tbuckley/cabot-search huggingface dataset:
Introduction of a patient communication course to postgraduate oncology training in Russia.
Authors: Maxim Kotov
Journal: Journal of Clinical Oncology (2020)

11022 Background: Communication skills are an obligatory part of postgraduate oncology education in European and Western countries and its benefits for doctors, patients, and the healthcare system are well-known. However, teaching efficient patient communication is challenging in developing countries where the paternalistic model is still spread and medical professionals are unaware that these skills are lacking. We hypothesize that a short simulation-based course for oncology residents introduces communication skills and raises awareness about its value. Methods: A 2-day communication course based on the Calgary-Cambridge model was taught to a cohort of PGY2 oncology residents. Lectures, seminars, and clinical simulations emphasizing a patient-centered approach, including open questions, active listening, identifying patient concerns, empathy, summarizing, and bad news delivery were conducted by certified teacher. A simulation exam was administered to those who completed the communication course and those who did not complete the course. Scores (max. 130) from two clinical scenarios assessed by the examiner, actors, and participant were compared between groups. Results: Ten PGY2 residents completed the course and seven did not complete the course. Medians scores for the first scenario given by the examiner, actor and resident were 99 (IQR: 90 – 122), 125 (IQR: 122 – 127) and 102 (IQR: 91 – 108) for course participants and 15 (IQR: 7-35), 18 (IQR: 12-34) and 61 (IQR: 41-83) for non-participants, respectively. Medians scores for the second scenario were also higher in participant group: 113.5 (IQR: 100-117), 107 (IQR: 98-118) and 104 (IQR: 99-112) vs. 22 (IQR: 12-50), 18 (IQR: 10 - 44) and 66 (IQR: 43-81), respectively. Four (40%) course participants and seven (100%) non-participants evaluated themselves higher than the examiner and actor. Conclusions: A short patient communication course for young oncologists effectively improves communication skills and provider self-awareness in developing countries.
Application of fiberoptic bronchoscopic-assisted nasotracheal intubation under awake induction with dexmedetomidine in ankylosing spondylitis patients
Authors: Xuequan Shao, Jie Yu, Zhongxin Pan, Lihua Zheng, Ling Xu
Journal: BMJ (2015)

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group. Group D: topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF: intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil. Fiberoptic bronchoscopic(FOB)-assisted awake nasotracheal intubation was performed. Mean arterial pressure (MAP), heart rate (HR), Pulse oxygen saturation (SpO2), Ramsay score and success rate of intubation were recorded and compared between two groups. The intubation conditions and level of comfort were also evaluated. MAP and HR of group D at FOB through postnaris(T1), peep the epiglottis(T2), intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P<0.05 or P<0.01) than those of group MF while Ramsay sedation scores were obviously higher (P<0.05) than those of group MF. Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF. Immediately after intubation, level 3 scores in grade 1 of group D (n=21) were significantly higher than group MF (n=12); initial success rate of intubation in group D was obviously higher than that in group MF (70%, n=21 vs. 47%, n=14). And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37%, n=11 vs. 67%, n=20). Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.


Key words: 
Sopndylitis, ankylosing; Dexmedetomidine
CTNNB1, PIK3CA, EIF1AX, and PTEN polymorphisms found in aggressive types of differentiated thyroid cancer.
Authors: Dauren Adilbay, Galym Adilbayev, Madina Orazgalieva, Viktoria Shipilova, Gulzhan Kidirbayeva, Nina Sloneva, Aizhan Amandosova, Saniya Ossikbayeva
Journal: Journal of Clinical Oncology (2020)

e18578 Background: Thyroid cancer incidence is rapidly increasing in all developing and developed nations. Despite the benign nature of most thyroid cases, there are aggressively behaving subgroups that need proper attention and tailored treatment. As of today, thyroid cancers stratified using the latest AJCC 8th edition staging system, which dramatically changed the staging system. Despite the implementation of the new system, there is still a need for better stratification of patients to groups that will benefit from extensive treatment. Methods: Retrospective analysis of 23 patients with papillary and follicular thyroid cancer treated in a tertiary cancer center in 2012 and 2013. All patients underwent different types of surgical treatment, FFPE blocks are obtained from pathology archives and additionally reviewed by two independent pathologists. DNA extracted from 20 patients FFPE blocks; 3 cases excluded. DNA analyzed by NGS on the MiniSeq Illumina platform using a custom panel of 14 genes and 200 SNPs associated with thyroid cancers. Results: All identified polymorphisms were selected based on the COSMIC registry. After excluding all types filtered based on frequency, 1329 polymorphisms identified. Fifty-two types are pathologic based on ClinVar database. All benign cases based on Polyphen and Clinvar excluded from the analysis. In patients with aggressive types of papillary and follicular thyroid cancer NRAS and HRAS identified in 8.33% cases, EIF1AX in 25% cases, PIK3CA in 58.33% cases, KRAS in 41.66 cases, TSHR in 33.3% cases and BRAF in 50% cases. Conclusions: We identified mutations in genes probably associated with the aggressive behavior of differentiated thyroid cancer. These mutations can be used as stratification criteria in the future after more data and trials confirm the results.
Effects of early enteral nutrition on short-term quality of life in patients with esophageal carcinoma after operation
Authors: Ji He, Zhenbing You, Wenze Tian
Journal: BMJ (2014)

A total of 62 patients with radical operation of esophageal carcinoma were divided into all-in-one nursing intervention group (research, n=32) and routine nursing group (control, n=30). With regards to postoperative flatus time, removal of chest tube drainage time, postoperative hospital stay and hospital costs, the research group was lower than the control group (P<0.05). After 2 weeks, from the postoperative quality of life questionnaire with the European Organization for Research and Treatment of Cancer, the scores of overall health of enteral nutrition group were higher than those of parenteral nutrition group while the symptom scores of fatigue, nausea & vomiting, insomnia, decreased appetite, constipation and economic difficulties were less than parenteral nutrition group (P<0.05). Early postoperative enteral nutrition can improve the quality of life in patients with esophageal cancer.


Key words: 
Esophageal neoplasms; Quality of life
The effectiveness of a non-physician provider-led palliative care intervention to improve outcomes in patients with cancer.
Authors: Audrey Ready, Alexander Knee, Vida Rastegar, Mihaela Stefan
Journal: Journal of Clinical Oncology (2020)

e24110 Background: Palliative care (PC) improves symptom burden, patient and family distress and quality of life of patients with advanced illnesses. Previous evidence has shown that non-physician providers (NPP) can be effective in delivering care with minimal physician support. NPP-led PC interventions could potentially address gaps in the workforce and provide access to PC services. The overall objective of this systematic review is to evaluate the effectiveness of NPP-led PC interventions in the management of adults with cancer. Methods: We searched ten electronic databases up to October 2018 for randomized or cluster control trials that evaluated NPP-led interventions in both adults receiving end of life care for advanced malignancies and/or their caregivers. NPPs included nurses, advanced practitioners, social workers or case-worker. Interventions included symptom management, hospice care, advance care planning (ACP) or decision support. We recorded the following outcomes: quality of life, patient symptoms (anxiety, depression, pain or distress), satisfaction with care and ACP. Study quality was assessed using the Cochrane risk of bias tool version 2.0. Results: Overall 5,241 publications were screened, resulting in 207 publications that underwent full text review. 13 studies (n = 2,007 participants) included only patients with diagnoses of cancer and an additional 2 studies (n = 396 participants) focused on mixed diagnoses of advanced illness, including cancer. Only 2 studies focused on both caregivers and patients. A nurse was the lead provider in 13 studies, and an advance practitioner in 2 studies. The NPP-led interventions were mostly psychosocial with four also providing symptom management. Interventions mostly consisted of education, care coordination information and support. A total of 3 studies focused solely on ACP, while 2 additional studies addressed this as part of the planned intervention. Nine studies reported quality of life outcomes and seven studies reported on anxiety and depression. There was considerable heterogeneity among the studies with respect to the nature of the intervention and the diagnoses of the study participants. All but one of the studies examined had high risk of bias, mostly due to issues related to missing outcome data or measurement of the outcome. Conclusions: In the setting of changing models of population health care delivery, the results of this systematic review could provide evidence for implementation of non-physician-led palliative care services outside of clinical trials.
门诊就诊患者的变化及满意度调查
Authors: 李杨, 程齐波
Journal: BMJ (2006)

采用调查问卷的方法对门诊患者进行调查.结果显示,来医院就诊者以中青年、高学历者为主,被调查者主要对各项医疗费用、等候时间满意度偏低,相反对医护人员的服务态度、技术水平总体评价较高.说明为了提高服务的满意度,医院不但要继续抓医务人员的服务态度和业务水平,更要注意直接服务以外的细节服务,特别是要尽可能降低医疗费用,缩短就诊的等候时间,完善医院的就诊流程。
Perioperative circulating tumor DNA analysis to predict patient prognosis in liver cancer.
Authors: Ledu Zhou, Ying Xu, Dong Wang, Ke Ye, Liang Xiao, Guo Long, Rongrong Chen, Xuefeng Xia
Journal: Journal of Clinical Oncology (2020)

4593 Background: Resection is a major method for early-stage liver cancer patients. Unfortunately, there still a few patients with post-operation recurrences. Circulating tumor DNA (ctDNA) had been reported as a biomarker in reflecting tumor load and treatment efficacy in some cancer species. Here, we report an application of ctDNA in the perioperative period of liver cancer using targeted sequencing with a 1021-gene panel. Methods: 97 patients diagnosed with liver cancer were enrolled in this study. Postoperative peripheral blood samples were collected within 7 days after surgery and analyzed using hybridization capture based NGS ERSeq method from all patients. Whether a mutant gene was detected in the peripheral blood was defined as ctDNA(+) and ctDNA(-), respectively. Results: Multivariate Cox analysis showed that the post-operation ctDNA was an independent poor prognostic predictor (AFP, RR: 1.0002, 95% Cl: 1.0001-1.0002; ctDNA, RR: 3.738, Cl: 1.872-7.691). 21 patients were ctDNA(+), and all of them had recurrenced (21/21, 100%), while 76 patients were ctDNA(-), and only 12 (12/76, 15.8%) patients had recurrenced. The median disease-free survival time was 5.0 months in ctDNA(+) group and the ctDNA(-) group had not reach the median time (Log-rank test, P &lt; 0.0001). ctDNA combined with AFP would effectively predict the prognosis of patients after surgery. AFP(H) ( &gt; = 400 ng/mL) and ctDNA(+) patients have the worst prognosis and all of the patients had relapsed, while AFP(L) ( &lt; 400 ng/mL) and ctDNA(-) patients had the best prognosis, with less than 20% of patients had relapsed (Log-rank test, P &lt; 0.0001). The median disease-free survival time was 2.0, 6.0 and 7.0 months in ctDNA(+)-AFP(H) (n = 8), ctDNA(-)-AFP(H) (n = 30) and ctDNA(+)-AFP(L) (n = 13) groups, respectively, while ctDNA(-)-AFP(L) group (n = 46) had not reach the median time statistically (Log-rank test, P = 0.0364). Conclusions: In summary, Perioperative ctDNA detection has great potential value clinically, and it also suggests that patients with positive ctDNA after surgery should receive some adjuvant treatments as soon as possible to improve the survival time.
中西医结合治疗支气管哮喘疗效观察
Authors: 丁明伟, 秦泗森, 张念轮, 朱洪柱
Journal: BMJ (2005)

为了探讨中西医结合治疗支气管哮喘的疗效,对联合采用西医疗法、经络综合疗法、中药穴位贴敷疗法治疗的75例支气管哮喘患者与仅采用西医疗法和经络综合疗法治疗的75例患者的症状和肺功能改善情况进行观察和对比。
Real-world treatment patterns of maintenance therapy in platinum-sensitive recurrent epithelial ovarian cancer: Are some patients missing out?
Authors: Haley Moss, Angeles Alvarez Secord, Jessica Perhanidis, Carol Hawkes
Journal: Journal of Clinical Oncology (2020)

e18042 Background: The clinical utility of maintenance therapy (MT) for patients with platinum-sensitive recurrent ovarian cancer (PSROC) has been validated in several clinical trials. We assessed real world treatment patterns using a US nationwide electronic health record database. Methods: A retrospective study of patients with PSROC between March 2017 and July 2019 was conducted using the Flatiron Health database. This longitudinal, demographically and geographically diverse de-identified database covers &gt; 2.2 million oncology patients in &gt; 280 cancer clinics. Patients were excluded if second or third line (2L or 3L) platinum-based chemotherapy (PBT) regimens included less than four or more than eight cycles of platinum. Information regarding somatic or germline BRCA mutations and homologous recombination deficiency (HRD) were obtained. Results: 2292 patients with PSROC were identified (had 2L or 3L treatment); 1214 of these received PBT at recurrence; 610 completed the PBT for recurrence on or after March 2017; 351 received 4–8 cycles of PBT; 225 patients had ≥2 months of active surveillance or were receiving MT of PARPi or bevacizumab (B) and were included in this analysis. 183 patients (80%) had BRCA testing and 14 patients (6%) had HRD testing. 46 (20%) had a germline or somatic BRCA mutations (t BRCA), 134 (59%) had a wildtype wt BRCA gene, and 48 (21%) were unknown. Of patients with tBRCA, 63% received a PARP inhibitor (PARPi), 17% received B, 20% received active surveillance. Of patients with wt BRCA, 40% received a PARPi, 24% received B, and 37% received active surveillance. Olaparib was the most commonly used PARPi among tBRCA patients (26%), while niraparib was most commonly used among wt BRCA patients (21%). MT was more common in younger patients, those with a better performance status and with a BRCA mutation. MT use trend increased by 21% during the study period. As PARPi use increased, the use of active surveillance as a post-platinum regimen decreased during the later time periods (Table). Conclusions: In this real world population, the majority of patients with PSROC are receiving maintenance therapy. While genetic testing is improving, universal testing of all patients with ovarian cancer remains the goal. The results provide insight into the shifting treatment patterns for patients with ovarian cancer. [Table: see text]
择期结直肠手术前是否需要机械性肠道准备
Authors: 韩加刚, 王振军
Journal: BMJ (2010)

目前,感染仍然是结直肠手术后的常见并发症之一,发生率为6%～25%.研究发现,结直肠术后的切口感染主要由内源性肠道细菌引起,因此减少肠腔内的粪便负荷和细菌数量,以及在污染时采取适当措施,以求得感染率的降低,这就是采用机械性肠道准备(mechanical bowel preparation,MBP)的初衷.机械性肠道准备包括两种方式,①顺行性机械准备,即使用泻剂;②逆行性机械准备,即灌肠法。
Tumor/normal genomic profiling in patients with metastatic solid tumors identifies pathogenic germline variants of therapeutic importance.
Authors: Erin Frances Cobain, Michelle Jacobs, Yi-Mi Wu, Dan R. Robinson, Pankaj Vats, Rashmi Chugh, Moshe Talpaz, Elena Martinez Stoffel, Arul Chinnaiyan
Journal: Journal of Clinical Oncology (2020)

1501 Background: Tumor molecular profiling via next-generation sequencing (NGS) is routinely utilized to direct patients toward clinical trials of targeted therapeutics. NGS testing of paired tumor/normal samples identifies incidental pathogenic germline variants (PGVs), having potential implications for patients and their families. Methods: From 2011-2018, 1,015 patients with metastatic, refractory solid tumors underwent targeted (1700 genes) exome and transcriptome sequencing of matched tumor/normal samples through the Michigan Oncology Sequencing program. Identified PGVs that conferred increased cancer risk or were associated with certain autosomal recessive conditions were reported to the treating oncologist. Chart reviews were conducted every 3 months to assess whether PGV identification impacted treatment decision making. Results: 169 PGVs were identified in 160 unique patients (15.8% of cohort). 69 PGVs (41%) harbored a clear somatic second hit event in the tumor. PGVs associated with defects in double-strand DNA repair ( BRCA1, BRCA2, ATM, PALB2, BRIP1) or DNA mismatch repair ( MLH1, MSH2 and PMS2) were identified in 49 patients (5% of cohort, 31% of patients with PGVs), 37 of which had not previously been identified. 14 PGVs in DNA double-strand repair and 7 PGVs in DNA mismatch repair were identified in cancer types not commonly associated with hereditary breast ovarian cancer or Lynch syndromes, including cancers of unknown primary origin and sarcomas. 7 patients received a PARP inhibitor (PARPi), 3 patients received an immune checkpoint inhibitor (ICI) and 1 patient received both PARPi and ICI therapy on the basis of a PGV in DNA repair. 6 patients achieved clinical benefit, defined as time on treatment ≥ 6 months. A patient with cancer of unknown primary origin and PGV in MSH2 achieved exceptional response to ICI therapy, with complete response ongoing and lasting 23 months. Conclusions: Targeted NGS of matched tumor/normal samples identified PGVs in about 1 in every 6 patients with metastatic solid tumors. Approximately 40% of PGVs are associated with a somatic second hit in the tumor, supporting their role in tumor pathogenesis. Unexpected PGVs with therapeutic implications are identified in patients with diverse cancer types, providing opportunities to use targeted therapies with potential for significant clinical benefit. Given this finding, testing for PGVs in DNA repair genes should be considered in all patients with metastatic solid tumor malignancies.
巧用冷敷减轻疼痛
Authors: 周仲华
Journal: BMJ (2006)

几天前的一个晚上,我在家里接到了一个病人的电话.她30岁,是一个图书馆的职员,她和丈夫及四岁的孩子都定期到我们全科门诊做健康检查.她挂电话来是咨询她的右手腕肿胀的问题.原来,那天早晨,她骑自行车去上班的时候,感觉右手腕突然被扭了一下,但是只有轻微的疼痛,也就没在意,到单位后依旧忙着整理图书、操作计算机等日常工作.晚上回家后又忙做饭、照看孩子,等她想喘一口气时,才注意到自己的右手腕已经肿起来,而且疼痛越来越重.电话里她说自己没有发烧,手腕也没有破溃、红、热的现象.我建议她可以做冷敷,问她家的冰箱里有什么现成的冰冻的东西,她说冰箱里有冻豌豆.我告诉她可以取出一些冻豌豆,放在一个塑料袋里,把袋口扎上,用毛巾包好,放在疼痛处20分钟左右,冷敷后再找一个长的弹力丝袜缠住肿胀的手腕,睡觉时用枕头或小被子把肿胀的手腕部分垫高,超过头部的水平.除了给她这些建议,我还预约她第2天早晨来全科门诊。
Efficacy of neoadjuvant chemotherapy (NAC) in male breast cancer (MaBC) compared with female breast cancer (FBC): A National Cancer Database (NCDB) study.
Authors: Jose Pablo Leone, Rachel A. Freedman, Michael J. Hassett, Julieta Leone, Sara M. Tolaney, Carlos Teodoro Vallejo, Bernardo Amadeo Leone, Eric P. Winer, Nancy U. Lin
Journal: Journal of Clinical Oncology (2020)

587 Background: NAC is frequently used in the treatment of FBC. The efficacy of NAC in MaBC is unclear. Few studies have compared outcomes for MaBC and FBC after similar treatment. The aim of this study was to compare proportions of pathologic complete response (pCR) between MaBC and FBC according to tumor subtype (TS). Secondary aims were clinical response and overall survival (OS). Methods: We evaluated men and women with breast cancer treated with NAC between 2010 and 2016 with known hormone receptor (HR) status and human epidermal growth factor receptor 2 (HER2) status at NCDB centers. The proportion with pCR (ypT0/Tis ypN0) was compared for MaBC and FBC for each TS by Fisher’s exact test. Logistic regression evaluated odds of pCR. OS was estimated by Kaplan-Meier and compared by log-rank test. Results: Of 7,721 MaBC and 859,096 FBC patients, 385 MaBC (5%) and 68,065 FBC (7.9%) underwent NAC and were included in this study. Median age for MaBC was 58 years (y) (range 23-88) and for FBC was 53 y (range 18-90). Within each TS, there were no significant differences in the distribution of tumor grade between MaBC and FBC. Clinical stage in MaBC and FBC were: Stage I: 8% v 11%, Stage II: 54% v 59%, Stage III: 38% v 30%; respectively. Median time from initiation of NAC to surgery was 143 days in MaBC and 148 days in FBC. Compared with FBC, MaBC had a lower proportion of complete clinical response (18% v 31%) and a higher proportion of no clinical response (14% v 7%); p &lt; 0.001. Proportions and odds of pCR were numerically lower in MaBC compared with FBC for each TS and statistically significant for HR+/HER2- and HR+/HER2+ (table). pCR was associated with OS in both MaBC and FBC. Specifically, in MaBC who achieved pCR v not, 5 y OS was 90% v 64.7%; p = 0.02. In FBC who achieved pCR v not, 5 y OS was 91.9% v 75.3%; p &lt; 0.01. Among pts receiving NAC, MaBC had worse OS at 5 y than FBC (67.1% v 79.0%; p = 0.02). Conclusions: Men receiving NAC achieved lower proportions of pCR than women and had significantly worse OS. However, pCR is prognostic in both MaBC and FBC. Limitations include small sample sizes for HR-/HER2+ and triple-negative TS and lack of detailed regimen information. Nevertheless, our results suggest that, compared with FBC, MaBC may be intrinsically more resistant to NAC. [Table: see text]