tbuckley/cabot-search huggingface dataset:
Abstract MS2-3: Tailoring systemic therapy for patients with lobular breast cancer
Authors: MA Colleoni
Journal: Cancer Research (2018)

Abstract Recent developments in breast cancer treatment include an increasing awareness of the role of systemic therapies in selected subgroups of patients. A consequence of this strategy is the importance of accurate and reliable histopathological assessment. Through the identification of lobular breast cancer, that account for up to 15% of all invasive breast carcinomas, it is possible to select patients with correlates of responsiveness to therapy other than important indicators of outcome. It was in fact demonstrated that the response to neoadjuvant chemotherapy is significantly lower in lobular breast carcinomas, if compared with the ductal histotype. Also the value of adjuvant chemotherapy in lobular carcinomas was recently questioned, while the magnitude of the effect of adjuvant trastuzumab is similar in lobular and ductal breast cancer. The diagnosis of lobular breast cancer might be relevant also for the selection of endocrine agents in the adjuvant treatment. In particular the relative effectiveness of letrozole compared with tamoxifen was shown to be greater for patients diagnosed with lobular breast cancer. Nevertheless, the use of available information has been limited in tailoring therapy on patients with the lobular subtype, due to the relative rarity of the disease, the absence of prospective studies and the limited number and size of retrospective analysis. The development of effective therapies for these patients should not rely on information mainly contributed from small retrospective analyses. Prospective tailored research through international cooperation is key to make progress and reach consensus on how to treat individual patients with lobular breast carcinomas. Citation Format: Colleoni MA. Tailoring systemic therapy for patients with lobular breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr MS2-3.
Inpatient Dermatologists—Crucial for the Management of Skin Diseases in Hospitalized Patients
Authors: Megan H. Noe, Misha Rosenbach
Journal: JAMA Dermatology (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Survival following upfront cytoreductive nephrectomy versus targeted therapy for metastatic renal cell carcinoma.
Authors: Bimal Bhindi, Elizabeth Butzer Habermann, Ross Mason, Brian Addis Costello, Lance C. Pagliaro, Robert Houston Thompson, Bradley C. Leibovich, Stephen A. Boorjian
Journal: Journal of Clinical Oncology (2018)

672 Background: The optimal sequence of cytoreductive nephrectomy (CN) and targeted therapy (TT) for patients with metastatic renal cell carcinoma (mRCC) remains to be established. Herein, we compared overall survival (OS) between patients with mRCC receiving initial CN with or without subsequent TT versus initial TT with or without subsequent CN. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed between 2006-2013 with RCC that was metastatic at diagnosis who received CN, TT, or both. Those with other prior cancer history were excluded. The cumulative incidence of receiving TT after CN and CN after TT were evaluated, with death prior to second treatment as a competing risk. To account for treatment selection bias, inverse probability of treatment weighting (IPTW) was performed based on the propensity to receive initial CN or TT. OS from diagnosis was compared using Cox regression. Sensitivity analyses were performed. Results: The cohort included 15,068 patients, of whom 6,731 underwent initial CN and 8,337 underwent initial TT. At 6 months from diagnosis, the probability of receiving TT after CN was 46.2%, with 13.6% of patients having died after initial CN prior to receiving TT. Meanwhile, the probability at 6 months of undergoing CN after initial TT was 4.4%, with 38.3% of this group having died prior to undergoing CN. In the IPTW analysis, baseline characteristics were balanced (standardized difference &lt; 0.1). Initial CN was associated with improved OS compared to initial TT (median 16.5 vs 9.2 months; HR 0.62; 95%CI 0.61-0.64; p &lt; 0.001). Findings were similar in all sensitivity analyses (propensity score matching and adjustment; regression adjustment; 6-month landmark analysis; clear cell mRCC subset; exclusion of patients who had metastasectomy). Conclusions: Although initial CN was associated improved OS versus initial TT in this national dataset, initial CN was associated with delays in, and even death prior to, receipt of TT. As such, while the survival data here support initial CN in appropriate surgical candidates, continued efforts to develop the optimal multimodal approach to these patients are warranted.
EFFECTS OF INTENSIVE BLOOD PRESSURE CONTROL IN PATIENTS WITH EVIDENT CARDIOVASCULAR DISEASE
Authors: Dimitrios Terentes-Printzios, Charalambos Vlachopoulos, Konstantinos Aznaourids, Nikolaos Ioakeimidis, Panagiotis Xaplanteris, George Lazaros, Dimitris Tousoulis
Journal: Journal of the American College of Cardiology (2018)
Defining cure in multiple myeloma: a comparative study of outcomes of young individuals with myeloma and curable hematologic malignancies
Authors: Praful Ravi, Shaji K. Kumar, James R. Cerhan, Matthew J. Maurer, David Dingli, Stephen M. Ansell, S. Vincent Rajkumar
Journal: Blood Cancer Journal (2018)

Abstract Advances in therapy in recent years have led investigators to challenge the dogma that multiple myeloma (MM) is incurable. We assessed overall (OS) and progression-free survival (PFS) of young patients ( ≤ 50 years) with MM and compared outcomes with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma (HL). All patients ≤ 50 years with newly diagnosed MM ( n = 212), FL ( n = 168), DLBCL ( n = 195), and HL ( n = 233) between 1 January 2005 and 31 December 2015 were included. Observed vs. expected survival was summarized by standardized mortality ratios (SMR). Compared to the background US population, excess mortality risk was seen at diagnosis in all four cancers, SMR 19.5 (15.2–24.5) in MM, 4.2 (2.3–7.2) in FL, 13.0 (9.2–18.4) in DLBCL, and 5.2 (2.6–9.3) in HL. We reasoned that cure would most likely occur in the first 3 years after diagnosis and be reflected by an overall survival probability similar to the background population. From the 36-month landmark, excess mortality risk was seen in MM (SMR 20.7 [14.7–28.3]) and FL (SMR 3.8 [1.5–7.8]), but not with DLBCL (SMR 3.1 [0.8–8.0]) or HL (SMR 0.9 [0.0–5.1]). MM patients have 20-fold excess mortality risk compared to the background population at diagnosis and at 3 years after diagnosis, suggesting that MM remains an incurable cancer.
The Significance of Flow Cytometry and Positron Emission Tomography and Computed Tomography (PET-CT) in the Assessment of the Minimum Residual Disease in Patients with Multiple Myeloma
Authors: Andrey Garifullin, Sergei Voloshin, Alexey Kuvshinov, Alexander Schmidt, Vasily Shuvaev, Yuriy Kryvolapov, Elena Belyakova, Evgeniy Krasnikov, Alexander Chechetkin
Journal: Blood (2017)
When applying for SHO or registrar posts in the United Kingdom, are UK or EU nationals preferred? Thank you.
Authors: Manoj Kumar
Journal: BMJ (2005)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site. <b>www.bmjcareers.com/advicezone</b>
Refreshingly non-pc—but honest
Authors: Alan A Woodall
Journal: BMJ (2005)

I enjoyed and agreed with Ray Lowry's article.1 As a specialist registrar in public health medicine who has spent years trying to acquire relevant clinical, epidemiological, research, and managerial experience so that I can be an effective practitioner, it galls me to have entered a specialty where mediocrity seems the current operational catchphrase.

I attend masters in public health courses where only a minority in a class of 30 (except the one …
Association of Racial/Ethnic Categories With the Ability of Genetic Tests to Detect a Cause of Cardiomyopathy
Authors: Latrice G. Landry, Heidi L. Rehm
Journal: JAMA Cardiology (2018)

Individuals of all races/ethnicities have a fundamental right to access health care and benefit from advances in science and medicine, including genetic testing.To determine whether detection rates for cardiomyopathy genetic testing differed between white people, Asian people, and underrepresented minorities (individuals of black, Hispanic, Native American, Alaskan Native, or Pacific Islander descent).We conducted a cross-sectional analysis of the genetic panel test results of 5729 probands who had a suspected diagnosis or family history of cardiomyopathy and who had been referred for testing between October 2003 and December 2017. Testing was performed at the Laboratory for Molecular Medicine at Partners Personalized Medicine in Cambridge, Massachusetts. Results were stratified into 3 categories of self-reported race/ethnicity: white, Asian, and underrepresented minorities.The primary outcome was whether a pathogenic or likely pathogenic variant was identified that explained the features or family history of cardiomyopathy. A secondary outcome was the number of test results that were inconclusive because of the presence of 1 or more variants of uncertain significance in the absence of an explanation for cardiomyopathy features or family history.A total of 5729 probands were studied (of whom 3523 [61.5%] were male). Of these, 4539 (79.2%) were white, 348 (6.1%) were Asian individuals, and 842 (14.7%) were underrepresented minorities. Positive detection occurred in 1314 white individuals (29.0%) compared with 155 underrepresented minorities (18.4%; χ21 = 39.8; P < .001) and 87 Asian individuals (25.0%; χ21 = 2.5; P = .12). Inconclusive results were found in 1115 white individuals (24.6%) compared with 335 underrepresented minorities (39.8%; χ21 = 83.6; P < .001) and 136 Asian individuals (39.2%; χ21 = 35.8; P < .001).These results show a significantly higher positive detection rate and a significantly lower rate of inconclusive results in white individuals in comparison with underrepresented minorities. This suggests greater clinical usefulness of genetic testing for cardiomyopathy in white persons in comparison with people of other racial/ethnic groups. This clear disparity warrants further study to understand the gaps in usefulness, which may derive from a lack of clinical testing and research in underrepresented minority populations, in the hopes of improving genetic testing outcomes for cardiomyopathy in nonwhite groups.
Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization
Authors: Ileana L. Piña, Qi Zheng, Lilin She, Hanna Szwed, Irene M. Lang, Pedro S. Farsky, Serenella Castelvecchio, Jolanta Biernat, Alexandros Paraforos, Dragana Kosevic, Liliana E. Favaloro, José C. Nicolau, Padmini Varadarajan, Eric J. Velazquez, Ramdas G. Pai, Nicole Cyrille, Kerry L. Lee, Patrice Desvigne-Nickens
Journal: Circulation (2018)

Background: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term benefit of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). Methods: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction ≤35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. Results: At baseline, women were older (63.4 versus 59.3 years; P =0.016) with higher body mass index (27.9 versus 26.7 kg/m 2 ; P =0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P &lt;0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P &lt;0.05). Over 10 years of follow-up, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confidence interval, 0.52–0.86; P =0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confidence interval, 0.48–0.89; P =0.006) were significantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no significant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P &gt;0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P =0.187) between sexes among patients randomized to CABG per protocol as initial treatment. Conclusions: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00023595.
When patients won’t leave or families won’t let them
Authors: David Oliver
Journal: BMJ (2018)

All clinicians in acute medical specialties probably see some patients who are medically stable but either don’t want to leave hospital or have relatives who actively or passively stop them leaving. We worry about how to handle this appropriately.

I’ve argued that doctors should rightly sometimes keep patients in a little longer if the right community services aren’t yet in place, or if they don’t feel quite well enough, if their carers are concerned, or if a move to another setting would upset them. But every decision we make about admission, discharge, or bed use has opportunity costs for other patients in need. Prolonging stays also exposes patients to many risks inherent in admission to hospital. We should minimise the number of days patients stay when hospital is no longer adding unique value.

We see inpatients whom …
DOES MUSIC IMPACT EXERCISE CAPACITY DURING CARDIAC STRESS TEST? A SINGLE BLINDED PILOT RANDOMIZED CONTROLLED STUDY
Authors: Karan Sarode, Waseem Shami, Sucheta Gosavi, Indika Mallawaarachchi, Alok Kumar Dwivedi, Debabrata Mukherjee
Journal: Journal of the American College of Cardiology (2018)
Challenges and opportunities in stroke genetics
Authors: Rainer Malik, Martin Dichgans
Journal: Cardiovascular Research (2018)

Stroke, ischaemic stroke and subtypes of ischaemic stroke display substantial heritability. When compared with related vascular conditions, the number of established risk loci reaching genome-wide significance for association with stroke is still in the lower range, particularly for aetiological stroke subtypes such as large artery atherosclerotic stroke or small vessel stroke. Nevertheless, for individual loci substantial progress has been made in determining the specific mechanisms mediating stroke risk. In this review, we present a roadmap for functional follow-up of common risk variants associated with stroke. First, we discuss in silico strategies for characterizing signals in non-coding regions and highlight databases providing information on quantitative trait loci for mRNA and protein expression, as well as methylation, focussing on those with presumed relevance for stroke. Next, we discuss experimental strategies for following up on non-coding risk variants and regions such as massively parallel reporter assays, proteome-wide association studies, and chromatin conformation capture (3C) assays. These and other approaches are relevant for gaining insight into the specific variants and mechanisms mediating genetic stroke risk. Finally, we discuss how genetic findings could influence clinical practice by adding to diagnostic algorithms and eventually improve treatment options for stroke.
INCREASED AORTIC WALL INFLAMMATION IN ADULT PATIENTS AFTER SUCCESSFUL COARCTATION REPAIR DETECTED 18F-FDG PET/CT IMAGING
Authors: Evangelos Oikonomou, Alexios Antonopoulos, Stella Brili, Iosif Cutajar, Nikoletta Pianou, George Spyrou, Emmanouil Athanasiadis, Alexandros Georgakopoulos, Pavlos Kafouris, Gerasimos Siasos, Constantinos Anagnostopoulos, Dimitris Tousoulis
Journal: Journal of the American College of Cardiology (2018)
Postgraduate diploma in medical ethics and law
Authors: Helen Dyson
Journal: BMJ (2006)

This is a part time course suitable for healthcare professionals and those working in related fields. Applicants must have a degree in a relevant subject or appropriate professional qualifications and experience.

The postgraduate diploma course at Keele University takes one academic year to complete. I did the course from September 2004 to June 2005, during my first year of specialist registrar training.

I was interested in learning more about contemporary issues in healthcare ethics and law. I want to train as a neonatologist and hoped that the course would help me deal better with the ethical problems and dilemmas I face in everyday practice. I was looking for …
Deranged Myocyte Microstructure in Situs Inversus Totalis Demonstrated by Diffusion Tensor Cardiac Magnetic Resonance
Authors: Zohya Khalique, Pedro F. Ferreira, Andrew D. Scott, Sonia Nielles-Vallespin, Philip J. Kilner, Robert Kutys, Maria Romero, Andrew E. Arai, David N. Firmin, Dudley J. Pennell
Journal: JACC. Cardiovascular imaging (2018)
Brian Joseph Foster
Authors: Christine Foster, Vanessa Foster, Timothy Foster
Journal: BMJ (2018)

In 1950 Brian Joseph Foster started his national service and served as a captain in the Royal Army Medical Corps at the Royal Victoria Hospital at Netley Abbey and then worked as area psychiatrist in Catterick District (northern command). In the same year he married Elizabeth Charlton of Newcastle, and later they had three children. In 1952, after two years of national service, Brian joined Michael Turner as a general practitioner at Blackthorns Practice in Netley. His career in the practice spanned almost 40 years. He was also a hospital …
Male doctors are more likely to receive sanctions than female doctors
Authors: Abi Rimmer
Journal: BMJ (2014)

Male doctors are much more likely to receive regulatory sanctions than female doctors, research has found. The study, carried out by Emily Unwin and a team of researchers at University College London and published in BMJ Open , found that 19% of the 2697 doctors on the General Medical Council’s list of registered medical practitioners who had received sanctions were women.1

Presenting her findings at the International Association of Medical Regulatory Authorities Conference in London last week, Unwin said that the research controlled for factors that were known to influence a doctor’s likelihood of receiving a sanction, such as the year that the doctor qualified, which country the doctor qualified in, …
A GP returner—five years on
Authors: Lesley Morrison
Journal: BMJ (2004)

Long live the four Rs: recruitment, retention, refreshment, and reflection. That was the philosophy of the general practitioner (GP) returners' scheme sponsored by the London Initiative Zone Educational Incentives programme, which I joined in 1998. I worked as a returner in a busy, demanding inner city London practice with an experienced, committed, and motivated trainer. Five years into being a GP principal, I am even more aware of its great value than I was then, and I would support anyone wanting to take advantage of the now established Department of Health scheme.

I initially trained in general practice in the late 1970s but was daunted by the long term and rather inflexible commitment which a partnership seemed to demand. I was aware that I would soon be thinking about starting a family and so I chose to work as a GP assistant. I enjoyed the work and at the same time developed a fascination for community medicine (as it was then), which I felt would complement and enhance …
Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study
Authors: Luke E. Grzeskowiak, Lisa G. Smithers, Jessica A. Grieger, Tina Bianco-Miotto, Shalem Y. Leemaqz, Vicki L. Clifton, Lucilla Poston, Lesley M. McCowan, Louise C. Kenny, Jenny Myers, James J. Walker, Robert J Norman, Gus A. Dekker, Claire T. Roberts
Journal: European Respiratory Journal (2018)

Asthma is a common chronic disease affecting the lives of reproductive age women and is associated with 8–13% of pregnancies [1]. While maternal asthma has been consistently associated with significant perinatal morbidities and mortality [2, 3], impacts on fertility are conflicting. In light of limited and conflicting evidence, the aim of this study was to examine the impact of asthma and asthma medication use on fecundability and time to pregnancy. Use of short-acting relievers but not long-term preventers is associated with reduced fertility in asthmatic women <http://ow.ly/fMAk30homkB> The authors wish to thank all of the SCOPE participants and the SCOPE research midwives in each centre, Robyn North (King's College London, UK) for her enormous contributions in establishing the SCOPE study, and Eliza Chan (University of Auckland, New Zealand) for her role in establishing the database. The SCOPE database is provided and maintained by MedSciNet AB. Author contributions: All authors contributed to: 1) either the conception and design of the study, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; 3) final approval of the version to be submitted; and 4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Abnormalities in 3-Dimensional Left Ventricular Mechanics With Anthracycline Chemotherapy Are Associated With Systolic and Diastolic Dysfunction
Authors: Kathleen W. Zhang, Brian S. Finkelman, Gaurav Gulati, Hari K. Narayan, Jenica Upshaw, Vivek Narayan, Ted Plappert, Virginia Englefield, Amanda M. Smith, Carina Zhang, W. Gregory Hundley, Bonnie Ky
Journal: JACC. Cardiovascular imaging (2018)