tbuckley/cabot-search huggingface dataset:
12-MONTH KINETICS OF GALECTIN-3 AND ITS RELATIONSHIPS WITH EXTRACELLULAR MATRIX FIBROSIS AND CARDIOVASCULAR OUTCOMES IN DILATED CARDIOMYOPATHY
Authors: Pawel Rubis, Sylwia Wiśniowska-Smiałek, Ewa Dziewięcka, Lusine Khachatryan, Aleksandra Karabinowska, Maria Szymonowicz, Ewa Wypasek, Piotr Podolec
Journal: Journal of the American College of Cardiology (2018)
Staff support is more important than IT in driving up appraisal rates
Authors: Matthew Limb
Journal: BMJ (2014)

Acute trusts can increase appraisal rates among doctors by having the right people in key posts, giving support, and taking tough action on “non-engagement,” the Faculty of Medical Leadership and Management has said.

A report of a study by the faculty1 argued that investment in people and simple, straightforward processes must come before investment in information systems. The study, which was commissioned by NHS England London and NHS England South, highlighted three roles as being crucial to achieving high appraisal rates: responsible officer, revalidation and appraisal administrator, and appraisal lead. 

The report said that boards had to ensure that these roles enjoyed adequate “status, time, and resources” and that initiatives to raise appraisal rates had to set clear expectations and be monitored appropriately. The faculty also said that, although some doctors needed “cajoling” to …
Abstract 14689: Impact of Left Ventricular Longitudinal Functional Mechanics on the Progression of Diastolic Function in Diabetes Mellitus
Authors: Yasuhide Mochiduki, Hidekazu Tanaka, Hiroki Takada, Fumitaka Soga, Kumiko Dokuni, Yutaka Hatani, Keiko Hatazawa, Hiroki Matsuzoe, Hiroyuki Shimoura, Junichi Ooka, Hiroyuki Sano, Keiko Ryo Koriyama, Kensuke Matsumoto, Ken-ichi Hirata
Journal: Circulation (2016)

Background:  Left ventricular (LV) diastolic dysfunction was identified as the earliest functional alteration in the course of diabetic cardiomyopathy, and also established it as an important prognostic marker in patients with diabetes mellitus (DM). Furthermore, LV longitudinal systolic dysfunction was closely associated with diabetic cardiomyopathy in DM patients with preserved LVEF. This study’ aim was to investigate the impact of LV longitudinal systolic function on LV diastolic function in DM patients with preserved LVEF.   Methods:  We studied 177 DM patients with preserved LVEF (all ≥50%), and 82 age-, gender- and LVEF-matched healthy volunteers as control. Global longitudinal strain (GLS) was defined as the average peak strain of 18 segments from standard apical views, GLS    Results:  For DM patients with LVSD (n=74), E/A and E’ were lower, and E/E’ and isovolumic relaxation time (IVRT) were greater than for DM patients without LVSD (n=103) and normal controls. Moreover, these parameters were lower for DM patients without LVSD than for normal controls. Multivariate analysis revealed that GLS was a strong determinative factor for E’ and E/E’ (β=0.30, p   Conclusions:  In contrast to age-related LV diastolic dysfunction in normal subjects, in DM patients with preserved LVEF, LV diastolic function was associated with LV longitudinal systolic function and LV dispersion independently of age. Our findings have obvious clinical implications for the management of DM patients.
Doctors working in prison: human rights and ethical dilemmas
Authors: Muriel Volpellier
Journal: BMJ (2006)

For prison doctors from any country, and all doctors interested in human rights, ethics, and forensic medicine. The course is free. It has been developed by the Norwegian Medical Association.

I started in January 2005 and finished in June 2005. It is a web based course, so you do it at your own pace.

I …
Think tank urges government to back regional pay and conditions
Authors: Caroline White
Journal: BMJ (2012)

The government should back current moves to introduce regional pay and conditions in the NHS and issue providers with a clear mandate to do so, says a report by the right wing think tank Reform.1

NHS organisations would do well to follow the South West Pay Terms and Conditions Consortium, which along with other groups of NHS trusts is now considering local pay deals for staff,2 it says.

Too often NHS organisations eschewed the flexibility of developing their own terms and conditions in favour of national contracts to manage workforce costs, says the report.

“Yet national policies …
Abstract P190: Triggering of Coronary Heart Disease by Infection Type: The Atherosclerosis Risk in Communities Study
Authors: Logan Cowan, Pamela Lutsey, Jim Pankow, Kunihiro Matsushita, Junichi Ishigami, Kamakshi Lakshminarayan
Journal: Circulation (2018)

Introduction: Acute infections are known triggers of coronary heart disease (CHD). It is unclear how the strength of the association varies by infection type. Hypothesis: We hypothesized that all acute infections increase CHD risk but the level of increased risk varies by infection type. Methods: Incident CHD (myocardial infarction and fatal CHD) cases were identified and adjudicated in the ARIC cohort. ARIC participants were linked to Medicare claims data. We used ICD-9 codes to identify 4 infection types based on infection frequency: cellulitis, pneumonia, urinary tract infections (UTI), and bloodstream infections. We used a case-crossover design and conditional logistic regression to compare infections among CHD cases 90 days before the event with two corresponding control periods 1 year and 2 years prior. The Wald test was used to assess differences between infection types. Results: A total of 1,312 CHD cases were identified. Among cases, 43 had cellulitis, 102 had pneumonia, 116 had a UTI, and 28 had a bloodstream infection within 90 days of the CHD event. All infection types were associated with higher CHD risk within 90 days of the infection; (odds ratios and 95% Cis) (cellulitis = 1.41 (0.93, 2.15), pneumonia = 5.60 (3.72, 8.43), UTI = 2.62 (1.92, 3.57), bloodstream infections = 4.77 (2.34, 9.71)) although cellulitis was not statistically significant (Figure). The association between infection and CHD was significantly stronger for pneumonia, UTI, and bloodstream infections compared to cellulitis (p&lt;0.05). Pneumonia and bloodstream infections were stronger CHD triggers compared to UTI but only pneumonia reached statistical significance (p&lt;0.05). Conclusions: Patients with pneumonia or bloodstream infections may be at particularly elevated CHD risk. Clinical trials of CHD preventive therapies during and immediately following infection to reduce the otherwise elevated CHD risk are needed. Healthcare providers should consider CHD risk during and immediately after infection and optimize preventive therapies.
Results of neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fuluorouracil for advanced esophageal cancer.
Authors: Manabu Emi, Yoichi Hamai, Yuta Ibuki, Morihito Okada
Journal: Journal of Clinical Oncology (2018)

171 Background: We previously reported a phase I study of neoadjuvant chemoradiotherapy (CRT ) with docetaxel, cisplatin, and 5-fuluorouracil (DCF) for advanced esophageal cancer. After that, we continued to conduct neoadjuvant CRT with DCF as phase II study and here, we report the results of this study including phase I. Methods: We performed neoadjuvant CRT with DCF chemotherapy and concurrent radiation therapy (40Gy including irradiation field) in patients with advanced esophageal squamous cell carcinoma. Dose of chemotherapy were as follows: docetaxel 25mg/m2 (level 1 n=17), or 30mg/m 2 (level 2 n=4) on day 1,15,29 and 43 and cisplatin 70mg/m 2 on day 1,29 and 5-fuluorouracil on day 1-4 and 29-32. The tumors were resected during weeks 10-13. Results: From Dec 2009 to Aug 2012, 21patients were enrolled and 19 patients underwent thoracic surgery. There were 17 male and four female subjects of ages ranging from 38 to 72 years (median, 61 years). Of these, 6 patients had stage IIIA esophageal cancer and two had stage IIIB esophageal cancer. All the patients had squamous cell carcinoma. Pathological complete response of primary tumor was achieved in 12 patients (63%) and complete pathological response of both primary tumor and lymph node was seen in eight patients (42%). During CRT, the most common grade 3/4 non-hematological toxicity were anorexia (29%) and esophagitis (29%). During CRT, septic shock caused by infection via catheter was observed and re-operation was performed in one patient with reconstructed gastric tube necrosis.One patient developed recurrent gastric tube ulcer in the anastomotic part 4years after esophagectomy. 10 patients are alive more than 5 years and 5-year overall survival is 47.6% and three of them were level II cases. Conclusions: This preoperative CRT regimen using triplets result in favorite prognosis, but treatment plan should be reconsidered because of relative high toxicity. Because high complete response rate of primary tumor were observed and long-term survival has been obtained at a high rate in the case of level II, we planned new phase I/II study of CRT with DCF without preventive irradiation field. Clinical trial information: R000002555.
I am a full time GP looking to develop a special interest in male sexual dysfunction (erectile dysfunction treatment, psychosexual counselling, etc). I cannot find a specific course and wondered about the best way of getting educated and accredited for independent practice
Authors: Alison Bigrigg
Journal: BMJ (2006)

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>
I am currently doing psychiatry and am interested in general practice. However I have been out of touch with medical and surgical specialties since 2001. I was wondering what courses and options are available for me. I have a specialty training 1 interview for GPVTS but am nervous about starting in acute medicine
Authors: Rodger Charlton
Journal: BMJ (2007)

Have a career related problem that needs answering? Can't find the 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 [www.bmjcareers.com/advicezone][1] [1]: http://www.bmjcareers.com/advicezone
Modernising Medical Careers and surgical training
Authors: Shervanthi Homer-Vanniasinkam
Journal: BMJ (2006)

What other help is available on? 

The MMC website at www.mmc.nhs.uk has a whole raft of information for trainees, including: The Applicant's Guide which covers all the logistics for doctors applying to the new Specialty Registrar (StR) training programmes or fixed term specialist training appointments (FTSTAs). You can also find the person specifications for all levels of specialty training (including FTSTAs) there. Another publication called MMC: The Facts has a short summary of how each key stakeholder is affected by the changes, and has a short precis of the process and timeline for recruitment. For those who would like to know the pathway to a specialty, a powerpoint presentation called “Choosing your Specialty” is on the website—it tells you which of the 16 core recruitment groups to apply for to get into a specific specialty.

The royal medical colleges' websites are a …
Current concepts in external fixation in trauma
Authors: Stephen P Guy, Peter Loughenbury
Journal: BMJ (2009)

A one day course on the use of external fixation in trauma. Short interactive lectures and dry bone workshops give trainees a stress free introduction to the use of external fixation and its application in real life scenarios.

Trauma and orthopaedic specialty trainees, ideally people in core trainee years 1-2 and specialty trainee years 3-4. The course would also be useful for foundation trainees with an interest in orthopaedics and trauma.

At the start of specialty training year 3.

Working in a tertiary centre as a junior registrar can be daunting, in particular having to definitively manage the polytraumatised patient or patients with complex open or closed high energy fractures. The safe application of external fixators can be both life saving and limb saving provided it is …
Patient safety in theatre teams—a practical approach to human factors
Authors: Charles Maxwell-Armstrong, Chris Gornall, Catherine Weeks, Claire Barrow
Journal: BMJ (2011)

This Royal College of Surgeons course is multiprofessional and is aimed at theatre teams that already work together. Those attending therefore include consultant surgeons and anaesthetists, theatre nurses, and operating department assistants. Three theatre teams of four participants were on the course we attended.

The course cost £2000 for the four participants, excluding accommodation, travel, and a course dinner.

Evidence is mounting that failures in non-technical skills such as leadership, communication, situation awareness, and decision making are contributing to adverse events during surgery. This, in conjunction with the introduction to our institution of the World Health Organization theatre checklist, made us keen to explore these issues further. This course is the only one currently available that …
Complex infrastructure and excessive control threaten commissioning group success
Authors: Caroline White
Journal: BMJ (2012)

The ability of clinical commissioning groups (CCGs) in England to “rebalance” the NHS risks being undermined by the complexities of the new commissioning architecture, competitive behaviours among GPs, and an overly controlling National Commissioning Board, a senior policy analyst at health think tank, the King’s Fund, has warned.

Speaking at a Westminster Health Forum Keynote Seminar in London on13 June, Nick Goodwin said that GPs were ideally placed to “rebalance the system” and create a more primary and community care led service, without which the NHS would be unsustainable. “As a principle, it’s clearly a good move,” he said.

But he wondered how easy it would be to forge effective and collaborative partnerships …
Immune-related adverse events (IrAE) of elderly patients (pts) receiving PD-1 or PDL-1 inhibitors (PDIs) in a community-oncology setting: The experience at Kaiser Permanente California.
Authors: Thach-Giao Truong, Christopher Yamamoto, Timothy Chiu, Fang Niu, Michele M. Spence, Jim Chan, Robert Michael Cooper, Helen Moon, Rita L. Hui
Journal: Journal of Clinical Oncology (2018)

124 Background: Checkpoint inhibitors (CI) are rapidly changing the treatment (Tx) landscape across multiple cancers. They have brought with them a new set of immune-related toxicities and complications . Currently, our knowledge of irAEs has been largely informed by clinical trials enrolling younger and fitter pts. In this study, we report the experience of our large community practice, where many elderly pts of diverse backgrounds received PDIs. Methods: We conducted a retrospective cohort study, including pts who were ≥65 years old (yo) and had received PDIs between FDA approval in 2014 and September 2016, with follow-up through December 2016. Through data-mining of our electronic medical record, we evaluated the incidence of irAE and Tx outcomes, stratified by age, ethnicity, gender, co-morbidity index, and tumor subtype. Results: There were 776 pts included in the analysis. 58% were male and 29% were non-Caucasian. 83% were ages 65 to 79 yo and 17% were ≥80 yo (range 80-94 yo). 28 % of pts had a CCI &gt; 5. Over 55% received PDIs for non-small cell lung cancer (NSCLC), followed by 12% for melanoma. 65-79 yo pts experienced similar incidence of irAE compared to pts ≥80 yo (14% vs 18%, p = 0.26). Notably, incidence was similar for gastrointestinal, pulmonary, and endocrine toxicity, though pts ≥80 yo experienced higher incidence of dermatologic toxicity (p = 0.01). Pts 65-79 yo received PDIs for median 3.3 months (mos), while pts ≥80 yo were on Tx for median 2.8 mos.The rate of irAE that resulted in health care utilization were noted in 15% of pts. Time to onset of irAE was similar between the 2 age groups (p = 0.40). Unadjusted hazard ratio (HR) for survival at the end of study was similar for pts 65-79 yo and ≥80 yo who had melanoma (HR = 0.99, p = 0.97) or NSCLC (HR = 1.32, p = 0.12). Conclusions: This is the first report of Tx outcomes with PDI use in elderly pts in a real-world setting. We found irAE rates and Tx outcomes to be similar for pts age 65-79 yo and those ≥ 80 yo. With rising cancer incidence among an ageing population, it is important for the oncology community to understand how CI therapy affects older pt groups to improve their cancer outcomes.
Global Protein Aberration Score (GloPAS): A comprehensive risk score to predict hepatocellular carcinoma biology and estimate patients’ survival.
Authors: Ahmed Omar Kaseb, Emma Zohner, Lianchun Xiao, Zeya Wang, Manal Hassan, Reham Abdel-Wahab, Karri Ballard, Robert A. Wolff, Hesham M. Amin, Wenyi Wang, James C. Yao, Jeffrey Morris
Journal: Journal of Clinical Oncology (2018)

287 Background: Existing hepatocellular carcinoma (HCC) staging systems use a small number of empirically selected clinical/biological variables. We hypothesize that GloPAS (global protein aberration score) will capture a more global measurement of disease biology that can partition HCC into three subsets: (1) essentially normal profiles, (2) extremely aberrant profiles, and (3) slightly aberrant profiles. Methods: We collected plasma samples and clinical data prospectively from 767 HCC patients (pts) and 200 healthy controls, and quantified 317 pts using Myriad RBM CLIA-certified panel, Austin, TX. We applied a deconvolution algorithm, originally developed for determining percent normal contamination for tumor, to quantify the degree of global protein aberration for each pt relative to normal controls. We defined three distinct groups of pts with low ( &lt; 0.3), medium (0.3-0.8), and high ( &gt; 0.8) GloPAS and assessed GloPAS association with overall survival (OS) and other prognostic factors using log-rank tests and compared the prognostic abilities of GloPAS vs. existing systems using concordance index(C-index). We developed a single-sample GloPAS (ssGloPAS) using an algorithm that can be applied to single sample setting. Results: Although determined without using information about OS or any pt-level clinical or demographic factors (i.e. unsupervised), GloPAS showed remarkable prognostic separability (low/med/high GloPAS, with median OS 38.2mo/18.3mo/7.1mo, p &lt; 0.0001). GloPAS prognostic ability was far above any existing HCC staging system (C-index = 0.75 vs. 0.58-0.70 p &lt; 0.0001), demonstrating even more prognostic information than key factors as metastatic status and vascular invasion. The ssGloPAS was able to recapitulate the global signal captured by the GloPAS score with a much smaller subset of 14 proteins. Conclusions: GloPAS significantly improved prediction of OS and prognostic stratification of HCC. After further validation, ssGloPAS could be used to guide therapy decisions and stratify HCC pts in clinical trials. The novel concept underlying GloPAS methodology can be applied to other cancers to build disease-specific prognostic scores.
Abstract PD2-17: Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up
Authors: E Cossu, E Costano, R Di Trapano, MC Pensabene, C Di Stefano, S Fosi, V Fiaschetti, I Portarena, O Buonomo
Journal: Cancer Research (2018)

Abstract Purpose: Contrast-enhanced Dual-Energy digital mammography (DE) is a recently used investigation that consists in acquiring low and high energy images after intravenous injection of iodinated contrast medium. The purpose of this study is to describe our experience about the role of DE in the diagnosis and follow-up of breast cancer. Materials and Methods: 50 patients, with heterogeneous breast pattern, already studied by mammography and ultrasound, were selected. They underwent DE mammography: 17 for mammographic or ultrasonographic suspicious findings (9/17 also examined with MRI), 21 for loco-regional staging (21/21 studied with MRI), 10 for oncologic follow-up (6/10 also underwent MRI). DE has been interrupted in two cases due to technical problems. Exclusion criteria of the study were: breast implants, pregnancy or lactation and contraindications to administration of contrast medium. DE results were compared with the post-operative or post-bioptical (Tru-cut or Vacuum Assisted Biopsy) histological findings. Results: DE showed a sensitivity of 76% in evaluation of Patients with mammographic or ultrasonographic suspicious findings: in comparison with MRI (9 patients), DE had a 55 % specificity (vs 22% of MRI). In locoregional staging DE proved to be more accurate than MRI in dimensional evaluation of unifocal cancer: DE accuracy was 91% vs 62% of MRI, which overestimated the size of most of lesions. In the count of tumor foci number in case of multifocal/multicentric disease MRI corresponded in 9/11 cases with histology (vs 3/11 cases of DE). DE showed a sensitivity of 100% and a 85.7% specificity in assessing oncologic follow-up Patients: in the comparison between DE and MRI (6 patients), DE got 1 false positive result, while MRI 3. Conclusion: DE can be a valuable diagnostic tool to help conventional techniques; it is also a possible alternative to MRI in some selected type of patients or where MRI is not available. Citation Format: Cossu E, Costano E, Di Trapano R, Pensabene MC, Di Stefano C, Fosi S, Fiaschetti V, Portarena I, Buonomo O. Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up [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 PD2-17.
Aberrant epithelial differentiation by cigarette smoke dysregulates respiratory host defence
Authors: Gimano D. Amatngalim, Jasmijn A. Schrumpf, Fernanda Dishchekenian, Tinne C.J. Mertens, Dennis K. Ninaber, Abraham C. van der Linden, Charles Pilette, Christian Taube, Pieter S. Hiemstra, Anne M. van der Does
Journal: European Respiratory Journal (2018)

It is currently unknown how cigarette smoke-induced airway remodelling affects highly expressed respiratory epithelial defence proteins and thereby mucosal host defence. Localisation of a selected set of highly expressed respiratory epithelial host defence proteins was assessed in well-differentiated primary bronchial epithelial cell (PBEC) cultures. Next, PBEC were cultured at the air–liquid interface, and during differentiation for 2–3 weeks exposed daily to whole cigarette smoke. Gene expression, protein levels and epithelial cell markers were subsequently assessed. In addition, functional activities and persistence of the cigarette smoke-induced effects upon cessation were determined. Expression of the polymeric immunoglobulin receptor, secretory leukocyte protease inhibitor and long and short PLUNC (palate, lung and nasal epithelium clone protein) was restricted to luminal cells and exposure of differentiating PBECs to cigarette smoke resulted in a selective reduction of the expression of these luminal cell-restricted respiratory host defence proteins compared to controls. This reduced expression was a consequence of cigarette smoke-impaired end-stage differentiation of epithelial cells, and accompanied by a significant decreased transepithelial transport of IgA and bacterial killing. These findings shed new light on the importance of airway epithelial cell differentiation in respiratory host defence and could provide an additional explanation for the increased susceptibility of smokers and patients with chronic obstructive pulmonary disease to respiratory infections.