tbuckley/cabot-search huggingface dataset:
Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications
Authors: J. Witte, K. Mehlis, B. Surmann, R. Lingnau, O. Damm, W. Greiner, E.C. Winkler
Journal: Annals of Oncology (2019)

Patients experiencing financial distress as a side-effect of cancer are not only reported in the United States, but also in third-party payer healthcare systems in Europe. Since validated survey instruments are a prerequisite for robust and comparable results, we aimed to compile and classify available instruments to enable both a better understanding of the underlying construct of financial toxicity and to facilitate further studies that are adjustable to various healthcare systems. We did a systematic literature search on studies that provide data on perceived cancer-related financial distress experienced by adult patients using PubMed, CINAHL and Web of Science databases up to 2018. We analyzed all detected instruments, items domains and questions with regard to their wording, scales and the domains of financial distress covered. Among 3298 records screened, 41 publications based on 40 studies matched our inclusion criteria. Based on the analysis of 352 different questions we identified 6 relevant subdomains that represent perceptions of and reactions to experienced financial distress: (i) active financial spending, (ii) use of passive financial resources, (iii) psychosocial responses, (iv) support seeking, (v) coping with care or (vi) coping with ones' lifestyle. We found an inconsistent coverage and use of these domains that makes it difficult to compare and quantify the prevalence of financial distress. Moreover, some existing instruments do not reflect relevant domains for patients in third-party payer systems. There is neither a consistent understanding of the construct of financial burden nor do available instruments cover all relevant aspects of a patients' distress perception. We encourage using the identified six domains to further develop survey instruments and adjust them to different health systems.
A lump in the vulva
Authors: Nisha Lakhi, Abha Govind
Journal: BMJ (2008)

A 29 year old Nigerian woman presented with a history of a swelling in the vulval area of two months' duration. She had no history of pain, tenderness, or vaginal discharge. Her menstrual cycles were regular. Previous cervical smears and gynaecological examination were normal. On examination, she had a large mass in the right labia. It was painless, non-tender, and fluctuant. It was distending the whole of the labium majus on the right (fig 1). Fig 1 She had excision biopsy under general anaesthetic, with good results (fig 2). Fig 2
Oral education is inadequate
Authors: Manjulika Das
Journal: BMJ (2005)

Medical students receive inadequate education on common oral diseases, and their diagnoses of oral disorders are poor, research in the British Journal of Oral and Maxillofacial Surgery claims (2005;43: 61-4).

Only half of the UK medical schools that responded teach oral pathology. And only 28% of medical staff could diagnose cases of oral diseases properly, compared with 89% of dentists.

Researchers investigated whether UK medical students, doctors, and dentists could …
Phantoms in the Brain
Authors: Sally-Ann S Price
Journal: BMJ (2000)

Professor Ramachandran is billed as one of the world's leading neuroscientists. His book is intended to be accessible to a lay audience, and cases from it have recently been seen in a television series. His subject is clearly of interest to medical students. Ramachandran presents bizarre cases of neurological problems where brain dysfunction has resulted in strange symptoms.

Examples include the impressively titled somatoparaphrenia, a syndrome where the patients deny that part of their …
US court ruling could end positive discrimination
Authors: Karen Hebert
Journal: BMJ (2003)

A US Supreme Court ruling is awaited, which may stop any consideration of race in medical school admissions.

The ruling could change future American university admissions procedures, by banning the use of affirmative action by universities, including medical schools, in decisions about admissions.

Cases were brought against the University of Michigan by Barbara Grutter and Jennifer Gratz. Grutter is a white female whose law school application was rejected. Gratz and Patrick Hamacher, both white, are …
Book review: Medical Ethics and the Future of Healthcare
Authors: Michael Maltese
Journal: BMJ (2000)

This wide ranging compilation of lectures, hosted by the Adelaide Hospital Society in Dublin in 1999, kicks off with a great overview of the current state of medical ethics. This sets the stage for an edited text that is meant to provide the lay reader with a basic introduction to medical ethics. Unfortunately, the varied chapters fall victim to discontinuity, reducing this work to an insufficient reference resource.

The book does cover some of the basics of ethics, such as patient autonomy …
A Landscape of Transcriptome Sequencing in Childhood Immune Thrombocytopenia(ITP)
Authors: Congcong Sun, Lixian Chang, Yanling Lv, Liu Chao, Chenghai Xue, Shunli Yang, Yang Lan, Xiaoyan Chen, Yingchi Zhang, Jinxia Guan, Xiaofan Zhu
Journal: Blood (2017)
Liquid Biopsy: Is There an Advantage to Analyzing Circulating Exosomal DNA Compared to cfDNA or Are They the Same?
Authors: Christoph Kahlert
Journal: Cancer Research (2019)

Abstract Cancer is one of the leading causes of death worldwide. This life-threatening disease requires novel strategies for the early detection and therapy response prediction. Circulating DNA was first described 70 years ago. However, only the recent evolution in the PCR-based sequencing techniques allow the minimally invasive molecular profiling of circulating mutant DNA from small-volume “liquid biopsies” such as blood, urine, or saliva. In this article, we aim to summarize the fast-growing evidence for cfDNA and exosomal DNA as minimally invasive diagnostic markers in solid tumors and to highlight their opposing diagnostic advantages and disadvantages.
HIV testing no longer needs special status
Authors: Kaveh Manavi, Philip D Welsby
Journal: BMJ (2005)

Before highly active antiretroviral therapy (HAART) was introduced, the advantages to infected individuals of knowing their HIV status were minimal, and counselling before HIV testing was the recommended practice.1 This usually limited testing by relying on people who were obviously at risk presenting themselves for testing. Such groups included injecting drug users and men who have sex with men and their sexual contacts. Targeting of these groups will become an increasingly less useful concept as HIV continues to spread into the population that is conventionally not at risk.



KUTZUTOMO KAWAI/PHOTONICAHIV can affect anyone



Do we need to reconsider if routine voluntary counselling and testing is appropriate today? Since 1991 heterosexual transmission of HIV has been the most common mode of transmission in the United Kingdom.2 Currently, nearly half of those infected heterosexually and a quarter of infected men who have sex with men in the United Kingdom are undiagnosed.3 A quarter of newly diagnosed patients in the United Kingdom in 2002 were diagnosed late with serious immunosuppression.3 Unless further initiatives are undertaken the epidemic will worsen. Possible initiatives would be to lower thresholds for HIV testing by reducing the emphasis on pre-test counselling.

Reasons for low HIV testing rates and thus low detection …
Tumor microenvironment-driven non-cell-autonomous resistance to antineoplastic treatment
Authors: Yidi Qu, Bo Dou, Horyue Tan, Yibin Feng, Ning Wang, Di Wang
Journal: Molecular Cancer (2019)

Drug resistance is of great concern in cancer treatment because most effective drugs are limited by the development of resistance following some periods of therapeutic administration. The tumor microenvironment (TME), which includes various types of cells and extracellular components, mediates tumor progression and affects treatment efficacy. TME-mediated drug resistance is associated with tumor cells and their pericellular matrix. Noninherent-adaptive drug resistance refers to a non-cell-autonomous mechanism in which the resistance lies in the treatment process rather than genetic or epigenetic changes, and this mechanism is closely related to the TME. A new concept is therefore proposed in which tumor cell resistance to targeted therapy may be due to non-cell-autonomous mechanisms. However, knowledge of non-cell-autonomous mechanisms of resistance to different treatments is not comprehensive. In this review, we outlined TME factors and molecular events involved in the regulation of non-cell-autonomous resistance of cancer, summarized how the TME contributes to non-cell-autonomous drug resistance in different types of antineoplastic treatment, and discussed the novel strategies to investigate and overcome the non-cell-autonomous mechanism of cancer non-cell-autonomous resistance.
Systematic review: presumed consent for organ donation
Authors: Helen Macdonald
Journal: BMJ (2009)

How does policy affect rates of organ donation? There are not enough donor organs to meet the demand in many countries, and the situation is expected to worsen. This is because people are living longer, and conditions such as type 2 diabetes, a common cause of end stage renal failure that needs transplantation, are increasing. The authors explain this background in their introduction. In the United Kingdom an organ donation taskforce has been created to find ways to increase organ donation. It published its recommendations on one way of increasing donation, presumed consent, in November 2008. The authors prepared this systematic review to help the taskforce consider presumed consent for the UK. Currently, in the UK people have to opt in if they want to donate their organs. In 2007 just 24% of the UK population were on the register, despite 90% being in favour of donation in general.1 This means doctors have to approach families in the difficult period around a patient’s death to ask relatives about organ donation, and 40% say no.2 In other countries, such as Spain, the onus is on individuals to opt out of donation, otherwise their consent to donation is presumed. Countries with presumed consent have some of the highest rates of organ donation. But it is not clear if presumed consent causes increased organ donation or if other factors are involved. These authors have tried to answer two questions: does presumed consent increase organ donation? And what do the public think about presumed consent for organ donation? Their results helped the taskforce to make recommendations on UK organ donation policy. #### The paper #### Abstract
Abstract 16543: The Atherosclerosis Candidate Gene Product Kalirin Reduces Atherosclerosis via Macrophage-Specific Mechanisms
Authors: Jiaohui Wu, A. Kyle Davidson, Alexander C Fanaroff, Lisheng Zhang, Karsten Peppel, Leigh Brian, Betty A Eipper, Richard E Mains, Neil J Freedman
Journal: Circulation (2017)

Kalirin is a 270-kDa scaffolding protein comprising 2 GTP exchange factors (GEFs). KALRN has been associated with human atherosclerosis (athero) in multiple genetic studies, and carotid injury prod...
Science and health communication
Authors: Tiago Villanueva, Irina Haivas
Journal: BMJ (2005)

Science and health communication is the interface between science and medicine, and the media. SciDev (www.scidev.net) is a massive hub of information on science communication and a great place to start. With its colourful fancy looks, it reads like a magazine, with weekly updated news, editorials, features, and book reviews. But there is more - for instance, sections devoted to particular scientific issues of each of the developing world regions, and the dossiers section offers a comprehensive approach to current hot topics in science. And the …
Defining the Hallmarks of Metastasis
Authors: Danny R. Welch, Douglas R. Hurst
Journal: Cancer Research (2019)

Abstract Metastasis is the primary cause of cancer morbidity and mortality. The process involves a complex interplay between intrinsic tumor cell properties as well as interactions between cancer cells and multiple microenvironments. The outcome is the development of a nearby or distant discontiguous secondary mass. To successfully disseminate, metastatic cells acquire properties in addition to those necessary to become neoplastic. Heterogeneity in mechanisms involved, routes of dissemination, redundancy of molecular pathways that can be utilized, and the ability to piggyback on the actions of surrounding stromal cells makes defining the hallmarks of metastasis extraordinarily challenging. Nonetheless, this review identifies four distinguishing features that are required: motility and invasion, ability to modulate the secondary site or local microenvironments, plasticity, and ability to colonize secondary tissues. By defining these first principles of metastasis, we provide the means for focusing efforts on the aspects of metastasis that will improve patient outcomes.
Always a medical student
Authors: Rakesh Biswas
Journal: BMJ (2003)

I started as a medical student 15 years ago. Now I am part of a teaching faculty, but I still feel like a student. The professor also feels the same way after 40 years. Science is always changing, and whatever we learn today is soon washed away by a deluge of newer evidence.

I remember how much I was in awe of my seniors, who always seemed to know so much. I thought that I too would know as much when I got to be a senior. Many years later and that moment of increased knowledge never came; I only find myself being thought of as more knowledgeable by my juniors. Whatever we learnt was instilled in us, such as the capability to …
Shadow in Tiger Country
Authors: Sally-Ann S Price
Journal: BMJ (2001)

When she was told that she had an incurable brain tumour and had only one year to live, Louise (“Weeze”) Arthur made an unusual decision: to set up an internet diary. She wrote this until just before she died earlier last year. After she died her husband, Tim, constructed this book, a compilation of the diary and his reflections on Louise's life.

The book's message is “Life is …
Video clip assessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise
Authors: Sandrine Jousse-Joulin, Maria Antonietta D'Agostino, Celine Nicolas, Esperanza Naredo, Sarah Ohrndorf, Marina Backhaus, Giorgio Tamborrini, Isabelle Chary-Valckenaere, Lene Terslev, Annamaria Iagnocco, Paz Collado, Cristina Hernández-Díaz, Frederique Gandjbakhch, Wolfgang A Schmidt, Georgios Filippou, Christian Dejaco, Martin Helmut Stradner, Mohamed Atia Mortada, Alojzija Hočevar, Stavros Chrysidis, Ghada El Mardenly, Juan José de Agustín, Ralf Thiele, Daryl K MacCarter, Stephanie Finzel, Petra Hanova, Alen Zabotti, Cornelia Glaser, Zarrin Alavi, Daniel Sten Hammenfors, Florence Gatineau, George AW Bruyn
Journal: Annals of the Rheumatic Diseases (2019)

To develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren's syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.Twenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren's syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1-5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.Consensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen's kappa 0.81) and inter-reader reliability was good (Light's kappa 0.66).New definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.
Acute abdominal pain in an older patient
Authors: Joseph Keighley, David Howlett
Journal: BMJ (2019)

An 84 year old woman with a history of atrial fibrillation, angina, and transient ischaemic attack presented to the emergency department with vomiting and acute abdominal pain, most severe in the right iliac fossa. She reported no alteration in bowel habit. During a recent hospital admission following a fall at home, the patient had not reported any abdominal pains and she had been well at the time of discharge. Initial observations were within normal limits and clinical examination revealed generalised abdominal tenderness. Blood results showed a metabolic acidosis, elevated lactate, and raised inflammatory markers (table 1). She was referred for urgent …
Precision Medicine in Internal Medicine
Authors: Krzysztof Kiryluk, David B. Goldstein, John W. Rowe, Ali G. Gharavi, Ronald Wapner, Wendy K. Chung
Journal: Annals of Internal Medicine (2019)

Medicine has long sought to match diagnostic and treatment approaches to the particular needs and risks of individual patients. The decreasing cost and increasing ease of genetic sequencing have propelled the rise of precision medicine. Precision medicine aims to use genetic and other information to provide care tailored to the individual patient, with the goal of improving clinical outcomes and minimizing unnecessary diagnostic and therapeutic interventions. Although developments in genetic sequencing have the potential to transform clinical care, there are important limitations, including uncertainty in the clinical interpretation of many genetic variants and concerns about privacy, discrimination, and cost. To help clinicians understand the basics of genetic sequencing and how to apply it in clinical practice, Annals of Internal Medicine is launching a new "Precision Medicine" series. This introduction provides a general overview of clinical sequencing, with a focus on germline variation. Subsequent articles will use a case-based format to provide concise summaries of specific clinical precision medicine scenarios that are relevant to the practice of internal medicine. These cases will highlight specific clinical indications; interpretation of genetic test results; and ethical, legal, cost, and privacy issues related to genetic testing. The goal is to provide practical information on the appropriate application and interpretation of genomics in routine clinical practice.
Association of response to TNF inhibitors in rheumatoid arthritis with quantitative trait loci for <i>CD40</i> and CD39
Authors: Athina Spiliopoulou, Marco Colombo, Darren Plant, Nisha Nair, Jing Cui, Marieke JH Coenen, Katsunori Ikari, Hisashi Yamanaka, Saedis Saevarsdottir, Leonid Padyukov, S Louis Bridges Jr., Robert P Kimberly, Yukinori Okada, Piet L CM van Riel, Gertjan Wolbink, Irene E van der Horst-Bruinsma, Niek de Vries, Paul P Tak, Koichiro Ohmura, Helena Canhão, Henk-Jan Guchelaar, Tom WJ Huizinga, Lindsey A Criswell, Soumya Raychaudhuri, Michael E Weinblatt, Anthony G Wilson, Xavier Mariette, John D Isaacs, Ann W Morgan, Costantino Pitzalis, Anne Barton, Paul McKeigue
Journal: Annals of the Rheumatic Diseases (2019)

We sought to investigate whether genetic effects on response to TNF inhibitors (TNFi) in rheumatoid arthritis (RA) could be localised by considering known genetic susceptibility loci for relevant traits and to evaluate the usefulness of these genetic loci for stratifying drug response.We studied the relation of TNFi response, quantified by change in swollen joint counts ( Δ SJC) and erythrocyte sedimentation rate ( Δ ESR) with locus-specific scores constructed from genome-wide assocation study summary statistics in 2938 genotyped individuals: 37 scores for RA; scores for 19 immune cell traits; scores for expression or methylation of 93 genes with previously reported associations between transcript level and drug response. Multivariate associations were evaluated in penalised regression models by cross-validation.We detected a statistically significant association between Δ SJC and the RA score at the CD40 locus (p=0.0004) and an inverse association between Δ SJC and the score for expression of CD39 on CD4 T cells (p=0.00005). A previously reported association between CD39 expression on regulatory T cells and response to methotrexate was in the opposite direction. In stratified analysis by concomitant methotrexate treatment, the inverse association was stronger in the combination therapy group and dissipated in the TNFi monotherapy group. Overall, ability to predict TNFi response from genotypic scores was limited, with models explaining less than 1% of phenotypic variance.The association with the CD39 trait is difficult to interpret because patients with RA are often prescribed TNFi after failing to respond to methotrexate. The CD39 and CD40 pathways could be relevant for targeting drug therapy.