tbuckley/cabot-search huggingface dataset:
NHS staff have achieved “mission impossible,” Hunt says
Authors: Tom Moberly
Journal: BMJ (2017)

NHS staff have “achieved mission impossible” over the past five years by improving care and maintaining access in challenging circumstances, Jeremy Hunt, England’s health secretary, has said.

Speaking at the NHS Confederation’s annual conference in Liverpool on 15 June, Hunt said that NHS staff had been working harder than ever over the past five years.

“Everything we do in the NHS is about making us the safest, highest quality healthcare system in the world,” he said. “That has been very, …
Difficulties In Providing Palliative Care For Terminal Cancer Patient In Rural India (West Bengal) – Experience Of An Ngo
Authors: Aditya Manna
Journal: Neuro-Oncology (2018)

As in any developing countries state of West Bengal in India has a huge burden of cancer patients in advanced stage coming from rural area where awareness regarding the usefulness of palliative care in rather poor. Our goal is to give a pain free good quality of life in these advanced stage cancer patients. This study is to identify the main difficulties in achieving the above goal in a rural village setting in India. Advanced cancer patients in need of palliative care in various villages in of rural India were selected for this study. Their symptoms and managements in that rural surroundings were evaluated by an NGO (under the guidance of a senior palliative care specialist) working in that area. An attempt was made to identify the main obstacles in getting proper palliative care in a rural setting. Pain, fatigue are the main symptoms effecting these patients. In most patients pain and other symptoms control were grossly inadequate due to lack of properly trained manpower in the rural India. However regular homecare visits by a group of social workers were of immense help in the last few months of life. NGO team was well guided by a palliative care specialist. There is a wide gap of trained manpower in this filled in rural areas of India. Dedicated groups from rural area itself need encouragement and proper training, so that difficult symptoms can be managed locally along with necessary social and psychological support to these patients.
Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study
Authors: Qi Liu, Dakui Luo, Peng Lian, Wencheng Yu, Ji Zhu, Sanjun Cai, Qingguo Li, Xinxiang Li
Journal: International Journal of Surgery (2018)
GERIATRIC IMPAIRMENTS AMONG OLDER PATIENTS HOSPITALIZED FOR ACUTE HEART FAILURE OR CORONARY ARTERY DISEASE: INSIGHTS FROM THE GET GOING TRIAL
Authors: Jonathan Buggey, Ahmad Younes, Parag Goyal, Ariela Orkaby, Robin Brusen, Christine Chung, Karen Alexander, Jonathan Afilalo, Scott L. Hummel, Richard Josephson
Journal: Journal of the American College of Cardiology (2018)
ELEVATED TROPONIN-I LEVEL QUANTITATIVELY ASSOCIATED WITH LEFT VENTRICULAR IMPAIRMENT IN ACUTE MYOCARDITIS
Authors: Kaoru Hirose, Aitoshi Isotani, Kyohei Yamaji, Takashi Morinaga, Takenori Domei, Makoto Hyodo, Yoshimitsu Soga, Shinnichi Shirai, Ando Kenji
Journal: Journal of the American College of Cardiology (2018)
I am in my fifth year at medical school and I'm planning to spend a year participating in a health promotion scheme in Africa. Is it better to do this now than after I have graduated?
Authors: Nick Beeching
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>
NTPROBNP AND INCIDENT CARDIOVASCULAR EVENTS ACROSS SYSTOLIC BLOOD PRESSURE (SBP) CATEGORIES IN THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Vijay Nambi, Wensheng Sun, John Mcevoy, James de Lemos, Ron Hoogeveen, Salim Virani, David Aguilar, Amil Shah, Chiadi Ndumele, Anita Deswal, Kunihiro Matsushita, Elizabeth Selvin, Aaron Folsom, Christie Ballantyne
Journal: Journal of the American College of Cardiology (2018)
A positive experience of a clinical attachment
Authors: Haitham Alshafey
Journal: BMJ (2004)

Two hours after the shock of discovering that I had failed part 2 of the membership exam of the Royal College of Obstetricians and Gynaecologists (MRCOG) for the second time, I decided that it was the time to try a clinical attachment in the United Kingdom. I was fed up and needed to know what else I had to do to pass.

I had previously thought about doing a clinical attachment but discarded the idea as being too expensive and not beneficial. I was naive to think that a clinical attachment would be easy to arrange.

I browsed the web to find the addresses of hospitals in the United Kingdom and then contacted them (300 postal letters). I received many replies, but no one wanted to take me. At …
CREAM study: Clinical correlation between immunotherapy-RElated clinical outcome and intestinal microbiote in metastatic patients.
Authors: Laura Orgiano, Alessio Cubeddu, Silvia Camera, Roberta Mascia, Mariele Dessi, Elisabetta Pedditzi, Maura Murru, Paolo Piredda, Michela Barca, Emma Saba, Vanessa Palmas, Tania Camboni, Elena Massa, Giorgio Astara, Aldo Manzin, Clelia Madeddu, Mario Scartozzi
Journal: Journal of Clinical Oncology (2018)

TPS215 Background: It's known that composition of intestinal flora can influence the development of inflammatory gastrointestinal diseases, even though the association of inflammation with specific intestinal microbes is still unknown, because the inflammation and its treatment can change the composition of microbiote. Some bacterial species are essential to maintain the mucosal physiological tolerance, although species such as Bacteroides, Clostridium and Faecalibacterium can induce the up-regulation of T-cells and stimulate the production of anti-inflammatory cytokines. Innovative therapies such as anti-CTLA-4 antibody and inhibitors of the PD-1 receptor are particularly involved in the up-regulation of lymphocyte system: among their side effects, the most relevant are those immune-mediated such as hypophysitis, thyroiditis and colitis. In particular this last one usually occurs within 16weeks from the start of treatment: about one third of patients develop intestinal inflammation of any grade as a result of immune system dysregulation. So, the high incidence of colitis in patients treated with immunotherapy offers the possibility to characterize the intestinal microbiote before the development of immune-mediated inflammation. In addition, our curiosity has been oriented to the response to immunotherapy and the HLA class expressed by our patients: which any better predictor of response to immunological treatment than this one? Methods: Our is a single-center study of clinical and biological parameters prospectively stratified. Specifically, we collect from patients eligible for immunotherapy a blood sample to analyze HLA class and an other one to analyze serum cytokines levels, inflammatory indices and a sample of fecal material at baseline and at least after 3 administrations of treatment: actually we enrolled 34 out of 40 planned patients; we suppose to complete the enrollment in 2 months. According to preliminary data published in literature, we expect to find an alteration of intestinal microbiote in metastatic patients treated with immunotherapy. Once we'll identify it, we want to assess whether there is any correlation with the patient's clinical outcome.
Nearly 900 consultants granted clinical excellence awards for 2012
Authors: Helen Jaques
Journal: BMJ (2013)

A total of 892 consultants in England and Wales were awarded clinical excellence awards for 2012, representing around 2% of the roughly 40 000 consultants employed by the NHS in the two countries.

New national clinical excellence awards were given to 300 consultants in England and 17 in Wales, the Advisory Committee …
Antiphospholipid antibodies and recurrent thrombosis after a first unprovoked venous thromboembolism
Authors: Clive Kearon, Sameer Parpia, Frederick A. Spencer, Trevor Baglin, Scott M. Stevens, Kenneth A. Bauer, Steven R. Lentz, Craig M. Kessler, James D. Douketis, Stephan Moll, Scott Kaatz, Sam Schulman, Jean M. Connors, Jeffrey S. Ginsberg, Luciana Spadafora, Vinai Bhagirath, Patricia C. Liaw, Jeffrey I. Weitz, Jim A. Julian
Journal: Blood (2018)
FGFR3-TACC3 fusion in bladder cancer: Enrichment in the young, never-smokers, and Asians.
Authors: Amin Nassar, Kevin Lundgren, Mark Pomerantz, Eliezer Mendel Van Allen, Atish Dipankar Choudhury, Lauren Christine Harshman, Mark A. Preston, Kent William Mouw, Xiao X. Wei, Bradley A McGregor, Toni K. Choueiri, Joaquim Bellmunt, David J. Kwiatkowski, Guru Sonpavde
Journal: Journal of Clinical Oncology (2018)

465 Background: Bladder cancer patients (pts) are typically elderly with median age ~70 years. We hypothesized that younger pts (≤age 50) with muscle-invasive bladder cancer (MIBC) have distinct molecular features, including potential driver mutations that could serve as therapeutic targets. Methods: We used the MIBC TCGA cohort (n = 412, Cell 2017) analyzed by whole exome sequencing as a discovery cohort, and then confirmed observations using 356 pts with MIBC and high grade (HG) non-MIBC analyzed at Dana Farber Cancer Institute (DFCI) by the Oncopanel assay. Oncopanel assesses 447 somatic cancer genes and 191 regions across 60 genes for rearrangement detection by massively parallel sequencing. We examined associations between age (≤50, 51-65, and &gt; 65) and molecular features, using the χ 2 test for discrete data, and the Wilcoxon Rank Sum Test for quantitative data. Nominal p values were obtained, and the FDR correction was employed to obtain q values. Results: The following DNA alterations were significantly enriched in the TCGA in ≤50 vs 51-65 vs &gt; 65 age groups respectively: focal deletion in CREBBP (3/25 [12%] vs 2/137 [1.5%] vs 1/250 [0.4%], p &lt; 0.0001, q = 0.0126); microRNA Cluster III (13/25 [52%] vs 53/137 [38.7%] vs 55/250 [22%], p = 0.0005, q = 0.0252); fusion in FGFR3-TACC3 (3/25 [12%] vs 2/137 [1.5%] vs 5/250 [2%], p = 0.0055, q = 0.1386). Given that FGFR3-TACC3 fusions are potential therapeutic targets, we examined the association between FGFR3-TACC3 fusions and clinical features in a pooled analysis combining the TCGA and DFCI cohorts totaling 768 pts. FGFR3-TACC3 fusions were enriched in: ≤50 age group vs 51-65 vs &gt; 65 (4/33 [12.1%] vs 7/232 [3%] vs 6/503 [1.2%] respectively, p = 0.0001). Fusions were also significantly more common in Asians vs. Blacks vs. Whites (6/47 [12.8%] vs 1/28 [3.6%] vs 10/666 [1.5%] respectively, p &lt; 0.0001) and in never-smokers vs. ever smokers (12/194 [6.2%] vs 5/545 [0.9%] respectively, p &lt; 0.0001). Conclusions: FGFR3-TACC3 fusion, a known potentially actionable genomic alteration in MIBC, is significantly enriched in young pts, never-smokers and those of Asian ethnicity. Clinical testing to detect FGFR3-TACC3 fusion should be prioritized for MIBC and HG-non-MIBC pts meeting these criteria.
Skin changes after a magnetic resonance imaging scan
Authors: Barian Mohidin
Journal: BMJ (2018)

A 54 year old woman with hepatitis C and end stage renal failure of unknown cause (for which she was receiving haemodialysis) had a magnetic resonance imaging scan with gadolinium in 2000. She experienced swelling and erythema of her limbs within 48 hours of the scan. This subsequently developed over months to diffuse aching pains, fibrosis with skin hardening and induration, and progressive weakness in all limbs, with substantial loss of muscle mass (figs 1 2 3). What is the clinical diagnosis?



Fig 1 
Skin fibrosis, induration, thickening, and scarring on the lateral aspect of …
Dose escalation with high-dose-3D-conformal/IMRT (HD-3D-CRT/IMRT) compared with low-dose 3D-conformal/IMRT plus HDR brachytherapy (LD-3D-CRT/IMRT+HDR-B) for intermediate- or high-risk prostate cancer: Disease control, survival, and toxicity.
Authors: Ines Guix, Jose Maria Bartrina, Jose Ignacio Tello, Ivan Garcia, Luis Quinzaños, Teresa Maria Lacorte, Teresa Guix, Benjamin Guix
Journal: Journal of Clinical Oncology (2018)

169 Background: To report early and late toxicity and biochemical outcome in a prospective series of 1,465 patients with intermediate- or high-risk clinically localized prostate cancer treated with either HD-3D-CRT/IMRT or with LD-3D-CRT/IMRT+HDR-B. Methods: Between 12/1999 and 10/2011, 1,465 pts (pts) with PSA›10, Gleason score›6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT or IMRT to the prostate in 38 fractions (group 1; 733 pts) or 46 Gy LD-3D-CRT or IMRT followed by 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 732 pts), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. 94 pts of group 1 (12.8%) and 20 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). 49 pts in group 1 (6.7%) and 10 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 102 months, the 10-year free-from-failure survival was 90.7% and 98.3% (p&lt;0.002) in group 1 and 2 respectively; free-from-metastases survival 95.9% and 97.8% (p&lt;0,006)for group 1 and 2 respectively; and cause-specific survival 97.1% and 98.2% (p&lt;0.08). Conclusions: High-dose 3D-EBRT + HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiotherapy. Control rates were significantly better with in the HDR-boosted patients as expected by higher effective-dose.
Glioma‐Targeted Delivery of a Theranostic Liposome Integrated with Quantum Dots, Superparamagnetic Iron Oxide, and Cilengitide for Dual‐Imaging Guiding Cancer Surgery
Authors: He‐Lin Xu, Jing‐Jing Yang, De‐Li ZhuGe, Meng‐Ting Lin, Qun‐Yan Zhu, Bing‐Hui Jin, Meng‐Qi Tong, Bi‐Xin Shen, Jian Xiao, Ying‐Zheng Zhao
Journal: Advanced Healthcare Materials (2018)

Abstract Herein, a theranostic liposome (QSC‐Lip) integrated with superparamagnetic iron oxide nanoparticles (SPIONs) and quantum dots (QDs) and cilengitide (CGT) into one platform is constructed to target glioma under magnetic targeting (MT) for guiding surgical resection of glioma. Transmission electron microscopy and X‐ray photoelectron spectroscopy confirm the complete coencapsulation of SPIONs and QDs in liposome. Besides, CGT is also effectively encapsulated into the liposome with an encapsulation efficiency of ∼88.9%. QSC‐Lip exhibits a diameter of 100 ± 1.24 nm, zeta potential of −17.10 ± 0.11 mV, and good stability in several mediums. Moreover, each cargo shows a biphasic release pattern from QSC‐Lip, a rapid initial release within initial 10 h followed by a sustained release. Cellular uptake of QSC‐Lip is significantly enhanced by C 6 cells under MT. In vivo dual‐imaging studies show that QSC‐Lip not only produces an obvious negative‐contrast enhancement effect on glioma by magnetic resonance imaging but also makes tumor emitting fluorescence under MT. The dual‐imaging of QSC‐Lip guides the accurate resection of glioma by surgery. Besides, CGT is also specifically distributed to glioma after administration of QSC‐Lip under MT, resulting in an effective inhibition of tumors. The integrated liposome may be a potential carrier for theranostics of tumor.
Intraperitoneal chemotherapy for gastric cancer with peritoneal dissemination: A single center retrospective analysis of 82 cases.
Authors: Masahiro Yoshida, Yasushi Tsuji, Syutaro Oiwa, Toshizo Takayama, Naoka Okamura, Junko Sugiyama, Tetsuya Sumiyoshi, Michiaki Hirayama, Hitoshi Kondo, Syunichi Okushiba
Journal: Journal of Clinical Oncology (2018)

170 Background: The prognosis of gastric cancer with peritoneal metastases remains dismal. Ishigami et al. have recently published a phase III study (PHOENIX-GC) aimed at clinical efficacy of intraperitoneal paclitaxel (PTX), which established intraperitoneal chemotherapy as a decent option for gastric cancer with peritoneal dissemination. According to this report, we have used various regimens of intraperitoneal chemotherapy, adjusted mainly based on previous treatments. Methods: Data from 82 patients with gastric cancer with peritoneal metastases who underwent intraperitoneal chemotherapy in our institute from February 2012 to July 2017 were retrospectively analyzed. The progression free survival (PFS), the overall survival (OS) and the 1-year survival rate were stratified by prior treatments. Results: Of the 82 patients, 38 (46.3%) were chemotherapy-naïve. The intraperitoneal regimens were assigned mainly according to the prior treatment: intraperitoneal PTX plus S-1/PTX was the most frequent (39 cases), followed by intraperitoneal PTX plus intravenous PTX (17 cases), intraperitoneal PTX only (6 cases), and the rest. The median PFS for the chemotherapy-naïve group and the previously treated group was 6.9 and 4.1 months, and the median OS was 12.8 and 7.9 months, and the 1-year survival rate was 72.2% and 34.4%, respectively. 10 patients (12.2%) achieved conversion surgery after confirmed complete response in the peritoneal metastases. Among these 10 patients, the median survival time is 22.7 months (7.6 + -47.7). Adverse events were also analyzed for each regimen, as for intraperitoneal PTX plus S-1/PTX, leukopenia, neutropenia and anemia occurred frequently. All regimens were comprehensively tolerable, and there were no treatment-related deaths. Conclusions: Intraperitoneal chemotherapy is a promising and feasible option for gastric cancer with peritoneal dissemination. There were several cases with long-term prognosis where conversion surgery was achieved.
Computational Modeling of Wound Suture: A Review
Authors: Arnab Chanda, Tysum Ruchti, Vinu Unnikrishnan
Journal: IEEE Reviews in Biomedical Engineering (2018)

Suturing is an acquired skill which is based on a surgeon's experience. To date, no two sutures are the same with respect to the type of knot, tension, or suture material. With advancement in medical technologies, robotic suturing is becoming more and more important to operate on complex and difficult to reach internal surgical sites. While it is very difficult to translate a surgeon's suturing expertise to an automated environment, computational models could be employed to estimate baseline suture force requirements for a given wound shape, size, and suture material, which could be subsequently processed by a robot. In the literature, there have been few attempts to characterize wound closure and suture mechanics using simple two- and three-dimensional computational models. Single and multiple skin layers (epidermis, dermis, and hypodermis) and tissues with different wound geometries and sizes have been simulated under simple wound flap displacements to estimate suture force requirements. Also, recently, sutures were modeled to simulate a realistic wound closure via suture pulling, and skin prestress effect due to the natural tension of skin was incorporated in a few models to understand its effects on wound closure mechanics. An extensive review of this literature on computational modeling of wound suture would provide valuable insights into the areas in which further research work is required. Discussion of various computational challenges in modeling sutures in a numerical environment will help in better understanding the roadblocks and the required advancements in suture modeling.
COMPARISON OF RATES OF BLEEDING AND VASCULAR COMPLICATIONS BEFORE, DURING, AND AFTER TRIAL ENROLLMENT IN THE SAFE-PCI TRIAL FOR WOMEN
Authors: Jennifer Rymer, Lisa Kaltenbach, Ajar Kochar, Connie Hess, Mitchell Krucoff, Ian Gilchrist, John Messenger, Sanjit Jolly, Alice K. Jacobs, J. Abbott, Daniel Wojdyla, Sunil V. Rao
Journal: Journal of the American College of Cardiology (2018)
The AO Foundation fracture management courses
Authors: Jatinder S Kang
Journal: BMJ (2009)

Last year was the 50th anniversary of the AO Foundation (Arbeitsgemeinschaft fur Osteosynthesefragen), loosely translated as the Working Group for Osteosynthesis.

The AO Foundation, founded in Switzerland in 1958, is a not for profit organisation made up of networks of surgeons who are dedicated to advancing the field of trauma and orthopaedic surgery.

Every December the AO Foundation runs courses on operative fracture management in Davos, where the foundation is based. They start with the basic “principles” courses and go up to the advanced “masters” courses.

Trainee surgeons, especially those in trauma and orthopaedic surgery. …
Alternating Bundle-Branch Block
Authors: Aditya Saini, Santosh K. Padala, Jayanthi N. Koneru, Kenneth A. Ellenbogen
Journal: Circulation (2018)

ECG CHALLENGEA 37-year-old woman with non-Hodgkin lymphoma undergoing chemotherapy and no other significant medical history was incidentally noted to have an irregular heart rhythm on physical examination, and a 12-lead ECG was obtained.ECG (Figure 1) showed sinus rhythm with alternating pattern of right bundle-branch block (RBBB) and left bundle-branch block (LBBB).What is the mechanism of the alternating bundle-branch block pattern noted on the ECG? 1. Alternating RBBB and LBBB premature ventricular contractions 2. Alternating phase 3 block in the bundle branches 3. Alternating phase 4 block in the bundle branches 4. Interpolated premature ventricular contractions with alternating bundlebranch morphologiesPlease turn the page to read the diagnosis.
Just another Saturday
Authors: John Quin
Journal: BMJ (2013)

Elton John, that well known pugilist, once insisted that “Saturday night’s alright for fighting.” Now it may well be for bespectacled neds up for a ruck. But most doctor types prefer a quiet night at home enduring X Factor while wrestling with a barrel load of SurveyMonkeys. We crave a gentler life.

But wait! Here’s another cuddly albeit cunningly cutting old fuddy duddy—John Betjeman—writing a poem he called “Five O’Clock Shadow.” Betjeman speaks for patients that this is the “time of the day when we feel betrayed” in the men’s ward—a time when “a doctors’ foursome out of the links is played.” Well that was back in the days when consultants could rely on the dogged Dr Finlay and his ilk doing the community cover, who worked all the hours that Tannochbrae or wherever gave them.

Consultant physicians in particular back then could instruct troubled juniors down the phone. Faced with an intractable supraventricular tachycardia they might urge …