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Tsuburaya A.,Shonan Kamakura General Hospital | Mizusawa J.,Clinical Data | Tanaka Y.,Saitama Cancer Center | Fukushima N.,Yamagata Prefectural Central Hospital | And 2 more authors.
British Journal of Surgery | Year: 2014

Background Locally advanced gastric cancer with extensive regional and/or para-aortic lymph node (PAN) metastases is typically unresectable and associated with poor outcomes. This study investigated the safety and efficacy of S-1 plus cisplatin followed by extended surgery with PAN dissection for gastric cancer with extensive lymph node metastasis. Methods Patients with gastric cancer with bulky lymph node metastasis along the coeliac artery and its branches and/or PAN metastasis received two or three 28-day cycles of S-1 plus cisplatin, followed by gastrectomy with D2 plus PAN dissection. The primary endpoint was the percentage of complete resections with clear margins in the primary tumour (R0 resection). A target sample size of 50 with one-sided α of 0·105 and β of approximately 0·2 corresponded to an expected R0 rate of 65 per cent and a threshold of 50 per cent. Results Between February 2005 and June 2007, 53 patients were enrolled, of whom 51 were eligible. The R0 resection rate was 82 per cent. Clinical and pathological response rates were 65 and 51 per cent respectively. The 3- and 5-year overall survival rates were 59 and 53 per cent respectively. During chemotherapy, grade 3/4 neutropenia occurred in 19 per cent and grade 3/4 non-haematological adverse events in 15·4 per cent. The incidence of grade 3/4 adverse events related to surgery was 12 per cent. There were no reoperations or treatment-related deaths. Conclusion For locally advanced gastric cancer with extensive lymph node metastasis, 4-weekly S-1 plus cisplatin followed by surgery including PAN dissection was safe and effective for some patients. Further investigation of this treatment strategy is warranted. Merits confirmation in a Western population © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

News Article | April 6, 2016
Site: www.scientificcomputing.com

SAN JOSE, CA — GPU Technology Conference — In order to advance healthcare by applying the latest artificial intelligence techniques to improve the detection, diagnosis, treatment and management of diseases, NVIDIA announced that it is a founding technology partner of the Massachusetts General Hospital (MGH) Clinical Data Science Center. MGH — which conducts the largest hospital-based research program in the United States, and is the top-ranked hospital on this year's US News and World Report "Best Hospitals" list — recently established the MGH Clinical Data Science Center in Boston. The center will train a deep neural network using Mass General's vast stores of phenotypic, genetics and imaging data. The hospital has a database containing some 10 billion medical images. To process this massive amount of data, the center will deploy the NVIDIA DGX-1 — a server designed for AI applications, launched earlier today at the GPU Technology Conference — and deep learning algorithms created by NVIDIA engineers and Mass General data scientists. "Deep learning is revolutionizing a wide range of scientific fields," said Jen-Hsun Huang, CEO and co-founder, NVIDIA. "There could be no more important application of this new capability than improving patient care. This work will one day benefit millions of people by extending the capabilities of physicians with an incredibly powerful new tool." Using AI, physicians can compare a patient's symptoms, tests and history with insight from a vast population of other patients. Initially, the MGH Clinical Data Science Center will focus on the fields of radiology and pathology — which are particularly rich in images and data — and then expand into genomics and electronic health records. "We now have the ability to expand the field of radiology beyond its predominant state of providing visualization for human interpretation," said Dr. Keith J. Dreyer, vice chairman of Radiology at Mass General, associate professor of radiology at Harvard Medical School and executive director of the center. "Guided by precision healthcare, we are entering the radiological era of biometric quantification, where our interpretations will be enhanced by algorithms learned from the diagnostic data of vast patient populations. Without the processing capabilities of GPUs, this would not be possible."

Ghelani S.J.,Childrens National Medical Center | Spaeder M.C.,Childrens National Medical Center | Pastor W.,Clinical Data | Spurney C.F.,Childrens National Medical Center | Klugman D.,Childrens National Medical Center
Circulation: Cardiovascular Quality and Outcomes | Year: 2012

Background: There is a lack of clear diagnostic and management guidelines for acute myocarditis in the pediatric population. We used a multi-institutional database to characterize demographics, practice variability, and outcomes in this population. Methods and Results: Patients with acute myocarditis (n=514) were identified from April 2006 to March 2011 using the Pediatric Health Information System database, and regional variations in management and outcomes were analyzed. Ninety-seven patients (18.9%) received extracorporeal membrane oxygenation, 22 (4.3%) received ventricular assist device, 21 (4.1%) received heart transplantation, and 37 (7.2%) died. Of the 104 patients who received extracorporeal membrane oxygenation or ventricular assist device, 17 (16.3%) had heart transplantation, 25 (24%) died, and 62 (59.6%) showed recovery of myocardial function. There was a decrease in the use of endomyocardial biopsy (P=0.03) and an increase in the use of magnetic resonance imaging (P<0.01) over the study period. Although the use of medications and procedures varied between different regions, the occurrence of death or heart transplantation showed no significant regional associations. The use of extracorporeal membrane oxygenation (odds ratio, 5.8;95% confdence interval, 2.9-11.4; P<0.01), ventricular assist device (odds ratio, 8.2;95% confdence interval, 2.7-24.9; P<0.01), and vasoactive medications (odds ratio, 5.7;95% confdence interval, 1.2-26.1; P=0.03) was independently associated with death/transplantation. Conclusions: There is significant temporal and regional variation in the diagnostic modalities and management used for pediatric myocarditis, which continues to have high morbidity and mortality. Extracorporeal membrane oxygenation, ventricular assist device, and vasoactive medications are independently associated with increased mortality/transplantation. © 2012 American Heart Association, Inc.

PROBLEM: The morbidity and mortality (M&M) conference is a vital event that can affect medical education, quality improvement, and peer review in academic departments. Historically, M&M conferences have emphasized cases that highlight diagnostic uncertainty or complex management conundrums. In this report, the authors describe the development, pilot, and refinement of a systems-based M&M conference model that combines the educational and clinical missions of improving quality and patient safety in the University of Colorado Department of Medicine. APPROACH: In 2011, a focused taskforce completed a literature review that informed the development of a framework for the redesigned systems-based M&M conference. The new model included a restructured monthly conference, longitudinal curriculum for residents, and formal channels for interaction with clinical effectiveness departments. Each conference features an in-depth discussion of an adverse event using specific quality improvement tools. Areas for improvement and suggested action items are identified during the conference and delegated to the relevant clinical departments. OUTCOMES: The new process has enabled the review of 27 adverse events over two years. Sixty-three action items were identified, and 33 were pursued. An average of 50 to 60 individuals participate in each conference, including interprofessional and interdisciplinary colleagues. Resident and faculty feedback regarding the new format has been positive, and other departments are starting to adopt this model. NEXT STEPS: A more robust process for identifying and selecting cases to discuss is needed, as is a stable, sufficient mechanism to manage the improvement initiatives that come out of each conference. © 2016 by the Association of American Medical Colleges

Tagami T.,University of Tokyo | Tagami T.,Nippon Medical School | Matsui H.,University of Tokyo | Horiguchi H.,Clinical Data | And 2 more authors.
Journal of Thrombosis and Haemostasis | Year: 2015

Summary: Background: The association between recombinant human soluble thrombomodulin (rhTM) use and mortality in patients with sepsis-associated disseminated intravascular coagulation (DIC) remains controversial. Objectives: To examine the hypothesis that rhTM could be effective in the treatment of patients with sepsis-associated DIC following severe pneumonia. Methods: Propensity score and instrumental variable analyses using a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database, were used. The main outcome was 28-day in-hospital all-cause mortality. Results: Eligible patients (n = 6342) from 936 hospitals were categorized into the rhTM group (n = 1280) or control group (n = 5062). Propensity score matching created a matched cohort of 1140 pairs with and without rhTM. No significant difference in 28-day mortality was documented between the two groups in the unmatched analysis (rhTM vs. control, 37.0%, 474/1280 vs. 36.9%, 1866/5062; odds ratio [OR], 1.00; 95%CI, 0.98-1.03), nor in the propensity-matched analysis (37.6%, 429/1140 vs. 37.0%, 886/1140; OR, 1.01; 95%CI, 0.93-1.10). The logistic regression analysis did not show a significant association between the use of rhTM and 28-day mortality in propensity-matched patients (OR, 1.00; 95%CI, 0.87-1.22). An analysis using the hospital rhTM-prescribing rate as an instrumental variable found that receipt of rhTM was not associated with reduction in mortality at 28 days (risk difference, 0.008; 95% CI, -0.08-0.98). Conclusions: This large retrospective nationwide study demonstrated that there might be little association between the use of rhTM and mortality in severe pneumonia patients with sepsis-associated DIC. A multinational randomized trial is required to confirm this. © 2014 International Society on Thrombosis and Haemostasis.

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