tbuckley/cabot-search huggingface dataset:
The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma
Authors: Ciaran O'Neill, Peter G. Gibson, Liam G. Heaney, John W. Upham, Ian A. Yang, Paul N. Reynolds, Sandra Hodge, Christine R. Jenkins, Matthew Peters, Guy B. Marks, Alan L. James, Jodie L. Simpson
Journal: European Respiratory Journal (2020)

Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs.The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs.Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD 433.70 (AUD 48.59-818.81) or EUR 260.22 (EUR 29.15-491.29)), unplanned healthcare visits (AUD 20.25 (AUD 5.23-35.27) or EUR 12.15 (EUR 3.14-21.16)), antibiotic costs (AUD 14.88 (AUD 7.55-22.21) or EUR 8.93 (EUR 4.53-13.33)) and oral corticosteroid costs (AUD 4.73 (AUD 0.82-8.64) or EUR 2.84 (EUR 0.49-5.18)); all p<0.05. Overall healthcare and societal costs were lower (AUD 77.30 (EUR 46.38) and AUD 256.22 (EUR 153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD 2072.30 (95% CI AUD 1348.55-2805.23) or (EUR 1243.38 (EUR 809.13-1683.14) assuming a willingness to pay per exacerbation avoided of AUD 2651 (EUR 1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant.Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.
Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018
Authors: Heather E. Hsu, Roshni Mathew, Rui Wang, Carly Broadwell, Kelly Horan, Robert Jin, Chanu Rhee, Grace M. Lee
Journal: JAMA Pediatrics (2020)

<h3>Importance</h3> Central catheter–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients. <h3>Objective</h3> To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals. <h3>Design, Setting, and Participants</h3> This time series study included 176 US hospitals reporting pediatric health care–associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018. Patients aged 18 years or younger admitted to PICUs or level III NICUs were included in the analysis. <h3>Main Outcomes and Measures</h3> The primary outcomes were device-associated rates of CLABSI in NICUs and PICUs and CAUTI in PICUs (infections per 1000 device-days). Secondary outcomes included population-based rates (infections per 10 000 patient-days) and device utilization (device-days per patient-days). Regression models were fit using generalized estimating equations to assess yearly changes in CLABSI and CAUTI rates, adjusted for birth weight (≤1500 vs &gt;1500 g) in neonatal models. <h3>Results</h3> Of the 176 hospitals, 132 hospitals with NICUs and 114 hospitals with PICUs contributed data. Of these, NICUs reported 6 064 172 patient-days and 1 363 700 central line-days and PICUs reported 1 999 979 patient-days, 925 956 central catheter–days, and 327 599 indwelling urinary catheter–days. In NICUs, there were no significant changes in yearly trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Results were similar in PICUs, with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01) remaining stable. While device-associated CAUTI rates in PICUs also remained unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), population-based CAUTI rates significantly decreased by 8% per year (IRR, 0.92; 95% CI, 0.86-0.98) and indwelling urinary catheter utilization significantly decreased by 6% per year (OR, 0.94; 95% CI, 0.91-0.96). <h3>Conclusions and Relevance</h3> Recent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicate that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed. Modest improvements in population-based CAUTI rates likely reflect more judicious use of urinary catheters.
Accuracy of New Equation to Calculate Low-Density Lipoprotein Cholesterol—Reply
Authors: Alan T. Remaley, Maureen Sampson
Journal: JAMA Cardiology (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Cardiology journal
Covid-19: Trump tests positive as US cases climb
Authors: Owen Dyer
Journal: BMJ (2020)

The US president has announced that he and his wife have tested positive for the coronavirus, only hours after he claimed that the “end of the pandemic is in sight.”

Donald Trump’s positive result is likely to complicate his re-election plans even if his symptoms prove mild, as his campaign planned an aggressive in-person tour to close the polling gap with Democrat Joe Biden, bearing a message—unsupported by the scientific evidence—that the US has left behind the worst of the pandemic. On 2 October case numbers in the US stood at 7.28 million, with nearly 208 000 deaths.

As recently as the morning of 1 October Trump was hoping to pack two rallies in Wisconsin that afternoon, even though his own White House Task Force had just moved the swing state into the “red” …
Evaluation of US State–Level Variation in Hypertensive Disorders of Pregnancy
Authors: Alexander J. Butwick, Maurice L. Druzin, Gary M. Shaw, Nan Guo
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Hypertensive disorders of pregnancy are important causes of maternal and perinatal morbidity in the US. However, the extent of statewide variation in the prevalence of chronic hypertension, pregnancy-induced hypertension or preeclampsia, and eclampsia in the US remains unknown. <h3>Objective</h3> To examine the extent of statewide variation in the prevalence of chronic hypertension, hypertensive disorders of pregnancy (including pregnancy-induced hypertension or preeclampsia), and eclampsia in the US. <h3>Design, Setting, and Participants</h3> A cross-sectional study using 2017 US birth certificate data was conducted from September 1, 2019, to February 1, 2020. A population-based sample of 3 659 553 women with a live birth delivery was included. <h3>Main Outcomes and Measures</h3> State-specific prevalence of chronic hypertension, hypertensive disorders of pregnancy, and eclampsia was assessed using multilevel multivariable logistic regression, with the median odds ratio (MOR) to evaluate statewide variation. <h3>Results</h3> Of the 3 659 553 women, 185 932 women (5.1%) were younger than 20 years, 727 573 women (19.9%) were aged between 20 and 24 years, 1 069 647 women (29.2%) were aged between 25 and 29 years, 1 037 307 women (28.3%) were aged between 30 and 34 years, 523 607 women (14.3%) were aged between 35 and 39 years, and 115 487 women (3.2%) were 40 years or older. Most women had Medicaid (42.8%) or private insurance (49.4%). Hawaii had the lowest adjusted prevalence of chronic hypertension (1.0%; 95% CI, 0.9%-1.2%), and Alaska had the highest (3.4%; 95% CI, 3.0%-3.9%). Massachusetts had the lowest adjusted prevalence of hypertensive disorders of pregnancy (4.3%; 95% CI, 4.1%-4.6%), and Louisiana had the highest (9.3%; 95% CI, 8.9%-9.8%). Delaware had the lowest adjusted prevalence of eclampsia (0.03%; 95% CI, 0.01%-0.09%), and Hawaii had the highest (2.8%; 95% CI, 2.2%-3.4%). The degree of statewide variation was high for eclampsia (MOR, 2.36; 95% CI, 1.88-2.82), indicating that the median odds of eclampsia were 2.4-fold higher if the same woman delivered in a US state with a higher vs lower prevalence of eclampsia. Modest variation between states was observed for chronic hypertension (MOR, 1.27; 95% CI, 1.20-1.33) and hypertensive disorders of pregnancy (MOR, 1.17; 95% CI, 1.13-1.21). <h3>Conclusions and Relevance</h3> The findings of this study suggest that after accounting for patient-level and state-level variables, substantial state-level variation exists in the prevalence of eclampsia. These data can inform future public-health inquiries to identify reasons for the eclampsia variability.
SAT0621 IMPACT OF HINDFOOT CORONAL/SAGITTAL ALIGNMENT ON METATARSUS PRIMUS ELEVATUS IN RHEUMATOID FOOT DEFORMITIES
Authors: Shinichi Mizuki
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Typical foot deformity patterns of patients with rheumatoid arthritis (RA) include hallux valgus, claw toes, splay foot, flat foot, and hindfoot valgus deformities. However, some patients show deformities different from a typical pattern, including metatarsus primus elevatus, described as dorsal elevation of the first metatarsal in relation to the lesser metatarsals, as we reported previously. In the report, we speculated that metatarsus primus elevatus might be associated with calcaneal inclination and hindfoot varus alignment. However, there are no studies on the association of hindfoot alignment with metatarsus primus elevatus in patients with RA. <h3>Objectives</h3> To elucidate the impact of hindfoot coronal/sagittal alignment on metatarsus primus elevatus in patients with RA. <h3>Methods</h3> A retrospective study was performed of standing anteroposterior and lateral radiographs of 81 feet in 53 patients who underwent surgical treatment for metatarsalgia in our hospital. The distance between the dorsal cortical bones of the first and second metatarsals (MPE) was measured on the lateral radiograph for the degree of metatarsus primus elevatus. Using a two-dimensional coordinate system on the lateral radiographic image where lines along the calcaneus tuberosity were defined as X and Y axes, ten anatomic points of the foot were measured. Calcaneal pitch, talar declination angle, and naviculocuboid (N/C) overlap ratio were measured for assessment of hindfoot sagittal and coronal alignment, respectively. We assessed the hallux valgus angle (HVA), the inter metatarsal angle between first and 2nd metatarsals (M1M2A), and the intermetatarsal angle between first and 5th metatarsals (M1M5A) for axial foot alignment. The correlations of MPE with other radiographic angular and coordinate data were statistically assessed using Spearman rank correlation coefficient. <h3>Results</h3> Median MPE was 1.7 mm (interquartile range: 0–5.2 mm). The first metatarsal head, first metatarsal-cuneiform and posterior talocalcaneal joint were shifted dorsally (r=0.70, p&lt;0.01; r=0.57, p&lt;0.01; r=0.42, p&lt;0.01, respectively). No correlation MPE with HVA and M1M5A were observed (r=-0.26, p=0.05; r=-0.25, p=0.07, respectively), however, M1M2A showed correlation with MPE (r=-0.52, P&lt;0.01). On the other hand, MPE showed a high degree of correlation with talar declination angle, calcaneal pitch, and N/C overlap ratio (r=-0.45, p&lt;0.01; r=0.35, p&lt;0.01; r=-0.45, p&lt;0.01, respectively). <h3>Conclusion</h3> In patients with RA, the hindfoot joints shifted dorsally in metatarsus primus elevatus. Moreover, hindfoot varus alignment and high-arched foot affect metatarsus primus elevatus. The results of the present study suggest the importance of evaluating hindfoot alignment when determining surgical treatment procedures for rheumatoid foot deformities. <h3>Disclosure of Interests</h3> None declared
Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study
Authors: Jennifer Jardine, Andrea Blotkamp, Ipek Gurol-Urganci, Hannah Knight, Tina Harris, Jane Hawdon, Jan van der Meulen, Kate Walker, Dharmintra Pasupathy
Journal: BMJ (2020)

Abstract Objectives To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. Design Cohort study using linked electronic maternity records. Participants 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. Main outcome measure A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. Results Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). Conclusions Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.
Relative Risk of Cardiovascular Disease Is Higher in Women With Type 2 Diabetes, but Not in Those With Prediabetes, as Compared With Men
Authors: Elena Succurro, Teresa Vanessa Fiorentino, Sofia Miceli, Maria Perticone, Angela Sciacqua, Francesco Andreozzi, Giorgio Sesti
Journal: Diabetes Care (2020)

OBJECTIVE Most but not all studies suggest that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in women with prediabetes compared with men with prediabetes. RESEARCH DESIGN AND METHODS In a cross-sectional study, in 3,540 adults with normal glucose tolerance (NGT), prediabetes, and diabetes, we compared the RR for prevalent nonfatal CVD between men and women. In a longitudinal study including 1,658 adults with NGT, prediabetes, and diabetes, we compared the RR for incidences of major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events, after 5.6 years of follow-up. RESULTS Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, hs-CRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in women with diabetes (RR 9.29; 95% CI 4.73–18.25; P &amp;lt; 0.0001) than in men (RR 4.56; 95% CI 3.07–6.77; P &amp;lt; 0.0001), but no difference in RR for CVD was observed comparing women and men with prediabetes. In the longitudinal study, we found that women with diabetes, but not those with prediabetes, have higher RR (RR 5.25; 95% CI 3.22–8.56; P &amp;lt; 0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81–4.08; P &amp;lt; 0.0001). CONCLUSIONS This study suggests that women with diabetes, but not those with prediabetes, have higher RR for prevalent and incident major adverse outcomes than men.
Multiple COVID-19 Clusters on a University Campus — North Carolina, August 2020
Authors: Erica Wilson, Catherine V. Donovan, Margaret Campbell, Thevy Chai, Kenneth Pittman, Arlene C. Seña, Audrey Pettifor, David J. Weber, Aditi Mallick, Anna Cope, Deborah S. Porterfield, Erica Pettigrew, Zack Moore
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), in institutes of higher education presents a unique set of challenges because of the presence of congregate living settings and difficulty limiting socialization and group gatherings. Before August 2020, minimal data were available regarding COVID-19 outbreaks in these settings. On August 3, 2020, university A in North Carolina broadly opened campus for the first time since transitioning to primarily remote learning in March. Consistent with CDC guidance at that time (1,2), steps were taken to prevent the spread of SARS-CoV-2 on campus. During August 3-25, 670 laboratory-confirmed cases of COVID-19 were identified; 96% were among patients aged <22 years. Eighteen clusters of five or more epidemiologically linked cases within 14 days of one another were reported; 30% of cases were linked to a cluster. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 within the university community. On August 19, all university A classes transitioned to online, and additional mitigation efforts were implemented. At this point, 334 university A-associated COVID-19 cases had been reported to the local health department. The rapid increase in cases within 2 weeks of opening campus suggests that robust measures are needed to reduce transmission at institutes of higher education, including efforts to increase consistent use of masks, reduce the density of on-campus housing, increase testing for SARS-CoV-2, and discourage student gatherings.
Increases in Actual Health Care Costs and Claims After Firearm Injury
Authors: Megan L. Ranney, Curtis Herges, Leanne Metcalfe, Jeremiah D. Schuur, Paul Hain, Ali Rowhani-Rahbar
Journal: Annals of Internal Medicine (2020)

Background: The incidence of firearm injury and death in the United States is increasing. Although the health care–related effect of firearm injury is estimated to be high, existing data are largely cross-sectional, do not include data on preinjury and postinjury health care visits and related costs, and use hospital charges rather than actual monetary payments. Objective: To compare actual health care costs (that is, actual monetary payments) and utilizations within the 6 months before and after an incident (index) firearm injury. Design: Before–after study. Setting: Blue Cross Blue Shield plans of Illinois, Texas, Oklahoma, New Mexico, and Montana. Participants: Plan members continuously enrolled for at least 12 months before and after an index firearm injury sustained between 1 January 2015 and 31 December 2017. Measurements: Eligible costs, out-of-pocket costs, and firearm injury–related International Classification of Diseases, Ninth or 10th Revision, codes. Results: Total initial (emergency department [ED]) health care costs for persons with index firearm injuries who were discharged from the ED were $8 158 786 ($5686 per member). Total initial (hospital admission) costs for persons with index firearm injuries who required hospitalization were $41 255 916 ($70 644 per member). Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347% (from $3984 to $17 806 per member) for those discharged from the ED and 2138% (from $4118 to $92 151 per member) for those who were hospitalized. The number of claims increased by 187% for patients discharged from the ED and 608% for those who were hospitalized. Limitation: Firearm injury intent was not specified because of misclassification concerns. Conclusion: In the 6 months after a firearm injury, patient-level health care visits and costs increased by 3 to 20 times compared with the 6 months prior. The burden of firearm injury on the health care system is large and quantifiable. Primary Funding Source: None.
The Effects Of Provent (TM) On Moderate-To-Severe Obstructive Sleep Apnea During Continuous Positive Airway Pressure Therapy Withdrawal: Primary Outcomes From A Randomized Controlled Trial
Authors: V Rossi, B Winter, N M Rahman, Yu L-M., J Fallon, C Clarenbach, K E Bloch, Stradling, M Kohler
Journal: American Journal of Respiratory and Critical Care Medicine (2013)
Helping People With Dementia Exercise Their Right to Vote
Authors: Rita Rubin
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Interleukin-33 activates regulatory T cells to suppress innate γδ T cell responses in the lung
Authors: Lucas D. Faustino, Jason W. Griffith, Rod A. Rahimi, Keshav Nepal, Daniel L. Hamilos, Josalyn L. Cho, Benjamin D. Medoff, James J. Moon, Dario A. A. Vignali, Andrew D. Luster
Journal: Nature Immunology (2020)