Validation of the PHEEM instrument in a Danish hospital setting.

The Postgraduate Hospital Educational Environment Measure (PHEEM) has been translated into Danish and then validated with good internal consistency by 342 Danish junior and senior hospital doctors. Four of the 40 items are culturally dependent in the Danish hospital setting. Factor analysis demonstrated that seven items are interconnected. This information can be used to shorten the instrument by perhaps another three items.

Use of 360-degree assessment of residents in internal medicine in a Danish setting: a feasibility study.

BACKGROUND: The aim of the study was to explore the feasibility of 360 degree assessment in early specialist training in a Danish setting. Present Danish postgraduate training requires assessment of specific learning objectives. Residency in Internal Medicine was chosen for the study. It has 65 learning objectives to be assessed. We considered 22 of these suitable for assessment by 360-degrees assessment. METHODS: Medical departments of six hospitals contributed 42 interns to the study. Each resident was assessed by ten persons of whom one was a secretary, four were nurses and five senior doctors. The assessors spent 14.5 minutes (median) to fill in the forms. RESULTS: Of the 22 chosen objectives, 15 could reliably be assessed by doctors, 7 by nurses and none by secretaries. CONCLUSIONS: The method was practical in busy clinical departments and was well accepted by the assessors. Reliability of the method was acceptable. It discrimintated satisfactorily between the good and not so good performers.

Immediate breast reconstruction after mastectomy for cancer.

AIMS: The oncological, surgical and cosmetic results, patient satisfaction and psychological morbidity of immediate breast reconstruction following mastectomy for breast cancer were evaluated. METHODS: From 1980 to 1994, 79 immediate breast reconstructions were performed in Malmö. From 1985 immediate breast reconstruction was performed in 21% of mastectomies among patients

Pedagogical methods and affect tolerance in medical students.

OBJECTIVES: There has been little evaluation, by means other than cognitive variables, of medical school curricula that include problem-based learning (PBL). This study aimed to investigate whether medical students' affect tolerance, an important prerequisite of empathy, was influenced by individual courses. DESIGN: The study is pseudo-randomised and cross-sectional, using a test of affect tolerance in students in their first, sixth and eighth term of medical school, during which they were kept together as one group for their pre-clinical studies, but were subsequently separated during the clinical part and were sent to two different university hospitals that used different teaching methods. SUBJECTS: Medical students. SETTING: University of Lund Medical School, Sweden. RESULTS: After receiving a short course in communications skills training, students in the sixth term had significantly higher mean scores on the test than students in their first term. In the eighth term, which is the surgery term, the mean scores for students attending the PBL course were still as high as those for students in the sixth term, while students in the course using conventional pedagogical methods had significantly lower mean scores. DISCUSSION: Since the content of the courses was similar and the composition of the two groups also fairly similar, we attribute the difference to the differing teaching methods. In the PBL course, the students were given continued and integrated communication skills instruction, in which it was possible for them to learn strategies to counteract the development of rigid psychic defences, which constitute an obstacle to affect tolerance and empathy.

BEME Guide No. 2: Teaching and learning communication skills in medicine-a review with quality grading of articles.

A literature search for articles concerning communication skills teaching and learning in medicine was done.The search yielded 180 pertinent articles, which were quality graded into the three categories of high, medium and low quality, using established criteria. Only those of high and medium quality were used for the review, which thus is based on 31 randomized studies, 38 open effect studies and 14 descriptive studies. Communication skills can be taught in courses, are learnt, but are easily forgotten if not maintained by practice.The most effective point in time to learn these at medical school is probably during the clinical clerkships, but there is no study that has specifically addressed this question.After a short period of training, doctors can be effective as teachers.The teaching method should be experiential as it has been shown conclusively that instructional methods do not give the desired results.The contents of communication skills courses should primarily be problem defining.All students should have communication skills training since those with the lowest pre-course scores gain the most from such courses. Men are slower learners of communication skills than women, which should be taken into account by course organizers. As there is only one really long-term follow up into the residency phase of communication skills training at medical school, those who have done randomized studies in the field should if possible carry out further follow-up studies.

Increasing incidence of and declining mortality from breast carcinoma. Trends in Malmö, Sweden, 1961-1992.

BACKGROUND: The incidence of breast carcinoma is increasing in most populations, whereas mortality caused by this disease is fairly constant. The authors analyzed the incidence of and mortality from invasive breast carcinoma in a population with access to good medical care, into which mammographic screening was introduced in 1976 and adjuvant therapy in 1978. METHODS: In a consecutive series of patients with invasive breast carcinoma from Malmö, 1961-1991, changes in age-adjusted incidence were analyzed and compared with incidence of the disease in the rest of Sweden. Age-adjusted breast carcinoma mortality was studied for the period 1964-1992. RESULTS: The introduction of mammographic screening was associated with an increase in breast carcinoma incidence. This was restricted to the age group that was eligible for screening (age 45-69 years) and to Stage I disease. Between 1977 and 1992, age-adjusted breast carcinoma mortality decreased in Malmö by 43% (95% CI, 26-56%) as compared with 12% (95% CI, 8-16%) in the rest of Sweden. The decrease was statistically significant in both populations and significantly greater in Malmö than in the rest of Sweden (P < 0.001). In Malmö the decrease was seen in two age groups, age 45-69 years and age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. There were no changes in incidence or mortality among women younger than 45 years in either population. CONCLUSIONS: Breast carcinoma incidence was strongly related to diagnostic activity, especially mammographic screening. The decrease in mortality occurred in temporal relation to the introduction of screening and adjuvant therapy, making a causal relation likely. The difference in results between Malmö and the rest of Sweden indicates an important role for screening in mortality reduction.

Breast cancer as cause of death--a study over the validity of the officially registered cause of death in 2631 breast cancer patients dying in Malmö, Sweden 1964-1992.

The validity of registered official cause of death (COD) concerning breast cancer patients in Malmö 1964-1992 was analysed. There was a high frequency of autopsy in the material and, therefore, the number of diagnostic errors should be low. Found discordance thus mostly reflect the quality of certifying and registration of COD. Of 2631 deaths discordance was found as to underlying COD in 121 cases (4.6%). Ninety-four of these represent outright errors. In 27 there was doubt about the reported COD. The number of discordant cases increased with age at death. Two kinds of systematic bias were found. One was a tendency to report breast cancer as contributing COD in patients with clinical cure. The other was a practice at the Registry to register breast cancer as underlying COD in cases with breast cancer reported as contributing COD. This practice was changed in 1981 causing an artificial decrease in registered breast cancer mortality.

Validity of breast cancer registration from one hospital into the Swedish National Cancer Registry 1971-1991.

To validate the Swedish Cancer Registry concerning breast tumours in female residents of Malmö 1971-1991, registry-entries were compared with clinical records. Correctness and completeness of entries was determined for invasive breast cancer (BC) and cancer in situ of the breast (CIS). As BC were registered 3,646 tumours. Of these 3,403 (93.3%) were confirmed as BC. Completeness was good with 1.1% of diagnosed tumours missing. Correctness of registered cases of CIS was 93.3%, but completeness only 63.3%. Most missing cases were registered as BC. In bilateral cancer correctness was 78.0% and completeness 77.2%. All aspects of registration improved during the period. Most differences between diagnosed and registered cases were due to coding CIS of intraductal type as BC. This practice changed in 1980 resulting in improved precision. Using registry data for epidemiological research the question of their validity must be addressed. Special consideration should be paid to coding practice at the registry.

Transgenic barley (Hordeum vulgare L.) by electroporation of protoplasts.

Protoplasts isolated from calli derived from cultured microspores of barley (Hordeum vulgare L. cv. Kymppi, an elite cultivar) were transformed with the neomycin phosphotransferase marker gene (nptII) by electroporation. Screening of the regenerated plants for the NPTII activity by gel assay resulted in three positive signals. Southern blot analysis and NPTII assays of second and third generation plants confirmed the genomic integration of the transferred gene and that the new trait was inherited by the progeny.

Primary prognostic factors in invasive breast cancer with special reference to ductal carcinoma and histologic malignancy grade.

BACKGROUND: In a study of 2290 cases of invasive breast cancer in Malmö, the prognostic value of histologic typing and axillary nodal status was examined. Two periods were studied: Period 1, 1961-1970, and Period 2, 1981-1988. METHODS: All primarily unilateral invasive breast cancers were included in the study and classified according to the histologic classification proposed by Linell et al. and Linell and Ljungberg (the Linell-Ljungberg classification), which includes a histologic grading of ductal carcinoma based on content of tubular structures. From Period 1, the tumors were reclassified. In Period 2, the Linell-Ljungberg classification was used as a clinical routine. Median follow-up in Period 1 was 23 years, and in Period 2, 5 years. Survival was calculated in relation to histologic type and axillary nodal status. RESULTS: The Linell-Ljungberg classification divides invasive ductal carcinoma (IDC) into two groups of approximately equal size: IDC of comedo type, 40% of total; and IDC of tubuloductal type, 30% of total. There was a significantly better survival rate in the tubuloductal group than in the comedo group. In a multivariate analysis, this difference was shown to be independent of axillary nodal status and tumor size. By combining histologic classification with axillary nodal status, one group of patients could be identified containing 90% of patients dying from breast cancer within 5 years of diagnosis and another group with less than 10% risk of dying from breast cancer within 5 years. CONCLUSIONS: Valuable prognostic information can be obtained in a clinical setting from routinely obtained primary prognostic factors in breast cancer: pTNM stage, histologic type, and histologic malignancy grade. This information should be considered the baseline in the clinical evaluation of other more elaborate prognostic factors.

Fertile transgenic barley to particle bombardment of immature embryos.

Transgenic, fertile barley (Hordeum vulgare L.) from the Finnish elite cultivar Kymppi was obtained by particle bombardment of immature embryos. Immature embryos were bombarded to the embryonic axis side and grown to plants without selection. Neomycin phosphotransferase II (NPTII) activity was screened in small plantlets. One out of a total of 227 plants expressed the transferred nptII gene. This plant has until now produced 98 fertile spikes (T0), and four of the 90 T0 spikes analyzed to date contained the nptII gene. These shoots were further analyzed and they expressed the transferred gene. From green grains, embryos were isolated and grown to plantlets (T1). The four transgenic shoots of Toivo (the T0 plant) produced 25 plantlets as T1 progeny. Altogether fifteen of these T1 plants carried the transferred nptII gene as detected with the PCR technique, fourteen of which expressed the nptII gene. The integration and inheritance of the transferred nptII gene was confirmed by Southern blot hybridization. Although present as several copies, the transferred gene was inherited as a single Mendelian locus into the T2 progeny.

Fibrin adhesive in radical mastectomy.

OBJECTIVE: To find out if fibrin adhesive glue applied locally would reduce the incidence of seroma after modified radical mastectomy for breast cancer. DESIGN: Prospective randomised study. SETTING: City hospital, Sweden. SUBJECTS: 68 women undergoing modified radical mastectomy with axillary clearance for breast cancer. MAIN OUTCOME MEASURES: Amount of postoperative drainage, number of seromas aspirated volumes; length of hospital stay, influence of surgeon operating. RESULTS: Seromas developed in a total of 40/68 patients (59%), 23/36 in the fibrin adhesive group (64%) and 17/32 in the control group (53%); p = 0.5 (95% confidence interval of the difference--0.13 to 0.34). There were no significant differences in the volume of aspirations or in hospital stay. The skill of the surgeon influenced the incidence of seromas, but the differences were not significant (p = 0.5). CONCLUSION: Local application of a fibrin adhesive glue has no effect on the incidence of seroma formation after modified radical mastectomy.