tbuckley/cabot-search huggingface dataset:
Outcomes of Positive Airway Pressure for Sleep Apnea—Reply
Authors: Bruce Neal, Zien Zhou, R. Doug McEvoy
Journal: JAMA (2017)

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Comparative Effectiveness of Resection vs Surveillance for Pancreatic Branch Duct Intraductal Papillary Mucinous Neoplasms With Worrisome Features
Authors: Yinin Hu, Lily E. Johnston, Vanessa M. Shami, Todd W. Bauer, Reid B. Adams, George J. Stukenborg, Victor M. Zaydfudim
Journal: JAMA Surgery (2017)

<h3>Importance</h3> The 2012 international consensus guidelines defined a subcategory of pancreatic branch duct intraductal papillary mucinous neoplasms with “worrisome features,” which may be followed with close surveillance. However, given the poor prognosis of invasive malignancy, the role of early, upfront resection requires further investigation. <h3>Objective</h3> To compare the utility of upfront resection vs long-term surveillance. We hypothesized that surveillance of these cystic neoplasms would offer greater long-term utility. <h3>Design, Setting, and Participants</h3> A Markov decision analysis model was constructed to estimate and compare 2 management strategies: early resection and long-term surveillance. Estimates for the utility of outcomes, probabilities of transitions between disease states, and probabilities of surgical morbidity were derived from a literature review of articles published between 1997 and 2014. The comparative effectiveness model’s variable estimates were based on data published predominantly by high-volume, tertiary referral centers. Model probability variable estimates were derived from large, retrospective, single-institution reports. For utility variables, estimates derived from studies using standard-gamble or time-tradeoff methods were given greater weight. <h3>Main Outcomes and Measures</h3> Expected utility was measured in terms of quality-adjusted life years using 3% annual discount. Probabilistic and 1-way sensitivity analyses were performed to assess the potential effects of uncertainty in estimates of key model variables. <h3>Results</h3> Early resection yielded 11.63 quality-adjusted life-years during 20 years of follow-up compared with 11.06 for surveillance. Probabilistic sensitivity analysis indicated that resection has a 94% likelihood of being more effective than surveillance. Early resection obtained greater utility only if each of the following criteria are met: life expectancy is at least 18 years, surgical mortality is less than 4.3%, and baseline preoperative utility is at least 0.78. Additional drivers of the model outcomes include the rate of progression from worrisome to high-risk features and the likelihood of finding cancer on resection for neoplasms with high-risk stigmata. <h3>Conclusions and Relevance</h3> Early resection compares favorably with surveillance in the management of branch duct intraductal papillary mucinous neoplasms with worrisome features. However, careful consideration of patient factors and surgeon outcomes is imperative.
Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction
Authors: Kevin S. Shah, Haolin Xu, Roland A. Matsouaka, Deepak L. Bhatt, Paul A. Heidenreich, Adrian F. Hernandez, Adam D. Devore, Clyde W. Yancy, Gregg C. Fonarow
Journal: Journal of the American College of Cardiology (2017)
Shiga Toxin–Producing <i>E. coli</i> Infections Associated with Flour
Authors: Samuel J. Crowe, Lyndsay Bottichio, Lauren N. Shade, Brooke M. Whitney, Nereida Corral, Beth Melius, Katherine D. Arends, Danielle Donovan, Jolianne Stone, Krisandra Allen, Jessica Rosner, Jennifer Beal, Laura Whitlock, Anna Blackstock, June Wetherington, Lisa A. Newberry, Morgan N. Schroeder, Darlene Wagner, Eija Trees, Stelios Viazis, Matthew E. Wise, Karen P. Neil
Journal: New England Journal of Medicine (2017)

In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin-producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer.A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples.A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility.This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens.
Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe
Authors: David Tate, Halim Awadie, Farzan Bahin, Lobke Desomer, Ralph Lee, Steven Heitman, Kathleen Goodrick, Michael Bourke
Journal: Endoscopy (2017)

Abstract Background and study aims Large series suggest endoscopic mucosal resection is safe and effective for the removal of large (≥ 10 mm) sessile serrated polyps (SSPs), but it exposes the patient to the risks of electrocautery, including delayed bleeding. We examined the feasibility and safety of piecemeal cold snare polypectomy (pCSP) for the resection of large SSPs. Methods Sequential large SSPs (10 – 35 mm) without endoscopic evidence of dysplasia referred over 12 months to a tertiary endoscopy center were considered for pCSP. A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months. Results 41 SSPs were completely removed by pCSP in 34 patients. The median SSP size was 15 mm (interquartile range [IQR] 14.5 – 20 mm; range 10 – 35 mm). The median procedure duration was 4.5 minutes (IQR 1.4 – 6.3 minutes). There was no evidence of perforation or significant intraprocedural bleeding. At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. First follow-up has been undertaken for 15 /41 lesions at a median of 6 months with no evidence of recurrence. Conclusions There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding.
Mumps epidemic in North America proves unusually stubborn
Authors: Owen Dyer
Journal: BMJ (2017)

A surge in cases of mumps in North America that began at the end of 2015 shows no sign of slowing, show figures released by the US Centers for Disease Control and Prevention (CDC) covering the first nine months of 2017.1

The CDC reports that the year to 7 October saw 4667 cases of mumps in 47 states—on course to narrowly surpass the 5833 US cases in 2016, which were a nearly fivefold rise from 2015. This two year surge is unusual, as previous spikes in mumps cases have typically lasted for months, not years.

“Mumps outbreaks are on the rise,” Janell Routh, CDC paediatrician, told the New York Times . “We are seeing it in a young …
QOL analysis of a phase II randomized controlled clinical trial comparing efficacy of cabazitaxel versus docetaxel as second line or above therapy in recurrent head and neck cancer
Authors: R. Chanana, V. Noronha, A. Joshi, V. Patil, S. Dhumal, A. Bhattacharya, A. Chandrasekharan, N. Pande, V.T. Talreja, S. Turkar, S. Shrirangwar, K. Prabhash
Journal: Annals of Oncology (2017)
Infezioni da Salmonella enterica del sierotipo Oranienburg associate con il consumo di formaggio Tirolese prodotto localmente
Authors: F Allerberger, P Kreidl, M P Dierich, E Klingsbichel, D Jenewein, C Mader, D Khaschabi, M Schönbauer, C Berghold
Journal: Eurosurveillance (2000)

Nel Tirolo (Austria) tra il 10 agosto e il 29 settembre 1999 sono stati registrati 16 casi, confermati da coltura, di infezioni enteriche da Salmonella enterica sierotipo Oranienburg. Di questi, 10 hanno avuto diarrea con sangue e 6 erano portatori asintomatici. Attraverso interviste a 11 dei 16 casi, si e potuto collegare l'epidemia a una fattoria alpina e al consumo di formaggio di latte di mucca prodotto localmente. Le indagini microbiologiche hanno rivelato la presenza di S. Oranienburg nel formaggio e nel pollaio. In questa fattoria il pollaio era vicino all'area di produzione del formaggio e le galline vi potevano circolare liberamente.
Abstract 16176: Impact of IVUS-guided PCI for Reducing Adverse Cardiovascular Events -One Year Data From Japanese Multicenter (KICS) Registry
Authors: Tomokazu Ikemoto, Kenji Sakamoto, Takayoshi Yamashita, Noriaki Tabata, Tomonori Akasaka, Daisuke Sueta, Takashi Miyazaki, Kenichi Tsujita, Sunao Kojima, Koichi Kaikita, Seiji Hokimoto
Journal: Circulation (2016)

Introduction:  Although intravascular ultrasound (IVUS) has been widely used in clinical settings, randomized data demonstrating the effect of IVUS for clinical events are limited. Lately, favorable results of IVUS-guided percutaneous coronary intervention (PCI), compared with Angio-guided PCI, were observed in previous studies.   Hypothesis:  In Japanese population, large-scale data will demonstrate the utility of IVUS-guided PCI, especially in terms of mortality.   Methods:  The Kumamoto Intervention Conference Study (KICS) is multicenter registry enrolling consecutive patients undergoing PCI in 16 centers in Japan and 6,219 consecutive procedures were enrolled in this registry. To elucidate the impact of IVUS usage, 5,801 subjects after successful PCI with 12-month follow-up data were enrolled.   Results:  In overall analysis, higher age, acute coronary syndrome (ACS), urgent PCI, and prior myocardial infarction (MI) were negative predictors for IVUS usage. Critical adverse events (all-cause mortality, cardiac death, nonfatal myocardial infarction and stent thrombosis) during 12-month follow up were significantly lower in the IVUS-guided group than in the Angio-guided group (3.4% vs 6.7%, 16% vs 4.7%, 0.5% vs 1.4%, 0.1% vs 0.2%, p  30 days after PCI), Kaplan-Meier analyses for cardiac death showed a significant difference between the 2 groups. In subgroup analysis, favorable results for IVUS usage in cardiac death were consistent with various patient status (in patients with diabetes, chronic kidny disease, ACS, urgent PCI, bare metal stent and drug eluting stent). Even after adjustment by propensity-score matching with predictive factors for cardiac death, IVUS-guided PCI was associated with lower incidence rate in prognostic events, especially in cardiac death compared with angio-guided PCI (2.1% vs 3.6%, p=0.004).   Conclusions:  In Japanese patients treated with IVUS-guided PCI, the rates of adverse cardiovascular events were significantly lower than with angiography-guidance alone, regardless of patient status in PCI, stent type, or comorbid conditions.
Role created to bridge gap between trainees and senior managers is hailed a success
Authors: Abi Rimmer
Journal: BMJ (2017)

A scheme developed by the Royal College of Physicians to help junior doctors improve their clinical leadership skills has been hailed as a success.

An independent review of the college’s Future Hospital Programme said that the role of chief registrar, created as part of the programme, has helped to support trainees.1 The programme was developed from the Future Hospital Commission and aims to improve care of patients by bringing specialist care closer to them.

The chief …
Abstract 18998: Incidentally Developed Atrial Fibrillation With During Electrophysiologic Study in Patients With Paroxysmal Supraventricular Tachycardia
Authors: Yong Soo Baek, Jong-Il Choi, Ra Seung Lim, Sung Hyun Kang, Jeong Hoon Chai, Juyong Sung, Soonwha Shin, Kyoung Jeong Ko, Hyun Soo Lee, Suk-kyu Oh, Yun Gi Kim, Hee-Soon Park, Kwang-No Lee, Seung-Young Roh, Jaemin Shim, Young-Hoon Kim
Journal: Circulation (2017)

Introduction: Atrial fibrillation (AF) can incidentally occur during electrophysiologic study (EPS) for paroxysmal supraventricular tachycardia (PSVT). We sought to investigate the clinical impact ...
S-1 and CPT-11 plus ramucirumab (IRIS+Rmab) as second-line chemotherapy for patients with oxaliplatin-refractory metastatic colorectal cancer: A multicenter phase II study in Japan (N-DOCC-F-C-1701)
Authors: K. Kobayashi, M. Morita, S. Ito, Y. Inoue, I. Yamaguchi, T. Kosaka, S. Kuba, C. Sakimura, A. Soyama, T. Adachi, S. Ohno, S. Kobayashi, T. Hara, M. Hidaka, N. Hayashida, K. Yamanouchi, K. Kanetaka, M. Takatsuki, S. Eguchi
Journal: Annals of Oncology (2017)
P2.05-018 Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Early-Stage Non-Small Cell Lung Cancer: Short-Term Outcomes of a Randomized Trial
Authors: D. Situ, H. Long, Q. Tan, Q. Luo, Z. Wang, G. Jiang, T. Rong
Journal: Journal of Thoracic Oncology (2017)
Barriers between providers and families regarding palliative care integration in a multidisciplinary pediatric oncology practice.
Authors: Lauren Draper, Samantha Pannier, Karely Mann, Douglas Beaty Fair, Holly Perlman, Dominic Moore, Anne C. Kirchhoff
Journal: Journal of Clinical Oncology (2017)

121 Background: Pediatric oncology patients are known to have high symptom burden. The pediatric oncology population is a natural fit for early integration of palliative care (PC), yet there are often systemic and communication barriers. We assessed oncologists and supportive care providers’ beliefs about PC and described how well prognosis is currently communicated between clinical team members and families. Methods: Primary Children’s Hospital (PCH) is the only pediatric tertiary care hospital serving the Mountain West region. We conducted surveys and semi-structured interviews with all pediatric oncologists at PCH (N = 12) and supportive care providers such as nurses and social workers (N = 13). Surveys were also administered to caregivers of patients (N = 23). Descriptive statistics were generated. Results: Oncologists and and supportive care providers differ even in their beliefs about who should receive PC and when it should begin. 41.7% (N = 5) of attending pediatric oncologists strongly agreed that their patients could benefit from a comprehensive PC consultation and that this should happen around the time of diagnosis. Of the supportive care providers only 15% (N = 2) strongly agree that their patients could benefit from a PC consultation, but 38% strongly agree it should begin at the time of diagnosis. Of the physicians, 33% (N = 4) believe the system currently in place is “adequate,” while only 8% (N = 1) of supportive care providers agree. Physicians report 100% of the time that they “often or always” discuss prognosis with a family, but only 44% (N = 10) of caregivers strongly agree that prognosis was clearly explained. 57% (N = 4) of patients report additional emotional support would have been helpful. Conclusions: Less than half of providers feel their patients could benefit from a PC consultation, despite the majority feeling the current system is inadequate. Also, providers and caregivers perceive discussions about prognosis, a key part of comprehensive PC, in different ways. Our findings demonstrate that a major barrier to the integration of a comprehensive PC program may be a lack of agreement among providers on the team and ineffective communication with families.
Activité grippale hétérogène en Europe
Authors: W J Paget, T J Meerhoff, H Rebelo de Andrade
Journal: Eurosurveillance (2003)

L'activite grippale en Europe au cours de la saison 2002-2003 a varie aussi bien en terme d'intensite de l'activite clinique qu'en termes de types et sous-types des virus en circulation. Generalement, la grippe B etait le type predominant dans les regions 'occidentales' d'Europe, (Portugal, Espagne, Royaume-Uni et Irlande), et la grippe A (H3N2) dans les regions 'centrales' et 'orientales' (Allemagne, Italie, Danemark, Suisse, Pologne, Slovenie, la Republique slovaque, les Pays-Bas). Certains pays ont connu une co-circulation, avec une premiere activite associee a la grippe B, puis une seconde, associee a la grippe A (Belgique, France et Espagne). En regle generale, les niveaux d'intensite (compares aux annees precedentes) etaient faibles (saison moderee) et les periodes d'activite grippale etaient plus longues dans les pays ou la grippe B etait predominante par rapport a ceux ou la grippe A (H3N2) l'etait. Tous les pays ou la grippe A (H3N2) etait predominante ont declare des niveaux eleves d'intensite compares aux annees precedentes : la Republique Tcheque, le Danemark, l'Allemagne et la Pologne. Dans les six pays disposant des incidences par tranche d'âge, les taux les plus eleves ont ete observes chez les 0-14 ans. Les souches du virus de la grippe qui circulaient en Europe etaient bien appariees aux souches entrant dans la composition du vaccin anti-grippal. Un faible nombre d'isolats (de type A/Fujian/411/2002 (H3N2)) rapportes en fin de saison presentaient une reactivite reduite aux anti-sera de la souche de vaccin. La composition du vaccin anti-grippal 2003-2004 est identique a celle du vaccin de la saison 2002-2003.
The expanding epidemic of HIV-1 in the Russian Federation
Authors: Chris Beyrer, Andrea L. Wirtz, George O’Hara, Nolwenn Léon, Michel Kazatchkine
Journal: PLoS Medicine (2017)

had been increasing at some 10% per year from 2011-2016 [2].Among Russian men aged 30-39 years of age, a group that has the highest male infection burden, some 2.8% were living with HIV infection in 2016 [2].AIDS deaths, too, are rising and now negatively impact life expectancy [3].From January to June 2017, some 14,631 AIDS deaths were recorded, a 13.5% increase over the previous 6-month period [3].HIV/AIDS has risen to feature in the top 10 causes of premature death in the RF-a 35% increase from 2005 [4].These realities should concern all who seek global control of the HIV pandemic.Despite the severity of this epidemic, including its scale, scope, and trajectory, remarkably little attention has been paid to the associated public health crisis in the international scientific literature.This may in part be due to the limited availability of data on HIV-1 in the RF that are presented and published outside Russia, and to the few international collaborations on HIV in the RF under the current administration.Therefore, we reviewed publicly available data in the Russian language on HIV-1 in the RF through mid-2017 and analyzed Russian federal and oblast (province)-level HIV policies and programs to assess the current burden of HIV-1 prevalence and incidence, the state of prevention programs as they relate to the epidemiology of HIV in the country, and policy impacts of current Russian laws, policies, and practices on the future trajectory of the epidemic.Cumulative Russian federal data through mid-2017 are available on Russian language websites from several oblasts, a Federal AIDS Center report, and from Rosstat, the Russian Federal Statistics Bureau [2,[5][6][7].Russian federal data are reported as cumulative diagnoses and as new diagnoses per 100,000 population.We used these data to generate burden maps of reported prevalence and of new diagnoses, by oblast, across the RF (Fig 1 andFig 2).Neither measure can be said to yield true HIV prevalence or incidence infection estimates, since they do not account for deaths (in the case of cumulative infections) or estimate the rate of new infections,
The yield of staging investigations in triple-negative breast cancer patients.
Authors: Renee Elizabeth Lester, Kara E. Laing
Journal: Journal of Clinical Oncology (2014)

1127 Background: Current guidelines suggest that asymptomatic Stage I and II node negative patients do not require staging investigations to rule out metastatic disease. Our provincial cancer centre’s guidelines released last year recommends blood work (CBC, kidney and liver function), CT scan of chest and abdomen, and bone scan for node positive breast cancer patients. Methods: We conducted a retrospective chart review of all triple-negative breast cancer patients diagnosed from January 2008 to December 2010. Triple negative is defined as <1% staining on immunohistochemistry (IHC) for both estrogen receptor (ER) and progestin receptor (PR) as well as the absence of HER2 overexpression on IHC or negative for gene amplification by FISH. The collected data included patients age, date of diagnosis, tumor size, grade, number of lymph nodes, presence/absence of lymphovascular invasion, and whether or not staging investigations were performed and their results. Results: One hundred and twelve patients were diagnosed with triple negative breast cancer in our centre between January 2008 and December 2010. Ninety five (86%) underwent staging investigations, 43 (45%) ordered by the medical oncologist and the remainder arranged by the referring physician. Twenty out of thirty stage I patients had some form of imaging (either bone scan, liver ultrasound, or CT). This did not yield any positive studies for metastatic disease. Similarly 25 out of 29 stage IIA patients were staged. Of those 25 patients, 12% had evidence of metastatic spread diagnosed on imaging. All 19 stage IIB patients were staged; of which 10.5% were also found to have metastatic disease. Conclusions: Stage I asymptomatic TNBC patients do not require routine staging investigations as the yield is quite low. However this study suggests that newly diagnosed triple negative patients that are stage II (either node negative or node positive) should undergo routine imaging to rule out any metastatic spread as this changes the intent of therapy. Further data collection is warranted. Stage # of pts # staged # by MO # positive Yield 1 30 20 6 0 0% 2A 29 25 14 3 12% 2B 19 19 9 2 10.5% 3A 15 14 7 1 7% 3B 6 6 3 0 3C 1 1 1 0 4 10 10 3 6 Total 110 86% 39% 12