tbuckley/cabot-search huggingface dataset:
Development of soft skills in general practice residency training
Authors: Li Ma, Yue Jiang, Na Li, Lei Wang, Chen Wang
Journal: BMJ (2017)

General practitioners need not only to have comprehensive knowledge and clinical competency, and also to have the soft skill that are social and personal management skills. In the residency training of general practice, it is necessary to pay attention to the soft skill development. The training institutions should adopt various measures: including soft skills cultivation in training contents, emphasizing soft skills training in the traditional teaching practice, establishing a variety of practice platforms and introducing soft skills in the evaluation and examination system.


Key words: 
Training; General practitioners
Never too young: Retrospective study on age and racial disparity in the outcome of primary CNS Lymphoma in south Texas.
Authors: Snegha Ananth, Michelle Janania Martinez, Juan Garza, Prathibha Surapaneni, Tyler William Snedden, David Gregorio, Sushanth Kakarla, Jeremy Rawlings, Joel Michalek, Qianqian Liu, Adolfo Enrique Diaz Duque
Journal: Journal of Clinical Oncology (2020)

e14553 Background: Primary CNS lymphoma (PCNSL) is a rare malignancy, comprising only 2% of primary CNS tumors in the United States.While it’s incidence has decreased in the immunocompromised population (HIV positive) secondary to widespread access of effective anti-retroviral therapy, it is suspected that the rates are increasing among immunocompetent people aged 65+ years at a rate of approximately 1.7% per year. Data from the Surveillance, Epidemiology, and End Results (SEER) looking into survival and incidence patterns in PCNSL have a majority of non-Hispanic (NH) white population with lesser proportion of other ethnicities. Understanding racial and ethnic disparities on outcomes and patterns of care are crucial given the rapid growth of the Hispanic (HI) population in the US. Therefore, our study aims to compare survival outcomes and contributing factors in HI vs NH with PCNSL, who were treated at the only NCI designated Cancer Center in South Texas. Methods: This is a retrospective study, where we identified patients who were diagnosed and treated for PCNSL at UT Health San Antonio, between January 2008 and December 2018. The patient characteristics, treatment patterns, and clinical outcomes were listed as descriptive statistics. Results: From 2008-2018, a total of 29 patients with PCNSL were included. Among those, 62% were HI(Hispanic) and the remaining 38% were NH(Non-Hispanic). The median age at diagnosis was 61 years (58 years in HI and 70 years in NH). 55% were below 65 years and 45% were older than 65 years. Everyone received chemotherapy (89% received R-MPV (DeAngelis protocol) and 9% received other high dose methotrexate containing regimens). However, in terms of receiving Whole Brain Radiation Therapy (WBRT), the patients in the younger group were more likely to receive it than were those in the elderly group (68% versus 23% respectively). Overall Survival (OS) rate at 3 years was 41 % in HI and 33 % in NH (p = 0.08) and at 5 years was 41 % in HI and 25 % in NH (p = 0.03). Conclusions: While there is increasing data on higher incidence of non-HIV PCNSL in elderly population &gt; 65 years, HI in our study population had a significantly lower median age at diagnosis with better survival and outcomes. Further studies on a larger patient population may help to describe the differences in incidence, tumor biology, genetics and outcomes in HI population.
Application of standardized patients in consultation skills training for resident general practitioners
Authors: Sun-fang Jiang, Yuan Zhang, Rong Zhou, Shan-zhu Zhu
Journal: BMJ (2010)

Objective To assess standardized patients (SP) in resident general practitioners training for their consultation skills to explore its role in clinical competence training. Methods SP are employed in standardized training for 52 resident general practitioners in Shanghai during May to July 2008 to assess trainees' clinical consultation skills, including medical history taking and physical examinations, as well as clinical competencies of trainers including medical history taking, physical examinations, clinical thinking (diagnosis, differential diagnosis and treatment plans), health education, medical record writing,and reception time management. Feedback and appraisal for their consultation skills were provided by SP later. Problems encountered in trainees' consultation were discussed in group manner with their trainers.And two mouths later, assessment with SPs was undergone again for their consultation skills to compare their scores in consultation skills and percentages of them passing the assessment before and after training. Results Trainees were enrolled in the training aged (28±1 ) years in average ( with a ratio of men to women of 19/33 ). Percentage of trainees passing the assessment by SP for consultation skills was significantly higher after training (88.5%) than that before it (46. 2% ) ( P   0. 05 ). Conclusions Application of SP can effectively enhance consultation skills of the trainees,especially in their medical history taking and physical examinations. However, there is still rooms to improvein their clinical thinking.

Key words: 
Teaching;  Standardized patients;  Objective structured clinical examination (OSCE); Clinical skills
Results of a randomized phase II/III study comparing perioperative adriamycin plus ifosfamide and gemcitabine plus docetaxel for high-grade soft tissue sarcomas: Japan Clinical Oncology Group study JCOG1306.
Authors: Kazuhiro Tanaka, Ryunosuke Machida, Akira Kawai, Robert Nakayama, Satoshi Tsukushi, Kunihiro Asanuma, Yoshihiro Matsumoto, Hiroaki Hiraga, Koji Hiraoka, Munenori Watanuki, Tsukasa Yonemoto, Satoshi Abe, Hirohisa Katagiri, Yoshihiro Nishida, Akihito Nagano, Yoshiyuki Suehara, Tomoko Kataoka, Haruhiko Fukuda, Toshifumi Ozaki, Yukihide Iwamoto
Journal: Journal of Clinical Oncology (2020)

11504 Background: Our previous phase II study for high-grade soft tissue sarcomas (STS), JCOG0304, suggested long-term favorable effects of perioperative adriamycin plus ifosfamide (AI) on survival of STS patients. We have also reported in 2015 ASCO Annual Meeting that a phase II/III trial to confirm the non-inferiority of perioperative gemcitabine plus docetaxel (GD) to AI for high-grade STS (JCOG1306) had been started. We herein report the results of JCOG1306 at the early termination by the preplanned second interim analysis. Methods: Patients with operable, FNCLCC grade 2/3 STS primary tumor (T2bN0M0 or anyTN1M0, AJCC 7th edition) or first local recurrent tumor in the extremities or trunk were randomized to AI or GD. Chemotherapy consisted of adriamycin 60 mg/m 2 plus ifosfamide 10 g/m 2 for AI or gemcitabine 1,800 mg/m 2 plus docetaxel 70 mg/m 2 for GD. The treatments were repeated for 3 courses preoperatively and 2 courses postoperatively in a 3-week interval. The primary endpoint in phase III part was overall survival (OS). Planned sample size was 140 with a one-sided alpha of 0.1, power of 0.7 and a non-inferiority margin of 8% at 3-year OS, assuming 3-year OS of AI to be 85% and that of GD as 87%. The patient accrual has started in February 2014 and finished in September 2018. Results: A total of 143 patients were enrolled and included in the efficacy analysis. Seventy and 73 patients were assigned to AI and GD, respectively. At the second interim-analysis on December 2019, the estimated 2-year OS was 94.3 % (95% confidence interval (CI) 83.4–98.1) in AI and 91.6 % (80.9–96.4) in GD (hazard ratio (HR) 2.55, 95% CI 0.67–9.78). The estimated 2-year progression-free survival was 81.9 % (95% CI: 69.5–89.7) in AI and 64.0 % (51.1–74.4) in GD (HR 2.32, 95% CI 1.22–4.39). There were no treatment-related deaths in both groups. The most common Grade 3 or higher adverse events in AI were neutropenia (88.4%), anemia (49.3%), and febrile neutropenia (36.2%), whereas those in GD were neutropenia (79.5%), febrile neutropenia (17.8%), and alanine aminotransferase (9.6%). Based on the result of this analysis, the Data Monitoring and Safety Committee of JCOG recommended terminating the study since the point estimate of HR was above the pre-specified allowable HR of 1.61. Conclusions: Although the toxicities were modest in GD, non-inferiority of GD to AI could not be confirmed. In the perioperative chemotherapy for high-grade STS in the extremities and trunk, AI remains the standard regimen. Clinical trial information: UMIN000013175 .
对全科医生培养方法的建议
Authors: 闫华, 王凤兰
Journal: BMJ (2009)

对2008年国内80所设置医学专业的院校招生情况做汇总分析,并对未来社区卫生服务人才培养提出建议. 利用互联网登录大学网站,查找80所设有医学专业院校2008年的招牛计划.招收全科医学本科生的学院分别是滨州医学院、广州医学院、重庆医科大学、南方医科大学、南京医科大学、徐州医学院、右江民族医学院、南通大学,其中招生人数最少的20人,最多的150人;招生比例最少的0.05%,最多的为5.50%。
DREAMM-5 platform trial: Belantamab mafodotin in combination with novel agents in patients with relapsed/refractory multiple myeloma (RRMM).
Authors: Paul G. Richardson, Swethajit Biswas, Beata Holkova, Nicola Jackson, Thelma Netherway, Sofia Paul, Geraldine Ferron-Brady, Anne Yeakey, Chris Shelton, Rocio Montes de Oca, Christoph Matthias Ahlers, Marc S. Ballas, Elaine Marie Paul, Ira Gupta, Joanna Opalinska, Katarina Luptakova
Journal: Journal of Clinical Oncology (2020)

TPS8552 Background: Single-agent belantamab mafodotin (GSK2857916), a B-cell maturation antigen targeting immunoconjugate, induced deep and durable responses in patients with RRMM, with a manageable safety profile (DREAMM-2, NCT03525678, Lancet Oncol.2020). A platform trial design allows efficient evaluation of belantamab mafodotin in combination with other anti-myeloma agents, such as a humanized wild-type IgG1 anti-OX40 agonist, an IgG4 inducible T-cell costimulatory (ICOS) agonist, and a gamma-secretase inhibitor. The unique, multimodal mechanisms of action (MoAs) of belantamab mafodotin, in combination with MoAs of these agents, has the potential to achieve synergistic effects in MM, to further enhance anti-myeloma activity without compromising safety. Methods: DREAMM-5 (NCT04162210) utilizes a master protocol with separate sub-studies comprised of sequential dose exploration (DE) and cohort expansion (CE) phases, to identify promising, effective belantamab mafodotin combinations when compared with a shared belantamab mafodotin monotherapy control arm (CE phase only). DE phases consist of multiple dosing cohorts with belantamab mafodotin combinations where patients are assigned to treatment slots by predetermined algorithmic approach (modified toxicity probability interval; N≤10 per cohort). Recommended phase 2 doses (RP2D) will be based on dose-limiting toxicities, safety, and pharmacokinetics. Interim analyses, based on overall response rate (ORR), determine if a RP2D is moved forward to a CE phase (N≥35 per cohort). Patients in the CE (stratified by number of prior therapies) will be randomized equally to open sub-studies. Eligible patients will have received ≥3 prior therapy lines which must include ≥1 immunomodulatory agent, proteasome inhibitor, and anti-CD38 antibody. The primary objectives are to identify RP2D for each combination (DE phase) and ORR (≥partial response, CE phase). Sub-studies 1 (combination with GSK3174998, OX40 agonist antibody) and 2 (combination with GSK3359609, ICOS agonist antibody) are currently enrolling. Sub-study 3 (combination with nirogacestat [PF-03084014; SpringWorks Therapeutics]) is projected to begin enrollment in the first half of 2020. Additional sub-studies will be explored based on scientific rationale and/or preclinical combination study results. Funding: GlaxoSmithKline (207495). Drug linker technology licensed from Seattle Genetics; monoclonal antibody produced using POTELLIGENT Technology licensed from BioWa. Clinical trial information: NCT04162210 .
Randomized prospective trial assessing <i>Bifidobacterium</i>-containing probiotic supplementation in metastatic renal cell carcinoma (mRCC) patients receiving vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs).
Authors: Nazli Dizman, Joann Hsu, Paulo Gustavo Bergerot, John D Gillece, Megan Folkerts, Lauren J Reining, Jeffrey M. Trent, Sarah K Highlander, Sumanta K. Pal
Journal: Journal of Clinical Oncology (2020)

5078 Background: Studies suggest a link between the gut microbiome and mRCC outcomes, including evidence that mRCC patients (pts) possess a lower abundance of Bifidobacterium spp compared to healthy adults (Pal et al Clin Cancer Res 2015). The aim of this study was to assess if Bifidobacterium-containing probiotics could modulate the gut microbiome and impact rates of clinical benefit (CB) from VEGF-TKIs. Methods: Pts initiating VEGF-TKI therapy for mRCC were randomized to probiotic supplemented (PSu) or probiotic restricted (PRe) treatment arms. Pts in the PSu arm consumed two 4 oz servings of Activia daily. Stool samples were collected prior to therapy and at wks 2, 3, 4 and 12. Gut microbiota composition was assessed using whole genome shotgun metagenomic sequencing (Zhu et al Microbiome 2018). The primary endpoint was change in Bifidobacterium spp with therapy. Microbiome composition was compared across pts with CB (complete/partial response or stable disease) versus no CB (NCB). Results: In total, 20 pts were enrolled. The most frequent VEGF-TKIs were cabozantinib (45%), sunitinib (25%) and lenvatinib (25%). Median progression-free survival (PFS) was 6.5 months (95%CI 0.3-12.9) and CB rate was 75%. Bifidobacterium animalis, the active ingredient of Activia, reached detectable levels in all pts in the PSu arm, but was only detectable in one pt in the PRe arm. CB rate was not significantly different in PSu vs PRe arms (70% vs 80%, p &gt; 0.05), and there was no difference in PFS. LDA effect size (LEfSe) analysis of MetaPhIAn2 data captured 25 enriched species demonstrating an LDA score &gt; 3 in either CB or NCB. Of those with high LDA scores, Barnesiella intesitinihominis and Akkermansia municiphila were the most significant members (p = 7.4 x 10 −6 and p = 5.6 10 −3 , respectively). While 92% of B. intestinihominis positive pts obtained a CB, only 50% of B. intestinihominis negative pts obtained CB (p = 0.036). Conclusions: This is the first prospective randomized study demonstrating modulation of the gut microbiome with probiotics in mRCC. While microbiome modulation by probiotics did not increase CB rates as intended, consecutive stool specimens allowed us to identify an association between B. intesitinihominis, A. municiphila and CB with VEGF-TKIs. In addition to the previously documented association between A. municiphila and immunotherapy outcome (Routy et al. Science 2018), this species may predict activity with VEGF-TKIs. Clinical trial information: NCT02944617 .
Real-world myeloid growth factor (MGF) prophylaxis patterns in patients receiving chemotherapy at intermediate-risk for febrile neutropenia (FN): A systematic review.
Authors: Weijia Wang, Edward C. Li, Kim Campbell
Journal: Journal of Clinical Oncology (2020)

e24116 Background: Many patients receiving myelosuppressive chemotherapy are at an intermediate risk (10-20%) of developing FN. In this setting, clinical practice guidelines recommend an individualized approach towards MGF prophylaxis based on regimen and patient-specific FN risk factors. The purpose of this review is to summarize and describe the real-world MGF prophylaxis patterns, patient-specific risk factors, and FN outcomes in patients receiving chemotherapy at intermediate risk of FN. Methods: We searched the MEDLINE database (PubMed) for peer-reviewed published articles using the keywords “primary prophylaxis,” “febrile neutropenia,” and “intermediate risk” from 2000-2020. Articles were included if they were cohort or case control studies, and excluded if the data were derived from clinical trials. Studies from outside the United States or where the methods cannot be verified were also excluded. Results: Out of 131 studies identified, 7 met the inclusion/exclusion criteria after review. Most studies included adult cancer patients diagnosed with breast, lung or colorectal cancer receiving chemotherapy identified using public/private insurance claims or electronic medical records. In the 2000s, MGF prophylaxis rates were around 17-22% in patients receiving intermediate-risk regimens; while in 2010s, the prophylaxis rate increased to &gt; 50%. Patient-specific FN risk factors were prevalent, but MGF primary prophylaxis rates among those receiving intermediate risk regimens were generally low (around 24-28%); approximately 25% of patients with &gt; 1 FN risk factor received primary prophylaxis. Primary prophylaxis rates differed by tumor type; breast cancer had the highest rate (~46%), followed by non-small cell lung (~24%), and colorectal (~8%). FN incidence varied among patients with FN risk factors (~7 to 29%) across intermediate risk regimens, and the relative risk of FN (vs. those without risk factors) ranged from 1.1 to 2.2. Conclusions: Although historically low, MGF prophylaxis in patients receiving intermediate risk regimens has been increasing. Patient FN risk factors were widespread and associated with increased FN incidence. Since appropriate primary prophylaxis in patients at intermediate-risk could potentially improve population-based FN-related outcomes, future studies should focus on whether biosimilar MGFs as primary prophylaxis are cost-effective and could better optimize the care reflected in current MGF practice guidelines.
小型临床演练评量简介
Authors: 顾杰, 祝墡珠, 杨华
Journal: BMJ (2011)

医学注重实践,其教学应以培养临床能力为重点.我国医学教育长期受应试教育影响,高分低能屡见,严重影响医师执业水平.虽问题导向学习、标准化病人、客观结构化临床考试等新型教学和考核方法已引入我国,但作为临床能力评价基础的轮转考核,多数国内院校仍采用传统出科考方式。
Effectiveness of intensive hypertension management model for patients with uncontrolled blood pressure in community
Authors: Shuping Zheng, Jinbao Ji, Xin Chen, Junli Zuo, Shaoli Chu
Journal: BMJ (2019)

Objective
To evaluate the effect of intensive hypertension management model for patients with uncontrolled blood pressure in community.


Methods
Three hundred and seven hypertensive patients, whose blood pressure was not controlled with administration of two or more kinds of antihypertensive drugs, entered in the intensive management program from May 2015 to December 2017. Using calcium channel blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers and diuretic as the primary scheme, the medication was adjusted by general practitioners under the guidance of specialists in tertiary hospitals. The seamless two-way referral between community and tertiary hospitals was implemented, and the blood pressure control, medication and adverse effects were analyzed.


Results
Among 307 patients, 157 were males (51.1%) and the mean age was (65.0±8.6) years. There were 246 (80.0%)patients with moderate and severe hypertension 44 (14.3%) patients complicated with diabetes, and 63(20.5%) patients having comorbidities, and the patients with high risk or extremely high-risk accounted for 85.0% (261/307). Through (3.97±1.21) months (1-6 months) intensive management, systolic blood pressure decreased from (167.56±16.73)mmHg(1 mmHg=0.133 kPa) in the baseline to (132.79±11.24)mmHg (t=33.34, P<0.01), and diastolic blood pressure from (95.34±12.59) mmHg to(79.11±7.85) mmHg (t=23.67, P<0.01), blood pressure control rate was 75.6%(232/307). No serious adverse reactions occurred. During the period 42 patients were referral to hospital through green channel with a referral rate of 13.7%, and six patients were diagnosed as secondary hypertension. Angiotensin receptor antagonists and calcium antagonists were the main antihypertensive drugs. After intensive management patients taking three or more antihypertensive drugs increased by 158 and those taking diuretics increased by 116.


Conclusions
The intensive management model is effective in patients with uncontrolled blood pressure in community. Early use of C+A,A+D,and A+C+D treatment schemes for uncontrolled patients in the community can improve the rate of reaching the target and is safe.


Key words: 
Hypertension; Disease management; Community health service; General practitioner
急性心肌梗死并发室间隔穿孔一例的诊治分析
Authors: 周琼, 杨伟宪
Journal: BMJ (2006)

患者男,70岁,因乏力、发热13 d,干咳、胸闷、气促10 d于2003年10月20日入院.患者于2003年10月7日无明显诱因出现乏力、发热,体温最高38.5℃,无明显胸闷、胸痛.先后于两家医院诊为上呼吸道感染,未查心电图.予静脉抗生素治疗数日,体温正常,但乏力加重,出现干咳、胸闷、气促.10月16日再次就诊时查心电图:V1～V6 ST段抬高0.1～0.4 mV, T波倒置,III、avF呈qr型,考虑急性前壁心肌梗死.次日于急救中心做超声心动图示急性心肌梗死伴室间隔穿孔,予主动脉内球囊反搏(IABP)治疗,同时予抗血小板、抗凝、利尿及扩血管等药物治疗,患者症状渐改善.为进一步诊治于10月20日转入我院.既往患 2型糖尿病3年;吸烟20年,10支/d;否认高血压、高脂血症史及冠心病家族史。
急性肺栓塞介入治疗的要点问题
Authors: 魏林
Journal: BMJ (2006)

肺栓塞是指血栓堵塞了肺动脉主干或分支所引起的肺循环障碍,其原因多与深静脉血栓形成有关.流入肺动脉的血栓大小、形状、数量及速度的不同,使肺栓塞的临床表现呈多样性和复杂性,因此临床上容易漏诊和误诊.尽管近年来国内临床上对肺栓塞的认识有所提高,但在一些地区急性肺栓塞仍呈现较高的漏诊率和误诊率。
胸腔内蒸馏水加顺铂灌注治疗恶性胸腔积液的疗效观察
Authors: 张兆卓, 付强, 张志强
Journal: BMJ (2007)

对154例恶性胸腔积液患者在彻底胸腔引流后,分别行经胸腔引流管胸腔内注入蒸馏水加顺铂(78例,观察组)和胸腔内注入顺铂(76例,对照组)治疗.结果 ,观察组完全吸收41例,部分吸收26例,无变化6例,进展5例,有效率86%(67/78);对照组完全吸收19例,部分吸收22例,无变化16例,病情进展19例,有效率54%(41/76).两组比较,差异有统计学意义(χ2=17.26,P＜0.05).提示,胸腔内蒸馏水加顺铂灌注是治疗恶性胸腔积液的有效方法。
Abstract 13380: Administration of Insulin-Like Growth Factor Prevents Cardiac Dysfunction and Expression of microRNA-1 in Apolipoprotein-E null Mice with Streptozotocin -Induced Diabetes
Authors: Yangxin Li, Hanjing Wu, Harnath Shelat, Jiuhong Yuan, Mang Zhu, Jiaming Xu, Jiangbo Qu, Minjuan Zheng, Chenmin Yang, Guoqiang Yuan, Yang Jiang, Hongwu Wang, Yong-Jian Geng
Journal: Circulation (2011)

Background: Many microRNA (miR) species have been found to serve as biomarkers, modulators or therapeutic targets for cardiovascular disease (CVD). Among them, miR-1 is preferentially expressed in ...