bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing and Assessing Climate Change Education in a Pediatrics Residency Curriculum
Authors: McShane Mark , Kumar Shelley , Zuniga Linessa 
Published: December 2024

Background For physicians to effectively combat the growing health crisis that is climate change, they should begin learning during medical training about its health implications. However, there is little data on residents’ knowledge of the climate crisis, and even less data regarding the effectiveness and acceptability of climate change education in graduate medical training programs.
Objective To incorporate a new educational session on the health implications of climate change into a residency curriculum and evaluate the acceptability of the session and its effects on residents’ knowledge, attitudes, and perceptions of the topic.
Methods In July 2021, a 90-minute, interactive, small-group format educational session on the health implications of climate change was incorporated into the first-year curriculum of a pediatric residency program. From July 2021 through June 2023, resident participants completed pre- and post-session surveys that assessed their knowledge, attitudes, and perceptions regarding health implications of climate change. Likert scale data were analyzed using Wilcoxon signed-rank tests.
Results Of the 109 residents scheduled to participate, 50 (46%) completed both the pre- and post-session surveys. Session participation increased residents’ self-reported knowledge of how climate change impacts health and how physicians can act as climate advocates. Ninety-eight percent of all post-session respondents (58 of 59) agreed that they would recommend the session to other residents. With 3 facilitators, the monthly session required ≤4 hours of preparation and ≤12 hours of direct teaching time per facilitator each academic year.
Conclusions A single educational session improved residents’ self-reported knowledge of the health implications of climate change and was well-received by participants.
Development and Implementation of a Climate Change and Health Curriculum Into Pediatric Residency Education
Authors: Padgett Christina L. , Ventre Sarah J. , Orrange Susan M. 
Published: December 2024

Background There is an increasing body of evidence demonstrating the impacts of climate change on health. Physicians recognize the significance but feel unprepared to address it. Despite a call to action from prominent medical organizations, climate change and health (CCH) education has remained sparse.
Objective To describe the development and feasibility of a formal climate change curriculum tailored to pediatric residency programs and to assess residents’ pre-intervention knowledge and self-reported comfort with this topic.
Methods We created a longitudinal, single-institution CCH curriculum for pediatric and combined internal medicine-pediatrics residents. Implementation and evaluation began in May 2023 and is ongoing. Several educational strategies are utilized, and assessment tools include knowledge- and attitudes-based assessments, case-based exercises, reflective writing, grading rubrics, and patient encounter assessments. Feasibility was tracked.
Results Sixty-one residents were eligible for participation at the beginning of the study. Pre-intervention knowledge-based assessments were completed by 14 of the 61 residents (23.0%), and attitude-based questions were completed by 12 residents (19.7%). Baseline knowledge assessment showed varied proficiency in CCH topics, and attitudes data showed that while most respondents felt CCH education was important (11 of 12, 91.7%), no respondents felt “very comfortable” discussing these topics with patients. In the first year of the curriculum, after residents applied knowledge in a small-group, case-based exercise, most groups were graded as “not yet competent” in all categories utilizing a rubric.
Conclusions This study demonstrates that a CCH curriculum can be feasibly designed and implemented.
Sustainability in Action: A Financial Incentive for Trainees Embracing Environmentally Friendly Quality Improvement Projects
Authors: Chen Esther H. , Fuentes-Afflick Elena 
Published: December 2024

Background Engaging and motivating busy trainees to work on reducing the climate impact of their clinical practice is challenging. To our knowledge, there are no published studies of graduate medical education (GME)–wide, institutional efforts to engage residents in implementing climate sustainability improvement projects.
Objective We piloted a novel, institution-wide, pay-for-performance (P4P) sustainability quality improvement (SusQI) program in 2023-2024 that enabled residents from all GME programs to implement SusQI projects with practice-changing improvement goals for a financial incentive.
Methods Project leaders were provided an opportunity to implement a project by identifying a SusQI problem and collaborating with stakeholders toward meeting environmentally friendly monthly improvement goals for an incentive payment. Eligible residents who reached their monthly goal for 6 months of the academic year would receive $400.
Results Of the 4 SusQI projects approved for the P4P program, 3 remained active after 6 months. One project stalled because of institutional barriers. Two hundred and ten residents participated. Environmental impacts included an increase in low anesthetic gas flow use in operating room cases (mean [SD] 25% to 53% [0.1]), increase of radiology workroom waste sorting into recycling and composting bins (mean [SD] 20% to 58% [0.1]), and increase in emergency department instruments recycled (mean [SD] 9% to 24% [0.2]). Two hundred and ten residents are set to receive $84,000 at the end of the year for meeting their SusQI goals.
Conclusions We were able to integrate sustainability into QI programs by implementing an institution-wide pay-for-performance SusQI program that encouraged residents to develop and implement environmentally friendly practice projects.
Adapting the Planetary Health Report Card for Graduate Medical Training Programs
Authors: Schear Sarah , Hampshire Karly , Diedrich Taylor , Waters Isabel , Barber Aisha 
Published: December 2024

Background Leading medical organizations recognize climate change as an urgent threat to public health and social justice. Medical students created the Planetary Health Report Card (PHRC) to evaluate and spur climate action in medical schools. Graduate medical trainees lack a similar tool to evaluate and improve their training programs and institutions.
Objective To adapt the PHRC to graduate medical education (GME) contexts and report preliminary validity evidence.
Methods In 2023, based on literature review, we adapted the 2022 undergraduate medical PHRC metrics on curriculum and sustainability. We modified keywords in all PHRC domains to apply to GME. We recruited participants with expertise in planetary health, sustainability, and health equity affiliated with GME. Using a modified Delphi Panel method, we surveyed participants on adapted metric validity. We determined percent agreement among participants.
Results We recruited 45 eligible participants, of whom 20 (44%) completed a first-round survey. Participants included a senior medical student, residents, fellows, faculty, and program directors from the United States, Canada, and the United Kingdom. Participants had a high level of agreement on metrics in the domains of curriculum, support for trainee-led initiatives, and sustainability. Some metrics in research and community engagement domains fell below the agreement threshold.
Conclusions In the first round of a modified Delphi Panel survey, trainees and faculty agreed that metrics adapted from the PHRC are relevant to evaluating GME programs on planetary health, sustainability, and environmental justice.
Understanding ACGME Standards for Simulation: A Document Analysis of Institutional and Program Requirements
Authors: Scott Alexis E. , Campbell Krystle K. , Carey Jeanne , Velez Larissa , Ambardekar Aditee , Scott Daniel J. 
Published: December 2024

Background Our institution has established priorities for graduate medical education (GME) simulation which include increasing adoption of, garnering additional financial support for, and creating a core simulation curriculum. Better understanding of the Accreditation Council for Graduate Medical Education (ACGME) simulation requirements will inform our efforts and serve as a guide for other institutions.
Objective The purpose of this study was to perform a structured review of ACGME simulation standards using a document analysis to guide GME simulation activities at an institutional level.
Methods A document analysis was performed from May 2023 to June 2024 to select and search ACGME Institutional and Program Requirements corresponding to the primary specialties for 21 clinical departments that financially support our simulation center. Content relevant to simulation was identified, and iterative coding with investigator team consensus was performed to assign categories, characterize the requirements, and interpret the findings.
Results Twenty-four documents included 120 simulation requirements that were assigned to 12 categories; 70 (58%) requirements were mandatory whereas 50 (42%) were not, and 48 (40%) were simulation-specific, whereas 72 (60%) were simulation-optional. All reviewed specialties had simulation requirements (average 5.4, range 2-12), but the ACGME Institutional Requirements did not. Moderate to strong evidence supported (1) simulation usage by all 21 departments; (2) the need for institutional resource support; and (3) institutional-level patient safety simulation curricula.
Conclusions This study identified a large number of simulation requirements, including mandatory patient safety curricula requirements, for all specialties analyzed.
Just-in-Time Simulation Training to Augment Overnight ICU Resident Education
Authors: Rabinowitz Raphael , Drake Carolyn B. , Talan Jordan W. , Nair Sunil S. , Hafiz Ali , Andriotis Anthony , Kogan Rebecca , Du Xinyue , Li Jian , Hua Wanyu , Lin Miao , Kaufman Brian S. 
Published: December 2024

Background Patients who decompensate overnight experience worse outcomes than those who do so during the day. Just-in-time (JIT) simulation could improve on-call resident preparedness but has been minimally evaluated in critical care medicine (CCM) to date.
Objective To determine whether JIT training can improve residents’ performance in simulation and if those skills would transfer to better clinical management in adult CCM.
Methods Second-year medicine residents participated in simulated decompensation events aligned to common medical intensive care unit (MICU) emergencies predicted to occur overnight by their attending intensivist. Simulation faculty scored their performance via critical action checklists. If the event occurred, MICU attendings rated residents’ clinical management as well. At the rotation’s conclusion, a variant of one previously trained scenario was simulated to assess for performance improvement. Resident perceptions were surveyed before, during, and after completion of the study.
Results Twenty-eight residents participated; 22 of 28 (79%) completed the curriculum. Management of simulated decompensations improved following training (initial simulation checklist completion rate 60% vs 80% final simulation, P≤.001, Wilcoxon r=0.5). Predicted events occurred in 27 (45%) of the 60 shifts evaluated, with no observed difference in faculty ratings of overnight performance (median rating 4.5 if trained vs 3.0 if untrained; U=58.50; P=.12; Mann-Whitney r=0.30). Residents’ self-reported preparedness to manage MICU emergencies improved significantly following training, from a median of 3.0 to 4.0 (P=.006, Wilcoxon r=0.42).
Conclusions JIT simulation training improved residents’ performance in simulation.
Crohn's disease revealed by duodenal stenosis: About one case
Authors: Chetibi Abdelkrim , Ghazali Malika , Kadem Said , Ghemit Rachid , Lamine Abbou Mohamed , Saidani Mustapha 
Published: December 2024

Crohn's disease can affect the entire digestive tract; however, it is rare to be presented with a duodenal involvement complicated by stenosis. Here, we report a case of a 27-year-old woman who began her Crohn’s disease with symptomatic duodenal stenosis, with repercussions on the general condition. The diagnosis was confirmed by gastrointestinal endoscopy and the patient was operated on after failure of medical treatment. She has benefited from a gastroenteroanastomosis and the postoperative follow-up was favourable.
Received: November 15th, 2023
Accepted: June 20th, 2024
https://dx.doi.org/10.4314/aamed.v17i4.14
Dysphagia as dominant symptom of posterior circulation stroke: a case report illustrating the diagnostic difficulty
Authors: Mahavivola Ernestho-ghoud Indretsy , Rasolonjatovo Emilson Charles , Lova Hasina Rajaonarison Ny Ony Narindra , Abdou Soilihi Moustafa , Ahmad Ahmad , Enintsoa Raveloson Nasolotsiry , Andriamamonjy Clement , Danielle Vololontiana Hanta Marie 
Published: December 2024

Posterior ischemic strokes are relatively rare and difficult to diagnose. Its main differential diagnosis is made with cerebral neoplasia. In the present article, we report an atypical case of a 70-year-old man, who presented with dysphagia as a dominant symptom with right facial palsy and right hemiparesis, associated with a chronic biological inflammatory syndrome. A brain cancer cause would be the most expected diagnosis. Brain MRI revealed multiple foci of bilateral posterior ischemic stroke suggestive of an embolic cause. Medical investigations allowed excluding cardioembolic disease, infectious, malignancies and other rheumatic affections. The only cause highlighted was a significant bilateral atheromatous spinal stenosis.
Received: March 7th, 2024
Accepted: July 25h, 2024
https://dx.doi.org/10.4314/aamed.v17i4.15
Extradural hematoma at the Kinshasa University Hospital: clinico-scannographic profile and post-treatment evolution
Authors: Mayindou Ketani Teddy , Londa Panzu Marthe , Muana Kabongo Jean-Richard , Mpoyi Tshiunza Chérubin , Eba Ntsambi Glennie 
Published: December 2024

Context and objective. The advent of two-wheeled vehicles has led to an increase in head injuries in Kinshasa. The objectives of the study were to describe the clinical profile of consequent extradural haematomas (EDH) and to investigate the determinants of post-therapeutic outcome. Methods. This was an analytic series of EDH cases followed up at Kinshasa University Hospital between January 2002 and December 2018. Variables of interest included clinical and therapeutic data as well as therapeutic course. Chi-square tests and linear regression were used, to compare proportions and establish the relationship between variables, respectively. Results. One hundred and two patient records (mean age 28.3 ± 15.2 years, male sex 92%) with EDH were compiled. Traffic accidents were the main etiology (70.6%). Focal and lateral signs were observed in 57.8% and 46.1% of cases, respectively. Head injuries were considered mild in 61.8% of cases, and severe in 18.6%. The median diagnosis time was 3 days, with 59% of associated intracerebral lesions and 75.5% of cranial fractures. Median operating time was 2 days. The mortality rate was 14.7%, and the median hospital stay was 21 days (1 and 119 days). Mortality was related to Glasgow coma score on admission (p<0.0001), delayed management (p=0.02), polytrauma context (p=0.021), existence of associated brain lesions (p=0.018), anisocoria and tight miosis (<0.0001). There was an association between hematoma volume, location (y=0.0026x+29, 713 / R2=3E-05) and time to management (y=1.1852x + 44.396/R2=0.0522). Conclusion. Diagnostic and therapeutic delays in EDH are long, justifying the high mortality, especially in cases of polytrauma and pupillary anomaly.
Received: February 3rd, 2024
Accepted: June 28th, 2024
https://dx.doi.org/10.4314/aamed.v17i4.4
Assessing dimensions of resilient safety culture in construction firms in Abuja
Authors: Shehu I.U. , Bala K. , Aliyu S.S. , Muhammad S. , Kado D. 
Published: December 2024

A resilient safety culture e involves continuous improvements in safety performance and the ability to foresee and anticipate the changing nature of safety risks in complex sociotechnical systems. This study aims to assess the dimensions of resilient safety culture (RSC) in Nigerian construction firms. A total of 132 questionnaires were distributed to medium and large construction firms within Abuja metropolis. The study found that construction firms in the area studied have implemented eight ( 8) safety practices each for psychological resilience and behavioural resilience. The implementation of these safety practices showcases the construction firms’ commitment to enhancing both the mental well well-being of employees and the behavioural aspects that contribute to overall safety. Additionally, nine ( 9) safety practices have been implemented for managerial resilience, emphasising the critical role of top management in fostering a resilient safety culture. These findings collectively suggest that the construction firms are actively striving to foster a resilient safety culture throughout their organisations. Based on these findings, the study recommends that construction firms can define, assess, and enhance their RSC by implementimplementing psychological, behavioural and managerial resilience framework . The assessment of these three dimensions suggests that maintaining consistently high safety performance in construction firms requires addressing not only project-specific hazards but also unexpected events, such as human error and unforeseen hazardous situations. The outcomes of this research contribute to construction safety management knowledge by advancing a theoretical foundation and empirical basis for defining and assessing resilient safety culture within the construction firms.
Intradural sequestration of lumbar disc herniation with cranial migration: a case report
Authors: Evzikov Grigoriy Yu. , Bashlachev Mikhail G. , Gaydash Maksim I. 
Published: December 2024

Intradural herniation of the intervertebral disc (IHID) is extremely rare. There are only a few reports of cranial migration of an intradural fragment of a sequestered disc herniation.Clinical case. A 51-year-old patient who had previously undergone two operations at L5–S1 and L4–L5 levels was admitted to the hospital with complaints of low back pain with radiation to both legs, numbness in the perineum and inner surface of the thighs, urinary retention, constipation. Magnetic resonance imaging revealed a 30 mm mass located at the level of the L3 vertebral body, within the dural sac and filling its entire transverse diameter. The cauda equina nerve roots were compressed. Surgery was performed: the herniated sequestrum (30×10×10 mm) was separated from the nerve roots fixed to it and removed. After surgery, sensation in the buttocks and inner thighs returned, and urinary urge appeared. Rehabilitation is ongoing.Discussion. In most cases, IHID is diagnosed intraoperatively. In the presented case, the genesis of the formation remained unclear before surgery, so a laminectomy approach was chosen, which allowed for extensive revision of the intradural space, thorough radiculolysis, and identification of the cranial migration of the sequestrated disc herniation. The only effective treatment for IHID is surgery.
Escape Room: ¡Sé inteligente, Muévete!: Una propuesta didáctica para conocer los efectos del ejercicio físico en la salud mental y cerebral en Educación Primaria
Authors: Violero Mellado Jesús , Segovia Yessica , Redondo-Tébar Andrés , Sánchez-López Mairena , Bermejo-Cantarero Alberto , Navarro-Martínez Óscar , Ruiz-Hermosa Abel , Díez-Fernández Ana , Visier-Alfonso María Eugenia 
Published: December 2024

Introducción: La alta prevalencia del sedentarismo y la insuficiente actividad física en la infancia es un problema persistente con graves repercusiones para la salud y el rendimiento escolar. Las escuelas, respaldadas por las leyes educativas que subrayan su importancia, deben fomentar hábitos y estilos de vida saludables y activos. Estrategias como los Escape Rooms, que motivan y fomentan la colaboración y la reflexión, podrían ser efectivas para enseñar al alumnado los beneficios de la actividad física y la reducción del sedentarismo para la salud física y mental.
Objetivo: El objetivo de este trabajo es presentar una experiencia didáctica mediante el Escape Room “¡Sé inteligente, Muévete!” para que el alumnado de Educación Primaria conozca los efectos de los hábitos saludables y la actividad física en la salud mental y cerebral. Además, se evaluó la percepción de aprendizaje y disfrute de los y las participantes.
Resultados: Los resultados mostraron una alta percepción de aprendizaje y disfrute. Las chicas puntuaron más alto en disfrute que los chicos, aunque sin diferencias estadísticamente significativas. No se encontraron diferencias estadísticamente significativas en la percepción de aprendizaje por curso, aunque los estudiantes de 3º curso puntuaron más alto que el resto de los grupos. En cuanto al disfrute, el alumnado de 6º curso percibió un menor disfrute que el resto de los cursos.
Conclusiones: El Escape Room "¡Sé inteligente, Muévete!" mostró ser divertido y efectivo para adquirir conocimientos y reflexionar sobre los efectos de los hábitos saludables y la actividad física en la salud mental y cerebral.
Revival
Authors: Carter Eric D. 
Published: December 2024

Abstract
This chapter focuses on how actors, networks, and ideas wove together to construct a distinctive field, social medicine, during the 1970s and 1980s. This chapter begins with a discussion of Juan César García, a PAHO functionary who initially shaped this second-wave Latin American social medicine network. Meanwhile, in Chile, the overthrow of Allende in 1973 not only meant a reversal of hard-won progress in health equity but also scattered a group of health workers into exile across the world, many to be absorbed into the growing network of Latin American social medicine. The experience of political exile and authoritarian regimes is also a theme in the last two sections of the chapter, focused on Argentina and Brazil and their roles in the new LASM. In Argentina, a small group of scholars interested in social medicine, based largely in Buenos Aires and Rosario, carried on their work clandestinely or in exile during the dictatorship, without having much impact on health policy or even on the teaching of health social sciences, at least not immediately. By contrast, in Brazil a movement that came to be known as collective health developed rapidly, achieving the most thorough institutionalization of any of the national groups in the new social medicine.
Resistance
Authors: Carter Eric D. 
Published: December 2024

Abstract
This chapter focuses primarily on the translation of second-wave Latin American social medicine (LASM) ideas from the realm of academia into progressive health policy. This chapter begins with a discussion of the landmark health reform that took place in Brazil during the 1980s and 1990s, which culminated in the creation of the SUS, the country’s unified health system, possibly the most noteworthy achievement of the second wave of LASM. But this achievement of collective health in Brazil was not widely emulated, due to unfavorable conditions produced by the rise of free-market ideologies across the region. The LASM community mounted a fierce critique of neoliberalism from academia, and when the Pink Tide came, starting in the late 1990s, LASM found an opportunity to directly influence health policy, including in Venezuela, Bolivia, and Mexico City. Cuba and Costa Rica are also considered: these two often-cited public health “success stories” from the Global South have seen little of the cutting-edge social theory and militant political praxis that have characterized social medicine over the past few decades.