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Ashlyn A Stackhouse,1,&ast; Damir Rafi,1,&ast; Risheka Walls,1,2 Rebecca V Dodd,1 Kerry Badger,1 Daniel J Davies,1 Celia A Brown,3 Adrian Cowell,1 Karim Meeran,1 Omid Halse,1 James Kinross,4 Martin Lupton,1 Elizabeth A Hughes,5 Amir H Sam1 1Imperial College School of Medicine, Imperial College London, London, UK; 2Imperial College Healthcare NHS Trust, London, UK; 3Warwick Medical School, Department of Medicine, Warwick, UK; 4Department of Surgery and Cancer, Imperial College London, London, UK; 5Health Education England, London, UK&ast;These authors contributed equally to this workCorrespondence: Amir H Sam, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan’s Road, London, W6 8RP, UK, Tel +442075895111, Email a.sam@imperial.ac.ukObjective: This study compared knowledge attainment and student enjoyment and engagement between clinical case vignette, patient-testimony videos and mixed reality (MR) teaching via the Microsoft HoloLens 2, all delivered remotely to third year medical students. The feasibility of conducting MR teaching on a large scale was also assessed.Setting & Participants: Medical students in Year 3 at Imperial College London participated in three online teaching sessions, one in each format. All students were expected to attend these scheduled teaching sessions and to complete the formative assessment. Inclusion of their data used as part of the research trial was optional.Primary and Secondary Outcome Measures: The primary outcome measure was performance on a formative assessment, which served to compare knowledge attainment between three forms of online learning. Moreover, we aimed to explore student engagement with each form of learning via a questionnaire, and also feasibility of applying MR as a teaching tool on a large scale. Comparisons between performances on the formative assessment between the three groups were investigated using a repeated measures two-way ANOVA. Engagement and enjoyment were also analysed in the same manner.Results: A total of 252 students participated in the study. Knowledge attainment of students using MR was comparable with the other two methods. Participants reported higher enjoyment and engagement (p< 0.001) for the case vignette method, compared with MR and video-based teaching. There was no difference in enjoyment or engagement ratings between MR and the video-based methods.Conclusion: This study demonstrated that the implementation of MR is an effective, acceptable, and feasible way of teaching clinical medicine to undergraduate students on a large scale. However, case-based tutorials were found to be favoured most by students. Future work could further explore the best uses for MR teaching within the medical curriculum.Keywords: medical education, augmented reality, online learning

The objective of this investigation was to study the relationship of the ghost cell ameloblastoma (GCA), which is a form of type II calcifying odontogenic cyst (COC), to the adamantinomatous craniopharyngioma (ACP). H&E sections of 26 examples of ACP were compared to three cases of GCA and to the reported microscopic features of that tumor. Clinical records of the ACPs were studied to determine their biologic behavior compared to that of the ameloblastomas. Immunohistochemical studies of nine examples of ACP were performed for KL1 (high mol.wt cytokeratins), 5D3 (low mol.wt cytokeratins) and involucrin (characteristic of terminally differentiated keratinocytes) using the peroxidase-antiperoxidase method. The results were compared with those reported for COC and ameloblastoma. ACP and GCA exhibited similar microscopic features, including pre-ameloblasts, tissue resembling stellate reticulum, ghost cells and calcifications; both tumors grew slowly and were invasive. ACP and COC, and by interpolation GCA, exhibited similar features with all three antibodies. The ghost cells did not exhibit any immunoreactivity but the adjacent cells stained positively for involucrin. The immunological features of ACP were similar to those reported in ameloblastomas for squamous differentiation. However, because of their rarity, no ameloblastomas exhibiting keratinization, including ghost cells, have yet been studied with these antibodies. We conclude that ACP and GCA are homologous lesions. [ABSTRACT FROM AUTHOR]

Background: Epidermolysis bullosa (EB), characterized by skin fragility and blistering, often requires hospitalization. Training for inpatient management of EB is limited, with no unified recommendations available in North America., Objective: To develop consensus-derived best practices for hands-on inpatient management of EB in both the neonatal and postneonatal period., Methods: A modified Delphi method (expert-based input via 2 surveys and a final review) was implemented. Available guidelines from EB Clinical Research Consortium centers were analyzed to determine areas of focus and formulate statements to be voted on by EB Clinical Research Consortium members, experienced EB nurses, and select family members. Study participants evaluated statements using a Likert scale: statements with at least 70% agreement were accepted; statements with 30% or more disagreement were rejected., Results: Ten areas of focus were identified. Delphi participants included 15 dermatologists, 8 nurses, and 6 nonhealth care caregivers. Consensus was established on 103/119 neonatal statements and 105/122 postneonatal statements; no statements were rejected. Most recommendations applied to both age groups., Limitations: Recommendations may require adjustment based on individual patient's clinical context., Conclusion: Using the Delphi method, a consensus-derived resource for hospital-based health care professionals who manage patients with EB has been developed to improve the quality of inpatient care., Competing Interests: Conflicts of interest Dr Garcia-Romero has received the EBCRC grant and has been a speaker for Cerave Latinamerica and Carnot Mexico Laboratories. Dr Price’s’ conflicts of interest are Aegle (PI clinical trial), Rheacell (PI clinical trial) Krystal Biotech (consultant). Dr Perman has served as a consultant for Abeona. Dr Lucky has served as investigator for Krystal Pharma and Phoenicis. Dr McCuaig’s conflicts of interest are AbbVie, Bausch, Boehringer, Galderma, Incyte, J&J, Eli Lilly, Leo, Novartis, Oreal Pfizer, Sanofi, and Sun. Dr Gorell has served as a consultant for Krystal Biotech, Abeona Therapeutics, and Amryt Pharma. Dr Levy’s conflicts of interest are Abeona, Castle Creek, Krystal, and Rheacell. Dr Bruckner’s conflicts of interest are Abeona (consultant), Amryt (consultant and investigator), Castle Creek (consultant and investigator), Krystal Biotech (consultant), Phoenix Tissue Repair (investigator), Phoenicis (investigator), Rheacell (investigator), and TWi Bio (consultant). Dr Paller has been an investigator for AbbVie, Applied Pharma Research, Dermavant, Eli Lilly, Incyte, Janssen, Krystal, Regeneron, and UCB; a consultant for Aegerion Pharma, Azitra, BioCryst, Boehringer-Ingelheim, Bristol Myers Squibb, Eli Lilly, Janssen, Johnson & Johnson, Krystal, LEO Pharma, Novartis, Primus, Regeneron, Sanofi/Genzyme, Seanergy, TWI Biotechnology, and UCB; and on the data safety monitoring board for AbbVie, Abeona, Catawba, Galderma, and InMed., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

A new strategy is presented for computing anharmonic partition functions for the motion of adsorbates relative to a catalytic surface. Importance sampling is compared with conventional Monte Carlo. The importance sampling is significantly more efficient. This new approach is applied to CH 3 * on Ni(111) as a test case. The motion of methyl relative to the nickel surface is found to be anharmonic, with significantly higher entropy compared to the standard harmonic oscillator model. The new method is freely available as part of the Minima-Preserving Neural Network within the ADTHERM package.

Purpose: Delivering fair and reliable summative assessments in medical education assumes examiner decision making is devoid of bias. We investigated whether candidate racial appearances influenced examiner ratings in undergraduate clinical exams., Methods: We used an internet-based design. Examiners watched a randomised set of six videos of three different white candidates and three different non-white (Asian, black and Chinese) candidates taking a clinical history at either fail, borderline or pass grades. We compared the median and interquartile range (IQR) of the paired difference between scores for the white and non-white candidates at each performance grade and tested for statistical significance., Results: 160 Examiners participated. At the fail grade, the black and Chinese candidates scored lower than the white candidate, with median paired differences of -2.5 and -1 respectively (both p  < 0.001). At the borderline grade, the black and Chinese candidates scored higher than the white candidate, with median paired differences of +2 and +3, respectively (both p  < 0.001). At the passing grade, the Asian candidate scored lower than the white candidate (median paired difference -1, p  < 0.001)., Conclusion: The racial appearance of candidates appeared to influence the scores awarded by examiners, but not in a uniform manner.

Violence against adolescents is a pressing health problem with long-term implications for future physical and mental well-being, such as thoughts of self-harm, which have been associated with suicidal ideation and completion. However, much of the research has been conducted only in high-income countries. This study aimed to examine the correlation between violence against adolescents and self-harm thoughts in La Romana, Dominican Republic (DR). Cross-sectional survey data was collected at a community-based clinic from participants aged 13-20. Participants were recruited through the clinic's adolescent program and peer referral, and verbal consent was obtained. A survey solicited information about each participant's demographics, experiences with violence, and thoughts of harm to self or others. The survey was completed by 49 adolescents. The mean age was 16.78 (SD 2.34); 65% were female. We performed t-tests and Fisher's exact to investigate the relationship between demographics, reported violence experiences and having self-harm thoughts. About half (45%) had experienced physical violence, 76% had experienced emotional violence, and 12% had experienced sexual violence. The most common perpetrators of physical and emotional violence were classmates (12% and 24%), and the most common perpetrator of sexual violence was an ex-partner (4.1%). Ten participants (20.4%) had thought about harming themselves. Self-harm thoughts were significantly associated with being female (p = 0.025), employed (p = 0.05), and to a higher number of experiences of physical (0.029) and sexual violence (p = 0.023). The results of this study suggest a high prevalence of both violence and self-harm thoughts in adolescents in the DR. Interventions that address physical and sexual violence against adolescents may be particularly important. Particular attention should also be paid to screening for self-harm thoughts in female-identifying adolescents. Further research is needed to better understand the relationship between violence and self-harm thoughts in adolescents in the DR., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Badger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life., Methods: This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature., Results: This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted., Conclusions: Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition., (© 2023. Institut National de la Santé et de la Recherche Médicale (INSERM).)

Background: The pathophysiological processes underlying the phenotypic spectrum of severe forms of epidermolysis bullosa (EB) are complex and poorly understood., Objective: To use burden mapping to explore relationships between primary pathomechanisms and secondary clinical manifestations in severe forms of EB (junctional and dystrophic EB [JEB/DEB]) and highlight strengths and weaknesses in evidence regarding the contribution of different pathways., Methods: Literature searches were performed to identify evidence regarding the pathophysiological and clinical aspects of JEB/DEB. Identified publications and clinical experience were used to construct burden maps to visually communicate plausible connections and their relative importance by subtype., Results: Our findings suggest that most of the clinical consequences of JEB/DEB may result from an abnormal state and/or faulty skin remodeling driven by a vicious cycle of delayed wound healing, predominantly mediated through inflammation. The quantity and quality of evidence varies by individual manifestations and disease subtype., Limitations: The burden maps are provisional hypotheses requiring further validation and are limited by the published evidence base and subjectivity in clinical opinion., Conclusions: Delayed wound healing appears to be a key driver of the burden of JEB/DEB. Further studies are warranted to understand the role of inflammatory mediators and accelerated wound healing in patient management., Competing Interests: Jemima E. Mellerio has undertaken paid consultancy and speaker for Amryt Pharmaceuticals DAC and Krystal Biotech Inc. Dimitra Kiritsi has undertaken paid consultancy for Amryt Pharmaceuticals DAC, Rheacell GmbH and FibRx Derm Inc; is a founder at Crowd Pharma GmbH. M. Peter Marinkovich has undertaken paid consultancy for Amryt Pharmaceuticals DAC; and is an investigator for Krystal Biotech Inc, Abeona Therapeutics Inc and Castle Creek Biosciences, through funding administered by Stanford University Office of Sponsored Research. Natividad Romero Haro has undertaken paid consultancy for Amryt Pharmaceuticals DAC, Kellie Badger has undertaken paid consultancy for Amryt Pharmaceuticals DAC, Meena Arora is an employee at Amryt Pharmaceuticals DAC. Marc A. Dziasko has undertaken paid consultancy services to Amryt Pharmaceuticals DAC. Mansi Vithlani has undertaken paid consultancy services to Amryt Pharmaceuticals DAC. Anna E. Martinez has undertaken paid consultancy for Amryt Pharmaceuticals DAC., (© 2023 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.)

Committee work is a requisite job function for many in academia, yet designing a productive collaborative experience often remains a challenge. In this article, we reflect on our experiences as part of a successful cross-institutional working group and describe strategies to improve leadership structure, group dynamics, accountability, and incentives for collaborative projects. As of January 2023, the National Institutes of Health (NIH) Data Management & Sharing (DMS) Policy requires investigators applying for funding to submit a Data Management and Sharing Plan (DMS Plan) that describes how scientific data will be managed, preserved, and shared. In response to this new policy, a community of more than 30 librarians and other research data professionals convened the Working Group on NIH DMSP Guidance, collaboratively producing comprehensive guidance about the policy for researchers and research support staff. In less than a year, the working group produced glossaries of NIH and data management jargon, an example data management and sharing plan, a directory of existing example plans, checklists for researchers and librarians, and an interactive repository finder. This group was a successful grassroots effort by contributors with diverse expertise and backgrounds. We discuss practical strategies for each stage of activity throughout the lifecycle of the working group; from recruiting members, designing pathways to encourage participation from busy professionals, structuring the meetings to facilitate progress and productivity, and disseminating final products broadly. We invite fellow librarians, data professionals, and academics to apply and build upon these strategies to tackle cross-institutional challenges., Competing Interests: Competing Interests The authors declare that they have no competing interests.

Background: As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to explore the relationship between the processes, context, participant experiences and impacts of the programme so that lessons can be learned for future emergencies and service-learning programmes., Methods: Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This explored differences in experience across demographics and contextual factors, correlations between aspects of induction, supervision and overall experience, and reviewed the impacts of the programme. Quantitative responses were statistically analysed and qualitative reflections were thematically coded to triangulate and explain quantitative findings. Follow up interviews were carried out to check back findings and co-create conclusions., Results: We received responses from 61 students and 17 supervisors. Student participants described predominantly altruistic motivations and transformational changes to their professional identity driven by feeling included, having responsibility, and engaging in authentic workplace-based learning afforded by freedom from the assessed curriculum. They reported new perspectives on their future professional role within the multidisciplinary team and the value of workplace-based learning. They reported increases in wellbeing and self-esteem related to feeling included and valued, and positively contributing to service provision at a time of need. Significantly higher overall satisfaction was associated with a personalised induction, active supervision, earlier stage of training, and male gender. Gender-related differences were not explained through our data but have been reported elsewhere and warrant further study. The duration, intensity and type of role that volunteers performed was similar across demographics and did not appear to modulate their overall experience., Conclusions: Whilst acknowledging the uniqueness of emergency volunteering and the survey response rate of 15% of volunteers, we suggest the features of a successful service-learning programme include: a learner-centred induction, regular contact with engaged and appreciative supervisors, and roles where students feel valued. Programmes in similar settings may find that service learning is most impactful earlier in medical students' training and that students with altruistic motivations and meaningful work may flourish without formal outcomes and assessments., (© 2021. The Author(s).)

Persons who come close to death but survive catastrophic accidents sometimes report very vivid experiences during times when their survival was in doubt, when they were believed to be dead, and during resuscitation efforts. This qualitative study builds upon existing research on near-death experiences (NDEs) by focusing on the oral accounts from a sample of individuals with large and life-threatening burns. The NDE accounts were obtained from burn survivors attending the Phoenix Society's World Burn Congress and are similar to reports by notable researchers ( Greyson, 2003 ; Moody, 1975 ; Ring, 1980 ) while reflecting the uniqueness of the individual survivor's experiences. Six major themes are reported. Counselors and health professionals need to be aware of and educated about NDEs as these experiences can have profound effects upon the individual. Patients who have had NDEs may need to discuss them but fear professionals will reject their stories as being crazy.

Burn recovery includes addressing any emotional, psychological, and social needs of the survivor and family. Providing support and resources is essential for a smooth transition from the acute phase of injury to rehabilitation and successful social and community reintegration. Priority psychosocial target areas are developing social skills, addressing body image concerns, and providing peer support. Peer support provides a unique perspective of shared experience that can instill hope and assist coping efforts of survivors and family. Health care professionals can be instrumental in connecting survivors to community support organizations. Discussed are considerations for aftercare planning and peer support's role., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Survivors of large burns may face positive and negative psychological after-effects from close-to-death injuries. This study is the first to examine their near-death experiences (NDEs) and posttraumatic growth (PTG) and life satisfaction afterwards. With an available sample of 92 burn survivors, half met the criteria for an NDE using an objective scale. Those who indicated religion was a source of strength and comfort had high scores on life satisfaction, PTG, and the NDE Scale. Individuals with larger burns reported greater PTG than those with smaller total body surface area burned (TBSA). There were no significant differences on life satisfaction, PTG, or NDEs when examined by gender or years since the burn injury. Elements of the NDE most frequently reported were: An altered sense of time, a sense of being out of the physical body, a feeling of peace, vivid sensations, and sense of being in an "other worldly" environment. Social workers and other health providers need to be comfortable helping burn survivors discuss any NDEs and process these through survivors' spirituality and religious belief systems as they recover.

A new consensus-based classification of congenital melanocytic nevi (CMN) has recently been proposed. It includes categories for projected adult size (PAS) and location, satellite nevi counts, and morphologic characteristics (color heterogeneity, rugosity, nodularity, and hypertrichosis). The objective of the current study was to test the applicability of the new categorization scheme and to correlate classification outcome with the patient's history of melanoma and neurocutaneous melanocytosis (NCM). Children and adults with CMN attending a patient conference in Dallas, Texas, in 2012 were invited to participate in the study. Anamnestical data were collected using a standardized questionnaire. Two dermatologists performed clinical examinations. Of 45 patients enrolled, 33 had a giant CMN (G1 [>40 cm PAS], n = 13; G2 [>60 cm PAS], n = 20), 12 had an NCM (5 symptomatic, 7 asymptomatic), and 1 had a history of melanoma. CMN size was positively correlated with NCM (p < 0.05). The classification system allowed an easy and detailed phenotypic characterization of each individual CMN. CMN size and morphology were difficult to assess in patients after surgical removal, and the number of satellite nevi at birth or during infancy was not always known. Our report provides practical aids for the application of the newly proposed CMN classification. Prospective evaluation of accurately classified patients in CMN registries will reveal the predictive value of the scheme. The small study sample limits meaningful conclusions regarding the correlation between CMN parameters and the risk of NCM and melanoma., (© 2014 Wiley Periodicals, Inc.)

Objective: Students with active duty military experience are a unique and growing population on college campuses in the United States. This study explores student veterans' perceptions of their transition to and experience in higher education., Method: This mixed methods study used a sample of 10 active military and reserve component student veterans to explore their perceptions of their personal strengths, challenges, factors impacting participation in university resource programs, and suggestions for ideal resources to support their academic success., Results: Content analysis yielded primary themes such as the strength of self-discipline, the challenge of social interactions, and the desire for programs that connect student-veterans and assist with social integration., Conclusion: Implications for education, retention, and transition from active duty are discussed.

Compassion is vital in burn care. Its delivery could be considered a professional duty and a characteristic of care that affects patient satisfaction. However, the description of compassionate care is underexplored in the burn care literature. This study investigates the concept of compassionate care and how it is described from the perspective of the burn survivor. A qualitative design with two focus groups at the Phoenix Society for Burn Survivors' World Burn Congress was used to examine views of compassionate care directly through 31 burn survivors' accounts to better understand the concept and its delivery within the context of burn care. Discussions were recorded and transcripts were analyzed for prominent themes and descriptive components. Participants were primarily Caucasian (77%), female (60%), with an average age of 47.6 years and an average TBSA burn of approximately 49% sustained approximately 12 years ago. Qualitative data analysis yielded primary themes of: 1) respect the person (subthemes were: establishing an empathic connection, restoring control through choice, providing individualized care, and going above and beyond), 2) communication (subthemes: interpersonal and informational), and 3) provision of competent care. The three primary themes were components of compassionate care; it was not defined by a single characteristic, behavior, or skill but might be best understood as the convergence of the three themes. Implications of findings and barriers to the provision of compassionate care are also discussed.

Objectives: To describe participants' experiences with training on, and implementation of, a collaborative care mental health approach for treating depression and anxiety in post-disaster New Orleans., Design: Healthcare providers from three organizations that participated in the Mental Health Infrastructure and Training (MHIT) program underwent semi-structured interviews., Setting: The MHIT program provided training and clinical support to community-based agencies., Participants: Social workers, care/case managers, primary care providers, and a psychiatrist that participated in trainings., Intervention: The MHIT project consisted of a series of trainings and clinical support designed in collaboration with specialists from Tulane University, RAND/UCLA, the University of Washington, and local community organizations with the goal of creating local resources to provide screening, diagnosis, triage, and treatment for depression and anxiety., Main Outcome Measures: Interview participants were asked to describe the impacts of training on the following areas: delivery of mental health services, ability to implement elements of the collaborative care model, care of clients/patients, and development of networks., Results: Interview transcript analysis identified themes highlighting the opportunities and challenges of implementing a collaborative care model., Conclusion: Implementation of a collaborative care model for treating depression and anxiety was possible in post-Katrina/Rita New Orleans and has potential for implementation in future post-disaster recovery settings.

Story-telling has been found to be beneficial following trauma, suggesting a potential intervention for burn survivors who frequently make use of? telling their story? as part of their recovery. This study is the first to examine the word content of burn survivors' Web-posted narratives to explore their perceptions of the event, supportive resources, their post-burn well-being, and re-integration using a comparison group and a text data analysis software developed by the widely recognized James Pennebaker. Suggestions for using expressive writing or story-telling as a guided psychosocial intervention with burn survivors are made.

Burns require psychosocial healing in addition to physical recovery as survivors face challenges such as scarring and altered appearance. An adjunct to interventions provided by social workers and other professionals is peer support from fellow burn survivors. But how do burn survivors view this intervention? This study examined a sample of burn survivors to learn about their views of peer support and the services of a national burn survivor organization. Outcome variables were explored relative to survivors' views of peer support to gauge its influence on psychosocial recovery. Findings suggest peer support is a promising resource in burn rehabilitation warranting further investigation.

This qualitative study examined 30 burn survivors' perceptions of the value of peer support in their own psychosocial rehabilitation. Little research is available that investigates the role of peer support in post-burn recovery in terms of perceived benefits and costs. Findings revealed strong positive views regarding the helpfulness of peer support. Burn survivors reported that peer supporters provided a sense of belonging and affiliation and gave hope and confidence. Two-thirds of the sample had served as peer supporters themselves after receiving their injuries, suggesting that mutual aid does involve reaching out to others. At the same time, survivors spoke of possible costs in helping others. Involving peer supporters in the psychological rehabilitation of burn survivors may be an important complement to the medical team.

This study investigated the development of a caring value orientation in four age groups. The sample included 1,247 students in grades 6, 8, 10, and 12 who were asked to complete a questionnaire, containing 14 contrasting word pairs and phrases, designed to measure preference for more caring, personal values. Gender differences were found across age groups and geographic regions. These findings are discussed in terms of theories that hypothesize gender differences in worldview.

In the competitive health care market of the 1990s, health care institutions face a significant number of fiscal challenges that threaten their survival. As part of the survival process, institutions must demonstrate--to the public and to regulatory agencies--that they are measuring the effect of their care structures and processes. Institutions must be willing to share these measurements with the public as well as to use them internally to identify performance problems and document the impact of process improvements or other changes. The report card is a simple, easily understood method for reporting quality data and comparing varying aspects of patient care processes and outcomes. However, as measurements, report cards are not robust enough to serve as the sole source of quality-related data, and interinstitutional comparisons may be misleading. This article explores the new phenomenon known as patient care report cards and discusses their usage in quality measurement and improvement.

Do automated wellness programs hold out the promise of improving the health of individuals and populations through the establishment of baseline wellness checkpoints? Nurse case managers have a strong interest in this question. The automation of wellness programs and the integration of this information into the continuum of a care information system model offers ongoing, interactive accountability of individual health status. The crowning glory will be the ultimate integration of the individual's personal health game plan with the provider's continuum of care offering. The strength of the nursing profession lies in its traditional role of promoting health through preventive measures (public health nursing) and managing the ill patient's progress toward his/her optimal health status. Therefore, nurses and nurse case managers should embrace wellness programs and wellness data availability. Because of their experience in using and understanding wellness data, nurses are in a unique position. Not only will they be able to assimilate rapidly the use of wellness data into their own practice, they also will be able to guide other professionals in its use. The table in this articles provides examples of the impact that automated wellness program data could have at various stages of the clinical decision-making process.

The selection and implementation of a clinical information system that provides meaningful patient data in a format that is usable by the clinician is a challenge facing many healthcare institutions. In the first issue of Nursing Case Management, we explored the information needs of the nurse case manager and the available and emerging computerized information systems tools to meet these specific needs. This follow-up article will focus on a typical clinical information system selection process; outline specific ways the nurse case manager can effectively influence that process; and provide examples and a checklist that will enable the nurse case manager to assist the institution in selecting and implementing the most appropriate system.

Regardless of the setting, the role of the nurse as a manager of care continues to grow and develop. The nurse case manager needs to have vital information readily available to facilitate critical thinking, analysis, and decision-making on the appropriateness of care provided to patients and to ensure that optimal outcomes are achieved. While there are a variety of clinical information systems available, it is evident that the complexity of the case manager's information needs presents challenges for software developers. Accordingly, nurse case managers must take an active role in defining and communicating their needs. The purpose of this article (the first of two) is to present a general overview of the information needs of the nurse case manager and the computerized information system tools available (and emerging) to meet these needs. A follow-up article in the next issue of Nursing Case Management will focus on a typical clinical information system selection process; outline specific ways the nurse case manager can effectively influence that process; and provide a checklist that will enable the nurse case manager to assist the institution in selecting and implementing the most appropriate system.