tbuckley/cabot-search huggingface dataset:
Effect of short-term training for OSCE examiners in general practice residency training final examination
Authors: Qian Chen, Xiangjie Zhang, Miao Xu, Zhigang Pan
Journal: BMJ (2018)

Objective
To evaluate the effect of short-term training of objective structured clinical examination (OSCE) examiner in general practice residency training final examination.


Methods
Sixty examiners from Xinjiang Uygur Autonomous Region participated in half-day workshop of OSCE. The participants were interviewed with questionnaire before and after the training program and the effect of training was evaluated.


Results
The study showed that 78.3%(47/60)examiners knew OSCE and understood the concept and implementation steps before the training; 21.7%(13/60)had used it before; 95.0%(57/60)examiners intended to learn the performance of OSCE. After training most participants completely or basically understood the 6 test stands and implementation methods of OSCE; the participants were highly satisfied with the training duration, contents and methods, and the satisfaction rates were all over 70%.


Conclusion
The examiners recognize the advantages of OSCE in assessment of clinical skills and have strong intention of application. Short-term training has a certain effect and feasibility.


Key words: 
Training; Objective structured clinical examination; General practitioner
Mortgage discrimination and breast cancer survival among older women in the United States.
Authors: Kirsten M. M. Beyer, Yuhong M. Zhou, Purushottam W. Laud, Emily McGinley, Tina W.F. Yen, Ann B Nattinger
Journal: Journal of Clinical Oncology (2020)

e13615 Background: Although racism and racial residential segregation are widely considered to contribute to health disparities, including in breast cancer, studies examining the impact of mortgage discrimination, a factor contributing to residential racial segregation, and breast cancer survival are limited. The objective of this study is to examine the relationship between redlining (mortgage discrimination based on property location) and survival among older women with breast cancer. Methods: Using the Home Mortgage Disclosure Act (HMDA) database, we estimated redlining for all census tracts in the Metropolitan Statistical Areas (MSAs) within 15 Surveillance Epidemiology and End Results (SEER) areas. This measure was linked by tract with a SEER-Medicare cohort of 27,516 women aged 66-90 years with an incident stage I-IV breast cancer in 2007-2009 and claims information through 2014. We used cox proportional hazards regression models with survival time as the outcome variable and a 4-level categorical logged redlining variable as the key predictor. We also modeled the hazard ratio using redlining as a continuous variable. Models were stratified by stage, ER/PR status, and age group and adjusted for comorbidity and MSA-level standard error. Results: At a median follow-up of 72 months, one-third of the cohort was deceased. The majority of the cohort had no comorbidities and had hormone receptor-positive, early stage (I/II) cancers. Redlining was associated with poorer survival. When redlining is discretized into four groups with approximate equal-sized intervals, the first and second highest redlining groups are significantly associated with all-cause mortality (HR = 1.226 [1.108, 1.355] for the highest group; HR = 1.159 [1.095, 1.228] for the second highest group). When redlining and its quadratic terms are included in the model, the original and square terms are significantly associated with all-cause mortality (HR = 1.177 [1.111, 1.248] for redlining; HR = 0.982 [0.973, 0.991] for squared redlining). Conclusions: The study suggests that redlining could negatively contribute to breast cancer survival. Persistent place-based mortgage discrimination, as a manifestation of institutional racism, could have long-term effects on people’s health, possibly by impacting health care access or exposing residents to harmful neighborhood conditions. Housing policies that seek to reduce or eliminate place-based mortgage discrimination could contribute to reducing breast cancer survival disparities.
Cultivation and incentive mechanism for general practitioners in community health service center
Authors: Yaling Li, Zhaohui Du
Journal: BMJ (2018)

The article introduces the practice of cultivating general practitioners (GPs) in Shanghai Weifang Community Health Service Center of Pudong New Area. The center has long emphasized in talent introduction and professional training for them. The cultivation of introduced talents included study in Zhongshan-Weifang general teaching clinic, the 3+ 2 continual education, study in specialty clinics and various assessment approaches, aiming to improve the their clinical competence. At the same time, the incentive mechanism is used, including salary raising, engagement in research projects, and position promotion. To build an excellent community health service team is the foundation for the quality service and comprehensive health system reform in community health service centers.


Key words: 
Community health service; General practitioner; Training mechanism; Incentive mechanism
Incidence of deep vein thrombosis in patients with obstructive sleep apnea-hypopnea syndrome
Authors: Xiu-yun L, Li-ying Cui, Tian-ji Zhu, Jing-sheng Dong, Hong Suo
Journal: BMJ (2011)

Twenty five patients with obstructive sleep apnea hypopnea syndrome (OSAHS) were classified as mild, moderate and severe grade according to apnea hyponea index and lowest oxyhemoglobin saturation.Lower limbs were examined with ultrasonography, blood routine and D-dimer levels were measured in all patients.The results revealed an increased incidence of deep vein thrombosis with the extent of obstructive sleep apnea.There was no deep vein thrombosis in patients with mild-grade OSAHS, while there were 2 in moderate and 3 in severe patients.The blood D-dimer levels were (498 ± 22) pg/L, (659 ±43 ) μg/L, ( 1528 ± 181 ) μg/L in mild, moderate and severe patients, respectively.The hemoglobin levels were (150 ± 8) g/L, ( 183 ± 15) g/L and (261 ± 26) g/L in mild, moderate and severe patients,respectively.There may be some association of obstructive sleep apnea hypopnea syndrome with deep vein thrombosis.

Key words: 
Sleep apnea,obstructive;  Thromboembolism
Results from a phase I, open-label study of ceralasertib (AZD6738), a novel DNA damage repair agent, in combination with weekly paclitaxel in refractory cancer (NCT02630199).
Authors: Jeeyun Lee, Seung Tae Kim, Simon Smith, Peter G. Mortimer, Bienvenu Loembé, Jung Hong, Iwanka Kozarewa, Andrew Pierce, Emma Dean
Journal: Journal of Clinical Oncology (2020)

3503 Background: Ataxia Telangiectasia and Rad3 Related (ATR) is an apical kinase with a critical role in the DNA-damage response. During normal DNA replication, ATR is recruited at stalled replication forks which can progress to double strand breaks if left unrepaired. AZD6738 is an oral inhibitor of the serine/threonine protein kinase ATR, a member of the phosphoinositide 3-kinase related kinase (PIKK) family. Methods: Eligible patients (pts) with advanced solid tumours were administered AZD6738 in combination with fixed dose paclitaxel 80 mg/m2 D1, D8, D15 in 28-day cycles. The dose of AZD6738 was escalated to reach a maximum tolerated dose (MTD) in a rolling 6 design. The trial evaluated safety, MTD, pharmacokinetics (PK) and pharmacodynamics (PD). Translational studies on plasma samples included cytokine analysis, panel sequencing of ctDNA, as well as IHC and immunofluorescence of immune cell markers. Results: 58 pts (34 melanoma, 15 gastric cancer (GC), 4 sarcoma, 3 colon cancer, 1 neuroendocrine and 1 hepatocellular cancer) were enrolled in 7 dose cohorts ranging 40mg OD to 240 mg BID. One dose-limiting toxicity (DLT) of neutropenic fever occurred in each cohort of n = 6 evaluable pts at AZD6738 160 mg BD and 240 mg BD days 1-14. Per protocol, the maximum tolerated dose of AZD6738 is 240 mg BID days 1-14. The most common toxicities (all causality, all grade) were: anorexia/nausea (n = 15, 26%), leukopenia (n = 11, 19%) and anemia (n = 11, 19%). 51 pts are evaluable for efficacy; we observed 1 complete response (1.9 %, melanoma), 12 confirmed partial responses (23.5%; 2 gastric, 10 melanoma all of which were post-immunotherapy), 18 stable disease (35.3%) and 20 disease progression (39.2%). The overall confirmed response rate from the dose escalation is 25.5%. Genomic analysis of baseline plasma (27 pts) revealed enrichment of NF1 somatic mutations and activating NRAS mutations amongst melanoma pts (6/18 and 4/18, respectively). Cyclical changes in interleukin-12 levels were observed in three pts with disease control which could reflect an immunological component to the mechanism of response. We will present a comprehensive case report of a patient with dramatic and durable response. Conclusions: We conclude that AZD6738 can be safely combined with weekly paclitaxel and propose a recommended phase II dose and schedule. The combination of AZD6738 and paclitaxel demonstrated promising anti-tumor activity with durable responses, especially in melanoma pts after failing anti-PD1 therapy. Clinical trial information: NCT02630199 .
Preclinical evaluation of SC0245, a small molecule inhibitor of ATR kinase.
Authors: Jian Wang, Qi Li, Yuanfeng Xia, Chi-Chung Chan, Xusheng Yuan, Yiwei Wang, Shuhui Chen, Wenyuan Qian
Journal: Journal of Clinical Oncology (2020)

e15642 Background: The ataxia telangiectasia and Rad3-related (ATR) kinase is a member of the phosphoinositide 3-kinase related kinase (PIKK) family. ATR plays an important role in maintaining genome integrity during DNA replication through the activation of Chk1, and regulation of the DNA damage response (DDR). Replication stress (RS) is a major source of genomic instability in cancer, and targeting the RS-response kinase ATR has emerged as a promising antitumor approach. The purpose of this study was to investigate the antitumor activity of SC0245, a small molecule inhibitor of ATR kinase, in preclinical models of ATM pathway or ARID1A deficient solid tumors. Methods: The kinase inhibiting activity of SC0245 was determined using the ATR/ATRIP(h) complex assays. The cellular anti-proliferative activity was evaluated with tumor cells which was ATM pathway or ARID1A deficient. The in vivo antitumor activity of SC0245 was evaluated in ATM pathway or ARID1A deficient cell-derived xenograft (CDX) mouse models of gastric cancer (SNU-601) and colorectal adenocarcinoma (LoVo). Results: SC0245 displayed potent kinase inhibiting activity for ATR/ATRIP complex with IC 50 14 nM, and had outstanding selectivity in the 104 onco-kinase panels. SC0245 significantly inhibited cell proliferation in ATM pathway or ARID1A deficient LoVo cells with IC 50 0.163 μM, SNU-601 cells with IC 50 0.218 μM. SC0245 showed excellent pharmacokinetics (PK) features with oral bioavailability ( &gt; 80%) in mouse, rat and dog. Moreover, in the SNU601 and LoVo CDX mouse models, SC0245 oral administration significantly inhibited tumor growth, with better efficacy than AZD6738. Conclusions: SC0245, a novel potent ATR kinase inhibitor, has marked antitumor efficacy in the ATM pathway or ARID1A deficient solid tumor animal models, and has outstanding PK properties. SC0245 represents a promising clinical candidate for treating solid cancers, such as gastric and colorectal cancers.
疾病管理实施过程概述
Authors: 姚崇华
Journal: BMJ (2007)

疾病管理是以疾病发展的自然过程为基础综合的、一体化的保健和费用支付体系.其特点是以人群为基础,重视疾病发生发展的全过程(高危的管理,患病后的临床诊治、保健康复,并发症的预防与治疗等),强调预防、保健、医疗等多学科的合作,提倡资源的早利用,减少非必需的发病之后的医疗花费,提高卫生资源和资金的使用效率。
Changes in blood hemorheology and early morning blood pressure in patients with obstructive sleep apnea-hypoventilation syndrome
Authors: Xiang-yan Zhang, Xian-wei Ye, Duan-xing Feng, Dan Li, Shan-shan Rao, Lin Liu
Journal: BMJ (2008)

Objective To investigate changes in morning blood pressure surge (MBPS) and blood hemorheology in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS) of various severity. Methods Total 118 patients with OSHAS diagnosed at the Department of Respiratory Diseases, People's Hospital of Guizhou Province were divided into three groups, i.e. , 31 mild, 40 moderate and 47 severe cases, based on their apnea-hypoventilation index (AHI), and 25 healthy persons were selected as controls. Blood hemorheology, oxygen saturation, morning blood pressure surge of the patients, as well as percentage of the time with oxygen saturation more than 90 percent of the total monitoring time (TS90%) were recorded. Results Early morning blood pressure surge was found in 21 cases (43%) with severe, eight (20%) with moderate and one (3%) with mild OSAHS. All indicators of blood hemarheology and TS90% were significantly higher in the patients with OSAHS than those in controls (P<0.05 ), those in moderate and severe OSAHS were significantly higher than those in controls (P<0.05 ) and those in severe OSAHS was significantly higher than those in moderate and mild OSAHS (P<0.05). All indicators of blood hemorheology were significantly higher in those with early morning blood pressure surge than those without it (P<0.05). Conclusions Blood viscosity, percentage of early morning blood pressure surge and TS90% in the patients with OSAHS are increased with severity of apnea-hypoventilation, and changes in blood hemorheology correlated with early morning blood pressure surge.

Key words: 
Sleep apnea, obstructive;  Hemorheology;  Blood pressure
Investigation of career anchor of the graduates of GP vocational training program
Authors: Jian Wang, Qi Zhao, Zhigang Pan
Journal: BMJ (2016)

Objective
To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university, to provide bases for making best GP career development strategy by health authorities.


Methods
Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital, Fudan university.152 questionnaires were issued and the effective response rate was 100%.


Results
The top of GPs' career anchor is job security orientation(106, 69.7%), followed by technical competence(28, 18.4%), service(8, 5.3%), managerial(5, 3.3%), autonomy(3, 1.9%), lifestyle(1, 0.7%), entrepreneurship(1, 0.7%), pure challenge(0, 0)and geographic security orientation(0, 0). We found that for male GPs, they displayed higher score for entrepreneurship orientation than female GPs(t=2.775, P=0.006). Those older than 35 displayed higher score for geographic security orientation than those younger than 35(t=-2.154, P=0.033). GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience(t=-2.414, P=0.017). The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were.


Conclusions
Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital, some career anchor orientations are related to age, gender and duration of work experience. Effective career management should be conducted based on these characters of the graduates' career orientation.


Key words: 
Inservice training; General practitioner; Career anchor
急性间质性肺炎一例
Authors: 程晓明, 秦维, 易祥华, 王长征, 李琦, 吴国明
Journal: BMJ (2005)

患者男,58岁,因咳嗽、咳痰、进行性呼吸困难1个月于2004年2月23日入院.既往体健,发病前因家庭装修曾接触过油漆、涂料等气溶胶类物质.1个月前受凉后咳嗽,咳少量黄白色黏痰伴气促,X线胸片示双下肺炎.抗炎1周后咳嗽、咳痰好转,但气促逐渐加重.入院查体:体温37.6℃,呼吸30次/min,口唇及指端紫绀,浅表淋巴结无肿大,双下肺可闻及高调湿哕音。
Association between insulin resistance and coronary artery disease
Authors: 矫杰, 李雅君, 刘群
Journal: BMJ (2006)

目的 探讨胰岛素抵抗在冠状动脉病变发生发展中的作用.方法选择行冠状动脉造影术的非糖尿病患者204例,根据冠状动脉造影结果将其分为冠心病组(136例)和对照组(68例),分析患者胰岛素抵抗指数(HOMA-IR)、空腹血清胰岛素水平与冠心病发生的关系及冠状动脉狭窄程度的关系.结果校正了性别、年龄、体重指数等影响因素后,冠心病组IR和血清胰岛素水平高于对照组(P＜0.05),logistic回归分析显示IR、空腹胰岛素水平与冠心病发生呈正相关,OR值分别为2.03和1.60(P＜0.05);不同程度冠状动脉狭窄组IR、空腹胰岛素水平有差异(P＜0.05),线性回归分析显示IR、空腹胰岛素水平与冠状动脉狭窄积分呈正相关,β值分别为0.57和0.45.结论胰岛素抵抗是冠状动脉病变的独立危险因素。
社区医院开展临终关怀服务的实践与探索
Authors: 刘志平
Journal: BMJ (2006)

临终关怀(hospice care)是指医护主体向被现代医学确认的治愈无望的临终患者及其家属提供的一种全面、综合的医护服务.临终关怀的宗旨是释缓临终患者的生理痛苦和精神恐惧,使其能无畏、尊严、安宁、舒适地走完人生的最后旅程.同时也使临终患者的家属在精神和心理上得到慰藉.朝阳门医院是以全科家庭医疗服务、临终关怀服务为特色的社区医院.自1992年以来已接收过数千名临终患者,在临终关怀的医护服务方面已取得一些经验.现收集、整理2000年至2004年临终患者的病例资料,在总结医护流程的同时展开相关问题的讨论。
Cohort 1 results of a phase I study of autolytic immunotherapy of metastatic neuroendocrine neoplasms using intralesional rose bengal disodium.
Authors: Mark McGregor, Timothy Jay Price, Gabby Cehic, Ian D. Kirkwood, Ruben Sebben, Jessica J. Reid, Susan Neuhaus, Eric Andrew Wachter, Guy Maddern
Journal: Journal of Clinical Oncology (2020)

e16694 Background: Metastatic neuroendocrine neoplasms (mNEN’s) originating in the gastrointestinal tract are frequently slow growing yet both symptom and disease control remain important. Treatment options include resection, chemoablation, systemic somatostatin analogues (SSA) or peptide receptor radionuclide therapy (PRRT), but additional options are needed, especially when available options have been exhausted. Intralesional (IL) rose bengal disodium (PV-10), an autolytic immunotherapy under development for solid tumors, is being investigated as a potential option for treatment-refractory patients (pts) with hepatic metastases. Methods: This phase 1 study is evaluating the safety, tolerability and objective response resulting from percutaneous administration of PV-10 in 12 pts with progressive mNEN refractory to SSA and PPRT; pts must have at least one injectable hepatic lesion (1.0-3.9 cm in longest diameter) not amenable to resection or other potentially curative therapy. In Cohort 1 (n = 6) pts received PV-10 to a single hepatic lesion per treatment cycle, and could receive PV-10 to additional uninjected hepatic lesions ≥6 weeks after prior injection. The primary endpoint is safety. Secondary endpoints include objective response rate assessed by independent review of contrast enhanced CT and by 68 Ga-DOTATATE PET. Results: Cohort 1 has fully enrolled, with 4 of 6 pts male, median age 65 yrs, range 47-72. Primary sites were: small bowel 3, pancreas 2, caecal 1. NET grade: Gd1 = 5, Gd2 = 1. All pts had progressed on prior SSA and PRRT. Median baseline CgA was 645 (range 30-2819). One pt received 4 PV-10 treatment cycles, 1 received 2 cycles, and 4 received a single cycle. Toxicity was acceptable, including transient pain post procedure, carcinoid flare and nausea. A partial response of injected lesions was observed in 50% of pts (injected lesion progression in 1 pt), with an overall response of stable disease achieved in 84% of pts by RECIST 1.1 (progressive disease in 1 pt). Progression free survival (PFS) was not reached by CT (range 2.4-25.3+ months), and was 6.1 months by PET. Median overall survival (OS) was ≥22.5 months, with three subjects alive at the data cut-off of Jan 2020 (range 18.1-33.8 months). Conclusions: Hepatic IL PV-10 elicited no safety concerns with encouraging evidence of both local response of injected tumors and prolonged systemic disease control in some pts. Enrolment to Cohort 2 is nearing completion where an additional 6 pts may receive injection of multiple lesions per treatment cycle. Clinical trial information: NCT00986661 .
Predicting residual tumor for T1 high-grade bladder urothelial carcinoma before second transurethral resection specimens.
Authors: Ario Takeuchi, Masaki Shiota, Junichi Inokuchi, Masatoshi Eto
Journal: Journal of Clinical Oncology (2020)

e17018 Background: Second transurethral resection (TUR), which is now recommended for all T1 high-grade bladder urothelial carcinoma, may not be necessary for patients with minimal tumor burden at the first TUR. T1 microstaging by the recognition of the muscularis mucosae or vascular plexus may be one promising method for evaluating tumor burden, but is sometimes technically difficult to assess. The number of TUR chips with tumor invading into lamina propria (T1chips) is easy to assess and can be available for all patients with T1 bladder urothelial carcinoma. Our aim was to determine clinicopathological factors which can predict the existence of residual tumor on the second TUR specimens for T1 high-grade bladder urothelial carcinoma. Methods: A total of 50 patients were diagnosed with T1 high-grade bladder urothelial carcinoma after the first TUR. We performed second TUR for the 50 patients. The median interval from the first and the second TUR was 6 week (range, 2-10). Voided urine cytology was taken in all patients between the first and the second TUR, at least 1 week after the first TUR. The existence of proper muscle tissue was confirmed in all specimens for the first and the second TUR. Tumor size, the number of tumor, the presence of carcinoma in situ (CIS), the number of TUR chips containing lamina propria invasion (T1chips) were recorded for the first TUR specimens. Results: A total of 20 (40%) patients had residual tumor on the second TUR. The second TUR stage was: T0 30 (60%); Ta/is 7 (14%); T1 9 (18%); and T2 4 (8%), respectively. In univariate analysis, positive urine cytology before the first TUR (48% vs 0% in negative), positive urine cytology between the first and second TUR (76% vs 21% in negative), and multiple T1 chips on the first TUR specimens (58% vs 6% in one T1 chip) were associated with residual tumor on the second TUR. In addition, in multivariate analysis, the number of T1 chips on the first TUR and urine cytology between the first and the second TUR were the significant predictors for residual tumor on the second TUR. Of 15 patients with multiple T1 chips and positive urine cytology between the first and the second TUR, 13 (87%) had residual tumor on the second TUR, compared to 0% (0/15) in those with one T1 chip and negative urine cytology between the first and the second TUR. Conclusions: Second TUR may not be necessary for all patients with T1 high-grade bladder urothelial carcinoma. The number of T1 chips on the first TUR and urine cytology between the first and the second TUR are useful factors for predicting second TUR stage.