tbuckley/cabot-search huggingface dataset:
End-of-life care planning in patients with recurrent gynecologic cancers.
Authors: Nathan L Jones, Shelley L Galvin, Timothy J Vanderkwaak, David J. Hetzel, Cameron Blair Harkness, Ashley S Case
Journal: Journal of Clinical Oncology (2013)

e20648 Background: Gynecologic oncologists and associates must provide appropriate, acceptable, and patient-centered end-of-life care. Most women with terminal gynecologic cancers do not have do-not-resuscitate (DNR) orders upon hospital admission and many do not receive effective palliative care. Our objective was to assess quality care indicators involving end-of-life care among gynecologic oncology patients treated at our institution. Methods: An IRB-approved retrospective chart review was performed on all patients with recurrent gynecologic cancers and terminal diagnoses who died from January 2009 through October 2012. Data included intervals to death from: diagnoses, DNR status, Hospice/Palliative Care Medicine (HPCM) involvement, and other factors related to end-of-life care. Chi-squared and discriminate analyses were utilized. Results: Complete data were available for 130 of 345 (37.7%) patients. Disease sites included cervix 28 (21.5%), uterine 37 (28.5%), ovarian 51(39.2%), and vaginal/vulvar 14 (10.8%). Median age at diagnosis and death was 63 and 65 years. Relative to death, diagnoses occurred at a median of 1.65 (0.05-32) years prior. 83 (63.8%) patients were DNR at their last hospitalization, 84(64.6%) had HPCM involvement, and 18(13.8%) had an advance care plan. When HPCM was involved, 83.3% were DNR as compared to 28.3% without involvement (p=0.0001). Patients were also significantly more likely to have DNR status with diagnosis of ovarian cancer and as the duration of time between diagnosis and death increased (p=0.0001). The provider obtaining DNR was most often faculty over residents or HPCM (60.2%, 27.7%, 12%). DNR status was declared by 57 (68.7%) patients and 26 (31.3%) power of attorneys. Median duration from DNR to death was 14 days (0-308) and median duration from HPCM involvement to death was 22 days (0-391). Conclusions: DNR status is associated with ovarian cancer, HPCM involvement, and increasing time from diagnosis to death. Earlier intervention from providers or HPCM could allow for greater patient autonomy and fewer interventions at end-of-life.
Sharing Medicine—A <i>JAMA Internal Medicine</i> Series
Authors: Robert Steinbrook, Rita F. Redberg
Journal: JAMA Internal Medicine (2017)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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 Internal Medicine journal
Nanoparticles administered intrapericardially enhance payload myocardial distribution and retention
Authors: Victor Segura-Ibarra, Francisca E. Cara, Suhong Wu, David A. Iruegas-Nunez, Sufen Wang, Mauro Ferrari, Arturas Ziemys, Miguel Valderrabano, Elvin Blanco
Journal: Journal of Controlled Release (2017)
Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence
Authors: Zhishun Liu, Yan Liu, Huanfang Xu, Liyun He, Yuelai Chen, Lixin Fu, Ning Li, Yonghui Lu, Tongsheng Su, Jianhua Sun, Jie Wang, Zenghui Yue, Wei Zhang, Jiping Zhao, Zhongyu Zhou, Jiani Wu, Kehua Zhou, Yanke Ai, Jing Zhou, Ran Pang, Yang Wang, Zongshi Qin, Shiyan Yan, Hongjiao Li, Lin Luo, Baoyan Liu
Journal: JAMA (2017)

<h3>Importance</h3> Electroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence (SUI), but evidence is limited. <h3>Objective</h3> To assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI. <h3>Design, Setting, and Participants</h3> Multicenter, randomized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015, with data collection completed in December 2015. <h3>Interventions</h3> Participants were randomly assigned (1:1) to receive 18 sessions (over 6 weeks) of electroacupuncture involving the lumbosacral region (n = 252) or sham electroacupuncture (n = 252) with no skin penetration on sham acupoints. <h3>Main Outcomes and Measures</h3> The primary outcome was change from baseline to week 6 in the amount of urine leakage, measured by the 1-hour pad test. Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary (72-hour incontinence episodes). <h3>Results</h3> Among the 504 randomized participants (mean [SD] age, 55.3 [8.4] years), 482 completed the study. Mean urine leakage at baseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group. Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group. At week 6, the electroacupuncture group had greater decrease in mean urine leakage (−9.9 g) than the sham electroacupuncture group (−2.6 g) with a mean difference of 7.4 g (95% CI, 4.8 to 10.0;<i>P</i> &lt; .001). During some time periods, the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 (95% CI, 0.2-1.7;<i>P</i> = .01), 2.0 episodes in weeks 15 to 18 (95% CI, 1.3-2.7;<i>P</i> &lt; .001), and 2.1 episodes in weeks 27 to 30 (95% CI, 1.3-2.8;<i>P</i> &lt; .001). The incidence of treatment-related adverse events was 1.6% in the electroacupuncture group and 2.0% in the sham electroacupuncture group, and all events were classified as mild. <h3>Conclusions and Relevance</h3> Among women with stress urinary incontinence, treatment with electroacupuncture involving the lumbosacral region, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks. Further research is needed to understand long-term efficacy and the mechanism of action of this intervention. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT01784172.
Occupational exposure to pesticides are associated with fixed airflow obstruction in middle-age
Authors: Sheikh M Alif, Shyamali C Dharmage, Geza Benke, Martine Dennekamp, John A Burgess, Jennifer L Perret, Caroline J Lodge, Stephen Morrison, David Peter Johns, Graham G Giles, Lyle C Gurrin, Paul S Thomas, John Llewelyn Hopper, Richard Wood-Baker, Bruce R Thompson, Iain H Feather, Roel Vermeulen, Hans Kromhout, E Haydn Walters, Michael J Abramson, Melanie Claire Matheson
Journal: Thorax (2017)

<h3>Rationale</h3> Population-based studies have found evidence of a relationship between occupational exposures and Chronic Obstructive Pulmonary Disease (COPD), but these studies are limited by the use of prebronchodilator spirometry. Establishing this link using postbronchodilator is critical, because occupational exposures are a modifiable risk factor for COPD. <h3>Objectives</h3> To investigate the associations between occupational exposures and fixed airflow obstruction using postbronchodilator spirometry. <h3>Methods</h3> One thousand three hundred and thirty-five participants were included from 2002 to 2008 follow-up of the Tasmanian Longitudinal Health Study (TAHS). Spirometry was performed and lifetime work history calendars were used to collect occupational history. ALOHA plus Job Exposure Matrix was used to assign occupational exposure, and defined as ever exposed and cumulative exposure unit (EU)-years. Fixed airflow obstruction was defined by postbronchodilator FEV<sub>1</sub>/FVC &lt;0.7 and the lower limit of normal (LLN). Multinomial logistic regressions were used to investigate potential associations while controlling for possible confounders. <h3>Results</h3> Ever exposure to biological dust (relative risk (RR)=1.58, 95% CI 1.01 to 2.48), pesticides (RR=1.74,95% CI 1.00 to 3.07) and herbicides (RR=2.09,95% CI 1.18 to 3.70) were associated with fixed airflow obstruction. Cumulative EU-years to all pesticides (RR=1.11,95% CI 1.00 to 1.25) and herbicides (RR=1.15,95% CI 1.00 to 1.32) were also associated with fixed airflow obstruction. In addition, all pesticides exposure was consistently associated with chronic bronchitis and symptoms that are consistent with airflow obstruction. Ever exposure to mineral dust, gases/fumes and vapours, gases, dust or fumes were only associated with fixed airflow obstruction in non-asthmatics only. <h3>Conclusions</h3> Pesticides and herbicides exposures were associated with fixed airflow obstruction and chronic bronchitis. Biological dust exposure was also associated with fixed airflow obstruction in non-asthmatics. Minimising occupational exposure to these agents may help to reduce the burden of COPD.
Plasma Perfluoroalkyl and Polyfluoroalkyl Substances Concentration and Menstrual Cycle Characteristics in Preconception Women
Authors: Wei Zhou, Lulu Zhang, Chuanliang Tong, Fang Fang, Shasha Zhao, Ying Tian, Yexuan Tao, Jun Zhang
Journal: Environmental Health Perspectives (2017)

Background: Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are persistent synthetic chemicals that are widely used in industrial applications and often detectable in humans. In rats, PFASs can interfere with the estrous cycle. In humans, menstruation has been viewed as a proxy of female fecundity, and periodic menstruation plays a critical role in endometrial sloughing in the absence of pregnancy and in preparing for embryo implantation. Objectives: We investigated the association between PFAS exposure and menstrual cycle characteristics in women who plan to become pregnant. Methods: Plasma level of 10 PFASs was measured in 950 women who were attempting to become pregnant and recruited in two preconception care clinics in Shanghai, China, from August 2013 to April 2015. Information on menstrual cycle characteristics was collected by questionnaires. Associations between PFAS levels and menstrual cycle regularity, length, and bleeding volume were examined using multiple logistic regression models. Results: Pre-pregnant women with higher levels of log-transformed perfluorooctanate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexanesulfonate (PFHxS) had increased odds of self-reported history of irregular menstrual cycle [PFOA-adjusted odds ratio (OR)=1.52 (95% CI: 1.08, 2.15); PFOS OR=1.29 (95% CI: 0.98, 1.70); PFNA OR=1.50 (95% CI: 1.03, 2.07); PFHxS OR=1.80 (95% CI: 1.17, 2.77)] and long menstrual cycle [PFOA OR=1.50 (95% CI: 1.06, 2.10); PFOS OR=1.34 (95% CI: 1.02, 1.75); PFNA OR=1.49 (95% CI: 1.05, 2.11); PFHxS OR=1.73 (95% CI: 1.13, 2.65)]. Log-transformed PFOA, PFOS, PFNA. and PFHxS levels were negatively associated with self-reported history of menorrhagia [PFOA OR=0.37 (95% CI: 0.21, 0.65); PFOS OR=0.57 (95% CI: 0.37, 0.90); PFNA OR=0.47 (95% CI: 0.26, 0.86); PFHxS OR=0.14 (95% CI: 0.06, 0.36)]. Conclusions: Certain PFASs are associated with abnormal menstruation in humans. https://doi.org/10.1289/EHP1203
Annals Graphic Medicine - Internship
Authors: Jason Bitterman
Journal: Annals of Internal Medicine (2017)

Web Exclusives4 July 2017Annals Graphic Medicine - InternshipFREEJason Bitterman, MDJason Bitterman, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G17-0001 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Disclosures: The author has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G17-0001.Author/Illustrator Information: Jason Bitterman a resident in physical medicine and rehabilitation at Rutgers New Jersey Medical School/Kessler Institute of Rehabilitation. You can see more of his medicine-related comics at www.bittermensch.com.Author Contributions: Conception and design: J. Bitterman.Drafting of the article: J. Bitterman.Final approval of the article: J. Bitterman. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals Graphic Medicine - July Plunge Michael Natter A Letter to New Interns Darren B. Taichman , Darilyn V. Moyer , and Christine Laine A Letter to New Interns Darren B. Taichman , Darilyn V. Moyer , and Christine Laine Metrics Cited byA Letter to New InternsDarren B. Taichman, MD, PhD, Darilyn V. Moyer, MD, and Christine Laine, MD, MPH 4 July 2017Volume 167, Issue 1Page: W3-W6KeywordsConflicts of interestDisclosureHealth careRehabilitation medicine ePublished: 4 July 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
BIM deletion polymorphism to predict systemic treatment outcome in advanced non-small cell lung cancer.
Authors: Jih-hsiang Lee, Yu-lin Lin, Hsuan-Yu Chen, Yeun-Chung Chang, Chong-Jen Yu, Jin-Yuan Shih, Kuan-Yu Chen, Pan-Chyr Yang, Chih-Hsin Yang
Journal: Journal of Clinical Oncology (2013)

8055 Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) and chemotherapies are treatments for EGFR mutant non-small cell lung cancer (NSCLC) patients. We explored the predictive factors for progression-free survival (PFS) and overall survival (OS) on first-line EGFR-TKIs and second-line chemotherapies in NSCLC patients. Methods: One hundred and six chemonaïve NSCLC patients who received first line gefitinib in a phase II study were prospectively followed until death. Clinical and molecular biomakers were correlated with PFS and OS. Results: The OS and PFS of first-line gefitinib treatment were 19.4 (95% CI 15.6-23.3) months and 7.4 (95% CI 6.7-8.1) months, respectively. Sixty-nine patients (65%) received subsequent second-line chemotherapy. Median PFS and OS of second-line chemotherapy were 5.7 (95% CI 4.8-6.6) and 15.1 (95% CI 10.5-20.2) months. Bcl-2-like protein 11 (also named as BIM) deletion polymorphism was found in 17 out of 101 (16.8%) patients tested. The median PFS from first-line gefitinib in patients carrying normal BIM and deletion polymorphism were 8.1 months and 3.6 months, respectively (p&lt;0.001), and the median OS were 22.1 months and 14.1 months, respectively (p=0.041); in 44 patients with common EGFR mutations (del 19 or L858R), the PFS for patients carrying normal BIM and deletion polymorphism were 9.6 months and 7.4 months, respectively (p=0.034). A multivariate analysis suggested that BIM deletion polymorphism and EGFR mutational status were independent predictors for gefitinib PFS (hazard ratio 2.83, p=0.001, and 0.63, p=0.03, respectively). Conclusions: BIM deletion polymorphism predicts shorter PFS in EGFR mutation NSCLC patients treated with first line gefitinib.
Efficacy and safety of modified docetaxel, cisplatine and 5FU (TPFm) in gastric cancer
Authors: Fahmi Mghirbi, Nesrine Mejri, Haifa Rachdi, Houda El benna, Nouha Daoud, Mehdi Afrit, Soumaya Labidi, Hamouda Boussen
Journal: Annals of Oncology (2017)
Recognizing Sepsis as a Global Health Priority — A WHO Resolution
Authors: Konrad Reinhart, Ron Daniels, Niranjan Kissoon, Flavia R. Machado, Raymond D. Schachter, Simon Finfer
Journal: New England Journal of Medicine (2017)

The World Health Organization has adopted a resolution on improving the prevention, diagnosis, and management of sepsis. Millions of lives can be saved if politicians, policymakers, health care administrators, researchers, and clinicians take coordinated actions.
Increasing Incidence of Multiply Recurrent <i>Clostridium difficile</i> Infection in the United States
Authors: Gene K. Ma, Colleen M. Brensinger, Qufei Wu, James D. Lewis
Journal: Annals of Internal Medicine (2017)

Clostridium difficile infection (CDI), the most common health care-associated infection, often recurs. Fecal microbiota transplantation is increasingly used to treat multiply recurrent CDI (mrCDI).To determine whether the incidence of mrCDI is increasing in proportion to CDI and to identify risk factors for mrCDI.Retrospective cohort study.United States.38 911 718 commercially insured patients in the OptumInsight Clinformatics Database, of whom 45 341 developed CDI.Age- and sex-standardized incidence rates for CDI and mrCDI.From 2001 to 2012, the annual incidence of CDI and mrCDI per 1000 person-years increased by 42.7% (from 0.4408 to 0.6289 case) and 188.8% (from 0.0107 to 0.0309 case), respectively. The increase in mrCDI incidence was independent of known risk factors for CDI. Those who developed mrCDI were older (median age, 56.0 vs. 49.0 years; adjusted odds ratio [aOR] per 10-year increase in age, 1.25 [95% CI, 1.21 to 1.29]) and were more likely to be female (63.8% vs. 58.7%; aOR, 1.24 [CI, 1.11 to 1.38]) and to have used antibiotics (72.3% vs. 58.8%; aOR, 1.79 [CI, 1.59 to 2.01]), proton-pump inhibitors (24.6% vs. 18.2%; aOR, 1.14 [CI, 1.01 to 1.29]), or corticosteroids (18.3% vs. 13.7%; aOR, 1.15 [CI, 1.00 to 1.32]) within 90 days of CDI diagnosis. Chronic kidney disease (10.4% vs. 5.6%; aOR, 1.49 [CI, 1.24 to 1.80]) and diagnosis in a nursing home (2.1% vs. 0.6%; aOR, 1.99 [CI, 1.34 to 2.93]) were also associated with increased risk for mrCDI.The primary analyses included only commercially insured patients in the United States.Relative to CDI, mrCDI incidence has disproportionately increased, indicating a rising demand for mrCDI therapies.National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Allergy and Infectious Diseases.
Pathologic complete response (pCR) rates after neoadjuvant trastuzumab emtansine (T-DM1 [K]) + pertuzumab (P) vs docetaxel + carboplatin + trastuzumab + P (TCHP) treatment in patients with HER2-positive (HER2+) early breast cancer (EBC) (KRISTINE).
Authors: Sara A. Hurvitz, Miguel Martin, William Fraser Symmans, Kyung Hae Jung, Chiun-Sheng Huang, Alastair Mark Thompson, Nadia Harbeck, Vicente Valero, Daniil Stroyakovskiy, Hans Wildiers, Karen Afenjar, Rodrigo Fresco, Hans-Joachim Helms, Jin Xu, Yvonne Gail Lin, Joseph A. Sparano, Dennis J. Slamon
Journal: Journal of Clinical Oncology (2016)

500 Background: K and P bind different HER2 domains and have marked antitumor activity in HER2+ breast cancer. KRISTINE (NCT02131064) is an open-label phase 3 study comparing neoadjuvant K + P (KP) vs TCHP in patients with HER2+ EBC. This provides the first phase 3 data for a complete neoadjuvant regimen omitting standard chemotherapy. Methods: The primary endpoint was pCR rate (ypT0/is, ypN0). Treatment-naive women with stage II-IIIC centrally assessed HER2+ EBC were randomized to 6 cycles of KP or TCHP and were then evaluated for pCR. The Cochran Mantel-Haenszel χ2-test stratified by hormone receptor status and clinical stage was used to compare pCR rates. The study had 90% power to detect a 15 percentage point increase in pCR from 60% (TCHP) to 75% (KP). Secondary endpoints included breast conserving surgery (BCS) rate, safety, and patient-reported outcomes. Results: Baseline demographic and disease characteristics were comparable between the TCHP (n = 221) and KP (n = 223) arms. pCR rates were 55.7% (95% CI 48.8–62.3%) and 44.4% (95% CI37.8–51.2%) in the TCHP and KP arms, respectively (p= 0.0155). More women in the TCHP vs KP arm underwent BCS (52.6% vs 41.7%, p= 0.0228). In patients with ER+ EBC, pCR was 44.8% in the TCHP arm and 37.9% in the KP arm; it was 72.4% with TCHP and 53.8% with KP in women with ER-EBC. The incidence of grade ≥ 3 AEs and SAEs was lower with KP in the safety population (Table). Time to a ≥ 10-pt decrease from baseline in health related quality of life (HRQoL, 4.6 vs 3.0 months) and physical function (4.9 vs 2.8 months) was longer in the KP arm. Conclusion:While treatment with KP led to pCR in 44.4% of women, TCHP yielded a significantly higher pCR rate. However, KP had a notably better safety profile, and HRQoL and physical functioning were maintained longer. Clinical trial information: NCT02131064. TCHP (n = 219) KP (n = 223) SAE, n (%) 63 (28.8) 11 (4.9) Grade ≥ 3 AE, n (%) 141 (64.4) 29 (13.0) Selected grade ≥ 3 AEs, % Neutropenia 40.6 0.4 Diarrhea 15.1 0.9 Thrombocytopenia 6.8 1.8 Mucositis 3.2 0.9 Hepatotoxicity 2.3 2.2 Peripheral Neuropathy 0.9 0.9 Hemorrhage 0.9 0.4 Pulmonary toxicity 0 0.4 Left ventricular dysfunction 0 0
Early-stage mantle cell lymphoma: a retrospective analysis from the International Lymphoma Radiation Oncology Group (ILROG)
Authors: B.S. Dabaja, A.D. Zelenetz, A.K. Ng, R.W. Tsang, S. Qi, P.K. Allen, D. Hodgson, U. Ricardi, R.T. Hoppe, R. Advani, P.M. Mauch, L.S. Constine, L. Specht, Y. Li, S.A. Terezakis, A. Wirth, G. Reinartz, H.T. Eich, B.M.P. Aleman, P. Barr, J. Yahalom
Journal: Annals of Oncology (2017)
Pregnancy In Type 1 Von Willebrand Disease: A Prospective Study of VWF Levels and Risk Factors for Bleeding
Authors: Suman L. Sood, Andra H. James, Doug Bolgiano, Margaret V. Ragni, Amy D. Shapiro, Iris Shihong, Rolando Vega, Char Witmer, Barbara A. Konkle
Journal: Blood (2010)
Adalimumab in the Management of Crohn's Disease (CD) Patients with a Loss of Response to Infliximab
Authors: M Anwar, M O'Sullivan, S Sarwar, B Ryan, N Breslin, H O'Connor, C O'Morain
Journal: Endoscopy (2006)

Aims: Chimeric tumour necrosis factor (TNF) alpha antibody, infliximab, is an effective therapy for active CD. Patients may become unresponsive to this therapy over time. Aim: to determine the efficacy of adalimumab, a fully humanised anti-TNF-alpha antibody, in CD patients who lost response to infliximab.