tbuckley/cabot-search huggingface dataset:
US health system must change to meet needs of seriously ill patients, says Harvard forum
Authors: Janice Hopkins Tanne
Journal: BMJ (2018)

Health policies need to change to improve the lives of Americans with serious illness, healthcare advocates have said. Strategies must cater to the emotional needs of patients and carers, improve coordination of care, and evaluate social care needs, although others said that “systemic change” was required.

The comments were made at a forum set up to discuss the reasons why seriously ill patients in the United States face financial ruin despite having health insurance.1 The forum was organised by the T H Chan School of Public Health at Harvard University, the New York Times , and the Commonwealth Fund, a private foundation that advocates for comprehensive healthcare.

The forum grew out of a national survey of nearly 1500 US adults who had serious health problems, such as heart disease, cancer, diabetes, or stroke, had been admitted to …
Chronic GI bleeding in a middle-aged woman
Authors: Hiroki Kitamoto, Masashi Fukushima, Tetsuro Inokuma
Journal: Gut (2018)

Clinical presentation A middle-aged woman without any underlying systemic disease was referred to our hospital due to a 1-month history of recurrent black diarrhoea and anaemia. At presentation, her vital signs were stable and the physical examination was unremarkable except for pale conjunctiva. Laboratory tests showed iron-deficiency anaemia with a haemoglobin concentration of 7.3 g/dL (reference range, 11.1–15.1 g/dL). As she had no severe symptoms of anaemia, we administered oral iron preparations without blood transfusion and her anaemia was gradually corrected. Oesophagogastroduodenoscopy, colonoscopy and contrast-enhanced abdominal CT revealed no cause of bleeding, so obscure GI bleeding was suspected. Capsule enteroscopy revealed black fluid in the proximal small intestine, and subsequent peroral double-balloon enteroscopy detected a 1 cm diameter hemispheric elevated lesion at the upper jejunum (figure 1A, B). The lesion was non-pulsatile and hard in consistency, appearing as a submucosal tumour (SMT). An ulcer was located at the top of the lesion, suggesting the source of bleeding, although no blood clot was present around the site. Figure 1 Endoscopic findings of the jejunum on white light endoscopy (A) and chromoendoscopy with indigo carmine dye (B). Questions What is your diagnosis? Do you try to obtain biopsy specimens from this lesion?
Incidence Rates of Type 2 Diabetes in People With Impaired Fasting Glucose (ADA vs. WHO Criteria) and Impaired Glucose Tolerance: Results From an Older Population (KORA S4/F4/FF4 Study)
Authors: Bernd Kowall, Wolfgang Rathmann, Brenda Bongaerts, Oliver Kuss, Andreas Stang, Michael Roden, Christian Herder, Wolfgang Koenig, Cornelia Huth, Margit Heier, Barbara Thorand, Karl-Heinz Ladwig, Rolf Holle, Christa Meisinger, Annette Peters
Journal: Diabetes Care (2018)

The American Diabetes Association (ADA) Expert Committee introduced impaired fasting glucose (IFG: 100–125 mg/dL [5.6–6.9 mmol/L]) as a category with an increased risk for diabetes (1). The World Health Organization (WHO) defined a higher IFG cut point of 110 mg/dL (6.1 mmol/L) because using the lower cut point would substantially increase IFG prevalence and there was no evidence it would lead to reduced progression to diabetes (2).

Our aim was to estimate the long-term incidence of type 2 diabetes in people with isolated IFG (i-IFG), isolated impaired glucose tolerance (i-IGT), and combined IFG/IGT. Contrary to previous studies, we split IFG into two subcategories (i-IFGlow: 100 to <110 mg/dL; i-IFGhigh: 110 to <126 mg/dL) according to the ADA and WHO cut points. We used oral glucose tolerance test (OGTT) data from the Cooperative Health Research in the Region of Augsburg (KORA) S4/F4/FF4 cohort study collected on 1,231 participants without known diabetes aged 55–74 years at baseline (1999–2001) and in two follow-up examinations (2006–2008 and 2013–2014) (3). Incident type 2 diabetes was defined as fasting glucose ≥126 mg/dL, 2-h glucose ≥200 mg/dL, or a type 2 diabetes diagnosis confirmed by a physician. We included 913 people (74%) with an OGTT or physician-confirmed type 2 diabetes at one or both follow-up investigations. Participants who died after baseline were either excluded if no data on their glycemic status during follow-up were available or censored if these data were available at the first follow-up examination. The mean follow-up time was 10.2 years. Self-reported age at diabetes diagnosis was used for calculation of person-years with physician-diagnosed diabetes during follow-up. Person-years were from baseline to the earliest of diagnosis of diabetes or last study …
Outcomes of Patients with Limited-Stage Aggressive Large B-Cell Lymphoma with MYC Rearrangement with and without BCL2 and/or BCL6 Rearrangements: A Retrospective Analysis from 15 US Academic Centers
Authors: Shalin K. Kothari, Shaoying Li, L. Jeffrey Medeiros, Emily C. Ayers, Daniel J. Landsburg, David A. Bond, Kami J. Maddocks, Anshu Giri, Brian T. Hess, Luu Q. Pham, Ranjana Advani, Yang Liu, Stefan Klaus Barta, Julie M. Vose, Michael C. Churnetski, Jonathon B. Cohen, Madelyn Burkart, Reem Karmali, Joanna Zurko, Amitkumar Mehta, Adam J Olszewski, Sarah S Lee, Brian T. Hill, Timothy F. Burns, Frederick Lansigan, Emma Rabinovich, David Peace, Adrienne Groman, Kris Attwood, Francisco J. Hernandez-Ilizaliturri, Pallawi Torka
Journal: Blood (2018)
Low and Decreasing Prevalence and Rate of False Positive HIV Diagnosis — Chókwè District, Mozambique, 2014–2017
Authors: Daniel Shodell, Robert Nelson, Duncan MacKellar, Ricardo Thompson, Isabelle Casavant, Didier Mugabe, Sherri Pals, Dawud Ujamaa, Juvencio Bonzela, Judite Cardoso, Salvador Machava, Carlos Lourenço, Chunfu Yang, Bharat Parekh, Ishani Pathmanathan, Andrew F. Auld, Stelio Tamele, Manuel Antonio Ouane, Vania Macome, Noela Chicuecue, Guita Amane, Luciana Kohatsu, Nely Honwana, Stanley Wei, Peter R. Kerndt, Edgar Monterroso, Alfredo Vergara
Journal: MMWR Morbidity and Mortality Weekly Report (2018)

In 2017, rapid human immunodeficiency virus (HIV) testing services enabled the HIV diagnosis and treatment of approximately 15.3 million persons with HIV infection in sub-Saharan Africa with life-saving antiretroviral therapy (ART) (1). Although suboptimal testing practices and misdiagnoses have been reported in sub-Saharan Africa and elsewhere, trends in population burden and rate of false positive HIV diagnosis (false diagnosis) have not been reported (2,3). Understanding the population prevalence and trends of false diagnosis is fundamental for guiding rapid HIV testing policies and practices. To help address this need, CDC analyzed data from 57,655 residents aged 15-59 years in the Chókwè Health and Demographic Surveillance System (CHDSS) in Mozambique to evaluate trends in the rate (the percentage of false diagnoses among retested persons reporting a prior HIV diagnosis) and population prevalence of false diagnosis. From 2014 to 2017, the observed rate of false diagnosis in CHDSS decreased from 0.66% to 0.00% (p<0.001), and the estimated population prevalence of false diagnosis decreased from 0.08% to 0.01% (p = 0.0016). Although the prevalence and rate of false diagnosis are low and have decreased significantly in CHDSS, observed false diagnoses underscore the importance of routine HIV retesting before ART initiation and implementation of comprehensive rapid HIV test quality management systems (2,4,5).
Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period: randomised controlled trial
Authors: Frances Mason, Amanda Farley, Miranda Pallan, Alice Sitch, Christina Easter, Amanda J Daley
Journal: BMJ (2018)

Abstract Objective To test the effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period. Design Two group, double blinded randomised controlled trial. Setting Recruitment from workplaces, social media platforms, and schools pre-Christmas 2016 and 2017 in Birmingham, UK. Participants 272 adults aged 18 years or more with a body mass index of 20 or more: 136 were randomised to a brief behavioural intervention and 136 to a leaflet on healthy living (comparator). Baseline assessments were conducted in November and December with follow-up assessments in January and February (4-8 weeks after baseline). Interventions The intervention aimed to increase restraint of eating and drinking through regular self weighing and recording of weight and reflection on weight trajectory; providing information on good weight management strategies over the Christmas period; and pictorial information on the physical activity calorie equivalent (PACE) of regularly consumed festive foods and drinks. The goal was to gain no more than 0.5 kg of baseline weight. The comparator group received a leaflet on healthy living. Main outcome measures The primary outcome was weight at follow-up. The primary analysis compared weight at follow-up between the intervention and comparator arms, adjusting for baseline weight and the stratification variable of attendance at a commercial weight loss programme. Secondary outcomes (recorded at follow-up) were: weight gain of 0.5 kg or less, self reported frequency of self weighing (at least twice weekly versus less than twice weekly), percentage body fat, and cognitive restraint of eating, emotional eating, and uncontrolled eating. Results Mean weight change was −0.13 kg (95% confidence interval −0.4 to 0.15) in the intervention group and 0.37 kg (0.12 to 0.62) in the comparator group. The adjusted mean difference in weight (intervention−comparator) was −0.49 kg (95% confidence interval −0.85 to −0.13, P=0.008). The odds ratio for gaining no more than 0.5 kg was non-significant (1.22, 95% confidence interval 0.74 to 2.00, P=0.44). Conclusion A brief behavioural intervention involving regular self weighing, weight management advice, and information about the amount of physical activity required to expend the calories in festive foods and drinks prevented weight gain over the Christmas holiday period. Trial registration ISRCTN Registry ISRCTN15071781 .
Prevention and Management of Bleeding Episodes in Patients with Acquired Hemophilia A
Authors: Paul Knöbl
Journal: Drugs (2018)

Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies inhibiting the function of coagulation factor VIII. It is characterized by spontaneous bleeding in patients with no previous family or personal history of bleeding. Although several large registries have collected clinical data on AHA, limited information is available on the optimal management of AHA because controlled clinical trials are lacking. AHA can easily be diagnosed if the problem (prolonged activated partial thromboplastin time in a bleeding patient) is recognized. After the effects of anticoagulants are excluded, low factor VIII activity and the detection of circulating inhibitors confirms the diagnosis. However, lack of familiarity with this rare condition may delay diagnosis and adequate therapy. Treatment of AHA is based on measures for prompt hemostatic control to stop (and prevent) bleeding, immunosuppression to eradicate the autoantibodies, and supportive care for the adverse effects of that treatment and patients’ often complex comorbidities. This article gives a comprehensive overview of the current knowledge about the pathophysiology, diagnosis, and treatment of AHA.
In patients with chest pain, HEART Pathway–guided and usual care did not differ for MACE or health care use
Authors: Alexander T. Limkakeng, Christopher B. Granger
Journal: Annals of Internal Medicine (2018)

ACP Journal Club18 December 2018In patients with chest pain, HEART Pathway–guided and usual care did not differ for MACE or health care useAlexander T. Limkakeng, Jr, MD, Christopher B. Granger, MDAlexander T. Limkakeng, Jr, MDDuke University, Durham, North Carolina, United States (A.T.L., C.B.G.)Search for more papers by this author, Christopher B. Granger, MDDuke University, Durham, North Carolina, United States (A.T.L., C.B.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2018-169-12-069 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationStopyra JP, Riley RF, Hiestand BC, et al. The HEART Pathway randomized controlled trial one-year outcomes. Acad Emerg Med. 2018. [Epub ahead of print]. https://pubmed.ncbi.nlm.nih.gov/29920834Clinical Impact RatingsEmergency Med: Cardiology: References1 Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8:195-203. [PMID: 25737484] Google Scholar2 Nerenberg RH, Shofer FS, Robey JL, Brown AM, Hollander JE. Impact of a negative prior stress test on emergency physician disposition decision in ED patients with chest pain syndromes. Am J Emerg Med. 2007;25:39-44. [PMID: 17157680] Google Scholar3 Johnson TV, Rose GA, Fenner DJ, Rozario NL. Improving appropriate use of echocardiography and single-photon emission computed tomographic myocardial perfusion imaging: a continuous quality improvement initiative. J Am Soc Echocardiogr. 2014;27:749-57. [PMID: 24726335] Google Scholar4 Schaffer JT, Hess EP, Hollander JE, et al. Impact of a shared decision making intervention on health care utilization: a secondary analysis of the chest pain choice multicenter randomized trial. Acad Emerg Med. 2018;25:293-300. [PMID: 29218817]. Google Scholar5 Pickering JW, Than MP, Cullen L, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med. 2017;166:715-24. [PMID: 28418520] Google Scholar Author, Article, and Disclosure InformationAffiliations: Duke University, Durham, North Carolina, United States (A.T.L., C.B.G.)This article was published at Annals.org on 4 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 December 2018Volume 169, Issue 12Page: JC69KeywordsDecision makingEmergency departmentHealth careHeartHospitalizationsIschemiaMortalityMyocardial infarctionTroponin ePublished: 18 December 2018 Issue Published: 18 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Significantly Improved Long Term Health Related Quality of Life (HRQL) and Neurocognition Following Familial Haploidentical Stem Cell Transplantation (HISCT) Utilizing CD34 Enrichment and Mononuclear (CD3) Addback in High Risk Patients with Sickle Cell Disease (SCD)
Authors: Mitchell Cairo, Susan K Parsons, Suzanne Braniecki, Julie-An Talano, Theodore B Moore, Qiuhu Shi, Carolyn A. Keever-Taylor, Rona Singer Weinberg, Brenda J. Grossman, Allen J Dozor, Deborah Friedman, Robert C McKinstry, James Verbsky, Chitti R Moorthy, Ruth Ann Weidner, Angie Mae Rodday, Janet Ayello, Mildred Semidei-Pomales, Allyson M. Flower, Yaya Chu, Erin Morris, Harshini Mahanti, Sandra Fabricatore, Olga Militano, Liana Klejmont, Carmella van de Ven, Lee Ann Baxter-Lowe, Elliott Vichinsky, Mark C. Walters, Shalini Shenoy
Journal: Blood (2018)
Circulating RNAs in advanced colorectal cancer patients reveal increased expression of PD-1 with conventional CRC therapy
Authors: M. Nasrullah, M.A. Bakhrebah, M.A. Hassan, A. Alghamdi, W.H. Abdulaal, M.A. Zamzami, A.A.-G. Ghafari, M.I. Khan, H. Choudhry
Journal: Annals of Oncology (2018)

Background: Colorectal cancer (CRC) is the third most diagnosed cancer among men and second among women globally. Generally, with age, the risk of this cancer grows and is happened by various genetic alterations. The immune system plays an important role against CRC and that provides a new means to CRC therapy. Our research is focused on the relative expression level of ten different immune genes namely IFNγ, CD 273, CD274, PD-1, β2M, CD3e, CD28, HLA-A, ICAM 1, and CTLA 4 which are known to play important role in immune regulation during different cancers. We hypothesize that the expression of the above-mentioned genes will be altered during CRC and therapy will promote the expression of genes involved in the activation of immune system. Methods: RNA was extracted from the whole blood sample of CRC patient (n = 50) and normal (n = 34) volunteers. Then cDNA was synthesized, and RNase inhibitor was used. Specific primers for all these genes were designed. Later, RT-qPCR has been done using SYBR® green master mix. Patient demographics were also recorded. All tested genes have been normalized to a housekeeping gene, RPL11. Values of relative expression for all genes were calculated using REST 2009 software. Results: Among screened genes, CD 273, CD274, and CTLA 4 were not expressed while, IFNγ, PD-1, β2M, CD3e, CD28, HLA-A, and ICAM 1 found expressed in CRC. After comparing the gene expression of advanced CRC patients with normal control, PD-1 found upregulated (P < 0.045). Clinicopathological correlation revealed PD-1 is highly expressed (P < 0.001) in advance stage of CRC patients upon treatment with both chemotherapy and immunotherapy (capecitabine, oxaliplatin, irinotecan hydrochloride, folinic acid, fluorouracil, and bevacizumab). Conclusions: Our study indicates significant induction of PD-1 at the advanced stage of CRC and during therapy. It suggests that conventional therapies for CRC must be modulated and/or a combination of therapy with anti PD-1 drug should be conducted for the better clinical outcome of CRC. Legal entity responsible for the study: Cancer and Mutagenesis Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia. Funding: King Abdulaziz City for Science and Technology. Disclosure: All authors have declared no conflicts of interest.
Post-Transplant Cyclophosphamide Versus Antithymocyte Globulin in Patients with Acute Myeloid Leukemia Undergoing Allogeneic Stem Cell Transplantation from One Antigen HLA-Mismatched Donors: A Retrospective Analysis from the Acute Leukemia Working Party of the EBMT
Authors: Giorgia Battipaglia, Myriam Labopin, Kroger Nicolaus, Antonin Vitek, Boris Afanasiev, Inken Hilgendorf, Johannes Schetelig, Arnold Ganser, Didier Blaise, Maija Itälä-Remes, Jakob R. Passweg, Francesca Bonifazi, Jürgen Finke, Annalisa Ruggeri, Arnon Nagler, Mohamad Mohty
Journal: Blood (2018)
Abstract P107: Small Dense Low Density Lipoprotein Subfractions are Independently Associated with Subclinical Atherosclerosis: The ELSA-Brasil study
Authors: Marcio S Bittencourt, Raul D Santos, Henrique Staniak, Steven Jones, Seth S Martin, Peter Toth, Michael J Blaha, Isabela Bensenor, Paulo A Lotufo
Journal: Circulation (2016)

Introduction: Low-density lipoproteins (LDL) are established risk factors for cardiovascular disease and a therapy target. Prior studies suggest that among the pool of plasma LDL, the small and dense subfractions are more strongly associated with risk. In the present study, we investigated whether LDL particle density is associated with the presence of subclinical atherosclerosis detected by coronary artery calcium score. Methods: We included 2869 (50.3±8.5 years, 54% women) participants from the ELSA-Brasil study who had no prior history of CVD, were not currently using lipid-lowering medications, and underwent CAC evaluation. We measured the fasting lipoprotein cholesterol fractions (in mg/dL) using the vertical auto profile (VAP) ultracentrifugation method. We analyzed the independent predictive values of LDL-1, LDL-2, LDL-3 and LDL-4, as well as the ln transformed ratio of small and dense (LDL-3 and LDL-4) to larger and more buoyant LDL particles (LDL-1 and LDL-2) (LLDR (Logarithmic of LDL Density Ratio)) using logistic regression. Results: Overall 749 (26%) of the participants had a CAC &gt;0, and 241 (8.1%) had a CAC &gt; 100. The mean LDL-1, LDL-2, LDL-3 and LDL-4 cholesterol were respectively (mg/dL): 22.5±9.4, 32.7±17.9, 47.1±20.4 and 10.4±10.8. Individuals with CAC&gt;0 had higher LDL-1, LDL-3 and LDL-4, but LDL-2 was not significantly different between groups. LLDLR was also significantly higher in those with CAC&gt;0. LLDR was associated with CAC&gt;0 even after multivariable adjustment for age, gender, smoking, diabetes, hypertension, systolic blood pressure and Friedwald LDL-cholesterol. (p&lt;0.01). Conclusion: In a large cohort of asymptomatic individuals, the ratio of small and dense to larger buoyant LDL-C particles is associated with CAC score. This association is independent and complementary to the calculated LDL-cholesterol levels.
Abstract 19025: Management and Outcomes of Acute Coronary Syndromes in Developing Countries: A Systematic Review
Authors: Jennifer A. Rymer, Fawaz Alenezi, Salim Virani, Zainab Samad
Journal: Circulation (2017)

Introduction: Cardiovascular disease is the leading cause of death among adults in developing countries. However, a comprehensive assessment of acute coronary syndrome (ACS) care is lacking. We per...
Acute respiratory failure in immunocompromised adults
Authors: Elie Azoulay, Djamel Mokart, Achille Kouatchet, Alexandre Demoule, Virginie Lemiale
Journal: The Lancet Respiratory Medicine (2018)

Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undetermined cause, a standardised diagnostic investigation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.
Infusion of third-party mesenchymal stromal cells after kidney transplantation: a phase I-II, open-label, clinical study
Authors: Pauline Erpicum, Laurent Weekers, Olivier Detry, Catherine Bonvoisin, Marie-Hélène Delbouille, Céline Grégoire, Etienne Baudoux, Alexandra Briquet, Chantal Lechanteur, Gianni Maggipinto, Joan Somja, Hans Pottel, Frédéric Baron, François Jouret, Yves Beguin
Journal: Kidney International (2018)