tbuckley/cabot-search huggingface dataset:
Evaluation of a Streamlined Oncologist-Led <i>BRCA</i> Mutation Testing and Counseling Model for Patients With Ovarian Cancer
Authors: Nicoletta Colombo, Gloria Huang, Giovanni Scambia, Eva Chalas, Sandro Pignata, James Fiorica, Linda Van Le, Sharad Ghamande, Santiago González-Santiago, Isabel Bover, Begoña Graña Suárez, Andrew Green, Philippe Huot-Marchand, Yann Bourhis, Sudeep Karve, Christopher Blakeley
Journal: Journal of Clinical Oncology (2018)

Purpose There is a growing demand for BRCA1/ 2 mutation ( BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors. Patients and Methods The prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway. The analysis population comprised 700 patients with ovarian cancer at 26 sites in the United States, Italy, and Spain. The primary objectives were to assess turnaround time and, using questionnaires, to evaluate stakeholder satisfaction (patients, oncologists, and geneticists or genetic counselors) with the oncologist-led BRCAm testing pathway. Results The median overall turnaround time was 9.1 weeks (range, 0.9 to 37.1 weeks), with median turnaround times in the United States, Italy, and Spain of 4.1 weeks (range, 0.9 to 37.1 weeks), 20.4 weeks (range, 2.9 to 35.4 weeks), and 12.0 weeks (range, 2.0 to 36.7 weeks), respectively. Patient satisfaction with the oncologist-led BRCAm testing pathway was high, with &gt; 99% of patients expressing satisfaction with pre- and post- BRCAm test counseling. Oncologist satisfaction with the BRCAm testing pathway was also high, with &gt; 80% agreeing that the process for performing BRCAm testing worked well and that counseling patients on BRCAm testing was an efficient use of their time. Oncologists expressed higher levels of satisfaction with the BRCAm testing pathway than did geneticists or genetic counselors. Conclusion The results of the ENGAGE study demonstrate that an oncologist-led BRCAm testing process is feasible in ovarian cancer. Development of local BRCAm testing guidelines similar to the one used in this study could allow faster treatment decisions and better use of resources in the management of patients with ovarian cancer.
Effect of macrophages on pancreatic cancer.
Authors: Evan Scott Glazer, Leighton F. Reed, Charlie J. Freeburg, S. Mazher Husain, Jeremiah Lee Deneve, Paxton Vandiver Dickson, David Shibata
Journal: Journal of Clinical Oncology (2018)

324 Background: Pancreatic Ductal Adenocarcinoma (PDAC) is expected to be the second leading cause of cancer related deaths by 2030. TGF-β is a well-studied PDAC mediator with a context dependent role as initially a tumor suppressor with potential to convert to a tumor promoter in later stages. Tumor associated macrophages and interleukins, such as the pro-inflammatory interleukin, IL23, are not well studied regarding PDAC. We hypothesized PDAC treated with TGF-β and macrophages would induce a more aggressive phenotype. Methods: We investigated aggressive behavior with a primary PDAC cell line in vivo and a metastatic PDAC cell line in vitro. A primary pancreatic cell line, Panc-1 cells, were pre-treated with PBS, IL23, macrophages (10:1 ratio of Panc-1 cells to macrophages), IL23 + macrophages, TGF-ß, TGF-ß + macrophages, or TGF-ß + macrophages + IL23. After treatment, cells were orthotopically implanted into the pancreas of NOD SCID gamma mice with 5 mice per group. Mice weights were recorded twice weekly for 4-weeks. Primary lesions and metastasis were investigated with ANOVA. AsPC-1 cells, a metastatic pancreatic cell line, were pre-treated with the same seven treatments. We investigated pSTAT3 expression and the streak closure in vitro. Results: Panc-1 cells treated with macrophages had the largest pancreatic tumor weight and diameter compared to PBS control, IL23 alone, and TGF-β alone (P &lt; 0.001). When macrophages treatment included TGF-β, pancreatic tumor weights and diameters decreased as compared to macrophages alone and macrophages + IL23 (P &lt; 0.001). Macrophage treatment induced higher liver weights and higher number of surface liver metastatic lesions suggesting higher metastatic disease burden (P &lt; 0.03). AsPC-1 cells treated with combinations of macrophages and TGF-β increased pSTAT3 expression compared to PBS control. AsPC-1 cells treated with macrophages closed the gap in the scratch assay faster than PBS control 24 hours after treatment (P &lt; 0.001). Conclusions: We demonstrated macrophages have a key role in converting primary pancreatic cancer into a more aggressive phenotype in vivo whereas they have less effect on metastatic pancreatic cancer in vitro.
Using Smartphones and Machine Learning to Quantify Parkinson Disease Severity
Authors: Andong Zhan, Srihari Mohan, Christopher Tarolli, Ruth B. Schneider, Jamie L. Adams, Saloni Sharma, Molly J. Elson, Kelsey L. Spear, Alistair M. Glidden, Max A. Little, Andreas Terzis, E. Ray Dorsey, Suchi Saria
Journal: JAMA Neurology (2018)

<h3>Importance</h3> Current Parkinson disease (PD) measures are subjective, rater-dependent, and assessed in clinic. Smartphones can measure PD features, yet no smartphone-derived rating score exists to assess motor symptom severity in real-world settings. <h3>Objectives</h3> To develop an objective measure of PD severity and test construct validity by evaluating the ability of the measure to capture intraday symptom fluctuations, correlate with current standard PD outcome measures, and respond to dopaminergic therapy. <h3>Design, Setting, and Participants</h3> This observational study assessed individuals with PD who remotely completed 5 tasks (voice, finger tapping, gait, balance, and reaction time) on the smartphone application. We used a novel machine-learning–based approach to generate a mobile Parkinson disease score (mPDS) that objectively weighs features derived from each smartphone activity (eg, stride length from the gait activity) and is scaled from 0 to 100 (where higher scores indicate greater severity). Individuals with and without PD additionally completed standard in-person assessments of PD with smartphone assessments during a period of 6 months. <h3>Main Outcomes and Measures</h3> Ability of the mPDS to detect intraday symptom fluctuations, the correlation between the mPDS and standard measures, and the ability of the mPDS to respond to dopaminergic medication. <h3>Results</h3> The mPDS was derived from 6148 smartphone activity assessments from 129 individuals (mean [SD] age, 58.7 [8.6] years; 56 [43.4%] women). Gait features contributed most to the total mPDS (33.4%). In addition, 23 individuals with PD (mean [SD] age, 64.6 [11.5] years; 11 [48%] women) and 17 without PD (mean [SD] age 54.2 [16.5] years; 12 [71%] women) completed in-clinic assessments. The mPDS detected symptom fluctuations with a mean (SD) intraday change of 13.9 (10.3) points on a scale of 0 to 100. The measure correlated well with the Movement Disorder Society Unified Parkinson Disease's Rating Scale total (<i>r</i> = 0.81;<i>P</i> &lt; .001) and part III only (<i>r</i> = 0.88;<i>P</i> &lt; .001), the Timed Up and Go assessment (<i>r</i> = 0.72;<i>P</i> = .002), and the Hoehn and Yahr stage (<i>r</i> = 0.91;<i>P</i> &lt; .001). The mPDS improved by a mean (SD) of 16.3 (5.6) points in response to dopaminergic therapy. <h3>Conclusions and Relevance</h3> Using a novel machine-learning approach, we created and demonstrated construct validity of an objective PD severity score derived from smartphone assessments. This score complements standard PD measures by providing frequent, objective, real-world assessments that could enhance clinical care and evaluation of novel therapeutics.
I'm thinking of getting out of medicine altogether after feeling thoroughly disappointed with the new foundation schemes. Is there a list of companies that will consider employing medical graduates or doctors?
Authors: Sarah Burnett
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>
Clinical features, treatment, prognosis, and outcome of 47 patients with pure squamous cell carcinoma of the prostate.
Authors: Daniel Brunnhoelzl, Jue Wang
Journal: Journal of Clinical Oncology (2018)

7 Background: Pure squamous cell carcinoma of the prostate is a rare entity. Data regarding clinical features, management, and treatment outcomes are limited. As such, management of this cancer has been variable throughout the reported literature, and with limited success. Methods: A systematic review of the literature and secondary data analysis was performed to characterize clinical features, management, and survival outcomes. Results: In total, 47 cases of histologically-confirmed pure squamous cell carcinoma of the prostate were included in analysis. Pure squamous cell carcinoma of the prostate is a disease of older males with mean age at diagnosis of 68.5 years (range 42-85). Urinary obstruction was reported as a presenting symptom in 60% of cases. PSA was usually normal with a mean value of 1.6 (n = 11). The disease was metastatic at diagnosis in 32% of patients among cases that stage was reported (n = 31). The most common sites ( &gt; 30%) of distant metastases are bone and lymph nodes. Metastasis to lung, liver, and brain were 20%, 7%, and 7%, respectively. In terms of management, chemotherapy was given in 28% of cases, radiation in 30%, and prostatectomy in 25.5%. Hormone therapy was rarely attempted (4%). Metastatic disease was associated with a significant decrease in survival when compared to localized disease, p = 0.006. Surgical management was associated with significantly increased survival, p = 0.041. Overall 1-year survival was 32%, while 3-year survival was 9%. Conclusions: Squamous cell carcinoma of the prostate has an aggressive clinical course and is associated with poor prognosis. There is urgent need for early detection and the development of novel treatment options.[Table: see text]
Biomaterial Scaffolds as Pre‐metastatic Niche Mimics Systemically Alter the Primary Tumor and Tumor Microenvironment
Authors: Brian A. Aguado, Rachel M. Hartfield, Grace G. Bushnell, Joseph T. Decker, Samira M. Azarin, Dhaval Nanavati, Matthew J. Schipma, Shreyas S. Rao, Robert S. Oakes, Yining Zhang, Jacqueline S. Jeruss, Lonnie D. Shea
Journal: Advanced Healthcare Materials (2018)

Abstract Primary tumor (PT) immune cells and pre‐metastatic niche (PMN) sites are critical to metastasis. Recently, synthetic biomaterial scaffolds used as PMN mimics are shown to capture both immune and metastatic tumor cells. Herein, studies are performed to investigate whether the scaffold‐mediated redirection of immune and tumor cells would alter the primary tumor microenvironment (TME). Transcriptomic analysis of PT cells from scaffold‐implanted and mock‐surgery mice identifies differentially regulated pathways relevant to invasion and metastasis progression. Transcriptomic differences are hypothesized to result from scaffold‐mediated modulations of immune cell trafficking and phenotype in the TME. Culturing tumor cells with conditioned media generated from PT immune cells of scaffold‐implanted mice decrease invasion in vitro more than two‐fold relative to mock surgery controls and reduce activity of invasion‐promoting transcription factors. Secretomic characterization of the conditioned media delineates interactions between immune cells in the TME and tumor cells, showing an increase in the pan‐metastasis inhibitor decorin and a concomitant decrease in invasion‐promoting chemokine (C‐C motif) ligand 2 (CCL2) in scaffold‐implanted mice. Flow cytometric and transcriptomic profiling of PT immune cells identify phenotypically distinct tumor‐associated macrophages (TAMs) in scaffold‐implanted mice, which may contribute to an invasion‐suppressive TME. Taken together, this study demonstrates biomaterial scaffolds systemically influence metastatic progression through manipulation of the TME.
More GPs could become trainers, researchers argue
Authors: Abi Rimmer
Journal: BMJ (2014)

More general practitioners could become trainers because the distance between practices and medical schools should not be considered a barrier to teaching, researchers have argued.1

Researchers from the University of Keele asked all 33 medical schools in the United Kingdom for details of the GP practices that provided undergraduate teaching for their medical students. They established that about 4390 GP practices in the UK offered undergraduate teaching. They added that the proportion of undergraduate medical training dedicated to general …
Enhanced uptake in 2D- and 3D- lung cancer cell models of redox responsive PEGylated nanoparticles with sensitivity to reducing extra- and intracellular environments
Authors: Claudia Conte, Francesca Mastrotto, Vincenzo Taresco, Aleksandra Tchoryk, Fabiana Quaglia, Snjezana Stolnik, Cameron Alexander
Journal: Journal of Controlled Release (2018)
I am thinking of becoming a GP. What is the GP equivalent of continuing professional development points?
Authors: Adam Sandell
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>
Back Pain in a Patient With Parotid Carcinoma
Authors: Punit Sharma, Tanweer Shahid, Mukti Mukherjee
Journal: Clinical Nuclear Medicine (2018)

Nonmalignant incidental findings in patients undergoing F-fluorodeoxyglucose (F-FDG) PET/CT for oncological indication are common. Here, we present such a case of a 40-year-old woman, treated case of adenoid cystic carcinoma of the left parotid gland, who subsequently presented with progressive back pain and deranged liver function tests. F-FDG PET/CT showed no definite malignancy but incidental finding of moderately severe acute pancreatitis, which was the cause of back pain.
Medical school outreach remains patchy, report finds
Authors: Caroline White
Journal: BMJ (2016)

Efforts to attract more students from disadvantaged backgrounds into medicine have yet to reach all areas of the UK—specifically parts of the north east, north west, and east of England, and Wales—a report has found.

The current state of medical school outreach in secondary schools was revealed in a report on the steps that were being taken to boost access to medicine.1 The report was an update of work that came out of the Selecting for Excellence Executive Group (SEEG) project.2

The SEEG project was set …
IS IT BETTER TO HAVE A VASCULAR COMPLICATION THAN PERFORM ALTERNATIVE ACCESS? RESULTS WITH A TF-FIRST STRATEGY
Authors: Cesar S. Staniloae, Danielle N. Sin, Hanah E. Lee, Homam Ibrahim, Kazuhiro Hisamoto, Nicholas Amoroso, Hasan Jilaihawi
Journal: Journal of the American College of Cardiology (2018)
Preoperative therapy for gastric adenocarcinoma in relation to oncologic outcomes in patients with complications after gastrectomy.
Authors: Diego Vicente, Naruhiko Ikoma, Y. Sabrina Chiang, Keith Fournier, Paul F. Mansfield, Jaffer A. Ajani, Brian D. Badgwell
Journal: Journal of Clinical Oncology (2018)

107 Background: Postoperative complications (POC) are associated with poor oncologic outcomes in gastric cancer, however, it is unknown if preoperative therapy has any impact on this association. We sought to evaluate the impact of POC on survival in patients with gastric cancer treated with upfront surgery versus those treated with preoperative therapy. Methods: We analyzed data from a prospectively maintained database of patients who had undergone resection of their gastric cancer at our institution between 1995 and 2015. Patients with T1N0 or M1 lesions, recurrent disease, mortality within 90 days, and GEJ tumors were excluded. Cox regression analyses were used to examine factors associated with overall survival (OS) and disease free survival (DFS). Interaction terms between complications and preoperative therapy were used in the multivariate model to determine their impact on OS and DFS. Results: 421 patients underwent resection of gastric cancer: 30% underwent upfront surgery, and 51% had a POC. Variables associated with POCs included total gastrectomy (p = 0.02) and additional organ resection (p = 0.05). Among patients who had POCs, 71% were infectious, 41% experienced multiple complications, and 55% were classified as Clavien-Dindo grade III or IV. On multivariable analysis, the presence of a POC had the strongest association with diminished OS (HR 3.5, 95% CI 1.9-6.5). Among patients who underwent upfront surgery, patients with a POC had shorter OS (5-year, 85% vs. 47%; p &lt; 0.001) and DFS (5-year, 76% vs. 46%; p &lt; 0.001) than those without a POC. In contrast, there was no difference in OS (5-year, 63% vs. 57%; p = 0.77) and DFS (5-year, 52% vs. 52%; p = 0.52) between patients with and without POC who received preoperative therapy. Interaction terms between preoperative therapy and complication in the multivariable Cox regression model were significant on OS (3.53 [95%CI: 1.92-6.52]) and DFS (2.84 [95%CI: 1.59-5.08]), which indicated that the negative impact of complications were reduced if patients received preoperative therapy. Conclusions: The use of preoperative therapy negated the impact of POCs on OS and DFS in patients undergoing resection for gastric cancer.
New era for European Respiratory Society clinical practice guidelines: joining efficiency and high methodological standards
Authors: Marc Miravitlles, Thomy Tonia, David Rigau, Nicolas Roche, Céline Genton, Valérie Vaccaro, Tobias Welte, Mina Gaga, Guy Brusselle
Journal: European Respiratory Journal (2018)

One of the most important tasks of a scientific society is the development of clinical practice guidelines (CPGs). The objectives of CPGs are to improve the quality and efficiency of healthcare, to reduce unjustified variations in the practices of diagnosis and treatment, and to improve patient outcomes. In order to fulfil these objectives, CPGs have to be evidence-based and therefore need to be developed through an unbiased process, consisting of systematic reviews, a standardised evaluation of the evidence and transparent evidence to decision (EtD) process. The European Respiratory Society (ERS) is committed to the development of the highest quality CPGs [1] and adopted the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach [2], which ensures that the ERS CPGs meet most of the Institute of Medicine standards for defining "trustworthy" CPGs [3]. Clinical practice guidelines have to respond to the needs of users <http://ow.ly/Vui330iwPbY>
Effectiveness of colon cancer awareness month compared to pancreatic cancer awareness month at increasing internet search activity.
Authors: Sajan Jiv Singh Nagpal, Dhruvika Mukhija, Ayush Sharma, Sahil Khanna
Journal: Journal of Clinical Oncology (2018)

240 Background: Colorectal and Pancreatic cancers have high mortality with about 50,000 patients dying from each annually. Cancer awareness months (CAMs) have been earmarked by cancer societies to change public attitudes towards prevention, screening and treatment of various cancers. Awareness campaigns lead by these societies have benefited significantly from readily available Internet access and growing social media. Internet search activity has been used as a surrogate tool to gauge public interest and awareness. We aimed to assess if cancer awareness months impact internet search activity for these cancers. Methods: Using Google Trends, a public web facility of Google Inc. based on Google Search, we compared the relative frequency of search of terms ‘Colon Cancer’ and ‘Pancreatic Cancer’ between 1st January 2004 and 31st December 2016 (n=156 months). The program assigns a reference value of 100 for the point of maximum popularity from among the search terms, and provides relative monthly scores for all terms, which we termed relative interest scores (RIS). Within each cancer, the median RIS was then compared for their respective awareness months (n=13; March for CRC and November for PC) to the to the remaining months (n=143). Results: The median (IQR) RIS for CRC was significantly higher for CRC during its CAM:54 (51-63) as compared to other months:47 (44-50); p=0.0001. However, there was no significant difference in the median RIS for PC during its CAM: 33 (27.5-35.5) as compared to other months: 31 (27-33); p=0.43. The point of maximum popularity during the study period (i.e. RIS 100), and other peaks in search volume for PC corresponded to significant news events associated with PC, and PC search volumes surpassed CRC in those months. Conclusions: Ongoing campaigns for CRC awareness appear to be effective in increasing internet search activity during its respective CAM. While differences could be due to established CRC screening guidelines, other reasons behind the success of CRC awareness campaigns should be adopted by PC as awareness campaigns for the two cancers are otherwise similar.
Annals Graphic Medicine - Is This What Depression Looks Like?
Authors: William J. Doan
Journal: Annals of Internal Medicine (2018)

Web Exclusives6 March 2018Annals Graphic Medicine - Is This What Depression Looks Like?FREEWilliam J. Doan, BA, MFA, PhDWilliam J. Doan, BA, MFA, PhDPennsylvania State University, University Park, Pennsylvania (W.J.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G17-0016 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The author/artist imagines what depression looks like inside himself and wonders, "Is this the black dog of depression I've read about?" Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Pennsylvania State University, University Park, Pennsylvania (W.J.D.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G17-0016.Author/Illustrator Information: William J. Doan, BA, MFA, PhD, is an artist and scholar whose work includes visual art, solo performance, historiography, and playwriting. He is currently Director of the School of Theatre at the Pennsylvania State University.Author Contributions: Conception and design: W.J. Doan.Drafting of the article: W.J. Doan.Final approval of the article: W.J. Doan. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Art and Science of Nursing 6 March 2018Volume 168, Issue 5Page: W9-W17KeywordsConflicts of interestDisclosure ePublished: 6 March 2018 Issue Published: 6 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...