tbuckley/cabot-search huggingface dataset:
Postgraduate diploma in the ethics of cancer and palliative care
Authors: Rajeena Ackroyd
Journal: BMJ (2004)

Who's it for? Anyone interested in the ethical issues in palliative care, including doctors, nurses, social workers, and chaplains. Designed for people who work full time.

When did you do it? 2002, in my first year of specialist registrar training.

Why did you do it? There are lots of ethical issues in palliative care. I wanted to improve my decision making skills when facing the …
Health Care Costs Associated With Incident Complications in Patients With Type 2 Diabetes in Germany
Authors: Katharina Kähm, Michael Laxy, Udo Schneider, Wolf H. Rogowski, Stefan K. Lhachimi, Rolf Holle
Journal: Diabetes Care (2018)

OBJECTIVE The aim of this study is to provide reliable regression-based estimates of costs associated with different type 2 diabetes complications. RESEARCH DESIGN AND METHODS We used nationwide statutory health insurance (SHI) data from 316,220 patients with type 2 diabetes. Costs for inpatient and outpatient care, pharmaceuticals, rehabilitation, and nonmedical aids and appliances were assessed in the years 2013–2015. Quarterly observations are available for each year. We estimated costs (in 2015 euro) for complications using a generalized estimating equations model with a normal distribution adjusted for age, sex, occurrence of different complications, and history of complications at baseline, 2012. Two- and threefold interactions were included in an extended model. RESULTS The base case model estimated total costs in the quarter of event for the example of a 60- to 69-year-old man as follows: diabetic foot €1,293, amputation €14,284, retinopathy €671, blindness €2,933, nephropathy €3,353, end-stage renal disease (ESRD) €22,691, nonfatal stroke €9,769, fatal stroke €11,176, nonfatal myocardial infarction (MI)/cardiac arrest (CA) €8,035, fatal MI/CA €8,700, nonfatal ischemic heart disease (IHD) €6,548, fatal IHD €20,942, chronic heart failure €3,912, and angina pectoris €2,695. In the subsequent quarters, costs ranged from €681 for retinopathy to €6,130 for ESRD. CONCLUSIONS Type 2 diabetes complications have a significant impact on total health care costs in the SHI system, not only in the quarter of event but also in subsequent years. Men and women from different age-groups differ in their costs for complications. Our comprehensive estimates may support the parametrization of diabetes models and help clinicians and policy makers to quantify the economic burden of diabetes complications in the context of new prevention and treatment programs.
Targeting IκappaB kinases for cancer therapy
Authors: Nikee Awasthee, Vipin Rai, Srinivas Chava, Palanisamy Nallasamy, Ajaikumar B. Kunnumakkara, Anupam Bishayee, Subhash C. Chauhan, Kishore B. Challagundla, Subash C. Gupta
Journal: Seminars in Cancer Biology (2018)
Robotic-Assisted vs Conventional Laparoscopic Surgery for Rectal Cancer
Authors: Sergio Alfieri, Giuseppe Quero, Amjad Parvaiz
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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Improved survival rates in kidney cancer patients with brain metastases treated with modern multidisciplinary approaches.
Authors: I. Alex Bowman, Alisha Bent, Tri Le, Alana Christie, Zabi Wardak, Bruce Mickey, Robert D. Timmerman, Raquibul Hannan, James Brugarolas
Journal: Journal of Clinical Oncology (2018)

601 Background: Brain metastases (BM) in RCC have been associated with poor overall survival. Systemic targeted and immunotherapy and the increasing use of stereotactic radiosurgery (SRS) is likely to improve outcomes. Methods: A retrospective database of mRCC patients treated at our institution between 2006 and 2015 was compiled and patients with BM identified. Overall survival (OS) was analyzed by the Kaplan-Meier method. BM patients were compared to non-BM patients after adjusting for the timing of BM diagnosis, either prior to or during 1 st line systemic therapy (ST). Results: 56 of 248 mRCC patients (22.6%) were diagnosed with BM, 35 (62.5%) prior to and 21 (37.5%) during 1 st line ST. 43/56 (77%) received definitive local therapy for BM (surgery 10, SRS 26, or both 7). 9 received WBRT only and 4 had no CNS-directed therapy. All patients received ST. The median OS for ST-naïve BM patients compared with non-BM patients was 19.5 vs. 28.7 months (p = 0.012). Survival for patients developing BM on 1 st -line therapy was not significantly different from patients without BM progressing on 1 st line ST (11.8 vs. 17.8 months, p = 0.66). BM patients with poor risk mRCC by IMDC criteria did worse than those without BM regardless of line of therapy. Conclusions: Survival for patients with BM and favorable or intermediate risk mRCC is significantly better than historical reports and similar to non-BM patients in our population which was heavily treated with both systemic and local therapies. Patients with BM and poor risk RCC had significantly worse survival, suggesting that risk group should be considered when counseling on prognosis and selecting treatment. [Table: see text]
Elevated plasma catecholamines functionally compensate for the reduced myogenic tone in smooth muscle STIM1 knockout mice but with deleterious cardiac effects
Authors: Prahalathan Pichavaram, Wen Yin, Kirk W Evanson, Jonathan H Jaggar, Salvatore Mancarella
Journal: Cardiovascular Research (2018)

Stromal interaction molecule 1 (STIM1) has emerged as an important player in the regulation of growth and proliferation of smooth muscle cells. Therefore, we hypothesized that STIM1 plays a crucial role in the maintenance of vascular integrity. The objective of this study was to evaluate whether reduced expression of STIM1 could modify the structure and function of the vasculature, leading to changes in blood pressure (BP).Smooth muscle-specific STIM1 knockout (sm-STIM1 KO) in mice resulted in arteries with ∼80% reduced STIM1 protein expression as compared with control mice. Mesenteric vessels exposed to increasing transmural pressure revealed attenuated myogenic reactivity and reduced vasoconstrictor response to phenylephrine in sm-STIM1 KO arteries. BP monitored via telemetry in sm-STIM1 KO and matched controls did not reveal differences. However, heart rate was significantly increased in sm-STIM1 KO mice. Consistent with these findings, plasma catecholamine levels were higher in sm-STIM1 KO than in control mice. Increased sympathetic activity in sm-STIM1 KO mice was unmasked by apha1-adrenergic receptor inhibitor (prazosin) and by treatment with the ganglion-blocking agent, hexamethonium. Both treatments resulted in a greater reduction of BP in sm-STIM1 KO mice. Cytoskeleton of cultured smooth muscle cells was studied by immunocytochemistry using specific antibodies. Staining for actin and vinculin revealed significant alterations in the cytoskeletal architecture of cells isolated from sm-STIM1 KO arteries. Finally, although sm-STIM1 KO mice were protected from Ang II-induced hypertension, such treatment resulted in significant fibrosis and a rapid deterioration of cardiac function.STIM1 deletion in smooth muscle results in attenuated myogenic tone and cytoskeletal defects with detrimental effects on the mechanical properties of arterial tissue. Although BP is maintained by elevated circulating catecholamine, this compensatory stimulation has a deleterious long-term effect on the myocardium.
Pustular Eruption (Iododerma?) in a Patient With Cancer Treated With Complementary and Alternative Medicine—Reply
Authors: Josh A. Hammel, John C. Selby
Journal: JAMA Dermatology (2018)

In Reply We thank Dr Nwabudike for his kind remarks regarding our recent Observation. Herein, we provide additional details concerning our diagnosis of iododerma while expanding our opinion on the role of Hoxsey herbal therapy in the outcome of this case.
TEMPORAL SOCIETY OF THORACIC SURGERY SCORE CHANGES INFLUENCE RISK CLASSIFICATION FOR PATIENTS UNDERGOING AORTIC VALVE REPLACEMENT
Authors: Ron Waksman, Toby Rogers, Rebecca Torguson, Linzhi Xu, Jiaxiang Gai, Joelle Salmon, Lowell Satler, Paul Corso
Journal: Journal of the American College of Cardiology (2018)
Revalidation will assess whether doctors treat patients with dignity
Authors: Ingrid Torjesen
Journal: BMJ (2012)

Revalidation will test whether doctors treat patients with dignity, and those that don’t should face disciplinary action or even dismissal, says the Commission on Dignity in Care.

On 29 February the independent commission, which was set up by the NHS Confederation, Age UK, and the Local Government Association, launched a report, Delivering Dignity, which sets out 48 recommendations to help ensure that older patients are treated with dignity and respect in hospitals and care homes ( BMJ 2012;344:e1538, doi).

Trailing the report on BBC Radio 4’s Today programme on Wednesday morning, Keith Pearson, co-chair of the commission said: “We say in the report quite clearly that if there is evidence that someone …
Abstract ES5-3: Biologic and health system determinants of breast cancer disparities in African Americans
Authors: KE Reeder-Hayes
Journal: Cancer Research (2018)

Abstract Despite significant progress in breast cancer screening and treatment over three decades, racial disparities in breast cancer mortality between African American (AA) and White women continue to widen. A cascade of factors, both biological and ecological, drive these disparities, including: (1) differences in presenting stage and uptake of breast cancer screening; (2) differences in subtype distribution, beginning with over-representation of hormone receptor negative, HER2 negative (triple negative) tumors in young AA women, and extending to recent evidence of potential biologic differences within hormone receptor positive (HR+) subtypes; (3) barriers to appropriate delivery of breast cancer care for AA women, including chemotherapy, radiation and targeted endocrine and biologic therapies; (4) differences in the impact of cancer treatment during survivorship and the impact of co-morbidities on post-diagnosis risk, including obesity, health-related quality of life and financial toxicity. Although the biologic and health system contributors to breast cancer disparities in AA women have been well studied, interventions designed to improve health equity for AA women with breast cancer are only beginning to emerge. Meaningful improvement in the survival gap will require close examination of how biology and healthcare access act as drivers of sub-optimal outcomes, and how both can be targeted to improve outcomes. Interventions with promise to impact racial disparities include programs that improve access to screening, patient navigation programs, and interventions to improve adherence to endocrine therapy, and some of these approaches are being tested in ongoing clinical trials. The impact of access to insurance should also be considered as an intervention for vulnerable populations, including AA women. Basic and translational research including efforts to identify therapeutic targets in triple negative breast cancer subtypes and to leverage genomics for better identification of high risk HR+ cancers may also disproportionately benefit AA patients due to their over-representation in these subtypes, but these efforts depend on adequate representation of AA patients in tissue biobanks and clinical trials, as well as adequate access to genomic testing. Citation Format: Reeder-Hayes KE. Biologic and health system determinants of breast cancer disparities in African Americans [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 ES5-3.
Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease
Authors: Iris M. van Hagen, Sara A. Thorne, Nasser Taha, Ghada Youssef, Amro Elnagar, Harald Gabriel, Yahia ElRakshy, Bernard Iung, Mark R. Johnson, Roger Hall, Jolien W. Roos-Hesselink
Journal: Circulation (2018)

Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease.The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention. Associations between patient characteristics and cardiac outcomes were checked in a 3-level model (patient-center-country).Most patients came from emerging countries (75%). Mitral stenosis (MS) with or without mitral regurgitation (MR) was present in 273 women, isolated MR in 117. The degree of MS was mild in 20.9%, moderate in 39.2%, severe in 19.8%, and severity not classified in the remainder. Maternal death during pregnancy occurred in 1 patient with severe MS. Hospital admission occurred in 23.1% of the women with MS, and the main reason was heart failure (mild MS 15.8%, moderate 23.4%, severe 48.1%; P<0.001). Heart failure occurred in 23.1% of patients with moderate or severe MR. An intervention during pregnancy was performed in 16 patients, 14 had percutaneous balloon mitral commissurotomy, and 2 had surgical valve replacement (1 for MS, 1 for MR). In multivariable modeling, prepregnancy New York Heart Association class >1 was an independent predictor of maternal cardiac events. Follow-up at 6 months postpartum was available for 53%, and 3 more patients died (1 with severe MS, 1 with moderate MS, 1 with moderate to severe MR).Although mortality was only 1.9% during pregnancy, ≈50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications.
Are publications and paper presentations at conferences good to have on a CV for an SHO job?
Authors: Thomas Shakespeare
Journal: BMJ (2004)

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.
ST3 recruitment in trauma and orthopaedics: what are the characteristics of successful candidates?
Authors: Yasmeen Khan, Jonathan Palmer, Timothy Briggs
Journal: BMJ (2014)

Recruitment into trauma and orthopaedics is competitive and has been subject to many changes in recent years, including the first national recruitment selection in 2013 for the third year of specialty training. <b>Yasmeen Khan and colleagues</b> describe this new national recruitment process and attempt to identify common characteristics of successful candidates
Multicentre observational screening survey for the detection of CTEPH following pulmonary embolism
Authors: Nicolas Coquoz, Daniel Weilenmann, Daiana Stolz, Vladimir Popov, Andrea Azzola, Jean-Marc Fellrath, Hans Stricker, Alberto Pagnamenta, Sebastian Ott, Silvia Ulrich, Sandor Györik, Jérôme Pasquier, John-David Aubert
Journal: European Respiratory Journal (2018)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism. Its incidence following pulmonary embolism is debated. Active screening for CTEPH in patients with acute pulmonary embolism is yet to be recommended. This prospective, multicentre, observational study (Multicentre Observational Screening Survey for the Detection of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Following Pulmonary Embolism (INPUT on PE); ISRCTN61417303 ) included patients with acute pulmonary embolism from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a stepwise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiological confirmation of CTEPH. Out of 1699 patients with pulmonary embolism, 508 patients were assessed for CTEPH screening over 2 years. CTEPH incidence following pulmonary embolism was 3.7 per 1000 patient-years, with a 2-year cumulative incidence of 0.79%. The Swiss pulmonary hypertension registry consulted in December 2016 did not report additional CTEPH cases in these patients. The survey yielded 100% sensitivity and 81.6% specificity. The second step echocardiography in newly dyspnoeic patients showed a negative predictive value of 100%. CTEPH is a rare but treatable disease. A simple and sensitive way for CTEPH screening in patients with acute pulmonary embolism is recommended.
Spending by Commercial Insurers on Chemotherapy Based on Site of Care, 2004-2014
Authors: Aaron N. Winn, Nancy L. Keating, Justin G. Trogdon, Ethan M. Basch, Stacie B. Dusetzina
Journal: JAMA Oncology (2018)

This database study analyzes trends in infused chemotherapy services performed in the physician office or hospital outpatient setting for commercially insured patients with cancer.
New online system for specialty training recruitment is planned for 2014
Authors: Helen Jaques
Journal: BMJ (2013)

Health Education England is planning a new national online system to coordinate selection and recruitment to postgraduate specialty medical and dental training in the United Kingdom.

The system will comprise a single online location where doctors can apply to specialty training in all specialties and locations and can receive and hold job offers. The system should improve access to information on careers and recruitment, decrease the time that trainees spend submitting applications, and decrease administration time, Health Education England has said. 

The system will also improve …
Preclinical study of antitumor activity of trastuzumab emtansine in HER2-positive biliary tract cancer.
Authors: Yoriko Yamashita-Kashima, Takaaki Fujimura, Sei Shu, Mieko Yanagisawa, Marie Mochizuki, Keigo Yorozu, Mirei Kouno, Koh Furugaki, Ryota Higuchi, Junichi Shoda, Naoki Harada, Yasushi Yoshimura
Journal: Journal of Clinical Oncology (2018)

256 Background: Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate composed of trastuzumab and DM1 (an anti-microtubule agent derived from maytansine) that is approved for the treatment of HER2-positive metastatic breast cancer. HER2-overexpression rate in biliary tract cancer (BTC) is reported as approximately 10%, and HER2-targeted therapy may enhance therapeutic efficacy in HER2-positive BTC. In this study, we investigated the antitumor activity of T-DM1 in several BTC cell lines and xenograft models. Methods: HER2 expression was detected by flow cytometry and Western blotting in 17 BTC cell lines. The cell growth inhibition activity of T-DM1 and DM1 was examined by quantifying the DNA with Hoechst 33258 nucleic acid stain. In vivo antitumor activity of T-DM1 was evaluated in three xenograft mouse models using cell lines with different levels of HER2 expression. HER2 expression in xenografts was assessed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), according to gastric cancer criteria. Cell cycle was assessed by flow cytometry after staining with propidium iodide. Apoptosis was assessed by caspase 3/7 activity measurement. Results: In the 17 BTC cell lines, HER2 expression was high in KMCH-1, Mz-ChA-1, and TGBC-18-TKB. Although cell growth inhibition of DM1 was similar in all cell lines (50% inhibitory concentration (IC50): 0.79–7.2 nM), that of T-DM1 was HER2-expression-dependent, with IC50 values in KMCH-1, Mz-ChA-1, and KKU-100 (which has low HER2 expression) of 0.031, 1.3, and 4.3 μg/mL, respectively. In KMCH-1 and Mz-ChA-1 xenograft models, T-DM1 treatment once every 3 weeks for 6 weeks showed significant dose-dependent antitumor activity, and tumor growth inhibition 21 days after first dose at 20 mg/kg T-DM1 was 108% (KMCH-1) and 75% (Mz-ChA-1), whereas there was no significant efficacy in KKU-100 xenograft model. Values for HER2 status (IHC score/FISH ratio of HER2 to CEP17) in KMCH-1, Mz-ChA-1, and KKU-100 tumor tissues were 3+/3.5, 2+/4.7, and 0/1.1, respectively. In KMCH-1, T-DM1 induced M phase arrest and apoptosis, as is reported in HER2-positive breast cancer cells. Conclusions: T-DM1 could be an effective therapy for HER2-overexpressed BTC.
Radically different approach to NHS workforce planning is needed, report says
Authors: Abi Rimmer
Journal: BMJ (2016)

The government and policy makers need to take a “radically different” approach to NHS workforce planning, the Health Foundation has said.

It said that the current style of workforce policy making was not effective and that, despite major changes elsewhere, the medical workforce had changed little in three decades.1 “We need a radically different approach,” it said.

In a report on workforce planning, the Health Foundation said …
GPs’ workload has reached “saturation” point, warns BMA
Authors: Caroline White
Journal: BMJ (2012)

Primary care has reached “saturation” point, with GPs simply unable to take on any more work without a substantial increase in resources, GP leaders have warned, adding that they will be pressing for this in the next round of contract negotiations.

“We’re at the point now where we are saying to the government, ‘You can’t ask for any more unless something happens to change [the situation]. So more staff and better premises, or you stop announcing initiatives you can’t deliver on,” declared the chairman of the BMA’s General Practitioners Committee, Laurence Buckman.

Buckman said that GPs were overwhelmed by the amount of work they were being expected to do. “GPs all around the country are telling us that they are …