tbuckley/cabot-search huggingface dataset:
Teaching High-Value Care on Rounds
Authors: Rachel J. Stern, Anna L. Parks
Journal: JAMA Internal Medicine (2015)

cian teaching time was positively correlated with discussion of any test-ordering principle (P < .001).Discussion | To our knowledge, this is the first publication documenting the frequency of discussion of American College of Physicians test-ordering principles by attending physicians on rounds.In our view, discussion of these principles offers potential benefits, including improved test-ordering appropriateness and more patient-centered care.Because ward rounds continue to serve as a key educational forum for trainees, our observation that only 1 in 5 encounters involves attending physician-led discussion of these principles is discouraging.Limitations of our study include the low occurrence rate and small sample size, thereby limiting detection of betweengroup differences.Our observer standardization process could have been more robust.Because annotation occurred in real time and episodes were not recorded, our study may be underreporting actual event frequencies.We did not track whether individual principles were discussed more than once per encounter or whether residents led discussion about test appropriateness.The single-institution nature and singular discipline limit generalizability.Our secondary analysis conflicts with findings of a previous study 6 showing that outpatient physicians who spend more face time with patients order fewer radiographic studies.However, we tracked discussion rather than test ordering.The suggestion that more frequent discussion occurs for new compared with known patients could arise from more frequent ordering of diagnostic tests during the initial 24 hours of hospitalization.Medical educators could consider standardizing discussion for all testing of newly admitted patients to optimize care and educational value.Larger studies are needed to explore further potential links between on-rounds teaching, trainee acquisition of high-value care principles, and patient outcomes.
Abstract 16468: Upcoding of Complication May Account for Declining Failure to Rescue Rates Following Major Cardiac Surgery
Authors: Andrew A Gonzalez, Amir A Ghaferi, Donald S Likosky
Journal: Circulation (2014)

Introduction: To guide public reporting and payment reform initiatives, payers are increasingly tying reimbursement to hospital performance on administratively-derived quality measures. This has created tension with the existing fee-for-service model where “upcoding” of post-operative complications may increase hospital revenue. Hypothesis: We hypothesized that current complication measures may inaccurately reflect hospital quality, due to increased upcoding. Methods: We used Medicare data (2000-8) for patients undergoing cardiac surgery. We compared rates of post-operative pulmonary complications and pulmonary-specific failure to rescue (FTR, ie mortality after a pulmonary complication) under one of two definitions: (1) allowing diagnostic codes solely for pulmonary failure to define a complication (unconditioned definition, UCD), or (2) conditioning the identification of a complication on having a treatment code for mechanical ventilation or intubation (procedure-conditioned definition, PCD). We considered PCD to be a better reflection of true hospital quality. Results: We studied 1,248,765 operations in 1027 hospitals. Over this time period, pulmonary complications decreased 0.3% under the PCD criteria but increased 14.3% under an UCD, p&lt;0.001. Since the PCD rate remained essentially unchanged (6.2% vs 5.9%, p&lt;0.001), this divergence was driven almost entirely by the prodigious increase in UCD complications (12.5% vs 20.3%, p&lt;0.001), Figure. There was no change in PCD-FTR rate (15.4% vs 15.5%, p=0.876) but a sizable decline in UCD-FTR rate (18.9% vs 11.7%, p&lt;0.001). Conclusions: Our findings suggest that current hospital surgical performance measures are sensitive to upcoding, and may provide qualitatively different reflections of quality depending on how they are derived. Measure developers should consider the implications of hospital upcoding, especially given its increasing incidence.
Abstract LB-006: Receptor tyrosine kinase EphA5 is a functional molecular target in human lung cancer
Authors: Fernanda Staquicini, Andrey Dobroff, Fortunato Ferrara, Sara D'Angelo, Andrew RM Bradbury, Wadih Arap, Renata Pasqualini
Journal: Cancer Research (2015)

Abstract The concept of targeted cancer therapy is predicated on the assumption that tumors have unique and sustained genetic abnormalities, and that direct targeting of such distinctive biological features can only be accomplished through the identification and validation of certain specific molecular markers. These principles are particularly relevant to lung cancer, the leading cause of cancer-related death worldwide. For patients with early-stage disease, surgical resection or primary radiotherapy are generally the standard treatments, whereas combined-modality therapy (radiation plus chemotherapy, with or without surgery) is preferred for locally advanced disease. However, most patients with lung cancer develop metastatic tumors and resistance to therapy, and ultimately die of their disease. Here, we identify EphA5 as a molecular target of lung cancer, and as a novel regulator of IR-induced cell cycle checkpoint and DNA damage repair, with unexpected roles in the resistance of lung cancer to radiotherapy. In the absence of EphA5, lung cancer cells displayed a defective G1/S cell cycle checkpoint, were unable to resolve DNA damage, and became radiosensitive. Upon irradiation, EphA5 was transported into the nucleus where it interacted with activated ataxia-telangiectasia mutated (ATM) at sites of DNA repair. In addition, we produced a new monoclonal antibody against EphA5 that sensitizes lung cancer cells to IR in vitro and improves the overall survival of mice bearing human lung cancer xenografts in combination with radiation therapy. These findings present a readily available and potentially effective strategy for the detection and treatment of lung cancer. Citation Format: Fernanda Staquicini, Andrey Dobroff, Fortunato Ferrara, Sara D'Angelo, Andrew RM Bradbury, Wadih Arap, Renata Pasqualini. Receptor tyrosine kinase EphA5 is a functional molecular target in human lung cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-006. doi:10.1158/1538-7445.AM2015-LB-006
Myth of glutamyltransferase
Authors: R. Gama, L. Manikam, H. L. Ashby
Journal: BMJ (2010)

Cobbold and colleagues state that γ-glutamyltransferase should be measured in all patients with raised serum alanine aminotransferase because if raised it would indicate alcohol related liver disease.1 Because of its ubiquitous distribution within the …
Preclinical development of tumor-infiltrating lymphocyte therapy for ovarian cancer
Authors: Donastas Sakellariou-Thompson, Cara Haymaker, Marie-Andree Forget, Amir Jazaeri, Patrick Hwu, Chantale Bernatchez
Journal: Journal for ImmunoTherapy of Cancer (2015)

Meeting abstracts Immunotherapy has become an effective cancer therapy, particularly in the case of checkpoint blockade and adoptive T cell therapy (ACT). ACT exploits the presence of tumor-infiltrating lymphocytes (TIL) by exponentially expanding their numbers ex vivo and re-infusing them into the
Kinome RNAi Screens Reveal Synergistic Targeting of MTOR and FGFR1 Pathways for Treatment of Lung Cancer and HNSCC
Authors: Katherine R. Singleton, Trista K. Hinz, Emily K. Kleczko, Lindsay A. Marek, Jeff Kwak, Taylor Harp, Jihye Kim, Aik Choon Tan, Lynn E. Heasley
Journal: Cancer Research (2015)

Abstract The FGFR1 is a therapeutic target under investigation in multiple solid tumors and clinical trials of selective tyrosine kinase inhibitors (TKI) are underway. Treatment with a single TKI represents a logical step toward personalized cancer therapy, but intrinsic and acquired resistance mechanisms limit their long-term benefit. In this study, we deployed RNAi-based functional genomic screens to identify protein kinases controlling the intrinsic sensitivity of FGFR1-dependent lung cancer and head and neck squamous cell cancer (HNSCC) cells to ponatinib, a multikinase FGFR-active inhibitor. We identified and validated a synthetic lethal interaction between MTOR and ponatinib in non–small cell lung carcinoma cells. In addition, treatment with MTOR-targeting shRNAs and pharmacologic inhibitors revealed that MTOR is an essential protein kinase in other FGFR1-expressing cancer cells. The combination of FGFR inhibitors and MTOR or AKT inhibitors resulted in synergistic growth suppression in vitro. Notably, tumor xenografts generated from FGFR1-dependent lung cancer cells exhibited only modest sensitivity to monotherapy with the FGFR-specific TKI, AZD4547, but when combined with the MTOR inhibitor, AZD2014, significantly attenuated tumor growth and prolonged survival. Our findings support the existence of a signaling network wherein FGFR1-driven ERK and activated MTOR/AKT represent distinct arms required to induce full transformation. Furthermore, they suggest that clinical efficacy of treatments for FGFR1-driven lung cancers and HNSCC may be achieved by combining MTOR inhibitors and FGFR-specific TKIs. Cancer Res; 75(20); 4398–406. ©2015 AACR.
Appraisal of Myeloperoxidase for Evaluation of Patients With Suspected Acute Coronary Syndromes⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.
Authors: David A. Morrow
Journal: Journal of the American College of Cardiology (2007)
P0379 : Cancer related symptoms (performance status 0 vs 1) determine prognosis of hepatocellular carcinoma patients treated with sorafenib. Analysis of a prospective data collection in 207 patients
Authors: M. Varela, M. Reig, C. Álvarez Navascués, A. Forner, V. Cadahía, Á. Díaz, M.L González-Diéguez, N. Llarch, M. Rodríguez, J. Bruix
Journal: Journal of Hepatology (2015)
Abstract 19350: Ventricular Functional Response During Exercise in Patients After Fontan
Authors: Barbara Cifra, Luc Mertens, Cameron Slorach, Mark K Friedberg, Andreea Dragulescu
Journal: Circulation (2014)

Background: Patients with a functionally univentricular heart after Fontan are at risk for long-term complications. The influence of ventricular systolic and diastolic function and functional reserve on exercise performance has not been well established in this population. The aim of the current study was to assess ventricular systolic and diastolic response during exercise in children after Fontan completion using semi-supine cycle ergometry stress echocardiography (SSCE). Materials and Methods: Sixteen Fontan patients (11 RV dominant, 5 LV dominant), mean age 14.2±2.1y and 16 age and gender matched controls were included. A stepwise SSCE protocol was used. TDI peak systolic (s’), early diastolic (e’) velocities and myocardial acceleration during isovolumic contraction (IVA) were measured in the free wall of the dominant ventricle at rest and at incremental heart rates (HR) and compared to control results at the LV lateral wall. IVA was used to evaluate the force-frequency relationship (FFR). Results: Systolic function was qualitatively good in all patients and there was no more than mild valvar regurgitation. Resting HR was not significantly different between patients and controls but peak HR was lower in the Fontan group vs controls (p=0.003). Systolic and diastolic TDI velocities, but not IVA values, were lower at rest in Fontan patients (s’ 3.5±1.2 vs. 7.5±2.5 cm/sec; e’ 5.9±1.9 vs. 12.9±3.0 cm/sec, p&lt;0.001). At peak exercise all parameters were lower in the Fontan group (s’ 6.4±1.3 vs. 14.4±4 cm/sec; e’ 9.4±2.8 vs. 18.2±3.7 cm/sec, p&lt;0.001; IVA 2.9±1.1 vs. 5.6±1.6 m/sec2, p=0.001). During increasing HR, TDI velocities and FFR showed a blunted response in Fontan patients compared to controls (see figure). Conclusions: Our results suggest significantly reduced systolic and diastolic myocardial response to exercise in Fontan patients compared to normal controls. The mechanism and clinical implications of these findings require further investigation.
Alectinib in ALK-positive, crizotinib-resistant, non-small-cell lung cancer: a single-group, multicentre, phase 2 trial
Authors: Alice T Shaw, Leena Gandhi, Shirish Gadgeel, Gregory J Riely, Jeremy Cetnar, Howard West, D Ross Camidge, Mark A Socinski, Alberto Chiappori, Tarek Mekhail, Bo H Chao, Hossein Borghaei, Kathryn A Gold, Ali Zeaiter, Walter Bordogna, Bogdana Balas, Oscar Puig, Volkmar Henschel, Sai-Hong Ignatius Ou
Journal: The Lancet Oncology (2015)
Time to wake up: individualising the approach to sleep promotion interventions
Authors: Hugh H K Fullagar, Jonathan D Bartlett
Journal: British Journal of Sports Medicine (2015)

Sleep is fundamental to normal physiological and cognitive function. Sleep promotion strategies have been used extensively in clinical settings, as a treatment for various ailments (ie, insomnia). However, sleep problems are prevalent outside these realms, with 56% of American, 31% of Western European and 29% of Japanese people suffering from sleep problems the previous year. The global public health concern over sleep has increased the demand for sleep promotion interventions, but the efficacy of these strategies is unclear in otherwise healthy and athletic populations. One possibility is due to the presentation and analysis of grouped data, despite sleep naturally being a highly variable and inherent trait. We argue the case for (1) presenting sleep data at the individual level and (2) individualising sleep promotion interventions.
Diagnosis, guardianship, and residential care of the mentally ill in medieval and early modern England
Authors: R Neugebauer
Journal: American Journal of Psychiatry (1989)

Histories of psychiatry concerning preindustrial Europe emphasize demonologic beliefs and physical mistreatment of the insane. Records of an English legal incompetency jurisdiction demonstrate that both government officials and laymen accepted that psychiatric disorders had biological and psychosocial origins. This jurisdiction, which developed a social welfare dimension by the seventeenth century, offered benevolent protection for the insane. Private guardians arranged for the lodging and care of their wards in private homes. While physicians played little role in the certification process, the guardians made frequent use of their skills. Furthermore, some physicians with established reputations in psychiatry accepted patients into their homes for prolonged cures.
P0891 : Resistance analysis of virologic failures in Hepatitis C genotype 1 infected patients treated with grazoprevir/elbasvir +/− ribavirin: The C-worthy study
Authors: S. Black, I. Pak, P. Ingravallo, P. McMonagle, R. Chase, M. Shaughnessy, P. Hwang, B. Haber, P.R. Harrigan, C. Brumme, A.Y.M. Howe
Journal: Journal of Hepatology (2015)
Response to Comment on Hoffstad et al. Diabetes, Lower-Extremity Amputation, and Death. Diabetes Care 2015;38:1852–1857
Authors: David J. Margolis, Ole Hoffstad
Journal: Diabetes Care (2015)

We thank van Netten et al. (1) for their kind words about our study (2) and we will try to address their concerns. With respect to Core Outcome Measures in Effectiveness Trials (COMET), as noted in our article, we used a medical record data source of more than 400,000 individuals with diabetes who on average were followed for 9 years (2). More than 6,000 of these individuals had a lower-extremity amputation (LEA). It is highly unlikely that this source or other population-based prospective data sources will ever be able to use the COMET initiative to collect information that might be more specific to diabetes, LEA, and …
Random-Effects Meta-analysis of Inconsistent Effects
Authors: John E. Cornell
Journal: Annals of Internal Medicine (2014)

Letters2 September 2014Random-Effects Meta-analysis of Inconsistent EffectsJohn E. Cornell, PhDJohn E. Cornell, PhDFrom University of Texas Health Science Center at San Antonio, San Antonio, Texas.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5017-9 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Statistical heterogeneity increases our uncertainty about the magnitude, expected clinical variation, and clinical informativeness of the available evidence for the relative benefits and harms of a medical intervention. Random-effects models estimate the additional uncertainty that we have about the expected clinical variation in the relative effectiveness of a treatment. Quantitatively, the added uncertainty increases the variance and produces a wider CI. Dr. Lander and Ms. Keum and colleagues focus on a less discussed issue in meta-analysis: differences in the point estimate for the pooled treatment effect between the fixed- and random-effects models.Random-effects models reweight the individual study ...Reference1. Armitage P. Statistical considerations: conclusion.. In: Wald NJ, Doll R, eds. Interpretation of Negative Epidemiological Evidence for Carcinogenicity. Lyon, France: International Agency for Research on Cancer; 1985:190. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center at San Antonio, San Antonio, Texas.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2886. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRandom-Effects Meta-analysis of Inconsistent Effects: A Time for Change John E. Cornell , Cynthia D. Mulrow , Russell Localio , Catharine B. Stack , Anne R. Meibohm , Eliseo Guallar , and Steven N. Goodman Metrics Cited byDiet and physical activity in pregnancy to prevent gestational diabetes: a protocol for an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluationEffects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysisMeta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma 2 September 2014Volume 161, Issue 5Page: 380KeywordsDisclosureDiureticsFallsPreeclampsiaStatistical models ePublished: 2 September 2014 Issue Published: 2 September 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
JOHANN LUCAS SCHÖNLEIN (1793-1864)
Journal: JAMA (1964)

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
All four putative ligand-binding domains in megalin contain pathogenic epitopes capable of inducing passive Heymann nephritis.
Authors: H Yamazaki, R Ullrich, M Exner, A Saito, R A Orlando, D Kerjaschki, M G Farquhar
Journal: Journal of the American Society of Nephrology (1998)

Megalin (gp330) is the main target antigen involved in the induction of Heymann nephritis (HN), a rat model of human membranous nephropathy. Its large extracellular region contains four putative ligand-binding domains separated by spacer regions. Previously, it was reported that the second ligand-binding domain (LBD II) of megalin is involved in the pathogenesis of passive HN because it is capable of binding antibodies in vivo and initiating formation of immune deposits (ID). This study explores the possibility that pathogenic epitopes might also be present in the other putative ligand-binding domains. Recombinant fragments of ligand-binding domains (LBD) I through IV expressed in a baculovirus system were used to generate polyclonal domain-specific antibodies. Antibodies raised against each of the recombinant megalin fragments reacted preferentially with its respective antigen and with whole megalin by immunoblotting. Each of the antibodies also gave a characteristic brush-border staining for megalin by indirect immunofluorescence on rat kidney. When rats were injected with the domain-specific antibodies to test their ability to produce passive HN, glomerular ID were present in kidneys of all injected animals. The staining pattern in glomeruli of rats injected with LBD I, III, or IV was similar to that obtained with antibodies to LBD II. It is concluded that passive HN can be induced with antibodies against LBD I, III, and IV, as well as LBD II, and that each of the ligand-binding domains contains a pathogenic epitope. These findings provide further evidence for the multiple epitope model of HN.