Miracle-dz/UniFAR-FTUs huggingface dataset:
Phase III trial comparing docetaxel and cisplatin combination chemotherapy with mitomycin, vindesine, and cisplatin combination chemotherapy with concurrent thoracic radiotherapy in locally advanced non-small-cell lung cancer: OLCSG 0007.

PURPOSE To demonstrate the efficacy of docetaxel and cisplatin (DP) chemotherapy with concurrent thoracic radiotherapy (TRT) for patients with locally advanced non-small-cell lung cancer (LA-NSCLC). PATIENTS AND METHODS Patients age 75 years or younger with LA-NSCLC, stratified by performance status, stage, and institution, were randomly assigned to two arms consisting of DP (docetaxel 40 mg/m(2) and cisplatin 40 mg/m(2) on days 1, 8, 29, and 36) or mitomycin, vindesine, and cisplatin (MVP) chemotherapy with concurrent TRT. RESULTS Between July 2000 and July 2005, 200 patients were allocated into either the DP or MVP arm. The survival time at 2 years, a primary end point, was favorable to the DP arm (P = .059 by a stratified log-rank test as a planned analysis and P = .044 by an early-period, weighted log-rank as an unplanned analysis). There was a trend toward improved response rate, 2-year survival rate, median progression-free time, and median survival in the DP arm (78.8%, 60.3%,13.4 months, and 26.8 months, respectively) compared with the MVP arm (70.3%, 48.1%, 10.5 months, and 23.7 months, respectively), which was not statistically significant (P > .05). Grade 3 febrile neutropenia occurred more often in the MVP arm than in the DP arm (39% v 22%, respectively; P = .012), and grade 3 to 4 radiation esophagitis was likely to be more common in the DP arm than in the MVP arm (14% v 6%, P = .056). CONCLUSION DP chemotherapy combined with concurrent TRT is an alternative to MVP chemotherapy for patients with LA-NSCLC.
A Review of the Psychiatric Care Provided to Patients who Subsequently Offended

Background : An examination (audit) of the files of patients who had received any mental health services in the year prior to an alleged offence may inform our understanding of the relationship between mental health and crime. More helpfully, it may provide information to facilitate a reduction in the rate of such tragic events Method : The records of all patients assessed by the Midland Regional Forensic Psychiatric service in the 26 months from January 2010 were screened. The 222 who received a diagnosis of a non-organic psychosis and who were recorded as having offended within one year of a previous psychiatric service attendance formed the cohort. The data extracted from their clinical files, relating primarily to that pre-offence psychiatric contact, included legal, clinical and contextual information. Results : Analysis examined the characteristics of this forensic population and most particularly, of their pre-offending service contact. This identified clinical practice and delivery issues which could reduce the rate of conversion of psychiatric patients to “forensic” status. Conclusions : The results inform issues of effectiveness of adult service delivery with particular consideration of the intensity of clinical contact, antipsychotic drug choice and adherence and the use of assertive treatment.
Phase I pharmacokinetic and pharmacodynamic study of 17-dimethylaminoethylamino-17-demethoxygeldanamycin, an inhibitor of heat-shock protein 90, in patients with advanced solid tumors.

PURPOSE To define the maximum tolerated dose, toxicities, pharmacokinetics, and pharmacodynamics of 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17DMAG). METHODS 17DMAG was given intravenously over 1 hour daily for 5 days (schedule A) or daily for 3 days (schedule B) every 3 weeks. Plasma 17DMAG concentrations were measured by liquid chromatography/mass spectrometry. Heat-shock proteins (HSPs) and client proteins were evaluated at baseline and after treatment on day 1 in peripheral blood mononuclear cells (PBMCs) and in pre- and post-treatment (24 hours) biopsies done during cycle 1 at the recommended phase II dose (n = 7). RESULTS Fifty-six patients were entered: 26 on schedule A; 30 on schedule B. The recommended phase II doses for schedules A and B were 16 mg/m(2) and 25 mg/m(2), respectively. Grade 3/4 toxicities included liver function test elevation (14%), pneumonitis (9%), diarrhea (4%), nausea (4%), fatigue (4%) and thrombocytopenia (4%). There were no objective responses. Four patients had stable disease. 17DMAG half-life was 24 +/- 15 hours. 17DMAG area under the curve (range, 0.7 to 14.7 mg/mL x h) increased linearly with dose. The median HSP90, HSP70, and integrin-linked kinase levels were 87.5% (n = 14), 124% (n = 20), and 99.5% (n = 20) of baseline. Changes in HSPs and client proteins in tumor biopsies were not consistent between baseline and 24 hours nor did they change in the same direction as those in PBMCs collected at the time of biopsy. CONCLUSION The recommended phase II doses of 17DMAG (16 mg/m(2) x 5 days or 25 mg/m(2) x 3 days, every 3 weeks) are well tolerated and suitable for further evaluation.
Caecal volvulus post‐appendicectomy in pregnancy: a case report

nosis with the interval between initial treatment of the primary tumour and diagnosis of ILN. Tocchi et al. found the only parameter with a statistically significant correlation with survival was interval to diagnosis, with better survival in the metachronous group, defined as metastases within 12 months. However, this association is not a universal finding. Hamano et al. found that metachronous ILN metastasis carried a worse prognosis. Not surprisingly, there are no clear guidelines for the management of isolated ILN metastasis. Johnson et al. showed that systemic chemotherapy and radiotherapy is a non-curative strategy. Adachi et al. reported survival benefit from surgical treatment in a case series of four patients diagnosed with isolated metachronous ILN metastasis from rectal carcinoma, with all patients alive at 3 years. Isolated metachronous ILN metastases from rectal cancer are rare. We recommend thorough exclusion of distant disease. Discussion in a multidisciplinary meeting can help clarify the role of adjuvant therapy. There is some evidence supporting groin dissection with survival benefit over chemoradiotherapy alone. In patients deemed suitable for groin dissection, we suggest a proactive approach to the management of groin incisions and lymphoedema risk.
Clinical challenges in the diagnosis and management of postural tachycardia syndrome

Postural tachycardia syndrome (POTS) is a multifactorial clinical syndrome defined by an increase in heart rate of ≥30 bpm on standing from supine position (or ≥40 bpm in children). It is associated with symptoms of cerebral hypoperfusion that are worse when upright and improve when in supine position. Patients often have additional symptoms including severe fatigue and difficulty concentrating. There are several possible pathophysiologic mechanisms including hypovolaemia, small-fibre peripheral neuropathy and hyperadrenergic states. POTS can also be associated with several disorders including mastocytosis, Ehlers-Danlos syndrome (hypermobility type) and autoimmune disorders. The treatment is focused on symptom relief and not solely on reducing tachycardia. Given its varying presentations, it is important to employ a practical, mechanism-focused approach to the diagnosis and management of POTS.
Patients′ awareness of antibiotic use in Bahraini health centers and community pharmacies

Objective: Patients′ understanding and perceptions of antibiotic use and resistance are crucial for the public health. This study aimed to explore the awareness of antibiotic utilization in 12 aspects among Bahraini patients attending health centers and community pharmacies and to find the associations of their awareness. Materials and Methods: A cross-sectional survey study with questionnaire interviews was conducted in Bahraini patients attending five health centers or four community pharmacies during January - June 2013. All data were analyzed using descriptive statistics and a Chi-squared test was performed with a significance level set at 0.05. Results: A total of 306 patients (156 in health centers and 150 in community pharmacies) participated in the study. Female respondents (57.2%) were nearly equal to the male. Most were adults aged 16-29 (47.7%) and educated at the university or school levels (88.2%). The majority were aware of the use for colds and relevant resistance, including 10 other aspects. Approximately 35% misconceived the medicine intake in terms of concomitant use with milk, daily doses, stopping time and reusability. Patients′ education was associated with six aspects of awareness, that is, decision on antibiotic prescribing, drug administration, treatment duration, drug resistance, reusability, and perceived side-effects (all P < 0.05). Conclusion: Bahraini patients are mostly aware of 12 antibiotic aspects despite some misconceptions. The public awareness and their expectations warrant further studies on a large scale to understand their self-medication and demand for antibiotic prescriptions.
Management of primary spontaneous pneumothorax: a review

Primary spontaneous pneumothorax is a common problem faced by doctors in medical practice. It is a significant global health problem affecting adolescent and young adults. This article will review the etiopathology, diagnosis and current management guidelines. It aims to improve clinical practice and compliance to the complexities of procedures involved in management.
Clinical Profile of Patients with Epilepsy

Epilepsy is a common and diverse disorder with many different causes. Outcomes are varied with 60—70% of newly diagnosed people rapidly entering remission after starting treatment and 20—30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress. It is a Descriptive Cross-sectional study which was conducted in Tribhuvan University Teaching Hospital from January 2013 to January 2014.A total of 150 patients participated in the study. There was statistically significant association between numbers of seizures before starting medication and the frequency of seizure after starting medication (p<0.001). DOI: http://dx.doi. org/10.3126/jonmc.v3i1. 12234 Journal of Nobel Medical College Vol. 3, No.1 Issue 6, 2014, Page: 31-34
The Chronic Care Model: congruency and predictors among primary care patients with osteoarthritis

Objective: The Chronic Care Model (CCM) and the 5A approach have achieved widespread acceptance and reflect the core elements of patient-centred care in chronic diseases, including osteoarthritis (OA). The aim was to assess to what extent current care for patients with osteoarthritis accords with the CCM in Germany and to reveal possible predictors to assess whether certain patients are more likely to receive care complying with the CCM than others. Methods: Cross-sectional observational study, addressing 1250 patients from 75 primary care practices in Germany. 1021 (81.7%) of the administered 1250 questionnaires were returned. The Patient Assessment of Chronic Illness Care (PACIC-5A) was used to assess accordance to the CCM and the 5A-approach. The impact of OA was assessed by means of the Arthritis Impact Measurement Scale (AIMS2-SF); the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. Two stepwise multiple linear regression models with the PACIC sum score and the 5A score as dependents were performed to reveal predictors of a high accordance to the CCM and to the 5A approach, respectively. Results: With a mean (SD) of 2.79 (0.83) in men and 2.67 (0.89) in women (p for difference = 0.89), the PACIC sum score was notably lower than in previous studies conducted in health maintenance organisation settings in the US. The PACIC score was associated with a higher educational level (β = 0.421; p = 0.008) and younger age (β = −0.319; p = 0.016); the 5A score was predicted by educational level (β = 0.344; p = 0.002), age (β = −0.386; p = 0.004) and the PHQ-9 score (β = −0.288; p = 0.005). Conclusions: Younger and better educated patients achieve higher scores on the PACIC score, indicating that their care accords to a higher degree with the CCM. Whether this reflects differences in physician behaviour toward different patient groups or rather different demands of these patient groups cannot be concluded from the presented data. Further research is needed to confirm our results and assess possible implications for implementing the Chronic Care Model in primary care.
Phase II randomized comparison of topotecan plus cyclophosphamide versus topotecan alone in children with recurrent or refractory neuroblastoma: a Children's Oncology Group study.

PURPOSE Single-agent topotecan (TOPO) and combination topotecan and cyclophosphamide (TOPO/CTX) were compared in a phase II randomized trial in relapsed/refractory neuroblastoma. Because responders often underwent further therapies, novel statistical methods were required to compare the long-term outcome of the two treatments. PATIENTS AND METHODS Children with refractory/recurrent neuroblastoma (only one prior aggressive chemotherapy regimen) were randomly assigned to daily 5-day topotecan (2 mg/m(2)) or combination topotecan (0.75 mg/m(2)) and cyclophosphamide (250 mg/m(2)). A randomized two-stage group sequential design enrolled 119 eligible patients. Toxicity and response were estimated. Long-term outcome of protocol therapy was assessed using novel methods-causal inference-which allowed adjustment for the confounding effect of off-study therapies. RESULTS Seven more responses were observed for TOPO/CTX (complete response [CR] plus partial response [PR], 18 [32%] of 57) than TOPO (CR+PR, 11 [19%] of 59;P = .081); toxicity was similar. At 3 years, progression-free survival (PFS) and overall survival (OS) were 4% +/- 2% and 15% +/- 4%, respectively. PFS was significantly better for TOPO/CTX (P = .029); there was no difference in OS. Older age at diagnosis and lack of MYCN amplification predicted increased OS (P < .05). Adjusting for randomized treatment effect and subsequent autologous stem-cell transplantation, there was no difference between TOPO and TOPO/CTX in terms of the proportion alive at 2 years. CONCLUSION TOPO/CTX was superior to TOPO in terms of PFS, but there was no OS difference. After adjustment for subsequent therapies, no difference was detected in the proportion alive at 2 years. Causal inference methods for assessing long-term outcomes of phase II therapies after subsequent treatment can elucidate effects of initial therapies.
Use of colour-coded labels for intravenous high-risk medications and lines to improve patient safety

Problem: Labelling of high-risk drug infusions and lines is a well-recognised safety strategy to prevent medication errors. Although hospital wards characterised by multiple high-risk drug infusions use different types of labelling, little is known about the contribution of a colour-coded label (CCL) to patient safety. Setting: A quality improvement programme audit at a tertiary care facility, the Hadassah University Medical Center Ein Kerem, Jerusalem, Israel. Strategy for change: A CCL for intravenous (IV) high-risk medications and lines was designed to promote safer medication administration at the intensive care unit bedside and in other acute wards. Methods: The purpose of the study was to compare a new CCL method (intervention) with the current labelling method (control). Laboratory simulation, imitating an intensive care unit, was designed. Safety of the medication treatment and overall duration of nurses’ orientation with drugs and lines at the patient’s bedside were measured. Effects of change: The use of the new CCL improved proper identification of IV bags (p<0.0001), reduced the time required for description of overall drugs and lines (p = 0.04), improved identification of errors at the treatment setting—drugs and lines (p = 0.03) and reduced the average performance time for overall tasks (p<0.0001). Lessons learnt: The use of CCLs for IV high-risk medications and lines can improve patient safety and improve medical staff efficiency.
Image-Based Anomaly Detection Technique: Algorithm, Implementation and Effectiveness

The frequent and large-scale network attacks have led to an increased need for developing techniques for analyzing network traffic. This paper presents NetViewer, a network measurement approach that can simultaneously detect, identify, and visualize attacks and anomalous traffic in real-time by passively monitoring packet headers. We propose to represent samples of network packet header data as frames or images. With such a formulation, a series of samples can be seen as a sequence of frames or video, revealing certain kinds of attacks to the human eye. This enables techniques from image processing and video compression to be applied to the packet header data to reveal interesting properties of traffic. We show that "scene change analysis" can reveal sudden changes in traffic behavior or anomalies. We also show that "motion prediction" techniques can be employed to understand the patterns of some of the attacks. We show that it may be feasible to represent multiple pieces of data as different colors of an image enabling a uniform treatment of multidimensional packet header data. We compare the effectiveness of NetViewer with classical detection theory-based Neyman-Pearson test
Adaptive downlink and uplink channel split ratio determination for TCP-based best effort traffic in TDD-based WiMAX networks

In this paper, we study the determination of downlink (DL) and uplink (UL) channel split ratio for Time Division Duplex (TDD)-based IEEE 802.16 (WiMAX) wireless networks. In a TDD system, uplink and downlink transmissions share the same frequency at different time intervals. The TDD framing in WiMAX is adaptive in the sense that the downlink to uplink bandwidth ratio may vary with time. In this work, we focus on TCP based traffic and explore the impact of improper bandwidth allocation to DL and UL channels on the performance of TCP. We then propose an adaptive split ratio (ASR) scheme which adjusts the bandwidth ratio of DL to UL adaptively according to the current traffic profile, wireless interference, and transport layer parameters, so as to maximize the aggregate throughput of TCP based traffic. Our scheme can also cooperate with the base station (BS) scheduler to throttle the TCP source when acknowledgements (ACKs) are transmitted infrequently. The performance of the proposed ASR scheme is validated via ns-2 simulations. The results show that our scheme outperforms static allocation (such as the default value specified in the WiMAX standard and other possible settings in existing access networks) in terms of higher aggregate throughput and better adaptivity to network dynamics.
Comparison of Lumbar Interbody Fusion Techniques Using Ray Threaded Fusion Cages and Pedicle Screw Fixation Systems

Study designThree groups of patients with low back pain, with or without sciatica, caused by degenerative disc disease were treated by lumbar interbody fusion. ObjectivesTo determine the differences, if any, in clinical outcomes, fusion status, and cost-effectiveness among patients who underwent three variations of lumbar interbody fusion surgery. Summary of background dataLumbar interbody fusion is an accepted treatment option in the management of patients with degenerative disc disease. Controversy with regard to interbody fusion centers on indications for surgery, surgical technique, and interpretation of results. Reported costs vary significantly among different surgical treatments, whereas patient outcomes have varied little. Materials and methodsProspective study of 46 patients who underwent 1 of 3 lumbar interbody fusion procedures was conducted. Group 1 had anterior lumbar interbody fusion using Ray threaded fusion cages (ALIF/TFC). Group 2 underwent posterior lumbar interbody fusion with Ray threaded fusion cages (PLIF/TFC). Patients in group 3 underwent posterior lumbar interbody fusion with concomitant posterior stabilization (PLIF/Plate). Clinical outcomes were assessed using the Prolo socioeconomic/functional improvement scale at 6 weeks, 6 months, 1 year, and 2 years after surgery. Fusion status was determined from flexion-extension, lateral, and anterior-posterior radiographs. Cost comparisons were made through data obtained from patient chart entries and billing records. ResultsSatisfaction and willingness to undergo the procedure again was reported in all but 1 case. Clinical outcomes at 1 year after surgery (P < 0.0001) were significantly increased with 28% of patients reporting excellent results, 41% reporting good results, 11% fair, and 20% poor. Similar results were reported at 2 years after surgery. Although all 46 (100%) of the patients met the outlined criteria for arthrodesis at 12 months after surgery, 4 (0.09%) patients reported persistent back pain requiring additional surgery at adjacent vertebral levels. There were no significant statistical differences among the 3 treatment groups except for operative time, anesthesia time, and cost. The total cost for PLIF/TFC and PLIF/Plate was significantly higher than for the ALIF/TFC group (P < 0.01). The mean combined costs, including surgeons' fees and instrumentation, averaged $12,040 for ALIF/TFC, $13,675 for PLIF/TFC, and $15,432 for PLIF/Plate. ConclusionThe results of this study demonstrate that there are no significant differences in clinical outcomes among the 3 treatment groups. Significant statistical differences were observed in operative time, including anesthesia time, and cost. Based on these data, it is difficult to justify (from a fiscal point of view) routine use of PLIF/Plate technique as a cost-effective treatment modality for patients with degenerative disc disease.
Reasons for discharges against medical advice: a qualitative study

Background There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multicategory provider focus-group interviews (FGIs). Methods Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical centre along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group and one nurse/social worker group were held. Focus-group interviews were transcribed, and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Results Eighteen patients, five physicians, six nurses and four social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker FGIs of reasons why patients leave against medical advice: (1) drug addiction, (2) pain management, (3) external obligations, (4) wait time, (5) doctor's bedside manner, (6) teaching hospital setting and (7) communication. Solutions to tackle DAMA identified by participants revolved mainly around enhanced communication and provider education. Conclusions In a large, academic medical centre, the authors find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication.