tbuckley/cabot-search huggingface dataset:
Performance in the Medicare Shared Savings Program After Accounting for Nonrandom Exit
Authors: Adam A. Markovitz, John M. Hollingsworth, John Z. Ayanian, Edward C. Norton, Phyllis L. Yan, Andrew M. Ryan
Journal: Annals of Internal Medicine (2019)

Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are associated with modest savings. However, prior research may overstate this effect if high-cost clinicians exit ACOs.To evaluate the effect of the MSSP on spending and quality while accounting for clinicians' nonrandom exit.Similar to prior MSSP analyses, this study compared MSSP ACO participants versus control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. To further account for selection effects, the share of nearby clinicians in the MSSP was used as an instrumental variable. Hip fracture served as a falsification outcome. The authors also tested for compositional changes among MSSP participants.Fee-for-service Medicare, 2008 through 2014.A 20% sample (97 204 192 beneficiary-quarters).Total spending, 4 quality indicators, and hospitalization for hip fracture.In adjusted longitudinal models, the MSSP was associated with spending reductions (change, -$118 [95% CI, -$151 to -$85] per beneficiary-quarter) and improvements in all 4 quality indicators. In instrumental variable models, the MSSP was not associated with spending (change, $5 [CI, -$51 to $62] per beneficiary-quarter) or quality. In falsification tests, the MSSP was associated with hip fracture in the adjusted model (-0.24 hospitalizations for hip fracture [CI, -0.32 to -0.16 hospitalizations] per 1000 beneficiary-quarters) but not in the instrumental variable model (0.05 hospitalizations [CI, -0.10 to 0.20 hospitalizations] per 1000 beneficiary-quarters). Compositional changes were driven by high-cost clinicians exiting ACOs: High-cost clinicians (99th percentile) had a 30.4% chance of exiting the MSSP, compared with a 13.8% chance among median-cost clinicians (50th percentile).The study used an observational design and administrative data.After adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects-including exit of high-cost clinicians-may drive estimates of savings in the MSSP.Horowitz Foundation for Social Policy, Agency for Healthcare Research and Quality, and National Institute on Aging.
Challenges of Personal Health Records
Authors: William D. Freeman, Meredith Karney
Journal: JAMA (2019)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
AB1266 THE CORRELATION BETWEEN SMOKING AND DISEASE ACTIVITY AND MRI INFLAMMATION IN EARLY AXIAL SPONDYLOARTHRITIS IN AN EGYPTIAN COHORT
Authors: fatma fayed, Abeer Abdelati
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> literature suggests that smoking is one of the crucial triggering factors of rheumatological diseases.<sup>(1)</sup> In axial Spondyloarthritis (axSpA), classified into radiographic SpA (AS) and non-radiographic SpA (nrSpA), smoking associated with disease activity and extra-articular manifestation. <sup>(2)</sup> The relationship between smoking and HLAB-27 as well as MRI inflammation in axSpA patients and the difference between nrSpA and AS regarding smoking have not been studied to date in details. Objectives: to investigate the influence of smoking on disease activity and MRI inflammation in axSpA patients (AS and nrSpA). <h3>Methods:</h3> sixty Egyptian patients (42 males and 18 females) with the mean age (31.33 ± 7.02), with early active axial spondyloarthritis (49 AS and 11 non-radiographic SpA) within two years disease duration, diagnosed based on ASAS classification criteria. All clinical indices (BASDI, BASFI, BASMI, ASDAS-CRP) were applied to all patients. HLA-B27 and the inflammatory markers (ESR, CRP) was done. MRI of sacroiliac joints was performed in a standard protocol using short tau inversion recovery and T1 sequences (slice thickness 3-4mm, both semi-coronal and semi-axial orientations), and scored by the Berlin method. Smoking use assessed by smoking pack-year index. <h3>Results:</h3> of all 60 patients, 38 smokers and 22 non-smokers. No significant difference regarding smoking packs index between nrSpA and AS. (p=0.822) There was a robust correlation between smoking packing index and the Berlin score of MRI in all axSpA patients (r<sub>s=</sub>0.631) (p=&lt;0.001). Moreover, there was a significant correlation between smoking and C-reactive protein (r<sub>s=</sub>0.952) as well as HLA-B27. (r<sub>s=</sub>0.340) (p&lt;0.001) Furthermore, a significant relationship between smoking and activity indices (BASDI (r<sub>s=</sub>0.961) and ASDAS-CRP (r<sub>s=</sub>0.938)). Otherwise, no significant correlation among smoking, BASMI, and BASFI as well as ESR. <h3>Conclusion:</h3> Smoking has no significant difference between AS and nrSpA. Smoking has a significant association with HLA-B27, the inflammatory lesions of MRI, and clinical indices (BASDI, ASDAS-CRP) as well as C reactive protein in AS and non-radiographic SpA patients while it has no association with the other clinical indices in term of BASMI and BASFI as well as the Erythrocyte sedimentation rate (ESR). <h3>References</h3> [1] Belbasis L, Dosis V, Evangelou E. elucidating the environmental risk factors for rheumatic diseases: An umbrella review of meta analyses. International journal of rheumatic diseases. 2018;21(8):1514-24. [2] Zhao S, Jones GT, Macfarlane GJ, et al. Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Rheumatology2018. <h3>Disclosure of Interests:</h3> None declared
Hantavirus pulmonary syndrome - Virginia, 1993
Authors: B. H. Hamory, C. Zwillich, T. Bollard, James Ballard, M. Connor, P. Lurie, M. Moll, J. Rankin, C. Smith, S. Jenkins, E. Barrett, G. B. Miller, W. Frampton, S. Lanser, C. R. Nichols, D. T. King, A. Kingsbury
Journal: JAMA (1994)
Aquatic Adaptation and Depleted Diversity: A Deep Dive into the Genomes of the Sea Otter and Giant Otter
Authors: Annabel C Beichman, Klaus-Peter Koepfli, Gang Li, William Murphy, Pasha Dobrynin, Sergei Kliver, Martin T Tinker, Michael J Murray, Jeremy Johnson, Kerstin Lindblad-Toh, Elinor K Karlsson, Kirk E Lohmueller, Robert K Wayne
Journal: Molecular Biology and Evolution (2019)

Abstract Despite its recent invasion into the marine realm, the sea otter (Enhydra lutris) has evolved a suite of adaptations for life in cold coastal waters, including limb modifications and dense insulating fur. This uniquely dense coat led to the near-extinction of sea otters during the 18th–20th century fur trade and an extreme population bottleneck. We used the de novo genome of the southern sea otter (E. l. nereis) to reconstruct its evolutionary history, identify genes influencing aquatic adaptation, and detect signals of population bottlenecks. We compared the genome of the southern sea otter with the tropical freshwater-living giant otter (Pteronura brasiliensis) to assess common and divergent genomic trends between otter species, and with the closely related northern sea otter (E. l. kenyoni) to uncover population-level trends. We found signals of positive selection in genes related to aquatic adaptations, particularly limb development and polygenic selection on genes related to hair follicle development. We found extensive pseudogenization of olfactory receptor genes in both the sea otter and giant otter lineages, consistent with patterns of sensory gene loss in other aquatic mammals. At the population level, the southern sea otter and the northern sea otter showed extremely low genomic diversity, signals of recent inbreeding, and demographic histories marked by population declines. These declines may predate the fur trade and appear to have resulted in an increase in putatively deleterious variants that could impact the future recovery of the sea otter.
PB2115 NRF1‐DEPENDENT PATHWAY: SALVAGE PATHWAY AFTER THE PROTEASOME INHIBITION IN MULTIPLE MYELOMA AND MANTLE CELL LYMPHOMA?
Authors: D. Fassmannová, F. Sedlák, K. Grantz Šašková
Journal: HemaSphere (2019)

Background: Proteasome inhibitors (PI) are compounds with anti‐neoplastic effect in various hematological cancers. Bortezomib, the first FDA approved PI compound, represents the backbone therapy in case of multiple myeloma (in the first line therapy and in relapse) and has proven efficacy in mantle cell lymphoma. However, the resistance to proteasome inhibitor treatment often occurs and limits the possibility of subsequent therapy. The mechanism of resistance to PI is not fully understood. Usually, it is associated with high expression of proteasome subunits or, in some cases, could be caused by mutations in proteasome subunits that hinder the binding site of the inhibitor. One of the homeostasis pathways that regulates the synthesis of proteasome subunits is the nuclear factor erythroid‐derived 2 related factor 1 (Nrf1)‐dependent pathway. Nrf1 is a transcription factor responsible for the regulation of the genes involved in protecting cells from oxidative stress and regulating proteasomal activity. In normal conditions, it is embedded in the membrane of endoplasmatic reticulum, retrotranslocated by VCP/p97 complex to cytosol, deglycosylated and processed by proteasome. However, when proteasome is inhibited, Nrf1 is cleaved by DDI2 protease, becomes active and acts as a transcription factor in the nucleus where it upregulates the synthesis of the proteasome. Aims: Evaluation of the roles of individual factors of Nrf1‐dependent pathway under the PI treatment of hematologic neoplasias. Methods The cell lines with various sensitivity to PI generated from various hematologic neoplasias (mainly multiple myeloma, mantle cell lymphoma) were treated by several PIs and the levels and forms of the components in the Nrf1‐dependent pathway were measured. Results: The presence of the Nrf1‐dependent pathway components in hematologic neoplasia was confirmed. The PI treatment in the majority of cell lines led to the increase of the levels of the activated form of Nrf1 while the DDI2 levels did not significantly change. Summary/Conclusion: The activation of the Nrf1‐dependent pathway responsible for the proteasomal units expression after the PI treatment in hematologic neoplasia derived cells suggests that the inhibition of this pathway can improve the sensitivity to PI and might potentially open up new approaches to the PI refractory disease therapy.
SAT0463 BRUCELLAR SPONDYLODISCITIS: CLINICAL, RADIOLOGICAL AND THERAPEUTIC FEATURES
Authors: Aicha Ben Tekaya, Khaoula Zouaoui, Ines Mahmoud, Olfa Saidane, Mohamed Ben Hammamia, Rawdha Tekaya, Leila Abdelmoula
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Brucellosis is an endemic disease around the Mediterranean and especially in Tunisia and Brucellar spondylodiscitis is the most common osteoarticular localization. <h3>Objectives:</h3> The aim of our study is to study the,clinical, radiological and therapeutic characteristics of Brucellar spondylodiscitis. <h3>Methods:</h3> This is a retrospective descriptive study, conducted over 20 years (1999-2019) at a Rheumatology Department. We collected cases of Brucellar spondylodiscitis. We studied the clinical, radiological features and therapeutics outcomes. <h3>Results:</h3> We included 23 patients, 15 men and 8 women, with a mean age of 53.21 years [31,79]. Contact with livestock or consumption of raw milk was noted in 16 cases. The diagnosis time was, on average, 3.8 months [1,9]. Spine pain was present in all cases, with lumbar seat in 16 cases and was inflammatory in 20 cases. At the examination, 19 patients had a limitation of spinal mobility and 4 had neurological abnormalities. A motor deficit with a horsetail syndrome was objectified in one case. We noted a biological inflammatory syndrome in 19 cases. Wright's serology was positive in 21 cases. Standard radiographs showed disc narrowing in 10 cases. 21 patients had spinal magnetic resonance imaging showing the abnormalities of the disc and adjacent vertebrae. We found abscess in four patients and epiduritis associated with the abscess in six patients. MRI showed spinal compression in 2 patients. Disco-vertebral biopsy was performed in 11 cases and helped to make the diagnosis in 3 cases. The patients had received antibiotic therapy with a combination of doxycylin and rifampicin with a mean total duration of 4.9 months [2.12]. Evolution was favorable in 19 cases. Complications were mainly neurological (n=3)or related to the toxicity of the treatment(n=3). <h3>Conclusion:</h3> Brucellar spondylodiscitis can be serious because of the neurological complications that it can cause. At the slightest diagnostic doubt, we should perform an MRI. And antibiotic treatment must be urgent and well-adapted with careful monitoring of patients. <h3>Disclosure of Interests:</h3> None declared
The cost-effectiveness of lipid lowering for primary cardiovascular prevention in chronic kidney disease: moving beyond statins
Authors: Carl P. Walther, Kevin F. Erickson
Journal: Kidney International (2019)

Because of high risk of cardiovascular disease, patients with chronic kidney disease may benefit from cholesterol-lowering therapy beyond statins. A cost-effectiveness analysis of adding ezetimibe to high-dose statins for primary cardiovascular disease prevention in patients with non–dialysis-dependent chronic kidney disease found treatment with ezetimibe to be cost-effective for many patients with chronic kidney disease. We describe the importance of this topic and explain key assumptions necessary for the investigators to arrive at their conclusions.
OP0156 HPR THE FEASIBILITY AND EFFECTIVENESS OF TELEMEDICINE FOR KNEE OSTEOARTHRITIS IN DISEASE MANAGEMENT: A RANDOMISED CONTROL TRIAL
Authors: Zhengping Huang, Xiaoyan Zhong, Zhimin Xie, LI. Tianwang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Osteoarthritis (OA) is a serious health concern worldwide, and patients with OA are in urgent need of proper long-term disease management to prevent disability and improve the quality of life. Research has started to investigate the feasibility and effectiveness of telemedicine in providing disease management for patients with chronic diseases. Guangdong Online Hospital (GOH) is the first officially recognized web-based hospital that widely provides telemedicine services in southern China. <h3>Objectives</h3> This study aimed to establish the feasibility and effectiveness of GOH in providing long-term disease management for patients with knee OA via a 6-month, randomised control trial (RCT). <h3>Methods</h3> 40 patients with knee OA were randomly assigned to receive conventional therapy (CT) in the clinic or conventional therapy plus a brief GOH-based intervention (CT-GOHT). GOH-based intervention included educational lectures, medical suggestions and psychotherapy. The primary outcome was the drop-out rates and the secondary outcomes included the mean change of the self-reported total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Multidimensional Fatigue Inventory (MFI), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI) from baseline to endpoint. <h3>Results</h3> The baseline characteristics were comparable between the two groups. 3 patients in CT group and 1 patient in CT-GOHT group lost to follow-up during the study (<i>P</i> = 0.598). A statistically significant difference was observed in the mean change of WOMAC recommended index of joint pain (8.82 ± 5.02 vs. 13.90 ± 7.63, <i>P</i> = 0.026), morning stiffness (3.12 ± 1.50 vs. 4.42 ± 2.06,<i> P</i> = 0.039), functional limitation (27.65 ± 9.91 vs. 38.84 ± 17.28,<i> P</i> = 0.025), HADS-Anxiety (3.24 ± 2.41 vs. 5.32 ± 3.23,<i> P</i> = 0.037), and PSQI global score (2.35 ± 1.54 vs. 4.21 ± 3.34,<i> P</i> = 0.043) from baseline to endpoint when comparing the CT group to the CT-GOHT group. In addition, Guangdong Online Hospital was widely accepted by the including OA patients for their disease management. <h3>Conclusion</h3> Delivering a telemedicine intervention to patients with knee OA via GOH is a feasible and potentially effective method in long-term disease management, especially for patients living in remote areas. The results provide preliminary experiences and guidance for an upcoming full-scale RCT in disease management via telemedicine. <h3>Trial registration</h3> ChiCTR1800014465. <h3>Reference</h3> [1] Huang Z, et al. Implementation of telemedicine for knee osteoarthritis: study protocol for a randomized controlled trial. Trials, 2018, 19(1):232. <h3>Disclosure of Interests</h3> None declared
MIGRATION FLOWS, IRON DEFICIENCY AND ANAEMIA AMONG PREGNANT REFUGEES IN NORTHERN GREECE
Authors: D. Adamidou, T. Sarmourli, T. Karafoulidou, M. Mainou, D. Mpartzoudis, O. Karakasidou, T. Vyzantiadis, T. Theodoridis, S. Theodoridou
Journal: HemaSphere (2019)
Abstract 213: Caracteristics of Kawasaki Disease in Chile: Temuco′s experience
Authors: Guillermo Soza, Carolina Cerda, Andreas Berkhoff, Claudia Lozano, Andrea Salgado
Journal: Circulation (2015)

Kawasaki Disease (KD) is a vasculitis mainly affecting children under two years old and harms arterial vessels (especially coronary) causing dilatation, aneurysms and eventual myocardial complications. Though etiology is unknown, a relationship with an infectious agent is suspected. Diagnosis is doing by clinical criteria and laboratory support. KD cases reported in Latin America go along abscence of management protocols and it is not considered notifiable disease. In order to contribute to a greater understanding of this disease, a retrospective - descriptive analysis of 75 patients diagnosed with KD at the time of discharge was carried out from January 2005 to August 2014 at Hospital Dr.Hernán Henríquez Aravena, Temuco, Chile. Information was tabulated in Microsof Office Excel 2007 and a statical analysis were performed using STATA 11.0 program. Average age 2 years 7 months (range 2 months to 17 years). Sex Male/Female 49%/51%. Prior consultations 85% (64/75). Initial diagnosis KD 51% (38/75). Fever 100% (75/75), 64%(48/75) about 39 ° C. Eye involvement 68% (51/75). Oropharyngeal erythema 87% (55/75). Strawberry tongue 40% (30/75). BCG erythema 19% (14/75). Rash 83% (62/75). Erythema/oedema of hands and foots 73% (55/75). Cervical adenopathy 41% (31/75). Irritability 55% (41/75). Leukocytosis 36% (27/75). Plaquetosis 69%(52/75) and periungual descamation 39% (29/75). Echocardiogram abnormal at startup 28% (21/75), (6/75)8% prior application of IVGG and 5%(4/75)remained with coronary involvement. A single dose of 2g/kg of Intravenous Gamma Globuline (IVGG) was administrated to 97%(73/75). Aspirin 50 mg/kg initial and 5 mg/kg during the following. A second dose of IVGG was required in 13% (10/75). Two patients were treated with anticoagulant for giant aneurysms and in one case, bilateral brachial aneurysms. Tipycal KD in 73% (55/75) and 27%(20/75) incomplete. Further clinical suspicion is needed, because a high percentage of patients had coronary involvement at diagnosis. Those who received early IVGG coronary involvement were lower. Prominent among coronary involvement factors are extreme age, atypical or incomplete forms and high RCP. Needed be considered KD as a notifiable disease, considering the economic and social implications.
PB2364 UNSUCCESSFUL COLLECTION OF AUTOTRANSPLANT DURING THE FIRST SESSION OF LEUKOCYTAPHERESIS IN PATIENTS WITH MULTIPLE MYELOMA AND EFFECTIVE STEM CELL MOBILIZATION
Authors: I. Kostroma, A. Zhernyakova, N. Romanenko, Z. Chubukina, I. Zapreeva, S. Bessmel’tsev, A. Chechetkin, S. Gritsaev
Journal: HemaSphere (2019)

Background: It is well known that the effectiveness of stem cell collection and the possibility to harvest suboptimal CD34+ cells number during the single apheresis session is dependent on the number of CD34+ cells circulating in the peripheral blood (PB), i.e. on the effectiveness of mobilization regimen. Aims: To determine the rate of unseccessful collections in patients with multiple myeloma (MM) when the number of CD34+ cells circulating in the PB is in accordance with the optimal level 20/1 mkl or more. Methods: Retrospective analyses of autotransplant collection in 55 MM patients have been done. Median age of patients was 56 (31‐67) years. Complete response, very good partial response and partial response were diagnosed in 12 (21.8%), 13 (23.6%) and 30 (54,5%) patients accordingly. 25 (45.5%) patients were treated with lenalidomide previously. Cyclophosphamide 3 g/m2 with granulocyte colony‐stimulating factor (G‐CSF) were used for stem cell mobilization in 28 (50.9%) patients. 26 (47.3%) patients were mobilized with vinorelbine 35 mg/m2 with G‐SCF and G‐SCF monotherapy was used in 1 (1.8%) patient. Results: The number of CD34+ cells circulating in PB at the day of the first apheresis procedure was 5‐694/1 mkl (Me 118). Median number of collected CD34+ cells was 5.53 × 10/6/kg (0.27‐29.23). The correlation between number of circulating CD34+ cells and the quantity of harvested CD34+ cells was confirmed: r = 0.503; p &lt; 0.05. At the same time there were 7 (12.7%) cases in which the number of collected CD34+ cells were lower than suboptimal level (0.25‐1.9 × 10/6/kg, Me 1.33 × 10/6/kg) despite the successful mobilization rate: 26‐118/1 mkl (Me 44). The second procedure of apheresis was done on the next day and in all cases except for the one there was the possibility to harvest CD34+ cell number enough to perform a single stem cell transplantation: 2.58‐3.48 × 10/6/kg. The place of central veun catheterization has been changed in all these cases except for the one. Summary/Conclusion: We suppose that a reason of unseccessful stem cell collection in MM patients with adequate rate of mobilization may be disturbance of the bloodstream speed in the apheresis system due to the anatomical characteristics of subclavia vein localization. A method to correct the problem is relief the central catheter puncture place.