A Stoma Quality of Life Scale

Purpose Few studies have evaluated the impact of a stoma on patient quality of life because of a lack of specific validated measures. This study documents the development and initial application of a Stoma Quality of Life Scale. Methods Content experts generated initial questions. Patient focus groups were conducted to ensure that the questions addressed all stoma-related issues considered important by patients. Responses from pilot groups allowed refinement to produce the final measure, the Stoma Quality of Life Scale, a 21-item questionnaire. Three scales are featured: Work/Social Function (6 items), Sexuality/Body Image (5 items), and Stoma Function (6 items). In addition, one item (scored separately) measures financial impact, one measures skin irritation, and two measure overall satisfaction. This questionnaire was administered to 100 consecutive ostomy patients, and readministered three weeks later. Reliability was assessed by using coefficient alpha for internal consistency and intraclass correlation coefficient for test-retest reproducibility. To test validity in extreme groups, scores were compared for patients with improved quality of life vs. those whose stoma worsened their quality of life. To evaluate convergent validity, we analyzed correlation of instrument scales with the SF12. Results The Stoma Quality of Life scales demonstrated adequate test-retest reproducibility (intraclass correlation coefficient >0.8) and acceptable internal consistency (coefficient alpha approximately 0.8). The scales were capable of discriminating between patients with better and worse quality of life after stoma formation (P < 0.02 for all scales). The Stoma Quality of Life scales significantly correlated (range, 0.12–0.75) with the Physical and Mental Health Composite Scale Scores of the SF-12. Conclusions The Stoma Quality of Life Scale demonstrates reasonable psychometric properties for measuring quality of life in patients with stomas. Further studies are needed to refine the instrument. Poster presentation at Digestive Disease Week, Orlando, Florida, May 17 to 22, 2003.     

Collaborative and supervisory relationships between attending physicians and advanced practice nurses in long-term care facilities

Recent years have seen an increased interest and use of advanced practice nurses in long-term care. Models of best practices of supervision and collaboration have been promulgated by many organizations, but none have specifically addressed how these interactions should occur in the nursing home setting. To better define the role of the attending physician and advanced practice nurses to provide optimal resident care, the American Medical Directors Association formed a work group to address collaborative and supervisory relationships in long-term care facilities.     

An approach to identify functional homologues and suppressors of genes in fission yeast

We have developed a procedure using a bank of temperature-sensitive (ts) mutants of fission yeast to identify mutants which can be rescued by expression of a plasmid-borne gene of interest. The procedure has been used to identify new ts alleles of cdc2 and swi7/pol1, a ts mutant rescued by actin, and to identify a ts allele of cdc11 which can be rescued by combined mammalian Myc and Max expression. The procedure should also be useful as an alternative approach to identify genes in fission yeast which are functionally homologous to genes of interest from other organisms. Received: 28 February 1997     

Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools?

This article provides an analysis of cancer decision aids (DAs), instruments developed to support oncologic patients facing tough screening or treatment decisions, with a particular attention to their level of personalisation. As discussed in our previous works, we argue that the personalisation of medicine should regard not only the genetic and clinical aspects of diseases but also the different cognitive, psychological and social factors involved in clinical choices. According to this vision, we analysed the existing randomised controlled studies on cancer DAs concluding that only few of them take into account individual variables such as cultural level, individual risk attitudes, personal beliefs, and emotional state that are crucial to determine people's reactions and health‐related choices. For these reasons, although quality standards have been published for these interventions, we suggest the need for further research in order to make these instruments more efficient in transforming and improving the actual clinical practice, improving patient empowerment and participation in health‐related decisions.     

The impact of expanding the numbers of clinical nurse specialists in cancer care: a United Kingdom case study

In the last few years there has been an increase in the number of clinical nurse specialists (CNSs) working in cancer care throughout the UK. This paper examines the issues raised by the proliferation of site-specific cancer CNS posts, developed to give a 'nursing lead' for a particular tumour type. The issues common to all CNS posts are exacerbated when a number of specialists are involved in the cancer journey, causing potential fragmentation and confusion. Key issues need to be addressed if the role is to remain credible, and ensure clarity for patients and the multiprofessional team. These include role clarification, sensitive integration, interface with other cancer CNSs and the multiprofessional team, evaluation, cost, education and training, recruitment and succession planning and the 'career cul-de-sac'. Cancer nursing's response to these challenges will set the professional agenda for education, training and future models of service delivery.     

Measurement of cancer attitudes: a review

Many psychologists maintain that the attitudes we hold about a particular topic or subject will influence the way in which we behave towards it: positive attitudes lead to positive behaviours and vice versa. A literature search was conducted using the databases of MEDLINE and CINAHL. This produced research-based evidence showing that despite treatment advances, cancer remains one of the most feared of all diseases, not only among the public but also among oncology health-care professionals. However, the practice of measuring attitudes is fraught with difficulties. This review article will discuss the link between attitudes and behaviour and review pertinent literature regarding public and professional attitudes towards cancer before critically analysing the most common tools for evaluating cancer attitudes and making recommendations for the future of attitude measurement.