Narrative Case Research Articles

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Poster 375: Incidence of Tendon Ruptures in the US: Comparison of Differences Across Racial Groups

Poster 383: Incidence of Sports Related Tendon Ruptures in the United States

Objectives: Physical activity is known to have multiple beneficial health effects, including a reduced risk of cardiovascular disease, improved insulin sensitivity and cognitive function [1,2]. Sports participation inherently increases the risk of musculoskeletal injury, including tendon rupture [3]. Tendon ruptures can be debilitating injuries and often require multidisciplinary treatment and long recovery periods and potentially lead to significant reductions in quality of life, lost productivity, and considerable healthcare costs [4]. Previous studies have been focused primarily on specific types of tendon injuries and/or specific patient populations such as high-level athletes and military trainees, which is not generalizable to the US population [5-8]. There currently exist no updated, population-based studies describing the incidence and demographics of all athletic/sports-related tendon ruptures in the general US population. The purpose of this study was to describe the contemporary epidemiology of athletic tendon ruptures in the US in the most recent two decades using a nationally representative sample. Methods: The NEISS database, a nationally representative sample of US hospital emergency departments was used to ascertain the incidence rates of various types of tendon ruptures in the Unites States. All cases from 2001-2020 were reviewed for case narratives to select only those cases with a clear diagnosis of an acute primary tendon rupture. After exclusions, a total of n=5,765 unweighted cases were identified, representing a national estimate of N=235,189 tendon ruptures (95% CI=186,833- 283,546). Finally, each case narrative was manually reviewed and cross-referenced with the case’s product codes to assign a primary injury mechanism to each patient record, and only those cases involving exercise-/sports-related injury mechanisms were included in the final analyses. Statistical analysis was performed using the survey data commands in Stata/IC, version 17.0 (StataCorp, College Station, TX, US), accounting for sample weights and the complex survey designs. The incidence rate (IR) of tendon ruptures and mechanism were calculated and chi-square tests were used to compare estimated IRs between groups. Student t-test/analysis of variance and design-adjusted Rao-Scott chi- square analysis was used for direct comparisons of means for continuous variables and proportions for categorical variables, respectively [9,10]. Temporal trends and annual percentage changes were assessed via regression analysis. Results: An estimated total of 141,382 individuals (95% CI=107,478-175,286) presented to US EDs with a sports-related tendon rupture over the study period for an overall incidence of 22.9 Person-Years at-risk (PYR) (95% CI=17.4-28.3). Mean age was 37.7 years (95% CI=37.0-38.5). Peak incidence of tendon ruptures occurred in the fourth decade and persons aged 20-40 years accounted for a majority of cases (78.2%). Achilles tendon rupture was the most common injury, representing over half of all cases (55.9%). Basketball was the most common sports-related injury mechanism, accounting for more than one-third of all injuries (36.6%) and a common mechanism for all tendon ruptures of the lower extremity. For sports-related injuries involving upper extremity tendons, weight lifting was the most common mechanism for most, including biceps, rotator cuff, and triceps/pectoralis tendon ruptures. Nearly half of all injuries occurred in contact sports (46.8%). The annual incidence of all sports-related tendon ruptures in the US increased significantly from 2001 to 2020 (AAPC=1.9, 95% CI=1.0-2.8; P<0.01). For comparison, the annual incidence of all non-sports-related tendon ruptures also increased significantly over the same time period (AAPC=4.9, 95% CI=3.7-6.1; P<0.01), and in fact increased at a significantly higher rate than that of all sports-related ruptures (P<0.01). Complete national injury estimate data for each specific type of sport or recreational activity, overall and for each type of tendon rupture, is reported in the Supplement Tables (Supplement 5,6). Conclusions: Tendon ruptures can be debilitating injuries for all patients and can especially affect personal and team performance of competitive athletes to differing degrees depending on the athlete’s particular sport [11]. There is a paucity of population-based studies describing the incidence and demographics of all athletic/exercise-related tendon ruptures in the general US population. This study highlights an increasing annual incidence of athletic tendon ruptures over the last two decades in the US, primarily affecting males of many different age groups. The incidence of nearly all types of tendon ruptures was significantly higher in males when compared with females, which is generally consistent with previous studies involving other large patient populations [12-16]. Previous population-based studies demonstrating an increased incidence of tendon ruptures in recent years have attributed these trends in part to increased athletic participation among adults of various ages [16–18]. Our results show the same trends and are likely attributed to increased participation in athletics, as well as the growing popularity of unconventional sports. [Table: see text][Table: see text][Table: see text][Table: see text]

Advances in Idiosyncratic Drug-Induced Liver Injury Issues: New Clinical and Mechanistic Analysis Due to Roussel Uclaf Causality Assessment Method Use

Clinical and mechanistic considerations in idiosyncratic drug-induced liver injury (iDILI) remain challenging topics when they are derived from mere case narratives or iDILI cases without valid diagnosis. To overcome these issues, attempts should be made on pathogenetic aspects based on published clinical iDILI cases firmly diagnosed by the original RUCAM (Roussel Uclaf Causality Assessment Method) or the RUCAM version updated in 2016. Analysis of RUCAM-based iDILI cases allowed for evaluating immune and genetic data obtained from the serum and the liver of affected patients. For instance, strong evidence for immune reactions in the liver of patients with RUCAM-based iDILI was provided by the detection of serum anti-CYP 2E1 due to drugs like volatile anesthetics sevoflurane and desflurane, partially associated with the formation of trifluoroacetyl (TFA) halide as toxic intermediates that form protein adducts and may generate reactive oxygen species (ROS). This is accompanied by production of anti-TFA antibodies detected in the serum of these patients. Other RUCAM-based studies on serum ANA (anti-nuclear antibodies) and SMA (anti-smooth muscle antibodies) associated with AIDILI (autoimmune DILI) syn DIAIH (drug-induced autoimmune hepatitis) provide additional evidence of immunological reactions with monocytes as one of several promoting immune cells. In addition, in the blood plasma of patients, mediators like the cytokines IL-22, IL-22 binding protein (IL-22BP), IL-6, IL-10, IL 12p70, IL-17A, IL-23, IP-10, or chemokines such as CD206 and sCD163 were found in DILI due to anti-tuberculosis drugs as ascertained by the prospective updated RUCAM, which scored a high causality. RUCAM-based analysis also provided compelling evidence of genetic factors such as HLA (human leucocyte antigen) alleles contributing to initiate iDILI by a few drugs. In conclusion, analysis of published RUCAM-based iDILI cases provided firm evidence of immune and genetic processes involved in iDILI caused by specific drugs.

Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach

Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.

Atypical Radiology Imaging of Squamous Cell Lung Carcinoma: A Case Report and Narrative Review

Introduction: Multiple well-circumscribed round nodules, also known as “Cannonball” appearance in the lungs, are typically associated with specific pulmonary metastases. However, limited reports denote the finding, especially if correlated with primary squamous cell lung carcinoma in the younger population. This is the first case report in Indonesia of a 19-year-old male with primary squamous cell carcinoma in the lung and chest radiograph image mimicking a “Cannonball” appearance Case Presentation: A 19-year-old male was presented with a history of progressing hemoptysis for two weeks with no other abnormal respiratory symptoms but a reduction of vocal fremitus. The subject is an occasional smoker and had a history of lung tuberculosis in 2009 and a suprarenal or adrenal mass. X-ray imaging revealed multiple bilateral pulmonary nodules, mimicking the “Cannonball” appearance. A fine needle aspiration (FNA) biopsy of a nodule was done and interpreted to be primary squamous cell carcinoma. Symptomatic treatment was given and the subject was discharged on the fifth day. Conclusions: A “Cannonball” appearance or its mimic is not always typical to certain carcinoma based on what this case report finds. In the case of a tumor, radiograph findings should also be correlated with other supporting tests such as biopsy and clinical presentation.

Attending to Process in Teacher Education: Small but Impactful Changes to the Teacher Supervision System

ABSTRACT This narrative case study describes the use of improvement science methods to strengthen the effectiveness of field experiences for teacher candidates. As part of a networked improvement community, we sought to reduce variation in the quality of field experience by providing a cohesive network of high-quality coaching supports. Using design-based methods grounded in the principles of improvement, we analyzed seven learning, design, and testing rounds to reduce variation in teacher candidates’ experiences as student teachers or interns. Results from early learning rounds suggested considerable structural variability in how supervisors conducted their POP cycles. The structural variability from these rounds led to two key change ideas to address variation in teacher candidates field experiences: a common POP cycle protocol and the use of a POP-cycle-aligned reflection form. The principles and tools of improvement highlighted small but significant changes to how supervisors support teachers within their field experiences.

Revitalization Analysis of Forms, Songs, and Functions of Presenting Traditional Music Srawung Krumpyung in Kulon Progo Regency

Traditional music Krumpyung is a local arts from Kulon Progo. The declining quality coupled with the lack of performers, containers, and limited performance time made the revitalization of Krumpyung happen. The objective of this research is to describe the result of revitalization analysis of the form, song, and function of presenting traditional music that done by Srawung Krumpyung as a step of regeneration and conservation efforts. This research is using qualitative research with narrative study and case study methods to determine that revitalization can be used as a step of regeneration and conservation efforts. Data collection technique that used in this research is snowball sampling by doing deep interview, collect data from Dinas Kebudayaan Kulon Progo Regency, or watching video documentations. The validity data form this research is measured by triangulation of sources. Data analysis technique that used in this research is interactive model by Huberman and Miles. Result of this research is revitalization can be used a step regeneration and conservation efforts by: (1) reconstruction, (2) refunctionalization, (3) representation, (4) reformation, (5) reinterpretation, (6) reorientation, and (7) recreation. The value of step regeneration and conservation efforts manifested in: (1) creativity, (2) love of the homeland, and (3) environmental care.

What Do We Owe to Patients Who Leave Against Medical Advice? The Ethics of AMA Discharges.

Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice.

Cefiderocol Treatment for Severe Infections due to Difficult-to-Treat-Resistant Non-Fermentative Gram-Negative Bacilli in ICU Patients: A Case Series and Narrative Literature Review.

Cefiderocol (FDC) is a siderophore cephalosporin now recognized as a new weapon in the treatment of difficult-to-treat-resistant (DTR) Gram-negative pathogens, including carbapenemase-producing enterobacterales and non-fermentative Gram-negative bacilli (GNB). This article reports our experience with an FDC-based regimen in the treatment of 16 extremely severe patients (invasive mechanical ventilation, 15/16; extracorporeal membrane oxygenation, 9/16; and renal replacement therapy, 8/16) infected with DTR GNB. Our case series provides detailed insight into the pharmacokinetic profile and the microbiological data in real-life conditions. In the narrative review, we discuss the interest of FDC in the treatment of non-fermentative GNB in critically ill patients. We reviewed the microbiological spectrum, resistance mechanisms, pharmacokinetics/pharmacodynamics, efficacy and safety profiles, and real-world evidence for FDC. On the basis of our experience and the available literature, we discuss the optimal FDC-based regimen, FDC dosage, and duration of therapy in critically ill patients with DTR non-fermentative GNB infections.

Particulate bone graft materials for periodontal and implant surgery: A narrative review and case series

Particulate bone graft materials for periodontal and implant surgery: A narrative review and case series

Advocacy on the outside: Advancing support for system‐impacted students through grassroots leadership

AbstractCommunity College Reentry Programs (CCRPs) are campus‐based programs that serve formerly incarcerated students by providing targeted services attuned to their needs. Currently, there are 62 community colleges in California that have CCRPs. While emerging research has begun to examine the experiences of students in these programs, little is known about the staff who lead them. This study uses a grassroots leadership perspective to examine how CCRP staff lead for organizational change. Through the presentation of two case narratives of CCRPs, I show how staff lead reform efforts towards advancing justice and equity for their students on campus and in the community. My findings have implications for strengthening aid for these programs and better supporting their staff.

Rethinking Yi’an (Medical Cases) as a Tool for Narrative Medicine in China

When narrative medicine (NM) was introduced into China, traditional Chinese medicine scholars found that the core concepts advocated by NM are manifested in Chinese yi’an. But why NM echoes with ancient Chinese yi’an? How can we better integrate NM into Chinese medical practices? To answer those questions, this article first investigates how NM establishes itself as a remedy to biomedicine by taking traditional healing models including TCM as its ideal Other. Then, the narrative traditions of both case histories and yi’an are examined respectively. This article argues that NM is searching for a lost tradition of narrative case histories, but yi’an functions as a living tradition of TCM. The Parallel Chart in NM, designed as a complement to the dehumanized hospital chart, is still based on a dichotomy of science and art and a conflictual doctor-patient model. But yi’an exemplifies the holistic and humane healthcare that NM hopes to achieve. A comparison of both genres also inspired us to rethink the genre of yi’an in NM. Thus, it is concluded that yi’an should be viewed as an epistemic genre integrating individualization and generalization, a bridge linking medicine and literature. And narrative yi’an can well serve as a tool for NM in China. It is also proposed that a thick description of yi’an be encouraged to further promote a pluralistic NM in China.

Rehabilitation of a lateral ankle reconstruction in a male professional football player – A narrative case report

ObjectivesLateral ankle sprains involving the ATFL and CFL are common injuries in football with a high recurrence rate. There is a lack of research to guide post-operative rehabilitation of football players following lateral ligament ankle reconstructive surgery. This narrative case report discusses the management of a lateral ligament reconstruction in a male professional football player. MethodsA 25-year-old professional footballer underwent a lateral ankle reconstruction following recurrent lateral ankle sprains leading to an unstable ankle. ResultsFollowing 11-weeks of rehabilitation the player was cleared to return to full-contact training. The player competed in his first competitive match 13-weeks post-injury and completed a 6-month full-training block, without episodes of pain or instability. ConclusionThis case report illustrates the rehabilitation process of a football player following a lateral ankle ligament reconstruction within a timeframe expected in elite sport.

Registration Experiences of Middle Eastern Qualified Midwives in Australia: A Narrative Case Study Analysis

BACKGROUND:Migrating to Australia to work as a midwife can be challenging, particularly for those from non-English speaking backgrounds, since they must achieve strict qualification standards, English language skills, and professional competence to be eligible for registration.AIM:The purpose of this study was to explore the registration experiences of Middle Eastern-qualified midwives in Australia.METHODS:Multiple case narrative study, underpinned by structuration theory, involving 19 Middle Eastern-qualified midwives from different states of Australia. Individual semi-structured interviews were conducted between November 2020 and September 2021 and digitally recorded and then transcribed. Transcriptions were analyzed in three stages, with categories generated in the second stage and core categories developed in the third.RESULTS:This study found that Middle Eastern-qualified midwives’ registration experiences were significantly impacted by evolutions in policies in Australia. The accounts of participants who applied for registration at varying stages suggested the process became more complicated over time. Overall, four categories emerged with varying prominence from the accounts of participants who applied for registration at different times including:language barrier, variation in the process, inadequate orientation,andmisdirection. Systemic issues were identified as significant barriers to the registration of Middle Eastern-qualified midwives in Australia.CONCLUSION:With Australia’s reliance on internationally qualified midwives, strategies should be developed to identify the language support, appropriate orientation, and regulatory adjustment necessary to reduce the underutilization of Middle Eastern-qualified midwives.

The role of Aboriginal education officers in the context of settler colonial schooling: challenges and possibilities

Educational policies indicate that the role of an Aboriginal Education Officer (AEO) is to build on contextual understanding and provide culturally appropriate support to assist Aboriginal and/or Torres Strait Islander students’ learning. There is little research exploring the role of the AEO from the perspective of Aboriginal peoples. The stories of four AEOs from New South Wales, Australia, will be shared through a narrative case study. This article will focus on AEOs’ experiences when they were initially employed in their schools. Findings suggest that the lack of clarity within the state-wide AEO statement of duties impacted the schools’ delegation to the AEOs. This, in turn impacted on the AEOs’ initial experience in the role and the inclusion of tasks that AEOs felt were outside of their expectations. Policy states that more Aboriginal educators are required in education systems but there are continual hurdles that AEOs face that prevent them from successfully performing their duties.

Disability-related factors affecting food security status: A case study from southern Ethiopia

This study looked at the state of food security and the factors that affect it among individuals with disabilities in Durame, a town in southern Ethiopia. The study used cross-sectional survey data from 205 disabled individuals who were chosen using a combination of stratified, proportionate to population size, and random sampling techniques. The required primary and secondary data were collected using a variety of instruments, including survey questionnaires, key informant interviews, focus group discussions, and case narrative telling techniques. The disability aspects and severity level among people with disabilities were identified using descriptive statistics in conjunction with multidimensional techniques utilizing principal component analysis. To determine how factors affected the level of food security, ordered logit regression was utilized. The results showed that 10 variables, including education level, sex, food expenditure, empowerment, employment situation, social cohesion, water access, institutional supports, extension contact, and media access, were identified as the significant determinants of food security status poeple with disabilities in the study area out of the 19 variables included in the model. The results led to the presentation of policy recommendations. In order to achieve food security for people with disabilities, coordinated efforts of stakeholders should be increased to improve access to education, employment, empowerment, infrastructure like water and mass media, creating social cohesion, more expansion and recognition of female roles, and institutional supports.

Pediatric primary renal lymphoma presenting with multiple masses: A challenging case report and narrative review.

Only 20 cases of pediatric primary renal non-Hodgkin's lymphoma have been reported since 1995, rare cases and a variety of imaging manifestations have led to difficulties in its diagnosis and treatment. Herein, we share in detail a case of primary renal lymphoma (PRL) in a child and summarize the common clinical manifestations, imaging features, and prognostic factors of pediatric PRL by retrospectively analyzing cases reported in the literature. A 2-year-old boy presented to the clinic with a large mass on the right side of his abdomen along with loss of appetite. Imaging revealed a large right renal mass, nearly replacing the entire renal tissue, along with numerous small nodules in the left kidney. Given no local adenopathy and metastases, the diagnosis was unclear. A percutaneous renal puncture was performed, which proved the diagnosis of Burkitt's lymphoma. Since no bone marrow involvement, this child was diagnosed with pediatric PRL. This PRL boy was treated with the NHL-BFM95 protocol and supportive care. Unfortunately, this boy died of multiple organ failure in the fifth month of treatment. As per literature review, the presentation of pediatric PRL is fatigue, loss of appetite, weight loss, abdominal swelling, or other nonspecific symptoms. Although in 81% of cases it often infiltrates the bilateral kidneys, urine abnormalities caused by pediatric PRL are uncommon. 76.2% of pediatric PRL were boys and 2/3 of all cases presented as diffuse renal enlargement. Those PRL presented as masses could easily be misdiagnosed as WT or other malignancies. Absent of local enlarged lymph node, no necrosis or calcification suggest atypical presentation of renal masses and a percutaneous biopsy is needed in timely establishing the accurate diagnosis for appropriate treatment. Based on our experience, percutaneous renal puncture core biopsy is a safe procedure.

A functional view on language: a methodology for mathematics education to study shifts in prospective teachers’ discursive patterns

This paper set out to contribute to mathematics education research by elaborating on a methodology developed during a study, trying to understand, view and follow shifts in prospective teachers' discursive patterns. The methodology aims to illustrate and describe how prospective teachers adapt to the context of teaching through a flexible process. This flexible process is then described in the result as a narrative. It is argued that the methodology can be used in relation to different theoretical directions, such as research about beliefs, knowledge, or identity. Another contribution is that the methodology presented gives insights into bridging the gap between different analytical levels, micro and macro. With a theoretical foundation in ‘Cultural Worlds’ [Holland, D., Skinner, D., Lachicotte, W., & Cain, C. (1998). Identity and agency in cultural worlds. Harvard University Press.] the Social Semiotic approach of Systemic Functional Linguistics, SFL [Halliday, M., & Hasan, R. (1989). Language, context, and text: Aspects of language in a social-semiotic perspective (2nd ed.). Oxford University Press] is used as a methodological tool. SFL offers a toolkit that allows the analysis of meaning at the clause level to uncover how and why a speaker produces a particular wording rather than any other in a specific social practice. The paper aims to illustrate and describe how to go beyond findings in the micro-analysis and then present the result as a narrative case.

Social work in the age of disconnection: Narrative case studies

Review of Social work in the age of disconnection: Narrative case studies. Michael Jarrette-Kenny and Miriam Jaffe (Eds.) Routledge, New York and Abingdon, 2022. ISBN: 978-1-032-21829-8, pp.211, paperback, NZD75.99.

Quality of MedDRA® Coding in a Sample of COVID-19 Vaccine Medication Error Data.

In recent years, there has been increasing interest from regulatory agencies and scientific organisations into the recording, coding and reporting of medication errors. Accuracy and consistency in the handling of medication error reports ensure the safety and effectiveness of medicines and provide reliable information to both healthcare professionals and patients. The authors have examined a sample of Medical Dictionary for Regulatory Activities (MedDRA®) coded reports that describe medication errors to assess the accuracy and consistency of MedDRA® coding, and to identify the main types of coding errors for the newly introduced COVID-19 vaccines. The sample of coded terms was assessed by two MedDRA® experts applying the Four Eyes Principle. It included 1500 reported terms drawn from the Uppsala Monitoring Centre database reported up to 25 August, 2021, describing medication errors for COVID-19 vaccines with their assigned MedDRA® terms. One third of the records could not be assessed because of incomplete or unclear verbatims. In one third, MedDRA® term assignments were correct, but another third of the sample was not adequately coded. The most frequent coding errors corresponded to vague MedDRA® Preferred Term assignments despite more detailed information being available in the verbatim for a more precise coding. This observation is similar to findings in the EudraVigilance database, where some of the most frequently assigned MedDRA® terms for medication errors also represent vague concepts. The findings indicate that understanding of medication error documentation and of the importance of accurate extraction of information from case narratives, as well as knowledge of MedDRA® content and coding guidelines need to be reinforced. The authors provide useful references to training opportunities and to the applicable International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use-Endorsed Guides for MedDRA® users.