tbuckley/cabot-search huggingface dataset:
Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients
Authors: David P. Miller, Nancy Denizard-Thompson, Kathryn E. Weaver, L. Doug Case, Jennifer L. Troyer, John G. Spangler, Donna Lawler, Michael P. Pignone
Journal: Annals of Internal Medicine (2018)

Background: Screening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened. Objective: To examine the effect of a digital health intervention, Mobile Patient Technology for Health–CRC (mPATH-CRC), on rates of CRC screening. Design: Randomized clinical trial. (ClinicalTrials.gov: NCT02088333) Setting: 6 community-based primary care practices. Participants: 450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening. Intervention: An iPad application that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients. Measurements: The primary outcome was chart-verified completion of CRC screening within 24 weeks. Secondary outcomes were ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests. All outcome assessors were blinded to randomization. Results: Baseline characteristics were similar between groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20 000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression odds ratio, 2.5 [95% CI, 1.6 to 4.0]). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) "self-ordered" a test via the program. Limitation: Participants were English speakers in a single health care system. Conclusion: A digital health intervention that allows patients to self-order tests can increase CRC screening. Future research should identify methods for implementing similar interventions in clinical care. Primary Funding Source: National Cancer Institute.
Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study
Authors: Marc Humbert, Camille Taillé, Laurence Mala, Vincent Le Gros, Jocelyne Just, Mathieu Molimard
Journal: European Respiratory Journal (2018)

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab. This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation. 872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL −1 in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL −1 (n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils &lt;300 cells·µL −1 (n=346). This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL −1 , and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.
Efficacy and Safety of Tiotropium in Children and Adolescents
Authors: Eckard Hamelmann, Stanley J. Szefler
Journal: Drugs (2018)

Asthma is one of the most common chronic diseases in children, with a high proportion of patients demonstrating poor control despite the availability of disease management guidelines. Global Initiative for Asthma guidelines include tiotropium as an add-on therapy option at Steps 4 and 5 in patients aged ≥ 12 years with a history of exacerbations, and tiotropium delivered via the Respimat® Soft Mist™ Inhaler has recently been approved for use as once-daily maintenance therapy for children with asthma over the age of 6 years in the USA. A large clinical trial program has been conducted in children, adolescents, and adults across the spectrum of asthma severity. Findings from these clinical studies and pooled analyses in children and adolescents with symptomatic moderate or severe asthma have demonstrated that tiotropium Respimat® as add-on to inhaled corticosteroids, with or without other maintenance therapies, is a well-tolerated and efficacious bronchodilator, showing improved lung function and trends towards improved asthma control, mirroring findings in adult studies. This review discusses the evidence to date for tiotropium Respimat® for the management of asthma in adolescents and children with symptomatic moderate and severe asthma, and considers the challenges of asthma management in these patients. Factors affecting this population group, such as poor adherence, underreporting of symptoms, and social and psychological issues, are highlighted, along with the need for active review and management of treatment to help achieve optimal control.
Immunophenotyping of Newly Diagnosed and Recurrent Glioblastoma Defines Distinct Immune Exhaustion Profiles in Peripheral and Tumor-infiltrating Lymphocytes
Authors: Malte Mohme, Simon Schliffke, Cecile L. Maire, Alessandra Rünger, Laura Glau, Klaus C. Mende, Jakob Matschke, Christina Gehbauer, Nuray Akyüz, Svenja Zapf, Mareike Holz, Miriam Schaper, Tobias Martens, Nils O. Schmidt, Sven Peine, Manfred Westphal, Mascha Binder, Eva Tolosa, Katrin Lamszus
Journal: Clinical Cancer Research (2018)

Purpose: Immunotherapeutic treatment strategies for glioblastoma (GBM) are under investigation in clinical trials. However, our understanding of the immune phenotype of GBM-infiltrating T cells (tumor-infiltrating lymphocytes; TILs) and changes during disease progression is limited. Deeper insight is urgently needed to therapeutically overcome tumor-induced immune exhaustion.Experimental Design: We used flow cytometry and cytokine assays to profile TILs and peripheral blood lymphocytes (PBLs) from patients with GBM, comparing newly diagnosed or recurrent GBM to long-term survivors (LTS) and healthy donors. TCR sequencing was performed on paired samples of newly diagnosed and recurrent GBM.Results: We identified a clear immune signature of exhaustion and clonal restriction in the TILs of patients with GBM. Exhaustion of CD8+ TILs was defined by an increased prevalence of PD-1+, CD39+, Tim-3+, CD45RO+, HLA-DR+ marker expression, and exhibition of an effector-/transitional memory differentiation phenotype, whereas KLRG1 and CD57 were underrepresented. Immune signatures were similar in primary and recurrent tumors; however, restricted TCR repertoire clonality and a more activated memory phenotype were observed in TILs from recurrent tumors. Moreover, a reduced cytokine response to PHA stimulation in the blood compartment indicates a dysfunctional peripheral T-cell response in patients with GBM. LTS displayed a distinct profile, with abundant naïve and less exhausted CD8+ T cells.Conclusions: TILs and PBLs exhibit contrasting immune profiles, with a distinct exhaustion signature present in TILs. While the exhaustion profiles of primary and recurrent GBM are comparable, TCR sequencing demonstrated a contracted repertoire in recurrent GBM, concomitant with an increased frequency of activated memory T cells in recurrent tumors. Clin Cancer Res; 24(17); 4187-200. ©2018 AACRSee related commentary by Jackson and Lim, p. 4059.
A Twin Study of Normative Personality and DSM-IV Personality Disorder Criterion Counts: Evidence for Separate Genetic Influences
Authors: Nikolai Czajkowski, Steven H. Aggen, Robert F. Krueger, Kenneth S. Kendler, Michael C. Neale, Gun Peggy Knudsen, Nathan A. Gillespie, Espen Røysamb, Kristian Tambs, Ted Reichborn-Kjennerud
Journal: American Journal of Psychiatry (2018)

Both normative personality and DSM-IV personality disorders have been found to be heritable. However, there is limited knowledge about the extent to which the genetic and environmental influences underlying DSM personality disorders are shared with those of normative personality. The aims of this study were to assess the phenotypic similarity between normative and pathological personality and to investigate the extent to which genetic and environmental influences underlying individual differences in normative personality account for symptom variance across DSM-IV personality disorders.
Sleep—a panacea?
Authors: Fiona Godlee
Journal: BMJ (2018)

Sleep (or lack of it) is back in fashion. Two recent books, Why We Sleep by neuroscientist Matthew Walker and The Business of Sleep by clinical psychologist Vicki Culpin, warn in the strongest terms that regularly sleeping less than seven hours a night is a disaster for our mental and physical wellbeing.

As a culture, we in rich countries are in the throes of what Culpin calls “an epidemic of sleeplessness,” increasing our risk of depression, …
JCDTRデータベースによる日本におけるICD/CRT‐D療法および予後の成績の分析
Authors: Mitsuhashi Takeshi, Shimizu Akihiko, Sekiguchi Yukio, Nishii Nobuhiro, Furushima Hiroshi, Yokoshiki Hisashi, Ueyama Takeshi, Nitta Takashi, Okumura Ken
Journal: Circulation (2013)
RELATIONSHIP BETWEEN GLOBAL LONGITUDINAL STRAIN AND INCIDENT ATRIAL FIBRILLATION IN THE GENERAL POPULATION: THE COPENHAGEN CITY HEART STUDY
Authors: Anne Marie Reimer Jensen, Sofie R. Biering-Sorensen, Rasmus Mogelvang, Gorm Jensen, Amil Shah, Jan Jensen, Tor Biering-Sorensen
Journal: Journal of the American College of Cardiology (2018)
Tandem high-dose chemotherapy and autologous hematopoietic stem cell transplantation (SCT) compared to single SCT for relapsed/refractory germ cell tumors (GCT).
Authors: Deepak Kilari, Parameswaran Hari, Muna Qayed, Raphael Fraser, Omar Davila, Shaji Kumar, Tomer Martin Mark, Yago Nieto, Anita D'Souza
Journal: Journal of Clinical Oncology (2018)

572 Background: Single-center observational studies have established the use of single or tandem SCT to salvage relapsed GCT but randomized trials are lacking. We analyzed outcomes and prognostic factors in 2,395 male SCT recipients for relapsed GCT between 1990 and 2015. Methods: Recipients of single or tandem SCT reported to the Center for International Blood and Marrow Transplant Research were identified. Outcomes were compared by SCT year: 1990-94 (N = 288), 1995-99 (N = 351), 2000-04 (N = 376), 2005-09 (N = 509) and 2010-15 (N = 871). A recent subset (n = 267, 2000-2015) with detailed disease- and transplant-related data was further analyzed with a multivariate (MVA) Cox proportional hazards model. Results: Median age at SCT was 31 (11-76) years and 49% received SCT within 12 months of diagnosis consistent with early relapse/primary refractory GCT. 26% had primary extragonadal GCT; 1,167 (49%) had intent to tandem transplant (TT). The median follow up was 51 (3-313) months. Day 100 non-relapse mortality was statistically similar at 8% in 1990-94 (vs. 4% in 2010-15) but 3-year progression-free survival (PFS) improved from 24 (18-31)% in 1990-94 to 47 (43-50)% in 2010-15 (p &lt; 0.0001) and 3-year survival (OS) from 35 (29-40)% to 54 (50-57)% in 2010-15 (p &lt; 0.0001). Compared with single SCT, TT recipients were younger 31 (16-62) vs 34 (13-76), with lower Hematopoietic Cell Transplantation-Comorbidity Index, more likely to undergo SCT after 1 line of chemotherapy (28% vs 9%), and within 1 year of diagnosis (51% vs 38%). TT was preferred over single SCT over time (48% of SCT were TT in 2000-04 vs. 81% in 2010-15). In MVA, non-seminoma histology, residual tumor at SCT, receipt of &gt; 1 line of pre-SCT chemotherapy and single SCT (vs. TT), were associated with worse PFS and OS. Year of SCT was not significant when adjusted for these covariates. Conclusions: In this large longitudinal cohort, improvements in PFS and OS were observed in recent years. SCT earlier in disease course and tandem SCT were associated with superior outcomes. These data involving a large cohort reported from 225 centers confirm specialized centers’ date in a real-world setting.
Pelvic lymph node metastases in prostate cancer: Preoperative detection with dynamic contrast-enhanced magnetic resonance imaging compared with postoperative pathologic result of pelvic lymph node dissection.
Authors: Jinho Hwang, Jung Jun Kim, Jong Jin Oh, Chang Wook Jeong, Sang Eun Lee, Seok-Soo Byun, Sangchul Lee
Journal: Journal of Clinical Oncology (2018)

171 Background: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). Methods: The data of 1528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in our institution were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI and pathologic lymph node metastasis (LNmet). The prediction model for pathologic lymph node (LNmet) was assessed using logistic regression analyses and the areas under receiver operating characteristic curves (AUCs) were evaluated. Results: The mean age of our cohort was 66.4 ± 6.7 years. Positive preoperative MRI finding was observed in 9.4% (145/1528) of patients. 5.3% (81/1528) of patients accompanied confirmed final pathologic LNmet. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariate analysis showed that preoperative MRI findings, clinical stage, and biopsy Gleason score were independent predictors for pathologic LNmet. Preoperative PSA, which was significantly related to pathologic LNmet in univariate analysis, failed to achieve independent predictor status in multivariate analysis. A better prediction model with greater accuracy was achieved by applying multivariate ROC analysis that included MRI findings, clinical stage, and biopsy Gleason score (AUC: 0.799 vs 0.613, p&lt;0.01). The corresponding newer prediction model showed better sensitivity(77.78%) and specificity(70.74%) within threshold value range when it was compared with the predictor model using conventional Partin triad. Conclusions: Preoperative MRI findings for pathologic LNmet showed limited prediction power, yet the predicting power was significantly increased when additional factors such as clinical stage, and biopsy Gleason score were included in the analysis. [Table: see text]
BMA urges general practice to prepare financially for “unacceptable” contract changes
Authors: Helen Jaques
Journal: BMJ (2013)

General practices have been urged by the BMA to start planning for the financial impact of the government’s proposed changes to the general medical services (GMS) contract, which will come into effect from 2013-14.1

The BMA’s General Practitioners Committee has estimated that the contract changes being forced through by the government could cost the average practice in England £31 000 a year. …
Lack of Effect of Teriparatide on Joint Erosions in Rheumatoid Arthritis Is an Expected Result: Comment on the Article by Solomon et al
Authors: Giovanni Adami, Maurizio Rossini, Ombretta Viapiana, Angelo Fassio, Luca Idolazzi, Giovanni Orsolini, Davide Gatti
Journal: Arthritis & Rheumatology (2017)
Development and validation of prediction models for the risks of diabetes-related hospitalization and in-hospital mortality in patients with type 2 diabetes
Authors: Tsai-Chung Li, Chia-Ing Li, Chiu-Shong Liu, Wen-Yuan Lin, Chih-Hsueh Lin, Sing-Yu Yang, Jen-Huai Chiang, Cheng-Chieh Lin
Journal: Metabolism (2018)
USE OF ALCOHOL SEPTAL ABLATION TO TREAT IATROGENIC LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION DURING TRANSCATHETER MITRAL VALVE REPLACEMENT
Authors: John Cyril Lisko, Patrick Gleason, Altayyeb Yousef, Stephen Clements, Vasilis Babaliaros, Stamatios Lerakis
Journal: Journal of the American College of Cardiology (2018)
IR(ME)R 2000 (ionising radiation (medical exposure) regulations 2000) theoretical training course in diagnostic radiology
Authors: Hamid Aizaz Chatha
Journal: BMJ (2009)

The IR(ME)R 2000 (ionising radiation (medical exposure) regulations 2000) theoretical training course in diagnostic radiology is run by the Radiological Protection Centre at St George’s Healthcare NHS Trust, London. This is a one day course and the emphasis is on covering the theoretical training requirements given in the IR(ME)R 2000 regulations. The course focuses on the basic physics of ionising radiation, the biological effects of radiation, the effects of fetal radiation, the regulations on protection of staff (Ionising Radiations Regulations 1999), the regulations on protection of patients (IR(ME)R 2000), patient dose, diagnostic reference levels, dose audit, occupational doses, personnel dosimetry, and dose reduction of staff and patients. The …
Pre-Hospital Paediatric Life Support (PHPLS)
Authors: Matthew O'Meara
Journal: BMJ (2007)

TOP TIPS 

Make sure you read the manual in advance. There were questions in the multiple choice exam from the manual that were not in the lectures. It also helps to read the current paediatric resuscitation guidelines before the course.

FURTHER INFORMATION 

The course is run by the British Association for Immediate Care (BASICS, www.basics.org.uk) and organised through the Advanced Life Support Group (www.alsg.org).

Healthcare professionals working in the field of prehospital care. Attendees range from paramedics and nurses to hospital trainees and …
Basic trauma course for junior doctors
Authors: Gemma Horn, Muhammad Imran Ul Haq, Faiz Sanwer
Journal: BMJ (2010)

The basic trauma course for junior doctors is run by the Education Centre at Solihull Hospital, West Midlands. The emphasis of the course is on the safe management of trauma in the initial years of training. It focuses on developing an understanding of the basic principles behind fracture biomechanics, acute bone and soft tissue injuries, and fracture fixation; learning how to plan management; and acquiring the necessary practical skills to assess trauma patients. 

The course is aimed at junior trainees who wish to pursue a career in trauma and orthopaedics or in accident and emergency and for those who deal with trauma. Most participants have passed the first part of the membership examination of the Royal College of Surgeons or the Royal College of Emergency Medicine and have more than four months’ experience in trauma and orthopaedics or accident and emergency. The candidates on my course were foundation trainees from all over the United Kingdom. …
Abstract 14960: Long-Term Survival With Implantable Cardioverter-Defibrillator in Different Symptomatic Functional Classes of Heart Failure
Authors: Yitschak Biton, Spencer Rosero, Arthur J. Moss, Wojciech Zareba, Valentina Kutyifa, Alon Barsheshet, Scott Mcnitt, Bronislava Polonsky, Ilan Goldenberg
Journal: Circulation (2016)

Background: ACC/AHA/HRS guidelines recommend implantable cardioverter-defibrillator (ICD) therapy primary prevention in all patients with severely reduced left ventricular ejection fraction (LVEF ≤...
Treat the lungs, fool the brain and appease the mind: towards holistic care of patients who suffer from chronic respiratory diseases
Authors: Thomas Similowski
Journal: European Respiratory Journal (2018)

<b>Mindfulness-based cognitive therapy can improve well-being in COPD patients beyond usual therapeutic measures: this is additional evidence for a holistic approach to chronic breathlessness</b>http://ow.ly/Dz2630irqvR
Scottish patients’ satisfaction with GPs has risen
Authors: Helen Jaques
Journal: BMJ (2012)

Patients in Scotland are more satisfied with their GP than they were two years ago but less happy with their experiences in accessing services.

A total of 90% of respondents to the 2011-12 Scottish patient experience survey of GP and local NHS services said that they had enough time with their GP and that their doctor had all the information they needed to treat them, up …
Active surveillance criteria in the age of targeted biopsies.
Authors: Jonathan Bloom, Graham R. Hale, Kareem Rayn, Samuel Gold, Vladimir Valera, Sherif Mehralivand, Brad J. Wood, Baris Turkbey, Howard L. Parnes, Peter A. Pinto
Journal: Journal of Clinical Oncology (2018)

116 Background: Many urologists are now using active surveillance (AS) to manage patients with low-risk prostate cancer. A variety of criteria have been proposed to select patients for AS. A key feature of these criteria is Gleason Group as determined by systematic or “random” biopsies (SB). In this study, we examined the progression of Gleason Group (GG) detected only on SB compared to patients with positive MRI-fusion or “targeted” biopsies (FB). Methods: A prospectively maintained database was queried for all patients who underwent an MRI guided FB and SB from 2007 to 2016 and chose AS as their primary management strategy. Patents with GG 1 or 2 were eligible. Patients were then followed with yearly PSA, exam, MRI and biopsy if warranted. FBs were reviewed to determine GG progression. We divided patients into those who had cancer detected on SB only and those who had positive FBs with or without a positive SB. Results: A total of 162 patients met our criteria with 73 having an initial positive FB and 89 having cancer only on SB and a negative FB. Median follow-up was 27.62 (4.14 – 96.56) and 33.83 (3.45-99.84) months, respectively. The two groups were similar in age (64.49 ± 6.57 vs. 62.08 ± 6.92 years, p = 0.03) and PSA (6.23 ± 4.23 vs. 5.67 ± 3.98 ng/ml, p = 0.39). The median time to pathologic progression for GG 1 patients with initial FB positive was 53.88 months and those with GG 1 on initial SB was 80.81 months (p = 0.003). The median time to pathologic progression for GG 2 patients with initial FB positive was 36.26 months and those with GG 2 on initial SB was 76.01 months (p = 0.099). Conclusions: Previously accepted AS criteria have been based on SBs. However, those patients placed on AS after a positive FB progressed fast than cancer detected only on SB. With MRI and FBs more routinely used in clinical practice, clinicians could use this information from FBs to better stratify and closely monitor patients during AS. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.
Editor’s Choice: The power of words
Authors: Tom Moberly
Journal: BMJ (2015)

Over the past 50 years many words that once had the power to shock have lost much of their impact. Outside professional life, swearing is now common, and people have grown adept at using expletives as nouns, verbs, adverbs, and adjectives. Many people also swear in the workplace, and the health sector has its fair share of those …