tbuckley/cabot-search huggingface dataset:
Cancer burden: Exploring the parallels between cancer hardship and the well-being of cancer caregivers.
Authors: Martha Raymond
Journal: Journal of Clinical Oncology (2018)

162 Background: The latest 2016 data from the National Cancer Institute’s Surveillance, Epidemiology &amp; End Results (SEER) Program estimates there are 15.5 million cancer survivors in the U.S. Millions of cancer survivors rely on cancer caregivers every day. Cancer caregivers play a vital role throughout the care continuum, and greatly impact a patient’s quality of life. Caring for a cancer patient affects all aspects of a caregiver’s life, including: changes to daily routine, work and family life; financial hardship; and emotional and psychological distress. Our study explores the cancer burden, unmet needs and well-being of cancer caregivers. Methods: Beginning in September 2015-September 2017, our professional facilitator with over 25 years of cancer advocacy experience hosted nationwide caregiver focus groups. Primary goals were reaching caregivers in rural, urban and community oncology settings to gain perspective from diverse populations. We met with cancer caregivers in 32 states via traditional focus group settings and online via facetime conferencing. Results: 778 caregivers (42% male, 58% female) participated in our focus groups. 88% reported high levels of stress and anxiety (I struggle to concentrate &amp; walk around feeling like I was kicked in the stomach); 78% were employed full time with an average of an additional 20+ hours per week devoted to caregiving responsibilities (Pulled in every direction – need balance); 66% reported self-health decline (No time for me – worry I will get sick and then what?) Describing in one word their current feelings, the top three responses were: Exhausted; Lonely; Overwhelmed. Conclusions: The burden of caring for a cancer patient is immense and all-consuming. Our conversations with caregivers will continue as we collaborate with partners, develop meaningful programs, and expand our outreach and resources to help lessen the burdens of cancer on caregivers.
Study Lays Foundation for TB Vaccine
Authors: Anita Slomski
Journal: JAMA (2018)

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Image-guided biopsy of non-palpable breast lesions: Experience of a university hospital in Mexico City.
Authors: Daniela Morales-Espinosa, Lilian Monica Navarro-Garcia, Dan Green, Daniel Motola, Gabriela Alvarado-luna, Ruben Cortes-Gonzalez
Journal: Journal of Clinical Oncology (2012)

e11098 Background: Breast cancer is the most common cancer in women in Mexico. It is mostly diagnosed at advanced stages. Objective: To describe the experience of image-guided biopsies of non-palpable breast tumors in a University Hospital in Mexico City. Methods: Medical records from the Radiology and Oncology Department (January 2007 - April 2011) were reviewed. Patients with incomplete medical records as well as those lacking imaging control and pathology report were excluded. Results: A total of 123 medical records were obtained,12 were excluded. The median age was 50 years (rank 21-88). Most patients were asymptomatic. Medical indications leading to biopsy: see table below. Of the studied population, 56% had a family history of any type of cancer; 40% had a family history of breast cancer. Nine patients had a past medical history positive for breast cancer, 8 patients had a past medical history of any type of cancer. 26 patients were nulligravid and 60 post-menopausal; of which 27 had received hormone replacement therapy. 24 patients had positive contraceptive use. Most patients were catalogued as BIRADs 4A. From all the imaged-marked lesions, only 18 were malignant; 72% of which were carcinoma in situ. Most procedures were ambulatory; only 15 patients had to be admitted. The complications rate was very low (6%), 1 procedure-related infection, 3 seromas and 3 hematomas. Conclusions: Imaging-guided biopsies are a safe, with very low morbidity, accessible procedure. It helps to prompt effective treatment; especially in patients with non-palpable lesions who would otherwise not be diagnosed until advanced stages. [Table: see text]
Sex difference of mutation clonality in diffuse glioma evolution
Authors: Hongyi Zhang, Jianlong Liao, Xinxin Zhang, Erjie Zhao, Xin Liang, Shangyi Luo, Jian Shi, Fulong Yu, Jinyuan Xu, Weitao Shen, Yixue Li, Yun Xiao, Xia Li
Journal: Neuro-Oncology (2018)

Sex differences in glioma incidence and outcome have been previously reported but remain poorly understood. Many sex differences that affect the cancer risk were thought to be associated with cancer evolution. In this study, we used an integrated framework to infer the timing and clonal status of mutations in ~600 diffuse gliomas from The Cancer Genome Atlas (TCGA) including glioblastomas (GBMs) and low-grade gliomas (LGGs), and investigated the sex difference of mutation clonality. We observed higher overall and subclonal mutation burden in female patients with different grades of gliomas, which could be largely explained by the mutations of the X chromosome. Some well-established drivers were identified showing sex-biased clonality, such as CDH18 and ATRX. Focusing on glioma subtypes, we further found a higher subclonal mutation burden in females than males in the majority of glioma subtypes, and observed opposite clonal tendency of several drivers between male and female patients in a specific subtype. Moreover, analysis of clinically actionable genes revealed that mutations in genes of the mitogen-activated protein kinase (MAPK) signaling pathway were more likely to be clonal in female patients with GBM, whereas mutations in genes involved in the receptor tyrosine kinase signaling pathway were more likely to be clonal in male patients with LGG. The patients with diffuse glioma showed sex-biased mutation clonality (eg, different subclonal mutation number and different clonal tendency of cancer genes), highlighting the need to consider sex as an important variable for improving glioma therapy and clinical care.
Thread-assisted mucosal defect closure using the locking-clip technique after gastric endoscopic submucosal dissection
Authors: Tatsuma Nomura, Akira Kamei, Shinya Sugimoto, Tetsuro Harada, Jun Oyamda
Journal: Endoscopy (2018)

Methods of closing mucosal defects after gastric endoscopic submucosal dissection (ESD) have been reported [1] [2] [3]. However, closing large mucosal defects in the stomach is considered difficult compared with other parts of the intestinal tract because the submucosal layer is thick [4]. We designed the thread-assisted closure method using a locking-clip technique (LCT) for closing mucosal defects.
Future Directions in Vascular and Interventional Radiology
Authors: Antoinette Gomes
Journal: Circulation (2013)

The field of vascular interventional radiology remains a fertile area of development for minimally invasive techniques to diagnose and treat vascular disease. Innovative scientists and physicians actively collaborate to develop new treatment paradigms and to refine and enhance previously developed methodology. Exciting new areas of activity, including sympathetic renal denervation for the management of refractory hypertension, the application of nanotechnology and stem cells to stent development, and new balloon catheters, will be described. Some of the organizational and scientific challenges to the development and implementation of these novel techniques will also be addressed.
Cochrane board confirms dismissal of director at appeal
Authors: Nigel Hawkes
Journal: BMJ (2018)

The board of Cochrane has voted to confirm the dismissal of Peter Gotzsche from all his roles in the organisation. The decision means that he ceases to be a member of Cochrane, director of the Nordic Cochrane Centre, and a member of the board, to which he was elected in 2017.

He had been removed from the board at an earlier meeting,1 but as was his right he had appealed against the decision. This appeal was always likely to be rejected, as four of his supporters had resigned from the board,1 leaving only those who had originally voted in favour of sacking him.

The statement issued by the …
Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.
Authors: Guadalupe R. Palos, Maria Alma Rodriguez, Paula A. Lewis-Patterson, Rachel Harris, Lewis E. Foxhall
Journal: Journal of Clinical Oncology (2018)

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.
A Designer Cross-reactive DNA Immunotherapeutic Vaccine that Targets Multiple MAGE-A Family Members Simultaneously for Cancer Therapy
Authors: Elizabeth K. Duperret, Shujing Liu, Megan Paik, Aspen Trautz, Regina Stoltz, Xiaoming Liu, Kan Ze, Alfredo Perales-Puchalt, Charles Reed, Jian Yan, Xiaowei Xu, David B. Weiner
Journal: Clinical Cancer Research (2018)

Cancer/testis antigens have emerged as attractive targets for cancer immunotherapy. Clinical studies have targeted MAGE-A3, a prototype antigen that is a member of the MAGE-A family of antigens, in melanoma and lung carcinoma. However, these studies have not yet had a significant impact due to poor CD8+ T-cell immunogenicity, platform toxicity, or perhaps limited target antigen availability. In this study, we develop an improved MAGE-A immunogen with cross-reactivity to multiple family members.In this study, we analyzed MAGE-A expression in The Cancer Genome Atlas and observed that many patients express multiple MAGE-A isoforms, not limited to MAGE-A3, simultaneously in diverse tumors. On the basis of this, we designed an optimized consensus MAGE-A DNA vaccine capable of cross-reacting with many MAGE-A isoforms, and tested immunogenicity and antitumor activity of this vaccine in a relevant autochthonous melanoma model.Immunization of this MAGE-A vaccine by electroporation in C57Bl/6 mice generated robust IFNγ and TNFα CD8+ T-cell responses as well as cytotoxic CD107a/IFNγ/T-bet triple-positive responses against multiple isoforms. Furthermore, this MAGE-A DNA immunogen generated a cross-reactive immune response in 14 of 15 genetically diverse, outbred mice. We tested the antitumor activity of this MAGE-A DNA vaccine in Tyr::CreER;BRAFCa/+;Ptenlox/lox transgenic mice that develop melanoma upon tamoxifen induction. The MAGE-A DNA therapeutic vaccine significantly slowed tumor growth and doubled median mouse survival.These results support the clinical use of consensus MAGE-A immunogens with the capacity to target multiple MAGE-A family members to prevent tumor immune escape.
Abstract P135: Predictors of Physical Activity Among African American Parents of Young Children: Personal and Environmental Factors
Authors: Kashica J Webber-Ritchey, Lois J Loescher, Ruth Taylor-Piliae
Journal: Circulation (2016)

Introduction: Regular physical activity (PA) is associated with decreased risk of cardiovascular disease (CVD). Prior research efforts to increase PA among African Americans (AAs) have not been effective in achieving recommended levels. Understanding factors that influence PA using a theory-based approach is needed. Methods: Cross-sectional study using social cognitive theory as the framework. Data were collected using an online survey from 96 AA parents of young children aged 6-12 years, living in Chicago, IL (average age=36 years, 59% women, 72% college-educated, 60% annual income&gt;$75,999) to describe PA ( International Physical Activity Questionnaire-short form, IPAQ-S ), personal ( PA Knowledge, Exercise Self-Efficacy-ESE and Outcome Expectations-OE ) and environmental factors (social economic status- MacArthur Subjective Social Status, neighborhood safety -Physical Activity Neighborhood Environmental Scale, and culture -African American Acculturation Scale ). Spearman’s rho (r s ) identified associations among PA, personal and environmental factors. Simultaneous multiple regression (all variables entered) was used to determine potential predictors of PA. Results: Moderate (30%, n=29) to high (54%, n=52) levels of PA were reported. There were significant correlations between PA and neighborhood safety (r s =.25), PA knowledge and culture (r s =-.30), ESE and culture (r s =.30), and OE and social economic status (r s =.24) (all values p&lt;.05). Overall, personal and environmental factors accounted for 33% of the variance in PA (F 11, 84 = 3.73, p&lt; .001). Significant predictors of PA included ESE (β=.21, t(84)=2.20, p=.030), neighborhood safety (β=.33, t(84)=3.56, p=.001), and an unexpected inverse of PA knowledge (β=-.25, t(84)=-2.42, p=.018). Conclusions: Unlike prior studies, we found AA parents of young children were physically active, knowledgeable of the PA guidelines, with moderate-high ESE, high social economic status, felt safe in their neighborhoods with a positive cultural identity. This study indicates that prior efforts to increase PA among AA parents of young children in Chicago are evident. Future research examining the influence of PA behavior on CVD risk factors among AA parents of young children is needed next. Keywords: African American, parents, physical activity, self-efficacy, neighborhood safety, social cognitive theory
New Promise for Vaccines against Tuberculosis
Authors: Barry R. Bloom
Journal: New England Journal of Medicine (2018)

Tuberculosis has now exceeded infection with the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) and malaria as the world's largest cause of death from an infectious disease. The World Health Organization (WHO) estimates that there are 10.4 million new cases and 1.7 million deaths annually, including 0.4 million deaths in people with HIV infection, of which 95% occur in low-and-middle-income countries.1 The WHO End TB Strategy has set the ambitious target of reducing the incidence of tuberculosis disease by 90% by 2035. Yet since 2000, although global tuberculosis mortality has declined by 30%, the incidence of disease is being . . .
Implementing an EHR guideline–based intervention in paper ordering systems.
Authors: Ari Bell-Brown, Kathryn Egan, Karma L. Kreizenbeck, Kate Watabayashi, Gary H. Lyman, Dawn L. Hershman, Aasthaa Bansal, William E. Barlow, Sean D Sullivan, Scott David Ramsey
Journal: Journal of Clinical Oncology (2018)

56 Background: Studies show Colony Stimulating Factor (CSF) prescribing is inconsistent with national guidelines. SWOG trial S1415CD is a pragmatic study comparing outcomes of CSF use in usual care with care that uses guideline-informed standing CSF orders. The intervention includes embedded CSF orders based on Febrile Neutropenia (FN) risk and system note wording describing guideline recommendations. Of 24 intervention sites, five (20.8%) use paper, presenting the challenge of translating an electronic health record (EHR) intervention to paper order entry systems (OES). Methods: Paper sites were surveyed on their chemotherapy OES to inform translation of the intervention. We worked with sites to develop a workflow consistent with the key principles of the intervention: Recommendation language 1) is present before prescribing CSF, 2) reaches all study-authorized orders, 3) reaches all patients on study-authorized orders, and 4) chemotherapy and CSF are ordered before the patient is enrolled. Results: Each site had a distinct workflow that was reworked (Table 1). Paper sites took 4-10 months (average 7.6) for implementation; EHR sites took 1-10 months (average 4.5). Conclusions: Implementing an EHR-centric intervention in paper sites is feasible with appropriate time and resources built into a project to account for the unique challenges. As paper sites represented one fifth of the intervention sites, it is vital to include paper sites in OES interventions for generalizability of results. Clinical trial information: NCT02728596. [Table: see text]
PTH-051 Endoscopic transpapillary gallbladder stenting for patients unsuitable for cholecystectomy: prospective single centre case series
Authors: Simon Phillpotts, Javed Iqbal, Christos Christodoulou, Ash Rohatgi, Sudeep Tanwar
Journal: Endoscopy (2018)

<h3>Introduction</h3> Cholecystectomy, the definitive treatment for symptomatic gallbladder disease, is precluded in many patients by a high operative risk. Endoscopic transpapillary gallbladder stenting (ETGS), first reported in 1990<sup>1</sup>, is described as an effective treatment for cholecystitis and symptomatic choledocholithiasis in patients who are not candidates for surgery<sup>2</sup>. The technical success of ETGS is largely limited by the ability to pass a guidewire through the cystic duct (76%–90%)<sup>2</sup>. Despite adoption internationally ETGS has not been used widely in the UK. <h3>Method</h3> Prospective case series of ETGS at a single centre. All patients were referred for ETGS by an Upper GI surgeon after being deemed unsuitable for cholecystectomy due to a prohibitive operative or anaesthetic risk. Indications included calculous cholecystitis, choledocholithiasis and gallstone pancreatitis. Informed consent obtained from all patients with risks of ERCP outlined including pancreatitis and perforation. <h3>Results</h3> 17 patients have been referred for ETGS thus far. 3 patients were declined for ETGS (2 with dementia, 1 symptoms deemed too mild). In total ETGS was attempted in 14 patients (8 female) with average age 78 years (56–91). CBD cannulation achieved at ERCP in all 14 patients (100%). ETGS were successfully inserted in 13 patients (93%), and one failure due to inability to achieve deep cannulation of the gall bladder despite entering the cystic duct. No procedure related complications thus far. First ETGS inserted November 2015. Thereafter, 2 of the 13 (15%) of patients with ETGS reported ongoing gallstone related symptoms during follow up (ongoing biliary pain and cholecystitis at 12 months; recurrent cholangitis at 6 months) <h3>Conclusion</h3> Hitherto, this is the largest prospective UK case series of ETGS for patients with symptomatic gallbladder disease in whom cholecystectomy is precluded. Whereas procedure related complications were not noted in our case series, 2 patients continued to experience gallstone related complications. Given the recent introduction of endoscopic ultrasound-guided transmural gallbladder drainage, we recommend further studies to compare the use of these 2 endoscopic modalities in this group of patients. <h3>References</h3> . FretisCB et al. Endoscopic transpapillary drainage of gallbladder empyema. <i>Gastrointestinal Endoscopy</i> 1990;<b>36</b>(5):523–5. . BaronTH et al. Interventional Approaches to Gallbladder Disease. <i>New England Journal of Medicine</i> 2015;<b>373</b>:357–65.
Allergy UK responds to comments about corporate sponsorship
Authors: Lynne Pritchard
Journal: BMJ (2018)

McCartney makes some specific comments that misrepresent Allergy UK and its activities.1

The statement in our leaflet, “Your GP will need to switch your infant to a prescribed formula,” has been taken out of context. The actual text reads: “If your infant receives a diagnosis of cow’s milk allergy, you will need …
Abstract 20524: Effect of Treating Specialty on Stroke Outcomes in Newly-Diagnosed Atrial Fibrillation: Findings From the TREAT-AF Study
Authors: Alexander C Perino, Jun Fan, Susan Schmitt, Mariam Askari, Daniel W Kaiser, Abhishek Deshmukh, Paul A Heidenreich, Mintu Turakhia
Journal: Circulation (2016)

Introduction: Prior studies have shown higher rates of oral anticoagulation (OAC) prescription for atrial fibrillation (AF) among physician subspecialists and AF specialty clinics. We evaluated the association of treating specialty with incident stroke among patients with newly-diagnosed AF. Methods: The TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study is a retrospective cohort study of patients with newly diagnosed AF treated in the Veterans Health Administration (VA). We identified patients with newly diagnosed, nonvalvular AF from 2004 to 2012 who were seen in primary care (including general medicine) or cardiology clinics (including electrophysiology) and who received any outpatient prescription within 90 days of new AF. Using VA and linked Medicare data, we determined incidence of ischemic stroke from inpatient claims and medical record data using validated algorithms. Multivariate Cox proportional hazards regression and mediation analysis were used to evaluate the asso...