Utilization of standardized patients to evaluate clinical and interpersonal skills of surgical residents

BACKGROUND: This project was designed to determine the growth of interpersonal skills during the first year of a surgical residency. METHODS: All categorical surgical residents were given a clinical skills examination of abdominal pain using standardized patients during their orientation (T1). The categorical residents were retested after 11 months (T2). The assessment tool was based on a 12-item modified version of the 5-point Likert Interpersonal Scale (IP) used on the National Board of Medical Examiners prototype Clinical Skills Examination and a 24-item, done-or-not-done, history-taking checklist. Residents' self-evaluation scores were compared to standardized patients' assessment scores. Data were analyzed using the Pearson correlation coefficient, Wilcoxon signed rank test, Student t test, and Cronbach alpha. RESULTS: Thirty-eight categorical residents were evaluated at T1 and T2. At T1, in the history-taking exercise, the scores of the standardized patients and residents correlated (Pearson = .541, P = .000). In the interpersonal skills exercise, the scores of the standardized patients and residents did not correlate (Pearson = -0.238, P = .150). At T2, there was a significant improvement in the residents' self-evaluation scores in both the history-taking exercise (t = -3.280, P = .002) and the interpersonal skills exercise (t = 2.506, P = 0.017). In the history-taking exercise, the standardized patients' assessment scores correlated with the residents' self-evaluation scores (Pearson = 0.561, P = .000). In the interpersonal skills exercise, the standardized patients' assessment scores did not correlate with the residents' self-evaluation scores (Pearson = 0.078, P = .646). CONCLUSIONS: Surgical residents demonstrate a consistently low level of self-awareness regarding their interpersonal skills. Observed improvement in resident self-evaluation may be a function of growth in self-confidence.     

Cimetidine-induced bicarbonate production in canine gastric pouches

Secretion of HCO₃^? into a mucus-gel “unstirred layer” has been proposed as part of the gastric mucosal defense system. Cimetidine has a cytoprotective effect on salicylate-challenged gastric mucosa independent of its acid-inhibiting property. This study was done to (1) evaluate whether cimetidine increases gastric mucosal HCO₃ and to (2) ascertain if ionic shifts accompany the HCO₃^? to explain the mechanism of its production. Six dogs with Heidenhain gastric pouches were fasted 24 hr prior to testing. Pouch access was provided by a cannula fitted with an airtight apparatus for test solution instillation and removal and transmucosal potential difference (PD) measurement. A test solution composed of 175 mM mannitol, 25 mM NaCl, and 50 mM EPPS buffer was used, its pH adjusted to above 8.0; ¹⁴C-labeled polyethylene glycol was added for volumetric determinations. Nine 15-min periods comprised each test: four control periods of iv saline infusion; a fifth period when an iv cimetidine bolus was given; and four test periods when doses of 2.5, 5, or 10 mg/kg/hr cimetidine were infused iv. Test solution (50 ml) was placed in the pouch and an initial sample taken; 15 min later a final sample was taken, the pouch rinsed, and the next period begun. Concentrations of HCO₃^?, Na⁺, K⁺, and Cl^? were determined for each sample as well as changes in osmolality, pH, volume, and PD. Mean net HCO₃^? increased from 79 μmol/15 min during saline infusions to 109, 124, and 123 μmol/15 min with 2.5, 5, and 10 mg/kg/hr cimetidine iv; all are significantly increased compared to saline controls (P < 0.01). None of the other measured parameters changed significantly after cimetidine infusion. Cimetidine causes modest but significant increases in gastric mucosal HCO₃^?. The clinical role, if any, of these increases in HCO₃^? in gastric mucosal defense remains to be determined.     

Estimation of hemopoietic potential by CFU-c and bone marrow scan in cancer patients

The concentration of granulocyte-macrophage colonies in culture (CFU-c) in bone marrow cells was estimated, and bone marrow radionuclide scans were performed in a group of 15 cancer patients prior to bone marrow harvest for autologous transplantation. Preharvest CFU-c counts on iliac-crest bone marrow aspirates correlated very well with CFU-c counts from fresh and frozen-thawed bone marrows. Technetium-99m-sulfur colloid radionuclide scans showed that the distribution of total-body bone marrow and increased peripheral radionuclide uptake correlated with higher preharvest and harvest CFU-c counts. Bone marrow scan results were available in 1 h, whereas CFU-c counts took 14 days to obtain. Bone marrow scans may facilitate the clinical estimation of hemopoietic activity in patients under consideration for autologous bone marrow transplantation.     

PREVENTION OF EXPERIMENTAL ALLERGIC ENCEPHALOMYELITIS (EAE) BY VITAMIN C DEPRIVATION

Scorbutic guinea pigs injected with CNS and mycobacterium to induce experimental allergic encephalomyelitis (EAE) showed no clear-cut neurological signs and failed to show histological evidence of central nervous system damage. The degree of protection afforded by vitamin C deprivation was related directly to the duration of the scorbutogenic diet and inversely to the strength of the CNS challenge. Vitamin C deprivation also abolished tuberculin sensitivity as measured by the PPD skin reaction. Upon restoration of vitamin C, the animals recovered their sensitivity to PPD but did not develop EAE. It was further demonstrated that these effects of vitamin C deprivation were not related to inanition or to the endogenous levels of 17-hydroxycorticosteroids.     

A phase II study of high-dose estrogens (diethylstilbestrol diphosphate) in prostate cancer

Twenty-five patients with metastatic prostate cancer resistant to primary hormone therapy, received high-dose intravenous diethylstilbestrol diphosphate (Stilphostrol [Miles Pharm], DES-P) in a Phase II study using established response criteria. Objective response rate was 17%, while 22% of the patients were subjectively improved. Moderate gastrointestinal toxicity was reported in 10 patients (40%). Thromboembolic complications were seen in 2 (8%). The role of high-dose Stilphostrol in the treatment of hormone-resistant prostate cancer is limited.     

Attrition of older adults in longitudinal surveys: detection and correction of sample selection bias using multigenerational data

OBJECTIVE: The purpose of this study was (a) to investigate whether attrition due to death and nonresponse leads to bias in estimated growth-decline trajectories when only complete data are used in longitudinal research, and (b) to examine the extent of the bias and possible solutions. METHODS: The study sample was a subset of the Longitudinal Study of Generations and included data from 208 G1-G2 parent-child dyads and 538 G2-G3 dyads over 30 years. We used a latent growth-decline curve model based on full information maximum likelihood estimation in order to compare parents' and adult children's reports on older respondents' health and intergenerational solidarity by parents' attrition status. RESULT: Results indicated that attrition due to mortality biased estimates of respondents' assessments of their functional health status over time, and parents' perceptions of the quality of the parent-child relationship deteriorated more rapidly among those who died by Time 7, but nonresponse did not seriously bias estimates of these measures. Using proxies, we found that functional impairment increased more rapidly when children reported about parents, especially in advanced old age. Discussion: These results support the use of full information in estimating growth curves where mortality is present but raise concerns when using child proxies to evaluate parental health or the quality of intergenerational relationships.     

Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being

OBJECTIVE: The migration of working-age adults from rural to urban China has altered traditional patterns of living arrangements and intergenerational support among elderly persons who remain in rural regions. This investigation examined how household composition and support exchanges with adult children influenced the psychological well-being of older parents in rural China. METHODS: Data derived from a 2001 survey of 1,561 parents aged 60 and older living in rural Anhui Province, China. We used multiple regression in order to estimate the effects of multigenerational living arrangements and intergenerational transfers of financial, instrumental, and emotional support on depression and life satisfaction in older parents. RESULT: Older parents living in three-generation households or with grandchildren in skipped-generation households had better psychological well-being than those living in single-generation households. Receiving greater remittances from adult children increased well-being and explained why living with grandchildren was beneficial. Stronger emotional cohesion with children also improved well-being. DISCUSSION: These results suggest that traditional family arrangements are beneficial in rural Chinese society as they represent the fulfillment of a cultural ideal. We discuss implications in the context of the corporate Chinese family, characterized by mutual aid and interdependence across generations, and its adaptation to social change.