tbuckley/cabot-search huggingface dataset:
Health department report will assess impact of revalidation
Authors: Matthew Limb
Journal: BMJ (2013)

Doctors are being questioned about their experiences of revalidation as part of a major new survey into the scheme’s impact.

The NHS Revalidation Support Team is examining the “current and expected” impact of the revalidation process and will assess how it is being implemented. The team has launched four separate surveys to collect information from doctors, appraisers, responsible officers, and employing organisations (http://bit.ly/1aQKDyN).1 Doctors’ views will be …
STUDIES IN EXPERIMENTAL EXTRACORPOREAL THROMBOSIS
Authors: Takuji Shionoya
Journal: The Journal of Experimental Medicine (1927)

1. Distilled water dialyzes through the collodion tube and causes hemolysis. Clotting of the hemolyzed blood in the collodion tube occurs later. 2. Bile salts accelerate the appearance and development of white thrombi in the heparinized animal. The masses of white thrombi are very loose, soft, fragile and easily broken into clumps of platelets. They are poor in fibrin or the fibrin is abnormal, since they have less retractility than those obtained from the use of physiologic sodium chloride solution or calcium chloride or serum. Despite the increase in number and size of white thrombi, normal clotting does not occur. 3. When the collodion tube is surrounded by 1 or 2 per cent d-glucose solution, tiny and numerous white thrombi appear as radiating figures. The masses of white thrombi are rather loose and fragile. The clotting time of the heparinized blood does not appear to be shortened. 4. When a 1 to 2 per cent solution of calcium chloride is used as the dialyzing fluid outside the collodion tube, or when it is injected into the circulation, the formation of white thrombi is accelerated. They grow very rapidly. In spite of the action of heparin, the white thrombi formed are not so fragile as when bile salts are placed outside of the collodion tube. Fibrin seems to form easily. Obstruction of venous cannula takes place speedily and if the clots in the cannula are not removed, the white thrombi in the collodion tube remain small and become red by sedimentation of red cells. 5. Intravenous use of 10 per cent solution of magnesium sulfate without heparin retards the coagulation of circulating blood and permits the blood to flow through the extracorporeal loop from three to four times as long as normal. The formation of white thrombi, as well as red, is retarded. Magnesium sulfate (1 per cent) in physiologic sodium chloride solution placed outside the collodion tube markedly retards the formation of white and red thrombi in the heparinized animal. Magnesium sulfate (10 per cent), 50 mg. for each kilo of body weight each hour, administered intravascularly in the heparinized animal definitely prevents the first stages of thrombosis, and consequently prevents clotting. 6. It is possible by the combined use of adequate amounts of magnesium sulfate and of heparin intravenously to prevent all stages of thrombus formation for from 1 to 3 hours.
Applied clinical ethics
Authors: Samantha Currie
Journal: BMJ (2010)

Nowadays, medicine is less paternalistic, and importance is placed on evidence based practice and individualised patient care. As advances in medicine continue and patients become more aware of their health and available treatments via the media and internet, justifiable and sound decisions are needed to ensure adequate care and a good doctor-patient relationship. However, these decisions can be complex and difficult.

The significance of having a working knowledge of medical ethics is now being recognised in medical school teaching and in the postgraduate setting with the emergence of several courses and diplomas. The applied clinical ethics course builds upon a basic understanding of the topic, rather than focusing solely on the principles, in order to equip clinicians with the tools to address ethical dilemmas at the coalface. This course has been taking place for several years now at Imperial College London and has many recognised expert speakers, ranging from clinicians …
A Sub-population of Group A Streptococcus Elicits a Population-wide Production of Bacteriocins to Establish Dominance in the Host
Authors: Baruch B. Hertzog, Yael Kaufman, Debabrata Biswas, Miriam Ravins, Poornima Ambalavanan, Reuven Wiener, Veronique Angeli, Swaine L. Chen, Emanuel Hanski
Journal: Cell Host & Microbe (2018)
THE EFFECT OF CATHETER-DIRECTED THROMBOLYSIS ON THE ECHOCARDIOGRAPHIC AND INVASIVE HEMODYNAMIC PARAMETERS IN PATIENTS WITH ACUTE SUBMASSIVE PULMONARY EMBOLISM
Authors: Colby Shanafelt, Vladimir Lakhter, Russell Rosenberg, Vikas Aggarwal, Paul Forfia, Anjali Vaidya, Chandra Dass, Huaqing Zhao, Yevgeniy Brailovsky, Farhan Raza, Riyaz Bashir
Journal: Journal of the American College of Cardiology (2018)
Most junior doctors are confident of achieving career goals, finds BMA study
Authors: Sally Carter
Journal: BMJ (2012)

Most junior doctors are confident that they will be able to work in the specialty they want, reach their desired grade, and live where they want to, show the results of a small cohort study by the BMA.1

The study surveyed 431 doctors who graduated from a UK medical school in 2006 as part of a 10 year longitudinal study, 229 of whom responded (response rate 53%). Six years after graduation, 66% of the respondents were in specialty training, 15% were working as GPs, and 7% were working or travelling abroad.

The doctors were asked how confident they …
Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities
Authors: Philip A. May, Christina D. Chambers, Wendy O. Kalberg, Jennifer Zellner, Haruna Feldman, David Buckley, David Kopald, Julie M. Hasken, Ronghui Xu, Gordon Honerkamp-Smith, Howard Taras, Melanie A. Manning, Luther K. Robinson, Margaret P. Adam, Omar Abdul-Rahman, Keith Vaux, Tamison Jewett, Amy J. Elliott, Julie A. Kable, Natacha Akshoomoff, Daniel Falk, Judith A. Arroyo, Dale Hereld, Edward P. Riley, Michael E. Charness, Claire D. Coles, Kenneth R. Warren, Kenneth Lyons Jones, H. Eugene Hoyme
Journal: JAMA (2018)

<h3>Importance</h3> Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. <h3>Objective</h3> To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. <h3>Design, Setting, and Participants</h3> Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. <h3>Exposures</h3> Alcohol consumption during pregnancy. <h3>Main Outcomes and Measures</h3> Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. <h3>Results</h3> A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children. <h3>Conclusions and Relevance</h3> Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.
Prognostic value of CD56, ASCL1, and other biomarkers in small cell bladder cancer (SCBC).
Authors: Vadim S. Koshkin, Jordan Reynolds, Paul Elson, Jesse McKenney, Kumiko Isse, Laura R. Saunders, Ming Hu, Andrew J. Stephenson, Amr Farouk Fergany, Byron Lee, Brian I. Rini, Jorge A. Garcia, Omar Y. Mian, Petros Grivas
Journal: Journal of Clinical Oncology (2018)

452 Background: Increased DLL3 expression (exp) and small cell % (SC%) were found in prior analyses to predict worse outcomes in SCBC. Assessment of gene and protein exp of other Notch pathway and neuroendocrine (NE) markers, such as ASCL1 and CD56, can help with prognostication and treatment target identification in SCBC. Methods: Among 63 patients (pts) with biopsy-confirmed SCBC seen at Cleveland Clinic (1993-2015), 52 had tissue available for IHC analysis of tumor biomarkers: DLL3, PD-L1, ASCL1 and CD56. All pts had clinical and outcomes data, and had SC% quantified by central path review. A subset of 39 pts had gene exp analysis using HTG EdgeSeq OBP assay. Correlations among biomarkers, between biomarkers and pt characteristics as well as gene exp were assessed. Multivariate analyses (MVA) were used to identify predictors of overall (OS) and progression-free survival (PFS). Results: In the 52 pt cohort, median age was 71, 83% were men, 39% had LN+ disease, and 79% had SC% &gt; 50%. Protein exp ( &gt; 1% of tumor cells) of DLL3, PD-L1, ASCL1 and CD56 was noted in 68%, 30%, 52% and 81% of pts, respectively. ASCL1 protein exp correlated with protein exp of DLL3 (r = 0.73, p &lt; .0001), CD56 (r = 0.35, p = .01), and SC% (r = 0.34, p = .01) and correlated with gene exp of several Notch genes and NE markers: DLL3, DLL4, Notch1, CHGA (p &lt; .05 for all). CD56/NCAM1 protein exp correlated with DLL3 protein exp (r = 0.32, p = .02) and with SC% (r = 0.26, p = .06) and with gene exp of DLL4, Notch1, SYP and NCAM1 (p &lt; .05 for all). In MVA, increased CD56 protein exp ( &gt; 30%) was associated with shorter OS (HR: 2.23; 95%CI 1.06-4.70, p = .03) and PFS (HR: 2.07; 95%CI 1.02-4.20, p = .04). Pts with low protein exp of both CD56 (≤30%) and DLL3 (≤10%) had longer median OS (103.4 vs 18.4 months, p = .01) and PFS (92.2 vs 11.4 months, p = .02) relative to pts with high protein exp of either biomarker. Conclusions: Most SCBC tumors expressed CD56, and increased exp predicted shorter OS and PFS, findings similar to those reported for DLL3. Low concurrent exp of both CD56 and DLL3 proteins was associated with better outcomes. Strong correlation of CD56/NCAM1 gene and protein exp suggests that its regulation may be at the transcriptional level. Gene exp signature prognostic of outcomes is currently being pursued in SCBC.
Consultants must not be made scapegoats over seven day services, says peer
Authors: Matthew Limb
Journal: BMJ (2015)

Hospital consultants’ reputation has taken a battering in the public debate over seven day NHS services, but consultants should not be made scapegoats, a former health minister and peer has said.

Brian Mawhinney, a former Conservative health minister, blamed the media for the attacks, which he said were, on the whole, “not warranted.” He said, “This debate cannot be resolved if we go around blaming other groups of people for their inadequacies or their failures, real or imagined.” He was speaking at a seminar he co-chaired on the future for seven day NHS services held by the Westminster Health Forum on 10 September.

He said that some problems concerning provision of services had to be …
Half of public health professionals have considered quitting in past three years
Authors: Gareth Iacobucci
Journal: BMJ (2014)

The BMA has warned of a “recruitment crisis” in public health medicine after a survey revealed that just over half of non-trainee public health professionals had considered leaving the profession in the past three years.

The survey1 also found that just under half of trainees had considered leaving their training in the same period. A lack of professional fulfilment, poor work-life balance, and concerns over deteriorating terms and conditions were all cited as potential reasons for leaving the profession.

The survey was based on responses from 590 people who worked within local authorities and Public Health England (340 medical and 250 non-medical). It revealed strong concerns about future workforce numbers: just …
Doctors’ complaints against other doctors double over four years
Authors: Abi Rimmer
Journal: BMJ (2015)

The number of complaints that the General Medical Council (GMC) received from doctors about other doctors almost doubled in the past four years, the regulator has said.

In its 2015 State of Medical Education and Practice report, the GMC said that the number of complaints it received from doctors almost doubled in four years, increasing from 654 in 2010 to 1277 in 2014.1

The GMC said that, if a doctor raised a concern that was not on behalf of their organisation, it was categorised by the GMC as …
PROSPECTIVE RANDOMIZED TRIAL OF RIVAROXABAN VERSUS WARFARIN IN THE EVALUATION OF PROGRESSION OF CORONARY ARTERY CALCIFICATION
Authors: Juhwan Lee, Rine Nakanishi, Dong Li, Kazuhiro Osawa, Kashif Shaikh, Chandana Shekar, Eranthi Jayawardena, Maja Blanco, Matthew Chen, Matthew Sieckert, Eric Nelson, Darius Billingsley, Matthew Budoff
Journal: Journal of the American College of Cardiology (2018)
Subconsultant posts must not be introduced “formally or by default,” BMA says
Authors: Tom Moberly
Journal: BMJ (2015)

Subconsultant grades should not be introduced “either formally or by default,” the BMA has said.

Delegates at the BMA’s annual representative meeting in Liverpool passed a motion on 24 June stating that “there must be no introduction of a subconsultant grade either formally or by default” and that “any moves to promote ‘generalism’ are not compatible …
More must be done to protect doctors from burnout, US researchers say
Authors: Matthew Limb
Journal: BMJ (2014)

Health service leaders must do more to keep doctors “happy, energised, and healthy” and help them perform well and avoid burnout, say US researchers.

The researchers, led by Michael Privitera at the University of Rochester Medical Center, have issued a “call to action” on the issue. They warned that rising levels of stress among doctors were endangering patients and staff and damaging performance, work relationships, and career choices. Uncoordinated health reforms and conflicting mandates from regulators, insurers, and state and federal agencies were also adding to pressure on providers and individuals, the researchers said.

Their study, reported in the Journal of Hospital Administration ,1 found high levels of physician burnout and occupational stress. “Physician …
Haploidentical transplantation outcomes for secondary acute myeloid leukemia: Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) study
Authors: Zhuoyan Li, Myriam Labopin, Fabio Ciceri, Didier Blaise, Johanna Tischer, Gerhard Ehninger, MT Van Lint, Yener Koc, Stella Santarone, Edouard Forcade, Luca Castagna, Emmanuelle Polge, Audrey Mailhol, Annalisa Ruggeri, Mohamad Mohty, Bipin N. Savani, Arnon Nagler
Journal: American Journal of Hematology (2018)

Abstract Secondary acute myeloid leukemia (sAML) traditionally has inferior outcomes compared to de novo AML. Allogeneic hematopoietic cell transplantation (HCT) is the sole potentially curative therapy. This study analyzes the outcomes for unmanipulated haploidentical HCT (haploHCT) for sAML using the Acute Leukemia Working Party (ALWP) registry of the European Society for Blood and Marrow Transplantation (EBMT). We identified 154 patients with sAML who underwent haploHCT from 2006 to 2016. Median age at HCT was 60 years with time from diagnosis to HCT 5 months. At transplantation, 69 patients were in first CR and 85 had active disease. Fifty‐seven (38.0%) patients underwent myeloablative conditioning and 97 (62.0%) reduced intensity conditioning (RIC) conditioning. Multivariate analysis showed that there was no difference in RI, nonrelapse mortality (NRM), leukemia free survival (LFS), overall survival (OS), or GVHD‐free/relapse free survival (GRFS) for conditioning intensity, age, performance status, or graft source. Active disease was associated with higher RI and inferior LFS, OS, and GRFS compared with patients in CR at time of transplant. T‐cell depletion with anti‐thymoglobulin resulted in higher NRM and inferior LFS, OS, and GRFS compared to post‐transplant cyclophosphamide (PTCy) (HR 2.25, 2.01, 2.16, and 1.73, respectively with P values &lt;.05). Our data shows that haploHCT is a feasible alternative for sAML when matched transplantation is unavailable.
Separating the impossible from the difficult
Authors: Tom Moberly
Journal: BMJ (2014)

The requirement to fit all the training that doctors need into the 48 hours a week that current regulations allow them to work poses a prickly puzzle for designers of medical training. Without any sign of an imminent, simple solution, the problem looks set to plague the profession for many years to come.

Restrictions on working hours have ended the 100 hour weeks …
Stress, Telomeres, and Psychopathology: Toward a Deeper Understanding of a Triad of Early Aging
Authors: Elissa S. Epel, Aric A. Prather
Journal: Annual Review of Clinical Psychology (2018)

Telomeres play an important part in aging and show relationships to lifetime adversity, particularly childhood adversity. Meta-analyses demonstrate reliable associations between psychopathology (primarily depression) and shorter telomere length, but the nature of this relationship has not been fully understood. Here, we review and evaluate the evidence for impaired telomere biology as a consequence of psychopathology or as a contributing factor, and the important mediating roles of chronic psychological stress and impaired allostasis. There is evidence for a triadic relationship among stress, telomere shortening, and psychiatric disorders that is positively reinforcing and unfolds across the life course and, possibly, across generations. We review the role of genetics and biobehavioral responses that may contribute to shorter telomere length, as well as the neurobiological impact of impaired levels of telomerase. These complex interrelationships are important to elucidate because they have implications for mental and physical comorbidity and, potentially, for the prevention and treatment of depression.
Cognitive performance in late adolescence and long‐term risk of early heart failure in Swedish men
Authors: Martin Lindgren, Peter Eriksson, Annika Rosengren, Josefina Robertson, Linus Schiöler, Maria Schaufelberger, David Åberg, Kjell Torén, Margda Waern, Maria Åberg
Journal: European Journal of Heart Failure (2018)

Heart failure (HF) incidence appears to increase among younger individuals, raising questions of how risk factors affect the younger population. We investigated the association of cognitive performance in late adolescence with long-term risk of early HF.We followed a cohort of Swedish men enrolled in mandatory military conscription in 1968-2005 (n = 1 225 300; mean age 18.3 years) until 2014 for HF hospitalization, using data from the Swedish National Inpatient Registry. Cognitive performance (IQ) was measured through a combination of tests, separately evaluating logical, verbal, visuospatial, and technical abilities. The results were standardized, weighted, and presented as stanines of IQ. The association between IQ and risk of HF was estimated using Cox proportional hazards models. In follow-up, there were 7633 cases of a first HF hospitalization (mean age at diagnosis 50.1 years). We found an inverse relationship between global IQ and risk of HF hospitalization. Using the highest IQ stanine as reference, the adjusted hazard ratio for the lowest IQ with risk of HF was 3.11 (95% confidence interval 2.60-3.71), corresponding to a hazard ratio of 1.32 (95% CI 1.28-1.35) per standard deviation decrease of IQ. This association proved persistent across predefined categories of HF with respect to pre-existing or concomitant co-morbidities; it was less apparent among obese conscripts (P for interaction =0.0004).In this study of young men, IQ was strongly associated with increased risk of early HF. The medical profession needs to be aware of this finding so as to not defer diagnosis.
Will a criminal background keep me from being a doctor?
Authors: Rebecca Viney
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>
Talking about career aspirations and retirement plans should become normal in NHS, says Working Longer Review
Authors: Abi Rimmer
Journal: BMJ (2014)

A change of culture is needed within the health service to normalise conversations between managers and staff about career aspirations and retirement plans, the Working Longer Review has said.

The review group was established in September 2012 to assess the impact that working beyond 60 years of age could have on NHS staff. Planned changes to the NHS pension scheme will mean that from 2015 members will have their normal pension age increased in line with the state pension age.1

A report …
Is there any banding system in the clinical fellow salary?
Authors: Justin Stebbing
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>
Government must introduce incentives to retain older GPs, says BMA
Authors: Abi Rimmer
Journal: BMJ (2018)

GPs have called on the government to invest in an incentive scheme to encourage GPs into permanent roles and look at ways to retain older GPs, the BMA has said.

Delegates at the BMA’s annual UK conference of local medical committees (LMCs) in Liverpool on 9 March voted in favour of a motion which called on the government to “do everything possible to support and sustain the …
Advanced paediatric life support course
Authors: Alice Mavrogordato
Journal: BMJ (2008)

Dealing with critically ill children can be one of the most frightening things for health professionals. When I started accident and emergency as a junior doctor everyone was asked what their greatest fears were—the sick child came top. This course helps give confidence and structure to dealing with those ill children.

Our course candidates consisted of doctors of all grades and nursing staff from anaesthetics, emergency medicine, intensive care, general practice, and paediatrics. Guidance on the Advanced Life Support Group’s website indicates that the course is appropriate for medical, senior nursing staff, emergency care practitioners, and operating department assistants.

As an anaesthetic …