tbuckley/cabot-search huggingface dataset:
Abstract 12440: Acetylcholine-Provoked Myocardial Lactate Production is Frequently Observed in Non-smoking Female Patients With Multivessel Coronary Spasm
Authors: Koichi Kaikita, Koji Sato, Naoki Nakayama, Eiji Horio, Hiromi Yoshimura, Kenichi Tsujita, Sunao Kojima, Shinji Tayama, Seiji Hokimoto, Hisao Ogawa
Journal: Circulation (2013)

Acetylcholine (ACh)-provocation test is widely used to diagnose coronary vasospastic angina (VSA). Myocardial lactate production (MLP) ratio is a supporting diagnostic marker useful in the evaluation of myocardial ischemia in ACh-provocation test. However, clinical characteristics, predictive factors, and long-term prognosis of ACh-positive patients according to MLP are not fully investigated. We enrolled 1279 consecutive patients who underwent the MLP measurement during ACh-provocation test in left coronary artery. Coronary spasm was defined as total or subtotal obstruction (focal spasm), or severe diffuse vasoconstriction (diffuse spasm) of epicardial coronary arteries. 673 ACh-positive patients were divided into two groups according to MLP [378 MLP-positive and 295 MLP-negative patients]. Female gender, non-current smoking, serum HDL cholesterol level, diffuse spasm, and multivessel spasm were significantly higher in the ACh-positive group with MLP than those without (57% vs. 32%, p≤0.001, 60% vs. 35%, p≤0.001, 56 mg/dL vs. 51 mg/dL, p=0.046, 47% vs. 37%, p=0.01, and 46% vs. 34%, p=0.001, respectively), while serum triglyceride level were significantly lower in the ACh-positive group with MLP than those without (97 mg/dL vs. 123 mg/dL, p=0.036). Multiple logistic regression analysis identified female gender (OR: 1.867; 95%CI: 1.220-2.856; p=0.004), smoking (OR: 0.492; 95%CI: 0.323-0.750; p=0.001), and multivessel spasm (OR: 1.681; 95%CI: 1.185-2.383; p=0.004), as significant predictors of MLP in ACh-positive patients. During a mean follow-up period of 49±19 months, MACE was registered in 43 patients in ACh-positive patients. The proportions of current smokers, and patients with organic stenosis, focal spasm, variant angina, and high systolic blood pressure were significantly higher in the ACh-positive patients with MACE than those without. Multivariate Cox hazard analysis identified non-diffuse spasm subtype but not MLP as predictor of MACE. In conclusion, ACh-provoked MLP was frequently observed in non-smoking female VSA patients accompanied with multivessel coronary spasm, highlighting the usefulness of MLP measurements as a supporting diagnostic marker for ACh-provoked coronary spasm in those patients.
Anti-EGFR monoclonal antibodies (MAb) combined with chemotherapy in metastatic colon cancer (mCRC) patients (pts): Meta-analysis of randomized trials.
Authors: Nirit Yarom, Avishay Sella, Gillian Gresham
Journal: Journal of Clinical Oncology (2014)

e14559 Background: Randomized controlled trials comparing 5FU-based chemotherapy with the addition of anti-EGFR MAb in pts with mCRC have reported conflicting results. The object of this analysis was to examine the impact of combining anti-EGFR MAb with chemotherapy on overall survival (OS) and progression free survival (PFS). Methods: A systematic review and meta-analysis was conducted. A primary search of the PubMed database was conducted to identify studies that compared combination 5FU-based chemotherapy with the addition of panitumumab (PMAB) or cetuximab (CMAB) from 2008 onward. Primary outcomes analyzed were OS and PFS for pts with KRAS wild type (KRAS WT). Pooled hazard ratios (HR) were computed under the random effects model and heterogeneity was assessed using the i-squared statistic. Results: There were 6 eligible studies included in the review. A total of 7061 patients were analyzed. Four studies described survival outcomes for patients treated with the addition of CMAB to either FOLFIRI (n=1), FOLFOX (n=2) or irinotecan (n=1). The remaining two compared the addition of PMAB to FOLFIRI in one trial and FOLFOX in the second. For OS in KRAS WT patients, the pooled HR was 0.88 [95% CI 0.80-0.970, p=0.008] in favor of anti-EGFR treatment. For PFS, the pooled HR was 0.77 [95% CI 0.70-0.86, p<0.001] for the addition of anti-EGFR treatment compared to the control treatment. Moderate heterogeneity was observed for OS (i2=44%) while no heterogeneity was observed for PFS (i2=0%). Exploratory analysis including only trials that compared the addition of anti-EGFR to irinotecan-based treatments reported summary HRs for OS and PFS of 0.82 [95% CI 0.74-0.92] and 0.72 [0.63-0.83], respectively. When comparing anti-EGFR to oxaliplatin-based treatments, the respective OS and PFS were 0.94 [95% CI 0.75-1.17] and 0.84 [95% CI 0.72-0.97]. Conclusions: In pts with WT KRAS mCRC, anti-EGFR MAbs were found to be associated with better OS and PFS when combined with chemotherapy. The benefit appears to be different depending on the chemotherapy backbone used. Due to limited RCT data available, these results should be interpreted with caution.
NHS managers should be regulated by a professional body, says BMA
Authors: Abi Rimmer
Journal: BMJ (2015)

NHS managers should be regulated by a professional body in the same way that doctors are regulated by the General Medical Council, the BMA has said. 

Delegates at the BMA’s annual conference for UK consultants in London on Wednesday 4 March voted in favour of a motion proposed by Maharukh Daruwalla, a consultant plastic surgeon. The motion said that any professional body for NHS managers should be statutory and should have the power …
Better Physician Writing and Speaking Skills
Authors: Neville W Goodman
Journal: BMJ (2007)

Forty one pages into this empassioned plea for doctors to communicate better, the first sentence of the fourth chapter reads, “It must be assumed that physicians who wish to write … are already familiar with … parallel construction, agreement of subject and verb, references of pronouns, dangling, trailing and misplaced modifiers, and other grammatical obligations.” Anyone who is so familiar has no need of this book; and anyone who is not so familiar needs much more than Gartland offers.

There are only 94 pages of text, but the …
Predictive factors of submucosal fibrosis before endoscopic submucosal dissection for superficial squamous esophageal neoplasia.
Authors: Byung Wook Kim
Journal: Journal of Clinical Oncology (2018)

41 Background: Endoscopic submucosal dissection (ESD) is an effective treatment modality for superficial squamous esophageal neoplasia (SSEN). However, submucosal fibrosis is an important obstacle to successful ESD. The aim of this study was to determine the ESD outcome in relationship to the degree of submucosal fibrosis of SSEN and to identify factors for predicting submucosal fibrosis. Methods: We retrospectively analyzed endoscopic and pathologic factors related to submucosal fibrosis in 41 patients with SSEN who underwent ESD. Also, en bloc resection, complication rate, and procedure time according to the degree of submucosal fibrosis were evaluated. Masson’s trichrome staining was used to evaluate histologic submucosal fibrosis. Results: A depressed type tumor (vs. nondepressed type tumor, P= 0.002), longer diameter of tumor greater than 20 mm (vs. longer diameter of tumor ≤ 20mm, P= 0.036), and delayed ESD after initial diagnosis (vs. immediate ESD after initial diagnosis, P= 0.005) were independent factors predictive of submucosal fibrosis. The severity of submucosal fibrosis was significantly associated with a higher complication rate such as bleeding and perforation. Also, as the severity of the submucosal fibrosis increased, the amount of time required for the ESD procedure increased. Conclusions: Longer diameter of tumor greater than 20 mm and macroscopic depression are endoscopic predictive factors of submucosal fibrosis in SSEN. Moreover, to avoid submucosal fibrosis, ESD should be attempted immediately after biopsy for the diagnosis of SSEN.
EUSeqMyTB to set standards and build capacity for whole genome sequencing for tuberculosis in the EU
Authors: Elisa Tagliani, Daniela Maria Cirillo, Csaba Ködmön, Marieke J van der Werf, Richard Anthony, Dick van Soolingen, Stefan Niemann, Vlad Nikolayevskyy
Journal: The Lancet Infectious Diseases (2018)
A phase II study of itraconazole in biochemically recurrent prostate cancer.
Authors: Mina Lee, Haemin Hong, Won Kim, Terence W. Friedlander, Lawrence Fong, Amy M. Lin, Eric Jay Small, Mallika Sachdev Dhawan, Xiao X. Wei, Tammy J. Rodvelt, Brigid Miralda, Charles J. Ryan, Rahul Raj Aggarwal
Journal: Journal of Clinical Oncology (2018)

362 Background: A subset of patients (pts) with biochemically recurrent prostate cancer (BRPC) are at risk for metastasis and lethal outcomes, yet many pts wish to defer or avoid androgen deprivation therapy in this setting. Itraconazole has previously demonstrated anti-tumor activity in castration-resistant prostate cancer independent of modulation of circulating androgen levels. We therefore evaluated itraconazole in a phase 2 study in BRPC as a potentially non-castrating treatment approach. Methods: Pts with BRPC and PSA doubling time (PSADT) ≤ 15 months, without metastases on conventional imaging (whole body bone scan + CT/MRI of the abdomen/pelvis), were enrolled in a single arm phase 2 study. Itraconazole was dosed at 300 mg PO BID until PSA progression by PCWG2 criteria, unacceptable toxicity, or pt withdrawal. The primary endpoint was the proportion of pts who achieved ≥ 50% decline from baseline in serum PSA after 12 weeks of protocol therapy. Secondary endpoints included change in PSADT, adverse events (AEs) by CTCAE version 4.0, and change in serum androgens (including testosterone (T) and androstenedione (ASD) from baseline to week 12. Results: 21 pts were enrolled. The median age was 72 (range 54-76), median baseline PSA was 7.6 ng/mL (range 1.5 – 45.5), and median PSADT was 5.7 months (1.2 – 13.0). Median baseline serum T was 336 ng/dL (165-626). Among the 19 evaluable pts, 9 pts (47%) experienced a PSA decline (mean decline 25.0 %, range 2 – 60 %) by week 12, including one patient (5%) with &gt; 50% PSA decline. Among the 10 pts without a PSA decline, the mean on-treatment vs. pre-treatment PSADT was numerically longer (13.2 vs. 4.8 months, p = 0.17). There was no significant change from baseline to week 12 serum T (mean change = 1.9%, p = 0.77) or ASD levels (mean change = 6.1%, p = 0.83). The most common grade ≥ 3 AE was hypertension (29%); hypokalemia of any grade was also common (24%). Conclusions: Itraconazole can modulate serum PSA levels without lowering serum T in pts with BRPC. However, the magnitude of effect is modest and treatment carries an appreciable risk of toxicities related to mineralocorticoid excess. Exploration of the relationship between mineralocorticoid-related AEs, itraconazole drug levels, and clinical outcomes is ongoing. Clinical trial information: NCT01787331.
Note to an Oncology Fellow
Authors: Theresa E. Vettese
Journal: Annals of Internal Medicine (2018)

On Being a Doctor6 March 2018Note to an Oncology FellowTheresa E. Vettese, MDTheresa E. Vettese, MDEmory University School of Medicine, Atlanta, Georgia (T.E.V.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1662 Audio Reading - “Note to an Oncology Fellow” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Note to an Oncology Fellow," by T.E. Vettese. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Dear J,Thank you for your thoughtful e-mail. I wish we could have had a personal conversation over a cup of coffee, but I understand that time is tight and by now you have probably moved on to a different hospital and rotation. Your message caused me to reflect not just on our recent interaction but also on the similar communications I have had with residents and fellows over the years. More important, it led me to contemplate the many conversations I didn't have because I was “too busy,” often running to a meeting that rarely left a lasting effect ... Author, Article, and Disclosure InformationAffiliations: Emory University School of Medicine, Atlanta, Georgia (T.E.V.)Corresponding Author: Theresa E. Vettese, MD, Emory University School of Medicine, Suite 408, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Note to an Oncology Fellow” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Note to an Oncology Fellow," by T.E. Vettese. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byFinding Hope and Healing When Cure Is Not Possible 6 March 2018Volume 168, Issue 5Page: 371-372KeywordsChemotherapyDyspneaFearHypercalcemiaOutpatientsPalliative careResearch laboratoriesRespiratory system proceduresRunningWeight loss ePublished: 6 March 2018 Issue Published: 6 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract ES5-2: Biologic, cultural and health systems influences on breast cancer disparities in Latinas
Authors: AG Ramirez
Journal: Cancer Research (2018)

Abstract Rationale Breast cancer is the top cause of cancer-related deaths in Latinas, who more likely than their peers to be diagnosed at advanced disease stage. This makes it critical to reduce the time from screening to diagnosis to treatment. Latinas also face other biologic issues, as well as cultural and linguistic barriers to proper breast cancer care. Patient navigation is a means for providing access to recommended cancer screening services, follow-up, diagnosis, and treatment in medically underserved populations. Objectives I led a series of studies to adapt patient navigation for Latino populations, specifically to reduce delays among Latinas to proper diagnoses and care. We trained our bilingual, bicultural patient navigators to help “navigate” underserved people through the complex care system and other barriers to care (finances, transit, child care, language, culture, etc.). Navigation aims to help reduce missed appointments, reduce delays in seeking care, increase follow-up care, and cover the entire ecological framework from policy, community, organizational, interpersonal, and survivor elements. Results The series of studies identified Latinas' delays in time to confirmatory diagnosis and start of treatment after an abnormal mammogram; and proved that patient navigation by a bilingual, bicultural patient navigator can reduce Latinas' times to diagnosis and treatment and significantly increase the proportion of Latinas initiating treatment. Our navigation helped patients receive diagnosis 4 times faster, and treatment start 1.5 times faster, than normal. Several aspects of a navigator's services were directly related to achieving these results. As a direct result of our patient navigation activities, we navigated significantly more women from confirmed breast cancer diagnosis to treatment initiation within 30 (69%) and 60 days (97.6%), with much lower rates for non-navigated women. Conclusion We conclude—based on a national study that shows women with breast cancer who wait longer than 60 days have a significantly lower survival rate—that our patient navigation is likely to have saved the lives of many Latinas. We have since applied this navigation to achieve greater compliance in following prescribed treatments and improved general and cancer-specific quality of life among cancer survivors. We also, based on these successful results, developed and posted online the Patient Navigator Manual: Developing and Implementing a Patient Navigator Program manual. The bilingual manual outlines the necessary steps and provides tools to incorporate navigation for Latinos at any organization. Citation Format: Ramirez AG. Biologic, cultural and health systems influences on breast cancer disparities in Latinas [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 ES5-2.
BMA Scotland is to ballot hospital doctors on further industrial action over pensions
Authors: Caroline White
Journal: BMJ (2012)

Hospital doctors in Scotland are poised to go it alone and take strike action involving emergency only cover if the Scottish government refuses to back down on changes to the NHS pension scheme.

The BMA’s Scottish Council will ballot hospital doctors in November on their willingness to take further, escalated industrial action, after the BMA’s UK council sanctioned the move this week.

The ballot will ask hospital doctors in Scotland whether they are willing to provide emergency only cover for an initial 24 hours, followed by further 24 hour periods. Doctors would not go to their normal place of work and …
Genome-wide analyses using UK Biobank data provide insights into the genetic architecture of osteoarthritis
Authors: Eleni Zengini, Konstantinos Hatzikotoulas, Ioanna Tachmazidou, Julia Steinberg, Fernando P. Hartwig, Lorraine Southam, Sophie Hackinger, Cindy G. Boer, Unnur Styrkarsdottir, Arthur Gilly, Daniel Suveges, Britt Killian, Thorvaldur Ingvarsson, Helgi Jonsson, George C. Babis, Andrew McCaskie, Andre G. Uitterlinden, Joyce B. J. van Meurs, Unnur Thorsteinsdottir, Kari Stefansson, George Davey Smith, Jeremy M. Wilkinson, Eleftheria Zeggini
Journal: Nature Genetics (2018)
Junior doctors should be trained in commissioning, say Future Forum education leads
Authors: Helen Jaques
Journal: BMJ (2012)

Postgraduate medical education and training should include modules on commissioning and give more priority to generalism, the House of Commons health select committee has heard.

Doctors have an important role in determining where resources should go so should receive training in commissioning, John Tooke, head of the School of Life and Medical Sciences at University College London, told the committee in its third oral evidence session on medical education, training, and workforce planning. 

“I see an opportunity in …
Immune checkpoint inhibitors are superior to docetaxel as second‐line therapy for patients with non‐small cell lung carcinoma
Authors: Mike Fillon
Journal: CA A Cancer Journal for Clinicians (2018)

Key Points When compared with docetaxel, checkpoint inhibitors prolong overall survival in second‐line and later lines of treatment among patients with advanced NSCLC. There was no significant increase in survival noted for patients with EGFR‐ mutant tumors. Checkpoint inhibitors should be considered for these patients only after all other effective therapies have been tried. Smoking status appears to have minimal effect on the relative efficacy of these 2 therapies.
London head and neck dissection course
Authors: Nabeela Ahmed, Waseem Ahmed
Journal: BMJ (2012)

The sixth London head and neck dissection course, a three day intensive course endorsed by the Royal College of Surgeons of England, took place at St George’s Hospital in April 2011. The faculty was made up of specialists in otolaryngology and maxillofacial and plastic surgery, with invited faculty from the anatomy department of the Royal College of Surgeons and distinguished overseas surgeons. The course organiser, Tunde Odutoye, is a consultant ear, nose, and throat (ENT) and head and neck cancer surgeon at St George’s Hospital. Using fresh frozen cadavers, the course emphasises the anatomy relevant to common head and neck procedures in a well supervised environment.

The course is aimed at junior trainees in ENT, maxillofacial, and plastic surgery, but the vast experience of the faculty means that it would also be suitable for more senior trainees and newly qualified consultants. About half the trainees were ENT and maxillofacial trainees from …
England women's football team doctor
Authors: Amy Greensill
Journal: BMJ (2007)

Pippa Bennett is the national governing body doctor for the England women's football teams, having studied sports medicine at Bath.

I was an undergraduate at Leeds and qualified in 1990. I did general practitioner vocational training in Kent before becoming a GP partner at Barnard Medical Practice, where I stayed for five years. I then studied for a masters degree in sports medicine at Bath University. My dissertation was on anterior cruciate injuries in female footballers. I am a member of the Faculty of Sport and Exercise Medicine, and I am on the Football Association and British Olympic Association medical committees and an executive member of the British Association of Sport and Exercise Medicine.

I knew I wanted to be a doctor from sixth form onwards. I always loved sport and had a childhood dream of playing at Wembley. I realised that I could make a career in sport and exercise …
Diploma in HIV medicine
Authors: Indrajith Karunaratne
Journal: BMJ (2011)

The diploma is designed to show that medical practitioners (UK or overseas) wanting to specialise in HIV medicine demonstrate a sound level of experience and competence. It is compulsory for specialist registrars in genitourinary medicine who follow the 2010 curriculum in the United Kingdom and is a popular qualification among specialist registrars in infectious disease. It is also suitable for doctors in gastroenterology, neurology, thoracic medicine, obstetrics, and paediatrics who have an interest in HIV medicine.

In September 2010, in the last year of my genitourinary medicine specialty training. The entry requirements include holding a medical …
Becoming a trainer in 2005
Authors: Karina Upton
Journal: BMJ (2005)

“It has also come at a time when... the increasing emphasis on “the measurable” seems to be taking us away from the heart of general practice” 

My own trainer seems to remember going on a residential weekend. He certainly had no assessment. His skills were gained through experience, reflection, and peer support. Was this enough? Was this (in his words), “perhaps a bit lacka-daisical”? The path to being a trainer is now highly structured—membership of the Royal College of General Practitioners (MRCGP) and three years of experience are an entry requirement to …