tbuckley/cabot-search huggingface dataset:
Reporting of clinical trial data: Are we fully utilizing the current clinical trial data to help manage the older adult cancer population?
Authors: J. T. Tam-McDevitt, W. Tew, S. Klapper, R. Hauser, S. Lichtman
Journal: Journal of Clinical Oncology (2007)

19546 Background: The number of older cancer patients will continue to increase as the population ages. Thus the demand for information on how to manage this population will continue to increase in importance. Clinical trials provide pertinent information to clinicians on treatment options, however, are the current available results matching the needs for the older cancer population? Methods: An evaluation was performed of published clinical trials to determine whether the data was analyzed, reported and discussed using age related criteria. Prospective studies involving 50 or more patients published from 01/2005–12/2006 in the Journal of Clinical Oncology (JCO), Cancer, and the Journal of the National Cancer Institute (JNCI) were reviewed. Results: There were 258 JCO, 58 Cancer, and 17 JNCI articles with the prespecified criteria. The median number of patients enrolled per trial is 212 (JCO), 77.5 (Cancer), and 954 (JNCI). The mean age of patients enrolled for all studies was 59.4 years (range 16 to 93 years). The number (%) of studies which stratified for age is 54 (20.9%) for JCO, 17 (29.3%) for Cancer, and 7 (41%) for JNCI. The number (%) of studies which included age in their analyses is 75 (29%) for JCO, 14 (24%) for Cancer, and 6 (35.3%) for JNCI. Age was mentioned in the discussion section in 40 (15.5%), 8 (13.8%), and 6 (35.3%), JCO, Cancer, and JNCI articles, respectively. Conclusions: The current clinical trials fail to provide ample data which clinicians need to best manage the older cancer population. Since there was a lack of age related analyses, valuable data may have gone unreported. ASCO and other organizations recognize the lack of data on the management of older cancer patients. The underrepresentation of this population in clinical trials certainly contributes to this lack of data. Data mining of these existing studies involving large numbers of patients may provide valuable age related information for clinicians. The continued development of trials involving the older cancer population will aid in increasing our knowledge. We would also like to put forth that journal reviewers and editors should require the incorporation and reporting of age related analyses in studies, especially those involving large number of patients. No significant financial relationships to disclose.
A comparison of immunohistochemistry (IHC) and dual-color silver in situ hybridization (SISH) with a novel method combining both gene and protein platforms on a unique slide for testing the HER2 in gastric carcinoma.
Authors: Dominique Werner, Achim Battmann, Kristina Steinmetz, Tobin Jones, Michele Martinez, Tiffany Lamb, Salah-Eddin Al-Batran
Journal: Journal of Clinical Oncology (2013)

4100 Background: Amplification and/or protein overexpression of HER2 in gastric cancer is a prerequisite to establish an adequate treatment strategy. The European standard defined HER2 positivity by IHC as first evaluation assay followed by ISH in 2+ cases. Gastric tumors are heterogeneous and separate evaluations lead to uncertainties and in localizing distinct clones and are time consuming. The aim of this study was to evaluate the feasibility of gene-protein platform in comparison to single staining methods. Methods: IHC plus SISH and gene-protein platform (IHC/SISH, protein/gene) method for HER2 were performed in randomly collected 100 cases of gastric carcinoma. Results of IHC and SISH were compared with IHC/SISH staining. Rüschoff criteria were applied. Tumors were HER2 positive when expression 3+ or 2+ plus gene amplification (EU-Norm) was found. In Second definition (US-Norm), tumors showing HER2 expression 3+ or amplification were considered HER2 positive. Results: 96 of 100 samples were eligible. Amplification was observed in 14.6% and 15.6% by SISH and IHC/SISH. 71.9% by IHC vs. 75.0% by IHC/SISH had no expression (0) and 10.4% (IHC vs. IHC/SISH) had weak (1+) HER2 expression. Moderate expression (2+) and overexpression (3+) were observed in IHC 6.3%/11.5% and IHC/SISH 6.3%/8.3%, respectively. There were high concordances in IHC assessment of cases with score 0 (94.8%; κ=0.87) and 3+ (96.9%; κ=0.83) and moderate concordances in 1+/2+ cases (89.6%; κ= 0.44 vs. 93.8%; κ=0.47). Rate of HER2 positivity was similar in standard or novel method. In EU Definition 14.6% vs. 10.4% (p=0.52) were positive, respectively, with very good concordance (95.8%; κ=0.81).Concordance between HER2 positivity in standard or novel method was very good (99.0%; κ=0.96) in US definition with no significant differences (17.7% vs. 16.7%; p=1). Conclusions: Gene-protein platform has been tested for first time in gastric carcinoma. Results showed that this novel platform can be a feasible alternative to single methods. Discrepancies in cases with weak or moderate HER2 expression can be a result of observer variability.
The Duodenal Tube and Its Possibilities.
Journal: JAMA (1927)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
British General Practice
Journal: JAMA (2000)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
New thinking on alcohol related harm in older adults
Authors: Rahul (Tony) Rao
Journal: BMJ (2019)

Stewart and McCambridge draw attention to the interplay between alcohol consumption and multimorbidity in older people.1 Although the NHS long term plan missed the opportunity to tackle the rising number of older people experiencing alcohol related harm (the sharpest rise over the past 15 years),2 much progress has been made in prevention.

As a frontline clinician, I …
Vaping: CDC investigation continues after patient dies from severe lung injuries
Authors: Abi Rimmer, Gareth Iacobucci
Journal: BMJ (2019)

The US Centers for Disease Control and Prevention (CDC) is investigating whether a death and almost 200 cases of severe lung illness are related to electronic cigarette use. <b>Abi Rimmer</b> and <b>Gareth Iacobucci</b> explore the situation in the US and the UK
What type of information is needed by AYA cancer survivors in Japan?
Authors: Chikako Yamaki, Yuki Nakatani, Toshiko Sato, Hikaru Taniguchi, Tomoko Takayama
Journal: Journal of Clinical Oncology (2019)

e23165 Background: Cancer patients and survivors in the adolescents and young adults (AYA) generation often have a wide range of unmet needs, which include health related matters, communication problems, relationship difficulties, and life roles. Japanese AYA cancer survivors supposedly have these same unmet needs, but it is not clear which specific types of needs should be provided. The purpose of this study was to explore the support needs of Japanese AYA cancer survivors and to propose what type of information they should be provided. Methods: Eleven AYA cancer survivors and their families participated in group interviews. All participants were recruited from the Cancer-Civil Panel of Center for Cancer Control and Information Services, National Cancer Center Japan (NCC-CIS), which is commissioned by the NCC president to support NCC-CIS activities. Participants were asked about their 1) difficulties and painful issues during their cancer history, 2) information needs to handle those difficulties, and 3) willingness to support AYA patients suffering from cancer. Interviews were audio recorded and transcribed verbatim. Three researchers coded the transcripts and constructed the categories to be assessed. Results: Difficulties and painful issues were compiled into four categories: (1) physical and psychological pain that come directly from cancer, (2) uncertainty of the situation and the future, (3) isolation and alienation that come from his/her unique experiences, and (4) distress of facing painful families. Information and support needs included three categories: (1) detailed experiences from the patient’s view, (2) ways to face his/her cancer and life role as a survivor, and (3) role models or companies for sharing the same experiences. All participants expressed the willingness to support someone by the disclosure of their own experiences. Conclusions: Japanese AYA survivors had unmet information needs for both medical and lifelong psycho-social issues. They would like to have information about a variety of personal and subjective experiences in order to recommend possible future solutions. These findings suggest that personal and narrative experiences would support AYA survivors in their efforts to confront their uncertain future with cancer.
Growing older and wiser
Authors: Laura Nunez-Mulder
Journal: BMJ (2019)

Welcome back from summer holidays—and for freshers, welcome to medical school.

From your first patient to your first medical society social, this year is going to bring a lot of new experiences. To help you feel ready, Jaime Chan and I explain what to expect, how to prepare, and what to pack in your bag for the different parts of medical school (p 8). Elsewhere in the issue, we prepare you for two situations you might come across in clinical placements: a person vomiting fresh blood (p 34), and an older person who recently fell and seems confused (p 20).

“Some words lose their original meaning or convey unrelated messages; others become derogatory or insulting. In medicine, elderly is one such term: it is outdated, conjures up bias, and does harm.” (p 30) says Javat Hekmat-panah, professor …
The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study
Authors: Jaclyn A. Smith, Lorcan McGarvey, Alyn H. Morice, Surinder S. Birring, Jadwiga A. Wedzicha, Massimo Notari, Antonio Zapata, Rosa Segarra, Beatriz Seoane, Diana Jarreta
Journal: American Journal of Respiratory and Critical Care Medicine (2019)
Development and validation of the automated imaging differentiation in parkinsonism (AID-P): a multicentre machine learning study
Authors: Derek B Archer, Justin T Bricker, Winston T Chu, Roxana G Burciu, Johanna L McCracken, Song Lai, Stephen A Coombes, Ruogu Fang, Angelos Barmpoutis, Daniel M Corcos, Ajay S Kurani, Trina Mitchell, Mieniecia L Black, Ellen Herschel, Tanya Simuni, Todd B Parrish, Cynthia Comella, Tao Xie, Klaus Seppi, Nicolaas I Bohnen, Martijn LTM Müller, Roger L Albin, Florian Krismer, Guangwei Du, Mechelle M Lewis, Xuemei Huang, Hong Li, Ofer Pasternak, Nikolaus R McFarland, Michael S Okun, David E Vaillancourt
Journal: The Lancet Digital Health (2019)

There is a critical need to develop valid, non-invasive biomarkers for Parkinsonian syndromes. The current 17-site, international study assesses whether non-invasive diffusion MRI (dMRI) can distinguish between Parkinsonian syndromes.
Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis
Authors: Nicholas R. Jones, Andrea K. Roalfe, Ibiye Adoki, F.D. Richard Hobbs, Clare J. Taylor
Journal: European Journal of Heart Failure (2019)

Abstract Aim To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results We searched in relevant databases from inception to August 2018 for non‐interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta‐analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5‐year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co‐morbidities, and treatment rates. Conclusion These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence‐based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
NET-CAGE characterizes the dynamics and topology of human transcribed cis-regulatory elements
Authors: Shigeki Hirabayashi, Shruti Bhagat, Yu Matsuki, Yujiro Takegami, Takuya Uehata, Ai Kanemaru, Masayoshi Itoh, Kotaro Shirakawa, Akifumi Takaori-Kondo, Osamu Takeuchi, Piero Carninci, Shintaro Katayama, Yoshihide Hayashizaki, Juha Kere, Hideya Kawaji, Yasuhiro Murakawa
Journal: Nature Genetics (2019)
Appropriateness of imaging in lung cancer in a national cohort.
Authors: Leah M. Backhus, Farhood Farjah, Thomas K Varghese, Aaron Cheng, Xiao Hua Zhou, Douglas E. Wood, Larry Kessler, Steven B Zeliadt
Journal: Journal of Clinical Oncology (2013)

7546 Background: Rising healthcare costs prompt emphasis on quality, appropriate care, and cost containment. Imaging is a source of high healthcare expenditures in cancer. We sought to examine variability of adherence to national guidelines for staging, and appropriateness criteria for imaging for patients with locally advanced lung cancer. Methods: Stage IIB, IIIA, or IIIB lung cancer patients were identified from the national VA Central Cancer Registry from 2004-2008 with linkage to VA data and Medicare claims. Imaging was assessed 180 days pre and post diagnosis per National Comprehensive Cancer Network guidelines and American College of Radiology Appropriateness Criteria for Imaging. Multivariate logistic regression with robust variance estimates (adjusting for within-cluster correlation by facility) was used to control for covariates and results reported as adjusted risk differences (95% confidence intervals [CI]). Results: Recommended imaging was performed in 69.5% of patients for brain imaging and 51.1% of patients for positron emission tomography (PET). Overutilization, with combined bone scintigraphy and PET (BS/PET), occurred in 19.7% of patients and did not vary over time (15.8% to 19.5% p=0.168). Facilities affiliated with a medical school had a 14.8 (CI -25.2, -4.4) percentage point lower utilization of PET. Facility volume and tumor board availability were not associated with variability. Appropriateness of imaging varied significantly by region. New England had the highest rates of imaging. Relative to New England, brain imaging was lowest in the Great Basin Region with 26.9 (-40.0, -14.0) percentage point decrease. Both recommended PET use and overutilization of BS/PET was lowest in the Mississippi Region with 25.0 (CI -49.3, -0.6) and 11.7 (CI – 23.3, -0.1) percentage point decrease respectively compared to New England. Conclusions: A significant proportion of patients do not receive recommended imaging and many undergo excessive imaging for lung cancer. Furthermore, there is substantial regional variation in imaging utilization. These observations are hallmarks of poor quality. A disease-based quality improvement plan aimed at modification via policy and reimbursement initiatives may mitigate poor quality care.
National society-supplied patient materials on prostate cancer screening for the general public: A readability analysis.
Authors: Michael Kevin Rooney, Alicia K. Morgans, Joshua J Meeks, Shilajit Kundu, Edward M. Schaeffer, Maha H. A. Hussain, John A. Kalapurakal, Sean Sachdev
Journal: Journal of Clinical Oncology (2019)

e23188 Background: Recent data suggest that prostate cancer mortality may be increasing for the first time in 20 years, possibly related to a decrease in PSA screening. Most professional societies recommend men aged 55 to 69 make screening decisions using a shared-decision making (SDM) model. However the quality and time of SDM can vary significantly, often leaving patients uncertain about the implications of pursuing or foregoing screening. In this setting of individualized decisions, patients may seek supplemental information. However, little is known about the accuracy, breadth and readability of available education materials, which if designed optimally could improve SDM. Methods: For 11 predetermined professional societies (ACP, ACPM, ACS, AFP, AMA, ASCO, AUA, CDC, NCI, NIH, USPSTF), patient education materials designed for prostate cancer screening were queried. Materials were analyzed using seven well-validated readability metrics and evaluated for educational content. For content comparison, 10 materials from academic cancer centers and independent organizations were identified using top public search engine results. Results: We identified 12 professional society materials and 20 from popular non-society sources. Mean readability level for society materials ranged from 9.7 to 11.3 grade, well above AMA and NIH recommended 6 th and 8 th grade reading levels (P &lt; 0.0001). In comparison to general materials, professional society materials more often discussed the role of risk factors in making screening decisions (70% vs 100%, P = 0.03). However, society materials did often omit important guideline-based content, including statements that decisions should involve patient values and preferences (42%) and can vary by patient age (35%). Conclusions: Widely available prostate cancer screening education materials are written at inappropriately high reading levels and often omit important content. Improvement of such materials would encourage SDM for patients considering screening.[Table: see text]
Risk Factors and Outcomes Associated With Treatment of Asymptomatic Bacteriuria in Hospitalized Patients
Authors: Lindsay A. Petty, Valerie M. Vaughn, Scott A. Flanders, Anurag N. Malani, Anna Conlon, Keith S. Kaye, Rama Thyagarajan, Danielle Osterholzer, Daniel Nielsen, Gregory A. Eschenauer, Sarah Bloemers, Elizabeth McLaughlin, Tejal N. Gandhi
Journal: JAMA Internal Medicine (2019)

Treatment of asymptomatic bacteriuria (ASB) with antibiotics is a common factor in inappropriate antibiotic use, but risk factors and outcomes associated with treatment of ASB in hospitalized patients are not well defined.To evaluate factors associated with treatment of ASB among hospitalized patients and the possible association between treatment and clinical outcomes.A retrospective cohort study was conducted from January 1, 2016, through February 1, 2018, at 46 hospitals participating in the Michigan Hospital Medicine Safety Consortium. A total of 2733 hospitalized medical patients with ASB, defined as a positive urine culture without any documented signs or symptoms attributable to urinary tract infection, were included in the analysis.One or more antibiotic dose for treatment of ASB.Estimators of antibiotic treatment of ASB. Secondary outcomes included 30-day mortality, 30-day hospital readmission, 30-day emergency department visit, discharge to post-acute care settings, Clostridioides difficile infection (formerly known as Clostridium difficile) at 30 days, and duration of hospitalization after urine testing.Of 2733 patients with ASB, 2138 were women (78.2%); median age was 77 years (interquartile range [IQR], 66-86 years). A total of 2259 patients (82.7%) were treated with antibiotics for a median of 7 days (IQR, 4-9 days). Factors associated with ASB treatment included older age (odds ratio [OR], 1.10 per 10-year increase; 95% CI, 1.02-1.18), dementia (OR, 1.57; 95% CI, 1.15-2.13), acutely altered mental status (OR, 1.93; 95% CI, 1.23-3.04), urinary incontinence (OR, 1.81; 95% CI, 1.36-2.41), leukocytosis (white blood cell count >10 000/μL) (OR, 1.55; 95% CI, 1.21-2.00), positive urinalysis (presence of leukocyte esterase or nitrite, or >5 white blood cells per high-power field) (OR, 2.83; 95% CI, 2.05-3.93), and urine culture with a bacterial colony count greater than 100 000 colony-forming units per high-power field (OR, 2.30; 95% CI, 1.83-2.91). Treatment of ASB was associated with longer duration of hospitalization after urine testing (4 vs 3 days; relative risk, 1.37; 95% CI, 1.28-1.47). No other differences in secondary outcomes were identified after propensity weighting.Hospitalized patients with ASB commonly receive inappropriate antibiotic therapy. Antibiotic treatment did not appear to be associated with improved outcomes; rather, treatment may be associated with longer duration of hospitalization after urine testing. To possibly reduce inappropriate antibiotic use, stewardship efforts should focus on improving urine testing practices and management strategies for elderly patients with altered mental status.