tbuckley/cabot-search huggingface dataset:
The inevitable failure of cost-containment strategies
Authors: Frank E. Samuel
Journal: JAMA (1987)

<h3>To the Editor.—</h3> Dr Schwartz<sup>1</sup>keeps reminding us that health care ration cards are inevitably just around the bend because of our insatiable appetite for health care services and technologies that are very expensive and perhaps fundamentally useless. Although much of what Dr Schwartz says is thoughtful, in at least two respects he is wrong. First, he seems impervious to the alleviation of human suffering made by technologies that make but a marginal change in the big picture. He discusses with extraordinary superficiality advances like coronary angioplasty that make a modest, but real percentage of coronary artery bypass surgery actually—as opposed to statistically—unnecessary. He discusses this particular advance as meaningless, apparently because it isn't important enough to change the big picture. No matter that many candidates for bypass surgery need not endure, among other things, having their breastbones cut down the middle by a surgical saw. And if the
Abstract 3038: Influence Of Beta-blockade On Mitral Regurgitant Volume In Patients With Degenerative Mitral Valve Prolapse
Authors: Ralph A Stewart, Ruvin Gabriel, Owen C Raffel, Brett Cowan, Alistair Young, Gillian Whalley, Chris Occleshaw, Irene Zeng, Andrew Kerr
Journal: Circulation (2007)

Introduction: Beta-blockers may be indicated for treatment of hypertension or atrial arrhythmias in patients with degenerative mitral valve prolapse (MVP) and moderate-severe mitral regurgitation (MR). However the influence of beta-blockade on the mitral regurgitant volume is uncertain. Methods: The influence of metoprolol on regurgitant volume was studied in 25 asymptomatic patients with moderate-severe MR due to MVP in a randomized double-blind cross over study. Metoprolol or placebo were titrated by an independent investigator according to symptoms, blood pressure and resting heart rate (mean dose 119mg, range 23.75 to 195mg/day). Severity of MR was assessed by cardiac magnetic resonance imaging (MRI) and echo-Doppler after 10 –14 days on each treatment. Regurgitant fraction was calculated using MRI from the difference between stroke volume by LV volumetry and aortic forward flow by phase contrast analysis. Results. Conclusion: Although metoprolol decreased heart rate and systolic blood pressure it does not influence the mitral regurgitant volume in patients with degenerative mitral valve prolapse.
Cardiovascular Medicine
Authors: Brian C. Weiford
Journal: JAMA (2005)

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
Symptomatic Carotid Artery Disease And Carotid Endarterectomy
Authors: L. Caplan
Journal: Annual Review of Medicine (1988)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), emerged in China in December 2019 and quickly spread around the globe, killing more than 4 million people and causing a severe economic crisis. ...Read More
Epidemiology of burns. The burn-prone patient
Authors: J. D. MacArthur
Journal: JAMA (1975)

Predisposition to burning was identified by history, by conversation with the family, or by physical examination. Factors that decreased the patient's ability to respond appropriately were considered as predisposing. A consecutive series of 155 hospitalized, burned, adult patients was reviewed. Approximately 50% of the entire series showed predisposition to burning; among the more severe burns, this fraction was 57%. Among women, predisposition was more prominent in all categories than among men. Among women, those predisposed to burning had larger burns and a greater likelihood of dying. Alcoholism led the list of predisposing factors, with senility, psychiatric disorders, and neurological disease following in order. The patient's own home was usually the site of the burn in those predisposed, with the initial ignition being in the patient's hair or clothing, the mattress, bedclothes, or an overstuffed chair. All of the burns occurring in hospital or mental institution patients were among those predisposed to burning. (<i>JAMA</i>231:259-263, 1975)
'Binge' drinkers at Massachusetts colleges. Prevalence, drinking style, time trends, and associated problems
Authors: H. Wechsler
Journal: JAMA (1992)

<h3>Objective.</h3> —To compare drinking patterns among college freshmen with those found among students at similar schools 12 years ago, and to describe in detail the differences between "binge" drinkers and "nonbinge" drinkers. <h3>Design.</h3> —Mailed survey. <h3>Setting.</h3> —Fourteen 4-year colleges in Massachusetts. <h3>Participants.</h3> —A total of 1669 first-year college students. <h3>Main Outcome Measures.</h3> —The survey instrument contains a variety of self-report measures of drinking behaviors, attitudes, and consequences. "Binge" drinking is defined as the consumption of five or more drinks on one or more occasions in the past 2 weeks. <h3>Main Results.</h3> —The proportion of "frequent-heavy" drinkers remained constant between the 1977 and 1989 surveys (30% vs 31% of men; 13% vs 14% of women), but today's students get intoxicated more often and are more motivated to drink to get drunk. The proportion of students who said "to get drunk" was a "somewhat" or "very important" reason for drinking was two to three times as high in 1989 as in 1977. Among students surveyed in 1989, binge drinkers drank greater quantities, with greater regularity, and experienced more intoxication and alcohol-associated problems than did nonbinge drinkers. Close to half of the binge drinkers (46.5% of men, 48.3% of women) were drunk twice or more in the past month, compared with 5% or fewer of the nonbinge drinkers. <h3>Conclusions.</h3> —The stability over time of the prevalence of frequent heavy drinking among college students indicates an apparent failure of both social and institutional policies to alter this behavior. Binge drinkers in particular appear to be a population whose drinking patterns and attitudes place them and those around them at increased risk for adverse consequences. (<i>JAMA</i>. 1992;267:2929-2931)
A Correction.
Authors: Lawrence F. Flick
Journal: JAMA (1894)

Philadelphia, June 4, 1894. <h3>To the Editor:</h3> —In the discussion before the College of Physicians of the city of Philadelphia, on the registration of tuberculosis, on Jan. 12, 1894, I made the following statement: "Dr. Williams, of the Brompton Hospital, has been quoted as an opponent of the theory of contagion, but he has written a paper in which he shows that a large number of nurses of the Brompton Hospital have contracted tuberculosis. I think that he has traced some fifteen or twenty cases." Dr. Williams has since then called my attention to the fact that I misquoted his article, and a re-reading shows that this is true. In my speech I spoke from memory and entirely extemporaneously. The fifteen or twenty cases which I credited to nurses occurred among persons who had been employed in one capacity or another about the hospital and really only one case occurred
Thinking Men
Authors: E. J. H.
Journal: Annals of Internal Medicine (1963)

Editorials1 March 1963Thinking MenE. J. H.E. J. H.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-3-556 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptArrival of the New Year was followed shortly by that of a new publication, Physiology for Physicians, coming from the American Physiological Society under the editorial direction of Dr. Julius H. Comroe, Jr. Each month this new organ will present, in 4 to 8 pages, one paper showing the pertinence of current physiological knowledge to clinical problems.Borrowing from Madison Avenue, Dr. Comroe tells us in his note of introduction thatPhysiology for Physiciansis for thethinkingphysician. We should like to think, therefore, that his new paper will have an enormous circulation. Presumably the articles will be written... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1963Volume 58, Issue 3Page: 556-556 ePublished: 1 December 2008 Issue Published: 1 March 1963 PDF downloadLoading ...
Gastric barotrauma
Authors: Ricardo Küttner Magalhães, Ricardo Marcos-Pinto, Sara Silva, Isabel Pedroto
Journal: Endoscopy (2014)

A 67-year-old woman with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis and related renal involvement was admitted to the emergency department with hemoptysis and respiratory failure. She had signs of respiratory distress, a peripheral O2 saturation of 76 %, hypotension and tachycardia. Noninvasive positive pressure ventilation was performed, but poor adaptation of the patient led to orotracheal intubation. During this procedure, after bag-mask ventilation, the esophagus was intubated twice with positive pressure, due to technical difficulties. Effective invasive ventilation was afterwards achieved. On the following day, the patient remained in the intensive care unit and an upper digestive endoscopy was performed because blood in the nasogastric tube and a fall in the patient's hemoglobin level were detected. A proximal esophageal hematoma was observed, compatible with trauma from the ventilation tube ([Fig. 1]) and tortuous longitudinal tears were seen in the lesser curvature of the proximal gastric body ([Fig. 2], [Fig. 3]). These lesions were suggestive of gastric barotrauma, a condition that arises when sudden gaseous distension of the gastric cavity occurs at high pressure and can lead to transmural rupture of the gastric wall. Thus, most of the cases described in the medical literature were approached surgically [1]. Barotrauma occurs in the lesser gastric curvature, probably because this part of the stomach has a lower capacity for distension, owing to the lack of mucosal folds [1] [2]. Gastric barotrauma has been reported after bag-mask ventilation, noninvasive positive pressure ventilation, air swallowing during diving and cardiopulmonary resuscitation [1 – 4]. In the present case, conservative management was successful.
Abstract 1769: Multidetector Computed Tomography allows accurate non-invasive Diagnosis of Etiology of Heart failure as compared with Coronary Angiography and contrast-enhanced MRI
Authors: Jean-Benoit le Polain de Waroux, Anne-Catherine Pouleur, Céline Goffinet, Agnès Pasquet, Jean-Louis Vanoverschelde, Bernhard L Gerber
Journal: Circulation (2007)

Background: The distinction of ischemic vs. non-ischemic origin is essential for prognosis and treatment of patients (pts) with congestive heart failure (CHF). To determine etiology, pts typically undergo invasive coronary angiography (CA). Additional information can be obtained by detecting necrosis or fibrosis on delayed enhanced (DE) magnetic resonance (cMR). Recently, we and others have demonstrated that detection of myocardial necrosis is also feasible by multidetector CT (MDCT) at the time of non-invasive coronary imaging. We therefore evaluated whether such a combined and comprehensive evaluation of coronary anatomy and infarct characterization by MDCT might be useful for determining the etiology of CHF. Methods: Sixty-one consecutive pts (44 males, 60 ± 16 years) with CHF (mean ejection fraction: 26 ± 11%) of undetermined etiology underwent MDCT, DE-MR and CA. Presence of coronary artery disease (CAD) and patterns of DE on MDCT were compared to CA and DE-MR. Results: According to CA, 27 pts (44%) had significant CAD (&gt;50% stenosis in at least one major coronary artery). DE-cMR demonstrated transmural or subendocardial DE in 21 of these 27 pts. These 21 pts were considered to have definite ischemic CHF (group 1). Among the 34 pts without CAD on CA, 23 had no DE on cMR, while 7 (11%) presented midventricular or sub-epicardial DE. These 30 pts were considered to have definite non-ischemic CHF (group 2). Four pts had transmural DE but no CAD and were considered to have probable ischemic CHF (group 3). Finally, 6 pts with CAD on CA, but without DE on cMR were considered to have probable non-ischemic CHF (group 4). Pts were also classified into the same 4 groups using coronary and DE-MDCT. On a per patient basis, agreement between coronary and DE-MDCT and CA/DE-cMR for the diagnosis of patients was excellent (κ=0.87; p&lt;0.001). Coronary and DE-MDCT had 96% sensitivity, 92% specificity and 93% accuracy for detecting definite (group 1) or probable (group 3) ischemic CHF as compared to DE-cMR and CA. Conclusion: Combined coronary and DE-MDCT allows for the accurate differentiation of ischemic vs non ischemic etiology of CHF as compared to CA and DE-cMR. Using this single test is however cheaper and faster than combined use of DE-cMR and CA for establishing etiology of CHF.
Dual HER2 Blockade Helps Prevent Breast Cancer Return
Journal: Cancer Discovery (2017)

Adding pertuzumab to an adjuvant regimen of trastuzumab for women with early-stage HER2+ breast cancer reduces the risk of disease recurrence, especially among those with node-positive and hormone receptor-negative disease. Results from the phase III APHINITY trial, which could help pertuzumab earn full approval for this indication, were presented at the 2017 American Society of Clinical Oncology Annual Meeting.
Phase II trial of irinotecan, carboplatin, and bevacizumab in patients with extensive-stage small cell lung cancer
Authors: D. R. Spigel, J. D. Hainsworth, D. A. Yardley, H. A. Burris, C. Farley, J. Zubkus, C. Meng, P. Murphy, R. Saez, F. A. Greco
Journal: Journal of Clinical Oncology (2007)

18130 Background: Bevacizumab (B) improves survival when combined with chemotherapy in non-small cell lung cancer treatment. Our center previously studied the role of B as maintenance therapy in patients (pts) with limited-stage small cell lung cancer (SCLC). The present multicenter community-based trial was designed to examine the role of B and chemotherapy in previously untreated pts with extensive- stage SCLC (ES-SCLC). Methods: The primary endpoint is to assess the median time to progression (TTP). Eligibility criteria: untreated ES-SCLC, ECOG PS 0–1, measurable disease, and informed consent. Exclusion criteria: hemoptysis, brain metastases, and therapeutic anticoagulation. Treatment: irinotecan (I) 60 mg/m 2 IV D1, 8, 15, and carboplatin (C) AUC=4 IV D1, and B 10 mg/kg IV D1 and 15 every 28D. Pts were restaged every 8 weeks. If no evidence of progressive disease (PD) after 4–6 cycles, pts received B x 6 months. This 2- stage trial was designed to achieve a 40% improvement in historical median TTP of 6 months. Results: 34 pts were enrolled from 2/06 to 12/06 (trial ongoing, n=50 planned). Data are available for 23 pts in this analysis. Baseline characteristics: median age 66 years; male/female, 52%/48%; and ECOG PS 0/1, 35%/65%. The objective response rate was 78% (95% CI 58%-90%), all partial responses. One pt had stable disease and no pts had PD. Four pts were not evaluable due to: comorbidity (off study), 2 pts; too early, 2 pts. With a median follow-up of 7 months, the median TTP and overall survival have not been reached. Grade (G) 3/4 non-hematologic toxicity: diarrhea (26%), hyponatremia, pain, arthralgia, fatigue (13% each), and dehydration, confusion, proteinuria (9% each). G3/4 hematologic toxicity was limited to neutropenia (13%). Other G3/4 toxicities were = 5%. There have been no episodes of G3/4 bleeding or treatment-related deaths. Conclusions: I/C/B appears to be safe and generally well tolerated in pts with ES-SCLC in this preliminary analysis. Further accrual and longer follow-up are necessary to assess median TTP. No significant financial relationships to disclose.
Working with virtually every federal agency
Authors: K. Glasbrenner
Journal: JAMA (1985)

"At ixt one time or another, I expect there's an occasion for the FDA to deal with virtually every other federal agency around," says William Schwemer, assistant associate commissioner, regulatory affairs. Schwemer says that the FDA regularly collaborates with government organizations that are interested in consumer-related problems and that have the resources available to help eradicate them. Some of the federal agencies contacted frequently include the Federal Trade Commission, US Postal Service, Environmental Protection Agency, Occupational Safety and Health Administration, Department of Agriculture, Centers for Disease Control, US Customs Service, branches of the US military, and the National Institutes of Health. Less frequent contacts are made with such agencies as the Department of Commerce, the Securities and Exchange Commission, and the Federeal Bureau of Investigation. In addition, the FDA works with state and local governments, he explains, in conducting product inspections, enforcing regulations, and finding solutions to technical problems. Schwemer
HIV/AIDS early treatment controversy cues new advice but questions remain
Authors: M. F. Goldsmith
Journal: JAMA (1993)

IN THE ATMOSPHERE of confusion about how best to treat people infected with the human immunodeficiency virus (HIV) that was engendered by reports at the Ninth International Conference on AIDS, held last month in Berlin, Germany, a panel convened by a US government agency met 2 weeks later in Bethesda, Md, to consider all the evidence and suggest a new, state-of-the-art, therapeutic approach. At what point physicians should reach into their scant antiretroviral armamentarium for one of the three drugs approved to intervene in the natural history of infection with the virus was the issue addressed by a group of nongovernmental experts on the acquired immunodeficiency syndrome (AIDS). The panel's 18 members convened for 3 days at the National Institute of Allergy and Infectious Diseases and issued somewhat cautious and necessarily complicated new recommendations— the first since 1990—for treating persons with the disease. While there is no regulatory authority behind
Tetanus and the institutionalized elderly
Authors: F. T. Sherman
Journal: JAMA (1980)

<h3>In Reply.—</h3> We did not comment in our recent article about tetanus immunization for the institutionalized elderly, because we endorse the Advisory Committee on Immunization Practices' (ACIP) position that "[tetanus] immunization is a universal necessity."<sup>1</sup> No specific information about the incidence of tetanus in nursing home residents is available from national epidemiologic data. Attempts to estimate the occurrence of this disease in nursing homes by extrapolation from incidence data are likely to be inaccurate, because they ignore qualitative differences between the health of nursing home residents and the general population. For example, infection of chronic skin ulcerations and gangrenous extremities—conditions surely more common in nursing home residents—accounted for 5% of cases of tetanus in one recent study.<sup>2</sup> We do not believe that the relatively low incidence of tetanus can appropriately be used in formulations designed to assess the cost-effectiveness of immunization. Cost-benefit studies are both inaccurate and difficult
Investigating dyspepsia
Authors: R. M. Zagari, L. Fuccio, F. Bazzoli
Journal: BMJ (2008)

#### Summary points Dyspepsia is a complex condition comprising chronic and recurrent symptoms related to the upper gastrointestinal tract. The cardinal symptoms are epigastric pain and discomfort, including postprandial fullness and early satiety, which may overlap with heartburn and regurgitation. Box 1 shows the various definitions of dyspepsia. Around 25-40% of adults in the general population have dyspepsia,1 2 and dyspepsia accounts for 2-5% of all consultations in primary care.3 Although several guidelines have been published,1 2 4 5 6 7 the management of patients with uninvestigated dyspepsia is still controversial. One outstanding dilemma is the choice of the most appropriate empirical strategy8; the benefit of early endoscopy in older patients without alarm symptoms is also widely debated.9 Dyspepsia has a substantial economic impact, and appropriate management is essential to reduce costs.2 This review examines strategies for managing patients with uninvestigated dyspepsia in primary care. We provide an overview of current guidelines and recommendations and report recent evidence from systematic reviews and clinical trials. #### Box 1 Definitions of dyspepsia ##### Symptoms relating to the upper gastrointestinal tract ##### UK (National Institute for Health and Clinical Excellence) ##### US (American Gastroenterological Association, American College of Gastroenterology)
Effects of Environmental Oxidant Stressors on Individuals with a G-6-PD Deficiency with Particular Reference to an Animal Model
Authors: Edward J. Calabrese, Gary Moore, Regina Brown
Journal: Environmental Health Perspectives (1979)

Individuals with a G-6-PD deficiency have long been known to be at increased risk to experience acute hemolysis following exposure to elevated levels of certain oxidant drugs and industrial chemicals. However, the recognition of enhanced susceptibility to environmental (or ambient) pollutants has generally not been considered. Recent theoretical studies have suggested that elevated levels of ambient ozone may be an etiologic factor in the onset of acute hemolysis in the G-6-PD deficient individual. Furthermore, the proposed usage of either chloramines or chlorine dioxide as replacements for chlorine for the disinfection of drinking water should be investigated with respect to their potential adverse effects of individuals at increased risk to oxidant stressors. In order to test these theoretical associations, two mouse strains, one with low and the other with high levels of G-6-PD activity in their red blood cells are being investigated to determine if they simulate human G-6-PD deficient and normal individuals, respectively. Preliminary results indicate that the mouse strain with low G-6-PD activity is markedly more susceptible to sodium chlorite than mice of the high G-6-PD strain. This differential susceptibility to sodium chlorite toxicity between the high and low G-6-PD mouse strains suggests that further research designed to validate the efficacy of this mouse model as a predictor of the human situation is warranted.