tbuckley/cabot-search huggingface dataset:
First phase implementation of cardio-oncology program in the middle-income country of Costa Rica at Hospital Metropolitano healthcare system.
Authors: Andres Wiernik, Jessica Pakonen, Luis Diego Flores, Giselle Preinfalk, Graciela Arab, Jose Sprok, Loretta Fernandez, Leonardo Lami, Carlos Solano, Raquel Acuña
Journal: Journal of Clinical Oncology (2020)

e24091 Background: Developing a cardio-oncology program in a middle-income country like Costa Rica can present unique opportunities and challenges. Hospital Metropolitano is a health care system in Costa Rica with a network of two hospitals, 36 clinics, and over 150,000 patients enrolled in its health plan, Medismart. Here we summarize our program, and the initial results of the implementation phase, hoping that institutions with similar resources in low-and-middle-income countries will use this as guidance to develop their own cardio-oncology program. Methods: A cardio-oncology committee was established in May 2019 and includes medical providers, clinical coordinators, administrative workers, and nursing and laboratory staff. A 4-month pre-launch period was established to create an institutional protocol after we reviewed guidelines and literature from similar programs in the United States and Europe. The protocol targets both active cancer patients undergoing treatment and cancer survivors. The program was launched in September 2019 and is currently in the first phase of implementation. Results: During the first phase of implementation, the program was limited to the outpatient setting and patients were referred exclusively by the medical oncology providers from our health care system. In this period, 28 patients met criteria for referral and all enrolled according to our protocol. The median age of our patients was 49 (range 16-77). 25 patients (89%) were female and 20 (71%) had a diagnosis of breast cancer. At the time of enrollment, 21 (75%) were receiving active cancer treatment and 7 (25%) were identified as cancer survivors. All patients are being followed prospectively. A committee review at the end of the first phase of implementation revealed that the most important challenges that the program needs to address for the second phase of implementation include the following: 1) patient education and outreach, 2) cost of care associated with the interventions recommended by the protocol, and 3) data tracking/registry given the lack of an electronic medical record. Conclusions: Our program represents a real-life experience of the challenges and opportunities that institutions in middle-income countries need to consider when launching such initiatives. To our knowledge, this is the first cardio-oncology program formally established in Central America and we are committed to continue to measure our outcomes prospectively and share these with the global oncology community.
Pathogenesis-Based Therapy With Repurposed Biologics for Monogenic Inflammatory Skin Disorders
Authors: Amy S. Paller
Journal: JAMA Dermatology (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Enhancing cancer literacy among Appalachian Kentucky middle and high school students.
Authors: Lauren Hudson, Chris Prichard, L. Todd Weiss, Nathan Vanderford
Journal: Journal of Clinical Oncology (2020)

11008 Background: Kentucky has the highest rates of overall cancer incidence and mortality in the United States and the Appalachian region of the state experiences the highest burden of the disease. Poor health behaviors, poverty, poor health care access, low education levels, and low health literacy drive the cancer disparities in Kentucky. Inadequate health literacy is associated with lower participation in preventive measures, which can increase one’s risk of developing cancer. Increasing cancer literacy among youth represents an opportunity to potentially decrease cancer disparities across Kentucky. In a recent study, we piloted a cancer education intervention in Kentucky middle and high schools to determine if such an intervention could enhance students’ cancer literacy. Through the study, we documented a significant increase in students’ short-term cancer literacy levels (Hudson L. et al. Journal of Cancer Education, in press). Methods: This quantitative survey research study aims to examine the long-term effects of the cancer education intervention on the cancer literacy of Kentucky middle and high school students. An online pretest cancer literacy survey consisting of 10 items was administered to a new set of 164 participants from six new schools, followed by the delivery of a cancer education presentation. Immediately following the presentation, participants took a posttest with identical items to the pretest. A follow-up identical test is being administered 3 months after the initial intervention to determine participants’ longer-term knowledge retention. Results: Replicating our prior work, significant (p &lt; 0.0001) increases in both average and median percent of correctly marked items (average: pretest = 50% versus posttest = 77%; median: pretest = 50% versus posttest = 80%) and scores on each individual question were observed immediately following the intervention. Additionally, the average rating as to how the intervention influenced students considerations toward encouraging a family member or friend to change their habits following the intervention was 8 (1 = extremely unlikely;10 = extremely likely). Conclusions: This work demonstrates an increase in cancer literacy levels after the educational intervention and indicates that the information motivates participants to share cancer prevention information with others. A follow-up survey will measure participants’ longer term knowledge retention levels. These data may suggest that a school-based educational intervention can change behaviors that can lower cancer incidence and mortality rates.
胎盘部位滋养细胞肿瘤伴肾病综合征一例
Authors: 张敏, 连岩
Journal: BMJ (2010)

患者女,39岁,孕2产2.因产后11个月出现阴道不规则出血3个月,腹胀、双下肢水肿、少尿2个月以肾病综合征于2008年3月收入山东大学附属省立医院内科.患者11个月前于当地医院顺产一男婴,3个月前出现阴道不规则流血,持续一个月后自行停止。
什么是循证物理诊断学
Authors: 吴东, 方卫纲, 曾学军, 沈悌
Journal: BMJ (2010)

当前循证医学方法已成为临床研究的主流.循证医学强调临床决策应依赖客观证据而不是个人经验或专家意见,强调用科学实证的态度寻找临床问题的最佳解决方案.循证医学的发展有利于临床诊疗的规范化和科学化进程,然而目前循证研究多集中于探讨特定疾病的诊断和治疗,评估症状和体征诊断意义的研究相对较少。
Feasibility and preliminary safety and efficacy of first-in-human intraperitoneal delivery of MCY-M11, anti-human-mesothelin CAR mRNA transfected into peripheral blood mononuclear cells, for ovarian cancer and malignant peritoneal mesothelioma.
Authors: Christina M. Annunziata, Armin Ghobadi, Eduardo J. Pennella, Julie Vanas, Charles Powell, Mira Pavelova, Cathy Wagner, Michael Kuo, Claudio Dansky Ullmann, Raffit Hassan, Premal H. Thaker
Journal: Journal of Clinical Oncology (2020)

3014 Background: MCY-M11 is a mesothelin-targeting chimeric antigen receptor (CAR) therapy made by a non-viral, mRNA-based platform, for rapid ( &lt; 1 day) CAR manufacturing. We are conducting a phase I dose escalation trial in ovarian cancer and malignant peritoneal mesothelioma (MPM) (NCT03608618). Methods: MCY-M11 are fresh, non-expanded, autologous peripheral blood mononuclear cells (PBMCs) transfected by flow electroporation with mRNA encoding a human anti-mesothelin CAR. Following a 3+3 design, patients are treated in dose level (DL) escalating cohorts (DL1 1.0 x 10 7 , DL2 5.0 x 10 7 , DL3 1.0 x 10 8 , DL4 5.0 x 10 8 cells/dose), in one cycle of weekly x 3 doses, intraperitoneal (ip) without preconditioning chemotherapy. Results: By January 2020, CP-M11-101 study successfully completed DL1 and DL2 without safety concerns. Based on 11 patients treated in DL1, DL2 and DL3, ip infusion of MCY-M11 is safe and well tolerated. No infusion-related adverse events and no dose limiting toxicities (DLTs) have occurred. No neurotoxicity has been observed. Most reported treatment-related adverse events have been Grades 1-2 per NCI CTCAE. One patient in DL3 presented with G2 pericarditis, fever and transient neutropenia clinically assessed as related SAEs, that resolved without further complications. These events were assessed as on-target off-tumor effects and possibly G1 cytokine release syndrome (CRS). Two unrelated SAEs (G2 confusion in a patient in DL2; G3 enterocutaneous fistula in a patient in DL3) were reported. These 2 patients have been replaced as they did not complete the evaluation period (3 weekly infusions and the DLT 43 day follow up). There have been no treatment-related discontinuations or deaths. Three patients in DL2 showed stable disease (SD) by RECIST 1.1 at the end of the DLT period. Of them, 1 completed the study and did not participate in additional follow up, 1 remained in SD 6 months, and 1 remained in SD 2 months. In DL3, 1 patient remains in SD at 2 months, and evaluation is pending for the other 2 patients. Enrollment is ongoing. Conclusions: Feasibility of 1-day manufacturing of MCY-M11 for ip delivery is demonstrated. Treatment has been safe. Initial SD observed in DL2 and DL3 with one-cycle infusions is encouraging and supports exploration of additional strategies such as the addition of preconditioning chemotherapy and multiple cycles to increase efficacy. Clinical trial information: NCT03608618 .
由孕妇死亡事件的处理中学些什么
Authors: 张晓林
Journal: BMJ (2008)

事故回放:2007年11月21日4:00左右,在北京打工的肖某带着已有9个多月身孕的妻子李某来到北京朝阳医院京西分院,要求治疗感冒.经医生诊断,发现肺炎已经导致孕妇的心肺功能严重下降,必须马上进行剖宫产。
Overall survival (OS) in advanced non-small cell lung cancer (aNSCLC) patients treated with frontline chemotherapy or immunotherapy by comorbidity: A real-world data (RWD) collaboration.
Authors: Donna R. R Rivera, Laura Lasiter, Jennifer Christian, Lindsey Enewold, Janet L. Espirito, Eric Hansen, Henry J. Henk, Lawrence H. Kushi, Daniel Lane, Yanina Natanzon, Ruth Pe Benito, Erik Rasmussen, Nicholas J. Robert, Mark Stewart, Connor Sweetnam, Olga Tymejczyk, Emily Valice, Joseph Wagner, Alia Zander, Jeff Allen
Journal: Journal of Clinical Oncology (2020)

e19270 Background: Friends of Cancer Research convened 9 data partners to identify data elements and common definitions for real world (rw) endpoints to evaluate populations typically excluded from clinical trials. Here we report on rwOS by frontline treatment and comorbidities. Methods: A retrospective observational analysis of patients with aNSCLC initiating frontline platinum doublet chemotherapy (chemo) or PD-(L)1-based immuno-oncologic (IO) therapy (monotherapy or chemo combination) between 1 Jan 2011 to 31 Mar 2018 was conducted using administrative claims, EHR, and cancer registry RWD. We evaluated rwOS from frontline therapy initiation using Kaplan-Meier methods, stratified by ECOG status, brain metastases (ICD), history of chronic kidney or liver disease (CKD/ CLD, ICD), and evidence of kidney or liver dysfunction (KD/ LD, lab-based). Results: A total of 33,649 patients were included (N 972-17,454) with 10 to 26% of patients receiving IO as frontline therapy. There was a broad range of comorbidity prevalence across datasets and patients with evidence of comorbidity had comparatively shorter 12-month OS (Table). Conclusions: RWD analyses can generate expanded evidence on patient outcomes for populations routinely excluded from clinical trials and may help inform decision making where sparse data exist on appropriate treatment approaches. Additional understanding of data missingness, sensitivity of definitions, and covariate adjustment are needed to make direct comparisons across regimens and data sources. [Table: see text]
Evaluation and prediction of medical complications after hip fracture surgery
Authors: Lei Wu, Yi Jiang, Jingliang Wu, Congxiao Zhang, Gengsheng Wei, Dong Wang
Journal: BMJ (2016)

Objective
To analyse the risk factors of medical complications after hip fracture surgery.


Methods
Clinical data of 327 hip fracture patients undergoing surgical treatment in Beijing Haidian Hospital from January 2009 to December 2013 were retrospectively studied. There were 114 males and 213 females with a mean age of (75.1±15.6) years, 129 patients(39.4%) had femoral neck fractures, and 198 patients(60.6%)had intertrochanteric fractures. Fifty four patients had medical complications during hospitalization (complication group) and 273 patients did not have complications (non-complications group). The clinical features, presurgical comorbidities and operative parameters were documented and compared between two groups. The risk factors of medical complications were assessed by regression analysis.


Results
Univariate analysis showed that age (t=2.85, P=0.007), lying in bed before fracture(χ2=12.86, P=0.000), the history of chronic obstructive pulmonary diseases(COPD) (χ2=9.45, P=0.000), coronary heart disease(χ2=10.67, P=0.000), heart failure(χ2=15.85, P=0.000), diabetes (χ2=3.22, P=0.024), cerebrovascular disease(χ2=4.21, P=0.008), anesthesia method(χ2=8.67, P=0.018), American Society of Anesthesiologists(ASA) score ≥3 level(χ2=2.01, P=0.042) and the delay time of operation (t=4.24, P=0.037) were significantly different between two groups. Multivariate regression analysis revealed that age(β=0.030, OR=1.030), lying in bed before fracture (β=2.303, OR=10.716), the history of COPD (β=0.831, OR=1.995), coronary heart disease(β=0.858, OR=2.392), heart failure(β=1.971, OR=7.333)and ASA score ≥3 level(β=0.809, OR=2.583) were the independent risk factors of medical complications after hip fracture surgery.


Conclusion
Age, lying in bed before fracture, the history of COPD, coronary heart disease, heart failure and ASA score ≥3 level would increase the risk of postoperative medical complications for patients with hip fracture.


Key words: 
Hip fractures; Postoperative complications; Medical complications; Forecasting
Clinical value of physical diagnosis for patients with functional illness at an ambulatory setting
Authors: Dong Wu, Wei-gang Fang, Jia-lin Chen
Journal: BMJ (2010)

Objective To evaluate diagnostic accuracy based on patient history and physical examinations in medical outpatients.Methods Totally, 145 consecutive patients visiting general internal medicine clinic at a university-affiliated teaching hospital during October 10 to 17, 2008 were recruited into the study and followed-up for 12 months.Results Eighteen of 145 patients ( 12.4% ) were lost to followup.Diagnosis was confirmed by follow-up for 45 ( 35.4% ) of those with medically unexplained symptoms (MUS).Sensitivity of physical diagnosis for those with MUS was 82.2 percent, with specificity of 95.1 percent, likelihood ratios of positive and negative results of 16.9 percent and 0.19 percent, its positive and negative prediction values of 90.2 percent and 90.7 percent, and overall accuracy of 90.6 percent,respectively.Conclusions MUS was common in medical clinical practice.Preliminary diagnosis for MUS based on patient history and physical examinations has been proved remarkably reliable.Carefully selected auxiliary laboratory evaluation combined with physical diagnosis is important for management of MUS.

Key words: 
Outpatient;  Medical history taking;  Physical examination
肝脏上皮样血管内皮瘤一例
Authors: 黄兴文, 唐小峰, 刘爱波, 梁鹏
Journal: BMJ (2011)

肝脏上皮样血管瘤是一种血管源性肿瘤,甚为少见.现报道一例影像学资料,以增加对该病认识. 患者女,39岁.半月前体检时超声发现肝脏多发占位性病变,无不适.体检:腹平,皮肤巩膜无黄染,全腹无压痛,未及肿块,肝脾肋下未明显触及。
PD-L1 expression and progression risk of stage III NSCLC patients on durvalumab consolidation.
Authors: Khalid Jazieh, Mohamed Gad, Anas M Saad, Nathan A. Pennell
Journal: Journal of Clinical Oncology (2020)

e21070 Background: Durvalumab is an anti-PD-L1 agent used as consolidation for patients with stage III non-small cell lung cancer (NSCLC) following chemoradiation. In the PACIFIC trial similar progression-free survival (PFS) and overall survival (OS) benefits were seen whether patients had PD-L1 expression of ≥25% or &lt;25%. In this study we sought to examine outcomes for patients with PD-L1 expression using the more commonly used &lt;1%, 1-49%, and 50-100% cutoff points. Methods: This was a retrospective analysis of 52 patients with stage III NSCLC who underwent treatment with chemoradiation followed by durvalumab maintenance. Patients were divided into groups of PD-L1 Negative (&lt;1% positivity), Low PD-L1 (1-49%), and High PD-L1 (50-100%) based on the percentage of tumor PD-L1 expression using local testing with the Dako 22C2 antibody. The primary endpoint was presence or absence of radiographic progression while on durvalumab or after completing therapy, while PFS and OS were also determined. Results: Of the 52 patients, 25% were in the High PD-L1 group, 21% in the Low PD-L1 group, 27% in the PD-L1 Negative group, and the remaining were not tested for PD-L1. The progression rates were 64.3%, 90.9%, and 23.1% for the PD-L1 Negative, Low PD-L1, and High PD-L1 groups respectively (Table). Using Chi-square analysis there was a significant association between the extent of PD-L1 expression and progression (p = 0.003). The odd’s ratio (OR) of progression in the High PD-L1 group compared to the PD-L1 Negative group was 0.167 (0.031-0.904, p = 0.038), and the OR of progression in the Low PD-L1 group compared to PD-L1 Negative was 5.556 (0.541-57.00, p = 0.149). There was a statistically significant difference in PFS between the groups (p = 0.019), but not OS. Conclusions: Our results show that PD-L1 expression may be useful in predicting the risk of cancer progression in stage III NSCLC patients undergoing durvalumab consolidation. Patients with high PD-L1 (50-100%) expression had significantly lower odds of disease progression and longer PFS compared to those who were negative for PD-L1. While the rate of progression was higher in the Low PD-L1 group, the OR was not statistically significant when compared to the PD-L1 Negative group. [Table: see text]
Two-dimensional and three-dimensional ultrasonography in diagnosis fetal congenital vertebral deformities
Authors: Qinghong Zhao, Hua Shi, Jiaqi Hu, Yuguo Zhang
Journal: BMJ (2018)

Prenatal 2D and 3D ultrasonographic examinations were performed for 67 008 pregnant women in Renmin Hospital of Wuhan University from January 2013 to December 2016. Among 69 013 fetuses, 71 cases of congenital vertebral deformities were diagnosed with a detection rate of 0.103%. There were 40 cases of semi-vertebrae, 23 cases of butterfly vertebrae, 2 cases of coronal vertebral body fissure and 6 cases of vertebral fusion. Half vertebral deformity was the most common vertebral abnormality accounting for 56.3%(40/71), and the coronal vertebral body fissure was the least abnormality. Among 71 abnormal vertebral fetuses, there were 40 cases with other abnormalities, of which 28 fetuses were induced abortion, 12 fetuses were born; there were 31 cases of simple vertebral body anomalies, of which 8 fetuses were born and 23 fetuses were induced abortion. In infants with a single vertebral anomalies had no significant scoliosis, X-ray examination was performed 3-6 months after birth, the results were consistent with prenatal ultrasound diagnosis. Fifty one cases of induced abortion were examined by X-ray, the prenatal diagnosis was consistent with X-ray findings in 48 cases, and the remaining 3 cases were all multiple hemi-vertebrae with missed diagnosis of congenital butterfly vertebral deformity.


Key words: 
Vertebral deformities; Congenital abnormalities; Ultrasonography, prenatal
Awareness and knowledge on stroke of residents in Fangzhuang community
Authors: Xiu-mei Liu, Hao Wu, Zhi-li Li
Journal: BMJ (2012)

A questionnaire survey on the awareness and knowledge about stroke was conducted in 392 residents of Fangzhuang community.The results showed residents in Fangzhuang had high awareness rate about stroke,the rates of knowing early symptoms of stroke were from 57.91％ to 79.08％.83.16％ (326) of residents knew to dial 120 or 999 at emergency.The community doctors were thought as the main resource of gaining the knowledge of stroke (78.32％ ).The results indicate that Fangzhuang community health service center plays an important role in health education and guidance for emergent management of stroke in the community.

Key words: 
Choice behavior;  Cerebrovascular accident
Redress the misconception of diagnosis and treatment for gouty arthritis
Authors: 施桂英
Journal: BMJ (2006)

近20年,国内许多医院相继建立了血清类风湿因子和人类白细胞抗原(HLA)-B27的检测方法,尽管它们为临床诊断提供了参考依据,但也带来一些负面影响.尤其明显的是,一些医师不问其他,简单地将类风湿因子阳性或HLA-B27阳性者诊断为类风湿关节炎或强直性脊柱炎,于是造成了对一些患者的误诊和误治.与上述现象同出一辙的是,许多医师也简单地将血尿酸增高等同于痛风,或对急性发作的痛风性关节炎(gouty arthritis)患者给予别嘌醇治疗,而且这种误诊误治的现象屡见不鲜.为此,有必要呼吁医务人员应对发病率日益增加的痛风性关节炎的诊断和处理提高认识,走出误区,规范治疗,防治结合。
Relationship between serum total bile acid and fetal prognosis in patients with intrahepatic cholestasis of pregnancy
Authors: Chen Hang, Xiao-xia Zhang
Journal: BMJ (2013)

To explore the relationship between serum total bile acid concentration and fetal prognosis in patients with intrahepatic cholestasis of pregnancy (ICP). A total of 131 ICP patients were divided into mild and severe ICP groups according to serum total bile acid concentration. And another 100 normal subjects during the same period were selected as control group. Their medical records and fetal prognoses were analyzed. The serum total bile acid, liver enzyme and lipid concentration of ICP patients were all significantly higher than those of the controls (P<0.01). The fetal prognoses of ICP patients were significantly different with those of controls (P<0.05). A high serum level of total bile acid of ICP patients may produce serious adverse effects on fetal prognosis.


Key words: 
Bile acids and salts; Infant, newborn