tbuckley/cabot-search huggingface dataset:
Royal colleges must improve data on diversity of exam candidates, BMA says
Authors: Abi Rimmer
Journal: BMJ (2014)

The BMA has called on medical royal colleges to improve their monitoring and evaluation of the demographic diversity of candidates taking college examinations.

In March 2013 the BMA wrote to 18 medical royal colleges to gather information on how they collected information on entry exams and their candidates. The association found that some colleges collected data on their candidates’ protected characteristics (age, disability, ethnicity, sex, religion and belief, and sexual orientation) but that the collection and monitoring of data were not consistent across characteristics. It also found that only eight of the 18 colleges analysed pass rates in relation to data gathered on the protected characteristics.

A report on the responses, published by the BMA’s equality and diversity …
Course on clinical management of chronic pain, Liverpool
Authors: Devjit Srivastava
Journal: BMJ (2010)

Patients with chronic pain present a formidable medical, psychological, social, and ethical challenge. There are few courses providing hands-on training in chronic pain. This course at Liverpool provides a comprehensive hands-on review of the most pertinent pain issues facing clinicians in their day to day practice.

The course is meant for healthcare professionals who have an interest in chronic pain management and already have some training or are embarking on a career in pain. Participants at the last course included anaesthetic trainees, fellows in chronic pain, pain consultants from abroad, anaesthetic consultants with an interest in pain, general practitioners, and staff grade anaesthetists with an interest in pain, as well as doctors from palliative care.

This course is organised by the Pain Relief Foundation (a registered charity) in association with the Faculty of Pain at …
Stimulation Of The Ep3 Receptor Causes Pulmonary Edema By Activation Of Trpc6 In Pulmonary Endothelial Cells
Authors: R. Samapati, A. Dietrich, W. M. Kuebler, C. Arenz, M. Schaefer, S. Uhlig, R. Nuesing, T. Gudermann, V. Flockerzi, Y. Yang, D. Adam
Journal: American Journal of Respiratory and Critical Care Medicine (2015)
PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 (PCSK-9) INHIBITORS IMPROVE LIPID PROFILE AND VASCULAR ATHEROSCLEROTIC PLAQUE FORMATION IN HIGH-RISK FAMILIAL HYPERCHOLESTEROLEMIA
Authors: Haruki Sekiguchi, Eri Yamamoto, Takuro Abe, Akiko Sakai, Kayoko Sato, Nobuhisa Hagiwara
Journal: Journal of the American College of Cardiology (2018)
LEFT VENTRICULAR PACING DUE TO INADVERTENT IMPLANTATION OF A PERMANENT ENDOCARDIAL PACEMAKER LEAD VIA A PATENT FORAMEN OVALE
Authors: Jesus Bueno Campa, Luis Olmos Dominguez, Gustavo Moreno Castillo, Milton Guevara, Karim Juarez Escobar, Hector Hugo, Guevara Gasca, Joaquin Gomez
Journal: Journal of the American College of Cardiology (2018)
Development and Validation of a Nomogram Prognostic Model for SCLC Patients
Authors: Shidan Wang, Lin Yang, Bo Ci, Matthew Maclean, David E. Gerber, Guanghua Xiao, Yang Xie
Journal: Journal of Thoracic Oncology (2018)

IntroductionSCLC accounts for almost 15% of lung cancer cases in the United States. Nomogram prognostic models could greatly facilitate risk stratification and treatment planning, as well as more refined enrollment criteria for clinical trials. We developed and validated a new nomogram prognostic model for SCLC patients using a large SCLC patient cohort from the National Cancer Database (NCDB).MethodsClinical data for 24,680 SCLC patients diagnosed from 2004 to 2011 were used to develop the nomogram prognostic model. The model was then validated using an independent cohort of 9700 SCLC patients diagnosed from 2012 to 2013. The prognostic performance was evaluated using p value, concordance index and integrated area under the (time-dependent receiver operating characteristic) curve (AUC).ResultsThe following variables were contained in the final prognostic model: age, sex, race, ethnicity, Charlson/Deyo score, TNM stage (assigned according to the American Joint Committee on Cancer [AJCC] eighth edition), treatment type (combination of surgery, radiation therapy, and chemotherapy), and laterality. The model was validated in an independent testing group with a concordance index of 0.722 ± 0.004 and an integrated area under the curve of 0.79. The nomogram model has a significantly higher prognostic accuracy than previously developed models, including the AJCC eighth edition TNM-staging system. We implemented the proposed nomogram and four previously published nomograms in an online webserver.ConclusionsWe developed a nomogram prognostic model for SCLC patients, and validated the model using an independent patient cohort. The nomogram performs better than earlier models, including models using AJCC staging.
Analysis of an online tool to explore evolving practice patterns in renal cell carcinoma (RCC).
Authors: Won Kim, Kristen Rosenthal, Thomas E. Hutson, Robert J. Motzer, Elizabeth R. Plimack, Kevin Obholz, Angelique Vinther, Brian I. Rini
Journal: Journal of Clinical Oncology (2018)

674 Background: The complex and rapidly evolving treatment (Tx) landscape for advanced RCC poses challenges for healthcare providers (HCPs), particularly those in community settings, to make Tx decisions. To better understand current RCC Tx patterns, we analyzed patient (pt) cases entered by HCPs in an online tool developed by 5 experienced RCC experts from leading academic institutions. Methods: The tool, developed in 2016 and updated in 2017, includes over 500 case variations based on key factors defined by the experts. HCPs enter pt information and their intended Tx plan; the tool provides expert Tx recommendations for the pt case entered, followed by a survey to determine if the recommendations changed the HCP Tx plan. This analysis compares intended Tx of HCPs vs expert recommendations for 1027 cases entered into the tool (2016, n = 470; 2017, n = 557). Pearson chi-squared and Fischer’s Exact tests were used for analyses. Results: There was substantial Tx variation between HCPs and experts. In the first-line setting, 65% of HCPs vs 81% of experts selected sunitinib or pazopanib in both 2016 and 2017 (P = .0014). After disease progression (PD) on a first-line TKI, experts selected nivolumab (nivo) as second-line Tx more often than HCPs (98% vs 26% in 2016, P &lt; .0001; 89% vs 37% in 2017, P &lt; .0001). There were significant changes in practice patterns from 2016 to 2017 for both experts and HCPs in pts who received 2 prior lines of Tx. After PD on a first-line TKI and then nivo, experts recommended cabozantinib as the TKI of choice in 76% of cases in 2017 vs 40% in 2016. After PD on a first-line TKI and then either axitinib or everolimus, experts selected nivo more often than HCPs (84% vs 30%, respectively; P = .002) in 2016; however, expert and HCP Tx plans were not significantly different in 2017 (100% vs 70%, respectively; P = .08). Of the survey respondents, 46% of HCPs who differed from experts in their Tx selection indicated that the tool changed their intended Tx. Conclusions: Practice patterns between experts and HCPs differed substantially in pts with Tx-refractory RCC. Given that expert recommendations often changed the Tx plan of HCPs, the potential of an online tool to improve clinical outcomes in pts with advanced RCC warrants further investigation.
What should I ask a GP practice before becoming a partner?
Authors: Judith Harvey
Journal: BMJ (2006)

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>
Abstract P6-05-01: Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/SOX2/miR-302b mediated malignant progression
Authors: M Picon-Ruiz, C Pan, K Drewes-Elger, K Jang, A Besser, D Zaho, C Morata-Tarifa, M Kim, TA Ince, D Azzam, S Wander, RJ Cote, HA Guy, D El-Ashry, P Torne-Poyatos, JA Marchal, JM Slingerland
Journal: Cancer Research (2018)

Abstract Consequences of the obesity epidemic on cancer morbidity and mortality are not fully appreciated. Obesity is a risk factor for many cancers, but the mechanisms by which it contributes to cancer development and patient outcome have yet to be fully elucidated. Here, we examined the effects of coculturing human-derived adipocytes with established and primary breast cancer cells on tumorigenic potential. We found that the interaction between adipocytes and cancer cells increased the secretion of proinflammatory cytokines. Prolonged culture of cancer cells with adipocytes or cytokines increased the proportion of mammosphere-forming cells and of cells expressing stem-like markers in vitro. Furthermore, contact with immature adipocytes increased the abundance of cancer cells with tumor-forming and metastatic potential in vivo. Mechanistic investigations demonstrated that cancer cells cultured with immature adipocytes or cytokines activated Src, thus promoting Sox2, c-Myc, and Nanog upregulation. Moreover, Sox2-dependent induction of miR-302b further stimulated cMYC and SOX2 expression and potentiated the cytokine-induced cancer stem cell-like properties. Finally, we found that Src inhibitors decreased cytokine production after coculture, indicating that Src is not only activated by adipocyte or cytokine exposures, but is also required to sustain cytokine induction. These data support a model in which cancer cell invasion into local fat would establish feed-forward loops to activate Src, maintain proinflammatory cytokine production, and increase tumor-initiating cell abundance and metastatic progression. Collectively, our findings reveal new insights underlying increased breast cancer mortality in obese individuals and provide a novel preclinical rationale to test the efficacy of Src inhibitors for breast cancer treatment. Citation Format: Picon-Ruiz M, Pan C, Drewes-Elger K, Jang K, Besser A, Zaho D, Morata-Tarifa C, Kim M, Ince TA, Azzam D, Wander S, Cote RJ, Guy HA, El-Ashry D, Torne-Poyatos P, Marchal JA, Slingerland JM. Interactions between adipocytes and breast cancer cells stimulate cytokine production and drive Src/SOX2/miR-302b mediated malignant progression [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-05-01.
Immune-related adverse events (irAE) in GU cancer patients receiving immune checkpoint inhibitors.
Authors: Peter Zang, Alexandra Drakaki, Izak Faiena, Betty Chan, Denice Tsao-Wei, Susan G. Groshen, David I. Quinn, Tanya B. Dorff
Journal: Journal of Clinical Oncology (2018)

422 Background: Immune checkpoint inhibitors (ICI), particularly PD-1 and PD-L1 antibodies, prolong survival in advanced renal cell (RCC) and urothelial cancer (UC) patients. However, they can cause a variety of serious irAE. We assessed frequency and onset of irAE at experienced centers, and evaluated whether baseline characteristics were associated with irAE. Methods: Pharmacy and clinic schedules identified RCC and UC patients treated with ICI at USC Norris (n = 51) and UCLA (n = 26) from 2014-2016. Prior radiation was defined as completion within 3 months before ICI. Fisher’s exact 2-tailed test was used to evaluate for associations of variables with irAE. Results: 77 patients median age 69 years (49-93) received ICI, 31 with RCC and 46 with UC; 36 received atezolizumab, 29 nivolumab, 9 pembrolizumab, 2 durvalumab, and 1 avelumab. 25 (32.5%) had irAE including pneumonitis (4%), myositis (3%), neurologic event (1%), hepatitis (8%), colitis (1%), rash (8%), endocrinopathy (6%), or hematologic event (1%). 11 (14%) required steroids, 3 (4%) required more intense immunosuppression (infliximab), 1 died of complications from irAE (pneumonitis). 5 were rechallenged with ICI after irAE resolution. Median time to onset of irAEs was 15 weeks; earliest onset of irAE (non-dermatologic) was 3 days after 1 st dose, latest onset was 112 weeks. Associations of irAE with variables are listed in the table. Conclusions: irAE were more common in our experience than in published datasets, especially endocrine events, and could occur after the first dose. There was an association between irAE and allergy to antibiotics as well as external beam radiation therapy (EBRT) within 3 months before ICI therapy. [Table: see text]
CDC tightens controls on scientists’ communication with news media
Authors: Peter Doshi
Journal: BMJ (2018)

The requirement for all information to be vetted could undermine scientific openness, reports Peter Doshi 

Questions have been raised about top-down efforts to constrain scientists at the Centers for Disease Control and Prevention. A CDC directive instituted quietly last summer requires all correspondence with the news media, no matter how basic an inquiry, to be cleared through its communications office in Atlanta. The existence of the directive was first reported by the media company Axios in September,12 but a freedom of information request by The BMJ has provided new details.

The newly released emails show that all requests from the news media, “even requests asking for data that is online,” now have to be cleared centrally.

Kathryn Harben, chief of the CDC’s central news media branch, announced the protocol in an email to colleagues on 28 August: “We …
Fibrous Dysplasia of the Rib Mimicking a Malignant Bone Tumor at SPECT/CT with 99mTc-MDP
Authors: Ludovic Fournel, Cristian Rapicetta, Alessandro Fraternali, Salvatore Bellafiore, Massimiliano Paci, Filippo Lococo
Journal: Clinical Nuclear Medicine (2018)

Abstract We herein report a case of a 43-year-old man with a right 8th-rib bone tumor exhibiting features of malignancy at CT-scan. Considering that a SPECT/CT with 99m Tc-MDP showed solitary intense radio-tracer uptake and the inconclusive results from a fine-needle biopsy, surgical en bloc tumor resection was performed. Pathologic analysis revealed a well-limited benign bone lesion (“fibrous rib dysplasia”) composed by a cellular fibrous proliferation. Since benign osseous diseases may present an intense scintigraphic tracer uptake (as in this case), we suggest a certain caution when interpreting the results of SPECT/CT with 99m Tc-MDP in order to avoid misdiagnosis and wrong treatments.
ULTRA-LOW-DOSE TWICE-DAILY ASPIRIN IMPROVES HEMOSTASIS AND MAINTAINS PLATELET INHIBITION IN ACUTE CORONARY SYNDROME PATIENTS RECEIVING TICAGRELOR
Authors: William Parker, Rachel C. Orme, Wael Sumaya, Jessica Hanson, Hannah Stokes, Hannah McMellon, Patricia Shaw, Heather Judge, Robert Storey
Journal: Journal of the American College of Cardiology (2018)
It is time to stand up to the politicians
Authors: Richard R Clark
Journal: BMJ (2007)

We welcome your rapid responses, whether in direct response to an article in Career Focus or as a way of sharing your own ideas. As long as it isn9t libellous or offensive, we9ll post it on our website. We print a selection of rapid reponses here and the writer of the best each month wins an <i>Oxford Handbook</i> of their choice. Letter of the month prize is donated by OUP.
PHARMACODYNAMIC EFFECTS OF SWITCHING FROM TICAGRELOR TO CLOPIDOGREL IN PATIENTS WITH CORONARY ARTERY DISEASE: RESULTS OF THE PROSPECTIVE, RANDOMIZED SWAP (SWITCHING ANTIPLATELET THERAPY)-4 STUDY
Authors: Francesco Franchi, Fabiana Rollini, Jose Rivas, Andrea Rivas, Malhar Agarwal, Megha Kureti, Deepa Nagaraju, Mustafa Wali, Zuber Shaikh, Maryuri Maldonado, Latonya Been, Siva Suryadevara, Daniel Soffer, Martin Zenni, Theodore Bass, Dominick Angiolillo
Journal: Journal of the American College of Cardiology (2018)
Bawa-Garba case: it’s the barrel that’s the problem
Authors: David J Nicholl
Journal: BMJ (2018)

I have been raising awareness of the implications of the erasure of Hadiza Bawa-Garba by the General Medical Council for several months, since I organised a letter to the Times .1 I told the Daily Mail that “what happened to Jack Adcock is an absolute tragedy, but the GMC has turned it into a disaster,”2 and …
Understanding Costs of Care in the Operating Room
Authors: Christopher P. Childers, Melinda Maggard-Gibbons
Journal: JAMA Surgery (2018)

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost.To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect.This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery.Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses.In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased.The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.
Terminally ill patients are happy to be involved in medical students’ teaching, study finds
Authors: Abi Rimmer
Journal: BMJ (2014)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Terminally ill patients are happy to be involved in medical students’ teaching, study finds Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Medical students’ sharing of patients’ images raises concerns over consent
Authors: Matthew Limb
Journal: BMJ (2015)

UK medical students have taken rapidly to sharing medical images by smartphone to aid their learning, raising concerns as to whether appropriate patient consent safeguards are in place.

Around 15% of the UK’s 41 000 students have now signed up to use Figure1, a free image sharing app that launched in Europe last year and was dubbed the “Instagram for doctors.” Its creator, Joshua Landy, who is an intensive care doctor working in Toronto, revealed the figure when he spoke at the Royal Society of Medicine’s medical innovations summit on 18 April.

Landy said that UK students were seizing the opportunity to collaborate with colleagues, uploading and discussing contributions that made up an “almanac” of millions of medical images. “Seeing more cases just brings you more opportunity to …
Mycophenolate mofetil versus azathioprine in scleroderma-associated interstitial lung disease: results from the Australian Scleroderma Cohort Study
Authors: C. Owen, G. Ngian, K. Elford, O. Moore, M. Nikpour, W. Stevens, S. Proudman, J. Roddy, J. Zochling, C. Hill, P. Nash, A. Sturgess, J. Sahhar
Journal: Arthritis & Rheumatology (2014)
Legal Challenges to State Drug Pricing Laws
Authors: Theodore T. Lee, Aaron S. Kesselheim, Amy Kapczynski
Journal: JAMA (2018)

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