Quality of analgesic treatment in patients with advanced prostate cancer: do we do a better job now? The Swiss Group for Clinical Cancer Research (SAKK) experience

GOALS OF WORK: The aim of this study was to evaluate pain intensity and the application of the WHO guidelines for cancer pain treatment in patients with prostate cancer treated at Swiss cancer centers. MATERIALS AND METHODS: We analyzed a series of five multicenter phase II clinical trials which examined the palliative effect of different chemotherapies in patients with advanced hormone-refractory prostate carcinoma. Of 170 patients, 1,018 visits were evaluable for our purpose, including ratings of pain intensity by patients and prescribed analgesics. MAIN RESULTS: No or mild pain was indicated by patients in 36 to 55% of the visits, more than mild pain in 30 to 46%. In 21% of the visits, the WHO pain treatment criteria (treatment according to one of the three steps; oral, rectal or transdermal application of the main dose; administration on a regular schedule) were fulfilled, and the Cleeland index was positive according to all recommendations. In 6% of the visits, neither the WHO criteria were fulfilled nor was the Cleeland index positive. This indicates insufficient pain treatment not following the WHO guidelines and that the prescribed analgesics were not sufficiently potent for the rated pain intensity. CONCLUSIONS: In this selective Swiss sample, the standard of analgesic treatment is high. However, there is still scope for improvement. This cannot solely be solved by improving the knowledge of the physicians. Programs to change the patients' attitude towards cancer pain, training to improve the physicians' communication skills, and institutional changes may be promising strategies.

Gender differences in the association of a high quality job and self-esteem over time: A multiwave study

High self-esteem often predicts job-related outcomes, such as high job satisfaction or high status. Theoretically, high quality jobs (HQJs) should be important for self-esteem, as they enable people to use a variety of skills and attribute accomplishments to themselves, but research findings are mixed. We expected reciprocal relationships between self-esteem and HQJ. However, as work often is more important for the status of men, we expected HQJ to have a stronger influence on self-esteem for men as compared to women. Conversely, task-related achievements violate gender stereotypes for women, who may need high self-esteem to obtain HQJs. In a 4-year cross-lagged panel analysis with 325 young workers, self-esteem predicted HQJ; the lagged effect from HQJ on self-esteem was marginally significant. In line with the hypotheses, the multigroup model showed a significant path only from self-esteem to HQJ for women, and from HQJ to self-esteem for men. The reverse effect was not found for women, and only marginally significant for men. Overall, although there were some indications for reciprocal effects, our findings suggest that women need high self-esteem to obtain HQJs to a greater degree than men, and that men base their self-esteem on HQJs to a greater extent than women.

Quality of life of grown-up congenital heart disease patients after congenital cardiac surgery

BACKGROUND: Due to better early and long-term outcome, the increasing population of grown-ups with congenital heart disease (GUCH) brings up unexpected quality of life (QoL) issues. The cardiac lesion by itself is not always the major problem for these patients, since issues pertaining to QoL and psychosocial aspects often predominate. This study analyses the QoL of GUCH patients after cardiac surgery and the possible impact of medical and psychosocial complications. PATIENTS AND METHODS: A questionnaire package containing the SF-36 health survey (health related QoL), the HADS test (anxiety/depression aspects) and an additional disease specific questionnaire was sent to 345 patients (mean 26+/-11 years) operated for isolated transposition of the great arteries (TGA), tetralogy of Fallot (TOF), and ventricular septal defect (VSD). The scores were compared with age- and gender-matched standard population data and in relation to the underlying congenital heart disease (CHD). RESULTS: In all SF-36 and HADS health dimensions the GUCH patients showed excellent scores (116+/-20), which are comparable to the standard population (100+/-15), regardless of the initial CHD (p=0.12). Eighty-two percent of the patients were found to be in NYHA class I and 83% patients declared that they do not consider their QoL to be limited by their malformation. Complications like reoperations (p=0.21) and arrhythmias (p=0.10) do not show significant impact on the QoL. The additional questionnaire revealed that 76% of adult patients have a fulltime job, 18% receive a full or partial disability pension, 21% reported problems with insurances, most of them regarding health insurances (67%), and 4.4% of adult patients declared to have renounced the idea of having children due to their cardiac malformation. CONCLUSION: QoL in GUCH patients following surgical repair of isolated TOF, TGA and VSD is excellent and comparable to standard population, this without significant difference between the diagnosis groups. However, these patients are exposed to a high rate of complications and special psychosocial problems, which are not assessed by standardized questionnaires, such as the SF-36 and HADS. These findings highlight the great importance for a multidisciplinary and specialized follow-up for an adequate management of these complex patients.

Panel report ECIS 2012: publication strategy for junior researchers: quantity vs. quality, importance of the first authorship and collaboration

The publication record is a key component of a successful academic career in IS. Despite its importance, its definition - especially for junior researchers―remains unclear. Is it better to have one A-publication or three Bpublications? Does being the third author on an A-publication carry more weight than being the first author on a Bpublication? Is it better to publish with as few co-authors as possible to demonstrate ability for independent work or is publishing with others a sign of good teamwork and academic excellence? Faced with these uncertainties, young researchers increasingly question the choices they make regarding their publication strategy. If unaddressed, these issues are bound to interfere with the quality of the IS research and scholars’ job satisfaction. This article raises these concerns associated with a publication strategy for junior researchers and reports the views voiced by five academics at a panel session at the European Conference on Information Systems 2012. In particular, the following topics are discussed: quantity vs. quality, value of the first authorship, the “optimal” number of authors, and the issues of co-authorship with an academic supervisor.

Who gets the high quality jobs ten years after compulsory school?

Good work quality is crucial for employee well-being and health. Indicators of work quality are, among others, aspects of one’s work organization and learning opportunities. Based on the Job-Demands Control model we investigate if a) young employees are confronted with different combinations of job characteristics, b) cluster membership is predicted through socio-demographic and educational factors as well as positive self-evaluations and health, and c) cluster membership leads to different associations with job-related and general well-being. Based on TREE (Transition from Education to Employment) data we found three clusters of job characteristics, i.e. high resources – low demands, medium resources – medium demands, and low resources – high demands. Likelihood to be in a more favourable group was higher for females and young employees who reported more positive self-evaluations and higher learning efforts after compulsory school. Young employees in more favourable groups also reported higher levels of job-related and general well-being.

Leader–member exchange (LMX), job autonomy, and creative work involvement

Researchers have claimed that high quality of supervisor–employee relationships (i.e., leader– member exchange; LMX) fosters creativity at work. Moreover, researchers have acknowledged that this relationship is not clear-cut but rather complex. The present study focused on the moderating role of job autonomy in the LMX-creative work involvement relationship. Longitu-dinal field survey data (N = 144) collected in a high-technology firm revealed a positive asso-ciation between LMX and creative work involvement and confirmed our assumptions on the moderating role of job autonomy. The positive relationship between LMX and creative work involvement was stronger when employees experienced greater job autonomy. Our findings point to the importance of considering the interplay of both, the leader–member relationship and job design issues for increasing employees' creative work involvement.

Reciprocal Relationships between Leader–Member Exchange (LMX) and Job Satisfaction: A Cross‐Lagged Analysis

While previous research has mainly emphasised the importance of leader–member exchange (LMX) to job satisfaction, there is a lack of research on reciprocal relationships between job satisfaction and LMX. In this study, we not only suggest that good LMX increases job satisfaction, but that job satisfaction can also enhance high-quality supervisor–employee relationships. A full cross-lagged panel analysis was used to test reciprocal relationships between LMX and job satisfaction. Employees (N= 279) of a large information technology company filled out questionnaires at two times, with a time lag of 3 months. In line with our predictions, findings revealed a positive relationship between LMX and job satisfaction both at Time 1 and Time 2. Moreover, LMX at Time 1 predicted the increase of job satisfaction at Time 2, and job satisfaction at Time 1 predicted the increase of LMX at Time 2. The results demonstrate the need to consider reciprocal relationships between job satisfaction and LMX when explaining employees' workplace outcomes. Our findings are discussed in terms of positive psychology theory.

Job satisfaction of Swiss general practitioners with and without proficiency certificate in homeopathy

Introduction: Job satisfaction and therefore wellbeing of physicians is an important issue in high quality and safety of health care provision. The role of additional qualification in complementary medicine (CM) for job satisfaction of general practitioners (GPs), however, has not been explored. This study compared job satisfaction of conventional and homeopathic Swiss GPs. Methods: Participants of the Swiss Family Doctors Conference 2013 and members of the Swiss Association of Homeopathic Physicians participated in the survey. They indicated the extent of job satisfaction on 17 questions covering patient care, work-related burden, income-prestige, personal rewards, and professional relations. Results: Data of n = 125 GPs with homeopathic proficiency certificate and data of n = 143 GPs without any proficiency certificate in CM were analyzed. Overall job satisfaction was high and did not differ between the groups. However, due to lower number of patients per day, homeopathic GPs reported higher satisfaction in relations with patients and with workload, and lower satisfaction with income and in relations with peers compared to conventional GPs. Controlling for further confounding variables (e.g. working hours per week, practice setting), homeopathic GPs reported less satisfaction with their income than their conventional colleagues. Conclusions: Longer consultation time and lower number of patients homeopathic GPs see per day, may allowthem to unfold a deeper and more satisfying relationship with their patients and to lessen the workload. However, this comes along with financial discontent compared to conventional GPs. Certification in homeopathy and increased consultation time, respectively, may represent a way to enhance GPs’ job satisfaction.

Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women

STUDY QUESTION: What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women? SUMMARY ANSWER: Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery. WHAT IS KNOWN ALREADY: The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before. However, previous studies focus on medical benchmarks without including the patient's perspective in a quantitative manner. STUDY DESIGN, SIZE, DURATION: A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women diagnosed with endometriosis and with at least one specific laparoscopic surgery in the past were enrolled in the study. The study investigated the effect of the minimally invasive surgery on health and on quality of work life of affected women. Questions used were obtained from the World Endometriosis Research Foundation (WERF) Global Study on Women's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 587 women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%) were included in the study. Our data show that 62% (n = 130) of the study population declared endometriosis as influencing the job during the period prior to surgery, compared with 28% after surgery (P < 0.001). The mean (maximal) absence from work due to endometriosis was reduced from 2.0 (4.9) to 0.5 (1.4) hours per week (P < 0.001). The mean (maximal) loss in working performance after the surgery averaged out at 5.7% (12.6%) compared with 17.5% (30.5%) before this treatment (P < 0.001). LIMITATIONS, REASONS FOR CAUTION: The mediocre response rate of the study weakens the representativeness of the investigated population. Considering the anonymous setting a non-responder investigation was not performed. A bias due to selection, information and negativity effects within a retrospective survey cannot be excluded, although study-sensitive questions were provided in multiple ways. The absence of a control group (sham group; e.g. patients undergoing specific diagnostic laparoscopy without treatment) is a further limitation of the study. WIDER IMPLICATIONS OF THE FINDINGS: Our study shows that indicated minimally invasive surgery has a clear positive effect on the wellbeing and working performance of women suffering from moderate to severe endometriosis. Furthermore, national net savings in indirect costs with the present number of surgeries is estimated to be €10.7 million per year. In an idealized setting (i.e. without any diagnosis delay) this figure could be more than doubled. STUDY FUNDING/COMPETING INTERESTS: The study was performed on behalf of the University Hospital of Bern (Inselspital) as one of the leading Swiss tertiary care centers. The authors do not declare any competing interests.