Opening the horizons of clinical reasoning to qualitative research

Clinical Reasoning (CR) is an important aspect of health professional education and effective prac-tice. It is a complex series of factors and cognitive functions, involving higher-level thinking to define prob-lems, examine the evidence and then making decisions and choices to improve the patient\u2019s physiological and psycho-social state.CR consists of 3 interconnected and interdependent sub-processes: clinical experience and clinical context and Evidence-Based Practice. This essay focuses on the opportunities that Qualitative Research offers during the CR process when the doctor finds the evidence to address a patient\u2019s health problem. Clini-cians are often faced with questions that randomized clinical trials or systematic reviews of efficacy studies can-not answer. For this reason, we considered it necessary to offer an expanded view of the process of interpretation of the scientific literature used in daily clinical practice through the complex process of Clinical Reasoning, through the use of studies conducted with qualitative methods, which are able to respond to a different range of clinical questions, and to support studies based on the effectiveness of treatments

PET/MRI in prostate cancer: a systematic review and meta-analysis

Aim: In recent years, the clinical availability of scanners for integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) has enabled the practical potential of multimodal, combined metabolic-receptor, anatomical, and functional imaging to be explored. The present systematic review and meta-analysis summarize the diagnostic information provided by PET/MRI in patients with prostate cancer (PCa). Materials and methods: A literature search was conducted in three different databases. The terms used were \u201ccholine\u201d or \u201cprostate-specific membrane antigen - PSMA\u201d AND \u201cprostate cancer\u201d or \u201cprostate\u201d AND \u201cPET/MRI\u201d or \u201cPET MRI\u201d or \u201cPET-MRI\u201d or \u201cpositron emission tomography/magnetic resonance imaging.\u201d All relevant records identified were combined, and the full texts were retrieved. Reports were excluded if (1) they did not consider hybrid PET/MRI; or (2) the sample size was < 10 patients; or (3) the raw data were not enough to enable the completion of a 2 7 2 contingency table. Results: Fifty articles were eligible for systematic review, and 23 for meta-analysis. The pooled data concerned 2104 patients. Initial disease staging was the main indication for PET/MRI in 24 studies. Radiolabeled PSMA was the tracer most frequently used. In primary tumors, the pooled sensitivity for the patient-based analysis was 94.9%. At restaging, the pooled detection rate was 80.9% and was higher for radiolabeled PSMA than for choline (81.8% and 77.3%, respectively). Conclusions: PET/MRI proved highly sensitive in detecting primary PCa, with a high detection rate for recurrent disease, particularly when radiolabeled PSMA was used

Local structural studies of Ba1−x_{1-x}Kx_xFe2_2As2_2 using atomic pair distribution function analysis

Systematic local structural studies of Ba$_{1-x}$K$_x$Fe$_2$As$_2$ system are undertaken at room temperature using atomic pair distribution function (PDF) analysis. The local structure of the Ba$_{1-x}$K$_x$Fe$_2$As$_2$ is found to be well described by the long-range structure extracted from the diffraction experiments, but with anisotropic atomic vibrations of the constituent atoms ($U_{11}$ = $U_{22} \ne U_{33}$). The crystal unit cell parameters, the FeAs$_4$ tetrahedral angle and the pnictogen height above the Fe-plane are seen to show systematic evolution with K doping, underlining the importance of the structural changes, in addition to the charge doping, in determining the properties of Ba$_{1-x}$K$_x$Fe$_2$As$_2$

Perception of nurses’ professional identity during the first wave of COVID-19 pandemic infections

Background and aim of the work: The main purpose of this study is to investigate on the experience of nurses working in the Covid-19 area focusing on their role’s perception. In particular, we explored the nurses’ perception of job satisfaction in relation to the images sent back by public opinion through the mass media and social communication channels. During the first wave of Covid-19 nurses have acquired media visibility, but their feeling is represented more by the discomfort of finding themselves suddenly glorified in the face of a lack of professional, social, and economic recognition. Materials and methods: A Mix-Method methodology and convenience sampling was adopted, on the population of professionals and students in post-graduate specializations, belonging to the Department of Medicine and Surgery of the University of Parma, and by nurses from the ASST-Bergamo Est, Lombardia Italy, who worked in the Covid emergency during the first wave of the pandemic, from February 2020 to May 2020. In the quantitative phase Stamm’s Professional Quality of Life Scale - ProQOL was administered to 89 respondents through a Google Form, In the qualitative phase, 3 Focus Groups were conducted on a total of 17 students. Results: At the ProQOL questionnaire, a moderate score was found in the Compassion Satisfaction scale (CF = 38.28) and in the Secondary Traumatic Stress subscale (STS-24.33), while low values emerged in the Burnout subscale (BO = 16.02). Five specific topics emerged from the focus groups: Professional collaboration, Job satisfaction, Nurse’s personal skills, Failure to protect the public image and the nursing profession. Conclusions: The professional collaboration, union with the work team, sense of solidarity, job satisfaction, professional growth, and awareness of one’s role seem to have worked favorably on Compassion Satisfaction, while keeping Compassion Fatigue levels under control

Take a picture! The role of visual methods in understanding psychiatric patient's everyday life

BACKGROUND AND AIM: Understanding the patient's experience of mental illness can foster better support for this population and greater partnership with healthcare professionals. This study aims to explore the application of visual methods in the psychiatric field and, in particular, the experience of people suffering from psychotic disorders because it is still an open question that has not been only partially empirically examined. METHODS: This qualitative study was conducted using two visual methods (auto-photography and photo-elicitation) associated with the narrative that emerged from an unstructured interview, in a clinical setting of adult Mental Health in Italy, between October 2019 and February 2020. A total of 5 patients and 5 corresponding referring healthcare professionals were identified and enrolled.&nbsp; Patients were asked to produce photographs following 4 thematic areas: "Fun", "Time", "Something indispensable", "Place where I feel good". RESULTS: A total of 85 photographs were produced. Visual methods have proved to be a useful technique in qualitative research in the area of adult psychiatry. From the interviews, it emerged that visual methods have allowed psychotic patients to use a new language to be able to communicate their emotions. CONCLUSIONS: The healthcare professionals involved also confirm the potential of this tool which, when combined with the traditional interview, is able to deepen the patient's knowledge by overcoming the verbal barriers that often make it difficult to reconstruct the individual experience of illness

Carbon on the Northwest European Shelf: Contemporary Budget and Future Influences

A carbon budget for the northwest European continental shelf seas (NWES) was synthesized using available estimates for coastal, pelagic and benthic carbon stocks and flows. Key uncertainties were identified and the effect of future impacts on the carbon budget were assessed. The water of the shelf seas contains between 210 and 230 Tmol of carbon and absorbs between 1.3 and 3.3 Tmol from the atmosphere annually. Off-shelf transport and burial in the sediments account for 60–100 and 0–40% of carbon outputs from the NWES, respectively. Both of these fluxes remain poorly constrained by observations and resolving their magnitudes and relative importance is a key research priority. Pelagic and benthic carbon stocks are dominated by inorganic carbon. Shelf sediments contain the largest stock of carbon, with between 520 and 1600 Tmol stored in the top 0.1 m of the sea bed. Coastal habitats such as salt marshes and mud flats contain large amounts of carbon per unit area but their total carbon stocks are small compared to pelagic and benthic stocks due to their smaller spatial extent. The large pelagic stock of carbon will continue to increase due to the rising concentration of atmospheric CO2, with associated pH decrease. Pelagic carbon stocks and flows are also likely to be significantly affected by increasing acidity and temperature, and circulation changes but the net impact is uncertain. Benthic carbon stocks will be affected by increasing temperature and acidity, and decreasing oxygen concentrations, although the net impact of these interrelated changes on carbon stocks is uncertain and a major knowledge gap. The impact of bottom trawling on benthic carbon stocks is unique amongst the impacts we consider in that it is widespread and also directly manageable, although its net effect on the carbon budget is uncertain. Coastal habitats are vulnerable to sea level rise and are strongly impacted by management decisions. Local, national and regional actions have the potential to protect or enhance carbon storage, but ultimately global governance, via controls on emissions, has the greatest potential to influence the long-term fate of carbon stocks in the northwestern European continental shelf

A protocol for Italian validation of DEMQoL-Proxy Scale: assessing the Quality of Life of people with moderate or mild dementia

In this paper, we propose an adaptation of a protocol for a tool's validation. We have utilized this phases-theory to validate in Italian language an instrument to assess Quality of Life for people with moderate or mild dementia. We will explain the example of our Italian validation of DEMQoL-Proxy considering each De Vellis's phase. We will explain our application of De Vellis's model to Italian example described. For the first three phases, we reproduced the original validating study in which authors (Smith et al., 2005) defined what to measure, how generate a set of items and the structure of the scale. Indeed, for the last five phases we explained the adaptation of De Vellis's model to Italian validation. We hope that this model could be effective to validating goals, for researchers and in particular for all professionals who deal with caregivers and patients with moderate and mild dementia. Furthermore, the measurement of the Quality of Life makes the scale widely useful within the various professional specialties and setting. Finally, thanks to the methodological assumptions adopted following the De Vellis's eight-phase model, we can affirm that this first Italian pre-validation of the DEMQoL-Proxy seems to be an excellent forerunner for its effective validation in the Italian context

General Synthesis Report of the Different ADS Design Status. Establishment of a Catalogue of the R&D needs

This document is a General Synthesis Report of the Different ADS Design Status being designed within the EUROTRANS Integrated Project; an FP6 European commission partially funded programme. This project had the goal to demonstrate the possibility of nuclear waste transmutation/burning in Accelerator Driven Systems (ADS) at industrial scale.The focus is on a Pb-cooled ADS for the European Facility on Industrial scale Transmuter (ETD/EFIT) with a back-up solution based on an He cooled ADS.As an intermediate step towards this industrial-scale prototype, an eXperimental Transmuter based on ADS concept (ETD/XT-ADS) able to demonstrate both the feasibility of the ADS concept and to accumulate experience when using dedicated fuel sub-assemblies or dedicated pins within a MOX fuel core has been also studied.The two machines (XT-ADS and Pb cooled EFIT) have been designed in a consistent way bringing more credibility to the potential licensing of these plants and with sufficient details to allow definition of the critical issues as regards design, safety and associated technological and basic R&D needs. The different designs fit rather well with the technical objectives fixed at the beginning of the project in consistency with the European Roadmap on ADS development.For what concerns the accelerator, the superconducting LINAC has been clearly assessed as the most suitable concept for the three reactors in particular with respect to the stringent requirements on reliability. Associated R&D needs have been identified and will be focused on critical components (injector, cryomodule) long term testing.The design of the different ADS has been performed in view of what is reasonably achievable pending the completion of R&D programmes. The way the EUROTRANS Integrated Project has been organised with other domains than the DM1 Design being specifically devoted to R&D tasks in support to the overall ETD/EFIT and ETD/XT-ADS design tasks has been helpful. The other domains were centred on the assessment of reactivity measurement techniques (DM2 ECATS), on the development of U-free dedicated fuels (DM3 AFTRA), on materials behaviour and heavy liquid metal technology (DM4 DEMETRA) and on nuclear data assessment (DM5 NUDATRA). Pending questions associated to technology gaps have been identified through the different appropriate R&D work programmes and a Catalogue of the R&D needs has been established.Finally, the work within the EUROTRANS integrated project has provided an overall assessment of the feasibility at a reasonable cost for an ADS based transmutation so that a decision can be taken to launch a detailed design and construction of the intermediate step Experimental ADS now already launched within the 7th FP programme under the name of Common Design Team (CDT)