Miracle-dz/UniFAR-FTUs huggingface dataset:
Outcomes of Prognostic Disclosure: Associations With Prognostic Understanding, Distress, and Relationship With Physician Among Patients With Advanced Cancer.

PURPOSE To determine how prognostic conversations influence perceptions of life expectancy (LE), distress, and the patient-physician relationship among patients with advanced cancer. PATIENTS AND METHODS This was a multicenter observational study of 590 patients with metastatic solid malignancies with progressive disease after ≥ one line of palliative chemotherapy, undergoing follow-up to death. At baseline, patients were asked whether their oncologist had disclosed an estimate of prognosis. Patients also estimated their own LE and completed assessments of the patient-physician relationship, distress, advance directives, and end-of-life care preferences. RESULTS Among this cohort of 590 patients with advanced cancer (median survival, 5.4 months), 71% wanted to be told their LE, but only 17.6% recalled a prognostic disclosure by their physician. Among the 299 (51%) of 590 patients willing to estimate their LE, those who recalled prognostic disclosure offered more realistic estimates as compared with patients who did not (median, 12 months; interquartile range, 6 to 36 months v 48 months; interquartile range, 12 to 180 months; P < .001), and their estimates were less likely to differ from their actual survival by > 2 (30.2% v 49.2%; odds ratio [OR], 0.45; 95% CI, 0.14 to 0.82) or 5 years (9.5% v 35.5%; OR, 0.19; 95% CI, 0.08 to 0.47). In adjusted analyses, recall of prognostic disclosure was associated with a 17.2-month decrease (95% CI, 6.2 to 28.2 months) in patients' LE self-estimates. Longer LE self-estimates were associated with lower likelihood of do-not-resuscitate order (adjusted OR, 0.439; 95% CI, 0.296 to 0.630 per 12-month increase in estimate) and preference for life-prolonging over comfort-oriented care (adjusted OR, 1.493; 95% CI, 1.091 to 1.939). Prognostic disclosure was not associated with worse patient-physician relationship ratings, sadness, or anxiety in adjusted analyses. CONCLUSION Prognostic disclosures are associated with more realistic patient expectations of LE, without decrements to their emotional well-being or the patient-physician relationship.
Standardization for a Korean Adaptation of the International Outcome Inventory for Hearing Aids: Study of Validity and Reliability

Background and ObjectivesZZThe evaluation of subjective outcomes of hearing aid fitting is of paramount importance along with audiometric improvement. The aim of this study was to develop a Korean adaptation of the International Outcome Inventory for Hearing Aids (IOIHA) and to determine its reliability and validity. Subjects and MethodZZThe translation of IOI-HA into the Korean version (K-IOI-HA) was completed through a process of forward translation, reconciliation, reverse translation and cognitive debriefing. K-IOI-HA was administered to 101 patients using hearing aids and visiting any the 10 referral hospitals. Reliability was evaluated by Cronbach’s alpha coefficient and by test-retest analysis. Validity was assessed by confirmatory factor analysis and criterion valid ity based on the results of pure tone audiometry. ResultsZZK-IOI-HA showed a good internal consistency (Cronbach’s α=0.83) and a high testretest reliability (r=0.943, p＜0.01). Validity checked by confirmatory factor analysis also showed good construct validity. ConclusionZZThe Korean version of IOI-HA is a reliable and valid tool for evaluating subjective outcomes of hearing aids. � Korean J Otorhinolaryngol-Head Neck Surg 2012;55:20-5
Annual Hazard Rates of Recurrence for Breast Cancer During 24 Years of Follow-Up: Results From the International Breast Cancer Study Group Trials I to V.

PURPOSE Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. We identified patient populations that remain at risk for an event at a median follow-up of 24 years from the diagnosis of operable breast cancer. PATIENTS AND METHODS International Breast Cancer Study Group clinical trials I to V randomly assigned 4,105 patients between 1978 and 1985. Annualized hazards were estimated for breast cancer-free interval (primary end point), disease-free survival, and overall survival. RESULTS For the entire group, the annualized hazard of recurrence was highest during the first 5 years (10.4%), with a peak between years 1 and 2 (15.2%). During the first 5 years, patients with estrogen receptor (ER)--positive disease had a lower annualized hazard compared with those with ER-negative disease (9.9% v 11.5%; P = .01). However, beyond 5 years, patients with ER-positive disease had higher hazards (5 to 10 years: 5.4% v 3.3%; 10 to 15 years: 2.9% v 1.3%; 15 to 20 years: 2.8% v 1.2%; and 20 to 25 years: 1.3% v 1.4%; P < .001). Among patients with ER-positive disease, annualized hazards of recurrence remained elevated and fairly stable beyond 10 years, even for those with no axillary involvement (2.0%, 2.1%, and 1.1% for years 10 to 15, 15 to 20, and 20 to 25, respectively) and for those with one to three positive nodes (3.0%, 3.5%, and 1.5%, respectively). CONCLUSION Patients with ER-positive breast cancer maintain a significant recurrence rate during extended follow up. Strategies for follow up and treatments to prevent recurrences may be most efficiently applied and studied in patients with ER-positive disease followed for a long period of time.
Improved Outcomes After Autologous Hematopoietic Cell Transplantation for Light Chain Amyloidosis: A Center for International Blood and Marrow Transplant Research Study.

PURPOSE Autologous hematopoietic cell transplantation, or autotransplantation, is effective in light-chain amyloidosis (AL), but it is associated with a high risk of early mortality (EM). In a multicenter randomized comparison against oral chemotherapy, autotransplantation was associated with 24% EM. We analyzed trends in outcomes after autologous hematopoietic cell transplantation for AL in North America. PATIENTS AND METHODS Between 1995 and 2012, 1,536 patients with AL who underwent autotransplantation at 134 centers were identified in the Center for International Blood and Marrow Transplant Research database. EM and overall survival (OS) were analyzed in three time cohorts: 1995 to 2000 (n = 140), 2001 to 2006 (n = 596), and 2007 to 2012 (n = 800). Hematologic and renal responses and factors associated with EM, relapse and/or progression, progression-free survival and OS were analyzed in more recent subgroups from 2001 to 2006 (n = 197) and from 2007 to 2012 (n = 157). RESULTS Mortality at 30 and 100 days progressively declined over successive time periods from 11% and 20%, respectively, in 1995 to 2000 to 5% and 11%, respectively, in 2001 to 2006, and to 3% and 5%, respectively, in 2007 to 2012. Correspondingly, 5-year OS improved from 55% in 1995 to 2000 to 61% in 2001 to 2006 and to 77% in 2007 to 2012. Hematologic response to transplantation improved in the latest cohort. Renal response rate was 32%. Centers performing more than four AL transplantations per year had superior survival outcomes. In the multivariable analysis, cardiac AL was associated with high EM and inferior progression-free survival and OS. Autotransplantation in 2007 to 2012 and use of higher dosages of melphalan were associated with a lowered relapse risk. A Karnofsky score less than 80 and creatinine levels 2 mg/m(2) or greater were associated with worsened OS. CONCLUSION Post-transplantation survival in AL has improved, with a dramatic reduction in early post-transplantation mortality and excellent 5-year survival. The risk-benefit ratio for autotransplantation has changed, and randomized comparison with nontransplantation approaches is again warranted.
Pneumococcal vaccinations effectively prevent blood culture‐negative infections that resemble occult pneumococcal bacteraemia or bacteraemic pneumococcal pneumonia at one to 36 months of age

The occurrence of blood culture‐positive pneumococcal bacteraemia and bacteraemic pneumonia decreased after large‐scale pneumococcal vaccinations were introduced. The aim of this study was to evaluate the effect of pneumococcal vaccinations on hospitalisations due to blood culture‐negative infections with fever and leucocytosis, without any other focus than pneumonic infiltration.
Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group.

PURPOSE Patients with metastatic rhabdomyosarcoma (RMS), except those younger than 10 years with embryonal RMS, have an estimated long-term event-free survival (EFS) of less than 20%. The main goal of this study was to improve outcome of patients with metastatic RMS by dose intensification with interval compression, use of the most active agents determined in phase II window studies, and use of irinotecan as a radiation sensitizer. PATIENTS AND METHODS Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites). RESULTS One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies. CONCLUSION Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.
West German Study Group Phase III PlanB Trial: First Prospective Outcome Data for the 21-Gene Recurrence Score Assay and Concordance of Prognostic Markers by Central and Local Pathology Assessment.

PURPOSE The 21-gene Recurrence Score (RS) assay is a validated prognostic/predictive tool in early hormone receptor-positive breast cancer (BC); however, only a few prospective outcome results have been available so far. In the phase III PlanB trial, RS was prospectively used to define a subset of patients who received only endocrine therapy. We present 3-year outcome data and concordance analysis (among biomarkers/RS). PATIENTS AND METHODS Central tumor bank was established prospectively from PlanB (intermediate and high-risk, locally human epidermal growth factor receptor 2-negative BC). After an early amendment, HR-positive, pN0-1 patients with RS ≤ 11 were recommended to omit chemotherapy. RESULTS From 2009 to 2011, PlanB enrolled 3,198 patients with a median age of 56 years; 41.1% had node-positive and 32.5% grade 3 disease. In 348 patients (15.3%), chemotherapy was omitted based on RS ≤ 11. After 35 months median follow-up, 3-year disease-free survival in patients with RS ≤ 11 and endocrine therapy alone was 98% versus 92% and 98% in RS > 25 and RS 12 to 25 in chemotherapy-treated patients, respectively. Nodal status, central and local grade, the Ki-67 protein encoded by the MKI67 gene, estrogen receptor, progesterone receptor, tumor size, and RS were univariate prognostic factors for disease-free survival; only nodal status, both central and local grade, and RS were independent multivariate factors. Histologic grade was discordant between central and local laboratories in 44%. RS was positively but moderately correlated with the Ki-67 protein encoded by the MKI67 gene and grade and negatively correlated with progesterone receptor and estrogen receptor. CONCLUSION In this prospective trial, patients with enhanced clinical risk and omitted chemotherapy on the basis of RS ≤ 11 had excellent 3-year survival. The substantial discordance observed between traditional prognostic markers and RS emphasizes the need for standardized assessment and supports the potential integration of standardized, well-validated genomic assays such as RS with clinicopathologic prognostic factors for chemotherapy indication in early hormone receptor-positive BC.
Patients Who Receive Androgen Deprivation Therapy Risk Adverse Cognitive Changes.

tion for adverse cognitive effects by a proportion of patients who received androgen-deprivation therapy (ADT). They compared 58 patients with nonlocalized or asymptomatic metastatic prostate cancer (PCa) who were about to commence ADT and observed the participants for 12 months; the findings were compared with those from a cohort of 84 men treated with prostatectomy alone and an additional 88 men who did not have a diagnosis of PCa. They found that participants in the ADT group were more likely to demonstrate impaired cognitive performance than contemporaries in the control/ reference groups over time. Baseline age, cognitive reserve, depressive symptoms, fatigue, and hot flush interference did not moderate the impact of ADT on impaired cognitive performance. In exploratory genetic analyses, GNB3 single nucleotide polymorphism rs1047776 wasassociatedwithincreasedratesofimpairedperformanceovertime in the ADT group. Whether or not ADT induces adverse cognitive changes in a proportionofpatientshasbeendisputedformanyyearsonthebasisof findings from longitudinal studies, including a number that received industry funding. To resolve the question, we undertook a randomized, controlled trial of 82 men with nonlocalized PCa who were allocated to leuprorelin (Lucrin), goserelin (Zoladex), cyproterone acetate(Androcur),ornotreatmentandwhowerereassessedat6and 12monthsafterbaseline;65participantscompleted6months,and62 of these continued for all 12 months of follow-up. 2,3 In addition to a nontreatment PCa control group, a noncancer community reference group was evaluated. Compared with baseline assessments, men who received ADT performedworseontwoof12testsofattentionandmemory;24of50 patients who were randomly assigned to active treatment and who were assessed 6 months later had a clinically significant decline in one ormorecognitivetests,butnotonepatientrandomlyassignedtoclose monitoringorfromthecommunityreferencegroupshowedadecline
Racial and Ethnic Variations in Lung Cancer Incidence and Mortality: Results From the Women's Health Initiative.

PURPOSE This study aimed to evaluate racial/ethnic differences in lung cancer incidence and mortality in the Women's Health Initiative Study, a longitudinal prospective cohort evaluation of postmenopausal women recruited from 40 clinical centers. METHODS Lung cancer diagnoses were centrally adjudicated by pathology review. Baseline survey questionnaires collected sociodemographic and health information. Logistic regression models estimated incidence and mortality odds by race/ethnicity adjusted for age, education, calcium/vitamin D, body mass index, smoking (status, age at start, duration, and pack-years), alcohol, family history, oral contraceptive, hormones, physical activity, and diet. RESULTS The cohort included 129,951 women--108,487 (83%) non-Hispanic white (NHW); 10,892 (8%) non-Hispanic black (NHB); 4,882 (4%) Hispanic; 3,696 (3%) Asian/Pacific Islander (API); 534 (< 1%) American Indian/Alaskan Native; and 1,994 (1%) other. In unadjusted models, Hispanics had 66% lower odds of lung cancer compared with NHW (odds ratio [OR], 0.34; 95% CI, 0.2 to 0.5), followed by API (OR, 0.45; 95% CI, 0.27 to 0.75) and NHB (OR, 0.75; 95% CI, 0.59 to 0.95). In fully adjusted multivariable models, the decreased lung cancer risk for Hispanic compared with NHW women attenuated to the null (OR, 0.59; 95% CI, 0.35 to 0.99). In unadjusted models Hispanic and API women had decreased risk of death compared with NHW women (OR, 0.30 [95% CI, 0.15 to 0.62] and 0.34 [95% CI, 0.16 to 0.75, respectively); however, no racial/ethnic differences were found in risk of lung cancer death in fully adjusted models. CONCLUSION Differences in lung cancer incidence and mortality are associated with sociodemographic, clinical, and behavioral factors. These findings suggest modifiable exposures and behaviors may contribute to differences in incidence of and mortality by race/ethnicity for postmenopausal women. Interventions focused on these factors may reduce racial/ethnic differences in lung cancer incidence and mortality.
Remote and rural general practice

[][1] General practice in the United Kingdom has to be adaptable. It has to supply general medical services to communities as diverse as inner city London and the Shetland Isles. Suburban practice shades into rural practice; definitions are complex and often unrewarding to pursue except for academic work. (1) Rural practices are, by definition, in the country but tend to have good, fast transport links to urban areas. Remote practices are those on offshore islands and in areas of low population density with long and tenuous transport links to cities and to district general hospitals. Such areas exist in many parts of Britain, including Devon and Cornwall, Cumbria, Northumberland, Wales, and Scotland. Remote and rural general practice has had a low profile, partly because it has, on the whole, worked quietly and efficiently, and partly because isolation reduces the visibility of both problems and achievements. There is evidence that remote and rural practices have been disproportionately affected by recent difficulties in recruitment.2 If you are self sufficient in personal and professional terms, if you enjoy outdoor sports and pursuits, relish the natural world in all weathers, enjoy having a high profile in a small community, and have undergone a fairly broad clinical training, then practice in a remote or rural area may be for you. Every remote practice is unique, but extended clinical skills are always needed. These may include prehospital trauma care, emergency medicine (such as thrombolysis for acute myocardial infarction), intrapartum obstetrics, and minor casualty skills. Many areas have community hospitals that fulfil varying needs from acute medical and maternity care to palliative care. Information technology and telemedicine are rapidly growing in importance. As the number of general practitioners in an area is often small, a management … [1]: /embed/graphic-1.gif
Vacuum Extraction and Forceps Delivery in a District Hospital

Summary: We compared 302 vacuum extractions and 205 forceps deliveries at Fairfield District Hospital, Sydney, over a period of 30 months. Age, parity, gestational age, length of labour and birth‐weight were not significantly different between the 2 groups. Significantly less analgesia was required for mothers whose babies were delivered by vacuum extraction compared with mothers with forceps deliveries (p < 0.01). Average blood loss was slightly higher during forceps delivery as compared with vacuum extraction and there was a significantly higher incidence of postpartum haemorrhage after forceps delivery (p < 0.05). More babies were jaundiced after vacuum extraction and more required phototherapy, but the differences were slight and were not statistically significant. We conclude that vacuum extraction is a useful and safe alternative to forceps delivery in a district hospital setting.
Perfil do atendimento odontopediátrico no setor de urgência e emergência da clínica odontológica do Centro Universitário do Pará – CESUPA

Objetivo: Avaliar o perfil do atendimento odontologico de urgencia e emergencia em criancas na faixa etaria de 0 a 12 anos atendidas no setor de Urgencia e Emergencia do curso de odontologia do Centro Universitario do Para. Materiais e Metodos: Este estudo foi do tipo analitico observacional retrospectivo, cujos dados foram coletados a partir das fichas clinicas, utilizadas no servico de urgencia e emergencia do Centro Universitario do Para (CESUPA), no periodo de janeiro de 2007 a dezembro de 2011. Buscou-se tracar um perfil dos usuarios pediatricos, assim como avaliar as principais causas e tratamentos. Resultados: Os resultados mostraram que a maioria dos pacientes atendidos era do genero masculino (50,4%) e na faixa etaria de 7 a 12 anos de idade (65,2%). O principal motivo da procura ao atendimento foi a dor de dente, sendo esta provocada na maioria dos casos por lesao de carie (53,7%), acometendo principalmente criancas em fase de denticao mista. Quanto ao tratamento executado, a exodontia (73,4%) foi o mais realizado. Conclusao: A carie e a principal ocorrencia de atendimento no servico de urgencia e emergencia da clinica odontologica do CESUPA, e o tratamento de escolha, na maioria das vezes, infelizmente, foi a exodontia, indicando assim, uma maior necessidade de programar estrategias educativas e preventivas na comunidade avaliada com base na promocao de saude bucal. Descritores: Tratamento de emergencia. Odontopediatria. Carie dentaria - Terapia.
Adjuvant Tamoxifen Plus Ovarian Function Suppression Versus Tamoxifen Alone in Premenopausal Women With Early Breast Cancer: Patient-Reported Outcomes in the Suppression of Ovarian Function Trial.

PURPOSE The Suppression of Ovarian Function trial showed improved disease control for tamoxifen plus ovarian function suppression (OFS) compared with tamoxifen alone for the cohort of premenopausal patients who received prior chemotherapy. We present the patient-reported outcomes. PATIENTS AND METHODS The quality-of-life (QoL) analysis includes 1,722 of 2,045 premenopausal patients with hormone receptor-positive breast cancer randomly assigned to receive adjuvant treatment with 5 years of tamoxifen plus OFS or tamoxifen alone. Chemotherapy use before enrollment was optional. Patients completed a QoL form consisting of global and symptom indicators at baseline, every 6 months for 24 months, and annually during years 3 to 6. Differences in the change of QoL from baseline between the two treatments were tested at 6, 24, and 60 months with mixed models for repeated measures with and without chemotherapy and overall. RESULTS Patients on tamoxifen plus OFS were more affected than patients on tamoxifen alone by hot flushes at 6 and 24 months, by loss of sexual interest and sleep disturbance at 6 months, and by vaginal dryness up to 60 months. Without prior chemotherapy, patients on tamoxifen alone reported more vaginal discharge over the 5 years than patients on tamoxifen plus OFS. Symptom-specific treatment differences at 6 months were less pronounced in patients with prior chemotherapy. Changes in global QoL indicators from baseline were small and similar between treatments over the whole treatment period. CONCLUSION Overall, OFS added to tamoxifen resulted in worse endocrine symptoms and sexual functioning during the first 2 years of treatment, with variable magnitudes of treatment differences. Short-term differences in symptom-specific QoL, treatment burden, and coping effort between treatment groups were less pronounced for patients with prior chemotherapy, the cohort that benefited most from OFS in terms of disease control.
Brucella species antibodies and isolation in wild boar in north-east Spain

BRUCELLOSIS is found in domestic and feral pigs around the world, and also in wild boar ( Sus scrofa ), and can be transmitted to human beings. It is considered to be a re-emerging disease in domestic pigs in Europe due to the increasing number of outbreaks on pig farms, often associated with