tbuckley/cabot-search huggingface dataset:
Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults
Authors: Nancy L. Schoenborn, Theron L. Bowman, Danelle Cayea, Craig Evan Pollack, Scott Feeser, Cynthia Boyd
Journal: JAMA Internal Medicine (2016)

<h3>Importance</h3> Clinical practice recommendations increasingly advocate that older patients’ life expectancy be considered to inform a number of clinical decisions. It is not clear how primary care practitioners approach these recommendations in their clinical practice. <h3>Objective</h3> To explore the range of perspectives from primary care practitioners on long-term prognosis, defined as prognosis regarding life expectancy in the range of years, in their care of older adults. <h3>Design, Setting, and Participants</h3> A qualitative, semistructured interview study was conducted in a large group practice with multiple sites in rural, urban, and suburban settings. Twenty-eight primary care practitioners were interviewed; 20 of these participants (71%) reported that at least 25% of their patient panel was older adults. The audiorecorded discussions were transcribed and analyzed, using qualitative content analysis to identify major themes and subthemes. The study was conducted between January 30 and May 13, 2015. Data analysis was performed between June 10 and September 1, 2015. <h3>Main Outcomes and Measures</h3> The constant comparative approach was used to qualitatively analyze the content of the transcripts. <h3>Results</h3> Of the 28 participants, 16 were women and 21 were white; the mean (SD) age was 46.2 (10.3) years. Twenty-six were physicians and 2 were nurse practitioners. Their time since completing clinical training was 16.0 (11.4) years. These primary care practitioners reported considering life expectancy, often in the range of 5 to 10 years, in several clinical scenarios in the care of older adults, but balanced the prognosis consideration against various other factors in decision making. In particular, patient age was found to modulate how prognosis affects the primary care practitioners’ decision making, with significant reluctance among them to cease preventive care that has a long lag time to achieve benefit in younger patients despite limited life expectancy. The participants assessed life expectancy based on clinical experience rather than using validated tools and varied widely in their prognostication time frame, from 2 years to 30 years. Participants often considered prognosis without explicitly discussing it with patients and disagreed on whether and when long-term prognosis needs to be specifically discussed. The participants identified numerous barriers to incorporating prognosis in the care of older adults including uncertainty in predicting prognosis, difficulty in discussing prognosis, and concern about patient reactions. <h3>Conclusions and Relevance</h3> Despite clinical recommendations to increasingly incorporate patients’ long-term prognosis in clinical decisions, primary care practitioners encounter several barriers and ambiguities in the implementation of these recommendations.
Targeted Therapy with Eculizumab for Inherited CD59 Deficiency
Authors: Britta Höchsmann, Christian Dohna-Schwake, Henriette A Kyrieleis, Ulrich Pannicke, Hubert Schrezenmeier
Journal: New England Journal of Medicine (2014)

Patients with CD59 deficiency have progressive neurologic dysfunction and episodes of hemolytic anemia. Eculizumab, a complement inhibitor, was administered to reverse hemolytic anemia in a patient. After the anemia improved, neurologic improvement was also noted.
QL-07 * TREATMENT OF FATIGUE IN A PATIENT WITH CORPUS-CALLOSUM GLIOMA AND ATYPICAL SLEEP DISORDER
Authors: A. Butts, D. Johnson, P. Brown, J. Cerhan
Journal: Neuro-Oncology (2014)

We present the case of a 53 year-old married gentleman with above-average IQ who has a high-grade glioma of the corpus callosum, severe fatigue, cognitive concerns, and an atypical sleep disorder. He has had severe daytime somnolence and poor concentration since childhood, with normal nighttime sleep. Since his teens, he has had two hours of alertness in the morning, followed by disabling sleepiness for the rest of the day. Epworth sleepiness scores have been extremely high (20 to 24). Diagnoses of ADHD, narcolepsy, and idiopathic hypersomnia had been applied, but he has not met full diagnostic criteria. From 2007 to 2012, escalating doses of stimulant medication were utilized, with the best response ("can attempt some household tasks" and "approaching a normal life" per his wife) on 400 mg modafinil, and 456 mg methylphenidate (seven times the recommended maximum). This allowed him to stay awake for some normal activities such as attending his child's baseball game. In June of 2012, the modafanil and methylphenidate were discontinued by his doctor because the sleep disorder could not be confirmed with polysomnograph and multiple sleep latency testing. The somnolence returned, and the patient became distraught and expressed suicidal ideation. He saw a psychotherapist who referred him to Neurology where the corpus callosum glioma was identified incidentally (biopsy confirmed grade III astrocytoma). Pre-treatment neuropsychological evaluation revealed impairment on digit-symbol coding (z= -2.0) and was otherwise normal. The tumor was treated with radiation and temozolamide, and is currently radiographically stable. Fatigue is an ongoing problem (Epworth = 17, he rates fatigue at 8/10). He takes 80 mg Adderall. He would like to resume the previous regimen and high dose of Ritalin. We explore practical and ethical considerations in the treatment of fatigue with special consideration for quality of life in the context of high-grade glioma.
1129 SINGLE SERUM INTERFERON MEASUREMENT DURING THE FIRST WEEK OF CONTINUOUS INTERFERON ALPHA-2B WITH ORAL RIBAVIRIN PREDICTS RVR AND THERAPY DISCONTINUATION IN PATIENTS WITH CHRONIC HCV-1
Authors: J. Lande, E. Grovender, C. Hamlen, S. Mische, S. Juth, R. Scherer, B. Van Antwerp
Journal: Journal of Hepatology (2012)
AB1390 The baseline characteristics and 1-year disease course of 206 patients with arthritis of ≤16 weeks duration in tallinn: A comparison with a similar cohort in OSLO:
Authors: T. Veldi, M.D. Mjaavatten, K. Otsa, T.K. Kvien, E. Lie
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Since 2005 the very early arthritis clinic (VEAC) at East Tallinn Central Hospital, serving approx. 700,000 inhabitants, have included patients (pts) between 18-75 years of age with arthritis of at least one peripheral joint with duration of joint swelling less than 16 weeks. The protocol was adopted from a multi-centre early arthritis study in Eastern Norway. <h3>Objectives</h3> To characterise the 1-year disease courses of pts recruited to a VEAC in Tallinn, Estonia between 2005 and 2011, and to compare them to pts in a VEAC in Oslo, Norway who were included and followed by the same protocol. <h3>Methods</h3> Pts from Diakonhjemmet Hospital in Oslo, serving approx. 600,000 inhabitants, were included as a comparator cohort for the current analyses. Both centres requested general practitioners to refer pts with recent onset arthritis, and pts were received with a maximum delay of 4 weeks. Pts with joint swelling due to osteoarthritis, gout, trauma and septic arthritis were excluded. Examinations at baseline and after 3, 6, 12 and 24 months included 66-swollen joint count (SJC) and 28-tender joint count (TJC), laboratory investigations and patient reported outcomes (PROs). Baseline characteristics and 6- and 12-month changes were compared between EAC pts in Tallinn and Oslo, and chi-square, two-samples t and Mann-Whitney U tests were applied as appropriate. <h3>Results</h3> The cohort in Tallinn included 206 pts, and the Oslo comparator cohort included 391 pts. Mean(SD) baseline age was 43.6(15.6) vs. 45.0(15.2) yrs and duration of joint swelling 6.7(6.2) vs. 5.4(4.9) weeks (p=0.004) (median duration 5.6 vs. 3.6 weeks, p=0.001). 75% vs. 53% were female (p&lt;0.001), 27% vs. 12% RF pos (p&lt;0.001) and 24% vs. 15% ACPA pos (p=0.01). The baseline distributions of mono-, oligo- and polyarthritis were 22%/40%/38% in Tallinn and 39%/37%/34% in Oslo. At 6 months 74% in Tallinn vs. 57% in Oslo had no swollen joints, 14% vs. 14% had 1 swollen joint, 10% vs. 14% had 2-4 swollen joints, and 1.5% vs. 14% had &gt;4 swollen joints. Baseline values and changes for various disease activity and HRQoL measures are shown in the table. Pts with available 6- and 12-month data were more often RF/ACPA pos, had longer disease duration, and a somewhat higher baseline SJC than pts without the available data. <h3>Conclusions</h3> Overall, baseline characteristics were similar in patients in Tallinn and Oslo, except serology, proportions of monoarthritis and some HRQoL items. Outcome was at least as good in Tallinn as in Oslo. These data contribute to the generalisability of the concept of VEAC. <h3>Disclosure of Interest</h3> None Declared
Medical Care Costs and Quality of Life after Randomization to Coronary Angioplasty or Coronary Bypass Surgery
Authors: Mark A. Hlatky, William J. Rogers, Iain Johnstone, Derek Boothroyd, Maria Mori Brooks, Bertram Pitt, Guy Reeder, Thomas Ryan, Hugh Smith, Patrick Whitlow, Robert Wiens, Daniel B. Mark, Allan D. Rosen, Katherine Detre, Robert L. Frye
Journal: New England Journal of Medicine (1997)

Randomized trials comparing coronary angioplasty with bypass surgery in patients with multivessel coronary disease have shown no significant differences in overall rates of death and myocardial infarction. We compared quality of life, employment, and medical care costs during five years of follow-up among patients treated with angioplasty or bypass surgery.
FRI0054 IL-6 negatively regulates osteoblast differentiation through ERK pathway in vitro
Authors: S. Kaneshiro, K. Ebina, M. Hirao, J. Hashimoto, K. Shi, H. Yoshikawa
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Interleukin-6 (IL-6), a potent inflammatory cytokine, plays a key role in the pathogenesis of rheumatoid arthritis (RA), including osteoporosis not only in inflamed joints but possibly also in whole body. Since increase of type 1 collagen N-propeptide, a bone formation marker, is recognized in RA patients treated with tocilizumab, a humanized anti- IL-6 receptor antibody, IL-6 could be thought to have negative effect on osteoblast differentiation. However, previous reports regarding the effects of IL-6 on osteoblast differentiation <i>in vitro</i> are not consistent. <h3>Objectives</h3> The objectives of this study was to clarify the effect of IL-6 on osteoblast differentiation <i>in vitro</i>, with consideration of intracellular signaling pathways. Cross-talk between these pathways was also investigated. <h3>Methods</h3> Osteoblast differentiation was induced in murine MC3T3-E1 osteoblastic cells with or without addition of IL-6 (soluble IL-6 receptor was used to enhance the effect of IL-6). Osteoblast differentiation was assessed by alkaline phosphatase (ALP) activity, expression of osteoblastic gene such as Runx2 and osteocalcin, and mineralization. ERK and STAT3 pathway phosphorylation was evaluated by Western blotting in the presence or absence of IL-6 as well as each specific inhibitor, U0126 and Stattic, respectively, and their effect on osteoblast differentiation were assessed. <h3>Results</h3> IL-6 significantly reduced ALP activity, and expression of osteoblastic gene, Runx2 and osteocalcin, and also inhibited mineralization in a dose-dependent manner, which indicates a negative effect of IL-6 on osteoblast differentiation. Signal transduction analyses by Western blotting demonstrated that IL-6 significantly promoted phosphorylation of ERK and STAT3. The negative effect of IL-6 on ALP activity was restored by inhibition of ERK in a dose-dependent manner. On the other hand, the negative effect of IL-6 on ALP activity was enhanced by inhibition of STAT3. These results indicate that ERK has negative effect on osteoblast differentiation, whereas STAT3 has positive one. Moreover, ERK inhibitor enhanced IL-6-triggered STAT3 phosphorylation, and STAT3 inhibitor enhanced IL-6-triggered ERK phosphorylation, suggesting that ERK and STAT3 signaling pathway negatively regulates each other. <h3>Conclusions</h3> IL-6 can be thought to negatively regulate osteoblast differentiation through ERK pathway. On the other hand, STAT3 pathway could have a positive regulatory role in osteoblast differentiation. Predominant activation of ERK signaling pathway compared to STAT3 signaling pathway may result in inhibiting osteoblastic differentiation. Inhibition of ERK might be of potential use in the treatment of osteoporosis in RA. <h3>References</h3> Garnero, P., et al., Arthritis Rheum, 2010. 62(1): p. 33-43. Ernst, M. and B.J. Jenkins,Trends Genet, 2004. 20(1): p. 23-32. <h3>Disclosure of Interest</h3> None Declared
An unusual case of pneumoperitoneum, pneumomediastinum, and subcutaneous emphysema following colorectal stent placement
Authors: Pragnesh Patel, Shivang Mehta, Shashideep Singhal
Journal: Endoscopy (2015)

A 51-year-old man with a history of rectal adenocarcinoma presented to the emergency department with abdominal pain, distension, and obstipation for 2 days. Computed tomography (CT) scan of the abdomen showed malignant colonic obstruction ([Fig. 1 a, b]). The patient underwent flexible sigmoidoscopy with successful deployment of a self-expanding metal stent (SEMS) for emergency decompression ([Fig. 1 c]).
SP0141 Collaboration Between Primary and Secondary Care: Early Detection of Inflammatory Arthritis
Authors: C. D. Mallen
Journal: Annals of the Rheumatic Diseases (2013)

<h3></h3> Inflammatory arthritis is common and costly for individuals, health services and societies. Current guidelines for the management of inflammatory highlight the importance of early administration of disease modifying medication and the titration of therapy against disease activity to try and achieve remission. Reasonable evidence exists to show that early institution of disease modifying drugs reduces the rate of progression of radiological damage in the long term. As such, the early detection of inflammatory arthritis is increasingly important for patients and clinicians alike. Delay in the diagnosis of inflammatory arthritis can occur at multiple points. Patients may not recognise the importance of their symptoms and may not consult promptly with a health care professional. General practitioners may fail to identify the relevance of the presenting symptoms and may not refer patients for specialist assessment, and long secondary care waiting times can prevent a rapid assessment and diagnosis by a specialist. This presentation will highlight the need for active collaboration between primary and secondary care to improve the detection of inflammatory arthritis. The importance of education for the general public and health care professionals will be emphasized, with local innovation and potential future developments highlighted. <h3>Disclosure of Interest</h3> None Declared
1106 INCREASED THE EXPRESSION OF REGULATORY T-CELLS IN NON RESPONDERS TO THE COMBINATION OF PEGYLATED INTERFERON AND RIBAVIRIN FOR THE TREATMENT OF CHRONIC HEPATITIS C
Authors: E.G. El-Ahwany, M.K. Zoheiry, M.M. Nosseir, M. El-Ghanam, F.M. Nagy, M. El-Refai, S.K. Zada
Journal: Journal of Hepatology (2012)
AB0557 Assessing the sexual impact of rheumatic disease in spondyloarthritis patients – where do we stand?
Authors: R. Aguiar, C. Ambrósio, I. Cunha, A. Barcelos
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The impact of rheumatic diseases on patients' sexuality has been, for a long time, an ignored topic. As quality of life in these patients became more valorized, sexuality, as a major aspect for the individual's well being, arised as a subject to be considered over the last decade<sup>1</sup>. The awareness of the physicians for the problem is of great importance, since the impact in sexual life might be a major concern and still, a quite uncomfortable topic for the patient – both with healthcare professionals and partners. <h3>Objectives</h3> To analyze the approach by the healthcare service and/or partners on the patients' perspective of the impact of the rheumatic disease in their sexual activity. <h3>Methods</h3> An anonymous questionnaire was performed, consisting in demographic data (sex, age, disease duration, civil status, professional status and educational level), and questions related to the importance attributed to sexual activity, as well as to the approach of the topic by the patient and healthcare professionals, with multiple choice questions and questions to be answered through a visual analogical scale. A descriptive study was performed. <h3>Results</h3> 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. Most of patients were married (56) or common law married (8); 19 patients had completed primary school only and less than one quarter were graduate or higher. In a visual analogical scale, mean importance give to sexual capacity was 74.67±24.55. Among the 76 patients, only 35 stated they talked about the subject with their partner; however, the great majority (66 patients) said they had the partner's understanding towards their limitations in sexual activity. The perception of conditioning in the conjugal relationship was, in a visual analogical scale, 33.68±31.56. 58 patients had never talked about it with anyone else and 65 had never been questioned by any health professional (rheumatologist, general practitioner or nurse). <h3>Conclusions</h3> This work emphasizes that the impact of spondyloarthritis on sexual activity is a topic rarely approached either by the patients, either by health professionals. Since patients valorize a lot their sexual capacity and seem not to talk about the limitations imposed by their disease, this subject might deserve a greater attention, including from rheumatologists and other healthcare professionals. <h3>References</h3> Helland Y, Kjeken I, Steen E, Kvien TK, Hauge MI, Dafinrud H. Rheumatic Diseases and Sexuality: Disease Impact and Self-Management Strategies. Arthritis Care &amp; Res 2011;5:743–750 <h3>Disclosure of Interest</h3> None Declared
Abstract 729: Plasma EBV DNA concentration and clearance rate as good prognostic factors for metastatic nasopharyngeal carcinoma
Authors: Cheng-Lung Hsu, Shiang-Fu Huang, Kai-Ping Chang, Hung-Ming Wang
Journal: Cancer Research (2012)

Abstract Purpose: To investigate the pretreatment copy number and the clearance rate of plasma EBV DNA as novel prognostic outcome markers for metastatic nasopharyngeal carcinoma (NPC) Experimental Design: Nineteen newly diagnosed and fifty-four relapsed metastatic NPC patients were treated at outpatient department (i.v. or i.v. plus oral chemotherapy followed by local irradiation boost where applicable). Multiple blood samples were collected before and during the first 6 weeks of chemotherapy. Plasma EBV DNA concentrations and half-life values of plasma viral clearance rates, t1/2, were determined by a real-time quantitative PCR. The association between the copy number of plasma EBV DNA, t1/2, and clinical outcome were analyzed. Results: Treatment response evaluated after 3-6 months of treatment showed the best response of 18 complete responses (CR)(24.7%), 21 partial responses (PR)(28.8%) and overall response rate was 53.5%. The pretreatment plasma EBV DNA concentrations and the t1/2 of plasma EBV DNA clearance rates had significant effects on treatment response and overall survival prediction. In the chemotherapy regimen, gemcitabine plus cisplatin had better treatment outcome than cisplatin plus oral UFT and calcium folinate based regimen. Multivariate analysis revealed both pretreatment EBV DNA load and t1/2 of plasma EBV DNA clearance rates but not chemotherapy regimen had significant effects on overall survival. Conclusions: The pretreatment plasma EBV DNA copy number and their clearance rates are significant predictors for NPC treatment outcome. In low copy number group, the t1/2 in the first 6 weeks may provide the physician to choose a tailored regimen for the patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 729. doi:1538-7445.AM2012-729
EL TIEMPO DE DEMORA EN LA REALIZACIÓN DE LA CÁPSULA ENDOSCOPICA INFLUYE EN SU CAPACIDAD DIAGNÓSTICA
Authors: V Martínez Escapa, V Pons Beltrán, L Argüello Viudez, M Ponce Romero, V Pertejo Pastor
Journal: Endoscopy (2010)

Introducción: La capacidad diagnóstica de la cápsula endoscópica (CE) en la hemorragia digestiva de origen oscuro (HDOO) es superior al 60%, con mayor rendimiento si se realiza próxima al episodio de sangrado. El retraso en su realización puede influir negativamente en su capacidad diagnóstica.
PWE-103 A risk stratification score for predicting 30-day mortality in<i>Clostridium difficile</i>associated diarrhoea
Authors: R Sood, L L Wong, R Swallow, S J Smale
Journal: Gut (2012)

<h3>Introduction</h3> <i>Clostridium difficile</i> associated diarrhoea (CDAD) causes significant morbidity and mortality in susceptible patients. There are no validated risk stratification scores to identify those patients at the greatest risk of death. <h3>Methods</h3> Data were collected on 125 sequential patients diagnosed with CDAD in our institution between August 2008 and October 2010. Data on age, co-morbidities, number of antibiotics prescribed and course length as well as other relevant medications such as proton pump inhibitor (PPI) were recorded. The length of and timing of any admissions in the preceding 13-month and physiological variables such as the patient9s temperature, blood pressure and pulse at diagnosis of CDAD were recorded as were any haematological and biochemical investigations taken within 24 h of diagnosis. <h3>Results</h3> Hospital admissions between 14 and 30 days (p=0.031), increasing co-morbidities (p=0.05), systolic blood pressure &lt;100 mm Hg (p=0.048) and heart rate greater than 100 beats per minute (p=0.043) were significantly associated with increased 30-day mortality. There was a clear trend of increased mortality for increasing length of stay (LOS) on the current admission before development of diarrhoea (If LOS greater than 7 days before onset, p=0.07), temperature &lt;35°C (p=0.07), recent discharge from hospital within 30 days (p=0.106) and to a lesser degree, low albumin (albumin &lt;30 g/l p=0.221) at the time of diagnosis, age &gt;85 years (p=0.947) and current PPI use (p=0.224). From the data, a scoring system was derived whereby 1 point was given to the non-statistically significant trends and 2 points to the statistically significant trends. If there were 1 to 3 co-morbidities, this was scored as 1 and greater than 3 co-morbidities scored as 2. There was a maximum score of 14. On applying this retrospectively to the existing database, 39 patients were identified where all the parameters in the scoring system were available. Of these, a score of 4 or less was associated with low risk of 30-day mortality (0% mortality in 13 patients). A score of 5 to 7 was associated with moderate risk of 30-day mortality (33.3% mortality in 15 patients) and a score of 8 or more to be associated with a high risk of 30-day mortality (72.7% mortality in 11 patients). <h3>Conclusion</h3> A simple scoring system holds promise for defining those patients at greatest risk of 30-day mortality from CDAD in our population. However a note of caution should be exercised. Applying a scoring system retrospectively to a dataset from which information has been used to derive the score does not validate it and a prospective study is planned to validate the York scoring system. <h3>Competing interests</h3> None declared.