tbuckley/cabot-search huggingface dataset:
Community-based palliative care and end-of-life care in elderly patients with pancreatic cancer.
Authors: Zhanni Lu, Cecilia M Ganduglia Cazaban, Luis G LeonNovelo, Sriram J. Yennu, Sadie H Conway, Linda D Highfield, Sharon Hermes Giordano, Hui Zhao
Journal: Journal of Clinical Oncology (2018)

70 Background: No population-based studies have evaluated the impact of community-based palliative care (CBPC) on aggressive end-of-life (EOL) care use and Medicare charges for elderly pancreatic cancer patients. We analyzed the impact of CBPC on aggressive EOL care use in the last 30 days of life and on emergency department (ED) and intensive care unit (ICU) Medicare charges using the SEER-Medicare data. Methods: 12399 elderly pancreatic cancer patients survived for at least 1 month after diagnosis from 2007 to 2013 were identified. CBPC and hospital-based palliative care (HBPC) users were identified by diagnosis codes and place of services and matched by the coarsened exact matching [786:786; age, sex, residence urbanization level, comorbidities, illness duration, palliative care (PC) exposure]. Zero-inflated Poisson and multivariable logistic/linear regression models examined the variations of aggressive EOL care use in the matched patients. Generalized linear regression with a gamma distribution determined how CBPC impacted ED and ICU Medicare charges. Results: 22.1% eligible patients (median age: 76 years) used PC in the 6 years, including 7.7% who used CBPC and 14.5% who used HBPC. The median duration from cancer diagnosis to death of CBPC, HBPC and Non-PC users was 11 months, 6 months and 8 months (P &lt; .001). Matched CBPC users were less likely than HBPC users to be admitted to ICU (risk ratio [RR], 0.64; 95% CI, 0.50-0.81), ED (RR, 0.63; 95% CI, 0.53-0.73), and hospital (RR, 0.50; 95% CI, 0.35-0.72). Compared to matched HBPC users, CBPC users utilized less life-extending care (OR, 0.59; 95% CI, 0.43-0.80) and had shorter hospital (Coef., −0.42; 95% CI, −0.65- −0.18) and ICU stays (Coef., −0.35; 95% CI, −0.59 - −0.10). They tended to die at home (OR, 1.46; 95% CI, 1.19-1.78) and not in ED/ICU/hospital settings (OR, 0.62; 95% CI, 0.45-0.83). CBPC users’ adjusted mean ED and ICU Medicare charges were 0.2% (P = .80) and 1.1% (P &lt; .001) lower than those of Non-PC users and 4.5% (P = .43) and 21.0% (P = .08) lower than those of matched HBPC users. Conclusions: CBPC users utilized less aggressive EOL care than HBPC users, implying CBPC's potential to reduce aggressive EOL care use. Their ICU Medicare charge was lower than that of Non-PC users.
Process measures of palliative and end-of-life care among young adults who died from cancer.
Authors: Hanneke Poort, Sophia Zupanc, Alexi A. Wright, Charlotta Lindvall
Journal: Journal of Clinical Oncology (2018)

54 Background: Timely delivery of palliative and end-of-life care (EOL) are essential components of high-quality cancer care. To date, however, few studies have examined process measures for EOL care in young adult (YA; ages 18-35 years) cancer decedents. Methods: We conducted a retrospective study using medical records of YA decedents who received cancer treatment at an academic cancer center between Jan. 1, 2012 and June 13, 2018. We used natural language processing (NLP) with validated key words to identify documentation of four process measures – palliative care involvement, and discussions of goals of care, code status, and hospice – from documented clinical encounters in the medical record within 6 months of death. Results: During this period 146/2,878 (5.1%) YA patients had a recorded death date and a first note at least 31 days prior to death. In this decedent cohort, the mean age was 28.2 years (SD=4.4) and 58.9% were men. The most common diagnoses were brain cancer (33.6%), sarcoma (19.9%), and breast cancer (12.3%). The 146 patients accrued 26,441 clinical notes during the last 6 months of life (median=116.5 notes, IQR 37.0-222.0). Using NLP, we identified that 68.5% of the 146 YAs had at least one process measure documented in the last 6 months of life, including: 54.1% palliative care involvement; 56.8% discussions of goals of care; 47.3% discussions of code status; and 51.4% discussions of hospice. On average, palliative care was documented 7.5 times (range 0-75); goals of care 6.1 times (range 0-43), code status 1.9 times (range 0-12), and hospice 8.1 times (range 0-67). Late documentation of process measures (defined as first recorded within 30 days of death) included: hospice (45.3%), code status (30.3%), palliative care (20.8%), and goals of care (9.6%). Notably, in 31.5% of YAs, we did not detect documentation of any process measures prior to death. Conclusions: In this cohort of YA cancer decedents, nearly one-third of YAs did not have documentation of any process measures, highlighting the importance of efforts to improve EOL care communication with this young population.
Prognostic Value and Clinical Impact of Pretreatment FDG PET in Pulmonary Lymphoepithelioma-Like Carcinoma
Authors: Tzu-Pei Su, Kung-Chu Ho, Chih-Wei Wang, Chun-Yu Lin, Chien-Ying Liu, Cheng-Ta Yang, Tzu-Chen Yen
Journal: Clinical Nuclear Medicine (2018)

Compared with other forms of non-small cell lung cancer, pulmonary lymphoepithelioma-like carcinoma (LELC) is rarer and portends better outcomes. We sought to investigate the prognostic role and clinical impact of pretreatment F-FDG PET in pulmonary LELC.A total of 71 patients with pulmonary LELC were identified through a retrospective review of clinical records. Of them, 41 underwent F-FDG PET for primary staging. Outcomes were assessed using the Kaplan-Meier method and Cox regression models with a forward stepwise selection procedure. Staging changes served as the main outcome measure for assessing the impact of F-FDG PET. For the purpose of analyses, all patients were restaged according the American Joint Committee on Cancer Staging Manual eighth edition.Stage and pretreatment F-FDG PET were significantly independent predictors of overall survival (OS) on multivariate analysis. Five-year OS rates for patients with stages I-II, III-IVA, and IVB were 92.3%, 70.4%, and 20.0%, respectively. The use of F-FDG PET for staging purposes was associated with a better OS (P = 0.003). Specifically, the 5-year OS rates for patients who were staged with and without F-FDG PET were 85.4% and 49.7%, respectively (P = 0.012). F-FDG PET resulted in a disease upstage in 28.6% of patients with CT-defined stages III-IVA; of them, 14.3% were upstaged to IVB disease.The American Joint Committee on Cancer eighth edition stage and pretreatment F-FDG PET were independent prognostic factors for OS in patients with pulmonary LELC. F-FDG PET imaging resulted in a better disease staging with a corresponding optimization of therapeutic interventions, which ultimately improved survival outcomes.
DNA Methyltransferase 1 Controls Nephron Progenitor Cell Renewal and Differentiation
Authors: Nicola Wanner, Julia Vornweg, Alexander Combes, Sean Wilson, Julia Plappert, Gesa Rafflenbeul, Victor G. Puelles, Raza-Ur Rahman, Timur Liwinski, Saskia Lindner, Florian Grahammer, Oliver Kretz, Mary E. Wlodek, Tania Romano, Karen M. Moritz, Melanie Boerries, Hauke Busch, Stefan Bonn, Melissa H. Little, Wibke Bechtel-Walz, Tobias B. Huber
Journal: Journal of the American Society of Nephrology (2018)

Background Nephron number is a major determinant of long-term renal function and cardiovascular risk. Observational studies suggest that maternal nutritional and metabolic factors during gestation contribute to the high variability of nephron endowment. However, the underlying molecular mechanisms have been unclear. Methods We used mouse models, including DNA methyltransferase ( Dnmt1, Dnmt3a, and Dnmt3b ) knockout mice, optical projection tomography, three-dimensional reconstructions of the nephrogenic niche, and transcriptome and DNA methylation analysis to characterize the role of DNA methylation for kidney development. Results We demonstrate that DNA hypomethylation is a key feature of nutritional kidney growth restriction in vitro and in vivo, and that DNA methyltransferases Dnmt1 and Dnmt3a are highly enriched in the nephrogenic zone of the developing kidneys. Deletion of Dnmt1 in nephron progenitor cells (in contrast to deletion of Dnmt3a or Dnm3b ) mimics nutritional models of kidney growth restriction and results in a substantial reduction of nephron number as well as renal hypoplasia at birth. In Dnmt1 -deficient mice, optical projection tomography and three-dimensional reconstructions uncovered a significant reduction of stem cell niches and progenitor cells. RNA sequencing analysis revealed that global DNA hypomethylation interferes in the progenitor cell regulatory network, leading to downregulation of genes crucial for initiation of nephrogenesis, Wt1 and its target Wnt4. Derepression of germline genes, protocadherins, Rhox genes, and endogenous retroviral elements resulted in the upregulation of IFN targets and inhibitors of cell cycle progression. Conclusions These findings establish DNA methylation as a key regulatory event of prenatal renal programming, which possibly represents a fundamental link between maternal nutritional factors during gestation and reduced nephron number.
Work and Cardiovascular Disease in China
Authors: Haider J. Warraich, Tracy Y. Wang, Robert M. Califf
Journal: JAMA Network Open (2018)

Zihan Jiang, MD; Rachel P. Dreyer, PhD; John A. Spertus, MD; Frederick A. Masoudi, MD, MSPH; Jing Li, MD, PhD; Xin Zheng, MD, PhD; Xi Li, MD, PhD; Chaoqun Wu, MD, MS; Xueke Bai, MS; Shuang Hu, PhD; Yun Wang, PhD; Harlan M. Krumholz, MD, SM; Hong Chen, MD; for the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Collaborative Group
What the HEC? Physician variation and attainable compliance targets in antiemetic prophylaxis.
Authors: Eric Roeland, Kathryn Jean Ruddy, Thomas William LeBlanc, Ryan David Nipp, Gary Binder, Silvia Sebastiani, Ravi C. Potluri, Luke M. Schmerold, Eros Papademetriou, Rudolph M. Navari
Journal: Journal of Clinical Oncology (2018)

74 Background: U.S. National Antiemetic Guidelines recommend upfront triple prophylaxis (NK1 receptor antagonist (RA) + 5HT3 RA + dexamethasone) for patients receiving highly emetogenic chemotherapy (HEC), including carboplatin AUC ≥ 4 per 2017 guidelines. While existing data show gaps in guideline compliance, variation between individual physicians is less studied, and a realistic target compliance rate remains unknown. Methods: In a large electronic health record database (IBM Explorys), we identified HEC courses of therapy initiated from 2012 to 2017. Guideline compliance was defined as triple prophylaxis at chemotherapy initiation. Patient courses for ≥ 7 day cycles of cisplatin or anthracycline + cyclophosphamide (AC), or carboplatin (≥ 14 day cycles as a proxy for AUC ≥ 4) were ascribed to oncologists based on encounter frequency. We then ranked physicians treating ≥ 5 HEC courses and evaluated guideline compliance and individual physician variation. Results: In total, 10,074 HEC courses were identified and attributed to 451 unique physicians. Overall antiemetic guideline compliance with cisplatin and AC averaged 68% and 81% respectively. When ranked by compliance, the top 20% of physicians were 2.5 - 1.5 times as compliant as the bottom 20% (cisplatin 100% vs 40%; AC 100% vs 67%). For cisplatin, 32% of physicians had &gt; 90% compliance; the remaining 68% were evenly distributed from 0 - 90%. For AC, 56% of physicians had &gt; 90% compliance, and another 14% had 80 - 90%; the remaining 30% were evenly distributed. For carboplatin, 62% of physicians had ≤ 10% compliance, and another 17% had 11 - 20%; however, the majority of these data preceded guideline inclusion of carboplatin AUC ≥ 4 as HEC. Rates were independent of course volume per physician. Conclusions: Considerable physician-level variation exists in triple antiemetic prophylaxis guideline adherence for HEC. Hundreds of physicians had &gt; 90% compliance with guidelines, suggesting 90% is a realistic target. However, the majority exhibited substantial gaps in NK1 RA use in HEC, placing patients unnecessarily at risk for CINV. Interventions are needed to bolster triple antiemetic prophylaxis in HEC, perhaps especially for carboplatin.
Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.
Authors: Armin Shahrokni, Amy Tin, Koshy Alexander, Saman Sarraf, Anoushka Afonso, Olga Filipova, Jennifer Harris, Robert J. Downey, Andrew Vickers, Beatriz Korc-Grodzicki
Journal: Journal of Clinical Oncology (2018)

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p &lt;0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p &lt; 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.
Researcher who edited babies’ genome retreats from view as criticism mounts
Authors: Owen Dyer
Journal: BMJ (2018)

He Jiankui, the Chinese researcher who rocked the field of genetics when he announced the birth of two babies whose genome had been edited to prevent HIV infection, defended his work before an audience of scientists at a Hong Kong genomics conference on 28 November.1

But He withdrew from a scheduled speaking slot the next day—a discussion about developing standards and moral principles for human germline editing—as criticism mounted from other scientists and from the Chinese government, while conference organisers called his research “irresponsible.”

He’s announcement of the birth of twins Lulu and Nana was timed to coincide with the second international summit on human genome editing. Though he had been scheduled to speak on the last day, organisers hurriedly made room for an earlier appearance.

A packed session at the University of Hong Kong saw him introduced by Robin Lovell-Badge of London’s Francis Crick Institute. “He has to be given a chance to explain what he has done and why,” said Lovell-Badge, threatening to end the meeting if there was “unruly behaviour.”

To audible gasps, He began contritely: “I must apologise that these results leaked before peer review.” News of the births did not leak inadvertently but was announced by He himself on YouTube and in an Associated Press interview on 25 November.

He said that his …
The Art of Suffering
Authors: David H. Rosen
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
Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries
Authors: Yingfen Hsia, Mike Sharland, Charlotte Jackson, Ian C K Wong, Nicola Magrini, Julia A Bielicki
Journal: The Lancet Infectious Diseases (2018)
RNA therapy: Are we using the right molecules?
Authors: Ai-Ming Yu, Chao Jian, Allan H. Yu, Mei-Juan Tu
Journal: Pharmacology & Therapeutics (2018)

Small-molecule and protein/antibody drugs mainly act on genome-derived proteins to exert pharmacological effects. RNA based therapies hold the promise to expand the range of druggable targets from proteins to RNAs and the genome, as evidenced by several RNA drugs approved for clinical practice and many others under active trials. While chemo-engineered RNA mimics have found their success in marketed drugs and continue dominating basic research and drug development, these molecules are usually conjugated with extensive and various modifications. This makes them completely different from cellular RNAs transcribed from the genome that usually consist of unmodified ribonucleotides or just contain a few posttranscriptional modifications. The use of synthetic RNA mimics for RNA research and drug development is also in contrast with the ultimate success of protein research and therapy utilizing biologic or recombinant proteins produced and folded in living cells instead of polypeptides or proteins synthesized in vitro. Indeed, efforts have been made recently to develop RNA bioengineering technologies for cost-effective and large-scale production of biologic RNA molecules that may better capture the structures, functions, and safety profiles of natural RNAs. In this article, we provide an overview on RNA therapeutics for the treatment of human diseases via RNA interference mechanisms. By illustrating the structural differences between natural RNAs and chemo-engineered RNA mimics, we focus on discussion of a novel class of bioengineered/biologic RNA agents produced through fermentation and their potential applications to RNA research and drug development.
Cytokines and chemokines in dermatomyositis
Authors: M. Chen, C. Quan, L. Diao, F. Xue, K. Xue, B. Wang, X. Li, X. Zhu, J. Zheng, H. Cao
Journal: British Journal of Dermatology (2018)

Dermatomyositis (DM) is a chronic immune disorder that primarily affects the muscle, skin, or even lungs and heart. The exact causes and workings of DM, as well as methods for monitoring disease activity in a patient and predicting how it will respond to treatment, are being researched. Irregularities in cells called cytokines and chemokines are commonly found in inflammatory disorders and are likely to play a role in DM. This study aimed to find out the association between blood levels of cytokines and chemokines, and the severity of symptoms, especially skin lesions (affected patches) and interstitial lung disease (ILD – a term used for a range of lung diseases), in people with DM or a subtype of the disease called clinically amyopathic dermatomyositis (CADM). They enrolled 40 DM/CADM patients, collecting blood samples, evaluating the scale of skin lesions and taking other information at their first visit to hospital. The researchers found that higher levels in the blood of the cytokine IFN-β and the chemokine CXCL-10 were linked to more severe symptoms (higher disease activity). Blood levels of the cytokines IL-6, IL-10, IL-18, IFN-β were significantly higher in the DM/CADM patients with a type of ILD called acute/subacute interstitial pneumonia (A/SIP) than the subset without. Higher blood levels of IL-6 and IL-18 were correlated with higher levels of an antibody called anti-MDA5 antibody (antibodies are produced by the immune system to fight off disease and infection). In conclusion, blood levels of IFN-β and CXCL-10 may be useful for assessing skin disease activity in DM/CADM. The cytokines IL-6, IL-10, IL-18 and IFN-β were highly correlated with the occurrence of A/SIP. In addition, IL-6 and IL-18 may play a role in the development of anti-MDA5 antibody associated ILD. These results may contribute to the better understanding of DM/CADM.
The Challenges of Improving Treatments for Depression
Authors: Pim Cuijpers
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