tbuckley/cabot-search huggingface dataset:
Prevalence of overweight and prediabetes in men receiving systemic therapies for metastatic prostate cancer.
Authors: Warner Finstad, Raimundas Galiauskas, James Cook, Kate Murphy, Derbrenn O'Connor, Eoin O Sullivan, Geraldine Markey, Conleth G. Murphy
Journal: Journal of Clinical Oncology (2018)

289 Background: Patients with metastatic prostate cancer receive several therapies which may be associated with a tendency to overweight and impaired glucose tolerance. These include androgen deprivation therapy and long term steroid therapy. We set out to assess the prevalence of overweight and diabetes/prediabetes in a cohort of patients attending an oncology day ward for a variety of systemic therapies. Methods: We performed a retrospective review of the medical records of men attending an oncology day ward for prostate cancer treatment. As part of their usual care, these men had regular height and weight checks and also had periodic hemoglobin A1C (HbA1C) measurements performed. The prevalence of prediabetes and diabetes in this patient population was assessed from the HbA1C results using the American Diabetes Association 2016 definitions. Information on patient steroid use (and type), and treatment type were also recorded. Results: Among 34 men with metastatic prostate cancer, the mean age was 74 (range 57-88). Therapies received included androgen deprivation therapy in all cases, with chemotherapy or novel androgen receptor pathway inhibitors such as abiraterone and enzalutamide. Only 12% had a pre-existing diagnosis of diabetes mellitus (all type 2). The majority (79%) are overweight or obese. 59% have pre-diabetes as per the American Diabetes Association 2016 Guidelines, while a further 24% meet criteria for diabetes. Only 18% have HbA1c in the normal range. 56% are on continuous long term steroid therapy, usually as part of their prostate cancer therapy. A further 23% receive intermittent steroids. Only 21% had received no steroids in the 6 months prior to first HbA1C check. 18% had castrate-sensitive disease and 82% had castrate resistant disease. Even among patients with castrate sensitive disease, 2/3 had abnormal HbA1c values. Conclusions: Overweight and prediabetes are very prevalent in men receiving systemic therapies for metastatic prostate cancer. A large percentage of men are on long-term steroid therapy which may be contributing to their risk of these conditions. Intervention is required for this group of patients to reduce the impact of therapy on cardiovascular and overall health.
Stronger US gun laws are linked to lower homicide and suicide rates
Authors: Jacqui Wise
Journal: BMJ (2018)

US states with the strictest gun laws have lower rates of firearm homicides and suicides than states with more relaxed laws, an observational study published in JAMA Internal Medicine shows.1

In 2015 some 36 352 deaths from firearms occurred in the United States: 22 018 (60.6%) from suicide and 12 979 (35.7%) from homicide. The overall death rate from firearms was 11.3 per 100 000, but the rate varies among states, from a low of 3.1 in Massachusetts to a high of 20.4 …
Metal-based <i>NanoEnhancers</i> for Future Radiotherapy: Radiosensitizing and Synergistic Effects on Tumor Cells
Authors: Yan Liu, Pengcheng Zhang, Feifei Li, Xiaodong Jin, Jin Li, Weiqiang Chen, Qiang Li
Journal: Theranostics (2018)

Radiotherapy is one of the major therapeutic strategies for cancer treatment. In the past decade, there has been growing interest in using high Z (atomic number) elements (materials) as radiosensitizers. New strategies in nanomedicine could help to improve cancer diagnosis and therapy at cellular and molecular levels. Metal-based nanoparticles usually exhibit chemical inertness in cellular and subcellular systems and may play a role in radiosensitization and synergistic cell-killing effects for radiation therapy. This review summarizes the efficacy of metal-based
Make reports on medical schools more accessible to students and trainees, GMC says
Authors: Abi Rimmer
Journal: BMJ (2014)

Reports from the General Medical Council (GMC) on the quality of medical schools and medical training should be made more accessible to medical students and doctors in training, an internal GMC report has recommended.

The GMC has reviewed its arrangements for quality assuring medical education and training that took place in 2012-13.1 It said that the review was needed after its merger in 2010 with the Postgraduate Medical Education and Training Board. At that point the GMC took responsibility for regulating undergraduate and postgraduate medical education and training. 

The review concluded that the GMC’s reporting mechanisms …
Comparative effectiveness of <i>nab</i>-paclitaxel plus gemcitabine versus FOLFIRINOX in metastatic pancreatic cancer: A nationwide chart review in the United States.
Authors: Sunnie S. Kim, James Signorovitch, Hongbo Yang, Oscar Patterson-Lomba, Cheryl Xiang, Brian Ung, Monika Parisi, John Marshall
Journal: Journal of Clinical Oncology (2018)

376 Background: nab-Paclitaxel plus gemcitabine ( nab-P+G) and FOLFIRINOX (FFX) are among the most common first-line (1L) therapies for metastatic adenocarcinoma of the pancreas (mPC), yet there is no head-to-head trial comparing their efficacy and real-world data is limited. As new second-line (2L) therapies become available, it is important to understand the real-world effectiveness associated with different treatment sequences. Methods: This retrospective cohort study compared the efficacy and safety of 1L nab-P+G vs. FFX, overall and under specific treatment sequences. Medical records were reviewed by 215 physicians across the US who provided information for mPC patients who initiated 1L with nab-P+G or FFX between 04/01/2015-12/31/2015. The outcomes of interest were overall survival (OS) and tolerability. OS was evaluated using Kaplan-Meier curves, and compared between cohorts using Cox proportional hazards model adjusting for baseline characteristics. Results: Medical records were reviewed for 654 patients receiving nab-P+G (n = 337) or FFX (n = 317) as 1L therapy for mPC. Patients in the nab-P+G cohort were older, less likely to have ECOG ≤ 1 and had more comorbidities than patients in the FFX cohort. There was no statistically significant difference in OS (adjusted HR = 0.99, p = 0.96), with median OS (mOS) being 12.1 and 13.8 months for nab-P+G and FFX, respectively. Among the subgroup of patients with ECOG ≤ 1, mOS was 14.1 and 13.7 months, respectively (adjusted HR = 1.00, p = 0.99). Among patients with 1L nab-P+G and FFX, 36.1% and 41.3% received 2L therapy and experienced mOS of 16.3 and 16.6 months, respectively (HR = 1.04, p = 0.76). Among commonly observed adverse events (AEs) (≥ 5% of patients in both cohorts), the rates of diarrhea, fatigue, mucositis, nausea and vomiting were higher in the FFX than nab-P+G cohort (all p &lt; 0.05). Conclusions: In a nationwide sample of mPC patients, real-world survival outcomes were similar between patients receiving 1L nab-P+G or FFX. both overall and among patients who went on to receive active 2L treatments. In addition, nab-P+G was associated with significantly lower rates of common AEs compared with FFX.
Clinical skills in spinal assessment and management
Authors: Samena Chaudhry, Peter A Bodkin
Journal: BMJ (2009)

The clinical skills in spinal assessment and management course was produced by the Raven Department of Education at the Royal College of Surgeons. Its aim is to teach trainees to assess and initially manage patients presenting with spinal conditions in the emergency department, outpatient, and ward settings. Courses are held twice a year, usually at the college but sometimes at other venues.

This course is specifically aimed at orthopaedic and neurosurgical trainees at specialty trainee 2 level and above, but is also suitable for anyone who is likely to have a day to day commitment to the care of patients who have had a spinal injury or who need elective or emergency spinal surgery. Indications for spinal surgery are expanding, as illustrated by the recent guidance from the National Institute for Health and Clinical Excellence on management of metastatic spinal cord compression.1 The ageing of the population means that increasing numbers of people need decompression for stenosis, often combined with correction of degenerative scoliosis. It is essential that …
Glioma patients prefer cognitive function assessment by a tablet based application over paper format testing
Authors: Rohitashwa Sinha, Rocio Fernandez Mendez, Rebecca Rastall, Jessica Ingham, Tom Manly, Stephen Price
Journal: Neuro-Oncology (2018)

To compare the use of a tablet based application to test cognitive function in low grade glioma patients with traditional paper format testing administered by neuropsychologists. We used well-validated tests of cognitive function via a tablet based application spanning all cognitive domains to prospectively assess 6 low grade glioma patients before and after resection surgery. The tablet tests were administered by research nurses and a research fellow, but did not require a neuropsychologist. The same patients also underwent traditional paper format cognitive testing by a neuropsychologist as part of their routine clinical care. The results of the two formats of testing were compared to analyse sensitivity for assessment of cognitive deficits and the patients completed a questionnaire about their experience and preference of the two formats. Both tablet and paper cognition testing formats longitudinally detected the mild to moderate deficits before and after surgery, which were most commonly in attention, memory and executive function domains. Via the questionnaire to assess the patients’ experience of both formats, they reported the tablet based tests to be faster, easier to understand and to their preference. This cohort of low grade glioma patients had mild to moderate cognitive deficits that spanned multiple domains prior to resection surgery. Additional cognitive deficits were found after surgery in all patients across multiple domains and were detected by both paper and tablet testing formats. The patients preferred tablet based cognitive testing and report it as being easier to understand and quicker to complete than traditional paper based formats. The efficiency of the tablet based format may enable greater access to objective cognitive testing for patients with brain tumours of all histological types during their treatment, especially given the paucity of neuropsychology resources available in the NHS to administer the paper based tests.
MEASUREMENT OF LEFT END DIASTOLIC PRESSURE IMPROVES PROGNOSTIC UTILITY OF GLOBAL REGISTRY OF ACUTE CORONARY EVENTS SCORE IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Daiga Saito, Takanori Ikeda, Mikihito Toda, Hideo Amano, Rine Nakanishi, Ryo Okubo, Ippei Watanabe
Journal: Journal of the American College of Cardiology (2018)
Development of prostate-specific antigen (PSA) screening nomograms for 15-year prediction of prostate cancer diagnosis (PCDx), mortality (PCM), and all-cause mortality (ACM).
Authors: Michael Austin Brooks, Sigrid V. Carlsson, Alexander Zajichek, Kevin M. Chagin, Jonas Hugosson, Michael W. Kattan, Andrew J. Stephenson
Journal: Journal of Clinical Oncology (2018)

110 Background: Recommendations for PSA screening encourage shared decision making between patients and providers, rather than population-based screening. Nomograms provide individualized risk predictions potentially enhancing informed decisions to undergo screening. Our objective was to develop PSA screening nomograms using demographic and follow-up data from two large randomized screening trials: the Göteborg Screening Trial ( Lancet Oncol. 2010;11:725-32) and Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial ( N Engl J Med. 2009;360:1310-9). The endpoints of the models were PCDx, PCM, and ACM at 15 years. Methods: Patients with screening prior to trial entry were excluded, leaving 59,951 total subjects: 19,899 and 40,052 from Göteborg and PLCO, respectively. Demographic information including age, family history of PCDx, ethnicity, Charlson Comorbidity Index, marital status, education, and control vs. screening arm were used as predictive variables. If screened, baseline PSA was used as an additional continuous variable. Models for ACM were first developed, then models predicting PCDx and PCM using competing risk analysis. Predictive accuracy was assessed using the concordance index (c-index) and calibration plots. Results: On multivariable analysis, all variables were significant (P &lt; 0.05) for predicting at least one outcome. Nomograms predicting PCDx, PCM, and ACM demonstrated reasonable discrimination: c-index 0.60, 0.65, 0.70, respectively. When a single baseline PSA was included, discriminative accuracy improved for PCDx and PCM, but remained the same for ACM: c-index 0.78, 0.74, 0.69, respectively. Estimates were well-calibrated for all endpoints. Conclusions: Using demographic information, we developed PSA screening nomograms, with good discrimination and calibration in predicting all three outcomes. A single baseline PSA improved nomogram discrimination substantially for PCDx and PCM. We will study the implementation of these nomograms into clinic practice to aid decisions for previously unscreened patients, or whether to continue PSA screening for patients with a known prior PSA.
O004 NIK-IKK complex controls NF-ΚB-dependent inflammatory activation of the endothelium in response to LTΒR ligation
Authors: P Kucharzewska, KCM Jeucken, CX Maracle, JP van Hamburg, H Olsson, SW Tas
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Introduction</h3> Sites of chronic inflammation, such as rheumatoid arthritis (RA) synovial tissue, often contain tertiary lymphoid structures with high endothelial venules (HEV). Ligation of the lymphotoxin (LT)-β receptor (LTβR) results in activation of canonical and NF-κB-Inducing Kinase (NIK)-dependent noncanonical NF-κB signalling in endothelial cells (EC), leading to HEV development. However, the relative contribution of the individual NF-κB pathways to inflammatory activation of EC is largely elusive. <h3>Objectives</h3> To identify the molecular pathways by which LTβR drives inflammatory activation of EC to promote interaction with leukocytes. <h3>Methods</h3> Primary human EC were treated with LTβ or LIGHT to activate LTβR, followed by analysis of downstream NF-κB signalling pathways and expression of adhesion molecules and inflammatory cytokines. To repress canonical NF-κB signalling pathway, a small molecule inhibitor of IKKβ was used, and noncanonical NF-κB signalling was repressed with siRNAs targeting NFκB2. The role of NIK in LTβR signalling was investigated using small molecule inhibitors and siRNAs targeting NIK, as well as adenoviral overexpression of NIK. The role of NF-κB signalling in RA was measured by stimulating EC with RA synovial fluid (RASF) followed by analysis of inflammatory mediators. <h3>Results</h3> LTβR-triggering in EC resulted in activation of both canonical and noncanonical NF-κB signalling, and induced inflammatory cytokine expression and immune cell adhesion. IKKβ inhibition repressed LTβR-induced inflammatory activation of EC, indicating that this process was mediated through canonical NF-κB signalling. Interestingly, inactivation of NIK also decreased LTβR-induced expression of inflammatory cytokines and leukocyte-adhesion, but silencing of NFκB2 had no apparent effect. Further analyses, including silencing and overexpression of NIK, demonstrated a clear role for NIK in activation of the canonical NF-κB pathway by amplifying IKK complex activity. RASF stimulation of EC resulted in activation of canonical and noncanonical NF-κB signalling, and increased the expression of inflammatory cytokines and adhesion molecules, which could be blocked by targeting NIK. <h3>Conclusions</h3> These findings suggest that in addition to regulating noncanonical signalling, NIK can serve as an amplifier of canonical NF-κB signalling and associated inflammatory responses in EC, which may play a role in development and maintenance of chronic inflammation. Consequently, NIK may be an attractive therapeutic target. <h3>Disclosure of interest</h3> P. Kucharzewska Employee of: Employed by AstraZeneca, K. Jeucken: None declared, C. Maracle: None declared, J. P. van Hamburg: None declared, H. Olsson Employee of: Employed by AstraZeneca, S. Tas: None declared
Abstract 13266: Non-contrast 3D Magnetic Resonance Imaging Offers and Alternative to Contrast Enhanced Multisclice Computed Tomography for Correct Aortic Valve Sizing in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Peter Bernhardt, Christoph Rodewald, Julia Seeger, Birgid Gonska, Dominik Buckert, Wolfgang Rottbauer, Jochen Wöhrle
Journal: Circulation (2015)

Introduction: For successful transcatheter aortic valve implantation (TAVI) correct sizing of the aortic annulus and left ventricular outflow tract in aortic valve stenosis is crucial. With multislice computed tomography (MSCT) 3D volume data sets of the aorta could be acquired in high spatial resolution, but the comorbid patients are exposed to nephrotoxic contrast agents leading to kidney injury in many cases. Hypothesis: The purpose of this study was to establish a useful method for sizing for TAVI without the use of contrast media. With MSCT serving as a the reference standard, we compared measurements of a non-contrast 3D steady-state free-precession (SSFP) magnetic resonance (MRI) for correct annulus sizing and decision for valve size. Methods: We examined 52 patients previous to TAVI with MSCT using a 256-MSCT and a 1.5 Tesla whole-body MRI scanner, respectively. MRI examination included a 3D SSFP sequence covering the entire ascending aorta. The 3D images of both imaging modalities were reconstructed for correct orthogonal view of the aortic annulus using a dedicated software (3mensio, Pie Medical Imaging, The Netherlands). Minimal and maximal annulus diameters, annulus perimeters, and areas of both imaging modalities were analyzed by two blinded and experienced readers in consensus. Virtual decision for valve size (Edwards Sapien 3) was based on the median of these diameters. Results: Mean age of the study cohort was 82.2±4.9 years, 32 (61.5%) were female. Log EuroScore was 25.2±4.8%. Mean annulus perimeter measured by MSCT was 76.7±6.9 mm, by MRI 76.5±6.7 mm (r=0.93, p&lt;0.0001). MSCT yielded a mean annulus area of 545.2±49.0 mm2 with good correlation to MRI, which resulted in a mean area of 543.5±47.0 mm2 (r=0.92, p&lt;0.0001). Decision for Sapien 3 valve size showed good correlation between MSCT and MRI (r=0.94, p&lt;0.0001). Conclusions: In conclusion, non-contrast 3D SSFP MRI shows good correlation to MSCT in the assessment of the aortic annulus and valve sizing for TAVI. The non-contrast MRI approach might be a reasonable alternative for aortic root sizing before TAVI without the use of nephrotoxic contrast agents, especially in patients with reduced kidney function.
CONSISTENCY OF LDL-C REDUCTION WITH EVOLOCUMAB: AN ANALYSIS FROM FOURIER
Authors: Arman Qamar, Robert P. Giugliano, Anthony C. Keech, Julia F. Kuder, Sabina A. Murphy, Thomas Liu, Christopher Kurtz, Scott M. Wasserman, Peter S. Sever, Terje R. Pedersen, Marc S. Sabatine
Journal: Journal of the American College of Cardiology (2018)
Medial tibial stress syndrome: diagnosis, treatment and outcome assessment (PhD Academy Award)
Authors: Marinus Winters
Journal: British Journal of Sports Medicine (2018)

My PhD consisted of three principal studies: (1) I investigated the reliability of diagnosing medial tibial stress syndrome (MTSS) using history and physical examination. (2) Then, I examined if there is an evidence-based treatment for MTSS in a systematic review. (3) Finally, I developed and validated a new patient-reported outcome measure (PROM) for athletes with MTSS: the MTSS score.

MTSS is one of the most common conditions in running athletes. Yet, it was unknown how to best diagnose (1) or treat it (2) and there was no PROM for athletes with MTSS (3). In particular:

1.  MTSS: a clinical diagnosis?
        The pathology of MTSS is equivocal; it’s a clinical pain condition. Therefore, making the diagnosis based on history and physical examination is the most logical approach. However, it was unclear if this can be done …
A career as a British trainee psychiatrist
Authors: Yasir Abbasi
Journal: BMJ (2006)

It was refreshing to read Amin Muhammed Gadit's Article “A Career as a Canadian Pychiatrist.”1

In the current climate where a new system of training will be introduced and the number of training posts is being reduced, knowing that we can build our careers somewhere else feels like a breath of fresh air.

Recently, I have seen a lot of my colleagues from overseas leave for Australia, Canada, and the United …
Disposal of Paper Records Containing Personal Information in Hospitals
Authors: Joshua Kapil Ramjist, Natalie Coburn, David Robert Urbach, Anand Govindarajan, Kathleen Anne Armstrong, Audrey Lynn Scott, Nancy Noel Baxter
Journal: JAMA (2018)

Disposal of Paper Records Containing Personal Information in HospitalsPatients have the right to expect safekeeping of personal information.In Ontario, as in many jurisdictions, protection of personal health information (PHI) is codified in legislation. 1 With patient information increasingly maintained in the electronic health record (EHR), paper records are frequently discarded, creating risk of paper-based privacy breaches.We assessed the presence, amount, and sensitivity of personally identifiable information (PII) and PHI (a subset of PII) found in hospital recycling bins.Methods | We conducted a recycling audit 2 of 5 teaching hospitals in Toronto, Ontario, Canada, from November 2014 to May 2016.Each institution's research ethics board determined that this study did not qualify as human subjects research.All hospitals had established PHI policies; for paper disposal, each hospital had recycling bins, garbage, and, for confidential information, secure shredding receptacles.At each site, all recycling was collected at least 3 times per week over 4 weeks from predesignated locations, including inpatient wards, outpatient clinics, emergency departments, physician offices, and intensive care units.Using definitions from the Personal Health Information Protection Act of Ontario, we considered PII information "that identifies an individual or for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify an individual."When coupled with information related to medical care, the items were considered PHI.
BMA hopes ballot will force contract change without need for strike
Authors: Abi Rimmer
Journal: BMJ (2015)

The BMA hopes that balloting junior doctors over industrial action will itself pressure ministers into changing their plans to impose a new contract on junior doctors in England.

The BMA will ballot junior doctors on industrial action from Thursday 5 November.1 The association has said that from this date ballot papers would arrive with junior doctor members who were eligible to vote in the ballot. The ballot will close on Wednesday 18 November.

Speaking to the BMJ Live event in London on Friday 23 October, Johann Malawana, chair of the BMA’s Junior Doctors Committee, said that the exercise of balloting junior doctors was about increasing the pressure on the government.

“This is all about pressure,” he said. “What we …
Revalidation has increased appraisal rates among SAS doctors
Authors: Abi Rimmer
Journal: BMJ (2014)

Preparation for revalidation has improved rates of appraisal among staff, associate specialist, and specialty (SAS) doctors, the General Medical Council has said.

Una Lane, the GMC’s director of registration and revalidation, presented figures on this increase in appraisals at an Academy of Medical Royal Colleges conference for SAS doctors in London on Friday. She said that appraisal rates among SAS doctors had increased since March 2011, when the GMC …