tbuckley/cabot-search huggingface dataset:
Quarter of UK hospitals have full time vacancies for stroke consultants, study finds
Authors: Abi Rimmer
Journal: BMJ (2014)

A quarter of UK hospitals currently have full time vacancies for stroke consultants, and there are not enough trainee doctors to fill them, a report published by the Sentinel Stroke National Audit Programme has found.

The audit report, which was prepared by the Royal College of Physicians, said that there were “considerable concerns about the consultant stroke physician workforce.”1 It said that one in four of the 301 hospitals that took part in …
Women doctors are to be helped towards top roles by NHS Leadership Academy
Authors: Ingrid Torjesen
Journal: BMJ (2012)

The NHS Leadership Academy has pledged to launch a formal strategy to tackle the dearth of women doctors in leadership roles in the health service.

Although women have made up around 60% of entrants to medical school for more than two decades, relatively few achieve leadership positions at board level in NHS organisations, and a similar pattern is being seen in the emerging clinical commissioning groups (CCGs).

The academy, which was launched last year and will be fully operational from April ( BMJ Careers , 12 Jul …
National Assembly committee calls for action on “excessive” hours for Welsh consultants
Authors: Helen Jaques
Journal: BMJ (2013)

The Welsh government and local health boards in Wales must take action to reduce the “excessive” hours worked by consultants in the country, the National Assembly’s Public Accounts Committee has said.

The committee also called on the Welsh government to develop guidance on job planning for consultants, which it says is often viewed as a “tick box exercise,” and on objectives of supporting professional activities (SPAs) time.

In February, the auditor general for Wales published a review of whether the 2003 contract for consultants in Wales had achieved its intended benefits.1 The review reported that, although £35m (€42m; $55m) was spent on implementing the new …
Doctors must do more to curb impact of medical myths on practice
Authors: Matthew Limb
Journal: BMJ (2013)

Doctors should do more to curb the effects on trainees’ practice of “medical myths” that can be mistaken for facts as they are passed on, US researchers have said.

A team led by Elinore Kaufman, from New York Presbyterian Hospital’s department of surgery, have warned about the telling of “horror stories” of past errors or adverse outcomes.

These stories lodge in the mind as inherited wisdom, they believe. Gaps in evidence based medicine are filled by tradition, common …
COMPREHENSIVE STRUCTURAL AND FUNCTIONAL ASSESSMENT FOR PREDICTION OF LEFT VENTRICULAR REVERSE REMODELING IN NON-ISCHEMIC CARDIOMYOPATHY
Authors: Marco Merlo, Marco Masè, Giancarlo Vitrella, Manuel Belgrano, Giorgio Faganello, Marco Gobbo, Marta Gigli, Alessandro Altinier, Pierluigi Lesizza, Giulia Barbati, Federica Ramani, Antonio De Luca, Gaetano Morea, Maria Assunta Cova, Davide Stolfo, Gianfranco Sinagra
Journal: Journal of the American College of Cardiology (2018)
Combination of bemcentinib (BGB324): A first-in-class selective oral AXL inhibitor, with pembrolizumab in patients with triple negative breast cancer and adenocarcinoma of the lung.
Authors: Murray Yule, Kjersti Davidsen, Magnus Bloe, Linn Hodneland, Agnete Engelsen, Maria Lie, Sebastien Bougnaud, Stacey D'Mello, Kristina Aguilera, Lavina Ahmed, Agata Rybika, Eline Milde Naeval, Anna Boniecka, Jean Paul Thiery, Salem Chouaib, Rolf A. Brekken, Gro Gausdal, James Lorens
Journal: Journal of Clinical Oncology (2018)

TPS43 Background: Activation of the receptor tyrosine kinase AXL has a profound suppressive effect on the innate immune system. AXL is overexpressed on multiple cell types in the tumour immune microenvironment including dendritic cells, NK cells and tumour-associated macrophages. AXL signalling in immune cells supports tumour immune escape by downregulating dendritic cell activity, modulating efferocytosis as well as favouring an immunosuppressive chemokine profile and M-MDSC expansion. AXL is prevalent in tumours resistant to anti-PD-1 therapy (Hugo, 2016). Axl expression in tumour cells confers resistance to effector T cell cytotoxicity. Bemcentinib (BGB324) is a first-in-class, highly selective and orally bioavailable small molecule AXL inhibitor in phase II clinical development. In pre-clinical models of pancreas, breast and lung cancer, inhibition of AXL signalling with bemcentinib reversed multiple tumour immune suppressive mechanisms as evidenced by increased infiltration of cytotoxic T lymphocytes, NK and NKT cells and decreased infiltration of M-MDSCs (Wnuk-Lipinska, 2017). Bemcentinib enhanced the effect of immune checkpoint blockade via PD-1 or CTLA-4 in lung and mammary adenocarcinoma mouse models and achieved sustained tumour immunity. Methods: BGBC007 (NCT03184558) and BGBC008 (NCT03184571) are open-label, phase II studies designed to assess the anti-tumour activity of bemcentinib in combination with pembrolizumab in patients with previously treated TNBC and adenocarcinoma of the lung respectively. All patients will be treated with bemcentinib in combination with pembrolizumab continuously for up to two years. The primary endpoint is objective response rate, secondary endpoints include duration of response, progression free survival according to RECIST 1.1, pharmacokinetics, safety and tolerability. Pretreatment tumour specimens are scheduled to assess AXL expression/signalling and PD-L1 expression; the levels of circulating immune-related cytokines and soluble AXL receptor will also be measured in longitudinal patient plasma samples. Both studies are open to recruitment. Clinical trial information: NCT03184558.
Nivolumab monotherapy in metastatic urothelial carcinoma: Longer-term efficacy and safety results from the CheckMate 032 study.
Authors: Padmanee Sharma, Margaret K. Callahan, Petri Bono, Joseph W. Kim, Pavlina Spiliopoulou, Emiliano Calvo, Rathi Narayana Pillai, Patrick Alexander Ott, Filippo G. De Braud, Michael Morse, Dung T Le, Matthew H. Taylor, Johanna C. Bendell, Dirk Jäger, David D. Chism, Scott Joseph Antonia, Nivedita Aanur, Lingfeng Yang, Jonathan E. Rosenberg
Journal: Journal of Clinical Oncology (2018)

414 Background: Nivolumab has shown efficacy and acceptable safety in 2 open-label, multicenter studies (CheckMate 032 and 275) and is approved for patients (pts) with metastatic urothelial carcinoma (mUC) after ≥1 platinum-based therapy. Here we report longer-term efficacy and safety results for pts with mUC in the phase 1/2 CheckMate 032 study who received nivolumab monotherapy based on &gt; 2 years of follow-up. Methods: Pts with mUC, regardless of programmed death-1 ligand 1 (PD-L1) expression status, received nivolumab 3 mg/kg intravenously every 2 weeks until progression or discontinuation. Tumor PD-L1 membrane expression was assessed with Dako PD-L1 immunohistochemical staining. Primary endpoint: objective response rate (ORR; RECIST 1.1); other endpoints: safety, progression-free survival (PFS), overall survival (OS), and duration of response. Results: Of 78 treated pts (median age 65.5 years; range, 31-85), 52 (66.7%) had received ≥2 prior therapies. At a minimum follow-up of 24 months, 11 pts (14.1%) remain on treatment. Treatment discontinuation was mainly due to disease progression (52 pts [66.7%]). Tumor PD-L1 expression was evaluable in 68 pts (87.2%); 26 (38.2%) pts had ≥1% and 42 (61.8%) had &lt; 1% expression. The table shows overall efficacy. Updated ORR was 25.6%, with 1 additional complete response (CR) achieved for a CR rate of 8%. Median duration of response was not reached. ORR, 1- and 2-year PFS and OS rates were similar between the PD-L1 &lt; 1% and &gt; 1% subsets. Grade 3 or 4 treatment-related adverse events (TRAEs) occurred in 22 pts (28.2%); most frequent were ↑lipase (6.4%), ↑amylase (5.1%), and maculopapular rash (3.8%). One pt had a grade 5 TRAE (pneumonitis). Conclusions: Nivolumab showed clinically meaningful, durable efficacy with promising long-term survival regardless of PD-L1 expression, and no new toxicity signals with longer-term follow-up in previously treated pts with mUC. Clinical trial information: NCT01928394. [Table: see text]
3D PRINTING FOR PREOPERATIVE PLANNING AND SURGICAL SIMULATION OF VAD IMPLANTATION IN A FAILING RIGHT SYSTEMIC VENTRICLE
Authors: Jacob Miller, Joseph Billadello, Rachel Simon-Lee, Monica Sharma, Gautam Singh, Pamela Woodard, Pirooz Eghtesady, Shafkat Anwar
Journal: Journal of the American College of Cardiology (2018)
MACHINE LEARNING MODELS TO PREDICT IN-HOSPITAL MORTALITY FOR ST-ELEVATION MYOCARDIAL INFARCTION: FROM CHINA ACUTE MYOCARDIAL INFARCTION (CAMI) REGISTRY
Authors: Jingang Yang, Xiang Li, Tiange Chen, Yingxue Li, Guotong Xie, YueJin Yang
Journal: Journal of the American College of Cardiology (2018)
Determining If Rest Is Best After Concussion
Authors: Christopher C. Giza, Meeryo C. Choe, Karen M. Barlow
Journal: JAMA Neurology (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Neurology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Neurology journal
Trajectories of Blood Pressure Elevation Preceding Hypertension Onset
Authors: Teemu J. Niiranen, Mir Henglin, Brian Claggett, Vito M. R. Muggeo, Elizabeth McCabe, Mohit Jain, Ramachandran S. Vasan, Martin G. Larson, Susan Cheng
Journal: JAMA Cardiology (2018)

<h3>Importance</h3> Given that hypertension remains a leading risk factor for chronic disease globally, there are substantial ongoing efforts to define the optimal range of blood pressure (BP). <h3>Objective</h3> To identify a common threshold level above which BP rise tends to accelerate in progression toward hypertension. <h3>Design, Setting, and Participants</h3> This longitudinal, community-based epidemiological cohort study of adults enrolled in Framingham, Massachusetts, included 1252 participants (mean [SD] age, 35.3 [2.7] years) from the Framingham Original Cohort, of whom 790 (63.1%) were women. Each participant contributed up to 28 serial examinations of standardized resting BP measurements between 1948 and 2005. <h3>Exposures</h3> Age and systolic BP. <h3>Main Outcomes and Measures</h3> Via a segmented mixed model, we identified significant change points in the association between advancing age and increasing systolic BP among individuals categorized by their age at hypertension onset. <h3>Results</h3> Individuals maintained a relatively stable resting systolic BP level prior to hypertension onset. Systolic BP level began to rise at a more rapid rate after reaching a level of 123.2 mm Hg (95% CI, 122.7-130.1 mm Hg) in people with onset at 40 to 49 years; 122.0 mm Hg (95% CI, 120.3-123.9 mm Hg) in those with onset between 50 and 59 years, 124.9 mm Hg (95% CI, 120.2-127.9 mm Hg) in those with onset between 60 and 69 years, and 120.5 mm Hg (95% CI, 118.0-123.2 mm Hg) in those with onset between 70 and 79 years (<i>P</i> = .29 for between-group heterogeneity). <h3>Conclusions and Relevance</h3> We observed that individuals in the community generally maintained a systolic BP of less than 120 to 125 mm Hg, above which systolic BP increased at a relatively rapid rate toward overt hypertension. This trend was consistent whether the hypertension manifested earlier or later in life. Thus, a resting systolic BP that chronically exceeds the range of approximately 120 to 125 mm Hg may represent an important threshold of underlying vascular remodeling and signal incipient hypertension irrespective of age. Further investigations are needed to unravel the sequence of hemodynamic and vascular changes occurring prior to hypertension onset.
Becoming a foundation year 1 doctor in August 2008?
Authors: Priya Desai
Journal: BMJ (2008)

It’s a cliche but also very true: the year ahead will be a huge rollercoaster of emotions and experiences. You may begin to doubt this if you’ve been left with unbanded jobs and few on-calls but it will still be one heck of an experience. No other occupation involves the highs and lows and the number of times a serious career change is considered as a career in medicine. That is even after just one year.

Having emerged from an unbanded, though fairly busy 9-5-ish medical house officer job, I moved through a very busy surgical rotation with on-call commitments and am currently doing an interesting yet laid back psychiatry post. The first few weeks of every job are the hardest. While trying to get your head around different policies, the mind numbing rotas, and trying to ensure you get paid, thoughts often fill your mind—“Will my team like me?” “Will the nursing staff make my life a misery?” “Will I look like a fool …
Passion and Determination Are the Genesis of Research
Authors: Suet Nee Chen
Journal: Circulation Research (2018)

Research Intertwines With Personal LifeOne summer, at age 30, I decided to become a certified open water scuba diver.By this time, my eyesight had progressed to -19 D and walking around on land without my glasses was akin to diving without a face mask.A poor eyesight is a serious problem for divers because underwater
Amplitude-modulated radiofrequency electromagnetic fields target hepatocellular carcinoma stem cells through activation of Cav 3.2 T-type calcium channels.
Authors: Hugo Jimenez, Minghui Wang, Jacquelyn W. Zimmerman, Michael J. Pennison, Sambad Sharma, Ivan Brezovich, Devin Absher, Richard M Myers, Barry R. DeYoung, David Caudell, Dwayne Godwin, Anand Ghanekar, Lance D Miller, Myles Capstick, Niels Kuster, Ralph D'Agostino, Alexandre Barbault, Kounosuke Watabe, Carl F Blackman, Boris Pasche
Journal: Journal of Clinical Oncology (2018)

332 Background: Amplitude-modulated 27.12 MHz radiofrequency electromagnetic fields (AM RF EMF) delivered via a spoon-shaped antenna placed on the patient’s tongue result in shrinkage of the primary and metastatic tumors in patients with advanced hepatocellular carcinoma (HCC). (Costa FP, et al. Br J Cancer. 2011;105:640-648.) The mechanism by which AM RF EMF have direct antiproliferative effect and disruption of the mitotic spindle on cancer cells is largely unknown. (Zimmerman JW, et al. Br J Cancer. 2012;106:307-313.) Methods: We assessed the Specific Absorption Rate (SAR) level and distribution inside the human body. In vitro experiments with HCC cells were performed as previously described (Zimmerman). Immunodeficient mice were subcutaneously implanted with Huh-7 HCC cells or patient-derived xenografts (PDX). Mice were exposed to HCC-specific AM RF EMF using systems replicating human exposure levels and treatment duration. Tumor samples were examined for EMT and cell cycle markers. Results: Intrabuccal delivery results in whole-body absorption of AM RF EMF. Proliferation of hepatitis B positive and negative cell lines as well as HCC cancer stem cells (CSCs) are blocked by AM RF EMF through Cav 3.2 T-type voltage gated calcium channels (VGCC). Proliferation of HCC is inhibited in vivo and tumor shrinkage occurs by dedifferentiation of HCC cells into quiescent myofibroblasts while the growth of intestinal and blood marrow cells is unaltered. Conclusions: Whole-body SAR ranges from 0.2 to 1 mW/kg and is significantly below the international safety limits for human exposure. Intrabucally-administered AM RF EMF is a novel targeted therapy for systemic treatment of advanced HCC with minimal off target effects. Inhibition of HCC CSCs may explain the extremely long term survival (&gt;5 years) of several patients with advanced HCC.
A randomized phase II clinical trial of gemcitabine, oxaliplatin, erlotinib combination chemotherapy versus gemcitabine and erlotinib in previously untreated patients with locally advanced or metastatic pancreatic cancer.
Authors: Sung Hee Lim, Jina Yun, Min-Young Lee, Han Jo Kim, Kyoung Ha Kim, Se Hyung Kim, Sang-Cheol Lee, Sang Byung Bae, Chan Kyu Kim, Namsu Lee, Kyu Taek Lee, Sung Kyu Park, Dae Sik Hong, Hyun Jong Choi, Jong Ho Moon
Journal: Journal of Clinical Oncology (2018)

344 Background: Erlotinib is the only targeted agent in combination with gemcitabine showing significantly improved outcomes in pancreatic cancer. Although combining platinum agent with gemcitabine has not provided clear survival benefit over gemcitabine alone, gemcitabine plus platinum resulted in improved response rate and progression-free survival (PFS). We tried to evaluate whether the addition of oxaliplatin to gemcitabine/erlotinib confers a clinical benefit to patients with locally advanced or metastatic pancreatic cancer. Methods: Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned to receive GEMOX-T (gemcitabine 1000mg/m 2 IV and oxaliplatin 50mg/m 2 IV on day 1, 8 plus erlotinib 100mg daily, every 3weeks) or GT (gemcitabine 1000mg/m 2 IV on day 1, 8 plus erlotinib 100mg daily, every 3weeks). The primary endpoint was overall response and secondary endpoints included PFS, overall survival (OS) and toxicity. Results: Between May 2013 and April 2016, 65 patients were randomly assigned to treatment group (33 in GEMOX-T arm, 32 in GT arm). The median age of all patients was 61 years (range, 41-76) and about 80% of patients had metastatic disease. The overall response rate was 18.2 % in GEMOX-T arm and 6.2% in GT arm ( P = 0.051). The disease control rate was significantly superior in GEMOX-T arm compared to GT arm (72.7% vs. 43.8%, P = 0.019), with 1 patient in GEMOX-T group continuing the treatment with stable disease. After a median follow up of 19.7 months, there was significant difference in PFS: the median PFS were 3.9 months for GEMOX-T arm and 1.4 months for GT arm (Hazard ratio: 0.58, 95% CI 0.35-0.96, P = 0.037). However, it did not translate to improvement of OS (median OS; 6.2 m for GEMOX-T arm, 5.1 m for GT arm, P = 0.118). The most common grade ≥ 3 hematologic adverse events were neutropenia (16.9%) and anemia (13.8%). Conclusions: The addition of oxaliplatin to 1 st line gemcitabine/erlotinib regimen demonstrated higher response rate and significantly improved PFS in patients with locally advanced or metastatic pancreatic cancer.
More consultants opt for early retirement as dissatisfaction with NHS grows
Authors: Helen Jaques
Journal: BMJ (2011)

The number of consultants taking voluntary early retirement in 2011 has shot up by nearly three quarters from the 2010 figure, new data from the NHS Business Services Authority’s pensions division show.

Voluntary early retirements before the age of 60 have risen by 72% in the past year, from 98 in 2010 to 169 in 2011—the first time in the five years of data available that the figure exceeded 100. Over this period the proportion of retiring consultants each year who took retirement early has almost doubled from 7.3% in 2006 to 14% in 2011.

This high rate of voluntary early retirement reflects the growing dissatisfaction among consultants with the changes under way in the NHS, says the BMA. Several …
Facial Displays Are Tools for Social Influence
Authors: Carlos Crivelli, Alan J. Fridlund
Journal: Trends in Cognitive Sciences (2018)

Based on modern theories of signal evolution and animal communication, the behavioral ecology view of facial displays (BECV) reconceives our 'facial expressions of emotion' as social tools that serve as lead signs to contingent action in social negotiation. BECV offers an externalist, functionalist view of facial displays that is not bound to Western conceptions about either expressions or emotions. It easily accommodates recent findings of diversity in facial displays, their public context-dependency, and the curious but common occurrence of solitary facial behavior. Finally, BECV restores continuity of human facial behavior research with modern functional accounts of non-human communication, and provides a non-mentalistic account of facial displays well-suited to new developments in artificial intelligence and social robotics.
Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department
Authors: Dustin G. Mark, Jie Huang, Uli Chettipally, Mamata V. Kene, Megan L. Anderson, Erik P. Hess, Dustin W. Ballard, David R. Vinson, Mary E. Reed
Journal: Journal of the American College of Cardiology (2018)
Low prevalence of fluoroquinolone resistance among patients with tuberculosis in the Philippines: results of a national survey
Authors: Dodge R. Lim, Anna S. Dean, Mary Rosary Taguinod-Santiago, Angeli Borbe-Reyes, Andrea Maurizio Cabibbe, Matteo Zignol, Ramon P. Basilio, Anna Marie Celina Garfin, Maria Cecilia G. Ama
Journal: European Respiratory Journal (2018)

Antimicrobial resistance (AMR) represents a global threat to public health and security. Misuse of antibiotics is the leading cause of AMR worldwide. Infections that are typically easily treatable can become life-threatening or even deadly. Multidrug-resistant (MDR) tuberculosis (TB) (defined as resistance to at least rifampicin and isoniazid, the two most powerful first-line anti-TB drugs) and extensively drug-resistant (XDR)-TB (defined as MDR-TB with additional resistance to any fluoroquinolone and a second-line injectable (SLI) agent) are forms of TB that are complex to treat, require longer and more toxic regimens [1], and have considerably worse prognosis and outcome [2, 3]. Resistance to anti-TB drugs poses a major challenge to ending the global TB epidemic by 2030 [4]. To estimate the burden of drug-resistant TB, and plan diagnostic and treatment services, surveillance of drug resistance among TB patients has been conducted worldwide since the 1990s [5]. Prevalence of fluoroquinolone resistance among Filipino TB patients is lower than in other countries in the region <http://ow.ly/7ywW30ix74W>
Simulation training can teach emergency medicine doctors about situational awareness
Authors: Anne Gulland
Journal: BMJ (2016)

Simulation training was one of the best ways to teach emergency medicine doctors situational awareness, researchers have said.1

The researchers said that it was a core non-technical skill and should be an important part of the medical curriculum. Situational awareness is the ability to gather information, recognise and understand the situation, and anticipate future problems and scenarios.

The authors of the paper said that learning situational awareness was “particularly challenging in the often chaotic, dynamic, and information poor environment” of the emergency department. “Simulation based education provides a safe environment to evaluate and develop a clinician’s situational awareness,” they said.

Simulated exercises should incorporate perception, comprehension, and projection—giving …