tbuckley/cabot-search huggingface dataset:
PREDICTORS OF PERSISTENT TRICUSPID REGURGITATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH BASELINE SIGNIFICANT TRICUSPID REGURGITATION
Authors: Berhane M. Worku, Marie-Tjherese Valovska, Adham Elmously, Polydoros Kampaktsis, Iosif Gulkarov, Catherine Castillo, Shing-Chiu Wong, Arash Salemi
Journal: Journal of the American College of Cardiology (2018)
Government plans to encourage more doctors to opt out of Working Time Directive
Authors: Abi Rimmer
Journal: BMJ (2014)

The government has said that it will consider how to encourage more doctors to opt out of working time restrictions established to comply with the European Working Time Directive.

The Department of Health in England said that it had accepted six recommendations made by an independent taskforce that looked into the directive’s implementation. The directive was fully incorporated into the NHS in 2009 and states that trainee doctors can work for a maximum of 48 hours a week over a six month period. The taskforce found that the directive had adversely affected training in certain medical …
I am a third year medical student. One of my tutors has offered me a DPhil studentship in his laboratory. Should I do the DPhil now or wait until I have finished medical school?
Authors: Brian Angus
Journal: BMJ (2004)

<i>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.</i>
Only 17% of doctors think that working time rules benefit the NHS
Authors: Matthew Limb
Journal: BMJ (2016)

Only 17% of doctors believe that the European Working Time Directive has benefited the NHS, a survey of UK medical graduates has found.

Most doctors said that the directive had had a “negative effect” on efficiency in managing patient care and over a third felt that it had worsened care quality. Nearly two thirds (62%) of senior doctors, however, said that the directive had improved their work-life balance.

The survey was carried out by the UK Medical Careers Research Group based at Oxford University’s Nuffield Department of Population Health. In 2013-14—11 years after they graduated—2056 doctors were questioned about the directive, which restricts the average length of the working …
ASSOCIATIONS OF SYSTOLIC BLOOD PRESSURE (SBP) &lt;120 (VERSUS 120-139) MMHG WITH OUTCOMES IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION (HFPEF) WITHOUT HYPERTENSION (HTN)
Authors: Poonam Bhyan, Phillip Lam, Apostolos Tsimploulis, Helen Sheriff, Charles Faselis, Prakash Deedwania, Wilbert Aronow, Gregg C. Fonarow, Ali Ahmed
Journal: Journal of the American College of Cardiology (2018)
A multicenter clinical trial of intravesical BCG in combination with ALT-803 in patients with BCG-unresponsive non-muscle invasive bladder cancer.
Authors: Karim Chamie, Amirali Salmasi, Charles Joel Rosser, Amy Rock, Lydia Ferguson, Hing C. Wong
Journal: Journal of Clinical Oncology (2018)

TPS544 Background: BCG unresponsive NMIBC includes patients with persistent high-grade disease or recurrence within 6 months of receiving at least two courses of BCG; or T1 high-grade disease at the first evaluation following BCG induction alone. The recommendation after failing BCG in patients suitable for surgery is cystectomy or for unwilling/unfit patients, salvage chemotherapy or immunotherapy (administered with limited success). This highlights a critical need for novel preservation therapies to facilitate a better quality of life and reduce health-care costs for patients who are unresponsive to BCG (Correa 2015, Dalbagni 2006, Dinney 2013, Kamat 2017). Altor BioScience has initiated a phase II clinical study in BCG unresponsive patients to expand on promising data collected from a compassionate use patient who remains disease free more than 2.5 years after ALT-803 plus BCG treatment for refractory NMIBC (Huang 2017). Methods: This is a Phase II, open-label, single-arm, multicenter study of intravesical BCG plus ALT-803 in patients with BCG unresponsive high grade NMIBC. Group A will enroll patients who have histologically confirmed presence of CIS [with or without Ta or T1 disease]. Group B will enroll patients who have histologically confirmed high-grade Ta or T1 disease (in the absence of CIS). All patients will receive BCG plus ALT-803 weekly for 6 consecutive weeks. A cystoscopy will be performed at Week 12. Patients with no disease or low-grade Ta will receive a maintenance course of therapy (3 weekly instillations of BCG plus ALT-803). Patients with residual CIS and/or high-grade Ta will receive a re-induction course of therapy. Presence of Ta will require a TURBT. Patients with greater than or equal to T1 disease or new CIS will be deemed treatment failures. Patients with a Complete Response (CR) or low-risk disease at Months 6, 9 and 12 are eligible for continued BCG plus ALT-803 maintenance. Patients will be followed for recurrence, progression, and survival. The primary endpoint is to assess complete response (CR; absence of lesions on cystoscopy or negative, for cause, biopsies along with negative urine cytology) of CIS at six months. Enrollment is underway. Clinical trial information: NCT03022825.
How do you become an oral and maxillofacial surgeon in the United Kingdom?
Authors: Andrew Gibbons
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 (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.
Human CTL-based functional analysis shows the reliability of a munc13-4 protein expression assay for FHL3 diagnosis
Authors: Hirofumi Shibata, Takahiro Yasumi, Saeko Shimodera, Eitaro Hiejima, Kazushi Izawa, Tomoki Kawai, Ryutaro Shirakawa, Taizo Wada, Ryuta Nishikomori, Hisanori Horiuchi, Osamu Ohara, Eiichi Ishii, Toshio Heike
Journal: Blood (2018)
Development of a dual university system health research partnership as a foundation for the Sustainable Development Goals
Authors: Gene D Morse, Jeffrey C Lombardo, Terrence Forrester, Horace Fletcher, Archibald McDonald, Andrew H Talal, Sanjay Sethi, Brian Tsuji, Venu Govindaraju, Jack DeHovitz, John F Lindo
Journal: The Lancet Global Health (2018)

BackgroundAn innovative dual-system collaboration between the University of the West Indies and the State University of New York was created and implemented by a joint Health Research Faculty Task Force to establish a platform for education and research that would yield an integrated approach to the Sustainable Development Goals (SDGs).MethodsFollowing the establishment of a joint Center for Leadership and Sustainable Development, a needs assessment was conducted to identify research and education priorities that would benefit from a dual-system linkage structure. Partnerships were facilitated using HUBzero—an open-source software platform with project-specific faculty and staff assigned to each development group.FindingsProgrammes in virology research; antimicrobial resistance and stewardship; liver, kidney, and metabolic diseases; and autoimmune diseases, together with the creation of a Clinical Research Center, were identified as highest priorities. Cannabinoid sciences and a joint effort in cancer research, natural products, and nanotechnology to identify indigenous compounds and develop nanomedicine were also key areas. A working group focused on a strategy for workforce planning through science, technology, engineering, and mathematics has also been implemented.InterpretationThis programme uses innovative technology platforms to promote shared project development and is a novel alternative to the traditional model that requires travel and prolonged visits at different training sites. A framework is now established to enable the Joint Health Research Faculty Task Force to begin implementation of high-impact health research initiatives as a foundation for multiple SDGs and to drive regional timelines and milestones. These education and research programmes will be funded through competitive research grants and used to complete data analytics for budget forecasting to achieve the SDGs.FundingNone.
The accident and emergency radiology survival course
Authors: Shan Shan Jing
Journal: BMJ (2010)

The accident and emergency radiology survival course started 10 years ago as a series of tutorials for local emergency department doctors (www.radiology-courses.com). It is organised by a group of radiology consultants and has rapidly become one of the most well known radiology teaching courses in the United Kingdom. Approved by the Royal College of Radiologists, the course awards seven category one continuing professional development credits to all delegates of the course. High quality information with emphasis on skeletal trauma is delivered by radiology consultants only, to provide participants with the knowledge, skills, and confidence to interpret radiographs obtained in the emergency department.

The course is directed mainly at foundation year and core trainee doctors working in an accident and emergency department or in trauma and orthopaedic surgery. It is particularly useful for those …
GP partners could be more cost effective than salaried GPs
Authors: Helen Jaques
Journal: BMJ (2011)

Taking on a new practice partner could cost the same as a salaried GP and could help current partners avoid new tax increases, the BMA’s General Practitioners Committee has said.

Practices should also look at the added value that a partner can bring in terms of continuity and sharing the practice’s workload rather than simply consider the financial comparison with a sessional GP, the committee adds, in new guidance to practices on taking on GPs. 

“When considering the role of a partner, it’s not just about looking at the salary costs, it’s looking at the partner taking on other roles outside of consultations such as the commissioning …
BMA reaches agreement on GP contract in Wales
Authors: Helen Jaques
Journal: BMJ (2013)

The BMA’s General Practitioners Committee for Wales has negotiated a settlement with the Welsh government on the general practitioners contract for 2013-14, after securing a key agreement on the minimum practice income guarantee. 

Earlier this month the committee rejected the proposed general medical services (GMS) contract because of concerns about the effect of removing the guarantee,1 which is received by more than 60% of practices in Wales.

The committee was worried that the plan to remove this source of income over a period of seven years could “fatally destabilise” some rural practices, in particular small surgeries and practices with more than one location.

The Welsh government has agreed not to take steps to remove the guarantee from April 2014 and will …
Reassessing Th1 <i>versus</i> Th17.1 in sarcoidosis: new tricks for old dogma
Authors: Edward S. Chen
Journal: European Respiratory Journal (2018)

Immunologically, sarcoidosis has been classically defined by the presence of a Th1-dominant environment localised to sites of disease, characterised by overexpression of interferon (IFN)γ and Th1-promoting interleukin (IL)12 and IL18 [1]. Accordingly, the downstream effects of enhanced Th1 are also observed in sarcoidosis, such as the expression of Th1-associated chemokines (MIG/CXCL9, IP10/CXCL10, ITAC/CXCL11, MCP1/CCL2, MIP1α/CCL3, MIP1β/CCL4, RANTES/CCL5) and their respective receptors (CXCR3, CCR5). Conversely, the presence of augmented Th2 has never been firmly documented in the sarcoidosis lung. While enhanced IFN-gamma expression remains a principal feature of sarcoidosis, its origin may involve factors beyond Th1 <http://ow.ly/qtyB30i48bU>
Encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF -mutant melanoma (COLUMBUS): a multicentre, open-label, randomised phase 3 trial
Authors: Reinhard Dummer, Paolo A Ascierto, Helen J Gogas, Ana Arance, Mario Mandala, Gabriella Liszkay, Claus Garbe, Dirk Schadendorf, Ivana Krajsova, Ralf Gutzmer, Vanna Chiarion-Sileni, Caroline Dutriaux, Jan Willem B de Groot, Naoya Yamazaki, Carmen Loquai, Laure A Moutouh-de Parseval, Michael D Pickard, Victor Sandor, Caroline Robert, Keith T Flaherty
Journal: The Lancet Oncology (2018)
SEX DIFFERENCES IN CATHETER ABLATION AND OUTCOMES OF ATRIAL FIBRILLATION IN YOUNGER ADULTS IN THE UNITED STATES, 2005-2014
Authors: Bing Yue, Xin Wei, Chayakrit Krittanawong, Ashish Correa, Mariam Khandaker, Shuyang Fang, Mike Gorenchtein, Davendra Mehta
Journal: Journal of the American College of Cardiology (2018)
Epigenetic regulation of NFE2 overexpression in myeloproliferative neoplasms
Authors: Jan C. Peeken, Jonas S. Jutzi, Julius Wehrle, Christoph Koellerer, Hans F. Staehle, Heiko Becker, Elias Schoenwandt, Thalia S. Seeger, Daniel H. Schanne, Monika Gothwal, Christopher J. Ott, Albert Gründer, Heike L. Pahl
Journal: Blood (2018)
Cough sensitivity to mannitol inhalation challenge identifies subjects with chronic cough
Authors: Heikki O. Koskela, Clair Lake, Keith Wong, John D. Brannan
Journal: European Respiratory Journal (2018)

Cough is the most common reason why people seek medical attention [1]. Cough hypersensitivity syndrome (CHS) is a new concept to describe a condition with long-standing hypersensitivity of vagal afferent nerves or an alteration of the central processing of their input regardless of the underlying cause [2]. The current definition of CHS is purely clinical; however, a test capable of demonstrating this hypersensitivity both reliably and feasibly might be used as a diagnostic test for CHS. Mannitol challenge is a promising diagnostic test for cough hypersensitivity syndrome <http://ow.ly/gWf530j9O7H> The authors would like to acknowledge the assistance of Peter Briffa and Phillip Munoz (both Dept of Respiratory Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, and Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia) with their assistance in the cough counting.
Impact of decipher test on adjuvant and salvage treatments received following radical prostatectomy.
Authors: John L. Gore, Marguerite Du Plessis, Darlene Dai, Kasra Yousefi, Darby Thompson, Lawrence Ivan Karsh, Brian R. Lane, Michael Franks, David Chen, Mark Bandyk, Adam S. Kibel, Hyung Lae Kim, William Thomas Lowrance, Paul Maroni, Scott David Perrapato, Edouard John Trabulsi, Robert J. Waterhouse, Elai Davicioni, Yair Lotan, Daniel W. Lin
Journal: Journal of Clinical Oncology (2018)

112 Background: Prostate cancer (PC) patients and providers have tremendous uncertainty as they decide on intervention with adjuvant or salvage radiation therapy (ART, SRT) after radical prostatectomy (RP). We prospectively evaluated the impact of Decipher test, a genomic classifier which predicts metastasis post-RP, on providers’ decision-making for ART and SRT. Methods: 150 men considering ART and 115 men considering SRT from 19 sites across the US were enrolled. Participating providers submitted a management recommendation prior to processing the Decipher test and again after receiving test results. We then followed patients for 12 months to assess actual treatment received and patient reported decisional conflict scale (DCS) and a validated survey on PC-related anxiety. Results: Pre-Decipher, observation was recommended for 89% of adjuvant men and 58% of salvage men. Post-Decipher, 17% of treatment recommendations changed in the adjuvant arm and 30% of recommendations changed in the salvage arm. Among adjuvant men, 78% maintained their recommended management 12 months after Decipher; 76% of salvage men maintained their recommended treatment after Decipher. Among 21 adjuvant men who intensified their treatment (observation to ART or ART to ART plus androgen deprivation therapy), 5 (24%) experienced biochemical recurrence with detectable PSA. In adjuvant men, PC-specific anxiety decreased differently among Decipher risk categories (p-value = 0.045), most notably among Decipher high risk men (9.07 [7.87, 10.26] pre-Decipher, 5.61 [5.35,5.88] 12 months post-Decipher). In salvage men, PC-specific anxiety decreased differently among those whose treatment were concordant (10.28 [8.1,12.47] pre-Decipher, 7.18 [6.82,7.54] 12 months post-Decipher) and those whose treatment were intensified (p-value = 0.01), and decreased differently among low-risk and high-risk Decipher patients (p = 0.04). Conclusions: Use of the Decipher test changed treatment decisions that was consistent with the eventual treatment received in three-fourths of adjuvant and salvage men after RP. Several men that pursued ART experienced PSA progression. PC-specific anxiety decreased in both adjuvant and salvage men. Clinical trial information: NCT02080689.
Atezolizumab (atezo) and subsequent therapies in patients (Pts) with metastatic urothelial carcinoma (mUC) outside clinical trials.
Authors: Pedro C. Barata, Vadim S. Koshkin, Prateek Mendiratta, Dharmesh Gopalakrishnan, Matt Karafa, Kimberly D Allman, Allison Martin, Jennifer Beach, Pam Profusek, Allison Janine Tyler, Laura S. Wood, Moshe Chaim Ornstein, Timothy D. Gilligan, Jorge A. Garcia, Brian I. Rini, Petros Grivas
Journal: Journal of Clinical Oncology (2018)

432 Background: The use of immune checkpoint inhibitors (ICI) has revolutionized treatment of mUC. Little is known about the outcomes and safety profile of pts treated with ICI outside of clinical trials, as well as about responses to subsequent therapies. Methods: A retrospective analysis of consecutive mUC pts who received ≥1 dose of atezo 1200 mg every 3 weeks from May 2016 through April 2017 was conducted. Exploratory assessments included overall response rate according to RECIST v1.1, progression-free survival (PFS) and overall survival (OS) since time of treatment initiation, and treatment-related adverse events (TRAE) according to CTCAE v4.03. Results: A total of 79 pts were identified; median age 72 (29-93), 71% men, 27% never smokers, 66% pure urothelial histology, 49% visceral disease, 76% ECOG PS 0-1 and 61% with 1-2 Bellmunt risk factors. Most pts (79%) had primary tumor in bladder, 62% prior surgery and 75% ≥ 1 prior treatment. Most pts (71%) had 1-2 prior lines of treatment, 4% of pts had 3 lines, and 25% of pts had no prior systemic treatment. Pts received a median of 4 atezo doses (1-18) and median treatment duration was 3.2 months (95%CI 1.9-4.5). In 55 pts evaluable for response, 25% had partial response, 36% stable disease and 38% progressive disease, with a median time to best response of 2.7 months (1.3-7.4) and median PFS 4.5 months (95%CI 3.4-5.6). Estimated OS for the entire cohort was 8.3 months (median not reached) and was not significantly different based on prior therapy. TRAE of any grade were noted in 89% of pts and mostly included fatigue (63%) and anorexia (28%). Two pts had grade 4 hyperbilirubinemia, and no toxic deaths were noted. At time of data analysis, 34% of pts remained on atezo, 16% received 1-2 subsequent treatments with median duration of 1.3 months ( 95%CI 0.5-2.2) and 8% PR as best response, 41% were referred to hospice or died, and 9% were lost to follow-up. Conclusions: Pts with mUC treated with atezo had comparable outcomes and toxicity to those reported in clinical trials. Pts who progressed on atezo were unlikely to receive subsequent treatment and the benefit of such treatment was limited. Results may impact clinical trial designs and timing in regard to ICI.
Toll-like receptor 9 antagonizes antibody affinity maturation
Authors: Munir Akkaya, Billur Akkaya, Ann S. Kim, Pietro Miozzo, Haewon Sohn, Mirna Pena, Alexander S. Roesler, Brandon P. Theall, Travis Henke, Juraj Kabat, Jinghua Lu, David W. Dorward, Eric Dahlstrom, Jeff Skinner, Louis H. Miller, Susan K. Pierce
Journal: Nature Immunology (2018)
Editor’s Choice: Sheltering the important from the urgent
Authors: Tom Moberly
Journal: BMJ (2015)

Between applying to medical school and completing medical training, doctors devote huge swathes of time to preparing for the next career hurdle they face. From applications and interviews to exams and e-portfolios, there is relentless pressure to keep on top of demands ahead of the next impending challenge.

In BMJ Careers this week Max Allan argues that this constant …
Break a leg
Authors: Prasanna Puwanarajah
Journal: BMJ (2008)

<h3>Objective</h3> In patients with newly diagnosed atrial fibrillation (AF), do baseline risk factors and stroke prevention strategies account for the geographically diverse outcomes. <h3>Design</h3> Global Anticoagulant Registry in the FIELD-Atrial Fibrillation is a prospective multinational non-interventional registry of patients with newly diagnosed AF (n=52 018 patients). <h3>Setting</h3> Investigator sites (n=1317) were representative of the care settings/locations in each of the 35 participating countries. Treatment decisions were all determined by the local responsible clinicians. <h3>Participants</h3> The patients (18 years and over) with newly diagnosed AF had at least 1 investigator-determined stroke risk factor and patients were not required to meet specific thresholds of risk score for anticoagulant treatment. <h3>Main outcomes and measures</h3> Observed 1-year event rates and risk-standardised rates were derived. <h3>Results</h3> Rates of death, non-haemorrhagic stroke/systemic embolism and major bleeding varied more than three-to-four fold across countries even after adjustment for baseline factors and antithrombotic treatments. Rates of anticoagulation and antithrombotic treatment varied widely. Patients from countries with the highest rates of cardiovascular mortality and stroke were among the least likely to receive oral anticoagulants. Beyond anticoagulant treatment, variations in the treatment of comorbidities and lifestyle factors may have contributed to the variations in outcomes. Countries with the lowest healthcare Access and Quality indices (India, Ukraine, Argentina, Brazil) had the highest risk-standardised mortality. <h3>Conclusion</h3> The variability in outcomes across countries for patients with newly diagnosed AF is not accounted for by baseline characteristics and antithrombotic treatments. Residual mortality rates were correlated with Healthcare Access and Quality indices. The findings suggest the management of patients with AF needs to not only address guideline indicated and sustained anticoagulation, but also the treatment of comorbidities and lifestyle factors. <h3>Trial registration number</h3> NCT01090362.
Patients are less likely to take healthy living advice from overweight GPs, study indicates
Authors: Abi Rimmer
Journal: BMJ (2015)

Patients are less likely to take advice about diet and exercise from doctors who are overweight, researchers have found. Last year Simon Stevens, the chief executive of NHS England, said that the NHS should set an example by helping its staff to lose weight.1

For the study, carried out on behalf of the Royal Society for Public Health, researchers surveyed 2100 adults across the UK. They found …
NON-INVASIVE ASSESSMENT OF LEFT ATRIAL PRESSURE USING ARTERIAL TONOMETRY AND ITS CORRELATION WITH TISSUE DOPPLER ECHOCARDIOGRAPHY AND PULMONARY CAPILLARY WEDGE PRESSURE
Authors: Rupesh Ranjan, Yaser Alhamshari, Sanjog Kalra, Aman Amanullah, Vincent Figueredo, Gregg Pressman
Journal: Journal of the American College of Cardiology (2018)
Conducting multidisciplinary meetings on rehabilitation wards or stroke units
Authors: Abdul Salam
Journal: BMJ (2006)

Multidisciplinary meetings play an important role in the management of patients recovering from stroke or needing rehabilitation. These meetings are headed by a medical officer, and it is imperative that they are organised efficiently in order to provide maximum patient care and a safe discharge. Because patients are discussed in absentia, prior preparation and a knowledge of issues other than solely medical ones are vital. Doctors need …