tbuckley/cabot-search huggingface dataset:
Mobile communication technology and tablet personal computer application in family hospital bed management
Authors: Ling-ling Gong, Guo-jun Zhu, Yin Tao
Journal: BMJ (2012)

Family hospital bed information (FBH) system running on tablet personal computer (PC) was developed from the analysis of 36 general practitioner′s requirements.The system shared information with the hospital information system (HIS).The establishment of FHB information management system and the mode of reviewing and editing medical records,prescription and personal health record on tablet PC improved the management efficiency and quality of FHB.

Key words: 
Home care services,hospital-based; Table personal computer
Contrasting fake news in oncology: The first declaration of good communication.
Authors: Rossana Berardi, Roberto Papa, Valerio Mattia Scandali, Mariangela Torniai, Maurizio Blasi, Andrea Brusa, Franco Elisei, Gian Luca Gregori, Giancarlo Laurenzi, Luca Marinelli, Massimiliano Marinelli, Graziella Mazzoli, Fabrizio Volpini, Michele Caporossi
Journal: Journal of Clinical Oncology (2020)

e19231 Background: Nowadays, in the “era of technology”, websites, online journals and social media give access to an extraordinary amount of medical information; moreover, many patients and their families employ websites and social media searching for additional clarifications about their own malignancies and the prescribed treatments. Misleading news are often disseminated generating false expectations, exaggerated anxiety and confusion even on officially supported websites. In oncology setting, disinformation is perhaps more deleterious than in other fields, with a considerable impact on single patients as well as on families and, more in general, on Public Health. In order to promote the best interaction between the world of health and the world of communication, a table of experts was established with the aim to draft a shared document identifying strategies to overcome barriers between communication and health care as well as to propose common criteria for an effective dissemination of medical information. Methods: On the basis of the "consensus conference" method in the RAND/UCLA variant, a modified version of Delphi methodology, a literature research has been conducted with the aim to select studies related to the best practices applied to health journalism regarding oncology setting. Results: Sixteen articles met the inclusion criteria, from which 72 recommendations were extracted and submitted to experts in communication and health professionals included in the technical table. After the evaluation of this panel, 57 recommendations scored more than 7 representing the selected statements shared together by communication experts and health professionals. This consensus and the drawn up shared document represent a concrete attempt to found a renewed and strategic alliance between health and communication operators in order to produce useful and reproducible indications for an effective dissemination of medical information. Conclusions: As the “American Declaration of Independence”, our “Declaration of Good Communication” has identified high-impact recommendations for the best management of patients, providing simple but fundamental concepts and recommendations about effective communication especially in oncology setting.
Color Doppler ultrasonography in monitoring thrombosis of lower limb deep vein after malignantthoracic tumor surgery
Authors: Na Ma, Xiu-jie Han, Chuan-yu Wang, Wen-li Jiang
Journal: BMJ (2012)

Sixty patients underwent surgery for malignant thoracic tumor were evenly randomized into control group (group A) and treatment group (group B).0.3 ml low-molecular-weight heparin was injected per 12 h for 3 d in group B from 24 h after surgery.Bilateral venous sonography of lower extremities were performed before and d1,d3 after operation.Blood coagulation marks PLT,PT,APTT,Fibrinogen (FIB)and D-dimer were determined at the same time.Diagnosis of calf vein thrombosis after surgery was confirmed by color Doppler sonography in 7 patients:1 in group B (3％) and 6 in group A (20％) (P ＜ 0.05 ).Thrombosis at calf intermuscular vein was found in 6 patients and thrombosis at posterior tibial vein in 1 patient.FIB and D-dimer had no significant difference on the dl ( P ＞ 0.05 ) between two groups,but significantly lower on the d3 after surgery in group B than that in group A ( P ＜ 0.05 ).Low-molecularweight heparin reduced blood hypercoagulation state and thrombosis.Color Doppler sonography can be a valuable method for detecting asymptomatic deep vein thrombosis in the early stage after surgery and monitoring the efficacy of thrombosis prevention.

Key words: 
Ultrasonography;  Venous thrombosis
Comparative effectiveness of systemic treatments for metastatic castration-sensitive prostate cancer: A parametric survival network meta-analysis of randomized controlled trials.
Authors: Lin Wang, Channing Judith Paller, Hwanhee Hong, Anthony De Felice, Caleb Alexander, Otis W. Brawley
Journal: Journal of Clinical Oncology (2020)

5532 Background: Treatment decision-making for metastatic castration-sensitive prostate cancer (mCSPC) is complicated by the unclear comparative effectiveness and widely varying costs of competing strategies. Objective: To compare the effectiveness and safety of systemic treatments for mCSPC. Methods: We searched bibliographic databases, regulatory documents, and trial registries for randomized controlled trials testing active drugs added to androgen deprivation therapy (ADT) for mCSPC. We used Cochrane risk-of-bias tool (version 2) to assess trial quality and Bayesian network meta-analysis (NMA) to estimate the relative effects of competing treatments. In addition to combing published time-invariant hazard ratios (HRs), we reconstructed survival data from Kaplan Meier curves to enable parametric survival NMA that allows time-varying HR. Results: Seven trials with 7,236 patients were included comparing six treatments (Table). Risk of bias is a concern for trials with open label (N=4), missing data (N=3), or unprespecified analysis (N=3). Ordered from the most to the least effective, treatments significantly improving overall survival (OS) include abiraterone acetate, apalutamide, and docetaxel; treatments significantly improving radiographic progression-free survival (rPFS) include enzalutamide, abiraterone, apalutamide, and docetaxel. (see HRs in Table) Allowing time-varying HR produced similar treatment rankings. Serious adverse events (SAE) were substantially increased for docetaxel (odds ratio [OR] 104.17, 95% credible interval [CI] 24.85-1012.32) and slightly increased for abiraterone (OR 1.42, 95% CI 1.11-1.83). Conclusions: Abiraterone provided the largest OS benefit with slightly increased risk of SAE. Apalutamide offered comparable OS benefit with abiraterone without increasing SAE risk. Although enzalutamide delayed rPFS to the greatest extent, longer follow-up is needed to examine its OS benefit. [Table: see text]
Normativity, social change, and the epistemological framing of culture
Authors: Andrew Buskell
Journal: Behavioral and Brain Sciences (2020)

Abstract The authors deploy an epistemic framework to represent culture and model the acquisition of cultural behavior. Yet, the framing inherits familiar problems with explaining the acquisition of norms. Such problems are conspicuous with regard to human societies where norms are ubiquitous. This creates a new difficulty for the authors in explaining change to mutually exclusive organizational structures of human life.
Clinical characteristics of cerebral syphilitic gumma
Authors: Junhua Gao, Wurong Li, Wenqing Wu, Dongmei Xu, Yuming Huang, Fang Wang
Journal: BMJ (2017)

Objective
To analyze the clinical characteristics of cerebral syphilitic gumma.


Method
The clinical characteristics, brain CT and MRI results and prognosis of 7 patients with cerebral syphilitic gumma admitted in Beijing Ditan Hospital from June 2012 to October 2016 were retrospectively analyzed.


Results
There were 5 females and 2 males in 7 patients. The symptoms or signs at onset were headache (n=5), increased white blood cells in cerebrospinal fluid (n=6) and increased protein contents in cerebrospinal fluid (n= 6). Total 10 lesions were detected in 7 cases, including 7 in cerebral lobe, and 3 in cerebellum, corpus callosum or intercrural space. The brain MRI showed nodular reinforcement in 5 cases, irregular circular reinforcement in 2 cases and obvious edema around the lesions in 6 cases. The patients were given intravenous infusion of 400 million units common penicillin, q. 4h for 2 wks, sequential intramuscular injection of 240 million units long-term penicillin q. w for 3 wks. Among 7 patients, 1 case died, 1 case showed symptomatic improvement and 5 cases obtained complete improvement with the significant imaging improvement.


Conclusion
Headache is the most common symptom at onset of cerebral syphilitic gumma, and the lesions mostly are located in the cerebral lobes with nodular enhancement in brain imaging, and the prognosis is generally good.


Key words: 
Neurosyphilis; Pathological conditions, signs and symptoms; Magnetic resonance imaging
Community-based hypertension management for elderly patients
Authors: Li Yang, Xiaoling Xu, Jing Yan, Wei Yu, Yifeng Zhang, Jianyong Luo
Journal: BMJ (2014)

Using the method of stratified random cluster sampling, 8 996 elderly hypertensive patients in community were selected in the study. Patients entered the community-based hypertension program receiving stratified management, individualized treatment and health education. After 3 years of intervention, the disease awareness rate, treatment compliance rate and hypertensive control rate were increased from 68.30%, 55.40% and 38.60% to 98.90%, 86.70% and 77.80%, respectively (P<0.05). The systolic and diastolic pressure, body mass index, triglyceride levels and other hypertension-related indicators were improved significantly, the number of individuals with obesity/overweight, smoking and drinking were decreased and those with regular exercise increased (all P<0.05). The results indicate that community-based comprehensive hypertension management is effective for hypertension control for elderly patients in community.


Key words: 
Hypertension; Disease management
Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives
Authors: Zibusiso Ndlovu, Rosie Burton, Rosanna Stewart, Helen Bygrave, Teri Roberts, Emmanuel Fajardo, Anafi Mataka, Elisabeth Szumilin, Bernhard Kerschberger, Gilles Van Cutsem, Tom Ellman
Journal: The Lancet HIV (2020)
The landscape of <i>MET</i> mutations in Chinese biliary tract cancers.
Authors: Shifeng Xu, Wei Rao, Yuanwen Zheng, Jianping Wang, Weiyu Hu, Guilan Dong, Jiangong Wang, Guibing Ren, Junping Shi, Yafei Wang, Milind M. Javle, Ming Yao
Journal: Journal of Clinical Oncology (2020)

e16652 Background: Biliary tract cancers (BTCs) are malignancies with poor prognosis and limited treatment options. MET is recurrently altered in various cancers that confer susceptibility to targeted MET inhibitors. It has been reported that the MET mutation frequency is 2-7% in intrahepatic cholangiocarcinoma (ICC) and 3.7% in extrahepatic cholangiocarcinoma (ECC) in Western countries. However, the characterization of MET in Chinese BTCs are not clear. Methods: Next-generation sequencing (NGS) targeting 450 cancer genes was performed on formalin-fixed, paraffin-embedded (FFPE) tumor tissues and matching blood samples that collected from a cohort of 926 Chinese BTC patients. Genomic alterations, including single nucleotide variations (SNV), short and long insertions/deletions (Indels), copy number variations, and gene rearrangements/fusions, were analyzed. The testing was carried out by a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Results: MET mutations were detected in 4.1% of patients with BTCs, including 5.3% in ICC, 3.4% in hilar cholangiocarcinoma (HCCA), 3.0% in ECC, and 2.6% in gallbladder cancer (GBCA). Gene amplification was the most common type of MET mutation in BTC (2.6%) compared with gene rearrangements/fusions (1.1%) and SNV (0.9%). Novel MET fusion partners, including TNS3 and TRIM4, and MET exon 14 skipping mutation, were also detected. There was no difference in tumor mutational burden (TMB) between patients with and without MET mutation (average TMB: 6.5 vs. 5.6 muts/Mb, P= 0.213). Among these BTC patients, an advanced ICC patient (performance status [PS] 3) who harbored MET gene amplification, received crizotinib as the first-line treatment. Four months later, the patient had a complete response without obvious side effects. Conclusions: To our knowledge, this is the largest BTCs cohort and the first report of MET mutation profiling in the Chinese patients. MET mutations were detected in 4.5% BTCs, and MET inhibitors may be potential treatment options for BTC patients. All types of MET mutations, including gene amplification, SNVs, and gene fusions, were detected in BTCs, which demonstrated that NGS might be a powerful tool to detect MET mutations. Altogether, MET is a promising target in BTCs, and detection of MET mutations is important and essential for predicting the sensitivity of targeted therapy. Clinical trial information: NCT03892577 .
A phase I/II study to assess safety and dose of ixazomib in combination with cyclophosphamide and dexamethasone in newly diagnosed patients with light chain (AL) amyloidosis.
Authors: Keren Osman
Journal: Journal of Clinical Oncology (2020)

8065 Background: AL amyloidosis is an incurable clonal plasma cell disorder characterized by tissue deposits of immunoglobulin light chain fragments leading to organ dysfunction and death. Standard treatment for newly diagnosed patients (pts) has traditionally included oral melphalan + dexamethasone as well as high-dose melphalan + ASCT. Here we report preliminary results of a Phase 1/2, open-label, multi-institution study of ixazomib (I) in combination with cyclophosphamide (Cy) and dexamethasone (D) in newly diagnosed AL amyloidosis. Methods: Eligible pts are ≥18 years with newly diagnosed, untreated biopsy-proven AL amyloidosis. A total of up to 30 pts will be enrolled, with up to 18 in the dose escalation arm (phase 1) and 12 in the maximum tolerated dose (MTD) expansion arm (phase 2) according to a classical 3+3 design. Four dose levels were evaluated in phase 1. I and Cy are given orally (PO) on days 1, 8, 15, and D 20mg PO on days 1, 8, 15, 22 of each 28-day cycle. Treatment continues for a total of 6 cycles or until disease progression, significant toxicity or withdrawal. The primary study objective in phase 1 is to establish the MTD and in phase 2 is to determine hematologic/organ response rate. Results: As of February 2020, 120 pts have been enrolled; 16 in phase 1 and 4 in phase 2. The MTD was established at dose level 3 (I 4mg and Cy 500mg). Median age is 65 years (range 46-79), 12 (67%) are male. Light chain isotype is lambda in 14 (78%). Seven pts (39%) have cardiac, 10 (56%) renal, 4 (22%) gastrointestinal, 1 (6%) hepatic, 2 (11%) soft tissue involvement, with 22% having multi-organ involvement. Four pts (22%) completed 6 cycles of therapy and 6 (33%) remain on study with a median of 3 cycles completed. Eight of 16 pts (50%) had at least 1 drug-related adverse event (AE) (any grade), most commonly edema (19%), fatigue (19%), dizziness/lightheadedness (13%) and lymphopenia (13%). Grade 3/4 AEs were rare with grade 3 lymphopenia, anemia, and hyponatremia occurring in 13%, 6%, and 6% of pts, respectively. Of 18 evaluable pts, 7 (39%) achieved ≥VGPR with the median time to best response 2 cycles (1-5). Conclusions: The combination of ICyD for pts with newly diagnosed AL amyloidosis is safe and well tolerated. Phase 1 is completed and the recommended phase 2 dose has been established. Deep hematologic responses (≥VGPR) have occurred and time to response appears similar to standard of care induction regimens, ie CyBorD. Phase 2 response data will be updated at the meeting.
Characteristics and satisfaction of outpatients in walk-in clinic of a Grade A tertiary hospital
Authors: Rongying Wang, Feng Li, Zhenyin He, Yan Wang, Wenwen Zhao, Jinyan Wang
Journal: BMJ (2017)

Objective
To assess the characteristics and satisfaction of outpatients in walk-in clinic of a grade A tertiary hospital.


Methods
A total of 1 100 outpatients visiting walk-in clinic of the Second Hospital of Hebei Medical University during March 2016 and June 2016 were randomly selected for the questionnaire survey. The self-designed questionnaire included the general information of patients, the satisfaction degree to the walk-in clinic, to special clinics of the hospital or to community clinics and related reasons, and suggestions for further improvement.


Results
Total 947 valid questionnaires were received with a retrieval rate of 86.09%. Most of participants had one chronic disease (594, 62.72%). The satisfaction degree of walk-in clinic(1.78)was higher than that of hospital special clinics(1.93)(P=0.010), in turn the latter(2.33)was higher than that of community clinics (P<0.001). The reasons for patient to choose the walk-in clinic were wide range of medications (389, 41.08%), reliable quality (285, 27.98%), short waiting time (249, 26.29%) and so on. Suggestions for improvement of the walk-in clinic were further reducing the waiting time (428, 45.20%), need specialists for chronic disease management (210, 22.18%), raising reimbursement rate (172, 18.16%) and so on. The reasons for patients to choose special clinic were need readjusting prescription (587, 61.99%), special disease or drug (427, 45.09%). The reasons of dissatisfaction with special clinic were long waiting time (476, 50.26%), frequent transfer to multiple departments (221, 23.34%), high registration fee(221, 23.34%). The reasons for patients to choose community clinic were short distance (350, 36.96%), better environment (350, 36.96%), short waiting time (184, 19.43%) . The reason of dissatisfaction with community clinic were low qualification of medical staff (405, 42.77%), insufficient medications (392, 42.39%); distrusting the quality of drugs (263, 27.77%). Suggestions for improvement of the community clinics were upgrading the qualification of medical staff (317, 33.47%), enlarging drug variety (298, 31.47%), improving medical environment (94, 9.93%) and so on.


Conclusion
Most outpatients visiting walk-in clinic of grade A tertiary hospital are highly satisfied the clinic. To meet the patients′ needs the primary medical unit should further improve their overall service.


Key words: 
Hospitals, general; Outpatient clinics, hospital; Community health center; Chronic disease
Phase I dose-escalation study of PSMA-targeted alpha emitter <sup>225</sup>Ac-J591 in men with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Scott T. Tagawa, Joseph Osborne, Escarleth Fernandez, Charlene Thomas, Muhammad Junaid Niaz, Amy Ciriaco, Shankar Vallabhajosula, Panagiotis J. Vlachostergios, Ana M. Molina, Cora N. Sternberg, Sharon Singh, John Babich, David M. Nanus, Karla V. Ballman, Neil Harrison Bander
Journal: Journal of Clinical Oncology (2020)

5560 Background: Antibodies (Abs) or small molecules can target PSMA with different biodistribution. Certain sites of PSMA expression (e.g. salivary/lacrimal glands, kidneys, small bowel) are not accessible to Abs. Given radiosensitivity of PC and potency of alpha emitters plus the ability to minimize targeting off tumor PSMA+ sites with J591, we performed a 1st in human study of 225 Ac-J591. Methods: Men with progressive mCRPC following at least 1 potent AR-pathway inhibitor (ARPI) and chemo (or unfit/refuse) without limit of # prior therapies (Ra-223 and 177 Lu-PSMA allowed) with ECOG PS 0-2 and adequate organ function were eligible. Baseline 68 Ga-PSMA11 PET was performed, but not used for eligibility. Initially 1-subject cohorts treated until transition to 3+3 at dose level 5 (predicted by dosimetry to have moderate toxicity) with a single infusion of 225 Ac-J591 (13.3 KBq/kg with planned escalation up to 93.3 KBq/kg). Dose-limiting toxicity (DLT) defined as attributable grade (Gr) 4 heme toxicity or Gr 3/4 non-heme tox. Imaging, genomic, patient-reported outcomes (PRO), and immune correlates embedded. Results: 22 men treated on 7 dose levels; median age 72.5 (range 58-89), PSA 147 (5-7168); 82% with &gt;2 prior ARPI, 64% chemo, 23% Ra-223, 55% 177 Lu-PSMA. 1 (5%) CALGB (Halabi) good prognostic risk, 10 (45%) intermed, 11 (50%) poor risk. 1 of 6 in cohort 6 (80 KBq/kg) had DLT (Gr 4 anemia and platelets); no others had attributable Gr &gt; 2 non-heme or Gr &gt; 3 heme AE (including 0 of 6 at the highest dose level 93.3 KBq/Kg). Gr 1/2 AE’s: 17 (77%) fatigue, 11 (50%) pain flare, 10 (45%) anemia (+1 Gr 3), 10 (45%) platelets, 6 (27%) nausea, 6 (27%) xerostomia (5 of 6 with prior 177 Lu-PSMA), 5 (23%) neutropenia, 4 (18%) AST elevation. Despite prior treatment including 177 Lu-PSMA and no selection for PSMA expression, 14 (64%) with any PSA decline, 9 (41%) with &gt; 50% PSA decline. 15 (68%) had initial PSA rise followed by decline from peak (delayed effect). 2 with response &gt; 1 year despite prior 177 Lu-PSMA. Of 15 with paired baseline and 12-wk CTC counts, 8 declined, 4 remained undetectable, 3 increased. In subset with complete PRO data (baseline to 12 wks), pain was improved or absent by BPI-SF in 63% and by FACT-P in 89%. Social and emotional well-being domains of FACT-P improved or stabilized in majority; physical well-being improved in most responders. Conclusions: Alpha-emitter 225 Ac targeting PSMA via J591 Ab is tolerable with early evidence of clinical activity in a pre-treated population with favorable PRO’s. Enrollment to expansion cohort being completed. Clinical trial information: NCT03276572 .
社区全科师资培训中的问题与对策探讨
Authors: 陈倩, 顾杰, 张渊, 祝墡珠, 王宏长, 徐莉苹
Journal: BMJ (2012)

我国目前社区全科师资绝大部分未经过正规的师资培训,师资问题已成为阻碍社区全科医师培训工作的主要因素.本文总结了近年来在临床和社区教学基地开展全科师资培训的相关经验,提倡发挥教学医院和临床教学基地的核心作用,推行“导师制”和“一对一”带教模式,建立社区师资准入体系,确立以ACGME核心能力为导向的培训目标,开展“三阶段形式”(理论课程、教学演练、教学实践)的中长期师资培训模式,注重教学理论与实践相结合,并采用整合式教学-评估理念将临床带教活动与教师教学能力评估有机结合,对社区全科师资的教学能力进行评估。