tbuckley/cabot-search huggingface dataset:
Diabetic Coma Without Ketoacidosis
Authors: G PANZRAM, G PENSE
Journal: JAMA (1963)

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
Medical education in the United States 1981-1982
Authors: W C RAPPLEYE
Journal: JAMA (1982)

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
PWE-266 The use of artificial neural networks to predict delayed discharge and readmission in enhanced recovery following laparoscopic colorectal cancer surgery
Authors: N Francis, A Luther, E Salib, L Allanby, D Messenger, A Allison, N Smart, J Ockrim
Journal: Gut (2015)

<h3>Introduction</h3> Artificial neural networks (ANNs) can be used to develop predictive tools to enable the clinical decision-making process. This study aimed to investigate the use of an ANN in predicting the outcomes from enhanced recovery after colorectal cancer surgery. <h3>Method</h3> Data was obtained from consecutive colorectal cancer patients undergoing laparoscopic surgery within the ERAS programme between 2002 and 2009 in a single centre. The primary outcomes assessed were delayed discharge and readmission within a 30 day period. The data was analysed using a Multi Layered Perceptron Neural Network (MLPNN), and a prediction tools were created for each outcomes. The results were compared with a conventional statistical method using Logistic regression analysis. <h3>Results</h3> A total of 275 cancer patients were included in the study. The median length of stay was 6 days (range: 2–49 days) with 67 patients (24.4%) staying longer than 7 days. Thirty four patients (12.5%) were readmitted within 30 days. Important factors predicting delayed discharge were related to failure in compliance with ERAS, particularly with the postoperative elements in the first 48 h. The MLPNN for delayed discharge had an area under a receiver-operator characteristic curve (AUROC) of 0.817, compared with an AUROC of 0.807 for the predictive tool developed from logistic regression analysis. Factors predicting 30 day readmission included overall compliance with the ERAS pathway and receiving neoadjuvant treatment for rectal cancer. The MLPNN for readmission had an AUROC of 0.68. <h3>Conclusion</h3> These results may plausibly suggest that ANN can be used to develop reliable outcome predictive tools in multi-factorial intervention such as ERAS. Compliance with ERAS can reliably predict both delayed discharge and 30 day readmission following laparoscopic colorectal cancer surgery. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Ramesh AN, Kambhampati C, Monson JRT, Drew PJ, Artificial intelligence in medicine. Ann R Coll Surg Engl. 2004;86:334–338 Bottaci L, Drew PJ, Hartley JE, Hadfield MB <i>et al</i>. Artficial neural networks applied to outcome prediction for colorectal cancer patients in separate institutions. <i>Lancet </i>1997;<b>350</b>:470–2
AB0562 Influence of Clinical and Immunological Activity in Pregnancies of Women with Systemic Lupus Erythematosus
Authors: E. Ucar Angulo, N. Rivera García, G. Oraa, A. Bilbao
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> In our center we observed in preliminar studies that within pregnant SLE patients, Anti-Ro Ab carriers suffered less abortions than non-carriers. <h3>Objectives</h3> It comes to test whether this results are statistically significant and if there is an association with other variables such as previous abortion and disease activity, described in the literature. <h3>Methods</h3> Population of 105 SLE pregnant women, atended in our Hospital pregnancy and Lupus Unit. Anti-Ro/La Ab and antiphospholipidic Ab analysis in the 105 patients mentioned. Also analysis of the SLE activity through Lupus Activity Index in pregnancy (LAIP) and Systemic Lupus Erythematosus Disease Activity Index in pregnancy (SLPDAI) tools applied to 88 prospective pregnancies, and the influence of previous abortions. <h3>Results</h3> 32 pregnancies with a history of previous abortion, resulting in 78.13% abortions and 21.87% births. 56 pregnancies with no prior history of abortion, resulting in 5.35% abortions and 94.64% births (p&lt;0.0001). 44 pregnancies Anti-Ro carriers, had 22.72% abortions and 77.27% births; and of 61 pregnancies non-carriers, causes 42.62% abortions and 53.38% births; OR:0.396, CI:0166-0944; p&lt;0.05. Other valued Ab presence, has not been significant, neither disease activity. <h3>Conclusions</h3> Previous abortions presence is the most negative influence on pregnancy outcome. Anti-Ro Ab presence is a protective factor of pregnancy. Disease activity does not affect pregnancy outcome, although the observed trend is to increase the abortion risk, enhancing SLPDAI value; we believe this result is determined by selecting pregnancy time in terms of disease activity. <h3>References</h3> Anselm Mak, Mike W.-L. Cheung, Alicia Ai-cia Cheak and Roger Chun-man Ho Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression, Rheumatology 2010;49:281–288 F. Mecacci, B. Bianchi, A. Pieralli, B. Mangani, A. Moretti, R. Cioni, L. Giorgi, G. Mello and M. Matucci-Cerinic Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies Rheumatology 2009;48:246–249 doi:10.1093 H.J.A. Carp, P.L. Meroni and Y. Shoenfeld. Autoantibodies as predictors of pregnancy complications Rheumatology 2008;47:iii6–iii8 Evelyn V. Rozenblyum, Sharon Sukhdeo, Edgar Jaeggi, Lisa Hornberger, Philip Wyatt, Carl A. Laskin, and Earl D. Silverman. Anti-Ro and Anti-La Antibodies in the General Pregnant Population: Rates and Fetal Outcomes. ARTHRITIS &amp; RHEUMATOLOGY Vol. 66, No. S11, March 2014, p S63. Monika Østensen, Peter M. Villiger, Frauke Förger. Interaction of pregnancy and autoimmune rheumatic disease, Autoimmunity Reviews 11 (2012) A437–A446. <h3>Disclosure of Interest</h3> None declared
Endogenous modulation of monoamine oxidase in schizophrenic and normal humans
Authors: R E Becker, C T Giambalvo
Journal: American Journal of Psychiatry (1982)

Plasma from normal subjects and chronic schizophrenic patients produced nearly equal inhibitory effects on platelet and bovine brain monoamine oxidase (MAO) activity. Plasma from controls and patients with high platelet MAO activity caused less decrease in platelet MAO kinetic variables (Km, Vmax) than plasma from subjects with midrange or low MAO activity. When bovine striatal MAO was used, with serotonin as substrate, plasma from schizophrenic patients caused less decrease in Vmax than plasma from controls. These inhibitory effects are associated with the presence in plasma of one or more nonalbumin proteins with low molecular weight.
Differential Amplification of the TGF-α Gene in Human Gliomas
Authors: W K Yung, X Zhang, P A Steck, M C Hung
Journal: Cancer Communications (1990)

The gene amplification and expression of transforming growth factor-alpha (TGF-alpha) and the epidermal growth factor receptor (EGF-R) in human gliomas was determined by Southern blot analysis and a receptor binding study. Amplification of the EGF-R gene was demonstrated in 3 of 11 tumors examined. All were glioblastomas, whereas the TGF-alpha gene was amplified in 7 of 11 tumors, and 6 of the 7 were recurrent glioblastomas and anaplastic astrocytomas. A competitive binding study with iodinated EGF showed a TGF-alpha-like activity ranging from 1.6-31.5 ng of EGF/microgram protein. These results suggest a differential expression of EGF-R and TGF-alpha genes among untreated and recurrent malignant gliomas.
Radiation recall pericarditis(RRP)induced by amrubicine
Authors: Takafumi Koyama, Kentaro Narita, Hiroko Yukawa, Yumi Fujimoto, Takao Fujisawa, Akiko Hasegawa, Yohei Harada, Ayako Hiramatsu, Takeshi Yanagihara, Yu Oyama
Journal: Annals of Oncology (2015)
Large Outbreak of Botulism Associated with a Church Potluck Meal — Ohio, 2015
Authors: Carolyn L. McCarty, Kristina Angelo, Karlyn D. Beer, Katie Cibulskas-White, Kim Quinn, Sietske de Fijter, Rick Bokanyi, Eric St. Germain, Karen Baransi, Kevin Barlow, Gwen Shafer, Larry Hanna, Kelly Spindler, Elizabeth Walz, Mary DiOrio, Brendan R. Jackson, Carolina Luquez, Barbara E. Mahon, Colin Basler, Kathryn Curran, Almea Matanock, Kelly Walsh, Kara Jacobs Slifka, Agam K. Rao
Journal: MMWR Morbidity and Mortality Weekly Report (2015)

On April 21, 2015, the Fairfield Medical Center (FMC) and Fairfield Department of Health contacted the Ohio Department of Health (ODH) about a patient suspected of having botulism in Fairfield County, Ohio. Botulism is a severe, potentially fatal neuroparalytic illness.* A single case is a public health emergency, because it can signal an outbreak. Within 2 hours of health department notification, four more patients with similar clinical features arrived at FMC's emergency department. Later that afternoon, one patient died of respiratory failure shortly after arriving at the emergency department. All affected persons had eaten at the same widely attended church potluck meal on April 19. CDC's Strategic National Stockpile sent 50 doses of botulinum antitoxin to Ohio. FMC, the Fairfield Department of Health, ODH, and CDC rapidly responded to confirm the diagnosis, identify and treat additional patients, and determine the source.
OP0231-HPR How do we Perceive Activity Pacing in Rheumatology Care? An International Delphi Survey
Authors: N. Cuperus, T. Vliet Vlieland, N. Brodin, A. Hammond, I. Kjeken, H. Lund, S. Murphy, Y. Neijland, C. Opava, S. Roškar, R. Sargautyte, T. Stamm, X. Torres Mata, T. Uhlig, H. Zangi, E. van den Ende
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Activity pacing is a recommended non-pharmacological intervention for the management of rheumatic and musculoskeletal diseases in international clinical guidelines. In clinical practice, activity pacing aims at adapting daily activities, and is often an important component of self-management programs. However, despite its wide endorsement in clinical practice, to date activity pacing is still a poorly understood concept. <h3>Objectives</h3> To achieve consensus by means of an international Delphi exercise on the most important aspects of activity pacing as an intervention within non-pharmacological rheumatology care. <h3>Methods</h3> An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced with activity pacing across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panellists identified and ranked the most important goals of activity pacing, behaviours of activity pacing (the actions people take to meet the goal of activity pacing), strategies to change behaviour in activity pacing (for example goal setting) and contextual factors that should be acknowledged when instructing activity pacing. Besides, topics for future research on activity pacing were formulated and prioritized. <h3>Results</h3> Of the 60 panelists, nearly two third (63%) completed all four Delphi rounds. The panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour and 10 contextual factors of activity pacing. These items were integrated into a consensual list containing the most important aspects of activity pacing interventions in non-pharmacological rheumatology care. Furthermore, the Delphi panel prioritized 9 topics for future research on activity pacing which were included in a research agenda. This agenda highlights that future research should focus on the effectiveness of activity pacing interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panellists, respectively. <h3>Conclusions</h3> The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of activity pacing. This study is an important first step to achieve better transparency and homogeneity within the concept of activity pacing for clinical practice and research. <h3>Disclosure of Interest</h3> None declared
What Kind of Non-bleeding Visible Vessel in a Peptic Ulcer Needs Aggressive Therapy?
Authors: H.-J. Lin, F.-Y. Lee, Y.-T. Tsai, S.-D. Lee, Chen-Hsen Lee
Journal: Endoscopy (1990)

A total of 57 patients with peptic ulcers showing non-bleeding visible vessels were followed for 1-26 months (mean +/- SEM: 13.8 +/- 1.7 months). The age was 56.2 +/- 2.1 years (mean +/- SEM). Blood transfusion with a mean volume of 3.89 units was given. Twenty-five (25/57, 43.9%) patients had rebleeding episodes within one month. Seventeen (17/57, 29.8%) patients were submitted to operation or therapeutic endoscopy due to failure of hemostasis. We analyzed eight clinical parameters on admission of these patients with the aid of a stepwise logistic regression test. Advanced age (over 60), blood transfusion of more than 500 ml and shock were found to be independent predictors of rebleeding. Advanced age (over 60) and coffee ground material in the stomach were found to be independent predictors of ultimate failure of conservative management. We recommend aggressive (either operation or therapeutic endoscopy) rather than conservative management in a patient with a non-bleeding visible vessel who has any of the following characteristics on admission: age over 60, volume of blood transfusion over 500 ml, shock and coffee ground material in the stomach.
US Highlights
Authors: Birte Twisselmann
Journal: BMJ (2006)

It's Thanksgiving this week, which means feasting for many in the United States. In an (un)timely reminder between the association of lifestyle and disease, this week's BMJ carries various articles on heart disease. 

Predicting the risk of death or myocardial infarction in patients with acute coronary syndrome is challenging because of the diverse clinical presentations. To guide triage and key management decisions, however, risk assessment is essential. Fox and colleagues report a prospective multinational observational study (doi: 10.1136/bmj.38985.646481.55) of 43 810 patients in 94 hospitals in 14 countries in Europe, North and South America, Australia, and New Zealand. They developed a new and widely applicable tool, the global registry of acute coronary events (GRACE) scoring system, using nine readily identifiable variables that independently predict death or myocardial infarction. Junghans and Timmis in the accompanying editorial (doi: 10.1136/bmj.39035.509016.BE) balance the advantages against the disadvantages and come out wondering whether this new scoring system is really so very different from other attempts at refining the process of risk assessment—or whether what's really needed is a closer look at why risk assessment in general is so difficult to adopt in clinical practice. 

More on matters of the heart: in the analysis and comment section, Wald and colleagues (doi: 10.1136/bmj.39000.486701.68) debate the evidence from various types of study on a possible association of raised homocysteine concentrations and cardiovascular disease and on whether folic acid, which lowers homocysteine, will help reduce the risk. They take the view that, although the evidence is not conclusive, it is sufficient to support a modest protective effect of folic acid, but encourage continuing review of this position in the light of new evidence. 

Prostate cancer is common and potentially serious, especially as most men with the disease have no symptoms. Few established risk prevention strategies exist, and testing has a poor positive predictive value. How, then to tackle a disease that in 2002 alone was diagnosed in 32 000 men in the United Kingdom, with more than 10 000 deaths attributed to it? US authors Timothy Wilt and Ian Thompson (doi: 10.1136/bmj.39022.423588.DE) in a comprehensive clinical review discuss the evidence on risk factors and prevention, detection, and treatment, to help family doctors answer patients' questions, capture ongoing research priorities, and clarify unanswered questions. All this in an interesting and readable article that may appeal to educated patients and doctors alike.
Activation‐Induced Killer Cell Immunoglobulin‐like Receptor 3DL2 Binding to HLA–B27 Licenses Pathogenic T Cell Differentiation in Spondyloarthritis
Authors: Anna Ridley, Hiroko Hatano, Isabel Wong‐Baeza, Jacqueline Shaw, Katherine K. Matthews, Hussein Al‐Mossawi, Kristin Ladell, David A. Price, Paul Bowness, Simon Kollnberger
Journal: Arthritis & Rheumatology (2015)

In the spondyloarthritides (SpA), increased numbers of CD4+ T cells express killer cell immunoglobulin-like receptor 3DL2 (KIR-3DL2). The aim of this study was to determine the factors that induce KIR-3DL2 expression, and to characterize the relationship between HLA-B27 and the phenotype and function of KIR-3DL2-expressing CD4+ T cells in SpA.In total, 34 B27+ patients with SpA, 28 age- and sex-matched healthy controls (20 B27- and 8 B27+), and 9 patients with rheumatoid arthritis were studied. KIR-3DL2 expression and other phenotypic characteristics of peripheral blood and synovial fluid CD4+ T cells were studied by flow cytometry, quantitative polymerase chain reaction, and Western blotting. T cell receptor clonality was determined by template-switch anchored reverse transcription-polymerase chain reaction and sequencing analysis. Cytokines were measured by enzyme-linked immunosorbent assay.Cellular activation induced KIR-3DL2 expression on both naive and effector CD4+ T cells. KIR-3DL2 binding to B27+ cells promoted expression of KIR-3DL2, the Th17-specific transcription factor retinoic acid receptor-related orphan nuclear receptor γt, and the antiapoptotic factor B cell lymphoma 2. KIR-3DL2+CD4+ T cells in patients with ankylosing spondylitis were oligoclonal and enriched for markers of T cell activation and for the gut homing receptor CCR9. In the presence of B27+ antigen-presenting cells, KIR-3DL2+CD4+ T cells produced less interleukin-2 (IL-2) but more IL-17. This effect was blocked by HC10, an antibody that inhibits the binding of KIR-3DL2 to B27 heavy chains.KIR-3DL2 binding to HLA-B27 licenses Th17 cell differentiation in SpA. These findings raise the therapeutic potential of targeting HLA-B27-KIR-3DL2 interactions for the treatment of B27+ patients with SpA.
Film: The Death of Mr Lazarescu
Authors: Khalid Ali
Journal: BMJ (2005)

Most recent television medical dramas have shown doctors as superheroes who can save lives with the brush of a magical wand. Cardio-pulmonary resuscitation by doctors on Casualty or ER always has a happy ending with patients walking out of hospital as healthy as ever. This is not the case in the recent Romanian surprise hit film The Death of Mr Lazarescu, which has won several international prizes, including a best film award at Cannes.​Cannes.




Figure 1



Lazarescu: shuttled from one department to another




The film follows the misfortunes of one Mr Lazarescu, a 63 year old widower who is fond of cats and a little too partial to alcohol. One night he develops stomach pains and a headache. These are not helped by the alcohol and some ibuprofen tablets that he is given by his neighbours, who take the opportunity, while they are in his flat, to express their disapproval of his lifestyle, self neglect, and continuous cynicism.

When Mr Lazarescu's pains get worse, he calls an ambulance to take him to casualty. Now the real drama begins as he is shuttled from one emergency department to another to see a specialist. Unfortunately for him, there has been a major road crash the same night, and most casualty departments are already full. Accompanied by a paramedic through this journey of disappointments and frustration, Mr Lazarescu is accused along the way of alcohol misuse, malingering, and abusive behaviour towards medical staff.

As soon as an investigation is completed in one hospital, he is sent to another hospital miles away for an urgent neurosurgical procedure. The farce continues—with health professionals dismissing Mr Lazarescu's deteriorating condition all the while—until the tragic ending.

Interlaced with black humour, the film tells a believable story, and one that doctors, patients, and relatives will recognise—sick patients turned away from hospital because of a lack of beds and misdiagnoses that result in patient deaths are common features of the popular press. The combination of a pressure to empty hospital beds and overstretched doctors on duty result in premature discharges with disastrous outcomes.

Director Cristi Puiu offers an acutely observed picture of the doctor-patient relationship. His film teaches us how to treat patients as human beings, and not as cases or figures in a hospital's performance league table. Watching this film made me think more about taking patients seriously, listening to their complaints, and respecting and maintaining their dignity; duties that every doctor should not forgot in a busy on-call day.
World Hepatitis Day: a timely reminder of the challenges ahead
Authors: M J van de Laar, P L Lopalco
Journal: Eurosurveillance (2008)

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