tbuckley/cabot-search huggingface dataset:
Non–Vitamin K Antagonist Oral Anticoagulants for Mechanical Heart Valves
Authors: Alberto Aimo, Robert P. Giugliano, Raffaele De Caterina
Journal: Circulation (2018)

The estimated prevalence of mitral or aortic valvular heart disease is ≈2.5% in the general population of Western countries, and is expected to rise with population aging. A substantial proportion of patients with valvular heart disease undergoes surgical valve replacement. Mechanical heart valves are much more durable than bioprostheses, and are thus preferentially implanted in patients with a longer life expectancy, but have the major drawback of requiring lifelong anticoagulation to prevent valve thrombosis because of their higher thrombogenicity. The non–vitamin K antagonist oral anticoagulants (NOACs) are replacing vitamin K antagonists in many settings, including bioprostheses, because of their favorable safety and efficacy profiles. However, mechanical heart valves currently pose an absolute contraindication to NOACs based on the results of a single phase II study comparing dabigatran and warfarin (RE-ALIGN [Randomized, Phase II Study to Evaluate the Safety and Pharmacokinetics of Oral Dabigatran Etexilate in Patients after Heart Valve Replacement]). That trial was stopped prematurely because of an excess of both stroke and bleeding with the dabigatran doses tested. Because of such negative findings, research in this area has been halted. We believe that several aspects of both the preclinical studies and the RE-ALIGN trial should be critically reevaluated. In our opinion, 1 single trial with a single NOAC does not represent sufficient evidence for dismissing a therapeutic strategy, anticoagulation with NOACs, that has shown better safety and at least similar efficacy as warfarin in the setting of atrial fibrillation and venous thromboembolism,. Herein, we reevaluate this topic to identify the patient profile that has the greatest likelihood of benefit from some of the NOACs, with a focus on factor Xa inhibitors, thus providing some perspectives for basic and translational research.
γ-Neurexin and Frizzled Mediate Parallel Synapse Assembly Pathways Antagonized by Receptor Endocytosis
Authors: Peri T. Kurshan, Sean A. Merrill, Yongming Dong, Chen Ding, Marc Hammarlund, Jihong Bai, Erik M. Jorgensen, Kang Shen
Journal: Neuron (2018)
Abstract 20571: Early Change in Right Ventricular Function Assessed Echocardiographically Predicts Up to 17 Year Survival in Pulmonary Arterial Hypertension
Authors: Alexander J Blood, Kishan Parikh, Thomas M Bashore, Richard A Krasuski
Journal: Circulation (2016)

Background: Baseline right ventricular (RV) function is a major determinant of outcome in patients with pulmonary arterial hypertension (PAH). However, the impact of changes in echo-assessed RV fun...
Late-stage tumors induce anemia and immunosuppressive extramedullary erythroid progenitor cells
Authors: Lintao Zhao, Ran He, Haixia Long, Bo Guo, Qingzhu Jia, Diyuan Qin, Si-Qi Liu, Zhongyu Wang, Tong Xiang, Jue Zhang, Yulong Tan, Jiani Huang, Junying Chen, Fang Wang, Minglu Xiao, Jianbao Gao, Xinxin Yang, Hao Zeng, Xinxin Wang, Chunyan Hu, Peter B. Alexander, Alistair L. J. Symonds, Jia Yu, Yisong Wan, Qi-Jing Li, Lilin Ye, Bo Zhu
Journal: Nature Medicine (2018)
FRI0646 Three-dimensional nail imaging by optical coherence tomography: a novel biomarker of response to therapy for nail disease in psoriasis and psoriatic arthritis
Authors: G Abignano, P Laws, F Del Galdo, H Marzo-Ortega, D McGonagle
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Nail disease is a common feature of psoriasis and psoriatic arthritis (PsA) and can impact quality of life significantly. The assessment of nail disease, unlike skin disease, is challenging with no tissue biomarkers feasible. Commonly used clinical outcomes include the Nail Psoriasis Severity Index (NAPSI) or the modified NAPSI system which are subjective. Optical Coherence Tomography (OCT) can detect changes in psoriatic nails and is a potential tool to assess response to therapy (1). <h3>Objectives</h3> To evaluate OCT imaging changes in cases with nail psoriasis following 6 month-therapy with Apremilast, a PDE4 inhibitor with known efficacy for nail disease in psoriasis and PsA. <h3>Methods</h3> Forty fingernails from four psoriatic patients were imaged at baseline and after 6 month-treatment with Apremilast 30 mg bd using Vivosight OCT scanner (Michelson Diagnostics Ltd., Kent, UK). Three OCT scans were collected from each fingernail (1 transverse and 2 longitudinal – proximal and distal) totalling 240 scans available for analysis. OCT scoring of the forty fingernails, at baseline and six months later, was carried out for changes including: 1. leukonychia/white spots; 2. pitting/localized surface irregularities; 3. diffuse surface waving; 4. onycholysis; 5. subungual hyperkeratosis. OCT score was arbitrarily calculated based on the absence (=0) or presence (=1) of each feature on the three scans of the corresponding fingernail (range 0–15). Macroscopic nail features were scored at baseline and 6 months later using the NAPSI scoring system by a Dermatologist blinded to OCT findings and compared with OCT score. Data were expressed as median (range). Comparison between baseline and follow up measurements was performed using Wilcoxon matched-pairs signed rank test. Difference between two groups and correlation were calculated using Mann-Whitney test and Spearman9s test respectively. Statistical analysis was carried out using GraphPad Prism software V.7.0. <h3>Results</h3> Based on NAPSI, twenty-eight/40 fingernails (70%) improved or remained stable after 6 months with the median NAPSI per nail falling from 3.5 (0–7) to 0 (0–6) (p&lt;0.0001). The OCT evaluation showed that the entire gamut of nail changes exhibited improvement or stabilization in thirty-three/40 (82.5%) nails after 6 months with median OCT score per nail falling from 8 (3–14) to 4 (1–9) (p&lt;0.0001). Difference of the change (Δ) of OCT score between baseline and follow-up significantly correlated with Δ-NAPSI (r=0.71, p&lt;0.0001). <h3>Conclusions</h3> OCT is able to identify all common psoriasis related nail pathology and changes after treatment. Further studies with larger numbers are needed to validate its potential role as a biomarker for nail disease. <h3>References</h3> Aydin SZ et al. Dermatology 2013. <h3>Disclosure of Interest</h3> None declared
Evaluation of the impact of a multidisciplinary intervention to increase pneumococcal vaccination rates in patients with advanced lung cancer.
Authors: Leila Rostamnjad, Kelly Goodwin, Jennifer Temel, Pamela Connolly, Julie Zydel, Gayle C. Blouin
Journal: Journal of Clinical Oncology (2018)

61 Background: National Comprehensive Cancer Network recommends pneumococcal vaccination for adults 19 years and older with cancer. Currently at Massachusetts General Hospital (MGH) pneumococcal vaccination is not part of routine cancer care. A vaccination quality improvement project was developed to increase pneumococcal vaccination in lung cancer patients. The primary objective of this evaluation is to assess the impact of a multidisciplinary intervention to increase pneumococcal vaccination in patients with advanced lung cancer receiving intravenous anticancer therapy. Methods: Thoracic oncology clinic schedule and patient electronic medical records were reviewed prospectively from 01/01/2018 to 05/31/2018 by the clinical pharmacist to identify patients with advanced lung cancer eligible for vaccination. Patients list along with recommended vaccine type and schedule was emailed by the clinical pharmacist to clinical team (oncologist, nurse practitioner and practice nurses). Practice nurses obtained immunization records for patients with non-MGH primary care providers. A designated thoracic oncology nurse practitioner ordered appropriate vaccines. Vaccinations were administered by infusion nurse. Results: 50 patients were identified as eligible for vaccination: 7 patients had history of receiving prevnar 13, and 9 patients had history of pnemovax 23. 34 patients had no prior vaccination history. Through this intervention, 10 patients completed vaccination with both prevnar 13 and pnemovax 23. 15 patients received one of the two recommended vaccines. 22 patients refused vaccination, and 3 patients died before their next scheduled infusion visit. Conclusions: Pneumococcal vaccination is recommended for patients with cancer prior to initiation or three months after completion of immunosuppressive therapies. However, it is not always feasible to vaccinate patients prior to start of therapy as delays in cancer care can lead to disease related complications. Incorporating multidisciplinary intervention to identify patients with advanced lung cancer who are candidate for pneumococcal vaccination can improve the adherence to the guidelines.
Measuring the financial stresses of childhood cancer and survivorship.
Authors: George Dahlman, Kathleen Gallagher
Journal: Journal of Clinical Oncology (2018)

96 G. Dahlman (Children’s Cause for Cancer Advocacy) K. Gallagher (Patient Advocate Foundation) Background: Families battling childhood cancer can face extraordinary financial challenges in access to care. Insurance barriers, coverage limitations and denials, high copays and extraordinary out-of-pocket costs threaten families’ ability to ensure supports necessary for successful treatment. Methods: From April 18, 2017 to May 31, 2017, CCCAA and the Patient Advocate Foundation (PAF) conducted a survey of pediatric cancer patients, caregivers and survivors through an online survey tool. Questions identified demographic and geographic attributes, type of insurance coverage, incidence and reason for insurance denials, degree and source of financial stress, out-of-pocket costs, and survivorship measurements. The survey was sent to unbiased cohort of patients and students from CCCA and PAF. Results: A total of 343 respondents completed the online survey: 143 or 42% were parents or caregivers. Another 143 or 42% were childhood cancer survivors. Among caregivers, 47 or 33% reported insurance denials for treatment, and 63 or 44% reported some level of financial hardship. Among the 44% of respondents reporting financial hardships, 25 or 39% had annual out-of-pocket costs exceeding $5,000. Beyond medical expenses, respondents identified employment and transportation costs, with 87% reporting compromised work schedules and over half reporting trouble getting their child to and from appointments. For survivors, 38 or 27% reported not receiving follow-up care at a late effects clinic, with 34 or 24% reporting that their cancer care impacted their ability to pursue higher education and 43 or 30% reporting that the cost of their medical care impacted their career course or job choice. Conclusions: This joint CCCA/PAF survey identified significant financial challenges, both medical and non-medical, for patients, caregivers and survivors of childhood cancer. This survey along with other data sources suggest that current data and research are insufficient to guide solutions to the care barriers that parents and survivors report.
Abstract 16179: Impact of a Genetic Risk Score for Coronary Artery Disease in Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study
Authors: Josh Knowles, Shirin Zarafshar, Aleksandra Pavlovic, Benjamin Goldstein, Michaela Kiernan, Sandra Tsai, Michael McConnell, Devin Absher, Euan Ashley, John Ioannidis, Themistocles Assimes
Journal: Circulation (2016)

Background: Adherence to primary prevention strategies that reduce coronary artery disease (CAD) risk is suboptimal. Hypothesis: Genetic data may serve as a motivator to reduce cardiovascular risk....
The PROCLIPI international registry of early‐stage mycosis fungoides identifies substantial diagnostic delay in most patients
Authors: J.J. Scarisbrick, P. Quaglino, H.M. Prince, E. Papadavid, E. Hodak, M. Bagot, O. Servitje, E. Berti, P. Ortiz‐Romero, R. Stadler, A. Patsatsi, R. Knobler, E. Guenova, F. Child, S. Whittaker, V. Nikolaou, C. Tomasini, I. Amitay, H. Prag Naveh, C. Ram‐Wolff, M Battistella, S. Alberti‐Violetti, R. Stranzenbach, V. Gargallo, C. Muniesa, T. Koletsa, C. Jonak, S. Porkert, C. Mitteldorf, T. Estrach, A. Combalia, M. Marschalko, J. Csomor, A. Szepesi, A. Cozzio, R. Dummer, N. Pimpinelli, V. Grandi, M. Beylot‐Barry, A. Pham‐Ledard, M. Wobser, E. Geissinger, U. Wehkamp, M. Weichenthal, R. Cowan, E. Parry, J. Harris, R. Wachsmuth, D. Turner, A. Bates, E. Healy, F. Trautinger, J. Latzka, J. Yoo, B. Vydianath, R. Amel‐Kashipaz, L. Marinos, A. Oikonomidi, A. Stratigos, M.‐D. Vignon‐Pennamen, M. Battistella, F. Climent, E. Gonzalez‐Barca, E. Georgiou, R. Senetta, P. Zinzani, L. Vakeva, A. Ranki, A.‐M. Busschots, E. Hauben, A. Bervoets, F.J.S.H. Woei‐A‐Jin, R. Matin, G. Collins, S. Weatherhead, J. Frew, M. Bayne, G. Dunnill, P. McKay, A. Arumainathan, R. Azurdia, K. Benstead, R. Twigger, K. Rieger, R. Brown, J.A. Sanches, D. Miyashiro, O. Akilov, S. McCann, H. Sahi, F.M. Damasco, C. Querfeld, A. Folkes, C. Bur, C.‐D. Klemke, P. Enz, R. Pujol, K. Quint, L. Geskin, E. Hong, F. Evison, M. Vermeer, L. Cerroni, W. Kempf, Y. Kim, R. Willemze
Journal: British Journal of Dermatology (2018)

Survival in mycosis fungoides (MF) is varied and may be poor. The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a web-based data collection system for early-stage MF with legal data-sharing agreements permitting international collaboration in a rare cancer with complex pathology. Clinicopathological data must be 100% complete and in-built intelligence in the database system ensures accurate staging.
Advance electronic screening of patients with cancer leveraging a new EHR to increase efficiency of care delivery, driving clinical care pathways in a perioperative anesthesia assessment center (PAAC), at a comprehensive cancer center.
Authors: Katy E. French, Shannon Popovich, B. Bryce Speer, Iris Recinos, Tayab Andrabi
Journal: Journal of Clinical Oncology (2018)

308 Background: Most cancer institutions are using electronic health records (EHRs). With MACRA and MIPS, this number will continue to grow. EHR’s can be frustrating as some are seen as more cumbersome than useful to patient care delivery. In 2017, the MD Anderson cancer center (MDACC) PAAC assessed over 20,000 patients. We wanted to demonstrate positive utility of our EHR. We hypothesized that advanced electronic screening of our cancer patients, leveraging a questionnaire embedded in the EHR, could increase efficiency by driving patient specific perioperative care pathways leading to positive patient experience while not negatively affecting our low same day surgery cancellation rate of 2.07%. Methods: In March of 2016, MDACC launched a new EHR and the PAAC commenced an online medical and anesthesia screening questionnaire to be completed via a secure online portal by our cancer patients in advance of the surgery date. The questionnaire was developed and vetted by specialists from many areas including anesthesia, cardiology, internal medicine, and surgery. The answers to these questions were validated by a healthcare provider, and the patient was directed to one of two care pathways. Complex patients were scheduled for an in person clinic assessment prior to surgery and all other patients were scheduled for a phone call assessment. We used reports created within our EHR to track baseline and 2017 data for numbers of patients directed to the 2 different pathways and same day surgery cancellation data throughout this time frame. Results: Using the online patient entered questionnaire, we were able to improve clinic efficiency by implementing two patient care delivery pathways. Using our new EHR we saw an increase of 18.4% in our phone assessment pathway for patients. Patient experience improved as we were able to offer patients more options in the delivery of care saving them time. Conclusions: Use of our new EHR and IT analytics helped drive patient-specific care pathways, improve efficiency and the patient experience. MDACC same day surgery cancellation rate remained 2.07%.
Structure-guided combination therapy to potently improve the function of mutant CFTRs
Authors: Guido Veit, Haijin Xu, Elise Dreano, Radu G. Avramescu, Miklos Bagdany, Lenore K. Beitel, Ariel Roldan, Mark A. Hancock, Cecilia Lay, Wei Li, Katelin Morin, Sandra Gao, Puiying A. Mak, Edward Ainscow, Anthony P. Orth, Peter McNamara, Aleksander Edelman, Saul Frenkiel, Elias Matouk, Isabelle Sermet-Gaudelus, William G. Barnes, Gergely L. Lukacs
Journal: Nature Medicine (2018)
Myocardial Infarction Risk After Discontinuation of Thienopyridine Therapy in the Randomized DAPT Study (Dual Antiplatelet Therapy)
Authors: Ada C. Stefanescu Schmidt, Dean J. Kereiakes, Donald E. Cutlip, Robert W. Yeh, Ralph B. D’Agostino, Joseph M. Massaro, Wen-Hua Hsieh, Laura Mauri
Journal: Circulation (2017)

Thienopyridine plus aspirin beyond 1 year after coronary stenting reduces myocardial infarction (MI) risk and increases bleeding risk in comparison with aspirin alone. The hazard associated with late thienopyridine discontinuation and risk factors for MI after discontinuation are poorly defined.In the DAPT Study (Dual Antiplatelet Therapy), after percutaneous coronary intervention and 12 months of thienopyridine (clopidogrel or prasugrel) plus aspirin, eligible patients remained on aspirin and were randomly assigned to continued thienopyridine versus placebo for 18 months. At 30 months, patients stopped the study drug and were observed for 3 months. Cumulative incidence of MI was assessed over 3 months after randomization (months 12-15) and 3 months after study drug discontinuation (months 30-33). The MI hazard for each of these periods was assessed across randomized treatment arms and by DAPT score values <2 or ≥2.Among the 11 648 randomly assigned patients, the monthly cumulative incidence of MI was lower with continued thienopyridine versus placebo at 12 to 15 months (0.12% versus 0.37%, P<0.001, in all patients; 0.13% versus 0.27%, P=0.02, in patients not treated with paclitaxel-eluting stents), and higher at 30 to 33 months (0.30% versus 0.15%, P=0.013, in all patients; in patients without paclitaxel-eluting stents, 0.18% versus 0.17%, P=0.91). The majority of MIs in both time periods (74% and 76%) were not related to stent thrombosis. After multivariable adjustment, treatment arm independently predicted MI at months 12 to 15 (P<0.001) and 30 to 33 (P=0.011). During months 12 to 15, patients with DAPT scores <2 or ≥2 both had lower rates of MI with continued thienopyridine (MI monthly incidence 0.16% versus 0.51%, P<0.001, for scores ≥2; 0.08% versus 0.24%, P=0.012, for scores<2, interaction P=0.064).Discontinuing thienopyridine after either 12 or 30 months is associated with an early increase in MI risk, mainly unrelated to stent thrombosis; the magnitude of risk is highest in the earlier time frame, and lower in patients not treated with paclitaxel-eluting stents. Although higher DAPT scores identify patients with greater absolute ischemic benefit (relative to bleeding harm) with continued thienopyridine therapy, discontinuation at 12 months increases MI hazard regardless of DAPT score group.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00977938.
Association between physician <i>US News &amp; World Report</i> medical school ranking and patient outcomes and costs of care: observational study
Authors: Yusuke Tsugawa, Daniel M Blumenthal, Ashish K Jha, E John Orav, Anupam B Jena
Journal: BMJ (2018)

To investigate whether the US News & World Report (USNWR) ranking of the medical school a physician attended is associated with patient outcomes and healthcare spending.Observational study.Medicare, 2011-15.20% random sample of Medicare fee-for-service beneficiaries aged 65 years or older (n=996 212), who were admitted as an emergency to hospital with a medical condition and treated by general internists.Association between the USNWR ranking of the medical school a physician attended and the physician's patient outcomes (30 day mortality and 30 day readmission rates) and Medicare Part B spending, adjusted for patient and physician characteristics and hospital fixed effects (which effectively compared physicians practicing within the same hospital). A sensitivity analysis employed a natural experiment by focusing on patients treated by hospitalists, because patients are plausibly randomly assigned to hospitalists based on their specific work schedules. Alternative rankings of medical schools based on social mission score or National Institute of Health (NIH) funding were also investigated.996 212 admissions treated by 30 322 physicians were examined for the analysis of mortality. When using USNWR primary care rankings, physicians who graduated from higher ranked schools had slightly lower 30 day readmission rates (adjusted rate 15.7% for top 10 schools v 16.1% for schools ranked ≥50; adjusted risk difference 0.4%, 95% confidence interval 0.1% to 0.8%; P for trend=0.005) and lower spending (adjusted Part B spending $1029 (£790; €881) v $1066; adjusted difference $36, 95% confidence interval $20 to $52; P for trend <0.001) compared with graduates of lower ranked schools, but no difference in 30 day mortality. When using USNWR research rankings, physicians graduating from higher ranked schools had slightly lower healthcare spending than graduates from lower ranked schools, but no differences in patient mortality or readmissions. A sensitivity analysis restricted to patients treated by hospitalists yielded similar findings. Little or no relation was found between alternative rankings (based on social mission score or NIH funding) and patient outcomes or costs of care.Overall, little or no relation was found between the USNWR ranking of the medical school from which a physician graduated and subsequent patient mortality or readmission rates. Physicians who graduated from highly ranked medical schools had slightly lower spending than graduates of lower ranked schools.