tbuckley/cabot-search huggingface dataset:
I am a general practitioner interested in training in cognitive behaviour therapy. Are there any GPs who have done this who are working in sessions outside general practice in which they use CBT, and in which setting?
Authors: Philip Crocket
Journal: BMJ (2004)

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 (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.
A human iPS cell-based model of medulloblastoma demonstrates co-operativity between SHH signalling and mutation in an epigenetic modifier
Authors: Jignesh Tailor, Miller Huang, Austin Smith, William Weiss
Journal: Neuro-Oncology (2018)

Medulloblastoma (MB), the most common malignant pediatric brain tumor, is comprised of four subgroups (WNT, SHH, Group 3, Group 4). While recurrent single nucleotide variations is rare in MB, mutation of epigenetic modifiers is frequent, suggesting a mechanism for tumorigenesis. Genetically engineered mouse models (GEMMs) recapitulate some aspects of MB, but fail to replicate the epigenetics characteristic of human MB. Therefore, we aimed to develop the first human stem cell based model of MB using iPSC derived from Gorlin syndrome (GS), a disease that predisposes patients to SHH MB due to heterozygosity for PTCH1. We differentiated iPSC from healthy (WT) or GS patients toward hindbrain neuroepithelial stem (NES) cells, a presumed cell of origin of MB. We then electroporated the NES cells with RNA-guided FokI Nucleases (RFN, CRISPR/dCas9-FokI) targeting GSE1 (formerly KIAA0182), a gene encoding an epigenetic modifier and co-mutated with PTCH1 in MB. These NSC were implanted orthotopically into the hindbrains of mice. By 92 days post-implantation, 80% of mice with GS NSC mutant for GSE1 developed tumors with histology consistent with MB. In contrast, GS NSC with wild-type GSE1 developed the first tumor at longer latency (> 140 days) while WT NSC have not generated tumors (> 300 days). Our human iPSC-based model of MB demonstrates a cooperative effect between SHH signaling and a mutation in an epigenetic modifier. We are currently investigating similarities and differences between our human MB with GEMMs and elucidating the role of epigenetic alterations in MB tumorigenesis.
Quantitative comparison of PD-L1 immuno-histochemical assays in hepatocellular carcinoma: The Blueprint-HCC study.
Authors: David James Pinato, Francesco A Mauri, Paolo Spina, Owen Cain, Abdul Siddique, Robert D Goldin, Stephane Victor, Corinna Pizio, Ayse Akarca, Renzo Boldorini, Luca Mazzucchelli, James M Black, Shishir Shetty, Teresa Marafioti, Rohini Sharma
Journal: Journal of Clinical Oncology (2018)

91 Background: Programmed cell death ligand 1 (PD-L1) expression by immunohistochemistry (IHC) enriches for responses to PD-1/PD-L1 inhibitors, however its role as a predictive biomarker in hepatocellular carcinoma (HCC) is inconclusive, with no consensus on any particular assay. We evaluated the performance of 4 different PD-L1 detection assays previously published in landmark clinical studies. Methods: PD-L1 IHC was performed on 4 serial sections from tissue microarray (TMA) blocks containing 100 archival cases of HCC that included tumour and surrounding non-tumorous tissue. Antibody clones E1LN3, 28-8, 22c3, SP263 were compared on the basis of percentage and intensity of staining in malignant cells (M) to generate an H-score (range 0-300). Immune cells infiltrating (ICI) and at the periphery, in non-tumorous tissue (ICP) were scored on a 4-tier system (0-3). Results: Patients were 76% males, 20% HCV-positive, 64% cirrhotic with a median age of 67 years. Median tumour size was 4 cm, 70% of patients had T1-T2 tumours and 48% were of grade 2. The proportion of PD-L1 positive cases according to M-ICI-ICP pattern was 2-6-2% for E1LN3, 10-18-19% for 28-8, 9-22-18% for 22c3 and 5-14-13% for SP263. Pairwise comparison of M H-scores revealed heterogeneity across antibodies, with highest concordance between E1L3N/SP263 (R2 = 0.95), E1L3N/22c3 (R2 = 0.65), 22c3/SP263 (R2 = 0.66) and increasing discordance for 28-8/22c3 (R2 = 0.44), E1L3N/28-8 (R2 = 0.29), and 28-8/SP263 (R2 = 0.26). Detection of PD-L1-positive immune infiltrates using a semi-quantitative scoring system revealed significantly different scores in pairwise non-parametric comparisons of ICI (p &lt; 0.05) but not ICP (p &gt; 0.05 for chi-square test). Conclusions: In the Blueprint-HCC study we demonstrated that quantification of PD-L1 protein levels in tumour cells, intra-tumoural and peri-tumoural infiltrate is characterised by inter-assay discordance in HCC. This has profound implications in the clinical development of predictive correlates of efficacy to immunotherapy in HCC. Sources of such discordance should be explored.
Juniors’ anger took government by surprise, BMA chairman says
Authors: Abi Rimmer
Journal: BMJ (2015)

Junior doctors’ sudden expression of anger over changes to their contract took the government by surprise, the chairman of the BMA has said.

Speaking at the British Association of Physicians of Indian Origin conference in Birmingham on Saturday 31 October, Mark Porter said that the government was caught out by junior doctors’ reactions to the proposed new contract.

“It was a sudden expression that I think has caught many people by surprise, particularly those in government—an expression of anger, dismay, and a call to action by junior doctors,” he said. “I think it has caught the government out in particular …
Gamma Oscillation Dysfunction in mPFC Leads to Social Deficits in Neuroligin 3 R451C Knockin Mice
Authors: Wei Cao, Shen Lin, Qiang-qiang Xia, Yong-lan Du, Qian Yang, Meng-ying Zhang, Yi-qing Lu, Jing Xu, Shu-min Duan, Jun Xia, Guoping Feng, Junyu Xu, Jian-hong Luo
Journal: Neuron (2018)
Abstract 17847: Sedation Use Alters Quantitative Electroencephalography in Comatose Post Cardiac Arrest Patients
Authors: Callie M Drohan, Alessandra Cardi, Jon C Rittenberger, Clifton W Callaway, Maria Baldwin, Jonathan Elmer
Journal: Circulation (2016)

Introduction:  Electroencephalography (EEG) has clinical and prognostic importance for comatose survivors of cardiac arrest. Recent interest in quantitative EEG (qEEG) analysis has grown. The qualitative effects of sedation on EEG are well known, but potentially confounding effects of sedatives on qEEG are poorly characterized in anoxic injury.   Hypothesis:  Sedation decreases amplitude-integrated EEG (aEEG) and alpha/delta ratio (ADR), increases suppression ratio (SR), and the magnitude of this change will predict neurological recovery.   Methods:  We routinely monitor comatose post-arrest patients with EEG for 48-72h, or until death or awakening. In this prospective study, we included consecutive EEG-monitored patients who had protocolized sedation interruptions, excluding those with contraindications to interruption such as seizure or hemodynamic instability. We used Persyst v12 to quantify SR, aEEG, and ADR and calculated medians for 10min immediately prior to sedation interruption and the last 5min of interruption. We used nonparametric tests to determine if the qEEG signal changed pre- to post- and whether this differed by outcome (Cerebral Performance Category 1-2 at hospital discharge vs 3-5).   Results:  Of 101 screened subjects, 22 met inclusion criteria (median age 58 years, 73% male). Sedation regimens varied (18 propofol; 13 fentanyl; 5 midazolam). Median duration of sedation interruption was 35min, and did not differ by sedative type. Pre-interruption, higher ADR and aEEG and lower SR predicted favorable outcome. Post-interruption, SR decreased (median change -0.85, IQR: -12.0 to 0), aEEG increased (0.38, IQR +0.02 to 1.07), but ADR did not change. SR decreased more among those with a poor outcome (P=0.01), but aEEG and ADR changes did not differ by outcome.   Conclusions:  In acute anoxic brain injury, sedation increases SR and decreases aEEG. Larger decreases in SR with sedation interruption predict worse outcomes, which may reflect a susceptibility of deafferentated cortex to suppress in response to sedation.
Some Years Having Passed Since I Lost You
Authors: Lawrence J. Hergott
Journal: Annals of Internal Medicine (2018)

Ad Libitum20 March 2018Some Years Having Passed Since I Lost YouLawrence J. Hergott, MDLawrence J. Hergott, MDCenter for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado (L.J.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2886 Audio Reading - “Some Years Having Passed Since I Lost You” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Some Years Having Passed Since I Lost You," by L.J. Hergott. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Now,some years having passed since I lost you,I am sometimes botheredthat you are less often on my mind.But, like today,the infrequent times I am alonewith nothing to dothat familiar surge of sorrow risesto overwhelm me.I do not fall to the floor,trembling,as I did in the early months.I stand,hand to my forehead—I wail,I bend,my fingernails dig deep into my skin,and I weep,and weep,and weep.I do not write of my sudden sorrowto let you know,or reassure you,that I have not forgotten us.You know.I write,missing you,tears still flowing,grateful to be reassured myself. Author, Article, and Disclosure InformationAffiliations: Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, Colorado (L.J.H.)Current Author Address: Lawrence J. Hergott, MD; e-mail, [email protected]net. PreviousarticleNextarticle Advertisement Audio Reading - “Some Years Having Passed Since I Lost You” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Some Years Having Passed Since I Lost You," by L.J. Hergott. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 20 March 2018Volume 168, Issue 6Page: 451KeywordsFalls ePublished: 20 March 2018 Issue Published: 20 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Prospective evaluation of geriatric assessments as predictors of complications and functional outcome after major urologic tumor surgery in the older population.
Authors: Andreas Kahlmeyer, Wencke Losensky, Danijel Sikic, Bastian Keck, Peter J. Goebell, Bernd Wullich
Journal: Journal of Clinical Oncology (2018)

597 Background: Old patients undergoing major urologic tumor surgery are at severe risk of functional deterioration. In this study we prospectively performed a comprehensive geriatric assessment to identify potential risk predictors for early functional outcome. Methods: Since January 2016, 75 patients undergoing elective cystectomy, prostatectomy or nephrectomy at the age of 70 or older have been enrolled prospectively. A selection of geriatric assessment tools was applied before surgery. Follow up data including standardized peri- and postoperative parameters were obtained at discharge and at day 30 and 180 after surgery (DRKS-ID: DRKS00009825). Results: 14.7% had radical cystectomy, 33.3% had radical prostatectomy and 52.0% had kidney surgery due to malignant tumor. The average age was 75.7 (70-88) years. Within hospital stay, 20.3% had major complications (Clavien-Dindo &gt; = 3) and 25% showed incomplete functional recovery at day 30 after surgery. The average reduction in activities of daily living (ADL) was -34.71. Major complications were significantly associated with impaired mobility (TUG, OR 7.350, p = 0.002), frailty (FrailScale, OR 5.007, p = 0.019) and ASA-Score (ASA, OR 4.400, p = 0.015). Incomplete functional recovery was strongly associated with preoperative impaired mobility (TUG, OR 11.524, p &lt; 0.001) but correlation with ASA-Score (ASA, OR 3.288, p = 0.070) and comorbidities (CCI, OR 3.833, p = 0.106) missed statistical significance. No correlation of functional deterioration was found with age and functional status at admission. The combination of selected assessment tools showed good prediction of early functional recovery (ErlangerIndex, OR 4.400, p = 0.019). Conclusions: Major urologic tumor surgery has a high risk of severe complications and incomplete recovery in old patients. Fast and easy-to-do preoperative assessment tools may predict functional outcome more precisely than age or preoperative functional status alone. Clinical trial information: DRKS00009825.
A Reassessment of Blaming Mass Shootings on Mental Illness
Authors: Matthew E. Hirschtritt, Renee L. Binder
Journal: JAMA Psychiatry (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 Psychiatry HomeNew OnlineCurrent IssueFor Authors Podcast 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 Psychiatry journal
Guanylate cyclase-C as a therapeutic target in gastrointestinal disorders
Authors: Scott A Waldman, Michael Camilleri
Journal: Gut (2018)

Functional gastrointestinal disorders (FGIDs) and IBDs are two of the most prevalent disorders of the GI tract and consume a significant proportion of healthcare resources. Recent studies have shown that membrane-bound guanylate cyclase-C (GC-C) receptors lining the GI tract may serve as novel therapeutic targets in the treatment of FGIDs and IBDs. GC-C receptor activation by its endogenous paracrine hormones uroguanylin and guanylin, and the resulting intracellular production of its downstream effector cyclic GMP, occurs in a pH-dependent manner and modulates key physiological functions. These include fluid and electrolyte homeostasis, maintenance of the intestinal barrier, anti-inflammatory activity and regulation of epithelial regeneration. Studies of the GC-C paracrine signalling axis have revealed the therapeutic potential of these receptors in treating GI disorders, including chronic idiopathic constipation and irritable bowel syndrome-constipation. This review focuses on the evolving understanding of GC-C function in health and disease, and strategies for translating these principles into new treatments for FGIDs and IBDs.
Basic practical skills in obstetrics and gynaecology
Authors: Sumeet Tuteja
Journal: BMJ (2009)

The basic practical skills in obstetrics and gynaecology course is run by the Royal College of Obstetricians and Gynaecologists and at other approved centres to introduce trainees to safe surgical techniques and obstetric clinical skills in a structured workshop environment. The course is intended particularly for year 1 and year 2 specialty trainees and is a mandatory requirement before moving on to year 3; however, foundation doctors are also allowed to take this course.

The course runs over three days and is held at the royal college and also at various regional centres approved by the college. The course is standardised to ensure that common objectives, content structure, and assessment methods are followed. The course consists of three modules that cover basic surgical skills and …
Prognostic impact of splenic hilar lymph node metastasis in proximal gastric carcinoma: A retrospective analysis of 665 patients treated with D2 total gastrectomy.
Authors: Oh Jeong, Young-Kyu Park, Seong Yeob Ryu
Journal: Journal of Clinical Oncology (2018)

11 Background: Standard D2 lymph node (LN) dissection for proximal gastric carcinoma includes removing splenic hilar LNs. However, patients with splenic hilar LN metastasis often show a poor prognosis even after curative surgery. This study aimed to investigate the prognostic impact of splenic hilar LN metastasis in proximal gastric carcinoma. Methods: We reviewed prospectively constructed data of 665 patients who underwent total gastrectomy with D2 LN dissection for proximal gastric carcinoma. Clinicopathological features and survivals were compared between patients with and without splenic hilar LN metastasis. The prognostic value of splenic hilar LN metastasis was examined using a multivariate Cox prognostic model. Results: Of 665 patients, 63 (9.5%) with stage III or IV disease had splenic hilar LN metastasis. Splenic hilar LN metastasis was associated with a larger tumor size, B4 gross type, undifferentiated histology, and lymphovascular invasion. The 5-year survival of patients with splenic hilar LN metastasis was significantly worse at each tumor stage (stage III = 45% vs. 66%, p = 0.044, stage IV = 12% vs. 32%, p = 0.017). The 5-year survival of patients with splenic hilar LN metastasis did not significantly differ from that of the distant metastasis group (26% vs. 31%, p = 0.484). Multivariate analysis revealed that splenic hilar LN metastasis is an independent poor prognostic factor when adjusting for tumor node metastasis stage and other prognostic factors. Conclusions: Patients with splenic hilar LN metastasis show a poor prognosis after surgery. More intensive adjuvant treatment and postoperative surveillance will be required for patients with splenic hilar LN metastasis.
GPs and specialists must end the “them and us” divide, says Gerada
Authors: Tom Moberly
Journal: BMJ (2013)

GPs and hospital doctors will have to change the way they work together if the health service is to improve continuity of care for patients, Clare Gerada believes.

Giving her final speech as chairwoman of the Royal College of General Practitioners at the college’s annual conference in Harrogate this week, Gerada said that the “them and us” divide between GPs and hospital specialists had to end. She also called for changes to the way GP services are organised to help improve the integration of services.

She argued that the current state of working relations between GPs and hospital specialists was­—in conjunction with a range of other factors—affecting the continuity of care given to patients. “We have to urgently address the twin scourges of our health system: poor continuity of care and fragmented care,” she said. “Both made worse by the Health and Social Care Act. Both …
CD301b/MGL2 <sup>+</sup> Mononuclear Phagocytes Orchestrate Autoimmune Cardiac Valve Inflammation and Fibrosis
Authors: Lee A. Meier, Jennifer L. Auger, Brianna J. Engelson, Hannah M. Cowan, Elise R. Breed, Mayra I. Gonzalez-Torres, Joshua D. Boyer, Mayank Verma, Aubyn Marath, Bryce A. Binstadt
Journal: Circulation (2018)

Valvular heart disease is common and affects the mitral valve (MV) most frequently. Despite the prevalence of MV disease (MVD), the cellular and molecular pathways that initiate and perpetuate it are not well understood.
Alina Teresa Piesowicz
Authors: David Ogilvie, Richard Chmielowski
Journal: BMJ (2018)

Alina Teresa Piesowicz was born in Warsaw in 1935. She spent her childhood in Poland during the war years before coming to England as a refugee shortly after the war ended. Her family settled in Ealing, and she gained a place at Guy’s Hospital Medical School in 1953, qualifying in 1958. …
Degree of Master of Surgery (Orthopaedics), MChOrth
Authors: Shah Alam Khan
Journal: BMJ (2007)

FURTHER INFORMATION 

Department of Musculoskeletal Science, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP. Tel 0151 706 4120, fax 0151 706 5815, www.liv.ac.uk/MusculoskeletalScience

The degree is mainly for those interested in a career in orthopaedics who have completed or are about to complete their registrar rotation and who are waiting for a consultant post. It is also useful for international medical graduates planning to return home after a period of training in the United Kingdom.

I completed it in December 2004. I did it as a specialist registrar.

I was …
Moving epidemic method (MEM) applied to virology data as a novel real time tool to predict peak in seasonal influenza healthcare utilisation. The Scottish experience of the 2017/18 season to date
Authors: Josephine L K Murray, Diogo F P Marques, Ross L Cameron, Alison Potts, Jennifer Bishop, Beatrix von Wissmann, Naoma William, Arlene J Reynolds, Chris Robertson, Jim McMenamin
Journal: Eurosurveillance (2018)

Scotland observed an unusual influenza A(H3N2)-dominated 2017/18 influenza season with healthcare services under significant pressure. We report the application of the moving epidemic method (MEM) to virology data as a tool to predict the influenza peak activity period and peak week of swab positivity in the current season. This novel MEM application has been successful locally and is believed to be of potential use to other countries for healthcare planning and building wider community resilience.