Immersion learning at an aphasia camp: Analysing student video reflections.

PURPOSE: Aphasia camps provide a learning context where students can gain knowledge and skills for clinical practise and regarding the lived experience of individuals affected by aphasia. The aim was to examine student learning experiences at a rustic, residential aphasia camp and explore the potential utility of video reflections. METHOD: Twenty-two student participants, who served as volunteer staff at an aphasia camp, reflected daily on their learning experiences. Manual, qualitative coding was used to characterise individual, verbal reflections conducted through video modality. RESULT: Three overarching themes were identified: applied learning, service, and clinical experience. Categories within applied learning included increased application of content knowledge, an evolving perspective of living with aphasia, and collaborative learning. Within service, students identified a commitment to making a meaningful impact, interpersonal relationships, and meeting the challenge. The clinical experience theme included increased confidence/self-efficacy and inspirational/rewarding categories. CONCLUSION: Aphasia camp is a unique learning environment where hands-on experiences influence students' knowledge, sense of civic responsibility, and developing clinical skills. Being immersed in a remote environment alongside individuals affected by aphasia fosters insights into the lived experience of aphasia and may enhance empathy. Video reflections appear to be a viable means of capturing authentic, organic, and emotional reflections.

Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome.

BACKGROUND: Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome. METHODS: Three hundred fifteen women with documented germ-line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women) and women who had undergone prophylactic bilateral salpingo-oophorectomy (47 women) were matched with mutation-positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow-up visit. RESULTS: There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman-year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman-year, yielding a prevented fraction of 100 percent (95 percent confidence interval, -62 to 100 percent). CONCLUSIONS: These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.

Influence of Photoperiod, Daylength, and Feeding Schedule on Tadpole Growth and Development: (tadpole/metamorphosis/thyroxine/photoperiod/feeding schedule).

The metamorphic rate of Rana pipiens tadpoles was studied under different photoperiods, daylengths, and feeding schedules. Tail resorption and hindlimb growth and development induced by immersion in 30 µg/l thyroxine (T4 ) were accelerated under longer photoperiods and continuous light when 6L: 18D, 12L: 12D, 18L: 6D, and 24L regimes were compared. Constant light exposure did not produce faster development than an 18 hr photoperiod, and initially was less effective. The rate of spontaneous and T4 -induced metamorphosis was greater the shorter the day on 9L:9D, 12L: 12D, or 15L: 15D cycles, although all groups received the same overall amount of light, but in different dosages. When feeding schedule but not the LD cycle was varied, groups of tadpoles fed on 18, 24, or 30 hr regimes showed no differences in growth and development rate on 19L: 5D, and only random variations under continuous light. Differences in metamorphic rate on 18, 24, or 30 hr days are not due to the feeding schedules, but to the LD cycles. From these experiments we conclude that illumination, particularly the length and frequency of the photoperiod, affects the utilization of T4 . Development rates independent of the total amount of illumination, but related to daylength and light schedule, suggest interaction of light with an endogenous timing mechanism.

Expectations for care: older adults' satisfaction with and trust in health care providers.

This study sought to determine whether community-dwelling older adults' expectations for care were met by identifying factors that influence trust in and satisfaction with health care providers. Data were collected using a demographic questionnaire and focus group methodology. A total of 39 older adults participated in 8 focus groups. Three categories of themes were identified: a sense of personal touch, technical proficiency, and environmental factors. These categories related to individual providers or practice environments. When providers and practice settings met expectations for care, then the elderly individual was satisfied. Trust was more complex, as the older adults indicated they could be satisfied but not trust providers or they could trust providers but not be satisfied. Implications for practice include spending quality time with older adults and treating them as individuals.

The development of trust in parents of hospitalized children.

ISSUES AND PURPOSE: The purpose of this study was to investigate the development of trust in parents of hospitalized children. METHODS: Using grounded theory, semistructured interviews were conducted with 15 parents of children previously hospitalized, focusing on parents' experiences during their child's hospitalization. Data were analyzed using a constant comparative process. Themes and the core variable were identified and a model of trust developed. RESULTS: The core variable related to the development of trust in healthcare providers was whether parents' expectations for care were met. Thematic areas that influenced whether expectations for care were met included preexisting trust; evaluation of care, including evaluation of technical skills and the meeting of parental and child needs; and behaviors of nurses and other healthcare providers that inhibited and fostered trust. PRACTICE IMPLICATIONS: Strategies to enhance trust are discussed.

American founder mutation for Lynch syndrome. Prevalence estimates and implications.

BACKGROUND: Recently, a new founder mutation, an exon 1-6 deletion in a mismatch repair gene (MMR), MSH2, in nine kindreds with Lynch syndrome was reported. In 3 of the kindreds this mutation was traced by genealogy through 11-12 generations to a common founder, and thus termed the American Founder Mutation (AFM). Since then, 13 additional 'unrelated' kindreds with AFM were detected by a recently designed single polymerase chain reaction. This test might serve as first-line screening for Lynch syndrome mutations, provided AFM was prevalent, which is assessed in the current study. METHODS: The number of current AFM carriers and the incidence of Lynch syndrome caused by AFM were estimated based on population growth of mutation carriers derived from genealogy data. For cross-checking, its annual incidence was also estimated based on published epidemiology data. RESULTS: There are 18,981 (5th and 95th percentiles, 6038 and 34,466, respectively) expected current AFM carriers, or 160 (range 51-290) Lynch syndrome cases diagnosed per year due to AFM estimated based on genealogy data. The incidence estimate closely overlaps with that based on published epidemiology data, which is 114-400 cases per year. CONCLUSIONS: A large number of AFM carriers are likely to exist in the U.S., which harbors significant implications for cancer control. Given the ease of detection, testing for AFM not only among members of the existing AFM families, but also among all patients with Lynch syndrome in the U.S. is proposed.

Nursing telephone triage and its influence on parents' choice of care for febrile children.

Nursing telephone triage is a mechanism whereby parents call for advice and referrals. One common call in pediatrics concerns children's fever, which may be managed at home. Giving parents proper advice may avoid unnecessary visits. This study investigated whether home-care advice given by nurses changed parents' original preference for care. Data were collected using an existing database to determine parents' preference for location of care before and actual location of care after a call. Of the 110 calls, 73 parents wanted a physician or emergency department visit but 53 followed nursing advice for home care. Findings suggest that although most parents wanted to have their child seen, a majority followed nursing advice for home care.

Screening adherence in BRCA1/2 families is associated with primary physicians' behavior.

This study provides an assessment of long-term breast and ovarian cancer screening behaviors and the variables associated with adherence with screening among women with or at 50% for having a BRCA1/2 mutation. Participants in the study included 112 women (33 mutation carriers and 79 at 50% risk). Data was collected through a mailed questionnaire, which included items to assess screening behaviors in the last 2 years, risk perception, cancer specific distress, adherence determinants, specific barriers, and cancer history. Statistical analysis included descriptive statistics and non-parametric tests to describe bivariate associations and regression analysis. Adherence rates were 72% for annual mammography, 21% for semi-annual clinical breast exam (CBE), 29% for monthly breast self-exam (BSE), and 19% for annual transvaginal ultrasound (US). Only one participant was adherent with semi-annual CA125. Variables that had a significant association (P < 0.05) with at least one screening modality included: a lack of time, marital status, education, cancer history, provider concern, perceived screening utility, confidence in ability to overcome barriers, cancer specific distress, and risk perception. Primary physician behavior, either in terms of screening recommendations or screening performance in the case of CBE, had significant independent association with adherence to mammography, CBE, and US screening recommendations. The results of this study highlight the essential role that primary physicians play in supporting their very high-risk patients' adherence.