tbuckley/cabot-search huggingface dataset:
Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants
Authors: James Grote
Journal: Annals of Internal Medicine (2019)

Letters16 July 2019Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician AssistantsJames Grote, MDJames Grote, MDPittsfield, Illinois (J.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0198 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I do not necessarily disagree with the conclusions of Jackson and colleagues' article (1) or Peters' accompanying editorial (2). However, I believe that Jackson and colleagues' cohort study is subject to a characteristic of VA populations that is frequently ignored: A substantial portion of VA patients take advantage of VA assistance for medications and supplies but receive medical care outside of the VA system. In my 5 years of working as a VA clinic physician (between 2007 and 2012), few diabetic patients I saw received supervision for their diabetes solely from VA sources; this was particularly true ...References1. Jackson GL, Smith VA, Edelman D, et al. Intermediate diabetes outcomes in patients managed by physicians, nurse practitioners, or physician assistants. A cohort study. Ann Intern Med. 2018;169:825-35. [PMID: 30458506]. doi:10.7326/M17-1987 LinkGoogle Scholar2. Peters AL. The changing definition of a primary care provider. Ann Intern Med. 2018;169:875-6. [PMID: 30458467]. doi:10.7326/M18-2941 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Pittsfield, Illinois (J.G.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0198. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants George L. Jackson , Valerie A. Smith , David Edelman , Sandra L. Woolson , Cristina C. Hendrix , Christine M. Everett , Theodore S. Berkowitz , Brandolyn S. White , and Perri A. Morgan Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants P. Dileep Kumar Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants George L. Jackson , Valerie A. Smith , David Edelman , Cristina C. Hendrix , and Perri A. Morgan Metrics 16 July 2019Volume 171, Issue 2Page: 144-145KeywordsCohort studiesDisclosureElectronic medical recordsNursesPopulation statistics ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction
Authors: Enrico Ammirati, Giacomo Veronese, Michela Brambatti, Marco Merlo, Manlio Cipriani, Luciano Potena, Paola Sormani, Tatsuo Aoki, Koichiro Sugimura, Akinori Sawamura, Takahiro Okumura, Sean Pinney, Kimberly Hong, Palak Shah, Öscar Braun, Caroline M. Van de Heyning, Santiago Montero, Duccio Petrella, Florent Huang, Matthieu Schmidt, Claudia Raineri, Anuradha Lala, Marisa Varrenti, Alberto Foà, Ornella Leone, Piero Gentile, Jessica Artico, Valentina Agostini, Rajiv Patel, Andrea Garascia, Emeline M. Van Craenenbroeck, Kaoru Hirose, Akihiro Isotani, Toyoaki Murohara, Yoh Arita, Alessandro Sionis, Enrico Fabris, Sherin Hashem, Victor Garcia-Hernando, Fabrizio Oliva, Barry Greenberg, Hiroaki Shimokawa, Gianfranco Sinagra, Eric D. Adler, Maria Frigerio, Paolo G. Camici
Journal: Journal of the American College of Cardiology (2019)
A multispecialty approach to immuno-oncology education for community providers.
Authors: Tara Perloff, Monique Dawkins, Jennie Robertson Crews, Jeffrey P. Gregg, Ivo Abraham, Lee S. Schwartzberg
Journal: Journal of Clinical Oncology (2019)

80 Background: The Association of Community Cancer Centers (ACCC) Immuno-Oncology Institute was developed in 2015 to prepare all members of the multidisciplinary cancer care team for the complex implementation of immuno-oncology in the community setting. Today, with more than 50 cancer immunotherapy indications and over 2,500 clinical trials with cancer immunotherapies, the challenges and issues related to recognizing and managing immune-related adverse events (irAEs) have grown even more complex for community practitioners. Methods: The ACCC Immuno-Oncology Institute assembled 4 working groups focused on addressing the diverse issues around the delivery and management of patients on cancer immunotherapies. The working groups were divided by 4 topics: staff training and education; multispecialty care coordination and communication; telemedicine; and big data. A detailed systemic review of the literature was conducted for each topic in the context of immuno-oncology, to determine the current landscape of information and available resources. The findings were then shared with the working group members and collaborative discussions ensued over 12 virtual committee meetings. The 19 working group members are diverse by discipline, including specialties such as emergency medicine, dermatology, primary care, survivorship, pathology, and academic researchers. Results: The ACCC Working Group Summit convened in September 2018 to develop innovative educational opportunities for community practitioners related to managing irAEs across the 4 topic areas. Eight unique action plans were developed by working group members. Conclusions: For each of the 4 key areas, working group members identified a list of opportunities that would improve how clinicians are managing irAEs for patients being treated with immunotherapy. It is critical for future educational interventions to encompass the multispecialty team perspective related to the management of irAEs.
Normalisation of MRI ventilation heterogeneity in severe asthma by dupilumab
Authors: Sarah Svenningsen, Ehsan Ahmed Haider, Rachel L Eddy, Grace Parraga, Parameswaran Nair
Journal: Thorax (2019)

Ventilation heterogeneity in asthma could be due to many reasons. Luminal obstruction due to inflammatory cells or mucus, smooth muscle constriction and airway wall thickness could all contribute individually or collectively to ventilation heterogeneity. Interleukin-4 and interleukin-13, acting through the common interleukin-4 receptor, have the potential to modulate all of these features of asthma.1 Inhaled hyperpolarised gas MRI provides a way to regionally visualise and quantify the functional consequence of these features.2 Dupilumab is a fully human monoclonal antibody directed against the alpha-subunit of the interleukin-4 receptor.3 Here, we report a severe asthmatic who showed significant improvement and normalisation of MRI ventilation heterogeneity and associated clinical and physiological variables with dupilumab treatment, suggesting that dupilumab modulated various aspects of luminal airway obstruction.

A 39-year-old atopic woman (total serum immunoglobulin E 1009 kU/L and peripheral blood eosinophils 1200 cells/µL) was seen for asthma in January 2015. She had mixed obstructive and non-obstructive spirometry (forced expiratory volume in one second (FEV1) 1.42 L (44%pred), forced vital capacity (FVC) 1.72 L (44%pred) and total lung capacity (TLC) 3.78 L (71%pred)), with 13% reversibility to salbutamol. Her asthma …
Neuron-Glia Signaling in Synapse Elimination
Authors: Daniel K. Wilton, Lasse Dissing-Olesen, Beth Stevens
Journal: Annual Review of Neuroscience (2019)

Maturation of neuronal circuits requires selective elimination of synaptic connections. Although neuron-intrinsic mechanisms are important in this process, it is increasingly recognized that glial cells also play a critical role. Without proper functioning of these cells, the number, morphology, and function of synaptic contacts are profoundly altered, resulting in abnormal connectivity and behavioral abnormalities. In addition to their role in synaptic refinement, glial cells have also been implicated in pathological synapse loss and dysfunction following injury or nervous system degeneration in adults. Although mechanisms regulating glia-mediated synaptic elimination are still being uncovered, it is clear this complex process involves many cues that promote and inhibit the removal of specific synaptic connections. Gaining a greater understanding of these signals and the contribution of different cell types will not only provide insight into this critical biological event but also be instrumental in advancing knowledge of brain development and neural disease.
<i>Notes from the Field:</i> Conjunctivitis Caused by Toxigenic <i>Corynebacterium ulcerans</i> — Missouri, 2018
Authors: Lauren M. Weil, Cindy Butler, Karla R. Howell, Sarah Sharr, Grace L. Paley, Andrew J. W. Huang, Robi N. Maamari, Lucia C. Pawloski, Pamela K. Cassiday, Anna M. Acosta, Susan Hariri, Tejpratap S. P. Tiwari
Journal: MMWR Morbidity and Mortality Weekly Report (2019)
Erratum for the Research Article: “Engineering a highly elastic human protein–based sealant for surgical applications” by N. Annabi, Y.-N. Zhang, A. Assmann, E. S. Sani, G. Cheng, A. D. Lassaletta, A. Vegh, B. Dehghani, G. U. Ruiz-Esparza, X. Wang, S. Gangadharan, A. S. Weiss, A. Khademhosseini
Journal: Science Translational Medicine (2018)

Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments.To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin.The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation.All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage.In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up.The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.
Rescue therapy for patients with anti-PD-1-refractory Merkel cell carcinoma: a multicenter, retrospective case series
Authors: Jaclyn LoPiccolo, Megan D. Schollenberger, Sumia Dakhil, Samuel Rosner, Osama Ali, William H. Sharfman, Ann W. Silk, Shailender Bhatia, Evan J. Lipson
Journal: Journal for ImmunoTherapy of Cancer (2019)

Merkel cell carcinoma (MCC) is a rare but clinically aggressive cancer with a high mortality rate. In recent years, antibodies blocking the interactions among PD-1 and its ligands have generated durable tumor regressions in patients with advanced MCC. However, there is a paucity of data regarding effective therapy for patients whose disease is refractory to PD-1 pathway blockade. This retrospective case series describes a heterogeneous group of patients treated with additional immune checkpoint blocking therapy after MCC progression through anti-PD-1. Among 13 patients treated with anti-CTLA-4, alone or in combination with anti-PD-1, objective responses were seen in 4 (31%). Additionally, one patient with MCC refractory to anti-PD-1 and anti-CTLA-4 experienced tumor regression with anti-PD-L1. Our report - the largest case series to date describing this patient population - provides evidence that sequentially-administered salvage immune checkpoint blocking therapy can potentially activate anti-tumor immunity in patients with advanced anti-PD-1-refractory MCC and provides a strong rationale for formally testing these agents in multicenter clinical trials. Additionally, to the best of our knowledge, our report is the first to demonstrate possible anti-tumor activity of second-line treatment with a PD-L1 antibody in a patient with anti-PD-1-refractory disease.
Weekly 20/56 mg/m² carfilzomib, lenalidomide, and dexamethasone until progression in early relapsed refractory multiple myeloma.
Authors: Cecile Gruchet, Valentine Richez, Stephanie Guidez, Guillemette Fouquet, Isabelle Azais, Geraldine Durand, Vincent Javaugue, Florent Plasse, Antoine Machet, Niels Moya, Helene Gardeney, Arthur Bobin, Anthony Levy, Florence Sabirou, Anthony Bonnin, Celine Dieval, Sylvain Primault, Frank Bridoux, Herve Avet-Loiseau, Xavier Leleu
Journal: Journal of Clinical Oncology (2019)

8041 Background: Triplet-based Carfilzomib (K), Lenalidomide and Dexamethasone combination (KRd) has led to approval in early RRMM based on ASPIRE International phase 3 study. However, K was used on a twice a week basis at 27mg/m 2 and limited to 18 months exposure. We have reported already that KRd on a weekly basis at 56 mg/m 2 was active similar to ASPIRE KRd and safe. We report herein the long-term exposure data on KRd weekly given until progression. We aimed to evaluate the efficacy of KRd given on a prolong duration beyond 18months, and to validate the safety profile of continuous exposure to K. Methods: 28 patients were prospectively recruited. Carfilzomib 20/56mg/m 2 was administered on days 1,8,15, Lenalidomide 25mg/day was given 21/28 days and Dexamethasone was administered weekly on 28 days cycles until progression. Results: With a median follow-up at start of KRd of 30 months, 50% of patients relapsed and 39% died. 24/28 patients received 1 prior line of treatment. 8/28 patients are still on treatment with duration &gt; 24 month and 6/28 with duration &gt; 30 months. The median number of cycles was 15. ORR and CBR was 85.7% and 89.3%, whom 46% ≥ CR ; with a median DOR of 13 months and 43% having more than 18 months. 6 patients had negative MRD at 10 -6 and normalized PET CT. Median of OS is not reached, and the 30 month-expected OS from the start of KRd was 56%. The median PFS and EFS was at 29 months, and the 30 month-expected PFS and EFS was 45%. PFS and EFS being superimposable speaks to that there was no safety concern related to prolonged exposure to K. Only 4 patients stopped KRd for safety issues. Hematologic and non-hematologic adverse events ≥ grade 3 were reported in 16/28 and 10/28 patients. Adverse events ≥ grade 3 seen in ≥10% of patients were neutropenia, thrombocytopenia, vomiting and pyrexia. Of note, 5 patients (18%) were ≥ 65 years old and showed similar data compared to the cohort. Conclusions: KRd weekly is effective and safe to early in RRMM patients, provides improved safety profile to patients allowing treating patients until progression. Further studies are warranted to confirm this data on a larger early RRMM population and validate the concept of long duration of treatment using Carfilzomib combination.
Multimodality treatment for intracranial germ cell tumors: Experience from an Asian tertiary hospital.
Authors: Dawn QQ Chong, Iain BeeHuat Tan, Daniel HY Tan, Eu Tiong Chua, Chee Kian Tham
Journal: Journal of Clinical Oncology (2013)

e13027 Background: Intracranial germ cell tumors (GCTs) represent up to 11 percent of pediatric central nervous system (CNS) tumors in Asia. We compared the efficacy of radiotherapy alone (RT) with platinum-based chemotherapy (CT) in combination with dose-attenuated RT. Methods: We identified 61 patients treated at National Cancer Centre Singapore from 1995 to 2011. Patient’s demographics, histopathologic characteristics and survival data were collected. Median follow up was 39 months. Results: Forty-eight (79%) patients were male; mean age at diagnosis was 17 years. Most (87%) patients had pineal or suprasellar tumors. The distribution of pure germinomas, non-germinomatous tumors and mixed tumors was 54 (89%), 5 (8%) and 2 (3%) patients, respectively. Twenty patients had RT alone, 2 had CT alone, and 31 received a combination of CT and attenuated RT. There was no difference in overall survival (OS) between unifocal or multifocal disease (p = 0.81). Amongst the germinomas, there was no difference in OS between patients given RT alone and CT combined with attenuated RT (median OS not reached vs 145 months, respectively, p = 0.668). Conclusions: Treatment with CT followed by dose attenuated RT is an alternative to conventional craniospinal RT and did not compromise survival in patients with germinomas. This may represent a therapeutic modality with a more favorable long term toxicity profile in these patients who have excellent long term outcomes.
Outcome, costs and dollar value of anticancer drugs in non-small cell lung cancer with emphasis on pembrolizumab.
Authors: Helmy M. Guirgis
Journal: Journal of Clinical Oncology (2019)

104 Background: Drug outcomes were analyzed in 9 clinical studies of advanced/metastatic non-small-cell lung cancer (NSCLC). Overall survivals were not reached in some studies. Objective: Weigh hazard ratios (HR), costs and dollar value of each drug vs. its control with emphasis on pembrolizumab (pembro). Methods: Protocols were followed, and parent company costs quoted. yearly-costs of pembro, bevacizumab (bev), pemetrexed (peme) and docetaxel (doc) were calculated. Probability of survival (PoS) was defined as (1.0-HR) and dollar value as cost/PoS. Results: Doc and bev carried black box warnings with estimated grade 3/4 adverse events &gt; 20% compared with pembro &lt;10% and peme &lt; 15%. Doc costs were $63,648. In second-line, estimated HR of doc versus supportive care was 0.70 and value $212,169. Pembro costs at 2mg/Kg x 80 Kg q3 weeks were $125,770. Compared with doc, pembro HR in PD-L1 &gt; 1.0% tumor proportion score (TPS) was 0.71 and value $433,690. Using the 200mg total dose, costs were $157,213 and value $542,114. In first-line, pembro versus chemo in &gt; 1.0% chemo demonstrated HR 0.81, and value $827,439, improving in &gt; 50% to 0.69 and $507,139 respectively. Pembro + chemo versus chemo in &lt; 1.0% were 0.59 and $383,446 improving in &gt; 50% to 0.42 and $271,057. Bev costs were $132,314, HR 0.79 and value $630,067. Peme were $97,947, 0.63-0.78 and $264,722-$445,213. Conclusions: Pembro at 160 mg total dose in 80 Kg patients reduced the 200 mg costs by 20% with proportionate savings at lower weights. Pembro dollar value were enhanced by dose adjustment, PD-L1 enrichment and chemotherapy.
Implementation of a Molecular Tumor Board in Clinical Decision Making at the Medical Center University of Freiburg
Authors: Rainer Claus, Lisa Lutz, Hauke Busch, Leman Mehmed, Agnes Csanadi, Britta Weddeling, Ralph Fritsch, Tilman Brummer, Julius Wehrle, Cornelius Miething, Thalia Erbes, Simone Hettmer, Volker Brass, Oliver Oehlke, Philipp Demmer, Frank Meiss, Christoph Peters, Martin Werner, Melanie Börries, Silke Lassmann, Justus Duyster, Nikolas von Bubnoff
Journal: Blood (2016)
Emerging treatment patterns and checkpoint inhibitor (CPI) use among newly diagnosed Merkel cell carcinoma (MCC) patients in the United States veteran population.
Authors: Ying Zheng, Shivani Pandya, Ting Yu, Mairead Kearney, Sulena Shrestha, Li Wang, Ruth Kim, Hemant Phatak
Journal: Journal of Clinical Oncology (2019)

139 Background: MCC is a rare and aggressive skin cancer with annual incidence of 2,500 in the U.S. Checkpoint inhibitors (CPIs) demonstrated durable disease response historically not seen with chemotherapy among MCC patients in clinical trials. Avelumab, a PD-L1 antibody, became the first and only approved treatment for metastatic MCC by the U.S. FDA in March 2017. This study evaluated emerging treatment patterns among MCC patients using the US Veterans Health Administration (VHA) database. Methods: This retrospective study identified newly-diagnosed MCC patients who initiated ≥1 systemic therapy from Oct. 2013 to Jan. 2018 and had continuous enrollment from ≥6 months pre-initial MCC diagnosis date until ≥2 months post-index date with follow-up until the earliest of death, disenrollment, or study end. The index date was defined as the start date of first-line (1L) systemic therapy. A subsequent line of therapy (2L) was defined by the earliest of new therapy addition, regimen switch, or a new/existing regimen after a &gt;60-day gap from the prior cycle end. Duration of 1L therapy was evaluated among patients treated with CPIs, National Cancer Comprehensive Network (NCCN)-recommended chemotherapy (recCTs), and other chemotherapy (oCTs). The median duration of therapy was estimated using the Kaplan Meier method. Results: Of the 120 MCC patients (72% pre-2017) with 1L systemic therapy, 17%, 45%, and 38% were treated with CPIs, recCTs and oCTs, respectively. More than 75% were white men aged ≥65 years with mean baseline Charlson comorbidity index scores ≥5. Carboplatin-etoposide (56%) and cisplatin-etoposide (26%) were the most commonly-used recCTs. The median duration of 1L therapy in patients treated with CPI, recCTs and oCTs was 300, 91, and 21 days, respectively. 2L therapy was initiated in 33% of all 1L patients. Conclusions: Among 1L MCC patients, CPIs treated patients appear to be on treatment longer than both recCTs and oCTs patients. These descriptive findings provide important insights into the emerging real-world treatment patterns amongst MCC patients in the VHA population.