tbuckley/cabot-search huggingface dataset:
Identifying positive deviants in healthcare quality and safety: a mixed methods study
Authors: Jane K O’Hara, Katja Grasic, Nils Gutacker, Andrew Street, Robbie Foy, Carl Thompson, John Wright, Rebecca Lawton
Journal: Journal of the Royal Society of Medicine (2018)

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.
Sequential Versus Concurrent Chemoradiation Therapy by Surgical Margin Status in Resected Non–Small Cell Lung Cancer
Authors: Vivek Verma, Amy C. Moreno, Waqar Haque, Penny Fang, Steven H. Lin
Journal: Journal of the National Comprehensive Cancer Network (2018)

Background: Postoperative chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) can be delivered sequentially (sCRT) or concurrently (cCRT). Without high-volume data, current guidelines recommend either option for patients with negative margins (M-) and cCRT for those with positive margins (M+). In this study, survival was compared between sCRT versus cCRT for M- and M+ disease; survival in patients who underwent sCRT was also assessed with chemotherapy-first versus radiotherapy (RT)-first. Methods: The National Cancer Database was queried for patients with primary NSCLC undergoing surgery followed by CRT. Patients were excluded if they received neoadjuvant chemotherapy or RT. Both M- and M+ (including R1 and R2) subcohorts were evaluated. Multivariable logistic regression ascertained factors associated with cCRT delivery. Kaplan-Meier analysis evaluated overall survival (OS); Cox proportional hazards modeling determined variables associated with OS. Propensity score matching aimed to address group imbalances and indication biases. Results: Of 4,921 total patients, 3,475 (71%) were M-, 1,446 (29%) were M+, 2,271 (46%) received sCRT, and 2,650 (54%) underwent cCRT. Median OS among the sCRT and cCRT groups in patients who were M- was 54.6 versus 39.5 months, respectively (P<.001); differences persisted following propensity score matching (P<.001). In the overall M+ cohort, outcomes for sCRT and cCRT were 36.3 versus 30.5 months (P=.011), but showed equipoise following matching (P=.745). In the R1 and R2 subsets, no differences in OS were seen between cohorts (P=.368 and .553, respectively). When evaluating the sCRT population, there were no OS differences between chemotherapy-first and RT-first after matching (P=.229). Conclusions: Postoperative sCRT was associated with improved survival compared with cCRT in patients with M- disease, with statistical equipoise in those with M+ disease. Differential sequencing of sCRT does not appear to affect survival.
A simplified scoring system in de novo follicular lymphoma treated initially with immunochemotherapy
Authors: Emmanuel Bachy, Matthew J. Maurer, Thomas M. Habermann, Bénédicte Gelas-Dore, Delphine Maucort-Boulch, Jane A. Estell, Eric Van den Neste, Réda Bouabdallah, Emmanuel Gyan, Andrew L. Feldman, Joan Bargay, Alain Delmer, Susan L. Slager, Maria Gomes da Silva, Olivier Fitoussi, David Belada, Hervé Maisonneuve, Tanin Intragumtornchai, Stephen M. Ansell, Thierry Lamy, Peggy Dartigues, Brian K. Link, John F. Seymour, James R. Cerhan, Gilles Salles
Journal: Blood (2018)
Positron Emission Tomography/Computed Tomography with 89Zr-girentuximab Can Aid in Diagnostic Dilemmas of Clear Cell Renal Cell Carcinoma Suspicion
Authors: Marlène C.H. Hekman, Mark Rijpkema, Erik H. Aarntzen, Sasja F. Mulder, Johan F. Langenhuijsen, Egbert Oosterwijk, Otto C. Boerman, Wim J.G. Oyen, Peter F.A. Mulders
Journal: European Urology (2018)
The area of the paarspinal muscle mass in patients with cirrhosis although not different from controls predicts cirrhosis-associated complications and death in a large mono-centric study
Authors: C. Engelmann, I. Nonnenmacher, L. Werlich, M. Moche, S. Ulrich, T. Kaiser, K. Sandra, K. Zeller, M. Bartels, T. Kahn, A. Surov, D. Seehofer, S. Schob, T. Berg
Journal: Journal of Hepatology (2018)
New Prevention Guidelines for Falls and Fractures—Looking Beyond the Letters
Authors: David B. Reuben
Journal: JAMA Internal Medicine (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 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
Peripheral eosinophilia in bullous pemphigoid: prevalence and influence on the clinical manifestation
Authors: K. Kridin
Journal: British Journal of Dermatology (2018)

Peripheral eosinophilia has been reported in 50-60% of patients with bullous pemphigoid (BP) and correlated positively with disease severity.To establish an association of peripheral eosinophilia with the different morphological characteristics of BP.The study was designed as a case-control study. Diagnosis of BP was grounded on well-established immunopathological criteria. Five age-, sex- and ethnicity-matched controls were randomly selected for each patient with BP.Overall, 225 patients with BP and 1125 control participants were enrolled. A total of 113 (50·2%) patients with BP and 49 (4·4%) controls had pathological peripheral eosinophilia (P < 0·001). An independent association between eosinophil count and the diagnosis of BP was observed [odds ratio 59·9 (per 1000 eosinophil μL-1 increase); P < 0·001]. Patients with BP with eosinophilia were significantly older at presentation (P = 0·003) and had increased palmoplantar involvement (P = 0·005), whereas patients with normal eosinophil counts had greater involvement of mucosal surfaces (P = 0·002) and the head and neck (P = 0·047). Patients with BP with extensive disease had significantly higher eosinophil counts than patients with mild-to-moderate disease (996·5 ± 1052·5 vs. 696·1 ± 962·6 cells μL-1 ; P < 0·001).Patients with BP with serum eosinophilia were significantly older and had higher palmoplantar involvement. Patients with BP with a normal eosinophil count were younger and presented more frequently with atypical clinical manifestations.
14Hematopoietic complement factor H deficiency elevates plasma IgM levels and reduces atherosclerotic lesion formation in Ldlr deficient mice
Authors: M Kiss, D Tsiantoulas, N Papac-Milicevic, L Goderle, M Ozsvar-Kozma, T Hendrikx, B Bartolini Gritti, F Porsch, F K Swirski, C J Binder
Journal: Cardiovascular Research (2018)
Cytokine‐Producing B Cells Promote Immune‐Mediated Bile Duct Injury in Murine Biliary Atresia
Authors: Joseph Bednarek, Brianna Traxinger, Dania Brigham, Jonathan Roach, David Orlicky, Dong Wang, Roberta Pelanda, Cara L. Mack
Journal: Hepatology (2018)

Biliary atresia (BA) is a neonatal T cell–mediated, inflammatory, sclerosing cholangiopathy. In the rhesus rotavirus (RRV)–induced neonatal mouse model of BA (murine BA), mice lacking B cells do not develop BA, and the lack of B cells is associated with loss of T‐cell and macrophage activation. The aim of this study was to determine the mechanism of B cell–mediated immune activation (antigen presentation versus cytokine production) in murine BA. Normal neonatal B cells in the liver are predominantly at pro‐B and pre‐B cellular development. However, BA mice exhibit a significant increase in the number and activation status of mature liver B cells. Adoptively transferred B cells into RRV‐infected, B cell–deficient mice were able to reinstate T‐cell and macrophage infiltration and biliary injury. Nonetheless, neonatal liver B cells were incompetent at antigen presentation to T cells. Moreover, 3‐83 immunoglobulin transgenic mice, in which B cells only present an irrelevant antigen, developed BA, indicating a B‐cell antigen–independent mechanism. B cells from BA mice produced a variety of innate and adaptive immune cytokines associated with immune activation. In vitro trans‐well studies revealed that BA B cells secreted cytokines that activated T cells based on increased expression of T‐cell activation marker cluster of differentiation 69. Conclusion : Neonatal liver B cells are highly activated in murine BA and contribute to immune activation through production of numerous cytokines involved in innate and adaptive immunity; this work provides increased knowledge on the capacity of neonatal B cells to contribute to an inflammatory disease through cytokine‐mediated mechanisms, and future studies should focus on targeting B cells as a therapeutic intervention in human BA.
Abstract 15876: Symptoms Consistent With Vagus Nerve Injury Post Radiofrequency Catheter Ablation for Atrial Fibrillation
Authors: Victoria Jacobs, Heidi T May, Brian G Crandall, Michael J Cutler, John D Day, Ben Chisum, Becca Ballantyne, Charles Mallender, Jeffrey S Osborn, J P Weiss, T J Bunch
Journal: Circulation (2016)

Introduction: The vagus nerve injury during catheter ablation for atrial fibrillation (AF) can significantly impact quality of life and result in symptoms of dysphagia, gastroesophageal reflex dise...
Dual Suppressive Effect of miR-34a on the FOXM1/eEF2-Kinase Axis Regulates Triple-Negative Breast Cancer Growth and Invasion
Authors: Recep Bayraktar, Cristina Ivan, Emine Bayraktar, Pinar Kanlikilicer, Nashwa N. Kabil, Nermin Kahraman, Hamada A. Mokhlis, Didem Karakas, Cristian Rodriguez-Aguayo, Ahmet Arslan, Jianting Sheng, Stephen Wong, Gabriel Lopez-Berestein, George A. Calin, Bulent Ozpolat
Journal: Clinical Cancer Research (2018)

Purpose: Recent studies indicated that dysregulation of noncoding RNAs (ncRNA) such as miRNAs is involved in pathogenesis of various human cancers. However, the molecular mechanisms underlying miR-34a are not fully understood in triple-negative breast cancer (TNBC).Experimental Design: We performed in vitro functional assays on TNBC cell lines to investigate the role of miR-34a in FOXM1/eEF2K signaling axis. TNBC tumor xenograft models were used for in vivo therapeutic delivery of miR-34a.Results: In this study, we investigated the role of p53-driven ncRNA miR-34a and found that miR-34a is associated with significantly longer patient survival in TNBC and inversely correlated with levels of proto-oncogenic eEF2K, which was associated with significantly shorter overall patient survival. We showed that miR-34a directly binds to the 3'-untranslated region of eEF2K and FOXM1 mRNAs and suppresses their expression, leading to inhibition of TNBC cell proliferation, motility, and invasion. Notably, restoring miR-34a expression recapitulated the effects of inhibition of eEF2K and FOXM1, the transcription factor for eEF2K and the direct target of p53, in TNBC cell lines, whereas overexpression of eEF2K and FOXM1 rescued the effects and signaling pathways mediated by miR-34a. Moreover, in vivo therapeutic delivery of miR-34a nanoparticles by systemic intravenous administration delayed tumor growth of two different orthotopic TNBC tumor xenograft models by inhibiting eEF2K and FOXM1, intratumoral proliferation and angiogenesis, and inducing apoptosis.Conclusions: Overall, our findings provide new insights into the tumor suppressor role of miR-34a by dual-targeting of FOXM1/eEF2K signaling axis and suggest that miR-34a-based gene therapy may be a potential therapeutic strategy in TNBC. Clin Cancer Res; 24(17); 4225-41. ©2018 AACR.
NHS faces huge challenge to become digitally driven by 2028, a decade later than originally promised
Authors: Nigel Hawkes
Journal: BMJ (2018)

The NHS is a world leader in using pagers and fax machines and should be ashamed of it, says a report by a Conservative MP, Alan Mak.1 New technology could transform the service, he concludes, but it relies instead on devices that were new in the 1980s.

The NHS is the largest user of fax machines in the world and is home to 10% of the pagers in circulation worldwide. These antiques rub shoulders with 70 000 NHS computer systems still running on Windows XP, which has lacked security updates or technical support from Microsoft for over four years.

Mak’s report is published by the Centre for Policy Studies, a Conservative think tank, and paints a bright future for an NHS transformed by digital technology. But it says that failures have so far been more common than successes, the national programme for IT launched in 2002 being by far …
Blood Neutrophils Are Reprogrammed in Bronchiectasis
Authors: Pallavi Bedi, Donald J. Davidson, Brian J. McHugh, Adriano G. Rossi, Adam T. Hill
Journal: American Journal of Respiratory and Critical Care Medicine (2018)

Rationale: Excessive neutrophilic airway inflammation is the central feature of bronchiectasis, but little is known about neutrophils in bronchiectasis.Objectives: To assess blood neutrophil phenotype in patients with bronchiectasis while stable and during exacerbations.Methods: In the clinically stable arm of this study, there were eight healthy volunteers, eight patients with mild bronchiectasis, and eight patients with severe bronchiectasis. In addition, six patients with severe bronchiectasis were compared with six patients with community-acquired pneumonia at the start and end of an exacerbation. We assessed neutrophils for spontaneous apoptosis, cell surface marker expression, degranulation, reactive oxygen species generation, phagocytosis, and killing of Pseudomonas aeruginosa (PAO1). In addition, blood neutrophil function was compared with airway neutrophil function in bronchiectasis.Measurements and Main Results: In stable bronchiectasis, compared with healthy volunteers, blood neutrophils had significantly prolonged viability, delayed apoptosis, increased CD62L shedding, upregulated CD11b expression, increased myeloperoxidase release, and impaired neutrophil phagocytosis and killing of PAO1. Bronchiectatic airway neutrophils had significantly lower bacterial phagocytosis and killing than their matched autologous blood neutrophils. Both blood and airway neutrophil phagocytosis and killing were impaired at the start of an exacerbation and improved following antibiotic treatment. In pneumonia, there was a significant improvement in phagocytosis and killing after treatment with antibiotics. During infections, there was no difference in phagocytosis, but there was significantly increased bacterial killing at the start and end of infection in pneumonia compared with bronchiectasis exacerbations.Conclusions: In bronchiectasis stable state, peripheral blood neutrophils are reprogrammed and have prolonged survival. This impairs their functional ability of bacterial phagocytosis and killing, thereby perpetuating the vicious circle in bronchiectasis.
Abstract 18702: Obesity Paradox in Women Undergoing Percutaneous Coronary Intervention With Drug-eluting Stents: Results From a Patient-level Pooled Analysis of Randomized Controlled Trials
Authors: Arash Ehteshami Afshar, Gennaro Giustino, Neda Dianai-Maleki, Usman Baber, Samantha Sartori, Melissa Aquino, Robert Saporito, Philippe G Steg, Stephan Windecker, Martin B Leon, Gregg W Stone, George D Dangas, Raban V Jeger, Marie-Claude Morice, Takeshi Kimura, Hyo-Soo Kim, Roxana Mehran
Journal: Circulation (2015)

Background: Obesity is associated with increased cardiovascular risk. Paradoxically, however, patients with higher body mass index (BMI) might have better outcomes after acute coronary syndrome treated with percutaneous coronary intervention (PCI). The effect of different BMI categories on long-term cardiac outcomes in women receiving drug-eluting stents (DES) has not been well characterized. Methods: We pooled patient-level data for female participants from 26 randomized trials of DES in patients with coronary artery disease. Patients were stratified according to BMI category in BMI &amp;lt 25 (normal weight), 25 to 30 (overweight), &amp;gt 30 to 35 (obese) or &amp;gt 35 (Morbidly obese). Primary endpoint was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction or target lesion revascularization. Secondary endpoint was all-cause mortality. Results: From 11,557 women included in the pooled database, 9,420 had received DES and had BMI data available. Patients with higher BMI were significantly younger and more likely to have hypertension, hyperlipidemia and diabetes mellitus. However, they exhibited lower anatomical and procedural complexity. There were no differences in crude 3-year MACE rates across the 4 groups (14.6% vs. 12.9% vs. 14% vs. 13.2%; p = 0.34) but normal BMI group was associated with increased all-cause mortality (5.9% vs. 4.0% vs. 4.2% vs. 4.5%; p = 0.01). Following multivariable adjustment the 3-year risk of MACE progressively decreased with increase in BMI category (HR: 0.76, 95% CI: 0.61 - 0.94; HR: 0.71, 95% CI: 0.54 - 0.92; HR: 0.52, 95% CI: 0.38 - 0.73; p &amp;lt 0.001; for overweight, obese and severely obese, respectively). Similarly, risk of 3-year mortality independently decreased in all BMI categories compared with normal BMI (HR: 0.41, 95% CI: 0.28 - 0.61; HR: 0.51, 95% CI: 0.32 - 0.80; HR: 0.48, 95% CI: 0.28 - 0.81; for overweight, obese and severely obese, respectively, p &amp;lt 0.001). Conclusion: Following PCI with DES, lower rather than higher BMI appears to be associated with higher risk of cardiac events and mortality. The reason for this paradoxical effect of obesity is not clear but may include unknown or unmeasured confounding variables or more aggressive therapies.
Preventive effect of mesenchymal stem cell culture supernatant on luminal stricture after endoscopic submucosal dissection in the rectum of pigs
Authors: Momoko Tsuda, Shunsuke Ohnishi, Takeshi Mizushima, Hidetaka Hosono, Kenichi Yamahara, Marin Ishikawa, Satoshi Abiko, Takehiko Katsurada, Yuichi Shimizu, Naoya Sakamoto
Journal: Endoscopy (2018)

Abstract Background Mesenchymal stem cells (MSCs) are valuable in regenerative medicine, and MSC culture supernatant (MSC-CS) reportedly inhibits inflammation and fibrosis. We investigated whether colorectal luminal stricture develops after circumferential endoscopic submucosal dissection (ESD) in the colorectum, and whether the development of luminal stricture could be prevented by using MSC-CS enema. Methods In the first experiment, we performed circumferential ESD in the rectums or distal colons of pigs (n = 4 in each group). We sacrificed the pigs on Day 22 and measured the degree of luminal stricture. In the second experiment, we performed circumferential ESD in the rectums of pigs and administered an MSC-CS gel or a control gel enema after ESD for 4 days. We sacrificed the pigs on Day 8 (n = 3 in each group) or 22 (n = 3 in each group) to measure the degree of luminal stricture, and performed histological analysis. Results Severe luminal stricture was observed in the rectum but not in the distal colon. Moreover, fiber accumulation in the submucosa and hypertrophy of the muscularis propria were observed in the rectum but not in the distal colon. The degree of luminal stricture in the rectum was significantly lower in the MSC-CS group than in the control group. Furthermore, MSC-CS attenuated myofibroblast activation and hypertrophy of the muscularis propria on Day 22, and reduced inflammatory cell infiltration on Day 8. Conclusions Luminal stricture after ESD developed only in the rectum because of the difference in myofibroblast activation and fiber accumulation. In addition, MSC-CS enema prevented luminal stricture after ESD, possibly by inhibiting the inflammatory reaction and fibrosis.
Discovering New Benefits From Old Drugs With Big Data—Promise for Parkinson Disease
Authors: Abby L. Olsen, Trond Riise, Clemens R. Scherzer
Journal: JAMA Neurology (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 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
Fecal blood loss comparing beta-cyclodextrine-piroxicam with naproxen in a 48-week study
Authors: M.C.W. Creemers, M.A. van 't Hof, M.J.A.M. Franssen, L.B.A. van de Putte, F.W.J. Gribnau, P.L.C.M. van Riel
Journal: Annals of the Rheumatic Diseases (2000)