tbuckley/cabot-search huggingface dataset:
Abstract P083: Modest Association Between the Number of Fast Food Restaurants in a Neighborhood with Cardiovascular Disease Incidence
Authors: Ilonca Vaartjes
Journal: Circulation (2016)

Background: In recent years, there has been an increasing interest in the association between neighbourhood environments and cardiovascular disease (CVD) outcomes. Applying advanced linkage techniques to existing databases enables new and more in-depth research in this field. Aim: To investigate the association between fast food restaurant (FFR) density and incident CVD. Methods: Through linkage with the Dutch Population Register, Hospital Discharge Register and Cause of Death Register we obtained a cohort of 35+ years adults who at 01-01-2009 had lived at the same address for 15 years and were not previously admitted for CVD during this period. We followed these persons for one year for incident CVD. Trough linkage with the Locatus database, a nationwide retail database, we obtained information about the number of FFR’s within 500m, 1000m and 3000m buffers from the exact address. Logistic regression analyses was used to investigate the association between FFR density and CVD incidence. We adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation. Results: In total 3,146,469 adults (46% male), aged 59.2 ± 12 were included. After one year 72,811 (2.3%) persons suffered from an incident CVD. The association with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers were shown in table 1. Conclusion: There is a modest association between FFR and incident CVD. The association was stronger when FFR’s are within 500m from a person’s home address and when there is a high number of FFR’s. Table 1: The association (OR (95% confidence interval)) with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers. Adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation.
Abstract 8256: Timing of Perioperative Methylprednisolone and Outcome in Infants Undergoing Heart Surgery
Authors: Sara K Pasquali, Jeffrey P Jacobs, Xia He, Marshall L Jacobs, Sean M O'Brien, Matthew Hall, Robert D Jaquiss, Karl F Welke, Eric D Peterson, Samir S Shah, J. W Gaynor, Jennifer S Li
Journal: Circulation (2011)

Sara K. Pasquali, 2011 Finalist and Presenting Author
Standardizing and optimizing institutional-level documentation in the electronic medical record era.
Authors: Amy Catherine Moreno, Seungtaek Choi, Lauren Elizabeth Colbert, Ahsan Farooqi, Katie Umberson, Bobby Korah, Joseph M. Herman
Journal: Journal of Clinical Oncology (2018)

155 Background: Although electronic medical records (EMR) offer numerous potential benefits, there are significant challenges to balance high quality patient care and clinical efficiency with the rising demands of required documentation. Our objective was to propose and implement a strategy to standardize and optimize EMR documentation. Methods: An EMR taskforce was created within our institution’s radiation oncology (RO) department consisting of representatives of the clinical staff and EMR coders. To optimize clinical documentation, disease-site specific consult templates were created using EMR standard data elements and personalized drop down menus (Smartlists). Meetings were held with the billing department for template review and with the analytics team to begin automated data extraction into research databases. Quality metrics such as the average number of clinic visits billed at levels 4 or 5 (B45) and the average number of hours per visit (AHV) were compared in different clinics within a 6-month pre- and post- template implementation time period. Results: Within 3 months of establishing the taskforce, 32 RO disease-specific templates were created and distributed for usage in clinic. Optimized template features include consistent cancer staging, standardized oncologic history entry, usage of macros for patients’ symptoms for multiple provider verification, imbedded disease-specific protocol list to improve patient screening and enrollment, and multiple Smartlists for common treatment recommendations. In the GI Clinic, B45 increased from 49.3 to 61.4 per month and similar trends were seen in the Thoracic Clinic (B45, 51.4 to 85.2 per month). The AHV decreased in both the GI (21 to 10 hours) and Thoracic (22 to 13 hours) clinics, showing a significant added value to use of standard documentation. Conclusions: EMR systems can be challenging to navigate; however, they also present a unique opportunity to optimize clinical and research efficiency if used properly. The implementation of standard documentation in our department led to significant improvement in clinical efficiency. Further efforts are being made to adopt these changes on an institutional-wide level.
Response to PD1 inhibition in conventional chondrosarcoma
Authors: Michael J. Wagner, Robert W. Ricciotti, Jose Mantilla, Elizabeth T. Loggers, Seth M. Pollack, Lee D. Cranmer
Journal: Journal for ImmunoTherapy of Cancer (2018)

<h3>Background</h3> Chondrosarcoma is one of the most common malignant bone tumors in adults. Conventional chondrosarcoma represents around 85% of all chondrosarcomas and is notoriously difficult to treat with chemotherapy. <h3>Case presentation</h3> We describe a 67-year-old man with metastatic conventional chondrosarcoma who was treated with nivolumab. Treatment was discontinued after restaging showed increased tumor burden, which later proved to be pseudoprogression. The patient restarted nivolumab and continues to have a near complete response. <h3>Conclusion</h3> Conventional chondrosarcoma may be sensitive to checkpoint inhibitors. Further, this case demonstrates clearly the phenomenon of pseudo-progression in this disease, a factor that must be considered in the design of clinical trials and clinical care. This case supports additional study of immunomodulatory agents in this deadly disease.
Examining the relative influence of multimorbidity on variations in older cancer patients’ experiences with care.
Authors: Erin Kent, Michelle Mollica, Carrie N. Klabunde, Neeraj K. Arora, Marc Elliott, Timothy S. McNeel, Ashley Wilder Smith
Journal: Journal of Clinical Oncology (2018)

14 Background: Cancer patients often have multiple chronic conditions and require complex care coordination. We compared older (ages 66+) cancer patients’ reports of their healthcare experiences based on level of multimorbidity. Methods: Data from the SEER-CAHPS combines cancer registry (Surveillance, Epidemiology, and End Results; SEER), patient experiences (Consumer Assessment of Healthcare Providers and Systems; CAHPS) and Medicare claims data. Multimorbidity was captured as: (1) the National Cancer Institute-Combined Comorbidity Index (NCCI, 16 Charlson conditions diagnosed ≤12 months prior to cancer); and (2) a Multimorbidity Burden Index (MBI), which categorizes conditions based on the impact to cancer treatment (no comorbidity, low/medium, and high). Outcomes were CAHPS patient experience measures: Doctor Communication, Getting Care Quickly, Getting Needed Care, Obtaining Prescription Drugs, Customer Service, and ratings of Overall Care, Personal Doctor, and Specialist. Multivariable linear regression provided associations of each multimorbidity measure with CAHPS measures controlling for standard case mix adjustors, years from diagnosis to survey and diagnostic stage. Results: The study cohort included 9305 cancer patients (53% male, 84% Non-Hispanic White, average age 77, average time from diagnosis 29 months), with a distribution of NCCI conditions as: 0 (cancer only), 73%; 1, 17%; ≥2, 10%. Cancer patients with NCCI = 0 and those with MBI = no comorbidity rated their Personal Doctor more negatively than those with any comorbidities ( p &lt; 0.02). Those with NCCI ≥ 2 or MBI = low/medium reported better Doctor Communication ( p &lt; 0.04). Those with high MBI rated their specialist physician better than those with no multimorbidity ( p = 0.04), and those with low/medium MBI reported better experiences Getting Care Quickly ( p = 0.02). No other associations were significant. Conclusions: Cancer patients with multimorbidity report better communication with their doctor and care = by = personal doctors and specialists. Increased attention to the care experiences of cancer patients with multimorbidity may lead to insights and interventions that benefit all cancer patients.
The impact of C1/D1 treatment follow-up calls on emergency room visits for chemotherapy patients.
Authors: Kimberly Davidson
Journal: Journal of Clinical Oncology (2018)

289 Background: One of the more challenging aspects of managing patients receiving chemotherapy is to reduce Emergency Room (ER) visits and ultimately hospital readmissions. Patients may not understand who or when to call with issues and may be concerned about reaching their physician or receiving a call back in a reasonable amount of time. Methods: C1/D1 calls were initiated with the Medical Oncology Care Coordinator (CC) staff in August 2017. All patients receiving a C1/D1 dose of a new treatment and change in regimen were called by the CC. During this call, the patient is asked several questions including how they are currently feeling, if they are having any issues as well as reviewing contact information and direction regarding if they have a fever. Re-education was provided to the staff in January 2018 regarding the importance of the calls. Also at this time, the CC were asked to do Nadir calls (repeat call 7-10 days after D1) for those patients who were determined to be high risk (percentage calculated using a toxicity formula). Results: Initially the % of ER visits were reduced after the C1/D1 calls were initiated but then began trending upward again. After re-education and the initiation of the Nadir calls, ER visits again trended down. Conclusions: Increased touch points with patients, including C1/D1 follow up calls, Nadir calls and toxicity checks for high risk patients contributed to a downward trend of treatment patients visiting the ER.[Table: see text]
Breathing pattern disorder in difficult asthma: Characteristics and improvement in asthma control and quality of life after breathing re‐training
Authors: Eve Denton, Janet Bondarenko, Robyn E. O'Hehir, Mark Hew
Journal: Allergy (2018)

Breathing pattern disorderin difficult asthma: characteristics and improvement in asthma control and quality of life after breathing re-trainingTo the Editor:Breathing pattern disorder (BPD), or dysfunctional breathing,encompasses heterogeneous disorders characterised by abnormal breathing patternsresulting in symptoms that mimic asthma.(1)BPDaffects24-29%ofpatients with asthma and 30-64% of patients with difficult asthma.(1-4)Diagnosis is generally based on Nijmegenscore, a questionnaire that detects hyperventilation, just one BPD form.(1,4, 5)Difficult asthma is distinct from severe asthma (6)and patient factors including comorbidities such as BDP are thought to be particularly important in patients with difficult asthma.In primary care, breathing retrainingfor patients with asthma improves quality of life (QOL).(7)Patients with difficult asthma present a much greater health burden and BPD is independently associated with worse asthma control and QOL, therefore, treatment may deliver a greater benefit.(8)This study,in patients with difficult asthma,examines BPDcharacteristicsand reportsoutcomes following breathing retraining.
The unbearable inadequacy of language
Authors: L. Farrell
Journal: BMJ (1996)

James Thurber once lamented the existence of those things, actions, expressions, situations, etc, which exist but have not yet been named—for example, to try and avoid someone in the street by stepping to one side. Your adversary mirrors your movements and together you shuffle from side to side in a bizarre little dance, both desperately trying to get past the other. Eventually you extricate yourselves with an embarrassed smile and go on your way. Recognise the situation? There's no word for it.

Medicine is particularly affected by this insufficiency of nomenclature, so we at the BMJ have decided to take urgent corrective action, and today we make a few suggestions of how these lost meanings could be usefully married to Irish place names, …
Creating an end-of-life dashboard with administrative data.
Authors: Tracy Wong, Irina Mezheritsky, Barbara Jagels, Elizabeth Trice Loggers
Journal: Journal of Clinical Oncology (2018)

304 Background: The care given at the End of Life (EoL) is a topic of great interest for cancer patients, oncologists and insurers. This focus has been guided by a desire to achieve the highest quality of life (QoL) near the end of life while simultaneously decreasing costs of what is deemed by many as futile life-sustaining efforts. While EoL measures are reported by hospitals and clinics to external quality programs, the ability for a single center to sustainably measure these data proves burdensome, thus limiting the ability to assess and monitor for the purposes of improvement. Seattle Cancer Care Alliance (SCCA), a single comprehensive cancer center, set out to create regular, accessible and actionable EoL reporting. Methods: This project was broken into 5 phases: (1) Determining rationale for reporting and defining the audience(s). (2) Defining the patient population and measures of interest. (3) Identifying data sources and ensuring data quality. (4) Developing the report and building a data visualization. (5) Sharing report with stakeholders to seek input on definitions visual display. Results: An EoL Metrics Dashboard was created and made available to all SCCA clinicians and staff. The dashboard provides rates for 10 EoL metrics: chemotherapy at 7/14/30 days before death, radiation treatment at 7/14/30 days before death, emergency department (ED) visit within 30 days of death (DoD), ED plus inpatient admission within 30 DoD, intensive care unit (ICU) stay within 30 (DoD), and death in the ICU. The denominator is defined as decedents with ≤3 visits at SCCA within 12 months of death. Data is displayed monthly, rolling 16-month with trendlines for EoL events. Data is viewable by EoL event, cancer type, sex, race, age at death and payor. There is also a permission-based view containing patient-level data. Conclusions: With clear data definitions and dedicated analytic resources it is feasible to create an automated EoL report using administrative data. The largest limitation is that the data available to a hospital or clinic is only inclusive of care within their facility. Also, while this report is useful to detect trends, additional analysis is required at the patient level to determine whether an event was avoidable or did not align with the patient’s wishes.
Follow-on RifAximin for the Prevention of recurrence following standard treatment of Infection with<i>Clostridium Difficile</i>(RAPID): a randomised placebo controlled trial
Authors: Giles Major, Lucy Bradshaw, Nafisa Boota, Kirsty Sprange, Mathew Diggle, Alan Montgomery, Aida Jawhari, Robin C Spiller
Journal: Gut (2018)

Background Clostridium difficile infection (CDI) recurs after initial treatment in approximately one in four patients. A single-centre pilot study suggested that this could be reduced using ‘follow-on’ rifaximin treatment. We aimed to assess the efficacy of rifaximin treatment in preventing recurrence. Methods A multisite, parallel group, randomised, placebo controlled trial recruiting patients aged ≥18 years immediately after resolution of CDI through treatment with metronidazole or vancomycin. Participants received either rifaximin 400 mg three times a day for 2 weeks, reduced to 200 mg three times a day for a further 2 weeks or identical placebo. The primary endpoint was recurrence of CDI within 12 weeks of trial entry. Results Between December 2012 and March 2016, 151 participants were randomised to either rifaximin or placebo. Primary outcome data were available on 130. Mean age was 71.9 years (SD 15.3). Recurrence within 12 weeks was 29.5% (18/61) among participants allocated to placebo compared with 15.9% (11/69) among those allocated to rifaximin, a difference between groups of 13.7% (95% CI −28.1% to 0.7%, p=0.06). The risk ratio was 0.54 (95% CI 0.28 to 1.05, p=0.07). During 6-month safety follow-up, nine participants died in each group (12%). Adverse event rates were similar between groups. Conclusion While ‘follow-on’ rifaximin after CDI appeared to halve recurrence rate, we failed to reach our recruitment target in this group of frail elderly patients, so the estimated effect of rifaximin lacks precision. A meta-analysis including a previous trial suggests that rifaximin may be effective; however, further, larger confirmatory studies are needed.
Improving patient safety: Utilization of standardized radiation oncology simulation templates.
Authors: Ashlyn S. Everett, Ginna Blalock, Drexell Hunter Boggs
Journal: Journal of Clinical Oncology (2018)

259 Background: Increasing patient volume and treatment complexity in the field of radiation oncology has resulted in increased number of errors possibly affecting patient safety. Effective methods of mitigating these errors include automation, computerization, simplification, and standardization. To improve quality of care and patient safety, our institution established consensus standardized treatment guidelines for each cancer site. However, physician orders for computed tomography (CT) simulation for radiation treatment planning continued to have extreme variability, with error rates of 31%. Therefore, a team was assembled to devise standardized orders to reduce error, improve patient safety, and improve quality of care in the CT simulation order process. Methods: For this study, we investigated 3 commonly treated sites at our institution: breast (14%), prostate (7%), and brain metastases treated with radiosurgery (14%). A standardized template CT simulation order was defined for each disease site using the consensus treatment guidelines. These orders were integrated into the electronic medical record (EMR) on March 5, 2018. To evaluate the efficacy of the intervention, CT simulation order data were queried for the two-month period before and after implementation of standardized template orders. Orders with variation from the treatment guidelines were counted to calculate error rates with and without standardized simulation orders. Results: In the two-months prior to implementation of the standardized order templates, 48 of 151 (31%) CT simulation orders for the three selected sites had variation from the consensus standardized orders. After implementation of the EMR standardized template, 17 of 129 simulation orders (13%) in the three selected sites had variations from the standard during this two-month period. Standardization of CT simulation orders using an EMR template reduced error rates from 31% to 13% (18% absolute reduction; 42% relative reduction). Conclusions: Simplification and standardization of CT simulation orders decreased error rates by 42%, thereby improving clinic efficiency and appropriate patient treatment.
The Polyploid State Restricts Hepatocyte Proliferation and Liver Regeneration in Mice
Authors: Patrick D. Wilkinson, Evan R. Delgado, Frances Alencastro, Madeleine P. Leek, Nairita Roy, Matthew P. Weirich, Elizabeth C. Stahl, P. Anthony Otero, Maelee I. Chen, Whitney K. Brown, Andrew W. Duncan
Journal: Hepatology (2018)

The liver contains a mixture of hepatocytes with diploid or polyploid (tetraploid, octaploid, etc.) nuclear content. Polyploid hepatocytes are commonly found in adult mammals, representing ~90% of the entire hepatic pool in rodents. The cellular and molecular mechanisms that regulate polyploidization have been well characterized; however, it is unclear whether diploid and polyploid hepatocytes function similarly in multiple contexts. Answering this question has been challenging because proliferating hepatocytes can increase or decrease ploidy, and animal models with healthy diploid‐only livers have not been available. Mice lacking E2f7 and E2f8 in the liver (liver‐specific E2f7/E2f8 knockout; LKO) were recently reported to have a polyploidization defect, but were otherwise healthy. Herein, livers from LKO mice were rigorously characterized, demonstrating a 20‐fold increase in diploid hepatocytes and maintenance of the diploid state even after extensive proliferation. Livers from LKO mice maintained normal function, but became highly tumorigenic when challenged with tumor‐promoting stimuli, suggesting that tumors in LKO mice were driven, at least in part, by diploid hepatocytes capable of rapid proliferation. Indeed, hepatocytes from LKO mice proliferate faster and out‐compete control hepatocytes, especially in competitive repopulation studies. In addition, diploid or polyploid hepatocytes from wild‐type (WT) mice were examined to eliminate potentially confounding effects associated with E2f7/E2f8 deficiency. WT diploid cells also showed a proliferative advantage, entering and progressing through the cell cycle faster than polyploid cells, both in vitro and during liver regeneration (LR). Diploid and polyploid hepatocytes responded similarly to hepatic mitogens, indicating that proliferation kinetics are unrelated to differential response to growth stimuli. Conclusion: Diploid hepatocytes proliferate faster than polyploids, suggesting that the polyploid state functions as a growth suppressor to restrict proliferation by the majority of hepatocytes.
Advantages of CAST for non-lifting adenomas
Authors: David Tate, Michael Bourke
Journal: Endoscopy (2018)

See also: Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions Endoscopy 2018; 50(01): 52-62DOI: 10.1055/s-0043-119215 See also: Dual-modality management of non-lifting colorectal neoplasia: CAST or ACA?Endoscopy 2018; 50(10): 1035-1036DOI: 10.1055/a-0588-5288