Narrative medicine describes the application of story to medical education and practice. Although it has been implemented successfully in many medical schools as a part of undergraduate medical education, applications to the residency environment have been relatively limited. There are virtually no data concerning the adoption of narrative medicine within surgical residencies. This paper provides a brief introduction to the formal discipline of narrative medicine. We further discuss how storytelling is already used in surgical education and summarize the literature on applications of narrative medicine to residents in other specialties. The relevance of narrative medicine to the ACGME core competencies is explored. We conclude with specific suggestions for implementation of narrative medicine within surgical residency programs.Background Patient-reported outcomes may be discordant to severity of illness as assessed by objective parameters. The frequency of this discordance and its influence on clinical outcomes in patients with heart failure is unknown. Methods and Results In HF-ACTION (Heart Failure A Controlled Trial Investigating Outcomes of Exercise Training), participants (N=2062) had baseline assessment of health-related quality of life via the Kansas City Cardiomyopathy Clinical Summary score (KCCQ-CS) and objective severity by cardiopulmonary stress testing (minute ventilation [VE]/carbon dioxide production [VCO2] slope). We defined 4 groups by median values 2 concordant (lower severity high KCCQ-CS and low VE/VCO2 slope; higher severity low KCCQ-CS and high VE/VCO2 slope) and 2 discordant (symptom minimizer high KCCQ-CS and high VE/VCO2 slope; symptom magnifier low KCCQ-CS and low VE/VCO2 slope). The association of group assignment with mortality was assessed in adjusted Cox models. Symptom magnification (23%) and symptom minimization (23%) were common. Despite comparable KCCQ-CS scores, the risk of all-cause mortality in symptom minimizers versus concordant-lower severity participants was increased significantly (hazard ratio [HR], 1.79; 95% CI, 1.27-2.50; P less then 0.001). Furthermore, despite symptom magnifiers having a KCCQ-CS score 28 points lower (poorer QOL) than symptom minimizers, their risk of mortality was not increased (HR, 0.79; 95% CI, 0.57-1.1; P=0.18, respectively). Conclusions Severity of illness by patient report versus cardiopulmonary exercise testing was frequently discordant. Mortality tracked more closely with the objective data, highlighting the importance of relying not only on patient report, but also objective data when risk stratifying patients with heart failure.Background Overweight adults have low circulating concentrations of ANP (atrial natriuretic peptide) and proANP fragments. We tested the hypothesis that an intensive lifestyle intervention with an intended weight loss would increase plasma concentrations of a proANP fragment in overweight children. Methods and Results We measured MR-proANP (midregional proANP) concentrations in plasma from overweight children who participated in the OOIS (Odense Overweight Intervention Study). OOIS randomized 115 overweight children (11-13 years, 55% girls) to an intensive day-camp intervention arm with increased physical activity and healthy diet or to a less intensive standard intervention arm for 6 weeks. We used linear mixed-effects modeling for repeated measures to estimate the difference in the mean change with 95% CIs in fasting plasma MR-proANP concentrations between the 2 arms, and we used partial least squares regression analysis to identify candidate mediators. Differences in weight, fitness, and metabolic factors were also analyzed. At baseline, fasting plasma MR-proANP concentrations were (median [interquartile range]) 35.0 pmol/L (26.8-42.0) in the day-camp intervention arm and 37.2 pmol/L (31.7-44.7) in standard intervention arm participants, respectively. After 6 weeks intervention, children in the day-camp intervention arm had increased their MR-proANP (5.4 pmol/L [0.8-10.0], P=0.022) and their fitness (2.33 mL O2/min per kg [0.52-4.14], P=0.012) and they had deceased their body mass index (-2.12 kg/m2 [-2.59 to -1.65], P less then 0.001) as compared with children in standard intervention arm. In the partial least squares analysis, decreases in fasting insulin and in estimated insulin resistance were associated with the observed increase in MR-proANP concentrations. Conclusions An intensive lifestyle intervention increases plasma MR-proANP among overweight children. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT01574352.Background It remains unclear whether beta-blocker use at hospital admission is associated with better in-hospital outcomes in patients with acute decompensated heart failure. Methods and Results We evaluated the factors independently associated with beta-blocker use at admission, and the effect of beta-blocker use at admission on in-hospital mortality in 3817 patients with acute decompensated heart failure enrolled in the Kyoto Congestive Heart Failure registry. There were 1512 patients (39.7%) receiving, and 2305 patients (60.3%) not receiving beta-blockers at admission for the index acute decompensated heart failure hospitalization. Factors independently associated with beta-blocker use at admission were previous heart failure hospitalization, history of myocardial infarction, atrial fibrillation, cardiomyopathy, and estimated glomerular filtration rate less then 30 mL/min per 1.73 m2. Factors independently associated with no beta-blocker use were asthma, chronic obstructive pulmonary disease, lower body Registration URL https//www.upload.umin.ac.jp/; Unique identifier UMIN000015238.
  Mediterranean diet (MD) adherence, physical activity (PA) patterns, and physical fitness are associated with physical, social, and psychological health in children.
 
  the purpose of this study was to determine the association of items of MD adherence, fitness components, and lifestyle with psychological and social health in Chilean schoolchildren.
 
  this cross-sectional study included 615 schoolchildren, both girls (n = 271, 11.7 ± 1.00 years old) and boys (n = 344, 11.8 ± 1.1 years old). Anthropometric parameters, fitness components, lifestyle, health-related quality of life (HRQoL), and self-esteem were measured.
 
  HRQoL showed an association with cardiorespiratory fitness (β 0.12, p < 0.001) and PA (β 0.32, p = 0.023). Self-esteem was inversely associated with screen time (β -1.35, p < 0.001). Moreover, social health presented a positive association with PA after school (β 0.06, p = 0.037).  https://www.selleckchem.com/products/gsk8612.html  In relation to MD adherence items, HRQoL was linked to the items "Takes a fruit or fruit juice every day" (β 1.