tbuckley/cabot-search huggingface dataset:
Effectiveness of strengthening management in bronchial asthma control among community patients
Authors: Xia Liu, Fengxian Yin, Yongxiang Zhang, Yunxian Lyu, Yanan Zhang, Jie Meng, Jing Wei, Wenqing Wang
Journal: BMJ (2020)

Objective
To evaluate the effectiveness of strengthening management in the bronchial asthma control among community patients.


Methods
One hundred and eighteen community patients with bronchial asthma were recruited from January 2017 to January 2018. The patients were divided into community strengthening management group (n=60) and control group (n=58), the annual times of acute attack, time to first exacerbation and annual medical expenses were compared between the two groups. The proportion of inhaled corticosteroid (ICS) administration was documented; the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), Leicester Cough Questionnaire (LCQ), Fractional exhaled nitric oxide(FeNO) and pulmonary function were evaluated in two groups.


Results
The management group had greater improvements in the proportion of ICS administration [45(75.0%) vs.36(62.1%), χ2=4.143], ACT [(20.7±3.9) vs.(18.1±4.1), t=3.213], LCQ [(13.5±5.3) vs.(10.8±3.0), t=2.603], FeNO [(29.8±12.8) vs. (37.1±11.1), t=2.018] than the control group after six months of management (all P 0.05) between two groups. The LCQ score [(16.5±4.2) vs. (13.5±5.3), t=3.186] and the MiniAQLQ score [(83.2±11.1) vs. (69.1±14.3), t=5.603] of the management group were significantly improved after 1 year of management than those after 6 months. There was significant improvement in time to first exacerbation [182(92, 284) vs. 92(58, 176), Z=4.384] and the annual exacerbation was significantly reduced [0(0, 1)vs. 2(1, 3), Z=-3.187], annual medical costs of management group were significantly lower than those of control group [(10 523.0±550.5)Yuan vs. (15 787.1±1 421.2)Yuan, t=2.653].


Conclusion
The strengthening management can effectively improve the control rate of bronchial asthma, reduce acute exacerbation, improve clinical symptoms and improve the quality of life in community patients with bronchial asthma.


Key words: 
Asthma; Community health services; Quality of life
创新思路探索政府购买社区公共卫生服务运行机制
Authors: 万红, 张晓林
Journal: BMJ (2007)

2006年,《国务院关于发展城市社区卫生的指导意见》明确提出,各级政府要提供社区公共卫生补助经费,为城市居民购买社区公共卫生服务.江西省人民政府将政府为城市居民购买社区公共卫生服务作为民心工程来抓,认真落实公共卫生服务补助经费.2007年按11元/人的标准筹集公共卫生补助经费,共筹集1.1亿元.该如何使用这一大笔经费?如何为居民购买公共卫生服务?如何选择购买方式?下面介绍本省的思考和做法。
Vaping and Youth—First, Do No Harm
Authors: Erika R. Cheng, Aaron E. Carroll
Journal: JAMA Pediatrics (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 Pediatrics 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 Pediatrics journal
肝癌的综合治疗
Authors: 任正刚, 杨秉辉
Journal: BMJ (2005)

原发性肝癌(以下简称肝癌)是我国常见的恶性肿瘤,在恶性肿瘤死亡率顺位中位于第2位.随着现代医学影像学的发展,肝癌已经能够得到及时地正确诊断.肝癌治疗的效果也较前有了较大提高[1].近年来各种新技术的临床应用,使肝癌的治疗有了更多可供选择的治疗方法,但同时也面临如何合理应用各种治疗方法以及各种方法的综合应用问题,这是当前肝癌治疗中应该受到重视的研究课题。
Effect of antibiotic use prior to or concurrent with immune checkpoint inhibitors on outcomes in patients with Hodgkin lymphoma.
Authors: Steven R Hwang, Alexandra Higgins, Betsy LaPlant, Matthew J. Maurer, Stephen M. Ansell, Gita Thanarajasingam, N. Nora Bennani
Journal: Journal of Clinical Oncology (2020)

8030 Background: There is growing interest in the identification of modifiable patient-specific factors that may predict response to immune checkpoint inhibitors (ICIs) in classical Hodgkin lymphoma (cHL). Recently, it has been proposed that antibiotic use could decrease the efficacy of ICIs in the treatment of advanced solid malignancies. The objective of our study is to assess whether antibiotic use prior to or concurrent with ICIs is associated with changes in outcomes in patients with cHL. Methods: Patients who received a PD-1 or CTLA-4 blocker for the treatment of cHL at Mayo Clinic Rochester between January 1, 2011 and October 20, 2018 were identified. We conducted a longitudinal retrospective chart review to identify those who received antibiotics within 30 or 90 days prior to initiation or concurrent with ICI therapy. Univariate cox regression analysis was used to assess for an association between antibiotic use and overall survival (OS) and progression-free survival (PFS) within these groups; a time-dependent variable was used for concurrent antibiotic use. Results: A total of sixty-two patients were identified (61% male, median age at ICI initiation 35 years [range: 19-87]). Median duration of follow up from ICI start was 38 months (range: 4-78). Twenty-one patients (34%) received antibiotics within 90 days of initiation of ICI, of which thirteen (21%) received antibiotics within 30 days. Thirty-five patients (57%) received antibiotics concurrently with ICI. Concurrent and prior antibiotic use within 90 days of ICI were both associated with inferior PFS (concurrent HR = 6.38 [95% CI 3.02-13.47]; 90-day HR = 2.21 [95% CI 1.10-4.47]) and OS (concurrent HR = 8.77 [95% CI 1.91-40.36]; 90-day HR = 2.96 [95% CI 1.09-8.04]). Conclusions: Antibiotic use is associated with inferior outcomes in patients with cHL treated with ICIs in this single institution cohort. This may reflect potential antibiotic effects on the gut microbiome (GMB) and immune system as has been suggested in prior studies. Further confirmatory studies and examination of potential confounding covariates are needed.
Exploring the validity of a synthetic control arm (SCA) for augmentation or replacement of a randomized control in difficult-to-study indications: A case study in relapsed or refractory multiple myeloma (R/R MM).
Authors: Ruthie Davi, Xiang Yin, Mark Stewart
Journal: Journal of Clinical Oncology (2020)

e20521 Background: The randomized clinical trial (RCT) is the gold standard in drug development. However, for indications where patients have a strong preference for the investigational product, such as many oncology and rare diseases, the use of a SCA may improve drug development and reduce patient burden. SCA is an external control constructed from patient-level data from previous clinical trials to match the baseline characteristics of the patients in an investigational group and can augment a single-arm trial or a RCT compromised by control arm early withdrawal or noncompliance in order to estimate treatment effects. This research explores whether the treatment effect (difference between arms) based on an SCA can mimic the treatment effect from a RCT. Tipping point analyses were explored to assess the impact of unobserved confounders on the SCA-based demonstration of efficacy. Methods: This case study is based on patient-level data from previous clinical trials in R/R MM. The SCA patients satisfied key eligibility criteria of the target RCT and were further selected using propensity score methods to balance the baseline characteristics in the SCA with the target randomized treatment group (TRT) from the original RCT. Sensitivity analyses utilizing methods proposed by Lin (1998) illustrate the robustness of the treatment effect to unobserved covariate(s). Results: Comparable balance was achieved in observed baseline characteristics between SCA and the matched patients from TRT. The treatment effect utilizing SCA is similar to the original RCT. The Kaplan Meier curve of overall survival for the SCA overlaps with that of the randomized control and the quantified differences between SCA and the matched patients from TRT are very similar to the original RCT. Tipping point analyses show changes in HRs under representative sets of assumptions regarding the unobserved confounder (results not shown). Conclusions: This case study demonstrates an SCA built from previous clinical trials, can be well-balanced at baseline with TRT and can provide similar treatment effect estimates as a RCT. Tipping point analyses can elucidate whether treatment effects are reliable despite a reasonable degree of confounding expected in a clinical setting. This suggests, in some settings, SCA can be used to augment or replace a randomized control in future trials without loss of understanding of the treatment effect. [Table: see text]
医患沟通技巧及其在告知中的地位
Authors: 吴兴田, 白晓红
Journal: BMJ (2011)

医患之间的良好沟通,在实现充分告知和知情同意权中具有重要意义.取得患者信任是实现良好沟通的前提,良好沟通应讲求沟通技巧与艺术. 1.沟通态度:医患间初始交流时的态度对建立患者信任极为重要,换位思考是前提,正如裘法祖教授 一文中所言:……我想,我们医务工作者在给患者看病治病的时候,在思想上应该形成这样一个概念,这就是:假如坐在或躺在你面前的患者是你的亲人的话…….医生的沟通态度直接体现了医生的责任心、人文素质和道德修养。
Ipilimumab (IPI) alone or in combination with anti-PD-1 (IPI+PD1) in patients (pts) with metastatic melanoma (MM) resistant to PD1 monotherapy.
Authors: Ines Pires Da Silva, Tasnia Ahmed, Serigne Lo, Irene L.M. Reijers, Alison Weppler, Allison Betof Warner, James Randall Patrinely, Patricio Serra-Bellver, Celeste Lebbe, Joanna Mangana, Khang Nguyen, Lisa Zimmer, Paolo Antonio Ascierto, Dan Stout, Megan Lyle, Oliver Klein, Camille Lea Gerard, Christian U. Blank, Alexander M. Menzies, Georgina V. Long
Journal: Journal of Clinical Oncology (2020)

10005 Background: PD1 induces long-term responses in approximately 30% of MM pts, however 2/3 are resistant (innate or acquired) and will require further treatment. A subset of these pts will benefit from IPI or IPI+PD1, but these pts are yet to be identified. We sought to determine; i) response rate (RR) and survival to IPI+/-PD1 after PD1 progression, and ii) clinical predictors of response and survival to IPI+/-PD1. Methods: MM pts resistant to PD1 and then treated with IPI+/-PD1 were studied. Demographics, disease characteristics and baseline blood parameters were examined. Univariate, multivariate and backward elimination technique analyses were performed to create predictive models of response and overall survival (OS). Results: Of 330 MM pts resistant to PD1 (median time to prog 2.9 months [0.5 – 42.3], 12% adjuvant, 88% metastatic; 70% innate, 30% acquired), 161 (49%) had subsequent IPI and 169 (51%) had IPI+PD1. Characteristics at start of IPI+/-PD1 were similar in IPI vs IPI+PD1 groups (stage M1D 27% vs 34%; elevated LDH 38% vs 40%), except IPI group had more ECOG ≥1 (60% vs 34%) and less BRAF mutation (mut) (21% vs 37%). Median follow-up from start of IPI+/-PD1 was 22.3 months (19.8 - 25.8); RR was 22%, higher in IPI+PD1 (31%) vs IPI (12%) (p &lt; 0.01). PFS and OS at 1 year were 20% and 48%, respectively; better with IPI+PD1 (27%/57%) vs IPI (13%/38%) (p &lt; 0.01). PD1 setting (adjuvant/metastatic) and response did not impact response to IPI+/-PD1. Most pts progressing on adjuvant PD1 had IPI+PD1 (88%) and RR was 33%. Neither the interval between PD1 and IPI+/-PD1 nor use of other drugs affected response to IPI+/-PD1. RR was similar in BRAF WT (23%) vs BRAF mut (RR 21%) pts. In BRAF WT pts, RR was higher with IPI+PD1 vs IPI (38% vs 9%, p &lt; 0.01), while RR was similar with IPI (24%) or IPI+PD1 (19%) in BRAF mut pts. One third of BRAF mut pts had BRAF inhibitors (BRAFi) prior to IPI+/-PD1 and lower RR (13%) vs those without BRAFi (RR = 25%, p &gt; 0.05). High grade (≥G3) toxicity (tox) was similar with IPI+PD1 (30%) or IPI (34%, p = 0.48), and was not associated with response. Stage III/M1A/M1B, normal LDH and treatment with IPI+PD1 were the best predictors of response (AUC = 0.69). These factors, in addition to sex (male), ECOG PS = 0, BRAF mut, progressed/recurred &gt; 3 months on PD1, and absence of bone mets were the best predictors of longer OS (AUC = 0.74). Conclusions: In pts resistant to PD1, IPI+PD1 has higher RR, longer survival, yet similar high grade tox than IPI alone. Predictive models of response &amp; survival will help select pts for IPI+/-PD1 after progressing on PD1.
关于全科医生制度建立的问题及建议
Authors: 祝墡珠
Journal: BMJ (2011)

自国务院推出建立全科医生制度以来，我觉得全科医生的春天来了。从2000年开始，上海复旦大学附属中山医院开始进行全科医生的规范化培训。迄今为止，上海已有243名规范化培训的全科医生毕业了，并在全国各地社区岗位上工作。现上海有13个大学的附属医院都有全科临床培训基地，正在培养的452名全科医生将于近2年毕业。纵观十余年的培养过程我有几点看法。
Bone metabolism biomarkers (BMB) and progression-free survival (PFS) in men with metastatic hormone-sensitive prostate cancer (HSPC): SWOG S1216, a phase III trial of androgen deprivation therapy (ADT) with or without orteronel.
Authors: Primo Lara, Edward Mayerson, Erik Gertz, Catherine Tangen, Amir Goldkorn, Marta Van Loan, Maha H. A. Hussain, Shilpa Gupta, Jingsong Zhang, Przemyslaw Twardowski, David I. Quinn, Nicholas J. Vogelzang, Ian Murchie Thompson, Neeraj Agarwal
Journal: Journal of Clinical Oncology (2020)

5523 Background: We previously reported that baseline BMB are independently prognostic for overall survival (OS) in men with castration resistant prostate cancer. We correlated BMB with outcomes in mHSPC as part of S1216, a phase III trial of ADT +/- the novel CYP17 inhibitor orteronel. Methods: Blood was obtained at study entry for bone resorption [C-telopeptide(CTx) &amp; Pyridinoline(PYD)] &amp; formation markers [C-terminal collagen propeptide(CICP) &amp; bone alkaline phosphatase(BAP)]. With prior DSMC approval, patients were sampled to mask potential treatment effect. Logistic regression was used to assess if BMB elevation above median was prognostic for a PFS event w/in 2 years across pooled study treatment arms, adjusting for baseline variables (including disease extent, PSA, age, pre-randomization ADT, &amp; presence of bone mets). An additional interaction term between BMB elevation &amp; presence of bone mets was included; if significant, separate models were developed for men +/- bone mets. Results: Of 1,313 men, 656 were included in this analysis. All 4 BMB levels were higher in men with a PFS event w/in 2 years vs. those with no PFS event. The odds ratio (OR) for a PFS event was significantly higher in men w/ elevated baseline BMB (see table). For BAP, a significant interaction between marker elevation and bone mets was seen (p = 0.003); men w/ bone mets and BAP elevation had an OR of 1.83 for a PFS event in 2 years. Conclusions: In men with newly diagnosed HSPC, elevated baseline levels of BMB were significantly associated with PFS, with about a two-fold increased risk of a progression event w/in 2 years. For CICP, CTx, &amp; PYD, this association was independent of the presence of bone metastases. Baseline BMB levels have strong prognostic value in the mHSPC context. Correlative analysis of BMB &amp; OS is planned. Clinical trial information: NCT01809691 . [Table: see text]
Preparing the peritoneal surface for intraperitoneal chemotherapy using high-intensity ultrasound (HIUS): Investigation of technical feasibility, safety and possible limitations.
Authors: Veria Khosrawipour, Piotr Frelkiewicz, Sören Reinhard, Jakub Nicpon, Tanja Khosrawipour, Hien Lau, Marek Pieczka, Alessio Pigazzi, Wolfram Trudo Knoefel, Agata Mikolajczyk
Journal: Journal of Clinical Oncology (2020)

e16045 Background: The penetration of chemotherapeutic drugs into metastatic peritoneal nodules remains at levels well below 1 mm, thus significantly limiting the antitumor effect of intraperitoneal chemotherapy (IPC). Recently, high-Intensity ultrasound (HIUS) has been discovered as a potential tool to improve peritoneal diffusion rates. Despite promising preliminary data, basic aspects regarding its technical feasibility, safety and possible limitations remain unclear. This study aims to enhance our current understanding of HIUS and test its applicability using an ex-vivo swine model. Methods: Three postmortem swine were subject to laparotomy with consecutive lavage with 0.9%NaCl saline and HIUS application. For this purpose, a large HIUS radiating pen was introduced into the abdominal cavity and HIUS was applied on two of the four abdominal quadrants for 300 seconds each at an output power of 70 W, 50 % amplitude and 20 kHz frequency. Following the procedure, small intestinal tissue samples were removed for further analyses. Results: In all specimen, peritoneal and subperitoneal layers showed structural changes only visible on a microscopic level. The peritoneal layer was transformed into a mash-like structure while the subperitoneal layer (depth of 142 +/- 28 µm) exhibited microcavities and vascular detachment from surrounding tissues. No bowel rupture or vascular perforations were observed. Conclusions: Our data indicate that HIUS is a technically feasible add-on procedure for IPC with measurable microscopic changes on the peritoneal surface and no apparent bowel toxicity. Pretreatment of the abdominal cavity with HIUS could significantly improve IPC efficacy. Further studies are required to optimize and evaluate this novel approach.
CNS involvement by North American-ATLL (NA-ATLL) is associated with discrete patterns and molecular profile involving XPO1 E571 and KLF2/PI3KCD in selected cases.
Authors: Nishi Shah, Riya Jayesh Patel, Astha Thakkar, Shafia Rahman, Ana Acuna-Villaorduna, Urvi Shah, Diego Adrianzen Herrera, Shira Slasky, Kira Gritsman, Mendel Goldfinger, Noah Saul Kornblum, Aditi Shastri, Ioannis Mantzaris, Lizamarie Bachier-Rodriguez, Ira Braunschweig, Amit Verma, Katharine Anne McNeill, B. Hilda Ye, Murali Janakiram, R. Alejandro Sica
Journal: Journal of Clinical Oncology (2020)

8063 Background: Information on central nervous system (CNS) involvement with NA-ATLL is limited. In this study, we describe CNS involvement in ATLL patients at a tertiary hospital in New York City. Methods: We considered CNS involvement if one of the following criteria was met 1) cerebrospinal fluid (CSF) cytology or flow cytometry was positive 2) CNS imaging was positive for disease involvement or 3) Physical exam findings were compatible with neurologic involvement. Results: Of 94 NA-ATLL patients, 21 (22.3%) had CNS involvement by ATLL. CSF was involved in 13/21 and 5/21 patients at diagnosis and relapse respectively. At diagnosis, MRI showed CNS involvement in brain and spine in 5/21 (24%) and 3/ 21 (14%) cases respectively. At relapse, imaging revealed brain and spine involvement in 2 patients each. Neurological exam was abnormal in 7 (33%) and 3 (14%) cases at diagnosis and relapse respectively. Next generation exon targeted sequencing was performed in 9 cases. Table shows the mutations (mtn) and functional groups with frequencies. XPO1 E571K mutation was present in 2 patients with extensive CNS disease and refractory to conventional treatment with an overall survival (OS) of 2 months. To our knowledge, this is the first time that XPO1 E571K is reported in a T-Cell malignancy. We also describe here a second set of mutations with CNS involvement (KLF2 and PI3KCD) in 2 patients. Median OS was 8.5 months, Median RFS was 6.5 months in our series. In most cases, the lymphomatous phenotype appeared to have direct mass-like extension (5/21) with several cases of accompanying osteolytic spine or skull lesions, whereas cases with hematogenous involvement tends to spread to the CSF by traversing the brain blood barrier. Conclusions: In this report we describe patterns of CNS involvement in ATLL and the associated mtns. We also describe two unique cases of XPO1E571K mtn in a TCL. [Table: see text]
Knowledge, attitudes, belief and practices in elderly hypertensive patients and hypertensive patients complicated with diabetes
Authors: Jie Gu, Yuan Zhang, Xiang-jie Zhang, Tian-hao Wang, Qian Chen, De-an Liu, Xiao-yan Ou, Ning Zhong, Li-ping Xu
Journal: BMJ (2013)

Objective
To compare the knowledge, attitudes, belief and practices (KABP) in elderly  patients and  patients complicated with diabetes mellitus (DM) in communities of Shanghai.


Methods
A cross-sectional study with simple random sampling was undertaken in 5 communities of Shanghai Xuhui District during May 2011 to July 2011. The target population were 47 572 patients incorporated into standardized management of hypertension. Total 3800 questionaires containing the basic information of patiens and their knowledge, attitudes, belief and practices on  were distributed and 3328 were retrieved with a response rate of 87.6%. The survey results of elderly (≥65 y)  patients and  patients with DM were analysed and compared.


Results
Total 1057 elderly patients aged (76.1±6.4)y had simple  and 42.5%(449/1057)were males; while 360 elderly  patients aged (75.9±6.4) y were complicated with DM and 41.7% (150/360) were males. The rates of awareness of hypertension is a chronic disease (99.4% vs. 96.5%, χ2=8.659, P=0.003) and hypertensive patients should persist in taking long-term medications (98.9% vs. 95.4%, χ2=8.898, P=0.003) was higher in patients with complicated DM than those in simple  patients. Most of them received education on hypertension-related knowledge from community out-patient clinics, while the percentage of this resource was higher in patients with  and DM (75.9% vs. 65.6%, χ2=12.913, P<0.05). There was no statistical difference in controlling dietary salt intake between two groups (88.3% vs. 88.8%, P=0.799). Patients with  and DM had shorter excise time than patients with simple  [(49±30)min vs. (53±31)min, t=3.362, P=0.001], they were more likely to visit  clinics(12.0% vs. 6.3%, χ2 =12.144, P<0.05)and more frequently to seeking hypertension-related medical help from tertiary hospitals(20.2% vs. 13.8%, χ2=7.832, P=0.005). The control rate of  in patients complicated with DM was significantly lower than that in simple  patients (15.3% vs. 79.2%, χ2=470.264, P<0.05).


Conclusions
Community out-patient clinic is the main source of knowledge on  for elderly  patients; so general practitioners should carry out individulized health education for blood pressure control, especially for those complicated with diabetes.


Key words: 
Hypertension; Diabetes mellitus; Health education; Aged
人胰岛素类似物简介
Authors: 张金苹
Journal: BMJ (2011)

胰岛素在临床的应用已有近90年的历史,期间胰岛素制剂也在不断地发生着变革,从最初的动物胰岛素发展到如今的生物合成人胰岛素,大大减少了胰岛素导致的过敏和皮下脂肪萎缩等情况的发生.但由于胰岛素药效学和药代学的特点,患者在取得较好血糖控制的同时,常常发生低血糖.为了能更好地控制糖尿病患者的血糖水平,减少低血糖的发生,且更便于注射,胰岛素类似物应运而生。