tbuckley/cabot-search huggingface dataset:
Assessment of language needs and resource use among Canadian immigrant patients with cancer.
Authors: Sophia Liu, Elliot Charles Smith, Alexandra McCartney, Amedra Basgaran, Karmugi Balaratnam, M Catherine Brown, Doris Howell, Jennifer M. Jones, Meredith Elana Giuliani, Wei Xu, Geoffrey Liu, Lawson Eng
Journal: Journal of Clinical Oncology (2018)

77 Background: Canada's foreign-born population is estimated to reach up to 30% by 2036. Immigrants diagnosed with cancer can face poorer cancer outcomes compared to non-immigrants due to language barriers affecting physician-patient communication and non-equivalent interpretation by untrained translators. Reducing this disparity is a growing challenge due to continued high immigration rates. As Canadian data is lacking, we explored the language needs and resource utilization of Canadian cancer patients. Methods: Adult cancer survivors from Princess Margaret Cancer Centre were surveyed in English on their socio-demographics, perceived communication difficulties, and interpreter use. Results: Of 470 patients, 45% were foreign-born; 37% self-identified as immigrants; 78% spoke mostly English at home. Among self-identified immigrants, median age at diagnosis was 60 years, 46% were female, and 59% completed post-secondary education. Top three countries of origin were China (23%), India (10%), and Italy (9%). Although 73% of immigrants reported English as their most comfortable language in which to receive healthcare information, 18% reported difficulties communicating with the doctor in English at a few visits or more, 14% indicated some discomfort communicating with their oncologist in English, and 4% of immigrants felt their cancer care was affected by a language barrier. Twenty-six percent of immigrants required interpretation, with 91% employing family, 7% utilizing professional interpreters, and only 19% have ever used the institutional language services. Conclusions: Although most immigrants identify English as their most comfortable language for healthcare delivery, some still experience communication difficulties with their oncologist during at least a few visits. However, most patients felt comfortable communicating with their oncologists and do not feel their cancer care is affected. Most relied on family members to interpret, while local hospital language resources were largely underutilized. Strategies for promoting professional translation service use may help improve immigrants’ experience, caregivers’ burden, and enhance physicians’ ability to counsel patients directly.
Reduced Opioid Marketing Could Limit Prescribing Information for Physicians
Authors: Benedic Ippolito, Stan Veuger
Journal: JAMA Internal Medicine (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 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
Reducing inappropriate empiric vancomycin use in neutropenic fever.
Authors: Nina Kim, Jessica Caro, Samantha Jacobs, Meenakshi Rana, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2018)

290 Background: Neutropenic fever is an oncologic emergency associated with high morbidity and mortality, requiring prompt antibiotic initiation. National infectious disease and oncology guidelines do not recommend vancomycin for standard empiric therapy, unless used for certain evidence-based indications. At our institution, we observed inappropriate use of vancomycin for neutropenic fever and implemented an intervention to educate providers regarding appropriate indications. Methods: We conducted a series of educational sessions focused on the evidence-based indications for vancomycin use in neutropenic fever with residents, nurse practitioners, fellows, and attending physicians. We also displayed educational posters in work rooms and patient units. We conducted a retrospective chart review to assess the impact on vancomycin prescribing practices and patient outcomes pre-intervention (9/1/17 - 2/28/18) and post-intervention (3/1/18 - 5/24/18). We used descriptive statistics and chi-square tests to assess differences. Results: Vancomycin was frequently prescribed without an appropriate indication in the pre-intervention period. Both the overall use and the inappropriate use of vancomycin decreased significantly in the post-intervention period (Table 1). There was no significant difference in mean duration of fever (2.7 vs 2.1 days, p = 0.06) or length of stay (30 vs 34 days, p = 0.58) between the pre- and post-intervention groups, respectively, despite the reduction in vancomycin use. Conclusions: Multidisciplinary educational sessions reduced unnecessary vancomycin use as empiric treatment for neutropenic fever without adverse patient outcomes. This is a low resource intervention that can be applied to other healthcare settings. Future work will evaluate the effect on cost.[Table: see text]
NHS agrees to pay millions to woman left paralysed by TB meningitis
Authors: Clare Dyer
Journal: BMJ (2018)

The NHS has agreed to pay millions of pounds to settle a negligence claim by a woman who was left tetraplegic by tubercular meningitis after twice being sent home by emergency department doctors at Chelsea and Westminster Hospital in London.

Named only as T to protect her identity, she will receive a lump sum of £350 000 (€390 000; $455 000) and an annual sum of £300 000 index linked for the rest of her life. Now aged 42, she is thought to have a life expectancy of around 70.

T, who was aged 35 at the time, was doing voluntary work at a high level and studying for a …
From A to Xeloda: Practical considerations for implementing a chemotherapy regimen ordering system intervention.
Authors: Kathryn Egan, Ari Bell-Brown, Karma L. Kreizenbeck, Kate Watabayashi, Gary H. Lyman, Dawn L. Hershman, Aasthaa Bansal, William E. Barlow, Sean D Sullivan, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

57 Background: SWOG S1415CD (NCT02728596) is a pragmatic trial comparing outcomes of colony stimulating factor (CSF) use in usual care with care that uses guideline-informed standing CSF orders for protocol chemotherapy regimens. To develop the regimen list, we reviewed, reconciled, and compiled a comprehensive list of 77 NCCN-recognized core regimens and 40 biologic variants for breast, non-small cell, and colorectal cancer, meant to capture a broad population and variety of practices and settings. The 24 intervention sites chose regimens representative of the 3 febrile neutropenia (FN) risk categories (high, intermediate, low) from the list to reconfigure in prescription ordering systems. The current analysis seeks to determine whether providing a comprehensive list of regimens resulted in increased enrollment of patients. Methods: For each site, we compared how many core regimens the site reconfigured to their average weekly rate of enrollment from date of first patient enrolled to 4/1/2018, controlled for cooperative group type and site-reported volume of breast, non-small cell lung, and colorectal cancer patients. For each regimen, we determined its relative popularity by tallying how many sites chose to reconfigure it for the trial. Results: Sites reconfigured an average of 56% (range: 19%-100%) of core regimens on our list. The 18 most popular core regimens chosen by 83-96% of sites provided enrollment coverage across all FN risk categories for all intervention sites and accounted for 91% of enrollment, although enrollment among those regimens varied widely (0-18% of all patients enrolled). Reconfiguring more regimens did not correlate with higher average weekly enrollment (r &lt; 0.1). Conclusions: Studies that wish to limit the number of regimens may want to focus on the most popular regimens as identified by committee or preliminary polling. Starting from a comprehensive set of regimens for a pragmatic trial focusing on chemotherapy ordering systems takes more time to compile and vet, is more difficult to implement in databases, is a burden to sites to review and reconfigure in ordering systems, and does not necessarily translate to increased enrollment rates. Clinical trial information: NCT02728596.
Continuous-Flow LVAD Support Causes a Distinct Form of Intestinal Angiodysplasia
Authors: Jooeun Kang, Samson Hennessy-Strahs, Pawel Kwiatkowski, Christian A. Bermudez, Michael A. Acker, Pavan Atluri, Patrick I. McConnell, Carlo R. Bartoli
Journal: Circulation Research (2017)

Rationale: The objective of this autopsy study was to determine whether gastrointestinal angiodysplasia develops during continuous-flow left ventricular assist device (LVAD) support. Objective: LVAD support causes pathologic degradation of von Willebrand factor (vWF) and bleeding from gastrointestinal angiodysplasia at an alarming rate. It has been speculated that LVAD support itself may cause angiodysplasia. The relationship to abnormal vWF metabolism is unknown. We tested the hypothesis that abnormal gastrointestinal vascularity develops during continuous-flow LVAD support. Methods and Results: Small bowel was obtained from deceased humans, cows, and sheep supported with a continuous-flow LVAD (n=9 LVAD, n=11 control). Transmural sections of jejunum were stained with fluorescein isothiocyanate–conjugated isolectin-B4 for endothelium to demarcate vascular structures and quantify intestinal vascularity. Paired plasma samples were obtained from humans before LVAD implantation and during LVAD support (n=41). vWF multimers and degradation fragments were quantified with agarose and polyacrylamide gel electrophoresis and immunoblotting. Abnormal vascular architecture was observed in the submucosa of the jejunum of human patients, cows, and sheep supported with a continuous-flow LVAD. Intestinal vascularity was significantly higher after LVAD support versus controls (5.2±1.0% versus 2.1±0.4%, P =0.004). LVAD support caused significant degradation of high–molecular-weight vWF multimers (–9±1%, P &lt;0.0001) and accumulation of low–molecular-weight vWF multimers (+40±5%, P &lt;0.0001) and vWF degradation fragments (+53±6%, P &lt;0.0001). Conclusions: Abnormal intestinal vascular architecture and LVAD-associated vWF degradation were consistent findings in multiple species supported with a continuous-flow LVAD. These are the first direct evidence that LVAD support causes gastrointestinal angiodysplasia. Pathologic vWF metabolism may be a mechanistic link between LVAD support, abnormal angiogenesis, gastrointestinal angiodysplasia, and bleeding.
Combining Immune Checkpoint Blockade and Tumor-Specific Vaccine for Patients With Incurable Human Papillomavirus 16–Related Cancer
Authors: Erminia Massarelli, William William, Faye Johnson, Merrill Kies, Renata Ferrarotto, Ming Guo, Lei Feng, J. Jack Lee, Hai Tran, Young Uk Kim, Cara Haymaker, Chantale Bernatchez, Michael Curran, Tomas Zecchini Barrese, Jaime Rodriguez Canales, Ignacio Wistuba, Lerong Li, Jing Wang, Sjoerd H. van der Burg, Cornelis J. Melief, Bonnie Glisson
Journal: JAMA Oncology (2018)

<h3>Importance</h3> In recurrent human papilloma virus (HPV)–driven cancer, immune checkpoint blockade with anti–programmed cell death 1 (PD-1) antibodies produces tumor regression in only a minority of patients. Therapeutic HPV vaccines have produced strong immune responses to HPV-16, but vaccination alone has been ineffective for invasive cancer. <h3>Objective</h3> To determine whether the efficacy of nivolumab, an anti–PD-1 immune checkpoint antibody, is amplified through treatment with ISA 101, a synthetic long-peptide HPV-16 vaccine inducing HPV-specific T cells, in patients with incurable HPV-16–positive cancer. <h3>Design, Setting, and Participants</h3> In this single-arm, single-center phase 2 clinical trial, 24 patients with incurable HPV-16–positive cancer were enrolled from December 23, 2015, to December 12, 2016. Duration of follow-up for censored patients was 12.2 months through August 31, 2017. <h3>Interventions</h3> The vaccine ISA101, 100 μg/peptide, was given subcutaneously on days 1, 22, and 50. Nivolumab, 3 mg/kg, was given intravenously every 2 weeks beginning day 8 for up to 1 year. <h3>Main Outcomes and Measures</h3> Assessment of efficacy reflected in the overall response rate (per Response Evaluation Criteria in Solid Tumors, version 1.1). <h3>Results</h3> Of the 24 patients (4 women and 20 men; 22 with oropharyngeal cancer; median age, 60 years [range, 36-73 years]), the overall response rate was 33% (8 patients; 90% CI, 19%-50%). Median duration of response was 10.3 months (95% CI, 10.3 months to inestimable). Five of 8 patients remain in response. Median progression-free survival was 2.7 months (95% CI, 2.5-9.4 months). Median overall survival was 17.5 months (95% CI, 17.5 months to inestimable). Grades 3 to 4 toxicity occurred in 2 patients (asymptomatic grade 3 transaminase level elevation in 1 patient and grade 4 lipase elevation in 1 patient), requiring discontinuation of nivolumab therapy. <h3>Conclusions and Relevance</h3> The overall response rate of 33% and median overall survival of 17.5 months is promising compared with PD-1 inhibition alone in similar patients. A randomized clinical trial to confirm the contribution of HPV-16 vaccination to tumoricidal effects of PD-1 inhibition is warranted for further study. <h3>Trial Registration</h3> ClinicalTrials.gov identifier:NCT02426892
Abstract 13809: Soluble TNFα Receptor 1 Level Predicts Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis
Authors: Hooman Bakhshi, Bharath Ambale-Venkatesh, Zahra Meyghani, Mohammad R Ostovaneh, Colin O Wu, Mary Cushman, Russell Tracy, David A Bluemke, João A Lima
Journal: Circulation (2016)

Introduction: Heart failure(HF) is a common chronic disease with growing incidence and prevalence. Innate and adaptive immunity have important roles in initiation and progression of HF. Therefore we investigated the association of key biomarkers including soluble tumor necrosis α receptor 1 ( sTNFαR1; first-wave cytokine activity) and interleukin-2 receptor(sIL-2R; T cell activation) with incident HF in a population based cohort. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) is a population based study consisting of 6814 men and women free of clinical cardiovascular disease at enrolment recruited from four ethnicities in six US field centers. We included all participants with available sTNFαR1 and sIL-2R level measurements at baseline exam (n=2848). Both probable and definite HF were considered as the endpoint of the study. Cox Proportional Hazard models were used to evaluate the association of inflammatory biomarkers and time to first HF after adjusting for traditional risk factors for HF. Results: The mean (SD) age was 61.6 (10.2) years and 46.4% were male. The median (IQR) sTNFαR1 (pg/ml) and sIL-2R (pg/ml) levels were 1292 (1107-1547) and 903 (727-1154). Over a median (IQR) follow up of 12.3 (11.6-12.8) years, 112 participants developed incident HF. Every 100 pg/ml higher sTNFαR1 level was associated with 5% higher risk of incident HF independent of traditional risk factors of HF (Table). The association with sIL-2R level was not statistically significant, although had a trend towards a modest association. Conclusion: sTNFαR1 level is associated with future HF in a multi-ethnic population based cohort.
Five-year PFS from the AETHERA trial of brentuximab vedotin for Hodgkin lymphoma at high risk of progression or relapse
Authors: Craig H. Moskowitz, Jan Walewski, Auayporn Nademanee, Tamas Masszi, Edward Agura, Jerzy Holowiecki, Muneer H. Abidi, Andy I. Chen, Patrick Stiff, Simonetta Viviani, Veronika Bachanova, Anna Sureda, Teresa McClendon, Connie Lee, Julie Lisano, John Sweetenham
Journal: Blood (2018)
FDG PET/CT Findings in TAFRO Syndrome
Authors: Masatoshi Hotta, Ryogo Minamimoto, Arisa Yashima, Masahiro Nakano, Hiroyuki Yamashita
Journal: Clinical Nuclear Medicine (2018)

A 67-year-old woman with prolonged fever, thrombocytopenia, and renal dysfunction underwent FDG PET/CT to evaluate underlying causes, including malignancy. PET/CT showed FDG uptake in ascites, subcutaneous edema, lymph nodes, spleen, and bone marrow. Subsequent bone marrow biopsy revealed myelofibrosis, and laboratory testing showed elevated concentrations of interleukin 6 in serum and ascites. These findings led to the diagnosis of TAFRO syndrome, a variant of multicentric Castleman disease, characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, and organomegaly. Because TAFRO syndrome is potentially fatal, accurate diagnosis is crucial. Characteristic FDG PET/CT findings facilitate the diagnosis of TAFRO syndrome, which is generally challenging.
<i>Candida auris</i> outbreak was linked to reusable axillary temperature probes, study finds
Authors: Susan Mayor
Journal: BMJ (2018)

Transmission of Candida auris , an emerging multidrug resistant pathogen, in a cluster of infections at the intensive care unit of a UK hospital was linked to reusable axillary temperature probes, a study has reported.1

“Our results indicate that reusable patient equipment may serve as a source of healthcare associated outbreaks of infection with C auris ,” said the researchers, led by David Eyre of Oxford University Hospitals NHS Foundation Trust.

C auris has recently been associated with several outbreaks worldwide, often in intensive care units. Europe …
Abstract 17038: Neural Remodeling and Increased Pro-arrhythmia in A Canine Model of Premature Ventricular Contraction-induced Cardiomyopathy
Authors: Alex Y Tan, Pranav Mankad, Ricardo Cardona-Guarache, Maureen Howren, Martha Joslyn, Shien-Fong Lin, Karoly Kaszala, Anthony Minisi, Kenneth Ellenbogen, Jose Huizar
Journal: Circulation (2016)

Introduction: Premature Ventricular Contraction (PVC)-Induced Cardiomyopathy (CM) is a major cause of non-ischemic CM. However, the presence or absence of neural remodeling and its consequences in ...
PD-1 up-regulation on CD4 <sup>+</sup> T cells promotes pulmonary fibrosis through STAT3-mediated IL-17A and TGF-β1 production
Authors: Lindsay J. Celada, Jonathan A. Kropski, Jose D. Herazo-Maya, Weifeng Luo, Amy Creecy, Andrew T. Abad, Ozioma S. Chioma, Grace Lee, Natalie E. Hassell, Guzel I. Shaginurova, Yufen Wang, Joyce E. Johnson, Amy Kerrigan, Wendi R. Mason, Robert P. Baughman, Gregory D. Ayers, Gordon R. Bernard, Daniel A. Culver, Courtney G. Montgomery, Toby M. Maher, Philip L. Molyneaux, Imre Noth, Steven E. Mutsaers, Cecilia M. Prele, R. Stokes Peebles, Dawn C. Newcomb, Naftali Kaminski, Timothy S. Blackwell, Luc Van Kaer, Wonder P. Drake
Journal: Science Translational Medicine (2018)

Pulmonary fibrosis is a progressive inflammatory disease with high mortality and limited therapeutic options. Previous genetic and immunologic investigations suggest common intersections between idiopathic pulmonary fibrosis (IPF), sarcoidosis, and murine models of pulmonary fibrosis. To identify immune responses that precede collagen deposition, we conducted molecular, immunohistochemical, and flow cytometric analysis of human and murine specimens. Immunohistochemistry revealed programmed cell death-1 (PD-1) up-regulation on IPF lymphocytes. PD-1+CD4+ T cells with reduced proliferative capacity and increased transforming growth factor-β (TGF-β)/interleukin-17A (IL-17A) expression were detected in IPF, sarcoidosis, and bleomycin CD4+ T cells. PD-1+ T helper 17 cells are the predominant CD4+ T cell subset expressing TGF-β. Coculture of PD-1+CD4+ T cells with human lung fibroblasts induced collagen-1 production. Strikingly, ex vivo PD-1 pathway blockade resulted in reductions in TGF-β and IL-17A expression from CD4+ T cells, with concomitant declines in collagen-1 production from fibroblasts. Molecular analysis demonstrated PD-1 regulation of the transcription factor STAT3 (signal transducer and activator of transcription 3). Chemical blockade of STAT3, using the inhibitor STATTIC, inhibited collagen-1 production. Both bleomycin administration to PD-1 null mice or use of antibody against programmed cell death ligand 1 (PD-L1) demonstrated significantly reduced fibrosis compared to controls. This work identifies a critical, previously unrecognized role for PD-1+CD4+ T cells in pulmonary fibrosis, supporting the use of readily available therapeutics that directly address interstitial lung disease pathophysiology.
Development and initial psychometric validation of the advisor experience survey.
Authors: Erica Bridge, Naomi Peek, Yvonne Leung, Lucia Vanta, Suman Dhanju, Simron Singh, Lesley Moody
Journal: Journal of Clinical Oncology (2018)

220 Background: Patient, family and public engagement builds strong, sustainable partnerships benefitting the planning, delivery and evaluation of health services. With growing international evidence and increased organizational investment supporting this type of engagement, evaluating the experience of these individuals is essential to ensuring meaningful participation and value. This study describes the development and psychometric properties of the Advisor Experience Survey in order to assess on-going patient, family and public advisor engagement at the system-level. Methods: The development and psychometric validation consisted of five steps: 1) literature review to identify relevant engagement experience items; 2) modified Delphi process where relevant engagement experience items were rated by experts; 3) cognitive interviews to ensure that items were clear and understandable; 4) pilot of survey; and 5) exploratory and confirmatory factor analysis (EFA; CFA) to determine construct validity. Results: The 13-item survey was disseminated to eligible patient, family and public advisors between April and September 2016 using FluidSurveys. All items were rated on a 5-point Likert scale. A total of 126 responses were included in the EFA and CFA. The final confirmatory solution consists of 3-factors (Support and Resources, Engagement Opportunities and Engagement Experience), including 9-items (X 2 = 31.4, df = 24; AGFI = 0.92; CFI = 0.99; SRMR = 0.02 and RMSEA = 0.05; 95% C.I. = 0.00-0.09). The 3-factor solution explains a total of 92% of the variance of the advisor engagement experience. Conclusions: The 3-factor Advisor Experience Survey with 9-items is acceptable for measuring the patient, family and public advisor engagement experience as it demonstrates good internal consistency and construct reliability. Cancer Care Ontario utilizes the 3-factor solution to report patient, family and advisor engagement experience at the system-level on a quarterly basis.
Pitfalls in diagnosing primary cutaneous aggressive epidermotropic <scp>CD</scp> 8 <sup>+</sup> T‐cell lymphoma
Authors: N.J. Deenen, L. Koens, E.H. Jaspars, M.H. Vermeer, R. Willemze, M.A. Rie, M.W. Bekkenk
Journal: British Journal of Dermatology (2018)