tbuckley/cabot-search huggingface dataset:
Thank You to Peer Reviewers, Authors, and Readers of <i>JAMA</i>
Authors: Phil B. Fontanarosa, Howard Bauchner, Robert M. Golub
Journal: JAMA (2019)

manuscripts, including 4398 research reports and 467 randomized clinical trials (Table).Of the 158 published Original Investigations, 75 were randomized clinical trials.We appreciate that authors have the confidence and trust in JAMA to submit their most important research reports for evaluation and consideration for publication.The quality and importance of these reports is reflected in our current impact factor of 47.7.In addition, many authors have taken advantage of the opportunity for them to designate at the time of submission that if their manuscript is not accepted by JAMA, it could be considered for referral to one of the 12 other journals in the JAMA Network, including our newest journal, JAMA Network Open.We express our appreciation to all authors who submitted manuscripts to JAMA and look forward to receiving additional manuscripts from you.In addition, we thank all who read, access, use, listen to, watch, and learn from our content in any format and venue.We continue to find new ways to distribute our content and make useful information readily available for all who access our publications.For example, visual abstracts are now available for many clinical trials, online commenting is available for Viewpoints, and the number of videos accompanying articles has doubled.The reach of JAMA has continued to diversify and increase substantially, well beyond the 286 000 weekly recipients of the print journal, and includes more than a million subscribers to electronic alerts for each new issue table of contents and for online first articles, more than 750 000 social media followers, approximately 31 million views of full-text articles (PDF or HTML) per year on the JAMA website, and an additional 19 million views of abstracts only.The entire JAMA Network had more than 118 million total website views (full-text, PDF, and abstract only) and 2.3 million podcast downloads in 2018.We are committed to transparency and continue to inform authors and readers about various JAMA and JAMA Network policies that affect biomedical publishing.Recent editorials have focused on conflict of interest, team science, and scientific misconduct. 2-4We will continue to publish editorials about various editorial policies that are of importance to the scientific community.We are honored to have the opportunity to serve the clinical, scientific, and academic communities who interact with JAMA as reviewers and authors, and all who experience and
Emergency Department Management of Deliberate Self-harm
Authors: Jeffrey A. Bridge, Mark Olfson, Jeffrey M. Caterino, Sara Wiesel Cullen, Amaya Diana, Martin Frankel, Steven C. Marcus
Journal: JAMA Psychiatry (2019)

Approximately 500 000 patients in the United States present to emergency departments (EDs) annually after deliberate self-harm 1 and are at high short-term risk for repeat self-harm 2 and suicide. 3Improving their emergency care is a key focus of national strategies to reduce the suicide rate, 4 yet little is known about ED management of deliberate self-harm.We provide the first national estimates, to our knowledge, of how frequently evidence-based management practices are used by EDs when treating patients who present for self-harm.How often does a staff member assess current suicidal intent or plans?How often does a staff member assess past suicidal thoughts and behaviors?How often are patients who present with self-harm provided a list of professionals or agencies that they can contact in a crisis?How often does a staff member assess access to means (eg, firearms, medications) needed to carry out the plan?How often is a follow-up outpatient appointment scheduled before they leave the emergency department?How often are patients who present with self-harm helped to recognize warning signs (situations, moods, or behaviors) that immediately precede a suicidal crisis for them?How often are patients who present with self-harm helped to develop an individualized plan to make their home safer by removing or restricting access to lethal methods such as firearms or medications?How often are patients who present with self-harm helped to learn strategies, such as relaxation techniques or physicial activities, that they can do by themselves to take their minds off problems?
Trends in CRC screening by average-risk Medicare enrollees over age 75: 2002-2010.
Authors: Charles L. Bennett, John Bian, Deborah Fisher
Journal: Journal of Clinical Oncology (2015)

1568 Background: Since 2001, Medicare has covered colorectal cancer (CRC) screening for average-risk enrollees. In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against routine CRC screening of the average-risk over age 75. Although Medicare CRC screening policy has no age limit on screening eligibility, there are concerns about inappropriate use of CRC screening services. Methods: The data consist of a 1998-2010 5% non-cancer sample of Medicare enrollees residing in SEER registry areas. We constructed 9-year panel data from 2002 to 2010. Each panel was assembled in the similar fashion. For illustration purpose, average-risk Medicare beneficiaries were included in the 2010 panel if they were 76 years or older in 2010; enrolled in FFS plans and Part A&B benefits in every single month in 2010 and the previous 9 years; not diagnosed with any indications for higher risks in 2010 and the previous 4 years. The outcomes are the up-to-date overall adherence status, and the specific modality (conditional on adherence). Chi-squared tests were used for statistical analyses. Results: The sample size of 9-year panel data of average-risk Medicare enrollees over age 75 ranges from 23,536 in 2002, 19,847 in 2008, to 19,609 in 2010. The overall CRC screening adherence rates increased from 12.69%, 17.44% and 20.88%, respectively. For the adherence rates by modality, the rates of adherence to colonoscopy increased from 2.18%, 14.67%, and 19.03%, respectively, while the rates of adherence to other modalities decreased rapidly. There was variation in overall adherence rates. Blacks were less likely than whites to be adherent (P < 0.01); women were less likely than men to be adherent. For the subpopulation over age 85, the rates of adherence to colonoscopy were .74%, 7.14%, and 11.24%, respectively. The differences in colonoscopy adherence by race and gender among the subpopulation were consistent to these among the population over age 75 (P < 0.01). Conclusions: Overall adherence rates have risen rapidly since 2002, largely driven by 2001 Medicare coverage decision on colonoscopy. The high proportion of the average-risk over age 75 who received screening colonoscopy services, a practice against USPSTF recommendation, warrants more research.
Risk of subsequent primary cancers after carbon ion radiotherapy, photon radiotherapy, or surgery for localised prostate cancer: a propensity score-weighted, retrospective, cohort study
Authors: Osama Mohamad, Takahiro Tabuchi, Yuki Nitta, Akihiro Nomoto, Akira Sato, Goro Kasuya, Hirokazu Makishima, Hak Choy, Shigeru Yamada, Toshitaka Morishima, Hiroshi Tsuji, Isao Miyashiro, Tadashi Kamada
Journal: The Lancet Oncology (2019)
Comprehensive genomic profiling of cancer of the appendix to reveal new routes to targeted therapies.
Authors: Daniel A. Goldstein, Julia Andrea Elvin, Kai Wang, Walid Labib Shaib, Michael R. Rossi, Philip J. Stephens, Jeffrey S. Ross, Bassel F. El-Rayes
Journal: Journal of Clinical Oncology (2015)

608 Background: Cancers of the appendix are rare forms of malignancy that include two major mucin producing tumors, mucinous adenocarcinoma (MA) and goblet cell carcinoid (GCC). There is no clear standard of care for management of these malignancies. We queried whether comprehensive genomic profiling (CGP) of MA and GCC would reveal differences in the pattern of genomic alterations (GA) of these two subtypes of appendiceal cancer and serve as a guide for targeted therapies for this disease. Methods: DNA was extracted from 40 microns of FFPE sections from 20 clinically advanced appendiceal carcinomas (9 GCC and 11 MA). Comprehensive genomic profiling was performed on hybridization-captured, adaptor ligation based libraries to a high mean coverage depth of &gt;600X for 3,230 exons of 182 cancer-related genes, plus 37 introns from 14 genes frequently rearranged in cancer. The results were evaluated for all classes of GA including base substitutions, short insertions and deletions, copy number alterations and fusions/rearrangements. Clinically relevant GAs were defined as GAs linked to drugs on the market or under evaluation in mechanism driven clinical trials. Results: Base substitutions in KRAS were seen in 73% of MA and 11% of GCCs. TP53 mutations were seen in 64% of MA and 22% of GCCs. MYC (36%), SMAD4 (27%), and APC (27%) mutations were found in MA but were absent in GCC. Other GA of low frequency, but clinically relevant in both subsets included ERBB2, GNAS, ARID1A, PIK3CA, NRAS, CTNNB1, BRCA1, BRAF, KDR, PTEN, MCL1, IDH1, FBXW7, and RICTOR. Conclusions: KRAS and TP53 mutations are common in appendiceal MA, but rare in appendiceal GCCs. This confirms the differences in biology and has implications regarding the use of targeted therapies such as anti-EGFR antibody treatments. The high frequency of clinically relevant genomic alterations uncovered in this study that can potentially serve as targets for therapies, either approved or in clinical trials, raises hope that CGP can lead to improvement in outcomes for patients with this aggressive form of malignancy.
A phase II study of dovitinib in patients with recurrent or metastatic adenoid cystic carcinoma (ACC).
Authors: Patrick Michael Dillon, Gina R. Petroni, Chris Moskaluk, Paula M. Fracasso, Michael G. Douvas, Jose Ricardo Perez, Nikole Varhegyi, Snjezana Zaja-Milatovic, Christopher Y. Thomas
Journal: Journal of Clinical Oncology (2015)

e17092 Background: ACCs frequently acquire a chromosome (6:9) translocation that leads to overexpression of the MYB oncogene with autocrine activation of the fibroblast growth factor receptor (FGFR). Dovitinib is a multikinase inhibitor of the FGFR 1-3, VEGFR and (PDGFR)-B receptors and suppresses the growth of primary ACC xenografts. Methods: In a single-arm, two-stage with expansion, phase II clinical trial, patients (pts) with recurrent or metastatic ACC that had progressed in the preceding 6 mo received dovitinib 500 mg orally 5 out of 7 days. The primary endpoint was partial response (PR) or better by RECIST (ORR). The null hypothesis was set at 1% with a .904 probability of rejection if true ORR is 18% in 21 pts. If rejected, 15 additional pts would be accrued to evaluate change in tumor growth rate Results: 35pts were evaluable for response. Median age was 55 yrs (27 to 75); median ECOG PS was 1 (0-2). Mean no. of prior therapies was 2.8. Two PRs of 2 and 6 mo duration were seen in first 21 pts satisfying the criteria for clinical activity. Although the ORR for all 35 was 6% (90% CI 1, 17), PR or stable disease ≥ 4 mo occurred in 71% (90% CI 55, 83). Secondary endpoints: median progression-free survival was 7.9 mo (CI, 7.3 to 9.1) and overall survival 22.1 mo (CI 18.1-NR). By change point analysis, treatment decreased the tumor growth rate slope from 1.95 to 0.63 (p < 0.001) and 3/15 pts experienced early metabolic responses (FDG PET scans). Toxicity: 22/35 pts experienced grade 3 or greater fatigue (1), nausea (1), diarrhea (1), transaminitis (1), hypertriglyceridemia (9), and/or acneiform rash (1). Seven patients stopped treatment early due to toxicity. QOL decreased at a quicker rate for early failures compared to patients with ≥ stable disease. Genetic studies to date: 10/15 tested tumors contained c-myb translocations. Conclusions: Although the final ORR was low, secondary endpoints support the conclusion that dovitinib influences the pathophysiology of ACC tumors. Future studies of FGFR targeted therapies for ACC should include studies to verify adequate target inhibition and genetic and phenotypic biomarkers to identify pts who would derive clinical benefit from treatment. Clinical trial information: NCT01524692.
Relationship between health care charges and ambulatory central line associated blood stream infections (CLABSI) in pediatric hematology-oncology patients.
Authors: Chris Wong Quiles, Stephanie Gottsch, Usha Thakrar, Belen Fraile, Amy Billett
Journal: Journal of Clinical Oncology (2015)

e17793 Background: CLABSI cause morbidity and mortality and increase costs of care. Inpatient CLABSI (IP-CLABSI) have an average attributable per patient cost ranging from $7,288-$29,156 (Scott, CDC, 2009). Little is known about the costs of CLABSI in the outpatient setting (OP-CLABSI). Pediatric Hematology-Oncology (PHO) patients who have central lines for months to years are an ideal population to study OP-CLABSI. Methods: We prospectively identified OP-CLABSI events in PHO patients at Dana-Farber Cancer Institute/Boston Children’s Hospital (DFCI/BCH) from 1/1/2012-12/31/2013. Events without an admission to BCH were excluded. We collected facility charge data and length of stay (LOS) for all related clinic (DFCI) and ED visits (BCH) and admissions (BCH). We did not capture charges for outside ED visits, professional fees, or care after discharge. Via chart review, each CLABSI was classified as CLABSI+ (hospitalizations with care unrelated to CLABSI extending LOS by > 24 hours) or CLABSI-only (all others). A sub-analysis of CLABSI-only excluded charges for cytotoxics because some patients received scheduled chemotherapy during their CLABSI care. Excel Pivot Tables were used to calculate frequency of visits and charges. Results: There were 74 unique CLABSI events in 61 patients. Room, pharmacy, and procedures charges accounted for 76% of total charges in CLABSI-only after excluding cytotoxics. Conclusions: OP-CLABSI in PHO patients result in significant additional healthcare cost, comparable or even greater than IP-CLABSI. This analysis suggests that preventing OP-CLABSI could result in substantial system savings, further validating the need for increased efforts to prevent OP-CLABSI. Group N Per CLABSI Charges LOS (days) Median Range Median Range All CLABSI 74 $40,852 $9,377-$262,428 6.5 1-38 CLABSI-only (with cytotoxics) 62 $36,612 $9,377-$193,324 6 1-30 CLABSI-only (without cytotoxics) $35,489 $9,377-$192,348 CLABSI+ 12 $89,935 $36,880-$262,428 15 6-38
Utility of pre-operative PET/CT staging in sentinel lymph node-positive melanoma.
Authors: Benjamin Scheier, Christopher D. Lao, Kelley M Kidwell, Bruce G. Redman
Journal: Journal of Clinical Oncology (2015)

6566 Background: Sentinel lymph node (SLN) mapping is an integral part of melanoma staging. If regional metastases are identified, patients often undergo lymph node dissection (LND) as definitive treatment. The National Comprehensive Cancer Network (NCCN) makes a category 2B recommendation- based on “low-level evidence” and a non-uniform consensus- that prior to LND, patients may be considered for staging by positron emission tomography with a computed tomography scan (PET/CT). PET/CT, however, lacks data supporting this use, may inconsistently impact treatment decisions and carries a risk of false positives that may detract from clinical utility. Methods: A retrospective evaluation of patients seen at the University of Michigan with melanoma and clinically silent regional lymph nodes between July 2013 and September 2014 was performed.We identified78 patients with positive SLN mapping, 46 of which underwent PET/CT prior to LND. Remaining patients either underwent no staging or CT with brain MRI. Outcomes measured include changes in clinical management and incidence of false positives, defined as biopsy-evaluated PET/CT findings non-diagnostic for melanoma. Results: Of the 46 patients who underwent PET/CT, 15 (33%) had abnormal findings distant from the primary tumor and local lymph node basin. 9 of those 15 patients (60%) had abnormalities biopsied prior to LND. Of the 46 patients assessed, only 3 (6.5%) had PET/CT findings that ultimately identified metastatic melanoma and precluded LND. This yields a false positive rate of 67% in screening for distant metastases. There was not a statistically significant association between T and N stage and whether or not patients underwent PET/CT imaging (Fisher’s exact test, p = 0.12 and 0.85, respectively). There was a statistical association between undergoing PET/CT and ulceration status (p = .004). Conclusions: The utility of PET/CT staging following SLN mapping in melanoma is unknown, despite its recommended use by the NCCN. In our retrospective review, we found that PET/CT has a high false positive rate and a minimal effect on patient management. PET/CT staging should be reevaluated as a category 2B recommendation by the NCCN and its utility evaluated prospectively in a clinical trial.
Helping My Husband Live and Die
Authors: Hedy S. Wald
Journal: JAMA Neurology (2019)

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Differences in financial disparities in Kentucky compared to the U.S. national level.
Authors: Jorge Arturo Rios-Perez, Shesh Rai, Donald M. Miller
Journal: Journal of Clinical Oncology (2015)

e17585 Background: The impact of financial burden of cancer care has on patients can be long-lasting. An accurate estimation of the financial burden of cancer could help patients and other stake-holders make decisions at different levels. National data is becoming available, but information about regional variations that would be important to consider for development of interventions at a local and regional level is lacking. We aimed to describe aspects of the financial burden of cancer in patients treated at a single referral center in Eastern Kentucky and compare them to national data. Methods: We conducted a survey on patients diagnosed with cancer that were receiving outpatient cancer therapy at the University of Louisville Cancer Center between March and July 2012. The survey intended to capture demographic information and perceptions of financial hardship due to cancer treatment. We constructed 95% confidence interval (CI) for the proportion of patients experiencing financial hardship at our institution in order to compare it to recently published national data from the 2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement (n = 1,592). Results: We surveyed 90 individuals. Forty of them (44%) reported to be working at the time of their cancer diagnosis. Of those working, four (10%) lost their jobs during treatment. Of the 87 patients who answered questions about financial distress during treatment, 50.6% (95% CI, 40.06% to 61.08%) reported that they experienced at least one financial difficulty during their cancer treatment. When compared to the national rate of patients experiencing financial hardship (27%), the patients at our institution have a significantly higher rate of financial distress. Also 23.45% of respondents reported that they were forced to use their life time savings to pay for the cost of their cancer care. Eight percent of the respondents reported that they considered filing for bankruptcy. Conclusions: Financial hardship from cancer care in the US appears to have significant regional variations. Further understanding of these variations could help to guide policy, direct resources, select interventions and make treatment decisions.
Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial
Authors: Gus Gazzard, Evgenia Konstantakopoulou, David Garway-Heath, Anurag Garg, Victoria Vickerstaff, Rachael Hunter, Gareth Ambler, Catey Bunce, Richard Wormald, Neil Nathwani, Keith Barton, Gary Rubin, Marta Buszewicz, Gareth Ambler, Keith Barton, Rupert Bourne, David Broadway, Catey Bunce, Marta Buszewicz, Amanda Davis, Anurag Garg, David Garway-Heath, Gus Gazzard, Rachael Hunter, Hari Jayaram, Yuzhen Jiang, Evgenia Konstantakopoulou, Sheng Lim, Joanna Liput, Timothy Manners, Stephen Morris, Neil Nathwani, Gary Rubin, Nicholas Strouthidis, Victoria Vickerstaff, Sarah Wilson, Richard Wormald, Haogang Zhu
Journal: The Lancet (2019)

Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two.In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223).Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 0·89 (SD 0·18) in the selective laser trabeculoplasty group versus 0·90 (SD 0·16) in the eye drops group, with no significant difference (difference 0·01, 95% CI -0·01 to 0·03; p=0·23). At 36 months, 74·2% (95% CI 69·3-78·6) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93·0%) than in the eye drops group (91·3%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of £20 000 per quality-adjusted life-year gained.Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.National Institute for Health Research, Health and Technology Assessment Programme.