tbuckley/cabot-search huggingface dataset:
Racism and exclusion in the NHS: an illustrative analogy
Authors: Arvindan Veiraiah
Journal: BMJ (2004)

EDITOR—Imagine a person who can walk only with the help of crutches and who commutes regularly by bus. At the bus stop, all users have to climb on to a platform before they can get into the buses, which have steep stairs. A queue forms only when a bus appears, and newcomers regularly push their way in. The bus company allows only passengers in certain seats to travel more than one stop at a time. Our protagonist often …
Management of growing teratoma syndrome (GTS): Results of the German Testicular Cancer Study Group.
Authors: Pia Paffenholz, David Pfister, Jonas Busch, Klaus Peter Dieckmann, Hans U. Schmelz, Axel Heidenreich
Journal: Journal of Clinical Oncology (2018)

566 Background: Growing teratoma syndrome (GTS) is an infrequent clinical phenomenon constituting only about 2 to 8% of all testis cancer patients. Data in the literature on the therapy of GTS are sparse, reflecting the rarity of the disease. The objective of was to determine the diagnostic, surgical and oncological outcome of patients with GTS treated in the 21st century. Methods: Between 01/2000 and 01/2010 post-chemotherapeutic retroperitoneal lymph node dissections (PCRLND) were performed in 296 patients with advanced NSGCT. We analysed the peri- and postoperative outcome of 16 patients (5.4%) that fulfilled the criteria of a GTS: enlarging metastatic mass in the retroperitoneum or visceral organs during systemic chemotherapy with normalized or decreasing tumour markers. Results: Mean patient age was 31 years (17-57). Initially, all patients had NSGCT with a good or intermediate prognosis according to IGCCCG; one patient had a poor prognosis. In all cases the primary tumour predominantly contained mature teratoma; two patients had a clinical stage IIb, nine and three presented with clinical stage IIc and III respectively. Median tumour diameter at time of surgery was 8.1 cm (1.5-32). Tumour markers were plateauing or normalized in all patients. Tumour masses were localized in the retroperitoneum in 15 patients; one patient demonstrated a pulmonary mass. After a median follow-up of 4.2 years, 2 patients developed outfield recurrences; all but one patients are alive. Conclusions: GTS is a rare disease among patients with advanced NSGCT and necessitates complete surgical resection of the masses with curative intention. Surgery should be considered at time of progression to facilitate complete removal of the growing teratoma and be performed in tertiary referral centers only.
Effect of therapeutic vaccine on CTLA4 and tumor debulking response in recurrent and metastatic HNSCC.
Authors: Somjin Chindavijak, Michael Har-Noy, Wirote Lausoontornsiri
Journal: Journal of Clinical Oncology (2018)

115 Background: Head and Neck Squamous Cell Carcinoma (HNSCC) is associated with multiple immune suppression and avoidance mechanisms . Blocking the PD-1 signal axis in second line provides a significant survival advantage compared to chemotherapy. However, checkpoint blockade efficacy is limited to the subset of patients that present with tumors highly infiltrated with effector immune cells. We investigated a novel vaccine designed to increase the infiltration of tumor-specific effector cells and counter-regulate the suppressive tumor microenvironment. Methods: Pre-treated r/m HNSCC patients with externally visible tumors were accrued. Tumor biopsy samples were processed at baseline to purify endogenous chaperones with calreticulin, hsp70, hsp90 and gr94/gp96 (CRCL) as a source of tumor neoantigen. Ex-vivo differentiated, allogeneic Th1 memory cells with CD3/CD28-coated microbeads attached (aTh1) expressing CD40L and IFN-gamma served as adjuvant. Subjects were primed with 4 weekly aTh1 ID injections to increase allo-specific Th1 memory titer. Primed subjects were provided 3 weekly ID injections of CRCL + aTh1 to increase tumor-specific Th1 memory titer followed by intravenous aTh1 in the 4th week to activate circulating memory cells through CD40-CD40L, causing their extravasation and trafficking to tumor lesions. Allo-rejection response produces a sustained Type 1 cytokine release which dys-regulates suppressor circuits. The ID/IV cycle was then repeated. Results: 10 subjects with recurrent or metastatic disease were accrued. All with prior radiochemotherapy. 50% (5/10) had clinical response with visible reduction in tumor burden. Vaccine was well tolerated. Debulking response correlated with increased CD3+ immune cell infiltration and decreased CTLA-4 expression. Conclusions: This individualized vaccine caused increased immune cell infiltration in tumors, down-regulation of CTLA4 and visible tumor debulking in a heavily pre-treated, chemotherapy-refractory population. These results provide rationale for further evaluation of this vaccine in a first-line setting with and without PD1/L1 blockade. Clinical trial information: NCT01998542.
Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials
Authors: A.C.R. Partridge, J.W. Bai, C.F. Rosen, S.R. Walsh, W.P. Gulliver, P. Fleming
Journal: British Journal of Dermatology (2018)

BackgroundPyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold‐standard treatments.
Factors affecting long-term and permanent contraceptive uptake among post-partum mothers at a hospital in Addis Ababa, Ethiopia: a cross-sectional study
Authors: Lemi Belay, Malede Birara
Journal: The Lancet Global Health (2018)

BackgroundFamily planning is important in reducing the total fertility rate and subsequent reduction in maternal and infant morbidity and mortality. Postnatal care represents a window of opportunity for education and communication to newly delivered mothers so that they may make appropriate choices on use of family planning. We assessed the barriers to uptake of long-term and permanent family planning methods among immediate post-partum mothers at Saint Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia.MethodsWe did an institution-based cross-sectional study from Jan 1 to June 30, 2017. The 6 months of study were used as strata, with equal allocation and systematic sampling used to select participants in each month. Post-partum mothers were interviewed using pretested semi-structured questionnaires. Data entry and analysis were done using SPSS version 17. Bivariate and multivariate logistic regression were done and adjusted odds ratios (aOR), 95% CIs, and p values set at 0·05 were used to determine statistical significance of the associations. χ2 tests were used for statistical analysis of results.Findings422 post-partum women were interviewed, 192 (45%) of whom started long-term or permanent contraception before discharge. 268 (63%) of women had received counselling on family planning and 241 (57%) got information about contraception from the health facility. Contraceptive counselling (aOR 2·138, 95% CI 0·004–0·331, p=0·003), getting information from the health facility (15·155, 1·848–124·257, p=0·011), and partner support (1·367, 0·175–0·771, p=0·008) were associated with uptake of long-term and permanent contraception. Reasons reported for non-use were fear of side-effects (84 [40%]), opposition from husband (52 [25%]), desire to have more children, lack of awareness, and use of other methods such as lactation amenorrhoea.InterpretationOne-to-one counselling with partner involvement would ensure that mothers receive complete information from health facilities, and hence could reduce myths and misperceptions and improve uptake of long-term and permanent methods of contraception.FundingSaint Paul's Hospital Millennium Medical College.
The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade
Authors: Kuan-Chieh Fang, Wei-Yu Kao, Chien-Wei Su, Po-Chun Chen, Pei-Chang Lee, Yi-Hsiang Huang, Teh-Ia Huo, Chun-Chao Chang, Ming-Chih Hou, Han-Chieh Lin, Jaw-Ching Wu
Journal: Liver Cancer (2018)

&lt;b&gt;&lt;i&gt;Background/Aims:&lt;/i&gt;&lt;/b&gt; Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (&lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age &amp;#x3e; 65 years, alkaline phosphatase &amp;#x3e; 100 U/L, creatinine &amp;#x3e; 1.0 mg/dL, alpha-fetoprotein &amp;#x3e; 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.
Medical training must enable doctors to lead and improve the health service, says academy
Authors: Caroline White
Journal: BMJ (2014)

Medical training in the UK must enable doctors to sustain, lead, and improve the health service, the Academy of Medical Royal Colleges has said.

The academy has issued a set of guiding principles for all parties involved in the training of UK doctors, in a bid to define expectations and guarantee the quality and safety of care.1 The principles emphasise that the delivery of high quality care depends on doctors having received excellent training. Training must realise doctors’ potential “to sustain, lead, and improve the national healthcare system, now and in the future,” and be provided in an environment …
Final results of PRODIGE 9, a randomized phase III comparing no treatment to bevacizumab maintenance during chemotherapy-free intervals in metastatic colorectal cancer.
Authors: Thomas Aparicio, Jaafar Bennouna, Karine Le Malicot, Francois Ghiringhelli, Valerie Boige, Julien Taieb, Olivier Bouche, Jean Marc Phelip, Eric Francois, Christian Borel, Roger Faroux, Jean-François Seitz, Stephane Jacquot, Dominique Genet, Faiza Khemissa, Etienne Suc, Françoise Desseigne, Patrick Texereau, Jean-Louis Jouve
Journal: Journal of Clinical Oncology (2016)

3531 Background: Conflicting results are reported for maintenance treatment with bevacizumab (bev) during chemotherapy free intervals (CFI) in metastatic colorectal cancer (mCRC). Methods: The objective was to compare the tumor control duration (TCD) by either bev maintenance (Arm A) or no treatment during CFI (Arm B) after induction chemotherapy (CT) (12 cycles of FOLFIRI + bev). CT was reintroduced at progression (8 cycles) and then a new CFI. The randomization was performed before induction CT. TCD was defined by the time between randomization and tumor progression during a CT sequence (Aparicio T et al, Dig Liver Dis, 2015). Per Protocol (PP) population was defined as patients (pts) with at least one CT reintroduction after first progression during CFI. We present the final analysis of the trial. Results: From March 2010 to July 2013, 491 pts were randomized. The median age was 64.6 years [range: 27 - 89], 64% of the pts were men, 93% of the pts were OMS 0-1 and 218 (44%) pts had a non-resected primary tumor. A progression during induction CT happen in 85 (17%) pts, 261 (53%) pts had at least one reintroduction, 107 (22%) pts had two and 51 (10%) pts had three or more re-introductions. Multivariate analysis in all pts revealed that WHO performance status ≥ 2, unresected primary tumor and BRAF mutation were associated with a shorter TCD. Unresected primary tumor and BRAF mutation were associated with a shorter overall survival (OS). Grade 3-4 toxicities were observed in 80% of the pts in arm A and 79% in arm B. Conclusions: The alternate irinotecan-based CT sequences with or without bev maintenance during CFI, revealed an impressive TCD. Bev maintenance monotherapy did not improved TCD, progression free survival (PFS) or OS. Clinical trial information: NCT00952029.Efficacy criteria. Arm A -Maintenance Median in months Arm B -No Maintenance Median in months HR [95% CI]; p-value All patients N = 246 N = 245 TCD 15.08 14.98 1.09 [0.87 - 1.37]; p = 0.43 PFS 9.20 8.90 0.92 [0.76,1.10]; p = 0.34 OS 21.65 21.98 1.05 [0.86,1.28]; p = 0.65 PP Population N = 124 (50%) N = 137 (56%) TCD 17.77 23.26 1.18 [0.87 ; 1.59]; p = 0.29 PFS 9.86 9.49 0.89 [0.69 ; 1.13]; p = 0.33 OS 27.47 28.58 1.09 [0.82 ; 1.45]; p = 0.56
Locums withdrawing work in wake of tax change must consider impact on patients, GMC says
Authors: Abi Rimmer
Journal: BMJ (2017)

Locum doctors who wish to withdraw their services from NHS trusts following tax changes should consider the impact of such action on patient safety, the General Medical Council has said.

Susan Goldsmith, deputy chief executive and registrar of the GMC, said, “We are aware that some locum doctors have told hospitals that they may withdraw services after new tax rules come into effect. While matters of pay and contracts are for individual trusts to resolve with those staff, our chief concern is patient safety.”

Goldsmith said that health services were under severe pressure and …
The Proposal to Lower <i>P</i> Value Thresholds to .005
Authors: John P. A. Ioannidis
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Submitting specimens for histopathology
Authors: Asma Faruqi
Journal: BMJ (2005)

Submitting a specimen for histopathology is a request for a consultant opinion. For this opinion to be effective, accurate identification and good preservation of the specimen are essential. Providing good clinical details is vital as the histopathological findings are interpreted in the clinical context. Withholding pertinent information is similar to expecting a colleague to manage a patient without allowing them to take a history. If these requirements are not …
Early-onset invasive aspergillosis and other fungal infections in patients treated with ibrutinib
Authors: David Ghez, Anne Calleja, Caroline Protin, Marine Baron, Marie-Pierre Ledoux, Gandhi Damaj, Mathieu Dupont, Brigitte Dreyfus, Emmanuelle Ferrant, Charles Herbaux, Kamel Laribi, Ronan Le Calloch, Marion Malphettes, Franciane Paul, Laetitia Souchet, Malgorzata Truchan-Graczyk, Karen Delavigne, Caroline Dartigeas, Loïc Ysebaert
Journal: Blood (2018)
Whole body PD-L1 PET in patients with NSCLC and melanoma.
Authors: David K. Leung, Joop De Langen, David Raunig, Anna-Larissa N. Niemeijer, Egbert F. Smit, Ronald Boellaard, David Vallez-Garcia, G.a.M.S. van Dongen, A.D. Windhorst, Marc C. Huisman, Andor W. J. M. Glaudemans, N. Harry Hendrikse, Ralph Adam Smith, Alex J. Poot, Dasa Lipovsek, David J. Donnelly, Samuel J. Bonacorsi, Linda M. Velasquez, Shuyan Du, Wendy Hayes
Journal: Journal of Clinical Oncology (2018)

139 Background: PD-(L)1 immunotherapy is effective in multiple tumors, including NSCLC and melanoma, but tumor PD-L1 IHC correlates only moderately with treatment outcome. This study aims to assess 1) safety of 18 F-BMS-986192 ( 18 F-PD-L1) in human, 2) PD-L1 quantification in tumors using 18 F-PD-L1 PET, 3) PD-L1 PET correlation with IHC and treatment outcome, and 4) intra and inter subject tracer uptake variability. Methods: Pts with NSCLC (N = 10) and melanoma (N = 3) were included. At baseline, pts received a static or multiphase dynamic whole body PET scan after injecting 200 MBq 18 F-BMS-986192. For NSCLC pts, (1) SUV(max, peak and mean) were measured for each delineable tumor (N = 32, 1-7 tumors/pt), (2) PD-L1 IHC (28.8 assay) was performed on the biopsy, and (3) response to Nivolumab therapy assessed by RECIST 1.1. Intra and inter subject variability and intraclass correlation were calculated using SUVs of all assessed tumors. Equal variance for PD-L1 status was evaluated by a Levene’s test. Four (3 female) pts underwent dosimetry study (ICRP 60). Results: No AEs related to radiotracer was observed. Dosimetry study demonstrated whole body exposure of 30 mGy at dose &gt; 1400 MBq. Biodistribution among pts is comparable. PD-L1 IHC from 13 biopsied lesions were evaluated, 5 &lt; 1%, 4 ≥1%, and 4 ≥50%. Tumor tracer uptake was measured in NSCLC pts and categorized by PDL-1 IHC as ≥50% or &lt; 50%. Clinical trial information: 2015-004760-11. Tumor SUVs did not correlate with RECIST 1.1 assessment. Lesion heterogeneity was reflected in both inter and intra pt variability (CVinter = 41%, CVintra = 53%, ICC = 0.41 for SUVpeak). Levene’s test showed no significance in variability between the two PD-L1 categories. Conclusions: PET-imaging with 18 F-BMS-986192 is safe and feasible in pts with NSCLC and melanoma. Pts with higher PD-L1 PET SUV have higher PD-L1 by IHC. Intra pt variability is similar to inter pt variability. With limited number of pts, no clear correlation of PET PD-L1 and tumor response is observed. A prospective study with this tracer is underway to further investigate 18 F-BMS-986192 in understanding of PD-L1 expression.[Table: see text]
Thirteenth annual principles of fracture management course
Authors: Mayank K Mittal
Journal: BMJ (2008)

The search for a basic fracture management course can be exhaustive and the waiting list long. Many of us spend a lot of money to travel, stay over, and attend these courses abroad.

This is a well organised and stimulating course that provides evidence based understanding of the principles underlying fracture management, and it is not biased by any particular product or company. This is a great advantage as the trainees get a complete overview of options available for treating a particular kind of orthopaedic injury. There is also a great deal of emphasis on how to manage orthopaedic trauma conservatively. This is important because most of the courses on the market are biased towards operative management and emphasis is on the product marketing. This is an indigenous, good quality course that has been running for 13 years. It takes place once a year, and the …
The DEAL trial: A diet and exercise intervention in (pre)-diabetics during treatment for non-muscle invasive bladder cancer.
Authors: Woodson Smelser, Vassili Glazyrine, Brian Barnes, Abigail Stanley, Misty Bechtel, Carrie Michel, Jeffrey M. Holzbeierlein, Jill Hamilton-Reeves, Eugene Lee
Journal: Journal of Clinical Oncology (2018)

473 Background: Patients with diabetes are at greater risk for bladder cancer (BC) as well as disease recurrence and progression. Even after controlling for clinical and pathologic risk factors, DM confers a 2x greater risk of recurrence and 9x greater risk of progression. We hypothesize that utilizing a carbohydrate restricted (CR) diet ( &lt; 130 grams/day) to decrease the bioavailability of glucose in patients with DM and BC, a “Warburg-like” tumor, has potential therapeutic benefit. We designed a study to assess the feasibility of a CR diet in patients with (pre)diabetes and non-muscle invasive bladder cancer receiving BCG therapy. Methods: This is a pilot study of 5 (pre)diabetic patients (defined as HgbA1c &gt; 5.7) with NMIBC receiving BCG and maintenance. A CR diet ( &lt; 130 g/day) was supplied for the first 12 weeks through a meal delivery service. Patients received weekly coaching with a nutritionist for 6 weeks during induction BCG and at the 3 month surveillance cystoscopy with dietary and activity goals implemented. Patients had laboratory evaluation at baseline and at 3 month intervals. Patients tracked their diet. Two (1 weekday, 1 weekend day) unannounced 24 hour diet recalls were obtained to monitor compliance. Dietary compliance was defined as &lt; 130 grams/day of carbohydrate intake. Results: Between 09/2016 and 05/2017, 5 patients were enrolled. Mean age was 66.2 years (Range 59-74). Three patients had diabetes and two patients had pre-diabetes. Two patients had CIS, 1 patient had high-grade Ta, and 2 patients had high-grade T1 disease. Mean baseline hemoglobin A1c was 7.6% (Range 5.9-11.8). Mean bodyweight and BMI were 92 kg (Range 66-105) and 28.2 (Range 23.1- 31.3) respectively. Regarding compliance, 4/5 (80%) patients completed dietary logs and weekly labs. Three patients (60%) achieved their goal of &lt; 130 grams carbohydrates/day on 24-hour dietary recall. Average 3-month HbA1c improved from 7.6% to 6.6% (Range 5.6-7.9). Conclusions: Eighty percent of patients completed dietary logs for the first three months of the trial; 60% achieved compliance with the CR diet. These data demonstrate the feasibility of a dietary intervention utilizing CR in patients with high-grade NMIBC undergoing BCG. Clinical trial information: NCT02716623.