Perception of childhood dissatisfaction with parents and selected personality traits in adulthood.

This study tested the hypotheses that perceptions of childhood dissatisfaction with parents are associated with higher scores on measures of intensity and chronicity of loneliness, anxiety, neuroticism, psychoticism, misanthropy, and external locus of control and lower scores on measures of self-esteem and sociability. The subjects were 537 Iranian students studying in American and Iranian universities. Both hypotheses were confirmed in a multivariate statistical model. We also found that dissatisfaction with parents was related to a lack of satisfactory relationships with peers.

[Sea-urchin injuries].

Sea urchins (Echinoidea) are found along the Mediterranean and especially the Red Sea coasts of Israel. The most important species are Diadema setosum on the Red Sea coast, and Paracentrus lividus on the Mediterranean. When stepped on, the brittle spines penetrate and the venom they carry causes further damage. Thus the injuries are mainly mechanical, but may be complicated by a foreign body reaction to the bits of spine, to small detached segments of their covering epithelium, and damage by the epithelial venom. Severe pain, edema, local sensory loss and sometimes suppuration ensue.

Postbaccalaureate preparation and performance in medical school.

The question whether postbaccalaureate preparation before matriculation in medical school contributes to medical students' performance was addressed by this study. A total of 610 (91%) of the students who entered Jefferson Medical College between 1985 and 1987 were the study sample. Fifty-eight of these students had taken nondegree undergraduate premedical courses and 15 had taken nondegree graduate courses. Fourteen students held graduate degrees and 60 students had some combination of the aforementioned types of postbaccalaureate preparations. The other 463 students had not taken postbaccalaureate courses. Grades received in medical school courses such as anatomy, biochemistry, mechanisms of disease, physiology, microbiology, pathology, and pharmacology, as well as total scores on Part I of the National Board of Medical Examiners examination were selected as performance variables. Statistical analyses showed that the students who had taken nondegree postbaccalaureate courses had lower undergraduate grade-point averages than those without such courses and received lower grades on some measures of performance in medical school. The students with such additional academic backgrounds were also older than the average medical student. When adjustments were made for undergraduate grade-point averages by applying analysis of covariance, the observed differences that favored the group without postbaccalaureate preparation either became nonsignificant or favored those with such preparation. The differences favoring those without postbaccalaureate preparation could be accounted for mostly by these students' higher undergraduate grade-point averages and younger ages. Implications for admission decisions with regard to the changing applicant pool are discussed.

A controlled trial to improve delivery of preventive care: physician or patient reminders?

OBJECTIVE: To improve the delivery of preventive care in a medical clinic, a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently, depending on level of initiative required of the physician or patient to complete a service. DESIGN: A prospective, controlled trial of five-months' duration. SETTING: A university hospital-based, general medical clinic. PARTICIPANTS: Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study. INTERVENTION: A computerized reminder system for physicians and a patient questionnaire and educational hand-out on preventive care. MEASUREMENTS AND MAIN RESULTS: Delivery of five of six audited preventive services improved significantly after the interventions were introduced. The computerized reminder alone increased completion rates of services that relied primarily on physician initiative; the questionnaire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services. Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone. CONCLUSIONS: These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors. Overall, the computer reminder was the more effective intervention.

Students' certainty during course test-taking and performance on clerkships and board exams.

Psychometric aspects of multiple-choice tests were investigated using a confidence-weighted scoring technique. The contributions of two indices, overconfidence and underconfidence, in the prediction of subsequent academic performance of examinees were studied. A total of 444 sophomore students (entering classes of 1982 and 1983) in one medical school were asked to indicate their confidence, on a 5-point scale (100, 75, 50, 25, and 0), in the correctness of their responses to each multiple-choice item on an Introduction to Clinical Medicine examination. Examinations were scored in two ways: in the conventional way, using the total number of correct responses, and by a confidence-weighted technique based on the level of certainty indicated for each response by the examinee. Only the conventional score determined the grade; the confidence-weighted score was calculated for the purely experimental purposes of this study. Overconfidence and underconfidence indices were also calculated by using the indicated levels of certainty. Improvements in the psychometrics of the examinations were observed when confidence-weighted scoring was used. In multiple-regression models, the confidence-weighted scores and indices of over- and underconfidence contributed significantly to predicting scores of the students studied on Parts I and II of the National Board of Medical Examiners examinations, whereas the conventional score did not contribute to the prediction of Part II scores. Significant differences on junior clerkship examinations and ratings were observed between those who were highly overconfident and those who were slightly overconfident. The highly overconfident students also estimated higher future incomes than did those who were slightly overconfident.

Postbaccalaureate preparation and performance in medical school.

Medical students with some postbaccalaureate preparations were compared with those without such preparations. Before adjustment for undergraduate GPAs significant differences were observed in the favor of those without such preparations, but after adjustments for undergraduate GPAs, the previously obtained differences became either non-significant, or significant in the favor of those with postbaccalaurate preparations.

Complications of flexible fiberoptic sigmoidoscopy. A conceptual approach.

This paper presents an overview of the potential risks associated with the use of the flexible fiberoptic sigmoidoscope. A reasonable review of the literature on endoscopy reveals few instances of admitted complications. We draw upon a decade of personal observations and experience with over 10,000 examinations to substantiate the actual and potential hazards of flexible fiberoptic sigmoidoscopy. A conceptual approach to recognizing and avoiding the consequences of complications is presented.

Preoperative radiation therapy and sphincter preservation by the combined abdominotranssacral technique for selected rectal cancers.

In an attempt to reduce the incidence of local recurrence and maintain normal sphincteric function in selected patients treated for rectal cancer, a clinical experience using full dose preoperative radiation therapy and a combined abdominotranssacral technique was begun in 1976. The first 24 of 55 patients treated have now been followed for 20 to 84 months, the median follow-up period being 39 months; sufficient data related to their clinical courses are available for analysis. Cancers were selected on the basis of unfavorability and location in the rectum (3- and 7-cm levels). Clinical staging of the disease was accurate and allowed selection and treatment of only those cancers considered unfavorable (stages B2 and C), thereby avoiding unnecessary radiation of more favorable tumors. One anastomotic disruption required reconstruction, but perioperative complications were otherwise unremarkable. Local recurrence in this group of highly unfavorable cancers has not been observed. Normal and sphincteric function has been preserved in each instance. Preliminary results indicate that full dose preoperative radiation therapy for selected unfavorable and low level cancers permits safe and effective sphincter preservation surgery by the combined abdominotranssacral technique. When proper precautionary measures are observed, surgery can be conducted with the expectation of normal continence and significant reduction in local recurrence.