tbuckley/cabot-search huggingface dataset:
Patient(Pt)-reported toxicities during breast cancer (BC) chemotherapy (CRx): Associations with pre-treatment (Tx) measures of quality of life (QOL) and Tx discontinuation.
Authors: Kirsten A. Nyrop, Allison Mary Deal, Shlomit S. Shachar, Ethan M. Basch, Bryce B. Reeve, Jordan T Lee, Seul Ki Choi, William Allen Wood, Carey K. Anders, Lisa A. Carey, Elizabeth Claire Dees, Trevor Augustus Jolly, Katherine Elizabeth Reeder-Hayes, Gretchen Genevieve Kimmick, Meghan Sri Karuturi, Raquel E. Reinbolt, Joellen C. Speca, Hyman B. Muss
Journal: Journal of Clinical Oncology (2018)

546 Background: CRx completion is essential to Tx effectiveness and may depend on pt-reported toxicities rated “moderate, severe or very severe” (MSVS) that mirror physician-assessed CTCAE grades 2-4. Methods: We prospectively collected pt-reported MSVS in pts with stage I-III BC at each cycle of conventional (neo)adjuvant CRx. Pts also completed a pre-Tx measure of QOL (Functional Assessment of Cancer Therapy-General). Results: 158 pts were mean age 54, 28% non-white, 37% ≤high school (HS), 56% married. 44% received anthracycline-based CRx. Pt-rated maximum toxicity level was 12% mild, 37% moderate, 33% severe, and 18% very severe. Mean number of toxicities rated MSVS was 4.5 (range 0-12), with 51% rating ≥4 toxicities as MSVS. In multivariable analysis (R2= 45%), un-married (p = .04), ≤HS (p = .03), lower pre-Tx QOL (p < .0001), and anthracycline-based CRx (p = .001) were associated with increased number of MSVS toxicities. 28 pts (18%) discontinued CRx. Mean number of MSVS toxicities was 5.5 (range 1-7) in pts who discontinued CRx compared to 4.3 (range 0-11) in pts who completed CRx (p = .08). Mean number of severe/very severe toxicities was 2.0 (range 1-7) in pts who discontinued CRx compared to 1.3 (range 0-9) in pts who completed CRx (p = .01). Conclusions: Pt characteristics and pre-Tx QOL are associated with pt reports of Tx toxicities. Cumulative number of higher severity toxicities is associated with CRx discontinuation. Patients whose chemotherapy treatment was discontinued, by patient-reported symptom severity Clinical trial information: NCT02328313.Symptom None/Mild Moderate/Severe/ Very Severe p value (2-sided) Fatigue 5/54 (9%) 23/104 (22%) .05 Insomnia 12/69 (17%) 16/89 (18%) .92 Anxiety 15/88 (17%) 13/70 (19%) .80 Arthralgia 16/93 (17%) 12/65 (18%) .84 Constipation 14/99 (14%) 14/59 (24%) .13 Myalgia 16/98 (16%) 12/60 (20%) .56 Diarrhea 17/94 (18%) 11/64 (17%) .89 Nausea 14/102 (14%) 14/56 (25%) .08 Peripheral neuropathy 17/107 (16%) 11/51 (22%) .38 Depression 19/112 (17%) 9/46 (20%) .70 Dyspnea 17/127 (13%) 11/31 (35%) .004 Vomiting 21/142 (15%) 7/16 (44%) .004
p53 inhibits CRISPR–Cas9 engineering in human pluripotent stem cells
Authors: Robert J. Ihry, Kathleen A. Worringer, Max R. Salick, Elizabeth Frias, Daniel Ho, Kraig Theriault, Sravya Kommineni, Julie Chen, Marie Sondey, Chaoyang Ye, Ranjit Randhawa, Tripti Kulkarni, Zinger Yang, Gregory McAllister, Carsten Russ, John Reece-Hoyes, William Forrester, Gregory R. Hoffman, Ricardo Dolmetsch, Ajamete Kaykas
Journal: Nature Medicine (2018)
Neurologic disorders in 4858 survivors of central nervous system tumors in childhood—an Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study
Authors: Line Kenborg, Jeanette Falck Winther, Karen Markussen Linnet, Anja Krøyer, Vanna Albieri, Anna Sällfors Holmqvist, Laufey Tryggvadottir, Laura Maria Madanat-Harjuoja, Marilyn Stovall, Henrik Hasle, Jørgen H Olsen
Journal: Neuro-Oncology (2018)

A comprehensive overview of neurologic complications among survivors of central nervous system (CNS) tumors in childhood is lacking. We aimed to investigate the risk for these disorders in a large, population-based study with outcome measures from nationwide hospital registries.We identified 4858 five-year survivors with diagnoses of CNS tumor in childhood in Denmark, Iceland, Finland, and Sweden in 1943-2007, and 166658 matched population comparison subjects. Inpatient discharge diagnoses of neurologic disorders were used to calculate relative risks (RRs) and absolute excess risks (AERs).A neurologic disorder was verified in 1309 survivors, while 92.4 were expected, yielding an overall RR of 14.2 (95% confidence interval [CI]: 13.3-15.1) and an AER of 20 hospitalizations per 1000 persons per year. The risks remained increased more than 20 years after diagnosis (RR: 6.3, 95% CI: 5.6-7.2; AER: 11, 9-12). The most frequent diagnoses were epilepsy (affecting 14.1% of all survivors) followed by hydrocephalus (9.5%) and paralytic syndromes (4.2%), with RRs of 28.7 (95% CI: 26.0-31.6), 243 (95% CI: 190-311), and 40.3 (95% CI: 33.1-49.2), respectively. Of these outcomes, 30%-40% were diagnosed prior to or synchronously with the CNS tumor. The survivors had highly increased RRs for infectious diseases of the CNS, disorders of cranial nerves, and degenerative diseases of the nervous system.Survivors of childhood CNS tumors are at markedly increased risk for neurologic disorders throughout their lives. Health care professionals must be aware of survivors who might benefit from preventive interventions and intensive follow-up.
Transition to the <i>ICD-10</i> in the United States
Authors: Rohan Khera, Karen B. Dorsey, Harlan M. Krumholz
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
Polarising the e-cigarette debate confuses people
Authors: Sarah Hepworth, Greg Fell
Journal: BMJ (2018)

We read with interest the article on whether the NHS should recommend e-cigarettes.1 It struck a polarising tone, which we fear will further confuse the public.

In an effort to take a sensible position on this divisive issue Sheffield Tobacco Control Board has published an updated consensus statement. We aim to be a vape-friendly city …
Abstract O.30: Novel Biomarker for Early Diagnosis of Kawasaki Diseases
Authors: Tai-Ming Ko, Ho-Chang Kuo, Jeng-Sheng Chang, Shih-Ping Chen, Yi-Min Liu, Hui-Wen Chen, Fuu-Jen Tsai, Yi-Ching Lee, Chien-Hsiun Chen, Jer-Yuarn Wu, Yuan-Tsong Chen
Journal: Circulation (2015)

Kawasaki disease (KD) is the most common cause of acquired heart disease in young children and has been suggested to be an immune-mediated condition, which was supported by our previous findings that FCGR2A, BLK, and CD40 are KD susceptibility genes. However, diagnosing KD can be difficult especially at early stage of the disease because of its varied clinical manifestations and lack of specific laboratory tests. The aim of the present study was to identify biomarkers that may aid in the early diagnosis of KD. We conducted a three-phase study: discovery, replication, and blinded validation. The 214 children with fever and clinical features suggestive of KD were recruited in Taiwan from separate geographic medical centers. By using an unbiased, large-scale, quantitative protein array, we globally analyzed the profiles of cytokines, chemokines, and cell adhesion molecules in their plasma samples. During the discovery phase [n (KD) = 37, n (control) = 20], the expression of one cell adhesion molecules, two chemokines, and three cytokines (Th-17-related), (named gene-1~6) were upregulated during the acute phase in KD patients compared to that in the controls. Receiver-operating characteristic analysis of the combined discovery and replication data [n (KD) = 77, n (control) = 77] showed that the level of gene-3 had high area under the curve values (AUC, 0.94). Using the optimal cut-off value to predict KD, the sensitivity and specificity of the gene-3 was found to be 90% and 87%, respectively. Blinded validation study also confirmed the excellent discrimination of gene-3 in identifying KD cases from non-KD cases among subjects who were highly suspected KD cases, including incomplete KD or febrile cases with scarlet fever, even in the very early stage (&lt;4 days).With intravenous immunoglobulin treatment, levels of gene-3 returned to normal. Furthermore, we also found the downstream receptor of gene-3 was activated in the T cells of acute KD patients. Taken together, the newly identified biomarker, gene-3, may be useful in diagnosing KD and monitoring patients’ treatment responses. The selective increase of gene-3 in KD also reveals that a novel unique signal pathway involved in KD, which may provide a critical clue for further investigating the pathogenesis of KD.
Breastfeeding and Future Maternal Health—No Causal Evidence
Authors: Claudia Gragnoli, Rongling Wu, Intekhab Ahmed
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
The HER2 inhibitor lapatinib potentiates doxorubicin-induced cardiotoxicity through iNOS signaling
Authors: Wan-Tseng Hsu, Ching-Ying Huang, Christopher Y.T. Yen, Ann-Lii Cheng, Patrick C.H. Hsieh
Journal: Theranostics (2018)

Rationale: Lapatinib (LAP) is a crucial alternative to trastuzumab upon the onset of drug resistance during treatment of metastatic human epidermal growth factor receptor 2-positive breast cancer.Like trastuzumab, LAP is commonly used alongside anthracyclines as a combination therapy, due to enhanced anti-cancer efficacy.However, this is notably associated with cardiotoxicity so it is imperative to understand the mechanisms driving this cardiotoxicity and develop cardioprotective strategies.To this end, here we utilize human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs), which exhibit several characteristics representative of in vivo cardiomyocytes that make them breakthrough models to study drug toxicity.Methods: We investigated LAP-and doxorubicin (DOX)-induced toxicity in hPSC-CMs and evaluated the involvement of inducible nitric oxide (NO) synthase (iNOS).The significance of iNOS-mediated cardiotoxicity was furthermore evaluated in animal studies.Results: LAP synergistically increased DOX toxicity in hPSC-CMs in a dose-and time-dependent manner.At concentrations that were otherwise non-apoptotic when administered separately, LAP significantly potentiated DOX-induced hPSC-CM apoptosis.This was accompanied by increased iNOS expression and pronounced production of NO. iNOS inhibition significantly reduced hPSC-CM sensitivity to LAP and DOX co-treatment (LAP-plus-DOX), leading to reduced apoptosis.Consistent with our observations in vitro, delivery of an iNOS inhibitor in mice treated with LAP-plus-DOX attenuated myocardial apoptosis and systolic dysfunction.Moreover, inhibition of iNOS did not compromise the anti-cancer potency of LAP-plus-DOX in a murine breast cancer xenograft model.Conclusions: Our findings suggest that iNOS inhibition is a promising cardioprotective strategy to accompany HER2-inhibitor/anthracycline combination therapies.Furthermore, these results support the promise of hPSC-CMs as a platform for investigating cardiotoxicity and developing cardioprotectants as a whole.
Scrap the Cap: <i>BMJ</i> calls for end to cap on non-EEA doctors being allowed to work in NHS
Authors: Gareth Iacobucci
Journal: BMJ (2018)

This week The BMJ launches its Scrap the Cap campaign calling for review of immigration policies so that doctors from overseas who have been offered jobs in the NHS can take up their posts.

More than 1500 visa applications from doctors with job offers in the UK were refused between December 2017 and March 2018 as a result of the Home Office’s cap on the number of tier 2 visas it issues to workers from outside the European Economic Area.1 It is anticipated that the limit on the number of tier 2 visas allocated each month will be reached for the sixth month in a row in May.

The result is hundreds of NHS posts remaining unfilled, putting extra pressure on overstretched staff and threatening the care of patients.

The BMJ ’s campaign launches with a petition to parliament (http://bit.ly/2JffJd2) aimed at demonstrating the strength of feeling against government red …
Recombinant oncolytic poliovirus combined with checkpoint blockade for breast cancer therapy.
Authors: Jeremy Force, Eda Holl, Michael Brown, Paul Kelly Marcom, Lars Grimm, David Boczkowski, Victoria Frazier, James Emmett Herndon, Darell D. Bigner, Eun-Sil Shelley Hwang, Matthias Gromeier, Smita Nair
Journal: Journal of Clinical Oncology (2018)

e12641 Background: Breast cancers thrive in an immunosuppressive microenvironment. Checkpoint blockade has had poor results in metastatic breast cancers. Recombinant oncolytic polio:rhinovirus (PVSRIPO) is a novel immunotherapy that infects and kills tumor cells. PVSRIPO enters cells through the CD155 receptor. Triple negative breast cancer (TNBC) tissues express CD155. In the E0771 immunocompetent orthotopic breast cancer murine model, we revealed a single intratumoral PVSRIPO injection significantly delays tumor growth, induces inflammation within the tumor, and stimulates immune cell tumor infiltration. The purpose of our study was to investigate PVSRIPO with checkpoint blockade for breast cancer therapy. Methods: BL6-CD155 transgenic mice were implanted in the mammary fatpad with 1x106 E0771CD155 tumor cells. Mouse PVSRIPO (mRIPO, 5x107 pfu) were injected intratumorally one time when tumors reached 100 mm3. Checkpoint antibodies (250 µg in 200 µL PBS) were injected intraperitoneally the day after PVSRIPO injection and then every 2-3 days four times. Mice were sacrificed on day 7 or 14 for immune analyses. Tumor growth was monitored over time. Results: Oncolytic poliovirus, anti-PD1, or -PDL1 monotherapies, and mRIPO + anti-PD1 or -PDL1 combination therapies significantly inhibited tumor growth compared to PBS controls, p = 0.0065, p = 0.010, p = 0.0007, p = 0.0006, and p < 0.0001, respectively. There were no significant differences in tumor growth inhibition between mRIPO and anti-PD1 or -PDL1 monotherapies. Combination of mRIPO with checkpoint blockade was more effective than each anti-PD1 or -PDL1 alone at controlling tumor growth, p = 0.12 and p = 0.09, respectively. Conclusions: Oncolytic poliovirus therapy is a novel immunotherapeutic approach that is effective as monotherapy in murine breast cancer models. A single injection of PVSRIPO was equivalent to repeated anti-PD1 or -PDL1 treatments in decreasing TNBC tumor burden. PVSRIPO combined with anti-PD1 or -PDL1 therapy provided improved tumor growth inhibition compared to monotherapies. We will conduct a phase I study with PVSRIPO + anti-PDL1 to determine if PVSRIPO enhances anti-PDL1 therapeutic efficacy in women with HER2 negative breast cancers.
Sex‐specific associations of obesity and N‐terminal pro‐B‐type natriuretic peptide levels in the general population
Authors: Navin Suthahar, Wouter C. Meijers, Jennifer E. Ho, Ron T. Gansevoort, Adriaan A. Voors, Peter van der Meer, Stephan J.L. Bakker, Stephane Heymans, Vanessa van Empel, Blanche Schroen, Pim van der Harst, Dirk J. van Veldhuisen, Rudolf A. de Boer
Journal: European Journal of Heart Failure (2018)
Insulin/IGF-driven cancer cell-stroma crosstalk as a novel therapeutic target in pancreatic cancer
Authors: Ayse Ceren Mutgan, H. Erdinc Besikcioglu, Shenghan Wang, Helmut Friess, Güralp O. Ceyhan, Ihsan Ekin Demir
Journal: Molecular Cancer (2018)

Pancreatic ductal adenocarcinoma (PDAC) is unrivalled the deadliest gastrointestinal cancer in the western world. There is substantial evidence implying that insulin and insulin-like growth factor (IGF) signaling axis prompt PDAC into an advanced stage by enhancing tumor growth, metastasis and by driving therapy resistance. Numerous efforts have been made to block Insulin/IGF signaling pathway in cancer therapy. However, therapies that target the IGF1 receptor (IGF-1R) and IGF subtypes (IGF-1 and IGF-2) have been repeatedly unsuccessful. This failure may not only be due to the complexity and homology that is shared by Insulin and IGF receptors, but also due to the complex stroma-cancer interactions in the pancreas. Shedding light on the interactions between the endocrine/exocrine pancreas and the stroma in PDAC is likely to steer us toward the development of novel treatments. In this review, we highlight the stroma-derived IGF signaling and IGF-binding proteins as potential novel therapeutic targets in PDAC.
Abstract 14256: The Prevalence and Prognosis of Early Repolarization and Brugada Electrocardiogram Pattern in Patients With Cardiovascular Risk Factors:Japan Morning Surge Home Blood Pressure (J-HOP) Study
Authors: Seigo Arima, Tomoyuki Kabutoya, Hajime Shinohara, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2016)

Introduction:  Patients at high risk for early repolarization (ER) and Brugada electrocardiogram patterns are also at high risk for sudden cardiac death. However, the prevalence and prognosis of ER and Brugada electrocardiogram (ECG) patterns in patients without ventricular fibrillation and with cardiovascular risk factors remains unclear.   Hypothesis:  We assessed the hypothesis that ER and Brugada ECG would be associated with cardiovascular events in Japanese patients with cardiovascular risk factors.   Methods:  Subjects were 3,128 patients enrolled in the Japan Morning Surge Home Blood Pressure Study who had one or more cardiovascular risk factors. An ER pattern was defined as J-point elevation of at least 0.1 mV from the baseline in at least 2 inferior or lateral leads. Brugada-type ECG was defined as follows: type 1, coved pattern: initial ST elevation ≥2 mm in V1/2; type 2: saddleback pattern in V1/2. The primary endpoints were death and nonfatal cardiovascular events (myocardial infarction, stroke, hospitalization for heart failure, aortic dissection).   Results:  During the mean follow-up period of 48±25 months, there were a total of 171 cardiovascular events. One thousand and sixty-eight patients had ER, 38 patients had type 1 Brugada ECG, and 41 patients had type 2 Brugada ECG. Patients with ER were older (64.9±10.7 vs. 63.7±10.6, p=0.003) and more likely to suffer cardiovascular events than patients without ER (N=2,049) (log rank 4.32, p=0.038). However, the difference of cardiovascular events was not statistically significant after adjusting for age and gender (p=0.11). Patients with type 1 Brugada ECG had a higher percentage of males (79% vs. 45%, p   Conclusions:  Early repolarization was not independently associated with poor prognosis, and Brugada-type ECG was not associated with poor prognosis.
Abstract 12008: Comprehensive Bivariate Meta-Analysis of Hypertension Trials With Heart Failure as an Outcome
Authors: William J Kostis, Jerry Q Cheng, Jeanne M Dobrzynski, Aakash Garg, John B Kostis
Journal: Circulation (2016)

Introduction: In meta-analyses, odds ratios (OR) are considered more meaningful to summarize data of multiple trials while absolute risk reduction (ARR) is more relevant to specific clinical questions. We developed a novel bivariate random effects meta-analysis method for simultaneous evaluation of ORs and ARRs. Methods: Using this method, we analyzed the efficacy of different classes of antihypertensive therapy in preventing heart failure (HF) in 54 randomized clinical trials not requiring diabetes as an inclusion criterion (331,728 patients, 12,969 events), including SPRINT and HOPE-3. Results: The expected relationship between OR and ARR for a given baseline risk was observed. Diuretics were superior to all other medications, both with respect to ARR and OR (ARR 14.6 per thousand, 95% CI 7.3-22.0; OR 0.52, CI 0.38-0.70). Intensive therapy (ARR 5.1, CI -1.9-12.1; OR 0.72, CI 0.46-1.11) was the second best, followed by ACEIs (ARR 4.9, CI 0.1-9.6; OR 0.81, CI 0.69-0.95), ARBs (ARR 4.4, CI -0.3-8.5; OR 0.90, CI 0.81-0.99), and DHPs (ARR 1.0, CI -3.4-5.4; OR 0.89, CI 0.86-1.16). Verapamil was associated with a trend toward increased absolute risk (ARR 2.3, CI -0.1-4.8; OR 1.17, CI 0.99-1.37). Multiple metaregression identified the magnitude of the difference between the blood pressure lowering from baseline in the active and control groups as the only significant association (p&lt;0.04) of the benefit in preventing HF. The effects on all-cause and cardiovascular mortality were consonant with the above with the exception of verapamil, where the adverse effect was attenuated when cardiovascular and all-cause death were considered. Conclusions: This new bivariate meta-analysis method combining ARR and OR is useful in clinical decision making, using ARR for specific clinical questions, OR to summarize studies. Based on information from all available studies, diuretics are the superior medication for the prevention of HF in hypertensive patients from both points of view.
Ridesharing and Text Messaging for Patients With Medicaid—Further Information—Reply
Authors: Krisda H. Chaiyachati, Roy Rosin, Judy A. Shea
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