tbuckley/cabot-search huggingface dataset:
Psychiatry and the nursing home
Authors: S Borson, B Liptzin, J Nininger, P Rabins
Journal: American Journal of Psychiatry (1987)

In the last two decades, nursing homes have become major providers of health services for the frail elderly. Despite ample evidence of need for specialized psychiatric services in the nursing home setting, the majority of patients who could benefit from such care do not receive it. The authors propose a fourfold role for the psychiatrist, encompassing clinical care, consultation, teaching, and research. Features of this role can be adapted to fee-for-service, community mental health center, and academic models of psychiatric practice.
Clinicopathologic Significance of Mismatch Repair Defects in Endometrial Cancer: An NRG Oncology/Gynecologic Oncology Group Study
Authors: D. Scott McMeekin, David L. Tritchler, David E. Cohn, David G. Mutch, Heather A. Lankes, Melissa A. Geller, Matthew A. Powell, Floor J. Backes, Lisa M. Landrum, Richard Zaino, Russell D. Broaddus, Nilsa Ramirez, Feng Gao, Shamshad Ali, Kathleen M. Darcy, Michael L. Pearl, Paul A. DiSilvestro, Shashikant B. Lele, Paul J. Goodfellow
Journal: Journal of Clinical Oncology (2016)

Purpose The clinicopathologic significance of mismatch repair (MMR) defects in endometrioid endometrial cancer (EEC) has not been definitively established. We undertook tumor typing to classify MMR defects to determine if MMR status is prognostic or predictive. Methods Primary EECs from NRG/GOG0210 patients were assessed for microsatellite instability (MSI), MLH1 methylation, and MMR protein expression. Each tumor was assigned to one of four MMR classes: normal, epigenetic defect, probable mutation (MMR defect not attributable to MLH1 methylation), or MSI-low. The relationships between MMR classes and clinicopathologic variables were assessed using contingency table tests and Cox proportional hazard models. Results A total of 1,024 tumors were assigned to MMR classes. Epigenetic and probable mutations in MMR were significantly associated with higher grade and more frequent lymphovascular space invasion. Epigenetic defects were more common in patients with higher International Federation of Gynecology and Obstetrics stage. Overall, there were no differences in outcomes. Progression-free survival was, however, worse for women whose tumors had epigenetic MMR defects compared with the MMR normal group (hazard ratio, 1.37; P &lt; .05; 95% CI, 1.00 to 1.86). An exploratory analysis of interaction between MMR status and adjuvant therapy showed a trend toward improved progression-free survival for probable MMR mutation cases. Conclusion MMR defects in EECs are associated with a number of well-established poor prognostic indicators. Women with tumors that had MMR defects were likely to have higher-grade cancers and more frequent lymphovascular space invasion. Surprisingly, outcomes in these patients were similar to patients with MMR normal tumors, suggesting that MMR defects may counteract the effects of negative prognostic factors. Altered immune surveillance of MMR-deficient tumors, and other host/tumor interactions, is likely to determine outcomes for patients with MMR-deficient tumors.
Enlarged Pinna
Authors: Maria Navedo, Pedro Redondo
Journal: New England Journal of Medicine (2015)

An 82-year-old man presented with a 1-year history of swelling of his left ear, with associated difficulty hearing. He had applied topical glucocorticoids for 4 months without response. On examination, the ear was enlarged, indurated, and erythematous, with no associated lymphadenopathy.
Hypertrophic osteoarthropathy: A case report
Authors: Cem Erçalık, Göksel Çelebi, Bilge Düden, Hüseyin Elik, David Ojalvo, Figen Yılmaz, Jülide Öncü, Gülgün Durlanık, Beril Doğu, Banu Kuran, Fatih Borlu
Journal: Journal of the American Academy of Dermatology (2016)
Effect of imipramine on depression and immune status in a sample of men with HIV infection
Authors: J G Rabkin, W M Harrison
Journal: American Journal of Psychiatry (1990)

Eleven men with major depression and human immunodeficiency virus (HIV) infection underwent an open trial of imipramine. Eight of nine (89%) who completed 12 weeks responded. The mean decline in T4 cells from baseline was 100 at week 12 and 16 at week 26. No major exacerbations of HIV infection occurred.
Association Between Plasma Genotyping and Outcomes of Treatment With Osimertinib (AZD9291) in Advanced Non–Small-Cell Lung Cancer
Authors: Geoffrey R. Oxnard, Kenneth S. Thress, Ryan S. Alden, Rachael Lawrance, Cloud P. Paweletz, Mireille Cantarini, James Chih-Hsin Yang, J. Carl Barrett, Pasi A. Jänne
Journal: Journal of Clinical Oncology (2016)

Purpose Third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have demonstrated potent activity against TKI resistance mediated by EGFR T790M. We studied whether noninvasive genotyping of cell-free plasma DNA (cfDNA) is a useful biomarker for prediction of outcome from a third-generation EGFR-TKI, osimertinib. Methods Plasma was collected from all patients in the first-in-man study of osimertinib. Patients who were included had acquired EGFR-TKI resistance and evidence of a common EGFR-sensitizing mutation. Genotyping of cell-free plasma DNA was performed by using BEAMing. Plasma genotyping accuracy was assessed by using tumor genotyping from a central laboratory as reference. Objective response rate (ORR) and progression-free survival (PFS) were analyzed in all T790M-positive or T790M-negative patients. Results Sensitivity of plasma genotyping for detection of T790M was 70%. Of 58 patients with T790M-negative tumors, T790M was detected in plasma of 18 (31%). ORR and median PFS were similar in patients with T790M-positive plasma (ORR, 63%; PFS, 9.7 months) or T790M-positive tumor (ORR, 62%; PFS, 9.7 months) results. Although patients with T790M-negative plasma had overall favorable outcomes (ORR, 46%; median PFS, 8.2 months), tumor genotyping distinguished a subset of patients positive for T790M who had better outcomes (ORR, 69%; PFS, 16.5 months) as well as a subset of patients negative for T790M with poor outcomes (ORR, 25%; PFS, 2.8 months). Conclusion In this retrospective analysis, patients positive for T790M in plasma have outcomes with osimertinib that are equivalent to patients positive by a tissue-based assay. This study suggests that, upon availability of validated plasma T790M assays, some patients could avoid a tumor biopsy for T790M genotyping. As a result of the 30% false-negative rate of plasma genotyping, those with T790M-negative plasma results still need a tumor biopsy to determine presence or absence of T790M.
Feasibility study of postoperative management based on ERAS of patients with gastrectomy.
Authors: Y. Sugiyama, N. Hirabayashi, J. Taomoto, T. Mimura, M. Yoshimitsu, S. Murakami, S. Saeki, H. Mukaida, W. Takiyama
Journal: Journal of Clinical Oncology (2011)

127 Background: Although the usefulness of the postoperative management based on Enhanced Recovery After Surgery (ERAS) program of patents with colectomy is shown, there are a few papers concerning ERAS program for gastric cancer patients. The aim of the present study was to examined whether a new postoperative management based on ERAS was feasible for pts with gastrectomy. Methods: From September 2009 to April 2010, we have adopted the new clinical pathway (CP) based on ERAS and oral rehydration therapy (ORT) for 30 consecutive gastric cancer patients who underwent curative gastrectomy. These pts began a oral rehydration solution (ORS) on the first postoperative day, and after the volume of ORS got 1,000 ml, we stopped intravenous transfusion. The incidence of adverse events, postoperative pt's activity score, which pt's daily activity was evaluated with, and total infusion volume of these pts were compared with 30 pts with the previous CP that were enrolled as a control group. Results: There were no significant differences in the clinical and operative factors between the two groups. The post operative patient's activity score of ERAS group was significantly higher up to 7th postoperative day (POD). Total infusion volume was significantly little besides, in most cases, infusion therapy was substituted for ORT with OS-1 within 2 POD. There was no difference in the hospitalized days, and the incidence of adverse events were statistically no significance between two groups. Conclusions: Our CP based on ERAS and ORT is feasible for patients with gastrectomy. No significant financial relationships to disclose.
Physicians' erotic and nonerotic physical involvement with patients
Authors: J A Perry
Journal: American Journal of Psychiatry (1976)

The author surveyed 164 female physicians to determine their attitudes and practices regarding erotic and nonerotic physican contact with patients. Compared with a previous study of male physicians (1), more female physicians believe in and engage in nonerotic touching, but fewer believe in and engage in erotic touching. None of the female physicians reported sexual intercourse with patients as compared with 11% of the male physicians in the previous study.
Website of the week: Empowering consumers
Authors: Tessa Richards
Journal: BMJ (2001)

The customer may be king in the retail trade, but in medicine only the most well educated and persistent approach royal status. For most, the gulf between “them” and “us” remains large, and the much vaunted movement to treat patients as partners remains more honoured in the breach than the observance.

But the tide is turning, and this week the BMJ presents encouraging UK data (p 517) to suggest that consumer involvement in the design and conduct of clinical trials is increasing. The study concludes by saying that a consumer-led electronic guide to running good controlled trials is needed and that consumer influence should be mobilised.

Serving patients' interests and canvassing more information about what those interests are is exactly what the new Cochrane Consumer Network website is about (www.cochraneconsumer.com). Launched a couple of weeks ago, this site is likely to prove an incredibly useful (free) resource for patients and, I suspect, many of their doctors. The visual appeal of the site may be more Cochrane than consumer, but it provides both short readable summaries of Cochrane reviews as well as, via www.clinicaltrials.gov and www.trialscentral.org, enough information about clinical trials to satisfy even the most assiduous of inquirers.

After becoming well versed in the science and rationale of clinical trials, someone caring for a relative with, say, Alzheimer's disease can, within a couple of clicks, become equally well briefed about the 22 ongoing clinical trials that are currently recruiting patients. The site also provides links to other evidence based healthcare sites, reputable sources of consumer health information, government health reports, and, most importantly, the skills needed to track down good information. Awareness of what the site's press release describes as “access to the kinds of information that only doctors have traditionally found easy to get” should ensure that potentially useful consumer feedback should not be long in coming.
EPIC: A phase III randomized, open-label study of ponatinib versus imatinib in adult patients with newly diagnosed chronic myeloid leukemia in chronic phase.
Authors: Jeffrey H. Lipton, Michael W. N. Deininger, Stephanie Lustgarten, Christopher D. Turner, Victor M. Rivera, Tim Clackson, Michele Baccarani, Jorge E. Cortes, Francois Guilhot, Andreas Hochhaus, Timothy P. Hughes, Hagop M. Kantarjian, Neil P. Shah, Moshe Talpaz, Frank G. Haluska
Journal: Journal of Clinical Oncology (2013)

TPS7129 Background: The hallmark genetic abnormality of chronic myeloid leukemia (CML), known as the Philadelphia chromosome, generates the BCR-ABL fusion gene; expression of BCR-ABL in hematopoietic stem cells gives rise to CML. Ponatinib is a potent oral pan–BCR-ABL tyrosine kinase inhibitor (TKI) that is active against native and mutated forms of BCR-ABL, including the T315I gatekeeper mutant. Results from the phase 1 and phase 2 studies of ponatinib demonstrated that ponatinib is generally well tolerated and has substantial anti-leukemic activity in patients with CML who are resistant or intolerant to prior TKI therapy, regardless of baseline mutation status. In addition, multivariate analyses suggest that ponatinib has greater activity in younger patients who are less heavily pretreated and have a shorter time since diagnosis. The phase 3 EPIC (Evaluation of Ponatinib vs Imatinib in CML) study is testing the hypothesis that ponatinib is an effective treatment for newly diagnosed chronic phase (CP) CML patients when compared with standard imatinib therapy. Methods: EPIC is a multicenter, international, phase 3, two-arm, open-label trial of ponatinib (45 mg once daily) versus imatinib (400 mg once daily) in patients with newly diagnosed CP-CML. Patients ≥18 years of age with CP-CML (diagnosed within 6 months prior to study entry) and adequate renal, hepatic, and pancreatic function are eligible for enrollment. Enrolled patients are assigned to receive ponatinib or imatinib in a 1:1 fashion, stratified by Sokal Risk score (low vs intermediate vs high). The primary efficacy endpoint for this trial is major molecular response (MMR) rate at 12 months. Secondary endpoints include MMR rate at 5 years, BCR-ABL IS &lt;10% rate at 3 months, CCyR rate at 12 months, progression-free survival, overall survival, and safety. A sample size consisting of 480 patients will provide 90% power to detect a 15% absolute increase in MMR rate at 12 months using an unstratified Fisher exact 2-sided test at an alpha level of 0.05. Assuming a 10% dropout rate, approximately 528 patients will be enrolled. The first patient was enrolled in August 2012. Clinical trial information: NCT01650805.
Physicians expertise in geriatric oncology care: A Web survey among Brazilian medical oncologists.
Authors: Luciola De Barros Pontes, Diogo Bugano Diniz Gomes, Luiz Victor Maia Loureiro, Fernanda Maris Peria, Theodora Karnakis, Rafael Kaliks Guendelmann, Auro Del Giglio
Journal: Journal of Clinical Oncology (2014)

e20527 Background: Brazil has 13 million people older than 65 years, with an expected increase to 39 million by 2040. This scenario will be accompanied by a growth in the incidence of cancer, bringing challenges related to the care of an older person with cancer. We aimed to investigate the attitude of oncologists regarding treatment of elderly cancer patients. Methods: Between November 2013 and January 2014, 933 emails were sent to medical oncologists in Brazil through a web-based survey link with questions about geriatric oncology (GO). Results: A total of 117 surveys were answered (12.5% response rate). Median age was 38.9 years (range, 27-64 years). 27.3% of the oncologists had finished their fellowship within 5-10 years and 36.7% were working in private practice. Only 26.5% reported the existence of a GO team at their facilities, mainly in academic medical centers. The majority of respondents (97.4%) were familiar with the concept of GO, 82% had read at least one article addressing older cancer patients issues, 78.6% were familiar with comprehensive geriatric assessment (CGA) and 65.8% with scales to predict the risk of chemo-toxicity. Having read a scientific article about GO (OR 8.5; 95% CI 3-24.2; p< 0.001) and the presence of a local GO team (OR 2.7; 95% CI 1.1-7.3; p=0.047) were variables correlated with the familiarity to CGA and chemo-toxicity scales. Nonetheless, only 36.7% and 29.1% apply CGA and chemo-toxicity scales, respectively, into their clinical practice. Moreover, 26.7% of the subjects, at least once, decided not to treat an older person based exclusively on its chronological age. 58.8% believed that a care plan agreed by a multidisciplinary team would be necessary for the majority of elderly cancer patients. The availability of a GO team would make oncologists more encouraged to refer elderly for treatment (OR 0.4; 95% CI 0.2-0.9; p=0.031), particularly for head and neck, lung and gastrointestinal cancers. Conclusions: Our study shows that the concepts of GO among brazilian oncologists are fairly widespread but insufficiently applied. In order to improve care, it is compelling to develop strategies to incorporate them as routine procedures to guide treatment decisions in elderly people with cancer.
P-127 Pathological versus clinical complete responders after preoperative treatment in rectal cancer: long term outcomes analysis
Authors: S. Iseas, M. Coraglio, A. Dieguez, M. Eleta, C. Bertoncini, H. Tejerina, M. Carballido, R. Bianchi, F. Leiro, G. Mendez, M. Barugel, E. Roca
Journal: Annals of Oncology (2016)
Effective Targeted Photothermal Ablation of Multidrug Resistant Bacteria and Their Biofilms with NIR‐Absorbing Gold Nanocrosses
Authors: Choon Peng Teng, Tielin Zhou, Enyi Ye, Shuhua Liu, Leng Duei Koh, Michelle Low, Xian Jun Loh, Khin Yin Win, Lianhui Zhang, Ming‐Yong Han
Journal: Advanced Healthcare Materials (2016)

With the rapid evolution of antibiotic resistance in bacteria, antibiotic‐resistant bacteria (in particular, multidrug‐resistant bacteria) and their biofilms have been becoming more and more difficult to be effectively treated with conventional antibiotics. As such, there is a great demand to develop a nonantibiotic approach in efficiently eliminating such bacteria. Here, multibranched gold nanocrosses with strong near‐infrared absorption falling in the biological window, which heat up quickly under near‐infrared‐light irradiation are presented. The gold nanocrosses are conjugated to secondary and primary antibodies for targeting PcrV, a type III secretion protein, which is uniquely expressed on the bacteria superbug, Pseudomonas aeruginosa . The conjugated gold nanocrosses are capable of completely destroying P. aeruginosa and its biofilms upon near‐infrared‐light irradiation for 5 min with an 800 nm laser at a low power density of ≈3.0 W cm −2 . No bacterial activity is detected after 48 h postirradiation, which indicates that the heat generated from the irradiated plasmonic gold nanocrosses attached to bacteria is effective in eliminating and preventing the re‐growth of the bacteria. Overall, the conjugated gold nanocrosses allow targeted and effective photothermal ablation of multidrug‐resistant bacteria and their biofilms in the localized region with reduced nonspecific damage to normal tissue.
Do not prescribe antibiotics for bronchiolitis in children, doctors are reminded
Authors: Jacqui Wise
Journal: BMJ (2016)

Children with bronchiolitis should not be given antibiotics to treat the infection and most cases can be managed at home, doctors are reminded in a new quality standard from the National Institute for Health and Care Excellence (NICE).1

The advice aims to reduce child hospital admissions for bronchiolitis. Last year more than 39 400 babies and young children were admitted to hospital with bronchiolitis in England. The infection is caused by a virus—usually the respiratory syncytial virus—and cannot be treated …
Improving pancreas surgery over time: Performance factors related to transition of care and patient volume
Authors: Jon Arne Søreide, Oddvar M. Sandvik, Kjetil Søreide
Journal: International Journal of Surgery (2016)

Pancreas surgery has evolved with better diagnostic imaging, changing indications, and improved patient selection. Outside high-volume tertiary centers, the documented effect of evolution in care and volumes are limited. Thus, we aimed to review indications and outcomes in pancreas surgery during the transition from community-based hospital to a university hospital.All pancreatic surgeries performed between 1986 and 2012 within a well-defined Norwegian population were identified from the hospital's database. Indications and postoperative outcomes, including mortality, were investigated.Of the 219 included patients (54% males; median age, 64 years), 150 (69%) underwent pancreatoduodenectomy; 55 (25%), distal resection; and 5 (2%), enucleation. The annual number of operations increased during the study period (from <10/yr to >20/yr). Most patients (169; 77%) underwent surgery for suspected malignancy. The 30-day mortality decreased significantly over time among patients treated for pancreatic cancer (from 16.1% to 3.5%; p = 0.012). Over time, significant reductions in median hospitalization time (19 versus 12 days; p < 0.001), re-operation rate (37.1% versus 8.4%; p < 0.001), and median ICU stay (3 versus 0 days; p < 0.001) were observed.The transition to university hospital and increase in volume has led to significant improvements in several performance metrics and reduced postoperative mortality. We believe improved perioperative management and focused, multidisciplinary care-bundles to be of importance.
Food for thought
Authors: Des Spence
Journal: BMJ (2007)

Cornwall's beaches are full of successful professional driftwood. While they sip mochas and gossip at 100 dB in accents that seem to lack the letter R, their boarding school children get drunk and snog in the dunes—a brief interlude before they reluctantly board the tedium express back to their lives. We Scottish interlopers are viewed with suspicion. We lack the social badges, but we also enjoy the surf, the escape, and the high quality of Cornwall's food. Interestingly, Cornwall's hospitals have improved their food at no extra cost by sourcing food locally.

When I was a junior doctor walking the wards I lost weight. In part this was due to the weight of a junior doctor's paraphernalia, but mainly it was the revolting hospital food. The canteen food varied in colour and consistency but all tasted the same. The NHS salad bar simply involved mixing a kilogram of salad cream with cold leftovers. It was hot toast with margarine (even then butter was recognised as being dangerous) that sustained me.

When the food trolley doors were flung open, so were the wards' windows, to let the stench out—a welcome relief to the institutional incubation we endured. Food was politely pushed around the plate and then straight into the slops. At the end of dinner time patients congregated in the smoking room for hot toast. But the poor souls on a prescription diet fared worse. Their mystical and utterly pointless diets consisted of fluorescently coloured jelly, but as it was “prescribed” it was forcibly spooned down. All patients lived in fear of the hospital dietitian.

Food is important to health, irrespective of the setting—so why can't we get something as basic as hospital food right? Unfortunately, hospital food has been “medicalised.” The recipes are the concoction of the medical “expert” and the accountant. The expert, obsessed with “healthiness,” insists on blandness; the accountant, obsessed with cost, insists on cheapness. The result: NHS food is centrally manufactured on an industrial estate outside Slough and shipped out in juggernauts overnight. Each unit costs 0.03 p per polystyrene plateful. When patients elect to eat the plate rather than the food, concerned doctors prescribe expensive sip feed—merely milkshakes with comic book names and a periodic table of additives. What insanity.

The solution is to retrain most dietitians as cooks, reopen local kitchens, source local seasonal foods, and work to classic British recipes. Encourage patients to eat together, and throw in a glass of wine. Fund it by stopping doctors scanning everyone all the time.

This summer, if I am admitted to hospital with deafness after a prolonged bombardment of name dropping while on holiday in Cornwall, at least I know the food will be good.
RE: RNA Disruption Assay as a Biomarker of Pathological Complete Response in Neoadjuvant Trastuzumab-Treated Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer
Authors: Sinead Toomey, Alex J. Eustace, Laura B. Pritzker, Ken P. H. Pritzker, Joanna Fay, Anthony O’Grady, Robert Cummins, Liam Grogan, John Kennedy, Darran O’Connor, Leonie Young, Elaine W. Kay, Norma O’Donovan, William M. Gallagher, Roshni Kalachand, John Crown, Bryan T. Hennessy
Journal: JNCI Journal of the National Cancer Institute (2016)