tbuckley/cabot-search huggingface dataset:
&lt;TITLE&gt;Coping With Back Pain&lt;/TITLE&gt;
Journal: JAMA (2000)

any individuals have an occasional backache, but when the pain becomes severe or you experience the pain more frequently you should consult a doctor.An article in the December 6, 2000, issue of JAMA discusses the reports on a study of frequent use of a back belt (a belt designed to protect the back from possible injury when lifting) by workers who lift merchandise.The researchers did not find any benefits to using a back belt.
Medical Curiosities
Journal: JAMA (1998)

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
Abstract 308: Pupil Diameter Predicts the Outcome in Patients With Cardiopulmonary Arrest
Authors: Shunichi Imamura, Masaaki Miyata, Risa Kamata, Yutaro Nomoto, Issei Yoshimoto, Kenta Ohmure, Hideto Chaenn, Naoya Oketani, Masakazu Ogawa, Shuichi Hamasaki, Mitsuru Ohishi
Journal: Circulation (2018)

Introduction: Early prediction of the outcome in patients with cardiopulmonary arrest (CPA) is important to select the optimal management. The pupil diameter is a simple neurological examination and it predicts the prognosis in patient with stroke. However, the clinical significance of pupil diameter in CPA has not been elucidated. Hypothesis: We hypothesized that pupil diameter would predict the prognosis of CPA patients. Methods: We retrospectively analyzed consecutive 45 patients with CPA and return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation in our hospital. We analyzed age, sex, cause of CPA, time during CPA, pupil diameter at admission and death in hospital. Results: The mean of age was 67±20 years and male were 34 (76%). The median of CPA time was 33 min [25%, 75%; 22, 46] and pupil diameter was 4.8 mm [3.0, 6.0]. The 26 (58%) patients died in hospital after ROSC. There was no significant difference in age and sex between survival (n=19) and dead (n=26). The CPA time was significantly shorter in survival than that in dead (21 min [10, 39] vs 30 min [30, 52], p=0.005). Furthermore, pupil diameter was significantly smaller in survival compared with dead (3.0mm [2.5, 4.3] vs 5.0mm [4.4, 6.0]) (Figure). The receiver-operating characteristic (ROC) curve for survival after ROSC demonstrated that the area under curve was 0.73 and provided an optimal cut-off value at 4.0mm in pupil diameter with 75% sensitivity and 75% specificity. When CPA time was 28 minutes, the area under curve was 0.76, and sensitivity and specificity were 78% and 71%, respectively. Conclusion: As same as CPA time, pupil diameter is suggested to predict the outcome after ROSC in CPA patients.
Abortion Law
Authors: W. G. Mills
Journal: BMJ (1965)

and among this group of patients there is a higher instance of endometrial hyperplasia.So much for cancer of the endometrium- that is, cancer of the corpus uteri." The pill" is known to alter the cytology of a cervical smear, but there is still no evidence that it causes carcinoma of the cervix.Anyway, unlike the endometrium, the health of the cervix can so easily be watched by means of frequent cervical smears.The cause of carcinoma of the ovary remains a mystery, and even the most enlightened research worker would find it difficult to connect the cause with " the pill."To summarize: From the cancer point of view it is my opinion that those women using "' the pill " as a contraceptive may be thoroughly reassured.But in so doing, of course, it must be firmly remembered that intermenstrual spotting, a common side-effect in patients using " the pill " regularly, should be regarded with some suspicion.
Dexamethasone and Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia
Authors: Binghao Zhao, Wenbin Ma
Journal: JAMA (2022)

To the Editor The COVID STEROID 2 trial1 assessed the effect of 12 mg/d vs 6 mg/d of dexamethasone on days alive without life support at 28 days, 28-day mortality, and 90-day mortality in patients with COVID-19 and severe hypoxemia. However, we have some concerns about this study.
Thyrotoxicosis
Authors: O. Garrod
Journal: BMJ (1960)

The treatment of thyrotoxicosis requires both radical 4nd palliative measures.Radical treatment aims at a partial suppression or ablation of the overactive thyroid gland.Suppression can be achieved with antithyroid drugs, and ablation either with radio-iodine or by subtotal thyroidectomy.Surgery will be mentioned only in connexion with pre-operative therapy, and to indicate where it is the treatment of choice.Some form of palliative or symptomatic treatment is usually required, at least until radical measures have taken effect.It may also be needed to control the ophthalmic, cardiac, or neurological complications of the disease. RADICAL TREATMENTChoice of treatment is governed by many factors.Among these are the age of the patient; the severity and duration of the disease; the size, type, and situation of the goitre; the scope and nature of any previous treat- ment; the kind and severity of the complications; the facilities available; and to some extent the wishes and fears of the patient after fair presentation of the various pros and cons.ANTTHYROID DRUGS Iodide Until 1944 iodide was the only safe and effective therapeutic agent for blocking the release of thyroid hormone.Iodide, by ways that are still obscure, causes involution of a toxic goitre when given in relatively large amounts.Its action is rapid, increasing the storage and diminishing the release of thyroid hormone, and so lessening toxicity.Also, it facilitates the surgeon's task by reducing the vascularity and increasing the firmness of the gland.Remissions were not infrequent from its use in mild cases of diffuse toxic goitre.But in severer cases usually the effects were
Book Review Blood Grouping Technic . By Fritz Schiff, M.D., and William C. Boyd, Ph.D. With a foreword by Karl Landsteiner, M.D., Sc.D. (hon.). 8°, cloth, 248 pp., with 45 illustrations and 67 tables. New York: Interscience Publishers, Incorporated, 1942. $5.00.
Journal: New England Journal of Medicine (1943)
Outcomes of Patients With Unfavorable Intermediate-Risk Prostate Cancer Treated With External-Beam Radiotherapy Versus Brachytherapy Alone
Authors: Neal Andruska, Benjamin W. Fischer-Valuck, Ruben Carmona, Temitope Agabalogun, Randall J. Brenneman, Hiram A. Gay, Jeff M. Michalski, Brian C. Baumann
Journal: Journal of the National Comprehensive Cancer Network (2022)

The NCCN Guidelines for Prostate Cancer currently recommend several definitive radiotherapy (RT) options for men with unfavorable intermediate-risk (UIR) prostate cancer: external-beam RT (EBRT) plus androgen deprivation therapy (ADT) or EBRT plus brachytherapy boost with or without ADT. However, brachytherapy alone with or without ADT is not well defined and is currently not recommended for UIR prostate cancer. We hypothesized that men treated with brachytherapy with or without ADT have comparable survival rates to men treated with EBRT with or without ADT.A total of 31,783 men diagnosed between 2004 and 2015 with UIR prostate cancer were retrospectively reviewed from the National Cancer Database. Men were stratified into 4 groups: EBRT (n=12,985), EBRT plus ADT (n=12,960), brachytherapy (n=4,535), or brachytherapy plus ADT (n=1,303). Inverse probability of treatment weighting (IPTW) was used to adjust for covariable imbalances, and weight-adjusted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) hazard ratios (HRs).Relative to EBRT alone, the following treatments were associated with improved OS: EBRT plus ADT (HR, 0.92; 95% CI, 0.87-0.97; P=.002), brachytherapy alone (HR, 0.90; 95% CI, 0.83-0.98; P=.01), and brachytherapy plus ADT (HR, 0.78; 95% CI, 0.69-0.88; P=.00006). Brachytherapy correlated with improved OS relative to EBRT in men who were not treated with ADT (HR, 0.92; 95% CI, 0.84-0.99; P=.03) and in those receiving ADT (HR, 0.84; 95% CI, 0.75-0.95; P=.004). At 10-year follow-up, 56% and 63% of men receiving EBRT and brachytherapy, respectively, were alive (P<.0001). IPTW was used to determine the average treatment effect of definitive brachytherapy. Relative to EBRT, definitive brachytherapy correlated with improved OS (HR, 0.90; 95% CI, 0.84-0.97; P=.009) on weight-adjusted MVA.Definitive brachytherapy was associated with improved OS compared with EBRT. The addition of ADT to both EBRT and definitive brachytherapy was associated with improved OS. These results suggest that definitive brachytherapy should be considered as an option for men with UIR prostate cancer.
Prescription charges.
Authors: B. W. Wyllie
Journal: BMJ (1968)

BaJourhave worked in Indonesia, Uganda, and Korea.Barred from surgery in the United Kingdom, in Indonesia I found myself in sole charge of a 300-bedded hospital with around 200 outpatients a day, responsible for the surgery, medicine, obstetrics, etc., for a population of 45,000 persons, the only doctor in a large tract of land.Thus it is interesting to note that the Interview Board believes that non-specialists who undertake surgery add considerably to their income and interest, but that it "cannot always be in the best interest of the patients."I agree that the practice of surgery adds to one's interest, but working for the impoverished Indonesians I considered myself fortunate to receive the equivalent of 7s.6d. for a radical mastectomy.Further, I wonder on what
Identification of muscle-invasion status in bladder cancer patients using natural language processing and machine learning.
Authors: Ruixin Yang, Di Zhu, Lauren Howard, Amanda M. De Hoedt, Zachary William Abraham Klaassen, Stephen J. Freedland, Stephen B. Williams
Journal: Journal of Clinical Oncology (2022)

447 Background: Mortality from bladder cancer (BC) increases exponentially once it invades the muscle. At the population level, accurate delineation of these patients is challenging. Methods: To develop and validate a natural language processing (NLP) model for automatically identifying muscle-invasive BC (MIBC) patients, aiding in population-based BC research. All patients with a CPT code for transurethral resection of bladder tumor (TURBT) (N = 76,060) were selected from the Department of Veterans Affairs (VA) Corporate Data Warehouse database. A sample of 600 patients (with 2,337 full-text notes) who had TURBT and confirmed pathology results were selected for NLP model development (500 patients) and validation (100 patients). Muscle-invasion (yes/no), unknown, or no cancer, were confirmed by detailed chart review of pathology notes. The NLP performance was assessed by calculating the sensitivity, positive predictive value (PPV), and overall accuracy at the individual note and patient levels. Results: In the validation cohort, the NLP model had overall accuracy of 88% and 92% at the note and patient levels. Specifically, PPV and specificity for predicting muscle-invasion on note level were 83% and 70%, respectively. The model classified non-muscle invasive BC (NMIBC) with 98% sensitivity at both the note and patient levels. Although the sensitivity for MIBC was 70% for note-level determination, the sensitivity was 86% when evaluated at the patient level. When applying the model to 71,200 patients VA-wide, the model classified 13,642 (19%) as having MIBC and 47,595 (66%) as NMIBC. The NLP model was able to identify invasion status for 96% TURBT patients at the population level. Inherent limitations include relatively small training set given the size of the VA population. Conclusions: This NLP model for identifying muscle-invasion at the population level had high accuracy. The NLP model may be a practical and accurate tool for efficiently identifying BC invasion status and may potentially aid in population-based BC research in the VA.
HOMOCYSTEINE METABOLISM
Authors: J. Selhub
Journal: Annual Review of Nutrition (1999)

▪ Abstract Homocysteine is a sulfur amino acid whose metabolism stands at the intersection of two pathways: remethylation to methionine, which requires folate and vitamin B 12 (or betaine in an alternative reaction); and transsulfuration to cystathionine, which requires pyridoxal-5′-phosphate. The two pathways are coordinated by S-adenosylmethionine, which acts as an allosteric inhibitor of the methylenetetrahydrofolate reductase reaction and as an activator of cystathionine β-synthase. Hyperhomocysteinemia, a condition that recent epidemiological studies have shown to be associated with increased risk of vascular disease, arises from disrupted homocysteine metabolism. Severe hyperhomocysteinemia is due to rare genetic defects resulting in deficiencies in cystathionine beta synthase, methylenetetrahydrofolate reductase, or in enzymes involved in methyl-B 12 synthesis and homocysteine methylation. Mild hyperhomocysteinemia seen in fasting conditions is due to mild impairment in the methylation pathway (i.e. folate or B 12 deficiencies or methylenetetrahydrofolate reductase thermolability). Post–methionine-load hyperhomocysteinemia may be due to heterozygous cystathionine β-synthase defect or B 6 deficiency. Early studies with nonphysiological high homocysteine levels showed a variety of deleterious effects on endothelial or smooth muscle cells in culture. More recent studies with human beings and animals with mild hyperhomocysteinemia provided encouraging results in the attempt to understand the mechanism that underlies this relationship between mild elevations of plasma homocysteine and vascular disease. The studies with animal models indicated the possibility that the effect of elevated homocysteine is multifactorial, affecting both the vascular wall structure and the blood coagulation system.
Foodborne disease surveillance in England and Wales 1984. Communicable Disease Surveillance Centre.
Journal: BMJ (1986)

Prepared by the Communicable Disease Surveillance CentreThis annual review of food poisoning and salmonellosis and other acute foodborne disease is based on laboratory reports, reports of food poisoning outbreaks from medical officers for environmental health and environmental health officers, and statutory notifications and "otherwise ascertained cases" of food poisoning.Tables I-III are comparable with those ofprevious years, though table I this year includes reports from medical officers for environmental health and environmental health officers.A new table (table IV) includes incidents of campylobacter infection and foodborne infections and intoxications from other or unspecified causes not included in table I.The definitions of cases, outbreaks, sporadic cases, incidents, statutory notifications, and otherwise ascertained cases of food poisoning remain unchanged.'Laboratory reported cases A total of 15 312 cases of bacterial food poisoning and salmonella infection were reported by laboratories in 1984 (table I), only slightly above the 1983 total, compared with increases of about 20% a year for 1981-3.Statutory notifications of food poisoning rose by 8%, from 12 273 to 13 242, and otherwise ascertained cases by 36%, from 5462 to 7455.number of family outbreaks of salmonella was balanced by an 18% increase in the number of general outbreaks.An additional 83 salmonella outbreaks, mostly family outbreaks reported only by medical officers for environmental health and environmental health officers, accounted for 13% of the overall total.An outbreak of staphylococcal food poisoning due to lasagne imported from Italy was reported in February.Following a warning via the European Community's "food warning hot line" a public health warning was issued by the DHSS on the day the first reports ofillness in England and Wales were received by the Communicable Disease Surveillance Centre.Altogether 47 cases from 10 incidents were associated with this product.2
Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest
Authors: Meshe Chonde, Jeremiah Escajeda, Jonathan Elmer, Frank X Guyette, Arthur Boujoukos, Robert L Kormos, Penny L Sappington, Anson J Smith, Mark Schmidhofer, Christopher M Sciortino, Clifton Callaway
Journal: Circulation (2018)

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.
Abstract 17264: Impaired Right Ventricular and Pulmonary Vascular Function in a Mouse Model of Sickle Cell Disease
Authors: David A Schreier, Diana M Tabima, Jennifer L Philip, Timothy A Hacker, Naomi C Chesler
Journal: Circulation (2018)

Introduction: In sickle cell disease (SCD), red blood cell abnormalities contribute to pulmonary hypertension (PH) in adults and children. Right ventricular (RV) hypertrophy and dilatation are also associated with SCD, likely due to a combination of PH and coronary microvascular disease. The goal of this study was to use a comprehensive hemodynamic approach to quantify the impact of SCD on RV function, RV afterload, and cardiopulmonary reserve. Hypothesis: We hypothesized that mice with SCD would have poor RV function, increased RV afterload, and less cardiopulmonary reserve compared to mice without SCD. Methods: 22 male Berkeley SCD mice and 24 male C57Bl6 mice (CTL) aged 30-32 weeks old were used. Approximately half of each genotype were used for RV function and VVC measurements; RV pressure-volume (PV) loops were obtained at baseline and after a brief inferior vena cava occlusion in an open-chest procedure. In the rest, RV afterload was quantified from simultaneous pulmonary artery pressure and diameter measurements in a closed-chest procedure. All measurements were obtained under normoxic ventilation (21% oxygen) and, subsequently, after acutely hypoxic (AH) ventilation (10% oxygen) to assess cardiopulmonary reserve. Results: RV hypertrophy and increased RV systolic pressure confirmed PH in SCD mice (Figure A). Cardiac output, RV end-diastolic volume, and preload-recruitable stroke work (PRSW) were increased in SCD mice and RV compliance was decreased compared to controls. In response to AH, cardiac output dropped dramatically (Figure B), PRSW decreased, pulmonary vascular resistance increased and compliance decreased more in SCD mice than in CTL mice, indicating decreased cardiopulmonary reserve in SCD mice. Conclusions: SCD mice demonstrate PH, compromised RV function and impaired cardiopulmonary reserve, which mimics clinical cardiopulmonary consequences of SCD and suggests that these mice are a useful tool to investigate mechanical mechanisms of cardiopulmonary progression in SCD.
Correction: Expression patterns and prognostic potential of circular RNAs in mantle cell lymphoma: a study of younger patients from the MCL2 and MCL3 clinical trials
Authors: Mette Dahl, Simon Husby, Christian W. Eskelund, Søren Besenbacher, Søren Fjelstrup, Christophe Côme, Sara Ek, Arne Kolstad, Riikka Räty, Mats Jerkeman, Christian H. Geisler, Jørgen Kjems, Lasse S. Kristensen, Kirsten Grønbæk
Journal: Leukemia (2022)
Does testing accelerate defibrillator failure?
Authors: G. Bashein
Journal: JAMA (1991)

<h3>In Reply.—</h3> From a writer with a face as red as an autumn apple to Dr Adams, Dr Howe, and the 50 some other readers who wrote to point out my misperception: thanks. You are absolutely correct, and I am pleased it is a sled, not a crutch.