tbuckley/cabot-search huggingface dataset:
Association of Hidradenitis Suppurativa With Body Image
Authors: Sylke Schneider-Burrus, Agata Jost, Eva Milena Johanna Peters, Ellen Witte-Haendel, Wolfram Sterry, Robert Sabat
Journal: JAMA Dermatology (2018)

Hidradenitis suppurativa (HS) leads to disfigurement and painful eruptions in terminal hair follicles of the intertriginous skin, mainly of axillary, genitofemoral, and perianal sites. It is associated with an excessive impairment of quality of life, psychiatric disorders, and sexual distress. Body image impairment has been linked to depression and anxiety and has been described for some dermatologic disorders but has not yet been investigated in patients with HS.To investigate whether body image is diminished in patients with HS and whether disease severity, age at onset, disease duration, obesity, depression, and anxiety are linked to body image impairment.This 12-month (August 1, 2009, to August 31, 2010) case-control study with a prospective, observational, cross-sectional design recruited 47 consecutive patients with HS entering a tertiary care center and 45 healthy control individuals matched for age, sex, and body mass index (BMI). One patient and 4 controls failed to complete the questionnaire and were excluded from the evaluation. Data analysis was performed from December 1, 2013, to February 15, 2014.The Frankfurt Body Concept Scale (FKKS) and the Hospital Anxiety and Depression Scale (HADS) were given to patients and controls. Correlations among FKKS, HADS, and disease features were calculated.Of the 46 patients and 41 controls included in the evaluation (mean [SD] age, 35.6 [1.6] years; 40 [46%] male and 47 [54%] female), HS significantly reduced body image (mean FKKS score, 234.2 [5.4] in patients and 276.9 [5.7] in controls; P < .001), even when controlled for BMI. A correlation was found for the extent of body image disruption and BMI (r = -0.589; P < .001), HADS-depression score (r = -0.619; P < .001), and HADS-anxiety score (r = -0.340; P = .03). No association was found for the body image score and the severity of HS, age at onset of disease, and duration of disease. The body contact subscale score was the only subscale score that was not different between patients with HS and controls.Patients with HS have major body image impairment, which might lead to depression and anxiety, disorders that have been largely acknowledged in HS. This study identified another element of the psychosocial burden of patients with HS and reveals that body image could potentially be used as an outcome measure in future studies of HS.
Other than MRCP and being registered with the General Medical Council, what are the requirements for entering specialist registrar training in dermatology in the United Kingdom
Authors: Susannah Baron
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>
Phase I study of immunotherapy for advanced ROR1+ malignancies with autologous ROR1-specific chimeric antigen receptor-modified (CAR)-T cells.
Authors: Jennifer M Specht, Sylvia Lee, Cameron Turtle, Carolina Berger, Josh Veatch, Ted Gooley, Erin Mullane, Colette Chaney, Stanley Riddell, David G. Maloney
Journal: Journal of Clinical Oncology (2018)

TPS79 Background: CAR-T cells have demonstrated marked tumor regression in patients (pts) with hematologic malignancies. ROR1, a tyrosine kinase orphan receptor, is expressed in triple negative breast cancers (TNBC) and non-small cell lung cancers (NSCLC) and is a novel candidate for CAR-T cell therapy. ROR1-specific CAR-T cells are engineered with lentiviral vector encoding ROR1 scFv/4-1BB/CD3ζ and a truncated EGFR molecule to permit elimination of ROR1 CAR-T cells in case of toxicity. Methods: NCT02706362 is a phase I study evaluating the safety and anti-tumor activity of adoptively transferred autologous ROR1 CAR-T cells in pts with advanced ROR1+ TNBC and NSCLC. Eligibility criteria include: metastatic TNBC or NSCLC; measurable disease; prior standard therapy with no maximum on number of prior regimens; tumor ROR1 expression &gt; 20% by IHC; KPS &gt; 70%; age ≥18; negative pregnancy test for women of childbearing potential; informed consent; adequate organ function. Exclusions are: active autoimmune disease or uncontrolled infection, HIV seropositive status, contraindication to cyclophosphamide, anticipated survival &lt; 3 months, and/or untreated CNS metastases. After screening, leukapheresis is performed, CD8+ and CD4+ T cells are selected, then transduced with the ROR1+ CAR lentivirus and expanded. Lymphodepletion with cyclophosphamide and fludarabine is followed 36-96 hours later by infusion of ROR1 CAR-T cells in escalating doses (3.3 x 10 5 /kg - 1 x 10 7 /kg cells with defined CD8+ and CD4+ composition). Pts are treated in cohorts of 2 to determine cell dose associated with an estimated toxicity rate of &lt; 25%. Primary aim is to determine the maximum tolerated dose (MTD) and safety of ex vivo expanded ROR1 CAR-T cells. Secondary aims include persistence and phenotype of transferred T cells, trafficking of T cells to tumor site, in vivo function, and preliminary antitumor activity of ROR1 CAR-T cells by RECIST 1.1. Dose escalation is determined by CRM algorithm with minimum of 21-day interval following infusion between pts. Preliminary estimates of efficacy will be obtained among all pts and those treated at estimated MTD. Six of 30 pts have been enrolled with no DLTs observed. Clinical trial information: NCT02706392.
Diploma in the medical care of catastrophes (DMCC)
Authors: Alexander Kumar
Journal: BMJ (2010)

Conflict and catastrophe medicine is a new and growing subspecialty of medicine that focuses on the study of disasters. This course aims to teach any doctor, nurse, or medical student, from a military or civilian background, the knowledge, skills, attitudes, and insight needed to work safely and ethically as an effective health professional within a low resource setting, or in an environment affected by conflict or catastrophe.

The course faculty has the greatest combined knowledge and experience in disaster management, with respected speakers including Professors Jim Ryan, Alan Hawley, and Tony Redmond and …
IMPACT OF CANCER ON MAJOR BLEEDING AND STROKE IN PATIENTS USING NOVEL ORAL ANTICOAGULANTS
Authors: Takao Sato, Koichi Fuse, Satoshi Fujita, Yoshio Ikeda, Hitoshi Kitazawa, Minoru Takahashi, Masaaki Okabe, Yoshifusa Aizawa
Journal: Journal of the American College of Cardiology (2018)
More NHS hospitals should recruit staff on basis of values, psychologists say
Authors: Matthew Limb
Journal: BMJ (2014)

More NHS hospitals should recruit staff according to their values and should provide “space” for reflective practice, a group of occupational psychologists has said.

The group argued that the NHS culture can be changed to boost staff wellbeing, create safer, patient centred workplaces, and foster coaching and mentoring more widely. The recommendations were included in a report by the British Psychological Society’s public policy group for occupational psychology.1

The report cited evidence of how the NHS can achieve the cultural change and care quality improvements that Robert Francis, Donald Berwick, and others have called for. “The NHS must ensure ‘psychological safety’ among its staff in order to create and sustain cultures of transparency and openness,” it …
Microsurgical skills course
Authors: Jiten B Morarji
Journal: BMJ (2011)

This microsurgical skills course is for doctors intending to specialise in ophthalmic surgery and is a prerequisite for all ophthalmology specialist trainees before they are permitted to perform eye surgery. In addition, the course has recently been opened to foundation year trainees and other medically qualified doctors who wish to pursue a career in ophthalmology.

I did this course in foundation year 1.

Having set my heart on a career in ophthalmology, I wanted to get some surgical experience in the field. Because of the highly specialised nature of the surgery, it is not easy as a junior doctor to get first hand exposure and practice; I felt the course offered such experience. Specifically, I …
Medical academics support wider access to academic foundation programme
Authors: Helen Jaques
Journal: BMJ (2012)

The number of places on the academic foundation programme should be increased, and posts should be made more available to applicants without previous formal research experience, medical academics have agreed.

Delegates at the BMA’s conference of medical academic representatives debated the availability of research opportunities for medical students and supported increasing the opportunities for academic experience within the foundation programme.

The chairman of the BMA’s Northern Ireland medical students committee, Luke Boyle, argued …
GMC is “absolutely committed” to introducing revalidation this year
Authors: Helen Jaques
Journal: BMJ (2012)

The General Medical Council has re-emphasised its commitment to introducing revalidation on schedule at the end of 2012, after the BMA raised concerns about a lack of progress on some issues ( BMJ Careers , 14 Apr, http://careers.bmj.com/careers/advice/view-article.html?id=20007089).

However, the regulator cautioned that it is not aiming for “every single thing to be in place” in time this year and that not all doctors will be expected to revalidate in the first year.

“There’s a sense that we have talked about revalidation for a long time, and everyone is …
Patient safety would be undermined if manslaughter review hampers reflective practice, NHS chief executive says
Authors: Tom Moberly
Journal: BMJ (2018)

Improvements to patient safety in the NHS would be undermined if doctors reflected less on their practice in the wake of the Hadiza Bawa-Garba case, the chief executive of NHS England has said.

Simon Stevens said that it would be a “retrograde” step if reflective practice was “diminished” as a result of the review that is underway in the wake of the case.

In February, England’s health secretary, Jeremy Hunt, announced a review …
Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study
Authors: Aimilia Exarchakou, Bernard Rachet, Aurélien Belot, Camille Maringe, Michel P Coleman
Journal: BMJ (2018)

<h3>Abstract</h3> <h3>Objective</h3> To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England. <h3>Design</h3> Population based cohort study. <h3>Setting</h3> England. <h3>Population</h3> More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013. <h3>Main outcome measures</h3> Age standardised net survival estimates by cancer, sex, year, and deprivation group. These estimates were modelled using regression model with splines to explore changes in the cancer survival trends and in the socioeconomic inequalities in survival. <h3>Results</h3> One year net survival improved steadily from 1996 for 26 of 41 sex-cancer combinations studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers. The deprivation gap observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. The deprivation gap widened notably for brain tumours in men and for lung cancer in women. <h3>Conclusions</h3> Little evidence was found of a direct impact of national cancer strategies on one year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.
Abstract ES9-2: Tracking progesterone receptor actions in breast cancer progression: Jekyll and Hyde
Authors: CA Lange
Journal: Cancer Research (2018)

Abstract Recent work on the actions for progesterone receptors (PRs) in breast cancer has raised the profile of PRs as players rather than simply markers of estrogen (E)-responsive luminal disease. Indeed, estrogen receptors (ERs) and PRs are intimate partners at the genome regulatory level rather than having a simple driver/passenger relationship. PRs alter breast cancer cell proliferation in complex ways and can be either growth inhibitory or stimulatory depending on the cell and hormonal context. Additionally, PRs are important drivers of normal mammary stem cell as well as cancer stem cell expansion. Along with ERs, targeting PRs as part of modernized endocrine therapies may provide a rational treatment alternative for women with ER- and PR-positive breast cancers. However, should PR agonists or antagonists be paired with anti-estrogens or estrogen-ablative therapies and when? This lecture will review historical and current literature on the complex topic of PR action in luminal breast cancer, with focus on key knowledge gaps and future steps that could speed translation of exciting research findings into useful clinical therapeutic applications. Citation Format: Lange CA. Tracking progesterone receptor actions in breast cancer progression: Jekyll and Hyde [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 ES9-2.
Costs of hospital bed and chair sensors include the time of healthcare workers monitoring them
Authors: Giuseppe Vetrugno, Angelico Spagnolo, Fabio De-Giorgio
Journal: BMJ (2018)

We agree with Oliver’s reflections on the coroner’s report about Ken Swift, an elderly inpatient who died because of a fall from a hospital bed.1

Oliver emphasises the uncertainty in published work about the effectiveness of specific technical and organisational measures to prevent falls in frail patients: at best, only 20% of such falls …
Personalized risk stratification for patients with early prostate cancer (PRONTO): A Canadian team biomarker project.
Authors: David Monty Berman, Robert Lesurf, Anna YW Lee, Palak Patel, Tamara Jamaspishvili, Walead Ebrahimizadeh, John Okello, Shaghayegh Rouzbeh, Nadia Boufaied, Laura A Lee, Simone Chevalier, Fadi Brimo, Vasundara Venkateswaran, Paul C Park, Ralph Buttyan, Axel A Thomson, Jacques Lapointe, Paul Christopher Boutros, John Bartlett
Journal: Journal of Clinical Oncology (2018)

109 Background: Current practice stratifies men with prostate cancer into risk groups based primarily on Gleason grade. When applied to biopsy samples, the Gleason grading is inaccurate due to sampling error and inter-observer variation. The result is that men either receive unnecessary surgical treatment, or they don’t receive adequate treatment, leading to worse outcomes. Previously published genomic tests have not successfully distinguished indolent low grade (G6 or GG1) cancers from their more aggressive intermediate grade (G7 or GG2 and 3) counterparts. PRONTO is specifically aimed at creating a multi-modal risk stratification tool to improve treatment stratification following a core biopsy diagnosis. Methods: PRONTO links 7 projects, each with novel diagnostic assays for risk stratification that focus on analysis of copy number variations (CNV), DNA hypermethylation, trans-differentiation, cancer metabolism, or the tumor microenvironment. We merged the best transcripts from each project into a single NanoString gene expression assay, measuring 393 transcripts, in a cohort of 365 cases of radical prostatectomy from low-to-intermediaterisk patients. To minimize sampling error, we took multiple samples, and obtained high grade, low grade and benign areas for each radical prostatectomy case. Results: Our primary goal was to develop a multivariate molecular classifier of grade that distinguished G6 from G7 (3+4 or 4+3). Cases were randomly partitioned into five equally sized groups. A supervised machine learning algorithm (random forests) was trained on samples from four of the groups, and then evaluated by testing on the fifth group. This process was repeated for each of the five groups, yielding a combined clinical and molecular classifier. DNA methylation profiles and CNV profiles are currently being integrated into our classifier Conclusions: We have developed a multivariate classifier that distinguishes low grade from intermediate grade prostate cancer. It will be clinically validated in biopsy samples from large cohorts of early prostate cancer patients.
RCGP certificate in management of drug misuse: part 1
Authors: Emma Clarke
Journal: BMJ (2012)

The course is aimed mainly at general practitioners hoping to improve services for drug users. It is also relevant to any healthcare professionals who come into contact with drug users through their work, such as doctors in hospital based posts, especially in emergency departments and psychiatry.

I completed the course during year 1 of my general practice specialty training; however, it would be relevant at any stage of training.

Throughout my training I have come into contact with substance misusers, but I have never felt confident discussing their drug use with them or prescribing their treatment.

With the aid of case studies, on the course we looked at issues to …
Abstract 2068: Systematic Undersized Rigid Ring Decreases Recurrence Rate Following Repair of Ischemic Mitral Valve
Authors: Raphaël Fontaine, Denis Bouchard, Philippe Demers, Raymond Cartier, Michel Carrier, Louis P Perrault
Journal: Circulation (2007)

Introduction: Chronic ischemic mitral regurgitation (MR) has been associated with poor long-term survival. Suboptimal midterm results have been a growing concern in the surgical community. In recent years, our approach to repair those valves has evolved to a standardized technique using complete, rigid and small annuloplasty rings. This study aims to compare this systematic approach with our prior experience from 1996 –2001 where recurrent MR rate was high. Methods: 129 patients underwent repair for pure ischemic mitral valve regurgitation between 2002 and 2005 at our institution. Of these patients, 99 had clinical and echographic follow-up. These patients were compared to the 1996 –2001 cohort of 73 patients. Results: Preoperatively, 84% of patients were in NYHA class III or IV, 17% had moderate MR, 83% had moderate-severe to severe MR. Sixteen were redo operations, mostly of previous CABG. All patients except one were treated with a complete rigid ring (Annuloflo 46.5%, Physioring 34.9%, Etlogix 13.9%, others 3.8%). Ring size was: 24 (0.8%); 26 (55.8%); 28 (38%); or 30 (4.5%). Mortality was 8.5% at 30 days, 14.7% at 1 year and 17.8% at 2 years. Immediate postoperative regurgitation was absent or trace in all patients. Freedom from reoperation was 97%. Mean postoperative NYHA class was 1.15 at a mean follow-up of 28 months. Recurrent moderate mitral regurgitation (2+) was 15.34%, severe mitral regurgitation (3+ to 4+) was 13.4% at a mean follow-up of 16 months. In the 73 patients from the period 1996 –2001 at the same echo follow-up time, the moderate and severe recurrence were: 37% and 21%. The decrease in the recurrence rate was highly significant (p=0.001). Conclusion: A more standardized approach to ischemic mitral valve repair has improved the high recurrence rate previously reported by our group. Long-term follow-up is necessary to confirm these findings.
Adverse effect of docetaxel versus surveillance after radical prostatectomy for high risk prostate cancer: Post-hoc analysis of the prospective randomized, open-label phase III SPCG 12 trial.
Authors: Goran M. Ahlgren, Michael Borre, Lisa Sengelov, Teuvo L. J. Tammela, Pirkko Kellokumpu-Lehtinen, Asgerdur Sverrisdottir, Jon Reidar Iversen
Journal: Journal of Clinical Oncology (2018)

30 Background: Adjuvant chemotherapy is standard treatment for other solid tumours, but so far has not proven effective in prostate cancer. Methods: Open-label, randomised multinational phase III trial. Enrolment 459 patients after prostatectomy. Inclusion criteria high risk (pT2 margin positive or pT3a Gleason score (GS) ≥4+3, pT3b or lymph node positive disease ≥GS 3+4). Patients assigned (1:1) to either six cycles of adjuvant docetaxel 75mg/m2 every three weeks without daily prednisone (ArmA) or surveillance (Arm B) until endpoint was reached. Primary endpoint was PSA progression ≥0.5ng/ml. Results: Median time to progression, death or last follow up was 56.8 months. Primary endpoint was reached in 190/459 patients (41.4%), 103 of 230 (44.8%) patients in Arm A and 87 (38.0%) of 229 in Arm B. In Kaplan-Myer analysis, there was evidence of non-proportional hazards over time. When 76 patients with PSA &gt; 0.2 after surgery were excluded from the analysis, the outcome showed proportional hazards and favoured surveillance in the KM-analysis (p = 0.02). The significant favour of surveillance remained in a Cox multivariate analysis including Gleason score, pT-stage, surgical margins and lymph node status (p = 0.03). Limitations were that not all patients received docetaxel by protocol, some patients received radiation treatment before end-point and lack of stratification for PSA after surgery. Conclusions: Adjuvant docetaxel without hormonal therapy or continuous corticosteroids may have an adverse effect on biochemical progression in patients with low or undetectable levels of PSA after surgery. Clinical trial information: NCT00376792.
Coronary Computed Tomographic Angiography and Potential for Overtreatment
Authors: Konstantinos Tsarpalis
Journal: JAMA Internal Medicine (2018)

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Starting a long journey
Authors: Tom Moberly, editor, BMJ Careers
Journal: BMJ (2014)

Many doctors will vividly remember their first day working as a medical practitioner. These same doctors may now find themselves struggling to reconcile the optimism they felt on that day with their less benign feelings towards the current working environment in the health service. These contrasting perspectives are considered in two articles in this week’s BMJ Careers.

Will Sapwell shares his …