A new instrument for residency program evaluation

The purpose of the study was to develop a comprehensive program evaluation instrument. Following pilot work with residents, a 69-item instrument consisting of statements with 5-point strongly agree to strongly disagree response options was distributed to 107 residents; 104 responded. Psychometric analyses revealed no ceiling or floor effects; 9 items were deleted. There were three subscales: workload (19 items; α = .76); educational environment (29 items; α = .72) and lifestyle issues (12 items; α = .62). Mean item scores were significantly higher for educational environment (3.53; SD 0.28) than for workload (2.78; SD 0.39) and lifestyle (2.96; SD 0.42). Items with the lowest scores reflected issues that were largely fixable. The 60-item instrument appears to be psychometrically sound, comprehensive, and exportable.     

Role conflict in student nurses: towards a positive approach for the 1990s

This review paper seeks to adopt a constructive approach towards the subject of the role conflict experienced by student nurses. The significance of role conflict is explored, as are its causes and its effects on the student. Role conflict is then discussed from the perspectives of social psychology in general and nursing in particular, and the paper concludes with an emphasis on the role of the nurse educator in helping the students deal actively and constructively with the role conflict that they will inevitably experience during their careers in nursing.     

Effects of Phyllanthus plant extracts on duck hepatitis B virus in vitro and in vivo.

The effects of extracts of five Australian Phyllanthus species (P. hirtellus, P. gunnii, P. gasstroemii, P. similis and P. tenellus), other plant extracts and the antiviral drug foscarnet on duck hepatitis B virus (DHBV) endogenous DNA polymerase (DNAp) activity were compared. All 5 Phyllanthus species caused 50% inhibition at concentrations of dry weight between 350-800 micrograms/ml, which is comparable with the effect described for P. amarus on the DNAp of human and woodchuck hepatitis B viruses. Incubation of P. hirtellus with 100 ID50 DHBV neutralized infection. However, neither P. gasstroemi extract, given by intraperitoneal injection (i.p.) at a dose of 20 mg/kg 3 times per week to ducklings early in the incubation period, or P. hirtellus extract, given to established DHBV carrier ducklings, prevented or eliminated infection.     

Operative mortality following surgery for carcinoma of the pancreas

A series of 85 patients with carcinoma of the pancreas seen in South India has been analysed. The median age was 50 years, 20% of patients being below years of age, and the male to female ratio was 4:1. Diabetes mellitus and smoking were more prevalent among males than in a control group, but this was not the case with alcoholism. Distribution of blood groups was the same as in controls. Clinical features of these patients are reviewed. Operative mortality in jaundiced patients was similar whether simple laparotomy, a biliary bypass procedure or a pancreaticoduodectomy was done. This mortality was related to the depth of jaundice and to the degree of abnormality in serum transaminase levels, but it was not related to the age of the patient, the stage of the disease, ECG evidence of ischaemic heart disease, or abnormalities in either serum albumin concentration or blood urea level. Following biliary bypass procedures 50% of patients were dead within eight months; after pancreatoduodenectomy this interval was increased to 18 months, but differences in the stage of the disease between the two groups would account for the difference in survival to some extent.     

The pattern of non-diabetic peripheral vascular disease in South India

One hundred and twelve South Indian males with non-diabetic peripheral vascular disease of the lower limb were classified clinically into three groups according to the level of obstruction (aorto-iliac, 26 patients; femoropopliteal, 46 patients; distal, 40 patients). Arteriography was done in 65 patients and serum lipid estimations in 69. In the aorto-iliac group the mean age was 45 years (+/- 11.6 s.d.); 23 per cent had hypertension, 28 per cent polycythaemia and 55 per cent hyperlipidaemia. Aortography suggested atheroma in most. In the femoropopliteal group the mean age was 39 years (+/- 12.8); 22 per cent had hypertension, 11 per cent polycythaemia and 21 per cent hyperlipidaemia. Arteriography showed lesions typical of atheroma in many and was consistent with thrombo-angiitis obliterans in some. In the distal group the mean age was 37 years (+/- 9.8); 8 per cent had hypertension, 20 per cent polycythaemia, 25 per cent hyperlipidaemia and 20 per cent had distal arterial disease of the upper limb. Arteriography was consistent with thrombo-angiitis obliterans in most cases. Atheroma seemed to be implicated in 96 per cent of the aorto-iliac group and in 64 per cent of the femoropopliteal group.     

Adolescent and young adult oncology

Cancer is the leading cause of death among the adolescent and young adult (AYA) population, excluding homicide, suicide, or unintentional injury. AYA patients should be managed by a multidisciplinary team of health care professionals who are well-versed in the specific developmental issues relevant to this patient population. The recommendations for age-appropriate care outlined in these NCCN Guidelines include psychosocial assessment, a discussion of infertility risks associated with treatment and options for fertility preservation, genetic and familial risk assessment for all patients after diagnosis, screening and monitoring of late effects in AYA cancer survivors after successful completion of therapy, and palliative care and end-of-life considerations for patients for whom curative therapy fails.     

Your Mother Should Know: A Comparison of Maternal and Paternal Attitudes and Behaviors Related to Gambling among Their Adolescent Children

Parental attitudes and behaviors are significant factors in the gambling behavior of their children yet few attempts have been made to explore them in depth. The current study compared mothers and fathers on these factors with particular attention paid towards the gambling of their own teenage children. Surveys were completed by 3,089 parents across Canada with at least one child between the ages of 13 and 18 years. Participants responded to items in three general areas: (1) parental attitudes towards gambling among adolescents, (2) parental involvement in gambling with their children, and (3) parental awareness of and involvement in youth gambling education and prevention measures. Several gender differences were revealed. Fewer fathers compared to mothers viewed gambling as a serious issue among teens, particularly fathers of teenage boys. Mothers were more likely to report gambling on raffle and lottery scratch tickets with their children; fathers were more likely to report engaging in gambling activities with their children, particularly sons, involving sports or competitive themes (i.e., poker, games of skill, sports lotteries, and sports pools). Mothers were also more likely to report having conversations with their children about gambling and to be more aware of educational materials to which their children are being exposed. Given the differences between mothers and fathers in how they view and react to youth gambling as a serious issue, prevention programs should aim to address the gender-specific attitudes and behaviors of parents.     

Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma discuss the workup and management of tumors of the exocrine pancreas. These NCCN Guidelines Insights provide a summary and explanation of major changes to the 2012 NCCN Guidelines for Pancreatic Adenocarcinoma. The panel made 3 significant updates to the guidelines: 1) more detail was added regarding multiphase CT techniques for diagnosis and staging of pancreatic cancer, and pancreas protocol MRI was added as an emerging alternative to CT; 2) the use of a fluoropyrimidine plus oxaliplatin (e.g., 5-FU/leucovorin/oxaliplatin or capecitabine/oxaliplatin) was added as an acceptable chemotherapy combination for patients with advanced or metastatic disease and good performance status as a category 2B recommendation; and 3) the panel developed new recommendations concerning surgical technique and pathologic analysis and reporting.     

Development of a scale to measure fidelity to manualized group-based cognitive behavioural interventions for people with intellectual disabilities

The context for the present study was a cluster-randomized controlled trial of a group-based anger-management intervention, delivered by day-service staff. We aimed to develop a scale to measure the fidelity of manualized cognitive-behavioural therapy (CBT) delivered to adults with intellectual disabilities in group-based settings. A 30-item monitoring instrument (the MAnualized Group Intervention Check: MAGIC) was adapted from an existing fidelity-monitor instrument for individual CBT. Two sessions for 27 groups were observed by pairs of monitors who had no other contact with the intervention. 16 observers participated, in 15 unique pairings. Observers recorded high levels of inter-rater reliability and the scale had good internal consistency. Fidelity ratings predicted two key outcomes of the intervention, and were themselves predicted by the therapists’ clinical supervisors.     

Intrahepatic biliary-intestinal bypass in malignant jaundice

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct-to-jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaundice.