tbuckley/cabot-search huggingface dataset:
M*A*S*H
Authors: David Haslam
Journal: BMJ (2007)

Insubordinate, frequently irritating, cynical, totally human, and 100% caring—who could ask for a better doctor than Dr Benjamin Franklin Pierce? 

I've always felt embarrassed that my medical hero is fictional. Be that as it may, I believe that M*A*S*H, the story of the 4077 Mobile Army Surgical Hospital during the Korean war, reached closer to the heart of what it means to be a doctor than any other work of art that I know. 

You can taste M*A*S*H in three distinct flavours. There was the original novel by Dr Richard Hornberger, written under the pseudonym Richard Hooker while he was waiting to see patients in his clinic, and based on his experiences in Korea. There was the Oscar winning 1970 film directed by Robert Altman, starring Donald Sutherland as Hawkeye and Elliot Gould as Trapper John, released at the height of the Vietnam war, and oozing humour and wit as well as blood and bone. And there was the extraordinary television series starring Alan Alda, which ran for 251 episodes but which is still showing in an endless and justified cycle of repeats around the world. 

I doubt if anyone realised quite what a hit the television show would be. Fox, which made the movie, still owned both the rights and the movie set, and so had a show that was cheap to make, initially at least. Larry Gelbart, who had visited Korea as a gag writer for Bob Hope, was recruited to write the script, but the only actor from the movie who was retained for the television series was Gary Burghoff, who played the wonderful Radar. 

If you've never seen M*A*S*H, then names like Radar, Hot Lips, Trapper, BJ, Klinger, Henry Blake, Sherman Potter, Charles Emerson Winchester 3rd, Father Mulcahy, or the world's greatest psychiatrist—Sidney Freedman—will mean nothing to you. And you may be puzzled as to what possible relevance the world of blood and guts surgery in a field hospital at war might have to a rural Cambridgeshire general practitioner, whose surgical skills were only ever limited to the occasional sebaceous cyst. 

But the great thing about all these people is that they cared. Hawkeye might have joked, womanised, drunk, teased, and argued—but, my God, how he cared. You could see it in the way that he cried, became angry and frustrated, and passionate. 

Medical school didn't teach us much about caring. The lecturers taught us about glycogen storage diseases, immune deficiency, the Krebs Cycle, and the median nerve. They taught us how to care for patients, but rarely mentioned caring about them. And so as doctors we develop coping strategies that somehow get most of us through the days, but which leave others permanently damaged—either unable to show their patients that they care, or else dependent on inappropriate supports. 

But when Hawkeye felt the pain of being a caring doctor it showed. It moved me then, it moves me now, and it still makes me laugh. What else could you ask for?
Memory reconsolidation and self-reorganization
Authors: William J Whelton
Journal: Behavioral and Brain Sciences (2015)

Abstract Lane et al. propose that memory reconsolidation through new emotional experiences is an integrative pathway to change in psychotherapy. My commentary suggests that memory reconsolidation is an element within self-reorganization. Given the focal nature of the self to every aspect of psychotherapy, it is a more useful construct on which to build integrative models than memory reconsolidation.
The Role of Cancer-Prevention Clinics in the Detection of Early Gastric Cancer
Authors: Morris E. Dailey, M. D.
Journal: JNCI Journal of the National Cancer Institute (1947)

Journal Article The Role of Cancer-Prevention Clinics in the Detection of Early Gastric Cancer Get access Morris E. Dailey, M. D. Morris E. Dailey, M. D. Division of Medicine, University of California Medical School, San Francisco Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 7, Issue 5, April 1947, Pages 375–377, https://doi.org/10.1093/jnci/7.5.375 Published: 01 April 1947
PWE-152 Retrospective observational cohort study of gastrointestinal stromal tumours (gists) in a uk regional cancer network
Authors: J Wheat, H Garrod, L Davies, WG Lewis
Journal: Gut (2015)

<h3>Introduction</h3> Gastrointestinal Stromal Tumours (GISTs) are tumours of mesenchymal origin that arise in the GI tract and account for approximately 0.1 to 3% of all gastrointestinal tumours. The aim of this study was to determine the relative incidence, clinical features and treatment outcome of GISTs diagnosed by a regional upper GI cancer network. <h3>Method</h3> One hundred and sixty one consecutive patients were identified through the regional upper GI cancer network. The median age was 66 (range 20–91) years; 86 male, 75 female. The primary outcome measure was survival. <h3>Results</h3> The anatomical distribution of the tumours was: gastric 74%; small bowel 15%; colorectal 3.8%; oesophageal 2.5%; unknown primary site 4.7%. Ninety-four (58.4%) underwent surgical resection. Thirteen were endoscopic (13.8%). Immunohistochemistry staining was performed on 46.6%, of which 89% were CD117 positive and 49.3% were CD34 positive. Malignant potential was recorded in 45.3% of cases: 12.4% benign; 14.3% low/low-intermediate; 8.7% intermediate; 3.7% high; 6.2% malignant. Overall 5- and 10- year survival was 79% and 53% respectively. Recurrent disease was identified in 6.8% of patients and progressive disease in 7.5%. Rectal and gastric GISTs had the poorest 5- and 10- year survival (p = 0.04). The median size of resected tumours was 5 cm (range 0.4 to 26 cm), and univariate analysis showed an association with survival (Chi<sup>2</sup>14.755, p = 0.005). On multivariable analysis, maximum dimension of resected tumour was the only variable independently associated with survival (HR 1.107, 95% CI 1.035–1.184, p = 0.03). <h3>Conclusion</h3> The majority of GISTs diagnosed were upper GI (76.5%). Five- and ten- year survival rates are longer than for other upper GI cancers and clinicians should be aware of this when counselling patients and planning management. <h3>Disclosure of interest</h3> None Declared.
Emotional claptrap
Authors: Des Spence
Journal: BMJ (2007)

Tears streamed down my face as I clutched my new born baby daughter—I was a father.” Nauseating but powerful, isn't it, even if it isn't true? Using an emotional hook is the writer's Trojan horse. Emotions breach the highest and most fortified walls of cynicism that surround individuals. This emotional manipulation is the essence of the science of marketing, and as doctors we are under permanent siege.

Medical marketing opens the Pandora's box of the human emotions—fear, love, lust, greed, humour, superiority, beauty, anger, violence, pity, faith, and all the rest. Flick through any medical publication, look at the advertisements, and spot the emotional barb, from youthful models for hormone replacement therapy, to George Clooney lookalikes with erectile dysfunction, old smiling men holding garden hoses, and elderly couples with dementia holding hands. Images and language are always kept simple, accessible, and memorable in a bid to evoke deep emotional memory. Whether I want to or not, I can recall countless promotional and emotive advertising campaigns.

Similarly, medical sales representatives appeal to us emotionally. Well paid, well educated, plausible, “professional,” and in every way designed to be flattering mirror images of ourselves, they are the embodiment of friendship and trust. Pharmaceutical representatives often change companies, but they rarely change their pitch because sales executives understand that the most fundamental emotion of all, trust, is a product of time.

Then there are the paid medical “experts.” No need for us (and this often includes said experts) to read the stupefying papers, just look at a couple of lame PowerPoint pie charts, a crass cartoon, and the bullet point “take home” messages to be swallowed and tastelessly regurgitated. Everybody is happy, no questions are asked, and we all get home early.

But then there is the ultimate emotional charge, real patients. A single patient can distort NHS priorities, as no one can resist the reflection of self in his or her eyes. Patients, through various support groups, are increasingly becoming the Semtex of marketing devices—a celebrity patient can score a direct hit, with a mushroom cloud of positive radioactive fallout.

All this emotional spin might seem obvious to us gifted doctor types—and anyway, aren't we constantly under the unseen gravitational marketing pull of huge corporate planets as we hurtle through the capitalist void of our lives? But the truth is that most doctors remain largely oblivious, and there exists no political will to limit medical marketing. The NHS needs, therefore, a firewall against the attack of the marketing Trojans, or else ever more wasteful system crashes and slow running are inevitable. Compulsory modules on medical marketing at medical schools would surely be a start.
Incidence of and survival after subsequent cancers in carriers of pathogenic MMR variants with previous cancer: a report from the prospective Lynch syndrome database
Authors: Pål Møller, Toni Seppälä, Inge Bernstein, Elke Holinski-Feder, Paola Sala, D Gareth Evans, Annika Lindblom, Finlay Macrae, Ignacio Blanco, Rolf Sijmons, Jacqueline Jeffries, Hans Vasen, John Burn, Sigve Nakken, Eivind Hovig, Einar Andreas Rødland, Kukatharmini Tharmaratnam, Wouter H de Vos tot Nederveen Cappel, James Hill, Juul Wijnen, Mark Jenkins, Kate Green, Fiona Lalloo, Lone Sunde, Miriam Mints, Lucio Bertario, Marta Pineda, Matilde Navarro, Monika Morak, Laura Renkonen-Sinisalo, Ian M Frayling, John-Paul Plazzer, Kirsi Pylvanainen, Maurizio Genuardi, Jukka-Pekka Mecklin, Gabriela Möslein, Julian R Sampson, Gabriel Capella
Journal: Gut (2016)

<h3>Objective</h3> Today most patients with Lynch syndrome (LS) survive their first cancer. There is limited information on the incidences and outcome of subsequent cancers. The present study addresses three questions: (i) what is the cumulative incidence of a subsequent cancer; (ii) in which organs do subsequent cancers occur; and (iii) what is the survival following these cancers? <h3>Design</h3> Information was collated on prospectively organised surveillance and prospectively observed outcomes in patients with LS who had cancer prior to inclusion and analysed by age, gender and genetic variants. <h3>Results</h3> 1273 patients with LS from 10 countries were followed up for 7753 observation years. 318 patients (25.7%) developed 341 first subsequent cancers, including colorectal (n=147, 43%), upper GI, pancreas or bile duct (n=37, 11%) and urinary tract (n=32, 10%). The cumulative incidences for any subsequent cancer from age 40 to age 70 years were 73% for pathogenic <i>MLH1</i> (<i>path_MLH1</i>), 76% for <i>path_MSH2</i> carriers and 52% for <i>path_MSH6</i> carriers, and for colorectal cancer (CRC) the cumulative incidences were 46%, 48% and 23%, respectively. Crude survival after any subsequent cancer was 82% (95% CI 76% to 87%) and 10-year crude survival after CRC was 91% (95% CI 83% to 95%). <h3>Conclusions</h3> Relative incidence of subsequent cancer compared with incidence of first cancer was slightly but insignificantly higher than cancer incidence in patients with LS without previous cancer (range 0.94–1.49). The favourable survival after subsequent cancers validated continued follow-up to prevent death from cancer. The interactive website http://lscarisk.org was expanded to calculate the risks by gender, genetic variant and age for subsequent cancer for any patient with LS with previous cancer.
Quality of life in patients with advanced renal cell carcinoma given nivolumab versus everolimus in CheckMate 025: a randomised, open-label, phase 3 trial
Authors: David Cella, Viktor Grünwald, Paul Nathan, Justin Doan, Homa Dastani, Fiona Taylor, Bryan Bennett, Michael DeRosa, Scott Berry, Kristine Broglio, Elmer Berghorn, Robert J Motzer
Journal: The Lancet Oncology (2016)
Jigsaw
Authors: Amanda J Redig
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
Factors associated with a successful insanity plea
Authors: H J Steadman, L Keitner, J Braff, T M Arvanites
Journal: American Journal of Psychiatry (1983)

The authors present data on all insanity pleas (N = 202) in Erie County, New York, between 1970 and 1980. No demographic, criminal history, current offense, or history of mental hospitalization factor was associated with acquittal. Of the variables studied, only the recommendation of the forensic examiner was associated with the court's decision to acquit by reason of insanity. When an insanity acquittal was recommended in the examination report, conviction ensued in only 17% of the cases. The proportion of pleas that were successful varied considerably over the 10 years studied. The authors discuss the critical need for more research on the plea stage of insanity defense proceedings.
Hypersensitivity reactions to CHIP.
Authors: C J Rodenburg, J van Ulsen, C Seynaeve, G Stoter
Journal: Journal of Clinical Oncology (1990)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1990.8.6.1119 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 2348229 Hypersensitivity reactions to CHIP. C J RodenburgxC J RodenburgSearch for articles by this author , J van UlsenxJ van UlsenSearch for articles by this author , C SeynaevexC SeynaeveSearch for articles by this author , G StoterxG StoterSearch for articles by this author https://doi.org/10.1200/JCO.1990.8.6.1119 PDF "Hypersensitivity reactions to CHIP.." Journal of Clinical Oncology, 8(6), p. 1119© 1990 by American Society of Clinical Oncology
Migraine Provoked by Aspartame
Authors: D R Johns
Journal: New England Journal of Medicine (1986)

A letter to the editor by a hospital doctor describes a case study concerning a 31 year-old white woman suffering with migraine headaches attributed to ingestion of soft drinks containing the artificial sweetener, aspartame, and tablets of aspartame (1-1.5 g/day). Avoidance of all diet soft drinks and aspartame for 10 days produced a complete disappearance of all headaches. A rechallenge with aspartame solution (500 mg) produced an identical headache in 1.5 hours, which was not produced by saccharin or sucrose solutions of equal sweetness (0.22 g and 90 g, respectively). A reply letter by a medical doctor affiliated with aspartame's producer critiques the case study associating aspartame with migraine, suggesting that the study be repeated using a double-blind, randomized, crossover, placebo-controlled design.(wz)
Hysteria and women
Authors: P Chodoff
Journal: American Journal of Psychiatry (1982)

Through the ages, hysteria has been considered to be a female disease. The author explores the historical record and concludes that the hysterical (histrionic) personality is a caricature of femininity. It develops under the influence of cultural forces, particularly male domination, and is not a natural attribute of women. He then inquires whether the concept of a distinct femininity is itself a stereotype or is based on inborn personality differences between the sexes. Citing current biological and ethological evidence, he favors the latter explanation. He suggests that the hypothesis of sex role distortion include not only the equation femininity-caricature-hysterical personality but also the cognate one, masculinity-caricature-"machoism."
PWE-128 Short-term changes in liver function tests predict long-term mortality
Authors: E Saffouri, E Lim, S Kim, CH Thompson
Journal: Gut (2015)

<h3>Introduction</h3> Liver function tests (LFTs) are commonly measured upon admission to hospital. LFT derangement on admission not only prompts investigation of pathology but also predicts short-term mortality. Longer-term implications of short-term changes in these tests are less well-studied. We sought whether fluctuations in LFTs during admission predict 12-month mortality and, if so, which LFTs were the best predictors. <h3>Method</h3> We included patients admitted non-electively for a period of at least 7 days to General Medicine at an urban Australian hospital from 2005 to 2012. LFTs (bilirubin, albumin, gamma glutamyl transferase, alkaline phosphatase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) were measured on admission and repeated at least once with the greatest change in each noted. Only the first relevant admission of each patient was analysed. Patients were excluded if they died during admission, were admitted to Intensive Care or carried a diagnosis of malignancy or liver disease. A logistic regression model was developed to determine 12-month mortality incorporating patients’ age, gender, co-morbidity index, heart failure diagnosis and admission LFTs. A second model also included intra-admission changes in LFTs. <h3>Results</h3> Of 4160 patients analysed, median age was 79 years (IQR 66–86), 25% had heart failure and 12-month post-discharge mortality was 17%. Admission albumin was low in 39% of patients; admission ALT was high in 14% of patients. Admission albumin predicted 12-month mortality better than other LFTs at admission. 12-month mortality was greater by: 37% (p = 0.02) with a standing diagnosis of heart failure; 4% (p &lt; 0.001) with a 1g/L intra-admission decrease in albumin; and 6% (p = 0.05) with a 100 IU/L intra-admission increase in ALT. Comparison of the two models showed that the intra-admission change model was superior to the admission-value model at predicting 12-month mortality. Of intra-admission changes in LFTs, a drop in albumin was the best individual predictor of 12-month mortality; a rise in ALT added predictive power. <h3>Conclusion</h3> Changes in LFTs predict long-term mortality better than a single value. In the absence of known liver disease, albumin predicts long-term mortality of elderly inpatients better than transaminases. This may reflect systemic influences on albumin such as nutritional status. Patients whose albumin falls during admission are at high risk of death within a year even if admission albumin levels are normal. Attention should be directed to reduce these patients’ mortality risk or consider planning end-of-life care. <h3>Disclosure of interest</h3> None Declared.
Long-Term Follow-up of Small Pulmonary Ground-Glass Nodules Stable for 3 Years: Implications of the Proper Follow-up Period and Risk Factors for Subsequent Growth
Authors: Jaeyoung Cho, Eun Sun Kim, Se Joong Kim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee
Journal: Journal of Thoracic Oncology (2016)
Author’s reply
Authors: Christopher R Blagg
Journal: BMJ (2008)

Selection bias has an important role, but almost all reports on quality of life have shown the benefits of home haemodialysis (HD), and patients are vocal about the advantages they have experienced. Even if survival is no better, surely willing and suitable patients should have access to a treatment that provides, for example, opportunity for longer or more frequent dialysis, improved quality of life, rehabilitation, and flexibility of scheduling?

In terms of urbanisation, Australia ranks 19th in the world (91% urbanisation) compared with the UK, which is 20th (90% urbanisation), and New Zealand, which is 32nd (86% urbanisation).1 On the basis of their registries, the rates per million for HD, peritoneal dialysis, and transplantation are also similar—303, 85, and 317 in the UK; 330, 88, and 322 in Australia; and 277, 176, and 302 in New Zealand.

In New Zealand there used to be little option but home HD if a transplant was not available. However, now 48% of patients receiving HD are in hospital based programmes. Also, while the total number of patients receiving dialysis per million now is roughly similar to that in the US and Australia, the proportion treated by peritoneal dialysis is almost double.

In our experience HD at home costs about half the cost of outpatient dialysis in a unit, but training costs are inadequately reimbursed in the US and break even is somewhere between one and two years. Patients receiving home HD are generally prime candidates, but in our programme only about 10% a year receive transplants.

In Australia and New Zealand dialysis programmes are primarily run from university and major medical centres that also provide widespread satellite units encouraging self care and independence for patients who do not want home HD. There are no for-profit dialysis corporations, which are only just beginning to see the benefits of home HD. The government of the state of Victoria, for example, actively encourages the use of home HD and pays a doctor more for patients who go home.
SAT0125 Utility of Select Plasma Mirnas for Diagnosis of Rheumatoid Arthritis and Monitoring of Disease Activity and Cardiovascular Risk
Authors: M. Ormseth, J. Solus, K. Vickers, A. Oeser, P. Raggi, C.M. Stein
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> MicroRNAs (miRNAs) are short RNA sequences that are gene expression regulators and potential mediators and markers of disease. Recently, plasma miR-24-3p and miR-125a-5p concentrations were shown to be elevated in rheumatoid arthritis (RA) and useful for RA diagnosis. We assessed the utility of seven candidate plasma miRNAs, selected for biologic plausibility, for diagnosis of RA and use as markers of disease activity and cardiovascular risk in RA. <h3>Methods</h3> The cross-sectional study included 168 patients with RA and 91 controls, of similar age, race and sex. Plasma concentrations of miR-15a-5p, 24-3p, miR-26a-5p, miR-125a-5p, miR-146a-5p, miR-155-5p, and miR-223-3p were measured by quantitative PCR. Utility of plasma miRNA concentrations for diagnosis of RA was assessed by area under the receiver operating characteristic curve (AUROC). Association between plasma miRNA concentrations and RA disease activity and cardiovascular risk measures were assessed by Spearman correlations. <h3>Results</h3> Plasma concentrations of miR-15a-5p, 24-3p, miR-26a-5p, miR-125a-5p, miR-146a-5p, miR-155-5p, and miR-223-3p were significantly increased in patients with RA. miR-24-3p had the highest AUROC for diagnosis of RA (AUROC=0.725), including among rheumatoid factor negative patients (AUROC=0.772). Among all patients with RA, the combination of miR-24-3p, miR-26a-5p and miR-125a-5p improved the model modestly (AUROC=0.737). miR-155-5p was weakly inversely associated with swollen joint count (P=0.024), but no other miRNAs were associated with disease activity or coronary artery calcium score. <h3>Conclusions</h3> The combination of miR-24-3p, miR-26a-5p and miR-125a-5p had strongest diagnostic accuracy for RA. Candidate miRNAs had minimal or no association with RA disease activity and coronary calcium score. <h3>Disclosure of Interest</h3> None declared