tbuckley/cabot-search huggingface dataset:
Are Patients' Office Visits with Physicians Getting Shorter?
Authors: David Mechanic, Donna D. McAlpine, Marsha Rosenthal
Journal: New England Journal of Medicine (2001)

Many believe that managed care creates pressure on physicians to increase productivity, see more patients, and spend less time with each patient.We used nationally representative data from the National Ambulatory Medical Care Survey (NAMCS) of the National Center for Health Statistics and the American Medical Association's Socioeconomic Monitoring System (SMS) to examine the length of office visits with physicians from 1989 through 1998. We assessed the trends for visits covered by a managed-care or other prepaid health plan (prepaid visits) and non-prepaid visits for primary and specialty care, for new and established patients, and for common and serious diagnoses.Between 1989 and 1998 the number of visits to physicians' offices increased significantly from 677 million to 797 million, although the rate of visits per 100 population did not change significantly. The average duration of office visits in 1989 was 16.3 minutes according to the NAMCS and 20.4 minutes according to the SMS survey. According to both sets of data, the average duration of visits increased by between one and two minutes between 1989 and 1998. The duration of the visits increased for both prepaid and nonprepaid visits. Nonprepaid visits were consistently longer than prepaid visits, although the gap declined from 1 minute in 1989 to 0.6 minute in 1998. There was an upward trend in the length of visits for both primary and specialty care and for both new and established patients. The average length of visits remained stable or increased for patients with the most common diagnoses and for those with the most serious diagnoses.Contrary to expectations, the growth of managed health care has not been associated with a reduction in the length of office visits. The observed trends cannot be explained by increases in physicians' availability, shifts in the distribution of physicians according to sex, or changes in the complexity of the case mix.
THE IMPACT OF AGE ON THE OUTCOMES AFTER CAROTID ARTERY STENTING OR ENDARTERECTOMY IN PATIENTS WITH MODERATE OR SEVERE CHRONIC KIDNEY DISEASE (STAGE 3 AND 4): INSIGHTS OF THE HEALTHCARE COST AND UTILIZATION PROJECT’S NATIONAL INPATIENT SAMPLE
Authors: Luis Gruberg, Fabio Lima, Yun Yen, Javed Butler
Journal: Journal of the American College of Cardiology (2016)
FRI0395 Five phenotype profiles are revealed by cluster analysis in patients with gout. Results from a cohort of 2762 patients
Authors: P. Richette, R.-M. Flipo, G. Errieau, L. Perrissin, P. Clerson
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Diet and genetic predisposition seem to be the main causal factors of primary gout. Gout is associated with hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular diseases that may combine differently among patients. In addition, elevation of uricemia is a well-known side-effect of diuretics. <h3>Objectives</h3> To examine whether demographics, comorbidities and use of diuretics would combine into different phenotype profiles in gouty patients. <h3>Methods</h3> CACTUS was a non-interventional cross-sectional multicentre study conducted in France from November 2010 to May 2011. It included 2762 gouty patients whose characteristics were analyzed with multiple correspondence analysis. The associations between the studied variables were graphically assessed. Cluster analysis was performed to identify subgroups of patients with similar characteristics using cluster method based on the complete linkage model. Variables used in cluster analysis were age, hypertension, obesity (BMI &gt;30 kg/m<sup>2</sup>), diabetes (use of oral ant diabetic agents or fasting glycaemia &gt;1.26 g/L), dyslipidaemia (grouping hypercholesterolemia and hypertriglyceridemia), heart failure, ischemic cardiac disease, renal failure, liver disorders (including liver insufficiency and increase in liver enzymes), cancer and use of diuretics. The number of clusters was chosen according to the values of the pseudo t<sup>2</sup> statistic. <h3>Results</h3> Five clusters (C1 to C5) have been individualised. Patients from C1 (N=801) were 52 years old with a familial history of hyperuricemia (26%); 27% were obese; none had cardiac, renal, nor hepatic failure. C2 (N=178) clustered the oldest patients (mean age 73 years) with hypertension (97%), heart failure (100%) and renal failure (33%); 76% were treated with diuretics. Obesity, diabetes and dyslipidemia were frequent (53%, 42% and 75% respectively). In C3, (N=1425) patients were 69 years old; 41% were obese; 73% were hypertensive and 76% presented with hypercholesterolemia; 31% were diuretics users. Patients from C4 (N=290) were 60 years old with metabolic disorders: obesity (49%) hypertension (72%), hypercholesterolemia (82%), hypertriglyceridemia (63%), liver enzymes disorders (71%); alcohol, beer and soda consumption was more frequent than for other clusters. 21% presented with ischaemic heart disease. All patients from C5 (N=68, mean age 72 years) but none from other clusters were suffering from a cancer. <h3>Conclusions</h3> Cluster analysis of risk factors for gout allowed us to clearly identify 5 different groups of clinical phenotypes, which could reflect different mechanisms of hyperuricemia. These data might help to optimize the management of risks factors for hyperuricemia in patients with gout. <h3>Disclosure of Interest</h3> None Declared
Tips for a Physician in Getting the Right Job, Part V
Authors: Jay A. Harolds
Journal: Clinical Nuclear Medicine (2013)

Some physicians interviewing for an executive job will encounter the same types of interviews that a physician looking for a clinical job will experience. Typically, at least some elements of the same types of interviews will be given. However, those who desire an administrative position may in addition encounter 1 or more different types of interviews, which are known as the stress, behavioral, and situational interviews. This article describes some characteristics of these interviews, to prepare physicians to do well in these situations.
Closure of an aortoesophageal fistula with an esophageal stent and hemoclip
Authors: S.-M. Tsai, Y.-Y. Chen, Y. Chin-Yuan, W.-L. Lai
Journal: Endoscopy (2011)

The patient was a 43-year-old man with a history of hypertension and a Stanford type B dissecting aortic aneurysm, which had been managed 9 years previously with an aortoplasty. He was admitted to hospital after 3 weeks of dysphagia for solid food and intermittent substernal discomfort. He had massive bloody vomiting and syncope. An emergent computed tomography (CT) scan showed dilatation of the medio-inferior saccular outpouching at the posterior aortic arch. An aortoesophageal fistula (AEF) was diagnosed and an endovascular stent was placed. An urgent upper gastrointestinal endoscopy revealed fresh blood and necrotic tissue at about 30 cm from the incisors. A Sengstaken–Blakemore tube was immediately inserted and the bleeding stopped.
Clinical Alert Stimulates Changes in Practice
Authors: C. Vanchieri
Journal: JNCI Journal of the National Cancer Institute (1988)

Journal Article Clinical Alert Stimulates Changes in Practice Get access Cori Vanchieri Cori Vanchieri Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 80, Issue 15, 5 October 1988, Pages 1185–1186, https://doi.org/10.1093/jnci/80.15.1185 Published: 05 October 1988
Monitoring Circulating Virus-Specific CD4+ T Cells and Probiotic Effect in an Experimental Rhinovirus Challenge Model
Authors: Lyndsey M. Muehling, Ronald B. Turner, Rachana Agrawal, Paul W. Wright, James T. Patrie, Sampo J. Lahtinen, Markus J. Lehtinen, William W. Kwok, Judith A. Woodfolk
Journal: Journal of Allergy and Clinical Immunology (2016)
FRI0308 Reducing gender disparities in willingness to consider total knee replacement (TKR): The impact of a brief educational intervention
Authors: E. Volkmann, A. David, J. Fitzgerald
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Studies suggest patients' willingness to consider TKR for osteoarthritis (OA) varies by gender and that women who undergo TKR have more severe OA and greater functional disability than men at the time of surgery.<sup>1</sup> <h3>Objectives</h3> To evaluate perceptions of TKR among men and women with knee osteoarthritis and to examine the impact of an educational intervention on changes in expectations of health outcomes following TKR. <h3>Methods</h3> Patients with moderate to severe knee OA viewed a video about knee OA treatments and subsequently participated in gender-segregated focus groups addressing patients' questions and concerns regarding TKR. Patients completed baseline and post-intervention questionnaires, which included an adapted Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess post-TKR expectations (0-100 scale with higher scores reflecting worse outcomes). <h3>Results</h3> At baseline, women (N=78) had poorer post-TKR expectations about pain compared with men (N=58) (26.4 vs. 18.2, respectively, p=0.28). Following the intervention, women's post-TKR pain expectations fell to levels comparable to male responders (Pre: 26.4 vs. Post: 18.2, p=0.005); whereas men had no significant change in their expectations scores. Women were also more willing to consider TKR after the intervention (Pre: 2.4 vs Post: 3.1, on a 1-5 Likert scale with higher scores reflecting greater willingness; <i>p</i>=0.020), while men had no significant change in their willingness to consider TKR after the video (Pre: 2.4 vs. Post: 2.6). In focus groups, women discussed risks of TKR more frequently than did men. Women also raised the issue that the risks may outweigh the benefits of TKR; whereas men did not raise this concern. In bivariate analysis of all patients, lower WOMAC post-operative expectation pain scores were correlated with an increased willingness to consider surgery (<i>r</i> =-0.21, <i>p</i>=0.017). Increased risk taking behavior was also associated with increased willingness to consider surgery (<i>r</i>=0.35, <i>p</i>&lt;0.001). In a logistic regression analysis controlling for age, gender and greater risk taking behavior, better WOMAC expected pain scores remained significantly correlated with willingness to consider surgery (OR 1.52, <i>p</i>=0.003). <h3>Conclusions</h3> Perceived post-TKR pain outcomes were independently associated with willingness to consider surgery. Improving patient knowledge of TKR through an educational intervention may help reduce gender disparities in expectations of and willingness to consider TKR. <h3>References</h3> Parsley BS, Bertolusso R, Harrington M, et al. Influence of gender on age of treatment with TKA and functional outcome. Clin Orthop Relat Res 2010;468:1759-64. <h3>Disclosure of Interest</h3> None Declared
Vesicoureteral Reflux to an Ectopically Located Right Kidney Visualized on Indirect Radionuclide Cystography
Authors: VOLKAN BEYLERGIL, ESER LAY ERGÜN
Journal: Clinical Nuclear Medicine (2002)

From Hacettepe University Medical Faculty, Department of Nuclear Medicine, Ankara, Turkey Received for publication July 1, 2001. Revision accepted February 15, 2002. Correspondence: Volkan Beylergil, Hacettepe University Medical Faculty, Department of Nuclear Medicine, 06100 Sıhhiye, Ankara, Turkey. E-mail:[email protected]
Myasthenia Gravis: Report of a Case with Exophthalmos, without Hyperthyroidism, Relieved by Neostigmine
Authors: Harvey A. Hatch
Journal: New England Journal of Medicine (1952)

MYASTHENIA gravis has frequently been described as a clinical entity. It is a disease characterized by abnormal skeletal-muscle fatigability. The cause is unknown. The myoneural junction seems to be the site of the main abnormal reaction. Insufficient acetylcholine or increased motor end-plate resistance appears to block incoming nerve stimuli. Neostigmine, physostigmine, diisopropyl-fluorophosphate and other anticholinesterases decrease this fatigability and may allow almost normal muscular strength. In recent years thymectomy has given occasional good results, and some cures have been reported. This procedure seems to increase the amount of transmitter substance at the myoneural junction. The symptomatology and diagnosis are fairly . . .
AB0684 Proposed criteria for activity, damage and impact of juvenile idiopathic arthritis associated uveitis: consensus effort from the multinational interdisciplinary working group for uveitis in childhood (miwguc)
Authors: I. Foeldvari, A. Heiligenhaus, C. Edelstein, J. Anton, T. Saurenmann, B. Bodaghi, K. Kotaniem, S. Nielsen, L. Sandfeld, G. Brumm, E. Rabinovitch, A. Ramanan
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Uveitis is the most common extraartricular manifesation of juvenile idiopathic arthritis (JIA). Uveitis, a potentially blinding disorder, is present in approx 10-18% of JIA patients, with a wide spectrum of presentations. Despite advances in treatment of childhood arthritis there are no definitions for assessment of activity, damage and impact of JIA associated uveitis. <h3>Objectives</h3> The purpose of our efforts was to develop and gain consensus on such definitions <h3>Methods</h3> At the second consensus meeting of the MIWGUC group, using a Delphi method we developed definitions for activity, damage and impact of disease based on already published outcome measures [1]. <h3>Results</h3> <h3>Conclusions</h3> We will validate these proposed definitions propsectively in a JIA associated uveitis cohort. Based on the results, we will weight these measures to develop an overall scoring system. <h3>References</h3> Heiligenhaus, A., et al., <i>Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: A consensus effort from the multinational interdisciplinary working group for uveitis in childhood (MIWGUC).</i> Arthritis Care Res (Hoboken), 2012. <h3>Disclosure of Interest</h3> None Declared
AB0329 The new 2010 ACR/eular classification criteria as possible predictor of treatment responses in early RA: Results from the swiss prospective observational RA cohort
Authors: R. Mueller, T. Kaegi, A. Finckh, J. von Kempis
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> New ACR/EULAR criteria for classification of rheumatoid Arthritis (RA) were recently proposed. <i>The aim of this analysis was to examine the impact of fulfilling the 2010 ACR/EULAR criteria at the initial visit on longterm progression of disease activity</i> <h3>Methods</h3> This is an observational cohort study within the Swiss RA registry. For this analysis we included patients suffering from an untreated early RA or undifferentiated arthritis (disease duration ≤1 year). The diagnosis was defined by the data-entering physician. Baseline diagnosis of RA/UA was reassessed according to the 2010 ACR/EULAR criteria scoring from 0 -10. The assessment was based on the 28 joint count for joint involvement (0-5 points) as defined by the criteria. Elevated acute phase reactants were determined if C reactive protein was ≥10mg/l or erythrocyte sedimentation rate was ≥28mm/h (1 point). Disease duration was determined positive (1 point) if the patient suffered ≥42 days starting from the first reminiscent symptoms. As the level of rheumatoid factor and CCP antibodies are not entered into the data base 0 points were dedicated to rheumatoid factor (RF) neg and anti citrullinated protein antibody (ACPA) neg patients, 2point for RF pos or ACPA pos patients and 3 points for RF pos and ACPA pos patients. We evaluated fulfilment of the 2010 ACR/EULAR criteria at baseline. The clinical picture was assessed comparing patients depending on fulfilling (≥6 points) the 2010 ACR/EULAR criteria at baseline. <i>Our primary outcome was DAS28 and HAQ scores at 2 years</i> <h3>Results</h3> <i>A total number 494 patients fulfilled inclusion criteria</i>. 129 patients fulfilled the 2010 ACR/EULAR at baseline, 365 were not classifiable as RA according to the new criteria at baseline. Mean disease duration, sex and disease activity at inclusion for ACR/EULAR neg and ACR/EULAR pos patients did not differ significantly. Of the patients fulfilling ACR/EULAR at baseline 67.4% were RF positive and 54.3% ACPA positive compared to 50.74% and 17.5%, respectively, for patients not fulfilling the ACR/EULAR criteria at baseline (p&lt;0.05). The patients fulfilling ACR/EULAR criteria at baseline developed a 50.74% reduction of disease activity as assessed by DAS 28 scores as compared by 28.41% reduction in ACR/EULAR negative patients independent on the treatment applied. HAQ scores decreased in parallel by 90% and 30%. No significant differences in the treatment protocol were found. <h3>Conclusions</h3> <i>The 2010 ACR/EULAR criteria appear to select a subset of patients who will evolve more favorably on conventional antirheumatic therapy.</i> Our data suggest that treatment decisions according to the new ACR/EULAR criteria for RA allows selecting patients who are more likely to respond to the anti rheumatic therapy. <h3>Disclosure of Interest</h3> None Declared
Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study
Authors: Esther J J Habets, Linda Dirven, Ruud G Wiggenraad, Antoinette Verbeek-de Kanter, Geert J Lycklama À Nijeholt, Hanneke Zwinkels, Martin Klein, Martin J B Taphoorn
Journal: Neuro-Oncology (2015)

Abstract Background Stereotactic radiotherapy (SRT) is expected to have a less detrimental effect on neurocognitive functioning and health-related quality of life (HRQoL) than whole-brain radiotherapy. To evaluate the impact of brain metastases and SRT on neurocognitive functioning and HRQoL, we performed a prospective study. Methods Neurocognitive functioning and HRQoL of 97 patients with brain metastases were measured before SRT and 1, 3, and 6 months after SRT. Seven cognitive domains were assessed. HRQoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BN20 questionnaires. Neurocognitive functioning and HRQoL over time were analyzed with linear mixed models and stratified for baseline Karnofsky performance status (KPS), total metastatic volume, and systemic disease. Results Median overall survival of patients was 7.7 months. Before SRT, neurocognitive domain and HRQoL scores were lower in patients than in healthy controls. At group level, patients worsened in physical functioning and fatigue at 6 months, while other outcome parameters of HRQoL and cognition remained stable. KPS &amp;lt; 90 and tumor volume &amp;gt;12.6 cm3 were both associated with worse information processing speed and lower HRQoL scores over 6 months time. Intracranial tumor progression was associated with worsening of executive functioning and motor function. Conclusions Prior to SRT, neurocognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Lower baseline KPS and larger tumor volume are associated with worse functioning. Over time, SRT does not have an additional detrimental effect on neurocognitive functioning and HRQoL, suggesting that SRT may be preferred over whole-brain radiotherapy.
No evidence of transmission from an acute case of hepatitis A in a foodhandler: follow-up of almost 1,000 potentially exposed individuals, London, United Kingdom, April 2012
Authors: V Hall, A Abrahams, D Turbitt, S Cathcart, H Maguire, S Balasegaram
Journal: Eurosurveillance (2014)

Identification of acute hepatitis A virus (HAV) infection in a foodhandler in a London hotel led to a large incident response. We identified three potentially exposed groups: hotel staff who had regularly consumed food prepared by the case and shared toilet facilities with the case, patients who shared the same hospital ward as the case and hotel guests who consumed food prepared by the case. We arranged post-exposure HAV vaccination for all 83 potentially exposed hotel staff and all 17 patients. We emailed 887 guests advising them to seek medical care if symptomatic, but did not advise vaccination as it was too late to be effective for most guests. Through the International Health Regulations national focal points and the European Union Early warning and response system (EWRS), we communicated the details of the incident to public health agencies and potential risk of HAV transmission to international guests. Potentially exposed hotel staff and guests were asked to complete an online or telephone-administered questionnaire 50 days following possible exposure, to identify any secondary cases. Survey response was low, with 155 responses from guests and 33 from hotel staff. We identified no secondary cases of HAV infection through follow-up.
Communicating in Organizations, Part II
Authors: Jay A. Harolds
Journal: Clinical Nuclear Medicine (2012)

Team projects are an important part of the innovative work done in large organizations. Individuals from various portions of the department or organization are chosen who have different areas of expertise, backgrounds, and personalities. In a properly functioning team, the group decisions made will be superior to those made by any individual on the team. There are many different conversations that are necessary during a team project to make sure that all goes optimally, and this article will focus on communication tips for leaders when starting a team.
Case 3-2016
Authors: Patricia M. Guglietta, Christopher J. Moran, Daniel P. Ryan, Pallavi Sagar, Amelia E. Huck
Journal: New England Journal of Medicine (2016)

A 9-year-old girl with chronic constipation was seen in the gastroenterology clinic because of increasingly frequent episodes of abdominal pain with associated nonbilious vomiting. A diagnosis was made.
Efficacité des larges mucosectomies colorectale: analyse d'une cohorte de 220 résections chez 188 patients
Authors: H Nawfal, D Tougeron, M Wangermez, M Beauchant, C Monegier du Sorbier, F Charier, T Barrioz
Journal: Endoscopy (2013)

L'exérèse des polypes adénomateux diminue le risque de cancer colorectal. Il persiste néanmoins un risque lié aux résections incomplètes ou aux polypes non détectés. La prise en charge optimale des lésions adénomateuses non polypoïdes est donc un enjeu important en endoscopie digestive. La faisabilité et l'efficacité de la mucosectomie est évaluée à travers les taux de complications et de récidives. L'analyse de ceux-ci, notamment en fonction de la morphologie de la lésion, pourrait optimiser la technique de résection. Le but de l'étude a été d'évaluer et d'analyser les taux de complications et récidives des larges mucosectomies colorectales.