tbuckley/cabot-search huggingface dataset:
P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses
Authors: A M George, S Gupta, S M Keshwara, M A Mustafa, C S Gillespie, G E Richardson, A C Steele, A I Islim, M D Jenkinson, C P Millward
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting &amp; methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.
Association of Neighborhood Gun Violence With Mental Health–Related Pediatric Emergency Department Utilization
Authors: Aditi Vasan, Hannah K. Mitchell, Joel A. Fein, David G. Buckler, Douglas J. Wiebe, Eugenia C. South
Journal: JAMA Pediatrics (2021)

Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood.To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization.This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021.Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence.ED encounters for a mental health-related chief complaint or primary diagnosis.A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]).Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.
The Effect of Discontinuing Denosumab in Patients With Rheumatoid Arthritis Treated With Glucocorticoids
Authors: Kenneth G. Saag, Michele T. McDermott, Jonathan Adachi, Willem Lems, Nancy E. Lane, Piet Geusens, Robert Kees Stad, Li Chen, Shuang Huang, Robin Dore, Stanley Cohen
Journal: Arthritis & Rheumatology (2021)

To evaluate changes in bone turnover and bone mineral density (BMD) in patients with rheumatoid arthritis (RA) receiving glucocorticoids, after discontinuation of denosumab for 12 months.We conducted a randomized, double-blind, placebo-controlled, phase II study of RA patients. Patients received placebo, denosumab 60 mg, or denosumab 180 mg every 6 months for 12 months and were followed up for an additional 12 months after discontinuation, during which no bone loss prevention therapy was instituted. Changes from baseline in serum C-terminal telopeptide of type I collagen (CTX), serum procollagen type I N-terminal propeptide (PINP), and lumbar spine and total hip BMD were evaluated.In this post hoc analysis of patients treated with glucocorticoids at study baseline (n = 82), levels of CTX and PINP decreased significantly from baseline in both denosumab groups. Following denosumab discontinuation, CTX returned to baseline and was not significantly different from the placebo group 6 and 12 months after discontinuation. Median percentage changes from baseline PINP in those treated with denosumab 60 mg were -0.16% and 15.3% at 6 and 12 months, respectively, after discontinuation (P = 0.062 and P = 0.017, versus placebo); corresponding changes with denosumab 180 mg were 9.0% and 75.8%, respectively (P = 0.018 and P = 0.002 versus placebo). Compared to placebo, lumbar spine and total hip BMD increased in patients receiving denosumab and returned to baseline 12 months after discontinuation. No osteoporotic fractures were reported during treatment or in the off-treatment period.In this analysis of short-term denosumab use in RA patients receiving glucocorticoids, denosumab discontinuation resulted in a gradual increase in bone turnover, which was associated with a return to baseline lumbar spine and total hip BMD.
Global Rheumatology Research: Frontiers, Challenges, and Opportunities
Authors: Joshua B. Bilsborrow, Ingris Peláez‐Ballestas, Bernardo Pons‐Estel, Christiaan Scott, Xinping Tian, Graciela S. Alarcon, Richard Bucala, Laura B. Lewandowski, Evelyn Hsieh
Journal: Arthritis & Rheumatology (2021)

Rheumatologic and musculoskeletal diseases (RMDs) are important causes of morbidity and mortality worldwide. The World Health Organization (WHO) considers musculoskeletal conditions to be the leading cause of disability worldwide, and the greatest independent contributors to chronic pain. Population-based surveys from low- and middle-income countries (LMICs) have demonstrated similar rates of RMDs compared with high-income countries.
Long-term exposures to air pollutants affect <i>F</i><sub>eNO</sub> in children: a longitudinal study
Authors: Yue Zhang, Sandrah P. Eckel, Kiros Berhane, Erika Garcia, Patrick Muchmore, Noa Ben-Ari Molshatzki, Edward B. Rappaport, William S. Linn, Rima Habre, Frank D. Gilliland
Journal: European Respiratory Journal (2021)

<b>Annual average PM<sub>2.5</sub> and NO<sub>2</sub> were associated with airway inflammation as measured by <i>F</i><sub>eNO</sub> in schoolchildren, adding new evidence that long-term exposure affects <i>F</i><sub>eNO</sub> beyond the well-documented short-term effects</b>https://bit.ly/3CGfYXN
Nonacog Beta Pegol for Prophylactic Treatment of Children with Hemophilia B: Up to 3.5-Year Data from the Paradigm™5 Clinical Trial
Authors: Susan Kearney, Elena Santagostino, Manuel Carcao, Faraizah Abdul Karim, Masashi Taki, Meng Yao Lu, May-Lill Garly, Marek Zak
Journal: Blood (2017)
Use of formative evaluation surveying and tailored digital education to identify and address knowledge and competency gaps in upper tract urothelial carcinoma (UTUC) care.
Authors: Tariqa Ackbarali, Wendy Turell, Elizabeth L. del Nido, Neal D. Shore, Phillip M. Pierorazio
Journal: Journal of Clinical Oncology (2021)

307 Background: Upper tract urothelial carcinoma (UTUC) treatment poses a unique challenge for clinicians, due to the complexity in diagnosis, risk stratification, and a lack of treatment options, leading to a lower patient quality of life. However, recent advances in kidney sparing treatment options have created an opportunity for clinicians to integrate newer therapies into practice and improve function for UTUC patients. To address these needs, a serial educational initiative was designed for the uro-oncology team. Methods: A 2-part CE activity was launched in partnership with Large Urology Group Practice Association live-online in June and December, 2020, and remains on-demand through December, 2021 at UroCareLive.com and OMedLive.com. The first activity focused on diagnosis, risk stratification, and newer treatments. Formative evaluation was applied to obtain feedback from the 1 st activity through an in-depth survey to clinician learners, the results of which were used to shape the content of the 2 nd activity. Formative evaluation survey results revealed gaps in recognizing disease progression (48%), risk stratification (with difficulty obtaining tissue from upper urinary tract noted as the most common barrier; 57%), and experience with newer agents leading to a lack of their use in practice (62%). Only 23% rated their team’s training on patient education as “Very Good” or “Excellent.” Additionally, knowledge and competence questions were administered pre-, immediate post-activity, and at 2-months follow-up. Data from these questions were analyzed to determine engagement and remaining gaps. Results: To date, 788 clinicians participated in the activity. All 8 pre/post-test questions demonstrated statistically significant improvements in knowledge and competence concerning risk stratification, treatment applications, and adverse event management. At 2-mos. follow-up, 75% reported improved behavioral impact on clinical practice and 55% reported impact on patient experience and outcomes. Learners provided write-in examples detailing changes such as improved confidence and understanding of newer treatment options, patient experience, and increased use of kidney-sparing treatments including mitomycin gel. Conclusions: The activity was successful in demonstrating sustained knowledge advances in critical areas such as tumor categorizing and risk stratification, the use of emerging treatment options, and management of adverse events in practice. Use of formative evaluation surveying allowed identification of practice gaps and barriers to change, providing an opportunity for tailored education addressing these needs. Learners also reported strong post-activity improvements in clinical practice and patient outcomes, illustrating the importance of serial education for the uro-oncology team.
Safety and Efficacy of a Typhoid Conjugate Vaccine in Malawian Children
Authors: Priyanka D. Patel, Pratiksha Patel, Yuanyuan Liang, James E. Meiring, Theresa Misiri, Felistas Mwakiseghile, J. Kathleen Tracy, Clemens Masesa, Harrison Msuku, David Banda, Maurice Mbewe, Marc Henrion, Fiyinfolu Adetunji, Kenneth Simiyu, Elizabeth Rotrosen, Megan Birkhold, Nginache Nampota, Osward M. Nyirenda, Karen Kotloff, Markus Gmeiner, Queen Dube, Gift Kawalazira, Matthew B. Laurens, Robert S. Heyderman, Melita A. Gordon, Kathleen M. Neuzil
Journal: New England Journal of Medicine (2021)

Typhoid fever caused by multidrug-resistant H58 Salmonella Typhi is an increasing public health threat in sub-Saharan Africa.We conducted a phase 3, double-blind trial in Blantyre, Malawi, to assess the efficacy of Vi polysaccharide typhoid conjugate vaccine (Vi-TCV). We randomly assigned children who were between 9 months and 12 years of age, in a 1:1 ratio, to receive a single dose of Vi-TCV or meningococcal capsular group A conjugate (MenA) vaccine. The primary outcome was typhoid fever confirmed by blood culture. We report vaccine efficacy and safety outcomes after 18 to 24 months of follow-up.The intention-to-treat analysis included 28,130 children, of whom 14,069 were assigned to receive Vi-TCV and 14,061 were assigned to receive the MenA vaccine. Blood culture-confirmed typhoid fever occurred in 12 children in the Vi-TCV group (46.9 cases per 100,000 person-years) and in 62 children in the MenA group (243.2 cases per 100,000 person-years). Overall, the efficacy of Vi-TCV was 80.7% (95% confidence interval [CI], 64.2 to 89.6) in the intention-to-treat analysis and 83.7% (95% CI, 68.1 to 91.6) in the per-protocol analysis. In total, 130 serious adverse events occurred in the first 6 months after vaccination (52 in the Vi-TCV group and 78 in the MenA group), including 6 deaths (all in the MenA group). No serious adverse events were considered by the investigators to be related to vaccination.Among Malawian children 9 months to 12 years of age, administration of Vi-TCV resulted in a lower incidence of blood culture-confirmed typhoid fever than the MenA vaccine. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT03299426.).
Hospitalization burden and end-of-life (EOL) care in elderly patients with glioblastoma (GBM).
Authors: Laura Donovan, Donna Buono, Melissa Kate Accordino, Jason Dennis Wright, Andrew B. Lassman, Dawn L. Hershman
Journal: Journal of Clinical Oncology (2021)

31 Background: GBM is associated with a poor prognosis and early death in elderly patients. Prior studies have demonstrated a high burden of hospitalization in this population. We sought to evaluate and examine trends in hospitalizations and EOL care in GBM survivors. Methods: Using SEER-Medicare linked data, we performed a retrospective observational cohort study of patients aged ≥ 65 years diagnosed with GBM from 2005-2017 who lived at least 6 months from the time of diagnosis. Aggressive EOL care was defined as: chemotherapy or radiotherapy within 14 days of death (DOD), surgery within 30 DOD, &gt; 1 emergency department visit, ≥ 1 hospitalization or intensive care unit admission within 30 DOD; in-hospital death; or hospice enrollment ≤ 3 DOD. We evaluated age, race, ethnicity, marital status, gender, socioeconomic status, comorbidities, prior treatment and percentage of time hospitalized. Multivariable logistic regression was performed to determine factors associated with aggressive end of life care. Results: Of 5827 patients, 2269 (38.9%) survived at least 6 months. Among these, 1106 (48.7%) survived 6-12 months, 558 (24.6%) survived 12-18 months, and 605 (26.7%) survived &gt; 18 months. Patients who survived 6-12 months had the highest burden of hospitalization and spent a median of 10.6% of their remaining life in the hospital compared to those surviving 12-18 months (5.4%) and &gt; 18 months (3%) (P &lt; 0.001). 10.1% of the cohort had claims for palliative care services; 49.8% of initial palliative care consults occurred in the last 30 days of life. Hospice claims existed in 83% with a median length of stay 33 days (IQR 12, 79 days). 30.1% of subjects received aggressive EOL care. Receiving chemo at any time (OR 1.510, 95% CI 1.221-1.867) and spending ≥ 20% of life in the hospital after diagnosis (OR 3.331, 95% CI 2.567-4.324) were associated with aggressive EOL care. Women (OR 0.759, 95% CI 0.624-0.922), patients with higher socioeconomic status (OR 0.533, 95% CI 0.342-0.829), and those diagnosed ≥ age 80 (OR 0.723, 95% CI 0.528-0.991) were less likely to receive aggressive EOL care. Race, ethnicity, marital status, and extent of initial resection were not associated with aggressive EOL care. Conclusions: A minority of elderly patients with GBM in the SEER-Medicare database survived ≥ 6 months; hospitalizations were common and patients spent a significant proportion of their remaining life hospitalized. Although hospice utilization was high in this cohort, 30% of patients received aggressive EOL care. Despite the aggressive nature of GBM, few patients had palliative care consults during their illness. Increased utilization of palliative care services may help reduce hospitalization burden and aggressive EOL care in this population.
Moderate-to-vigorous intensity physical activity from young adulthood to middle age and metabolic disease: a 30-year population-based cohort study
Authors: Jason M Nagata, Eric Vittinghoff, Kelley Pettee Gabriel, Andrea K Garber, Andrew E Moran, Jamal S Rana, Jared P Reis, Stephen Sidney, Kirsten Bibbins-Domingo
Journal: British Journal of Sports Medicine (2021)

Objectives To determine the association between moderate-to-vigorous intensity physical activity (MVPA) trajectories (course over age and time) through the adult life course and onset of metabolic disease (diabetes and dyslipidaemia). Methods We analysed prospective community-based cohort data of 5115 participants in the Coronary Artery Risk Development in Young Adults study, who were black and white men and women aged 18–30 years at baseline (1985–1986) at four urban sites, collected through 30 years of follow-up. Individualised MVPA trajectories were developed for each participant using linear mixed models. Results Lower estimated MVPA score at age 18 was associated with a 12% (95% CI 6% to 18%) higher odds of incident diabetes, a 4% (95% CI 1% to 7%) higher odds of incident low high-density lipoprotein (HDL) and a 6% (95% CI 2% to 11%) higher odds of incident high triglycerides. Each additional annual 1-unit reduction in the MVPA score was associated with a 6% (95% CI 4% to 9%) higher annual odds of diabetes incidence and a 4% (95% CI 2% to 6%) higher annual odds of high triglyceride incidence. Analysing various MVPA trajectory groups, participants who were in the most active group at age 18 (over 300 min/week), but with sharp declines in midlife, had higher odds of high low-density lipoprotein and low HDL incidence, compared with those in the most active group at age 18 with subsequent gains. Conclusion Given recent trends in declining MVPA across the life course and associated metabolic disease risk, young adulthood is an important time period for interventions to increase and begin the maintenance of MVPA.
Letter to the Editor: Serum bioavailable 25‐hydroxyvitamin D levels correlate with hepatocellular carcinoma survival
Authors: Lu‐Lu Zhai, Shi‐Hui Zhen, Zhi‐Gang Tang
Journal: Hepatology (2021)

FUNDING INFORMATIONSupported by the Zhejiang Provincial Natural Science Foundation of China (No. LGF19H290004). To the editor, It was with great interest that we read the article by Fang et al.[1] In this study, the researchers investigated the relationship between total, free, and bioavailable serum 25‐hydroxyvitamin D (25‐OHD) levels and survival in a large, prospective cohort of patients with HCC. The results showed that higher serum 25‐OHD levels were significantly and independently associated with increased survival in the HCC cohort, but neither total nor free serum 25‐OHD was associated with survival. This is an intriguing study with important clinical value, and we appreciate the efforts of the researchers. However, several concerns deserve to be discussed. First, ultraviolet (UV) light from sunlight is known to convert 7‐dehydrocholesterol in the skin into vitamin D3 (cholecalciferol), which is the main way to obtain endogenous vitamin D in humans.[2,3] In addition to the production of vitamin D in the body from UV radiation, vitamin D in food is also an important source, and the amount of vitamin D in different types of food varies.[4] When the level of vitamin D in the body increases, the level of 25‐OHD, which is converted in the liver through hydroxylation, increases accordingly.[5] Therefore, the duration of sunlight exposure and dietary structure (type and amount of food) should be considered as important confounding factors affecting the prognosis of HCC. Second, although the researchers showed that elevated serum bioavailable 25‐OHD was independently associated with a good prognosis in HCC patients, its predictive performance for HCC prognosis was not investigated. Therefore, we suggest that the researchers obtain the AUC by receiver operator characteristic curve analysis or calculate Harrell's concordance index (C‐index) to assess the predictive power of bioavailable 25‐OHD for HCC prognosis. Finally, we also suggest that the researchers use decision curve analysis to obtain the net benefit of prognostic indicators to assess the clinical utility of bioavailability 25‐OHD. CONFLICT OF INTEREST None to report. AUTHOR CONTRIBUTIONS Lu‐Lu Zhai, Shi‐Hui Zhen, and Zhi‐Gang Tang designed the study and wrote and reviewed the manuscript.