bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical reasoning: concept analysis
Authors: Simmons Barbara 
Published: March 2010

simmons b. (2010)  Clinical reasoning: concept analysis. Journal of Advanced Nursing 66(5), 1151–1158.AbstractTitle.  Clinical reasoning: concept analysis. Aim.  This paper is a report of a concept analysis of clinical reasoning in nursing.Background.  Clinical reasoning is an ambiguous term that is often used synonymously with decision‐making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning.Data sources.  Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008.Review methods.  Rodgers’s evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving.Results.  Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision‐making. Our concept analysis defines one of these terms, ‘clinical reasoning,’ as a complex process that uses cognition, metacognition, and discipline‐specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions.Conclusion.  This concept analysis provides a middle‐range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.
General anaesthesia and day‐case patient anxiety
Authors: Mitchell Mark 
Published: March 2010

mitchell m. (2010) General anaesthesia and day‐case patient anxiety. Journal of Advanced Nursing 66(5), 1059–1071.AbstractTitle.  General anaesthesia and day‐case patient anxiety. Aim.  This paper is a report of a study carried out to uncover the most anxiety‐provoking aspects of general anaesthesia and determine what interventions may help to alleviate such anxiety.Background.  General anaesthesia has proved to be highly anxiety‐provoking. With the rise in elective day surgery, this aspect of patients’ experience has become a prominent issue. Indeed, with brief hospital stays, limited contact with healthcare professionals, restricted formal anxiety management and the acute psychological impact of day surgery, such anxiety may be increasing.Method.  As part of a larger study, a questionnaire was given on the day of surgery to 1250 adult patients undergoing surgery with general anaesthesia over a two year period from 2005–2007. The issue examined was anxiety in relation to the environment, hospital personnel and general anaesthesia. Participants were requested to return the questionnaire by mail 24–48 hours following surgery, and 460 completed questionnaires were returned.Findings.  A total of 85% of respondents experienced some anxiety on the day of surgery. Immediate preoperative experiences and concerns about unconsciousness were highly anxiety‐provoking. Using factor analysis Preoperative Anaesthetic Information, Anaesthetic Catastrophising, Final Support, Personal Support, Imminence of Surgery, Possible Adverse Events and Final Preoperative Experiences were identified as central features. Multiple regression demonstrated Preoperative Anaesthetic Information, Anaesthetic Catastrophising and Imminence of Surgery were statistically significantly associated with an overall increased level of anxiety.Conclusions.  Focusing on the timely, formal delivery of information about anaesthesia management, emphasizing the notion of ‘controlled unconsciousness’ and dispelling misconceptions associated with general anaesthesia may help to limit patient anxiety.
The response of intestinal mucous cells to the presence of enteric helminths: their distribution, histochemistry and fine structure
Authors: Dezfuli B S , Pironi F , Campisi M , Shinn A P , Giari L 
Published: March 2010

AbstractHistochemical and ultrastructural investigations were conducted on the mucous cells of the intestine of brown trout, Salmo trutta L., naturally infected with the cestode Cyathocephalus truncatus (Pallas, 1781) and the acanthocephalan Echinorhynchus truttae Shrank, 1788. A subpopulation of 45 S. trutta were examined of which 15 specimens harboured E. truttae, 15 of which were infected with C. truncatus and 15 fish, the control group, were uninfected. In histological sections, hyperplasia and hypertrophy of the mucous cells were evident at the site of parasite infection. Enhanced mucus secretion was also recorded in infected fish. The number of mucous cells close to the site of parasite attachment within the intestine was significantly higher than the number detected in uninfected individuals and in infected individuals at sites 1 cm or greater from the point of parasite attachment. There were no significant differences between the number of mucous cells found at the latter two sites. Alcian blue and periodic acid‐Schiff’s staining of representative histological sections revealed a significant increase in the number of mucous cells staining positively for acid glycoconjugates compared to the number of cells found in the intestines of uninfected S. trutta. In transmission electron microscopy sections, each mucous cell typically possessed an elongated, basally positioned nucleus. The cytoplasm was observed to possess numerous electron dense and lucent vesicles, in addition to well‐developed rough endoplasmic reticulum, Golgi apparatus and a few round mitochondria.
Short‐term dynamics of the carbon isotope composition of CO2 emitted from a wheat agroecosystem – physiological and environmental controls
Authors: Kodama N. , Ferrio J. P. , Brüggemann N. , Gessler A. 
Published: March 2010

AbstractUnderstanding environmental and physiological controls of the variations in δ13C of CO2 respired (δ13CR) from different compartments of an ecosystem is important for separation of CO2 fluxes and to assess coupling between assimilation and respiration. In a wheat field, over 3 days we characterised the temporal dynamics of δ13CR from shoots and roots, from the soil and from the whole agroecosystem. To evaluate the basis of potential variations in δ13CR, we also measured δ13C in different organic matter pools, as well as meteorological and gas exchange parameters. We observed strong diel variations up to ca. 6% in shoot, root and soil δ13CR, but not in δ13C of the putative organic substrates for respiration, which varied by not more than ca. 1% within 24 h. Whole ecosystem‐respired CO2 was least depleted in 13C in the afternoon and most negative in the early morning. We assume that temporally variable respiratory carbon isotope fractionation and changes in fluxes through metabolic pathways, rather than photosynthetic carbon isotope fractionation, governs the δ13C of respired CO2 at the diel scale, and thus provides insights into the metabolic processes related to respiration under field conditions.
Group‐Size Effect on Vigilance and Foraging in a Predator‐Free Population of Feral Goats (Capra hircus) on the Isle of Rum, NW Scotland
Authors: Shi Jianbin , Beauchamp Guy , Dunbar Robin I. M. 
Published: March 2010

AbstractMany previous studies have found that as group size increases, individual vigilance levels decrease and forage intake increases (group‐size effect), but few such studies have considered the impact of within‐group interactions and other confounding factors on the direction of group‐size effects. A free‐ranging population of feral goats (Capra hircus), with little predation threat, was studied on the Isle of Rum (northwest Scotland), from Jun. to Nov. 2000, to investigate the effects of group size on individual vigilance levels and foraging efficiency after taking into account the effect of confounding factors (e.g. sex, season, time of day, habitat, predation risk) and within‐group interactions (via changes in movement rates while feeding). Our results show that, while group size exerted a negative influence on individual vigilance levels and a positive effect on movement rate, foraging efficiency never increased with group size and even decreased at certain times of day. There was no sex difference in individual vigilance in feral goats, but foraging efficiency was higher in females than in males. Goats were more vigilant in fall than in summer. The results imply that the benefits for foraging obtained from the reduced vigilance level in larger groups may be constrained or offset by increased interaction (or competition) within larger groups even in a population that faces negligible predation risk.
Human cytomegalovirus infection inhibits response of chronic hepatitis‐C‐virus‐infected patients to interferon‐based therapy
Authors: Bader El Din Noha G , Abd El Meguid Mai , Tabll Ashraf A , Anany Mohamed A , Esmat Gamal , Zayed Naglaa , Helmy Amr , El Zayady Abdel Rahman , Barakat Ahmed , El Awady Mostafa K 
Published: March 2010

AbstractBackground and Aim:  Cytomegalovirus (CMV) is a ubiquitous pathogen that infects the majority of humans. Co‐infection of CMV and hepatitis C virus (HCV) may deteriorate the prognosis of HCV‐infected patients. This study was conducted to examine the role of CMV reactivation in determining the response rate to treatment with interferon and ribavirin therapy in chronic HCV patients.Methods:  Viral loads and genotyping were assessed using reverse transcription polymerase chain reaction and Innolipa systems, respectively. Reactivation of CMV in HCV patients who were all positive for CMV immunoglobulin G antibodies was tested by amplification of the gB1 gene using the end‐point dilution quantitative‐nested polymerase chain reaction method.Results:  CMV DNA was detected in 89.7% of non‐responders and in 34.6% of sustained virological responders. Patients with reactivated CMV had significantly higher fibrosis scores (72.7%) than those with undetectable CMV DNA (23.8%, P = 0.002). Patients with positive CMV had higher rates of non‐response and relapse (79.5%) than those with negative CMV DNA (19%). Chronic HCV patients with latent CMV had higher rates of response (81%) to treatment than those with reactivated CMV (20.5%, P < 0.001). Therefore, HCV patients with reactivated CMV and advanced fibrosis were least likely to achieve a sustained virological response following interferon therapy. This possibility is reduced to 50% of its original value in patients with reactivated CMV without fibrosis.Conclusions:  Besides the staging of liver fibrosis, CMV co‐infection should be considered as an extremely important factor when designing predictive models for HCV response to interferon treatment.
Accuracy of multiparametric magnetic resonance imaging in detecting recurrent prostate cancer after radiotherapy
Authors: Arumainayagam Nimalan , Kumaar Senthil , Ahmed Hashim U. , Moore Caroline M. , Payne Heather , Freeman Alex , Allen Clare , Kirkham Alex , Emberton Mark 
Published: March 2010

OBJECTIVETo assess the role of multiparametric magnetic resonance imaging (mp‐MRI) of the prostate in evaluating local recurrence of prostate cancer, using transperineal template‐guided 5 mm‐spaced biopsies as a reference standard, in men treated with external beam radiotherapy (EBRT) for prostate cancer.PATIENTS AND METHODSThe study included 13 patients with evidence of biochemical recurrence after EBRT who had undergone mp‐MRI and prostate mapping. Each MRI scan (consisting of T1/T2 weighting, dynamic contrast enhancement and diffusion weighting) was reported by two expert uro‐radiologists. Each prostate was divided into four regions of interest (ROI), generating 52 paired datasets for analysis.RESULTSThe mean (range) age of the men was 65.5 (55–70) years, the mean prostate‐specific antigen (PSA) level before EBRT was 36.6 (4.5–150) ng/mL, the mean time from EBRT to biochemical recurrence was 5.7 (3–10) years and the mean PSA level at the time of recurrence was 7.1 (0.83–27.9) ng/mL. Eleven men had histological evidence of recurrence, with 23 of 52 ROIs involved with cancer. Overall accuracy, as expressed by the area under a receiver‐operator curve, was 0.77 and 0.89 for all cancer, with accuracies of 0.86 and 0.93 for those cancers with ≥3 mm biopsy core length. Inter‐observer variability was measured by calculating κ coefficients, which showed fair and moderate agreement between radiologists.CONCLUSIONSInterpretation of mpMRI of the prostate after previous EBRT is challenging. Our results show that the accuracy is good using an accurate reference standard. These results need verification in more patients, but have implications for determining presence or absence of local recurrence and subsequent local salvage therapy.
Experiences of follow‐up after treatment in patients with prostate cancer: a qualitative study
Authors: O’Brien Rosaleen , Rose Peter W. , Campbell Christine , Weller David , Neal Richard D. , Wilkinson Clare , Watson Eila K. ,   Prostate Cancer Follow‐up Group
Published: March 2010

OBJECTIVETo develop an understanding of experiences of follow‐up in patients with prostate cancer, to seek explanations as to why men’s needs might not be well met, and explore views on the possible role of primary care in follow‐up. The experiences of these patients, and views on the delivery of follow‐up care, have been relatively neglected compared to those diagnosed with other cancers.PATIENTS AND METHODSIn all, 35 patients were recruited from 20 practices across three regions in the UK. Maximum variation was sought by purposely sampling by age (59–82 years), treatment, length (0.75–14 years) and mode of follow‐up.RESULTSPatients’ descriptions of the content and organization of follow‐up showed the shortcomings of follow‐up, which included system failings causing patients to be lost to follow‐up, and unmet psychosexual needs. Patients were mainly positive about the prospect of follow‐up taking place outside the hospital setting. However, some expressed concerns about current follow‐up practices and suggested several improvements that need considering if primary care were to take a greater role.CONCLUSIONThis study identified some general deficiencies with the current system of follow‐up, and our data indicate that primary care could have a role in addressing some of these.
Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer
Authors: Sanchez‐Salas Rafael , Prapotnich Dominique , Rozet Francois , Mombet Annick , Cathala Nathalie , Barret Eric , Galiano Marc , Cathelineau Xavier , Vallancien Guy 
Published: March 2010

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVE To assess the effect of age and comorbidity on short‐term complications, long‐term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer.PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index. Short‐term postoperative complications, transfusion rate, duration of hospital stay, long‐term continence and oncological outcome were analysed by age and comorbidity classes.RESULTS Of the 2048 men, 297 were aged ≥70 years and 281 had a Charlson index of >0 (mainly diabetes 31%, chronic pulmonary disease 26%, prior other nonmetastatic cancer 16%, prior myocardial infarction 12%). Compared with younger men, senior men had significantly higher pathological stages and tumor grades. Of those 297 men aged ≥70 years, 90 (30.3%) developed biochemical relapse, none died from prostate cancer and five (1.7%) died from another cause over a median follow‐up of 5 years. The occurrence and severity of short‐term postoperative complications were more strongly related to comorbidity than chronological age. Multivariate analysis with stepwise regression confirmed that most important predictors of short‐term postoperative complications were a Charlson index of ≥2, prostate weight of >80 g, obesity and age of ≥70 years. Postoperative continence significantly declined with age (ranging from 87% in men aged <60 years to 67.5% in men aged ≥70 years). Predictors of long‐term incontinence were age of ≥70 years, obesity and need for perioperative transfusion.CONCLUSIONS LRP is feasible and effective in fit senior men (aged ≥70 years) with localized prostate cancer, including those at high risk of dying from it.
Prognostic value of initial prostate‐specific antigen levels after salvage cryoablation for prostate cancer
Authors: Levy David A. , Pisters Louis L. , Jones J. Stephen 
Published: March 2010

OBJECTIVETo assess the prognostic value of initial prostate‐specific antigen (PSA) levels after salvage cryoablation (SCA) for the long‐term biochemical progression‐free survival (bPFS) in patients with prostate cancer.PATIENTS AND METHODSIn all, 455 hormone‐naïve patients from the Cryo On Line Data Registry, and treated with whole‐gland SCA were assessed for PSA‐based bPFS using the Phoenix criteria. The initial PSA level measured after SCA was considered the nadir. Kaplan‐Meier plots of bPFS for initial PSA level of <0.6, ≥0.6–≤5.0 and >5.0 ng/mL were constructed and plotted to 60 months.RESULTSIn all, 280 patients had an initial PSA level of <0.6 ng/mL after SCA. At 12, 24 and 36 months 80%, 73.6%, and 67% of patients, respectively, were progression‐free. For 118 patients with an initial PSA level after SCA of ≥0.6–≤5 ng/mL, 28% and 50% of these patients at 6 and 12 months, respectively, had PSA progression. Of 57 patients with an initial PSA level of ≥5 ng/mL, 64% progressed at 6 months. The PSA level before SCA and Gleason score correlated with bPFS by Spearman correlation (P < 0.001 and 0.002), respectively.CONCLUSIONCurative therapy in prostate cancer not responding to radiotherapy is extremely challenging. There is no definition of success for cryosurgical treatment. The available data indicate that an initial PSA level of <0.6 ng/mL after SCA portends a favourable (67% at 36 months) bPFS. Individuals with initial PSA levels of ≥0.6 ng/mL after SCA are at risk of short‐term biochemical progression (50% at 12 months).
Serum inflammatory proteins and frontal lobe dysfunction in patients with cardiovascular risk factors
Authors: Hoshi T. , Yamagami H. , Furukado S. , Miwa K. , Tanaka M. , Sakaguchi M. , Sakoda S. , Kitagawa K. 
Published: March 2010

Background:  Recent studies have shown that the levels of circulating inflammatory markers are associated with cognitive decline and cerebral small‐vessel disease. Frontal lobe dysfunction is believed to be a relatively characteristic neuropsychological symptom in vascular cognitive impairment caused by cerebral small‐vessel disease. The purpose of this study was to investigate whether the levels of serum inflammatory markers are associated with frontal lobe dysfunction, particularly executive dysfunction.Methods:  Between January 2003 and September 2007, 388 patients who had one or more atherosclerotic risk factors and subsequently underwent brain MRI and neuropsychological testing including mini‐mental state examination (MMSE), frontal assessment battery (FAB), and modified Stroop test were enrolled in this study. We evaluated the effect of serum levels of inflammatory markers and white matter lesions on frontal lobe function.Results:  The FAB score was negatively correlated with serum inflammatory marker levels (hsCRP; r = −0.170, IL‐6; r = −0.143, IL‐18; r = −0.175) and white matter lesions. In the modified Stroop test, interference measure was positively correlated with the levels of hsCRP (r = −0.198), and IL‐18 (r = −0.152), and white matter lesions. However, the MMSE score was not correlated with either inflammatory marker levels. The association between hsCRP and FAB score or interference measure remained significant when controlling for other confounding factors and MRI findings.Conclusions:  The circulating level of hsCRP is associated with frontal lobe dysfunction in patients with cardiovascular risk factors independent of white matter lesions in brain MRI.
Adapting the Individualized Care Scale for cross‐cultural comparison
Authors: Suhonen Riitta , Berg Agneta , Idvall Ewa , Kalafati Maria , Katajisto Jouko , Land Lucy , Lemonidou Chryssoula , Schmidt Lee A. , Välimäki Maritta , Leino‐Kilpi Helena 
Published: March 2010

Scand J Caring Sci; 2010; 24; 392–403

Adapting the Individualized Care Scale for cross‐cultural comparison Rationale:  Cross‐cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker’s ability to respond to patients’ individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care.Aim:  To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross‐cultural study.Design:  A cross‐sectional comparative study.Settings:  Twenty‐seven orthopaedic and trauma in‐patient units at 14 hospitals in 5 countries.Participants:  A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33).Methods:  A systematic forward‐ and back‐translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach’s alpha coefficients and average inter‐item correlations. Construct validity was examined using sub‐scale correlations to total scales and principal components analysis.Results:  The use of the range of options and the sub‐scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach’s alpha coefficients (0.77–0.97) and average inter‐item correlations (0.37–0.77) were acceptable. The sub‐scale correlations to total scales were high (0.83–0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%.Conclusions:  The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.