tbuckley/cabot-search huggingface dataset:
Impact of an oncology clinical pharmacist specialist in an outpatient multiple myeloma clinic.
Authors: Amin Virani, Zach Schlei, Andrzej J. Jakubowiak, Jagoda Jasielec, Christine Gleason, Megan Ackermann, Brittany Wolfe, Sarah Major, Amanda McIver, Sandeep Parsad
Journal: Journal of Clinical Oncology (2020)

e14030 Background: Improvements in cancer treatment, supportive care, and the approval of oral chemotherapy medications over the past decade have resulted in an increasing number of cancer patients treated in outpatient settings. Transitioning cancer treatments to the outpatient setting places greater emphasis on proper medication counseling and optimal side effect management. Current literature demonstrates improvements in medication adherence and effective cancer related symptom management with the addition of an oncology pharmacist. Historically, the University of Chicago Medical Center (UCMC) has not employed pharmacists into their ambulatory oncology clinics. UCMC is evaluating pharmacist’s roles in these clinics. Methods: The primary objective of this project is to evaluate the clinical and financial impacts of an oncology clinical pharmacist specialist in an interdisciplinary multiple myeloma (MM) clinic. This will be evaluated by monitoring the interventions made by the pharmacist in clinic through a validated scoring tool. This tool associates a value for each type of intervention made based on current literature and internal evaluations at UCMC. The oncology clinical pharmacist specialist will be available for consult by the MM clinic staff. The pharmacist may be consulted for any medication related inquiry. Based on the consult the pharmacist will categorize their interventions into twelve predefined intervention categories. Results: Study results showed the implementation of a clinical pharmacist specialist into the MM clinic over 39 clinic days resulted in 241 patient consults and 474 interventions made by the pharmacist. The most frequent interventions made by the pharmacist were medication teaching (97), dose adjustments by pharmacist (82) and medication reconciliation (63). Based on the dollar values associated with each intervention type, the value of interventions made by the pharmacist during the study period was $189,441 with a predicted annual value of $757,764. Conclusions: An clinical pharmacist specialist in the MM clinic lead to dramatic and sustainable financial and clinical impacts. Further investigation into other oncology clinics is warranted.
Initial report of treatment of uveal melanoma with hepatic metastases with yttrium90 internal radiation followed by ipilimumab and nivolumab.
Authors: David R. Minor, Takami Sato, Marlana M. Orloff, Jason J. Luke, David J. Eschelman, Carin F. Gonsalves, Robert D. Adamo, Ricky T Tong, Devron H. Char, Rani Anne, Kevin B. Kim
Journal: Journal of Clinical Oncology (2020)

10025 Background: Hepatic metastases from uveal melanoma have no established therapy, with a median survival of only 6-12 months. To date therapy with checkpoint inhibitors has yielded minimal results. To take advantage of possible synergy between radiation and immunotherapy we treated patients with yttrium90 internal radiation followed by immunotherapy. Methods: Patients received yttrium90 (Sir-Spheres) via hepatic artery infusion in two treatments, one to each lobe 3-4 weeks apart, followed in 3-6 weeks by ipilimumab and nivolumab for 4 doses, then nivolumab maintenance. Results: We are presenting interim results because of the excessive toxicity seen when these FDA-approved modalities were used in sequence with the FDA-approved dosages. Initially dosing of yttrium90 (Y90) followed the package insert “BSA method” but after 8 patients we had 5 cases of grade 3-4 hepatic toxicity; in 4 cases the toxicity was observed after just the Y90. One case of cirrhosis occurred in a patient whose liver received 40-45Gy; her cirrhosis was felt most likely due to the Y90. Y90 dosing was then reduced to limit dosage to normal liver to 35Gy, and none of the next 5 patients have had more than grade 2 hepatic toxicity. Dosage to the normal liver is approximated by the MIRD formula: Actual delivered liver dose [Gy] = 50 * Administered activity [GBq] * (1 – Lung shunt fraction) / kg of treated liver. If calculated dose was &gt; 35GY, dosage in GBq is reduced proportionally. Toxicity in the first 5 patients to receive immunotherapy included one grade 4, two grade 3 and two grade 2 hepatic toxicities, and only 3 of the 5 patients received more than one dose of ipilimumab. We then reduced dosing of ipilimumab from 3mg/kg x 4 to 1mg/kg x 4 because of this excessive autoimmune toxicity. Of 13 patients, 10 received both Y90 and immunotherapy, and 3 had responses (1 CR, 2 PR) with 3 patients stable &gt; 5months. Median progression-free survival for all patients is 27 weeks and median overall survival is greater than 48 weeks. Treatment with Y90 produced an over 50% fall in peripheral blood lymphocytes which was reversed in most patients by the immunotherapy. Conclusions: With dose modifications this therapy appears feasible and objective tumor responses were seen. Sequential therapy with Y90 and immunotherapy appears tolerable if radiation to normal liver is limited to 35Gy and ipilimumab dose is 1mg/kg. Clinical trial information: NCT02913417.
Circadian blood pressure pattern in patients with aldosterone-producing adenoma and its associated factors
Authors: Yu Zhang, Jian-bin Liu, Xiao-pei Cao, Wan-ping Deng, Xiao-juan Zhao, Ji-yan Wu, Zhi-min Huang
Journal: BMJ (2013)

Objective
To investigate the circadian blood pressure pattern in patients with aldosterone-producing adenoma.


Methods
Circadian variation of blood pressure was assessed by 24-h ambulatory blood pressure monitoring (ABPM) in 20 patients with adrenal aldosterone-producing adenoma (APA) and 25 patients with essential hypertension (EH).


Results
Compared to EH group, the body mass index, serum potassium concentration, upright plasma renin activity and angiotensin Ⅱ levels in APA group were lower and the serum sodium concentration and upright plasma aldosterone concentration were higher (all P 0.05]. Multivariate Logistic regression analysis showed no independent predictors for non-dipper circadian blood pressure pattern.


Conclusion
There are no significant differences in proportion of non-dipper circadian blood pressure pattern and blood pressure characteristics between APA and EH patients.


Key words: 
Hyperaldosteronism, primary; Aldosterone producing adenoma; Ambulatory blood pressure monitoring
Family doctor team care reduces morbidity of disabled elderly in home care
Authors: Jun Zhao, Yong Ma, Lei Peng
Journal: BMJ (2016)

Objective
To assess the effect of family doctor team care on morbidity of disabled elderly in home care.


Methods
Eighty six disabled elderly patients with home care in Shanghai Xujiahui community were enrolled from February 2014 to January 2015. The patients were randomly divided into intervention group and control group with 43 cases in each. In intervention group, the family doctor team provided long-term, comprehensive and integrated care, and in control group the conventional home care was provided. The rates of morbidity and readmission to hospital were documented during the 3, 6 and 12 month-follow-up, and compared between two groups.


Results
The incidence rates of bedsore, pneumonia and deep vein thrombosis in intervention group was significantly lower than those in control group [after 6 months: 4.9% (2/41) vs. 28.9%(11/38), χ2=8.311; 2.4% (1/41) vs. 21.1%(8/38), χ2=6.769; 2.4% (1/41) vs. 15.8%(6/38), χ2=4.353, respectively; after 12 months: 2.4%(1/41) vs. 42.1%(16/38), χ2=18.374; 4.9% (2/41) vs. 28.9%(11/38), χ2=8.311; 7.3% (3/41) vs. 28.9%(11/38), χ2=6.328, respectively; all P<0.05]. The number of cases with bedsore healing(6/7 vs. 0, χ2=18.555)and pneumonia recovery[5/6 vs. 4.3%(1/23), χ2=18.092] was significantly more and that with pneumonia deterioration(0 vs. 52.2%(12/23), χ2=5.340)was significantly less in intervention group than those in control group (all P<0.05). More cases with deep vein thrombosis improved(1/3 vs. 0, χ2=3.949)and less cases with deep vein thrombosis deteriorated(0 vs. 8/11, χ2=5.091)in intervention group than those in control group (P<0.05). And both the readmission rate for home care patients [2.4%(1/41) vs. 36.8%(14/38), χ2=15.175] and for patients with complications [1/12 vs.43.8%(14/38), χ2=4.872] was much lower in intervention group than that in control group (both P<0.05).


Conclusion
The family doctor team care can reduce the risk of complications and readmission to hospital, and also can improve the quality of life of home care disabled elderly, as well as reduce the burden of family and society.


Key words: 
Physicians, family; Home care; Disabled elderly
脑卒中危重症的评估和处理原则
Authors: 曾红科, 王桥生
Journal: BMJ (2009)

脑卒中(卒中)是一种突然起病的脑血液循环障碍性疾病,根据是否有血管破裂可以分为缺血性脑卒中和出血性脑卒中.缺血性脑卒中又可以分为动脉粥样硬化性血栓性脑梗死、脑栓塞和腔隙性脑梗死等;出血性脑卒中有脑出血和蛛网膜下腔出血.部分脑卒中患者起病急,病情进展迅速,短时间内即可出现意识障碍,甚至呼吸循环衰竭,危及生命.在临床诊治中做到及时识别,病情严重危重程度的正确评估和及时准确的治疗,对抢救患者生命、改善患者预后有着重要意义。
基本医疗保险不同支付方式对贫困职工医疗服务的影响
Authors: 迟慧, 董素花, 王文军
Journal: BMJ (2004)

分析城市职工基本医疗保险不同支付方式的运营以及贫困职工医疗服务利用情况.结果表明,各种支付制度运行情况良好,其效率有进一步提高的潜力,不同支付方式对贫困职工医疗服务利用有间接影响.需继续完善各种支付制度,及时调整有关支付政策,加强对医院行为的监督力度。
遗传性血管性水肿一例
Authors: 彭蕻琳, 周一平, 刘慧
Journal: BMJ (2006)

患者女,27岁,因四肢、面部反复发作性水肿22年,复发1 d,呼吸困难3 h,于2005年9月20日急诊入院.患者22年前,每当挤压或碰撞皮肤后,接触处即出现皮肤黏膜局限性、非凹陷性、无痛性、非瘙痒性水肿.水肿常以受压部位为起点,向远端蔓延,一般在24 h内达到高峰。
The potential of a CLIA-certified prognostic/predictive molecular test to address the rising costs of non-small cell lung cancer.
Authors: Michael J Mann, David Jablons, Ken O'Day, Wayne Su, Padma Sundar
Journal: Journal of Clinical Oncology (2020)

e21671 Background: Treating recurrences of non-small cell lung cancer (NSCLC) is increasingly expensive but still rarely curative. Disease free survival (DFS) among resected stage I-IIA patients remains only 50-70%. Guidelines advocate adjuvant therapy in “high-risk” patients in this population to reduce these costly and deadly recurrences, but recognize that conventional criteria have not been validated to stratify risk or predict benefit. A CLIA-certified, commercially available 14-gene expression risk profile (DetermaRx) has been extensively validated among stage I-IIA non-squamous NSCLC patients; prospective data now suggest that the test predicts improved DFS with adjuvant therapy. We therefore studied the potential economic impact of this molecular test on early stage NSCLC. Methods: Model variables included: relative increase in DFS with adjuvant treatment of molecular intermediate- and high-risk patients (25.5%; range 12.3-41.3%); cost of adjuvant ($8,760; $8,144-$9,376) or late-stage ($284,500; $224,900-345,200) treatment; and compliance with recommendations for adjuvant therapy (75%; 60-90%). Ranges were based on: historical trials and recent prospective data, published cost literature, and published survey data, respectively. Parameters were varied in a multifactorial, one-way sensitivity analysis to assess the impact of parameter uncertainty. Results: Reduction of recurrences with implementation of the 14-gene assay resulted in an average cost savings of $11,608/patient (potential systems savings of ~$450 million), even when including the cost of molecular risk stratification ($4000/patient) and of cisplatin-based adjuvant chemotherapy for molecular high- and intermediate-risk patients. Lower bound assumptions for relative improvement, cost of care, and compliance yielded persistent savings of $3,699, $8,091 and $8,486, respectively. Conclusions: Utilization of this predictive molecular risk stratification assay in the management of stage I-IIA non-squamous NSCLC has the potential to significantly reduce lung cancer costs in an era of targeted therapy and immunotherapy, while at the same time improving DFS and saving lives.
Differential diagnosis between Crohn's disease and intestinal tuberculosis based on clinical manifestations, endoscopic and CT findings
Authors: Qing-qiang Zhu, Jing-tao Wu, Wen-xin Chen, Jin Zheng, Ming-xiang Chen, Xian-fu Luo
Journal: BMJ (2012)

The clinical data,endoscopic and CT findings of 39 patients with Crohn's disease(CD) and 24 patients with intestinal tuberculosis (ITB) were retrospectively reviewed.Diarrhea,hematochezia,perianal disease,intestinal obstruction,occurred more frequently in CD than in ITB (P ＜0.05 or ＜0.01).Night sweating,febrility,pulmonary tuberculosis and ascites were more common in ITB than in CD (P ＜0.01).The endoscopic findings showed that longitudinal ulcer,cobblestone sign,intestinal stricture were detected more often in CD than in ITB (P ＜ 0.05 or ＜ 0.01),but transverse ulcer and rodent ulcer were more frequently found in ITB than in CD (P ＜0.05 or ＜0.01).On the CT imaging mural gas,fat,enteric cavity stenosis and layering thickening were more common in CD than in ITB (P ＜ 0.05 or ＜ 0.01),but mural single layer thickening and hollow lymph nodes were discovered more frequently in ITB than in CD (P ＜ 0.01).The degree of intestinal wall thickening,enhancement and lymph nodes enlargement of ITB were more severe than that of CD (P ＜ 0.01).The clinical manifestations combined with endoscopic and CT finding may improve the differential diagnosis between Crohn's disease and intestinal tuberculosis.

Key words: 
Crohn disease; Tuberculosis, gastrointestinal
非阿托品化和阿托品化治疗重度乐果中毒的效果
Authors: 李瑞梅, 和立
Journal: BMJ (2011)

有机磷农药乐果的毒性作用大,中毒后病情发展迅速,死亡率高.为探讨有效救治乐果中毒患者方法,对非阿托品化和阿托品化治疗重度乐果中毒患者的效果做一对比分析. 1.对象与方法:随机双盲法选取我院自1995年11月至2004年10月期间收住的重度有机磷农药乐果中毒急诊患者96例,男50例,女46例,年龄17～68岁,平均年龄35岁。
我在美国学习全科医学的见闻和体会
Authors: 谷建
Journal: BMJ (2006)

今年6月末至8月初在我的老师美国家庭医师Peter的安排下,我作为一名全科医师先后到美国的Tulsa、Kansas、New Mexico 3个全科(家庭)医师培训项目学习参观,受益匪浅,现将一些见闻与体会与大家分享。
An open-label, phase I trial of BI 754091 alone and in combination with BI 754111 in Asian patients (pts) with advanced solid tumors.
Authors: Yoon-Koo Kang, Kensei Yamaguchi, Do-Youn Oh, Shunsuke Kondo, Yasutoshi Kuboki, Manabu Morimoto, Hiroki Hara, Sun Young Rha, Chia-Chi Lin, Yoshifumi Tachibana, Miaomiao Ge, Mabrouk M. Elgadi, Shigehisa Kitano
Journal: Journal of Clinical Oncology (2020)

3054 Background: Dual blockade of immune checkpoint molecules, PD-1 and LAG-3, may enhance the anti-tumor response versus PD-1 blockade alone. This Phase I trial investigated BI 754091, an anti-PD-1 antibody, as monotherapy and in combination with BI 754111, an anti-LAG-3 antibody, in Asian pts with advanced solid tumors. Methods: This trial comprised 3 parts. Parts 1 and 2 (dose escalation) were in pts with unresectable/metastatic solid tumors. In Part 1, pts received BI 754091 240 mg intravenously (iv), every 3 weeks (q3w); in Part 2, pts received BI 754091 240 mg in combination with BI 754111 (400 mg, 600 mg or 800 mg iv, q3w). Dose escalation was guided by a Bayesian logistic regression model, with overdose control. The primary endpoint in Parts 1 and 2 was maximum tolerated dose (MTD) of BI 754091 alone or in combination with BI 754111, based on dose-limiting toxicities (DLTs) in Cycle 1. In Part 3, BI 754091 240 mg plus BI 754111 600 mg q3w was assessed in 4 expansion cohorts. Cohorts A–C included pts with: A) gastric/esophagogastric junction cancer; B) esophageal cancer; C) hepatocellular cancer; all had received ≥1 line of prior systemic therapy and no prior anti-PD-(L)1 therapy. Cohort D included pts who had received prior anti-PD-(L)1 therapy for the tumor types in Cohorts A–C. The primary endpoint in Part 3 was objective response (confirmed complete response or partial response [PR] per RECIST 1.1). Results: In Part 1, 6 pts received BI 754091 240 mg. In Part 2, 9 pts received BI 754091 240 mg plus BI 754111 (400 mg/600 mg/800 mg; n = 3 per cohort). No DLTs were reported in Parts 1 and 2. In Part 3, 121 pts were treated (97 [80%] male, median age 61 years [range 23–80]); Cohorts A/B/C/D included 33/33/20/35 pts. All-grade adverse events (AEs) and treatment-related AEs (TRAEs) were experienced by 96 (79%) and 47 (39%) pts, respectively. The most commonly reported AEs (all/≥G3) were pyrexia (21%/0%), decreased appetite (17%/2%), anemia (11%/6%), and nausea (9%/0%). 36 (30%) pts reported immune-related AEs, most commonly hypothyroidism, in 7 (6%) pts. Confirmed PR was observed in 6 pts (5%; Cohort A/B, n = 4/2) and 35 (29%) pts had stable disease (Cohort A/B/C/D, n = 9/11/10/5). Conclusions: MTD was not reached for BI 754091 monotherapy or for BI 754091 in combination with BI 754111. The recommended dose for the combination was determined as BI 754091 240 mg plus BI 754111 600 mg q3w. Treatment was well tolerated and consistent with that observed in the global trial. Preliminary anti-tumor activity was seen. Clinical trial information: NCT03433898 .
第二十届亚太肝脏病学会会议上慢加急性肝衰竭相关热点问题
Authors: 闫涛, 王慧芬
Journal: BMJ (2010)

肝衰竭是临床常见的严重肝病症候群,病死率高.一直以来,学者们对肝衰竭的定义、分类和诊断标准都有不同的标准,难以达成一致性意见.2005年美国肝病学会发布了急性肝衰竭的处理建议.2006年我国制定了第一部 [1],将肝衰竭分为四类:急性肝衰竭(acute liver failure,ALF)、亚急性肝衰竭(subacute liver failure,SALF)、慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)和慢性肝衰竭(chronic liver failure,CLF),这是第一次正式将ACLF的定义写入指南.2008年亚太肝脏病学会年会上提出了ACLF指导意见的专家共识[2]。
Safety and efficacy of fecal microbiota transplantation (FMT) in the management of recurrent clostridioides difficile infection (rCDI) in cancer patients.
Authors: Hiba Ali, Weijie Ma, Shruti Khurana, Zhi-Dong Jiang, Herbert L. DuPont, Pablo Okhuysen, Anusha Thomas, Yinghong Wang
Journal: Journal of Clinical Oncology (2020)

e24048 Background: Cancer patients are at a significantly increased risk of rCDI by virtue of a compromised immune function from underlying malignancy, anti-cancer therapy and frequent antibiotic use for opportunistic infections. Furthermore, cancer patients have shown to have a lower response rate to standard oral antibiotics for CDI. Data is limited in regards to the safety and efficacy of FMT in managing rCDI in cancer patients. We aim to describe our experience of the same at a tertiary care cancer center. Methods: We conducted a retrospective study of cancer patients who underwent FMT for rCDI at the MD Anderson Cancer Center 06/2017-01/2020. FMT was performed through colonoscopy with universal donors’ stool. Baseline clinical data were collected and analyzed. Results: Our sample comprises 19 patients of whom 12 had solid tumors and 7 hematological malignancies, most of which were stage 4 at the time of FMT. The mean age was 66.5 years. Most patients received proton pump inhibitor, antibiotics and cancer therapy within 3-6 months of FMT. On average, each patient had 3 episodes of CDI, received 4 courses of antibiotic treatments, and required 4 CDI related hospitalizations within 1 year prior to FMT. Majority of the CDI episodes were managed with a combination of antibiotics. Bezlotoxumab was used in 4 cases. 18 patients received FMT once, while one patient was treated with FMT thrice. Clinical response was seen in 74% patients with a median time of 1 day. 5 patients had refractory CDI including 3 recurrent rCDI, and 2 persistent symptoms. Compared to patients with good response, these refractory cases received more frequent antibiotics following FMT (100% vs 43%, p=0.033). Side effects were mostly mild GI complaints in 15.8% patients with no serious adverse events or mortality related to FMT. Conclusions: Our study shows that FMT is a safe and effective treatment for rCDI in cancer patients and provides rapid resolution of symptoms; Subsequent antibiotic use for the management of cancer related complications can negatively affect the efficacy of FMT. [Table: see text]
Impact of hyperglycemia on prognosis for patients admitted to medical intensive care units
Authors: Bo Zhou, Jing Li
Journal: BMJ (2009)

Objective To evaluate the impact of hyperglycemia in patients admitted to medical intensive care units(MICU)on their prognosis.Methods Medical records of 1016 patients,including 126 cases of known diabetes,359 cases with newly diagnoses hyperglycemia,and 531 normoglycemic cases,admitted to MICU in Wuhan University People's Hospital during September 2006 to September 2007 were reviewed to compare their case-fatality,length of hospital stay,length of MICU stay,mechanical ventilation,blood transfusion and antibiotics use.Results In.hospital case-fatality was 22.8%(82/359)in patients with newly-diagnosed hyperglycemia.significantly higher than that in patients with known diabetes of 12.7% (16/126)and in normoglyeemic cases of 5.1%(27/531)(P＜0.01),and that Was higher in those with diabetes than those with normal blood glucose level(P=0.002).Proportions of patients who needed mechanical ventilation,blood transfusion,antibiotics use was higher in newly diagnosed hyperglycemia group than those in the other two groups.Conclusions Hyperglycemia represents an important mal'ker of poor clinical outcomes and mortality in patients admitted tO MICU.Patients with newly diagnosed hyperglycemia had a significantly higher case-fatality and poorer outcomes than those with known diabetes or normoglyeemia.

Key words: 
Hyperglycemia; Intensive care units; Prognosis
Endoscopic findings of colonic polyps with different pathological types
Authors: Yan Feng, Ye Zong, Shu-tian Zhang
Journal: BMJ (2012)

The endoscopic findings of 884 cases of colonic polyps with different pathological types were retrospectively analyzed.Among all cases,there were 418 cases of tubular adenoma (47.3％ ),92 cases of fluff tubular adenoma ( 10.4％ ),334 cases of inflammatory polyps ( 37.8％ ) and 40 cases of hyperplastic polyps (4.5％ ).There were significant differences in age,location,polyp surface morphology and Yamada grouping among colonic polyps with different pathological types (P ＜0.05).The average age of fluff tubular adenoma group [ (64 ± 12)y] was the highest among all patients; and the average diameter of polyps was the largest [ ( 1.38 ± 1.09 ) cm ],lobulated and mulbenry,polyps were the most common forms; and the majority of fluff tubular adenoma was Yamada type Ⅲ or Ⅳ.The results indicate that fluff tubular adenoma was associated with higher age,larger polyp size,surface morphology and Yamada grouping (P ＜0.05).

Key words: 
Intestinal polyps; Endoscopy,gastrointestinal