tbuckley/cabot-search huggingface dataset:
BMA calls for five years of training for GPs
Authors: Abi Rimmer
Journal: BMJ (2013)

The BMA’s General Practitioners Committee has called for five years of GP training and more funding for GP trainers in its report on the future of general practice.1

The report, which sets out the committee’s vision of the future of the profession, said that general practice was under “severe pressure.” Job satisfaction among GPs is the lowest it has ever been since the introduction of the 2004 GP contract, and stress is at an all time high.

To meet the “significant challenges” facing the NHS, the report said that general practice needed more GPs to create an integrated and personalised model of patient care that would be delivered by a team built around the patient’s …
PERCUTANEOUS CORONARY INTERVENTION VERSUS LEFT INTERNAL MAMMARY ARTERY ROBOTIC-ASSISTED CORONARY ARTERY BYPASS FOR LEFT ANTERIOR DESCENDING ARTERY CHRONIC TOTAL OCCLUSION
Authors: Farshad Forouzandeh, Eric Stahl, Sulay Patel, Yi-An Ko, Chao Zhang, Dustin Staloch, Jon Suh, Suegene Lee, Nitin Sabharwal, Zakaria Almuwaqqat, Bill Gogas, Wissam Jaber, Michael Halkos, Habib Samady
Journal: Journal of the American College of Cardiology (2018)
Preliminary results of a study on focal low dose rate prostate brachytherapy using Cesium <sup>131</sup>.
Authors: Brian Joseph Moran, Michelle H. Braccioforte
Journal: Journal of Clinical Oncology (2018)

151 Background: Prostate cancer patients continue to seek out minimally invasive therapies with equal disease eradication, but with less morbidity, lower cost and multiple salvage options. Our objective was to evaluate PSA response and determine rate of prostate specific antigen (PSA) kinetics in patients undergoing permanent low dose rate (LDR) focal prostate brachytherapy at a single institution. Methods: Between 4/2015 – 1/2017, 52 patients, of which 25% of patients were diagnosed with prostate cancer using a stereotactic transperineal mapping biopsy approach, while 75% had a standard transrectal prostate biopsy, were treated with LDR focal prostate brachytherapy. Dose to target was 115 Gy using Cesium-131. 30 patients (57.7%) were considered low risk, 21 pts (40.4%) were intermediate, and 1 patient (1.9%) was high risk. Treatment was limited to the side of the gland where the cancer was diagnosed. Because there is no agreed upon standard regarding PSA control, we are choosing to call the percent change in PSA the “Impact PSA”. Results: Median pre-treatment prostate volume was 51.6 cm 3 (range 18 – 129 cm 3 ), while the median target volume was 17.8 cm 3 (range 7.6 – 39.4 cm 3 ). Additionally, the median prostate volume treated was 33.73% (range 17.6 – 95.3%). Our data demonstrates that patients in whom 25-50% of the gland treated, resulted in an Impact PSA of approximately 25% - 50% decrease in total PSA between 3 - 6 months, with continued decreases of 55% at 1 year, and 77% at 2 years. Conclusions: Focal therapy outcomes are highly variable and related to volume of ablation. For low volume disease, LDR focal brachytherapy may be a viable option for patients. Optimal outcome assessment after focal therapy is yet to be determined. Since there is untreated gland with the potential to produce PSA, perhaps stable patterns in PSA kinetics, rather than a nadir, is more valuable. We will continue to follow-up with this cohort to report long term results and closely study the Impact PSA.
Abstract 13231: Atrial Fibrillation Recurrence After Catheter Ablation is Associated With Left Atrial Appendage Volume and Plasma Docosahexaenoic Acid Levels
Authors: Tomoyuki Shiozawa, Kazunori Shimada, Gaku Sekita, Seiji Miura, Haruna Tabuchi, Hidemori Hayashi, Hamad Al Shahi, Tomoyasu Kadoguchi, Yurina Sugita, Shohei Ouchi, Tatsuro Aikawa, Shuhei Takahashi, Tetsuro Miyazaki, Shinichiro Fujimoto, Masataka Sumiyoshi, Yuji Nakazato, Hiroyuki Daida
Journal: Circulation (2016)

Background: Risk factors for atrial fibrillation (AF) recurrence in patients undergoing catheter ablation (CA) are unclear. We assessed whether left atrium (LA) and LA appendage (LAA) volume, cardio-metabolic markers such as oxidative and glycation stresses, endothelial function, and polyunsaturated fatty acids (PUFAs) levels were associated with AF recurrence. Methods: Seventy-seven consecutive patients with AF undergoing first-time CA (mean age, 59 ± 8 years; male, 81%; paroxysmal AF, 65%; chickenwing morphology, 49%) were enrolled. LA, LAA volume, and morphology were measured using 3D-computed tomography. Measurements of skin auto-fluorescence advanced glycation end-products (AGEs), circulating PUFAs, and vascular function using EndoPAT were performed immediately before CA. Results: Patients with AF recurrence (36%) had larger LAA volumes (19 ± 13 vs 14 ± 4 cm 3 , P = 0.04) and a larger LAA orifice area (4.9 ± 2.0 vs 3.2 ± 2.1 cm 2 , P = 0.001) than those without AF recurrence, whereas LA diameter and LA volumes were not significantly different. NT-proBNP levels were significantly higher in patients with AF recurrence (527 ± 604 vs 245 ± 268 pg/mL, P = 0.03) than in those without AF recurrence. Notably, AF recurrence occurred in all patients (n = 5) with giant LAAs (≥25 mL). There were no differences in AGEs or vascular function between patients with and without AF recurrence. LAA volume was significantly and negatively associated with docosahexaenoic acid (DHA) levels (P = 0.006, r = –0.32), and patients with giant LAAs (≥25 mL) had significantly lower levels of DHA than other patients (107 ± 36 vs 157 ± 46 μg/mL, P = 0.04). Multiple regression analysis determined that log NT-proBNP and plasma DHA levels were independent factors for LAA volume (P = 0.03, P = 0.02, respectively), when adjusted for age, left ventricular (LV) ejection fraction, LV diameter at end systole, AF detected age, log NT-proBNP, plasma EPA, and DHA levels. Conclusions: A large LAA volume and higher NT-proBNP levels were associated with AF recurrence after CA; AF recurred in all patients with giant LAAs (≥25 mL). Moreover, low levels of DHA were associated with a large LAA volume. Thus, the association between LAA volume and low plasma DHA levels may be an important factor for post-CA AF recurrence.
Risk of de novo Hepatocellular Carcinoma after HCV Treatment with Direct-Acting Antivirals
Authors: Fabian Finkelmeier, Georg Dultz, Kai-Henrik Peiffer, Bernd Kronenberger, Franziska Krauss, Stefan Zeuzem, Christoph Sarrazin, Johannes Vermehren, Oliver Waidmann
Journal: Liver Cancer (2018)

&lt;b&gt;&lt;i&gt;Background and Aims:&lt;/i&gt;&lt;/b&gt; The aim of the study was to evaluate the risk of hepatocellular carcinoma (HCC) development after treatment with direct-acting antivirals (DAAs) and to compare HCC occurrence in these patients with that among patients treated with interferon (IFN)-based therapies. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We analyzed a large cohort with chronic hepatitis C virus patients for the onset of new HCC after DAA treatment. A historical IFN-treated cohort was investigated for comparison. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A total of 819 patients were included in the DAA group. The median follow-up period was 263 days (0–1,001). Twenty-five patients (3.6 HCCs/100 person-years; 3.1%) were diagnosed with de novo HCC within the time of observation. No patient without cirrhosis had developed HCC. Patients with newly diagnosed HCC were mostly male, older, and treatment-experienced and had a lower 12-week sustained virologic response (SVR12) rate and higher levels of liver inflammation markers. The median time to HCC was 312 days (0–880). Investigation of the subcohort of 269 cirrhotic patients yielded an HCC rate of 8.9 HCCs/100 person-years. In this cohort, non-SVR12 was an independent risk factor for de novo HCC (HR 4.48; 95% CI 1.51–13.12; &lt;i&gt;p&lt;/i&gt; = 0.007). Twenty-four patients (96%) with new HCC were Child-Pugh class A and 17 (68%) were diagnosed in early BCLC stage A. For the IFN-treated patients, we calculated an overall risk of HCC occurrence of 1.3/100 person-years (19 patients out of 351; 5.4%). The median time to diagnosis was 38.8 months (0–113). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; The de novo HCC rates did not differ between the DAA-treated patients and those who received IFN. Achievement of SVR is of utmost importance for HCC prevention.
Diploma in the medical care of catastrophes (DMCC)
Authors: Peter Shirley
Journal: BMJ (2005)

The diploma is aimed at those doctors who find themselves required to provide a humanitarian medical and surgical response, and are at the scene at major manmade and natural disasters. This diploma is offered by the Worshipful Society of Apothecaries of London, the only non-university medical licensing body in the United Kingdom.

I had become interested in pre-hospital care and environmental medicine. The concept and aims appealed to me and after talking to a couple of colleagues who had spoken positively about it, I decided to do it.

I successfully completed the exam early in 2002, about four years after first registering an interest. I was overseas at the point of submitting the diploma, …
Emergency medicine run-through pilot scheme opens to existing trainees
Authors: Abi Rimmer
Journal: BMJ (2014)

Existing trainees in emergency medicine can take part in a pilot scheme of run-through training, which is designed to improve recruitment in this specialty and make it a more attractive career choice.

From early 2014 trainees will be able to take part in the pilot, which will be offered by all local education training boards in England, Northern Ireland, Scotland, and Wales. It is supported by the College of Emergency Medicine, the General Medical Council, and the BMA’s Junior Doctors Committee.

A guidance note issued by Health …
P113 Arginase I and the metabolic control of osteoclastogenesis
Authors: JS Brunner, M Hofmann, V Saferding, A Vogel, A Lercher, P Cheng, G Schabbauer, S Blüml
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Introduction</h3> Osteoclasts are giant, multi-nucleated cells that derive from the monocyte-macrophage linage and are regulators of bone turnover. Availability and catabolism of L-Arginine have been implicated with immune cell biology, skewing inflammatory responses within myeloid cells in a pro- or anti-inflammatory manner. <h3>Objectives</h3> While the role of L-Arginine within certain myeloid lineages such as macrophages is well appreciated, its role within osteoclasts is relatively unknown. We therefore aim to investigate L-Arginine metabolism in the context of osteoclastogenesis. <h3>Methods</h3> We analysed osteoclastogenesis of C57BL/6J wildtype bone marrow cells <i>in vitro</i> in the presence and absence of recombinant Arginase 1 (recArg1). This approach was complemented via qPCR analysis of relevant osteoclast marker genes and an extracellular flux assay. We further investigated the effect of recArg1 regarding an <i>in vivo</i> model called serum transfer arthritis, where we treated C57BL/6J wildtype mice with the recombinant enzyme. Disease severity was then assessed using clinical scores and paw histology. <h3>Results</h3> We observed that <i>ARG1</i> mRNA expression was downregulated from the progression of a precursor to a mature osteoclast. We incubated day 3 osteoclast precursors with recArg1 and observed that addition of 1000 ng/ml recArg1 abolished osteoclastogenesis. L-Arginine deprivation led to a decrease in the oxygen consumption rate of osteoclast precursor cells, assessed 48 hour after RANKL addition. Using serum transfer arthritis, an established murine <i>in vivo</i> model, recArg1 treated mice showed reduced disease severity combined with a significant decrease in the presence of osteoclasts. Treatment efficiency was evaluated using an L-Arginine ELISA, where the amino acid was found to be absent in the serum of treated mice. <h3>Conclusions</h3> We propose that the amino acid L-Arginine is critical for the development of osteoclasts from myeloid precursors and hypothesise that its abundance, influenced by recArg1 addition, influences development and severity of osteoclast driven diseases. <h3>Disclosure of interest</h3> J. Brunner Grant/research support from: Bio Cancer Treatment International Ltd, M. Hofmann Grant/research support from: Bio Cancer Treatment International Ltd, V. Saferding Grant/research support from: Bio Cancer Treatment International Ltd, A. Vogel Grant/research support from: Bio Cancer Treatment International Ltd, A. Lercher: None declared, P. Cheng Shareholder of: Bio Cancer Treatment International Ltd, G. Schabbauer Grant/research support from: Bio Cancer Treatment International Ltd, S. Blüml Grant/research support from: Bio Cancer Treatment International Ltd
Mobilised to Iraq: a surgical trainee's tale
Authors: Jo Krysa
Journal: BMJ (2004)

Mobilisation papers to go to Iraq arrived on my desk during the first year of my specialist registrar training in surgery.

I have been in the territorial army for over four years, but the unit had not been deployed since the second world war and so compulsory mobilisation was a bit of a shock. At that time I did not know how my training would be affected, and to be honest the idea of spending six months in Iraq scared me. I was given two weeks to organise my life and present myself at the army unit. My deployment was fully supported by my family and the programme director of the higher surgical training committee, for which I am grateful. I completed the predeployment training and arrived in Iraq at the beginning of July.

We spent five days acclimatising in Kuwait. We then moved on to our respective posts. I was a medical officer …
Women of the world take over
Authors: John Quin
Journal: BMJ (2012)

Late afternoon in a quiet central European bar, and I’m thinking, “How come only about 10% of consultants in certain hospital specialties are women?” As you do. At a neighbouring table sit two American businessmen and an elegant elderly lady. You recognise her voice. Yoko. It’s Yoko Ono! And so, excited, you think of what you might say to the queen of conceptual art, that paragon of second wave feminism. 

You think of all the women you’ve worked with and admired and conclude that you should say something, anything, to her. Maybe she’ll trip off some koan that will inspire hardworking female colleagues who are up against …
IMPACT OF NEOATHEROSCLEROSIS OBSERVED AT MORE THAN 3 YEARS AFTER DRUG-ELUTING STENT IMPLANTATION ON SUBSEQUENT ADVERSE EVENTS
Authors: Yohei Sumino, Taishi Yonetsu, Yoshihisa Kanaji, Eisuke Usui, Masahiro Hoshino, Hiroaki Ohya, Masahiro Hada, Tadashi Fukuda, Rikuta Hamaya, Yoshinori Kanno, Tsunekazu Kakuta
Journal: Journal of the American College of Cardiology (2018)
How do I perform a telephone interview with a newspaper interested in my plastic surgery research?
Authors: Carl Gray
Journal: BMJ (2004)

<i>Got 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 (www.bmjcareers.com/advicezone) 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.</i>
Unexplained lung disease is killing dentists, says US agency
Authors: Owen Dyer
Journal: BMJ (2018)

An apparent cluster of cases of idiopathic pulmonary fibrosis (IPF) among dentists in Virginia has led the US Centers for Disease Control and Prevention (CDC) to warn that the profession has a potentially elevated risk of developing the progressive lung disease, which has a median survival of three to five years from diagnosis.1

The unusual number of dentists who have had treatment for IPF at a Virginia pulmonary specialist clinic was first noticed by one of the dentist patients himself, who brought it to …
Review on Otological Robotic Systems: Toward Microrobot-Assisted Cholesteatoma Surgery
Authors: Bassem Dahroug, Brahim Tamadazte, Stefan Weber, Laurent Tavernier, Nicolas Andreff
Journal: IEEE Reviews in Biomedical Engineering (2018)

Otologic surgical procedures tend over time to become minimally invasive due to the development of medicine, micro-techniques and robotics.This trend is expected to reduce the patient's recovery time and to improve the accuracy in diagnosis and treatment.One of the most challenging difficulties that face such techniques are precise control of the instrument and supply of an ergonomic system to the surgeon.The objective of this literature review is to present requirements and guidelines for a surgical robotic system dedicated to the middle ear surgery.This review is particularly focused on cholesteatoma surgery (diagnosis and surgical tools) which is one of the most frequent pathologies that urge for an enhanced treatment.The paper also presents the current robotic systems which are implemented for otologic applications.
Early Immunologic Shifts Occurring in Cow’s Milk (CM) Oral Immunotherapy (OIT)
Authors: Jose Luiz Rios, Alfredo Alves Neto, Flávia de Carvalho Loyola, Marilúcia Alves da Venda, Amannda Oliveira Rodrigues Andrade, Carolina Oliveira Santos
Journal: Journal of Allergy and Clinical Immunology (2018)
GP leaders pass vote of no confidence in GMC
Authors: Gareth Iacobucci
Journal: BMJ (2018)

General practice leaders have passed a vote of no confidence in the General Medical Council (GMC) in light of the regulator’s actions in the Hadiza Bawa-Garba case.

A motion passed at the annual UK local medical committees conference in Liverpool also directed the BMA’s general practitioners committee to advise GPs to disengage from written reflection in appraisal and revalidation until adequate safeguards are in place.

In January the GMC successfully appealed to the High Court to have Bawa-Garba removed from the medical register, after the Medical Practitioners Tribunal Service had decided not to strike her off when she was found guilty of gross negligence manslaughter.1

Zoe Norris, chair of the BMA GP …
A phase II study of durvalumab following multimodality therapy for locally advanced esophageal adenocarcinoma: Big Ten Cancer Research Consortium BTCRC-ESO14-012 study.
Authors: Hirva Mansurali Mamdani, Laith I. Abushahin, Bryan J. Schneider, Rozina A. Chowdhery, Borys Hrinczenko, Ahran Lee, Susan M. Perkins, Kenneth Kesler, Shadia Ibrahim Jalal
Journal: Journal of Clinical Oncology (2018)

TPS194 Background: The standard of care for locally advanced esophageal adenocarcinoma is concurrent chemoradiation (CRT) followed by esophagectomy with lymphadenectomy. Approximately 30% of patients achieve a complete pathologic response (pCR) with this multimodality approach, which has been correlated with improved disease-free survival. The risk of relapse in the remaining 70% of patients who have pathologic evidence of persistent disease in the surgical specimen is extremely high and estimated at 60-70%. Preclinical studies have demonstrated that radiation with or without concurrent chemotherapy upregulates the programmed cell death receptor- 1 (PD-1) pathway by inducing a local inflammatory response, an effect that persists for a number of months after cessation of therapy. Durvalumab is a selective, high affinity, engineered human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80, and has shown activity in metastatic esophageal cancer. The aim of this study is to evaluate efficacy of post-operative durvalumab with respect to decreasing the relapse rate in patients who do not achieve pCR following CRT. Methods: Patients with esophageal adenocarcinoma who have pathologic evidence of persistent disease in the surgical specimen following neoadjuvant concurrent CRT (carboplatin plus paclitaxel or cisplatin plus 5-FU) and R0 resection are eligible for enrollment on this single arm phase II study. Durvalumab 1500mg IV every 4 weeks is started within 1-3 months of surgery and continued for up to 1 year. The primary endpoint is 1-year relapse free survival (RFS). Secondary endpoint is to assess the incidence and severity of overall and treatment related adverse events. Exploratory endpoints include PDL1 expression in tumor and tumor infiltrating lymphocytes, assessment of Immunoscore within the center and invasive margin of the tumor, and the correlation between changes in circulating tumor cell numbers in response to PD-L1 inhibition. The study is currently open to accrual at 5 sites in the Big Ten Cancer Research Consortium and 17 of the planned 23 patients have been enrolled within the past 14 months. Clinical trial information: NCT02639065.
Services Provided By Internal Medicine Physicians Compared With Emergency Physicians: Flawed Data
Authors: Tim Xu, Angela Park, Ge Bai
Journal: JAMA Internal Medicine (2018)

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Stimulation of RAC1/PAK1 signalling upregulates DNA damage repair genes via the BCL6/STAT5-switch
Authors: P. Barros, A.J. Amaral, L.B. Abrantes, T. Oliveira, H. Louro, M.J. Silva, P. Jordan, M. Gama-Carvalho, P. Matos
Journal: Annals of Oncology (2017)
Overall survival and treatment patterns among real-world patients with locally advanced or metastatic urothelial carcinoma treated with first-line therapy.
Authors: Jason C Simeone, Beth L Nordstrom, Ketan Patel, Alyssa B Klein, Laura Horne
Journal: Journal of Clinical Oncology (2018)

464 Background: Although platinum-based chemotherapy has been the standard of care for the treatment of locally advanced or metastatic urothelial carcinoma (UC), overall survival (OS) remains poor. Real world data on the treatment patterns for UC and effectiveness of these treatments are limited. Methods: Patients with locally advanced or metastatic UC who received first line therapy were identified from the Flatiron Oncology electronic medical record database from 2011–2016; patients who previously received immunotherapy treatment were excluded. Treatment characteristics included the most frequently administered first-line regimens in the study cohort and the time from advanced/metastatic diagnosis to start of first-line therapy. Median OS from the start of first-line therapy was calculated using Kaplan-Meier curves and 95% confidence intervals (CI) are presented. Results: Of 1,811 included patients who met study inclusion and exclusion criteria, the mean age was 70.4 ± 9.5 years, and 73.2% were male. Fewer than 3% of patients were tested for PD-L1 during follow-up. Platinum-based chemotherapy was the most commonly prescribed first-line treatment and immunotherapy was used in 1.3% of first-line regimens (Table 1); patients received a median of one treatment line during follow-up. The median OS was 12.7 months (95% CI: 11.8–13.5) from initiation of first-line therapy. Conclusions: Overall survival among locally advanced/metastatic UC patients who received first-line therapy in a real-world setting was approximately one year. As immunotherapy treatment for UC becomes more common, the impact on OS in the real world setting remains to be seen. [Table: see text]