tbuckley/cabot-search huggingface dataset:
Esophageal Injury and Atrioesophageal Fistula Caused by Ablation for Atrial Fibrillation
Authors: Sunil Kapur, Chirag Barbhaiya, Thomas Deneke, Gregory F. Michaud
Journal: Circulation (2017)

Esophageal perforation is a dreaded complication of atrial fibrillation ablation that occurs in 0.1% to 0.25% of atrial fibrillation ablation procedures. Delayed diagnosis is associated with the development of atrial-esophageal fistula (AEF) and increased mortality. The relationship between the esophagus and the left atrial posterior wall is variable, and the esophagus is most susceptible to injury where it is closest to areas of endocardial ablation. Esophageal ulcer seems to precede AEF development, and postablation endoscopy documenting esophageal ulcer may identify patients at higher risk for AEF. AEF has been reported with all modalities of atrial fibrillation ablation despite esophageal temperature monitoring. Despite the name AEF, fistulas functionally act 1 way, esophageal to atrial, which accounts for the observed symptoms and imaging findings. Because of the rarity of AEF, evaluation and validation of strategies to reduce AEF remain challenging. A high index of suspicion is recommended in patients who develop constitutional symptoms or sudden onset chest pain that start days or weeks after atrial fibrillation ablation. Early detection by computed tomography scan with oral and intravenous contrast is safe and feasible, whereas performance of esophageal endoscopy in the presence of AEF may result in significant neurological injury resulting from air embolism. Outcomes for esophageal stenting are poor in AEF. Aggressive intervention with skilled cardiac and thoracic surgeons may improve chances of stroke-free survival for all types of esophageal perforation.
Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy
Authors: Ann Marie Navar, Benjamin Taylor, Hillary Mulder, Eugene Fievitz, Keri L. Monda, Anna Fievitz, Juan F. Maya, J. Antonio G. López, Eric D. Peterson
Journal: JAMA Cardiology (2017)

Although PCSK9 inhibitors (PCSK9i) were approved in 2015, their high cost has led to strict prior authorization practices and high copays, and use of PSCK9i in clinical practice has been low.To evaluate patient access to PCSK9i among those prescribed therapy.Using pharmacy transaction data, we evaluated 45 029 patients who were newly prescribed PCSK9i in the United States between August 1, 2015, and July 31, 2016.The proportion of PCSK9i prescriptions approved and abandoned (approved but unfilled); multivariable analyses examined factors associated with approval/abandonment including payor, prescriber specialty, pharmacy benefit manager, out-of-pocket cost (copay), clinical diagnoses, lipid-lowering medication use, and low-density lipoprotein cholesterol levels.Of patients given an incident PCSK9i prescription, 51.2% were women, 56.6% were 65 years or older, and 52.5% had governmental insurance. Of the patients given a prescription, 20.8% received approval on the first day, and 47.2% ever received approval. Of those approved, 65.3% filled the prescription, resulting in 30.9% of those prescribed PCSK9i ever receiving therapy. After adjustment, patients who were older, male, and had atherosclerotic cardiovascular disease were more likely to be approved, but approval rates did not vary by patient low-density lipoprotein cholesterol level nor statin use. Other factors associated with drug approval included having government vs commercial insurance (odds ratio [OR], 3.3; 95% CI, 2.8-3.8), and those filled at a specialty vs retail pharmacy (OR, 1.96; 95% CI, 1.66-2.33). Approval rates varied nearly 3-fold among the top 10 largest pharmacy benefit managers. Prescription abandonment by patients was most associated with copay costs (C statistic, 0.86); with abandonment rates ranging from 7.5% for those with $0 copay to more than 75% for copays greater than $350.In the first year of availability, only half of patients prescribed a PCSK9i received approval, and one-third of approved prescriptions were never filled owing to copay.
Cancer Survivorship Care in Advanced Primary Care Practices
Authors: Ellen B. Rubinstein, William L. Miller, Shawna V. Hudson, Jenna Howard, Denalee O’Malley, Jennifer Tsui, Heather Sophia Lee, Alicja Bator, Benjamin F. Crabtree
Journal: JAMA Internal Medicine (2017)

<h3>Importance</h3> Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. <h3>Objective</h3> To explain why primary care has not begun to integrate comprehensive cancer survivorship services. <h3>Design, Setting, and Participants</h3> Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. <h3>Main Outcomes and Measures</h3> Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. <h3>Results</h3> The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. <h3>Conclusions and Relevance</h3> To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure.
Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis
Authors: Nicole E. Rich, Stefany Oji, Arjmand R. Mufti, Jeffrey D. Browning, Neehar D. Parikh, Mobolaji Odewole, Helen Mayo, Amit G. Singal
Journal: Clinical Gastroenterology and Hepatology (2017)
Sixty seconds on . . . hookworm
Authors: Anne Gulland
Journal: BMJ (2017)

Yes, that’s right, the parasite, thought to affect about 450 million people globally, that is common in countries with poor sanitation. But it’s also been found in one of the richest countries in the world: the United States.

Hookworm infection, historically a big problem in the southern US states, was thought to have been wiped out sometime in the 1950s. However, a community organisation, the …
Is gabapentin effective for women with unexplained chronic pelvic pain?
Authors: Andrew W Horne, Katy Vincent, Roman Cregg, Jane Daniels
Journal: BMJ (2017)

This article is linked with a commentary on “What to do in the light of this uncertainty” by James Duffy. 

#### What you need to know

Chronic pelvic pain in women is a common presentation in primary care. Pain persists or recurs over at least six months1 and can be distressing, affecting physical function, quality of life, and productivity.2 Nearly 38 per 1000 women are affected annually in the UK. Global estimates range from 2.1% to 24% of the female population.34

Endometriosis, adenomyosis, adhesions, pelvic inflammatory disease, irritable bowel syndrome, bladder pain syndrome, nerve entrapment, and musculoskeletal pain are among the common causes.45 These are often identified by screening for pelvic infection (eg, Chlamydia trachomatis ), pelvic imaging (eg, ultrasound, magnetic resonance imaging), and diagnostic laparoscopy.1 Some 40%-55% of women with chronic pelvic pain in secondary care appear to have no obvious underlying pathology based on clinical history, examination, and investigations.46 Management of this group of women is challenging and there are few established gynaecological treatments. The Royal College of Obstetricians and Gynaecologists recommends a combination of pharmacological interventions, physiotherapy, and cognitive behavioural therapy.1 Often women try several methods sequentially or in combination.478Figure 1⇓ presents a common diagnostic and treatment approach that women with chronic pelvic pain might be offered.



Fig 1  Flow diagram showing the possible “treatment journey” (and timelines) for a woman who presents to primary care with …
A Time to Sequence
Authors: Sarah K. Baxter, Mary-Claire King
Journal: JAMA Pediatrics (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 Pediatrics 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 Pediatrics journal
Immunomodulation by Entinostat in Renal Cell Carcinoma Patients Receiving High-Dose Interleukin 2: A Multicenter, Single-Arm, Phase I/II Trial (NCI-CTEP#7870)
Authors: Roberto Pili, David I. Quinn, Hans J. Hammers, Paul Monk, Saby George, Tanya B. Dorff, Thomas Olencki, Li Shen, Ashley Orillion, Dominick Lamonica, Roberto S. Fragomeni, Zsolt Szabo, Alan Hutson, Adrienne Groman, Susan M. Perkins, Richard Piekarz, Michael A. Carducci
Journal: Clinical Cancer Research (2017)

On the basis of preclinical data suggesting that the class I selective HDAC inhibitor entinostat exerts a synergistic antitumor effect in combination with high-dose IL2 in a renal cell carcinoma model by downregulating Foxp3 expression and function of regulatory T cells (Treg), we conducted a phase I/II clinical study with entinostat and high-dose IL2 in patients with metastatic clear cell renal cell carcinoma (ccRCC).
Reply
Authors: Sandra Rebouissou, Paulette Bioulac‐Sage, Jean‐Charles Nault, Julien Calderaro, Jessica Zucman‐Rossi
Journal: Hepatology (2017)

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. Reply: We thank Sanjay Kakar and Linda D. Ferrell for their interest in our recent work regarding the genotype‐phenotype correlation of CTNNB1 mutations in liver tumors. In their letter, the authors raised two concerns related to the interpretation of glutamine‐synthetase (GS) immunostaining patterns according to ß‐catenin mutation type in CTNNB1 gene. They underlined that the patterns of expression of GS and ß‐catenin are not easy to interpret using immunohistochemistry (IHC), and they questioned the rationale of defining new GS IHC criteria that may impact clinical diagnosis of hepatocellular adenomas (HCAs) at risk of malignant transformation and patient management. One important finding of our study was the strong association between IHC pattern of GS, ß‐catenin mutation type, and activity in HCA. In light of this study, we concluded that mutations occurring in exon 3 of ß‐catenin are the most important to diagnose for clinical purposes because of their high risk of malignant transformation.1 However, among these exon 3 mutations, mutation at codon S45 showed a heterogeneous GS pattern, different from other exon 3 mutations, occasionally difficult to identify, and to differentiate from some cases of exon 7/8 mutations, which are associated to a low risk of malignant transformation. Therefore, we suggested that mutation screening could be proposed to refine the diagnosis and risk of malignant transformation. Comments from Sanjay Kakar and Linda D. Ferrell contribute to an active debate within the pathology community related to the use of IHC in the risk assessment of HCA malignant transformation.2 In this line, we believe that GS IHC criteria should be revised: We need a more comprehensive study of the correlation between ß‐catenin mutations and GS IHC patterns at the international level. This study should be conducted blindly by a representative community of liver pathologists of different countries in a large collection of HCA including all subtypes characterized by molecular biology and gene mutation screening. Frozen samples should also be used given that ß‐catenin alterations comprise large deletions that are frequently missed by sequencing DNA extracted from formalin‐fixed, paraffin‐embedded samples. The most recent HCA molecular classification3 should be used as the reference, and the analysis should aim to (1) assess more accurately the sensitivity and specificity of GS immunostaining as a surrogate marker to identify exon 3 ß‐catenin mutated HCA, (2) assess the interobserver agreement, and (3) redefine consensus international GS IHC criteria for diagnosis purposes. Such an analysis has not been yet published and is currently ongoing.
Manipulating ocular endothelial tight junctions: Applications in treatment of retinal disease pathology and ocular hypertension
Authors: Matthew Campbell, Paul S. Cassidy, Jeffrey O'Callaghan, Darragh E. Crosbie, Pete Humphries
Journal: Progress in Retinal and Eye Research (2017)

Protein levels of endothelial tight-junctions of the inner retinal microvasculature, together with those of Schlemm's canal, can be readily manipulated by RNA interference (RNAi), resulting in the paracellular clefts between such cells to be reversibly modulated. This facilitates access to the retina of systemically-deliverable low molecular weight, potentially therapeutic compounds, while also allowing potentially toxic material, for example, soluble Amyloid-β1-40, to be removed from the retina into the peripheral circulation. The technique has also been shown to be highly effective in alleviation of pathological cerebral oedema and we speculate that it may therefore have similar utility in the oedematous retina. Additionally, by manipulating endothelial tight-junctions of Schlemm's canal, inflow of aqueous humour from the trabecular meshwork into the Canal can be radically enhanced, suggesting a novel avenue for control of intraocular pressure. Here, we review the technology underlying this approach together with specific examples of clinical targets that are, or could be, amenable to this novel form of genetic intervention.
Distress and psychiatric morbidity in cancer patients: Prevalence and association with mortality in a two-year longitudinal study.
Authors: Caryn Mei-Hsien Chan, Wan Azman Wan Ahmad, Mastura Md Yusof, Gwo Fuang Ho, Edward Krupat
Journal: Journal of Clinical Oncology (2014)

9529 Background: Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In the present study, we aimed to prospectively examine the prevalence of distress and psychiatric morbidity in a consecutive series of cancer patients in follow-ups of up to 24 months from diagnosis and its association with mortality. Methods: Participants were 467 consecutively recruited adult cancer patients attending oncology follow-ups at a single academic medical centre. Assessment consisted of the Hospital Anxiety and Depression Scale (HADS) at baseline (T1) and 4- to 6-weeks (T2), and structured clinical interviews at 6-months (T3) and 12- to 18-months (T4). All patients were followed up to 24-month survival with comparison between co-morbid psychiatric cases and non-cases made. Overall survival was calculated using the Kaplan-Meier method. The research protocol was reviewed and approved by the institutional ethics committee. Results: Of 467 patients, 217 patients with elevated total HADS scores (≥ 16) at baseline (T1) and 4- to 6-weeks (T2) met criteria for a DSM-IV-TR Axis I disorder (major mental disorders) at 6-months follow-up (T3). At 12- to 18-months follow-up (T4), 115 patients were re-interviewed, with 102 patients assigned a diagnosis. Overall prevalence of psychiatric comorbidity was approximately 46%. Seventy four deaths occurred during the 24-month study period (27 in the non-case group, 47 in the case group). The main cause of death was disease progression. Cancer patients without psychiatric morbidity had a survival benefit of 2.24 months, or 67 days. Mean survival at 24 months was 20.87 months (95% CI 20.06-21.69) for cancer patients with psychiatric morbidity versus 23.11 months (95% CI 22.78-23.43) for those without (p < 0.001). Conclusions: Findings demonstrated a survival benefit of 2.24 months for cancer patients without psychiatric comorbidity. The high rate of psychiatric morbidity makes it essential for clinicians to identify patients most at risk and offer appropriate intervention, as there is good evidence to support the efficacy of monitoring and active treatment.
Expression profile of healthy erythroid progenitors
Authors: A T Merryweather-Clarke, A Atzberger, W Shah, H B Woffendin, S Soneji, C Waugh, K Clark, J Brown, J Sloane-Stanley, W G Wood, T C Freeman, Higgs, V Buckle, Robson Kjh.
Journal: American Journal of Hematology (2007)
Shark cartilage in the water
Authors: Simon I R Noble
Journal: BMJ (2006)

How much will Herceptin really cost? Balancing local and national priorities is not newEditor-Herceptin for early stage breast cancer is a cost effective treatment, and it is right that the NHS should make it available.The challenge of funding new treatments and balancing local and national priorities is one the NHS has faced since its inception. 1 The process the National Institute for Health and Clinical Excellence (NICE) follows for evaluating new medicines is the most rigorous anywhere in the world, and local NHS organisations can have confidence that implementing our recommendations is an effective use of their resources.NICE's independent advisory committees do not rubber stamp decisions.They make them based on an objective and impartial interpretation of the evidence.Those who suggest otherwise should come forward with their evidence for doing so.It is wrong to suggest that a single recommendation from NICE will necessarily cause other services to be reduced and that these decisions are made by clinicians only.Many demands are made on available funds in any hospital at any one time and it is the responsibility of local NHS management, working with their clinical teams, to make the best use of these resources.This difficult job is made easier by NICE guidance and the support tools we offer, such as our commissioning guides and our forthcoming advice on shifting spending from less to more effective treatments.
Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves
Authors: Curtis W. Noonan, Erin O. Semmens, Paul Smith, Solomon W. Harrar, Luke Montrose, Emily Weiler, Marcy McNamara, Tony J. Ward
Journal: Environmental Health Perspectives (2017)

Background: Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. Objectives: Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. Methods: A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. Results: Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=−7.8 to −0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. Conclusions: Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. Trial registration: ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849
Endoscopic resection in esophageal adenocarcinoma: a basic requirement for future management algorithms
Authors: Neil Gupta, Prateek Sharma
Journal: Endoscopy (2017)

See also: Exploring diagnostic and therapeutic implications of endoscopic mucosal resection in EUS-staged T2 esophageal adenocarcinomaEndoscopy 2017; 49(10): 941-948DOI: 10.1055/s-0043-112492
Adverse effect of hydroxyurea on spermatogenesis in patients with sickle cell anemia after 6 months of treatment
Authors: Isabelle Berthaut, Dora Bachir, Salma Kotti, Céline Chalas, Katia Stankovic, Florence Eustache, Célia Ravel, Anoosha Habibi, Sylvie Brailly-Tabard, Laurence Lévy-Dutel, Alexandre Bleibtreu, Tabassome Simon, Frédéric Galactéros, François Lionnet, Jacqueline Mandelbaum
Journal: Blood (2017)