Professional boundaries. A matter of therapeutic integrity

1. Establishing and maintaining boundaries creates a relational space in which the patient and nurse are able to explore treatment issues within the safety of the therapeutic relationship. 2. The therapeutic relationship in founded on the basis of trust, respect, and appropriate use of power. Understanding the power differential within the nurse patient relationship is critical to the establishment and maintenance of professional boundaries. 3. Therapeutic integrity is rooted in knowledge, experience, and clinical judgment. As such, there are not always clearly demarcated answers to the tough questions posed by the dilemmas in practice. 4. Questions arising from practice challenge nurses to reflect on the meaning of boundaries in their personal and professional lives.     

Evaluation results of a 21st birthday card program targeting high-risk drinking

The B.R.A.D. Birthday Card initiative was started on the campus of Michigan State University (MSU) in April 1999. MSU administrators send the safe-drinking 21st birthday card (B.R.A.D.) and laminated wallet card to students shortly before their 21st birthday. OBJECTIVE: To evaluate the effectiveness of the 21st birthday card, MSU and B.R.A.D., Inc, applied for and were awarded a 2-year US Department of Education grant in 2001. PARTICIPANTS: The authors surveyed 1,731 students within 2 weeks of their 21st birthday. METHODS: Of all students turning 21 years old during the study, the authors randomly selected students for each group. A control group received no card. All others received the standard B.R.A.D. card or a gender-tailored message card. RESULTS: Key findings include: 74% of students saved part of the card, 65% shared the card with family or friends, 22% reported thinking about the card during their celebration, 12% reported drinking less because of the card, 15% reported learning something new about alcohol poisoning, and 98% believed that MSU and B.R.A.D. should continue sending cards to students. CONCLUSIONS: Receiving, reading, and recalling the content of the B.R.A.D. card appears to reduce the total number of drinks a celebrant consumes.     

Sex Ratio Effects on Marital Formation and Dissolution, 1980–2000

Although marriage market characteristics are often used to explain in–out marriage transitions, Guttentag and Secord's sex ratio thesis provides a unique theoretical framework by which to elucidate marriage and divorce. The theory emphasizes the availability of “opposite” sex partners as an important factor, but hypothesized outcomes assume a gendered marriage market whereby males are more socioeconomically powerful than females. Using geographically standardized census tract data (N = 65,443), I examine the theory empirically across three decennial time points. After establishing that males, on average, hold a disproportionate amount of socioeconomic power, I conduct cross‐sectional regression analyses of marriage and divorce from 1980 to 2000. Results partially support the theory. While female marriage is consistently related to sex ratios as expected, sex ratios influence male marriage as expected only in some time periods and female and male divorce do not operate as expected in any time point. The findings imply that marriage entry and dissolution have distinctive causal mechanisms, suggesting the need for further theorization and research.     

On correcting measurement error in the persistence rate estimator

In the field of education, it is often of great interest to estimate the percentage of students who start out in the top test quantile at time 1 and who remain there at time 2, which is termed as “persistence rate,” to measure the students’ academic growth. One common difficulty is that students’ performance may be subject to measurement errors. We therefore considered a correlation calibration method and the simulation–extrapolation (SIMEX) method for correcting the measurement errors. Simulation studies are presented to compare various measurement error correction methods in estimating the persistence rate.     

A Bayesian method for safety signal detection in ongoing blinded randomised controlled trials

Sponsors have a responsibility to minimise risk to participants in clinical studies through safety monitoring. The FDA Final Rule for IND Safety Reporting requires routine aggregate safety evaluation, including in ongoing blinded studies. We are interested in estimating the probability that the true adverse event rate in the experimental arm exceeds that in the control arm. We developed a Bayesian approach that specifies an informative meta-analytic predictive prior on the event probability in the control arm and an uninformative prior on that in the experimental arm. We combined these priors with a mixture likelihood that considers each patient in the ongoing blinded study may belong to the experimental or control arm. This allowed us to estimate the quantity of interest without unblinding. We evaluated our method by simulation, pairing scenarios that differed only in whether a safety signal was present or missing, and quantifying the ability of our model to discriminate using signal detection theory. Our approach shows benefit. It detects safety signals more reliably with greater sample sizes and for common rather than rare events. Performance does not deteriorate markedly when historical studies exhibit heterogeneous hazards or non-constant hazards. Our method will allow us to monitor safety signals in ongoing blinded studies with the goal of earlier identification and risk mitigation. Our method could be adapted to use informative priors on both arms or predictive covariates where pertinent data exist. We stress that ongoing safety monitoring should involve a multi-disciplinary team where statistical methods are paired with medical judgement.