tbuckley/cabot-search huggingface dataset:
‘Referral into a Void': Opinions of General Practitioners and Others on Single Point of Access to Mental Health Care
Authors: Rosalind Raine, Simon Carter, Tom Sensky, Nick Black
Journal: Journal of the Royal Society of Medicine (2005)

In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs’ concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues’ skills and good communication. Factors that hamper these must be addressed in the development of this system of referral.
The sewing needle and the knee
Authors: R. H. Ramsey
Journal: JAMA (1967)

A study of 21 cases of sewing needle fragments accidentally broken off in and about the knee joint demonstrates a uniform mechanism of injury. Penetration occurs with the patient kneeling on a carpet into which the needle has lodged. The needle is broken by the sudden extension of the knee in reaction to the pain. Full appreciation of the mechanism of injury should all but eliminate major difficulty (nine of the 21 cases in this series) in surgical recovery of the retained needle fragment.
Radiology Quiz
Authors: Ian C Bickle, Barry Kelly
Journal: BMJ (2001)

This 68 year old ex-publican presented to his GP complaining of difficulty swallowing for the past two months. The difficulty started several weeks ago with solids getting “stuck,” but had become steadily worse. He also complained more recently of pain on swallowing. Over the past three months he admitted to losing 10 kg in weight. He has a history of alcohol dependency and smokes 40 cigarettes a day. His GP sent him to hospital for the urgent procedure seen below.
In vivo regulation of plasminogen function by plasma carboxypeptidase B
Authors: Carmen M. Swaisgood, Detlef Schmitt, Dan Eaton, Edward F. Plow
Journal: Journal of Clinical Investigation (2002)

The major functions of plasminogen (Plg) in fibrinolysis and cell migration depend on its binding to carboxy-terminal lysyl residues. The ability of plasma carboxypeptidase B (pCPB) to remove these residues suggests that it may act as a suppressor of these Plg functions. To evaluate this role of pCPB in vivo, homozygote pCPB-deficient mice were generated by homologous recombination, and the resulting pCPB–/– mice, which were viable and healthy, were mated to Plg–/– mice. Plg+/– mice show intermediate levels of fibrinolysis and cell migration compared with Plg wild-type and deficient mice, reflecting the intermediate levels of the Plg antigen in their plasma. Differences in Plg-dependent functions between pCPB+/+, pCPB+/–, and pCPB–/– mice were then analyzed in a Plg+/– background. In a pulmonary clot lysis model, fibrinolysis was significantly increased in mice with partial (pCPB+/–) or total absence (pCPB–/–) of pCPB compared with their wild-type counterparts (pCPB+/+). In a thioglycollate model of peritoneal inflammation, leukocyte migration at 72 hours increased significantly in Plg+/–/pCPB+/– and Plg+/–/pCPB–/– compared with their wild-type counterparts. These studies demonstrate a definitive role of pCPB as a modulator of the pivotal functions of Plg in fibrinolysis and cell migration in vivo.
MADRID
Journal: JAMA (1920)

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
Resolution after radiotherapy of severe pulmonary damage due to paraquat poisoning
Journal: BMJ (1984)

gerous than their more psychiatrically normal peers.Other less dramatic but important effects of mental illness may indirectly have contributed even more.For example, inability to give a permanent address is known to be a factor in determining custodial remand,4 and, as expected, those with active psychiatric symptoms in general (X2=30 66, df= 1, p <0 0001) and with a
The worldwide prevention of meningococcal infection. Still an elusive goal
Authors: L. H. Harrison
Journal: JAMA (1995)

Few organisms evoke more fear among the public than<i>Neisseria meningitidis</i>, particularly when it occurs in outbreaks and epidemics. The meningococcus is among a limited number of endemic pathogens in industrialized nations that can kill a healthy young adult within several hours. Large epidemics of<i>N meningitidis</i>infection occurred in the United States until 1944 and still occur in the nonindustrialized world. Attack rates can approach 1% and millions of cases can occur during a meningococcal epidemic.<sup>1</sup> The meningococcus is a leading cause of bacterial meningitis and bacteremia in the United States. An estimated 2600 cases occur each year, almost half among children 2 years old and younger.<sup>2</sup>The annual incidence of meningococcal infection is approximately one case per 100 000 population. Survivors of meningococcal infection often suffer severe sequelae.<sup>3</sup>The meningococcus has taken on an increased relative importance in the United States since the decline of
Reply to Nadir I. Osman, Christopher R. Chapple, Sheila MacNeil's Letter to the Editor re: Guido Barbagli, Massimo Lazzeri. Clinical Experience with Urethral Reconstruction Using Tissue-engineered Oral Mucosa: A Quiet Revolution. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2015.05.043
Authors: Guido Barbagli, Massimo Lazzeri
Journal: European Urology (2015)
AMA GRAMS
Journal: JAMA (1972)

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
Catheterization and mortality in elderly patients with acute myocardial infarction
Authors: L. H. Kuller
Journal: JAMA (1995)

<h3>To the Editor.</h3> —Dr McClellan and colleagues<sup>1</sup>unfortunately misinterpret the results from the Health Care Financing Administration administrative hospital discharge database used for the evaluation of invasive coronary diagnostic and therapeutic procedures. The analytic techniques they have applied cannot determine the efficacy or effectiveness of cardiac catheterization or whether they are overused or underused. The problems with their methods of data analysis were discussed in a classic article by Sheps in 1958.<sup>2</sup>In that article, Sheps described the problem of evaluating the efficacy of polio vaccine. For example, consider 100 000 individuals who were given polio vaccine and 100 000 controls. The subsequent rate of clinical polio was 57/100 000 in the controls and 16/100 000 in the intervention group. The difference of 41/100 000, or 0.04%, was so small that policymakers today would probably be advised by outcomes research to reconsider vaccination programs. Now, if we take
RECURRING GONORRHEA.
Authors: HARRY GREENBERG
Journal: JAMA (1899)

tion with catgut and section one-quarter of an inch be¬ low this; 6, closure of the wound with a buried cat¬ gut stitch, and application of a collodion dressing.The entire operation can be performed on both sides in less than ten minutes, without any pain to the pa¬ tient.The wound will heal so perfectly that no scar can be discovered.The advantages of dealing with habitual criminals in this manner can be summed up as follows:1.It would do away with hereditary criminals from the father's side.2. Aside from being sterile the criminal would re¬ main in his normal condition.3. This method would protect the community at large without harming the criminal.4. The same treatment could reasonably be sug¬ gested for chronic inebriates, imbeciles, perverts and paupers.
ERRATUM
Authors: Bart Barlogie, Robert Kyle, Kenneth Anderson, Philip Greipp, Hillard Lazarus, David Hurd, Jason Mccoy, Dennis Moore, Shaker Dakhil, Keith Lanier, Robert Chapman, Jeana Cromer, Sydney Salmon, Brian Durie, John Crowley, Roberto Ciccarelli, Lorenzo Muzio
Journal: Journal of Clinical Oncology (2006)
More Years for the Asking
Journal: JAMA (1941)

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
An attempt to correlate “comprehensive geriatric assessment” (CGA), treatment assignment and clinical outcome in elderly cancer patients: Results of a phase II open study
Authors: G. Mantovani, E. Massa, G. Astara, C. Madeddu, F. M. Tanca, E. Sanna, C. Spiga, L. Deiana
Journal: Journal of Clinical Oncology (2007)

19592 Background and Methods: The design was a prospective Phase II open study. Elderly (age =65 years) cancer patients (pts) of different sites were assigned to 3 different CGA categories: “fit”, “intermediate” and “frail”. Therefore, an appropriate treatment was administered and the clinical outcome was assessed. “Fit” pts were assigned standard chemotherapy, “intermediate” pts tailored (chemo-) therapy, “frail” pts monochemotherapy (as “supportive” therapy) or only “supportive care”. The primary endpoint of the study was to correlate CGA with treatment and clinical outcome which was based on: objective clinical response (RECIST), ECOG PS, toxicity (NCI CTC v.3), survival. Patients who completed at least 3 months of treatment were evaluable. At December 2006, 136 pts were enrolled; 114 (mean age 73.6 years) 104 of whom stage IV were evaluable: 36 “fit”, 36 “intermediate” and 42 “frail”. At baseline no difference was found between the CGA categories as for clinical characteristics (M/F ratio, stage, tumor site) except for ECOG PS which was significantly higher in frail pts (ANOVA test). Results: At 3 months the objective clinical response to the assigned treatment was: 9 CR, 9 PR, 13 SD and 5 PD for “fit” pts; 9 PR, 14 SD and 13 PD for “intermediate” pts; 6 PR, 11 SD and 25 PD for “frail” pts. As for the correlation of CGA categories with treatment and clinical outcome: a significantly higher OR, particularly CR, in favor of fit pts was observed, ECOG PS was maintained significantly higher in frail pts, toxicity was the highest in intermediate pts, the dose intensity was highest in fit pts. At the multivariate regression analisys the independent predictive factors for the clinical response were initial CGA and dose intensity. Conclusions: The study confirms: 1) Fit pts should be treated with the most active regimens not differently from adult pts; 2) the “intermediate” group should be probably better assessed as for inclusion criteria; 3) frail pts need a more exhaustive assessment of the quality of life currently not included in the CGA. In conclusion, the CGA assessment is strongly recommended as an essential tool for the clinical evaluation of elderly pts. Large prospective clinical trials in this field are awaited. No significant financial relationships to disclose.
Nigeria, Farabale
Authors: Stanley P. Bohrer
Journal: JAMA (1966)

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
Radiation May 'Liberate' Virus
Journal: JAMA (1966)

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
Multicenter phase 2 study to identify the optimal neo-adjuvant combination scheme of ipilimumab (IPI) and nivolumab (NIVO) (OpACIN-neo).
Authors: Elisa A. Rozeman, Alexander Christopher Jonathan Van Akkooi, Emilie Routier, Alexander M. Menzies, Hanna Eriksson, Myles Smith, Richard A. Scolyer, Christoph Hoeller, Johan Hansson, Caroline Robert, James M. G. Larkin, Georgina V. Long, Christian U. Blank
Journal: Journal of Clinical Oncology (2017)

TPS9600 Background: The outcome of high risk stage IIIb and IIIc melanoma patients is poor, with a 5 year overall survival (OS) rate of &lt; 50%. Adjuvant high dose IPI significantly improves 5 year progression free survival (PFS) and OS. In stage IV patients the combination of IPI and NIVO improves response rates (RR) and PFS compared to monotherapy, but at cost of higher toxicity. Neo-adjuvant treatment may be a favorable approach as immune checkpoint inhibition (ICI) is of greatest value at the moment of TCR triggering and therefore dependent on the amount of antigen present. The phase Ib OpACIN study comparing neo-adjuvant and adjuvant IPI and NIVO showed that neo-adjuvant treatment is feasible as all patients underwent surgery on time. The neo-adjuvant pathological RR was 80%, although 18/20 patients (90%) stopped early due to ≥1 grade 3 or 4 immune-related adverse events (irAEs). To date (median follow-up 45 wks), none of the 8 responders in the neo-adjuvant arm have relapsed. This raises the question whether the neo-adjuvant IPI and NIVO schedule can be adjusted to reduce toxicity but preserve efficacy. Methods: The aim of the multi-center phase 2 OpACIN-neo trial is to identify an optimal neo-adjuvant combination scheme of IPI and NIVO. 90 patients with resectable stage III melanoma will be randomized 1:1:1 between three combination schemes of IPI and NIVO. Patients in arm A will receive 2 courses standard regimen IPI 3mg/kg + NIVO 1mg/kg q3wks, in arm B IPI 1mg/kg + NIVO 3mg/kg q3wks, and in arm C 2 courses of IPI 3mg/kg q3wks directly followed (2-24hr) by 2 courses NIVO 3mg/kg q2wks. All patients will undergo surgery at week 6. The primary endpoints are rate of grade 3/4 irAEs, pathological RR, and radiologic RECIST 1.1. An interim analysis is planned after 13 patients have been accrued to each arm (according to the Simon 2-stage design). Major inclusion criteria are: ≥1 measurable lymph node metastases (according to RECIST 1.1) that can be biopsied, no history of in-transit metastases in the last 6 months, and naïve for ICI. Baseline biopsies and blood samples (week 0, 6, 12) will be taken for translational research. The first center started inclusion in December 2016, until now 2 patients have been enrolled. Clinical trial information: NCT02977052.
Child health computing.
Authors: E Ross, N Begg
Journal: BMJ (1991)

randomised controlled studies in psoriasis, " insulin dependent diabetes mellitus,'2 and uveitis'3; and promising results have been obtained in rheumatoid arthritis,"4 myasthenia gravis,5 primary biliary cirrhosis,'6 and Crohn's disease.'7Its efficacy has also been shown in uncontrolled trials in the nephrotic syndrome, systemic lupus erythematosus, and various dermatological and haematological disorders, although not in multiple sclerosis." In psoriasis in particular, cyclosporin has been shown to be effective and safe for up to one year provided that the guidelines for treatment are strictly observed. 19Long term experience in these conditions is still limited.Several features are common to these studies in different conditions.Cyclosporin has a quick onset ofeffect (within two to 12 weeks, depending on dosage), but relapse after withdrawing it is almost universal and is in keeping with the reversible inhibitory action of cyclosporin on cytokine synthesis by T lymphocytes.Cyclosporin does not affect the clinical course of the disease.Nevertheless, many patients who are unresponsive to or intolerant of conventional drug treatment may benefit from cyclosporin or achieve a useful reduction in their steroid dosage.Cyclosporin may do far more than simply act on T cells.It seems to be effective in some autoimmune disorders associated with antibodies-for example, pemphigus and pemphigoid and myasthenia gravis.In skin diseases it may well have an anti-inflammatory action through inhibiting eicosanoid synthesis, while in the nephrotic syndrome it may act predominantly through a haemodynamic action to reduce excretion of protein.Because of the possible drug interactions and other adverse effects careful review of all patients is mandatory.Among the guidelines for its safe use are an initial dosage of no more than 5 mg/kg a day, unless a rapid effect is critical, and the maintenance of trough blood concentrations of cyclosporin at 200 ng/ml or less (as measured by radio- immunoassay).If serum creatinine concentrations rise more than 30% above baseline the dose should be reduced.The use of cyclosporin in less advanced disease-for example, in acute type 1 diabetes-has to be individually and carefully balanced against the risks of both the disease and alternative treatment.Drug toxicity may outweigh the apparent benefit of improved efficacy.Long term follow up is essential to monitor blood pressure and to ascertain the risk of chronic irreversible renal impairment and the consequences of chronic immunosuppression.Though further clinical trials of cyclosporin, both alone and in combination, are justified in autoimmune disease, these must be restricted to formal investigations conducted by experienced clinicians skilled in using cyclosporin and with facilities for monitoring the long term risks.Only then will it be possible to pass valid judgment on its value for autoimmune disease.
Physician Attitudes
Authors: John N. Chappel
Journal: JAMA (1977)

PHYSICIAN attitudes are recognized as being a crucial factor in determining medical treatment. Studies of diagnostic practice indicate that the pervasive attitude among physicians is that "it is better to suspect illness than not—better safe than sorry." Yet in the case of chemically dependent persons, that traditionally positive attitude is often reversed. Negative attitudes toward chemically dependent persons are often taught indirectly in the medical school. Pejorative statements made by attending physicians and house staff about "junkies" and "winos" are a familiar part of medical education. Fisher and his colleagues<sup>1</sup>have shown that attitudes toward alcoholic patients are more negative in the second year of medical school and continue until they reach a substantially lower level among house staff. The effects of these negative attitudes have been noted at many levels. <h3>Diagnosis</h3> Diagnosis of drug dependence may be delayed or missed. Chafetz<sup>2</sup>and others have noted that many