tbuckley/cabot-search huggingface dataset:
Analysis for the needs in general practice training
Authors: 潘志刚, 丁永明, 江孙芳, 崔黎兰, 祝墡珠
Journal: BMJ (2008)

Objective To study the changes in needs of standard training for general practice during the period of 2000 to 2006.Methods Sixty-two trainees participated in a municipal training program for general practitioners(GPs)in Zhongshan Hospital,Shanghai were interviewed by questionnaire to understand their recognition of general practice and needs in training for general practice,and compared to other 53 trainees who entered an another training program in 2000.Results Nineteen of 53 trainees(36percent)trained in 2000 could understand all the six aspects of general practice,including medical and health care,preventive care,rehabilitative care,health education and family planning techniques service,51(94 percent)were willing to accept such training,and 30(57 percent)did not satisfy with current conditions in community health care service.As compared,their recognition for general practice,acceptance of training,and satisfaction with their working condition improved obviously in trainees trained in 2006,with proportions of 100 percent,100 percent and 98 percent,respectively.But,main reason for dissatisfaction with community health care service could still attribute to less attention paid to general practice by relevant leadership.Conclusions Nowadays.the needs in general practice training by health care workers in communities increased greatly,but which still should be supported by governmental policies.

Key words: 
Community dedicine;  Education,medical,continuing;  Questionnaires
Preventable patient acute mortality after EMR-generated QTc alerts.
Authors: Benjamin Aaron Bleiberg, Jingsheng Yan, Donglu Xie, Tammy Lightfoot, Hong Zhu, Joan Reisch, David Sher, Alvin Chandra, Stephanie Terauchi, David E. Gerber, Saad A. Khan
Journal: Journal of Clinical Oncology (2020)

e19359 Background: EMR generated QTc prolongation alerts are ubiquitous in cancer patients. Their significance and impact on mortality is unknown. Methods: From 2006-2018, 19,223 adult cancer patients at UT-Southwestern hospitals had EMR generated QTc prolongation drug alerts. We collected information on cancer site, demographics and alert details. Deaths ≤10 days from a first QTc alert (acute mortality) were considered more attributable to QTc prolongation. We analyzed overall patient survival through multivariable Kaplan-Meier analysis and Cox regression with the two-outcomes (dead/alive) using a ≤10 days cutoff and followed patients for 365 days from their 1 st alert. Results: Analysis of mortality from 1st QTc alert demonstrated statistically significant (p = &lt; 0.05) higher risk of ≤10-day mortality in: patients age &gt; 70 yrs, hazard ratio (HR) = 2.32; black, HR = 1.26 or other/unknown race, HR = 1.29; and increasing number of QTc alerts, particularly patients with 6-10, HR = 1.67 or &gt; 11 HR = 1.88 alerts. Females had lower mortality compared to males, HR = 0.83. Compared to a head and neck cancer patient baseline, significantly increased ≤10-day mortality was seen in: GI, HR = 2.16; lung, HR = 1.94; blood, HR = 1.46; soft tissue, HR = 2.26; and female genital, HR = 1.55 cancers. Male genital, HR = 0.39; breast, HR = 0.57; and endocrine, HR = 0.48 cancers had significantly decreased ≤10-day mortality. In patients with EKG’s recorded: 34 males who died ≤10-days of their 1 st alert had significantly longer QTc intervals compared the 5465 who survived to day 11 (469 vs 450 msec, p = &lt; 0.0001). There was no QTc prolongation in the 24 females who died ≤10-days compared to the 4392 who survived to Day 11. Deaths ≤10 days after a QTc alert were rare (total 149/19,223; range 0.01 for male genital to 2.5% for GI), while the majority of deaths within 1 year of a patient’s 1 st alert occurred between 11-180 days (range 1.03% for endocrine to 11.05% for lung). Most patients were alive &gt; 1 year after their 1 st alert: 63.77% (lung)-95.9% (endocrine). Conclusions: Patients with EKG-proven prolongation of QTc intervals after QTc alerts likely represent a segment of the population where intervention may reduce acute mortality. It is unclear whether the QTc interval prolongation is the actual cause of death or if the EMR alerts identify patients with co-morbidities associated with high risk of acute mortality.
Incidence of non-breast cancer neoplasms (non-BCN) diagnosed prior and subsequent to breast cancer (BC): Single institution experience.
Authors: Zorica Tomasevic, Zoran Tomasevic, Danica Grujicic, Marina Nikitovic, Zorka Milovanovic
Journal: Journal of Clinical Oncology (2020)

e13689 Background: The risk for developing subsequent non-BCN in BC patients is recognized as growing problem hence more patients are long term survivors. Limited data are available for non-BCN developed prior to BC. Better defining of types and frequency of non-BCN might be important for recognition of cancer predisposing factors. We aim to evaluate incidence, type, and time of development for all non-BCN in BC patients at the Institute for Oncology and Radiology of Serbia (IORS). Methods: During 2019, 2384 BC patients were seen at the IORS for treatment or follow up, all medical records have been evaluated for potential non-BCN diagnosis. Results: 230 (9.7%) patients also had variety of histologically confirmed non-BCN: in 78 (34%) as prior to BC, median 5 years (1-42); as synchronous with BC in 12 (5%) median 4 months (0 &lt; 12 months) and in 140 (61%) as subsequent to BC, median 8 years (≥1-33). Six most frequent non-BCNs are presented in table. Conclusions: Amongst 230 BC patients 34 different non-BCN were identified. All non-BCNs were more frequently developed subsequently to BC, representing 61% of all non-BCN cases, with expected exception of HL hence 12/13 (92%) occurred prior to BC. EC,TC, OC, CRC and LC, represents 54 % of all non-BCN and were diagnosed more frequently as subsequent to BC while TC had similar incidence as prior and subsequent to BC. Subsequent development might be related solely to genetic factors, but at least in some cases, influence of BC treatment (tamoxifen, cyclophosphamide, radiotherapy) cannot be excluded.[Table: see text]
Clinical analysis of 237 patients with acute paraquat poisoning
Authors: Zunqi Liu, Kai Liu, Zhaobao Wang, Haishi Wang, Xingguo Zhang, Yan Gu, Deya Shang, Dongxing Liu, Hui Tan
Journal: BMJ (2014)

The clinical data of 237 suicidal patients with acute paraquat poisoning from April 2010 to November 2012 were retrospectively analyzed.There were 122 males and 115 females with a mean age of 34.9 (11-83) years.The crude 60-day mortality was 59.1% (140/237). All patients with trace or clear blue results in their urine dithionite tests survived and 128/152 (84.2%) patients with dark blue results in their urine dithionite tests deceased.A significant correlation existed between urine paraquat concentrations and degrees of severity for paraquat poisoning following ingestion (Spearman correlation 0.720, P<0.01). The receiver operating characteristics area under the curve of the amount ingested was 0.887(0.845-0.928). Under a cutoff value of 36.5 ml, the amount ingested had a sensitivity of 81.4% and a specificity of 80.2% in predicting mortality.The prognosis of patients with paraquat poisoning was closely related with the amount ingested.And urine dithionite test might be a reliable indicator of the severity and prognosis of acute paraquat poisoning.


Key words: 
Paraquat poisoning; Dithionite test
Going off pathway: Problem or good care?
Authors: Stephen B. Edge, Lu Liu, Nessa Stefaniak, Monica L. Murphy, James E. Thompson, Jens Hillengass, Grace K. Dy, Boris W. Kuvshinoff, Mishellene McKinney
Journal: Journal of Clinical Oncology (2020)

7014 Background: Clinical oncology pathways (COP) provide decision support and benchmarking against national standards. Some organizations provide financial incentives for using COP-recommended treatment (on pathway: OnP). Treatment (Rx) other than COP recommended Rx (off pathway: OffP) is appropriate for some cases. There are limited data on the appropriateness of OffP Rx. This study examines rates and reasons for OffP Rx in one cancer center. Methods: All systemic Rx decisions entered in the ClinicalPath COP from 10/1/18 - 9/30/19 were classified as OnP (including Rx on a clinical trial) or OffP and as adjuvant/neoadjuvant therapy (ADJ) or for metastatic cancer (MET). Oncologists must provide free text reasons for OffP Rx. Records of all OffP care were reviewed by a senior nurse-led team and physician to verify and classify OffP reasons. Cases without clear documentation were referred to the treating oncologist and/or multidisciplinary team for review. Justified OffP reasons (R1-6) were classified as: R1. Documented drug toxicity and/or treatment-limiting co-morbidity; R2. Prior treatment precluding pathway Rx; R3. New drug indication or molecular targeted therapy not in COP; R4. Continuation of Rx started prior to referral; R5. Other clearly documented and reviewed provider or multidisciplinary team rationale; and R6. Patient preference. Results: There were 2,997 COP treatment decisions for 2,389 patients. The OnP rate was higher for ADJ than for MET Rx (87% vs. 78%). Non-justified OffP care accounted for 1% of cases. 69% of OffP Rx was because of known drug toxicity, co-morbidity limiting therapy, prior therapy precluding COP choice, and new drug indications (Table). Conclusions: COPs provide decision support and practice benchmarking. Lower OnP rates for MET Rx likely reflect the nuances of Rx for advanced cancer. Most OffP care was justified and appropriate. Financial incentives that focus on the percentage of COP OnP care could paradoxically harm the quality of care, especially given the high percentage of OffP decisions for reasons of drug toxicity, co-morbidity and new drug indications. [Table: see text]
胎儿脑室扩张35例临床分析
Authors: 张雅英, 沈晓慧, 孙达成
Journal: BMJ (2007)

对15 032例孕中晚期孕妇的胎儿进行超声检查,测量胎儿侧脑室宽度,探讨胎儿脑室扩张情况与临床结果之间的关系.结果 显示,B超能敏感地发现脑室扩张,但需结合MRI、染色体检查等综合判断预后。
Association of medical comorbidities and cardiovascular disease with toxicity and survival in patients receiving checkpoint inhibitor immunotherapy.
Authors: Andrew Johns, Lai Wei, Madison Grogan, Sandipkumar Patel, Mingjia Li, Marium Husain, Kari Lynn Kendra, Gregory Alan Otterson, Jarred Thomas Burkart, Dwight Hall Owen, Carolyn J Presley
Journal: Journal of Clinical Oncology (2020)

7039 Background: Checkpoint inhibitor immunotherapy (IO) is widely used to treat advanced cancer in pts. with medical comorbidities (MC), but the effect of MC on outcomes is poorly understood. Methods: We performed a single institution retrospective cohort study of pts. who received IO from 2011-2018. Immune-related adverse events (irAEs) were graded by Common Terminology for Adverse Events criteria, v4.0. MC were abstracted by query of ICD-10 codes corresponding to diagnoses in the Charlson Comorbidity Index (CCI) at any time prior to IO start. Modified CCI scores excluding points for cancer were calculated for each pt. Bivariate analysis with chi-squared statistics was used to describe characteristics and MC of pts. with vs. without irAEs. Overall survival (OS) was estimated by the Kaplan-Meier method (from start of first-line IO) and compared using the log-rank test. The association of CCI score and individual MC with irAEs and OS was tested with regression models adjusted for pt. characteristics. Results: Among 671 pts. with advanced cancer (39.6% melanoma; 21.8% non-small cell lung) treated with IO, median age 65 (IQR 55-74) years, the most common MC were COPD (24%) and diabetes (20%). 33.8% of pts. had CCI score ≥2. Neither CCI score nor any specific MC were associated with any grade or ≥G3 irAEs (P &gt; 0.05). Increasing CCI score was significantly associated with decreased OS (P = 0.002). CHF (13.9 vs. 8.1 months, P = 0.008) and previous MI (14.2 vs. 10.1 months, P = 0.009) were associated with decreased median OS but did not remain significant in the regression model. Among pts. without cardiovascular disease (CVD), pts. with ≥G3 irAEs had longer OS than pts. with no ≥G3 irAEs (P &lt; 0.001). This OS benefit for ≥G3 irAEs was not seen in pts. with CVD (P = 0.94). See table for adjusted HR. Conclusions: Risk for irAEs does not appear to be impacted by MC. Pts. with MC have shorter OS, but no specific MC are associated with OS after adjustment for pt. characteristics. OS is significantly increased among pts. without CVD who experience ≥G3 irAEs. CVD may be an important predictor of OS in pts. with irAEs and should be evaluated in patients receiving IO. [Table: see text]
How much do community residents know about dermatosis and venereal diseases and its impact factors
Authors: Qing Xiang, Yu Zhu, Yan-ming Liu
Journal: BMJ (2008)

Randomized sampling-based questionnaire among 2000 community residents and personal contact with selected populations were conducted.Based on incidence or clinical featuxes of dermatosis and venereal diseases and recognition-related impact factor analyses,we provided evidence for community-based health education and behavior intervention.Our findings showed that itching was the most common skin disease,and fungous infection displayed an increasing trend.Viral diseases increased significantly in recent years.Patients failed to understand the skin diseases,although they partly had some misleading information about venereal diseases.Health care providers should perform more health education and behavior interventions regarding dermatosis and venereal diseases for community residents to improve their health condition or quality of life.

Key words: 
Skin diseases; Health knowledge,attitudes,practice
Association of geriatric comanagement with reduction in adverse surgical outcomes among patients 75 or older with cancer with prolonged hospital stay.
Authors: Armin Shahrokni, Soo Jung Kim, Koshy Alexander, Sung W. Sun, Sincere McMillan, Robert J. Downey, Beatriz Korc-Grodzicki
Journal: Journal of Clinical Oncology (2020)

12036 Background: Patients with prolonged hospital stay following surgery are at higher risk of readmission, emergency room visits, and mortality. In our study, we assessed the relationship between Geriatric Comanagement (GERI-CO) and adverse outcomes among these patients. Methods: In a retrospective study, patients aged 75+ with cancer who had hospital length of stay longer than 75% of cohort (8 days or longer) postoperatively at Memorial Sloan Kettering Cancer Center from 2011-18 were studied. GERI-CO status was obtained from medical records. Differences in sociodemographic, frailty, surgery, and comorbid conditions between GERI-CO and non-GERI-CO patients were assessed. Frailty was assessed by Memorial Sloan Kettering Frailty Index, score 0 to 11, higher score reflective of more frailty. Composite adverse outcome is a composite score of 30-day readmission, or emergency room visit, or 90 day mortality. Multivariable regression analysis was used to assess the relationship between GERI-CO and postoperative adverse outcome. Results: In total 1118 patients (634, 56.7% in the GERI-CO) were included. Patients in GERI-CO were older (80.8 vs. 79.9), more likely to undergo 3+ hours of surgery (66% vs. 43%), have 100+ cc intraoperative blood loss (78% vs. 72%), and have liver disease (16% vs. 10%), but were less likely to have kidney disease (19% vs. 25%), cardiac disease (28% vs. 35%), myocardial infarction (8% vs. 12%), pulmonary disease (15% vs. 20%), ASA-PS 4+ (11% vs. 21%) compared to non-GERI-CO patients. Gender, Frailty and the rest of comorbid conditions, and average length of stay (15 days) did not differ between groups. GERI-CO patients were less likely to have 30-day hospital admission (11% vs. 18%), emergency room visit (14% vs. 22%), or 90 day mortality (6% vs. 15%), and composite adverse outcome (20% vs. 37%) compared to non-GERI-CO patients. In the multivariable analysis, after adjustment for age, frailty, ASA-PS, operation time, intraoperative blood loss, kidney, cardiac and pulmonary disease, patients in GERI-CO were less likely to have composite adverse outcome (OR = 0.57, p = 0.002). Conclusions: GERI-CO program for patients with prolonged length of stay following surgery is associated with reduced 30-day hospital readmission, emergency room use, and 90-day mortality.
辛伐他汀用于急性冠状动脉综合征强化降脂治疗的临床观察
Authors: 刘晓红, 苟志平, 孙小丽
Journal: BMJ (2007)

将急性冠状动脉综合征58例患者在常规治疗的基础上随机分为辛伐他汀40 mg组和20 mg组,均为每晚服药1次.分别在用药前、用药4周、8周测定总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)及肝肾功能、C反应蛋白(CRP),并记录不良反应.结果 显示,用药4周、8周时40 mg组患者TC、LDL-C、CRP较20 mg组明显降低,两组患者不良反应发生情况未见明显差异.提示急性冠状动脉综合征患者服用40 mg辛伐他汀能够更有效地降低TC、LDL-C和CRP水平,且具有良好的安全性。
Empirical study for women and children institutions of infant mental health
Authors: Zong-shun Jiang, Liu-ying Liu, Hong Lu, Li-hong Liao, Hai-yan Ni, Shun-li Tang
Journal: BMJ (2013)

The samples of experimental and control groups were obtained by 1:1 matching method and divided into development (242 pairs) and sign (156 pairs) groups. Through a 10-month group and case type intervention, Gesell test was performed for 5 zone development quotients of large motor, fine motor, adaptability, speech and personal-social to determinate the effectiveness of interventions. Before intervention, t values of the development group were 1.07, 1.42, 0.78, 0.62 and 1.67 while those of sign group -1.48, -1.96, 1.82, 1.78 and -1.73 respectively. The inter-group comparison of various developmental quotient differences had no statistical significance (P>0.05). After intervention, t values of the development group were 9.85, 8.92, 3.57, 11.21 and 9.30 for inter-group comparison and -31.65, -36.94, -46.26, -37.56 and -49.85 for intra-group comparison. The results of sign group were 10.91, 9.61, 10.75, 12.01 and 14.36 for inter-group comparison and -23.20, -31.75, -44.94, -33.58 and -54.58 for intra-group comparison. Between intra-group and inter-group, the comparison of the developmental quotient differences had statistical significance (P<0.01). In two experimental groups, the post-intervention developmental quotients in 5 zones are better than those pre-intervention levels. It shows that preventive intervention of infant mental health is effective.


Key words: 
Child psychology; Maternal-child health center
Phase I trial of drug resistant immunotherapy: A first-in-class combination of MGMT-modified γδ t cells and temozolomide chemotherapy in newly diagnosed glioblastoma multiforme.
Authors: Lawrence S. Lamb, Shirley Gibbs, Thriumaine Pillay, Melissa Beelen, William Ho, Louis B. Nabors
Journal: Journal of Clinical Oncology (2020)

TPS3150 Background: Temozolomide (TMZ) transiently upregulates GBM-specific stress-induced NKG2D ligands that are targeted by innate immune effector cells. Leveraging this effect is problematic, however, due to the lymphodepleting effects of TMZ.Genetic modification of ex vivo expanded and activated with an MGMT-expressing lentivector allows simultaneous chemotherapy and γδ T cell therapy that targets the tumor when NKG2DL are maximally expressed. We have termed this Drug Resistant Immunotherapy (DRI). Patient-derived xenograft mouse models of both primary and recurrent GBM treated with DRI have shown a significant survival advantage that were otherwise impervious to either cell therapy or TMZ. These preclinical findings and associated safety data provide the rationale to initiate a Phase I trial of DRI in primary GBM. Methods: This first in human study will evaluate the safety and optimal dosing frequency of the DRI with TMZ (NCT04165941).Eligibility criteria include the following: GBM eligible for resection, ≥18y, adequate organ and marrow function, and KPS≥70. Six to 12patients with newly diagnosed GBM are being enrolled in a 3 + 3 design into 1 of 2 fixed dose levels (DL) of DRI. Following tumor resection and immediately prior to induction chemo/radiotherapy, an apheresis product is collected and γδ T cells expanded in Zoledronic Acid (Novartis) and rhIL-12 (Miltenyi) and transduced with a P140K-MGMT lentivector (Miltenyi Lentigen, Gaithersburg, MD), harvested, and cryopreserved. At initiation of maintenance phase TMZ therapy, patients receive 150mg/m 2 intravenous TMZ concurrently with intracranial injection of 1 x 10 7 γδ T cells (DL1) delivered through a Rickham reservoir previously inserted into the tumor cavity at resection. The patient then receives 4 daily doses of oral TMZ followed by 24d rest. Treatment cycles escalate from 1 to 3 (DL2) DRI doses following a safety observation period and absence of dose limiting toxicity. Maintenance TMZ treatment will continue for 6 cycles. Safety evaluations consist of routine laboratory analyses, clinical measurements (physical exams, vital signs), neurological function and evidence DRI γδ T cell related toxicity. Peripheral blood will be obtained for comprehensive immuno-phenotyping and T cell function analysis. Clinical benefit of DRI will be characterized by evaluating responses (CR, PR, SD and PD) and determining progression-free, median, and overall survival. As of February 2020, enrollment into DL 1 is ongoing. Clinical trial information: NCT04165941 .
Phase I trial of autologous cMET-directed CAR-t cells administered intravenously in patients with melanoma &amp; breast carcinoma.
Authors: Payal D Shah, Alexander Chan Chi Huang, Xiaowei Xu, Paul J. Zhang, Robert Orlowski, Tina Matlawski, Joanne Shea, Amanda Cervini, Ravi K. Amaravadi, Julia C. Tchou, Lynn Mara Schuchter, E. John Wherry, Gerald P. Linette, Rosemarie Mick, Irina Kulikovskaya, Simon F. Lacey, Gabriela Plesa, Carl H. June, Robert H. Vonderheide, Tara C. Mitchell
Journal: Journal of Clinical Oncology (2020)

10035 Background: Advanced relapsed/refractory melanoma and metastatic triple-negative breast cancer are lethal diseases for which effective therapies are limited. We conducted a pilot phase I clinical trial (NCT03060356) to establish the safety and feasibility of intravenous autologous chimeric antigen receptor (CAR) T cell immunotherapy targeting cMET, a cell-surface antigen that is highly expressed in these cancers. Methods: Subjects had metastatic or unresectable melanoma (Mel) or triple-negative breast cancer (BC) with ≥30% expression of cMET on archival tissue or screening biopsy. Eligible subjects had measurable disease and progression on at least 1 prior therapy. Patients (pts) received up to 6 doses (1x10 8 total T-cells per dose) of RNA electroporated anti-cMET CAR T cells over a 2-week period without antecedent lymphodepleting chemotherapy. Subjects underwent pre- and post-infusion biopsies. The primary objective was to determine feasibility and safety of treatment. Results: 77 subjects (39 mel, 38 BC) were prescreened for tumor cMET expression and 37 (17 mel, 20 BC) met the eligibility threshold. Seven pts (4 BC, 3 Mel) received cMET-directed CAR T infusions on study. Mean age was 50 years (35-64); median (M) ECOG 0 (0-1); M prior lines of chemotherapy/immunotherapy were 4/0 for BC pts and 1/3 for Mel pts. 6 of 7 pts received all planned CAR T cell infusions, and 1 received 5 infusions. 5 pts experienced grade (G) 1 or G 2 toxicity that was possibly or definitely related to study. Toxicities occurring in ≥1 pt included: anemia (n = 3), fatigue (n = 2), and malaise (n = 2). No G ≥3 toxicities or cytokine release syndrome were observed. No pts discontinued therapy due to toxicity. Best response was stable disease in 4 pts (2 BC, 2 Mel) and PD in 3 pts (2 BC, 1 Mel). Messenger RNA signals corresponding to CAR T cells were detected by RT-PCR in the peripheral blood of all pts during the infusion period and in 2 pts after the infusion period. 6 pts underwent baseline biopsy and 4 pts underwent post-infusion biopsy. Immunohistochemical stains of CD3, CD4, CD8, CD163, L26, PD1, PDL1, Foxp3, Ki67, Granzyme B and Phospho-S6 were performed on pre- and post-treatment tissue biopsies and are being evaluated. Conclusions: Intravenous administration of RNA-electroporated cMET-directed CAR T cells was safe and feasible. Future directions include examination of this target using a lentiviral construct in combination with lymphodepleting chemotherapy. Clinical trial information: NCT03060356.