The Experience of Widowed Head of the family during Role Transition: A Qualitative Study

Introduction: Early widowhood causes an increase in stress and health risks in mothers. The objective of this study was to investigate life experiences of these women regarding being the head of the household and its consequences. Method: In this descriptive, exploratory study in-depth interviews were held with 24 widowed parents until achieving data saturation. The data were analyzed using the constant comparative method. Results: The results of data analysis were classified into four main categories: acceptance of the paradoxical identity of a guardian without a guardian, difficulties facing the female head of the household, contexts of difficulties, and female weariness. The subcategories of each category were also determined. Conclusion: The results indicate that lack of attention to widowed female head of the family, who continued to care for their children voluntarily and often in stressful situations, will have negative consequences. Therefore,, beside economical support, they also need the comprehensive support of their family during the process of role transition. Moreover, they need the support of social welfare and social healthcare delivery systems, especially community health nurses, in order to adapt positively to life after the death of their spouse. Keywords: Quality study, Role transition, Support, Widow-headed famil

Effect of gastrointestinal resection on sunitinib exposure in patients with GIST

Background: GIST patients often undergo GI-surgery. Previous studies have shown that imatinib and nilotinib exposures were decreased in GIST patients with prior major gastrectomy. We investigated whether major gastrectomy influences the exposure to sunitinib and its active metabolite SU12662. Methods: Pharmacokinetic data from 305 GIST patients included in 4 phase I-III trials were analyzed. Patients were subdivided into 6 groups according to their prior GI-surgery. Apparent clearance (CL/F) and dose-corrected steady-state plasma exposures (AUC24,ss) of sunitinib and SU12662 were estimated using a population PK approach. ANCOVA was performed to test for differences in AUC24,ss and CL/F between each surgery subgroup and controls. Results: Major gastrectomy did not influence sunitinib or SU12662 exposure. The geometric mean of sunitinib and SU12662 AUC24,ss was decreased by 21% and 28% in patients with both gastrectomy and small bowel resection (n = 8) compared to controls (n = 63) for sunitinib (931 ng*hr/mL (95%-CI; 676–1283) versus 1177 ng*hr/mL (95%-CI; 1097–1263); p < 0.05) and SU12662 (354 ng*hr/mL (95%-CI; 174–720) versus 492 ng*hr/mL (95%-CI; 435–555); p < 0.05). No significant differences in exposure were observed in each of the other subgroups versus controls. Conclusion: In contrast to previous results for imatinib and nilotinib, gastrectomy alone does not influence sunitinib or SU12662 exposure. This should be taken into account for the treatment of gastrectomized GIST patients with TKIs. In patients who had undergone both gastrectomy and small bowel resection, sunitinib and SU12662 exposures are significantly, although clinically not relevantly, decreased

Leadership and management curriculum planning for Iranian general practitioners

Introduction: Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern’s curriculum planning cycle. Methods: This study was conducted in 2011-2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern’s curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin’s method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14. Results: In the qualitatively stage of this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3.59. Other results were shown in the paper. Conclusion: Results of this study indicated the need to provide educational programs for GPs; it led to a systematic curriculum theory and clinical management using Kern cycle for general practitioner’s discipline. Implementation and evaluation of this program is recommended

The Nessesity and Quality of Management Education in MD Program in Iran: A Qualitative Study

Introduction: Leadership and management skills are intrinsic to medical care, but low attention has been paid to them in educational curriculum for general practitioners in many countries including Iran. This study, based on Kern’s curriculum planning cycle, has investigated key informants` experiences and point of views about necessity and quality of management education in order to develop management courses to be embeded in general practitioner educational curriculum. Methods: In this qualitative study, using content analysis and purposeful sampling, data were collected by 2 focus group discussions and 28 semi-structured interviews, with key informants in healthcare management and medical education, physician directors and organizational colleagues such as nurses, administrative and insurance experts, till data saturation was achieved in 2011. Sampling was done in Iranian medical sciences universities and Ministry of Health and Medical Sciences. Data was analysed using constant comparison based on Strauss and Corbin’s method. Results: After data analysis, 6 main categories emerged:Necessity of management courses for undergraduate medical students, Required Knowledge, Required Skills, Properties and objectives of the management course and its appropriate education setting, Educational strategies and methods, Evaluation and feedback methods. Conclusion: In addition to showing the necessity of formal inclusion of management courses in general practitioner curriculum, results of this study introduced the required educational settings and methods based on participants` experiences. Future studies are needed to examine the efficiency and detect the administrative problems involved

Academic training and clinical placement problems to achieve nursing competency

Introduction: High quality of care is one of the requirements of nursing which depends on the nursing competency. In this connection, the aim of this research was to determine the problems related to the academic training (nursing’ educational program) and clinical practice to achieve competency from the viewpoint of nurses, faculty members, and nursing students. Methods: The study was an analytical cross-sectional one. The sample consisted of the academic staff, the third and the fourth year nursing students and nurses in practice. The instrument of the study was a two-part researcher-made questionnaire with 22 questions in the theoretical- clinical realm to assess problems related to the theoretical and clinical teaching in nursing, and 23 questions to assess the clinical functions. The questionnaire was validated in terms of both face and content validity. Its reliability, using Cronbach’s Alpha coefficient, was 0.72 in the theoretical-clinical and 0.73 in the clinical realm. Both descriptive and analytical statistics were used to analyze the data, using SPSS software. Results: The results of this study indicated that from the participants’ viewpoints, the most important problems in the academic education for nurses to acquire competency were as follows: lack of academic research during the clinical period (88.9%), no application of theoretical aspects of the nursing process in practice (85.6%), insufficient knowledgeable and professional educators (81.1%), the use of traditional routine-oriented methods on the wards (75.6%); also insufficient time for performance based on knowledge in relation to the nurse’s workload (86.5%), weakness and usefulness of scientific function encouragement systems in clinic (85.2%), and learnt theoretical subjects not coming into practice in clinical fields after graduation (75.6%). Conclusion: Efforts to reduce the gap between the theoretical and practical (clinical function) knowledge in educational and work environment are required to improve the training of qualified nurses