bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meaning and value in medical school curricula
Authors: Lipworth Wendy , Kerridge Ian , Little Miles , Gordon Jill , Markham Pippa 
Published: September 2012

AbstractRationale, aims and objectivesBioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real‐world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners.MethodCurriculum analysis: Thirty‐two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In‐depth, semi‐structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted.ResultsWhile representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real‐world’ clinical practice that are largely ignored. These fell into two broad domains: (1) ‘sociological’ concerns about enculturation, bureaucracy, intra‐professional relationships, and public perceptions of medicine; and (2) epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols.ConclusionsOur findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice.
Unreasonable reasons: normative judgements in the assessment of mental capacity
Authors: Banner Natalie F. 
Published: September 2012

AbstractThe recent Mental Capacity Act (2005) sets out a test for assessing a person's capacity to make treatment choices. In some cases, particularly in psychiatry, it is unclear how the criteria ought to be interpreted and applied by clinicians. In this paper, I argue that this uncertainty arises because the concept of capacity employed in the Act, and the diagnostic tools developed to assist its assessment, overlook the inherent normativity of judgements made about whether a person is using or weighing information in the decision‐making process. Patients may fail on this criterion to the extent that they do not appear to be handling the information given in an appropriate way, on account of a mental impairment disrupting the way the decision process ought to proceed. Using case law and clinical examples, I describe some of the normative dimensions along which judgements of incapacity can be made, namely epistemic, evaluative and affective dimensions. Such judgements are complex and the normative standards by which a clinician may determine capacity cannot be reduced to a set of criteria. Rather, in recognizing this normativity, clinicians may better understand how clinical judgements are structured and what kinds of assumption may inform their assessment.
Imperfection, practice and humility in clinical ethics
Authors: Garchar Kim 
Published: September 2012

SummaryIn this essay, I provide a description of the discipline of ethics using the philosophies of Aristotle and the American pragmatist John Dewey. Specifically, I argue that ethics is an active undertaking that is ambiguous and pluralistic. I then normatively prescribe the way in which clinical ethicists ought to approach their work in medicine. Rather than endeavouring to become, or behaving as if they are, experts, clinical ethicists must be humble. They must practise ethics. That is, they must admit ethics is the study and pursuit of the good life but that this study and pursuit occurs imperfectly in the face of problematic situations.
The history of blood transfusion prior to the 20th century – Part 1
Authors: Learoyd P. 
Published: September 2012

SUMMARYBlood transfusion, that is the transference of blood from the circulation of one individual to that of another for practical therapeutic purposes, is of relatively recent origin. Although it only became a routine practical possibility during and shortly after the Second World War, the concept of the infusion of blood has a much longer history. Practical transfusion has to some degree paralleled and in many instances been the consequence of developments in other sciences. However, the early history of blood transfusion is to some extent one of mysticism, professional rivalries, disregard of published work and a desire to maintain the status quo with regard to ‘established medical procedure’. This article summarises some of the major aspects relating to the early history of blood transfusion.
Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub‐Saharan Africa: systematic review and meta‐analysis
Authors: Mugglin Catrina , Estill Janne , Wandeler Gilles , Bender Nicole , Egger Matthias , Gsponer Thomas , Keiser Olivia ,   for IeDEA Southern Africa
Published: September 2012

AbstractObjectives  To assess the proportion of patients lost to programme (died, lost to follow‐up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub‐Saharan Africa, and determine factors associated with loss to programme.Methods  Systematic review and meta‐analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow‐up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random‐effects meta‐analysis.Results  Twenty‐nine studies from sub‐Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta‐analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60–84) had a CD4 cell count measured, 40 (95% CI 26–55) were eligible for ART and 25 (95% CI 13–37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio‐economic status and in recent time periods.Conclusions  Monitoring and care in the pre‐ART time period need improvement, with greater emphasis on patients not yet eligible for ART.
Diagnosis of treponemal co‐infection in HIV‐infected West Africans
Authors: Mamoojee Yaasir , Tan Grace , Gittins Sandra , Sarfo Stephen , Stephenson Lisa , Carrington David , Bedu‐Addo George , Phillips Richard , Appiah Lambert T. , Chadwick David 
Published: September 2012

AbstractObjectives To evaluate the performance of two enzyme immunoassays (EIA), Murex and ICE, and the Determine TP point‐of‐care test (POCT) in diagnosing treponemal infection (syphilis or yaws) in patients attending a large HIV clinic in Ghana; to determine the prevalence of treponemal co‐infections; and to characterise demographic and clinical features of patients with infection.Methods Samples were tested with EIAs and rapid plasma reagin (RPR), then POCT and reference assays forTreponema pallidumto determine prevalence of active and past infection. Sensitivity and specificity of each assay were calculated and demographic and clinical characteristics of patients compared. Data were collected from case notes of patients retrospectively.Results Overall, 45/284 patient samples (14.8%, 95% CI, 11.1–19.4%) wereTreponema pallidumparticle agglutination (TPPA) positive, and of these, 27 (64.3%) were RPR positive and 4 (8.9%) were treponemal IgM positive. Both EIAs and Determine TP POCT showed high sensitivities and specificities for identifying infection although RPR was less reliable. Clinical features of syphilis or yaws were rarely identified in TPPA‐positive patients suggesting most had previous or late latent infection. Treatment of various intercurrent infections using short courses of antibiotics active againstT. pallidumwas common in the clinic.Conclusions A high proportion of this HIV‐infected cohort showed evidence of treponemal infection. Both EIAs as well as the POCT were practical and effective at diagnosing treponemal co‐infection in this setting. RPR alone was unreliable at identifying active treponemal co‐infection, however might be useful in some settings where treponemal‐specific assays are unaffordable.
Maternal recall of birthweight and birth size in Entebbe, Uganda
Authors: Lule Swaib A. , Webb Emily L. , Ndibazza Juliet , Nampijja Margaret , Muhangi Lawrence , Akello Florence , Kakande Muhammed , Kizindo Robert , Elliott Alison M. 
Published: September 2012

AbstractObjectives  To assess the reliability of maternally recalled birthweight and size in Entebbe, Uganda.Methods  The study population comprised 404 mothers, who were participants in the Entebbe Mother and Baby Study (EMaBS). Mothers were recruited to EMaBS during antenatal care, maternal characteristics were recorded during pregnancy, and birthweight was recorded at delivery. Four to seven years after delivery, mothers were asked to recall the child’s birthweight and size. Their responses were compared with the birthweight recorded in the EMaBS database.Results  Of 404 interviewed mothers, 303 (75%) were able to give an estimate of birthweight and for 265 of these EMaBS data on recorded birthweights were available. Women who were educated and whose children had low birth order were more likely to be able to give an estimate: 37 (14%) recalled the exact recorded birthweight; a further 52 (20%) were accurate to within 0.1 kg of the recorded weight. On average, mothers overestimated birthweight by 0.06 kg (95% CI: 0.00–0.13 kg, P = 0.04). Recalled and recorded birthweights showed moderate agreement with an intraclass correlation coefficient of 0.64. Four hundered mothers gave an estimate of birth size: the sensitivity and specificity of recalled birth size for classifying low birthweight were 76% (95% CI: 50–93%) and 70% (95% CI: 65–75%), respectively.Conclusions  Mothers’ recall of birthweight was not precise but in absence of other data, recall of birthweight and size may have some value in epidemiological studies in these settings.
Effectiveness of an intervention on uptake of maternal care in four counties in Ningxia, China
Authors: Zhou Hong , Zhao Chun‐Xia , Wang Xiao‐Li , Xv Yi‐Chong , Shi Ling , Wang Yan 
Published: September 2012

AbstractObjectives  To understand the utilisation of prenatal care and hospitalised delivery among pregnant Muslim women in Ningxia, China, and to explore the effectiveness of the integrated interventions to reduce maternal mortality.Methods  Cross‐sectional surveys before and after the intervention were carried out. Using multistage sampling, 1215 mothers of children <5 years old were recruited: 583 in the pre‐intervention survey and 632 in the post‐intervention study. Data on prenatal care and delivery were collected from face‐to‐face interviews. Maternal mortality ratio (MMR) data were obtained from the local Maternal and Child Mortality Report System.Results  After the intervention, the MMR significantly decreased (45.5 deaths per 100 000 live births to 32.7 deaths). Fewer children were born at home after the intervention than before the intervention (OR, 0.11; 95% CI, 0.08–0.15). The proportion of women who attended prenatal care at least once increased from 78.2% to 98.9% (OR, 24.55; 95% CI, 11.37–53.12). The proportion of women who had prenatal visit(s) in the first trimester of pregnancy increased from 35.1% to 82.6% (OR, 8.77; 95% CI, 6.58–11.69). The quality of prenatal care was greatly improved. Effects of the intervention on the utilisation of maternal care remained significant after adjusting for education level and household possessions.Conclusions  The findings suggest that integrated strategies can effectively reduce maternal mortality.
Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource‐poor country
Authors: Al‐Qubati Yasin , Janniger Edmund J. , Schwartz Robert A. 
Published: September 2012

AbstractLeishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost‐effective, simple, successful, and affordable option.
Prevalence and treatment of palmoplantar keratoderma and tinea pedis in patients with Sézary syndrome
Authors: Martin Stephanie J. , Duvic Madeleine 
Published: September 2012

AbstractBackground  Mycosis fungoides (MF) and the Sézary syndrome (SS) are non‐Hodgkin's lymphomas that present with cutaneous lesions. Sézary syndrome is characterized by blood involvement, exfoliative eryrthroderma, lymphadenopathy, pruritus, keratoderma, and immunosuppression. This study was to estimate the prevalence of palmoplantar keratoderma and tinea pedis in Sézary syndrome and to analyze the effectiveness of anti‐fungal treatment.Methods  We conducted a retrospective review of 1562 prospectively collected patients at the MD Anderson Cancer Center Cutaneous Lymphoma Clinic over sixteen years. All patients’ palms and soles were evaluated for clinical evidence of keratoderma (hyperkeratosis) and for dermatophytosis (tinea pedis or unguum) by examining scales under 10% potassium hydroxide by light microscopy for hyphae.Results  Of 138 Sézary syndrome patients (88 men, 50 women, median age at diagnosis 64 years), 85 (61.6%) had palmoplantar keratoderma; 45 of the 85 Sézary syndrome patients (52.9%) also had coexisting tinea pedis. Only 14 (10.1%) had tinea pedis without keratoderma. Treatment for tinea pedis resulted in microscopy cure of keratoderma in 12 of 45 (26.7%) patients and clinical improvement.Conclusions  The prevalence of palmoplantar keratoderma in Sézary syndrome is 61.6%, with co‐existing tinea pedis found in 52.9%. Palmoplantar keratoderma with tinea pedis showed clinical improvement with fungicidal therapy suggesting that tinea often contributes to the pathogenesis and severity of Sézary syndrome‐related keratoderma.
Smashed skin grafting or smash grafting – a novel method of vitiligo surgery
Authors: Krishnan Ajay , Kar Sumit 
Published: September 2012

AbstractIntroduction Vitiligo is an acquired progressive disorder characterized by destruction of melanocytes in the lesion and the lesional hair follicles. A number of new therapeutic options for vitiligo have become available over the last decade or so both on the medical as well as surgical side. One among them is the smashed skin grafting or simply smash grafting, which is a modification of split‐thickness grafting. In this method, the graft undergoes “smashing” before being applied to the recipient site. Though a simple and effective procedure, very few people are doing the procedure either due to lack of awareness or due to lack of published data.Materials and methods Smash skin grafting was performed in 26 patients with vitiligo in Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.Results Smashed skin grafting helped to achieve more than 90% repigmentation of the vitiligo patches in our patients.Conclusions Smashed skin grafting is a simple procedure with fewer side effects, better outcome, and high patient satisfaction or, in simple words, it can be considered as an alternative to various conventional surgical modalities like punch grafting and melanocyte cell culture methods. This article deals with the steps of the procedure, results of the surgery in a small group of patients, and the necessity of increasing the awareness of smash grafting.
Melanoma in South‐East Europe: epidemiological data from the central cancer registry and clinicopathological characteristics from the hospital‐based registry in Serbia
Authors: Kandolf‐Sekulović Lidija , Živković‐Perišić Snežana , Radević Tatjana , Rajović Milica , Dinić Miroslav , Zolotarevski Lidija , Mijušković Željko , Zečević Radoš D. , Novaković Marijan 
Published: September 2012

AbstractBackground  Melanoma in South‐East Europe shows varying incidence from 1.7 per 100,000 in Albania to 14.5 per 100,000 in Slovenia, but more detailed data from this region are scarce. In this study, we report epidemiological and clinicopathological characteristics of melanoma in central Serbia.Materials and methods  Epidemiological data were retrieved from the Cancer Registry of Central Serbia and clinicopathological data from the hospital‐based registry.Results  The ASR(W) incidence rate of melanoma was 4.2/100,000 (males) and 3.9/100,000 (females), and ASR(W) mortality rates were 1.9/100,000 (males) and 1.4/100,000 (females), with recorded rising trends in both of them. Data from the hospital‐based registry revealed a total of 266 patients treated from 2005 to 2010, with the median age at diagnosis of 57 (13–86) years. The most frequent histopathological subtype was superficial spreading melanoma (SSM; 63.53%), and ulceration was present in 40.6% of primary tumors. Median Breslow thickness was 3 mm (0.1–25 mm). Primary tumors with thickness of more than 4 mm were found in 31.95% of patients, and in this group statistically significant difference was found for younger age in patients with SSM (55 years vs. 61 years, P = 0.04).Conclusion  Low incidence rates in central Serbia and probably other countries of South‐East Europe are accompanied by a large percentage of thick tumors and a significant proportion of younger patients with thick tumors. This points to the urgent need for more effective primary and secondary prevention of melanoma in these countries.
Efficacy of intradermal radiofrequency combined with autologous platelet‐rich plasma in striae distensae: a pilot study
Authors: Kim In Su , Park Kui Young , Kim Beom Joon , Kim Myeung Nam , Kim Chan Woong , Kim Sung Eun 
Published: September 2012

AbstractBackground  Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post‐inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet‐rich plasma (PRP) is an effective treatment known for its wound‐healing effects.Methods  Nineteen Asian female patients with striae distensae were enrolled in this study. Three sessions of intradermal RF (1134‐kHz frequency, 12‐W power, 26‐G electrode size) combined with autologous PRP were performed in each patient at intervals of four weeks. Patients were evaluated subjectively by the investigators and by themselves.Results  Evaluation of clinical results at four weeks after treatment showed that only one (5.3%) of the 19 patients achieved excellent improvement, whereas seven (36.8%) demonstrated marked improvement, six (31.6%) showed moderate improvement, and five (26.3%) showed mild improvement. None of the patients showed worsening of striae distensae. A total of 63.2% of patients reported they were “satisfied” or “very satisfied” with the degree of overall improvement.Conclusions  Intradermal RF combined with autologous PRP appears to be an effective treatment for striae distensae.
Elderly patients' experiences using adaptive conjoint analysis software as a decision aid for osteoarthritis of the knee
Authors: Rochon Donna , Eberth Jan M. , Fraenkel Liana , Volk Robert J. , Whitney Simon N. 
Published: September 2012

AbstractBackgroundDecision making in knee osteoarthritis, with many treatment options, challenges patients and physicians alike. Unfortunately, physicians cannot describe in detail each treatment's benefits and risks. One promising adjunct to decision making in osteoarthritis is adaptive conjoint analysis (ACA).ObjectiveTo obtain insight into the experiences of elderly patients who use adaptive conjoint analysis to explore treatment options for their osteoarthritis.DesignParticipants, all 65 and older, completed an ACA decision aid exploring their preferences with regard to the underlying attributes of osteoarthritis interventions. We used focus groups to obtain insight into their experiences using this software.ResultsContent analysis distributed our participants' concerns into five areas. The predicted preferred treatment usually agreed with the individual's preference, but our participants experienced difficulty in four other domains: the choices presented by the software were sometimes confusing, the treatments presented were not the treatments of most interest, the researchers' claims about treatment characteristics were unpersuasive and cumulative overload sometimes developed.ConclusionAdaptive conjoint analysis presented special challenges to our elderly participants; we believe that their relatively low level of computer comfort was a significant contributor to these problems. We suggest that other researchers choose the software's treatments and present the treatment attributes with care. The next and equally vital step is to educate participants about what to expect, including the limitations in choice and apparent arbitrariness of the trade‐offs presented by the software. Providing participants with a sample ACA task before undertaking the study task may further improve participant understanding and engagement.
Small body size increases the regional differentiation of populations of tropical mantellid frogs (Anura: Mantellidae)
Authors: Pabijan M. , Wollenberg K. C. , Vences M. 
Published: September 2012

AbstractThe processes affecting species diversification may also exert an influence on patterns of genetic variability within species. We evaluated the contributions of five variables potentially influencing clade diversification (body size, reproductive mode, range size, microhabitat and skin texture) on mtDNA divergence and polymorphism among populations of 40 species of frogs (Mantellidae) from two rainforest communities in Madagascar. We report an inverse association between body size and nucleotide divergence between populations but find no influence of other variables on genetic variation. Body size explained ca. 11% of the variation in nucleotide divergence between populations and was coupled with high FST levels and an absence of haplotype sharing in small‐bodied and medium‐sized frogs. Low dispersal ability is likely the proximate mechanism producing higher population differentiation in small mantellids. The lack of genetic cohesion among populations establishes regional genetic fragmentation which in turn has the potential to accelerate rates of allopatric speciation in small frogs relative to large species. However, there is little evidence of increased speciation rates in these or other small‐bodied organisms. We reconcile these contradictory observations by suggesting that lower dispersal ability also curbs colonization of new areas, decelerating diversification in weak dispersers. Our results imply that the intermediate dispersal model also applies to amphibians and may explain inconsistent previous results on the correlation of body size and speciation rate.