tbuckley/cabot-search huggingface dataset:
Incremental oncology workload generated by immunotherapy in the first-year of treatment.
Authors: Marika Cinausero, Silvio Ken Garattini, Alessandro Marco Minisini, Francesca Valent, Chiara Riosa, Donatella Iacono, Marianna Macerelli, Victoria Andreotti, Marco Giavarra, Maria Grazia Vitale, Gianpiero Fasola
Journal: Journal of Clinical Oncology (2020)

e14143 Background: The rapid development of immunotherapy (IO) has transformed the cancer therapy landscape with growing impact on oncology workload. Given the few data on this topic, we conducted a study to estimate the shift in workload generated by any new metastatic cancer patient treated with IO and referred to the Oncology Department of the Academic Academic Cancer Center of Udine, Italy, within the 12 months of first consultation. Methods: We collected from our “Data Warehouse” electronic accountability system all new diagnosis of metastatic cancer between 01.01.2017 and 31.12.2018, resulting in a first consultation and leading to a second clinical episode during the following year, in order to assess the oncology workload. The population was divided into patients that received IO (anti-CTLA-4/PD-1/PDL1) versus patients treated with “other treatments”. Mean number per patient and standard deviation were calculated for clinical episodes (first consultations, treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up and inpatient oncology advices). The total number of patients treated and the number of episodes were recorded. Mean numbers of episodes in the IO group and “other treatments” group were compared using Student’s t-test (significance p &lt; 0.005). Follow-up data was collected up to 31.12.2019. Results: A total number of 969 patients were considered (854 “other treatments” group and 115 IO group), resulting in a total of 12407 clinical episodes over the period of 12 months (first consultations excluded). Compared to “other treatments” group, patients in the IO group generated a greater workload in terms of treatment sessions (9.59 vs 6.83 per patient, p &lt; 0.0001), re-evaluations (2.55 vs 1.88, p = 0.0002), and unplanned presentations (2.19 vs 1.51, p = 0.08). On the other hand, follow-up visits workload was greater for “other treatments” group (0.83 vs 0.63, p = 0.0002). No differences were found regarding hospitalizations and inpatient oncology advices. Further analysis will be presented. Conclusions: IO represents a new frontier in oncology landscape, leading to outcome’s improvement and longer lasting treatment periods. The estimate of oncology workload generated by new diagnosis of metastatic cancer requiring IO, is crucial for implementing more sustainable systems and for planning clinical activities.
Scientific understanding low back pain and standard treatment
Authors: 周雪峰, 邹德威
Journal: BMJ (2011)

腰痛是日常生活中经常碰到的身体疾患.根据国外的资料,人的一生当中发生腰痛的几率高达60%～80%.国内北京大学第三医院的小样本正常人群普查结果显示,腰痛的发生率为60%,这与国外统计结果基本相符。
合理解释辅助检查的临床意义
Authors: 周仲华
Journal: BMJ (2007)

我最近碰到这样一个病人,20岁,做保姆工作.1个月前因为胸痛而就诊于一家大医院的呼吸科,她当时除了胸痛外没有其他症状.接诊医生简单地问了病史之后给她开了血常规和胸部X线片检查,血常规回报正常,X线片检查结果是肺纹理增强.据此医生给她下了支气管炎的诊断,并给她开了抗生素.她服了1周抗生素后胸痛的症状没有一点缓解,再次就诊时她来到了我的全科门诊。
Effect of personalized approach to therapy in non-small cell lung cancer (NSCLC) with liver metastasis with immunotherapy on outcomes.
Authors: Kristine Badin, Bushra Waseem, Asad Ullah, Nagla Fawzy Abdel Karim, Ihab Eldessouki, Boyd Guttery
Journal: Journal of Clinical Oncology (2020)

e21504 Background: Patients with NSCLC with liver metastasis tend to have significantly reduced overall survival (OS) compared to NSCLC with metastasis to other sites. We aimed looking at the patients with lung cancer at our institution over a five year period and assess the outcome of NSCLC with liver metastasis based on different treatment modalities. Methods: This is a retrospective study of patients with NSCLC and liver metastasis over the past five years. Patient data was securely collected and stratified based on demographics, histology, driver mutation analysis, date of diagnosis, place of metastasis, date of treatment, types of treatment received, and date of death, as applicable. Results: Eight of 132 patients had liver metastasis. Out of which one had SCLC and was treated with carboplatin-etoposide-atezolizumab with OS of 17 months. Remaining seven were NSCLC where five patients had adenocarcinoma and 2 had squamous histology. Pembrolizumab was part of treatment for all 4 patients with adenocarcinoma. 5th patient was treated with chemotherapy and had OS of 2 months. Female to male ratio 3:2 for adenocarcinoma and 0:2 for squamous histology with equal ethnic distribution. Two patients had squamous histology, both males and had average OS of 4.5 months. Conclusions: Patients with liver metastasis regardless of the histology, have short overall survival. However it was observed that such patients when treated with immunotherapy as part of their treatment modality do much better compared to those who did not. Specifically immunotherapy benefits are more pronounced in patients with adenocarcinoma histology compared to squamous. However further studies are indicated to evaluate personalized approach to therapy in NSCLC with liver metastasis. Our study was limited based on our limited number of patients.
Evaluation of patient and healthcare provider (HCP) knowledge, attitudes, and behavior for safety and use of pexidartinib.
Authors: Maribel Salas, Michele Julian, Leonidas Drogaris, Zahidul Islam, Mackenzie Henderson, Annette Stemhagen, Natalie O'Donnell, Nora Tu
Journal: Journal of Clinical Oncology (2020)

e23580 Background: Pexidartinib, a kinase inhibitor, is approved for treatment of adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Due to risk of serious and potentially fatal liver injury, pexidartinib is available via a Risk Evaluation and Mitigation Strategy (REMS) Program. A requirement of the REMS is to conduct a qualitative evaluation of stakeholder Knowledge, Attitudes, and Behavior (KAB) of risks via surveys. The objective of the qualitative evaluation is to review key risk message questions with respect to understanding, relevance, clarity and provide recommendations on alternative language, phrasing, and structure. Methods: Anonymized, one-on-one 45–60-min phone interviews with patients and HCPs were conducted by UBC. Patients ≥18 y, diagnosed with TGCT (prioritized) or metastasis/sarcoma of the connective tissue, with different levels of education and fluent reading/speaking English were included. To participate, HCPs were required to treat patients with TGCT (prioritized) or metastasis/sarcoma of the connective tissue, treat patients ≥75% of their time, and clearly read/speak English. Participants were required to complete an Interview Release Form (IRF) and confirm access to a computer/tablet. Participants had little/no familiarity with pexidartinib materials. All interviews followed a standard process, used a pre-scripted guide on general instructions, confidentiality, safety event reporting, rapport building and assessment of health literacy (patients only). Feedback regarding understanding, relevance, and clarity were used to recommend potential alternate language/phrasing. To receive compensation participants were required to execute/return the IRF. Results: Twelve patients were interviewed, majority 67% had TGCT; mean age 52 y; 58% female; 42% reported some college/associates degree. 12 HCPs were interviewed, 67% treated patients with TGCT; 100% male; mean years practicing 22; all spent 75% or more time seeing patients; primary specialty Orthopedics. Areas of confusion/misunderstanding were reported, and questions were then revised. Patient findings: complexity and wordiness; HCP findings: repetition/difficulty reading, and some terminology was not self-explanatory. Conclusions: Feedback from HCPs and patients was received to improve the key risk messages of the KAB. Qualitative research is recommended to improve comprehension and data quality collected.
Survey on awareness rate of knowledge about vascular cognitive impairment in community physicians in Beijing
Authors: Qianlu Zhao, Longxi Ren, Xiaojuan Ru, Ju Yang, Hongliang Cui
Journal: BMJ (2014)

Objective
To survey the awareness rate of knowledge about vascular cognitive impairment (VCI) in community physicians.


Methods
A questionnaire survey on the awareness of knowledge about VCI was conducted in 87 community physicians from 4 community hospitals in Beijing Chaoyang District from October to December 2012. Among all participants there were 27 males and 60 females with an average age of (39±11) years, 85%(74/87)had college or university degrees, 90%(78/87)held primary or middle-level professional titles, 41%(36/87), of them were internists.


Results
All participants completed the questionnaire. The awareness rate about minor and major neurocognitive disorder was 39%(60/87); the rates of various causes of dementia were 51%(44/87)-100%(87/87)and various symptoms of cognitive impairment were 79%(69/87)-99%(86/87), respectively. The awareness rate of cognitive impairment as initial symptom displayed in stroke was 54%(47/87). The awareness rates of knowledge related to diagnosis and treatment of dementia were 57%(50/87)- 97%(84/87)and 80%(70/87)-100%(87/87), respectively. The awareness rates about that Alzheimer's disease and dementia with Lewy bodies were not reversed by early treatment were 46%(40/87)and 37%(32/87), respectively. The awareness rates of vascular risk factors were 20%(17/87)-100%(87/87)and those about the mode of health education were 52%(45/87)- 95%(83/87). There was 36%(31/87)community physicians who thought that they possessed VCI-related knowledge.


Conclusions
The results of survey suggest that community physicians shall upgrade their knowledge of diagnosis and treatment for vascular cognitive impairment.


Key words: 
Cognition, vascular; Physicians, primary care; Questionnaires
非霍奇金淋巴瘤伴低钙血症一例
Authors: 杨治芳, 王平芳, 刘建英, 汤佳珍
Journal: BMJ (2009)

患者女,38岁.因全身骨痛4个月于2006年4月5日入院.诉2005年12月始,无明显诱因出现阵发性肩背部疼痛,继而腰骶部及四肢、胸骨等处骨痛,呈放射性刺痛,进行性加重,伴乏力及行走困难.近2个月,出现不规则发热,多在午后或夜间。
The clinical effects of the transvaginal vesicovaginal fistula repair operation mediated by the Foley catheter
Authors: Li Hong, Bing-shu Li, Min Hu, Yan-xiang Cheng, Xue-xian Xu
Journal: BMJ (2011)

Forty nine patients with vesicovaginal fistula underwent transvaginal repair by the use of Foley catheter in our hospital.The clinical data were retrospectively analyzed.The success rate of primary operation was 98% (2/49), the mean operation time was (85±8)min, the mean postoperative hospital stay was( 13±2) d, the rate of postoperative urine leakage was 2%(1/49), the mean bladder capacity was (378±53)ml.Transvaginal repair of vesicovaginal fistula by the use of Foley catheter is an effective surgical modality with satisfactory results.

Key words: 
Vesicovaginal fistula;  Gynecologic surgical procedure
Low-level viremia and cirrhotic complications in patients with chronic hepatitis B according to adherence to entecavir
Authors: Seung Bum Lee, Joonho Jeong, Jae Ho Park, Seok Won Jung, In Du Jeong, Sung-Jo Bang, Jung Woo Shin, Bo Ryung Park, Eun Ji Park, Neung Hwa Park
Journal: Clinical and Molecular Hepatology (2020)

Background/Aims: Low-level viremia (LLV) after nucleos(t)ide analog treatment was presented as a possible cause of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, detailed information on patients’ adherence in the real world was lacking. This study aimed to evaluate the effects of LLV on HCC development, mortality, and cirrhotic complications among patients according to their adherence to entecavir (ETV) treatment.Methods: We performed a retrospective observational analysis of data from 894 consecutive adult patients with treatment-naïve CHB undergoing ETV treatment. LLV was defined according to either persistent or intermittent episodes of &lt;2,000 IU/mL detectable hepatitis B virus DNA during the follow-up period. Good adherence to medication was defined as a cumulative adherence ≥90% per study period.Results: Without considering adherence in the entire cohort (n=894), multivariate analysis of the HCC incidence showed that LLV was an independent prognostic factor in addition to other traditional risk factors in the entire cohort (&lt;i&gt;P&lt;/i&gt;=0.031). Good adherence group comprised 617 patients (69.0%). No significant difference was found between maintained virologic response and LLV groups in terms of the incidence of liver-related death or transplantation, HCC, and hepatic decompensation in good adherence group, according to multivariate analyses.Conclusions: In patients with treatment-naïve CHB and good adherence to ETV treatment in the real world, LLV during treatment is not a predictive factor for HCC and cirrhotic complications. It may be unnecessary to adjust their antiviral agent for patients with good adherence who experience LLV during ETV treatment.
成功老龄的研究概况
Authors: 吴文源
Journal: BMJ (2006)

成功老龄(successful aging,SA)是指那些与增龄相关的功能状况无改变或改变甚微的老年人群.尽管他们年事已高,但认知功能良好,身心健康;常态老龄是指有与增龄相关的改变,但未达到病理变化和残疾程度的老年人群,或介于病态老龄和成功老龄之间的正常人群[1,2]。
Medical oncologists’ perceptions of clinical trials for underrepresented populations.
Authors: Giselle Katiria Perez, Elyse R. Park, Nora K. Horick, Helen Mizrach, Ryan David Nipp, Sydney Crute, Bruce Allan Chabner, Beverly Moy
Journal: Journal of Clinical Oncology (2020)

e19062 Background: Ethnic/racial minorities and socioeconomically disadvantaged patients remain underrepresented in cancer clinical trials (CCT), challenging the accuracy and generalizability of findings. While oncologists’ recommendations influence trial participation, we know little about their perspectives on recommending CCT to underrepresented patients. Methods: From 9/16-5/19 we conducted a sequential mixed methods study to assess oncologists’ attitudes toward recommending underrepresented patients for CCT. We performed individual interviews with 17 oncologists, developed a survey instrument, and surveyed a randomly selected sample of 98 oncologists (from ASCO, NCORP, MGH; RR = 31.2%). Descriptive statistics summarized attitudes, practices and challenges with trial enrollment of underrepresented patients. Results: Content analysis of interviews (age = 46.9, female = 37.5%, white = 75.0%) revealed overall support for CCT. Indeed, 84.4% of survey respondents (age = 53.3, female = 31.3%, white = 78.6%) considered CCT as central to their professional identity. Yet, 37.5% agreed CCT placed undue burden on oncologists. Oncologists’ concerns around informed consent and perceived lack of clinical/personal equipoise discouraged recommending CCT participation to vulnerable patients. Interviews revealed that nearly all believed that patients with certain vulnerabilities (e.g., literacy, social, financial barriers) had needs that conflicted with CCT demands, increasing the potential for harm. Oncologists were less likely to recommend CCT to patients who do not reliably report side effects (91.2%), demonstrate difficulty comprehending the costs/benefits of CCT (88.7%), lack support (87.6%), live far away (76.3%), or face insurance obstacles (73.2%). Notably, 67.7% affirmed they presented trials with varying enthusiasm based on perceived patient challenges; 32.4% deemed it hard to justify enrolling patients if efficacious standard treatment options exist outside of trials. Oncologists desired navigation support (63.3%) to offset concerns and facilitate trial discussion/enrollment. Conclusions: Findings confirm that oncologists value CCT; however, they experience conflict when considering CCT for patients with pre-existing hardships. Time constraints interfere with oncologists’ ability to adequately address and overcome perceived challenges to participation. Our findings underscore the need for programs that integrate informational support with patient navigation to increase enrollment of underrepresented patients into CCT.
Role of technology in a prospective surveillance and early intervention model for preventing lymphedema: The RE-AIM framework.
Authors: Deonni Stolldorf, Louise Koelmeyer, John Boyages, Jerrod Nelms, Katrina Gaitatzis, Sheila H. Ridner
Journal: Journal of Clinical Oncology (2020)

e14005 Background: Translation of research derived technology into busy clinical practice can be difficult. The effectiveness of technology translation can be assessed by applying the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework. Methods: The RE-AIM evaluation framework was applied to the use of bioimpedance spectroscopy (BIS) in the prospective surveillance and early intervention model of care for breast cancer survivors at risk of arm lymphedema. Data was obtained during an interim analysis from four hospital sites (public and private settings) in Australia who were participating in the PREVENT international study. Women with breast cancer were monitored for lymphedema from a pre-treatment baseline and at regular intervals for a minimum of 12-months. Results: Each of the RE-AIM framework components were evaluated at patient, practitioner and institutional levels. Patients in both public (n = 50) and private settings (n = 61) were Reached with BIS technology which demonstrated Effectiveness of early surveillance with 16 participants being identified for an early prevention intervention. Each of the four sites Adopted the use of BIS technology using various Implemented strategies like education of all stakeholders and development of referral and care pathways. Adherence rates for mandatory study visits was 88. 48% for the prospective surveillance and the early intervention model of care group and were Maintained for a minimum 12 months following completion of the recruitment phase of the study. Conclusions: The effectiveness of using a technology such as BIS in a prospective surveillance and early intervention model of care in breast cancer in both public and private settings has been demonstrated using the RE-AIM framework. The translation of research into clinical practice has been successfully achieved with the PREVENT study. Clinical trial information: NCT02167659.
First-line immunochemotherapy for follicular lymphoma in the GALLIUM study: Prognostic value of PET-CT status after long-term follow-up.
Authors: Tina Nielsen, Sally Barrington, Michel Meignan, Deniz Sahin, Andrea Knapp, Anastasiia Kinkolykh, Michael Herold, Wolfgang Hiddemann, Robert Marcus, Judith Trotman
Journal: Journal of Clinical Oncology (2020)

8025 Background: The prognostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) response assessment following first-line immunochemotherapy for advanced-stage symptomatic follicular lymphoma (FL) was previously demonstrated for patients (pts) enrolled in the Phase III GALLIUM study (NCT01332968; Trotman et al. ICML 2017). Here, we evaluated the association between PET complete metabolic response (CMR) and survival after longer follow-up in this patient population. Methods: In the GALLIUM study, 1202 pts with previously untreated FL were randomized 1:1 to induction therapy of 1000mg obinutuzumab (G; Days 1, 8, 15 of Cycle 1 then Day 1 of subsequent cycles) or 375mg/m 2 rituximab (R; Day 1 of each cycle), in combination with chemotherapy (CHOP, CVP, or bendamustine) (Marcus et al. New Engl J Med 2017). PET-CT scans were mandatory, where available, at baseline and end-of-induction (EOI) for the first 170 pts enrolled, and optional thereafter. For this response analysis, the Lugano 2014 criteria were applied by an independent review committee (IRC) (Cheson et al. J Clin Oncol 2014). Associations between EOI PET complete metabolic response (PET-CMR) status and progression-free survival (PFS) and overall survival (OS) were evaluated, with hazard ratios (HR) stratified according to chemotherapy regimen and FL International Prognostic Index. Results: Of the 609 pts with a baseline PET scan, 595 (98%) had detectable lesions. Of these, 519 pts had an EOI PET evaluable by Lugano 2014 criteria. At EOI, per IRC assessment, 450/595 (76%) pts had achieved CMR. Pts with non-available scans were considered as non-responders and were excluded from the landmark (LM) analyses. Pts who died or progressed (CT-based progression assessment) before or at EOI were excluded from the PFS LM analysis; pts who died before EOI were excluded from the OS LM analysis. After a median follow-up of 76.5 months, EOI PET status was highly prognostic for both longer investigator-assessed PFS (non-CMR vs CMR: HR 3.40; 95% CI: 2.33–4.97; p &lt; 0.0001) and longer OS (HR 3.34; 95% CI: 1.81–6.17; p &lt; 0.0001). Six-year investigator-assessed PFS from EOI was 62.6% (95% CI: 57.0–67.6) for CMR pts compared with 23.4% (95% CI: 12.2–36.7) for non-CMR pts; the corresponding OS was 91.3% (95% CI: 88.1–93.6) vs 79.6% (95% CI: 68.0–87.4). Conclusions: With more than 6 years of follow-up, this analysis confirms that after first-line chemoimmunotherapy for FL, achieving CMR on PET-CT is an early and strong predictor of increased PFS and OS. Clinical trial information: NCT01332968 .
Excretion of SARS-CoV-2 in human breast milk
Authors: S. Costa, B. Posteraro, S. Marchetti, E. Tamburrini, B. Carducci, A. Lanzone, P. Valentini, D. Buonsenso, M. Sanguinetti, G. Vento, P. Cattani
Journal: Clinical Microbiology and Infection (2020)