tbuckley/cabot-search huggingface dataset:
Multimorbidity medications and poor asthma prognosis
Authors: Sébastien Chanoine, Margaux Sanchez, Isabelle Pin, Sofia Temam, Nicole Le Moual, Agnès Fournier, Christophe Pison, Jean Bousquet, Pierrick Bedouch, Marie-Christine Boutron-Ruault, Raphaëlle Varraso, Valérie Siroux
Journal: European Respiratory Journal (2018)

Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis. We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life). The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: “Few multimorbidity-related medications” (43.5%), “Predominantly allergic multimorbidity-related medications” (32.8%) and “Predominantly metabolic multimorbidity-related medications” (23.7%). Compared with women belonging to the “Few multimorbidity-related medications” profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life. The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.
NHS chief denies knowledge of £2m spent on gagging orders
Authors: Helen Jaques
Journal: BMJ (2013)

David Nicholson, chief executive of NHS England, has denied knowledge of £2m spent on gagging orders, after an investigation revealed a legal loophole used to silence more than 50 NHS staff.

A request under freedom of information legislation by the Conservative MP Stephen Barclay discovered that at least 52 NHS staff had been paid off through use of “judicially mediated settlements” since 2008.1 Under these settlements a hospital reaches an agreement on termination of employment with an employee. The agreement is then signed off by a judge or senior lawyer rather than …
Management of patients after laparoscopic procedures
Authors: Natalie S Blencowe, Richard Waldon, Mark N Vipond
Journal: BMJ (2018)

### What you need to know Laparoscopy has revolutionised abdominal surgery over the past 30 years. Fifteen million laparoscopic surgical operations are performed worldwide every year, of which 10% are performed in the UK.1 Laparoscopy involves the use of cameras and specially designed instruments that enable surgeons to perform operations without making large abdominal incisions. It has gained worldwide popularity and acceptance by surgeons and patients alike. Better intraoperative visibility, minimal scarring, less pain, shorter hospital stay, and faster recovery are the main advantages of laparosocopic surgery.2 This practice pointer discusses the considerations around management of patients following laparoscopic surgical procedures. It is predominantly UK focused, although information about wound care, thromboprophylaxis, and complications should equally apply elsewhere. As well as cholecystectomy, appendicectomy, and tubo-ovarian procedures, laparoscopy is now increasingly used for hysterectomy, bariatric procedures, and many gastrointestinal and urological cancer resections, and it is also possible to perform aortic aneurysm repair laparoscopically.345 Technological advances have resulted in the development of several variations on the "standard" laparoscopic approach. These are described in box 1. Box 1 ### Variations on standard laparoscopic techniques #### Single incision laparoscopic surgery The surgeon operates almost exclusively through a single entry point, typically the patient's umbilicus, leaving a single scar #### Natural orifice endoscopic surgery Performed with an endoscope passed through a natural orifice (eg, mouth or anus) then through an internal incision (eg, stomach or colon), thus … RETURN TO TEXT
EFFECT OF COMBINED BETA-BLOCKER AND BETA-AGONIST USE ON CLINICAL OUTCOMES AMONG MEDICAID BENEFICIARIES WITH COEXISTING HEART FAILURE AND ASTHMA
Authors: Demilade Adedinsewo, Junjun Xu, Oluwatosin Omole, Akintunde Akinjero, Obiora Egbuche, Nicolas Bakinde, Adesoji Oderinde, Anekwe Onwuanyi, Herman Taylor, Mohamad Yamani
Journal: Journal of the American College of Cardiology (2018)
<i>RASA1</i>/<i>NF1</i>-Mutant Lung Cancer: Racing to the Clinic?
Authors: Shunsuke Kitajima, David A. Barbie
Journal: Clinical Cancer Research (2018)

Although mutation of NF1 has been described in non-small cell lung cancer (NSCLC), co-mutation with RASA1, another Ras-GTPase activating protein (RasGAP), defines a novel genetically defined subclass of NSCLC. RASA1/NF1-mutant cell lines are highly sensitive to MEK inhibitors, warranting clinical evaluation of MAPK inhibition in this subclass of patients. Clin Cancer Res; 24(6); 1243-5. ©2018 AACRSee related article by Hayashi et al., p. 1436.
Undergraduate Plastic Reconstructive and Aesthetic Surgery (UPRAS) conference
Authors: Alexander Young
Journal: BMJ (2009)

The Undergraduate Plastic Reconstructive and Aesthetic Surgery (UPRAS) conference is an annual one day event held at the Royal Society of Medicine. The conference was established by two Imperial College graduates and is in its second year. Plastic surgery is not currently part of the undergraduate curriculum, and the conference aims to provide undergraduates and junior doctors with a greater understanding of the specialty. The day is divided into morning lectures and afternoon tutorials and practical sessions that aim to convey core principles and concepts of plastic surgery.

It is aimed at medical students and junior doctors with an interest in plastic surgery. 

Attendees are encouraged to submit cases or posters for presentation at the conference. Cases and posters selected …
Abstract ES3-3: Progress, paradigms, and pathways of long non-coding RNAs in cancer
Authors: L Yang
Journal: Cancer Research (2018)

Abstract Despite recent advances in cancer research, many cancer types continue to be deficient of FDA-approved targeted therapies and also have poor prognoses. One of the fundamental challenges in developing targeted therapies against cancer lies in the absence of characterized molecular mechanisms that underlie tumor initiation and progression. These setbacks demand improved identification of biomarkers for human cancer, among which long non-coding RNAs (lncRNAs) show promise. It has become increasingly apparent that lncRNAs are aberrantly expressed in a broad spectrum of cancers and that they play key roles in promoting and maintaining cancer characteristics, demonstrating their clinical potential as biomarkers and therapeutic targets. In this review, we focus on the recent discoveries of lncRNAs in cancer signaling pathways as key signal transduction mediators. We review the functional roles of lncRNAs as protein, RNA and lipid binding partners in regulating cellular responses to extracellular signals and discuss their clinical potential as diagnostic indicators, stratification markers, and therapeutic targets of combinatorial treatments. Specifically, the following topics will be discussed: 1) Somatic mutations or disease-associated SNPs of lncRNAs implicate lncRNAs as cancer risk genes; 2) Through RNA-protein, RNA-RNA, RNA-lipid interactions, lncRNAs modulate cancer signaling pathways and consequences; 3) Dysregulation of lncRNAs lead to hyper- or hypo-activation of cellular pathways, leading to resistance to current targeted therapies; 4) Targeting lncRNA alone or a co-targeting strategy may help overcome the targeted therapy resistance. Citation Format: Yang L. Progress, paradigms, and pathways of long non-coding RNAs in cancer [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 ES3-3.
Identification of Three Rheumatoid Arthritis Disease Subtypes by Machine Learning Integration of Synovial Histologic Features and <scp>RNA</scp> Sequencing Data
Authors: Dana E. Orange, Phaedra Agius, Edward F. DiCarlo, Nicolas Robine, Heather Geiger, Jackie Szymonifka, Michael McNamara, Ryan Cummings, Kathleen M. Andersen, Serene Mirza, Mark Figgie, Lionel B. Ivashkiv, Alessandra B. Pernis, Caroline S. Jiang, Mayu O. Frank, Robert B. Darnell, Nithya Lingampali, William H. Robinson, Ellen Gravallese, Vivian P. Bykerk, Susan M. Goodman, Laura T. Donlin
Journal: Arthritis & Rheumatology (2018)

In this study, we sought to refine histologic scoring of rheumatoid arthritis (RA) synovial tissue by training with gene expression data and machine learning.
Taskforce seeks to tackle “crisis” in emergency medicine recruitment
Authors: Caroline White
Journal: BMJ (2012)

Expanding the routes into training in emergency medicine, developing the role of the advanced nurse practitioner, and relaxing immigration rules are all options currently being considered by an emergency medicine taskforce in a bid to ease the shortage of doctors in the specialty.

The taskforce—which includes representatives from the royal colleges, the Department of Health, the General Medical Council, and NHS Employers—was set up last year amid a realisation that a crisis point had been reached and that the safety of patients was under threat.

“We have been aware of difficulties [caused by shortages] in isolated parts of the country for around two years, but the real crisis has occurred in the past 12 months,” Ruth Brown, vice president of the College of Emergency Medicine, told BMJ …
Can YKL-40 be used as a biomarker and therapeutic target for adult asthma?
Authors: Xiang Tong, Dongguang Wang, Sitong Liu, Yao Ma, Hong Fan
Journal: European Respiratory Journal (2018)

The YKL-40 may be used as a potential biomarker and therapeutic target for adult asthma http://ow.ly/fgAw30h99Nt
National trends in the management of patients with positive surgical margins at the time of radical prostatectomy.
Authors: Kamyar Ghabili, Kevin Nguyen, Walter Hsiang, Jamil Syed, Alfredo Suarez-Sarmiento, Brian M. Shuch, Henry Soo-Min Park, James B. Yu, Michael Leapman
Journal: Journal of Clinical Oncology (2018)

111 Background: The optimal management approach for patients with positive surgical margins (PSM) at radical prostatectomy (RP) has not been definitively assessed. To better understand contemporary patterns of care, we sought to examine time trends and determinants of adjuvant therapy in a large national sample of men with prostate cancer (PCa) treated with RP. Methods: We queried the National Cancer Database (NCDB) to identify men with clinically-localized PCa diagnosed from 2010 to 2014 who had PSM at RP performed as initial primary definitive treatment. We used descriptive statistics to examine subsequent management strategies, assessed as no adjuvant therapy as part of the initial planned course of management, receipt of adjuvant radiation therapy (RT), and receipt of adjuvant RT in combination with androgen deprivation therapy (ADT). Binary logistic regression models were constructed to identify patient, tumor, and facility features associated with receipt of adjuvant therapy. Results: During the study period, we identified 44,523 patients with PSM. Of those, 5,179 (11.6%) men received any adjuvant RT (+/- ADT), while only 1,380 (3%) received adjuvant RT with ADT. Use of adjuvant RT did not change over the study period ( p= 0.61). On multivariable analysis men of uninsured status (p = 0.003), Medicaid insurance (p = 0.001), and patients treated in non-academic facilities (p &lt; 0.001) were more likely to receive adjuvant RT. In addition, use of adjuvant RT was associated with higher pre-treatment PSA (p &lt; 0.001), pathologic stage (p &lt; 0.001) and Gleason grade group (p &lt; 0.001), decreasing distance from the treatment center (p &lt; 0.001), and shorter duration between diagnosis and RP (p &lt; 0.001). Receipt of adjuvant ADT with RT was associated with clinical and pathologic features; however, not with sociodemographic factors. Conclusions: The majority of patients experiencing PSM at RP did not receive adjuvant RT, and rates of adjuvant therapy have remained stable over time. In addition to adverse clinical and pathologic features, sociodemographic and facility factors were significantly associated with receipt of adjuvant RT; however, the addition of ADT appears largely driven by disease characteristics.
Sirolimus in patients with clinically active systemic lupus erythematosus resistant to, or intolerant of, conventional medications: a single-arm, open-label, phase 1/2 trial
Authors: Zhi-Wei Lai, Ryan Kelly, Thomas Winans, Ivan Marchena, Ashwini Shadakshari, Julie Yu, Maha Dawood, Ricardo Garcia, Hajra Tily, Lisa Francis, Stephen V Faraone, Paul E Phillips, Andras Perl
Journal: The Lancet (2018)
Measuring and improving the quality of mental health care: a global perspective
Authors: Amy M. Kilbourne, Kathryn Beck, Brigitta Spaeth‐Rublee, Parashar Ramanuj, Robert W. O'Brien, Naomi Tomoyasu, Harold Alan Pincus
Journal: World Psychiatry (2018)

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.
Serial PET Changes of Extraocular Muscle Hypermetabolism in Sporadic Fatal Insomnia
Authors: Yince Loh, Sidney R Hinds
Journal: Clinical Nuclear Medicine (2009)

The chronological development of positron emission tomography abnormalities in prion disease is unclear. A 44-year-old man with no significant family history presented with cognitive difficulties, paranoia, and insomnia. He had prominent saccadic intrusions and a lurching gait. Cell count, metabolic panel, copper, thyroid, and urine heavy metals were normal. Cerebrospinal 14-3-3 and antithyroid antibodies were not detected. Positron emission tomography demonstrated decreased thalamic F-18 fluorodeoxyglucose uptake. Over months, cortical metabolism decreased while uptake increased in the extraocular muscles. Eighteen months later, the patient aspirated and died. Hypermetabolism of the extraocular muscles reflects increased motor activity from continuous saccades, which results from loss of cortical fixation.
CAREGIVERS OF PATIENTS CONSIDERING DESTINATION THERAPY LEFT VENTRICULAR ASSIST DEVICE AND A SHARED DECISION-MAKING INTERVENTION: CHARACTERISTICS AND OUTCOMES IN THE DECIDE-LVAD TRIAL
Authors: Colleen Kelley McIlvennan, Daniel Matlock, Jocelyn Thompson, Shannon Dunlay, Shane LaRue, Eldrin Lewis, Chetan Patel, Laura Blue, Erin C. Leister, Keith Swetz, Diane Fairclough, Vicie Baldridge, Mary Walsh, Larry Allen
Journal: Journal of the American College of Cardiology (2018)
BMA raises concern about plan to cut occupational health services for GPs
Authors: Abi Rimmer
Journal: BMJ (2014)

The BMA has written to the Department of Health for England to raise concern about cuts to occupational health services for GPs.

The joint letter from Paul Nicholson, chairman of the BMA’s Occupational Medicine Committee and Chaand Nagpaul, chairman of its General Practitioners Committee, sought assurances over the future of occupational health services for GPs and their staff.

The letter said, “We believe that the stress caused by rising workloads and work intensity that many NHS staff are presently under is adding to the need for appropriate specialist led occupational health services.”

A spokeswoman for NHS England said that, after a review of occupational …
Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool
Authors: Marie Fallon, Jane Walker, Lesley Colvin, Aryelly Rodriguez, Gordon Murray, Michael Sharpe
Journal: Journal of Clinical Oncology (2018)

Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects.
I am an overseas doctor who has completed three years of training in community health. I am interested in pursuing a career in public health in the United Kingdom. What would I need to do to get shortlisted for a specialist registrar position apart from working in a clinical post for a year (as advised by a director in public health)?
Authors: Joyce Carter
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>
PREDICTING FACTORS FOR 5 YEAR ADVERSE EVENTS AFTER TREATMENT FOR ACUTE AORTIC DISSECTIONS
Authors: Truls Myrmel, Alan Braverman, Mark Peterson, Edward P. Chen, Eduardo Bossone, Thomas Gleason, Arturo Evangelista, Marco Di Eusanio, Nimesh Desai, Patrick T. O'Gara, Udo Sechtem, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, G. Chad Hughes, Kim Eagle
Journal: Journal of the American College of Cardiology (2018)
National determinants of active surveillance among patients with clinical stage 1A kidney tumors.
Authors: Amanda Lu, Kevin Nguyen, Adam C Nolte, Oriyomo Alimi, Walter Hsiang, Kamyar Ghabili, Jamil Syed, Brian M. Shuch, Michael Leapman
Journal: Journal of Clinical Oncology (2018)

694 Background: Active surveillance (AS) has been increasingly recognized as a viable management strategy for patients with small renal masses (SRM). To better understand the contemporary management landscape of SRMs we examined practice patterns in a nationally representative cancer database. Methods: We identified patients with clinical T1a renal masses within the National Cancer Database (NCDB) between 2010 to 2014. Patients were classified according to initial management received including AS, surgery, ablation, or other treatment. We characterized time trends in the use of surveillance versus definitive therapy and examined clinical and socio-demographic determinants of AS among patients with small renal masses using multivariate logistic regression models. Results: We identified 59,189 patients who satisfied the inclusion criteria. Of the total cohort, 1,733 (2.9%) individuals received initial management with AS, while 57,456 (97.1%) received definitive treatment. There was a slight increase in initial management with surveillance however rates remained less than 5% in all years. On multivariate analysis, patient age (OR: 1.08, 95% CI 1.08-1.09), treatment at an academic center vs. community center (OR: 2.05, 95% CI: 1.83-2.29), and African American vs. Caucasian race (OR: 1.56, 95% CI:1.35-1.80) were independently associated with use of active surveillance. Moreover, regional-level differences were observed with the highest utilization of AS in the West North Central census division. Conclusions: Based on cancer registry data, national utilization of AS for SRMs remains very low, and we observed clinical and facility-level differences. Further investigation is warranted to better understand the factors underlying management for patients with SRMs.