tbuckley/cabot-search huggingface dataset:
You’ve been bleeped: the confused patient
Authors: Hayley Andrews, Andrew Clarke, Sunjay Parmar, Sarah Stoneley, Charlotte Messer, Rakesh Patel
Journal: BMJ (2015)

#### Scenario

You are a foundation year one (FY1) doctor working a busy on-call ward cover shift. Your bleep goes off at 19:45–it’s staff nurse Laura, bleeping you for the second time about an 83 year old man who is confused on ward 3. You haven’t had a chance to make it there during your shift and as you pick up the phone you are aware that several outstanding tasks are left to do before you hand over at 21:30.

#### Bleep

“Hi doctor, sorry to bother you again. I am bleeping you about the same patient, Mr B Wildered. He is still shouting out, won’t stay in bed, and is wandering around the ward. I think he is seeing things now because he keeps pointing to things that are not there. He is starting to become aggressive and we need you to come to see him now. When do you think you’ll be with us?”

### How would you react to this bleep on the phone?

Dealing with confused patients is commonplace when carrying the bleep on a ward cover shift, with anywhere from 10% to 50% of hospital inpatients experiencing an episode of acute confusion during admission.1

When responding to this bleep you should aim to determine the nature of the confusion. Is it acute, chronic, or acute on chronic—that is, delirium in a patient with pre-existing dementia)? You should also be able to investigate and instigate initial management plans for the common causes of delirium. Lastly, you need to ensure that you understand the Mental Capacity Act (2005) and how to handle a situation where patients are a danger to themselves, staff, or other patients.2

Delirium is an acute confusional state that develops over a couple of days and has a fluctuating course. It is more common in patients older than 65 years; however it can occur at any age. …
Abstract P6-05-10: MicroRNA-137 inhibits cancer progression by targeting DEL-1 in triple negative breast cancer cells, MDA-MB-231
Authors: YS Chae, DW Baek, IH Lee, SJ Lee, RK Lee, J Lee, J Jung, H Park, J-H Jeong, J Kang, J Park
Journal: Cancer Research (2019)

Abstract Background: This study aimed to investigate the function of microRNA-137 in Del-1 expression in triple negative breast cancer (TNBC) cells and tissues. Methods: The Del-1 mRNA and microRNA levels were measured using a qRT-PCR in breast cancer cells (MDA-MB-231, MCF7, SK-BR3, and T-47D) and tissues from 20 patients with TNBC. The effects of miR-137 on cell proliferation, migration, and invasion were determined using MTT, wound healing, and Matrigel Transwell assays. Results: microRNA-137 (miR-137) levels were remarkably low and Del-1 mRNA expression was higher in MDA-MB-231 cells as compared to other breast cancer cell lines. The luciferase reporter assay revealed that miR-137 binds directly at the 3¢-UTR of Del-1 and that Del-1 expression was downregulated by miR-137 mimics and rescued by its inhibitors. Furthermore, miR-137 inhibited the cell proliferation, migration, and invasion of MDA-MB-231 cells. Moreover, among the 30 TNBC specimens, miR-137 was downregulated (p &amp;lt;0.0001) and the level of Del-1 in plasma was significantly elevated as compared to normal controls (p &amp;lt; 0.0001). Conclusions: In conclusion, miR-137 regulates Del-1 expression in TNBC via directly binding to the Del-1 gene, and thereby affects cancer progression. This suggests that miR-137 may be a new therapeutic biomarker for patients with TNBC. Keywords: Del-1, triple negative breast cancer, miR-137, biomarker Citation Format: Chae YS, Baek DW, Lee IH, Lee SJ, Lee RK, Lee J, Jung J, Park H, Jeong J-H, Kang J, Park J. MicroRNA-137 inhibits cancer progression by targeting DEL-1 in triple negative breast cancer cells, MDA-MB-231 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-05-10.
Trainee obstetrician is suspended for giving patient wrong advice and trying to conceal it
Authors: Clare Dyer
Journal: BMJ (2019)

A registrar in obstetrics and gynaecology who altered hospital records to conceal his mistaken advice to a patient in labour has been suspended from the UK medical register for two months.

Christopher Mawson told a patient who had gone into labour at 23 weeks’ gestation that her baby would not be viable because of its prematurity, when in fact a significant minority of babies survive such early births and there are treatment options to improve their chances.

He counselled not intervening to preserve the infant’s life, a decision that expert witnesses for both sides agreed that a paediatrician should have discussed with the parents.

It was also trust policy for a paediatrician to attend all births at 23-24 weeks’ gestation, yet Mawson did not summon a paediatrician or neonatologist, nor discuss the baby’s care with one, he admitted to the medical …
Examining the independent and joint effects of molecular genetic liability and environmental exposures in schizophrenia: results from the EUGEI study
Authors: Sinan Guloksuz, Lotta‐Katrin Pries, Philippe Delespaul, Gunter Kenis, Jurjen J. Luykx, Bochao D. Lin, Alexander L. Richards, Berna Akdede, Tolga Binbay, Vesile Altınyazar, Berna Yalınçetin, Güvem Gümüş‐Akay, Burçin Cihan, Haldun Soygür, Halis Ulaş, EylemŞahin Cankurtaran, Semra Ulusoy Kaymak, Marina M. Mihaljevic, Sanja Andric Petrovic, Tijana Mirjanic, Miguel Bernardo, Bibiana Cabrera, Julio Bobes, Pilar A. Saiz, María Paz García‐Portilla, Julio Sanjuan, Eduardo J. Aguilar, José Luis Santos, Estela Jiménez‐López, Manuel Arrojo, Angel Carracedo, Gonzalo López, Javier González‐Peñas, Mara Parellada, Nadja P. Maric, Cem Atbaşog˘lu, Alp Ucok, Köksal Alptekin, Meram Can Saka, Celso Arango, Michael O'Donovan, Bart P.F. Rutten, Jim van Os
Journal: World Psychiatry (2019)

Schizophrenia is a heritable complex phenotype associated with a background risk involving multiple common genetic variants of small effect and a multitude of environmental exposures. Early twin and family studies using proxy‐genetic liability measures suggest gene‐environment interaction in the etiology of schizophrenia spectrum disorders, but the molecular evidence is scarce. Here, by analyzing the main and joint associations of polygenic risk score for schizophrenia (PRS‐SCZ) and environmental exposures in 1,699 patients with a diagnosis of schizophrenia spectrum disorders and 1,542 unrelated controls with no lifetime history of a diagnosis of those disorders, we provide further evidence for gene‐environment interaction in schizophrenia. Evidence was found for additive interaction of molecular genetic risk state for schizophrenia (binary mode of PRS‐SCZ above 75% of the control distribution) with the presence of lifetime regular cannabis use and exposure to early‐life adversities (sexual abuse, emotional abuse, emotional neglect, and bullying), but not with the presence of hearing impairment, season of birth (winter birth), and exposure to physical abuse or physical neglect in childhood. The sensitivity analyses replacing the a priori PRS‐SCZ at 75% with alternative cut‐points (50% and 25%) confirmed the additive interaction. Our results suggest that the etiopathogenesis of schizophrenia involves genetic underpinnings that act by making individuals more sensitive to the effects of some environmental exposures.
Abstract P6-09-09: Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients
Authors: S-C Gwark, J Kim, YH Kim, MS Kim, JY Park, SB Lee, G Sohn, IY Chung, BS Ko, HJ Kim, JW Lee, BH Son, SH Ahn
Journal: Cancer Research (2019)

Abstract Background: We aimed to evaluate the clinical implication of circulating tumor cell (CTC) counts in correlation with prognosis and radiologic/pathologic response to therapy in locally advanced breast cancer patients undergoing preoperative systemic therapy. Methods: From Feb 2014 to May 2017, 207 patients without distant metastasis were prospectively enrolled from AMC. CTC counts were analyzed before-during-after the therapy. CTC isolation was performed using a SMART BIOPSY™ SYSTEM Isolation kit (Cytogen, Inc., Seoul, Korea). Recurrence-free and overall survival was analyzed according to CTC counts. Result: The mean follow-up period was 22.46 months and mean age was 46.48 years. One or more CTC was identified in 132 of 203 patients(65.0%) before NST, in 135 of 186 patients(72.0%) during NST and 103 of 171 patients(60.2%) after NST. Initial tumor burden at diagnosis -tumor size, lymph node metastasis- was not correlated with CTC positivity. Overall, CTC count ((≥1 CTC, ≥2 CTCs, and ≥5 CTCs) was not correlated with response to therapy. Using RECIST criteria, 86.5% (179/204) were responders (complete, partial response, CR/PR) and 12.1% (25/204) were non-responders (stable, progressive disease, SD/PD). 14.5% (30/207) showed a pathologic complete response (pCR), yet no association was found between CTC count/changes and radiologic/pathologic response to therapy. Also, CTC count was not correlated with prognosis among the whole population. However, HR+ tumors, CTC detection before NST was significantly associated with treatment response by RECIST criteria (responder vs. non-responder) (p=0.003, p=0.017 and p=0.023, respectively). Conclusions: Our findings support limited value of CTC count for locally advanced breast cancers undergoing neoadjuvant systemic therapy. Citation Format: Gwark S-C, Kim J, Kim YH, Kim MS, Park JY, Lee SB, Sohn G, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH. Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-09-09.
Serum Ethylamine Levels as an Indicator of <scp>l</scp>-Theanine Consumption and the Risk of Type 2 Diabetes in a General Japanese Population: The Hisayama Study
Authors: Toshiharu Ninomiya, Noriyuki Kanzaki, Yoichiro Hirakawa, Masahito Yoshinari, Mayu Higashioka, Takanori Honda, Mao Shibata, Satoko Sakata, Daigo Yoshida, Takanori Teramoto, Susumu Takemoto, Shozo Nishimoto, Jun Hata, Takanari Kitazono
Journal: Diabetes Care (2019)

This study investigated the association between serum ethylamine levels as an indicator of l-theanine consumption and the development of type 2 diabetes in a Japanese community.A total of 2,253 community-dwelling Japanese individuals aged 40-79 years without diabetes were monitored for 7 years. Serum ethylamine levels were divided into quartiles: ≤0.86, 0.87-2.10, 2.11-5.28, and ≥5.29 ng/mL. Kinetic analysis of serum ethylamine concentrations was performed after ingestion of l-theanine-rich green tea products containing 8 mg of l-theanine by 12 healthy volunteers.During follow-up, 282 subjects developed type 2 diabetes. The age- and sex-adjusted cumulative incidence of type 2 diabetes decreased significantly with elevating levels of serum ethylamine (P for trend = 0.04). This association remained unchanged after adjusting for potential confounding factors. The multivariable-adjusted hazard ratio (HR) for type 2 diabetes was significantly lower in the fourth quartile of serum ethylamine than in the first quartile (HR 0.69, 95% CI 0.49-0.98). This trend of decrease in diabetic risk across serum ethylamine levels was more prominent in middle-aged subjects and in subjects with prediabetes, obesity, or insulin resistance. Kinetic analysis estimated that the minimum concentration at the steady state was >5.90 ng/mL in the case of twice-daily ingestion with an interval of 12 h.Higher serum ethylamine was significantly associated with lower risk of the development of type 2 diabetes in a general Japanese population. The measurement of serum ethylamine concentration would be a useful biomarker for the objective estimation of l-theanine consumption.
On the first day of Christmas my patient gave to me . . .
Authors: Maham Khan
Journal: BMJ (2011)

The doctor-patient relationship is unique. It requires professional distance and an implementation of boundaries on the part of the doctor. As medical students, we are witnesses to how events might challenge those boundaries, potentially damaging the relationship if handled badly. But we can also nurture and strengthen it through good communication skills. Such events—for example, breaking bad news—can be easily recognised and prepared for through guidelines and training. Others might not be as straightforward and present themselves disguised as a box of chocolates or an exquisitely wrapped watch. With woolly guidelines and …
Abstract P4-13-04: Not presented
Authors: ME Cazzaniga, L Blasi, P Pronzato, M Giordano, O Garrone, M Donadio, L Del Mastro, L Livi, C Natoli, A Michelotti, A Turletti, F Riccardi, M De Laurentiis, P Marchetti, F Montemurro, E Romagnoli, S De Placido, L Biganzoli, A Bologna, E Bria, G Mustacchi
Journal: Cancer Research (2019)

Abstract This abstract was not presented at the conference. Citation Format: Cazzaniga ME, Blasi L, Pronzato P, Giordano M, Garrone O, Donadio M, Del Mastro L, Livi L, Natoli C, Michelotti A, Turletti A, Riccardi F, De Laurentiis M, Marchetti P, Montemurro F, Romagnoli E, De Placido S, Biganzoli L, Bologna A, Bria E, Mustacchi G. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-04.
Abstract BS1-3: New insights into early-stage bone colonization of disseminated breast cancer cells
Authors: X Zhang
Journal: Cancer Research (2019)

Abstract The fate of disseminated tumor cells is heavily influenced by their microenvironment niche. The osteogenic niche promotes cancer cell proliferation and bone metastasis progression. We investigated the underlying mechanisms using a variety of pre-clinical models and bioinformatics analyses of clinical data. We find that disseminated tumor cells may follow a “migration-by-tethering” mechanism to reach the osteogenic niche and establish tight direct interaction with the osteogenic cells. This interaction in turn profoundly alters signaling cascades in bone micrometastases. Heterotypic adherens junctions between cancer cells and osteogenic cells induce activation of the mTOR signaling. Gap junctions mediate calcium flux from osteogenic cells to cancer cells, and activate the calcium signaling. Upon the development of these junctions, ER signaling in ER+ breast cancer cells is dramatically suppressed, conferring endocrine independence. These alterations lead to unexpected therapeutic resistance and sensitivity, which were elucidated in part by a novel ex vivo bone-in-culture array system. Our findings, together with others in the literature, demonstrate the importance of considering microenvironment effects in metastatic therapies, and suggest novel therapeutic strategies to eliminate micrometastases. Citation Format: Zhang X. New insights into early-stage bone colonization of disseminated breast cancer cells [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr BS1-3.
Abstract P5-02-03: Testing machine learning algorithms' performance for non-invasively identifying breast cancer molecular subtypes using BI-RADS evaluations
Authors: A Ozcan, U Aksoy Ozcan, S Ekemen, S Ulus, B Oyan
Journal: Cancer Research (2019)

Abstract Purpose: Inter- and intra-observer variability adversely affects interpretation of highly advantageous MRI data in breast cancer diagnosis, prognosis and therapeutic decisions. Machine learning (ML) might potentially provide support to the physicians for objective decision strategies. In this work, ML methods using BI-RADS features were tested for non-invasively determining molecular subtypes of breast cancer. Methods: In this IRB approved study, Out of 126 consecutive patients' retrospective data with written consent, 69 patients (mean±std age 48.24±11.62 and range [27-82]) with full histopathological and MRI data were selected. In surgical histopathological data ER+PR+HER2- was classified as luminal HER2(-), ER+PR+HER+ was classified as luminal HER2(+), ER-PR-HER2+ was classified as HER2(enriched) and ER-PR-HER2- was classified as triple negative. The cohort revealed 51 luminal HER2(-), 11 luminal HER2(+), 7 triple negative cases without any HER2(enriched) occurrence. DCE, DW, T2W MRI data were obtained on a 1.5T Magnetom Espree (Siemens, Erlangen, Germany) scanner which were subsequently interpreted in consensus by 2 radiologists of 15 and 10 years of experience. Age, mass and non-mass properties, non-enhancing BI-RADS findings, ADC values obtained from radiologist drawn ROIS and kinetic curve properties were fed to 22 standard ML algorithms provided in Matlab® (Mathworks, Natick, MA, USA) as predictors for 3 categories. The algorithms were run by cross validating on 50 folds whereby reported classifier accuracy was obtained from each of the observations when in held-out fold. Results: Out of 22 ML algorithms tested Support Vector Machine's Fine Gaussian variant, Ensemble Boosted Trees and Fine K-Nearest Neighbor resulted in 76.8%,71.0% and 53.6% accuracy with (100%, 18%, 0%), (92%, 9%, 14%) and (67%, 18%, 14%) true positive rates for predicting each histopathological category respectively. Furthermore, PCA based dimension reduction worsened the outcomes indicating high sensitivity to the feature set. Conclusion: ML algorithms demonstrated potential as a decision support system increasing assessment objectivity with an added non-invasiveness advantage. However, overall algorithm performance indicates further studies with larger cohorts and broader feature are necessary for refinements and improving ML methodology in breast cancer imaging. Citation Format: Ozcan A, Aksoy Ozcan U, Ekemen S, Ulus S, Oyan B. Testing machine learning algorithms' performance for non-invasively identifying breast cancer molecular subtypes using BI-RADS evaluations [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-02-03.
Abstract P4-15-03: Not presented
Authors: K-D Yu, Z-M Shao
Journal: Cancer Research (2019)

Abstract This abstract was not presented at the conference. Citation Format: Yu K-D, Shao Z-M. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-15-03.
Estimating Neurologic Prognosis in Children
Authors: Monica E. Lemmon, Peter A. Ubel, Annie Janvier
Journal: JAMA Neurology (2019)

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Professionalism in medical students
Authors: Vimmi Passi
Journal: BMJ (2010)

The Kings Fund, in association with Student BMJ , held a series of consultations in 2009 and 2010 on professionalism in medical students to examine how it might affect their training and practice in the future. The report , 21st Century Doctor: Understanding the Doctors of Tomorrow summarises the consultations’ findings . 

The development of medical professionalism in undergraduate medical education is intended to ensure that future doctors maintain high professional standards in all aspects of patient care.1 Over the past decade, the importance of teaching medical professionalism has been emphasised by international experts in North America and Europe. However, there are currently no guidelines on the most effective ways of helping medical students to develop high standards of medical professionalism.2 Numerous definitions of medical professionalism have been provided by major medical organisations.2 This report used the Royal College of Physician’s definition, which describes medical professionalism as, “A set of values, behaviours and relationships that underpins the trust that the public …
Abstract 014: Comparative Cost-Effectiveness of 10-Year Atherosclerotic Cardiovascular Disease Risk Equations Over 10 Years of Follow-up: The Multi-Ethnic Study of Atherosclerosis
Authors: Gabriel S Tajeu, Ciaran Kohli-Lynch, Yiyi Zhang, Paul Muntner, Steven Shea, Andrew Moran
Journal: Circulation (2018)

Introduction: Uncertainty remains regarding the most efficient and cost-effective 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction tool for identifying moderate to high-risk patients for primary prevention statin treatment. Methods: We utilized the CVD Policy Model, a computer microsimulation model of ASCVD incidence, prevalence, mortality, and costs, to compare cost-effectiveness of statin treatment at varying 10-year predicted ASCVD risk thresholds for Framingham CVD (FRS-CVD), Reynolds Risk Score (RRS), and Pooled Cohorts Risk Equations over a 10-year time horizon in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cost effectiveness was assessed at predicted 10-year risk ≥ 20.0%, 15.0%, 10.0%, 7.5%, 5.0%, and 2.5%. We restricted the simulation cohort to participants aged 50 to 74 years who were not taking statins at baseline (n = 2,871). Moderate intensity statin treatment effectiveness was parameterized in the model as a 29% low-density lipoprotein cholesterol reduction. Total cost comprised statins ($100/year), side effect costs, and ASCVD event costs. Disability from treatment side effects and ASCVD events were included. Results: Average FRS-CVD, RRS, and Pooled Cohorts 10-year predicted ASCVD risks were 18.8%, 11.3%, 12.2%, for men and 8.9%, 4.3%, 6.6%, for women, respectively. At the same predicted risk, FRS-CVD consistently selected the most patients for treatment, and RRS the fewest ( Figure ). Compared with no treatment, treating patients with RRS ≥ 20% was cost saving in men. Subsequent risk threshold strategies with incremental cost effectiveness &lt;$75,000/quality-adjusted life-year (QALY) for men were: FRS-CVD ≥ 20% ($13,046), RRS ≥ 7.5% ($17,774), and RRS ≥ 5.0% ($19,891). For women, the non-dominated thresholds were: Pooled Cohorts ≥ 15% ($27,908) and Pooled Cohorts ≥ 7.5% ($72,377). Conclusions: At cost-effectiveness thresholds less than $75,000/QALY, RRS was the highest value tool for men while the Pooled Cohorts Risk Equations performed best for women.