Disclosure of date/acquaintance rape: who reports and when

OBJECTIVE: To estimates rates and correlates of disclosure of date/acquaintance rape or attempted rape and verbally coercive sex among a diverse sample of adolescent and young adult females. DESIGN: Secondary data analysis of cross sectional data. SETTING: Urban adolescent healthcare facility. PARTICIPANTS: Adolescents who were identified as having experienced rape/attempted rape (n = 86) or verbally coerced sex (n = 68) in the last 12 months from study examining sexual violence. MAIN OUTCOME MEASURES: Disclosure of forced sex (logistic regression) and the timing of disclosure (survival analysis). INTERVENTIONS: None. RESULTS: Almost 60% of victims who experienced rape/attempted rape disclosed this information to one or more individuals, whereas only 47% of those who experienced verbally coerced sex told another person. Multivariate analyses found that drinking by the partner (AOR = 4.6) and shorter dating history (AOR = 6.3) were associated with disclosure of rape/attempted rape; timing of this disclosure was facilitated by Caucasian ethnicity (RR = 3.5), having a dating partner who drank > or = 1 drinks (RR = 2.5), and the perpetrator being someone other than the victim's boyfriend or partner (RR = 2.5). With regards to verbally coerced sex, reporting no pressure to use alcohol (AOR = 10.7) was the only factor associated with disclosure. No significant predictors of timing to disclosure were detected for this type of victimization. CONCLUSIONS: Perpetrator's alcohol use and a shorter dating history are important variables associated with disclosure of rape/attempted rape as well as timing to disclosure. Factors affecting the disclosure of verbally coerced sex and the latency associated with disclosure are less well defined.     

Long-term risk of medical conditions associated with breast cancer treatment

Early and late effects of cancer treatment are of increasing concern with growing survivor populations, but relevant data are sparse. We sought to determine the prevalence and hazard ratio of such effects in breast cancer cases. Women with invasive breast cancer and women with no cancer history recruited for a cancer research cohort completed a mailed questionnaire at a median of 10 years post-diagnosis or matched reference year (for the women without cancer). Reported medical conditions including lymphedema, osteopenia, osteoporosis, and heart disease (congestive heart failure, myocardial infarction, coronary heart disease) were assessed in relation to breast cancer therapy and time since diagnosis using Cox regression. The proportion of women currently receiving treatment for these conditions was calculated. Study participants included 2,535 women with breast cancer and 2,428 women without cancer (response rates 66.0 % and 50.4 %, respectively) Women with breast cancer had an increased risk of lymphedema (Hazard ratio (HR) 8.6; 95 % confidence interval (CI) 6.3–11.6), osteopenia (HR 2.1; 95 % CI 1.8–2.4), and osteoporosis (HR 1.5; 95 % CI 1.2–1.9) but not heart disease, compared to women without cancer Hazard ratios varied by treatment and time since diagnosis. Overall, 49.3 % of breast cancer cases reported at least one medical condition, and at 10 or more years post-diagnosis, 37.7 % were currently receiving condition-related treatment. Responses from survivors a decade following cancer diagnosis demonstrate substantial treatment-related morbidity, and emphasize the need for continued medical surveillance and follow-up care into the second decade post-diagnosis.     

Perceptions of roles, practice patterns, and professional growth opportunities

Broadening the scope of advanced practice providers (APPs) has been offered as a solution to increasing healthcare costs, workforce shortage, and increased demand. To understand present scope and barriers to broadening it, the authors describe the perceptions and practice patterns of APPs. This cross-sectional study used a computerized self-report survey of 32 targeted nurse practitioners and physician assistants employed in the cancer center of an urban teaching hospital; 31 were included in the quantitative analyses. Survey items covered education and training background, expertise, professional resources and support, duties, certification, and professional development. Respondents practiced in a variety of oncology specialty areas, but all had advanced degrees, most held specialty certifications, and 39% had attended a professional or educational meeting within the last year. They spent a majority of their time on essential patient-care activities, but clerical duties impeded these; however, 64% reported being satisfied with the time they spent with patients and communicating with collaborating physicians. A model of advanced oncology practice needs to be developed that will empower APPs to provide high-quality patient care at the fullest extent of their knowledge and competence.     

Horizontal violence in nursing

Horizontal or lateral violence is considered an act of aggression among nursing professionals. Horizontal violence creates a negative work environment impairing teamwork and compromising patient care. The effects of horizontal violence and strategies for prevention and management are addressed.     

Comments on protecting clients about whom we write (and speak)

This comment lauds Barbara Sieck's article ("Obtaining clinical writing informed consent versus using client disguise and recommendations for practice", Psychotherapy, 49, pp. 3-11.) as a solid review not only for therapists but for all clinicians and researchers. Her review also is relevant for assorted spoken presentations and for presentation of psychological assessment excerpts/reports, film clips, and qualitative research data and findings. Procedures that promote adequate disguise are listed, with an emphasis on the importance of authentically engaging the person-to-be-presented in discussion of the intended audience/readers and of what is being illustrated. The latter step serves not only the integrity of the participant but also their sense of contributing and of being respected.     

Plasmid-mediated resistance in Enterobacteriaceae: changing landscape and implications for therapy

Antimicrobial resistance is increasing worldwide, and pathogenic microorganisms that are resistant to all available antimicrobial agents are increasingly reported. Emerging plasmid-encoded extended-spectrum β-lactamases (ESBLs) and carbapenemases are increasingly reported worldwide. Carbapenemase production encoded by genes located on mobile genetic elements is typically accompanied by genes encoding resistance to other drug classes, often but not necessarily located on the same mobile element. Multiple plasmid-mediated mechanisms of resistance against the fluoroquinolones and aminoglycosides have been described, and the combination of plasmid-mediated resistance with chromosomally encoded resistance mechanisms of multiple drug classes now results in strains that are resistant to all of the main classes of commonly used antimicrobial drugs. Clinical studies of antimicrobial therapy and outcome of patients infected with ESBL- or carbapenemase-producing strains of Enterobacteriaceae compared with patients infected with susceptible strains are limited in their design but suggest a worse outcome after infection with resistant strains. Alternative options for the treatment of infections caused by carbapenem-resistant strains of Enterobacteriaceae are limited. Current strategies include colistin, fosfomycin, tigecycline and temocillin. Although in vitro testing suggests strong activity for each of these drugs against a large proportion of carbapenem-resistant strains of Enterobacteriaceae, clinical evaluations do not provide strong evidence for equivalent or improved outcome. Oral treatment with fosfomycin tromethamine is effective against lower urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli. Intravenous fosfomycin may be beneficial and safe for patients when used as part of a combination therapy in the management of severe infections caused by carbapenem-resistant Klebsiella pneumoniae. Tigecycline is only indicated for the treatment of complicated skin and skin structure infections and complicated intra-abdominal infections in Europe, and is also approved for treatment of community-acquired pneumonia in the US. Clearly, further research on the clinical and safety outcomes in the treatment of multidrug-resistant Enterobacteriaceae with these existing alternative drugs, and the development of new and unrelated drugs, are urgently warranted.