tbuckley/cabot-search huggingface dataset:
Employing electronic health record data to predict risk of ED visits for new patients.
Authors: Robert Michael Daly, Dmitriy Gorenshteyn, Lior Gazit, Stefania Sokolowski, Kevin Nicholas, Claire Perry, Lynn Adams, Abigail Baldwin, Lauren L. Katzen, Yeneat O. Chiu, Diane Lauren Reidy, Brett A Simon, Wendy Perchick, Isaac Wagner
Journal: Journal of Clinical Oncology (2018)

144 Background: Acute care accounts for half of cancer expenditures and is a measure of poor quality care. Identifying patients at high risk for ED visits enables institutions to target symptom management resources to those most likely to benefit. Risk stratification models developed to date have not been meaningfully employed in oncology, and there is a need for clinically relevant models to improve patient care. Methods: We established a predictive analytics framework for clinical use with attention to the modeling technique, clinician feedback, and application metrics. The model employs EHR data from initial visit to first antineoplastic administration for new patients at our institution from January 2014 to June 2017. The binary dependent variable is occurrence of an ED visit within the first 6 months of treatment. From over 1,400 data features, the model was refined to include 400 clinically relevant ones spanning demographics, pathology, clinician notes, labs, medications, and psychosocial information. Clinician review was performed to confirm EHR data input validity. The final regularized multivariate logistic regression model was chosen based on clinical and statistical significance. Parameter selection and model evaluation utilized the positive predictive value for the top 25% of observations ranked by model-determined risk. The final model was evaluated using a test set containing 20% of randomly held out data. The model was calibrated based on a 5-fold cross-validation scheme over the training set. Results: There are 5,752 antineoplastic starts in our training set, and 1,457 in our test set. The positive predictive value of this model for the top 25% riskiest new start antineoplastic patients is 0.53. The 400 clinically relevant features draw from multiple areas in the EHR. For example, those features found to increase risk include: combination chemotherapy, low albumin, social work needs, and opioid use, whereas those found to decrease risk include stage 1 disease, never smoker status, and oral antineoplastic therapy. Conclusions: We have constructed a framework to build a clinically relevant model. We are now piloting it to identify those likely to benefit from a home-based, digital symptom management intervention.
Survivorship care plan visits: Mixed methods analysis of patient surveys.
Authors: Natalie Garces, Daisuke Goto, Carol J. Farhangfar, Tara Eaton
Journal: Journal of Clinical Oncology (2018)

174 Background: Survivorship Care Plans (SCPs) are endorsed by cancer advocacy groups and required for accreditation, yet benefits are unclear. The purpose of this quality initiative was to assess the benefit of SCPs. Methods: From June 2015 to September 2017, survivors who had a SCP visit were surveyed to report their understanding of key survivorship topics pre/post visit; the most valuable information learned and plans to use the information. Descriptive statistics and qualitative analysis were performed. Subgroup analysis was performed for age, insurance, marital status, and race. Wilcoxon signed-rank test computed statistical significance. Results: Of 794 surveys, 657 (83%) were complete and evaluable. Surveys were collected from breast (436 [66%]), lung (45 [7%]), colorectal (33 [5%]), head and neck (25 [4%]), melanoma (24 [4%]), endometrial and ovarian (20 each [3%]), and other (54 (8%) cancer survivors. Statistically significant ( p&lt;0.05) improvements in all questions (Table 1) were noted across nearly all disease sites. Exceptions were endometrial, head and neck, and melanoma, which already had &gt; 75% answering “completely understand” for selected questions pre- SCP visit. Subgroup analysis found no significant differences. Self-management was a theme in the “other” insurance status subgroup (14) qualitative analysis. Four (36%) indicated an interest in information about programs to improve healthy behaviors. Conclusions: There was major positive impact of the SCP visit on patient-reported understanding of all survivorship topics. Providers may benefit from focusing SCP discussion on areas the survivor reports as “some” or “no” understanding pre- SCP visit. Providers should connect survivors to resources to support self-identified needs. [Table: see text]
Creating a Partnership Between Dermatologists and Geriatricians—Reply
Authors: Eleni Linos, Mary-Margaret Chren, Ken Covinsky
Journal: JAMA Dermatology (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 Dermatology 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 Dermatology journal
Adverse reactions to drugs and biologics in patients with clonal mast cell disorders: A Work Group Report of the Mast Cells Disorder Committee, American Academy of Allergy, Asthma &amp; Immunology
Authors: Melody C. Carter, Dean D. Metcalfe, Almudena Matito, Luis Escribano, Joseph H. Butterfield, Lawrence B. Schwartz, Patrizia Bonadonna, Roberta Zanotti, Massimo Triggiani, Mariana Castells, Knut Brockow
Journal: Journal of Allergy and Clinical Immunology (2018)

Providers caring for patients with mastocytosis are tasked with the decision to consider therapeutic options. This can come with some trepidation because information available in the public domain lists numerous mast cell (MC) activators based on data that do not discriminate between primates, rodents, and MC lines; do not consider dosage; and do not take into account previous exposure and resultant clinical findings. This being said, there is support in the literature for an enhanced MC response in some patients with mastocytosis and in cases in which there is a greater incidence of adverse reactions associated with certain antigens, such as venoms and drugs. Thus this report provides a comprehensive guide for those providers who must decide on therapeutic options in the management of patients with clonal MC disease.
Lactic Acid Accumulation in the Tumor Microenvironment Suppresses 18F-FDG Uptake
Authors: Silvan Türkcan, Louise Kiru, Dominik J. Naczynski, Laura S. Sasportas, Guillem Pratx
Journal: Cancer Research (2018)

Abstract The process by which tumor cells take up 2-[18F]fluoro-2-deoxy-D-glucose (FDG) is heterogeneous and influenced by a multitude of factors. In mouse tumor grafts, the core of the tumor often presents lower FDG uptake than the periphery. Whether this pattern is caused by the intrinsic avidity of individual cells for FDG, the density of viable cells in the tumor, or the perfusion of the radiotracer remains unknown. In this study, we used radioluminescence microscopy to measure FDG uptake in single cells isolated from the core and periphery of the tumor and found that differences in FDG uptake persist on the level of single cells. Single cells from the core of 4T1 and MDA-MB-231 tumors grafts took up 26% to 84% less FDG than those from the periphery. These differences were observed in mice with large tumors (&amp;gt;8 mm diameter) but not in those with smaller tumors. To explain the origin of these differences, we examined the influence of three microenvironmental factors on FDG uptake. Hypoxia was ruled out as a possible explanation because its presence in the core would increase and not decrease FDG uptake. Higher cell proliferation in the periphery was consistent with higher FDG uptake, but there was no evidence of a causal relationship. Finally, lactate was higher in the core of the tumor, and it suppressed FDG uptake in a dose-dependent fashion. We therefore conclude that lactic acidosis—the combination of lactate ion buildup and acidic pH—can increase the heterogeneity of FDG uptake in MDA-MB-231 and 4T1 tumor grafts. Significance: Analysis of single cells from heterogeneous tumors reveals the role played by the tumor microenvironment, lactic acidosis in particular, on the uptake by tumor cells of 18F-FDG, a PET imaging agent.
The perspective of a breast cancer patient: A survey study assessing needs and expectations.
Authors: Muhammad Sardar, Nasreen Shaikh, Mary Danish, David Julius Sharon, Dr. Shira Goldberg
Journal: Journal of Clinical Oncology (2018)

32 Background: Patient satisfaction is one of the key indicators of health care quality. We aim to identify patients’ needs and expectations in a breast cancer clinic to provide a patient-centered care and better overall satisfaction. Methods: A 17-item survey was administered to 49 patients at a breast cancer clinic. The survey was designed after a thorough literature review and approved by an oncologist and a palliative care physician. Results: Self-reported knowledge about disease was reported adequate by 95.9% of our patients yet only 46.9% of our patients could identify the stage of their cancer. More education was desired by 39% of patients including various treatment options (35%), common complications (29%), prognosis (22%) and risk factors (14%). Cancer-related emotional stress and physical symptoms were reported by 53% of our patients. Social/professional life was affected by cancer in 49% of the patients. Majority of our patients (57%) wanted their oncologist to address social/emotional issues and 28% felt the need of more focus on physical symptoms in their subsequent visits. End-of-life care (EoLC) discussions were considered an integral component of overall care by 22% of our patients. Components of EoLC discussions that patients stated they could benefit from included prognosis (24.5%), life expectancy (24.5%), treatment effect on quality of life (20.4%), palliative care (10.2%), hospice (10.2%), advance directives (14.3%), and family involvement in medical decision-making (12.2%). More patients wanted to initiate EoLC discussions when they requested it (30.6%) or their oncologist thought it was appropriate (30.6%) as compared to when it may change treatment course (12.2%) or at diagnosis (8.2%). More patients wanted to have EoLC discussions only once (40.8%) as compared to at regular intervals (32.7%). Conclusions: A discrepancy between self-reported and actual knowledge in breast cancer patients emphasizes the need of patient education. Most patients rely on their oncologist for their diagnosis related emotional and social issues. Surprisingly, a quarter of our patients consider EoLC discussions important even though majority of our patients were healthy and having stage I disease.
Prediction and Characterization of Diffuse Large B-Cell Lymphoma (DLBCL) Cell of Origin (COO) Subtypes Using Genomic Features from Targeted Next-Generation Sequencing
Authors: Sally E Trabucco, Ethan S Sokol, Jay A Moore, Sophia Maund, Garrett M Frampton, Vincent A Miller, Jeffrey Venstrom, Lee A Albacker, Laurie H Sehn, Mikkel Z Oestergaard, Christopher R Bolen
Journal: Blood (2018)
Devices Help Surgeons See Parathyroid Tissue
Authors: Rebecca Voelker
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
Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014
Authors: James Tsai, David M. Homa, Andrea S. Gentzke, Margaret Mahoney, Saida R. Sharapova, Connie S. Sosnoff, Kevin T. Caron, Lanqing Wang, Paul C. Melstrom, Katrina F. Trivers
Journal: MMWR Morbidity and Mortality Weekly Report (2018)

Exposure to secondhand smoke from burning tobacco products can cause sudden infant death syndrome, respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1). There is no risk-free level of secondhand smoke exposure (2). CDC analyzed questionnaire and laboratory data from the National Health and Nutrition Examination Survey (NHANES) to assess patterns of secondhand smoke exposure among U.S. nonsmokers. The prevalence of secondhand smoke exposure among U.S. nonsmokers declined substantially during 1988-2014, from 87.5% to 25.2%. However, no change in exposure occurred between 2011-2012 and 2013-2014, and an estimated one in four nonsmokers, or approximately 58 million persons, were still exposed to secondhand smoke during 2013-2014. Moreover, marked disparities persisted across population groups. Exposure prevalence was highest among nonsmokers aged 3-11 years (37.9%), non-Hispanic blacks (50.3%), and those who were living in poverty (47.9%), in rental housing (38.6%), or with someone who smoked inside the home (73.0%), or among persons who had less than a high school education (30.7%). Comprehensive smoke-free laws and policies for workplaces and public places and smoke-free rules for homes and vehicles can further reduce secondhand smoke exposure among all nonsmokers.
Does ACP promote increased hospice utilization? A practice experience among three diverse OCM populations in Texas.
Authors: Sabrina Q. Mikan, Cynthia B. Taniguchi, Lalan S. Wilfong, J. Russell Hoverman
Journal: Journal of Clinical Oncology (2018)

6 Background: A community oncology practice participating in the Oncology Care Model (OCM) has interest in promoting hospice utilization through delivery of proactive advance care planning (ACP) services. This review of data seeks to understand geographic and ethnic variations in Medicare population utilization of ACP program services and timely transition to hospice care at the end of life. The study population included over 43% having stage IV disease at diagnosis; 19% had lung cancer. Methods: Three sites in Texas were selected for review. Site 1: central Texas urban community with primary non-Hispanic population. Site 2: south Texas urban community with primary Hispanic population. Site 3: central/east Texas rural community with primary non-Hispanic population. A 15-month retrospective review of ACP and hospice data was performed for deceased patients having OCM enrollment between January 1, 2017 and March 31, 2018. A total of 224 chart reviews were performed. Results: Little difference in hospice utilization is noted among the various populations, each demonstrating a hospice transition of care for more than 60% of OCM participants reviewed. All sites, however, showed median days in hospice care of five days or less. Formal ACP education was provided for 22% to 27% of urban study populations, while occurring for only 12% of patients seen in the rural setting. Written Advance Directives are captured in the electronic medical record more frequently for non-Hispanic patients when compared to those of Hispanic ethnicity. Formal values and goals for care were not routinely and formally assessed at these study sites, even though a validated tool for assisting with this important component of end-of-life preparedness is available. Conclusions: This study identified notable gaps in service provision to assist patients with end-of-life decision making. Increased efforts to provide ACP counseling services are needed to assist patients and families with ability to consider the additional level of care that is provided when electing hospice care. Overall, work is needed to improve hospice length of stay in all sites reviewed, but particularly among the Hispanic population of south Texas.
A novel tumor suppressor gene ARHI (DIRAS3) enhances polymerization of microtubules and increases the anti-tumor activity of paclitaxel
Authors: Zhen Lu, Robert Luo, Xuhui Zhang, Yinhua Yu, Robert Bast
Journal: Cancer Research (2007)

3640  Taxanes contribute to both curative and palliative therapeutic regimens for a wide variety of malignancies. These compounds are thought to act by stabilizing microtubules, leading to the formation of non-functional bundles that suppress mitosis and induce apoptosis. The dynamic organization of microtubules is tightly controlled by a variety of molecules, including microtubule associated proteins (MAPs) and several Rho family members. ARHI is a Ras superfamily member and a novel imprinted tumor suppressor gene whose expression is silenced or downregulated in a majority of ovarian and breast cancers through several mechanisms, including genetic or epigenetic regulation. Our recent data indicate that ARHI promotes tubulin polymerization. Expression of ARHI has been shown to inhibit cancer cell growth, to produce G2M cell cycle arrest, and to induce autophagy. Co-immunoprecipitation and proteomic analysis indicate that ARHI is associated with both tubulin and MAPs in ovarian cancer cells. Forced expression of ARHI increases tubulin acetylation and polymerization, thus stabilizing microtubules. Induction of ARHI expression enhances the anti-tumor effect of paclitaxel, associated with an increase in the formation of non-functioning microtubule bundles and suppression of mitosis. ARHI also antagonizes nocodazole’s de-polymerizing effect on microtubules. These data indicate that ARHI may be an important and novel regulator of microtubule stability. Our previous data have shown that treatment with epigenetic modifiers, such as demethylating agents and histone deacetylase inhibitors, can re-activate ARHI expression and inhibit tumor cell growth. We can now test whether cancer cells that retain ARHI expression are more susceptible to taxanes and if the re-expression of ARHI with epigenetic modifiers, might also potentiate susceptibility to taxane therapy.
Implications for workability and survivability in populations exposed to extreme heat under climate change: a modelling study
Authors: Oliver Andrews, Corinne Le Quéré, Tord Kjellstrom, Bruno Lemke, Andy Haines
Journal: The Lancet Planetary Health (2018)

BackgroundChanges in temperature and humidity due to climate change affect living and working conditions. An understanding of the effects of different global temperature changes on population health is needed to inform the continued implementation of the Paris Climate Agreement and to increase global ambitions for greater cuts in emissions. By use of historical and projected climate conditions, we aimed to investigate the effects of climate change on workability (ie, the ability to work) and survivability (the ability to survive).MethodsIn this modelling study, we estimated the changes in populations exposed to excessive heat stress between the recent past (ie, 1986–2005) and 2100. We used climate data from four models to calculate the wet-bulb globe temperature, an established heat exposure index that can be used to assess the effects of temperature, humidity, and other environmental factors on humans. We defined and applied thresholds for risks to workability (where the monthly mean of daily maximum wet-bulb globe temperature exceeds 34°C) and survivability (where the maximum daily wet-bulb globe temperature exceeds 40°C for 3 consecutive days), and we used population projections to quantify changes in risk associated with different changes to the global temperature.FindingsThe risks to workability increase substantially with global mean surface temperature in all four climate models, with approximately 1 billion people affected globally after an increase in the global temperature of about 2·5°C above pre-industrial levels. There is greater variability between climate models for exposures above the threshold for risks to survivability than for risks to workability. The number of people who are likely to be exposed to heat stress exceeding the survivability threshold increases with global temperature change, to reach around 20 million people globally after an increase of about 2·5°C, estimated from the median of the models, but with a large model uncertainty. More people are likely to be exposed to heat stress in urban than in rural areas. Population exposure can fluctuate over time and change substantially within one decade.InterpretationExposure to excessive heat stress is projected to be widespread in tropical or subtropical low-income and middle-income countries, highlighting the need to build on the Paris Agreement regarding global temperature targets, to protect populations who have contributed little to greenhouse gas emissions. The non-linear dependency of heat exposure risk on temperature highlights the importance of understanding thresholds in coupled human-climate systems.FundingWellcome Trust.