tbuckley/cabot-search huggingface dataset:
A New Era for Residency Training in Internal Medicine
Authors: Sara B. Fazio, Alwin F. Steinmann
Journal: JAMA Internal Medicine (2015)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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 Internal Medicine journal
Evaluation of immune cell subsets of cancer patients treated with Avelumab, a fully human IgG1 anti-PD-L1 MAb capable of mediating ADCC of human tumor cells
Authors: Lauren Lepone, Renee Donahue, Italia Grenga, Caroline Jochems, Kwong-Yok Tsang, Simon Metenou, Jacob Richards, Christopher R Heery, Ravi Madan, James L Gulley, Jeffrey Schlom
Journal: Journal for ImmunoTherapy of Cancer (2015)

Meeting abstracts Several monoclonal antibodies (MAbs) with demonstrated clinical anti-cancer activities have been engineered as fully human IgG1 entities to also encompass their potential to mediate antibody-dependent cell-mediated cytotoxicity (ADCC) of human tumor cells. Avelumab (MSB0010718C,
Value of mefloquine chemoprophylaxis in military personnel
Authors: Andrew D Green, Timothy J Hodgetts, David A Ross, Patrick Connor
Journal: BMJ (2015)

Gogtay and Ferner raise important issues regarding the use of mefloquine for malaria chemoprophylaxis in British military personnel.1 However, we feel that some points need clarification.

Although malaria has had a major impact on British Armed Forces in the past, the last operational death of a British service person from malaria occurred in …
MPs may hold inquiry into safety of using antimalarial mefloquine in military
Authors: Adrian O’Dowd
Journal: BMJ (2015)

Pressure is building to end the practice of routinely giving the antimalarial drug mefloquine (Lariam) to UK military personnel and to investigate the drug’s safety.

MPs on the parliamentary defence select committee sent a letter on 8 September to the defence secretary, Michael Fallon, asking whether he had plans to reassess the drug’s safety in the light of recent concerns raised by the military.1

Mefloquine is licensed in the United Kingdom by the Medicines and Health Products Regulatory Agency, on the basis of expert guidance from Public Health England’s advisory committee for malaria prevention.

The drug is one type of antimalarial given to military personnel serving overseas. However, the possible side effects of the drug listed by the MHRA include “depression and suicidal ideation, anxiety, panic, confusion, hallucinations, paranoid delusions, and …
Internal Medicine Resident Computer Usage
Authors: David Ouyang, Jonathan H. Chen, Jason Hom, Jeffrey Chi
Journal: JAMA Internal Medicine (2015)

The first 6 months of the intern year was the most common period for NSIs, previously unreported in the literature.Dental residents were more likely to experience an NSI than other trainees, in contrast to literature findings that suggest surgery residents are at greatest risk. 8Previous literature excludes dental trainees.Dental residents may be more likely to experience an NSI based on the nature of their work (ie, the dark oral cavity with difficult illumination and learning mirrored image procedures).Resident education and training during orientation may reduce risk.For new residents, additional procedural skill simulation using sharp instruments may decrease NSI.However, a majority of residents felt comfortable in procedures with instruments causing injury. 3Despite resident-reported mastery, caution to avoid both overconfidence and decreased attention to NSI risk is warranted.We found that PGY-1 residents, especially during the first 6 months of training, are at greatest risk of NSI.Highest injury rates were observed for dentistry, obstetrics and gynecology, and surgery.Source patient seropositivity was low in this series.Simulation training during orientation and timeout reminders may increase procedural experience, decrease complacency, and reduce NSIs.
Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals
Authors: Roland Diel, Albert Nienhaus, Doris Hillemann, Elvira Richter
Journal: European Respiratory Journal (2015)

Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.
Health access America--strengthening the US health care system
Authors: J. S. Todd
Journal: JAMA (1991)

Although Americans remain generally satisfied with the health care provided to them, sufficient access to high-quality, affordable health care for citizens without health care insurance has become an increasing problem in the last decade. Using the policy development process of the American Medical Association, Health Access America was conceived by the Association to improve access to affordable, high-quality health care. The proposal consists of six fundamental principles and 16 key points. This article specifically focuses on the five points that, if enacted into law, would improve access to health care for Americans who are, for various reasons, without health insurance.  ( JAMA . 1991;265:2503-2506)
Does happiness itself directly affect mortality? The prospective UK Million Women Study
Authors: Bette Liu, Sarah Floud, Kirstin Pirie, Jane Green, Richard Peto, Valerie Beral
Journal: The Lancet (2015)

BackgroundPoor health can cause unhappiness and poor health increases mortality. Previous reports of reduced mortality associated with happiness could be due to the increased mortality of people who are unhappy because of their poor health. Also, unhappiness might be associated with lifestyle factors that can affect mortality. We aimed to establish whether, after allowing for the poor health and lifestyle of people who are unhappy, any robust evidence remains that happiness or related subjective measures of wellbeing directly reduce mortality.MethodsThe Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. 3 years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed. The main analyses were of mortality before Jan 1, 2012, from all causes, from ischaemic heart disease, and from cancer in women who did not have heart disease, stroke, chronic obstructive lung disease, or cancer at the time they answered this baseline questionnaire. We used Cox regression, adjusted for baseline self-rated health and lifestyle factors, to calculate mortality rate ratios (RRs) comparing mortality in women who reported being unhappy (ie, happy sometimes, rarely, or never) with those who reported being happy most of the time.FindingsOf 719 671 women in the main analyses (median age 59 years [IQR 55–63]), 39% (282 619) reported being happy most of the time, 44% (315 874) usually happy, and 17% (121 178) unhappy. During 10 years (SD 2) follow-up, 4% (31 531) of participants died. Self-rated poor health at baseline was strongly associated with unhappiness. But after adjustment for self-rated health, treatment for hypertension, diabetes, asthma, arthritis, depression, or anxiety, and several sociodemographic and lifestyle factors (including smoking, deprivation, and body-mass index), unhappiness was not associated with mortality from all causes (adjusted RR for unhappy vs happy most of the time 0·98, 95% CI 0·94–1·01), from ischaemic heart disease (0·97, 0·87–1·10), or from cancer (0·98, 0·93–1·02). Findings were similarly null for related measures such as stress or lack of control.InterpretationIn middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality.FundingUK Medical Research Council, Cancer Research UK.
AVERT<sup>2</sup>(a very early rehabilitation trial, a very effective reproductive trigger): retrospective observational analysis of the number of babies born to trial staff
Authors: Julie Bernhardt, Richard I Lindley, Erin Lalor, Fiona Ellery, Jan Chamberlain, John Van Holsteyn, Janice M Collier, Helen M Dewey, Brooke Parsons, Marjory Moodie, Sheila Lennon, Geoffrey A Donnan, Amanda G Thrift, Leonid Churilov, Peter Langhorne
Journal: BMJ (2015)

<b>Objective</b>&nbsp;To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. <b>Design</b>&nbsp;Retrospective observational analysis. <b>Setting</b>&nbsp;56 acute stroke hospitals in eight countries. <b>Participants</b>&nbsp;1074 trial physiotherapists, nurses, and other clinicians. <b>Outcome measures</b>&nbsp;Number of babies born during trial recruitment per trial participant recruited. <b>Results</b>&nbsp;With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. <b>Conclusion</b>&nbsp;The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group. <b>Trial registration</b>&nbsp;Australian New Zealand Clinical Trials Registry no 12606000185561. <b>Disclaimer</b>&nbsp;Participation in a rehabilitation trial does not guarantee successful reproductive activity.
A Phase I First-in-Human Study of Nesvacumab (REGN910), a Fully Human Anti–Angiopoietin-2 (Ang2) Monoclonal Antibody, in Patients with Advanced Solid Tumors
Authors: Kyriakos P. Papadopoulos, Robin Kate Kelley, Anthony W. Tolcher, Albiruni R. Abdul Razak, Katherine Van Loon, Amita Patnaik, Philippe L. Bedard, Ariceli A. Alfaro, Muralidhar Beeram, Lieve Adriaens, Carrie M. Brownstein, Israel Lowy, Ana Kostic, Pamela A. Trail, Bo Gao, A. Thomas DiCioccio, Lillian L. Siu
Journal: Clinical Cancer Research (2015)

Nesvacumab (REGN910) is a fully human immunoglobulin G1 (IgG1) monoclonal antibody that specifically binds and inactivates the Tie2 receptor ligand Ang2 with high affinity, but shows no binding to Ang1. The main objectives of this trial were to determine the safety, tolerability, dose-limiting toxicities (DLT), and recommended phase II dose (RP2D) of nesvacumab.Nesvacumab was administered intravenously every two weeks with dose escalations from 1 to 20 mg/kg in patients with advanced solid tumors.A total of 47 patients were treated with nesvacumab. No patients in the dose escalation phase experienced DLTs, therefore a maximum tolerated dose (MTD) was not reached. The most common nesvacumab-related adverse events were fatigue (23.4%), peripheral edema (21.3%), decreased appetite, and diarrhea (each 10.6%; all grade ≤ 2). Nesvacumab was characterized by linear kinetics and had a terminal half-life of 6.35 to 9.66 days in a dose-independent manner. Best response by RECIST 1.1 in 43 evaluable patients included 1 partial response (adrenocortical carcinoma) of 24 weeks duration. Two patients with hepatocellular carcinoma had stable disease (SD) > 16 weeks, with tumor regression and >50% decrease in α-fetoprotein. Analyses of putative angiogenesis biomarkers in serum and tumor biopsies were uninformative for treatment duration.Nesvacumab safety profile was acceptable at all dose levels tested. Preliminary antitumor activity was observed in patients with treatment-refractory advanced solid tumors. On the basis of cumulative safety, antitumor activity, pharmacokinetic and pharmacodynamic data, the 20 mg/kg dose was determined to be the RP2D.
Nasal and pharyngeal eosinophil peroxidase levels in adults with poorly controlled asthma correlate with sputum eosinophilia
Authors: M. A. Rank, S. I. Ochkur, J. C. Lewis, H. G. Teaford, L. J. Wesselius, R. A. Helmers, N. A. Lee, P. Nair, J. J. Lee
Journal: Allergy (2015)

The objective of the study was to compare nasal, pharyngeal, and sputum eosinophil peroxidase (EPX) levels with induced sputum eosinophil percentage in 10 adults with poorly controlled asthma and 10 normal controls. EPX was measured using an ELISA and normalized for grams of protein for nasal and pharynx specimens and for mL-gram of protein for sputum. Sputum EPX levels were statistically different between asthma and control subjects (P = 0.024). EPX levels measured in the nasal and pharyngeal swab samples derived from the same patients were also different between asthma and control subjects, each displaying a high degree of significance (P = 0.002). Spearman's correlation coefficients for nasal EPX and pharyngeal EPX levels compared to induced sputum eosinophil percentage were 0.81 (P = 0.0007) and 0.78 (P = 0.0017), respectively. Thus, there is a strong association in a given patient between both nasal and pharyngeal EPX levels and the eosinophil percentage of induced sputum.
Curriculum in Canadian Medical Education
Authors: J W Macleod
Journal: JAMA (1963)

In general, its teaching curriculum reflects the history of a medical school's interaction with a series of pressures, such as the staggering advance of scientific knowledge and the social demand for greater security against hazards to the welfare of entire populations. Secondary consequences include the isolation of the scientist and loss of the overall view; decline in interest in teaching; depersonalization of medical care; hospital-centred instruction and loss of contact with the viewpoint of the community at the very time that it is demanding more attention. Compensating trends include: increasing confidence in scientific methods, team-work in teaching, the project method of teaching, comprehensive care clinics, and research in educational methods. The conclusion favours medical education that is devoted to the educational needs of the student, to the health needs of the individual patient and of the community, and to the advancement of knowledge and understanding.
Telemedicine in Prehospital Stroke Evaluation and Thrombolysis
Authors: Ahmed Itrat, Ather Taqui, Russell Cerejo, Farren Briggs, Sung-Min Cho, Natalie Organek, Andrew P. Reimer, Stacey Winners, Peter Rasmussen, Muhammad S. Hussain, Ken Uchino
Journal: JAMA Neurology (2015)

Mobile stroke treatment units (MSTUs) with on-site treatment teams that include a vascular neurologist can provide thrombolysis in the prehospital setting faster than treatment in the hospital. These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence.To test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU.Prospective observational study conducted between July 18 and November 1, 2014. The dates of the study analysis were November 1, 2014, to March 30, 2015. The setting was a community-based study assessing telemedicine success of the MSTU in Cleveland, Ohio. Participants were the first 100 residents of Cleveland who had an acute onset of stroke-like symptoms between 8 am and 8 pm and were evaluated by the MSTU after the implementation of the MSTU program at the Cleveland Clinic. A vascular neurologist evaluated the first 100 patients via telemedicine, and a neuroradiologist remotely assessed images obtained by mobile computed tomography (CT). Data were entered into the medical record and a prospective registry.The study compared the evaluation and treatment of patients on the MSTU with a control group of patients brought to the emergency department via ambulance during the same year. Process times were measured from the time the patient entered the door of the MSTU or emergency department, and any problems encountered during his or her evaluation were recorded.Ninety-nine of 100 patients were evaluated successfully. The median duration of telemedicine evaluation was 20 minutes (interquartile range [IQR], 14-27 minutes). One connection failure was due to crew error, and the patient was transported to the nearest emergency department. There were 6 telemedicine disconnections, none of which lasted longer than 60 seconds or affected clinical care. Times from the door to CT completion (13 minutes [IQR, 9-21 minutes]) and from the door to intravenous thrombolysis (32 minutes [IQR, 24-47 minutes]) were significantly shorter in the MSTU group compared with the control group (18 minutes [IQR, 12-26 minutes] and 58 minutes [IQR, 53-68 minutes], respectively). Times to CT interpretation did not differ significantly between the groups.An MSTU using telemedicine is feasible, with a low rate of technical failure, and may provide an avenue for reducing the high cost of such systems.
Dose Delays, Dose Reductions, and Relative Dose Intensity in Patients With Cancer Who Received Adjuvant or Neoadjuvant Chemotherapy in Community Oncology Practices
Authors: Neelima Denduluri, Debra A. Patt, Yunfei Wang, Menaka Bhor, Xiaoyan Li, Anne M. Favret, Phuong Khanh Morrow, Richard L. Barron, Lina Asmar, Shanmugapriya Saravanan, Yanli Li, Jacob Garcia, Gary H. Lyman
Journal: Journal of the National Comprehensive Cancer Network (2015)

A wide variety of myelosuppressive chemotherapy regimens are used for the treatment of cancer in clinical practice. Neutropenic complications, such as febrile neutropenia, are among the most common side effects of chemotherapy, and they often necessitate delays or reductions in doses of myelosuppressive agents. Reduced relative dose intensity (RDI) may lead to poorer disease-free and overall survival.Using the McKesson Specialty Health/US Oncology iKnowMed electronic health record database, we retrospectively identified the first course of adjuvant or neoadjuvant chemotherapy received by patients without metastases who initiated treatment between January 1, 2007, and March 31, 2011. For each regimen, we estimated the incidences of dose delays (≥7 days in any cycle of the course), dose reductions (≥ 15% in any cycle of the course), and reduced RDI (<85% over the course) relative to the corresponding standard tumor regimens described in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines).This study included 16,233 patients with 6 different tumor types who received 1 of 20 chemotherapy regimens. Chemotherapy dose delays, dose reductions, and reduced RDI were common among patients treated in community oncology practices in the United States, but RDI was highly variable across patients, regimens, and tumor types (0.486-0.935 for standard tumor regimen cohorts). Reduced RDI was more common in older patients, obese patients, and patients whose daily activities were restricted.In this large evaluation of RDI in US clinical practice, physicians frequently administered myelosuppressive agents at dose intensities lower than those of standard regimens.
CELL SURFACE IMMUNOGLOBULIN
Authors: Ellen S. Vitetta, Inge Grundke-Iqbal, Kathryn V. Holmes, Jonathan W. Uhr
Journal: The Journal of Experimental Medicine (1974)

Lymphoid cells from the spleen, lymph nodes, and thoracic duct of axenic and control mice were incubated with [(3)H]tyrosine and synthesis and secretion of protein and Ig studied. It was found that only IgM was synthesized by cells from axenic mice whereas cells from control mice also synthesized IgG. Splenocytes from both axenic and control mice had 8S IgM on their surface. Radiolabeled splenocytes from axenic mice were incubated to determine the kinetics of release of (125)I-labeled cell surface IgM and [(3)H]tyrosine-labeled IgM. Cell surface IgM was shed as 8S with an initial half-life of release of 5-8 h whereas [(3)H]tyrosine-labeled Ig was secreted as 19S with an initial half-life of 2-3 h. These findings suggest that two independent pathways are involved. It is suggested that small lymphocytes shed 8S IgM and plasma cells secrete 19S IgM. It was observed that lymphoid cells from axenic mice synthesize a higher proportion of IgM relative to total protein. Electron microscopic examination of splenocytes from such mice revealed a markedly higher proportion of plasma cells and a paucity of lymphoblasts compared to controls. It was suggested, therefore, that axenic mice lack a population of stimulated T cells which can induce a switch from IgM to IgG synthesis and which is capable of suppressing IgM synthesis. Lymphoid cells from axenic mice synthesize and secrete less protein that coprecipitates with antigen-antibody complexes.
Dissecting the tumor micro-environment in triple negative breast cancer identifies a mutually exclusive expression pattern of the immune co-inhibitory molecules B7-H4 and PD-L1
Authors: Donald R Shaffer, Virna Cortez-Retamozo, Kumiko Nagashima, Tong Zi, ChengYi J Shu, Igor Feldman, Veronique Neumeister, Jeff Smith, Mohammad Zafari, Rebecca Larson, Matthew Silver, Robert Mabry, Michael Briskin, Tanya Novobrantseva, David Rimm, Sriram Sathyanarayanan
Journal: Journal for ImmunoTherapy of Cancer (2015)

Meeting abstracts B7-H4 is a member of the B7 family of co-regulatory receptors. It is believed to negatively regulate T cell function and has been associated with poor prognosis in renal cell and ovarian cancers. We performed an unbiased analysis of TCGA gene expression data and identified triple