tbuckley/cabot-search huggingface dataset:
Perceptions of cancer care coordination in patient-family caregiver dyads.
Authors: Izumi Okado, Ian Pagano, Tracey Hewitt, Kelnia Azevedo, Cherie Guillermo, Erin Fukaya, Kasimira Chirieleison, Kevin Cassel, Randall F. Holcombe
Journal: Journal of Clinical Oncology (2020)

e14036 Background: Family caregivers (FCGs) can play a key role in coordinating care for cancer patients. However, little is known about FCGs’ perspectives of care coordination (CC). In this cross-sectional study, we evaluated perceptions of CC in cancer patient-family caregiver dyads using the Care Coordination Instrument (CCI), a validated self-report measure with excellent psychometric properties. Methods: Patients receiving active treatment for cancer and their primary FCGs (N = 54 dyads) completed the 29-item CCI (patient) and the CCICG (a parallel FCG version) at private oncology practices or hospital-based facilities from June to Sept. 2019. The CCI and CCICG assess overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The CCICG includes a supplemental questionnaire that assesses the degree of caregiver CC involvement on a 4-point Likert scale. Mixed regression models were used to examine differences between patients and FCGs’ perceptions of CC and to identify predictors of dyadic differences on the CCI scores. Pearson’s correlation was used to evaluate associations between FCGs’ perceptions of CC and the degree of caregiver involvement. Results: CCICG Total scores demonstrated a bimodal distribution, representing FCGs’ perceptions of CC in distinct high and low subgroups; thus, all analyses were conducted by subgroups (highCG, lowCG). Overall, no dyadic differences were found in the highCG group on the CCI scores. However, in the lowCG group, FCGs reported poorer Total (p < .01), Communication (p < .01), Navigation (p < .01), and Operational (p < .05) scores than patients. Provider setting (private practices) and the absence of an identified patient navigator significantly predicted poorer FCG Total scores compared to patients’ perceptions (p < .05). FCGs’ Total scores were inversely associated with the degree of caregiver involvement among FCGs in the lowCG group (p < .05) but not among FCGs in the highCG group. Conclusions: Our findings demonstrate that a subgroup of FCGs has poorer perceptions of CC that differ significantly from patient perceptions and is most apparent for patients receiving treatment in a private practice setting and in the absence of a patient navigator. These FCGs report a high degree of caregiver involvement and may be providing additional CC support that is not recognized by cancer patients. These findings underscore the need for interventions to support FCG CC involvement as a member of the care team in order to improve the quality and value of patient-centered cancer care delivery.
Influence of narrow-band ultraviolet B on serum vitamin D3 for patients with atopic dermatitis
Authors: Zequn Miao
Journal: BMJ (2015)

To explore the clinical efficacies of narrow-band ultraviolet B (NB-UVB) for atopic dermatitis (AD). Thirty AD patients (observation group) and 30 homochromous healthy volunteers (control group) were compared. The post-treatment scores of Scoring AD (SCORAD) and visual analogue scale (VAS) [(29.4±9.5) & (3.2±1.1) points] were lower significantly those pre-treatment [(60.7±11.4) & 6.3±1.6) points] (P 0.05). And the pre-treatment serum levels of 25(OH)D3 and 1, 25(OH)2D3 were all significantly lower in observation group than those in control group (P<0.01). Thus NB-UVB therapy is both safe and effective for AD and it can boost significantly the serum level of vitamin D3.


Key words: 
Dermatitis, atopic; Vitamin D3
Perceived value of cancer survivorship care among Asians and Native Hawaiian/Pacific Islanders.
Authors: Jared David Acoba, Sharon Tamashiro, Marci Chock
Journal: Journal of Clinical Oncology (2020)

e22522 Background: Numerous studies have evaluated the impact of cancer survivorship care. However, no study to date has focused on Asian or Native Hawaiian/Pacific Islander (NH/PI) cancer survivors. It has been well documented that Asian and NH/PI patients often suffer from inferior cancer outcomes compared to White patients, and differences in their experience with cancer survivorship care could contribute to this disparity. Methods: Surveys were sent to 1410 cancer survivors who were treated at a community cancer center with curative intent and who had received survivorship care plans between Jan 2014 and June 2018. The 26-item questionnaire evaluated patients’ perception of various aspects of their survivorship care plan and follow-up physician visits. All responses were anonymous. Results: Of the 360 patients who responded, 24% were White, 54% Asian, and 13% NH/PI. Compared to Whites, Asian and NH/PI patients were younger (p = 0.004), less educated (p = 0.004), and reported a lower income (p &lt; 0.0005). Among all patients, 62% reported that the survivorship care plan was “very helpful” and 86% rated their satisfaction with physician follow-up visits as “very good” to “excellent.” There were no racial differences in satisfaction with either survivorship care plan or physician follow-up. In a multivariate binary logistic regression, Asians and NH/PI patients were significantly more likely to rate ongoing survivorship care as helpful compared to Whites, OR 4.08 (95%CI, 2.13-7.82). Conclusions: There were no racial differences in patient satisfaction with their survivorship care plans and follow-up care. However, Asian and NH/PI patients valued ongoing cancer survivorship care follow-up significantly more than White patients. Whether more extensive survivorship care would lead to improved outcomes among Asian and NH/PI cancer patients should be investigated further.
ACT for prevention and prophylaxis of cancer-associated thrombosis (CAT).
Authors: Nikolaos Tsoukalas, Athina Christopoulou, Christos N Papandreou, Nikolaos Kapodistrias, Anna Koumarianou, Stavros Peroukidis, Haralabos Kalofonos, Georgios Samelis, Charalampos Andreadis, Alexandros Ardavanis, Epaminontas Samantas, Alexandros Bokas, Athanasios Ligdas, Ilias Athanasiadis, Vasileios Barbounis, Nikolaos K. Kentepozidis, Dimitrios Mavroudis, Athanasios Athanasiadis, Pavlos Papakotoulas, Ioannis Boukovinas
Journal: Journal of Clinical Oncology (2020)

e14135 Background: CAT is the 2 nd leading cause of death in oncology patients and there is need for thrombosis management across the natural history of cancer because of its dynamic nature. Anticoagulant therapy is the cornerstone of prevention and treatment, since thrombosis interferes with cancer treatment, increases health care resource utilization, imposes emotional and economic burden. Methods: A prospective observational study conducted by HeSMO across Greece, aiming to record the clinical practice of CAT prophylaxis in patients with solid tumors. Ambulatory, high risk for thrombosis, active cancer patients who received thromboprophylaxis are enrolled after signing informed consent. Results: Preliminary results are collected from 17 oncology departments. From the 272 enrolled patients, 176 (64.7%) have completed second visit (3-4 cycles of anticancer treatment). Primary cancers included: lung 31.3%, pancreas 26.1%, colorectal 13.6%, gynecological cancers 10.2%, stomach 7.8%, bladder 6.3%, and others.75.6% of the patients had metastatic disease. 1/3 of the patients were smokers or ex-smokers, and 33% underwent surgery. Most of patients (65.9%) were at 1 st line treatment and 17.6% at 2 nd line. The vast majority (90.3%) were treated with High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) such as cisplatin etc. Regarding Khorana score, 65.1% had ≥2. In particular, 86.7% of patients with Khorana score ≤1 received HRTCAs while 95.4% of patients with score = 2.All patients received thromboprophylaxis, specifically: 93.0% tinzaparin, 5.2% fondaparinux and 1.8% other (enoxaparin, bemiparin) with average duration 5.3±3.1 months. 67.1% of the patients received higher than standard prophylactic doses. 3 patients (1.7%) experienced thrombotic events (2 DVT and 1 PE). These 3 patients had metastases and were treated with HRTCAs. Five grade 1 bleeding events were reported (2.8%). Conclusions: Thromboprophylaxis of CAT is both safe and effective. Oncologists are alerted about CAT negative influences in cancer patients’ prognosis. Apart from Khorana score, factors such as metastases, use of HRTCAs along with drug-drug interactions, increase the LMWHs usage often in higher than prophylactic doses in CAT management. Clinical trial information: NCT03909399.
Risk factors of atrial fibrillation in hyperthyroidism patients
Authors: Danyang Sun, Wei Li, Wei Zheng, Guizhi Zhang, Jian Tan
Journal: BMJ (2019)

Objective
To investigate the risk factors of atrial fibrillation (AF) in hyperthyroidism patients.


Methods
The clinical data of 557 patients with hyperthyroidism receiving 131I treatment from January 2015 to May 2018 were enrolled in the study. There were 50 cases with AF and 507 patients without AF before the treatment. Univariate and multivariate logistic regression were applied to analyze the risk factors of AF in hyperthyroidism patients.


Results
Compared to non-AF patients, AF patients had older age [(59.1±10.6) vs. (41.9±13.7) years, t=6.75, P<0.01], more males[42.0%(21/50] vs. 19.7%(100/507), χ2=14.11, P<0.01], longer duration of hyperthyroidism [66.0 (6.8, 120.0) vs. 12.0(3.0, 72.0) months, Z=2.83, P=0.02], higher prevalence of coronary artery disease [16.0%(8/50) vs. 2.6%(13/507)] and hypertension[30.0%(15/50) vs. 9.3%(47/507)], higher serum creatinine (SCr) [51.5(46.0, 64.3) vs. 42.0(35.0, 51.0) μmol/L, Z=4.62, P<0.01], serum uric acid (SUA) [(360.6±90.3) vs. (313.4±80.3) μmol/L, t=3.76, P<0.01]and gamma-glutamy transpeptidase (GGT)[72.1 (38.0, 97.0) vs. 42.2(17.0,48.8) U/L, Z=4.97, P<0.01] and total bilirubin (TBIL) (21.3±8.8) vs. (13.8±7.7) U/L, t=5.26, P<0.01], direct bilirubin(DBIL)[12.6(7.9,17.4) vs. 5.5(4.1,7.9)μmol/L, Z=6.62, P=0.00)]and lower blood platelet (PLT) [(188.5±60.8) ×109/L vs. (241.0±65.1)×109/L, t=4.52, P<0.01]. And there were no significant differences in thyroid hormone level and thyroid autoimmune antibody levels. Univariate and multivariate analysis showed that the age (OR=1.23, 95%CI: 1.09-1.38, P<0.01), SUA (OR=1.01, 95%CI: 1.00-1.20, P=0.05), DBIL (OR=1.65, 95%CI: 1.01-2.72, P=0.05), GGT (OR=1.04, 95%CI: 1.01-1.08, P=0.01) were risk factors for AF in patients with hyperthyroidism.


Conclusion
Older age, abnormal serum SUA, DBIL and GGT are risk factors for atrial fibrillation in patients with hyperthyroidism, to timely control hyperthyroid and to give symptomatic treatment for those patients are necessary.


Key words: 
Hyperthyroidism; Atrial fibrillation; Hyperuricemia; Bilirubin; Risk factors
美国社区医疗的构成及系统支持
Authors: 杨雪松
Journal: BMJ (2007)

2006年5月,作为卫生部医院与公共卫生管理研修班的成员,走访了美国北卡罗来那州Cumberland县的cape fear valley health system(GFVHS)医疗集团、县卫生局以及南部地区卫生教育中心(southern regional area health education center,SRAHEC),对当地的医院及社区医疗、继续医学教育有了一些了解,并和同行的美方教师及国内同行进行了探讨,有很多感触,特别是对于美国的社区医疗和医学教育体系留下了较深刻的印象。
Identifying functional loss of <i>ATM</i> gene in patients with advanced cancer.
Authors: Patrick Glen Pilie, Jinesh S. Gheeya, Keith Kyewalabye, Rohit Vivek Goswamy, Khalida M Wani, Hung Le, Erick Campbell, Nora Sylvia Sanchez, Dong Yang, Benjamin Garmezy, Ecaterina Elena Ileana Dumbrava, Jordi Rodon Ahnert, Timothy Heffernan, Vijaykumar Holla, Kenna Rael Shaw, Funda Meric-Bernstam, Alexander J. Lazar, Wei-Lien Wang, Timothy A Yap
Journal: Journal of Clinical Oncology (2020)

3629 Background: ATM is frequently mutated in cancer, and defects may serve as a putative predictive biomarker. However, the functional impact of most ATM variants is not well known. In this study, we examined the relationship between ATM variants and ATM protein expression to better discern ATM functional defects in patients (pts) with advanced cancer. Methods: We retrospectively identified pts seen at MD Anderson Cancer Center who had ATM variants detected on CLIA-certified next generation sequencing (NGS) assays. ATM immunohistochemistry (IHC) was performed on available tumors. We then prospectively assessed ATM IHC on tumors from pts who were referred for DNA damage repair inhibitor (DDRi) trials. Functional classification of the variants was performed via published in silico tools and/or precision oncology decision support (PODS). An IHC cut-off of 100% loss in tumor cell nuclei defined ATM loss of protein (LOP). Results: Of 1394 ATM-mutant tumors identified retrospectively, ATM alterations were classified as 16% (N = 216) inactivating, 12% (N = 163) potentially inactivating, 71% (N = 993) variant of unknown significance (VUS), and 2% (N = 22) benign. Coding variants were seen across the ATM exonic structure/splice sites, and 20 individual variants were shared in &gt; 10 pts. 263/297 available retrospective tumor samples had interpretable IHC results; 27% (N = 72) had ATM LOP. LOP was most prevalent in tumors with inactivating ATM variants (39/100, 39%); but, importantly, LOP was seen in 20% (N = 33/162) of potentially inactivating/VUS, thus better clarifying their functional impact. In the prospective cohort of 217 pt tumors, 17% (N = 37) had ATM LOP. 29% (N = 62/217) of this cohort also had ATM variants. ATM LOP was seen in 48% of tumors with inactivating variants (N = 14/29), 25% of tumors with potentially/VUS(N = 9/36), and 9% (N = 14/156) of tumors without ATM variants identified. ATM LOP was detected most commonly in colorectal (24%; N = 8/34), cholangiocarcinoma (20%; N = 6/30), prostate (16%; N = 16/104) and pancreatic (9%; N = 1/11) cancers among this cohort of pts referred for DDRi trials. Conclusions: ATM coding variants occurred across the gene, with certain variants shared across tumor types. The functional impact of most ATM variants was VUS, and ATM LOP can help clarify function in up to 25% of these VUS. Also, ATM LOP can be seen even in tumors without ATM variants identified, suggesting epigenetic or post-translational loss. Future prospective studies assessing predictive capability of paired DNA and protein-level profiling of ATM are warranted.
A whole transcriptome sequencing (WTS)-based cMet dysregulation biomarker assay with correlates to cMet DNA mutations and cMet protein expression.
Authors: Xiaoling Zhang, Phillip Stafford, Brian Baker, Jeffery Kimbrough, Fabio M. Benedetti
Journal: Journal of Clinical Oncology (2020)

e15676 Background: Selective cMet kinase inhibitors (cMet-i) have demonstrated promising clinical activity as single-agents in non-small cell lung cancer (NSCLC) with cMet exon-14 skip mutations (MET∆14). APL-101 (PLB-1001) is a selective cMet-i and has demonstrated single-agent anti-tumor activity in secondary glioblastoma (GBM) harboring MET∆14 and/or MET fusion with evidence of blood-brain barrier permeability (Cell. 2018, 175: 1665-1678). A WTS-based cMet biomarker assay is being developed under Caris MI Transcriptome platform to predict clinical response to monotherapy APL-101 in tumors with cMet dysregulation (NCT03175224). Methods: In a pilot study, we used Caris WTS to analyze 202 patient samples of NSCLC (78%) and other tumor types (22%) mostly GBM and gastrointestinal tumors to establish key parameters of Caris WTS in detection of cMet dysregulation. These samples were also analyzed by DNA-seq and IHC to understand the correlations of Caris WTS to DNA-based cMet mutation detection and cMet protein expression. The samples included 63 (31%) MET∆14, 48 (24%) MET fusions based on WTS and covered a broad dynamic range in cMet expression and copy number variations. In order to establish a stable baseline against which to compare MET mRNA expression, 123 unique tissue samples from 93 unique non-tumor tissues covering 27 unique tissue types were analyzed for wild-type MET expression. Results: Concordance between WTS and DNA-seq in detection of MET∆14 was 84% based on 67 cases analyzed by both methods. WTS identified 45% positive MET∆14, compared to 35% by DNA-seq. Out of 11 discordant cases, 9 were positive by WTS and 2 positive by DNA-seq. The number of transcripts carrying MET∆14 variants correlated with cMet wild type mRNA expression (n = 63, r = 0.88, p&lt; 0.0001). cMet mRNA expression correlated with total cMet protein by IHC in MET fusion subset (n = 43, ρ = 0.65, p= &lt; 0.0001), MET∆14 subset (n = 55, ρ = 0.64, p&lt; 0.0001), and in all samples (n = 175, ρ = 0.75, p&lt; 0.0001). In 175 cases with both WTS and IHC results, 9 MET∆14 positive cases had no detectable cMet protein on plasma membrane albeit all showed a detectable level of total cMet protein. Conclusions: A cMet WTS assay has been established to identify patients with cMet dysregulation including MET∆14 and MET fusion. cMet IHC and DNA-seq may offer secondary utility to differentiate WTS-identified METΔ14 patients to further strengthen the prediction of clinical response to a cMet inhibitor.
Should Percutaneous Coronary Intervention Be Considered for Left Main Coronary Artery Disease?
Authors: Sanjay Kaul
Journal: JAMA Internal Medicine (2020)

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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Internal Medicine journal
Prevalence of irritable bowel syndrome in adults of a Shanghai community
Authors: Yu-miao Wu
Journal: BMJ (2011)

A survey on the prevalence of irritable bowel syndrome (IBS) was conducted in 595 adults from Changzheng Community of Shanghai. The results showed that 73 out of 595 subjects had irritable bowel syndrome (according to the Rome Ⅲ criterion) with a prevalence rate of 12.3%. There were significant differences in prevalence of IBS among residents with different ages and jobs, and with or without depression (P < 0. 05, or 0. 01). The findings indicate that the prevalence rate of IBS is high in community,so attention should be paid in general practice.

Key words: 
Irritable bowel syndrome
Association of depression with microinflammation, serum zinc level, and malnutrition in maintenance hemodialysis patients
Authors: Chun-hua Zhang, Shen Shen, Shi-xiang Wang
Journal: BMJ (2012)

Objective To investigate the prevalence of depression in maintenance hemodialysis (MHD) patients. Additionally,to explore the relationship between depression and microinflammation,serum zinc levels and malnutrition in MHI) patients.Methods One hundred fifty-seven MHD patients were enrolled in this study.The patients were divided into two groups:depressed patients and non-depressed patients,according to the Beck Depression Inventory.The following data were collected:social factors,biochemical index,serum zinc levels,malnutrition-inflammation (MIS) score and IPI score.Binary logistic regression analysis was performed.Results Symptoms of depression were exhibited by 45.2％ of MHD patients (71/157 ).Symptoms of moderate or severe depression were exhibited by 24.2 ％ of the patients ( 38/157 ).However,signicant differences were shown in age [( 62 ± 11 ) vs.( 50 ± 13 ) years old],MIS score [( 7.2 ± 2.2 ) vs.( 3.3 ± 1.6 ) scores],white blood cell count [( 6.4 ± 1.8 ) × 109/L vs.( 5.8 ±1.5) × 109/L],high sensitivity C-reactive protein (hsCRP) [(9 ±6) vs.(4 ±4) mg/L],hemoglobin [(10.7±1.5) vs.(11.3±1.5) g/L],albumin[(33±4) vs.(37 ±3) g/L],fasting glucose [(6.7±3.5) vs.(5.6±2.1) mmol/L],serum zinc [(8.5±2.6) vs.(10.1 ±2.9) μmol/L] between depressed patients and non-depressed patients ( All P ＜ 0.05 ). Binary logistic regressive analysis revealed that the independent risk factors of depression in MHD patients were their MIS score ( OR =2.908,95％ CI =2.037 -4.151 ),as well as their hsCRP( OR =1.217,95％ CI=1.075 - 1.370),serum zinc and fasting glucose levels(OR=1.315,95％CI=1.039 - 1.664).Conclusions There was a high prevalence of depression in MHD patients.Depression is also highly correlated with microinflammation,serum zinc levels,and malnutrition.MIS scores,hsCRP,serum zinc levels and fasting glucose levels.

Key words: 
Renal dialysis;  Depression ;  Inflammation;  Zinc;  Malnutrition
Phase II study of eribulin and pembrolizumab in patients (pts) with metastatic soft tissue sarcomas (STS): Report of LMS cohort.
Authors: Michael Nathenson, Edwin Choy, Neena D Carr, Hayley D Hibbard, Emanuele Mazzola, Paul J. Catalano, Katherine Anne Thornton, Jeffrey A. Morgan, Gregory Michael Cote, Priscilla Merriam, Andrew J. Wagner, George D. Demetri, Suzanne George
Journal: Journal of Clinical Oncology (2020)

11559 Background: Responses to single agent PD-1/PD-L1 inhibitors in STS remain limited with occasional responses in undifferentiated pleomorphic sarcomas (UPS), liposarcomas (LPS), and other sarcomas, and rare responses in leiomyosarcoma (LMS). Since cytotoxics and/or targeted therapies such as CDK4/6 inhibitors may alter the tumor microenvironment (TME) and potentiate the effect of immunotherapy, combination approaches may be needed to potentiate STS immunotherapy. The mechanism by which eribulin controls LPS may involve TME modification, and therefore it is attractive to test in combination with pembrolizumab in STS subtypes. This report summarizes the results from the LMS cohort from this ongoing trial. Methods: Pts treated with at least one prior therapy received eribulin 1.4mg/m2 (day 1, 8) and pembrolizumab 200mg (day 1), every 21 days. Pts continued therapy until progressive disease, death, or unacceptable toxicity. Primary endpoint was progression-free survival (PFS) at 12 weeks, with 60% PFS at 12 weeks required to deem the combination promising. Tumor assessments (RECIST 1.1) were performed at screening and every 6 weeks thereafter. Secondary endpoints included overall survival (OS), objective response rate (ORR), and clinical benefit rate (CBR). Results: Nineteen pts with LMS were enrolled from May 2019 to Sept 2019. The median age was 62 (range 48-80). Eleven (58%) patients had uterine LMS. The median # of prior therapies was 4 (range 1-7). The median follow-up was 19.7 weeks. The PFS at 12 weeks was 42.1% (90% CI: 27.0%-65.5%), with median PFS of 11.1 weeks. Median OS was not reached during the follow-up period. There was 1 partial response, and 5 confirmed stable disease for ORR of 5.3% and CBR of 26.3%, after 12 weeks. The rate of grade 3 or higher toxicity was 68% overall, most commonly neutropenia, anemia, weight loss, diarrhea, elevations of lipase, and alkaline phosphatase. These side effects were reversible. The most common adverse events were fatigue, neutropenia, anorexia, AST increase, and nausea. Conclusions: Eribulin and pembrolizumab in LMS did not meet the predefined endpoint for efficacy. The LPS and “other STS subtype” cohorts of this trial are actively enrolling. Clinical trial information: NCT03899805 .