bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interaction of adjuvant androgen deprivation therapy with patient comorbidity status on overall survival after radical prostatectomy for high‐risk prostate cancer
Authors: Linder Brian J , Boorjian Stephen A , Umbreit Eric C , Carlson Rachel E , Rangel Laureano J , Bergstralh Eric J , Karnes R Jeffrey 
Published: December 2012

BackgroundTo evaluate the impact of adjuvant hormonal therapy after radical prostatectomy on overall survival in high‐risk prostate cancer patients, stratified by comorbidity status.MethodsWe identified 1247 patients who underwent radical prostatectomy from 1988 to 2004 for high‐risk prostate cancer, as defined by National Comprehensive Cancer Network classification. Comorbidity status was stratified by Charlson Comorbidity Index as 0, 1 or >2, as well as by the presence or absence of cardiovascular disease. Overall survival was estimated by the Kaplan–Meier method, and compared within each comorbidity category/adjuvant hormonal therapy strata with the log–rank test.ResultsMedian patient age was 65 years, and the median postoperative follow up was 11.2 years. In total, 419 patients (34%) received adjuvant hormonal therapy. The distribution of Charlson Comorbidity Index was 0, 1 and ≥2 in 861 (69%), 244 (20%) and 142 (11%) patients, respectively. The 10‐year overall survival for patients who received adjuvant hormonal therapy versus those who did not was 75% versus 82% (P = 0.54) for patients with Charlson Comorbidity Index = 0, 72% versus 76% (P = 0.83) with Charlson Comorbidity Index = 1, and 70% versus 68% (P = 0.33) with Charlson Comorbidity Index ≥2. Meanwhile, 155 (12%) patients had cardiovascular disease, and the 10‐year overall survival for patients with cardiovascular disease who received adjuvant hormonal therapy was 72%, compared with 76% without adjuvant hormonal therapy (P = 0.97). On multivariate analysis, receipt of adjuvant hormonal therapy was not associated with non‐prostate cancer mortality (P = 0.24).ConclusionsAdjuvant hormonal therapy after radical prostatectomy for high‐risk prostate cancer does not increase non‐prostate cancer mortality, even among patients with multiple comorbidities. Additional studies are warranted to determine optimal multimodal treatment approach for high‐risk patients.
Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates
Authors: Linder Brian J , Frank Igor , Umbreit Eric C , Shimko Mark S , Fernández Nicolás , Rangel Laureano J , Karnes R Jeffrey 
Published: December 2012

ObjectivesTo examine the ability of standard and saturation transrectal prostate biopsy techniques to predict appropriate candidates for active surveillance.MethodsBetween 2005 and 2007, 500 consecutive patients underwent transrectal ultrasound‐guided biopsy by a standard template (12 cores) or saturation template (≥18 cores, median 27 cores), with subsequent radical prostatectomy. Using the criteria of Gleason score ≤6, clinical stage T1 or T2a, prostate‐specific antigen <10 and ≤33% of cores involved, 218 patients were potential candidates for active surveillance. Pathology results from the prostatectomy specimens were used to determine the accuracy of each biopsy technique. Biochemical failure after prostatectomy was evaluated using logistic and Cox proportional hazards regression.ResultsA standard biopsy was carried out for 124 patients and saturation biopsy for 94 patients. There was no statistically significant difference between the groups in terms of median age (P = 0.14), preoperative prostate‐specific antigen (P = 0.52) and clinical stage (P = 0.23). Similar rates of Gleason score ≥7 at the time of radical prostatectomy were found, with 14% for standard biopsy and 15% for saturation biopsy (P = 0.70). Upstaging was shown in two standard biopsy patients (1.6%) and no saturation biopsy patients (P = 0.62). A multivariate analysis adjusting for prior prostate biopsy, preoperative prostate‐specific antigen and clinical stage showed no difference in the rate of upgrading based on biopsy technique (P = 0.26). During follow up, 5‐year biochemical failure‐free survival estimates were not significantly different (P = 0.11).ConclusionsIn men with prostate cancer, standard and saturation transrectal prostate biopsies techniques are equally predictive of candidates for active surveillance.
Perceptions from the front line: Professional identity in mental health nursing
Authors: Hercelinskyj Gylo , Cruickshank Mary , Brown Peter , Phillips Brian 
Published: December 2012

AbstractIn the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses (MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN.
The dynamics of infection and the persistence of immunity to A(H1N1)pdm09 virus in Israel
Authors: Weil Merav , Shohat Tamar , Bromberg Michal , Bassal Ravit , Dichtiar Rita , Mandelboim Michal , Sofer Danit , Cohen Dani , Mendelson Ella 
Published: December 2012

BackgroundInfluenza virus A(H1N1)pdm09 first appeared in Israel in late April 2009, disappeared in mid‐March 2010, and reappeared in late October 2010. Symptoms were mostly mild without need for medical care.ObjectivesTo provide targets for future pandemic preparedness and response by evaluating the dynamics and cumulative incidence of A(H1N1)pdm09 infection, the virus‐specific seroprevalence (HI antibody titer >1:40) at the height of the pandemic, during its decline and thereafter.MethodsA cross‐sectional seroepidemiological study was conducted on 6911 serum samples collected before, during, and after the pandemic.ResultsCumulative incidence of infection derived from the differences between post‐ and pre‐pandemic seroprevalence was 54·1%, 32·9%, 22·9%, 14·8%, and 6·3% in age‐groups 0–9, 10–19, 20–49, 50–79, and ≥80 years, respectively, and 28·5% for all age‐groups combined. Vaccination could have contributed at the most 4·6% to the post‐pandemic population seroprevalence. High pre‐pandemic immune response (47·4%) found in a cohort aged 15–18 year was strongly associated with birth years 1990–1993. Morbidity began to decline in mid‐November 2009 at 32·8% population seroprevalence (45% in ages 0–19 year) and stopped in March 2010 at 43·4% population seroprevalence in February 2010 (70% in ages 0–19 year). Between February and September 2010, seroprevalence declined by 12·2% allowing virus recirculation from October 2010.ConclusionsOur study provides targets for controlling future influenza pandemics in Israel. Vaccination should focus on the younger age‐groups (0–19 year) which played a key role in transmission of the A(H1N1)pdm09 due to lack of background immunity (ages 0–9 year) and high exposure rates (ages 10–19 year).
Reconstructing a lost tradition: the philosophy of medical education in an age of reform
Authors: Martin Christopher 
Published: December 2012

Context  At the 100th anniversary of Abraham Flexner’s landmark report on medical education, critical reassessment of the direction of medical education reform evinced valuable interdisciplinary contributions from biomedicine, sociology, psychology and education theory. However, to date, philosophy has been absent from the discussion despite its long standing contribution to studies on education in other professions.Methods  This discussion paper examines how the philosophical tradition can contribute to scholarship in medical education. It begins with an explanation of the scholarly tradition of philosophy of education and its role in thinking in education more generally. It then makes links between this tradition and the context of medical education in the Flexner era of education reform. The paper then argues that this tradition is necessary to the understanding of medical education reform post‐Flexner and that doctors must benefit from an education derived from this tradition in order to be able to carry out their work.Discussion  These foundations are characterised as a hidden, but always present, tradition in medical education. Two ways in which this ‘lost tradition’ can inform medical education theory and practice are identified: firstly, by the establishment of a public canon of medical education texts that express such a tradition, and, secondly, by the incorporation of a variety of ‘signature pedagogies’ exemplary of liberal education.
From sick role to practices of health and illness
Authors: Frank Arthur W 
Published: December 2012

Context Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them.Methods This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons’ concept of the ‘sick role’. Four turning points since Parsons are then discussed with reference to the theory developed by, respectively, Harold Garfinkel, Michel Foucault and Pierre Bourdieu, and what is called the ‘narrative or dialogical turn’. In considering these, the author argues for a theory‐grounded research that relates specific problems to what Max Weber called the ‘fate of our times’.Conclusions The conclusion considers how medical education research can critique the reproduction of a discourse of scarcity in health care, rather than participating in this discourse and legitimating the disciplinary techniques that it renders self‐evident.
Narrative, emotion and action: analysing ‘most memorable’ professionalism dilemmas
Authors: Rees Charlotte E , Monrouxe Lynn V , McDonald Laura A 
Published: December 2012

OBJECTIVES Although previous studies have explored medical learners’‘most memorable’ experiences, these have typically focused on patient deaths or mistakes. Drawing on multiple theoretical perspectives to understand the interplay between narrative, emotion and action, this paper aims to explore thewhatsandhowsof written narratives of most memorable professionalism dilemmas: what types of dilemma are most memorable? When and where do they take place? How do students act? What characteristics relate to these dilemmas? How are dilemmas narrated?METHODS A total of 680 students from 29 of 32 UK medical schools provided a written narrative of their most memorable dilemma as part of their responses to an online questionnaire exploring the impact of professionalism dilemmas on moral distress. We employed quantitative thematic and discourse analysis of all narratives using Linguistic Inquiry Word Count software (liwc) and conducted a narrative analysis of one exemplar.RESULTS The most common themes across all narratives concerned dilemmas that related to issues of patient care with reference to the actions of health care professionals or students, student abuse, and consent and intimate examination. A total of 41.1% of experiences had occurred over 6 months previously and 80.1% had taken place in hospital settings. Overall, 54.9% of narrators reported having done something in the face of their dilemma, although only 13.2% described taking obvious or direct action. Numerous characteristics were related to most memorable dilemmas (e.g. narratives citing intimate examinations were more likely to take place in surgical settings). A total of 92.6% of narratives included negative emotion talk and numerous significant relationships emerged between types of emotion talk and most memorable dilemmas (e.g. more anger talk in abuse narratives). Our narrative analysis of one exemplar illustrates the richness of emotion talk and more subtle devices to establish emotional tone.DISCUSSION Findings extend previous research into issues related to professionalism by exploring relationships between narrative, emotion and action in the context of written narratives of most memorable dilemmas. We encourage medical educators to help students construct coherent and emotionally integrated narratives to make sense of negative professionalism dilemmas.
Discourse(s) of emotion within medical education: the ever‐present absence
Authors: McNaughton Nancy 
Published: December 2012

Context Emotion in medical education rests between the idealised and the invisible, sitting uneasily at the intersection between objective fact and subjective values. Examining the different ways in which emotion is theorised within medical education is important for a number of reasons. Most significant is the possibility that ideas about emotion can inform a broader understanding of issues related to competency and professionalism.Objectives The current paper provides an overview of three prevailing discourses of emotion in medical education and the ways in which they activate particular professional expectations about emotion in practice.Methods A Foucauldian critical discourse analysis of the medical education literature was carried out. Keywords, phrases and metaphors related to emotion were examined for their effects in shaping medical socialisation processes.Discussion Despite the increasing recognition over the last two decades of emotion as ‘socially constructed’, the view of emotion as individualised is deeply embedded in our language and conceptual frameworks. The discourses that inform our emotion talk and practice as teachers and health care professionals are important to consider for the effects they have on competence and professional identity, as well as on practitioner and patient well‐being. Expanded knowledge of how emotion is ‘put to work’ within medical education can make visible the invisible and unexamined emotion schemas that serve to reproduce problematic professional behaviours. For this discussion, three main discourses of emotion will be identified: a physiological discourse in which emotion is described as located inside the individual as bodily states which are universally experienced; emotion as a form of competence related to skills and abilities, and a socio‐cultural discourse which calls on conceptions from the humanities and social sciences and directs our attention to emotion’s function in social exchanges and its role as a social, political and cultural mediator.
Gender matters in medical education
Authors: Bleakley Alan 
Published: December 2012

Context  Women are in the majority in terms of entry to medical schools worldwide and will soon represent the majority of working doctors. This has been termed the ‘feminising’ of medicine. In medical education, such gender issues tend to be restricted to discussions of demographic changes and structural inequalities based on a biological reading of gender. However, in contemporary social sciences, gender theory has moved beyond both biology and demography to include cultural issues of gendered ways of thinking. Can contemporary feminist thought drawn from the social sciences help medical educators to widen their appreciation and understanding of the feminising of medicine?Discussion  Post‐structuralist feminist critique, drawn from the social sciences, focuses on cultural practices, such as language use, that support a dominant patriarchy. Such a critique is not exclusive to women, but may be described as supporting a tender‐minded approach to practice that is shared by both women and men. The demographic feminising of medicine may have limited effect in terms of changing both medical culture and medical education practices without causing radical change to entrenched cultural habits that are best described as patriarchal. Medical education currently suffers from male biases, such as those imposed by ‘andragogy’, or adult learning theory, and these can be positively challenged through post‐structuralist feminist critique.Conclusions  Women doctors entering the medical workforce can resist and reformulate the current dominant patriarchy rather than reproducing it, supported by male feminists. Such a feminising of medicine can extend to medical education, but will require an appropriate theoretical framework to make sense of the new territory. The feminising of medical education informed by post‐structuralist frameworks may provide a platform for the democratisation of medical culture and practices, further informing authentic patient‐centred practices of care.
Subarachnoid‐pleural fistula in a child: The cause and treatment
Authors: Karabayir Nalan , Demirkol Demet , Odaman Al Isık , Dolas Ilyas , Sencer Altay 
Published: December 2012

AbstractHydrothorax of the cerebrospinal fluid after a subarachnoid‐pleural fistula is a rare condition. Subarachnoid‐pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid‐pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccured after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid‐pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid‐pleural fistulae.
Acetaminophen administration in a patient with Gilbert's syndrome
Authors: Nakagawa Taku , Mure Takeo , Yusoff Surini , Ono Eiichi , Harahap Indra Sari Kusuma , Morikawa Satoru , Morioka Ichiro , Takeshima Yasuhiro , Nishio Hisahide , Matsuo Masafumi 
Published: December 2012

AbstractThe patient was an 8‐year‐old Japanese girl with Gilbert's syndrome (GS). Based on the DNA analysis, she was homozygous for a T‐to‐G transversion at nucleotide position 1456 in the UGT1A1 gene, leading to the substitution of aspartate for tyrosine at position 486 of the UGT1A1 enzyme. Because this mutation is located in an exon common to UGT1A genes, all the UGT1A enzymes may be affected. It is well‐known that UGT1A1, UGT1A6 and UGT1A9 enzymes glucuronidate acetaminophen. To evaluate acetaminophen tolerance in the patient, serum acetaminophen levels were determined after oral administration of acetaminophen (15 mg/kg). The maximum serum acetaminophen level reached (12.8 µg/mL) was far below the toxic level. The finding suggested that the usual therapeutic dose of acetaminophen is safe for the GS patient. The combination of mutation analysis in UGT1A1 and acetaminophen loading test may be useful to avoid adverse effect in GS patients.
Acute encephalopathy and tubulointerstitial nephritis associated with Yersinia pseudotuberculosis
Authors: Kaito Hiroshi , Kamei Koichi , Ogura Masao , Kikuchi Eriko , Hoshino Hideki , Nakagawa Satoshi , Matsuoka Kentaro , Abe Jun , Ito Shuichi 
Published: December 2012

AbstractWe report the case of a 28‐month‐old boy with encephalopathy and acute tubulointerstitial nephritis possibly associated with Yersinia pseudotuberculosis (Yp) infection. He was transferred to our center because of impairment of renal function and altered consciousness. He had fever for 5 days after recurrent vomiting and diarrhea. Computed tomography scan was normal, but electroencephalogram (EEG) analyses showed generalized slow wave patterns. Continuous hemodialysis was undergone and then his renal function was improved, but altered consciousness persisted. Single photon emission computed tomography (SPECT) revealed abnormally low signals at entire field, which suggested that he was suffered from encephalopathy. Phenobarbital administration and post‐encephalopathy rehabilitation were started, and he recovered in fully premorbid state with normal EEG and SPECT findings on the 33rd hospital day. Various bacterial cultures were negative, but both Yp antibody and Yp‐derived mitogen (YPM) antibody, the antibody of a specific Yp exotoxin, had an extremely high titer. This is the first report of encephalopathy potentially caused by Yp, indicated by the presence of a high Yp and YPM antibody titer.
Endometrial cancer in a 14‐year‐old girl with Cowden syndrome: A case report
Authors: Baker William David , Soisson Andrew Patrick , Dodson Mark Kane 
Published: December 2012

AbstractThe appearance of endometrial cancer in adolescence is uncommon and warrants investigation for an hereditary cancer syndrome. Cowden syndrome is an autosomal dominant cancer syndrome associated with a germline PTEN mutation and increased risk of breast, thyroid, endometrial and colon cancer. In this report we present a case of a 14‐year‐old nulligravid female diagnosed with grade 1 endometrial adenocarcinoma. She subsequently developed fibrocystic breast disease and colon polyps and was diagnosed with Cowden syndrome at age 20. We therefore recommend formal evaluation for Cowden syndrome to be considered when endometrial cancer is diagnosed in adolescence.