Assessing culture: pediatric nurses' beliefs and self-reported practices

Assessment of culture is an essential step in providing effective nursing care to a culturally diverse patient population. The purpose of this study was to describe the beliefs and self-reported practices of pediatric nurses from four Children's Hospitals regarding the process of assessing culture. The 584 respondents indicated they worked with a culturally diverse patient population and frequently experienced cultural conflicts. Findings indicated cultural assessments were not routinely performed. The majority indicated that learning more about the child's culture would improve the effectiveness of their nursing care. Respondents were willing to conduct cultural assessments on selected patients if this task could be accomplished in less than 15 minutes. Recommendations include guidelines for developing and implementing an appropriate cultural assessment process within a hospital setting.

Differentiation of autoimmune thrombocytopenia from thrombocytopenia associated with immune complex disease: systemic lupus erythematosus, hepatitis-cirrhosis, and HIV-1 infection by platelet and serum immunological measurements

A method and approach are described to differentiate classic autoimmune thrombocytopenia (ATP) from immune complex-associated thrombocytopenia in systemic lupus (SLE), hepatitis/chronic liver disease (LIV-ITP) and HIV-1 related thrombocytopenia (HIV-1-ITP). The platelet immunologic profile of IgG, C3C4 and IgM was measured with a solid-phase ELISA, employing 125I-staphylococcal protein A to detect indicator antibody binding. Polyethylene glycol was employed to precipitate immune complexes (PEG-IC). Platelet-associated IgG (PAIgG) was 2.8-, 5.6- and 5.8-fold higher in SLE, LIV-ITP and HIV-1-ITP patients respectively compared to ATP patients: platelet C3C4 was 3.2-, 4.8- and 4.5-fold higher respectively; platelet IgM was 2.2-, 3.7- and 3.8-fold higher respectively; serum PEG-IC levels were 4.2-, 4.8- and 2.1-fold higher respectively. With all parameters measured, there was no overlap between the 75th percentile for ATP patients and the 25th percentile for all three cohorts. The likelihood of having a platelet C3C4 level higher than the highest ATP level was 69% for SLE, 90% for LIV-ITP and 94% for HIV-1-ITP respectively; with PEG-IC measurements the likelihood was 83%, 100% and 100% respectively. Serum IgG, C3, C4, IgM and PEG-IC were examined for a possible relationship with platelet measurements. Except for a positive correlation between serum and platelet IgM in ATP, r = 0.5, P < 0.04, there was no positive correlation with any of the parameters measured. An inverse correlation was noted between PEG-IC level and platelet C3C4 in SLE, r = 0.7, P < 0.04. Thus platelet immunologic profile and serum PEG-IC level measurements differentiated classic ATP from immune complex-associated thrombocytopenias (SLE, LIV-ITP, HIV-1-ITP). Except for IgM measurements in ATP, platelet measurements could not be attributed to their respective serum concentration.

Effects of immigration on the dynamics of simple population models

Many simple population models exhibit the period doubling route to chaos as a single parameter, commonly the growth rate, is increased. Here we examine the effect of an immigration process on such models and explain why in the case of one-dimensional ("single-humped") maps, immigration often tends to suppress chaos and stabilise equilibrium behaviour or cyclical oscillations of long period. The conditions for which an increase of immigration "simplifies" population dynamics are examined.

Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign

BACKGROUND

The Defeat Depression Campaign, which was run by the Royal College of Psychiatrists and the Royal College of General Practitioners (RCGP) from 1992 to 1996, aimed to educate general practitioners (GPs) to recognize and manage depression.

AIM

To measure the educational impact on GPs of the Defeat Depression Campaign.

METHOD

A postal survey using a structured questionnaire was distributed to 2046 GPs obtained by systematically sampling 1 in 14 GPs from alphabetical lists from family health services authorities (FHSAs) in England and Wales. The questionnaire covered awareness of the campaign, awareness and use of campaign materials, and ratings of the usefulness of the campaign in relation to other educational activities.

RESULTS

Two-thirds of GPs were aware of the campaign and 40% had definitely or possibly made changes in practice as a result of it. Impact of materials was highest for a consensus statement on the recognition and management of depression in general practice and for guidelines derived from it, each of which had been read in detail by about one quarter of responders and was known of by an additional one third. Impact was low for the other materials. The campaign had the highest impact among younger GPs, members of the RCGP, and (less strongly) among those who had undertaken a six-month post in psychiatry, those who were working in larger practices and fundholding practices, and women; 56% of GPs had attended a teaching session on depression in the past three years.

CONCLUSION

A national campaign of this kind can have a useful impact, but it needs to be supplemented by local and practice-based teaching activities.

Diagnostic medical exposures in the U.K

Surveys in the U.K. have identified the patterns of patient exposure from diagnostic medical radiological procedures and have led to the development of structured advice to promote optimisation of patient protection, including diagnostic reference levels for some common conventional X-ray examinations. Trends for reductions in individual patient and collective doses from these particular procedures have been offset by increasing application of computed tomography. Practice in diagnostic nuclear medicine is conducted by authorized physicians on the basis of recommended maximum usual activities of radiopharmaceutical for specific procedures.

Crystal structure of an RNA octamer duplex r(CCCIUGGG)2 incorporating tandem I.U wobbles

The crystal structure of the RNA octamer duplex r(CCCIUGGG)2has been elucidated at 2.5 A resolution. The crystals belong to the space group P21and have unit cell constants a = 33.44 A, b = 43.41 A, c = 49.39 A and beta = 104.7 degrees with three independent duplexes (duplexes 1-3) in the asymmetric unit. The structure was solved by the molecular replacement method and refined to an Rwork/Rfree of 0.185/0.243 using 3765 reflections between 8.0 and 2.5 A. This is the first report of an RNA crystal structure incorporating I.U wobbles and three molecules in the asymmetric unit. Duplex 1 displays a kink of 24 degrees between the mismatch sites, while duplexes 2 and 3 have two kinks each of 19 degrees and 27 degrees, and 24 degrees and 29 degrees, respectively, on either side of the tandem mismatches. At the I.U/U.I mismatch steps, duplex 1 has a twist angle of 33.9 degrees, close to the average for all base pair steps, but duplexes 2 and 3 are underwound, with twist angles of 24.4 degrees and 26.5 degrees, respectively. The tandem I.U wobbles show intrastrand purine-pyrimidine stacking but exhibit interstrand purine-purine stacking with the flanking C.G pairs. The three independent duplexes are stacked non-coaxially in a head-to-tail fashion to form infinite pseudo-continuous helical columns which form intercolumn hydrogen bonding interactions through the 2'-hydroxyl groups where the minor grooves come together.

Changes in public attitudes to depression during the Defeat Depression Campaign

BACKGROUND

Aims of the Defeat Depression Campaign between 1991 and 1996 included the reduction of stigma associated with depression, education of the public about the disorder and its treatment and encouragement of earlier treatment-seeking. Newspaper and magazine articles, radio and television programmes and other media activities were employed.

METHOD

Surveys of public attitudes were conducted by MORI in late 1991, early 1995 and mid-1997. Each covered approximately 2000 subjects, sampled to be representative of the population of Great Britain. Structured interviews covered views on depression, treatment and general practitioners (GPs).

RESULTS

There were significant positive changes regarding attitudes to depression, reported experience of it, attitudes to antidepressants, and less consistently, to treatment from GPs. Changes were of the order of 5-10%. Throughout, attitudes to depression and to treatment by counselling were very favourable, whereas antidepressants were regarded as addictive and less effective.

CONCLUSIONS

Positive attitude change was achieved during the Campaign, although there is still room for improvement in some aspects.

Social identity and individual productivity within groups

The purpose of the present research was to show how social identity theory can be applied to enhance individual productivity within groups. Three experiments manipulated in-group identifiability and importance of the group for one's social identity, and compared individual's productivity when working alone to when working in a group setting. The group setting in the first study involved either a collective of unrelated individuals, a group of participants expecting future interaction, or a group working for a group reward. The second study compared productivity in groups with four differing interdependent reward structures. The final study examine the impact of group members wearing a common uniform (vs. no uniform) and the presence (or absence) of an out-group. Results supported the general prediction that group productivity would be enhanced by factors that increase group categorization and the importance of the group to members' social identities (future interaction, interdependent reward structure and uniform/outgroup present). However, productivity in groups was not influenced by perceptions of the task or identifiability of performance. These findings extent social identity theory by suggesting that group members will increase their in-group position through individual work efforts.

The growth law of primary breast cancer as inferred from mammography screening trials data

Despite considerable progress in understanding tumour development, the law of growth for human tumours is still a matter of some dispute. In this study, we used large-scale mammography screening trial data to deduce the growth law of primary breast cancer. We compared the empirical tumour population size distributions of primary breast cancer inferred from these data to the distributions that correspond to various possible theoretical growth functions. From this, we showed that the data are inconsistent with the exponential, logistic and Gompertz laws, but support power law growth (exponent approximately 0.5). This law indicates unbounded growth but with slowing mass-specific growth rate and doubling time. In the clinical size ranges, it implies a greater decline in the mass-specific growth rate than would be predicted by the Gompertz law using the accepted parameters. This suggests that large tumours would be less sensitive to cycle-specific therapies, and be better treated first by non-cell cycle-specific agents. We discussed the use of our study to estimate the sensitivity of mammography for the detection of small tumours. For example, we estimated that mammography is about 30% less sensitive in the detection of tumours in the 1 to 1.5-cm range than it is in detecting larger tumours.

Childhood personality influences on social-cognitive development: a longitudinal study

The relation of childhood personality to the development of friendship understanding and moral judgment in adolescence was considered in a longitudinal study. Personality at age 7, assessed with the California Child Q-Set, was characterized in terms of ego-resiliency and ego-control. IQ and social class were also measured. Friendship understanding was assessed when the participants were ages 7, 9, 12, 15, and 19, and moral judgment was elicited when the participants were 12, 15, and 19. Ego-resiliency was found to predict social-cognitive development in adolescence, even after the effects of IQ and childhood measures of social-cognitive development were controlled for. Analyses indicate that the effects of ego-resiliency on social-cognitive development are largely unmediated by the ability to focus attention or by social participation.

Phenotypic characterisation of the dendritic cell infiltrate in prostate cancer

PURPOSE

To investigate whether dendritic cells (DC), which as professional antigen presenting cells have the capacity to stimulate immune responses against tumour associated antigens, are recruited into and activated within prostate cancer.

MATERIALS AND METHODS

Immunoenzyme and immunofluorescence labelling was used to identify leucocyte and DC subsets within 15 cases of prostate cancer. Cell numbers were compared with numbers in adjacent normal prostatic tissue. Total DC numbers were identified as CD45+ leucocytes not coexpressing any lineage specific markers. The Langerhans cell (LC) subset was detected using anti CD1a staining and activated DC were identified by their expression of either CD83, CD86 or CMRF44.

RESULTS

DC were found to represent a small subset of leucocytes present in both benign and malignant prostatic tissue. Statistically there were significantly less DC and LC in prostate cancer compared with normal prostatic tissue. While only a small subset of DC expressed markers of activation in prostate cancer, this was significantly more than the virtual absence of activated DC in normal prostatic tissue.

CONCLUSIONS

This is the first time that DC have been studied in prostate cancer using the relatively new DC specific monoclonal antibodies CD83 and CMRF-44. These findings suggest that there is no active recruitment of DC into prostate cancer and those DC present are only minimally activated.

Can prototypes inform moral developmental theory?

L. J. Walker and R. C. Pitts (1998) suggest that research on prototypes of moral excellence can lead to important new insights for accounts of moral development that are unlikely to emerge from the efforts of theorists working within psychological or philosophical paradigms. In this commentary, I argue that (a) experts in philosophical and psychological paradigms can and do contribute to revisions of theories of moral excellence, and (b) the study of prototypes has limited value for resolving some important theoretical issues. Three research topics that can be informed by the investigation of prototypes of moral excellence are described.

Childhood personality influences on social-cognitive development: a longitudinal study

The relation of childhood personality to the development of friendship understanding and moral judgment in adolescence was considered in a longitudinal study. Personality at age 7, assessed with the California Child Q-Set, was characterized in terms of ego-resiliency and ego-control. IQ and social class were also measured. Friendship understanding was assessed when the participants were ages 7, 9, 12, 15, and 19, and moral judgment was elicited when the participants were 12, 15, and 19. Ego-resiliency was found to predict social-cognitive development in adolescence, even after the effects of IQ and childhood measures of social-cognitive development were controlled for. Analyses indicate that the effects of ego-resiliency on social-cognitive development are largely unmediated by the ability to focus attention or by social participation.

Ergonomics and education: fad, failure or fraction of back injury prevention?

Ergonomics, in the traditional definition, is the science of design of work sites and work methods which influence production performance. In recent years, worker complaints and reports of injuries have caused evaluation of the effect of work stressors on workers. Currently, the rehabilitation specialist plays a pivotal role in both prevention and management of physical work related complaints. Rehabilitation ergonomic practitioners combine a scientific background in function and pathology with the act of developing preventive or restorative remedies. A volunteer group of sixteen rehabilitation professionals who utilize ergonomic principles in the workplace developed a document, identifying job functions of the newly defined field. This paper presents philosophy and a model for educational development and potential credentialing areas for rehabilitation ergonomists.

Spiritual care for children with cancer

OBJECTIVES

To review literature pertinent to spirituality of children with cancer and to identify practical strategies for providing care for this dimension in children.

DATA SOURCES

Nursing research and literature about pediatric nursing care and spirituality; theoretical formulations of Piaget, Fowler, and Erikson.

CONCLUSION

Children diagnosed with cancer have unique spiritual needs that place them at risk for developing spiritual distress. With the diagnosis may come experiences of loss of normalcy, physical stamina, relationships, body image, and future goals. Spiritual care includes interventions that assist children to find meaning and purpose in life, to continue relationships, and to transcend beyond the self.

IMPLICATIONS FOR NURSING PRACTICE

Spiritual care includes caregiver and child assessment and interventions appropriate to the developmental stages of infancy through adolescents. Tables outlining how this can be done by oncology nurses are included.

The Defeat Depression Campaign: psychiatry in the public arena

OBJECTIVE

The adequate recognition and treatment of depression are inhibited by negative public attitudes and gaps in professional expertise. This paper describes the activities and efforts of the Defeat Depression Campaign, a joint activity of the Royal College of Psychiatrists and the Royal College of General Practitioners, in the United Kingdom.

METHOD

A 5-year campaign was undertaken from 1992 to 1996, aimed at enhancing public awareness and attitudes and providing professional education.

RESULTS

An informational media campaign directed toward the general public was successfully undertaken. Leaflets, books, and audiotapes were also prepared and distributed to the public. Multiprofessional conferences on specific aspects of depression were organized. An extensive program of general practice education included consensus conferences and statements, recognition and management guidelines, training videotapes, and other publications. Public attitudes were found to be relatively favorable, except attitudes toward antidepressants, which were viewed as addictive. A general consequence of the campaign was the development of much additional public material and professional education not directly originating from the campaign. Aspects of the campaign are being evaluated, including public attitude change, impact of educational materials on general practitioners, and prescription of antidepressants.

CONCLUSIONS

A campaign of this kind serves a useful function in enhancing public education and awareness and improving professional recognition and management of depression.