tbuckley/cabot-search huggingface dataset:
Annals Consult Guys - Fasting Before Anesthesia: A Cappucino On Call?
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2017)

Web Exclusives21 November 2017Annals Consult Guys - Fasting Before Anesthesia: A Cappucino On Call?FREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this author and Howard H. Weitz, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W17-0011 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Howard and Geno (the Consult Guys) help decide whether a procedure requiring anesthesia may proceed after a patient drank a cappuccino.For more videos from and information on Annals Consult Guys, visit go.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment RoyACP8 May 2018 Percentage of milk Is there a limit as to the quantity of milk? If not if the patient drank water after Cappuccino, wont it make it a clear liquid diet and the patient can go for the surgery? Author, Article, and Disclosure InformationAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Janssen, Portola; Consultancies: Bristol-Myers Squibb, Janssen. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 21 November 2017Volume 167, Issue 10Page: CG1KeywordsAnesthesiaDisclosureResearch grantsResearch reporting guidelines ePublished: 21 November 2017 Issue Published: 21 November 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.Loading ...
PTU-044 Role of deep sedation in endoscopy
Authors: CC Yau, R Hiles, S Sonwalkar
Journal: Gut (2017)

Introduction  Sedation and analgesia are considered an essential component and are commonly used by endoscopists in endoscopic procedures. 1  The primary goal of a procedure involving sedation is to reduce a patient’s anxiety and discomfort as well as improving their tolerability for the examination. Four stages of sedation have been classified ranging from minimal sedation (anxiolysis), moderate (conscious sedation), deep sedation to general anaesthesia. Deep sedation is defined as a stage where a patient can not be easily aroused but responds purposefully following repeated painful stimulus. 2   Traditionally patients who fail conventional sedation for endoscopy have heavier sedation in operating theatres, which requires occupying the emergency theatre and use of valuable theatre resources.  With the dedicated deep sedation endoscopy services we are able to provide such a service as scheduled.  Method  Huddersfield Royal Infirmary has been running a deep sedation endoscopy service on every alternate Tuesday since June 2014. The aim is to manage patients who tolerate endoscopic procedures poorly. From their database, 127 patients were included between August 2015 and August 2016. All patients were referred as either fast track, urgent or routine. Deep sedation endoscopy is conducted in the endoscopy department with anaesthetic set up and presence of endoscopist, endoscopy nurse, an operating department practitioner and anaesthetist. Induction agents include Propofol 1% and occasionally Alfentanil without intubation.  Results  127 patients were included from 140 procedures conducted. 77% (108/140) of these were gastroscopy, 17% (24/140) were colonoscopy and 6% (8/140) were sigmoidoscopy. 7 patients were referred as fast track, with a mean of 17 days and median 13 days until procedure. 9 patients were referred as urgent, with a mean of 24 days and median of 21 days until procedure.  Conclusion  The introduction of a deep sedation session in the endoscopy department has effectively minimised the resources such as theatre use and staffing involvement. It has also improved the quality of endoscopy secondary to a familiar environment whose use by the endoscopist and anaesthetist are familiar with the procedure involved.  Guidelines for referring a patient for endoscopy under deep sedation should be anticipated to ensure resources are being used appropriately. Further studies are indicated to establish whether this will reduce waiting times for patients who need the service.  References  . Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol2006;101:967–974.  . Gross JB, Bailey PL, Connis RT, Cote CJ, Davis FG, Epstein BS, et al. Practice guidelines for sedation and analgesia by non- anesthesiologists. Anesthesiology2002;96:1004–1017.  Disclosure of Interest  None Declared
Abstract 17804: Echocardiographic and Radiologic Predictors of Atrial Fibrillation in Acute Ischemic Stroke
Authors: Shilpi Mittal, Janhavi Modak, Ilene Staff, Michael Phipps, Gilbert Fortunato, Louise D McCullough
Journal: Circulation (2015)

Introduction: Atrial fibrillation (AF) is an important risk factor for stroke. Approximately 15-25% of cryptogenic ischemic strokes (CIS) are due to AF. Hypothesis: Patients with echocardiographic markers including left atrial dilatation (LAD) and valvular disease and/or radiologic findings including a hyper-dense vessel sign (HDV sign), prior cortical or cerebellar stroke, and hemorrhagic transformation (HT) are more likely to have stroke due to AF. Methods: This is a single center, retrospective case control study of patients admitted with acute ischemic stroke (AIS) from 2008-2013. Patients with a new diagnosis of stroke and a defined stroke etiology (large vessel, cardio-embolic, small vessel and other, TOAST classification) were included. CIS patients or those without imaging/echocardiographic studies were excluded. Images were reviewed for prior stroke, HT, a HDV sign and stroke location (left or right anterior, posterior, multifocal). Echocardiograms were reviewed for LAD, ejection fraction&lt;35%, moderate-severe mitral regurgitation (MR), moderate-severe aortic regurgitation, mitral stenosis, aortic stenosis, left ventricular segmental akinesis, diastolic dysfunction, LVH and patent foramen ovale. Results: Charts of 600 patients were reviewed and 383 patients were included in the analysis. 185 patients had AF as the etiology of their stroke. The remainder had no known AF. Univariate and multivariate logistic regression was performed using SPSS. LAD, moderate to severe MR, HDV sign, and HT were found to accurately predict AF in patients with AIS. LAD had an OR of 6.9 (CI 4.4-10.8, p&lt;.0001) and HDV predicted AF with an OR of 2.2 (CI 1.2-4.2, p&lt;.016) even after controlling for LAD, MR, and HT. Conclusion: Echocardiographic and radiologic markers help predict AF as a stroke etiology in AIS patients. This is the first study, to the best of our knowledge, to show that HDV sign is a positive predictor of AF. Prospective studies with larger cohorts are needed to confirm these findings in CIS patients. These markers could be added to demographic information to enhance prediction of occult AF and the need for chronic cardiac monitoring.
Proof-of-concept of a risk calculator of chemotherapy induced (febrile) neutropenia (CIN/FN) based on real-world evidence (Monitor-GCSF study)
Authors: C. Bokemeyer, M. Aapro, H. Ludwig, P. Gascón, M. Boccadoro, K. Denhaerynck, A. Krendyukov, K. Macdonald, I. Abraham
Journal: Annals of Oncology (2017)
Abstract 18982: E3317 Promotes Cholesterol Efflux in Macrophage Cells via Enhancing ABCA1 Expression
Authors: Yanni Xu, Xiao Wang, Ni Li, Liu Chao, Xuan Zuo, Jinque Luo, Shuyi Si
Journal: Circulation (2017)

Introduction: Reverse cholesterol transport (RCT) is a process which plays an important role in cholesterol, lipid and glucose metabolism. Regulating the activities of key transporters and receptor...
Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients
Authors: Molly Candon, Stephen Zuckerman, Douglas Wissoker, Brendan Saloner, Genevieve M. Kenney, Karin Rhodes, Daniel Polsky
Journal: JAMA Internal Medicine (2017)

Under the Affordable Care Act (ACA), Medicaid fees for primary care physicians were raised to Medicare levels in 2013 and 2014.The size of the federally funded increase varied widely, as Medicaid fees were close to Medicare levels in some states and Medicaid paid less than half for the same services in other states. 1 A previous study found that higher Medicaid fees in 2014 were associated with increased primary care appointment availability for new Medicaid patients. 2Now that most states have returned to lower fee levels, it is time to examine whether declining Medicaid fees are associated with decreased primary care appointment availability for new Medicaid patients.Methods | Appointment availability was measured with an audit study (described fully elsewhere 3 ), in which trained staff simulated new patients and requested the earliest appointment available from randomly selected primary care physicians in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas.The sample frame (from the SK&A Office-Based Physician Database) included any practice with at least 1 primary care physician serving working-aged adults (≥18 years) and was refreshed in 2016.Scripted callers referred to a Medicaid plan accepted by that practice, which was determined with a preaudit survey.With some exceptions, callers were different across waves, although they underwent the same training and used identical scripts.Some, but not all, practices were called in multiple waves.The study was conducted before the ACA Medicaid fee increase was fully enacted (2012) and then repeated during its implementation (2014) and after its expiration (2016).
Enfermedades infecciosas en Roma en el año del milenio
Authors: P Giorgi Rossi, M. Sangalli, A. Faustini, F Forastiere, C. A. Perucci
Journal: Eurosurveillance (2003)

En 2000, el ano del milenio, visitaron Roma veintiseis millones de personas. En 1997 se introdujo un sistema mejorado de vigilancia de las enfermedades infecciosas, con atencion especial a los brotes de enfermedades transmitidos por alimentos (foodborne disease outbreaks; FBDO), meningitis y legionelosis. Esta rapida red de alerta conecta a los servicios de salud con las principales fuentes de diagnostico y vigilancia basada en laboratorios. Para la legionelosis se implanto la vigilancia internacional. Se adoptaron medidas de control especificas para los FBDO. No se observo ningun incremento en la incidencia global de estas enfermedades, ni se aislaron patogenos atipicos en los FBDO o meningitis en el ano 2000, con respecto a 1998-99. Aumentaron los casos de legionelosis y los FBDO con implicacion de turistas extranjeros (10/4 y 7/2 observados/esperados respectivamente). Tres de un total de seis FBDO con implicacion de peregrinos se produjeron en albergues religiosos. Pese a que el sistema de vigilancia observo un incremento de casos de legionelosis y FBDO en turistas extranjeros, el ano del milenio no influyo en la epidemiologia de las enfermedades infecciosas en la poblacion residencial de Lazio.
Antiviral therapy improves survival in patients with HBV infection and intrahepatic cholangiocarcinoma undergoing liver resection
Authors: Zhengqing Lei, Yong Xia, Anfeng Si, Kui Wang, Jun Li, Zhenlin Yan, Tian Yang, Dong Wu, Xuying Wan, Weiping Zhou, Jingfeng Liu, Hongyang Wang, Wenming Cong, Mengchao Wu, Timothy M. Pawlik, Wan Yee Lau, Feng Shen
Journal: Journal of Hepatology (2017)
Abstract MP26: Biomarkers of n-6 Polyunsaturated Fatty Acids and CVD Risk: A Global Pooling Project of 19 Cohort Studies
Authors: Matti Marklund, Tzu-An Chen, Janette de Goede, Fumiaki Imamura, Federica Laguzzi, Kiesha Prem, Cécilia Samieri, Peilin Shi, Jyrki Virtanen, Maria Wennberg, Kerry Wong, Jason H Wu, Xia Zhou, Rozenn N Lemaitre, Dariush Mozaffarian, Ulf Risérus
Journal: Circulation (2016)

Background: Despite cholesterol-lowering and other potential beneficial properties of dietary linoleic acid (LA; 18:2n-6), LA has been considered pro-inflammatory and is a precursor to arachidonic acid (AA; 20:4n-6), which has also been considered harmful for CVD. Thus, the role of n-6 fatty acids in CVD prevention remains debated. Objective: To investigate across harmonized global studies the relation of circulating/tissue biomarker levels of LA and AA with incidence of CVD, CHD, and stroke. Methods: We conducted a pooled analysis within a global consortium of prospective cohort or nested case-control studies having circulating or tissue biomarker measures of LA and AA. Each study ascertained CVD risk, including incident CVD, CHD, ischemic stroke (IS), and/or CVD mortality in adults with no prevalent CVD at baseline. Standardized individual-level analysis was conducted in each study using pre-specified models, exposures, outcomes, and covariates. Study-specific estimates were pooled using inverse variance-weighted fixed effects meta-analysis. Results: We evaluated 19 studies, including 6,569 total CVD events, 2,407 CVD deaths, 6,557 CHD events, and 2,237 IS events (values may not sum due to cohort-specific outcomes). In continuous (90th vs 10th percentile) multivariable-adjusted analyses, higher levels of both LA and AA were associated with lower risk of incident CVD, with modest between-compartment heterogeneity (I2=33-35%) (Figure). LA and AA were inversely associated with CVD mortality, with RRs (95% CI): LA 0.81 (0.73 - 0.90) and AA 0.90 (0.81 - 0.99). LA, but not AA, was associated with lower risk of incident CHD and IS, with RRs (95% CI) 0.94 (0.88 - 0.99) and 0.80 (0.69 - 0.92), respectively. Conclusions: Based on harmonized analysis of multiple studies on free-living populations, biomarker levels of the two major n-6 fatty acids are associated with lower risk of CVD incidence and mortality. Relevance of potential differences in compartment-specific associations requires further investigation.
Who should receive endoscopic variceal ligation after recovering from acute variceal bleeding?
Authors: Xingshun Qi, Nahum Méndez‐Sánchez, Andrea Mancuso, Fernando Gomes Romeiro, Xiaozhong Guo
Journal: Hepatology (2017)

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. To the Editor: The 2016 practice guidance by the American Association for the Study of Liver Diseases recommends that nonselective beta‐blockers (NSBBs) combined with endoscopic variceal ligation (EVL) should be the first‐line choice of therapy for the prevention of variceal rebleeding.1 This recommendation is primarily based on the results of an updated systematic review and meta‐analysis that NSBBs combined with EVL is superior to each treatment alone at decreasing the risk of rebleeding.2 However, two recent studies regarding secondary prophylaxis of variceal bleeding in liver cirrhosis seem to challenge the recommendation.3 First, in an individual patient data meta‐analysis of randomized controlled trials, Albillos et al.3 found that additional use of EVL might have a higher mortality (incidence rate ratio, 1.40; 95% confidence interval [95% CI], 0.87‐2.27; P = 0.167) and risk of all‐source rebleeding (incidence rate ratio, 1.36; 95% CI, 0.87‐2.14; P = 0.180) and variceal rebleeding (incidence rate ratio, 1.24; 95% CI, 0.75‐2.05; P = 0.410) in patients with Child‐Pugh class B/C who received NSBBs; but the difference was not statistically significant. Second, in a randomized controlled trial, Villanueva et al.4 found that the hemodynamic response–guided therapy group had a significantly lower risk of rebleeding (hazard ratio, 0.53; 95% CI, 0.29‐0.98), further decompensation (hazard ratio, 0.68; 95% CI, 0.46‐0.99), and mortality (hazard ratio, 0.59; 95% CI, 0.35‐0.99) than the conventional treatment group. Notably, in the hemodynamic response–guided therapy group, hemodynamic responders and nonresponders received NSBB alone and in combination with EVL, respectively; by comparison, in the conventional treatment group, all patients received a combination of NSBB and EVL. Thus, it might be reasonable to conclude that additional EVL would not be beneficial for improving the outcomes if there was no hemodynamic response to NSBB. Collectively, these recently published data emphasize the importance of risk stratification and individualizing care for portal hypertension.5 More high‐quality studies should reevaluate who should and should not receive EVL among patients who recover from acute variceal bleeding. For example, should EVL be combined with NSBB in cases of Child‐Pugh class B/C? Additionally, should EVL be given in the absence of a hemodynamic response to NSBB?
P2.07-005 Impact of Baseline Leptomeningeal and Brain Metastases on Immunotherapy Outcomes in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients
Authors: C. Henon, L. Mezquita, E. Auclin, S. Ammari, C. Caramella, C. Le Pechoux, A. Botticella, D. Planchard, A. Gazzah, R. Ferrara, J. Lahmar, G. Martinez-Bernal, J. Adam, J. Soria, B. Besse
Journal: Journal of Thoracic Oncology (2017)
Tonicity-Responsive Enhancer-Binding Protein Mediates Hyperglycemia-Induced Inflammation and Vascular and Renal Injury
Authors: Soo Youn Choi, Sun Woo Lim, Shabnam Salimi, Eun Jin Yoo, Whaseon Lee-Kwon, Hwan Hee Lee, Jun Ho Lee, Braxton D. Mitchell, Satoru Sanada, Afshin Parsa, Hyug Moo Kwon
Journal: Journal of the American Society of Nephrology (2017)

Diabetic nephropathy (DN) has become the single leading cause of ESRD in developed nations. Bearing in mind the paucity of effective treatment for DN and progressive CKD, novel targets for treatment are sorely needed. We previously reported that increased activity of tonicity-responsive enhancer-binding protein (TonEBP) in monocytes was associated with early DN in humans. We now extend these findings by testing the hypotheses that TonEBP in macrophages promotes hyperglycemia-mediated proinflammatory activation and chronic renal inflammation leading to DN and CKD, and TonEBP genetic variability in humans is associated with inflammatory, renal, and vascular function-related phenotypes. In a mouse model of DN, compared with the wild-type phenotype, TonEBP haplodeficiency associated with reduced activation of macrophages by hyperglycemia, fewer macrophages in the kidney, lower renal expression of proinflammatory genes, and attenuated DN. Furthermore, in a cohort of healthy humans, genetic variants within TonEBP associated with renal function, BP, and systemic inflammation. One of the genetic variants associated with renal function was replicated in a large population-based cohort. These findings suggest that TonEBP is a promising target for minimizing diabetes- and stress-induced inflammation and renovascular injury.
Phase 1 Study of Pomalidomide Given at the Time of Early Lymphocyte Recovery after Induction Timed Sequential Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia (AML) and High-Risk Myelodysplastic Syndrome (HR-MDS)
Authors: Joshua F. Zeidner, Raul Montiel-Esparza, Hanna A. Knaus, Sofia Berglund, Amer M. Zeidan, Shannon R. McCurdy, Gabrielle T Prince, Lukasz P Gondek, Gabriel Ghiaur, Margaret M. Showel, Amy E. DeZern, Keith W. Pratz, B. Douglas Smith, Mark J. Levis, Matthew C Foster, Katarzyna Jamieson, Hendrik W. Van Deventer, Howard Streicher, Judith E. Karp, Leo Luznik, Ivana Gojo
Journal: Blood (2016)
Long‐term outcomes for different surgical strategies to treat left ventricular outflow tract obstruction in hypertrophic cardiomyopathy
Authors: Richard Collis, Oliver Watkinson, Constantinos O'Mahony, Oliver P. Guttmann, Antonis Pantazis, Maria Tome‐Esteban, Victor Tsang, Venkatachalam Chandrasekaran, Christopher G.A. McGregor, Perry M. Elliott
Journal: European Journal of Heart Failure (2017)
Stuff goes wrong, so act now
Authors: Michala Iben Riis-Vestergaard, Johannes Haushofer
Journal: Behavioral and Brain Sciences (2017)

Pepper & Nettle make an ambitious and compelling attempt to isolate a common cause of what they call the behavioral constellation of deprivation. We agree with the authors that limited control can indeed help explain part of the difference in observed present-oriented behavior between the poor and the rich. However, we suggest that mortality risk is not the primary mechanism leading to this apparent impatience.
The PULSES project: Teaching the vital elements of code status discussions to oncology residents.
Authors: Oren Hannun Levine, Ines B. Menjak, Stephanie Yasmin Brule, Meghan McConnell, Sukhbinder K. Dhesy-Thind, Som Mukherjee, Melissa C. Brouwers
Journal: Journal of Clinical Oncology (2017)

46 Background: Discussions with cancer patients around cardiopulmonary resuscitation, or ‘code status,’ are often led by trainees in oncology, but formal education for this competency is lacking. In this study, we developed and tested a novel communication tool, the PULSES framework, for informed code status decision-making (a six-step approach summarized by the PULSES acronym [see Table]), through an educational workshop. Methods: A multicentre randomized controlled trial was carried out at 3 academic cancer centres in Ontario, Canada. Residents in medical oncology (MO) and radiation oncology (RO) programs completed a workshop and an observed structured clinical exam (OSCE). Participants were randomized to complete the training before the OSCE (experimental arm) or after the OSCE (control arm). Randomization was stratified for centre and oncology discipline. Expert raters evaluated communication with two rating tools: the novel PULSES scale and the communication skills assessment form (CSAF), a validated benchmark tool that is not specific to oncology content. The primary outcome was improvement in PULSES scores. Results: Forty-six residents consented to participate (28 RO and 18 MO). Groups were well balanced for program and year of training. Participants in the experimental group had higher mean PULSES score than those in the control group (80.4±13.5 vs 63.4±9.7; p&lt;.001; maximum score = 108). There was no significant effect for oncology program and no significant interaction between program and training condition. Scores from the PULSES and CSAF scales were highly correlated (R = 0.864). Conclusions: The PULSES training improved performance among oncology residents for code status discussions. Improved communication scores were not scale-specific. The PULSES framework offers a standardized approach and can be incorporated into competency-based curricula for postgraduate oncology programs. Future work will explore whether communication training in this area impacts patient-level outcomes. [Table: see text]