bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reasoning like a doctor or like a nurse? An integrative review protocol
Authors: Vreugdenhil Jettie , Somra Sunia , Ket Hans , Custers Eugène J F M , Reinders Marcel E , Dobber Jos , Kusurkar Rashmi A 
Published: September 2021

IntroductionClinical reasoning, a major competency for all health professionals, has been defined and studied ‘within’ each profession. We do not know if content, process and outcomes are comparable ‘between’ physician and nursing clinical reasoning. This paper aims to set up a protocol for an integrative review to analyse and synthesise the scientific nursing and medical clinical reasoning literature. It builds on the history of nursing and medical clinical reasoning research and aims to create a higher level of conceptual clarity of clinical reasoning, to increase mutual understanding in collaboration in patient care, education and research.Methods and analysisThis integrative review follows stepwise the methods described by Whittmore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation.The initial systematic and comprehensive search strategy is developed in collaboration with the clinical librarian and is performed in electronic databases, PubMed, CINAHL, PsycInfo and Web of Science from 30 March 2020 to 27 May 2020. Empirical and theoretical studies are included. This search will be accompanied by ancestry searching and purposeful sampling. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart will summarise the selection process. The quality of eligible studies will be evaluated with a checklist, suitable for diverse study methods.The data analysis is inspired by concept analysis of Walker and Avant and layered analysis of an intervention of Cianciolo and Regehr. We will extract the data of the included studies conforming these layers and features, to capture the multifaceted nature of clinical reasoning in both professions. The data will be presented in a validity matrix to facilitate comparing and contrasting.Ethics and disseminationEthics approval is not required. The outcomes will be disseminated through conference presentations and publications.
Bladder cancer and exeRcise trAining during intraVesical thErapy—the BRAVE trial: a study protocol for a prospective, single-centre, phase II randomised controlled trial
Authors: Arthuso Fernanda Z. , Fairey Adrian S. , Boulé Normand G. , Courneya Kerry S. 
Published: September 2021

IntroductionNon-muscle invasive bladder cancer (NMIBC) accounts for about 75% of newly diagnosed bladder cancers. The treatment for NMIBC involves surgical removal of the tumour followed by 6 weekly instillations of immunotherapy or chemotherapy directly into the bladder (ie, intravesical therapy). NMIBC has a high rate of recurrence (31%–78%) and progression (15%). Moreover, bladder cancer and its treatment may affect patient functioning and quality of life. Exercise is a safe and effective intervention for many patient with cancer groups, however, no studies have examined exercise during intravesical therapy for NMIBC. The primary objective of the Bladder cancer and exeRcise trAining during intraVesical thErapy (BRAVE) trial is to examine the safety and feasibility of an exercise intervention in patients with bladder cancer undergoing intravesical therapy. The secondary objectives are to investigate the preliminary efficacy of exercise on health-related fitness and patient-reported outcomes; examine the social cognitive predictors of exercise adherence; and explore the potential effects of exercise on tumour recurrence and progression.Methods and analysisBRAVE is a phase II randomised controlled trial that aims to include 66 patients with NMIBC scheduled to receive intravesical therapy. Participants will be randomly assigned to the exercise intervention or usual care. The intervention consists of three supervised, high-intensity interval training sessions per week for 12 weeks. Feasibility will be evaluated by eligibility, recruitment, adherence and attrition rates. Preliminary efficacy will focus on changes in cardiorespiratory fitness and patient-reported outcomes from baseline (prior to intravesical therapy) to pre-cystoscopy (3 months). Cancer outcomes will be tracked at 3 months, and 1-year follow-up by cystoscopy. Analysis of covariance will compare between-group differences at post-intervention (pre-cystoscopy) for all health-related fitness and patient-reported outcomes.Ethics and disseminationThe study was approved by the Health Research Ethics Board of Alberta-Cancer Committee (#20–0184). Dissemination will include publication and presentations at scientific conferences and public channels.Trial registration numberNCT04593862; Pre-results.
Multimorbidity and clinical reasoning through the eyes of GPs: a qualitative study
Authors: Ritz Claire , Sader Julia , Cairo Notari Sarah , Lanier Cedric , Caire Fon Nathalie , Nendaz Mathieu , Audétat Marie-Claude 
Published: September 2021

ObjectivesDespite the high prevalence of patients suffering from multimorbidity, the clinical reasoning processes involved during the longitudinal management are still sparse.This study aimed to investigate what are the different characteristics of the clinical reasoning process clinicians use with patients suffering from multimorbidity, and to what extent this clinical reasoning differs from diagnostic reasoning.DesignGiven the exploratory nature of this study and the difficulty general practitioners (GPs) have in expressing their reasoning, a qualitative methodology was therefore, chosen. The Clinical reasoning Model described by Charlin et al was used as a framework to describe the multifaceted processes of the clinical reasoning.SettingSemistructured interviews were conducted with nine GPs working in an ambulatory setting in June to September 2018, in Geneva, Switzerland.ParticipantsParticipants were GPs who came from public hospital or private practice. The interviews were transcribed verbatim and a thematic analysis was conducted.ResultsThe results highlighted how some cognitive processes seem to be more specific to the management reasoning.Thus, the main goal is not to reach a diagnosis, but rather to consider several possibilities in order to maintain a balance between the evidence-based care options, patient’s priorities and maintaining quality of life. The initial representation of the current problem seems to be more related to the importance of establishing links between the different pre-existing diseases, identifying opportunities for actions and trying to integrate the new elements from the patient’s context, rather than identifying the signs and symptoms that can lead to generating new clinical hypotheses. The multiplicity of options to resolve problems is often perceived as difficult by GPs. Furthermore, longitudinal management does not allow them to achieve a final resolution of problems and that requires continuous review and an ongoing prioritisation process.ConclusionThis study contributes to a better understanding of the clinical reasoning processes of GPs in the longitudinal management of patients suffering from multimorbidity. Through a practical and accessible model, this qualitative study offers new perspectives for identifying the components of management reasoning. These results open the path to new research projects.
Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis
Authors: Khumalo Gugulethu Eve , Lutge Elizabeth E , Naidoo Praba , Mashamba-Thompson Tivani Phosa 
Published: September 2021

ObjectivesTo synthesise qualitative studies that address the barriers to and facilitators of providing HIV services by community health workers (CHWs) in sub-Saharan Africa (SSA).DesignThis meta-synthesis was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included studies that were published between 2009 and 2019. The Ritchie and Spencer framework and the Supporting the Use of Research Evidence framework were used for thematic analysis and framework analysis, respectively. The Qualitative Assessment and Review Instrument was used to assess the quality of selected studies.Eligibility criteriaQualitative studies published between 2009 and 2019, that included CHWs linked directly or indirectly to the Ministry of Health and providing HIV services in the communities.Information sourcesAn extensive search was conducted on the following databases: EBSCOhost- (ERIC; Health Source-Nursing/Academic Edition; MEDLINE Full Text), Google Scholar and PubMed.ResultsBarriers to rendering of HIV services by CHWs were community HIV stigma; lack of CHW respect, CHWs’ poor education and training; poor stakeholders’ involvement; poor access to the communities; shortage of CHWs; unsatisfactory incentives; lack of CHW support and supervision, lack of equipment and supplies and social barriers due to culture, language and political structures. The altruistic behaviour of CHWs and the availability of job facilitated the provision of HIV services.ConclusionThe delivery of HIV services by CHWs in SSA is faced by more lingering barriers than facilitators. Planners and policymakers can minimise the barriers by investing in both CHW and community training regarding HIV services. Furthermore, sufficient funding should be allocated to the programme to ensure its efficiency.PROSPERO registration numberCRD42020160012.
Multiparametric MRI of early tumor response to immune checkpoint blockade in metastatic melanoma
Authors: Lau Doreen , McLean Mary A , Priest Andrew N , Gill Andrew B , Scott Francis , Patterson Ilse , Carmo Bruno , Riemer Frank , Kaggie Joshua D , Frary Amy , Milne Doreen , Booth Catherine , Lewis Arthur , Sulikowski Michal , Brown Lee , Lapointe Jean-Martin , Aloj Luigi , Graves Martin J , Brindle Kevin M , Corrie Pippa G , Gallagher Ferdia A 
Published: September 2021

BackgroundImmune checkpoint inhibitors are now standard of care treatment for many cancers. Treatment failure in metastatic melanoma is often due to tumor heterogeneity, which is not easily captured by conventional CT or tumor biopsy. The aim of this prospective study was to investigate early microstructural and functional changes within melanoma metastases following immune checkpoint blockade using multiparametric MRI.MethodsFifteen treatment-naïve metastatic melanoma patients (total 27 measurable target lesions) were imaged at baseline and following 3 and 12 weeks of treatment on immune checkpoint inhibitors using: T2-weighted imaging, diffusion kurtosis imaging, and dynamic contrast-enhanced MRI. Treatment timepoint changes in tumor cellularity, vascularity, and heterogeneity within individual metastases were evaluated and correlated to the clinical outcome in each patient based on Response Evaluation Criteria in Solid Tumors V.1.1 at 1 year.ResultsDifferential tumor growth kinetics in response to immune checkpoint blockade were measured in individual metastases within the same patient, demonstrating significant intertumoral heterogeneity in some patients. Early detection of tumor cell death or cell loss measured by a significant increase in the apparent diffusivity (Dapp) (p<0.05) was observed in both responding and pseudoprogressive lesions after 3 weeks of treatment. Tumor heterogeneity, as measured by apparent diffusional kurtosis (Kapp), was consistently higher in the pseudoprogressive and true progressive lesions, compared with the responding lesions throughout the first 12 weeks of treatment. These preceded tumor regression and significant tumor vascularity changes (Ktrans, ve, and vp) detected after 12 weeks of immunotherapy (p<0.05).ConclusionsMultiparametric MRI demonstrated potential for early detection of successful response to immune checkpoint inhibitors in metastatic melanoma.
Thromboprophylaxis for Children Post‐Fontan Procedure: Insights From the UNIVERSE Study
Authors: McCrindle Brian W. , Michelson Alan D. , Van Bergen Andrew H. , Suzana Horowitz Estela , Pablo Sandoval Juan , Justino Henri , Harris Kevin C. , Jefferies John L. , Miriam Pina Liza , Peluso Colleen , Nessel Kimberly , Lu Wentao , Li Jennifer S. , Chantada Guillermo , Peirone Alejandro , Lenzi Andrea Wirich , Binotto Maria Angelica , Dahdah Nagib , Sato Keisuke , Ono Hiroshi , Sagawa Koichi , Muneuchi Jun , Samion Hasri , Ruiz Sergio , Palacios Alexis , Breur J.M.P.J , Gutierrez‐Iarraya Federico , Alvarez Teresa , Albert Dimpna , Rueda Fernando , Rossano Joseph , Hill Kevin , Heydarian Haleh , Niebler Robert , Weber Howard , Pietra Biagio , Bergen Andrew Van , Alejos Juan , Menon Shaji , Steiner Marie , Cramer Jonathan , Reinking Ben 
Published: September 2021

Background
Patients with single‐ventricle physiology who undergo the Fontan procedure are at risk for thrombotic events associated with significant morbidity and mortality. The UNIVERSE Study evaluated the efficacy and safety of a novel liquid rivaroxaban formulation, using a body weight–adjusted dosing regimen, versus acetylsalicylic acid (ASA) in children post‐Fontan.

Methods and Results
The UNIVERSE Study was a randomized, multicenter, 2‐part, open‐label study of rivaroxaban, in children who had undergone a Fontan procedure, to evaluate its dosing regimen, safety, and efficacy. Part A was the single‐arm part of the study that determined the pharmacokinetics/pharmacodynamics and safety of rivaroxaban in 12 participants before proceeding to part B, whereby 100 participants were randomized 2:1 to open‐label rivaroxaban versus ASA. The study period was 12 months. A total of 112 participants were enrolled across 35 sites in 10 countries. In part B, for safety outcomes, major bleeding occurred in one participant on rivaroxaban (epistaxis that required transfusion). Clinically relevant nonmajor bleeding occurred in 6% of participants on rivaroxaban versus 9% on ASA. Trivial bleeding occurred in 33% of participants on rivaroxaban versus 35% on ASA. For efficacy outcomes, 1 participant on rivaroxaban in part B had a pulmonary embolism (2% overall event rate); and for ASA, 1 participant had ischemic stroke and 2 had venous thrombosis (9% overall event rate).

Conclusions
In this study, participants who received rivaroxaban for thromboprophylaxis had a similar safety profile and fewer thrombotic events, albeit not statistically significant, compared with those in the ASA group.

Registration

URL:
https://www.clinicaltrials.gov
. Identifier: NCT02846532.
Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure
Authors: Sanjoy Shubrandu S. , Choi Yun‐Hee , Sparrow Robert T. , Jneid Hani , Dawn Abbott J. , Nombela‐Franco Luis , Azzalini Lorenzo , Holmes David R. , Alraies M. Chadi , Elgendy Islam Y. , Baranchuk Adrian , Mamas Mamas A. , Bagur Rodrigo 
Published: September 2021

Background
Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure.

Methods and Results

The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%,
P
=0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%,
P
=0.09) and death (0.3% versus 0.1%,
P
=0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in‐hospital MAE were observed in women (1.61‐fold), and those with preprocedural congestive heart failure (≈2‐fold), diabetes (≈1.5‐fold), renal disease (≈2.6‐fold), anemia (≈2.7‐fold), and dementia (≈5‐fold). In patients <80 years old, a higher risk of in‐hospital MAE was encountered among women (≈1.4‐fold) and those with diabetes (≈1.3‐fold), renal disease (≈2.6‐fold), anemia (≈2‐fold), and dyslipidemia (≈1.2‐fold).

Conclusions
Patients ≥80 years old had higher rates of in‐hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in‐hospital MAE among both groups.
A Note on the Alleged Egyptian Etymology of Sabaoth
Authors: Lenzo Giuseppina , Nihan Christophe 
Published: September 2021

Abstract
This note provides a detailed criticism of the etymology relating the divine name or title ṣĕbā’ôt in Hebrew with Egyptian ḏbȝt/ḏbȝty, as initially proposed by M. Görg and S. Kreuzer.
„Ištar“ und „Marduk“ als jüdische Protagonisten, Purim als neues Fest der Befreiung: Zur Theologie und zum historischen Ort des Esterbuches
Authors: Hutzli Jürg 
Published: September 2021

Abstract
This article deals with two theological paradoxes in the Book of Esther (Masoretic Text). Arguably, the most striking characteristic of the book is that it does not mention God. At the same time, the two Jewish protagonists bear names that are identical with, or at least strongly reminiscent of, those of the Babylonian deities Marduk and Ištar. While the author of Esther seems to completely ignore the cultic laws of the Pentateuch, at the end of the book he strongly emphasizes the foundation of the Purim feast. Although each of these four topics has been dealt with in scholarship, they are seldomly—and if so, only partly—investigated with regard to their mutual coherence. In aiming to do this, the present article undertakes to reevaluate the theological profile of the Book of Esther (as expressed in the Masoretic Text) as well as its historical location. As for the latter question, the intriguing statement related to “relief and deliverance coming to the Jews from another place” in Est 4:14 provides an important hint.
Beyond Belief
Authors: Ferguson Christine 
Published: September 2021

Abstract
Over the last decade, esotericism studies has witnessed a distinct literary turn, as more and more of the field’s primarily religious studies-based researchers have recognized the value, and indeed, centrality, of imaginative literature to the transmission of occult and new religious ideas. Although welcome, this impetus has sometimes taken an anti-aesthetic shape, reducing the texts it incorporates to little more than empirical evidence of authorial belief or practical occult experience. Accompanying this tendency has been a suspicion of the formalist, post-modern, and/or political forms of interpretation common within contemporary literary studies as being ideologically tainted or even wilfully perverse in their resistance to surface meaning. My article uses a case study of Arthur Conan Doyle’s The Land of Mist (1926), a seemingly straightforward example of an emic novel whose author’s spiritualist belief and conversionist intentions are well known, to demonstrate the limitations of such a biographically reductionist hermeneutic, and to call for a greater diversity of approach within literary esotericism studies.
The Effect of Soil on the Summertime Surface Energy Budget of a Humid Subarctic Tundra in Northern Quebec, Canada
Authors: Lackner Georg , Nadeau Daniel F. , Domine Florent , Parent Annie-Claude , Leonardini Gonzalo , Boone Aaron , Anctil François , Fortin Vincent 
Published: September 2021

AbstractRising temperatures in the southern Arctic region are leading to shrub expansion and permafrost degradation. The objective of this study is to analyze the surface energy budget (SEB) of a subarctic shrub tundra site that is subject to these changes, on the east coast of Hudson Bay in eastern Canada. We focus on the turbulent heat fluxes, as they have been poorly quantified in this region. This study is based on data collected by a flux tower using the eddy covariance approach and focused on snow-free periods. Furthermore, we compare our results with those from six Fluxnet sites in the Arctic region and analyze the performance of two land surface models, SVS and ISBA, in simulating soil moisture and turbulent heat fluxes. We found that 23% of the net radiation was converted into latent heat flux at our site, 35% was used for sensible heat flux, and about 15% for ground heat flux. These results were surprising considering our site was by far the wettest site among those studied, and most of the net radiation at the other Arctic sites was consumed by the latent heat flux. We attribute this behavior to the high hydraulic conductivity of the soil (littoral and intertidal sediments), typical of what is found in the coastal regions of the eastern Canadian Arctic. Land surface models overestimated the surface water content of those soils but were able to accurately simulate the turbulent heat flux, particularly the sensible heat flux and, to a lesser extent, the latent heat flux.
Prevalence and 5-year trend of incidence for medical illnesses after the diagnosis of bipolar disorder: A nationwide cohort study
Authors: Chen Pao-Huan , Tsai Shang-Ying , Pan Chun-Hung , Chen Yi-Lung , Su Sheng-Siang , Chen Chiao-Chicy , Kuo Chian-Jue 
Published: September 2021

Objective: Medical comorbidities are prevalent in patients with bipolar disorder. Evaluating longitudinal trends of the incidence of medical illnesses enables implementation of early prevention strategies to reduce the high mortality rate in this at-risk population. However, the incidence risks of medical illnesses in the early stages of bipolar disorder remain unclear. This study investigated the incidence and 5-year trend of medical illnesses following bipolar disorder diagnosis. Methods: We identified 11,884 patients aged 13–40 years who were newly diagnosed as having bipolar disorder during 1996–2012 and 47,536 age- and sex-matched controls (1:4 ratio) who represented the general population from Taiwan’s National Health Insurance Research Database. We estimated the prevalence and incidence of individual medical illnesses yearly across the first 5 years after the index date. The adjusted incidence rate ratio was calculated to compare the occurrence of specific medical illnesses each year between the bipolar disorder group and control group using the Poisson regression model. Results: Apart from the prevalence, the adjusted incidence rate ratios of most medical illnesses were >1.00 across the first 5-year period after bipolar disorder diagnosis. Cerebrovascular diseases, ischaemic heart disease, congestive heart failure, other forms of heart disease, renal disease and human immunodeficiency virus infection exhibited the highest adjusted incidence rate ratios during the first year. Except for that of renal disease, the 5-year trends of the adjusted incidence rate ratios decreased for cerebrovascular diseases, cardiovascular diseases (e.g. ischaemic heart disease, other forms of heart disease, and vein and lymphatic disease), gastrointestinal diseases (e.g. chronic hepatic disease and ulcer disease) and communicable diseases (e.g. human immunodeficiency virus infection, upper respiratory tract infection and pneumonia). Conclusion: Incidence risks of medical illnesses are increased in the first year after bipolar disorder diagnosis. Clinicians must carefully evaluate medical illnesses during this period because the mortality rates from medical illnesses are particularly high in people with bipolar disorder.