tbuckley/cabot-search huggingface dataset:
PTU-004 Percutaneous endoscopic gastrostomy care?– prospective evaluation of a simple teaching intervention in improving nursing knowledge and confidence
Authors: TE Conley, M Povah, B Collins, V Theis, M Fox
Journal: Gut (2017)

Introduction  Percutaneous Endoscopic Gastrostomies (PEG) for enteral tube feeding are commonplace - point prevalence 92 per million, 2010  1 . PEG care needs to be delivered by skilled practitioners owing to the potential for complication. Anecdotally, we were concerned by a lack of nursing confidence pertaining to PEG care and subsequently saw opportunity for quality improvement.  Aim  To determine baseline levels of nursing knowledge and confidence pertaining to PEG care in our trust; and to develop, deliver, and evaluate the efficacy of a simple teaching programme in improving this baseline.  Method  Single centre prospective audit of 83 nurses spanning the medical care group (elderly medicine, gastroenterology, and acute medicine) at Whiston Hospital (September-December 2016). Data was collected using a basic safety screening questionnaire, which sought to establish whether common issues encountered could be dealt with appropriately and safely. This was re-audited following delivery of a teaching intervention.  Results  In the acute, post-insertion setting, baseline knowledge was sub-optimal. We identified 39% of staff potentially using PEG tubes too early, reduced to 6% post intervention. Knowledge regarding management of complications varied according to experience. Confidence in  intervening  in the acute setting was lacking. Just 33% of nurses would be confident in inserting a foley catheter to maintain tract patency in the event of dislodgement, improving to 72% post intervention. Teaching promoted knowledge of potential contraindications to re-insertion, such as an immature tract (improving from 20% to 88% post intervention). When faced with a blocked tube only 55% of nurses expressed confidence in intervening; post education, awareness of using warm water in this scenario rose from 34% to 70%. Baseline knowledge regarding PEG maintenance was acceptable; all nurses were aware of the need to regularly rotate the PEG and that a safe minimum angle of 30 degrees should be maintained during feeding. However, just 18% had heard of the Buried Bumper Syndrome.  Conclusion  Baseline knowledge pertaining to the care of the PEG fed patient, and confidence in managing common complications was lacking. A simple, tailored educational session successfully identifies gaps in knowledge, improves confidence, and could deter potentially dangerous behaviour. We hope that increasing the confidence of the workforce will translate into fewer complications, a reduction in the need for re-intervention, and an increased PEG lifespan. Ideally, we would like to extend our program into nursing homes to prevent unnecessary hospital admissions in this already frail patient population.  Reference  . BANS: Annual BANS Report, 2011; Artificial Nutrition Support in the UK 2000–2010.  Disclosure of Interest  None Declared
The Parkinson Pandemic—A Call to Action
Authors: E. Ray Dorsey, Bastiaan R. Bloem
Journal: JAMA Neurology (2017)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Neurology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Neurology journal
Abstract 14875: Impact of Calcification and Long-Term Outcomes of Intravascular Ultrasound-Guided Stent Implantation for Atherosclerotic Subclavian Artery Obstructive Lesions
Authors: Hiroki Yorifuji, Masami Nishino, Yutaka Matuhiro, Hitoshi Nakamura, Keisuke Yasumura, Koji Yasumoto, Yu Nushiro, Kiyoshi Masuyama, Naotaka Okamoto, Akihiro Tanaka, Naoki Mori, Nobuhiko Makino, Yasuyuki Egami, Ryu Shutta, Jun Tanouchi
Journal: Circulation (2015)

Background: Currently, stent implantation for Subclavian artery obstructive lesions (SAOD) is an established method. Intravascular ultrasound (IVUS) provides valuable information for vessel and lumen at pre and post stenting, but there are a few reports on the effect of calcification and long-term outcomes of these methods using IVUS. Methods: We performed IVUS-guided stent implantations for SAOD in 14 arteries of 14 patients between February 2010 and December 2014. The main indications for subclavian artery stenting were arm claudication (10 patients), subclavian steal syndrome (3 patients) and coronary steal syndrome (1 pateint). Ten lesions were stenotic and four lesions were completely obstructed. We divided our patients into 2 groups according to the grade of calcification using IVUS: mild-calc group who showed none or 1/3 circumference calcification in the lesion and severe-calc group who showed more than 1/3 circumference calcification. We compared the IVUS parameters including pre minimum lumen diameter (MLD) (short axis), pre minimum lumen area (MLA), post minimum stent area (MSA), post minimum stent diameter (MSD) (short axis) and symmetric index (minimum/maximum stent diameter) between the two groups. Resutls: IVUS-guided stent implantations for SAOD were successful without perioperative complications in all patients. During follow-up observation (4-60 months, mean 21.8 months), 1 restenosis occurred. Post MSD (short axis) and post MSA were significantly lower in severe-calc group than mild-calc group while there were no significant differences between the two groups. Conclusion: IVUS-guided stent implantation for SAOD achieved satisfactory long-term outcomes. However, calcification may be correlated with worse outcomes in these lesions.
PTU-007 Improving documentation after paracentesis – optimising patient safety with good record keeping
Authors: S Hessey, A Payne, NN Than, D Patch
Journal: Gut (2017)

Introduction  Paracentesis is frequently performed by trainee doctors. The procedure is associated with significant complications including bleeding and viscera perforation, hence comprehensive documentation is essential. Good record keeping facilitates better communication between staff and, consequently, improves patient care. We aimed to assess the quality of paracentesis documentation at the Royal Free Hospital and improve areas identified as suboptimal in order to maximise patient safety.  Method  A total of 21 documentation components were identified as essential for safe ascitic drain insertion, management and removal based on current British Society of Gastroenterology guidelines and expert opinion. We reviewed the case notes of 50 patients who underwent paracentesis over a 5 month period.  Results  We divided the 20 essential documentation components into three parts: 9 documentation points for drain insertion, 5 instructions for drain management and 6 documentation points for drain removal.  We found that 100% of paracentesis procedures were documented in black ink in the correct section of the case notes and all entries included record of verbal consent. Otherwise there was a large variation in the quality of documentation with an average of 52% (n=29) compliance with the essential documentation components. In particular, explanation of procedure-associated complications, pre-procedure INR and platelet count results, time of drain removal, total volume drained and volume of albumin administered, were poorly recorded.  In order to encourage better compliance with the essential documentation components, we designed a poster for the doctor’s office. No improvement was detected as a result of this intervention. We therefore designed a sticker to facilitate clear record keeping of the essential components after paracentesis. Introduction of the sticker resulted in an immediate and sustained increase in documentation compliance to 81% (n=14). The greatest improvement was seen in regard to recording details of the procedure (100%, n=14) and post-procedure care instructions (100%, n=14).  Conclusion  Following introduction of the sticker, overall documentation improved dramatically within days and was sustained over subsequent weeks. Using a pre-designed sticker also helps to educate trainees about procedural complications and management of patients following ascitic drain insertion.  Disclosure of Interest  None Declared
Amiodarone pulmonary toxicity
Authors: A. Leonard, P. Corris, D. Parums, L Donaldson, I S Grant, M R Naysmith, J S. J Thomas, G. A J Jessurun
Journal: BMJ (1997)

Nicotine replacement therapy should be prescribable on NHSEditor-I welcome the publication of the open letter to the prime minister about tobacco-the most important preventable cause of death in Europe. 1 As Jo E Asvall points out in the letter, tobacco control demands the support of, and action by, the total government, not just the Department of Health.Among the actions Asvall calls for is that "support for smoking cessation is made widely available, particularly through primary health care professionals, including doctors, nurses, pharmacists, and dentists."Nicotine replacement therapy (nicotine gum, patches, nasal spray, and oral inhaler) is now fully established as an effective adjunct to such professional advice and support.Systematic review of many trials has shown a doubling of sustained smoking cessation when nicotine replacement therapy is compared with placebo. 2 The offer of nicotine patches to motivated subjects for a week in the first instance could be a useful policy. 3 But the recommendation of such therapy by health professionals and the use of such therapy by smokers are severely limited by NHS "blacklisting."I can prescribe on the NHS for alcohol problems and even obesity.I can also prescribe for tobacco addiction-but only products of unproved efficacy for this problem, such as tranquillisers and antidepressants, not one of proved effectiveness.Why not nicotine replacement therapy?So much for evidence based medicine.
The utilization of inpatient palliative care services (PCS) in patients with metastatic cancer receiving critical care therapies (CCTs).
Authors: Kah Poh Loh, Meng-Shiou Shieh, Maya Abdallah, Penelope Pekow, Peter Lindenauer, Mihaela Stefan, Supriya Gupta Mohile, Tara Lagu
Journal: Journal of Clinical Oncology (2017)

103 Background: PCS have been shown to improve symptom management, quality of life and survival in patients with metastatic cancer as well as reduce healthcare costs. We aimed to investigate the utilization pattern of inpatient PCS and outcomes in metastatic cancer patients across the various cancer subtypes who received CCTs. Methods: We used the 2010 California Healthcare Cost and Utilization Project - State Inpatient Database to identify patients (≥18 years) and above with metastatic cancer who received CCTs, defined as the use of invasive mechanical ventilation, acute dialysis, total parenteral nutrition, percutaneous endoscopic gastrostomy or tracheostomy. We examined the use of inpatient PCS and outcomes including inpatient mortality, length of stay, discharge to skilled nursing facility, cost of care and presence of do-not-resuscitate. Results: A total of 9,348 hospitalizations were identified. The cancer subtypes were lung (14%), breast (5%), colorectal (13%), genitourinary (8%) and others (37%). Overall, 19% had documented involvement of inpatient PCS. Patients with lung cancer had the highest utilization of inpatient PCS (25%), compared to breast (20%), genitourinary (17%) and colorectal (13%) cancers. Other outcomes are shown in Table. Conclusions: Inpatient PCS were underutilized in patients with metastatic cancer who were critically ill. Future studies should look into the benefits of early integration of inpatient PCS in this population who are at high-risk of mortality. [Table: see text]
Abstract 12927: Concurrent Pneumonia has no Association With 30-Day All-Cause or Heart Failure Readmissions but is Associated With Higher 30-Day Pneumonia Readmission and MayBe Associated With Higher 30-Day All-Cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure
Authors: Chakradhari Inampudi, Ross D Fletcher, Sijian Zhang, Charity Morgan, Prakash Deedwania, Gregg C Fonarow, Wilbert S Aronow, Wen-Chih Wu, Cynthia J Brown, Stepfan D Anker, Richard M Allman, Ali Ahmed
Journal: Circulation (2015)

Background: Pneumonia (20%) is the second leading cause for 30-day all-cause readmission after heart failure (HF; 27%). However, little is known about the impact of pneumonia during index HF hospitalization on 30-day all-cause readmission. Methods: Of the 8049 Medicare beneficiaries hospitalized for decompensated HF (72% with known HF) discharged alive from 106 U.S. hospitals (1998-2001), 2048 (25%) had pneumonia (1670 on admission and 378 in-hospital). Using propensity scores for pneumonia, we assembled a matched cohort of 1982 pairs of patients balanced on 33 baseline characteristics. Results: 30-day all-cause readmissions occurred in 899 (23%) of matched patients and there was no difference between those with and without pneumonia (HR, 1.00; 95% CI, 0.88-1.15; p=0.947; Fig, left). 30-day pneumonia readmission occurred in 41 matched patients which was higher among those with pneumonia (HR, 1.96; 95% CI, 1.03-3.74; p=0.041). 30-day HF readmission occurred in 342 patients but had no association with pneumonia (HR, 1.10; 95% CI, 0.89-1.36; p=0.365). 30-day all-cause death occurred in 303 patients, which was higher among those with pneumonia (9% vs 7%; HR, 1.26; 95% CI, 1.00-1.58; p=0.046; Fig, right). These associations persisted throughout 12 months post-discharge. Conclusions: Among patients with HF, on-admission or in-hospital pneumonia during index hospital admission is associated with significantly higher 30-day death and pneumonia readmissions but not with 30-day all-cause or HF readmissions
The efficacy of dose reduced crizotinib for advanced ALK-positive non-small cell lung cancer
Authors: M. Naito, Y. Naoki, S. Takata, S. Ishii, Y. Taniguchi, N. Saijo, A. Tamiya, N. Omachi, K. Okishio, S. Morita, A. Tanaka, T. Shiroyama, N. Morishita, H. Suzuki, N. Okamoto, T. Hirashima, S. Atagi
Journal: Annals of Oncology (2017)
Blind Obedience and an Unnecessary Workup for Hypoglycemia
Authors: Elizabeth Y. Wang, Lauren Patrick, Denise M. Connor
Journal: JAMA Internal Medicine (2017)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
P2.07-007 Retrospective Analysis of Antitumor Effects and Biomarkers of Nivolumab in NSCLC Patients with EGFR Mutations
Authors: S. Watanabe, H. Tanaka, K. Nozaki, M. Sato, M. Arita, Y. Mishina, S. Shoji, K. Ichikawa, R. Kondo, T. Sakagami, T. Koya, T. Kikuchi
Journal: Journal of Thoracic Oncology (2017)
Human primary liver cancer–derived organoid cultures for disease modeling and drug screening
Authors: Laura Broutier, Gianmarco Mastrogiovanni, Monique MA Verstegen, Hayley E Francies, Lena Morrill Gavarró, Charles R Bradshaw, George E Allen, Robert Arnes-Benito, Olga Sidorova, Marcia P Gaspersz, Nikitas Georgakopoulos, Bon-Kyoung Koo, Sabine Dietmann, Susan E Davies, Raaj K Praseedom, Ruby Lieshout, Jan N M IJzermans, Stephen J Wigmore, Kourosh Saeb-Parsy, Mathew J Garnett, Luc JW van der Laan, Meritxell Huch
Journal: Nature Medicine (2017)
NADPH oxidases in Parkinson’s disease: a systematic review
Authors: Karim Belarbi, Elodie Cuvelier, Alain Destée, Bernard Gressier, Marie-Christine Chartier-Harlin
Journal: Molecular Neurodegeneration (2017)

Parkinson's disease (PD) is a progressive movement neurodegenerative disease associated with a loss of dopaminergic neurons in the substantia nigra of the brain. Oxidative stress, a condition that occurs due to imbalance in oxidant and antioxidant status, is thought to play an important role in dopaminergic neurotoxicity. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases are multi-subunit enzymatic complexes that generate reactive oxygen species as their primary function. Increased immunoreactivities for the NADPH oxidases catalytic subunits Nox1, Nox2 and Nox4 have been reported in the brain of PD patients. Furthermore, knockout or genetic inactivation of NADPH oxidases exert a neuroprotective effect and reduce detrimental aspects of pathology in experimental models of the disease. However, the connections between NADPH oxidases and the biological processes believed to contribute to neuronal death are not well known. This review provides a comprehensive summary of our current understanding about expression and physiological function of NADPH oxidases in neurons, microglia and astrocytes and their pathophysiological roles in PD. It summarizes the findings supporting the role of both microglial and neuronal NADPH oxidases in cellular disturbances associated with PD such as neuroinflammation, alpha-synuclein accumulation, mitochondrial and synaptic dysfunction or disruption of the autophagy-lysosome system. Furthermore, this review highlights different steps that are essential for NADPH oxidases enzymatic activity and pinpoints major obstacles to overcome for the development of effective NADPH oxidases inhibitors for PD.
Gendered influences on adolescent mental health in low-income and middle-income countries: recommendations from an expert convening
Authors: Chisina Kapungu, Suzanne Petroni, Nicholas B Allen, Luisa Brumana, Pamela Y Collins, Mary De Silva, Tarun Dua, Jumana Haj-Ahmad, Ashley Leichner, George Patton, Beverly Pringle, Olayinka Omigbodun, Karlee L Silver, Georgia Lockwood Estrin, Sagri Singh, Nabila Zaka, Willibald Zeck
Journal: The Lancet Child & Adolescent Health (2017)
Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays — United States
Authors: Andre F. Dailey, Brooke E. Hoots, H. Irene Hall, Ruiguang Song, Demorah Hayes, Paul Fulton, Joseph Prejean, Angela L. Hernandez, Linda J. Koenig, Linda A. Valleroy
Journal: MMWR Morbidity and Mortality Weekly Report (2017)

Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Persons are unaware of their infection because of delayed HIV diagnoses that represent substantial missed opportunities to improve health outcomes and prevent HIV transmission.Data from CDC's National HIV Surveillance System were used to estimate, among persons with HIV infection diagnosed in 2015, the median interval (and range) from infection to diagnosis (diagnosis delay), based on the first CD4 test after HIV diagnosis and a CD4 depletion model indicating disease progression and, among persons living with HIV in 2015, the percentage with undiagnosed infection. Data from CDC's National HIV Behavioral Surveillance were analyzed to determine the percentage of persons at increased risk for HIV infection who had tested in the past 12 months and who had missed opportunities for testing.An estimated 15% of persons living with HIV in 2015 were unaware of their infection. Among the 39,720 persons with HIV infection diagnosed in 2015, the estimated median diagnosis delay was 3.0 years (interquartile range = 0.7-7.8 years); diagnosis delay varied by race/ethnicity (from 2.2 years among whites to 4.2 years among Asians) and transmission category (from 2.0 years among females who inject drugs to 4.9 years among heterosexual males). Among persons interviewed through National HIV Behavioral Surveillance, 71% of men who have sex with men, 58% of persons who inject drugs, and 41% of heterosexual persons at increased risk for HIV infection reported testing in the past 12 months. In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year.Delayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others.Health care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.
Phase 1 study of quizartinib in combination with induction and consolidation chemotherapy in patients with newly diagnosed acute myeloid leukemia
Authors: Jessica K. Altman, James M. Foran, Keith W. Pratz, Denise Trone, Jorge E. Cortes, Martin S. Tallman
Journal: American Journal of Hematology (2017)

Novel therapies have potential to improve outcomes in patients with acute myeloid leukemia (AML) harboring FLT3-ITD mutations that have high risk of relapse and poor survival following standard of care (SOC) cytarabine/anthracycline-based induction/consolidation chemotherapy. Quizartinib is a selective and highly potent FLT3 inhibitor that has shown strong single-agent activity in relapsed or refractory (R/R) AML. This phase 1, open-label, sequential group dose-escalation trial (NCT 01390337) is the first evaluating safety and tolerability of quizartinib in combination with SOC chemotherapy in newly diagnosed AML (ndAML). Nineteen patients unselected for FLT3 mutational status received one of three quizartinib dihydrochloride dose levels (DL): 60 mg/d for 7 days (DL1; n = 6), 60 mg/d for 14 days (DL2; n = 7), and 40 mg/d for 14 days (DL-1; n = 6); administered orally starting on day 4 of chemotherapy. Median age was 43.8 years. Ten patients completed induction and consolidation. Three patients experienced dose-limiting toxicities (DLTs): 2 at DL2 (1 pericardial effusion; 1 febrile neutropenia, decreased platelet count, and QT prolongation); 1 at DL-1 (pericarditis). Maximum tolerated dose (MTD) was identified as DL-1. Most common grade 3/4 adverse events were febrile neutropenia (47%), neutropenia (42%), thrombocytopenia (32%), and anemia (26%). There were no apparent additional toxicities with addition of quizartinib to chemotherapy although grade ≤1 QT prolongation was observed at MTD. Sixteen patients (84%) achieved a response; 14 (74%) composite complete response; 2 (11%) morphologic leukemia-free state. The phase 3 QuANTUM-First trial (NCT02668653) is further evaluating the effect of quizartinib plus SOC chemotherapy in ndAML FLT3-ITD mutated patients.