tbuckley/cabot-search huggingface dataset:
Adjunctive Psychotherapy for Bipolar Disorder
Authors: David J. Miklowitz, Orestis Efthimiou, Toshi A. Furukawa, Jan Scott, Ross McLaren, John R. Geddes, Andrea Cipriani
Journal: JAMA Psychiatry (2020)

Several psychotherapy protocols have been evaluated as adjuncts to pharmacotherapy for patients with bipolar disorder, but little is known about their comparative effectiveness.To use systematic review and network meta-analysis to compare the association of using manualized psychotherapies and therapy components with reducing recurrences and stabilizing symptoms in patients with bipolar disorder.Major bibliographic databases (MEDLINE, PsychInfo, and Cochrane Library of Systematic Reviews) and trial registries were searched from inception to June 1, 2019, for randomized clinical trials of psychotherapy for bipolar disorder.Of 3255 abstracts, 39 randomized clinical trials were identified that compared pharmacotherapy plus manualized psychotherapy (cognitive behavioral therapy, family or conjoint therapy, interpersonal therapy, or psychoeducational therapy) with pharmacotherapy plus a control intervention (eg, supportive therapy or treatment as usual) for patients with bipolar disorder.Binary outcomes (recurrence and study retention) were compared across treatments using odds ratios (ORs). For depression or mania severity scores, data were pooled and compared across treatments using standardized mean differences (SMDs) (Hedges-adjusted g using weighted pooled SDs). In component network meta-analyses, the incremental effectiveness of 13 specific therapy components was examined.The primary outcome was illness recurrence. Secondary outcomes were depressive and manic symptoms at 12 months and acceptability of treatment (study retention).A total of 39 randomized clinical trials with 3863 participants (2247 of 3693 [60.8%] with data on sex were female; mean [SD] age, 36.5 [8.2] years) were identified. Across 20 two-group trials that provided usable information, manualized treatments were associated with lower recurrence rates than control treatments (OR, 0.56; 95% CI, 0.43-0.74). Psychoeducation with guided practice of illness management skills in a family or group format was associated with reducing recurrences vs the same strategies in an individual format (OR, 0.12; 95% CI, 0.02-0.94). Cognitive behavioral therapy (SMD, -0.32; 95% CI, -0.64 to -0.01) and, with less certainty, family or conjoint therapy (SMD, -0.46; 95% CI, -1.01 to 0.08) and interpersonal therapy (SMD, -0.46; 95% CI, -1.07 to 0.15) were associated with stabilizing depressive symptoms compared with treatment as usual. Higher study retention was associated with family or conjoint therapy (OR, 0.46; 95% CI, 0.26-0.82) and brief psychoeducation (OR, 0.44; 95% CI, 0.23-0.85) compared with standard psychoeducation.This study suggests that outpatients with bipolar disorder may benefit from skills-based psychosocial interventions combined with pharmacotherapy. Conclusions are tempered by heterogeneity in populations, treatment duration, and follow-up.
Metronomic oral vinorelbine in a real-world population of advanced non-small cell lung cancer patients
Authors: Fernanda Estevinho, Rita Gomes, Direndra Hasmucrai, Fernando Barata
Journal: Pulmonology (2020)

An increasing body of evidence from clinical trials and real-world studies suggests that metronomic oral vinorelbine (VNR) is a promising treatment option for elderly and unfit advanced non-small cell lung cancer (NSCLC) patients. The aim of this multicenter study was to present real-world data about the experience in treatment of NSCLC with metronomic VNR in Portugal. Retrospective data from NSCLC patients not eligible for conventional chemotherapy or tyrosine kinase inhibitors who received oral metronomic VNR irrespective of treatment line and dose was retrieved from 19 Portuguese Oncology Centers between 2016 and 2018. A total of 293 patients were included, with a median of 76 (39 − 94) years; 71% were ≥70 years old. Patients had a median of 3 comorbidities and predominantly (61%) ECOG PS 2. Most (42%) received metronomic oral VNR as first-line treatment. Overall response rate was 18%, with 42 (18%) partial and no (0%) complete responses. A total of 54% of patients experienced stable disease and 28% of patients, disease progression. Disease control rate was 72%. Patients were a median of 4 (1 − 40) months on treatment. Treatment discontinuation was observed in 90%, mostly (67%) due to disease progression, followed by death (16%). Adverse events leading to treatment discontinuation were only reported in 5% of patients. Female gender (HR 0.601, 95% CI 0.434 − 0.832; p = 0.002) and ECOG PS 1 (HR 0.625, 95% CI [0.443 − 0.881]; p = 0.007) were significantly associated with a lower risk of metronomic oral VNR discontinuation. Overall, 21% of patients experienced G3/4 toxicity. The present real-world results agree with what has been previously reported by other international Centers and support the concept that metronomic scheduling is a relevant and safe approach to treat advanced NSCLC patients.
A provider-focused, point-of-care technology to improve clinical trial accrual.
Authors: Sidharth Anand, Sarah Marie Larson, Katrina Fischer, John A. Glaspy
Journal: Journal of Clinical Oncology (2020)

309 Background: Low accrual to clinical trials is a significant burden to advancing research efforts, particularly detrimental to patients who may benefit clinically from enrollment in a promising trial. Low accrual has been linked to a lack of provider awareness of clinical trials at the point of care and current technology solutions have not adequately addressed this important issue. Methods: We aimed to develop a system to improve clinical trial access for patients throughout UCLA Hematology-Oncology through the development of a point of care web-based tool to allow providers to easily identify available clinical trials for their patients. First, we built a comprehensive database of current clinical trials at UCLA, with special emphasis on streamlined exclusion/inclusion criteria. We incorporated this database into a front-end web and mobile-responsive tool with a user-friendly interface allowing users to rapidly identify patients eligible for clinical trial enrollment. We launched this tool 1/15/2019 to 56 oncologists at UCLA Health. Results: From 1/15/19 to 6/14/19 we had had a total of 713 unique logins to the clinical trials website. This included “academic oncologists,” those oncologists specializing in a particular disease sub-type and often a ‘hub’ for clinical trials, with an average of 6.4 logins per oncologist, and “community oncologists” with an average of 18.8 logins per oncologist over that time frame. A brief survey of users who logged in over 4 times during that time revealed that on average, 4-5 additional patients per user were screened for clinical trials not previously identified. Conclusions: Clinical trial accrual can be enhanced through improved provider awareness of available trials at the point-of-care. A well-designed user interface with features to help facilitate provider navigation to available trials and quick inclusion and exclusion criteria were critical to the success of the tool. Although the web-based tool achieved its primary purpose in improving clinical trial awareness, its utility diminished over time due to the lack of real-time updates of trial data. Based on provider feedback, if the available trial data can be updated and maintained on a regular basis, this can be a valuable tool to improve clinical trial awareness and subsequently, accrual.
Managing outpatient oncology visits during COVID-19 pandemic: Addressing patients' concerns and precautionary measures.
Authors: Nashmia Al Mutairi, Mohammad Al Harbi, Hussam Shehata, Noridayu Mohammed Rashid, Abdul-Rahman Jazieh
Journal: Journal of Clinical Oncology (2020)

35 Background: Implementation of precautionary measures in response to COVID-19 pandemic involve patients pre-visit screening of patients to detect any potential risk of infection and proper patient flow to the clinic and adherence to social distancing. Our study evaluates our center experience with the pre-visit screening calls and plans to optimize the process. Methods: As precautionary measure to COVID-19 pandemic, all patients scheduled for oncology outpatient visit were called by a nurse to screen them for any acute respiratory infection (ARI) and triage their visit into physical visit or virtual visit. Patients with high ARI score were directed for proper isolation and COVID-19 testing process and recommended to have virtual clinic visit with their oncologists. Those who have low ARI score and require in person clinic visit receive confirmation of appointment during the call with visit instructions. A tally of all responses and decision were maintained for process monitoring. Results: Between March 23, and June 13, 2020, 1,905 patients had pre-visit screening calls. Nurses could not reach 82 (4%) patients and 23 patients expired per family member report. Out of 1800 patients who responded to call, 1392 (77 %) had confirmed physical appointment, 179 (10%) switched to virtual appointments. Sixteen out of the 19 patients who have high ARI score have swab done. All patients were tracked to assure proper management of their symptoms and continuity of oncological care. A total of 229 (12.7%) patients refused to come due to COVID-19 concerns and all were rescheduled based on primary oncologists decision. A quality improvement project was initiated to understand the concerns of patients who refused to come and address them properly. Conclusions: Pre-visit screening call is a critical intervention, not just in assuring adherence to infection control measures, but in identifying patients concerns and addressing them. There is a need for implementation of updated patient education and awareness approach about the risk of COVID-19 infection and the importance of adherence to their cancer treatment plans.
What Is the Association Between Depression and Cardiovascular Disease?
Authors: ChunHei Li, Timothy Woo, Sashiananthan Ganesananthan
Journal: JAMA Psychiatry (2020)

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Implementing clinic to home telehealth services to promote quality of life for ambulatory oncology palliative care patients.
Authors: Megan Begnoche, Dana Guyer, Susan F. Korber, Mary Anne Fenton
Journal: Journal of Clinical Oncology (2020)

259 Background: The Lifespan Cancer Institute (LCI) identified strategies to improve the palliative care experience and outcomes by providing clinic to home telehealth services. LCI is an integrated academic medical center program combining three hospital programs operating at five outpatient sites. One quality goal is to embed and increase palliative care within the fabric of oncology by providing palliative telehealth in the home to avoid office visits, ED and hospital admissions. Methods: LCI’s multidisciplinary palliative care team, including administrators, physicians, advanced practice providers and community partner physicians assessed telehealth challenges with a vulnerable patient in the home setting. Process development included operations, technology, patient and staff education. The group modified existing Lifespan system workflows, clinic to clinic video for behavioral health and clinic to clinic for providers, to create the clinic to home method. This process benchmarked patient and behavioral health noting video differences with the clinic setting versus the home. Results: Outcome metrics include no show rate, chemotherapy within 14 days of death, ED/ICU within 30 days of death, patient and provider experience. Initial data shows no show rates decreased from 10% (January) to 6% (May) as telehealth increased. Patients marked deceased within 3 months of a LCI visit for January (n = 52) and May ( = 61) unfortunately did not have a negative trend for chemotherapy in the last 14 days of life (Jan: 8%, May 15%). ED and ICU visits both had modest decreases from January (ED 50%, ICU 29%) to May (ED 48%, ICU 21%). In anticipation of future Press Ganey results, patient feedback includes an increase of comfort while at home. Provider satisfaction increased with the ability to assess the patient in their own home instead of the sterile clinic environment. Encountered challenges include insurance restrictions for Rhode Island (not a rural state), technology, and remote trouble shooting. Conclusions: The success of clinic-to-home telehealth services set the foundation for the COVID-19 telehealth insurgence and led to the palliative team acting as role models to medical and radiation oncology. End of life oncology patients stayed home while having their palliative needs addressed remotely. The innovative approach to implementing telehealth services will serve as a model for future LCI telehealth programs including treatment education sessions, oral chemotherapy follow-up, survivorship and post hospital discharge assessments.
Pathogenic variants in actionable MODY genes are associated with type 2 diabetes
Authors: Amélie Bonnefond, Mathilde Boissel, Alexandre Bolze, Emmanuelle Durand, Bénédicte Toussaint, Emmanuel Vaillant, Stefan Gaget, Franck De Graeve, Aurélie Dechaume, Frédéric Allegaert, David Le Guilcher, Loïc Yengo, Véronique Dhennin, Jean-Michel Borys, James T. Lu, Elizabeth T. Cirulli, Gai Elhanan, Ronan Roussel, Beverley Balkau, Michel Marre, Sylvia Franc, Guillaume Charpentier, Martine Vaxillaire, Mickaël Canouil, Nicole L. Washington, Joseph J. Grzymski, Philippe Froguel
Journal: Nature Metabolism (2020)
Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.
Authors: Atul Batra, Shiying Kong, Rodrigo Rigo, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2020)

90 Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as &lt;46000 CAD/annum; low education was defined as a neighborhood in which &lt;80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P &lt; .001) and those with low income (30.4% vs 25.9%,P &lt; .001) or low educational attainment (30.7% vs 27.6%,P &lt; .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P &lt; .001), low income (OR,1.17;95%CI,1.12-1.21;P &lt; .001) and low education (OR,1.08;95%CI,1.04-1.11;P &lt; .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]
Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort
Authors: Tracey G Simon, Bjorn Roelstraete, Hamed Khalili, Hannes Hagström, Jonas F Ludvigsson
Journal: Gut (2020)

Objective Population-based data are lacking regarding the risk of overall and cause-specific mortality across the complete histological spectrum of non-alcoholic fatty liver disease (NAFLD). Design This nationwide, matched cohort study included all individuals in Sweden with biopsy-confirmed NAFLD (1966 to 2017; n=10 568). NAFLD was confirmed histologically from all liver biopsies submitted to Sweden’s 28 pathology departments, after excluding other etiologies of liver disease, and further categorised as, simple steatosis, non-fibrotic steatohepatitis (NASH), non-cirrhotic fibrosis and cirrhosis. NAFLD cases were matched to ≤5 general population comparators by age, sex, calendar year and county (n=49 925). Using Cox regression, we estimated multivariable-adjusted HRs (aHRs) and 95% CIs. Results Over a median of 14.2 years, 4,338 NAFLD patients died. Compared with controls, NAFLD patients had significantly increased overall mortality (16.9 vs 28.6/1000 PY; difference=11.7/1000 PY; aHR=1.93, 95% CI=1.86 to 2.00). Compared with controls, significant excess mortality risk was observed with simple steatosis (8.3/1000 PY, aHR=1.71, 95% CI=1.64 to 1.79), non-fibrotic NASH (13.4/1000 PY, aHR=2.14, 95% CI=1.93 to 2.38), non-cirrhotic fibrosis (18.4/1000 PY, aHR=2.44, 95% CI=2.22 to 2.69) and cirrhosis (53.6/1000 PY, aHR=3.79, 95% CI=3.34 to 4.30)(p trend &lt;0.01). This dose-dependent gradient was similar when simple steatosis was the reference (p trend &lt;0.01). The excess mortality associated with NAFLD was primarily from extrahepatic cancer (4.5/1000 PY, aHR=2.16, 95% CI=2.03 to 2.30), followed by cirrhosis (2.7/1000 PY, aHR=18.15, 95% CI=14.78 to 22.30), cardiovascular disease (1.4/1000 PY, aHR=1.35, 95% CI=1.26 to 1.44) and hepatocellular carcinoma (HCC) (1.2/1000 PY, aHR=11.12, 95% CI=8.65 to 14.30). Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.
Abstract 15864: ICU Utilization in Stable ST-segment Elevation Myocardial Infarction Patients Treated With Rapid Reperfusion: A Report From ACTION Registry
Authors: Jay S Shavadia, Anita Y Chen, Alexander C Fanaroff, Laine Thomas, James de Lemos, Michael C Kontos, Tracy Y Wang
Journal: Circulation (2017)

Introduction: Rapid reperfusion for ST-elevation myocardial infarction (STEMI) reduces the risk of adverse cardiovascular events. In an era of rapid primary percutaneous coronary intervention (PCI)...
Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy With the Detection of Anti-GM3 and Anti-GM4 IgG Antibodies, Masquerading as Brown-Sequard Syndrome
Authors: Zhi-Hua Zhou, Qing-Yun Yu, Ming-Fan Hong
Journal: JAMA Neurology (2020)

This article describes a woman with a disease that was initially diagnosed as Brown-Sequard syndrome but later shown to be glial fibrillary acidic protein astrocytopathy involving anti-GM3 and anti-GM4 IgG antibodies.
Thoracic cancers international COVID-19 collaboration (TERAVOLT): Small-cell lung cancer andother rare thoracic malignancies
Authors: A. Cortellini, A. M. C. Dingemans, O. Arrieta, J. Baena, M. Brighenti, E. Felip, M. C. Garassino, P. Garrido, C. Genova, F. Grosso, L. Horn, L. C. Huang, J. Van Meerbeeck, S. Peters, E. Nadal, J. Rogado, Y. Shyr, M. Tiseo, V. Torri, A. Trama, H. Wakelee, J. G. Whisenant, G. Viscardi, F. Barlesi, S. Popat
Journal: Clinical Cancer Research (2020)

Background: At the last update of the TERAVOLT registry, patients with thoracic malignancies and COVID-19showed a high mortality rate (35 5% overall and 31% due to COVID-19) compared to the general population and toother solid tumors  Major determinants of mortality were age, Eastern Cooperative Oncology Group PerformanceStatus (ECOG-PS), and previous administration of chemotherapy  No cancer-specific data are available with respectto small-cell lung cancer (SCLC) and other rare thoracic malignancies  Methods: TERAVOLT is an international, multicenter observational registry launched to collect data on patients withthoracic malignancies diagnosed with COVID-19 infection  Risk factors for hospitalization and mortality wereidentified by Wilcoxon rank sum tests (continuous variables) or χ2 tests (categorical variables)  Here we present thesubgroup analyses of SCLC and other rare thoracic malignancies, including malignant pleural mesothelioma (MPM), thymic carcinoma/thymoma, and carcinoid/neuroendocrine lung tumors  Results: As of June 4th, 2020, a total of 581 patients with COVID-19 and thoracic cancers have been entered;among them, 66 (11%) were SCLC, 22 (4%) were MPM, 18 (3%) were thymic carcinoma/thymoma, 12 (2%) werecarcinoid/neuroendocrine lung tumors, and 442 (76%) NSCLC;21 were an unknown type  Among SCLC patients,54% were > 65 years old, 56% were males, 98% were current/former smokers, 31% had an ECOG-PS ≥ 2, 67%had stage IV disease, 82% were on current oncologic treatment at the COVID-19 diagnosis, and 58% werereceiving chemotherapy alone or in combination with immune checkpoint inhibitors  Among other non-NSCLCpatients, 56% were > 65 years old, 56% were males, 69% were current/former smokers, 24% had an ECOG-PS ≥ 2,50% had stage IV disease, 52% were on current oncologic treatment at the COVID-19 diagnosis, and 37% werereceiving chemotherapy alone or in combination with immune checkpoint inhibitors  Overall, 79 7% of the patientsrequired hospitalization, 15 4% were admitted to an ICU, and 39 8% died (36 2% due to COVID-19)  Among SCLCpatients, 74 2% required hospitalization, 14 3% were admitted to an ICU, and 42 2% died (37 5% due to COVID-19) Among SCLC patients, age > 65 years old (p=0 81), gender (p=0 71), smoking status (p=1 0), ECOG-PS ≥2(p=0 17), disease stage of IV (p=0 37), and having received chemotherapy alone or with checkpoint inhibitors(p=0 84) were not associated with mortality  Conclusions: This analysis confirmed that patients with thoracic malignancies have a high mortality and risk forhospitalization due to COVID-19 overall  SCLC patients showed the highest mortality rate among thoracic cancerpatients
Dual-branch combination network (DCN): Towards accurate diagnosis and lesion segmentation of COVID-19 using CT images
Authors: Kai Gao, Jianpo Su, Zhongbiao Jiang, Ling-Li Zeng, Zhichao Feng, Hui Shen, Pengfei Rong, Xin Xu, Jian Qin, Yuexiang Yang, Wei Wang, Dewen Hu
Journal: Medical Image Analysis (2020)