tbuckley/cabot-search huggingface dataset:
Decision Rules for the Use of Radiography in Acute Ankle Injuries
Authors: Ian G. Shell
Journal: JAMA (1993)

<h3>Objective.</h3> —To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. <h3>Design.</h3> —Survey prospectively administered in two stages: validation and refinement of the original rules (first stage) and validation of the refined rules (second stage). <h3>Setting.</h3> —Emergency departments of two university hospitals. <h3>Patients.</h3> —Convenience sample of adults with acute ankle injuries: 1032 of 1130 eligible patients in the first stage and 453 of 530 eligible patients in the second stage. <h3>Main Outcome Measures.</h3> —Attending emergency physicians assessed each patient for standardized clinical variables and classified the need for radiography according to the original (first stage) and the refined (second stage) decision rules. The decision rules were assessed for their ability to correctly identify the criterion standard of fractures on ankle and foot radiographic series. The original decision rules were refined by univariate and recursive partitioning analyses. <h3>Main Results.</h3> —In the first stage, the original decision rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.97 to 1.0) for detecting 121 malleolar zone fractures, and 0.98 (95% CI, 0.88 to 1.0) for detecting 49 midfoot zone fractures. For interpretation of the rules in 116 patients, κ values were 0.56 for the ankle series rule and 0.69 for the foot series rule. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. In the second stage, the refined rules proved to have sensitivities of 1.0 (95% CI, 0.93 to 1.0) for 50 malleolar zone fractures, and 1.0 (95% CI, 0.83 to 1.0) for 19 midfoot zone fractures. The potential reduction in radiography is estimated to be 34% for the ankle series and 30% for the foot series. The probability of fracture, if the corresponding decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.8%) in the ankle series, and 0% (95% CI, 0% to 0.4%) in the foot series. <h3>Conclusion.</h3> —Refinement and validation have shown the Ottawa ankle rules to be 100% sensitive for fractures, to be reliable, and to have the potential to allow physicians to safely reduce the number of radiographs ordered in patients with ankle injuries by one third. Field trials will assess the feasibility of implementing these rules into clinical practice. (<i>JAMA</i>. 1993;269:1127-1132)
Mental Health
Authors: George E Vaillant
Journal: American Journal of Psychiatry (2003)

OBJECTIVE: Only in the last 30 years has psychiatry begun to develop empirical approaches to conceptualizing and assessing positive mental health. Six models of mental health are reviewed here. METHOD: The author points out pitfalls in research on mental health, e.g., equating average with healthy, failing to distinguish trait from state, overlooking cultural norms, and conversely, blindly accepting the culture’s values. He describes the six models and provides history and research needs for each. RESULTS: The first model, being “above normal,” is epitomized by DSM-IV’s axis V, the Global Assessment of Functioning Scale. High scores represent “superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities.” The goal of the second model, positive psychology, is intervention to maximize positive qualities, such as self-efficacy. Maturity and Erikson’s four developmental tasks (identity, intimacy, generativity, integrity) are the basis of the third model. The author adds two other tasks: career consolidation and “keeper of the meaning.” The fourth model is emotional or social intelligence, the ability to read other people’s emotions. Surprisingly, subjective well-being, the fifth model, is as much a characteristic of temperament as of a benign environment. The last model, resilience, is epitomized by DSM-IV’s Defense Function Scale, which categorizes coping mechanisms in terms of adaptational value. CONCLUSIONS: As with the blind men and the elephant, each model describes only some aspects of mental health. Further research may reveal the contribution of each.
Cavitating lung lesions
Authors: G. A. Alvero
Journal: JAMA (1974)

<h3>History</h3> A 45-year-old woman was admitted to the hospital for further evaluation of a dry cough and generalized malaise of seven months' duration. Four years ago, the patient had had stage II carcinoma of the cervix that was treated with cobalt therapy and radium-seed implantation. Biannual chest roentgenograms during the interval had been interpreted as normal. Physical examination showed no abnormalities, except for some nondiscrete small lymph nodes palpable in the anterior area of the neck. Tuberculin test as well as skin and serologic tests for fungal diseases were negative. The remainder of the laboratory examinations gave normal results. Admission chest roentgenogram is shown in the Figure. <h3>Diagnosis</h3> Carcinoma of the cervix with cavitary metastases to the lungs. <h3>Comment</h3> The Figure shows three nodular lesions in the lungs, two in the left lung and one in the right, each approximately 2 1/2 cm in diameter. All lesions show central cavitation
Characteristics of drug abusers admitted to a psychiatric hospital
Authors: L. J. Hekimian
Journal: JAMA (1968)

One hundred and twelve drug abusers admitted to Bellevue Psychiatric Hospital were studied from a social, motivational, psychiatric, and pharmacological view. Heroin users were usually sociopathic and were costing the city $10 million a day in crimes to support their habit. Emotionally disturbed but younger groups tended to use marihuana, amphetamines, and hallucinogens. Fifty percent of this group were considered to be schizophrenic before taking drugs and 37% required state hospitalization. Thus, protracted psychotic states thought to be due to drug ingestion may be due to preexisting mental disturbances. A desire for euphoria, possibly stemming from underlying depression, was most frequently the reason given for drug abuse. Influences by friends or environment was the second most frequent reason. Almost all patients had experiences with drugs other than the one which caused admission to the hospital.
A prepaid medical plan. Cost, use, and effects in a retirement home
Authors: W. M. Bortz
Journal: JAMA (1977)

A model experience of a prepaid medical plan for a group of people is analyzed. No-barrier cost and physician access lead to altered use characteristics. Among these are increased physician, nurse, and nursing home use, and decreased hospital use. The overall cost is increased. Any comprehensive health-care plan that would propose comprehensive first-dollar coverage would likely encounter similar use characteristics. (<i>JAMA</i>238:1269-1271, 1977)
Patient Histories
Authors: Amit Majmudar
Journal: JAMA (2006)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Characterizing the young patient with aortic dissection: Results from the International Registry of Aortic Dissection (IRAD)
Authors: James L. Januzzi, Eric M. Isselbacher, Rosella Fattori, Jeanna V. Cooper, Dean E. Smith, Kim A. Eagle, Christoph A. Nienaber, Linda A. Pape
Journal: Journal of the American College of Cardiology (2003)
Notes/News
Authors: A Woolf
Journal: Annals of the Rheumatic Diseases (1995)

European Rheumatologists in Training (EULAR Standing Committee for Education and Training) EURORITS Travel Bursary Scheme was established to improve the interaction between junior rheumatologists in different European countries and increase their awareness, knowledge and experience of rheumatology as practised throughout Europe.To enable this, the EULAR Standing Committee for Education and Training will help arrange visits of one to two weeks to centres in other European countries and, if possible, offer a travel bursary made available by EULAR, national rheumatological societies, and the pharmaceutical industry.Visits may be to any centre of choice, but several departments in various European countries are prepared to host such visits occasionally; details are available on request.
Update: Newborn Screening for Sickle Cell Disease—California, Illinois, and New York, 1998
Journal: JAMA (2000)

Sickle cell disease (SCD) is a common single-gene disorder that affects three of every 1000 black newborns and approximately 50,000 persons in the United States. Children affected with SCD are at increased risk for severe morbidity (e.g., severe hemolytic anemia, splenic dysfunction, pain crises, and bacterial infections) and mortality, especially during the first 3 years of life. In 1993, California, Illinois, and New York collectively accounted for approximately 20% of all births to blacks. All three states offer universal newborn screening for hemoglobinopathies. To assess the effectiveness of newborn screening programs for SCD and for receipt of and compliance with early medical interventions (e.g., penicillin prophylaxis and pneumococcal vaccination and other vaccination patterns), a 3-year collaborative follow-up study was conducted from 1995 through 1998 in California, Illinois, and New York. This report summarizes the results of this study, which demonstrate the difficulty in retrospectively finding children who were screened at birth so that data for evaluating program effectiveness can be assessed.
AERIAL TRANSMISSION OF TYPHOID FEVER.
Journal: JAMA (1992)

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
GASTROENTEROLOGY
Journal: JAMA (1970)

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
OHIO AGAIN ACTS TO AID ITS HOSPITALS
Journal: JAMA (1933)

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
The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study
Authors: Rupert W. Major, David Shepherd, James F. Medcalf, Gang Xu, Laura J. Gray, Nigel J. Brunskill
Journal: PLoS Medicine (2019)

Background The Kidney Failure Risk Equation (KFRE) uses the 4 variables of age, sex, urine albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) in individuals with chronic kidney disease (CKD) to predict the risk of end stage renal disease (ESRD), i.e., the need for dialysis or a kidney transplant, within 2 and 5 years. Currently, national guideline writers in the UK and other countries are evaluating the role of the KFRE in renal referrals from primary care to secondary care, but the KFRE has had limited external validation in primary care. The study's objectives were therefore to externally validate the KFRE's prediction of ESRD events in primary care, perform model recalibration if necessary, and assess its projected impact on referral rates to secondary care renal services. Methods and findings Individuals with 2 or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR values < 60 ml/min/1.73 m2 more than 90 days apart and a urine ACR or protein-to-creatinine ratio measurement between 1 December 2004 and 1 November 2016 were included in the cohort. The cohort included 35,539 (5.6%) individuals (57.5% female, mean age 75.9 years, median CKD-EPI eGFR 51 ml/min/1.73 m2, median ACR 3.2 mg/mmol) from a total adult practice population of 630,504. Overall, 176 (0.50%) and 429 (1.21%) ESRD events occurred within 2 and 5 years, respectively. Median length of follow-up was 4.7 years (IQR 2.8 to 6.6). Model discrimination was excellent for both 2-year (C-statistic 0.932, 95% CI 0.909 to 0.954) and 5-year (C-statistic 0.924, 95% 0.909 to 0.938) ESRD prediction. The KFRE overpredicted risk in lower (<20%) risk groups. Reducing the model's baseline risk improved calibration for both 2- and 5-year risk for lower risk groups, but led to some underprediction of risk in higher risk groups. Compared to current criteria, using referral criteria based on a KFRE-calculated 5-year ESRD risk of ≥5% and/or an ACR of ≥70 mg/mmol reduced the number of individuals eligible for referral who did not develop ESRD, increased the likelihood of referral eligibility in those who did develop ESRD, and referred the latter at a younger age and with a higher eGFR. The main limitation of the current study is that the cohort is from one region of the UK and therefore may not be representative of primary care CKD care in other countries. Conclusions In this cohort, the recalibrated KFRE accurately predicted the risk of ESRD at 2 and 5 years in primary care. Its introduction into primary care for referrals to secondary care renal services may lead to a reduction in unnecessary referrals, and earlier referrals in those who go on to develop ESRD. However, further validation studies in more diverse cohorts of the clinical impact projections and suggested referral criteria are required before the latter can be clinically implemented.
Giving Pediatric Immunizations the Priority They Deserve
Authors: Kenneth S. Polin
Journal: JAMA (1993)

<h3>To the Editor.</h3> —I wish that the Editorial by Dr Shalala<sup>1</sup>was more realistic. Our new Secretary of the Department of Health and Human Services has an approach that is not going to improve the current state of affairs in our population. Here in Chicago, the Board of Health offers vaccines at no cost to recipients. We also have programs to bring public health nurses to some of the economically disadvantaged communities to immunize the children who are otherwise not going to the clinics. Although it would seem that such programs would ensure vaccine compliance, such is not the case. It is important for those in positions of power to realize that what would seem to be a solution does not work when the hypothetical meets the real world. "Negotiating" the price to reduce the costs of the vaccines is unrealistic. There are certainly profits being made by some
Error in Abstract
Journal: JAMA (2016)

Gonzalo Hernández, MD, PhD; Concepción Vaquero, MD; Laura Colinas, MD; Rafael Cuena, MD; Paloma González, MD; Alfonso Canabal, MD, PhD; Susana Sanchez, MD; Maria Luisa Rodriguez, MD; Ana Villasclaras, MD; Rafael Fernández, MD, PhD
CSF lactic acid levels an aid to diagnosis
Authors: William Check
Journal: JAMA (1979)

In cases of suspected infection of the CNS, chemical analyses and differential cell counts of the CSF are helpful but not always decisive in differentiating between a bacterial and a viral etiology. Gram's stains and cultures are negative in 10% to 30% of cases, especially when antibiotic therapy has been started before lumbar puncture is done. Recent reports, however, indicate that a simple rapid test, determination of the level of lactic acid in the CSF, can accurately discriminate between the two causes of meningitis. The test can also aid in differentiating between two forms of monoarticular arthritis. In one investigation, physicians at the Wadsworth Veterans Administration Hospital in Los Angeles studied 97 patients with a tentative diagnosis of infection of the CNS, based on the presence of fever and neurological signs (<i>J Infect Diseases</i>137:384-390, 1978). For all patients, the CSF was analyzed for number of WBCs and polymorphonuclear leukocytes
Freshly Voided Urine Temperature: A Test for Factitial Fever
Authors: Bonnita M. Nord
Journal: JAMA (1972)

<h3>To the Editor.—</h3> Occasionally the differential diagnosis of the condition of a patient with a fever of unknown origin will include factitial fever.<sup>1,2</sup>Factitial fever is an elevated thermometer reading but normal body temperature due to fraudulent manipulation of the thermometer.<sup>3,4</sup>Once this diagnosis is entertained, however, it may be difficult to prove. One method of proof which has been suggested many times is simultaneous determination of the oral or rectal and freshly voided urine temperature.<sup>1-4</sup>The purpose of this paper is to examine the accuracy and practicality of this procedure on a busy general medicine ward. <h3>Materials and Methods.—</h3> The general medicine ward of the 483rd USAF Hospital, Cam Ranh Bay, Vietnam, is a 33-bed open ward. Staffed by one to two nurses and three to five corpsmen (orderlies) during the day, it admits from 5 to 15 clinically ill male servicemen daily, over half of
Correspondence
Authors: NORMAN SARTORIUS
Journal: World Psychiatry (2012)

Dear Editor, Thank you for letting us see the letter by P. Corrigan and M. Angermeier. We think that the guidance on how to combat stigmatization of psychiatry and psychiatrists 1 should be seen within the context of WPA activities concerning stigma. The WPA has implemented the world's largest international collaborative project against the stigma of mental illness 2, a project which generated anti-stigma action in 18 countries of Africa, the Americas, Asia and Europe. Groups that have participated in this project continue to work together and see the reduction of stigma of mental illness and the stigmatization of people who suffer from them as their goal. The WPA, convinced of the importance of this work, also created a scientific section dealing with stigma and sponsored four major conferences (in Leipzig, Queenstown, Istanbul and London) that brought together researchers, members of user and carer organizations, health decision makers and practitioners of medicine and psychiatry. WPA's programs resulted in a large number of publications dealing with various aspects of stigma and its reduction. WPA's congresses over the past two decades regularly included symposia and other events dealing with stigma and ways of reducing it. It was to complement these activities that the WPA included a project dealing with the stigma of psychiatry in its Action Plan 2008–2011 and consequently created a Task Force that was requested to produce guidelines that might help in reducing the stigma that marks psychiatry and psychiatrists. Reducing that emanation of the stigma of mental illness to psychiatry as a profession and a service would increase the interest of students of health professions in psychiatry and improve the prestige of the profession, as P. Corrigan and M. Angermeier say, but would — more importantly — also reduce the reluctance of people with mental health problems to seek help from psychiatric services and significantly contribute to the potential of psychiatrists and other mental health specialists to advocate the needs of people with mental illness and to seek a higher priority for mental health programs in national health plans. Both P. Corrigan and M. Angermeier have helped WPA in its fight to reduce the stigma of mental illness and its consequences in the past. We hope that WPA can count on their continued collaboration in all of its anti-stigma activities, including those that might improve the image of psychiatry and the psychiatrists.