tbuckley/cabot-search huggingface dataset:
End of life: A focus upon making doing the right thing easier in challenging conversations.
Authors: Kathleen Dunn, Marjorie Hepler, Imran Shariff, Diane Denny, DBA, Pamela A. Crilley
Journal: Journal of Clinical Oncology (2018)

174 Background: Communication surrounding end of life decisions is difficult for patients and their loved ones as well as the clinicians involved in their care. An audit of end of life measures brought to light an area of opportunity across a national network of five geographically dispersed medical centers that resulted in a quality improvement project which sought to enhance communication processes among clinicians and patients. Methods: Utilizing principals of complexity theory, a multidisciplinary task force developed a communication tool to guide clinicians in discussions with patients and improved upon the electronic health record (EHR) to make documentation clearer, easier and more meaningful. “Words that Matter” with scenarios and suggestions for clinicians to introduce palliative care or hospice to patients were established. EHR enhancements included structured fields for hospice discussion and referral based upon network defined objective clinical criteria. A hospice referral field was also created to allow physicians to place an order along with discontinuing chemotherapy without leaving the note. Education was provided to clinicians in various formats. Implementation occurred early fall 2017. Results: Structured fields allow for easier electronic data pulls for reports to measure process improvement and communication. Outcome measures of interest include: chemotherapy administered in the last 14 days of life and timeliness of referral to hospice. Additional process metrics are in place to measure utilization of supporting resources. Conclusions: Effective communication of end of life issues and timely hospice referral is an integral part of care. Communication tools and criteria prompt our physicians to engage in discussions and refer patients earlier in their journey, when appropriate. Providing structured fields in the EHR has made documentation more complete.[Table: see text]
Real-world genetic testing patterns in metastatic colorectal cancer: Balancing adoption challenges with performance efficiency.
Authors: Adrianne Waldman Casebeer, Charron Long, Dana Angela Drzayich Jankus, Patrick Racsa, Teresa Rogstad, Bryan A. Loy, Jonas A. De Souza
Journal: Journal of Clinical Oncology (2018)

46 Background: Evaluation of real-world data regarding genetic testing for metastatic colorectal cancer (mCRC) highlights the successes and challenges of precision medicine. Guidelines recommend genetic testing to inform mCRC treatment choice. However, there is a lack of real-world evidence regarding genetic testing patterns, including adoption and efficiency. Methods: This retrospective analysis identified adult patients with newly diagnosed mCRC (2015-2106), Medicare Advantage coverage with a pharmacy benefit (MAPD), and claims evidence of CRC-related genetic testing. Inclusion required diagnosis of colon/rectal cancer on ≥2 medical claims and new metastatic disease. Paid and unpaid claims identified genetic testing, which was classified as limited RAS, extended KRAS/NRAS, limited + extended, and BRAF. Efficiency was measured as time-to-testing and time-to-treatment once testing was performed. Results: The study included 4,408 patients with mCRC and MAPD, with a median age of 72 years. Evidence of limited +/- extended testing was noted for 667 (15.1%) of patients. Of these, 78.3% initiated CRC treatment. Limited, extended, and limited + extended testing was observed for 51.7%, 4.5% and 43.8% of patients, respectively. BRAF was observed for 46.4%, 23.3% and 63.7% of patients with limited, extended, or limited + extended testing, respectively. For the 69.2% of patients tested prior to treatment, the median number of days between mCRC diagnosis and first genetic test was 6 [range: 0-31] days, with 25 [13-46] days between testing and treatment. When treatment preceded testing, the median number of days from treatment to test was 72.0 [20-251]. Of patients with &gt; 1 genetic test, most patients had all tests on the same day (96.9%) or within 7 days (97.8%) of diagnosis, with no differences by type of testing. Conclusions: Per guidelines, mCRC-related genetic testing was completed efficiently after diagnosis and prior to treatment initiation for most patients. Genetic testing rates remain low, perhaps indicating barriers to scaling precision medicine. Ongoing research to explore ways to expedite adoption of precision medicine, while maintaining its efficiency, is needed.
Mothers of Zika babies make a splash
Authors: Jacqui Thornton
Journal: BMJ (2018)

Natalie Bouges

The babies splash around happily, the mothers are joyful; here is the positive side of bringing up a child with a Zika related disability.

In 2015 the plight of pregnant women who had been infected by the Zika virus, leaving their babies with microcephaly, was reported worldwide.1 Joana Passos, a marketing executive living in Salvador, Brazil, was one of them. She says that having Gabriela, 2, was the best thing that …
Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema
Authors: Jennifer E. Thorne, Elizabeth A. Sugar, Janet T. Holbrook, Alyce E. Burke, Michael M. Altaweel, Albert T. Vitale, Nisha R. Acharya, John H. Kempen, Douglas A. Jabs
Journal: Ophthalmology (2018)
The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment
Authors: Perrine Parize, Laurent Dacheux, Florence Larrous, Hervé Bourhy
Journal: Eurosurveillance (2018)

The epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophylaxis (PEP) collected from the network of French antirabies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians' efforts to adjust rabies risk assessment to the evolution of the epidemiological situation.
Referral rates and supportive care metrics for a first-year community oncology AYA program.
Authors: Elizabeth H. Cull, John Mcalhany, Sarah B Taylor, Heather Bowers, Kerri Susko, Aniket Saha
Journal: Journal of Clinical Oncology (2018)

63 Background: Adolescent and young adult (AYA) oncology patients have a unique set of needs compared to younger and older patients that are often not addressed by primary providers in a busy clinical setting. Genetic counseling, fertility preservation, clinical trial enrollment and psychosocial support are a few of the key needs to address in this group. The AYA Cancer Program was created to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA cohort. This study examines the number of patients referred to the AYA Cancer Program in its first year and evaluates the role of the program in addressing the supportive care needs of AYA patients. Methods: The study assessed patients actively under treatment between ages 15-39 from September 1, 2016 to September 1, 2017. The number of referrals to the AYA program, participation in the AYA program, and met supportive care needs (fertility, genetics, clinical trial participation) were examined. Results: During the first year of the clinic, 63 (22%) of the 288 AYA patients seen throughout the whole institution were seen in the AYA clinic. An additional 34 (12%) patients were referred but did not come to the appointment. 192 (69%) patients were not referred. Compared to non-referred patients, AYA clinic patients were more likely to be enrolled on a clinical trial (54% vs. 18%), have a documented fertility counseling discussion (94% vs. 16%) and receive a genetics referral (69% vs. 43%). Patients that were referred to the clinic but did not come were slightly more likely than non-referred patients to be offered the above services as well but still trailed the group of patients seen in the AYA clinic. Conclusions: Patients that were seen in the AYA program were more likely to receive fertility referrals, genetic referrals and had increased clinical trial participation compared to patients that were not referred. This highlights the essential role of the AYA clinic in meeting these under addressed needs in the AYA population. [Table: see text]
Abstract 15625: Flecainide Modulates Action Potential Properties of Cardiac Sympathetic Neurons
Authors: Wen-Chin Tsai, Peng-Sheng Chen, Michael Rubart-von der Lohe
Journal: Circulation (2015)

Introduction: Sympathetic nerve activity is important in the genesis of catecholaminergic polymorphic ventricular tachycardia (CPVT). Flecainide is effective in managing patients with CPVT. Hypothesis: We hypothesize that flecainide in clinically relevant concentrations alters electrical properties of cardiac sympathetic nerves. Methods: We used the perforated-patch technique in current-clamp mode to record action potentials from single sympathetic neurons isolated from stellate and superior cervical ganglia of ∼2-month-old mice. Action potentials in response to current pulses (10 ms, 0.05 to 0.2 nA, 0.2 Hz) were acquired in control, 1, 5, 10 μM flecainide, and wash out. Results: Flecainide dose-dependently decreased action potential amplitude (in mV, medians with 25 and 75% percentiles) from 131.6 [127.0 - 138.0; control] to 131.1 [123.7 - 137.5; 1 μM], 128.9 [120.0 - 134.4; 5 μM] and 126.1 [115.9 - 132.6; 10 μM ; P &lt; 0.05 by Repeated Measures ANOVA], and upstroke dV/dt max (in V/s) from 172 [109 - 216; control] to 158 [110 - 198; 1 μM), 109 [98 - 174; 5 μM) and 92 [84 - 147; 10 μM; P &lt; 0.05]. Action potential duration at 50% repolarization was significantly prolonged at 10 μM flecainide ( P &lt; 0.05). The changes were reversible upon washout. Resting membrane potential was unaltered. The Figure shows representative action potentials for control and 10 μM flecainide. Conclusions: Flecainide-induced changes in action potential properties are compatible with inhibition of neuron-type voltage-gated Na + channels and K + channels. These actions may decrease sympathetic excitability on the heart, thus help control CPVT.
Association of Buprenorphine-Waivered Physician Supply With Buprenorphine Treatment Use and Prescription Opioid Use in Medicaid Enrollees
Authors: Hefei Wen, Jason M. Hockenberry, Harold A. Pollack
Journal: JAMA Network Open (2018)

Expanding treatment for opioid addiction has been recognized as an essential component of a comprehensive national response to the opioid epidemic. The Drug Addiction Treatment Act and its amendments attempted to improve access to treatment by involving office-based physicians in the provision of buprenorphine treatment.To estimate the association of availability of buprenorphine-waivered physicians with buprenorphine treatment use and, secondarily, with prescription opioid use among Medicaid enrollees.This economic evaluation study used state-level panel data analysis to estimate the association between the number of buprenorphine-waivered physicians and the Medicaid-covered buprenorphine prescribing rate and opioid prescribing rate among Medicaid fee-for-service and managed care enrollees throughout the United States between January 1, 2011, and December 31, 2016.Buprenorphine prescribing rate and opioid prescribing rate, measured as the number of buprenorphine prescriptions and opioid prescriptions covered by Medicaid on a quarterly basis per 1000 enrollees.The sample included 1059 quarterly observations. Two additional 100-patient-waivered physicians per 1 000 000 residents (approximately a 10% increase) were associated with an increase in the quarterly number of Medicaid-covered buprenorphine prescriptions of 0.46 (95% CI, 0.24-0.67) per 1000 enrollees and a reduction in the quarterly number of opioid prescriptions of 1.01 (95% CI, -1.87 to -0.15) per 1000 enrollees. Furthermore, 5 additional 30-patient-waivered physicians per 1 000 000 residents (approximately a 10% increase) were associated with an increase in the quarterly number of Medicaid-covered buprenorphine prescriptions of 0.37 (95% CI, 0.22-0.52) per 1000 enrollees and a reduction in the quarterly number of opioid prescriptions of 0.96 (95% CI, -1.85 to -0.07) per 1000 enrollees. A 10% increase in the number of buprenorphine-waivered physicians was associated with an approximately 10% increase in the Medicaid-covered buprenorphine prescribing rate and a 1.2% reduction in the opioid prescribing rate.Expanding capacity for buprenorphine treatment holds the potential to improve access to opioid addiction treatment, which may further reduce prescription opioid use and slow the ongoing opioid epidemic in the United States.
Label‐Free Quantification Proteomics for the Identification of Mesenchymal Stromal Cell Matrisome Inside 3D Poly(Ethylene Glycol) Hydrogels
Authors: Yannick R. Devaud, Eva Avilla‐Royo, Christian Trachsel, Jonas Grossmann, Ivan Martin, Matthias P. Lutolf, Martin Ehrbar
Journal: Advanced Healthcare Materials (2018)

Abstract Cells modulate the functional properties of their environment by depositing extracellular matrix (ECM) proteins during biological processes in vivo and in vitro. Despite the ECMs central role in tissue formation, its quantification in hydrogels like Matrigel, which have a complex materials‐inherent biopolymer composition is exceptionally challenging. Here, the use of protein‐free, synthetic poly(ethylene glycol) hydrogels enables the analysis of deposited human bone marrow mesenchymal stromal cells ECM directly harvested from fresh 3D cell cultures by a tandem mass spectrometry (LC‐MS/MS) method. In this study, it is proved that a label‐free LC‐MS/MS quantification method can selectively identify proteins deposited in 3D synthetic hydrogels following different growth factor (GF) treatments. Furthermore, it is shown that the sequence in which GFs are administered and the choice of stimuli significantly influences the number and abundance of ECM proteins. Therefore, this provides a versatile method to optimize GF treatments in synthetic hydrogel‐based regenerative medicine and tissue engineering approaches.
Annals Graphic Medicine - Excuse Me, Doctor, Just a Question …
Authors: Lucia Briatore, Ilaria Pozzi
Journal: Annals of Internal Medicine (2018)

Web Exclusives2 October 2018Annals Graphic Medicine - Excuse Me, Doctor, Just a Question …FREELucia Briatore, MD, PhD and Ilaria PozziLucia Briatore, MD, PhDASL 2 Savonese, Savona, Italy (L.B.)Search for more papers by this author and Ilaria PozziSavona, Italy (I.P.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G18-0002 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: ASL 2 Savonese, Savona, Italy (L.B.)Savona, Italy (I.P.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G18-0002.Author/Illustrator Information: Lucia Briatore, MD, PhD, is an internist and diabetologist working in ASL2 Savonese, Savona, Italy. She is interested in medical humanities. Ilaria Pozzi is a freelance illustrator in Savona, Italy. You can view her work on Facebook (facebook.com/ilapo/).Author Contributions: Conception and design: L. Briatore, I. Pozzi.Drafting of the article: I. Pozzi.Final approval of the article: L. Briatore, I. Pozzi.Written by Lucia Briatore, MD, PhD, and illustrated by Ilaria Pozzi. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 2 October 2018Volume 169, Issue 7Page: W30-W32KeywordsConflicts of interestDisclosureHealth careMedical ethics, humanities, and education ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Implications of short-term follow-up tomosynthesis mammography on downstream workup after breast conservation therapy.
Authors: Kevin Weinberger, Brittany Colosimo, Shaakir Hasan, Steven Gresswell, Sidney Anderson, Rodney E Wegner, Mark G. Trombetta
Journal: Journal of Clinical Oncology (2018)

311 Background: We previously reported that premature (less than 6 months) follow-up screening mammography after radiotherapy in breast conservation therapy was associated with an increased rate of unnecessary downstream workup. We now present the results of a similar study conducted with follow-up tomosynthesis mammogram (TS). Methods: Between the years 2015-2017, 143 consecutive breast cancer patients between ages 33 – 82 were treated with lumpectomy and adjuvant radiotherapy with follow-up TS and reviewed in this IRB-approved study. Cases were stratified by time interval until the first post-radiation TS, and secondarily by radiation technique: conventional fractionation (n = 84), hypofractionation (n = 59), boost (n = 116), no boost (n = 27), and accelerated partial breast irradiation (n = 10). The primary endpoint was the rate of further imaging/workup following TS, correlated with clinical, treatment, and post-treatment timing related variables using multivariable binomial regression analysis. Results: The patient cohort included the following clinical characteristics: 6 patients with ductal carcinoma in-situ (the remaining demonstrated either invasive ductal or invasive lobular histology), Ninety-seven patients had stage T1 lesions, 34 had T2, and 4 had T3/T4 lesions. Eighteen patients were node+, 95 ER+/ Her2-, 13 were triple negative, and 13 triple positive. No patients had clinical suspicion of recurrence before their first follow-up TS. Conclusions: Unlike with post-treatment screening two-dimensional mammography, there was no association with post-treatment tomosynthesis timing and downstream workup. Further study should be considered to confirm these preliminary findings.
Radioguided Surgery With Gallium 68 Dotatate for Patients With Neuroendocrine Tumors
Authors: Mustapha El Lakis, Andreas Gianakou, Pavel Nockel, Douglas Wiseman, Amit Tirosh, Martha A. Quezado, Dhaval Patel, Naris Nilubol, Karel Pacak, Samira M. Sadowski, Electron Kebebew
Journal: JAMA Surgery (2018)

Neuroendocrine tumors (NETs) express somatostatin receptors, which can be targeted with radiolabeled peptides. In a variety of solid tumors, radioguided surgery (RGS) has been used to guide surgical resection. Gallium 68 (68Ga) dota peptides have been shown to be more accurate than other radioisotopes for detecting NETs. A pilot study previously demonstrated the feasibility and safety of 68Ga-dotatate RGS for patients with NETs.To evaluate what intraoperative techniques and thresholds define positive lesions that warrant resection during 68Ga-dotatate RGS.This prospective cohort study, conducted between October 23, 2013, and February 14, 2018, included 44 patients with NETs who underwent 68Ga-dotatate RGS.Gallium 68-dotatate RGS.The in vivo and ex vivo tumor to background ratio (TBR) was assessed for resected lesions and correlated with the histopathologic findings.Forty-four patients (22 women and 22 men; mean [SD] age, 51.0 [13.7] years) had 133 lesions detected on preoperative imaging scans, with a diagnosis of a pancreatic NET (19 of 44 [43%]), gastrointestinal NET (22 of 44 [50%]), and pheochromocytoma or paraganglioma (3 of 44 [7%]). The TBR was obtained by normalizing to the omentum (106 of 133 [79.7%]) or other solid organs (27 of 133 [20.3%]). The omentum had a significantly lower mean (SD) count than other solid organs for background count activity 3 hours after injection (22.1 [17.0] vs 34.5 [39.0]; P < .001). The lesions containing NETs had a higher TBR than those that did not contain NETs (18.9 vs 4.4; P < .001). On a receiver operating characteristic curve analysis, a TBR of 2.5 had a sensitivity of 90% and a specificity of 25%, and a TBR of 16 had a sensitivity of 54% and a specificity of 81%.A TBR of 2.5 or greater is a highly sensitive threshold for indicating a lesion to be consistent with a NET on histologic findings and thus warranting surgical resection. The omentum should be used as the background count activity for 68Ga-dotatate RGS for patients with abdominal NETs.
<i>Akkermansia muciniphila</i> strain ATCC BAA-835 does not promote short-term intestinal inflammation in gnotobiotic interleukin-10-deficient mice
Authors: Christiane Ring, Robert Klopfleisch, Katja Dahlke, Marijana Basic, André Bleich, Michael Blaut
Journal: Gut Microbes (2018)

Akkermansia muciniphila is a common member of the intestinal microbiota of healthy human individuals. Its abundance is negatively associated with inflammatory bowel disease and metabolic disorders and the oral administration of A. muciniphila improves the symptoms of metabolic disease in mice. Therefore, A. muciniphila is a promising candidate for the treatment of type-2 diabetes and obesity. However, some studies using animal models of intestinal inflammation reported that A. muciniphila may exacerbate gut inflammation. Because of these contradictory reports the present study aimed to clarify the role of A. muciniphila in the development of intestinal inflammation and the conditions promoting it. For this purpose, the short-term colitogenic potential of A. muciniphila strain ATCC BAA-835 was investigated in colitis-prone, gnotobiotic IL-10-deficient (Il10-/-) mice. Il10-/- mice mono-associated with A. muciniphila showed no signs of intestinal inflammation based on body-weight change, histopathological scoring and inflammatory markers. Additional association of the mice with the colitogenic Escherichia coli strain NC101 led to cecal but not colonic inflammation. However, the severity of the inflammation did not exceed that observed in mice mono-associated with E. coli NC101. Il10-/- mice colonized with a simplified human intestinal microbiota showed increased histopathology, but no increase in inflammatory markers. Furthermore, co-colonization with A. muciniphila did not modify histopathology. The turnover of intestinal mucus was similar in all groups despite the mucus-degrading property of A. muciniphila. Overall, the data do not support a short-term pro-inflammatory effect of A. muciniphila strain ATCC BAA-835 in the Il10-/- mouse model for inflammatory bowel disease.