tbuckley/cabot-search huggingface dataset:
The prognostic significance of non‐sentinel lymph node metastasis in cutaneous and acral melanoma patients—A multicenter retrospective study
Authors: Wei Sun, Yu Xu, JiLong Yang, ZhiChao Liao, Tao Li, Kai Huang, Poulam Patel, WangJun Yan, Yong Chen
Journal: Cancer Communications (2020)

Abstract Background Whether non‐sentinel lymph node (SLN)‐positive melanoma patients can benefit from completion lymph node dissection (CLND) is still unclear. The current study was performed to identify the prognostic role of non‐SLN status in SLN‐positive melanoma and to investigate the predictive factors of non‐SLN metastasis in acral and cutaneous melanoma patients. Methods The records of 328 SLN‐positive melanoma patients who underwent radical surgery at four cancer centers from September 2009 to August 2017 were reviewed. Clinicopathological data including age, gender, Clark level, Breslow index, ulceration, the number of positive SLNs, non‐SLN status, and adjuvant therapy were included for survival analyses. Patients were followed up until death or June 30, 2019. Multivariable logistic regression modeling was performed to identify factors associated with non‐SLN positivity. Log‐rank analysis and Cox regression analysis were used to identify the prognostic factors for disease‐free survival (DFS) and overall survival (OS). Results Among all enrolled patients, 220 (67.1%) had acral melanoma and 108 (32.9%) had cutaneous melanoma. The 5‐year DFS and OS rate of the entire cohort was 31.5% and 54.1%, respectively. More than 1 positive SLNs were found in 123 (37.5%) patients. Positive non‐SLNs were found in 99 (30.2%) patients. Patients with positive non‐SLNs had significantly worse DFS and OS (log‐rank P &lt; 0.001). Non‐SLN status ( P = 0.003), number of positive SLNs ( P = 0.016), and adjuvant therapy ( P = 0.025) were independent prognostic factors for DFS, while non‐SLN status ( P = 0.002), the Breslow index ( P = 0.027), Clark level ( P = 0.006), ulceration ( P = 0.004), number of positive SLNs ( P = 0.001), and adjuvant therapy ( P = 0.007) were independent prognostic factors for OS. The Breslow index ( P = 0.020), Clark level ( P = 0.012), and number of positive SLNs ( P = 0.031) were independently related to positive non‐SLNs and could be used to develop more personalized surgical strategy. Conclusions Non‐SLN‐positive melanoma patients had worse DFS and OS even after immediate CLND than those with non‐SLN‐negative melanoma. The Breslow index, Clark level, and number of positive SLNs were independent predictive factors for non‐SLN status.
Acute on-snow severe injury events in elite alpine ski racing from 1997 to 2019: the Injury Surveillance System of the Austrian Ski Federation
Authors: Michael Barth, Hans-Peter Platzer, Anton Giger, Werner Nachbauer, Peter Schröcksnadel
Journal: British Journal of Sports Medicine (2020)

Objectives The study aimed to (1) determine the incidence and gender-specific risk ratio of acute on-snow severe injury events (SIE) in elite alpine ski racing, (2) examine the development of SIE over 22 seasons, and (3) analyse SIE with respect to the severely injured body parts and structures. Methods Data recorded in the Austrian Ski Federation’s Injury Surveillance System over 22 seasons were analysed. The Austrian Ski Team consists of four groups: Team National (n=477), Team A (n=444), Team B (n=696) and Team C (n=608). Team National and Team A comprised World Cup, Team B European Cup and Team C junior alpine ski racers. Simple and multiple Poisson regressions were calculated. Results The SIE incidence was 15.7 (95% CI 14.2 to 17.5) per 100 skier seasons. ACL injury events accounted for 70.8% of severe knee injury events and 48.6% of SIE. The incidence of severe ACL injury events was 7.6 (95% CI 6.6 to 8.9). Female World Cup alpine ski racers had a 1.65 times (95% CI 1.02 to 2.69) higher risk of severe ACL injury events than their male counterparts. Conclusion The incidence of acute on-snow SIE in World Cup alpine ski racing was higher than previously reported. Despite various prevention efforts, the average seasonal incidence of SIE in World and European Cup alpine ski racers has grown from approximately 11 in 1997 to 23 in 2019; thus with roughly one more injured athlete every second season.
Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge
Authors: Michelle P. Lin, Ryan C. Burke, E. John Orav, Tynan H. Friend, Laura G. Burke
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Ambulatory follow-up care is frequently recommended after an emergency department (ED) visit. However, the frequency with which follow-up actually occurs and the degree to which follow-up is associated with postdischarge outcomes is unknown. <h3>Objectives</h3> To examine the frequency and variation in ambulatory follow-up among Medicare beneficiaries discharged from US EDs and the association between ambulatory follow-up and postdischarge outcomes. <h3>Design, Setting, and Participants</h3> This cohort study of 9 470 626 ED visits to 4728 US EDs among Medicare beneficiaries aged 65 and older from 2011 to 2016 who survived the ED visit and were discharged to home used Kaplan-Meier curves and proportional hazards regression. Data analysis was conducted from December 2019 to July 2020. <h3>Exposures</h3> Ambulatory follow-up after discharge from the ED. <h3>Main Outcomes and Measures</h3> Postdischarge mortality, subsequent ED visit, or inpatient hospitalization within 30 days of an index ED visit. <h3>Results</h3> The study sample consisted of 9 470 626 index outpatient ED visits to 4684 EDs; most visits (5 776 501 [61.0%]) were among women, and the mean (SD) age of patients was 77.3 (8.4) years. In this sample, the cumulative incidence of ambulatory follow-up was 40.5% (3 822 133 patients) at 7 days and 70.8% (6 662 525 patients) at 30 days, after accounting for censoring and for mortality as a competing risk. Characteristics associated with lower rates of ambulatory follow-up included beneficiary Medicaid eligibility (hazard ratio [HR], 0.77; 95% CI, 0.77-0.78;<i>P</i> &lt; .001), Black race (HR, 0.82; 95% CI, 0.81-0.83;<i>P</i> &lt; .001), and treatment at a rural ED (HR, 0.75; 95% CI, 0.73-0.77;<i>P</i> &lt; .001) in the multivariable regression model. Ambulatory follow-up was associated with lower risk of postdischarge mortality (HR, 0.49; 95% CI, 0.49-0.50;<i>P</i> &lt; .001) but higher risk of subsequent inpatient hospitalization (HR, 1.22; 95% CI, 1.21-1.23;<i>P</i> &lt; .001) and ED visits (HR, 1.01; 95% CI, 1.00-1.01;<i>P</i> &lt; .001), adjusting for visit diagnosis, patient demographic characteristics, and chronic conditions. <h3>Conclusions and Relevance</h3> In this cohort study of Medicare beneficiaries discharged from the ED, nearly 30% lacked ambulatory follow-up at 30 days, with variation in follow-up rates by patient and hospital characteristics. Having an ambulatory follow-up visit was associated with higher risk of subsequent hospitalization but lower risk of mortality. Ambulatory care access may be an important driver of clinical outcomes after an ED visit.
Is there any health and geographical disparity in indigenous and non-indigenous women of Western Australia (WA)? A retrospective review with respect to de novo metastasis.
Authors: Azim Khan, Hilary Laura Martin, Lisa Spalding, Andrew David Redfern
Journal: Journal of Clinical Oncology (2020)

115 Background: Indigenous women with breast cancer have substantially higher mortality then non-Indigenous women. They are more likely to live in more remote communities with potential delays to presentation, investigation and diagnosis as well as slower access to cancer treatment facilities, potentially impacting survival. Here we explore by evaluating the diagnosis of de-novo metastasis and any association of remoteness, highlighting the geographic and possibly early access to treatment. Methods: A cohort of patients was retrospectively selected comprising age- and remoteness matched Indigenous and non-Indigenous women in a 1:1 ratio from the Western Australian Cancer Registry. Further data were collected from medical records and results systems. Remoteness was defined by the ARIA system. In addition, the distance from the nearest treatment center was calculated. The survival analysis was performed by Indigenous status and remoteness. Results: The final cohort comprised 250 Indigenous and 261 non–Indigenous women. Of the total, 7.6% (19/250) and 7.7% (20/261) were identified to have de-novo metastasis. At 10 years of follow up, most de-novo metastatic patients in both groups were from remote communities, distributed as 10.1, 9.1, 7.8, 8.7 and 5.0 % in metropolitan, inner regional, outer regional, remote and very remote areas respectively. In Indigenous group with de-novo metastasis the average distance of patient from treatment center was 1720km for vs 1018 km in Non-Indigenous patient with a p-value of 0.03. In non-metastasis cohort, Indigenous patient has 1065 km v 1241 km in non-indigenous group. Considering outcomes for those developing metastatic disease, median survivals after metastatic diagnosis were shorter for Indigenous patients, 21 v 33 months, p = 0.03. Conclusions: Indigenous women in WA with metastatic breast cancer have inferior survival outcomes from diagnosis of metastases relative to non-Indigenous peers. Most de-novo metastatic patients were from remote locations in both cohorts but no relation between remoteness and de-novo metastasis, identified to be impacting survival. Future studies are needed to better elucidate if any geographical, health care disparities and improve on treatment related outcomes. It is suggested to derive targeted policies to improve survival outcome of all Indigenous cancer patients, particularly those residing in remote areas.
Helen Salisbury: Older lives are not worth less
Authors: Helen Salisbury
Journal: BMJ (2020)

If you’re lucky, age brings wisdom and leisure, but for many it means illness, frustration, and failing bodies. “I’m sorry to be such a nuisance, doctor,” older patients often tell me. I reassure them that they’re not a nuisance and that, if they didn’t trouble me with their ailments, I’d be out of a job.

While a few patients stockpile medication, others worry about “bankrupting the NHS” and try to avoid any treatment that’s not strictly necessary. I try to explain that they’ve already paid for the care and medicines they now need, through a lifetime of taxes.

In this pandemic, I’ve been reminded again of the risk of ageism in healthcare. …
Door-to-Needle Time and Long-term Outcomes in Patients With Stroke—Reply
Authors: Shumei Man, Gregg C. Fonarow
Journal: JAMA (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 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
Antithrombotic Strategies in Patients With Atrial Fibrillation and Percutaneous Coronary Intervention
Authors: Sebastian J. Reinstadler, Bernhard Metzler, Gert Klug
Journal: JAMA Cardiology (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 Cardiology 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 Cardiology journal
Embrace your discomfort: leadership and unconscious bias in sport and exercise medicine
Authors: Katherine Rose Marino, Dane Vishnubala, Osman Hassan Ahmed, Phathokuhle Cele Zondi, Jackie L Whittaker, Andrew Shafik, Christina Y Le, Dean Chatterjee, Anjolaoluwa Odulaja, Nigel Edward Jones, Jane S Thornton
Journal: British Journal of Sports Medicine (2020)

Unconscious bias is present at all levels of society. It exists within our Sport and Exercise Medicine (SEM) community and is detrimental to the specialty and those it serves. Many may be unaware of how unconscious bias has impacted their career trajectory, and that of their peers. This editorial explores the concept of unconscious bias and prompts actions to initiate meaningful change.

The human brain is complex, programmed to make quick judgements about people and situations based on visual, verbal and behavioural cues.1 Over time, unconscious pathways form between these cues and how we judge them, gaining strength with each unchallenged repetition. These habituated norms can leave us feeling unsettled when we experience something outside of our expectations. This is referred to as unconscious bias, a consequence of learnt stereotypes deeply ingrained within our beliefs, influencing the way we automatically and subconsciously engage with people and situations. The nature of our individual bias is nurtured from childhood through cultural conditioning, media portrayals and upbringing.2 

### Issues of unconscious bias in SEM

While conscious bias has created, and overtly contributes to, many of society’s inequalities, unconscious bias is covert, overlooked and too often unaddressed. Unconscious bias has perpetuated inequality resulting in certain groups having fewer rights, privileges and less power than others.3 It is ubiquitous, and the implications within SEM communities are significant, resulting in …
Redesigning care coordination from the patient’s perspective.
Authors: Mark Liu, Aarti Bhardwaj, Carol Kisswany, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2020)

6 Background: Cancer patients are frequently admitted to the hospital requiring medical oncologists to take an active role in coordinating with multiple teams. In an effort to redesign care to put patients at the center and address increasing demands on our medical oncologist’s time, we created the Oncology Coordinator (OC) role focused on care setting transitions. We aimed to evaluate whether the OC would improve quality of care and decrease healthcare utilization. Methods: The OCs, are non-clinical and serve as a single point of contact for disease-based teams as patients prepare for elective admissions or discharge from the hospital. The 3 OCs received specialized training in systems and processes in both settings. They coordinate outpatient appointments, prescription delivery, transportation while also providing clinical support. Additionally, they facilitate two interdisciplinary rounds per day across three dedicated oncology units and assist with patients off-unit. We evaluated all patient discharges facilitated by the OCs during 1/1/19-2/29/20 and compared that to non-OC facilitated discharges. Using descriptive statistics, we evaluated the OCs impact on 7- and 30-day readmissions, discharge before noon rate (DBN), average time from admission to chemotherapy start and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Results: We had a total of 2,818 discharges between 1/1/19-2/29/20; 1,032 (36.6%) facilitated by the OCs. For those OC facilitated discharges we observed a 5.07% reduction in 7-day readmissions and 30-day readmissions (2.6%). We observed an overall higher average monthly rate of DBN (4.85%) compared to non-OC facilitated discharges. In addition, the average time from admission to chemotherapy administration decreased by 1 hour 31 minutes (6.8%) for the OC facilitated admissions. In the HCAHPS survey, there were improvements in Discharge Information and Care Transitions on the inpatient units where OCs were most active. Conclusions: At our academic medical center, the OCs have contributed to reduction in readmissions, time from admission to chemotherapy administration as well as improvements in discharges before noon and patient experience. This pilot demonstrates that investment in dedicated lay staff to facilitate admissions and discharges for cancer patients across care settings could lead to meaningful improvements in healthcare utilization, quality and the patient experience. Future work will evaluate the sustainability of this program and evaluate association with healthcare costs.
Assessing the demographics of fertility preservation discussions in cancer patients.
Authors: Michael E Auster, Michelle Janania Martinez, Jean-Pierre Blaize, Lakene Raissa Djoufack Djoumessi, Brian Warnecke, Abhishek Pandya, Kate Ida Lathrop
Journal: Journal of Clinical Oncology (2020)

135 Background: Young adults undergoing cancer treatment often face increased risk of infertility. Despite current ASCO guidelines recommending prompt fertility preservation education, knowledge about prevalence and barriers to oncofertility care is lacking. This is particularly true for patients in medically underserved and minority communities. This study sought to characterize the utilization of oncofertility counseling in a major Hispanic serving institution. Methods: Retrospective chart review was performed at the University of Texas Mays Cancer Center San Antonio and included patients diagnosed with testicular, early stage breast cancer or leukemia/lymphoma between age 18-40 from 2015-2019. Demographic data including ethnicity, race, funding, zip code were collected. Chart reviewed determined if fertility counseling was provided and which patients elected for oncofertility treatments. Results: Of 304 evaluable patients, only 120 had documented fertility discussions. There was no significant difference in the odds of counseling between gender, funding, or race. However, the odds of receiving fertility discussions was higher in non-Hispanic whites compared to Hispanic whites with an odds ratio of 1.94 (P value of 0.032). For those who opted for fertility treatment there was no statistically significant difference between diagnosis, race, ethnicity, or payment status. Conclusions: Our study demonstrates oncofertility discussions occur in a relatively small proportion of eligible patients. Additionally, patients who self -identify as Hispanic were less likely to receive fertility discussions. This study demonstrates that more research is necessary to evaluate the barriers to fertility discussion and treatment, and how these barriers result in decreased oncofertility education in Hispanic young adults with curable malignancies. [Table: see text]
Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring
Authors: Chunyuan Qiu, Jane C. Lin, Jiaxiao M. Shi, Ting Chow, Vimal N. Desai, Vu T. Nguyen, Robert J. Riewerts, R. Klara Feldman, Scott Segal, Anny H. Xiang
Journal: JAMA Pediatrics (2020)

Although the safety of labor epidural analgesia (LEA) for neonates has been well documented, the long-term health effects of LEA on offspring remain to be investigated.To assess the association between maternal LEA exposure and risk of autism spectrum disorders (ASDs) in offspring.Data for this retrospective longitudinal birth cohort study were derived from electronic medical records from a population-based clinical birth cohort. A total of 147 895 singleton children delivered vaginally between January 1, 2008, and December 31, 2015, in a single integrated health care system were included. Children were followed up from the age of 1 year until the first date of the following occurrences: clinical diagnosis of ASD, last date of health plan enrollment, death, or the study end date of December 31, 2018.Use and duration of LEA.The main outcome was clinical diagnosis of ASD. Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) of ASD associated with LEA exposure.Among the cohort of 147 895 singleton children (74 425 boys [50.3%]; mean [SD] gestational age at delivery, 38.9 [1.5] weeks), 109 719 (74.2%) were exposed to maternal LEA. Fever during labor was observed in 13 055 mothers (11.9%) in the LEA group and 510 of 38 176 mothers (1.3%) in the non-LEA group. Autism spectrum disorders were diagnosed in 2039 children (1.9%) in the LEA group and 485 children (1.3%) in the non-LEA group. After adjusting for potential confounders, including birth year, medical center, maternal age at delivery, parity, race/ethnicity, educational level, household income, history of comorbidity, diabetes during pregnancy, smoking during pregnancy, preeclampsia or eclampsia, prepregnancy body mass index, gestational weight gain, gestational age at delivery, and birth weight, the HR associated with LEA vs non-LEA exposure was 1.37 (95% CI, 1.23-1.53). Relative to the unexposed group, the adjusted HR associated with LEA exposure of less than 4 hours was 1.33 (95% CI, 1.17-1.53), with LEA exposure of 4 to 8 hours was 1.35 (95% CI, 1.20-1.53), and with LEA exposure of more than 8 hours was 1.46 (95% CI, 1.27-1.69). Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Adding fever to the model did not change the HR estimate associated with LEA exposure (adjusted HR for LEA vs non-LEA, 1.37 [95% CI, 1.22-1.53]).This study suggests that maternal LEA may be associated with increased ASD risk in children. The risk appears to not be directly associated with epidural-related maternal fever.