An investigation into self, peer and tutor assessments of student psychiatric nurse's written work assignments.

As part of an 84-week experiential psychiatric nurse training course, a group (n = 19) of post registration student nurses (PRSNS) were involved in the process of writing four essays on aspects of psychiatric nursing during their first 16 weeks of school based study days. The marking criteria for each essay was determined in the classroom by the PRSNS together with their tutor, and the essays were subsequently written in the student's own time. Assessment and grading of each essay was carried out by the student, a peer, and a tutor, using the agreed marking criteria. Analysis of the independently awarded grades for all of the essays reveals that students consistently award themselves lower grades than either their peers or their tutors, with tutors awarding the highest grades in 3 of the 4 essays. Further analysis reveals that peers and tutors, and peers and students grades correlated significantly in 2 out of the 4 essays.     

Frontotemporal dementia and parkinsonism linked to chromosome 17 with the N279K tau mutation

We present a case of frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP‐17) harboring the N279K mutation in the MAPT gene from the family known as pallido‐ponto‐nigral degeneration (PPND). This 49‐year‐old man was followed for 17 years. He presented at age 41 years with left leg stiffness and en‐bloc turning. During the course of his illness he developed a constellation of symptoms including parkinsonism, pyramidal signs, vertical gaze palsy, dysphagia, dystonia, personality and cognitive dysfunction, weight loss and mutism. Gross neuropathological examination showed mild atrophy of the cerebral cortex, hippocampal formation, amygdala, thalamus, subthalamic nucleus and depigmentation of the substantia nigra. Microscopy revealed neuronal loss and gliosis in the same regions. Tau immunohistochemistry showed pretangles, numerous threads, grain‐like structures and oligodendroglial tau‐positive inclusions (“coiled bodies”). In the spinal cord the tau pathology was more abundant in gray than white matter. Pretangles and threads were present in the anterior and, to a lesser extent, in the posterior horns. FTDP‐17 should be suspected in patients with a history of familial parkinsonism combined with behavioral and cognitive changes, onset before age 65 years and an aggressive clinical course.     

The effects of transurethral prostatectomy on serum prostate specific antigen

Serum prostate specific antigen (PSA) was recorded in 75 patients immediately before and after transurethral resection of the prostate (TURP). Fifty-eight patients had benign prostatic hypertrophy (BPH) and 17 had prostatic carcinoma (CaP). In patients with BPH there was a statistically significant rise in PSA immediately following TURP. No such rise was seen in patients with prostatic carcinoma. A statistically significant correlation was identified between the weight of the benign hypertrophic prostate and the baseline pre-operative serum PSA. Because of the effects of TURP on serum PSA it is important to avoid PSA estimations immediately following such surgery. The failure of the malignant prostate to release PSA in significant amounts during TURP suggests that the elevated levels of PSA found in patients with prostatic carcinoma arise not from the local disease but from its metastases.     

Quantification of prostatic cancer metastatic disease using prostate-specific antigen.

The serum prostate-specific antigen (PSA) of 58 men with benign prostatic hypertrophy (BPH) and 17 men with carcinoma of the prostate (CaP) was correlated with the weight of prostatic tissue resected at transurethral prostatectomy (TURP). A significant correlation was identified between the weight of resected BPH tissue and the serum PSA (p less than or equal to 0.001; r = 0.54). No such correlation was seen in the CaP patients. By arbitrarily dividing the serum PSA by the prostate weight, it was possible to devise an index. This index corrected PSA in relation to prostatic size and unlike PSA in isolation did not differ significantly between normal controls and those with BPH. The index in CaP was significantly greater than that of either controls or BPH (p less than or equal to 0.001). Furthermore the index of metastatic CaP (M1) was significantly higher than that of nonmetastatic disease (MO) (p = 0.05). The higher index found in CaP would seem to be related to the bulk metastatic tumor, either manifest or occult. Comparing the index of CaPs to that found in normal and benign disease (a constant) offers a possible means of estimating the extent of local and metastatic tumor mass.     

THE MEASUREMENT OF SOCIOECONOMIC INEQUALITY AND SOCIAL CLASS IN AUSTRALIA: A REVIEW OF PAST PRACTICES AND RECENT DEVELOPMENTS

Recent findings have pointed to an association between socioeconomic status and health in Australia but have, in the process, raised important questions about the validity of various methods of determining a respondent's location within the hierarchy. While some of the problems associated with the use of the Australian Bureau of Statistics classification were known, the full extent of these deficiencies was not. This paper reviews past and present methods of measuring socioeconomic inequality in Australia. After pointing to the criteria which should be applied to determine the adequacy of any method of socioeconomic classification, the paper reviews the main strengths and weaknesses of the methods of classification used in health-related research in Australia.     

Limitations of a convolution method for modeling geometric uncertainties in radiation therapy: the radiobiological dose-per-fraction effect

The convolution method can be used to model the effect of random geometric uncertainties into planned dose distributions used in radiation treatment planning. This is effectively done by linearly adding infinitesimally small doses, each with a particular geometric offset, over an assumed infinite number of fractions. However, this process inherently ignores the radiobiological dose-per-fraction effect since only the summed physical dose distribution is generated. The resultant potential error on predicted radiobiological outcome [quantified in this work with tumor control probability (TCP), equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and generalized equivalent uniform dose (gEUD)] has yet to be thoroughly quantified. In this work, the results of a Monte Carlo simulation of geometric displacements are compared to those of the convolution method for random geometric uncertainties of 0, 1, 2, 3, 4, and 5 mm (standard deviation). The alpha/betaCTV ratios of 0.8, 1.5, 3, 5, and 10 Gy are used to represent the range of radiation responses for different tumors, whereas a single alpha/betaOAR ratio of 3 Gy is used to represent all the organs at risk (OAR). The analysis is performed on a four-field prostate treatment plan of 18 MV x rays. The fraction numbers are varied from 1-50, with isoeffective adjustments of the corresponding dose-per-fractions to maintain a constant tumor control, using the linear-quadratic cell survival model. The average differences in TCP and EUD of the target, and in NTCP and gEUD of the OAR calculated from the convolution and Monte Carlo methods reduced asymptotically as the total fraction number increased, with the differences reaching negligible levels beyond the treatment fraction number of > or =20. The convolution method generally overestimates the radiobiological indices, as compared to the Monte Carlo method, for the target volume, and underestimates those for the OAR. These effects are interconnected and attributed to assuming an infinite number of fractions inherent in the implementation of the convolution technique, irrespective of the uniqueness of each treatment schedule. Based on the fraction numbers analyzed (1-50), and the range of fraction numbers normally used clinically (> or =20), the convolution method can be used safely to estimate the effects of random geometric uncertainties on prostate treatment radiobiological outcomes, for both the target and the OAR. Although the results of this study is likely to apply to other clinical sites and treatment techniques other than the four-field, further validation similar to those done in this study may be necessary prior to clinical implementation.     

Factors influencing levels of research activity in clinical psychologists: a new model

There are concerns in the USA and UK about low levels of research activity amongst clinical psychologists emerging from doctoral level training. The authors explore existing evidence and theory pertaining to this phenomenon. Three relevant theoretical strands are identified, along with related empirical studies and commentaries in practitioner journals. These different sources are integrated to suggest a more complete model of factors influencing clinical psychologists' research intentions, and in turn research activity itself: vocational preferences, research training experienced during qualifying training, practice context, value placed on expected outcomes of doing research, perceived norms for clinical psychologists in relation to doing research, research self‐efficacy, professional identity and, most tentatively, sex role identity. Our new model points to training interventions, either pre‐ or post‐qualification, that may increase the likelihood of clinical psychologists carrying out clinical research that will contribute to their profession's knowledge base, beyond their time in qualifying training. Copyright © 2006 John Wiley & Sons, Ltd.     

Complication Rates Following Total Ankle Arthroplasty in Inpatient versus Outpatient Populations: A Systematic Review & Meta-Analysis

Total ankle arthroplasty (TAA) is used as an alternative to ankle arthrodesis for adults with severe ankle arthritis. Numerous orthopedic centers have entered the healthcare market offering fast-tracked joint replacement protocols, meanwhile, TAA has been excluded from these joint centers, and is primarily performed in the inpatient setting. The purpose of this study is to examine short-term complications in the inpatient and outpatient settings following TAA using a systematic review and quantitative analysis. We considered all studies examining short-term complications following TAA performed in the inpatient versus outpatient setting occuring within 1 year of the index operation. We summarized data using a pooled relative risk and random effects model. A pooled sensitivity analysis was performed for studies with data on complication rates for inpatient or outpatient populations, which did not have a control group. The quality of included studies was assessed using the Cochrane risk of bias tool. Nine studies were included in the quantitative analysis, with 4 studies in the final meta-analysis. Subjects undergoing inpatient surgery experienced a 5-times higher risk of short-term complications compared to the outpatient group (risk ratio 5.27, 95% confidence interval 3.31, 8.42). Results did not change after sensitivity analysis (inpatient weighted mean complication rate: 9.62% vs outpatient weighted mean 5.02%, p value <.001). The overall level of evidence of included studies was level III, with a moderate to high risk of bias. Outpatient TAAs do not appear to pose excess complication risks compared to inpatient procedures, and may therefore be a reasonable addition to experienced centers that have established a fast-track outpatient total joint protocol.