Creating a culture of patient-focused care through a learner-centered philosophy.

This paper will discuss the teaching-learning process used in the Patient-Focused Care Course at a major teaching hospital in Canada that is transforming nursing practice from a provider driven to a patient-focused approach. The experiential and reflective nature of the course offers opportunities for nurses to link theory with practice, to think critically and reflectively about their own values and beliefs and to translate that meaning into practice. The learning process reflects principles of adult learning based on Knowles andragogical model which differs from the traditional pedagogical model of teaching. The essence of andragogy is a constant unfolding process of discovery based on dialogue. Utilization of adult learning principles that support critical thinking and foster transformational change present an alternative to traditional ways of teaching and learning the art and science of nursing practice.

The relationship of stress, competitive anxiety, mood state, and social support to athletic injury.

STUDY OBJECTIVE: We examined the role of stress, competitive anxiety, mood state, and social support in athletic injury. Specifically, we hypothesized that athletes reporting high levels of stress, high competitive trait anxiety, negative mood state, and low social support would exhibit greater incidence of injury and injury severity. DESIGN AND SETTING: Correlational analysis. Major Canadian university. SUBJECTS: Voluntary sample, 55 male varsity athletes (42 football, 81% of the football team, and 13 rugby, 74% of the rugby team), ages 19-28 yr (x = 22). MEASUREMENTS: The inventories Sport Competition Anxiety Test (SCAT), Social Support Scale, Social Athletic Readjustment Rating Scale (SARRS), and Profile of Mood States (POMS) were administered. Internal consistency of the self- report measures was tested using Cronbach's alpha coefficient. Injury rate and severity were recorded by the head student therapist throughout the season. RESULTS: Correlational analyses performed using Pearson correlational coefficient revealed that competitive anxiety (r = .29, p = .03) and tension/anxiety mood states (r = .43, p = .001) were related to injury frequency, and that tension/anxiety (r = .44, p = .008), anger/hostility (r = .30, p = .02), and total negative mood state (r = .28, p = .038) were related to injury severity. Individually, the two sports yielded somewhat different results: for football, injury frequency and injury severity were related to tension/ anxiety (r = .43, p = .004 and r = .47, p = .002, respectively). Vigor/activity was found to be significantly related to injury rate (p = .02), but since the internal consistency of vigor/activity was less than .70 on the Cronbach alpha scale, this significant finding was disregarded. In rugby, injury frequency was related to tension/anxiety (r = .58, p = .04) and depression/ dejection (r = .57, p = .04). CONCLUSIONS: These findings are useful for athletic trainers in identifying athletes who may possess psychological factors predisposing them to athletic injury. Subsequently, athletic trainers can instruct these athletes or refer them for assistance in psychological preventive interventions.

Returning injured athletes to competition: a role and ethical dilemma.

This study investigated the extent to which decisions by coaches and athletic trainers concerning the return of injured athletes to competition were influenced by the player's status and the game situation. Samples were drawn from Oregon high school and Canadian university basketball teams. Coaches and athletic trainers completed a questionnaire in which they decided whether an injured player should be returned to competition. The scenarios included winning, losing, or close games and involved a starter, first substitute, or bench player. Chi-square analyses revealed that coaches made decisions based on both a player's status and the game situation. In contrast, athletic trainers' decisions were not significantly influenced by these variables. Since the role of the coach seemingly makes it difficult to make health related decisions concerning injured players, athletic trainers should be responsible for such decisions.

Glycoconjugate with terminal alpha galactose. A property common to basal cells and a subpopulation of columnar cells of numerous epithelia in mouse and rat.

Glycoconjugates associated with the basal cell layer of various types of epithelia in the mouse and rat were examined histochemically with a battery of lectin-horseradish peroxidase (HRP) conjugates of differing sugar binding specificities. Basal cells in paraffin sections of composite tissue blocks stained with an isolectin from Griffonia simplicifolia (GSA I-B4) specific for terminal alpha-galactose residues but failed to react with the other lectins. Basal cells in epithelium lining striated and excretory ducts of salivary and lacrimal glands, tongue, esophagus, trachea, renal calyx, ureter, urinary bladder, urethra, epididymis and vas deferens stained selectively and intensely for content of a glycoconjugate with terminal alpha-galactose. This galacto-conjugate appeared associated with the plasmalemma of basal cells. Basal cells with a galactocalyx formed an intermittent to continuous layer generally increasing in prevalence distally in glandular duct systems. A minor population of pyramido-columnar cells with cytosolic GSA I-B4 reactivity occurred in striated ducts and appeared less numerous in intralobular excretory ducts and more prevalent in extraglandular ducts. In trachea and renal pelvis, the GSA I-B4 positive cell profiles ranged from low cuboidal to tall pyramidal in contour, but the latter appeared not to reach the lumen. In contrast, no GSA I-B4 positive basal cells were seen in any segment of the pancreatic or bile ducts or in the epithelium of the gastrointestinal tract. These findings suggest that the basal cells found in similar sites in different epithelia and possessing in common a unique alpha-galactoconjugate may function in a manner common to all and not simply in providing progenitor cells for epithelial renewal.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyloric regurgitation and gastric ulcer.

Using a radiological test for pyloric regurgitation described by Capper, Airth, and Kilby (1966), it was confirmed that the pylorus is normally competent but incompetent in gastric ulcer and chronic alcoholic gastritis and often incompetent in chronic duodenal ulcer. The significance of pyloric regurgitation in the aetiology of gastric ulcer is discussed.