tbuckley/cabot-search huggingface dataset:
Abstract P009: Risk of Mortality According to Burden of Atrial Fibrillation: Results From a 60-year Cohort Study
Authors: William F McIntyre, Mahmoud Tourabi, Philip D St John, Robert B Tate
Journal: Circulation (2016)

Introduction: Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and is associated with an increased risk of stroke and mortality. These risks can be modified with oral anticoagulation therapy. Clinically, the arrhythmia can be permanent or intermittent. Prior studies that have used time-constant, categorical covariates to examine the relationship between the pattern of AF and the occurrence of adverse events have produced conflicting results. We hypothesized that the amount of time that patients spend in AF, hereinafter termed arrhythmia “burden”, may be important in predicting adverse events. Objective: To examine the effects of the burden of AF on all-cause mortality. Methods: The Manitoba Follow-Up Study is a longitudinal, prospective study of 3983 originally healthy young men (mean age at entry 30 years) who have been followed with routine medical and electrocardiographic examinations since 1948. After 60 years of follow-up to July 1, 2008, AF had been documented on the electrocardiograms of 581 men (15% of the cohort) and 3182 (80%) of the original cohort had died. We created a Cox proportional hazards model with time-dependent covariates to estimate relative risks for mortality according to AF burden. AF status during each follow-up visit was classified as persistent when the patient was in AF on consecutive examinations, transient when the patient reverted to sinus rhythm after being in AF and incident when the patient developed AF after a period in sinus rhythm. Results: Results of the Cox proportional hazards regression model are displayed in the Table. Age, persistent AF and incident AF were all significant variables in the model. Holding all the other variables constant, persistent AF increased the risk of death by two times and incident AF increased the risk of death by 87%. Conclusions: Persistent AF and incident AF are associated with increased all-cause mortality. Estimating AF burden may have implications for risk stratification in patients with AF.
Pharmacy contributions to improving care and sustaining change in a comprehensive cancer center.
Authors: Megan Brown, David L. Crosby, Megan H. Howe, Konstantin H. Dragnev
Journal: Journal of Clinical Oncology (2018)

150 Background: Delivery of care in an outpatient hematology/oncology clinic is complex and requires the coordination of numerous services for timely and efficient treatment of patients. The Norris Cotton Cancer Center in Lebanon, NH, began a comprehensive assessment of clinic and infusion operations in 2012 and developed a system-wide initiative to address inconsistent performance in infusion, clinic and pharmacy services. Methods: Cancer center staff and leadership were trained on lean six-sigma methodology to initiate system-wide improvements through targeted project work. We collaborated with quality improvement experts and our analytics team to obtain and analyze data from our EMR. Then we established process measures for all operational areas and a key performance indicator (KPI) for hem/onc infusion: “on time performance.” The pharmacy contributed to on-time performance by focusing improvement initiatives on turn-around time (TAT) for clinical reviews and order verification, TAT for drug preparation, and initiating a process for pre-making chemotherapy. Results: "On-time performance” was initially defined as the percentage of patients whose first medication began within 45 minutes of their scheduled infusion start time. The baseline of 63% in 2012 was improved to 86% in 2018. Through sustained process improvement work and concerted efforts to further improve the patient experience and utilization of resources, an interdisciplinary team targeted a 15 minute on-time performance measurement; this baseline of 28% was improved to 47% in less than a year. In 2012 the pharmacy set a goal of reviewing and verifying orders within 30 minutes, and completing drug preparation within 45 minutes of order verification. The baseline percentage of orders reviewed within 30 minutes was 47% and this increased to 93% in 2018. Our baseline percentage of doses prepared within 45 minutes was 37% and the current median time for drug preparation across all orders is 45 minutes. The pharmacy currently pre-makes approximately 11% of doses. Conclusions: The cancer center pharmacy increased efficiency and improved on-time performance in delivery of care by using data-driven continuous improvement methods.
Use of a Wearable Activity Monitor in a Home-Based Exercise Intervention for Peripheral Artery Disease
Authors: Pierre-Yves de Müllenheim, Pierre Abraham, Bénédicte Noury-Desvaux
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
Abstract 19901: Significance of an Increase in Diastolic Blood Pressure During a Stress Test in Terms of Comorbidities and Long-Term Total and CV Mortality
Authors: Nóra Sydó, Tibor Sydó, Béla Merkely, Nasir Hussain, Shausha Farooq, Karina G Carta, Francisco Lopez-Jimenez, Joseph G Murphy, Thomas G Allison
Journal: Circulation (2016)

Introduction: A gradual decrease in diastolic blood pressure (DBP) with exercise is considered a normal response, but the significance of an increase in DBP with exercise has not been validated. Hy...
Pembrolizumab plus Chemotherapy for Squamous Non–Small-Cell Lung Cancer
Authors: Luis Paz-Ares, Alexander Luft, David Vicente, Ali Tafreshi, Mahmut Gümüş, Julien Mazières, Barbara Hermes, Filiz Çay Şenler, Tibor Csőszi, Andrea Fülöp, Jerónimo Rodríguez-Cid, Jonathan Wilson, Shunichi Sugawara, Terufumi Kato, Ki Hyeong Lee, Ying Cheng, Silvia Novello, Balazs Halmos, Xiaodong Li, Gregory M Lubiniecki, Bilal Piperdi, Dariusz M Kowalski, Keynote Investigators
Journal: New England Journal of Medicine (2018)

Standard first-line therapy for metastatic, squamous non–small-cell lung cancer (NSCLC) is platinum-based chemotherapy or pembrolizumab (for patients with programmed death ligand 1 [PD-L1] expression on ≥50% of tumor cells). More recently, pembrolizumab plus chemotherapy was shown to significantly prolong overall survival among patients with nonsquamous NSCLC.
Novel therapeutic approaches to xeroderma pigmentosum
Authors: J.L. Weon, D.A. Glass
Journal: British Journal of Dermatology (2018)

The study of xeroderma pigmentosum has yielded unforeseen advances regarding how defects in the nucleotide excision repair pathway result in this devastating disease, but development of therapeutic strategies has trailed behind the mechanistic discoveries.This review aims to cover clinical presentation, molecular mechanisms and current management, and highlights more recent insights into targeting the deficiencies secondary to the DNA repair defects to prevent skin cancer and/or neurological degeneration.This review article discusses novel therapeutic approaches to xeroderma pigmentosum that focus on metabolic defects downstream of nucleotide excision repair.Current research demonstrates that specific sulfonylureas promote clearance of DNA damage and increase resistance to ultraviolet radiation in a cellular model of xeroderma pigmentosum. Moreover, nicotinamide attenuates the effects of ultraviolet radiation in cells, and caloric restriction decreases DNA damage burden in animal models of xeroderma pigmentosum.Clinical management of patients with xeroderma pigmentosum still focuses on preventative avoidance of sun exposure as opposed to therapies that would improve the patients' condition; thus, novel approaches to this disease are warranted.
Hemoglobin A<sub>1c</sub> Targets for Glycemic Control With Pharmacologic Therapy
Authors: David Walton
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Hemoglobin A1c Targets for Glycemic Control With Pharmacologic TherapyDavid Walton, MDDavid Walton, MDKaiser Permanente, Honolulu, Hawaii (D.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0371 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read the ACP guidance statement (1) with interest. I believe that the evidence on diabetic women of child-bearing age and glycemic control is clear and without dispute: An HbA1c level greater than 6.5% is associated with adverse pregnancy outcomes (that is, an increased risk for miscarriage and birth defects). I am concerned that the recommendations on glycemic control will result in more women of child-bearing age presenting with an HbA1c level close to 8% and a marked increase in adverse pregnancy outcomes. I encourage the authors to clarify that HbA1c levels in this population should be ...Reference1. Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med. 2018;168:569-76. [PMID: 29507945]. doi:10.7326/M17-0939 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Kaiser Permanente, Honolulu, Hawaii (D.W.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0371. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians Amir Qaseem , Timothy J. Wilt , Devan Kansagara , Carrie Horwitch , Michael J. Barry , Mary Ann Forciea , and Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Joel Zonszein and Michael Brownlee Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Timothy J. Wilt , Michael J. Barry , Devan Kansagara , and Amir Qaseem Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Deep Dutta and Satinath Mukhopadhyay Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy Derek T. O'Keeffe and Spyridoula Maraka Metrics 2 October 2018Volume 169, Issue 7Page: 512KeywordsCongenital disordersDisclosureDrug therapyHbA1cHemoglobinMiscarriagePregnancy ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.
Authors: Nicole Mittmann, Ning Liu, Marnie MacKinnon, Soo Jin Seung, Nicole Look Hong, Craig Earle, Sharon Gradin, Saurabh Sati, Sandy Buchman, Frances Catriona Wright
Journal: Journal of Clinical Oncology (2018)

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.
Are Bone Mineral Density and Fractures Related to the Incidence and Progression of Radiographic Osteoarthritis of the Knee, Hip, and Hand in Elderly Men and Women? The Rotterdam Study
Authors: Arjan P. Bergink, Fernando Rivadeneira, Sita M. Bierma‐Zeinstra, M. Carola Zillikens, M. Arfan Ikram, André G. Uitterlinden, Joyce B. J. van Meurs
Journal: Arthritis & Rheumatology (2018)

To examine the longitudinal relationship between bone mineral density (BMD) and the incidence and progression of knee, hip, and hand osteoarthritis (OA), and to examine the relationship between prevalent vertebral and nonvertebral fractures and the incidence and progression of OA in elderly men and women in the Rotterdam Study.Age- and sex-specific quartiles of baseline femoral neck BMD data were constructed for 4,154 subjects. Radiographs were scored for incidence and progression of knee and hip OA, and for incidence of hand OA. Prevalent vertebral fractures were scored using the McCloskey/Kanis method, and prevalent nonvertebral fractures were reported by baseline interview.Subjects in the highest quartile of femoral neck BMD had an increased risk of incident radiographic knee OA (ROA) (odds ratio [OR] 1.58 [95% confidence interval (95% CI) 1.14-2.18]), and an increased risk of incident hip ROA (OR 1.57 [95% CI 1.06-2.32]), compared to the lowest quartile. No significant relationship was found between high femoral neck BMD and progression of knee or hip ROA or the incidence of hand ROA. Prevalent vertebral and nonvertebral fractures were not related to an increase in the incidence or progression of knee or hip ROA. However, vertebral fractures were associated with incident hand ROA (OR 1.74 [95% CI 1.02-2.98]).Results from the present study confirm earlier findings and thus provide strong evidence that high femoral neck BMD is a prognostic risk factor for the development of knee and hip ROA. Vertebral fractures were found to be a risk factor for incident hand ROA.
Cangrelor in Ticagrelor-Loaded STEMI Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Dimitrios Alexopoulos, Christos Pappas, Danai Sfantou, Ioanna Xanthopoulou, Matthaios Didagelos, Petros Kikas, Antonios Ziakas, Dimitris Tziakas, Haralambos Karvounis, Efstathios Iliodromitis
Journal: Journal of the American College of Cardiology (2018)
Abstract 17901: Women, Depression & Chronic Kidney Disease Are Associated With Higher Readmissions Following Pulmonary Vein Isolation for Atrial Fibrillation: A Retrospective Cohort Study
Authors: Apurva Patel, Balwinder Singh, William Newman, Susan Farkas
Journal: Circulation (2016)

Introduction: There is lack of data in identifying factors associated with readmissions following pulmonary vein isolation (PVI) from community hospitals. Hypothesis: We examined the hypothesis tha...
Genome-Informed Targeted Therapy for Osteosarcoma
Authors: Leanne C. Sayles, Marcus R. Breese, Amanda L. Koehne, Stanley G. Leung, Alex G. Lee, Heng-Yi Liu, Aviv Spillinger, Avanthi T. Shah, Bogdan Tanasa, Krystal Straessler, Florette K. Hazard, Sheri L. Spunt, Neyssa Marina, Grace E. Kim, Soo-Jin Cho, Raffi S. Avedian, David G. Mohler, Mi-Ok Kim, Steven G. DuBois, Douglas S. Hawkins, E. Alejandro Sweet-Cordero
Journal: Cancer Discovery (2018)

Osteosarcoma is a highly aggressive cancer for which treatment has remained essentially unchanged for more than 30 years. Osteosarcoma is characterized by widespread and recurrent somatic copy-number alterations (SCNA) and structural rearrangements. In contrast, few recurrent point mutations in protein-coding genes have been identified, suggesting that genes within SCNAs are key oncogenic drivers in this disease. SCNAs and structural rearrangements are highly heterogeneous across osteosarcoma cases, suggesting the need for a genome-informed approach to targeted therapy. To identify patient-specific candidate drivers, we used a simple heuristic based on degree and rank order of copy-number amplification (identified by whole-genome sequencing) and changes in gene expression as identified by RNA sequencing. Using patient-derived tumor xenografts, we demonstrate that targeting of patient-specific SCNAs leads to significant decrease in tumor burden, providing a road map for genome-informed treatment of osteosarcoma. SIGNIFICANCE: Osteosarcoma is treated with a chemotherapy regimen established 30 years ago. Although osteosarcoma is genomically complex, we hypothesized that tumor-specific dependencies could be identified within SCNAs. Using patient-derived tumor xenografts, we found a high degree of response for "genome-matched" therapies, demonstrating the utility of a targeted genome-informed approach.This article is highlighted in the In This Issue feature, p. 1.
GP exodus could force hundreds of practices to close in next five years, royal college warns
Authors: Gareth Iacobucci
Journal: BMJ (2018)

More than 2.5 million patients in England could lose their GP practice to closure in the next five years unless urgent measures are taken to reduce the number of doctors leaving the profession, the Royal College of General Practitioners has warned.

The college said “untenable” workload pressures were pushing older GPs towards the exit door, and called for urgent initiatives to improve retention of the workforce.

The college gave the warning after conducting an analysis that found that 762 practices across the UK were at risk …
Experience of financial toxicity among gynecologic oncology patients.
Authors: Sara Bouberhan, Alice Kennedy, Mary K. Buss, Laureen Moss, Kathleen Nolan, Christopher Awtrey, John Lee Dalrymple, Leslie A. Garrett, Fong W. Liu, Michele R. Hacker, Katharine Esselen, Meghan Shea
Journal: Journal of Clinical Oncology (2018)

90 Background: “Financial toxicity” (FT) is increasingly recognized as an adverse outcome associated with cancer treatment. The degree of FT in the gynecologic oncology patient population has not been studied. This study used the comprehensive score for financial toxicity (COST) tool, a recently-validated survey, to examine FT in the gynecologic oncology population. Methods: All follow-up patients at a gynecologic oncology practice were invited to complete a cross-sectional survey including the COST (scale = 0-44) tool and a quality-of-life (QOL) survey, the EQ-5D-5L. Demographic and treatment data were gathered with additional survey questions and chart review. We dichotomized COST scores into low FT (top two tertiles) and high FT (bottom tertile); a lower COST score indicates higher FT. We assessed the correlation between COST and QOL scores using the Spearman correlation coefficient (r) and used univariable and multivariable linear regression to identify predictors of greater FT. We used log-binomial regression to calculate risk ratios (RR) and 95% confidence intervals (CI) for patient-reported financial outcomes. Results: Approximately 75% of approached patients responded; 224 were included in this analysis. The median FT score was 29.0. Greater FT was correlated with worse QOL (r = 0.43, p &lt; 0.01). In multivariable regression, income &lt; $50,000 (p &lt; 0.01) and income from $50,000-$99,999 (p &lt; 0.01) compared to income ≥$100,000; younger age (p &lt; 0.01); and part-time employment (p = 0.01) and unemployment (p = 0.01) compared to full time employment were significant predictors of greater FT. The high FT group had an increased risk of delaying or avoiding care (RR: 4.5, 95% CI: 1.6-12.3); borrowing money or applying for financial assistance (RR: 17.0, 95% CI: 4.0-71.6); and using savings or reducing spending to meet healthcare costs (RR: 2.5; 95% CI: 1.9-3.4) relative to the low FT group. Conclusions: High FT was common in the gynecologic oncology population and was strongly associated with delays or avoidance of clinical care, requiring financial assistance, and worse QOL scores. Further study is needed to investigate FT in a broader patient population within gynecologic oncology and to identify strategies for intervention in clinical practice.