tbuckley/cabot-search huggingface dataset:
Consultant activity and NHS productivity
Authors: Nick Black
Journal: Journal of the Royal Society of Medicine (2013)

Karen Bloor et al.'s1 recent paper demonstrates that consultant clinical activity, as measured by FCEs, declined from 1999 to 2009 despite improvements in pay in 2003. However, as your correspondent Andrew Will2 correctly pointed out, this measure takes no account of the benefits that might have resulted from the new contract as regards the quality and outcomes of services.

The widely held view that NHS productivity declined during this period has, as the authors acknowledge, been challenged3 and recently the very organization that created this myth has accepted its error. In December 2012, the Office for National Statistics concluded that rather than falling by 0.4% a year, productivity rose by about 0.7% a year.4 As this new estimate still pays scant regard to improvements in the quality of care, it seems likely that productivity really rose even faster. While there is no room for complacency and even greater improvements in productivity are required over the next decade, official recognition that previous claims of falling productivity were inaccurate is welcome. It is important that the National Audit Office5 and the Public Accounts Committee6 are made aware that they were misled and, in turn, misled politicians and the public.
Behavior Modification for Physicians' Practices
Authors: Arthur Schapiro
Journal: Annals of Internal Medicine (1990)

Letters and Corrections1 January 1990Behavior Modification for Physicians' PracticesArthur Schapiro, MD, Maude Ham, MBA, Becky Levan, BAArthur Schapiro, MDSearch for more papers by this author, Maude Ham, MBASearch for more papers by this author, Becky Levan, BASearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-1-77 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:In a recent article(1) on the integrated inpatient management model, Dr. McMahon and colleagues clearly outlined some of the problems facing hospitals in the United States. In addition, they suggested a management and physician participation model to address the problem of cost containment. Although this model shows promise, I believe its success may be limited. On the management side it will be limited to academic institutions that have a "captured" or financially bound medical staff. Most community hospitals have medical staffs comprising privately practicing physicians who represent their own economic entity. I believe it would be difficult...Reference1. McMahonCreightonBernardPittingerKelley LFAWW. The integrated inpatient management model: a new approach to clinical practice. Ann Intern Med. 1989;111:318-26. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Daniel Freeman Memorial Hospital Inglewood, CA 90301 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1990Volume 112, Issue 1Page: 77-77KeywordsBehaviorInpatientsMedical staff Issue Published: 1 January 1990 PDF DownloadLoading ...
James Sinclair Stewart
Authors: J. Stewart, S. Kane
Journal: BMJ (2012)

After Aberdeen Grammar and Mill Hill Schools, and national service in the Royal Army Service Corps in Malaya, James Sinclair Stewart (“Jimmy”) entered Middlesex Hospital Medical School on a classics scholarship, later extended to include anatomy and physiology. While there, he edited the medical school journal.

His junior posts at the Middlesex Hospital included that of deputy resident medical officer, at times taking responsibility for all admissions except obstetrics, including during the Asian flu epidemic of 1957, when his duties included the care of many afflicted nurses.

As a registrar and subsequently senior registrar …
The appropriateness of hysterectomy. A comparison of care in seven health plans. Health Maintenance Organization Quality of Care Consortium
Authors: S. J. Bernstein
Journal: JAMA (1993)

To develop and test a method for comparing the appropriateness of hysterectomy use in different health plans.Retrospective cohort study.Seven managed care organizations.Random sample of all nonemergency, non-oncological hysterectomies performed in the seven managed care organizations over a 1-year period. Patients who were not continuously enrolled in a plan for 2 years prior to their hysterectomy were excluded.Proportion of women undergoing hysterectomy in each plan for inappropriate clinical reasons according to ratings derived from a panel of managed care physicians.Overall, about 16% of women underwent hysterectomy for reasons judged to be clinically inappropriate. Only one plan had significantly more hysterectomies rated inappropriate compared with the group mean (27%, unadjusted). Adjusting for age and race did not affect the rankings of the plans and had little effect on the numeric results.The rates of inappropriate use of hysterectomies are similar to those for other procedures and vary to a small degree among health plans. This information may be useful to purchasers when they consider which health plans to offer their employees.
Amino acid substitutions in the hepatitis C virus core region are the important predictor of hepatocarcinogenesis
Authors: Norio Akuta, Fumitaka Suzuki, Yusuke Kawamura, Hiromi Yatsuji, Hitomi Sezaki, Yoshiyuki Suzuki, Tetsuya Hosaka, Masahiro Kobayashi, Mariko Kobayashi, Yasuji Arase, Kenji Ikeda, Hiromitsu Kumada
Journal: Hepatology (2007)

We showed previously that amino acid (aa) substitutions in hepatitis C virus core region (HCV-CR) are negative predictors of virologic response to pegylated interferon (IFN) plus ribavirin therapy. HCV-CR induces hepatocellular carcinoma in transgenic mice, but the clinical impact is still unclear. To evaluate the impact of aa substitutions in HCV-CR on hepatocarcinogenesis, we performed a follow-up study on 313 noncirrhotic consecutive naïve patients infected with HCV genotype 1b who received IFN monotherapy. The median follow-up was 14.7 years. A sustained virologic response (SVR) after the first IFN was achieved by 65 patients (20.8%) (group A). Of 248 patients (79.2%) of non-SVR after first IFN, 112 (35.8%) did not receive additional IFN (group B), and the remaining 136 (43.5%) received multicourse IFN monotherapy (group C). As a whole, cumulative hepatocarcinogenesis rates in double wild-type (arginine at aa 70/leucine at aa 91) of HCV-CR were significantly lower than those in nondouble wild-type. Multivariate analyses identified 3 parameters (fibrosis stage 3, nondouble wild-type of HCV-CR, and group B) that tended to or significantly influenced hepatocarcinogenesis independently. With regard to hepatocarcinogenesis rates in group C according to HCV-CR and the mean alanine aminotransferase (ALT) during IFN-free period, significantly higher rates were noted in patients of nondouble wild-type with ALT levels of more than 1.5 times the upper limit of normal (25.7%) compared with the others (2.4%). Conclusion: Amino acid substitutions in the HCV-CR are the important predictor of hepatocarcinogenesis. In multicourse IFN therapy to nondouble wild-type, we emphasize the importance of reducing the risk of hepatocarcinogenesis by mean ALT during an IFN-free period below 1.5 times the upper limit of normal.
Abstract CT318: FOLFOXIRI+B-mab showed powerful effect as preoperative chemotherapy for multiple liver metastases of colorectal cancer
Authors: Yasushi Ichikawa, Ayumu Goto, Noritoshi Kobayashi, Motohiko Tokuhisa, Takashi Ishikawa, Atsushi Ishibe, Kazuteru Watanabe, Kazunori Nojiri, Yoshibumi Kumamoto, kazuhisa Takeda, Mitsuyoshi Ota, Hirotoshi Akiyama, Kuniya Tanaka, Itaru Endo
Journal: Cancer Research (2014)

Abstract Background; R0 resection for liver metastases of colorectal cancer is one of the promising treatment to improve prognosis of advanced colorectal cancer. Powerful regimen FOLFOXIRI including 3 cytotoxic drugs; 5FU, irinotecan and oxaliplatin was reported as promising treatment for advanced colorectal cancer (J Clin Oncol 2007; 25: 1670-76). In our department Phase I/II study of FOLFOXIRI+B-mab including fluoroiuracil/oxaliplatin/irinotecan/bevacizumab for advanced liver metastases of colorectal cancer as pre-operative chemotherapy has been conducted now, and Phase II was on going. In this study, we report effect and safety of FOLFOXIRI+B-mab. Methods: The study was designed as a single-arm, open-label phase I/II trial. Phase I was conducted to decide tolerated dose (MTD) of irinotecan and 150 mg/m2 was decided as recommended dose. Patients who are colorectal cancer with 4 or more liver metastases and no other distant metastases are included. The regimen includes bevacizumab; 5 mg/kg, irinotecan; 150 mg/m2, oxaliplatin; 85 mg/m2, l-LV; 200 mg/m2, 5FU; 400 mg/m2 administered on day 1, followed by 5FU; 2400 mg/m2 continuously administered for 46 hours. R0 resection rate of liver metastases as primary endpoint will be evaluated. Results: Currently, 16 patients were enrolled. Two patients dropped out because of grade 3 diarrhea and grade 3 thromboembolism. One patient is waiting for liver resection and R0 resection of liver metastases was performed for 9 patients. In the 14 patients excluding 2 drop out, 13 showed PR and average of reduction rate was 51%. There was no pathological CR in the 9 patients who was performed R0 resection. There was no severe postoperative complication in them. Conclusion: This regimen is safe and shows high PR rate. So, the regimen is effective and improve R0 resection rate for multiple liver metastases of colorectal cancer. Further investigation of this study is still ongoing now. Citation Format: Yasushi Ichikawa, Ayumu Goto, Noritoshi Kobayashi, Motohiko Tokuhisa, Takashi Ishikawa, Atsushi Ishibe, Kazuteru Watanabe, Kazunori Nojiri, Yoshibumi Kumamoto, kazuhisa Takeda, Mitsuyoshi Ota, Hirotoshi Akiyama, Kuniya Tanaka, Itaru Endo. FOLFOXIRI+B-mab showed powerful effect as preoperative chemotherapy for multiple liver metastases of colorectal cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT318. doi:10.1158/1538-7445.AM2014-CT318
Challenges in Inflammatory Bowel Disease, 2nd Edition
Authors: J. Lindsay
Journal: Gut (2007)

Edited by D P Jewell, N J Mortensen, A H Steinhart, J H Pemberton, B F Warren. Published by Blackwell, Oxford, 2006, $129.95 (hardback), pp 400. ISBN 978-1-4051-2234-4

There are many challenges facing a gastroenterologist managing patients with inflammatory bowel disease (IBD), not least keeping up with the pace of research into the genetic and immunological basis of the disease and into novel therapeutic paradigms, which must be weighed against tried and tested treatments. There are many texts that cover all aspects of the aetiology, epidemiology and management of IBD. Those interested in IBD will often find these lengthy books cumbersome to read …
Association of ACE gene polymorphism with arterial stiffness in patients with type 2 diabetes.
Authors: H Taniwaki, T Kawagishi, M Emoto, T Shoji, M Hosoi, K Kogawa, Y Nishizawa, H Morii
Journal: Diabetes Care (1999)

OBJECTIVE: To assess the relationship between the insertion (I)/deletion (D) polymorphism of the ACE gene and arterial distensibility in patients with type 2 diabetes and healthy control subjects. RESEARCH DESIGN AND METHODS: Aortic and carotid arterial distensibility were evaluated by measuring aortic pulse-wave velocity (a-PWV) and carotid stiffness beta using an echo-tracking system in 137 patients with type 2 diabetes and 260 age-matched control subjects. RESULTS: a-PWV and carotid stiffness beta were significantly higher in patients with type 2 diabetes than in age-matched control subjects (P &amp;lt; 0.05). Both stiffness beta and a-PWV were significantly higher in the patients with the II genotype than in those with the DD genotype (P &amp;lt; 0.001). In the control subjects, multiple regression analysis showed that age and decreased HDL cholesterol were independently associated with increased a-PWV (R2 = 0.244, P &amp;lt; 0.0001) and that age, systolic and diastolic blood pressure, and BMI were independently associated with increased carotid stiffness beta (R2 = 0.454, P &amp;lt; 0.0001). In the patients with type 2 diabetes, age, gene dose of the I allele, and systolic and diastolic blood pressure were independently associated with increased a-PWV (R2 = 0.545, P &amp;lt; 0.0001), and age, gene dose of the I allele, and systolic blood pressure were associated with increases in carotid stiffness beta (R2 = 0.314, P &amp;lt; 0.0001). CONCLUSIONS: These results suggested that ACE polymorphism is associated with the impairment of aortic and carotid distensibility in patients with type 2 diabetes.
Tc-99m Ciprofloxacin (Infecton) in Abdominal Tuberculosis
Authors: Bruce K. Adams, Inas Youssef, Shehnaaz Parkar
Journal: Clinical Nuclear Medicine (2006)

A 25-year-old man presented with a 2-month history of night fever, sweating, abdominal pain, and swelling. He tended livestock and frequently consumed unpasteurized milk. Examination revealed wasting and a “doughy” distended abdomen. Ultrasound showed matted loops of bowel and a pelvic fluid collection. An Infecton scan demonstrated abnormal abdominal uptake. A 35-year-old woman was admitted with fever, acute urinary retention, abdominal distension, and progressive weight loss. The patient was wasted and had gross ascites. The right kidney was not seen on a Tc-99m DTPA scan, and there was a scar in the left upper pole. Abnormal abdominal and pelvic activity was seen on Infecton scintigraphy. Both patients had negative chest radiographs and responded dramatically to antitubercular therapy.
Visualization of Renal Angiomyolipoma on F-18 FDG PET/CT
Authors: Robert T. Arnold, Daniel T. Myers
Journal: Clinical Nuclear Medicine (2009)

Focally increased FDG activity in the kidney can present a significant diagnostic dilemma. In the presented case, a 75-year-old woman underwent whole body F-18 FDG PET/CT after diagnosis of recurrent left breast cancer. A solid hypermetabolic mass was found in the left kidney and reported as possible renal cell carcinoma. However, pathologic diagnosis revealed a lipid-poor angiomyolipoma, a rare finding. A literature search revealed only one other similar case. This case highlights the necessity to consider several pitfalls when confronted with a focal hypermetabolic renal lesion, including primary and secondary neoplasms, infectious etiologies, and calyceal diverticulae. Anatomic correlation with CT images is crucial, but does not always allow definitive diagnosis, as in the case of hypermetabolic lipid-poor angiomyolipoma.
478 Mechanism of PXR regulation of bile acid metabolism
Authors: J CHIANG, A CHAKRABARTI, T LI, E OWSLEY, S ZOLLA
Journal: Hepatology (2003)

Geniposide (GE) is one of the major iridoid glycosides isolated from the fruit of Gardenia jasminoides Ellis that has been used to treat hepatic disorders including cholestasis. However, the underlying mechanisms for GE ameliorating the reduction in bile acids accumulation by α-naphthylisothiocyanate (ANIT) remain unclear.The purpose of this study is to characterize the efficacy of GE in regulation of bile acids uptake, synthesis, metabolism, and transport in ANIT-induced rats.Sprague–Dawley rats were orally administrated with vehicle, GE (25, 50, and 100 mg/kg), and ursodeoxycholic acid (UDCA) (60 mg/kg) once daily for seven days. On the fifth day, a single dose of ANIT (75 mg/kg) was administrated via oral gavage. Blood biochemical determination, bile flow rate and liver histopathology were measured to evaluate the protective effect of GE. The mRNA expressions and protein levels of transporters and enzymes involved in bile acids homeostasis were determined by quantitative real-time polymerase chain reaction (PCR) and western blot to study the underlying mechanism of GE against ANIT-induced rats.GE (25, 50, and 100 mg/kg, po) dose-dependently prevented ANIT-induced changes in serum markers for liver injury. GE treatment reduced basolateral bile acids uptake via repression of OATP2 (P<0.05). Bile acids biosynthesis was decreased through down-regulation of CYP7A1, CYP8B1, and CYP27A1 (P<0.05). GE significantly increased canalicular bile acids secretion via BSEP (P<0.05), subsequently stimulating bile flow during cholestasis. GE also markedly enhanced mRNA level of basolateral transporter OSTβ (P<0.01). Bile acids transported to the plasma were cleared into the urine, resulting in down-regulation of plasma bile acids. However, GE did not alter the mRNA levels of CYP3A2, UGT1A1 and SULT2A1. Furthermore, the gene and protein expression analysis demonstrated activation of FXR, PXR, and SHP after GE administration.GE attenuates ANIT-induced hepatotoxicity and cholestasis in rats, due to regulation enzymes and transporters responsible for bile acids homeostasis.
Postprandial Hepatic Lipid Metabolism Requires Signaling through Akt2 Independent of the Transcription Factors FoxA2, FoxO1, and SREBP1c
Authors: Min Wan, Karla F. Leavens, Danish Saleh, Rachael M. Easton, David A. Guertin, Timothy R. Peterson, Klaus H. Kaestner, David M. Sabatini, Morris J. Birnbaum
Journal: Cell Metabolism (2011)
Effects of sleep disorders and fatigue on HIV disease progression in older children and adolescents
Authors: M.E. Paul, P.Y. Brouwers, D.G. Glaze, J.M. Reuben, B. Lee, L.L. Harris, C.A. Kozinetz, M.W. Kline, H.L. Schwarzwald, S.B. Foster, C.D. Jackson, W.T. Shearer
Journal: Journal of Allergy and Clinical Immunology (2005)

RATIONALE: Children with chronic illnesses have sleep disruption, daytime attention deficits, and impulsivity, and altered blood leukocyte subtypes, sleep-regulating hormones, and pro- and anti-inflammatory cytokines. Children with HIV infection exhibit similar sleep disorders and fatigue, but their effects upon HIV disease progression and immunity are unknown. METHODS: A cohort of 30 HIV+ and 30 HIV-exposed children (8-18 yr.) with detailed clinical database was secured for study. Previously validated questionnaires and test instruments (sleep habits, daytime sleepiness, neurocognition) were administered to HIV+ and control children. Blood from these children was activated with phorbol myristate acetate (PMA) or lipopolysaccharide (LPS) to assess tumor necrosis factor-alpha (TNF-a, pro-inflammatory, sleep-inducing cytokine) and interleukin-10 (IL-10, anti-inflammatory, sleep-inhibiting cytokine) expression in activated T cells to determine the relationship between sleep disturbance, fatigue, and cytokines levels. RESULTS: Psychological testing revealed that there was a positive relationship between plasma IL-10 and neurocognitive functioning in 30 HIV+ children (r = 0.40, p < 0.05). A study of a subgroup of 11 HIV+ children and 10 controls showed that TNF-a was elevated in PMA-stimulated CD3+ T cells (p = 0.049), and IL-10 was lower in LPS-stimulated CD3+ T cells (p = 0.008). CONCLUSIONS: Children with HIV infection demonstrate higher blood levels of the sleep-inducing cytokine, TNF-a; reduced blood levels of the sleep-inhibiting cytokine, IL-10; and neurocognitive deficits. These early results of this clinical study indicate that it may be possible to determine if sleep disorders and fatigue are related with disease progression in HIV+ children.
Atlas of Plastic Surgery
Authors: Bradford Cannon
Journal: JAMA (1964)

The first edition of this book was published in 1948. Many of the favorable comments expressed in reviews at that time are applicable to this second edition. Unfortunately, there has been little change in the material, even though there is supposedly "revision of various chapters to present current advances of tested value in the special areas covered." The "current advances" are conspicuous by their absence. For example, the chapter on cleft lip and cleft palate has not been changed despite improved methods of repair reported in the last decade. Similarly, improved techniques for correcting protruding ears have been described in the recent literature, but there is essentially no revision of this chapter. On the other hand, the commendable features of the first edition have been retained. Each of the eight chapters reviews the normal anatomy of a particular region, offering line drawings and photographs of deformities, and detailed operative procedures.
FDG and 82Rb PET/MRI Features of Brain Metastasis of Breast Cancer
Authors: Yang Lu
Journal: Clinical Nuclear Medicine (2015)

A 64-year-old woman with stage IV breast cancer underwent an FDG and 82Rb PET brain studies. The PET brain images were fused with MRI brain T1 post-contrast images. The known enhancing left superoposterior frontal brain metastasis is positive on both FDG 82Rb PET/MRI images. The 82Rb PET/MRI showed better target-to-noise ratio, but showed nonspecific uptake in the superior sagittal sinus.
Reading and Upper Thames and Oxford and District Branches. The Alleged Increase in Insanity
Authors: R. H. Noott
Journal: BMJ (1900)

FROM time to time during the last ten years there have appeared in the daily press most alarming assumptions as to the terrible increase in insanity.These statements have for the most part been the result of a false method of statistical in- vestigations.In dealing with statistics relating to this subject we must be very careful to distinguish between figures referring to "existing" lunatics, that is, the total number of registered lunatics, and those referring to " occurring " lunatics, that is, the number of new cases registered.The absolute increase in the number of lunatics in the official cognisance of the Commisioners in Lunacy during the last thirty or forty years, which at first sight appears to be so appalling, has been ex- plained to be due to the accumulation which has necessarily resulted from various causes to be afterwards referred to.In the early part of 1890 Mr. Noel Humphreys read a paper on this subject before the Royal Statistical Society, in which he came to the conclusion that at that time there who no evi- dence of any appreciable increase in " occurring" insanity.From time to time since that date various writers have dealt with the subject..The late Dr. Hack Take contributed ex- haustive articles on The Alleged Increase of Insanity in the Journal ofMental Science for October, i893, and April, I894, in both of which he came to the same conclusion as Mr. Humphreys.So lately as February, 1897, the Commissioners in Lunacy issued a special report on the subject, and after dealing in detail with the causes which led to any apparent increase, they conclude by saying that they " have been unable to satisfy themselves that there has been any important in- crease of ' occurring,' or fresh insanity."The number of registered lunatics, however, goes on steadily increasing, and it would seem that the explanations so often put forward to account for such increase now scarcely suffice; that, indeed, there is an increase in the number of fresh cases of lunacy out of proportion to the increase in population.STATISTICAL FALLACIES.An enthusiastic, but not very discreet, statistician has quite recently published a calculation, based on one of the tablQs in the annual report of the Commissioners in Lunacy, from which we gather that in the year 230I every one will be mad.Truly an appalling prospect!From the accompanying table it will be seen that, whereas