tbuckley/cabot-search huggingface dataset:
Risk factors for infection in patients with permanent dual hemodialysis catheters
Authors: 刘红燕, 王瑞, 施菁玲, 邱昌建, 石明, 贾汝汉
Journal: BMJ (2010)

Clinical data of 116 patients with implanted permanent dual catheters for hemodialysis,including 18 with infection and 98 non-infection, during January 2006 and July 2009 were retrospectively analyzed to study risk factors for catheter-related bacteremia (CRB). Duration of catheter implantation,primary disease, routine blood examinations and blood biochemical examination of the patients were analyzed between the two groups. COX proportional hazard regression analysis was performed for all predictor variables. Results showed that overall incidence of bacteremic episodes was 0. 314 per 1000 catheter-day.Compared to that in infection group, levels of hemoglobin, plasma albumin, peripheral lymphocyte count and ratio of CD4/CD8 in non-infection group were significantly higher ( all P ＜ 0. 05 ), and OR of CRB were 4. 011 (P =0. 0213) for diabetes mellitus and 7. 181 for hemoglobin level less than 80g/L (P = 0. 0020),respectively. It is suggested that improving nutrition status and correcting anemia for patients with hemodialysis are necessary to reduce CRB.

Key words: 
Infection ;  Catheters,indwelling ;
Psychological distress, social function and financial burden of cancer patients receiving treatment in an African setting.
Authors: Musliu Adetola Tolani, Peter Pase Abur, Muhammad Daniyan, Stanley Emeka Nwabuoku, Aisha Mustapha, Mutiu Bashiru
Journal: Journal of Clinical Oncology (2020)

e19048 Background: The improvement in the quality of cancer treatment is key to increasing survival. However, the functional well-being of these patients is equally important. This study aimed to assess the degree of psychological distress, social function and financial burden in patients undergoing cancer treatment in our center. Methods: A cross-sectional study was designed to prospectively recruit patients in our teaching hospital between December 2019 to February 2020. Those with cancer, aged 18 years and above, who had surgery, chemotherapy and (or) radiotherapy for treatment were included while those who had not commenced cancer treatment were excluded. Information on their clinicopathologic characteristics was obtained. The degree of psychological distress was assessed using a distress thermometer (DT) based on an 11-point scale. Social function was assessed using validated SCARF social functioning index (SSFI) (Cronbach's alpha = 0.818) which has 4-domains, each with scores ranging from 0 (very poor) to 4 (very good). Financial burden (FB) was assessed on a 5-point Likert scale. SPSS was used for data analysis with p &lt; 0.05 considered significant. Results: Seventy-two patients were analyzed with a mean age of 50.3 ± 13.7 years and male to female ratio of 0.8:1.0. The median time from diagnosis was 6.0 (2.5 – 16.0) months and 51 (70.8%) were on palliative treatment. The median psychological distress score was 6.0 (4.0 – 8.0) while the mean SSFI score was 12.0 ± 3.3. Relationship with immediate family (3.4 ± 0.7) had a significantly higher sub-score than two other domains (occupational role: 2.3 ± 1.4, p &lt; 0.001; self-concern/care: 3.0 ± 1.0, p &lt; 0.001). Fifty patients (69.4%) had heavy or extreme financial burden with 34 (47.2%) admitting to income reduction since onset of therapy. Female sex (p &lt; 0.001, 95% CI: 1.246 – 3.597), higher ECOG score (p = 0.033, 95% CI: 0.061 – 1.383) and palliative treatment (p = 0.038, 95% CI: 0.084 – 2.768) were independent predictors of psychological distress. Conclusions: Despite the marked psychological distress and huge financial burden in patients receiving cancer treatment in this setting, they still maintained a relatively normal status in most of the social function domains.
Teamwork model of home beds service in community
Authors: Bao-fu Yao
Journal: BMJ (2009)

The utilization of home bed service in 10 community health centers of Hongkou district,from January 2006 to December 2008, was reviewed. The major disorders in home bed service were stroke,hypertension, coronary disease, diabetes and the chronic bronchitis in the aged, which counted for 92. 69%of all conditions. Compare with 2006, the number of home beds was increased by 8. 35% in 2008. Statistics showed that the conditions of 86. 01% patients were improved or steady with the home bed service. There are urgent needs and demands for development and improvement of home beds service, which will be an important component in the integrated community-based health service.

Key words: 
Foster home care;  Community health services
High-dose vitamin D supplementation for cancer-treatment-induced bone loss in 164 breast and prostate cancer patients: A pooled analysis of two randomized controlled trials (RCTs).
Authors: Luke Joseph Peppone, Amber Kleckner, Julia Ellen Inglis, Jennifer E Reschke, Elizabeth Belcher, Ian Kleckner, Huiwen Xu, Po-Ju Lin, Karen Michelle Mustian, Michelle Christine Janelsins, Eva Culakova
Journal: Journal of Clinical Oncology (2020)

12105 Background: Aromatase Inhibitor (AI) therapy and androgen deprivation therapy (ADT) significantly accelerate bone loss and increase fracture risk. Vitamin D (VITD) protects against bone loss, but it is unclear whether the recommended daily allowance (RDA; 600 IU/day for ages 51-70) of VITD is sufficient for cancer patients. Data from two RCTs were pooled to examine the safety and efficacy of high-dose VITD versus the RDA of VITD on bone mineral density (BMD). Methods: 164 breast and prostate cancer patients on AIs and ADT, respectively, with low VITD (&lt;32 ng/ml) were randomized to either high-dose VITD (50,000 IU/week; n=99) or placebo (n=65) for 24 weeks. All subjects received 600 IU/day of VITD. Of the 99 subjects assigned to high-dose VITD, 38 breast subjects also received the Exercise for Cancer Patients (EXCAP) program combining walking and resistance training. Serum VITD and calcium were assessed at weeks 0, 6, 12, 18, and 24. BMD was assessed at the hip and spine via DXA at weeks 0 and 24. The effect of high-dose VITD was tested via ANCOVA model adjusted for cancer type, baseline BMD and VITD. Results: High-dose VITD significantly reduced the amount of hip BMD loss versus the RDA of VITD (high-dose VITD: −0.8% vs placebo: −2.6%; p&lt;0.01) over 24 weeks. Hip BMD loss was greater for subjects on ADT (high-dose VITD: −1.5% vs placebo: −4.1%; p=0.03) than subjects on AI therapy (high-dose VITD: −0.2% vs placebo: −1.7%; p=0.02). Among the high-dose VITD group, there was no BMD difference at the total hip between those who received EXCAP exercise vs no EXCAP (p=0.96). The largest differences in BMD were for those with lower baseline VITD levels (&lt;27 ng/ml) for both total hip (high-dose VITD: −0.6% vs placebo: −3.2%; p&lt;0.001) and femoral neck (high-dose VITD: +0.2% vs placebo: −2.4%; p=0.03). No between-group pooled differences were noted for total spine BMD (high-dose VITD: −0.2% vs placebo: −0.1%; p=0.82). High-dose VITD increased serum VITD without negatively affecting serum calcium (Table). Conclusions: High-dose VITD was safe and effective in significantly reducing hip BMD loss, with the largest benefit in those with lower baseline VITD levels. A phase III RCT is needed to confirm these findings. NCI Funding: K07 CA168911/R21 CA175793/UG1 CA189961/T32 CA102618 Clinical trial information: NCT02064946, NCT01419730 . [Table: see text]
Applicability of 360-degree evaluation in teaching ability assessment of community general practice trainers
Authors: Qian Chen, Zhigang Pan, Tianhao Wang
Journal: BMJ (2016)

Objective
To investigate the feasibility of 360-degree evaluation in teaching ability assessment of community general practice trainers.


Methods
The 360-degree evaluation questionnaire was used to assess the teaching ability of 39 general practice trainers in 3 community teaching bases in Xuhui District of Shanghai during January to March 2014. Five dimensions were included in the questionnaire: ability of primary care, ability of common disease management, clinical skills and appropriate community technology, teaching ability and personal overall ability. Each trainer was evaluated by 2 managers, 2 colleagues, 2 nurses, and 2 trainees, beside trainer him(her)self.


Results
Total 343 questionnaires were rechieved with a response rate of 97.7%. The average overall scores of assessments from trainers themselves, managers, colleagues, nurses, and trainees were 6.66±0.85, 6.91±1.28, 8.06±0.58, 8.36±1.68, and 8.12±0.81, respectively. The scores from nurses were the highest in all dimensions of the questionnair. The overall scores and scores of each dimention assessed by colleagues, nurses and trainees were significantly higher than those from trainers themselves (P  0.05 for all). The overall cronbach's alpha was greater than 0.9 in every aspect of assessors. The cronbach's alpha of all dimension was greater than 0.8, except that of primary care ability assessed by trainers themself (0.694).


Conclusion
The 360-degree evaluation combines the assessments of community service ability, clinical ability, comprehensive quality and teaching ability, so it is practicable for teaching ability assessment of general practice trainers in community.


Key words: 
Teacher training; Teaching; 360 degree evaluation; General practitioners
高校社区高血压病管理特点及管理思路
Authors: 朱慧楠, 王桂云, 林延明
Journal: BMJ (2012)

高校做为功能社区,高血压病管理有不同于普通社区的特点.高校教职员工工作压力较大,长期精神紧张,是高血压病易患人群,且中低年龄组人群高血压病患病比例相对较高.由于高血压患者人群相对固定,有利于健康宣教的开展;患者的文化素质较高,有利于理解接受健康指导,患者的依从性较好.但由于高校医院人员编制有限,医生需承担大量门诊、校内师生体检、急诊、值班、计划免疫、各类保健等日常工作,高血压病管理人员不足,实施高血压规范化管理有一定困难。
Deep learning for improved prediction of late-onset cardiomyopathy among childhood cancer survivors: A report from the St. Jude Lifetime Cohort (SJLIFE).
Authors: Fatma Gunturkun, Robert L Davis, Gregory T. Armstrong, John L. Jefferies, Kirsten K. Ness, Daniel M. Green, John Thomas Lucas, Deokumar Srivastava, Melissa M. Hudson, Leslie L. Robison, Daniel A. Mulrooney, Elsayed Z Soliman, Ibrahim Karabayir, Oguz Akbilgic
Journal: Journal of Clinical Oncology (2020)

10545 Background: Early identification of survivors at high risk for treatment-induced cardiomyopathy may allow for prevention and/or early intervention. We utilized deep learning methods using COG guideline-recommended baseline electrocardiography (ECG) to improve prediction of future cardiomyopathy. Methods: SJLIFE is a cohort of 5-year clinically assessed childhood cancer survivors including baseline ECG measurements. Development of cardiomyopathy was identified from clinical and echocardiographic measurement using CTCAE criteria (grade 3-4). We applied deep learning approaches to ECG, treatment exposure and demographic data obtained at baseline SJLIFE assessment. We trained a cascaded model combining a 12-layer 1D convolutional neural network to extract features from waveform ECG signals with a 2-layer dense neural network to embed features from other phenotypic data in tabular format to determine if use of deep learning with ECG data could improve prediction of cardiomyopathy. Results: Among 1,218 subjects (median age 31.7 years, range 18.4-66.4) without cardiomyopathy at baseline evaluation, 616 (51%) were male, 1,041 (85%) white, 157 (13%) African American and 792 (65%) were survivors of lymphoma/leukemia. Follow-up averaged 5 (0.5 to 9) years from baseline examination. Mean chest radiation dose was 1350 cGy (range 0 to 6,200 cGy) and mean cumulative anthracycline dose was 191 mg/m 2 (range o to 734 mg/m 2 ). A total of 114 (9.4%) survivors developed cardiomyopathy after baseline. A cascaded deep learning model built on a training set (N = 974 participants) classified cardiomyopathy in the test set (N = 244 participants) using both clinical and ECG data with a sensitivity of 70%, specificity of 73%, and AUC of 0.74 (95% CI 0.63-0.85), compared to a model using clinical data alone (sensitivity 61%, specificity 62%, and AUC 0.67, 95% CI 0.56-0.79). In subgroup analyses, models predicting cardiomyopathy within 0-4 years following baseline had a sensitivity, specificity, and AUC of 77%, 78%, and 0.78 (0.65-0.91), respectively. When predicting cardiomyopathy 5-9 years following baseline, model performance dropped to a sensitivity, specificity, and AUC of 70%, 70%, and 0.68 (0.50-0.87), respectively. Conclusions: Deep learning using ECG at baseline evaluation significantly improved prediction of cardiomyopathy in childhood cancer survivors at high risk for cardiomyopathy. Future directions will incorporate deep learning approaches to echocardiography to further improve prediction.
Differential immune pathways in classic and mixed variants of anaplastic thyroid cancer.
Authors: Hannah J Young, Rebecca Pharaon, Kimberley-Jane C. Bonjoc, Feras Ally, Holly Yin, Robert Kang, Thomas Gernon, Ellie Maghami, Ammar Chaudhry
Journal: Journal of Clinical Oncology (2020)

e18579 Background: Patients with anaplastic thyroid cancer (ATC) have poor outcomes due to treatment resistance with an estimated 5-year survival rate of 7%. Although “classic” ATC can arise de novo from follicular thyroid cells, it can also arise in association with papillary thyroid carcinoma (PTC), as a “mixed” histology. The immunologic and molecular differences between these histological subtypes have not been well-characterized. We aimed to investigate the differences in immune signatures in these histological subtypes to assess immune pathway differences in the classic ATC and mixed ATC/PTC tumor microenvironment. Methods: Classic ATC and mixed ATC/PTC cases (N = 12) from 1998 to 2018 with viable formalin-fixed paraffin-embedded (FFPE) tissue were identified and selected by a board-certified pathologist. 4 samples exhibited both PTC and ATC components while 8 were classic ATC cases, as confirmed by a pathologist. In the 4 mixed ATC/PTC histology specimens, 3 were identified to contain greater than 80% ATC involvement while the fourth was characterized as 40% ATC and 60% PTC. The NanoString Immune Profiling panel contains more than 770 genes. It was performed with extracted RNA to evaluate and compare the gene expression of classic ATC versus mixed ATC/PTC. Results: Majority of patients (N = 11) developed metastatic disease, a common feature of ATC, and are currently deceased (N = 10). The NanoString panel identified several differentially expressed immune pathways in the mixed ATC/PTC in comparison to the classic ATC group. There is upregulation of CD3 (p &lt; 0.01) and CD8 (p &lt; 0.01) transcripts in the mixed ATC/PTC group, but not CD4 transcripts (p &gt; 0.05). Additionally, we found that genes associated with B cell and T cell function were significantly upregulated in the mixed ATC group, including CD27 (p &lt; 0.01), CD28 (p &lt; 0.05), BTLA (p &lt; 0.01), CTLA4 (p &lt; 0.01), LAG3 (p &lt; 0.05), and TIGIT(p &lt; 0.01). We did not observe any significant differences in the expression of PD1 (p &gt; 0.05) or MR1 (p &gt; 0.05) between classic ATC and mixed ATC variants. Conclusions: Our study demonstrates a significant difference in the immune landscape between classic and mixed variants of ATC. Our results indicate there may be an increase in immune cell infiltration and tumor inflammation in the mixed ATC variant, which suggests patients with the mixed ATC variant may show a positive response to immunotherapy.
Predictive factors for combined anti-PD-1 and anti-angiogenic therapy in multiline treatment of advanced non-small cell lung cancer.
Authors: Yina Wang, Xiaobin Li, Yao Chen, Mingyan Xu, Lele Song
Journal: Journal of Clinical Oncology (2020)

e15059 Background: Immune checkpoint inhibitors (ICIs), such as PD-1/ PD-L1 inhibitors, have made a significant breakthrough in lung cancer first-line treatment. However, there are few reports on stratification, therapeutic response and prognosis prediction of NSCLC patients treated with immunotherapy combined with anti-angiogenic therapy in multiline therapy. The aim of this study was to investigate the clinical efficacy of anti-PD-1 plus anti-angiogenic therapy in the second-line or multiline treatment of NSCLC, and to explore potential predictive biomarkers for response and prognosis in this combined therapy. Methods: A total of 22 advanced NSCLC patients were recruited in this study, in which 14 patients received this combined immunotherapy as second-line therapy, and 8 patients as multiline therapy. Genomic profiles were determined with blood by a 451-gene next-generation sequencing panel. Sequencing data were analyzed with R packages and statistics analysis was performed with SPSS 20 software. P ≤ 0.05 was regarded as statistically significant. Results: All patients were followed up until progression or the end of this study. The objective response rate (ORR) assessed by an independent radiology review was 22.7%, and the median progression-free survival (PFS) time for all patients was 5.25 months. Surprisingly, the pre-therapeutic blood tumor mutation burden (bTMB) could not discriminate clinical benefit from non-benefit group in this combined therapy (P = 0.167). However, we found that the concentration of pre-therapeutic blood circulating free DNA (cfDNA) was an independent predictor of PFS (HR = 27.75, P = 0.003), in which higher cfDNA concentration correlated with poorer outcomes. Meanwhile, patients harboring MIKI67 gene mutations or gene variations related to hyper-progressive disease showed significantly shorter PFS time (p &lt; 0.05). In addition, patients with negative ctDNA before therapy might benefit more from this combined immunotherapy (P = 0.068). Conclusions: Our study suggested that the combined strategies may improve clinical efficacy of ICIs in second and multiline therapy. The pre-therapeutic bTMB was not predictive for clinical benefit in multiline combined therapy. Patients with pre-therapeutic high concentration of cfDNA, MIKI67 mutations or gene variations related to hyper-progressive disease may be less likely to benefit from the combined therapy. Our findings may improve the prediction of therapeutic effect and prognosis in future combined treatment involving immunotherapy.
中国医疗卫生体制改革和社区卫生服务
Authors: 刘俊
Journal: BMJ (2008)

中国医疗卫生体制改革(以下简称医改)是构建和谐社会非常重要的一项基础工程,受到全国上下的关注.2008年4月11日,温家宝总理在中南海召开了第一次关于中国医改总体方案的座谈会,听取医药界人士对于医改的意见,显示了党和国家领导人对民生问题、对健康问题、对构建和谐社会问题的高度关注,也预示着中国医改总体方案不久即将出台,征求全国人民的意见。
Randomized phase II study of rituximab, methotrexate (MTX), procarbazine, vincristine, and cytarabine (R-MPV-A) with and without low-dose whole-brain radiotherapy (LD-WBRT) for newly diagnosed primary CNS lymphoma (PCNSL).
Authors: Antonio Marcilio Padula Omuro, Lisa Marie DeAngelis, Theodore Karrison, Joe A Bovi, Marc Rosenblum, Benjamin W. Corn, Denise Correa, Jeffrey Scott Wefel, Sanjay Aneja, Christian Grommes, Lauren Schaff, Steven E. Waggoner, Enrico C. Lallana, Maria Werner-Wasik, Fabio Iwamoto, Timothy J. Robinson, Eric Donnelly, Timothy Struve, Minhee Won, Minesh P. Mehta
Journal: Journal of Clinical Oncology (2020)

2501 Background: MTX-based chemoradiotherapy is effective in PCNSL, but carries a risk of severe neurotoxicity (NT), especially in the elderly. In a phase II single arm study, R-MPV-A chemotherapy was combined with substantially reduced doses of radiotherapy (23.4 Gy), achieving prolonged progression free survival (PFS) and overall survival (OS) with acceptable NT. Because R-MPV-A had never been tested without radiotherapy, we conducted a randomized study to determine if the low doses of radiation played a role in the observed disease control, and to characterize NT as compared to chemotherapy alone. Methods: Patients were stratified by MSK RPA class and randomized to receive R-MPV-A with LD-WBRT (chemoRT arm) versus R-MPV-A alone (chemo arm). MTX dose was 3.5g/m2 infused over 2 hours. Filgrastim and pegfilgrastim support was given to all patients. LD-WBRT dose was 23.4 Gy (1.8 Gy X 13). The primary endpoint was intent-to-treat (ITT) PFS. A sample size of 89 would provide 80% power to detect a hazard ratio (HR) of 0.63, with one-sided alpha level of 0.15. Results: A total of 91 patients were randomized, of whom 4 were ineligible. Among eligible patients, 43 were enrolled in the chemoRT arm and 44 in the chemo arm. Median age was 66 (chemoRT) and 59 (chemo). Median KPS was 80 for both arms. Response rates following R-MPV were 81% (chemoRT) and 83% (chemo). In the chemoRT arm, 37 patients (86%) received LD-WBRT. After median follow-up of 55 months (m), the median ITT PFS was 25 m in the chemo arm and not reached in the chemoRT arm (HR 0.51; 95% CI [0.27, 0.95]; p = 0.015). The 2-year PFS was 54% (chemo) and 78% (chemoRT). Salvage radiotherapy has been given to 11 patients in the chemo arm. Median OS was not reached in either arm, with data still maturing. In both arms, most common grades 3 or 4 toxicities were anemia (27%), lymphopenia (41%), neutropenia (35%), thrombocytopenia (26%), ALT (23%) and AST (13%). One patient died from sepsis (chemo arm). As per investigators’ assessment, the rate of clinically defined moderate to severe NT was 11.4% (chemo) and 14% (chemoRT), p = 0.75. Conclusions: The study met the primary endpoint, demonstrating the addition of LD-WBRT to R-MPV-A improves PFS in newly diagnosed PCNSL. As per investigator’s assessment, NT rates were not statistically significantly increased, but further neuropsychological testing and neuroimaging analyses are ongoing to characterize cognitive decline and how it compares to other consolidation treatments. Clinical trial information: NCT01399372 .
Effects of social skills training on subjective life satisfaction of long-term hospitalized patient with chronic schizophrenia
Authors: Jian-jie Wu, Nian Zhu, Yuan-qing Duan, Jian-ping Zhang, Pei-yan Zhang, Xiao-jun Wang
Journal: BMJ (2009)

Objective The study was conducted to investigate the effect of social skills training on subjective life satisfaction in long-term hospitalized patients with chronic schizophrenia.Methods A total of 82 cases with chronic schizophrenia were divided into skills training group (40 cases) and control group (42 cases).Patients in training group were offered language training, role training and vocational skills training for 12 months in total.Before and after treatment, Positive and Negative Symptom Scale (PANSS), Global Assessment Scale (GAS), Activity of Daily Living (ADL) Scale, Social Support Perception Inventory (SSPI), Insight and Attitude Assessment Questionnaire (ITAQ), Subjective Quality of Life Scale (SQLS), as well as WHO Quality of Life Scale in Brief (WHOQOL-BREF) were used to assess the patients of two groups.Results After treatment, PANSS total score in training group was significantly lower than that in control one (t=0.44, P<0.01), and scores of the negative symptoms and general pathological symptoms were significantly lower in training group than those in control one (t=0.64, P<0.01 and t=0.72, P<0.01, respectively).GAS, ADL, SSPI and ITAQ scored better in the training group than in the control one, with a statistically significant difference (t=2.90, P<0.01; t=2.39, P<0.05; t=2.98, P<0.01; and t=3.37, P<0.01, respectively).SQLS score was significantly lower in the training group than that in control one (t=10.66, P<0.01), and WHOQOL-BREF score was significantly higher in the training group than that in the control one (t=3.94, P<0.01).Conclusion Social skills training can effectively improve subjective satisfactions of the long-terra hospitalized patients with chronic schizophrenia.

Key words: 
Chronic disease;  Schizophrenia;  Rehabilitation;  Social skills training
Current status and perspective of community management for chronic complications of diabetes mellitus
Authors: Shuai Li
Journal: BMJ (2017)

随着生活方式改变及老龄化加剧，糖尿病患者呈快速上升趋势，其慢性并发症的发生也有增无减，高患病率、高致残致死率给社会及家庭带来沉重的经济负担，影响患者生命质量。目前，糖尿病及慢性并发症管理模式形式多样，尚缺乏可推广的证据支持；但依托社区开展糖尿病管理工作是必然趋势；互联网技术的出现将推动糖尿病慢性并发症社区管理的创新。