tbuckley/cabot-search huggingface dataset:
GP launches online campaign to promote general practice asking #whyGP
Authors: Abi Rimmer
Journal: BMJ (2015)

A GP has launched an online campaign to highlight the positive aspects of a career in general practice.

Dominic Patterson, a GP and deputy director for postgraduate GP education in Yorkshire and the Humber, has launched the hashtag #whyGP on Twitter and the WhyGP website (http://whygp.uk), to encourage more junior doctors to enter the profession.

Speaking to BMJ Careers, Patterson said that he launched the campaign after seeing the Royal College of General Practitioners’ recruitment video (www.rcgp.org.uk/policy/future-gp.aspx), which he thought failed to connect with its intended audience. He said, “There were lots of trainees …
Cardiovascular comorbidities in German prostate cancer patients under androgen deprivation therapy: Results from a retrospective analysis of patient data in urological outpatient centers.
Authors: Andreas Eisenhardt, Sebastian Vosgerau, Michael Gedamke, Tim Schneider
Journal: Journal of Clinical Oncology (2018)

339 Background: Androgen deprivation therapy (ADT) with LHRH agonists leuprolide/goserelin compared to GnRH antagonists has been associated with higher risk for cardiovascular (CV) disease in patients with hormone-sensitive prostate carcinoma (hsPCa). Real life data from German PCa-patients with CV disease treated with ADT are lacking. Our study aimed to analyze occurrence of comorbidities with a focus on CV disease in hsPCa-patients treated with ADT. Methods: HsPCa-patients with initiation of ADT (1999–2014) and an ADT duration of a minimum of 12 months were included. Data were collected retrospectively from medical records and documented in a standardized electronic case report form by three German urological outpatient centers. Primary outcomes of interest were frequency of CV disease and hospitalization due to CV events. Descriptive statistics were performed. An ethics committee approval was obtained from Ärztekammer Nordrhein. Results: Data from 753 patients were evaluated. The mean and median age of patients was 75.4 years and 77 years. 556 patients were treated with a LHRH agonist, 59 with an antiandrogen, 132 with a LHRH agonist and an antiandrogen and 6 with a GnRH antagonist. CV disease was the most common comorbidity (241 patients), also when patients with hypertension as the sole CV comorbidity were disregarded (111 patients). 44 patients were hospitalized due to a CV event during or subsequently to an ADT. Of these, 27 patients initiated ADT with pre-existing CV disease. Overall, 21 patients were hospitalized due to myocardial infarction or stroke. Conclusions: Our results show CV disease as the most common comorbidity in German hsPCa-patients, yet our methods could be underestimating CV disease in this interdisciplinary field. Before initiating an ADT, the patient's CV risk profile should therefore be evaluated carefully. The literature suggests that different ADT types are associated with different CV risk, thus the choice of ADT should be considered to reduce the risk of additional CV events. Besides cost savings to health care systems, patients gain quality of life through prevented CV events.
Education and training levy could vary by provider, says chairwoman of Future Forum subgroup
Authors: Helen Jaques
Journal: BMJ (2012)

The planned education and training levy, designed to ensure that all organisations that benefit from employing publicly trained doctors pay back into the public purse, could potentially differentiate between large private healthcare providers and smaller not for profit groups such as charities and social enterprises, Julie Moore, chairwoman of the NHS Future Forum’s education and training group, has told MPs.

The levy, which is part of the government’s plans to put medical education and training in the hands of employers, could otherwise prevent charities and social enterprises from providing NHS services, Ms Moore told the House of Commons select committee on …
Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in Asian Practice: Perspectives for Surgical Pathology and Cytopathology
Authors: Andrey Bychkov, Chan Kwon Jung, Zhiyan Liu, Kennichi Kakudo
Journal: Endocrine Pathology (2018)

The introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was initiated and promoted by pathologists. Recent Asian studies added new knowledge to the existing literature to aid a better understanding of NIFTP. Our original data and the results of a meta-analysis suggest that the initial rate of NIFTP has been overestimated, averaging 9.1% (95% confidence interval [CI] 6.0–12.7%) of all papillary thyroid cancers worldwide. The incidence of NIFTP in the Asian population (1.6%, 95% CI 0.9–2.5%; 7 studies) is significantly lower than that reported in the non-Asian series (13.3%, 95% CI 9.0–18.3%; 18 studies). Such difference could be attributed to various perceptions of histological diagnostic thresholds, different nature of papillary thyroid carcinoma, and different approaches in the management of thyroid nodules. The active surveillance for indeterminate nodules and NIFTP, largely represented in the indeterminate cytologic categories, promoted by Japanese institutions establishes a new paradigm to reduce overtreatment of these patients. The lower prevalence of NIFTP in the Asian series indicates a low impact on the risk of malignancy in cytopathology, as it was demonstrated in our original multi-institutional cohort of thyroid nodules, and may predict a low impact on the performance of commercial molecular tests. Several Korean studies addressed the issue of BRAF mutation in NIFTP, which prompted the current refinement of the diagnostic criteria for NIFTP. Our survey of Asian pathologists found that the term NIFTP has not been universally adopted in the local practice. Endocrine pathologists must promote the new entity through provision of educational activities.
Method of diagnosis of pancreatic adenocarcinoma: A Nova Scotia experience.
Authors: Caitlin Lees, Wilma M Hopman, Tallal Younis, Nathan William Dana Lamond, Ravi Ramjeesingh
Journal: Journal of Clinical Oncology (2018)

252 Background: The gold standard for the diagnosis of pancreatic adenocarcinoma involves pathologic confirmation, as identified in consensus guidelines. Little is known about the care of patients with pancreatic cancer in Nova Scotia. This retrospective study intends to clarify the methods utilized in Nova Scotia to diagnose pancreatic adenocarcinoma and identify variables associated with pathologic confirmation of diagnosis. Methods: A provincial database, involving patients diagnosed with unresectable pancreatic adenocarcinoma between January 1, 2011 and December 31, 2014, was created as identified by the surveillance and epidemiology unit of the program of care for cancer. Pearson chi-square was used to determine significant differences between groups and logistic regression was used to identify those variables associated with a specific pathologic diagnosis. Results: Of the 264 patients identified, most were diagnosed by a combination of imaging and an elevated CA 19-9 level (n = 120, 45.5%) and 24.2% (n = 64) by imaging alone. Significant predictors of diagnosis by imaging alone included i) age 65 or more vs less than 65 (n = 55, 31.3% vs n = 9, 10.2%; p = 0.001), and ii) living in areas served by community hospitals (rather than a tertiary care centre) (n = 46, 28.6% vs n = 18, 17.5%; p = 0.014). A pathologic diagnosis was attempted (non-diagnostic or positive) in 40.2% of patients (n = 106), and a pathologic diagnosis was actually obtained in 30.3% of patients (n = 80). Patients were significantly less likely to have an attempted pathologic diagnosis if they were over 65 (OR = 1.95, 95% CI 1.13 – 3.38), female (OR = 1.78, 95% CI 1.05 – 3.01), or resided in a community with a tertiary care centre (OR = 2.02, 95% CI = 1.17 – 3.49). Conclusions: A significant majority of patients in Nova Scotia were diagnosed with pancreatic adenocarcinoma without pathological confirmation, and nearly a quarter of these patients were diagnosed on the basis of imaging alone. The lack of pathologic diagnosis does not conform to consensus guidelines of management of pancreatic cancer and suggests that more work needs to be done to improve care for these patients.
I am an overseas graduate working as a senior house officer in medicine. What rights do I have in terms of claiming family accommodation from my employer when they don't have any available?
Authors: John Adsett
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.
REDUCTION IN LEFT VENTRICULAR OUTFLOW TRACT GRADIENT WITH MAVACAMTEN (MYK-461) IN SYMPTOMATIC OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY PATIENTS (PIONEER-HCM)
Authors: Daniel Jacoby, Steven Lester, Anjali Owens, Andrew Wang, Don Young, Radhika Tripuraneni, Marc Semigran, Stephen Heitner
Journal: Journal of the American College of Cardiology (2018)
EXCESS NATIONAL US EXPENDITURES ASSOCIATED WITH LIPITOR USE AFTER INTRODUCTION OF GENERIC ATORVASTATIN: INSIGHTS FROM THE MEDICAL EXPENDITURES PANEL SURVEY, 2012-2014
Authors: Haider Warraich, Joseph Salami, Rohan Khera, Victor Okunrintemi, Khurram Nasir
Journal: Journal of the American College of Cardiology (2018)
Abstract P5-07-13: MicroRNA-mediated restoration of tamoxifen sensitivity in triple negative breast cancer through modulation of estrogen receptor alpha/beta ratio using <i>Myrothamnus flabellifolius</i>
Authors: N Fultang, Z Klase, I Mercier, B Peethambaran
Journal: Cancer Research (2018)

Abstract Triple negative breast cancer (TNBC) represents approximately 20% of all breast cancer cases worldwide. Prognosis for this subtype of cancer is especially dire due to the absence of Estrogen (ER), Progesterone and Human Epidermal Growth Factor receptors, usually targeted by neoadjuvant therapies like Tamoxifen. Myrothamnus flabellifolius (MF), a well-studied South African medicinal herb, has shown significant potency against TNBC with minimal effect on normal cells. In this study, we use miRNA profiling, Ingenuity Pathway Analysis (Qiagen), MTT, immunoblots and immunofluorescence to characterize the targeted cytotoxic mechanism of MF in TNBC. We found deregulation in the expression of several oncogenic and anti-cancer miRNAs in TNBC post MF treatment. Using Ingenuity Pathway Analysis to analyze the miRNA expression profiles of the treated cells, we determined Estrogen Signaling as a pathway significantly affected by MF in TNBC. Immunoblots confirmed increase of the ERa/ERß ratio in TNBC, a well-studied marker for Tamoxifen-therapy sensitivity in TNBC. MTT cell viability assay and Annexin V staining confirmed increased sensitivity to Tamoxifen post treatment with low doses of MF, with up to 70% cell death at half the IC50 of Tamoxifen in TNBC. This study establishes a potential non-toxic therapeutic to supplement Estrogen-receptor targeting therapies in TNBC by increasing the ERa/ERß ratio. The data also evaluates the ERa/ERß ratio as a potential target for combination therapies in TNBC. Citation Format: Fultang N, Klase Z, Mercier I, Peethambaran B. MicroRNA-mediated restoration of tamoxifen sensitivity in triple negative breast cancer through modulation of estrogen receptor alpha/beta ratio using Myrothamnus flabellifolius [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 P5-07-13.
Rac1 is a novel therapeutic target in mantle cell lymphoma
Authors: Tian Tian, Chengfeng Bi, Ashley L. Hein, Xuan Zhang, Cheng Wang, Songfei Shen, Ji Yuan, Timothy C. Greiner, Charles Enke, Julie Vose, Ying Yan, Kai Fu
Journal: Blood Cancer Journal (2018)

Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma, comprising 6-8% of human B-cell non-Hodgkin lymphomas 1 .R-CHOP, which combines rituximab with cyclophosphamide, hydroxydaunorubicin (Doxorubicin/Adriamycin), oncovin (Vincristine) and prednisone, is the most common regimen employed for treating MCL.Nevertheless, most patients are destined to relapse after initial therapy 2 , highlighting the urgent need for new therapeutic strategies.Here, we explore a member of Rac family of small guanosine triphosphatases (GTPase), Rac1, as novel target for MCL treatment.Rac family proteins cycle between active GTP-bound and inactive GDP-bound states.Studies have shown that Rac1 plays a critical role in a variety of cellular responses, including cell proliferation and survival, gene transcription, adhesion, motility and forming of the actin cytoskeleton 3 .Overexpression of Rac1 has been reported in several types of solid tumors, including breast cancer and pancreatic cancer 4,5 .In hematological malignancies, studies have shown that Rac1 GTPase activated by BCR-ABL represented a novel target in chronic myeloid leukemia.Additionally, Rac1 inhibition delays the development of acute leukemia in a murine model in vivo 6 .However, the role of Rac1 in lymphoma thus far has not been clearly defined.Rac1-GTP interacts with multiple effectors and activates numerous downstream signaling pathways such as PI3K/Akt, AMPK and ERK pathways 7 .Among them, the Akt signaling is one of the most commonly deregulated oncogenic pathways in MCL.Constitutive activation of
Abstract 21015: Coronary Inflammation in Humans Drives Spatial Changes of Perivascular Adipose Tissue Composition Detectable by a Novel Computed Tomography-Based Technology
Authors: Alexios S Antonopoulos, Evangelos K Oikonomou, Fabio Sanna, Nikant Sabharwal, Sheena Thomas, Laura Herdman, Marios Margaritis, Cheerag Shirodaria, Anna-Maria Kampoli, Ioannis Akoumianakis, Mario Petrou, Rana Sayeed, George Krasopoulos, Constantinos Psarros, Patricia Ciccone, Carl M Brophy, Janet Digby, Andrew Kelion, Raman Uberoi, Suzan Anthony, Nikolaos Alexopoulos, Dimitris Tousoulis, Stephan Achenbach, Stefan Neubauer, Keith M Channon, Charalambos Antoniades
Journal: Circulation (2017)

Background: Non-invasive detection of vascular inflammation remains an unmet goal. We hypothesized that phenotypic changes in perivascular adipose tissue (PVAT) induced by vascular inflammation can be quantified using a new computed tomography angiography (CTA) methodology. Methods: In Arm 1, human PVAT adipocytes were cultured +/- inflammatory cytokines (n=7) or co-cultured with vascular tissue (+/-Angiotensin-II, n=6) to assess the effects of vascular inflammation on PVAT differentiation. In Arm 2, AT explants (epicardial, subcutaneous and thoracic AT) from 453 cardiac surgery patients were used in histology and gene expression studies to relate the ex vivo images with in vivo CT scan information (n=105) on the biology of the explants. In Arm 3, in 267 patients undergoing diagnostic CTA, PVAT attenuation (Fat Attenuation Index (FAI) defined as the average CT attenuation of AT), was analysed around the proximal right coronary artery. In Arm 4, PVAT FAI around unstable (culprit) and stable coronary plaques was calculated in 22 CAD patients undergoing CTA. Results: In Arm 1, Angiotensin-II (A) and proinflammatory cytokines (B) prevented lipid accumulation and adipocyte differentiation in cultured PVAT. In Arm 2, adipocyte size by histology was inversely correlated with FAI in vivo (C). Both FAI of AT explants (not shown) and FAI in-vivo (n=105) were negatively associated with epicardial AT differentiation as assessed by FABP4 expression (D). In Arm 3, PVAT FAI change over distance from RCA wall was significantly different in CAD compared to no CAD patients (E). In Arm 4, PVAT FAI was significantly increased around unstable plaques (F). Conclusions: Human vessels exert paracrine effects on surrounding PVAT, affecting local intracellular lipid accumulation in preadipocytes, which can then be monitored using a CT imaging approach. This novel methodology can be implemented in clinical practice to detect unstable plaques in the human coronary vasculature.
HIV-TRACE (TRAnsmission Cluster Engine): a Tool for Large Scale Molecular Epidemiology of HIV-1 and Other Rapidly Evolving Pathogens
Authors: Sergei L Kosakovsky Pond, Steven Weaver, Andrew J Leigh Brown, Joel O Wertheim
Journal: Molecular Biology and Evolution (2018)

In modern applications of molecular epidemiology, genetic sequence data are routinely used to identify clusters of transmission in rapidly evolving pathogens, most notably HIV-1. Traditional 'shoe-leather' epidemiology infers transmission clusters by tracing chains of partners sharing epidemiological connections (e.g., sexual contact). Here, we present a computational tool for identifying a molecular transmission analog of such clusters: HIV-TRACE (TRAnsmission Cluster Engine). HIV-TRACE implements an approach inspired by traditional epidemiology, by identifying chains of partners whose viral genetic relatedness imply direct or indirect epidemiological connections. Molecular transmission clusters are constructed using codon-aware pairwise alignment to a reference sequence followed by pairwise genetic distance estimation among all sequences. This approach is computationally tractable and is capable of identifying HIV-1 transmission clusters in large surveillance databases comprising tens or hundreds of thousands of sequences in near real time, that is, on the order of minutes to hours. HIV-TRACE is available at www.hivtrace.org and from www.github.com/veg/hivtrace, along with the accompanying result visualization module from www.github.com/veg/hivtrace-viz. Importantly, the approach underlying HIV-TRACE is not limited to the study of HIV-1 and can be applied to study outbreaks and epidemics of other rapidly evolving pathogens.
Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission
Authors: Lene Vestergaard Ravn-Nielsen, Marie-Louise Duckert, Mia Lolk Lund, Jolene Pilegaard Henriksen, Michelle Lyndgaard Nielsen, Christina Skovsende Eriksen, Thomas Croft Buck, Anton Pottegård, Morten Rix Hansen, Jesper Hallas
Journal: JAMA Internal Medicine (2018)

Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society.To determine whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number of readmissions and emergency department (ED) visits.This randomized clinical multicenter study (Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer [OPTIMIST]) enrolled patients from September 1, 2013, through April 23, 2015, with a follow-up of 6 months completed on October 31, 2015. Consecutive medical patients in an acute admission ward who were 18 years or older and who used 5 or more medications were invited to participate. Of 1873 patients invited to participate, 1499 (80.0%) accepted. The medication review and patient interview were conducted in the hospital and followed up in collaboration with primary care. Analysis was based on intention to treat.The patients were randomized into 3 groups receiving usual care (no intervention), a basic intervention (medication review), and an extended intervention (medication review, 3 motivational interviews, and follow-up with the primary care physician, pharmacy, and nursing home).The prespecified primary outcomes were readmission within 30 or 180 days and ED visits within 180 days. The primary composite end point was readmission or an ED visit within 180 days. Secondary outcomes were drug-related readmissions within 30 and 180 days after inclusion, and all-cause mortality and drug-related mortality.A total of 1467 patients (679 men [46.3%] and 788 women [53.7%]; median age, 72 years; interquartile range, 63-80 years) were part of the primary analysis, including 498 randomized to usual care, 493 randomized to the basic intervention, and 476 randomized to the extended intervention. The extended intervention had a significant effect on the numbers of patients who were readmitted within 30 days (hazard ratio [HR], 0.62; 95% CI, 0.46-0.84) or within 180 days (HR, 0.75; 95% CI, 0.62-0.90) after inclusion and on the number of patients who experienced the primary composite end point (HR, 0.77; 95% CI, 0.64-0.93). The study showed a nonsignificant reduction in drug-related readmissions within 30 days (HR, 0.65; 95% CI, 0.39-1.09) and within 180 days (HR, 0.80; 95% CI, 0.59-1.08) after inclusion and in deaths (HR, 0.83; 95% CI, 0.22-3.11). The number needed to treat to achieve the primary composite outcome for the extended intervention (vs usual care) was 12.A multifaceted clinical pharmacist intervention may reduce the number of ED visits and hospital readmissions.clinicaltrials.gov Identifier: NCT03079375.
NOVEL CARDIAC FIBROBLAST-DERIVED EXTRACELLULAR MATRIX EDUCATES MONOCYTES INTO ALTERNATIVELY ACTIVATED MACROPHAGES WITH LOW INFLAMMATORY MARKER EXPRESSION
Authors: Keith Spinali, Eric Schmuck, Sydney Walker, Anisa Dhilllon, John Kink, Debra Bloom, Peiman Hematti, Amish Raval
Journal: Journal of the American College of Cardiology (2018)
Dobutamine Stress Echocardiography for Management of Low-Flow, Low-Gradient Aortic Stenosis
Authors: Mohamed-Salah Annabi, Eden Touboul, Abdellaziz Dahou, Ian G. Burwash, Jutta Bergler-Klein, Maurice Enriquez-Sarano, Stefan Orwat, Helmut Baumgartner, Julia Mascherbauer, Gerald Mundigler, João L. Cavalcante, Éric Larose, Philippe Pibarot, Marie-Annick Clavel
Journal: Journal of the American College of Cardiology (2018)
IMPACT OF CORONARY ARTERY REVASCULARIZATION COMPLETENESS ON OUTCOMES OF PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: A META-ANALYSIS OF STUDIES USING THE RESIDUAL SYNTAX SCORE
Authors: Guy Witberg, Oren Zusman, Pablo Codner, Abid Assali, Ran Kornowski
Journal: Journal of the American College of Cardiology (2018)
Junior doctors’ morale review to be completed by the end of 2016
Authors: Abi Rimmer
Journal: BMJ (2016)

The review of junior doctors’ morale that was commissioned by the government will be completed by the end of 2016, the Academy of Medical Royal Colleges has said.

Speaking in the House of Commons on 11 February, health secretary Jeremy Hunt announced plans to impose a new contract on junior doctors in England. At the same time, Hunt said that a review was needed into …