus research or anticipate the compelling association of these viruses with certain human cancers. The viral nature of human warts was first suggested in 1907 by Ciuffo, who demonstrated their transmission by cell-free filtrates.2 Shope first described the papillomavirus as the etiologic agent of infectious papillomatosis of rabbits in 1933.3 Subsequent studies by Rous established that benign rabbit papillomas could advance to become malignant squamous-cell carcinomas and that specific nonviral cofactors (i.e., coal tar or methylcholanthrene) could . . .
Zinc Interference With Copper Metabolism
Authors: Harold H. Sandstead
Journal: JAMA (1978)

Elsewhere in this issue ofThe Journal, Prasad et al (p 2166) describe a manifestation of the toxic effects of zinc in humans that has not been generally appreciated. They report the occurrence of copper deficiency (hypocupremia, leukopenia, and anemia) in a patient treated with ten times the recommended dietary allowance for zinc<sup>1</sup>during a prolonged interval. In other patients given similar therapy, they found decreased levels of plasma copper and ceruloplasmin. Their observations were consistent with other recent reports.<sup>2</sup> It has long been known from studies in animals that high levels of zinc can interfere with metabolism and absorption of copper.<sup>3</sup>Zinc will induce the synthesis of metallothein.<sup>4</sup>Metallothein may regulate the amounts of zinc and copper absorbed into the body from intestinal epithelial cells in a manner analogous to the regulation of iron absorption by ferritin.<sup>5</sup>At physiological levels, zinc bound to metallothein
Gastric acid suppression and outcomes from clostridium difficile infection: a population-based study
Authors: S. Khanna, S. L. Aronson, P. P. Kammer, D. S. Pardi
Journal: Gut (2011)

<h3>Introduction</h3> Several studies show an increasing incidence and severity of Clostridium difficile infection (CDI). Use of gastric acid suppression medications like proton pump inhibitors (PPI) has been shown to predispose hospitalized patients to CDI. The need for discontinuation of these medications in patients with CDI is controversial. We compared clinical features, treatment and outcomes in a population-based cohort of adult patients with CDI on acid suppression medications to a cohort not on these medications. <h3>Methods</h3> A computerized diagnostic index, capturing all patient encounters for Olmsted county residents, identified adult CDI cases from 1991–2005. ‘Definite’ CDI was defined as positive stool toxin by Enzyme Immune Assay, in patients with diarrhoea (3 or more bowel movements/day), abdominal pain or unexplained leucocytosis. Severe CDI was defined by a white blood cell count more than 15,000/uL or a creatinine rise of greater than 50% from baseline. Recurrent CDI was defined if diagnostic criteria were met within 8 weeks of diagnosis after symptom resolution. Treatment failure was defined as a change in treatment within 14 days due to non-response. <h3>Results</h3> There were 385 definite CDI cases with mean age 60.6 years and 65.5% females. A third of patients (36.3%) were on gastric acid suppression agents (23.3% on PPI, 13.5% on H2 blockers and 0.5% on both). On univariate analysis, patients on gastric acid suppressive medications were significantly older (69 vs 56 years, p &lt; 0.001) and more likely to have severe infection (34.2% vs 23.6%, p = 0.02), compared to patients not on acid suppression. On adjusting for age by logistic regression, there was no difference in risk of severe infection in patients on acid suppression versus not. Initial treatment (metronidazole in 88% cases), treatment failure (18.5% vs 20.3%) and CDI recurrence (26.4% vs 32.5%) were similar in the two groups. <h3>Conclusion</h3> In our population-based cohort, about one third of the patients were on a gastric acid suppression agent. These patients were older, but had similar severity, initial treatment, response and recurrence rates. It might be reasonable to continue these agents in patients with CDI, if clinically indicated. More studies are needed to further study the effect of these drugs in CDI.
Protecting Athletes From Sudden Cardiac Death
Authors: Paul D. Thompson, Benjamin D. Levine
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
VTA CRF neurons mediate the aversive effects of nicotine withdrawal and promote intake escalation
Authors: Taryn E Grieder, Melissa A Herman, Candice Contet, Laura A Tan, Hector Vargas-Perez, Ami Cohen, Michal Chwalek, Geith Maal-Bared, John Freiling, Joel E Schlosburg, Laura Clarke, Elena Crawford, Pascale Koebel, Vez Repunte-Canonigo, Pietro P Sanna, Andrew R Tapper, Marisa Roberto, Brigitte L Kieffer, Paul E Sawchenko, George F Koob, Derek van der Kooy, Olivier George
Journal: Nature Neuroscience (2014)
Methodologic Issues and Approaches to Spatial Epidemiology
Authors: Linda Beale, Juan Jose Abellan, Susan Hodgson, Lars Jarup
Journal: Environmental Health Perspectives (2008)

Spatial epidemiology is increasingly being used to assess health risks associated with environmental hazards. Risk patterns tend to have both a temporal and a spatial component; thus, spatial epidemiology must combine methods from epidemiology, statistics, and geographic information science. Recent statistical advances in spatial epidemiology include the use of smoothing in risk maps to create an interpretable risk surface, the extension of spatial models to incorporate the time dimension, and the combination of individual- and area-level information. Advances in geographic information systems and the growing availability of modeling packages have led to an improvement in exposure assessment. Techniques drawn from geographic information science are being developed to enable the visualization of uncertainty and ensure more meaningful inferences are made from data. When public health concerns related to the environment arise, it is essential to address such anxieties appropriately and in a timely manner. Tools designed to facilitate the investigation process are being developed, although the availability of complete and clean health data, and appropriate exposure data often remain limiting factors.
715 ASSESSMENT OF THE VIROLOGICAL PROFILES OF UNTREATED PATIENTS WITH CHRONIC HEPATITIS DELTA (CHD) REQUIRES LONGITUDINAL MEASUREMENTS OF HBV DNA AND HDV RNA
Authors: G. Brancaccio, A. Madejon, G. Stornaiuolo, G. Cuomo, V. Soriano, G.B. Gaeta
Journal: Journal of Hepatology (2010)
Syndromes of Acute Nonlymphocytic Leukemia
Authors: H. PHILLIP KOEFFLER
Journal: Annals of Internal Medicine (1987)

The marriage of cytogenetics and molecular biology has resulted in major advances in our understanding of acute nonlymphocytic leukemia. These technologies reveal a number of clearly recognizable syndromes of acute nonlymphocytic leukemia. This review describes the salient features of several of these syndromes: acute myelomonocytic leukemia with abnormal eosinophils; acute nonlymphocytic leukemia with 11q abnormalities [biphenotypic leukemia with t(4;11); and acute monocytic leukemia with t(9;11)]; acute nonlymphocytic leukemia with t(8;21); acute promyelocytic leukemia; acute nonlymphocytic leukemia with normal or elevated platelet counts and rearranged 3q21 and 3q26; and acute nonlymphocytic leukemia with increased basophils and t(6;9). The pathogenesis of therapy-related leukemias is discussed also.
Color Doppler ultrasound signals of thoracic lesions. Correlation with resected histologic specimens.
Authors: W H Hsu, J Ikezoe, C Y Chen, P C Kwan, C P Hsu, N Y Hsu, C D Chiang, W L HO
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Sixty-eight patients with thoracic lesions (48 with lung cancer and 20 with benign lesions) underwent color Doppler ultrasound (US) examinations. Of those, 21 patients (13 with lung cancer and eight with benign lesions) also received resections, and the correlation between color Doppler US signals and resected histologic specimens was evaluated. Our results showed that three patterns of color Doppler US signals could be detected and confirmed: pulsatile flow (artery), constant flow, and triphasic flow (pulmonary vein). Among the 48 patients with lung cancer, pulsatile flow, constant flow, and/or triphasic flow were detected in 34 (71%), 24 (50%), and 14 (29%), respectively. Among the 20 patients with benign lesions, only pulsatile flow and/or triphasic flow were detected in nine (45%) and eight (40%), respectively. From the correlation between color Doppler US signals and histologic specimens, constant flow was representative of the true neovascularity of lung cancers, and it was valuable for differentiating lung cancers from benign lesions (p = 0.00008, sensitivity = 0.50, and specificity = 1.0). Although color Doppler US still had some limitations in detecting blood vessels in thoracic lesions, the correlation between the vascularity represented by color Doppler US signals and histologic specimens was excellent. We conclude that color Doppler US is a valuable method for assessing blood flow in thoracic lesions and differentiating lung cancers from intrapulmonary benign lesions.
Case of Cervical Spina Bifida, Successfully Treated by Injection
Authors: J. W. Cousins
Journal: BMJ (1886)

99.59.nMay 15th.The wound was suppurating freely.Pulse 88 ; tem- perature 99'.Mlay 16th.Puilse 80 ; temiiperature 98'.He wvas imiore rational.Mlay 17th.His condition was the same.The edges of the wound were plde anid sodden.May 19th.He was very hungry, eating all day.MLay 20th.His state wvas the same.Pulse 100 * temperature 99'.His imiind was clearer.May 21st.He was not so well; was much quieter.lIe hadl head- ache.Pulse 120 ; temperature 102°.May 22nd.He was better.The wound gaped, exposingo bone.Pulse 86 ; temperature 98'.May 24th.The left arm trembled and twitched.There was coInsiderable loss of co-ordination in the entire limb.May 26th.He was better in every way; and clear mentally.May 30th.The trembling continued.He vomited twice.After this date, all the symptoms steadily improved.Vision gra- dually became normal.The wound healed soundly, all weakness of the left arm disappeared, and the boy made a complete recovery.
Aberrant dendritic cell function conditions Th2‐cell polarization in allergic rhinitis
Authors: C. Pilette, M. R. Jacobson, C. Ratajczak, B. Detry, G. Banfield, J. VanSnick, S. R. Durham, K. T. Nouri‐Aria
Journal: Allergy (2013)

Myeloid (m) and plasmacytoid (p) dendritic cells (DCs) regulate immune responses to allergens, whereas it remains unclear whether abnormal DC function characterizes patients with airway allergy and whether putative dysfunction exists only in target organs. To evaluate DC function from patients with allergic rhinitis (AR), we assessed nasal, cutaneous as well as blood DCs after in vivo and in vitro allergen challenge, respectively.DCs were immunostained in nasal and skin tissues, and cytokine expression was assessed by dual immunofluorescence. Cytokine production and regulation of cocultured peripheral CD4+ T cells were assayed by ELISA.In AR patients, local allergen challenge resulted in increases in pDC and mDC numbers at 8 h in the nasal mucosa and at 8-48 h in the skin. Defects in IL-10 and IFN-α were observed in both organs from AR. Blood mDCs from AR exhibited reduced IL-10 and IL-12 expression. The capacity of activated pDCs from AR to produce IFN-α and to trigger IL-10 by allogeneic CD4(+) T cells was diminished, whereas mDCs from these patients supported Th2- and Th17-cell differentiation.In allergic rhinitis, DCs are altered not only locally but also in the systemic circulation. mDCs and pDCs increased in airway and skin tissues exposed to the allergen and displayed reduced production of IL-10 and 'type 1 signals' (IL-12, IFN-α) both locally and in blood. Functional studies showed that this results in preferential Th2/Th17-cell polarization and impaired generation by blood DCs of IL-10+ T cells, linking systemic DC dysfunction and biased T-cell responses.
Population screening for hemochromatosis: A comparison of unbound iron-binding capacity, transferrin saturation, and C282Y genotyping in 5,211 voluntary blood donors
Authors: Paul C. Adams, Ann E. Kertesz, Christine E. McLaren, Robert Barr, Anthony Bamford, Subrata Chakrabarti
Journal: Hepatology (2000)

Early diagnosis and treatment of hemochromatosis is essential to prevent organ damage. Screening strategies to detect early hemochromatosis include testing for iron overload and/or genetic testing. Voluntary blood donors numbering 5,211 were screened with unbound iron-binding capacity (UIBC), transferrin saturation (TS), and genetic testing for the C282Y mutation of the HFE gene. The study found 16 C282Y homozygotes (1 in 327), 69 compound heterozygotes, 371 simple heterozygotes, and 4,755 normals. There were 5 men and 11 women homozygotes with a mean age of 42, range 28 to 57. Mean UIBC (24 +/- 7 microL) and TS (48% +/- 17%) in homozygotes were significantly different from compound heterozygotes, simple heterozygotes, and normals (ANOVA). Only 3 homozygotes had an elevated serum ferritin. Family studies found an additional 4 iron-loaded homozygotes. Optimal thresholds were < or =28 micromol/L for UIBC and > or =46% for TS. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for UIBC of 0.93 (0. 85-1.0, 95% confidence interval), and for TS of 0.83 (0.7-0.95). Screening with UIBC to preselect those for genotyping is a cost-efficient strategy for population screening for hemochromatosis.
Relationship of TIMI Myocardial Perfusion Grade to Mortality After Administration of Thrombolytic Drugs
Authors: C. Michael Gibson, Christopher P. Cannon, Sabina A. Murphy, Kathryn A. Ryan, Rebecca Mesley, Susan J. Marble, Carolyn H. McCabe, Frans Van de Werf, Eugene Braunwald
Journal: Circulation (2000)

Although improved epicardial blood flow (as assessed with either TIMI flow grades or TIMI frame count) has been related to reduced mortality after administration of thrombolytic drugs, the relationship of myocardial perfusion (as assessed on the coronary arteriogram) to mortality has not been examined.A new, simple angiographic method, the TIMI myocardial perfusion (TMP) grade, was used to assess the filling and clearance of contrast in the myocardium in 762 patients in the TIMI (Thrombolysis In Myocardial Infarction) 10B trial, and its relationship to mortality was examined. TMP grade 0 was defined as no apparent tissue-level perfusion (no ground-glass appearance of blush or opacification of the myocardium) in the distribution of the culprit artery; TMP grade 1 indicates presence of myocardial blush but no clearance from the microvasculature (blush or a stain was present on the next injection); TMP grade 2 blush clears slowly (blush is strongly persistent and diminishes minimally or not at all during 3 cardiac cycles of the washout phase); and TMP grade 3 indicates that blush begins to clear during washout (blush is minimally persistent after 3 cardiac cycles of washout). There was a mortality gradient across the TMP grades, with mortality lowest in those patients with TMP grade 3 (2.0%), intermediate in TMP grade 2 (4.4%), and highest in TMP grades 0 and 1 (6.0%; 3-way P=0.05). Even among patients with TIMI grade 3 flow in the epicardial artery, the TMP grades allowed further risk stratification of 30-day mortality: 0.73% for TMP grade 3; 2.9% for TMP grade 2; 5.0% for TMP grade 0 or 1 (P=0.03 for TMP grade 3 versus grades 0, 1, and 2; 3-way P=0.066). TMP grade 3 flow was a multivariate correlate of 30-day mortality (OR 0.35, 95% CI 0.12 to 1.02, P=0.054) in a multivariate model that adjusted for the presence of TIMI 3 flow (P=NS), the corrected TIMI frame count (OR 1.02, P=0.06), the presence of an anterior myocardial infarction (OR 2.3, P=0.03), pulse rate on admission (P=NS), female sex (P=NS), and age (OR 1.1, P<0.001).Impaired perfusion of the myocardium on coronary arteriography by use of the TMP grade is related to a higher risk of mortality after administration of thrombolytic drugs that is independent of flow in the epicardial artery. Patients with both normal epicardial flow (TIMI grade 3 flow) and normal tissue level perfusion (TMP grade 3) have an extremely low risk of mortality.
RACIAL DIFFERENCES IN PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY: FINDINGS FROM THE PROSE-ICD STUDY
Authors: Robert Kennedy, Yiyi Zhang, Sameer Gafoor, Mansour Mehdi, Bharat Singh, Darshan Dalal, Barbara Butcher, Manish H. Shah, Eric Bukata, Joseph E. Marine, David D. Spragg, Sunil K. Sinha, Ronald D. Berger, Hugh Calkins, Robert G. Weiss, Eliseo Guallar, Gordon F. Tomaselli, Alan Cheng
Journal: Journal of the American College of Cardiology (2010)