tbuckley/cabot-search huggingface dataset:
I am an NHS midwife with an MSc and special training in neonatal intensive care. I am 36 and have a young family. Do you think I'm too old to start a new career in medicine; and is there any financial support available to me?
Authors: Paul O'Neill
Journal: BMJ (2004)

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.
Many consultants are considering leaving NHS or retiring early over pay changes
Authors: Helen Jaques
Journal: BMJ (2013)

A majority of consultants (58%) are considering leaving the NHS or retiring earlier than planned in response to planned changes to their pay and reward schemes, a survey by the Hospital Consultants and Specialists Association indicates.

Nearly three quarters of respondents to the survey said that they did not believe that the recommendations of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) on their pay would incentivise medical staff to perform to a higher standard. 

The association, a trade union that represents around 3400 senior hospital …
ACCURACY OF QUANTITATIVE FLOW RATIO OBTAINED FROM 3D COMPUTATIONAL QUANTITATIVE CORONARY ANGIOGRAPHY IN COMPARISON WITH INVASIVE FRACTIONAL FLOW RESERVE AS A REFERENCE
Authors: Yoshinori Kanno, Taishi Yonetsu, Yoshihisa Kanaji, Eisuke Usui, Masahiro Hoshino, Masahiro Hada, Yohei Sumino, Tadashi Fukuda, Rikuta Hamaya, Tsunekazu Kakuta
Journal: Journal of the American College of Cardiology (2018)
A new era in holistic care: bridging the gap between dermatologists and oncologists for the treatment of malignant melanoma
Authors: S. Muthiah, D. Tang, B. Nasr, S. Verykiou
Journal: British Journal of Dermatology (2018)

Melanoma is the most aggressive skin cancer with incidence rates rising by 360% in the last 30 years and projected to increase by a further 7% between 2014 and 2035.1 Patients are referred to dermatology to make the diagnosis, excise the primary tumour and offer clinical surveillance. However, when melanoma spreads beyond loco‐surgical regional control, patient care is then transferred to a multidisciplinary team (MDT) including oncologists, plastic surgeons, dermatologists, radiologists and histopathologists. At any point during the patient's journey, from diagnosis through to treatment of metastatic melanoma, dermatological input is required. The recent emergence of targeted treatments, immunotherapies and combination regimes has revolutionized clinical outcomes for patients with metastatic disease; however, as seen in most systemic cancer treatments, this has also unveiled a plethora of cutaneous side‐effects.2,3,4,5,6,7 These cutaneous toxicities have garnered considerable attention, due to frequent occurrence, visibility and impact on the physical and psychological health of patients with melanoma, resulting in dose reduction or cessation of treatment.8,9,10 The rapid expansion of melanoma treatments and the increasing number of cutaneous side‐effects that accompany such treatments has left dermatologists and oncologists feeling ill‐equipped to recognize and manage the wide spectrum of complications alone. Instead, oncologists and dermatologists should work alongside each other to allow prompt diagnosis, reporting and treatment of dermatology‐related treatment side‐effects for improved patient outcomes.
How does the BMJ careers chronic illness matching scheme work and is it confidential?
Authors: Rhona MacDonald
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>
Effect of transarterial chemoembolization plus external beam radiotherapy on survival of patients with hepatocellular carcinoma showing macroscopic vascular invasion compared with sorafenib: A randomized trial.
Authors: Sang MIN Yoon, So Jung Lee, Jong Hoon Kim, Ji Hoon Shin, Jihyun An, Han Chu Lee, Baek-Yeol Ryoo, Young-Suk Lim
Journal: Journal of Clinical Oncology (2018)

210 Background: Sorafenib is the sole treatment option for advanced stage hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) with unsatisfactory response rate and survival benefit. Combined transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results in these patients by observational studies. Here, we report the efficacy and safety of TACE plus RT compared to sorafenib in patients with advanced HCC and MVI. Methods: This study was a randomized, open-label trial at an academic tertiary care center. Between 2013 and 2016, 90 treatment-naive patients with liver-confined HCC showing MVI were randomly assigned to receive sorafenib (400 mg twice-daily; n = 45; sorafenib group) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE; n = 45; TACE+RT group). Primary endpoint was 12-week the progression-free survival (PFS) rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to Response Evaluation Criteria in Solid Tumors (version 1.1). Crossover of treatment was permitted after confirming disease progression. Results: All patients had portal vein invasion of HCC and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. At week 12, the PFS rate was significantly higher in the TACE+RT group than the sorafenib group (77.8% vs. 26.7%; P&lt; 0.001). The TACE+RT group showed significantly higher radiologic response rate (33.3% vs. 2.2% at 24 weeks; P&lt; 0.001), significantly longer median time to disease progression (30 weeks vs. 8 weeks; P&lt; 0.001), and significantly longer overall survival (55 weeks vs. 43 weeks; P= 0.04), compared with the sorafenib group. No patients in the TACE+RT group discontinued treatment due to hepatic decompensation. Conclusions: In patients with advanced HCC showing MVI, first-line treatment with TACE+RT was well-tolerated and provided improved progression-free survival, objective response rate, time to disease progression, and overall survival, compared with sorafenib treatment. Clinical trial information: NCT01901692.
Abstract MP31: State-Level Impact of Low Physical Activity on All-Cause Disease Burden
Authors: Patrick Sur, Ashkan Afshin
Journal: Circulation (2018)

Introduction: While a consensus for the beneficial effects of physical activity exists, the optimal level of exercise and its effect on the disease burden across all states of the United States has not been evaluated. Objective: To systematically quantify the attributable burden to physical inactivity in all states of the United States by age, sex, year, and cause. Methods: We obtained data on categorical prevalence of domain-specific and total physical activity levels from nationally or subnationally representative surveys. Risk-outcome effect sizes of total physical activity were gathered from a meta-analysis of prospective cohort studies. The optimal level of physical activity was determined based on the activity levels associated with lowest risk of mortality in prospective observational studies. A comparative risk assessment analysis then quantified the proportion of death and disability attributable to low physical activity. The variation of physical activity levels and its associated burden was further evaluated across each state of the United States. Results: In 2016, physical inactivity accounted for 87 (95% UI: 122.6- 44.5) thousand DALYs in the United States (84.4% from CVD, 9.1% from DM, and 6.5% from cancers), with 59% of DALYs coming from men and 41% in women. Only 5 states (WY, ME, MT, AK, VT) demonstrated mean total physical activity levels above our suggested physical activity level of 3500 MET-mins per week. The highest burden attributable to physical activity was seen in Mississippi, while the lowest was seen in Colorado (955 &amp; 458 DALYs per 100,000, respectively). Conclusion: Our findings suggest that population inventions to increase physical activity at the population level could save hundreds of thousands of life years across the United States.
Prognostic significance of interphase FISH in monoclonal gammopathy of undetermined significance
Authors: Arjun Lakshman, Shilpa Paul, S. Vincent Rajkumar, Rhett P. Ketterling, Patricia T. Greipp, Angela Dispenzieri, Morie A Gertz, Francis K. Buadi, Martha Q. Lacy, David Dingli, Amie L. Fonder, Suzanne R. Hayman, Miriam A. Hobbs, Wilson I. Gonsalves, Yi Lisa Hwa, Prashant Kapoor, Nelson Leung, Ronald S. Go, Yi Lin, Taxiarchis V. Kourelis, Rahma Warsame, John A. Lust, Stephen J. Russell, Steven R. Zeldenrust, Robert A. Kyle, Shaji K. Kumar
Journal: Leukemia (2018)
Rebuild commitment to staff to curb soaring locum costs, NHS is told
Authors: Caroline White
Journal: BMJ (2015)

The NHS must rebuild its commitment to staff and must make them feel valued to help curb the soaring costs of agency staff, the chief executive of the NHS Confederation has said.

Speaking at the confederation’s annual conference in Liverpool on 3 June, Rob Webster cited two reasons why the NHS continually spent too much on agency staff. One was a misalignment between policy, services, financial planning, and workforce planning, culminating in insufficient staff numbers to fill the rotas. The other was cultural, he said, commenting, “I think we have lost the ‘social contract’ with some staff.”

The apparent willingness of some staff to return to their NHS organisations …
GPs express support for junior doctors
Authors: Abi Rimmer
Journal: BMJ (2016)

GPs have expressed their support for junior doctors and have strongly condemned the imposition of a new contract on the junior workforce.

GPs attending the BMA’s conference of local medical committees (LMCs) held in London on Thursday 19 May voted overwhelmingly in favour of a motion that “condemns the imposition of the new unsafe and unfair contract on junior doctors.”

After the announcement that the BMA and the government had reached an agreement on a new contract for junior doctors in England, subject to a ballot of BMA members, the conference motion was amended.1 Rather than stating …
How do I organise some time doing research in the United States, most likely after I have completed the new two year foundation programme?
Authors: Howard Clark
Journal: BMJ (2004)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
INCIDENCE AND PREDICTORS OF DYSKALEMIA IN REAL-WORLD HEART FAILURE PATIENTS WITH PRESERVED, MID-RANGE AND REDUCED EJECTION FRACTION
Authors: Gianluigi Savarese, Hong Xu, Marco Trevisan, Ulf Dahlstrom, Bertram Pitt, Lars Lund, Juan Jesus Carrero
Journal: Journal of the American College of Cardiology (2018)
Hydrocortisone plus Fludrocortisone for Adults with Septic Shock
Authors: Djillali Annane, Alain Renault, Christian Brun-Buisson, Bruno Megarbane, Jean-Pierre Quenot, Shidasp Siami, Alain Cariou, Xavier Forceville, Carole Schwebel, Claude Martin, Jean-François Timsit, Benoît Misset, Mohamed Ali Benali, Gwenhael Colin, Bertrand Souweine, Karim Asehnoune, Emmanuelle Mercier, Loïc Chimot, Claire Charpentier, Bruno François, Thierry Boulain, Franck Petitpas, Jean-Michel Constantin, Gilles Dhonneur, François Baudin, Alain Combes, Julien Bohé, Jean-François Loriferne, Roland Amathieu, Fabrice Cook, Michel Slama, Olivier Leroy, Gilles Capellier, Auguste Dargent, Tarik Hissem, Virginie Maxime, Eric Bellissant
Journal: New England Journal of Medicine (2018)

Septic shock is characterized by dysregulation of the host response to infection, with circulatory, cellular, and metabolic abnormalities. We hypothesized that therapy with hydrocortisone plus fludrocortisone or with drotrecogin alfa (activated), which can modulate the host response, would improve the clinical outcomes of patients with septic shock.
How foraging works: Uncertainty magnifies food-seeking motivation
Authors: Patrick Anselme, Onur Güntürkün
Journal: Behavioral and Brain Sciences (2018)

Abstract Food uncertainty has the effect of invigorating food-related responses. Psychologists have noted that mammals and birds respond more to a conditioned stimulus that unreliably predicts food delivery, and ecologists have shown that animals (especially small passerines) consume and/or hoard more food and can get fatter when access to that resource is unpredictable. Are these phenomena related? We think they are. Psychologists have proposed several mechanistic interpretations, while ecologists have suggested a functional interpretation: The effect of unpredictability on fat reserves and hoarding behavior is an evolutionary strategy acting against the risk of starvation when food is in short supply. Both perspectives are complementary, and we argue that the psychology of incentive motivational processes can shed some light on the causal mechanisms leading animals to seek and consume more food under uncertainty in the wild. Our theoretical approach is in agreement with neuroscientific data relating to the role of dopamine, a neurotransmitter strongly involved in incentive motivation, and its plausibility has received some explanatory and predictive value with respect to Pavlovian phenomena. Overall, we argue that the occasional and unavoidable absence of food rewards has motivational effects (called incentive hope ) that facilitate foraging effort. We show that this hypothesis is computationally tenable, leading foragers in an unpredictable environment to consume more food items and to have higher long-term energy storage than foragers in a predictable environment.
Pancreatoscopy-guided laser lithotripsy in a patient with difficult ductal stone
Authors: Gonçalo Alexandrino, Luís Lourenço, Catarina Rodrigues, David Horta, Jorge Reis, Jorge Canena
Journal: Endoscopy (2018)

A 63-year-old man with heavy alcohol consumption was referred to our institution for upper abdominal pain, weight loss, and a computed tomography scan showing signs of chronic pancreatitis (parenchymal calcifications and atrophy of the pancreatic body/tail).
NONBACTERIAL THROMBOTIC ENDOCARDITIS (NBTE) IN A PATIENT WITH TRANSIENT ISCHEMIC ATTACKS, ADENOPATHY AND A NEWLY DIAGNOSED MURMUR
Authors: Vicente Jimenez Franco, Felipe Valdes, Arturo Cadena, Carlos Sanchez-Diaz, Hernan Azpiri, José Gildardo Paredes-Vázquez
Journal: Journal of the American College of Cardiology (2018)
I have full registration and specialist registration in G(I)M with the GMC. I started cardiology training in Hungary, but I haven't worked in the United Kingdom. How should I gain an NTN in cardiology?
Authors: Shrilla Banerjee
Journal: BMJ (2005)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
Prognostic and predictive role of CTCs and AR-V7+ CTCs expression in metastatic catrate resistant prostate cancer (mCRPC): A feasibility study.
Authors: Marco Maruzzo, Elisabetta Rossi, Umberto Basso, Antonella Facchinetti, Giuseppe Anile, Francesco Pierantoni, Sara Galuppo, Laura Evangelista, Enrico Pizzirani, Rita Zamarchi, Vittorina Zagonel
Journal: Journal of Clinical Oncology (2018)

367 Background: Circulating tumor cells (CTC) counts ≥ 5/7.5 mL predict shorter survival in patients (pts) with mCRPC. Moreover, the presence of androgen receptor splice variant-7 mRNA (AR-V7) in CTCs is thought to play a relevant role in the development of primary or acquired resistance to enzalutamide (E) or abiraterone (A). We developed a new immunofluorescence-based assay for AR-V7+ CTCs and tested its association with PFS and OS. Methods: We performed a single-centre observational prospective trial enrolling pts with mCRPC candidate to receive E or A. CTC samples have been collected at baseline, after 1 month (mo) and every 3 mos thereafter until progression or at 12 mos without progression. CTCs have been enumerated with CellSearch System. We integrated the standard assay with a mAb able to recognize the AR-V7 protein. Slides from samples underwent automated immunofluorescent staining and AR-V7+ CTCs were enumerated. Results: Since Sep 2016, 31 pts have been enrolled (Table). We compared CTC counts between standard and the integrated assay and found no differences in the mean total CTC number ± (Wilcoxon Signed Rank test, p= 0.31). 16 out of 28 evaluable pts (57%) had ≥ 1 CTCs at baseline, 9 pts (32%) had ≥ 5 CTCs/7.5 ml, 4 pts (14.3%) were AR-V7+ before any exposure to A or E. After a median follow-up time of 8.1 mos, 6 pts have progressed and 4 died. No association has been found between CTCs ≥ 5/7.5 mL and survival. The presence of at least 1 AR-V7+ CTC at baseline did not correlate with PSA response, but had a weak association with shorter PFS (log-rank test, p = 0.055) and a significant impact (p = 0.02) on OS. Conclusions: We developed a new integrated assay for AR-V7+ CTCs, based on an automated platform that permits serial sampling with low inter- / intra-test variability. The clinical utility in anticipating the resistance to E or A is under study. [Table: see text]
The Diagnostic Yield of Brugada Syndrome After Sudden Death With Normal Autopsy
Authors: Michael Papadakis, Efstathios Papatheodorou, Greg Mellor, Hariharan Raju, Rachel Bastiaenen, Yanushi Wijeyeratne, Sara Wasim, Bode Ensam, Gherardo Finocchiaro, Belinda Gray, Aneil Malhotra, Andrew D’Silva, Nina Edwards, Della Cole, Virginia Attard, Velislav N. Batchvarov, Maria Tome-Esteban, Tessa Homfray, Mary N. Sheppard, Sanjay Sharma, Elijah R. Behr
Journal: Journal of the American College of Cardiology (2018)
Few paediatricians have time for research, survey finds
Authors: Abi Rimmer
Journal: BMJ (2015)

Over 80% of paediatricians have no time for research work, the Royal College of Paediatrics and Child Health has found.

The college surveyed paediatric consultants and staff grade doctors, from whom it received 1924 responses. Of the respondents, 82% (1311) said that they did not have any time in their job plan that was allocated to research.

Four fifths (1149) of the …
Level 1 emergency ultrasound course
Authors: Zaynab Jawad
Journal: BMJ (2011)

The level 1 emergency ultrasound course is held in various locations including London and Cambridge. This article relates to the course I attended at St Helier Hospital in Sutton.

The level 1 emergency ultrasound course is the first step in achieving competency in level 1 emergency ultrasound. The College of Emergency Medicine now recommends that all trainees in emergency medicine should be competent in level 1 emergency ultrasound by specialty training year 5. The course covers both the knowledge and practical skills required to achieve this. Although the course is aimed mainly at emergency medicine trainees, surgical trainees and foundation doctors also attended.

I did the course to gain a better understanding of the use of ultrasound and its practical …
COMPARISON BETWEEN TIMI AND GRACE SCORES AS A PREDICTOR FOR SHORT- AND LONG-TERM OUTCOME IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION
Authors: Nitinan Chimparlee, Jarkarpun Chaipromprasit, Siriporn Athisakul, Vorarit Lertsuwunseri, Wacin Buddhari, Wasan Udayachalerm, Suphot Srimahachota
Journal: Journal of the American College of Cardiology (2018)
Government has still not got a grip of the GP workforce crisis, says BMA
Authors: Abi Rimmer
Journal: BMJ (2015)

The government has still not fully understood the extent of the workforce crisis in general practice, the BMA has said. 

Chaand Nagpaul, chair of the BMA’s General Practitioners Committee, said that general practice was facing a workforce crisis, with over 600 training places unfilled this year, something the government had failed to recognise. “There have been small steps in the right direction, such as through the 10 point workforce plan for general practice, but overall ministers have still not got a grip of the workforce crisis,” …
Sphingosine kinase 1 promotes liver fibrosis by preventing miR‐19b‐3p‐mediated inhibition of CCR2
Authors: Tian Lan, Changzheng Li, Guizhi Yang, Yue Sun, Lihang Zhuang, Yitao Ou, Hui Li, Genshu Wang, Tatiana Kisseleva, David Brenner, Jiao Guo
Journal: Hepatology (2018)

Chronic liver disease mediated by activation of hepatic stellate cells (HSCs) and Kupffer cells (KCs) leads to liver fibrosis. Here, we aimed to investigate the molecular mechanism and define the cell type involved in mediating the sphingosine kinase (SphK)1-dependent effect on liver fibrosis. The levels of expression and activity of SphK1 were significantly increased in fibrotic livers compared with the normal livers in human. SphK1 was coexpressed with a range of HSC/KC markers including desmin, α-smooth muscle actin (α-SMA) and F4/80 in fibrotic liver. Deficiency of SphK1 (SphK1-/- ) resulted in a marked amelioration of hepatic injury, including transaminase activities, histology, collagen deposition, α-SMA and inflammation, in CCl4 or bile duct ligation (BDL)-induced mice. Likewise, treatment with a specific inhibitor of SphK1, 5C, also significantly prevented liver injury and fibrosis in mice induced by CCl4 or BDL. In cellular levels, inhibition of SphK1 significantly blocked the activation and migration of HSCs and KCs. Moreover, SphK1 knockout in KCs reduced the secretion of CCL2, and SphK1 knockout in HSCs reduced C-C motif chemokine receptor 2 ([CCR2] CCL2 receptor) expression in HSCs. CCL2 in SphK1-/- mice was lower whereas microRNA-19b-3p in SphK1-/- mice was higher compared with wild-type (WT) mice. Furthermore, microRNA-19b-3p downregulated CCR2 in HSCs. The functional effect of SphK1 in HSCs on liver fibrosis was further strengthened by the results of animal experiments using a bone marrow transplantation (BMT) method.SphK1 has distinct roles in the activation of KCs and HSCs in liver fibrosis. Mechanistically, SphK1 in KCs mediates CCL2 secretion, and SphK1 in HSCs upregulates CCR2 by downregulation of miR-19b-3p. (Hepatology 2018).
I desperately want to work overseas as a relief, health, or aid worker. I have a large student debt. Is it possible to find humanitarian work and expect a salary?
Authors: Mark Wilson
Journal: BMJ (2004)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.