tbuckley/cabot-search huggingface dataset:
Navigating uncertainty
Authors: Helen Macdonald
Journal: BMJ (2017)

Thought leaders, creative types, and scientists may embrace uncertainty as a route to creativity, discovery, and fulfilment.But uncertainty is often ignored, feared, and hushed up in clinical medicine.Our editorialist Steven Hatch invites clinicians to stop trafficking in certitude, with diagnoses and research results that sound triumphantly final (doi:10.1136/bmj.j2180).If we sound certain we participate in self delusion and encourage it among our patients.If uncertainty is embraced, its admission "forms the starting point for a more open conversation between patient and clinician," he writes.But uncertainty may not feel creative and liberating in day to day practice, and it can be a driver of excess and harm such as antibiotic prescribing for minor or viral infections.A quest to reduce uncertainty and improve outcomes for patients has a place at the heart of clinical research.In an editorial Anna Mae Scott and Chris Del Mar explain how doctors' uncertainty about acute lower respiratory tract infection can lead them to overprescribe antibiotics for fear of serious infection (doi:10.1136/bmj.j2398).The authors of the linked research paper argue that trials of different antibiotic prescribing strategies-immediate, delayed, or none-for acute infection are inadequately powered to supply data on the harms (doi:10.1136/bmj.j2148).Their prospective cohort study of more than 28 000 people aged over 16 presenting to primary care with acute lower respiratory tract infection finds that harms were uncommon among those who opted to avoid antibiotics.But
An ADC for Triple-Negative Breast Cancer
Journal: Cancer Discovery (2015)

Abstract A phase II study indicates that sacituzumab govitecan (IMMU-132), a Trop-2–specific antibody linked to the irinotecan metabolite SN-38, prolongs the progression-free survival of patients with advanced triple-negative breast cancer. IMMU-132 is well tolerated, causing fewer and more manageable side effects than irinotecan.
Wiener Zeitschrift für Innere Medizin, Vienna
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
Lithium carbonate, haloperidol, and irreversible brain damage
Authors: W. J. Cohen
Journal: JAMA (1974)

Four acutely agitated patients with diagnoses of mania were treated with a combined regimen of lithium carbonate and high doses of haloperidol—a form of therapy that had been used previously in Metropolitan Hospital without reported adverse effects. In these four, severe encephalopathic syndromes developed. Symptoms consisted of lethargy, fever, tremulousness, confusion, and extrapyramidal and cerebellar dysfunction, accompanied by leukocytosis and elevated levels of serum enzymes, blood urea nitrogen, and fasting blood glucose. Two patients suffered widespread, devastating, irreversible brain damage. Two others were left with persistent dyskinesias. Causal factors have not been identified. (<i>JAMA</i>230:1283-1287, 1974)
Recent Contributions to the Medical Problems of Old Age
Authors: Frederic D. Zeman
Journal: New England Journal of Medicine (1957)

Malignant TumorsAlthough the prevalence of malignant tumors increases with the years there is no direct relation. The general opinion is that the longer one lives, the longer one is exposed to the causative agents of cancer, whatever they may be. The slow growth of many tumors in the elderly must be appreciated and used to advantage. This characteristic should also be borne in mind in the interpretation of survival statistics, since a group weighted with older patients may show an apparent benefit unrelated to the procedure involved. Several cases come to mind in which operation for carcinoma of the . . .
Influence of Some Factors on Cadmium Pharmacokinetics and Toxicity
Authors: Krista Kostial, D. Kello, Maja Blanusa, Tea Maljkovic, I. Rabar
Journal: Environmental Health Perspectives (1979)

Cadmium metabolism in the young and in conditions of dietary contamination with ash from coal gasification were investigated. The experiments were performed in adult rats which received ash in the diet (5%) and/or cadmium in drinking water (100 ppm) over a period of five weeks and in sucklings whose mothers were given the same treatment throughout pregnancy and lactation. In pharmacokinetic studies, 115mCd was administered orally or intraperitoneally to determine the intestinal absorption, retention, and distribution. Cadmium toxicity (LD50) was determined in different age groups of animals treated with ash for five weeks before a single oral or intraperitoneal administration of cadmium chloride. After intraperitoneal administration, 115mCd body retention decreased with age and was independent of the dietary treatment. Sucklings had a higher retention in the blood, carcass, and gut than adults. After oral administration, sucklings had a much higher body retention than adults regardless of the dietary treatment of their mothers. Cadmium toxicity was also independent of the dietary treatment. Most striking was a very high oral toxicity of cadmium in sucklings. It is concluded that the young might be at a special risk at the same level of environmental cadmium exposure because of the high oral cadmium toxicity at this age which is most probably due to a high cadmium retention in the gut. It is also concluded that the mixture of elements contained in ash is not likely to influence cadmium metabolism and toxicity in conditions of dietary exposure.
Liver cell uptake and degradation of soluble immunoglobulin G immune complexes in vivo and in vitro in rats
Authors: A Johansson
Journal: Hepatology (1996)

Immune complexes were formed between dinitrophenylated human serum albumin (DNP-HSA) and polyclonal rabbit immunoglobulin G (IgG) anti-DNP antibodies at antibody excess. The antigen was labelled with isotope (125I-tyramine-cellobiose) or fluorochrome, (6-[fluorescein-5-(and-6)-carboxamido] hexanoic-acid, succinimidyl ester). The radiolabelled antigen, native or antibody complexed, was given intravenously to rats. Radioactivity was measured in various organs at 1 hour following injection. The liver was the main site for removal of the antigen as well as of the immune complexes. Within the liver, immune complexes were mainly associated with nonparenchymal liver cells, the total recovery from Kupffer cells being about 10 times greater than from the liver endothelial cells. The uncomplexed radiolabelled antigen was readily degraded by both cells types. After IgG complexing, the degradation decreased, both in Kupffer cells and in liver endothelial cells. In vitro experiments with isolated liver cells, showed that IgG complexing increased antigen uptake to about the same extent in Kupffer cells and in liver endothelial cells. The degradation of both antigen and immune complexes was less efficient in vitro than in vivo. Immune complex uptake in vitro was shown also by confocal fluorescence microscopy in Kupffer cells and in liver endothelial cells. Also in vitro, only minor uptake was found in the hepatocytes. We conclude that both liver endothelial cells and Kupffer cells are involved in the hepatic handling of soluble IgG immune complexes, but we found no evidence for substantial uptake by hepatocytes. (Hepatology 1996 Jul;24(1):169-75)
Errata
Authors: Mr Meggison, William Thomson Barker, Robert M'le'llan, De Campbell, Toom Of, Mr Tuson, Charles Moore, Mr De, Morgan Dixon
Journal: BMJ (1848)

MI$CELLANEOUS.Newcastle-upon-Tyne Infirmary, in which chloroform was also emploved, about four months ago.The fatal event took place about three minutes from the first inhalation of the chloroform, the nail having been removed in the interval.An inquest was held, and the immediate cause of death was stated by Sir John :ife and Dr. Glover to have been congestion of the lungs.The verdict of the jury was, " that the deceased, Hannah Greener, died from congestion of the lungs, from the effect of chloroform, and that no blame can be attached to
Miscellanea Medica
Journal: JAMA (2000)

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
Biochemical epidemiology of gallbladder cancer
Authors: B Strom
Journal: Hepatology (1996)

To evaluate the a priori hypotheses that an increased level of glyco and tauro lithocholic acid, perhaps because of a decreased capacity for hepatic sulfation, contributed to the biochemical epidemiology of gallbladder cancer, a case-control study was undertaken at four hospitals in La Paz, Bolivia, and at one hospital in Mexico City, Mexico. Eighty-four cases with newly diagnosed histologically confirmed gallbladder cancer were compared with 264 controls with cholelithiasis or choledocholithiasis in the absence of cancer and with 126 controls with normal biliary tracts. All study subjects were undergoing abdominal surgery. Interview data were collected for all study subjects, as well as blood, bile, and gallstone specimens when feasible. Sera were analyzed for carcinoembryonic antigen, cholesterol concentration, and total bile acids. Bile specimens were analyzed for carcinoembryonic antigen; and for concentration of bile salts; cholesterol; phospholipids; and the glycine and taurine conjugates of cholic, ursodeoxycholic, chenodeoxycholic, deoxycholic, and lithocholates; sulfoglycolithocholate; and sulfotaurolithocholate. Gallstone specimens were analyzed for the percentage of cholesterol content, the percentage of calcium bilirubinate content, and the percentage of calcium carbonate content. Serum bile acids were increased in cases versus the two control groups (median 11.7 nmol/mL vs. 9.3 nmol/mL for stone controls and 8.2 nmol/L for nonstone controls, P ≤ .02 for each pairwise comparison). Biliary bile acids were markedly decreased in the cases (median 3.98 μmol/mL vs. 33.09 μmol/mL, and 154.0 μmol/L, respectively, P ≤ .0001 for each comparison), even after excluding those with a serum bilirubin higher than 2.0 mg/dL. Bile cholesterol was lower for the cases as well (median 1.70 μmol/mL vs. 4.90 μmol/mL, and 16.81 μmol/ mL, respectively, P ≤ .02), as was the concentration of bile phospholipids (median 2.97 μmol/mL vs. 6.26 μmol/mL, and 52.69 μmol/mL, P = .1 and .0004, respectively). Contrary to our a priori hypothesis, there was no difference between the cases and either control group in their bile concentrations of lithocholate, the proportion of bile acids which were sulfated, or the concentration of nonsulfated lithocholate. However, the cases had a higher concentration of ursodeoxycholate (UDC) (P < .004 for both control groups), especially glycoursodeoxycholate (P < .001 for both control groups). A previously published suggestion that gallstone size differed between cases and controls was not confirmed. In conclusion, cases with gallbladder cancer differed from controls with stones and from controls with normal biliary tracts in their serum and bile biochemistries. These findings may be a reflection of the disease process, or may provide useful clues to its pathogenesis.
Lectures on the Principles of Surgical Diagnosis: Especially in Relation to Shock and Visceral Lesions
Authors: F. Le Gros Clark
Journal: BMJ (1868)

An accomplished and eminent physician, when speaking in his lectures of the value of diagnosis in medicine, and of its forming " the indispensable basis of all advances in physic as a practical art," goes on to observe that, "almost all we know concerning the proper treatment of the sick is originally derived from observation, not of the nature of diseases, but of the effects of remtedies."This apparent paradox embodies an important truth, as it is employed by its author in application to the practice of physic; because, as I took occasionto remark in my last lecture, the actionof medicines canbelearned
Brain injury in boxing. Council on Scientific Affairs
Journal: JAMA (1983)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Pretraining for International Medical Graduates
Authors: Charles D. Sands
Journal: Annals of Internal Medicine (1993)

Letters1 March 1993Pretraining for International Medical GraduatesCharles D. Sands, MD and Daniel W. Jones, MDCharles D. Sands, MDSearch for more papers by this author and Daniel W. Jones, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-5-199303010-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In our combined 30 years of clinical experience in various teaching hospitals, medical schools, and community health programs in Asia, we have worked with many Asian physicians who have received part or all of their graduate training in the United States. Some have had excellent experiences and have returned to their native country to make important contributions in health care. Many who train in the United States, however, acquire technical skills but fail to acquire the basic clinical skills necessary to appropriately apply their technical skills. As Dr. Levey notes [1], this results from a failure to ...REFERENCE1. Levey GS. Internal medicine and the training of international medical graduates: a time for open discussion and new approaches. Ann Intern Med. 1992; 117:403-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byImmigrant Health Care Providers in the United States 1 March 1993Volume 118, Issue 5Page: 396-398KeywordsAntibioticsElectrocardiographyGraduate medical educationHealth careMedical educationPrevention, policy, and public healthReasoningSurgeonsToxicity ePublished: 15 August 2000 Issue Published: 1 March 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Violet Cure
Authors: Valerie Wohlfeld
Journal: JAMA (2007)

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
Can Laboratory Animal Carcinogenicity Studies Predict Cancer in Exposed Children?
Authors: David P. Rall
Journal: Environmental Health Perspectives (1995)

A key to the prevention of childhood cancer is the control of carcinogens to which children are exposed.The first step in this process is to identify those chemicals that are likely to cause cancer in children.The best way to identify carcinogens, today, is the use of the rodent lifetime cancer test-the bioassay.The test has vocal critics, but is adequately reliable if properly used.Perhaps the major criticism concerns the use of the maxi- mum tolerated dose as the highest dose tested.Critics claim that this dose causes cellular killing.The resultant cellular proliferation "fixes" preexist- ing mutations that can lead to cancer.This occurs but in a small fraction of the tests, and the high dose is necessary to achieve statistical sensitivity.All human carcinogens have been shown, when properly studied, to be carcinogenic in rodents.Many human carcinogens were first shown to cause cancer in rodent tests.Regulators rarely ban chemicals that have been demonstrated to be carcinogenic.Further, most chemicals in use today have not been properly tested.The potential errors in the rodent cancer test seem small when compared to the errors in the economic projections of the effects of restricting chemicals.Although not perfect, the rodent cancer test, when used properly, can help protect our children, and us, from cancer.
Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies
Authors: A. Stagnaro-Green
Journal: JAMA (1990)

We screened 552 women who presented to their obstetrician in the first trimester of pregnancy using highly sensitive enzyme-linked immunosorbent assays for the presence of thyroglobulin and thyroidperoxidase autoantibodies and found an incidence of positivity of 19.6%. The tendency to secrete detectable levels of thyroid autoantibodies was significantly correlated with an increased rate of miscarriage. Thyroid autoantibody—positive women miscarried at a rate of 17%, compared with 8.4% for the autoantibody-negative women. Individual levels of thyroglobulin and thyroidperoxidase autoantibodies were similarly related to this increased miscarriage rate, with no evidence of autoantibody specificity in the relationship. Furthermore, the increase in miscarriages could not be explained by differences in thyroid hormone levels, the presence of cardiolipin autoantibodies, maternal age, gestational age at the time of maternal entry into the study, or previous obstetric history. We conclude that thyroid autoantibodies are an independent marker of "at-risk" pregnancy. (<i>JAMA</i>. 1990;264:1422-1425)
Medical Evaluations of Healthy Persons
Journal: JAMA (1983)

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
Physician Service Opportunities Abroad
Authors: M. F. Goldsmith, P. Gunby
Journal: JAMA (1996)

THE DIRECTORY on the following pages lists organizations that offer US physicians short-term and long-term service opportunities overseas. It is the fifth such directory to be published in<i>JAMA</i>since 1984. Organizations that indicated they no longer provide such opportunities have been dropped, and those heard from since 1993, when the last directory appeared, have been added. Listing does not imply endorsement by the American Medical Association, but any organization that wishes to be listed in the future may send the relevant information to<i>JAMA</i>at any time. <h3>Aspects to Consider</h3> Physicians who find opportunities of interest in the directory are reminded that there are many things to consider before packing their bags. Among these considerations are the following: <h3>Licensing.</h3> —What are the licensing requirements for a physician practicing in a particular country or program? If a visiting US physician needs a special license, how can it be obtained and