tbuckley/cabot-search huggingface dataset:
Physician Time Spent Using the Electronic Health Record During Outpatient Encounters
Authors: Abigail Zuger
Journal: Annals of Internal Medicine (2020)

Letters6 October 2020Physician Time Spent Using the Electronic Health Record During Outpatient EncountersAbigail Zuger, MDAbigail Zuger, MDNew York, New York (A.Z.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0276 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Overhage and McCallie's interesting article (1) provides a large-scale overview of physician interactions with the EHR. A careful reading has left me with some questions.First, I believe that the last 2 columns in Table 2 of the article are mislabeled. Perhaps they should read “Mean Active EHR Time per Physician per Month” and “Mean Active EHR Time per Physician per Day”?Second, the final row in Table 2 gives a “total” for all study physicians and encounters. However, the values in the final 2 columns of this row are puzzling. Are they means? Weighted means? How ...Reference1. Overhage JM, McCallie D. Physician time spent using the electronic health record during outpatient encounters. A descriptive study. Ann Intern Med. 2020;172:169-74. [PMID: 31931523]. doi:10.7326/M18-3684 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: New York, New York (A.Z.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0276. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysician Time Spent Using the Electronic Health Record During Outpatient Encounters J. Marc Overhage and David McCallie Jr. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters Kiyofumi Oya , Yuta Ishiyama , and Kashiwagi Hideyuki Physician Time Spent Using the Electronic Health Record During Outpatient Encounters J. Marc Overhage and David McCallie Physician Time Spent Using the Electronic Health Record During Outpatient Encounters Joseph A. Stankaitis Physician Time Spent Using the Electronic Health Record During Outpatient Encounters John Weiser Metrics 6 October 2020Volume 173, Issue 7Page: 593-594KeywordsConflicts of interestDisclosureElectronic medical recordsOutpatients ePublished: 6 October 2020 Issue Published: 6 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Nanoparticle-encapsulated siRNAs for gene silencing in the haematopoietic stem-cell niche
Authors: Marvin Krohn-Grimberghe, Michael J. Mitchell, Maximilian J. Schloss, Omar F. Khan, Gabriel Courties, Pedro P. G. Guimaraes, David Rohde, Sebastian Cremer, Piotr S. Kowalski, Yuan Sun, Mingchee Tan, Jamie Webster, Karin Wang, Yoshiko Iwamoto, Stephen P. Schmidt, Gregory R. Wojtkiewicz, Ribhu Nayar, Vanessa Frodermann, Maarten Hulsmans, Amanda Chung, Friedrich Felix Hoyer, Filip K. Swirski, Robert Langer, Daniel G. Anderson, Matthias Nahrendorf
Journal: Nature Biomedical Engineering (2020)
Exploring prognostic indicators in the pathological images of hepatocellular carcinoma based on deep learning
Authors: Jie-Yi Shi, Xiaodong Wang, Guang-Yu Ding, Zhou Dong, Jing Han, Zehui Guan, Li-Jie Ma, Yuxuan Zheng, Lei Zhang, Guan-Zhen Yu, Xiao-Ying Wang, Zhen-Bin Ding, Ai-Wu Ke, Haoqing Yang, Liming Wang, Lirong Ai, Ya Cao, Jian Zhou, Jia Fan, Xiyang Liu, Qiang Gao
Journal: Gut (2020)

Tumour pathology contains rich information, including tissue structure and cell morphology, that reflects disease progression and patient survival. However, phenotypic information is subtle and complex, making the discovery of prognostic indicators from pathological images challenging.An interpretable, weakly supervised deep learning framework incorporating prior knowledge was proposed to analyse hepatocellular carcinoma (HCC) and explore new prognostic phenotypes on pathological whole-slide images (WSIs) from the Zhongshan cohort of 1125 HCC patients (2451 WSIs) and TCGA cohort of 320 HCC patients (320 WSIs). A 'tumour risk score (TRS)' was established to evaluate patient outcomes, and then risk activation mapping (RAM) was applied to visualise the pathological phenotypes of TRS. The multi-omics data of The Cancer Genome Atlas(TCGA) HCC were used to assess the potential pathogenesis underlying TRS.Survival analysis revealed that TRS was an independent prognosticator in both the Zhongshan cohort (p<0.0001) and TCGA cohort (p=0.0003). The predictive ability of TRS was superior to and independent of clinical staging systems, and TRS could evenly stratify patients into up to five groups with significantly different prognoses. Notably, sinusoidal capillarisation, prominent nucleoli and karyotheca, the nucleus/cytoplasm ratio and infiltrating inflammatory cells were identified as the main underlying features of TRS. The multi-omics data of TCGA HCC hint at the relevance of TRS to tumour immune infiltration and genetic alterations such as the FAT3 and RYR2 mutations.Our deep learning framework is an effective and labour-saving method for decoding pathological images, providing a valuable means for HCC risk stratification and precise patient treatment.
Lopinavir–ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
Authors: Peter W Horby, Marion Mafham, Jennifer L Bell, Louise Linsell, Natalie Staplin, Jonathan Emberson, Adrian Palfreeman, Jason Raw, Einas Elmahi, Benjamin Prudon, Christopher Green, Simon Carley, David Chadwick, Matthew Davies, Matthew P Wise, J Kenneth Baillie, Lucy C Chappell, Saul N Faust, Thomas Jaki, Katie Jefferey, Wei Shen Lim, Alan Montgomery, Kathryn Rowan, Edmund Juszczak, Richard Haynes, Martin J Landray
Journal: The Lancet (2020)

Lopinavir-ritonavir has been proposed as a treatment for COVID-19 on the basis of in vitro activity, preclinical studies, and observational studies. Here, we report the results of a randomised trial to assess whether lopinavir-ritonavir improves outcomes in patients admitted to hospital with COVID-19.
COVID-19 Trends Among School-Aged Children — United States, March 1–September 19, 2020
Authors: Rebecca T. Leeb, Sandy Price, Sarah Sliwa, Anne Kimball, Leigh Szucs, Elise Caruso, Shana Godfred-Cato, Matthew Lozier
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

Approximately 56 million school-aged children (aged 5-17 years) resumed education in the United States in fall 2020.* Analysis of demographic characteristics, underlying conditions, clinical outcomes, and trends in weekly coronavirus disease 2019 (COVID-19) incidence during March 1-September 19, 2020 among 277,285 laboratory-confirmed cases in school-aged children in the United States might inform decisions about in-person learning and the timing and scaling of community mitigation measures. During May-September 2020, average weekly incidence (cases per 100,000 children) among adolescents aged 12-17 years (37.4) was approximately twice that of children aged 5-11 years (19.0). In addition, among school-aged children, COVID-19 indicators peaked during July 2020: weekly percentage of positive SARS-CoV-2 test results increased from 10% on May 31 to 14% on July 5; SARS-CoV-2 test volume increased from 100,081 tests on May 31 to 322,227 on July 12, and COVID-19 incidence increased from 13.8 per 100,000 on May 31 to 37.9 on July 19. During July and August, test volume and incidence decreased then plateaued; incidence decreased further during early September and might be increasing. Percentage of positive test results decreased during August and plateaued during September. Underlying conditions were more common among school-aged children with severe outcomes related to COVID-19: among school-aged children who were hospitalized, admitted to an intensive care unit (ICU), or who died, 16%, 27%, and 28%, respectively, had at least one underlying medical condition. Schools and communities can implement multiple, concurrent mitigation strategies and tailor communications to promote mitigation strategies to prevent COVID-19 spread. These results can provide a baseline for monitoring trends and evaluating mitigation strategies.
Assessment of Factors Associated With Long-term Posttraumatic Stress Symptoms Among 56 388 First Responders After the 2011 Great East Japan Earthquake
Authors: Masanori Nagamine, Erik J. Giltay, Jun Shigemura, Nic J. van der Wee, Taisuke Yamamoto, Yoshitomo Takahashi, Taku Saito, Masaaki Tanichi, Minori Koga, Hiroyuki Toda, Kunio Shimizu, Aihide Yoshino, Eric Vermetten
Journal: JAMA Network Open (2020)

<h3>Importance</h3> First responders are at risk for developing symptoms of posttraumatic stress disorder (PTSD). Little is known about the risk factors for developing PTSD during a years-long period after complex mass disasters. <h3>Objective</h3> To explore the long-term course of PTSD symptoms and to identify risk factors and their relative association with PTSD among first responders dispatched to the 2011 Japanese earthquake, tsunami, and nuclear disaster. <h3>Design, Setting, and Participants</h3> This 6-year, large, prospective cohort study was part of a continuous longitudinal study of Japan Ground Self-Defense Force first responders. The data were collected at 1, 6, 12, 24, 36, 48, 60, and 72 months after mission completion from 2011 to 2017. Of approximately 70 000 eligible participants, 56 388 were enrolled in this study. Data were analyzed from 2017 to 2020. <h3>Exposures</h3> Stress exposures owing to personal or professional disaster experience (eg, duties with body recovery or radiation exposure risk) and working conditions (eg, deployment length, postdeployment overtime work). <h3>Main Outcomes and Measures</h3> The Impact of Event Scale–Revised score assessed PTSD symptoms; scores of at least 25 were defined as probable PTSD. Cox proportional hazards regression models assessed the risk factors for incidence of probable PTSD. <h3>Results</h3> Among the 56 388 participants, 97.1% were men, and the median age at enrollment was 34 (range, 18-63) years. A probable PTSD rate was 2.7% at 1 month and showed a downward trend in the first year and a subsequent plateau. The cumulative incidence of probable PTSD was 6.75%. The severity of PTSD symptoms demonstrated a high degree of rank-order stability over time. Rather than professional disaster experience, sociodemographic factors and working conditions were independently associated with the incidence of probable PTSD: personal experience of the disaster (hazard ratio [HR], 1.96; 95% CI, 1.72-2.24), deployment length of at least 3 months (HR vs &lt;1 month, 1.75; 95% CI, 1.52-2.02), increased age (HR for ≥46 vs ≤25 years, 2.28; 95% CI, 1.79-2.92), and postdeployment overtime work of at least 3 months (HR vs little to none, 1.61; 95% CI, 1.39-1.87). <h3>Conclusions and Relevance</h3> Given these findings, in the future, first responders' PTSD symptoms might be mitigated by shortening deployment length, avoiding postdeployment overtime work, and paying special attention to the needs of personnel with personal experience of the disaster or older age. Efforts to alleviate responders' initial symptoms will be required.
Abstract IA06: Concepts of cancer and metastasis: Historical perspective
Authors: Claire Lugassy, Raymond L Barnhill
Journal: Cancer Research (2020)

Abstract In medicine, as in all of human history, there is a permanent back and forth between two principal modes of thought: (i) magical/religious/ fears/obscurantism, leading to dogma;, and (ii) intellectual activities resulting in the questioning of dogma and opening doors to new concepts. Concerning cancer, since ancient Egypt, several methods of thinking have been instituted and then rejected, influenced by new discoveries but also by the cultural context. With respect to mechanisms of cancer metastasis, after considerable debate in the 19th century, intravascular dissemination of cancer was finally imposed and is still accepted as the only mechanism for distant metastasis. However, at present, other perspectives are now taken into consideration, and in particular melanoma angiotropism, pericytic mimicry, and extravascular migratory metastasis (EVMM). This new field of cancer research may open promising new strategies for reducing or preventing melanoma metastasis. Citation Format: Claire Lugassy, Raymond L Barnhill. Concepts of cancer and metastasis: Historical perspective [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr IA06.
The Delicate Balancing Act of Childhood Cancer Treatment—Not Too Much but Not Too Little
Authors: Lisa Gallicchio, Kathy J Helzlsouer
Journal: JNCI Journal of the National Cancer Institute (2020)

The treatment of childhood cancer is a success story.As a result of marked advances in treatments, death rates from the major types of childhood cancer in the United States have decreased by more than 60% over the past several decades, from 6.3 per 100 000 population in 1970 to 2.0 per 100 000 population in 2017 (1).Today, the overall 5-year relative survival rate for individuals diagnosed with a childhood cancer exceeds 80% compared with 68% in the mid-1970s (1).Although childhood cancer incidence rates are generally higher among Whites compared with Blacks, mortality rates are similar, with a noted disparity in the overall 5year relative survival rate between Blacks (80.9%) and Whites (86.5%) for those aged 0-14 years at diagnosis (2).The treatment success for childhood cancers has come with associated costs of increased risks of adverse health and quality-of-life outcomes.These adverse health conditions can include cardiovascular disease, cognitive dysfunction, frailty and, ultimately, premature mortality (3).The Childhood Cancer Survivor Study (CCSS), established in 1994 across selected centers in the United States and Canada, recruited childhood cancer survivors retrospectively in 2 waves covering survivors treated in 1970 through 1999 (4).Noteworthy findings from the CCSS indicate that nearly one-third of childhood cancer survivors report at least 1 severe or life-threatening adverse health condition 20 years after diagnosis (5), resulting in the shortening of life expectancy compared with that of the general population (6).The challenge of treating childhood cancer is to maintain and improve on treatment success while minimizing late adverse effects.One option to tackle this challenge is tailored treatment approaches, with possible de-escalation of treatment (7).Finding the right amount of treatment is a delicate balancing act: not too much and not too little.The need to find that perfect location on the treatment fulcrum is demonstrated in the study by in this issue of the Journal.The authors compared all-cause and cause-specific late mortality among childhood cancer survivors in the United States with those in the United Kingdom using data from the CCSS and the
Challenges and Opportunities in Implementing Pharmacogenetic Testing in Clinical Settings
Authors: Wan-Chun Chang, Reo Tanoshima, Colin J.D. Ross, Bruce C. Carleton
Journal: The Annual Review of Pharmacology and Toxicology (2020)

The clinical implementation of pharmacogenetic biomarkers continues to grow as new genetic variants associated with drug outcomes are discovered and validated. The number of drug labels that contain pharmacogenetic information also continues to expand. Published, peer-reviewed clinical practice guidelines have also been developed to support the implementation of pharmacogenetic tests. Incorporating pharmacogenetic information into health care benefits patients as well as clinicians by improving drug safety and reducing empiricism in drug selection. Barriers to the implementation of pharmacogenetic testing remain. This review explores current pharmacogenetic implementation initiatives with a focus on the challenges of pharmacogenetic implementation and potential opportunities to overcome these challenges.
Tofacitinib for the Treatment of Nail Lesions and Palmoplantar Pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome
Authors: Chen Li, Zhaohui Li, Yihan Cao, Li Li, Feng Li, Yueting Li, Dingkun Xiong, Xia Wu, Wen Zhang, Xiaofeng Zeng
Journal: JAMA Dermatology (2020)

<h3>Importance</h3> Nail involvement is common in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, which has a strong association with quality of life in patients with SAPHO. Tofacitinib is an oral Janus kinase inhibitor that has been previously shown to be effective for nail psoriasis. <h3>Objective</h3> To assess the efficacy and safety of tofacitinib for the treatment of nail involvement in SAPHO syndrome. <h3>Interventions</h3> Participants received tofacitinib, 5 mg, twice daily, for 12 weeks. <h3>Design, Setting, and Participants</h3> This open-label, single-arm, prospective pilot study included 13 patients with SAPHO syndrome accompanied by nail lesions and active palmoplantar pustulosis who were recruited from Peking Union Medical College Hospital from September 2019 to December 2019. Follow-up was completed in March 2020. Analysis began March 2020. <h3>Main Outcomes and Measures</h3> The primary end point was the percentage of the change from baseline in Nail Psoriasis Severity Index scores at week 12. Secondary end points included the percentage of the change from baseline in Palmoplantar Psoriasis Area and Severity Index scores, change from baseline in Visual Analogue Scale scores in global osteoarticular pain, Dermatology Life Quality Index scores, and inflammatory markers. Adverse events were recorded throughout the study. <h3>Results</h3> Thirteen female Asian patients (means [SD] age, 39.7 [12.3] years) were included, all of whom completed the study. At week 12, significant improvements were observed in Nail Psoriasis Severity Index scores (median, −67% [interquartile range (IQR), −56% to −77%];<i>P</i> &lt; .001) and Palmoplantar Psoriasis Area and Severity Index scores (median, −71% [IQR, −58% to −78%];<i>P</i> &lt; .001). Significant improvement was also noted in Dermatology Life Quality Index scores (median, −12 [IQR, −8.5 to −15];<i>P</i> &lt; .001) at week 12. A significant decrease in Visual Analogue Scale scores in global osteoarticular pain was observed at week 8 (median, −4 [IQR, 0 to −5];<i>P</i> = .02) but was not significant at week 12. Inflammatory marker levels were decreased, as indicated by erythrocyte sedimentation rate (median, −8 mm/h [IQR, −4 mm/h to −11 mm/h];<i>P</i> &lt; .001) and high-sensitivity C-reactive protein levels (median, −1.6 [IQR, −0.3 to −4.1];<i>P</i> = .01). No severe adverse events were observed. <h3>Conclusions and Relevance</h3> In this pilot study, tofacitinib yielded significant remission of nail lesions and palmoplantar psoriasis accompanied by an improvement in quality of life in patients with SAPHO syndrome. Additional follow-up studies to evaluate the long-term efficacy and safety of tofacitinib for nail involvement in SAPHO syndrome are warranted. <h3>Trial Registration</h3> Chinese Clinical Trial Registry number:ChiCTR1900025941
Association between elevated serum IgG4 (sIgG4) concentrations and the phenotype of patients with primary sclerosing cholangitis (PSC)
Authors: M P Manns, B Eksteen, M L Shiffman, C Levy, K V Kowdley, A J Montano-Loza, H L Janssen, R P Myers, D Ding, M Subramanian, J G McHutchison, M R Charlton, C L Bowlus, A J Muir, R W Chapman
Journal: Hepatology (2015)
Dysbiosis in the oral microbiomes of anti-CCP positive individuals at risk of developing rheumatoid arthritis
Authors: Zijian Cheng, Thuy Do, Kulveer Mankia, Josephine Meade, Laura Hunt, Val Clerehugh, Alastair Speirs, Aradhna Tugnait, Paul Emery, Deirdre Devine
Journal: Annals of the Rheumatic Diseases (2020)

An increased prevalence of periodontitis and perturbation of the oral microbiome has been identified in patients with rheumatoid arthritis (RA). The periodontal pathogen Porphyromonas gingivalis may cause local citrullination of proteins, potentially triggering anti-citrullinated protein antibody production. However, it is not known if oral dysbiosis precedes the onset of clinical arthritis. This study comprehensively characterised the oral microbiome in anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals without clinical synovitis (CCP+at risk).Subgingival plaque was collected from periodontally healthy and diseased sites in 48 CCP+at risk, 26 early RA and 32 asymptomatic healthy control (HC) individuals. DNA libraries were sequenced on the Illumina HiSeq 3000 platform. Taxonomic profile and functional capability of the subgingival microbiome were compared between groups.At periodontally healthy sites, CCP+at risk individuals had significantly lower microbial richness compared with HC and early RA groups (p=0.004 and 0.021). Microbial community alterations were found at phylum, genus and species levels. A large proportion of the community differed significantly in membership (523 species; 35.6%) and structure (575 species; 39.1%) comparing CCP+at risk and HC groups. Certain core species, including P. gingivalis, had higher relative abundance in the CCP+at risk group. Seventeen clusters of orthologous gene functional units were significantly over-represented in the CCP+at risk group compared with HC (adjusted p value <0.05).Anti-CCP positive at-risk individuals have dysbiotic subgingival microbiomes and increased abundance of P. gingivalis compared with controls. This supports the hypothesis that the oral microbiome and specifically P. gingivalis are important in RA initiation.
Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men
Authors: Shingo Fukuma, Toshiaki Iizuka, Tatsuyoshi Ikenoue, Yusuke Tsugawa
Journal: JAMA Internal Medicine (2020)

Obesity and cardiovascular risks have become major public health problems. However, evidence is limited as to whether population-level lifestyle interventions for obesity and cardiovascular risk factors are associated with improved population health outcomes.To investigate the association of the national health guidance intervention in Japan with population health outcomes.This cohort study used a regression discontinuity design that included men aged 40 to 74 years who participated in the national health screening program in Japan from April 2013 to March 2018.Assignment to the national health guidance intervention (counseling on healthy lifestyle and appropriate clinical follow-up for individuals found to have waist circumference of 85 cm or greater with 1 or more cardiovascular risk factors during annual national health screening program).Changes in obesity status (body weight, body mass index, waist circumference), and cardiovascular risk factors (blood pressure, hemoglobin A1c level, and low-density lipoprotein cholesterol level) 1 to 4 years after screening.Of 74 693 men (mean [SD] age, 52.1 [7.8] years; mean [SD] baseline waist circumference, 86.3 [9.0] cm), the assignment to the health guidance intervention was associated with lower weight (adjusted difference, -0.29 kg; 95% CI, -0.50 to -0.08; P = .005), body mass index (-0.10; 95% CI, -0.17 to -0.03; P = .008), and waist circumference (-0.34 cm; 95% CI, -0.59 to -0.04; P = .02) 1 year after screening. The observed association of the guidance assignment attenuated over time and was no longer significant by years 3 to 4. No evidence was found that the health guidance intervention was associated with changes in participants' systolic blood pressure, diastolic blood pressure, hemoglobin A1c level, or low-density lipoprotein cholesterol level in years 1 to 4.Among working-age men in Japan, the national health guidance intervention was not associated with clinically meaningful weight loss or other cardiovascular risk factor reduction. Further research is warranted to understand the specific design of lifestyle interventions that are effective in improving obesity and cardiovascular risk factors.