tbuckley/cabot-search huggingface dataset:
Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation
Authors: Benedikt Schrage, Peter Moritz Becher, Alexander Bernhardt, Hiram Bezerra, Stefan Blankenberg, Stefan Brunner, Pascal Colson, Gaston Cudemus Deseda, Salim Dabboura, Dennis Eckner, Matthias Eden, Ingo Eitel, Derk Frank, Norbert Frey, Masaki Funamoto, Alina Goßling, Tobias Graf, Christian Hagl, Paulus Kirchhof, Danny Kupka, Ulf Landmesser, Jerry Lipinski, Mathew Lopes, Nicolas Majunke, Octavian Maniuc, Daniel McGrath, Sven Möbius-Winkler, David A. Morrow, Marc Mourad, Curt Noel, Peter Nordbeck, Martin Orban, Federico Pappalardo, Sandeep M. Patel, Matthias Pauschinger, Vittorio Pazzanese, Hermann Reichenspurner, Marcus Sandri, P. Christian Schulze, Robert H.G. Schwinger, Jan-Malte Sinning, Adem Aksoy, Carsten Skurk, Lukasz Szczanowicz, Holger Thiele, Franziska Tietz, Anubodh Varshney, Lukas Wechsler, Dirk Westermann
Journal: Circulation (2020)

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort.Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%).In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
Current state assessment of the organization and delivery of systemic treatment in Ontario.
Authors: Kathy Vu, Daniela Gallo-Hershberg, Aliya Pardhan, Rosemary Ku, Sivanuja Paras, Vishal Kukreti, Leta Marie Forbes
Journal: Journal of Clinical Oncology (2020)

20 Background: In 2019, Ontario Health (Cancer Care Ontario) published 54 standards to ensure high quality and safe delivery of systemic treatment (ST) in Ontario, along with 16 recommendations for take-home cancer drugs (THCD). The standards/recommendations focused on 7 domains for the delivery of ST delivery and 8 domains for THCD. These domains varied between the two documents but also overlapped on issues including prescribing, patient care, patient education and training and education for providers. The standards for ST delivery were also prioritized according to Very High, High or Medium priority with regards to implementation expectations. The objective of this project was to obtain a baseline assessment of alignment with the standards/recommendations for all ST sites within Ontario. Methods: A validated electronic survey that linked to all standards/recommendations was distributed to 75 ST sites in August 2019. Sites had 8 weeks to complete the survey with their multi-disciplinary teams. Data was analyzed centrally using quantitative analysis methods by region as well as by site level. Results: The response rate was 100%. Overall, alignment in all domains was higher for intravenous cancer drug (IVCD) delivery as compared to THCD delivery. Important areas of gaps include CPOE/PPO use (75% for both IVCD and THCD); appropriate drug labels (90% for IVCD versus 52% for THCD); prescribing/dispensing independent double checks (IDC) (95% for IVCD versus 38% for THCD); pump independent double check (83% of sites); continuous ST with central line (86% of sites); standardized tool for THCD education (40%); and oncology training/education (96% of RNs versus 20% of pharmacists). Conclusions: The main gaps that were identified through the current state assessment were related to THCD, as opposed to IVCD. To ensure alignment with the standards/recommendations, these gaps should continue to be an area of focus for quality improvement. The survey was instrumental in informing provincial, regional, and local strategies to address these gaps and to ensure high quality, safe practices are embedded in ST delivery as outlined in the published best practice documents.
Replicability of Treatment Effect in Study of Blood Pressure Lowering With Dementia
Authors: Orestis A. Panagiotou, Iman Jaljuli, Ruth Heller
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
Characteristics of medical malpractice claims related to cancer in Florida.
Authors: Guanming Chen, Jinhai Huo, Vivek Ghosal, Sokol Daniel
Journal: Journal of Clinical Oncology (2020)

202 Background: Florida is among the states that have highest number of cases and total medical malpractice payments. The aim of the study is to examine the characteristics of cancer-related malpractice cases in Florida. Methods: Cancer-related malpractice claims with payment occurred during Jan. 2005 to Dec. 2015 were identified from the Florida Office of Insurance Regulation (FLOIR) database. The characteristics of malpractice cases examined in the study includes cause of allegation, severity of injury, specialty of healthcare provider, length of delay in diagnosis, settlement stage, and indemnity paid. Results: A total of 811 claims were identified. The most common general cause was delay in diagnosis (49.8% of total claims), followed by failure to interpret test result (9.3%) and failure to perform procedure (9.2%). Among the claims of delay in diagnosis, 22.7% were breast cancer, followed by lung cancer (11.1%), and head and neck cancer (10.9%). About 30% claims reported death caused by malpractice. Radiologist (26.1%) was the most common specialty among all specialties, followed by general practice (12.2%) and internal medicine (11.6%). Radiologists were also more likely to have recurrent malpractice claims. The median payout was $250,000 (mean $277,493). The period from case report to settlement was 1.64 years on average. Conclusions: Delay in diagnosis was the most common cause of cancer-related malpractice suits. Our results aligned with previous reports that radiologists were more likely to be involved in the malpractice claims. This study highlights possible pathways to reduce malpractice litigation, as well as improving quality of care in cancer treatment.
Prostaglandin E2 decreases basophil activation in patients with food‐induced anaphylaxis
Authors: Rosa M. Muñoz‐Cano, Rocio Casas, Giovanna Araujo, Cinthia de la Cruz, Margarita Martin, Jordi Roca‐Ferrer, Maria Perez, Maria Torradeflot, Clara San Bartolome, Cesar Picado, Joan Bartra, Mariona Pascal
Journal: Allergy (2020)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Randomized Trial of Afatinib Plus Cetuximab Versus Afatinib Alone for First-Line Treatment of <i>EGFR</i>-Mutant Non–Small-Cell Lung Cancer: Final Results From SWOG S1403
Authors: Sarah B. Goldberg, Mary W. Redman, Rogerio Lilenbaum, Katerina Politi, Thomas E. Stinchcombe, Leora Horn, Everett H. Chen, Sandeep H. Mashru, Scott N. Gettinger, Mary Ann Melnick, Roy S. Herbst, Megan A. Baumgart, Jieling Miao, James Moon, Karen Kelly, David R. Gandara
Journal: Journal of Clinical Oncology (2020)

PURPOSE The irreversible ErbB family tyrosine kinase inhibitor (TKI) afatinib plus the EGFR monoclonal antibody cetuximab was previously shown to overcome resistance to EGFR TKIs. We studied whether the combination of afatinib plus cetuximab compared with afatinib alone would improve progression-free survival (PFS) in patients with treatment-naive EGFR-mutant non–small-cell lung cancer (NSCLC) by preventing or delaying resistance. METHODS Patients with EGFR-mutant NSCLC without prior treatment of advanced disease were enrolled in this phase II, multicenter trial and randomly assigned to receive afatinib 40 mg orally daily plus cetuximab 500 mg/m 2 intravenously every 2 weeks or afatinib alone. The primary end point was PFS. RESULTS Between March 25, 2015 and April 23, 2018, 174 patients were randomly assigned, and 168 (83 on afatinib + cetuximab and 85 on afatinib) were eligible. There was no improvement in PFS in patients receiving afatinib plus cetuximab compared with afatinib alone (hazard ratio [HR], 1.01; 95% CI, 0.72 to 1.43; P = .94; median, 11.9 months v 13.4 months). Similarly, there was no difference in response rate (67% v 74%; P = .38) or overall survival (HR, 0.82; 95% CI, 0.50 to 1.36; P = .44). Toxicity was greater with the combination: grade ≥ 3 adverse events related to treatment occurred in 72% of patients receiving afatinib plus cetuximab compared with 40% of those receiving afatinib alone, most commonly rash and diarrhea. Dose reductions were more common in patients receiving the combination, and 30% of patients in this arm discontinued cetuximab due to toxicity. At interim analysis, there was insufficient evidence to support continued accrual, and the trial was closed. CONCLUSIONS The addition of cetuximab to afatinib did not improve outcomes in previously untreated EGFR-mutant NSCLC, despite recognized activity in the acquired resistance setting.
Diagnostic endoscopic submucosal dissection with targeted tunnel to reach the suspect area first in order to diagnose muscular invasion and differentiate T1b from T2 cancers
Authors: Camille Meunier, Jérémie Jacques, Jérôme Rivory, Thomas Lambin, Thomas Walter, Thierry Ponchon, Mathieu Pioche
Journal: Endoscopy (2020)

Characterization of colorectal neoplasia with Kudo's [1] and Sano's patterns [2] distinguishes superficial neoplasia (submucosal invasion < 1000 μm) displaying Kudo Vi and/or Sano 3a patterns from deep invasive cancers (DIC) (> 1000 μm) that display Kudo Vn or Sano 3b patterns. Endoscopic submucosal dissection (ESD) is a curative treatment for T1 colorectal cancer with submucosal invasion when the tumor does not display budding, lymphovascular invasion and poorly differentiated components, but depth of invasion over 1000 μm is not an independent risk factor of lymph node metastasis [3]. This leads to a new challenge to distinguish lesions with deep submucosal invasion, which are potentially treatable with ESD, from T2 cancers, for which ESD is unfeasible and dangerous since the submucosa disappears below the lesion. Waiting for optical criteria, Japanese experts have proposed attempting ESD with diagnostic intent [4] to obtain, if successful, a precise pathology evaluation (risk factors) to guide further management.
Transmission Dynamics by Age Group in COVID-19 Hotspot Counties — United States, April–September 2020
Authors: Alexandra M. Oster, Elise Caruso, Jourdan DeVies, Kathleen P. Hartnett, Tegan K. Boehmer
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

CDC works with other federal agencies to identify counties with increasing coronavirus disease 2019 (COVID-19) incidence (hotspots) and offers support to state, tribal, local, and territorial health departments to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (1). Understanding whether increasing incidence in hotspot counties is predominantly occurring in specific age groups is important for identifying opportunities to prevent or reduce transmission. The percentage of positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results (percent positivity) is an important indicator of community transmission.* CDC analyzed temporal trends in percent positivity by age group in COVID-19 hotspot counties before and after their identification as hotspots. Among 767 hotspot counties identified during June and July 2020, early increases in the percent positivity among persons aged ≤24 years were followed by several weeks of increasing percent positivity in persons aged ≥25 years. Addressing transmission among young adults is an urgent public health priority.
Genome-Wide Association Study for Waldenström Macroglobulinemia Identifies Novel Susceptibility Loci
Authors: Mary L McMaster, Sonja I Berndt, Jianqing Zhang, Susan L Slager, Shengchao Li, Elizabeth E Brown, Karin Ekstrom-Smedby, Geffen Kleinstern, Bin Zhu, Charles Chung, Laurie Burdette, Ju-Hyun Park, Brenda M Birmann, Brian K Link, James McKay, Alain Monnereau, Lindsay M. Morton, Alexandra Nieters, Alex Smith, Roel Vermeulen, Henrik Hjalgrim, Claire Vajdic, Lauren Teras, Belynda Hicks, Nilanjan Chatterjee, Nathaniel Rothman, Kenneth Offit, James R. Cerhan, Joseph Vijai, Lynn R Goldin, Christine F Skibola, Neil E Caporaso
Journal: Blood (2017)
The metabolic enzyme pyruvate kinase M2 regulates platelet function and arterial thrombosis
Authors: Manasa K. Nayak, Madankumar Ghatge, Gagan D. Flora, Nirav Dhanesha, Manish Jain, Kathleen R. Markan, Matthew J. Potthoff, Steven R. Lentz, Anil K. Chauhan
Journal: Blood (2020)
Electronic patient-reported outcomes (ePRO) platform engagement in cancer patients during COVID-19.
Authors: Susan A Frailley, L. Johnetta Blakely, Leah Owens, Ashley Roush, Toni S. Perry, Veera Hellen, Natalie R. Dickson
Journal: Journal of Clinical Oncology (2020)

172 Background: Tennessee Oncology partnered with an ePRO platform solution to support patients during their cancer care journey. This cloud-based ePRO platform is designed to assist in improving the management of symptoms. Providing two core pieces of functionality allow both the patient and care teams to retrieve information quickly and communicate effectively. The patient portal is patient input driven and allows the patient to communicate with their care team, track symptoms, and access their health records via website or mobile app. The clinician portal provides multiple care teams the ability to manage and prioritize patient needs as well as communicate directly with patients. In March 2020, due to the pandemic, patients needed a convenient and remote way to communicate with the care team. Our communication plan had to be nimble and provide immediate updates to our large patient population. We leveraged our ePRO platform to meet this need. Methods: We focused efforts on increasing patient engagement by educating them on the benefits of this communication platform. We utilized secure messaging to send appointment details and for Telehealth visits a link to the visit was sent. We were able to provide weekly updates outlining our latest information regarding our safety protocols. Results: We noted an increase in the activation of patient accounts and patient-initiated messages in our ePRO platform. We saw an average of 1,000 new patient accounts activated each month during March, April and May. We saw that patient-initiated messages through the platform showed a 15% increase from February to March. The response rate for patients completing post-treatment questionnaires increased 8% from February to May. Conclusions: By providing patients with a single communication platform to contact their care teams outside of their office visits, patients become an active part of their care journey. As an organization, we continue to identify ways to connect our patients to their care team in a meaningful way through technology. Whether during normal business hours or after-hours, patients need a simple, reliable and consistent way to engage with their care team.
A post-traumatic painful deformity of the elbow
Authors: Tun Hing Lui, Xiaohua Pan
Journal: BMJ (2020)

A woman in her 60s fell on her partially extended right elbow, resulting in painful deformity of the elbow with a posterolateral dimple (fig 1). She was otherwise healthy.



Fig 1 
Deformity of the patient’s right elbow: dislocated radial head (a), olecranon (b), and tensed triceps tendon (c) resulting in a skin depression (d) just proximal to the radial head



On examination, she had no neurovascular deficit. She could not move her elbow because of severe pain in the joint and surrounding muscle guarding. The deformity was fixed (the elbow could not be flexed or extended). No bruising was visible around the elbow joint, which suggested that no substantial muscle tearing had occurred, and anteroposterior and lateral radiography (fig 2) showed no fractures. The …
Portable MRI—Coming to the ICU?
Authors: Jennifer Abbasi
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
Wildfires, Global Climate Change, and Human Health
Authors: Rongbin Xu, Pei Yu, Michael J. Abramson, Fay H. Johnston, Jonathan M. Samet, Michelle L. Bell, Andy Haines, Kristie L. Ebi, Shanshan Li, Yuming Guo
Journal: New England Journal of Medicine (2020)

Wildfires, Global Climate Change, and Human Health Wildfires are increasingly common and projected to worsen with climate change. Health consequences include burns and mental health effects, as wel...
Health outcomes of 1000 children born to mothers with inflammatory bowel disease in their first 5 years of life
Authors: Shannon Linda Kanis, Sanne Modderman, Johanna C Escher, Nicole Erler, Ruud Beukers, Nanne de Boer, Alexander Bodelier, Annekatrien C T.M Depla, Gerard Dijkstra, Anne-Baue Ruth Margaretha van Dijk, Lennard Gilissen, Frank Hoentjen, Jeroen M Jansen, Johan Kuyvenhoven, Nofel Mahmmod, Rosalie C Mallant-Hent, Andrea E van der Meulen-de Jong, Anahita Noruzi, Bas Oldenburg, Liekele E Oostenbrug, Pieter C.J. Ter Borg, Marieke Pierik, Mariëlle Romberg- Camps, Willem Thijs, Rachel West, Alison de Lima, C Janneke van der Woude
Journal: Gut (2020)

Objective The aim of this study was to describe the long-term health outcomes of children born to mothers with inflammatory bowel disease (IBD) and to assess the impact of maternal IBD medication use on these outcomes. Design We performed a multicentre retrospective study in The Netherlands. Women with IBD who gave birth between 1999 and 2018 were enrolled from 20 participating hospitals. Information regarding disease characteristics, medication use, lifestyle, pregnancy outcomes and long-term health outcomes of children was retrieved from mothers and medical charts. After consent of both parents, outcomes until 5 years were also collected from general practitioners. Our primary aim was to assess infection rate and our secondary aims were to assess adverse reactions to vaccinations, growth, autoimmune diseases and malignancies. Results We included 1000 children born to 626 mothers (381 (61%) Crohn’s disease, 225 (36%) ulcerative colitis and 20 (3%) IBD unclassified). In total, 196 (20%) had intrauterine exposure to anti-tumour necrosis factor-α (anti-TNF-α) (60 with concomitant thiopurine) and 240 (24%) were exposed to thiopurine monotherapy. The 564 children (56%) not exposed to anti-TNF-α and/or thiopurine served as control group. There was no association between adverse long-term health outcomes and in utero exposure to IBD treatment. We did find an increased rate of intrahepatic cholestasis of pregnancy (ICP) in case thiopurine was used during the pregnancy without affecting birth outcomes and long-term health outcomes of children. All outcomes correspond with the general age-adjusted population. Conclusion In our study, we found no association between in utero exposure to anti-TNF-α and/or thiopurine and the long-term outcomes antibiotic-treated infections, severe infections needing hospital admission, adverse reactions to vaccinations, growth failure, autoimmune diseases and malignancies.
알코올간질환 : 알코올간질환의 병태생리
Authors: 김인희
Journal: Clinical and Molecular Hepatology (2008)

Alcoholic liver disease (ALD) has a known etiology but a complex and incompletely known pathogenesis. Alcohol intake has been shown to increase the production of reactive oxygen species, lower cellular antioxidant levels, and enhance oxidative stress in many tissues, especially in the liver. Alcohol-induced oxidative stress plays a major role in the mechanisms by which ethanol produces liver injury. Kupffer cells activation by endotoxin via Toll-like receptor 4 is also involved in alcohol-induced liver injury. Oxidative mechanisms play a role in the progression of liver fibrosis by triggering the release of pro-fibrotic cytokines and activating collagen gene expression in hepatic stellate cells. Finally, immune responses towards antigens originating from the reactions of lipid peroxidation products with hepatic proteins might represent one of the mechanisms that contribute to perpetuate chronic hepatic inflammation in ALD.
Helen Salisbury: Climbing out of our silos
Authors: Helen Salisbury
Journal: BMJ (2020)

At the start of this pandemic, fear and uncertainty led to a "blitz spirit" of cooperation across the medical arena: we all needed to pull together or the good ship NHS would sink, taking us and our patients with it.Six months on, everyone is tired and fractious.Feeling overworked and underappreciated, many of us are looking over our shoulder for someone to blame.