tbuckley/cabot-search huggingface dataset:
Establishment of family health assessment index system in Shanghai urban communities
Authors: Lan Zhu, Yimin Huang, Dan Gu, Hua Fu
Journal: BMJ (2017)

Objective
To establish a standardized and feasible family health assessment index system based on the family practice system in Shanghai urban communities.


Methods
On the basis of literature review and special topic discussion, a preliminary index system framework was developed and an expert consultation questionnaire was compiled. Twenty one experts of general practice, medical specialties, health administration and public health management were invited and two rounds of improved Delphi expert consultation were conducted. The results of statistical analysis were summarized and the evaluation index system was established.


Results
The evaluation index system included 5 first-level indicators, 17 second-level indicators and 63 third-level indicators. The weight coefficients of first-level indicators in basic information, family structure, family function, family resources and health status of the family members were 0.199 6, 0.197 5, 0.201 7, 0.185 0, 0.216 2, respectively. In the two rounds of consultation, the positive coefficient of experts was both 100%, the degree of expert authority was 0.867 and 0.880, and the coordination coefficient was 0.294 and 0.415, respectively (P<0.05). The operational coordination coefficients were 0.320 and 0.402 (P<0.05), respectively.


Conclusion
The family health assessment index system constructed by the Delphi expert consultation method can provide reference for family doctors to carry out family health assessment in urban communities.


Key words: 
Delphi technique; Health assessment; Family doctor system service
Diagnostic value of CT scan for closed chest injury
Authors: Wu-jiang Yu
Journal: BMJ (2011)

CT findings and complete clinical data of 185 cases with closed chest injuries were retrospectively analyzed.The diagnosis of 185 cases were pulmonary contusion ( n = 185 ),pulmonary laceration ( n = 35 ),Macklin effect ( n = 5 ) and lung herniation ( n = 1 ).CT findings of lung contusion appeared as thick and vagur lung marking (n =9),small points shadows (n = 12 ),blotchy shadows (n =48),small pieces shadows (n=10),ground-glass shadows (n=16),large pieces shadows (n =5),diffuse patchy clouding shadows (n = 17) or mixed lesions (n = 68).CT appearance of lung laceration included pulmonary hematomas (n = 12),cavitary lesions with air ( n = 19),cavitary lesions with air-fluid levels ( n = 53 ).Macklin effect appeared as bronchus-,pulmonary vessel-adjacent air collection and mediastinal air collection (n=5).Traumatic pulmonary hernia appeared as lung herniation through an intercostal space.Initial CT scan missed one case of pulmonary contusion and 2 cases of pulmonary laceration.

Key words: 
Thoracic injury,closed; Tomography, X-ray computed
Effect of genomic and transcriptional alterations in first-line chemotherapy on subsequent immunotherapy in non-small cell lung cancer (NSCLC) patients.
Authors: Yayi He, Xiaobin Li, Shiying Dang, Guifeng Liu, Lele Song, Bo Zhu, Caicun Zhou
Journal: Journal of Clinical Oncology (2020)

9614 Background: Recent studies have demonstrated that first-line immunotherapy has better therapeutic response than second-line immunotherapy in NSCLC patients. However, the mechanism behind this observation has not been elucidated. The aim of this study is to investigate the mechanism of unfavorable influence that the first-line chemotherapy exerts on subsequent immunotherapy. Methods: 29 NSCLC patients without tyrosine kinase inhibitor (TKI)-related driver gene (EGFR, ALK, ROS1, RET, BRAF, C-MET) mutations were enrolled in this study. Paired cancer tissues before and after chemotherapy were collected, and NGS-based WES and mRNA sequencing were performed. Sequencing data were analyzed with R packages and statistics analysis was performed with SPSS 20 software. P ≤ 0.05 was regarded as statistically significant. Results: We found that the total number of SNV/INDEL mutations and the tumor mutational burden (TMB) decreased significantly following chemotherapy. The decrease of mutation burden correlated well with therapeutic response: patients with partial response (PR) exhibited significant decrease while patients with stable disease (SD) or progression of disease (PD) did not. Meanwhile, a sharp decrease in common mutations before and after chemotherapy was observed in PR and PD patients, but not SD patients, suggesting that mutational change reflected the therapeutic response. The change in copy number variations (CNVs) exhibited similar trends and correlation with therapeutic response. Subsequent analysis on mRNA levels revealed a sharp decrease in the expression levels of genes related to antigen processing and presentation as well as other factors relevant to immunotherapy response. Pathway enrichment analysis showed that the genes with decreased expression mainly represented immune-related signaling pathways or biological processes. Conclusions: Our study revealed a possible mechanism underlying unsatisfactory multiple-line immunotherapy following chemotherapy, and indicated that first-line chemotherapy may influence the tumor microenvironment to exert unfavorable influence on subsequent immunotherapy.
Venous thromboembolism (VTE) incidence and risk factors in patients (pts) with non-small cell lung cancer (NSCLC) receiving front-line therapy.
Authors: Jai Narendra Patel, Myra M. Robinson, Hailey Hill, Lauren Lu, Daniel Slaughter, Edward S. Kim, Asim Amin, Kathryn Finch Mileham
Journal: Journal of Clinical Oncology (2020)

e19293 Background: VTE incidence varies based on factors such as tumor type, stage, and treatment. There is limited data on VTE incidence and risk factors in NSCLC pts receiving first-line therapies, including immune checkpoint inhibitors (ICIs) and targeted therapies (TTs). Methods: This is a single institution retrospective cohort study of adult NSCLC pts who received first-line treatment between July 2003 and July 2019. Treatments included chemotherapy (chemo) (platinums, taxanes, pemetrexed, gemcitabine, etoposide, bevacizumab), ICI (pembrolizumab, nivolumab, atezolizumab, durvalumab), chemo + ICI, or TT (erlotinib, gefitinib, afatinib, osimertinib, crizotinib, alectinib, ceritinib). Diagnosis codes (ICD 9/10 codes) confirmed VTE (deep vein thrombosis and/or pulmonary embolism) and presence of risk factors which are summarized in Table. Landmark VTE incidence was estimated from cumulative incidence curves for time to VTE, death as a competing risk. Time to VTE distributions were compared between groups with Gray’s tests. Univariable and multivariable competing risk analyses identified risk factors for time to VTE. Results: In 1,618 evaluable pts, the median age was 66 years, 53% were male, 79% White, 18% Black, 58% had adenocarcinoma, 32% squamous cell carcinoma, and 47% metastatic disease. 1178 received chemo, 172 ICIs, 157 chemo + ICI, and 111 TTs. 6-month VTE rates per arm were 5.3%, 7.0%, 7.2%, and 12.0% and 12-month rates were 8.9%, 8.1%, 11.7%, and 13.3%, respectively. Cumulative incidence of VTE was not significantly different between treatment groups (p = .27). Univariable and multivariable analyses are summarized in the Table below. Conclusions: Treatment type was not associated with VTE risk in first-line NSCLC, but rates were numerically highest in pts receiving TTs. Khorana risk score was significantly associated with VTE risk and may identify those likely to benefit from thromboprophylaxis. [Table: see text]
Comparison of carbon nanoparticles and methylene blue for sentinel lymph node mapping in laparoscopic staging of early endometrial carcinoma
Authors: Yanrong Jin, Weizhi Chen, Wei Ma, Chunling Li
Journal: BMJ (2019)

To compare carbon nanoparticles with methylene blue for sentinel lymph nodes mapping in laparoscopic staging of early endometrial carcinoma. Forty five patients with stage Ⅰ or stage Ⅱ endometrial carcinoma undergoing laparoscopic operation from January 2016 to January 2018 were randomly divided into two groups:methylene blue was applied in 20 cases and carbon nanoparticies were applied in 25 cases for sentinel lymph node (SLN) mapping in laparoscopic staging; and the images of two tracers were compared. The development time of nano-carbon group was shorter[(16.4±3.4) min vs.(21.0±5.9)min,t=3.26, P=0. 02] and duration was longer [(73.1±14.3) min vs.(54.6±14.9)min, t=5.41, P=0.04] than those of methylene blue group. In lymphatic mapping, the detection rate of SLN in nano-carbon group was significantly higher than that of methylene blue group [95% (21/22) vs. 5/18]. For detection of metastatic SLN,the sensitivity of methylene blue group was 1/2 and that of nano-carbon group was 4/4 (χ2=66.70, P<0.01). The results indicate that both methylene blue and Nano-carbon tracer can be used for SLN mapping in laparoscopic staging of early endometrial carcinoma, and nano-carbon tracer is recommended as the first choice to predict pelvic lymph node metastasis in endometrial carcinoma surgery.


Key words: 
Endometrial neoplasms; Carcinoma; Sentinel lymph node; Carbon nanoparticies; Methylene blue
Transforming the site feasibility assessment process for oncology clinical trials.
Authors: Dax Kurbegov, Patricia A. Hurley, David Michael Waterhouse, Grzegorz S. Nowakowski, Edward S. Kim
Journal: Journal of Clinical Oncology (2020)

e14092 Background: Current methods to assess trial sites for clinical trial participation are onerous, with unnecessary redundancies and no-value steps that impact research site resources and clinical trial participation. This project sought stakeholder feedback on recommendations to transform industry sponsor and contract research organization (CRO) processes for evaluating sites for trials. Methods: An ASCO task force developed recommendations to improve the feasibility assessment process and standardize and centralize questions and forms. A survey was conducted with sites, industry trial sponsors, and CROs to obtain feedback and assess buy-in for the recommendations. Results: Respondents were from 28 oncology research sites (19 academic, 9 community-based), 8 sponsors, and 4 CROs. All stakeholders agreed that the current process is burdensome (93% sites, 90% sponsors, 100% CROs), standardization will improve the process (86% sites, 87% sponsors, 75% CROs). All agreed a centralized portal will reduce burdens (93% sites, 100% sponsors, 75% CROs) and expedite trial start-up (89% sites, 100% sponsors, 75% CROs). Site certification was a viable option for sites (86%) and CROs (75%), but less so for sponsors (57%). Most respondents preferred a two-tier model: 1) a short site questionnaire followed by a pre-study visit for new interactions, and 2) only a pre-study site visit or a teleconference if there is an existing relationship. The greatest benefits were time savings, expedited start-up, reduction in personnel resources, and cost savings. The greatest barriers to adoption were buy-in and alignment from sponsors/CROs and insufficient information about site or protocol. Top predictors of a site’s success on a trial were physician engagement, available patients, and site experience. Conclusions: Site feasibility assessments are important for all stakeholders to establish trial suitability. However, current methods impose tremendous burdens on site resources (reported by authors elsewhere). While this sample is limited, the proposed process and standardization changes show promise to reduce burdens and costs for all stakeholders and expedite patient enrollment onto clinical trials.
Changes in Opioid Prescribing Patterns Among Generalists and Oncologists for Medicare Part D Beneficiaries From 2013 to 2017
Authors: Ankit Agarwal, Andrew Roberts, Stacie B. Dusetzina, Trevor J. Royce
Journal: JAMA Oncology (2020)

<h3>Importance</h3> In response to the opioid epidemic, policies aiming to reduce opioid prescribing, misuse, and abuse may have the unintended consequence of restricting access to necessary opioid therapy for cancer-related pain. It is unknown how opioid prescribing patterns have changed among generalists and oncologists during this era. <h3>Objective</h3> To examine trends in opioid prescription rates for Medicare Part D beneficiaries from 2013 to 2017 among oncologists and generalists. <h3>Design, Setting, and Participants</h3> This repeated cross-sectional study of generalist physicians (internal medicine, family medicine, geriatric medicine, general practice) and oncology specialists (medical oncology, hematology-oncology, and radiation oncology) analyzed the Medicare Provider Utilization and Payment Data: Part D prescriber files from 2013 to 2017. <h3>Exposures</h3> Generalist vs oncology specialty. <h3>Main Outcomes and Measures</h3> Outcomes included physician-level rates of both opioid and long-acting opioid prescriptions per 100 Medicare Part D beneficiaries. Poisson regression was used to estimate annual predicted outcome rates and incidence rate ratios, adjusting for prescriber characteristics and state fixed effects. <h3>Results</h3> We analyzed the prescribing patterns of 251 820 generalists and 14 210 oncologists. From 2013 to 2017, the annual adjusted predicted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists (adjusted incidence rate ratio [aIRR] = 0.73; 95% CI, 0.73-0.73) and from 77.8 to 58.8 among oncologists (aIRR = 0.76; 95% CI, 0.74-0.77). The rate of long-acting opioid prescriptions per 100 Medicare beneficiaries also decreased from 8.0 to 5.4 for generalists (aIRR = 0.67; 95% CI, 0.66-0.68) and from 18.6 to 13.3 for oncologists (aIRR = 0.72; 95% CI, 0.69-0.74). <h3>Conclusions and Relevance</h3> We found large declines in opioid prescription rates for Medicare beneficiaries by generalists and oncologists from 2013 to 2017. Opioid policy and advocacy appear to have been effective in reducing the extent of opioid prescribing in the Medicare population. Similar declines between generalists and oncologists raise concern that access to cancer pain management may have been inadvertently restricted. How much of the decrease in prescribing by oncologists is appropriate vs inappropriate deserves further investigation.
Rational strategies of insulin use for blood glucose control
Authors: Xiaoyan Xing
Journal: BMJ (2019)

随着医学科学的发展，在胰岛素制剂不断发生变革的同时，胰岛素临床应用领域也取得了很大的进展，并积累了丰富的临床经验和循证医学证据。2型糖尿病患者是否需要胰岛素治疗以及胰岛素治疗方案的选择均是个体化的决策，视病情而异，最终目的是达到良好的血糖管理。
Application of Lean Six Sigma theory in clinical medicine
Authors: Hui Gong, Weili Yan, Liyun Chen, Daoping Song, Ping Lu, Xin Wang, Gang Wu
Journal: BMJ (2017)

One of the effective methods to resolve the conflict between the ever-increasing medical demands and relatively limited medical resources is to improve the work efficiency of the medical institutions as well as to effectively control their operating cost through continuous reforms and improvements of the management modes in the medical industry. The Lean Management and Six Sigma Management theories which have been applied in manufacturing industry and service industry are now gradually being introduced to clinical medicine. This article systematically describes the Lean Management and Six Sigma Management theories and illustrates some examples of its application in health management renovation and the effects achieved.


Key words: 
Hospital administration; Lean Six Sigma Theory
Predicting overall survival (OS) and overall response (OR) following durvalumab treatment in patients with multiple cancer types using a hybrid modeling strategy.
Authors: Ting Chen, Yanan Zheng, Lorin Roskos, Donald E Mager
Journal: Journal of Clinical Oncology (2020)

e15161 Background: This study aimed to predict OS/OR and identify key predictors in patients with diverse cancer types treated with durvalumab, a PD-L1 targeting monoclonal antibody, using a hybrid modeling strategy that combines population pharmacodynamic (PD) modeling and machine learning (ML) algorithms. Methods: Individual longitudinal tumor size measurements and OS/OR data were available for 855 patients who received durvalumab therapy (10 mg/kg Q2W or 20 mg/kg Q4W; NCT01693562). Nine cancer types included non-small cell lung cancer (NSCLC), bladder cancer (BC), microsatellite instability-high (MSI-H) cancer, hepatocellular carcinoma (HCC), squamous cell carcinoma of the head and neck (SCCHN), gastroesophageal cancer (GEC), ovarian cancer (OC), pancreatic adenocarcinoma (PDAC) and triple-negative breast cancer (TNBC). A tumor kinetic model was developed to characterize diverse temporal profiles using a population-based modeling approach. Individual estimated tumor kinetic model parameters and patient demographic/physiological factors were used as inputs for predicting OS/OR using several ML approaches. Results: The final tumor kinetic model with liver metastasis (LM), neutrophil/lymphocyte ratio (NLR), tumor size at baseline (TBSL) and cancer types as covariates characterized the temporal tumor size data well. HCC and MSI-H cancer have the slowest tumor growth rate constant (kg), while GEC, SCCHN and TNBC have the fastest kg. BC, NSCLC and OC have the highest tumor killing rate constant. The most important predictors of OS identified by ML approach were tumor kinetic parameters (kg, fraction of drug-sensitive cells, time-delay in immune response), along with baseline disease factors, including hemoglobin (HGBBL), albumin (ALB), and NLR. Decision tree-based algorithms showed the best performance in predicting OR with accuracy above 90%. In addition to tumor kinetic parameters, PD-L1 expression on tumor cells (TC) and ALB were the most important predictors of OR. Conclusions: A combined population PD/ML approach showed good predictions of OS/OR in patients with different cancer types treated with durvalumab. LM, NLR,TBSL and cancer types were found to be important factors for tumor kinetics. In addition to tumor kinetic parameters, HGBBL, ALB, and NLR were found to be important predictors of OS, and TC and ALB were found to be important predictors of OR. These findings could provide a guidance on patient selection in future clinical trials.
FOxTROT: neoadjuvant FOLFOX chemotherapy with or without panitumumab (Pan) for patients (pts) with locally advanced colon cancer (CC).
Authors: Jenny F. Seligmann
Journal: Journal of Clinical Oncology (2020)

4013 Background: FOxTROT has reported marked down-staging, reduced perioperative morbidity and a trend towards fewer recurrences with 6 wks of oxaliplatin-fluoropyrimidine neoadjuvant chemotherapy (NAC) in CC (Seymour, ASCO 2019 abstract 3504). Using updated data, we investigate the contribution of panitumumab (Pan) and tumour markers to efficacy of NAC. Methods: 1053 pts with radiologically-staged T3-4, N0-2, M0 CC were randomly allocated (2:1) to either 6 wks of NAC and 18 wks of postoperative adjuvant chemotherapy (AC) or 24 wks of AC. 279 pts with RAS-wt tumours were also randomised 1:1 to receive Pan or not with NAC. The primary endpoint was freedom from recurrence or residual disease at 2 years for NAC vs AC, and depth of extramural spread for the Pan randomisation; secondary endpoints include safety, histological downstaging, CC-specific survival and OS. Results: Of 699 allocated pre-and-postoperative chemotherapy, 674 (97%) started and 612 (88%) completed NAC. 684/699 (97.8%) pre-and-postoperative and 349/354 (98.6%) control patients underwent tumour resection. There was marked T- and N-down-staging and tumour regression with NAC (all p&lt;0.001). There were fewer disease recurrences within 2 years in the NAC than AC group: 15.6% (109/698) vs 19.5% (69/354), RR=0.76 (95%CI 0.56-1.02), P=0.07. Response to NAC was significantly (p&lt;0.001) less in MMR-deficient (dMMR) than MMR-proficient (pMMR) tumours: 7%(8/115) vs 23%(128/553) moderate or greater histological tumour regression. Reductions in 2-year recurrence were also seen only in pMMR tumours [RR=0.72 (0.52-1.00), p=0.05], with no apparent benefit in dMMR tumours: RR=0.94 (0.43 to 2.07), p=0.9]. Analyses of panitumumab will be presented. Conclusions: Six weeks of NAC for operable CC can be delivered safely, with marked histopathological down-staging, and may result in better disease control at 2 years in pMMR disease. Clinical trial information: 87163246 .
Target value of parathyroid hormone in hemodialysis patients
Authors: Zongli Diao, Wang Guo, Sha Liu
Journal: BMJ (2017)

The target value of intact parathyroid hormone (iPTH) in main international guidelines is not consistent completely. Furthermore, the evidence levels of clinical studies these guidelines based on are generally low and most of them are based on observational studies. Some studies even showed that there was no association between iPTH level and clinical outcomes. This review focuses on the following three points for reassessing iPTH target value: comparison of iPTH target value in main international guidelines, the difference of iPTH target value in large clinical studies and reasons for the difference.


Key words: 
Parathyroid hormone; Hyperparathyroidism, secondary
Optimizing cancer care using digital technologies requires coordinated multi-stakeholder effort.
Authors: Sendhilnathan Ramalingam, A Jay Holmgren, Jennifer Goldsack, Adam Conner-Simons, Edmondo Robinson
Journal: Journal of Clinical Oncology (2020)

e14108 Background: Oncology has unique characteristics that predict early benefit from digital technologies including a culture of patient involvement in trials, genetic testing, and longitudinal assessments including objective measures. However, implementation of digital tools is slow for many reasons including lack of incentives/interoperability, and high-profile cases highlighting inadequate data governance. We report results from the Digital Medicine Society’s study of the stakeholders involved in using digital technologies to optimize health, with a focus on oncology. Methods: We performed 16 interviews with diverse Key Opinion Leaders (KOLs) including physicians, executives, senior government officials, patients, payers, tech innovators, and investors. KOLs received a pre-interview list of topics. We used the Delphi method, an evidence-based approach to compile expert opinions, to iteratively refine recommendations. Results: We identified priorities for 5 stakeholder groups to facilitate digital tool implementation (Table); all groups must also act now to develop a framework for data governance. We describe 4 categories of early success in oncologic digital tools: regimen/drug choice, drug approval efficiency, digital user training, and patient generated health data. Conclusions: Data and technology have great potential to improve cancer care. Multi-stakeholder involvement and a framework for US health data governance are needed. [Table: see text]
Postural (Orthostatic) Proteinuria: No Cause for Concern
Authors: Richard J. Glassock
Journal: New England Journal of Medicine (1981)

The discovery of proteinuria in a urine specimen randomly collected during an examination for employment, induction into the armed services, qualifying for insurance, or a school health program ("chance" proteinuria) is a frequent and perplexing problem. It may engender considerable anxiety in the patient or family because of the general perception that such proteinuria is an omen of potentially serious underlying renal disease. Worse, it can lead to unnecessary and potentially harmful investigation unless a properly staged approach to evaluation is undertaken.As vividly demonstrated by the remarkable footnote to an illustrious chapter in the history of nephrology, provided by . . .
骨平滑肌肉瘤二例
Authors: 韩庶勇, 许艳梅, 武卫华, 武培敬
Journal: BMJ (2005)

例1 男,50岁,左大腿摔伤2 h,于1998年5月10日入院.查体:左下肢外翻畸形,髋膝不能活动.X线:左股骨下端1/4处粉碎性骨折,远折端骨密度不匀,虫蚀状,皮质变薄.诊断:左股骨肿瘤.全身其他部位检查无异常.手术见骨折端大量肉芽组织,骨髓腔消失,皮质溶骨性破坏,取肉芽组织送检.随访至今健在。