tbuckley/cabot-search huggingface dataset:
Only 22% of UK GPs think NHS works well, down from half in 2013, new survey shows
Authors: Michael McCarthy
Journal: BMJ (2015)

Many primary care doctors in the United States, the United Kingdom, and eight other rich countries think that their practices are not prepared enough to manage patients with multiple chronic conditions, a new survey by the US based non-profit think tank the Commonwealth Foundation has found.1

The doctors also said that they found it difficult to coordinate care with other providers of health and social care and expressed dissatisfaction with the practice of medicine.

Norwegian primary care doctors were the most likely to say that they were satisfied with their healthcare system, with 67% saying that it worked well, while US doctors were the least likely to express satisfaction, with just 16% saying that their system worked well. In the UK a fifth (22%) reported that their healthcare system worked well, a substantial drop since 2013, when an earlier Commonwealth Foundation survey found that nearly half thought the UK health system worked well and needed only minor changes.2

The survey found that primary care doctors in Germany, the US, the UK, and Sweden reported higher than average levels of dissatisfaction with the practice of medicine, with about a third in …
Bridging Translation by Improving Preclinical Study Design in AKI
Authors: Mark de Caestecker, Ben D. Humphreys, Kathleen D. Liu, William H. Fissell, Jorge Cerda, Thomas D. Nolin, David Askenazi, Girish Mour, Frank E. Harrell, Nick Pullen, Mark D. Okusa, Sarah Faubel
Journal: Journal of the American Society of Nephrology (2015)

Despite extensive research, no therapeutic interventions have been shown to prevent AKI, accelerate recovery of AKI, or reduce progression of AKI to CKD in patients. This failure in translation has led investigators to speculate that the animal models being used do not predict therapeutic responses in humans. Although this issue continues to be debated, an important concern that has not been addressed is whether improvements in preclinical study design can be identified that might also increase the likelihood of translating basic AKI research into clinical practice using the current models. In this review, we have taken an evidence-based approach to identify common weaknesses in study design and reporting in preclinical AKI research that may contribute to the poor translatability of the findings. We focused on use of N-acetylcysteine or sodium bicarbonate for the prevention of contrast-induced AKI and use of erythropoietin for the prevention of AKI, two therapeutic approaches that have been extensively studied in clinical trials. On the basis of our findings, we identified five areas for improvement in preclinical study design and reporting. These suggested and preliminary guidelines may help improve the quality of preclinical research for AKI drug development.
Video-Based Surgical Coaching
Authors: Caprice C. Greenberg, Janet Dombrowski, Justin B. Dimick
Journal: JAMA Surgery (2015)

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 Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
Diagnostic error remains a pervasive, underappreciated problem, US report says
Authors: Michael McCarthy
Journal: BMJ (2015)

Diagnostic errors contribute to approximately 10% of patient deaths and to as many as 17% of hospital adverse events, yet have remained largely ignored in recent quality improvement and patient safety initiatives, a new report from the US Institute of Medicine has found.

The report, which was released on 22 September, said, “Without a dedicated focus on improving diagnosis, these errors will likely worsen as the delivery of healthcare and the diagnostic process continue to increase in complexity.”1

The panel recommended eight steps for reducing diagnostic errors including: improving teamwork and …
Ethics of limb allografts
Authors: K. J Mukamal
Journal: BMJ (2002)

Uncertainty remains about efficacyEditor-The article by Lenzer and the associated commentary by Saver et al raise many serious issues, among which is the residual state of uncertainty concerning the efficacy of alteplase (tPA) in acute ischaemic stroke. 1 Confronted by opposing interpretations of the aggregate data published to date and the now known baseline imbalance in the severity of stroke in the National Institute of Neurological Diseases and Stroke (NINDS) trial, doctors are presented with a conundrum: what action do the data support?The reported unwillingness of the investigators and sponsor of the National Institute of Neurological Diseases and Stroke trial to provide data for additional analysis is disturbing.Emanuel et al have described seven requirements for the ethical conduct of clinical research, among which is social and scientific value. 2 Social value presupposes the public dissemination of research results.I have formulated a standard for the scientific and ethical review of trials that elaborates on this requirement. 3mplicit in this requirement is the necessity for the public dissemination of the complete dataset acquired during a clinical trial.This allows interested investigators to apply recognised analytic techniques in an attempt to resolve (or diminish) residual uncertainty concerning the clinical implications of the trial's results.This ethical requirement has not yet been met for the National Institute of Neurological Diseases and Stroke trial.
Importance of Normal Aging in Estimating the Rate of Glaucomatous Neuroretinal Rim and Retinal Nerve Fiber Layer Loss
Authors: Jayme R. Vianna, Vishva M. Danthurebandara, Glen P. Sharpe, Donna M. Hutchison, Anne C. Belliveau, Lesya M. Shuba, Marcelo T. Nicolela, Balwantray C. Chauhan
Journal: Ophthalmology (2015)
Patent Ductus Arteriosus in Preterm Neonates—Concerns With Some Recommendations
Authors: Sergio G. Golombek, Augusto Sola
Journal: JAMA Pediatrics (2015)

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 Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Half of Dutch doctors cried at work last year, survey finds
Authors: Tony Sheldon
Journal: BMJ (2015)

Nearly half of Dutch doctors have cried at work, and a quarter have cried in the presence of their patients, a study by researchers at Tilburg University in the Netherlands has shown. Doctors found this “undesirable” but not necessarily “unprofessional.”

The confidential inquiry, published in the Dutch Medical Association’s journal Medisch Contact , gathered responses from 776 doctors in primary and secondary care, approached …
GPs' views of consultants' non-urgent referral of patients to other consultants
Authors: C. Essex
Journal: BMJ (1996)

Low blood pressure is unlikely to be complication of dementia process EDrrOR,-Zhenchao Guo and colleagues report an association between low blood pressure and different types of dementia, including Alzheimer's disease.' Adults with Down's syndrome have a high prevalence of Alzheimer's disease2; they also have significantly lower diastolic and systolic blood pressures than the general population.3We reviewed data from a five year prospective longi- tudinal study investigating aging in a cohort of adults with Down's syndrome to explore a possible association between low blood pressure and Alzheimer's disease.Measurements of blood pressure and evidence used in making a diagnosis of Alzheimer's disease according to criteria in the International Classification of Diseases (10th revision)4 were available for 80 subjects aged over 45.Twenty one subjects fulfilled the criteria for Alzheimer's disease.The mean age of the group without dementia was 52.6 years and that of the group with dementia was 55.0 years (t=0.32,P=0.75).The mean systolic blood pressure was 109.5 mm Hg and 114.7 mm Hg respectively (t=1.6,P=0.25), and the mean diastolic blood pressure was 76.6 mm Hg and 75.9 mm Hg respectively (t=0.32,P=0.75).Thus there was no significant difference in either blood pressure between the two groups.Incessant hypoperfusion due to persistent low blood pressure in adults with Down's syndrome may predispose to the development of neuropathological changes of Alzheimer's disease.We found no evidence, however, that low blood pressure is a complication of the clinical demen- tia process in people with Down's syndrome.
Age-related mutations and chronic myelomonocytic leukemia
Authors: C C Mason, J S Khorashad, S K Tantravahi, T W Kelley, M S Zabriskie, D Yan, A D Pomicter, K R Reynolds, A M Eiring, Z Kronenberg, R L Sherman, J W Tyner, B K Dalley, K-H Dao, M Yandell, B J Druker, J Gotlib, T O'Hare, M W Deininger
Journal: Leukemia (2015)
Alterations in bone marrow metabolism are an early and consistent feature during the development of MGUS and multiple myeloma
Authors: C Ludwig, D S Williams, D B Bartlett, S J Essex, G McNee, J W Allwood, E Jewell, A Barkhuisen, H Parry, S Anandram, P Nicolson, C Gardener, F Seymour, S Basu, W B Dunn, P A H Moss, G Pratt, D A Tennant
Journal: Blood Cancer Journal (2015)

Alterations in bone marrow metabolism are an early and consistent feature during the development of MGUS and multiple myeloma
Association Between Leukemia and Topical Use of Pimecrolimus
Authors: Yik Weng Yew, Hong Liang Tey
Journal: JAMA Dermatology (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Disallowed and Allowed Gene Expression: Two Faces of Mature Islet Beta Cells
Authors: Katleen Lemaire, Lieven Thorrez, Frans Schuit
Journal: Annual Review of Nutrition (2016)

Glucose homeostasis greatly depends on the match between fluctuating insulin demands and adjusted rates of insulin secretion, which is the function of pancreatic beta cells. Emerging evidence suggests that when neonatal beta cells mature, they acquire two faces of differentiated function: an expected "visible face" that depends on specific beta cell proteins needed for regulated insulin release, but also a "hidden face" that represses ubiquitous proteins to prevent inappropriate beta cell function such as elevated basal hormone secretion or insulin release triggered by exercise. This review highlights this novel concept, and we first propose that hidden faces may also be relevant for other specialized tissue functions, such as ketogenesis in the liver. Next, we discuss three scenarios in which aberrant gene expression causes abnormal glucose-induced insulin release and the epigenetic regulation of the hidden face in beta cells. We conclude with perspectives for new research, including beta cell replacement to cure diabetes.
Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort
Authors: Ding Ding, Kris Rogers, Hidde van der Ploeg, Emmanuel Stamatakis, Adrian E. Bauman
Journal: PLoS Medicine (2015)

Background Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors. Methods and Findings Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006– April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data. Conclusions Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors.
The Clinical Pathological Conference
Authors: J W OBERMAN, G H GUIN, E C RICE
Journal: JAMA (1971)

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
Effect of Macitentan on Hospitalizations
Authors: Richard N. Channick, Marion Delcroix, Hossein-Ardeschir Ghofrani, Elke Hunsche, Pavel Jansa, Franck-Olivier Le Brun, Sanjay Mehta, Tomás Pulido, Lewis J. Rubin, B.K.S. Sastry, Gérald Simonneau, Olivier Sitbon, Rogério Souza, Adam Torbicki, Nazzareno Galiè
Journal: JACC Heart Failure (2014)
Excessive testing of adults with type 2 diabetes
Authors: Rodney A Hayward
Journal: BMJ (2015)

Our fondness for treating numbers is harming patients

When I began my medical training in 1980, I commonly encountered patients whose bodies were ravaged by end stage complications of diabetes. These patients often had marked visual impairment, debilitating neuropathy, myopathies, and diabetes related renal insufficiency, well before age 65 years. I still occasionally see such individuals, but they are rare, and tend to come from the 10-15% of patients who still have poor glycemic control. Improvement in diabetes care is a medical success story, but increasing evidence suggests that overly aggressive treatment is an under-appreciated problem.

In a linked study,1 McCoy and colleagues report that a cohort of patients with excellent glycemic control of their type 2 diabetes received glycated hemoglobin (HbA1c) monitoring that exceeded recommended guidelines, and that this excessive testing was associated with excessive treatment. These results are yet another example of how prone our profession is to taking useful tests and treatments to excess. The common belief that there is “no harm in looking” continues to result in not just waste, but also palpable patient harm. The temptation to treat suboptimal numbers too often overrules more judicious judgments based on …
Integrating Addiction Services Into General Medicine
Authors: Wilson M. Compton, Carlos Blanco, Eric M. Wargo
Journal: JAMA (2015)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity
Authors: Ben-Gary Harvey, Yael Strulovici-Barel, Robert J. Kaner, Abraham Sanders, Thomas L. Vincent, Jason G. Mezey, Ronald G. Crystal
Journal: European Respiratory Journal (2015)

Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide ( D LCO ), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low D LCO ” smokers is unknown. From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal D LCO (n=59) and smokers with normal spirometry/low D LCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α 1 -antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers. In the normal spirometry/normal D LCO group assessed over 45±20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low D LCO group, followed over 41±31 months, 22% developed GOLD-defined COPD. Despite appearing “normal” according to GOLD, smokers with normal spirometry but low D LCO are at significant risk of developing COPD with obstruction to airflow.
The Inhibitory Receptor NKG2A Sustains Virus-Specific CD8+ T Cells in Response to a Lethal Poxvirus Infection
Authors: Aaron S. Rapaport, Jill Schriewer, Susan Gilfillan, Ed Hembrador, Ryan Crump, Beatrice F. Plougastel, Yaming Wang, Gaelle Le Friec, Jian Gao, Marina Cella, Hanspeter Pircher, Wayne M. Yokoyama, R. Mark L. Buller, Marco Colonna
Journal: Immunity (2015)
Assessment of Chronic Snorers
Authors: D G Golding-Wood, M J Brockbank, A R Swanston, C B Croft
Journal: Journal of the Royal Society of Medicine (1990)

Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.