tbuckley/cabot-search huggingface dataset:
Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients
Authors: Christopher S. Parshuram, Karen Dryden-Palmer, Catherine Farrell, Ronald Gottesman, Martin Gray, James S. Hutchison, Mark Helfaer, Elizabeth A. Hunt, Ari R. Joffe, Jacques Lacroix, Michael Alice Moga, Vinay Nadkarni, Nelly Ninis, Patricia C. Parkin, David Wensley, Andrew R. Willan, George A. Tomlinson
Journal: JAMA (2018)

<h3>Importance</h3> There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. <h3>Objective</h3> To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. <h3>Design, Setting, and Participants</h3> A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. <h3>Interventions</h3> The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). <h3>Main Outcomes and Measures</h3> The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. <h3>Results</h3> Among 144 539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144 539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, −0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69];<i>P</i> = .96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, −0.34 [95% CI, −0.73 to 0.05 per 1000 patient-days]; adjusted rate ratio, 0.77 [95% CI, 0.61 to 0.97];<i>P</i> = .03). <h3>Conclusions and Relevance</h3> Implementation of the Bedside Paediatric Early Warning System compared with usual care did not significantly decrease all-cause mortality among hospitalized pediatric patients. These findings do not support the use of this system to reduce mortality. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT01260831
Since the introduction of foundation programmes the number of freestanding posts has come down drastically. What is the prospect for foreign graduates with some experience in surgical and medical fields after their graduation?
Authors: Sabina Dosani
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>
NHS staff numbers show biggest drop in a decade as managers and support staff fall
Authors: Helen Jaques
Journal: BMJ (2012)

The number of staff working in the NHS in 2011 has fallen by the largest factor in 10 years thanks to a decrease in clinical support and infrastructure staff, in particular managers.

The number of doctors in the NHS, however, has increased by 1.8% since 2011 and 3.7% year on year since 2001 to a total of 143 836 doctors, according …
Training in genitourinary medicine is still good, despite the Health and Social Care Act
Authors: Margaret Kingston, Katia Prime
Journal: BMJ (2018)

Training in genitourinary medicine has been affected by the tendering of sexual health services in England, but nationally it remains high quality, as shown by the annual General Medical Council survey of doctors in training.1 The uncertainty resulting from tendering has affected recruitment in recent years, but the figures are not as described by White2: in 2017, 55% of national …
Gelatin Nanoparticle-Coated Silicon Beads for Density-Selective Capture and Release of Heterogeneous Circulating Tumor Cells with High Purity
Authors: Qinqin Huang, Fu-Bing Wang, Chun-Hui Yuan, Zhaobo He, Lang Rao, Bo Cai, Bolei Chen, Susu Jiang, Zhiqiang Li, Jincao Chen, Wei Liu, Feng Guo, Zheng Ao, Shi Chen, Xing-Zhong Zhao
Journal: Theranostics (2018)

Background: Circulating tumor cells (CTCs) are a burgeoning topic in cancer biomarker discovery research with minimal invasive blood draws. CTCs can be used as potential biomarkers for disease prognosis, early cancer diagnosis and pharmacodynamics. However, the extremely low abundance of CTCs limits their clinical utility because of technical challenges such as the isolation and subsequent detailed molecular and functional characterization of rare CTCs from patient blood samples. Methods: In this study, we present a novel density gradient centrifugation method employing biodegradable gelatin nanoparticles coated on silicon beads for the isolation, release, and downstream analysis of CTCs from colorectal and breast cancer patients. Results: Using clinical patient/spiked samples, we demonstrate that this method has significant CTC-capture efficiency (>80%) and purity (>85%), high CTC release efficiency (94%) and viability (92.5%). We also demonstrate the unparalleled robustness of our method in downstream CTC analyses such as the detection of PIK3CA mutations. Conclusion: The efficiency and versatility of the multifunctional density microbeads approach provides new opportunities for personalized cancer diagnostics and treatments.
WILL NT-PROBNP/BNP RATIO DISCRIMINATE RESPONDER AND NO RESPONDER AMONG PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION UNDERGOING TREATMENT WITH SACUBITRIL-VALSARTAN? SYSTEMATIC REVIEW AND POST HOC ANALYSIS OF PARADIGM-HF TRIAL
Authors: Eduardo Pitthan, Vania Hirakata, Juarez Barbisan, Clarissa Rodrigues
Journal: Journal of the American College of Cardiology (2018)
How long do doctors have to complete their house jobs after passing MB BS?
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>
ATHEROSCLEROSIS AS MANIFEST BY THORACIC AORTIC CALCIUM: INSIGHTS FROM A REMOTE NATIVE POPULATION WITH EXTREMELY LOW LEVELS OF CORONARY ATHEROSCLEROSIS AND TRADITIONAL CV RISK FACTORS
Authors: Randall C. Thompson, Benjamin C. Trumble, Michael Gurven, Chris J. Rowan, Katherine M. Walsworth, Frances Neunuebel, Adel H. Allam, Bruno Frohlich, Samuel Wann, David E. Michalik, M. Linda Sutherland, James Sutherland, Guido P. Lombardi, Bret Beheim, Jonathan Steiglitz, Jagat Narula, James K. Min, Caleb Finch, Gregory Thomas, Hillard Kaplan
Journal: Journal of the American College of Cardiology (2018)
Having worked for 12 unblemished years as a doctor, eight as a GP, I was erased from the GMC register in April for a mistake I made in 2000-1. What steps can I take to put me in the best position to obtain restoration in five years?
Authors: Brian Keighley
Journal: BMJ (2005)

<b>www.bmjcareers.com/advicezone</b> 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.
VALIDATION OF DAPT SCORE FOR PROLONGED DUAL ANTIPLATELET THERAPY IN ACUTE MYOCARDIAL INFARCTION PATIENTS
Authors: Daniel Veron Esquivel, Fernando Batiz-Armenta, Aldo Cesar Cazares-Diazleal, Sandra Oviedo-Moguel, Sergio Martin Jarvio-Fernandez, Juan Manuel Arce-Gonzalez, Juan Betuel Ivey-Miranda
Journal: Journal of the American College of Cardiology (2018)
Nutritional Support from the Intestinal Microbiota Improves Hematopoietic Reconstitution after Bone Marrow Transplantation in Mice
Authors: Anna Staffas, Marina Burgos da Silva, Ann E. Slingerland, Amina Lazrak, Curtis J. Bare, Corey D. Holman, Melissa D. Docampo, Yusuke Shono, Benjamin Durham, Amanda J. Pickard, Justin R. Cross, Christoph Stein-Thoeringer, Enrico Velardi, Jennifer J. Tsai, Lorenz Jahn, Hillary Jay, Sophie Lieberman, Odette M. Smith, Eric G. Pamer, Jonathan U. Peled, David E. Cohen, Robert R. Jenq, Marcel R.M. van den Brink
Journal: Cell Host & Microbe (2018)
Broader based GP training programmes will be piloted in 2016, says government
Authors: Abi Rimmer
Journal: BMJ (2015)

“Broader based” GP training programmes will be piloted in 2016, the government has announced. The plan is laid out in Health Education England’s mandate for April 2015 to March 2016.1 The mandate outlines the priority areas that the government has identified for HEE to take forward …
MECHANICAL CIRCULATORY SUPPORT FOR ACUTE MYOCARDIAL INFARCTION BEYOND CARDIOGENIC SHOCK: ROLE OF IMPELLA VERSUS INTRAAORTIC BALLOON PUMP IN MID-TERM MYOCARDIAL RECOVERY
Authors: Federico Pappalardo, Tania Sorrentino, Marina Pieri, Michele Oppizzi, Giulio Melisurgo, Rosalba Lembo, Alberto Zangrillo
Journal: Journal of the American College of Cardiology (2018)
CHARACTERISTICS OF CARDIAC ARREST AND BYSTANDER RESUSCITATION WITHIN OUTPATIENT DIALYSIS CLINICS IN NORTH CAROLINA
Authors: Patrick Hank Pun, Matthew Dupre, Monique Anderson, Steen M. Hansen, Clark Tyson, Brian Frizzelle, Kimberly Vellano, James Jollis, Bryan McNally, Christopher Granger
Journal: Journal of the American College of Cardiology (2018)
Prognostication in non-small cell lung cancer.
Authors: Bruno Gagnon, Ioannis Gioulbasanis, Victor Cohen, Carmela Pepe, David I. Small, Lin Yang, Eleni Isidora Perdikouri, Goulnar Kasymjanova, David Morris, Neil MacDonald, Jason Scott Agulnik
Journal: Journal of Clinical Oncology (2012)

e18098 Background: For modern evidence-based medicine, a well defined risk scoring system on survival has important clinical implications for identifying patients with a poor prognosis. The objective of this study was to develop a Montreal Prognostic Score (MPS) based on risk scores of the baseline clinical markers. Methods: A training Cohort (TC) and confirmatory cohort (CC) of patients with non small-cell lung cancer were used to develop a Montreal Prognostic Score (MPS) and were assembled of patients from 3 different oncology centres: Jewish General Hospital in Montreal, Quebec, Canada; the University General Hospital of Heraklion Crete, Greece; and at the University General Hospital of Larissa, Greece. Stage, performance status, smoking status, CRP, Albumin, LDH and WBC from TC were entered in a Cox’s model on survival. Independent prognostic factors (p ≤ 0.1) were assigned a relative risk score by dividing their Proportional Hazard by the lowest one rounding to the closest integer. A 3 risk groups’ regression based total score (MPS) was finally developed by regrouping subgroups of patients with similar median survival. The MPS was tested on the CC. C-statistics was used to test the accuracy of the MPS. Results: 638 pts were included in the study: 314 in the TC and 324 in the CC. Majority of patients were stage 4 adenocarcinomas with good performance status treated with platinum-based chemotherapy. Stage, performance status, CRP, Albumin, LDH and WBC retained independent prognostic value and were used to create the MPS. The MPS predicted 3 well defined risk groups of patients with the following median survival and (95% CI) in months: high risk group (87 patients), 5.0 (4.2—7.0); intermediary risk group (98 patients), 9.6 (8.4—11.9); and low risk group (84 patients) 15.2 (12.4—25.1). When the MPS is applied to CC, the results were replicated for each risk group. Overall the TC had a C-stats of 0.673 (95% CI: 0.668, 0.679) while the CC of 0.702 (95% CI: 0.696, 0.708). Conclusions: We have developed a Montreal Prognostic Score based on stage, performance status and the baseline value of CRP, Albumin, LDH, WBC. This MPS has a high capacity of discriminating survival and might have wide implications in clinical practice and research.
UK International League Against Epilepsy EEG course
Authors: Krishna Chinthapalli
Journal: BMJ (2012)

The UK ILAE (International League Against Epilepsy) EEG course was set up as an annual course in 2011 under the league’s auspices. It came about after a consultant neurologist, Tejal Mitchell, and a consultant neurophysiologist, Andrew Michell, saw a similar successful course on electroencephalograms aimed at clinicians being run in Australia and were convinced that a UK course on EEGs would help doctors request EEGs more appropriately and improve their interpretation of them. In turn, this would aid management of patients with epilepsy and other neurological disorders.

It is targeted at neurologists at registrar or consultant level, but anyone who requests EEGs will find it useful. Many delegates …
Adjuvant etoposide plus cisplatin (EP) for pathologic stage (PS) II nonseminomatous germ cell tumor (NSGCT).
Authors: Deaglan Joseph McHugh, Samuel Funt, Deborah Silber, Andrea Knezevic, Sujata Patil, Devon O'Donnell, Stephanie Tsai, Victor E. Reuter, Joel Sheinfeld, Brett Stewart Carver, Robert J. Motzer, Dean F. Bajorin, George J. Bosl, Darren R. Feldman
Journal: Journal of Clinical Oncology (2018)

567 Background: The risk of relapse after primary retroperitoneal lymph node dissection (RPLND) for patients (pts) with PS IIA NSGCT is 10-20% and increases to over 50% for pts with PS IIB NSGCT. Cisplatin-based chemotherapy reduces the relapse risk to approximately 1%. Standard adjuvant chemotherapy regimens consist of 2 cycles of EP or 2 cycles of bleomycin plus EP (BEP). Methods: From March 1989 to April 2016, 156 pts with PS II NSGCT seen at Memorial Sloan Kettering Cancer Center and assigned to two cycles of EP chemotherapy following RPLND were included. Pts from a prior analysis (Kondagunta, JCO, 2004) were included with updated survival outcomes and expanded histopathologic parameters. Each cycle consisted of cisplatin 20mg/m 2 and etoposide 100mg/m 2 administered on days 1 to 5 at 21-day intervals. Demographics, histopathologic features, therapeutic and survival outcomes were recorded. Results: Median age was 28 years (range 15-52). 30 pts (19%) had pN1 disease, 122 (78%) pN2 disease and 4 (3%) pN3 disease. Median number of positive lymph nodes was 3 (range 1-37) and median size of the largest positive node was 2.0cm (range 0.4-7.0cm). 69 pts (45%) had extranodal tumor extension. Embryonal carcinoma, seminoma, mature teratoma and yolk sac were the predominant histological subtypes in the RPLND pathology in 115 (90%), 8 (6%), 4 (3%) and 1 (1%) pts respectively. 150 pts (96%) received 2 cycles of EP, 5 (3%) received 1 cycle of EP and one received 4 cycles of EP due to a transient marker increase following his first cycle. Dose delays occurred in 54 (38%) pts, mostly due to neutropenia (44/54 delays). With a median follow-up of 9 years, 2 pts (1 pN2 and 1 pN3) relapsed; both achieved a complete response to paclitaxel, ifosfamide and cisplatin (TIP), remaining disease-free at 65 and 143 months respectively. 3 pts died, all unrelated to GCT or treatment, for 10-year relapse-free and overall survival rates of 98% and 99%, respectively. Conclusions: This is the largest series reported to date on adjuvant chemotherapy with EP for PS II NSGCT. With 100% disease-specific survival and acceptable toxicity, these data confirm the efficacy of 2 cycles of EP and suggest that inclusion of bleomycin (e.g. BEP) in this setting is not necessary.
Effects of patient gender on urologist decision-making regarding treatment of the localized renal mass introduction and objective.
Authors: Ankur Shah, William Ulmer, Paul Feustel, Rebecca Leigh O'Malley
Journal: Journal of Clinical Oncology (2018)

646 Background: Gender disparity in the proportion of patients receiving nephron sparing strategies (NSS) for the treatment of localized renal masses has been demonstrated in large population series as well as in single centers of excellence. Reasons for the discrepancy remain elusive. We aimed to assess urologist treatment patterns for localized renal masses in both genders to gauge the existence of provider-based gender biases. We hypothesize that female patients may be recommended more aggressive treatment due to provider biases related to patient gender. Methods: Urologists were randomly emailed 1 of 2 surveys including 6 vignettes of various patients with renal masses. Both surveys were identical other than the vignette patient gender (VPG) which was male in 50% and female in 50%. Self-selected respondents chose the single best treatment option from the following choices: active surveillance (AS), percutaneous or laparoscopic ablation (ABL), partial nephrectomy (PN), and radical nephrectomy (RN). Fisher’s exact test was used to assess differences in treatment recommended based on VPG. Nominal logistic regression was performed to assess the magnitude of differences. Results: Of the 423 urologists who completed the survey there was an even response to both surveys (210 vs. 213). Most respondents were male (93%), married (89%) and in private practice (44%). Age and time practicing were evenly distributed and median number of nephrectomies done per year was 15. There were no significant differences in demographics between the respondents of the 2 surveys. When comparing AS, ABL, PN, and RN the only vignette that differed based on VPG was question 3 (p = 0.019). Comparison of any NSS vs. RN in question 3 showed male VPG was 1.67 times more likely to be recommended RN (p = 0.040). Urologist gender had no effect on these findings. Conclusions: In this survey study of practicing urologists we found that male patient gender increased recommendations for radical surgery and less nephron sparing strategies in a hypothetical older patient with a localized renal mass. Provider biases do not appear to be solely responsible for gender disparities seen in the treatment of a localized renal mass.
Concurrent gut transcriptome and microbiota profiling following chronic ethanol consumption in nonhuman primates
Authors: Tasha Barr, Suhas Sureshchandra, Paul Ruegger, Jingfei Zhang, Wenxiu Ma, James Borneman, Kathleen Grant, Ilhem Messaoudi
Journal: Gut Microbes (2018)

Alcohol use disorder (AUD) results in increased intestinal permeability, nutrient malabsorption, and increased risk of colorectal cancer (CRC). Our understanding of the mechanisms underlying these morbidities remains limited because studies to date have relied almost exclusively on short-term heavy/binge drinking rodent models and colonic biopsies/fecal samples collected from AUD subjects with alcoholic liver disease (ALD). Consequently, the dose- and site-dependent impact of chronic alcohol consumption in the absence of overt liver disease remains poorly understood. In this study, we addressed this knowledge gap using a nonhuman primate model of voluntary ethanol self-administration where rhesus macaques consume varying amounts of 4% ethanol in water for 12 months. Specifically, we performed RNA-Seq and 16S rRNA gene sequencing on duodenum, jejunum, ileum, and colon biopsies collected from 4 controls and 8 ethanol-consuming male macaques. Our analysis revealed that chronic ethanol consumption leads to changes in the expression of genes involved in protein trafficking, metabolism, inflammation, and CRC development. Additionally, we observed differences in the relative abundance of putatively beneficial bacteria as well as those associated with inflammation and CRC. Given that the animals studied in this manuscript did not exhibit signs of ALD or CRC, our data suggest that alterations in gene expression and bacterial communities precede clinical disease and could serve as biomarkers as well as facilitate future studies aimed at developing interventions to restore gut homeostasis.
Managing migraine in pregnancy
Authors: Sheba Jarvis, Pooja Dassan, Catherine Nelson Piercy
Journal: BMJ (2018)

### What you need to know A 36 year old woman who is 17 weeks pregnant with a 15 year history of migraine presents with an episode of a frontal unilateral headache. It is associated with nausea and visual aura consisting of mainly zigzag lines. She says that this headache is similar to her usual migraines, with two other episodes during this pregnancy so far, each lasting for about five or six hours and then resolving. Clinical examination is normal, including blood pressure and urine analysis. Migraine is one of the commonest neurological complaints in pregnancy, and most affected women either self manage or are managed by non-specialists.1 Many women with a pre-existing history of migraine attacks will see an improvement during pregnancy (particularly those with menstrual related migraine), while those who have migraine with aura are more likely to have an unpredictable course. For a few women, migraine may occur for the first time during pregnancy, which causes anxiety and poses a diagnostic challenge.1 The urgent priority when a patient presents with a headache during pregnancy should be to distinguish primary causes (such as migraine, tension headaches, and cluster headaches) from serious secondary causes. Secondary causes of headaches (such as pre-eclampsia and cerebral venous thrombosis) require urgent assessment and are more likely to occur after 12 weeks gestation (box 1).2 Box 1 ### Primary and secondary causes of headaches in pregnancy and important clinical features #### Primary causes #### Secondary causesRETURN TO TEXT
Integrating the Genetics of Race and Ethnicity Into Cancer Research
Authors: Lisa A. Newman, John Carpten
Journal: JAMA Surgery (2018)

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BLOODLESS TRANSCATHETER MITRAL VALVE REPLACEMENT: A VALVE TEAM APPROACH TO A JEHOVAH'S WITNESS
Authors: Charles D. Nicolais, Jacqueline Sherrer, William Moser, Kellie Simmons-Massey, Brian O'Murchu, Vikas Aggarwal, Brian P. O'Neill, Martin G. Keane, Kenji Minakata, Robert Boova, Lynn Punnoose, Pravin Patil
Journal: Journal of the American College of Cardiology (2018)