bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of narrative medicine on medical students’ readiness for holistic care practice: a realist synthesis protocol
Authors: Huang Yufrica , Monrouxe Lynn V , Huang Chien-Da 
Published: August 2019

IntroductionHolistic healthcare considers the whole person—their body, mind, spirit and emotions—and has been associated with narrative medicine practice. Narrative medicine is medicine performed with narrative skill and has been offered as a model for humanism and effective medical practice. Narrative medicine interventions have been associated with physicians’ increased empathy and more meaningful interactions with patients about managing their illness and preventative medicine. However, while there is some evidence that certain groups are more open to narrative practices (eg, traditional vs Western medical students), the extent to which narrative medicine interventions during undergraduate medical education impacts on students’ readiness for holistic care, as well as the underlying reasons why, is unknown.Methods and analysisRealist review is a theory-driven approach to evaluate complex interventions. It focuses on understanding how interventions and programmes work (or not) in their contextual setting. This realist synthesis aimed to formulate a theory around the influence of narrative medicine medical students’ readiness for holistic care practice. We will follow Pawson’s five steps: locate existing theories, search strategy, study selection, data extraction, data analysis and synthesis. We will use the following electronic databases: Web of Science, Medline, Scopus and Embase. Articles between January 2008 and September 2018 will be included. Results will be written according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standard for reporting realist syntheses.Ethics and disseminationEthics approval was obtained from the Chang Gung Memorial Hospital for the wider study. The findings of this review will provide useful information for academics and policymakers, who will be able to apply the findings in their context when deciding whether and how to introduce narrative medicine programmes into medical students’ curricula. We will publish our findings in peer-reviewed journals and international conferences.PROSPERO registration numberCRD42018115447.
A Female Shankaracharya?
Authors: DeNapoli Antoinette E. 
Published: August 2019

Abstract
This article examines the practices through which a female religious leader (guru) in India by the name of Trikal Bhavanta Saraswati (in shorthand, “Mataji”) constructs women’s alternative authority in a high powered lineage of male Hindu gurus called Shankaracharyas. Mataji’s appropriation of the Shankaracharya leadership demonstrates an Indic example of “dharmic feminism,” by virtue of which she advocates the female as normative and, through that radical notion, advances a dharmic platform for gender equality in institutions in which women rarely figure among the power elite. Through narrative performance, Mataji reshapes the boundaries of religious leadership to affirm new possibilities for female authority in a lineage that has denied women’s agency. Exploring her personal experience narratives and the themes they illuminate can shed light on why her leadership intervenes in an orthodox lineage of male authority to exercise alternative authority and exact transformation of contemporary Hinduism.
Agents of Change
Authors: Borchgrevink Kaja 
Published: August 2019

Abstract
This article examines the intersection of religion, gender and development through an analysis of religious practice and development engagement among women activists in two religio-political aid organizations in contemporary Pakistan. Situated on the margins of the mainstream aid and development field, these women are rarely conceded agents of development. Yet focusing on improving women’s position and wellbeing, their activities are similar to those of many other development NGO s. As part of religio-political movements advancing gender complementarity and segregation, women’s activism and conceptions of development reflect a particular intersection of religion, gender and class. A close read of women’s discourse and practice reveals how women interpret and appropriate Islamic teachings, local cultural practices, and global norms by balancing ideology and pragmatism. In the process of negotiating, upholding and resisting norms and practices, these activists can be seen as active agents of change in their local contexts.
Correlation between stage of small-cell lung cancer and inflammatory factors
Authors: Kim Taeyun , Choi Hyunji , Oak Chul-Ho , Jang Tae-Won , Jung Mann-Hong , Kim Jehun 
Published: August 2019

Background Several biochemical markers are associated with the stage of small-cell lung cancer. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are useful inflammatory markers and related to poor survival. This study aimed to evaluate the correlation between the disease extent of small-cell lung cancer and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. Methods The study was performed retrospectively in a single South Korean medical center from 2010 to 2016. Of 217 patients pathologically diagnosed with small-cell lung cancer, 157 were included in the analysis. The correlation between disease extent and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was measured by Student’s t test and analysis of variance. Results Neutrophil-to-lymphocyte ratio (limited disease: 2.38 ± 1.53, extensive disease: 3.25 ± 2.20, p = 0.004) and platelet-to-lymphocyte ratio (limited disease: 122.21 ± 63.13, extensive disease: 153.09 ± 98.57, p = 0.026) were highly associated with disease extent. Neutrophil-to-lymphocyte ratio was associated with advanced TNM stage (stage I: 3.53 ± 3.44, stage II: 2.66 ± 0.95, stage III: 2.34 ± 1.49, stage IV: 3.26 ± 2.22, p = 0.049), and platelet-to-lymphocyte ratio was proportional to the TNM stage but there was no statistical significance (stage I: 111.77 ± 30.76, stage II: 110.71 ± 34.04, stage III: 123.42 ± 64.48, stage IV: 154.68, p = 0.105). Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were increased in advanced stages of small-cell lung cancer, especially when stage was classified into extensive and limited disease. It is necessary to analyze the effect on survival outcome.
Patient Preference and Physical Demand for Hands-Free Single Crutch vs Standard Axillary Crutches in Foot and Ankle Patients
Authors: Martin Kevin D. , Unangst Alicia M. , Huh Jeannie , Chisholm Jamie 
Published: August 2019

Background: Weightbearing restrictions following foot and ankle surgery require the use of appropriate assistive devices for nonweightbearing ambulation during the recovery period. Selecting an appropriate assistive device that safely optimizes mobility and participation in daily activities is important to patient compliance and satisfaction. The purpose of this study was to compare physiologic demand, perceived exertion, and patient preference between a hands-free single crutch (HFSC) and standard axillary crutches (SACs) in foot and ankle patients. Methods: Using 44 preoperative orthopedic foot and ankle patients who had a mean age of 32 (19-51) years, a prospective, randomized, crossover study was performed. The sample consisted of 35 males and 9 females. The mean body mass index (BMI) was 26 (19-36), the mean height was 1.7 m, and the mean weight was 82 kg. Patient data and preactivity heart rate were recorded for all patients, who were then randomized to either an HFSC or SACs. Each patient was randomly assigned to the device they would utilize first using a random number generator. They then crossed over to the other device after vitals returned to within 10% of their baseline heart rate. Every subject completed a 6-minute walk test (6MWT) using both assistive devices in a crossover manner. Immediately following each 6MWT, postactivity heart rate, self-selected walking velocity (SSWV), perceived exertion using the OMNI Rating of Perceived Exertion (OMNI-RPE), and perceived dyspnea using the Modified Borg Dyspnea Scale were obtained. After completing both 6MWTs, patients were asked which assistive device they preferred the most. Results: The HFSC was preferred by 86% of patients. Significantly lower dyspnea scores (2.8 vs 5.3; P < .001), fatigue scores (2.4 vs 5.5; P < .001), preactivity and postactivity change in heart rate (28 vs 46 bpm; P < .001), and mean postactivity heart rate (107 vs 122 bpm; P < .001) were found using the HFSC compared with the SACs. The SAC group trended toward a higher SSWV (0.8 vs 0.77 m/s; P = .08). Those with a BMI greater than 25 also preferred iWALK over SACs ( P < .05). Neither group had any falls. Sixty-eight percent of patients complained of axillary/hand pain with the SACs, while 7% complained of proximal leg strap discomfort with the HFSC. Conclusion: The results of the current study in our relatively healthy cohort found that foot and ankle patients who were nonweightbearing preferred the HFSC over SACs. They experienced less physiologic demand as well as discomfort and perceived less exertion when using the HFSC compared with SACs. Level of Evidence: Level II, prospective comparative study.
Analysis of the Effect of Tibial Stem Length on Coronal Plane Deformity of the Tibial Component in Total Ankle Arthroplasty
Authors: Berlet Gregory C. , Langan Travis M. , Jamieson Marissa D. , Ferrucci Allen M. 
Published: August 2019

Background: Coronal plane deformity is common in patients who undergo total ankle arthroplasty. The correction of this deformity is paramount to the long-term survival of the implant. Coronal plane correction is achieved with soft tissue balancing and, in some part, is maintained through articular geometry constraint. The purpose of this study was to assess the influence of tibial component stem length on the coronal plane stability. Methods: A consecutive case series of stemmed implants that met inclusion criteria were reviewed to determine the correction and maintenance of the correction of coronal plane deformity with special emphasis on the effect of modular tibial stem lengths of 2 and >2 segments. Twenty patients received a tibial component with 2 stem segments, and 23 patients received a tibial component with >2 stem segments. At an average patient age of 62.1 years at implantation, there was no significant difference between the 2 cohorts with respect to preoperative deformity or demographics. Results: Our case series had a mean coronal deformity of 5.7 degrees, with valgus being more common than varus. At a mean final radiographic follow-up of 266.3 days after the first postoperative weightbearing radiography, coronal deformity increased by 0.4 degrees ( P = .031). From the first postoperative measurement to the last postoperative measurement, there was no difference in mean coronal plane ankle deformity change between patients who received 2 stem segments and patients who received >2 stem segments ( t = −1.14, df = 41, P = .259). Conclusion: Coronal plane deformity had a tendency to recur, albeit at a much smaller angle than preoperatively. This recurrence of deformity did not occur because of tibial component movement. Tibial stem lengths of >2 segments did not influence the maintenance of correction of coronal plane deformity or the stability of the tibial component in the coronal plane. Level of Evidence: Level III, retrospective comparative series.
Factors associated with difficult intravenous access in the pediatric emergency department
Authors: Lee Se Uk , Jung Jae Yun , Ham Eun Mi , Wang Sang Won , Park Joong Wan , Hwang Soyun , Kim Do Kyun , Kwak Young Ho 
Published: August 2019

Background: Successful intravenous catheter placement plays a vital role in the pediatric emergency department. We assessed pediatric emergency department–related factors associated with difficult intravenous catheter placement. Method: We retrospectively reviewed the electronic medical records of patients younger than 18 years who had an intravenous catheter placement attempt during their pediatric emergency department stay. Difficult intravenous access was defined as intravenous catheter placement requiring more than one attempt. The demographic-, clinical- and procedure-related factors were collected, and a logistic regression analysis was used to evaluate the factors associated with difficult intravenous access. Result: In total, 925 patients were enrolled, and 77 (8.32%) cases had difficult intravenous access. The median age of the patients was 3.0 (interquartile range = 1–9) years, and 496 (53.6%) patients were male. After adjustment, we found that age (odds ratio = 0.91, 95% confidence interval = (0.85–0.98), p = 0.01); a history of prematurity (odds ratio = 2.31, 95% confidence interval (1.08–4.98), p = 0.03); the intravenous catheter insertion site (foot versus hand odds ratio = 5.65, 95% confidence interval = (2.97–10.75); p < 0.001); and the experience of the provider (<6 months versus ⩾12 months odds ratio = 4.59, 95% confidence interval = (1.92–11.01), p = 0.01) were associated with difficult intravenous access. However, the acuity of disease, crowdedness at the pediatric emergency department, sex, vein visibility, vein palpability, intravenous catheter size, patients’ experience with intravenous access, and time of day were not significantly correlated with difficult intravenous access. Conclusion: The success rate of intravenous catheter placement at the pediatric emergency department could be improved by experienced providers. The acuity of disease and crowdedness at the pediatric emergency department were not significantly associated factors.
Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions
Authors: Subahi Ahmed , Osman Mohammed , Adegbala Oluwole , Abubakar Hossam , Kheiri Babikir , Yassin Ahmed S , Khalid Mowyad , Akintoye Emmanuel , Eljack Ammar , Osman Khansa , Alkhouli Mohamad 
Published: August 2019

Background Percutaneous peripheral arterial intervention (PPAI) patients are at a high risk of developing heparin-induced thrombocytopenia due to the need for repeated and prolonged heparin exposure. We sought to investigate the incidence, outcomes, and economic impact of heparin-induced thrombocytopenia post-PPAI utilizing the National Inpatient Sample. Methods All patients who underwent PPAI (age ≥18 years) from 2007 to 2014 were identified by using ICD-9-CM codes. Patients were then classified into two groups based on the presence or absence of heparin-induced thrombocytopenia during hospitalization. In-hospital outcomes were compared between the two groups after propensity-score matching to account for differences in baseline characteristics. Results Heparin-induced thrombocytopenia was reported in 527 patients (0.23%). After adjusting for patient-level and hospital-level characteristics, in-hospital mortality differences were not significantly different between patients with heparin-induced thrombocytopenia vs. those without heparin-induced thrombocytopenia (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.67 to 1.57, p = 0.951). However, PPAI patients with heparin-induced thrombocytopenia were more likely to develop ischemic stroke (OR 3.84, 95%CI 1.26 to 11.75, p = 0.018), deep venous thrombosis/pulmonary embolism (OR 1.32, 95%CI 0.79 to 1.79, p = 0.078), and acute kidney injury requiring dialysis (OR 4.04, 95%CI 1.72 to 9.50, p = 0.001). Furthermore, post-PPAI patients who developed heparin-induced thrombocytopenia had longer hospitalizations (13.8 vs. 9.8 days, p < 0.0001), higher cost of stay ($62,022 vs. $44,904, p < 0.0001), and higher rates of non-routine home discharges (50.15% vs. 42.19%, p = 0.013). Conclusion Among patients who underwent PPAI, heparin-induced thrombocytopenia was associated with a higher risk of venous thrombosis/pulmonary embolism, ischemic stroke, acute kidney injury requiring dialysis, prolonged hospital stay, and increased cost.
Glycemic Variability and Hypoglycemic Excursions With Continuous Glucose Monitoring Compared to Intermittently Scanned Continuous Glucose Monitoring in Adults With Highest Risk Type 1 Diabetes
Authors: Avari Parizad , Moscardo Vanessa , Jugnee Narvada , Oliver Nick , Reddy Monika 
Published: August 2019

Background: The I-HART CGM study has shown that real-time continuous glucose monitoring (rtCGM) has greater beneficial impact on hypoglycemia than intermittently scanned continuous glucose monitoring (iscCGM) in adults with type 1 diabetes at high risk (Gold score ≥4 or recent severe hypoglycemia using insulin injections). In this subanalysis, we present the impact of rtCGM and iscCGM on glycemic variability (GV). Methods: Forty participants were recruited to this parallel group study. Following two weeks of blinded rtCGM (DexcomG4), participants were randomized to rtCGM (Dexcom G5; n = 20) or iscCGM (Freestyle Libre; n = 20) for eight weeks. An open-extension phase enabled participants on rtCGM to continue for a further eight weeks and those on iscCGM to switch to rtCGM over this period. Glycemic variability measures at baseline, 8- and 16-week endpoints were compared between groups. Results: At the eight-week endpoint, between-group differences demonstrated significant reduction in several GV measures with rtCGM compared to iscCGM (GRADE%hypoglycemia, index of glycemic control [IGC], and average daily risk range [ADRR]; P < .05). Intermittently scanned continuous glucose monitoring reduced mean average glucose and glycemic variability percentage and GRADE%hyperglycemia compared with rtCGM ( P < .05). At 16 weeks, the iscCGM group switching to rtCGM showed significant improvement in GRADE%hypoglycemia, personal glycemic status, IGC, and ADRR. Conclusion: Our data suggest most, but not all, GV measures improve with rtCGM compared with iscCGM, particularly those measures associated with the risk of hypoglycemia. Selecting appropriate glucose monitoring technology to address GV in this high-risk cohort is important to minimize the risk of glucose extremes and severe hypoglycemia. Clinical trial registration: ClinicalTrials.gov NCT03028220
Effect of Graft-Host Interference Fit on Graft Integration after Osteochondral Allograft Transplantation: A Comparative MRI Analysis of Two Instrumentation Sets
Authors: Ackermann Jakob , Duerr Robert A. , Barbieri Mestriner Alexandre , Shah Nehal , Gomoll Andreas H. 
Published: August 2019

Objective Precise graft-host interference fit is a potentially import factor for the successful incorporation of osteochondral allograft (OCA) transplants for the treatment of symptomatic focal cartilage defects. It was hypothesized that selection of OCA plug instrumentation set has a significant effect on graft integration and morphology after OCA transplantation Methods Thirty-one patients who underwent OCA transplantation between July 2013 and July 2016 were identified for this comparative magnetic resonance imaging (MRI) analysis. Patients were stratified into two groups based on the treatment with the Arthrex Allograft OATS Instrument Set or the JRF Ortho Osteochondral Allograft Plug Instrumentation. MRI was obtained at 12 months postoperatively. All grafts were assessed for integration using the Osteochondral Allograft MRI Scoring System (OCAMRISS), host marrow edema size, graft-host interface distance, graft cartilage integrity, cyst size, graft contour and presence of effusion. Results At a mean follow-up of 11.39 ± 1.98 months, 95.5% of all grafts showed osseous integration into the recipient bone with 68.2% presenting without cystic changes of the graft or host-graft junction. No differences were seen in any OCAMRISS subscale besides cartilage signal, which demonstrated minimal differences ( P = 0.046). Conclusion OCAs show excellent osseous integration at the graft-host junction at 12 months postoperatively. The comparative MRI analysis of two instrumentation sets yielded no significant differences in terms of graft integration, bone marrow edema, or cystic formation. Hence, this study cannot recommend one instrumentation set over the other. Consequently, the individual preference should guide the surgeon’s selection of instrumentation for OCA transplantation.
Outcome of concomitant treatment with thiopurines and allopurinol in patients with inflammatory bowel disease: A nationwide Danish cohort study
Authors: Thomsen Sandra Bohn , Allin Kristine Højgaard , Burisch Johan , Jensen Camilla Bjørn , Hansen Susanne , Gluud Lise Lotte , Theede Klaus , Kiszka‐Kanowitz Marianne , Nielsen Anette Mertz , Jess Tine 
Published: August 2019

BackgroundThiopurine and allopurinol in combination are associated with clinical remission in inflammatory bowel diseases but their influence on subsequent outcomes is unclear. We compared outcomes during exposure to both thiopurines and allopurinol versus thiopurines alone.MethodsWe established a nationwide cohort of patients with inflammatory bowel diseases exposed to thiopurines ± allopurinol during 1999–2014, using registry data. Patients were followed until hospitalization, surgery, anti‐TNFα, or death (as a primary composite outcome). We used Poisson regression analyses to calculate incidence rate ratios overall and stratified by calendar period (assuming the combined exposure was unintended before 2009).ResultsA total of 10,367 patients with inflammatory bowel diseases (Crohn’s disease, n  = 5484; ulcerative colitis, n  = 4883) received thiopurines. Of these, 217 (2.1%) also received allopurinol. During 24,714 person years of follow‐up, we observed 40 outcomes among thiopurine‐allopurinol‐exposed patients, and 4745 outcomes among those who were thiopurine exposed; incidence rate ratio, 1.26 (95% confidence interval, 0.92–1.73). The incidence rate ratios decreased over time: 4.88 (95% confidence interval 2.53–9.45) for 1999–2003, 2.19 (95% confidence interval, 1.17–4.09) for 2004–2008 and 0.80 (95% confidence interval, 0.52–1.23) for 2009–2014.ConclusionOur nationwide inflammatory bowel disease cohort study shows that concomitant thiopurine‐allopurinol is as safe to use as thiopurines alone, with a tendency towards a positive effect on clinical outcomes in recent calendar periods when combined use was intended.