MS

thesisThe effect of computer-reported clinical information on the cardiologist's behavior in the interpretation of electrocardiograms (ECGs) was studied using 100 inpatient ECGs. Using an automated medical record system (HELP), the pertinent demographic and clinical information was printed on a clinical label. Two cardiologists independently read these 100 ECGs twice, once without the label and once with the label provided. A sample of twenty-five ECGs was chosen from the 100 ECGs for estimation of intraobserver variability. These twenty-five ECGs were independently read again with and without the clinical label. An appropriate time delay between the readings was allowed to insure independence of the readings. The following results were observed: (a) The myocardial infarction (MI) and chamber enlargement interpretations, the intraobserver variability of one cardiologist was reduced from 25 percent to 14.7 percent and a corresponding decrease from 22.7 percent to 6.7 percent for the other cardiologist. Statistically, the decreases in both cases were found to be significant. (b) The overall inter-observer variation showed statistically insignificant reduction (16.3 percent to 13 percent). However, for MI interpretation, the corresponding reduction from 24 percent to 13 percent might be clinically significant. (c) For MI, chamber enlargement and repolarization change interpretations; the frequency of agreement between the cardiologists was approximately 2.00 times that of the disagreement in the diagnoses. (d) For the interpretation of repolarization changes in the twenty-five ECGs, the frequency of changes from nonspecific to a specific interpretation increases from 2 percent to 36 percent after the introduction of the clinical label. Therefore, it was concluded that the availability of demographic and clinical information in a total hospital information system provides useful data to the cardiologist for the interpretation of ECGs

MS

thesisThe effect of computer-reported clinical information on the cardiologist's behavior in the interpretation of electrocardiograms (ECGs) was studied using 100 inpatient ECGs. Using an automated medical record system (HELP), the pertinent demographic and clinical information was printed on a clinical label. Two cardiologists independently read these 100 ECGs twice, once without the label and once with the label provided. A sample of twenty-five ECGs was chosen from the 100 ECGs for estimation of intraobserver variability. These twenty-five ECGs were independently read again with and without the clinical label. An appropriate time delay between the readings was allowed to insure independence of the readings. The following results were observed: (a) The myocardial infarction (MI) and chamber enlargement interpretations, the intraobserver variability of one cardiologist was reduced from 25 percent to 14.7 percent and a corresponding decrease from 22.7 percent to 6.7 percent for the other cardiologist. Statistically, the decreases in both cases were found to be significant. (b) The overall inter-observer variation showed statistically insignificant reduction (16.3 percent to 13 percent). However, for MI interpretation, the corresponding reduction from 24 percent to 13 percent might be clinically significant. (c) For MI, chamber enlargement and repolarization change interpretations; the frequency of agreement between the cardiologists was approximately 2.00 times that of the disagreement in the diagnoses. (d) For the interpretation of repolarization changes in the twenty-five ECGs, the frequency of changes from nonspecific to a specific interpretation increases from 2 percent to 36 percent after the introduction of the clinical label. Therefore, it was concluded that the availability of demographic and clinical information in a total hospital information system provides useful data to the cardiologist for the interpretation of ECGs

The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer

Introduction: Older patients experience a higher risk of treatment-related toxicity (TRT). The G8 screening tool was developed to separate cancer older patients fit to receive standard treatment from those who are frail and experiencing functional decline due to reduced organ function and multiple comorbidities. The Cancer and Aging Research Group chemotherapy toxicity tool (CARG-tt) questionnaire was developed to predict chemotherapy toxicity in geriatric patients. This prospective observational study evaluated the performance of G8 and CARG-tt in predicting severe TRT in older Chinese cancer patients. Methods: Chinese patients aged ≥65 with a diagnosis of solid malignancy and scheduled to receive anti-cancer treatment (chemotherapy or targeted therapy) were enrolled from March 2016 to July 2017 at the Department of Clinical Oncology at Queen Mary Hospital in Hong Kong. All patients completed the G8 and CARG-tt screening and pre-treatment assessments before starting treatment. Patients were monitored for any severe TRT, which was defined by grades 3–5 using the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03, treatment discontinuation, or unexpected hospitalization from starting to 30 days after treatment. Results: A total of 259 patients (male: 154, 59.5%; median age: 73.4, age range: 65–93) were enrolled in the study. Two hundred and ten (81.1%) patients received chemotherapy while the rest (n = 49, 18.9%) received targeted therapy. Overall, 146 patients (56.8%) experienced severe TRT. The mean G8 score was 12.4 (SD: 2.8). The G8 score had a significant association with unexpected admission (cutoff: 14, 41.3% vs. 26.5%, p = 0.03) but not significant in other types of TRTs. The mean CARG-tt score was 7.67 (SD: 3.7); it was not associated with severe TRTs. Conclusions: The G8 and CARG-tt demonstrated a weak prediction of severe TRT in older Chinese cancer patients. Future studies need to develop predictive tools for TRT in patients receiving novel antineoplastic therapies, with a focus on subgroup analysis for different populations

Changes in agricultural policies in communist China, 1949-1960: an historical analysis

published_or_final_versionComparative Asian StudiesMasterMaster of Art

Bisphosphonates for advanced prostate cancer

Background The prevalence and incidence of pain and skeletal complications of metastatic bone disease such as pathologic fractures, spinal cord compression and hypercalcemia is high and an important contributor to morbidity, poor performance status and decreased quality of life. Moreover, pathologic fractures are associated with increased risk of death in people with disseminated malignancies. Therefore, prevention of pain and fractures are important goals in men with prostate cancer at risk for skeletal complications. Objectives To assess the effects of bisphosphonates in men with bone metastases from prostate cancer. Search methods We identified studies by electronic search of bibliographic databases including the Cochrane Controlled Trials Register and MEDLINE on 13 July 2017 and trial registries. We handsearched the Proceedings of American Society of Clinical Oncology (to July 2017) and reference lists of all eligible trials identified. This is an update of a review last published in 2006. Selection criteria We included randomized controlled studies comparing the effectiveness of bisphosphonates in men with bone metastases from prostate cancer. Data collection and analysis Two review authors independently extracted data and assessed the quality of trials. We defined the proportion of participants with pain response as the primary end point; secondary outcomes were skeletal-related events, mortality, quality of life, adverse events, analgesic consumption and disease progression. We assessed the quality of the evidence for the main outcomes using the GRADE approach. Main results We included 18 trials reporting on 4843 participants comparing the effect of bisphosphonate administration to control regimens. Primary outcome: there was no clear difference in the proportion of participants with pain response (RR 1.15, 95% CI 0.93 to 1.43; P = 0.20; I-2 = 0%; 3 trials; 876 participants; low quality evidence). In absolute terms, bisphosphonates resulted in a pain response in 40 more participants per 1000 (19 fewer to 114 more). Secondary outcomes: bisphosphonates probably reduced the incidence of skeletal-related events in participants with prostate cancer metastatic to bone (RR 0.87, 95% CI 0.81 to 0.94; P = 0.27; I-2 = 19%; 9 trials; 3153 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 58 fewer SREs per 1000 (85 fewer to 27 fewer). We found no clinically relevant differences in mortality (RR 0.97, 95% CI 0.91 to 1.04; P = 0.43; I-2 = 1%; 9 trials; 2450 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 16 fewer deaths per 1000 (47 fewer to 21 more). Outcome definition of quality of life and themeasurement tools varied greatly across trials and we were unable to extract any quantitative data for meta-analysis. Bisphosphonates probably increased the number of participants affected by nausea (RR 1.19, 95% CI 1.00 to 1.41; P = 0.05; I-2 = 0%; 9 trials; 3008 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in seven more cases of nausea per 1000 (0 fewer to 14 more). Bisphosphonates probably increased the number of renal adverse events (RR 1.65, 95% CI 1.11 to 2.46; P = 0.01; I-2 = 0%; 7 trials; 1794 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 22 more renal adverse events per 1000 (4 more to 50 more). We found no clear difference in the number of participants with osteonecrosis of the jaw between groups (RR 1.92, 95% CI 0.75 to 4.90; P = 0.17; I-2 = 0%; 5 trials; 1626 participants; very low quality evidence). In absolute terms, bisphosphonates resulted in seven more cases with osteonecrosis of the jaw per 1000 (2 fewer to 29 more). We observed no clinically relevant difference in the proportion of participants with decreased analgesic consumption (RR 1.19, 95% CI 0.87 to 1.63; P = 0.28; I-2 = 37%; 4 trials; 416 participants). Statistical analysis revealed that bisphosphonates probably reduced the number of participants with disease progression (RR 0.94, 95% CI 0.90 to 0.98; P = 0.006; I-2 = 0%; 7 trials; 2115 participants; moderate quality evidence). In absolute terms, bisphosphonates resulted in 36 fewer cases of disease progression per 1000 (71 fewer to 7 fewer). Findings of our predefined subgroup and sensitivity analyses were no different from those of the primary analyses. Authors' conclusions Based on low quality evidence, there may be no clinically relevant difference in the proportion of men with pain response between bisphosphonates and control regimens inmenwith bonemetastases fromprostate cancer. Bisphosphonates probably decrease the number of skeletal-related events and disease progression. These benefits need to be weighed against the increased risk of renal impairment and nausea in men receiving bisphosphonates. Future studies should explicitly evaluate patient important outcomes such as quality of life and pain by using standardized and comparable assessment tools

Confirmation of the First Hong Kong Case of Human Infection by Novel Swine Origin Influenza A (H1N1) Virus Diagnosed Using Ultrarapid, Real-Time Reverse Transcriptase PCR▿

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