tbuckley/cabot-search huggingface dataset:
Reducing opioid utilization after urologic oncology surgery.
Authors: Kerri Stevenson, Jessica Kee, Elizna Van Zyl, Anisia Dugala, Jay Bakul Shah
Journal: Journal of Clinical Oncology (2018)

269 Background: Multiple sources have reported on widespread abuse of opioid pain medications among Americans. For many patients, the first encounter with these addictive substances happens when they are prescribed opioids for acute pain management after surgery. Unfortunately, 6% of opioid-naïve patients become newly addicted to opioid medications after surgery. As a high-volume surgical department, we aimed to reduce our reliance on opioid medications to manage post-operative pain by 50% from a baseline morphine equivalent daily dose (MEDD) of 95.1 to a target of 47.5 MEDD. Methods: We retrospectively reviewed daily opioid use, pain scores, and anxiety scores for inpatients recovering from surgery for urologic cancers at our institution over 4 months. We generated process maps, Ishikawa diagrams, and Pareto charts to identify causes contributing to excess opioid use. We designed opioid-sparing pain regimens (using varying combinations of acetaminophen, ketorolac, gabapentin, and local anesthetic) and we identified key drivers required to reliably decrease excess opioid use. Initial interventions were aimed at educating providers and nurses on availability and efficacy of non-opioid medications and later interventions sought to facilitate adoption of the novel pathways. Results: Over the course of this QI project involving 443 patients, the median opioid use per patient decreased 46% from 95.1 to 51.5 MEDD. This reduction in opioid requirements after implementation was successfully achieved across multiple surgery types ranging from robotic prostatectomy (55.1 MEDD) to open radical cystectomy (50.6 MEDD). There was no increase in 24- or 48-hour post-operative pain score associated with use of opioid-minimizing pathways (3.03 vs. 3.04 and 2.92 vs. 2.96, respectively; p &gt; 0.05 for both). Similarly, there was no change in anxiety score at 24- or 48-hours after surgery (0.15 vs. 0.12 and 0.48 vs. 0.30, respectively; p &gt; 0.05 for both). Conclusions: We decreased opioid use after surgery by 46% without compromising pain control. In the nationwide effort to combat the opioid epidemic, health care providers can play a pivotal role as gatekeepers by decreasing reliance on opioids in the post-operative period.
Use of a Wearable Activity Monitor in a Home-Based Exercise Intervention for Peripheral Artery Disease—Reply
Authors: Mary M. McDermott, Bonnie Spring, Diane Treat-Jacobson
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Impact of Visit-to-Visit Fasting Plasma Glucose Variability on the Development of Type 2 Diabetes: A Nationwide Population-Based Cohort Study
Authors: Jung A. Kim, Ji Sung Lee, Hye Soo Chung, Eun Roh, You-Bin Lee, So-hyeon Hong, Nam Hoon Kim, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi
Journal: Diabetes Care (2018)

OBJECTIVE Although increasing evidence suggests the association between short-term variability of fasting plasma glucose (FPG) and diabetic complications or mortality, the impact of visit-to-visit variability of FPG on the development of type 2 diabetes (T2D) has not been evaluated. RESEARCH DESIGN AND METHODS Our analysis included 131,744 Korean men and women without diabetes using the Korean National Health Insurance System cohort with periodic health examination program. FPG variability was calculated using the coefficient of variation (FPG-CV), SD (FPG-SD), and variability independent of the mean (FPG-VIM). RESULTS During the median follow-up time of 8.3 years, Kaplan-Meier curves demonstrated lower disease-free probability in the higher FPG variability group compared with the lower FPG variability group. Multivariable Cox proportional hazards analysis exhibited that the hazard ratio for incident T2D was 1.67 (95% CI 1.58–1.77, P &amp;lt; 0.001) in the highest quartile of FPG-CV compared with the lowest quartile of FPG-CV after adjusting for confounding variables, including mean FPG. The association between FPG variability and the risk of T2D was consistent when modeling using FPG-SD and FPG-VIM in both normal and impaired fasting glucose groups. A 1 SD increase in the FPG-CV was associated with a 24% increased risk of T2D in the fully adjusted model. CONCLUSIONS Increased variability of FPG is associated with the development of T2D independently of diverse risk factors.
Clinical evidence guidelines in systemic lupus erythematosus: revaluation
Authors: Morton Scheinberg
Journal: Annals of the Rheumatic Diseases (2018)

Clinical evidence guidelines in systemic lupus erythematosus: revaluationThe paper on the First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus (SLE) points to some conclusions that need to be further clarified since the bulk of evidence points to a different direction. 1Belimumab safety and efficacy has been well documented since its approval during the last 5 years, and in particular the skin and joint domains appear to have a preferential site of major clinical improvement associated with reduction of flares and steroid tapering. 2However, the authors when placing the best available evidence of therapy for those domains group belimumab with methotrexate and leflunomide for joint manifestations and indicates superiority favouring methotrexate.For the mucocutaneous manifestations, belimumab is grouped with methotrexate, azathioprine, mycophenolate, cyclosporine and cyclophosphamide, and due to cost and availability, recommendation favours methotrexate and azathioprine.We feel that this degree of recommendation fails to overview the best medical literature published in the past few years pointing to the superiority of belimumab in improving joint and skin disease when compared with other domains, allowing maintenance of steroid sparing and decrease of adverse events by continuous use of daily steroids also reducing the use of immunosuppressive drugs. 3 4The authors should explain how that conclusion could be reached even when cost issues are raised since there is well-published literature pointing to benefits of belimumab in the long run for several social services when compared with cheaper immunosuppressive drugs that do not reduce steroid intake and lead to increased adverse events and opportunistic infections. 5The upcoming opportunity to use the subcutaneous route of administration will certainly create additional opportunities for patients with SLE with active disease that could benefit from add-on existing therapies 6 The recent questioning of expert consensus on expert consensus addresses this approach properly and indicates that, although nice, it is not necessarily relevant to accuracy.
Determinants of in-hospital antibiotic prescription behaviour: a systematic review and formation of a comprehensive framework
Authors: E.B. Warreman, M.M.C. Lambregts, R.H.P. Wouters, L.G. Visser, H. Staats, E. van Dijk, M.G.J. de Boer
Journal: Clinical Microbiology and Infection (2018)
Conflicts of interest disclosure forms and management in critical care clinical practice guidelines
Authors: Waleed Alhazzani, Kimberley Lewis, Roman Jaeschke, Bram Rochwerg, Morten Hylander Møller, Laura Evans, Kevin C. Wilson, Sheena Patel, Craig M. Coopersmith, Maurizio Cecconi, Gordon Guyatt, Elie A. Akl
Journal: Intensive Care Medicine (2018)
Mitigating risk of preventable medical errors across a network through event sharing.
Authors: Diane Denny, DBA, Caitlyn Shinners
Journal: Journal of Clinical Oncology (2018)

234 Background: Medical errors are the 4 th leading cause of death in the US. Oncology providers are not immune to preventable medical errors occurring in the treatment of their patients. As a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer, clinicians and quality professionals recognized an opportunity to encourage and formalize the process of sharing safety events, lessons learned, and action plans to mitigate the risk of repeat occurrence. Methods: An Alert Notification process was established consisting of an algorithm depicting two avenues for action when an event occurs. If the event is considered urgent, characterized by immediate high-risk of repeat occurrence or high-risk of severe harm, an alert is called. The hospital nursing officers and quality directors along with the corporate director of pharmacy and vice president of quality/safety convene within 24 hours of the event to: 1) resolve or “halt” the process; 2) escalate if needed; and 3) formulate a communication plan regarding any change in process. If the event does not meet urgent criteria, the hospital conducts a root cause analysis (RCA) or common cause analysis, depending upon the algorithm. A summary of RCAs conducted for events resulting in temporary or permanent severe harm or worse are presented at the network’s monthly safety meeting, with action plans implemented across sites. Results: The notification algorithm was implemented in September 2017. Since its inception, three events have been communicated using the Urgent Alert Notification, including a syringe recall that halted use at all sites until all lot numbers could be checked, and affected syringes pulled. Several events and near misses have been communicated using the non-urgent process, including for example, discussion of a retained foreign object which resulted in review of processes for orienting staff to new products. Conclusions: The process has promoted communication across the five centers as an error prevention strategy. The sharing allows all sites to cross-fertilize resolutions to minimize rework, reduce the risk of repeat events, and build collective knowledge ensuring patient safety is our first commitment.
Genome-Wide Temporal Profiling of Transcriptome and Open Chromatin of Early Cardiomyocyte Differentiation Derived From hiPSCs and hESCs
Authors: Qing Liu, Chao Jiang, Jin Xu, Ming-Tao Zhao, Kevin Van Bortle, Xun Cheng, Guangwen Wang, Howard Y. Chang, Joseph C. Wu, Michael P. Snyder
Journal: Circulation Research (2017)

Rationale: Recent advances have improved our ability to generate cardiomyocytes from human induced pluripotent stem cells (hiPSCs) and human embryonic stem cells (hESCs). However, our understanding of the transcriptional regulatory networks underlying early stages (ie, from mesoderm to cardiac mesoderm) of cardiomyocyte differentiation remains limited. Objective: To characterize transcriptome and chromatin accessibility during early cardiomyocyte differentiation from hiPSCs and hESCs. Methods and Results: We profiled the temporal changes in transcriptome and chromatin accessibility at genome-wide levels during cardiomyocyte differentiation derived from 2 hiPSC lines and 2 hESC lines at 4 stages: pluripotent stem cells, mesoderm, cardiac mesoderm, and differentiated cardiomyocytes. Overall, RNA sequencing analysis revealed that transcriptomes during early cardiomyocyte differentiation were highly concordant between hiPSCs and hESCs, and clustering of 4 cell lines within each time point demonstrated that changes in genome-wide chromatin accessibility were similar across hiPSC and hESC cell lines. Weighted gene co-expression network analysis (WGCNA) identified several modules that were strongly correlated with different stages of cardiomyocyte differentiation. Several novel genes were identified with high weighted connectivity within modules and exhibited coexpression patterns with other genes, including noncoding RNA LINC01124 and uncharacterized RNA AK127400 in the module related to the mesoderm stage; E-box-binding homeobox 1 ( ZEB1 ) in the module correlated with postcardiac mesoderm. We further demonstrated that ZEB1 is required for early cardiomyocyte differentiation. In addition, based on integrative analysis of both WGCNA and transcription factor motif enrichment analysis, we determined numerous transcription factors likely to play important roles at different stages during cardiomyocyte differentiation, such as T and eomesodermin ( EOMES ; mesoderm), lymphoid enhancer-binding factor 1 ( LEF1 ) and mesoderm posterior BHLH transcription factor 1 ( MESP1 ; from mesoderm to cardiac mesoderm), meis homeobox 1 ( MEIS1 ) and GATA-binding protein 4 ( GATA4 ) (postcardiac mesoderm), JUN and FOS families, and MEIS2 (cardiomyocyte). Conclusions: Both hiPSCs and hESCs share similar transcriptional regulatory mechanisms underlying early cardiac differentiation, and our results have revealed transcriptional regulatory networks and new factors (eg, ZEB1) controlling early stages of cardiomyocyte differentiation.
Monocyte and macrophage phenotypes: a look beyond systemic sclerosis. Response to: 'M1/M2 polarisation state of M-CSF blood-derived macrophages in systemic sclerosis' by Lescoat <i>et al</i>
Authors: Maurizio Cutolo, Amelia Chiara Trombetta, Stefano Soldano
Journal: Annals of the Rheumatic Diseases (2018)

We read with interest the new data from Lescoat et al and their interesting comments concerning our research letter on the identification of circulating cells coexpressing M1 and M2 phenotype markers in patients affected by systemic sclerosis (SSc) compared with healthy subjects (HSs).1 2 

In their study, Lescoat et al evaluated the mean of fluorescence intensity of specific markers of M1 and M2 phenotypes (CD80, CD206, CD204, CD163, CD169 and CD200R1) in macrophage colony-stimulating factor (M-CSF) resting blood monocyte-derived-macrophages (MDMs) from HSs exposed to in vitro stimuli aiming to polarise them towards the M1, M2a and M2c phenotypes. The markers were also evaluated on the cell surface of the MDMs obtained from 11 to 16 SSc patients not treated with glucocorticoids and compared with those obtained from 13 HSs.1 The important conclusion highlighted is cultured circulating MDMs from patients with SSc showcells with a mixed M1/M2 signature, supporting our results.2 

We will soon be able to complement …
The probacterial effect of type I interferon signaling requires its own negative regulator USP18
Authors: Namir Shaabani, Nadine Honke, Nhan Nguyen, Zhe Huang, Kei-ichiro Arimoto, Daniel Lazar, Taylor K. Loe, Karl S. Lang, Marco Prinz, Klaus-Peter Knobeloch, Dong-Er Zhang, John R. Teijaro
Journal: Science Immunology (2018)

USP18 acts as a key effector molecule downstream of IFN-I signaling to promote primary and secondary bacterial infections.
<i>Clostridioides difficile</i> Infection
Authors: Alice Y. Guh, Preeta K. Kutty
Journal: Annals of Internal Medicine (2018)

Clostridioides difficile (formerly Clostridium difficile) infection is the most frequently identified health care–associated infection in the United States. C difficile has also emerged as a cause of community-associated diarrhea, resulting in increased incidence of community-associated infection. Clinical illness ranges in severity from mild diarrhea to fulminant colitis and death. Appropriate management of infection requires understanding of the various diagnostic assays and therapeutic options as well as relevant measures to infection prevention. This article provides updated recommendations regarding the prevention, diagnosis, and treatment of incident and recurrent C difficile infection.
Abstract 17575: Looking Beyond Left Ventricular Ejection Fraction: Investigating the Utility of Multi-factorial Computational Modeling to Predict Sudden Cardiac Death Following Acute Coronary Syndrome in the MERLIN-TIMI36 Trial
Authors: Alex Van Esbroeck, Mohammed Saeed, Benjamin M Scirica, Collin M Stultz, John V Guttag, Satinder Singh, David A Morrow, Zeeshan Syed
Journal: Circulation (2015)

Introduction: Guidelines to prevent sudden cardiac death (SCD) following acute coronary syndrome (ACS) are widely based on cutoffs defined on left ventricular ejection fraction (LVEF) with limited use of other available data. Methods: We investigated the improvement in predicting post-ACS SCD using a multi-factorial model that integrates an assessment of left ventricular dysfunction through echocardiography with a broader set of other parameters collected routinely during hospitalization for ACS. Patients in the MERLIN-TIMI36 trial were admitted within 48 hours of ischemic symptoms for non-ST-elevation ACS and followed for a median of 348 days. SCD was adjudicated by a blinded clinical events committee. Data from 4,404 patients with LVEF and other clinical parameters routinely collected during index hospitalization (demographic, comorbidity, history, laboratory, electrocardiographic, and medication variables) were used to train and validate a logistic regression model to predict SCD using stepwise backward elimination and leave-one-out cross-validation. Results: The stepwise elimination process retained age, history of congestive heart failure, ST depression, beta blocker use, BNP, LVEF, and ischemia and ventricular tachycardia on continuous ECG as variables in the model. The model achieved significant improvements in discrimination, calibration and reclassification relative to LVEF, and demonstrated further utility in stratifying patients with mild/moderate left ventricular dysfunction or normal systolic function (Table 1). The model also resulted in higher sensitivity without increasing false positives relative to the LVEF&lt;=30% rule (38% increase in correct predictions of SCD). Conclusions: Risk stratification for post-ACS SCD is significantly improved using multi-factorial models to integrate information in LVEF with other clinical parameters routinely collected during hospitalization.
Nature of T cell epitopes in lupus antigens and HLA-DR determines autoantibody initiation and diversification
Authors: Zhenhuan Zhao, Jiling Ren, Chao Dai, Carol C Kannapell, Hongyang Wang, Felicia Gaskin, Shu Man Fu
Journal: Annals of the Rheumatic Diseases (2018)

Objectives The generation of systemic lupus erythematosus (SLE)-related autoantibodies have been shown to be T cell dependent and antigen driven with HLA-DR restriction. In this study, the initiating antigen(s) and the mechanism of autoantibody diversification were investigated. Methods T cell epitopes (T-epitopes) of SmD1 (SmD) were mapped by T-T hybridomas generated from DR3 + AE 0 mice immunised with SmD and with SmD overlapping peptides. TCRs from the reactive hybridomas were sequenced. The core epitopes were determined. Bacterial mimics were identified by bioinformatics. Sera from DR3 + AE 0 mice immunised with SmD peptides and their mimics were analysed for their reactivity by ELISA and immunohistochemistry. Samples of blood donors were analysed for HLA-DR and autoantibody specificities. Results Multiple HLA-DR3 restricted T-epitopes within SmD were identified. Many T-T hybridomas reacted with more than one epitope. Some of them were cross-reactive with other snRNP peptides and with proteins in the Ro60/La/Ro52 complex. The reactive hybridomas used unique TCRs. Multiple T-epitope mimics were identified in commensal and environmental bacteria. Certain bacterial mimics shared both T and B cell epitopes with the related SmD peptide. Bacterial mimics induced autoantibodies to lupus-related antigens and to different tissues. HLA-DR3 + blood donors made significantly more SLE-related autoantibodies. Conclusions The unique antigenic structures of the lupus-related autoantigens provide the basis for being targeted and for T and B cell epitope spreading and autoantibody diversification with unique patterns. SLE-related autoantibodies are likely generated from responses to commensal and/or environmental microbes due to incomplete negative selection for autoreactive T cells. The production of SLE-related antibodies is inevitable in normal individuals. The findings in this investigation have significant implications in autoimmunity in general.
Quality of care during active surveillance in low-risk prostate cancer patients: A population-based approach.
Authors: Narhari Timilshina, Antonio Finelli, George A. Tomlinson, Beate Sander, Shabbir M.H. Alibhai
Journal: Journal of Clinical Oncology (2018)

16 Background: Active surveillance (AS) has become a widely accepted management strategy for low-risk (Gleason score ≤6) prostate cancer (PC). Given the large proportion of low-risk PC (60-90%) patients who currently receive AS, adherence to clinical guidelines on AS and variations in care at the population level remain surprisingly poorly understood. Further, it is presently unclear how often patients receive high quality AS care in community settings (almost all published data come from academic centers), yet the majority of AS occurs in community settings. Thus, there is significant interest in developing system-level quality indicators (QIs). We sought to develop structure-process-outcome-based QIs to enable benchmarking during AS follow-up using data available in Canadian administrative databases. Methods: We performed a detailed literature search on QIs in PC as well as broader theoretical concepts on QIs and consulted with clinical leaders from a major cancer centre. Current guidelines on AS and potential quality indicators were identified from a literature search. AS-specific QIs were tested among low-risk PC who were managed with AS between 2002-2011 using population-level cancer registry databases. We assessed adherence to clinical guidelines using QIs, and compared with health care system-related characteristics. Results: 25 indicators were proposed [structure of care (n = 5), process of care (n = 16) and health outcomes (n = 4)]. Overall 39% received AS, with 88% managed by a urologist. Only 43% of low volume (≤3 positive cores) patients underwent AS. Adherence of confirmatory biopsy with guidelines was performed on only 32% of patients, and adherence was better in higher volume institutions, among higher volume physicians, and in cancer centers. 5-and 10-year PC specific survival were significantly better among high volume physicians. Conclusions: We have proposed a set of QIs for measuring AS care. Initial data show that higher volume institution or higher volume physician and cancer center had better adherence to quality of AS care. Long term survival was better among patients treated by high volume physicians. Further validation of these QIs is ongoing.
PET/CT Imaging for Solitary Primary Bone Lymphoma of Thoracic Vertebra
Authors: Guohua Shen, Minggang Su, Bin Liu, Anren Kuang
Journal: Clinical Nuclear Medicine (2018)

Primary bone lymphoma without classic nodal lesions or advanced disease may be mistaken for other osseous diseases, especially when involving a single bone site. In this patient, a series of imaging modalities including MRI, bone scan, and F-FDG PET/CT revealed only 1 solitary osseous lytic lesion with abnormal uptake in the third thoracic vertebra, suggesting a primary skeletal malignancy. The subsequent histopathologic examination confirmed the diagnosis of diffuse large B-cell lymphoma. After chemotherapy, he achieved an excellent clinical and metabolic response.