tbuckley/cabot-search huggingface dataset:
Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions
Authors: Laura R. Wherry, Sarah Miller
Journal: Annals of Internal Medicine (2016)

In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults.To evaluate whether the state Medicaid expansions were associated with changes in insurance coverage, access to and utilization of health care, and self-reported health.Comparison of outcomes before and after the expansions in states that did and did not expand Medicaid.United States.Citizens aged 19 to 64 years with family incomes below 138% of the federal poverty level in the 2010 to 2014 National Health Interview Surveys.Health insurance coverage (private, Medicaid, or none); improvements in coverage over the previous year; visits to physicians in general practice and specialists; hospitalizations and emergency department visits; skipped or delayed medical care; usual source of care; diagnoses of diabetes, high cholesterol, and hypertension; self-reported health; and depression.In the second half of 2014, adults in expansion states experienced increased health insurance (7.4 percentage points [95% CI, 3.4 to 11.3 percentage points]) and Medicaid (10.5 percentage points [CI, 6.5 to 14.5 percentage points]) coverage and better coverage than 1 year before (7.1 percentage points [CI, 2.7 to 11.5 percentage points]) compared with adults in nonexpansion states. Medicaid expansions were associated with increased visits to physicians in general practice (6.6 percentage points [CI, 1.3 to 12.0 percentage points]), overnight hospital stays (2.4 percentage points [CI, 0.7 to 4.2 percentage points]), and rates of diagnosis of diabetes (5.2 percentage points [CI, 2.4 to 8.1 percentage points]) and high cholesterol (5.7 percentage points [CI, 2.0 to 9.4 percentage points]). Changes in other outcomes were not statistically significant.Observational study may be susceptible to unmeasured confounders; reliance on self-reported data; limited post-ACA time frame provided information on short-term changes only.The ACA Medicaid expansions were associated with higher rates of insurance coverage, improved quality of coverage, increased utilization of some types of health care, and higher rates of diagnosis of chronic health conditions for low-income adults.None.
Systemic Granulomatous Reaction to a Foreign Body after Hip Replacement
Authors: Michel Péoc'h, Christophe Moulin, Basile Pasquier
Journal: New England Journal of Medicine (1996)

gives a moving account (Jan.11 issue) 1 of his 20 years as a patient with progressive Parkinson's disease.His description of the various phases of the illness and his struggle to stay in control present a fine model for other patients to discover ways to accommodate themselves to the disease without surrendering their dignity.We are concerned that his overly generous praise of pallidotomy may mislead readers who uncritically accept his statement that pallidotomy "relieves most of the manifestations of the disease in most patients."Pallidotomy effectively reduces levodopa-related dyskinesias and limb rigidity on the side contralateral to the lesion, and to a lesser extent it can lessen tremor and improve walking.Unfortunately, many of the medically intractable symptoms, such as postural instability, falling, muffled speech, dysphagia, and cognitive decline, do not improve.Even when the benefit of surgery is dramatic, the duration of the response is still unknown.It is gratifying that pallidotomy has become a serious treatment option for well-selected patients with Parkinson's disease.However, it is a mistake to make unqualified generalizations about all patients when the evidence at this time permits only cautious optimism for some.
Palliative chemotherapy preferences and factors that influence patient choice in advanced cancer
Authors: M. Kim, K. Lee, M. Hyun, Y. Do, H. Song, J. Kim, J. Baek, S. Bae, H. Ryoo, K. Park
Journal: Journal of Clinical Oncology (2006)

16010 Background: We conducted this prospective study to determine the treatment preference of patients receiving chemotherapy in a palliative setting. We investigated the survival threshold for justifying toxicity, the factors influencing individual preference for chemotherapy, and the attitude of patients towards randomized trials. Methods: 138 patients (median age, 58 years; 73% male) with advanced cancer who had received at least one cycle of palliative chemotherapy were recruited. General demographic information, patient preferences for palliative chemotherapy, and randomized trials were determined using structured patient interviews. Results: The median age was 58 years (range, 25–77 years), and the majority of the study population were male (73%). 73 patients (60.1%) answered that they had some support by dependents. Fewer than half were given information about the impact of their chemotherapy on survival (n = 64, 48.1%), and just over one third of patients (n = 53, 40.5%) were presented with an alternative to anticancer therapy, such as supportive care (p &lt; 0.001). While 75.7% of patients agreed to receive chemotherapy with mild toxicity, only 57.9% of patients agreed to chemotherapy with severe toxicity (p = 0.002). The median survival threshold was 12 months for mild toxicity, and 21 months for severe toxicity. Patients who experienced improvement of symptoms or quality of life were more likely to judge the treatment as acceptable. 105 patients (78.4%) refused a clinical trial with randomization between a conventional chemotherapy and supportive care. There were 85 patients (62.6%) that would refuse randomization between conventional chemotherapy and investigational chemotherapy. Finally, 58.6% of patients agreed to participate in trials with investigational agents. Conclusions: In the palliative setting, a discussion of prognosis and the merits of chemotherapy is a necessary part of the treatment decision-making processes, and choosing the proper treatment for cancer patients. Individual preferences assume greater importance in this setting. Randomized trials must be carefully designed with a priori equipoise. No significant financial relationships to disclose.
The treatment of drug abuse: evolution of a perspective
Authors: L Brill
Journal: American Journal of Psychiatry (1977)

Current approaches to the treatment of drug addiction are based on an earlier approach derived from a traditional psychoanalytic framework. The author describes how this framework has been modified by three broad areas of understanding, i.e., issues related to addicts, to the methods of psychoanalysis, and to the earlier incomplete understanding about drugs. The comprehensive, multimodality treatment approach used today draws on psychoanalysis's contribution of a rational framework for the understanding of personal behavior in all forms of treatment and the need for a relationship as the core of all treatment, regardless of the modality.
Assessment of Inhibitory Antibody Formation in Subjects with Hereditary Angioedema Treated with Plasma-Derived C1-Esterase Inhibitor Concentrate (Berinert®)
Authors: Henriette Farkas, Dumitru Moldovan, Krystyna ObtuÅ, owicz, T. Shirov, Jonathan M. Edelman, Debora Williams-Herman, Mikhail Rojavin
Journal: Journal of Allergy and Clinical Immunology (2016)
Muscle Percussion and Neostigmine Test in the Clinical Evaluation of Neuromuscular Disorders
Authors: Aneel N. Patel, R. Kumara Swami
Journal: New England Journal of Medicine (1969)

The clinical distinction between myopathic and neurogenic disorders of the motor unit is often difficult, since both lesions appear as flaccid, areflexic paralyses, often with variable muscular atrophy. Whereas electromyography and muscle biopsy are often used in differential diagnosis, the simpler bedside technics of muscle percussion and neostigmine-induced fasciculation are frequently neglected. An idiomuscular response to percussion was seen in all of 66 patients with neurogenic atrophy, but in only 16 of 52 patients with myopathies and in 20 of 104 controls. A brisk response was only found in neural atrophy. Fasciculations in response to neostigmine were seen in 51 of the 66 neurogenic atrophies, none of the myopathies and seven of the 104 controls. The presence of a brisk idiomuscular response and the occurrence of neostigmine-induced fasciculations indicate a neurogenic lesion, usually central, whereas their absence favors a diagnosis of myopathy.
Modulation of Cellular Immune Function by Cyclophosphamide in Children with Minimal-Change Nephropathy
Authors: J. Feehally, T. J. Beattie, P. E. C. Brenchley, B. M. Coupes, I. B. Houston, N. P. Mallick, R. J. Postlethwaite
Journal: New England Journal of Medicine (1984)

Cyclophosphamide is widely used to induce a remission of minimal-change nephropathy, but concerns have been raised about whether its effects on cellular immunity persist after treatment is discontinued. We studied functional and numerical measures of cellular immunity in children who had minimal-change nephropathy with frequent steroid-responsive relapses and were receiving cyclophosphamide (2.5 mg per kilogram of body weight per day for eight weeks). Sequential studies during such treatment showed that cyclophosphamide caused lymphopenia, particularly among T helper cells, resulting in a significant fall in the immunoregulatory (helper/suppressor) cell ratio. This change persisted 1 to 3 months after cyclophosphamide was discontinued, but measures of immune function reverted to normal after 6 to 12 months. Children with minimal-change nephropathy in long-term remission had no difference in T-cell subpopulations, lymphocyte responses to mitogens, or suppressor-cell function that could be attributed to the disease itself or to the previous use of cyclophosphamide.
Gemcitabine and cisplatin double as neoadjuvant chemotherapy for operable 1B-IIIB stage NSCLC patients
Authors: V. Gorbounova, B. Polotsky, A. Marenich, V. Breder, K. Laktionov, S. Gerasimov, E. Dgebuadze, A. Fedenko, A. Kolesnik, E. Rodnikova
Journal: Journal of Clinical Oncology (2007)

18190 Background: the ongoing open-label, nonrandomized clinical trial on the evaluation of the efficiency and safety of gemcitabine/cisplatin as neoadjuvant chemotherapy of operable NSCLC. Methods: 37 chemonaive patients (male- 30 (81%) and female- 7 (19%), median age 54), ECOG 0–1 with morphologically verified NSCLC recieved gemcitabine 1250 mg/m 2 IV on days 1,8 plus cisplatin 75 mg/m 2 IV on day 1. The follow-up period was 3 years after the surgery. Results: Most of patients recieved 3 cycles in neoadjuvant setting. IB stage had 5 (13.5%) patients, IIB- 3 (8.1%), IIIA- 23 (62.2%) and IIIB- 6 (16.2%) patients. At baseline 12 (32.3%) patients had ECOG 0 and 25 (67.7%) ECOG 1. CR was registered in 3 (8.1%) patients, PR in 12 (32.3%), SD in 19 (51.3%) and PD in 2 (5.4%) and 1 patient was not assessed. The most common hemotologic toxicity was mild/moderate neutropenia that didn’t need dose reduction or intercycle interval prolongation. 25 patients underwent curative surgery with median survival of 30 months, 1-year survival of 81%, 2-year survival- 60% and 3-year survival - 40%. There was no statistically significant dependance between the level of pathomorphosis and the intensity of clinical response.6 patients recieved explorative thoracotomy and 6 didn’t recieve any surgery. Conclusions: Preliminary results show that gemcitabine/cisplatin combination is an effective and well-tolerable neoadjuvant regimen for patients with operable NSCLC. No significant financial relationships to disclose.
Removing contact from school rugby will not turn children into couch potatoes
Authors: Allyson M Pollock, Graham Kirkwood
Journal: British Journal of Sports Medicine (2016)

Background: Recently, an open letter calling for a ban on tackling in school rugby was sent to the Chief Medical Officers (CMOs) and Ministers of Sport in Education and Health in the UK and the Republic of Ireland. The Royal College of Paediatrics and Child Health (RCPCH), and the Faculty of Sports and Exercise Medicine (FSEM), have responded with statements on their respective websites.1 ,2 These statements mirror claims made in a commentary in the BJSM co-written by the CMO of Scotland, entitled “Turning people into couch potatoes is not the cure for sports concussion”.3 

Both the RCPCH and FSEM statements take an approach of denying the evidence that exists, creating a smokescreen of new initiatives that await evaluation and finally conflating the benefits of physical activity and exercise with sport and contact sport in particular.

First, turning to the suppression and denial of evidence of harm. Writing on behalf of the FSEM, Dr Jackson claims that “There is insufficient good evidence to …
Excellent Quality of Lives for Previously Treated Adult T-Cell Leukemia/Lymphoma Patients After Autologous Dendritic Cell Vaccine Therapy Targeting Htlv-1 Tax Antigens
Authors: Y. Suehiro, T. Iino, A. Hasegawa, N. Watanabe, M. Matsuoka, R. Tanosaki, A. Utsunomiya, I. Choi, M. Shiratsuchi, T. Teshima, K.A. Akashi, M. Kannagi, N. Uike, J. Okamura
Journal: Annals of Oncology (2014)
Safety and effectiveness of bevacizumab (BV) and chemotherapy (CT) in elderly patients (pts) with metastatic colorectal cancer (mCRC): Results from the BRiTE observational cohort study
Authors: M. F. Kozloff, M. M. Sugrue, D. M. Purdie, J. D. Berlin, P. J. Flynn, F. F. Kabbinavar, D. J. Sargent, W. Dong, A. Grothey
Journal: Journal of Clinical Oncology (2008)

4026 Background: BV prolongs overall survival (OS) and progression-free survival (PFS) when added to CT for 1st- line (FL) and 2nd-line treatment (tx) of pts with mCRC. Subgroup analyses (ages ≥65 vs <65) in the pivotal trials (RCTs) with BV + CT showed significant improvement in PFS and OS without increased toxicity. The BRiTE study previously showed comparable safety and effectiveness (PFS, 1-yr survival rate) in pts ≥65 vs <65. This report further delineates the clinical outcomes in the following elderly subgroups: 65–74, >75 and >80. Methods: Pts and methods for BRiTE have been described (Sugrue, GI Cancer Symposium 2007; A345). Cox regression assessed the independent effect of age on survival after adjusting for other known prognostic factors. Results: Of 1,953 pts in BRiTE, 896 were ≥65 [65–74 (533), ≥75 (363)] and 161 were ≥80. Table shows tx, BV-targeted safety events, and survival outcomes. As predicted based on SEER-Medicare data, a lower median OS for elderly subgroups was observed in univariate analyses (Table). After adjusting for pre- and post-treatment pt factors in multivariate analyses, the hazard ratio for age ≥75 vs <65 was 1.1, 95% CI = 0.9–1.3 (p=0.2). Conclusions: BRiTE's large cohort of elderly mCRC pts offers a unique opportunity to analyze BV + CT tx outcomes in a population poorly represented in RCTs. Apart from a higher rate of ATEs in older pts (previously described in RCTs; Scappaticci, JNCI 2007;99;1232–9), BV-targeted safety in the elderly was comparable to that in pts <65. PFS in the elderly was similar to pts <65 in BRiTE and in pivotal BV trials. Multivariate analyses revealed that the lower median OS observed in older pts was partly attributed to poorer PS and relative underexposure to active CT agents and post-PD tx in the elderly. These results indicate that age alone should not be a barrier to using BV-containing treatment in pts with mCRC. All (N=1,953) <65 (n=1,057) 65–74 (n=533) ≥75 (n=363) ≥80 (n=161) ECOG PS ≥2 7.0 4.9 7.1 12.7 11.8 Tx (%) FL FOLFOX 55.9 61.3 54.0 43.0 37.9 FL bolus 5FU/LV 6.8 3.2 7.9 15.4 21.1 Post-PD any 87.9 89.5 86.3 85.4 82.0 Post-PD w/BV 34.6 38.6 32.5 26.2 22.4 Safety (%) GI perf 1.9 2.5 1.5 1.1 0.6 ATE 2.0 1.5 1.5 4.1 4.3 Grade 3–4 bleed 2.5 2.0 3.4 2.5 1.2 New/worsening HTN 20.2 20.1 20.1 20.9 21.1 Survival (mo) Med PFS 10.0 10.2 9.7 9.8 9.2 1-yr survival rate (%) 74.6 77.3 72.5 70.0 66.5 Med OS 24.5 28.0 21.3 19.5 17.3 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Genentech, Inc. Genentech, Inc., Roche, sanofi-aventis Genentech, Inc. Genentech, Inc., Roche, sanofi-aventis
Healing Sacral Fracture Masquerading as Metastatic Bone Disease on a 68Ga-PSMA PET/CT
Authors: Pieterjan Gykiere, Lode Goethals, Hendrik Everaert
Journal: Clinical Nuclear Medicine (2016)

Prostate-specific membrane antigen (PSMA) is a cell surface glycoprotein, which is frequently overexpressed on prostate cancer cells. A Ga-PSMA PET/CT can be used for early detection of lymph node or bone metastases after radical prostatectomy when there is biochemical recurrence. This report describes PSMA uptake in a healing fracture masquerading as metastatic bone disease in a patient with a history of prostate adenocarcinoma. Clinicians reporting Ga-PSMA PET/CT should be aware of this potential important pitfall.
P24 Underuse of beta-blockers in patients with heart failure and COPD
Authors: D Skinner, B Lipworth, G Devereux, V Thomas, J Ling, J Martin, V Carter, D Price
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Cardiovascular comorbidity is common in COPD. Retrospective health informatics studies have shown putative benefits of beta-blockers (BB) in reducing both mortality and exacerbations in COPD.<sup>1</sup> BB are established in heart failure (HF) guidelines including those patients who have concomitant COPD. However, there remain concerns regarding bronchoconstriction in COPD even with cardio-selective BB. For example, 55% of patients with COPD, who had a myocardial infarction (MI), were not prescribed a BB.<sup>2</sup> We wished to assess the use of BB for patients with HF who also have COPD. <h3>Methods</h3> The Optimum Patient Care Research Database was used to identify QOF codes for 104,945 patients with COPD, 24,413 with HF and 13,421 with both conditions, where there was at least 1 year of data. We evaluated co-prescribing of BB with either ACE-inhibitor (ACEI) or Angiotensin-2 receptor blockers (ARB) in patients with HF/COPD and their association with inhaler therapy. Heart failure treatments were compared between groups using multinomial logistic regression. <h3>Results</h3> In patients with HF/COPD, mean age was 79 years, 60% males and 27% had prior MI. 21.6% of patients with HF and COPD (n = 2,984) were taking a BB in conjunction with either ACEI/ARB as compared to 42.2% of patients with HF alone (n = 10,303) (p &lt; 0.001). In HF/COPD patients on triple inhaler therapy with ICS/LABA/LAMA there were 46.5% taking ACEI/ARB without BB (n = 1,292) verses 29.3% taking ACEI/ARB with BB (n = 813) (odds ratio [OR] = 1.59, 95% CI 1.46, 1.74, p &lt; 0.001). Corresponding figures for those patients on dual inhaler therapy with ICS/LABA were 47.3% (n = 1,275) verses 22.2% (n = 599) respectively (OR = 2.13, 95% CI 1.93, 2.35, p &lt; 0.001). <h3>Conclusions</h3> Taken together these data therefore provide strong evidence of an unmet need in COPD patients who should be prescribed beta-blockers more often for concomitant HF. <h3>References</h3> 1 Short PM, Lipworth SI, Elder DH, Schembri S, Lipworth BJ. Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. <i>BMJ</i> 2011;<b>342</b>:d2549 2 Quint JK, Herrett E, Bhaskaran K, <i>et al</i>. Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. <i>BMJ</i> 2013;<b>347</b>:f6650
Hereditary Hemochromatosis in an Adult Due to H63D Mutation: The Value of Estimating Iron Deposition By MRI T2* and Dissociation Between Serum Ferritin Concentration and Hepatic Iron Overload
Authors: Mohamed A. Yassin, Ashraf T Soliman, Vincenzo Desanctis, Sandara Abusamaan, Ahmed Elsotouhy, Nader Aldewik
Journal: Blood (2014)
RTRB-02EFFECTIVENESS OF MULTIPLE FRACTIONS GAMMA KNIFE THERAPY FOR RECURRENT MALIGNANT ASTROCYTIC TUMORS WITHOUT BEVACIZUMAB
Authors: Kenichiro Asano, Seiko Hasegawa, Kosuke Katayama, Hiroki Ohkuma
Journal: Neuro-Oncology (2015)

INTRODUCTION: As temozolomide (TMZ) therapy has now become standard therapy for malignant glioma (MG), patients surviving for the long term have increased.However, use of gamma knife as second-line therapy for recurrent MG cases is not always effective.We therefore compared single-and multiple-fraction groups to clarify survival and outcomes for patients with recurrent MG.MATERIAL AND METHODS: A total of 16 consecutive cases of recurrent MG were given Gamma Knife therapy between April 2010 and September 2014 without bevacizumab, including 12 cases of glioblastoma, 1 case of anaplastic astrocytoma, and 3 cases of anaplastic oligoastrocytoma.Seven cases (total number, 8 cases) were single-fraction cases and 9 cases (total number, 13 cases) were multiple-fraction cases.RESULTS: The single-fraction group was given a 50% marginal dose of 21 -24 Gy to a total of 15 lesions.The multiple-fraction group was given a 50% marginal dose of 7.5-14.5Gy in two or three fractions, to a total of 36 lesions.Mean number of lesions treated, M-PFS, M-OS, and tumor control rate (CR, PR, SD) were 1.9, 2.3 months, 7.6 months, and 25% in the singlefraction group, and 2.8, 3.4 months, 10.0 months, and 67.2% in the in the multiple-fraction group, respectively.CONCLUSIONS: Although no significant differences in PFS, OS, or tumor control rate were evident between single-and multiple-fraction groups, the multiple-fraction group tended to show longer PFS and OS and better control rate compared to the singlefraction group.
Optimising treatment for post-operative lung cancer recurrence
Authors: Dragan Subotic, Paul Van Schil, Bogdan Grigoriu
Journal: European Respiratory Journal (2016)

Surgical treatment offers the best chances for long-term survival in patients with primary nonsmall cell lung cancer (NSCLC). However, long-term survival after surgery remains less than 50%, mostly due to a 30–77% rate of tumour recurrence. Unlike the distant type of recurrence that is treated nonsurgically in the vast majority of patients, local or loco-regional recurrence, which occurs in 4.6–24% of patients after complete resection (∼80% of cases in the first 2 years) [1], raises several concerns related to the optimal therapeutic approach. The second lung resection is a valuable option for post-operative lung cancer recurrence <http://ow.ly/U8z3c>
Accidental Perforation of the Colon and Rectum in Newborn Infants
Authors: Eric W. Fonkalsrud, H. William Clatworthy
Journal: New England Journal of Medicine (1965)

PERFORATION of the gastrointestinal tract in the newborn infant is a major catastrophe that causes death in over three fourths of the babies, despite the availability of modern diagnostic and therapeutic technics in institutions designed to care for sick infants.1 We were therefore chagrined to find that 10 of the 76 intestinal perforations treated at the Columbus Children's Hospital during the past fifteen years were accidentally caused. Three of these infants died as a result of complications arising from the associated peritonitis.The major causes of the large-bowel perforations in our experience were the following: enemas given to constipated infants . . .
Treatment of Hypertension Associated with the Solitary Ischemic Kidney
Authors: Samuel A. Marable, Fred T. Moore, James F. Schieve
Journal: New England Journal of Medicine (1966)

FOR some, the absence of a single organ that is normally paired within the human body rules out a surgical approach on the remaining organ. This point of view seems illogical in the light of the different appraisal given to surgical procedures on organs not normally paired, such as the heart and liver. It is particularly unjustified in stenosis of the renal artery supplying a solitary kidney. Physiologic-data now available indicate that surgical intervention may bring more profound and lasting improvements than in patients possessing the traditional 2 kidneys, only 1 of which is affected by a major arterial stenosis. . . .