tbuckley/cabot-search huggingface dataset:
Consequences of Physicians' Ownership of Health Care Facilities — Joint Ventures in Radiation Therapy
Authors: Jean M. Mitchell, Jonathan H. Sunshine
Journal: New England Journal of Medicine (1992)

Physicians are increasingly the owners of health care facilities to which they refer patients for services but at which they do not practice. We studied such ownership arrangements, known as "joint ventures," in the field of radiation therapy, examining their effects on access, use of services, costs, and quality.Because 44 percent of free-standing facilities providing radiation therapy in Florida in 1989 were joint ventures, as compared with 7 percent elsewhere (95 percent confidence interval, 3 to 10 percent), we compared data for Florida with comparable data for the remainder of the United States. We also compared radiation-therapy facilities in Florida that were established as joint ventures with those that were not. Since most data were derived from entire populations rather than from samples, any differences found were of necessity statistically significant.No joint-venture facilities providing radiation therapy were located in inner-city neighborhoods or rural areas, but 11 percent of other free-standing facilities and hospital-based facilities were located in such areas. Among free-standing facilities, joint ventures received 39 percent of their revenues from patients with well-paying insurance coverage, as compared with 31 percent for facilities that were not joint ventures (P < 0.01). The frequency and costs of radiation-therapy treatments at free-standing centers were 40 to 60 percent higher in Florida than in the rest of the United States; there was no below-average use of radiation therapy at hospitals or higher cancer rates that explained the higher rates of use or higher costs in Florida. Radiation physicists at joint-venture facilities (the principal personnel involved in quality control other than physicians) spent 18 percent less time with each patient over the course of treatment than did their counterparts at free-standing facilities that were not joint ventures (P < 0.05). Mortality among patients with cancer in Florida was not lower than the U.S. average, even though joint ventures are much more common in that state.Joint ventures in radiation therapy appear to have adverse effects on patients' access to care. They also appear to increase the use of services and costs substantially. Some indicators show that joint ventures cause either no improvement in quality or a decline. Our results add to the evidence indicating that physicians' self-referral generally has negative consequences. We recommend legislation to ban ownership of joint ventures by referring physicians. Such legislation needs to be carefully designed in order to achieve its objectives and forestall new, financially abusive arrangements.
OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A UNITED STATES POPULATION-BASED STUDY
Authors: Tanush Gupta, Prakash Harikrishnan, Dhaval Kolte, Sahil Khera, Wilbert Aronow, Marjan Mujib, Chandrasekar Palaniswamy, Ali Ahmed, Diwakar Jain, Sachin Sule, Gregg Lanier, Howard Cooper, Gregg Fonarow, Julio Panza
Journal: Journal of the American College of Cardiology (2015)
Abstract 848: VCAM-1 expression in epithelial ovarian cancer
Authors: Jennifer M. Scalici, Melissa Henretta, Jill Slack-Davis, Kristen Atkins
Journal: Cancer Research (2010)

Abstract Vascular cell adhesion molecule-1 (VCAM-1) is a cell surface adhesion molecule with known expression on the peritoneum of some advanced stage epithelial ovarian cancer patients. Previous study by our group has implicated VCAM-1 as a mediator of metastatic invasion of peritoneal surfaces by tumor cells in advanced disease, as inhibition of its function resulted in decreased tumor burden and improved overall survival in an animal model. We propose that VCAM-1 expression is a potential site of targeted therapy and in addition, expression may also serve as an early indicator of disease recurrence. We aim to correlate VCAM-1 expression with disease stage and histology to determine when in the course of disease expression begins. After IRB approval, archived tissue blocks from 1998-2008 containing samples of tumor, omentum, and peritoneum were evaluated for the presence of mesothelial cells. IHC staining of VCAM-1 was performed. Samples were evaluated and scored by a single pathologist blinded to stage and tumor type. All tissue samples from stage 1 patients were negative for VCAM-1 expression. The majority of samples from stages 3 and 4 were positive. Of the stage 2 samples, 50% were positive; those were primarily of serous histology. This suggests that there is an increase in peritoneal VCAM-1 expression as tumor cells leave the confines of the ovary and may serve as a marker of metastasis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 848.
P1038 NEW QUALITY CRITERIA FOR TRANSIENT ELASTROGRAPHY CAN INCREASE THE PROPORTION OF VALID MEASUREMENTS WITH HIGH ACCURACY FOR DETECTION OF LIVER CIRRHOSIS AND PORTAL HYPERTENSION
Authors: P. Schwabl, S. Bota, P. Salzl, M. Mandorfer, B.-A. Payer, A. Ferlitsch, J. Stift, F. Wrba, M. Trauner, M. Peck-Radosavljevic, T. Reiberger
Journal: Journal of Hepatology (2014)
Transparency and the foundations of the health service
Authors: J. T. Elliott
Journal: BMJ (2013)

The NHS was founded to provide, in the interest of patients, the best care as near to their homes as possible.

Hospital management committees—local worthies and councillors, a public health adviser, and members experienced in nursing and general practice—supported and supervised this provision. Senior hospital executives—medical superintendent, matron, and secretary—attended meetings. Members of the management committee visited all wards and departments of the hospital regularly and spoke to patients and staff. Local transparency was inevitable and accountability implicit.

The present “trust” system of management is …
AB0466 Quantiferon (QFT) identifies latent tuberculosis (LTB) but does not help the evaluation of the efficacy of prophylaxis in inflammatory arthritides
Authors: F. Peruzzi, F. Bartalesi, L. Attala, A. Cavallo, G. Fiori, S. Maddali-Bongi, C. Bruni, F. Nacci, F. Bartoli, S. Cappelli, V. Denaro, A. Bartoloni, M. Matucci-Cerinic
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The screening for LTB before anti-TNF therapy is mandatory. Tuberculin Skin Test (TST) and QFT Gold in tube (QFT-GIT) may help in the detection of LTB patients who submitted a prophylactic treatment. <h3>Objectives</h3> Evaluate the role of by QFT-GIT in the evaluation of the efficacy of the LTB prophylaxis in patients affected by rheumatic disease <h3>Methods</h3> Out of 561 patients (263 Rheumatoid Arthritis (AR), 126 Psoriatic Arthritis (PsA) and 73 Spondiloarthropaty (SpA), 5 Inflammatory Bowel Disease (IBD) and 94 with other immunomediated chronic disease), we performed TST and QFT as screening tests and QFT was performed at the end the prophylaxis. <h3>Results</h3> After screening, LTB was diagnosed in 87 patients who were submitted to prophylaxis (Isoniazid for 9 months or Isoniazid plus Rifampicin for 3 months).We compared by analysis of variance the value of QFT index at the beginning and at the end the therapy (QFT-GIT medium value at the beginning 5.39 and 4.0 at the end). This comparison showed no statistically significant differences (significance value 0.31). <h3>Conclusions</h3> QFT-GIT is helpful to identify LTB but our data show that QFT-GIT index is not useful to asses the efficacy of the TB prophylaxis and rule out during the follow up the TB re-infection. QFT may be useful in identifying the TB infection during the follow up of patients who were negative at the screening. <h3>Disclosure of Interest</h3> None Declared
Consistency of Myocardial Mass Computations as a Quality Control Check on Rest and Stress Left Ventricular Ejection Fractions Computed From 82Rb PET Data
Authors: Andrew Van Tosh, Nathaniel Reichek, Barbara Phippen-Nater, Christopher J. Palestro, Kenneth J. Nichols
Journal: Clinical Nuclear Medicine (2014)

Changes in left ventricular (LV) ejection fraction (EF) seen in gated Rb data are of interest because the heart is in a genuinely different physiologic state during stress than at rest. A measure that validates internal consistency of LV EF data would be highly desirable. Left ventricular mass calculations are performed simultaneously with EF determinations, requiring similar operator choices, and although LV volumes may change from rest to stress, mass values should be constant. Constancy of LV mass calculations could provide a useful internal check on the consistency of LV EF computations.We retrospectively reviewed data for 205 patients referred for evaluation of known or suspected coronary disease who had rest and regadenoson stress gated Rb PET/CT myocardial perfusion imaging. Equilibrium gated myocardial perfusion PET data were analyzed to calculate LV volumes, EF, and simultaneously mass values.Rest mass ranged from 62 to 284 g (median, 115 g), stress mass from 39 to 315 g (median, 120 g), and differences were -25 to +25 g (median, 1 g). Rest and stress mass values were statistically similar (121 ± 37 g vs 124 ± 49 g, P = 0.45) and correlated strongly with one another (r = 0.94, P < 0.0001).Left ventricular mass calculations are constant from rest to stress over a wide range of ventricular volumes and ejection fractions. Consistency of LV mass values can serve as confirmation of the appropriateness of operator choices when LV EF calculations are performed.
SAT0510 Grey-Scale Ultrasonography with Power Doppler Technique: an Available Tool for the Assessment of Subclinical Joint Inflammatory Activity in Juvenile Idiopathic Arthritis
Authors: P. Collado, R. Merino, G. Genaro, S. Bustabad, M. L. Gamir, I. Calvo, M. Garcia, J. Garrido
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Musculoskeletal ultrasonography (US) has been routinely used to confirm synovial effusion in children with arthritis. Recent studies show that US is more sensitive than clinical examination in detecting synovitis in juvenile idiopathic arthritis (JIA). In addition, given the high sensitivity of US in detecting subclinical synovitis, minimal effusion or even age-related variations, it remains important for the interpretation of US abnormalities in the clinical context. Since mostly data focusing on US detection of JIA synovitis include grey-scale (i.e. B-mode) US, the actual significance of US-detected subclinical synovitis in asymptomatic joints remains unclear. <h3>Objectives</h3> To investigate the usefulness of ultrasonography with power Doppler (PDUS) for detecting synovitis compared with clinical examination on large number of joints in JIA. <h3>Methods</h3> This multicenter study included 42 children with active JIA. Clinical and PDUS assessments were performed blindly on 44 joints. Active disease was defined by high acute phase reactants with clinically active arthritis. Active arthritis on US was defined as synovial hypertrophy, effusion, or increased vascularity on power Doppler (PD) scan. For the US-image analysis the OMERACT definitions for Rheumatoid Arthritis of synovitis was applied [1]. McNemar test was used to compare the percentage of joints showing synovitis detected by clinical examination and by PDUS. <h3>Results</h3> In total, 1848 joints were examined both clinically and by PDUS. Physical examination showed 277 joints (15.0%) having clinically active synovitis, and of these, 184 (10%) had synovitis confirmed by US. Furthermore, up to 177 joints (9.6%) were shown to have synovitis on US examination alone. The percentage of joints with synovitis confirmed by PDUS (19.5%, n=361 joints) was statistically higher than the percentage of joints having clinically active synovitis, 15.0% (<i>p</i> &lt; 0.0005). Of the 361 joints with GS synovitis detected by US examination, 116 (32.1%) joints were shown to have inflammatory activity by PD signal detected in SH. Subclinical active synovitis was confirmed by PDUS in 51/177 joints (28.8%) that only seemed to have synovitis on US examination. <h3>Conclusions</h3> The study shows that the PD-technique along with GS examination increases the sensitivity of US for detecting subclinical synovitis in JIA. However, longitudinal studies in children are required to know subsequent structural damage. <h3>References</h3> Wakefield RJ, Balin PV, Szkudlarek M et al. OMERACT 7 Special Interest Group: Diagnosed musculoskeletal ultrasound including definitions for ultrasonography patology. J Rheumatol 2005;32:2485-2487 <h3>Disclosure of Interest</h3> None Declared
A1.17 Analysis of two essential sub-processes of long distance migration of synovial fibroblasts from patients with rheumatoid arthritis
Authors: B Zimmermann, S Köppert, S Lefèvre, S Rehart, U Müller-Ladner, E Neumann
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Synovial fibroblasts (SF) play a central role in cartilage destruction and angiogenesis in rheumatoid arthritis (RA). RASF can migrate from their implantation site through the vasculature to distant implanted cartilage in the SCID mouse model. Interaction of RASF with endothelial cells (EC) is required for RASF-mediated angiogenesis and migration. In this study, expression of the E-selectin ligand CD15s, interaction of RASF with EC via E-selectin as well as kinetics of vascular growth induced by RASF in the SCID mouse model were analysed. <h3>Methods</h3> Double staining in RA and osteoarthritis (OA) synovium for CD15s and vimentin as well as single staining for CD15s on serum stimulated RA- and OASF was performed. Flow assays were performed with RA- and OASF to analyse adhesion to selectin-coated capillaries as well as TNF-stimulated or latent HUVEC. In the SCID mouse model 1.5x10<sup>5</sup> RASF and healthy cartilage were implanted ipsilaterally and cartilage without RASF contralaterally. Implant images were taken, implants removed and angiogenesis analysed by CD31 staining. Neovascularisation next to and into the implants was determined at days 3-40. <h3>Results</h3> All RA tissues (n = 12) expressed CD15s. Of those, in 67% CD15s signals were co-localised with vimentin, mainly in the sublining (50%) but also inside vessels (33%). In addition solely RA serum increased CD15s expression in RASF (80%, n = 5) and 33% of OASF (n = 3). RASF (n = 6) adhered significantly stronger to E-selectin-coated capillaries than to P-selectin at all flow rates (e.g. 18.4 ml/h: E-sel. = 16.6 ± 4.4 <i>vs.</i> P-sel. = 1.0 ± 1.5, p = 0.00001; 30.5 ml/h: E-sel. = 8.0 ± 3.5 <i>vs.</i> P-sel. = 0.2 ± 0.4, p = 0.0003). RASF adhered also significantly stronger to E-selectin coating than OASF (n = 5; e.g. 30.5 ml/h: E-sel. = 0.9 ± 0.3, p = 0.0016). Adhesion of RASF (n = 3) to TNF-stimulated HUVEC was significantly increased compared to OASF at 18.4 ml/h (9.7 ± 2.2). Anti-CD31 implant staining revealed that angiogenesis started at day 9, increased over time and was similar at both sites. Tortuous and larger vessels in the murine skin close to implants were visible early (day 3-12) and decreased over time, especially ipsilaterally. Later, during neovascularisation (day 9-40), small vessels sprouted into the implant. <h3>Conclusion</h3> The data show that, RASF can express CD15s, the ligand for E-selectin and adhere stronger to E-selectin and to TNF-stimulated EC compared to OASF. <i>In vivo</i>, in the SCID mouse implants, RASF can actively induce neovascularisation illustrated by a distinct pattern in vessel formation. Thus, expression of CD15s and the ability to interact with EC could represent important steps for vascular transmigration relevant for RASF long distance migration.
Pharmacologic and Antiarrhythmic Actions of Ambonestyl (2-Diethylaminoethyl-Isonicotinamide) in Man
Authors: Byron B. Clark, Benjamin Etsten
Journal: New England Journal of Medicine (1955)

EXPERIMENTAL studies1 2 3 suggested that certain chemical structures might be capable of suppressing ventricular arrhythmia without possessing some of the actions previously associated with antiarrhythmic drugs such as depression of cardiac conduction, elevation of ventricular electrical threshold, hypotension and local anesthetic activity. Ambonestyl (2-diethylaminoethyl-isonicotinamide, MC 4112) was found to be a compound with just such specificity. The chemical structure of Ambonestyl and its relation to procaine amide are shown below: Extensive laboratory investigation in animals4 has demonstrated that Ambonestyl is as effective as procaine amide in the unanesthetized dog in suppressing persistent ventricular tachycardia and multiple premature ventricular contractions resulting from . . .
P3-13-11: Survival Benefit Associated with Post-Mastectomy Radiation for Node-Positive, Intermediate-Risk Breast Cancer Patients: Results of a Study from the SEER Registry Data.
Authors: DP Horowitz, J Ng, RJ Burri
Journal: Cancer Research (2011)

Abstract Background The role of post-mastectomy radiation therapy (PMRT) for breast cancer patients with intermediate-risk (1-3 positive nodes) disease remains controversial. This Surveillance, Epidemiology, and End Results (SEER) study investigated the impact of PMRT in the intermediate-risk breast cancer patient population on cause-specific survival (CSS) and overall survival (OS). The study also investigated the impact of estrogen receptor (ER) status, which has been reported in the SEER database since 2004, on the impact of PMRT in this patient population on CSS and OS. Methods: The SEER database was used to identify all breast cancer patients who were treated between 2004–2007, who had undergone mastectomy, and who had T1-2 tumors and 1–3 pathologically positive lymph nodes. The status of radiation therapy, ethnicity, tumor grade, TNM stage, year of diagnosis, number of LNs sampled, number of LNs positive, and estrogen/progesterone receptor status was recorded. Patients missing pathologic or treatment-related information were excluded. Statistical analysis for CSS and OS was performed using the Kaplan-Meier method and analyzed using the log-rank test. Multivariable analysis was performed using the Cox proportional hazards regression model. Statistical analyses were performed using PASW, version 18. Results: 10,517 patients were identified, with a median follow-up of 21.8 months (range 0–47 months). 2339 patients (22.2%) received PMRT. Younger patients, increasing tumor size, increasing tumor grade, and ER negative tumors were more likely to receive PMRT. PMRT was associated with improved OS, 92.8% (95% CI 91.294.4%) versus 88.7% (95% CI 87.7−89.7%), p &amp;lt; 0.001. However, there was no overall CSS benefit to PMRT, p = 0.197. In the subgroup with ER positive tumors, PMRT was associated with both improved OS, 95.5% (95% CI 93.9−97.1%) versus 91.0% (95% CI 90.0−92.0%), p &amp;lt; 0.001, and improved CSS, 97.6% (95% CI 96.6−98.8%) versus 96.1% (95% CI 95.3−96.9%), p = 0.009. Multivariate analysis showed that PMRT was significantly associated with improved survival (HR 0.744, p = 0.011); increasing age, tumor grade, ER negative tumors, increasing tumor stage, and increasing positive nodal ratio were associated with increased risk of death. Conclusion: Patients with intermediate risk breast cancer who received PMRT have improved OS compared to those who did not receive PMRT. For patients with ER positive tumors, PMRT also appears to be associated with improved CSS. Greater consideration for post-mastectomy radiation therapy use may be warranted for this patient population. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-11.
SAT0270 Cardiovascular disease is related to disease activity in ankylosing spondylitis
Authors: I.J. Berg, A.G. Semb, S.A. Provan, H. Dagfinrud, D. van der Heijde, T.K. Kvien
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Studies have suggested a higher risk of cardiovascular (CVD) in patients with ankylosing spondylitis (AS). The increased risk of CVD cannot be explained by traditional risk factors alone and this study evaluated the influence of disease activity on CVD risk. <h3>Objectives</h3> To compare prevalence of established CVD between a cohort of AS patients, dichotomized according to levels of disease activity, and a population control group. Secondly we compared levels of Augmentation Index (AIx), a surrogate marker of CVD risk across the same groups <h3>Methods</h3> In 2008-2010 159 patients with AS and 134 controls from the Oslo area were examined. The AS cohort comprise hospital-recruited patients diagnosed according to the mNew York classification criteria. The control population was randomly selected by Statistics Norway. CVD was recorded based on interview with a cardiolgist. AIx estimation, measuring arterial stiffness, was performed using a Sphygmocor apparatus. Disease activity was measured by the AS disease activity score (ASDAS) including 4 patient reported questions and CRP. The ASDAS cut-off was set at 2.1 dividing patients into low-moderate and high-very high disease activity. Statistical analyses were performed with SPSS 17.0 using bivariate tests as appropriate. Validity of the results was confirmed in logistical and linear regression models adjusted for age, gender and smoking habits. <h3>Results</h3> The groups were comparable regarding demographic data (AS vs controls): age (50.0 vs 52.7 p=0.17), gender/male (61.6% vs 58.2% p=0.55) and current smoking (18.9% vs 22.6% p=0.44). Acute phase reactants were as expected elevated in AS vs controls (ESR median:16 vs 8, p&lt;0.001 and CRP median:3 vs 1, p&lt;0.001). Total cholesterol was significantly lower in the AS group compared to controls: (mean±SD) 5.42±1.12mmol/l vs 5.75±0.96mmol/l p=0.009. Odds ratio for CVD was 3.3 (CI: 1.1-9.6) p=0.03 in high-very high ASDAS groups compared to controls. AIx was significantly higher in the high-very high ASDAS groupscompared to controls: 20.2 (CI 18.1-22.3) vs 17 (CI 15.7-18.8), p=0.002. The subgroup analyses are presented in Figure 1. <h3>Conclusions</h3> We found significantly higher odds ratio (OR) for established CVD among patients with active AS despite the total AS group having significantly lower total cholesterol. The increased risk of CVD was further confirmed by a significantly increased AIx in patients with high ASDAS. <h3>Disclosure of Interest</h3> I. J. Berg Consultant for: MSD, A. G. Semb: None Declared, S. Provan: None Declared, H. Dagfinrud: None Declared, D. van der Heijde: None Declared, T. Kvien: None Declared