tbuckley/cabot-search huggingface dataset:
Patient-Sharing Networks of Physicians and Health Care Utilization and Spending Among Medicare Beneficiaries
Authors: Bruce E. Landon, Nancy L. Keating, Jukka-Pekka Onnela, Alan M. Zaslavsky, Nicholas A. Christakis, A. James O’Malley
Journal: JAMA Internal Medicine (2017)

Physicians are embedded in informal networks in which they share patients, information, and behaviors.We examined the association between physician network properties and health care spending, utilization, and quality of care among Medicare beneficiaries.In this cross-sectional study, we applied methods from social network analysis to Medicare administrative data from 2006 to 2010 for an average of 3 761 223 Medicare beneficiaries per year seen by 40 241 physicians practicing in 51 hospital referral regions (HRRs) to identify networks of physicians linked by shared patients. We improved on prior methods by restricting links to physicians who shared patients for distinct episodes of care, thereby excluding potentially spurious linkages between physicians treating common patients but for unrelated reasons. We also identified naturally occurring communities of more tightly linked physicians in each region. We examined the relationship between network properties measured in the prior year and outcomes in the subsequent year using regression models.Spending on total medical services, hospital, physician, and other services, use of services, and quality of care.The mean patient age across the 5 years of study was 72.3 years and 58.5% of the participants were women. The mean age across communities of included physicians was 49 years and approximately 78% were men. Mean total annual spending per patient was $10 051. Total spending was higher for patients of physicians with more connections to other physicians ($1009 for a 1-standard deviation increase, P < .001) and more shared care outside of their community ($172, P < .001). Spending on inpatient care was slightly lower for patients of physicians whose communities had higher proportions of primary care physicians (-$38, P < .001). Patients cared for by physicians linked to more physicians also had more hospital admissions and days (0.02 and 0.18, respectively; both P < .001 for a 1-standard deviation increase in the number of connected physicians), more emergency visits (0.02, P < .001), more visits to specialists (0.37, P < .001), and more primary care visits (0.11, P < .001). Patients whose physicians' networks had more primary care physicians had more primary care visits (0.44, P < .001) and fewer specialist and emergency visits (-0.33 [P < .001] and -0.008 [P = .008], respectively). The various measures of quality were inconsistently related to the network measures.Characteristics of physicians' networks and the position of physicians in the network were associated with overall spending and utilization of services for Medicare beneficiaries.
Preventing depression in the offspring of parents with depression: A systematic review and meta-analysis of randomized controlled trials
Authors: Johanna Loechner, Kornelija Starman, Katharina Galuschka, Jeanette Tamm, Gerd Schulte-Körne, Julian Rubel, Belinda Platt
Journal: Clinical Psychology Review (2017)

One major predictor of depression onset is having a depressed parent. This study provides the first systematic review and meta-analysis of preventive interventions for offspring of depressed parents. We searched six literature databases and included randomized controlled trials which concerned the non-depressed offspring (aged 18 or younger) of a depressed parent, who received a preventive intervention designed to reduce the risk of depression or a comparison condition. Primary and secondary outcome measures were the severity and incidence of childhood depression. 14 publications reporting data from seven trials (n = 935 children) were included and were of relatively high quality. The effect of the interventions (versus any control condition) on depressive and internalising symptoms at post-intervention follow-up (up to four months) was small but significant [g′ = − 0.20, 95% CI (− 0.34; − 0.06), p = 0.005; I2 = 0.00%]. The interventions also had a small but significant effect on depression incidence [Risk Ratio = 0.56; 95% CI(0.41;0.77); d′ = − 0.42]. Intervention effects were not present in the short-term (up to 12 months post-intervention) or long-term (15–72 months post-intervention) follow-ups. Interventions targeting the offspring of depressed parents show promise not only in reducing symptoms of depression but also in preventing the onset of depression, at least immediately after the intervention.
Couple-based mind-body intervention for patients with metastatic lung cancer and their spouses.
Authors: Kathrin Milbury, Rosalinda Engle, Zhongxing X. Liao, Anne S. Tsao, April Owens, Eduardo Bruera, Lorenzo Cohen
Journal: Journal of Clinical Oncology (2017)

179 Background: Given the incurable nature of metastatic lung cancer, patients and their spouses are at risk of experiencing psychological and spiritual distress. To address these concerns, we developed a couple-based mind-body (CBMB) intervention. This formative research aimed to examine intervention acceptability and initially efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. Methods: We first conducted focus groups followed by a single-arm trial. Focus group participants completed program exercises and then semi-structured interviews and written evaluations including Likert-scale and open-ended questions. In the single-arm trial, the four intervention session were delivered over a 2-week period focusing on cultivating mindfulness, interpersonal connection, gratitude and purpose. Couples completed measures of depressive symptoms (CES-D), cancer distress (IES), spiritual well-being (FACT-Sp) and sleep disturbances (PSQI) before and after the program. Results: Focus groups (n = 7 dyads) revealed high acceptability ratings of the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable for the single arm trial (n = 7 dyads). All patients (67% male; µ age = 55 years) and partners (33% male; µ age = 59 years) rated the intervention as useful. Paired t-test analyses revealed large effects for sleep disturbances ( d= 1.83) and medium effects for cancer distress ( d= .61) for patients and large effects for depressive symptoms for spouses ( d= .90). Conclusions: Based on this two part study, the CBMB intervention appears to be acceptable and subjectively useful. There was also preliminary evidence regarding treatment gains for both patients and partners. A randomized controlled trial is warranted to further examine this supportive care strategy.
Novel approach for cancer-related fatigue: A double-blind randomized clinical trial.
Authors: Claudia Vaz De Melo Sette, Barbara Bonaparte Ribas de Alcântara, Felipe Melo Cruz, Jean Henri Maselli Schoueri, Daniel de Iracema Gomes Cubero, Auro Del Giglio
Journal: Journal of Clinical Oncology (2017)

234 Background: Fatigue is one side effect of cancer and its treatment, and remains as the most prevalent symptom for those who survived. To date, the search for novel approaches regarding Cancer-Related Fatigue persists. As such, Paullinia cupana – a medicinal plant – has shown promising results for the treatment of chemotherapy-induced fatigue. Methods: We conducted a phase II randomized double-blind clinical trial, in which we compared a standardized dry purified Paullinia cupana extract (PC-18) - in doses of 7.5 mg and 12.5 mg given orally twice a day - to placebo for the treatment of fatigue in women with early breast cancer scheduled to receive their first cycle of adjuvant systemic chemotherapy. Only patients that experienced increase in the score of either BFI, HAD or Chalder fatigue scales following the first cycle of chemotherapy were included. For possible associations between qualitative variables, Chi-square test was used. Poisson regression was used to test for the relationship between the drug used and the outcome regarding the difference assessed in scores aforementioned. The significance level was 5%. The program used was Stata 12.0. This study has been approved by our Institutional Review Board (number: 34327214.1.1001.0082) and participants have all signed informed consent forms. Results: PC-18 on 7.5 mg has not been statistically significant with any improvements on assessed scores when compared to placebo (IRR 0.99 [CI] 0.81 – 1.23, p = 0.958 for BFI; IRR 1.04 [CI] 0.56 – 1.95, p = 0,898 for HAD; IRR 0.95 [CI] 0.75 – 1.19, p = 0.645 for Chalder), while greater dosage (12.5mg) has shown the following outcomes regarding the scores (IRR 0.49 [CI] 0.30 – 0.81, p = 0.005 for BFI; IRR 0.89 [CI] 0.45 – 1.76, p = 0,735 for HAD; IRR 0.99 [CI] 0.80 – 1.23, p = 0.914 for Chalder) in the same comparison. Conclusions: Disregarding preliminary data on previous studies, PC-18 has not shown to be better than placebo. Clinical trial information: 34327214.1.1001.0082.
P3.01-011 Clinocopathological Profile and Role of Immunohistochemistry in the Diagnosis of Primary Lung Cancer - A Prospective Study from Eastern India
Authors: Pritinanda Mishra, Susama Patra, Prasanta Mohapatra, Mamita Nayak, Radhamohan Gharei, Manoj Panigrahi, Sourin Bhuniya
Journal: Journal of Thoracic Oncology (2017)
Allergen manufacturing and quality aspects for allergen immunotherapy in Europe and the United States: An analysis from the <scp>EAACI AIT</scp> Guidelines Project
Authors: A. Bonertz, G. Roberts, J. E. Slater, J. Bridgewater, R. L. Rabin, M. Hoefnagel, M. Timon, C. Pini, O. Pfaar, A. Sheikh, D. Ryan, C. Akdis, J. Goldstein, L. K. Poulsen, R. van Ree, C. Rhyner, D. Barber, O. Palomares, R. Pawankar, D. Hamerlijnk, L. Klimek, I. Agache, E. Angier, T. Casale, M. Fernandez‐Rivas, S. Halken, M. Jutel, S. Lau, G. Pajno, G. Sturm, E. M. Varga, R. Gerth van Wijk, S. Bonini, A. Muraro, S. Vieths
Journal: Allergy (2017)

Abstract Adequate quality is essential for any medicinal product to be eligible for marketing. Quality includes verification of the identity, content and purity of a medicinal product in combination with a specified production process and its control. Allergen products derived from natural sources require particular considerations to ensure adequate quality. Here, we describe key aspects of the documentation on manufacturing and quality aspects for allergen immunotherapy products in the European Union and the United States. In some key parts, requirements in these areas are harmonized while other fields are regulated separately between both regions. Essential differences are found in the use of Reference Preparations, or the requirement to apply standardized assays for potency determination. As the types of products available are different in specific regions, regulatory guidance for such products may also be available in one specific region only, such as for allergoids in the European Union. Region‐specific issues and priorities are a result of this. As allergen products derived from natural sources are inherently variable in their qualitative and quantitative composition, these products present special challenges to balance the variability and ensuring batch‐to‐batch consistency. Advancements in scientific knowledge on specific allergens and their role in allergic disease will consequentially find representation in future regulatory guidelines.
Critical Lessons From High-Value Oncology Practices
Authors: Douglas W. Blayney, Melora K. Simon, Beatrice Podtschaske, Scott Ramsey, Margaret Shyu, Craig Lindquist, Arnold Milstein
Journal: JAMA Oncology (2017)

Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost.To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing "high value" that may be tested and adopted by others to produce similar results."Positive deviance" was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results. To quantify value, oncology practices located near the US Pacific Northwest and Midwest with low mean insurer-allowed spending were identified. Among those, practices with high quality were selected. A team then conducted site visits to interview practice personnel from June 2, 2015, through October 3, 2015, and to probe for attributes of high-value care. A qualitative analysis of their interview results was performed, and a panel of experienced oncologists was convened to review attributes occurring uniquely or frequently in low-spending practices for their contribution to value improvement and ease of implementation. Four positive deviant (ie, low-spending) oncology practices and 3 oncology practices that ranked near the middle of the spending distribution were studied.Thematic saturation in a qualitative analysis of high-value care attributes.From the 7 oncology practices studied, 13 attributes within the following 5 themes emerged: treatment planning and goal setting, services supporting the patient journey, technical support and physical layout, care team organization and function, and external context. Five attributes (ie, conservative use of imaging, early discussion of treatment limitations and consequences, single point of contact, maximal use of registered nurses for interventions, and a multicomponent health care system) most sharply distinguished the high-value practice sites. The expert oncologist panel judged 3 attributes (ie, early and normalized palliative care, ambulatory rapid response, and early discussion of treatment limitations and consequences) to carry the highest immediate potential for lowering spending without compromising the quality of care.Oncology practice attributes warranting further testing were identified that may lower total spending for high-quality oncology care.
MAIT cells: a novel therapeutic target for alcoholic liver disease?
Authors: Bin Gao, Jing Ma, Xiaogang Xiang
Journal: Gut (2017)

Bacterial infection is one of the most frequent and severe complications of advanced alcoholic liver disease (ALD), including alcoholic cirrhosis and severe alcoholic hepatitis (SAH). Patients who suffered from SAH are susceptible to bacterial infection with one study reporting 50% of them developed bacterial infection.1 Additionally, standard corticosteroid treatment further increased the risk of bacterial infection in patients with SAH.1 Thus, infection is highly relevant for the outcome of SAH and represents an important therapeutic target. However, except antibiotic treatment, there are currently no other specific therapies that effectively control bacterial infection in SAH due to incomplete understanding of the pathogenesis of bacterial infection in these patients.

The mechanisms underlying the increased risk of bacterial infection in ALD are complex and multifactorial. The high incidence of bacterial infection may be partly explained by gut bacterial overgrowth, dysbiosis and translocation of gut bacteria and their products in patients with ALD.2 3 Impaired host defence against bacterial infection is probably another important mechanism contributing to the increased risk of bacterial infection in patients with ALD. It has been well documented that excessive alcohol consumption has broad and significant inhibitory effects on many key components of the immune system. For example, neutrophils, the first cellular line of defence against microorganisms, have impaired functions in patients with SAH, such as weakened reactive oxygen species production, reduced exocytosis/phagocytosis, declined chemotaxis and severe bactericidal defect.4 T cells from patients with SAH, but not alcoholic cirrhosis, expressed elevated levels of inhibitory mediators (eg, programmed cell death 1, PD ligand 1) that markedly inhibited T cell functions against bacterial infection.4 Although many types …
UCP1-independent signaling involving SERCA2b-mediated calcium cycling regulates beige fat thermogenesis and systemic glucose homeostasis
Authors: Kenji Ikeda, Qianqian Kang, Takeshi Yoneshiro, Joao Paulo Camporez, Hiroko Maki, Mayu Homma, Kosaku Shinoda, Yong Chen, Xiaodan Lu, Pema Maretich, Kazuki Tajima, Kolapo M Ajuwon, Tomoyoshi Soga, Shingo Kajimura
Journal: Nature Medicine (2017)
Immunotherapy of Hepatocellular Carcinoma: Facts and Hopes
Authors: Mercedes Iñarrairaegui, Ignacio Melero, Bruno Sangro
Journal: Clinical Cancer Research (2017)

Abstract Treatment of patients with hepatocellular carcinoma (HCC) in the advanced stage remains a great challenge, with very few drugs approved. After decades of failure of immune therapies, immune checkpoint inhibitors have emerged as potentially effective treatments for patients with HCC in the advanced stage. Immune checkpoints, including human cancer, cytotoxic T-lymphocyte protein 4 (CTLA-4), and programmed cell death protein 1 (PD-1), are surface proteins expressed in a variety of immune cells and mostly provide immunosuppressive signals. Monoclonal antibodies able to block these molecules have shown antitumor activity against a wide spectrum of human cancers. Clinical experience with checkpoint inhibitors in HCC includes early trials with the anti–CTLA-4 agent tremelimumab and a large phase II trial with the anti–PD-1 agent nivolumab. The latter has shown strong activity particularly as second-line therapy, both in terms of tumor response and patient survival. At least three topics should be the focus of future research: (i) the search for activity in patients at less-advanced stages, including the adjuvant treatment of patients with resectable or ablatable tumors; (ii) the enhanced efficacy of combination therapies, including particularly the combination with those targeted and locoregional therapies that may have a synergistic effect or act upon mechanisms of primary or acquired resistance to checkpoint inhibitors; and (iii) the identification of clinical features and serum or tissue biomarkers that would allow a better patient selection for individual treatments. Hopefully, ongoing trials will help to design better treatments in the future. Clin Cancer Res; 24(7); 1518–24. ©2017 AACR.
Response to: Comment on l’Ami <i>et al</i> titled ‘Successful reduction of overexposure in patients with rheumatoid arthritis with high serum adalimumab concentrations: an open-label, non-inferiority, randomised clinical trial’ by den Broeder <i>et al</i>
Authors: Merel J l’Ami, Charlotte L M Krieckaert, Michael T Nurmohamed, Ronald F van Vollenhoven, Theo Rispens, Maarten Boers, Gerrit Jan Wolbink
Journal: Annals of the Rheumatic Diseases (2017)

We thank den Broeder et al for their interest in our study and for their suggestions concerning further research.1 Our study did not target the broad issue of dose tapering, but focused on the population of patients with rheumatoid arthritis with high adalimumab concentrations (>8 µg/mL).2 We hypothesised that given the wide variation in serum concentrations on standard dosing and the established plateau in the concentration–response relationship—even in active disease3—there would be a role for individualised dosing to optimise adalimumab therapy. Unlike den Broeder et al , we find nothing peculiar about our research question or design …
Functional link between tetraploidization and expression of centrosome-associated genes in mantle cell lymphoma
Authors: K. Neben, G. Ott, S. Schweizer, J. Kalla, G. Wrobel, T. Katzenberger, M. Hahn, A. D. Ho, H. K. nrad Muller Hermelink, P. Lichter, A. Kramer
Journal: Blood (2003)
Behavioural text message reminders to improve participation in cervical screening: a randomised controlled trial
Authors: Sarah Huf, Dominic King, Robert Kerrison, Tim Chadborn, Adele Richmond, Deborah Cunningham, Ellis Friedman, Heema Shukla, Fu-Min Tseng, Gaby Judah, Ivo Vlaev, Ara Darzi
Journal: The Lancet (2017)
Integration of spiritual care services along with supportive care clinic in a comprehensive community cancer center.
Authors: Abhinav Binod Chandra, Laree Carlson, Angelic Alvarez, Vivek Kumar, Jeanne Elnadry
Journal: Journal of Clinical Oncology (2017)

181 Background: A grave illness like cancer can lead to substantial spiritual distress for patients and their care givers. Not meeting patients’ spiritual needs have been reported to lower ratings of quality and dissatisfaction with care. The FACIT-Sp-12 is used in research studies investigating health related quality of life (HRQOL) outcomes in cancer patients and has special focus on faith, meaning and peace. Methods: We introduced a unique model at the cancer center by having the chaplain resident and pain/palliative care physician evaluating and following patients together during the weekly Supportive Care Clinic. FACIT-Sp-12 score was also calculated for 92 patients on 164 visits during October 2016 till July 2017. Results: Overall, the FACIT-Sp-12 score was calculated for 92 (52 females and 40 males) patients with median age of 69 years (range 36-89). Sixty-eight (74%) were non-Hispanics while native language was English for 71 (77%) patients. The baseline FACIT-sp-12 score ranged between 16 and 48 with median score of 38. Thirty-two patients had follow up visits. 15 of these patients had improvement in their FACIT-Sp-12 score, 12 patients’ score had decreased and 5 patients’ scores were unchanged. There was an increase in FACIT-Sp-12 score in the males but after adjusting for gender, age, race, language and number of follow up visits, none of the variables could predict increase in the FACIT-Sp-12 score. Conclusions: We have successfully implemented this model of integrating spiritual support services to the delivery of cancer care. Decrease in FACIT score may coincide with distress associated with worsening symptoms or change in patient’s condition, and offers an opportunity to address the increased spiritual needs and assistance with coping during times of distress. Future prospective studies will prove instrumental in validating this approach and hopefully become a service reimbursable by health insurances, and thereby become universally accessible.
Age-related inflammatory bone marrow microenvironment induces ineffective erythropoiesis mimicking del(5q) MDS
Authors: Y Mei, B Zhao, A A Basiorka, J Yang, L Cao, J Zhang, A List, P Ji
Journal: Leukemia (2017)

Anemia is characteristic of myelodysplastic syndromes (MDS). The mechanisms of anemia in MDS are unclear. Using a mouse genetic approach, here we show that dual deficiency of mDia1 and miR-146a, encoded on chromosome 5q and commonly deleted in MDS (del(5q) MDS), causes an age-related anemia and ineffective erythropoiesis mimicking human MDS. We demonstrate that the ageing bone marrow microenvironment is important for the development of ineffective erythropoiesis in these mice. Damage-associated molecular pattern molecules (DAMPs), whose levels increase in ageing bone marrow, induced TNFα and IL-6 upregulation in myeloid-derived suppressor cells (MDSCs) in mDia1/miR-146a double knockout mice. Mechanistically, we reveal that pathologic levels of TNFα and IL-6 inhibit erythroid colony formation and differentially affect terminal erythropoiesis through reactive oxygen species-induced caspase-3 activation and apoptosis. Treatment of the mDia1/miR-146a double knockout mice with all-trans retinoic acid, which promoted the differentiation of MDSCs and ameliorated the inflammatory bone marrow microenvironment, significantly rescued anemia and ineffective erythropoiesis. Our study underscores the dual roles of the ageing microenvironment and genetic abnormalities in the pathogenesis of ineffective erythropoiesis in del(5q) MDS.