"Mentor" is a term widely used in academic medicine but for which there is no consensus on an operational definition. Further, criteria are rarely reported for evaluating the effectiveness of mentoring. This article presents the work of an Ad Hoc Faculty Mentoring Committee whose tasks were to define "mentorship," specify concrete characteristics and responsibilities of mentors that are measurable, and develop new tools to evaluate the effectiveness of the mentoring relationship. The committee developed two tools: the Mentorship Profile Questionnaire, which describes the characteristics and outcome measures of the mentoring relationship from the perspective of the mentee, and the Mentorship Effectiveness Scale, a 12-item six-point agree-disagree-format Likert-type rating scale, which evaluates 12 behavioral characteristics of the mentor. These instruments are explained and copies are provided. Psychometric issues, including the importance of content-related validity evidence, response bias due to acquiescence and halo effects, and limitations on collecting reliability evidence, are examined in the context of the mentor-mentee relationship. Directions for future research are suggested.

A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. Recommended Citation Yeo, Theresa; Burrell, Sherry A; Sauter, Patricia K; Kennedy, Eugene P; Lavu, Harish; Leiby, Benjamin E; and Yeo, Charles, "A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients." (2012 Methods:One hundred and two patients with resected PPC consented to participate in this study and were randomized to either an Intervention Group (IG) or a Usual Care Group (UCG).Subjects completed visual analog scales, the FACIT-Fatigue Scale (FFS) and the Short Form36v2® after surgery and again 3 to 6 months after hospital discharge. Results:Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, pre-op fatigue and pain levels, adjuvant therapy and baseline walking distance. Patients in the IG had significantly improved scores on the FFS at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared to the UCG. Using hierarchical cluster analysis three mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG. Conclusion:This is the first prospective, randomized and controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients

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Pancreatic cancer affects 44,000 Americans and at least 250,000 individuals worldwide annually. The incidence is slowly increasing after a recent period of decline. Cases are predicted to increase globally because of increased longevity and the widespread adoption of cancer-causing behaviors, such as cigarette smoking, dietary indiscretion, and a global increase in diabetes. Well-known risk factors for pancreatic cancer are advancing age, tobacco smoking, obesity, certain inherited familial disorders, second-hand smoke exposure, chronic pancreatitis, and diabetes. Associations with human immunodeficiency virus, ABO blood group, hepatitis B virus, human immunodeficiency virus, and Helicobacter pylori have also been identified.

Heat stroke (HS) is a serious and potentially life-threatening condition defined as a core body temperature >40.6 degrees C. Two forms of HS are recognized, classic heat stroke, usually occurring in very young or elderly persons, and exertional heat stroke, more common in physically active individuals. An elevated body temperature and neurologic dysfunction are necessary but not sufficient to diagnose HS. Associated clinical manifestations such as extreme fatigue; hot dry skin or heavy perspiration; nausea; vomiting; diarrhea; disorientation to person, place, or time; dizziness; uncoordinated movements; and reddened face are frequently observed. Potential complications related to severe HS are acute renal failure, disseminated intravascular coagulation, rhabdomyolysis, acute respiratory distress syndrome, acid-base disorders, and electrolyte disturbances. Long-term neurologic sequelae (varying degrees of irreversible brain injury) occur in approximately 20% of patients. The prognosis is optimal when HS is diagnosed early and management with cooling measures and fluid resuscitation and electrolyte replacement begins promptly. The prognosis is poorest when treatment is delayed >2 hours.

Purpose: Heritable genetic variations can affect the inflammatory tumor microenvironment, which can ultimately affect cancer susceptibility and clinical outcomes. Recent evidence indicates that IDO2, a positive modifier in inflammatory disease models, is frequently upregulated in pancreatic ductal adenocarcinoma (PDAC). A unique feature of IDO2 in humans is the high prevalence of two inactivating singlenucleotide polymorphisms (SNP), which affords the opportunity to carry out loss-of-function studies directly in humans. In this study, we sought to address whether genetic loss of IDO2 may influence PDAC development and responsiveness to treatment.Experimental Design: Transgenic Ido2 þ/þ and Ido2 À/À mice in which oncogenic KRAS is activated in pancreatic epithelial cells were evaluated for PDAC. Two patient data sets (N ¼ 200) were evaluated for the two IDO2-inactivating SNPs together with histologic, RNA expression, and clinical survival data.Results: PDAC development was notably decreased in the Ido2 À/À mice (30% vs. 10%, P < 0.05), with a female predominance similar to the association observed for one of the human SNPs. In patients, the biallelic occurrence of either of the two IDO2-inactivating SNPs was significantly associated with markedly improved disease-free survival in response to adjuvant radiotherapy (P < 0.01), a treatment modality that has been highly debated due to its variable efficacy.Conclusions: The results of this study provide genetic support for IDO2 as a contributing factor in PDAC development and argue that IDO2 genotype analysis has the immediate potential to influence the PDAC care decision-making process through stratification of those patients who stand to benefit from adjuvant radiotherapy.

BACKGROUND: This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy hospital length of stay to 5 days without increasing complication or readmission rates. STUDY DESIGN: Pancreaticoduodenectomy patients (high-risk patients excluded) were enrolled in an IRBapproved, prospective, randomized controlled trial (NCT02517268) comparing a 5-day Whipple accelerated recovery pathway (WARP) with our traditional 7-day pathway (control). Whipple accelerated recovery pathway interventions included early discharge planning, shortened ICU stay, modified postoperative dietary and drain management algorithm, rigorous physical therapy with in-hospital gym visit, standardized rectal suppository administration, and close telehealth follow-up post discharge. The trial was powered to detect an increase in postoperative day 5 discharge from 10% to 30% (80% power, a ¼ 0.05, 2sided Fisher's exact test, target accrual: 142 patients). RESULTS: Seventy-six patients (37 WARP, 39 control) were randomized from June 2015 to September 2017. A planned interim analysis was conducted at 50% trial accrual resulting in mandatory early stoppage, as the predefined efficacy end point was met. Demographic variables between groups were similar. The WARP significantly increased the number of patients discharged to home by postoperative day 5 compared with controls (75.7% vs 12.8%; p < 0.001) without increasing readmission rates (8.1% vs 10.3%; p ¼ 1.0). Overall complication rates did not differ between groups (29.7% vs 43.6%; p ¼ 0.24), but the WARP significantly reduced the time from operation to adjuvant therapy initiation (51 days vs 66 days; p ¼ 0.005) and hospital cost ($26,563 vs $31,845; p ¼ 0.011). CONCLUSIONS: The WARP can safely reduce hospital length of stay, time to adjuvant therapy, and cost in selected pancreaticoduodenectomy patients without increasing readmission risk.