Comparative effectiveness of chemotherapy vs resection of the primary tumour as the initial treatment in older patients with Stage IV colorectal cancer.

AIM: The objectives were to determine trends in the use of chemotherapy as the initial treatment and to evaluate the comparative effectiveness of initial chemotherapy vs resection of the primary tumour on survival (intention-to-treat analysis) in Stage IV colorectal cancer (CRC). METHOD: This cohort study used 2000-2011 data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, including patients ≥ 66 years of age presenting with Stage IV CRC. Cox proportional hazards models and instrumental variable analysis were used to compare the effectiveness of chemotherapy as the initial treatment with resection of the primary tumour as the initial treatment, with 2-year survival as the end point. RESULTS: The use of chemotherapy as the first treatment increased over time, from 26.8% in 2001 to 46.9% in 2009 (P < 0.0001). The traditional Cox model showed that chemotherapy as the initial treatment was associated with a higher risk of mortality [hazard ratio (HR) = 1.35; 95% CI: 1.27-1.44]. When accounting for known and unknown confounders in an instrumental variable analysis, chemotherapy as the initial treatment suggested benefit on 2-year survival (HR = 0.68; 95% CI: 0.44-1.04); however, the association did not reach statistical significance. The study findings were similar in six subgroup analyses. CONCLUSION: The use of chemotherapy as the initial therapy for CRC increased substantially from 2001 to 2009. Instrumental variable analysis found that, compared with resection, chemotherapy as the initial treatment offers similar or better 2-year survival in patients with Stage IV CRC. Given the morbidity and mortality associated with colorectal resection in elderly patients, chemotherapy provides an option to patients who are not good candidates for resection.

Nursing students' and faculty's perceptions of the characteristics of 'best' and 'worst' clinical teachers: a replication study.

This replication study described and compared the characteristics of 'best' and 'worst' clinical teachers as perceived by 185 Greek students of nursing and 31 clinical teachers. It is a replication of Mogan & Knox's (1987) study, which has also been replicated by Nehring (1990). The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) was used for data collection. This tool is a 48-item seven-point-scale checklist which describes discrete teacher characteristics grouped in five categories or subscales. Subjects were invited to rate their 'best' clinical teacher using the NCTEI, and then their 'worst' clinical teacher. Faculty's and students' perceptions agreed with most of the highest-rated characteristics of the 'best' clinical teachers. There was less agreement in the lowest-rated characteristics of the 'worst' teachers. There were not significant differences between the rating of students and faculty when categories of characteristics were compared, with the exception of the category 'interpersonal relationship' of the 'worst' teachers. The most distinguishing characteristics between 'best' and 'worst' clinical teachers for students and faculty in this study and in both Mogan & Knox's and Nehring's samples, were being a good role model and encouraging a climate of mutual respect.