bluuebunny/crossref_metadata_2025_split huggingface dataset:
Living in a paradox – women’s experiences of body and life‐world after meningioma surgery
Authors: Wenström Ingrid , Eriksson Lars E. , Ebbeskog Britt 
Published: August 2011

wenström i., eriksson l.e. & ebbeskog b. (2012) Living in a paradox – women’s experiences of body and life‐world after meningioma surgery. Journal of Advanced Nursing68(3), 559–568.AbstractAims.  The aims of the study were to describe how persons who have undergone benign meningioma surgery experience their body and life‐world and to illuminate the meaning of the illness, operation and recovery.Background.  Meningioma, which is often benign, is the most commonly diagnosed brain tumour. Studies have shown that persons with meningioma tend to be more psychologically affected than persons with other brain tumours. To our knowledge, no previous studies have focused on the life‐world or body experience of these persons.Method.  Narrative interviews with seven women conducted over a 6‐month period (2008–2009) were analyzed using a phenomenological hermeneutical method.Findings.  Four themes were identified: In between double threats: the tumour and operation: the participants seemed to perceive a paradox in the sense that the tumour was both benign and threatening and the surgery both curing and risky; the wound as an open gate: the wound is visibly healed, but perceived as unhealed; the suffering body overflows life: the participants were prevented from regaining their body, feeling fragile and oversensitive to impressions; and the need to be embraced by attention: taking the participants’ needs seriously facilitated understanding of the diagnosis.Conclusion.  The participants in this study described emotional distress when recovering from meningioma surgery. It is essential for nurses to be aware of the various meanings people ascribe to events that disrupt their lives and the transition process in connection with meningioma treatment.
The effects of an educational training workshop for community leaders on self‐efficacy of program planning skills and partnerships
Authors: Li I‐Chuan , Chen Yu‐Chi , Hsu Ling‐ling , Lin Chih‐hsuan , Chrisman Noel J 
Published: August 2011

li i‐c., chen y‐c., hsu l‐l., lin c‐h. & chrisman n.j. (2012) The effects of an educational training workshop for community leaders on self‐efficacy of program planning skills and partnerships. Journal of Advanced Nursing68(3), 600–613.AbstractAim. This aim of this study was to evaluate the effects of a 6‐month educational workshop for community leaders designed to improve their confidence in health promotion programmes and to develop partnerships among the participants.Background. It is important for public health nurses to work with community leaders to provide community‐orientated services. However, only a few existing studies have reported the content and effects of training programmes aimed at enhancing the capabilities of community leaders.Methods. A participatory action research design with pre‐ and post‐test methods was applied in this study. Fifteen community leaders completed a 6‐month educational workshop that was held in Tamsui, Taipei and Taiwan. It was designed to enable community leaders to improve their confidence in planning health programmes and developing group partnerships. Data were collected from April 2009 to October 2009, and descriptive statistics and Wilcoxon signed‐rank test analyses were carried out.Results. Participants demonstrated improvements in their self‐efficacies of planning health programmes by completing a structured questionnaire after attending a 6‐month educational workshop (Z = −2·90, P = 0·004). Their confidence in data collection, needs assessment and diagnosis, programme planning, and programme evaluation were significantly improved (Z = −3·1, P = 0·002; Z = −2·42, P = 0·016, Z = −2·84, P = 0·004, and Z = −2·68, P = 0·007, respectively).Conclusions. Providing training workshops for community leaders is a useful strategy for increasing their capabilities and confidence in planning health programmes. Nurses have a responsibility to advocate and provide training programmes for community leaders.
Women’s experiences of undergoing coronary artery bypass graft surgery
Authors: Banner Davina , Miers Margaret , Clarke Brenda , Albarran John 
Published: August 2011

banner d., miers m., clarke b. & albarran j. (2011) Women’s experiences of undergoing coronary artery bypass graft surgery. Journal of Advanced Nursing 68(4), 919–930.AbstractAim.  This paper is a report of a study of women’s experiences of coronary artery bypass graft surgery.Background.  Worldwide, coronary heart disease is the leading cause of morbidity and mortality. It has traditionally been viewed as primarily affecting men. However, a growing body of literature exploring gender differences in this area is challenging accepted beliefs, particularly in relation to outcomes. Despite this, awareness of how women interpret and respond to the experiences of cardiac surgery remains limited.Methods.  At regional cardiothoracic centres in England and Wales, during 2003 to 2006, data were collected from 30 women preoperatively and at 6 weeks and 6 months postoperatively using semi‐structured interviews. A constructivist grounded theory approach was adopted and data were analysed using extensive coding and constant comparison techniques.Results.  A substantive theory of the public–private dialogue of normality emerged demonstrating that participants faced lifestyle disruptions as they attempted to privately normalize and integrates limitations, while minimizing a public display of illness. During the preoperative period, participants experienced difficulties recognizing and acting on symptoms and endured physical and emotional distress while waiting for surgery. Following surgery, women experienced functional limitations which forced them to relinquish normal activities and roles. As recovery progressed, women came to accept their changed health status and renegotiated state of normality.Conclusion.  The findings increase understanding about the adjustments which women undergoing cardiac surgery make as part of living with a long‐term condition and support the need to develop innovative gender‐sensitive health education and services.
How to make real, constructive, progress in medicine
Authors: Simon Jeremy R. 
Published: August 2011

AbstractRationale  One's understanding of medical progress – what it is, how it is pursued and how it is assessed – may be deeply dependent on one's understanding of the metaphysics of medicine, and of diseases in particular.Aims and Objectives  In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way.Conclusions  This new account, Constructive Realism, may provide a better account of medicine than either realism or constructivism.
Statistics‐based research – a pig in a poke?
Authors: Penston James 
Published: August 2011

AbstractMuch of medical research involves large‐scale randomized controlled trials designed to detect small differences in outcome between the study groups. This approach is believed to produce reliable evidence on which the management of patients is based. But can we be sure that the demonstration of a small, albeit statistically significant, difference is sufficient to infer the presence of a causal relationship between the drug and the outcome?A study is claimed to have internal validity when other explanations for the observed difference – namely, inequalities between the groups, bias in the assessment of the outcome and chance – have been excluded. Despite the various processes that are put into place – including, for example, randomization, allocation concealment, double‐blinding and intention‐to‐treat analysis – it remains doubtful whether the groups are equal in terms of all factors relevant to the outcome and whether bias has been excluded. As for the exclusion of chance, not only may inappropriate statistical tests be used, but also frequentist statistics has been subjected to serious criticisms in recent years that further bring internal validity into question.But the problems do not end with the flaws in internal validity. The philosophical basis of large‐scale randomized controlled trials and epidemiological studies is unsound. When examined closely, many obstacles emerge that threaten the inference from a small, statistically significant difference to the presence of a causal relationship between the drug and the outcome.Given the influence of statistics‐based research on the practice of medicine, it is of the utmost importance that the flaws in this methodology are brought to the fore.
The role of prudent love in the practice of clinical medicine
Authors: Marcum James A. 
Published: August 2011

AbstractRationale Virtues are an important component in the practice of clinical medicine. Prudence or wisdom and charity or love are often viewed as crucial for virtuous practice. Generally, the two virtues are discussed separately, with no connection between them; however, a synergy exists between the two virtues as a compound virtue of prudent love in which the properties of the compound virtue transcend those of the individual virtues.Aims and objectives To examine the nature of prudent love and to discuss its role in the practice of clinical medicine.Methods Philosophical and conceptual analyses.Results Prudent love exhibits properties, which are the result of a synergistic interaction between the two individual virtues. Succinctly, prudent love synergism is an outcome of a particular structural relationship between the two virtues in which motivational love prompts the prudent clinician to acquire and utilize clinical competence, which then allows the loving clinician to take care of an individual patient's health care needs. In turn, the virtuous clinician's ability to meet those needs successfully feedbacks onto the motivation to satisfy them initially, thereby encouraging and enhancing the clinician to fulfil them even more prudently and lovingly, not only for the individual patient but also for other patients.Conclusions The compound virtue of prudent love provides a comprehensive approach to practising medicine that meets not only the needs of patients but also fulfils the physician's sense as healer. Although challenges face teaching virtues in the medical curriculum, strategies are available for incorporating training in virtues into the curriculum.
Robot decisions: on the importance of virtuous judgment in clinical decision making
Authors: Gelhaus Petra 
Published: August 2011

AbstractRationale, aims and objectives The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non‐emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule‐ and principle‐based moral orientation and biomedical knowledge and skills.Methods Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov.Results Althoughprima faciea rule‐oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible.Conclusion Although an infallibly rule‐oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non‐emotional, non‐human being. Because these are crucial preconditions for good clinical practice, enough attention should be given to develop these virtues and emotional skills, in addition to the usual attention on knowledge, technical skills and the obedience to moral rules and principles.
Dealing with systems and understanding contexts: what it might mean to be a ‘good health care practitioner’
Authors: Duncan Peter , Stephenson Anne 
Published: August 2011

AbstractThe increasing complexity of contemporary health care policy and practice leads us to ask questions about what might constitute ‘the good health care practitioner’. Yet, attempts through empirical work to address such questions are sparse. This paper reports on a small‐scale qualitative study, which sought to explore questions with a number of health care professionals and academics about the nature of ‘the good practitioner’. Four themes emerged from our exploration and analysis: the difficulty in trying to talk about ‘the good practitioner’, the importance of systems and contexts in understanding this area, the place of consultation and diagnosis in conceptions of ‘good practice’ and ‘the good practitioner’, and the dissembling of the elusive idea of the ‘practitioner who is good’ into a more realistic idea of constituent ‘good practices’. We draw conclusions from our work and suggest a way forward.
Functional anatomy of the Arabidopsis cytokinesis‐specific syntaxin KNOLLE
Authors: Touihri Sonja , Knöll Christian , Stierhof York‐Dieter , Müller Isabel , Mayer Ulrike , Jürgens Gerd 
Published: August 2011

SummaryIn plant cytokinesis, Golgi/trans‐Golgi network‐derived vesicles are targeted to the plane of cell division where they fuse with one another to form the partitioning membrane (cell plate). This membrane fusion requires a specialised syntaxin (Qa‐SNARE), named KNOLLE in Arabidopsis. KNOLLE is only made during the M‐phase of the cell cycle, targeted to the plane of cell division and degraded in the vacuole at the end of cytokinesis. To identify the parts of KNOLLE required for proper targeting and function in membrane fusion, we generated chimeric syntaxins comprising complementary fragments from KNOLLE and MVB‐localized PEP12 (SYP21). Surprisingly, targeting of the chimeric protein was not specified by the C‐terminal membrane anchor. Rather the N‐terminal region including helix Ha and the adjacent linker to helix Hb appeared to played a critical role. However, deletion of this N‐terminal fragment from KNOLLE (KNΔ1–82) had the same effect as its presence in the chimeric protein (KN1–82‐PEP1264–279), suggesting that targeting to the plane of cell division occurs by default, i.e. when no sorting signal would target the syntaxin to a specific endomembrane compartment. Once the full‐length syntaxin accumulated at the plane of division, phenotypic rescue of the knolle mutant only required the SNARE domain plus the adjacent linker connecting helix Hc to the SNARE domain from KNOLLE. Our results suggest that targeting of syntaxin to the plane of cell division occurs without active sorting, whereas syntaxin‐mediated membrane fusion requires sequence‐specific features.
System responses to long‐term drought and re‐watering of two contrasting alfalfa varieties
Authors: Kang Yun , Han Yuanhong , Torres‐Jerez Ivone , Wang Mingyi , Tang Yuhong , Monteros Maria , Udvardi Michael 
Published: August 2011

SummarySystems analysis of two alfalfa varieties, Wisfal (Medicago sativa ssp. falcata var. Wisfal) and Chilean (M. sativa ssp. sativa var. Chilean), with contrasting tolerance/sensitivity to drought revealed common and divergent responses to drought stress. At a qualitative level, molecular, biochemical, and physiological responses to drought stress were similar in the two varieties, indicating that they employ the same strategies to cope with drought. However, quantitative differences in responses at all levels were revealed that may contribute to greater drought tolerance in Wisfal. These included lower stomatal density and conductance in Wisfal; delayed leaf senescence compared with Chilean; greater root growth following a drought episode, and greater accumulation of osmolytes, including raffinose and galactinol, and flavonoid antioxidants in roots and/or shoots of Wisfal. Genes encoding transcription factors and other regulatory proteins, and genes involved in the biosynthesis of osmolytes and (iso)flavonoids were differentially regulated between the two varieties and represent potential targets for improving drought tolerance in alfalfa in the future.
Induction and detoxification of maize 1,4‐benzoxazin‐3‐ones by insect herbivores
Authors: Glauser Gaétan , Marti Guillaume , Villard Neil , Doyen Gwladys A. , Wolfender Jean‐Luc , Turlings Ted C.J. , Erb Matthias 
Published: August 2011

SummaryIn monocotyledonous plants, 1,4‐benzoxazin‐3‐ones, also referred to as benzoxazinoids or hydroxamic acids, are one of the most important chemical barriers against herbivores. However, knowledge about their behavior after attack, mode of action and potential detoxification by specialized insects remains limited. We chose an innovative analytical approach to understand the role of maize 1,4‐benzoxazin‐3‐ones in plant–insect interactions. By combining unbiased metabolomics screening and simultaneous measurements of living and digested plant tissue, we created a quantitative dynamic map of 1,4‐benzoxazin‐3‐ones at the plant–insect interface. Hypotheses derived from this map were tested by specifically developed in vitro assays using purified 1,4‐benzoxazin‐3‐ones and active extracts from mutant plants lacking 1,4‐benzoxazin‐3‐ones. Our data show that maize plants possess a two‐step defensive system that effectively fends off both the generalist Spodoptera littoralis and the specialist Spodoptera frugiperda. In the first step, upon insect attack, large quantities of 2‐β‐d‐glucopyranosyloxy‐4,7‐dimethoxy‐1,4‐benzoxazin‐3‐one (HDMBOA‐Glc) are formed. In the second step, after tissue disruption by the herbivores, highly unstable 2‐hydroxy‐4,7‐dimethoxy‐1,4‐benzoxazin‐3‐one (HDMBOA) is released by plant‐derived β‐glucosidases. HDMBOA acts as a strong deterrent to both S. littoralis and S. frugiperda. Although constitutively produced 1,4‐benzoxazin‐3‐ones such as 2,4‐dihydroxy‐7‐methoxy‐1,4‐benzoxazin‐3‐one (DIMBOA) are detoxified via glycosylation by the insects, no conjugation of HDMBOA in the insect gut was found, which may explain why even the specialist S. frugiperda has not evolved immunity against this plant defense. Taken together, our results show the benefit of using a plant–insect interface approach to elucidate plant defensive processes and unravel a potent resistance mechanism in maize.
Same description, different values. How service users and providers define patient and public involvement in health care
Authors: Rise Marit By , Solbjør Marit , Lara Mariela C. , Westerlund Heidi , Grimstad Hilde , Steinsbekk Aslak 
Published: August 2011

AbstractBackground  Patient and public involvement in health care is important, but the existing definitions of the concept do not integrate the stakeholders’ own perceptions.Objective  To investigate and compare service users’ and service providers’ own definitions of patient and public involvement and their implications.Design, setting and participants  Qualitative study with mainly individual in‐depth semi‐structured interviews conducted between June 2007 and June 2009. Data were analysed using a grounded theory approach.Results  A total of 20 patients, 13 public representatives and 44 health service providers/managers in both somatic and mental health care were interviewed. A common definition of patient and public involvement emerged: It is founded on mutual respect, carried out through dialogue aiming at achieving shared decision making. Nevertheless, users and providers assigned different values to the core aspects: Respect was imperative for service users and implied for providers, dialogue was a way to gain respect for service users and to achieve good outcome for providers, and both worried that the other party wanted to make sole decisions.Conclusions  Users and providers need to consider that although they have a common definition of involvement in health care, they assign different values to its aspects. Increasing and improving patient and public involvement therefore requires knowledge on and dialogue between the parties about these differences.
‘Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital
Authors: Knight Denise A , Thompson Diane , Mathie Elspeth , Dickinson Angela 
Published: August 2011

AbstractBackground  Many older people use one or more prescribed medicines on a daily basis. Effective medicines management at hospital discharge can support appropriate use of medicines following discharge and help avoid unnecessary hospital re‐admission. Many people, however, feel they receive insufficient information about medicines on discharge from hospital.Objectives  To explore older people and their family carers’ experience of hospital discharge in relationship to the organization and management of medicines.Design  Qualitative interviews with older people over 75 years old, taking four or more medicines, and their carers, following discharge from hospital in the United Kingdom (UK). Participants completed medication diaries prior to the interview.Setting  Interviews took place in the participant’s home.Results  Nineteen interviews were conducted involving 12 carers and seven older people. Participants were generally not satisfied with the discharge process, particularly concerning perceived delays in discharge. Inadequate explanations about medicines at discharge were commonly reported and led to omission of medicines, incorrect dosage, anxiety and confusion. Poor communication between the hospital and general practitioners or community pharmacists was also evident.Conclusions  Despite significant policy recommendations and research in this area, many problems with the management of medicines during hospital discharge were shown, and a lack of partnership was evident between hospital staff and patients/family carers regarding the use of medicines post‐discharge. Improved medicines management during hospital discharge is required to ensure older people take their medications as prescribed and to protect them from the adverse effects of medicines not being taken correctly.