tbuckley/cabot-search huggingface dataset:
Abstract 16620: Automated External Defibrillator Awareness in the U.S. Latino Population
Authors: Shaun K McGovern, D. Daphne Owen, Andrew Murray, Marion Leary, Marina Del Rios, Benjamin S Abella, Audrey L Blewer
Journal: Circulation (2017)

Introduction:  The prompt use of automated external defibrillators (AEDs) by bystanders can greatly improve survival from sudden cardiac arrest (SCA) occurring in public locations, yet use of AEDs is strikingly low, possibly due to lack of public awareness. Previous studies have highlighted disparities in CPR provision and training in Latino communities, yet no studies have assessed AED awareness and associated racial disparities.   Hypothesis:  We sought to estimate AED awareness and associated racial variation on a national level. We hypothesized that Latinos would be less likely than non-Latinos to be aware of what an AED was and who can use an AED.   Methods:  As a cross-sectional study, we administered a random digit dial survey to a nationally-representative adult sample, offered in English and Spanish, collecting both demographic information and AED knowledge. Using survey-weighted logistic regression adjusted for location, income, education level, gender, and age, we assessed AED awareness in a Latino population compared to a non-Latino population.   Results:  From 09/2015-11/2015, 9,022 individuals completed the survey. Of those, 68% had never been AED trained, 24% had been trained, and 8% were unfamiliar with an AED. When assessing for racial variation, 26% of Latinos reported not knowing what an AED was, compared to 5% of non-Latinos. Using logistic regression, Latinos were significantly more likely to not know what an AED was compared to non-Latinos (OR 3.88, 95% CI: 3.17-4.75, p   Conclusions:  Latinos were significantly less likely to know what an AED was or know who could use an AED compared to non-Latinos. These findings provide important evidence of racial disparities in AED awareness that may impact SCA outcomes, especially in Latino-predominant neighborhoods.
Impact of SSRI Therapy on Risk of Conversion From Mild Cognitive Impairment to Alzheimer’s Dementia in Individuals With Previous Depression
Authors: Claudia Bartels, Michael Wagner, Steffen Wolfsgruber, Hannelore Ehrenreich, Anja Schneider
Journal: American Journal of Psychiatry (2017)

Depression is associated with an increased risk of Alzheimer's disease. Research has shown that the selective serotonin reuptake inhibitor (SSRI) citalopram decreases amyloid-β generation and plaque load. The authors evaluated the impact of SSRI treatment on CSF biomarkers and progression from mild cognitive impairment (MCI) to Alzheimer's dementia.Data sets from 755 currently nondepressed participants from the longitudinal Alzheimer's Disease Neuroimaging Initiative were evaluated by Kaplan-Meier analysis and analyses of variance and covariance with ApoE4 status and age as covariates.In MCI patients with a history of depression, long-term SSRI treatment (>4 years) was significantly associated with a delayed progression to Alzheimer's dementia by approximately 3 years, compared with short-term SSRI treatment, treatment with other antidepressants, or no treatment and compared with MCI patients without a history of depression. No differences in CSF biomarker levels were observed between treatment groups.Long-term SSRI treatment may delay progression from MCI to Alzheimer's dementia.
CAR T-Cell Therapies in Glioblastoma: A First Look
Authors: Denis Migliorini, Pierre-Yves Dietrich, Roger Stupp, Gerald P. Linette, Avery D. Posey, Carl H. June
Journal: Clinical Cancer Research (2017)

Glioblastoma is an aggressive malignancy with a poor prognosis. The current standard of care for newly diagnosed glioblastoma patients includes surgery to the extent, temozolomide combined with radiotherapy, and alternating electric fields therapy. After recurrence, there is no standard therapy and survival is less than 9 months. Recurrent glioblastoma offers a unique opportunity to investigate new treatment approaches in a malignancy known for remarkable genetic heterogeneity, an immunosuppressive microenvironment, and a partially permissive anatomic blood-brain barrier. Results from three first-in-man chimeric antigen receptor (CAR) T-cell trials targeting IL13Rα2, Her2/CMV, and EGFRvIII have recently been reported. Each one of these trials addresses important questions, such as T-cell trafficking to CNS, engraftment and persistence, tumor microenvironment remodeling, and monitoring of glioma response to CAR T cells. Objective radiologic responses have been reported. Here, we discuss and summarize the results of these trials and suggest opportunities for the field. Clin Cancer Res; 24(3); 535-40. ©2017 AACR.
Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis
Authors: Deepa Patel, Leslie A. Castelo-Soccio, Adam I. Rubin, Jenna L. Streicher
Journal: JAMA Dermatology (2017)

Utility of Baseline Transaminase Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis
Abstract 12104: Asymptomatic Acute Complications of Atrial Fibrillation Ablation Using Irrigated Radiofrequency Technology
Authors: Thomas Deneke
Journal: Circulation (2016)

Introduction: Complications after atrial fibrillation (AF) ablation are rare and therefore consequent analysis of risk factors is often hard. Although, in asymptomatic patients silent cerebral events (SCE) in magnetic resonance imaging (MRI) and endoscopically detected esophageal thermal lesions (EDEL) have been documented in a much higher percentage of these patients. These asymptomatic complications may serve as surrogate indicators for the potential for severe complications. Hypothesis: We evaluated the incidence of SCE and EDEL in patients undergoing AF ablation using irrigated radiofrequency ablation technologies. Methods: Overall 375 pts undergoing either single-tip contact-force irrigated RF ablation (N=231) or multipolar irrigated RF (nMARQ, N= 170). EDEL using post-ablation endoscopy (days 1 - 4) and SCE using diffusion-weighted brain MRI (days 1 - 3) were documented and related to procedural and patient-specific parameters. No symptomatic complications occurred in this patient cohort. Results: 327 pts underwent post-ablation endoscopic evaluation for EDEL and 335 post-ablation MRI to detect SCE. Overall incidence of EDEL was 16% (53) including 4.5% (15) esophageal ulcers and 21% (72) had SCE. In the single-tip RF ablations 12% had EDEL and 20% SCE whereas in the nMARQ ablations 21% had EDEL and 23% SCE. The incidence of EDEL was higher in patients undergoing esophageal temperature monitoring using a thermal esophagus probe with non-insulated large metal electrodes (30% versus 6% in single tip and 31% versus 6% in nMARQ ablations). The use of this specific probe was the only independent predictor of EDEL. The incidence of SCE was relevantly lower in patients ablated under continuous oral anticoagulation (12% versus 37% for single tip and 15%versus 31% for nMARQ ablations). Conclusions: AF ablation using irrigated RF involves a risk of asymptomatic complications to the esophagus and brain relevantly higher than symptomatic complications. Reduction of asymptomatic complications may warrant beneficial effects on the most severe complications of AF ablation like periprocedural stroke and atrio-esophageal fistula.
Kidney disease in the setting of HIV infection: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Authors: Charles R. Swanepoel, Mohamed G. Atta, Vivette D. D’Agati, Michelle M. Estrella, Agnes B. Fogo, Saraladevi Naicker, Frank A. Post, Nicola Wearne, Cheryl A. Winkler, Michael Cheung, David C. Wheeler, Wolfgang C. Winkelmayer, Christina M. Wyatt, Ali Abu-Alfa, Dwomoa Adu, Lawrence Y. Agodoa, Charles E. Alpers, Fatiu A. Arogundade, Gloria Ashuntantang, Corinne I. Bagnis, Raj Bhimma, Isabelle Brocheriou, Arthur H. Cohen, Karen Cohen, H. Terence Cook, Sophie de Seigneux, June Fabian, Fredric O. Finkelstein, Mark Haas, Lisa Hamzah, Bruce M. Hendry, Valentine Imonje, J. Charles Jennette, Paul L. Kimmel, Mary E. Klotman, Paul E. Klotman, Chris P. Larsen, Mignon I. McCulloch, Pulane Mosiane, Cynthia C. Nast, Ikechi G. Okpechi, Patricio E. Ray, Avi Z. Rosenberg, Michael J. Ross, Lene Ryom, Luan Truong, Ifeoma Ulasi, Liffert Vogt, Martin Zeier
Journal: Kidney International (2018)

HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge of the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.
Abstract 19537: Association of Spontaneous Preterm Delivery and Postpartum Vascular Function: Is Spontaneous Preterm Delivery Associated With Clustering of Future Maternal Cardiovascular Risk MarkErs? Results From the SPACE Study
Authors: Margo B Minissian, Sarah Kilpatrick, Jo-Ann Eastwood, Wendie Robbins, Mary-Lynn Brecht, Galen Cook Wiens, C. Noel Bairey Merz, Lynn V Doering
Journal: Circulation (2017)

Introduction:  Traditional atherosclerotic cardiovascular disease (ASCVD) risk factors are established, however less is known about a woman’s cardiovascular response to pregnancy, which appears to predict future maternal ASCVD. Spontaneous preterm delivery (sPTD) is associated with a three-fold increased risk of future maternal ASCVD. We investigated the association between sPTD and markers of maternal ASCVD risk.   Hypothesis:  We hypothesize that compared to women with term delivery, women with sPTD will demonstrate greater vascular dysfunction postpartum.   Methods:  In a case controlled, matched study, we enrolled 20 women with sPTD (gestation ≤34 weeks) and 20 control women (gestation ≥39 weeks) matched for age (±5 years), parity, ethnicity and route of delivery. We collected vascular function measured by augmentation index (AIx75) and central pulse pressure (CPP), a measure of smooth muscle tone; and pulse wave velocity (PWV), a measure of arterial stiffness, within 24-72 hours postpartum. Mixed effects linear regression models were used to analyze the data.   Results:  The mean age at enrollment for sPTD and controls was 33 ± 6 years and 32 ± 6 years respectively. Women with sPTD had significantly lower AIx75 (24.10 ± 16.10% vs 39.90 ± 15.2%, p=0.001), and CPP (29.1±5 mmHg vs. 34.6 ±6 mmHg, p=0.004), respectively, compared to controls. Furthermore, women with sPTD and chorioamnionitis (n=8) had significantly lower AIx75 than matched controls (13.5 ±13.7% vs 39.9 ± 15.2% vs, p=0.001) respectively, while women with sPTD without chorioamnionitis had a trend toward lower AIx75 than matched controls (26.6± 15.9% vs. 39.9 ± 15.2%, p=0.065). There was no difference between sPTD and controls in PWV (5.12 ± 1.62 m/s vs 5.58 ± 1.51m/s, p=0.1219), respectively.   Conclusions:  Women with sPTD have significantly lower smooth muscle tone measured by AIx75 and CPP, but not lower arterial stiffness, measured by PWV compared to matched controls. These results suggest physiological differences between the two groups possibly due to compounding of vasodilatory effects in smooth muscle tone from localized chorioamnionitis and early gestational age. Further research is required to delineate mechanistic differences in sPTD and its association to future maternal ASCVD risk.
Evaluation of family perceptions of palliative medicine department family meetings: Before, during, and after.
Authors: Andrea Cartin, Sonia Ocampo, Adriana Méndez, Yandali Murillo, Daniela Zeledón, Rodbin Campos, María Luisa Rebolledo, Tatiana Hincapie, Julia Houed, Alberth Vasquéz, Marco Vinicio Williams
Journal: Journal of Clinical Oncology (2017)

156 Background: A Palliative Medicine Department (PMD) began in March of 2011 at a national hospital in Costa Rica. Treatment has focused on patient care, and attending the needs of the patients’ family; therefore, an integral approach to the family unit has been performed by a program of Family Meetings(FM). The program has allowed the families of Hematooncological disease patients to be involved in advanced care planning, and defining primary goals of treatment, while receiving information and psychological support. This study reports the families´ perception of the PMD FM before and after the meeting; and the evaluation of the family by the Palliative Care team, during the meeting. Methods: Information was gathered between of April and July of 2015 using a set of three questionnaires - one before, one during and one after - the meetings in the PMD. The information included population characteristics, the family’s feelings and concerns, and their level of satisfaction of their doubts being addressed and answered. Also, information was obtained concerning the agreed upon care plan and the diagnosis of the family established by the team. Results: A total of 47 family members ware included the study. Before, the interviewees most commonly referred feeling anxious (67.4%), sad (19%) and powerless (14%); the information they wanted to obtain was associated with the evolution and prognosis of the disease, and the best moment to initiate hospice care. Afterwards, families referred feeling anxious (35%), sad (34%) and powerless (31%). The most common family diagnosis was anticipatory grief (59%), and an adequate support network was identified in 38.5% of families. The agreed upon care plan mainly included education of coping and communication methods with the patient, patient homecare education, and immediate referral to hospice care. Conclusions: This study concluded that despite an increase in feelings of sadness and powerlessness, families reported a decrease in anxiousness; this was associated with families’ reporting that their doubts were addressed and answered in 97.9% of cases. Also, the set of questionnaires used during the Family meetings are a useful tool for patients’ family evaluation and diagnosis.
Abstract 17178: CRISPR-mediated Insertions or Deletions of the Human LMNA Homolog in Zebrafish as a Model of Early-onset Cardiac Conduction Disease
Authors: Kenshi Hayashi, Manu Beerens, Eva Buys, Patrick Sips, Micah L Burch, An Xiao, Yanbin Zhao, Noboru Fujino, Kenji Sakata, Tetsuo Konno, Hayato Tada, Akihiro Nomura, Toyonobu Tsuda, Ryota Teramoto, Yoji Nagata, Yoshihiro Tanaka, Masa-aki Kawashiri, Masakazu Yamagishi, Calum A MacRae
Journal: Circulation (2017)

Introduction: Next-generation sequencing has generated many gene variants associated with sudden cardiac death in diseases like cardiac conduction disease (CCD). Determining which of these are caus...
Oncology medical home: Payer return on investment (ROI).
Authors: Winston Wong, Joseph Cooper, Daniel Winn, Tim Olson, Ram Swarup Trehan, Jeffrey A. Scott, Bruce A. Feinberg
Journal: Journal of Clinical Oncology (2013)

e17582 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.
Availability and Use of Shared Data From Cardiometabolic Clinical Trials
Authors: Muthiah Vaduganathan, Amulya Nagarur, Arman Qamar, Ravi B. Patel, Ann Marie Navar, Eric D. Peterson, Deepak L. Bhatt, Gregg C. Fonarow, Clyde W. Yancy, Javed Butler
Journal: Circulation (2017)

Sharing of patient-level clinical trial data has been widely endorsed. Little is known about how extensively these data have been used for cardiometabolic diseases. We sought to evaluate the availability and use of shared data from cardiometabolic clinical trials.We extracted data from ClinicalStudyDataRequest.com, a large, multisponsor data-sharing platform hosting individual patient-level data from completed studies sponsored by 13 pharmaceutical companies.From January 2013 to May 2017, the platform had data from 3374 clinical trials, of which 537 (16%) evaluated cardiometabolic therapeutics (phase 1, 36%; phase 2, 17%; phase 2/3, 1%; phase 3, 42%; phase 4, 4%). They covered 74 therapies and 398 925 patients. Diabetes mellitus (60%) and hypertension (15%) were the most common study topics. Median time from study completion to data availability was 79 months. As of May 2017, ClinicalStudyDataRequest.com had received 318 submitted proposals, of which 163 had signed data-sharing agreements. Thirty of these proposals were related to cardiometabolic therapies and requested data from 79 unique studies (15% of all trials, 29% of phase 3/4 trials). Most (96%) data requesters of cardiometabolic clinical trial data were from academic centers in North America and Western Europe, and half the proposals were unfunded. Most proposals were for secondary hypothesis-generating questions, with only 1 proposed reanalysis of the original study primary hypothesis. To date, 3 peer-reviewed articles have been published after a median of 19 months (9-32 months) from the data-sharing agreement.Despite availability of data from >500 cardiometabolic trials in a multisponsor data-sharing platform, only 15% of these trials and 29% of phase 3/4 trials have been accessed by investigators thus far, and a negligible minority of analyses have reached publication.
Cardiovascular Outcomes and Risks After Initiation of a Sodium Glucose Cotransporter 2 Inhibitor
Authors: Jacob A. Udell, Zhong Yuan, Toni Rush, Nicholas M. Sicignano, Michael Galitz, Norman Rosenthal
Journal: Circulation (2017)

Clinical trials have shown cardiovascular benefits and potential risks from sodium glucose cotransporter 2 inhibitors (SGLT2i). Trials may have limited ability to address individual end points or safety concerns.We performed a population-based cohort study among patients with type 2 diabetes mellitus with established cardiovascular disease newly initiated on antihyperglycemic agents within the US Department of Defense Military Health System between April 1, 2013, and December 31, 2016. Incidence rates, hazard ratios (HRs), and 95% confidence intervals (CIs) for time to first composite end point of all-cause mortality and hospitalization for heart failure event, major adverse cardiovascular events (defined as all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke), and individual end points were evaluated using conditional Cox models comparing new SGLT2i users with other antihyperglycemic agents. The exploratory safety end point was below-knee lower extremity amputation. Intent-to-treat and on-treatment analyses were performed.After propensity matching, 25 258 patients were followed for a median of 1.6 years. Compared with non-SGLT2i, initiation of SGLT2i was associated with a lower rate of all-cause mortality and hospitalization for heart failure (1.73 versus 3.01 events per 100 person-years; HR, 0.57; 95% CI, 0.50-0.65) and major adverse cardiovascular events (2.31 versus 3.45 events per 100 person-years; HR, 0.67; 95% CI, 0.60-0.75). SGLT2i initiation was also associated with an ≈2-fold higher risk of below-knee lower extremity amputation (0.17 versus 0.09 events per 100 person-years; HR, 1.99; 95% CI, 1.12-3.51). Because of the disproportionate canagliflozin exposure in the database, the majority of amputations were observed on canagliflozin. Results were consistent in the on-treatment analysis.In this high-risk cohort, initiation of SGLT2i was associated with lower risk of all-cause mortality, hospitalization for heart failure, and major adverse cardiovascular events and higher risk of below-knee lower extremity amputation. Findings underscore the potential benefit and risks to be aware of when initiating SGLT2i. It remains unclear whether the below-knee lower extremity amputation risk extends across the class of medication, because the study was not powered to make comparisons among individual treatments.