[Exploring nurse, usage effectiveness of mobile nursing station]

BACKGROUND

A mobile nursing station is an innovative cart that integrates a wireless network, information technology devices, and online charts. In addition to improving clinical work and workflow efficiencies, data is integrated among different information systems and hardware devices to promote patient safety.

PURPOSE

This study investigated the effectiveness of mobile nursing cart use. We compared different distributions of nursing activity working samples to evaluate the nursing information systems in terms of interface usability and usage outcomes.

METHODS

There were two parts of this study. Part one used work sampling to collect nursing activity data necessary to compare a unit that used a mobile nursing cart (mobile group, n = 18) with another that did not (traditional group, n = 14). Part two applied a nursing information system interface usability questionnaire to survey the mobile unit with nurses who had used a mobile nursing station (including those who had worked in this unit as floating nurses) (n = 30) in order to explore interface usability and effectiveness.

RESULTS

We found that using the mobile nursing station information system increased time spent on direct patient care and decreased time spent on indirect patient care and documentation. Results further indicated that participants rated interface usability as high and evaluated usage effectiveness positively. Comments made in the open-ended question section raised several points of concern, including problems / inadequacies related to hardware devices, Internet speed, and printing.

CONCLUSION

This study indicates that using mobile nursing station can improve nursing activity distributions and that nurses hold generally positive attitudes toward mobile nursing station interface usability and usage effectiveness. The authors thus encourage the continued implementation of mobile nursing stations and related studies to further enhance clinical nursing care.

Long-term regional control in the observed neck following definitive chemoradiation for node-positive oropharyngeal squamous cell cancer

Traditionally, patients treated with chemoradiotherapy for node-positive oropharyngeal squamous cell carcinoma (N+ OPSCC) have undergone a planned neck dissection (ND) after treatment. Recently, negative post-treatment positron-emission tomography (PET)/computed tomography (CT) imaging has been found to have a high negative predictive value for the presence of residual disease in the neck. Here, we present the first comprehensive analysis of a large, uniform cohort of N+ OPSCC patients achieving a PET/CT-based complete response (CR) after chemoradiotherapy, and undergoing observation, rather than ND. From 2002 to 2009, 302 patients with N+ OPSCC treated with 70 Gy intensity-modulated radiation therapy and concurrent chemotherapy underwent post-treatment clinical assessment including PET/CT. CR was defined as no evidence of disease on clinical examination and post-treatment PET/CT. ND was reserved for patients with <CR on either PET/CT, clinical examination, or other imaging. 260 patients (86.1%) had clinical and radiographic CRs, and underwent neck observation (rate of regional control, 97.7%; 5-year overall survival, 79.8%). The four observed patients experiencing neck recurrence had initial staging of N1 (n = 2), N2b (n = 1), and N2c (n = 1). Three of four were successfully surgically salvaged. There was no association between N stage and rate of neck recurrence (p = 0.74). 52 and 25% of patients undergoing ND had viable tumor in the neck after positive and negative PET/CT, respectively. We conclude that patients achieving CRs after chemoradiation, based on clinical and PET/CT assessment, have a high probability of regional control, with a 2.3% regional failure rate, and may be safely observed without planned ND.

Strategic collaboration councils in the mental health services: what are they working with?

INTRODUCTION

In recent years collaboration has become an important part of the delivery of welfare services. One response to these collaborative efforts has been the introduction of strategic collaboration between different welfare agencies. Strategic collaboration is arguably the most open-ended form of service integration, as both purpose and membership are open to negotiation. This article will examine the work in strategic collaboration councils in the mental health services.

METHOD

The study is based on observations in eight strategic collaboration councils in Sweden. The councils were observed over 12 months, and every meeting that was held during that time was observed and tape-recorded.

RESULTS

FOUR BASIC ACTIVITIES WERE IDENTIFIED: the exchange of information, the identification of problems, organizing events and activities, and organizing the councils. Even though these activities were identified, the main focus was to exchange information. The councils' work also varied in terms of how they make decisions and agreements, and whether their focus is more on internal or external issues.

CONCLUSION

FROM THE IDENTIFIED ACTIVITIES, THE COUNCILS CAN BE CLASSIFIED INTO FOUR IDEAL TYPES: the information council, the problem-identification council, the decision-making council, and the self-organizing council.

Lipid management in 13,000 high risk cardiovascular patients treated under daily practice conditions: LIMA Registry

AIMS

We aimed to document the drug management of patients at high cardiovascular risk in daily practice, with the special focus on lipid-lowering treatment.

METHODS AND RESULTS

In this prospective noninterventional study in 2387 outpatient centers throughout Germany, a total of 13,942 high-risk patients (mean age 65.7 years, 61.6% males) were treated with simvastatin 40 mg/day at entry as monotherapy. All patients were followed up for 12 months in terms of drug utilization, laboratory values, target attainment, and clinical events (including death, hospitalization, vascular events, and dialysis). Patients had coronary heart disease in 35.0%, diabetes mellitus in 24.4%, and the combination of coronary heart disease plus diabetes mellitus in 25.7%. In 21% of patients, a cholesterol absorption inhibitor was added to statin therapy at the entry visit, and in 23%, this was added at the follow up visit 6 months later. The target values for low-density lipoprotein-cholesterol (<2.6 mmol/L) were reached by 31.8% of patients at entry and by 50.0% at the end of this registry after 12 months. Mean blood pressure decreased (from 135.9/80.5 mmHg at baseline) by 3.1/1.9 mmHg after 12 months. In patients with documented diabetes, the targeted glycated hemoglobin (HbA1c <6.5%) was reached by 33.5% at baseline and by 40.0% after 12 months. Clinical events occurred in 11.7% of patients between baseline and month 6, and in 12.0% between months 6 and 12.

CONCLUSION

In patients at high risk for cardiovascular events, comprehensive management under daily practice conditions leads to improvement of lipid, glucose, and blood pressure parameters. There is a need to improve secondary prevention among high-risk patients.

Emergency department observation units and the older patient

An increasing number of emergency departments (EDs) are providing extended care and monitoring of patients in ED observation units (EDOUs). EDOUs can be useful for older adults as an alternative to hospitalization and as a means of risk stratification for older adults with unclear presentations. They can also provide a period of therapeutic intervention and reassessment for older patients in whom the appropriateness and safety of immediate outpatient care are unclear. This article discusses the general characteristics of EDOUs, reviews appropriate entry and exclusion criteria for older adults in EDOUs, and discusses regulatory implications of observation status for patients with Medicare.

Observed Personality in Childhood: Psychometric and Behavioral Genetic Evidence of Two Broad Personality Factors

We examined broad dimensions of children's personalities (total n = 1056; age = 3.5 to 12 years) based on observers' perceptions following a few hours of structured interaction. Siblings' behaviors during a two-hour cognitive assessment in the home were rated separately by two different observers. Exploratory and confirmatory factor analyses clearly revealed a two-factor solution in three different samples. There was correspondence between parent-rated temperament and the observer-rated factors. Cross-sectional analyses indicated lower Plasticity among older children and higher Stability among older children. Sex differences were negligible. Plasticity and Stability were correlated in the .2 to .3 range. Most of the sibling similarity in the Plasticity was due to additive genetic influences, whereas most sibling similarity in Stability was attributable to shared environmental influences. The findings implicate a biometric factor structure to childhood personality that fits well with emerging bio-social theories of personality development.

Attending to insects: Francis Willughby and John Ray

Francis Willughby and John Ray were at the forefront of the natural history of insects in the second half of the seventeenth century. Willughby in particular had a deep interest in insects' metamorphosis, behaviour and diversity, an interest that he passed on to his friend and mentor Ray. By examining Willughby's contributions to John Wilkins's Essay towards a Real Character (1668) and Ray's Methodus insectorum (1705) and Historia insectorum (1710), which contained substantial material from Willughby's manuscript history of insects, one may reconstruct how the two naturalists studied insects, their innovative use of metamorphosis in insect classification, and the sheer diversity of insect forms that they described on the basis of their own collections and those of London and Oxford virtuosi. Imperfect as it was, Historia insectorum was recognized by contemporaries as a significant contribution to the emerging field of entomology.

Therapy of newly diagnosed follicular lymphoma

Newly diagnosed follicular lymphoma is relatively common and can be effectively treated with several differing approaches. Although the disease is often considered incurable, it is highly responsive to therapy when indicated. This review discusses the indications for treatment, risk stratification systems, treatment options with supporting clinical trial data, and expected therapeutic outcomes in newly diagnosed follicular lymphoma.

Reliability of observers' subjective impressions of families: a generalizability theory approach

Parenting was observed in videotaped interactions in 30 families referred for child conduct problems. Generalizability coefficients and the impact of varying numbers of raters were estimated. Two measurement designs were compared: All raters observed all families ("crossed" design) and a different rater observed each family ("nested" design). The crossed design provided higher generalizability coefficients than a nested design, implying inflated generalizability estimates if a crossed estimation model is used for a nested data collection. Three and four raters were needed to obtain generalizability coefficients in the .70-.80 range for monitoring and discipline, respectively. One rater was sufficient for a corresponding estimate for positive involvement and for an estimate in .80-.90 range for problem-solving. Estimates for skill encouragement were non-acceptable.

Intercultural caring from the perspectives of immigrant new mothers

OBJECTIVE

To describe and interpret the perceptions and experiences of caring of immigrant new mothers from an intercultural perspective in maternity care in Finland.

DESIGN

Descriptive interpretive ethnography using Eriksson's theory of caritative caring.

SETTING

A maternity ward in a medium-sized hospital in western Finland.

PARTICIPANTS

Seventeen mothers from 12 countries took part in the study.

METHODS

Interviews, observations, and field notes were analyzed and interpreted.

RESULTS

Most mothers were satisfied with the equal access to high-quality maternity care in Finland, although the stereotypes and the ethnocentric views of some nurses negatively influenced the experiences of maternity care for some mothers. The cultural background of the mother, as well as the Finnish maternity care culture, influenced the caring. Four patterns were found. There were differences between the expectations of the mothers and their Finnish maternity care experience of caring. Caring was related to the changing culture. Finnish maternity care traditions were sometimes imposed on the immigrant new mothers, which likewise influenced caring. However, the female nurse was seen as a professional friend, and the conflicts encountered were resolved, which in turn promoted caring.

CONCLUSION

The influence of Finnish maternity care culture on caring is highlighted from the perspective of the mothers. Intercultural caring was described as universal, cultural, contextual, and unique. Women were not familiar with the Finnish health care system, and many immigrant mothers lacked support networks. The nurse/patient relationship could partly replace their support if the relationship was perceived as caring. The women had multiple vulnerabilities and were prone to isolation and discrimination if they experienced communication problems.

A confidant support and problem solving model of divorced fathers' parenting

This study tested a hypothesized social interaction learning (SIL) model of confidant support and paternal parenting. The latent growth curve analysis employed 230 recently divorced fathers, of which 177 enrolled support confidants, to test confidant support as a predictor of problem solving outcomes and problem solving outcomes as predictors of change in fathers' parenting. Fathers' parenting was hypothesized to predict growth in child behavior. Observational measures of support behaviors and problem solving outcomes were obtained from structured discussions of personal and parenting issues faced by the fathers. Findings replicated and extended prior cross-sectional studies with divorced mothers and their confidants. Confidant support predicted better problem solving outcomes, problem solving predicted more effective parenting, and parenting in turn predicted growth in children's reduced total problem behavior T scores over 18 months. Supporting a homophily perspective, fathers' antisociality was associated with confidant antisociality but only fathers' antisociality influenced the support process model. Intervention implications are discussed regarding SIL parent training and social support.

Variations in Observed Park Physical Activity Intensity Level by Gender, Race, and Age: Individual and Joint Effects

BACKGROUND

Parks are important settings for physical activity (PA), but few studies have documented the actual behaviors of park users. The purpose of this study was to examine the individual and joint effects of various park user demographic characteristics on observed PA intensity levels.

METHODS

Four parks were observed using the System for Observing Play and Recreation in Communities. Observers recorded the age group, gender, race, and intensity level of all park users in 83 activity areas over two weekends at each park. Logistic regression examined whether male/White, female/White, and male/non-White users were more likely than female/non-White users to be observed engaging in moderate-to-vigorous PA (MVPA) rather than sedentary activity across 4 age groups.

RESULTS

In total, 8612 users were observed during the study. In the child age group, male/White users were significantly more likely to be observed in MVPA than female/non-White users. For teens, female/White and male/White users were less likely to engage in MVPA. For both adults and seniors, female/White and male/White users were more likely to be observed in MVPA.

CONCLUSION

Observations revealed significant differences in intensity levels across gender, age, and race groups. Future interventions should emphasize park design that promotes increased MVPA among diverse groups.

Minor ailments in out-of-hours primary care: an observational study

BACKGROUND

Many consultations are partly or totally spent on minor ailments. A minor ailment is defined as a health complaint which, by simple actions, patients could handle themselves.

OBJECTIVE

To investigate the prevalence, type of conditions, and time spent on minor ailments in consultations in out-of-hours care in Norway.

DESIGN AND SETTING

An observational study of consultations at six out-of-hours primary care centres was carried out during evenings and weekends in November and December 2008. Main outcome measures were number and type of minor ailments, as well as consultation time. The minor ailments were predefined by a list of conditions. Conditions which, by certain pre-set criteria, still needed a doctor's professional advice were reclassified as "no minor ailment".

RESULTS

A total of 210 consultations were observed. The patients' mean age was 28 years (range 0-94). Cough, fever, sore throat, upper respiratory tract infection, and earache contributed 76% of the 211 minor ailments registered. After reclassification, 58 (28%) of the 210 consultations registered were classified as partly or totally a minor ailment. These minor ailments represented 18% of the doctors' total consultation time in the 210 observed consultations.

CONCLUSION

More than a quarter of the observed consultations were partly or totally spent on addressing minor ailments. This shows a potential for empowering patients to rely on self-care also for minor ailments in out-of-hours primary care.

Nonexpert ratings of family and parent-child interaction

Observational methods benefit the study of family process, but many expert rating systems are costly and time-consuming. This study examined the utility of using small groups of eight to ten nonexperts to rate family conflict and maternal sensitivity. Videotaped triadic interactions of 39 families were drawn from Lindahl (1998), and 22 mother-toddler free-play interactions were drawn from Baker, Messinger, Lyons, and Grantz (2010). Sixty undergraduates rated interactions from these samples in real time using computer-assisted technology. Nonexpert ratings of family conflict were reliable, demonstrated high concordance with expert ratings, and replicated a key finding from Lindahl (1998). Nonexpert ratings of maternal sensitivity replicated a relevant finding from Baker, Messinger et al. (2010). Concordance was lower for maternal sensitivity, however, because of the tendency of nonexperts to overattend to sensitive structuring compared with emotional supportiveness. A second study indicated that as few as six nonexperts could effectively rate maternal sensitive structuring, but that nonexperts were unable to accurately rate emotional supportiveness. Implications for research methods and for our understanding of these important family constructs are discussed.

Rhesus monkeys (Macaca mulatta) rapidly learn to select dominant individuals in videos of artificial social interactions between unfamiliar conspecifics

Social animals, such as primates, must behave appropriately in complex social situations such as dominance interactions. Learning dominance information through trial and error would be dangerous; therefore, cognitive mechanisms for rapid learning of dominance information by observation would be adaptive. We used a set of digitally edited artificial social interactions to examine whether rhesus monkeys (Macaca mulatta) can learn dominance relationships between unfamiliar conspecifics through observation. Our method allowed random assignment of stimulus monkeys to ranks in an artificial hierarchy, controlling for nonbehavioral cues that could indicate dominance. Subject monkeys watched videos depicting 1 stimulus monkey behaving dominantly toward another and were rewarded for selecting the dominant individual. Monkeys rapidly learned this discrimination across 5 behavior types in Experiment 1 and transferred performance to novel videos of new individuals in Experiment 2. In addition, subjects selected the dominant individual more often than expected by chance in probe videos containing no behavioral dominance information, indicating some retention of the relative dominance status of stimulus monkeys from training. Together, our results suggest that monkeys can learn dominance hierarchies through observation of third-party social interactions.

Amounts served and consumed of school lunch differed by gender in Japanese elementary schools

School lunches serve to improve nutritional status and to promote the health of children. The purpose of this study was to investigate the portion sizes of school lunches served and consumed in Japanese elementary schools. In addition, gender difference in servings and consumption were also studied. A cross-sectional study was undertaken between October 2007 and February 2008 in schools located in Tokyo and Okayama, Japan. A total of 192 fifth-grade children attending four elementary schools participated in this study. Weighed plate waste methods and observation were used to collect dietary data for two non-consecutive days. The proportion of children who chose staple foods along with main dishes and/or side dishes for at least one day was higher in boys than in girls (respectively, for staple food: 42.1% vs. 9.3%, for main dish and/or side dish: 68.4% vs. 44.3%, P < 0.001). The ratio of initial amount served to amount offered was 0.88 ± 0.11 for boys and 0.84 ± 0.10 for girls (P < 0.05). The ratio of amount consumed to amount offered was 1.04 ± 0.19 for boys and 0.88 ± 0.12 for girls (P < 0.001). Weight was related to amount consumed both in boys (r = 0.222, P < 0.05) and in girls (r = 0.201, P < 0.05). These findings suggest that the nutritional standards of school lunch programs should take into account gender differences. Clearly, boys were more likely to consume more than the initial amounts served due to their higher propensity to take second helpings. Boys feel few reservations about taking second helpings to adjust their total intake. However, school lunch plans should take into consideration girls' reluctance to do so, by serving appropriate initial portion sizes.

Effectiveness and tolerability of a fixed-dose combination of olmesartan and amlodipine in clinical practice

Objectives:

To assess the efficacy and tolerability of a fixed-dose combination of olmesartan and amlodipine in an unselected population of patients in primary care and to compare the results with recent randomized controlled trial evidence.

Methods:

A multicenter, noninterventional, noncontrolled observational study with 8241 hypertensive patients seen by 2187 physicians in daily practice. Blood pressure (BP) reduction, comorbid disease, pharmacotherapy, and tolerability were documented over a 12–18-week observational period.

Results:

Patients had a mean age of 62.8 ± 11.8 years (48.1% female), and 74.8% had at least one comorbid risk factor or condition. In total, 51.3% received olmesartan-amlodipine 20/5 mg, 30.6% received 40/5 mg, and 17.9% received 40/10 mg at baseline, mostly because of lack of efficacy on prior antihypertensive therapy (73.8%). BP at baseline was 161.8 ± 16.6/93.6 ± 10.2 mmHg (39.8% had Grade 2 hypertension), and the observed BP reduction was −29.0 ± 17.1/−13.5 ± 10.9 mmHg (P < 0.0001), with a significant correlation between BP at baseline and BP reduction (Spearman’s Rho −0.811 for systolic BP and −0.759 for diastolic BP). BP reduction appeared to be dependent on dose and prior antihypertensive therapy, but not on age, gender, body mass index, duration of hypertension, or the presence of diabetes. At the final visit, 69.4% (4.3% at baseline) were controlled (<140/90 mmHg). Adverse drug reactions were observed in 2.76% of the study population; 94.25% of these adverse drug reactions were judged as nonserious events, and 31.5% of all adverse drug reactions reported were peripheral edema.

Conclusion:

The fixed-dose olmesartan-amlodipine combination was effective and well tolerated in an unselected population of patients in primary care practice. These results confirm prior randomized controlled trial evidence.

Development of a Brief Waiting Room Observation for Behaviours Typical of Reactive Attachment Disorder

OBJECTIVE

  To develop a brief standardised observational schedule for Reactive Attachment Disorder (RAD) in school-age children to aid clinician recognition of these behaviours.

DESIGN

  A new structured observational schedule for symptoms of RAD was developed using unstructured observation of children in a clinic waiting room setting. The measure's ability to discriminate between a sample of children with RAD and a normative sample was established by comparing scores in these two groups.

METHOD

  Children aged 5-8 years (n = 77 [38 RAD cases and 39 controls]) were observed with their primary caregiver in a standardised waiting room setting. A structured observational tool was developed that tested the reliability, sensitivity and specificity of each item.

RESULTS

  The schedule has good internal consistency (0.75). The individual items on the observational schedule were predominantly highly discriminatory between cases and comparisons, showing both reasonable sensitivity and excellent specificity. Certain questions were dropped due to poor discrimination and/or poor inter-rater reliability.

CONCLUSION

  The 10-item observational schedule for RAD in school-age children provides a promising tool for assessment, although further research will be required to evaluate its ability to discriminate between RAD and other disorders.

[Expanded scalp flap in cicatricial areas affected by burns sequelae - an observation]

Les séquelles esthétiques des alopécies cicatricielles sur séquelles de brûlures sont responsables de préjudices empêchant parfois la réinsertion sociale du patient, surtout chez les sujets de sexe féminin. Le cuir chevelu permet la réalisation de lambeaux permettant de couvrir ces alopécies. Les Auteurs décrivent le cas d'une jeune patiente victime d'une alopécie cicatricielle sur séquelles de brûlures chez qui ils ont réalisé un lambeau expansé du cuir chevelu et mettent le point sur la prise en charge de ces lésions à travers ce cas clinique et une revue de littérature.

Family Mealtime Q-Sort: A measure of mealtime practices

Studies outlining the protective functions of shared family meals suggest that helping families experience successful meals is an important goal. Measuring the effectiveness of family mealtime interventions necessitates the ability to quantify both the frequency and context of shared mealtimes. This article introduces a new instrument, the Family Mealtime Q-Sort, describes its development, and presents preliminary data about its psychometric properties. Data from initial evaluation of the Family Mealtime Q-Sort using family mealtime videos (N = 51) demonstrate acceptable interrater reliability, promising validity, and the ability to compare family mealtimes to an independently derived, culturally appropriate standard. The results suggest that the Q-sort adequately measures important dimensions of a successful mealtime including a positive atmosphere, making use of the shared time to engage in meaningful conversation, and proceeding with a clear plan and minimal distractions. Further research on the tool is warranted.

The implementation of a mobile problem-specific electronic CEX for assessing directly observed student-patient encounters

BACKGROUND

Facilitating direct observation of medical students' clinical competencies is a pressing need.

METHODS

We developed an electronic problem-specific Clinical Evaluation Exercise (eCEX) based on a national curriculum. We assessed its feasibility in monitoring and recording students' competencies and the impact of a grading incentive on the frequency of direct observations in an internal medicine clerkship. Students (n = 56) at three clinical sites used the eCEX and comparison students (n = 56) at three other clinical sites did not. Students in the eCEX group were required to arrange 10 evaluations with faculty preceptors. Students in the second group were required to document a single, faculty observed 'Full History and Physical' encounter with a patient. Students and preceptors were surveyed at the end of each rotation.

RESULTS

eCEX increased students' and evaluators' understanding of direct-observation objectives and had a positive impact on the evaluators' ability to provide feedback and assessments. The grading incentive increased the number of times a student reported direct observation by a resident preceptor.

CONCLUSIONS

eCEX appears to be an effective means of enhancing student evaluation.

Clinical assessment of scapular positioning in musicians: an intertester reliability study

CONTEXT

The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians.

OBJECTIVE

To examine the intertester reliability of scapular observation and 2 clinical tests for the assessment of scapular positioning in musicians.

DESIGN

Intertester reliability study.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty healthy student musicians at a single university.

MAIN OUTCOME MEASURE(S)

Two assessors performed a standardized observation protocol, the measurement of the distance between the posterior border of the acromion and the wall, and the modified lateral scapular slide test. Each assessor was blinded to the other's findings.

RESULTS

The intertester reliability coefficients (kappa) for the observation in relaxed position, during unloaded movement, and during loaded movement were 0.41, 0.63, and 0.36, respectively. The kappa values for the observation of tilting and winging at rest were 0.48 and 0.42, respectively; during unloaded movement, the kappa values were 0.52 and 0.78, respectively; and with a 1-kg load, the kappa values were 0.24 and 0.50, respectively. The intraclass correlation coefficient (ICC) of the measurement of the acromial distance was 0.72 in relaxed position and 0.75 with the participant actively retracting both shoulders. The ICCs for the modified lateral scapular slide test varied between 0.63 and 0.58.

CONCLUSIONS

Our results demonstrated that the modified lateral scapular slide test was not a reliable tool to assess scapular positioning in these participants. Our data indicated that scapular observation in the relaxed position and during unloaded abduction in the frontal plane was a reliable assessment tool. The reliability of the measurement of the distance between the posterior border of the acromion and the wall in healthy musicians was moderate.

Observation, assisting, apprenticeship: cycles of visual and kinesthetic learning in dental education

Dentists are self-selected for visual and kinesthetic learning preferences. Watching another practitioner perform treatment can be incredibly didactic, both before and after learning the procedure. This missing part of dental education has the capacity to play a tremendous role in dental education for all levels of practitioner. Dental students in their clinical years begin to realize the meaning of dentistry as a practice, a set of skills that are never perfected. Abundant evidence demonstrates that cycling between observation and practice enhances procedural learning and retention, yet this mechanism is vastly underused in dental education. Collaborative treatment paradigms, wherein the able student assists a more experienced practitioner, can create mentorship. Learning potentially esoteric information or subtle nuances of clinical acumen is facilitated by the contextual framework of the clinical environment and is strengthened by emotional attachments through interpersonal interactions. In this article, we explore the evidence surrounding mentorship and clinical observation both before and after students are given the responsibilities of patient care, which together recapitulate clinical apprenticeship. Finally, we present examples of how apprenticeship can be brought back to dental education, including evaluation of a clinical assisting program that we implemented and explanation of a hypothetical faculty-student practice partnership model.

Environmental health research and the observer's dilemma

BACKGROUND

Environmental health researchers frequently study people in occupational, educational, recreational, or domestic settings who are exposed to hazardous agents.

OBJECTIVE/DISCUSSION

Deciding whether-and how-to inform research subjects about risks they face in their environment can be a challenging task for investigators. Because legal rules and professional guidelines do not cover this topic, investigators must carefully consider their ethical obligations in light of the facts and circumstances.

CONCLUSION

To navigate through this dilemma, investigators should consider the evidence for the risks, the nature of the risks, the usefulness of risk information to the subjects, and the effects on the study and community of informing subjects about risks.

Confidentiality in the waiting room: an observational study in general practice

An ethnographic study using overt non-participatory observation was used to investigate confidentiality breaches in 13 GP practice reception and/or waiting areas in Lincolnshire. Staff and patient behaviours were observed for 2 hours. Aspects of management systems and physical environment were also thematically analysed. Forty-four instances occurred where patient-identifiable information was overheard. Of these instances, 22 were initiated by staff, 22 by patients, 33 face-to-face, and 10 from telephone conversations. Breaches included name and address, symptoms, conditions, or test results. Interaction between systems and physical environment in relation to 'attention focus', 'sound' and 'layout', increased the likelihood of breach of confidentiality. Further research on the patient perspective is recommended.

Fourth-grade children are less accurate in reporting school breakfast than school lunch during 24-hour dietary recalls

OBJECTIVE

To compare reporting accuracy for breakfast and lunch in 2 studies.

DESIGN

Children were observed eating school meals and interviewed the following morning about the previous day. In Study 1, 104 children were each interviewed 1 to 3 times with >or=25 days separating any 2 interviews. In Study 2, 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, with these interviews separated by >or=29 days.

SETTING

12 schools.

PARTICIPANTS

Fourth-grade children.

MAIN OUTCOME MEASURES

For each meal, food-item variables (observed number, reported number, omission rate, intrusion rate, total inaccuracy) and kcal variables (observed, reported, correspondence rate, inflation ratio).

ANALYSIS

General linear mixed models.

RESULTS

For each study, observed and reported numbers of items and kcal, and correspondence rate (reporting accuracy), were greater for lunch than for breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than for lunch. In Study 1, for each meal over interviews, total inaccuracy decreased and correspondence rate increased. In Study 2, for each meal for boys for reverse and for girls for forward order, omission rate was lower and correspondence rate was higher.

CONCLUSIONS AND IMPLICATIONS

Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order x sex (Study 2), reporting accuracy was low for breakfast and lunch.

Conventional energy and macronutrient variables distort the accuracy of children's dietary reports: illustrative data from a validation study of effect of order prompts

OBJECTIVE

Validation-study data are used to illustrate that conventional energy and macronutrient (protein, carbohydrate, fat) variables, which disregard accuracy of reported items and amounts, misrepresent reporting accuracy. Reporting-error-sensitive variables are proposed which classify reported items as matches or intrusions, and reported amounts as corresponding or overreported.

METHODS

58 girls and 63 boys were each observed eating school meals on 2 days separated by > or =4 weeks, and interviewed the morning after each observation day. One interview per child had forward-order (morning-to-evening) prompts; one had reverse-order prompts. Original food-item-level analyses found a sex-x-order prompt interaction for omission rates. Current analyses compared reference (observed) and reported information transformed to energy and macronutrients.

RESULTS

Using conventional variables, reported amounts were less than reference amounts (ps<0.001; paired t-tests); report rates were higher for the first than second interview for energy, protein, and carbohydrate (ps< or =0.049; mixed models). Using reporting-error-sensitive variables, correspondence rates were higher for girls with forward- but boys with reverse-order prompts (ps< or =0.041; mixed models); inflation ratios were lower with reverse- than forward-order prompts for energy, carbohydrate, and fat (ps< or =0.045; mixed models).

CONCLUSIONS

Conventional variables overestimated reporting accuracy and masked order prompt and sex effects. Reporting-error-sensitive variables are recommended when assessing accuracy for energy and macronutrients in validation studies.

[Not Available]

Les sinusites nosocomiales ne sont pas rares en réanimation. Elles surviennent en général dans les suites d'une intubation nasotrachéale voire même orotrachéale. Le tubage gastrique peut être à lui seul à l'origine d'une sinusite nosocomiale. Nous rapportons le cas d'une patiente hospitalisée qui a été victime de brûlures étendues chez qui la sonde nasogastrique a été à l'origine d'une pansinusite dont l'issue a été fatale.

[Not Available]

Aussi loin que l'on remonte dans la littérature, on retrouve des récits relatant des accidents consécutifs à la fulguration chez l'homme. La foudre était alors associée à la colère des dieux ou à la notion de châtiment. La fulguration correspond à un transfert d'énergie entre un cumulonimbus de charge négative et un objet de charge positive se trouvant au niveau du sol. Les lésions déterminées sont à la fois thermiques et électrothermiques. Bien que l'arrêt cardiorespiratoire soit une cause bien documentée de décès, la plupart des cas rapportés dans la littérature décrivent un éventail très disparate des séquelles qui surviennent suite à cet accident. Les Auteurs rapportent le cas d'un patient atteint par la foudre en insistant particulièrement sur les complications neurologiques qui sont survenues en cours d'évolution. Se basant sur cette observation et sur une revue de la littérature, les Auteurs soulignent que le pronostic des patients atteints par la foudre est plus favorable que généralement rapporté.

The Home Observation for Measurement of the Environment Revisited

This review describes the Home Observation for Measurement of the Environment (HOME). After describing the structure of the instrument, it shows how it has been used successfully in studies on normally developing children and on samples drawn from high-risk populations. These are followed by studies showing how the HOME has been used to evaluate interventions. Although most interventions are not designed primarily on the basis of the HOME outcomes, the instrument has been used as a measure of the effectiveness of the intervention schedule. HOME has been used extensively in research to reveal relationships between several aspects of the home environment and children's developmental outcomes. The very good relationship between HOME scores and children's measures of developmental competence has also been found in non-normative populations and research has attempted to identify the specific aspects of the home environment, as indexed by the HOME subscales that reveal the strengths or the weaknesses of homes of at-risk populations.

Functional anatomy of execution, mental simulation, observation, and verb generation of actions: a meta-analysis

There is a large body of psychological and neuroimaging experiments that have interpreted their findings in favor of a functional equivalence between action generation, action simulation, action verbalization, and perception of action. On the basis of these data, the concept of shared motor representations has been proposed. Indeed several authors have argued that our capacity to understand other people's behavior and to attribute intention or beliefs to others is rooted in a neural, most likely distributed, execution/observation mechanism. Recent neuroimaging studies have explored the neural network engaged during motor execution, simulation, verbalization, and observation. The focus of this metaanalysis is to evaluate in specific detail to what extent the activated foci elicited by these studies overlap.