Interdisciplinary education in a community-based geriatric evaluation clinic.

BACKGROUND: Demographic predictions are challenging schools of medicine to emphasize geriatrics. This article describes a geriatric evaluation (GET) clinic and explores the opportunity for residents to attain core geriatric competencies. DESCRIPTION: The GET clinic is located in a small Midwestern city associated with a community-based medical school. It is staffed by an interdisciplinary team consisting of a geriatrician, a gerontological nurse specialist, and a social worker. Residents, medical students, and nursing students are frequent participants. EVALUATION: Descriptive data indicate that the clinic experience addresses the core competencies set forth by the American Geriatric Society. The clinical outcomes indicate that the clinic is effective in maintaining the functional status of patients and has a positive effect on family caregivers. Residents and students rate their experience as excellent. CONCLUSIONS: The GET clinic provides a unique interdisciplinary educational opportunity. Further investigation is needed to determine if residents who participate do attain core competencies.

Transitions in the lives of elderly women who have sustained hip fractures.

Hip fractures represent a major health problem within the older population, especially for elderly, white women. As the older woman transitions through the recovery process following hip fracture, her ability to meet basic needs, fulfil usual roles, and maintain well-being is threatened. Despite the rehabilitation provided to these women, studies suggest that hip fractures frequently result in permanent decline in functional status. Little is known about what characterizes those few elderly women who do recover to their previous level of functioning. In this context, a study was designed to identify factors which promote function and enable a successful transition following hip fracture. A total of 15 women ranging in age from 72 to 82, who had returned home alone following care in a Midwestern subacute unit, participated in three focus groups. The data were analysed using the grounded theory method. The findings revealed that the women were confronted with an array of problems, which were labelled function-inhibiting factors. To overcome these problems, the women mobilized their adaptive approaches to life. In addition, they identified various interdisciplinary interventions, labelled function-promoting factors, which helped to provide a successful transition. From these findings, a programme of interdisciplinary interventions was identified which could be implemented in subacute units and tested to establish its effectiveness in promoting a successful transition following hip fracture.

Developing a team for multicultural, multi-institutional research on fatigue and quality of life.

PURPOSE/OBJECTIVES: To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue. DATA SOURCES: Articles, book chapters, personal experience. DATA SYNTHESIS: Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population. CONCLUSIONS: Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning. IMPLICATIONS FOR NURSING PRACTICE: The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.

Cancer rate differentials between blacks and whites in three metropolitan areas: a 10-year comparison.

This article compares cancer rate differentials for 1989-1993 and 1979-1981 between black and whites in Los Angeles, Nashville, and Atlanta, In Los Angeles and Atlanta, the black/white relative risk of lung cancer incidence has increased. While the relative risk for prostate cancer has decreased, blacks still show an excess incidence. White women still show a higher incidence of breast cancer, but the risk is closer to one. In all three cities, the excesses of black male lung cancer and female breast cancer mortalities have increased. The excess of black prostate cancer mortality increased in Atlanta and Nashville but decreased in Los Angeles. The excess of black cervical cancer mortality fell in Los Angeles and Atlanta but rose in Nashville. These results indicate a continuing need to develop and implement culturally sensitive interventions targeted at the black population.

Attitudes of African Americans regarding screening for prostate cancer.

The purpose of this study was to identify attitudes associated with the willingness of African Americans to participate in prostate cancer screening. Subjects > or = 40 years were recruited from South Central Los Angeles. Fifty-six respondents were divided into low or middle socioeconomic groups based on education and occupation. Focus group discussions were conducted to assess knowledge, attitudes, and beliefs about prostate cancer screening and treatment, willingness to participate in screening, incentives and barriers toward participating in screening, and source of medical care. The middle socioeconomic respondents expressed a greater willingness to participate in prostate screening. This difference was attributed to their greater knowledge about the disease and screening procedures, enhanced access to health promotion activities, being less fearful of discovering abnormal results, exposure to more aggressive behavior on the part of the provider with respect to screening, and receiving medical care in an environment that is more respectful toward the consumer. Efforts to increase minority participation in prostate cancer screening or prevention studies must take these findings into consideration.

Attitude of African-Americans regarding prostate cancer clinical trials.

The purpose of this study was to qualitatively assess attitudes associated with the willingness of African-Americans to participate in prostate cancer clinical trials. Fifty-six African-American males, 40 years of age and older, were recruited from South Central Los Angeles. Respondents were divided into lower or middle socio-economic groups based on education and occupation. Focus group discussions were conducted to assess their knowledge about prostate cancer and willingness to participate in prostate cancer clinical trials. In addition, information was obtained to identify their incentives and barriers towards participating in prostate cancer research. Middle socio-economic respondents expressed a greater willingness to participate in prostate cancer clinical trials than did men of lower socio-economic status. Many indicated that they would be more likely to participate if they were encouraged to do so by a physician or researcher who was viewed as being competent and compassionate. Barriers to participation in prostate cancer clinical trials included concerns about drug toxicity, medical experimentation and distrust of the medical establishment. Endeavors aimed at increasing minority representation in prostate cancer clinical studies should address these issues.

Comparison of 3' and 5' biotin labelled oligonucleotides for in situ hybridisation.

Oligonucleotide probes enzymatically labelled at the 3'-end with biotin have been used successfully to detect target RNA and DNA in combination with in situ hybridisation. Addition of multiple biotin residues to the 3'-end increases the hybridisation signals, but it is not known whether the same principle is applicable to the 5'-end. We have labelled a 35-base oligonucleotide during synthesis with 1, 5 and 12 biotin molecules at the 5'-end and compared it to conventional 3'-labelling. In additional experiments the probes were labelled at both ends. Probes were applied to histological sections obtained from paraffin-embedded cell-clot-complexes that contain uninfected and Rhinoviral-infected cells, using a standard in situ hybridisation protocol with appropriate controls. Hybridisation signals were compared for intensity of cytoplasmic signal and sensitivity as number of positive cells. Both parameters increased in parallel with higher numbers of biotin residues attached to the 5'-end and 12 biotin residues were almost as effective as 3'-enzymatic tailing. The sensitivity could be increased above that of either 3'- or 5'-labelling by the addition of residues at both ends of the probe. The 5'-attachment of biotin residues can extend the value of oligonucleotide probes employed for in situ hybridisation and yield increased sensitivity when combined with 3'-enzymatic labelling.

A creative recruitment program. Future nurses' camp.

Attracting high school students into nursing is a concern of staff development educators. "Future Nurses' Camp" was a creative, cost-effective program developed by a hospital education department. A 2-week, fun-filled, informative camp that included the use of high-tech equipment and patient-care decision games promoted a positive image of nursing. Experiencing nurses' roles reinforced the students' desire to enter nursing.