tbuckley/cabot-search huggingface dataset:
Diabetes Prevention and Treatment in Shanghai Communities
Authors: Yu-miao Wu, Ke-jun Yang
Journal: BMJ (2008)

Based on Shanghai Guideline for Diabetes Prevention and Treatment(2005), 578patients with diabetes or abnormal glucose metabolism in Shi Men Er Road Community were managed at different levels during the past 2 years. Seventy percent of the patients were identified by general practitioners. Follow-up was initiated by general practitioners(60%)or other healthcare providers(40%).Our findings suggested that traditional disease management model focused mainly on acute conditions, while community health center-based model Was expected to meet the need for chronic disease prevention and treatment and play an important role in minimizing economic burden and improving doctor-and-patient relationship.

Key words: 
Community health services; Diabetes
由病例分析看骨关节炎的诊断和治疗
Authors: 王钱, 黄慈波
Journal: BMJ (2006)

骨关节炎(OA)又称骨关节病、退行性关节病和增生性关节炎等,是一种最常见的风湿性疾病,其基本病理改变为关节多种致病因素引起的进行性软骨变性、破坏及丧失,关节软骨及软骨下骨边缘骨赘形成,由此引起一系列的关节症状和体征,临床表现为关节疼痛、僵硬、肿大、畸形和功能障碍,常伴有继发性滑膜炎,发病率随年龄增大而逐渐增加.因此,如果得不到及时正确的治疗,随着病情的进展,会导致不可逆的关节畸形和功能障碍,严重影响生存质量。
mHealth for breast cancer patient navigation: What patients want—What clinicians need.
Authors: Maen Farha, Mary A Hill, Kelly Rosendall, Kelly M Smith
Journal: Journal of Clinical Oncology (2020)

e19244 Background: mHealth interventions support patient behavior change, promote adherence to treatment provide patient education, and clinical decision support. Research on mHealth interventions has focused on unidirectional communication from providers to patients. mHealth to support patient navigation through multidisciplinary breast cancer care (MBCC) has not been realized. Our team explored the information needs and perceived benefits and barriers to the design and adoption of mHealth solutions to support patient-centered MBCC. Methods: We conducted a prospective cohort study with patients and family members of patients with breast cancer (Stage 0-III), clinicians and practice staff participated semi-structured interviews/focus group to explore stakeholder perceptions of mHealth across the domains of: information needs, communication, technology preferences, and barriers and facilitators to adoption and implementation. Transcripts were analyzed using concurrent content analysis and recruitment continued until saturation of themes was achieved within each stakeholder group. Results: We conducted 22 interviews and 5 focus groups with 49 participants generating 466 individual responses. Patients, clinicians, and staff found existing communication pathways (e.g., calls to office, patient portal) sufficient in meeting patient’s needs. Family members and caregivers saw the potential of mHealth as beneficial to decision-making and treatment adherence. Patient access to health information on a smartphone between visits was perceived positive to support care organization. Clinicians and staff recognized the need for patient engagement to optimize treatment outcomes. Concerns about workload, privacy and security, and misinterpretation of information shared in mHealth apps were perceived as barriers to adoption. Recommendations included EHR integration, existing “in-box” management workflow, and team engagement in information management processes. Conclusions: mHealth can play a pivotal role in supporting patient-clinician-family dynamics for MBCC. Designers of mHealth should carefully consider the relative value of applications to the clinical workflow, patient and family needs, and identify team-based approaches to supporting adoption and implementation.
FGFR2 inhibition could suppress spermatogenesis.
Authors: Ilya Tsimafeyeu, Nataliya Lapina, Mikhail Byakhov, Nadezhda Dragun, Evgenia Gavrilova, Anastasia Skorobogatova, Kira Stosman, Marina Melikhova, Olga Vakunenkova, Vadim Kashuro, Mikhail Rozhko, Sergei Tjulandin
Journal: Journal of Clinical Oncology (2020)

e15659 Background: The incidence of cancer among the people of reproductive age is constantly increasing. Although FGF2/FGFR2 expression in the male reproductive tract has been reported, there is no evidence of the impact of FGFRs inhibitors on sperm function. Therefore, the objective of this large study was to determine the effects of alofanib, selective FGFR2 allosteric extracellular inhibitor on the regulation of sperm physiology using the rat and rabbit models. Methods: Two-hundred forty Sprague-Dawley rats and 30 Chinchilla white rabbits received alofanib (0–40.5 and 0–21.6 mg/kg/day, respectively) intravenously on a consecutive daily dosing schedule for six months. Eighty rats and 8 rabbits were in the control group. The subchronic study evaluated high doses (300 mg/kg/day) of alofanib for 2 months in 15 male rats. Necropsy was conducted following treatment/recovery periods, and histologic examinations were performed. Results: Animals were active. After injections of a dose equivalent to a human therapeutic dose during 6 months, most of the seminiferous tubules were empty, the elements of spermatogenesis were not classified, and altered primary spermatogonia and spermatocytes were distinguished in male rats. After injections of a five-fold dose, all seminiferous tubules were empty and expelled by a cylindrical epithelium. Very similar changes in sperm physiology were founded in rabbits. Most of the seminiferous tubules were blank, and some tubules contained eosinophilic amorphous masses. High doses of alofanib resulted in pronounced atrophy of the spermatogenic tubule epithelium. Multinucleated giant cells were observed in the lumen of a part of the tubules. There were no changes in untreated animals. Conclusions: FGFR2 inhibition led to the suppression of spermatogenesis. Male cancer patients should be informed of this potential adverse event before treatment with FGFR2 inhibitors.
Correlation of longtime efficacy maintenance PARP inhibitor therapy with pre-treatment in a single-institution experience.
Authors: Maria Ornella Nicoletto, Andrea Grego, Alessandra Baldoni, Giulia Tasca, Antonio Sommariva, Marco Tonello, Valter Torri, Pierluigi Pilati
Journal: Journal of Clinical Oncology (2020)

e18084 Background: The use of PARP inhibitors (Olaparib-Niraparib) has shown an important benefit in PFS in patients with relapsed ovarian cancer both with gBRCA and non-BRCA mutation. Methods: This was a single-institution, retrospective cohort study of 93 patients. Clinical data were obtained by the review of the electronic medical report. The 93 patients were treated with PARP Inhibitors(PARP-I) between Apr 2014 and Dic 2019. The patients were evaluated according to age, BRCA mutation, pretreatment with Trabectedin, Bevacizumab, last line of pretreatment with Platinum-Gemcitabine+Paclitaxel versus Caelyx-Oxaliplatin, number of previous lines of chemotherapy, residual disease before PARP-I. Statistical analysis of survival was performed with Kaplan-Meyer, univariate and multivariate analysis with Cox regression. Disease Free Survival (DFS) was evaluated from the start of PARP-I therapy while Overall Survival (OS) from the diagnosis. Results: Median age was 64 (42-90), patients with germinal mutation BRCA were 34 (36.6%), 58 without mutation and 1 patient without genetical analysis. 20 (21,5%) patients were pretreated with Trabectedin plus Pegylated Liposomal Doxorubicine (PLD), while 8 (8,6%) with Trabectedin-Bevacizumab, 26 (28%) patients were pretreated with Bevacizumab +/- Trabectedin. Before PARP-I patients more frequently were pretreated with 2-3 line 60, 64.5%): in the last line of pretreatment chemotherapy 47 (50,4%) patients received PLD+-Oxaliplatin versus Carboplatin-Taxol or Carboplatin-Gemcitabine. In 64% of the patients CTscan or ecography showed residual disease &gt; 1 cm before starting PARP-I treatment . Median follow-up was 17 months: 54 (58.1%) patients in PARP-I treatment relapsed, while 32 (34.1%) patients died. Multivariate analysis showed a significant association in the number of lines pretreatment: in more than 3 lines HR was 2.00 (CI 1.2-3.4, p = 0.012), according to residuum less or more 1 cm prior to start PARP therapy (logrank p = 0,0286). Conclusions: The administration of PARP is important for OS immediately after 2° line chemotherapy in platinum sensitive patients Logrank p = 0.0065, with higher response not significant, about OS specially if following non-anemic PLD-Oxaliplatin therapy (p = 0,0849 Logrank) Also significant is OS according to residuum less or more 1 cm prior to start PARP therapy (logrank p = 0,0286) The doses and relative reductions in PARP-I did not change efficacy.
Serum progesterone levels in early pregnant women and its relation to luteal maintenance therapy for pregnancy protection
Authors: Jiao Cheng
Journal: BMJ (2015)

Objective
To investigate serum levels of β-human chorionic gonadotrophin (β-HCG) and progesterone (P) in early pregnant women, and their relation to luteal maintenance therapy for early pregnancy protection.


Methods
One hundred and thirty five infertility women treated in Department of Gynecology and Obstetrics of Beijing Chaoyang Hospital from January 2007 to December 2011. Total 150 pregnancy cycles, including 84 with intrauterine insemination (IUI) and 66 with natural conception, were divided into two groups: normal intrauterine pregnancy group (group A, n=80) and early pregnancy loss group (group B, n=70). Medical history, ultrasonic findings, serum female hormone, P and β-HCG levels at early pregnancy stage were analyzed.


Results
The age of group A and group B was (30.0±3.9) years and (30.7±4.9) years, respectively (P>0.05). The follicle-stimulating hormone/luteinizing hormone in group A and group B was 1.57±0.96 and 1.56±1.08; the estradiol levels in two groups were (152±66) pmol/L and (147±69) pmol/L, respectively (both P>0.05). There were no differences in dominant follicles and endometrial thickness between groups A and B (P>0.05). Ovulation promotion and luteal support treatments were adopted in both groups: 50%(40/80) of cycles in group A received ovulation promotion, 73%(58/80) of cycles received luteal support, while 44%(31/70) and 76%(53/70) received in groups B, respectively. The levels of serum progesterone in group A during 14-21 d, 22-27 d and ≥28 d after ovulation were higher than those in group B at each time points (P 0.05).


Conclusion
Dynamic monitoring of serum progesterone level in early pregnancy may be used as an auxiliary index for prediction of pregnancy outcome, but it may not be an indicator for luteal maintenance therapy.


Key words: 
Pregnancy trimester, first; Intrinsic factor; Abortion, spontaneous; Progesterone; Corpus luteum maintenance
Evaluation of immune-related adverse events (irAE): Utilizing the patient-reported outcomes of the common terminology criteria for adverse events (PRO-CTCAE) in a phase II study of ipilimumab (ipi) in men with castration-sensitive prostate cancer (CSPC).
Authors: Daniel Vargas Pivato de Almeida, Justine Anderson, Daniel Costin Danila, Michael J. Morris, Susan F. Slovin, Wassim Abida, Erica Simone Dayan, Tracy Curley, Gabrielle Arauz, Raymond E Baser, Howard I. Scher, Karen A. Autio
Journal: Journal of Clinical Oncology (2020)

e24174 Background: Incorporation of the PRO-CTCAE during chemotherapy is associated with fewer ER visits and improved survival. Limited data exist using this tool to capture irAE in immunotherapy trials. We collected select PRO-CTCAEs in a clinical trial evaluating an immune checkpoint inhibitor (ICI) in patients (pts) with CSPC. Methods: Cohort A (Coh A) enrolled de novo metastatic CSPC; Cohort B (Coh B) enrolled recurrent CSPC after radical prostatectomy (RP). Treatment consisted of 4 doses of ipi and 8 months of androgen deprivation therapy (ADT) in Coh A &amp; B, and RP in Coh A. PRO-CTCAEs were collected at each ipi or ADT administration, and during follow-up. PRO-CTCAE items included abdominal pain, diarrhea, fatigue, anorexia, nausea, vomiting, rash and pruritus, with the correspondent attributes of frequency (freq), severity (sev), interference (int), and presence. Results: 16 pts were treated (Coh A: 7; Coh B: 9) with 181 matched pairs of PRO-CTCAE and CTCAE. The study was terminated early for an unfavorable risk:benefit ratio. PRO-CTCAE completion at required visits was 85.4% in Coh A and 98.1% in Coh B. Cohen’s kappa coefficients was lowest for pruritus (k = 0.10, slight agreement) and highest for rash (k = 0.64, moderate agreement). CTCAE captured diarrhea in 10 pts, 4 of whom received steroids. 75% (3/4) of pts receiving steroids graded diarrhea as ‘frequently’ or ‘almost constantly’ on the PRO-CTCAE while 66.7% (4/6) of those who did not receive steroids reported the same frequency. Conclusions: IrAE were more commonly reported and of higher grade by patients using the PRO-CTCAE as compared to clinician reporting, consistent with existing literature in non-ICI studies. Diarrhea as reported by the PRO-CTCAE did not associate with steroid use in this small trial. Further studies are needed to evaluate irAE using PRO-CTCAEs and the potential role in management of these toxicities. Clinical trial information: NCT02020070 . [Table: see text]
An independent review of arterial occlusive events (AOEs) in the ponatinib (PON) phase II PACE trial (NCT01207440) in patients (pts) with Ph+ leukemia.
Authors: James L Januzzi, Joseph Garasic, Scott Kasner, Vickie McDonald, Mark C Petrie, Jonathan Seltzer, Michael J. Mauro, Kevin Croce, Ellin Berman, Michael W.N. Deininger, Andreas Hochhaus, Javier Pinilla-Ibarz, Franck E. Nicolini, Dong-Wook Kim, Daniel J. DeAngelo, Hagop M. Kantarjian, Jing Xu, Shouryadeep Srivastava, Daniel Naranjo, Jorge E. Cortes
Journal: Journal of Clinical Oncology (2020)

7550 Background: The final 5-year analysis of the PACE trial, which evaluated use of PON in pts with refractory chronic myeloid leukemia (CML) and Ph+ acute lymphoblastic leukemia, identified a 25% incidence of AOEs (Cortes, Blood 2018) from a search utilizing &gt; 400 preferred terms (PTs) defined by MedDRA and related to vascular ischemia or thrombosis. We performed a retrospective review using an independent Endpoint Adjudication Committee (EAC) to better understand clinically relevant AOE rates in PACE. Methods: The EAC consisted of 3 cardiologists, 1 hematologist, and 1 neurologist to review AOEs (identified using &gt; 500 terms) in PACE using American College of Cardiology/American Heart Association (ACC/AHA) definitions for major adverse cardiovascular events (MACE), and to review pt profiles including event, severity, concomitant medication, and hospitalization data. These results were compared with MedDRA PT search results. The EAC was blind to dose, dose modification, and investigator causality opinion. Results: The PACE review included 449 heavily pretreated pts with Ph+ leukemia (median age, 59 y; 47% female; 93% ≥2 tyrosine kinase inhibitors). With median follow-up 37.3 mo in all pts, AOEs were identified by MedDRA PT search in 25% of pts and EAC-verified in 17% (Table). In each category listed in the table, the EAC verification identified fewer AOEs and serious AOEs. Serious AOEs were identified by MedDRA PT search in 20% of pts and EAC-verified in 16%. Events that were not associated with a cardiovascular etiology or failed to meet the MACE definition set forth by the ACC/AHA were determined by the EAC not to be an AOE. Conclusions: The independent EAC review showed a lower rate of clinically relevant AOEs than was reported in PACE, suggesting an earlier possible overestimation that may not accurately reflect the risk of AOEs with PON. The ongoing PON dose-ranging OPTIC study will further evaluate the PON risk:benefit profile. Clinical trial information: NCT01207440 . [Table: see text]
妊娠合并阵发性室上性心动过速急诊治疗13例
Authors: 原芳, 杜松
Journal: BMJ (2005)

阵发性室上性心动过速(PSVT)在妊娠期间对母婴有潜在的不利影响,因此采用对胎儿无害的快速有效的复律措施十分重要.现对我院急诊科2000至2002年13例妊娠合并PSVT患者的治疗总结如下。
Personalised pharmacotherapy: an interim solution for antidepressant treatment?
Authors: A. M. Chekroud, J. H. Krystal
Journal: BMJ (2015)

<h3>Abstract</h3> A number of recent studies have shown that cell shape and cytoskeletal texture can be used as sensitive readouts of the physiological state of the cell. However, utilization of this information requires the development of quantitative measures that can describe relevant aspects of cell shape. In this paper we develop a set of quantitative measures, some used previously and others that are new, that have desirable properties for shape and texture quantification of cells. These measures, broadly classifiable into the categories of textural, spreading and irregularity measures, are tested by using them to discriminate between osteosarcoma cell lines treated with different cytoskeletal drugs. We find that even though specific classification tasks often rely on a few measures, these are not the same between all classification tasks, thus requiring the use of the entire suite of measures for classification and discrimination. We provide detailed descriptions of the measures, as well as codes to implement them. Image based quantitative analysis has the potential to become a new field of biological data ("image-omics"), providing quantitative insight into cellular processes. <h3>Summary statement</h3> We develop a set of quantitative measures for studying changes in the shape and texture of cells, and experimentally validate their performance on osteosarcoma cells perturbed with different cytoskeletal drugs.
Semi-automated discovery of real-world patient pathway from U.S. electronic health records: Advanced non-small cell lung cancer (aNSCLC).
Authors: Fei Yang, Ju Zhang, Tyler J. O’Neill, Vishakha Sharma, Matthew Stewart Prime
Journal: Journal of Clinical Oncology (2020)

2048 Background: A good understanding of cancer care continuum presents opportunities to uncover unmet medical needs and improve outcomes and clinical workflow efficiency. However, patient care is poorly understood in real-world clinical practice. This study aimed to discover real-world patient pathways for advanced non-small cell lung cancer (aNSCLC). Methods: This study included patients diagnosed with aNSCLC (stage IIIB and above) at their initial diagnoses between 2011-2018 from the Flatiron Health electronic health records (EHR)-derived deidentified database. Overall survival (OS) was calculated using the Kaplan-Meier method. We also explored the application of process mining analytics (Heuristics Miner &amp; Directly-Follows Graphs) to describe and visualize real-world patient pathways, following patients from initial diagnosis, through any National Comprehensive Cancer Network guideline-recommended companion diagnostics (CDx; including EGFR, ALK, ROS1, KRAS, BRAF, or PD-L1) and treatment patterns, until death or end of the study. Results: A total of 39,156 eligible patients were included. During a median follow-up of 0.78 years (interquartile range [IQR] 1.27), 28,801 (73.6%) patients died (median OS 11.6 months [95% CI 11.4 -11.8]). We established a semi-automated process discovery pipeline that transforms high-dimensional EHR datasets in table format as input into real-world event logs and produces a series of patient pathway graphs as output. The patient pathway graphs showed 19,878 (50.8%) patients had CDx testing within a median 11 days (IQR 18) and 29,241 (74.7%) patients started first-line therapy within a median 1.2 months (IQR 1.2) after the initial diagnosis. When we stratified analysis by years of initial diagnosis (2011-2014 vs 2015-2018), 38.8% (6808 of 17546) vs. 60.5% (13070 of 21610) patients had their first CDx testing within median 12 days (IQR 21) vs. 10 days (IQR 17) respectively. Conclusions: This study suggested an uptake of 56% increase of CDx utilization over the last 8 years in real-world clinical setting and that patient pathways can be analyzed and visualized in a semi-automated fashion.
Variations in objective knowledge among decision-support persons of patients with early stage breast cancer.
Authors: Victoria A Wytiaz, Christine M Veenstra, Sarah T. Hawley
Journal: Journal of Clinical Oncology (2020)

e19110 Background: Patients with breast cancer face complex decisions regarding treatment options, and frequently involve family, friends, and other decision supporters in decision-making. A high-quality decision is one that is both informed and values-concordant. While much has been done to evaluate the quality of decision-making among patients, very little is known about how decision supporters fit within that framework. Thus, we sought to understand variations in objective knowledge among decision supporters. Methods: Patients with stage 0-II breast cancer reported to Georgia and LA SEER registries in 2014-15 and their key decision support person (DSP) were surveyed separately. DSPs were asked 4 objective knowledge questions regarding breast cancer treatment with responses dichotomized into high/low knowledge. Bivariate analyses and multivariable regression models were used to assess associations between DSP knowledge and important DSP characteristics (type of DSP, age, race, education), level of DSP engagement in 3 domains of patients’ decision-making (feeling informed about decisions, extent of and satisfaction with their involvement in decisions, and being aware of patients’ values/preferences), and patient clinical factors (stage, chemotherapy receipt, radiation receipt, type of surgery). Results: 2502 patients (68% RR) and 1203 eligible DSPs (70% RR) responded. Most DSPs were husbands or daughters. 21% were Latino, 17% were black, 20% had &lt;high school education. Overall,53% DSPs had high objective knowledge. DSPs with high knowledge were more likely to be non-Black, non-Spanish-speaking Latinos, have a higher level of education, and report high engagement in the domains of satisfaction with their involvement in patients’ decision-making and awareness of patients’ values/preferences (all p &lt; 0.05). After adjustment, high objective knowledge among DSPs was associated a higher level of education (OR = 2.44; 95% CI = 1.67-3.57) and high awareness of patients’ values/preferences (OR = 1.40; 95% CI = 1.06-1.84). Conclusions: Objective knowledge about breast cancer treatment was varied among DSPs of patients with breast cancer. Highly engaged DSPs (aware and satisfied) were more likely to have high knowledge, suggesting that involving DSPs may be an untapped mechanism for improving patients’ understanding of treatment options. These finding suggest that DSPs can play a role in improving decision quality in patients, and that interventions focused on decision-making may benefit from modules directed to DSPs as well as patients.