bluuebunny/crossref_metadata_2025_split huggingface dataset:
Footprints of Birth: An Innovative Educational Intervention Foregrounding Women's Voices to Improve Empathy and Reflective Practice in Maternity Care
Authors: Swordy Alice , Noble Lorraine M. , Bourne Theresa , Van Lessen Logan , Lokugamage Amali U. 
Published: September 2020

Introduction:
A global movement on respectful maternity care has arisen because of widespread accounts of dehumanized maternity care. This article considers the use of a transformative learning approach to highlight patient agency and personhood in health care. An educational intervention using patient narratives was introduced in a maternity unit to foster a culture of listening and responsiveness to women's voices. This article reports the impact on staff and student learning, empathy, and reflective practice.

Methods:
A total of 245 interprofessional providers participated in 14 workshops over a 16-month period. Participants represented a range of health professions including medicine, midwifery, nursing, and allied professions. Senior management, administrators, and peer support volunteers also attended. Session sizes ranged from 5 to 60 attendees. The format included documentary-style videos of patient feedback followed by audience discussion. Discussion points were collected and qualitatively analyzed for participants' critical reflection, emotional engagement, cognitive dissonance, and perspective transformation.

Results:
Learners reflected on the client–caregiver relationship and care provision. Staff and students showed empathy for the women sharing their stories. Learners were disturbed by failings in care and wished to improve services. All provider groups highlighted the importance of communication, compassion, and patient autonomy as key elements of maternity care.

Discussion:
Multiprofessional learners engaged emotionally with women's narratives and reflected critically on their roles in maternity care. Learners' responses showed evidence of transformative learning. Staff and students recognized the value of providing respectful, empathic care. Educational interventions highlighting patients' voices may promote patient autonomy by reducing dehumanization in health care.
Development of an Instrument to Assess the Perceived Effectiveness of Academic Detailing
Authors: Smart Mary H. , Monteiro Andrea L. , Saffore Christopher D. , Ruseva Aleksandrina , Lee Todd A. , Fischer Michael A. , Pickard Alan Simon 
Published: September 2020

Introduction:
Academic detailing (AD) is an effective, evidence-based education outreach method of promoting clinician behavior change. Detailer feedback is important for program evaluation but is rarely systematically collected. The study's objective was to develop a measure capturing the detailer's perception of the effectiveness of an AD program.

Methods:
A six-item measure with a five-level scale was initially developed from the literature review and expert panel consultation. Item constructs were usefulness, acceptability, feasibility, relevance, effectiveness of communication, and readiness to change. The measure was piloted, refined, and tested during an opioid-focused AD program that included two visits. The instrument structure was evaluated using exploratory factor analysis, measure reliability was assessed using item–item correlation (rho), corrected item–total correlation, Cronbach alpha (α), and item response theory.

Results:
The initial six-item instrument demonstrated unidimensionality. The Cronbach α for the measure was 0.74 (visit 1) and 0.79 (visit 2); one item (relevance) was redundant (α = 0.73 and 0.79 when deleted) and therefore dropped. Items related to usefulness, acceptability, and readiness to change displayed high item–item correlation (rho ≥ 0.50) and contributed the most information and seemed to operate as a single scale (ie, “likelihood to change”) based on item response theory analysis. Items related to feasibility and communication were slightly different constructs and should be reported separately.

Discussion:
The five-item detailer assessment of visit effectiveness (the “DAVE”) instrument provides a standardized approach to assess AD. Further study of its validity and broader use in other programs and educational outreach activities is encouraged.
The Role of Bias in Knowledge Translation: Lessons Learned from a Dissemination of Best Practices in Maternal Opioid Use
Authors: Nichols Tracy R. , Gringle Meredith R. 
Published: September 2020

Introduction:
Increases in opioid use during pregnancy fueled concerns among reproductive health advocates, policy makers, and providers in North Carolina, United States. A stakeholder group designed a set of knowledge translation (KT) interventions to increase the use of evidence-based practices across relevant health care and social service arenas. Efforts to decrease stigma was included as a best practice. Understanding the process and the contexts in which KT intervention activities occur can help increase their effectiveness. Toward that end, this study examined how stigma was addressed and how audiences responded to evidence-based messages.

Methods:
Data were collected over a seven-year period and included observations of KT activities (conferences, workshops, and community meetings), focus groups and interviews conducted with providers, and a review of publicly available documents, including KT intervention materials. Clarke's situational mapping was initially applied, and stigma emerged as a critical contextual element. Data were then analyzed to identify how stigma was addressed and how evidence-based messages were received.

Results:
Despite direct stigma-reduction messages, biases against maternal drug use and ambivalence toward evidence-based recommendations of harm reduction principles were found in audience responses. Findings also revealed tensions around the interpretation of knowledge and the appropriate implementation of best practices between “experts” and among practitioners.

Discussion:
Stigma and professional biases may serve as significant barriers to KT activities. Results suggest that even under the best of circumstances, evidence-based practices for highly stigmatized and controversial issues are difficult to disseminate and may require unique approaches.
Structuring Mentoring in Medicine and Surgery. A Systematic Scoping Review of Mentoring Programs Between 2000 and 2019
Authors: Chua Wen Jie , Cheong Clarissa Wei Shuen , Lee Fion Qian Hui , Koh Eugene Yong Hian , Toh Ying Pin , Mason Stephen , Krishna Lalit Kumar Radha 
Published: September 2020

Introduction:
Evidence of novice mentoring's successes in having senior clinicians support junior doctors and/or medical students in their clinical, academic, and research goals has spurred efforts to include mentoring in the core medical curriculum. However, lack of effective structuring threatens the viability of mentoring programs, precipitating ethical concerns about mentoring. This review aims to answer the question “what is known about mentoring structures in novice mentoring among medical students and junior doctors in medicine and surgery postings?,” which will guide the design of a consistent structure to novice mentoring.

Methods:
Levac (2010)'s framework was used to guide this systematic scoping review of mentoring programs in medicine and surgery published between 1 January 2000 and 31 December 2019 in PubMed, ScienceDirect, ERIC, Embase, Scopus, Mednar, and OpenGrey. A “split approach” involving concurrent independent use of a directed content analysis and thematic approach was used to analyze included articles.

Results:
Three thousand three hundred ninety-five abstracts were identified. There was concordance between the 3 themes and categories identified in analyzing the 71 included articles. These were the host organization, mentoring stages, and evaluations.

Conclusion:
The data reveal the need for balance between ensuring consistency and flexibility to meet the individual needs of stakeholders throughout the stages of the mentoring process. The Generic Mentoring Framework provides a structured approach to “balancing” flexibility and consistency in mentoring processes. The Generic Mentoring Framework is reliant upon appropriate, holistic, and longitudinal assessments of the mentoring process to guide adaptations to mentoring processes and ensure effective support and oversight of the program.
Health Professions Educators' System-Oriented Roles as Educational Advocate, Quality Improver, and Broker
Authors: Kumar Koshila , Schoo Adrian 
Published: September 2020

Introduction:
Health professionals have many facets to their educational role. Although the teaching and student support dimensions of health professionals' educational role are highly visible in the literature, other nontraditional elements are not. This study presents a broader conceptualization of health professionals' educational role, with a focus on the strategic dimensions of their role.

Methods:
Participants were health professionals from different clinical backgrounds and teaching settings, with a formal role in education. Data were collected using a survey (n = 41) and interviews (n = 9), and this article focuses on reporting the qualitative findings of this study. Thematic analysis was used for data interpretation.

Results:
Health professionals have three strategic dimensions to their educational role. The first strategic dimension is educational advocacy, which is aimed at championing education at different levels and parts of the educational system and building educational capacity. The second strategic dimension is educational quality improvement which is focused on shifting narratives around education and educational change in health service settings and leveraging educational evidence. The final strategic dimension is educational brokerage which is oriented at connecting clinical and educational communities and building trust and consensus.

Discussion:
Beyond the microlevel of learning and teaching, health professionals engage in strategic work that is focused on the broader educational mission within health. Continuing professional development initiatives can empower health professionals to optimize these strategic and system-focused educational roles and responsibilities.
Definitions of Physician Certification Used in the North American Literature: A Scoping Review
Authors: Price David , Campbell Craig , Van Hoof Thomas J. , ElChamaa Rima , Jeong Dahn , Chappell Kathy , Moore Don , Olson Curtis , Danilovich Natalia , Kitto Simon 
Published: September 2020

Introduction:
The authors sought to identify how physician specialty certification is defined in the North American literature.

Methods:
A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data.

Results:
A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing.

Discussion:
Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.
Brain cancer incidence: a comparison of active-duty military and general populations
Authors: Bytnar Julie A. , Lin Jie , Eaglehouse Yvonne L. , Enewold Lindsey , Shriver Craig D. , Zhu Kangmin 
Published: September 2020

Background
In the USA, brain cancer disproportionately affects young adults. The US military has a younger age structure than the general population and may have differential exposures related to brain cancer. This study aimed to compare the incidence rates of brain cancer in the active-duty military and general populations to provide clues for future etiologic research. The rates between military service branches were also compared.

Methods
The data for this study were from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age- and sex-adjusted incidence rates of malignant neuroepithelial brain cancer among adults 20–54 years of age from 1990–2013 were calculated and compared between the two populations, given as incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

Results
The age and sex-adjusted incidence rate for malignant neuroepithelial brain cancer was significantly lower in the active-duty population than in the US general population (IRR = 0.62, 95% CI,  0.56–0.68). The reduced incidence rate in the active-duty population was observed in men, all races, individuals 20–44 of age, and for all histological subtypes and time periods assessed. There were no significant differences in rates between the military service branches.

Conclusion
The incidence rates of neuroepithelial brain cancer were lower in the active-duty military population than the US general population. This study highlights the need for more research to enhance our understanding of variations in brain cancer incidence between these two populations.
Caring for the Poor
Authors: Yuchs Kimi Collyer , Bonham C. Elizabeth 
Published: September 2020

ABSTRACT:
Living in a culture of poverty challenges people when they seek healthcare. Attitudes of healthcare workers caring for the poor can affect both return to care and subsequent health outcomes. This quality improvement project at a U.S. Midwestern hospital employed a quasi-experimental design to examine the effect of a voluntary educational intervention on nurses' attitudes toward the culture of poverty. Findings indicated a significant positive change in attitude dealing with stigmatizing statements about people living in the culture of poverty.
What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years?
Authors: Verspeek Jason , Nijenhuis Thijs A. , Kuijpers Martijn F. L. , Rijnen Wim H. C. , Schreurs B. Willem 
Published: September 2020

Abstract

Background
The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years.

Questions/purposes
We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.

Methods
Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°

Results
The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39).

Conclusion
We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization.

Level of Evidence
Level IV, therapeutic study.
Attitudes on Prophylactic Antibiotic Use in Dermatologic Surgery: A Survey Study of American College of Mohs Surgery Members
Authors: Aizman Leora , Barbieri John S. , Lukowiak Tess M. , Perz Allison M. , Sobanko Joseph F. , Shin Thuzar M. , Higgins Harold William , Giordano Cerrene N. , Maher Ian A. , Golda Nicholas , Miller Christopher J. , Etzkorn Jeremy R. 
Published: September 2020

BACKGROUND
Antibiotic prescriptions associated with dermatologic surgical visits are increasing and prescribing practices vary among surgeons.

OBJECTIVE
To describe dermatologic surgeons' attitudes and practices regarding prophylactic antibiotic use for surgical site infection (SSI), to compare current prescribing practices to those of a 2012 survey, and to determine surgeons' interest in clinical trial data on the utility of prophylactic antibiotics.

MATERIALS AND METHODS
This was a cross-sectional online survey of the American College of Mohs Surgery (ACMS) members. Survey items were adapted from a 2012 survey of ACMS members.

RESULTS
The survey was initiated by 101 ACMS members. 75.25% (76/101) of surgeons reported routinely prescribing prophylactic antibiotics to reduce SSI risk. The use of prophylactic antibiotics varied with clinical scenario. Most providers (84.21%, 64/76) prescribe postoperative antibiotics, with an average course of 6.56 days. 40.21% (39/97) of respondents were uncertain if prophylaxis prevents SSI, and up to 90.63% (87/96) indicated interest in clinical trial data evaluating the efficacy of oral antibiotics for SSI prevention.

CONCLUSION
Dermatologic surgeons continue to report varied attitudes and practices for SSI prophylaxis. Evidence from clinical trials is desired by surgeons to guide clinical practice.
Risk of Renal Cell Carcinoma Associated with Calcium Channel Blockers
Authors: Kristensen Kasper Bruun , Habel Laurel A. , Gagne Joshua J. , Friis Søren , Andersen Klaus Kaae , Hallas Jesper , Pottegård Anton 
Published: September 2020

Background:
We examined whether the apparent association between renal cell carcinoma (RCC) and use of dihydropyridine calcium channel blockers (CCBs) was explained by confounding by indication since hypertension, the main indication for CCBs, is a risk factor for RCC.

Methods:
Using Danish health registries, we conducted a nested case-control study including 7315 RCC cases during 2000–2015. We matched each case with up to 20 controls on age and sex using risk-set sampling. We estimated odds ratios (ORs) for long-term CCB use associated with RCC using conditional logistic regression. We addressed confounding by indication by (1) adjusting for hypertension severity indicators; (2) evaluating dose-response patterns; (3) examining whether other first-line anti-hypertensives were associated with RCC; and (4) using an active comparator new user design by nesting the study in new users of CCBs or angiotensin-converting enzyme inhibitors (ACEIs).

Results:
The adjusted OR for RCC associated with long-term CCB use compared to non-use was 1.76 (1.63–1.90). After we additionally adjusted for hypertension severity indicators, the OR remained elevated (OR 1.37; confidence interval [CI] 1.25, 1.49) with evidence of a dose-response pattern. Other anti-hypertensives were also associated with RCC, for example, ACEIs (OR 1.27; 95% CI = 1.16, 1.39) and thiazides (OR 1.22; 95% CI = 1.12, 1.34). In the active comparator new user design, the OR was 1.21 (95% CI = 0.95, 1.53) for use of CCBs compared with ACEIs.

Conclusions:
In this population, confounding by indication appeared to explain at least part of the association between RCC and dihydropyridine CCBs.
Serotonergic antidepressants for sleep disturbances in perimenopausal and postmenopausal women: a systematic review and meta-analysis
Authors: Cheng Yu-Shian , Sun Cheuk-Kwan , Yeh Pin-Yang , Wu Ming-Kung , Hung Kuo-Chuan , Chiu Hsien-Jane 
Published: September 2020

Abstract

Importance:
Although previous meta-analyses mainly focused on the effects of hormonal treatment against menopausal sleep disturbances, the therapeutic role of antidepressants has not been systematically addressed.

Objective:
To study the therapeutic benefit and safety of antidepressants in menopausal sleep disturbances.

Evidence review:
Randomized controlled trials assessing the therapeutic effects of antidepressants against menopausal sleep problems were identified from the PubMed, Cochrane Library, and Science Direct databases from inception to March 1, 2020. Studies that were clinical trials with placebo controls were included. Subgroup analyses were conducted according to a random effects model.

Findings:
Analysis of seven eligible randomized controlled trials including a total of 1,949 perimenopausal and postmenopausal women showed the effectiveness of serotonergic antidepressants against sleep disturbances despite the small effect size (Hedge  g = 0.24, 95% CI = 0.11-0.38). The efficacy remained significantly better than that of placebo for postmenopausal women (Hedge  g = 0.25, 95% CI = 0.04-0.45), participants with hot flashes (Hedge g = 0.18, 95% CI = 0.02-0.34), and those without diagnosis of major depressive disorder (Hedge g = 0.23, 95% CI = 0.06-0.40). There was no difference in therapeutic benefit between sedating and nonsedating serotonergic antidepressants. Besides, the dropout rate did not differ between antidepressant and placebo groups.

Conclusions and Relevance:
Our results showed that serotonergic antidepressants were effective against sleep disturbances in perimenopausal and postmenopausal women. The efficacy remained significant for women without major depressive disorder. The dropout rates were also comparable between serotonergic antidepressants and placebo groups.