tbuckley/cabot-search huggingface dataset:
A cost-utility analysis of apalutamide for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC).
Authors: Ambika Parmar, Narhari Timilshina, Urban Emmenegger, Shabbir M.H. Alibhai, Martin Smoragiewicz, Beate Sander, Kelvin K. Chan
Journal: Journal of Clinical Oncology (2020)

e19369 Background: The therapeutic landscape for patients with mCSPC has evolved over the last decade given the growing body of evidence demonstrating efficacy for the earlier application of oral androgen receptor signaling inhibitors, such as with abiraterone and enzalutamide. Recently the success of the TITAN trial established the superior efficacy of apalutamide combined with androgen deprivation therapy (ADT), with a 33% reduction in mortality versus ADT alone, and a tolerable toxicity profile. However, with substantially higher costs than ADT alone, the cost-effectiveness of this combination is critical to evaluate. Methods: A cost-utility analysis of apalutamide+ADT versus ADT alone was conducted from the Canadian healthcare perspective. A state-transition model with probabilistic analysis was used to compare the two strategies over a lifetime horizon. Model inputs were informed by the TITAN trial (transition probabilities, adverse events [AE], subsequent therapy), published literature (utilities) and Canadian costing resources (systemic therapy [initial and subsequent], routine care [physician visits, imaging], AE, end-of-life care costs). Primary outcomes included expected life-year gains (LYG), quality-adjusted life-years (QALY), lifetime cost (in 2018 Canadian dollars), and the incremental cost-effectiveness ratio (ICER). Multiple scenario analyses were conducted to assess parameter and model uncertainty. Cost and effectiveness were discounted at 1.5% as per Canadian guidelines. Results: From the base-case analysis expected LYG and QALY for ADT and apalutamide+ADT were 4.11, 5.57 and 3.50, 4.85, respectively. Expected cost over a lifetime horizon was $37,553 and $254,205, respectively. The ICER for apalutamide+ADT as compared to ADT alone was $160,483/QALY. Through scenario analysis, cost-effectiveness of apaluatmide+ADT was achieved with apalutamide price reductions of &gt;50%, relative to a cost-effectiveness threshold (CET) of $100,000/QALY. Scenario analysis of alternative long-term survival expectations with apalutamide+ADT demonstrated cost-effectiveness (relative to CET $100,000/QALY) with expected improvements in the 5-year survival rate of 29% as compared to ADT (versus base-case expected improvement in 5-year survival of 15%). Conclusions: Apalutamide+ADT is unlikely to be cost-effective from the Canadian healthcare perspective at current list prices. Improvement in cost-effectiveness is most likely to be achieved through price reductions in apalutamide drug costs.
Primary care provider involvement in thyroid cancer survivorship care.
Authors: Archana Radhakrishnan, David Reyes-Gastelum, Sarah T. Hawley, Ann S. Hamilton, Kevin C. Ward, Lauren P. Wallner, Megan Rist Haymart
Journal: Journal of Clinical Oncology (2020)

e14028 Background: While prior research has examined how primary care providers (PCPs) can help care for breast and colon cancer survivors, little is known about the role of PCPs in thyroid cancer survivorship. We surveyed PCPs to understand their involvement and confidence in providing several aspects of thyroid cancer survivorship care. Methods: Thyroid cancer patients (N = 2632) diagnosed in 2014-2015 and identified from the Georgia and LA SEER registries, were surveyed, and identified their PCPs, who then were also surveyed (N = 162, 56% response rate). PCPs were asked to report their: 1) involvement in thyroid cancer long-term surveillance (not involved: never/rarely vs. involved: sometimes/often/almost always involved); and 2) confidence in handling four aspects of thyroid cancer survivorship care (low: not at all/a little/somewhat vs. high: quite/very confident). We examined PCP factors (individual, practice, attitudes and beliefs) associated with PCP involvement in long-term surveillance using multivariable logistic regression. We then examined associations between PCP involvement in long-term surveillance and PCP confidence in handling the four aspects of thyroid cancer survivorship care using Chi-squared tests. Results: The majority of PCPs (76%) reported involvement in long-term surveillance. Adjusted odds of PCPs reporting involvement was greater among PCPs who somewhat/strongly believed that PCPs have the skills necessary to provide survivorship care (OR 4.33; 95% CI 1.38-15.37), and PCPs who noted clinical guidelines as being the most influential in guiding treatment (OR 4.48; 95% CI 1.67-13.07). PCP reports of high confidence in handling the four aspects of survivorship care were consistently less than 50%: when to refer patient to specialist (40%), role of neck ultrasound (36%), role of random thyroglobulin levels (27%), and when to end long-term surveillance (14%). PCPs who reported involvement in long-term surveillance were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs. 7.9% for those not involved, p &lt; 0.01) but not the other aspects of survivorship care. Conclusions: Though many PCPs reported they were involved in thyroid cancer long-term surveillance, gaps remain in their confidence in handling several aspects of thyroid cancer survivorship care. Guidelines were noted as important in influencing management; therefore, developing guidelines that specifically delineate PCP roles in thyroid cancer survivorship may present one opportunity to increase PCPs’ confidence about their participation.
Treatment adherence of patients with systemic rheumatic diseases in COVID-19 pandemic
Authors: George E Fragoulis, Gerasimos Evangelatos, Aikaterini Arida, Vasiliki-Kalliopi Bournia, Kalliopi Fragiadaki, Anastasios Karamanakos, Evrydiki Kravvariti, Katerina Laskari, Stylianos Panopoulos, Maria Pappa, Maria G Tektonidou, Petros P Sfikakis
Journal: Annals of the Rheumatic Diseases (2020)

We read with great interest the preliminary German Society of Rheumatology recommendations for the management of patients with autoimmune inflammatory rheumatic diseases (AIRD) during the COVID-19 pandemic.1 As other regulatory bodies suggest2 3 patients should not discontinue their anti-rheumatic treatment because of fear.1 

Herein, we investigated to which extent patients with AIRD altered their treatment during COVID-19 pandemic and whether there are any factors that affected their decision. We telephone-interviewed (14 April 2020–22 April 2020), 500 consecutive AIRD-patients followed-up in our centre and recorded the following parameters: age, sex, cohabitation, region of residence (urban, semiurban, rural), level of education (first, second, third), employment status, disease duration, current treatment and presence of co-morbidities (hypertension, hyperlipidemia, coronary heart disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), depression, anxiety).

Specific questions referred to the COVID-19 pandemic period in Greece, starting on 26 February 2020, with predefined answer-options, were asked: discontinuation of any medication received for AIRDs, possible reasons that led to drug discontinuation (including fear of immunosuppresion and lack of resources/drug shortage), whether advise was received from a clinician or other sources, symptomatology compatible with COVID-19 infection, subjective assessment (on …
Culture of circulating tumour cells derived from non-small cell lung cancer.
Authors: Kenneth John O'Byrne, Joanna Kapeleris, Arutha Kulasinghe, Majid E Warkiani, Connor Gerard O'Leary, Rahul Ladwa, Ian Vela, Paul Leo, Peter Sternes, Chamindie Punyadeera
Journal: Journal of Clinical Oncology (2020)

e21692 Background: Tumour tissue-based information is limited. Liquid biopsy can provide valuable real-time information through circulating tumour cells (CTCs). Profiling and expanding CTCs may provide avenues to study transient metastatic disease. Methods: 70 NSCLC patients were recruited. CTCs were enriched using the spiral microfluidic chip and a RosetteSep™ using bloods from NSCLC patients. CTC cultures were carried out using the Clevers media under hypoxic conditions. CTCs were characterized using immunofluorescence and mutation-specific antibodies for samples with known mutation profiles. Exome sequencing was used to characterized CTC cultures. Results: CTCs ( &gt; 2 cells) were detected in 38/70 (54.3%) of patients ranging from 0-385 CTCs per 7.5ml blood. In 4/5 patients where primary tumours harboured an EGFR exon 19 deletion, this EGFR mutation was also captured in CTCs. ALK translocation was confirmed on CTCs from a patient harbouring an ALK-rearrangement in the primary tumour. Short term CTC cultures were successfully generated in 9/70 NSCLC patients. Whole exome sequencing confirmed the presence of somatic mutations in the CTC cultures with mutational signatures consistent with NSCLC. Conclusions: This study demonstrates a workflow for ex vivo culture of CTCs from NSCLC blood samples.
Unidirectional barbed suture used in laparoscopic transabdominal preperitoneal hernia repair
Authors: Chuanjiang Huang, Xiaojun Zhao, Ning Xu, Zhiyi Cheng, Guiyuan Liu, Xiaolan You
Journal: BMJ (2017)

The clinical data of 42 patients undergoing laparoscopic transabdomical preperitoneal (TAPP) hernia repair in Taizhou People′s Hospital from January 2015 to June 2016 were retrospectively analyzed.In this series, 22 patients used Vicryl™ polyglactin suture (group A) and 20 patients used the unidirectional barbed suture (group B). The clinical efficacy and postoperative complications were compared between the two groups.There were no significant differences in volume of intraoperative blood loss[(7.3±3.2) vs.(7.9±3.2)ml], length of postoperative hospital stay[(14.6±1.2) vs.(4.8±1.1)d], pain scores [visual analogue scale(VAS), 1.9±0.9 vs. 2.1±1.0] at the first-day after operation, body discomfort(1 vs. 0 case), and incidence of chronic pain and recurrence between the two groups (P>0.05). The time of operation and peritoneum suturation in group B was markedly shorter than that in group A [(34.3±7.1) vs.(40.4±9.9)min, (9.8±1.8) vs.(13.1±4.8)min, both P<0.05]. Both unidirectional barbed suture and VicrylTM polyglactin suture are safe, effective in peritoneum suturation for inguinal hernia repair; however, the unidirectional barbed suture has advantages of shorter operation time and less difficulty of surgical procedure.


Key words: 
Suture, unidirectional barbed; Laparoscopy, hernia, abdominal; Repair
艾滋病的农村防治问题和策略
Authors: 赵红心
Journal: BMJ (2006)

艾滋病(AIDS)由人类免疫缺陷病毒(HIV)感染引起,主要侵犯人体的免疫细胞,导致被感染者免疫功能部分或完全丧失,从而发生各种各样的感染或肿瘤,其临床表现多种多样,给诊断和治疗带来了一定的困难。
The BRCA founder outreach study: Initial results of a digital health model.
Authors: Kelly Morgan, Heather Symecko, Daniella Kamara, Colby Jenkins, Jeffrey Levin, Jenny Lester, Kelsey Spielman, Lydia E. Pace, Vanessa Marcell, Temima Wildman, Yuri Anthony Fesko, Jacob Heitler, Mark E. Robson, Katherine Nathanson, Nadine M. Tung, Beth Y. Karlan, Susan M. Domchek, Judy Ellen Garber, Jada G. Hamilton, Kenneth Offit
Journal: Journal of Clinical Oncology (2020)

2007 Background: NCCN now endorses BRCA founder mutation genetic testing (GT) via longitudinal studies in all Ashkenazi Jewish (AJ) individuals. The BRCA Founder OutReach (BFOR) study offers pre-GT online education with posttest engagement of primary care providers (PCPs). Methods: The study in 4 US cities enrolls those age &gt; 25 with &gt; 1 AJ grandparent. Participants enroll online with chatbot and video education, have GT at local centers, receive results from their PCP or BFOR staff, and are surveyed 12 weeks post disclosure and annually for 5 years. Univariate analyses and multivariable (MV) logistic regression models were used to evaluate characteristics associated with not completing GT, selecting PCP to disclose GT, and positive GT. Results: As of January 2020, 4754 participants consented (77.5% female, median age 51); 37.7% never previously considered GT. Cancer family histories (FHx) were 56.4% low risk (LR), 36.4% high risk (HR), and 7.2% had a familial mutation (FM). To date, 3658 participants (76.9%) completed and 677 (14.2%) did not complete GT; the remainder are pending. Only 34.8% of participants selected PCP to disclose GT, and 42.6% of PCPs agreed. Of the 124 mutation carriers (3.4%) identified, 60.5% had a FM. At the 12-week survey, 65.4% of mutation carriers planned to proceed with recommended screening or scheduled risk reducing surgery; 3.5% of those with negative GT and HR FHx reported further GT. Satisfaction was high (mean 9.58/10, SD 1.12) and unrelated to result (p&gt;.05). Conclusions: A digital model for founder mutation testing engaged those with LR FHx and no prior experience with GT. Older participants were more likely to complete the study. Males were less likely to enroll but more likely to carry mutations. The majority of those who tested positive had a FM. A minority of results were disclosed by PCPs. Continued follow up is needed to determine long term outcomes. [Table: see text]
糖皮质激素在系统性红斑狼疮中的应用
Authors: 顾越英, 叶霜
Journal: BMJ (2006)

糖皮质激素(glucocorticoids,GC)在系统性红斑狼疮(systemic lupus erythematosus,SLE)的应用要追溯到半个多世纪前,Mayo Clinic的Hench医生因为率先成功将GC应用于类风湿关节炎(RA)和SLE而成为1950年诺贝尔奖得主[1],迄今为止,他仍然是惟一获得诺贝尔奖的风湿病学家.半个世纪以来,由于GC强大的抗炎和免疫抑制作用,其已成为治疗SLE的基石.但同时由于其突出的副作用,GC被喻为一把双刃剑;加之SLE的病情复杂多变,疗程漫长,患者对GC的敏感性有差异等原因,使得GC在SLE的临床使用需要有经验的医生富于艺术性的灵活掌握。
Impact of palliative care on end-of-life outcomes in hematologic malignancies.
Authors: Ari Pelcovits, Dominic Decker, Dana Guyer, Thomas William LeBlanc, Adam J. Olszewski, Pamela Egan
Journal: Journal of Clinical Oncology (2020)

12026 Background: Patients (pts) with hematologic malignancies (HMs) receive more aggressive end-of-life (EOL) care and often die in the hospital. The impact of palliative care (PC) on EOL quality outcomes in HMs has not been well described. In 2017 we embedded a PC specialist within our inpatient malignant hematology team to facilitate the use of early PC. We sought to determine if this practice was accompanied by a shift in EOL outcomes. Methods: We conducted a retrospective review of pts diagnosed with acute myeloid leukemia (AML) at our institution in the 2 years before (Cohort A) and after (Cohort B) implementation of embedded PC. We identified pts who received PC and if it was early (during initial inpatient stay) or late (sometime after). We then examined EOL quality outcomes: hospitalizations and intensive care (ICU) admissions in the last 30 days of life, chemotherapy use in the last 14 days of life, and use of hospice and death out of hospital (DOH), using Fisher’s exact test to compare proportions. Results: Among 139 AML pts, 46 in Cohort A, 93 in Cohort B, we identified 34 and 47 decedents in each cohort respectively. The use of PC was significantly higher in Cohort B (75% vs 43%, P= 0.0006), with a significant increase in early PC (52% vs 11%, P &lt; 0.0001). There was no significant improvement in EOL quality outcomes between Cohort A and B, or uniquely among pts receiving early PC ( P &gt; 0.05); however, PC use in general across all cohorts was associated with significant increase in hospice use and fewer ICU admissions ( P =0.016 and 0.0043, respectively). Among pts not receiving PC, a numerical improvement was noted in EOL metrics between Cohorts A and B ( P &gt; 0.05; see table). Conclusions: PC for pts with AML was associated with significantly better EOL quality outcomes. We also observed improvement in EOL metrics over time among pts not receiving PC, which may indicate a culture shift with the embedded PC service, whose benefit extended to pts not directly receiving PC. Embedding a PC specialist and early PC in AML, however, was not significantly associated directly with EOL care improvements. The value of these interventions in HMs may be better measured using patient-reported outcomes and quality of life measures rather than strict EOL outcomes. Further research should consider potential differential role of PC among pts with HM undergoing aggressive/curative, or non-intense/palliative therapy. [Table: see text]
社区卫生服务全科团队建设的思考
Authors: 吴玉苗, 王瑞芳
Journal: BMJ (2009)

2003年7月,上海市卫生局制定了 ,并开始在5个区11家社区卫生服务中心试行全科团队服务新模式,2004年又将试点扩大到19个区33家.至2006年,33个社区已组建全科服务团队156个,随后,扩展到146家社区卫生服务中心.本文就团队与高效团队的内涵和特征、全科服务团队的概念与产生动因、目前全科刚队建设存在问题、对策、建议等进行阐述。
A comparison of well-child care guidelines in China and the United States
Authors: Zhong-hua Zhou, Shi-hong Jin
Journal: BMJ (2012)

Objective To describe well-child care guidelines in the United States and compare it to China's guidelines so as to inform child health policymakers and providers in developing improvements for China well-child care practices.Methods We used a multistage approach to identify features of well-child care guidelines.The following methods are used:literature review,key informant interviews,site visits to both China and the United States and summarization of experiences.The differences and similarities of the contents were compared.Results Both China and the United States emphasize the importance of well-child care and the basic contents such as immunization,growth monitoring,lab screening and health education are similar for well-child care from 0 to 6 years old.Differences exist in that China's well-child guidelines are a set of general principles,without specific instructions,and only cover children from 0 to 6 years old.There are no guidelines in China for children older than 6 years old.Conclusions China needs a more detailed well-child care guidelines with specific instructions for all-aged children; despite some similarities,there are applicable learnings from that of the United States' for improvement in China's.

Key words: 
Child health services; Guidelines; China; United States
以双上肢无力为主要表现的巴特综合征一例
Authors: 张明, 吕韶燕, 张涛, 田林红
Journal: BMJ (2012)

报道1例以双上肢无力为主要症状的巴特(Batter)综合征.此病为少见的常染色体隐形遗传性疾病,肌无力和麻痹主要以双下肢为主.提示对持续时间长、补钾效果不佳而血压正常、无明显原因的低钾血症患者,如只有双上肢的无力为主要症状时,不能以固定思维简单化处理。
Multidisciplinary tumor boards: A prospective study of the impact on patient management in a community-based Brazilian cancer center.
Authors: Marcos Costa, Carlos Henrique Teixeira, Renata Peixoto, Waldec Jorge, Felipe Ades, Ariel Galapo Kann, Ricardo Caponero, Cheng Tzu, Eliza Dalsasso Ricardo, Taciana Mutão, Larissa Machado, Jefferson Pimenta, Marcelo Santos
Journal: Journal of Clinical Oncology (2020)

e19261 Background: MDTB have emerged as a valuable forum to address questions related to patient management. There is a general data lack of its overall benefit by attending physicians. However, few reports describe numerical impact on patient care of this tailor-made and shared model of medical decision. Methods: We describe, in this prospectively-collected study, data from a Cancer Center (HAOC) regarding multiple weekly, 1h-long discussions, as part of MDTB (GU, neuro-oncology GI, thorax, HN, breast, gyneco, melanoma/sarcoma and palliative care). Only newly-diagnosed or on-treatment challenging cancer cases were included. Attendees (onco, surgeons, RT, paths and radiologists) pooled their expertise to warrant quality and maximize resources. The primary endpoint was change in the medical planning. In our institution, further adherence to MDTB recommendations are left totally at physician discretion. Results: From Oct/17 to Feb/19, 413 cases were discussed (60% female), mean of 2.9 cases/MDTB, but GI (3.8), thorax (3.7) and breast (2.94) were above the median. Mean was 13.4 doctors/MDTB - more in breast (16.5), GI (15.8) and uro (15.1). Mean of oncologist/MDTB in general was 6.1, but 8.1 in GI, 7.8 thorax, breast 6.8 and 6.7 uro. Mean of surgeons/MDTB in general was 3.5, but 6.2 in breast, 5.8 uro and 5.5 GI. 100% of all had at least 1 oncologist and uro/GI/breast had at least 1 surgeon in 100% of them. In 50% (uro), 44% (neuro), 23.5% (breast), 6.4% (thorax) and 3.7% (GI) had at least 1 physician of 5 major areas. Oncologists engaged with more cases: 80.4% (thorax), 70.6% (uro), 59.6% (GI), 56.5% (HN). Prostate (38.2%), metastasis (neuro, 28.9%), colorectal (18.2%), lung adenoCA (43.5%), mouth (30.4%), ductal carcinoma (35.8%) were the more frequently discussed per system. In 25.7%, MDTB changed original medical planning. By site: GI (35,6%), thorax (24,7%), breast (22,6%), neuro (21,7%), uro (17,7%) and HN (17,4%). Oncologists were responsible more in thorax (73,9%) and less in breast (33%) and surgeons more in breast (50%) and less in GI (33%). Adherence to NCCN guidelines was total. Finally, but not measurable, a sizeable number of cases requires significant weekly time-effort. Conclusions: This study confirms MDTB leading role in cancer care, highlighting the importance of teamwork for more precise patient care. We point out that it led to substantial practice-changing in our institution, reinforcing its importance in a scenario which doctors are confronted with increasing complexities in patient management.
Early intervention with tiotropium in Chinese patients with GOLD stages I-II chronic obstructive pulmonary disease (Tie-COPD): study protocol for a multicentre, double-blinded, randomised, controlled trial
Authors: 李晓尘, 周玉民, 陈淑云, 郑劲平, 钟南山, 冉丕鑫
Journal: BMJ (2014)

Introduction
Owing to the high and increasing morbidity and mortality, chronic obstructive pulmonary disease (COPD) has become a major public health problem worldwide. Although the majority of patients with COPD are in the early stages, little attention has been paid to them, in particular regarding to early intervention. Tiotropium bromide can significantly relieve symptoms and reduce the incidence of acute exacerbations of COPD. Therefore, we hypothesise that therapy with tiotropium bromide will benefit patients with COPD with early-stage disease.


Method/analysis
A randomised, double-blinded, placebo-controlled, parallel-group, multicentre clinical trial (Tiotropium In Early COPD study, Tie-COPD study) is being conducted to evaluate the efficacy and safety of long-term intervention with tiotropium in patients with COPD with early-stage disease. A total of 839 patients with COPD who satisfied the eligibility criteria were randomly assigned (1∶1) to receive a once daily inhaled capsule of either tiotropium bromide (18 μg) or matching placebo for 2 years. Measurements will include forced expiratory volume in 1 s, health-related quality of life, grade degree of breathlessness related to activities, COPD exacerbations and pharmacoeconomic analysis.


Ethics/dissemination
This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University. Recruitment started in November 2011 and ended in October 2013, with 839 patients randomised. The treatment follow-up of participants with Tie-COPD is currently ongoing and is due to finish in November 2015. The authors will disseminate the findings in peer-reviewed publications, conferences and seminar presentations.


Trial registration
ClinicalTrials.gov (NCT01455129).
老年人叶酸、维生素B12水平与心血管疾病的相关性探讨
Authors: 燕虹, 王蓓芸, 杨庆良, 孙宜萍
Journal: BMJ (2004)

选择冠心病患者50例,健康对照组50例,单纯高血压、高血脂、糖尿病各30例,分别测定其血浆叶酸、维生素B12水平及血糖、血脂等.结果显示冠心病组血浆叶酸、维生素B12水平较健康对照组降低(P＜0.01),高血脂组显著低于高血压、糖尿病组(P＜0.01),血脂中甘油三酯、载脂蛋白E与维生素B12更具有相关性(P＜0.05).表明叶酸、维生素B12缺乏是心血管疾病的间接危险因素。
该怎么治疗他的上呼吸道感染
Authors: 张晓林
Journal: BMJ (2007)

有一位76岁男性退休职工,因患冠心病长期服用单硝酸异山梨酯(鲁南欣康).夏季病情比较平稳,每天1片服用即可,冬季为控制心脏病发作,改为每天2～3次,每次1片.患者同时患有前列腺增生,长期服用前列康.3天前患者上呼吸道感染,到附近的社区卫生服务站看病,医生开了患者经常服用的药物感康,嘱其一天2次,每次1片.服用后第2天下午,患者感到症状缓解不理想,又自己加服新康泰克,当天下午,患者感觉症状好多了,但发生了急性尿潴留,紧急送往上级医院急诊科实施插管导尿。
A Mouse Model of SARS-CoV-2 Infection and Pathogenesis
Authors: Shi-Hui Sun, Qi Chen, Hong-Jing Gu, Guan Yang, Yan-Xiao Wang, Xing-Yao Huang, Su-Su Liu, Na-Na Zhang, Xiao-Feng Li, Rui Xiong, Yan Guo, Yong-Qiang Deng, Wei-Jin Huang, Quan Liu, Quan-Ming Liu, Yue-Lei Shen, Yong Zhou, Xiao Yang, Tong-Yan Zhao, Chang-Fa Fan, Yu-Sen Zhou, Cheng-Feng Qin, You-Chun Wang
Journal: Cell Host & Microbe (2020)