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JAMA Revisited, 1915: Why Physicians Err in Diagnosis

Mistakes due to gross ignorance and faulty judgment may be overcome and are being overcome by increased preliminary requirements and other improvements in medical education and by an endeavor on the part of most physicians to keep abreast with the advance in medical knowledge. Mistakes due to lack of time and thorough study will be overcome when physicians resolve to study each case thoroughly with the use of the many available accessories to medical practice. http://ja.ma/1H6r3AR
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A Piece of My Mind: The Absence of Something—Lawrence J. Hergott

Of the many burdens a patient or physician may carry, the death of a beloved is among the worst, but I have learned that there are other kinds of absences individuals may feel similarly. http://ja.ma/1H6r6wr
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Treatment of syphilis is based on stage of infection and on whether there is evidence of central nervous system involvement. Treponema pallidum remains extremely susceptible to penicillin, an antimicrobial agent targeting bacterial cell wall synthesis. During more than 60 years of use, there has never been a documented case of penicillin resistance. http://ja.ma/1Hddhcq
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Successful neurosyphilis treatment requires the presence of adequate, prolonged cerebrospinal fluid (CSF) concentrations of a treponemicidal antimicrobial. Benzathine penicillin G should not be used because it does not reliably achieve sufficient concentrations in CSF. Intravenous administration of aqueous crystalline penicillin G achieves adequate CSF levels and is the treatment of choice for neurosyphilis. Procaine penicillin injections also achieve treponemicidal levels in CSF, and there is evidence of clinical improvement in some studies, but the regimen is often difficult to complete because of the need for multiple intramuscular injections that can be painful and the requirement for adherence to oral probenecid 4 times daily. http://ja.ma/1NoZ9Rh
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The Art of JAMA: Clown With Folded Arms—Walt Kuhn

In Clown With Folded Arms, the subject wears the face paint of an auguste clown, the circus goofball who usually gets most of the laughs. One of the most famous auguste characters was Lou Jacobs (1903-1992), who was also trained as a contortionist. Jacobs originated the classic midget car act, which required him to wedge his 6-foot 1-inch frame into a 23-inch automobile. On cue, Jacobs would drive his car into the center ring, honking the horn, and pull up to a gas pump. As the car’s engine sputtered and backfired, Jacobs would extricate his body and oversized shoes and then lean over the tiny car to remove its radiator cap. When the cap came off a trick snake sprang out, and the audience went wild. http://ja.ma/1H7hotU

(Courtesy of the Pennsylvania Academy of the Fine Arts [http://ja.ma/1H7hn99], Philadelphia; Joseph E. Temple Fund, 1945.8.) 
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Syphilis occurs in overlapping stages, classified according to symptoms and time since initial infection. Appropriate staging is important for determining infectivity and treatment duration. A diagnosis of early syphilis (primary, secondary, and early latent syphilis) implies that T pallidum infection occurred within the previous year. Late syphilis represents manifestations occurring more than 1 year and even decades after initial infection. Latent syphilis refers to T pallidum infection with reactive syphilis serologic findings but without clinical manifestations of disease. It includes both early latent (within 1 year of infection) and late latent (1 year or more after infection) syphilis. http://ja.ma/1OJjsua
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Researchers, clinicians, and other professionals with an interest in Down syndrome can now access deidentified data from DS-Connect: The Down Syndrome Registry, where people in the Down syndrome community voluntarily and securely store personal health information, including symptoms, diagnoses, and other medical issues. http://ja.ma/1H6r5sk
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Have them in circles
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Now, she’s in equipoise, chronic, and all
    she gets is a monthly 15-minute
    Med check and Risperidone.
http://ja.ma/1H7hDVI
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Will the History and Physical Examination Help Establish That Irritable Bowel Syndrome Is Causing This Patient's Lower Gastrointestinal Tract Symptoms?

Individual symptoms have limited accuracy for diagnosing irritable bowel syndrome (IBS) in patients referred with lower gastrointestinal tract symptoms. The accuracy of the Manning criteria and Kruis scoring system were only modest. Despite strong advocacy for use of the Rome criteria, only the Rome I classification has been validated. Future research should concentrate on validating existing diagnostic criteria or developing more accurate ways of predicting a diagnosis of IBS without the need for investigation of the lower gastrointestinal tract. http://ja.ma/1EgNjqR
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Despite limitations in published studies, the predominance of evidence (including more recent high-quality studies) supports parenteral penicillin as the treatment of choice for syphilis http://ja.ma/1EgsdZK
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Have them in circles
269 people
Joslin Diabetes's profile photo
KT McGraw's profile photo
Meera Ramsooksingh's profile photo
MHIN's profile photo
Alf Bau's profile photo
Justin Shin's profile photo
Yi Lian's profile photo
Andre Roman's profile photo
Iz Zarn's profile photo
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Science, Medicine, Public Health, Peer-review, Medical Journal
Introduction
JAMA, published continuously since 1883, is an international peer-reviewed general medical journal published 48 times per year. JAMA is the most widely circulated medical journal in the world. The online version is made freely available to institutions in developing countries. The Editor-in-Chief of JAMA is Howard Bauchner, MD.
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