tbuckley/cabot-search huggingface dataset:
Abstract 17892: Effects of Systemic Pyruvate on Cerebral and Systemic Hemodynamics in Newborn Lambs Following Asphyxial Cardiac Arrest
Authors: Vasantha H Kumar, Sylvia F Gugino, Carmon Koenigsknecht, Praveenkumar Chandrashekeran, Justin Helman, Satyan Lakshminrusimha
Journal: Circulation (2016)

Introduction: Infants with perinatal depression often require cardiopulmonary resuscitation. Mitochondrial failure to generate ATP during hypoxia-ischemia (HI) & release of reactive oxygen species during reperfusion contributes to cellular damage. Pyruvate alters the fundamental bioenergetics of mitochondria at the early phase of HI & hence may have long-term implications on inflammation & repair providing cardio- and neuroprotection following cardiac arrest (CA). Hypothesis: We hypothesize that systemic pyruvate in the immediate post recovery phase of CA would improve cardiac function, systemic hemodynamics and oxygen utilization by the brain in newborn lambs with asphyxial CA. Methods: Term lambs were exteriorized by C-section, instrumented & delivered. Asphyxia induced by cord occlusion (CO) along with ETT clamping. CO / ETT clamped until HR of zero (7 - 15min); CA maintained for 5min. The lambs were resuscitated after CA until ROSC. On stabilization, Pyruvate (LD - 100mg/kg over 10min; infusion - 1mM/...
포스터 전시 : 호산구성 간농양 1예
Authors: 김준형, 박재석, 정소연, 이재욱, 김남일, 서정일, 양창헌, 이창우
Journal: Clinical and Molecular Hepatology (2003)

배경/목적: 호산구성 간농양은 여러 가지 원인으로 간에 호산구가 침윤되어 다양한 모양의 결절을 형성하는 질환으로 원인으로는 기생충감염이 가장 많고 알러지성 질환, 약물, 과호산구증후군의 간침범 및 악성종양 등이다. 상복부 불쾌감, 소화불량 등의 비특이적인 증상을 호소하거나 아무런 증상없이 우연히 발견되는 경우도 있다. 저자들은 아무런 증상없이 간초음파에서 다발성 결절이 관찰되어 복부전산화단층촬영과 간조직검사상 호산구성 간농양으로 확진된 경우를 경험하였기에 보고하는 바이다. 증례: 40세 남자 환자로 10년전 T12 척추손상으로 인한 양측하반신 마비가 발생하여 재활의학과에서 치료하던중 시행한 간초음파검사에서 간내 다발성 저음영 결절이 관찰되어 내과로 전원되었다. 과거력상 8년전 붕어회를 먹은적이 있었고 최근 1년간 미꾸라지 엑기스를 복용해왔으며 평소 회를 즐겨 먹는다고 하였다. 이학적검사상 양측 하반신 마비를 제외하고는 특이소견을 볼 수 없었다. 혈액검사상 백혈구수 10,300/mm3, 혈색소 14.2 g/dL, 헤마토크리트 43.8%, 혈소판 328,000/mm3, 호산구수 52%(5900개), IgE >1000 KIU/mL(정상치<120 KIU/mL), 피부반응검사상 간흡충 1:120으로 양성반응을 보였다. 복부전산화단층촬영상 간내 2cm 미만의 다발성 저음영 종괴가 관찰되었고 간조직검사상 다발성 호산구 침윤과 함께 Charcot-Leyden crystal이 보이는 간농양으로 확진되었다. 간흡충에 의한 호산구성 간농양으로 추정하고 프라지퀜텔을 투여하였으며 2개월후 시행한 추적검사에서 호산구수가 25%(3500개)로 감소하였고 복부전산화단층촬영에서는 간내 다발성 종괴가 관찰되지 않았다. 환자는 현재 특이소견 없이 외래에서 추적관찰중이다.
Promoting patient engagement in bladder cancer (BC) care through education.
Authors: Hamsa Jaganathan, Anne Roc, Wendy Turell, Stephanie Chisolm, Nihal Mohamed, Matthew Galsky
Journal: Journal of Clinical Oncology (2018)

176 Background: BC is the 6 th leading cause of cancer in the US and it is estimated that 81,190 Americans will be diagnosed this year. Promoting patient knowledge and involvement in BC care have led to successful management strategies. We offered 1 hour of online education to patients and their caregivers to provide clinical and supportive information that lends a sense of control, supports effective self-management, and promotes patient-physician communication. Methods: PlatformQ Health Education, in partnership with the Bladder Cancer Advocacy Network, developed and executed an interactive education program for patients with BC and their caregivers, which was broadcast live online on cancercoachlive.com on September 29, 2017 and on-demand through March 29, 2018. The program was viewed on cancercoachlive.com by 587 learners and attracted 533 additional learners through social media channels (e.g. Facebook). Education focused on treatment options and the accessibility of resources and support. Self-reported surveys, distributed to patients and caregivers 8 weeks after the program, were analyzed for improvements in perceived engagement in their cancer care. Results: After participating in the education, a majority of the learners reported they felt knowledgeable on treatment options to discuss with their HCPs (92%, n = 60) and resources and information they can use for self-care strategies (88%, n = 58). Follow-up survey results (n = 60) also indicated that the education helped 50% of learners enhance their communication with their HCP. Moreover, 54% of learners (n = 48) felt more in control of health care decisions, and 36% of learners (n = 59) reported improvements in their health-related behaviors. Write-in examples focused on staying informed of treatments and side effects, seeking support, and proactively asking questions to their HCPs. Conclusions: As ASCO guidelines note, providing patients with preoperative information and encouraging them to take an active part in the decision-making process are essential elements to achieving positive outcomes in BC. Results from the patient survey indicate that participating in an interactive, online education program enhanced knowledge and promoted patient engagement in BC care.
Characterization of sick visits at an enhanced oncology urgent care center.
Authors: Anish Parikh, Donna Berizzi, Che-Kai Tsao, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2018)

285 Background: The Oncology Care Unit (OCU) is an urgent care center open during after-hours and weekends for patients with cancer and blood disorders at the Mount Sinai Hospital. This 6-bed, nurse practitioner-run unit aims to decrease the need for emergency room (ER) visits and hospitalization in this high risk patient population. Herein we characterize utilization of this unit for urgent clinical management (“sick visits”). Methods: We identified all patients treated in the OCU between 5/12/17 and 4/8/18, and collected information on diagnosis, treatment, and utilization of the ER or hospitalization. We used descriptive statistics to identify characteristics of those patients treated in the OCU. Results: Of the 1,934 visits to the OCU, 100 (5%) were coded as “sick visits”. Of this cohort, 39% had solid tumors, 44% liquid tumors, and 17% benign hematologic conditions. Among the oncology patients, the average number of prior treatment lines was 4.6 and average time since diagnosis was 51.3 months. Of all cancers, 84% were classified as advanced stage or high-risk. Treatments for the entire group included: transfusion (T, 20%), hydration (H, 20%), and infusion (I, 13%). Similarly, 39% of visits were for H+I, 3% for T+H, 4% for T+I, and 1% for T+H+I. 5% of patients had a repeat, unplanned OCU sick visit in the next 7 days. Among the sick visits, 28% resulted in hospitalization, with a 14-day average length of stay. Further results are shown in Table 1. Conclusions: The OCU provides enhanced diagnostic and therapeutic services for high-risk hematology/oncology patients. These services often exceed the capabilities of a busy practice and would otherwise prompt an ER visit and/or hospitalization. We now aim to study the effect of the OCU on ER utilization and admission rates as well as to analyze its cost effectiveness. [Table: see text]
Mosaic HIV Vaccine Shows Promise
Authors: Anita Slomski
Journal: JAMA (2018)

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Abstract 18003: Left Ventricular Long Axis Function Assessed During Routine Cine-Cardiac Magnetic Resonance Imaging is an Independent Predictor of Mortality in Patients With Reduced Ejection Fraction: A Multicenter Study
Authors: Simone Romano, Jennifer Jue, Robert Judd, Raymond J Kim, Han W Kim, Igor Klem, Dipan J Shah, John Heitner, Vibhav Rangarajan, Satish J Chacko, Brent White, Afshin Farzaneh-Far
Journal: Circulation (2016)

Introduction: Left ventricular contraction involves a complex interplay between myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis function appears to play a fundamental role in cardiac mechanics and there is increasing evidence that it may provide independent prognostic information in a number of disease states. The aim of this study was to evaluate the prognostic value of lateral mitral annular plane systolic excursion (MAPSE) as an index of long axis function, in a large multicenter population of patients with reduced ejection fraction (EF) undergoing CMR. Hypothesis: Long axis function measured using lateral MAPSE during routine cine-CMR is an independent predictor of mortality in patients with reduced EF. Methods: Data analysis was performed on 619 consecutive patients with EF<40% undergoing CMR with cine and late gadolinium enhancement (LGE) imaging at 4 US hospitals. Lateral MAPSE was measured in the 4-chamber cine view as the simple displacement of ...
Abstract 16845: Ethnicity and Gender Predict Ejection Fraction Recovery in Patients With Heart Failure and Reduced Ejection Fraction in a Large Urban Teaching Medical Center
Authors: Dmitry M Yaranov, Pujan P Patel, Wesam Ostwani, Khadeeja Esmail, Justin Tinsley, Alan B Miller
Journal: Circulation (2017)

Introduction: Heart failure with recovered ejection fraction (HFrecEF) is an emerging clinical subgroup of patients with previous heart failure with reduced ejection fraction (HFrEF). The aim of th...
Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Authors: Rohan Khera, Kumar Dharmarajan, Yongfei Wang, Zhenqiu Lin, Susannah M. Bernheim, Yun Wang, Sharon-Lise T. Normand, Harlan M. Krumholz
Journal: JAMA Network Open (2018)

<h3>Importance</h3> The US Hospital Readmissions Reduction Program (HRRP) was associated with reduced readmissions among Medicare beneficiaries hospitalized for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. It is important to assess whether there has been a signal for concomitant harm with an increase in mortality. <h3>Objective</h3> To evaluate whether the announcement or the implementation of HRRP was associated with an increase in either in-hospital or 30-day postdischarge mortality following hospitalization for AMI, HF, or pneumonia. <h3>Design, Setting, and Participants</h3> In this cohort study, using Medicare data, all hospitalizations for AMI, HF, and pneumonia were identified among fee-for-service Medicare beneficiaries aged 65 years and older from January 1, 2006, to December 31, 2014. These were assessed for changes in trends for risk-adjusted rates of in-hospital and 30-day postdischarge mortality after announcement and implementation of the HRRP using an interrupted time series framework. Analyses were done in November 2017 and December 2017. <h3>Exposures</h3> Announcement of the HRRP in March 2010, and implementation of its penalties in October 2012. <h3>Main Outcomes and Measures</h3> Monthly risk-adjusted rates of in-hospital and 30-day postdischarge mortality. <h3>Results</h3> The sample included 1.7 million AMI, 4 million HF, and 3.5 million pneumonia hospitalizations. Between 2006 and 2014, in-hospital mortality decreased for the 3 conditions (AMI, from 10.4% to 9.7%; HF, from 4.3% to 3.5%; pneumonia, from 5.3% to 4.0%) while 30-day postdischarge mortality decreased from 7.4% to 7.0% for AMI (<i>P</i>for trend &lt; .001), but increased from 7.4% to 9.2% for HF (<i>P</i>for trend &lt; .001) and from 7.6% to 8.6% for pneumonia (<i>P</i>for trend &lt; .001). Before the HRRP announcement, monthly postdischarge mortality was stable for AMI (slope for monthly change, 0.002%; 95% CI, −0.001% to 0.006% per month), and increased by 0.004% (95% CI, 0.000% to 0.007%) per month for HF and by 0.005% (95% CI, 0.002% to 0.008%) per month for pneumonia. There were no inflections in slope around HRRP announcement or implementation (<i>P</i> &gt; .05 for all). In contrast, there were significant negative deflections in slopes for readmission rates at HRRP announcement for all conditions. <h3>Conclusions and Relevance</h3> Among Medicare beneficiaries, there was no evidence for an increase in in-hospital or postdischarge mortality associated with HRRP announcement or implementation—a period with substantial reductions in readmissions. The improvement in readmission was therefore not associated with any increase in in-hospital or 30-day postdischarge mortality.
Mapping the Supratentorial Cerebral Arterial Territories Using 1160 Large Artery Infarcts
Authors: Dong-Eog Kim, Jong-Ho Park, Dawid Schellingerhout, Wi-Sun Ryu, Su-Kyoung Lee, Min Uk Jang, Sang-Wuk Jeong, Jeong-Yong Na, Jung E. Park, Eun Ja Lee, Ki-Hyun Cho, Joon-Tae Kim, Beom Joon Kim, Moon-Ku Han, Jun Lee, Jae-Kwan Cha, Dae-Hyun Kim, Soo Joo Lee, Youngchai Ko, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Keun-Sik Hong, Yong-Jin Cho, Jong-Moo Park, Kyusik Kang, Tai Hwan Park, Kyung Bok Lee, Kyoung-Jong Park, Heung-Kook Choi, Juneyoung Lee, Hee-Joon Bae
Journal: JAMA Neurology (2018)

Cerebral vascular territories are of key clinical importance in patients with stroke, but available maps are highly variable and based on prior studies with small sample sizes.To update and improve the state of knowledge on the supratentorial vascular supply to the brain by using the natural experiment of large artery infarcts and to map out the variable anatomy of the anterior, middle, and posterior cerebral artery (ACA, MCA, and PCA) territories.In this cross-sectional study, digital maps of supratentorial infarcts were generated using diffusion-weighted magnetic resonance imaging (MRI) of 1160 patients with acute (<1-week) stroke recruited (May 2011 to February 2013) consecutively from 11 Korean stroke centers. All had supratentorial infarction associated with significant stenosis or occlusion of 1 of 3 large supratentorial cerebral arteries but with patent intracranial or extracranial carotid arteries. Data were analyzed between February 2016 and August 2017.The 3 vascular territories were mapped individually by affected vessel, generating 3 data sets for which infarct frequency is defined for each voxel in the data set. By mapping these 3 vascular territories collectively, we generated data sets showing the Certainty Index (CI) to reflect the likelihood of a voxel being a member of a specific vascular territory, calculated as either ACA, MCA, or PCA infarct frequency divided by total infarct frequency in that voxel.Of the 1160 patients (mean [SD] age, 67.0 [13.3] years old), 623 were men (53.7%). When the cutoff CI was set as 90%, the volume of the MCA territory (approximately 54% of the supratentorial parenchymal brain volume) was about 4-fold bigger than the volumes of the ACA and PCA territories (each approximately 13%). Quantitative studies showed that the medial frontal gyrus, superior frontal gyrus, and anterior cingulate were involved mostly in ACA infarcts, whereas the middle frontal gyrus and caudate were involved mostly by MCA infarcts. The PCA infarct territory was smaller and narrower than traditionally shown. Border-zone maps could be defined by using either relative infarct frequencies or CI differences.We have generated statistically rigorous maps to delineate territorial border zones and lines. The new topographic brain atlas can be used in clinical care and in research to objectively define the supratentorial arterial territories and their borders.
Quality improvement interventions to reduce chemotherapy dose-modification ordering errors at a large academic medical center.
Authors: Margaret Soriano, Anne Chang, Aralee Galway, Laura Listro, Evaline Liu, Jessica McGuire, Therese Marie Mulvey, Sheila O'Donoghue, Aparna Raj Parikh, Erika Rosato, David P. Ryan, Lawren White, Melissa Anne Woolwine, Steven J. Isakoff
Journal: Journal of Clinical Oncology (2018)

264 Background: Despite clear advantages of Electronic Health Records (EHR) systems for safe cancer chemotherapy administration, persistent opportunities exist to further reduce chemotherapy order errors. Unintended dose escalation orders of previously dose reduced chemotherapy were the most commonly reported “near-miss” medication safety events at our institution. This can lead to potential patient harm, delays in care, decreased patient satisfaction, reduced infusion room efficiency, and increased care team workload and decreased satisfaction. We sought to reduce chemotherapy order errors using interventions developed with process improvement techniques. Methods: Unintended dose escalation errors per month (the primary outcome measure) were identified through the hospital safety reporting system and by monitoring the EHR (EPIC) chemotherapy administration reports to identify dose escalations. All cases were confirmed with primary chart review. The pre-intervention baseline assessment period was 6/2017-11/2017, and the post intervention period was 12/2017-5/2018. Two interventions were selected: 1) Revision of the nursing chemotherapy checklist posted on all infusion room workstations for use prior to releasing chemotherapy orders; and 2) educating ordering providers and nurses about new EHR functionality to display prior and future chemotherapy orders. Statistical Process Control chart analysis was conducted with upper (UCL) and lower (LCL) control limits of 3 standard deviations. The primary aim was to reduce the number of chemotherapy errors by 50% in the post-intervention period. Results: The pre-intervention period averaged 3.83 chemotherapy ordering errors per month (UCL = 9.71, LCL = 0). The post-intervention period significantly reduced the average errors per month to 1.33 (UCL = 4.97, LCL = 0). The copy/forward feature in multi-day cycles was the most common source of unintended dose escalations. Conclusions: Implementation of the 2 interventions resulted in a 65% reduction of unintended dose modification errors. Based on successful results and positive staff feedback, we plan to roll out these interventions at additional satellite facilities.
Prevalence of Undetectable Vaccine‐Induced Immunity Against Hepatitis B Virus in US Adults at High Risk for Infection
Authors: Yee Hui Yeo, Michael H. Le, Ellen T. Chang, Linda Henry, Mindie H. Nguyen
Journal: Hepatology (2018)

In 2015, the Centers for Disease Control and Prevention reported a substantial increase in the number of acute hepatitis B virus (HBV) infections in the United States. Although national guidelines recommend vaccination of adults at high risk for HBV infection, the prevalence of undetectable immunity (i.e., susceptibility) in this population remains unknown. In this study, we analyzed a nationally representative sample using the National Health and Nutrition Examination Survey to evaluate the prevalence, trend, and predictors of undetectable vaccine‐induced antibodies against HBV surface antigen (&lt;10 mIU/mL) among high‐risk adults from 2003‐2014. Among adults at high risk for HBV infection, the prevalence of undetectable immunity decreased from 83.2% in 2003‐2004 (95% confidence interval [CI]: 81.3‐85.0) to 69.4% (about 64 million) in 2013‐2014 (95% CI: 66.0‐72.6). The prevalence decreased significantly in individuals with multiple sex partners or sexually transmitted disease and in pregnant women. However, there were no significant changes in men who have sex with men (MSMs), intravenous drug users (IDUs), hepatitis C virus (HCV)‐infected and patients with diabetes, and those with elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT). Mexican Americans had the highest prevalence of undetectable immunity (77.6%, 95% CI: 72.6‐81.9), followed by non‐Hispanic whites (70.1%, 95% CI: 66.9‐73.1). Older age, lower socioeconomic status, and having at least 1 high‐risk factor were associated with a higher risk of undetectable immunity, whereas an increased risk among the foreign‐born disappeared after multivariable adjustment. Conclusion : Approximately 64 million high‐risk adults in the United States remain susceptible to HBV infection, especially MSMs, IDUs, diabetics, HCV patients, and populations with elevated AST/ALT. To eliminate HBV, efforts should be made to increase screening and vaccination in high‐risk adults.
Strategies for reducing grade 2 and 3 adverse events due to immunotherapy in a Spanish university hospital.
Authors: Ana Gomez, Paloma Gómez Solana, Elena Ruiz, Antonio Anton, Enrique Aranda, Carlos Camps, Manuel Constenla, Juan Jesús Cruz, Eduardo Díaz Rubio, Margarita Feyjoo, Jesús García Foncillas, Pedro Gascon, Vicente Guillem, Rafael Lopez, Ilse Lugo, Alfredo Carrato
Journal: Journal of Clinical Oncology (2018)

288 Background: To develop an improvement project, the Lung Cancer Unit of Ramón y Cajal Hospital (Madrid) analyzed 45 patients treated with immunotherapy in 2017 and detected that 55% presented moderate-to-severe Adverse Events (AEs). Consequently, a specialized team from Ramon y Cajal Hospital and ECO Foundation proposed to identify improvement areas that reduce grade 2 (G2) and 3 (G3) AEs. ECO is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Methods: The team used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). A data collection process was conducted before attending the first out of three sessions of the QTP with the revision of medical records from lung cancer patients. The goal for the final QTP session in late-June 2018 was to reduce G2 and G3 AEs by 25%, by standardizing patient education sessions using ASCO guidelines for the management of immune-related AEs. Results: The data collected showed that G2 and G3 AEs had an impact on quality of care, specifically a treatment delay in 31% of patients, unscheduled visits in 19%, serious complications in 11% and patient dissatisfaction with the reporting system. The team created a cause and effect diagram, in which the most relevant causes were inadequate patient knowledge and a lack of communication with patients between visits, in addition to a Pareto chart, in which the more frequent AEs were asthenia, respiratory infection, cough, among others. A run chart of percentage of G2 and G3 AEs during 2017 displayed that G2 AEs were higher during January and August; and G3 AEs in February and December. The team, including patient advocates, prioritized the implementation of these short-term measures for patients: improvement of education, education follow-up, satisfaction questionnaire development and AE knowledge test. By mid-June 2018, new data will be collected to determine the effectivity of these measures. Conclusions: This improvement approach indicates the need to continue further quality projects in healthcare. Broader participation of Spanish hospitals in improvement initiatives will enhance the goal of a quality-oriented health care system.
Current strategies in pulmonary rehabilitation
Authors: K Wagg, E Wilcock, J Williams, L Sewell, M Steiner, M Morgan, S Singh, J O'connor, T Cartwright, C Lee, L Nabarro, P Evans, A Clow, D Peters, Z Abrahams, A Williamson, S Purcell, H Broomfield, P Davies, A Morley, P Jamieson, N Gibson
Journal: Thorax (2009)

This shows that it is feasible to deliver a self-management package in primary care as a stand alone manual, with significant improvements demonstrated in dyspnoea, exercise performance and anxiety.