tbuckley/cabot-search huggingface dataset:
Perceptions of Pain
Authors: Upasana Tayal
Journal: BMJ (2003)

Medicine has never been the most sociable of professions for providing suitable dinner party chat. But Perceptions of Pain is a striking and thoughtful book of photographs that considers the most common medical symptom and is relevant for medical students, doctors, patients, and the general reader. The book represents eight months of working with patients from St Thomas's pain clinic. All of the patients had intense untreatable pain for between nine and 42 years.

Because pain is subjective, doctors have been accused of …
Pictures of good health
Authors: Alexandra Pitman
Journal: BMJ (2002)

The art world has been kicking up a fuss again. But this time it's about what art, if any at all, should go into NHS hospitals to help give patients a more pleasant environment. As the Saatchi collection makes a gift of contemporary works for hospital display, Alexandra Pitman looks at the ensuing argument



24 Hours, by Mark Cannon. On loan to St George's Hospital, Tooting--Cardiology department



Waterlines by Richard Long is familiar to anyone who spends a lot of time in hospitals. The huge grey print shows the dribbles of waterlines made by the artist on a trek through Portugal and Spain in 1989 and was one of six prints offered to hospitals by the King's Fund in the late 1980s. The contemporary works, by artists including Anish Kapoor and Helen Chadwick, were chosen by art critic Richard Cork and made available at low prices. Many hospitals took up the offer, recognising the importance of the arts in providing a stimulating and invigorating environment for patients.

The idea of using art to enliven the healthcare environment for patients, staff, and visitors can be traced right back to the Renaissance.1 Florence Nightingale observed in 1859 that “variety of form and brilliancy of colour in the objects presented to patients have a powerful effect” and “are actual means of recovery.” The theory is that spartan clinical surroundings can be humanised by introducing colour, interest, and the human touch. Since the goal of health care is to …
Complicated and Uncomplicated Acute Appendicitis Are Different Diseases—Do Not Compare Apples With Oranges—Reply
Authors: Gentian Kristo, Kamal M. F. Itani
Journal: JAMA Surgery (2019)

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
Rates of child sexual abuse are growing in Gambia
Authors: Irina Haivas
Journal: BMJ (2004)

Child sexual abuse, through sex tourism and sexual exploitation by men, is increasing in Gambia, says a new report by the Gambian government and Unicef.

Many tourists from developed countries visit the country mainly to have sex with young adults or children. Tourists in Gambia come mainly from Britain, Sweden, Norway, Denmark, Finland, the Netherlands, and Germany.

“Gambia is a vulnerable target for unscrupulous visitors such as suspected or convicted paedophiles who enter the country in search of a …
Abstract GS1-01: Landscape of the breast tumour microenvironment at single-cell resolution
Authors: A Swarbrick, SZ Wu, D Roden, G Al-Eryani, S O'Toole, E Lim
Journal: Cancer Research (2019)

Abstract Breast cancers are a complex 'ecosystem' of diverse cell types, whose heterotypic interactions play central roles in defining the aetiology of disease and its response to therapy. The next generation of therapies will likely be based upon an integrated understanding of the malignant, microenvironmental and immune states that define the tumour and inform treatment response. However, our poor understanding of the tumour microenvironment (TME) of breast cancers has limited the development and implementation of new drugs that target stromal and immune cells. Single cell genomics (SCG) is a remarkable new platform to examine the compositional, gene expression and other parameters of thousands of cells, rapidly and at scale. We have used a multi-dimensional SCG approach to characterise the TME in a unique cohort of early and metastatic breast cancers with rich clinico-pathological annotation. We have conducted single cell RNA-Sequencing on more than 125,000 cells collected from 22 patients. Malignant cells showed remarkable intra-tumoural heterogeneity for canonical breast cancer features, such as intrinsic subtype, hormone receptor expression and activity, drug targets, drug resistance signatures and transcriptional drivers. Cancer Associated Fibroblasts (CAFs), which are classically studied as a single cell type, were heterogeneous across primary and metastatic sites. Interestingly we identified a myofibroblast-like subset and an inflammatory-mediator subset and propose multi-faceted roles in regulating malignancy and tumour immunity. Distinct transcription factor networks regulated these polarised states. We applied a new method known as CITE-Seq to measure cell surface immune markers and checkpoint proteins simultaneous to RNA-Sequencing. We resolve the tumour-immune milieu with high precision and generate new transcriptional signatures of breast tumour-infiltrating leukocytes. To track lymphocyte clonal dynamics through space and time, we developed a novel method known as RAGE-Seq to permit simultaneous full length lymphocyte receptor- and RNA-sequencing at single cell resolution. We observe clonal expansion and trafficking of CD4+ and CD8+ T lymphocytes between the lymph nodes, blood and tumor of patients. In comparison, B cells were polyclonal, suggesting an absence of antigen-dependent clonal expansion. This data provides by far the most extensive insights into the cellular landscape of breast cancer and will reveal new biomarkers and opportunities for stromal- and immune-based therapy. Citation Format: Swarbrick A, Wu SZ, Roden D, Al-Eryani G, O'Toole S, Lim E. Landscape of the breast tumour microenvironment at single-cell resolution [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS1-01.
Abstract 011: Retinal Signs Are Associated With Increased 20-Year Dementia Risk in the Atherosclerosis Risk in Communities Study
Authors: Jennifer A Deal, A. Richey Sharrett, Marilyn Albert, Karen Bandeen-Roche, Sheila Burgard, Sonia Davis, Rebecca F Gottesman, David Knopman, Thomas Mosley, Barbara Klein, Robert Klein
Journal: Circulation (2018)

Introduction: The microvascular contribution to dementia may be under-recognized because of the inability to visualize the brain microvasculature in vivo. Although the easily-imaged retinal vasculature may be a surrogate measure for that in the brain, large prospective studies of the relationship between retinal vascular signs and dementia are scarce. Hypothesis: Retinal signs are associated with greater subsequent risk of all-cause dementia and etiologic subtype over 20 years in 12482 men and women (mean age of 60 years when retinal signs were measured, 22% African American). Methods: Retinal signs were measured using fundus photography (1993-1995). Presence and etiology of dementia and mild cognitive impairment (MCI) were adjudicated using data collected in 2011-13, including a complete neuropsychological battery and brain magnetic resonance imaging (subset of participants). For participants not attending the 2011-13 visit, dementia cases were identified using the Telephone Interview for Cognitive Status–Modified or informant interview, or by hospitalization or death certificate code. Multivariable-adjusted Cox proportional hazards models and logistic regression were used to quantify the relationship of retinal signs with dementia risk and with etiologic subtype, respectively. Results: During a mean 16 years of follow-up, 1259 (10%) participants developed dementia. Moderate or severe (vs. no) retinopathy (hazard ratio [HR], 1.86; 95% CI: 1.36, 2.55) and generalized arteriolar narrowing, measured as the central retinal arteriolar equivalent (CRAE, narrowest quartile vs. widest three quartiles), (HR, 1.26; 95% CI: 1.09, 1.45) were associated with all-cause dementia. Results did not differ by diabetes, race or APOE ε4 genotype. Retinopathy was associated with cerebrovascular-related dementia and MCI (odds ratio, 2.66; 95% CI: 1.30, 5.42). Conclusions: Retinal photography captures small vascular signs in the eye that are related to increased dementia risk. Emerging techniques, such as optical coherence tomography angiography, may have the sensitivity to provide surrogate indices of microvascular lesions relevant to dementia in older adults.
Dispelling the MMC myths
Authors: Derek Gallen, Shelley Heard
Journal: BMJ (2007)

Derek Gallen and Shelley Heard consider concerns often expressed about the UK Modernising Medical Careers programme The software underpinning the Medical Training Application Service (www.mtas.nhs.uk) will process online application forms, sending them to a scoring panel consisting of trained senior clinicians. For the foundation programme, the computer adds final scores and matches electronically on behalf of the foundation schools. Senior doctors are involved in every application processed by the system. Selection for specialty training will be through a two stage process:
Surgical training needs an upgrade
Authors: Justin Loke
Journal: BMJ (2008)

The surgeons of the future face serious challenges. A major concern is the reduction in surgical training time. For example, the European Working Time Directive has reduced surgical training time by two thirds. The strong response from senior surgeons in the United States to the reduction in surgical training time to just over 80 hours a week (even though this is still nearly twice the European quota) reflects the gravity of the situation. In the United Kingdom, this reduction in training time is exacerbated by the extra foundation year after graduation, which has resulted in an additional year …
Minerva: February 2003
Authors: M Butler, H J C R Belcher
Journal: BMJ (2003)

Spiders inspire legendary levels of fear and anxiety. But an Australian prospective follow up study of 750 people who attended emergency departments with definite spider bites found surprisingly few significant clinical effects. Among these 6% of bites, most caused persistent pain, but no early allergic reactions or necrotic ulcers were recorded, and secondary infection occurred in just seven bites. Widow spiders were the worst culprits, and rapid identification of the type of spider would increase the opportunity of giving antivenin ( Quarterly Journal of Medicine 2002;95:723-31).

Heres the latest search for another use of statins: this time they are being tested as a treatment for multiple sclerosis. American scientists used mouse models to show that atorvastatin prevented disease relapse and lowered levels of inflammation in the nervous system. They say the drug seems to shift the bodys production of destructive T cells, causing it to produce anti-inflammatory T cells ( Nature 2002;420:78-84).

A UK national programme launched in October encourages the reporting of all clinical errors and significant events in order to learn from them. The US healthcare system has recently come under similar close scrutiny. One survey of patients using American emergency departments found that most users …
Minerva: November 2000
Authors: S Chatterjee, S D West, J Wessels
Journal: BMJ (2000)

Minerva was never able to detect ketones on a patient's breath, even when others recognised the characteristic smell from the end of the bed. A small sample of health workers who were tested on their odour discrimination also had trouble with acetone, often mistaking it for alcohol ( Academic Emergency Medicine 2000;7:1168–9). It's equally difficult to distinguish wintergreen from camphor, although probably less clinically important. Participants' poor performance improved slightly on a retest, but only on uncommon smells.

Australian surgeons performed 7887 lower limb amputations in people with diabetes between 1995 and 1998, an average of 13.97 per 100 000 total population ( Medical Journal of Australia 2000;173:352–4). The national diabetes strategy aims to reduce these figures by half by the year 2005, partly by making sure that at least four fifths of people with diabetes get their feet looked at by a doctor once a year.

Raccoons may be cute, but many of them carry raccoon roundworm, an ascarid that can infect children. One 11 month old boy was left severely brain damaged after raccoon roundworm encephalitis (www.pediatrics.org/cgi/content/full/106/4/e56). A close look in his back garden and an adjoining vacant lot revealed 21 raccoon toilet sites, …
Letter by Ke and Shen Regarding Article, “Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease: Results From the Cooper Center Longitudinal Study”
Authors: Chaofu Ke, Yueping Shen
Journal: Circulation (2019)

We read with great interest the work by Abdullah et al, 1 in which the authors examined the long-term association of low-density lipoprotein cholesterol (LDL-C) with cardiovascular disease mortality in a low 10-year risk cohort.According to the results, LDL-C≥160 mg/dL was correlated with increased cardiovascular disease mortality, thus supporting consideration of new LDL-C thresholds for lipid-lowering interventions in low-risk individuals.We appreciate the authors' contribution to an inadequately studied field, but 1 important issue has not been fully addressed by the authors.In the article, hazard ratios of all-cause mortality were calculated for different categories of LDL-C.The results clearly showed that these attenuated hazard ratios were not significant or marginally significant in univariable Cox analyses.Most importantly, results of multivariable Cox analyses were not provided.As indicated in the baseline characteristics given in Table 1, many influential factors of all-cause mortality (eg, sex, age, hypertension, body mass index, and high-density lipoprotein cholesterol) were largely unbalanced between the reference group and the higher LDL-C groups.All of these factors are prone to result in higher all-cause mortalities in the higher LDL-C groups compared with the reference group.After adjustment of these potential confounders, the minimal positive associations of LDL-C with all-cause mortality might vanish or even be reversed.Although this article focused on cardiovascular disease mortality, the ultimate benefit of LDL-C lowering is not justified if elevated LDL-C did not contribute to increased all-cause mortality.This issue should be treated seriously because in a systematic review of 30 cohorts with 68 094 elderly people (≥60 years of age), an inverse association between LDL-C and all-cause mortality was seen in 16 cohorts representing 92% of subjects, and none of the other cohorts found a positive association between LDL-C and all-cause mortality. 2Moreover, statin treatment, the most widely used LDL-C lowering therapy, has been proven to account for a variety of adverse effects such as diabetes mellitus 3 and myalgia. 4Therefore, more rigorous analyses and interpretations of the associations of LDL-C with non-cardiovascular disease mortality and all-cause mortality are essential before drawing conclusions about the clinical implications of LDL-C.
Viewpoint: Convention or convenience?
Authors: Azghar Ali
Journal: BMJ (2007)

Have you ever found yourself wondering, while hunched over a patient trying to elicit the murmur of mitral regurgitation, why your back feels it's being torn apart? Wouldn't it be easier if you just examined the patient from the left side of the bed?

What about palpating an abdomen? Have you often found (or missed, for that matter) a liver or spleen when only using one hand? Wouldn't it be better to use both hands rather than being made to use a one-handed technique …
Comparative analysis of the phase III clinical trials of anti-PD1 monotherapy in head and neck squamous cell carcinoma patients (CheckMate 141 and KEYNOTE 040)
Authors: Sara I. Pai, Sandrine Faivre, Lisa Licitra, Jean-Pascal Machiels, Jan B. Vermorken, Paolo Bruzzi, Viktor Gruenwald, Raul E. Giglio, C. René Leemans, Tanguy Y. Seiwert, Denis Soulieres
Journal: Journal for ImmunoTherapy of Cancer (2019)

Two phase III clinical trials (CheckMate 141 and KEYNOTE 040) have independently demonstrated that overall survival (OS) in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients, who have failed platinum-based therapy, can be improved with anti-PD1 monotherapy. Treatment with nivolumab or pembrolizumab in R/M HNSCC patients led to an improved OS with a hazards ratio (HR) of 0.70 (95%CI 0.51–0.96; <i>p</i> = 0.01) and HR of 0.80 (95%CI 0.65–0.98, <i>p</i> = 0.0161), respectively, as compared to standard of care (SOC) chemo monotherapy regimens (specifically, cetuximab, docetaxel, or methotrexate). The gain in OS was similar in both studies, underscoring the role of anti-PD1 drugs in R/M HNSCC patients. One of the striking discrepancies between CheckMate 141 and KEYNOTE 040 was the OS observed in the control SOC arms (6.9 months median in KEYNOTE 040 versus 5.1 months in CheckMate 141), which inadvertently set a higher threshold in the bio-statistical analysis of KEYNOTE 040 so that the clinical outcome of every patient was influential in the analysis. We perform a comparative analysis of the two studies to identify potential factors in the control arm that can impact clinical trial bio-statistical outcomes and which may have implications for future immunotherapy clinical trial designs.
Student debt is soaring
Authors: Helen Barratt
Journal: BMJ (2002)

Student debt has soared over the past three years, according to the latest NatWest annual survey. The bank anticipates that students finishing in 2002 will feel the full impact of tuition fees and the removal of grants, graduating with record debts of around £10 000 ($14 500; €16). The average graduate debt has increased by a massive £6700 since 1999.

Graduate starting salaries have also risen with today's average graduate earning around £13 500. Many are guaranteed a considerable hole in …
Aβ and tau prion-like activities decline with longevity in the Alzheimer’s disease human brain
Authors: Atsushi Aoyagi, Carlo Condello, Jan Stöhr, Weizhou Yue, Brianna M. Rivera, Joanne C. Lee, Amanda L. Woerman, Glenda Halliday, Sjoerd van Duinen, Martin Ingelsson, Lars Lannfelt, Caroline Graff, Thomas D. Bird, C. Dirk Keene, William W. Seeley, William F. DeGrado, Stanley B. Prusiner
Journal: Science Translational Medicine (2019)

Cellular assays reveal a decline in Aβ and tau pathological conformers in Alzheimer’s disease brain samples.
Rigorous Trial Design Is Essential to Understand the Role of Opioid Receptors in Ketamine’s Antidepressant Effect—Reply
Authors: John H. Krystal, Gihyun Yoon, Ismene L. Petrakis
Journal: JAMA Psychiatry (2019)

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 Psychiatry 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 Psychiatry journal
Viewpoint: Ethicist on the ward round
Authors: Daniel K Sokol
Journal: BMJ (2007)

Not so long ago in the BMJ I quipped that most professional medical ethicists could not distinguish their “gluteus maximus from their lateral epicondyle” and suggested that such ethicists should undergo a short clinical attachment (2006;333:1226 doi: 10.1136/bmj.39055.658762.59).



Soon after publication, a nephrologist kindly invited me to observe a ward round at his hospital. It proved to be a puzzling experience, not because the blood gases, creatinine levels, diagnostic tests, and myriad statistics recited by a junior doctor sounded like one of Mallarme's incomprehensible poems, but because, as the afternoon progressed, I noticed the “patient as person” fading behind this shroud of science. I felt comfortable with my consultant, my team with their dangling stethoscopes; the all knowing computer wheeled by the bedside; and the timid patient, dwarfed by our confident crowd. Ethics seemed a million miles away.

This absence of ethics was most puzzling of all. I spend my days thinking, teaching, and writing about medical ethics, but there, in a group of doctors and with the patient before me, the subject seemed alien. “Think,” I urged myself, “what are the ethical issues here?”

My reverie would soon be interrupted: “Urine output … raised creatinine levels … metabolic acidosis … abdominal x ray.” Even in cases that I knew had obvious …
Loin and low back pain
Authors: Rebecca Leslie, N Ridley
Journal: BMJ (2008)

A 50 year old male bricklayer presented to the emergency department with a five day history of pain in his left loin. He had a history of irritable bowel disease and low back pain. Acute renal colic was suspected and an intravenous urogram examination was performed (figure 1). Thirty minute film from intravenous urogram