Standardization of lower extremity quantitative lymphedema measurements and associated patient-reported outcomes in gynecologic cancers.

Practice changing standardization of lower extremity lymphedema quantitative measurements with integrated patient reported outcomes will likely refine and redefine the optimal risk-reduction strategies to diminish the devastating limb-related dysfunction and morbidity associated with treatment of gynecologic cancers. The National Cancer Institute (NCI), Division of Cancer Prevention brought together a diverse group of cancer treatment, therapy and patient reported outcomes experts to discuss the current state-of-the-science in lymphedema evaluation with the potential goal of incorporating new strategies for optimal evaluation of lymphedema in future developing gynecologic clinical trials.

Trends in hospital admissions for burns in England, 1991-2010: a descriptive population-based study.

OBJECTIVES: To describe trends in admissions to English hospitals and 30-day in-hospital mortality associated with a primary diagnosis of burns. DESIGN: Descriptive population-based study. SETTING: England. PARTICIPANTS: Patients admitted to hospital with a primary diagnosis of burns between 1991 and 2010. MAIN OUTCOME MEASURES: Age-specific and age-standardised admission rates, and 30-day in-hospital mortality percentages. RESULTS: During 1991-2010, there were 188,597 admissions to hospitals in England with a primary diagnosis of burns. Annual numbers of admissions decreased between 1991 and 2002, followed by a steeper increase up to 2010. Rates were higher in males, in the age groups 0-4 and ≥85 years, and in persons from deprived areas of residence, most ethnic minorities, and urban areas. There were 3196 in-hospital deaths within 30 days of admission for burns between 1991 and 2010. Between 2000 and 2010, this mortality decreased from 1.99% to 0.91%. The highest rates of 30-day in-hospital deaths occurred in the elderly and the lowest in children. CONCLUSION: Although in-hospital mortality from burns has decreased in recent years, if the recent upward trend in hospital admissions is genuine, it will have resource implications for regional burns units, and also suggests the need for a renewed emphasis on primary prevention. Observed inequalities with respect to age, gender, deprivation, ethnicity, and urban-rural status provide a rational basis for targeting primary prevention initiatives.

Attitudes, beliefs and values of students in undergraduate medical, nursing and pharmacy programs.

First and final year students in medicine, nursing and pharmacy programs at the University of Auckland completed a questionnaire used in studies of professional subcultures. Before entering training, students differed in how they believed clinical work should be organised. The collectivist attitude of pharmacy students was greater among those completing their studies than it was among those commencing study. Doctors, nurses, pharmacists and other professional groups are expected to work in multidisciplinary teams to deliver high quality health services. This study suggests that the individualistic attitudes of medical students may need to be addressed during training if medical students are to graduate with a commitment to working in teams, an expectation of clinical governance.

The professional subcultures of students entering medicine, nursing and pharmacy programmes.

This study sought to determine the attitudes, beliefs and values towards clinical work organization of students entering undergraduate medicine, nursing and pharmacy programmes in order to frame questions for a wider study. In the Faculty of Medical and Health Sciences, The University of Auckland students entering medicine, nursing and pharmacy programmes completed a questionnaire based on that used by Degeling et al. in studies of the professional subcultures working in the health system in Australia, New Zealand, England and elsewhere. Findings indicate that before students commence their education and training medical, nursing and pharmacy students as groups or sub-cultures differ in how they believe clinical work should be organized. Medical students believe that clinical work should be the responsibility of individuals in contrast to nursing students who have a collective view and believe that work should be systemized. Pharmacy students are at a mid-point in this continuum. There are many challenges for undergraduate programmes preparing graduates for modern healthcare practice where the emphasis is on systemized work and team based approaches. These include issues of professional socialization which begins before students enter programmes, selection of students, attitudinal shifts and interprofessional education.

Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management.

This paper explores similarities and differences in the value stances of clinicians and hospital managers in Australia, England, New Zealand and China, and provides some new insights into how we theorise about the health profession and its relations with management. The paper draws on data derived from a closed-ended questionnaire administered to 2637 hospital-based medical, nursing and managerial staff. We examine variations between the countries in the value orientations of doctors, nurses and managers by considering their assessments of issues that are the focus of reform. In particular, we examine the ways in which the Chinese findings differ from those of the other countries. Whereas the results from the Commonwealth hospitals showed a marked division between clinicians and managers about issues that can affect clinical autonomy, this was not the case in the Chinese hospitals. The concluding discussion traces these differences to a number of cultural, organisational and policy-based factors. The implications of our findings on how we conceive the relationship between professionals and organisations are then discussed, as are further lines of research.