tbuckley/cabot-search huggingface dataset:
Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018
Authors: Maximilian Holle, Tory Wolff, Marc Herant
Journal: JAMA Network Open (2021)

The concentration of health care expenditures has important implications for managing risk pools, drug benefit design, and care management.To examine trends in the concentration of health care spending in different population groups and expenditure categories in the US between 2001 and 2018.This study is a cross-sectional analysis of Medical Expenditure Panel Surveys (MEPS) collected between 2001 and 2018. The MEPS is a household survey of medical expenditures weighted to represent national estimates in the US. Respondents were a nationally representative sample of the US civilian noninstitutionalized population. Data analysis was performed from December 2020 to February 2021.The main outcome is the concentration of health care expenditures as measured by the cumulative percentage of health expenditure vs percentage of ranked population. This study reports trends in the distribution of populations across 4 concentration curve parameters: top 50% expenditure (high spenders), next 49% expenditure (medium spenders), next 1% expenditure (low spenders), and nonspenders.The mean sample size of the MEPS surveys used in the analysis was 34 539 individuals, and the sample size varied between 30 461 and 39 165 individuals over the years studied. On the basis of data from 30 461 MEPS respondents (15 867 women [52.1%]; mean [SD] age, 38.9 [24.0] years) in 2018, the top 4.6% (95% CI, 4.3%-4.9%) of the US population by spending accounted for 50% of health care expenditures. Although this fraction varied across population groups or expenditure categories, it remained remarkably stable over time with one exception: the concentration of spending on prescription drugs. In 2001, one-half of all expenditures on prescription drugs were concentrated in 6.0% (95% CI, 5.6%-6.4%) of the US population, but by 2018, this proportion had decreased to 2.3% (95% CI, 2.1%-2.5%). This change does not appear to be associated with a change in the overall share of prescription drug expenses, which increased by only a small amount, from 20.4% in 2001 to 24.8% in 2018.The overall concentration of health care expenditures remained stable between 2001 and 2018, but these findings suggest that there has been a sharp increase in the concentration of spending on prescription drugs in the US. This coincides with the genericization of many primary care drugs, along with a shift in focus of the biopharmaceutical industry toward high-cost specialty drugs targeted at smaller populations. If this trend continues, it will have implications for the minimum scale of risk-bearing and drug management needed to operate efficiently, as well as the optimal cost-sharing features of insurance products.
Screening for Chlamydia and Gonorrhea
Authors: Jeanne Marrazzo, Jodie Dionne-Odom
Journal: JAMA (2021)

US Preventive Services Task Force; Karina W. Davidson, PhD, MASc; Michael J. Barry, MD; Carol M. Mangione, MD, MSPH; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; Alex H. Krist, MD, MPH; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; James Stevermer, MD, MSPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD
Impact of the first covid-19 lockdown in Germany on the rate of acute infections during intensive chemotherapy for hodgkin lymphoma
Authors: A. S. Jacob, H. Goergen, M. Fuchs, S. Gillessen, S. Kreissl, A. Pluetschow, J. Momotow, V. Schaub, A. Huettmann, M. Haenel, A. Zimmermann, J. Dierlamm, J. Meissner, S. Mathas, S. Martin, A. Engert, C. Lehmann, P. Borchmann
Journal: HemaSphere (2021)

Background: Acute infections and fever under chemotherapy are an important cause for morbidity and mortality in hematologic malignancies such as Hodgkin lymphoma (HL). Prophylactic anti-infective concomitant medication is prescribed frequently. Another protective measure could be self-protection via social distancing and wearing facemasks. However, evidence on the effect of self-protection on infections during chemotherapy is currently not available. Aims: We asked if the frequency of acute infections during chemotherapy for advanced-stage HL decreased when Corona Virus Disease 2019 (COVID-19) protection measures were in effect. Methods: We analyzed the occurrence of infections during all documented eBEACOPP cycles that started between 01 March and 30 June of 2017-2020 among patients treated within the GHSG HD21 study in Germany. We compared cycles starting between March and June 2020 with cycles starting between March and June of 2017-2019 regarding infection rates and infection characteristics by logistic regression models and means of descriptive statistics. Results: We analyzed 911 cycles of 313 adult patients treated with 4 to 6 cycles of eBEACOPP. We found a significant decrease in the frequency of infections during chemotherapy for HL during COVID-19 lockdown from131 (19.6%) of 670 cycles in the years 2017-2019 to 30 (12.6%) of 239 cycles during COVID-19 lockdown (OR 0.574 (95% CI 0.354- 0.930), P = 0.024). Correspondingly, 20 (24.1%) of 83 patients had an infection during the COVID-19 lockdown versus 99 (43.2%) of 229 patients in the years 2017-2019 (P = 0.0023). The strongest effect was observed for unspecified infections (unknown type of etiologic agent), occurring in 39 cycles (5.8%) during 2017-2019 in comparison to 5 cycles (2.1%) during COVID-19 lockdown. There was also a strong trend towards fewer minor infections: during the COVID-19 lockdown period there were 8 cycles (3.3%) with a minor infection compared to 66 cycles (9.9%) with an infection during the reference period. Summary/Conclusion: The significant and relevant decrease observed in acute infections while receiving chemotherapy for HL during the COVID-19 lockdown demonstrates the potential of protective measures to shield patients from transmissible pathogens. We conclude that these measures may be recommended for cancer patients at risk for infections during chemotherapy.
BMA moves to neutral position on assisted dying
Authors: Gareth Iacobucci
Journal: BMJ (2021)

The BMA has voted to move to a position of neutrality on assisted dying, including physician assisted dying.

On Tuesday 14 September the BMA’s annual representative meeting narrowly passed a motion to move from the current stance of opposing a change in the law to allow a physician assisted death or physician assisted suicide and instead to adopt a position of neutrality. Some 49% of representatives (149) voted for the motion, 48% (145) voted against, and eight abstained.

In a BMA membership survey last year, to which almost 30 000 doctors responded, 40% said the BMA should support a change in the law, 33% said it should remain opposed, and 21% wanted it to take a neutral stance.12

The motion, proposed by Robin Arnold …
Development of a virtual intervention for patients with lung cancer transitioning to surveillance after curative treatment.
Authors: Katina Massad, Lara Traeger, Joseph A. Greer, Jennifer Temel
Journal: Journal of Clinical Oncology (2021)

181 Background: Patients with lung cancer who are treated with curative intent are rarely included in quality-of-life (QOL) intervention research in cancer, and the transition from treatment to surveillance is an understudied phase in lung cancer. Given the high risk of recurrence in this population, we aimed to 1) characterize the QOL challenges of patients with lung cancer who complete curative treatment and 2) develop and refine an intervention to support patients during their transition to surveillance. Methods: We first conducted semi-structured interviews to explore the QOL challenges of patients in transition from lung cancer treatment to surveillance (n = 12). Interviews were transcribed, coded, and analyzed using a thematic analysis approach. Results were used to develop the content, timing, and delivery of a cognitive behavioral intervention to enhance patient QOL during the transition to surveillance. We conducted an open pilot with patients within 3 weeks of completing lung cancer treatment (systemic therapy +/- radiation) to test and refine the intervention (n = 5). Mixed methods data were collected to evaluate intervention feasibility, acceptability, and areas for refinement. All study procedures were conducted at an academic medical center in the New England region. Results: Qualitative study results indicated that during the transition to surveillance, patients with lung cancer (6 female, 6 male; age range: 26-76) faced unexpected challenges in coping with residual symptoms (e.g., dyspnea, fatigue), uncertainty about future health, and changes in close relationships. Results were used to develop a 5-session intervention to address patient challenges with a coping skills framework that balanced acceptance-and change-oriented approaches. Study clinicians delivered intervention sessions remotely (video or telephone). Of 6 patients approached, 5 enrolled in the pilot (all female; age range: 62-73; 1 declined due to time commitment). Pilot patient feedback indicated that the intervention timing and content targeted patients’ current needs and concerns. Patients valued the opportunity to normalize and address current challenges and to cope with difficult emotions. Results suggested further refinements to the timing for patient recruitment and the order of session content to enhance skills uptake. Conclusions: Patients who are treated for lung cancer with curative intent may face unexpected QOL challenges related to residual symptoms, health uncertainty, and changes in close relationships during the transition to surveillance. Results enhance our understanding of lung cancer survivorship and provide a framework for addressing QOL challenges in this population. Remote delivery of this manualized intervention supports scalability for survivors of cancers with high risk of recurrence. This model will be tested further in a larger scale efficacy trial. Clinical trial information: 04450043.
Visual Gene Expression Reveals a cone-to-rod Developmental Progression in Deep-Sea Fishes
Authors: Nik Lupše, Fabio Cortesi, Marko Freese, Lasse Marohn, Jan-Dag Pohlmann, Klaus Wysujack, Reinhold Hanel, Zuzana Musilova
Journal: Molecular Biology and Evolution (2021)

Vertebrates use cone cells in the retina for color vision and rod cells to see in dim light. Many deep-sea fishes have adapted to their environment to have only rod cells in the retina, while both rod and cone genes are still preserved in their genomes. As deep-sea fish larvae start their lives in the shallow, and only later submerge to the depth, they have to cope with diverse environmental conditions during ontogeny. Using a comparative transcriptomic approach in 20 deep-sea fish species from eight teleost orders, we report on a developmental cone-to-rod switch. While adults mostly rely on rod opsin (RH1) for vision in dim light, larvae almost exclusively express middle-wavelength-sensitive ("green") cone opsins (RH2) in their retinas. The phototransduction cascade genes follow a similar ontogenetic pattern of cone-followed by rod-specific gene expression in most species, except for the pearleye and sabretooth (Aulopiformes), in which the cone cascade remains dominant throughout development, casting doubts on the photoreceptor cell identity. By inspecting the whole genomes of five deep-sea species (four of them sequenced within this study: Idiacanthus fasciola, Chauliodus sloani; Stomiiformes; Coccorella atlantica, and Scopelarchus michaelsarsi; Aulopiformes), we found that they possess one or two copies of the rod RH1 opsin gene, and up to seven copies of the cone RH2 opsin genes in their genomes, while other cone opsin classes have been mostly lost. Our findings hence provide molecular evidence for a limited opsin gene repertoire in deep-sea fishes and a conserved vertebrate pattern whereby cone photoreceptors develop first and rod photoreceptors are added only at later developmental stages.
A Guideline for Reporting Mediation Analyses of Randomized Trials and Observational Studies
Authors: Hopin Lee, Aidan G. Cashin, Sarah E. Lamb, Sally Hopewell, Stijn Vansteelandt, Tyler J. VanderWeele, David P. MacKinnon, Gemma Mansell, Gary S. Collins, Robert M. Golub, James H. McAuley, A. Russell Localio, Ludo van Amelsvoort, Eliseo Guallar, Judith Rijnhart, Kimberley Goldsmith, Amanda J. Fairchild, Cara C. Lewis, Steven J. Kamper, Christopher M. Williams, Nicholas Henschke
Journal: JAMA (2021)

Mediation analyses of randomized trials and observational studies can generate evidence about the mechanisms by which interventions and exposures may influence health outcomes. Publications of mediation analyses are increasing, but the quality of their reporting is suboptimal.
P13.04 Survival analyses for determining clinical relevance of molecular markers in translational glioblastoma research - a systematic review
Authors: B Fitt, G Loy, E Christopher, P M Brennan, M T C Poon
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Pre-clinical glioblastoma studies can assess the relevance of their findings to patient survival using integrated clinical and genomic data. Validity of univariable analyses requires an assumption that molecular markers are randomly distributed across patient characteristics to mitigate the confounding effects of clinical variables. Multivariable survival analyses adjusting for clinical variables do not change the association if this assumption holds. We aimed to assess this by summarising the types of survival analyses and their results in translational glioblastoma research. MATERIAL AND METHODS We systematically searched Medline and Embase Jan 2008 to Feb 2021 for glioblastoma cell line or animal studies validating their molecular markers in The Cancer Genome Atlas (TCGA) or the Chinese Glioma Genome Atlas (CGGA) using survival analyses. Studies that exclusively used genomic data without laboratory findings were excluded. Two reviewers independently assessed study eligibility and extracted data. Data items included patient inclusion criteria, characteristics of survival analyses, and whether molecular markers had statistically significant association with overall survival. RESULTS Of 1,047 potentially eligible studies, we included 59 pre-clinical glioblastoma studies that tested the association between their molecular markers and survival using TCGA or CGGA data. All studies used TCGA data and 2 also used CGGA data. Sixteen (27%) studies specified their patient inclusion criteria from TCGA for survival analysis. Eight studies exclusively investigated sets of molecular markers, leaving 51 studies reporting 126 molecular markers. Eighteen (31%) studies used multivariable survival analysis in addition to univariable analyses. All molecular markers underwent univariable analyses, of which 12 (10%) molecular markers had additional multivariable survival analyses. In the 13 multivariable analyses on 12 molecular markers, four (31%) markers were associated with survival in the univariable analyses but not in the multivariable analyses. CONCLUSION Most pre-clinical studies used univariable survival analyses alone in public genomic repositories to assess the relevance of their results to patient survival. Our findings demonstrated that multivariable analyses are needed to account for confounding effects of clinical variables. Using relevant components from reporting guidelines for observational studies can improve the transparency and quality of translational studies.
Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward
Authors: Amila K. Nanayakkara, Helen W. Boucher, Vance G. Fowler, Amanda Jezek, Kevin Outterson, David E. Greenberg
Journal: CA A Cancer Journal for Clinicians (2021)

Abstract Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens ( Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacter spp .). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic‐resistant infections will have a major positive impact on the care of those with cancer.
Non-alcoholic fatty liver disease is a risk factor for cardiovascular and cardiac diseases: further evidence that a holistic approach to treatment is needed
Authors: Christopher D Byrne, Giovanni Targher
Journal: Gut (2021)

Many,1 but not all,2 previous studies investigating the association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) have shown that NAFLD is a risk factor for CVD morbidity and mortality. The debate over the last 5 years as to whether NAFLD is an independent CVD risk factor has focused on the suggestion that the association between NAFLD and increased CVD risk occurs because of residual confounding by metabolic syndrome-associated cardiovascular risk factors.

With the burgeoning 21st problem of obesity, NAFLD has become a common disease that is often present but remains often undiagnosed in the adult population. Thus, in large registry studies investigating associations between NAFLD and outcomes such as CVD,2 it is not possible to prove that subjects in the control (reference) group do not have NAFLD. When undiagnosed NAFLD occurs in subjects in the reference group, this causes misclassification bias, and misclassification bias always attenuates the strength of any association between the exposure variable (ie, NAFLD) and the outcome (CVD), towards the null. Moreover, among the few published NAFLD histology cohorts, to date, that have investigated the association between NAFLD and risk of incident CVD, all have been limited by small sample sizes (previous largest study, n=603) with few recorded outcomes and imprecise estimates of risk across NAFLD histological …
Race, insurance status and treating facility type associated with completeness of medical record in patients with breast cancer.
Authors: Marita Yaghi, Nadeem Bilani, Iktej Jabbal, Leah Elson, Maroun Bou Zerdan, Hong Liang, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2021)

143 Background: The National Cancer Database (NCDB) is a large registry that collates real-world medical record data from millions of patients in the United States. A previous published study using the NCDB found that gaps in the medical record were associated with worse overall survival outcomes. We investigated cases of breast cancer in this registry to understand which factors were predictive of records with missing data. Methods: We screened for missing data in 54 clinical parameters documented by the NCDB pertaining to the diagnosis, workup, management and survival of patients with breast cancer diagnosed between 2004 and 2017. We performed univariate statistics to describe gaps in the dataset, followed by multivariate logistic regression modeling to identify factors associated lack of completeness of the medical record – defined as the presence of &gt; 3 missing variables. Results: A total of n = 2,981,732 patients were included in this analysis. The median number of missing variables per record was 3 (5.6% of clinical parameters surveyed). 52.1% of records had ≤ 3 variables missing, while 47.9% had &gt; 3 variables missing. Predictors of a record with missing data in &gt; 3 variables were: age, race, insurance status and facility type . Regarding race, we found that records of Asian patients were less likely to have missing data as compared to records of White patients (OR 0.75, 95% CI: 0.74-0.76, p &lt; 0.001). Conversely, there was no difference in completeness of the medical record between Black and White patients (OR 0.99, 95% CI: 0.99-1.01, p = 0.890). Patients with private insurance (OR 0.77, 95% CI 0.76-0.79, p &lt; 0.001), or Medicaid (OR 0.65, 95% CI 0.64-0.67, p &lt; 0.001) or Medicare (OR 0.66, 95% CI 0.64-0.67, p &lt; 0.001) were also less likely to have missing data compared to uninsured patients, with patients on private insurance being the least likely to have incomplete records. Finally, patient records from academic programs (OR 0.91, 95% CI 0.90-0.92, p &lt; 0.001) were less likely to contain &gt; 3 missing variables compared to records from patients treated at community cancer programs. Conclusions: Despite high fidelity of NCDB data, social determinants of health including insurance status and treating facility type, were associated with differences in the completeness of the medical record. Improvements in documentation and data quality are necessary to optimize use of real-world data in cancer registries. Further research is needed to determine how these differences could be independently associated with inferior outcomes.
Breast cancer patients therapeutic adherence during the COVID-19 pandemic in Indonesia: Knowledge level analytical study.
Authors: Widyanti Soewoto
Journal: Journal of Clinical Oncology (2021)

89 Background: Corona virus diseases 2019 (COVID-19) pandemic is a new challenge for Indonesia's cancer patient’s treatment. Patients face problems in undergoing therapy during the pandemic due to government lockdown regulations. Cancer patients, especially breast cancer, still do not understand how to deal with this problem. This study aims to determine COVID-19 knowledge’s effect on therapeutic adherence in breast cancer patients in Indonesia. Methods: This study was a cross-sectional study conducted from February to April 2021. This study involved breast cancer patients from various regions in Indonesia. The research instrument employed the UNS-CASKQ14 questionnaire (Universitas Sebelas Maret-Cancer Altitude Satisfaction Knowledge Questionnaire) to determine COVID-19 knowledge and therapeutic adherence levels in breast cancer patients. The data were then tested the Spearman Rho correlation utilizing SPSS 25. Results: There were 812 respondents in this study, with the most respondents in the age range of 50-59 years (31.8%). As many as 222 (27.3%) respondents had a low knowledge level about COVID-19, 511 (62.9%) respondents had a sufficient knowledge level, and 79 (9.8%) respondents had a good knowledge level. As many as 369 (45.4%) respondents had a low therapeutic adherence level, and 443 (54.6%) respondents had a good adherence level during the COVID-19 pandemic. Based on the Spearman Rho correlation test between COVID-19 knowledge and therapeutic adherence levels, the results obtained were p = 0.51 (p &gt; 0.05), with the Spearman Rho coefficient value = 0.026. Conclusions: There was no significant effect between COVID-19 knowledge and therapeutic adherence levels in breast cancer patients during the COVID-19 pandemic in Indonesia.