tbuckley/cabot-search huggingface dataset:
Standard of Care: Reasonable But Not Perfect
Authors: Rita Suri, Donna Kanar Socol, Michael Gitlin
Journal: American Journal of Psychiatry (2020)

A" was a 30-year-old married Hispanic woman with four children who had a diagnosis of schizoaffective disorder.Her history was significant for multiple psychiatric hospitalizations, including one in her early 20s, one shortly after the birth of her third child, and four recent admissions for symptoms of mood instability, auditory hallucinations, agitation, suicidal ideation, and threats of harming her children and husband.On multiple occasions, Ms.A was brought to the emergency department by the police after her husband reported that she was feeling suicidal, homicidal, and paranoid.The Department of Children and Family Services had been contacted because of concern about the safety of the children.Ms. A's treatment history included pharmacotherapy with fluoxetine, paroxetine, haloperidol, risperidone, olanzapine, fluphenazine, and propranolol.She reported that haloperidol caused fatigue, restlessness, and difficulty thinking.She had also been treated with haloperidol decanoate because of poor medication adherence.Her past history was significant for a suicide attempt with an overdose of "protein pills" while pregnant with her third child.After her most recent psychiatric hospitalization, Ms.A was followed in an outpatient rehabilitation clinic by a multimodal treatment team that met weekly and included a second-year psychiatry resident (Dr.P), an attending psychiatrist, a psychologist (Dr.M), and a nurse.As a resident, Dr. P had the responsibility of formulating and documenting treatment decisions regarding patient care and informing the attending psychiatrist, with whom he met on a weekly basis for individual supervision, of these decisions.Ms. A continued to display symptoms of hypomania, disorganization, and difficulty managing her children.Dr. P obtained a consultation from a Spanish-speaking attending who determined that Ms. A's ability to comprehend English was sufficient for communication about her ongoing care and recommended treatment with either valproic acid or lithium.Because of the atypical features of her illness, Dr. P selected valproic acid.After discussing the risks, including teratogenicity, with continued
Prevalence of asthma in patients with atopic dermatitis: A systematic review and meta-analysis
Authors: Nanna Ravnborg, Danni Ambikaibalan, Gaurav Agnihotri, Shmuel Price, Supriya Rastogi, Kevin R. Patel, Vivek Singam, Yuki Andersen, Anne-Sofie Halling, Jonathan I. Silverberg, Alexander Egeberg, Jacob P. Thyssen
Journal: Journal of the American Academy of Dermatology (2020)
Dementia: US recommends against screening over 65s because of insufficient evidence
Authors: Ingrid Torjesen
Journal: BMJ (2020)

The US Preventive Services Task Force has recommended against screening people aged over 65 for mild to moderate cognitive impairment, saying that the evidence is insufficient to assess the balance of its benefits and harms.1

This advice is line with the task force’s 2014 recommendations,2 as well as last year’s UK National Screening Committee recommendations against systematic population screening for dementia.3

Despite the lack of evidence to support screening, Medicare, the US national health insurance programme, added detection of cognitive impairment to its annual wellness visit in 20114 and has continued to back it despite the 2014 advice.2

In England, dementia screening was introduced by the back door in October 2014 after the UK National Screening Committee also advised against it. GPs were paid £55 (€66; $71) …
International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))
Authors: Roald Bahr, Ben Clarsen, Wayne Derman, Jiri Dvorak, Carolyn A Emery, Caroline F Finch, Martin Hägglund, Astrid Junge, Simon Kemp, Karim M Khan, Stephen W Marshall, Willem Meeuwisse, Margo Mountjoy, John W Orchard, Babette Pluim, Kenneth L Quarrie, Bruce Reider, Martin Schwellnus, Torbjørn Soligard, Keith A Stokes, Toomas Timpka, Evert Verhagen, Abhinav Bindra, Richard Budgett, Lars Engebretsen, Uğur Erdener, Karim Chamari
Journal: British Journal of Sports Medicine (2020)

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
Update on KEYNOTE-199, cohorts 1-3: Pembrolizumab (pembro) for docetaxel-pretreated metastatic castration-resistant prostate cancer (mCRPC).
Authors: Emmanuel S. Antonarakis, Josep M. Piulats, Marine Gross-Goupil, Jeffrey C. Goh, Ulka N. Vaishampayan, Ronald De Wit, Tuomo Alanko, Satoshi Fukasawa, Kenichi Tabata, Susan Feyerabend, Raanan Berger, Helen Wu, Jeri Kim, Charles Schloss, Johann S. De Bono
Journal: Journal of Clinical Oncology (2020)

104 Background: The KEYNOTE-199 multicohort phase 2 study (NCT02787005) showed that pembro monotherapy has antitumor activity and acceptable safety in patients (pts) with mCRPC previously treated with a next-generation hormonal agent (NHA) and docetaxel in cohort 1 (C1) (RECIST-measurable, PD-L1 + disease), C2 (RECIST-measurable, PD-L1 − disease), and C3 (bone-predominant disease, irrespective of PD-L1). Updated results with additional follow-up for C1-3 are presented. Methods: Pts previously received ≥1 NHAs and 1 or 2 chemotherapies, including docetaxel. Pts received pembro 200 mg Q3W for 35 cycles or until progression or intolerable toxicity. Primary end point was ORR. Key secondary end points were DCR, DOR, PSA (≥50%) response rate, rPFS, OS, and safety. Results: Of 258 pts enrolled (C1=133; C2=67; C3=58), 6 completed (C1=4; C3=2) and 252 discontinued (C1=129; C2=67; C3=56) therapy, primarily due to progression (C1=106; C2=61; C3=45). Median follow-up was 9.6 mo (C1, 9.5; C2, 7.9; C3, 14.2). ORR (95% CI) for pts with measurable disease was 6% (2.6-11.5) in C1 and 3% (0.4-10.4) in C2 (Table; includes other efficacy results). Treatment-related AEs of any grade/grade 3-5 occurred in 57%/16% in C1, 60%/15% in C2, and 71%/17% in C3. 1 pt in each cohort died of a treatment-related AE (C1, sepsis; C2, unknown; C3, immune-related pneumonitis). Conclusions: With additional follow-up, pembro monotherapy continued to show antitumor activity and disease control in pts with RECIST-measurable and bone-predominant mCRPC previously treated with both NHA and docetaxel. Pts experienced durable responses. Safety was consistent with the known safety profile of pembro. Clinical trial information: NCT02787005. [Table: see text]
Omalizumab Improves Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps Irrespective of Asthma Status
Authors: Claus Bachert, Philippe Gevaert, Jonathan Corren, Joaquim Mullol, Joseph Han, Randall Ow, Sanna Toppila-Salmi, Isam Alobid, Derrick Kaufman, Bongin Yoo, Monet Howard, Rui Zhu, Monica Ligueros-Saylan, Kit Wong, Lutaf Islam, Theodore Omachi
Journal: Journal of Allergy and Clinical Immunology (2020)
Abstract 16139: Artificial Intelligence to Identify Acute Coronary Syndroms: Detection of Vulnerable Coronary Plaques in OCT Images With Deep Learning
Authors: Yang-Yang Deng, Sijie Liu, Peiwen Shi, Jingmin Xin, Nanning Zheng, Yue Wu, Zuyi Yuan
Journal: Circulation (2018)

Introduction: Optical coherence tomography (OCT) is an intravascular imaging modality which is widely used clinically for coronary plaque characterization. It has the ability to measure the fibrous...
Adjuvant docetaxel for high-risk localized prostate cancer: Update of NRG Oncology/RTOG 0521.
Authors: Howard M. Sandler, Theodore Karrison, A. Oliver Sartor, Leonard G. Gomella, Mahul B. Amin, James Purdy, Jeff M. Michalski, Mark Garzotto, Nadeem Pervez, Alexander G. Balogh, George Rodrigues, Luis Souhami, M. Neil Reaume, Scott Williams, Raquibul Hannan, Christopher U. Jones, Eric M. Horwitz, Joseph P. Rodgers, Felix Y Feng, Seth A. Rosenthal
Journal: Journal of Clinical Oncology (2020)

333 Background: High-risk, localized prostate cancer has a poor prognosis. We hypothesized that adj docetaxel (D) and prednisone and long-term (24 mos) androgen suppression (AS) and radiation therapy (RT) would improve overall survival (OS) and tested this in NRG/RTOG 0521. Results with med follow-up of 5.7 yrs were reported (JCO 37:1159, 2019), showing a benefit of D (HR=0.69, 90% CI: 0.49-0.97, 1-sided p=0.034). Med follow-up is now 10.4 yrs and we report updated results for OS and metastasis (DM). Methods: NRG/RTOG 0521 opened 12/05 and closed 8/09 with targeted accrual of 600 and designed to detect a HR of 0.49, based on improvement in 4-yr OS from 86 to 93%. With 0.05 1-sided type I error and 90% power &gt;78 deaths were required. Pts were stratified by predefined risk groups. Group 1: Gl 9-10, any T; Group 2: Gl 8, PSA&lt;20, T≥T2; Group 3: Gl 8, PSA≥20, any T; Group 4: Gl 7, PSA≥20, any T. maxPSA ≤150. RT dose was 75.6 Gy. Chemo consisted of 6, 21-day cycles of D starting 28 days after RT. Results: Of 612 accrued, 563 were eligible/available for analysis. By risk group 1-4, there were 297, 116, 64, and 86 pts. Med PSA 15 ng/mL. 10-yr OS rates were 64% [95% CI: 58-70%] for AS+RT and 69% [95% CI: 63-75%] for AS+RT+CT (HR = 0.89, 90% CI: 0.70, 1.13, 1-sided p=0.22). However there was evidence of non-proportional hazards (Grambsch-Therneau test, p=0.016). Thus survival was alternatively evaluated with restricted mean survival time (RMST). The difference in RMST at 10 yrs was 0.42 yrs (90% CI: 0.07-0.77, 2-sided p=0.048). Cumulative incidence of DM at 10 yrs was 22% [95% CI: 17-27%] for AS+RT and 20% [95% CI: 15-25%] for AS+RT+CT (2-sided log-rank p=0.29). At 10 years most deaths occurred in risk group 1: 62 in AS+RT and 50 in AS+RT+CT (HR= 0.93, 95% CI: 0.66-1.32, 2-sided log-rank p=0.16). There was no new related Grade 5 toxicity. Conclusions: OS findings, reported after follow-up of 5.7 yrs, demonstrated a small beneficial effect of adding D to AS and RT. With longer follow-up the benefit of D remains, but the HR varies over time and the OS curves have converged. Support: U10CA180868 (NRG Operations), U10CA180822 (NRG SDMC), U24CA180803 (IROC) from the NCI and Sanofi-Synthelabo Int. Clinical trial information: NCT00288080.
Practice trends and attitudes of medical oncologists on new therapies in urothelial carcinoma.
Authors: Kristen Rosenthal, Matt D. Galsky, Matthew I. Milowsky, Alexandra Howson, Timothy A. Quill, Kevin Obholz
Journal: Journal of Clinical Oncology (2020)

472 Background: Treatment options for patients with metastatic urothelial carcinoma (mUC) have dramatically changed. The goal of this study was to assess the worldwide impact and use of new therapeutic developments in clinical practice. Methods: The study consisted of qualitative telephone interviews (3/25/19-4/5/19) and a quantitative online survey (3/20/19-5/27/19) with questions designed to determine current practice trends and specific challenges faced by clinicians. Participants were recruited via email and answers were compared with those of experts and guideline recommendations. Results: A total of 30 US-based clinicians completed the interviews and 491 participants (US, n = 156; ex-US, n = 335) completed the online survey. Most participants (69%) treated ≤ 10 patients with UC per month. For newly diagnosed mUC, many participants failed to select appropriate first-line therapy based on creatinine clearance (CrCl) and PD-L1 expression (Table). Only 58% of clinicians correctly selected SoC cisplatin-based chemotherapy for eligible patients based on CrCl. For cisplatin-ineligible patients, 60% of clinicians indicated use of an immune checkpoint inhibitor (ICI) despite low PD-L1 expression. Many clinicians were also unfamiliar with novel agents. Only 56% recognized the mechanism of action (MoA) of erdafitinib, an FGFR inhibitor approved during the survey period, and 31% recognized the MoA of enfortumab vedotin, an investigational agent with FDA breakthrough therapy designation. About 40% of US clinicians and &lt; 20% of ex-US clinicians indicated confidence to use these agents in clinical practice if available. Conclusions: This study highlights the need for ongoing education on the optimal use of novel therapeutic strategies to care for patients with mUC. [Table: see text]
Assisted dying: your vote counts
Authors: Richard Hurley
Journal: BMJ (2020)

The BMA is currently polling members on whether it should change its opposition to doctor assisted dying. The Royal College of General Practitioners, also opposed, recently polled its members on the same question. Last year, after a poll of its members, the Royal College of Physicians changed its stance from opposition to neutrality.1

The BMJ has long advocated for a change in the law to give dying people the option to hasten their death if their pain were unbearable and palliation could offer no more.2 Because doctors’ views diverge, we believe medical organisations should take a neutral stance: such an important decision must rest with society.

The Canadian Medical Association and the Royal Australian College of General Practitioners, for example, say …
Real-world outcomes in patients (pts) with metastatic urothelial carcinoma (mUC) who received first- or second-line immunotherapies (IO) in the United States (US).
Authors: Marley Boyd, Srinivas Annavarapu, Gurjyot K. Doshi, Kentaro Imai, Eric Sbar, James Luke Godwin, Haojie Li, Guru Sonpavde
Journal: Journal of Clinical Oncology (2020)

457 Background: Benefit of IO (PD1 and PD-L1 inhibitors) for mUC was observed in clinical trials but real-world evidence for benefit and clinical outcomes is limited. Methods: This was a retrospective study of adult pts with mUC who initiated IO regardless of PD-L1 expression in the first- (1L cohort) or second-line (2L cohort) setting between 5/1/2016-1/31/2019 in the US Oncology Network (USON), a network of community oncology practices. Descriptive and Kaplan-Meier analyses to evaluate baseline characteristics, treatment patterns and clinical outcomes were conducted using data from USON’s electronic heath record. Results: Among 393 pts in the 1L cohort, median (range) age at IO initiation was 77 (42, 90+), 74% were male, 69% were White, and 19.1% and 4.1% had ECOG performance status (PS) 2 and 3/4, respectively. Among the 366 pts in the 2L cohort, median (range) age at IO initiation was 70 (29, 90+), 74% were male, 71% were White, and 19.7% and 1.4% had ECOG PS 2 and 3, respectively. Median (range) follow-up durations from IO initiation were 4.2 (0, 34.1; 1L cohort) and 4.1 (0, 31.3; 2L cohort) months (mo), during which time 43.1% (1L cohort) and 44.4% (2L cohort) of pts died. Median overall survival (OS) from IO initiation (95% confidence interval [CI]) was 10.6 (9.7, 13.2) mo for the 1L cohort and 9.4 (7.1, 11.5) mo for the 2L cohort; 1-year survival probabilities (95% CI) were 46.6% (40.1%, 52.8%; 1L cohort) and 43.4% (36.8%, 49.8%; 2L cohort). By the end of the follow-up, 48.1% of 1L pts and 47.8% of 2L pts were alive and did not advance to next line of therapy, and 13.5% of 1L and 13.4% of 2L cohort pts advanced to the next line of therapy. Median (95% CI) treatment durations were 2.6 (2.1, 2.9) and 2.8 (2.2, 3.5) mo for the 1L and 2L cohorts, respectively; 6-mo ongoing treatment probabilities (95% CI) were 26.6% (22.2%, 31.2%; 1L cohort) and 31.4% (26.4%, 36.4%; 2L cohort). Conclusions: OS of pts in the real world receiving 1L and 2L IO appears consistent with clinical trial results, although survival follow-up is limited. A minority of pts received post-IO therapy. Future research should examine influence of pt characteristics and PD-L1 expression on treatment choice and outcomes.
Full-length 5'RACE identifies all major HBV transcripts in HBV-infected hepatocytes and patient serum
Authors: Bernd Stadelmayer, Audrey Diederichs, Fleur Chapus, Michel Rivoire, Gregory Neveu, Antoine Alam, Laurent Fraisse, Kara Carter, Barbara Testoni, Fabien Zoulim
Journal: Journal of Hepatology (2020)
Clinical and Genetic Risk Prediction of Cognitive Impairment After Blood or Marrow Transplantation for Hematologic Malignancy
Authors: Noha Sharafeldin, Joshua Richman, Alysia Bosworth, Yanjun Chen, Purnima Singh, Sunita K. Patel, Xuexia Wang, Liton Francisco, Stephen J. Forman, F. Lennie Wong, Smita Bhatia
Journal: Journal of Clinical Oncology (2020)

Using a candidate gene approach, we tested the hypothesis that individual single nucleotide polymorphisms (SNPs) and gene-level variants are associated with cognitive impairment in patients with hematologic malignancies treated with blood or marrow transplantation (BMT) and that inclusion of these SNPs improves risk prediction beyond that offered by clinical and demographic characteristics.In the discovery cohort, BMT recipients underwent a standardized battery of neuropsychological tests pre-BMT and at 6 months, 1 year, 2 years, and 3 years post-BMT. Associations between 68 candidate genes and cognitive impairment were assessed using generalized estimating equation models. Elastic-Net regression was used to build Base (sociodemographic), Clinical, and Combined (Base plus Clinical plus genetic) risk prediction models of post-BMT impairment. An independent nonoverlapping cohort from the BMT Survivor Study with self-report of learning/memory problems (as identified by their health care provider) was used for model replication.The discovery cohort included 277 participants (58.5% males; 68.6% non-Hispanic whites; and 46.6% allogeneic BMT recipients). Adjusting for BMT type, age at BMT, sex, race/ethnicity, and cognitive reserve, SNPs in the blood-brain barrier, telomere homeostasis, and DNA repair genes were significantly associated with cognitive impairment. Compared with the Clinical Model, the Combined Model had higher predictive power in both the discovery cohort (mean area under the receiver operating characteristic curve [AUC], 0.89; 95% CI, 0.85 to 0.93 v 0.77; 95% CI, 0.71 to 0.83; P = 1.24 × 10-9) and the replication cohort (AUC, 0.71; 95% CI, 0.66 to 0.76 v 0.63; 95% CI, 0.57 to 0.68; P = .004).Inclusion of candidate genetic variants enhanced the prediction of risk of post-BMT cognitive impairment beyond that offered by demographic/clinical characteristics and represents a step toward a personalized approach to managing patients at high risk for cognitive impairment after BMT.
Impact of facility volume on complications from immunotherapy for renal cell carcinoma.
Authors: Eugene Blanchard Cone, Ye Wang, Stephen Reese, Steven Lee Chang
Journal: Journal of Clinical Oncology (2020)

672 Background: Better outcomes have been generally associated with higher volume providers/hospitals. Recent work found an association between higher volume facilities and survival for advanced cancer patients. Volume and treatment complications for medical cancer therapy is unexplored. We studied a retrospective cohort of patients with metastatic renal cell carcinoma receiving immunotherapy at high and low volume hospitals. Methods: We used Premier Healthcare Data, which includes administrative data from all payors at over 700 community and academic hospitals, and captures 20% of all hospital discharges in the US, including infusions performed in hospital clinics. Using ICD9 codes we identified patients with metastatic renal cell carcinoma treated with nivolumab from 2015-17. Clinicodemographic data were obtained for patients and hospitals. The primary exposure was dichotomized hospital treatment volume (top quartile = high volume). Outcomes were immunotherapy-related complications for which the patient re-presented to the Emergency Department or was readmitted, and readmission for other cause. We performed mixed effects logistic regression adjusting for complex survey design to achieve national representation. Results: We included 15,724 weighted hospital encounters (5,835 at low-volume hospitals and 9,889 at high-volume hospitals). Urban, teaching hospitals were more likely to be high volume, but all patient factors were balanced. We observed 1,457 complications at high volume hospitals and 1,734 at low volume hospitals. There were no significant differences by volume of hospital in overall rates of complications (OR 0.92, 95% CI 0.82-1.09) or in rates of individual complications, with the exception of ocular complications (n=11, all low volume hospitals). We observed that high volume hospitals significantly reduced odds for readmission (OR 0.09, 0.03-0.24) unrelated to immunotherapy complications. Conclusions: We found no difference in immunotherapy-related complication rates by facility volume. This is reassuring for community administration of immunotherapy. Further study is needed to elucidate why we saw significantly more therapy-unrelated readmissions at lower volume hospitals.