tbuckley/cabot-search huggingface dataset:
Aortic Stenosis, Heart Failure, and Aortic Valve Replacement
Authors: Siddhartha Mengi, James L. Januzzi, João L. Cavalcante, Marisa Avvedimento, Attilio Galhardo, Mathieu Bernier, Josep Rodés-Cabau
Journal: JAMA Cardiology (2024)

Heart failure (HF) and aortic stenosis (AS) frequently coexist, presenting a complex clinical challenge due to their intertwined pathophysiology and associated high morbidity and mortality. Despite numerous advancements in transcatheter and surgical aortic valve replacement (AVR), HF decompensation remains the leading cause of cardiac rehospitalization and a major predictor of mortality in patients with AS, before or after AVR. This review aims to provide a comprehensive analysis of the interplay between AS and HF, delving into myocardial changes caused by stenotic insult, the impact of AVR on these changes, and the prevalence and contributing elements of HF before and after AVR.
Upper-Extremity Approach for Secondary Access in TAVI—Ready for Standard Clinical Practice?
Authors: Michiel Voskuil
Journal: JAMA Network Open (2024)

Geert A. A. Versteeg, MD; Maxim J. P. Rooijakkers, MD; Kimberley I. Hemelrijk, MD; Pieter J. Vlaar, MD, PhD; Daniël C. Overduin, MD; Marleen H. van Wely, MD; Hugo M. Aarts, MD; Dirk-Jan van Ginkel, MD; Lokien X. van Nunen, MD, PhD; Robert Jan van Geuns, MD, PhD; Leen A. F. M. van Garsse, MD, PhD; Guillaume S. C. Geuzebroek, MD, PhD; Michel W. A. Verkroost, MD; Aysun Cetinyurek-Yavuz, PhD; Robin H. Heijmen, MD, PhD; Jurrien M. ten Berg, MD, PhD; Pim A. L. Tonino, MD, PhD; Ronak Delewi, MD, PhD; Niels van Royen, MD, PhD
Parsing Signal vs Noise—Secondary Analyses of RCTs
Authors: Gregg C. Fonarow, Ajay J. Kirtane, Clyde W. Yancy
Journal: JAMA Cardiology (2024)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast JAMA+ AI Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Cardiology journal
Lipodermatosclerosis and Pulmonary Hypertension in Systemic Sclerosis
Authors: Srijana Davuluri, Puneet Kapoor, Swarna Nandyala, Shufeng Li, Julia Simard, Matthew Lewis, David Fiorentino, Lorinda Chung
Journal: JAMA Dermatology (2024)

Importance Lipodermatosclerosis (LDS) stems from vascular dysfunction and dermal inflammation and thereby is mechanistically similar to systemic sclerosis (SSc). The association of LDS with SSc in the clinical setting has not been well characterized in the literature. Objective To evaluate the prevalence of LDS in SSc and the association of LDS with vascular complications, particularly pulmonary hypertension, in patients with SSc. Design, Setting, and Participants This retrospective cohort study used prospectively collected longitudinal data from a cohort of patients from the multidisciplinary rheumatology and dermatology clinic at a single tertiary care center from November 2004 to November 2022. Adult patients (aged ≥18 years at the time of cohort entry) with SSc were included. Exposure Clinical diagnosis of LDS based on expert opinion or histopathologic findings. Main Outcomes and Measures The main outcomes included prevalence of LDS, the association of LDS with the macrovascular complications, including pulmonary hypertension, digital gangrene and/or scleroderma renal crisis. Disease complications, including cardiac arrhythmias and heart failure, were compared among patients with and without LDS. Results Among 567 patients with SSc (494 [87.1%] female; mean [SD] age, 53.4 [14.4] years), 25 (4.4%) had LDS and 542 (95.6%) did not have LDS. Skin ulceration occurred in 8 patients with LDS (32.0%). Patients with LDS had higher frequencies of cardiac arrhythmia (11 of 24 [45.8%] vs 145 of 539 [26.9%]), heart failure (7 [28.0%] vs 55 [10.1%]), and pulmonary hypertension (12 [48.0%] vs 137 of 541 [25.3%]) compared with patients without LDS. Frequency of scleroderma renal crisis and digital gangrene did not differ significantly between patients with and without LDS (0 vs 37 [6.8%] and 4 [16.0%] vs 69 of 538 [12.8%], respectively). Among patients with LDS, 9 (36.0%) were either discharged to hospice or died during follow-up compared with 115 patients without LDS (21.2%). Lipodermatosclerosis was associated with pulmonary hypertension (adjusted prevalence odds ratio, 3.10; 95% CI, 1.33-7.25). Conclusions and Relevance In this cohort study, LDS was a rare clinical manifestation in patients with SSc but was associated with pulmonary hypertension. Therefore, patients with LDS should be closely monitored and screened for pulmonary hypertension.
Value and Affordability of Shelter-Based Opioid Treatment Among People Experiencing Homelessness
Authors: Mark Bounthavong
Journal: JAMA Network Open (2024)

Avik Chatterjee, MD, MPH; Emily A. Stewart, BS; Sabrina A. Assoumou, MD, MPH; Stavroula A. Chrysanthopoulou, PhD; Hana Zwick, MS; Rebecca Arden Harris, MD, MSc; Ryan O'Dea, MS; Bruce R. Schackman, PhD; Laura F. White, PhD; Benjamin P. Linas, MD, MPH
Perianal Paget Disease
Authors: Jiang-Wei Cheng, Bo-Wen Zheng, Jiu-Hong Li
Journal: JAMA Dermatology (2024)

This case report describes a woman in her 70s with an erythematous plaque with superficial erosion, focal white scale, and surrounding hyperpigmentation located circumferentially around the anus and extending anteriorly to involve the perineum.
Again
Authors: Kathleen Brodowski
Journal: JAMA (2024)

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 JAMA+ AI Journals 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 2024 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
Hidradenitis Suppurativa and Maternal and Offspring Outcomes
Authors: Kaiyang Li, Vincent Piguet, David Croitoru, Shu Qin Wei, Émilie Brousseau, Elizabeth O’Brien, Nathalie Auger
Journal: JAMA Dermatology (2024)

Importance Hidradenitis suppurativa (HS) is associated with morbidity in persons of reproductive age, but the effect on maternal and offspring outcomes is understudied. Objective To determine the association of HS with pregnancy outcomes and maternal and child morbidity in the long term. Design, Setting, and Participants This population-based longitudinal cohort study with up to 16 years of follow-up took place between 2006 and 2022 in Quebec, Canada. . Exposure Maternal HS. Main Outcomes and Measures Outcomes included hypertensive disorders of pregnancy, gestational diabetes, and other birth outcomes as well as the long-term risk of hospitalization up to 16 years after delivery. The study used adjusted log-binomial and Cox proportional hazards regression models to estimate the association between maternal HS and pregnancy outcomes or hospitalization following pregnancy. Outcomes in both mothers and offspring were assessed. Results There were 1 324 488 deliveries during the study, including 1332 (0.1%) among mothers with HS. Compared with patients without HS, patients with HS had a greater risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.55 [95% CI, 1.29-1.87]), gestational diabetes (RR, 1.61 [95% CI, 1.40-1.85]), and severe maternal morbidity (RR, 1.38 [95% CI, 1.03-1.84]). In neonates, maternal HS was associated with risk of preterm birth (RR, 1.28 [95% CI, 1.07-1.53]) and birth defects (RR, 1.29 [95% CI, 1.07-1.56]). In the long term, HS was associated with 2.29 times the risk of maternal hospitalization (95% CI, 2.07-2.55) and 1.31 times the risk of childhood hospitalization (95% CI, 1.18-1.45), including hospitalization for respiratory, metabolic, psychiatric, and immune-related morbidity over time. Conclusions and Relevance This cohort study found that HS is associated with adverse maternal and offspring outcomes in the peripartum period and in the long term. Early detection and management of HS may help mitigate these outcomes.
Tumor hypoxia: long ignored but now detectable and potentially actionable
Authors: Ralph P. Mason
Journal: Clinical Cancer Research (2024)

Summary Oxygen-enhanced MRI was successfully applied to 24 patients with human papillomavirus–associated oropharyngeal cancer. This prospective trial rigorously evaluated reproducibility and changes with respect to tumor radiation. Analyses compared hypoxic volumes and hypoxic fractions. It represents important progress in developing a practical approach to assessing tumor hypoxia in patients noninvasively. See related article by Dubec et al., p. XX
Antipsychotic Drugs and Cognitive Function
Authors: Lena Feber, Natalie L. Peter, Virginia Chiocchia, Johannes Schneider-Thoma, Spyridon Siafis, Irene Bighelli, Wulf-Peter Hansen, Xiao Lin, Daniel Prates-Baldez, Georgia Salanti, Richard S. E. Keefe, Rolf R. Engel, Stefan Leucht
Journal: JAMA Psychiatry (2024)

Importance Cognitive deficits are a substantial part of the symptoms of schizophrenia spectrum disorders (SSDs) and contribute heavily to the burden of disease. Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition. No previous network meta-analysis compared antipsychotics to placebo, which is important to determine whether use of these drugs is associated with cognitive performance in SSDs at all. Objective To determine the association of treatment with various antipsychotics and cognition in patients with SSDs. Data Sources Cochrane Schizophrenia Trials Register through June 25, 2023. Study Selection Randomized clinical trials examining the effects on cognition of antipsychotic drugs or placebo in participants with SSD. Data Extraction and Synthesis A systematic review and random-effects frequentist network meta-analysis was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses–Network Meta-analysis reporting guideline. Main Outcomes and Measures The primary outcome was change in overall cognition score calculated for each study. Secondary outcomes included cognitive domains, quality of life, and functioning. Results This study included 68 studies involving 9525 participants (mean [SD] age, 35.1 [8.9] years; 5878 male [70%] and 2890 [30%] female; some studies did not provide this information). There were few clear differences between antipsychotics, but first-generation dopamine antagonists haloperidol (standardized mean difference [SMD], 0.04; 95% CI, −0.25 to 0.33) and fluphenazine (SMD, 0.15; 95% CI, −0.39 to 0.69) as well as clozapine (SMD, 0.12; 95% CI, −0.23 to 0.48) ranked low. No individual antipsychotic was associated with a clearly better outcome than placebo, but antipsychotics as a group were, with small effect sizes (mean SMDs: adrenergic/low dopamine, −0.21; serotonergic/dopaminergic, −0.26; muscarinic, −0.28; dopaminergic, −0.40). Conclusion and Relevance Although data are relatively sparse, those reviewed in this study suggest that first-generation dopamine antagonists and clozapine should be avoided when cognitive deficits are a concern. Antipsychotics are not procognitive drugs. The overall small superior outcomes compared to placebo may be explained by less disordered thought patterns associated with fewer positive symptoms rather than cognitive deficits in the proper sense. The findings also suggest that harmonizing measurement of cognitive function in randomized clinical trials would be beneficial.
Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts
Authors: Avik Chatterjee, Emily A. Stewart, Sabrina A. Assoumou, Stavroula A. Chrysanthopoulou, Hana Zwick, Rebecca Arden Harris, Ryan O’Dea, Bruce R. Schackman, Laura F. White, Benjamin P. Linas
Journal: JAMA Network Open (2024)

Importance Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications. Objective To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts. Design, Setting, and Participants This economic evaluation study in Massachusetts used a cohort state-transition simulation model. Two cohorts were modeled starting in 2013, including (1) a closed cohort of a fixed population of PEH with history of high-risk opioid use over their lifetimes and (2) an open cohort in which membership could change over time, allowing assessment of population-level trends over a 10-year period. Data analysis occurred from January 2023 to April 2024. Exposures Model exposures included (1) no shelter-based buprenorphine (status quo) and (2) offering buprenorphine in shelters statewide. Main Outcomes and Measures Outcomes included overdose deaths, quality-adjusted life-years (QALYs) gained, and health care and modified societal perspective costs. Sensitivity analyses were conducted on key parameters. Results In the closed cohort analysis of 13 800 PEH (mean [SD] age, 40.4 [13.1] years; 8749 male [63.4%]), shelter-based buprenorphine was associated with an additional 65.4 person-weeks taking buprenorphine over an individual’s lifetime compared with status quo. Shelter-based buprenorphine was cost saving when compared with the status quo, with a discounted lifetime cost savings from the health sector perspective of $1300 per person, and 0.2 additional discounted QALYs per person and 0.9 additional life-years per person. In the population-level simulation, 254 overdose deaths were averted over the 10-year period with the shelter-based buprenorphine strategy compared with the status quo (a 9.2% reduction of overdose deaths among PEH in Massachusetts). Overdose-related and other health care utilization undiscounted costs decreased by $3.0 million and $66.4 million, respectively. Shelter-based opioid treatment generated $44.7 million in additional medication and clinical costs, but saved $69.4 million in overdose and other health costs. Conclusions and Relevance In this economic evaluation of clinical and economic outcomes among PEH, shelter-based buprenorphine was associated with fewer overdose deaths and was cost saving. These findings suggest that broad rollout of shelter-based buprenorphine may be an important tool in addressing the overdose crisis.
Emergency Care Use During Pregnancy and Severe Maternal Morbidity
Authors: Eugene R. Declercq, Chia-Ling Liu, Howard J. Cabral, Ndidiamaka Amutah-Onukagha, Hafsatou Diop, Pooja K. Mehta
Journal: JAMA Network Open (2024)

Importance Pregnant individuals who repeatedly use emergency care during pregnancy represent a population who could be disproportionately vulnerable to harm, including severe maternal morbidity (SMM). Objective To explore patterns of unscheduled care visits during pregnancy and ascertain its association with SMM at the time of birth. Design, Setting, and Participants This cohort study used data from a statewide database that linked hospital records to births and fetal deaths occurring between October 1, 2002, and March 31, 2020, in Massachusetts. Pregnant individuals experiencing births or fetal deaths during the study period were included. Data analysis was conducted from June 2022 to September 2024. Exposure The exposure was 4 or more cases of emergency use, defined as either an emergency department visit or observational stay during pregnancy not resulting in hospital admission. Pregnancy episode was ascertained by subtracting the gestational age at birth from the date of birth. Main Outcomes and Measures The outcome of interest was the odds ratio (OR) for SMM at the time of birth. The algorithm includes 20 conditions or procedures (excluding transfusion) identified through International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes across the study period. Results A total of 774 092 pregnant individuals (mean [SD] age, 31.2 [5.8] years; 16.8% Hispanic, 9.3% non-Hispanic Asian or Pacific Islander, 9.5% non-Hispanic Black, 63.1% non-Hispanic White) with emergency care visits during the pregnancy were included; 31.3% of these individuals had at least 1 visit. Overall, 18.1% had 1 visit and 3.3% had 4 or more visits. Four or more unscheduled visits were common among those younger than age 25 years (8.7%), with Hispanic (5.7%) or non-Hispanic Black (4.9%) race and ethnicity, with public insurance (6.5%), or with a comorbidity (19.0%) or an opioid use–related hospitalization (26.8%) in the year prior to pregnancy. Of those with 4 or more unscheduled visits, 43.8% visited more than 1 hospital during pregnancy. In a multivariable analysis of the likelihood of SMM, those with 4 or more unscheduled visits had an adjusted OR of 1.46 (95% CI, 1.29-1.66) compared with those with 0 visits. Conclusions and Relevance This cohort study found that high emergency care use during pregnancy was associated with an increased risk for SMM. With a significant proportion of those with frequent unscheduled visits also using multiple hospitals, solutions that are community-based and integrated across health systems may be most beneficial.
Characterizing GLP-1 Receptor Agonist Use in Preadolescent and Adolescent Populations
Authors: Margaret G. Miller, Pauline Terebuh, David C. Kaelber, Rong Xu, Pamela B. Davis
Journal: JAMA Network Open (2024)

This cross-sectional study examines the characteristics of preadolescent and adolescent populations who received glucagon-like peptide-1 (GLP-1) receptor agonists.
Open Access Publishing Metrics, Cost, and Impact in Health Professions Education Journals
Authors: Sawsan Abdel-Razig, Dora Stadler, Leen Oyoun Alsoud, Sophia Archuleta, Halah Ibrahim
Journal: JAMA Network Open (2024)

Publishing in health professions education (HPE) journals is an integral component of academic discourse and career progression. Research in this field is shifting to an open access (OA) publishing model.
Failure to Rescue Female Patients Undergoing High-Risk Surgery
Authors: Catherine M. Wagner, Karen E. Joynt Maddox, Gorav Ailawadi, Andrew M. Ibrahim
Journal: JAMA Surgery (2024)

Importance Female patients have higher mortality rates after high-risk surgery than male patients. It is unknown whether this mortality gap is due to different rates of postoperative complications or if complications are addressed differently by sex, causing complications to lead to death—so-called failure to rescue. Objective To evaluate sex differences in failure to rescue across high-risk surgical procedures. Design, Setting, and Participants This retrospective cohort study was conducted using data from Medicare beneficiaries from October 2015 to February 2020 who underwent high-risk vascular or cardiac surgical procedures, including abdominal aortic aneurysm repair, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement or repair. Data analysis was performed from August 2023 to March 2024. Exposures The primary exposure was patient sex. Main Outcomes and Measures The primary outcomes were risk-adjusted rates of complications, 30-day mortality, and failure to rescue, which was defined as a death occurring after a serious complication. Categorical variables are presented as frequencies and proportions and compared using χ 2 analysis. Continuous variables were tested for normality and compared using a t test. Results A total of 863 305 Medicare beneficiaries were included in this study cohort, of whom 304 176 (35.2%) were female. Mean (SD) age was slightly higher in female patients (74.8 [9.3] years) than male patients (73.4 [8.5] years), and female patients had more comorbidities than male patients (≥2 Elixhauser comorbidities, female: 262 809 [86.4%] vs male: 465 231 [83.2%]). Female patients were more likely to receive care at large hospitals and hospitals with a higher surgical case volume. Overall, female and male patients had similar rates of complications (female: 14.98% vs male: 14.37%; adjusted relative risk [aRR], 1.04; 95% CI, 1.03-1.05; P &amp;amp;lt; .001). However, female patients had higher rates of 30-day mortality (female: 4.22% vs male: 3.34%; aRR, 1.26; 95% CI, 1.23-1.29; P &amp;amp;lt; .001) and higher rates of failure to rescue (female: 10.71% vs male: 8.58%; aRR, 1.25; 95% CI, 1.22-1.28; P &amp;amp;lt; .001). A similar pattern was observed when stratified by each procedure. Conclusions and Relevance In this cohort study among Medicare beneficiaries undergoing high-risk surgery, male and female patients experienced similar rates of serious complications, but female patients with complications were more likely to die. In other words, clinicians fail to rescue female patients with complications after high-risk surgery more often than male patients. Improving the recognition and management of female patients’ complications postoperatively may narrow the sex disparity after high-risk surgery.
Utilization of Primary Cytoreductive Surgery for Advanced-Stage Ovarian Cancer
Authors: Alexandra Bercow, Taylor Stewart, Amy J. Bregar, Allison Gockley, Varvara Mazina, J. Alejandro Rauh-Hain, Alexander Melamed
Journal: JAMA Network Open (2024)

This cohort study examines changes in surgical approach for patients with stage III and IV epithelial ovarian cancer from 2010 to 2021.
Breast Cancer in Users of Levonorgestrel-Releasing Intrauterine Systems
Authors: Lina Steinrud Mørch, Amani Meaidi, Giulia Corn, Marie Hargreave, Charlotte Wessel Skovlund
Journal: JAMA (2024)

This study uses data from nationwide Danish registries to assess breast cancer risk with continuous use of levonorgestrel-releasing intrauterine systems, accounting for other hormonal exposures.