tbuckley/cabot-search huggingface dataset:
Longitudinal analysis of bladder cancer-specific mortality trends in the United States.
Authors: Sophia C. Kamran, Anushka Ghosh, Saveli Goldberg, Fumiko Chino, Jason A. Efstathiou
Journal: Journal of Clinical Oncology (2022)

445 Background: Bladder cancer is the most common malignancy of the urinary system. Advances in diagnosis, imaging, and treatments have led to improvements in bladder cancer management. Recent data demonstrate decreasing bladder cancer-specific mortality (BCSM) rates between 2014-2018 for both males and females, however, these trends have not been further examined by race, ethnicity, or geographical location. Using a comprehensive dataset of BCSM over 2 decades, we sought to evaluate differences in BCSM rates overall and by sex, race, ethnicity, location and urbanization category in the United States (US). Methods: Age-adjusted mortality rates for bladder cancer (ICD10 code 67) were obtained for males and females of all ages in the US from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. BCSM rates from 1999-2019 were estimated using linear regression. BSCM trends were evaluated by sex, race (White vs. Black), ethnicity (Hispanic vs. Non-Hispanic), urbanization category, and census region. BCSM rates were compared by F-test. Data analysis was performed using SAS 9.4. All p-values are based on a two-sided hypothesis test with values &lt; 0.05 considered statistically significant. Results: From 1999-2019, age-adjusted BCSM rate overall has decreased linearly by (-)0.0073 per 100,000 population/year (p &lt; 0.05). Evaluating by sex, both female [(-)0.131] and male [(-)0.022] BCSM rates decreased yearly (p &lt; 0.05). By ethnicity, male Hispanic and female Non-Hispanic patients had significantly decreasing BCSM rates [(-)0.021 and (-)0.011, respectively, p &lt; 0.05]. White patients had a slightly decreasing rate of BCSM [(-)0.0003, p = NS] while Black patients had an increasing BCSM rate [(+)0.022, p &lt; 0.05] – the difference between the two rates was significant (p &lt; 0.0001). BCSM rates were significantly decreasing in all census regions (Northeast, Midwest, South, Midwest, p &lt; 0.05). BCSM rate in micropolitan (rural) regions has increased yearly [(+)0.006], and rate differences between rural vs large fringe metro (suburban) and vs small metro (population &lt; 250,000) categories, both with significantly decreasing BCSM rates, were statistically significant (p = 0.03 and p = 0.047, respectively). Conclusions: Using comprehensive data on BCSM in the United States over two decades, we demonstrate that the overall mortality rate from bladder cancer has been decreasing. However, when disaggregating age-adjusted BCSM by sex, race, ethnicity, census regions, and urbanization categories, significant differences in mortality rates are found including worsening mortality for Black patients, demonstrating that improvements in BCSM are not equitable across variables. Further evaluation of these trends is important to understand how to target specific populations to improve BCSM and overall outcomes for all patients with bladder cancer.
Uncertainty Rounds
Authors: Mark L. Cohen
Journal: JAMA (1983)

A cartoon on the bulletin board of our medical school classroom showed a well-dressed physician sitting behind an enormous desk in front of a diploma-filled wall. He was on the telephone, and with a somewhat puzzled expression said: "I'm sorry... could you put that into the form of a multiple-choice question?" Even as freshmen we appreciated the irony. But now, comparing the lessons of medical school to the realities of clinical practice, I believe this response may be related to the skepticism toward physicians that has been evident in popular publications and is bemoaned in the medical press. Physicians are not adequately prepared to deal with uncertainty; yet uncertainty is everywhere in medicine. Like the cartoon doctor, we all were taught as students that the modus operandi of the physician is to collect data, to reflect on and analyze those data, and to arrive at "The Answer." In the basic
Monilia Peritonitis
Authors: P. C. Reynell, E. A. Martin, A. W. Beard
Journal: BMJ (1953)

kindly examined the sections and made the following comments on the morphology of the fungi." The tissue sections showed infection by two different fungi, neither of which can be identified specifically without a culture.One of the fungi shows a coarse septate mycelium bearing tufts of stunted terminal branches, indistinguishable from the vegetative mycelium of Aspergillus fumigatus in
Epidemic keratoconjunctivitis.
Authors: J C Hart, V J Marmion, S K Clarke, D L Barnard
Journal: BMJ (1971)

Elsewhere in the Scottish report' Doctors in an Integrated Health Service it states that "the community medicine specialist could en- sure that rehabilitation and after-care were co-ordinated."Perhaps it would have been prudent, before pre-empting areas of rehabilitation for this new grouping of community medicine, to wait until the two committees which have been studying the place of re- habilitation within the Health Service for the past three years in England and Wales and in Scotland, under the chairmanship of Sir Ronald Tunbridge and myself respectively, had resorted.
Stress reaction of bone in Army trainees
Authors: R. C. Elton
Journal: JAMA (1968)

For four years, the author's practice of orthopedics has been primarily with the problem of the Army trainee. A relatively large number of stress fractures has been seen. As our ability to recognize these fractures increased, we saw them in greater numbers (Fig 1 to 6). Four individuals with stress fractures of the tarsal navicular bones have now been observed, one showing bilateral involvement of the navicular and of the right first cuneiform. To my knowledge, neither the navicular nor the cuneiform bone has been previously reported as a site for this type of fracture. Some of the bones never did show a fracture line on x-ray film. In the light of this, the term "stress reaction" of bone indicates that in a normal, healthy person, usually a young adult male, a process can occur which is regional in nature and manifests itself by osteoporosis of bone, followed by breakdown
Selected Abstracts
Journal: JAMA (1976)

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
Alcoholic myopathy.
Authors: E T O'Brien, P Goldstraw
Journal: BMJ (1969)

The untoward effects of excessive alcohol on the nervous system, heart, and liver are well recognized.That alcohol may cause a variety of clinical syndromes involving skeletal muscle is not so well known. CASE REPORTA 46-year-old Irish window cleaner began to complain of sharp pains in the limbs and swelling of the calf muscles in March 1968, in association with gastric pain, anorexia, vomiting and loss of about 2 st.(12-7 kg.) in weight.Since the age of 16 he had been drinking 18 to 20 pints (10 to 11 litres) of beer daily.Four months later his arms and legs had become weak, and his fingers often became cold and blue with occasional swelling of the ankles.By February 1969 he found it difficult to climb stairs and to rise from the horizontal position.He complained of dis- comfort on swallowing solid food and he had noticed occasional melaena.He no longer had abdominal pain and vomiting, and his weight had remained steady.He had not worked for six months and had continued drinking alcohol.On examination he was a thin, neglected man with rather prominent eyes and a fine tremor of the outstretched hands.There was enlargement of the right breast, in which a smooth, hard, mobile swelling was palpable, but no other stigmata of hepatic disease were found.The heart and blood pressure were normal.The liver was smooth and enlarged by 3 cm.There was obvious muscle wasting and weakness, mainly involving the shoulder and pelvic girdle muscles and the proximal muscles of the limbs.The muscles of the forearm were spared and there appeared to be some pseudohypertrophy of the calf msucles with minimal subcutaneous oedema.No neurological abnormality was demonstrable.A provisional diagnosis of myopathy due to an underlying neoplasm or to hyperthyroidism was made.
First-line pembrolizumab in advanced urothelial carcinoma: Clinical parameters associated with efficacy in the phase 2 KEYNOTE-052 and phase 3 KEYNOTE-361 trials.
Authors: Tibor Csoszi, Thomas Powles, Ajjai Shivaram Alva, Daniel E. Castellano, Mustafa Ozguroglu, Peter H. O'Donnell, Yohann Loriot, Noah M. Hahn, Aude Flechon, Alejo Rodriguez-Vida, Ronald De Wit, Susanna Y. Cheng, Stephane Oudard, Christof Vulsteke, Evan Y. Yu, Jianxin Lin, Kentaro Imai, Blanca Homet Moreno, Arjun Vasant Balar, Petros Grivas
Journal: Journal of Clinical Oncology (2022)

521 Background: First-line treatment with pembrolizumab (pembro) monotherapy has shown durable clinical activity in selected patients (pts) with advanced/unresectable or metastatic urothelial carcinoma (UC). In a pooled population of pts with advanced UC from the single-arm phase 2 KEYNOTE-052 (NCT02335424) and the randomized, open-label, phase 3 KEYNOTE-361 (NCT02853305) studies, this exploratory analysis evaluated the relationship between baseline characteristics and clinical outcomes of first-line pembro monotherapy. Methods: Cisplatin-ineligible pts with advanced UC were enrolled in KEYNOTE-052 and chemotherapy-naive pts with advanced UC were enrolled in KEYNOTE-361. For analysis of predictive factors for ORR and OS in pembro-treated pts, the purposeful selection method was used to build the multivariable logistic regression model (ORR) and multivariable Cox model (OS), beginning with a univariable analysis of each independent variable. Any variable in the univariate model with P &lt; 0.10 was a candidate for the multivariate model. The stepwise selection method was used to select the variables in the final model. Significance of the final model was set at P &lt; 0.05. Data cutoff dates were September 26, 2020 (KEYNOTE-052) and April 29, 2020 (KEYNOTE-361). Results: This pooled analysis included 681 pts treated with pembro monotherapy (KEYNOTE-052, N = 374; KEYNOTE-361, N = 307 [170 were cisplatin ineligible]). Median follow-up was 51.9 mo (range, 22.0-65.3). ORR was 29.4% (95% CI, 26.0-32.9; 69 CRs, 131 PRs), and median DOR was 33.2 mo (range, 1.4+ to 60.7+). Median OS was 12.5 mo (95% CI, 11.0-14.6). By multivariate analysis, independent factors significantly associated with higher ORR were PD-L1 status (combined positive score [CPS] ≥10 vs CPS &lt; 10; odds ratio [OR], 1.90 [95% CI, 1.33-2.71]; P = 0.0004), site of metastasis (lymph node only vs visceral disease; OR, 1.66 [95% CI, 1.06-2.59]; P = 0.0265), liver involvement (absent vs present; OR, 1.75 [95% CI, 1.06-2.89]; P = 0.0294), and baseline hemoglobin level ≥10 vs &lt; 10 g/dL; OR, 2.17 [95% CI, 1.09-4.31]; P = 0.0276). Multivariate analysis of OS is displayed in the Table. Conclusions: This exploratory multivariate analysis identified numerous factors, including PD-L1–positive status (CPS ≥10), lymph node only metastasis, and lower ECOG PS score, associated with improved clinical outcomes in pts with advanced UC treated with first-line pembro monotherapy. Clinical trial information: NCT02335424 and NCT02853305. [Table: see text]
INTRAPERITONEAL BLOOD TRANSFUSION
Journal: JAMA (1923)

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
Impact of selection bias on outcomes in veterans with muscle-invasive bladder cancer receiving bladder preserving trimodality therapy.
Authors: Abhishek Kumar, Nikhil V. Kotha, Tyler J. Nelson, Daniel R. Cherry, Tyler F. Stewart, Rana R. McKay, Brent S. Rose
Journal: Journal of Clinical Oncology (2022)

462 Background: Retrospective studies using large registries comparing outcomes between radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) to trimodality therapy (TMT), which includes transurethral resection of bladder tumor followed by chemoradiation, often cannot distinguish whether patients receiving TMT were eligible for cystectomy but declined or simply ineligible for cystectomy. The objective of this study was to compare survival outcomes of patients with MIBC receiving TMT stratified by whether they were cystectomy-eligible to patients receiving RC +/- NAC. Methods: We used the national Veterans Affairs’ (VA) database to identify patients diagnosed between 2000-2017 with urothelial histology, MIBC (T2-4a/N0-3/M0) who underwent RC or TMT. Overall survival (OS) was evaluated with multivariable Cox proportional hazards model. Bladder cancer-specific mortality (BCSM) was evaluated with multivariable Fine-Gray regression. We conducted a chart review of clinical notes to ascertain if patients were eligible for cystectomy. Results: Overall 2306 Veterans with MIBC were included: 1472 (64%) with RC without NAC, 506 (22%) with RC-NAC, 107 (4.6%) with TMT eligible for RC, and 221 (9.4%) with TMT ineligible for RC. Median follow up time was 4.7 years. Patients receiving RC were on average 10 years younger, had higher creatinine clearance, and fewer comorbidities than those receiving TMT. Cystectomy-eligible TMT patients had higher creatinine clearance and fewer comorbidities than those ineligible for cystectomy. On multivariable analysis, compared to RC-NAC, TMT in cystectomy-eligible patients was associated with similar OS (hazard ratio [HR] 0.99; 95% confidence interval [CI] 0.76 - 1.28; p = 0.93) and BCSM (HR 1.02; 95% CI 0.71-1.47; p = 0.91). Compared to RC-NAC, TMT in cystectomy-ineligible patients was associated with inferior OS (HR 1.39; 95% CI 1.13 - 1.71; p = 0.002) and BCSM (HR 1.61; 95% CI 1.23 - 2.10; p &lt; 0.001). Conclusions: There is a significant selection bias among patients with MIBC receiving TMT. Cystectomy-eligible patients receiving TMT likely have similar survival outcomes as those receiving RC. Comparisons between RC and TMT in large registry data that lack information regarding eligibility for cystectomy in the TMT arm may be unreliable.
Central pain.
Authors: L S Illis
Journal: BMJ (1990)

greater wealth-on health care -the United States now spends 15 times as much as Britain, though its population is only four times greater.McLachlan reiterates thi basic economic facts: measured by per capita spending Britain has one of the cheapest health care systems in the world.And it is this highly.effective system that is now to be transformed for reasons of ideology.Should it not by now be obvious that the immediate prospect for the NHS is that it will be disrupted and disheartened over the next two years as its staff struggle to introduce new control and costing systems without the essential accounting infrastructure?Every health region is installing information systems and hiring accountants and computer programmers while closing beds and cutting down the numbers of outpatient clinics (including specialist clinics such as family planning clinics).7The NHS is steaming full ahead into an iceberg that will prove as devastating as the one that sank the Titanic.McLachlan is only the latest in a series of well informed and articulate commentators who have drawn attention to a forseeable disaster.Is there no one on the bridge prepared to order the engines to slow-or, even better, go full astern?
Measurement and initial characterization of leukocyte telomere length in 474,074 participants in UK Biobank
Authors: V. Codd, M. Denniff, C. Swinfield, S. C. Warner, M. Papakonstantinou, S. Sheth, D. E. Nanus, C. A. Budgeon, C. Musicha, V. Bountziouka, Q. Wang, R. Bramley, E. Allara, S. Kaptoge, S. Stoma, T. Jiang, A. S. Butterworth, A. M. Wood, E. Di Angelantonio, J. R. Thompson, J. N. Danesh, C. P. Nelson, N. J. Samani
Journal: Nature Aging (2022)
Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study
Authors: Ruth S. Weinstock, Barbara H. Braffett, Thomas J. Songer, William H. Herman, Shihchen Kuo, Rose A. Gubitosi-Klug, Lori Laffel, Siripoom McKay, Maggie Siska, Michelle Van Name, Philip S. Zeitler
Journal: Diabetes Care (2020)

OBJECTIVE To examine the relationship between health care coverage and HbA1c in young adults with youth-onset type 2 diabetes who transitioned to community diabetes care after receiving care during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Participants completed questionnaires annually. HbA1c was measured in a central laboratory. Data from 2 years before and after transitioning to community care (2013–2016) were examined and compared between states with and without expanded Medicaid. RESULTS In 2016 (n = 427; mean age 24 years), 2 years after transitioning to community care, 93% of participants in states with Medicaid expansion had health care coverage compared with 68% (P &amp;lt; 0.0001) in states without Medicaid expansion. Mean HbA1c was 9.8% in participants with government coverage, 9.3% with commercial coverage, and 10.1% in those with no coverage (P = 0.0774). Additionally, 32%, 42%, and 66% of those with government coverage, commercially covered, and no coverage, respectively, were not attending outpatient diabetes visits (P &amp;lt; 0.0001). Of those with government coverage, 83% reported they had adequate coverage for insulin syringes/needles/pens, and 89% for glucose-monitoring supplies, with more limited coverage in those with commercial plans. Participants with commercial coverage had higher education attainment (P &amp;lt; 0.0001); 52% had HbA1c ≥9.0% compared with 64% of those who were government covered and 58% with no coverage (P = 0.0646). CONCLUSIONS More young adults with type 2 diabetes from the TODAY cohort had health care coverage in states with expanded Medicaid but glycemic control remained poor, regardless of coverage. New therapies and approaches are needed for this vulnerable population.
Sequelae
Authors: Rachel Elizabeth Morgan
Journal: JAMA (2019)

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
Abstract 148: The Time Interval Between the R-Wave and Maximum Aortic Pressure Affects Chest Compression Hemodynamics in a Swine Model of Pseudo Electro-Mechanical Dissociation
Authors: Joshua W Lampe, Karen L Moodie, Jeffrey R Gould, Christopher L Kaufman, Norman A Paradis
Journal: Circulation (2018)

Introduction: The prevalence of pseudo electro-mechanical dissociation (P-EMD) as an initial cardiac arrest state is increasing. P-EMD manifests a weak ventricular contraction, which is not sufficient to sustain life. However, the presence of a weak ventricular contraction may lead to interference with or synergy with the blood flow generated by a chest compression depending on the time interval between the compression and ventricular contraction. Hypothesis: We hypothesize that the interval between a chest compression and the ventricular contraction during P-EMD will influence the hemodynamics created by the chest compression. Methods: Using our well established hypoxic P-EMD model, we measured blood pressures and ECG during mechanical chest compression (100 CPM, 2”). A nearest-neighbor analysis determined the time interval between the R-wave and the peak aortic pressure, defined as t peak AOP - t Rwave . Peak aortic pressures that had more than one R-wave nearest neighbor were excluded. 1,497 chest compressions were analyzed. Intervals were divided into quartiles, and hemodynamic parameters were compared between the quartiles using a repeated measure ANOVA with Bonferroni correction. Results: Interval (int) quartiles were defined as: Q1: int &gt; 100 ms; Q2: 100 ms &gt; int &gt; 0.0 ms; Q3: 0.0ms &gt; int &gt; -90 ms; Q4: - 90 ms &gt; int. Mean arterial pressures (MAP) in mmHg as a function of interval are: Q1: 33.8±0.6; Q2: 41.1±0.6; Q3: 38.3±0.6; Q4: 33.1±0.6. The MAP value for compressions with an interval in Q2 was higher than the other quartiles ( p &gt; 0.05). Coronary perfusion pressures (CPP) in mmHg as a function of interval are: Q1: 11.7±0.5; Q2: 15.3±0.5; Q3: 15.6±0.5; Q4: 12.9±0.5. The CPP values for compressions with an interval in Q2 or Q3 was higher than the other quartiles ( p &gt; 0.05). Conclusions: The interval between the R-wave and the peak aortic pressure generated by a chest compression has a significant effect on the resulting hemodynamics. Shorter intervals, both positive and negative are associated with improved blood pressures during resuscitation from P-EMD. These data suggest that delivery of standard CPR during P-EMD can result in a mix of effective and less effective compressions.