Clear Definition Research Articles

Narrative Medicine and Empathy: A Phenomenological Perspective

ABSTRACT In Rita Charon's account of narrative medicine, empathy seems to be an essential element of the clinical relationship. However, empathy has not received much attention, which I believe is problematic. First, I show that not only is there no clear definition of what empathy is, but that this conceptual gap creates ambiguity about its role in the practice of narrative medicine. Second, I argue that certain passages in Charon's work seem to implicitly characterize empathy as a combination of cognitive empathy, affective empathy, and sympathy, and that its inclusion in the practice of narrative medicine can be problematic. Third, following Dan Zahavi, I argue that a phenomenological account of empathy not only seems most compatible with the practices, values, and theoretical framework of narrative medicine, but is also capable of resolving the problems posed by alternative definitions of empathy and the ambiguity about the role of empathy in narrative medicine.

Values as Motives: Implications for theory, methods, and practice.

The concept of human values is central to the study of culture, ethics, politics, anthropology, sociology, social psychology, environmental studies, health policy, education, management, and human capital. Because it represents the ultimate "why" behind decisions and behaviors, as a concept it plays an outsized role in both theory and practice in each of these fields. Despite the centrality of human values in these domains, the concept lacks theoretical consensus among scholars and practitioners. Like the concepts of subjective well-being, organizational culture, employee engagement, and leadership, the values literature suffers from concept proliferation and cries out for clearly stated definitions that embed the concept within a solid theoretical framework. In this article, we advocate for a fundamental reconsideration of the concept of values, anchoring it within a new psychological theory of human motivation based on first principles. Our primary contribution lies in demonstrating that the operational definitions utilized by academics and practitioners alike can be thought of as attempts to approach concepts of human motivation, specifically, emotional needs, without fully getting there. We review the leading definitions of human values in the literature, concluding that they can be distilled to a fundamental set of human emotional needs, each associated with extensive literatures of their own. We introduce a comprehensive framework of 12 human emotional needs and argue that a comprehensive motivational framework offers significant advantages over current theoretical approaches, which tend to spin off an ever-expanding list of concepts. We consider the impact of embedding values concepts within existing motivational constructs with clear benefits for: (a) theory development, (b) method development, and (c) practical applications, emphasizing the advantages of clear operational definitions.

Status of Telenursing and Future Use Intentions in Home Health Care in the Post-COVID-19 Era

This study aimed to investigate the current status and workload of telenursing by home healthcare nurses in the post-COVID-19 era, where telenursing has become indispensable, and identify factors that influence the intention to use telenursing. This study employed a cross-sectional descriptive approach based on an online survey. A total of 137 active home care nurses were surveyed for over 6 weeks starting in December 2022. Among the participants, 33.8% (N = 44) responded that they were currently using telenursing services. Most telenursing was conducted for consultation and education, using various technologies. The intention to use telenursing was significantly higher among individuals with higher educational levels and telenursing experience. The greater the social influence, which indicates the extent to which people around them believe that telenursing should be used, and more positive the attitudes toward telenursing, the higher the intention to use it. A clear definition of telenursing is required to improve people’s understanding of telenursing before its official implementation in Korea. Telenursing may be used to provide health care education and consultation while maintaining the continuity of care not only for patients receiving home health care but also for community-dwelling patients. To recognize and evaluate current telenursing practices, telenursing content should be recorded accurately. Finally, attitudes toward telenursing and social influence must be considered when developing strategies to improve nurses’ intentions to use and activate telenursing in the near future.

New energy vehicles and the political geoecology of China’s Ecological Civilisation

Ecological Civilisation has been China’s policy concept to frame its environmental sustainability strategy. While it lacks a clear definition, its multiple practices show a reliance on the development and implementation of technologies that reduce pollution levels and beautify the country. One of those technologies are New Energy Vehicles (NEV), which stand at the centre of an e-mobility transition across urban China. I engage with the growing debate on China’s Ecological Civilisation and e-mobility transition by reflecting on the critical junctions between this policy concept and the NEV industry. I suggest that the New Energy requirements of China’s Ecological Civilisation rely on power relations that enhance state capacity domestically and transnationally. In this sense, the pursuit of New Energy to build China’s Ecological Civilisation relies on moral and sovereign forms of power. In a context of increasing tensions between China and countries in the North Atlantic, my contribution shows that these forms of power enhance China’s state capacity through its economic infrastructure, re-producing old dependencies and inequalities.

The effect of classroom acoustics and noise on high school students’ listening, learning and well-being: a scoping review

PurposeThe purpose of this paper is to systematically map research on the effect of classroom acoustics and noise on high school students’ listening, learning and well-being, as well as identify knowledge gaps to inform future research.Design/methodology/approachThis scoping review followed the PRISMA-ScR protocol. A comprehensive search of four online databases (ERIC, PubMed, Scopus and Web of Science) was conducted. Peer-reviewed papers were included if they conducted a study on the effect of classroom acoustics or noise on students’ listening, learning or well-being; had a clear definition of the noise level measurement; were conducted with high school students; and had the full text in English available.FindingsIn total, 14 papers met the criteria to be included in the review. The majority of studies assessed the impact of noise on students’ listening, learning or well-being. Overall, the results showed that higher noise levels have a negative effect on students’ listening, learning and well-being. Effects were even more pronounced for students who were non-native speakers or those with special educational needs such as hearing loss. Therefore, it would be beneficial to limit unnecessary noise in the classroom as much as possible through acoustic insulation, acoustic treatment and classroom management strategies.Originality/valueThis paper is the first review paper to synthesize previous research on the effect of classroom acoustics and noise on high school students’ listening, learning and well-being. It provides an analysis of the limitations of existing literature and proposes future research to help fill in these gaps.

Development of a Cancer Pathway Support Guide for Patients and Carers: A Codesign Project

Background. Cancer diagnosis is a complex and multifaceted process that can be stressful and anxiety-provoking for patients. Evidence-based tools and information aids that can be used for guiding and supporting patients during cancer investigations and after diagnosis are limited. This paper presents a user-centred codesign project that aims to develop a cancer pathway support tool for patients, carers, and healthcare professionals. Method. A mixed-method codesign approach was used including prototype development (January–March 2022), three online codesign workshops (April–June 2022), one-to-one feedback, and beta testing informed by the standardised Theoretical Framework of Acceptability (TFA) questionnaire (July–October 2022). Nine individuals with lived experience of cancer contributed to the project and are referred to as codesigners. Results. The codesigners valued the potential importance of a tool that can be used by the patients and carers if they want specific information about cancer investigations, diagnosis, and treatment. The ability to select what they need as opposed to long leaflets and generating their own questions for the healthcare providers were highlighted as important aspects of improving patient care. The tool was collectively designed to provide clear definitions of the cancer care pathway and easily accessible links from trusted resources and includes practical information to minimise the burden that can be experienced from preparation for appointments and tests. Beta testing results with a small sample of potential users including patients, carers, and healthcare providers (n = 23) showed high acceptability of the guide (range = 7–35, mean = 28.52, and standard deviation = 3.88) based on the TFA questionnaire. Conclusion. A cancer pathway support tool called “Your Cancer Pathway Support Guide (YCPSG)” was developed as a result of an iterative codesign process aiming to improve patient experience and outcomes for people referred on a suspected cancer pathway or who have been diagnosed with cancer. The tool provides information and support in both digital and PDF formats. Further studies are needed to evaluate the potential impact of “Your Cancer Pathway Support Guide” on patient outcomes and experience and the wider system.

External comparators and estimands

The estimand framework as defined by the ICH E9(R1) addendum aims to clearly define “the treatment effect reflecting the clinical question posed by the trial objective”. It intends to achieve this goal of a clear definition by specifying the 5 estimand attributes: treatment conditions, population, endpoints, handling of intercurrent events (IEs), and population-level summary. However, hybrid clinical/observational research like External Comparators (ECs) leads to new reflections on existing attributes and to considerations for additional ones. Specifically, treatment conditions and exposure may be more difficult to handle in the EC, and especially Standard of Care (SoC) treatment needs detailed attention. The external population typically cannot be based on the classical Intention-to-treat population and constitutes also an approximation only. Endpoints may not be comparable across cohorts, and IEs may be more different than in an RCT setting, such that the hypothetical treatment policy according to the ICH E9(R1) addendum may become of greater interest especially for long-term endpoints. Finally, the necessary assumptions for some population-level summaries (e.g., the proportional hazards assumption) can become more fragile when joining data from different sources due to induced heterogeneity. Finally, it is shown that the baseline definition and the marginal estimator are candidates for additional estimand attributes in case the estimand framework is revised to account for observational study needs.

Summing over non-singular paths in quantum cosmology

In this paper we provide the DeWitt propagator and its wave function in quantum cosmology using the path integral formulation of quantum gravity. The DeWitt boundary condition is introduced as a way to avoid the Big Bang singularity by positing that the wave function of the Universe vanishes near the Big Bang. However, there is currently no clear definition of the DeWitt boundary condition in the path integral formulation. To address this issue, we use the image method, which eliminates singular paths in the forbidden region of the infinite potential, and apply this method to quantum cosmology based on the Batalin–Fradkin–Vilkovisky formulation of the path integral. We investigate the validity of the image method, and in particular, find that this method is only appropriate when the potential has symmetry with respect to the boundary. We then show that the DeWitt propagator and the DeWitt wave function derived from the image method are consistent with solutions of the Wheeler–DeWitt equation for certain models of quantum cosmology.

Untangling the commons: three different forms of commonality

AbstractThe term “commons” is used with increasing frequency in the public debate and scientific literature in various fields (including economics and sociology). However, this term is often ambiguous and used to denote quite different things. Obviously, any concept, and therefore also the concept of “commons”, does not have an “essence”. Clear definitions do not serve to capture what something is in itself, but only to rigorously specify what use is made of a given expression. In other words, linguistic precision is not a value in itself, but becomes necessary when misunderstandings can arise – as happens in the case under discussion. This article critically revisits the notion itself of “commons”. It is based on an extensive interdisciplinary literature review. However, the intent is not to provide an overview of the state of the art but to suggest a critical reframing of the discourse. The overall aim is not solely to distinguish different uses of the term; it is also to clarify the real scope and meaning of each definition of it – such as the one proposed by Elinor Ostrom, which is too often inappropriately invoked. As the article demonstrates, Ostrom’s view on many issues perfectly aligns with the Hayekian account of the evolutionary, emerging nature of a significant number of successful institutions and forms of organization.

Expanding the Genotype-Phenotype Correlations and Mutational Spectrum in Inherited Retinal Diseases: Novel and Recurrent Mutations.

Background Inherited retinal diseases (IRD) represent a prominent etiology of visual impairment on a global scale. The lack of a clear definition of the etiology and genotypic spectrum of IRD is attributed to the significant genetic variability seen. Additionally, there is a scarcity of available data about the correlations between genotypes and phenotypes in this context. This study aimed to clarify the range of mutations and the associations between genotypes and phenotypes in IRD. Methods This cohort consists of 223 patients who have been diagnosed with a range of retinal illnesses, such as retinitis pigmentosa (RP), Stargardt (STGD)/STGD-like disease, Usher syndrome, and Leber congenital amaurosis (LCA). The validation of each mutation and its pathogenicity was conducted by bioinformatics analysis, Sanger sequencing-based co-segregation testing, and computational assessment. The link between genotype and phenotype was analyzed in all patients who possessed mutations as described in the recommendations established by the American College of Medical Genetics. Results A total of 223 cases, comprising Turkish and Syrian families, were examined, revealing the presence of 175 distinct mutations in the IRD gene. Among these mutations, 58 were identified as unique, indicating that they had not been previously reported. A total of 119 mutations were identified to be likely pathogenic, while 104 mutations were classified as pathogenic. The study identified patterns of heredity, namely autosomal recessive, dominant, and X-linked inheritance. Conclusions The findings of this study broaden the clinical and molecular aspects of IRD and further enhance our understanding of its complex nature. The discovery of previously unknown relationships between genetic variations and observable traits, as well as the wide range of genetic variants associated with IRD, significantly contributes to our existing understanding of the diverse phenotypic and genotypic characteristics of IRD. This new information will prove invaluable in facilitating accurate clinical diagnoses as well as personalized therapeutic interventions for individuals affected by IRD.

The Concept of Child-Centred Care in Healthcare: A Scoping Review.

Although child-centred care is increasingly referred to within the nursing literature, a clear definition of child-centred care and clarity around the concept is yet to be achieved. The objectives of this review were to examine the following: (1) What constitutes the concept of child-centred care in healthcare? (2) How has the concept of child-centred care developed? (3) What is the applicability of child-centred care and what are its limitations? (4) How does the concept of child-centred care benefit and inform children's healthcare? In total, 2984 papers were imported for screening, and, following the removal of duplicates and screening, 21 papers were included in the scoping review. The findings suggest that child-centred care is an emerging, ambiguous poorly defined concept; no clear consensus exists about what constitutes child-centred care. Although it seems antithetical to argue against child-centred care, little robust evidence was identified that demonstrates the impact and benefit of child-centred care. If child-centred care is to be a sustainable, convincing model to guide practice and compete with other models of care, it needs to establish robust evidence of its effectiveness, the impact on children and their families, as well as the wider impacts on the healthcare system.

Adenomyosis and fertility-sparing surgery: A literature appraisal.

Adenomyosis is an intricate pathological condition that negatively impacts the uterus. It is closely related to the more well-known endometriosis, with which it shares parallels in terms of diagnosis, therapy, and both microscopic and macroscopic features. The purpose of this narrative review is to give a clear univocal definition and outlook on the different, patient-adapted, surgical treatments. MEDLINE and PubMed searches on these topics were conducted from 1990 to 2022 using a mix of selected keywords. Papers and articles were identified and included in this narrative review after authors' revision and evaluation. From the literature analysis, authors reported the following surgical techniques: laparoscopic double/triple-flap method, laparotomic wedge resection of the uterine wall, laparotomic transverse H-incision of the uterine wall, laparotomic wedge-shaped excision, and laparotomic complete debulking excision by asymmetric dissection technique. Each of these techniques has strengths and weaknesses, but the literature data on the pregnancy rate are somewhat limited. The only certain information is the risk of uterine rupture up to 6.0% after surgical treatment for uterine adenomyosis. Over the years, the surgical approach continued to reach a positive result by minimally invasive treatment, with less hospitalization, less postoperative pain, and less blood loss. Over the years, the gynecological surgeon has gained the skills, training and increasingly sophisticated surgical techniques to target effective therapy. That's why a hysterectomy is no longer the only surgical resource to treat adenomyosis, but in patients who wish to preserve the fertility, there is a wide variety of surgical alternatives.

A systematic review of literature examining the application of a social model of health and wellbeing.

Following years of sustained pressure on the UK health service, there is recognition amongst health professionals and stakeholders that current models of healthcare are likely to be inadequate going forward. Therefore, a fundamental review of existing social models of healthcare is needed to ascertain current thinking in this area, and whether there is a need to change perspective on current thinking. Through a systematic research review, this paper seeks to address how previous literature has conceptualized a social model of healthcare and, how implementation of the models has been evaluated. Analysis and data were extracted from 222 publications and explored the country of origin, methodological approach, and the health and social care contexts which they were set. The publications predominantly drawn from the USA, UK, Australia, Canada and Europe identified five themes namely: the lack of a clear and unified definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health. The review identified a need for a clear definition of a social model of health and wellbeing. Furthermore, consideration is needed on how a model integrates with current models and whether it will act as a descriptive framework or, will be developed into an operational model. The review highlights the importance of engagement with users and partner organizations in the co-creation of a model of healthcare.

A novel histologic description of the fibrous networks in the lid-cheek junction and infraorbital region.

The aim of this study was to identify the anatomical feature of retaining ligament and fat compartment on the lower eyelid and infraorbital region using a histological method, and to investigate clear definitions for them which could be used generally in the clinical area. Eighteen specimens from eight fresh Korean cadavers were stained with Masson trichrome or hematoxylin and eosin. The ligamentous and fascial fibrous tissue were clearly identified. The ligamentous fibrous tissue which traversed in the superficial and deep fat layer was skin ligament and orbicularis retaining ligament (ORL). The fascial fibrous tissue enclosed the orbicularis oculi muscle (OOc) and circumferencial adipose tissue. Based on the ligamentous and fascial structure, three fat compartments, septal, suborbicularis oculi and infraorbital fat compartment, could be identified. The OOc attached to orbital rim and dermis by ORL and skin ligament, and the muscle fascicle and fat fascicle provided the connection point to the ORL and skin ligament as enclosing all muscle and fat tissue. The combination of the force made by the skin ligament in the lower eyelid and ORL may decide the level and form of the infraorbital grooves.

Defining digital nursing.

The use of technology in health care, including nursing, is growing, owing in part to the COVID-19 pandemic and in response to national policy. To investigate nurses' perceptions of digital nursing (DN). Community and primary care nurses from across Wales were recruited (n=249) through a survey comprising open and closed questions. This was supplemented with semistructured interviews (n=25). Thematic analysis was used to analyse qualitative data. Nurses had a broad range of perspectives on what DN meant, with four main themes being identified: access; impact on care; technology; and digital future. The positive impacts of DN on ways of working and patient outcomes were supported by answers to closed survey questions. Many nurses understand the value of digital tools within nursing and are clear about their benefits for patients, nurses and multiprofessional teams. However, there is a need for a clear definition and increased awareness of DN.

Causal‐mechanical explanations in biology: Applying automated assessment for personalized learning in the science classroom

AbstractOne of the core practices of science is constructing scientific explanations. However, numerous studies have shown that constructing scientific explanations poses significant challenges to students. Proper assessment of scientific explanations is costly and time‐consuming, and teachers often do not have a clear definition of the educational goals for formulating scientific explanations. Consequently, teachers struggle to support their students in this process. It is hoped that recent advances in machine learning (ML) and its application to educational technologies can assist teachers and learners in analyzing student responses and providing automated formative feedback according to well‐defined pedagogical criteria. In this study, we present a method to automate the entire assessment‐feedback process. First, we developed a causal‐mechanical (CM)‐based grading rubric and applied it to student responses to two open‐ended items. Second, we used unsupervised ML tools to identify patterns in student responses. Those patterns enable the definition of “meta‐categories” of explanation types and the design of personalized feedback adapted to each category. Third, we designed an in‐class intervention with personalized formative feedback that matches the response patterns. We used natural language processing and ML algorithms to assess students' explanations and provide feedback. Findings from a controlled experiment demonstrated that a CM‐based grading scheme can be used to identify meaningful patterns and inform the design of formative feedback that promotes student ability to construct explanations in biology. We discuss possible implications for automated assessment and personalized teaching and learning of scientific writing in K‐12 science education.

Utility of Intermediate Care Units: A Systematic Review Study

Intermediate care units (IMCUs) have become increasingly important in the care of critical and semi-critical patients, particularly during the COVID-19 pandemic. However, there is still no clear definition of their structural characteristics, specialties, types of patients, and the benefits they provide. The aim of this work is to describe the current state of implementation and operation of IMCUs in hospitals and patient care. To achieve this goal, a systematic review was conducted in the Web of Science, Scopus and CINAHL databases, along with a hand search. The research yielded 419 documents, of which 26 were included in this review after applying inclusion and exclusion criteria. The results were highly diverse and were categorized based on the following topics: material resources, human resources, continuity of care, and patient benefits. Despite the different objectives outlined in the studies, all of them demonstrate the numerous benefits provided by an IMCU, along with the increased relevance of this type of unit in recent years. Therefore, this systematic review highlights the benefits of IMCUs in the care of critical patients, as well as the role of health workers in these units.

A rare case report of accessory thyroid in the superior mediastinum in the form of multinodular goiter

Retrosternal expansion of a goiter is one of the most common types of mass in the upper mediastinum. Although there is no clear definition of retrosternal, substernal, or mediastinal goiter in the literature, it usually refers to an extension of thyroid tissue from the cervical part that continues to the anterior mediastinum of the aortic arch. One of the interesting features of these cervical mediastinal lesions is that they may not be continuous. Such goiter types classically present with compression symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea, and less frequently, these masses can compress neurovascular structures, leading to superior vena cava (SVC) syndrome and Horner’s syndrome. In our case report, A 47-year-old female from North Karnataka presented to the hospital with history of dyspnea, dysphonia, and dysphagia persisting for the last 3 years. After careful examination and investigation, a diagnosis of thymoma was made initially. However, upon biopsy of the excised tumor, unexpected finding was revealed, it was identified as a multinodular goiter (MNG) rather than a thymoma.

Randomized controlled trials on promoting self-care behaviors among informal caregivers of older patients: a systematic review and meta-analysis

BackgroundInformal caregivers of older patients often neglect their self-care, despite the mental and physical health effects of caregiving. Randomized controlled trials (RCTs) on self-care interventions for informal caregivers are lacking, making it difficult to determine effective strategies. This systematic review explored the definition and categories of self-care RCTs for informal caregivers and a meta-analysis was conducted to determine the effectiveness of these interventions.MethodsSeven databases (Scopus, Web of Science, MEDLINE, PubMed, ProQuest, CINAHL, and Embase) were searched for articles in English reporting on self-care intervention outcomes for informal caregivers of patients aged 60 years or older. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup, sensitivity, and publication bias analyses were conducted.ResultsEighteen studies were included in the systematic review, of which fifteen studies were included in the meta-analysis. RCTs lacked a clear definition of self-care, mainly focused on promoting physical and mental health and individual capacity, and neglected disease prevention. The interventions focused on self-management for health and individual agency, with less attention on health literacy, decision-making capacity, self-monitoring for health status, and linkage to the health system. Meta-analysis results showed that RCTs had a small effect on reducing anxiety (SMD = -0.142, 95% CI [-0.302, 0.017], p = .081) but a significant effect on reducing depression (SMD = -0.214, 95% CI [-0.353, -0.076], p = .002). Country and type of caregiver significantly contributed to the effect of reducing caregivers’ depression in subgroup analysis.ConclusionsStudies on caregiver-centered self-care interventions are limited, resulting in a lack of a clear definition and comprehensive intervention. RCTs indicated a small effect on informal caregivers’ mental health, and interventions should consider both mental and physical health. More evidence is needed on the effectiveness of self-care interventions for informal caregivers’ anxiety and physical health.

RETURN TO SPORT FOLLOWING CLOSED ACHILLES TENDON RUPTURE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF ELIGIBLE STUDIES EVALUATING MANAGEMENT STRATEGIES, PATIENT FACTORS, AND LEVEL OF ATHLETIC ACTIVITY

IntroductionAchilles Tendon Rupture (ATR) is a prevalent injury in Western society. Much of the recent research has focused on measuring surgical methods and strength regained, rather than practical measures such as Return to Sport (RTS). A large systematic review was published in 2016 setting a benchmark RTS as 80%. The aim of this systematic review was to provide an up-to-date RTS following ATR.MethodsPubMed and SPORTdiscuss databases were used to search for eligible studies published since 2017 that focused on closed Achilles tendon ruptures with clear definitions of return to sport and a minimum length of follow-up. The Newcastle-Ottawa grading tool was used to assess risk of bias in all included studies.ResultsOf 15 articles identified, 9 were ‘good’ and 6 were ‘fair’ after bias assessment, with none excluded for being poor. Return-to-sport (RTS) rate following Achilles tendon rupture was 76.76% (95% CI 74.19, 79.34 P= <0.001). Non-professional athletes had a higher RTS rate (78.29%; 95% CI 74.89, 81.68 P= <0.001) than professional athletes (74.91%; 95% CI 70.98, 78.85 P= <0.001). Surgical intervention resulted in a lower RTS rate (74.17%; 95% CI 70.74, 77.60 P= <0.001) than conservative management (70.00%; 95% CI 60.48, 79.52 P= <0.001).ConclusionThese findings highlight the need to identify factors affecting RTS rates, including the type of management, level of sport, and patient-specific factors. Clinicians can use these findings to guide informed shared decision-making with patients regarding the long-term implications of ATR and to develop more targeted rehabilitation strategies for this injury.