tbuckley/cabot-search huggingface dataset:
Brain Abscess in an Adult Patient With Congenital Heart Disease
Authors: Kiersten Kelly Frenchu, Malik Bilal Ahmed
Journal: JAMA Cardiology (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 Cardiology 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 Cardiology journal
External validation of a screening instrument to identify cardiometabolic predictors of mortality in individuals with cancer.
Authors: Bogda Koczwara, Billingsley Kaambwa, Michelle Miller
Journal: Journal of Clinical Oncology (2018)

5 Background: Cancer survivors are at risk of higher mortality from other causes, in particular, cardiovascular and metabolic. We have previously reported on a development of a brief screening instrument to identify cardiometabolic predictors of mortality in older individuals using the Australian Longitudinal Study of Ageing, which showed that age, sex, history of cerebrovascular disease, non-adherence to exercise guidelines, and smoking predicted for mortality(Lim et al. 2017). The objective of this study was to validate our findings using an external database. Methods: Two external validation cohorts of cancer survivors recruited to the Australian Longitudinal Study on Women’s Health study were used: an older group aged between 70 and 75 at time of recruitment (cohort 1) and a younger group aged between 45 and 50 at time of recruitment (cohort 2). These were compared to the original development cohort who were aged 70 years and over at time of recruitment. The Cox proportional hazards model previously estimated in the development cohort was used to predict mortality at 10 years in the validation cohorts. Measures of discrimination and calibration were calculated. Results: There were 1764 and 1833 women in the two validation cohorts and 294 men and women in the original development cohort. Validation cohorts had lower mortality rates (31% and 4% in validation cohorts 1 and 2, respectively, versus 61% in the development cohort) and validation cohort 2 had a higher proportion of individuals reported to have met exercise guidelines (59%) compared to the development cohort (24%) and validation cohort 1 (0.11%). All measures of discrimination for the validation cohorts were within the range of acceptable published estimates. Calibration showed that, overall, the tool had acceptable predictive accuracy but performed best in the good prognostic groups. Conclusions: We have demonstrated that the screening tool developed in older cancer survivors, performs adequately in cohort of younger women cancer survivors although further calibration is needed to improve performance. Further validation in mixed gender cohorts and usability testing are planned.
Using a pedigree-based questionnaire to improve efficiency in a general oncology genetics clinic.
Authors: Joshua Michael Gulvin, Sarah Pass, Patricia De Los Rios, Hilary Y. Ma, Alyssa G. Rieber
Journal: Journal of Clinical Oncology (2018)

66 Background: Genetic counseling has two major components – education and medical history. Our Lyndon B Johnson (LBJ) General Oncology Genetics Clinic includes a diverse patient (pt) group. The majority of pts do not speak English, requiring medical translation, which lengthens encounters. To improve efficiency, a pre-visit genetics questionnaire (GQ) was created to gather pt and family history. Methods: The GQ includes: breast-obstetric history, urologic history, colon history, dermatology, maternal and paternal family history. Between November 2, 2017 and May 10, 2018 pts were contacted before their encounter. The GQ was given to pts, who were encouraged to complete it in advance, return electronically, or bring to the visit. Encounter duration for pts was calculated based on their check in and check out time documented in Epic. A partially completed GQ is defined as leaving a major section blank, like paternal or maternal history. Results: 92 pts were seen in the LBJ Oncology Genetics Clinic. The overall compliance rate for a completed GQ was 37% (Table 1). 51% of the pts were non-English speaking. For pts who completed the GQ, the mean overall cycle time is 55 minutes, which is reduced on average 33.0% compared to those who did not complete the GQ. Encounter duration in minutes, and compliance rate. Conclusions: We demonstrate that using a pedigree-based GQ in an Oncology Genetics Clinic is feasible with non-English speaking pts and can reduce clinic cycle times up to 33%. The greatest reduction in cycle time occurred when a completed GQ was emailed to the clinic. Interestingly, non-English speaking patients had a shorter cycle time compared to English speaking patients, which could be explained by an approximately twice as high compliance rate in the non-English speaking patients, further supporting the association between GQ completion and cycle time reduction. To improve cycle time further, increasing overall compliance rate from 37% provides a future direction.[Table: see text]
Brexit: the clock is ticking
Authors: Rebecca Coombes
Journal: BMJ (2018)

Amid the confusion and political in-fighting over Brexit, this week we publish a debate between two economists on whether leaving the EU will harm the NHS (doi:10.1136/bmj.k4014). In the absence of a definite deal, we are still no clearer about the implications for health, so here is an attempt to test some of the evidence.

Yes, leaving will damage Britain’s health, says Anand Menon, citing a smaller economy after Brexit and vastly fewer NHS staff from other EU countries. Since the referendum …
Abstract 15566: Thirty-Day Readmission After Percutaneous Mitral Valve Repair With MitraClip
Authors: Kamil F Faridi, Jeffrey J Popma, Jordan B Strom, Changyu Shen, Eunhee Choi, Robert W Yeh
Journal: Circulation (2017)

Introduction: Limited data are available on rates and predictors of 30-day hospital readmission after percutaneous mitral valve repair with the MitraClip device (Abbott Vascular, Santa Clara, CA). ...
CSF Aβ1–42 level is associated with cognitive decline in early Parkinson’s disease with rapid eye movement sleep behavior disorder
Authors: Maowen Ba, Guoping Yu, Min Kong, Hui Liang, Ling Yu
Journal: Translational Neurodegeneration (2018)

Rapid eye movement sleep behavior disorder (RBD) is associated with cognitive decline in early Parkinson's disease (PD). However, the underlyling basis for this association remains unclear.Parkinson's Progression Marker's Initiative (PPMI) subjects underwent baseline RBD testing with RBD sleep questionnaire (RBDSQ). Serial assessments included measures of motor symptoms, non-motor symptoms (NMS), neuropsychological assessment, blood and cerebrospinal fluid (CSF) biomarkers. Up to three years follow-up data were included. We stratified early PD subjects into PD with RBD (RBDSQ score > 5) and PD without RBD groups. Then, we evaluated baseline biomarkers in each group as a predictor of cognitive decline using Montreal Cognitive Assessment (MoCA) score changes over three years in regression models.Four hundred twenty-three PD subjects were enrolled at baseline, and a total of 350 PD subjects had completed 3 years of study follow-up with completely serial assessments. We found that at baseline, only CSF β-amyloid 1-42 (Aβ1-42) was significantly lower in PD subjects with RBD. On three years follow-up analysis, PD subjects with RBD were more likely to develop incident mild cognitive impairment (MCI) and presented greater cognitive decline in MoCA score. Lower baseline CSF Aβ1-42 predicted cognitive decline over 3 years only in PD subjects with RBD (β = - 0.03, P = 0.003). A significant interaction between Aβ1-42 and the 2 groups confirmed that this effect was indeed higher in PD with RBD than the other individual (β = - 2.85, P = 0.014).These findings indicate that CSF Aβ1-42 level is associated with global cognitive decline in early PD with RBD. The addition of CSF Aβ1-42 to RBD testing increase the likelihood of identifying those at high risk for cognitive decline in early PD.
Underutilization of GnRH analogues (G) and exemestane (E) in young patients with early-stage breast cancer (BC) in Ontario.
Authors: James Keech, Maureen E. Trudeau, Phillip S. Blanchette, Annie Ngan, Andrea Eisen
Journal: Journal of Clinical Oncology (2018)

73 Background: In 2014-15, the randomized control trials SOFT and TEXT showed that premenopausal women with hormone receptor-positive, early stage BC treated with ovarian suppression (G or oophorectomy) in combination with E had improved outcomes compared to those treated with tamoxifen (T) alone. The largest benefit was observed in women younger than 35 ( &lt; 35y). In Ontario, these regimens are not fully publicly funded for premenopausal women. We examined the utilization of adjuvant G + E for premenopausal BC patients in Ontario, as underutilization might reflect difficulty accessing these drugs. Methods: We determined the current utilization of adjuvant endocrine therapy for patients with BC through Ontario’s systemic therapy database. In particular, we examined the utilization of T, E and E + G in BC patients &lt; 35y as these patients are expected to have the highest rates of uptake based on the outcomes of SOFT and TEXT. Results: In the first year following the publication of SOFT and TEXT, 20% of BC patients receiving adjuvant endocrine therapy received E + ovarian suppression (G or oophorectomy). This value was 14% in the following year, reflecting low uptake of the optimal treatment strategy. Conclusions: In Ontario, uptake of G + E is low in BC patients &lt; 35y. One possible barrier to access is the lack of public funding for these drugs in this population. The low uptake may also reflect the toxicity associated with this treatment and the need for further knowledge translation. A 2017 provincial prioritization process ranked this unmet funding need as a high priority. Thus, a funding submission will be prepared to promote access to this evidence informed therapy. The submission will include a full evidence review and pharmacoeconomic analysis.[Table: see text]
“Myth” of being indispensable should not protect bullying doctors from punishment, says Francis
Authors: Abi Rimmer
Journal: BMJ (2018)

Doctors should receive the same treatment as nurses and other NHS staff if they are guilty of misconduct, Robert Francis QC has said.

Francis, who led the 2013 inquiry into the scandal at Mid Staffordshire NHS Foundation Trust, was speaking at a conference on bullying and undermining in the NHS, held at the Royal College of Surgeons of Edinburgh on 24 September. …
The quality of breast cancer quality measures.
Authors: Whitney Lane, Christel Rushing, Daniel Nussbaum, Dan G. Blazer, Rachel Adams Greenup
Journal: Journal of Clinical Oncology (2018)

108 Background: To assess quality in breast cancer care, standardized metrics are needed. Many accepted breast performance metrics are based on evidence-based practice; however, most fail to reflect patient choice in treatment decisions. Given the focus on patient-centered breast care, we sought to determine how compliance with established quality metrics correlates with receipt of breast cancer care impacted by patient preference. Methods: American College of Surgeons (ACS) National Cancer Data Base facilities were designated compliant or non-compliant based on Commission of Cancer (CoC) breast metrics MASTRT, BCSRT and HT*, which all improve survival. Compliant facilities met the expected performance rate (EPR) for all three metrics, while non-compliant facilities failed to meet the EPR for any. Rates of breast conserving surgery (BCS) for early stage cancer, immediate breast reconstruction (IBR), and contralateral prophylactic mastectomy (CPM) are proposed metrics that are impacted by patient preference. For these, quality is defined as high rates of BCS, high rates of IBR, and low rates of CPM. Multivariable logistic regression models were used to estimate the association between facility level rates on these measures and the probability of treatment at a CoC compliant facility. Results: 729 facilities were included in the analysis. Based on the CoC measures, 79 (10.8%) were considered compliant and 650 (89.2%) non-compliant. Rates of BCS and IBR did not differ between compliant and non-compliant facilities; however, women treated at compliant facilities were more likely to undergo CPM (26.3% vs 21.4%; p = 0.02). In a multivariate model treatment at compliant facilities was associated with higher rates of BCS, IBR, and CPM; however, the predictive value of these metrics was minimal (Estimated OR range: 1.01-1.03). Conclusions: Rates of preference driven therapies do not differentiate CoC compliant and non-compliant hospitals. The quality of a hospital’s breast care is likely poorly measured by metrics that are influenced by, but cannot account for patient values. *MASTRT (RT≤1yr of diagnosis in women with ≥4 +lymph nodes); BCSRT (RT ≤1yr of diagnosis for women ≤70 receiving BCS); HT (hormone therapy recommended ≤1yr of diagnosis for HR-positive breast cancer)
Abstract 15368: A Fatty-Acid Binding Protein 4 Inhibitor Prevents Proliferation, Migration and Inflammatory Responses in Vascular Smooth Muscle Cells
Authors: Yuta Okamura, Akihiro Sekiguchi, Taisuke Kogane, Chiharu Kakuda, Yuzaburo Sakamoto, Muneyoshi Okada, Hideyuki Yamawaki
Journal: Circulation (2016)

Backgrounds: Fatty-acid binding protein (FABP) 4 is an adipocytokine. Since blood FABP4 level is increased in hypertensive subjects, we tested the hypothesis that FABP4 controls key pathological pr...
Recent developments and highlights in rhinitis and allergen immunotherapy
Authors: Sietze Reitsma, Soma Subramaniam, Wytske W. J. Fokkens, De Yun Wang
Journal: Allergy (2018)

Abstract This review paper aims to provide an overview of recent developments in the field of allergic and non‐allergic rhinitis, as well as allergen immunotherapy. Recent advances in phenotyping and endotyping various forms of rhinitis have brought us one step closer towards tailoring treatment more appropriately for a given patient. Updates on local allergic rhinitis are also covered. Allergen immunotherapy ( AIT ) is an area of significant interest, with multiple original papers and recent position papers and guidelines published. Evidence related to the application of AIT in seasonal and perennial allergic rhinitis ( AR ), local allergic rhinitis and novel and expanded applications is discussed in the publication.
Impact of clinic characteristics on the adoption of a guideline-based standing order algorithm and patient accrual in the pragmatic cluster-randomized trial SWOG S1415CD (NCT02728596).
Authors: Kate Watabayashi, Ari Bell-Brown, Kathryn Egan, Karma L. Kreizenbeck, Gary H. Lyman, Dawn L. Hershman, Aasthaa Bansal, William E. Barlow, Sean D Sullivan, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

60 Background: The S1415CD intervention requires the integration of guideline-based prescribing recommendations and standing orders for primary prophylactic colony stimulating factors into existing chemotherapy order systems at community practices within the National Cancer Institute’s Community Oncology Research Program. We looked at the impact of clinic level characteristics on the length of time needed to successfully adopt the intervention and subsequent patient accrual. Methods: We calculated the length of time between randomization and intervention completion for each intervention arm clinic and classified them as short onset (2-5 months, N = 5), medium onset (6-8 months, N = 12) or long onset (10-12 months, N = 7). We compared baseline survey responses about clinic characteristics to onset times. Results: Type of EMR software and the number of chemotherapy regimens reconfigured for the trial had no effect on onset time. All short and medium onset clinics placed orders through an EMR, while 5 of 7 long onset clinics used paper orders. Long onset clinics had less reported nurse involvement in the reconfiguration workflow (change initiation, approval, fulfillment and dissemination) at 14% of clinics vs. 25% of medium onset and 75% of short onset clinics. The average weekly patient accrual rates observed after intervention completion were 1.0 in the short onset (range 0.6-1.5), 0.8 in the medium onset (0.2-1.3) and 0.6 in the long onset (0.1-2.0). Conclusions: When recruiting clinics for trials that require health record system changes, it may be helpful to consider aspects of the system modification workflow such as type of hospital departments involved, as clinics with less nursing involvement may take longer to complete the changes. The inclusion of clinics using different EMR software did not impede onset, but clinics using paper may require more time. Length of onset had no meaningful impact on weekly accrual rates; however, it did determine when clinics could start recruitment, affecting the total number of months clinics could recruit during the study accrual period. Clinical trial information: NCT02728596.
FDA Approval: Blinatumomab for Patients with B-cell Precursor Acute Lymphoblastic Leukemia in Morphologic Remission with Minimal Residual Disease
Authors: Emily Y. Jen, Qing Xu, Aaron Schetter, Donna Przepiorka, Yuan Li Shen, Donna Roscoe, Rajeshwari Sridhara, Albert Deisseroth, Reena Philip, Ann T. Farrell, Richard Pazdur
Journal: Clinical Cancer Research (2018)

Abstract On March 29, 2018, the FDA granted accelerated approval for blinatumomab (Blincyto; Amgen, Inc.) for the treatment of adults and children with B-cell precursor acute lymphoblastic leukemia (BCP ALL) in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1%. Blinatumomab is a CD3xCD19 bispecific antibody approved previously for the treatment of relapsed or refractory BCP ALL. The basis for this accelerated approval was a single-arm trial. For the 86 patients in first and second complete remission with MRD ≥ 0.1%, conversion to MRD &amp;lt; 0.01% was achieved after one cycle of blinatumomab by 85.2% [95% confidence interval (CI): 73.8%, 93.0%] and 72.0% (95% CI: 50.6%, 87.9%), respectively, and the estimated median hematologic relapse-free survivals (RFS) were 35.2 months (95% CI: 0.4–53.5) and 12.3 months (95% CI: 0.7–42.3), respectively. Hematologic RFS was considered substantial independent of whether patients underwent subsequent allogeneic stem cell transplantation. The safety profile for blinatumomab was established in prior studies, and no new safety signals were observed in the new population. Cytokine release syndrome and neurotoxicity remain significant risks. The FDA is requiring confirmation of clinical benefit in a randomized trial.
Essential elements of caregiver support in gynecologic oncology.
Authors: Lauren Hand, Grace Campbell, Teresa Hagan, Young Ji Lee, Sarah M. Belcher, Mary Roberge, Heidi AS Donovan
Journal: Journal of Clinical Oncology (2018)

160 Background: Caregivers are instrumental to the health and well-being of gynecologic cancer patients and can be deeply affected by the demands of caregiving. Our aims were to increase awareness of the unmet needs of family caregivers of women with gynecologic cancers and provide recommendations for essential elements of support needed by caregivers to ensure that family caregivers are recognized and supported as key members of the patients’ care teams. Methods: Over the course of a year, a 16-person steering committee and 40 stakeholders, including caregivers, patients, and clinicians, participated in a modified Delphi approach to assemble, review and prioritize a set of essential elements for caregiver support. The process culminated in a multi-disciplinary research roundtable. Stakeholders prioritized caregiver needs and discussed, brainstormed and prioritized essential support services necessary to meet those needs, using three rounds of consensus-building activities. Basic descriptive statistics were performed to feed means and rankings back to stakeholders prior to each round. Results: Stakeholders prioritized the top three needs of caregivers as: 1) to obtain information about their loved one’s cancer (M = 4.18, SD = 4.33), 2) how to provide support and comfort to their loved one (M = 3.18, SD = 3.92) and 3) how to maintain their own emotional health and well-being (M = 2.94, SD = 3.90). Fifteen Essential Elements of Support to address the needs of caregivers of women with gynecologic cancers were identified. These ranged from supports that are immediately actionable (e.g., information for the caregiver on managing the patient’s symptoms, skilled-care training, a point-person to help navigate the system) to more aspirational supports (e.g., integrative services focused on the health and well-being of the caregiver). Conclusions: Caregivers are an integral part of cancer care, though their needs are inconsistently addressed by the care team. In order to provide comprehensive quality care, clinicians and healthcare systems should strive to provide caregivers with the Essential Elements of Support identified in this study and continue to build a healthcare system incorporating caregivers’ needs.