tbuckley/cabot-search huggingface dataset:
Doctors who leave NHS pension scheme should receive employer contributions, says BMA
Authors: Abi Rimmer
Journal: BMJ (2017)

Doctors who leave the NHS pension scheme should be refunded any future contributions from their employer, the BMA has said.

Delegates at the BMA’s annual representative meeting in Bournemouth on 28 June voted in favour of a motion which said that doctors who are “forced to withdraw from the NHS pension scheme on breaching their lifetime allowance should be refunded future NHS employer contributions.”

The lifetime allowance is the maximum amount of pension savings a doctor can have without incurring a tax …
I am in my first year of an SHO post in obstetrics and gynaecology. How can I acquire a post of anatomy demonstrator?
Authors: Paul Rae
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>
IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis
Authors: Chia-Hung Chou, Chi-Sheng Hung, Che-Wei Liao, Lin-Hung Wei, Ching-Way Chen, Chia-Tung Shun, Wen-Fen Wen, Cho-Hua Wan, Xue-Ming Wu, Yi-Yao Chang, Vin-Cent Wu, Kwan-Dun Wu, Yen-Hung Lin
Journal: Cardiovascular Research (2018)

An excess of aldosterone results in cardiac remodelling and fibrosis. Interleukin-6 (IL-6) is a key mediator in the fibrotic process; however, the effect of aldosterone on the expression of IL-6 remains unclear. We investigated whether aldosterone induces the expression of IL-6 and thereby contributes to the fibrotic process. In this clinical study, we prospectively enrolled 25 patients with primary aldosteronism (PA) and 26 patients with essential hypertension (EH). The PA patients had higher plasma IL-6 levels, left ventricular mass index, degree of myocardial fibrosis, and more impaired diastolic function than the EH patients. In addition, plasma IL-6 levels were positively correlated with 24-h urinary aldosterone and echocardiographic parameters. In cell studies, we investigated the possible molecular mechanism how aldosterone-induced IL-6 secretion and the further effects of collagen production. Aldosterone significantly induced IL-6 protein and mRNA production in human umbilical vein endothelial cells. Intracellular signalling occurred through the mineralocorticoid receptor/PI3K/Akt/NF-kB pathway. In cardiac fibroblasts, IL-6 trans-signalling played a critical role in aldosterone-induced IL-6-enhanced fibrosis-related factor expression. To further investigate the role of IL-6 trans-signalling in aldosterone-induced cardiac fibrosis, we measured the severity of myocardial fibrosis in aldosterone infusion mice models including an IL-6 chemical inhibitor and Sgp130 Knockin Transgenic Mice. Mice receiving recombinant soluble gp130 and Sgp130 Knockin Transgenic Mice prevented myocardial fibrosis and cardiac hypertrophy by aldosterone infusion. IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis.
ASSOCIATIONS BETWEEN DIABETES MELLITUS AND OUTCOMES WITH THE COMBO BIO-ENGINEERED STENT: FROM THE MASCOT POST-MARKETING REGISTRY
Authors: Jaya Chandrasekhar, Antonio Colombo, Melissa Aquino, Tiong Kiam Ong, Zhen Ge, Serdar Farhan, Michael Kang Yin Lee, Andres Iniguez, Lauren Joyce, Clayton Snyder, Samantha Sartori, Usman Baber, Debbie Morrell, Francesca Elmore, Stephen Rowland, Roxana Mehran
Journal: Journal of the American College of Cardiology (2018)
BMA calls for clarity over health issues ahead of Scottish independence vote
Authors: Caroline White
Journal: BMJ (2013)

The potential effects of Scottish independence on medical students and doctors’ migration around the UK need to be clearly set out, said the chairman of the BMA in Scotland, Brian Keighley.

Writing in a post on the BMA blog site,1 Keighley said that BMA Scotland would not be taking sides in the debate on Scottish independence in the run up to next year’s referendum, because of the “widely divergent and deeply held personal views” on the matter among its membership.

He said that, with less than a year to …
Abstract MP73: Emergency Call First Strategy versus Bystander Cardiopulmonary Resuscitation First Strategy for Out-of-Hospital Cardiac Arrest
Authors: Tatsuma Fukuda, Naoko Ohashi-Fukuda, Yutaka Kondo, Kei Hayashida, Ichiro Kukita
Journal: Circulation (2018)

Introduction: Lay rescuers have a crucial role in successful cardiopulmonary resuscitation (CPR), specifically the first three links in the chain of survival, for out-of-hospital cardiac arrest (OHCA). However, randomized controlled trials on the priority of emergency call (Call first) versus bystander CPR (CPR first) do not exist, and comparative data are very limited. We aimed to assess the association between the priority of bystander’s action (Call first vs. CPR first) and neurologic outcome after OHCA. Methods: This nationwide population-based study of patients who experienced OHCA from January 2005 to December 2014 was based on the data from the Japanese government-managed registry of OHCA. Patients provided bystander’s action (both emergency call and bystander CPR) within 1 minute of witness were included, and Call first strategy was compared with CPR first strategy. The primary outcome was one-month neurologically favorable survival, defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1(good performance) or 2(moderate disability). The secondary outcomes were prehospital return of spontaneous circulation (ROSC) and one-month overall survival. Results: A total of 25,840 patients were included; 4,430 (17.1%) were treated with Call first approach, and 21,410 (82.9%) were treated with CPR first approach. Among total cohort, 2,696 (10.4%) survived with neurologically favorable status one month after OHCA. In the propensity score-matched cohort, one-month neurologically favorable survival was lower among Call first group compared with CPR first group: 364 of 4,430 patients (8.2%) vs. 457 of 4,430 patients (10.3%), respectively (Risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70-0.91). Similar associations were observed for one-month overall survival (RR, 0.90; 95%CI, 0.82-0.99), although there were no significant differences in prehospital ROSC (RR, 0.94; 95%CI, 0.86-1.02) between the Call first and CPR first groups. In subgroup analyses, the association between delayed bystander CPR and worse neurological outcome did not change regardless of subgroup characteristics. Conclusions: In witnessed OHCA, Call first approach was associated with a decreased chance of one-month neurologically favorable survival compared with CPR first approach. These observational findings warrant a randomized clinical trial to determine the priority of emergency call or bystander CPR for OHCA.
Remitting Seronegative Symmetric Synovitis With Pitting Edema Associated With Partial Melanoma Response Under Anti–<scp>CTLA</scp>‐4 and Anti–Programmed Death 1 Combination Treatment
Authors: Mona Amini‐Adle, Muriel Piperno, Jérémie Tordo, Luc Thomas, Stéphane Dalle, Valérie Dubois, Aurélien Marabelle
Journal: Arthritis & Rheumatology (2018)
Costs of care with liver directed therapy (LDT) and sorafenib (S) in patients (pts) with hepatocellular carcinoma (HCC).
Authors: Arun K. Singavi, Aniko Szabo, James P. Thomas, Paul S. Ritch, Abdel Alqwasmi, Sarah White, William S. Rilling, Ben George
Journal: Journal of Clinical Oncology (2018)

383 Background: 80% of HCC pts present with advanced disease, treatment for such pts is palliative in nature. It is important to ascertain cost associated with such palliative therapy, considering modest survival benefit afforded by these treatments. Methods: Utilizing a non-Medicare national claims database (MarketScan), we analyzed a cohort of pts with HCC diagnosis (Dx). Consistent with literature, pts selected had at least two claims with HCC code (155.0) between 1/1/2010 and 12/31/2013, at least 2 claims with chronic liver condition within 1 year of the HCC Dx, no claims for other malignancies for 1 year before HCC Dx, and excluded hepatectomy or transplant. Follow up was from date of first HCC claim to end of continuous insurance coverage (EOC) with prescription drug claim tracking, or 12/31/2015. Pts were divided into 4 groups based on receipt of S, LDT, combined therapy (LDT+S), or best supportive care (BSC) after HCC Dx. Costs obtained by adding payment (Pmt) amounts for all inpatient, outpatient, and drug claims over follow-up period. Demographics and costs were summarized using means for continuous and frequencies for categorical variables. No adjustment for censoring was done, as no reason available for EOC. Average monthly cost was computed for each pt, and then averaged over pts. Results: Data were available for 6,987 patients over specified period, 67% were males, mean age was 60.2 years. Cost data by therapy received are summarized in the table below. Conclusions: Majority of HCC pts in this database were treated with BSC. Time to EOC tracked was significantly shorter for pts treated with S, compared to other 3 groups. Monthly cost associated with LDT, LDT+S, and S were not substantially different, but higher than cost associated with BSC. Prospectively collected survival, quality of life and cost data are important to ascertain true impact of palliative therapy in pts with advanced HCC. [Table: see text]
Heavy use of agency staff linked to worse patient and staff experiences
Authors: Anne Gulland
Journal: BMJ (2018)

Staff and patient experiences are worse in trusts that spend more on agency staff, a report has found.1

The report, by the health charities the King’s Fund and Picker, looked at the 2016 NHS staff survey, the 2016 NHS inpatient survey, NHS spend on agency staff, sickness rates, bed occupancy rates, and numbers of nurses and doctors to find the relationships between the experiences …
CONTEMPORARY REASONS AND CLINICAL OUTCOMES FOR PATIENTS WITH SEVERE, SYMPTOMATIC AORTIC STENOSIS NOT UNDERGOING AORTIC VALVE REPLACEMENT
Authors: Liang Tang, Mario Goessl, Aisha Ahmed, Ross Garberich, Hiroki Niikura, Robert Farivar, Wesley Pedersen, Kevin Harris, Paul Sorajja
Journal: Journal of the American College of Cardiology (2018)
Clinico-pathological analyses of the relationship between <i>SMAD4</i>, <i>TP53</i>, <i>CDKN2A</i> mutations and recurrence and prognosis in patients with pancreatic cancer: A single institutional study.
Authors: Masaru Fukahori, Yoshiki Naito, Hiroto Ishikawa, Tomoyuki Ushijima, Sachiko Nagasu, Keisuke Miwa, Takahiko Sakaue, Kenjirou Takahashi, Masamichi Nakayama, Makiko Yasumoto, Yusuke Ishida, Yoshinobu Okabe, Kouji Okuda, Takuji Torimura
Journal: Journal of Clinical Oncology (2018)

319 Background: Gene mutations of SMAD4, TP53 and CDKN2A( p16) have been reported to be associated with poor prognosis and metastatic burden in advanced pancreatic cancer (PC). On the other hand, the association between these gene mutations and recurrence in PC is still unclear. The present study aimed to whether the 3 gene mutations were related to the recurrence and the prognosis in PC patients. Methods: Formalin-fixed paraffin-embedded tumor samples were gathered from patients with PC who underwent curative resection between January 2014 and December 2015. We retrospectively evaluated a relationship between the mutation status of SMAD4, TP53 and p16 and the recurrence and prognosis in patients with PC. Results: Totally, fifty-six samples of patients with PC (Stage I/ II/ III: 5/6/45 (UICC 7th)) were included in this analysis. Recurrence was seen in 32 patients (57.1%). Patients with PC both recurrence and advanced pathological stage showed poor prognosis. Each 3 gene mutation did not show a significant association with recurrence. TP53 and p16 single mutations did not show significant association with prognosis. However, the patients with PC who have SMAD4 mutation showed a significant poor prognosis (Overall survival: 18.6 vs. 34.5 months, p = 0.03). Multivariate analysis showed only recurrence was a significant prognostic factor (p = 0.01) Conclusions: The present study suggested that there was no association between SMAD4 and recurrence, whereas in case of recurrence, SMAD4 mutation may be associated with prognosis in PC patients.
FDA to begin releasing clinical study reports in pilot programme
Authors: Peter Doshi
Journal: BMJ (2018)

The US Food and Drug Administration (FDA) has announced it will disclose clinical study reports (CSRs) in a pilot programme to begin this month.12 Participation in the pilot will be voluntary for sponsors, include up to nine recently approved drug applications, and is limited to CSRs for the key “pivotal” trials that underpin drug approval.

Declaring that “transparency can be a powerful tool for innovation,”3 FDA commissioner Scott Gottlieb also argued the public CSRs would help streamline the FDA’s evaluation of drug applications and “create a more efficient review process.”4

The announcement, made on 16 January at a transparency forum led by Johns Hopkins School of Public Health, thrusts the regulator into an activity senior officials have in recent years resisted, arguing that data sharing was an activity best left to the companies that own the data, not middlemen like the FDA.

Historically, the agency’s position has been that laws such as the Trade Secrets Act prohibit it from releasing trial data,5 and there have been only a handful of cases where the FDA has released CSRs, sometimes in response to …
GRO-α and IL-8 enhance ovarian cancer metastatic potential via the CXCR2-mediated TAK1/NFκB signaling cascade
Authors: Mingo Ming-Ho Yung, Hermit Wai-Man Tang, Patty Chun-Hui Cai, Thomas Ho-Yin Leung, Siew-Fei Ngu, Karen Kar-Loen Chan, Dakang Xu, Huijuan Yang, Hextan Yuen-Sheung Ngan, David Wai Chan
Journal: Theranostics (2018)

Intraperitoneal metastasis is a common occurrence and is usually involved in the poor prognosis of ovarian cancer.Its specific metastatic pattern implies that certain indispensable microenvironmental factors secreted in the peritoneal cavity can direct metastatic ovarian cancer cells to permissive niches for secondary lesion formation.However, the underlying molecular mechanisms are ill defined.Herein, we report that GRO-α and IL-8 are predominately upregulated in culture media derived from either normal or cancerous omenta and are associated with increased ovarian cancer aggressiveness.Methods: OCM was established from culture medium of fresh human omental tissues.Primary and metastatic ovarian cancer cell lines were generated from human tumor tissues and verified by specific antibodies.The functional roles of GRO-α, IL-8, and their specific receptor CXCR2 were examined by neutralizing antibodies, shRNA gene knockdown, CRISPR/Cas9 gene knockout and pharmaceutical CXCR2 inhibitor SB225002.The oncogenic properties of ovarian cancer cells were examined by in vitro and in vivo mouse models.Results: Both GRO-α and IL-8 can activate TAK1/NFκB signaling via the CXCR2 receptor.Intriguingly, TAK1/NFκB signaling activity was higher in metastatic ovarian cancer cells; this higher activity makes them more susceptible to OCM-induced tumor aggressiveness.Treatment of ovarian cancer cells with GRO-α and IL-8 neutralizing antibodies or ablation of CXCR2 by shRNA gene knockdown, CRISPR/Cas9 gene knockout, or CXCR2 inhibitor SB225002 treatment significantly attenuated TAK1/NFκB signaling and decreased in vitro and in vivo oncogenic and metastatic potential, suggesting CXCR2 plays a key role in the GRO-α and IL-8-governed metastatic spreading of ovarian cancer cells in the intraperitoneal cavity. Conclusion:This study highlights the significance of GRO-α and IL-8 as the key chemokines in the peritoneal tumor microenvironment and suggests the utility of targeting their receptor CXCR2 as a potential target-based therapy for peritoneal metastases of ovarian cancer.
Mendelian Randomization Concerns—Reply
Authors: Fernando Pires Hartwig, Maria Carolina Borges, Jack Bowden
Journal: JAMA Psychiatry (2018)

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Klinefelter Syndrome: Integrating Genetics, Neuropsychology, and Endocrinology
Authors: Claus H Gravholt, Simon Chang, Mikkel Wallentin, Jens Fedder, Philip Moore, Anne Skakkebæk
Journal: Endocrine Reviews (2018)

Although first identified over 70 years ago, Klinefelter syndrome (KS) continues to pose substantial diagnostic challenges, as many patients are still misdiagnosed, or remain undiagnosed. In fact, as few as 25% of patients with KS are accurately diagnosed and most of these diagnoses are not made until adulthood. Classic characteristics of KS include small testes, infertility, hypergonadothropic hypogonadism, and cognitive impairment. However, the pathophysiology behind KS is not well understood, although genetic effects are also thought to play a role. For example, recent developments in genetics and genomics point to a fundamental change in our understanding of KS, with global epigenetic and RNA expression changes playing a central role for the phenotype. KS is also associated with more general health markers, including higher morbidity and mortality rates and lower socioeconomic status (which likely affect both morbidity and mortality). In addition, hypogonadism is associated with greater risk of metabolic syndrome, type 2 diabetes, cardiovascular disease, breast cancer, and extragonadal germ cell tumors. Medical treatment typically focuses on testosterone replacement therapy (TRT), although the effects of this therapy have not been studied rigorously, and future studies need to evaluate the effects of TRT on metabolic risk and neurocognitive outcomes. This review presents a comprehensive interdisciplinary examination of recent developments in genetic, endocrine, and neurocognitive science, including the study of animal models. It provides a number of recommendations for improving the effectiveness of research and clinical practice, including neonatal KS screening programs, and a multidisciplinary approach to KS treatment from childhood until senescence.
Hospital doctors’ pay has increased by 0.4% since last year
Authors: Abi Rimmer
Journal: BMJ (2014)

Hospital doctors’ pay rose by 0.4% from June 2013 to June 2014, figures from the Health and Social Care Information Centre show.

On average, NHS doctors in England, including consultants and registrars but excluding locums and GPs, earned £59 051, a 0.4% increase on the 2013 figure, the centre said.1 Earlier this week, …
Skin cancer prevention messages on Facebook: Likes, shares, and comments
Authors: Adi Nosrati, Matthew A. Pimentel, Ashley Falzone, Roshini Hegde, Shilpa Goel, Mary-Margaret Chren, Rachel Eye, Eleni Linos, Sherry Pagoto, Barbara J. Walkosz
Journal: Journal of the American Academy of Dermatology (2018)
Prolonged survival of transplanted stem cells after ischaemic injury via the slow release of pro-survival peptides from a collagen matrix
Authors: Andrew S. Lee, Mohammed Inayathullah, Maarten A. Lijkwan, Xin Zhao, Wenchao Sun, Sujin Park, Wan Xing Hong, Mansi B. Parekh, Andrey V. Malkovskiy, Edward Lau, Xulei Qin, Venkata Raveendra Pothineni, Verónica Sanchez-Freire, Wendy Y. Zhang, Nigel G. Kooreman, Antje D. Ebert, Charles K. F. Chan, Patricia K. Nguyen, Jayakumar Rajadas, Joseph C. Wu
Journal: Nature Biomedical Engineering (2018)
Phase 1 study of bispecific HER2 antibody-drug conjugate MEDI4276 in patients with advanced HER2-positive breast or gastric cancer
Authors: M. Pegram, E. Hamilton, A.R. Tan, A.M. Storniolo, N. Elgeioushi, S. Marshall, S. Abdullah, M. Patel
Journal: Annals of Oncology (2018)
PERCUTANEOUS CORONARY INTERVENTIONS FOR AORTOOSTIAL CHRONIC TOTAL OCCLUSIONS: INSIGHTS FROM A MULTICENTER REGISTRY
Authors: Peter Tajti, Dimitrios I. Karmpaliotis, Khaldoon Alaswad, Farouc Jaffer, Robert Yeh, Mitul Patel, Ehtisham Mahmud, James Choi, M. Nicholas Burke, Anthony Doing, Catalin Toma, Barry Uretsky, Elizabeth Holper, David Kandzari, Nicholas Lembo, Santiago Garcia, Oleg Krestyaninov, Dmitrii Khelimskii, Michalis Koutouzis, Jeffrey Moses, Ajay Kirtane, Ziad Ali, Bavana Rangan, Subhash Banerjee, Emmanouil Brilakis
Journal: Journal of the American College of Cardiology (2018)
Stress and fatigue remain high despite working time rules, GMC finds
Authors: Helen Jaques
Journal: BMJ (2013)

Working time rules have not cut stress and fatigue among junior doctors, because the regulations have affected shift patterns and increased the intensity of work, the General Medical Council has found.

Trainees surveyed on behalf of the GMC reported that they worked shift and on-call patterns that, despite complying with the regulations, had a negative effect on their health and wellbeing.

Junior doctors also said that the working time regulations had cut the hours they worked but not the amount of work needing to be done. This led to more intense shifts and increased pressure to get work done, they said.

The GMC said that hospitals should “urgently” consider implementing a seven day service delivered by consultants to ease the pressure on trainees. The GMC’s chief executive, Niall Dickson, said, “We must never go back to the ridiculous hours worked in the past when patients …
Health secretary shuts door on talks over locum GP pension contributions
Authors: Helen Jaques
Journal: BMJ (2013)

The secretary of state for health, Jeremy Hunt, has closed the door on the possibility of any future negotiations with the BMA over who pays employers’ contributions to pensions for locum GPs.

Changes to pension regulations in April this year moved the responsibility for paying the employer element of locum GPs’ pension contributions from primary care trusts to individual general practices.1 …