tbuckley/cabot-search huggingface dataset:
Doncaster intermediate surgical skills course
Authors: Darryl Ramoutar, Andrew Titchener
Journal: BMJ (2010)

This intensive one day course concentrates on building on the skills learnt in basic surgical skills. The focus is on technique rather than end results, as good technique inevitably leads to good practice regardless of the surgical discipline. The course is almost entirely practical, with intensive sessions learning how to perform various types of knot tying, including slip knots, surgical knots, and the tying of knots in confined and deep spaces. The few lectures are on topics such as theatre and patient preparation and identification of the instruments commonly used in theatre, the names of which many trainees are not familiar with. There are sessions on instrument …
Impact of Medicaid expansion on diagnosis and management of patients with testicular cancer.
Authors: Xinglei Shen, Mindi TenNapel
Journal: Journal of Clinical Oncology (2018)

551 Background: One crucial aspect of the Affordable Care Act is the optional Medicaid expansion, which started in 2014. Patients with testicular cancer may derive particular benefit from Medicaid expansion due to demographics overlap. We hypothesize that Medicaid expansion would improve outcome in these patients. Methods: We reviewed the Surveillance Epidemiology and End Results (SEER) database for testicular cancer diagnosed from 2010 to 2014. Among the SEER regions, we separated in to states that did (CA, CT, HI, IA, KY, MI, NJ, NM, WA) or did not (AK, GA, LA, UT) undertake expansion. Medicaid data from CMMS were used to measure the degree of Medicaid expansion (EXP). Data from 2010-2013 was used as baseline, and 2014 as the effect of EXP. Chi-square test was used to compare between groups. Results: We identified 12731 cases of testicular cancer from 2010 to 2014. Within SEER regions, overall Medicaid enrollment increased by 30.4% from 2013 to 2014 in the EXP states, and by 8.4% in non-EXP states. Expansion did not affect incidence of testicular cancer. In the EXP states, Medicaid coverage for testicular cancer increased from 14.8% to 19.4% in 2014 (p &lt; 0.001) and uninsured decreased from 8.7% to 4.3% (p &lt; 0.001). In non-EXP states, coverage with Medicaid (9.7% to 8.8%, p = 0.60) and uninsured (13.6% to 12.9%, p = 0.68) did not change. Within individual states, we noted a linear correlation between % increase in Medicaid enrollment and % decrease in uninsured cases (R = 0.58). Among Medicaid patients in EXP states, stage I cases increased (52% to 60%), stage III cases decreased (27% to 20%). There was no change among insured patients (70.6% to 73.3% for stage I, and 10.9% to 9.1% for stage III). In contrast, in non-EXP states, Medicaid patients had decrease in stage I and increase in stage III cases. Medicaid patients had higher rates of no treatment and lower rates of lymph node assessment for stage II NSGCT compared to insured patients, but this did not vary with EXP. Conclusions: Medicaid expansion reduced rate of uninsured for patients with new diagnosis of testicular cancer. There was a shift to earlier stage of diagnosis in Medicaid patients, but no apparent effect yet on management. Future studies will focus on change over time and effect on survival.
IMPACT OF SUBINTIMAL PLAQUE MODIFICATION PROCEDURES ON HEALTH STATUS AFTER UNSUCCESSFUL CHRONIC TOTAL OCCLUSION ANGIOPLASTY
Authors: Taishi Hirai, James Aaron Grantham, James Sapontis, David Cohen, Steven P. Marso, William L. Lombardi, Dimitrios I. Karmpaliotis, Jeffrey Moses, William Nicholson, Ashish Pershad, R. Michael Wyman, Tony Spaedy, Stephen Cook, Parag Doshi, Robert Federici, Karen Nugent, Kensey Gosch, John Spertus, Adam Salisbury
Journal: Journal of the American College of Cardiology (2018)
CORONARY SINUS REDUCER™ RETAINS PATENCY AND EFFICACY AT TWELVE YEARS: A FIRST IN MAN PROSPECTIVE CARDIAC CT ANGIOGRAPHY OUTCOME STUDY
Authors: Keyur H. Parikh, Parth Parikh, Deepa Shah, Parloop Bhatt, Piyush Thakar, Ajay Naik, Hemang Baxi, Shmuel Banai
Journal: Journal of the American College of Cardiology (2018)
How to get the best out of your house officer
Authors: Priya V Joshi, Vaibhav J Joshi
Journal: BMJ (2006)

1. [↵][1]Modified quote from George Orwell. Animal Farm. London: Secker and Warburg, 1945. 2. [↵][2]National Patient Safety Agency. Medical error . 1st ed. London: NPSA, 2005. [1]: #xref-ref-1-1 "View reference 1 in text" [2]: #xref-ref-2-1 "View reference 2 in text
Model Heterogeneity in Predicting Outcomes of Patients with Myelodysplastic Syndromes (MDS)
Authors: Karam Al-Issa, Yazan F. Madanat, Sudipto Mukherjee, Cassandra M. Hirsch, Aaron T. Gerds, Nour Abuhadra, Ahed Makhoul, Hassan Awada, Mohammad Fahad B Asad, Abhinav Goyal, Anjali S. Advani, Teodora Kuzmanovic, Bartlomiej P. Przychodzen, Hetty E. Carraway, Jaroslaw P. Maciejewski, Mikkael A. Sekeres, Aziz Nazha
Journal: Blood (2017)
Man flu is related to health communication rather than symptoms and suffering
Authors: John Axelsson, Julie Lasselin, Mats Lekander
Journal: BMJ (2018)

Sue’s paper on “man flu” is an entertaining read.1 But we think that man flu is more likely due to men communicating their symptoms differently from women, rather than having different immune functioning.

In a study of 1700 people with the common cold, Macintyre found that men over-rated their symptoms compared with a clinician’s judgment more often than did …
Elastase activity on sputum neutrophils correlates with severity of lung disease in cystic fibrosis
Authors: A. Susanne Dittrich, Iris Kühbandner, Stefanie Gehrig, Verena Rickert-Zacharias, Matthew Twigg, Sabine Wege, Clifford C. Taggart, Felix Herth, Carsten Schultz, Marcus A. Mall
Journal: European Respiratory Journal (2018)

Neutrophil elastase (NE) is a key risk factor for severity of cystic fibrosis (CF) lung disease. Recent studies identified increased NE activity on the surface of airway neutrophils from CF-like mice and patients with CF. However, the role of surface-bound NE in CF lung disease remains unknown. We determined the relationship between surface-bound NE activity and severity of lung disease in CF.Surface-bound NE activity was measured on sputum neutrophils from 35 CF patients and eight healthy controls using novel lipidated Förster resonance energy transfer reporters and correlated with free NE activity, neutrophil counts, interleukin-8, myeloperoxidase and antiproteases in sputum supernatant, and with lung function parameters.Surface-bound NE activity was increased in CF compared to healthy controls (p<0.01) and correlated with free NE activity (p<0.05) and other inflammation markers (p<0.001). Surface-bound and free NE activity correlated with forced expiratory volume in 1 s % predicted (p<0.01 and p<0.05), but only surface-bound NE activity correlated with plethysmographic functional residual capacity % pred (p<0.01) in patients with CF.We demonstrate that surface-bound NE activity on airway neutrophils correlates with severity of lung disease in patients with CF. Our results suggest that surface-bound NE activity may play an important role in the pathogenesis and serve as novel biomarker in CF lung disease.
The search for the perfect curriculum vitae
Authors: P J Livesley
Journal: BMJ (2005)

Your CV outlines the history of your career and is the tool that will get you shortlisted for interview for the job of your choice. <i>Heshan Ariyasena</i>, <i>N Tewari</i>, and <i>P J Livesley</i> have asked seven consultants what they think a “successful” CV should include
CD4, CD8 and PD1 immunoexpression in oral premalignant lesions (PML) and oral squamous cell carcinoma (OSCC) and its association with malignant transformation.
Authors: Aline Lauda Freitas Chaves, Ana Gabriela Silva, Flavia M Maia, Gabriele F Lopes, Luciana V. Muniz, Joao Marcos A. Soares, Helio B. Santos, Leandro A Barbosa, Alexandre Andrade, Luiz Fernando B Paula, Adriano M Loyola, Eddie F.C Murta, Marcia A Michellin, Rosy I.M.A. Ribeiro
Journal: Journal of Clinical Oncology (2018)

113 Background: OSCC is a public health problem worldwide, mainly due to its advanced stage diagnosis. The late diagnosis is a nonsense problem in view of this neoplasia often begins as PML. Clinical, molecular and immunological factors have been associated with the cancerization process. Objective: evaluate clinical differences and immunohistochemistry expression of PD1, CD4 and CD8 in PML that transformed in OSCC (PML-OSCC) and PML that didn´t transformed in OSCC (PML-NOSSC). Methods: CD4, CD8 and PD1 immunohistochemistry studies were carried out on PML and OSCC samples of 11 patients with PML – OSCC and PML samples of 14 patients with PML-NOSCC. Statistical differences were analyzed between the two groups: PML-OSCC and PML-NOSCC. Results: Non-homogenous leukoplakia, tongue and lack of exposure to tobacco were associated with cancerization. PD1 strong immunoexpression were observed in 63.6% of PML and 90.9% of OSCC. There was no statistical difference CD4+ cells level in PML-OSCC and PML-NOSCC. A significant increase in CD8+ cells was noted in OSCC comparing with PML–OSCC (p = 0.05). CD8+ cells levels is higher in PML-NOSCC compared with PML-OSCC (p = 0.027). Conclusions: CD8+ cells infiltrate more PML-NOSCC than PML-OSCC. Carcinoma is more infiltrated by CD8+ cells than its associated premalignant lesion. The evolution of immune response from an immunosurveillance phase to editing, equilibrium, suppression and immuno-escape can be present in oral carcinogenesis process. Research Funding: FAPEMIG (Minas Gerais State Research Foundation).
More doctors from India and Dubai sought to fill emergency medicine posts
Authors: Abi Rimmer
Journal: BMJ (2014)

A second round of recruitment for emergency medicine posts in England has begun in India and Dubai.

Health Education England and the College of Emergency Medicine are recruiting doctors from India to work in hospital emergency departments in England. The programme has been launched as a result of low recruitment levels into emergency medicine. In 2013 and 2014 fewer than half the places in higher training for this specialty were filled.1

Kevin Reynard, dean of the College …
GP workforce expansion efforts must begin at medical school
Authors: Tom Moberly
Journal: BMJ (2013)

Efforts to expand the GP workforce must involve changing how medical students are selected and taught, rather than just increasing training posts, the medical director of Health Education England (HEE) believes.

Wendy Reid raised the issue at the annual conference of the Royal College of General Practitioners this month. She called for a “different dialogue” between medical schools and workforce planners about the expectations of medical students and said that this dialogue needed to encompass selection into medical school.

“If your selection is done by interview, and the only people interviewing hold chairs of academic molecular biology, genetics, and obstetrics and gynaecology, you are probably not going to see selection of people who have the values and behaviours necessary to work in a difficult primary care environment,” she said.

Reid argued that getting young people to choose general practice would involve ensuring that medical schools understood their responsibility. “Their responsibility is not just to produce the research doctors of tomorrow, not just to provide a number of people doing X at laboratory …
Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial
Authors: Elizabeth A. Pyatak, Kristine Carandang, Cheryl L.P. Vigen, Jeanine Blanchard, Jesus Diaz, Alyssa Concha-Chavez, Paola A. Sequeira, Jamie R. Wood, Robin Whittemore, Donna Spruijt-Metz, Anne L. Peters
Journal: Diabetes Care (2018)

OBJECTIVETo assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODSEighty-one young adults (age 22.6 6 3.5 years; hemoglobin A 1c [HbA 1c ] = 10.8%/95 mmol/mol 6 1.9%/20.8mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months.IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls.Blinded assessors collected data at baseline and 6 months.The primary outcome was HbA 1c ; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction.Change scores were analyzed using Wilcoxon rank sum tests. RESULTSIntent-to-treat analyses showed that IG participants showed significant improvement in HbA 1c (20.57%/6.2mmol/mol vs. +0.36%/3.9mmol/mol, P = 0.01), diabetesrelated QOL (+0.7 vs. +0.15,P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7,P = 0.05) as compared with CG participants.There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES.No study-related serious adverse events were reported. CONCLUSIONSThe REAL Diabetes intervention improved blood glucose control and diabetesrelated QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.
Is it true that to get a specialist registrar type 1 rotation, one must have done some dedicated research work and must have a number of publications and presentations?
Authors: Rahul Rao
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>
Development and pilot testing of a decision support intervention for men with prostate cancer.
Authors: June M. Chan, Matthew R. Cooperberg, John Neuhaus, Mark Bridge, Lauren Stupar, Tia Weinberg, Jeanette M Broering, Imelda Tenggara, Emil Lavaki, Janet E. Cowan, Stan Rosenfeld, Stacey A. Kenfield, Erin Van Blarigan, Jeff Simko, John Witte, Peter Carroll, Jeffrey Belkora
Journal: Journal of Clinical Oncology (2018)

132 Background: We evaluated the feasibility and efficacy of a decision support intervention designed to help men with low-risk prostate cancer consider active surveillance and standard treatments. The intervention incorporated a decision aid with coaching and question-listing. Our decision aid is the first to include data on long-term survival and side effects from men with prostate cancer undergoing active surveillance, surgery, and radiation. Methods: To develop the intervention, we conducted focus groups using the Nominal Group Technique. We used a survey instrument from the International Patient Decision Aids Standards to measure the stakeholder endorsement of our intervention. To test the intervention, we administered it to newly diagnosed men with low-risk prostate cancer (Gleason sum &lt; = 3+4, stage &lt; = T2N0M0, PSA &lt; = 10 ng/ml) seen at UCSF. Before and after the intervention, we administered a survey with questions from the Decision Quality Instrument for Prostate Cancer. Our primary outcome was change in knowledge as assessed by two multiple-choice items: How many men diagnosed with early stage prostate cancer will eventually die of prostate cancer? How much would waiting 3 months to make a treatment decision affect chances of survival? Correct answers were: “Most will die of something else” and “A little or not at all.” Results: The development phase involved 6 patients, 1 family member, 2 physicians, and 5 other health care providers and four iterations of the intervention until consensus endorsement was reached. In the pilot test, 57 men consented, and 44 received the decision support intervention and completed surveys at both timepoints. Before the intervention, 30/44 (68%) got both questions right, compared to 36/44 (82%) after the intervention. 82% maintained or achieved perfect scores; 16% answered 1 or more incorrectly both before and after the intervention; and 2% answered both items correctly before, but 1 wrong after. Conclusions: This novel decision support intervention was feasible, and appeared to improve knowledge and informed decision-making. Data will guide the development of a larger scale randomized clinical trial to improve decision quality in men with prostate cancer, in the community. Clinical trial information: NCT02451345.
Asthma Control, Viral Infections, and Severity of Asthma Exacerbation Symptoms in Children Seen in the Emergency Department
Authors: Olga Hardin, Darrell L. Dinwiddie, Sudeepa Bhattacharyya, Chunqiao Luo, Ashley Stoner, John C. Kincaid, Kurt Schwalm, Thomas J. Abramo, Tonya M. Thompson, Stacie M. Jones, Richard C. Kurten, Joshua L. Kennedy
Journal: Journal of Allergy and Clinical Immunology (2018)
Momelotinib therapy for myelofibrosis: a 7-year follow-up
Authors: Ayalew Tefferi, Daniela Barraco, Terra L. Lasho, Sahrish Shah, Kebede H. Begna, Aref Al-Kali, William J. Hogan, Mark R. Litzow, Curtis A. Hanson, Rhett P. Ketterling, Naseema Gangat, Animesh Pardanani
Journal: Blood Cancer Journal (2018)

Abstract One-hundred Mayo Clinic patients with high/intermediate-risk myelofibrosis (MF) received momelotinib (MMB; JAK1/2 inhibitor) between 2009 and 2010, as part of a phase 1/2 trial (NCT00935987); 73% harbored JAK2 mutations, 16% CALR , 7% MPL , 44% ASXL1 , and 18% SRSF2 . As of July 2017, MMB was discontinued in 91% of the patients, after a median treatment duration of 1.4 years. Grade 3/4 toxicity included thrombocytopenia (34%) and liver/pancreatic test abnormalities (&lt;10%); grade 1/2 peripheral neuropathy occurred in 47%. Clinical improvement (CI) occurred in 57% of patients, including 44% anemia and 43% spleen response. CI was more likely to occur in ASXL1 -unmutated patients (66% vs 44%) and in those with &lt;2% circulating blasts (66% vs 42%). Response was more durable in the presence of CALR type 1/like and absence of very high-risk karyotype. In multivariable analysis, absence of CALR type 1/like (HR 3.0; 95% CI 1.2–7.6) and presence of ASXL1 (HR 1.9; 95% CI 1.1–3.2) or SRSF2 (HR 2.4, 95% CI 1.3–4.5) mutations adversely affected survival. SRSF2 mutations (HR 4.7, 95% CI 1.3–16.9), very high-risk karyotype (HR 7.9, 95% CI 1.9–32.1), and circulating blasts ≥2% (HR 3.9, 95% CI 1.4–11.0) predicted leukemic transformation. Post-MMB survival (median 3.2 years) was not significantly different than that of a risk-matched MF cohort not receiving MMB.
I have passed part 1 of the exam for membership of the Royal College of Paediatrics and Child Health; is it worth completing the second part, even though I want to be a general practitioner?
Authors: Fiona Jewkes
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.
THE EFFECT OF CARDIAC RESYNCHRONIZATION THERAPY ON OUTCOMES IN WOMEN: A SUBSTUDY OF THE RESYNCHRONIZATION-DEFIBRILLATION FOR AMBULATORY HEART FAILURE TRIAL
Authors: Dominique De Waard, Jaimie Manlucu, Anne Gillis, John Sapp, Anthony Tang, George Wells, Ratika Parkash
Journal: Journal of the American College of Cardiology (2018)
Dose escalation of cabozantinib as a viable option for the treatment of mRCC.
Authors: Martin Boegemann, Laura-Maria Krabbe, Andres Jan Schrader, Axel Semjonow, Yvonne Klaile, Katrin Schlack
Journal: Journal of Clinical Oncology (2018)

636 Background: Cabozantinib (C) is a tyrosin kinase inhibitor (TKI) specific for VEGFR, MET and AXL. The phase-3 registration trial METEOR showed that C significantly improved progression-free and overall survival compared to Everolimus in patients with advanced/metastatic renal cell carcinoma (RCC) after failure of at least one VEGFR TKI and C was granted approval. In METEOR, starting dose for C was 60 mg once daily and dose de-escalation to 40 or 20 mg or stopping of C was done based on toxicity. The median dose was 43 mg. The dose had to be reduced in 62% of patients. By packing insert of C the recommended starting dose is 60 mg. We assumed that starting with 40 mg of C and escalating to 60 mg after getting accustomed to side effects may lead to a higher median dose of C. Methods: We report 20 RCC patients all started with C 40 mg and escalated to 60 mg when possible. We calculated the median time on therapy and the median dose and determined the best response. Results: The median time on C was 77 days for the patients having stopped therapy (n = 9). The median dose of C for the whole cohort was 46.0 mg. For the patients still on therapy (n = 11), the median dose was 47.7 mg. Eleven (55%) patients could be escalated to 60 mg (10 (91%) remained on 60 mg) and only 5 (25%) of patients had to be de-escalated to 20 mg. C did not have to be stopped due to toxicity. For best response, 47% reached partial remission, 13% stable and 40% progressive disease. Conclusions: Starting with 40 mg of C and escalating to 60 mg when possible may lead to a higher median dose of C compared to standard vice versa and seems to achieve responses comparable with the METEOR trial. These findings are limited by the small number of patients but warrant a prospective trial directly comparing both the escalating and de-escalating dosing schemes.
Development of a Molecular Signature to Monitor Pharmacodynamic Responses Mediated by In Vivo Administration of Glucocorticoids
Authors: Yanhua Hu, Julie A. Carman, Deborah Holloway, Selena Kansal, Li Fan, Christine Goldstine, Deborah Lee, John E. Somerville, Robert Latek, Robert Townsend, Alyssa Johnsen, Sean Connolly, Somnath Bandyopadhyay, Nancy Shadick, Michael E. Weinblatt, Richard Furie, Steven G. Nadler
Journal: Arthritis & Rheumatology (2018)

To develop an objective, readily measurable pharmacodynamic biomarker of glucocorticoid (GC) activity.Genes modulated by prednisolone were identified from in vitro studies using peripheral blood mononuclear cells from normal healthy volunteers. Using the criteria of a >2-fold change relative to vehicle controls and an adjusted P value cutoff of less than 0.05, 64 up-regulated and 18 down-regulated genes were identified. A composite score of the up-regulated genes was generated using a single-sample gene set enrichment analysis algorithm.GC gene signature expression was significantly elevated in peripheral blood leukocytes from normal healthy volunteers following oral administration of prednisolone. Expression of the signature increased in a dose-dependent manner, peaked at 4 hours postadministration, and returned to baseline levels by 48 hours after dosing. Lower expression was detected in normal healthy volunteers who received a partial GC receptor agonist, which is consistent with the reduced transactivation potential of this compound. In cohorts of patients with systemic lupus erythematosus and patients with rheumatoid arthritis, expression of the GC signature was negatively correlated with the percentages of peripheral blood lymphocytes and positively correlated with peripheral blood neutrophil counts, which is consistent with the known biology of the GC receptor. Expression of the signature largely agreed with reported GC use in these populations, although there was significant interpatient variability within the dose cohorts.The GC gene signature identified in this study represents a pharmacodynamic marker of GC exposure.