tbuckley/cabot-search huggingface dataset:
Confession
Authors: H. James Merchant
Journal: Annals of Internal Medicine (2003)

On Being a Doctor5 August 2003ConfessionH. James Merchant, MDH. James Merchant, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-3-200308050-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Somewhere along the line, we learn that a patient's chart should not be tampered with and to do so is a breach of medical ethics. But I once did, and I think it was the right thing to do. Here's the story.It was a long time ago, as they say, and in another country. I had finished my first year of residency and, as scheduled, went into the Army. I was an OBV, an obligated volunteer. If one did not volunteer for a commission in the service, he would be drafted at an inconvenient time; hence, most of us ... Author, Article, and Disclosure InformationAffiliations: Note: H. James Merchant, MD, is a pseudonym.Corresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoJudging a Confession Sheila Feit Judging a Confession H. James Merchant Metrics Cited byJudging a ConfessionSheila Feit, MD 5 August 2003Volume 139, Issue 3Page: 229-230KeywordsAcademic medicineChartsMedical ethicsPhotographyPregnancyResidencySpermUpper respiratory tract infectionsUterusVasectomy ePublished: 5 August 2003 Issue Published: 5 August 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
THE BOSTON MEDICAL LIBRARY.
Journal: JAMA (1901)

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
Intestinal ischaemia.
Authors: I E Gillespie
Journal: Gut (1985)

Leading article Intestinal ischaemiaEvery gastroenterologist, physician or surgeon, in the course of his day-to-day practice sees hundreds of patients with peptic ulcer, gall stones, diverticular disease, spastic colon, and many other complaints, but will come across only one or two in whom the abdominal symptoms are caused by intestinal ischaemia.It is therefore unrealistic to expect even a very
HEXAMETHYLENAMIN AND SYSTEMIC ANTISEPSIS
Journal: JAMA (1924)

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
Performance of the thrombolysis in myocardial infarction risk index in the National Registry of Myocardial Infarction-3 and -4A simple index that predicts mortality in ST-segment elevation myocardial infarction
Authors: S WIVIOTT, D MORROW, P FREDERICK, R GIUGLIANO, C GIBSON, C MCCABE, C CANNON, E ANTMAN, E BRAUNWALD
Journal: Journal of the American College of Cardiology (2004)
AASLD/ILTS transplant course
Journal: Hepatology (2003)

Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Demetriou AA, Brown RS Jr, Busuttil RW, Fair J, McGuire BM, Rosenthal P, Am Esch JS 2nd, Lerut J, Nyberg SL, Salizzoni M, Fagan EA, de Hemptinne B, Broelsch CE, Muraca M, Salmeron JM, Rabkin JM, Metselaar HJ, Pratt D, De La Mata M, McChesney LP, Everson GT, Lavin PT, Stevens AC, Pitkin Z, Solomon BA. Liver Support Unit, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 8215, North Tower, Los Angeles, CA 90048, USA. [email protected]OBJECTIVE: The HepatAssist liver support system is an extracorporeal porcine hepatocyte-based bioartificial liver (BAL). The safety and efficacy of the BAL were evaluated in a prospective, randomized, controlled, multicenter trial in patients with severe acute liver failure. SUMMARY BACKGROUND DATA: In experimental animals with acute liver failure, we demonstrated beneficial effects of the BAL. Similarly, Phase I trials of the BAL in acute liver failure patients yielded promising results. METHODS: A total of 171 patients (86 control and 85 BAL) were enrolled. Patients with fulminant/subfulminant hepatic failure and primary nonfunction following liver transplantation were included. Data were analyzed with and without accounting for the following confounding factors: liver transplantation, time to transplant, disease etiology, disease severity, and treatment site. RESULTS: For the entire patient population, survival at 30 days was 71% for BAL versus 62% for control (P=0.26). After exclusion of primary nonfunction patients, survival was 73% for BAL versus 59% for control (n=147; P=0.12). When survival was analyzed accounting for confounding factors, in the entire patient population, there was no difference between the 2 groups (risk ratio=0.67; P=0.13). However, survival in fulminant/subfulminant hepatic failure patients was significantly higher in the BAL compared with the control group (risk ratio=0.56; P=0.048). CONCLUSIONS: This is the first prospective, randomized, controlled trial of an extracorporeal liver support system, demonstrating safety and improved survival in patients with fulminant/subfulminant hepatic failure.[Abstract reproduced by permission of Ann Surg 2004;239:660–667; discussion 667–670]
Multicenter phase II study of SIR-sphere plus sorafenib as first-line treatment in patients with nonresectable hepatocellular carcinoma: The Asia-Pacific Hepatocellular Carcinoma Trials Group Protocol 05 (AHCC05).
Authors: P. K. Chow, D. Poon, K. M. Win, H. Singh, H. S. Han, A. Goh, S. Choo, R. H. Lo, S. B. Tan, K. C. Soo
Journal: Journal of Clinical Oncology (2010)

4072 Background: Selective internal radiation therapy (SIRT) is an effective treatment modality for local disease control while sorafenib confers survival benefit albeit modest tumoral response rates. Combined sorafenib/SIRT may confer further survival benefit. This phase II study is pursuant to the phase I trial that established the safety of combination SIRT-sorafenib therapy used in the following method. Methods: Patients with inoperable HCC with or without metastatic disease/vascular involvement were administered Y-90 SIR-sphere (max dose 3 GBq) and subsequently administered sorafenib therapy (400 mg bd). CT scan evaluation was done 3 monthly. Sample size of 35 was based on response rate (CR + PR) of 30% and a no further interest response rate of 10% with type I error of 0.05 with greater than 85% power to reject null hypothesis. Results: 35 patients were enrolled from June 2007 to June 2008. Median age was 62.5 years (range 48–72), 27 were males and 8 female. Median follow up was 34 weeks (10 - 72 weeks). Tumour response was 12% CR (4 cases), 21% (PR) (7 cases), 47% SD (16 cases) and 21% PD (7 cases). There were 3 treatment-related adverse events of grade 3 and above. Median overall survival was 47 weeks (95% CI 34 to 70 weeks). Conclusions: The SIR-sphere and sorafenib combination therapy demonstrated good efficacy in advanced HCC especially in patients without metastatic disease and exceeded the target response rate. This combination therapy should be further assessed in a phase III trial. BCLC CR PR SD PD Median survival B (n = 12) 1 4 7 0 Not reached C (n = 22) 3 3 9 7 36 weeks Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer-Schering Pharmaceutical, Sirtex Medical Bayer-Schering Pharmaceutical, Sirtex Medical Bayer-Schering Pharmaceutical, Sirtex Medical
Antibody Detection in Pernicious Anaemia
Journal: BMJ (1966)

injections of Primolut Depot (17-alpha-hexanoyl- preg-4-ene 3:20-dione), 250 mg.intramuscularly once weekly.She was Rh-positive, group A.On admission her haemoglobin estimation, total, and differential white-cell counts were within normal limits.On 14 October repeat blood count showed her total W.B.C. to be 11,100 cu.mm., of which 14% were eosinophils.From 10 to 24 September she was given A.C.T.H. injections daily, but she declined treatment by corticosteroid drugs.The rash at this stage was "less troublesome"-possibly under the influence of A.C.T.H. Weekly Primolut Depot injections were continued until she left the ward on 21 October.This preg- nancy terminated at seven and a half months with a stillbirth, and on 21 July 1964 pregnancy number five was diagnosed.At that time she complained of itching feet and spots on the arms.This pregnancy also terminated spon- taneously at about 12 weeks.She was next seen here on 11 December 1964 with a three-month history of recurrence of rash, which commenced soon after she began taking Ovulen (ethynodiol acetate 1 mg.-and mestranol 0.1 mg.).The Ovulen was stopped, and one week later the rash was fading.On 30 March she recommenced taking Ovulen, and on 17 April she developed a mild itchy eruption scattered over the trunk and limbs.She resumed her course of "pills" on 26 April, and by 13 May she had an extensive eruption on the trunk and limbs, especially over the
CPR-Not-Indicated and Futility
Authors: Andrew F. Shorr
Journal: Annals of Internal Medicine (1996)

Letters1 January 1996CPR-Not-Indicated and FutilityAndrew F. Shorr, MD, MPHAndrew F. Shorr, MD, MPHWalter Reed Army Medical Center; Washington, DC 20307Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-1_Part_1-199601010-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their recent article, Waisel and Truog [1] attack unilateral do-not-resuscitate policies that use definitions of futility encompassing more than physiologic functioning. They rest their claim on the belief that a physiologically based conception of futility does not lead to the imposition of value judgments on patients. This assertion, however, is flawed. Consider a patient desiring antibiotics for what her physician concludes is a viral illness [2]. In this instance, antibiotic therapy would be futile in a physiologic sense. However, the patient may view her interaction with the physician differently; treatment may give the patient a sense ...References1. Waisel DB, Truog RD. The cardiopulmonary resuscitation-not-indicated order: futility revisited. Ann Intern Med. 1995; 122:304-8. Google Scholar2. Tomlinson T, Brody H. Futility and the ethics of resuscitation. JAMA. 1990; 264:1276-80. Google Scholar3. Cassel EJ. The Nature of Suffering and the Goals of Medicine. New York: Oxford University Pr; 1991:66-81. Google Scholar Author, Article, and Disclosure InformationAffiliations: Walter Reed Army Medical Center; Washington, DC 20307 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1996Volume 124, Issue 1_Part_1Page: 76KeywordsAntibioticsDo not resuscitate ordersEmotionsResuscitation Issue Published: 1 January 1996 CopyrightCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Toxic Evaluation of Organic Extracts from Airborne Particulate Matter in Puerto Rico
Authors: Darwin R. Reyes, Osvaldo Rosario, Jose F. Rodriguez, Braulio D. Jimenez
Journal: Environmental Health Perspectives (2000)

In recent years, several hypotheses have emerged to explain the toxicologic activity of particulate matter. Organic compounds, ultrafine particles, biologic components, and transition metals are some of the constituents that reportedly exert some type of adverse effect on human health. A considerable fraction of the urban particulate matter consists of carbon compounds, which originate mostly from anthropogenic sources. The toxicity of organic fractions from particulate matter have been mainly evaluated by considering their mutagenic activity. This research expands on the toxicologic profile of organic compounds adsorbed to particulate matter, specifically in Puerto Rico, by using the cytotoxic neutral red bioassay (NRB). The NRB uses normal human epidermal keratinocytes or other types of cells to measure the effect on cell viability when exposed to organic compounds associated to the particles in the air. We validated the NRB for particulate matter by using a standard reference material (SRM 1649). We used the NRB to determine toxicologic differences of extracts between an urban industrialized site with anthropogenic activity versus a coastal region with less human activity. The cytotoxicity associated with organic compounds in particulate matter collected at the urban industrialized site was detected in both the particulate matter (3/4) 10 microm in aerodynamic diameter (PM(10)) and particulate matter (3/4) 100 microm in aerodynamic diameter (PM(100)). Greater toxic effects were observed in PM(10) extracts than in PM(100) extracts, but PM(10) toxic effects were not significantly different from those in PM(100). The extracts from the industrialized site were more cytotoxic than the extracts from coastal reference site, although in the summer, extracts from both sites were significantly cytotoxic to normal human epidermal keratinocytes. In addition, the nonpolar extracts of both PM(10) and PM(100) exerted the greatest cytotoxicity, followed by the polar, and, finally, the moderately polar extract. This study demonstrates that extracts from the Guaynabo industrialized site were more toxic than similar extracts obtained from a reference coastal site in Fajardo, Puerto Rico.
Highlights
Journal: JAMA Surgery (2018)

Medical malpractice litigation against surgical residents does occur and may place trainees at risk of burnout.Thiels et al abstracted 87 malpractice cases involving surgical residents from the US Westlaw legal database (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015).These data highlight the importance of perioperative management, particularly among junior residents, and the importance of appropriate supervision by attending physicians to mitigate litigation risk.
Adenine arabinoside monophosphate coupled to lactosaminated human albumin administered for 4 weeks in patients with chronic type B hepatitis decreased viremia without producing significant side effects
Authors: M Cerenzia
Journal: Hepatology (1996)

A conjugate of adenine arabinoside monophosphate phate (ara-AMP) has been studied both in Europe and (ara-AMP) with the liver-targeting molecule lactosamithe United States [1][2][3][4][5] with controversial results on longnated human serum albumin (L-HSA) was administered term efficacy.A metaanalysis 6 of six randomized, conby intravenous infusion for 28 days to eight patients trolled studies showed a significantly larger percentage with chronic type B hepatitis.The daily dose varied of hepatitis B e antigen (HBeAg) loss and HBV-DNA among the patients, ranging from 34 mg/kg to 53 mg/ negativation in the treated group.However, the painful kg (equal to 1.5 and 2.3 mg/kg ara-AMP, respectively).sensory peripheral neuropathies and severe myalgias Pharmacokinetic analysis indicated that, at every dose caused by this drug limited its use and led to its withtested, the conjugate was disposed of without accumuladrawal in Britain and the United States. 7In order to tion.Viral DNA serum levels fell markedly during treatreduce these adverse reactions, the lysosomotropic apment; values rose again when treatment was ceased.The L-HSA-ara-AMP conjugate did not cause either the neu-proach to antiviral chemotherapy 8,9 was adopted, and rotoxic side effects of free ara-AMP or other adverse clinara-AMP was conjugated with lactosaminated human ical reactions.It produced a significant increase both in serum albumin (L-HSA). 10-13L-HSA is a neoglycoproserum alkaline phosphatase activity and platelet numtein which selectively enters into hepatocytes 14 after ber, and a small but significant decrease in erythrocyte binding to the asialoglycoprotein receptor. 15 In laboranumber.These laboratory parameters returned to nortory animals, L-HSA-ara-AMP was selectively taken mal levels within 2 months after treatment.12][13]16 In preliminary clinical bodies (Ç20 pmol of conjugate bound by 1 mL of serum) studies, the conjugate was administered to HBV-inin one patient only.In conclusion, the present results fected patients for 3 to 7 days; coupled ara-AMP inhibindicate that the L-HSA-ara-AMP conjugate can exert the antiviral activity of ara-AMP in chronic type B hepa-ited virus growth at a daily dose 3 to 6 times lower titis patients without producing the neurotoxic side efthan that of the free drug. 17,18 fects which hamper a 4-week period of treatment withIn the present study, L-HSA-ara-AMP was given to the free drug.(HEPATOLOGY 1996;23:657-661.)eight patients with chronic type B hepatitis for 28 consecutive days.The conjugate exerted a marked antivi-Not all patients with chronic hepatitis B virus (HBV) ral activity without producing either the neurotoxic infection respond to interferon alfa, so other antiviral side effects which usually appear 3 weeks after adminagents are sought for partial or nonresponders.The istration of the free drug 1 or other adverse clinical reactherapeutic effect of adenine arabinoside monophostions.
Prospective study of perinatal transmission of Chlamydia trachomatis
Authors: J. Schachter
Journal: JAMA (1986)

During a five-year period, 262 (4.7%) of 5,531 pregnant women had positive cervical cultures for<i>Chlamydia trachomatis</i>, and 131 of their infants were followed up prospectively to ascertain the outcome of chlamydial exposure during the birth process. Culture-confirmed inclusion conjunctivitis of the newborn was seen in 23 (18%) of the infants. Chlamydial pneumonia was diagnosed in 21 (16%) of the infants at risk.<i>Chlamydia trachomatis</i>was recovered from 47 of the infants (36%), while 79 (60%) showed serologic evidence of infection. Subclinical rectal and vaginal infections were detected in 14% of infants at risk. In our population, 2.8% of newborn infants show serologic evidence of perinatal chlamydial infection and 1.4% develop either chlamydial pneumonia or conjunctivitis. Incidence rates of this magnitude indicate the need for programs aimed at preventing perinatal transmission of<i>C trachomatis</i>. (<i>JAMA</i>1986;255:3374-3377)
A prospective study of nucleot(s)ide analogue discontinuation in non-cirrhotic HBeAg-negative chronic hepatitis B patients: interim analysis at week 48 demonstrates profound reductions of HBsAg associated with ALT flare
Authors: Samuel Hall, Gareth Burns, Miriam Levy, John Lubel, Amanda Nicoll, Gail Matthews, Paul Desmond, William Sievert, Scott Bowden, Stephen Locarnini, Jacinta Holmes, Kumar Visvanathan, Alexander Thompson
Journal: Journal of Hepatology (2020)
Organ procurement expenditures and the role of financial incentives
Authors: R. W. Evans
Journal: JAMA (1993)

<h3>Objectives.</h3> —To evaluate the billed charges for organ procurement and to consider the role of financial incentives to encourage organ donation. <h3>Design.</h3> —Observational study. Data were obtained on donor organ acquisition charges from a random sample of kidney, heart, liver, heart-lung, and pancreas transplants. <h3>Setting.</h3> —The data were based on 28.7% of all transplants performed in the United States in 1988. <h3>Main Outcome Measure.</h3> —Total charges for donor organ acquisition. <h3>Results.</h3> —The median charges (1988 dollars) for donor organs were as follows: kidney, $12 290; heart, $12 578; liver, $16 281; heart-lung, $12 028; and pancreas, $15 400. Since 1983, kidney acquisition charges have increased by 12.9%, heart charges by 64.1%, and liver charges by 61.8%, after adjusting for inflation. Between 9% and 31% of total transplant procedure—specific charges were associated with donor organ acquisition. <h3>Conclusions.</h3> —There is wide unexplained variation in organ procurement charges. Data on actual costs are required to establish the appropriateness of current charges. Prevailing billing and payment methods should be reevaluated in an effort to address a variety of issues related to reimbursement. Current payment methods may actually contribute to cost inefficiency. Finally, while financial incentives may enhance the efficiency of organ procurement efforts, they will adversely affect the cost-effectiveness of transplantation. (<i>JAMA</i>. 1993;269:3113-3118)
Radioimmunological therapy
Authors: G. Paganelli, M. Chinol, H. S. Stoldt, F. Aftab, J. Geraghty, A. G. Siccardi
Journal: Clinical Nuclear Medicine (1998)

Radioimmunotherapy (RIT) differs from conventional external beam radiation in that it is a form of systemically targeted therapy. Its anti-tumour effect is primarily due to the associated radioactivity of the radiolabeled antibody, which continuously emits exponentially decreasing low-dose-rate radiation. In some situations, the antibody itself may contribute to tumour cell killing. Important determinants of RIT are: the characteristics of the antibody (specificity, affinity, avidity, dose and immunoreactivity); the radionuclide label (emission properties and chemical stability of the radio-immunoconjugate); the targeted antigen (location, density, heterogeneity of expression, stability and modulation) and the nature of the targeted tumour (e.g. intrinsic radiosensitivity, proliferation rate, volume, tumour bed, etc.).