tbuckley/cabot-search huggingface dataset:
Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.
Authors: Ali Haider, Yu Qian, Zhanni Lu, Syed Mussadiq Ali Akbar Naqvi, Amy Zhuang, Akhila Sunkepally Reddy, Shalini Dalal, Joseph Anthony Arthur, Kimberson Cochien Tanco, Rony Dev, Janet L. Williams, Jimin Wu, Diane D. Liu, Eduardo Bruera
Journal: Journal of Clinical Oncology (2018)

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]
Opioid prescribing upon discharge for patients with solid malignancies.
Authors: Ashima Lal, Jennifer Ann LaFollette, Constance Terrell
Journal: Journal of Clinical Oncology (2018)

50 Background: Pain is a common symptom associated with cancer resulting in increased health care utilization. We aim to study patients admitted with uncontrolled pain and review their discharge medications after development of an effective pain regimen while hospitalized. Anecdotally, we observe patients are being discharged with suboptimal regimens resulting in increased Emergency Department (ED) visits or readmissions. By identifying suboptimal opioid prescriptions we hope to improve care and patient satisfaction and minimize ED visits or readmission rates. The primary objective is to identify opportunities for improvement of opioid prescribing upon discharge for medical oncology patients. Methods: Retrospective study exempt from IRB review. We reviewed admitted patients with a solid tumor cancer diagnosis and consult to inpatient medical oncology at a safety-net hospital in an urban Southeastern population from June to November 2017 with data collected on 29 patients. Data was analyzed using descriptive statistics. Potential health-system cost avoidance was calculated. Results: 51% of patients were discharged with a lower daily oral morphine equivalent (DOME) than received while inpatient, with a median of 12 days until scheduled follow-up appointment. While 75% of patients were prescribed an adequate supply for long acting opioids, only 39% received an adequate supply of short acting opioids. 12 patients (41%) returned to the ED or urgent clinic within 30 days. 4 events were associated with a lower DOME and/or inadequate supply compared to their inpatient regimen. The total amount billed for missed opportunities showed the hospital was reimbursed only 25%. Conclusions: Opportunities to prevent discrepancies in discharge regimens exist. Pain regimens should be assessed for accuracy and supply at discharge and appointments. Patients should be discharged with a sufficient amount of opioids until their follow up, including ensuring insurance coverage of medication prescribed, with emphasis on patients maintaining their outpatient appointments. We plan to continue analysis post continuous QI initiative to improve clinical practice in pain management for patients with solid tumor malignancy.
Annals Story Slam - A Beautiful Death
Authors: Maria Jogova
Journal: Annals of Internal Medicine (2018)

Web Exclusives4 December 2018Annals Story Slam - A Beautiful DeathFREEMaria Jogova, MDMaria Jogova, MDUniversity of Toronto, Toronto, Ontario, Canada (M.J.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W18-0031 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Video. Annals Story Slam - A Beautiful Death "A Beautiful Death," by Maria Jogova, MD (Duration 6:15)Building on the popular Annals feature “On Being a Doctor,” storytellers share stories about the experience of doctoring on video.For more videos from and information on Annals Story Slam, visit go.annals.org/StorySlam. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: University of Toronto, Toronto, Ontario, Canada (M.J.)Current Author Address: Maria Jogova, MD; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 4 December 2018Volume 169, Issue 11Page: SS1 ePublished: 4 December 2018 Issue Published: 4 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...
Communicating Oncologic Prognosis with Empathy (COPE).
Authors: Farya Phillips, Boone W Goodgame, Barbara L Jones
Journal: Journal of Clinical Oncology (2018)

38 Background: Clear communication between patients and providers is imperative to maximize patient outcomes, particularly for patients with incurable cancer who require prompt engagement in decision-making. In response to the need to engage in quality patient-centered communication, an interprofessional team, representing medicine, nursing, social work, and spiritual care developed a simple, single-page tool that summarizes the prognosis and treatment plan for patients with incurable cancers. This pilot study evaluates the communication guide, Communicating Oncologic Prognosis with Empathy (COPE), for discussing prognosis and treatment options for cancer patients. Methods: A pilot test of 30 participants with incurable cancer was completed at an oncology clinic. The communication guide was evaluated using a pre- and post-test design, participants completed a prognosis and treatment perception survey (PTPQ) prior to their first oncology appointment. Patients then met with their oncologist and the COPE guide was used to guide the discussion and patients received a copy of the COPE guide. The COPE guide was placed in the patient chart and other members of the healthcare team were able to use the tool to provide the patient with support and explore the patient’s response to information received. Patients completed the post-test PTPQ at 4 week follow up and completed exit interviews to assess patient reported impact on communication with medical team, caregivers, and quality of life. Results: Key findings revealed participants prefer receiving detailed information about prognosis and have differing perceptions about goals of treatment compared to the oncology team. The tool seemed to facilitate mostly accurate information recall regarding prognosis and treatment options. Conclusions: Despite the high value patients placed on knowing about prognosis and quality of communication with their medical team, the majority reported incongruent goals of treatment and likelihood of cure compared with their oncologist, highlighting major gaps in patients’ understanding of their prognosis. The COPE guide serves as a promising mechanism to enhance patient-centered communication about prognosis and treatment for patients with incurable cancer.
Abstract 17111: Novel Global Ultrasound Imaging and Continuous Dipole Density Mapping: Initial Findings in AF Patients
Authors: Patrick Heck, Petr Neuzil, Vivek Reddy, Andrew Grace
Journal: Circulation (2015)

Introduction: Electro-anatomic mapping is standard practice in AF ablation procedures. Virtual anatomies are created to locate structures and navigate catheters and voltage (V) is used to map arrhythmias. Methods: A novel non-contact imaging and Dipole Density (DD) mapping system (AcQMap), consisting of a basket catheter (48 Ultrasound (U/S) transducers, 48 electrodes) and console, simultaneously acquires 100,000+ U/S points/min to reconstruct the chamber anatomy and 150,000 intracardiac unipolar V samples/second to map cardiac activity. The 3D surface is algorithmically reconstructed from the U/S point-set with mesh-density comparable to segmented CT (sCT). Inverse and Forward algorithms are applied on intracardiac V to derive and display activation as DD and unipolar V maps, respectively, upon the U/S-constructed 3D anatomy (Figure). Patients listed for AF ablation were consented for U/S and DD mapping. U/S LA anatomy was created from full and sub-sampled point-sets and compared to pre-procedure sCT. DD and V maps were derived for each patient and depolarized surface areas were compared. Results: Seven patients (57% Male, Age 61.4 ± 10.3 yrs, AF duration 4.2 ± 2.3 yrs) were enrolled. Complete data sets were collected in 6 subjects. Surface-points must be acquired for at least 30 seconds to achieve a consistent median distance between AcQMap and sCT surfaces. The absolute median distance between surfaces was 2.71 mm. During AF, the mean depolarized area for DD maps was 26.9 cm2, significantly less than for V maps (110.6 cm2, p &lt; 0.001). Overall V:DD ratio was 4.11 for AF. Conclusions: Real-time U/S based LA reconstruction was rapid and compared favorably to sCT. DD map provides 4.11 times higher resolution than V maps. The combination of CT-quality anatomy and DD mapping opens the possibility to map AF with more precision to identify areas of interest as potential ablation targets.
Movement for Movement: a practical insight into embedding physical activity into the undergraduate medical curriculum exemplified by Lancaster Medical School
Authors: Ann Bernadette Gates, Michelle Grace Swainson, Rachel Isba, Robert G Wheatley, Fiona Anne Curtis
Journal: British Journal of Sports Medicine (2018)

Getting people active and staying active is a major implementation challenge.1 Despite international and national strategic intent, most countries fall woefully short on delivery.2 The objectives of the 2018 WHO Global Action Plan for Physical Activity (GAPPA) clearly require improved education and communication to patients, communities and society on the benefits of physical activity (PA).

The Movement for Movement ‘community of practice’ was specifically created to deliver this complex, interrelated system change.3 

Movement for Movement3 embeds PA into the undergraduate healthcare curriculum4 5 and provides current, clinically valuable, evidence-based resources developed by: curators, authors, peer reviewers and student reviewers, and endorsed by the UK Council of Deans of Health. These resources are free to providers of undergraduate medical and healthcare education to support capacity building in the healthcare workforce. An implementation plan in a sample of English medical schools (funded by Public Health England/Sport England in 2017/2018) is complete.6 

This work is recognised as a UK best practice exemplar by the 2018 WHO Europe Physical Activity Fact Sheets7 and the 2018 WHO Europe Physical Activity in the Health Sector report.8 There is also considerable ongoing collaboration to deliver further strategic support and leadership focusing on the valuable ‘social capital’ that healthcare professionals provide across all the GAPPA objectives and specifically the social determinants of health.

Lancaster Medical School pioneered the full implementation of the Movement for Movement resources and is empowering future …
2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Authors: Ashish R. Panchal, Katherine M. Berg, Peter J. Kudenchuk, Marina Del Rios, Karen G. Hirsch, Mark S. Link, Michael C. Kurz, Paul S. Chan, José G. Cabañas, Peter T. Morley, Mary Fran Hazinski, Michael W. Donnino
Journal: Circulation (2018)

Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, it is unclear whether these medications improve patient outcomes. This 2018 American Heart Association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. This article includes the revised recommendation that providers may consider either amiodarone or lidocaine to treat shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest.
Cardiac Outcomes After Treatment for Depression in Patients With Acute Coronary Syndrome
Authors: Brett D. Thombs, Roy C. Ziegelstein
Journal: JAMA (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Livestock 2.0 – genome editing for fitter, healthier, and more productive farmed animals
Authors: Christine Tait-Burkard, Andrea Doeschl-Wilson, Mike J. McGrew, Alan L. Archibald, Helen M. Sang, Ross D. Houston, C. Bruce Whitelaw, Mick Watson
Journal: Genome biology (2018)

The human population is growing, and as a result we need to produce more food whilst reducing the impact of farming on the environment. Selective breeding and genomic selection have had a transformational impact on livestock productivity, and now transgenic and genome-editing technologies offer exciting opportunities for the production of fitter, healthier and more-productive livestock. Here, we review recent progress in the application of genome editing to farmed animal species and discuss the potential impact on our ability to produce food.
Insulin Clearance After Oral and Intravenous Glucose Following Gastric Bypass and Gastric Banding Weight Loss
Authors: Ankit Shah, Marlena M. Holter, Fatima Rimawi, Victoria Mark, Roxanne Dutia, James McGinty, Bruce Levin, Blandine Laferrère
Journal: Diabetes Care (2018)

Hepatic insulin clearance is a significant regulator of glucose homestasis. We hypothesized that the improvement in insulin clearance rates (ICRs) under fasting conditions and in response to oral and intravenous (IV) glucose would improve similarly after Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) as a function of weight loss; the difference in ICR after oral and IV glucose stimulation will be enhanced after RYGB compared with AGB, an effect mediated by glucagon-like peptide 1 (GLP-1).In study 1, the ICR was calculated under fasting condition (F-ICR), after oral glucose (O-ICR), and after an isoglycemic IV glucose clamp (IV-ICR) in individuals from an established cohort with type 2 diabetes mellitus (T2DM) before, after 10% matched weight loss, and 1 year after either RYGB (n = 22) or AGB (n = 12). In study 2, O-ICR was studied in a separate cohort of individuals with T2DM (n = 22), before and 3 months after RYGB, with and without exendin(9-39) infusion.In study 1, age, BMI, T2DM duration and control, and ICR did not differ between RYGB and AGB preintervention. Weight loss at 1 year was two times greater after RYGB than after AGB (31.6 ± 5.9% vs. 16.6 ± 9.8%; P < 0.05). RYGB and AGB both significantly increased F-ICR, O-ICR, and IV-ICR at 1 year. ICR was inversely associated with insulinemia. The difference between IV-ICR and O-ICR was significantly greater after RYGB versus AGB. GLP-1 antagonism with exendin(9-39) led to an increase in O-ICR in subjects post-RYGB.Weight loss increased ICR, an effect more pronounced after RYGB compared with AGB. Our data support a potential role for endogenous GLP-1 in the control of postprandial ICR after RYGB.
The genomics of desmoplastic small round cell tumor reveals the deregulation of genes related to DNA damage response, epithelial–mesenchymal transition, and immune response
Authors: Andrea Devecchi, Loris De Cecco, Matteo Dugo, Donata Penso, Gianpaolo Dagrada, Silvia Brich, Silvia Stacchiotti, Marialuisa Sensi, Silvana Canevari, Silvana Pilotti
Journal: Cancer Communications (2018)

Abstract Background Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive, and poorly investigated simple sarcoma with a low frequency of genetic deregulation other than an Ewing sarcoma RNA binding protein 1 ( EWSR1 )‐Wilm's tumor suppressor ( WT1 ) translocation. We used whole‐exome sequencing to interrogate six consecutive pre‐treated DSRCTs whose gene expression was previously investigated. Methods DNA libraries were prepared from formalin‐fixed, paraffin‐embedded archival tissue specimens following the Agilent SureSelectXT2 target enrichment protocol and sequenced on Illumina NextSeq 500. Raw sequence data were aligned to the reference genome with Burrows–Wheeler Aligner algorithm. Somatic mutations and copy number alterations (CNAs) were identified using MuTect2 and EXCAVATOR2, respectively. Biological functions associated with altered genes were investigated through Ingenuity Pathway Analysis (IPA) software. Results A total of 137 unique somatic mutations were identified: 133 mutated genes were case‐specific, and 2 were mutated in two cases but in different positions. Among the 135 mutated genes, 27% were related to two biological categories: DNA damage‐response (DDR) network that was also identified through IPA and mesenchymal–epithelial reverse transition (MErT)/epithelial–mesenchymal transition (EMT) already demonstrated to be relevant in DSRCT. The mutated genes in the DDR network were involved in various steps of transcription and particularly affected pre‐mRNA. Half of these genes encoded RNA‐binding proteins or DNA/RNA‐binding proteins, which were recently recognized as a new class of DDR players. CNAs in genes/gene families, involved in MErT/EMT and DDR, were recurrent across patients and mostly segregated in the MErT/EMT category. In addition, recurrent gains of regions in chromosome 1 involving many MErT/EMT gene families and loss of one arm or the entire chromosome 6 affecting relevant immune‐regulatory genes were recorded. Conclusions The emerging picture is an extreme inter‐tumor heterogeneity, characterized by the concurrent deregulation of the DDR and MErT/EMT dynamic and plastic programs that could favour genomic instability and explain the refractory DSRCT profile.
Overcoming MCL1 Resistance in Multiple Myeloma
Authors: Ka Tat Siu, Cherrie Huang, Cristina Panaroni, Kenta Mukaihara, Keertik Fulzele, Rosemary Soucy, Justin Cidado, Lisa Drew, Shrikanta Chattopadhyay, Noopur Raje
Journal: Blood (2018)
IFNγ-Induced IFIT5 Promotes Epithelial-to-Mesenchymal Transition in Prostate Cancer via miRNA Processing
Authors: U-Ging Lo, Rey-Chen Pong, Diane Yang, Leah Gandee, Elizabeth Hernandez, Andrew Dang, Chung-Jung Lin, John Santoyo, Shihong Ma, Rajni Sonavane, Jun Huang, Shu-Fen Tseng, Loredana Moro, Arnaldo A. Arbini, Payal Kapur, Ganesh V. Raj, Dalin He, Chih-Ho Lai, Ho Lin, Jer-Tsong Hsieh
Journal: Cancer Research (2018)

IFNγ, a potent cytokine known to modulate tumor immunity and tumoricidal effects, is highly elevated in patients with prostate cancer after radiation. In this study, we demonstrate that IFNγ can induce epithelial-to-mesenchymal transition (EMT) in prostate cancer cells via the JAK-STAT signaling pathway, leading to the transcription of IFN-stimulated genes (ISG) such as IFN-induced tetratricopeptide repeat 5 (IFIT5). We unveil a new function of IFIT5 complex in degrading precursor miRNAs (pre-miRNA) that includes pre-miR-363 from the miR-106a-363 cluster as well as pre-miR-101 and pre-miR-128, who share a similar 5'-end structure with pre-miR-363. These suppressive miRNAs exerted a similar function by targeting EMT transcription factors in prostate cancer cells. Depletion of IFIT5 decreased IFNγ-induced cell invasiveness in vitro and lung metastasis in vivo. IFIT5 was highly elevated in high-grade prostate cancer and its expression inversely correlated with these suppressive miRNAs. Altogether, this study unveils a prometastatic role of the IFNγ pathway via a new mechanism of action, which raises concerns about its clinical application.Significance: A unique IFIT5-XRN1 complex involved in the turnover of specific tumor suppressive microRNAs is the underlying mechanism of IFNγ-induced epithelial-to-mesenchymal transition in prostate cancer.See related commentary by Liu and Gao, p. 1032.
Partha Kar: Stan Lee’s lessons for the NHS
Authors: Partha Kar
Journal: BMJ (2018)

Last month the world lost Stan Lee, the great comic book creator. I was one of many who mourned his loss. As a child I loved the colourful panels and stories of heroism in comic books, and as I’ve grown older I’ve become aware of some important life lessons they’ve taught me. Those lessons—around management, leadership, and equality—are ever more important as the NHS faces an uphill struggle to maintain staff morale.

For one thing, comic books help us understand our colleagues by creating vivid characters who personify specific personality types. Personality types have been …
The Natural Course of Bsep Deficiency : Results from the Global Napped-Consortium
Authors: Daan van Wessel, Richard J. Thompson, Tassos Grammatikopoulos, Agustina Kadaristiana, Irena Jankowska, Patryk Lipinski, Piotr Czubkowski, Emmanuel M. Gonzales, Emmanuel Jacquemin, Anne Spraul, Etienne M. Sokal, Mohammad Shagrani, Dieter Broering, Talal Algoufi, Nejat Mazhar, Emanuele Nicastro, Deirdre A. Kelly, Gabriela Nebbia, Henrik Arnell, Bjorn Fischler, Jan Hulscher, Daniele Serranti, Cigdem Arikan, Esra Polat, Dominique Debray, Florence Lacaille, Cristina Goncalves, Loreto Hierro, Gema Munoz Bartolo, Yael Mozer-Glassberg, Amer Azaz, Jernej Brecelj, Antal Dezsofi, Pier Luigi Calvo, Enke Grabhorn, Ekkehard Sturm, Wendy Van der Woerd, Bettina E. Hansen, Henkjan J. Verkade
Journal: Hepatology (2018)