tbuckley/cabot-search huggingface dataset:
Opioid Cap Laws and Opioid Prescriptions After Total Joint Replacements in Older Adults
Authors: Caroline P. Thirukumaran, Derek T. Schloemann, Jalpa A. Doshi, Kevin A. Fiscella, Benjamin F. Ricciardi, Meredith B. Rosenthal
Journal: JAMA Network Open (2025)

Importance Despite the opioid crisis and a growing call for minimizing opioid use, opioids remain an important part of postoperative pain management, with more than 80% of patients filling at least 1 opioid prescription following total joint replacements (TJRs). Little is known as to whether state laws that restrict or cap opioids for acute pain reduce post-TJR opioid use. Objective To evaluate the association of an opioid cap law in New York (Section 3331) with post-TJR opioid prescribing. Design, Setting, and Participants This cohort study analyzed Medicare data from 2014 to 2019 for New York and California (control state). Participants were Medicare beneficiaries who underwent elective TJRs before (April 2014 to June 2016) or after (August 2016 to September 2019) Section 3331 implementation. Data were analyzed from June 2023 to August 2024. Exposure Implementation of New York Section 3331 in July 2016. Main Outcomes and Measures The primary end point was total morphine milligram equivalents (MMEs) filled from discharge to day 7, days 8 to 30, and days 31 to 90 after TJR. Key independent variables were legislation phase (before or after Section 3331 implementation), treatment or control state, and the interactions between these 2 variables. Difference-in-differences regression models were used to assess the association of interest. Results The pre–Section 3331 cohort included 32 253 TJR encounters among 31 028 patients, of whom 9924 (31.98%) underwent TJRs in New York hospitals. The mean (SD) age of the cohort was 73.43 (5.49) years; 19 442 encounters (60.28%) were among females. The estimated change in total MMEs filled in the 7-day post-TJR period after vs before Section 3331 implementation was −135.08 (95% CI, −146.62 to −123.53; P &amp;amp;lt; .001) in California and −178.00 (95% CI, −191.98 to −164.02; P &amp;amp;lt; .001) in New York, resulting in a Section 3331–associated change of −42.92 MMEs (95% CI, −61.04 to −24.80 MMEs; P &amp;amp;lt; .001) in New York compared with California. Section 3331 was not associated with statistically significant changes in total MMEs filled in the 8 to 30–day and 31 to 90–day post-TJR periods. Conclusions and Relevance The findings of this retrospective cohort study of TJRs among Medicare beneficiaries suggest that New York Section 3331 achieved its intended objective, as it was associated with reduced opioid fills in the immediate 7-day post-TJR period in New York compared with California. Additional refinements may further reduce opioid prescribing in New York, and these findings may serve as a foundation for refining laws in other states that may not achieve their intended targets or have not implemented similar laws.
Convergence of Cannabis and Psychosis on the Dopamine System
Authors: Jessica Ahrens, Sabrina D. Ford, Betsy Schaefer, David Reese, Ali R. Khan, Philip Tibbo, Rachel Rabin, Clifford M. Cassidy, Lena Palaniyappan
Journal: JAMA Psychiatry (2025)

Importance Despite evidence that individuals with a cannabis use disorder (CUD) are at elevated risk of psychosis and that the neurotransmitter dopamine has a role in psychosis, the mechanism linking cannabis use and psychosis remains unclear. Objective To use neuromelanin-sensitive magnetic resonance imaging (MRI), referred to as the neuromelanin-MRI signal , a practical, proxy measure of dopamine function, to assess whether a common alteration in the dopamine system may be implicated in CUD and psychosis and whether this alteration can be observed in those with a CUD whether or not they have a diagnosis of first-episode schizophrenia (FES). Design, Setting, and Participants This longitudinal observational cohort study recruited individuals from 2019 to 2023 from an early psychosis service and the surrounding communities in London, Ontario. The sample included individuals with and without CUD, with some in each group also diagnosed with FES. Exposures FES and CUD diagnoses from the Structured Clinical Interview for DSM-5 . Main Outcomes and Measures Neuromelanin-MRI signals within the midbrain (substantia nigra [SN]/ventral tegmental area [VTA]) including a subregion previously linked to the severity of untreated psychosis (a priori region of interest). Linear mixed-effects analyses were performed relating neuromelanin-MRI signals to clinical measures. Results A total of 36 individuals without CUD (mean [SD] age, 22.3 [3.2] years; 29 male [81%]; 12 with FES) and 25 individuals with CUD (mean [SD] age, 24.3 [4.7] years; 22 male [88%]; 16 with FES) participated in the study. One-year follow-up was completed for 12 individuals with CUD and 25 without CUD. CUD was associated with elevated neuromelanin-MRI signal in a set of ventral SN/VTA voxels (387 of 2060 SN/VTA voxels, corrected P = .03, permutation test). CUD was also associated with elevated neuromelanin-MRI signal in the psychosis-related region of interest ( t 92 = 2.12, P = .04) with a significant dose-dependent association (higher burden of CUD symptoms associated with higher neuromelanin-MRI signal, F 1, 96 = 4.89; P = .03). In contrast, participants with FES did not exhibit a significant elevation in neuromelanin-MRI signal (241 SN/VTA voxels had elevated signal, corrected P = .09). There was no association between time and neuromelanin-MRI signal. Conclusions and Relevance Elevated dopamine function in a critical SN/VTA subregion may be associated with psychosis risk in people with CUD. Cannabis was associated with the hypothesized final common pathway for the clinical expression of psychotic symptoms.
Automating the Addiction Behaviors Checklist for Problematic Opioid Use Identification
Authors: Angus H. Chatham, Eli D. Bradley, Vanessa Troiani, Donielle L. Beiler, Parker Christy, Lori Schirle, Sandra Sanchez-Roige, David C. Samuels, Alvin D. Jeffery
Journal: JAMA Psychiatry (2025)

Importance Individuals whose chronic pain is managed with opioids are at high risk of developing an opioid use disorder. Electronic health records (EHR) allow large-scale studies to identify a continuum of problematic opioid use, including opioid use disorder. Traditionally, this is done through diagnostic codes, which are often unreliable and underused. Objective To determine whether regular expressions, an interpretable natural language processing technique, could automate a validated clinical tool (Addiction Behaviors Checklist) to identify problematic opioid use. Design, Setting, and Participants This cross-sectional study reports on a retrospective cohort with data analyzed from 2021 through 2023. The approach was evaluated against a blinded, manually reviewed holdout test set and validated against an independent test set at a separate institution. The study used data from Vanderbilt University Medical Center’s Synthetic Derivative, a deidentified version of the EHR for research purposes. This cohort comprised 8063 individuals with chronic pain, defined by diagnostic codes on at least 2 days. The study team collected free-text notes, demographics, and diagnostic codes and performed an external validation with 100 individuals with chronic pain from Geisinger, recruited from an interventional pain clinic cohort. Main Outcomes and Measures The primary outcome was the evaluation of the automated method in identifying patients demonstrating problematic opioid use and its comparison with manual medical record review and opioid use disorder diagnostic codes. Methods with F1 scores were evaluated (a single value that combines sensitivity and positive predictive value at a single threshold) and areas under the curve (a single value that combines sensitivity and specificity across multiple thresholds). Results Among the 8063 patients in the primary site (5081 female [63%] and 2982 male [37%]; mean [SD] age, 56 [16] years) and 100 patients in the validation site (57 female [57%] and 43 male [43%]; mean [SD] age, 54 [13] years), the automated approach outperformed diagnostic codes based on F1 scores (0.73; 95% CI, 0.62-0.83 vs 0.08; 95% CI, 0.00-0.19 at the primary site and 0.70; 95% CI, 0.50-0.85 vs 0.29; 95% CI, 0.07-0.50 at the validation site) and areas under the curve (0.82; 95% CI, 0.73-0.89 vs 0.52; 95% CI, 0.50-0.55 at the primary site and 0.86; 95% CI, 0.76-0.94 vs 0.59;95% CI, 0.50-0.67 at validation site). Conclusions This automated data extraction technique may facilitate earlier identification of people at risk for and who are experiencing problematic opioid use, and create new opportunities for studying long-term sequelae of opioid pain management.
Pregnancy-Related Deaths in the US, 2018-2022
Authors: Yingxi Chen, Meredith S. Shiels, Tarsicio Uribe-Leitz, Rose L. Molina, Wayne R. Lawrence, Neal D. Freedman, Christian C. Abnet
Journal: JAMA Network Open (2025)

Importance The US has the highest rate of preganncy-related death among high-income countries, and disparities continue to widen despite many of these deaths being largely preventable. Objective To examine the age-standardized national rates of pregnancy-related death from 2018 to 2022 in the US, stratified by cause, and to compare the rates across state and race and ethnicity. Design, Setting, and Participants This serial cross-sectional study used nationwide data on births and pregnancy-related deaths from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women aged 15 to 54 years from 2018 to 2022 were included. Exposure State, race and ethnicity, and age. Main Outcomes and Measures The primary outcomes were all-cause and cause-specific maternal death and late maternal death (ie, deaths occurring &amp;amp;gt;42 days and up to 1 year after pregnancy). The age-standardized annual and aggregated rate of pregnancy-related mortality (ASR) was estimated by age group and race and ethnicity, and state-specific crude pregnancy-related mortality rates per 100 000 live births and 95% CIs were calculated. Results During 2018 to 2022, there were 6283 pregnancy-related deaths, including 1891 late maternal deaths. The ASR increased by 27.7% from 25.3 deaths per 100 000 live births (95% CI, 23.7-26.9) in 2018 to 32.6 deaths per 100 000 live births (95% CI, 31.2-34.8) in 2022. The increase was observed across age group and was disproportionately driven by deaths that occurred among women aged 25 to 39 years (by 36.8%, 2018 vs 2022). There was a considerable variation in rates by state, ranging from 18.5 to 59.7 deaths per 100 000 live births. If the national rate was reduced to the lowest state rate, 2679 pregnancy-related deaths could have been prevented in 2018 to 2022. American Indian and Alaska Native women had the highest ASR (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behavior disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death. Conclusions and Relevance In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority.
Dermatologic Care and Skin Health of Migrant Populations in the US
Authors: Herbert B. Castillo Valladares, Penelope Kim-Lim, Aileen Y. Chang
Journal: JAMA Dermatology (2025)

Importance Despite literature on migrant skin health globally, there remains a critical gap in understanding the dermatologic care and skin health of migrants in the US, where immigrants represent 13.9% of the population. Objective To understand the spectrum of dermatologic conditions reported among US migrant populations, identify considerations for dermatologic care delivery, and synthesize the current literature on skin health. Evidence Review PubMed, Embase, and ClasePeriodica were searched for articles published from January 2000 to December 2022 using search terms related to dermatologic conditions and migrants. Original research articles, review articles, case reports, and case series that reported on dermatologic conditions affecting migrant populations within the US and US territories were included. Findings Of 87 articles included, cross-sectional studies accounted for 37 (42.5%), followed by case reports and case series (36 [41.4%]), qualitative studies (3 [3.4%]), and a mixed-methods study (1 [1.1%]). Articles discussed a range of dermatologic conditions: infections (45 [51.7%]), inflammatory conditions (33 [37.9%]), traumatic wounds (16 [18.4%]), neoplasms (10 [11.5%]), pigmentary disorders (10 [11.5%]), signs of torture/violence (4 [4.6%]), cosmetic (3 [3.4%]), hair/nail disorders (1 [1.1%]), and genodermatoses (1 [1.1%]). Of 65 articles (74.6%) reporting migrants’ country of origin, Mexico was most frequently reported (28 [43.0%]), followed by Guatemala (14 [21.5%]), Vietnam (8 [12.3%]), and 38 other countries. Four themes were developed: (1) exposures before and during migration were risk factors for dermatologic conditions that presented at destination; (2) occupational and environmental exposures were risk factors for dermatologic conditions that developed at destination; (3) structural factors limited migrants’ access to quality health care; and (4) educational interventions targeting different learner groups were opportunities to improve skin health of migrants. Conclusions and Relevance This scoping review found that exposures before, during, and after migration and health care access are associated with the skin health of US migrant populations. Research opportunities include focusing on a broad spectrum of dermatologic diseases, countries of birth, occupations, and vulnerable populations, such as women and children, as well as implementing and evaluating policy that addresses structural barriers migrants face in accessing quality health care.
Foley Catheter Management
Authors: Anne P. Cameron, Glenn T. Werneburg
Journal: JAMA Surgery (2025)

Importance About 100 million urinary catheters are used globally each year. Urinary catheters are effective to establish bladder drainage, but they are associated with risks, including infection and encrustation. To mitigate the associated risks, an understanding of urinary catheter indications, placement and removal techniques, and maintenance is necessary. Observations This review describes catheter management and complications. Specifically, catheter indications and alternatives, catheter types, insertion and removal techniques, and catheter maintenance are reviewed. Catheter-associated complications and strategies to minimize risk are described. Conclusions and Relevance Using best practices related to catheter management optimizes bladder drainage while minimizing the associated risks, including catheter-associated urinary tract infection, catheter encrustations, bladder spasms, and catheter-associated pain.
Association of Patient Cost-Sharing With Adherence to GLP-1a and Adverse Health Outcomes
Authors: Donglan Zhang, Nihan Gencerliler, Amrita Mukhopadhyay, Saul Blecker, Morgan E. Grams, Davene R. Wright, Vivian Hsing-Chun Wang, Anand Rajan, Eisha Butt, Jung-Im Shin, Yunwen Xu, Karan R. Chhabra, Jasmin Divers
Journal: Diabetes Care (2025)

OBJECTIVE To examine the associations between patient out-of-pocket (OOP) costs and nonadherence to glucagon-like peptide 1 receptor agonists (GLP-1a), and the consequent impact on adverse outcomes, including hospitalizations and emergency department (ED) visits. RESEARCH DESIGN AND METHODS This retrospective cohort study used MarketScan Commercial data (2016–2021). The cohort included nonpregnant adults aged 18–64 years with type 2 diabetes who initiated GLP-1a therapy. Participants were continuously enrolled in the same private insurance plan for 6 months before the prescription date and 1 year thereafter. Exposures included average first 30-day OOP costs for GLP-1a, categorized into quartiles (lowest [Q1] to highest [Q4]). Primary outcomes were the annual proportion of days covered (PDC) for GLP-1a and nonadherence, defined as PDC &amp;lt;0.8. Secondary outcomes included diabetes-related and all-cause hospitalizations and ED visits 1 year post-GLP-1a initiation. RESULTS Among 61,907 adults who initiated GLP-1a, higher 30-day OOP costs were associated with decreased adherence. Patients in the highest OOP cost quartile (Q4: $80–$3,375) had significantly higher odds of nonadherence (odds ratio [OR]1.25; 95% CI 1.19–1.31) compared with those in Q1 ($0–$21). Nonadherence was linked to increased incidence rates of diabetes-related hospitalizations or ED visits (incidence rate ratio [IRR] 1.86; 95% CI 1.43–2.42), cumulative length of hospitalization (IRR 1.56; 95% CI 1.41–1.72), all-cause ED visits (IRR 1.38; 95% CI 1.32–1.45), and increased ED-related costs ($69.81, 95% CI $53.54–$86.08). CONCLUSIONS Higher OOP costs for GLP-1a were associated with reduced adherence and increased rates of adverse outcomes among type 2 diabetes patients.
Targeting the ER stress sensor IRE1 protects the liver from fibrosis through the downregulation of the proteostasis factor P4HB/PDIA1
Authors: Younis Hazari, Lama Habbouche, Valeria A. Garcia Lopez, Hery Urra, Javier Diaz, Giovanni Tamburini, Mateus Milani, Sylvere Durand, Fanny Aprahamian, Reese Baxter, Menghao Huang, X Charlie Dong, Luis Gonzalez-Rojas, Juan Francisco Silva, Ignacio Tapia-Dufey, Helena Vihinen, Vlad Ratziu, Fabienne Foufelle, Jan G. Hengstler, Eija Jokitalo, Jessica L Maiers, Lars Plate, Guido Kroemer, Beatrice Bailly-maitre, Claudio Hetz
Journal: Hepatology (2025)

Collagen is the main cargo of the secretory pathway, contributing to hepatic fibrogenesis due to extensive accumulation of extracellular matrix. An excess of collagen deposition is a characteristic feature of several chronic liver diseases. Collagen overproduction imposes pressure on the secretory pathway, altering endoplasmic reticulum (ER) proteostasis. Here we investigated the possible contribution of the unfolded protein response UPR, the main adaptive pathway that monitors and adjusts protein production capacity at the ER, to collagen biogenesis and liver disease. Genetic ablation of the ER stress sensor IRE1 in the liver using conditional knockout mice reduced liver damage and collagen deposition in models of fibrosis, steatosis, and acute hepatotoxicity. Proteomic profiling identified the prolyl 4-hydroxylase (P4HB, also known as PDIA1) as a major IRE1-regulated gene, a critical factor involved in collagen maturation. Cell culture studies demonstrated that IRE1 deficiency results in collagen retention at the ER, reducing its secretion, and this phenotype is rescued by P4HB/PDIA1 overexpression. Analyses of human MASH samples revealed a positive correlation between IRE1 signaling and P4HB/PDIA1 expression as well as the severity of the disease. Altogether, our results establish a role of the IRE1/P4HB axis in the regulation of collagen production and support its implication in the pathogenesis of liver fibrosis.
Immune Checkpoint Inhibitor–Induced Lipodystrophy
Authors: Julia Riganti, Ana C. Torre, Pietro Sollena, Dimitra Koumaki, Azael Freites-Martinez, Julie Delyon, Antoine Communie, Michela Starace, Luca Rapparini, Aimilios Lallas, Dimitrios Mavroudis, Devaux Suzanne, Luis D. Mazzuoccolo, Mattheos Bobos, Vincent Sibaud, Zoe Apalla
Journal: JAMA Dermatology (2025)

This case series describes lipodystrophy, a rare adverse event associated with immune checkpoint inhibitor therapy.
Concordance of 30-Day Mortality and In-Hospital Mortality or Hospice Discharge After Sepsis
Authors: Hallie C. Prescott, Megan Heath, Namita Jayaprakash, Raymund B. Dantes, Chanu Rhee, Patricia J. Posa, Scott A. Flanders
Journal: JAMA (2025)

This study uses a multihospital cohort to evaluate 2 candidate outcome measures being considered for benchmarking by the CDC and CMS for community-onset sepsis hospitalizations: 30-day mortality after admission and composite in-hospital mortality or hospice discharge.
Symptomatic Necrosis With Dual Immune-Checkpoint Inhibition and Radiosurgery for Brain Metastases
Authors: Eugene J. Vaios, Rachel F. Shenker, Peter G. Hendrickson, Zihan Wan, Donna Niedzwiecki, David Carpenter, Warren Floyd, Sebastian F. Winter, Helen A. Shih, Jorg Dietrich, Chunhao Wang, April K. S. Salama, Jeffrey M. Clarke, Karen Allen, Paul Sperduto, Trey Mullikin, John P. Kirkpatrick, Scott R. Floyd, Zachary J. Reitman
Journal: JAMA Network Open (2025)

This cohort study evaluates whether immune-checkpoint inhibition therapy concurrent with radiosurgery is associated with risk of symptomatic radionecrosis among US patients with brain metastases.
Sigmoid Resection vs Conservative Treatment After Diverticulitis
Authors: Alexandre Santos, Panu Mentula, Tarja Pinta, Shamel Ismail, Tero Rautio, Risto Juusela, Aleksi Lähdesmäki, Tom Scheinin, Ville Sallinen
Journal: JAMA Surgery (2025)

Importance Laparoscopic elective sigmoid resection is a treatment option for patients with recurring, persistent painful, or complicated diverticulitis, but outcomes of surgery compared with conservative treatment are unclear in long-term follow-up. Objective To compare quality-of-life (QOL), complication, and recurrence outcomes of surgery vs conservative treatment in patients with recurring, persistent painful, or complicated diverticulitis. Design, Setting, and Participants The open-label Laparoscopic Elective Sigmoid Resection Following Diverticulitis (LASER) randomized clinical trial was conducted in 6 Finnish hospitals. Ninety patients with recurring, persistent painful, or complicated diverticulitis were randomized (1:1) to elective sigmoid resection or conservative treatment from September 2014 to October 2018. Herein, outcomes are reported at 4-year follow-up using the intention-to-treat principle. Data analysis for this 4-year follow-up was performed from October 2023 to November 2024. Interventions Laparoscopic elective sigmoid resection vs conservative treatment. Main Outcomes and Measures Secondary outcomes, such as Gastrointestinal Quality of Life Index (GIQLI) scores, complications, and recurrences, within 4 years are reported using intention-to-treat and post hoc per-protocol analyses. Results Of 90 enrolled patients (28 male [31%] with mean [SD] age of 54.11 [11.9] years; 62 female [69%] with mean [SD] age of 57.13 [7.6] years), 45 were randomized to elective sigmoid resection and 45 to conservative treatment. Among those randomized to conservative treatment, 14 of 44 (32%) underwent sigmoid resection within 4 years (patients with lower QOL on average). The mean (SD) GIQLI score was 115.3 (17.8) in the surgery group vs 109.8 (19.8) in the conservative treatment group (mean difference, 5.54 [95% CI, −2.98 to 14.06]) at 4 years. Recurrence of diverticulitis occurred in 6 of 38 patients (16%) (4 [10%] after surgery) in the surgery group vs 34 of 37 patients (92%) in the conservative treatment group. Severe postoperative complications occurred in 4 patients (10%) in the surgery group vs 5 patients (11%) in the conservative treatment group. Conclusions and Relevance High crossover rates from conservative treatment to surgery indicate that patients with low QOL in the conservative treatment group often require surgical intervention; elective sigmoid resection did not improve QOL compared with conservative treatment in 4-year follow-up, even though it was effective in preventing recurrences of diverticulitis and did not lead to increased rates of postoperative complications. Upfront surgery may be preferable in patients with low QOL, but initial conservative treatment is an option for patients with near-normal QOL. Trial Registration ClinicalTrials.gov Identifier: NCT02174926