tbuckley/cabot-search huggingface dataset:
Abstract 12123: Periodicity-Analysis of a Photoplethysmography Signal May Support Pulse Detection in a Few-Second Compression-Pause During Cardiopulmonary Resuscitation
Authors: Ralph Wijshoff, Christoph Haarburger, Jens Muehlsteff, Gerrit Jan Noordergraaf
Journal: Circulation (2016)

Introduction: Pulse checks during cardiopulmonary resuscitation (CPR) are typically performed by manual palpation, which is unreliable and can interrupt compressions for longer than the recommended 10 s. Hypothesis: Presence of a spontaneous pulse can be detected in a compression-free photoplethysmography (PPG) signal within 5 s, by assessing the periodicity of the signal. Methods: We measured nasal PPG signals in 11 pigs during periods of 10-min baseline, arrest induction, 20-min 30:2 CPR, defibrillation, and 20-min post return of spontaneous circulation (ROSC), with aortic pressure and thoracic impedance as references. We annotated pulse presence and obtained compression-free windows of PPG signals from the ventilation pauses and by segmenting the baseline and post-ROSC phases in 4-s non-overlapping windows. Pulse presence was detected by assessing signal periodicity in the autocorrelation function (ACF), which compared a window of the PPG signal to time shifts of this window. Windows with pulse had local maxima in the ACF when a time shift aligned the pulses in both windows (Fig. 1a). Pulseless windows had unstructured ACFs (Fig. 1b). We assessed periodicity via the maximum prominence of all peaks at non-zero shift in the ACF. Prominence is the amplitude relative to the largest surrounding minimum (Fig. 1a,b). We used the prominence and related features in a logistic regression classifier to quantify pulse absence and presence on a continuous scale from 0 to 1 (Fig. 1c). We trained and validated the classifier via five-fold cross-validation, regarding a classifier output of ≥0.5 as indicative of pulse presence. Results: Sensitivity was 97.1% and specificity was 96.2%. Conclusions: Periodicity analysis allows for pulse detection in PPG signals within 5 s. This could be used during existing ventilation pauses to prepare for a faster pulse check or avoid an unnecessary pulse check. Fig. 1: (a) ACF for pulse presence. (b) ACF for pulse absence. (c) Classifier output.
Trainee GP who falsified timesheet is suspended for four months after GMC intervened
Authors: Clare Dyer
Journal: BMJ (2018)

A trainee GP who falsified a timesheet after providing weekend senior house officer cover at a hospital has been suspended from the UK medical register for four months after a successful appeal by the General Medical Council.

Despite finding that his actions were dishonest, a medical practitioners tribunal decided in January 2017 that Iheanyi Nwachuku’s fitness to practise was not impaired and let him off with a warning.

But the GMC appealed and in August 2017 a …
Influence of CHAARTED, STAMPEDE, and LATITUDE eligibility criteria on utilization of abiraterone (A) and docetaxel (D).
Authors: Shruti Parshad, Urban Emmenegger
Journal: Journal of Clinical Oncology (2018)

301 Background: A and D improve the survival of men with high-risk localized or metastatic hormone-naïve prostate cancer (HNPC) when combined with androgen deprivation therapy (ADT). However, the two drugs differ regarding side effects, treatment duration, and associated costs. Furthermore, different eligibility criteria were used in the seminal phase III studies. Since the latter may impact on drug access in many constituencies, we decided to study how applying the eligibility criteria of CHAARTED, STAMPEDE and LATITUDE for drug funding purposes might influence the utilization of A versus D. Methods: 102 men with HNPC were referred from 06/2014 to 09/2017 to the medical oncology service at Odette Cancer Centre (Toronto/ON, Canada) for consideration of additional systemic therapy secondary to ADT. After extraction of baseline patient characteristics, we applied the eligibility criteria of CHAARTED (both high-volume [HV] and low-volume [LV] definition), STAMPEDE, and LATITUDE to determine the rate of men qualifying for treatment with A, D, or either of the two agents. Results: 98.0, 69.6, 28.4, and 47.1 percent of all 102 men fulfilled the STAMPEDE, CHAARTED-HV, CHAARTED-LV, and LATITUDE criteria, respectively. Considering that A funding for HNPC therapy is pending in Ontario, and that D funding is limited to men with CHAARTED-HV disease, the rate of D therapy was 62.0, 69.0, and 77.1 percent of patients conforming to STAMPEDE, CHAARTED-HV, and LATITUDE, respectively. 42 of 48 men (87.5%) conforming to LATITUDE would also be candidates for D, whereas 42 of 71 CHAARTED-HV patients (59.2%) would be eligible for A as alternative treatment. Hence, while all men fulfilling the STAMPEDE criteria (100 of 102, 98%) could be considered for either A or D, only 42 of 102 patients (41.2%) would be candidates for both of the drugs if the CHAARTED-HV and LATITUDE criteria were applied. Conclusions: In our patient population, applying the more restrictive CHAARTED-HV and LATITUDE criteria - as opposed to STAMPEDE - would result in around 30% or 50% fewer men offered D or A secondary to ADT, respectively. In addition, only around 40% of men would conform to both CHAARTED-HV and LATITUDE, and thus be candidates for both drugs.
Saline Shortages — Many Causes, No Simple Solution
Authors: Maryann Mazer-Amirshahi, Erin R. Fox
Journal: New England Journal of Medicine (2018)

Saline Shortages — Many Causes, No Simple Solution There was already a shortage of saline solution in the United States when Hurricane Maria devastated Puerto Rico, home to a key saline manufacturer, causing the problem to reach critical levels. Fixing the problem will require a multifaceted approach.
Response to: ’Optimising the efficacy of gait retraining'
Authors: Jean-Francois Esculier, Blaise Dubois, Jean-Sébastien Roy
Journal: British Journal of Sports Medicine (2018)

A recent editorial was published in BJSM 1 following a randomised clinical trial (RCT) conducted by our research team, which compared three rehabilitation programmes in runners with patellofemoral pain (PFP).2 In Dr Davis’ editorial, it was stated that our running intervention was not optimal due to a heterogeneous sample, unstandardised gait modifications and unstructured retraining schedule. While several interesting arguments were presented, readers must keep in mind that the current level of evidence on gait retraining for injured runners is far from conclusive.

Previous studies on gait retraining for runners with PFP have addressed specific running mechanics such as rearfoot striking or excessive hip adduction.3 4 However, not all runners with PFP show ‘altered’ mechanics, and PFP is not specific to rearfoot strikers (non-rearfoot strikers also develop PFP). In fact, training errors are thought to contribute to running injuries even in those with ‘optimal’ mechanics.5 Aiming to maximise the external validity of our RCT, we included runners regardless of distal or proximal kinematics, and prescribed individualised …
Letter by Spartalis et al Regarding Article, “Cardiomyocyte Regeneration: A Consensus Statement”
Authors: Michael Spartalis, Eleni Tzatzaki, Eleftherios Spartalis
Journal: Circulation (2018)

][4] We believe that the role of PRP in cardiomyocyte regeneration deserves further experimental investigation and large-scale prospective randomized clinical trials.The combined treatment approach of stem cell therapy and PRP could open new horizons and help our understanding of cardiomyocyte regeneration.
Optimising sleep for night shifts
Authors: Helen McKenna, Matt Wilkes
Journal: BMJ (2018)

### What you need to know

### Sources and selection criteria

We selected published guidance on sleep and shift work from the National Institute for Health and Care Excellence (NICE) and the Royal Colleges of Physicians and Anaesthetists. We then searched PubMed and Cochrane databases (to May 2017) for observational studies, randomised controlled studies, meta-analyses, and systematic and narrative reviews relating to the health consequences of shift work and for each proposed sleep intervention given in table 1. Priority was given to randomised controlled trials and meta-analyses, but given the interdisciplinary nature of sleep and shift work, and the overall quality of evidence, we also considered observational studies and grey literature from aviation and heavy industries, as well as published expert opinion.

Night shift work occurs during the period of the sleep-wake cycle (“circadian phase”) programmed for sleep. Alertness, cognitive function, psychomotor coordination, and mood all reach their lowest point between 3 and 5 am1 After the shift, workers must rest during the circadian phase least conducive to sleeping,2 which compounds fatigue and can lead to chronic sleep disturbance.3 A recent systematic review linked night shift work with an increased risk of sleep loss, occupational accidents, obesity and weight gain, type 2 diabetes, coronary heart disease, and breast, prostate, and colorectal cancers.4 In a 2017 survey of 2231 UK trainee anaesthetists, more than 70% reported that fatigue affected their physical and psychological wellbeing. Fifty seven per cent described an accident or near-miss travelling home from night shifts.5

Performance on night shift declines with …
Nodal downstaging in gastric cancer in relation to survival when ypN0 is achieved.
Authors: Naruhiko Ikoma, Jeannelyn Estrella, Wayne Lewis Hofstetter, Prajnan Das, Jaffer A. Ajani, Keith F. Fournier, Paul F. Mansfield, Brian D. Badgwell
Journal: Journal of Clinical Oncology (2018)

93 Background: The AJCC 8 th edition introduced ypStage for patients with gastric cancer due to the increasing use of preoperative therapy. ypN0 patients have better survival than ypN+ patients; however, whether patients who had clinically positive nodal disease before preoperative therapy (cN+ ypN0) have similar survival to those who had “natural N0” (cN0 ypN0) disease is unknown. Methods: We reviewed an institutional database to identify patients with gastric adenocarcinoma who underwent potentially curative R0 resection after preoperative chemo- or chemoradiation therapy. Patients were categorized into 3 groups based on nodal status: natural N0 (cN0 ypN0), downstaged N0 (cN+ ypN0), and ypN+. Univariable and multivariable Cox regressions were performed to determine associations with overall survival (OS). Results: We identified 316 patients who met study criteria, including 74 (23%) patients with GEJ tumors; 56% were white and 62% were male. Preoperative chemoradiation therapy was given to 239 (76%). Ninety-four (30%) had natural N0, 93 (29%) had downstaged N0, and 129 (41%) had ypN+ disease. Of all patients, 136 (43%) patients died during a median follow-up of 3.1 y. Median OS was 7.7 y, and 5-year OS was 60.3%. OS did not differ in patients with natural N0 disease (5-y OS, 72%) and those with downstaged N0 disease (5-y OS, 69%) ( p = 0.776), even though the downstaged N0 group had more advanced baseline cT disease than did the natural N0 group ( p &lt; 0.001). On multivariable analysis adjusting for other factors, including ypT category, OS did not differ between natural N0 and downstaged N0 patients (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.54-1.48; p = 0.666), but it was shorter in ypN+ patients (HR, 1.82; 95% CI, 1.15-2.87; p = 0.010). Sensitivity analyses also showed equivalent OS in the natural N0 and downstaged N0 groups within the ypT0-2 group ( p = 0.936) and the ypT3-4 group ( p = 0.608). Conclusions: In patients with gastric cancer who underwent preoperative therapy, we found similar OS in patients with natural N0 and those with downstaged N0 disease. As ypN+ patients had poor OS, achieving ypN0 status is an important hallmark demonstrating the effectiveness of preoperative therapy.
Radiology services are “on their knees,” royal college warns
Authors: Anne Gulland
Journal: BMJ (2016)

The president of the Royal College of Radiologists has warned that radiology services are “on their knees,” after its annual census showed that nearly a 10th of radiology posts were vacant.

The workforce survey for 2015 showed an average vacancy rate of 9%, although it warned that the real rate may have been higher because not all roles were advertised. Since 2010 the vacancy rate has fluctuated between 7% and 12%.1

“These figures suggest that a situation has developed whereby one in 10 consultant radiologist posts in the UK will be vacant for the foreseeable future,” the report warns.

The …
I currently work as a staff grade in accident and emergency/surgery. I am taking home less per month than I was as a senior house officer in the exact same job—is this possible?
Authors: Simon Eccles
Journal: BMJ (2007)

Have a career related problem that needs answering? Can9t find the 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>
Abstract P4-13-14: Risk of recurrence and death in breast cancer patients after delayed deep inferior epigastric perforator flap reconstruction
Authors: H Adam, A-C Docherty Skogh, Å Edsander Nord, I Schultz, J Gahm, P Hall, J Frisell, M Halle, J de Boniface
Journal: Cancer Research (2018)

Abstract PURPOSE Post-mastectomy reconstruction using the deep inferior epigastric perforator (DIEP) flap is increasingly performed in breast cancer patients. The procedure induces large tissue trauma and it has been hypothesized that the release of growth factors, angiogenic agonists and immunomodulating factors may reactivate dormant micrometastasis. The aim of our study was to contrast the risk of breast cancer recurrence in patients undergoing DIEP reconstruction to patients treated with mastectomy alone. PATIENTS AND METHODS We conducted a retrospective nested case-control study. Cases were defined as breast cancer patients operated with delayed DIEP reconstruction at Karolinska University Hospital, Sweden, between 1999-2013. Three controls, defined as breast cancer patients operated with conventional mastectomy without delayed reconstruction, were matched to each case based on age, tumour stage and year of mastectomy. The primary endpoint was breast cancer-specific survival. Survival analysis was carried out by Kaplan–Meier survival estimates and Cox proportional hazard regression analysis. RESULTS In all, 254 cases and 729 controls were included and had a median follow up of 134 and 122 months, respectively (p=0.004). Breast cancer recurrence occurred in 50 (19.7%) cases and 174 (23.9%) controls, respectively (p=0.171). Ten-year breast cancer-specific survival was 90.7% for cases and 85.2% in controls (p=0.067). The corresponding figures for 10-year overall survival was 89.6% and 80.0%, respectively (p&amp;lt;0.001). Higher tumor stage and positive axillary lymph nodes, but not DIEP reconstruction, were independent risk factors for death due to breast cancer. CONCLUSION Our findings did not support the hypothesis that breast cancer patients undergoing DIEP reconstruction would have a higher rate of breast cancer recurrence than patients undergoing mastectomy alone. Citation Format: Adam H, Docherty Skogh A-C, Edsander Nord Å, Schultz I, Gahm J, Hall P, Frisell J, Halle M, de Boniface J. Risk of recurrence and death in breast cancer patients after delayed deep inferior epigastric perforator flap reconstruction [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 P4-13-14.
‘SMOKE’ DETECTED ON TRANSESOPHAGEAL ECHOCARDIOGRAPHY IS A RISK FACTOR FOR STROKE IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING CATHETER ABLATION
Authors: Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Giovanni Della Rocca, John Burkhardt, Javier Sanchez, Patrick Hranitzky, Gerald Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea Natale
Journal: Journal of the American College of Cardiology (2018)
Efficacy and Safety of Cyclophosphamide Treatment in Severe Juvenile Dermatomyositis Shown by Marginal Structural Modeling
Authors: Claire T. Deakin, Raquel Campanilho‐Marques, Stefania Simou, Elena Moraitis, Lucy R. Wedderburn, Eleanor Pullenayegum, Clarissa A. Pilkington
Journal: Arthritis & Rheumatology (2018)

In patients with severe or refractory juvenile dermatomyositis (DM), second-line treatments may be required. Cyclophosphamide (CYC) is used to treat some connective tissue diseases, but evidence of its efficacy in juvenile DM is limited. This study was undertaken to describe clinical improvement in juvenile DM patients treated with CYC and model the efficacy of CYC treatment compared to no CYC treatment.
BMA issues ultimatum on GP contract in Northern Ireland
Authors: Helen Jaques
Journal: BMJ (2013)

The BMA in Northern Ireland has warned that GPs would not deliver the government’s “Transforming Your Care” programme if the Department of Health, Social Services and Public Safety went ahead with its plans to impose a new general medical services (GMS) contract in April.

GPs in Northern Ireland would not be able to manage the huge amount of extra work implied by the new GMS contract and the movement of work from hospitals to primary care that will occur under Transforming Your Care, the Northern Ireland General Practitioners Committee …
Treatment and clinical outcomes of very elderly (≥ 80 yrs) metastatic castration-resistant prostate cancer (mCRPC) patients (pts): A single-institution retrospective analysis.
Authors: Orazio Caffo, Stefania Kinspergher, Francesca Maines, Sveva Macrini, Antonello Veccia
Journal: Journal of Clinical Oncology (2018)

327 Background: The development of mCRPC is generally observed in senior adults and in the daily clinical practice it is frequent to treat pts ≥ 80 yrs. In this population comorbidities can influence the treatment choices and, consequently, the clinical outcomes. The aim of this retrospective study was to describe management and clinical outcomes in mCRPC pts ≥ 80 yrs treated in the daily clinical practice. Methods: We retrospectively evaluated all mCRPC pts treated in our Institution from 02/2002 to 06/2015 and recorded their medical history, anticancer treatments and survival outcomes. Results: We evaluated a consecutive series of 45 pts aged ≥ 80 yrs: median age was 83 yrs (range 81-90 yrs). At the time of mCRPC development bone, nodal, and lung mets were present in 84%, 60%, and 9% of the cases, respectively; no pts with liver mets were observed. Pain was present 53.3% of the pts, the ECOG PS 2 rate was 17.1%. These baseline characteristics were not statistically different compared to those of the younger counterpart. Most of the elderly pts received docetaxel (78%), although this rate was significantly higher (96%) in the younger population (p &lt; 0.0001); similarly elderly pts received less frequently cabazitaxel (CAB) (2% vs 16%, p = 0.01). On the contrary elderly population received more frequently only new generation hormonal agents [abiraterone (AA) or enzalutamide ENZ)] without any chemotherapy (22% vs 4%, p &lt; 0.0001). The median cumulative overall survival (OS) from the start of the first treatment line for mCRPC was 20.5 mos (compared to 21.1 of younger pts). In the elderly population a significant different median OS was observed by comparing pts who received the new agents [NAs (AA, CAB, ENZ, Radium 223)] e those who did not (22.9 vs 13.0 mos, p = 0.001). Conclusions: Although the limitation due to its retrospective nature, our analysis showed that mCRPC pts ≥ 80 yrs were managed differently than younger ones. Nevertheless, the survival outcomes did not differ from the younger counterpart and also very elderly pts benefitted from the introduction of NAs in the daily clinical practice.
Abstract PD8-02: Mechanisms of recurrence: Paired analysis of primary and metastatic triple negative breast cancer
Authors: Z-M Zhao, S Yost, Y-C Yuan, C Warden, J Chuang, Y Yuan
Journal: Cancer Research (2018)

Abstract Background: Triple negative breast cancer (TNBC) is the most aggressive subtype of invasive breast cancer that lacks ER, PR, and HER2 expression. It is a heterogeneous disease with several molecular subtypes: basal-like1 (BL-1), basal-like 2 (BL-2), mesenchymal (M), and luminal androgen receptor (LAR). Treatment for TNBC is normally limited to chemotherapy, and relapse is common. Here we report molecular alterations associated with TNBC metastasis by analyzing the genomic profiles of paired primary and metastatic TNBCs. Methods:50 paired TNBCs were identified through an IRB-approved protocol via the City of Hope (COH) Biospecimen Repository. DNA mutation and mRNA expression profiles of 10 paired primary and metastatic TNBCs were analyzed. DNA mutations were identified using exome sequencing by FoundationOne®. Affymetrix Human Genechip 2.0 was used for mRNA expression profiling. Raw data were normalized and processed using Expression Console, and linear regression was performed using Limma to identify the differentially expressed genes between primary and metastatic TNBCs. Results: DNA mutation profiling showed that multiple mutations occurred within genes covering pathways of PI3K/AKT/mTOR, DNA repair, RAS/MAPK, cell cycle, and growth factor receptor signaling, reconfirming genomic heterogeneity of TNBCs. Gene expression profiles were analyzed for Lehmann's TNBC molecular subtypes (BL-1, BL-2, M, and LAR). Six of ten TNBCs showed phenotype shift between the primary and metastatic TNBCs. Several unique gene expression patterns were identified by comparing the paired TNBCs. CCNE1 and TPX2 were co-overexpressed in metastatic TNBCs compared to paired primaries. This mirrored prior studies in ovarian cancer, where co-overexpression of CCNE1 and TPX2 were found related to clonal resistance against chemotherapy. Splicing factors TRA2B and SRSF7 were also over-expressed in metastatic TNBCs compared with primaries. The analysis studying the association of CCNE1 and TPX2 with overall survival is ongoing using TCGA. Conclusion: Overall, these results show the comparative changes between primary and relapsed TNBCs and indicate the heterogeneity of molecular mechanisms of recurrence. CNNE1 and TPX2 may represent important genes involved in TNBC metastasis. Further analyses including a total of 50 paired TNBCs are currently underway. Study Contact: Yuan Yuan MD PhD, City of Hope Comprehensive Cancer Center; Duarte, CA 91030; Email: yuyuan@coh.org Citation Format: Zhao Z-M, Yost S, Yuan Y-C, Warden C, Chuang J, Yuan Y. Mechanisms of recurrence: Paired analysis of primary and metastatic triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD8-02.
Cardiology is most competitive specialty for higher training
Authors: Helen Jaques
Journal: BMJ (2011)

More than six applications were received for every specialty training year 3 (ST3) post in cardiology during round one of recruitment to higher specialty training this year, making it the most competitive medical specialty in which to get a training placement, according to figures from the Royal College of Physicians.

The college has published data on the numbers of posts, numbers of applications made, …